Transcripts For CSPAN3 Democrats Hold Hearing On Impact Of House-Passed Health Care Bill 20170517

Please go to americaspeaksout. Or trumpcare. This is an ongoing conversation that we want to have, not just today. We know that there are other Critical Issues that have come up in the last 24 hours but we feel that its so important that we remain focused as well on one of the most important issues to all of us as americans and our families. Which is the ability to see a doctor, to take our child to the doctor and have afford medical care when we need it. Your voices are needed now more than ever. Because last week, republicans passed a bill, as we know, trumpcare that is a triple whammy for families. In my state of michigan and across the country. Higher costs, Less Health Care, all to pay for tax cuts for millionaires and billionaires. Unless youre vn Insurance Company executive or a very wealthy person, trumpcare is a very bad deal for you. 24 Million People will lose insurance. Medicaid will be cut by 880 billion to pay for the tax cuts for the very wealthy, leaving millions of senior in Nursing Homes, children, people with disabilities and work families with Less Health Care or no coverage at all. Seniors get hit with a huge tax, paying five times more for health care than younger people. Employer coverage is at risk for tens of millions of americans, and no no preexisting conditions are not really covered. We as democrats know that we need to Work Together to continue to make Health Care Better and lower out of pocket costs for americans, including Prescription Drug costs. But thats not what the republican majority is doing. And to make it worse, the Trump Administration is working overtime to administrative liver unravel our Health Care System. They are eliminating the payment structure for Insurance Companies that guarantees preexisting expe preexisting conditions and other are covered. No longer doing strong outreach so younger and healthier people are part of the insurance pool in order to bring the cost down. The new secretary of health and Human Services has cut enrollment time to sign up for Health Insurance in half. Why . So Insurance Companies will stop participating in the marketplace, and the republicans can then say, look, its a mess. People cannot get affordable insurance. Obamacare is failing. We know that health care is personal to all of us and our families. Thats why its so important your voice is heard today and we continue to hear your voices. Unfortunately, republicans have no hearings, no public discussion. They didnt wait for the analysis by the Budget Office of the cost and impact on people. Thats now how democracy is supposed to work. And thats why we are so grateful you have traveled here today to share your stories with us. Thank you and i would now turn to the ranking member, our leader on the finance committee. Thank you very much for the terrific work youre doing here. Im happy to be here with my partner, senator murray. The Health Committee and finance committee share responsibility. Good to be with all of you. One of the first rules in the senate is friends must not filibuster friends. So im going to be real short and just make a couple of points. The first is the reason its so important to have all of you here is that political change isnt top down. It doesnt start in government buildings and trickles down to the grassroots. Its not trickle down, its bottom up. So as all of you terrific organizations, go out and mobilize and go to Community Meetings and go to marches and rally for the agenda were discussing today its going the make a huge difference. People are really paying attention. I will touch on that. I want to come back to the point that senator stabenow as made and that is the hundreds of billions of dollars in medicaid cuttance the hundreds of billions of dollars in terms of tax breaks for the fortunate few for the wealthy are really two sides of the same poisonous coin. You cut medicaid that dramatically, people are going to suffer and i will tell you this idea of giving thousands and thousands of dollars of tax relief annually to the most fortunate and the most wealthy defies common sense and it doesnt pass the smell test when it comes to fairness. Thats number one. Number two is youre hearing talk about how maybe the Senate Republicans will rewrite the bill. There is no evidence as of this afternoon that they are moving away from this basic frame of hundreds of billions of dollars worth of tax cuts and tax breaks for the fortunate and hundreds of billions of dollars in cuts in medicaid. The last point that i would like to mention is that when i was home, and a described this as a tsunami of sufferings, a plague that is going to produce debt and anguish for thousands of people in my home state, we went generation by generation. It would be very helpful if all of you might consider that. The youngsters on special needs, no one knows more about this than senator hassan. We have 40 of the School Districts getting help. Medicaid for those youngsters. That is an area where the medicaid cuts will hurt. If youre 17 or 18 and you have a brush with cancer and are cures but these folks are able to redefine preexisting conditions. Those High School Students may carry that cancer condition like a Scarlet Letter through their whole life. Then i went on and talked about workers because the far right is trying to say to the workers you guys are home free. The house is going to lift the cap on outofpocket costs that people could pay and what this will mean is that the cap for example that limits what you could be charge for cancer will be busted and you get a cancer condition youll bust that cap in a hurry. Then theres the age tax for people who are 50 to 64 and then finally, the indignity with respect to Nursing Homes because medicaid pays for two out of three of the nursing home beds in america. This is pain and suffering that spans the generations. So im really glad that youre here. Senator murray, senator stabenow, and i, between us, are on the committees that will deal with it. Were lucky to have our colleagues with us. Chair stabenow, senator murray, thank you for all of our cooperation. I look forward to hearing from our colleagues. Thank you so much. Senator patty murray who is our ranking democrat and the leader on the health, education, labor, and pensions committee. Thank you for your leadership in putting this together today. Im grateful to all of our witnesses today, especially those of you who are sharing your personal stories. Its so important your voices are heard. Im hearing from people like you whose lives will be at risk. As a result of these harmful policies that republicans are pushing under trumpcare and one thing i hear especially often is worry about people who would withstand the skyrocketing premiums and higher outofpocket costs that would result if trumpcare would pass congression. Trumpcare would end the guarantee of the essential Health Benefits and decrease the availability of tax credits. What that means is that families that are at risk of losing access to Maternity Care or Mental Health or Substance Abuse Disorder Services and Prescription Drugs would really be in trouble. Trumpcare would increase premiums by as much as 20 . Average costs will go up on middle class as well as lower income enrollees and trumpcare would be especially devastating for Older Americans by allowing plans to charge higher premiums effectively raising what is known as the age tax. What is clear is that trumpcare is not about helping patients or families. It is about President Trump getting his way and delivering massive tax cuts for Insurance Companies and the very wealthy. That might be a great way to score political points with their base but it is not good for patients and it is not good for families. My hope is that todays hearing will help bring more discussions around that will allow Senate Republicans to get them the message that they should once and for all drop their damaging, politically motivated effort to undermine our Health Care System in ways that raise costs for families. And i hope instead they will work with us to continue fixing our Health Care System so that it works for patients and families. And im confident that millions of people who have been speaking up and making themselves heard will continue to the so and are prepared to hold republicans account fastball they choose to stay on a partisan harmful route. I think all of my colleagues who are coming, and are here now. This is one of the most important things to families that we should be talking about. Thank you, so much, senator murray. And we are grateful for all of our colleagues who have joined us. We stand united in our concern and our determination to make sure that people in this country, that we all have the health care that we need that we can afford and are working together to make things better, not take health care away. Were now pleased to hear from our witnesses. And i will introduce everyone and then well start with mrs. Johnson. Cindy johnson is from bloomington, indiana. Cindy will share her familys story of fighting for health care for her daughter. And we are very grateful you are here. Gina walkington, from wisconsin. She will share her story with Preventative Health and family planning. Excuse me, planned parenthood. Carol hardaway. I think we have two additional senators r, i know they want to be here and both are champions for health care. So in their absence i will introduce carroll she will tell us her story about gaining Health Care Coverage as a result of Medicaid Expansion and what it has meant to her. And michael dunkley. I will turn to senator kaine for this one. Thanks mr. Dunkley for being with us. Just quickly about michael. Michael has a very powerful story. He shared it with a because i put a story on my Senate Website and i asked people to share what would happen to them if the aca were repealed as the republicans in the house essentially did and as we fear the Senate Republicans are trying to do as well. He will tell you a story. Its a powerful one. He is a fulltime caregiver for his wife who has m. S. And at age 64, he was diagnosed with cancer. Dealing with both being a health care caregiver for a wife with a serious physical condition and dealing with a cancer diagnosis, you know, thats more than anybody should have to bear. But having to bear with it in a system that has a humane Health Care System versus one that has no Health Care Safety net is dramatically different. Well hear from mr. Dunkley about that story. Thank you very, very much. Next we have teresa miller, the pennsylvania insurance commissioner. Commissioner miller will speak about the Health Care Markets in pennsylvania and how trumpcare will affect her state. I indicated earlier to you that senator casey was singing your praises and is so grateful for your being here today. And then finally, rod nelson. Rod is president and ceo of mackinow health in michigan. Congratulations on your recognition as world hospital leader of the year. We are privileged to have you with us today. Rod is here to talk about the challenges for rural families in accessing quality Affordable Care. Lets start with mrs. Johnson. Thank you so much. Honorable members of congress it is my great privilege to be with you this afternoon. I want to thank senator stabenow for this invitation to share my familys story today. I come from a background of generational poverty in southern indiana. My parents were among the working poor and relied on food stamps to make ends meet. We couldnt afford Health Insurance so it was a good thing i was a Pretty Healthy kid. I worked diligently and became the first person in my family to go to college. I worked as a math teacher for a number of years. Later when i wanted to start a family and discovered i would have a baby girl with down syndrome my life changed dramatically. It became very clear after