Story talks about the measure being offered by bill cassidy of louisiana, and also Lindsey Graham of South Carolina. What is in this measure . Lastis is the republicans ditch effort at trying to reveal the Affordable Care act. Is change thed do existing system of both the Affordable Care act and medicaid, and change it. It would get a set amount of money to do whatever they wanted in their Health Care System. They would implement those planet like the Affordable Care act, or single care, are more liberal, or they can go a conservative route and undo some of the Affordable Care act. Thatonsumer protections some folks like, particularly. Governors would be able to undo those things and have this pot of money to implement their own Health Care System. We will take you look at some of the details offered up by him , we will come back to our discussion. We keep medicaid in place, as it is today. We try to give more flexibility, indiana was a good example of what could happen. One thing about medicaid i dont like is if you get a headache, you can write to the emergency room and pay a big medicaid bill. I want to put medicaid people into care. The smoke some , thats something that should be considered. I want to treat people who are low income, all of us need to be responsible for our health care. We have a Medicaid Program the just rights check no matter what the outcomes are. In your eight, to slow the growth of medicaid down. It grows faster than medical inflation. Medical inflation is way beyond it, why . Because its inefficient. Weve proven at the state level that if you can get it better bank for your buck for your medicaid. Incentivize innovation. In year eight, if we dont do that, heres what happens to the country. By 2038, all of the money you spend in texas to washington goes to pay the interest on the debt, medicare and medicaid and Social Security. There will be one penny for the department of education, department of the senate. Thats how quickly they are growing. With the medicaid on a more sustainable fashion path because its an important program. Because its an important program. We allow flexibility to get Better Outcomes for the taxpayer and the patients. The second block grants, this is money that would have been spent by bureaucrats in washington. Under the first republican proposal, you would get a refundable tax edit to go out and buy insurance somewhere. We would give Insurance Companies money so they wouldnt collapse on the obamacare exchanges. What we decided to do, instead of giving eight refundable tax credit to an individual byproduct, instead of giving a bunch of money to Interest Companies to prop them up, we are going to take that same amount of money and give it back to the state about 2026, they all get the same contributions. What did we do . We told we retail the individual mandate, states can reimpose if they like. We revealed the medical device at that hurts innovation. We left the other obamacare taxes in place, theres no more taking from the four, giving to the rich. I wish we didnt have to do that, but we need the money to transition in a fair, sound way. To my friends on the other side, we leave the taxes in place, we just give the money to somebody else, its called state control, local control, not washingtonbased health care. We do it in a way where everyone gets the same contribution from the federal government. Trump, without you, we cant do this. European you will be the one that signed the law, if we can never get into the death. Let me tell everybody in america, dont worry singlepayer health care will never get to the republicancontrolled house. We have had the majority in the senate. We are not going to need you to veto singlepayer health care. What we need you to do is implement a new system to stop the march toward singlepayer health care. If we dont change where we are going, the government is going to own it all from cradle to grave. On your watch, you can stop that. Once we get the money and the power out of washington, thats the end of it singlepayer health care. Once people know they have somebody to respond to their needs at the state level versus bureaucrat that will never meet, is not going back to washingtonbased health care. President trump, you have the chance in your first term to set us on a new. Health care closer to the patient, money based on not where you live, but parity, innovation versus bureaucracy. What a legacy it would be, for that to happen, i know youre busy with hurricanes and north korea, youre going to have to get on the phone and help us. I believe you will, i know you can, im asking you to do it. Thank you for what you said today, thank you for being willing to push this forward. My colleagues on this site, there are three options left for americans, propping up obamacare, which will never work, bernie care, which is fullblown singlepayer health care, or this block great approach. I ask a question. Who are we, what do we believe is republican . Our democratic friends are clear on who they are and what they believe, heres what i believe. Send the money home. Send the money to where the patient lives, put it in at the hands of doctors and hospitals in the communities, and make sure that the people and the state are responsible to the needs of the individuals in that state, replace the bureaucrats and elected officials. You will improve polity and outcomes will be better, it will be more physically sustainable. At the end of the day, those governors whoever they may be, that can figure out Quality Health care in a sustainable fashion will not only get reelected, but other people will copy what you do. If we leave the money and power here, there is not going to be anywhere innovation. Singlepayer health care only works at the printing press. Unlimited dollars. Keep printing the money, a block grant will bring out the best in america. It will create Better Outcomes for patients, and it will take us off the path of becoming greece. This is where we are heading. You can watch all of the remarks about his proposals that change the current healthcare law at cspan. Org. Just type the names of the cosponsor, Cassidy Graham into the search bar. Tweet from President Trump showing his support for this notosal, he writes i would sign Graeme Cassidy if it did not include coverage of preexisting conditions, it does. Repeal and replace. Political Senior Health care reporter, who else is supporting this bill . Two otherve cosponsors, senator ron johnson republican from rick wisconsin and the power from nevada. He is considered to have the toughest reelection race of all republicans in 2018. He jumps on board with this right away, also former senator Rick Santorum from pennsylvania conservative. He has taken a bit of credit for this bill, saying hes comparing this to welfare reform in the 1990s, which was considered a big conservative win. He says that he went to senator graham after the senate failed to repeal the Affordable Care act in july, he said one of you do Something Like healthcare reform . Rick santorum and Lindsey Graham, they are kind of the brain children behind this plan. Thats why we are calling it Graham Cassidy. What about the governor . Statethis is you and with bloc grants, what are you hearing from the states . It has been really interesting, the republican governors are pretty split. We are seeing republican governors who say we love the idea of a, give us control, we want that authority, give us those dollars. Other republican governors are very skeptical. Want a national system, they say they dont want their money to be cut, most state would see their funding cut in some way after this plan. Ohio, it datesm that they out front with that idea. Most democratic governors say they dont like it either. Republicans are generally split, democrats are generally opposed. The senator has said he doesnt support Cassidy Graham, why is senator rand paul against it . Is the only senator that has come out very strongly against this bill. He says its not revealing enough of the Affordable Care act, he says i promised my voters that i would do obamacare, he says that this bill was federal set in stone. That stamped money with approval from republicans and he doesnt want to see that happen. Room there,wiggle he talked about how he liked Association Health care plan, the idea that a group of people can get together and buy their own Health Care Insurance together. He indicated that its something he would really like. They are opposed. Theres no way that any democrats are going to support this. Manchin, the most conservative democrat that the Vice President tried to call him and get his support, it was a short conversation. Democrats say they are ready to fight to and now to try to stop this. If Majority Leader Mitch Mcconnell has the vote theres very little democrats could do to stop the bill. He talked about democratic opposition, we took it to the streets, maybe the steps of the capitol. Andill take a look at that get back to our discussion. People power, stop trumpcare so far and people power will stop them again next week. Political change as everybody here knows doesnt start in washington dc, and trickle down to the grassroots. It has not trickled down. Thank you for being here, because political change is bottom up, we are going to win. Complicated fight. Seniors, weing for are working on an economic tightrope because this cassidy bill got the protection. We are fighting for kids, we are fighting for the disabled, let me tell you one thing, we are not going to let cassidy turn back the clock and allow people toh preexisting conditions face discrimination. E are not going back thethe ranking democrat on Senate Finance committee we deal with medicaid and medicare, and funding womens health. Tries to take away women in america the right to see their Health Care Provider of their choice is going to have to run over me and women are going to win. My colleagues are in the middle of a boat. You have a number of others coming out. I wanted to come out, i was director of the great for a full head of hair,. Means, i knowis what people power means. We didnt win that last fight by osmosis. ,e won it because of all of you we have Something Like 11 days to make sure that once again, people power prevails over special interest Insurance Companies, and drug companies. We are banking on you. Again, people power doesnt allow turning back the clock on her people. Thank you. [applause] when a sen. Wyden said theyre they are coming after seniors, make no mistake. They are and nursing home facilities, this is an attack on seniors, just said is is an attack on women, people, anyone who might get sick in the United States of america. Thats all of us. Right, this happened because we resisted. When we started this fight, planned parenthood alone gave over one million supporters. We are supplier we are fired up to go. We are ready to go. Lets give it up for our next here to fight for us to help millions of americans keep their Health Insurance and better improve our Health Care System, senator durbin. [applause] just when you thought it was safe to go home, just when it you thought it was safe to go back to the office, just when you thought you could take some time off, here they come again. Are we ready . Is question before us whether or not we are going to stand up as we did once before, effectively and protect americans who can be here today. Lobbyists,t afford folks who need basic Health Insurance and access to health care are counting on us. I know we went home after a victory a few weeks ago, took off the fighting she was, but the jersey back on the shelf, said theres another big win or us. We are back on the field ready to fight, we are ready to play, we are going to win this because we have to. The question i have to ask is this, the American Hospital association stands with us, and stood with us when we be back health care last time. They with us again at this time . There are. All of the doctors across america said health care was trumpcare was terrible when it came to care for individuals. Are the doctors want to be with us again . Yes. Nurses . Health care clinics . All of them. And alba planned parenthood . And how about planned parenthood . We dedicate our team back on the field. We will fight and get a game coming up right away. As soon as this week is over, we go into the final week of senate rules for them to bring down this latest version of trumpcare. This much i can tell you about the latest version, its worse than any version they ever brought before. Meaner, itle, its cuts back on medicaid. Half of the children born in the state of illinois, their mothers are cared for, and they are brought into this world because of medicaid. Disabled people across my state, and so many that she represents. So many people that she represents count on one program to make sure that they have all of Quality Health care, program is medicaid. When it comes to School Districts across my state, half of them get assistance from helping kids for special education, transportation, counselors, even feeding tubes, from medicaid. When it comes to the most expensive part of the program, helping seniors have the medical care they need late in life is one program, medicaid. We are fighting for medicaid because we are fighting for america, we are fighting for justice when it comes to health care, which the senator happens to believe is a right, and not a privilege. , lets dustn you, off the equipment lets take the field and get ready to win again. Fight to make sure we protect health care for all americans. Thank you, everybody. [applause] lets give it up for senator durbin. [applause] we are in a crisis at this country. People should not have to die due to lack of access to care. That is currently happening, it will get worse if this bill passed bill is passed. Health care is a human right. Health care is a human right. Health care is a human right. Health care is a human right. What is health care . A human right. What is health care . A human right. Thank you. You sound great. The republicans are divided. Im not just talking about the senators, im talking about their people. Republican voters do not like it, they are not representing anyone but the billionaires. Our site is united, our entire Democratic Caucus is united from senator manchin all the way to senator bernie sanders. Lets give him a round of applause. Thank you all for being here today. We beat back the republicans when they wanted to throw 23 Million People off of Health Insurance. We beat them when they wanted to throw 22 Million People off of Health Insurance. We beat them when they wanted to throw 16 Million People off of Health Insurance. We dam well are going to be them today, where they want to throw 30 Million People off of Health Insurance. Saying, that in the year 2017, we should be talking about health care as a right for all people, not a privilege. Level, on a moral level, i have a very difficult howerstanding how it could be that any member of the United States senate could cast a vote to throw people off of Health Insurance when today, they are struggling with diabetes, cancer, heart disease, parkinsons disease, what happens to you if you have a lifethreatening illness and you are suddenly thrown off of the insurance that keeps you alive . What happens to you . Thousands of people a year will die if that legislation becomes more. I have a hard time understanding how any member of the senate could vote for a legislation which takes insurance and support away from disabled children who are now on the Medicaid Program. What happens to you if you are a kid with down syndrome . If you are a child with autism . If you are a kid with asthma . If you are a child with some very difficult disease . To you and your family if medicaid is stripped away from you . This is and sisters, profound moral issue. The truth is, as youve already heard, the overwhelming majority of the American People, democrats, independents, and republicans, understand that in the United States of america we must not take away the lifeline of Health Insurance from millions of our people. [applause] that is what the American People understand. It is time for my republican colleagues to start listening to the American People. And not to believe in our class and their wealthy campaign contributors. Keep up the fight, we are going to win this. Health care is a right, trumpcare is wrong. Health care is a right, trumpcare is wrong. Health care is a right, john kerry is wrong. Health care is right health care is not right, trumpcare is wrong. State, the state of texas, planned parenthood. I have seen personally what that looks like. Look atad friends who me in the eye and wonder what they are going to do with their health care. For women, getting your annual exam and having access to Birth Control is a vital part of our health care. I see out of touch politicians strip that away from thousands of women in my state. Its misogynist, politicians year at our capital are trying to make a replica of texas across the United States. The way to texas all washington, d. C. To stop this from happening. Are you here to stop this from happening . [applause] highest has one of the mortality rates in the country. Its equivalent to a lot of developing countries. We dont want to see that spread around the country. Woman, someone like me has a higher percentage of dying from earth. Im here to protect those women, we are here to protect those women. Seth workers here to protect those women. We are gathered here again, i feel like this is a 1980s horror movie. Its like nightmare on capitol hill part five. Any senseis or have in our country. Every step we take has to be fun for and worked for, we know at this critical moment here we are again. Our country has constantly working to expand opportunity, to expand our conception of justice, to expand our conceptions of freedom, sacrifice, and struggle. He we are again. In a moral moment in our country, after working 50 years ago to expand access to health care with medicare and medicaid, after just one decade or so ago with the Affordable Care act that 20 million more people got expanded access to health care and the quality that comes with having that security. Again, we have people that are trying to take our progress and drive us back. Two we have to now stand up and say no. We will not go back, we will not go back. You can say it again, we will not go back. We will not go back. I want to tell you this right now, theres a lot of folks out here that do not understand urgency and the crisis that we are in. , thee end of the day biggest enemy that we face in these coming days and hours is not just the crave and cruel bill that has been proposed, but ultimately, it will be the silence and inaction and indifference of all of us. Woke togot to get folks the crisis that we have. We have to awaken people to the urgency of this moral moment in our country. We now in this country have witnessed how this congress can work. Just yesterday, in a bipartisan way, we passed a National Defense will worth billions and billions of dollars. You saw people come together to protect the National Defense, weve learned in the last weeks that the National Defense isnt just threats from abroad from north korea or iran, the National Defense we fought as hurricanes swept into our country. There, we saw people, first saying are you a republican or democrat, are you rich or poor . We responded in a unified fashion for the National Defense. Now,l tell you right cancer doesnt care if you are rich or poor. Diabetes doesnt care if you are rich or poor. Autism is a challenge that affects families of all backgrounds. When it comes to the conceptions of our National Defense, its not only important that we have the Worlds Largest military, we in america should have the worlds best health care. [applause] in a country this wealthy that can afford Nuclear Weapons and aircraft carriers, we should be able to stand up and say that every american has a right to affordable Quality Health care. [applause] in a nation that has the best military, spending more money than the next Nine Countries combined, we should be able to say the United States of america can make sure every child born in our nation is born with Quality Health care. Nation wheree a Senior Citizens dont fear that they want be able to afford a nursing home. We should have a nation of where we know that if someone has a condition or an illness, that theyre on the access to a doctor is not an emergency room. We should know that if theres a veteran, someone who stood up for their country, when their home family members, cousins, and neighbors, we should the standing for them, as well. In this moment in our nation, we have to remember that the determination of this moment will be decided by the people, because the power of the people is greater than the people in power. It is time that we live up to our free live up for free, as a nation of life, liberty, and the pursuit of happiness or everyone in our nation. You cannot have life, liberty, and the pursuit of happiness if you do not have health care. Its time that we live up to the old that we all say when we put on are hand on our hearts, its a nation of liberty and justice. Were all. When you can i have justice. Where health care is acceptable only to the few and not to all of us. We have to have a liberty in this country, you cannot have liberty in america if evil are chained to fear because they coverage. E afford you can i have liberty when you are shackled to the uncertainty of knowing that your child gets sick, when your family is thrown in bankruptcy because they cannot afford health care. Become the truth that so many people of other nations now anenjo we are strong enoughy and noble enough to have a system of health care that serves everyone of our people. Today, we are in a crossroads. Will we go forward to the day where every american has access to health care, or will we allow a republican bill that tries to take us back . I say we will not go back, we and we mustard, fight every day until we have justice in this country for all. Thank you very much. [applause] the Senate Finance committee holds a hearing on monday on the latest Republican Health care. Plan the cassidy grant proposal we heard about is life 90. Onday morning on cspan2 more on the plan, Senate Republican leaders were joined by senators graham and cassidy at the Republicans Party lunch. We will hear from Democratic Leaders later. Good afternoon, everyone. I