Transcripts For CSPAN2 Key Capitol Hill Hearings 20160915

Coming up open cspan 2, president ial nominee gary johnson addresses the economic club. And the House Oversight committee where the law stands six years later. And, after that, two subcommittee look at the decision to leave Health Insurance marketplaces and now an update from the road to the white house. Joining us is nick gas, at po lith take co, and his work is Available Online and youve had a busy day. Its been a busy couple of few days, and as, it everyday, with this election approaching its last few weeks. Well, lets talk about some of the eight stories that you have written, Hillary Clinton back on the campaign trail tomorrow. Shell be in North Carolina and then in washington, dc, for a couple of days. What can we expect . I think what is most important for Hillary Clinton, is that she gets out on the trail and she shows that shes healthy, and shes able to be transparent about what happened, to discuss her plan to improve the lives of americans, and to defeat donald trump and why donald trump is the wrong choice. Her campaign feels that a return to normal, would do her well. And it will improve the swoon that we have seen her sustain, in recent polls. Also, looking ahead had to next week, when she will be in new york, and they announce he had a number of bilateral meetings, her session with the equip shan president , and getting a Quick Response from the Trump Campaign. That was announced earlier that shell be meeting with equip and ukraine and possibly others that will be happening next week. Not a specific day. All to potentially give the former secretary of state more credibility going forward, showing that shes already speaking with these dignitaries and she is reminding voters she has the experience of doing so. It carries the consequence of the Trump Campaign being able to, as they have done, point out that, its another reminder of her failed leadership, and experience, as secretary of state. So, shes counting on more people to see that experience aspect rather than remembering every detail about her legacy as secretary of state. A specific example by the Trump Campaign, calling it a failed reset with rush. I never thought i would say, doctor oz and a president ial candidate in the same sentence but were talking about his program and donald trump who was in new york, taping the program that will air tomorrow. What did he release . What did he tell doctor oz . Its unclear what he told doctor oz, but what we reported on, and my colleague, and spoke to a few people, who were at the taping, that was he talked about his weight, how he would like to lose some pounds, and he is 6 3, and hes 236. Other people say, he said 267. His b. M. I. Would be almost obese, overwailgt, and, according to c. D. C. , body mass index. Might not be the most reliable indicator of health. But donald trump said other things, according to other reports as well, where he would talk about his main exercise is moving his hands while he is speaking. He didnt seem to say that he had the greatest diet, he said he liked eating fast food because he knows whats in it. There were reports that donald trump was going to release detailed information about his health records. Clearly, thats not the case. That would not be, it still could be the case that theyre going put out some form of health records. Expectations became overblown when it was reported that he would be appearing on the doctor oz show. He said that he was going to be asking him a series of questions while also saying he wasnt going to ask him anything that he didnt to want answer. So, it turned out that donald trump did give him a couple pieces of paper with his medical information. Its unclear everything that they talked b. Well see how it looks on the show tomorrow from the taping today. But, its clear that, the Trump Campaign has been saying theyll put out more detailed medical information. Whether it is the couple pieces of paper, or, its unclear whether that is going to satisfy voters and the media, based on the fact that a lot of people want more information from Hillary Clintons campaign and they are going to be providing that, particularly after the events of last weekend. Let me ask you about the story about the new York Attorney general who was on cbs denying that his investigation, into the foundation is politically motivated. Hes a Hillary Clinton supporter and this is coming eight weeks before the election. It is possible that they are painting it as a political hit job. I think was the word, or something to that effect. Saying that, donald trump, this investigation thing that, donald trump and the foundation did not act in good faith, with their donation to pam bondis campaign that he paid the fine for. This is tit titfortat politicl move that the campaigns can fight over. It minimights the significance of the concerns of both campaigns because theyre looking at individual contributions. Theyre not looking at ap foles apples. But apples to oranges. Nick well let you get back to work but thank you for your time, on what has been a very busy day. Thank you. Cspan continues on the road to the white house. Were going to get things done. Big things, thats who we are. We will have one Great American future, our potential is unlimited. Ahead, live coverage of the debates on cspan, the radio app and cspan. Org. Monday, is the first president ial debate. Tuesday, october 4, vicepresident s pence, and, tim kaine debate, in virginia. And on sunday, october 9, washington university, host the second president ial debate, and third and final debate between Hillary Clinton and donald trump, taking place at the university of nevada, live coverage of the debates cspan, listen live on the free cspan app. Road to the white house coverage continues with president ial nominee gary johnson. He spoke to the Detroit Economic Club about a recent economic conference in which he failed to answer a question. This is about an hour. Now folks, it is my pleasure, to introduce our guest speaker, and our moderator. The honorable gary johnson was elected governor of new next co in 1994 as republican in an overwhelming Democratic State and reelected to a second term four years later. Despite his two terms, he still prefers to call himself an entra per 4. He started a doortodoor happen r handyman business. It was one of the Largest Construction Companies in new mexico with more than 1,000 employees. I would call that. As a businessman he ran for governor, and his passion, for helping people. Although he considers himself to be libertarian, he has believed that good Public Policy should be based on practical cost benefit analysis rather than just strict ideology. He is best known for ressisting the temptation to solve every problem with government. He also cut taxes, 14 times, without ever raising them. He balanced the states budget and left new mexico with a billion dollar surplus. During his two terms, he improved the schools, and executed a major infrastructure overhaul. In the president ial election, he participated in the Republican Party primary as a avid skier, ironman and biker, he has scaled the highest peak on each of the 7 constiments, including mount everest. Please join me in welcome mooring the hon nant gary johnson. [applause] okay. Shabazz, if you live in indiana, you know this man from t. V. He is Award Winning political writer, and he has been covering and writing about state and local government, in indians o indiana i was basically a crime reporter. He hosts the talk show, and writes opinions for the star, and, recorder, and the state house file. Com. Hes ap frequent panel list to channel 6, this week, and inside indiana business. He is editor and publish sher of indy palm will a particulars. Org, as one of the best political blogs in the nation. You are a busy man. Hes an attorney, and holds teaching positions at the university of indianapolis, and, ivey Tech Community college. Please join me in welcome mooring shabazz. [applause] thank you. With that, take it away. All right. First of all, i want to extend a thank you to you folks here, for having me up here to play moderator. Just to want let you know i was in west. Lafayette, last night ad this morning was get up at 5 00 to make it here. And i can tell you, getting home at 5 00 was much more fun than getting up. It is our pleasure to be here and as the governor will tell you, you can ask him anything, and everything, because hes that kind of person. Heres the first question, and this came up, in the car this morning. The last two times we add president s whose last name was johnson, one got impeached and the other got us into vietnam. Well, lets start with the impeach meant side. I have done a couple of things in my life or believe in several things, but one of them, is if you tell the truth you dont have to remember anything. Another is, the unforgivable, is saying one thing and doing another. I many 23409 a hip crit. And then, with with regard to Lyndon Johnson and getting involve in vietnam, i do fault johnson for escalating the vietnam war. My first vote for president was mcgovern against nixon because of the vietnam war. I dont think that we should involve ourselves, in supporting regime change. I cannot think of one example where that has worked out positively. Lets start with the big issue thats on the minds of lots of folks, jobs and the economy. I did a little bit of research, in michigan, the latest unemploy meant figures show 4. 5 . And detroit it 9. 1, what can or what should the role of the president be in job creation . When i ran in the 2012 cycle, rick perry was beating his chest over the fact that he had created more jobs in texas than anybody else running for president. They did an analysis and it was me. My response was, it was the same as when i was governor, i did not create one single job. Private sector creates t. Government does not. But what i did do, and would do as president , is create certainty, certainty, that taxes were only going to go down, and rules and regulations were only going to get better from a common sense standpoint, and i did run State Government. I will run federal government. I will appoint everyone, to head these agencies. Rules and regulations will not get any worse. Theyll get better. Taxes ill sign onto any proposal that simplifies taxes or any proposal that reduces taxes. Over an eightyear periods as governor, non not one penny of tax went up. So given that kind of certainty, it would be wonderful to sign onto reduction in taxes, but in an environment of uncertainty, i suggest business does have confidence and jobs do grow. How do we restore, the date at that time shows the economy is turning around. A lot of americans dont people t. They dont people like theyre making more money, and how do you make that connection with the American Voter . Having been governor of new mexico and running for president , i do think that capitalism is alive and well. I do believe that pay to play exists and thats when government picks winners and losers and i will tell you, having been governor of new 34ebgs co, you can bring an end to that. I add supporter after i left office talking about pay to play and i said, jerry, i didnt do any of that. And he goes, gary i know that, we all know that. Its never happened before r before and it will never happen again. I will tell you that Good Government is easy. It is easy to bring that to an end. And what i think people are really looking for, is equal opportunity. It is a system that is game and i believe that. I believe that overnight with whom you elect you can bring that to an end. The issue of trade and trade deals. Nafta, or the transpacific partnership. Are you a free trader . What is your position . Well, im free trade. That would mean no tariffs. Of course, donald trump is talking about a 35 tariff on imported goods. That number is 1. 4 . Who is going to pay for the 35 . I make the pledge that as president of the United States im going sign onto anything that makes things better. Nothing is perfect. I would sign sign the tpp. We are all about hightech, high wage jobs and it would do that. What about the criticism, that those deals that undermine american manufacture mooring and going overseas and brings them back here to america. Do we need renegotiate what we have . Pledge to you, as president of the United States, and i love this aspect, of being governor, i immersed myself in these issues, from the standpoint of making things better. A analysis of everything that came on my desk, will this make things better . Now, saying that, i may have vetoed more legislation than the other 49 governors. I vetoed 750 bills. Only two were overturned. I took line item veto to a new artform. I saw a lot of legislation, that benefited those that had money and influence and giving them more. I saw a lot of legislation that was spending money that wairnlts going to have any impact whatsoever on the issue itself. I was also transparent, writing veto messages and going before the people and explaining my side. I just think that its sitting in a state that was 21 democrat, me beingal andly conservative that i got reelected the second time than the first time. I think it speaks volumes to the fact that people appreciate good stewardship of tax dollars. We are in michigan, in the motor city, 9 automobile bailout, back in the last decade, would you have supported it . Free trade. Thats about letting the market. No i would not have bailed it out. I would not have bailed out wall street. Im not doing this in a vacuum. Jeff is my economics adviser and staff, no one, on that staff believes that there would have been a financial failure were we to have not bailed out wall street. They made hor ran choices. They should have been rewarded, by having gone bankrupt. We do have a mechanism for restructuring and it is bankruptcy. I dont think michigan would have died. But i think that government interjecting itself in business does pick winners and losers. The other big issue, immigration. What is your position . Do you support path to citizenship . Round up 11 Million People . Build a wall . Will well, i think that we should embrace immigration. Were a country of immigrants. Wharton school of business thats Donald Trumps alma mater came out with an analysis restricting immigration. It will have a negative impact on our economy. Allowing for more high skill workers would have a minimal positive impact on this country, increasing immigration, very positive on the economy. 11 million undocumented workers, i have to tell you, thats grounded or the deportation, thats grounded in untrue. These are hardworking people who have come across 9 border, undocumented because the United States has made it impossible for them to get a work visa. Make it easy for anybody that wants to work, to be able to get a work visa, it should entail a background check and a Social Security card. Building a fence, is just crazy. They are taking jobs that u. S. Citizens dont want. Theyre the cream of the crop when it comes to workers, and if you talk about the deportation of 11 million undocumented workers in, new mexico, where 50 is hispanic, thats a doortodoor taking people out of their homes, that they have owned. 