Transcripts For CSPAN2 Book Discussion On Overcoming Obamacare 20150530

I wanted to start with a philosophical question. You have written that universal coverage is the morally worthy goal, michael, you were the author of what you call the anti universal coverage manifesto. I want to get you to fight about this. Why dont you start and explain why you think from a freemarket perspective it should be the governments rolled to provide universal coverage . I would put it slightly differently. I would put it this way. We never say when you hear people like michael cannanore a number of people say we can never outbid the left on covering people with Health Insurance we should try to outbid them but do something that is not publicly accessible in the middle somewhere. We would never say that about smart phones we would never say freemarket cant outbid the government on the ability of every american to have a smart phone. We would save 3 markets cant outbid the government on giving People Better jobs and more Economic Growth. Why is it we accept the progressive premise that the only way to expand access to highquality health care is through government . I would argue you can expand health care for more people at lower cost through free market than through government. However the goal of expanding access to coverage and care is the noble and appropriate one and one thing we get trapped in is we live in this progressive debate where it is all about what the government can do and cant do. We dont embrace the policy goal the policy goal of expanding access to care and coverage is something freemarket can achieve better and the government and that is what we should be striving to do. What would you say . My role exaggerates the differences, let me try to do this. Of course we can outbid the left when it comes to making Health Care Better and more affordable. Within the reach of more poor people. That should be our goal. The problem is expanding coverage, if you make that or proxy it interferes with the goal of better more affordable Higher Quality coverage for everybody. At a certain point, as Ken Jeff Atwater will let knowledge nobel prizewinning article on uncertainty in the welfare of medical care that everyone sites whenever Government Intervention they want in markets, acknowledge that insurance is pointless incidents situations because the cost exceeds the benefits. And when i say it people like me say we care about when it comes to covering people with Health Insurance is because the left can always have a single payer system and have the Government Cover everyone. Whereas if we are going to Produce Market principles individuals make those choices after is in point people will buy known as much coverage or address in point not as much coverage as the government wants or not any coverage at all. That is important, not only healthy but crucial for the operation of a high performing healthinsurance market and Health Care Market but we are never going to get universal coverage if we just allow people to make their own choices. To get there it will make expanding coverage or universal coverage our goal the left will always say you are a failure because you havent delivered universal coverage. That is why advocate interventions that make health care worse and more expensive and take it out of peoples reach. That is why we shouldnt even concede the goal of universal coverage or the government should be expanding coverage because it frustrates what is really our shared goal of making Health Care Better and more affordable and more secure. Two points in response there is no reason we should set the lefts definition of the terms. Traditional understanding of what insurance is when we think of Car Insurance or Homeowners Insurance you get Car Insurance if you crash your car you are protected from catastrophic financial loss. The fact that the left and distorts the meaning of the word insurance to mean prepayment for all Health Care Services doesnt mean we should simply accept that. Is a noble goal for every american to have the ability to of forbes through Health Insurance that protects them from bankruptcy due to injury or illness. That is a noble policy goal of free markets can achieve. Youre making it easy for me to exaggerate our differences. Heres another way. Another criticism i have of the law l. A. Law of conservatives approach health care and Health Care Reform is the idea that they are trying to sell the public that insurance should only be for catastrophic illnesses. If you buy a health plan is to have a 5,000 deductible and cover nothing else, conservatives lose a lot of people when they talk like that because people are very risk averse and wants more coverage than that and should be free to buy it and there is a lot of value that health plans can provide below the 5,000 deductible especially the medical literature finding out what intervention, what Preventive Care is Cost Effective and covering that with no copay. And take care of their illness so they dont end up with complications later on. It is important that we not try to offer for people any definition of what insurance should be. We should leave that individual consumers as well. This is another way conservatives get in trouble on health care. What do you think . Should it be a goal of conservatives to try to move toward universal coverage . I dont think it is the governments do your obligation to provide universal coverage. It is a free country and people are allowed to live freely they are not all going to choose to have Health Insurance but it is also a worthy goal to make it possible as it can be, lowering costs having a vibrant market where people can choose the coverage they want. As a practical matter in the obamacare debate if we want to repeal obamacare we have to offer an alternative that focuses on cost and coverage as a political reality and somewhere in between two gentlemen on either side of me, i would agree i dont think there is any need to outperform liberals on estimates of the number of people who would be covered under an obamacare alternative but you have to make a goodfaith effort, you cant afford to just casually get clobbered if you want to win politically. I think one area where that planned to chris from we talked about and repealing obamacare. And fully compatible with obamacare, and implemented without the need to repeal obamacare and put you at odds with a lot of people on this issue, so why did you make that decision . To be clear what the plan does, the plan can repeal obamacare with replacement approach and the same end results of repealing large chunks of obamacare that taking what is remaining and changing it to end up in the same place. The reason that option is important is any replacement plans we as republicans or conservatives propose has to get through the senate and you dont have 60 votes in the United States senate. What we dont talk about all in the obamacare debate but the fact is unless we have 60 votes and even if you did, not all 16 republicans will agree with each other so getting 60 votes as democrats demonstrated is not so easy. They lost the public option because Joe Lieberman and ben nelson said no to the public option. People like howard dean had meltdowns on m snbc saying we should burn down obama care because it doesnt have a public option. We dont have 60 votes. If we dont have 60 votes and if we have to pick off six republicans at 54 votes, lets assume the majority is maintained in 2017 which is no small thing because they have a lot of stuff up for grabs in the next election but if republicans are lucky enough to have 60 more votes in 2017 they have to find six democrats to go along with whatever they want to do to replace obamacare and it will be hard to find democrats whose support revealing every word of obamacare. I do think however there is bipartisan support for market warranted plant that achieved policy goal of making it more accessible to more people. Why we for repeal in 2012 . The subsidies had not yet coming to play. In 201020112012, if we could repeal obamacarefully, before it went into place, then we would have a lot more options. How would you do that with no where near 60 votes . Theres a difference between replacing and appealing obamacare. A lot of us believed we could repeal obamacare, just repeal all loans through reconciliation which requires only 51 votes. Replacing obamacare cant be done through reconciliation. Because of regulatory changes you have to make the reconciliation, a budgetary process allows certain changes to the law that have to do with the budget and revenue and spending. The challenge with health care is chunks of it had to do with revenue spending and regulating insurance or preexisting conditions and things like that. Replacement plan because it has to do with regulatory changes does require 60 votes. That is why obamacare was passed with 60 votes in the senate so you can probably, we dont know for a fact that you can probably repeal obamacare with reconciliation with only 50 or 51 votes but you wont be able to replace it and that king we are all agreed you got to replace it. I dont see where that has changed. In 2012 by your own reasoning, you could regular obamacare using reconciliation you could still do it in 2017 in either case you will need 60 votes to get a full replacement package, large portions of that reconciliation, and what has changed and the reality is president obamas second term there have been 181 polls taken on obamacare according to real clear politics and all 180 one have shown it to be unpopular. To give up on repeal at this point seems to me to be politically totally unnecessary and at the same time rather fatalistic view believe as i do that repealing obamacare is the most important thing we could possibly do in the political realm. That misrepresentation, i still support the repeal of obamacare but i think we have to make sure that whatever we propose can get 60 votes in the senate and if we get 60 vote