her birth that to coordinate her medical care i would have to be a stay at home mom. We went from a twoincome family with no medical expenses to a singleincome family with massive medical expenses. I remember opening an envelope from the hospital with a bill for 64,000. And that was just to rent the equipment in the hospi f for her surgery the month before. I began to realize this was our new reality, because more bills would soon be showing up. It felt like the hardearned middleclass lifestyle that worked so hard to attain was slipping away. Over the next several years, the bills added up. Besides deductibles and co pays there were many expenses that insurance just didnt cover. Medical equipment, hightier medications, therapies, specialized feeding supplies and more. Testing led to testing and no answers. Our outofpocket costs are spiraling with no end insight and my daughters condition was deteriorating. We took out a home equity line of credit and while my lifetime cap was fast approaching. Then came the Affordable Care act and i gained peace of mind knowing that lifetime cap had been eliminated. After eight years on a waiting list, a daughter became eligible for medicaid disability. That covered much of what private insurance did not. That has meant a much brighter financial future for my family. I have reentered the workforce and have made progress paying down our medical debt and even saving for college for my other two children. Im grateful for the protections of the aca. Thats an understatement. And the safety net it helps families around the country. I know and love in their stories i share with my consent. For my son am a his fifth grade classmate he has epilepsy and lives in the same state as senator wrong. For my former colleague, who has a daughter who requires a tra tracheotomy. For my friend in indiana whose quadruplets sons, two of whom are on the autism spectrum and one of whom has Cerebral Palsy has been able to seek employment and live more independently in their community. Thanks to the medicaid waiver. For a friend in louisiana whom i only know through facebook has many medical struggles struggles. His son has a mental condition due to a rare disease he contracted at three months of age. For my friend here who has my back. The mother of this beautiful 11yearold who was born blind and has Cerebral Palsy and microcephaly. Right here in virginia and for my own precious daughter with down syndrome who had Successful Surgery last year and for the First Time Ever is attending school fulltime and speaks with pure joy about the friends she is making there. As a parent, nothing else matters when your child is sick. Your world shrinks and Everything Else just falls away. I would have sold my house, my car, literally done anything to make sure that my daughter had access to the care she needed. No parent should ever have to have that worry and wonder if theyre going to have the lifesaving provisions that their child needs. To avoid bankruptcy. The Affordable Care act meant the difference between life and death for my daughter and Financial Stability for my family. It has given us a chance to seek a financially secure life that we would have been hard to achieve otherwise. Senators, i urge you to do whatever necessary to preserve the provisions of the aca including the elimination of lifetime caps, protections for those with preexisting conditions and coverage for essential Health Benefits. I urge you to reject anything to funding including the per capita models would reduce access for people with disabilities, low income households, seniors, and expecting morris and expecting mothers and others. I ask you to encourage health care for americans because we do everything we can to keep it accessible and comprehensive. The stakes are just simply too high. Thank you, senators, for your time and consideration. Thank you. We apologize for the microphone going on and off. Im not sure what thats about. Thank you so much for your testimony. Thank you for inviting me to be here today i am honored to share my story with all of you. My name is Gina Walkington and i live in bristol, wisconsin and im a mother to three rambunctious, energetic, amazing boys. I am here today because i know that if i did not have access to planned parenthood in my 20s, i wouldnt be a mother today. In 2006 when i was 20, my best friend and i made appointments to get exams at planned parenthood. We went for three reasons. At 20 i was uninsured. Although i was insured through my parents the topic of sexual and Reproductive Health was not something that was really ever discussed or we were comfortable talking about. And the sliding scale and privacy of planned parenthood was essential to me as a 20yearold woman. A week after my appointment at planned parenthood, i had a pap test and got a supply of birth control. A week after planned parenthood called to explain that my test came back abnormal and they found precancerous cells in my cervix. For a 20yearold woman in college, thats a terrifying thing to hear. So many things run for your head when you hear precancerous cells and in addition to other fears i knew that if it was left untreated i might not be able to have children. At that time as a 20yearold i hadnt really thought about kids. I wasnt sure it was even something i wanted but when faced with it possibly being taken away it suddenly becomes very precious to you. The clinician at planned parenthood walked me through what to do next and helped me move quickly so the cells did not have a chance to spread. I quickly had a procedure done to remove the cells and now a healthy mother of three. Had planned parenthood not been so easily accessible and affordable to me, my life might have turned up radically different. Had i waited to get care, i could have lost the ability to have children, or even died. Planned parenthoods Preventive Care is what saved my life. I am not the only person who can say that. Another woman i met who lives in wisconsin, whose name is christie went to planned parenthood to get a pap test in her 20s. Her cancer cells were more widespread. She was able to get them removed, and is here today, but is not able to have children. If she were here today she would tell you that planned parenthood saved her life too. Planned parenthood provides cancer stricreening to 650,000 people a year. Nearly 72,000 people had earlystage cancer or abnormalities in 2014 alone. I joined with four of those women to to draw attention to how essential planned parenthood is. For making cancer screenings accessible and affordable. Through the network, i met a woman from rural Northern New York who couldnt get an appointment to check out the lump in her breast for three weeks. She called planned parenthood and they got her in that day. I met a woman who at 19 had a footballsized tumor on her ovary. We are just a few of the thousands and thousands of women whose lives have been changed by planned parenthood. The American Health care act would block people from going to planned parenthood for Preventive Care. Republicans supporting this bill have suggested that those people could go to Community Health centers. Where i live there are two planned Parenthood Health centers and two Community Health centers that provide screenings and birth control. They have said that they would not be able to accommodate the patient load from planned parenthood as they are overloaded and refer many to planned parenthood. For women, Reproductive Health should not be treated as a luxury. It is essential. Every woman deserves access to the care that planned parenthood provides. It is irresponsible and dangerous to block access to an woman because of where they live or how much moneyt they make. When i think of planned parenthood i think of my three boys who are here because of the care that i received. Im telling my personal story because i have learned to be brave. I need to speak up because there are millions who need care that planned parenthood provides. So today im asking you all to be brave for me, for my community, and for the women of this country to please stand with planned parenthood. You are looking at a lot of brave people here all of us together. I mentioned earlier that senator van hollen was going to be joining us. Im going to turn to him for a moment. Thank you for telling your personal stories. And to ms. Hardaway, thank you for coming from marylands Eastern Shore to tell your story and i believe along with my colleagues that its going to be that personal testimony that you all provide that will turn the tide ultimately. Because we can talk about the statistics and all the cuts in dollar terms but you can tell that story in human terms. So to my colleagues, Carol Fisher Hardaway is here to tell her personal story. Thank you for convening this critical hearing and for the opportunity to share with this house repeal bill would mean for me and my care. I look forward to testifying before you today. My name is carol hardaway. When i was 32 years old i reached into my babys crib only to realize i could not feel him. My arm felt like it was asleep. Like i must have slept on it wrong. I grabbed my son with the other hand and did not give it much of a thought. Within minutes after arriving at the bar for work i couldnt hold the glasses and shakers i needed to do my job. Something was wrong. And i needed to go to the hospital. They tested me for everything. Stroke, meningitis, you name it. The tests were inconclusive. I was sent home a week later with no diagnosis. Four years later, i had issues with my vision. It began to rapidly deteriorate taking me from nearperfect vision to near legally blind. I went to an optometrist. He didnt know what was causing this woman in her 30s to lose vision so suddenly. He passed me to an ophthalmologist, then retina specialist, then a neurophthalmologist. Who did an mri. The scan showed tiny specks on my brain. Lesions. Clearly multiple sclerosis. Quite a diagnosis for a single mother whose only son was about to turn 5. As you know, ms is a debilitating nervous disorder. There is no cure. For me it is led to fatigue, increasingly painful spasms and the occasional attack, which is an intense period of heightened symptoms. Those days, sometimes weeks are the worth. To be clear, m. S. Does not define me but it does inform how and where i live. Allow me to explain. In 1995, i lost my Health Insurance when my husband and i started our own business. From that point forward i was uninsurable. Along with my debilitating and chronic conditions, i survived two heart attacks. Not exactly the type of risk you want on your books. When i tried to qualify for the texas highrisk pool which was terrible insurance, by the way. I needed declination letters, declining letters from health Insurance Companies. Shouldnt be too hard, right . Yes, xyz company, like to enroll in your plan. Female, nonsmoker, two heart attacks, high blood pressure, depression, oh, and multiple sclerosis. Every insurer i called laughed at me. That what was health care in america meant before the Affordable Care act. That all changed on march 23rd, 2010 when president obama signed aca into law. I could not be more grateful for him than every other senator and staffer and advocate in this room who made that happen. Thank you all from the bottom of my heart. My health continued to deteriorate, but i finally had hope. At that point i was walking with a cane and couldnt always put my own pants on. I had to bring a stool to the garden because i wouldnt sure i could get back up. I would pick up shifts around town to pay the bills but i couldnt always go in and sometimes when i did, id fall. Taking lunch plates and my dignity down with me. Rick perry chose politics over the people of texas. It became painfully clear that the only way i was going to be able to get care and it was becoming urgent was a to leave my home and to move to maryland. On january 19, 2014, my son showed up