Transcripts For CSPAN2 Phillip Klein On Overcoming Obamacare 20240622

There hasnt been any agreement on any single proposal. But that may be about to change. A combination of the republican takeover of the senate, a looming Supreme Court decision and the white house race are putting more pressure than ever before on republicans to offer some sort of alternative to obamacare. But before they could get to any sort of agreement, there are some fundamental philosophical disagreements that need to be worked out about how to get and move the country into a more free market direction. And thats why i wrote my book, overcoming obamacare. And what i tried to do is i looked at the flurry of plans that have been offered as alternatives to obamacare. And i sorted them into three basic approaches or schools of thought. The first school of thought i called Reform School and this is comprised of people who say that at this point it might be unrealistic to fully repeal obamacare. And holding out for full repeal shouldnt be a barrier to instituting reforms to the overall system that will move things in a more marketoriented direction. The second approach i describe as the replace school and this is comprised of people who think that obamacare does, in fact, need to be repealed but that it can only be done that way if opponents offer a credible alternative that in some way grapples with the changes that obamacare have made and the beneficiaries that its created. The last but not least is what i call the restart school, and this is comprised of people who think that obamacare needs to be repealed and fully wiped off the books and that the only way that you can create a true free market alternative is from starting from scratch and focusing on lowering costs rather than just figuring out a way to expand coverage. So were fortunate today to be joined with three very forceful advocates for these various approaches. I want to start with iowa Vick Roy Avik roy of the Manhattan Institute whos authored his own plan as an alternative to obamacare, and he also was recently named as a policy adviser to rick perry. Next we have Jeff Anderson whos the director of the 2017 project, and he is also he has also authored an obamacare alternative thats very close to some of the plans that have been offered on capitol hill with some changes that we can talk about. And michael cannon of the Cato Institute has been described as obamacares singlemost relentless antagonist. And hes gained notoriety recently as one of intellectual architects of the Supreme Court challenge to obamacares federal Insurance Exchange subsidies. So i wanted to start with a philosophical question. Avik, youve written that universal coverage is a morally worthy goal. Michael, youve been the author of what youve called the antiuniversal Coverage Club manifesto. So i just want to get you two to fight about this. So avik, why dont you start and explain why you think from a free market perspective that it should be the governments role to provide universal coverage. Well, i would put it slightly differently. I would put it this way for example, we never say we would never well what you hear people like michael cannon, not necessarily michael cannon a number of people say it, we can never outbid the left on covering people with Health Insurance. So we shouldnt try to outbid them, we should just do something thats kind of politically acceptable in the middle somewhere. But we would never say that about, say smartphones. We would never say free markets cant outbid the government on the ability for every american to have a smartphone. We wouldnt say free markets cant outbid the government on giving People Better jobs and more Economic Growth. So why is it that we accept the progressive premise that the only way to expand access to High Quality Health Care is through government . I would argue actually, that you can expand access to health care for more people at a lower cost through free markets than through government. However, the goal of expanding access to coverage and care is a noble and appropriate one, and one thing i think we get so trapped in is we live in this progressive debate where its all about what the government can do and cant do. We dont actually embrace the policy goal of expanding access to care and coverage which is something free markets can achieve better than the government, and thats what we should be striving to do. Michael, what would you say . I see it as my role here to exaggerator the differences between avik and me, and let me try to do that. Of course, we can outbid the left when it comes to making Health Care Better and more affordable and bringing it within the reach of more poor people and thats what we should be doing. That should be our goal. The problem is that expanding coverage, if you make that your proxy for that goal, it actually interferes with the goal of better more affordable coverage for everybody. Because at a certain point as even Kenneth Arrow acknowledged, nobel prizewinning economist wrote a seminal argument on uncertainty in the world of economics and medical care that everyone justifies whatever Government Intervention they want in market. Even Kenneth Arrow acknowledged that insurance is pointless in certain situations because the costs exceed the benefits. And when i say and people like me say that we cant outbid the left when it comes to covering people with Health Insurance its because the left can always say, well, well have a singlepayer system, the governments going to cover everyone. Whereas if were going to use market principles and let individuals make their choices, after a certain point people are going to buy not as much coverage or at a certain point, some people are not going to buy any coverage at all. Thats actually important. Thats not only healthy thats crucial for the operation of a high performing Health Insurance market and health care market. But were never going to get to universal coverage if we just allow people to make their own choices. And to get there and we make expanding coverage or universal coverage our goal, then the left will always be able to say youre a failure because you havent delivered on universal coverage. And then advocate interventionings that make d interventions that make health care worse and more expensive. Thats why we shouldnt even concede the goal of universal coverage or even the government should be expanding coverage because it frustrates which is really our shared goal of making Health Care Better and more affordable and more secure. Two points in response to that. First, theres again, no reason we should accept the lefts definition of the terms. The traditional understanding of insurance, Car Insurance or Homeowners Insurance you get Car Insurance so that if you crash your car youre protected from catastrophic financial loss. Thats what Health Insurance should be. The fact that the left distorts the meaning of the word insurance to mean, actually, prepayment for all Health Care Services doesnt mean we should simply accept that. We should say, yes its a noble goal for every american to have the ability to afford true Health Insurance that protects them from bankruptcy due to injure or illness. Thats a noble policy goal, and free markets can achieve it. Youre making it easy for me to exaggerate our differences. Another criticism i have of the law the way a lot of conservatives approach health care and Health Care Reform is this idea that theyre trying to sell the public that insurance should only be for catastrophic illnesses, that if you buy a health plan, it should have a 5,000 deductible and cover nothing else below the deductible. I think the conservatives lose a lot of people when they talk like that, because a lot of people are very riskaverse, so they might want they should be free to buy it. They should be free to buy it, and theres also a lot of value that health plans can provide below that 5,000 deductible. Finding out what interventions what sort of Preventive Care is Cost Effective and maybe covering that with no copayments so that diabetics who maintain, take care of their illness and so they dont end up with complications later on. I think that its very important that we not try to offer for people any definition of what insurance should be. We should leave that to individual consumers as well. I think this is another way that conservatives get themselves in trouble on health care. Now jeff, what do you think . Do you think it should be a goal of conservatives to try to move toward universal coverage . I certainly dont think its the governments duty or obligation to provide universal coverage. Its a free country, and if people are allowed to live freely, then theyre not all going to choose to have Health Insurance. But i think its also a worthy goal to make it as possible as it can be, lowering costs having a vibrant market where people can actually choose to buy coverage if they want. I think as a practical matter in the obamacare debate if we want to repeal obamacare we do have to offer an alternative that focuses on both costs and coverage as a political reality. And i would fall somewhere in between, i think, of the two gentlemen on either side of me. I would agree, i dont think theres any need to outperform liberals on estimates of the number of people who would be covered under an obamacare alternative, but i think you have to at least make a good faith effort. You cant afford to just get absolutely clobber inside that vein if you want to clobbered in that reign if you want to win pretty d in that vein if you want to win politically. I think what jeff and michael talked about is when it comes to repealing obamacare. Now, youve released a plan that youve argued is fully compatible with repealing obamacare, but that it could be implemented without the need to repeal obamacare. But thats put you at odds with a lot of people on this issue. So why did you make that decision . Yeah. So i think just to be clear about what the plan does the plan can repeal obamacare and replace it with the replacement approach or you can get to the same end result by repealing large chunks of obamacare but then taking whats remaining and changing it to end up in the same place. And the reason why that option is important is because any replacement plan that we as republicans or conservatives propose has to get through the United States senate. And we dont have 60 votes in the United States senate. And so, and this is something that we dont talk about at all in the obamacare debate at all. But the fact is unless we have 60 vote, and even if you did have 60 votes not all 60 republicans are going to agree with each other