Future of the Affordable Care act under the Trump Administration. The House Oversight and Reform Committee heard from advocates, opponents of aca, as well as patient who benefited from the law. This hearing is just under four hours. Committee will come to order. Without objection, the chair is authorized to declare a recess of the committee at any time. This full Committee Hearing is convening regarding the administrations attack on the aca. I now recognize myself for five minutes to give an Opening Statement. We are here today because on march 25th, 2019 nk, the Trump Administration filed a twosentence letter with the United States court of appeals before the 5th circuit reversing its own previous position in the case of texas versus United States in asserting for the first time that it would not defend any portion of the Affordable Care act in court. If the Trump Administrations position prevail s and the entie aca is struck down, there will be catastrophic implications for millions of americans in the entire United States Health Care System. Ive often said that voting for the Affordable Care act was the most important vote of my career. And let me tell you why. When Congress Passed the aca in 2010, we enshrined into law the promise that all americans have the right to accessible, affordable, Health Insurance coverage. The aca established new protections and to end legalized discrimination against approximately 130 Million People in the United States with preexisting conditions. The aca authorized states to expand their Medicaid Programs and approximately 17 million americans gained coverage as a result. The aca created Online Marketplaces for consumers to purchase insurance with Financial Assistance through premium tax credits and costsharing reduction payments, and today, nearly 9 million individuals receive Financial Assistance to obtain coverage through the individual market. The aca improved the quality of coverage for millions more by requiring the plans cover a set of essential health benefits, provide coverage for Preventative Services such as immunizations and screen tests and allow young adults to stay on their parents plans until they turn 26. If the Trump Administration is successful, all of these federal protections would disappear. People with preexisting conditions like diabetes, cancer, hiv, asthma, Substance Use disorder, or even pregnancy, could be denied Health Care Coverage or charged more. Babies born with Health Conditions could be uninsurable for their entire lives. And Insurance Companies in the individual and Small Group Markets would not have to cover essential services such as preventative care, hospitalizati hospitalizations, emergency services, Maternity Care, and Prescription Drugs. However, since President Trump took office in january 2017, Neither Administration nor Congressional Republicans have offered a plan to replace the aca that would prevent coverage losses or the elimination of Consumer Protections. House republicans have voted 69 times to repeal the aca. The last proposal, which failed to pass the senate in 2017, would have increased the number of uninsured by 21 Million People. Theres something wrong with that picture. During the 2016 campaign, President Trump promised repeatedly that he would come up with a plan to replace the aca but never did. Never did. Now that hes running for president again, he promises promises have now returned. Youll be hearing them shortly, if you have not already heard them. In april, he promised to release, and i quote, a really great, plan. After the 2020 election. Unfortunately, nobody has seen it. Ironically, if the Trump Administration is successful in striking down the entire aca, it would directly undermine many of their own policy goals. Including tackling the Opioid Epidemic, lowering Prescription Drug prices and ending the hiv end dem ek. We wanted to hear from the administration about why they suddenly reversed hair positi dn in litigation. We wanted to know what the administrations plan is for millions of people. If they went in court and invalidate the entire aca. We invited the acting director of the office of management and budget, russell voet, to testify at todays hearing, but he declined. Apparently, he did not want to answer these crucial questions that affect so many millions of americans with their with something thats very personal, and thats their health. Ive often said to my proteges that one thing that we must always ask ourselves every day, i think, and that is what is the enemy of my deestiny . What is the enemy of my destiny . What will stop me from reaching where god meant for me to go . And theres one common denominator that i noticed that all that applies to all of us, health. Health. And enjoying a life where you can truly pursue happiness. So although the Trump Administration refuses to answer these basic and critical questions, were very fortunate to have a panel of legal and policy experts and patient witnesses who can tell us exactly what it will mean if the Trump Administration is successful in eliminating the Affordable Care act. And i ask our entire committee not to be blinded by what we see. Dont be blinded. The experts are here. Theyll let you know. They are the witnesses. They are on the front line. They deal with these matters every day. And then there are others who have gone through and continue to go through difficult circumstances. I can relate. Now that im on a walker and ive learned what it is to be disabled. And it is a tremendous task in most instances just to get dressed. I got it. And i often say to our witnesses who have tcome to share with us their personal stories, thank you. Thank you. For taking your pain, turning it into a passion to do your purpose. Pain, passion, purpose. And so they traveled from across the country, from utah, missouri, pennsylvania, new york, to share their stories with us. Theyre here to tell us what life was like for them and their loved ones before the aca was passed. So i thank you again. And with that, i yield now to the very distinguished gentleman from ohio, the Ranking Member of our committee, mr. Jordan. Thank you, mr. Chairman. I, too, want to thank our witnesses for making the trek here and being willing to share their story. I was hoping today that we could have a discuss about Real Solutions that will make the lives of Everyday Americans better, talk about the costs of health care, access to health care, coverage, preexisting conditions. Theres no one on this committee who would support denying coverage to americans with preexisting conditions. I was hoping we could focus on those issues, but unfortunately, like so many other hearings in this committee, were not. Rather than working toward bipartisan solutions, this committee is once again looking to score political points by attacking anything the Trump Administration does to improve the health care for American People. Next door in the Judiciary Committee, we reported out milli multiple bills that would have had meaningful impact on the cost of pripgescription drugs. Worked for months to cut down red tape, make improvements to how affordable generic drugs come to market. Those bills were all bipartisan. I was pleased to vote for them. In fact, many of them passed the Judiciary Committee unanimously. We could be talking about bipartisan substantive issues here today, instead, instead were going to talk about why the democrats are upset that the administration thinks americans deserve Something Better than the failed ideas of obamacare. Under obamacare, make no mistake, americans saw their premiums skyrocket and their Health Care Choices reduced. The majoritys title for todays hearing is trumps efforts to undermine the aca. Undermine the aca . Think about what we were told when this bill passed now, what, nine years ago . I call them the nine lies of obamacare. Think about this. Remember this one . If you like your doctor, you can keep your doctor. You all remember that one . How about the one, if you like your plan, you can keep your plan . We were told by the president of the United States premiums were going to go down. He then got more specifics, premiums will go down on average 1,500. He said deductibles would decline. Five false statements right there. Oh, remember this one . This was in the fall of 2013. Remember this one . They told us the website was going to work. They told us the website was secure. Your information would be secure there. They told us that these coops were wonderful, end all be all creations. 23 were created. Guess how many are still in existence . Four. The other 19 went bankrupt. Oh, the other ninth lie, first they told us it was not a tax. Then they told us it was a tax. You cant tax at all, individual mandate is gone, its a penalty. Nine different lies were told about obamacare. The title is called how can you undermine something thats already failed . I dont expect my democratic colleagues to acknowledge it, but the Trump Administration has worked to increase competition, transparency, and quality of care in our health care markets. Increased competition, transparency, and quality of care are all goals we all should share. I dont know if theres anything the Trump Administration could do, though, that would satisfy my colleagues on the other side of the aisle. Timing of this hearing is also particularly troubling. Just yesterday the 5th circuit began oral arguments in a case that could invalidate obamacare due to recent changes in the law. The administration chose not to defend obamacare in this appeal. That decision is entirely consistent with similar actions taken by other administrations in the past for other laws. But here we are. Democrats sought to have the director of omb here this morning to testify about how the Trump Administration made this decision. Could have had a witness from hhs. Could have had a witness from doj. No, they wanted someone from omb. Make no mistake, this isnt about serious congressional oversight. This hearing is about trying to manufacture a controversy based on Anonymous Sources and news reports. This hearing is just another attack on President Trump, and its disappointing. We could have had a productive discussion today about Real Health Care policy. Hopefully we can still do some of that. I hope we can. I know thats what our side is going to try to do. Could have had a real discussion of how to make health care more competitive, more transparent, more Cost Effective and with better quality of care. I hope at some point this committee will stop its relent list politic les political attacks, and makes a real difference in the lives of our constituents. Again, i want to thank our witnesses coming here to tell your story but i think the country deserves Something Better. Than the lies we were told. Anyone remember the name, Jonathan Gruber . Remember that name . The New York Times called him the architect, the architect, of the Affordable Care act. And hes the guy who was caught on tapes a few years later, remember, calling us all stupid, calling americans stupid, for buying the lies that the Obama Administration told us when they passed this thing. Again, its not my words. Its Jonathan Gruber. The architect of obamacare. But somehow, the minority or the majority says this is a hearing on efforts to undermine a law that was passed with so many false statements made about it. Mr. Chairman, i yield back. Thank you very much. Let me be clear to the witnesses. We want constructive solutions. Believe me. Life is short. I dont waste peoples time. And i damn sure dont waste mine. Now i would ask that our witnesses in a minute stand, in a minute, but let me introduce them first. Abbe gluck, professor of law, director of the sol moman cente for health, law and policy, Yale University law school. Thank you. Frederick isasi is executive director of families u sarks. David balat is director of right on Health Care Initiatives, texas Public Policy foundation. Paul gibbs is one of our Patient Consumers from west valley, utah. Welcome. Casey dye is another Patient Consumer from monroeville, pennsylvania. Stephanie burton is another one of our Patient Consumers from kansas city, missouri. And i will now yield to the distinguished gentlelady from new york to introduce one of her constituents. I thank you so much, mr. Chairman. It is my honor and pleasure to introduce my good friend and constituent, peter morley. Peter is an outstanding patient advocate, the most effective one i have ever met in my entire life. He is a twotime cancer survivor living with lupus. Peter is an extraordinary advocate for the millions of americans who cant come to congress to advocate for themselves but are living with preexisting conditions, whose lives depend on consistent and sufficient Health Care Coverage that is guaranteed to them under the Affordable Care act. I first met peter two years ago on twitter when he reached out to me to ask what he could do to save health care. He depended on it. Many of his friends depended on it. What can i do . I never dreamed how far he could go. He is a true example of how one person can make a difference. Peter, i said become an advocate. He started in the city of new york going to forums, press conferences, meetings, then expanded it to coming to congress over 21 times, including today, testifying before congress. He has held over 150 meetings with members of congress and senators on both sides of the aisle. He is incredibly effective. He is the voice for the many people that need to know whats happening on social media. He has a huge follow iing. He uses this platform to lift up the struggles, hopes and dreams, of so many people who are struggling with Health Care Issues and his goal is to save the Affordable Care act. Thank you so much for all your dedication, peter, thank you. I want to recognize mr. Roy for an introduction. I thank the chairman. Really quickly want to welcome david balat who is here. Hes recently a constituent in texas 21. He works at the texas Public Policy foundation, also in the 21st Congressional District of texas, austin, texas. David is a longtime, been actively involved in the Health Care Industry and Health Administration and other areas of health. Hes a great expert on health. Glad to have you here, and thank you for representing the great state of texas and texas 21. Thanks, david. Thank you very much. Now, those of you who can stand, please take the oath. Do you swear or affirm that the testimony you are about to give is the truth, the whole truth, and nothing but the truth, so help you god . Let the record show that the witnesses answered in the affirmative. Thank you. You may be seated. I just want to let you know that the microphones are very sensitive. Speak directly into them. Make sure theyre on when you speak. Nothing like testimony that we cant hear. And without objection, your written statement will be made part of the official record. With that, professor gluck, you are now recognized to give an oral presentation on your testimony. I want to remind the witnesses that we all have your official statements. We want to try to limit this to five minutes. I know i know. I know. Its hard. But we you see all these people here . All them want to ask you all questions. So i just want you to give a statement kind of summarizing. Stay within that five minutes and there will be a light that comes on and let you know that you need to end, okay . All right. Professor gluck. Chairman cummings, Ranking Member jordan, members of the committee, good morning. Good morning. I appreciate the opportunity to testify here today. Texas versus azar is unlike any other major case involve lg the Affordable Care act. This is the first major challenge where there has been a consensus among legal experts including prominent aca opponents that the Lower Court Decision was dangerously wrong. The stakes are enormous. 20 Million People will lose their Health Coverage immediately. Millions more will be adversely affected. The aca reaches every aspect of the Health Care System. Not just people with preexisting conditions. 10 million got health care through an exchange. 17 million through the Medicaid Expansion. Seniors on medicare got billions of dollars in benefits. Also losing would be anyone who wants a vaccine, preventative care, Substance Use treatment, and much more. All gone. Its critical to appreciate the overreach of the texas decision that the entire aca has to go and the administrations decision to support it despite the opposing legal consensus. For example, i filed a brief in this case where jonathan adler, the most influential critic of the aca during the last Major Supreme Court case. Another brief was filed by two republican attorneys general. Many other prominent conservatives including judge michael mcconnell, michael cannon of cato, and the wall street journal filed briefs or wrote to oppose the case. That is because this case is about more than just obamacare. It is about the violation of a centuriesold legal principle that safeguards congressional lawmaking power. The principle is called severability. Unlike the legal questions at issue in the other cases, severability is settled, nonpolitical law. All nine justices applied the exact same test. The doctrine addresses what a court would do if it finds one part of a statute invalid. Does it strike down the entire statute or just the offending provision . The texas case, as you know, involved the 2017 tax law in which congress made one change to the aca. It reduced to zero the penalty for failing to obtain insurance. The plaintiffs argue that coverage provision is unconstitutional but thats not whats causing the crisis. That provision is not being enforced. Whats causing the crisis, theyre also arguing the entire aca has to go down with it. That conclusion is at odds with unbroken Supreme Court precedent on severability. There are two parts to the test. First, we presume that we save, not destroy. Chief Justice Roberts and Justice Kavanaugh both recently wrote that courts must sever to the narrowest extent possible. Second, legislative intent. As Justice Alito recently wrote, unless it is evident that congress would not have enacted the rest, the remainder of the law remains standing. Sometimes this test can be difficult. Its hard to know what congress would have wanted. But this case is not difficult and thats what makes it different. The courts do not have to and are absolutely not permitted to guess whether congress would have wanted the aca to stand because he or congress, itself, not a court, eliminated the penalty and left the rest of the statute standing. By leaving the aca intact, congress made as clear as possible in the text its determination that the aca should continue. It doesnt matter that some members of congress wished to repeal the law. It doesnt to implement the preferences of those who lost the vote would be for the court to accomplish what congress could not over two years of trying to repeal. Thats what the texas court did. To excerpt from the two republican attorneys general, congress 2017 amendment establishes the law is capable of functioning without the mandate and that congress prefer the law to no law at all. Moreover, to get the results it wished, the texas court had to ignore the intention of the 2017 congress and focus instead on the 2010 congress. But the 2010 congress, i must emphasize, is irrelevant. Later congresses are allowed to amend statutes passed by earlier congresses and courts are not allowed to give one congress more power than the next. The legitimacy of congress 2017 judgment is not undermined by the fact that an earlier Congress Might have said something different. Ive already alluded to the enormity of the consequences. In addition to the 20 million who would lose coverage, we would again be charged based on health risks and caps would be imposed. Kids couldnt stay on parents plans until 26. Women could be charged more than men again. No more subsidies to make insurance affordable. We would lose basic Services Many of us now take for granted that were not provided before. Maternity care. Prescription drug coverage. Preventative screenings. And the acas major drug bene t benefits for seniors. The administration, itself, cant accomplish its own initiatives, whether ending the hiv crisis or the Opioid Crisis without the acas reforms. Mr. Chairman, it is not every day that vigorous legal adversaries take a joint position. This case is about much more than the aca or even about dire consequences. It is about separation of powers, congressional power, and the limits on judges. I thank you, and i look forward to your questions. Thank you very much. M chairman cummings, Ranking Member jordan, and members of the committee. Thank you for the opportunities to testify today. Im frederick isasi, the executive director of families u skrks usa. For 40 years weve served both in d. C. And the state level. Our mission is to allow every individual to live their greater potential. Our work is to represent the needs and interests of families. We are extremely proud of our bipartisan work just this year to address surprise medical bills, Prescription Drug costs and improved pricing transparency. With bipartisanship possible, it saddens me greatly to be here today to discuss the impact of this