Proposals to Achieve Universal Health Care Coverage / HealthChoice

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good morning everyone the Subcommittee on health will now come to order the chair now recognizes herself for five minutes for an opening statement and welcome to our colleagues that are at the table and everyone that is here in the hearing room today's hearing features house colleagues who will present their legislative proposals to advance what I have always called the North Star of the Democratic Party and that is to achieve

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universal health care for the American people five members are or will be at the witness table two representatives mr. Lujan and Miss Schakowsky will speak from the committee seats and two others representative Cedric Richmond and representative VC are submitting written statements every American should feel secure that if they get sick or if they're hurt they will receive the care

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they need without going bankrupt that principle is why President Johnson signed Medicare and Medicaid into law despite the protests at that time that it was quote socialized medicine and the Moscow party line today medicare covers 44 million Americans and medicaid covers 75 million Americans our goal to achieve universal coverage motivated Congress to pass the Children's Health Insurance

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Program in 1997 it's why President Obama signed the Affordable Care Act into law in 2010 which today provides health coverage to more than 20 million Americans but we know there's more work to be done to achieve universality during our second panel today we will hear the stories of fellow Americans who live in daily fear that they'll lose their health care because of a decision by their employer their insurer or this

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president my hope rises as I see the talented colleagues before us who will present their proposals and broaden our thinking that's why I specifically asked each to be here today my hope rises as I look out at doctors nurses and patients in the audience who dedicated their lives to achieving quality health care for every American Advent is a season of hope and an appropriate time for colleagues on both

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sides of the aisle to approach this hearing with open minds and hearts knowing that the goal is to have health care for every American shortly before his death senator Ted Kennedy wrote a letter to President Obama about health reform and what he called quote that great unfinished business of our society he wrote what we face is above all a moral issue that at stake are not just

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the details of policy but fundamental principles of social justice and the character of our country I think we all need to reflect on that moral issue today I now would like to yield the remainder of my time to congresswoman Dingell is she here pardon me she's on her way well we're gonna move on because the chair is now going to recognize dr. Burgess ranking member of

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the subcommittee for his five minutes for an opening statement actually before I start that ask you ma'am consent request and ask consent to insert into the record the two letters that mister asking for this hearing so in the year and also I'm okay thank you thank you for convening the hearing certainly mr. Walden and I have requested this and we requested it very

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early in the year and I appreciate that you took our request seriously so chairman pallone and chairwoman issu stated in noticing this hearing that universal health care coverage has long been the North Star the democratic party every bill before us today is paving the road to the North Star that is even possible the idea is we accomplished one size fits all health care another Advent analogy three

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wisemen not quite the same but I'm not sure they'd appreciate your comparison as this North Star journey would lead our health care system as we currently know it to disintegrate if in fact we're listening to the great philosopher Joni Mitchell then the Northern Star is not very reliable it is as it is constantly in the dark Medicare for all would eliminate private insurance employer sponsored health insurance Medicaid children's health insurance plan upon which many Americans depend I'm

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concerned about the consequences for existing Medicare beneficiaries the policy would raid the Medicare trust fund which is already slated to go bankrupt in 2026 this will not help our nation's seniors have been paying into and depending upon the existence of Medicare for their health care needs and retirement for literally their entire lives more than 70 percent of Americans are satisfied with employers their employer-sponsored insurance which does provide robust protections we should

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focus on strengthening the parts of our health insurance markets that are working however instead of building upon the success of our existing health insurance framework a one-size-fits-all policy would tear it down I also feel obligated to mention having been in the health care provider business a the doctor business coverage does not equal care it never has and never will single-payer healthcare would be another failed attempt as a one-size-fits-all

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approach to health care single-payer is reality not what not one size fits all it's one size fits no one single-payer health care would cost over 33 trillion dollars for the first 10 years this high price tag would require new tax increases in fact it would double the currently projected federal individual and corporate income tax collections in order to pay for it according to the Mercatus Center so each and every one of these bills before us today is about Medicare for all and the pathway to

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socialized medicine we have all seen the reports of increased wait times for patients in countries like Canada with up to almost nine weeks for a specialist consultation Hospital stand to lose billions under a medicare-for-all plan the New York Times reported rural hospitals saying that they would virtually closed overnight while others said that would they would try to offset the steep cuts by laying off hundreds of thousands of workers and abandoning the lower paying services such as mental health services we simply cannot afford

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the financial or human suffering that what accompanies such a misguided policy it's clear that this takeover of even one sector of the healthcare industry we're gonna be talking about later this week prescription drugs in speaker Pelosi's hr3 bill and it would reduce the number of new drugs coming to the market the Congressional Budget Office estimated between eight fifteen new drugs would fail to come to the market over the course of the next ten years the Council of Economic Advisers

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anticipated as many as a hundred drugs doesn't matter which figure you use everyone is in agreement that it would reduce new drugs coming that we've all wanted through innovation I support common-sense market-driven improvements to our health care system the goal should be to increase access to health care services and drive down the cost for our patients these universal health care coverage bills are all going in the wrong direction in fact I introduced HR 1510 the Premium

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Relief Act of 2019 which does include reinsurance that is coupled with a structural form of the Affordable Care Act this would give States more choice on how to repair their markets that have been damaged by previous legislative attempts even better this legislation is fully paid for by stopping bad actors from gaming the system there are policies that we could work on to get Americans to reduce their cost and complexity of health care but we have before us today

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nine bills that fail to have a single Republican co-sponsor among them I'm glad we finally are having this hearing madam chair it's been a long time coming and some certainly something we should have done as we started this year at the end of the day we really hope the Energy and Commerce Committee can open the blinds and reveal what the Northstar really looks like completely in the dark I yield back gentleman yields back I now would like

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to yield the minute and a half that I would I want to yield to congresswoman Dingell so that you can make use of the time that you asked for thank you today we have the opportunity to discuss legislation that would once and for all address the cost index and access issues that continue to deny millions of Americans the right to quality affordable health care every member of this committee has heard from an every member of this Congress has heard from

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constituents who are fearful and frustrated by a current health care system we've received letters and calls from individuals who face devastating financial hardship as a result of predatory health insurance companies enabled by our current system and as I've always said when I would take John to the doctor it was like holding a town hall person after person would come up and share their stories that were just there were people that were desperate and scared and needed help we can and

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must do better this is the promise of Medicare for all a comprehensive system of coverage that empowers all Americans the Medicare for all Act of 219 would provide coverage for all Americans improved traditional Medicare by offering additional benefits at lower costs and utilize administrative efficiencies in negotiations to bring down prices this is a historic day I thank you madam chair for scheduling this hearing we've never had a medicare-for-all hearing in this committee and I look forward to

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discussing this legislation further with our distinguished experts today and to keep answering questions in giving people the facts as we go forward thank you madam chair the chair now recognizes the chairman of the full committee mr. pallone for his five minutes for an opening statement thank you madam chair since the passage of the Affordable Care Act more than 20 million Americans have gained the peace of mind that comes from knowing that they and their loved ones have health insurance this landmark law

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resulted in the highest insured rate in our nation's history it also expanded consumer protections so that no matter where you live or work in the u.s. your family would have access to affordable comprehensive health care the ACA ended debates of insurance companies price gouging older Americans charging women more than men and discriminating against people with pre-existing conditions and not only prevented health insurance companies from discriminating against people with pre-existing conditions it also required insurance companies to cover a set of essential health benefits

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like hospitalization emergency services maternity care and substance use disorder services it also eliminated annual and lifetime limits on coverage that for years had forced people with pre-existing conditions into bankruptcy thanks to the ACA young Americans can stay on their parents plan until they turn 26 the law also expanded Medicaid which made health insurance available to millions of low-income Americans including many was serious in chronic pre-existing conditions and unmet medical needs yet millions more would be covered today if it were not for the

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continued resistance of Republican governors to the laws Medicaid expansion and the repeated attempts by congressional Republicans and the Trump administration to undermine and dismantle the law House Republicans voted sixty nine times to repeal the ACA luckily they failed to do so but they did repeal the laws individual mandate increasing prices for everyone meanwhile 20 Republican attorneys general governors sued the federal government challenging the constitutionality of the law the Trump administration has taken

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the extraordinary position of refusing to defend the law in the courts if the Republicans is successful in court it would cause millions of people to lose their health insurance eliminate protections for people with pre-existing conditions and immediately spiked health care costs for all Americans I firmly believe that today we would be very close to universal coverage had it not been for the sabotage and for the refusal of Republican governors to expand Medicaid I also believe that had the final law included the public option as supported by a majority of this committee and the house at the time that

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we would be even closer to universal coverage now unfortunately that's not the case and millions of Americans remain uninsured particularly in states that have refused to expand Medicaid also among the uninsured are undocumented immigrants and their families when we drafted the ACA I work to include the undocumented but I couldn't get the votes and I'd like to know how the various bills before us today would address the undocumented when people get sick they make other people sick so it makes no sense to exclude any group of people regardless

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of their legal status and under the trump administration the uninsured rate has gone up and American families have lost coverage including hundreds of thousands of children we need to enact policies that include all the uninsured and that's why we're here today the bills were considering reflect Democrats continued commitment to achieving universal coverage and making health care more affordable and accessible for all Americans I believe that we must continue to build on the success of the ACA until health care is truly a right for all Americans which it

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should be I look forward discussion and yield the balance of my time the gentlewoman from Illinois mr. Kowski today really does mark a landmark day to discuss ways the United States of America can join the rest of the industrialized world and seeing that healthcare is a right and not a privilege for all of our people you know we spend more than any other country on health care right now yet

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millions of people don't have access to care we have the highest rates of infant mortality mortality we have a shorter lifespan and we can do better so I have been a co-sponsor and a supporter of single-payer health care since a lot of you in this room were even born but I also want to say that I am a co-sponsor of every single bill that is going to improve healthcare in this country because we have to move

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forward I the I I'm a co-sponsor of a bicameral public option bill ever since the Affordable Care Act didn't include it I'm a co-sponsor and you'll hear from representative DeLauro on Medicare for America I am a medicare-for-all I'm a co-sponsor of that and was there at its inception so we don't know exactly what path were

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going to take but over the last 50 years we have seen some dramatic changes we have seen Medicare and Medicaid get passed we've seen the ACA and these are examples of the dynamic changes that we can make and that we should be making we need to work together Americans are asking us begging us to improve our health care system they all want to be covered we can do this and we're going to hear about how we can do this today I

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thank the panel and I yield back gentleman yield back mr. pallone what are you dreaming about there over there aiming about a better world lovely I now would like to recognize the ranking member of the full committee my friend mr. Walden for his five minutes I want to join chairman in dreaming about a better world it's that spirit we should have here this holiday season thanks for holding this hearing I think it really

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is important to flesh out these issues and and learn a lot about them I as you know our committee is move forward on maternal mortality legislation Kowski reference that was a huge issue and it is and I'm glad we've moved forward on some of those specific issues this is the committee that created Medicare Part D to help seniors get access to affordable prescription drugs that never been a part of Medicare before we did that House passed it I helped write it support it all along this is the committee that led the effort to bipartisan way on 21st century

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cures I know there's an effort beginning to look at it cures 2.0 so we can find these magic miracles that are saving people's lives and invest in American innovation and research this is the committee that is on the cusp of reauthorizing and fully funding our community health centers for the next five years I'm a big fan of our community health centers when I chaired the committee helped lead the effort to fully fund them and chairman pallone and I are working together on legislation to stop surprise billing so consumers

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aren't ripped off when they go to the emergency room one in five are getting a surprise bill today that's wrong we're on the cusp of dealing with that and we fully funded Children's Health Insurance Program in the last Congress when I chaired the committee for 10 years had never been fully funded for more than five so I think we all share a commitment to trying to find answers to the costs of health care to access issues when it comes for health care some of us however think that that Medicare for all is not the right approach that it would actually take

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away the health insurance 180 million Americans have today many of whom have bargained for that health insurance as part of very aggressive Union employer bargaining agreements they've traded away wages in order to have better health care or lower cost deductibles and all Medicare for all would strip that away from them as it would take away Medicare Advantage plans and put it all under one system and and I'll just tell you when Washington politicians promise you something for free you better hold on to your wallets as you

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know 84 percent of Americans actually like the health insurance they have today we all think it's probably too expensive we all wish it were a little better we can work to make changes to fix some of those issues but one size fits all system that Ryan's care and restricts access and blows a hole in the budget you is not where many of us are at at the presidential debate in October a top Democrat said and I quote if you eliminated the entire Pentagon every single thing it would pay for about a total of four months close quote of this

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medicare-for-all plan these plans are so complex and confusing and costly that even the Congressional Budget Office could not figure out the price tag however to think tanks one on the left one on the right came up with a range of between 28 trillion and 32 trillion dollars over the next ten years other versions we've heard about would cost upwards of fifty two trillion dollars even doubling the current doubling the current personal and corporate taxes would not cover the costs doubling doctors and hospitals

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could see payment cuts of forty percent forty percent how would they keep their doors open what happens to our access to care we can look north to Canada the Fraser Institute did some research on this and found that a doctor's referral for specialty care the medium wait time was 20 weeks double what it was 25 years ago that's a government-run system Canada's facing a shortage of medical providers and in some provinces some hospitals have responded by actually closing their emergency rooms two days a week British Columbia 300 patients died

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waiting for surgery between 2015 and 2016 because of a lack of anesthesiologists and according to the British Columbia anesthesiologist society they say that's a huge problem Canada has 16 cat scans for every million people in America we have 45 for every million people that means that you can get access to care quicker here get those scans delay in denial of care is how government-run health care systems control costs you see what's going on in England right now with a young boy that

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was being treated I think in a hallway they ration care they delay care if the government sides the treatment or drug you need is not cost-effective you're denied access we had that debate in this committee the data are clear about how long you wait to get access to miracle drugs and in other countries upwards of 40% of the new drugs are not available these are cancer drugs these are new drugs on the market that would save lives and do in America we've got to deal with the issue of cost certainly but there's a way to do that

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and by the way most of these government-run systems prevent you from going around the government-run system some people do flee a country come to another one mainly America to get access to care when their own government system fails them it's not just a theory it's what happens in in some of these countries so I'm not a fan of that complete government takeover I am a fan of reform and of making sure we have the network in place madam chair thanks for having this hearing I yield back the gentleman yields back I just the chair wants to remind members

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that pursuant to committee rules all members written opening statements shall be made part of the record and certainly the written statements of the two members that are part of the nine proposals that we're going to hear about today so they don't really need any introduction but I think that it's appropriate to still do so it is it's an

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honor to welcome our colleagues here today for for this hearing each of them is going to speak for five minutes to present their specific proposal each one differs and I think that as I said in my opening statement that it's important for everyone to listen because we have varying sets of ideas and I think that we need to have an open mind about them

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so beginning with congresswoman rosa DeLauro from my home state where i was born and raised connecticut welcome to you too representative jayapal from the state of washington welcome to you too representative Higgins from New York thank you for making yourself available today to representative Delgado from the state of New York and representative mana Kowski from New Jersey welcome to

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each one of you thank you for the work that you've put into the product that the legislation that you're going to explain to us today so we'll start with congresswoman DeLauro you recognized for five minutes to speak to your legislation 1384 the Medicare for no 2452 I'm sorry the Medicare for America Act you all know the light system so I don't need to

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explain that to anyone thank you for welcome thank you so much and to Cheers congressman pallone took congresswoman Eshoo ranking members Walden and Burgess I'm delighted to be here this morning it's an honor for me to join with the members of this committee and also to be with all of my colleagues here this morning and what is a critical critical discussion on what are the pathways that we can move forward to universal care I am here this morning to advocate for Medicare for America which I first

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introduced with my dear friend and my colleague congresswoman jan Schakowsky we did this in December 2018 and we reintroduced it dismay Medicare for America achieves universal affordable high-quality health coverage by creating a program based on Medicare and Medicaid it covers all Americans through auto enrollment starting at birth while maintaining high quality affordable employer coverage Medicare for America moves every individual currently enrolled on the individual exchanges and

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Medicare beneficiaries on to the program individuals and children enrolled in Medicaid and CHIP are transitions onto Medicare for America over time to ensure that their care is not disrupted as we transform our healthcare system we made this deliberate choice after working with members of the disabilities community who know all too well about disruptions in the face of budget cuts and other complications for those with employer sponsored coverage two things can be true and our true employers have