on everything. So its not so easy. They lost the public option because Joe Lieberman and ben nelson said no to the public option and people like howard dean had meltdown cans on msnbc saying we should burn down obamacare because it doesnt have a public option right . So we dont have 60 votes. And so if we dont have 60 votes and were going to have to pick off, say six right now the republicans have 54 votes. Lets assume they maintain that majority in 2017 which is no small thing but if republicans are lucky enough, theyre still going to have to find six democrats to go along with whatever they want to do to replace obamacare. And i think its going to be hard to find democrats who support repealing every single word of obamacare. I do, however think there is support for a marketo credibilitied plan. So given those political realities, why were you for repeal in 2012 . Because the subsidies hadnt get come into play. I think a lot of us felt in 2010 2011, 2012 that if we could repeal obamacare fully before obamacare went into place, then we would have a lot more options. How would you do that with nowhere near 60 votes in the senate . Theres a difference between replacing obamacare and repealing it, right . So there was a lot of evidence to believe that we could repeal obamacare, just repeal alone through reconciliation which requires only 51 votes. However, replacing obamacare cant be done through reconciliation. You have to because of all the regulatory changes you have to make the reconciliation process for those who dont know is the budgetary process that allows you to make certain changes to the law that have to do with the budget. They have to have a Material Impact on revenues or spending. The challenge with health care is big chunks of it have to do with revenue and spending, but big chunks of it have to do with regulation how you regulate insurance, preexisting conditions, things like that. So a replacement plan, because it has to do with regulatory changes, not justifies call changes, does require not just fiscal changes, does require 60 votes. You can probably repeal obamacare with reconciliation with only 50 or 51 votes but you wont be able to replace it, and i think we all i guess i dont see where thats changed n. 2012 you could buy your own i think its right repeal obamacare using reconciliation. You can still do it in 2017, i should say 2013, 2017. In either case youre going to need 60 votes to get a full replacement package although you could get, certainly, large portions of that through reconciliation. So i dont really see what has changed. And the reality is that in pram pas second president obamas second term there have been 181 polls taken on obamacare according to real clear politics, and all 118 have shown it to be unpopular. So to give up on repeal at point seems to me to be politically totally unnecessary and at the same time rather fatalistic if you believe as i do, that repealing obamacares the most important thing that we can possibly do in the political realm. Thats a misrepresentation of my view. I still support the repeal of obamacare. I just think that we have to make sure that whatever we propose can get 60 votes in the senate. And so if we can get 60 votes in the senate for repealing obamacare and replacing it with what i propose great. If we have to do Something Different but we get to the same end result, great. I mean, but your plan keeps a lot of elements of obamacare. You have the preexisting condition ban, you have a lot of the Insurance Regulations not as strip gent as obamacare. Stringent as obamacare. You have the tax credits. They dont quite, arent quite as generous as obamacare. But even the sort of replacement, if you want to call it, is sort of still has a lot of elements. Well, i think if youre arguing that any plan that attempts to offer tax credits to the uninsured is somehow obamacare like, then there are probably a half dozen to nine different plans that republicans would propose including jeff, that are obamacarelike. I would contend that republicans in service for a long, long time have said that the best way to reform the Health Care System is to let patients control the dollars and not the government. Let people buy whether its Health Insurance or hsas or generous Health Insurance plans or catastrophic plans large hsas as michael has advocated in the past, let people have those options and let people buy plans that make sense for them. And the question is not the end result, which we all share but its how you get there. And, again with any replace plan requiring 60 votes in the senate, we have to at least be intellectually prepared for the possibility that we cant do exactly what we do if republicans controlled 60 votes in the senate. So all i tried to do with transcending obamacare is say here are some options. We can do it the repeal and replace way. We can do it by mite grating to migrating to this new system, but having a lot of different ways to get there so we can put together the legislative majority to get it done. Yeah. I think what youre hinting at phil theres a colossal difference between keeping the architecture of obamacare. It took 2700 pages to lay this architecture out. I mean, keeping it and just trying to rearrange it some or scrapping it and starting over is a huge, huge difference. And i think that youre glossing over that a little bit i think youre misrepresenting, misrepresenting the plan. The plan doesnt do that. Because you have called a lot of these plans obamacarelike. So i wanted to get your thoughts on this. So republicans conservatives and notice i say republicans conservatives and i dont say we because im not a republican, and im not a conservative. But republicans and conservatives have gotten themself in a lot of trouble over health care in the past because the right doesnt spend as much time and energy on health care as the left does. And so they have, theyve fallen for ideas like an individual mandate. Because they didnt think these things through enough and realize that wait a second, an individual mandate used as a coercive power of government to provide people with Health Insurance the same way a singlepayer system does, so theyre really two different, theyre two degrees of the same animal. So they ended up endorsing that back in the early 90s and then 20 years later we ended up with that, with 60 votes for that in congress because republicans werent following their principles and thinking closely enough about these things. I think the same thing is happening right now when it comes to Health Insurance tax credits. I do call them obamacarelike. Its because they involve a lot of redistribution, like obamacare does. Its because they function exactly like an individual mandate where either you buy a governmentdefined Health Insurance plan and pay less money to the government, or you dont, and you pay more money to the government thousands of dollars. Its effectively a penalty for not, for not obeying the mandate that you purchase Health Insurance. And it gives the government as much control over what your Health Insurance plan looks like as the individual mandate does. And so these are obamacarelike plans, and its why i dont think that why i think we should repeal obamacare and dont worry yet about what will get 60 votes in the senate. Because im afraid of whatever plan republicans are going to throw together in order to get 60 votes in the senate at this point because they all think that these obamacarelike proposals are the way to go. And if they do that, if they repeal obamacare and replace it with something obamacarelike, then well basically still have obamacare, except itll have bipartisan support, and well never get rid of it. But on the flip side of what avik was saying about the 60 votes in the senate, youll never get 51 votes for reconciliation for the repeal of obamacare if it looks like theres no alternative on the horizon. Youre simply not going to well, there are all sorts of alternatives that were talking about. But i mean, you have to put forward some sort of turn that actually deals with coverage. Michael and i were testifying yesterday in the senate together, and he made a similar point or claimed that a tax credit is roughly akin to the individual mandate in obamacare, that a tax credit effectively mandates that you buy insurance. By that logic the Child Tax Credit effectively mandates that everyone have a child. Who would make that argument . Childless couples are a little annoyed by that. You could take everything to sort of theoretical extreme but i think that is a profound difference between the government mandating that you buy a product or service the federal government doing so for the first time in american history, and offering a tax break in whatever form to people who buy who choose to buy that well, actually theres a tax credit for childcare, and a lot of stayathome, a lot of families, the stayathome parent are really offended that they are effectively being penalized by the tax code because they make that choice to stay at home and raise their own children. I think thats a perfect i need to make a factual comment about something mike said. Mike said the tax credits are a mandate to buy insurance. Thats not true because you could structure the tax credit so that its entirely deposited in Health Savings accounts which means you dont necessarily have to buy insurance with it. You could just save through compound interest and have it roll over for your health care needs. So its not necessarily true that the tax credit then its not a Health Insurance, then its not a Health Insurance tax credit. And ive been talking about Health Insurance tax credits. Even hen its still its a tax credit used to purchase Health Insurance or health care or both. In that case, for a lot of people it would be just a government, a cash payment from the government into their Health Savings account. I think the key thing to point out here is just that theres this distinction between a tax credit and a Tax Deduction. And, basically if its a tax credit, it means that it could probably be extended to more people because people at the lower end of the income spectrum that dont have a high Tax Liability could still get the same amount of money whether its 2,000 or 3,000 or whatever. It is not a tax cut, it is a cash payment from the federal government. Yeah. Anything beyond whatever the Tax Liability is of that person becomes the equivalent of just a flatout subsidy as opposed to a deduction which just limits somebodys income tax liabilities. But that doesnt benefit a lot of uninsured people who dont have much of a liability. You know and what we need to do for them