expect you already know we spent much talking about Graham Cassidy, lots of interests, and the bill that senator cassidy and the graham have been working on. I asked them to join us today and lead off. Ive never felt better about where we are at. Its ricky clear to me where the country is going it is pretty clear to me where the country is going. It is going to bankruptcy, more decisions are other away from where you live. In 1996, we blocked granted money for Wealth Health care reform and it worked like a charm. To put governors in charge of the program. We held them accountable. Heres the choice for america. Socialism or federalism when it comes to health care. Four states get 40 of the money new york,acare, california, massachusetts, and maryland represent 20 of the population. Our goal is by 2026 to make sure every patient in every state is the same contribution roughly from the federal government and allow people in your state to make decisions that would have been made in washington. The most beneficial aspect that this bill has followed, if you dont like obamacare, who do you complain to . You can complain to me, but i dont run it. If i can get South Carolina in charge of this money that would have been spent in washington right a bearcats unelected a bureaucrat that unelected. If you dont like your health care, somebody will listen to you. Your governor and state health representative. You can go to the state house representative, who likely goes to the same hospital you do you can go to your governor, who will listen to you because they care about your vote, if nothing else. Im trying to take the money and power in washington and send it back to us or to the patient. If you believe the government closer to the people is the best government, why not health care . We know how this movie ends if we dont change. We are going to have a singlepayer Health Care System in this country that is going to bust the budget, we are going to start rationing here like you have never seen. Obamacare is failing for a reason, its a bad idea. State control of health care will work, because the people in charge will be accountable to you, unlike obamacare, where the person in charge could give it dam about were could give a damn about what you think. 425 years, i treated patients in louisianas Charity Hospital system. Bringn my lifes work to health care and covers to those who do not have it. When a fellow back home tells me that he is paying over 40,000 a year in premiums, plus the 5,000 deductible and more money on top of that, we know that the system is failing. I spoke on the jimmy kimmel test, where those who have needs would have their needs addressed, its a must beyond families reach. He cannot afford his insurance coverage. Thats not the way it should be. We want to take all of the dollars here in washington dc, and return it down to the states for the states to do whats best for that state. If youre in a state which has not expanded medicaid, you are going to do great. All of those lower income sections, floridians, meiners, sections, you will have dollars to help get insurance that they currently do not have. If your state has expanded medicaid, we do our best to help you on this we dont want to hurt folks. We run it through the chip program, i hear no one complain about the chip around. It is something on a bipartisan basis that has been recognized to be unaffected way to provide access to quality care to those in need. We take him through the chip around, we continue projections, whatever waiver a state which is to have, they must ensure the secretary that they continue to provide adequate and affordable coverage for those with preexisting conditions. That is our backstop, we reserve health care minority, but we give taxpayers for the state to be inventive. Some of which were squashed by obamacare. Virus pull, which obamacare put out of business. Ower premiums by 20 in indiana, where they prefunded savings account to beer income hoosiers to empowered to purchase their own services, they found the cost went down and outcomes improved. We give it to the states. Yearsdoctor, for 25 caring those who did have coverage. I think the Graham Cassidy Howard Johnson is a better job for this than the status quo. . Any questions on the substance any questions on the substance . Been inaid youve never a better statement is before. You know almost any repeal and replace plan is going to get in with the same 46 republican gases. We may be higher than that, why is it different than july . Day, wee end of the need 50 votes. If you are a republican, chances are you believe in federalism. If you dont, you probably are not a republican. The last effort to repeal and replace obamacare was better than obamacare, but did not embrace the concept that bill was talking about. I believe most republicans like the idea of statecontrolled health care versus washington, d. C. Controlled health care. Employer assessments are going out next month, by the end of 2018 2017. Over 90,000 businesses will get a notice from the government that is four point billion billion. 420 a lot of republicans want to stop that from happening 4. 8 billion. A lot of republicans want to stop that from happening. We have to find an idea that is uniquely republican, but over time has proved to work in other areas like wealth were have to report. I would hate to be the democrat that voted against more money for my state, and more power. Democrat, in missouri. You are going to get far more money under this proposal than obamacare, and if your state would have more control over the money. To reject that money and control means you believe that somebody in washington cares more about people in missouri than people missouri. You believe its ok to help california, new york, maryland, and massachusetts more than missouri. Thats what a democrat would have to say if they voted no. If you are a republican, and you vote against federalism, you have to explain to people back home why washington knows better. Almost every state except the four i describe, do very well under this new approach to taking the money out of washington. I think the idea is more powerful, i think the substance is much more fair. At the end of the day, i believe we are going to get 50 republican votes, they it there are going to be a lot of democrats struggling with a no vote. At least eight of them their states do better than obamacare in terms of funding, they will have more control of the money. Thats going to be a hard know. Passing this bill without the tbls full appraisal . They told us they have a score for us, the coverage that will be on the cash aspect of it. We will have a chance to look at that. You all understand we would have to deal with this before september 30. We will have to deal with it, because the vehicle expires at the end of the month. If we were going to go forward, we would have to act before september 30. We are in the process of discussing all of this. Everybody knows that the opportunity expires at the end of the month. Heres the test for republicans. If we work hard to repeal obamacare, Mitch Mcconnell and the leadership has sent everything weve asked and then some. I spoke to paul ryan, he said he liked that he sent it. House, its crunch pass every republican out there believes that its going to pass. Every republican believes theres a good thing we are in charge. We have been the biggest political beneficiary of obamacare and we want to try to make patients the beneficiary of our idea. At the end of the day, will we try again . I would argue that yes we because i do not want to go back to South Carolina and say that i did everything i could to repeal obamacare and not believe it in my heart. Senator mcconnell is doing everything he can, paul ryan told me to my face if i pass it, we passed it. This plan has been out there for a couple of months, how do you convince americans that you truly think this would lead to Better Health care and its not just to do something before the deadline . I think youve heard the arguments. It is better than the status quo, by far. I think thats an argument we are all comfortable making. Theres limited time left in the calendar your, how concerned are you about . Time . Getting everything you want to get done . It will be fine. The next big rarity is tax reform the next big priority is tax reform. Senator graham has raised a lot of concerns early in the process about how this was working, how you are moving through. Timetable,ompressed do you feel like you will adequately address the concerns . The hearing is scheduled on monday, we have one vote on the nda, the defense bill. Democrats objected to tom cotton amendments. My friends on the other side love process when it meant just them. It will be a public hearing. , you can have different opinions about the quality of this bill. At the end of the day, this is the only process left available to stop a march towards socialism. We have between now and the end of the month to have a vote about whether this is better than the status quo. My friends on the other side are never going to agree to a bipartisan proposal that is anything other than popup obamacare. Ive talked to the president five times in the last two days, he is focused like a laser. He has told me his not going to for good money after bad, is excited after this state centric Health Care System. All i can tell you is that the process left to us is that the Democratic Party has is never going to give us anything that fundamentally changes obamacare. We have had weeks of talking to, the only time they have gotten service is when they are afraid that my bill may pass. Now theyre coming to me, what about this and that . Him there you have it, ladies and gentlemen. I am proud to be joined by my colleagues. Hey, folks. Tickets were else. [laughter] take it somewhere else. [laughter] ok. I am proud to be joined by my durbin,es senator senator, to talk about health care. We heard a lot of talk about the state and governors just released was a letter. Governorsts, five posted the socalled grahamcassidy bill and more in favor of a bipartisan negotiation such as that of senator alexander and senator murray. I heard our republican colleagues speak. There was a word missing. People. Patients. Care. All this stuff, democrat, republican, governors, washington. How about how this will affect people . Millions will lose coverage. No preexisting conditions. An end to medicaid as we know it. Tens of millions of people could well lose coverage. People who desperately need Financial Services would lose it. Our republican colleagues do not seem to care about how this affects the average american. That is why trumpcare previous Trumpcare Bills were so unpopular. That is like this bill is unpopular. Despite all their efforts, they are struggling because their own senators know that the public dislikes this bill. Latest version of trumpcare may live under a new name of grahamcassidy, but no matter how many ways they try to dress it up and hide it, it is even more dangerous and reckless than the previous bill that was defeated. Simply put, trumpcare is a sham. They are crafting in the dark of night. Pne hearing on one day without a twoscore and only witnesses, that is a hearing . Come