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shifted many Americans to high deductible plans with less generous coverage and many are very satisfied including those union members that negotiated very good coverage in lieu of wages in lean budget years so Medicare for America allows high quality affordable private employer sponsored coverage to remain or employers can enroll their employees in Medicare for America and continue to pay a contribution or those employees who work for these employers

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that continue to offer private coverage can choose Medicare for America and their employer contributes toward the premium this way no one is locked in to employer sponsored coverage let me touch on something that I hear from most of my constituents and that is cost for individuals seniors families living below 200% of the federal poverty level they will have no premiums and no cost-sharing there are never there are never any out-of-pocket cost for children under 21

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and for maternity services for preventive and chronic disease services for long-term services and supports and for prescription drugs there are also zero deductibles zero annual out-of-pocket costs are no more than $3500 for individuals $5,000 for families on a sliding scale and premiums are capped no more than 8% of income for enrollees and are determined on a sliding scale and additionally on the

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topic of the cost of the program our bill includes pay-fors I asked you to read it I won't enumerate all of them but the pay-fors are there let me discuss let me discuss what is innovative about Medicare for America today health care benefits are too dependent on your zip code universal coverage must be universal so Medicare for America is explicit and the benefits covered especially with respect to long-term services and supports we're in a crisis family spend themselves into

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poverty to get the care their aging loved ones need hundreds of thousands of individuals with developmental and intellectual disabilities that way years for services that may never come so Medicare for America establishes the gold standard for long-term services and supports we partnered with members of the disability community on the entire bill in order to ensure their needs the resulting coverage home health aides personal attendant care services hospice care coordination respite services to name a few we

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prioritized those supports and services for Workforce Development raising the reimbursement rates for direct care workers and ensuring a career pipeline credentialing and worker rights then in the interim the bill recognizes the central role that family caregivers play by compensating them for their work because it is work beyond the LTSs workforce Medicare for America preemptively raises reimbursement rates for primary care and mental and

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behavioral health and cognitive services far too many individuals face roadblocks because reimbursement rates are too low far too many providers are way down or scared off because of mounting debt and choose only private insurance so Medicare for America establishes all-payer rate setting private insurance pays the Medicare for America rate it all comes back to getting patients the care they need that is why we ban private contracting current law allows providers to cover individuals and

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medical and private coverage they also talk about paying out-of-pocket for care even if their insurance covers the benefit it's a two tiered system that must not continue patients deserve to be treated fairly to get the care they need we acknowledge the crippling of the student loan debt so that in many health care workers face that often leaves the private contractor so we say to providers pay our rates see our patients and we forgive 10 percent of your student loans by making smart

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investments upfront the American people save a great deal of money in the long run at its core Medicare for America is about ensuring that every American has health care and as we debate into the future on universal health care coverage my view a Medicare for America is the best way forward in providing historic change amen thank you Thank You congresswoman DeLauro with all the energy she always brings to everything that she does thank you next we we welcome and thank

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congresswoman jayapal she is the sponsor of HR 1380 for the Medicare for All Act and so you have your five minutes to present your proposal and thank you again for being here today I know that you have judiciary as well so away we go thank you so much chairwoman su ranking member Burgess and chairman pallone and ranking member Walden and distinguished members of the Subcommittee on health thank you for holding this historic

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hearing this is a great day and let me start by saying that the Affordable Care Act was critically important in expanding health care for tens of millions of Americans across the country and and providing insurance for those who had pre-existing conditions but equally important the Affordable Care Act allowed Americans to dream of a future where everybody had the right to health care and for us we need to ensure that we don't stop with the Affordable Care Act and that we get to the place where we have universal care for all

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people in our country and that's why I'm so proud to have introduced along with my esteemed colleague representative Debbie Dingell HR 1380 for the Medicare for All Act of 2019 our 119 co-sponsors over half of the Democratic caucus many of you on this committee thank you for your input and your support as we developed this bill this is now the fourth historic hearing we have had on Medicare for all in the House of Representatives and that would not be possible with an without an enormous

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movement for Medicare for all and I want to particularly recognize quickly a few groups physicians for a National Health Program National Nurses United who you'll hear from today Public Citizen the labor coalition the Disability Rights Coalition and a racial justice coalition and a Women's Coalition that worked with us for over six months to develop this piece of legislation I would submit the most comprehensive and bold solution to fix our broken health care system we simply wouldn't be

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here without their leadership our nation's health care system is the most expensive in the world contemplate that this year we will spend almost three point nine trillion dollars or 18 percent of our GDP on healthcare expenditures and that is almost double what every other industrialized country in the world spends over the next decade our current health care system will cost America about fifty five trillion dollars what is that astronomical spending get

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us the highest maternal and child mortality rates among our peer countries and the lowest life expectancy it gets us five hundred thousand Americans who every year are forced into bankruptcy because of medical costs it gets us seventy million people who still remain uninsured or underinsured and that is just a bad deal why is America so far behind our pure countries you might ask that because profit-making motives are baked into our system and our health

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care system incentivizes putting profits over patients for-profit insurance companies with extremely high administrative waste stand between Americans and good quality affordable health care every American knows someone a loved one a friend a child or a parent who has suffered a health care crisis and they know that the system we have doesn't work so how do we respond to this I think if we really want to fix this we have to do three things first any plan that proposes to fix our health

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care crisis has to cover everyone not just expand coverage for some but cover everyone guaranteed second it has to provide comprehensive benefits and high quality health care when you need it and finally it has to take on the out-of-control costs administrative waste and for profit motive of the current system and bring down costs for American families our bill HR 1380 for is a 125 plus page bill a comprehensive

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plan to lay out exactly how we get there and it is the only plan that does all three of those things our bill improves the successful Medicare program that we have but it expands it to cover every one with a guaranteed government insurance plan including comprehensive benefits vision hearing dental mental health and of particular importance long-term care for people with disabilities and older Americans all of this with no co-pays no private insurance premiums and no deductibles

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and because all doctors and hospitals will be in network medicare for all gives the American people more choice than ever before no more worrying about a massive surprise bill that you might get no more worrying about what happens if you have to quit your job because you're too sick to work no more worrying if you want to go start a small business but you can't afford the cost of health care HR 1380 for also includes important cost containment measures to ensure that we rein in health spending it bolsters rural hospitals and safety net hospitals

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with special provisions to help these hospitals stay open and thrive and have patients who are all insured I want to be clear that every study including the Koch brothers conservative study says that we will save money with a medicare-for-all plan American families will pay 14 percent less than they currently pay in health care costs and that's why over 250 economists sent a letter to Congress saying that Medicare for all is the right plan for our economy it's why former CMS administrator under President Obama Don

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Berwick said that after being the director of Medicare for some he now believes it's time for Medicare for all and it's why 30 unions for the first time don't listen to the arguments that unions don't want this for the first time 30 unions including the major unions in our country have supported this bill now it is up to us and it is time for them to pass Medicare for all I'm just listening to my mentor rosa DeLauro who took a more regular order it is time for us to pass Medicare for all

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thank you madam chair thank you thank you very much for Chuck being here today in testifying well now call on congressman Brian Higgins welcome Brian it's wonderful to see you here and you have five minutes to present your proposal yeah thank you very much chairwoman esthe you in chairman pallone and ranking member Burgess I just want to say that I was a proud supporter of the Affordable Care Act which will be ten years old this

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March but even the president the speaker recognized that the passage of the Affordable Care Act represented a start not a finish and that it was highly imperfect in many ways including the lack of a public option to be a real countervailing force to private insurance because I think buying large private insurance screws people they jack up premiums they jack up deductibles they jack up co-pays and then when you go to use the insurance that you already paid too much for there's very little underlying insurance

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you know before the Affordable Care Act if you had a kid it was stuck with childhood cancer an insurance company could deny you coverage because of a pre-existing condition you can't do that anymore it's against the law and the only federal law that protects people with pre-existing conditions is the Affordable Care Act and 2010 Democrats lost control of the house because of health care 2018 Republicans lost control the house because of health care or even let's

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move forward I want to talk about three things complexity cost and leverage the human body has 11 organ systems there's 70,000 ways that those organ systems can fail there's 4,000 medical procedures there's 6200 fda-approved prescription drugs there are 206 bones in the human body there are 30 trillion cells in 200 cell types the human body in health care

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is fascinating but complicated the United States government pays 1.3 trillion dollars health care this year under Medicare Medicaid in the Veterans Administration then another 360 billion dollars in prescription drugs that's a lot of money the federal government pays about a third of the entire the nation's entire health care bill but it's also a lot of leverage and that's what I want to talk about today all of these bills are

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outstanding we need to make progress by using the best public option that already exists and that's Medicare Medicare has been around for 54 years it is wildly popular with those who have it and those who provide services for those who have that as their health insurance ninety-six percent of Medicare beneficiaries have access to both the primary care doctor and a physician specialists and all of

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the hospital institutions take Medicare as well I've a bill that would allow people 50 to 65 to buy Medicare as a medical option the Henry J Kaiser Family Foundation that has done extraordinary work in this regard says that 77% of the American people support a Medicare buy-in 50 to 65 why that age demographic because this age demographic 50 to 65 is

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to this century what the traditional Medicare population was to the previous century and that is that private insurance had every opportunity to write policies for people that were older in sicker but chose not to do it and a good and generous nation responded by establishing the Medicare program and then all the privates wanted in on it when it was deemed to be profitable and successful under the Medicare Advantage program this age demographic experiences

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very high pre-existing conditions about 50% their premiums are very high their deductibles are very high and their co-pays are very very high give me an example a 60 year old able to buy into Medicare at their own cost that will not adversely affect the Medicare Hospital trust fund according to the RAND Corporation and the Henry J Kaiser Family Foundation would save 48 percent when compared to a

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goal plan on the individual market now Rand also said that six million Americans would take advantage of that plan that's almost 14 thousand people per congressional district and I would remind you that that age demographic also votes so it's good on the politics it's good on the substance I think we have an obligation too much like we said 10 years ago we need the next iteration the next exciting iteration of Medicare

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expansion and I believe that my bill should be in that conversation relative to that goal thank you very much thank you very much and thank you for being on time as well on time with your conclusion using your five minutes it's a pleasure to welcome and thank representative Delgado from New York to present his idea his proposal which is HR 2000 the Medicare X

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Choice Act so well thank you Thank You chairwoman Thank You ranking member Burgess chairman pallone it is really nice to be with you all this afternoon or this morning I'm pleased see the committee considering my bill Medicare X Choice Act and I'm honored to have the opportunity to explain why it is a priority of mine the title of today's hearing proposals to achieve universal

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health care coverage a urgent need indeed we are the richest nation in the world and yet the only developed one without some form of universal coverage if unable to qualify for Medicare TRICARE or Americans are left to fend with a system that is entirely beholden to the profit motives of the private insurance marketplace as a result millions of

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Americans are priced out of the market and left uninsured or have insurance but simply can't afford to take advantage of it it's unacceptable we have got to achieve universal health care coverage and I believe we can get there with a public option I promised my constituents I would pursue this path and with that promise in mind this spring introduced the Medicare X Choice Act along with my colleagues including representative Higgins and Larson's

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Medicare X establishes a public option of government-run insurance plan available in the marketplace for anyone to buy if they're uninsured or unhappy with their current plan the effect of a public competitor in the private insurance marketplace will undoubtedly bring down the skyrocketing cost of premiums and deductibles the plan starts in rural areas where coverage options can be scarce and that automatically enrolls every child in the chip program

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critically Americans who like their current plans like many union members who have spent years bargaining for what they have now or seniors on Medicare Advantage can keep them this plan covers every American in just three years it also attacks the underlying affordability crisis that plagues families across the country an issue not discussed in nearly enough we start by one requiring Medicare to negotiate drug prices to increasing federal support for those who need it by eliminating the

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subsidy cliff for Americans above 400% of the federal poverty line and increasing the tax credit for those individuals below it and three authorizing 30 billion over three years for a national reinsurance program under this bill a family of four with an income of one hundred and one thousand dollars we see their premiums cut in half we do all that without costing the federal government the Congressional Budget Office recently found that Medicare X would actually add

58:47

money to the Treasury over time Medicare X fulfills the promise of the Affordable Care Act that health care coverage will be simpler more accessible and more affordable when families can choose the plan that works best for them every time I've held a town hall and I've held quite a few I hear from folks about the costs of health care Congress needs to get this done so families don't have to choose between paying medical bills or buying groceries as this committee

59:18

considers the health care legislative options I hope you will find two main takeaways from my testimony today more choice lower costs two concepts I hope everyone on this panel can get behind I thank the committee again for your time and the opportunity to share my priorities with all of you we thank the gentleman it's a great source of pride

59:47

to all of us that of the five that are speaking at the witness table this morning that mr. Delgado and Malinowski are new members of Congress this is their first term and you are a source of pride to us and you more than hit the ground running with ideas you're fresh off the campaign trail and it is it's always refreshing to see what new people

01:00:20

bring to the Congress so thank you as a combination with with the others but you know it's a it's a pleasure to both welcome and recognize mr. melih now ski for your five minutes to talk about your proposal which is HR 45:27 the expanding health care options for early retirees Act thank thank you so much for those kind words chairwoman su mr. ranking member Burgess

01:00:52

thank you for the opportunity to testify today alongside my colleagues each of whom had put forward thoughtful proposals to get us closer to that North Star of universal coverage and speaking of North Stars mr. Burgess Joni Mitchell is Canadian which means she comes from a country with lower health care costs and higher life expectancy so I'm hoping you might have her for the next panel to answer some of mr. Walden's concerns chairman pallone

01:01:25

also want to thank you for for your leadership and your work with mr. Walden especially on the surprise medical billing issue let's please get that passed before we go home for the holidays oh it would be a huge win I think for all of our constituents I'm here to talk about a bill that I also hope that we can find common ground on my bill the expanding health care options for early retirees Act would allow retired first responders firefighters police officers EMTs to buy

01:01:56

into Medicare beginning at age 50 due in part to the physically demanding nature of their work first responders often retire earlier than other workers and can experience gaps in coverage until they become eligible for Medicare this legislation would close that gap coverage under this bill would be identical to the coverage provided under the existing Medicare program retirees would be eligible for tax credits subsidies and tax advantage contributions from their former employers or pension plan further the

01:02:28

bill specifically requires that it be implemented in a way that will not harm the existing Medicare program beneficiaries or trust fund we're grateful to have the support of the International Association of firefighters the Fraternal Order of Police the National Association of police organizations the National sheriffs organization Association the National Troopers coalition the International Union of police associations the National Conference on Public Employee Retirement system's AFSCME among other organizations many of

01:03:00

their representatives are with us today and since introducing the bill in September my office has received dozens of phone calls and letters and messages from people all across the United States describing how it would help them or a family member a person from Wilson County Tennessee wrote to us this is such a needed law more and more agencies are washing their hands of ensuring first responders when they retire it is not a young person's job and when we retire we are damaged physically and

01:03:32

emotionally and need the health care that eats up most of our pension a paramedic from Florida wrote I'm 53 and can retire in two years health care has been my major concern after my retirement I pray for all of you working on this proposed bill a paramedic firefighter from Oregon wrote I was born to be a firefighter in the community I was born and raised in you naturally never think about your body wearing out I've had several toradol and steroid

01:04:01

shots in both my elbows shoulders and neck over my career so I can be at work answering my community's calls it would be so helpful being eligible for Medicare benefits when I retire and use paper in Texas quoted the head of the Abilene Police Officers Association saying the bill would allow us to retire at a good age and be able to afford health care this affords us the opportunity to retire earlier spend more time with our families and enjoy life

01:04:31

this is why we are here today examining how to improve our healthcare system so that every American can spend more time with our families and enjoy our lives so that we can choose a profession we love and to change it when we please without the crushing existential anxiety that comes from being uninsured or under insured without the fear that an accident or illness could lead to bankruptcy I believe that everybody who wants Medicare teachers caregivers coal

01:05:02

miners farmers service workers everyone should be able to live with the dignity and security that the program provides but as we debate how to free every American of the anxiety of dealing with the current health care system let us at least do something to free the few the dedicated and brave few who risk their health and their lives to protect us thank you so very much I yield back the gentleman yields back and let me express on behalf of all of