20, 30 years ago, it was not the issue that it is today. It was because you could not gate work visa, you came over and bought at house and your kids have had kids and now were going deport leading citizens, in new mexico, theme be deported back to mexico. Its wrong. Do we do citizenship or green status . For the 11 million that are here make it as easy as possible for them to get a work visa. As long as they have been law abiding. Comprehensive reform needs to lay out pathway to citizenship. No undocumented worker should be able to jump the line but we need to establish citizenship. If you look at our medicare, Social Security, our economy, house mooring i think we are we benefit by increasing immigration. Another issue, i was listening to the news program, donald trump is scheduled to make a visit to flint, michigan. The mayor, and the two senators, held a news conference, to bring attention to the crisis. Is that a situation that the government should be involved in . It is as situation that the government should be involved in. They have a responsibility to protect us. In this case, pollution. I support the epa. When the whole flint thing broke, as governor of new mexico i add program that no one else had in the countrydy it for eight years. I add program called open door of a 4, where anyone could come and see me on the 3rd thursday of every month, starting at 4 00 in the afternoon until 10 00, at night. Flint, michigan would have come to me, at open door after four, if other avenues would have failed. If i would not have done something at that first meeting, the second meeting, everybody would have been in that will meeting, and i would have been in the middle of that. I dont want to point fingers. I dont know what happened in michigan other than this really is a failure of government, and the inability it communion indicate. And as president of the United States im going to have an open door of a 4 policy as president of the United States, theres some logistics, but its a way to stay connected and it was one of the most valuable things that i did. Where do you find na medium between overregulation versus held and safety concerns . Thats what i love about the job. That line there, what is overregulation . What is just nuts . Where is common sense . I come back to open door of a 4, the states closed, an underpass in northern new mexico saying big trucks could not fit under the under pass causing trucks to have a 6hour detour. Trucker comes in and says, they have closed t. Well they closed it because your truck wont fit. I have driven my truck 6 million miles, and i go underneath that bridge at 70milesperhour. Theres nothing wrong. Ill get that bridge opened up tomorrow. I called the secretary of that department, he laughed and he said that bridge, trucks dont fit yes they do and we opened it up. My point is, government does go awry. There should be mechanisms to differentiate between what is good and what is capri husband is behavior by bureaucrats. But it should be, that vigilance. Good government was easy. National security and foreign policy, this past sunday we just marked 9 11. Since then we have been involved in iraq and afghanistan. What is your position on the war against terrorism. After 9 11, i supported going into afghanistan. We were attacked and we attack back. Al qaeda,but after being in afghanistan for 7 months we wiped out al qaeda. We didnt get bin laden, but we should have gotten out of there, and left our options open. I believe we should get out of afghanistan tomorrow, and for all of the horrible consequences, which i believe can be mitigated, is anyone here kidding themselves that those same circumstance, wont exist 20 years from now . When it came to iraq that was regime change. That was going in, supporting regime change. At that time i said, look, we have the lets not do this. We have the military surveillance capability to see what somebody is having for lunch. We will be able to see them and roll out any weapons of ms. Destruction and have all sorts of options. I do believe going into iraq, has resulted in this syriann civil war, and, isis, that it was the henchmen that fled, to rock ka. Were a support the kurds against isis. But the kurds are side way wes turkey, who is our ally but not such a good ali since we inrate ised iraq. You cant make this up. But when we support regime change, libya, syria, iraq, we supported the free syriann army against as sad, and this happened in allen aleppo. We supported the the Free Syrian Army against as sawed administration. Bush was paying assad to fight them. And arms end up in the islamists hands. You cant make this you up. Aleppo. You got a little bit of flack, during an interview. 90 of the public, has probably no idea where aleppo is, and, they arent running for president. Did that hurt your campaign . Was i expecting a aleppo doe, in this campaign with 100 certainty . I was expect mooring aleppo day. Im expecting at least one more aleppo day, and however many there are, it is what it is. 90 of americans arent running for president. I should have known that. Theres no excuse for having spaced on aleppo, thinking it was an act crow film. Such is life. Its indicative of all of our lives. We all have mistakes. Its how we deal with mistakes. Everyday, every one of us are confront we had adversity, we can crawl up . A ball and give up or, you know, smile on your face this is the way it goes and keep on, im smile on your face and keep on. The culture, american politics. Weve always had brash discourse, lately it is more brash. Theres a school, that attributes this to social media, and so much news choice thats individuals go to the news source, that justifies their world and does not try to get outside of those silos. What do you do . What can youwhat can you do n those silos so we can have more civil discourse. 3, that is sales pitch, three things for the upcoming election. The third thing, myself and bill, we are the only Third Party Candidates in all 50 states. So you elect trump or clinton, is the polarrighty going to get any better . Does anybody believe theyre going to get along when all they want to do is kill each other . No way. Nobody believes that. Third, bill and gary johnson, former governors, right down the middle. Fiscally conservative. Socially inclusive, skeptical when it comes to military intervention. Free traders, hiring democrats, republicans, everybody, standing back and calling out both sides to come to the table to deal with the issues of the day. Being able to side with both sides on individual issues, being able to come together, in a big way. I think that third scenario is the only one that has possibilities. Hillary clinton and donald trump have never high disapproval ratings. 50s, and trump, 64 . With that said, why are you having a hard time crack that go 15 for the debates. My name has never appeared on the top line of any president ial poll. Not one national poll. If mickey mouse were on the top line of a national poll, he would be at 30 because he is a known commodity. But hes not on the ballot. So, 70 of america doesnt know that i exist. Unique today, 50 of americans, that are going to register to vote are registering as independents, where is that represent recent station . It is bill wells and myself. Right down the middle on all of this stuff. What do you say to this individual, in the audience, listen mooring. Brien listen mooring and hes with me, i get it. But you know, third party, i dont know. I feel like, i cant win. Well, what do you tell that individual . Thats key to all of this, you might be able to win. To win, and we still believe that were going to run the table on this. We have to be in the president ial debates. Expected to garner more viewership than the super bowl. Well you cant be there if you are not at 15 . And you cant be at 15 if youre not on the top line of these polls and 100 of the media starts off by reporting the top line. 70 of america does not know we are in this race. So what do i say to those that say, thats a wasted vote . Thats voting for something you dont believe n. Nothing will change. They have become so polarizing. They have done this to themselves. Marijuana, what do you think . You knew it was going to come up. Well, we should, in 1999 i was the highest elected official, in the United States to call for the legalization highest as in elected not on something. [laughter] [applause] just to want make sure. [laughter] ive been wait forget three days to say use that line. [laughter] you were saying . Tens of millions of americans are convicted felons, that but for our drug laws would be tax paying citizens. We have the highest incarceration rate, of any country in the world and i refuse to believe we are any less law abiding, and that has its roots in the drug war. I believe that we are going legalize marijuana and when we do that, this country will take a leap of understanding when it comes to other drugs, and recognize that the drug issue is a Health Problem as opposed to a criminal justice problem. Let me say, indulging in any sort of marijuana, alcohol, any substance, becoming impaired, getting behind the wheel of a car thats always going to be illegal. Government has to play a role in that. When it comes to the legalization of marijuana that will ab state issue. Just like chovment there are still counties, where there are dry counties. But as president of the United States i would de schedule marijuana as a class 1 narcotic allowing the research to go along with it, that needs to occur. Impairment needs to be established. Something that does not exist, and, the banking issues that exist in now half the states that have legal medical marijuana and four recreational and dc, would resolve those banking issues. Were coming down to the last five minutes up here, so if you have questions that you would like to ask, feel free start texting those. Weve had questions and concerns about the health of our elected officials. Mrs. Clinton, and, donald trump was supposed to go on doctor oz, today. Thats now changed to a conversation about medical health. With the fact that everybody running for president is over 60, and we get more health issues. How are you feeling . [laughter] if im not elected president of the United States, i will be skiing 120 days this upcoming season, because i built my dream home north, because the skiing is good. And then next june im planning to ride the divide, a 3,000 mile race. Thats my plan next june. I many going to have a physical tomorrow because of this issue and, i may be its not such a high bar. But, and i hate to be, i hate to embellish, but, i will be the fittest president of the United States ever. [laughter] [applause] were almost done with our conversation, before we get questions, which you can text. When you look around at america, today, what would you say is our final question, our greatest challenge, and greatest opportunity . I dont think life in this country has ever been better . Ever. We get along with one another, better than ever. We communicate better than ever. Our kids are smarter than ever. We have issues. All lives matter. Okay . But, black lives matter, and heres why. Blacks are getting shot at the rate of 6 times that of whites. If you are of on lore, four times youll nd end up behind bars f. You are white you are not taken out of your car, and roughed up, like those of color, and roughed up to, where, as a white person if i were subject to that same treatment i would have the cuffs on me. So we do have discrime nation. Weve had our heads in the sand. I pose to you myself, i have had my head in the sand. But we will come to grips with this. Fatter, and more accurately and put things in place as president of the United States i will be in control of the department of the justice, having appointed the head of the department of justice and threads can be looked at, best and worst, and so that we can overcome the problems that were facing. But this is america, today. That is wonderful place. We all know that. We all know it. Ladies and gentlemen, mr. Gary johnson. Many. [applause] we had several different questions on taxes. So, we add student ask what are your views on simpliif a indication of our tax policy . Several people wanting to know how do you lower the budget and provide more services . Robust military . With certainty, taxes will not go up under a johnson presidency. And i say that, with regard to bill wells. Not one penny, not one penny. Cut taxes 14 times. Bill, furloughed 8,000 state employees, the first day, and he was a republican that served in a states that 41 democrat. So, government will get smaller, and taxes simplified and lowered. In that kind of environment, that creates confidence, i think, the economy grows with that. Reducing spending is so important. Look, bill wells and i are pledging to submit a balanced budget to congress, an item breath in 100 days. Whats the significance of that . It is for those kids that i talk to first in this morning. My generation is going to get healthcare and retirement and theyll have to pay this. No, and to do nothing when it comes to medicaid and medicare, and, they need to be done to reduce or make them sound, in the case of Social Security. Military, our pledge, and invisible national defense. But that doesnt mean that the Defense Department isnt 20 overblown. The pentagon itself, in the mid90s, requisitioned the commission, the b. R. A. C. Commission that 25 more u. S. Bases could be closed, but there was not political will to accomplish it. I will bring that will to make this happen. This job is about doing whats right. What needs to be done. And thats why im seek tsmght i really, from a personal standpoint there was nothing more stimulating than being at the very heart of all these issues, and will it make things better . In this case, better, we are headed to a fiscal cliff. Bankruptcy, whatever you want to call it. Well print money to cover the deficit. At some point it is going to have inflation. Thank you. One of the questions that was most popular, is all about the Affordable Care act. And if elected to office what would be your approach . Thats another one of those acts, i do agree with chief justice ronltds, that it is as tax. My Health Insurance premiums have quadrupled. I have not been to see a doctor for three years. But well sign legislation that makes healthcare more affordable and legislation that makes it better. Well, what are the component thats would make it better . It would be opening upheld care to the free market. Healthcare is as far removed from the free market as it can be current limit but if you add free market economy, when it came to healthcare, none would have Health Insurance to cover ourselves. We would have insurance to cover ourselves for injury, and illness, and we would pay as you go, in a system, would cost about one fifth of what it costs. We would have xrays. And pricing with outcomes. We go to the doctor, we we haveo idea what it is going cost and when we get the bill you know that nobody is paying that. Thats what we have today, if we could have a free market approach we would address health from the start as opposed to poor healthcare. Diet and exercise. Lifestyle would be such a huge component on the frontend. But it should be market driven, should be free market driven. [applause] they announced its top employees are banned from contributed to go political campaigns. What would you do, to stop corporations from contributing to the erosion of our liberties. I think the reform thats needed when it comes to campaign finance, number one, there should be Unlimited Campaign contribution. But, there should be 100 transparency. Something that does not exist today. Limiting campaign droon boosting is its a protection, the number 1 factor when it comes to vote mooring is name familiarity, and if you have held an office you have an upper hand over anybody else. The super packs today. Zero transparency. Make it Unlimited Campaign contribution but 100 transparent. I would sign it, that they would have to wear nascar jackets and