is the most important thing we can do for them, is to get everyone else controlling all of their Health Care Dollars and spending every one of those Health Care Dollars as if they own it. If we get 150 Million People spending Health Care Dollars more wisely, that is the single most important thing we can do for people of modest means. Because that will spark a revolution in Cost Containment and drive prices downward and Bring Health Care within the reach of more people. But the point you make is important. This is, and this is a criticism that ive got of Governor Jindals standard deduction for Health Insurance. I feel that is a better step than or a better proposal than Health Insurance tax credits because it does not involve redistribution. But anytime you have government conditioning a benefit, be it a subsidy or a tax cut on x, it has to define what x is so the people know if theyre complying, they dont know if theyre eligible for that Tax Deduction. So a standard deduction for Health Insurance still lets the government define what your Health Insurance plan looks like, because it gets to define what insurance qualifies for that deduction. So i think that, ive said before im not just saying that because hes here. But ive said before that i think that Governor Jindals Health Care Proposal is the best that ive seen among the republican candidates, but i think it still has that very serious flaw. Yeah. You want to just quick on that, and i want to move on to another topic. The biggest difference in the right among those who feel we have to have an alternative, theres some disagreement there i think its very clear politically that if we want to repeal obamacare, we have to have an alternative. The American People have been waiting to see what would go in obamacares place. The biggest disagreement other than that on the right has been between a Tax Deduction approach and a tax credit approach. Philosophically the 2017 project plan would offer a tax credit. Fill soft clay if we were operating in a vacuum, i would have no problem with the Tax Deductionbased approach. But were in a world where there are families under obamacare i mean, the vast majority of the middle class gets nothing under obamacare. You can go on the kaiser calculator the typical 40yearold woman who makes 35,000 a year does not get a penny. There but there are families who get over 20,000 in subsidies under obamacare. Its just politically unrealistic to say youll take a 20,000 subsidy and replace it with a Tax Deduction of nothing. And that would be the result, because the sort of family thats getting 20,000 under obamacare does not pay any taxes, and that includes payroll taxes if you combine all their total tax effect, they would get nothing. And to be able to try politically to say youll go from 20,000 to nothing and like it i just to me, thats a recipe to have, we can talk a lot about obamacarelike, thats obamacare forever. Well have obamacare for the rest of our days if thats the case. So i think as a political reality, youve got to go the tax credit route which means these folks would actually get the same thing as everyone else. 2017 project plan, a 1200 2100, 3000 tax credit just depending on their age. But i think a way to bridge this seemingly impassable gap is that the tax credit should be is as conservative as we can possibly make it. What i mean by that is lets give the tax credit to vims and families and to individuals and families and not have it be a sub city do to Insurance Companies like subsidy to Insurance Companies like obamacare. Remove the merrick penalties make marriage penalties, make it a very conservative tax credit. Michael would say itll never be conservative enough, and i respect that. We can get close enough, and then we can repeal this monstrosity while still putting things on a glide path toward a genuine free market and restore ising americans liberty. So i think before we go further into this sort of broader comprehensive alternative, right now were facing a more immediate question which is that the Supreme Court is going to soon decide on a major case involving the legality of subsidies that are gone through federal Insurance Exchanges. And if that happens, there are millions of people who will lose insurance subsidies and will have difficulty paying for insurance. And right now a lot of republicans are talking about various contingency plans as to what to do. So i want to get the panels perspective on what you think the best approach for republicans to take, and ill start with michael since youve been the most directly engaged on the Supreme Court case. I think theres a lot that congress should be doing right now primarily investigating how this even happened, that the irs is taxing and borrowing and spending tens of billions of dollars without congressional authorization. Contrary to clear limits the congress put on the agencys power in the Affordable Care act. I think that that will if they have a proper investigation, that will drive that will show them what they should be doing if the court rules in the challengers favor and drive their legislative proposals. If those subsidy cans disappear subsidies disappear, and its important to point out that if the court rules for the challengers then itll have two effects. First, itll exempt 57 million employers and individuals in 38 states from the individual and employer mandates. So its a huge tax cut. Theyre being those people are being subjected to illegal taxes right now. They will be freed from those taxes. There are also about 6. 7 Million People in those federal Exchange States who are receiving illegal subsidies, and those illegal subsidy cans will disappear under a ruling for the challengers. So the question then becomes what should congress do . A lot of people in congress are talking about well, we have to provide something to those people who lost subsidies because theyre victims. I think a clarifying point is in order here. If you think that someone who has lost an illegal subsidy is a victim and deserves to get that back, maybe youve been in washington too long. They are victims, yes. They are victims of a false promise. They are victims of the rest of obamacare. The Affordable Care act provisions that make Health Insurance too expensive for them. We should remedy those things. We shouldnt remedy the fact that the court followed the law and stopped a massive breach of the law and a breach of the the trust we put in government. So what should congress do if the court rules for the plaintiff . The first thing they should do is hold a repeal vote, because repeal is released for the vast majority of people that are the true victims here, the people who are whose Health Insurance premiums were increased by the aca to the point where these subsidies were necessary. You repeal obamacare you get rid of those mandates and regulations and let people buy get their old health plans back. You might want to put in there some sort of high risk pool because there will be people who are low income and have expensive illnesses and political reality will dictate you do something for them. You dont have to create a new system of redistribution, it can be a Small Program like the preexisting Insurance Program that was in the original aca. Then the president will veto that. If you do it through reconciliation, get it to his desk hell veto that. Then what do you do . Well, no one really knows. But you have to lay down that marker and not negotiate with yourself by proposing some half measure, least of all some measure that ratifies or baptizes the illegal subsidies that the president has been issuing for the past year and a half. You lay could be a mark down a marker, you see what you need to do to get to 60 votes or close enough to 67 vote that is the president will get nervous and be willing to compromise. I think there are some ethical lines here that Congress Absolutely must not cross, and one of them is we cannot reward the irs for breaking the law by baptizing those illegal subsidies and making them illegal. What about you, jeff . Do you think thats a viable strategy . No. I think republicans are fooled in a matter of 48 hours, if that, if thaw tried to come out and say is, well its a tax cut for some people, so all these millions of people who are now going to lose their insurance and kids will go off their cancer care or whatever, at least other people will get tax cuts. I mean im not entirely unsympathetic to your view of, i mean, there would be some improvements in terms of liberty. And the court should absolutely stop the payment of these illegal subsidies. But i think republicans have to have again its sort of a microcosm of a larger debate. They need an alternative and this is the perfect time to put one forward and say, all right in the 37 or whatever states that lose their illegal obamacare subsidies, we would effectively repeal and replace obamacare or give the state an offramp to choose to effectively repeal and replace obamacare and substitute a conservative alternative with a simple ising, flat simple, flat, agebased but other flat tax credit to be used to buy insurance of your choice. And i think the biggest selling point with the American Public and one that our side greatly underestimates the political potency of there would be an opportunity to say the biggest problem in health care for seven years has been you get a great care if you get Health Insurance through youringing taxing break if you go through your employer. So finally we would give a tax break in the form of a tax credit, this would be a bonanza for middle class americans even while saving colossal amounts of money versus obama care, and this wide swath of the middle class, i think, would be very receptive to this message, and itd be a lot harder than people think for president obama to say im not going to let you have this long overdue tax break that your next door neighbor who gets employer insurance gets. Itd be nice if republicans could unite around that proposal. You mentioned senator sass position which is, basically allow assistance to go to people, only those people who were already getting subsidies under obamacare. No new people. And it would not be based on the obamacare subsidy formula and it would only be for a limited period of time. I think thats a good fallback position. Anyway, those are our thoughts, the 2017 project. Avik, what do you think . I think michael has done a great job bringing this case to the Supreme Court, i salute him for it. The rule of law dictate that is the Supreme Court ought to side with the challengers in this case because it was illegal for the Treasury Department to let these subsidies