01:05:36

the members of the committee both sides of the aisle for not only accepting our invitation to be here today to describe your idea your legislative proposal but the clarity in which you have done so we we're legislators we're lawmakers and

01:06:03

it's incumbent upon us to respect the thinking that goes into each person's proposal and your thoughtfulness is on display this morning I know that two of our colleagues have left but I might kudos to each of you all five of you so thank you for spending time with us here this morning and now you can go on with

01:06:37

the rest of your ruffle schedule for the day and the staff will prepare the table for the second panel of witnesses and you can come let's say we need to change the the nametags at the table so they know where they're sitting but tell me do that with some sense of timeliness who's going to do that understand all right let's get to it maybe everyone can

01:07:09

check their phones while we're waiting now I'm not expecting a call but people like to say what messages they've received I totally have to go okay we're now going to hear from our second panel of witnesses on this all-important issues and we welcome you we thank you for making yourselves available to us today first Miss Sarah Rossum bound she's a health law and policy professor at the

01:08:56

Milken Institute of Public Health at George Washington University welcome and thank you to you mr. Peter Morley patient advocate thank you to you and welcome Miss Jean Ross the president of the National Nurses United welcome to you dr. Douglas holtz-eakin president in the American action forum it's nice to see you again and thank you for being here today dr. Scott Atlas senior fellow at the Hoover Institution at Stanford

01:09:26

University which I have the privilege of representing thank you and it's wonderful to see you again so we will now I will now recognize mr. Rosenbaum for your five minutes of testimony and you can begin I think you all know what the lighting system in green when you see the yellow light speed up because on the heels of the yellow light comes the red light welcome and you may proceed do

01:09:59

you have your microphone on yes close so we all can hear you very well every word over the past half century Congress has pursued various solutions in its effort to ensure all Americans as the limits of what could be achieved through a voluntary employer insurance system became evident especially for the elderly the poor and low-income people and people with disabilities we've embraced over many years a range of solutions ranging from a single-payer

01:10:31

solution in the case of Medicare to efforts to strengthen public and private insurance and expand our largest public health program Medicaid much work remains to be done and of course this work takes place against a backdrop of the highest cost health system among wealthy nations after years of progress the number of uninsured is growing again and millions more underinsured because costs are too high and coverage is too limited using an incremental payer approach the American assuming the Affordable Health Care Act

01:11:02

the Affordable Care Act accomplished a great deal immediately before the law took effect 44 million people were uninsured by 2016 the number had dropped twenty six point seven million progress occurred at all income levels and in all states but especially among lower income people and of course in the ACA s Medicaid expansion states preventive coverage has improved markedly and coverage has improved for children and adults with disabilities people with serious health conditions have benefited from the loss essential

01:11:33

health benefit rules that brought in coverage and limit out-of-pocket exposure while promoting actuarial value 54 million Americans have benefited from the protection against pre-existing condition exclusions and discriminatory coverage practices Medicare prescription drug coverage has improved 2.3 million young adults have coverage through their parents plans and community health centers have doubled their capacity but now the latest census data show that we're moving backwards the percentage of

01:12:03

uninsured Americans is growing from 7.9 percent in 2017 to 8.5% in 2018 we're up to twenty seven point five million uninsured children and adults the Trump administration is championing a lawsuit that could dissing sure over 20 million people overnight 14 states remain without the Medicaid expansion and over 2 million people are caught in this coverage gap ineligible for Medicaid but too poor for tax subsidies other administration initiatives are aiming to push Medicaid enrollment still lower

01:12:35

through block grants work experiments and other administration strategies the administration has targeted the private insurance reforms under the ACA in order to erode access to higher value policies in favor of what experts call junk insurance while taking constant aim at laws essential health benefit and affordability provisions I think that we face two major challenges one set in the near term and one set for a longer term discussion and they are reflected in the

01:13:08

amazing range of bills you have before you today and the deeper thinking that's gone on behind those bills the first is to what I would call staunch the flow we need steps to redouble the effort to incentivize the Medicaid expansion where it's not happened and people who depend on subsidized private insurance need more help the ACA insurance market needs to be stabilized in order to promote affordable coverage that's an immediate set of needs in the longer term you face bigger decisions as you well know what

01:13:40

is the best mix of public and private insurance coverage do we preserve employer coverage do we maintain multiple programs or consolidate various public programs into one major alternative if we move in this direction should this program be open to employers and individuals or just individuals and should it remain and instead should we retain multiple public programs with various targeting built in how broad should public coverage be should it

01:14:10

subsume long-term care should we use auto enrollment to cut down on churn what is the best approach to financing reform and in order to achieve true health equity do we need to think beyond coverage itself and also focus on community level investments in order to ensure accessible health care and a broad continuum of health promoting policies thank you very much for this opportunity thank you it's so wonderful

01:14:40

to have people widen the lens welcome again and thank you mr. Morley you have five minutes to offer your testimony okay sorry Thank You chairwoman su ranking member Burgess and members of the subcommittee I'm honored to speak with you today on my 28th trip to DC since July 2017 to fight for health care my name is Peter Morley in 1997 I had an injury during a lapse of insurance coverage all

01:15:22

treatment and medication costs were paid out of my own pocket when a later needed surgery my insurance company considered my injury to be a pre-existing condition and my claims were denied it was a financial burden totaling in tens of thousands of dollars in 2007 I was permanently disabled from an accident I was spared the costly medical bills of for spinal surgeries because I had continuous health coverage in 2011 I

01:15:53

survived kidney cancer and fought my way into remission after losing part of my right kidney in 2013 I was diagnosed with lupus which causes me severe fatigue and most day it's most days it's a struggle to get out of bed I now manage over ten pre-existing conditions take 38 different medications and receive 12 biologic infusions to slow the progression of my disease I live on the brink of financial ruin and only

01:16:24

live modestly thanks to insurance and the fact that I can't be discriminated against because of a pre-existing condition pre-existing conditions are a way of life for me as well as millions of others most people like me with chronic diseases can live happy and productive lives but only if we are provided access to health insurance that can't be taken away from us because an insurance company decides it's in their best interest not to cover something or if Congress decides to repeal our

01:16:55

insurance or if the Trump administration sabotages and refuses to defend the Affordable Care Act as someone who spends majority of my waking hours in doctors offices the ACA has meant focusing on healing not bankruptcy I did not ask to be chronically ill I used to be very private about my health but once President Trump was elected and said to repeal the ACA I could no longer be silent in December 2016 I decided to

01:17:27

foster awareness for lupus and advocate for health care my congresswoman carolyn Maloney has taken up my cause and those of people like me in the last two and a half years I have traveled to DC twenty-seven times I've collected the health care stories of thousands of people who shared theirs personal stories and concerns with me I have held over 350 meetings with Democratic and Republican members of Congress alike many of you actually sit here in front

01:17:57

of me today my message is simple if you think people don't get hurt when this administration doesn't defend the ACA think again we do I do millions do and if you think pre-existing condition protections are not important remember someone you love could have an accident be diagnosed with cancer or lupus at any time and that will change how you think about this I know firsthand your health

01:18:31

care can change in an instant this past July I testified for the late congressman Elijah Cummings he thanked me for taking my pain turning it into a passion to do my purpose I will never forget those words so today in the spirit of our beloved congressman I haven't asked of this entire subcommittee please work together to make health care of all Americans your

01:19:03

passion I put my health at great risk to travel here and share these stories I never know if this is the last time I'm healthy enough to come to DC but I'm here today to ask you to protect the ACA so we can enhance it and move towards universal health insurance for all Americans thank you for allowing me the opportunity to testify and I'm happy to answer your questions what an honor to have you here thank you

01:19:37

for your courage and your tenacity it really is an honor to have you here and what we're going to do with everything to help keep you healthy and I'll never forget your testimony in your words just as you will never forget our late Elijah Cummings and now it's a pleasure to recognize Miss Jean Ross the president

01:20:08

of the National Nurses United for your five minutes of testimony thank you again for being here and for what you will say so you're recognized good morning and thank you chairwoman su ranking member Burgess and members of the subcommittee for inviting me to testify today my name is Jean Ross I've been a registered nurse in Minnesota for forty-five years and I am president of National Nurses United the largest union representing bedside

01:20:39

nurses in the United States with over 150,000 members in my testimony today I want to illustrate two main points first our current patchwork system of public programs and private for-profit insurers is ineffective inefficient and financially honest and unsustainable second the only way we can guarantee every person living in this country receives the care they need is by adopting a single-payer medicare-for-all system every day nurses witnessed the failure of our

01:21:11

current health system I've watched as patients don't seek the care they need because they can't afford their co-pays or deductibles or don't have insurance I've watched as insurers refused to cover the care that my patients need over many years I cared for countless patients who showed up in the ER with severe illnesses only because they could not afford preventive care one patient always stands out to me he arrived in the ER and a hypertensive crisis we treated him for an imminent stroke I

01:21:42

learned he was rationing his blood pressure medication instead of taking it every day as prescribed he was taking it every two days he knew he needed to take those pills daily but he could not afford the medication even with his private insurance plan as a nurse I have so many stories like this but I'm also a mother and a grandmother and this broken system has affected my family too my son Tony suffers from a leaky heart valve for the past 15 years he's been consistently unable to afford

01:22:12

the cardiology care he needs so he just doesn't see his cardiologist as a nurse I know that this valve could lead to heart failure as his mother I live with the constant fear this could happen to my son because the health system I work in is failing him my daughter's a single parent and she struggled to afford the co-pays for my grandchildren's care when my grandson Evan was an infant my daughter called me because he was sick she wanted my advice as a nurse she didn't have the money to take him to the doctor I told her I

01:22:43

would pay the copay because I knew that Evan needed immediate attention medical attention now indeed he was suffering from encephalitis which is an inflammation of the brain which can cause permanent brain damage and even death I am so grateful that I had the economic resources to help because if I hadn't like so many other patients who don't have the means Evan would have been in severe trouble as a grandmother I want to leave my grandchildren with a country where health care is a right where they know when they or their

01:23:14

children get sick they will only have to worry about their health and not the cost as a nurse for 45 years I know these stories are not unique 30 million people have no health insurance and additional 44 million people are underinsured yet the u.s. spends more money on health care per capita than any other nation in the world but despite paying top dollar for our health care we get poor results our country ranks poorly on many international health indicators including average life

01:23:45

expectancy infant and maternal mortality and death from preventable diseases high cost and poor health outcomes persist because access to insurance is not the same as guaranteed health care for all this brings me to my second point single-payer medicare-for-all is the only way we can guarantee healthcare while also reducing the amount of money we spend on health care overall under Medicare for all we will transform our profit-driven Health System insurance system into a health care system one

01:24:16

that prioritizes patient care everyone will receive quality comprehensive therapeutic care without any financial barriers with Medicare for all doctors and nurses we'll be able to provide care based on our professional judgment without insurance company interference will have better patient outcomes and will save money too as you consider different options to improve our health system I encourage you to consider the following questions will this proposal guarantee safe therapeutic health care to every person in the country

01:24:47

regardless of their ability to pay will it allow people to get health care independent of where they work or if they have a job will it reduce administrative complexity and waste in this system and control costs there is only one bill before the subcommittee today that will achieve all of these things HR 1380 for the Medicare for All Act of 2019 authored by congresswoman Jaya Paul and Dingell the primary responsibilities of a registered nurse is to protect the health and well-being of our patients in my professional

01:25:20

judgment the only way we can put our patients first as we're and morally bound to do is through Medicare for all I urge every member of Congress to support HR 1380 for thank you thank you miss Ross it's now a pleasure to recognize dr. holtz-eakin who is you recognized for your five minutes of testimony and thank you again for joining us today

01:25:51

I'm sure woman s you ranking member Burgess and members of the committee thank you for the privilege of being here today to discuss these proposals for progress toward universal coverage which is a indeed a and a very important goal for the United States the the proposals fall into two broad categories as you've heard somewhere like Medicare for all sweeping single-payer reforms which would cover everybody the nine states and then a series of more targeted reforms that they take the character of Medicare buy-ins Medicaid bonds and and public

01:26:23

options I want to discuss them and turn the proposal for Medicare for all it is a a truly sweeping reform unlike any single-payer elsewhere on the globe other single payers do not ban private insurance indeed often supplement it do not eliminate a role for Regents and states but often rely on them to deliver this their health care and their insurance they don't eliminate co-pays and other incentives for individuals to utilize care effectively and in one case

01:26:55

Britain they actually own and operate the hospitals in this case that no such thing goes on so this is this is not something where you can say we're going to get something looks like something else or in the world this is like nothing else that has ever been proposed and it has embodied in it inevitably some serious trade-offs among them will be the trade-off between covering folks in this manner and access to care and the quality of that care in the data it is quite clear that as hospitals try to reach higher quality goals they can be more successful the larger the fraction

01:27:26

of commercial payers they have in their patient base that that relationship between the rate of reimbursement and the quality of the cares is quite strong and important in the research these proposals would diminish the rate of reimbursement for hospitals and thus would inevitably degrade the quality of that care in the extreme one would worry that the reimbursements would be so low that hospitals could not actually be able to remain open and thus diminish access to care entirely which is obviously counter to the basic intention but if something needs to be dealt with

01:27:57

in these proposals the easiest way to deal with it of course is to reimburse at higher rates but that's going to be extraordinarily expensive as proposed the the Medicare for all is on the order of 30 trillion estimates for 30 to 35 get in that ballpark to give you a flavor for what that means as a matter of public finances if you were to finance that in the traditional fashion of Medicare with a payroll tax you would need to have a 21 percentage point increase in the payroll tax according to a Heritage Foundation study and in doing that

01:28:27

additional payroll taxes would be outweighed the the savings in health premiums for two-thirds of American households today we would financially be worse off by the imposition of this proposal and to what end the goal will obviously is universal coverage but if you look at the the 30 million odd uninsured individuals in America half of them are already eligible for an important public program the ACA Medicaid or chip others are turning down an offer for employer sponsored insurance they've been offered that indeed if you can identify the the group

01:28:59

that really you might be able to get it's about two and a half million individuals who are relatively low income and did not reside in a Medicaid expansion state is it worth overturning the enormous heterogeneity and rich complexity of the US healthcare system for two and a half million individuals there's got to be a better way to do that some of the other approaches are more targeted so for example there's a Medicare buy-in proposal that you heard congressman Higgins described we've taken a look at that at the American action forum the the think-tank that I

01:29:30

run in an hour estimate that that bill would get about two hundred ninety three thousand Americans to buy Medicare by in the first year by the end of ten years it will be down to about 170 180 seven thousand individuals to the extent that there are increases in coverage from that bill it comes from adding additional funding to the existing ACA channels but even with a hundred eighty billion dollars in additional federal and federal money total coverage only rises by about 500,000 individuals so we have these two approaches a sweeping turnover the American health care system

01:30:02

to little gain and some approaches that are targeted but probably not very effective and so I'd encourage the community to continue to search for ways to get to universal coverage but these don't appear to be the way to go I thank you and look for the chance to answer your questions thank you for your testimony it's pleasure to welcome dr. Atlas and you have five minutes to present your testimony thank you for accepting our invitation to be here okay

01:30:33

Thank You chairwoman Ashu ranking member Burgess and members of the committee for the opportunity to speak today the overall goal of you health care reform should be to broaden access for all Americans to high quality medical care not simply to label them as insured the notion that single-payer healthcare represents a goal for health system reform is mainly driven by the attractiveness of a simple concept the government explicitly quote guarantees medical care in England the NHS Constitution explicitly states quote you have the right to receive NHS services

01:31:05

free of charge on quote despite taxing citizens 160 billion dollars per year the opposition the single-payer care though should not focus only on massive new taxes that will be required but instead on the well-documented half-century of its failure in the medical literature to provide timely quality medical care the truth is that single-payer systems including in the UK Canada Sweden and other European and Nordic countries imposed shockingly long waiting times for doctor appointments diagnostic procedures drugs and surgery

01:31:36

that are virtually never found in the United States specifically as a means of rationing care indeed the Supreme Court of Canada in the 2005 Jolie decision famously stated quote access to a waiting list is not access to health care unquote Berwick calculated that over a 16 year period over 44,000 additional Canadian women died due to Canada's imposed wait times for medically necessary care in England alone a record 4.2 million patients are on NHS waiting list a