have logos, comment surratt with the size of the contribution from gm, cocoa cola. Google, whatever. [laughter] in light of, this is a student question, in light of the resep shootings in orlando and san bernardino, what would do you . Well, first of all, what do you do to stop domestic shootings . We should, and i support second amendment. That said we should be open to a discussion on how we keep guns out of the hands of the mentally ill and be open to a discussion and a debate how you keep guns out of the hands of would be terrorists. As president of the United States i would love to know what transpired between the f. B. I. And the orlando, when it worked up to a certain point. I bet the f. B. I. Has some good ideas. Bill wells has said that we should instigate a task force to take these calls in, and start to develop program, but a strategy for how to deal with would be terrorists, which makes a lot of sense. Now well switch to education. In your opinion, what are some keys to restoring Educational Excellence . And also, your campaign wants to reform education. So, would School Vouchers be a part of that . As governor of new mexico i was the most outspoken governor regarding school choice. I made a pledge, as the governor, that i would increase educational funding as a percentage of the budget for yeech year i was in office anddy that. What i did, i put more money into education, which gave me the freedom to say, what i said, in new mexico, which is we need to bring competition to public education. So for six years in new mexico i proposed a fullblown voucher system that would have brought competition to public education. I do believe that education should be a state issue, period. I do believe. [applause] if we had 50 labs of innovation and best practice, that we would have fabulous success, that would get emulated by overstates. As president of the United States, as what should the federal role be in education . I propose apololishing the federal department of education. Michigan gives washington 13 cents and then michigan gets back 11 cents. How do you like that . And then washington says to get your 11 cents you have to do, a, b, krrks, did and it costs them 157 cents to get the 11 cents. Why not leave the 6 cents in michigans hands and allow michigan to compete with every overstate where we would really have best practice im going to predict that best practice will be bringing competition to public education. The model of the future, is the kaun academy. Its free. And many of you, are familiar with that. I think many think it was established under George Washington when the department of education was established under jimmy carter. And has there been anything added since its been in exist tins . I dont think so. [applause] we have two quick questions, what impact will millennials have on this election and what is your plan to attract millennials . Well, im leading in millennials, 1824, second place, 1836. And probably some cringing hair, whatever you define, 1834. I think that the things that im saying not only attract millennials but it encompass what 60 believe. Thats my opinion and, i think that if i were allowed on the debate stage, i think my name familiarity would go from 30 to 100 and that would both well for becoming the next president of the United States. But, with regard to millennials, were leading in that 1824 age group. I would also like to point out, there was a poll, that have been two polls down by, on active military personnel, and who may favor to be president of the United States, and im the overwhelming choice to be the next commanderinchief. [applause] so, last question. You are frequently photographed playing cles while on the campaign trail. Who would you say is the superior player . [laughter] so, when note for. [laughter] then we played game number 2 00 a. M. And he said i underestimated you and i will not let that happen again. He said this in front of National Media and is repeating this. I am again so game number three is looking grand gram. Thanks for travelling to our city. Thanks for coming to detroit. [applause] of course, ladies and gentlemen, the meeting is adjourned. [applause] [inaudible conversations] [inaudible conversations] [inaudible conversations] , to order that injection we can go into recess at any time we have an important hearing today and the Affordable Care act premium increases it is a concern to most americans about uh cost of health care. Under the Affordable Care act Health Insurance premiums are soaring this one says millions cannot afford Health Insurance. One but then these headlines are not from today. From this week or even this year before it was passed the Affordable Care act. That will not come as a surprise to anyone for how horrible the individual Insurance Market was before Congress Passed the Affordable Care act. Insurance Companies Used to be able to discriminate against women. They could charge more for those with preexisting conditions. Cancer or exclusions or caps on coverage or terminate policies when people got sick and deny coverage altogether. People who were lucky enough to get insurance for never premiums they decided to charge. These premiums were increasing by double digits every year. Before we passed the Affordable Care act the Insurance Market was a complete mess but today is to examine recent increases in healthinsurance premiums. Republicans love the fact even though it has improved the health care of our constituents. There is one critical fact that they do not want you to know. Premium increases have then lower in the cbo when Congress Passed the Affordable Care act. They are lower than we anticipated and could they estimated premiums are between 12 and 20 higher than they are today. Here is another key factor. Been National Health care spending has slowed even more than one repass the Affordable Care act. Spending across medicare, medicaid and private Insurance Market. National Health Care Spending 2014 through 2019 will be 2. 6 trillion last less than cns as we pass the Affordable Care act. For 20 million americans. With more comprehensive coverage is is now the results of the lowest and injured rate unfortunately my colleagues will not talk about these facts. This is the rest of the story. And without Offering Solutions of their own. From day one republicans have been focused to undermine the allotted it has taken every single opportunity to sabotage by any means necessary. And try to defund and voted 60 times to repeal or weaken. If we want to talk about the premium increases we also need to talk about Drug Companies that are jacking up the prices of their drugs and now want our witnesses to talk about that. Those Drug Companies that are jacking up prices have a set of fact premiums . With the skyrocketing Prescription Drug prices. That is acrosstheboard and for that reason i am pleased twofold a hearing over the increases and we have all requested dash hearing and i do appreciate mr. Chairman to work with us to get the documents that we will be getting. What we be clear i have told my staff Prescription Drug price prices in the unconscionable raising of those prices is one of my top three priorities in this congress. And the reason why is because it is not fair like putting a gun to a sick person head to say pay or go into bankruptcy or pay or get sicker or pay or die. So we cannot even have this discussion unless we address that i hope he provides testimony this time and thanks again and i yield back. Im not sure farmer boy is coming back but i appreciate your passion. We will hold of recon record to submit a written statement. I will provide the chief operating officer at hhs. The commissioner of that administration speaking of behalf of the National Association of insurance commissioners. We have that principle one speaking on behalf of the Health Insurance plan and partner and head of the actuarial house practice speaking on behalf of Blue Cross Blue Shield. And the Vice President of Health Policy at the center for american progress. Thanks for being here. So please rise and raise your right hand. Use solidly swear or affirm your testimony is the truth the whole truth and nothing but the truth . Thankyou you may be seated let the record reflect the inserted the affirmative. Please limit your oral testimony to no more than five minutes. Your written record is part of the record and a recognized for five minutes pdf. Members of the committee thinks for the continuing work to provide consumers with Affordable Access highway coverage in has made our health says system the security that comes from knowing they will have access to Health Coverage when they needed at the same time dash shift that serves all consumers regardless of their history is for all of us to Work Together to build and test new businesses to provide the care people needed. We are making historic gains as 20 more of million americans with those uninsured rates for american is the lowest on record. It is lower than originally projected with 25 percent less than the original estimate. But we do expect 2017 to be a transition year. Because previously operated no one knew how much it would cost everyone so as a result some initially priced below the cost and now we need to catch up. As evidence independent experts are between 12 dash 20 lower. Sundown the Stabilization Program and more people getting care and data shows the futures and the marketplace is strong and to participate in the opportunity. We know that premium increases have reallife consequences. Builtin protections for consumers and provide tax credits and consumers are always protected. And majority can access coverage for less than 75 per month. And those who remain doc primary regulators to help support their efforts for the rate to preview provision to make sure it is evaluated by experts. Is important to remember 150 americans pet premium growth in has slowed or the slowest growth rate on record since passed health care rates have risen at the slowest in 150 years but more needs to be done. And with the Health Care Costs with the benefit of the taxpayers and consumers. And whether they get at coverage by rewarding Health Care Providers with the quality not the quantity that they deliver. With the market place serving as a laboratory to help build a Better Health care system. Theyre succeeding and is paying off for the marketplace as a whole. And the market actually fell slightly by 21 percent which is a positive sign for Long Term Health one. States that saw above average growth of a moment to show that growth leads to a broader and healthier risk pool to bring down costs. Making the market place even more attractive over the past several months we made improvements to the Risk Adjustment Program to help issuers account and reaching out to the marketplace to medicaid coverage or many other actions we have taken. And those others and they have responded. But with the health care of america to continue to have access to quality affordable Health Coverage. Thankyou sinecure now recognize for five minutes to make mr. Chairman and Ranking Member and members of the committee i am the appointed commissioner of the trusted ministrations to be here to represent the National Association of the insurance commissioners. With the Short Historical review of the Insurance Market that will add context to our discussion regarding rate changes january of next year. Of the early 80s and 90s the Health Insurance market had conditions discussed during the debates of the Affordable Care act. 1993 the assembly passed a Small Group Insurance reform which included provisions similar to those contained in that aca including guaranteed issue, standard benefit plan and adjusted community rate. And those created disruptions to the up market as that a vault into a competitive market with a single digit premium increases. And how that was enacted but eventually that would be equilibrium but unfortunately do it to of variety of factors created by a california has now extended into the fourth tier implementation and corrections are long over due. And concerned about the individual market to cite substantial losses in the individual markets and some have closed their doors that means thousands of consumers will need to be enrolled in a new health plan from a different carrier by december 15 or not have coverage on january 1st theres only one offering individual coverage and there would be one or two without any plans at all on the exchange and they are only offering the hmos style benefits within very narrow Provider Network from the individual market that dramatically reduces the coverage Corporate Options and increases the of pricing. Also the individual market carriers are requesting premium increases for more than 50 i and my colleagues take very responsibility under state law that all rates are justified nondiscriminatory or sufficient to ensure solvency with the proposed rate increases are thoroughly reviewed them more transparent than ever. We had to public rate hearings but those individual markets for too many consumers and they want to know why. Rising Health Care Costs remain the driving force behind the premiums and must be addressed if coverage will ever be truly affordable for the of broadest possible group of policyholders. Another result is the implementation of uncertainty. As any actuary and with regulations which young girl healthier consumers so that their risk pools are sicker with the uncertainty of medicaids dash the medicated use with those enrollment periods to contribute to adverse selection. So the of risk before a the market deteriorates. As far as funding carriers receiving less one the court or pavement have higher than expected risk adjustment bills and receiving payments and to seek precedence over policy holders we will see more carriers fail as regulators are forced to step in sooner to preserve those dollars with the benefit of policy holders i will afford to any questions that you may have. Thank you for the opportunity to testify on the premium rate increase in the non group Health Insurance market i am not principle in the firm of consulting testifying on behalf of the americas Health Insurance plan American Trade Association with the millions of americans across the country and with those policy options to make them more affordable in the longterm. And what existed prior to 2014 allowed for a broad increase of the individuals of Health Insurance to significantly you reduce the population as health plan actuaries had limited information in the likely of the exchange of the last market and developed by actuaries that our consistent with 2014 with that Data Available for the price and it follows a similar pattern the wide range of rate increases the average increase for the Second Lowest plan was seven and a half percent consistent with underlying medical trends but to put it simply Health Insurance is the reflection of Health Care Delivery it is the primary driver of a the and more specifically the premium calculations for 2017 include the medical trend the composition the expiration to out of three premiums Stabilization Programs and the special enrollment programs. As discussed earlier it is relatively unknown. And in general the composition of the risk pool and another significant factor with the transitional reentrant program to force insurance across there premiums and has not worked as designed with upward pressure on premium rates. In those enclaves cost 24 higher during the first three months of employment in all Health Insurance to idealize their cost it continues to be a market in transition. To make them more affordable and of long term to redress the factors that are driving the Health Care Costs per, written testimony shows several opportunities for legislative action to provide relief from rising Health Care Costs in the market. Put the Risk Adjustment Programs with the verification of a special annulment comedies changes and others with more changes in the of marketplace. And thank you for that opportunity of accord to answer any questions. 