Transcripts For CSPAN2 House Rules Committee Votes To Approve Rule For Debate On Health Care Bill 20170324

Continue its consideration of hr1628, the American Healthcare act of 2017. As i had committed to each of your members of this committee at the end of our over 12hour plus initial hearing on this topic, i had once again invited expert witnesses who would be available not only to testify with us before today but also on the managers amendment that was submitted last evening to the rules committee. I want to thank the gentlemen from montgomery, texas. Is that spring, kevin . The woodlands. Yes, sir. I want to thank both of you for getting up. Hes use today getting up early. I did a paper route. My early radio days. Except im better dressed. I want to thank both of you for being here. It obviously is necessary for the end of a professional product thats being done. In all seriousness, we appreciate you taking time to testify on this fourpage amendment and to explain thoroughly what it does, why its necessary and more importantly some of the impacts that you believe will be attached to it. The underlying legislation has been already discussed before the committee as i said for some more than 12 hours but we feel like its important to finish off the task properly. As you know and i both know, it was a topic of conversation on media yesterday and certainly within all of our members. So without objection, anything that you have in writing will get b in the record and i i would like to defer the ranking gentleman, the gentleman from massachusetts. Thank you, mr. Chairman and good morning, everyone, or maybe just good morning. Theres not much good about this morning. For all those who havent been following the twist and drama, let me recap. We are here at the early hours to report a rule on a healthcare bill that will push at least 20 Million People off of Health Insurance. A bill that will be voting that in a matter of hours. If is that wasnt enough, the rule will rewrite the bill to make it far worse, how much worse, its hard to say. We only got the back room deal late last night. We barely had time to read it ourselves, let alone hear from the bipartisan congressional budget on what the impacts might be. We were given no information from my republicans friends about what the final product of this disastrous process would look like until late last night. We havent gotten a clue how many people will be hurt by the latest version of this bill. Im not one to menace words as you all know, but i dont have the ability to adequately express my outrage here, mr. Chairman. We do know that this bill will take away healthcare from 20 million hard working americans. We know its a crushing age tax forcing americans age 50 to 64 to pay premiums five times higher than what others pay for Health Coverage no matter how healthy they are and we know it steals from medicare, shorting the life by three years and funds that seniors fend onto get the longterm care they need. We know that this back door deal will kill requirement for Insurance Companies to offer essential Health Benefits, benefits such as emergency services, Maternity Care, Mental Health care, substance addiction treatment, pediatric services, prescription drugs and many other basic essential health care services. These are called essential Health Benefits for a reason. Now, again, we dont even know how many people this plan will hurt. We also dont know what the costs will be and we cant know those things until we get an analysis from a nonpartisan congressional budget which, of course, we wont have before we have to vote on this reckless legislation. When we will get that cbo analysis . Who knows, maybe a week from tuesday we will see it. We only just got the cbo estimate for the original 4 managers amendment last night and the verdict was grim. Somehow the republicans have managed to leave 24 million americans out in the cold, not one more person covered than in original bill while spending 187 billion more than in the last bill thanks to the tax cuts for the wealthy for the wealthy that are contained in the bill. So every time you come out of a back door, this bill gets worse. Maybe we ought to consider a bill to put locks on the back rooms that you guys huddle in. I shutter to think what the cbo might think on americans essential Health Benefits, unfortunately we dont have a chance before casting our votes, mr. Chairman, i am truly deeply disturbed by what we are doing here this morning. It is your responsible and hurt americans we were sent here to represent and with that i yield back my time. I appreciate the gentleman not only his viewpoint respected but also would like to thank the other Committee Member who is are here and your staff who have taking their time this morning. Gentlemen, today you are once again tasked with a mission, that mission is not only to address the issue that you came to us to but to understand that probably no where else but washington is our savings called spending. And you would recognize very clearly that this is an effort that you have undertaken for a long period of time, you have expertise, knowledge about the ramifications and i appreciate you both being here today. Now with that said, chairman walden or chairman brady, i will let you decide how you would like to have your conversation, testimony with us but i want to thank you but i will let you as you wish to prepare your remarks for you to engage this committee. Thank you, mr. Chairman. I think we agreed that i would go for and followed by my colleague. Thank you, mr. Chairman, members of the committee, thank you for giving us the opportunity to come back at this hour. Ii want to briefly discuss the amendment that we filed yesterday. First, the amendment add maternity coverage and newborn care to the use of funds for the patient and state stability fund. The amendment also clarifies that for purposes of the fundaMental Health and Substance Abuse Disorders Services including inpatient and outpatient Clinical Care for treatment of addiction and Mental Illness as well as early identification and intervention for children and young adults with serious Mental Illness, you can use the funds for those purposes. The amendment also provides an additional 15 billion to the patient and state stability fund. That additional fund, my colleagues is solely devoted, solely devoted to states for maternity coverage and newborn care because we heard from our colleagues, both sides of the aisle that this was credibly important to do, and it can be used for Mental Health Additional Services and to help those with Substance Abuse disorders. These are all important topics. We heard from many of you on this panel yourselves about how important it was that we take care of these people among us who need this kind of help. So we added 15 billion on top of the 100 billion already included in the underlying bill. And by the way, we have great flexibility on how states can use that money. I had a good meeting with my governor yesterday and explained to her on the impact of oregon that would occur beginning next year, 2018 and 2019 before any of the other major changes in this bill take effect, 182 million each of those two years which will help with budget gap and the use for very, very important services. The amendment also requires states to determine essential benefits beginning 2018 for purposes of the premium tax credit, so this change only applies to those who use the premium cashcredit for those insurance products. Now, this is not that unusual. Ive heard the the comments from my colleague of massachusetts. This does not affect the employer plans, it does not affect medicare, the Large Group Market already is exempt from the federal mandates where 155 million of our citizens get their Health Insurance through their employer, not what we are doing here. Theyve already been exempt and by the way, this congress not this year, last year, last congress voted unanimously, unanimously to remove the essential Health Benefit mandate of the federal government for the Employer Market in the 51 to 100 employee range because they knew the negative impact that would take place. How do we know . Because their independent analysts out there who have Given Congress the data points. Last year the Congressional Budget Office said the regulations governing Insurance Benefits would have made nongroup premiums 27 to 30 higher in 2016 than they would have been otherwise. According to a 2009 analysis they conducted. We know the benchmark premiums increased to 2014 to 2015 and 25 , 25 on our citizens from 2016 to 2017 which 34. 2 premium increase from 2014 to 2017 for the bench mark plans. Is it any wonder that our governors said, please, give us relief from this one size fits all federal mandate, please. In 2009cbo sent an extensive letter to them. This is the original of their prediction of a 27 to 30 premium increase. How can premiums skyrocket at 23 one year and 27 the next year and theyre projected to go up, maybe just high single digits, it maybe we heard 3040 in some markets. So we are trying to say lets give flexibility back to the state, by the way with the conversation with my governor yesterday, if oregon we wanted to maybe taken essential benefits, you can do that, his answer was yes. By the way, we do most of these in law today. If you we wanted to keep the ratio 1 to 3 versus 1 to 5 or what it costs for one person versus another, you can do that under state law and she said, yeah, we could. And i said you probably would and they said, yeah. It might work in might not. We will see in terms of the market but they have the right. They have the right to get it right, they have the right to innovate. Thats what we are giving them back. We know what the democrats did, drove up insurance rates. We dont fix this, people will be left in some counties and some states with no choice on this market, no choice. We know that in 2016 there were 225 counties in america where citizens had one choice on this Insurance Market we are trying to save. This year its a thousand 22 counties, one out of every three and next year will be worse. For my friends on the left, do nothing as you would propose to save the market or join us in the bipartisan effort youve been a part of in the past on this very issue where some of you were cosponsors of almost identical legislation involving the essential Health Benefits to free it up in the largersmall Business Market because you knew then it was a problem. It remains a problem and it sticks it to people who are least able to we want their premiums to come down. We are trying to bend this cost down. We fully believe, mr. Chairman, this