on. Bill. Re ashamed of this they are afraid to find out what it actually does. And so we get another bill in the dark of night. The process is awful. We heard of justice being blind, our republican colleagues should be Walking Around with bibles because they do not want to see the bill were they are being forced to vote for. With all the cuts for people and unpopularity and meanness. They dont want to go home and taliban who lives or. Or son has cancer that an Insurance Company can make insurance unaffordable. They do not want to tell them that. They do not want to tell middleclass families in the suburbs that mom or dad in the nursing home may no longer get coverage. They do not want to tell whoearold young man desperately needs opioid treatment that it may go away. This isnt simply making the decisions at the stake. They make the cut. Washington that hurts average people and then tell the states to tell whos a cuts. This is not a neutral bill that simply devolve power to the states. It is a bill to end medicaid as we know it and let the governors do the dirty work. 10 governors from the state of colorado, ohio, alaska, montana, pennsylvania, virginia, nevada, message is in message massachusetts and vermont said do not do it. Do not do grahamcassidy. Our budget and policy priorities will result in about 700 billion in cuts to health care by 2027. It would cause millions to lose coverage. It would deeply cut medicaid. Would bring us back to the days when companies could discriminate against people with preexisting conditions. They could get rid of Consumer Protections that give americans access to Maternity Care and Substance Abuse drugs. Intos her the markets chaos, resulting in 15 Million People losing coverage. Do its work,he cbo if it were not pressured to put out something that is just a few lines, this would all be told by cbo. How do we know . Bills in the past have been scored by similar provisions. They are afraid the public will hate this bill so they are trying to rush it through in the dark of night. We want, above all, a bill that protects average americans, not slashes the health care they need, whether the governor or washington tries to do that. It is wrong. We want to work in a bipartisan process to make things better. We want the house, the president , Republican Leadership to stop pressuring those who want to come up with a to refrainsolution from doing so. We can make it work in a bipartisan way. The final thing i say is this. We have seen very hopeful outs of bipartisanship in the last month. Andg back to this trumpcare grahamcassidy which set down which shut down the bipartisanship. Thinking for you must all my colleagues. Thank you to everyone who has email, to call, to be involved in this effort one more time to have a form of trumpcare, which is actually worse than the last one. Said, we willumer not have a full cbo score for weeks the. Post of the provisions have been scored into different ways. We know what is coming. Do know it is disastrous for people in michigan across the country. It is disastrous we talk about the law of basic Health Care Provisions for people percent people. Essentially, it would let states give Insurance Companies because this is who we are talking about making decisions Insurance Companies a bright green light to the prophets before patients. When does stopping health care . When does health care stopping health care . When it doesnt cover prescription drugs . When it doesnt cover Maternity Care . When it doesnt cover Emergency Rooms . When it doesnt cover people that have preexisting conditions . Is a Health Insurance if it doesnt cover Mental Health or Substance Abuse treatment in the middle of an Opioid Epidemic . Republicanemind health care is a political, it is personal. The way they were talking about it, standing right here, was very political. For all of us, for our families and the people in this country, it is very personal. When a young Cancer Patients cannot afford the medication that keeps her alive. Because her insurance wont. Over it, it is personal when a mechanic realizes his lifetime dream of owning and own shop has to pay more for insurance because he hurt his isk a few years ago, that very personal. When a woman has to pay more for her Health Insurance just because she is a woman, that is personal. You know what . I take it personally. People in michigan take it personally. All of my colleagues take it personally. That is why we will fight this in every way possible on behalf of the people we represent. Senator durbin. Face, check. We were watching in the thanks, chuck. We were watching when the republicans gave their press conference. They said this is about the Great National debate between socialism and states rights. Really . It is not about the debate between this. It is about basic health care for the families of america. If this is a hot deal for governors across america, how do you explain five republican governors, like the governor of alaska and the governor of nevada, coming out publicly against the notion of states r ights . Why would they be turning their back to make this decision locally and be popular for votes . Because they can count. And when they counsel they realize there is not enough money under this plan coming from washington to sustain health care in their states and to keep up with the cost of health care in the future. Realists. They understand its full well. It is not a question between socialism and states rights. Basict we will provide care. I dont you people talking about Social Security because it is a washington program. They realize it has liberated them in their senior years. The same is true for medicare. The second issue i want to raise was one raised by the other sponsor of this legislation. The jimmy kimmel test. The member when he referred to that . You know what that is all about. This gentleman with wellknown on latenight tv had a tough time. His baby was born with a serious problem. He raised a question on his tv show. What will happen to families like mine under all this talk about the new trumpcare . Under this version, it is not a good outcome. First off, if the family happens to be under medicaid, there is a question as to whether there is enough coverage. Born in babies illinois are covered by health care medicaid. When you cut back on medicaid, you listen the opportunity. Once the baby is born, left the family has a child with a preexisting condition, under this Trumpcare Bill it will not them the rest of their lives when they try to buy Health Insurance. Ort is one thing we stood up on the Affordable Care act and said were not going to give in on this at all. We do not want people discriminated against because they have a member of their family or with a birth defect or because someone has survived cancer care or someone has diabetes and their family. They walk away from it in this bill. They say that is one of the options Insurance Companies can play with when they decide what your premiums will be. When you look at this bill, there is a real reason why they do not want the American People to take a hard look at it. The race will go up for Senior Citizens, that is why aarp is opposed. The reimbursement that hospitals will go down. That is why the American Hospital association and the state chapters of those it. Carell not provide quality that nurses and doctors note we need. This is a rally point. Many people thought july this battle was over for this year. It is not. It will pick up and team and in importance. I am going to make a couple of additional points. My colleagues said it very well. The first point is right after grahamcassidyheller passes, healthcare markets will enter the reason that is the case, and i urge you to talk about state Insurance Commissioners about trump 2. 0. You have a combination of no cost sharing plus a rollback in Consumer Protection so that you will have a particularly large number of people who are frail invulnerable. Make no mistake frail and vulnerable. Make no mistake with what will happen. The second point i want to mention is several of the republicans talk in the press conference talked in the press conference about how great their proposal will be for chip. A money0 uses chip as program. The reality is you cannot have a young chip program if decimate medicaid. Two are that directly links. The idea that somehow this bill is going to be good for chip is just absurd. This is a bargain, basement block grant. We will pull out all the stops to derail it. Beat trumpcare before. We will be using people power to beat trumpcare again. About the groups being reengaged, are you concerned about the speed this has regained . A week ago, no one solve this hadnt even raised its ugly head. Now, the groups are mobilized. He will find the hospitals, the aarp, the nurses, cancer care, and all the societies, they are all mobilized. They realize it is even worse than the last one. This weekend, you will see huge mobilization. In the earlier press conference, they said it would be a tough vote for senator it for the senator and misery. Are you confident this will not get any democratic votes . I am. It hurt people in every state. Of insuranceprived if you have a preexisting condition in every state. There are dramatic cuts to medicaid in every state. Whether you are democrat or republican, if you are presenting your people, you do not want this bill. Senator graham laid out a campaign ad against a lot of your democratic colleagues saying put natural interest ahead of people in your state. I dont even get what they say. We are talking about the people. Their conference with simply about state, national, washington, federal, socialism, states rights. They didnt have about people because the turks people and they know it. We are this because we care about people. A the 2018 election as reference mantra care, they will get clobbered and they know it is a referendum on health care, they will get clobbered and they know it. To you think the United States should stay in the iran deal . I do. I have the agreement was a bad agreement, but i also sent that letter c once it passes but i also said once it passes, let us give it a little time to see if it works. If iran violates the deal, let that is one thing. Thank you. By the way, unlike our Republican Leadership, we are not trying to hurry to get out of here. Were happy to talk about this issue. Do you notice . [laughter] because youoncerned say the bill had only raised its head a few days ago . You talked about groups mobilizing this weekend. Because there is a degree of uncertainty, do you believe people are so nervous on your side . What we have done it looked at what the bill does and then we looked at how cbo has scored previous bills with similar precision provisions. We have strong numbers. If they dispute our numbers they should wait for a cbo score. Youre talking about how this came up subtly. You think that was a republican strategy to let things go quiet for a while then bring this up . They have never been willing 4 totrumpcare 1, 2, 3, or have to pay for discussion. They know well they have been pushed with some of their , they know it is a popular. The last Trumpcare Bill is not even as severe as this one. You are of 20 of americans supported it and a majority