to my home in texas with a moving truck. The High School Football team came over to load the truck go bobcats, and this began my 1400 mile journey to receive quality Affordable Health care. Within two weeks, i started receiving treatment for ms, 24 years after my initial diagnosis. This is all thanks to the Medicaid Expansion. My weekly shot manages my symptoms and significantly cuts back on my spasms. Because of this im able to work as a proud substitute teacher. When my Health Declines every six months my neuroyolgs orders an antiinflammatory steroid infusion. This dramatically improves my energy, speech, and overall function. I got a shot last week and im a whole new woman. The House Republican health or appear Health Repeal bill cuts medicaid even when President Trump promised he wouldnt. Under the republican plan i would be the biggest loser. Not only would i lose my medicaid, the new age tax would make coverage or treatment completely unaffordable. Ill tell you the same thing i told my congressman, andy harris before he shut off his phone lines. The House Republican Health Repeal plan would put me in a wheelchair. Those who say that medicaid is broken dont know how it has fixed me. Let me be clear as i stand here before you, as a 63yearold working woman m. S. , Medicaid Expansion is working. Dont let them tell you i cant see a doctor or a specialist or a hospital or a pharmacy. Not only am i not having any problems with the coverage, Medicaid Expansion is my lifeline. You have got to save it for me and the millions who depend on the coverage. Fight like hell because we will be fighting like hell right there with you. With that ill be happy to answer any questions you may have. Bravo thank you [ applause ] thank you, carole, thank you to all of you. You reaffirm and energize us. Thank you so much. Mr. Dunkley . Yes, thank you. Thank you. Good afternoon and thank you to senator stabenow for inviting me to participate today in this discussion. My name is michael dunkley, i am 64 years old, and i live in alexandria, virginia. And im here today to tell you my experience with the Health Care System over the last several years. In the summer of 2013 i was experiencing increasing series of back pains which i attributed to just my declining physical season. Condition. But over the summer it became worse and worse. Your story is so resonant, because my wife has been battling multiple sclerosis for 24 of those years and her condition is actually in a more advanced stage. She has whey what they call secondary progressive. She has been on Disability Insurance for some years now and i am her care giver. She convinced me to go see a doctor. He initially thought that it would be a hernia. They did a ct scan and on friday afternoon an hour after i got home the phone rang and the doctor wants you and your wife in his office on monday morning. Would you like to speak to the doctor . He said, forget the hernia, you have masses all over your chest wall. Youll have to start thinking differently. Have a good weekend. So monday morning we go in and he throws a bunch of stuff on the screen and says this is lung cancer, third stage, who is your oncologist . Boom, boom, boom. He got me to see an oncologist immediately, and after a series of many tests them a it was determined that i had nonhodgkins lymphoma, large cell, stage four. I asked my oncologist what was stage five. His office overlooked Arlington National cemetery and he said, that is stage five. That is where my father a Marine Corps Office is buried who died from multiple sclerosis. So we have these threads weaving together. The first day you could register for the Affordable Care act. I got two thirds of the way through the system and it stopped working, but i knew that it would not take effect until january 1. The other thing that was running along is at this point i was unemployed and i was paying for medical insurance through my cobra plan. Which was 875 a month. In early december, i spoke with a representative at healthcare. Gov and in 15 minutes i was completely registered and had a brandnew plan that would take effect january 1. December 31, my cobra expired. A minute later i had a new plan that with the subsidy, i was paying 575 per month. Which was less than the 875 but i also had a plan that had a zero deductible and an 850 out of pocket limit. Three days after that policy started i had my fifth chemo that generated charges around 35,000. I had another round of chemo and on february 14 the next year, my oncologist reformed me that i was in informed me that i was in 100 remission. What the internal medicine guy had thought was lung cancer was this membrane cancer had spread throughout my body, my lungs, my stomach, going down my throat. The bulges were due to lymph nodes that are normally the size of a grain of rice, to the size of a lemon. There are crushing my vertebrae come up my spine, my ribs. So that very initial series of transfers that the Affordable Care act gave me got me through the first chemo. Since then, because of a problem with the chemo, both of my hips broke and had to be replaced. That generated probably another 140,000 in charges. I continue to have these p. E. T. ct nuclear scans. I am in remission. I am able to continue my lifes joint of loving my wife, taking care of and helping her, and i am so honored to be able to speak out. There are millions of voices, stories that are far more complicated, but they come down to a bottom line and that is we are all sailing on this ship of life together. And youre on the voyage so lets help everybody as we go along. Getting back to the Affordable Care act. I say patient care and Affordable Care act. Both components protected me. I could not be declined for a preexisting condition. I was in the middle of chemo with massive cancer everywhere. They wouldnt have given me a policy or i would have had to come up with the cash to pay for the procedures, 35,000 here, 5,000 there. I will turn 65 next month and i will be going off the exchange and going on to medicare. I am just optimistic that will continue the exist. Really, to be honest, the only way that we can endure is with a singlepayer system. To invest in the health of the people makes the body politic healthy. The nation will thrive. When people are sick, they cant function, they cant perform, its a drain. And i really look forward to the session and look forward to actually seeing the Patient Protection Affordable Care act strengthened rather than jetsonned. We are so pleased that you are here and doing well. Commissioner miller . Welcome. Thank you, good afternoon members of the Senate Democratic policy committee. Thank you so much for the opportunity to be here today. I applaud the committee for holding this hearing to highlight the Significant Impact that repealing the Affordable Care act and replacing it will have on millions of americans. Im just really honored to be on a panel with so many brave people next to me. Before the aca, sick people often couldnt get Health Insurance due to a preexisting condition or if they could, they paid significantly more for it. They could face annual and lifetime limits. That left them financially devastated. Women would often see higher coverage costs than men and not have access to contraception or Maternity Care covered. Critical Services Like Substance Use Disorder Treatment and Services Like Prescription Drugs were often difficult, if not impossible, to find coverage for. Most importantly, more than 10 of pennsylvanias and more than 16 of americans nationwide went uninsured. Since the acas passage, the national uninsured rate has fallen to 8. 6 . Pennsylvanias uninsured rate has dropped to 6. 4 , the lowest its ever been. In my written testimony, i provide statistics on how millions of pennsylvanians have benefited from the aca. And statistics are important. But as this hearing demonstrates, whats absolutely critical is that we dont lose sight of the fact that behind these statistics are real people, real human beings that will be significantly impacted by changes made to our Health Care System. Im not going the sit here today and tell you that the aca is perfect. Its not. But the narrative that the republicans in washington are pushing that the aca is failing and unless Congress Takes action, it will implode, is just false. Millions have benefited from the aca and the employer markets have seen a moderation of cost since passage of the aca. There are legitimate issues with the individual market. But this is a small market generally covering about 5 of the population and this is also the market heavily subsidized through the aca. I generally hear from the 1 to 2 in pennsylvania who dont have access to this assistance. It is this small population that do not have access that the market may not be serving as well as it could. While individual markets are facing issues, in pennsylvania, i can tell you that the market will not implode unless the federal government takes adverse action like refusing payment for cost sharing reductions that would cause it to implode. Unfortunately, instead of having a conversation about how we make sure everyone in the individual market is served well by the system, in other words solving a real problem were talking about repealing the Affordable Care act and replacing it with a system that could result in 24 million or more people losing their Health Insurance. I want to offer context on some aspects of the bill that passed the house last week. Her has been a lot of talk and a lot of confusion about how the ahca does or does not protect people with preexisting conditions. Many of the republicans who voted for the ahca insist that people with preexisting conditions will not be adversely impacted. With the addition of a lastminute amendment last week, states have the option to return to a preaca world. States would be able to opt out of the Health Benefits requirement meeting consumers with Significant Health needs could be playing more for less robust coverage. States that receive these waivers would be required to establish high risk pools. To provide coverage for sick people. Historically, high risk pools have not proved to be an effective way to cover highrisk individuals. If you look closely at the experience of the 35 states who had highrisk pools before the aca as well as the federal governments experience running the preexisting insurance plan, one thing is clear, there didnt ever seem to be enough money to run these highrisk pools in a way that truly protects people with preexisting conditions. So you end up with high prix yums, coverage limbation and enrollment caps to address these funding issues. The ahca removes requirements that Insurance Companies offer plans with cost sharing. It may make coverage less expensive but it shifts the costs to consumers who see the out of pocket costs. Additionally, the ahca moves subsidies away from premiums that help lower premiums to adding flat tax credits based on age and eliminates all assistance which helps lowincome americans pay for out of pocket costs. It is hard to see how these changes do not result to the preaca world where more people opt to go without care because theyre concerned about the costs. The aca is not perfect, but the ahca is not the solution. Instead of talking about a plant plan that will result in at least 24 million americans losing their insurance, reducing benefits covered by insurance and shifting cost of care to consumers we should talk about common sense changes to our system that will ensure the promise of the aca, access to affordable and Quality Insurance and health care is a reality for all americans. Thank you. Thank you so much. Before turning to mr. Nelson i know that senator Maggie Hassan is going to be leaving and wanted to say a few words. We thank you for your passion and strong leadership. Thank you very much. I do regret i have to leave. But i want to thank all of the panelists who have