will do that and i yield back my time. Thank you very much. Chairman brady. Thank you for allowing know testify in support of the American Healthcare act and i would ask that the rules committee make note of the Second Degree amendment, the managers amendment to the bill. We know why we are here. Obamacare is a sinking ship and its taking a lot of good americans down with it. We have made the strong case and america recognizes premiums are skyrocketing. Theres so very little choice. People cant see their local doctors and nurses or hospitals. This is clashing and clashing soon. American healthcare act as we have discussed unburdens more than a trillion dollars off of our families that have more expensive Healthcare Plan costs because of these taxes or Small Businesses, patient who is need over the counter medicines. We cut more than 1 trillion of spending that washington simply cannot afford and cannot sustain. We make important reforms on medicaid to give state it is flexibility to tailor and force Small Businesses to offer health care their workers dont need. We defund planned parenthood and shift that money to Community Clinics so women can truly get the health care that they deserve, we go beyond that, we begin to restore state control of health care and we begin to restore the free market thats chattered today. The last time we were before you, we brought an amendment that provides tax relief sooner, the local businesses and to local families, we created more flexibility and more resources for those in medicaid and vulnerable populations and we provided the space so the senate can do more to help those who were in the 50 to 64yearold age range. Thats an area we all agree we want to do more on going forward. Today this amendment is about wrestling control and power from politicians in washington in giving it back to the people. This amendment is about lowering healthcare costs and empowering states to tailor plans to their communities, to their regions, to their families and, yes, it increases funds to those states to address the very families that chairman walden just talked about. This amendment rejects the washington knows best, one size fits all that frankly has wrecked obamacare and hurt so many people. It recognizes that states are unique. Georgia is so different than massachusetts. Texas from california. It recognizes that regions are unique. The valley in texas with a heavy hispanic population where you see more stroke and diabetes is so much more different than the suburbs of houston where you have young families with growing kids and empty nesters whose concerns are for colonscopy and in rural texas where they are far in between. And it also recognize that is people are unique as well. Let me just tell you what the critics will say today, the critics will say that we that washington is abandoning important provisions in healthcare law like Mental Health care or Substance Abuse or Maternity Care, but that is not true. What we are recognizing is each of these are important provisions to different people at different times in their lives. It allows state to tailor the plans to provide those important provisions to their communities and their people at their times in their lives. We will hear today that this will allow plans in a race to the bottom. I will tell you what, the biggest junk plan is the obamacare plan you cant afford and cannot use. And the race to the bottom is obamacare itself, a program that is struggling that is not long for existence and will hurt a lot of people as it goes down. We will also hear criticism that the cbo score is not available to date. Its not. And that is a bit unusual. Its unusual for the right reasons because the Congressional Budget Office will no longer just survey washington about health care, it will survey every state in the nation to determine what type of Healthcare Plans are trying to for them, not right for washington, whats right for them. They wont be talking in limiting discussions to washington, d. C. They will be surveying 50 states to determine what plans will be available to them and what Congressional Budget Office will ultimately tell us is that more people will be picking up more plans because they are tailored to their needs, that this will cost some more money because more people will be using that individual tax credit for health care that actually they can use and need and want. And so we are postponing the medicare surcharge for a few years to make sure that more people can use that tax credit and this bill remains a deficit reduction bill. Bottom line is, whats wrong with health care is that its coming from washington, that people in washington believe they know best, that one size fits all and frankly f obamacare continued, i think there would be one plan across america, none of which would work. Today is about health care not driven by special interest. Its health care driven by what our families and our communities need. Thats what this amendment is all about and i urge its passage, thank you, mr. Chair. Thank you very much, gentleman. Im going to differ to the woman from wyoming, we will go in reverse order. Shes taking time to be here every day. I sat in that seat for nine years and rarely did i got to go first. So the first whack can come from the gentlewoman. Thank you very much, mr. Chairman. I just want to thank again the two chairmans for being here this morning. And i think theres something very fundamental as we have been discussing for months and months here about what we are doing and as i listened to my colleagues on the other side of the aisle, you know, their assumption that underlies their questions and their challenges and their attacks is very much that the only thing that happens of the economy happens that the federal government orders that it happens and thats fundamentally at odds with how our economy works. I want to ask you chairman brady, you mentioned that we may be on the path here to just the single provider if we continue down this course and i think thats a very important point and as you look at what we are trying to do, can you talk a little bit more about the extent to which the changes that we are making are part of an overall effort to fundamentally remaining the system so that people and states are in charge of their care and talk specifically also, if you dont mind, the extent of which the charge that is women are going to be hurt, mothers are going to be hurt and children going to be hurt is at odds with the reality of what we are doing. We are going to give people the right and ability to purchase the insurance that they need and the resources to do so . Lets start with the second point. This bill and this amendment, excuse me, is all about insuring that states can design Healthcare Plan that is are right for them and right for their regions. What it means is that instead of washington demanding a list of 11 certain benefits, it empowers state to determine which plan and which populations need those benefits and so beginning next year congresswoman, each state will determine what those essential benefits are for their state and for their plan. In massachusetts, for example, which has a full Health Care Plan in place may chose to retain all 11 for every plan. Well, thats their right. Wyoming where sometimes towns are few and far between where there arent providers in every corner and where theres hardworking ranchers, where those who work energy rigs and others may be in man camps, where there is a different population. Wyoming may instead choose plans that are right for those regions with the priorities these benefit that is fit those pieces in wyoming, not from washington, d. C. What we know from what the cbo will ultimately analyze looking at states is that as a result of taking that power out of washington, gives it back to the states and communities, the more people will choose plans that are right for them, so much so that we include funding here and it is a fundamental, make no mistake, this is a fundamental change from obamacare, it rejects the washington mandate, we all know best up here for that power of the people and its going to be critical. Those provisions as you said in your first point, this is about making sure each of those elements are available to people who need them at the time in their life when they need them. Thats so much smarter and more usable than what we have today. Thank you, and chairman walden, we talked before about the extent to which we are not here debating two versionses of the world that we havent seep and that we have to think about theoretically. We now are living in a situation where we have seen their version. We have tested their version and its been tested at great costs and expense to many people around the country in terms of bankruptcy, skyrocketing costs, in terms of choices. Why is it so important that we will now be giving People Choice and control power over their own lives and insurance policy sp . I appreciate your question and your counsel on these matters. This is really serious stuff. They hoped they were doing something that would work, they just can be the admit that its failing. We can see that and people in this market can feel that and we are here to rescue them and stop this market from collapse. I have told people that if there were a different occupant in the white house, they would be facing the fact that people in one out of three counties in america are only going to have one choice and in some areas we have been told next year there may be no option, how can you sit on your hands and the biggest amendment you offer, the most important amendment you would offer on a reform, you would think you would offer it first, in our committee we spent ten hours debating the democrats first most important amendment which is to rename the bill. Ten hours before we voted. That was i mean, come on. This tough is serious for people. Thats why we are not dragging it out. We are trying to move forward and my state, with all due respect, is probably is about as blue as your state is red and let if i could just share because i think coming from a blue state perspective, its important to hear what my state said about exactly the amendment thats before us today, not this exact amendment but the essential benefits and the Health Authority there said the existing health rules mandate that is states choose a benefit package from a limited number of existing health plans. These rules prevent states from developing new and innovative plans that could incentivize prevention and improve healthcare outcomes through reduced or eliminating cost sharing for highvalue services. Flexible plan