84 allowing me to be with you with their rising premiums would be Affordable Care act on behalf of Blue Cross Blue Shield the National Federation of independent communitybased and locally operated lacrosse Blue Shield Companies to more than 107 million members with an 85 year history to provide coverage of local communities across the United States. We face extraordinary challenges which i described in my written testimony. 2017 and be the first that we reset the premiums and the market based on a thorough understanding on the health of that market and insurers have come to understand that they are older and sicker than they initially assumed and send the report that they found the prevalence of hiv is four times higher and hepatitis c is twice as high than n the Employer Group of market. Hospital admissions are 40 higher and out of cost pocket is 22 higher. But that situation persist today in order to create a marketplace individuals will need to that value equation congress ended ministration could improve the verification of those provisions to make other changes and with the premium tax credit to encourage healthier people to enroll. Afford to the discussion. You are recognized for five minutes. While evaluating the markets context is important. Individual market was all a tile and people did not have much choice. The difference is this market did not work for anyone who was sec even as they put in place Consumer Protections the average gift mart premium was 10 percent lower than the average premium in 2013 the rate of the uninsured is that a historic low giving more peace of mind that of an additional 21 million americans. Contrary to popular perception it is stable and to improving the cost per enrollee fell by point 1 . So this takes the question why are they increasing premiums substantially . When the new markets launched in 2014 they underpriced the premiums there was so of lot of uncertainty in some underprice the premiums to establish a foothold and as a result the average premium came in 15 percent lower than the cbo had projected. Congress also constrained the Risk Corridor Program which was designed specifically to address pricing in the newmarket congress did so after insurers have already priced their plans 2015 and 2016 resulting shortfall is responsible for about twothirds of the financial losses incurred by insurers in 2014 premium increases were not sufficient to close the gap and, pounding the of problem reinsurance began to phase out. It is not surprising that markets are due for a correction and 2017 although it will be significant the structure will act as a stabilizing force. Premiums will still be 11 lower than the average premiums would have been of the Affordable Care act. Even the markets are not in crisis policymakers should take additional actions to a celebrate accelerate the equilibrium. Tomb productively as possible and to my written testimony airconditioned or Consumer Protections the second demonstration shin prohibited providers from Medicare Medicaid through the changes in the states should establish their own reInsurance Programs in job offers states the federal savings result from war premium tax credits to pay for the reinsurance. And should expand the reach iran areas over the larger geographical areas with the nature of urban and rural areas to provide greater choice. They should require all plans to be sold through the change that they are only outside the exchange to help broaden the risk pool of other insurers. With the Medicaid Programs the market premiums and to use active purchasing to get the best deal for all programs. From the participation of medicaid or Medicare Advantage should be able to participate. Number eight having guaranteed choice plan and less partisan times in the medicare Prescription Drug program. And to attack call bohai cost of specialty drugs. That is one of the biggest factor cited by large insurers and of the middle income people and to act in a constructive spirit as well as cut and run or root for failure. I will go to the gentleman from michigan for a series of questions but i would like to comment as thought remarks to defy the reality i look forward to robust questioning to see if you can back at that. I think that this started with dr. to defy credibility. I know positions have been taken and i am expecting a total end of land of bosnia not in kansas with the Detroit Free Press health plan solana Michigan Insurance exchange a 17point 3 with the medicare expansion stay. That means a financial therefore tax payers and general and those that get the Health Insurance from the website 2. 0 of the 14 insurers of the individual market plans they includes include the increase with across blue shield of michigan 16. 8 by Health Alliance and by havana the Health Analysis of 2017 rate increase for those individual plans found the average silver planned the second cheapest plan would rise 11 2017. And i appreciate the hearing today to get away from simply selling something this failed to years ahead of time but i dont have health care. And then found out my out of pocket expenses preakness me from caring for my health. Now i have that often shoulder. What impact as the rate filing process had impact on premiums . And certainly the premium increases requested are higher than anybody would like to cnn from that perspective we was like to be able to justify the rates with the reagan the tory process puts a barrier and twoseat exactly and as for as far as limiting the choice of the marketplace i cannot speak directly to any specific plan but it does make it more difficult to make sure they maintained there solvency to get the rate increase that is necessary the law around the country is pacific that requires us to approve or disapprove rates to make sure that they are adequate and to protect solvency and so what happens the of beginning of may to with the press perceived rate increases from the carriers of the actuarial data some use outside consultants to scrub the data to challenge the data and those projections of the carriers we had separate increases were different stakeholders or consumer groups at the end of the day become now with the final rates in maryland is an example. Look at the aggregate into approved aggregate rates 24. 5 million less. And two agreed so the end result is we are required to approve adequate rates. So the problems some carriers had is they cannot get the rates they believe are sufficient to operate their business. We have to collect revenues to pay the of claims of the administrative expense and the reserves that government requires. The key is a necessarily the approval process but to get sufficient rates in order to run their organizations. Gentlemen from tennessee five minutes. Welcome to the panel of experts and this is about as exciting as watching paint dry so i will put the cookies on the lower shelf. So none of these echoes that political outrage to my friends on the other side of the ideal try to express. As it was sparsely attended and of testimony was summed up by the witness that concludes in the final paragraph on page seven it has been over six years since be a california was signed into law and was long past due for state and federal policy makers to move past politics to make substantive corrections to above all for the more favorable risk pools and more regulations with the individual healthInsurance Markets. But here we have a committee that has no jurisdiction. We are purely an investigative to translate into pure political theater. And to study the issues so lets be viewed the bidding of the American Enterprise institute the thinktank reported that there still is no substitute republican plan so there is no alternative so there isnt a question if we only did the republican plan. I was a supportive of that and to solve these problems to get down constructive it is much easier to criticize. So as pointed out in her testimony the vast majority are paying less than 75 a month. That is an awesome deal and to translate into to a 3 increase. To spiral insurance policies has happened over four years. And the cost under the aca is less than expected. I will repeat that. For those it did not live merinos of the trends will continue but this is astonishingly good news that we live in a culture. And most folks dont understand what the insurance with the act most of the regulatory patterns and some do a good job to manage this those that have jurisdiction over insurance but the control of health costs is challenging and the big three automakers, of those were the instigators but nobody questions pricing but to point this out that the medical prices in the detroit area are far higher because nobody was questioning the of bills. So moving into the era where people are questioning the bills with coinsurance and that is a good thing so to compare that silver plan we already have more clarity from previous generations. And a Better Benefits package. Some gopac as far as 1993, i guaranteed issue, with those necessary elements of the Insurance Market so there are ways to solve these problems with a bipartisan action. But just one moment also little fairness the chairman was here and the fact that he is not here at this moment does not mean he does not consider this very important. We have been in a lot of hearings but he has a bill bill, a major bill and another committee so want to make sure that is clear to all of us. I think the gentlemen and as we go to the gentlemen from tennessee in 91 to clarify one quick thing youre not outraged do you buy your Health Insurance from healthcare. Gov quick. I may federal employees. Commissioner . No. I have employer coverage xx by your health care from healthcare. Gov but. Employee coverage. No. So perhaps they are not outraged because you dont have to use the system. I will read this portion and she was shocked the cheapest plan with the 4,000 deductible without the pocket expenses that i am still looking for the affordable part so Blue Cross Blue Shield of 62 is up 62 after going 39 last year and they pay for nothing where am i supposed to get another 6,000 and also paid at least 6,000 out of pocket for health care. Pdf. And he said that it is four times the original cost of the premium citing the cause for the increase and a 61 yearold from knox bill pays 761 a month now which was nearly a 60 over the prior premium the year before and included a 3,000 network deductible and said this is expensive before the of policy pays out now she is notified that this 62 per cent increase will bring my monthly premium to 1,200 of month to bring it this much out of pocket with the 3,000 deductible the president has promised on many occasions that they would be lower by 2,500. Into sen dash message about his premium increases that in reality i feel we are experiencing is the sellout of the federal government to pass on the issues that we were told were not as simple. With the individual that testified to increase by 4,000. That is what we are hearing in my district and all over tennessee. Per person than any country in the world by far and i sometimes think that the people who foisted this affordable socalled unAffordable Care plan didnt work but then people would demand that we go to the single parent plan and then end up with shortages, over quality of healthcare. I was on the congress to few weeks ago with the newspaper in ireland they had a front page story and said we had 500,000 people on waiting lists for medical care. You multiply that times 70 for the United States and see where we are headed. The chair recognizes the gentleman from michigan for five minutes. In the six years since Congress Passed the aca, we found ourselves in this hearing again and again and its being debated somewhat call it with undermining this historic wal w. Thereve been more than 60 times we voted to repeal and undermine the aca. Theyve cut critical funding and the majority have held a hearing after hearing just like today using the overheated rhetoric and claims that seemed to be exaggerated. Its really tiresome because when i came to this congress, i recognized that the aca wasnt perfect, and im willing to work with the other side of the aisle to make it better but i never get the chance to have that conversation because it is continuous attacks to repeal it. How many have gained quality affordable Insurance Coverage since the aca past. 20 million. 20 Million People have gained Insurance Coverage. The aca also cut the rate in half and its now have a Historical Rate of 6. 1 according to the National Center on health statistics. What was the primary goal . To increase access to quality affordable coverage. Then i would say we are well on our way to reaching that goal. Imagine how much we could accomplish if republicans and democrats would Work Together and stood up against this. I can understand the differences of opinion but its unacceptable to have a stalemate on an issue that is so important to the American Public and if we can sit here today and clearly identify the areas that we should address so that we can make it better, then why dont we do that . Why cant we come together to make this plan back because we have changed 20 Million People in america. We have affected 20 Million People and we have increased the goal we are on our way and we have increased that number and im speaking today the facts are the facts and i will not say that its perfect but i can tell you that it is the foundation for us to build on and we waste time hearing after hearing after hearing where we refuse to come to the table and say lets fix what is wrong with this so thate can continue to make the country competitive with others who are providing healthcare for all of the citizens to make it affordable and with that i yield back my time. The chair recognizes the gentleman from arizona. Before being elected by ownd and operated a practice for more than 25 years so i know a few things about healthcare and how ihealth care and howit works in. One of the reasons i ran for congress was out of the frustration and the way washington was Damaging Health care with obamacare. Now another is heading. Health insurance provider pulled out a growing list of insurers that announced their intention to pull out of arizona due to the heavy losses introduced by the obamacare regulations. This is leaving my constituents without access to any Insurance Marketplace plans. What is leaving zerwas leaving e options what he meant when he told them if you like your plan you can keep your plan . I think you may have seen last week blue cross and blue shield did announce they will be staying in that county. Its to give access by providing thats not what he meant. But all the caramel is a bureaucratic red tape that has left tens of thousands scrambling to find Health Insurance. So the administration seems to know the bill is inherently flawed and unworkable as it was passed. The administration decided to delay the aspects of the wall isnt that correct . We have said as we do with the Medicare Program we want to continue to make improvements. Once again, answer the question. Thank you for answering. How many individual changes have been made to try to make it workable . How many congressional actions . Spin it how many actions have you taken, let