Transcripts For CSPAN3 House Oversight Committee Hearing On The Affordable Care Act 20240714

Committee will come to order. Without objection the chair is authorized to declare a vereces of the committee at any time. This full Committee Hearing is convened regarding the administration ee administrations attack on the aca. I recognize myself for five minutes to give an Opening Statement. We are hear today because of on march 25th, 2019, the Trump Administration filed a two sentence letter with the United States court of appeals with the fifth circuit reversing its own previous position in the case of texas versus United States and asserting for the first time that it would not defend any portion of the Affordable Care act in the court. If the Trump Administrations position prevails and the entire 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, 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, end quote, 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 epidemic. We wanted to hear from the administration about why they suddenly reversed their position 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 vought, 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 destiny . 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 come 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 discussion 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 multiple bills that would have had meaningful impact on the cost of Prescription 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 relentless 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 Solomon Center for health, law and policy, Yale University law school. Thank you. Frederick isasi is executive director of families usa. 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 following. 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 involving 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 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. 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 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 pathway 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 preexisting 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 Emergency 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 Department services. 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 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 with preexisting conditions, not help them. As an adviser, im called to 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 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 both 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 hirschsprungs 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 called bilateral ureteral reflux, which meant that urine was going back up the ureters into my kidneys instead of down where it belongs. Now, the costs of that were 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 be 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. Im a member of the church of jesus christ of latter day saints, a church very wellknown for its generosity in 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 for lack of health care because they can go to the emergency room. You cant get a kidney transplant at the er. 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 immunosuppressant medication to keep my own body from rejecting the kidney. I also have to take other medications which deal with the side effects caused by that immunosuppressant medication. I also because my doctors later discovered a chronic distended 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 rules, face as they go through life. As parents, we want to make sure we can do the most seepgs 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 much 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 tessie got coverage through chip. In 2016 is, my husband, thanks to the aca, we didnt have to worry about going uninsured again. My Employers Health plan would cost 1,175 a month and thats just for the two of us. We pay 60 a month for our son max who is on chip and our daughter chessie is covered under the ph95 medicaid loophole for her disability. After my husband lost his job in 2016, we wanted to move closer to family and your state, mr. Jordan, of ohio, in florida and arizona. Guess what, mr. Jordan . Therefore we have to stay in pennsylvania. We also had to tear our life around the needs of chessie. For example, my husband is now going back to college to switch careers in in the Health Care Field which doesnt require us moving from state to state to find a job. Thanks to the aca in 2018, i was able to get a mammogram. It showed i had three lumps in my left breast. Biopsies were done and thankfully they were all benign but what if i was uninsured and the results turned out differently . This could have been financially disastrous for my family. Before the followup this year in may, i looked at my husband and i was kind of joking and being serious. I actually just have the doctor remove both of my brevities. If i get cancer, i might be uninsured. This is my reality and the reality of millions of families in america. 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 conditionton cover those with disabilities. I also had decided to get a pelvic exam two years in a row and when the doctor asked me why i scheduled this way because now you can go to between three to five years, i told her the truth. Im worried im not going to have coverage next year. She was glad i made the choice to come in. Im an lpn who works in proceediatric 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 chessie who is right here in the white with a little pink headphones. Where is she . Okay, all right. Seems to be listening to your testimony. Im not as important. Since shes been 19 months old, she has been in therapies or o. T. , speech and she also learned 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, socialize aging and work. At the age of 3, she was seen by three doctors, two diagnosed her with developmental language disorder, dld. A condition where children have problems understanding or using spoken language. She will have this in adulthood. The other doctor diagnosed her on autism spectrum but all doctors agree that she needs intense speech taper. In school, she received speech three times a week and o. T. One time a week. She also gets speech and offering t. Once a week outpatient. She has a mobile therapist to comes to our house two hours per week. A mobile therapist helps chessie to appropriately express her thoughts, her feelings and work on coping skills, practicing social skills in all. Chessie gets six therapies a week not including the mobile therapist. If she loses her medicaid coverage and we had to pay it would cost us 129,000 a month. Because my husband is in school, we could never afford that. The hard work of her had therapist has improved her life skills tremendously. Today she talks to her friends on her own and has made sith academic progress. Last year she was a c student, this year all as and one b in math and reading shes is two years behind. To break it down to you, imagine a tripod and she is on top of the tripod. The three legs represent one us her parents, two her therapist and a third one is her teachers and aides. If you cut medicaid, youre going to knock down that tripod and knock down all the progress 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 you guys are going to affect. Thank you. Thank you very much. Smus burton. And chairman cummings, the distinguished members of the committee, good morning. Morning. My name is stephanie burton. 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 hang my own shingle she wouldly after passing the bar. 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 win the 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 even afford a routine doctors visit. Something was terribly wrong with this picture. The Affordable Care act changed all of that. On january 1st, of 2014, i enrolled in a Health Insurance plan i purchased through the marketplace for less than 100 a month thanks to a subsidy. I no longer had to decide between paying my mortgage and going to the doctor. Ive been able to be manage my diabetes and get the medications i need to stay healthy for my kids and clients. Its a huge load off of my mind. Ive been covered through the marketplace 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 always says if youre traveling with small children, in the event of an emergency first place the oxygen mask over yourself and then over the small child. Not every parent this seems counterintuitive because 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 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 7th of this year, i was selfemployed without the oxygen of employerprovided Health Insurance. Upon accepting this new position eight years after having to hang my own shingle im not offered Health Insurance through my employer. Though that benefit option is great, i can still say the policy that i have through the marketplace is better. I have had the same team of doctors since i enrolled in 2014. Although the need isnt as urgent for me today as it was eight years ago, i can be honestly 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 have not have been healthy enough in 2014 to accept the position i have now. Maintaining Preventive Health care through routine visits thanks to my aca coverage 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. This there should be no hobsons choices when it comes to health care or housing. During this administration, i frequently wonder what would happen if i lost my coverage and what would it mean for high children. In the event that 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 not a partisan issue. 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 a wise and single mother of four children be forced to choose between housing and health care issue. Its 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 we endured before the aca. Thank you. Thank you very much. Mr. Morley . Thank you, chairman cummings. Ranking member jordan and members of the committee, i am honored to speak with you today. My name is peter morley. In 1997, i had al 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 totalinging 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 fantastic 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 interests 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 aca has meant focusing on healing, not bankruptcy. I used to be very private about my health. But once President Trump was elected and set to repeal the aca, i could no longer be silent. In december, 2016, i decided to foster awareness for lupus and advocate for health care. My congresswoman, carolyn maloney, 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 aca terminating it as the president has said is a grave form of subversion. In the last two years, i have traveled 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 aca, 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 firsthand your health care can changing in an instant. And if you think the aca 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 aca, 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 im healthy enough to come to d. C. I would be remiss if i did not mention my friend and advocate of medically fragile children, natalie weaver, whose own daughter sophia weaver, passed away in may. Sophia suffereded from rhetts syndrome and many other preexisting conditions and endured 30 surgeries in her shorten 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, miss maloney. Thank you, mr. Chairman, for calling this very meaningful hearing. I am so proud that one of my constituents, peter morley, 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 of patients and their families have reached out 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 and is there anyone that stands out to you . Absolutely. There are many that actually stand out to me. The hardest stories for me to listen to are the people who could have been saved had the aca 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 can healed. I hear from patients who, excuse me, rather caregivers who are they have medically 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 they are 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 the 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 a lot of courage to come here and to share something so vulnerable and so personal. I know. I know you suffer from chronic diseases and i know personally from our exchanges that its very painful for you physically to come here. Why do you make these trips . Because honestly, congresswoman, i never expect to sit whether its a democratic or republican legislate tore, 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, you know, peter, thank you, thank you. I can feel that you know something positive may come out of all 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 and to 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 . Yeah. What would happen to these families . A lot of them would lose coverage and access. And what would it mean to the parents of a medically fragile children who have reached out to you if the entire Affordable Care act, what would happen to them if the Affordable Care act was eliminated . I honestly dont know but i do know that they experience just even if that didnt happen, they experience an incredible deal of stress. And this this even having to focus on that has caused them undue stress and its already stress as we all know when we have a chronic illness. Its stress upon stress. My time has expired. Im proud to be in this fight with you and i am so proud of you. Im proud of you. Yield to mr. Hice. Thank you, mr. Chairman. I think theres two basic reasons why were having this hearing today. Number one has just come up. Its an opportunity to trash the president to impugn the president for not defending obamacare. And i get where our witnesses are coming from from that perspective. But that is the purpose, 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. Just look at the numbers and it is very clear obamacare does not work. Has not worked, is not going to work. We were told that there would be some 25 Million People enrolled in obamacare by now. Just hasnt happened. The truth what has happened insurance premiums have skyrocketed. Skyrocketed. Under obamacare. Deductibles have soared. Coverage networks and access to providers have shrunk in some cases been eliminated. Insurance coverages have fled the aca 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 hole have benefited. Im not going to deny that. And, of course, our panel is full of them today. And i appreciate the testimony from our witnesses, our panelists today. About i can also tell you, for every person who has benefitted from obamacare, we can find tons of folks who are have been hurt from it. You know, i look at the panel today, mr. Chairman, six out of the 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, from greensboro, georgia, who talks about how he has suffered. No objection to the record. Thank you. Ill reverse it somewhat of whats been said already today. If you think that people dont get hurt by aca, you need to think again. Ralph, for example, before obamacare, he paid 700 a month for insurance with 35 hundai deductible. Both of those, in fact, he now pays has nearly 14,000 deductible. And his monthly costs are about 1200 a month. A couple years ago, his two children, he has four children. Two of them were in an accident. Hes still paying for 30,000 plus dollars that had to come out of pocket before taxes, before grocery, before mortgage, before college. And so this thing absolutely goes both ways. The second reason were here today is really to lay the lat form 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 employer sponsored medical coverage, medicaid, medicare, all of it gone. Mr. Bell lot, let me just ask you, what would what can we expect from a government single pair Health System . You can certainly expect rationing of services. Thats what weve seen in many other countries that have gone this way. Many politicians have said those are models we want to look for, that we want to look towards to emulate. My experience in being in those countries and working with patients ill give you a spec example if i may. We were my wife and i were on medical missions in costa rica that has a single