in the senate for replacing it with what i propose, great. If we have to do Something Different but it to the same end result great. Your plan keeps a lot of elements of obamacare. You have a lot of insurance regulation not as stringent as obamacare. You have the tax credits, they dont quite are not quite as generous as obamacare but even though replacements if you want to call it that, is still has a lot of elements. If you are arguing any plan that attempts to offered tax credits to the uninsured is somehow obamacarelike, halfdozen to nine different plans, that are obamacarelike. I contend that republicans and conservatives for a long time have said the best way to reform the Health Care System is to let patients have the dollars, let people buy whether it is healthinsurance or generous healthInsurance Plans or catastrophic plans, as michael advocated in the past let people have those options and let people buy plants that make sense for that the question is not the end results which we all shared but how you get there and with any replace requirement, 60 votes in the senate, and we can do what we do if republicans control 60 votes in the senate. Here are some options, we can do it through repeal, we can do it by migrating to the new system but what is important is having the end resulted having a lot of ways to get there so we can put together the legislative majority to get it done. What you are hinting at, there is a colossal difference between keeping the architecture of obamacare, and keeping it and huge difference. You misrepresenting that. You have called a lot of these plans obamacarelike. I wanted to get your thoughts on this. Republicans, conservatives, republicans conservatives i dont say we because im not a republican and not a conservative but republicans and conservatives have gotten themselves a lot of trouble over health care in the past because the right doesnt spend as much time and energy on health care as the left does. So they have fallen for ideas like an individual mandate because they didnt think this through enough to realize an individual mandate, the coercive power of government provides Health Insurance l. A. Single payer system does two degrees of the same animal. And end ed up with 60 votes in congress, republicans were not following their principles were thinking closely enough about these things. Tax credit, and obamacare like, a lot of redistribution like obamacare does and individual mandate. And you dont or pay more money to the government. Thousands of dollars. And not obeying the may you purchase Health Insurance. And withheld Insurance Plan looks like, what the individual mandate does. And these are obamacarelike plants and i dont think, get 60 votes in the senate. And get 60 votes in the senate at this point and think these obamacare is a like proposals are the way to go. If they do that they reveal obamacare and replace with obamacare is a light they will have obamacare, bipartisan support at every get rid of it. On the flip side of the 60 votes in the senate, you never get 60 votes for reconciliation. For the repeal of obamacare, an alternative on the horizon. People look forward some alternatives the deal with coverage, and mike and i were testifying in the senate and made a similar point, claim that a tax credit is roughly akin to the individual mandate in obamacare that a tax credit officially mandates that you buy insurance. By that logic the Child Tax Credit mandate everyone have a child. Who would make that argument . Childless couples are annoyed by that. You can take anything to a theoretical extreme but theres a profound difference between the government mandating that you buy a product or service, the federal government for the first time in American History, and offering a tax break in whatever form to people who choose to buy. There is a tax credit for child care. A lot of stay at home families, stay at home parents are really offended that they are effectively being penalized by the tax code because they made the choice to stay at home and raise their children. Perfect example. A factual comment, mike said the tax credits are a mandate to buy insurance. That is not true because you could structure the tax credit so is deposited in Health Savings accounts which means you dont have to buy insurance with it. You could use it to just save through compound interest and have it roll over for your health care needs. Not necessarily through the tax credits healthinsurance tax credit talking about Health Insurance, even healthinsurance. Healthcare or both. For a lot of people it would be a government cash payment from the government into Health Savings account. The key thing to point out here is there is this distinction between a tax credit and Tax Deduction and if it is had tax credit in means that it could probably be extended to more people because people at the lower end of the income spectrum that dont have a high Tax Liability could still get the same amount of money whether it is 2,000 or whatever. It is a tight cash payment from the federal government. Anything beyond what the tax liabilities of that person becomes the equivalent of a product subsidy as opposed to a deduction which just when met somebodys income Tax Liability but that doesnt benefit all loss of uninsured people who dont have much liability. What we need to do it for them, because anyone controlling their Health Care Dollars and spending every one of those Health Care Dollars as if they own it, if we get 150 Million People spending health care more wisely that is the most important thing we could do for people of modest means because that will spark a revolution in Cost Containment and drive prices down remembering health care and the reach of more people but the point you make is important. This is criticism that i got of governor Bobby Jindals standard deduction for Health Insurance, better proposals and Health Insurance tax credits because it does not involve redistribution but anytime you have Government Conditioning a benefit, subsidy or a tax cut it has to define what x is so people dont know if theyre eligible for the Tax Deduction. Standard deduction for healthinsurance let the government define what your Health Insurance plan looks like because what insurance qualifies for that deduction. I think as i said before, not just because it is here but i said before the i think governor Bobby Jindals healthcare proposal is the best i have seen among the republican candidates that has a serious flaw. You want to click on that, i want to move on. Biggest difference on the right, who believe we have to have an alternative. Theres some disagreement there. I think it is very clear publicly, we have to have an alternative. The American People have been waiting to see what will go in obamacares place. The biggest disagreement has been between tax reduction of pro tour tax credit approach. Philosophically, to offer a tax credit, we are operating in a political vacuum no problem with a Tax Deduction based approach but were not operating in a political vacuum and we are in a world where there are families the vast majority of middleclass gets nothing under obamacare. A kaiser calculated as a pull foryearold woman who makes 35,000 a year does not get a penny under obamacare, but there are relatively low income general the elderly families that get 20,000 in subsidies under obamacare. It is politically unrealistic to say he will take a 20,000 subsidy and replace it with a Tax Deduction of nothing and that would be the result because the sort of family that is getting 20,000 under obamacare does not pay taxes including payroll taxes, combine their total tax effects, they would get nothing and to be able to try publicly to say you go from 20,000 to nothing and like it, to me that we could talk about Obamacare Obamacare forever or the rest of our days if that is the case so as a political reality you got to go the tax credit route which means these folks would get the same thing as everyone else. 1,200, 3,000 tax credit depending on age but a way to bridge the seemingly impossible gap is the tax credit should be as conservative as we can make it. What i mean is lets give the tax credit to individuals and families and not have it be a subsidy for 2 Insurance Companies like obamacare, lets not income test it which would make it simpler, get the irs out of things remove marriage penalty, making it a very conservative tax credit. Michael would say i will never be conservative enough and the respect that but if we get close enough and repeal of this monstrosity while still putting things on a glide path toward a genuine freemarket restoring americanss in the birdie. Before we go further into this sort of broader comprehensive alternative right now we are facing a more immediate question which is the Supreme Court is going to soon and decide on a major case involving the legality of subsidies that have gone for through federal insurance exchanges. There are millions of people who will lose insurance subsidies will have difficulty paying for insurance and right now lot of republicans are talking about various contingency plans as to what to do. I want to get the panels perspective on what you think the best approach for republicans to take and i will start with michael since you have been the most directly engaged in the Supreme Court case. There is a lot congress should be doing right now primarily investigating how this even happened, the irs is taxing and filing and spending tens of billions of dollars without congressional authorization contrary to clear limits congress put on the agencys power on the Affordable Care act. If they have a proper investigation, what we should be doing as the court rules drive their legislative proposals. If those subsidies disappear it is important to point out if the court rules for the challengers then it will have two affect, it would exempt 57 million employers and individuals, in 38 states from the individual employer mandate so it is a cute tax cut, those people being subject to legal taxes right now. Also about 6. 