The National Live book festival starting 10 a. M. Eastern saturday on cspan2s book tv. Maryland senior senator ben cardin held a town hall on health care. He also discussed medicaid and medicare. He was joined by the leader of Johns Hopkins university. Short talk on republicans failed efforts to repeal the Affordable Care act and then took questions. [inditinct conversations] [indistinct conversations] [raps gavel] hoping to have a town hall meeting where we can have a discussion about health care. I want to welcome [applause] thanks. For all lets have a discussion for all. Good evening. Welcome to everyone who came this evening. My name is tom lewis. Im the Vice President for government and Community Affairs for Johns Hopkins. I want to welcome you to Johns HopkinsMontgomery County campus. Promised 11 years we have been offering postgraduate level courses here. I want to introduce our speaker. For 20 cardin served years in the maryland house of delegates, the youngest ever elected to lead the maryland house of delegates. Markd a very distinguished as the u. S. Congressman from maryland. He went to the senate. In the senate, he is the highestranking republican [laughter] democrat inranking the Foreign Relations committee, and he also serves on the committee for environment and public works and also finance. And verylong distinguished record on a number of health care issues. He is a great champion of nih and medical research in general. [applause] i want to devote a few minutes to housekeeping before we get into it. Number one, if everyone just as a courtesy could please silence their phones. Also, as a courtesy, could you not hold up signs. It blocks people behind you. We want to have a discussion where everyone can see in here, and that is part of our democratic process. I appreciate that. If anyone means restrooms, they are out the door into the rights. We are going to have and to the right. We will have a short presentation by the senator and the opportunity for questions. I would say just one last thing on health care before i introduce the senator does she has a very long and distinguished career on health care. When he was still speaker of the house, i had the great good fortune to be the Committee Lawyer for the committee in the maryland house of delegates that deals with health care, health care and the environment, and while i was there, senator cardin, then speaker cardin championed a package of six bills that constituted a major reform of health care in maryland, helped to preserve the maryland medicare waiver, which has been a great boon to this date. It has helped maryland, although hospital rights do seem very high. I would say maryland has had a lower rate increase in the National Average every year in that time. He has great expertise in this area and this is again, a very uncertain time in health care and we are very fortunate to have a u. S. Senator who has the indepth experience that senator cardin has. So, very pleased, we are all very pleased at hopkins that senator cardin chose this location. I want to take one more moment just to introduce elected officials. I know senator roger manno, delegate Charlie Barkley i representingnny is also here. Skin and with that, i want to introduce senator ben cardin. Let me thank tom lewis and the Hopkins Family for allowing use this opportunity for a town hall type meeting, which i always enjoy. I thank you all for being here. Its an honor to represent you in the United States senate. By, first,tart acknowledging our collective of texasor the people on this flood. Proportions historic proportions. The damage is incredible and our in ary needs to respond very aggressive way to help the people of texas. Tuesday. Will return on and i can assure you that ill be working with my colleagues on aisle tos of the provide a very robust relief to who are today whose lives have literally been upended as a result of this storm. I know i speak for marylanders. We have, i understand, first from Montgomery County. Theyve already gone down to texas to help. Thank you. [applause] we have many who have joined in National Efforts to provide texas. To the people of and this will be continuing. Im always proud of how to thesers respond types of tragedies. First explain that, starting in january, i became which meansenator, mccullskyor retired and i miss him. We all miss him. She tells me she doesnt miss being in washington, d. C. [laughter] when the president ishes one when the president issues one of his morning tweets, she will call me and what are you going to do . Usei want to make sure we all 10 members of our congressional delegation to work on issues that are priorities our state. So during this time that congress is not in session, ive been traveling through maryland to peoples concerns, to explain how i see things in washington, and to get your input. Yourk very closely with federal delegation. Giving me Chris Van Holland from montgomery doing a great job in the senate. Professions committee, on appropriations committee, and he has been an effectiv effective way from one. Rasknik, joined with john sarbain, environmental chesapeake bay, john delaney who has been very sensible on trying to bring our country together on economic policies. We have a very strong federal team that i work with in Montgomery County. You to know that. Its team maryland. I work with the state officials, that we canials, so utilize the talent of all 10 members to help the people of maryland. Aboutt i want to talk health care. I know theres people who want to talk about other issues and we will. Happy to talk about whatever is on your mind. But give me a chance first to talk