01:32:07

hundred thousand of them have been waiting for more than six months for treatment after receiving their diagnosis the average Canadian woman maybe not Joni Mitchell waits five months for her GP visit to her treatment by her gynecologist in the UK single-payer system were the 19% of those referred for quote urgent treatment for cancer wait more than two months for their first treatment in Canada almost eight months for brain surgery after seeing the doctor these long waits are the defining feature of

01:32:37

all single-payer systems and they stand in stark contrast to US health care waiting lists are not a feature in the United States as stated by the OECD and verified by numerous studies even for low priority checkups us wait times are far shorter than for seriously ill patients in countries with single-payer care single-payer systems also restrict the availability of new drugs including cancer drugs sometimes four years of the world's 54 new cancer drugs from 2013 to

01:33:05

2017 by 2018 94 percent were available for Americans for Brits 70 percent in Canada 53 percent in France 43 percent in Australia 28 percent these long waits have major consequences in the medical literature not anecdote worse health outcomes than the u.s. system from cancer heart disease stroke hypertension diabetes why would Americans voluntarily move toward a system proven worse than current US health care Americans should also ask why the US would move toward

01:33:38

single-payer care when every other country with decades of that experience now use private care to solve their failures governments in Finland Ireland Italy the UK the Netherlands Norway Spain Sweden Denmark all with single-payer care spend taxpayer money now sometimes even outside their own country on private care to solve their unconscionable failures Americans should also wonder why those with financial means spend even more money than they're already high taxes for something that is quote guaranteed and free half of all

01:34:08

Brits earning more than 50 thousand pounds now buy or plan to buy private insurance here's the reality only the poor in lower middle class are stuck with nationalized singer payer health care because only they can afford cannot afford to circumvent the system those who advocate a conversion to Medicare for all failed to acknowledge this widely published evidence in the world's top medical journals and they fail to acknowledge that continued access to care is already at risk according to the actuary of CMS who calculated that most hospitals nursing facilities and in-home

01:34:39

health care providers already lose money per patient with Medicare and they fail to acknowledge this that about 70 percent of seniors choose to rely on private insurance supplementing or replacing traditional Medicare coverage why would beneficiaries need that if pure government insurance was so satisfactory what's wrong with offering government insurance as an option because government insurance expansions only erode or crowd out private insurance the public option not a moderate or compromise proposal it

01:35:11

is simply a more insidious pathway to single-payer health care where only the affluent could afford to circumvent that contrary to the false guarantees the only valid guarantees from single-payer health care it's worse health care for Americans in higher taxes rather than compelling Americans to accept an inferior government-run system that literally restricts medical care to regulate costs why not focus on creating conditions long proven to bring down prices while simultaneously improving quality and every other good or service

01:35:41

in the United States incentivizing empowered consumers to seek value for their money with cheaper broadly available higher deductible care less burdened by regulations markedly more valuable and expanded health savings accounts tax reforms to eliminate counterproductive incentives and then coupling that with strategic increases by deregulation and breaking down anti-consumer barriers to competition in the supply of doctors and hospitals these reforms would permit all

01:36:11

Americans rich or poor to access the same excellence of medical care that the affluent including some of the most strident advocates for single-payer care for the rest of us all use for their own personal health care thank you thank you now we will we've concluded the witnesses opening statements and we'll move to member questions so I'm going to recognize myself for five minutes for

01:36:41

questions now we have obviously the whole span of of what thinking on public and private health insurance and and that's been expressed rather eloquently by each witness I'm taken with the following and that is that the

01:37:12

percentage of people that still are not insured in our country I don't understand why people that are eligible are not enrolled it's such a loss because they're subjected to all of the things that we know mr. Morley you spoke to them and that they're not enrolled that's a whole nother issue but it's 6.8 million people in our country

01:37:43

now in terms of the ACA we have we brought the percentage of uninsured down so weak but we need to always remember that there were 14 states where governors denied their own constituents the coverage that they were entitled to where the federal government for five years was picking up the full tab I'd like to hear from each one of you and I

01:38:16

I'm sorry to say this dr. analysts but I I think that you don't agree with anybody on the panel but you can try to answer the question may you may you may have that's something that you like somewhere but for each one of you in terms of the thoughtful proposals that have been put forward by the nine members of Congress what do you think will best help to achieve universal

01:38:47

health care in our country so I'll start with miss Rosenbaum very much and everyone be brief I have three you have three minutes to answer that and that'll be my only question but I'm curious to hear from each one of you what fits with your thinking thank you so if you look at the number of people in the United States who are not enrolled but who are eligible for something the the overwhelming majority will tell you that it's because they could they can't afford it and getting to affordable

01:39:19

quality coverage of course is a very complicated thing to do I think the reality for this country over the past half-century has been a an employer system that was limited in its reach to begin with it worked very well and it continues to work well for people who are in it but what do you think I mean my question is very specific of the of the nine proposals is there anything given your background

01:39:51

research all that you know that you think would best help us achieve universal health care in the country because of the backdrop there's got to be some combination over and it may change over time of a strong public insurance option coupled with potentially private insurance option for people who have good comprehensive coverage do you ever take the next step thank you but we need to I don't need to get to the others all right and you're gonna have the opportunity to tell me

01:40:23

more in with written questions that it will be submitted to all the witnesses mr. Morley thank you for asking this question I just have to say I've you know the majority of my advocacy has been defending the Affordable Care Act so thank you I for that your so long but I've had very limited opportunity to to think proactively but I take my cues from congresswoman Schakowsky all of

01:40:54

them I support all of them anything that's going to get us access to to increase access I I believe in all about you are so beautiful mr. Ross we already know where you are right but if you want to restate it I would like to start by saying that we have always been very appreciative of the ACA oh and we appreciate the United nurses did in that effort certainly because it moved us so much closer to

01:41:27

making sure that everyone got hmm now we need to take the next step it won't do it anymore not as long as private insurers are involved okay we have to eliminate barriers to care and really medicare for all is the only one that will do that thank you dr. holtz-eakin I'd say two things first I want to echo the importance of genuine delivery system reforms to make whatever gains and coverage.you achieves sustainable they just won't stay unless we do that that's why I'm very worried of the Medicare for all that's going backwards to fee-for-service medicine which this

01:41:59

committee with macro recognized was not the way to go in terms of the low-hanging fruit there's a report out today that there are four point seven million people who could sign up for a zero premium bronze plan today so it can't be cost there's something else going on cover those people thank you very much yes I mean the the the disconnect in in my view and with my proposal is that the goal is not to label someone as insured the goal should

01:42:30

be to bring the cost of medical care down and when you bring the cost of medical care down insurance premiums come down because eighty percent of insurance premiums are due to cost of care and all government outlays for programs for healthcare are are much less and by that way you broaden access to care so the way to do that is to empower patients by putting them in the driver's seat and controlling the money to getting rid of the regulation that is false I appreciate it and I flex your original

01:43:00

testimony and I should just announce that December 15th is the deadline for enrollment so whomever is listening in if it's c-span and everyone else we're talking about insurance affordable coverage everyone understand December 15th and now I would like to recognize thank you witnesses for answering my question now it's a pleasure to recognize the ranking member the gentleman from Texas mr. Burgess for his

01:43:33

five minutes of questions thank you and let me just give you a few minutes to wrap up what you were saying or a few seconds to wrap up we're saying yes well the basic plan should be to get people to be incentivized to save money on healthcare by higher deductibles paying more directly cheaper insurance and therefore care about the cost of care to increase the supply of competitors for that money and to get rid of the in in really

01:44:04

incorrect incentives in the current tax code that make people incentivize people to spend more on health care that's the way everything in the United States gets reduced price with higher quality that's exactly how it works and it can work with health care as we have evidence that it does donate I thank you for your observations thank you for your testimony it was some of the most interesting I've read in a while dr. Halsey can you talked somewhat about the I guess the phenomenon is

01:44:36

cross-subsidization currently the current Medicare system does not reimburse for the cost of the care so that cost that that Delta is covered by generally employer sponsored insurance or individual insurance can you speak to that what would happen in a world where there was no longer the ability for that cross subsidization I'm deeply concerned about that in these proposals a because

01:45:08

there is evidence that many institutions have negative medicare margins they lose money seeing a Medicare beneficiary proposals that would move everyone to Medicare levels of reimbursement or something close to that run the risk of turning everyone into that put that position and that risks cutting off access to care entirely particularly if you've got a single rural hospital you can't can't pay the bills that's a that's a concern to me that that level the importance of that level of reimbursement for things was brought home by some of the work the administration did on on international

01:45:40

drug prices where the intention was that the drugs are cheaper elsewhere but what was not caught in that proposal was that of the 27 most expensive drugs that Medicare patients the United States get and use only eleven were available in all the other 16 that were studied if you don't reimburse at adequate levels people do not get access to modern care that's what I'm concerned about getting rid of the commercial subsidy runs that risk and of course as you know I spent years of my life trying to get rid of a Medicare formula called the sustainable growth

01:46:11

rate formula and congratulations the effect of that of course was to limit the number of providers who would I mean one of the questions I got at Town Hall's when I first became a member of Congress was how come you turn 65 and you've got to you got to change your doctor and the answer was because their doctor was not no longer taking Medicare was not a was not a participating physician because of the ratcheting down of reimbursement rates it happened automatically every year you're in and

01:46:42

you're out that grant was if you could and you didn't mention your in your oral test well anybody written testimony you talked a little bit about the difference in infant mortality rates the united states other parts of the world and i think the statement that you have is about how the united states the effort to save some of the most premature infants is different from other parts of the world some people would argue well

01:47:14

maybe that's not a worthwhile activity but i will just tell you 1976 i mean a medical school and a neonatal intensive care unit was unheard of and today every good-sized hospital has one so our ability to take care of those infants has increased because of that i just wonder if you had any thoughts on that yes i do i think this is very important visa vie what's been said about both life expectancy and infant mortality these statistics are very coarse and poorly calculated numbers and i'll give

01:47:47

you the specific reason why infant mortality for instance is not a valid indicator at all because when you look at the way it's calculated the european countries the united states counts every live birth as a live birth with one heart rate look at countries in Western Europe who are so-called pure Nations some of them don't count infants as having been born unless they are a certain gestational age or unless they survive 24 to 48 hours they don't count the babies who

01:48:23

died as having been born if they don't live that long so you can imagine in a fraction if you change the denominator you have a totally invalid statistic this is documented in the peer-reviewed medical literature this is not my assertion same thing with life expectancy although a little bit different most of the deaths and young people in the United States are not even due to illness immediate gunshot wound to the head in murder is not a reflection of health care quality okay and when you look at for instance

01:48:53

lifestyle behavior is very different in the US and other countries 40% of the difference in life expectancy between the US and other countries is due to one lifestyle behavior obesity if you standardized for these things you see these statistics are not meaningful that's why to me the best way to sort of compare health care systems is to look hard follow the common speeding lobbies I'm sorry there's too many here a lot of fact yeah just before I yield back I'd like to ask unanimous consent to add to the record a letter from the Texas

01:49:24

Hospital Association so ordered happy to place it in the record thank you now our the gentleman yields back now it's a pleasure to recognize the chairman of the full committee mr. pallone Thank You Jaron women I should thank you for that in this hearing I was one of the drafters of the ACA obviously very proud of that fact and I do believe that the ACA could have and still can achieve almost universal coverage I mean

01:49:56

the idea was that you know 65 some percent of the people get their insurance through his employer and then we had this large group of people who buy insurance individually on the marketplace but can't afford it so the idea was to try to make it affordable and that's where the subsidies came in and the mandate you know what the idea what the mandate was that you know we'll give him enough of a subsidy so they'll buy insurance rather than a penalty to not buy it but there was still two groups that were still out there even with that scenario one were

01:50:27

those who wouldn't be able to pay a premium and that's why we wanted to expand Medicaid and then the last group were the uninsured I mean I'm sorry not the uninsured the undocumented which as far as I'm concerned you know we should have addressed and we had a debate but we couldn't get the votes so I wanted a as Miss Rosenbaum you know with regard to the Medicaid expansion you know the the it was but it was not supposed to be optional under the ACA but the supreme court holding in MN FIB versus Sebelius

01:51:00

said they had a choice whether to expand or not and if all with the states were willing to put aside this partisanship and act in the best interests of their residents I think we'd be much closer to the goal of universal coverage so let me quickly because I want to get to the undocumented can you tell us as of today how many states have expanded Medicaid everybody but 14 a couple are still on the verge of phasing in but they're okay and for those states that expanded Medicaid you know they got a pretty generous deal in terms of how much of that closest paid for if I the federal

01:51:31

government correct yes and Congressman V Z's bill that were considering today the incentivizing Medicaid expansion Act would make that offer even more generous correct yes so if all states were to expand Medicaid as originally intended by the ACA how many people do you think would gain coverage that don't have its word about 15 million now it's roughly another 2 million people a little more than 2 million okay now do you want to not open it because I want to get to the undocumented but would you give me any

01:52:02

sense of why you think these states are still rejecting the Medicaid expansion is a strictly ideology what does anything looked at a lot I would say it's a deep philosophical opposition to the expansion cost certainly doesn't explain it the Federal Financing doesn't explain it even even at the current rate so I would say we're dealing with something deeper ideological all right now let me get to the undocumented you know we we know that a large portion of this country is uninsured rate comes

01:52:33

from undocumented individuals what would you like that if we covered all the undocumented what you know what do you think percentage-wise that would mean well I mean that that would be universal coverage there are proposals that are universal up to legally present immigrants that and also that addressed the short term that people who have been here for less than five well let me put it to this way let's assume that everybody who was legally here and

01:53:03

documented had insurance coverage I think we would be agar to say we still may be the only at 95% because it'd be another 5% that are undocumented I mean I know that's a huge right know and and it's not it's not a good thing for any health care system to leave anybody out it okay but would you agree you know even if everyone was covered who was legal you'd probably still have another five percent of the total population that's not covered because they're undocumented okay so um I mean I agree with you it doesn't make any sense you

01:53:33

get sick you spread disease I mean what are we talking about here it's you know it's it's not you can't operate in isolation so I mean those undocumented people obviously have health care needs how do they get back here and what course does that add to our system how is this does this make any sense I don't think so to not cover the undocumented in terms of the course to our system and how we operate those who are willing to come forward use isolated public health services in in extreme situations they would turn to an

01:54:05

emergency department but the care is uneven too late and too many people live in the shadows really without any health care at all there there are no waiting lists for people who are uninsured but also doesn't it just not make sense from a course point of view because if those people got preventative care and were able to see a doctor they wouldn't end up in the hospital emergency room because they wouldn't get as sick I mean you want to comment on that absolutely and it's very difficult to begin to quantify these kinds of shifts but very

01:54:37

important to bring everybody in to deal with health problems before they become serious enough to be high-cost alright thank you so much thank you madam chair the gentleman yields back it's a pleasure to recognize the gentleman from Illinois mr. Shimkus for his five minutes a question thank you madam chairman and I appreciate the hearing and IP appreciate people in the health care sector because as compassionate trying to do the right thing even those who are trying to make sure we can pay for it adequately we're on it for the right reasons

01:55:08

you know this year when we passed Medicare Part D helpful I was here when we did expansion of Medicare Advantage very helpful so but numbers and budgets and dollars matter so dr. Holst ikan what happens with the hospital insurance h i trust fund in 2026 at that point it will be exhausted and what does that mean exhausted it means that the payments out

01:55:39

to hospitals will have cumulative li exceeded the payroll taxes going in and at that point there will not be the legal authority to reimburse for care can you say that again at that point it will be illegal for you to reimburse hospitals for their carrots a better care beneficiaries they'll have to do it so how do by adding more people to Medicare how does it help solve this 2026 funding problem it would not help solve that would increase the outflow without raising the inflow so it

01:56:09

actually would probably create a insolvency much sooner yes and dr. hatless you identify this in your testimony kind of on your figure three here in your statement no different than our problems with social security workers today pay for Medicare for retirees more people retiring and living longer it's financially unsustainable is that what you're trying to say here on