7 Million People in federal Exchange States receiving illegal subsidies and those illegal subsidies will disappear. Under ruling for the challengers. The question then becomes what should congress to teach you a lot of people in congress are talking about the have to provide subsidies for people who are subsidies because they are victims. Clarifying point is in order here. If you think someone who has lost an illegal subsidy, and deserves to get that back media have been in washington too long. To the point where these subsidies were necessary. You repeal obamacare, you get rid of those mandates and regulations and let people get their old health plans back. You might want to put in there some sort of high risk pool, because there will be people who are low million and have very expensive illnesses, and political reality will take tate you do something for them will dictate you do something for them. It could be a Small Program like the preexisting Insurance Program in the original aca. Then the president will veto that. If you do it through reconciliation, get it to his desk hell veto that. Then what do you do . You have to lay down that marker and not negotiate with yourself by proposing some half measure at least of all some measure that baptizes the illegal subsidies that the president has been issuing for the past year and a half. You lay down a marker, you see what you need to begin to do to get to 60 votes or 67 votes or close enough that the president will get nervous and be willing to compromise. I think theres an ethical line here that Congress Absolutely must not cross, and one of them is we cannot reward the irs for breaking the law by baptizing those illegal subsidies and making them legal. What about you, do you think thats a viable strategy . No. I think republicans would fold in a matter of 48 hours be that if they tried to come out and say, well, its a tax cut for some people, so all these millions of people who are not going to lose their insurance, at least other people would get tax cuts. I mean, im not entirely unsympathetic to your view. I mean, there would be some improvements in terms of liberty. And the court should absolutely stop the payment of these illegal subsidies. But i think republicans have to have, again, its sort of a microcoz m of a larger debate. They need an alternative, and this is the perfect time to put one forward and say, all right, in the 37 or whatever states that lose their illegal obamacare subsidies, we would effectively repeal or replace obamacare and give the state an offramp to choose to replace obamacare and substitute a conservative alternative with a simple, flat agebased but otherwise flat tax credit used by insurance of your choice. And i think biggest selling point in that with the American Public and one that our side greatly underestimates the political potency of is there would be an opportunity to say the biggest problem in health care for 70 years is you get a great tax break if you get Health Insurance through your employer, but if you buy it on your own, you get no tax break whatsoever. And so, finally we would give the tax break in the form of a tax credit which for most people in the middle class would be a tax cut would be a bonanza for middle class americans even while saving colossal amounts of money, and this wide swath i think, would be very receptive to this message, and itd be a lot harder than people think for president obama to say im not going to let you have this long overdue tax break that your next employer gets. I think that a good fallback position is you mentioned senator sass position which is basically allow assistance to go to people, only those people who are already getting subsidies under obamacare no new people, and it would not be based on the obamacare subsidy formula and it would only be for a limited period of time. I think thats a pretty good fallback position. And those are our thoughts. What do you think . Yeah. First of all let me just say i think michael has done incredible work bringing case to the Supreme Court. I salute him for it. I think theres no question that the rule of law dictates that the Supreme Court ought to side with the challengers in this case because it was illegal for the Treasury Department to let these subsidies flow through the federal exchange. I want to actually make a thematic point that relates to both king very burwell contingency plans debate and the Obamacare Repeal and replace debate. And that is you have a lot of people i shouldnt say a lot of people, you have a small number of people out there who have decided to appoint themselves the popes of conservativism and say that unless you agree with me, youre a rino [inaudible] [laughter] youre not a real conservative. Governor jindal says any plan that involves tax credits is obamacarelike. Any plan that would raise taxes on people who have employerbased coverage in order to equalize the tax credit, thats obamacarelike except for the fact that Bobby Jindals plan does exactly the same thing. We can get into that later if we want. And, n. , this is an unhelpful thing that, i think, Governor Jindals done well youre a rino unless you agree with me. And were always going to be a dysfunctional movement if people who agree with you on 90 of the issues are somehow the enemy and were going to only drive americans into the hands of Hillary Clinton. Into the hands of Hillary Clinton if we do that. And i think we have to focus much more on what we agree on. And i think we have to articulate a vision of how to expand access to health care and Health Coverage using free markets. Because with the people who dont already agree with us on every single ideological point thats how were going to win them over, by really focusing on how our policies will make life better for people. I think too often we get caught up in these scholastic arguments about how many tax credits you can fit on the head of a pin instead of actually discussing how to make life better for people using free markets. I want to see if there are any questions from the audience at point. We could start to theres a microphone coming around. Does anyone hi. Im john greene with the National Association of health underwriters. Just real quick, first on h is sas, you have to have an underlying plan to contribute to them so you have to have insurance. And the other thing is if the subsidies go away, republican governors are going to be very nervous. And i think that the president has a plan, slide a piece of paper, have him sign something. Why dont we reduce expand the rating bands . Its a simple message to say to the American People were going to adjust the market rules to make things cheaper for you, all right . So that reduces the cost of the these subsidies. Well and then allow people use subsidies outside exchange and give them a special enrollment right to use it. Its real simple to day one kind of thing. We can talk about all the other things we might do later, but on day one youve got to do something, and youve got to do something dramatic. So across state lines aint gonna do it. Changing the rating bands will. If you expand rating bands, you make it happier. Thats an important day one thing. Pretty simple. I totally agree with you. So and thats actually one of the things i highlight is the fact that one of the biggest things about obamacare that i think a lot of people dont realize is the degree to which its expansion of government power and control isnt so much the taxing and the spending, though thats important too, to repeal and roll back. Its actually the regulations that are the biggest driver how obamacare transforms health care in this country. Particularly for healthy people, play by the rules and have the premiums that are relatively low to show for it who are now going to pay a lot more because of things like rating bands and things like that that you mentioned. So thats an extremely important thing to repeal about obamacare. And just, again to reiterate the point. I think all of the support for repealing obamacare, in my plan i have a never of different ways to get there. Thats exactly right. You want to do everything you can from executive action and then everything youve got to do through legislation. Do whatever you can, all of the above, use all the tools you have. On the point about hsas, its true that today you have to have a certain type of Insurance Plan in order deposit money many your hsa taxfree. Thats because Congress Passed a law imposing those requirements. Theres no reason why that law has to stay in place. We can expand the ability of americans to save for their own health care by changing the way the tax treatment of hsa is currently legislated. I agree that the worst thing about obamacare or i think you said this the regulations. Not so much the spendings terrible, taxings terrible but the worst thing is the coercion. I mean, effectively the obamacare debate, i think, is a debate that comes down to liberty versus coercion. And the only solution in that is to repeal coercion and side with liberty. Kind of in that vein, i would say with all due respect that the worst thing that i think republicans in congress can do is look to make obamacare better. And the way you described or in other ways. The response to king v. Burwell that is well turn the subsidies back on, but only in exchange for letting us make obamacare better thats a two for one for president obama. He gets what he wants, he gets obamacare to be a little more bipartisan like it would have been from the start if he had simply chosen to work with many of the republicans who had their hands outstretched, who were more than happy to work with him h. I think we need to remember back many 2010 you may recall before the Health Summit that secretary sebelius said we want to hear republicans ideas at the Health Summit but youve got to remember, this is comprehensive legislation, and all the pieces