spoken. Mr. Nelson, i will get a report on your testimony. To echo what my colleagues have said, when people throughout our country stand up and speak up about what their real experiences are like, that enables us to make change. I have shared some of the experiences of some of you at the table. Mrs. Johnson, thank you for your testimony. We share special children. So i look at health care from the perspective of a senator, a former governor, and a mom of a young man whoser cerebral pals condition is stable thanks to the health care he has received. You are all speaking about the value of health care to all of us as individuals. To us as a community of americans who know that we need to be healthy to thrive together. I am very grateful to all of you. I look forward to working with you and so many other americans who are speaking up about their experiences. Speaking from their hearts about what the aca has meant to them and commenting, commissioner, as you just did about the fact that the aca isnt perfect but there are ways to improve it. Lastly. It is the priority that i bring to the senate on behalf of the people of new hampshire. It hasnt been covered in todays testimony but Medicaid Expansion made possible by the aca is absolutely critical to new hampshires ability to fight the heroin and Opioid Crisis that is ravaging our state. I want to make sure i am expressing for all of my constituents how important the aca is as we combat the terrible epidemic. I thank you for being such a strong advocates today. Take care. Thank you senator hassan, and mr. Nelson. I recognize that chapter. That is the Upper Peninsula of michigan. Yes, it is. Thank you for the opportunity to speak to you this afternoon. This is an incredible privilege. Thank you. My name is rodney nelson. I am the president and ceo of this Health System in michigan. Our main campus, built in 2010 with Usda Rural Development funds, a critical program, includes a 48bed nursing home, a 15bed critical access hospital that provides 24hour emergency room care primarily for rural patients with a 25 to 30mile radius and the millions of visitors that come to the straits region annually. We also operate the mackinac medical center, and the straits area pharmacy which is opening midjune with the support of the 340b Discount Drug program. It would not have happened without it. For the first time in 18 years that i have lived there our community will have access to Prescription Services on saturdays and sundays so they dont have to drive 60 to 100 miles round trip to the walmarts in the surrounding communities. Were unique in that the second floor of our hospital is occupied by the tripe of chippewa indians Tribal Health services. They donated the land our hospital is on. They contributed funding. They are a separate entity. They are licensed separately, accredited separately but we Work Together and we actually share a board room together as a symbol of the relationship. Additionally we have patients who travel up to 70 miles one way for chemotherapy in the upper pencely in communities like trout lake and curtis, michigan that are 35 to 50 miles away. We provide Outpatient Surgical Services for the first time in the Community Since 1980, so our community doesnt have to travel. For basic surgery services. If significant provisions of the Affordable Care act are stripped away, mackinac straits will anticipate cuts in the millions of dollars. Among the services that could be discontinued and but put this together quickly, could be the Chemotherapy Program i just mentioned, a Pediatric Program that employs a physician assistant and parttime physician, a seven day a week walk in clinic. And many other services on the island would have to be drastically cut back. The American Health care act as passed by the house would be detrimental to my city, to the county, and the hospitals across the state. Not only does the ahca reduce funding for medicaid, but traditional Medicaid Programs as well. Here are a few data points. In Mackinac County, 7. 9 of our residents under 65 are enrolled in the healthy michigan plan. Michigans Medicaid Expansion. Because of a trigger in the provision in our medicaid engs passion law michigan is most likely to lose the healthy michigan plan effective january 1, 2020. Under the ahca this means 7. 9 of my community loses its coverage overnight. It does not include those who will lose coverage under changes that could be made to the individual market and the cost of coverage. This is immensely frustrating after the effort we expended in the eastern Upper Peninsula to enroll eligible individuals in the health care benefit. Three hospitals in the sioux, the sioux tribe worked together to do this. On average, michigan hospitals have seen a 50 decrease in the number of people coming to the hospital without an insurance card. If 100 people came without a card in 2013, in 2015, it was only 50 people coming to the hospital without some type of coverage. The ahca undoes most of that progress. In march 2017, Mackinac County had a 20. 5 unemployment rate. 20. 5 . We are 83 out of 83 in the state of michigan. Recently the healthy michigan plan makes a huge difference to their ability to maintain their health, to find employment while our area continues to struggle with economic recovery. The ahca is doubly cruel because the heltds system is the largest employer in the county with 300 employees and a payroll in excess of 14 million. Thats in a county of 11,000 people in a town of 2500. 50 of the hospital is invested in our 50 of the operating costs are invested in our employees. The ahca limits Health Benefits for the people who can least and at the same time continues to reduce medicare reimbursement for our overall Health System. Michigan hospitals will give up 10 billion in medicare reimbursement between 2010 and 2026 under the Affordable Care act. This is the hospital contribution to coverage expansion. While the ahca eliminates the bulk of coverage expense it keeps cutting the hospital reimbursement. Michigan hospitals keep paying for coverage that no longer exists. Between 2010 and 2026, the 24 hospitals in Congressional District one will see cuts of more than 500 million. These funds were intended to expand coverage by expanding coverage hospitals would retain the revenue necessary to retain our staff andically in additions. If hospitals continue to experience reductions and our patients lose Health Care Coverage, Accessible Health Care Services will not be available for our communities. Since 50 of our operating expenses are for salaries and benefits its obvious we cannot find adequate savings to offset this tragic financial impact. We are vested in a healthy community. And the ability of our patients to obtain Health Care Coverage, access to Health Care Services when they need it is critical in the county. It is no a wealthy area, as evidenced by our high unemployment rate. One illness can bankrupt a family, one bankruptcy could mean the end of a small business, job loss, more downward pressure on the overall economy. The ahca threatens coverage and threatens our Health Care System. Its that simple. Thank you. Thank you very much for that testimony, rod. And well now turn to questions and well call on colleagues in order of their coming into the room and myself and senator murray and proceed with other colleagues. I do want to welcome people who have been live streaming. Were glad to have you with us. Weve had several thousand people so far that are tuning in and we would welcome you to join us in the conversation by joining americaspeaksout or trumpcare and we want to continue the nelson, im glad y mentioned jobs. Obviously the most important thing is access to affordable also an issue of jobs. We know under what House Republicans passed were told that this could cost us three million jobs across the country. You are the largest employer, as you said, in your county. I assume that for a lot of other communities that i know well around michigan that thats the same thing, right, in other communities as well . Thats correct. Yes. And so if youre not there, then the doctors arent there, the health care is not there, and the jobs arent there. I did want to ask you about another impact, which you have a great 48bed nursing home. Im pleased to work with you on developing that. Im wondering about the impact of the medicaid cuts on your nursing home and the patients that you serve. You know, i asked that of our administrator. Were really proud. We have a five star rated facility, and it took about five years to get that through the dedication of our staff. I asked our administrator if we have cuts whats going to happen. He said, youve got two choices. Either you want good care or our residents are going to suffer, because where do you cut in a nursing home . You cut the staff. I mean thats the only place you can really cut. So i think if lets see, 95 , we have 48 beds. What kind of care can we give or expected to give if we cant pay our employees . I mean either were going to invest and take care of our seniors, our most vulnerable, or were not. I just dont understand, theres not a choice here. I understand. We know that the majority of those in longterm care and nursing home care, receiving that care through medicaid, so this is very serious for seniors. Mrs. Walkington. Thank you, again. If plan parenthood didnt have a kli clinic or didnt exist, how would you have gotten your Health Screening . I believe i wouldnt have. At that time, being 20, i wasnt thinking that i was going to get the results that i did. The driving force to going was having a place like planned parenthood that you could get birth control, std testing, you know, at low cost, safe screenings and private, judgment free. So i really believe that i would have just waited, and who knows where i would be. Well, were glad planned parenthood had a clinic and that you didnt wait. Thanks. Thank you. Mrs. Hardaway, could you talk a little bit more about your experience in high risk pool . Were hearing all of this talk about preexisting conditions are still covered even though we know as a fact that thats not true in terms of it being part of insurance and that costing more and maybe even bankrupting people in the process. Could you talk to us . When i first when i first found out about the high risk pool i thought, well, theres an opportunity. Looking into it further, it required a 15,000 annual deductible. 