me answer it for you, 70. In my first three terms i am out represent over 85 of the geography and arizona. Most of the rural aspects. So i can give you two that have been hurt. You can make statistics say anything you want. Ive got a pretty good background on statistics. I am going to come back to you. If we took this highly regulated industry and streamlines the process and gave money to people for their ability to buy into the marketplace and came up with the industry coming up with a different idea and competitive advantage, do you think that we could actually come up with a industry solution to this problem . Im afraid of that is a little beyond what im prepared to talk about today. Its certainly possible but i cant say with any certainty that the answer is yes. When you are looking at this marketplace we are seeing fewer and fewer options. Is the hole in pending with certain changes come at the changes that are in my written testimony i think the marketplace can continue to improve. A vibrant marketplace has lots of entries and opportunities and options is that true . Are we shrinking in the options and opportunities . We are shrinking in the options and opportunities going into 2017, yes. Im going to make a comment. We made it even worse in healthcare, so my advice ends up being in the emergency room with an injury that we cant figure out. Its going to be three months before she sees her primary care dr. Shes been in the emergency room twice and they wont take an mri because they dont have the authorization. Its pretty incredible that thats what exists today in arizona. Its pretty incredible but that thats what is happening. So in the way care is being applied i think the way the that marketplace and the industry has an opportunity that we can reset im one of the people that has looked at different options outside of that process and ive got to say im pretty sad with what i see folks on the other side of the aisle complaining about. The chair recognizes the gentleman from the District Of Columbia. Thank you mr. Chairman. Its been six years since Congress Passed the Affordable Healthcare act, and the majority has bee been the majority for tt entire time. All they have done is posed to repeal it 60 times. They could have come forward with their own bill. The closest they come is no bill at all. Its a recently unveiled a proposal from speaker over im that he calls a better way. After all of this criticism it does recycle a lot of bad ideas. For example, it rolls back the vital Consumer Protections and if you can imagine this it would allow companies once again to discriminate by charging high premiums based on race and sex and health status. I cannot believe any member of congress would want to go back to those old days. What effect would repealing the Consumer Protections have on those who have gained coverage . It would shift the cost back to consumers and i think the way to think about it is that the goal was to spread the risk broadly and some of the alternatives that have been floated, what they do is quarantine so what they do is repeal the Health Benefits so youre not guaranteed coverage for drugs, Mental Health care which i think we would all agree are essential. And most critically, reduced the value of coverage. One congressman was talking about how constituents have written about the high deductibles so the answer is not to actually reduce the value back to the way that it was before to rely on Health Savings accounts and plans that is going in the wrong direction and it seems to me that there are Obvious Solutions to address that issue. Any large piece of legislation this is a work in progress that has been achieved on its first iteration. You mentioned the cap on outofpocket expenses. Let me ask how important have the tax credit spent in helping people with poor healthcare . 85 of consumers to qualify for some sort of Financial Assistance and we put out an analysis earlier this year that goes statebystate so folks can see even with significant increases that consumers are protected because if premiums to go up the Financial Assistance goes up as well so the majority can purchase a plan for less than 75 a month. Imagine that less than 75. Of the majority of the consumers can protect, can be protected. If it were not for these tax credits they wouldnt be in the market at all and im curious about what insurance is all about spreading the risk, and that is essential to this or any Insurance Program which leads me to the question about the option for turning medicaid into a block grant with these options. Block Grant Program which would say do whatever you want to do or imposing a cap on the benefits that would not keep up with the growth of Health Care Costs. Both of those options would leave states with less funding and take away care from those who can least afford it. Do you think that the changes would have a negative effect on the private Insurance Market . They would roll back the Medicaid Expansion and as i mentioned in my testimony, states that have done Medicaid Expansion, their premiums in the private markets were 7 lower and thats because the population from 12038 of poverty would be in the medicaid risk Pool Institute of the exchange. The time is expired. The majority is showing that it failed on its option. Thank you mr. Chairman. The gentleman from texas. I cant get started without questioning some of the characterization of the speakers and House Republicans. I am not sure where the panelists were the gentle lady from the District Of Columbia has reviewed the detailed plan outlined on the website. I would encourage you to do that at this point im going to go ahead and ask some of my questions. In your testimony you said that the cbo estimate said that we were actually below the estimates for what this plan would cost. How does that jive with everybodys Health Insurance going down 2,500 it seems like you knew the estimates you refer to in your testimony at the time the Affordable Care act was enacted the new they were going to go up. We are talking about two different groups of those i mentioned one ar of the 150 miln americans who get our hope insurance through our employersr employers and if you look at the cost of those premiums its actually been the slowest grow growth. She had to visit the emergency room earlier this year wiped out her savings account. They are challenging for folks which is why they have a limit on outofpocket costs and for folks who have incomes below 250 poverty they have limits and inability. Im required to purchase my insurance on the dc exchange i could see over a thousand dollars a month for these premium increases that we are talking about our double digits i could see as much as a 2,000 per year increase in my premium. That doesnt sound affordable to me either. The important part about the Affordable Care act is now but you know what you are buying it covers the essentia those essenh benefits, Prescription Drug costs and such. I was better off i will tell you that. Im also concerned about the lack of Coverage Options that are available. They are for the 27 rate increases for your company just phenomenally what do you see going happening in those increases for people forced to buy through the exchange please understand the blue cross and Blue Shield Association i am representing is a federation of 36 independently run plans. The strategy and pricing decisions of any specific plan one of the complaints im hearing out of my hometown of Corpus Christi and the areas i represent is if he wanted to buy a plan now in cities like houston, there simply isnt one available. You are stuck with an hmo. You have a gatekeeper before you can get the care. Why are we losing all these choices . A thats one of the problems that we are seeing around the country. In some parts we are seeing folks only having an option of a ppo and other countries and counties they may only have an option of an hmo, so the shrinkage of competition and carriers is a real problem. Thank you. And one last question for you as my time is about to expire. When he asked the question about the intent to move to a singlepayer system, use my old. Is that because he believed that to be true or what is your take on that . Its because we work so collaboratively with the department of insurance and private issuers to provide americans access to affordable coverage through private insurance, so i think my smile was we work so closely with folks in the private sector that i dont see how that intent could be read into what we are doing. It certainly seems to be the end result with premiums going so high and deductibles skyrocketing in the choice is coming down, the American People are incredibly dissatisfied and it seems like if you were to create a system designed to wreck what i would consider to be the best Healthcare System in the world, youve done it. I would say that im out of time. The chair recognizes the gentleman from illinois. Im very concerned about the significant premium increases weve been discussing and especially the ones that are going up in 2017 on the illinois Health Insurance exchange. The premium tax credits will share the vast majority of the 335,000. But as the Chicago Tribune reported recently if it increased by 50 , the premium tax credits would ensure that two thirds of the illinois enrollees could still enroll in plan that cost 100 or less per. I am concerned about the impact on the 84,000 who dont qualify for tax credits and i would like to know what steps we can take to empower them to be smart shoppers in the exchange and what reforms are needed to make sure they protect people from unreasonable hikes. With that i would like to address this idea of the falling healthcare rate increases. Following healthcare rate increases. I understand all states are required to increase 10 or greater with cms. Each state determines whether or not to reject or modify them even though they have to file them with cms. Am i correct in understanding the state review programs are not created equal and some regulators are weak and some are strong . Theres theres a number of states in which we do that process but in the majority of states the department of insurance goes through that process but i agree in terms of the authorities they have. While some states provide relief from the race from the citizens others like illinois we dont have the enabled regulators for these astronomical rate increases. Im hearing the term foul and useuse for the state like illins that they can use them is that correct and can you explain that file and used term a little bit . I think my colleague can probably speak to this in addition but yes depending on what state you are in there are different authorities they can review them but essentially cant change them. Did you have a comment on that . I will not speak to illinois that i will tell you that maryland hasnt followe followee when it comes to Health Insurance that other parts are file and use but just because it is vital an file and use doesnn that we lose our regulatory authority. Can you tell me do we need to change the policies so they can do more to stop these increases to make it unaffordable or what could potentially be done in . If you look across the country i think its what we are seeing in states that do have the ability to do the reviews you are seeing folks look at those rates and make changes to them. I think what we have been talking about for this year there are some onetime upward pressures on those rates, but we have been working very closely with the state department of insurance and when they are working closely with their insurance to make sure that the rates are appropriate. So it is a statebystate issue or anything that can be done at the federal level . Statebystate. Is there any type of coincidence or matching with a states that are more file and use and have less enabled regulators versus the states who for example have misused medicare expansion . So, we have seen that in Medicaid Expansion states the market has seen premium increases that are about 7 less so we are seeing where Medicaid Expansion is having an impact on the marketplace premiums and i could get back to you where i dont have it at my fingertips but there are studies that have shown theyre the states have more engagement on the process and they are able to do some additional work on understanding and justifying those rates. Do you have the public hearings in maryland, how does that work . I discussed this earlier we had the proposed rates that were given to us in the first. We receive all the actuarial documentation and data. We have a team of actuaries that challenge the projections and experience. In maryland this year we have two public hearings and then we ultimately approve those that were about 24. 5 million less than was originally requested that you bring up a great point and that is as it is always the case, the vast majority of the middle class that doesnt have access to medicaid subsidies and they are being hurt by these rates and my concern is that it is the business debt spiral in other words as the rates increasing folks to pay 100 cents on the dollar its going to be the folks that are healthier and younger that are going to choose to leave the market and pay the penalty and the experience will deteriorate further. The chair recognizes the gentleman from florida for five minutes. Congress has imposed limitations on is that correct . And i think that reflects the will of the congress but i was wondering because this memo that was issued on september 9 said about the payments and the prospect of the lawsuits. They are seeking the announced that have not been paid to date as any lawsuit of the department is defending those claims on behalf of the United States however as in all cases. You basically invite a lawsuit. I think as we have set up last yeasaid thatlast year and s year these payments are in obligation of the federal government. Thats not new. There are ongoing lawsuits and they represent us and continue to work through a legal process. Can you say whether anybody with hhs has encouraged the lawsuit settlements . I think doj is the one that would need to answer the questions about the ongoing litigation. If there are people in your department who were encouraging this in conversations with insurers or others, that would be something that would be noteworthy so can you say whether thats happened . The process of litigation has been moving forward and doj is doing their work as they would in any other. That nobody has done anything to try to point in this direction where you would have lawsuit settlements is that what you are saying . As we said last year this is an obligation of the federal government. I understand that it do question his congress hasnt provided that money in the appropriations process obviously you disagree but the question is knowing the congress expressed its intent and refused to provide the funds, can you now try to use the judicial process to get around the prohibition that congress enacted. Can you provide a committe the e with any documentation on your end where people are discussing these lawsuits . Weve been focusing on implementing the wall. But there is no documents that we would get correspondence involving the lawsuits . The lawsuits are handled by the department of justice. For the answer is no. Im not asking about the department of justice. Im asking whether you and anyone in your agency has correspondence about facilitating lawsuits. Can you answer that question . Obviously we are the client. The doj is representing us. Our general counsel does correspond. What about outside actors . Our general counsel is the