01:56:39

this figure three yes what what figure you're alluding to shows that the number of workers funding per Medicare beneficiary started out when the program started at 4.6 and now it's about two point something and so when you have not enough people working to fund the program at the same time as this explosion of an aging population and actually a positive of people living longer living longer also means incurring more medical expenditures because older people well

01:57:11

then I reclaim my time and I appreciate that so I were friends here understand that there is a funding crisis I've said it for 20 years someday someone's gonna believe us that there is a funding problem on Social Security that's a funding problem with Medicare and we we're part of the problem of Medicare because who in this room who doesn't get visited by people saying the coding for fee for services screwed up pay us more right who doesn't

01:57:41

get visited by folks here in the audience who say we're not compensated enough right and that's and that's going to continue let me ask a question to both you dr. ho Deacon and dr. atlas what happens when a new product comes to market under Medicare for all it's not clear okay and we're talking about this too we have this big HR 3 drug debate about well maybe 10 new Dropbox blockbuster drugs won't get their market

01:58:12

some estimates are a hundred if you're the the patient who's looking for that life-saving new drug you want to be able to get it and it is I think the the countries that we've talked about who have single-payer systems they're their actuary on they're not actuary but they're listing takes a long time for new products come on the market it's that correct that that's absolutely correct in the u.s. of new brand name drugs new new therapies available

01:58:43

95% are available in three or four months that that number is not half that size and Medicare Advantage under Medicare for all what happens to that it's gone it's gone let me finish with this I'm from rural America a lot of our hospitals or not-for-profit faith-based institutions and who do their best to cover folks madam chairman I like to submit to write letters from the record from the National Right to Life Committee April

01:59:15

29 29 2009 teen and the March for Life Action and whenever you're willing to do that and I know you may want to look at it but I want to read a statement there are certain key details of this legislation that would mean dramatic and radical departure from long-standing abortion related policy the legislation required government funding of abortion without limitation and also likely would require unwilling hospitals and doctors to perform abortion procedures when you

01:59:46

go into a government system and you don't have choice you have to play by the rules and okay it's a pleasure - the gentleman yields back it's a pleasure to recognize our colleague mr. Engel from New York for his five minutes of questions thank you madam chair and I have a lot to get and

02:00:19

I'm going to see if I can do it all but let me first say health care continues to eat a growing share of every American family's income we know that from from your years of watching this and also from the testimony today the trend is reflected by the healthcare sector consuming an increasing portion of our nation's GDP in 2016 it's accounted for 18% of our GDP but in 2026 it will jump to 20% in that trend it's unaffordable and unsustainable and every day like my

02:00:51

colleagues I hear heartbreaking stories from my constituents about how families are having to choose between paying for life-saving healthcare and other necessities such as groceries so I am pleased to be an original co-sponsor of the Medicare for all Act and a founding member of the Medicare for all caucus this legislation will improve and expand Medicare for all Americans and will provide new benefits including dental vision and hearing or without co-pays premiums and deductibles as I've said many times before health care is a human

02:01:23

right and I believe that HR 1380 for will every American access high-quality health care ms Ross let me ask you could you please describe how Medicare for all will save money and put our nation's healthcare expenditures on a sustainable financial footing I think the biggest savings in Medicare for all will come from administrative costs because right now there are so many different plans to administer nurses and doctors just want

02:01:55

to care for their patients that's their main goal so without the interference of the interference of those insurance companies we can actually do that so you've got the the lowering of the administrative costs you've got accurate budgeting which we've not had before that's actually sustainable thank you madam chairwoman I'd like to ask unanimous consent to submit into the

02:02:25

record a letter in support of HR 1380 for from 253 leading economists discussing how this bill will reduce health care costs while guaranteeing every American access to comprehensive care so ordered thank you let me also say again madam chair I want to thank you and mr. pallone for holding today's important hearing the ACA Affordable Care Act which I helped to author I was on this committee when we tried so hard

02:02:55

first to get a everyone covered and then for a public option we didn't have the votes but the ACA has enabled over 20 million Americans to become covered including a hundred thousand of my constituents and yet despite this remarkable progress the Trump administration has taken actions to gut the ACA including promoting junk plans and curtailing outreach programs this committee has led the charge to reverse this sabotage through legislation such

02:03:27

as the strengthening health care and lowering prescription drug costs Act and I want to thank chairwoman issue for for her hard work with that with that said we must continue to build on the ACA success and two of the bills before us today introduced by New York my colleagues in New York Brian Higgins and Antonio Delgado would create public options to help improve access to coverage let me ask miss Rosenbaum how would a public option is envisioned by the bills drafted by congressman Higgins and

02:03:58

Delgado helps strengthen the ACA marketplaces what they would do is introduce a competitive alternative to private plans for especially vulnerable older Americans whose health care costs are quite expensive relatively speaking this would give them a more affordable way to buy care thank you and finally mr. Morley I have a question for you because I want to thank you for coming from my hometown New York

02:04:29

City to testify one of the hallmark features of the ACA is that it prohibits health insurance companies from discriminating against Americans living with pre-existing conditions such as diabetes the Center for American Progress estimates that nearly three hundred and eleven thousand of my constituents below the age of 65 have a pre-existing condition and the Trump administration's efforts to weaken these protections through regulatory actions jeopardize the health coverage of my constituents so I want to thanks the leadership of members like congresswoman

02:05:01

Kuster who offer the protecting Americans with pre-existing conditions the house is fighting back against these policies so mr. Morley could you describe the impact that eliminating the ACA protections for pre-existing conditions would have on your ability to access health care services it wouldn't just obviously be mine it would be for 130 million Americans so I can't really speak for myself on that I think the stress of all the sabotage has been done

02:05:32

by the Trump administration has been really in overwhelming at times I've lost a lot of sleep as I'm sure a lot of a lot of people have that's that's the number one concern I hear from people but limiting my my access to haier the insurance companies can go back to discriminated excuse me discriminating against me and as I stated in my in my oral testimony you know I've experienced that already and it's cost me tens of thousands of

02:06:05

dollars and I had the ability to work at that point in my life and I don't have the ability to work anymore so there's no way that I could pay for that I have monthly infusions each one of my infusions for my lupus cost ten thousand dollars and there's no way I could pay for that thank you thank you madam chair the gentleman yields back I just want to add something to what the gentleman from New York said relative to

02:06:37

the ACA and the public option the House passed that it was the Senate that fell short on we all feel very strongly about it because we fought so hard and we achieved what we wanted to achieve in the house but I think it's important to have that as part of the record it's a pleasure to recognize the gentleman from Missouri mr. long for his five minutes of questions it's a pleasure to be recognized by my buddy the madam chairwoman and thank you and thank you

02:07:09

all for being here today on this extremely important topic every day where we hear someone in fact when I go home I usually give him the health report and there's things like every day someone's coming down with the disease someone we know someone were close to near and dear to my daughter she's 30 now 25 years old she was diagnosed with Hodgkin's lymphoma she went through all of the treatments and lost her hair got

02:07:40

her hair back and doing very very good now affecting to get married next October and I'm wearing today my st. Jude Children's Research Center tie that I'm very passionate about have been for over well close to 40 years now guess what over 30 years when I was a option heir before this life for 30 years I was on the National Board of Directors and we picked one national charity to support and that was st. Jude's I always try and showcase my st. Jude Tide any opportunity Sunday

02:08:13

night we were at the Kennedy Center Honors two of the honorees one that founded Earth Wind and Fire suffered from Parkinson's disease before his demise and Linda Ronstadt who had to give up singing one of the most beautiful voices ever was honored Sunday and she had to give it up due to Parkinson's disease so again it's a very very important topic and thank you all for being here dr. atlas first name Charles middle name Charles and he not

02:08:45

many people know who that was anymore I don't think I'm showing my age but I've never met an atlas that wasn't named Charles so I'm just curious but inquiring minds want to know but if you think back to 2013 with the rollout of healthcare.gov and all the issues that they had getting the website opening up and I think six people actually were able to sign up that first day it took months and months to get it where it was fully functional and more than a one and a half billion dollars

02:09:15

over budget to get it up and going in the end healthcare.gov website finally launched about three and a half years after the passage of the Affordable Care Act Medicare for all bills estimated a cost over 30 trillion dollars and would fully transition from our current health care system to a single-payer system in two years so if the United States government couldn't build a functioning website in three and a half years and went massively over-budget trying how

02:09:47

can we possibly expect the government to successfully transition to a single-payer system in just two years and stay on budget any comment yeah I don't think there's an answer to the question except I would say to the point about why single-payer why Medicare for all will save money it's because the same reason that every other single-payer system is less than the United States they restrict the use of healthcare and they have worse results for that so if that's what the voters are interested in doing having

02:10:18

worse health care and having more people die like Canada and England and everywhere else and no access to these drugs that we enjoy as Americans you know that that would be a reform that would be appropriate I think the best way to get access is to reduce the cost for everyone just like it's done that's why the cell phone in your pocket it's a supercomputer doesn't cost twenty thousand dollars from competition and empowering consumers who care about the price of what they're actually directly buying okay the Harvard School of

02:10:50

Business determined that the lack of relevant experience lack of leadership and time constraints where the primary factors leading to healthcare.gov initial failure do you believe the United States government currently has the manpower resources management talent and expertise to fundamentally and take over our healthcare system not in the government no the private sector would okay in your testimony the opposition to single-payer should not you said that

02:11:21

the opposition to single-payer should not focus only on requirement of four massive new taxes but instead on the well-documented half-century of its failure to provide timely quality medical care this failure is not just about low priority checkups or routine appointments it's about people that are seriously ill you note that the UK's NHS system has set a standard and declared it would be acceptable for fifteen percent of cancer patients and I've spoken of cancer patients including my daughter here this morning to wait two

02:11:52

full months and when I think of the day that I took her to the emergency room here in Washington and first was told her there was nothing wrong and go home but they had an IV in her arm and she couldn't get dressed and go home they decided to do an x-ray and they came back and they said you have a large mass in your chest and it's malignant waiting to full two full months for treatment would definitely not be acceptable in her case or it should not be in anyone's case and one out of five patients has to

02:12:22

wait over two months for their first treatment of cancer and I've beyond my time by 20 seconds and I yield back to my friend gentleman yields back I'm a kind' chairwoman I have a hard time cutting people off it's only at the urging of others that I do this so it's a yes he is a a real live auctioneer you can hear it in his voice

02:12:53

now all the let's see we have all of our women to ask questions the gentlewoman from California miss Matsui is recognized for five minutes for her questions thank you very much and I want to thank the witnesses for all being here today and and thank chairwoman su for having this hearing here today you know for the past decade our health care system has been constantly under attack Republicans in Congress in the state houses across the country have made it their mission to repeal or

02:13:26

systematically undermine the Affordable Care Act the goal of universal coverage has long been as we always say a North Star for the Democratic Party we believe everyone to have access to care and I was disappointed with more progressive policies to expand coverage for ultimately left out of the Affordable Care Act but that's why this moment presents a unique opportunity the ACA improved the quality of basic care everyone receives it unlocked access to care for Americans who haven't

02:13:56

historically shut out of or priced out of the system is expanded coverage to over 20 million Americans since it was signed into law while acknowledging our successes we must also recognize the need for improvement the need to look up again at the North Star of universal coverage and ask ourselves what comes next it is my hope that today we can have a productive conversation about how to obtain universal coverage increase the role of federal government and lowering the cost of care and maintain a

02:14:27

row as the global leader in cutting-edge treatments and health technology our path forward will say a lot about who we are as a nation health care touches all of our lives in some way that's why I'm excited by the proposed before us today all of which united by the common goal of improving the access and affordability of healthcare California is the first state in the nation to approve coverage affordability for lower middle income consumers by expanding subsidies available through

02:14:58

our ACA marketplace covered California California has also reinstated the individual mandate tax penalty as a result of both policies planned so through our health insurance marketplace so our record low statewide average rate change of less than 1% for 2020 bringing savings and stability to entire individual market many of the bills were discussing today would enhance ACA premium tax credits and cost-sharing subsidies to marketplace enrollees Ms Rosenbaum can

02:15:30

you briefly explain how the ACA subsidy cliff works and what groups face the biggest affordability challenges as a result of this phenomena and poverty and it works by keeping down your cost of coverage to a certain percentage of your

02:16:00

income currently the subsidy has sort of a steep cliff and ends completely at 400% of poverty the cost sharing assistance is similar in that it essentially discounts the cost of care at the point of service but it's cliff is steeper it ends at 250 percent right so you'd agree that improving subsidies is key to increasing coverage for both low and middle income individuals so if we were to scale these solutions

02:16:33

national nationwide how would you expect enhanced subsidies covered with return an individual mandate to impact over on uninsured rates and the stability individual marketplace along probably along with of course something for the Medicaid expansion states that have not expanded would probably raise the insured levels by at least 10 million people even more with auto enrollment sure now in the Medicaid expansion states AC is working as we envisioned filling in historical

02:17:08

coverage gaps tied to income level by expanding Medicaid eligibility and providing subsidies for purchasing coverage and non-expansion States many adults as incomes are above Medicaid eligibility but below the threshold for subsidies are trapped in a coverage gap mr. Rosenbaum how many uninsured people nationwide will be eligible for Medicaid if their states expanded its so our larger populations of people caught in the coverage gap concentrated in certain

02:17:37

states or parts of the country mr. Morley I just want to make a comment thank you for your testimony we really do understand what you have been going through and we were really want to work on behalf of you and many other patients such as ourselves and thank you for sharing your unique perspective with us I'm equally concerned about the actions taken by the administration to undermine Medicaid and they say protections and and that have increasingly exposed you

02:18:13

know consumers to coverage acts and believe me that is what we're trying to do today to ensure that we level the playing field and understand how important it is thank you very much appreciate it thank you very much for saying I appreciate that gentlewoman yields back it's a pleasure to recognize the gentleman from Kentucky mr. Guthrie for his five minutes of questions thank you very much sorry I was there's another hearing of this full committee at subcommittee that was meeting earlier and was there on foreign drug inspections so I've been able to hear your stories mr. Morley but god bless

02:18:45

you and thanks for being here to share what I want I kinda want to talk about with dr. Atlas and dr. Holz akin is I think all of us are here wanting people to be covered with the question is that we get to when you look at Medicare for all how does it change the health care system we have today where we're currently in discussion this week about HR 3 which is setting a price for for pharmaceuticals we all want lower drug prices and there's a bar bipartisan bill to do that but now we're going to we're resetting drug prices to the point where CBO says we will get

02:19:15

less 8 to 15 less cures over the next 10 years and people on this committee and that hearing said if we're gonna lose miracle cures or they didn't say that and put the words if we're gonna lose some cures because we're gonna have lower drug prices that's that's a trade-off we're willing to pay I like to take people when they come to my district to Owensboro with fantastic Medical Center Bowling Green to medical hospitals Elizabethtown motocross field Danville Ephraim McDowell father of modern gynecology hospital and and just say if we were in a European or state or

02:19:48

Canada we a city this size would not have a hospital this of this quality of my opinion I mean and I tell them taking me to a cities of less than a hundred thousand people that have world-class you can do heart surgery we do a lot of different things so the concern is we go down this path is and we have to it's not just a slogan that we can put it on a bumper sticker or a t-shirt its houses going to affect the health care system that Americans have we can cure sickle cell anemia we as cystic fibrosis is going to be a disease that people can live with further it's going to be a maintenance disease artificial pancreas

02:20:19

is available now just the things that are coming out of this country and we are subsidizing the rest of the world and that's an issue that we try to address an HR 19 on drugs is that we have a US trade negotiator negotiate with those drugs but just ramping down payments and giving in order to get a hundred percent universal coverage in one plan Medicare for all at the expense of that which I don't say how you take that much money out of the system and not lose hospitals for example under the Affordable Care Act we did Medicaid

02:20:49

expansion and within my state expanded Kentucky and with Medicaid expansion it was paid for by decreasing the dish payments disproportionate share payments because if everybody's covered we're not going to have to have these subsidies well I will tell you every rural hospital in Kentucky today an expanded state would say if you and we're making it up we're gonna we're doing Medicaid expansion and dis payments because it just doesn't work they would all say they would close have difficult spirit particularly the smaller ones almost say Owensboro Bowling Green but smaller hospitals will close they told me if we didn't make up