design that can help Consumer Choice while allowing insurers to moderate future premium increases. They make various recommendations basically to give them this flexibility which is what we are proposing today and they say without sacrificing access to comprehensive coverage which they can provide and guaranty asking every one of our states, they say regulation of benefit requirements should be delegated to state regulators. Regulation of benefit requirements should be delegated to state regulators. Now, my state well, it may be more blue than yours because you have a republican governor, we havent had one since 1987. [laughter] my point is governor governor do see in arizona, the governor of maine, the insurance commissioner of mississippi. They are all saying, please, please, unshackle us, we know the market. Its like my colleague from texas said, different regions of my state may be different plans and opportunities but we want to make sure people have access to affordable insurance. We all share that goal. Lets not kid ourselves, we are finding and looking you should every rock to say how can we help drive town premium costs, give innovation a chance and and fix this mess and but we want to make sure that states not only have the flexibility and regulation but have the funding in their accounts to attack the most problems we see. Opioid abuse being high on that list and so we give states an additional 15 billion on top of a 10 billion on top of safety net funding for nonexpansion states, we turn off cuts on the hospital that is are called for under law, under the Affordable Care act, quote, unquote, obamacare, we turned off those cuts, we give flexibility, we think it will drive costs, we do know this. When the Congressional Office looked at the design the last time, they were off because this stuff is complicated and difficult. I dont know how they do it, they do. The short of it, they didnt get Consumer Behavior right then and they were off by 2 to 1. 20Million People say i will pay the irs a penalty rather than by insurance in the obamacare exchange. So, you know, its not working. Lets make it work. And again, the proposal before us today on essential benefits, nobody objected to when we did this to rescue the basically small Business Market of 51 to 100 employees. That was called the pace act. Nobody in the house objected. Senator schumer was the cosponsor. Colleagues were cosponsor. I mean, we all recognized this was about to derail that small Business Market of 51 to 100. We said, please take it off. There are no essential benefit requirements, 155 Million People get their insurance today, so we are nothing effects them. 51 of americans get their insurance from employers, most of them are exempt from the mandate. The only place well, not the only place but biggest place it applies is in the market that by the way, coincidently is collapsing. And this is a contributing factor to that collapse. So lets take off the pressure, respond to our at a states, give innovation a chance. Thank you very much, mr. Chairman, and i just want to say, you know, echo what you said that although we are we are very heavily engaged in debating and discussing policy matters an discussing how this will affect Insurance Markets and how it will affect medicaid, at tend of the day all of us know that people are at the heart of this and peoples lives are affected and what our speaker has said is absolutely the case. This is an act of mercy and what we are doing and certainly in my state of wyoming we are anxious and ready and we welcome the chance to finally be in a position where we are making determination about our health care, about what makes sense for us and individuals across the state have the power to make those decisions an choices, so i will just close by saying, i could not be more honored that this is one of the very first things that i get to do as a member of this body. Its something that we will remember proudly. Im confident and i look forward very much today to being able to vote on this very important piece of legislation. With that i yield back. I want to thank the gentlewoman of hitting the heart of why we are here this morning and thank you very much, gentleman from massachusetts. Thank you, mr. Chairman. I thought we would have the gentleman explain the amendment so i think we have to reopen the hearings. I think i have a few questions. Let me begin by simply saying i appreciate you being here but im not convinced and, you know, with regard to Mental Health and Substance Abuse services, you know, the bill eliminates the guaranty of coverage and treatment and replaces it with the slush fund that that states may or may not use which may or may not provide care where you live which may or may not be affordable and state has to match what the federal government puts up shifting more cost to the states and additionally you guys cut nearly 900 billion out of medicaid. With regard to Maternity Care, the amendment includes a slush fund for states that can be used for maternity and newborn care. You mentioned that in our opening statement. Pregnant women and newborn need slush fund. What does the unsured woman and child do when time expires . I worry that the bill thats going before the house today will return us when they sole policies with few protections . Ms. Cheney said i saw your version of the health care. We had that before the Affordable Care act, for the record, before essential Health Benefits, only 12 states, only 12 required maternity coverage and only 17 required mental Health Coverage. The result is in many instances women not able to see the doctors they would like to see for their own care. And what we knew from before was unaffordable costs for many women who needed Maternity Care which was unacceptable. I dont think thats the flexibility that we would want to see. Where states deny people the kind of coverage that they now have and that they rely upon. Lets not have a race to the bottom when it comes to americans. Look, i have no, i mean, my colleagues have come here to kind of make this spin what is the latest diversion of this bill. None of us could really know truly whats in this bill for some days. I thought interesting quote from one of my republican colleagues, the gentleman from new york, mr. Collins, the buffalo broad guy who came before him and the quote is, there is quote misunderstanding into quote of the health care bill. Once it is passed quote we can have the chance to really explain it, and a quote. We are not going to explain it before he vote on and debate on it. We will explain it after you vote on it and potentially pass it. I dont know. I dont think thats the way we ought to proceed. And this amendment is four pages. I had to say its probably the most dangerous for pages on the planet if it does what we think it does. I guess my question to both of you at this particular moment, i assume this be the last rules committee we have on this bill, i hope it is, but its about the process. I mean, im just curious whether youre proud of the process that insubstantial and nimitz and changes the bill at 10 30 p. M. We saw a bill would gather at seven this morning not being able to digest all of the implications of that amendment. There will be no cbo score as you pointed out. And we then go to the floor and then vote on it. You know, it just seems to me that given the fact that you voted for martial law or rule that will keep us here until monday to bring up anything you want between now and monday, i mean, you couldve waited until tomorrow. You couldve waited until sunday. The senate surely is not going to meet over the weekend. You couldve waited until monday, but it would have given an opportunity for there to be more transparency. I dont want to belabor this point but i think that, id like to get your opinion whether youre proud of this process that we are engaged in speaking if i may. Ill just take my experience in the ways and means committee, seven years ago, under Speaker Pelosi and chairman wrangle we were given an 800 page bill the evening before i didnt ask about seven years ago. I asked about last night. 300 page managers and him at midnight. Does that mean notes because it includes provisions of this house is already considered im assuming that is a yes. This is a process that you are proud of. Speed and im very proud that were wrestling power out of washington and giving it back to the states and communities and patience to deserve it. Im willing to bet that the as much democrats and republicans watching the process who are ashamed of the process. I include myself in that. This is not the way we should be bring the bill to the floor that is going to adversely impact millions and millions of americans. The changes in the fourpage amendment are substantial. These are not minor changes, and if there was a hearing i think we would hear [inaudible] i understand why you are ashamed, because you were for the principles of a bring before you come before today. You are against them. You didnt objectively past the pace at which did exactly for that Small Group Market of 51100 what were doing here, you give flexibly to states on show your conflict with that. Thats what were doing today spin i have what changed . Your state adopted the principles of the pace act because they saw [talking over each other] look at, if you guys can you come up out of this process thats fine. Still im proud of the productspin i yield to the gentleman. Yield for one common. What change is a trillion dollars in tax cuts and 800 million taken out of medicaid. Thank you. And i guess we will follow Chris Collins advice, a misunderstanding but once it is passed will have a chance to really explain it. Happy to yield. Mr. Collins is seeing if you pass it then people can read it. Is that what he saying . Understand what speed and sometimes you need to pass it i guess. And we will be able to find out more come if there are more Little Goodies the buffalo bride in the bill, but any event, as i said that beginning, i cant adequately express how horrified, especially on the a l this could have such a negative impact on people. Anyway, nothing we can do here. I yield back. Thank you very much. The gentleman from oklahoma. Thank you very much, mr. Cha. Just quicker for the record how long is the base bill, how many pages . One hundred pages or so. It was 117. Something like that. How long are the amendments collectively, this one . The last one was a couple dozen pages. How much time have we had to read this material . Four pages . In the hundred odd pages. Its only three pages aligned in two words on the fourth page. How long was obamacare . 