15,000 a year for a long time, because i fall into the gap. It also was approximately 600 a month premium. Well, with treatments that im now receiving through the Medicaid Expansion, one of those treatments would cost 15,000. Just one. And so the high risk pool, yes, it is high risk, but also very, very high cost and absolutely formidable. I couldnt have afforded it, you know, even if it was available. Thank you very much. One more question and then ill turn to senator murray. Mr. Dunkley, you were diagnosed with cancer when you were in your early 60s, and we know that the trump care plan would allow Insurance Companies to discriminate based on your age and charge you up to five times more or if theres a waiver unlimited amounts of money. What would that kind of an age tax on your health care have meant to you and to your family . Well, taking january 1st, 2014, my cobra had expired the night before. That plan was 875 a month. I had a 15,000 outofpocket limit and 7,500 deductible but i had a health plan. If it had been a five times greater cost, the plan i was on was a platinum plan that i chose through healthcare. Gov. My portion was 575, the normal cost is about 1,100. Multiply it by five, it would put it close to 6,000 for a months worth of health care which was actually less than again, with the deductibles and the out of pocket. It is just catastrophic. You know, youre under so much strain when diagnosed with cancer, especially stage four, that you become sort of focus on just every moment of every day. To have the knowledge that, again, during that time when healthcare. Gov was about to take effect, that gave me a few nights restful sleep. Without knowing that was going to happen, if things had stayed the same, despair, anguish. Again, for a while there during the chemo i couldnt walk. I lost 30 pounds of muscle mass in 30 days. This new plan such as it is, is so draconian in the way that it distributes the pain. Were all going to experience pain in life the longer we live, and to me these are questions that almost shouldnt even be asked. As a child my favorite story was the emperors new clothes. When you see something that is so obvious, that person is ill, lets help them, it doesnt come down to ideology, it is just basic human empathy. I felt thats what was absent with what is proposed, with no hearings affecting 20, 30 million americans and they dont have a hearing . As far as i know, the process was limited. The dead of night literally the thing appears. To be honest from what ive legislation because it doesnt exist on the capitol website because of the amendment. They dont even have the final pdf. So we dont know whats in it per se, but the senate plan that is going to materialize somehow, there are no female members of the staff. I understand there are female senators as far as i can tell. There are. Yes, there are. Again, as was said earlier, this is a nonstarter. The Patient Protection Affordable Care act has worked. It is not perfect, but it is a step in the right direction but, again, it just comes down to basic human decency for our fellow citizens, our fellow travelers on this great voyage. And a healthy compatriot is you walk forward together. It is not zero sum. Thank you so much. For me to advance, you dont have to retreat. So thank you. Thank you. Senator murray. Again, thank you all so much for sharing your testimony and your stories. I am listening to you and, mrs. Johnson, im positive when you started out you never expected to have a child on medicaid, and i hear so many derogatory comments here from people about medicaid. Well, we can cap it, we can cut it. Those people can get a job. I mean we should have a big banner here that says, there but for the grace of god and remind all of us what can happen. So i appreciate your sharing that and we need to remember that. Mr. Johnson, mrs. Hardaway, your stories hit me personally because my father was diagnosed with multiple sclarosis when i was 13. Seven kids in the family, my family didnt expect that. Had a huge impact and, of course, this was long before aca benefits. I remember my parents struggling so mightily, being turned down by Insurance Companies, not going to the doctor. My mom fell and broke her foot once and never went to the doctor, limped around for months and even years but never got her foot set because it was one more bill they couldnt afford. So this was before aca. This is america. We shouldnt have that. I remember asking my parents one time, you know, how are we going to get through this, and my mom said, were crawling to medicare, and she was in her 50s. So we dont we dont want to go back to that and we shouldnt have to go back to that. We are a much better country than that. So i really appreciate your coming and reminding us all of how where but for the grace of god and that we have a responsibility to make sure that no one in this country lives hoping to crawl to medicare. So thank you, all of you. Mrs. Walkington, thank you for talking about planned parenthood. It has been lost in the fog of the other things that have gotten out, but the fact is that the house bill will take 2. 5 Million People away from access to health care, and you talked about the privacy thats so important. It is why you went there. What i hear the rhetoric here around is, well, you will find another place, you can go to community clinic. You said a minute ago you would not have gone, so you would be a statistic that is extremely expensive perhaps, even loss of life, because you didnt go because you didnt have that capability to go someplace where you felt that you were going to get the kind of care and privacy that you needed. So i am deeply concerned about that, and you have talked you have a Cancer Survivor Group through planned parenthood which is awesome, but you must hear this all the time from people. So let me ask you the question that i hear from the other side. You can go somewhere else. What do those people tell you about going somewhere else . Thats really not a possibility. So i live in a very rural area of wisconsin. I live in speaker paul ryans district, and people in rural areas already struggle to get to their doctors. I know, you know, the last thing that the majority of my neighbors would want is less access to health care and less access to doctors. I saw a poll recently that said 55 of paul ryans constituents are against defunding planned parenthood. They want planned parenthood to remain funded. The Community Health centers in my area, of which there are only two in the district that provide Reproductive Health care and cancer screenings, so it would be comparable to planned parenthood, they have waiting lists that take weeks. You dont know how what can happen in those weeks, how quickly things could spread. If you were a young person like i was when i went to planned parenthood, what can change in weeks . You forget, you decide not to make the appointment. You know, especially people who are sick or worried about a lump like some of my friends from the cancer network, Cancer Survivors Network of planned parenthood, you cant wait several weeks. And planned parenthood can see patients sooner, and thats really the standard that all Health Care Centers need to be held to. Okay. Thank you. Mrs. Johnson, i want to ask you because this is one that i understand a lot about. Cutting the essential Health Benefits that the that the house did would hit preexisting condition which we are hearing a lot of talk about, but it would also deal with the Lifetime Benefit cap that has been taken off because of aca. How would that have impacted you . Well thank you. Well, there are months when my daughters medications cost more than my husband makes in a month, and eliminating essential Health Benefits preventive measures that keep people healthy, thats just unconscionable to me. And so [ inaudible ] struggle to keep her healthy and, again, you know, there were a lot of things that werent covered by insurance but a lot of things that were. And, again, we there were so many expenses that were piling up besides what was covered [ inaudible ] policy, but when you were looking at the numbers under the policy, if she had reached her lifetime cap [ inaudible ] family would have lost their Health Care Coverage. So not just my daughter, but it is this kind of collateral damage. So everyone in our family would have been [ inaudible ] and because some Insurance Companies just having Downs Syndrome itself is a preexisting condition, i have a friend who [ inaudible ] coverage when their child was born with Downs Syndrome. They were told they could not put that child on their familys policy because they were born with [ inaudible ]. Thats there from the very beginning. So and these Health Care Costs for these families pileup so quickly, and those [ inaudible ] and annual caps, quite frankly, are literally the life line, so that they can make sure that they can pay for their childs medications that month or their treatments or whatever it is that theyre needing access to that month. Thank you. Thank you again to all of you. Really appreciate it. Thank you so much. Senator booker, welcome. Thank you. You know, it is tough not to get emotional when you hear these incredible stories. I want to i just want to thank you all for your testimony today. You know, it hits home because the stories you share are stories that ive seen in my own state and from people hotel me that the Affordable Care act literally, once they were able to sign up, it just changed their lives. And when youre struggling and you all tell this story so courageously, that the struggle with the illness alone, but then to add on to it the anxiety, the stress and the worry, i will even say the trauma of not knowing if youre going to be able to balance your illness with rent or with food. Mrs. Hardaway talking about and i was talking to my mother about youre fighting just to hold on to your dignity and to do the things that people take for granted. And to think that i live in a country where and this is what got me last week, because im just a guy that was taught to love and respect everyone. But to watch people pass a piece of legislation and literally not even know what it would do to the country and to their constituents, and to be able to shut out the voices within their own districts, of democrats, republicans, independents, people that dont care about politics but want to stay alive or want their family not to suffer. And so to have you all be willing to come here to washington and tell your stories, you know, weve been talking about this a lot as just a group of friends. Im sitting with people that ive come to love in the short time ive been in washington, and so i just want to repeat the urgency for more people to follow your lead and to tell their story. I mean we just need more americans to be willing to let folks know what this really means, not in data, not with statistics, but real american voices, because you cant listen. You know, mr. Dunkley, i cant listen to you without hurting, just listening to what you endured. I mean, first of all, you give talking about gender, you just give a model of manhood, of your willingness to fight your own illness, to be the kind of husband to your wife and to profess the love that you have. So i just want to take a moment to ask more people to do what you all are doing. We dont need a hearing. Were talking about millions of americans that are enduring the anxiety right now, watching washington d. C. Hold their family. And im hoping more people will post their stories like we heard about senator van hollands website. Were asking people to put america speaks out. We should have the largest hearing in america with people willing to put their testimony out there, share their stories. Thats what i want right now because i cant sit through listening to your truth without feeling everything i believe this country should be and stand for at risk. And the commissioner said it right. This aint a perfect law, the aca, but if we take all of the ground we gained and allow it to go backwards right now, to thrust other americans and im not just talking a handful. Im talking about million also of americans back into the reality. And this craven idea that someone that gets a disease is somehow lesser or it is their fault, that they should suffer, who am i that i a millionaire should have to pay for your medical cost . I apologize for using all of my time not to ask you questions, but i heard i mean how much mrs. Johnson, you are just sitting there telling the stories of your friends, the people that you know, and this is the most pernicious evil type of privilege, that says that if a problem is not affecting me or my family that it is not really that much of a problem. But you can be sure that if it was a Congress Person and their health or the health of their spouse and this was going to affect them, you can be sure they would not have passed this law. And so this is a time where silence is the worst enemy of what were trying to do, and we need more people to speak up and speak out. Because this is a test of what kind of country will we be, where is our heart, where is our compassion . And dont tell me the nation that can send human beings to the moon, that can map the human genome, that could literally have the Largest Military force known to humanity, cant design a Health Care System that cant protect the most vulnerable of its citizens. I dont want to hear another mother