02:21:22

the dish payments when the policy was everybody be covered but the problem is the payments are so low even the people cover the hospitals can't make it up so doctor atlas or Hosea nor open up to any why what what do you see if we go to one size reimbursements for Medicaid Medicaid to all of our hospitals and our providers what kind of health care system would you see for instance we know under HR 3 that 50% of the drugs that would be priced in or HR 3 are not available in Canada they're not they're

02:21:53

just not available that that's a fact and and so what would you see with our so I can I'll answer about the drug pricing issue that hasn't been brought up but you look at what a single-payer system does with drug price and we can look at the NHS they have a budget impact test of 2017 they set a number and if the system is going to cost 20 million pounds or more for a drug they're not going to have that drug available and they're gonna quote negotiate and they give themselves three years if your wife has breast cancer and wants one of these new drugs she's gonna

02:22:23

sit there for three years while the government the NHS negotiates that price down it's been calculated by the NHS itself and the Alzheimer's Foundation in the UK that a drug for Alzheimer's would have to cost less than four dollars a month to be approved because so many people need it so if you look at it this way ironically the more people that need the drug when you're capping the total expenditure the more people that need the drug the less likely it will be available that's what the NHS budget

02:22:54

impact test does you can't have the government a third party the government doesn't care if your wife doesn't get her drugs she cares if she does this one point out is that we can't just sell that we're creating a whole new payment system and not affect the health care system we have there's I think people are visioning we're gonna have exactly what we have in somebody else is paying for it and that's not what will happen at my feet we know that the CMS actuary just now said it that they're warning in 2018 hospitals and nursing facilities

02:23:25

and in-home care are going out of business because they're losing money per patient if you lose money per patient you don't make up for that in volume as the old joke goes I mean that restricts access to existing technologies and in the data we see that increasing quality which is the adoption of medical innovation is correlated with higher reimbursements you put all that at risk and the International evidence shows it our domestic evidence shows it as well thank you very much I yield back gentleman yields back

02:23:55

I have a factoid and that is a lot of people said things about the Affordable Care Act all members of Congress received their health care through the Affordable Care Act all staffers received their health care through the Affordable Care Act I think there's only one member that has not accepted it and that's dr. Burgess but that was his choice so I think that we have a lot of people and invested in it and I just can't help

02:24:27

but say thank God for Medicare and Medicaid where would people in this country be without that coverage so it's a pleasure to recognize the gentlewoman from Florida Ms castor for her five minutes well Thank You chairwoman su and let me thank you for this hearing because isn't it refreshing that we can focus on how we are going to lower the cost of health care in America expand access build upon Medicare Medicaid in the Affordable Care Act so thank you very much dr. Rosenbaum in

02:25:00

your testimony you cite the lasting and measurable achievements under the Affordable Care Act and Peter Morley thank you for for being here and speaking on behalf of millions of Americans with pre-existing conditions when you say the Affordable Care Act here we are ten years later it's a time to take stock what stands out to you overall dr. Rosemont I think the remarkable effect of the affordability provisions the enormous

02:25:30

impact of the market reforms for people like Peter Morley and and the vision of combining access to affordable with actually improvements in communities to access to so the protection no longer can they an American be discriminated against for any pre-existing condition it's been very meaningful for young people to stay on their parents policies until they're age 26 and to mr. Shimkus who was here remember the Affordable Care Act extended the life of the Medicare trust

02:26:02

fund and it strengthened Medicare and it helped close the doughnut hole now the Democrats this week are going to pass one of the missing links to allow Medicare to negotiate prices and drive down drug cost and then carry that over to private insurance so that's going to be a great thing for families you know coming from the state of Florida boy there's some good news and there's some really difficult news we've led in the marketplace every year we have about 1.8

02:26:34

million Floridians who sign up for affordable coverage under health care gov at the same time we have a little less than a million of a residents who are stuck in the coverage gap that means they're too poor to access the tax credits this is crazy okay Floridians and this goes for Texas too we want to bring our tax dollars home and Leavitt partners did a study recently came out thirteen point eight

02:27:07

billion dollars of your tax dollars they want to give them back to the state of Florida so that about a million of our residents you can get signed out for Medicaid health care services chairwoman su when you talk about this this cohort of people who don't have health coverage because of that Florida the fact they haven't expanded Medicaid ten percent of all working adult are all uninsured adult population comes because

02:27:40

of that coverage gap so I appreciated chairman pallone and and congresswoman Matsui highlighting this doctor is among can we just we can look at mr. VC's legislation to increase the incentives I mean 13.8 billion dollars a we cover people we would it would help our GDP we'd be able to hire we'd be healthier Impa more I mean across the board what else can we do we have to just go ahead and say we intended Medicaid to be

02:28:11

expanded under the Affordable Care Act do we have to craft that again and pass it and would it withstand scrutiny at the Supreme Court well certainly further incentivizing states to expand coverage it's a good idea why is they not expand coverage it's a bit of a mystery especially since the expansion would not only extend coverage to all the people who are left out but it would actually bring down the cost of premiums in the marketplace because in states that start their marketplace coverage at 138

02:28:43

percent of poverty the premiums tend to be lower so it's good can we just pass the law go back and constitutional but certainly many people among them that sweetening the pot is a very good thing to do so Peter Morley thank you for for providing a real-world example of what

02:29:14

how meaningful it is to have health care coverage you know we're in the holiday season now and is there any better gift to a loved one than health insurance and tell it remind us what the what the deadline is first of all thank you for saying that I spent three days in Congress last week in the House and the Senate making videos with with people like

02:29:44

congresswoman cast a caster the deadline for the federal exchange deadline is December 15th Wow that's Sunday it's Sunday go to healthcare.gov that's the way that that we keep enhancing the ACA and just to add on when you talk about Medicaid expansion a lot of people I've heard for majority people in Texas and Florida those are two major states that have not

02:30:15

expanded Medicaid and I am very sympathetic and compassionate to that so thank you for mentioning that thank you I made the announcement December 15th whoever is tuned in it's a pleasure to recognize the gentlewoman from Delaware miss blunt right Rochester for her five minutes of questions thank you madam chairwoman and I want to thank both panels for your testimony and the

02:30:47

deliberations as I was sitting here listening to the testimony I thought of a quote from Martin Luther King that says of all the forms of inequity injustice in health care is the most shocking and inhumane a decade ago this very subcommittee debated one of the country's most sweeping and comprehensive pieces of health care policy the Affordable Care Act 20 million Americans gained health coverage

02:31:18

through either the marketplace or Medicaid expansion and for the first time patients received critical protections from things like coverage denials because of a pre-existing condition like you shared mr. Morley or lifetime limits on essential health benefits Delaware alone saw the state's uninsured rate dropped to 5% but an issue that's still plaguing our health care system is cost I held town hall

02:31:48

meetings I met with families I met with small businesses in my state and three things kept coming up for many the out-of-pocket costs were unaffordable for some there were gaps in coverage or they were under underinsured and number three health inequities and disparities still persist which is why we're still talking about maternal mortality in this country since hearing those concerns I've been working on a comprehensive

02:32:18

strategy the cap costs now Act I'm gonna say it again the cap cost now act my bill would cap out-of-pocket cost including premiums deductibles and co-pays so no one is spending their whole paycheck for health care no matter where they are getting their health insurance the cap costs now Act would allow us to achieve truly universal coverage by automatically covering everyone through an easy-to-navigate

02:32:49

system with new options for coverage such as a Medicare program for those 50 to 64 finally the bill would align incentives in our health care system to better tackle health inequity and continue our nation's move towards value-based care unaffordable out-of-pocket health care costs aren't just an issue in my state the Commonwealth Fund has found that about one in six Americans face health care costs they can't afford even with

02:33:20

health insurance deductibles alone have tripled in the last decade more than four and ten workers enrolled in a high deductible plan reported that they don't have enough savings to cover their deductible in other words in the words of one of our previous witnesses if you can't afford it you don't have it so I'd like to thank my colleagues for their leadership who were on the first panel and their work on the various pieces of legislation and and I'd like to thank

02:33:51

all of you who are on this panel we all want our constituents to have quality health care and we all want our constituents to be able to afford it with my plan we can move towards affordable universal coverage without starting from scratch or removing the 180 million Americans in employer sponsored insurance from their existing plans we can immediately get to the work by building on the current foundation of our nation's health care system to provide everyone with coverage that is

02:34:23

affordable and universal as I began to roll out my health care proposal in the upcoming weeks I want to encourage my colleagues to look out for it and to support the PAP costs now Act thank you and I yield back gentlemen what excuse me the gentlewoman yields back pleasure to recognize the gentleman from Georgia mr. Carter for his five minutes of questioning thank you madam chair and thank all of you for being here I appreciate this very much you taking

02:34:54

time out this is extremely important extremely important to the future of our country to the future of health care in our country in particular I find an interesting that we're having this discussion during the same week that we're also going to be voting on speaker Pelosi's bill HR 3 that is going to to essentially keep up to a hundred life-saving drugs from coming to the market if it were to be enacted and that comes from the from the Economic

02:35:26

Development Commission and that's what they have proposed even CBO tells us that we can expect anywhere from 8 to 15 drugs not to come to market if this were to be passed but doctor atlas I wanted to ask you because I think your testimony really tells the full story if it does it's come up in our debates about the anti cures bill HR 3 as you mentioned you in your testimony as well that other single-payer systems have far fewer choices in terms of medicines

02:35:57

available to them is that correct that's absolutely true and since most new drugs are cancer drugs people die because of that you've cited some figures I listened attentively to to your opening statement about other countries and comparing us to what is available and here in America as opposed to what's available in those other countries do you have that by chance again yes I do because I was speaking so quickly that probably no one remembers what I said I'd like to make

02:36:28

sure they do remember what you said because I certainly heard it the latest data on the 54 new cancer drugs launched from 2013 to 17 in the world within two years the United States patients had 94 percent available Brits had 70% Canada's cancer patients had 53% of those drugs France 43% Australia 28% it's proven in economics but not and in drugs in particular when you cap prices you're

02:36:58

going to stop the production the availability of good and the innovation of that good the real solution to drug prices is to figure out why they're costing so much because the cost of developing a drug has exploded over the past decade to two and a half billion dollars in 15 years and nobody is going to develop a drug if they're not going to get that money back so we as a government really have added a lot of bureaucracy and a lot of hurdles to the and therefore costs to the development of new drugs and that's

02:37:28

where the attention should be focused and you know for those of you who don't know and I'm sure members of committee know currently I'm the only pharmacist serving in Congress I spent my professional career dealing with this I've seen nothing shorter so glad that you said it excuse them but anyway I have seen nothing short of miracles through the way of research and development and what has come on the

02:37:59

market I give the example all the time of the drug sovaldi here's a drug that when I first started practicing pharmacy in 1980 if you were diagnosed with hepatitis C you were gonna die I mean that's all there was to it now how phenomenal is it that we can cure that disease with a pill that is simply phenomenal to me someone who who was there at that time who saw people who came in who were diagnosed with that disease and and knew that they were they were diagnosed that they were going to

02:38:29

be dying soon but now we can treat them that is phenomenal now you know the thing that concerns me so much is that both sides both Democrats and Republicans want the same thing I get it I understand that if a drug cost $85,000 is not accessible to you it does you no good whatsoever I get the fact that we need to bring prescription drug prices down I also understand that there are other things that we can do aside from from what is being proposed in HR 3 that will lower drug prices without stifling

02:39:01

in and that's what I'm trying to get to here and let me ask you dr. Atlas why would these countries restrict their patients access to these medications is it is it simply just to manage the cost of government that's exactly well they're trying to they're trying to minimize the cost that they're paying out for their healthcare system and the way that they all do it is to restrict the use of care the availability of Technology the availability of drugs and their results of their survivals in these specific diseases are worse than

02:39:31

ours exactly and and again I don't fault my colleagues on the other side of the aisle they want the same thing I want we all want the same thing to bring the prescription prices down and we can do that and and I see the need for transparency so much because I know what's going on here and I know that there are middlemen who are who are bringing no value whatsoever to the system but are taking profits out of the system and thank you again dr. Atlas for being here and for bringing up this important point thank all of you for being here thank you madam chair and I

02:40:03

yield back the gentleman yields back it's a pleasure to recognize the gentleman from Massachusetts mr. Kennedy for his five minutes of questions thank you madam chair I want to thank my colleagues for I think um unanimous a is this point I'll agree how important this hearing is grateful to to be here for it I want to thank our witnesses for your courage for your testimony for your service and for your perspective it is important that we get this right let's start by just walking through some of the comments that I think some of our

02:40:36

colleagues have made and and has been put forward in testimony this question that some aspect of a more robust guarantee of access to coverage is somehow going to make sure that drugs are not available mr. Ross are you familiar with the statistics that roughly 26 percent of patients in need of insulin ration their care I am and so does that seem like insulin is in fact readily available in the United Sates of America it does not

02:41:05

are when we talk about the fact that procedures might end up an expanded wait times are you aware that for gofundme that popular crowdsource fundraising website that a third a third of the donations of a GoFundMe page are used for health care costs were you aware that I am aware of that are you aware that the founder of GoFundMe said that quote I'll get this more or less right that he did not they do not intend to found a site that would be one of the most influential health care companies but it turns out that

02:41:36

they did hear that yes and we talked about wait times an access to care are you aware miss Ross that fifty five percent of the counties in our country do not have a single practicing psychiatrist psychologist or social worker I am aware are you aware of the fact that about fit over fifty percent of the adults in this country and need of mental baby'll illness won't get the access that they care today yes are you were the fact that that's actually worse for kids absolutely so I was at a Regional Hospital in my district a little while ago keep in mind in a state

02:42:07

with 98% 98% of people covered with health insurance ninety-eight there was a little boy that was waiting that was being boarded he'd been waiting for over a hundred and fifty hours and Counting waiting for a bed that they couldn't get the the stretchers down the hallways in the emergency room because there's so many patients suffering mental illness waiting for a bed that a mom had come in to my office now a couple years ago detailing her daughter's challenges with mental behavioral illness and at one point they their daughter was bored of

02:42:39

it on a neurology floor at a academic Medical Center in Boston for 19 days as they called looking for a bed from Virginia to Maine 19 days any guess as to how much it would cost a board a child at a neurology floor waiting for a bed and Boston a lot that sounds about right to me mr. holeczek and I think would agree with a lot figure so I these stories and these statistics out because

02:43:10

I think the reality that I think many of us experience in our healthcare system today is that when we talk about quality when we talk about access when we talk about what treatments are available without question without question they're right without question from perspective doctor atlas what you just said is correct the challenge that we're I would tell you and challenge others on this is that the focus of that system ends up being on those who have access to it and not the drastic number of Americans that don't and the fact that even today in a

02:43:43

place like Massachusetts that is so proud of the healthcare industry that we have invested in and that we have nurtured that a story that ran in the Boston Globe about eight months ago about a year ago about a african-american woman who slipped and fell in a minority part of Boston broke her wrist got in a cabin went to Boston Medical Center the old city hospital she broke her wrists out in front of her down the block from New England Baptist it's where the Boston Celtics go to get our orthopedic surgery she didn't even know that the hospital was there even if

02:44:13

she did it wouldn't have mattered because it's a private hospital they don't take Medicaid but when we have when Medicaid shifting gears is a largest payer of mental health services in this country and the vast majority of providers won't take Medicaid because their reimbursement rates are so low yes if I can afford to pay out of pocket I have access but for so many others that don't they don't mr. Moore they would not be here but for the grace of God of Affordable Care Act and the fact that certainly I mean mr. Moore you've been

02:44:44

elephant about your story but how many people in this country how many people are we even forced to have to tell your story honestly I've lost track I really it's I mean I I will never understand why we all can't just work together to bring that access for everyone and so my time is up here I I will just say this this is complex and this is complicated and there are trade-offs but the core

02:45:19

question here is that for a system that every single one of us will draw on when you're born into a system or whether you watch it welcome a new child or watch a loved one pass through it why would we not want to make sure that if the system is there for everyone else that seems to know a lot for a loved one could I add one comment to that would I be allowed well I think we need to move along because it's 24 minutes past 20 No seconds past the gentleman's time I now