lawsuit. As youve heard, and it bears repeating, if the aca is struck down, 20 Million People in america will lose Health Insurance coverage, period. That includes more than 300,000 people in your home state, maryland, chairman cummings, and more than 700,000 people in the home state of congressman jordan. Beyond that, vital Consumer Protections will be stripped from people with preexisting conditions, women, older adults. For those of us who receive our Health Insurance from employers, hundreds of millions of americans, we could be subject, again, to annual or lifetime limits in our Health Insurance policies. Meaning we could lose access to coverage when we are the sickest and need it most. Further, since the aca, we cut the National Insurance rate for adults and children by almost half, including gains for families in Rural America, veterans, older people, premedicare and many, many others and the aca included a host of other improvements. As we heard, the aca lowered seniors cost in medicare. Increases solvency of the Medicare Trust fund. The aca even created a bathway for affordable biologic drugs to treat Breast Cancer, leukemia and diabetes. Many will try to focus todays discussion to the vast improvements created in the aca to focus instead of the impact of the aca on Health Insurance premiums. We at families usa share the publics deep concern about premium costs and making to Work Health Care much more affordable. However, the data are very clear. It is wrong to say that the aca is the cause of high insurance premiums. First, despite all the rhetoric, according to the president s own actuaries, premiums in the Employer Market have grown more slowly since the aca took effect in 2014. And in the individual market, most families in the marketplace are paying less for their coverage. For others in the marketplace, we know costs have increased, but, and this is important, this is largely because the aca forbids insurers from discriminating against people with prekiexisting conditions. Many more people, both kids and adults with complex Health Care Needs can get access to affordable insurance because of the aca and their costs are shared among all of us. And despite the truth that the aca has lowered premium costs for most, we can all agree, we all agree, that Health Insurance premiums were rising too fast before the aca and premiums are still rising too fast. Health insurance premiums primarily reflect the cost of the care paid for by the insurance. For example, the cost of Prescription Drugs, hospitals, physicians. As we all know, the underlying cost of health care have increased far in excess of our paychecks for decades. Most recently because Health Care Prices are skyrocketing, no one in this chamber or watching from home doubts this as a nation we have got to get a handle on Health Care Costs, but to blame the aca for out of control Health Care Costs is like a drowning man blaming a life preserver for getting them wet. And members of the committee, the public does not want the aca to be overturned for for well over a year a majority of americans support the law. When polling on individual coverage elements of the aca, the publics support grows overwhelmingly both among democrats and republicans. Finally, lets not forget how we got here. Republican leaders in congress and President Trump failed to repeal the aca so they passed a law that zeroed out the individual mandate, partisan attorneys general filed suit to say that without the amendment, the entire law should fail. As weve heard both conservative and progressive legal scholars believe the litigation is groundless, and many also believe that the president has failed in his constitutional duties by choosing not to defend the health care law. As a result, our basic health care hangs in the balance, and this is why one of the broadest groups of Health Care Stakeholders in our nations history supports the aca. From the american medical association, aarp, the American Hospital association, the american cancer society, the american heart association. At families usa, we hope this troubling hour will pass, that the bedrock protections of the aca will remain and that tens of millions of families across the country can breathe a sigh of relief. They will know that because of the aca, if they or their children get sick, or they need to get health care, they wont lose their home or all the other things theyve worked for simply to get care. Thank you, again, for the opportunity to testify, and i look forward to taking questions. Thank you very much. Mr. Balat . Thank you, chairman cummings, Ranking Member jordan and all the distinguished members of this Important Committee for having me here today. My name is david balat. Im the director of the right on Health Care Initiative of the texas Public Policy foundation. Id also like to thank the others who have come here to testify this morning. I firmly believe we all want the same things. We want affordability. We want accessibility. And health care, we simply have different ideas of how to get there. For those patients that are here today, who may have benefited from the aca, thank you for your bravery in telling your story because i know the difficulty you face in dealing with this broken system. Health care is an american issue, not a political one. Its personal. Not partisan. My experience as a health care executive, hospital administrator, and patient advocate, precedes this. Lawmakers have consistently conflated and confused Health Insurance with health care. Im here to confirm to this body that coverage is not care. As a hospital administrator, ive seen people use the mrnl department for basic primary care. Even though they may be insured, theyre unable to afford their deductibles which inflated 200 to 400 in the last decade. The aca sought to reduce emergency beapartment servidepa. Its been the opposite, particularly in states that have expanded medicaid. Outside the emergency departments, access to care has been an issue as well under our Current System. It was no better prior to the introduction of the aca, but the problems have certainly been exacerbated since its passage. The number of providers which accept the plans is minimal and shrinking. Leaving patients waiting for appointments to see their primary care physician. When they do get to see their doctor, they may be referred to a specialist which, again, can prove difficulty especially if finding one in their region. The Administrative Burden created by the aca has limited choice for those who are most vulnerable. In fact, a study in february of this year titled the effect of Health Insurance on mortality power analysis, what we can learn from the Affordable Care act coverage expansions, it dem zr demonstrated there was no effectively demonstrating the enrollment in the aca had the same impact as having other forms of coverage or no coverage at all. Even those patients on the aca exchange are left with a deductible and obligation. These large financial obligations left to the patient often leave them in the position of not being able to afford going to the doctor and often waiting when they have to go to the emergency room which further drives up the cost of care. Let me be clear. Insurance coverage under the aca has has driven up the cost of care has hurt patients withadvi help patients understand the complexity of health care. Theres always a Common Thread in their frustration. They dont get to decide. They pay more and they get less. Needless to say, we have a corrupt system full of perverse incentives in virtually every segment of the industry. Rather than the patient being in charge of very personal decisions, government regulations have empowered Insurance Companies to be in charge. The patient and doctor are the main ones who care about Patient Health and yet they have limited decision power. The decisions are being made instead by government administrators, the Insurance Companies, and a number of other middlemen. We have a lack of affordability and inefficiency because there are entirely too many middlemen who have come between the doctor and patient in that relationship. The medicare bureaucracy sets prices for services and the Insurance Companies enforce those fixed prices on everyone else, even in the private market. We need a system in which everyone has a choice and the Government Role is limited to a safety net. The Current System is failing because it is unaffordable and unreliable. Americans understand that the problem is the high cost of health care and what they want is to be empowered to make decisions for themselves and their families and to have a sense of peace of mind. This doesnt come from government mandates. This is evident when people are involved in participating in their Care Management with their doctor. We hear about the number of uninsured in this country but not all of them are without care. I am among that statistic of the uninsured. But i would assert id get Better Health care as a patient because to repeat my point, coverage is not care. I use direct primary care and medical cost sharing for my catastrophic coverage. For myself and my family. These models, in addition to the many others that have been promoted by the Trump Administration, do not have exclusions for preexisting conditions and are demonstrating a higher degree of accessibility and affordability. The high cost of care in the country increased significantly during the time of the aca. The high cost of care is the single biggest reason why health care has become less accessible. The high cost of care is what American People care about. The high cost of care is the direct result of the federal government attempting to Fix Health Care and failing. Choice and competition, not a onesizefitsall plan is what we need for something as local and personal as health care. We need a landscape of choices that are as diverse and as personal as all of us. Thank you very much. I look forward to your questions. Thank you. As we now move to mr. Gibbs. Let me say to our patient witnesses, again, i want to thank you for being here. I think your testimony is so important. So often here on capitol hill, we look at statistics and we read about people having problems, but theres nothing like having people who go through it every second of their lives. So, mr. Gibbs, and thank you. Thank you, mr. Chairman, thank you, members of the committee, for giving me the opportunity to speak today. Ive heard this law referred to as it commonly is by the names either the Affordable Care act or obamacare. For me, its important to call this law by its full name. The Patient Protection and Affordable Care act because the Patient Protections of the aca have been a gift from god for people like me and families like mine. My Health Care Story begins in 1974 when my twin brother and i were born with serious medical conditions. He had a condition called hershbrungs disease in his intestines which caused him to need 17 surgeries by the time he was 5 years old. I had nine surgeries on my kidneys for a condition call ee bilateral uretial reflux, meaning urine was going back up the ureters into my kidneys instead of down where it belongs. Now, the costs of that were e s seve severe. My parents never got out of the financial burden of those Health Care Costs for my brother and me. Within the past ten years, theyve passed away with virtually nothing material to their names but with a great legacy of caring for their family as much as anyone ever could. It was in november of 2008 that my doctor told me in a routine visit, i thought a routine visit, that i was in endstage kidney failure and needed a transplant as soon as possible. I was working. I was going to school. I was doing my best to do a contributing member of society, but i had no Insurance Coverage. Now, coverage may not be care, but when you need a 79,000 surgery, there is no care without coverage. Known for its generosity and taking care of its members, but my church couldnt pay for a 79,000 surgery. And i needed two surgeries. My kidneys were in bad enough shape that they were considered an infection risk for the new kidneys, so they had to be removed first ten years ago this week. Ive heard opponents of the aca say people dont die in america because of health of lack care because they can go to the emergency room. You cant get a kidney transplant at e. R. Now, i was fortunate. I fit the fairly narrow qualifications for medicaid before aca expansion, and i also fit qualifications for medicare coverage. Those allowed me to have that life lifesaving surgery ten years ago this august. But the expenses didnt end there. Every day, i have to take immune no suppressant medication to keep my own body from rejecting the kidney. I also have to take other medications caused by the side effects of the immunosuppressant medication. I also because my doctors later discovered a chronic descended bladder may have caused it to begin with. I have to use these catheters five or six times every day just to be able to empty my bladder. Without the aca, it would be an expensive prospect for me to be able to urinate. All of these expenses together add up to almost as much per month as my mortgage payments. Now, i hear talk of protecting preexisting conditions on other plans that everybody wants to protect preexisting conditions. Well, the previous plans that have been put forth include things like pushing people like me into expensive and unreliable highrisk pools. Those are not protections for preexisting conditions. Potential lockouts for not having continuous coverage are not protections for preexisting conditions. I hear talk that we want to relentless attacks on the administration, the aca, people like me feel relentlessly attacked by this administration and by the members of committees like this one who keep attacking the aca. My son, peter, 5 months old this week, was born with a kidney condition similar to mine. He, like chairman cummings talked about, is one of those babies who could be shut out for life. He had a kidney surgery two weeks ago, and without the aca, he wouldnt have the protections to ensure that he can receive the followup care he may need his entire life just for being born with a bad kidney. Hes one of two sons i have who had the chance to be born because of the wisdom of the Patient Protection Affordable Care act which gave me this coverage. In conclusion, i want to say that we are guaranteed in the declaration of independence the rights, the inalienable rights of life, liberty and the pursuit of happiness. Life comes first because without life, all other all other rights are meaningless. Being subject to Insurance Companies being able to deny us coverage or make it prohibitively expensive because were sick is not liberty, and without those protections, without that access to health care, there can be no pursuit of happiness. My sons deserve the right, they deserve the right to be born. They deserve the right to stay alive. And they deserve to have a father who has access to the care he needs to stay alive for them. Thank you very much. Thank you. Thank you very much. And congratulations. Thank you. Ms. Dye. Thank you, chairman cummings and the committee for letting me talk today. Over the past nine years, my family has faced a lot of challenges, but i hope you hear my story and recognize that im not some unique one in a million story. The challenges my family have faced are like so many families who work hard, play by the by t rules, faced as they go through life. As parents, we want to make sure we can do the most essential thing for our kids and keep them safe and healthy. We also want to know as they go through their own journeys they will also overcome challenges and continue to pursue their dreams. In august of 2010, my husband lost his job. We couldnt afford cobra. Between august and november of that year, he and i went uninsured. Our 1yearold daughter got coverage through chip. In 2016 my husband lost a second manufacturing job. Thanks to the a. C. A. We didnt have to worry about going uninsured again. My Employers Health plan would cost per month. We pay 60 a month for our son who is on chip and our daughter is covered under the loop hole for her disability. After my husband lost his job in 2016, we wanted to move closer to family in your state of ohio and florida and arizona. Your state told me my daughter wouldnt get the services she needed. So therefore we have to stay in pennsylvania. We also had to tear our life around the needs of chessy. My husband is going back to college to switch careers in a health care field, which doesnt require us moving from state to state to find a job. Thanks to the a. C. A. In 2018, i was able to get a mammogram that showed i had three lumps in my left breast. Biopsies were done and thankfully they were benign. If i were uninsured and results were differently this could have been financially disastrousi. I looked at my husband and said i should just have a doctor remove both of my breasts because i might not have cancer next year. If i get cancer i might be uninsured. This is my reality and reality of millions of families in america. And the fact is i dont trust the Republican Party to say that you care about me and my family and the rest of the families in america to cover preexisting condition, to cover those with disabilities. I also had decided to get a pelvic exam two years in a row. When a doctor asked me why i scheduled it this way because you can go between three and five years, i told her im worried i wont have coverage next year. He said she was glad i made the choice to come in. Im actually an lpn who works in pediatric home care. A lot of kids i take care of are on medicaid. Not only is my job, but the lives of my patients are at risk if you guys make cuts to these vital programs. Our daughter who is right here with the little pink head phones where is she . Okay. All right. Seems to be listening to your testimony. Im not as important. Since she has been 19monthold, she has been in therapies for speech and also sign language so she could communicate with us. Speech we use in every day life from watching tv, listening to music, reading books, talking to our friends, socializing and work. At the age of 3, she was seen by three doctors, two diagnosed her with developmental language disorder where children have problems understanding or using spoken language. She will have this in adulthood. The other doctor diagnosed her on the autism spectrum. All doctors agree she needs intense speech therapy. In school, she receives speech three times a week and o. T. One time a week. She also gets speech and o. T. Once a week in outpatient. She has a mobile therapist that comes to our house two hours per week. A mobile therapist helps her to appropriately express her thoughts, feeling and work on coping skills, practicing social skills in all. She gets six therapies a week and not including mobile therapists. If she loses her medicaid coverage it would cost us to keep her at a current level of therapy. Because my husband is in school and on one income we can never afford it. Today she talks a lot and she talks to her friends on her own. She has made significant academic progress. Last year she was a c student. This year she got all as and one b. In math and reading she is two years behind, just to break it down to you, imagine a tripod and she is on top of the tripod. The three legs represent us her parents, two is the therapist and the third is her teacher and her aides. If you guys cut medicaid, youre going to knock down that tripod and take away and knock down all the progress that she has made. The only chance of her being a productive member of our society and being able to get a job and hopefully make minimum wage is these crucial programs that you guys have in place right now. I just want you to realize what you guys are doing and not just think of my family and my daughter, but the millions of families around the United States that you guys are going to affect. Thank you. Thank you very much. Chairman cummings, Ranking Member jordan and the distinguished members of the committee, good morning. Good morning. I live in kansas city, missouri. In august of 2008 i left my job as a probation officer to attend law school. I could not afford Health Coverage so i was uninsured throughout school. Upon graduating in december of 2010, like many of my classmates, i was unable to find work and was forced to starting my own Legal Practice meant i still had no health care. As a single mother of four young children, that was devastating. My diabetes went untreated for five years. When my health got so bad that i could not tough it out, i was forced to seek medical care in the emergency room only. As a mother, i felt i had let my children down. I had done everything that seemed right by furthering my education, yet i still couldnt afford a routine dr. s visit. On january 1, 2014 i enrolled in a Health Insurance plan i purchased through the market place. I no longer had to decide between paying my mortgage and going to the doctor. I have been able to manage my diabetes and get the medication yz need to stay healthy for my kids and my clients. Its a huge load off of my mind. I have been covered through the market place since the beginning of the first open Enrollment