tell me about the fear that they have that their child wont be able to live free or healthy because we have designed a system that shuts them out. So i just want to thank you for your stories and your testimony, and i pray to god that we can get more people to do the same so that we have a chorus of love and conviction that is so loud that no Congress Person, no senator can shut out the truth that you all are giving us today. Because theres no way anybody can believe that we cant figure out a way to provide coverage for all americans. Thank you very much. Thank you very much, senator, and i would just say amen. Thank you, thank you. So senator kaine, thank you so much. Thanks to all of you. I just want to pick up on what my friend corey was saying. Mrs. Johnson, as you started to testify, tears just started rolling down my face. I have heard a lot of stories like this. I will tell you the reason i was crying is the people who passed this law, they could care less what any of you think. They could care less what any of your experiences are. When the house was considering the first version of the bill, they had three hearings. There was a hearing in the House Energy Committee in february on medicaid that didnt allow any patient witnesses. There was one in the same committee in february about the collapsing health market. They allowed somebody from the American Cancer Society and one insurance commissioner to speak. In the house ways and Means Committee had a hearing on the individual mandate and they didnt allow any patient witnesses. When the version came up that they voted on, they didnt have any hearings. They didnt have any witnesses. They didnt allow any amendments. They didnt even wait for a cbo score to tell them how many people would lose insurance, how much more people would pay and how folks with preexisting conditions could be affected. They did not care one bit what any of your experiences were. The reason weve invited you here today is were afraid the same thing is going to happen here in the United States senate. When the Affordable Care act was passed in 2010, let me tell you the way the democrats handled this. The Senate Finance committee had 53 hearings. The senate Health Committee had 47 hearings. The final senate bill on the floor included 147 republican amendments that were offered by republicans and passed, and even though the republicans made a political decision to oppose the bill on the floor, they proposed amendments that democrats in good faith considered, and in writing the bills, the democrats who wrote it in 2010 includes stakeholders like you and listened to them to try to craft a bill. Weve invited you today because we are deathly afraid what were hearing from our republican colleagues here is that they have their group of 12 guys trying to come up with a bill that they can put on to the floor without hearing from one of you about any of your experiences and without allowing any amendments. Thats what theyre trying to do. And you saw what happened when the house passed that bill after refusing to listen to any of you. They went down to the white house in a bus and they had a big, big celebration, like theyd landed on the moon or something. This from a president who said over and over again, nobodys going to lose coverage, nobodys going to pay more, nobody with a preexisting condition will ever get kicked around because of that. The bill that they celebrated down at the white house didnt just break those promises, it shattered them into a million pieces and then drove over the pieces with a bull dozer and then poured acid on the pieces. Well, you can be darn sure that were going to do everything to make sure we listen to you and that america listens to you, and that we will not for a minute entertain anything in this body, if we are given the chance, and were going to yell as loud as we can and take the chance. Were not going to entertain anything that would break the promises that this president has made. Why would we vote for or allow something to pass that shatters promises that he made to the American People . Were going to hold him accountable and make sure that we dont do anything that doesnt meet those promises. Your stories really make a difference. Thank you. Thank you so much. You can hear the passion, i mean all of us are so appreciative that youre here and are absolutely committed to doing Everything Possible to move forward rather than backwards on providing health care for people and making sure it is affordable. Senator franken, thank you so much. Thank you, senators, for having this hearing, and thank all of you for your moving testimony. You know, i see that, mr. Nelson, you were the Rural Health Care leader of the year, is that it . In michigan. Yes, senator. And of the United States . Yes, senator. You see, minnesota has a lot of rural Health Systems, and so [[ inaudible ]]. I understand that. And when i went around minnesota on this one iteration, the first iteration of this bill i heard from hospitals, from Nursing Homes, clinics, that this was terrible for rural Health Systems. How would it affect your system in terms of your being able to employ the number of people you employ . What would it do to your system . We would have to come up with a strategy and cut, and when i look at my community i think of my community as the Upper Peninsula. I grew up there. There are seven other hospitals up there that that exist in counties that have some of the highest unemployment rates in the state. There are women in my hometown of newberry, michigan that travel 100 miles to deliver their babies, to markette, to potosky and sometimes to the sioux. We have delivered three babies in our Emergency Department in the last three years. We delivered a four pound premie on Mackinac Island in our facility over there. So if 50 plus of our patients are medicare and medicaid, it is going to have a devastating effect on us and the communities not only across the Upper Peninsula, but youve got 1425 critical access hospitals in the United States serving rural america. Those hospitals will be hit hard. Thats exactly what i hear. Commissioner miller, you said that the and i think weve heard how the law has helped people. You said it is not perfect, but one of the things you testified was about you have a sustainable market there in pennsylvania, but they are arguing that theres a death spiral. I would like to ask you to what extent have republican efforts to sabotage the market, have what role theyve played in driving up the cost in the individual market and making it increasingly unstable . Im referring to republican efforts to block risk corridor payments and the administrations refusal to commit to funding cost sharing reduction payments, et cetera. Thank you for that question, senator. And theres no question, although i mention we do have a market that is on its way to being a stable market in pennsylvania, theres no question that those actions have impacted our market in pennsylvania as well as the individual markets across the country. I think in pennsylvania and in markets across the country one of the impacts is that families have not had as many choices of health plans as they would have otherwise, because all of their actions have made the individual market an unattractive place to participate and just simply not a market that a lot of Companies Want to be in. I think this is a really important point because the very people who are claiming that obamacare is failing are the very people that have done everything they can to juunderme the law every step of the way. Exactly. As you mention, eliminating essentially not paying all of the risk corridor payments that were paid. They knew exactly what they were doing when they did that. Not giving the assurances to Insurance Companies even now that cost sharing reductions will continue. These are payments that help low income people pay their outofpocket cost sharing when they go to get care, and those flowthrough Insurance Companies. So, once again, the republicans who have done this, they know exactly what theyre doing with this. These actions have been very target, and the goal has been to undermine the individual market and to make obamacare fail. Unfortunately, in some cases theyve gotten close to actually being successful. I think the good news is, you know, in places like pennsylvania, ive worked really closely with our carriers, recognizing that this hasnt been a very attractive market to participate in because of a lot of these actions. And we feel like weve put our market on a path to stability, and it is really all of the uncertainty and the discussions happening in washington d. C. Right now about repealing the aca that is causing companies to continue having that conversation about whether they want to continue participating in this market. I feel pretty optimistic that the companies in pennsylvania that are still on our exchange and we lost two last year but we still have five im optimistic, cautiously optimistic theyre going to remain in the market for 2018. But we are going to get plans and rate filings on may 22nd is our deadline. We are literally a week and a half away from getting those filings. And theyre living under this uncertainty right now. For 2018, and they dont know what the rules for 2018 are. So the republicans have made this as unattractive a market as they possibly can. And despite that, in places like pennsylvania, you know, we still feel like were getting back to a more stable market. And im finishing, but while were sitting here tearing up, i want to thank you for your testimony, theyre cackling. This is really reprehensible. Thank you all. Thank you so much. Senator markey. Thank you all for being here. You make us feel better because you are here and you are fighting. Youre like walking, talking antidepressants for us. You give us a reason to know that we have to that we have to fight every single day to make sure that the house of Representatives Health care bill never becomes the law of our nation, and we are going to do that. We are going to fight every single day. Their plan is a very simple plan. Cut medicaid by 880 billion for the poor or the sick, for the elderly. As a tax break for the wealthiest people in our country. That is immoral, that is inhumane. We will not allow that to happen. If you kick these republicans in the heart, you will break your toe. How they can harm the most vulnerable to create a tax break for the most welloff, for the most healthy, for the most wealthy in the history of our country is absolutely totally wrong. But they do it because they harbor an ancient animosity towards every one of these programs that they never wanted to see put on the books, medicaid and medicare and all of these programs. So they are going to do their best to leave these programs as debtsoaked relics of what they look like today if they could be successful, but we will not let them do it. We are going to fight every single day to make sure it never happens. So the senators who you see here today are going to make sure that that does not happen, but were going to need the whole country to rise up, to fight against their cruelty, against their intent, which is not to help people, not to make people healthier, but in fact just to create the funding for the tax break for those who do not need it. I would like to turn, if i could, for just a second to this Opioid Epidemic and the fact that 2. 8 million americans right now receive coverage for Addiction Treatment in the Affordable Care act. And if they are successful, they will put into danger the treatment that those 2. 