payer. The wife of the pastor that we were with was diagnosed with cervical cancer. She was approved for vurgry but she had to have an ultrasound first. She couldnt have it for 12 months. She asked when will i be able to have the surgery . They said probably another 12 months after that. She had access. She may never get to the point where she has that surgery. But the rationing is an inevitability when you have a limited amount of resources. And those resources continue to decrease the more burden we place on the medical professionals that are actually delivering the care. Gentlemans time has expired. Doctor, would you like to respond to that . Mr. Hice had said he wants to see both sides. Whats the other side of this . I saw you shaking your head, go ahead. What occurred to me. Your mic, your mic. We want to hear you. With respect to discussing the case thats the subject of this hearing, 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 legal principle. And the administration doesnt get to decide whether to defend a law based on whether it likes the policy in the law or not. Thats your job. Congresss job is to pass the policies. The administrations decision not to defend is only defensible under very limited circumstance in which theres a real unsettled legal question and as i said in my testimony, what is striking about this case is that theres a dramatic legal consensus across both sides of the aisle that the principle at issue, the legal principle severability is settled. And that theres no place not to defend the law. I would also just note that you know weve 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 and i also would point out that the Trump Administration itself is actually relying on the statute for a lot of its initiatives. I heard this morning that the Trump Administration announce add executive order about Kidney Disease that depends on the center for medicaid innovation. That will it be gone if the Affordable Care act is eliminated. The thivl initiative. Point of order, mr. Children. Whose time is this . Im trying to help you, man. You asked the question. And. Not. I asked her to finish answering the question. She was shaking her head. I allowed her to do that because i know you want a fair hearing and want to hear both sides. Thats what you just said. This is my time. Mr. Chairman, 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 . Yeah, thats the point. The oby crisis, as well. All their Health Policies rely on the statute, as well. It is important to recognize when were talking about what the statute has to offer. Thank you very much. Thank you for giving us both sides. Miss 2340norton. Thank you very much, mr. Chairman. It took a lot of chutzpah to hear my friend on the other side go down the list of the costs going up of health care, deductions going up when that is a direct result of actions that the Republican Congress took when they controlled this house. Now, theyre complaining about action that they took to diminish the Affordable Health care act. Well, one of those actions was to take away the mandate. The district i represent the nations capital, 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, just 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 saving a d. C. Mandate and so almost everybody has health care. Miss burton, i was interested in your testimony because it looked to me as though you had done all that will anybody could be expected to do. You finished law school, you found you couldnt find employment and then did you 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 condition. Is that true . Thats correct. What would be any idea what the purchase of Health Insurance would have been for you before the aca in. 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. Yes. Did that take any toll on your health. Absolutely. As a single mother of four kids, do you 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 8200 hours a week. I took time away from my kids to make sure they had everything that they needed. I dont have any regrets about that. Id give anything to make sure that theyre okay. But im all they have. So if i am gone, theres not somebody else willing to step up and take over that burden. Then came the Affordable Health care act. Yes, maam. With the marketplace. What what kind of coverage were you able to get, and how much did that plan cost . My plan with my subsidy costs 62 a month. And it was. Compared to, remind us, compared to. 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 doctor and a great team of doctors because i have so many conditions. I have narcolepsy, i have asthma, i have diabetes. I have sleep apnea. I have cat ta flexi. Because of that, i have a team of doctors. And my. Now, but now you work for the District Attorneys Office. Now, 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. Now you would 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 das office is supplemental. Its not federal. So it doesnt cover the benefits that you guys might have. My policy through the marketplace is still better than the insurance my employer offers. I did take it for my children. So you had Health Insurance offered by your employer. You compared that to the aca, and you decided to stick with the aca coverage . Thats correct. The gentle ladys time has expired. Did you finish answering the question . Yes, sir. Thank you very much. Mr. Comber. Thank you, mr. Chairman. Id like to welcome, im over here, like to welcome all the witnesses here today and just have three quick general questions id like to ask the entire panel just with a show of hands for the take of time. Do you all support or how many support eliminating employer sponsored 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 other side of the aisle support . Does 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 medicaid. And before the Affordable Health care act, kentucky had a high medicaid population. After the Affordable Health care act, kentucky expanded medicaid. And what happened when they expanded medicaid, a significantly a significant number of new people got on medicaid 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. 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. And 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 that are in the private market. And theyre very upset because the premiums continue to skyrocket. So we have a problem with the Affordable Health care act. Mr. Balat, the reason i asked the question about extending health care to Illegal Immigrants because i watched the democratic debate the other night and there were ten on the panel. They were asked a question how 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 and thats our focus. Thats who we take care of. What it would do to health care, what it would do to our communities, 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 as i said in my testimony. If they do get in to see their doctor getting a special referral is very difficult. Then getting the medication that they may need. I hear all the time that doctors dont like to take care of medicaid patients. Nothing could be further from the truth. They dont like the Administrative Burden that is consistent with how we deal with medicaid and the aca 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 air care. Were going to see our ers continue to be flooded and increase in population. Right. Well, 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 obama theres no way to fix the obamacare situation especially in kentucky with the massive expansion of medicaid. So hopefully, well have a discussion in the future in congress about ways to make health care more affordable to the working people that are paying while at the same time protecting people with preexisting conditions which is a priority for me and i think every member of this congress. Thank you, mr. Chairman. I yield backing. Mr. Raskin. Thank you very much, mr. Chairman. Professor gluck, 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 as opposed to the Affordable Care act and was your nemesis essentially, your counterpart on behalf of the Affordable Care act back in the burwell case. Is that right . Yes, it is. It is extraordinary. So youre talking about a distinguished lawyer who was opposed to the Affordable Care act and thought it was orally unconstitutional but he thinks it would be absolutely absurd and outrageous to use the invalidation of one provision which zeroed out the penalty for not purchasing insurance to unravel the entire act. Is that right . Correct. You cite a bunch of other conservative legal scholars who are on that side. Would you repeat some of the ones you mentioned. Sir, republican attorneys general from montana and ohio, judge Mike Mcconnell judge mcconnell. Yes, professor sam bray, professor kevin wal. In what context is judge mcconnell taking a position against the administrations point of view here. Judge mcconnell authored a brief with two other noted conservative legal scholars arguing that theres no jurisdiction to decide the case and filed the brief not on behalf of the either party but on behalf of the blue states. Undercore this point for our colleagues. Obviously we have a difference whether or not 20 Million People should be stripped of Health Insurance and about the general progress weve nad under the act. Lets go to the point about legal severability. In 2017, there were efforts to repeal the whole Affordable Care act. I remember that. I was in congress then and they had voted 69 different times to repeal the Affordable Care act in its entirety. They werent able to do it because there was a mass uprising around the country. People went out to all the town Hall Meetings and said dont do this. Eloquent, riveting testimony like the kind weve heard from patients dont do this to our families and werent able to get enough republicans to do it even though republicans controlled a majority. Instead they passed a provision zeroing out the penalty on the compulsory purchase of insurance policy. That was it and at that point, everybody agreed that the Affordable Care act should be saved. Some people thought it was a great thing, some thought it was a terrible thing. But now, theres the proposition being pushed by i dont even want to say conservative republicans because a lot of conservative republicans on our side but by an extreme fakz faction apparently within the Trump Administration, theres a position that the invalidation of this one provision where i dont know if its the passage of this one provision, but undoes the entire act and undoes everything. The protection for 26yearolds, preexisting condition coverage, all of the medicaid provisions all the provisions that expand peoples access to Prescription Drug benefits, closing of the doughnut hole, everything in there theyre saying is now toppled because this one provision is gone. Now, 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, were going to strike down a 2,000page piece of legislation . Yeah, i think one of the reasons you see this unprecedented consensus youre absolutely right that this case goes to the power of congress to let the court do what it did here. Court is taking over congressional law making power. Its usurping congressional law making power. Legal skol larnz liberal scholars alike value separation of powers. I wouldntent even want to win that way. If i thought 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 hey, were going to go ahead and destroy the entire act, i wouldnt support that because that is an absolutely defeat of legislative power, isnt it. Thats what the wall street editorial page saying nobody hates obamacare than we do but this is a corruption of the rule of law. What are some of the other things that would fall if the administration gets is position in destroying the aca. The reach of the statute cannot be overstated. Medicare Prescription Drugs, no discrimination based on health status, the Indian Health care program. They would invite us to believe we all knew that when that vote took place that we were essentially going to undo it if one phrase or one sentence dropped out of the legislation. Courts are not allowed to do that. Courts are not allowed to presume that the legislatures sewed the seeds of its own destruction into a statute. They have to defer to the legislature. Thank you for reaching across the aisle to bring conservative scholars in and to work with them on defending this critical principle of the severability of provisions that are struck down by a court. Thank you. I yield back, mr. Chairman. Mr. Miller. Thank you, chairman cummings and Ranking Member jordan. Before i begin, i would like to read a portion of a testimonial from one of mr. Hices constituents from madison, georgia. She writes, i coown 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. Mr. Chairman, i ask for the unanimous consent that the full statement be entered into the record. Without objection. Thank you. Thank you all for being here today. It has been over nine years since the aca has been signed into law. We all know that when a law is inr 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 program completely and chase after a single payer system which would further increase Health Care Costs on taxpayers inevitably 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 is the solution. Mr. Balat, has the aca lowered monthly premium for person americans . No, they have not. In fact, how much have premiums gone up for americans on average since this law was enacted . Its been significant and a range depending on the part of the country that theyre in, but its been 200 to 400 in some cases. Thats terrible. How has the aca kept deductibles the same or lowers them for our constituents . Outside of the exchange or within the exchange . Within the exchange . Ing. Okay . Whatever, listen to me. Your health is number one. Whatever you need. Let us know. Okay. All right. Thank you, mr. Chairman. The premiums within the exchange have been theyve gone up probably closer to 60 , 70 . The outside in the private market, theyve gone up substantially more. Thank you. It sounds liking what the goals for the aca intended to be have not really been enacted. How has the Current Administration helped insure american thoz have increased access to health care. Well, i think some of the examples have already been given. You know, people have talked about fixing the aca. I think some of the measures mentioned are attempts at fixing it such as the opioid, hiv and kidney initiatives. It looks to me that the white house and the administration are looking to improve upon the acas foundation but theyve 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, Insurance Health plans, extending those for those that may be in transition longer than the amount of time that was initially prescribed helping people who are losing jobs, having to move, that are going through a divorce. Its allowing them more time to go through that transition period. Association health plans was another solution that was put out there. And they experienced great success. And some reports were showing there were double digit savings that people were able to pool together and buy employer style Business Health plans. So that was another good innovation and then the hras, Health Reimbursement arrangements that will become effective january 1st. That will allow the individual market to come back because that went away effectively when the aca was first implemented. Employers will be able to dedicate defined amounts of fuyou. Mr. Chairman, ill yield back the rest of my time to the gentleman from texas. Sorry. Five seconds. Sorry. Mr. Balat, could you expand on your concerns earlier you stated about the medicare for all and expanding coverage to the extent that that would drive up costs of health care. Time has expired but you may answer the question. The cost of health care continues to go up. The more weve had the government involved in trying to fix this entity, this industry, the more weve had the cost to go up. We see the same thing in higher. The more the 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 theyre there, the Administrative Burden, the shackles that we put on people that are doing the work, on the front line, trying to help the patients. Were hurting ourselves by doing this. I thank the chair. Good lord, mr. Balats comments about the federal government, that would come as news to a lot of universities and colleges. Specially for profit colleges. Lets stop regulating it and prices will go down and of course cheating will stop and people wont be embezzled or defrauded with voting credentials or credits. That logic escapes me. Professor, have you looked at the economics of Health Care Insurance premiums . Yes. So mr. Balat says ever since the Affordable Care act, premiums have just skyrocketed. Is there in fact a correlation . And yes, you can answer as well. 