Period and i found the coverage affordable and easy to use. When taking a flight, the attendant says if you are traveling with small children in the event of an emergency first place the oxygen mask over yourself and then the small child. To every parent, we consistently put our children first. However, if we do not take care of ourselves and our health first, we will not be around to care for our children. The Affordable Care act was like that oxygen mask. It allows me to have health care to keep myself healthy so i can continue to work and provide for my children. Until march 7 of this year, i was selfemployed without the option of employerprovided Health Insurance. Upon accepting this new position eight years after having to hang my own shingle, i am offered my Health Insurance through my employer. Though the benefit option is great, the policy i have through the market place is better. I have had the same team of doctors since i enrolled in 2014. Although the need isnt as urgent as me today as it was eight years ago, i can say that the Affordable Care act saved my life. The last five years of coverage have kept me the healthiest i have been in the 11 years since i started law school. One of the requirements of my Current Employment was to undergo a health physical. I have no doubt that i would not have been healthy enough in 2014 to accept the position i have now. Maintaining Preventive Health care through routine visits has allowed me to continue to treat my diabetes without fear of being turned away. Access to health care should be a fundamental human right to all people. There should be no lapse in choices when it comes to health care or housing. During this administration, i frequently wonder what would happen if i lost my coverage. In the event i had to return to private practice, would i be able to afford my insurance without my subsidy . Would i be lucky enough to last without the treatment that i receive . This is a what happens to families without Health Coverage issue. Its a why are we turning back the hands of time issue . It is why should a single mother of four children be forced to choose between housing and health care issue. We create another undue burden on society if we cant keep parents healthy enough to raise their children issue. So i ask you and i urge you all, both sides, dont take away the coverage from 20 Million People. Dont return to the crisis, the Health Crisis that we endured before the a. C. A. Thank you. Thank you very much. Thank you, chairman cummings, Ranking Member jordan and members of the committee. I am honored to speak with you today. My name is peter moorely. In 1997, i had an injury during a lapse of Insurance Coverage. All treatment and medication costs were paid out of my own pocket. When i later needed surgery, my Insurance Company considered my injury to be a preexisting condition, and all my claims were denied. It was a financial burden totaling in tens of thousands of dollars. In 2007, i was permanently disabled from an accident. I was spared the costly medical bills of four spinal surgeries because i had continuous Health Coverage. In 2011, i survived Kidney Cancer and fought my way into remission after losing part of my right kidney. In 2013, i was diagnosed with lupus which causes me severe fatigue and most days its a struggle to get out of bed. I now manage over ten preexisting conditions, take 38 different medications and receive 12 biologic infusions to slow the progression of my disease. I live on the brink of financial ruin and only live modestly thanks to insurance and the fact that i cant be discriminated against because of a preexisting condition. Preexisting conditions are a way of life for me as well as millions of others. Thanks to advances in science and medicine, most people like me with chronic diseases can live happy and productive lives, but only if we are provided access to Health Insurance that cant be taken away because an Insurance Company decides its in their best interest not to cover something or if congress decides to repeal our health care or the single greatest threat we face to our health today, the Trump Administrations refusal to defend the Affordable Care act. As someone who spends the majority of my waking hours in doctors offices, the a. C. A. Has meant focussing on healing, not bankruptcy. I used to be very private about my health. But once President Trump was elected and set to repeal the a. C. A. , i could no longer be silent. In december 2016, i decided to foster awareness for lupus and advocate for health care. My congresswoman has taken up my cause and those of people like me. The Trump Administrations reckless support for the texas versus azar lawsuit to tear down the entire a. C. A. , terminating it as the president has said, is a grave form of subversion. In the last two years, i have travelled to d. C. 20 times to advocate for thousands of people who shared their Health Care Stories for me. I have met with democratic and republican members of congress alike. My message is simple. If you think people dont get hurt when the administration doesnt defend the a. C. A. , think again. We do. I do. Millions do. If you think preexisting conditions arent important, remember someone you love could have an accident, be diagnosed with cancer or lupus at any time. And that will change how you think about this. I know first hand your health care can change in an instant. And if you think the a. C. A. Isnt perfect, your job as our representatives isnt to tear it down. Its to make it better. I appreciate the committee holding this hearing today. If the Trump Administration can choose not to defend the a. C. A. , citizens like me understand that future administrations can do that with any law. I put my health at great risk to travel here and share these stories. I never know if this is the last time i am healthy enough to come to d. C. I would be remised if i did not mention my friend and advocate of medically fragile children, natalie weaver, whose own daughter, sophia weaver passed away in may. Sofia endured 30 surgeries in her short ten years of life. Natalie spent precious time away from her daughter for the betterment of Health Care Access for all children. She will never get that time back. These are the sacrifices that we make as advocates. That is why i am here today to ask you to protect the Affordable Care act and to hold the Trump Administration accountable for not defending Health Insurance for all americans. Thank you for allowing me the opportunity to testify. And im happy to answer your questions. Thank you very much. Pain, passion, purpose. I will now yield to the distinguished lady from new york. Thank you, mr. Chairman for calling this very meaningful hearing. And i am so proud that one of my constituents was invited to testify. He is the most effective patient advocate i have ever met. And he has been a fierce defender of the Affordable Care act. Peter, thousands offamilies hav to you to share their stories and asked you to bring those stories to congress. Can you share what some of these stories are like . Is there any one that stands out to you . Absolutely. There are many that actually stand out to me. The most the hardest stories for me to listen to are the people who could have been saved had the a. C. A. Been enacted. And also the patients who would have like some of these people, these patients have testified here today, they would have been diagnosed sooner. Their conditions would have been more under control, and in some cases healed. I hear from patients who excuse me, rather, caregivers who are they have medicalically fragile children. And they get their Health Insurance because of Medicaid Expansion. I hear from people in states such as texas, florida, North Carolina and tennessee who dont have that same luxury because their states have not expanded medicaid. And theyre denied that type of coverage had they lived in a separate state and they cant afford to move to another state to receive that type of coverage. Those are the stories that keep me up at night. And, of course, since i have lupus, anyone who reaches out to me who suffers from lupus and tells me thank you peter for going to d. C. , i dont know where you get that energy to do it. And truthfully, i dont know either. Im grateful to be here. Its that energy as these patients have testified. It takes a lot of guts and courage to come here and talk about something so personal. I know from our exchanges that it is painful for you physically to come here. Why do you make these trips . Because honestly i never expect to sit, whether its a democratic or republican legislator, i never expect to change anyones mind. But what i what i have learned from coming down here is it brings me hope, hope that there is a chance for change, hope that one person will listen, because it really only takes one person. And the hope that the people who follow me on social media, they receive and they say to me, peter, thank you, thank you. I can feel that you know something positive may come out of all of this sabotage that we have witnessed. Peter, the Trump Administrations recent attack on the Affordable Care act in the form of the texas versus United States court case really threatens health care for millions of americans. What would it mean for your friends, the patients and families that youve spoken to, if protections for people with preexisting conditions are eliminated . In some cases it might limit their access to medications into lifesaving infusions and to cancer treatments. And it could i mean, it very well would mean death. What about if medicaid was eliminated . What would that mean . Medicaid expansion. What would happen to these families . A lot of them would lose coverage and access. What would it mean to the parents of medically fragile children who have reached out to you if the entire Affordable Care act was eliminated . I honestly dont know. I do know that they experience even if that didnt happen, they experience an incredible deal of stress. Having to focus on that has caused them undue stress. It is stress when we have a chronic illness. I am proud to be in this fight with you. I am so proud of you. Im proud of you. I yield now. Thank you, mr. Chairman. I think there are two basic reasons why were having this hearing today. Number one has just come up. Its an opportunity to trash the president and impugn the president for not defending obamacare. I get where our witnesses are coming from from that perspective. That is one of the purposes of this hearing. But the reality is obamacare is failing. And the president is not defending a failing policy, bad policy. And he is right not to defend that m that. You just look at the numbers. Obamacare does not work. We were told that there would be some 25 Million People enrolled in obamacare by now. It just hasnt happened. The truth, what has happened . Insurance premiums have sky rocketed under obamacare. Deductibles have soared. Coverage networks and access to providers have shrunk and in some cases been eliminated. Insurance companies have fled the a. C. A. Marketplaces. Rural hospitals have suffered enormously. I have a number of them in my district. And they have suffered tremendously because of obamacare. Many rural hospitals have actually closed their doors. And yes there are people who have benefitted. Im not going to deny that. Of course, our panel is full of them today. And i appreciate the testimony from our Witnesses Today. For every person who has benefitted from obamacare, we can find tons of folks who have been hurt from it. And i look at the panel today, mr. Chairman, six out of seven are democratic witnesses. Where are the ones in fact, i would like, mr. Chairman, to have entered into the record a letter from a constituent back home, ralph, who talks about how he has suffered. Unobjected. We are told that ill just reverse it of what has been said already today. If you think people dont get hurt by a. C. A. , you need to think again. Ralph, for example, before obamacare paid 700 a month for insurance with 3,500 deductible. He now has nearly 14,000 deductible and his monthly costs are about 1,200 a month. A couple years ago two children were in an accident. He is paying for 30,000 plus that had to come out of pocket. Thats before taxes, before gro grocery, before mortgage, before college. This thing absolutely goes both ways. The second reason were here today is really to play the platform for medicare for all. And that is the attempt that the democrats are putting forth in spite of the failures of obamacare, the Democratic Party is going to double down and push for medicare for all at a cost of some 32 trillion. It would totally eliminate employersponsored coverage. All of it gone. Let me just ask you. What can we expect from a government Single Payer Health system . You can certainly expect rationing of services. Thats what we have seen in many other countries that have gone this way. Many politicians have said those are models that we want to look for, that we want to look towards to emulate. My experience in working with patients, ill give you a specific example, if i may. My wife and i were on medical missions in coast resta rica wi single payer. The wife of the pastor we were with was diagnosed with cervical cancer. She couldnt have an ultrasound for 12 months. When will i be able to have the surgery . Probably another 12 months after that. She had access. She may never get to the point where she has that surgery. The rationing is inevitability when you have limited amount of resources. Those continue to decrease the more burden we place on medical professionals that are actually delivering the care. Would you like to respond to th that . Whats the other side of this . I saw you shaking your head. What occurred to me your mic. We really want to hear you. With respect to discussing the case one of the things that i would emphasize is that the case in texas is not a policy referendum. Its not a case about the benefits or not of the Affordable Care act. Its a case about a settled legaled principle. And the administration doesnt get to decide whether to defend the law based on whether it likes the policy in the law or not. Thats your job. The administrations decision not to defend is only defensible under very limited circumstance in which there is a real unsettled legal question. What is striking about this case is that there is dramatic legal consensus across both sides of the aisle that the legal principle severability is settled and there is no place not to defend the law. I would also just note that we have heard a lot of statistics about the benefits of the Affordable Care act including dropping the insurance rate by some 46 , including getting women covered at record rates. I would point out that the Trump Administration is relying for initiatives. I read one that that would be gone if the Affordable Care act is eliminated. The hiv Initiative Point of order, mr. Chairman. Whose time is this . Im trying to help you, man. You asked the question. I asked her to finish answering the question. I allowed her to do that. I know you want a fair hearing. I know you want to hear both sides of it. Thats what you just said. Six out of seven is not exactly giving a fair hearing. Come on, man. We want a fair hearing. Youre getting it. Are you finished . Thats the point. Virtually all of your own Health Care Policies rely on the statute, as well. I think that is important to recognize that when were talking about the benefits of what the statute has to offer. Thank you very much. Thank you for giving us both sides. Ms. Norton. Thank you very much, mr. Chairman. It took a lot of hearing my friend go down the list of the costs going up of health care and deducts going up. When that is a direct result of actions that the Republican Congress took when they controlled this house. They are complaining about actions that they took to diminish the Affordable Care act. Well, one of those actions was to take away the mandate. The district i represent, the nations capitol, the district of columbia, has a rate of about 96 covered which means that virtually everybody is covered. Thats people going from one side to the other who may not be covered. And thats because as my republican friends took actions thats detailed by my colleague on the other side that undermined the health care act. In my district, they simply made up for them themselves, for example, as i indicated by reinstating a d. C. Mandate. So also everybody has health care. I was interested in your testimony because it looked to me as though you had done all that anybody could be expected to do. You finished law school. You found you couldnt find employment. And then you did what is really difficult for someone just out of law school. You opened your own practice. Your children were covered, you said, by medicaid. But you could not get coverage in the individual market, i understand, because of a preexisting conviction. Is that true . Thats correct. Any idea what the purchase of Health Insurance would have been for you before the a. C. A. . It was 895 a month, which is more than my mortgage. I was going to ask you compared to what other expenses. You indicated your mortgage. So you chose to give up coverage for yourself in order to pay the rent and provide for your children. Did that take any toll on your health . Absolutely. As a single mother of four kids, you do what you have to do to maintain. You do what you have to do for their interests, even if it means you sacrifice your own. I worked in private practice 8,200 hours a week. I took time away from my kids to make sure that they had everything they needed. I dont have any regrets about that. I am all they have. If i am gone, there is not somebody else willing to step up and take over the burden. Then came the Affordable Care act. Yes, maam. With the market place. What kind of coverage were you able to get . And how much did that plan cost . My plan with my subsidy cost 62 a month. Compared to what . The 895 that i would have had to pay for an hmo coverage. The plan i got through the marketplace was a ppo coverage. I was able to choose a doctor. Ive got a great team of doctors, because i have so many conditions. I have narcolepsy. I have asthma. I have diabetes. I have sleep apneea. Because of that, i have a team of doctors. Now you work for the District Attorneys Office. Thats a Government Agency. Correct. And the Government Agency we work for, the United States government, provides health care for everybody who is sitting on this podium. You have what we would have. Did you take your health care that was provided by the District Attorneys Office . My health care that i have through the d. A. s office is supplemental. Its not federal. It doesnt cover the benefits that you guys might have. My policy through the market place is still better than the insurance my employer officers. Now, i did take it for my children. So you had Health Insurance offered by your employer and compare that to the a. C. A. And you decided to stick with the a. C. A. Coverage. The gentle ladys time has expired. Did you finish answering the question . Yes, sir. Thank you very much. I would like to welcome all the witnesses here today. I just have three quick general questions id like to ask the entire panel just with a show of hands for the sake of time. Do yall support or how many support eliminating employersponsored insurance . Second question, how many on the Panel Support the current version of medicare for all, which i believe if my math is correct, 17 members of this committee on the other side of the aisle support . Anyone support medicare for all . Last question, do you support extending Health Care Benefits to Illegal Immigrants . A couple. This is one of the areas that i find troubling, because i represent kentucky. I represent a poor district. I represent a district that has a High Percentage of people on medica medicaid. And before the Affordable Care act, kentucky had a high medicaid population. After the Affordable Care act, kentucky expanded medicaid. What happened when they expanded medicaid, a significant number of new people got on medicaid. And what that did was it cut the pie into very small pieces. In fact, 30 of kentucky is on medicaid now. There are so many people on medicaid that the providers continue to get cut, and people on medicaid are finding a hard time finding a provider who will actually take them. So medicaid hasnt been cut in kentucky. The fact that so many people are on medicaid, the services are automatically getting cut. Everybody cant be on medicaid. And medicaid in kentucky is Free Health Care. Thats a great deal for the people that have Free Health Care. But somebodys paying for the Free Health Care. And the people that are paying for Free Health Care are the people in the private market. And theyre very upset because premiums continue to sky rocket. So we have a problem with the Affordable Care act. The reason i asked the question about extending health care to Illegal Immigrants, because i watched the democratic debate the other night. There were ten on the panel. They were asked the question how many support extending health care, Free Health Care to Illegal Immigrants. And if i remember correctly, all ten raised their hands. Thats