about the health care issues, because i am still deeply concerned. Admittedly, eight months ago, i think most of us felt that the of the Affordable Care act was a foregone conclusion. It did not happen. [applause] becauset didnt happen the power in our country is not the unitedesident of states. Its not with our judicial of government. Crowd member no. And i would submit its not congress of the United States. Its with we the people. You all have the power. Spoke out against the efforts to repeal and then repeal and replace the Affordable Care act. I was with a group in regards to this morninghanges in Montgomery County. And they said, what can you do to make a difference . Well, in health care, you put a face on the issue. Of millionsout tens of people losing health care. Specificus the examples of people who would be disadvantage if the republican bill in the house in thelaw or the bill senate that was offered by the Republican Leadership became law. Heard about families, children born with severe that would have reached their caps within the first couple months of life. We heard stories about people who would not have been able to get the Preventive Health care that they need. About howtories peoples lives would have been very much disrupted and they couldnt get the health care services. It was a matter of life and death. Supporter of the Affordable Care act. Im proud to have supported it. Be part ofto congress that passed it. [applause] the results of the affordable tens of millions of people who did not have Health Insurance now have Health Insurance. The results of the affordable have quality now coverage. The coverage which you need. Preventive health care. It provides pediatric dental. We know the tragedy of the in prince georges county, in 2007, who lost his life because he couldnt get dental care. It covers addiction. It covers behavioral health. It covers the services that people need. Its quality coverage. Abuse ofates the practices of private insurance preexistinguch as conditions. Being a woman is no longer a preexisting condition. [cheering] have caps, caps that meant, if you had cancer and you needed the treatment for cancer, you could see the caps within a matter of your first month of treatment. That no longer is the case. Major dramatic improvements to the Health Care System. Now, there are issues that we have to deal with in health care. The bill that passed the house of representatives would have cut tense of millions of tens of millions of people out of coverage. It would have denied the protection we had an private insurance. It was moving in the wrong direction. Im frequently asked, why didnt with someorward proposals with the republicans to improve it . Inl, the train was moving the wrong direction. I wasnt going to get on a train. There wasnt anything in their bill that i could support. It, and we against were able to stop it. [applause] the same thing with the senate bill, including the skinny bill they put out. It wouldnt have been 20some only 15 million. But it would actually have been worse, because the cap they put the medicaid system was more severe. Im just going to applaud we the to how you spoke out, because we the people you you. They tried to divide they said, look, well make an exception for children that have very difficult conditions. And the advocates for the children recognize that that was tobargain that they wanted get on, because if you cut the medicaid system, youre not going to have the facilities in to treat our system and they knew that if you cut the medicaid system, the states would not be able to maintain the coverage. Firm. Stayed you didnt bend. And we won the vote. And i want to thank the republicans who joined us in that effort. [applause] they showed a lot of courage in their votes. Now, several months ago, i becauseed legislation im going to acknowledge the Affordable Care act is not perfect. Can be improved. I would also acknowledge that we in theassed a major bill congress seeing how it works and seeing where you can make it better. I have said that from the beginning. A proud supporter of the Affordable Care act. Of good. Ne a lot we can make it better. We can improve it. Deals withslation two major problems in our in the Affordable Care act. Lack of competition. Particularly in the individual market. Want to define the problem so we understand its a problem. Relativelycts a small percentage of the overall market. The individual marketplace, and one where we have significant problems, where we had the rate increases that were Just Announced, is about 6 of our market here in maryland. About 6 . And the premium increases are way too high. The reason forin it, and theres ways that ways n make it better and my legislation does that. And about twothirds of the people in this group get subsidies. So youre really talking about one to two percent that are in trouble as a result of these changes. Thats too many. Youve got to help them. [applause] we gotta make it better. So what does my bill do . First, more competition. So i put back in the one part of act that wele care lost that i thought was a tragic mistake. Thats putting a public option in the plan. [applause] so that you know there will always be, always be a plan available. And its always its not going to go any place. Going to discriminate. Its going to always be there for you, to protect you. The other parts that we do is that if you look at why we had thee increases in individual marketplace, its major factors. E the first is that sicker people whereasing the plan, Young Healthy people are not. Is not going to force a mandate. That means younger, healthier people are not going