flow through the federal exchange. I want to actually make a thematic point that relates to both the king v. Burwell contingency plans debate and the Obamacare Repeal and replace debate, and that is that you have a lot of people i shouldnt say a lot of people, you have a small number of people out there who have decided to appoint themselves the popes of conservativism and say unless you agree with me, youre a rino or [inaudible] [laughter] its obamacare lite, youre not a real conservative. For example, Governor Jindal says any plan that involves tax credits is obamacarelike. Any plan that would raise taxes on people who have employerbased coverage in order to equalize the [inaudible] except that Bobby Jindals plan does exactly the same thing. We can get into that later if we want. And this is an unhelpful thing that Governor Jindals done, a lot of other people, well, youre a rino unless you agree with me. And were always going to be a dysfunctional movement if people agree with you on 90 of the issues are somehow the enemy. And were going to only drive americans into the hands of Hillary Clinton. Into the hands of Hillary Clinton if we do that. And i think we have to focus much more on what we agree on. And i think we have to articulate a vision of how to expand access to health care and Health Coverage using free markets. Because for the people who dont already agree with us on every single ideological point thats how were going to win them over, by really focusing on how our policies will make life better for people. And i think too often we get caught up in these scholastic arguments about how many tax credits you can fit on the head of a pin instead of actually discussing how to make life better for people using free markets. I want to see if there are any questions from the audience at this point. We could start to theres a microphone coming around. So does anyone all right hi. Im john green with the National Association of health underwriters. So just real quick first on hsas, you have to have an underlying plan to contribute to them. So you have to have insurance. And the other thing is if the subsidies go away, republican governors are going to be very nervous. And i think that the president has a plan. Slide a piece of paper have him sign something. Why dont we reduce expand rating bans . Its a simple message to say to the American People were going to adjust the market rules to make things cheaper for you, all right . So that reduces the costs of these subsidies. Well and then allow people to use subsidies outside the exchange and give them a special enrollment right to use it. Its real simple, its a day one kind of thing. We can talk about all the other things we might do later but on day one youve got to do something, and youve got to do something dramatic. Selling across state lines aint gonna do it, but changing the rating bands will. If you expand the rating bands you make it cheaper. And thats an important day one thing. Pretty simple. I totally agree with you. So thats actually one of the things that i highlight. One of the biggest things about obamacare that i think a lot of people dont realize is the degree to which its expanse of government power and control. It isnt so much the taxing and spending though thats important too to repeal and roll back, but its actually the regulations that are the biggest driver of how obamacare transforms health care in this country. Particularly for Healthy People who have worked hard and played by the rules and have the premiums that are relatively low to show for it who are going to now pay a lot more because of things like rating bands and things like that that youve mentioned. So thats an extremely important thing to repeal about obamacare. And just, again, to reiterate the point i think all of the support for repealing obamacare in my plan i have a number of different ways to actually get there. And to your point about the day one, thats exactly right. Thats what you want to do. You want to do everything you can through executive action, and then do everything youve got to do through legislation. Use all the tools you have. On point about hsas, its true that today you have to have a certain type of Insurance Plan in order to deposit money in your hsa taxfree. Thats because Congress Passed a law imposing those requirements. Theres no reason why that law has to stay in place. We can expand the ability of americans to save for their own health care by changing the way the tax treatment of hsa is currently legislated. I agree with avik that the worst thing about obamacare or, i think you said it, the regulations. Not so much, i mean, the spendings terrible, the taxings terrible, but the worst thing is the coercion. Effectively, the obamacare debate, i think, is a debate that comes down to liberty versus coercion. And the only solution in that is to repeal coercion and side with liberty. Kind of in that vein, i would say with all due respect that the worst thing that i think republicans in congress can do is look to make obamacare better in like, the way you described or in other ways. The response to king v. Burwell is well turn the subsidy cans back on, but only in exchange for letting us make obamacare better. Thats a twoforone for president obama. He gets what he wants, he gets obamacare to be a it little bit more bipartisan like it would have been from the start if he had chosen to work with the republicans who had their hands outstretched. We need to remember you may recall before the Health Summit that secretary sebelius said we want to hear republicans ideas at Health Summit but this is comprehensive legislation, and it all fits together. You cant really tweak one part or plot another part, it all goes together. Well, lets remember that. It needs to be comprehensively repealed. And along the way i think the worst thing we can do is try to fix it. Is there any other yeah, im gregory roberts. Im a reporter for the advocate newspaper. Im here in d. C. But the newspapers in baton rouge in new orleans in louisiana. I asked this question of the freshman senators who gave a press conference, bill cassidy was the lead speaker and i was accused of raising a strawman, which i didnt want intend to do. My sense is that the administration or whomever you want to point a finger at didnt sit around four, five, six years ago and say weve got a perfect Health Care System. Everybodys covered, theres no issue with uninsured people, its the most Wonderful Health system in the world, but lets invent this elaborate program thats going to be highly controversial and create an enormous make me spend a huge amount of political capital. I feel that there were issues that there was a consensus, a broad public consensus needed to be addressed. One of those was the number of people who were uninsured in this country which was tens of millions of people often compared to to other developed countries where thats not the case. We did have a private sector system in effect the not, not totally because of medicare and medicaid regulations. There was still a problem that needed to be fixed. So how do you solve the problems that this program was intended to solve that were widely recognized as problems without resorting to some of the mechanisms that youve criticized . No, its a great thats a straw man . Thats what i was told. Oh. I think i think its great question. I think you highlight something thats very important, which is that were here talking about overcoming obamacare. And the last time we were all in a room together at the Cato Institute, i made the point that obamacare is not the only thing we have to overcome. Its actually the programs that were installed in the great society, medicaid and medicare, that were the government takeover of the Health Care System. Before obamacare was each an apple in president obamas or senator obamas eye half of all health spend anything this country was Government Spending, because of medicare and medicaid. The federal debt that we have today is driven by unsustainable spending growth in medicare and medicaid. And so we talked some of us argue that obamacares unfixable, and theres nothing we can do except repeal it, burn it down to the ground and do something else. Well if obamacares unfixable, then medicare and medicaid, which have been entrenched for 50 years are also unfixable but also causing a lot of problems. And yet were not shy about saying heres how we would reform medicaid, medicare heres how we push those programs in a more marketoriented direction. So i think one thing thats very important for us to understand, i think a lot of conservatives have the impression that we had a free Market Health care system before 2010 and that obamacare came along and was a socialist takeover of america. Thats not that what happened. There was a gigantic step change in Government Health care in 1965 and then that was like this. And then obamacare is like this much on top of it. It goes in the wrong direction. But its additive to that gigantic growth in Government Spending and government regulation and government coercion that took place in 1965. And i think one of the big mistakes that guys like jeff make, and he and i have argued about this a lot is that he ignores that larger, fundamental problem of medicare and medicaid. He basically says theyre kind of, you know, theyre in concrete, we cant really do much about them, so we should focus on obamacare because thats newer and less entrenched. I would argue it doesnt matter whether its less entrenched. The fundamental thing is were going over a fiscal cliff because of all these programs, and we have to tackle them all, and we have to use whatever tools we have available to actually move all those programs in a marketoriented direction and achieve the policy goal of expanding access to health care and making it more affordable not just for all americans who are uninsured but for the taxpayers who are footing the bills for all these programs. So we have to actually be more ambitious than simply looking at obamacare. We have to look at the broad sweep of Government Intervention in the Health Care System. And if we dont do that, weve set our sights too low. Of course, it does matter, though, whether theyre more entrenched or less trenched. Lets go after the thing that is sitting in wet cement and has never been popular. Its hugely important to go after medicare. I, i mean, i think that paul ryan style medicare proposal may be the second most important thing we could do after repealing obamacare. And the 2017 project would take people off medicaid and put them into private insurance. I certainly agree these are big big problems as well, but lets