potentially millions of new americans on what i would presume would be medicaid. What happens to the Current Health care system in america if my friends on the other side of the aisle and those running for president from the other party get their wish and extend Free Health Care to millions and millions of Illegal Immigrants . Thank you for the question. Im a child of immigrants. Its important what we do in this country for the people that are here. We as americans have always taken care of our communities. Thats our focus. Thats who we take care of. What it would do to health care, what it would do to our communities and what it would do to the medical professional community is it would strain it even further. Let me tell you what happens in medicaid today. Its very difficult to get in and see the doctor. The wait times are exceptionally long. If they get in to see the doctor, getting a specialist referral is very difficult because less specialists participate in medicaid panels. Then getting the medication that they may need. I hear all the time that doctors dont like to take care of medicaid patients. They got into that field to take care of patients. They dont like the Administrative Burden that is consistent with how we deal with medicaid and the a. C. A. Exchange and so on. Its going to stretch it out. Were going to see less people participating on those panels. And it will leave people without care. We will see e. R. S continue to be flooded and increase in population. I think thats an important part that needs to be mentioned in this hearing is that everyone cant have Free Health Care. And weve got a problem with the Health Care System in america. We had a problem before obamacare. It got worse after obamacare. And there is no way to fix the obamacare situation especially in kentucky with the massive expansion of medicaid. Hopefully well have a discussion in the future in congress about ways to make health care more affordable for the working people that are paying while protecting people with preexisting conditions, which is a priority for me and i think every member of this congress. Thank you, i yield back. Thank you very much. Professor, let me start with you, because you said something extraordinary which is that your partner in filing an amicus brief against this attempt to destroy the Affordable Care act and strip 20 Million People of their Health Insurance is a person who was opposed to the Affordable Care act and was your nemesis essentially, your counter part on behalf of the Affordable Care act back in the burr well case. Is that right . Yes, it is. It is extraordinary. So youre talking about the distinguished lawyer who was opposed to the Affordable Care act and thought it was originally unconstitutional. He thinks it would be absurd and outrageous to yousafzai the validation of one provision which zeroed out the penalty for not purchasing insurance to unravel the act. You cite a bunch of other legal scholars who are on that side. Will you repeat some you mention . Republicans attorneys general from montana and ohio. Professor kevin walsh. In what context is judge mcconnell taking a position against the administrations point of view here. Arguing that there is no jurisdiction to decide the case. I want you to under score. Lets just go to the point about legal severability. There were efforts to repeal the Affordable Care act. I was in congress then. They voted 69 different times to repeal the Affordable Care act. They werent able to do it because there was a massive uprising. Eloquent, riveting testimony like the kind we heard today from patients. They werent able to get enough republicans to do it even though the republicans controlled the majority. Instead, they passed this one provision zeroing out the pen everybody agreed that the Affordable Care act should be saved. Some people not it was a great thing or a terrible thing. Now there is the proposition being pushed by preexisting condition coverage, all of the provisions that expand access to Prescription Drug benefits. Everything in there they are saying is now toppled because this one provision is gone. What does that do to the power of congress when we thought we were passing one thing and now the courts say, well, because this one provision is out, we will strike down a 2,000page piece of legislation. I think one of the reasons you see this unprecedented consensus you are absolutely right that this case goes to the power of congress to let the court do what it did here and value separation of powers. I wouldnt want to win that way. In other words, if i thought that the Affordable Care act was the creature of the devil himself and i wasnt able to get it through congress but we were able to chip off a little piece of it and then later some judges say were going to go ahead and destroy the entire act, i wouldnt support that, because that is an absolute defeat of legislative power. Thats what the wall street journal editorial page said this is a corruption of the role of law. What are other things that would fall if the administration gets into position in destroying the a. C. A. . I dont think it would be overstated the reach of the statute. You have medicare Prescription Drugs, no discrimination based on health status, fda approvals. Courts are not allowed to do that. Courts are not allowed to presume that the legislature sewed the seeds of its own destruction into the statute. Thank you for what youre doing and thank you for reaching across the aisle to bring conservative scholars in and work with them on defending the critical principle of the i yield back. Mr. Miller. Thank you chairman cummings. I would like to read a portion of a testimonial from one of the constituents from madison, georgia. She writes, i coowned a Small Business in madison, georgia when obamacare was first passed we were one of the businesses that lost our Health Care Coverage. When finding new coverage, my insurance went from 385 a month to 643 due to the fact that im a female which is an increase of 67 . Im beyond child bearing ability, but i still have to have maternity coverage. I ask for the unanimous consent that the full statement be entered into the record. Without objection. Thank you and thank you all for being here today. It has been over nine years since the a. C. A. Has been signed into law. We all know that when a law is enacted that often there are kinks or problems that need to be worked out and issues that need to be resolved as we move forward. However, the obamacare has had countless issues since its enactment and has harmed health care for citizens across the United States. Republicans have been saying for years that we need a fix for this program to decrease the premiums, stabilize the market, increase access to care and to protect those with preexisting conditions. Now my colleagues across the aisle have decided to abandon this and chase after a single payer system which would further increase Health Care Costs on taxpayers and decrease access to care for people who need it the most. In west virginia, enrollments in our exchange has decreased while many are now enrolled in employer insurance due to the booming economy, many have cited high deductibles as a reason for going uninsured. We need to solve this problem and a single payer system is certainly not the solution. Has the a. C. A. Lowered monthly premiums for americans . No, they have not. In fact, how much of premiums gone up for americans on average since this law was enacted . Its been significant and it has been a range depending on the part of the country that they are in. Its been 200 , 400 in some cases. Thats terrible. How has the a. C. A. Kept deductibles the same or lowered them for our constituents . Outside of the exchange or within the exchange . Within the exchange. Are you okay . Your health is number one. Whatever you need, let us know. Thank you, mr. Chairman. The premiums within the exchange have been they have gone up probably closer to 60 , 70 . The outside in the private market they have gone up substantially more. Thank you. It sounds like what the goals for the a. C. A. Intended to be have not really been enacted. How has the Current Administration helped ensure americans to have increased access to health care . Well, i think some of the examples have already been given. People have talked about fixing the a. C. A. I think some of the measures that have been mentioned are attempts at fixing it, such as the opioid, hiv and kidney initiatives. It looks to be that the white house and the administration are looking to improve upon the a. C. A. s foundation. They have done other things, as well. The executive order that the president put out in 2017 that would expand the already existent Short Term Limited Duration plans, extending those for those that may be in transition longer than the amount of time that was initially prescribed, helping people who were losing jobs, having to move, that are going through a divorce. Its allowing more time to go through the transition period. Association health plans was another solution that was put out there. They experienced great success. Some reports were showing that there were double digit savings and people were able to pool together and buy employerstyle Business Health plans. So that was another good innovation. And then the hra,s Health Reimbursement arrangements, that will allow the individual market to come back, because it went away effectively when the a. C. A. Was first implemented. Employers will be able to dedicate defined amounts of funds that are part of the Compensation Plan for the employee to go out and be a consumer of what fits them and their family the best. Thank you. Mr. Chairman, ill yield back the rest of my time to the gentleman from texas. You have five seconds. Could you expand on your concerns . Earlier you stated about the medicare for all and expanding coverage and the extent that that would drive up cost to health care . Time has expired, but you may answer the question. The cost of health care continues to go up. The more that we have had the government involved in trying to fix this entity, this industry, the more we have had the cost to go up. We see the same thing in higher education. The more federal government has gotten involved, the higher tuitions have become. Weve seen lots of technology, televisions, iphones that arent heavily regulated. But those prices go down. Yet when the government is involved in an industry, those prices go up. What comes with those costs, the reason that they are there, all the regulations, the Administrative Burden, the shackles that we put on people that are doing the work on the front line and trying to help the patients, were hurting ourselves by doing this. I thank the chair. Good lord, the comments about the role of federal government. That would come to news to a lot of universities and colleges especially forprofit colleges. Lets get government out of the way and prices will go down and of course cheating will stop and people wont be embezzled or defrauded with phony crednchles or credits. That logic escapes me. Professor, have you looked at the economics of Health Care Insurance premiums . To the extent that a law professor can. He says ever since the Affordable Care act premiums have just sky rocketed. Is there in fact a correlation . Is there a correlation between the adoption of the Affordable Care act and these, i dont know, all of a sudden inexplicable premium increases that apparently are unprecedented. Everything was stable and hunkydory. 35 Million People didnt have Health Care Coverage. Somebody has to suffer. So youre correct. The Affordable Care act made insurance more affordable for millions of people. To the extent we had premium instability a lot is attributable to action of the administration. And the Republican Congress. This strikes me as amazing. We do everything we can to sabotage the law and then we are horror struck that it hassane impact on the cost of insurance because the mechanisms we put in place to try to keep those down and keep it affordable were destroyed in the eight years the republicans controlled the Congress Even before mr. Trump took office. Would that be a fair statement . Yes, i think it is. Please comment. It is important that we deal with facts in this conversation. Now youre talking crazy. You are in the United States congress. We know the answer to this question. We know what happened to premiums. The first thing i say is this has been study. The Commonwealth Fund looked and surveyed the American Public. The percentage of people reporting that couldnt afford Health Insurance was cut in half after the a. C. A. One of the central parts of the a. C. A. Was support to make sure that coverage was affordable. Most people are paying far less than they were before the a. C. A. Period. Its well documented. In addition, as you point out, we have dynamics at play. The number one reason that premiums are high in this country is not the Affordable Care act. Its because the Health Care Prices in the country are out of control. The American People know this. We know were paying too much for Prescription Drugs and hospital care. We know were paying doctors too much. To blame the a. C. A. For that is a drowning man blaming his life preserver because he is wet. It is preposterous. That is not the reason that we have high Health Insurance premiums in this country. Can you remind us of a couple of the successful efforts by my republican friends during their majority attending here in the house and the congress where they succeeded, in fact, in gutting certain provisions of the Affordable Care act that were directly related to trying to keep pressure down on premium increases . So as you know congress turned off the very important stabilization payments for the industry. There was a lawsuit about paying cost sharing reduction payments. There was an attempt to reduce enrollment on the exchange, reduce money for critical bridge business tween individuals and enrollment. Recently, there has been a vigorous attempt to split the insurance pool, divide the Insurance Markets and make health care more unaffordable for those in the a. C. A. Market. And here i was thinking were preverse and the Affordable Care act drove up prices mindlessly. You tell me there is a cause and effect. Its not the Affordable Care act. It is the insidious relentless drive to cut the Affordable Care act which they couldnt defeat legislatively, but they could do it administratively and through amendments to laws that made it much harder for the protections, the bumpers that protected us. Thats exactly right. The largest percentage increase we saw was after the payments were stopped. My time is up. Thank you both for illuminating my understanding of what really happened. Mr. Gibbs. I dont think anybody on this panel, in this room or the president of the United States doesnt support preexisting conditions. Its a tragedy when somebody loses their coverage because of preexisting conditions. We had a bill that addressed that and protected preexisting. Its unfortunate that the other side of the aisle wouldnt work with us. I think it is interesting when looking at what is going on, we talk about the costs. I had a neighbor come to me. My county was down to one insurer on the exchanges. She was going to lose her Health Insurance because that was going away. The other thing i hear a lot about is people talking about the deductibles are so high. One reason i hear people are none sured, there are 30 million uninsured because the deductibles are so high and thats a problem. I do notice the comments earlierbed how the Affordable Care act has failed. Most of the people running for president on the other side of the aisle arent running on obamacare. Theyre running on medicare for all which i think would be a real big disaster. I give you an example. We had a good friend here a few years ago that on friday at 4 00 in the afternoon had severe chest pains. At 11 00 that night she had a quadruple by pass. What would happen if that was in canada or anywhere else . Would that person get that care that fast in a system where we have medicare for all . In an emergency situation, that would be different. That would certainly be considered an emergent situation. If it were a planned procedure, the wait times would be exceedingly longer than what we would have in this country. It amazes me. We talk about research and medical research comes a long way proving life expectancies, people having a Higher Quality of life. What is your thinking and what was your thinking if we have a singlepayer governmentfunded system. What happens to the private sector taking an innovative i dont know if i could speak to that. The one thing i do want to say is even when we talk about all these other issues we keep going back to insurance and we talk about insurance and we dont talk about the patients. The real victim is the patient and the cost of care. Insurance has contributed to it and of course premiums went up after the risk corridor payments were removed. They were put in place to artificially decrease premiums so it look like it made sense in which it did not. Lets look to see what will happen to patients themselves. Thats the tragedy of whats going to happen in the future. President trumps executive order saying that association plans are back in effect and one of my neighbors, thats what helped her get insurance. Can you tell us about what happened . They had a great deal of popularity and the federal judge essentially said the association plans were around the Affordable Care act and they are still in operation. Much like but the federal suit, they are still able to operate. And its cause to people who are able to create those kinds of plans to proceed further. They do give individuals the ability to have options and because the exchanges, theres no competition. Because it functions like an employer plan theres no exclusion for preexisting conditions. Its affordable because you have a bigger base and there are more options. They can choose different types of solutions and not just traditional insurance. I think its a big help and gives you more options and a greater ability to direct my own health care. Ive got 20 seconds left. All this time, what can i do . I would ask one question. Describe a little bit what you say what are the alternatives we can look at with respect to empowering patients instead of Insurance Companies . For the life of me im not understanding why we are focused on insurance and my colleagues seem more concerned about insurance than care. Can you talk about care and Patient Access . You may answer the question. Let me give an example, the personal one that i use, direct primary care. Insurance, i will say it this way. The recent healthcare has become more inefficient and unaffordable is because there has been a wedge driven between the relationship between doctor and patient. Healthcare is a very personal situation. I think all the witnesses have talked about their team that should be looked the part that way. I pay 60 a month for unlimited 24 seven access to primary care physician text, secured video chat and the like. Thank you mr. Chairman. I want to level set some information here. There has been talk about governmentbacked singlepayer systems. We already have two of them in the United States United States and its called Veterans Affairs and medicare. Im hoping members on the other side of the aisle suggest that though should be eliminated because they are singlepayer systems. I want to point out the fact that there are 40 industrialized developed country in the world. 39 have universal healthcare and only one does not. The wealthiest, greatest country in the world, the United States of america. I take exception with your testimony that we have that when the government is involved those countries spend half of what we spend. We spent 18 1 2 . We have a very inefficient system and while it may not be perfect it has brought Quality Insurance to individuals who didnt have it. I hope i pronouncing this correctly. I wanted to touch base on a couple of areas. With litigation going on in texas and the potential we are facing that the aca could be eliminated as we know it and the protections under it and some of the other key areas, one of them is talking about the doughnut hole that a lot of senior space seniors face in the crisis. If it was drawn out in totality as the impact on Senior Citizens and prescription prices in general . If the aca was repealed by these judges the first thing that would happen is medicare costs would go cost. Their premium cost would go up, and the Medicare Trust Fund Solvency would immediately be weakened. It would have a specific to what it would do a large. The entire pathway to ride low cost highvalue biologics seems to treat leukemia, to treat lupus, and some of the most devastating illnesses would disappear. It would have a very negative effect. I want to say something. This discussion about the Physician Health plan and forms of new kinds of insurance, lets be clear. Hurting people letting them to play tricks on consumers, it allows Insurance Companies to play tricks. Weve done a lot of work across the aisle, this congress, on surprise medical bills. The American People are fed up with buying insurance and then not getting financial protection. What we are hearing is a description of Insurance Products that would exclude hospital care or exclude Prescription Drugs altogether. Its letting Insurance Companies play tricks on consumers again. That is not a pathway to Affordable Access for the American People. For hurting the Financial Stability of our nations families. When we heard a member on the other side say that everyone here would support the view that the president supports coverage for pre existing conditions, let me point out i dont believe that. I believe that actions are greater than words. Wouldnt tens of millions of americans, i believe even over 100 americans would lose pre existing coverage . By the way, its almost half of the people, over half of the people who went to the market, tried to get coverage but had preexisting conditions and couldnt get coverage. This question has been answered. Republican leaders passed legislation that was an alternative to the Affordable Care act. We were told 6. 