of the puzzle fit together. You cant really tweak one part, it all goes together. Well lets remember that. It needs to be comprehensively repealed. And along the way, i think worst thing we can do is try to fix it. Is there any other finish. Yeah, im gregory robs. Im a reporter for the advocate newspaper. Im here in d. C. But the newspapers in baton rouge and new orleans in louisiana. I asked this question of freshmen senators who gave a news conference, bill cassidy was kind of the lead speaker and i was accused of raising a straw man which i didnt intend to do. My sense is that the administration, whomever you want to point a finger at, didnt kind of sit around four, five or six years ago and say weve got a perfect Health Care System. Everybodys covered theres no issue with uninsured people. Its the most Wonderful Health system in the world but lets invent this elaborate program thats going to be highly controversial and create an enormous make me spend a huge amount of political capital. I feel that there are issues, that there was a consensus, a broad public consensus needed to be addressed. One of those was the number of people who are uninsured in this country which was tens of millions of people. Often compared to other developed countries where thats not the case. We did have a private sector system in effect, not totally because of medicare and medicaid regulations. There is still a problem that needed to be fixed. So how do you solve the problems that this program was intended to solve, that were widely recognized as problems without resorting to some of the mechanisms that youve criticized . Thats a great thats a straw man . [laughter] thats what i was told. [laughter] well, i think its a great question. I think you highlight something thats very important which is that were here talking about overcoming obamacare. And the last time we were all in a room together at cato institute, i made the point that obamacare is not the only thing we have to overcome. Its actually the programs that were installed in the great society, medicaid and medicare that were the government takeover of the Health Care System. Before obamacare was even an apple in president obamas or senator obamas eye, half of all Health Spending in this country was Government Spending because of medicare and medicaid. The federal debt that we have today is driven by unsustainable spending growth in medicare and medicaid. And so we talked, some of us argue that obamacares unfixable, and theres nothing we can do except repeal it, burn it down to the ground and do something else. Well, obamacares unfixable, then medicare and medicaid which have been entrenched for 50 years are also unfixable and also causing a lot of problems. Were not shy by saying heres how we would reform medicaid medicare, heres how we push those programs in a more marketoriented direction. So i think one thing thats very important for us to understand i think a lot of conservatives have the impression that we had a free Market Health care system before 2010 and then obamacare came along and was a socialist takeover of america. Thats not what happened. There was gigantic step change in Government Health care in 1965. And then that was like this. And then obamacares like this much on top of it. It goes in the wrong direction. But its additive to that gigantic growth in Government Spending and government regular ration and Government Co regulation and government can coercion that took place in 1965. And i think one of the big mistakes that guys like jeff make and he and i have argued about this a lot is that he ignores that larger fundamental problem of medicare and medicaid. He basically says theyre in concrete, we cant really do much about em so we should focus on obamacare because thats newer and less entrenched. I would argue it doesnt matter. The fundamental thing is were going over a fiscal cliff because of all these programs and we have to tackle them all all we have to use whatever tools we have available to actually move all those programs in a marketoriented direction and achieve the policy goals of expanding access to health care and making it more affordable not just for all americans who are uninsured, but for the taxpayers who are footing the bills for all these programs. So we have to actually be more ambitious than simply looking at obamacare. We have to look at the broad sweep of Government Intervention in the Health Care System. And if we dont do that we set our sights too low. Of course it does matter whether theyre more entrenched or less entrenched. Lets go after the thing that has never been popular. I mean i think its hugely important to go after medicare. I mean, i think that paul ryans style medicare premium support proposal may be the second most important thing we could do after repealing obamacare. And the project alternative would take people off medicaid and put them on to, into private insurance. So i certainly agree these are big big problems as well. But lets focus on, i mean, some of this does come down to a debate over how bad is obamacare. I think its one of the i think its arguably the worst piece of legislation pass t in American History and it needs to be repealed. The American People never wanted it. In answer to your question, sir i fully agree that the Health Care System was broken even before obamacare was passed. I think the biggest way was the federal government had created this very unfair situation in the tax code where employerbased insurance got a great tax break, and the individual market didnt, and as a result the individual market shriveled up and nearly died. And the way to inject life into the individual market is to get the governments foot off the scale and equalize the tax treatment of the two sides. And thats really at the core of what the 2017 project alternative tries to do. I think the fugitive slave act was the worst law passed in American History, so ill disagree on that. You just stole my line. I just mouthed that to john desser. And i think as much as we dislike obamacare, we immediate to keep it in we need to keep it in perspective. There are many worse laws passed. Most of it was not about the uninsured, it was about cost. There was no human cry to cover the uninsured among public. Jonathan gruber admitted as much when he said that everyone in the white house knew that the public doesnt want to cover the up insured, the public wants their premiums to go down. These two are related, but its an important distinction. And the reason why everyones premiums are too high and why Health Caring costs so much is all the previous Affordable Care acts that congress had passed including medicare and medicaid and ill throw hipaa in there. And i think that something that didnt happen by congressional legislation in the 1950s but beginning of the 1940s was the tax preference for employersponsored insurance policy. You call this a private market as though that now makes it a free market because we hang the label private on top of it. But this gives your employer control over 10,000 i think now its 11 or 12,000 of your earnings if you have family coverage, and it lets your employer choose your health plan. When a government policy take your money away from you and lets someone else pick your Health Insurance, thats not a free market. Thats a Government Health plan. And the horse that the government decided to back with this tax preference is a type of Health Insurance that disappears when you get sick and you cant work anymore. This is not a free market. This is insane. And thats one of the i dont it depends on which day you catch me. Some days i think we have to reform medicare sometimes i think we have to reform employersponsored insurance first because i cant decide which one has been more harmful. But youre right, there were a lot of problems that all the Affordable Care act did was double down on them. Took all these government failures that have been in place for decades and said, you know what we need . We need even more government to fix all the failures created by all these previous Government Interventions. I dont think its going to work. Were going to end up with more failure, and thats why im such an to point. One last question. John desser with eHealth Insurance. If key to the turns on the can to the lawsuit do we need Government Exchanges in the who are you with . EHealth Insurance. Private Health Insurance. Is that a private Health Insurance exchange . Just to clarify. Happy to clarify. I clarify that because the answer is, no. Of course we dont need the government to create an exchange. An exchange they say is a marketplace where people can come together to buy and sell Health Insurance. People were doing that before the government created these regulatory bureaucracies. Theyre doing it through brokers. EHealth Insurance is a web site where you can comparison shop, and it existed before obamacare. Be these things if these things work, they provide value the government doesnt need to subsidize them. If they dont the government should not subsidize them. I would agree completely we do not need governmentrun exchanges. It made me half about how president obama would say healthcare. Gov would be like expedia. Com. We already had eHealth Insurance which was like what did he say . Itd be just like eHealth Insurance. [laughter] well, at this point i want to conclude this segment of our program but of course there is a very great book that you can read that has expanded treatment of all of these ideas and there are copies of overcoming obamacare in the entryway. So thank you for coming out and for the engaging panel. [applause] so our next guest governor bobby jindal needs very little introduction but i just wanted to highlight a few parts of his biography that are particularly relevant to Health Care Policy in todays discussion. Governor jindal studied Health Policy at oxford and he at a very young age served as secretary of louisianas department of health and hospitals. In 1998 he