2400 pages spin i just want to note in the record, its hard to read and what you can get her and company. I dont think theres any excuse for any member of congress the matter where you are on the issue not having at the time to read this bill. Weve been talking about this issue for multiple years as both my friends pointed out. Things have been voted on time and time and time again. Its been poure pored over and r and over. And frankly i do know when we do get to cbo and all wish we had it, that that score will continue to show this reduces the deficit. We can debate how much but we know its going to be lower, if [inaudible] i dont need to ask you guys a lot of questions. I spent a lot of, multiple subjects a lot of early mornings and late nights with both of you over the years, a lot of different ive never been prouder than the way you fled europe respective committees and the product you brought before. I think you brought something that keeps our commitments, keeps our promises, opens options. And again i know whats in front of my state. I know that our rates are going up 69 under obamacare next year. Year. I know we have a single provider. Thank god we have one because im not sure in another year we will. I look at whats in front of me and i see, frankly, an option for everything a person in my state to have a tax credit to begin to build a plan that they would like. I see choices in competition, and i see some hope. And i know this product has changed and i think has gotten better. Under your leadership and the participation of every member of certainly our conference with the last several weeks. I want to commend the president of United States for being part of the process, leadership, being part of that. But i understand precluded whats in front of me and i think most members do. And i think you have given us an opportunity here to move forward, moving the right direction. Dont have a lot of questions. Mr. Cole come if i might, i just want to thank your company, our former colleague mary fallin who wrote to us and said heres some things that would help oklahoma. Are some things that would help america. One of the things she said is relaxed or eliminate the federal design, such as complicated mental tears, ranges, Health Benefits, age range, instead of elastic control of a minimum core set of operating principles including Insurance Plan actuary of and Risk Mitigation methods. This is what were doing. I came out the private sector. My parents came out of the depression i was taught to work hard and are willing to work day and night, and i spent a lot of weekends in my own business working day and night to solve problems. We had a transmitter burnout at two. They didnt wait until monday. He got into it to a human or whatever and you would place the tube. Thats what i feel like unto here today. Im willing to stay here and work day in night and over the weekend to solve this problem and everyone of us should be willing to do that because people are suffering out there. We are going to fix this market together. Well, my friends have been doing that, and again as a set of very proud of both of them, proud of the committees of the lead. We are not a very big state but buti guarantee you we will put y of the vote we have with you guys today. Thank you very much for your service and what youve done and look forward to working with you today, and hopefully to a successful conclusion. With that, mr. Chairman, i yield back. I would offer a vision. Oklahoma is a great state and a great neighbor. When we been in trouble in texas, especially in droughts, oklahoma a, so thank you so much. The gentleman from florida. I think both are witnesses as well as all of us were here this morning. I want to set the record straight on a couple of things. I guess were going to go to the floor at nine or thereabouts but if you all want to keep on talking, then i certainly will do the same thing. I would say to my very good friend from oklahoma that it doesnt matter how many pages you have. You can have a paragraph that can do as much damage as a thousand pages, or in this instance these four pages, and in this seconddegree amendment for the managers amendment of establishing my considered opinion of some of the most egregious dangers that are likely to come down the pike. And also let me set the record straight about something. I ran for congress in 1992, and myself and three opponents in that election, and the republican opponent, all advocated that we should have universal health care. Now, its the nature of the district largely because of the significant number of seniors that are there, and the significant number of poor people. I believe that we really want to solve this problem, if we really want america to have a system, then whether you like it or not ideologically, a singlepayer system would benefit the vision the Insurance Company scope the hospital and all the people are talking about. But you never intended there to be a health plan of consequence of this nation. You are the same people that didnt support social security. You are the same people in large measure ultimately became, ultimately beneficial, and now you still want to change it. So dont give me that rumble in the background. You didnt get anything at all about medicare that much until people started liking it, and some of you did vote for it back in that period of time. But you sure enough dont like medicaid. Although the go back to you, mr. Chairman, and straighten you about my governor. I made a statement to you that my governor did not expand medicaid. I was correct and you are correct when you said that he initially offered that we should expand medicaid. But he flipflopped. When the senate had a bill in the state of florida that wouldve expanded medicaid, he did not raise his finger to do one single solitary thing about it. So medicaid has always been a problem in florida, and what we wound up doing was leaving 900,000 people in the lurch in the state that i am privileged to serve. You all now talk about block granting an medicaid. Let me go back a few years to win Mike Bilirakis and guess, both my door was here. Mike was always the means and managed to assure that 300 million that went to florida was going to be block granted. And much of that money went into the general revenue and did not go to help poor people. When the deal is done here, what we will have done is help rich people. And we will not have helped poor people. So the question that have for you two gentlemen is do you believe in the cbo score cracks they recently issued one on the 23rd which ultimately in essence says a little bit about the same thing that they said in the earlier one, but now were getting rid without it. So do i believe that the 200 people that we are paying nearly 50 million a year, and i might at last time i looked, the chair who, hhs secretary engineered to become the director is a republican. So do you guys believe in the cbo, notwithstanding a difficult it is to protect, project of the future . I would say we are not asked to give our belief of cbo. What we are required to do is take that information and be informed as we move forward. And what the cbo says let me let me give you some of the information given the freedom not to be forced into my time. Mr. Brady, i reclaim my time. The cbo and the joint committee on taxation estimates that in 2018, 14 million more people would be uninsured under the legislation that is, then more than under current law. Do you agree with that . I agree that 11 million of them, free from obamacare mandate, will choose not to buy health care they dont want and cant afford. The increase, continue on from cbo. The increase in the number of uninsured people relative to the number under current law would reach 21 million in 2020. 24 million in 2026, and in 2026, an estimated 52 Million People under age 65 would be uninsured compared with 28 million who would like insurance that you under current law. Thats from the director of cbo. Do you agree in part quite do you think any part of that is a fact . If i could just respond to do things, and i will respond directly to your question because no, i dont agree. But the second part is the insinuation that we dont care about people on medicaid. I am offended by that. I reject that, and i think because the member does not know my history in terms of working on this issue in oregon, when i became majority, i created a select committee, bipartisan, to implement expand medicaid coverage and help for those in the low income. Its called the Oregon Health plan. It has been passed before and we expanded it. I have worked on these issues to expand access to care in a rural district speed tell me about the 800 million that is being taken out of medicaid when in fact, all we had to do was leave the taxes that are here for very wealthy people, 400 people are receiving a substantial increase in their tax. Do you not see how that affects medicaid . Okay. Ill try to bring the tone down here speak im not going to bring my tone ten. Im mad as hell as what youre doing and i dont have to be nice to know what when youre being nasty to poor people speak well, lets take this one at a time because you asked me about the cbo data. I disagree with it. The reason i disagree with it in part, because its difficult for them to make these calculations. As you recall, prior indication for 2016 was off by about a two to one ratio. They thought 21 Million People would be on the rolls. Its 10. 