of trump voters were against it. They know this is a very bad medicine vote for the American People and politically for them. That is why they try to rush and hide it and they dont want to have the russians discussion. S. That is why they were so quick to get out of here. Discussiontalk about by the senate . Bigger mcconnell said some senators senator mcconnell said they using these talks are stalled do you think the talks are stalled . I spoke to patty murray. The response she said was genuine. I have good faith and senator alexanders believe in bipartisanship. I hope you wont let those partisan pressures get him off course. Know how much senator alexander admires howard baker. A hearing looking at the latest Republican Health care plan is getting old for monday morning. Republican senators Lindsey Graham is expected to testify. [captions Copyright National cable satellite corp. 2017] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org]. Senate Majority Leader Mitch Mcconnell. Here is senate Majority Leader Mitch Mcconnell. Plummeting costs. Many thought our constituents deserved better. That is why we did what we voting for a repeal so we can replace it with something better. They defeated our every effort to improve health care. Thus far, they succeeded. Thus far, they have yet to offer own. Us solutions of their last week, our colleague from vermont rolled out Health Care Legislation that would quadruple down on the failures of obamacare. It envisions what is basically a fully governmentrun, singlepayer system. The kind of system that would strip so Many Americans of their health plan and take away decisions after their own health care. That would require high tax increases. The already collapsed in the homer in the senators state of vermont when they try to do it. This is a massive expansion. They think this is what it would look like. You can be sure they will do everything in their power to impose it but we do not have to accept it as our feature. That is what senators graham and cassidy believe. They rolled out a Health Care Proposal of their own last week. It would allow states and governors to implement Better Health care ideas by taking more decisionmaking power out of washington. Governors and state legislators of both parties would have the opportunity and responsibility to make quality and Affordable Health care available to their citizens in a way that works to their own particular space. It has a great deal of support. I want to thank senator graham and cassidy for all their hard work. They know how important it is to move beyond the failures of obamacare. They know the opportunity to do. O was passes by just heard we just heard senator Mitch Mcconnell say he will not bring up a repeal if he does not get 50 votes. The majority leader has wiggle room on whether there will be a vote next week. How so . Said he considers him on the floor next week. That leaves little room. It doesnt necessarily mean a post will be called. Maybe senators will be talking about the legislation on the floor. The majority leader set for the last several weeks, if you find 50 votes, we will go on a repeal. An notice will be if you bring up the bill without 50 votes, to you send another signal to your public . Rs, donors the we tried really hard and we cant do it. Or do they up to 50 votes and say they accomplished with a promised to their voters for years. If they get through the senate they take it to the house. Maybe the house can have it. There are pros and cons either way. A failure is always a failure. Because in the message if you do not have the votes. Why are we seeing this push for another repeal effort now . Republicans have until september 30 two pass the bill votes. Ly 50 after the 30th, they would have to have 60 votes. Democrats could filibuster it. Because there are 50 to Senate Republicans, in theory they votes. Be able to get 50 that will expire on the 30th. After that, good luck. Cassidy graham kathygraham is not the only proposal being considered. Senate Health Committee have been Holding Hearings on a bipartisan proposal that would change the individual Health Insurance markets. What is the outlook for the proposal . Is not very good is not very good. The lead excited about a proposal. He wanted to work on a bill that was very narrow. It was aimed at stabilizing the Insurance Market for next year, making sure premiums were not out of control. Earlier this week, he said all the attention on grahamcassidy, he also put some blame on bernie sanders, he said all the partisan attention put the steam took the steam out of their efforts and it became clear the House Speaker set up the house told not bring up a bill what senator alexander wanted to do. He said they were calling off the talks. Hankeringook at the the hearings. One involved state governors. This is about 50 minutes, and then we will return to you in our discussion. This hearing is about taking one small step. The small step on a big issue, which has been locked in partisan stalemate for seven years. It is a step Congress Needs to take by the end of this month. Big to 18not so million americans. Get healthont insurance from the government are on the job, they buy them from that is the individual market. Nearly 300 million americans have Health Insurance. From a market. Buy it from a market. 9 million of those 18 million have no government help. Theyre the ones most hurts. Most hurt. Let us take someone in tennessee. Would receive no tax benefit to cover his 71 hundred dollars per year premiums. This does not include detectables or copays. Next year, the Tennessee Department of insurances premiums will go up as an increase between 1500 and 3000 and in premiums next year that doesnt include increases in deductibles and copays. She will have to pay a fit of your income on Health Insurance fifth of her a income on Health Insurance. At the end of september, blue our largest insurer, pulled out of the individual market in knoxville, nashville, and memphis. Forjust in tennessee but everybody. That could happen again at the end of this september and congress doesnt act if congress doesnt act. If that happens, millions of americans could literally be left with zero options to buy insurance in the individual market. Last year, only 4 of american counties have one insurance commissioner on the exchange. This year, 36 have one insurer. 50 of the counties will have one insurer only on the exchange. If we do act, we can limit increases next year. 2018. We can continue support for copays and untouchables for many lowincome families. We can make certain that Health Insurance is available in every county and lay groundwork for future premium decreases. I would suggest we do this by taking two actions, although there may be others. Appropriate costsharing payments through the end of 2018 to help with copays and deductibles for low income americans. The section 1332 waiver in the Affordable Care have moretes can flexibility to devise ways to provide coverage with more choices and lower costs. On the first, payments are extra subsidies or discounts for low income individuals who receive premium subsidies under the law. They help these individuals pay for out of pocket costs like copays and decibels, but their overall effect is to lower premiums and individual markets. Section 1332 wingers are already written into the Affordable Care act under some circumstances. They will allow states less ability from certain elements of the law, such as essential health benefits. They do not produce the patient protections most of us support, including protections for those with preexisting conditions and ensuring those under 26 may remain on their parents arents insurance and have no lifetime limits. For the 1332ply waiver. Seven state applied. Two states have received the waivers so far. Democrats will, have to agree to something. More flexibility for states. Some may be reluctant to support this. Republicans will have to agree to something, additional funding through the Affordable Care act, that some may be reluctant to support. That has caused a compromise, and much smaller but similar agreement to the compromise that created the senate in 1789. With the founders created a senate with two members from each state and a house based on population, that was a compromise. This was a compromise that we ought to be able to accept. Cautionarys were included in bills tuberculin replace major parts of the Affordable Care act. This section is already in the Affordable Care act, but it is a difficult old to you l to use. Tooo bige were able to take the steps i mentioned earlier, we ought to be able to take this small, limited, bipartisan step on Health Insurance. If we dont, millions of americans will be hurt. Timing is a challenge, so i propose we come to a consensus by the end of next week. When our hearings are complete so congress can act on what we recommend before the end of september. Otherwise we will not be able to affect insurance rates next year. The department of health and Human Services require Insurance Companies to submit their final 20, and thetember Department Plans to put the rate online by september 27. We can do it here because were plowing familiar ground. Our goal is a small step, and so Many Americans will be hurt if we fail. If we do not do it, it will not be possible for republicans to blamingical claims democrats. The winner will be on everyone of us, and deservedly so. Were beginning to conversations at an important moment. There is a lot of work that needs to be done to undo the damage the administration caused the Health Care System because the administration is still trying to create some care by sabotage. Our Healthcare System is more stable than President Trumps tweets would have me believe that it is weaker as a direct result of steps being taken. The president has undermined outreach and consumer assistance efforts and put forward executive orders, seemingly uncertaintyobject into the market. Last week, the Administration Cuts funding for outreach by 90 and funding for consumer assistance by over 40 . Another example is the threat to cut off payments to reduce coverage costs for low income people. Should these outofpocket cost reductions be discontinued independent analysis suggests premium to be an average of 20 higher next year for the most popular plans on the exchanges. There will be more uncertainty in the market and patients and families will likely have fewer options when they pick their plans. That is unacceptable and avoidable. Congress can act right away to confirm once and for all that outofpocket reductions will continue and we will have a very narrow window to do that as the chairman said before insurances finalize their plans for 2018 later this month. Im very glad there are members on both sides of the aisle who agree that we do need to take and it is critical we work toward a multitier solution in order to provide the kind of certainty that will have the ost impact on families premiums. Months to develop rates. If we do not find a multitier tryingn, we will be back to solve the same problem a few months from now. That is not with certainty looks like. This discussion around strengthening the system is exactly what democrats have hoped for over the last two few