was appointed as executive director of the National Bipartisan commission on the future of medicare. And in the bush administration, he was assistant secretary of hhs. More recently last year his policy Group America next, released its own obamacare alternative and hes been very outspoken about what he thinks is best approach for republicans. And more recently hes been thinking and praying in his words, about potentially jumping into the white house race. So without further ado, Governor Jindal . [applause] thank you very much. Thank you all very very much. Thank you. I intend to keep my remarks short. I dont think you need to hear another speech, and id like to spend more of our time in questions. I want to thank phil and the washington examiner. I know this event was rescheduled, so i want to thank all of yall for coming back. Maybe the Obama Administration found out what we were up to and interfered with the original meeting date. I want to posit two things up front. If president obama could go back in time, if he were thensenator obama, maybe even president elect obama and if you could go to him and tell him, look, if you persist with obamacare in your first term when youve got a majority of the house, youve got 60 members in the United States senate now, remember, there are a lot of things he wanted to get done; cap and trade, card check immigration reform, tax code reform. There were a lot of things that this president campaigned on had promised the American People he wanted to get done. If you went to him and said if you insist on doing obamacare and really the other major legislative initiative hed had up to that point was the stimulus bill and said if you do this as one of your very first initiatives, youre going to lose the majority in the senate, youre going to lose the majority in the house and youre going to lose the ability to pursue your other initiatives, now you may be a twoterm president , but youre not going to be able to pursue any of these other things you campaigned on or cared about, i think he still would have done it. I think from his perspective now, remember he promised us he wanted to be like Ronald Reagan as president. Not that he wanted to be conservative or free market or try to win the cold war but rather, he wanted to be transformative in the other direction. From the lefts perspective getting obamacare done was the single most important domestic policy achievement they can point to in decades. If your view is wanting to grow the power and the influence of government, having the government that involved in health care something that is a growing, important part of our economy and is so critical important to each of us, you couldnt think or a better accomplishment. So those that think this was a big political mistake, it was a blunder, i think theyre wrong. I think the left, unlike the right, they deserve at least credit for knowing exactly what theyve wanted to accomplish when it comes to health care. Theyve been move anything that direction can incrementally times and big steps at times. Lets not forget, Hillary Clinton started back in the early t 0s with hillarycare and the left has fought to get to their vision of governmentrun health care. Now, theyre not done. What they really want is a singlepayer, governmentrun system. But too often on the right weve not had the same clarity, persistence, weve viewed health care as a democratic issue or a liberal issue and i think thats wrong. Just like i dont think education should be a democrat or liberal issue. I think conservatives, republicans need to be playing offense on health care and education. The second thing id say, if the president were able to listen to some of the debates youve heard here and in other quarters, i think hed be pleased. I think if the president could do go to the republicans and say, look, i listened to your alternatives, and were looking and listening to your programs as long as they do three things. One, as long as were creating a new Entitlement Program. That is absolutely critical. Secondly, as long as were using the tax cold to redistribute. Tax code to redistribute. Were going to use massive tax increases in the tax code to redistribute from one group or people to another. And third as long as we measure success by how many people have cards at the end of the day. If he were able to get those three things dope, i think he would done, i think he would declare victory. And i think hes been very successful in having conservatives and having republicans Debate Health care on his terms. Now, interestingly, those werent the terms he used when he was a candidate. When he was a candidate in 2008, thensenator obama sounded very much like a conservative. He told thensenator clinton who had an individual mandate the issue was affordability. Were going to have to force people to buy health care, we need to make it more affordable. He told senator mccain we dont need a cadillac tax. Both of which, by the way ended up in obamacare. So i am one that thinks that conservatives and republicans need an alternative to obamacare. I think its great that were all for repealing and i think thats wonderful. But i do think we need to replace it. For a couple of reasons. One, i dont think we can go back to where health care was before obamacare. Americas Health Care System was the best many world, but i also had significant challenges. I think one of reasons we are where we are today is is that for too long when we had the chance we didnt address those challenges. And we need to address those challenges. Secondly i also think if we dont offer our own alternative, i do hope the Supreme Court does the right thing and rules the law is what it says. But they do that and we dont have an alternative, we all know whats going to happen. The president s going to stand up he will have a very sympathetic family or group of individuals with him. Meet so and so whos got cancer and needs chemotherapy. Meet so and so whos got diabetes, and theyre only able to afford their treatments thanks to obamacare. And these mean stingy republicans simply wont make a simple onepage change in the law to allow them to keep their coverage theyve got today their lifesaving coverage theyve got today. We will fall victim to that if we dont have an alternative. We need that alternative today. Not tomorrow not when the court rules, but today. And i know there are a lot of people thinking about running for president , and i would say to anybody thinking about running for president , you need to have your own detailed plan about how ore place obamacare. Now, i have offered a plan, and im happy to talk about it. Its not the only plan. A lot of folks have plans. But i do think anybody thinking about running for president needs to do more than just talk about polls or fundraising or consulting. They need to think about what they would do if they were actually elected president. And so i hope youll see many people offer detailed plans. Im actually surprised candidates havent already done that. To my knowledge were the only potential candidate or actual candidate thats actually offered a detailed plan. People may like it people may not like it but at least weve had at least weve had the courage to say this is what we would do. Sixteenpoint plan and yeah, we do a deduction instead of a tax credit, and yes, we allow interstate purchase of insurance, and were specific on medicaid and medicare reforms as well as state licensing reforms medical liability frivolous lawsuit reforms. But the point is as republicans as conservatives we need to say what were for not just what were against. And i think obamacare gives us a great opportunity even before Supreme Court rules to say what were for. Ill close by just saying again two things. One, we shouldnt fall into this trap of saying were going to measure success by his terms. Remember, his terms are you need a new Entitlement Program his terms are that not only do you have the new Entitlement Program tax increases and third, were going to count success by the number of cards people have. Think how silly that is. Whether they have meaningful access or not. It doesnt matter to us whether the deductible is so high that you cant afford your coverage. Doesnt matter if the networks are so tight you cant see the doctor you want to go see. You cant take your child to the specialist that they need to see. But were going to declare victory because you have a card. Thats the rationale behind the push for Medicaid Expansion behind much of whats driven obamacare. Were all comparing our plans about well, how many cards do you give out . We are done as a conservative movement and more importantly were done as a country. If we honestly say we cant take any steps we cant undo the dependence this president has created, this is a new ford, no mart what you do, might rearrange it, but this is a new floor and its too politically tough to fight for independence in this country. 