3 million americans with preexisting conditions would end up paying much more for Health Insurance coverage or not be covered. It looks like you are chomping at the bit. Can you weigh in on this . Microphone. Millions of people were denied insurance because of pre existing conditions. Thats evidence you have thats readily accessible. And reenacting preexisting conditions alone would not really do nearly enough or anything for people who have serious medical conditions. If you have coverage and its priced prohibitively it does nothing. If you have coverage and it does not include the benefit of a Prescription Drug you need, that does nothing. If you have coverage but no subsidies to pay for it or you dont have medicare or medicaid, the coverage does nothing. I think the preexisting conditions discussion is more important but the tip of the iceberg. Thank you for your testimony. The litigation occurring, did the Supreme Court find it unconstitutional . The mandate . No. The mandate was not found unconstitutional . Theres no such thing as a mandated with the Supreme Court supported was found that the mandate cannot be construed constitutionally as but was it constitutional as a tax . Thats the point. Its unconstitutional. Pure and simple. The mandate is unconstitutional. If you do not have the power in the Commerce Clause of the only power that remains is taxing power. Then what . The taxes zeroed out. The text does not exist, correct . Is there a tax . The tax is set at zero. There is a mandate in the legislation. The mandate is unconstitutional. The Supreme Court said this body does not have the power under the Commerce Clause to have a mandate to make people make americans purchase a product in commerce. The tax is zero. The tax no longer exists. Therefore, where do we sit today . The very thing that saved the mandate, the tax which is now zero, doesnt exist. This is the theory that underlies the District Courts opinion. This is why were here. Its not a policy choice as my colleagues know, its because its a question. Its a constitutional question about the power of this body. Then you have a taxing power question. Now we dont have a question. Of this is where we now stand today. If its not true that it forged in the opinion, did find it to be an severable, is it not true that the District Court found it to be in severable . I appreciate that question. First of all, the mandate of the enforceability of the coverage provision is really not the issue in the case. Is not being forced. What is the issue is the application of the next question, what happens without that provision . Does the whole statute get stuck get shot down . But its very important, Supreme Court opinions. They were indeed based on the courts perception of the provision and that issue in this case is the 2017 congress amendment, to hold otherwise is to undervalue the power of the 2017 congress vis vis the 20 reclaiming my time, four judges have addressed that its in severable. On severable. The Obama Administration argued that in his inextricably intertwined and the entirety of the aca has language dotted throughout the aca saying it is of the aca. They describe the individual mandate is as one of the three legged school stool without which the aca should not stand this is at the heart of the litigation in question and why it is before the circuit. Thats why arguments were held yesterday. Yesterday there were quite Great Questions from panels, the judges on the panel sorry, and its why frankly the carter appointee did not ask a single question, because this is a legitimate litigation and we will see then what unfolds. With respect to my colleague from california making the comment that quote, about singlepayer that we have medicare and va. Im interested that weve got bipartisan agreement that we need to make changes to make it better. To get out into the marketplace and get access to care and a singlepayer solution is not meeting the needs of veterans serving this country with valor. When we talk about the wealthiest and greatest country in the history of the world and compare ourselves to other countries, the one outstanding that doesnt have singlepayer health care, i would argue that theres a reason why were the wealthiest and greatest, because we shun the status of that my colleagues on the other side of the i would care to put on the backs. They are forced up repeat pay premiums they cant afford, forced to get healthcare they werent able to have before, forced to be put into a system that is sub par, forced to say theres coverage one 20 Million People when the vast majority is medicaid coverage which is driving out the bear very people that medicaid was designed to take care of. This is what we are talking about. A 32 trillion medicare for all scream scheme which will blow up the ability to have a Healthcare System that is affordable for the vast majority of the American People. Thank you very much. I think its important to note for the record that mr. Roy just came out for privatizing the va which the overwhelming majority of our veterans absolutely oppose and are quite happy with the healthcare they are receiving and want it to continue. The headline of which says name the much criticized federal program that has saved the us to us 2. 3 million . It starts with affordable. One month after the aca, and this is from the article, one month after it passed the office of the actuary and health and Human Services projected the Financial Impact in a report quote estimated financial effects of Patient Protection and Affordable Care act is amended. The official Record Keeper estimated healthcare costs under the aca will reach 4. 14 trillion a year and constitute 20. 2 of gross domestic product. Back forward back to 2018 during the Trump Administration when the same Office Released the official tabulation of healthcare spending, the bottom line cumulatively from 2010 to 2017, the aca reduced healthcare spending a total of 2. 3 the aca reduced healthcare spending a total of 2. 3 trillion. Health expenditures were lower than projected and kept healthcare spending under 18 of gb gdp. It did this while expanding healthcare coverage through previously uninsured americans and the medicare bill of 2017 was 10 70 billion less and spending for medicaid and the childrens Health Insurance program was a whopping 250 billion below expectations partially, but only due to the failure of some states to extend expand the program. The actuary predicted that ensure your sponsored insurance would cost 1. 2 trillion in 2017 but came in at 1. 04, a difference of 170 billion for that year. Put another Way Healthcare spending in 2017 was 2000 less per person than projected to be in for the 176 million 176 million employers who have that, their premiums averaged under 1000 per person. I could go on but weve entered the article into the record. Essentially we need to be dealing with facts. Thats why we have these hearings. The fact is that healthcare costs have actually been lowered. Premiums on average have lowered for people and weve added 20 million to healthcare. That being said, some of you may know that im a Breast Cancer survivor. I talk about it openly and its something that i live with and live in fear with, i understand all of your concerns and the thought process you went through about potentially having a prophylactic vasectomy or any other prophylactic surgery. No matter how assured i was that i did as much as i could do to prevent cancer from coming back, i think about it every day. Like every single cancer survivor that i know. Taking care of your health and making sure that you have the ability to go to the doctor when you are sick and not worry about how you are going to pay for it because of what the fear was for every single uninsured or underinsured american before the Affordable Care act . Its absolutely paramount. I would like to ask unanimous consent to enter this letter from, we have a letter from 17 advocacy organizations plus the american cancer society. Without objection. Before the aca the patients represented by their organization were often forced to delay or folk forgo healthcare. This is exactly the world the Trump Administration would like to take us back to. Is it true that before the aca more than 40 of people who applied for insurance were denied coverage . And i want to simultaneous ask about the impact on seniors because nearly 1 5 of residents in my district are seniors and we havent talked a lot about the coverage gap known as the doughnut hole that would be reestablished if we go back to preaca. But if you could also tell us what would happen to this provision if the administration exceeds succeeds . Im sure my time will run out after that. To your first question about the impact on the aca with pre existing conditions, your staff is right. We had almost half of the people who were applying being denied coverage because they had a preexisting condition. And its important to note this, in this country most of us get coverage through employersponsored coverage. When we get sick we lose that coverage and then guess what . Without protection, you dont have anything. This is not just about people right now. Its every Single Person in this room watching from their homes right now. May i answer . If the sherman is okay with that. If the chairman is okay with that. You will write that the protections have been widely underappreciated. 60 million seniors got access to free Preventative Services without a copay. 5 million benefited from a coverage gap and we only have Prescription Drug coverage around 2000 and then there was a large gap until the coverage benefit kicks back in. We call that the doughnut hole. Seniors had to pay outof pocket. More than 5 million benefit from that. Medicare provisions also have a drug negotiation component that ends up lowering costs by 26 billion in drug costs. I would say that all of that will be gone if this decision is upheld. I appreciate your indulgence and i yield back. Before we go to mr. Norman, i try to make sure that i run a fair hearing. Mr. Roy, im going to recognize for it a minute because he wanted to clarify something. I would just ask my colleague to maybe reframe her comments that i was calling for the privatization of the va when in fact what i said was the va needs improvement and is seeking improvement through the better the veteran commit Affairs Committee is seeking improvement and to improve it allowing private sector options to supplement Veterans Healthcare. I think you mischaracterized a little bit what i said and i would ask if shed be willing to acknowledge that that was not what i said. I appreciate the gentlemans request. If the gentleman is willing to say that he is opposed to privatizing health care at the va and making sure that the va can continue to provide the Excellent Healthcare Services that it provides that the overwhelming majority of veterans support, continuing, then sure. Im not going to get into a backandforth. Mr. Chairman . That i if you are not willing to acknowledge that that i would characterize your position correctly. Know you mischaracterized it and you did so blatantly when what i said was bipartisan support for reclaiming the child the time the chairman gave me we have a bipartisan agreement that choice and mission our purpose to va, adding Market Forces is a good thing. Bipartisan agreement. Thats a mischaracterization what you said, characterizing that i said we should fully privatize it. We should inject market choices and provide more choices for veterans. Since the gentleman has now addressed me and taken his time back and wants me to correct how i characterized his position and has refused to acknowledge that he opposes privatization is a symbol simple statement. I didnt hear him say it. So if hes not willing to say that, then the direction that the Republican Party has been taking us in with the va including the Trump Administrations pushing in that direction for more private Market Forces and healthcare coverage at the va, and by the way i wish of the military construction and Veterans Affairs appropriations subcommittee, im responsible for the budgeting of the entire va. So you dont say that on the record so i will not recharacterize what i said you said. Im not going to engage in inquisition. I wasnt trying to. Hello . Then why what you say you oppose privatization . You say you oppose mission and choice . I did oppose mission and choice. Well there you go. I did. Ranking member . We can read the transcript. The gentleman from texas did not say he was in favor privatizing. He just talked about choice. This characterization by the lady from four to is that he said he was for privatizing the va. He did not say that. The transcript will be clear because we all heard it. Thats all hes saying, to clarify that simple fact. We will take a look at the transcript. He will not say that he opposes it. We are getting ready to go to mr. Norman. I tried to a did the best i could with what i had. Mr. Norman . I want to thank all of the panelists, particularly the ones that have preexisting conditions to take the time to come here. I will take issue with of the seven. Really the intent was to trash this president and to advocate medicare for all. I take issue with what you said about all republicans being against any type changes in healthcare. Mr. Jordans state is not covering your particular problem, okay, i dont know which one of you did but this is not a partisan issue. All of us want democrats and republicans alike. The fact that where we have a different world feel, all of you raise your hand i think for coverage for every illegal in this country. Everyone of you. Thats estimated, except mr. Missed dice i didnt raise my hand for anything because i was uncomfortable with this. The majority of you raised your hand for healthcare for everybody. We have anywhere from, we dont know how many illegals are here. Just as six or seven that have predisposed to a penny, i could fill this room with everybody behind you with that single mom who takes issue with obama care. They cant afford the premium jump from 400 to in many cases 6000. I could bring the gentleman in who happens to be 75 years old that doesnt want a mandated maternity healthcare and having to pay for one in his policy. I wish we could have had a more balanced panel because our intent is to solve this problem. Single provider as it does not work in the private sector to will not work and has not worked with obama care because if each of you had a single provider for one drugstore, im sorry the price is and im in the private sector. I will say it has not worked for the majority of businesses. Look at the physicians that are leaving. Look at them that are leaving. Were not going to be able to get the specialists that each one of you have had if it keeps going like its going. I yield the balance of my time from congressman roy. Can i please acknowledge mr. Norman . He actually brought up my name in his questioning or his stance. I will reclaim my time. Ill talk to you privately. Ive yielded my time to mr. Roy. Chairman, can i also state i was not in the room when you asked that question . I want to have that go on record that i did not raise my hand. I have never mentioned that i am for medicare for all. I would also like to make that statement. I came here for a hearing about the Affordable Care act and it seems that most of this has been about medicare for all. I didnt raise my hand for medicare for all. Im not talking about medicare for all. Why do we keep coming back to medicare for all . This is supposed to be a hearing about the Affordable Care act. Esther chairman . Id like to yield my full time but i think it was over. Right at two minutes, to congressman roy. Thank you mr. Chairman. Let me ask you a question. Was it not true that in 2013 the lie of the year was if you like your Healthcare Plan you can keep your Healthcare Plan . Thats correct. And millions of people were kicked off because it requires a small group lanes to provide 10 essential benefits and while 22 Million People gained coverage 6 million lost coverage they had before obama care correct . 2. 6, transition from medicaid, 600,000 transmission out of those 20 odd million was at halfandhalf medicaid through the aca . It was more on the Medicaid Expansion. And is it not true that is crowding out people who are the original purpose for medicaid . We are now crowding out people. Their study saying in illinois for example, a study showed that people died on a waiting list because they were trying to get care because medicaid was getting crowded out by healthier individuals . Your time is expired. You may answer the question. I have not seen that particular study. As we go on, let me say this. It seems that my republican colleagues would love to distract us. You asked the question in the efforts to sabotage this aca by focusing on medicare for all. Todays hearing, you are right. Its about protecting the law of the land and the threat that this administration is posing to healthcare for millions of americans. Thats what this is about. My colleague . Thank you mr. Cummings and allowing witnesses to come. Thank you for coming. A few minutes ago i think you were trying to point out to mr. Roy that his discussion around some of the justices statements about severability was fighting the last war, the 2010 war rather than the more current battle that is most relevant to the question of severability. I appreciate you doing that and mr. Royce decision voluntarily mr. Roys decision. Whats not fair is the force that some of the written is witnesses who represent millions of patients across the country, to go back and fight the last war. Thats what the Trump Administration, republicans here in congress are doing. I remember chairman cummings, when you and others were part of and helped lead hearings back in 2010 where we heard all of these that were desperate to get coverage that they did not have. We made a promise that we would do everything we could to try to deliver that coverage to them. And we did that with the Affordable Care act. Now they are back again telling the same stories from the standpoint of being terrified that they could lose coverage that has been made available to them under the Affordable Care act. I want to thank you for that testimony which is extremely powerful. I dont know why my republican colleagues think that its a strong position to argue for taking this fundamental coverage away from millions of americans. I wish them the best with that line of argument. Going forward i think its clear from what the polls show that americans dont want to throw away the aca. We can debate what we do from here, but the great majority of americans want to hold on to the coverage that theyve been given. And by the way, no evidence whatsoever that theres any kind of cogent coherent meaningful replacement plan for the aca. Notwithstanding, 69 and counting on part of the republicans here in congress to repeal the Affordable Care act. In your testimony you discuss essential protections and Health Programs that would disappear if the aca were to be struck down. Does this include guaranteed issue of preexisting condition protection . Yes it does. What about the Community Rating detection that prohibits insurers from charging older adults significantly more than they call charge younger . Without go away . Yes it would. What about premium tax credits and costsharing reduction payments that make coverage more affordable for middle income families . That would also be gone. What about the Medicaid Expansion . Gone. What about prevention and Public Health fund . What would help happen to funding for essential Health Programs like those that support safe drinking water, children immunizations and Smoking Cessation . All those funds would be eliminated. Now we come down to the point i was emphasizing earlier. Has the Trump Administration or Congressional Republican put any meaningful replacement plan for the aca that would provide the same coverage gains and Consumer Protections that we just ran through . Nothing has come even close. Wire preexisting condition protections on their own without the acas other provisions not a sufficient replacement plan . Republicans, i give them some credit. They figured out that no