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 are apparently unprecedented, never happened before. The premiums werent going up. Everything was stable and hunky dory. 35 Million People didnt have Health Care Coverage but somebody has to suffer. Professor . So youre correct. The Affordable Care act made insurance more affordable for millions of people to the extent that weve had some premium instability, a lot of it is attributable to the administration and the Republican Congress itself. Yes this strikes me as amazing. We do everything we can to sabotage the law and now we are horror struck that theres gambling. It has an 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. Youve been shaking your head. Please comment. Its really important that we deal with facts in this situation. Now youre talking crazy. You are in the United States congress. We know the answer to this question. We know what happens to premiums. The first thing to say is, this has been studied. They surveyed the American Public and the percentage of people reporting they could not afford insurance in the market was cut in half after the aca. One of the most central parts of the aca was, support, make sure that coverage was affordable. Most people in the exchange are getting that. Most people are paying far less for their premiums now than they were before. It is empirical and well documented. In addition, as you point out, there is a lot of dynamics at play. The number one reason that premiums high in this country is not the Affordable Care act. It is because the Health Care Prices in this country are out of control. It is a totally distinct thing. The American People know this. We know were paying too much for Prescription Drugs, for hospital care, were paying doctors too much. We know that. To blame the aca is a drowning man blaming his life preserver because he is wet. It is preposterous. That is not the reason we have high Health Insurance premiums. Can you and the professor remind us of a couple of the successful efforts by my republican friends during their majority tenure here in the house and in the congress . Where they succeeded and backed in gutting certain provisions of the xakt were directly related to try to keep pressure down on premium increases. Sure. So as you know, congress turned off Three Streams of very important stabilization payments for the Insurance Industry. There was then a lawsuit about the continuing ability of the administration to pay cost share and reduction payments which showed dramatic instability into the Insurance Market of there was then an attempt to reduce enrollment on the exchange. Reduce money for navigators which are critical bridges between individuals and enrollment and recently there has been a vigorous attempt to split the insurance pool, divide the Insurance Markets, and make health care more affordable for those still in the aca markets. Here i was thinking, were per verse and it just drove up prices mindlessly. Now you say, yeah, there is a cause and effect of it is not the Affordable Care act. It is in fact the insidious relentless drive to gut the Affordable Care act which they couldnt have beat legislatively but they could do it both administratively through amendments to laws that made it much harder for the protections, the bumpers. The largest we saw was after the payments were stpd. My time is up. Thank you for illuminating my understanding of what really happened. I dont think anybody in the panel or the president of the United States doesnt support having preexisting conditions in the bill. It is a tragedy when somebody loses their coverage or health care because of preexisting conditions. And unfortunately, the last congress, we had a bill in the house that addressed that. That protected preexisting conditions. It is unfortune that the other side of the aisle wouldnt work with us to make it better. My county was down to one insurer in the exchanges. The deductibles were so high and they cant afford them. These Million People are uninsured is because the deductibles are so high and its a problem. How the Affordable Care act has failed, most of the people running for president on the other side of the aisle are not running on obamacare. Theyre running on medicare for all which i think would be a real big disaster. Ill 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 bypass. Now, 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 emergency situation. But if it were a planned procedure, the wait times would be exceedingly longer than what we would have in this country. It just amazes me. We talk about research and, medical research has come a long ways. People have Higher Quality of life. What is your thinking with a pinl payer system . What happens to the private sector being innovative . What do you see happening . I dont know that i can speak to that. Even when we talk about the other issues, we keep going back to insurance and we talk about insurance and we dont talk about the patient. The real victim in this is the patient and the cost of care itself. The insurance has contributed to it. Of course, the premiums went up after the risk order payments were reduced because they were put in place to artificially decrease the premiums in the aca so it looked like it made sense, which it did not. So lets look to see what will happen to the patients themselves . Thats the real tragedy of what will be in the future and how well decide that well take care of our citizens in this country. Let me interrupt you. President trump gave an executive order to create association plans to come back into effect because the obamacare waived the plans. One of my neighbors, thats what helped her get insurance was the association plans. Can you tell us what is happening with the association plans . They were growing at a good clip. They had a great deal of popularity and then there was a suit that a federal judge essentially said the plans were an end run around the Affordable Care act. Theyre still in operation. Much like what happened with the federal suit in aca. Theyre still able to operate. However, the uncertainty is caused many people who want to create those kinds of plans to not proceed further because they dont know. But the association plans do give individuals the ability to have options. Absolutely. Because the exchanges, there is no competition there. Because it functions like an employer plan, theres no exclusion for preexisting conditions. It is affordable pause you have a bigger base. Yes. There are more options. They can choose among different types of solutions and not just traditional insurance. And we know that Health Exchange rkts a big help to that. I have that as the federal plan and i think it is a big help. It gives me more options and a better ability to direct my own health care. All this time. What can i do . One question of what are some things we can do with respect to empowering patients . I dont understand why were focused on insurance. You may answer the question. Let me if i have an example of what i use. I use direct primary care. Insurance has, ill say it this way. This has been a relationship between doctor and patient. Health care is a very personal it is very personal. All the testimony has been about the team. It is a direct membership type of plan. I pay on the order of 60 a month for unlimited 24 7 access to my primary care physician i can communicate with him via electronic means, text, secure video chat and the like. Thank you very much. Thank you, mr. Chairman. I do want to level set some information here. Theres been talk about government backed single payer systems. We already have two government backed single payer systems in the United States. It is called veteran affairs and medicare. And im hoping the members on the other side of the aisle are not suggesting they should be eliminated because theyre single payer systems. I want to point out that it is 40 industrialized countries in the world. 39 of them have universal health care. Only one does not. The wealthiest, greatest country in the history of the world, the United States of america. And mr. Balat, i take exception with your testimony that we have, that when the government is involved in providing Health Care Insurance, it drives prices up. In fact those 39 countries who have universal health care spend about half of what we spend on health care. We spend 18. 5 on gdp on our health care. We know we have a very inefficient system. While the aca may not be perfect, it has certainly brought Quality Insurance to a lot of individuals who did not have it. I hope im pronouncing your name correctly, i want to touch base with you on a couple areas. With the litigation going on in texas and the potential that were facing at 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 the seniors face in prescription prices. Can you talk a little about what the impact would be if the aca was thrown out in totality as the impact on Senior Citizens and prescription prices in general . You bet. So first of all, if the aca was repealed by these judges, the first thing that would happen is the seniors, medicare costs would go up. The Medicare Trust care solvency would immediately be weakened so it would have a very specific and negative effect. In addition, the entire pathway to provide high, low cost, high value, to treat leukemia, lupus, some of the most devastating illnesses in this country would disappear. That was part of the law. So it would have a very, very negative effect. This discussion about Association Health plans and other forms of new kinds of insurance, lets be really clear. What were talking about there is, hurting people with preexisting conditions and hurting people, letting Insurance Companies play tricks. It excludes people and it allows Insurance Companies to play tricks. We know and 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 protections. What we are hearing today is a description of Insurance Products that would, for example, exclude hospital care. Or exclude Prescription Drugs altogether. It is letting Insurance Companies play tricks on consumers again and that is not a path way to Affordable Access for the American People. It is a pathway for tricks and for hurting the Financial Stability of our nations families. And when we heard a member on the other side say that everyone here would support the view that the president supports coverage for preexisting conditions, let me point out, i dont believe that. I believe actions are greater than words. If the aca was struck down in its entirety, wouldnt millions, tens of millions of americans, i believe over 100 million americans would lose preexisting coverage . Thats right. And by the way, it is almost half of the people, im sorry, over half the people before the aca who went to the individual market tried to get coverage and had preexisting conditions and couldnt get coverage. This question has been answered. Republican leaders passed legislation that was the alternative to the Affordable Care act. The cbo told us that 6. 3 million americans with preexisting conditions would end up paying much more for their Health Insurance coverage or not be covered. They actioned this question and they hurt people with preexisting conditions. Thats the truth. And professor, it looks like youre chomping at the bit to say something. I wanted to add turn on your microphone. I was nodding in agreement. Because the Affordable Care act, i think the number was 52 Million People were denied insurance because of preexisting conditions. So thats a statistic you have right there thats readily accessible. And furthermore, that just to emphasize, reenacting preexisting conditions alone would not really do nearly enough for really any people with serious medical conditions. If you have coverage, that coverage is priced prohibitively, it does nothing. If you have coverage but it doesnt include the benefit of the Prescription Drug you need to treat your disease, that does nothing. If you have coverage but you dont have six did i to pay for the coverage, or you dont have medicare, medicaid to pay for it, it does nothing. So the preexisting conditions discussion is important but it is just the tip of the iceberg. Thank you for your testimony. Mr. Chairman, i yield back. Thank you, mr. Roy. Thank you. A couple quick questions for professor gluck. With respect to the litigation, did the Supreme Court find the mandate unconstitutional . The mandate . Yes or no. No. It was not found unconstitutional. No. There is no such thing as the mandate itself. What the Supreme Court did was found that the mandate was not, could not be construed constitutionally, it was constitutional as a tax. Thats the point. The mandate is unconstitutional. Thats what the court said. The mandate is unconstitutional. The only power that remained was the taxing power. Then what happened . It was zeroed out. Which means what . It does not exist, right . Theres no tax. Is there a tax today . The tax is set at zero. There is no tax today. There is a mandate in the legislation. The mandate is unconstitutional. The Supreme Court said this body does not have the power under the clause to have a mandate to make americans go purchase a product in commerce. The tax is now zero. The tax no longer exists. Therefore, where do we sit today . The very thing, 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. And this is why were in front of this. It is not because of a policy choice as some have suggested. This is because it is a question. A constitutional question. It is a question about the power of this body and whether this body can mandate that individuals by something in the marketplace. When it was determined to be a tax, the penalty, then you have a taxing power question. Now we dont have a taxing power question and this is where we now stand today. Is it not true that with respect to severability, that four justices in the opinion did find it to be inseverable . Is it not true that they found it to be inseverable . I really appreciate that question. For two reasons. First of all, the mandate, the enforceability of the coverage position is not the issue in the case. It is not being enforced. What is at issue is what happens without the provision. Does whole statute get struck down . With respect to your second question, it is very important about the previous Supreme Court opinions. Those opinions were indeed based on the courts perception of the 2010 Congress View of that provision. What is at issue in this case is the 2017 amendment to hold otherwise is to undervalue the power of the 2017 congress visavis reclaiming my time, four Supreme Court judges have addressed it and said it is unseverable. The Obama Administration argued that it is intertwined and the entirety of the aca has language dotted throughout the aca saying the mandate is essential to the aca. In fact, it was described as one of a three legged stool without which the aca shouldnt stand. This is what is at the heart of the litigation in question. This is why it is before the fifth circuit. Thats why the arguments were held yesterday. There were Great Questions from the panel i haves on the judge. The judges on the panel asking the questions and it is why the carter appointee didnt ask a single question. This is a very legitimate litigation and well see then what unfolds. With respect to my colleague from california making the comment that, quote, that we have medicare. Im interested that we have bipartisan agreement that we need to make changes to the v. A. To make it better and one of those to rely on market choices, on choice, on the mission act. To have more choices for our veterans to get access to care. That a single payer solution isnt meeting the needs of our veterans who are serving this country with valor. That when we talk about the wealthiest and greatest country in the history of the world, when we compare ourselves to other countries, were the one country that doesnt have Single Payer Health care, there is a reason that were the wealthiest and greatest. We shun the very statism that my colleagues on the other side of the aisle would dare to put on the backs of the American People so they are forced to pay premiums they cant afford. Forced to give up what they had before or they were able to have before. Forced to be put into a system sub par. Forced to say theres now coverage for 20 Million People when the vast majority is medicaid coverage which was designed to take that out. This was what were talking about a 32 trillion medicare for all scheme had will blow up medicare, the ability for us to have a Health Care System affordable for the vast majority of the American People. With that, i will yield back the 5 seconds i have left. Thank you. I think it is important to note for the record that mr. Roy just came out for privatizing the v. A. Which the overwhelming number of our veterans absolutely oppose and are quite happy with the health care theyre receiving and want it to continue. That having been said, i would like to ask unanimous consent to put this into the record. It says name much criticized program that has saved the u. S. 2. 