focus on some of this does come down to a debate over how bad is obamacare. I think its arguably the worst piece of legislation passed in american history, and it needs to be repealed. The American People never wanted it, and theres no reason why they should be stuck with it. In answer to your question, sir, i fully agree that the Health Care System was broken even before obamacare was passed. I think the biggest way it was broken was the federal government had created this very unfair situation in the tax code where employerbased insurance got a great tax break and the individual market didnt, and as a result, the individual market shriveled up and nearly died. Known short among the public. Jonathan gruber says much whenever when the white house knew the public doesnt want to cover the uninsured, they won their premiums to go down. It is an important distinction. The reason everyones premiums are too high, but for the affordable characters of the previous Affordable Care acts congress had passed including medicare and medicaid andand some did not happen by congressional legislation, but beginning in 1940s, employer sponsored insurance. The private market as those that somehow makes it a free market because you have private on top of it but this tax reference, employer sponsored insurance gives your employer control over 10,000, your earnings if you have family coverage and your employer has your health plan. When they pick your Health Insurance, that is not a free market, that is a Government Health plan. The horse the government decided to back is a type of Health Insurance that disappears when you get sick and cant work anymore. This is not a free market. This is insane. It depends which day you catch me. Some days you have to reform medicare, sometimes i think you have to reform tax sponsored insurance first because i can decide which has been more harmful. You are right, there were a lot of problems but all the Affordable Care act did was double down. All these failures have been in place for decades and we need even more government to fix the failures created by previous Government Intervention. Is not going to work. That is why i am such an opponent. One last question. If the king lawsuit turns on the question whether the subsidy federal exchange one basic question is do we need Government Exchange . Sure you with . To change that. To clarify of course we dont need the government to create those the exchange of the marketplace where people can get to get it to buy Health Insurance. People were doing that before the government created regulatory bureaucracies we, exchanges, theyre doing it through brokers, the Health Insurance is a website where you can compare it and it existed before obamacare. If these things work the government provides value to the government to subsidize and the government should not subsidize. I agree completely. Government run exchanges, made me laugh when president obama talked about healthcare. Gov will be like expedia. Com. We had the Health Insurance was like expedia. Com. Just like the Health Insurance. Well. At this point i want to conclude this segment of our program, but of course there is a great book you can read that has expanded treatment of all of these ideas and there are copies of overcoming obamacare in the entryway. So thank you for coming out and the engage in panel. [applause] our next guest, governor bobby jindal need little introduction, but i wanted to highlight a few things that are relevant to Health Care Policy in todays discussion. Governor bobby jindal studied Health Policy at oxford and at a young age served as secretary louisianas department of health and hospitals. In 1998 he was appointed executive director of the National Bipartisan commission on the future of medicare and in the bush administration, he was assistant secretary of hhs. More recently his policy Group America next released its own obamacare alternative that he has been very outspoken about what he thinks is the best approach for republicans. More recently he has been thinking and praying in his words about potentially jumping into the white house race. Without further ado governor bobby jindal. Thank you very much, thank you. I intend to keep my remarks short. I dont think you need to hear another speech. I would like to spend more time in questions. I think the washington examiner. I know this event was rescheduled and i thank you for coming back. May be the Obama Administration found out what we are to interfere with the original meeting date. I was positive of two things up front. President obama could go back in time, if he were then senator obama or president elect obama if you could tell him, if you persist with obamacare in your first term, a majority of the house, 60 members in the United States senate, a lot of things you wanted to get done catch and trade card check, immigration reform, tax code reform a lot of things this president campaigned on and promised the American People wanted to get done. If you went to him and said if you insist on doing obamacare the of the images legislative initiative you have to that was the stimulus bill and if you do this as one of your first initiatives you are going to lose the majority in the senate, you are going to lose the majority in the house and you are going to lose the ability to pursue your other initiatives. Maybe a two term president but you wont be able to pursue any of these other things you campaigned on or cared about. He still would have done it. I think from his perspective, he promised he wanted to be like Ronald Reagan as president , not that he wanted to be conservative or free market or try to win the cold war but wanted to be transformed if in the direction. From the lefts perspective getting obamacare done was the single most important domestic policy achievement that you can point to in decades. If your view is wanting to grow the power and influence of government having the government that involved in health care, an important part of the economy that is critically important to each of us, you cant think of a better policy accomplishment. This was a big political mistake, a blunder, i think they were wrong. I think the left and like the right deserve at least credit for knowing exactly what they wanted to accomplish when it comes to health care. They have been moving in that direction incrementally at times and in big steps at times, Hillary Clinton started in the host s, at least for the last 16 or 17 years fought to get to their vision of government run health care. They are not done. What they would want is a single payer government run system but too often on the right we have not had the same clarity, the same persistence, we View Health Care as a democrat issue or liberal issue. That is wrong. I dont King Education should be democrat or liberal issue i think conservatives, republicans need to play offense on health care and education, the second thing i say. If the president were able to listen to some of the debate you have heard here in other quarters i think he would be pleased. I think the president could go to the republicans and say i listened to your alternatives and we are listening to your programs along as they do three things, one, as long as we are creating a new Entitlement Program. That is absolutely critical. Secondly as long as we are using tax code to redistribute. We are going to use tax increases and tax cut to redistribute from one group of people to another, and third as long as we measure success by how many people have cars at the end of the day. If you were able to get those three things and he would declare victory. I thing he has been very successful in having conservatives and republicans Debate Health care on his terms. Interestingly those were not the terms he used when he was a candidate. When he was a candidate in 2008 senator obama sounded like a conservative. Senator clinton had an individual mandate the issue was of portability. We need to make it affordable he told senator john mccain we dont need a cadillac tax, both of which ended in obamacare. I am one that thinks conservatives and republicans need an alternative to obamacare. I think it is great the we are all for appealing and i think that is wonderful but i think we need to replace it. For a couple reasons. One, i dont think we can go back to where health care was obamacare. Americas Healthcare System was the best in the world that it had significant challenges. I think one of the reasons we are where we are today is for too long when we had the chance we didnt address those challenges and we need to address those challenges. Secondly i think if we dont offer our own alternative, i hope the Supreme Court does the right thing and rules the law is what it says that if they do that and we dont have an alternative we know what will happen. The president says stand up and have a sympathetic family or group of individuals. So and so has cancer and needs chemotherapy or so and so has diabetes, or afford their treatments thanks to obamacare. And these mean stingy republicans wont make a symbol one page change in the law to keep their coverage or lifesaving coverage they got today. We will fall victim to that of we dont have an alternative, we need that alternative today. Some people laughing king of running for president. We need to have your own detailed plan how to replace obamacare. I am happy to talk about it. A lot of folks have plans. And someone else needs to talk about polls or at fund raising or consulting but what they would do if they were elected president. I hope you will see many people offered detailed plans. Im surprised canada has not done that. We are the only actual candidate that has offered a detailed plan. People may like the or not but at least we have had the courage to say this is what we would do. We do deduction instead of a tax credit. We allow interstate purchase of insurance and voluntary purchasing pools and specific and medicaid and medicare reforms and state licensing reforms medical liability, frivolous lawsuit reforms but the point is as republicans and conservatives we need to say we are for, not just we are against and obamacare gives us a great opportunity even before the Supreme Court rules to say we are for two things, we shouldnt fall into this trap of saying we measure success by his terms. His terms are you need a new Entitlement Program, is terms are not only do you need a new Entitlement Program that tax increases that distribute. And count success by the number of cars people have. Success is how many people have cars without meaningful access or not. Doesnt matter whether the deductible is so high you cant afford coverage or if the networks are so tight you cant see the doctor you want to see or take your child to the specialist they need to see the we declare victory because you have a car. That is the rationale behind the push for Medicaid Expansion and much of what has given obamacare and conservatives are falling into that trap, we compare plans by how many cars you give out. That is not a measure of success. The real measure of success is to deal with what then senator obama said in 2008 when he was campaigning to be president when he said the real issue was affordability. He seems to have forgotten that in his actual plan. There are other reasons to be against obamacare. You cant keep your doctor if you want you cant keep your plan if you want, we are not going to get your premiums, the list goes on but the final observation, a lot of people who have never been elected to office till you politically we cant do this or that. A lot of people never stood before a voter tell you is this is the right thing to do from a policy perspective or principal perspective, politically it is not popular. If we are willing to except as a new base line now that the democrats created this dependency we can never go below that, we are done as a conservative movement and we are done as a country. If we honestly say we cant take any steps we cant undo the dependence, no matter what you do deliver services differently but this is a new floor of dependency and too publicly tough to fight for independence with beijing fully in dollars of debt, record low participation in the workforce gdp growth of 0. 