one in america wants to lose the coverage now available for preexisting conditions. So they keep invoking that saying we will hold on to that even though we are jettisoning the rest of the Affordable Care act. You explain why its important to have other provisions in place in order to have protection . Its not enough to have insurance. You have to be entitled to get insurance, you have to be able to afford the insurance and it has to cover the things for which you are sick. Just having the ability to get insurance doesnt stop them from charging you more for that insurance if you are sick, from creating benefits that dont include, say, hiv drugs or give you Financial Assistance to make that affordable like subsidies or Medicaid Expansion. I want to close by again thinking witnesses and our chairman for bringing witnesses forward today. I would like to get a handle here on current problems we are having. Could you in general describe what is happening for people who are fighting for insurance on their own . Both the cost of insurance and the size of deductibles over the last five or six years . I can share with you that in the private market, premiums have gone up for employerbased plans when they are available. Dramatically . Considerably. On the order of 1500 for family, they could be around 2000 a month. Devastating. When they came into being they were coupled with High Deductible Health plans. The deductibles today i think on average are six or 7000 but i heard one recently of 14,000. Devastating for people not eligible for medicaid correct . Without question. And the majority of people in this country that dont have 1000 in their savings accounts , its an unreachable number. Unbelievable what people have to put up with. Ive heard stories of healthcare problems that i would not have believed. It still amazes me when the Affordable Care act was passed or the on Affordable Care act, whatever they call it. It amazes me how people get elected to congress and think they are so smart that they can take over such a big segment of the American Economy and make it better. How Many Americans are on the Affordable Care act despite the hoopla over it . Just over 8 million. Based on the exchange . Between 8 million and 9 million. Under 3 of americans. Wheres the big increase in government involvement in healthcare since obama care can then. Medicaid expansion. How much is the reimbursement and how much they pay people to provide Medicare Medicaid compared to medicaid in the private sector . Medicaid is your lowest reimbursement whether you are a physician. It is just below medicare rates typically. Medicare is about 60 of what private reimbursement is. Weve change the system to put more and more people on medicaid. We are driving up the cost for people not on medicaid. Is the reason therefore the cost of people who are not eligible for aca, the reason they are being punished and just put in such an impossible position is because the change in the way the huge number of people will now who are expected to get healthcare through medicaid type plans, who before, they have gotten healthcare in other ways. Is that whats going on . If i could ask you to restate the question. Okay. Right now the reason the cost is going up is because more people are getting healthcare through medicaid. People who in the past would have gotten healthcare either through employers or purchasing on their own. Is that accurate . It is. So in other words this dramatic rocket in cost, the people not eligible for medicaid, it didnt just happen. It was by design almost, or maybe people were just so stupid. I cant believe people would be so stupid they didnt realize it was going to happen but thats what happened, right . I have one more question. We now hear people talk about picking up healthcare for all of the Illegal Immigrants flowing into the country. Id like you to describe who will wind up picking up the tab for that one. The american taxpayer. The taxpayer or anyone paying for insurance on their own . Whoever is paying into the system to be the ones paying for everybody that is benefiting. A word was used earlier talking about being forced into a situation they dont want to be in and being patient should the aca be revealed repealed. We are being forced to participate in programs we dont want. Thats an active force currently with the aca in place. Mr. Waltz . Thank you. I want to thank witnesses. Welcome to congress. As the debate continues, the heart of this is about patients who need healthcare. I want to ask to go back to some of our patients, thank you for coming. Mr. Gibbs i will start with you. What would it mean to you and to your son when he grows up, if the acas previous protections. It would mean that if something went wrong and i lost my kidney and his kit if it declined, there would be no guarantee of any rights to health care. Theres no guarantee he would be able to receive treatment for that kidney problem he was going with. It would mean he is born with, i do believe access to healthcare is 100 a fundamental right and something we cannot exist without. I mentioned life liberty and the pursuit of happiness. Without healthcare you do not have that access. How about you . What would it mean if the condition protect pre consisting preexisting condition protections were law . It would mean that i wouldnt be able to afford coverage. I have an expensive hobby of having four children and i simply could not afford to pay 895 a month for Health Insurance. Before i would do that i would go without i did previously. I use limited resources to raise the kids i brought into this world so they dont have to be a burden on the American People in society. I do everything i can to be responsible. How about you . Is 10 and for her expressions she is two or three years behind her peers. Its never going to go away. Shes going to have this in adulthood. Speech therapy, she needs a. In order to be a productive member of society, its almost like life support for her. What a lot of people dont understand, if they talk about employer insurance, a lot of that does not cover speech. You get 10 sessions a year. If you could explain to me how her daughter, two or three years behind, how is 10 sessions going to help . If we are fortunate enough, we dont have a preexisting condition but if you have children and you are worried about how they are going to be affected, its really existential and all of us can identify with that. I want to ask you to think about just emotionally, what was it like and how did you feel before you had that guarantee of protection and you had a child who was sick and no confidence you could get. For me it was what did i do . Was i not taking care of myself during pregnancy . I also felt like my country, congress was saying that my daughter doesnt matter. Her life doesnt matter, her future, and thats hard for me to take. They kept saying we are the greatest country in the world but yet the greatest country in the world is telling my 10yearold daughter she doesnt matter and thats heartbreaking for me. Part of it felt like it was my fault because i had a kidney condition and i felt guilty that he may have inherited it from me. But part of me also felt that it was not my fault because when i chose to have that child the Affordable Care act was in place. I made a responsible choice to have a child who could be guaranteed the right to healthcare. Healthcare choices being made but not by me. I want to thank all of the witnesses. Mr. Chairman, what we did here, there are life circumstances that none of us can control and if you cant get a fair shot that is about justice. Thats not about personal responsibility. There are a lot of life choices we make but when its circumstances beyond your control and you cant get healthcare because the law wont allow it, thats on us. Justice requires we protect those preexisting condition protections. And then people get sick and people die. Mr. Chairman, Ranking Member . I think most of us know im an er physician and cancer survivor, the father of a cancer survivor and the founder and ceo of the healthcare come any that when i left, employed over 1000 medical providers and saw 1. 5 million patients are so. I love caring for people and being a doctor. So much so that i started free healthcare clinics in clarksville and memphis tennessee. I do care, and my opposition to the aca is because i think the aca is going to crash the very system that todays witnesses have praised. First i want to tell everyone about a shift that i had. My first patient was a gang member who had been shot in the lower him and. The guy was punching at stuff and we tried to save his life after giving him worldclass care. I walked out saying at least with government payer i get paid for the risk of taking pair of care of this patient. But near the end i had a woman who had a few days prior gotten a dose of chemo. The chemo had lowered her immunity system to a point that small infections threatened her life. With her, her two children and a worried husband, she was only 35 years old and did not have insurance. As we stabilized her i realize that Early Detection saved this young womans life in europe. Socialized medicine has delayed early protectionist care is rationed and thats why mortality rates for specific illnesses are far better in the United States than they are in europe or canada. She would not have received timely detection and chances of survival would have been significantly less than a socialized system. I was working at an er and met a patient who was the ceo of a large corporation. He hopped on his personal jet, flew to nashville and came to my er because he could seen the scene faster than waiting on a government system in canada. You can get an mri for your dog that day because theres a free market and veterinarian care in canada but not for grandmas knee. Youre going to wait six months. Socialized medicine does not work. It doesnt provide better care. Study after study has shown that medicare patients have equal outcomes to patients without insurance at all. Those are the real numbers. The aca is not socialized medicine. But it does is take money from taxpayers and increased rates for Small Businesses. Yes it has raised rates. I was on the insurance committee. We had to improve those increases. Hundreds of percent. It takes those dollars and gives that money to patients who cant afford care and allows them to what, purchase Health Insurance and participate in the incredible care other americans are getting through their employer are out of their own pocket . Unfortunately that isnt going to last. Youve given great testimony about how it works. Its not going to last. You see by intention or accident the aca creates pressures on the Healthcare System that are crashing the system that Witnesses Today were praising. You like your insurancebased care and i appreciate you sharing it, but aca is driving Cost Shifting to a point where Small Businesses cant afford it and more people are shifted to Government Systems as this dynamic pushes people into government care. Medicare medicaid all of that. We move to more and more socialized medicine and at some point the shifts cause the system to crash. That means insurancebased systems that the a site acas providing you and that youve given great testimony on is going to go away. Cant last. Maybe thats exactly what the leaders of the democratic hardy want. Medicare for all will be a dismal. Im a veteran. I know. Ask your veterans. 32. 6 trillion over 10 years. If you tax 100 of income earners you only get 700 billion. 700 billion versus 32 point. 700 billion versus 32. 6 trillion doesnt add up. If the aca is driving us through that system intentionally or accidentally, the government is not the answer. Government healthcare is rationed care. Late detection and worse mortality. We need solutions to healthcare. And my plan ive written a bill this year to create a healthcare swipe card. Unlike would would fix the problem and provide help to more people, not encourage, particularly my freshman democrats to look at my plan. The people i talked to love it even democrats but the healthcare you are getting is insurancebased. You love it. You want to see it continue. Help us get rid of the Affordable Care act which is driving us to a singlepayer. The gentlemens time is aspired expired but you are shaking your head. I thought you were going to shake it off. Id like to respond to something. I think again it is important that we actually have information and facts. What we know in this country is a few things. Number one, if you look at the information comparatively. Babies are dying at faster rates, moms are dying, we have more preventable medical injuries occurring in the United States than other countries. Thats what the data shows. Right now in this country the reason that health care is so expensive, and the studies are super clear, are not because we brought everyone in and give them access to Health Insurance. Its because the Health Insurance sector is increasing prices at astronomical rates. They see whats happening to Prescription Drugs, they see whats happening when they get these hospital bills. Thats why the system is unsustainable. The notion that ensuring that everyone has a shot at getting healthcare when they need it is breaking the bank is preposterous. He brings up a point that contradicts something and if i could clarify 30 seconds. You have to make sure you compare apples to apples. They eat less Fried Chicken in europe. Okay . They smoke less than us. Its not just the Healthcare System. It is the Healthcare System plus lifestyle and all that. While some of this stuff just mentioned about cost of drugs and all that stuff, i get it, you cannot compare apples and oranges. You have to compare apples to apples. Im not trying to be rude, just trying to move the hearing along. Miss kelly. I get amazed every time i come back to this committee. I was not here when my colleagues voted for or against the Affordable Care act but i know that since ive been here, no democrat thought that was a perfect bill but i know that since weve been here weve never been given the chance to work on the bill especially when pres. Obama was the president. All we had a chance to do was repeal repeal repeal and he put a lot of things he wanted more things in the bill but trying to get one republican to support the bill, he made concessions and no one wound up voting for the bill as you guys know. And then we spent over 63 times trying to repeal it. Im glad you mentioned about Maternal Mortality and infant mortality. It was safer to have a baby 25 years ago and sit its not just from people eating Fried Chicken. That is not the reason. I know you are going there. I just wanted to add that for the record. I wanted to ask you mr. Isasi, how do uninsured rates in states that have expanded their Medicare Program compared to those that have not . Its an important point to make that what we do know, what we actually know is that earlier the witness that said access to Health Insurance had no impact on mortality. That study actually says in the published study, our results should not be interpreted as evidence that Health Insurance has no effect on mortality. What we do know, and published in the journal of medicine, is that when people have access to Health Insurance and medicaid they live longer lives and are healthier. Thats the truth. I will also say weve heard a lot about this question about hospitals closing and people losing access. Before working as an executive director i worked with republicans and democrats across the country. The number one way to make sure that a rural hospital doesnt close is to expand medicaid. And the men worried about losing it is not a state that has expanded medicaid. What we know is not only are people healthier and able to get the care that they need, but we see Larger Movement from public insurance into employer sponsored coverage. I also want to think witnesses for sharing your personal stories. I know that its not easy to do. Also, im married to a doctor, hes an anesthesiologist and he supports the aca. I think its important thing as ive said in Opening Statements. It is supported by the american medical association. By the American Hospital association. The cancer society. The heart association. We have one doctor who says he doesnt like the aca but all of the associates they represent, providers are saying this is important for the American People and for us. Also they are correct in the fact that you can find someone that believes this or believes that and its personal experience. We have to look holistically and overall at what is the greatest benefit. Prof. Gluck, what would happen if the Trump Administration prevails in court . It would end. All those people who got insurance would be thrown off. Im the chair of the congressional blackhawk brain trust and information we been driven given when you look at africanamerican mens and the rate of prostate cancer, it has gone down significantly since the aca and also Breast Cancer in women and black women in black women has gone down because of access and care because of the aca. I wrote an article about disparities in cancer care across races and geographic regions. Its been found that the court Affordable Care act has been proven to reduce disparities that in recent memory. Because im one of the covered screening and checkups. Its incredibly important for health justice. Are you finished . Yes, thank you. A little earlier, mr. Hice from georgia mentioned that some of his rural hospitals were closing. I dont think georgia is one of the states that accepted medicaid under aca. If they did i think it would be a little bit different. Can you comment on that and comment on uncompensated care . How has that been affected . If you look at hospital closures in Rural America, almost all of them, and i mean almost all, north of 80 , are occurring in nonexpansion states, states that chose not to expand medicaid. They have that ability and dont do it and rural hospitals end up closing. I was part of a lot of negotiations with governors trying to expand medicaid. This was the number one issue. When you have a group of people who have Health Insurance they do not keep doors open. Mr. Higgins . I think all of our guests for your courage in being here and your stories are touching. Im going to tell a story as well. Injuries for my years as a Police Officer including a reconstructed eye socket. As a cop, a cops son in louisiana, 1216 dollars an hour. A captain when i resigned my position for office, i was earning 20 per hour. My wife was a receptionist. 12 an hour. Health insurance for many years, before the a. C. A. , it was always the same. 300500 per month. Then the insurance premiums went up to unaffordable. Deductibles were always, 500 1000. It went up to 5000. Having a healthcare card from the aca does not mean having healthcare. One of my colleagues mentioned we want to destroy the aca. We were told you can keep your plan, your doctor and your premiums will go down by 2500. You will have more access to care, those with preexisting conditions will be protected. If the aca had manifested well, and americans had not suffered the incredible increases in premiums and deductibles. We would not be having this conversation. President obamas crown jewel would be safe. But the fact is we must represent the interest of the american citizens that we serve. Before the aca it was common for 36 Insurance Companies to compete for a group policy. That business of Companies Large and small is gone. We dont have a competitive market anymore. These companies have to search and beg. It used to be the other way around. Insurance companies would come to american businesses large and small and seek that business. With the coverage they would provide for their employees. My coverage expense, after the aca went up every year, quickly over 1000 a month. I couldnt afford it man, do the math. If you are a cop earning 16 an hour. The wife of the cop earning 12. Very quickly you had to make a decision, buy groceries or Health Insurance, what do you think we did . We bought groceries. That was never an issue before the aca. The aca expense was not a distraction. As my colleague said, it was a disaster. Having an aca policy card is not having healthcare. A policy for a regular working american at 1000 a month, just to have the privilege of paying cash for your healthcare all year because you have a 14,000 deductible that you never hit. That is not healthcare. Not that we need to provide to our nation, that is not real. My wife and i had to buy a non aca policy. That was reality. We had to buy a nonaca policy and subject to punitive fines from our own government whom we served and i am a veteran as well. Because they were down the line, the seizure of our property from the irs of all places because we had the audacity to buy a nonaca policy. The seizure of our policy was down the line but groceries were not. I am not opposed to the aca because it was president obamas crown jewel. I am opposed to the aca because it has been an abysmal failure and a massive seizure of american property and american freedoms. Mister balat you mentioned, i thank you all for being here, mentioning reasonable postures and my fellow children of god and fellow americans have shared meaningful stories that touched our hearts. Help us fix this thing, that is what we seek. I yield. Just a brief statement. First of all, we want all americans to have access to highquality Health Insurance. An 18 increase in Health Insurance premiums in one year, guess what year that was, 1987. An 11 increase in 2002. What we know for sure is that after the aca was enacted the increase in premiums where most americans get coverage, it was slower. 