3 million. Hint, it starts with affordable. One month after they passed it, they projected the impact in a report entitled, estimated financial effects of the Patient Protection and Affordable Care act as amended. The governments official Record Keeper estimated Health Care Costs under the aca would reach 1. 4 million and constitute. Fast forward to december 2018, notably during the Trump Administration, when that same Office Released the official tabulation of Health Care Spending in 2017, the bottom line, cumulatively from 2010 to 2017, the aca reduced herring spending a total of 2. 3 trillion. In 2017 alone the article continues, Health Expenditures were 650 billion lower than expected and kept Health Care Spending under 18 of gpp. A tad over where it was in 2010. Did it all this while expanding Health Care Coverage to more than 20 million uninsured americans. Compared to the 2010 projections the governments medicare bill in 2017 was 10 , 70 billion less and spending for medicaid in the program was a whopping 250 billion below expectations. Partially but only partially due to the failure of some states to expand the program. The actuary had predicted that it would cost 1. 21 trillion in 2017. It actually came in at 1. 04 trillion. A difference of 170 billion for that year. Put another care, Health Care Spending in 2017 was 2,000 less per person than it was expected to be. For the 176 million americans who have private employer sponsored insurance, their lower premiums averaged just under 1,000 per person. I could go on but weve entered the article into the record. So essentially, we need to be dealing with the facts. Thats why we have these hearings. And the fact is that Health Care Costs have been lowered. Premiums on average have lowered for people and weve added 20 million to the Health Care Roles with. That having been said, some of you may know im a Breast Cancer survivor. I talk about it very openly. It is something that i live with and live in fear. Miss dye, i understand all of your concern is that the thought process you went through about possibly having a prophylactic mastectomy. No matter how assured i was of, that i did as much as could i do to prevent that cancer from coming back, i think about it every single day. Like every single cancer survivor i know. So taking care of your health and making sure that you have the ability to go to the doctor when youre sick, and not worry about how youre going to pay for it. What the fear was for every single uninsured american, or underinsured american before the Affordable Care act is absolutely paramount. And what this debate is all about. I would like to ask unanimous consend to enter this letter from, we have a letter from 17 advocacy organizations, plus the American Cancer Society into the record. Without objection. As the letter notes, the patients represented by their organizes were forced to delay or forego Necessary Health care which is simply unacceptable. Thats 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 ask simultaneously with the remainder of my time about the impact on seniors. Because nearly 1 5 of the residents in my district are seniors. And we havent talked a lot about the coverage gap known as the doughnut mole would be reestablished if we actually go back to the bad old days pre aca. If you could tell us, what would happen to this provision if the administration succeeds in overturning the aca . Then im sure my time will run out. So to your first question, the impact of the aca on people with preexisting conditions, your stats are exactly right. We had almost half the people applying being denied coverage because they had a preexisting condition. And that means, and it is important to note this. In this country most of us get coverage through our employer sponsored coverage. When we get sick, we lose that coverage. Without protections, we dont have anything. This is not just about people in the individual market. It is about every person in this room and watching from their homes right now. May i answer . If the chairman is all right with that. Remaining time. So congresswoman, youre exactly right that the Affordable Care act protections for medicare have been widely underappreciated. 60 million seniors got access to free preventive access. 5 million benefited from the coverage gap before the Affordable Care act. You only had Prescription Drug coverage up to a low number, around 2,000. And then there was a large gap until coverage benefit kicked back in. We call that the doughnut hole seniors had to pay out of pocket. More than 5 million seniors benefited from that. The medicare provisions had a drug negotiation component to it that wound up lowering costs by some 26 billion in drug costs over the life of the bill. I would say that all of that would be gone if the decision is upheld. Thank you. I appreciate your indulgence. I yield back. Before we go to mr. Norman, i try to make sure that i run a fair hearing. Im going to recognize for a minute. You wanted to clarify something. Mr. Roy . I would ask my colleague to maybe reframe her comments that i was calling for the privatization of the v. A. What i said was that the v. A. Needs improvement and the v. A. Is seeking improvement, the Veterans Affairs committee is seeking improvement through choice and mission to improve private sector options to supplement the Veterans Health care. So i think you mischaracterized a little bit what i said and i would ask if she would be willing to acknowledge that is not what i said. I recognize her. I appreciate the gentlemans request. If the gentleman is willing to say that he is opposed to privatizing health care at the v. A. And making sure that the v. A. Can continue to provide the Excellent Health Care Services that it provides, that the overwhelming majority of veterans support, continuing, then sure. Well, im not going on get into a back and forth about characterizing. What i am hey, hey. Whoa mr. Chairman then i would characterize if youre not willing to characterize that, i would characterize your position correctly. No. You mischaracterized my position and you did so blatant. Chairman reclaiming the time the chairman gave me, we have a bipartisan agreement that choice and mission are improvements to the v. A. That adding Market Forces are s a good thing. Bipartisan agreement on that. That is a mischaracterization. What you said about, characterizing what i said we should fully privatize the v. A. We should inject market choices and have more choices for veterans. Since the gentleman has now addressed me and has taken his time back and wants me to correct how i characterized his position and he has refused to acknowledge that he opposes privatization, that is a simple statement. I didnt hear him say he opposes privatization of health care at the v. A. If hes not willing to say that, the direct the Republican Party has been taking us in with the v. A. , including the Trump Administrations pushing in that direction for more private Market Forces for health care at the v. A. I share the military construction and, i chair the committee, so im responsible for the budgeting for the entire varks along with my colleagues. So you wont say that on the record so i will not recharacterize what i said you said. Im not going to engage in an inquisition i was not trying you mischaracterized my statement. Hello. Hello. Why wont you say you oppose privatizing the v. A. . Will you say you oppose mission and choice . Did i oppose it. Y yes, i did. Please. The committee is not in order. The Ranking Member. We can read the transcript. The gentleman from texas did not say he was in favor of privatizing. He did not say anything about it. He talked about choice. His characterization by the lady, the gentle lady from florida was that he said he was for privatizing the v. A. He did not say that. The transcript will be clear because we all heard it. Thats all hes saying to clarify simple fact. All right. Well take look at the transcript. And he wont say, mr. Chairman, that he opposes it. Right now were getting ready to go to mr. Norman. I tried to work thank you. I couldnt do it. But did i the best i could with what i had mr. Norman. Thank you. I specifically want to thank all the panelists. Particularly the ones that have preexisting conditions to come here. I will take issue with the six of the seven, as he said, were 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, i assume, any type changes in the health care. I take issue. I think mr. Gibbs you singled out mr. Jordans state is not covering your particular problem. Okay. I dont know which one of you did. Heres what, this is not a partisan issue. This is something all of us want. Democrats and republicans alike. The fact that i think, where we have a different world view, all of you raised your hand, i think, for Health Coverage for every illegal in this country. Every one of you. Thats estimated, except mr. Balat. Everybody else. I think you mentioned i didnt raise my hand for anything because i was uncomfortable with it. Let me rephrase it. The majority of you raised your hand, other than mr. Balat, raise your hand for health care for everybody. We dont know how many illegals are here. Could i fill this room with everybody behind you. He takes issue with obamacare. They cant afford the premium jump from 400 to six, in many cases, 6,000. I could bring the gentleman in who happens to be 75 years old who doesnt want a mandated Maternity Health care, having to pay for in his policy. I wish we could have had a more balanced panel. Our intent is to solve this probl problem, single provider as it does not work in the private sector will not work and has not worked with obamacare. It may be one, if each of you had a single provider for, lets say, drug stores. One drugstore to shop from. Im sorry. The prices you couldnt afford, as we cant afford health care now. Im in the private sector. Im a businessman. And i will say that it has not worked for the majority of the businesses and look at the physicians leaving. If theyre leaving, look at them who are leaving west wont be able to get special i haves now that each of you have had if it keeps going. Can i please acknowledge mr. Norman . Because he brought up my name in his questioning, or his stance. Ill reclaim my time. Ill talk to you privately. Ive yielded my time to mr. Roy. Chairman, can i also state that i was not in the room when you asked that question . So i did not raise my hand and i never mentioned that i am for medicare for all. I came here for the Affordable Care act and it seems most of this has been about medicare for all. I did not raise my hand in support 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 about the Affordable Care act. Thank you. Mr. Balat, let me ask you, was it not true that in 2013, if you if you like your Health Care Plan you can keep your Health Care Plan . Thats correct. And millions were kicked off because it provided. While many gained coverage, 6 Million People lost the coverage they had before obamacare, correct . Thats correct. 2. 4 were transready. 600,000. From nongroup to uninsured. Of those who gained coverage, of the 20 odd million, was that about half and half medicaid and through aca . It was more on the Medicaid Expansion. Is it not true that is crowding out people who are the original purpose for medicaid was those who were the most vulnerable. Were now crowding out people. There are studies saying in illinois, in 2016, a study shows 762 people died while on a waiting list because they were trying to get care because medicaid was getting crowded out by healthier individuals shoved out by the medicaid rolls. It seems our republican members would love to distract us. You asked the question this is about protecting the law of the land and the threat this administration is posing to the health care for millions of americans. Thats what this is about. My colleague from maryland. Thank you, chairman cummings. Thank you for inviting these witnesses. And i want to thank the witnesses for coming. Professor gluck, welcome. A few minutes ago, i think you were trying to point out to mr. Roy that his discussion around 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. And mr. Roys decision voluntarily to go back and fight last war, of course, is his to make. What is not fair is to force some of the witnesses 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 to lead hearings back in 2010 where we heard all of these stories. We were hearing them from the perspective of people that were desperate to get coverage that they did not have. We made a coverage to do everything we could to deliver that coverage. And we did that with the Affordable Care act. Now theyre back again. Now theyre terrified that they could lose the coverage thats 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 they think it is 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 it is 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 there is any kind of cogent, coherent, meaningful replacement plan for the aca. Notwithstanding all the attempts, 69 and counting, on the part of the republicans here in congress to repeal the Affordable Care act. Professor, in your testimony, you discuss the essential Patient Protections and Health Programs would disappear if the aca were to be struck down. Does this include guaranteed issue and preexisting conditions protection . Yes, it does. What about the Community Rating protection that prohibits insurers from charging older adults significantly more than they charge younger enrollees . Would that go away . Yes, it would. Who whatever about premium tax credits and cost sharing payments that make coverage more affordable for middle income families . That would be gone. What about the acas Medicaid Expansion . Gone. What about the prevention and Public Health fund . What would happen to funding for essential public Health Programs like those that support safe drinking water, children immunizations, and Smoking Cessation . All those would be eliminated. Let me come back to a point i was emphasizing earlier. Has the Trump Administration or Congressional Republicans put forward any meaningful replacement plan for the aca that would provide the same coverage gains and Consumer Protections that we just went through over the last few seconds . No. Nothing has come even close. Why, let me ask you this. Why are preexisting condition protections on their own without the acas other provisions, not a sufficient replacement plan . Because we keep, i mean, republicans, i give them some credit. They figured out that nobody in america wants to lose the coverage now available for preexisting conditions. So they keep invoking them saying well hold on to that even as were jetsoning all the rest of the Affordable Care act. Can you explain why it is important to have other provisions in place in order for that to be an effective protection . Youre absolutely right. It is not enough to have insurance. Just 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. So just having the ability to get insurance doesnt stop insurers from charging you more if you are sick. From creating benefits that dont include, say, your hiv drugs, and it doesnt give you the kind of Financial Assistance to make that affordable like the subsidies or the Medicaid Expansion. Thank you. And i want to thank our witnesses and our chairman for bringing those witnesses forward today. I