4. I think they have have a difficult time understanding how the market will respond. Spin let me respond to you with reference to that. Among the reasons that they made, that miscalculation was the fact that a substantial number of republican states chose not to involve themselves in medicaid. That had an impact on the number of people that cbo had calculated spirit can i address that . Of course. Actually that number i gave you are those on the exchange, not an medicaid. This was looking at how many people had signed up for the insurance product and obamacare. And remember that i think the number is 9 million that paid the penalty or took six point 5 million in 20 okay. I told my track my numbers right. Six point 5 million paid irs a penalty of what, six, seven ago saint i dont want that product. And another 12 million or so got an extension. All im saying to my dear friend, this market isnt working for these people. We want to get to work for them so that spin im their friend. The republicans absolve themselves of any responsibility for the fact that the program itself did not work when, in fact, for seven years and including just recently you hammered this particular measure and sold it as something that would fail rather than work to do anything that would make it be successful spin i appreciate the gentleman to question and actually i would take issue with it, because this congress in bipartisan ways in almost every case worked to solve the problems as we went along. We passed 20 piece of legislation that president barack obama signed into law dealing with fixes and changes to obamacare. Number 4775 democratic votes to do that. And so together over the years, what we did plead for for the entire year 2010 on the energy and commerce committee, we put 13 request into then chairman of the subcommittee on health, mr. Pallone, just to do an oversight hearing about how this law was working. There were no oversight hearings into we got into the majority and then we said there are problems, lets Work Together to fix these problems and we did. And we passed 20 bills that became law. And just spent a whale of a lot of time seeking the calls of the managed to fill. Now you put a lot of things in here to try to make this bill seem less horrible than it really is. The fact is that even though you add 15 billion for Mental Health and Substance Abuse fund, i find it interesting that a portion of that is called slush. I know what happens with slush funds in states and here, and you are getting coverage for the largest Behavioral Health payer, medicaid, which contributed more than 67 million of behavioral and Mental Health in one year here let me ask you, do you all agree that this measure provides a trillion dollars in tax cuts for primarily wealthy people and corporations . No. How much does it provide . Provides 1 trillion in tax relief to families who buy Health Insurance plans, patient to buy overthecounter medicine, Small Businesses who can barely afford health care for the workers, and for companies that of seeing their jobs move overseas because obamacare has taxed them out of business. I see. So the 400 wealthiest people in this country to receive any benefit from this i didnt say that. Spin im asking. So do you agree that ive made the statement of when we started this that there were, and mike in my opinion, one person not having adequate insurance is too many. But do you all agree that some people, never mind whether cbo says 24 million, you argue whatever you do, if your bill becomes law that some people, some millions of people will be uninsured . Do you agree with that . I would agree with this, that if we do nothing to will be more people falling out. Because these markets collapse and do not have a chance to buy insurance. So thats exactly right. Agree with you. Thats why were here today spin i represent as many people as you do. Every member who represents virtually the same number of people. And i believe those people want to Work Together speak i have said we should be locked up. Until we get a measure. We know this bill provides 274 billion in tax cuts for the highest income people in this country. You can name it anything that theyre doing. Let me ask you whether or not your bill as presently before us increases premiums 1520 in the next two years . Over the next ten years it decreases im asking you about two years. According to the cbo estimates, they believe that that will occur. But in the amendment today so you like cbo . To be clear, more affordable plans were used by more americans, which is why we provide the funding for more americans and also make that argument about when the people got their money, the rich people, that its going somewhere, another way to get to the poor people and it will create this great economy and you got in this measure go to work if you receive medicaid persons and you are ablebodied. And i agree ablebodied people everywhere ought to be working. But i also think that government, both state and local and federal, should be the employer of last resort. Because all of us know that the are no jobs and therefore its going to be exceedingly hard for people to get work. I want in this way, mr. Chairman. Chairman. My friend for my opening spoke of the speakers notion that this bill is an act of mercy and i quote her, quoting him, i didnt hear him say that. I want to give you just a few organizations that dont believe its an act of mercy. Easter seals is greatly concerned that this removes the federal funding guarantee that currently exists in medicaid. The United Methodist church says the bill has been promoted as a fix to the Health Care Law system in the United States, what it will do nothing to improve access and affordability. Instead of our many congregations and community in which we live and serve. People will die because of efforts like this to roll back health care. The Episcopal Church says this current proposal fails woefully short of our spiritual calling to care for the least of the, as well as a noble value of the fun which our great nation was founded. The Catholic Health association of United States says we strongly encourage the full house to reject this replacement bill, and work to craft legislation that addresses the real issues without creating unneeded chaos in the system and coverage for those who need health care. The washington religious staff committee, they say the scriptures of the traditions of christians, jews and muslims as was the sacred teachings about the faith understand and addressing the general welfare of the nation includes giving particular attention to people experiencing poverty or sickness. For their sake and for the common good, we must continue to make progress toward a u. S. Health care system that is inclusive, equitable, affordable, accountable and accessible for all. The millions of people who could be affected deserve truth of comprehensive replacement that would protect the access to coverage, changes to the aca or medicaid will in fact, the health of millions of americans will impact and i wont bother to go for the butter wanted to and by using Sister Simone campbell, the network advocate for catholic social justice. She says after reviewing the house gop replacement bill, the answer is a resounding no. Instead of providing Greater Health security, the bill increases cost for older and sicker patients entrusted with cuts the medicaid program, all while providing huge tax cuts for wealthy corporations and individuals. This is not a faithful way forward, and must be rejected. I have said to you before that youre going to own this mess, and i wish it wasnt that way. I would be willing and i believe many of my brothers and assisters here in congress would be willing to work with anybody to do what all of us do what we can do or should you. I yield to the gentleman from massachusetts. Again, i find it interesting that the general from texas referenced the cbo at one point. There are 200 employees who work there. We spend they are awesome. They do wonderful work. We pay 5 50 million a year to find that come and get who we are and we are not, you know, we dont have a cbo score or report or estimate on the latest bill. I just want to mention remarks by a colleague of yours, mo brooks, republican. Hes on tv right now, apparently, and this is what he said. He said its one of the worst bills ive seen in my 30 years, end quote. Who says congress can be bipartisan anymore . Their strong bipartisan opposition to this bill, no matter what new backroom deals are struck. And i think youre going to be surprised that amongst your own membership how many people are not going to be there for this. Some have objections on the right and some of the more moderate members are horrified by the rollback of protections on essential services, but there is bipartisan opposition also what this country against what youre doing. I think the gentleman speak i yield back. Thank you. The gentleman from georgia is recognized. Mr. Chairman, i want to confess that i may miss understand the meaning of the word backroom deal. Ive not been down to the white house. I absolutely every televised presentation of that. I havent traveled to any of the back rooms, and if you like i am pretty well informed about whats going on. Rather than being something done in the privacy of a room. This is something that has played out in front of every single one, not just of us, but of my 700,000 constituents back home. And im grateful for that. Cant i just say when they rammed obamacare through here they also refused to allow cameras in the rules committee it was a republican majority that allowed the cam in the rules committee, that a larger statement itself to now be shown. Thats a back room right there. I wasnt invited in that room. Neither were any of the democrats. Thats one of the back rooms speak i appreciate the children observing. And ill tell you what were talking about in that backroom. And if you take issue with it, there enough. We are talking about a four page and in the today that requires the patient states stable to fund to focus more attention and more money on, let me make sure i have this right, maternity coverage and newborn care. I think that something we believe in. I think a significant something thats made the deal better. It goes on to require that Mental Health and Substance Abuse Disorder Services be included in that. It goes on to focus on both inpatient and outpatient treatment of Mental Illness and addiction. My friends, i agree with my friend from florida. I wish we couldve done this in a collaborative way. Candidly, i believe there was a possibility. I dont believe thats what i dont blame gentleman from oregon but i will say when your committee spent hour upon hour upon hour dealing with emotions and whether or not to change the name of the bill it was want and mimic and it took ten hours of debate before we voted the first time. Im not going to try to characterize whether that was a democratic delay effort or an effort to improve the bill that those are the kind of things that make people think we cant do it and it could just be that this environment is to toxic on this one bill. We all know the history, but i want to agree with my friend from florida. He was quoting folks writing in the bill and he said this bill, the changes in the film impact the health of millions of americans. I want to stipulate that that is true. Its true across the country. It is certainly true in my district. It is going to impact the health of millions of americans and it will do so in a dramatically positive way. Ill give you an example. I told you about a ct scan. I asked you if you no one should cost. We talk about state flexibility. It turns out i can drive right down the road here in d. C. And at that ct scan done for 1900. 