years. As i said before, if we were together i am more than ready to consider additional ideas on the other side of the aisle to make our system work better for families. To be clear, that means moving forward, not backward unaffordability affordability, coverage, and quality of care. Family have rejected the damaging approach on it with and gotten ridts of protections for preexisting conditions. I think we are all i think we all agree threading the needle will not be easy, but i believe an agreement that protects families from higher cost and maintains the guardrails of our Current System is possible. This agreement will not only make a real difference of the patients and families that we serve, but it could provide a bipartisan foundation for future work. This work did not end when the Affordable Care act passed. It did today. There is more to do to lower extend coverage, and improve quality of care. We should be able to Work Together on these issues in a bipartisan way. I hope with todays conversation, we continue to turn the page away from trumpcare and partisanship that andave seen too much up start working on Health Care Policies to help our patients and families up for the care they need. That is the goal we should be focused on. I am the insurance commissioner for the state of washington. I want to thank you for your bipartisan commitment to address the challenges that we had Insurance Commissioners are facing but also you are facing in the coming months. This is especially true for the individuals and families who buy their own Health Insurance, some 330,000 people in the state of washington. Are thelly are they canary in the coal mine. If theres a problem in the individual market, it is a problem for all of us. Early retirees, selfemployed, people who work for employers who do not offer Health Insurance. The individual market is a critical safety net. There are relying on us to find a path forward. It offers a great deal more certainty than what we have right now. Washington state has fully embraced the Affordable Care act in the very beginning. Sincee a stable market 2014. Our uninsured rate has plummeted from 50 down to under 6 in the 15 to washington under 6 . There have been two counties in the state of washington who did not have health insuraers. I am nervous about what will happen next year. Because of the growing uncertainty and actions by the administration, our individual markets are in peril. The proposed average rate increases that we have seen for 2018 are 23 . In years past it has been under 10 . Counties have only one in sure insurer. Weeks will be very telling. Will be making final decisions as to whether they will participate in the marketplace or not. Congress must act quickly to address these growing uncertainties. You must permanently fund the cost sharing reduction payments. That is something that will help a great deal in our marketplace. In effect some 72,000 people in the state of washington. For a low income family in the state of washington, the delectable is the difference between being 1200 with the csrs are 14,000. A federal to create Insurance Program this year. This would show your commitment to stabilizing the market. It works very well the state of washington for the first three years that we had a reInsurance Program. We would like to see a continuing. Another way of reassuring the Insurance Market that the insurance carriers dont get help financially because of predictability and helps us hold down rates. Make sure you maintain the coverage inaffordability guardrails in the 1332 waivers. We want it by the rules but we dont want to see the health benefits, guarantees on outofpocket costs are loaded away. As a Consumer Protections we dont want anyone to see with the marketplace. Let me think you must take bold action now for the markets. Peoples of hardworking are counting on us. Crystalsiolating are allowed to occur and they are occurring right now. We saw this in the 1990s and we saw the individual market in the state of washington totally collapse. That is something no one wants to go through. Hardwarehardware harbinger. In washington have been for the whole country in the individual market. Our life depends on it and rest on your bipartisan efforts. Thank you, mr. Chairman. Has experienced difficulties, but our individual market is not collapsing. Insurers file for an average assuming no2018 changes. I am pleased to report the insurers are seeing improved experience with this market, and that is reflected in the rate increases. Im concerned it is on battleground because of the uncertainty surrounding the future of the aca and payments for costsharing reductions. I cannot stress how difficult this uncertainty is on our markets. The payment have a Significant Impact on rates. This will hurt the web percent 2 of 1 to pennsylvanians who do not receive subsidies. Rate have to be finalized based on finite assumptions. Consumers will be left to bear the burden of premium increases bychoices necessitated uncertainty. Congress should allocate funding until at least 2019. Oklahoma has been worrying for too long. I look forward to seeing how congress will finally address these problems in time to meet their 2018 deadlines. The implementation of obamacare in oklahoma has been a failure. In 2014, the carrier sustained heavy losses. Carriers sustained heavy losses, and by 2016 that number had dropped to only one carrier. What is happening now cannot be sustained. We can expect oklahomans will eventually have no market with no options. Over the past four years, rates on her marketplace have. Ncreased by 130 studies estimate that approximately 30,000 individuals who do not qualify for premium exited the nongroup market in oklahoma between 2016 and 2017. Small Business Owners are suffering. , manymiums have spiked people in oklahoma, where the average per capita income is just above 25,000 annually, are being forced to pay higher premiums for a policy they cannot afford to use. Further, carriers have sustained large losses in the marketplace. They have responded by narrowing their provider networks. It turns out you cant always keep your doctor. Many other states are facing similar issues. Unfortunately, all efforts to repair and amend obamacare have failed. I am encouraged by the Trump Administration priorities, particularly in a correcting state flexibility and autonomy. In oklahoma, obamacare gives us no other options at this point. Oklahoma submitted a 1332 waiver application under the obamacare framework. This focuses on a Market Stabilization Program using federal funding and state used assessments. This will create a Regional Program for carriers operating in the marketplace. Subsequent writers waivers will gain state worker state control over obamacare requirements. However, i am not convinced obamacare waivers will be the solution to our problem. We need an Innovative Solution that returns power back to the states, to implement ideas tailored to fit each states specific needs and Health Insurance. Thats why i have encouraged the proposals out there like the ones from senators ram and cassidy, which would repeal the individual employer mandates, block grant dollars to the United States. If some states one to keep their regulations from obamacare, thats great. That works for them, but it is not working for oklahoma, and we should have the opportunity to face something different, or else we face an uncertain future. Let me ask about the issue of cost sharing that has been raised by everyone. I think we recognize that uncertainty within the market is deadly. Accuracy. Move with there have been some that have suggested i believe the chairman said we need to extend the cost sharing subsidies through 2018, 2019 is another day that has been out there. I think the governor is, in fact , asking for an extension at least through 2019. If we were to do it at least through 2018, does that provide sufficient certainty, or does it , 2019 ore longer beyond, to give the certainty . Right now we are giving monthtomonth and we know that does not work, so could you speak to that . I believe it has to be at least two years. There is enough consternation in the market that the insurers looking the insurers are looking for more than a oneyear commitment. I have seen two havenots area of at least 2019 two headnods. At least 2019 . Senators are already planning 2019. It is two years out already. In order to give perfect ability, you have to give more certainty going into the future that it is going to be there so they dont leave the market, and that is the biggest concern i the yelling fire in a crowded theater and they all leave. We have seen it happen in Washington State in the 1990s, and it should not be replicated for the rest of the country. Announcer the Second Senate Health Committee hearing on the individual Insurance Market featured a Bipartisan Group of governors. Republican bill haslam and of tennessee, democrat Steve Bullock of montana, republican charlie baker, massachusetts, Democrat John had the Democrat John hickenlooper of. Olorado here now are the governors opening statements. It is an honor to be here with this group of governors who i consider friends and no to the problem solvers. My request to this committee this morning is that you do two things. First, you move quickly to destabilize the individual Insurance Marketplace. Second, that you undertake an effort to Work Together to improve the cost of health care. Our Unemployment Rate is the lowest in history. It became the first state in the nation to offer two three years of Community College to our citizens. Is among thecapita lowest, if not the lowest, in the country. But the crisis of health care and the uncertainty of its future threaten our citizens and budget. The primary difference between , andning tennessee now when a very young governor Lamar Alexander led the state, is the impact that health care has on the state and Everything Else we do. Today, tennessee finds itself with only three carriers offering a ca compliant coverage. In over 80 of our counties, citizens have only one insurance option, and these are provided at substantial cost. Future choicesof at higher costs is not sustainable. We are on a path where citizens will not have an option to purchase from the Insurance Marketplace or cant pay for the limited options that are available to them. Either way, the system fails. Congress should take steps now to prevent the total collapse of the Health Insurance market by, number one, funding cost share reduction payments, two, creating a shortterm reInsurance Program, and three, providing flexibility to the states. In tennessee, about 60 of our facilitated marketplace participants are enrolled in csr plans. Failure to fund csr payments will increase premiums significantly, create even more uncertainty around the future of participating carriers, and actually increase the federal deficit due to higher premium tax credits. This is not a recipe for success. It is also important to understand that our marketplace was facing collapse before this current discussion of csr payments. Other actions and reforms will be needed to address the crisis. Second, congress can take additional action to stabilize markets by funding a shortterm reInsurance Program that