yield back my time. Thank you very much. Mr. Balat, i would like the get a handle on current problems were having. Could you in general describe what is happening in this country for people had are fending for their insurance on their own . Both the cost of insurance and the size of deductibles over the last five or six years . Could i share with you that premiums have, talking about in the private market, premiums have gone up for employer based plans and individual plans when theyre available. Dramatically . Pardon . Dramatically . Considerably. Yes. Where they used to be 300. Theyre on the order of 1,500. For a family around 2,000 a month. Devastating. How about deductibles . You know, the hsas, when hsas came into being, they were coupled with High Deductible Health plans and there was a reason why that dollar amount was set at 3,500. That was considered a High Deductible Health plan. Deductibles today are on average, 6,000, 7,000 i heard recently 14,000. Devastating for people without medicaid. Without question. And for those that dont have 1,000 in their savings accounts, it is an unreachable number. Unbelievable what people have to put up with. Ive heard stories of Health Care Problems that i wouldnt have believed ten years ago were possible. It still amazes me and i was not around here when the Affordable Care act was passed, or the unAffordable Care act. It amazes me how people get elected to congress and think theyre so smart that they can take over such a big segment of the American Economy and make it better. Lets look at why those costs have gone up so dramatically. First of all, how Many Americans are on the Affordable Care act . Despite all the hoopla over it . Just over 8 million. I think it is 11 million . On the exchange . Between 8 and 9 million. So youre talking, what . Under 3 of americans are on it for all the hoopla. Wheres the big increase in government involvement in health care since obamacare kicked in . I would say the Medicaid Expansion. Okay. And in medicaid, youre down in texas. But how much is the reimbursement . How much has the government paid female provide medicaid compared to medicare and compared to what the private sectors charged . Medicaid is typically your lowest reimbursement. Whether youre a physician or a facility. It is just below medicare typically. So youre maybe saying half . Just north of half. Okay. So in other words, as we change the system to put more and more people on medicaid, what were doing is, were driving up the cost for people not on medicaid. Is that true . Absolutely. Okay. And is the reason there for the cost of people who arent eligible for aca . The reason theyre being punished . And just put in an impossible position, is because the change in the way the huge number of people now are expected to get their health care through medicaid type plans, who before may have gotten health care other ways. Is that whats going on . If i can ask to you restate the question, please. Okay. Right now the reason the cost is going up is because more people are Getting Health Care through medicaid. People who in the past would have gotten health care either through their employer or purchasing their own. Is that accurate . It is, it is. So in other words, this dramatic rocket up in costs, the people who arent eligible for it didnt just happen. It was by design almost. Or maybe people were so stupid, thais people would be so benefiting. Theyre talking about being forced into a situation they dont want to be in should the aca be repealed. Were being forced as citizens to participate in programs we dont want. Im going to thank the witnesses. Welcome to congress. The debate continues thank you for coming. Mr. Gibbs, ill start with you. What would it mean to you and to your son when he grows up if the acas preexisting conditions protections are eliminated . Thank you. It would mean that if something went wrong and i lost my kidney, or something went wrong and peters kidney declined, that he would have absolutely no guarantee of any rights to health care. Any guarantee that he would be able to receive treatment for that kidney problem that he was born with. It would mean that he was born with a sentence to lose a fundamental right. And i do believe that the access to health care is 100 a fundamental right. Something we cannot exist without. I mentioned life, liberty, and the pursuit of happiness. Health care, without health care, you dont have that access to life. And it is not a choice that you made this decision for your son. Absolutely not a choice. How about you . What would it mean to your family if the aca preexisting condition protections are no longer 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. And before i would do that, i would go without, like i did previously. I use the resources for the four kids i brought into this world so they dont have to be a burden on the American People and society. Ive done everything i can to be responsible. Thank you very much. How about you . Thank you for the question. The shes 10. For her speech, her expressive and receptive, she is two to three years behind her peers. It is never going to go away. She will have it through adulthood. Her speech therapy, she needs it. To be a productive member of society, it is almost like life support for her. And what a lot of people dont understand, they kind of laugh, but your republican colleagues, they want to talk about employer insurance. Well, a lot of employer insurance does not coverage speech at all. And the ones that do, you only get ten sessions a 84. So if you can please explain to me how my daughter has, shes 2 to 3 years behind, how those ten sessions a year will help. If were fortunate enough to not have a preexisting condition, at some point a lot of us will. If you have children and youre really worried about how theyre going to be affected, it is really existential. All of us can identify with that. I want to ask you each to think about, emotionally, what is it like and how did you feel before you had that guarantee of protection and you had a child who was sick. And you had no confidence could you get it. Did it feel like it was your fault that your child was sick . For me, i felt like that was my fault. What did i do . Was i not taking care of myself during pregnancy . And everything like that. I also felt that my country, the congress, was saying that my daughter doesnt matter. That her life doesnt matter. Her future. And thats hard for me to take. Especially when they kept saying that we are the greatest country in the world but yet the greatest country in the world is telling my 10yearold daughter she doesnt matter. That is heart breaking for me. Go ahead. Ive got just a little time here. For me, when my son was born, the aca was in place. Part of me 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 wasnt my fault. When i chose to have that child, the Affordable Care act was in place. I made responsible choice to have a child who could be guaranteed the right to health care. An irresponsible choice is being made but not by me. All right. Thank you. I want to thank all the witnesses. Mr. Chairman, what we did here, there are life circumstances that none of us can control. If you cant get a fair shot, thats about justice. Thats not about personal responsible. There is a lot of life choices we do make. Thats on us. You cannot get health care because the law wont allow it. Thats on us. And justice requires we protect those preexisting condition protections. Thank you. People get sick and people die. Mr. Green. Ranking member, i think most everyone knows im an e. R. Physician, cancer survivor, the father of a cancer survivor, im also the founder and ceo of a Health Care Company that when i left employed over 1,000 medical providers and saw 1. 5 million patients or so a year. I love caring for people. I love being a doctor. So much so that i started Free Health Care clinics in clarksville, tennessee, 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. But first i want to tell everyone about a shift i had in the e. R. My first patient was a gang member. Hed been shot in the lower abdomen. He was punching at the staff and yelling at us all. Were trying to save his life. After giving this guy world class care, i walked out thinking, at least with government payer, i would get paid for the risks taking care of this patient. But near the end of my shift, aid woman who had just a few days prior, gotten her dose of chemo. She was febrile as the chemo had lowered her immunity system that the infection threatened her life. With her were two children and a worried husband. The woman was only 35 years old. She didnt have insurance. As we stabilized her, i realized that Early Detection had saved this young womans life. In europe, socialized medicine has delayed Early Detection as care is rationed and thats why mortality rates for specific illnesses are far better in the United States than in europe and canada. That woman would not have received timely detection and her chances of survival would have been significantly less than a socialized system. I was working in an e. R. And met a patient who was a ceo of a Major Corporation in canada. He had a laceration. He hopped on his personal jet, flew nashville, tennessee, and came to my e. R. Because he could have been seen faster flying to the u. S. Than waiting on a Government Run Health Care snem canada true. Story. In canada you can get an mri for your dog that day because theres a free market and veterinarian care. But you cant get one for grandmas knee. Youre going to wait six months. Socialized medicine does not work. It does not provide better care. Study after study has shown medicaid patients have equal outcomes to patients without insurance to all. Those are real numbers. The aca is not socialized medicine. What it does is takes money from taxpayers and increased rates for Small Businesses. Yes, it has raised rates. I was on the committee in the Tennessee State senate. We had to increase those hundreds of percent. It gives that money to patients who comafford care and allows them to do what . Purchase Health Insurance and participate in the incredible care other americans are getting either through their employer or out of their own pocket. But unfortunately, that isnt going to last. Youve given great testimony about how it works. It is not going to last. You see, either by intention or accident, the aca creates pressures on the Health Care System that are crashing the very system that the Witnesses Today were praising. You like your aca insurance based care and i appreciate that. Aca is driving the Cost Shifting to a point that Small Businesses cant afford and it more people are shifted to government systems. As this dynamic pushes people on to the government care, medicare, medicaid, all of that, we move to more and more socialized medicine. At some point the shifts cause the system to crash. That means the insurance based system aca is providing you, that youve given great testimony on today is going to go away. It cant last. But maybe thats exactly what the leaders of the Democrat Party want. Medicare for all will be abysmal. It will be akin to the v. A. Im a veteran. I know. Ask your veterans. 36. 2 trillion over ten years. If you tax 100 of income earners at the top levels you only get 700 billion. It doesnt add up. Yet the aca is driving us toward that system. I repeat. Either intentionally or accidentally. The government is not the answer. Government health care is rationed care. Late detection and worse mortality. We need solutions to health care and my plan, i have written and it is a bill this year to create a health care swipe card. Unlike what mr. Sarbanes said, would fix the problem and allow to us provide help to even more people and i encourage particularly my freshman democrats to go look at my plan. I think the people that ive talked to love it. Even democrats. But the health care youre getting is insurance based. You love it. You want to see it continue. Help us get rid of the Affordable Care act which is driving us to a single payer. Thank you. Although gentlemans time has expired, miss gluck, you seem like you were shaking your head. I would like to respond to something. I think again, it is important that we actually have information and facts in this conversation. What we know is a few conversation. We one, if you look at the information comparatively comparing the u. S. To other countries, our babies are dying at faster rates, our moms are dying at faster rates. We have more preventible injuries in the United States occ occurring than in other countries. The reason health care is so expensive and the studies are super clear on this is not because weve brought everyone in and given them access to Health Insurance. Its because the Health Insurance sector is increasing prices at astronomical rates. We notice, the American People notice. They see whats happening when they get those hospital bills. That is why the system currently is unsustainable. The notion that ensuring that everybody has a shot at Getting Health Care when they need is breaking the bank is preposterous. Mr. Chairman, he brings up a point that kind of contradicts something. Ill take 30 seconds. 30 seconds. Yes, sir. You have to make sure you compare apples to apples. When we compare life spans and things like that in our country versus others, i mean they eat less Fried Chicken in europe, they smoke less than us. Its not just the Health Care System. It is the Health Care System plus lifestyle and all of that. While some of the stuff that was just mentioned about the cost of drugs, i get it, but you cant compare apples and oranges. Just responding to that point. No, no, no. Im not trying to be rude. Just trying to move the hearing along. Thank you mr. Chair. 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 the perfect bill. But i know since i have been here, we have never been given the chance to work on the bill especially when president obama was the president. All we had a chance to do is repeal, repeal, repeal, repeal. And i know that he put a lot of things in the bill. He wanted more things in the bill, but in trying to get one republican to support the bill, you know, he made concessions and then no one wound up voting for the bill, as you guys know. And then we spent, i think, over 63 times trying to repeal it. And also im glad you mentioned about Maternal Mortality and infant mortality. It was safer to have a baby 25 years ago and its not just from people eating Fried Chicken. That is not the reason. Oh, i know you were going there. I just want to add that for the record. I wanted to ask you how do the uninsured rates in states that have expanded their medicare programs compare to those that have not . Its an important point to make that what we actually know earlier the witness next to me cited a cite that said access to insurance had no impact on mortality. That study actually says in the published study, our results should not be interpreted that health has no effect on mortality. What we do know from the journals of medicine is when people have access to Health Insurance they live longer lives and they are healthier. That is the truth. I will also say weve heard a lot about this question of hospitals closing in districts and people losing access. Before working at families usa as the executive director i ran health care for the National Governors association. I worked with republicans and democrats across the country. The number one way to make sure a rural hospital doesnt close is to expand medicare. Exactly. How has the Public Health improved in states that have expanded medicaid . Not only are people healthier and able to get the care they need, but we also see Larger Movement from people from public insurance into employer coverage as they get jobs. Its all connected, its all interlinked. I also want to thank the witnesses for sharing your personal stories. I know its not easy to do and i really appreciate it. Im married to a doctor. Hes an anesthesiologist and he supports the aca. I think its important, as i said in my Opening Statements, its supported by the american medical association, the heart association, the cancer society. So we have one doctor who says he doesnt like the aaca but al the associations who represent providers say this is really important for the American People and for us. Theyre right in the fact that, yes, you can find someone that believes this or believes that. Its personal