1900. About five minutes down the road. I can drive across the river into virginia. I can have the same ct scan done for 900. Or i can drive 25 minutes down the road to maryland and have it done for 98. 1900, 900, or 98. Would you free up my state to construct a program for our people and the way that provides flexibility to unleash that kind of Market Information . You make changes that we cannot, that we cannot know today the limits of the positive impact that will happen. Im looking for i understand that cbo has a lot of work to do. Im looking at these four pages and the changes that they make. Im not an economist but theres no set of circumstances where this language does not result in better coverage, better care and more injured individuals in my great state of georgia. I really am grateful to you for not focusing on how many folks have insurance. [inaudible] spirit instead focusing on how many folks have access to care. The essential benefits package that exist today would have a 7000 copay for every individual in america. And actually for constituents in my district it doesnt matter how many benefits you put in the essential benefits package, if they had to pay 7000 to access them, they are worth nothing to them. And you provide the flexibility here for georgia to craft a program that serves these underserved populations. It is not about who has a card and a pocket. Its not about what the light of legislation says. Its about whether that child in my district can have access to that care. You do this for folks. Im grateful to you for not getting it because it wouldve been easy to give up. With the gentleman yield . I want to go back to what you started with, which is the disparity of costs for procedures and the lack of transparency. Because i think the thing, i think most people are most concerned about when did you have insurance, youve got to figure this interest market at all, but what are these cost drivers . And for the life of me i cant understand how one place is 1900 and another place its 98, but beyond that we probably dont know as consumers, there is no easy way to figure that out. I want the tonic and transparency into this health care process. I want to drive prices down. Want to increase Consumer Choice. As an informed consumer is going to have the most effect at driving down price in this market because thats what competition does everyone else except in health care where its so opaque. You have to all the resources as a member of congress to get the best place to go to get the best deal on an mri. So i appreciate the gentleman spirit point of inquiry. It appears like were having a hearing now and i guess what is troubling is its very onesided. We have two republican witnesses but we dont have any democrats here. I think we gave each opportunity to have witnesses. Maybe we should call them because i think at this point it looks like it is turning into a hearing so i think we ought to maybe see whether there might be something we ought to do. I would ask my colleagues to yield spirit as soon as i get the time back. To say to my friend for massachusetts, i think you are right. I had not intended, i thought youd said as long as youre the time youre going to go ahead and have the hearing and i should not have followed your lead. But to my friend from your state excuse me. I followed the lead spirit i have to stipulate. You mentioned, all of us have the same sympathies im sure, that you want that child to have access. There is a distinction between having access and being that so we dont have. Heres what i wanted to do. I failed when i talked about the cbo comment so far weve done that and i just wanted to ask you to yield so i can ask that year to allow the president march 23 iteration scdot be made a part of the record speak without objection. But thats for yesterdays wording. That wasnt today. March 23. And mr. Chairman, by true by person fashion i will accept his advice and yield back. Thank you very much. The gentleman from colorado. Thank you, mr. Chairman. It is very important that we are, since were the only House Committee to any kind of hearing on this new new amendment its very important for us to take the time. We need to do our job. I do want to confirm that we are, and i have one or two on the other stuff we just got the cbo score and want to move on to this new amendment. This new amendment did these things come up in either of your committees, the delay of the repeal of medicare tax, the removal of the essential benefits or the Additional Support for the fund . My question is are these new concepts were bringing before this committee or at least three things in this new new amendment also debated in your committees . Yes spirit it is new to us or they were debated in committees spirit both medicare surcharge and are ranking meal offered amendment related to Health Benefits of themselves spirit so were the First Committee to actually see them in amendment for or what it offered an amendment in either of your committees as well . You mentioned the medicare delay was. So the medical medicare surcharge for wealthy individuals, that tax was offered as an amendment and the committee and has been subject of hearings throughout the years in our committee as well. We had an amendment. It was a debated and i believe defeated. So before i get to the new amendment i have a couple, two things about the bill itself. What is as you know we just got the cbo scoring on what is now the old new amendment, the managers and him awake saw a few days ago. One of the surprises in that it would increase the deficit substantially over the original bill, about 187 billion in additional deficit over the original bill spirit it was not a deficit bill. It was a deficit reduction bill. You can express it in different ways. You can see this reduces the deficit by last but at the end of the day the deficit would be 187 billion more under the managers amendment that under the original bill. Thats what the scoring said. I think would you like to talk about why . Id be happy to in amendment but one of the great surprises of that is that while increasing the deficit by 187 billion and actually would cover any additional people. That seems very hard to do to me. I dont even know if i could do that if i tried. If youre going to increase the deficit by 187 billion, you think someone would at least get coverage out of it. Im happy to yield to see were all that money is going that is increasing the deficit by 108 18 september more under the managers amendment that would be under the existing bill. So other 186 billion, 184 billion is tax relief, et cetera and that all the people who buy Health Insurance, overthecounter prescriptions in medications as well. And the bulk of it is tax relief for americans in a 5064yearold age group who oftentimes can have hired medical costs. The decision was made across our conference to do more to help them ensure Affordable Health care, the broadest range of plans which this amendment by the way helps ensure more affordable as well. And then the remaining 40 million was more resources that was provided through medicaid for a number of people, frankly, who are vulnerable and nursing homes. And we want to ensure you have additional resources. Is that correct . Thats correct. And so we have listened to people who said, and we look at the last cbo score and said there are ways here we need to make this even better than it started out. That takes money and we put it in here. But at the same time you increasing the deficit by 187 billion. Cbo scoring shows, while your goals may be noble, it doesnt extend coverage to any more people. The same number of people lose coverage, the 24 million, under managers amendment which where the scoring back some of the original bill. So while perhaps your policy goals are laudable it didnt seem to reach them. At least it would have covered a million or two, but somehow you seem to have covered no additional people with that increased deficit spending. To be then put back into a bill outside of regular order in a managers amendment. It does happen. Im sure you can find some point in history where republicans and democrats have done it, but its unusual when theres a bipartisan vote that committed an amendment in the committee that it was taken back out in the ether can i just respond for accuraciesome it was a different amendment. I said it was related to eh bs, because you asked if this issue was debated. Im sorry if i wasnt clear on that, but it was related to ehbs. [inaudible conversations] okay. Well, i dont know. The note i have says the amendment was defeated in committee, and youre putting it back in the bill. I think what youre saying is theres some differences between this amendment and what was offered in committee id be happy to get with your staff, if youd like, to go through the specifics. Okay. Now, getting on to the new amendment oh, actually, one more question on the bill. A surprising number of my constituents ask what happens to members of congress and our staffs under this bill, and i was hoping you could address that. I believe theres no change. Im in the d. C. Shop exchange which is the obamacare market. Mr. Hastings is. I dont know about others. Well, one of the we stay in that. The Affordable Care act is it removed members of congress from the federal health care benefits. If that part is being repealed s there anything in this bill that would guarantee members of congress wouldnt go back on federal health care benefitses . Yeah, i know this is complicated stuff. We dont repeal exchanges, we remain in the exchangeses. Members of congress, i think, should stay in the exchange. Yeah. And im in the exchange. Because, you know, we should feel the same pain that our constituents have felt that are in the exchange. And, you know, rise or fall based on our policies. And so im in the exchange. I pay i have a blue cross policy in the d. C. Shop. I was forced into it [inaudible conversations] interestingly enough, the a lot of our constituents believe that we dont pay for Health Insurance oh [laughter] an argument, but i hear that all the time, that we have free Health Insurance. Oh, yeah. So let me just Alert America thank you. [laughter] well, and as i said, many constituents inquired about this, and i wanted to ask about, again, whether theres anything in the bill that would prohibit members of congress or our staffs by being put from being put back on the federal benefit plan. I dont believe we change anything relative to that. [inaudible] no. So you leave the part as it is. We didnt no special back room deals for members of congress in here. So youre keeping some elements of it, like the part yes. [inaudible] congress off the federal employee