one that interacts because we are the client. But not outside actors. Just is their interaction between the general accounts or people just basically trying to bring people along to see that the litigation is on the track the administration would like to see. I think its been very public that theyve moved forward. A judge in one of the cases related to one of the first cases moving forward asked for all motions to be submitted by september 23. So everything is evolving on a normal course. We may have to send a request for some of these documents to see that this is transparent. Let me ask you this. The department of health and Human Services do they agree with the department of Justice Office of Legal Counsel which has stated in its analysis of Judgment Funds cannot be used to circumvent a prohibition on the appropriations enacted by congress. I would have to talk to my lawyer. We would like to get an answer on that. Do you know, did your counsel or anyone else come for before the september 9 memo was issued . Our counsel does interact with the department of justice has br the subject of the litigation. Do you know they reviewed the memo . I know they are working towards whatever process is unfolding. Thats not the issue. The issue is this conflicts with a 1998 opinion about whether you can use Judgment Funds in this way and theyve been on the record saying that is illegal and improper and my question to you was that shown to the Justice Department for their advice or consent . I wouldnt be able to speak to that. Is it the position of the general counsel using good Judgment Funds in that matter is appropriate and legal . I would have to have our lawyers get back to you. But the general counsel did approve the memo, do you know if they reviewed it . Im out of time and yield back. The chair recognizes the gentleman from massachusetts for five minutes. Thank you mr. Chairman and the witnesses for helping us with our work. We have this article in the boston globe and it really does explain the problem we are having. We have one subsidized network plan that offers access to the hospital, two of the finest hospitals in the country that do a lot of Important Research for us but the plan that would allow those enrollees to go to the hospitals pumped up their premiums by about 21 so thousands of people are faced with the fact that one of the big fears of the Affordable Care act coming and i want to confess i voted against it for a number of reasons and my opinion and my vote will not change if it were held again today. But we were worried that we might end up with two Healthcare Systems, one for the people they could afford it and then everybody else on the subsidy. They cant get access to the good doctors. That is exactly what is happening here or is threatened. We have one subsidized network and if this goes away and people cant pay that increase, then the doors are locked at two of the finest hospitals in the country and im worried about that. The basic idea behind the Affordable Care act was as it was presented to congress, since we were paying multiples of what other countries were paying in terms of trying to provide health care for their citizens, if we could just squeeze that cost we could use the savings than the cost curve to cover the people who are uninsured, that was the idea but as we have seen coming in as jonathan, i know people use that as a punchline but he is a very smart an man tt testified before the senate and he admitted that it was on Cost Containment. We have strong incentives to get coverage, very low incentives to actually squeeze the cost down and there were several other items in the Affordable Care act that caused me to vote against it. One was an antitrust exemption so in the Senate Version we gave back the antitrust exemption to companies under the Affordable Care act so that they could act in restraint of trade, so that one Insurance Company can cover an entire state and squeeze out competition because theyve got everybody signed up. We allowed that. It was taken out in the house, put back in the senate and that was part of the final bill. The other piece, we eliminated the public option so we were relying on the public option to put out a barebones plan to compete with some of these private plans so that by competition if the state put out a barebones plan at low cost with reliable and providing Adequate Health care, people would buy that and it would be up to the private insurers to compete with that so we eliminated a lot of competition that would have otherwise occurred and then lastly put it in a socalled cadillac tax. So you have these good employee is who sat down with their employees and worked out a plan because healthcare wasnt asked back then so a lot of these Union Employees said rather than take money in our envelope we will take good healthcare which would help their families. Now we turned around after they did that and to those employers and unions we punished them. Now we have postponed back that it has eliminated the antitrust exemption, the cadillac tax, and eliminated the public option, what impact has that had on moving forward backs and we are trying to meet the goal of the Affordable Care act. Thank you for the question. I think if you look at the hospitals in boston that is a unique situation and we shouldnt judge based on reputation alone. I would refer you these are the best doctors in the city its where my wife goes and its a generally accepted those are the best hospitals. But i would refer you to your own commission which has identified as the main driving factor in the health care cost. We are also Teaching Hospitals. So its benefiting the rest of the country to cost more and deliver healthcare when you are a Teaching Hospitals and if you are not. They are heavily subsidized without much transparency or accountability but that is a different issue from the rest of your question which is on trust and the public option. They didnt change the law on the exemption. We changed it in the house version. We took out the antitrust exemption. I would support removing it. The house bill never became law. On the public option i said in my testimony i support i would call it a guaranteed choice plan and i think the president has voiced support for that. The gentle man is out of time, so i appreciate and im sorry to cut you off. Its just been implied that theyve somehow reduce cost and increased coverage. In fact i believe i heard that someone actually Say Something along the lines of having the lowest of care cost in history. Im trying to wrap my head around this kind of nonsense. Its not the federal governments responsibility to take over the Healthcare Industry in the first place and i am as concerned as anyone with Health Care Costs, but government intrusion is the problem, not the solution. If obamacare is as great as it is im curious why none of the witnesses here participate. We all know that this is a disaster. What sets this hearing apart from other hearings is now we have a track record that we are able to look back on and see where this has been taking us and we have a track record to look at what the president and his administration originally told us versus what has come to fruition things like would have already come up today and if you like your healthcare you can keep it and if you like your dr. We have to track record t the tw that was totally false. As we look at these kind of things we have to face reality, now we are facing the fourth enrollment appear to and this whole thing is coming off the tracks. Its a Natural Disaster and economic disaster. You mentioned 20 Million People. You are including the medicaid people, the real numbers are 12 million actual people enrolled in obamacare, just over half of what was predicted and all this contributes to the problem. Many of you know firsthand the scott insurers that are leaving. It wasnt long ago United Health backed away, and why because they are hemorrhaging in their cost. They cannot survive despite the fact that billions of taxpayer dollars are subsidizing. Insurance companies are still losing and it cant continue. And for those Insurance Companies that remain, premiums are going up and up and up just to cover the cost. Going up again in 2017 looking at a National Average of 25 increase this year. Blue cross blue shield going up over 20 in georgia this year just to cover costs. Lets face reality we have 20 million perhaps who think that they have insurance but in reality, and ive worked this dozens of times. The hospitals dont get paid and we have the hospitals on the verge of collapse because nobody is paying for the coverage they are getting. The problem goes up and up this year 65 of americans are actually going to have a higher deductible option this is not affordable for anybody. Its not affordable for the entire nation and yet we have people continuing to try to defend it. Its clear to anyone watching and experiencing this, which none of you are experiencing and none of you participated people who are experiencing, they know what its doing to their families and to their Healthcare Options and i think its time that we get honest with this whole reality and face the facts that this is a disaster and we need to get rid of this thing and let the free market enterprise and individuals with their doctors determine whats best for them rather than the government getting involved in this and that i will yield back. The chair recognizes the gentleman from virginia for five minutes. I couldnt disagree more with my friend from georgia and his characterization. I find it ironic was not the aca my old on the republican governors Healthcare Plan bill in massachusetts . Yes, mitt romney. Was not the scheme rather than having a single payer system but the idea of stakeholders having skin in the game so they become conscious and the republican think tank idea . The Heritage Foundation came up for the idea with the individual mandate. Absolutely heart and a soul and incorporated it into this takeover is characterized. Doctor cohen, when i had to face voting i told them there are three things i will measure. Is there a meaningful basket of reforms to protect consumers, does it address the longterm cost curves that we have some hope of reducing the growth in cost in terms of health care in america and does it address the problem, the crisis, the scandal of huge numbers of uninsured americans does it reduce the number in your opinion did we address those three things or not and are they working or not today . Let me take them in reverse. Weve talked about the uninsured consumers lets just stop there. I dont know what the legislator in georgia has done. The republican majority against the wishes of the democratic governor have refused to take advantage of the provision that medicaid. Medicaid will cover 400,000 uninsured virginians and the scandal was not taking advantage of that has cost billions of dollars, money we are entitled to but not taking advantage of and every year we have a voluntary clinic in a rural part of the state where thousands of people without Health Insurance line up overnight to get basic medical care highlighting the need. My friend talks about hospitals closing. Weve had hospitals close in areas because of the fact we are not taking advantage of that medicaid provision for political reasons not only concern for patients but if we want to do something, that is money to be taken advantage of and some republican governors havent such as Governor John Kasich of ohio isnt that correct . Please continue with the other two. On the Consumer Protection i think now weve been talking about essential Health Benefits so folks know that they have good Health Insurance when they are purchasing is also important to note theyve prevented the services that everyone has access to. Its not just in the marketplace but its across the market that we were able to take advantage of through our employersponsored coverage as well. The other Consumer Protection given that we are talking about premiums today is the medical loss ratio. Thats a Consumer Protection in and of itself. Insurance companies paid back 2 billion when theyve overcharged them and thats an important backstop for what weve been talking about related to the cost. Now theres a backstop protects consumers as well and on your third point about the Cost Containment, that is a place where in my other hat related to what we are doing in the medicaid world we are thinking about Cost Containment everyday moving towards the alternative payment models and making great progress as well as thinking about the costs. And a final question one of the criticisms at the time of the debate as we were going to kill Medicare Advantage, and my friends on the other side of the aisle just scared thats going to happen. So what happened to Medicare Advantage plans to premiums go up and down, benefits expanded, what happened to enrollment . Certainly it did today. Its been increasing substantially despite the cuts in the Affordable Care act to eliminate the subsidies the plans were getting so the system is much more efficient and is not cutting enrollment. And about premiums seem pretty stable. And benefits actually expanded. I cant speak to that. I dont know. At some point the critics have to take responsibility for charges theyve made a. The chair recognizes the gentleman from georgia for five minutes. Thank you all for being here. Let me preface my remarks by saying i disagree with my friend from virginia. Im not going to speak from my partisan view. Im going to speak as a healthcare professional and i want to ask you some very serious questions. In a state of georgia where i practiced pharmacy for the last 30 years, regulators approved a 21. 4 increase over the average premium, 21. 4 average premium increase for the 2017 exchanges. This is taking into account that you will be picking up 70,000 to 90,000 more customers because theyve exited the market. Bad as i understand it, Blue Cross Blue Shield is the only plan that covers all the counties in the state of georgia is that correct . Im here on behalf of the association and i cant comment on the situation for any specific plan. Let me assure you thats whai just said is true. A 21. 4 because of the fact that they are having to pick up 70,000 to 90,000 more because the Insurance Plan they exited the market and thats understandable. And before they ask for the 21. 4 they were only asking for a 15. 1 . Using 21. 4 increase is a significant increase . I would characterize that as significant. Anyone disagree with that on the panel . Dddj 21. 