experiences. But we have to look wholistically and overall that what is the greatest benefit. What would happen to Medicaid Expansion if the Trump Administrations position prevails in court . Well, it would end and all of those people who got insurance would be thrown off the rolls. Im the chair of the Congressional Black Caucus health brain trust. Information weve been given when you look at africanamerican men, the rate of Prostate Cancer has gone down significantly since many more have the aca and also Breast Cancer in black women has also gone down because of access and care because of the aca. Yeah. I recently wrote an article about disparities in cancer care across races and geographic regions. It has been found that the Affordable Care act has done more to reduce disparities in cancer than anything else in recent memory. Part of that is because of the covered early screening and changeup check ups. Would the gentle lady yield . Yes. A little earlier the representative from georgia mentioned that some of his rural hospitals were closing. I dont think georgia is one of the states that accepted the medicaid under aca. If they did, i think it would be a little bit different, i think. Can you comment on that and comment on uncompensated care . How has that been affected by the aca. What we know if you look at hospital close yours in rurures hospitals, 80 are occurring in nonexpansion states, states that choose not to expand medicaid. They have that ability, they dont do it and the rural hospitals end up closing. I was part of a lot of negotiations with governors trying to expand medicaid. This is the number one issue. Its the reason hospitals push for it, because they know when you have a group of people in a Small Community that do not have Health Insurance, they cannot keep their doors open. Health insurance provides access and allows for the economics of that community to survive and the hospital to survive. Mr. Higgins. I thank all our guests here today for your courage in being here. Your stories are touching. Im going to tell a story too. My wife has ms, its a preexisting condition. I have four children, three living. I lost a daughter long ago to a condition she was born with. I myself have many, many physical injuries from my years as a police officer, including a reconstructed eye socket. As a cop, cops earn in louisiana 12, 13, 15, 16 an hour. As a captain, when i resigned my commission to run for office, i was earning 20 an hour. My wife was a receptionist. She earned 12 an hour. Health insurance for many years before the aca was always the same, 300, 400, 500 a month. They say insurance premiums went up to unaffordable, 800, 900, 1,000 a month. Deductibles went up to 2, 3, 4, 5,000. Having a Health Care Card from the aca does not mean having health care. One of my colleagues mentioned that we want to destroy the aca. We were told you can keep your plan, you can keep your doctor, your premiums will go down by 2500, youll have more access to car 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 wouldnt 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. It was common for three, four, five or six Insurance Companies to compete for the group policy. That business of Companies Large and small, thats gone. You dont have a competitive market anymore. Those companies have to search around beg. It used to be the other way around. Insurance companies would come to american businesses, large and small, and seek that business for the coverage they provide their employees. My coverage expense after the aca went up every year. It was quickly over 1,000 a month. Couldnt afford it, man. Do the math. Youre a cop earning 15, 16 an hour, the wife of a cop earning 12, very quickly you had to make a decision are you going to buy groceries or Health Insurance. What do you think we did . We bought groceries. That was never an issue boyfriend t 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 health care. An unaffordable policy for regular working american at 1,000 a month, just have the privilege of paying cash for your health care all year because you have a 5, 6, 7, 14,000 deductible that you never hit. Thats not health care that we need to provide to our nation. Thats not real. My wife and i had to buy nine aca policy. That was reality. We had to buy a nine aca policy and we were subject to punitive fines from our own government whom we served, and im a veteran as well. Because the fines were down the line. The seizure of our property from the irs, of all places, because we have the audacity to buy a nonaca policy. That seizure of our property was down the line, but groceries were not. Im not opposed to the aca because it was president obamas crown jewel. Im opposed to the aca because its been an abysmal failure and a massive seizure of american property and american freedoms. Youve mentioned reasonable postures. You my fellow children of god, my fellow americans, have shared meaningful stories that touched our hearts. Help us fix that thing, man. Thats what we seek. Just a brief statement, which is, you know, first of all, this is literally the admission of our organization. We want all americans to have high quality to affordable Health Insurance. An 18 increase in Health Insurance premiums in one year. Guess what year that was . That was 1987. An 11 increase in Health Insurance premiums, that was 2002. What we know for sure is after the aca was enacted the increase in premiums for employer sponsored coverage where most americans get coverage was slower. It was 2 , it was 1 . These are the cms actuaries own facts and figures. There have been problems with Health Insurance premiums in this country for decades. We are with you. I think everybody on this panel is with you. We have to solve this problem, but to blame the Affordable Care act because in 1987, 30 years before it was even conceived of, there was an 18 increase seems a little bit absurd. Thank you, mr. Chairman for convening todays hearing and 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 lived experiences here. I know 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 courage of everyday people who quite literally put their lives on the line, their bodies on the ground and stood in the gap. And i believe that the same will be true again. So thank you for your courage and for being here today. Certainly in my district, almost half of the residents are living with one or more preexisting conditions. Im grateful for our attorney general who has been leading the fight on the front lines helping to protect the aca and affirming that health care is a fundamental right for all of us. Mr. Moorly im paraphrasing but it was very poignant and resonant when you said that instead of fighting to stave off bankruptcy because of the aca you got to focus on staying well and staying alive. The fact that in this we find ourselves at a time when people have to ask 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 foregoing the life saving insulin my child needs to stay alive. I want to focus my line of questions on the persistent inequities and disparities a rollback to the aca would cost for the 67 million women and girl who is li girls who live with a preexisting condition. Could you explain for the committee what Health Insurance coverage was like for women before the aca . Women have benefitted enormously. Thank you for the question. According to kaiser, the uninsured rate on women dropped from 19 to 11 under the law. Before the aca, only 12 of individual plans covered Maternity Care, which is a shocking statistic. Women could be charged 50 more than men for insurance because of the health risks that they posed because of conditions like pregnancy. The aca ended that discrimination and pricing based on gender. It also significantly helped Womens Health because it now covers without a copay significant Preventive Services that are very important to women. I mean, much more than contraception, Breast Cancer screening, colon cancer screening, hiv, the hpv vaccine. It keeps women healthier which results in healthier pregnancies. So women were paying out of pocket . Yes. Is there anything else youd like to elaborate on as far as how the aca put a stop to those discriminatory practices . All of those protections would be gone. You wouldnt have basic things like Maternity Care covered for a huge swath of the population. You spoke of having to deal with being uninsured for so long. Before the aca women could be denied for pregnancy, Breast Cancer or treatment for sexual or domestic violence. Were also in the midst a national Maternal Mortality crisis. Women are no safer giving birth today than they were 30 years ago. How important was it to you and your family they were able to have Maternity Care during that time . It was very important to me. Ive had four csections. I did not have natural birth with any of my children. My pregnancies were all very high risk. My youngest child i gave birth in the first semester of my second year of law school. One of the biggest complications was my uterus had completely 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. Case in point, 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 or what condition was in place at that time. Thank you. Just really quickly, 1 in 4 residents in my district benefit from the law that requiallows to remain on their parents plan until the age of 26. Can you explain why this is important . Its important to me because of the mother of four children, my older two children are 19 and 18. They work but their jobs dont provide health care. Through the health care i now have through my employer, my kids are still covered. Its important. We have kids and we expect them to continue their education and go to college, but we dont have a means for them to be insured during that time. We want to have safety nets but we put impossible choices in their way. By allowing that kor ing thaing 26, it allows them to pursue an education without having to worry about if they get sick, whats going to happen to them. Thank you. So right now in north dakota we have the same number of people uninsured as we did ten years ago or prior to the implementation of the Affordable Care act. Weve passed Medicaid Expansion at our state level. Weve done all of those things. Considering that we are a lot of Small Businesses, a lot of small family farms, what weve done is shifted the burden up the economic food chain. If youre a small family farmer, youre not employed so you cant get insurance through your employment. You dont qualify for medicaid and you dont qualify for Medicaid Expansion. One of the Major Concerns of obamacare in regards to the ongoing litigation is the lack of Insurance Products to Small Business owners, sole proprietors, farmers who have largely been priced out of the market. Can you elaborate on any proposals that could increase coverage in Rural America . I suggested earlier whats happening with Rural America is many of the farm coops that exist have been taking advantage of the Association Health plans. I understand earlier that the witness to my right was saying that was an opportunity for Insurance Companies to play tricks. People are walking into these things with eyes wide open and theyre shopping responsibly and addressing the needs they have and the groups they represent. Thats been a good solution. For those that are in transition, theyre using the shortterm plans. More importantly, most importantly is were looking at addressing hsas and personal accounts that people can start to use their own money rather than having the government pay directly into the Insurance Companys coffers, allow us to purchase our own insurance for ourselves. That would be a big boon to the rural community. I would also add the use of telemedicine and the technical advances thats been a big help for rural remote areas. Its how we deliver medicare. People drive 100 miles now. As a state, weve done a great job over 50 years putting up picket fences for licensing and those types of issues. And now in the last several years weve done a pretty good job of reducing those picket fences so things like te telemedicine can be brought into Rural America. I appreciate that and i would just also say we didnt have a lot of choice before. We have a state of 750,000 people. The markets adjust to that, but over ten years we have seen insurers flee our markets. To say weve stabilized after ten years like thats some kind of accomplishment is really not the point, because it was unsustainable to go any farther than stabilizing at some point in time. Ive been part of the Health Care Industry for 20 years. What were talking about is not going back to aca. Its not a binary choice. Its not aca today or preaca. What we can do is create an environment thats better, that will help address the real problems that people have for themselves and for their children. Lets give people choice. I just want to add one more thing. One other issue that nobodys brought up about the Affordable Care act is that the Kaiser Family foundation has said that 20 of all innetwork claims in the aca are denied by the Insurance Companies. Thats protecting people. I appreciate that. I hope whatever we do moving forward gives states like north dakota and our governor and our insurance commissioner more ability to make decisions and the federal government less. I yield to mr. Roy. In 2009 a cbojct report said that by 2016 a new law would cause premiums to increase in the individual market by 1013 . I dont believe so. I dont recall. The Obamacare Administration caused premiums to double. Every age group experienced an increase of between 5663 . In the exchange, yes. Premiums increased an average of 60 . In the four years before the aca every age group and family type either experienced an increase, a decrease or an increase of 9. 2 or less. The dollar amounts varied from 2500 to a different dollar amount. If you look at this chart back here, the red lines are post obamacare. The blue lines are immediately preceding obamacare. We dont have witnesses here testifying for all the people who lost insurance because of obamacare. We dont have families here testifyi testifying who were paying the premiums represented by those red bars. Im just trying to figure out how we can make sure all of america is not getting stuck with insurance or the inability to get the health care of their choosing because weve created a system thats too expensive. The gentlemans time has expired but you may answer that question. In spite of what happens with the aca, my role is to help with research and educating lawmakers to find as many choices and find as many options and solutions that work well regardless of the geography here in the unite. It was 13 miles. That was my community. Its absurd to think we can manage the Health Care Insurance coverage and the health care for people states away. It must be done at the state and local level. Thank you very much. Ms. Tlaib. Thank you, mr. Chairman and thank you all so much for being here. Ms. Burton, i was very touched by your statement. I wasnt here, but i was able to get a written statement. Something that you said at the end was beautiful, that this is not a partisan issue, that its about what happens to families without Health Care Coverage. What should a si why should a single mother of four children be forced to choose between housing and health care and is it we are better as a nation if we keep our people healthy. While the Affordable Care act has helped millions of americans obtain Health Care Coverage nationwide, areas such as wayne county in my home state of michigan have some of the biggest impacts. According to a report from georgetowns University Center for family states that have expanded medicaid under the ac a have seen sharp declines. Why has Medicaid Expansion been so effective . Thank you so much for that question. One of the things is that before the aca was passed, there was a misperception in the American Public and a lot of lawmakers if you were poor enough you got medicaid and that wasnt the cas case. Before Medicaid Expansion there was nothing there for him, no insurance whatsoever. Medicaid expansion said if youre poor enough, were going to give you access to Health Insurance. Thats why its been such a successful and important part of the Affordable Care act. The acas Medicaid Expansion is one of the many forms that would disappear if the Trump Administration previails in court. Is that correct . Yes it is. 