finish. We stay in the exchange. Well rise or fall based on the policies were putting before the Congress Just as our constituents i think that makes sense, by the way. I think we ought to be tied by that. If our policies arent good, were going to pay the price too. We think theyre going to be better, by the way, and drive down cost. On that topic going to the newest amendment, which i would point out most members of congress, myself included, saw for the first time this morning. I saw it for the first time at 6 30 this morning. We probably have colleagues that havent yet seen it because it was just posted. When youre talking about eliminating essential services, what youre talking about eliminating as part of every Insurance Plan is ambulatory patient services, emergency services, coverage for hospitalization, coverage for pregnancy, maternity and newborn care, Mental Health and Substance Abuse, use Disorder Services, Mental Health parity piece, prescription trucks, Rehabilitative Services, Laboratory Services and testing, preventive and Wellness Services and chronic disease managementing and pediatric invests. Thats from healthcare. Gov. Those are the essential services that for something to be considered insurance, it has to meet which would be eliminated under this. My question is about the other piece, the medicare tax. Its my understanding that this managers amendment which, again, were just seeing for the first time would increase the medicare tax by about 1 for five more years over the original bill, is that right . Five years. It continues the existing right. So it, it taxes more than the original bill, just to be clear. And it seems like a lot of that money is going into the new Entitlement Program or the slush fund to the states. Is some of it also reserved for deficit reduction in this plan . I know we dont have the cbo score, so back of the envelope. When you take the revenues from the tax increase, you subtract out the additional money youre sending to the states, are you anticipating there would be additional deficit reduction under this bill . So the bill would be 150 billion of deficit reduction now. In the amendment, because with we are providing for more use of the health care right. Tax credit because there are more affordable plans, we include this provision so that we would continue to have a strong deficitreduction bill as it moves to the senate. So i do want to correct one thing you said yes. This amendment eliminates the essential benefits. It does not. It restores to the state the power to design them. Well, but what it would eliminate is washington knows best mandates that drive up health care costs. Well, it eliminates them as a guarantee. It eliminates washingtons power well, washingtons power to protect Peoples Health could i respond as well . On june 17th of 2015, you, like others, became cosponsor of h. R. 1624. It did almost precisely what were doing here and was passed unanimously by the congress. That took away the states, the federal mandate on the Employer Market between 51100, left it up to the states. So what youre concerned about today, i think you can get some relief on that you supported before when it passed the house and, actually, you cosponsored fundamentally whats in this amendment today for the employee, Employer Market between 51100. Well, if that was the bill before us, wed be having a different discussion well, because it passed unanimously, and nobody objected. How it fits together than simply this piece. So but do you have a there are a number of bipartisan ideas which democrats would be happy to work with republicans on and get them to the president s desk and would the gentleman yield . But in the context of this bill, theres not a lot in it to like. Now, if we want to have a process where we can find out can we save money, can we cover more people, can we make health care more affordable and we make sure were doing it right by having the scoring come back from the Congressional Budget Office, were happy to look at a number of elements of this bill as potential aspects of how to do that. But in seeing this for the first time at 6 30 this morning without a Congressional Budget Office score, obviously, thats a nonstarter. We just dont know whats happening. Clearly, again, in this new managers amendment focusing on that, because we talked about some other things there is a 5 increase in this new amendment over the original bill. I think im understanding that some of that goes to the state, the sort of state vertebra fund that people state slush fund that people would use. The money theyre going to get under this is still far less than the costs foisted on them, so many of them see it as yet another unfunded washington requirement where theyre effectively getting far less money than it will cost them. Now, you are also now allowing them to change or to deprive, if you will, americans of prescriptioning drug access, Mental Health parity, Rehabilitative Services and many of them might, in fact, be forced to do that financially. But would the gentleman yield . Might be insufficient to maintain those essential services. Happy to yield. Yeah. We do not repeal the mental parity requirement . What . We do not repeal the mental parity requirement. Well, im looking at the essential services, and one of of the essential services is Mental Health and Substance Use services. To me, that is saying that Insurance Plans dont need to cover Mental Health. Its actually a little different with the parity requirement, thats a separate so what is still required, lets take it hypothetical, states said we dont want to have Mental Health and Substance Abuse services in our essential services, what does Mental Health parity accomplish outside of that if its not covered . Its still a requirement under the law, and the states would have the authority to determine the levels of the products that are offeredded like your state would, like my state would, like my democratic governor said they would continue to do. And the slush fund you referred to, 15 billion into helping people with Mental Health, helping people with opioid addiction. We think thats more than a slush fund, we think thats an important investment in Peoples Health and lives. The states ive heard from all say theres a hole. So youre telling the states they need to raise taxes or remove some of the essential benefits, and thats exactly what theyre going to have to do if this new law were to come out of washington. So, again, while you increase taxes in this new managers amendment, while you increase the size of the new federal Entitlement Program, you fail to actually cover more people. Just as the first managers amendment increased the deficit by 187 billion, didnt cover one additional person. So, again, are you correct that theres elements of in that we could talk together about and Work Together on . Of course there are, absolutely. And theres many ideas that democrats have proposed that we hope would be considered in any effort. But to do that, were going to im going to move at least more an open rule. Im hopeful that then democrats and republicans can bring forward good amendments that will expand coverage and reduce costs, and we can have a process whether it takes a day or a week. Were not saying take months. I think democrats are just saying lets take enough time on the floor where we can offer amendments and vote on them and have a better work product rather than be ashamed of as so many members seem to be about this work product that we can all be proud of or at least 300 or 320 of us can be proud of and the president can be proud of. I think that this misses that bar despite the last minute tax increases in the managers amendment, despite the increased deficits i should say in part because of the increased deficits, the lack of clarity about how it impacts the deficits. We can do better, i know we can do better. I hope that everybody looks in the mirror and asks themselves, can we do better. Not can i do better, because we all have our own perfect Health Care Plan. Im saying can we do better. I think the resounding answer is yes which is why i oppose this bill in its current form, and i yield back. Gentleman yields back his time, thank you very much. The gentleman from louisville, texas, dr. Burgess. Dr. Burgess does not seek time. The gentleman from alabama. Mr. Chairman . Yes, sir. Read the bill, understand the amendment, support the amendment, yield back. Thank you very much. Gentleman from the state of washington. Gentleman does not seek time. The gentleman from windsor, colorado. Thank you, mr. Chairman. Just briefly, i wanted to ask my friend and colleague from colorado if he had a dimmer for that tie. [laughter] could you turn that down just a little bit . Between the shiny scalps between the two of us and the brightness of that tie the gentleman yield, i just wanted to make sure that you were awake on that side of the aisle. [laughter] awake but blind. Very briefly, chairman brady, first, i very much appreciate the time we get to spend every week at a dinner, and i very much appreciate the example you set for the new members of congress. My question is the gentleman from massachusettss has used words like back room deals and misleading and slush fund, bribe, ashamed, horrifying. Youve been here longer than i have. Do you ever get used to that is. Never. Never. S it is frustrating because these are such basic principles. So how should americans get their health care . Should it do dictate should it be dictated and direct canned by washington, or should it be tailored to their needs and offered through their states and communities . I think the answer most americans believe they deserve health care directed in their communities and states tailored to their needs. Is it possible to disagree about an issue in this place and actually not use inflammatory words and try to get the public all upset and actually not go to the motives of people and actually talk about policies . You know, i think there is, and i hope we will return to that soon. I wanted to read you a quote. Its from barney frank, and he said it in the huffington post, and i dont typically read the huffington post, but one of my staffers did give this to me. He said but, frankly, the president ought to never have mentioned, as he did, that if you like your existing Overall Health care strategy, you can hold it. That wasnt accurate, and you shouldnt lie to individuals. And they just lied to folks. Did you serve with barney frank, by any chance . Yes, sir. Was he a republican or democrat . Democrat. Okay. I also wanted to read you another quote and get your thoughts on this. This is