2 and we call this a recovery, we have given up on the American Dream. That is why i think the obamacare fight is important. If we mean anything as a conservative movement we need to stand against government dependence. Is important to have a full plan to repeal and replace obamacare and i dont think that plan can simply be a repackaged redecorated version of government dependence. I will stop there and be happy to take your questions about anything i have said or anything folks want to talk about. I will ask a few questions to start off with. You sort of set a lot of the plans that were offered in congress are obamacare like or dont represent full repeal. Can you explain or define the policy distinction between what you would consider obamacare light and what you would consider a genuine alternative. A couple things. This sounds fairly inside d. C. When you talk about baselines. What does that really mean . A lot of these plans have said the new world is obamacare is the law of the land so if we spend more than before obamacare but less, that is a spending cut. Obamacare is the law of the land, we raise taxes but not as much as he did that is a tax cut. That is nonsense. Full appeal means we are repealing all of the spending increases and all of the tax increases, period. That is the first point. A lot of points for the United States senate and house and governors but mainly the United States house and senate last year, one election opposing the president s policy, one of the most popular tv ads in november of 2014 was we are going to repeal obamacare, give us the majority, we will repeal obamacare. I campaigned for a lot of candidates. I dont remember the fine print saying were just going to repeal the easy parts. Just repeal part of it. The rhetoric on the campaign trail was give us a majority and we will reveal that and those candidates won in purple, red and blue states which tells me that the people want obamacare to be repealed. As a baseline, as a starting point you have to get rid of all the tax increases, get rid of spending increases and start by saying how do we reduce costs . That is a full appeal and replace of obamacare. What they would argue is obamacare has been the law of the land in 2010, in 2017, when a republican president , perhaps by the dingell is in a position to implement an alternative, the baseline would have been in place for seven years that is what the assumption is. They say isnt it kind of bizarre to go back to what the world would have looked like in 2010 had something never happened . I would not wait for 2017. They need a replacement plan today and the court ruling gives them a change. We need to challenge the president to do the right thing and challenged democrats up for election to do the right thing, we should concede the we cant do this. As an earlier speaker said simply negotiate against ourselves. If women that they should have been honest to voters. They should have said we dont really mean it when we see repeat obamacare. It is the law of the land long enough we are going to modify it. They should have had that election and given the voters an honest choice and third back to a point i made earlier, if respected new level of dependence as the norm we are done because this president has grown government dependence and spending of borrowing to unsustainable unprecedented levels. I would argue a bigger deck outside health care but including obamacare if we take this as a new normal we wont see the Economic Growth we are accustomed to, we wont preserve the American Dream for our children and grandchildren, it is absolutely critical if we are going to restore what we want, what we view as freedom in this country and the American Dream, opportunity to work hard and get a great job in this country we can sustain this level of spending, borrowing and dependence. The fundamental mistake republicans this is the new baseline, we can do better than this, it is realistic to go back before obamacare was the law of the land and that is what it a told us they were going to do. They didnt mean it they should have released an honest number. There are conservatives who would challenge you and say you are actually the one that is a rendering, giving in to the idea that democrats perpetuate fact any freemarket plan isnt going to be able to cover, isnt going to compete on coverage with democrats. They say your action is the one that is giving in to the premise of the left. How would you respond to that . Two things with it is a mistake to measure success by how many cards people have when it is not meaningful access. Once you fall on that the democrats will be always willing to spend more and once we follow that debate all we do is become cheaper democrats. We are not doing some been radically different, just if they are going to get you a similar system this quickly we will get there more slowly. That is the wrong debate have. And insurance you dont want and willing to count as coverage with meaningful access. And after a couple years there is no meaningful physical Health Care Improvements after medicare expansion but we will count as a success does cause you have a medicare card. That is not success. When you stand up what he said was popular. When he got elected saying things, he didnt talk about giving people cards. Talkedabout driving down costs. And the issue is affordability. He was right and she was wrong in 2008. As conservatives we need to stand up for liberty and say you are right. If you want to elect a party that will buy something you dont want that is not what we see. If you want to focus on making people affordable, helping people who are truly vulnerable you need to help people with preexisting conditions or the individual market, you dont deal with it without takeover of health care. And over 10 years according to the use of high risk fools. Who truly need that help. And the Health Care System, and it is fundamentally a mistake to measure dependence as a success. That is what the president would want us to do. On the Supreme Court case if the Supreme Court struck down the federal Exchange Subsidies. And ruling and black letter law. And the subsidies and the mandates for the most part go away. The most important mandates to go away if the court rules tens of billions of dollars of spending cuts. To preempt what the president will try to do politically and for substantive reasons that is why it is so important congress, once it happens or before it happens, repeal and replacement plan we wont benefit the state exchange. On the idea that you outlined lets take that scenario. Republicans have a full comprehensive replacement and obama the joys it and then what . You are left with a situation in which millions of people are losing coverage, obama has the names of those people as you said he could put them out and say look at these people who are losing their coverage. Republicans have said that they feel lot of pressure to do something talk about creating some sort of bridge that would the essentials media temporary pact that would keep people at least until 2017. You are talking about two hypotheticals lets assume congress, assume the president has something, but wait, lets go back to the second hypothetical, the second to third hypothetical, before the court rules now instead of the president saying look at this person about to lose their coverage republicans saying that is not right, mr. President. We have a plan that helps people that need help. If you sign this bill and not veto it. It is the different discussion and debate and i dont know the we know what will happen. It is a different scenario than if we pass nothing and the president can say here is my 1page bill or even worse, here is each h s pretending the federal exchanges estate run exchanges or some cosmetic agreement with individual states. That is a very different scenario and instead of that the temptation is to surrender before the bite starts. We see that time and again on amnesty, executive orders, the iran bill the negotiations with iran, i dont think congress should surrender. We are talking about three steps that havent happened yet. Lets go fight lets go past and debate the president , and we dont want people to fall behind the gaps. You oppose some of the republican alternatives that would say lets extend the subsidies for existing people not allow new enrollees, federal Exchange Subsidies have a way. To pass the full repeal and replace plan. Lets pass that, get that to the president s desk. You wouldnt rule it out down the road. I am saying we need to repeal the plant and replace it and lets do that instead. And the repeal plan, go at that with the president. On your plan, another one of the criticisms is you have a plan that moves, this is something we talked about in the earlier program relies on a standard deduction rather than a tax credit and what that does is tells people they can get a standard amount of money that reduces their Tax Liability up to that point when they purchase Health Insurance. One of the criticisms of that approach is not only the idea that it can