would limit losses to carriers that provide coverage in the marketplace. This should produce lower premiums, which should attract new, newer healthier individuals to the marketplace. A third way to offer flexibility is to offer it to the states to address their unique challenges. A waiver process should be expedited, and the guard where else currently guardrails currently placed upon waiver requirements should attract younger individuals to the marketplace. I realized some of the things i just outlined around stabilization cost more money, and i am asking for this at a time when many governors including myself are emphasizing the skyrocketing cost of health care. But the reality is that failure to address the immediate stabilization needs while Congress Works on the bigger issue of cost will almost certainly result in collapse of the market. Some may say the only way to ensure legislative action on cost and realize real reform is total collapse. I dont subscribe to that. I think every governor here and those back home believe that we can move to stabilize the market now while we work to take on the issue of Health Care Costs. Having health destabilize the hopet, it is my strong that this committee will turn sights to the cost of health care, which is crippling businesses and families and overwhelming all the other needs that should be addressed in state and federal budget. We must all recognize what has been missing in the argument over the Affordable Care act. The law was supposed to solve two Critical Issues around health care in america. The first was the large number of people who did not have Health Insurance or cannot afford coverage. Secondly, the Affordable Care act was supposed to make Health Care Affordable. Unfortunately it has provided coverage for government subsidies for millions of people to have coverage of the same exorbitant costs. One of the criticisms of the Affordable Care act is that it , saying that part it would provide free or subsidized insurance to more people without simultaneously addressing the hard things addressing cost. Addressing cost is difficult politically and otherwise. One of the drivers of Health Care Costs is the misalignment of incentives that are created when we compensate providers based on the volume of care they provide, rather than on outcomes or efficiency. In tennessee, we are working to change the way we pay for and deliver health care so that providers are compensated based on value, and congress should make a clear commitment to this type of payment innovation. All of us, republicans, democrats, and independents, should agree that our current path is not sustainable. Debate about the Affordable Care act, there has been a lot said about how immoral it would be to have millions lose health coverage. I understand the argument. I am a republican governor who proposed a conservative plan to increase Medicare Coverage in our state. However, can we all in knowledge that it is just as morally questionable to cover everyone with Health Insurance and put the bill on a credit card to be paid by our grandchildren and not do everything we can to make Health Care Affordable now . Thank you again to the entire committee. As governors, we stand with you to partner and strengthen the individual market and our entire Health Care System. Governor bullock, welcome. Chairman and members of the committee, thank you. First, thank you for inviting , democrats and republicans, to appear before you today. Whatever comes out of washington nor does not come out of it, were on the frontlines of dealing with it. Recognizing your recognizing of the importance of our involvement in the discussion is significant. Second, thank you for working together. As we learned from the passage of the aca, meaningful and lasting reform will be hamstrung if implemented over the uniform objection of the minority party. I applaud the chair and members of the committee for doing all you can to ensure that congress of thet repeat errors past, or even errors of the past month. We are all familiar with the old adage, the only way to eat an elephant is one bite at a time. My thanks to the single or focus on the immediate steps congress can take to stabilize premiums and help individuals in the Insurance Market. Anymore governing ndc may seem like a zerosum game, a few winwin scenarios. Add greater stability to the overall Health Care System and individual markets, i do believe that your efforts will read will reap political rewards on both sides. Some may call me a dreamer, but it might even prove to be a model for further efforts. Following the eating the elephant analogy, it may be only one bite that this committee is sinking, but it is important. The last time i was with chairman alexander, again with bipartisan governors, he handed out his pocket died to the basics of health care pocket guide to the basics of health care coverage. The exchanges on only represent 6 of all those insured,4 of thpose but stabilizing the individual market impacts all areas of coverage and also has a highly pronounced impact on places like where i lived. Ns and rurala i americans are less likely to have that option of employersponsored insurance. 80 of those insured amount cannot are on the individual market. Three out of four enrolled in a marketplace planner for rural or frontier areas of our state. Montanans enrolled in a marketplace land have received tax credits to make the payments affordable. I do believe we can find Common Ground in driving down costs, stabilizing the marketplace, and the time to do it is now. While Health Care May be complex, it does not take a brain surgeon to figure out how to stabilize the individual market. The effort i have been involved a roadmap and member of actions that this committee can take. Perspectives of the five governors appearing before you this morning are certainly of diverse landscapes, we are uniform in insisting the cost share and reduction payments be continued. All of it in her testimony urged you to create a temporary Stability Fund. Toall agree that you need make sure both a healthy and unhealthy continued to be covered in order to read the risk spread the risk. Committee will work across the aisle with one another to undertake even those four measures, you will accomplish your name and stabilize the individual market. If you just get the csr payments, you would take significant steps to do so. It also does not take a brain surgeon to sabotage our Current System. The interaction and messages coming in from d. C. Are doing it now. In montana, our largest insurer has proposed a rate increase for next year 10 times higher than it would be, because of the uncertainty that the president has created. Finally, more important than being governor, im inherent. I am a parent. Ago, address five days irish policymakers to act like our kids are watching and learning from our behavior, are, and our deeds, because indeed they are. I implore you to do the same. In a time of seeming dysfunction, this committee and congress can Work Together to destabilize the individual market, beginning to eat the elephant one bite at a you. I want to thank you for this opportunity to testify on stabilizing premiums in helping thank you for this opportunity to testify. We deal with these issues every day and we want to work with congress and the federal government on health care reform. Achievedetts has nearuniversal coverage with the highest level of entered individuals in the nation. That because we have been working and reworking it for more than 10 years. Of our bipartisan success is the belief that healthcare coverage is a shared commitment, not the responsibility of government. As you consider measures to stabilize premiums and address the individual market, i would like to address four points. First, bipartisan cooperation is essential. Congress should take immediate steps to resolve the federal cost sharing reduction payments until longerterm reforms are enacted. Employersproviders, and people on the certainty about what rates are going to be. The monthtomonth recess edition costsharing reductions is not stabilization. They should be maintained for at least two years. A key contributor to market stability is the presence of younger and healthier people in the market. When massachusetts passed its 2006, were law in included an individual mandate, which i support. No one really knows when they might get sick or have a tragic accident. Once it happens, they will seek care, and it will be provided. In many circumstances they will be unable to pay for. Everybody else who has insurance will be paying for the Health Care Services rendered to those without coverage. Unlimited access to purchase coverage, many will purchase access only when they need it and drop it once the carriers provided. That defeats the whole idea behind insurance, in the first place. Coverage, and using incentives and consequences is a critical element to ensure everyone is treated fairly. Different states can choose different approaches. Want to make insurance affordable for people who dont have access, we need to nudge everyone into purchasing coverage and keeping it. Congress should establish broader parameters for Insurance Market reforms that include greater latitude for states to meet the unique needs of their residents. 1332 waivers should be broadened. Committed to is continuing to provide Health Insurance for all of our residents. Increased waiver flexibility would allow us to more effectively meet that commitment. Where changes to 1332 waivers would be of significant benefit, are essential health care compliance, benefit design and budget neutrality. Massachusetts is a strong benefit state. We support essential health benefits. However, even in our state it was a challenge to adapt to the overly strict federal framework of the aca. Congress should take action to address Health Care Costs and one critical driver is rising pharmaceutical costs. The fdaxpediting approval process, increasing competition by ensuring generic drug availability and creating greater opportunities to negotiate prices should be pursued. As you consider these reforms, i would ask that any lay just late of changes legislative changes occur on a gradual time like. Outeed to grandfather certain programs in order to prevent market shocks. Governors or prevent are responsible for the physical health of our state and our residents. Any reforms should not shift greater Financial Burdens onto states. Legislation requires finetuning and adjustments and in massachusetts, we have repeatedly revisited healthcare reform, as conditions have changed. And our commonwealth is better for that. As we congress to commit, did, to returning to the table in a bipartisan fashion, to review and revise any enacted reforms in the coming years. Thank you again, for this opportunity to provide testimony on this important issue. We look forward to working with you and other members of congress as you consider legislation. I submitted written testimony that goes into greater length on these and other issues. Thank you. Ake lessons on that or anything else. Questions on that or anything else. Thank you, governor baker. Governor hickenlooper, welcome. Hickenlooper thank you chairman alexander, Ranking Member murray, and