from jonathan gruber, and he was actually employed by the democrats to work and ite was called the architect of the Affordable Care act. And he said in terms of riskrated subsidies, if you had a law which said that Healthy People are going to pay in, you made explicit that Healthy People pay in and sick people get money, it would not have passed, okay . Lack of transparency is a huge political advantage. And basically, call it the stupidity of the American Voter or whatever, but basically that was really, really critical for the thing to pass. And the thing was the Affordable Care act. Just wondering what your thoughts are on this. My belief, congressman, is that americans are smart. They know theyre being forced on to plans they cant afford and cant use. Young people figured it out very quickly, they were being overcharged. And the rest of america now knows this is a sinking ship, obamacare, and it will take so many of them down. And that Congress Needs to act now. And at the end of the day, you correct me, but americans want to be in control of their health care, not washington. And thats what the amendment before us today does. It rips power out of washington, d. C. And returns those choices and control back to the american people. Thats the heart of this amendment. Thank you. I yield back, mr. Chairman. Gentleman yields back his time. Thank you. Gentlemen, i want to thank you. I want to just in my brief comments, i want to say, first of all, that i concur with both of you and in particular with chairman brady. The Congressional Budget Office is a valuable asset to United States congress and the american people. And i tell you that i i will tell you that i have had nothing but fabulous are work from and have confidence in, and we ghei them a tough task we gave them a tough task. Secondly, chairman walden, you and i have always had a saying about what were trying to do; that is, were trying to leave our campsite better than what we found it as eagle scouts. We have that obligation on ourself, and i hope and believe that thats what we are trying to do here today. I want to thank both of you for taking your morning, and youre now excused and thank you very much. Mr. Chairman . Mr. Chairman . Yes. If i could, i just want to acknowledge the hard work on both sides of the dais the staff has put in. This has been an unusually lengthy process both through the committee process, ways and committee, energy and commerce and now in the rules committee, and our staff have been with us every step of the way, so i applaud them. Thank you very much. And i believe the accolades go to both sides, not just the staff, because the performance of this has been important. Okay. Is there any other member that would [inaudible] oh, were closed, were done. Okay. This now closes the hearing portion of the section that we were here today for, h. R. 1628. Chairman will be in receipt of a motion from the gentleman from oklahoma. Mr. Chairman, i move the committee grant h. R. 1628, the American Health care act of 2017, and closed rule. The rule provides four hours of debate equally divided and control by the chair and Ranking Member of control in the budget. The rule waives all points of order against consideration of the bill, provides that the amendment printed in part a of rules Committee Report modified by the amendmentprinting part b of the report shall be considered as adopted. The rule provides that the amendment printed in part c of the rules Committee Report modified by the amendments printed in part d and part e of the report shall be considered adopted. And finally, the rule provides that the rule as amended shall be considered as read. The rule provides one motion to recommit with or without instructions. Thank you very much. Youve now heard the motion from the gentleman from the great state of oklahoma. Id like to defer to myself for a brief explanation. H. R. 1628, the American Health care act, is a closed rule, four hours of debate provided to the chair and Ranking Member of the committee on budget or their designees. It selfexecutes the managers amendments as amendment and allows a motion to recommit to our friends, the democrats. We would now ask for any amendment or discussion. Mr. Chairman . Gentleman from massachusetts. First of all, mr. Chairman, in response to mr. Park, let me just state for the record and let me be very clear, i meant every word i said, and i stand by every word i said. The gentleman wanted to quote some democrats, ive just been handed a stack of quotes from republicans one after another from senator mike to john kasich to governor paula page, i go right down the list, all expressing deep concern over the very flawed process that the republicans have undertaken here. These are all republicans. I would normally read them all, but im a nice guy, and so im not going to read them all to you today so we can move forward. But, mr. Chairman, i just want to say that i am disappointed by this rule, but im not surprised. As my friend from florida said the other night, a bad process will lead to a bad product, and this rule is a bad product. First of all, its closed. No amendments allowed, even though many members from your conference want a chance to debate their ideas on the floor. And beyond that, frankly, its a mess. Lets see if i can follow this. The amendment in part a will be amended by the amendment in part b. The amendment in part c will be amended by the amendments in part d and e. The bill was broken, and you slapped together some deals to try to fix it. Both the bill and the deals were so sloppy, they both also needed technical fixes, by the way. And now weve got one last back room deal being written into the bill. What a mess, mr. Chairman. There are fixes to the fixes to the fixes. And i dont know, but maybe you can get us a flow chart for the floor. But as i said at the beginning, the disappointment that we have in this process and in the final product cannot adequately be expressed in records words, so in words, so with that, i yield back my time. The gentleman yields back his time, thank you very much. We will move forward on the motion. Gentleman from colorado. I move to grant an open rule to h. R. 1628, and if i may speak to that, mr. Chairman . Gentlemans recognized for discussion. As i indicated, i think this body can do better collectively, and we can have a process that if this amendment passes, i will also make an amendment to, that i would reconsider friendly to increase the time for the debate of the bill. Because i think we will need more than a few hours. And well just go and, you know, for a week or two and offer a lot of great ideas and, hopefully, well have a better work product. And i hope my colleagues support my amendment, and i yield back. Thank you very much. I hear a motion on the floor for an open rule. I also would open it to a discussion. Id like to and im sure the gentleman said this, i may have heard it wrong, but well have a rule for one hour and four hours of debate. Yeah. And what i said is if my First Amendment passes, ill actually do a subsequent amendment to increase the time of the debate. Okay. But im not going to do that right now i get that. Im just trying to make sure we all for clarification. I offer nothing but accolades for the gentleman to offer that amendment. Is there further amendment or discussion . Im sorry, sir, further discussion on the amendment . Mr. Chairman, as the rules committee designee to the budget committee, id say that i hope there will be some Health Care Bills that we can bring under an open process, but because of the reconciliation nature of this bill and the way that each provision has to be vetted by the senate parliamentarian, we this bill just cant be done in that kind of process on the floor, and i would oppose the gentlemans amendment. Thank you very much. Gentleman from massachusetts. No, i would just say we talk about process, we have five amendments here that are selfexecuted that the majoritys making an order, so i would support the gentlemans amendment. Okay. Lets move to a vote. The vote will now be on the published amendment. Those in the favor signify by saying aye. Aye. Those opposed, no the gentleman asks for a roll call vote, the clerk will poll the committee. [roll call] the clerk will report the total. Three yeas, nine nays. Its not agreed to. Not agreed to for discussion. Gentleman from colorado. Well, i since that motion failed, im not going to increase the debate time. I mean, i think, you know, its theres a lot to debate, and it may very well take longer, but i think that i wont make that amendment at this time since theres really no amendments to discuss besides the ones that are selfexing cuting in the selfexecuting in the managers amendment, mostly just the bill itself, and ill yield back. Thank you very much. The vote will now be on the motion from the gentleman from oklahoma. Those in favor signify by saying aye. Aye. Those opposed, no . The eyes the aye z have it the gentleman requests a roll call vote. The clerk will poll the committee. [roll call] clerk will report the total. Nine yeas, three nays. The motioning is agreed to, its agreed to accordingly. I will be handling this for the majority. [inaudible] the gentleman will be handling this, mr. Mcgovern, will be handling this for democrats. Okay. Weve completed our work. Let me go back over and say again thank you to the members and the staff for a lot of hard work [inaudible conversations] quickly. [inaudible] i would say that i would anticipate that we will get that done quickly. Thank you very much. This finishes the rules Committee Work for the week. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] members of the House Rules Committee will now head over to the House Chamber as the republicans Health Care Plan moves to the floor for debate. The house will first consider and vote on the amendment to the rule debated this morning by the rules committee. Assuming that passes, we expect the house to start or general debate on the bill itself. Again, President Trump delivered an ultimatum to house conservatives yesterday. The hill reporting the president told those members hell leave obamacare in place unless they get onboard with White Housebacked legislation to repeal and replace the sevenyearold Health Care Law. Politico is saying today the vote is too close to call. According to the hills unofficial whip list, this morning up to 33 House Republicans could vote in opposition to the measure. Its expected that all democrats will vote no on the bill, and republicans need to get 215. If all this adds up, the numbers are not there for the bill to pass. The house gavels in at nine a. M