Have a town hall meeting where we can have a discussion about healthcare. I want to welcome thank you. Free speech for all. Also lets just have a discussion for all. So, good evening, welcome to everyone who came this evening. My name is tom louis. Im the Vice President for government and Community Affairs for Johns Hopkins. And i want to welcome you to the Johns Hopkins montgomery campus. For 30 years we have been offering graduate Level Education courses here. I want to say a little bit about the speaker tonight. Before i introduce him. Senator carden served for 20 years in the maryland house of delegates. He was the youngest speaker ever elected to lead the maryland house of delegates. He was also after that spent 20 years in as a u. S. Congressman from maryland. And had a very distinguished mark there. He was elected to the u. S. Senate and in the senate he is the highest ranking democrat on republican dominated Foreign Relations committee. And he also serves on the committees on environment and public works. And also finance. He has a long and very distinguished record on a number of healthcare issues. Hes a great champion of nih. And medical research in general. I want to just take a couple moments for housekeeping before we get into it. Number one, if everyone just as a courtesy could please silence their phones. Also, as a courtesy can you please not hold up signs. It blocks people behind you. We want to have a nice discussion where everyone can see and hear. And that part of the democratic process. I appreciate that. If anyone needs restrooms theyre out to the door and to the right. We are going to have a short presentation by the senator. And then an opportunity for questions. I would say just one last thing on healthcare before i introduce the senator. He has a very long and distinguished career in healthcare. When he was still a 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 healthcare dealt with healthcare in the environment. And while i was there, senator carden then speaker carden championed a group a package of about six bills which constituted a major reform of healthcare in maryland. It helped to preserve the maryland medicare waiver. Which has been a great boom to the state. It has helped maryland, although hospital rates seem very high, i will say maryland since that time has had a lower rate of increase than the National Average in every year since that time. So, he has great expertise in the area. This is again a time of great uncertainty in healthcare. And we are very fortunate to have a u. S. Senator who has the breath and depth of experience that senator carden has. So very pleased that we are all very pleased that senator carden chose this location. I want to take one more moment and introduce elected officials who are here. I know senator roger. Delegate barkly, i think also is representing congressman ras kin. Recently a state senator. Also here. And with that, i want to introduce senator ben carden. Thank you. Tom, thank you very much. Let me thank tom and the Hopkins Family for allowing us to 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 and the United States senate. I want to start by first acknowledging our collective concern for the people of texas. On this flood. It is of historic proportions. The damage is incredible. And our country are needs to respond in a very aggressive way to help the people of texas. Congress will return on tuesday. And i can assure you that ill be working with my colleagues on both sides of the aisle. To provide a very robust relief to the people today. Who are lives have been up ended. As a result of this storm. I know i speak for marylanders. We understand First Responders from Montgomery County have gone down to texas to help. Thank you. We thank the county for that. We have marylanders who joined in National Efforts to provide relief to the people of texas and this will be continuing. Im always proud of how marylanders respond to the types of tragedy. I want to first explain that starting in january, i became the senior senator. Which means which senator retired, and i miss him. We all miss her. She calls me frequently. She tells me she doesnt miss being in washington these days. And when the president issued one of his morning tweet, she will sometimes call me and say ben, now what are you doing to do . Hes very much engaged in the process. But i want to make sure we use all ten members. All ten members of our congressional delegation. To work on issues that is are priority for the state. So, during this time the congress is not in session. I have been traveling through maryland. To listen to peoples concerns. To explain how i see things occurring in washington. And to get your input. I work very closely with your federal delegation. I thank you for giving me chris van holen. From Montgomery County. Who is doing a great job in the senate. Hes on the appropriation committee. And other important committees and part of leadership. Hes been engaged in effective way from day one. Replacing him in the house of representatives, jamie ras kin. Hes joined with john. Who represents this area. Very well in Montgomery County. On a environmental issues. The chesapeake bay, john delayny who has been sensible in bring our country together in economic policy. We have a strong federal team that i work with in Montgomery County. I want you to know that. Its team beyond. I work with the state officials, county officials. So we can utilize the talent of all ten members to help the people in maryland. Tonight i want to talk about healthcare. I know theres people want to talk about other issues and we will. Im more than happy to talk about whatever is on your mind. Give me a chance, first to talk about the healthcare issues. I am still deeply concerned. Admittedly eight months ago most of us felt the appeal of the Affordable Care act was a foregone conclusion. It did not happen. And it didnt happen because the power in our country is not with the president of the United States, its not with our Traditional Branch of government, and i would con fez its not with the congress of the United States. Its with we the people. You all have the power. And you spoke out against the efforts to repeal then repeal and replace the Affordable Care act. I was with a group in regards to immigration changes this morning. In Montgomery County. They said what can you do to make a difference . Well when healthcare you put a face on the issue. We talked about tens of millions of people losing healthcare, you gave us the specific examples of people who would be at a tremendous disadvantage if the republican bill in the house became law. Or the bill in the senate that was offered by the Republican Leaders leadership became law. We heard about families of children born with severe disability 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 healthcare they need. We heard stories about how peoples lives would have been very much disrupted and they couldnt get the it was a matter of life and death. Im a strong supporter of the Affordable Care act. Im proud to have supported it. I am proud to be part of congress that passed it. [ applause ] the results of the Affordable Care act, tens of millions of people who did not have Health Insurance now have Health Insurance. The results of the Affordable Care act, you now have quality coverage. The coverage which you need. Preventive health care. It