18 trillion in debt. Record low participation in the work force. Calling this a recovery . We have given up on the American Dream and that is why i think the obamacare fight is so important. I if we mean anything as a conserve tv movement we need to take stand dense government dependence and its important to have a full plan to repeal obamacare and the plan cant be a repackaged, redecorated version of government dependence. Im going to ask a few doze start off with. A few questions to start off with you. Said a a lot of the plans republicans have oured in congress are obamacare light. Can you explain what you consider obamacare light and what you consider a genuine alternative . This sounds very much inside d. C. Talking about baseline and wonkish. A lot of the plans have said obamacare is the law of the land so with spend more before its a spending cut. Obamacare is the law of the land but if we raise taxes not as much as he did its a tax cut. Nonsense. Full re peel means were repealing all of the spending increases and tax increases period. Thats the first point. Now a lot of candidates for the United States senate, as well as the house and governors mainly the house and Senate Last Year won elections opposing the president s policies. One of the most popular tv ads well repeal obamacare. Give us the majority and well repeal obamacare. I dont remember the fine print saying well just repeal the easy parts. We didnt really mean it. The rhetoric on the campaign trail was give us the majority and well reit, and those candidates won in purposing red and blue states which tells me people want obamacare to be repealed. You have to get rid of tax increases and then reduce costs. Thats a full repeal. Thered argue obamacare has been the law over the land in 2010. In 2017, when a republican president , perhaps president jindal is in a position to implement an alternative the baseline would have been in place for seven years. Thats sort of what the assumption is. So theyd say isnt it bizarre to good back to what the world would have looked like in 2010 had something never happened . I thick the need to pass the replace today. The court ruling gives them a chance weapon need to challenge the from do the right thursday and challenge the democrats up for election to do the right thing. We shouldnt as an earlier speaker said, simply negotiate against ourselves. If they really meant that, they should have been honest to to the voters. Should have said, we dont really mean it when we say well repeal obamacare. We cant do it. Its been the law of the lan long enough, well just move modify it, and if we accept this new level of dependence as the norm were done. This president has now grown government dependence and spending and borrowing to unsustainable, unprecedented levels, spend outside of health care and including obamacare if this is the new normal we wont see Economic Growth we are accustom testimonied want to preserve the American Dream for our children and grandkid. Its critical, if we restore what we view as freedom in this country, and American Dream and the opportunities to work hard and get a great job in this country, cant sustain this level of spend borrowing and dependence so its mistake for republicans to concede this new baseline. Its absolutely really isic to go back before obamacare what the law of the land and thats what they told us they were going to do. If they didnt mean it that sheave ha been honest there are conservatives who say youre actually the run that is surrendering and giving into the idea that democrats perpetuate that any free market plan isnt going to be able to cover and isnt going to be able to compete on coverage with democrats, and theyd say youre the one giving into the premise of the left. How do you respond . I think its a mistake to measure success by how many cars people have when its not meaningful access democrats will always be ready to spend more, and once we fall into that debate we become cheaper democrats. Were just saying, theyre going to get you to the single are payer system and well get there slow limp once you can see the premise, of course the president is willing to use the federal law to force you to buy insurance you dont want and its willing to counting a coverage cards meaningful access including medicaid, then you fall into a trap, theres no meaningful physical Health Care Improvements after Medicaid Expansion but well count it as a discuss becauseow have a medicaid card. Thats not success. When he said in iowa was popular. He got elected saying things. The didnt talk about giving people cards. He talked about driving down costs and making healthcare more affordable. He said to hillary the issue is affordablity and he was right. So we need to stand up for liberty and say if you want to let a party that can use the force of government to force you to buy something you dont want, thats not what we stand for. I you wont a party that is g. O. P. To make medical costs affordable you need to help people with preexisting conditions or people price it oust the individual market. Not with massive federal takeover of health care there better more targeted ways to do it our plans giving the states hundred billion over the ten years talk about the use of high risk pools and help people who truly need help but i dont think you need a federal takeover of the Healthcare System to help those that truly need the help and i think its a mistake to measure dependence as success and thats what the president wants us to do. On the Supreme Court case, which you mentioned just to clear right off the bat if the Supreme Court struck down the federal exchange sucks subsidies you would not set up a exchange in louisiana. We would. No lets say the state gives a clear ruling based on the black letter law if the law is interpreted that way not only do the subsidies go away but the mandate goes away. So individual employer mandate go away for the most part. I have written an oped showing if the court rules that way thats in effect a tax cut for our economy for businesses and families, tens of billions of dollars, spending cuts of hundreds of billions of dollars but preempts what the president will try to do politically and thats why i think its important that Congress Pass not once it happens before it happens a replace repeal and replace. Metropolitan but we wouldnt set up the state exchange. On the idea that you outlined lets take that scenario. So republicans pat a full comprehensive replacement and then 0 obama vetoes and it youre still left with a situation in which millions of people are losing coverage, obama has the names of those people as you said. He could put them out and say look at these people who are losing their coverage. Republicans have said that theyd feel a lot of pressure to do something and theyve talked about creating some sort of bridge that would essentially be a temporary patch that would keep people over at least until 2017 where you could pass a youre talking about two hypotheticals three. Lets assume that congress and the president does something. But lets go back to the second hypothetical, the second to the third hypothetical. Lets say Congress Passes before the court rules. Now to instead of the president saying look at this president about to lose coverage, republicans say no, that not right. We have a plan that helps people if you sign the bill. Its a very different discussion and debate and i dont know we know exactly what is going to happen in that scenario. I think the different scenario than if we pass nothing and then the president can say here my onepage bill or heres hhs pretending these are staterun exchanges. I know that the temptation in d. C. Especially congress, is to surrender before the fight starts and we have seen that time and time again. On amnesty executive orders, iran bill, the organizations with iran. I dont think congress should surrender. Were talking about three steps that havent happened yet. Lets fight. Lets go pass that bill and lets go debate the president and say, we dont want those people to fall between the gaps elm thats why we want you to sign our bill cannot veto it. To be clear you oppose some of the republican alternatives that would say lets extend the subsidies for existing people, not allow new enroulettes but people of theyre receiving federal exchange subs byes would have a way to keep them flowing. I think the best thing for congress to do right now is pass the full repeal and replace man. And i think instead of negotiating with ourselves lets pat that, get to the president s desk. You wouldnt rule it out down the road. We need to repeal the entire plain and replace it. Im slew lets pass the full repeal plan and have the debate with the president. And on your plan, another one of the criticisms is you have a plan that moves toward this is something we talked about in the earlier program that it relies on a standard deduction rather than a tax credit, and what that does is it tells people that anyway can get a standard amount of money that reduces their Tax Liability up to the point when they purchase Health Insurance. One criticism of that approach is that not only the idea it can create broad access not as much but could unravel the employerbased market because right now you have these pools where employers have a nice mix of healthy and sick and old and young, whereas if there is a standard deduction people who can get cheap insurance because theyre young would take the deduction, go get cheap insurance, and then you have employers stuck with only the older and sick and most expensive customers which drives up insurance costs. So a lot of employers might say were not going to keep having employerbased insurance anymore, and this has been this is how half of americans get their insurance. So how would you respond to that . I guess there are three different positions one could take there are dozens but lets on one extreme those that say look, were absolutely wed to the employerprovided Healthcare System. I was an accident of height but it is where we are today. So well allow people in. If you have employer privated health care you dont get anything outside of that. Youre forced to buy that health care whether you like it or not, whether its cheaper or more expensive than what you can get on your own exif you have Employer Provided Health care available to you youre not eligible for deduction tax credits. Thats one stream. A lot of people in employerprovide evidence healthcare coverage whether they wanted or not. The other extreme this is an accident of history so well give everybody money to shop on their own and take away the exclusion and take away peoples ability to get health care through the employers. We have done neither. We said if you provide a high enough deduction in a shutter short term, do you allow interstate purchase of are inance purchasing pools where people can get economy of scale through players and faithbased organizations, professional, trade associations, they get the same protections by joining the groups and