create broad access but it can unravel the employer base market essentials nikons when you have these tools where employers have a nice mix of healthy and old and younger whereas if there is standard deduction, people get cheap insurance because they are young, and and have employers stuck with the older and sec and expensive customers. So a lot might say we are not going tab employer based insurance anymore and this is how half of americans get their insurance. How would you respond to that . Two positions one could take, i guess there are dozens but the sake of simplicity, on one extreme those that say we are absolutely at the employer provided Health Care System, it is where we are today dont want to do anything to change it. If you have Employer Provided Health care you dont get anything out side of that. You are forced to buy it whether it meets your needs or if it is good for you or cheaper or more expensive for you can get on your own if you have Employer Provided Health care available you are not eligible for deductions, tax credit, that is one extreme. Whether they wanted or not. This is an accident of history you give everybody money to shop on their own or take away the exclusion or peoples ability to get health care through their employers. We have gotten out of those extremes. We have said that if you provide a high enough deduction in the short term based on what people are spending you allow interstate purchase insurance or voluntary purchasing pools with economies of scale not just to their employers but also a faith based organizations, professional trade associations, the employers get today said they get the same protections by joining these groups and people weave their employers, they dont have to go into the individual market, you make those reforms there will be of voluntary and gradual movement if people buy health care where they want. Freedom is a good thing and there are some people who say we want to tell you how to receive your health care, it will be the government will tell you or you have to buy for your employer or the Government Exchange market place. I think freedom is the good thing, julius is a good thing. I trust the American People to decide for themselves rather than being told how to get their health care but it is done in a way we think is gradual and incrementally enough to cause disruption to the employer provided market place. That is one of the major sources of stability for privately purchased health care and new marketplaces are not going to be created overnight so is important to create a gradual path way where people have more joy leases and it will happen incrementally. I dont think this worstcase scenario can happen because people wont have all these different choices. There will be a more robust marketplace, that is a great thing, competition is a great thing. At the same time we are expanding access, obamacare curtailed some of the people to buy products that meet their healthcare needs. In a variety of circumstances people will have all kinds of options to pay for their health care to save against Health Care Expenses through their employers or on their own, we shouldnt be afraid of competition and choice or trusting the american consumers. As conservatives lead of the lead in their not, we believe the American People are smart enough to make their own decisions or we dont enjoy in the left. Any more questions . Americans for prosperity. One thing we are hearing a lot about in panic mode leading up to the court case is state legislators and governors saying you hold our feet to the fire, no exchange, no Medicaid Expansion and a lot of these solutions are coming essentially federally centric, whether it is through a bill or transcend the obamacare, federal legislation, do you think theres any hope what would your message to state legislators to tell the congressional delegation we had answers give us control . What your message was to them do you think that is the pliable option or is the message in the debate in washington for that to be something republicans in congress will believe and hold on to . I am obviously in state flexibility not just as a governor but by political background philosophy as well couple things. In our plan we give state lot more flexibility when it comes to running their medicaid programs, giving Global Brands flexibility with accountability. Part of a reason you hear so much about this debate in d. C. Is obamacare has done damage from the federal level. In louisiana 70,000 louisiana and want access to their Health Care Plan because both plans are no longer available because of obamacare, they were canceled because of obamacare. The problem, the state led effort is we cant give him access to their Health Care Plans without the federal government getting in the way. The hhs has been given the authority, if you think of obamacare has done be on distribution and mandate and the expansion would it really does at its core i believe is tries to make Health Insurance with you get it through the private sector or not basically a public utility. Basically the federal government, the hhs and howard to review benefits, review profitability reduce the overhead expense and all these other things so you can buy your own insurance and the state level but basically you can have whatever color you want as long as you want a black model t. It is all the same because the federal government is taking so much power away from the state and regulating Health Insurance and regulating benefit design, regulating affordability, but i believe states can do other things in terms of interstate and compacts and other things, because of the power of the federal government has. We need to get the federal government out of the way, we can go help their citizens, for example you are limited in what you do. I cant impact of federal tax code as governor. If i want to help people in my state go by, it is hard to do that without congress, without the administration removing some of the restrictions. There is absolutely a proper role for the states to play in this in terms of insurance regulation medicaid, but the problem is obamacare to way, i dont think it is amended to the constitution. It is true in education and other areas. Your message is right theres a reason we have to win the fight in d. C. To give states the flexibility to respond. Thank you so much for your leadership and Detailed Health plan, i am thrilled to hear you mention the tenth amendment so i want to pitch you the biggest question on that theme republicans always include in their list of talking points on Health Care Medical malpractice reform, that usually means the fed will override all the state court laws about how you handle medical malpractice, attorneys fees, all these different things. My constitution doesnt authorize congress to do that. What does your constitution say . If you read the plan we did our medical liability reforms in the context of federally paid for programs. The extent joy we pay for the federal governments medicare or medicaid or Health Care Programs we said lets do the port reform within those programs, the federal taxpayer, tens of billions of dollars and federal interest in that because the federal government is paying for it but at the state level, louisiana, california, at the state level we did that without the federal government doing it to us. So we purposely started with tort reforms in the federally paid for programs. Thank you. The Health Policy reporter, the examiner of course it has been noted the Supreme Court could strike subsidies to federal exchanges better chance they might not. How are you going to in your state almost 200,000 people did get insurance on the exchange, a majority got subsidies. How will you convince those people to vote for you if you are running on promises to take those subsidies awake . A couple things. It was over 180,000, down the how many paid their premiums that they made a selection on the web site. And completed their premium. Little lower than that but regardless what the final numbers are, the important thing is to say the president loves to say the republicans just want to take things away we are not saying we want to take something away, we want to give you Something Better. Instead of the federal government forcing to buy a product you dont want that is inflated in cost because of federal regulations we are doing what the American People said they wanted which is driving down the cost of health care and making health care more accessible to folks so they are not forced not only to buy benefits pay for benefits they dont want but to join Insurance Plans that may not cover their providers so some of the complaints from folks is obama, 20yearold single male guy why am i paying for 0 bj y n benefits . Why am i joining and network where my childs pediatrician or my specialists arent included . Democrats would love to position this as the debate of free stuff and republicans just want to take things away from you, the two points we would make is we are actually trying to give you Something Better which is access to affordable highquality health care and secondly it is very important for republicans to take that back because it is not only true in obamacare but the proposal to have Free Community college of folks, why not Free Community college, free car, free house . The American People are smart enough to know this isnt sustainable somebody has to pay for this. Is over 18 trillion of debt and counting. The American People including folks in louisiana and other states are smart enough to know we have to get the private sector economy going again and stop stealing from children and grandchildren. Free benefits the federal government gives us are financed for borrowing money from china and making promises not just obamacare but the status of medicare, Social Security medicaid. I love these programs to be fair for the people of louisiana for children and grandchildren are not going to be there without the current path way but people are smart enough in louisiana and across the country to know that and realize this idea it is not sustainable. It will be very expensive if it is not us, it will be children and grandchildren and the great thing, i dont think as louisiana and across the video i dont think we are willing to mortgage our childrens future. Every generation, for our parents, this generation is no different. To shrinking the size of government and making sure there are opportunities for growth for children and grandchildren as well. Inside Health Policy in d. C. Backing off of king andrew weill, i am curious what your conversations with other governors on what to do