87,000 people alone in my district. It is not just medicaid coverage that will be cost. Currently 79 million americans live in what we call primary Care Health Professional Shortage areas, meaning there is less than one physician for every 3500 people. Michigan has the third highest number of shortage areas for primary care and the Metro Detroit area has over 20. This equals that individuals already have to travel further to receive Health Care Coverage. In many communities where hospitals have closed they have to travel further to receive emergency medical services. Under the aca, patients do not have to pay copay if they go to an out of Network Emergency room, correct . Would that change go if the Trump Administration previlailsn court . Under the aca there are protections for out of network billing. Theyre not complete but they are there. If the Trump Administration suceeds suceeds instead hospitals would be forced to provide more uncompensated care, is that correct . What is likely to happen particularly to hospitals in shortage areas like detroit if the number of individuals requiring uncompensated care increases. Would this help or hurt their stability to keep our doors open. Every hospital will show up and say without that coverage we could risk closing our doors. The aca has also address provider shortages through something called the Community Health center fund. Can you explain what that fund does . Before my dad worked at ford and finally g, i went to a clin and i remember going in. It was required for us to be able to do the medical exams. He didnt say pass the Affordable Care act, pass obamacare and your premium wills go up but dont worry this bill wont be the cause. I would dispute that its not the cause. I think mr. Roy offered some numbers that show that it may in fact have been. In the past decade, whats the single biggest change to Health Care Policy in this country . To Health Care Policy . Yeah. That would be the aca. Would be obamacare, right . Without question. When obamacare was passed, the single biggest change to Health Care Policy in the last decade, projections were we were going to have 24 Million People enrolled in it today. How many are enrolled in obamacare today just in the exchange. Between 89 million. Its not even a close to a third of what was projected. T we were told if you like your doctor, you can keep your doctor. Is that true . Its not true. When obamacare passed, again the single biggest change in American Health care in the last decade, we were told if you like your plan, you could keep your plan. Was that true . No, sir. It was not. When obamacare passed, we were told premiums were going to decline. Again for the record, did that happen . No, it did not. For everyone, premiums in the exchange, out of the exchange, everybodys costs went up. It did. The cost of the premiums went up. With the subsidy, it went felt by the people who were part of the exchange. Do you think we were lied to back in 2010 . Congressman, i want to speculate. The New York Times said the architect of obamacare going to the white house several times and meeting with all the key players said this, if any american really believes that obamacare is going to control costs, ive got some reali estae in white water, arkansas id like to sell them. So the guy who put it all together said it was going to drive up costs and it certainly has. Have the coops worked . Data shows that they have. The 23 coops. I was referring to the others. The ones in the private sector have. 23 set up, only four left, 19 bankrupt. Obamacare passed, single biggest Health Care Policy change in the last decade in this country. Are there more choices today than there were in the 2010 . There are not. Many of the carriers have left. Our individual market in texas was Provider Networks were smaller or larger . Much smaller which has contributing to the surprise billing issue. What happens when youve only got one insurance provider in a market . Premiums go up. Youve got one supplier of a product in any market, typically you dont have the kind of price consumers would prefer, do you . No, you typically dont. You said in your Opening Statement that the aca hurts families with preexisting conditions. That stuck out in my mind. I actually wrote it down several hours ago when we started this hearing. Can you elaborate on that . It really is a function of cost. Lets talk about insurance. The reason preexisting conditions is even a thing is because insurance is coupled with employment. The fact that we dont have more portable personal insurance plans causes us to jump from place to place. That creates that preexisting condition issue. In health care we just call them conditions. Preexisting conditions is an insurance term. But how its affected families is as these premiums have increased, as these deductibles have increased to such high levels, theyre just priced out of the market. If theyve had a plan theyve had in some cases, ive talked to some people, ive had my insurance for 15 years and i just cant afford it anymore. Now they have to go to another solution, they have a preexisting condition. That wasnt an issue as long as theyve had their plan theyve had for 15 years. Thank you. Thank you very much. Thank you, mr. Chairman. Thank you all for being here today. When i speak to people in my district whether theyre Community Health centers and clinics, hospital associations or patient groups, i hear we must focus on increasing access to Services Like treatment centers. The counties that make up my district are part of 40 california counties taking part in the drug pilot program. In that vein, what tools has the aca provided to help us fight the Opioid Epidemic. This really cannot be stated strongly enough. The number one tool in this country to combat the Opioid Epidemic is the Medicaid Expansion. Ive worked with governors all over this country who are trying to stop this terrible plague in this country. You need to have coverage to cover you for your pain treatment that is not necessarily a pill but lets say is a behavioral therapy treatment. If you are addicted, theres nothing more effective than getting more americans covered. Its something we need Additional Resources for, not the opposite. The acas Medicaid Expansion has reduced the unmet need for treatment by as much as 18 . You noted that medicaid is the largest payer for Addiction Treatment in this country. Medicaid provides comprehensive coverage to nearly 4 in 10 nonelderly adults dealing with opioid addiction. What would happen to people who have gained access to treatment through the Medicaid Expansion . They would lose it. The crisis that were trying to solve would get even worse. Its that simple. Theres no plan to i have not been made aware of a plan. I would say that the administrations own plan to combat the crisis depend on that Insurance Coverage being in place. There are other aspects of the aca that have facilitated expanded access to treatment. The aca also expanded parity for Mental Health and Substance Use coverage meaning insurance plans are now required to cover these Services Just as they cover medical and surgical benefits. How would eliminating these provisions connect people with Substance Abuse treatment . These people who now have access to treatment would lose it. You would go back to a time in which they were out there by themselves maybe relying on pills and not getting treatment to combat the crisis. Do you believe insurance without the aca would cover these kinds of services . Federal law requires Mental Health parity but we know Mental Health parity provisions have not been adequately enforced. You dont want insurers just covering a cheap pill. They need deeper Insurance Coverage to accomplish that. Weve received a statement from the record from pennsylvania insurance commissioner crediting the Affordable Care acts protection for preexisting conditions and expanded coverage of Mental Health and Substance Use disorders for helping the state fight the Opioid Epidemic. She wrote over turning it would effectively undo a decade of progress. I would like to enter the statement into the record. We are truly facing the worst Public Health crisis in a generation, yet this administration is doing everything in its power to take Health Insurance coverage away from the people who need it the most. It starts with protecting and expanding rather than taking away health care for the millions of americans battling Substance Use disorders. Thank you. Thank you for being here today. Appreciate the time that youre taking to be here and share your stories, especially the witnesses who are here with the personal stories. Appreciate you being here from the great state of texas. My insurance went from 345 a month to 1200 a month, my premium increased drastically, premiums increased from 247 a month to 1,024 a month. My 225 a month catastrophic plan was declared illegal and premiums doubled. My insurance tripled in cost. It costs more and has fewer benefits. Premiums increased, deductibles increased 1500 more a month. I was forb i was forced to go on obamacare and lost my doctors. My dad had to get obamacare and they denied him the medicines he needed. Hes limited on doctors. Ive been without insurance for seven years because its cheaper to pay the fee. Do these stories sound familiar . I hear these stories all the time and many from the patients who were come into my own facilities. We asked how has obamacare affected you and this is the response weve gotten. While i appreciate the testimonies of the witnesses who are here and i dont discount them at all, it would have been nice if the committee had allowed us more than one witness so we could have had a more wellrounded understanding of how this is affecting the American People. The point is that a one size fits all approach doesnt work for the American People. The one thing that hasnt happened over the last decade, we havent had a real discussion about health care. Obamacare should have been more dubbed obama coverage. All the testimonies were hearing is about how many people are covered when i think the real question should be how do we get better access to care. The goal for all of us regardless of which side of the aisle youre on is care for the American People, not more coverage. So i think it would help us all if we could work our policy making toward that objective and do so in a way that brings into light a wellwound wellrounded understanding of how this is truly affecting the American People. Theres been some talk about socialized medicine, whether or not obamacare is or isnt that. One of the Major Concerns when the aca was being debated was whether it would be a first step to socialized medicine and universal health care. Could you explain the similarities . Indeed i believe my understanding is over half the Democratic Committee members have endorsed medicare for all. Putting these two together, is there a similarity, is there not . The similarity is governor sponsored health care versus individual choice. Thats what the distinction is at its purest level. What we want is to have people that have the freedom to use their own money the way that they wish and to have some kind of coverage that protects them in a catastrophic fashion. Were not in a place where we have that kind of relationship with our medical professionals anymore, because insurance has been what weve been pushed into. And insurance youre right, coverage is not what health care is. I would say those folks that you read their stories, the increases in those premiums, many of them, the ones that ive talked to are still uninsured today. They had good insurance. They were able to take care of their chronic disease. They were able to buy their medications, they were able to go see their doctor. And today theyre uninsured and theyre having a challenge getting other kinds of coverage because of a nowpreexisting condition directly because of the aca making things more expensive. Do you believe Market Forces can work to help provide more access to care . Ive seen it happen without question. I yield my remaining time to the current sitting Ranking Member, my friend from texas, mr. Roy. I thank my friend from texas. I would ask my other friend from texas, just expanding a little bit, i believe that the number is somewhere in the vicinity of 17 and my colleagues have in fact supported medicare for all. Im happy to correct that number if its not right but i think thats right. Thats a sizable number. Could you explain to me why if obamacare is working so well, some of my colleagues are racing to change it and offer a new approach in the form of medicare for all . You may briefly answer the question. I dont know that i could explain for them. However, it does seem as if theyre abdicating their support of the aca by going to this plan. Its a show that the current plan does not currently meet the needs of the people of this country. Ms. Lawrence. Thank you, mr. Chair. I want to 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 of the congressional caucus on womens issues and the congressional caucus on foster youth, i firmly believe that the wellbeing 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 as a preexisting condition. I would like to ask 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, so ordered. Thank you, mr. Chair. The letter notes that before the aca, women with high risk pregnancies could be unable to afford medical help for the rest of the year and babies born preterm, quote, exhaust a lifetime cap before the first birthday. How did the aca preexisting conditions protections on annual lifetime limits change the outcomes of individuals . Its one of the most critical protections in the Affordable Care act. This is not just for people buying coverage in the marketplace. This is for all of us. For most americans getting coverage through their employers, the aca banned the ability of those insurers from limiting putting lifetime or annual caps. In particular for moms who are giving birth to complex babies, babies with complex Health Care Needs, they could exhaust their entire benefit for their lifetime in a matter of just a few months. Just for the record, america and everyone listening, the United States of america is leading in Maternal Mortality. Thats women dying in childbirth. And the fact that were having a discussion and if you want to say its insurance, you cant discuss the insurance if youre not talking about health care and health care are lives. So professor, if the Trump Administration prevails in court, what would happen to these requirements . Well, all of those caps would be put back in place, meaning lifetime caps, annual caps, no caps on outofpocket maximums. You would also have a return to a time in which insurers could refuse to insure you for Maternity Care. Before the aca, only 13 of plans covered Maternity Care. And women in 11 state Capital Cities couldnt purchase maternity coverage. Until something changes, the only way that we can continue as a human race is through birth and pregnancies and its an insult for us not to provide the care for women who are giving birth. Now is that correct . Insurance are now required to cover Preventive Services increasing Maternal Health visits without cost savings. You talked about being a mom, four beautiful children. Before the aca you were 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 preexisting Health Condition and the health of your daughter to have insurance during that time. It was critical. As i mentioned previously, all of my children were born via cesarean. If i wouldnt have had the insurance to be able to cover that, i still wouldnt have come from under those bills. Ive had very high risk pregnancies that were very difficu 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. Ive got to raise and take care of them. My closing comment is that when we talk about aca, were talking about for me sh a passion i have for children and women and pregnancy, that we not allow this shade of saying its ineffective and cant happen because the women protecting them and in this country to say that were leading in women dying and pregnancy, this is a way for us to address that and reverse those trend. I yield back. Thank you so much. Ms. Ocasioocasiocortez. Theres been a lot of talk about how improving Health Care Outcomes for American Families is going to lead to all these dystopian outcomes, that were going to be rationing care. Everyone here, raise your hand fufb if