if people leave their employers they dont have to exhaust cobra before they can go into the individual market. You make reforms and see a voluntary and gradual movement as people buy health care where they want. Freedom is a good thing and some people say no, we want to tell you how you should receive your health care. Or the government or you have to buy it through your employer or through this Government Exchange marketplace. I actually think freedom is a good thing and choice is a good thing and i trust the American People to decide for themselves rather than being told, but we have done it in a way that we think is gradual and incremental enough doesnt cause disruption of the employerprovide market place. That important. Thats one of the major soreses of stability for privately purchased health care and these new marketplaces arent going to be created overnight, so i think its important that you create a gradual pathaway where people have more choice asks that will happen incremental limit dont think this worse Case Scenario can happen because i dont think people overnight will have all these different choices. Youll esa more robust markplace, competition is a great thing. Were also expanding access to hh as and mm as. I think folks in a variety of circumstances will have all kinds of options to pay for their own health care, save against their Health Care Expenses through their employers are on their own with shouldnt be afraid of competition and choice. Shouldnt be afraid of dusting american consumes. We either believe the American People are smart enough to make their own decisions or we dont and join the left. Anymore questions . Americans for prosperity. One thing we have been hearing a lot, the panic mode leading up to the court case, the state legislators and governors are saying you held our feet to the fire no exchange no, method okayed expansion, and then a lot of these solutions are federally centric. Too you think theres any hope and what would you youre message to state legislators to tell their delegation, we have answers, give us control. Too you think what is your message and is that a viable option or is the message and the debate too centered here in washington for that to be something that republicans and Congress Actually believe and hold on to. Im obviously going to believe a lot in state flexibility, not just because im a governor but at political background and philosophy as well. We give states more give states global grants, flexible with accountability. Part of the reason you hear this debate in d. C. Is that obamacare has done damage from the federal level so in louisiana, for example, over 70,000 louisianans lost access to healthcare plans because both plans are not available because of obamacare. They were cancelled. The problem the stateled effort is we cant give them access back to their healthcare plans without the federal government getting out of the way. Secondly, now that the hhs has been given the authority basically when you think about what obamacare does at its core beyond the redistribution,on the map debts and medication expansion what it does at its core, believe tries to make Health Insurance whether through private sector or not basically like a public utility and at the third government now being empowered to review benefits and review profitable, overhead expense and these other things. So you can buy your own insurance at the state level but you can have whatever color you want as long as its a black model t. The federal government has taken so much power away from the states in regulating Health Insurance, regulating benefit designing regulating affordability, and i do believe that states need have there are things states can do in terms of interstate insurance and compacts but at the end of the day theyre very severely limited because of the powers obamacare gave to the federal government, and part of the ron the debate is here is we need to repeal that. Get the federal government out of the way so they can help their citizens. At the state level you are limited i cant impact the federal tax code as a governor. I i want to help people in my state by ahsaomha, its hard 0 for me to do it without congress or administration reducing restrictions so theres a proper role for the states to play in this in terms of insurance regulation and medicaid, but part of the problem is obamacare took away i dont thing this president read the tenth amendment, or doesnt believe it. Its true in education and many other areas. So i think your message is right. Theres a reason we have to win the fight in d. C. To give states the flexibility to respond. Governor, deep clancy, dufor your leadership and your very Detailed Health plan. Its excellent. Im thrilled to hear you mention the tenth amendment and so i want to pitch you what i hope is a softball question on that theme. Republicans always include in their list of talking points on health care, medical malpractice reform that usually means the feds are going to override all the state court laws about how you handle medical malpractice award caps and attorneys are fees and he can english rule. My constitution doesnt authorize congress to do that. What does your constitution say . What we did in our plan, we actually did our medical liability reforms in the context of federally aid programs. To the extent we pay for the the federal government is paying for medicare or medicaid or Health Care Programs we said lets do the tort reform within those programs, save the federal taxpayer, by the way tens of billions of dollars and the there is a federal interest because the federal government is paying for it. At the state level louisiana and california, two of the earliest states with caps. At the state level without the federal government doing it to us. In our plan we purposely started with a tort reform in the federalry paid for programs. Thank you. Page cunningham. Of course its been noted the Supreme Court could strike the subsidies to the federal exchanges but theres a chance they might not. In your state almost 200,000 people, how many people did get insurance on the exchange, the majority of those got subsidies. Howry going to convince to the people to run for you if you promising to take the subsidies away. It was over 180,000 i dont know how many paid premium outside bud made a selection on the web site. But regardless, what the final numbers are the important thing is to say that i know the president loves to say the republicans just want to take things away. Were not saying we want to take something away. We want to give you something better. So instead of buying something that is something you dont want were doing what the American People said they wand which is driving down the cost of health care and making health care more accessible to folks so theyre not forced to pay for benefits they dont but also join Insurance Plans that may not cover their provider. So some complaints you hear im a 20yearold single male guy why aim paying for ob gyn or joining a network where my doctors or specialist arent included. Democrats love the debate were for more free stuff and the run are republican runs just want to take theirs away from you. We are actually trying to give you something better, access to Affordable High Quality Health Care and secondly, its very important for republicans to take a step back. This is not only true in obama camps lets thick be president s proposal to give Free Community college to folks. Why not a free car a free house. I think the American People are smart enough to know this isnt sustainable. Something has to pay for this. Its over 18 trillion of debt and counting and the American People including the folks in louisiana and the other states, are smart enough to know that we got to get the private sector economy growing again and stop stealing from our children and grandchildren, these socalled free benefit the federal government gives us are being fonsed borrowing money from china and making you heard from the earlier speakers speak not just about obama catches look at status of medicare, social secures medicaid. I want the programs to be there for the people of louisiana who want them to be there for my children and grandchildren. Theyre not going to be there our current path. People are smart enough in louisiana and across the country to know that and realize that the idea that government can give you everything for free is not sustainable and at some point we have to pay the bills and its going to be very expensive. If not us, our children and grandchildren, and the greatest thing about the American People, dont think i know in last and across the country in louisiana and across the country were not willing to mortgage our childrens future. Every generation left more opportunities for their kids and im confident this generation is no david. Well do the right thing when it comes to some rinking the side shrinking the size of government. Kind of piggybacking off of king bur well, im curious what your conversations with other governors on what to do if the plaintiffs win what those have entailed and what your day one plan is, if they decide to strike them down immediately and not wait. Well, look, i dont want to speak for the federal government. Something we talk about at conferences and different governors take different positions based on what they think is best for their states. I have been saying this clearly comes as no surprise to anybody that we are in louisiana im absolutely against us doing an exchange. Were oneat the first states that wouldnt do the exchanges and the reality is that helicopter changed and the federal government i 0 this administration does this often. We want you to be our partners but you have no flexibility or decisionmaking that. Well tale you what to do. Thats not a partnership. The reality is all the responsibility but no authority in either setting up the exchange or medicaid or the other components of obamacare. We made clear we wouldnt