4 increase is a significant increase . Yes it is. Anyone else disagree please shake your head know if you disagree. You look like you are contemplating this. You dont think it is a significant increase . I think you have to look whether it is the average premium or the premium for the silver plan and im not sure having not looked im not sure what you are referring to. Let me assure you it is the average premium. Youd have to look at the average, thats what the subsidies are tied to. I dont care whose idea it was, republicans or democrats, it was a bad idea. The one thing it hasnt been is affordable. Dont we see that . One of the first things they taught us when i entered the Georgia Legislature they said when you are in the hole, quit digging. Well, guess what, we keep digging. More plans keep coming out and what happens . We keep digging. How ridiculous can we be. 23 and 17 have gone bankrupt. Guess what, we are not helping healthcare come a profession that i practiced for over 30 years. We are ruining it. The Affordable Care act is ruining healthcare in america. Dont we get a . On tthat . Until keep the free mak in the Healthcare System and hed patients have control and doctors have control, Health Care Professionals have control over health car healthcare decis not going to work. Its not affordable and i dont care if its a republican idea or a democratic idea, it was a bad idea. Let me ask you a question. In july of this year the president said too Many Americans still struggle to pay for their visit, covered their deductibles or pay for their monthly insurance bills. Do you agree . I think what he went on to say is with the increased subsidies we could address a lot of those issues. Thats why we need to do. Havent we tried that . Its working pretty well, 20 million covered. Of Health Care System are you practicing in . Im practicing in the one where both can get coverage for less than wha what good does it do than to get coverage if they have a 21 increase year after year . Some places are having a 50 increase. Whatever you do just go back to the office and say we are going to take the affordable part of. Thats all im asking you to do is take the affordable part off, just take that out of the title. Say youre doing it for this poor pharmacist from savanna georgia. Mr. Chairman, i yield. Im going to take my Blood Pressure medicine. [laughter] i think the gentleman from georgia and the chair recognizes the gentleman from maryland. On that note i hope the gentleman will be able to afford the Blood Pressure medicine. Let me ask you this. You said something i think we need to stick a pin in. You said in the states that took advantage of the medicaid provisions of the Affordable Care act the premium increases were 7 lower is that what you said . Yes, correct. And so, we have people now who if we did not have the Affordable Care act would not have insurance because of things like preexisting conditions in other words somebody had a Breast Cancer scare, would it be able to get insurance is derived . Thats right, preexisting conditions could have caused you to have absolutely no options. So they were just out of lu luck. So if they were like my motherinlaw who is sadly dying from Breast Cancer, what would they do . Have to depend on charity thats the real deal. We are the United States of america, and this is about trying to make sure that we take care of our own. Ive said this many times when i look at the states that do not take advantage of a medicaid provision in the Affordable Care act, to me it is a very sad thing because youve got a situation where literally people are left to get sick and many die early. Thats real. So when we talk about experiences, the experience of being ill and not able to get the care that one needs, thats something i think we need to go back to as a nation. We know the aca has significantly expanded the individual Insurance Market at 11 Million People who did not have coverage before. Some insurance have been more successful in adapting in the new marketplaces. It seems that a smaller and smaller regional insurers that have more experience seem to be doing relatively well while larger legacy insurers have struggled. Some of these have done better than others at adapting to this market. I understand there are companies that are doing well and others that are not and i cant speak to any specific company. They are the ones that have the ability to negotiate with providers and have authority over the ability to manage their costs while and there are other factors in Healthcare Trends that can affect the increase in Prescription Drugs lately. Im glad you said that. You went exactly where i wanted to go. Near the floor and eight of them use those. That is not unique. Believe me i know. But to know that all of us imbeciles because we wanted to know why this company could raise the price of a pill from 7 or 13 to dissents up at 750 . So nobody can tell me all over the pharmaceutical industry. So what has to have the effect. Isnt everything but what do you suggest . You are the experts. What do you suggest we do about that . Do we just sit back and let that happen . Itt you know, we proposed earlier this year some projects for cost in the im Medicare Program so we are making char thinking of of total cost of care that all the folks are thinking of the total cost is thinking about the quality and the quantity. I will not get into what we are or not doing with the pharmaceutical cost that is outside the framework. But certainly. Would you like gcs do something about it . To make absolutely especially Specialty Pharmaceuticals have a significant increase. As we look at the market it is something we have to address but also at Affordable Health care and i can tell you someone i have seen increased premiums with higher deductibles and less benefits than when i was purchasing in the private sector. That will go to the gentleman from alabama. So far there are others that are coming down the pipeline we have heard the clip to say if you like your doctor you can keep him. Which it turns out was completely not true hundreds of thousands of people then this will likely mean new doctors. What kind of comfort but it is the exact opposite of what they promise. Those of preexisting conditions. I am talking about those but the promise the president made to the people who already have insurance that were doing business with some of the companys hundreds of millions of dollars. In the Employer Market we have seen very little change of what employers are offering in terms of coverage that is when they talk about this abo projections that they see less erosion. And light of the fact enlighten those who have insurance and now there are 50 million additional people since the open enrollment began so looks like they are being injured in the government plan. For a halfmillion of private insurance that have lost insurance. I think for all of of political speak, it hasnt worked the way it is supposed to work and hundreds of thousands that have lost access to the health care prior. And unlike my colleagues like to have a battle to correct this to get a back to where it works lacrosse blue shield of alabama editor rate increase yes one dash three yet they increase those individual plants can you give me an idea what accounts for the disparity . Lacrosse Blue Shield Association of the independently run plans is what i am not privy to. Alex back to have some concern about the losses of lacrosse lucio of minnesota with a Health Care Service in illinois montana and new mexico texas lacrosse placentia the tennessee lost 300 million West Virginia lost 266 million and the companies that you represent sustain this type of losses greg. That is the primary loss for those rate increases. Doublea2 point out not only impacting the economy but they are restricting their expansion of the planet to cut back hours having a devastating impact with a Budget Hearing with former cbo director and looking at the Economic Growth and how overregulated the economy is there now projecting over the next few years with the 70 year average but that has to do with health care. It is having a devastating impact on the economy and individuals and families and driving companies out of the marketplace those who provided insurance from lacrosse placentia 04 years. Nighttime is almost expired but listening to the Opening Statement that it failed because nobody had done it the right way i think that is the arguments for the Affordable Care act. I yield back. Welcoming the gentleman from south carolina. Have a couple of followup questions on this memo that was sent out action it was public regarding the risk corridors and i think you are right as the videotaped your the client that makes sense. Why would you send this out to . Why would they tell you not to talk to the people that might be some new . Dont talk to the people who will sue you let me do that. Arrest of of the documents describe but was happening as well as reiterating our commitment to of program and says that whenever there is litigation risk you can go talk to our lawyers. That is not what says you can read that we know number of issuers are looking to see that risk corridor that have not been paid to date and they are vigorously defending those claims as an all cases where up then to discussing the resolution and willing to begin discussions at any time it doesnt say call the doj or dont call us has anybody called you . I think they know the department of justice represents us. Yes they do so why send this . Normal course of business but. Litigation is. We know you can sue us but we can talk settlement without doj have you done that . What the paper says last year is we have an obligation and we have always said that yes reset that out with our obligations. Did it have an invitation at the yen to have people call you to begin discussions. At that. 1 year ago there was no litigation. But now they are suing us in federal court. As anybody contacted you . I imagine those conversations are happening. I imagine a lot of things with that is not my question. Update may have contacted dlj and you would not know that. They candles of matters. For everybody who might be able to sue over the are risk corridor what is the deadline to file the lawsuit i dont know. The end of the term . As we said it is a threeyear program and there is an obligation. Nothing new we had and said last year. But to mention briefly whether or not the Judgment Fund could be used that there is no money and appropriations and that was senator rubio amendment but there was no money left an appropriations for the risk corridor payments spread is the opinion of hhs that the Judgment Fund might be available to make those payments but i want to read and this is a quote from the department of justice, the Judgment Fund is not available simply because an agency may have insufficient funds at a particular time to pay a judgment prevail lack sufficient funds to pay a judgment of statutory authority, the recourse is to seek funds from congress to be legally available to pay a judgment or settlement and it is not available misses the Clinton Administration decision 1998. For those rethinking about calling you they should know is the opinion of some lawyers others that are democrats from clinton that in order for these payments to be made that converse should appropriate that many and it is not proper for this administration for any war under the Judgment Fund. The chair recognizes a series of questions in your testimony said there are signs that the Financial Performance is improving. Do you stand by that statement . The Financial Conditions . I was citing a Goldman Sacks report. You may be quoting babette in the Insurance Industry is improving. Ambitious citing a report that is your testimony i asking you to clarify. Is the Financial Condition improving quite. I think it will after this price correction there was underpricing in 2014 then that fades out. So let me go with that. This is my five minutes. You are pontificating and not answering the question. If this day a onetime adjustment is what will fix the aca because they underprice things because of the corridor. Is that correct . There will be a transition house fast that happens depends on whether congress can take additional action. Lets assume congress will not take additional action because the risk corridors in the of bill and of law that you helped to work on . You were part of that team byword for the hen Senate Health committee. Is set your part of the team that actually drafted protection the Patient Protection pledge. Correct. Is there working the way you win tended it to work . To make it is insuring a lot more americans. That is not what i asked is it working the way you intended quick. It is taking longer than i expected. That is fair enough. How does your statement of a onetime fixes and adjustment correspond with your sworn testimony in 2013 . Converging evidence indicates the changes are working as intended Competition Among plans improvisers that was your testimony 2013 now with says it isnt working so we may have to do a one time fix or adjustment hattie you reconcile the two of those . Actually the competition was too competitive and the rates came to love they came into low. You dont have a degree in economics greg. Now. Finance . You say to much competition is what created this . I want to find that economic principle that you will grab to suggest that. What economic principle. Markets are hyper competitive that encouraged them to underprice their premiums are now a correction is due for the underpricing. So you are suggesting, when the government is involved we create false markets with subsidies that has nearly effect whatsoever on the financial viability . Did understand the question. When you have a subsidy it comes with the guarantee having to pay for preexisting conditions with the unintended and surer, does that not make the market reacted in unusual ways . To make it was a new market with the uncertainty about pricing. With your sworn testimony today that we had to much competition . We had to much pricing uncertainties and yes they came into los. You are a lawyer i guess you have a degree of Public Policy . I have a lot degree from university of virginia is any of that allowing you to do models . Most of of testimony, United Healthcare is lost the billion dollars on the exchanges over the last to plan years. And now is expected to lose 600 net 650 million and 475 million. And with the five states has lost 1. 