02:45:50

would like to recognize the gentleman from Virginia mr. Griffith for his five minutes questions thank you madam chair ms Ross we try to get along on this committee if you've got something short say it thank you it's just is very difficult for me to hear the comparisons to other countries single pears with the constant comment that people are dying and denied care as long as the for profit motive is present in this country that's what's happening now the only way for them to get make

02:46:21

their profit is to deny care well and and I and I don't necessarily agree with you on that and would would take exception but we do try to be courteous on this committee and try to work together that being said dr. atlas too many rural hot today many rural hospitals are closing because they cannot afford to stay in business leading to access problems for sick Americans one of the major reasons for these closures is is that Medicare and mr. Kennedy mentioned Medicaid doesn't pay hospitals enough according to medpac hospitals are unable to make money

02:46:53

caring make money caring from Medicare patients if it wasn't for privately insured patients even more hospitals in rural communities would close research by the consulting firm Navigant predicts that a Medicare that a Medicare public option plan would put up to 55 percent of rural hospitals at high risk for closure now say this with the backdrop that my rural Western Commonwealth of Virginia district has lost two hospitals

02:47:23

in the last few years we're trying to get one of them back but many of the plans we are discussing today involve expanding Medicare if more patients are covered by government health care won't that lead to even more rural hospital closures and access problems well absolutely of course like I said before the CMS actuary put out the statistic that and in fact a statement that we expect access to Medicare participating physicians to become a significant issue

02:47:54

quote-unquote and the reason is because Medicaid and Medicare paid not just lower than private insurance but below the costs of delivering the care that's the point and so it brings you back to what what I believe is the whole solution that should be the focus which is to reducing the cost of care without needing to limit or restrict the use of care if you reduce the cost of care everybody gets access including those on government programs yeah and I appreciate that and I guess you know the

02:48:25

question is big how can we guarantee access to care for patients in rural areas not a medicare-for-all plan if there are no open hospitals in rural communities and for those who haven't heard me say this before sometimes you look at a map in point A to point B dozen look like it's very far but when you have a mountainous district like I do it may be hay sided Dickenson the mayor of hay sy plans on an hour if he's going to a meeting in Dickinson for travel time and the same is true when we closed down the Scott County Hospital that meant a minimum of 45 minutes to an hour

02:48:57

for many of the people in Scott County to get to the nearest hospital just for basic stuff not even counting something that might be more complex but how can we guarantee that those folks are actually going to have care it's not like getting in a cab and going to the next hospital down the road there is no hospital down the road well that's that again the solution is to introduce the the forces that bring down the prices for every other good or service in the United States that's how you ensure access not just based on price but based

02:49:26

on value or quality dr. Holt II can anything to add to that I think that's the essence of it I don't think anyone's here to defend the status quo the question is how can you go forward and what set of reforms would deliver a downward pressure on delivering the cost of quality care I appreciate it with that I yield back thank you the gentleman yields back actually you know the GAO analyzed data and found that rural hospitals in states that had expanded Medicaid as of April

02:49:57

2018 were less likely to close compared with rural hospitals in states that had not expanded Medicaid so we deal with a lot of plek cities and but i think the these the facts need to be stated so that you know that we build on the foundation of facts and it seems to me that we're in an era where that foundation continues

02:50:27

to be eroded on a daily basis so it's a pleasure to recognize the gentleman from California my friend mr. Cardenas for his five minutes questions thank you madam chair and I appreciate the opportunity to have this hearing and also to the ranking member Burgess thank you so much and I want to say thank you for pointing out that statement that when the politicians take the politics out of their decision-making more people have access to health care under the current system which you just pointed out with certain states not accepting

02:50:58

that responsibility and opportunity I appreciate the opportunity to hear from my colleagues and other experts such as yourselves thank you very much on what it is most important of the issues facing our nation I'm proud to serve on a committee that does not shy away from topic simply because they're difficult and I myself know what it is to grow up in a family a working family where my parents faced the choice between going to the doctor or having enough food to feed their family a choice that too many

02:51:30

American families faced today to say that the establishment of federally qualified health centers changed our lives is an understatement for the first time we could get preventive care we could go to the doctor when we first started feeling sick instead of when it was on dire emergency the Affordable Care Act provided these same opportunities for more than 20 million Americans that before then did not truly have access to health care many of them are live in the very district that I'm proud to serve

02:52:01

although I was not yet a member of this committee when the Affordable Care Act passed the house I know many of my colleagues were I think most of my Democratic colleagues are united in our firm belief that all Americans deserve access to quality health coverage together it's imperative that we continue that work because while many Americans have benefited from these reforms there are still too many without care that's why it is so important that we're having this hearing today and discussion this very critical issue mr. atlas

02:52:34

when some of the comments that were made and you in fact pointed out that some hospitals are closing hospitals closing is that a new phenomenon in the United States or have we had that happen over the past decades hospitals closings and/or every American having access to health care is that are those two new phenomenons do all Americans have access to health care today well it's illegal to turn somebody away when they come down okay you know okay let me qualify

02:53:06

my question over there how many Americans actually have health care coverage and direct access to preventive care today a hundred percent or not well everyone with insurance has free preventive care is that cover a hundred percent of Americans no not not everybody ops for for insurance okay god and thank you mr. Ellis reclaiming my time I was trying to have a nice dialogue with you and a simple one but you're complicating the answer bottom line is this in the United States of

02:53:36

America we've a hundred percent of Americans have never had truly access to health care just like outlined during a period of time in my family's history when I was growing up we truly didn't have access to health care preventive care excuse me today Americans don't before the Affordable Care Act we never were at a hundred percent during the Affordable Care Act the new system or not at a hundred percent hospitals have closed and opened etc over the history of time in the United States of America my point

02:54:07

is this what I don't appreciate is when members of Congress try to point out that today's system is the worst that it's been and that's just not true we haven't a system that needs improvement that is true we have a system that's trying to get more working families in every family and every child more access to health care and to me that's what the core of this hearing is about today how do we improve our system how do we

02:54:40

get to a better system where the percentages go up and the individuals and the families and the children truly have access to real health care preventive care etc I hate to point out that an emergency room cannot turn somebody down that's a conversation for another day I hope we never have to narrow our selves to that conversation so the main thing that I think this hearing is about today is how can we as elected members of Congress and the House of Representatives the people's

02:55:10

house how can we advance some legislation that will bring us to a better state a better place where more Americans can appreciate the fact that they can live through a health care situation instead of died because of non access to health care that is at the core of what this hearing is about and I really do appreciate all of you coming forward mr. Morley thank you so much for your bravery of coming forth before all of us and letting us know that no one should suffer through what you've had to suffer through thank you very much madam

02:55:42

chair I yield back the gentleman yields back and chair now recognizes the gentleman from Florida mr. Billy raucous for his five minutes thank you madam chair I appreciate so much I dr. holtz-eakin does medicare-for-all repeal Obamacare that's the first question yes okay if so why would Democrats now support to repeal Obamacare you will have to ask them I don't okay could this be taken as an admission of Obamacare

02:56:13

failure to make health care more for oh boy more accessible through increased government intervention and mandates again I would direct you to the authors okay I let me let me ask you this can it be guaranteed that taxes will not be raised on the middle-class to pay for Medicare for all or that individuals and families will not lose coverage under Medicare for all or that seniors benefits will not be changed or reduce

02:56:45

of course if Medicare Advantage is very popular my dear strict about 40% of Medicare recipients are on Medicare Advantage and we've got to protect Medicare Advantage and Medicare for seniors in general so that's what my main concern is our seniors that are on Medicare now a traditional Medicare but also Medicare Advantage I can they could they be affected by this medicare for all bill the bill would eliminate Medicare

02:57:16

Medicare Advantage included so that would be gone so it Medicaid it would eliminate private insurance so those individuals would definitely be affected the bill was silent on financing the costs which are substantial I personally believe having looked at a variety of these that it's implausible to imagine that that that taxpayer cost could be picked up by a small subset of affluent Americans it's simply too big a number okay so when you say the Medicare for all did you feel that the

02:57:46

reimbursement would be cut for hospitals doctors and nurses etc health care providers in general reimbursements will be cut to to Medicare reimbursement rates in some variations slightly above that which is well below the average of what they get now from commercial players and this would produce financial stresses and those would be solved by other diminishing access and quality or by raising the reimbursements and the taxes necessary to finance it okay thank you dr. Alice does medicare for all lead to government rationing if so why well

02:58:20

the purpose of Medicare for all as other single-payer systems part of it is going to be controlling cost and the way that controls cost is certainly not by letting people be price sensitive it eliminates concern for price so yes the only way to control cost in the single-payer systems is to restrict care and that means rationing of care yes that's proven all over the world yeah well give me a specific country where that takes place the rationing please well the United Kingdom Canada every

02:58:52

Western European you know Denmark Netherlands Italy France everywhere okay thank you very much I appreciate the answer this is very dear to my heart the co-chair of the rare disease caucus in creaking increasing access to breakthrough cures and treatments again are one of my priorities and I'm sure the entire committee both Democrats and Republicans that's one of their priorities as well Howard Medicare for all impact patients

02:59:24

with rare diseases in your opinion doctor atlas well I think that there is sort of an indirect a longer-term problem with single-payer systems and that is they don't just control the costs by restricting access to things like new drugs I mean the drugs new drugs are the basis for the new survivals for these rare diseases generally speaking but they also are going to inhibit innovation because if you're reducing the costs by restricting the use in restricting the upside of

02:59:56

developing new technology and new drugs the the goods are not produced that's just a fact okay thank you very much madam chair if no one else wants my time I'll yield back and I do appreciate you holding this hearing and then allowing us to to ask the questions yeah I'll be happy to you know if you like please but your microphone on please I was looking right at you miss Ross so and you were shaking your head I just wanted to give

03:00:27

you an opportunity to respond to my colleagues question of how well obviously we're not proponents of denying care to people we're we're proponents of making sure that everybody gets them there's been a lot of discussion about the rural hospitals very near and dear to our hearts too you're right the main reason is the non expansion of Medicaid but the other is the for-profit motives of private employers Hospital corporations that come in and they opt for a model that

03:00:58

will serve them better make them more money so they closed off services that people in those communities really need and they move them to other people places so that our patients cannot get the care that they need that they once were able to so a medicare-for-all actually globalised budgets and it has a budget for special projects which ensures that those rural hospitals and others will be built and opened the gentleman yield back thank you the gentleman yields back

03:01:29

pleasure recognized from California dr. Ruiz for his five minutes of questions thank you very much for having this hearing this very very important hearing and I'm so happy that we're now presenting a variety of different options that can move the health care system in America forward because I truly believe and I know many of us in this room believe that every American should get the care they need when they

03:01:59

need it at an affordable low cost and that should be our goal our goal in order to achieve that should be universal coverage everybody should have coverage and we that is how we should one look at our efforts and to making sure that out-of-pocket costs are low for people for patients miss Roz you and I are made from the same fabric because we've worked in the emergency

03:02:30

departments and so we know what it means to fight for people for our patients and put them at the very center of our universe and you know we've made some progress the ACA went a long way in moving us towards that goal in fact because of the ACA over 20 million individuals are now insured let me just remind people that being uninsured is a health risk some may say how can that be I tell you straight up it's a health

03:03:00

risk because if you don't have insurance you can't afford you can't afford your medicine if you get sick and you will get sicker and you will present to the emergency department if you make it with ICU type level care and your ability to recuperate is even worse so yes being uninsured is a risk factor health risk factor and you can die for not being able to prevent certain illnesses so this is of

03:03:32

important urgency for all of us we see the benefits of Medicaid expansion when we look at expansion States versus non-expansion States in terms of the providers and the hospitals if you just expanded Medicaid in those states that could expand Medicaid but for political reasons chose not to you would reduce the uninsured rate by five percent just by that alone so but unfortunately the ACA has not been fully implemented

03:04:03

there's been a lot of changes since then to make it worse because the number one singular goal of the of you know the Republican Party since Obama passed this was to destroy it to sabotage it to then say see it's not working at the expense of the American people's health and so what are our next steps you know well definitely we need to stabilize the market we need to reduce overall healthcare costs and then we got to look

03:04:34

at adding some provisions that would increase the ability for Americans to have coverage and therefore to eliminate the uninsured problem health risks of the American people here so professor Rosenbaum you know there are a variety of federal public option plans that we have looked at today to accomplish universal coverage and in other specifics of how we do that varies but can you talk generally about the

03:05:06

benefits of adding a public option to our current system specifically is there research to suggest that a public option will increase competition lower cost yes thank you very much I I do believe that adding a strong public option both gives people access in communities that right now are poorly served by private insurance plans and by injecting additional competition into the system help stabilize the cost of care and keep

03:05:38

it under control well you know the thing the focus here is that we need a preferential option we need a perfect not just any option we need a preferential option and when you look at health insurance you want to make sure that it is expansive and protects you and will cover what you need to be covered and let's I'm an emergency medicine doctor so there's nobody who's immune to accidents nobody's immune to that unfortunate surprise diagnosis that you get that you never thought you would

03:06:08

ever get like cancers and whatnot so we need to make sure that it's affordable and that it's can cover as many ailments that that we need to protect patients in addition to that we must address a couple of other issues and one is the provider shortage that we have in our country we need to we don't have enough nurses we don't have enough doctors and

03:06:39

we need to also look at the delivery of our health care system and where we focus our resources for prevention in public health not on expensive end-of-life kind of care but the prevention and the public health at the beginning thank you and the gentleman yields back that's right a pleasure to recognize the gentleman from North Carolina mr. Hudson for his five minutes of questions thank you madam chair I appreciate you holding

03:07:10

us here today I thank the witnesses for your time being with us today while I support the broad goals of all the pieces of legislation we're considering today which is expand access to affordable health coverage I have grave concerns with the impacts these bills would have on real people who need to access our health care system and madam chair my friend from California just finished speaking and he isn't truly my friend but I have to disagree with his characterization that Republicans want to destroy the health care system to score some political point I think

03:07:42

everyone in this room wants to make this system better wants to make it more affordable and and I think the the the question is how do we get there first broadly speaking the population we're trying to help roughly 28 million Americans who cannot afford insurance or have decided not to purchase insurance by comparison 293 million Americans do have insurance which is a little more than nine out of every 10 people in this country are insured Medicare is already going broke the program currently covers roughly 44

03:08:13

million people in this country under Medicare for all it would have to cover 327 million people that's 7 times the size it currently covers to think that we could add 7 times more people to the Medicare program without a cutting benefits defies common sense second we'd also be eliminating an entire segment of our economy and giving providers a massive pay cut I shudder to think what would happen to access to care in rural areas of my district which are already hamstrung for example montgomery county

03:08:44

in my district there's only one psychiatrist and only two part-time psychiatrists for the entire county any further cuts and benefits or pay rates would exacerbate this problem doctor atlas you spoke at length in your testimony about the quality of care in this country compared to other countries including wait times experienced by those patients have you ever studied the private systems that exist alongside the public system in those countries such as in Canada or Great Britain and if so can you speak to who has access to these private systems yes there's an

03:09:15

increasing trend in countries with single-payer specifically the UK as a florid example but also all the other countries of Western Europe that people with money opted out of the system he or not opt out they pay their taxes but they then supplement there's a there's a significant increase in buying private insurance significant increase in paying out-of-pocket and they all avoid using their single-payer system of the people who are affluent enough to do it and

03:09:46

that was my point that the only people stuck with the single-payer system are the very people that everybody in this room wants to help the low-income people so in single-payer countries the average taxpayer has to wait while wealthy customers don't have to they can see a doctor immediately well that's exactly right there's a parallel system basically in the UK as there is here really with the Medicaid system which everybody in this room probably knows has worse outcomes than comparable patients with

03:10:16

private insurance to celebrate an expansion of Medicaid when no one in Congress would want that coverage for their family I find a little bit unconscionable Medicaid has worse outcomes from surgery cancer heart procedures lung transplants than the same patients with private insurance because of the restrictive access to technology and drugs that Medicaid covers my plan is to make Medicaid money go for a bridge toward private insurance

03:10:48

we want everybody in the country to have excellence to the access to the excellence of American health care not a separate parallel pathway for poor people I agree it doesn't sound fair to have one system for the wealthy and a different one for those who aren't you also testified that the trend in single-payer countries is moving towards private options for health insurance to supplement or even complete circumvent the government-run system why do you think it is and should it be instructive for us as we examine these extreme