do that. I think we have to have a replacement plan in place before the court makes a decision. I know a lot of help the cal hypotheticals. Nobody knows how theyll come down and in louisiana we have made it clear were not doing a state exchange. We think obamacare needs to be repealed and replaced, and so i certainly would continue to call on congress to put nat in place inch louisiana we are different from other states and, every state delivers health care differently. We have not expanded mid medicaid. We have a network of charity 4079s. Other states dont do that. We have different mechanisms. Every state has their own mechanisms and theyll still be there to people who need access and dont otherwise have access to health care and we have those safety net mechanisms in place and other states have their own safety nets in louisiana we have ten hospitals in the state as well as clinics, but the best solution is for republicans to truly pass not just the repeal legislation. I want them to do, but pass a replacement bill as well. Can you talk a bit about the sort of lobbying campaign . We talk a lot about how the public reaction and how president obama might lose the prospect of millions reducing Health Insurance to try to get republicans to give in the other pressure comes from lobbyists and n. O. W. Have a lot of powerful industries that are vested in obamacare. The Medicaid Expansion one of the ways in which theyve been able to get a lot of republican governors to go along has been through heavy lobbying by the hospitals. And certainly if the federal Exchange Subsidies get caught off, insurance lobbyist will very aggressively be lobbying to set up exchanges. What would you argue to other governors should say to Hospital Insurance lobbyists pushing them to do this . Thats a great point. The reality is many of these spitelement programs are entitlement to providers and theyre actually the ones that push hardest for the programs for funding for these programs. Lets take the Insurance Companies, take the hospitals. When it comes to Medicaid Expansion in my states and other states, and obamacare in general. First look at the hospitals. Ill give you louisianas example. If we had done medication chance in louisiana were not up to 250,000 louisianans would be moved from private insurance to medicaid. My point to hospitals is, thats more than the number of previously uninsured people moved into medicaid. So youd have for every previously uninsured person in medicaid youd have more than one person prevented from being private insurance now on medicaid. If youre a hospital youre no longer gifting Blue Cross Blue Shield or private insurance raise. Youre not getting medicaid rates. My point is to be careful what you ask for because the reality is over time medicaid is increased as a percentage of almost every state our states budget and the way states respond is reduce rates and before hospitals could cost shift to the private sector when medicaid wasnt paying their full share. So the hospitals need to be very careful, this crowding out because in Medicaid Expansion under obamacare there are no anticrowdout provisions, no ability to say were targeting this to people previously uninsured. So hospitals may end up i said that part of what obamacare does is turn Insurance Companies into public utilities. Hospitals could very much end up being very dependent on government rates and end up being underpaid for the care theyre delivering and then youll see a degree racing in quality and access. I they dont think thats going to happen, lament at what happens with physicians in the scr. I now they have this socalled fix. Secondly Insurance Companies are not going to maintain once they become they need to understand where the leftes going with this. At the end of the day insurance becomes a commodity under obamacare theyve wont have the margins because theyre regulated under the federal government, and you get to the point where you have de facto sing are pair government single payer government so to privateers the benefits outweigh the risk, be careful what you wish for. Some Drug Companies thought well have more patients but theyre beginning to realize at some point the Legislators Congress is going along around and see they have to billion budgets and generally theyve done two things. They either reduced volume of Services Sometimes arbitrarily how many times we have seen caps, you can only see the doctor this many times and then the reduce prices and historically when they reduce prices through administrative pricing, providers can cost shift remember doing medicare reform in the 90s this is another topic which is why we need to do premium support. A democratic economist said youre at the third government i it setting 10,000 prices in 3,000 counties. That is the future of American Health care if we continue to grow the federal governments involvement in health care. I dont think thats a fewer providers want and they need to be very careful trading what they think are shortterm gains for having the federal government in the long term micromanaging their delivery of health care. Its bad for innovation and access and quality. John develop sir with eHealth Insurance you. Said we should not capitulate to the president s standards for success in Health Reform and you mentioned affordability was a standard he neglected he acquiesced to. Do i understand that your definition of affordability is more consumer friendly than obamacare . In other words i think under obamacare you have to pands 9. 5 of your income beforor relieved of the mandate butow define affordable in the block grants to states to help people who dont qualify for the standard deduction for Health Insurance that the state has to make basic insurance available in that state for i think less than 6. 5 of adjusted income in the state. So under youre vision of Health Reform people consumers are treated better in terms of affordability and consumerism than under obamacare. Die have that right . You do. One tweak. Such a nice question i dont want to i want to give you a short answer and say yes the only tweak is in the state grant its not just based on a consumers income. Its also those who may have preexisting conditions and people that dont have enough income where the deduction true he helps them and people who are priced out. I think the president was right to say if you got preexisting condition, it can be toxic obama cars. Unfortunately he screwed up the rest of the Health Care System. But the short answer isey, and tweaks of helping people with preexisting conditions. Briefly obviously we have the president ial race coming up. What role do you think own kaz not just obamacare but alternatives is going to play in the 2016 race. Do you think theres more pressure now for republican candidates to come up with comprehensive alternatives than there has been in the past . Absolutely. We spent the last year and a half coming win detailed policy ideas on health care, energy, foreign policy, and this election is different back in the 90s there was a sense maybe even early 2000s the difference in parties wasnt too great. The idea was maybe a time of peace, relative prosperity, won the cold war elects dont really maybe the elects didnt matter that much. We can have elections based on personalities, who tells the best jokes who is the best on tv. This is a very different time for our country. I think people on the left and right afree that this is an election about the direction of our country. You have two parties in very different places. I would argue the Democratic Party has been taken over by the radical left. So they dont want to do deen, frustrating private unions that would getgo construction jobs to apiece the radical environmentalists. They dont want to do School Choice that would help kids disproportinally from poor and minority families because of teacher unions. They dont want understoodable energy not just the keystone pipeline. Its production on federal lands and dont want to support a host of policies that would bring back goodpaying manufacturing jobs. I argue this eye lex is no longer just about incremental differences. This is about two different visions of the future of the country, and fundamentally a distinction about the American Dream. Is it about government dependence or people being able to work and get a goodpaying job. I challenge anybody thinking about running for president to come up with their open detail. On Obamacare Repeal and replace, on all of these issues. This is an important election and voters will demand that. I think especially voters especially Republican Voters but all voters are interested to hear what potential candidates have to say about obamacare. Identity yes to say you want to repeal it. Everybody says that. I think the next question is, what are you going to do instead and how are you going replace it . Said you were thinking and praying about running. Do you have a legislative session going the the mid of june. June 11th. This is our third week. We have a nineweek session and i said id make my decision after the conclusion of the session. Its important whoever we elect as president has to be somebody who wants to do something not nobody its important to offer detailed ideas because its about ideas and substance. Eye biased towards governors itch think theyve got proven track records. In our state we cut our budget 26 . Actually some returning shrunk the size of the government. We measure success not in government prosperity but the peoples president spirit, and thats the peoples prosperity. So its not about how many people have cars. Its whether we have highquality Affordable Health care. That what healthcare reform should. We he question is, who do you want to be in control . Patients and doctors or government and bureaucrats. Government or insurance bureaucrats. Doesnt matter. You want it to be individuals in control. The consumer, patient american family. Well, thank you for coming. Thank you very much