you have been uninsured in your life. Keep your hand raised and also raise your hand if youve been insured but your deductible was exceedingly expensive so that you rarely got coverage or went to the doctor. Ive been there too. I was uninsured less than a year ago. I was uninsured seven months ago. I want folks to raise your hand again because i know what being uninsured is like. Its not just a financial issue. It is the stress and it is the anxiety when you wake up every morning and you dont know if youre going to slip on a curb, if youre going to find something on your body that you want to get checked out, if your knee starts to ache, everything becomes a spiral of anxiety because you dont know how youre going to afford it. So when we talk about rationing care in a for profit Health Care System with no guardrails where its the west wild where youre allowed to profiteer off of insulin, off of peoples lives. How many of you in your time of being uninsured or having health care that was too expensive delayed getting a prescription or delayed going to the doctor . So you rationed your own care, is that correct, ms. Burton . Yes, absolutely. The cost of a for profit Insurance Company forced you to ration your own care, correct . Absolutely. I know exactly what thats like. I rationed my own health care for ten years. I was on a selfimposed wait list for ten years, not going to an orthopedist when my knee hurt, not going to seek Mental Health care or counselling when my father died. All of those things. You know, you shared with us, what you had the courage to share with us about your miscarriage, about the fact that you had a miscarriage in the middle of an emergency room and you were uninsured during that time. That is correct. You were uninsured so you miscarried in an emergency room and you were never able to get the followup care that you needed, you never knew what happened to your baby, correct . That is correct. Because insurance was too expensive, correct . Correct. Because ceos needed to offer a profit margin, correct . Correct. This right here is a complete, complete condemnation of the for profit Health Care Insurance industry, because while theyre talking about how socialized medicine, how a public guarantee to the right to health care will force us to ration care, we are rationing our own care. Were not talking about months long waiting lists under the system we have right now. Were talking about years long waiting lists for the system that we have now. Ill move on quickly. A key part of the aca is Medicaid Expansion, correct . Yes. This allows people of lower incomes. Medicaid expansion allows people of lower incomes to essentially get covered by medicaid, correct. The very most Vulnerable People in this country. That is a core part of the Affordable Care act. Yes. Now, there are some states that have not opted into this expansion. Thats right. The states that have chosen to not cover, to not expand care to our lower income americans, american that are most vulnerable include alabama, is that correct . That is correct. Florida. Correct. Kansas. Correct. Mississippi. Correct. Missouri. Correct. North carolina. Correct. South carolina. Correct. Oklahoma. Correct. South dakota. Correct. Tennessee. Correct. Texas. Correct. Wisconsin. Correct. Wyoming. Correct. These are the states that have chosen not to cover the most vulnerable americans, correct . Thats right. And these are the states that are also were seeing a lot of their representation trying to combat the aca when theyre not even buying into it to protect their own, correct . Were talking about 2. 5 Million People who dont have coverage because they have not expanded medicaid. Why do you think they are doing that . Well, i used to work with the governors on this very question. The truth to that answer is because it was tainted as obamacare and it was a completely political decision. So people are not getting insurance in these states for political reasons, thats your testimony . Absolutely. Thank you so much. Thank you. Ms. Ocasiocortez, people are dying and getting sick. I will now go to mr. Gosar. Youre from texas, right . I am. Are you familiar with federally qualified Health Centers . I am. Let me review. My understanding is its first come first serve, youre seen on my basis and your requirement for payment is a sliding fee scale, is that true . That is correct. Technically there is coverage for these populations . Hmm. Interesting. So let me ask you another thing. You know, ive heard a number of things today in regards to the aca. Who are the three groups that actually benefited from the aca . Let me explain. Okay. Big hospitals. The Insurance Industry. And pharmaceuticals. In fact, if you invested prior to the aca, in all those, youre a very wealthy individual. Because one of the things weve overlooked is the lack of k competition. We incentivized Insurance Industry to gobble each other up so you have regional monopolies. Then we had no competition in regards to the hospitals. Then what we had is a blowout in the pharmaceutical industry. So these are the theres some common de nnominators here. I also know you had a we had a conversation about v. A. And im very astute about that. Im from arizona. So the veterans that were dying were in my state. I also represent, have represented over 85 of the geography of arizona. So a lot of rural areas. Okay . And its its the implementation of the c. H. O. C. H. O. I. C. E. Program actually saved us so it helps the members out in the rural areas to pick and choose those providers. It makes a big difference. Can you elaborate a little bit more in regards to the veterans administrations s s s as a we build specially adapted housing for disabled veterans and quite a few connections to the veteran community. I dont hear a lot of positive things about v. A. Talk about rationing. Talk about long wait lines. Theres a time ive seen veterans in my home say my ptsd is to bad, i cant come out my front door. The only reason he came out to talk to me is to say, we need to fix the v. A. So theyre a wonderful example of what a single payer would look like. Youve got limited choices. You got long wait lines. The care in many cases is good but getting to it is often difficult, and what does it matter if you have the access if you dont have it until something until after something catastrophic happens or until youve been living with pain for months and months and sometimes years . So, yeah, its problematic. Its very similar to how some of the other industrialized countries operate. And thats not what i would want for the people of this nation. Yes, sir. Now, in getting back to pursuing how do we take care of people, one of the biggest problems, and just for clarity here, i was no fan, by the way, i was a dentist in a previous live, so i know a little bit about the Health Care Industry. I was no fan of what was prior to obamacare, and im no fan of obamacare. Nor was i. I think theres something else. My point is is somethings gong gone awry here. The problem is theres no real gatekeepers. We wput them out of business. That would be primary care physicians. Suspect that tr isnt that true is. Yes. To stay in practice, you have to sell your soul to the hospital in order to stay as a general practice. Thats the case. 50 of our primary care physicians are currently employed by hospital systems. I also heard today in the conversation that were providing health care for all sorts of individuals coming here illegally. At the same time, were stealing their welleducated people for medicine, for doctors, are we not . A lot of our physicians coming here are from overseas because nobody from the United States is really going into that discipline. Its becoming less and less, but were also weve also contributed to that problem as a government because even in this country, those that are coming out of medical school, we dont have the residency spots for them. Yeah. I want to yield the rest of my time to the gentleman from texas. Okay. Let me were at the end of this hearing but i have a few questions. I have not asked questions. But let me, before i conclude todays hearing, i want to enter into the record six letters the committee has received in recent days including submissions from the lobbyists, the National Partnership for women and families, the National Womens law center, and the Veterans Health and advocate Sergeant Edward corcoran. All of these letters express concern about the grave impact that the Trump Administrations position in texas law that could have on millions of americans and the u. S. Health care system. Ask unanimous consent. So ordered. You know, as i sit here and i listen to all of this, i ask myself, mr. Isasi, first of all, Health Care Cost is going to go up no matter what, am i right . Absolutely. And i have for at least seven years been fighting with some many of my colleague s to bring down the cost of Prescription Drugs. How much does that play in the cost of Health Care Going up . That the cost that we see in premium increases are mostly because of the prices being paid for the services that people get. So if Prescription Drugs go up in price, premiums go up. If hospital prices go up, premiums go up. Thats what drives the vast majority of price increases in Health Insurance. No doubt about it. No doubt about it whatsoever. Wow. And so its very difficult, as you probably know, to get the conch congress to move in a direction of reducing the cost of drugs. Prescription drugs. Matter of fact, my first and only meeting with the president was just about that subject. That was two years ago. And price of Prescription Drugs has gone up, not come down. And so, you know, the thing that im sitting here thinking, i listened to mr. Balat, you will never convince me that the aca is perfect, but nor can you convince me that it cannot be fixed so its both effective and efficient and so that were covering our people in this country. Would you agree with that . 100 . We could do it. Absolutely, we could make coverage more affordable, increase subsidies for people higher on the income scale who are suffering because theres not support for them. There are things we could do to really strengthen and make the aca a much more effective program. No question. And there does seem to be a string in some of the questioning that sort of blames the victim. And i dont like that word, but the person who is going through some difficulty. As if to say, oh, its your fault. Well, i can tell you, i was 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. And as im sitting here and listening to our patient advocates, our patient folks, consumers, you know, i was thinking, i think and i, 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 perspective. Theres nothing like suffering. Theres nothing like being disabled. Theres nothing like having your life change overnight. Its nothing like taking two hours to get dressed. Come on, now. Its nothing like sharing your pain. The idea that you would come here and the stories that you have told are so personal, but youre willing to share them with the world to make somebody elses life better. And some kind of way, theres something in here that i think we are missing, and i think president obama said it best. He said, we have in our country quite often an empathy deficit. An empathy deficit. And so some kind of way we got to get around to making sure that all people are taken care of. Its almost like feels like youre saying, well, i cant help you because i got to help this person, i got to help i believe we can help all of us if we have the will. And it can be an effective and efficient system and one that will work for all americans. Now, we talk about the rising Health Care Costs. We should be talking about ways to ensure that all americans have access to Affordable Health care. We need to remember how far we have come under the Affordable Care act, especially in the individual market. Mr. Isasi, id like to ask you about the individual market whewhen you described in your written testimony, as i quote, terrible, prior to the aca, but now, quote, much, much better, end of quote, thanks to the Affordable Care act. Before the aca, you state that 60 of consumers in the individual market before the aca found it, quote, very difficult or impossible to find affordable insurance. Now the aca has cut that number down to 34 . And more consumers are finding the coverage they need so more consumers are buying insurance. Sir, isnt it a measure of success that more people are able to afford the coverage they need under the Affordable Care act . Absolutely. And more people are spending their own money to buy Health Insurance under the aca as well. And one of the things that has happened in my district and in our state of maryland, when the Trump Administration pulled away the navigator money, you know who did the navigating . The members of congress. You know why . Because we didnt want people to have an opportunity that they did not know about. If you dont know about an opportunity, you might as well not have it. And 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, you know, chairman, by the way, thats also one of the most effective ways to bring premiums down. To get everyone to participate. And weve seen that in massachusetts, weve seen that in california. No doubt about it. Wow. So, let me just say this, my republican colleagues have claimed that the aca has 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 the administrations position in a texas lawsuit would create chi cro across in the market resulting in higher premiums and out of pocket costs for consumers in pennsylvania and across the country. I requested this may be part of the record, without objection, so ordered. If my colleagues were serious about making coverage more affordable for the American People, they would condemn the administrations actions. Im going to conclude the hear ing but i, again, want to thank you. I want to thank all of you for being here. I especially want to thank our consumers. It is theres something about pain. Its something about it that is a driving force and as ive said in other hearings, when bad things happen to you, do not ask the question, why did it happen to me, but why did it happen for me . Why and in this instance, why did it happen for the people of the United States . And i want you to keep those words in mind. Those three words. Pain. Action. Purpose. I thank the chairman. I just wanted to also thank the witnesses. All of you, for your time. Its been a pretty good length hearing. Thank you for taking the time. Those of you who have been battling illnesses and your testimony, i appreciate it. Im a cancer survivor. There are a lot of people on this committee that have had illnesses and dealing with it. The chairman is right. This is something about which we should be able to agree more. We have different perspectives on how to address making sure everybody can afford high Quality Health care, but i appreciate all of you all coming here and testifying on behalf of the entire committee and including those in the minority. Thanks to the chairman. Thank you very much. Id like to thank our witnesses for testifying, again. Without objection, all members will have five legislative days within which to submit additional written questions for the witnesses to the chair which will be forwarded to the witnesses for their responses. I ask our witnesses to please respond as promptly as possible when you get those questions. With that, this hearing is adjourned. I got to go. I got to go. I know. If you want more information on members of congress, order csp cspans congressional direct y directory, Available Online at cspanstore. Org. Tonight on cspan3, American History tv looks at postcold war u. S. Foreign policy. Well hear about u. S. japanese relations after world war ii, the containment theory and the vietnam war. Later, a behind the scenes look at the cuban revelation. American history tv is tonight on cspan3 starting at k8 eastern. I live in a country where there are no public transportation, where there are no that i can walk and a woman to leave the house, to do anything h in her life, she needs a car and to function and drive this car, she needs a man. Sunday night on q a Saudi Arabian women rights activist Manal Al Sharif talks about her book, daring to drive. For us, daring to drive is more act of civil disobedience because woman is not supposed to drive. We show that we are able, we are capable,