2 or 1 , these are facts and figures we are looking at. There have been problems with Health Insurance premiums in this country for decades. We are with you, i think everyone on this panel is with you, we have to solve this problem. But to blame the Affordable Care act, 30 years before it was conceived of there was an 18 increase which seems absurd. Thank you mister chairman for shining a light on what a critical lifeline the aca has been for millions of families. I want to thank all of you for bringing the expertise of your experiences here. Just your advocacy alone will save lives. Ultimately the aca was saved the last time, not simply for the conviction of lawmakers but for the conviction of everyday people who quite literally put their lives on the line. Their bodies on the ground and stood in the gap. I believe that this will be true again so thank you for your courage. In my district, massachusetts, my Congressional District, almost half of the residents are living with one or more pre existing conditions. I am thankful for the leadership of our attorney general. Leading the fight against helping the aca and affirming healthcare as a fundamental right. Mister morley, i am paraphrasing but it was very resident when you said instead of fighting to stave off bankruptcy, because of the aca, you got to focus on staying alive. We find ourselves at a time where people have to ask, the questions such as do i feed my family or pay my rent or do i go start a go fund me campaign. Or do i risk forgoing my life savings my child needs. I want to focus my line of questions on the disparities, a rollback of the aca would cost to the 66 million women and girls who live with a pre existing condition. Attacking it puts the health and wellbeing of our nations families at risk. Professor gluck could you explain what Health Insurance coverage was like for women before the aca. Women have benefited enormously. From the aca protections. According to kaiser, the uninsured rate on women went from 19 to 11 , before the aca only 12 of individual plans covered Maternity Care. Women could be charged 50 more than men for insurance because of the health risks they pose because of conditions like pregnancy. The aca ended that discrimination. Also significantly helping Womens Health because it now covers without a copay, Significant Services that are very important to women. Much more than contraception, Breast Cancer screening, hiv and hpv vaccine. And much more than that. The Medicaid Expansion is worth noting. Helping women have healthier pregnancies. So women were paying outof pocket . Yes. All right. Is there anything else you would like to elaborate on professor, as to how the aca put a stop to discriminatory practices . With the case pending in texas, all of those protections would be gone. You would not have basic coverages like Maternity Care, for a huge swath of the population. As one with a chronic illness you spoke of the stress of dealing with being uninsured for so long. Before the aca women could be denied for things like pregnancy, Breast Cancer or domestic violence. Representative kelly alluded to a national crisis, women are no safer giving birth today than they were 30 years ago. How important was it to you and your family that you are able to have courage of Maternity Care . It was very important for me, i have had four csections. My youngest child i gave birth my second year of law school. One of the biggest complications was my uterus had attached to my abdomen. My csection was a lot more extensive than it had been for the previous three. Had i not had coverage during that time, i wouldnt have had the followup care that i needed. In 2014 i suffered a miscarriage 10 weeks in and i did not have insurance. I had my miscarriage in the emergency room and i never got to follow up to see why my baby died. Just really quick, the residence in my district benefits from the aca allowing them to remain on their parents plan until the age of 26. Would anyone like to elaborate on why this is important. Your time is expired but you may answer the question. It is important to me because as a mother, my oldest children are 1918, their jobs dont provide healthcare. So through the healthcare i now have through my employer my kids are still covered. It is important that, we have kids and we expect them to continue their education in college but we dont have a means for them to be insured during that time. While we want to have these safety nets in place, we put impossible choices in their way. By allowing that coverage until 26 years of age, it allows them to go through with the safety of pursuing an education which out without having to worry. Thank you mister chairman. Chair, so right now in north dakota we have the same number of people uninsured as we did 10 years ago prior to the implementation of the Affordable Care act. We have passed Medicaid Expansion at the state level, and all of those things. Considering we are a lot of Small Businesses, small family farms, what we have done is shifted the burden up the food chain. If you are a small family farmer youre not employed so you cant get insurance through your employment and you dont qualify for medicaid and expansion. One of the Major Concerns with obama care, is the lack of Insurance Products to Small Business owners, sole proprietors, farmers, who have largely been priced out of the market. My first question to mister balat, can you elaborate on any proposals which could increase coverage in Rural America . I had suggested earlier, what is happening with Rural America, many farm coops have been taking advantage of the Association Health plans. I understand earlier the witness to my right was saying there was an opportunity for Insurance Companies to play tricks. People are walking into these things with eyes wide opens and shopping responsibly and addressing needs for themselves and the groups they represent. That has been a good solution for those in transition. They are using the shortterm plans. More importantly, most importantly, we are looking at addressing hsas and personal accounts that people can start to use their own money rather than having it, having the government pay directly into the Insurance Companys coffers. Allowing us to purchase our own insurance for ourselves. That would be a big boon to the rural community. And the use of telemedicine and the advances we have had has been a big help for remote rural areas. Outside of insurance or anything, it is how we deliver medical care. People drive 100 miles now. As a state we have done a great job over 50 years putting up picket fences for licensing and those types of issues. And over the last several years we have reduced those picket fences with things like telemedicine and those options. But those are independent of obama care. I appreciate that and i would also say we didnt have a lot of choice before. We have a state of 750,000 people. The markets adjust but over 10 years we have seen insurers flee our markets. To say that like it is some kind of accomplishment, is not the point because we couldnt go any further. I think its also important to say, i have been part of the Healthcare Industry for 20 years. What we are talking about is not going back to before the aca. What we can do is create a environment that is better and will help address the real problems that people have for themselves and their children. I want to add one more thing, one other issue that no one has brought up about the Affordable Care act, the Kaiser Family foundation has said that 20 of all in Network Claims are denied by the Insurance Companies. That is not protecting people. I hope whatever we do moving forward gives our insurance commissioner more ability to make decisions the with that i yield to my friend from texas. Mister balat, in 2009 a report said by 2016 a new law would cause premiums to increase by 1013 is that right . I dont recall. The obama Care Administration caused premiums to double. In the first four years, every age group experienced an increase of 5363 . In 2013 and 2017, premiums increased an average of 60 . Before the aca, every family or age group experienced an increase of 9. 2 or less. The dollar amount varied from 2500, to a different amount, my point is, the redline is host obama care. The blue line is before obama care. We dont have witnesses testifying for all of the people who lost their care because of obama care. We dont have families testifying who are paying the premiums in those red bars. That is what we are dealing with. We have 330 million americans, we are talking about 20 million, 10 or 11 million of whom are covered by medicare and some covered by obama care. Im trying to figure out how we can make sure all of america is not getting stuck with insurance or the inability to get the healthcare of their choosing because we have created a system that is too expensive. The gentlemans time has expired but you may answer that question. In spite of what happens with the a. C. A. My role is to help with research and educating lawmakers. To find as many choices and options and solutions, that work well regardless of the geography here in the United States. In texas alone, my home state. South texas is so different than north texas. Culturally, geographically. Going back to my hospital days. My primary service area was 13 miles. It is absurd to think we can manage the healthcare, Insurance Coverage and health care for people, states away. It must be done at the state and local level. Thank you very much. Miss tully but. Thank you for being here. I was very touched by your statement ms. Burton. Something that you said at the end that was beautiful, this is not a partisan issue, about what happens to families with healthcare coverage. Why should a single mother of four b forced to choose between healthcare. And we are better as a nation if we keep our people healthy. While the Affordable Care act has helped millions of americans obtain healthcare coverage, areas such as wayne county in my home state of michigan have some of the biggest impact. According to a report from georgetown university. States that have expanded medicaid under aca have seen sharp declines in the rates of uninsured populations. For example in michigan, it decreased from 12. 9 to 6. 1 in 2017. Why has Medicaid Expansion been so effective. One of the things is, before the aca was past there was a misperception in the American Public and a lot of Lawmakers Said if you were poor enough you got medicaid. That wasnt the case. What Medicaid Expansion did is it said there is a group of people for whom nothing exists. In the morning i walk my dog and there is a gentleman there with severe illness, he is homeless. Before medicaid there was nothing for him. There was a whole group of americans who had access to nothing. Medicaid expansion said if you are struggling enough in your life we will give you act as the Health Insurance and it has been such a successful and important part of the Affordable Care act. The Medicaid Expansion is one of the many reforms would disappear if the Trump Administration prevails in court, is that correct . Yes it is. Our Community Stands to lose, 87,000 people alone in my district, it is not just medicated medicaid coverage. 39 million americans are in what we call primary care areas. Shortage areas. Michigan has the third highest number of shortage areas. This means that individuals already have to travel further to receive healthcare coverage in the many communities where hospitals have closed in recent years. Mister isasi, under the aca, they do not have to pay cosay at an out of Network Emergency room. Would that change if the Trump Administration prevails in court . Under the aca the protections for outofnetwork billing are incomplete but they are there. Millions of americans risk losing healthcare coverage but this does not mean americans will not stop needing emergency medical care. Instead half of them will be able to provide more uncompensated care. What is likely to happen, particularly to hospitals in shortage areas with the number of uncompensated care increasing. Will this hurt their ability to keep their doors open . There is no question whatsoever. In every state in the country every hospital could say they could risk closing their doors. The aca has helped address provider shortages. Can you explain what that fund does . Could you ask the question again. The Community Health center fund, are you familiar . So a significant increase in the funding, all of this operates in Rural America and inner cities. Before my dad worked at ford and finally got access to healthcare. I went to one of those clinics. In southwest detroit. I remember going in and they do all of those things but it was required for us to get access to school. To do the medical exams. I really believe, the Trump Administrations refusal to extend the aca threatens to widen the existing healthcare gap and make it harder for americans to Access Healthcare if they needed. On our road to medicare for all, crossing my fingers, we must continue to close the gap and expand vital care. I represent the third and fourth Congressional District in the country and i can tell you, at the front line when i speak to my residence, healthcare is always at the forefront. Between taking care of their children, groceries and those everyday issues. Thank you again for your panel and thank you mister chairman. Thank you, mister jordan. Mister isasi. It looks a lot like a former chairmans name. I think ive counted no less than four times it is wrong to say obama care is the cause of increased premiums, you have said that several times. I dont think that was the promise. The promise was obama care was going to lower premiums. When democrats voted for this, when president obama rolled it out, he didnt say pass the Affordable Care act , and your premiums will go up but dont worry this bill will be the cause. I would dispute, even if we take your assessment its as accurate. I think mister roy just offered some numbers that show that it may have been. In the past decade, what is the single biggest change to healthcare policy in this country . That would be the aca. So lets go back through the basics, when obama care was passed, the single biggest change to healthcare in the last decade, projections were we would have 24 Million People enrolled today, how many are enrolled today just in the exchange . Between 89 million. A third of what was projected. When obama care passed again, the biggest change in the last year, we were told if you liked your doctor you could keep your doctor. Was that statement true . Know its not true. When obama care passed, we were told if you like your plan you can keep your plan, was that true . Know it was not. And we were told premiums were going to decline. Again did that happen . No it did not. For everyone, employer sponsored plans, everyones cost went up is that right . The cost of the premiums went up but with the subsidy it wasnt felt by those who are part of the exchange. Do you think we were lied to back when the bill passed in 2010 . Congressman i dont want to speculate as to what the intent was. You dont have to because the architect of it, mister gruber. The architect of obama care, going to the white house several times and meeting with the key players. He said, if any american really believes obama care will control cost i have some real estate in whitewater arkansas i would like to sell them. So the guy who put it all together told us it would drive up costs and it certainly has. Have the coops worked . The data shows they have. The few that are still left have . Oh, the coops. I was referring to the others. All exactly the ones in the private sector have. 23 were set up, only for our left. Are there more healthcare choices today, the single biggest healthcare policy change in the last decade, are there more choices today than 2010 . There are not. Many of the carriers have left. Our individual market in texas. Provider networks are smaller or larger . Smaller. Contributing to the surprise billing issue. What happens when theres only one insurer in the market. Rates go up. You have one supplier of a product in any market, and you usually dont have the price consumers would prefer do you . No. I would ask you this, you said in your Opening Statement that the aca hurts families with preexisting conditions. That stuck out in my mind. I wrote it down. Can you elaborate . It is a function of cost. When people do have insurance, lets talk about insurance. The reason preexisting conditions is even a thing is because, insurance is coupled with employment. The fact we dont have more portable personal insurance plans, causes us to jump from tank place to place. Creating the preexisting condition issue. Preexisting conditions is an insurance term. As these factors increase they are priced out of the market. If they had a plan, in some cases ive had my insurance for 15 years and i just cant afford it anymore. Now they have to look for some other product. Or go to another solution and they have a preexisting condition. That wasnt an issue soon so long as they had the plan. Thank you so much. Thank you all for being here today. When i speak to people in my district, whether they are Health Centers and clinics, hospital associations or patient groups. I hereby large we must focus on increasing access on critical services. The Affordable Care act massively expanded Mental Health and Substance Abuse protections for 62 million americans. Arguments we heard yesterday from the Trump Administration posed an imminent threat to the wellbeing of america. I would like to first focus on how the aca is focusing on the Drug Overdose epidemic. With opioids accounting for nearly 48,000 deaths. In california, it is growing in popularity. The rate of medical enrollees, has nearly quadrupled from the end of 2014. The counties that make up my district are part of 40 california counties taking part in the organized Delivery System pilot program. Joining the effort to improve treatment under californias medicaid section 1115 waiver. What tools has the a. C. A. Provided to help us fight the Opioid Epidemic. This cant be said strongly enough. The number one tool in this country to combat the Opioid Epidemic is the Medicaid Expansion. I have worked with governors all across the country trying to stop this terrible plague. Governor bashir from kentucky can speak eloquently. One of the worst hit states, the Medicaid Expansion helped him save lives. Providing the therapy they need to deal with the addiction. Anyone else want to add to that . I think before the a. C. A. , 45 of plans did not cover Substance Abuse treatment. You need treatment both before and after so you need insurance access. You need coverage for pain treatment that is not necessarily a pill but perhaps behavioral therapy. You need the coverage on the backend if you are addicted. There is nothing more important to combating the crisis in getting more americans covered. This is something we need Additional Resources for. Lets focus on medicaid. The Medicaid Expansion has reduced the need by as much as 18 . You noted that medicaid is the largest payer for med addiction treatment. According to the Kaiser Family foundation they provide comprehensive coverage to nearly 410 adults dealing with addiction. If the aca is overturned what would happen to those who have gained access to the expansion. They would lose it and the crisis we are dealing with now would get worse. Is that that simple . It depends on Insurance Coverage being in place. There are other aspects that have expanded access. You mentioned subsidies to help people purchase insurance through the marketplace. Also parity for Mental Health and Substance Abuse coverage. How would eliminating these provisions, in connecting people with Substance Abuse treatment. People who now have access to Mental Health would lose it and go back to a time in which they were out there by themselves relying on pills and not getting the kind of treatment they need. Do you believe Insurance Companies without the aca would cover these kinds of things. Speak we know these have not been adequately enforced and there are different ways to get this kind of treatment. You dont want insurers just covering a pill, you want them covering the services that get them off pills and get them the kind of treatment they need. We have received a statement from the pennsylvania insurance commissioner crediting the pre existing conditions and expanded coverage of abuse disorders. She said overturning the aca would undo a decade of Progress Making sure those with Mental Health and Substance Abuse disorders would have access to services. We are truly facing the worst public Health Crisis in a generation and the administration is doing everything they can to take Health Insurance