5 billion. Are you saying this is caused by too much competition by. By underpricing and with congress to step been to constrain the program and it all comes to ahead and 2017. So you say it is congresss fault you draft of law . Congress came in an amended after past. Whoever voted for the allot fault that this is happening . My testimony was congress by constraining the programs selected any republicans vote for that block . You were here. New nell. I dont believe so. Is a your sworn testimony that it is a working . No. Whose fault is that . You drafted that. I am trying to figure out. Let me say your testimony doesnt line up with the facts are you aware of the internet there is a way to gain the system if you quit paying your premium in the fall then you come back to reapply in january are you aware greg. Know i am not. Are you aware that some people tried to gain the system to quit playing premiums because you are required to cover them even though they dont pay the premium price begins we are familiar with that problem. Ru . Yes we would like to see some type of action to prevent that from happening. Isnt that a good idea not allow them to gain the system price hike we have the Program Integrity unit focused on related to the marketplace of various assets we are very much focused. How many have been denied when they apply and january what. When they apply through healthcare. Gov. Deal had the number . , a people have be stopped to quit paying in the of ball but then apply a in january have many say by the way they are gaming the system wexner those are two different systems so the issue words are those folks. They cannot do anything about it. The people were doing three months of insurance to reapply and they cannot do anything about it they need your help. That is why that partnership previous activities. Family people have you caught in fraud and prosecuted . The answer it is zero. Fair enough. I am asking you. Fair enough. Tammany have been prosecuted for fraud . Zero. Recognize the Ranking Member. We will get to the bottom of that . Absolutely. We are focused to make scheerer the of market is solid for the future that the folks take it seriously and we work closely with the state regulators and others that they follow the rules of the road and the problem continues to mature we will do that. Practicing law for many years with all walks of life if we define a way to get around something coming to get people out of trouble trying to get around a system that doesnt mean that you deny the people that Health Coverage it doesnt mean they will allow them to sit there and die. Sit there and die. So we need to go after that to deal with that. I agree we need to deal with that. With other avenues of fraud in the marketplace we have taken action whether to rescind coverage or those proper authorities taking action we are not that authority that we pass that along. I think what you are saying in a bipartisan way we need to address this very real problem because it is affecting the insurer. The chair recognizes the gentleman from new mexico. Actually this is not my intended question but i will take the privilege for my five minutes to follow up on the fraud issue on one instance we robustly delta with fraud but those incredible allegations hhs cns allowed by virtuous acquisition to have 100 percent of the Health Care Provider contracts the following review finds no credible allegations and now we have no access of fire Insurance Coverage so this is a very important question of the chairman and Ranking Member to identify and how to be careful these mechanisms are not used that we dont understand those provisions. Here is my opinion. The federal government and State Government are ill equipped to deal with Insurance Companies prior to the Affordable Care act to navigate health care for constituents, countless underutilization over utilization the narrow ring of networks and contracts for parity and inappropriate transfer inappropriate billing supplies i could spend 20 minutes just on the issue of Insurance Companies and including the profits of the Affordable Care act medicaid and medicare components i am not so sure that we talk about that context of the entire Health Care System we want to repeal or do nothing. It is complicated for those that are illequipped to deal with the system as it is then the Insurance Companies so people pay more to provide Consumer Protection. And outside of premiums and subsidies to out of pocket cost. I do think that cns theyre rarely hear this from me i do think adjusting the enrollment. Were helpful but not be enough. What more can you be doing . I appreciate that we are taking steps within the authority and even last week with those to the special enrollment. I want more than that. We are encouraging states to discuss with us of the pathway for what they can do at this date global. The affordable karan racked wanted to move away from the high risk schools. But if you look at the Medicaid Expansion and related issues we are in trouble so look at what this committee i only have one minute left, i dont think Insurance Companies have done their fair share to address this issue in a fair or productive way and the aca gives many ways to do this as a subsidy began as the debate of the Affordable Care act the stock price has increased by more than 200 despite those increase profits and the fact we dont talk about the private market exchanges and i keep reading about my state pulling out of exchanges with those guaranteed access they were promised, i thinks congress did a the industry a huge favor to give thousands more enrollees and thousands of opportunities to maintain your access to managedcare. So i am very interested in the dnc emerging like the managedcare options we may think minimum participation is required if you keep those managedcare protections have you feel about that greg. I am not familiar with those of the this is beyond my ability to comment on them. From a premium standpoint standpoint, the the actuaries from what it costs to deliver the care on the exchanges. I am not of time but the population would not be as sick as they are the favored getting care from Insurance Companies. I remember years ago reading the japanese the leaders of the world and consuming pharmaceuticals the looks like the americans are blowing by a 35 more can you give me a shot what we spend so much more than other countries . Youre all looking at each other. In this country they charge high prices because they can. We are prescribing more drugs but that is driven by the price increases. Anybody else . With the number of Prescription Drugs they are taking is this true . Medicine has devolved we have keepers for things but those are a real issue. We need to find a place to innovate and make sure we have access to those life saving drugs. So physicians try to do best so the prices are not Something Better in a position to control to use those tools in front of them. Pharmaceuticals are willing to do that. For the Affordable Care act compliant plans what services are they required to have that no Additional Charge . Cemetery acquired with no cost sharing certain plans decide to offer more as a benefit to attract different types of population. Is a required to cover epipen and quest. Formularies are decided to recover Prescription Drugs but there are specific rules how those are covered. Epinephrine is covered by dunno if the epipen is covered or any individual xx know why it wouldnt be automatic . That is pretty mandatory. I have to go back to look at the rule. Bob and i am happy to follow up with Additional Details it comes from the plants themselves to set the rules of the road with the benchmark. With some parents rather have that option that no Additional Charge . The answer is yes. It is a rhetorical question. Would you let the consumer decide what they need vs. Washington bureaucrats . That is a rhetorical question. If i could just point out in those markets that existed Prescription Drug coverage was not a guarantee. About 20 of plans did not carry any Prescription Drugs so the Affordable Care act with those Health Benefits is actually increasing its increasing things. So i will yield the final 10 seconds. I think each of you for your testimony. You have been heretofore and died appreciate your testimony and hopefully in might of some of those questions today there are a number of things that are bipartisan in terms of our desire to get used to address. The loophole may have been intentional but what i would say it does not allow insurers to do with they have done in the past appealed pay your premium. And your coverage quits the Ranking Member and i are committed that you address that other than that they were willing to address that is that correct . With those confines of the 90 day grace period want to make sure theyre not gaming. But you know, they are . But we cannot do that for. Here is my concern that the front end whether hhs or cms when you open the hood sometimes there isnt airconditioning as a prime example you were looking at a fraud we had somebody who contacted us to say they were able to enroll through healthcare. Gov with the exchange of the birthday of october 30th 1124 that they are 891 years old. If theyre able to do that under our system right now then Fraud Prevention is less than robust. Hearty winter somebody a hundred 91 years old . I dont know whom they might be. We are balancing maybe somebody who had the fact finder. Get should say this says you are a hundred 91 years old. There is high probability you are not isnt there something automated . Once the vapor is their information and to healthcare. Gov that checks uh data sources that we have like the Social Security number. And then it doesnt go from you to the insurers. Between hhs and cms when it comes to fraud and enrollment. There is the policy decision that the implementation decision and from what i hear the Insurance Company want you to engage and when day inquire you get crickets and hear nothing. So in the nicest why i am asking you on that 90 day issue if they say if they see fraud go with the full power we will not tolerate is an appropriate figure out how they will navigate. Aquino it is on the internet . Yes. I believe you that it is there. You have seen it . Day partnership. Is anybody on your staff cnet . I will be shocked. If there is no further business we are adjourned. [inaudible conversations] [inaudible conversations] here to talk about the irs commissioner impeachment resolution, alou and what are behind this effort . The resolution and coming up followed by two House Republicans but the the more our members of the caucus they have then frustrated with the allegations of the irs but the failure of the current commissioner and other rises otherwise be frustrated by the fact the committees has not move forward with proceedings with the privileged resolution ; the current articles of the impeachment showdown begins how they take aim at the irs commissioner. And with House Republican leadership. Title date this is the fight with other members of the house. Certainly there are conservatives that are very upset with the irs not only the way of the conservative political groups but the increase and it is somewhat widespread with skepticism is the of gravity. But you have occurred speaker ryan then mccarthys day they want this process to with here to regular order to the Relevant Committee it one dash community. And House Republican conference is getting together for a special meeting water you expecting to happen by. At classic conversation to get together behind closed doors and those likeminded members to make their case and i will expect we will hear from chairman and speaker ryan and they will make their cases for the best way for word. And to see how that shakes out. And there has been a couple of visits to capitol hill what have they said and their defense . He spoke to his most pointed critics of the Republican Study Committee meeting. So even if you think i have done terrible things you should follow the usual impeachment process and not the short circuit in of the judiciary committee, you should be given an opportunity or be granted due process with the articles of impeachment. And those impeachment articles that is how the process puerto rico in right now. So that all only impeachment are there other methods of discipline . Yes. Has been some discussion, they pass a resolution through the Committee Earlier this year but it has not gone to the floor but that is an option if that is what the leadership feels but there are other options as well. There are an amber of ways to go to bat down or up. There is a motion to send that back to say we will file that process that the impeachment is warranted also a motion of the effort to entirely. Another ingredient in the culture and of issues cauldron of issues of those funding measures to take us back september 30th . To make and the last 24 hours the Democratic Leaders will choose which issues to be be solved. Whether funds of of package will go to an affiliate and puerto rico for zika by but there could be a quick resolution in the senate to find some Common Ground that tomorrow it will clear though Water Resources and leader mcconnell if they want to go forward after that. Thanks for the update. Spent devoted not to postpone the vote the impeachment effort put out the tweet tool then of hearing of the commissioner next wednesday. [inaudible conversations] spent many sand gentleman please take your seats. The subcommittee will come to new order and todays hearing is timely as we fleur and the startling news over the summer confirming our worst fears that some of the most sick dividend insurers said United Health are opting out of the Affordable Care act insurance exchanges. This is disconcerting on several levels for those who are paying more to get less. One of the most ambitious aspects was the creation of the Health Insurance marketplace and to lead to lower costs for consumers and insurers but with the consumer Health Insurance options they are now more limited and driven out of the marketplace the exchanges have faced numerous problems with more enrollment sicker people enrolling and larger operational cost. And with those persistent and vulnerability is of the application eligibility and enrollment processes. This week the edgy a zero released two reports of the lack of real safeguards. Of the 18 to subsidize plans 17 received coverage. Gao was 15 over 15 with one fictitious applicant in three different states at the same time. Also established the consumer operated program. And wine as failing as recently by tuesday. And the coops were set up but instead of the original coops funded with the 2. 3 billion of taxpayer dollars and to result in the higher outofpocket cost. But the oversight of Investigations Committee has critical work as the of functionality but the Staff Reports are thorough as a reminder of the misguided promises we have some of the officials around these troubling reports. The hhs Deputy Inspector general of the gao. As well as the steps taken by cms to improve the exchange risk. Noun the chair recognizes five minutes for your Opening Statement. Just six years since the enactment before went into effect delivered on the principal goal today 20 million more have Insurance Coverage and they are at the all time low with this improvement should not be undervalued this is despite at political opposition to chip away at the of law with the inherent challenges to destabilize the new marketplace. But then the past four subjects to accept the aca as the law of the landing get back to work. With the individual Health Insurance market is deeply broken. They would sell junk plans with preexisting conditions and they were locked out of the market. Did when they need coverage of most. And for the standard that is more robust. Those premiums are between 12 and 40 lower. And to grow more slowly. The of marketplace created under the Affordable Care act is in its infancy. With Medicare Advantage and Medicare Part b. In with a high a premium increase. And we have seen similar headlines with the ensures to navigate the new landscape of the Consumer Protections and consumers no surprise there adapting a different rates. With the cost of quality rather than cherry picking of the preexisting conditions. The Affordable Care act is not perfect but it will take an effort for those that stabilize the of market in cattle maybe done if were honest of these meaningful critiques as a unique transition and it is designed to support the market in the early years to have a onetime effect on cost but yes we see the marketplace will strengthen by robust outreach effort not taking a vantage of the opportunity. And to curb abuse of those shortterm plans. A stabilization of the marketplace in the future. Its now time for congress to preside partnership and come together and improve the law. The American People are counting on it and i look forward to hearing from our witnesses and i yield back my time. We now recognize the gentleman from pennsylvania doctor murphy five minutes for an Opening Statement. The committee began its investigation of the faithbased exchanges in 2015 and we aimed to understand why they correctly and effectively utilized billions in federal grant funding. The committee requested and received documents from the original state exchanges and over the course of two hearings we heard testimony from leaders and federal officials. Our investigation found the centers for medicaid and Medicare Services cms wasted 4. 6 billion in grants due to excessively careless management and oversight. Disappointingly and despite the fact that four out of the 17 exchanges have closed down a very small and very inconsequential amount of improperly spend federal dollars have been recouped by cms. We were told a state exchanges would be selfsustaining by janu1,