8 million americans are now eligible to receive. So, commissioner miller, could you please take that issue and tell us from your perspective what the consequences are to all of those people who receive that coverage if it is removed, if they are not covered for treatment in terms of what the impact will be on the individual and their families . Thank you for that question, senator. This is this is a huge concern for us. Access to Mental Health and Substance Use Disorder Treatment, those were services that in the preaca world often were not Services People had access to, and obviously in pennsylvania the Opioid Crisis is having the same impact that it is having i think across the country. In pennsylvania between the individual market and our Medicaid Expansion weve had over 175,000 pennsylvanians who accessed Substance Abuse treatment disorder because of the Affordable Care act. In pennsylvania 175,000 people would be the Third Largest city in pennsylvania. Thats a lot of people. Obviously the impacts that this crisis is having on families and on communities is is unreal, and so eliminating or putting at risk coverage for these services is unthinkable at this point. I sincerely hope thats not where we end up going. If people were dying across the country at the same rate theyre dying in massachusetts, that would be 100,000 deaths a year from opioid overdoses. It would be 75,000 people a year dying from fentanyl in their system. We need more treatment, not less. There isnt enough treatment today, much less stripping away the protection these families receive from the Affordable Care act. So thank you all for being here. More of how it transforms peoples lives because that law is on the books and how their lives will be transformed yet again if it was taken away. It would be so horrific, that it is imperative that we work every day to make sure that they are not successful. So thank you for being here. Thank you, madam chair. Thank you so much, senator markey. Mr. Nelson, it reminds me when i was in the Upper Peninsula a few weeks ago talking to Small Businesses and asked them their number one challenge, and they said the opioid addiction and how it is affecting their ability to get employees and wanting to see more treatment and prevention and education. So thank you so much for raising that. Senator blumenthal. Thank you for being with us. Thank you. Thank you so much for having this hearing, senator, which i think is so important because we are trying to educate americans about the reallife consequences of this bill, as my colleagues have mentioned before now. Theyve been very eloquent while ive been here. I cant match their el against, particularly reverend booker. I have been talking all day so im getting a little tired of hearing myself speak. We are here to listen to you. My question really is if have you any suggestions for us, how we can raise these issues with americans so that they better understand . Obviously you have friends and neighbors, they know your situation, or maybe they dont. You know, people dont walk into the supermarket and start shouting about a relative who has cancer or a child with Downs Syndrome or, you know, people tend to be private. Im wondering how we can make more americans aware of the really powerful stories youve brought to us, and im very grateful youre here, but do you have suggestions for us . Yes, sir. Well, just the idea of having a portal available where people can easily speak and perhaps upload, you know 30 years ago i worked in telecommunications where the first cellphones we sold were 2. 5, 3,000, i worked in the days of beepers, when dinosaurs roamed the earth. Today everyone has phones that can broadcast in hd, but the main thing is people feel isolated and they dont have a portal, something that you mentioned the hashtag earlier, where the shared stories make you understand that youre not in it alone. Illnesses in particular become compartmentalized. You are focused on getting through that day, and then the clouds of financial uncertainty and laws that have not been reveal, that things are done in darkness and people despair, but they feel alone. So if there were a way that people could safely share as much as they wanted to, you know. Privacy obviously is important to people, but without knowing what the person next to you is experiencing we have no way to walk in their shoes. Again, i get back to empathy, of being able to understand that we are all connected together, and i am hopeful i reveal it back to when it was said in a hearing that long last, senator, have you know sense of decency, of shake. That goes back some years. Mccarthy, i think. It was. It was the one that broke that particular story to the point people said, my goodness, this is just not fair, it is not right. Again, you feel so alone when you are fighting your own battle. So if there were ways that citizens could add the shared story which gives us more information to make the correct solutions. Im just curious, is there any timetable whatsoever before whatever is going to be produced by the senate actually hits the floor . My understanding is that it cannot be filibustered, it is part of the budget reconciliation act or something. It is going to take at least several defections, as it said, and i hate that word because basically where is the human heart. You mentioned it is made of stone. Everyone feels this pain, and we shared together and hopefully we can get some hearts to soften and do the right thing because it is the right thing to do. Sounds simple, but we appreciate the help that you all provide. You know, one person standing on a corner with a sheet, you might reach five people. Through the power of the connected world now, one statement can reach billions in minutes. So all i came here today was to tell the truth on my story. Didnt need embellishment. It is ongoing, but i feel encouraged that there are mechanisms and people who care, who have access more to the levers of real power. So we live in Interesting Times and were on this voyage together, and i look forward to a successful docking in some land of happiness and safety. Well, thank you for that very eloquent statement and for your courage and strength to come here, all of your courage and strength to be here today, because i do think that your stories and we will make sure that they are communicated will have an effect. And im thinking more the United States senate, which is a bubble, maybe a platform, but still a single entity, what we can do to spread this word. Ive been having town halls around my state and asking people to come forward with their stories, and i am amazed by how many of those stories Concern Health care and how many of their fears and apprehensions Concern Health care. So it is not just the folks sitting at this table. It is really widely felt and, again, many, many thanks for your help. Well, thank you so much. Let me stress again that we invite people to join us at americaspeaksout or childcare. I welcome certainly people coming to my Senate Facebook page, website as well as i know my colleagues do. I believe we have at least one other colleague that may be joining us in a moment, so im going to ask a couple more questions, and i also want to just indicate, mr. Johnson, as an aunt of a wonderful young man, a wonderful nephew who has Downs Syndrome, who is now 30 years old and doing incredibly well and he is working and he actually codirects the Michigan State University Pep Band at basketball games, and we are so proud of barry. He is doing incredibly well. And with devoted family and, fortunately, had a dad with insurance that was willing to cover him. But it was really just fortunate, good fortune that that happened at the time. Weve talked a lot about medicaid which is so critically important, but we also know that majority of people get their insurance through their employer. One of the concerns that i have thats not been focused on a lot about the House Republican bill is that theres a gigantic loophole in it where they speak about a state can get a waiver to make it even worse by waiving everything, but they dont talk about the fact that if you are a multistate employer, which we have one. Were proud of our manufacturers and others in michigan. Theyre in multiple states. The loophole says that if you are in a state just one state, maybe you are in five states with your business, but one of those states decides to do a waiver, that you essentially can pick that state as your domicile for health care, and then all of your employees are affected by not having the essential benefit package, Maternity Care, Mental Health, addiction services, maybe hospitalization, Prescription Drugs, all of those things that we consider basic care. We go back to the days of when you could get a cheap policy i remember so many people coming to me and saying, ive had Health Insurance for a long time but then i got sick, and i found out it didnt cover hospitalization. So i feel like that ad thats on tv where they tell you, the good news is it covers zombies if you get attacked by zombies, but it doesnt cover anything else. So we dont want to go back to those days. So im wondering, commissioner miller, if you could speak a bit about people who have employersponsored insurance and how you would see these changes in health care affecting them as well. Yes. Thank you, senator. You know, we do talk a lot about the Significant Impacts on people who have medicaid coverage and people who have coverage in the individual market, but we certainly know that those are not the only markets impacted. According to the cbo, trump care, the haca will likely result in fewer people getting coverage through their employer because it eliminates the employer mandate which will likely result in more employers not offering coverage. I think thats one impact that could be a Significant Impact. Of course, you will see more people in the individual market and running into the same issues weve talked about with the individual market as well. Thank you very much. And what affects do you think that waiving the Prescription Drug benefits would have on individuals act to afford onescr thanks for that question. Im actually going to talk about a particular individual. Linda, whos 60yearold woman in Beaver County has multiple sclerosis. We have heard stories about this today. She relies on a drug called tekfadera, she is on a marketplace plan. She was told by her pharmacist this drug could cost her as much as 12,000 per month without insurance. This is only one of 15 drugs that she takes. Without drug coverage, even if you consider the discount programs she would have available, it would be easy to say that her drug costs could be as high as 20,000 per month. As a person who has had ms for 24 years, she relies on these medications to support her mobility and independence. So i think you would find that many people would not be able to afford Prescription Drugs without access to Health Insurance that covers this benefit. Prescription drugs are obviously a critical part of care for people with health needs. Across the board, people with cancer or diabetes, high blood pressure, hepatitis c, all of these people need medications to get and stay healthy. We also know that Prescription Drugs are the Fastest Growing cost in our system, and we know that there are some drugs with very high prices. So i think the impact on consumers of having to pay these costs directly would be absolutely devastating in a lot of cases. Thank you very much. Mrs. Johnson, what does your regimen of care look like for you on a daily basis . What does that look like . Thank you, senator. So i was asked this question actually last week at Bloomington Hospital as i was giving a talk there to physicians, nurses, social workers, people working for child protective services, just a whole set of kind of like a system of care sort of unit in our local community. I was asked that question, and i actually put it back to them and said, i just want folks to just take a guess on the number of appointments that my daughter had in february. Shortest month of the year, only 28 days. I just started taking comments from those in attendance, and then finally i spoke back to them. None of them had gotten them. None as high. It was 27 appointments