if the plaintiffs win, what those have entailed and what your day one plan is if they decide immediately. I dont want to speak to other governors at consequences and different governors will take different positions based on what is best, i can speak for myself as i have said this clearly no surprise to anybody that we are in louisiana i am against this doing and exchange, we are one of the first states Medicaid Expansion and exchanges, the reality is we havent changed. We want to be partners no decision writing authority. We will tell you what to do but you will be our partners. It is not about partnership. And the Authority Setting the the exchange. We have to have a replacement plan in place before the court makes the decision. A lot of hypotheticals, when they make the ruling, none of us knows what they will say, how they are going to come down, in louisiana we made very clear we are not doing a state exchange. We think obamacare needs to be repealed and replaced. I would continue to call on congress to put that in place. In louisiana we are different from other states, every state delivers health care differently. We have not expanded medicaid, we have publicprivate partnerships, we have a network of Charity Hospitals different mechanisms, every state has their own mechanisms in place and they will still be there for people who need access and dont otherwise have access to health care and we have the safety net mechanisms and other states have their own safety nets. And dozens of clinics as well. The best solution is republicans to ask not just to repeal legislation. The sort of lobbying campaign and president obama might lose the prospect of millions reducing Health Insurance. The other pressure will come from lobbyists. We now have a lot of powerful industries vested in obamacare. The Medicaid Expansion, one of the ways in which we have been able to get a lot of republican governors to go along has been heavy lobbying by hospitals, and certainly if the federal Exchange Subsidies get cut off, insurance lobbyists will very aggressively be lobbying to set up a chain. What do you say or what would you argue to other governors to Hospital Insurance lobbyists who were pushing them to do this. That is a great point. Many of these programs are and titles to the providers and they are actually the ones that pushed hardest for these programs for funding these programs. What do you take the insurance company, the hospitals, when it comes to Medicaid Expansion, in my state and other states, when it comes to obamacare in general. I give you louisianas example. When we did look Medicaid Expansion in louisiana and wind wont as long as i am governor 250,000, 250,000 louisiana will move from private insurance to medicaid. At my deck of hospitals is that is more than the number of previously uninsured people moving into medicaid so for every previously uninsured person you would have more than one person prevented from being private insurance and medicaid so if you are no longer getting Blue Cross Blue Shield or private insurance rates youre not getting medicaid rates for those 250,000 people, be careful what you asked for because the reality is overtime medicaid has increased as a percentage of almost every state, our states budget and the way states respond is reduce rates. The 4 hospitals could cost shift to the private sector when medicaid was not paying the full share they wont be able to do that when medicaid becomes 30 , 40 plus of hospitals patient load. Hospitals, this crowding out because in Medicaid Expansion under obamacare there are no anti crowd out provisions, only targeting this to people who are previously uninsured, hospitals need to be careful what they wish for because they may end up part of obamacare does is turn Insurance Companies and to public utilities, hospitals could very much end but being very dependent on government rates and underpaid for the care of their delivering and youll see a deterioration in quality and access, one of the reasons look what has happened with positions, the debate that goes on year after year, now they have this socalled fix. Secondly Insurance Companies, once they become they need to understand where the left is going with this. At the end of the insurance becomes a commodity under obamacare, they wont have the margins because they will be regulated under the federal government. At some point you get to the point you have single payer government sold to the providers to those that think in the short term the benefit outweighs the longterm risks i tell them be careful what they wish for. You have seen some Drug Companies come to their realization as well, some of them thought the short term will have more patients. They are beginning to realize that some point still legislators, congress will look around and see they have to balance their budgets and generally two things, they have reduced volume of services, sometimes arbitrarily, sometimes you see the doctor this many times or this Many Services one size fits all approach and a reduced prices it historically when they reduced prices the administrative pricing providers, you cant do that doing medicare reform in the 90s, gets us on another topic you do premium support democratic economists said the problem of medicare is you are setting 10,000 prices in 3,000 counties. That happens in medicare administrator of pricing, that is the future of American Health care if we continue to grow the federal government involvement in health care. I dont think that is the future providers really want. They need to be careful reading what they think are shortterm gains having the federal government in the long term micromanaging their delivery of health care. That for access and quality. I think you said we should not capitulate to the president s standards for Health Reform, the standard he neglected and acquiesced to. Your definition of affordability is more consumer friendly than obamacare . Under obamacare you had spent 9 of your income before relieved of the mandate. But i believe you defined affordability and block grants to help the people who dont qualify for standard deduction for Health Insurance that the state has to make basic insurance in the state. A justin come in the state. Under your vision of Health Reform with affordability and consumerism and obamacare. July have that right . Such a nice question, i will give you a short answer and say yes. In state grants and people who dont have everybody else would be people, the president was right to say if you have a preexisting condition it can be tough. Unfortunately he ends of screwing the rest of the Health Care System, the short answer is yes with a couple weeks in terms of how we help people with preexisting conditions as well. Just briefly, the president ial race coming up what will do you think obamacare not just obamacare about alternatives play in the 2016 race, how much do you think there is more pressure for republican candidates to come up with a comprehensive alternative so . Coming up with a detailed policy ideas on health care, education, energy and Foreign Policy. This election is different. And the 90s, there was a sense in the 90s in early 2,000s that the differences were not that great. You had compassionate conservatives, the idea was there was a time of peace relative prosperity, we won the cold war, maybe the elections didnt matter that much. We could have elections based on personalities, who tells the best jokes, a different time for our country. People on the left and right would agree this is an election about the direction, i would argue Democratic Party has been taken over by the radical left. Frustrating private unions get good construction jobs to appease the radical environmentalists. They dont want to do School Choice though it helps kids disproportionately from poor and minority families because of teachers unions. They dont want Affordable Energy the Keystone Pipeline and production of federal lands, to support a host of policies to bring back manufacturing jobs and radical donors. It is about two different features of the country and it is divisions and obamacare, different visions on School Choice, Energy Independence Foreign Policy fundamentally it is the distinction of the American Dream. Is it about government dependence or people being able to work and get a good paying job . I challenge anybody thinking of running for president or declared as a candidate to come up with their own values on Obamacare Repeal and replace, all of these issues that this is an important election voters demand that, especially voters Republican Voters are very interested to hear what potential candidates have to say about obamacare. Easy to say you want to repeal it. The next question is what do you do instead and how do you replace it . You said you were thinking and praying about running, you have a legislative session going for the middle of june. This is our third week, we have between one week session, i will make my decision after the conclusion of the session. It is important whoever we elect as president is someone who wants to do something, not just someone who wants to be somebody. All these detailed ideas so that this election is a debate about values and substance. I am biased toward governors might not surprise anybody, they have proven track records and done things and cut our budget 26 , shrunk the size of the government 30,000 fewer state employees and private sector economy doing well. We measure success not in government prosperity but the peoples prosperity and that is the heart of obamacare and i dont think Health Care Reform can be a debate about how many people have cars or whether it is whether we actually have high quality Affordable Health care. That is what Health Care Reform should be. The question is simple, to be wanting control . Do you wanted to be patients and their doctors or bureaucrats . Government bureaucrats or insurance bureaucrats doesnt matter. You want individuals in control, the consumer the patient the american family. Thank you for coming. [applause] is there a Nonfiction Author of books you would like to see featured on booktv . Send us an email to booktv cspan. Org, tweet us at booktv, post it on our wall facebook. Com booktv. Now we want to introduce you to jennifer baumgardner, publisher and executive director of the feminist press. What is the feminist press . Guest the feminist press is a regular independent nonprofit literary press. We really focus on work by women but not just by women, voices that have been marginalized in some way, it was founded 45 years ago to recovery law and literature that had gone out of print because it was written b