other members of this committee. I appreciate the opportunity to briefly share our plan for stabilizing the individual Health Insurance market. Brandeis popularized the idea that states are critical to democracy. May serve asstates a laboratory and try social or economic experiments without the risk of the rest of the country. Implemented we have the Affordable Care act for seven years, as long as i have been governor. For many coloradans, it has been a success. We expanded medicaid and created a statebased marketplace. Around 600,000 coloradans now have care because of the aca, thats 10 . Affordable care act. We need to move toward a system that, that compensates quality and good health, not quantity. For the coloradans in the marketplace, many continue to struggle. Orado has 14 counties almost 25 of our counties with only one insurer on the exchange. It is also home to some of the highest premiums in the country. In rural colorado making less than 15,000 will. Ay over 12,000 in premiums that is simply unacceptable. Insurance premiums are projected to increase by as much as 27 . Thats a big problem areas are bipartisan thats a big problem. Our bipartisan governors have been working on a common sense set of solutions to help make insurance more affordable and markets more stable for this crucial 7 of the population. We can do a lot more at the state level, especially with congressional support. Our plan asks you to explicitly fund costsharing reductions at least through 2019. Funding through 2018 alone will only put us right back where we are now in a matter of months. It will foster uncertainty, threatened to drive a premiums, and force insurers out of the market. We also need your support by creating a Stability Fund that will help us set up reassurance reinsurance or similar programs. Tax incidenceing for Insurance Companies to enter counties with only one insurer, while getting americans to live in these counties the opportunity to buy the same insurance that federal workers have. The aca givesf states the ability to innovate to lower costs, while ensuring that certain basic guidelines are met. Existing regulations limit our ability to come up with creative solutions. Thats why we are asking for a streamlined way for submission and approval process, and additional flexibility in applying the budget neutrality provisions of this section. We believe all this can be done in a fiscally responsible way by offsetting costs. We need to address the underlying drivers of healthcare costs as well. Thats why we are asking federal government to empower consumers with rice and quality information price and quality information. We cant stabilize the market without Funding Priorities of like weight, management, family planning, and injury prevention. Governors have proven we can innovate. We are like startup companies. We learn from the states. We tweak, constantly improve. Thats part of being laboratories of democracy. In colorado, we are trying to pinch pennies. We are reducing costs and promoting a competitive market while improving care and increasing transparency. We have a lot to be proud of, but recent federal action and inaction is undermining our effort. It is time for the federal government to work with us, not your us without against us. Without your help, it is like climbing a Colorado Mountain without a parka or crampons. It cant be done. Efforts ine your calling this hearing. Lasting solutions that make Health Insurance more affordable and markets more stable will need support from both sides of the aisle and leadership from states. I look forward to answering your questions. Thank you, governor hickenlooper. Governor herbert, welcome. Governor herbert we are honored to address you on this important issue. The markets for affordable Health Insurance protect the families of utahs entrepreneurial selfemployed. It will be in responsible to allow these markets to collapse simply because of political paralysis. Having served as chair of the National Governors association, and soon to be the next president of the council of state governments, i have a broad appreciation of the role that states have in our federal system. I would therefore urge congress to get past the hope karen bass and delegate through responsibly to find solutions to the laboratories of democracy, as governor hickenlooper mentioned. I ask each state to take on the full role of regulating our Health Insurance markets. You can let the states experiment as laboratories of democracy to determine what policy works and does not work. For your information, the state of utah has one of the lowest healthcare costs in the nation. That stems from our local culture and favorable demographics, but it also comes from such practices as evidencebased measures of use ofveness, innovative managed care organization, and empowering doctors and patients alike to make more informed choices. I believe if you empower the states to determine their own healthcare destiny, the states will innovate and create Practical Solutions for the most complex healthcare issues of the day. We will learn from each other, and therefore he will improve. Under current law, empowering states means rater flexibility healthining essential benefits, and simplifying the state innovation waiver process. But innovation goes well beyond coming to the u. S. Department of health and Human Services on bid in the and with a hope for favorable treatment. Selfdetermination would mean a block grant of medicaid and Affordable Care funds that get us to funding parity in the 50 states. Before achieving the vision, Congress Needs to provide immediate certainty to the individual Insurance Markets. End, i recommend establishing a defined transition period. Tos would allow markets stabilize. This should be done while anticipate the intestines the adjustments. I am personally not a fan of costsharing reduction payments area nevertheless, in the near term, individual Insurance Markets need predictability in order to price their products adequately. The csrs was destabilize utahs Insurance Market, putting at who benefit from this program. Funding should be included through at least 2018 or 2019. We should also look for market oriented incentives. For example, congress could immediately reduce the cost of premiums by eliminating the Health Insurance tax. Insurance products can be better tailored to demand by allowing wider arrayoffer a of products, including more high deductible plans. Participation could be incentivize by greater flexibility in Health Savings accounts. The government should fund a fororary Insurance Program states to offer their own risk stabilization programs. At the bottom of all this, Health Insurance needs to be protectingits job in against unforeseen healthcare costs instead of being used for some vehicle for social justice reform. To get there, the excessive burden of Regulatory Reform restrictions that we have placed on insurance policies needs to be peeled back, and that needs to be done with predictability and transparency. Frankly, most of americas consumers dont care whether or not a law is repealed or replaced. Ns want to know that they will be able to purchase reliable Health Insurance to protect them against lifes Unexpected Health challenges. , they need to know that if they experience a medical catastrophe, there is a safety net that will prevent them from spiraling into a financial catastrophe. The states are able to better address these issues for the unit populations and unique demographics than the federal government, which is too often trapped in a onesizefitsall mentality. I would urge you to consider a healthcare future that gives back to the States Alliance share of responsibility. This is something that both sides of the aisle can support, giving more authority to governors and state houses. Returning control to the state is prudent policy, but also prudent politics. Thank you for listening. Host gary herbert,or saying he wants more control over health care to go back to the states. This brings us back to republicans continue efforts to repeal the Health Care Law. Why didnt the bipartisan approach work . They ran into a lot of trouble early on. Theyve been talking about repeal and replace for eight years. This has always been so entrenched in politics. Republicans had to line up against the law, they had to line up to say they would repeal it if they could. They said they would never do anything to undermine it. And i think it would really the hard to get out of those entrenched positions. Democrats seemed a little unwilling to give on adding some flexibility to a part of the law that republicans have really been eyeing, which is getting states flexibility to do a plan that they want. Even if senator alexander and senator murray were able to come to a deal, it is a little hard to see that it would have gotten 60 votes in the senate. Maybe they had a chance but i think it would have been a really tough slog. Host looking ahead, what can we expect next week from capitol hill, and congress . Republicans are still trying to pass Cassidy Graham but at this point they are still short of votes. I think we are going to see a lot of scrambling to get those get those votes. And if they do put it on the floor, democrats will try very hard to stop it. They have one more toolbox one more tool in the toolbox that they can use. Ram a. S the votea that is unlimited amendments. Any senator can offer an amendment and a can get a vote. So democrats could offer hundreds of amendments. It typically doesnt go that dozens of perhaps amendments. So i think we are going to see them put up a real fight. It is going to be a long week. Anything you know ahead of the Senate Finance hearing that has been scheduled . That will be on monday. He has made mccain, clear that he wants regular order. Regular order would Mean Committee hearings. Senate finance chairman orrin hatch says he will have a hearing on monday. I expect a lot of partisan talk. I think we will see democrats try to defund the law, and republicans will be saying the Health Care Law needs to be repealed and grahamcassidy needs to be put in its place. Definitely, a lot of politics. That on thel have cspan networks, next monday. And we will cover your reporting, on politico. Com. For much more on health care, go to our website, cspan. Org. Mccainona senator john has Just Announced his opposition to the latest attempt the Affordable Care act. In a statement senator mccain says, in part, i cannot in good conscience vote for the grahamcassidy proposal. I believe we could do better working together, gop and democrats, and have not really tried. He went on to say i do not know much about cost, how it will affect insurance premiums, and how may people will be helped or hurt by it. Whicht a full cbo score, would be available to lead of the month, we want to have answers to any of those questions. Sent aesident mike pence tweet saying, the American People know obamacare has failed. We have seen a premiums rise in maine by 55 . The American People know we can do better. And billLindsey Graham cassidy would testify in monday about their Health Care Proposal. That is live on monday 2 00 p. M. , on cspan3. I noticed chaos written on
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