to join. Going to have adverse risk selection, which is a pool that is going to be more expensive. President trump could fix that by just enforcing the law. Were asking too much for the president to enforce the law. [applause] the second thing is the law provides what we call cost sharing expenses, recovery for companies. Ce thats so they can reduce their copays and deductibles. That was supposed to be a fell on payment, but it government to keep the premiums more reasonable in the individual marketplace. A Court Decision that raises question as to whether its mandatory or not. Obama, thatesident was no problem. Hes going to make the payments because thats part of the plan. Is raisingrump questions as to whether hes going to continue those payments or not. Payments werering made for this month but we dont know if theyre going to be made for the month of september or october. And the insurance premiums reflect higher premiums because uncertainty. We can fix that. My legislation mandates those we know very clearly so those payments will be received. The third thing that could be is not too much on maryland but its important thehe country, is to use reinsurance programs in markets that are relatively small. Reinsurance will spread the risk in small groups so that you premiums. Reasonable it was originally used it has not been used. Administration is not using it. The legislation i filed would use of reinsurance, which would also bring down rates. Now, thats one part of the problem. Second part of the Health Care Problem. And the second part of the Health Care Problem is the cost of health care. Its too expensive. Thee got to bring down gross rate of Health Care Costs in america. Legislation looks at several issues that could reduce the growth rate of Health Care Costs. Is Prescription Drug costs. You cant justify americans what canadians pay for the exact same pills that are manufactured right here in america. Its time for that to change. Requires thetion same discounting in the medicaid in thethat we get medicaid system and for collective bargaining so we can the full market sure to bring down the cost of prescription medicines. Be it saves hundreds of billions over the 10year window. Saving. Major cost the other is just as dramatic. And were doing a lot of this in and i applaud our maryland legislators who have really taken the lead on this. Is at [applause] they deserve a round of applause. [applause] they stayed in the Medicaid Program. Care. Rovided coordinated they had a small market plan, a payer waiver. Have charity hospitals. Maryland has taken the lead in health care and we thank them their leadership. So what we want to do, though, in order to bring down costs is intee more coordinated inte grayive integrative care units. So if you end up in an emergency room in the middle of the night and they give you drugs and keep you alive. And they then tell you to go home and seek treatment the next never seeks person treatment. Youve got to have the treatment available on site. Do this ingrams that maryland. We have the coordinated program in maryland between schepper and mosaic that does this. But we have to have more coordinated programs. For thertly responsible bill that passed the congress, the act that provides this inte integrative care model. Dokidney care, we can now telemedicine so people can get their renal treatment at a rather thanpot having to travel a long distance. We can use telemedicine. Psycho telepsychic medicine. Can use different ways of bringing down the cost of health care. Improving the Delivery System is very important to bring down the Health Care Costs. Thats what we should be talking about. So i come here tonight on health care. Tell you we, the people, have made a difference. We are not out of the woods. I dont believe for one minute mcconnell wont try to bring this bill back up if he vote. He has the 50th so we may see this again. Haveencouraged we chairman alexander and Ranking Member murray, and we have the and Ranking Member of the Senate Finance committee that i serve on, that are on bipartisan hearings and working together. Thats what we need to do. To president stened trump and i see what hes trying to do. And it concerns me that there be additional tactics used. I want to say one more thing about health care. That was outrageous. And that is the manner in which was considered. And you should be concerned about this. Yes member hell, [applause] you should be concerned about this. Voted one bill we about two hours before we voted it. Crowd member ha and it was released in the night. Of the and we were expected to have a debate on that. There was not one effort for a committee hearing, not one opportunity in committee to ther amendments to change bill. Unlike the Affordable Care act that went through numerous of hearings,ths months of markups, many, many by democrats or republicans, that became part of the bill. Process is important were a democracy. Process is important. [applause] toso, as we return washington on tuesday, as Congress Comes back into session, theres a lot of issues going to be coming up. I mean, theres a lot of issues. Passed the fy18 budget yet. I know thats a surprise to my state legislature who passed their budget months the county council that passed their budget. We are on a fiscal year that 1. Ins october we have less than four weeks by the time we come back, as to the fiscal year. Were also running into the risk becauseaying our bills of this arbitrary debt ceiling that we have that could cause higher Interest Rate costs for the federal government and we wont be paying some of our bills. Is coming to head as well as President Trump<