away from those who need it most. If the president wants to tackle the Opioid Epidemic, it does not start with taking aWay Healthcare. I yield back my time. Thank you chairman and thank you witnesses for being here today. We appreciate the time youre taking to be here and share your stories. Mister balat, appreciate you being here from the great state of texas. Does this sound familiar. My insurance went from 345 a month to 1200 a month. Increasing drastically from 247 a month to 1024 a month. My deductible went from 1500 to 6000. My 225 per month plan was declared illegal and premiums doubled. It costs more and has fewer benefits. Premiums increased, deductibles increased, i was forced to go on a obama care and lost all my doctors. My dad had to get obama care and they denied him the medication he needed along with the secure surgery he needed. His meds became beyond expensive. Do these stories sound familiar . I hear the stories all the time. Many of the patients in my own facilities. One of the reasons these sound familiar, we asked how has obama care affected you. This is the response we have gotten. While i appreciate the testimonies of the witnesses here and i do not discount them at all. It would have been nice if the community would have allowed us more than one witness so we could have a more wellrounded understanding of how this affects the American People. A onesizefitsall approach does not work for the American People. One thing that hasnt happened over the last decade is everyone keeps talking about healthcare but we havent had a real discussion about healthcare. Obama care as it was dubbed, should have been dubbed as obama coverage. All the testimony we are hearing is from people who are covered, when the real question should be how do we get better access to care. The goal for all of us regardless of what side of the aisle you are on. Care for the American People, not more coverage. I think it would help us all if we could work our policymaking toward that objective and do so in a way that brings in light, a wellrounded understanding of how this is truly a affecting American People. Can you tell me, there has been talk about socialized medicine and whether or not obama care is that. One of the Major Concerns when the aca was being debated as was whether it would be the first step to socialized medicine. Can you explain the similarities. I believe my understanding is over half of the Democratic Committee members have endorsed medicare for all so putting these two together. Is there a similarity . The similarity is government sponsored healthcare versus individual choice. That is the distinction in its purest level. What we want is to have people have the freedom to use their money the way they wish and to have some kind of coverage that protects them in a catastrophic fashion. But we are not in a place where we have that kind of relationship with our medical professionals anymore because insurance has been, what we have been pushed into. You are right, coverage is not what healthcare is. I would say those folks that you read their stories, the increases in those premiums, many of them, are still uninsured today. They had good insurance and were able to take care of their chronic disease or by their medication. Today they are uninsured and they are having a challenge. Getting other kinds of coverage because of a now preexisting condition. Directly the cause of the aca making things more expensive. Can the market work to provide more access. I have seen it happen. I yield my remaining time. I would ask my other friend from texas, balat, expanding a little bit. I believe the number is somewhere around 17. Who have supported medicare for all. Could you explain to me why, if obama care is working so well, so many of my colleagues are racing to change it and offer a new approach in the form of medicare for all after we were promised the aca was not a path to a universal coverage position. I dont know that i could explain for them, however, it does seem as if they are advocating their support of the aca by going to this plan. It is a show that the current plan does not meet the needs of the people of the country. Thank you mister chair. I will start by saying this meeting is not about medicare for all, as hard as others have tried we are not going to dilute this debate. I want to thank my chair for holding this hearing. The aca has increased access to care for every stage of childrens lives. Beginning with improved access to Maternity Care for Better Health outcomes for children. As the cochair for the congressional caucus on women, i firmly believe that the well being of our countrys children is of great importance. Thanks to the aca. The insurers who are no longer able to deny coverage for Maternity Care, and treat pregnancy and the preexisting condition. I would like to ask unanimous consent to enter into the record a letter from the march of dimes highlighting how important the aca is to the health of children and women. Without objection. The letter notes that before the aca, women with highrisk pregnancies could be unable to afford medical health for the rest of the year. Babies born preterm, exhaust a lifetime cap before the first birthday. How did the aca preexisting conditions protections and, changing the Health Outcomes of such individuals. It is one of the most critical protections, this is not just for people buying coverage in the marketplace. It is for all of us. For most americans getting coverage through their employers, the aca banned the ability of those insurers from limiting lifetime or annual caps. In particular for moms giving birth with complex babies. They could exhaust their entire benefit for their lifetime in just a few months. And for the record, the United States of america is leading in Maternal Mortality. That is women dying during childbirth. The fact that we are having a discussion, and if you want to say it is insurance. You cant say insurance if we are not talking about healthcare. If the Trump Administration prevails in court what would happen to these requirements. All of those caps would be put back in place. Lifetime caps, annual caps. No outofpocket maximums. You would also have a time where they can refuse for Maternity Care. Before the aca only 13 of plans new life was good, women in 11 state Capital Cities couldnt purchase maternity coverage. Until something changes, the only way that we can continue as the human race is through birth and pregnancy. It is an insult for us not to provide the care for women who are giving birth. Mister isasi, insurance is now required to cover Preventative Services including Maternal Health visits without cost savings. Thats right. You have spoke about being the mom of four beautiful children. Before aca you are uninsured for years except for when you briefly qualified for medicare during your pregnancy, how important was it for your health, as a mother with a pre existing health condition, and the health of your daughter to have insurance during that time . It was critical. All four of my children were born via cesarean. So if i wouldnt have had the insurance to be able to cover that. I still wouldnt have come up from under those bills. I have had highrisk pregnancies, that were very difficult. It was utterly necessary that i am there to be able to take care of my children. Its not enough to just have them, i have to raise them. My closing comment is, when we talk about aca, we are talking about, the path for children and women and pregnancy, that we not allow this shade of saying it is ineffective. The women protecting in this country, saying that we are leading. This is a way for us to address that. I yield back. Thank you so much. There has been a lot of talk today about how improving healthcare opportunities for American Families will lead to all sorts of dystopian outcomes. This idea that we will be rationing care. I am curious for those here, raise your hand if you have been uninsured in your life. Keep your hand raise. Also raise your hand if you have been insured but your deductible was exceedingly expensive. So you rarely went to the doctor. I have been there to. I was uninsured less than a year ago. Seven months ago. I want folks to raise their hand again, because i know what being uninsured is like. Its not just a financial issue, is the stress and it is the anxiety when you wake up every morning and you dont know if you are going to slip on the curb, or find something on your body you want to get checked out or if youre knee starts to ache. Everything becomes a spiral of anxiety as you dont know how you will afford it. When we talk about rationing care in a forprofit system with no guard rails, where you are allowed to profiteer off of insulin, and off of peoples lives. How many of you in your time of being uninsured or having healthcare that was too expensive, delayed getting a prescription or delayed going to the doctor. So you rationed your own care, is that correct . Absolutely. The cost of a forprofit Insurance Company caused you to ration your own care is that right . The mac exactly. I was on a selfimposed waitlist for 10 years. Not going to an orthopedist of when my knee hurt. Not seeking Mental Health care when my father died. All of those things. If you had shared with us, what you had the courage to share, about the fact that you had a miscarriage in the middle of a emergency room and you said you were uninsured at that time. You were uninsured so you miscarried in the emergency room and you were never able to get followup care that you needed. And you never knew what happened to your baby . Thats correct. Because insurance was too expensive is that correct . Correct. This right here is a complete condemnation of the forprofit healthcare Insurance Industry. While they are talking about how socialized medicine and a public guaranteed it to the right to healthcare will force us to ration care. We are not talking about month long waiting list but years long waiting lists for the system we have now. I will move on quickly. The key part of the aca mister isasi is Medicaid Expansion. This allows people of lower incomes, to essentially get covered by dedicated correct . The very most rural people of the country. There are some states that have not opted into this expansion. I have looked into some of these states. The states that have chosen to not expand care, to our lower income americans. The most vulnerable including alabama. Florida. Kansas, mississippi, missouri, oklahoma . Correct. Tennessee, texas, wisconsin and wyoming. Correct. These are the states who have chosen not to cover the most vulnerable americans. And these are the states that are also, we are seeing a lot of their representation trying to combat the aca when they are not even buying into it to protect their own. We are talking 2. 5 Million People who dont have coverage. Why do you think theyre doing that . I used to work with the governors on this very question, the truth of that answer is, it was tainted as obama care and it was a political decision. So people are not getting insurance in the state for political reasons . Absolutely. Thank you. People are dying, and getting sick. I will now go to mister ghose are. Mister balat you are from texas right . Yes. Are you familiar with federally qualified Health Centers . I am. My understanding is that it is first come first serve, seen on any basis, technically, there is coverage. Yes. Interesting. Let me ask you another thing, i have heard a number of things in regards to the aca, who are the three groups who benefited from the aca . Let me explain. Big hospitals, the Insurance Industry and pharmaceuticals. In fact if you invested prior to the aca in all of those you are a very wealthy individual. One of the things we have overlooked is the lack of competition. The incentivized Insurance Industry to gobble each other up. So we have regional monopolies. Then they had no competition in regards to the hospitals. Then what we had is a blowout in the pharmaceutical industry. There are some common denominators. I know we had a conversation about the va. I am very astute about that. The veterans that were dying, were in my state, arizona. I also have represented over 85 of the geography of arizona. A lot of rural areas. The implementation of the choice program, saved us. It actually helped those members in the rural areas to pick and choose their providers. Can you elaborate a little more on the Veterans Administration as a singlepayer type apparatus and why it is insufficient for the veterans . I also serve for the veterans charity. Quite a few connections to the veteran community. I dont hear a lot of positive things about the va. You talk about rationing, long wait lines. There was a time when i have seen veterans in their homes that said my ptsd is so bad i cant even come out. The only reason he came out was to say we need to fix the va. They are a wonderful example of what a singlepayer would look like. You have limited choices, long wait lines, the care in many cases is good but getting to it is often difficult. What does it matter if you have the access if you dont have it until after something catastrophic happens or until you have been living with pain for months and months. So yes it is problematic and similar to how these other industrialized countries operate and that is not what i would want for the people of this nation. Getting back to pursuing how to we take care of people. One of the biggest problems, and just for clarity, i was a dentist in a previous life so i know a little bit about the Healthcare Industry. I was no fan of what was prior to obama care nor am i a fan of obama care. My point is, something has gone awry. The problem is there is no real gatekeepers, we put them out of business. That would be primary care physicians, is that true . To stay in practice you basically have to sell your soul to a hospital in order to stay as a general practice. That is the unfortunate case, more than 50 of all of our primary care physicians are employed by hospital systems. I also heard today in the conversation that we are providing healthcare for all sorts of it individuals coming here illegally. And what we are actually doing is stealing for their doctors . A lot of our physicians come here from overseas because no one in the United States is really going into that discipline. It is becoming less and less but we have contributed as a government. Those coming out of medical school, we dont have residency spots for them. I will yield the rest of my time to the gentleman from texas. Let me, at the end of this hearing, i have a few questions. Before i conclude todays hearing, i would like to enter into the record, six letters the community has received in recent days. Including some from the lobbyist , the National Partnership for women and families. And the Veterans Health and advocate Sergeant Edward corr pullman, all of these letters expressing concern about the grave impact of the Trump Administrations position could have on millions of americans and the u. S. Healthcare system. As i sit here and listen to all of this, i asked myself, mister isasi. First of all, healthcare cost is going to go up no matter what, am i right . Absolutely. And, i have for at least seven years, been fighting with, many of my colleagues to bring down the cost of Prescription Drugs. How much does that play in the course of healthcare going up. The cost we see, are mostly because of the prices being paid for the Services People get. So if Prescription Drugs go up, premiums go up. That is what drives the vast majority of price increases in Health Insurance. No doubt about it . No doubt whatsoever. So it is very difficult, as you probably know, to get congress to move in the direction, of reducing the cost of drugs. As a matter of fact, my first and only meeting, with the president was about that subject two years ago. The price of Prescription Drugs had gone up and not come down. The thing im thinking about. You will never convince me, that the aca is perfect. For people higher on the income scale, theres a lot of things we could do to really strengthen and make the aca a much more effective program, no question. There does seem to be a string in some of the questioning that sort of blames the vic them. I dont like that word but the person going through some difficulty as if to say its your fault. I can tell you im fine. I could walk just like you could a year and a half ago. Now i cant walk without a walker. That was overnight, literally. As im sitting and listening to our patient advocate, folks, consumers, im thinking, and god forbid if more people went through some of the stuff or had family members who went through what you have gone through, perhaps they would have a different per spec. Theres nothing like suffering. Its nothing like being disabled. Its nothing like having your life change overnight. Its nothing like taking two hours to get dressed. Come on now. Theres nothing like sharing your pain. The idea that you would come here and the story that you have told are so personal but you are willing to share them with the world to make someone elses life better. In some kind of way theres something in here that i think we are missing and i think pres. Obama said it best. He said we have in our country quite often and empathy deficit. Theres some way we have to get around to making sure all people are taken care of. Saying well i cant help you because ive got to help you have got to help you. We can help everyone if we have the will. It can be an efficient system and one that will work for all americans. We talk about the rising healthcare cost and we should be talking about ways to ensure that all americans have access to affordable healthcare. We need to remember how far we have come under the Affordable Care act especially in the div the market. Mr. Isasi id like to ask you about the individual market. When you described in your written testimony, and i quote terrible prior to the aca, but now quote much much better, thanks to the Affordable Care act. Before the aca you say 60 of consumers in the individual market before the aca impossible to find affordable insurance. Now the aca has cut that number to 34 and more consumers are finding the coverage that they need so more consumers are buying insurance. Isnt it a measure of success that more people are able to afford the coverage that they need under the Affordable Care act . Absolutely. More people are spending their own money to buy insurance under the aca. One of the things that has happened in my district and in our state of maryland, when the Trump Administration pulls away the navigator money you know who did the navigating . The members of congress. You know why . We didnt want people to have an opportunity that they did not know about. If you dont know about an opportunity you may as well not have it. We spent hours upon hours trying to get the word out. The deadlines and all that kind of thing so that people could be insured. And one of the ways to bring premiums down to get everyone to participate, weve seen that in massachusetts and california. No doubt about it. Wow. Let me just say this. My republican colleagues have claimed that the aca have made Insurance Coverage unaffordable. As mr. Isasi has pointed out, the opposite is true. Before todays hearing the Committee Received a letter from the Pennsylvania Insurance Department commissioner jessica altman. In this letter, commissioner altman describes how that administrations lawsuit would chaos resulting in higher premiums and outof pocket costs for consumers in pennsylvania and across the country. I request this be made on the record without ejection objection. My colleagues were serious about making coverage more affordable for the American People it will condemn the administrations actions. Im going to conclude the hearing but again i want to thank you. I want to thank all of you for being here. And especially i want to thank our consumers. Theres something about pain, something about it that is a driving force. As ive said, when bad rings happen to you do not ask the question of why did it happen to me but why did it happen for me . In this instance, why did it happen for the people of the United States . I want you to keep those words in mind. Pain action purpose. Do you understand . I just wanted to also think the witnesses, all of you, for your time. This has been a pretty good length hearing. Those of you who have been able battling illness, thank you. Im a cancer survivor and the chairman is right. Theres something about we should be able to agree more. We have different per spec this on how to address making sure everyone can afford high quality healthcare but i appreciate all of yall testifying and on behalf of the entire committee, including those in the minority. Thank you very much. Id like to thank our witnesses for testifying again. All members will have five legislative days within which to submit additional written questions for the chair which will be forwarded to witnesses for their responses. I ask witnesses to please respond as proudly as possible when you get those questions. With that, the hearing is adjourned. Ive got to go. I want to start by setting the stage a little bit. We called this manpower morale after tet and by