03:11:18

proposals what is the question I didn't hear it well just to continue on the thought you're saying that that that for the folks who can afford it private insurance options are supplementing or replacing it and maybe you've answered it already but but why do you think this phenomena is happening in these other countries that the wealthy go to a separate system and everyone else is stuck in because the single-payer coverage restricts care and as we see in the United States we can expand Medicaid

03:11:49

all we want but Medicaid is not accepted by more than half of doctors including doctors who have signed contracts to accept Medicaid according to HHS data so you label someone as insured but that's not the same as having access to care very well as my time is expiring madam chair I yield back thank you gentleman yields back I just want to add dr. Atlas what you said about Medicaid mr. Morley would not be alive were it not for yeah now we're not individuals well I'm

03:12:23

talking about the the data in the medical literature so that doesn't include doctor no it won't throw these here yeah I mean we all are taxi and we have many mr. Morley's in our country the chair would now would like to recognize the gentlewoman from California miss Barragan for her five minutes of questions thank you there was conversation about the one system for the wealthy one for the poor hello

03:12:56

so there was a conversation about assistant for the wealthy and assistant for the poor that's actually very much describes what we have happening in this country you have I work it's even worse you have people who don't have access to any care at all and so this is the problem and this is why we need to figure out how to get to universal care because access to health care is a human right everybody should have access to it

03:13:27

now I represent a district that's a majority-minority district it's almost 90% Latino African American and it's very working-class and one of my colleagues likes to hand out a list of where congressional district lies by income mine it's 358 out of 435 people are struggling and people don't have access to health care now the ACA was a step in the right direction it did help increase access to health care but there is still a lot of people who are left behind still a lot

03:13:58

of people who don't have that access and some people who may have something they get duped into buying some of these junk plans and then they realize they really don't have coverage and so I want to thank the panelists for being here today and for this conversation miss Ross I want to thank you for your work my sister is a nurse and I know that you have been on the frontlines of fighting for Medicare for all and making sure that everybody has access to health care and I think the bottom line is

03:14:30

we can probably all agree that everybody should have access to health care and the disagreement happens to be on how we get there and I mentioned to you the district make the makeup of my district can you explain what the benefit would be to communities of color if we had Medicare for all and how the bill would reduce minority health disparities I think I would point to again what I talked about with how its administered

03:14:59

the globalized budgets there would be negotiations between the hospital and the regional directors and you would look at what you need for the following year looking at what you needed for the year before for one thing and then you would project so if you knew you had rural hospitals communities that are under just underserved and you needed more staff in those hospitals maybe you needed to build a hospital those are the kinds of things you would look at putting into the budget so that people

03:15:30

had put previously been unserved and underserved would be able to get care great thank you miss Ross in addition to being a registered nurse you are also a national union leader as the president of the largest union of registered nurses in the country we often hear politicians telling us that Medicare for all would be bad for union members and that unions wouldn't support it but your Union does support Medicare for all as do many national and local unions

03:16:01

across the country mr. Ross can you tell us why do unions support this bill well right now there's at least 9.3 million unions that represent union workers that that do i do want Medicare for all and I think if you look back at our history we're to the point now where we can't negotiate anymore for our better wages and working conditions pension benefits because everything is taken up with bargaining for health care if you look at most of the strikes

03:16:33

across the country in the last several years they've all been over health care benefits so I think we see the handwriting on the wall and also I know Union workers who might like to switch jobs they're afraid to because they've got their insurance tied to their employer Thank You mr. Morley thank you for your advocacy you are on the hill all the time and you're very active on social media and you're telling your story and telling people about how important it is

03:17:03

for us to fight on health care something that I'm proud Democrats have been doing and have been working on a bipartisan basis to to make sure we find solutions as best we can under current conditions mr. Morley is there anything you want to share with us any considerations you you want to tell us about any of the bills before us today I just I just want to say I really think it's so important for

03:17:35

I love to see more of a bipartisan effort there was no need to bring up anything about HR three today because this is not an HR 3 hearing so that makes me kind of Angry so any and all bills that will get us towards coverage increase our coverage for all Americans is what I'm trying to achieve as a as a patient and for all the patients that have reached out to me through social media that's all I've ever wanted and to

03:18:07

protect the protections for pre-existing conditions that are already in place the expanded Medicaid the the ways that the ACA is helped Medicare that's all I've ever wanted and I don't want to see those protections removed wait thank you all for your work I yield back the gentlewoman yields back the chair now recognizes the gentleman from Montana mr. John forté thank you madam chair this is a very important hearing for the future of our country I appreciate the

03:18:38

panelists being here Medicare is critical to Montana Montana seniors we should work to protect these benefits that they've earned I believe the federal government must honor the commitment it made to our seniors but Medicare for all will destroy Medicare as we know it to a casual observer medicare-for-all sounds appealing on its face but it's really just a marketing gimmick to dig deeper beyond the slick marketing efforts of a catchy name

03:19:08

medicare-for-all is nothing more than a government-run single payor payer healthcare system it would end Medicare as we know it and leave our seniors in the cold Medicare for all in practice is Medicare for none now some of my Democrat colleagues will claim Medicare for all as a proposal out of a fringe out of touch wing of the Democrat Party but the truth is it's taken over the Democrat Party by storm many Democrats jockeying for the presidency and 2020

03:19:39

support Medicare for all and half of the Democrats in the house have co-sponsored Medicare for all let's be clear Medicare for all would gut Medicare and the VA for our veterans and force 225,000 Montana seniors who rely on Medicare to the back of the line Montana seniors have earned these benefits and lawmakers shouldn't undermine Medicare and threaten health care coverage of Montana seniors Medicare for all would devastate rural

03:20:12

health care we've heard that on the committee today especially those in Montana they already face overwhelming challenges since 2010 more than a hundred rural hospitals have closed their doors and nearly 40% of all rural hospitals operate on a budget shortfall under Medicare for all hospitals in Montana would take a 40% payment reduction hospitals in our rural areas would struggle further and patients with lude lose access entirely too critical

03:20:42

providers like oncologists and heart surgeons Medicare for all will lead to worse access to care in our rural communities in addition to gutting Medicare and eliminating access to care in our rural communities Medicare for all is a fiscally irresponsible budget buster Elizabeth Warren a front-runner in the Democrat primary has proposed Medicare for all that would cost 52 true in dollars with a straight face she

03:21:12

campaigns that her plant plan will not raise taxes on the middle class I don't believe that it doesn't pass the reasonability test Medicare for all would terrify Americans who rely on Medicare and who like their employer spa and and who like their employer-sponsored plans under Medicare for all private insurance would be banned folks this is a government takeover of health care plain and simple we are not a socialist country Medicare

03:21:42

for all will gut Medicare and the VA as we know it and put Montana seniors at the back of the line to force 225,000 Montanans who rely on Medicare to share their pool with everyone isn't fair to Medicare seniors Montana seniors in reality Medicare for all is Medicare for none instead of a reckless government takeover of our health care system we should take a bipartisan approach to fix our broken health care system we should protect patients with pre-existing

03:22:13

conditions increase transparency and choice preserve rural access to care and lower costs let's get to work on that and end this socialist charade now doctor atlas as I said earlier it seems like our rural providers will struggle under a medicare-for-all proposal what do you believe will happen to rural hospitals and other providers under Medicare for all well under a single-payer system where private insurance is banned we already know that

03:22:44

Medicare pays less than the cost of delivering the care they serve these hospitals survived because of the extra reimbursement they get from the private insurers so it's sort it's very naive to think that oh we're just gonna wipe out private insurance and have the Medicare payments support all these hospitals the hospitals will go out of business just like the CMS actuary said in 2018 ok mr. doctor Atlas would you agree that this

03:23:15

legislation and Bill's like it would also require taxpayers to fund elective abortion with no limitation I don't know the answer to that how would you rate well with that madam chair I'm glad we're having this hearing today it's very important for the American people that we preserve access to quality care and get costs down and with that I yield back the gentleman yields back the gentleman from Maryland

03:23:46

mr. sarbanes is recognized for five minutes thank you madam chair I'm going to thank the panel first of all I want to push back pretty hard on the doomsday scenario that is being painted by some of our colleagues on the other side of the aisle which to me amounts to fear-mongering there's a lot of distortions of what the cost of the medicare-for-all proposal would be these scenarios about what

03:24:19

would happen to hospitals rural hospitals the fact the matter is that under the current Medicare and Medicaid programs there's a lot of investment and that's what it is that goes into those kinds of hospitals and delivery systems and so if you had a medicare-for-all system I think you would continue to see that kind of investment it's not like we would just walk away from these critical parts of our delivery system so that has to be accounted for when we're having

03:24:49

this discussion the thing about the Medicare for all proposal and there's many they've been present and they all have different merits is to me it's it's the most honest in the sense that I think that's where we're going to land ultimately the fact that matter is Americans like Medicare they like Medicaid they like the veteran's health care system they've basically already made a judgment that these systems that are delivered and led out of the public

03:25:22

sector are ones that give them a sense of confidence about their their health care and so I think that it's just a matter of time before we get to a place where we have a Medicare for All system as as representative jeyapaul described it it's got the three things you want it's got universal coverage and access so everybody is covered it's got a

03:25:54

comprehensive set of benefits so people understand that when they need to see a doctor they need to go to the hospital they need to get care that that is going to be available to them and it eliminates the the wasteful overhead and the predatory practices of the health insurance industry which has inflicted a lot of suffering on people for four decades now so that's what Americans want that's

03:26:26

where we're going to be ultimately the discussion that we're having we're seeing it play out even in sort of the presidential sweepstakes is how do you transition how quickly do you get there I think there's an appetite to get there as quickly as we can and that's being discussed and it's part of it what I think are very robust and meaningful and carefully executed analyses of the Medicare for all plan

03:27:00

that had been put forward so it doesn't help things to just engage in this kind of knee-jerk denigration of Medicare for all pulling out of thin air some of these numbers predictions and fear-mongering that's not a constructive contribution to the discussion now I wanted to ask miss Ross on it now I have a minute and a half left because I couldn't stop talking

03:27:31

but there's Marilyn just there's just a report released by CMS about Maryland's all payer model which includes global budgeting and it did show that when you when you put global budgeting in place in that instance you would reduce Medicare expenditures by 2.8% Hospital expenditures by 4.1% reducing admissions and avoidable hospitalizations and I was just curious to get your perspective on kind of global budgeting obviously many

03:28:03

of the proposals included here Medicare for all as well incorporates conceptually this idea of more global budgeting and so if you could speak to how that would promote transparency potentially lower costs and benefit patients and underserved and vulnerable communities if you think that kind of approach would achieve those things I do indeed in it it's I think we're lucky that we have the example of Maryland because it's worked so well there for

03:28:35

those who might not know Maryland started there what amounts to global budgeting in 2010 and they started with rural hospitals and it was so successful than they they put in the rest of their hospitals private and public and what they found was I've got some figures that their global budget saved Medicare as a payor over four hundred twenty million in just three years and originally their goal was to save 330 million over five years so it was a whopping success and from a nurses

03:29:06

perspective what it does for for patients is wonderful because it reduced infection rates it improved care it reduced readmission rates and though I need two things interrupt your the gentleman's thanks very much fired and we have votes on the floor I just want to inform members that the the members that are not part of the subcommittee I don't think are gonna have the opportunity I would stay or not for the fact that we have votes on the floor so where is miss Dingell is she here all right I'm gonna call on miss Kelly from

03:29:38

the state of Illinois for her five minutes and if miss Dingell comes back we'll take her but then we're going to have to close the hearing so the gentlewoman from Illinois is recognized for her five minutes thank you all for your testimony today and your patience one thing I have to say you know we worked hard on I wasn't here but my colleagues worked hard on the Affordable Care Act and I don't think there's a Democrat that would say that was a perfect bill but a lot of people that didn't have coverage received coverage

03:30:09

but as we know there's still about twenty seven and a half million people that don't have the coverage but when I came here instead of spending time and time and time trying to repeal the bill we should have been working on how we could make it better but all we faced was a wall and I think we voted to repeal it 63 plus times so you know let's be honest about you know what happened and then there was the trifecta of Republicans Senate House and the

03:30:40

president and we still didn't improve health care in this nation I am the chair of the Congressional Black Caucus health brain trust so I'm very concerned about the disparities in health for minorities we when it comes to morbidity and mortality I mean we lead the cause I had a bill the mames Act that dealt with maternal mortality B and as you some of you know black woman died three to four times the rate of white women I had a bill that would take the Medicaid

03:31:11

coverage to a year instead of two months but I could not get one Republican on that bill even though we talked about you know we don't want two different health care systems for poor and for the rich but then when we have the opportunity we don't do it now we got a bill out but we had to water it down now miss Rosenbaum you mentioned the need for coordination across health care public health education and job development service systems could you expand upon this and explain what other ways to address disparities and improve

03:31:43

community health aside from increasing access to care which we all know is needed yes I'd like to actually begin by disagreeing with doctor atlas I think the infant mortality problem in the United States is very real it is not Sara Lee and since simply a matter of numbers and how we count and it's made all the more real by the terrible disparities on the basis of race and income I think it's very important to couple any health

03:32:15

coverage reform legislation with provisions that do the kinds of things that the brain trust has been such an advocate for which is bulking up public health bringing health care providers under sort of a broader public health umbrella making sure that part of the health care experience is care management to be able to get better access to the kinds of services and interventions that we commonly call the social determinants at this point making sure that when you walk in the door for

03:32:47

health care you not only have good health care but you have access to nutrition to housing assistance to other things that make people healthy the Affordable Care Act actually did a good job of starting that process of bridging between health and healthcare the community health center expansion is of course incredibly important the public health trust fund was important and I think it's absolutely key that the Black Caucus continued as it was it was the

03:33:16

leader on those kinds of equity measures that it continued to lead on these issues thank you and because the time I go back the gentleman yields back and do we have anyone else's miss tingly all right I'm going to place in the record of the following documents an article from the Century Foundation health reforms North Star report from the

03:33:48

Century Foundation wrote to universal coverage coalition letter from advocates for youth at all a letter from n-double-a-cp at all regarding Medicare for all letter from the Fraternal Order of Police in support of HR 45:27 letter from the International Association of firefighters in support of HR 527 letter from the health care Leadership Council statement from the American Nurses Association and the statement from

03:34:18

representative Cedric Richmond and a statement from becbs of California as well as the documents that congressman Shimkus asked to be entered in the record hearing no objections so ordered or recognize the gentleman from Virginia for his additions thank you madam chair I ask unanimous consent to include the

03:34:49

following into the record I understand these documents have been shared previously with the majority of these statements from the American Hospital Association America's health plan health insurance plans Blue Cross Blue Shield Association Chamber of Commerce partnership for America's health care future partnership for employer sponsored coverage Texas Hospital Association March for Life letter National Right to Life ethics and religious liberty commission susan b anthony lists American action forum American Hospital Association a committee for responsible federal budget Heritage Foundation Mercatus Center partnership for America's healthcare

03:35:20

future polling from partnership for America's healthcare future news articles and op-eds from the hill of Washington Post one-pagers from Blue Cross Blue Shield Association Congressional pro-life caucus partnership for America's healthcare future and partnership for employer sponsored coverage thank you so ordered all members pursuant to committee rules have 10 business days to submit additional questions for the record to

03:35:50

be answered by the witnesses who have appeared today and I ask each witness to respond as promptly as possible to any questions that are submitted to you before I gavel the adjournment of the subcommittee I want to thank each one of you you've taken a great deal of your time put a great deal of effort into your written testimony each one of you has the passion that you've brought to

03:36:21

the witness table you've traveled to come to be with us I thank each one of you at the beginning of this year as when my colleagues elected me the chairwoman the question was asked will you have a hearing on medicare-for-all and I said that I would no one had to twist my arm off for it this subcommittee has been the most productive subcommittee of the Energy and Commerce Committee so it may be

03:36:51

December that we're having this hearing but we have taken up major legislation all year long and that was appropriate and now this hearing so I thank all the advocates that have travelled to be with us thank you for your passion for your big dreams keep it up and with that the subcommittee is adjourned okay

Proposals to Achieve Universal Health Care Coverage

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