provides pediatric dental. We know the tragedy of the driver here 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. It eliminates the abuse of practices of private Insurance Companies, such as preexisting conditions. Being a woman is no longer a preexisting condition. [ cheering ] you no longer 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. But 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 Health Insurance. It was moving in the wrong direction. Im frequently asked, why didnt you come forward with some proposals with the republicans to improve it . Well, the train was moving in the wrong direction. I wasnt going to get on a train. There wasnt anything in their bill that i could support. I spoke out against it, and we 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 million, only 15 million. But it would actually have been worse, because the cap they put on the medicaid system was more severe. Im just going to applaud we the people as to how you spoke out, because we the people you know, they tried to divide you. They said, look, well make an exception for children that have very difficult conditions. And the advocates for the children recognize that that was no bargain that they wanted to get on, because if you cut the medicaid system, youre not going to have the facilities in our community to treat our children. System and they knew that if you cut the medicaid system, the states would not be able to maintain the coverage. So you stayed firm. You didnt bend. And we won the vote. And i want to thank the courageous republicans who joined us in that effort. [ applause ] they showed a lot of courage in their votes. Now, several months ago, i introduced legislation because im going to acknowledge the Affordable Care act is not perfect. It can be improved. I would also acknowledge that we never passed a major bill in the United States congress seeing how it works and seeing where you can make it better. I have said that from the beginning. Im a proud supporter of the Affordable Care act. It has done a lot of good. We can make it better. We can improve it. And my legislation deals with two major problems in our in the Affordable Care act. One is the lack of competition. Particularly in the individual market. Now, i want to define the problem so we understand its a serious problem. But it affects a relatively small percentage of the overall market. The individual marketplace, and thats the 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. And i can explain the reason for it, and theres ways that ways that we can 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 really 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 the Affordable Care act that we 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 government plan available. And its always its not going to go any place. Not 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 large increases in the individual marketplace, its because of three major factors. The first is that sicker people are joining the plan, whereas Young Healthy people are not. The president has announced hes not going to enforce the mandate. That means younger, healthier people are not going to join. Youre 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. But maybe 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 the Insurance Companies. Thats so they can reduce their copays and deductibles. That was supposed to be a required payment, but it fell on government to keep the premiums more reasonable in the individual marketplace. But there was a Court Decision that raises question as to whether its mandatory or not. Well, for president obama, that was no problem. Hes going to make the payments because thats part of the plan. President trump is raising questions as to whether hes going to continue those payments or not. Those costsharing payments were 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 of the uncertainty. We can fix that. My legislation mandates those payments very clearly so we know those payments will be received. The third thing that could be done, and this is not too much on maryland but its important in the country, is to use the reinsurance programs in markets that are relatively small. The reinsurance will spread the risk in small groups so that you have more reasonable premiums. It was originally used it has not been used. The Trump Administration is not using it. The legislation i filed would require the use of reinsurance, which would also bring down rates. Now, thats one part of the problem. Theres a 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. Weve got to bring down the growth rate of Health Care Costs in america. So my legislation looks at several issues that could dramatically reduce the growth rate of Health Care Costs. First on my list is Prescription Drug costs. You cant justify americans paying twice what canadians pay for the exact same pills that are manufactured right here in america. Its well past time for that to change. So my legislation requires the same discounting in the medicare system that we get in the medicaid system and the collective bar cannigaining tha get in the medicaid system so we can use the full market to bring down the cost of prescription medicines. That would be it saves hundreds of billions over the 10year window. Thats a major cost saving. The other is just as dramatic. And were doing a lot of this in maryland and i applaud our maryland legislators who have really taken the lead on this. And that is [ applause ] they deserve a round of applause. [ applause ] they stayed in the medicaid program. They provided coordinated care. They had a small market plan, a payer waiver. We dont have charity hospitals. Maryland has taken the lead in health care and we thank them very much for their leadership. Those in the state legislature. So what we want to do, though, in order to bring down costs is to use more coordinated integrated care models. So if you have a drug problem and you end up in the emergency room in the middle of the night and they give you drugs to keep you alive. And they then tell you to go home and seek treatment the next day, and the person never seeks treatment. Youve got to have the treatment available on site. We have programs that do this in maryland. We have the coordinated program in maryland between schepper and mosaic that does this. But we have to have more coordinated programs. I was partly responsible for the bill that passed the congress, the cure act that provides this integrated care model for addiction services. We got to use this more aggressively in differentiated fields. In kidney care, we can now do telemedicine so people can get their renal treatment at a convenient spot rather than having to travel a long distance. We can use telemedicine. Psycho telepsychic medicine. We can use these different ways of bringing down the cost of health care. So 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. To tell you, we, the people, have made a difference. We are not out of the woods. I dont believe for one minute that Mitch Mcconnell wont try to bring this bill back up if he thinks he has the 50th vote. So we may see this again. I am encouraged we have chairman alexander and Ranking Member murray, and we have the chairman and Ranking Member of the Senate Finance committee that i serve on, that are calling on bipartisan hearings and working together. Thats what we nee