my had just during february alone. I really cant overstate how that affects my ability to work outside the home because her the level of care that my daughter requires, not just just getting her to appointments, theres just a great deal of time and resources that that takes away from other expenses that my family faces. So we get up, we rise early because she starts her day with a onehour flush, a daily infusion that takes about an hour. I do a dogandpony show to keep her attention during that time. We then take her to school. Shes actually at a Specialized School currently that so we cant get transportation. So i will drive her there, or my husband will, each morning. And then almost inevitably there are multiple appointments throughout the day that i will need to go and pick her up again and take her to different clinics or to get an extra at the hospital for ongoing treatments for her gi issues and such things. So thats just a normal day in our house. And then and actually just today on the way over here as we were walking to this room, i got a call from one of her specialists to discuss changes to her medication dosages. So this is just it is kind of par for the course. Theres not a day that goes by that i dont get a medical bill in the mail and that i dont speak with one of our specialists or speak with someone who is involved in her care to try to continue to provide what i believe is the quality that she needs and deserves. Thank you so much. She is lucky to have you as a mom. Thank you. Weve been joined by senator elizabeth warren. Senator warren, welcome. We have had a wonderful hearing, very powerful testimonies. Were so glad you could be here. Thank you. I want to say thank you very much to senator stainow for pulling this together for everyone, how much this matters. The senator has been herding all of us and trying to get it together so we would have a chance to put real faces behind the story of what happens if the republicans are able to repeal health care for so many millions of americans. I am also grateful to all of you for being here. Im sorry i havent been able to be here for all of the testimony, as im sure youve heard theres a lot going on today. But it doesnt mean that we can turn away from this critical issue. You know, it hasnt even been a week since the republicans voted in the house to tear up our Health Care System, to rip away coverage from the people who need it most, to open the door to discrimination based on preexisting conditions. Now that theyre going avm after medicaid and after private insurance, including employersponsored Health Insurance plan, no one is safe. No one is safe. That has to be the message we underline today. Republicans are not just taking away Health Care Coverage. Theyre also tearing apart the Financial Security of millions of american families. You know, a law that says Insurance Companies cant charge people more if they have a preexisting condition or that they cant stop paying benefits for people who have cancer or whose medical bills exceed a certain preset dollar amount isnt just a health care law. It is a law that protects people from crushing medical bills, that could cost them their home, from foreclosure, and ultimately for many from bankruptcy. I want to see if we could explore that a little bit more. I know that you testified earlier, mrs. Johnson, about the time before the Affordable Care act and medicaid were available to you, when your family struggled financially to try to make sure that you were covering your Daughters Health care. Could you just say a bit about what it feels like when your family is in that position, when you know that the choices that you must make for the health of your daughter put your familys entire Financial Security at risk . You know, the kinds of things you think about at 3 00 in the morning. Thank you, senator. And you do, because youre not asleep at 3 00 a. M. Because youre up and youre concerned about, you know, how youre going to pay those bills that just keep coming relentlessly. I can say that i have kind of a saying in our house, when your child is turning blue nothing else matters. And for years that was kind of where we were, just trying to make sure that if she wasnt breathing well that that we attended to that, and there were times that i didnt have room to really think much about the financial devastation that it was causing to my family because we were spending weeks at a time in the hospital just trying to keep her alive. So when i would get home and find in my mailbox literally a stack of medical bills, i cant tell you what that would do to my spirit. I just would feel crushed, to be honest. And yet i still had to pick up and keep going for the sakeful my daughter because i didnt know when that next hospitalization was coming. So we just carry on. Yeah. Bless your heart. But a reminder of how important it is to have medicaid, how important it is to have Health Insurance. Yes, maam. All around. Mr. Dunkley, i understand over the last few years you have received bills for tens of thousands of dollars for your cancer treatments and your hip replacement surgery. If you hadnt had insurance through the Affordable Care act for these costs, can you just say a word about what you would have done, what your life would be like . Well, it would be dramatically different, much worse. My wife suzanne, who has advanced multiple sclerosis, i am her caregiver. During the cancer diagnosis that came out of the blue, it was pretty advanced, i was pretty close to dead, the mental strain just from that but i knew that the Affordable Care act was coming online, and it came online and the cost i was able to afford. In the new world, say if they would offer me a policy it might be five times as much, which without the subsidy would be close to 6,000 a month. Wow. My wife is on Disability Insurance. I am currently on social security. I would like to get back working again. I do audio visual work and narration so i can work at home. I try to stay close because she needs me and i wouldnt be anywhere else. I mean thats where i want to be, is by her side. But this new from what i understand of the new law, it is draconian, it is heartless. I went from a 7,500 deductible on my old cobra plan to zero deductible. I went from 15,000 out of pocket to 1,8750 which i passed two days after the health care. Gov started because my next chemo was around 35,000. We would not be in our home. We would have had to sell it with extreme duress. We had family and friends that set up a temporary gofundme site. Again, these are ice floes on the river and you hop from one to the next and hope it will support your weight. Any time that we can focus on our own Health Rather than the clouds of uncertainty and my wife suzanne is concerned every day. She stays up, it is hard to go to sleep because you wonder what youre going to read tomorrow, and sometimes it is worse than you might have imagined. So without the Patient Protection Affordable Care act i probably would not be here to speak with you today. I wouldnt have gotten finished with my treatment, the cancer would have probably killed me, or we would be living on the kindness of others, and i like to be able to pull my own weight, to be participatory. I think thats where sharing our stories, were not alone but we need a mouth piece. We need a way to get the story out that, you know, we feel good at. I am just glad to be able to talk. My story is pretty simple, but it is truth and there are millions more like me. So thank you again for listening, for asking and listening. Well, thank you. You know, the reminder for the very clear reminder that access to health care is a matter of life and death. Yes, oh, absolutely. For many people around this country. So thank you for your testimony on that, mr. Dunkley. I just want to say senator mcconnell didnt show up todays hearing. All of the senators were invited. He didnt show up to hear from any of you, but i just want to ask for anybody that would like to answer, if senator mcconnell were here what would you like to say to him . Hes about to make the decision in the United States senate about who goes forward on a health care revision and what that revision is going to look like. A short statement that you would like to give to him, i would like to be able to hear it. Mrs. Hardaway, were going to record all of these for him. Okay. I think the one thing i would like to say is why. When was the last time that you were told you could not go to a doctor because they didnt take your health care, your insurance . Medicaid is not for the poor. Medicaid is for those of us who need health care as desperately, if not more so, than anyone else in the country. Commissioner miller was talking about her friend whose medications upward of 20,000 a month. I am an m. S. Patient as well and mine are there. Without them i would not be a contributing member of society. I would be in a wheelchair. I dont want to be in a wheelchair. I enjoy working with my babies. I am a substitute prek and kindergarten teacher, and i love them. They are my joy. But the fact that i have medications available to curb the tremors it is a little daunting when you are working with a fiveyearold and all of a sudden your hand because theyre, ms. Carol, are you okay . You know, theyre very, very theyre babies. And without that i could not have that gift, and i would like to ask if he would walk in my shoes for one month. I had a very devastating incident last week where i had an exacerbation, and im sure mr. Dunkley is well aware of these, and to the point where i could not pick my foot up high enough to put my own pants on. Thats not okay. Thats not okay. Thank you. Thank you. Anyone else have a melsage . Yes, ms. Walkington. Thank you for giving me the opportunity to say this. I would like to say that this bill is terrible for women. Blocking access to planned parenthood blocks access to preventative care, cancer screenings, which saved my life, and it takes away essential Health Benefits like Maternity Care, preexisting condition coverage. Having a csection would be a preexisting condition, surviving Domestic Abuse would be a preexisting condition. How horrible in and of themselves but collectively theyre atrocious. The second thing i would say is because this is so devastating to women, there need to be women at the table when theyre considering this bill, considering revisions. Women need to have a voice. So thank you. Thank you. Thank you, mrs. Walkington. Anyone else want to add anything . Mr. Nelson does. Thank you, senator warren. By the way, i saw you about four years ago speak. Very impressive. Thank you. Thank you very much. I would tell senator mcconnell to set aside ideology, to bring in Health Care Leaders like rick pollack and the American Hospital association, and learn about the complexity of health care. I would ask that they approach it like michigan did. You had a republican governor working with a Senate Minority leader, gretchen witmer. You is the support of senator peters, senator richards bill, was a republican, and it was bipartisan. They involved the Michigan Health and hospital association. Brian peter, our wonderful ceo, engaged the association. Laura oppel is with me, a Senior Vice President from the mha. So it was a group effort. There were factions of the Republican Party that didnt want it to pass, but it was a u. P. Senator that threw the vote over. So thats what i would recommend. I should add on that. You know, thats how we did it in massachusetts. It was a republican governor, a democratic legislature. We put together Health Care Coverage because we believed that health care is a basic human right, and we wanted coverage for everyone and to find ways to lower the cost to make that happen. We recognize we didnt get it right the first time out. We had to go back, we had to readjust, we had to amend, but we tried to do it in a very bipartisan way and to make it work. I agree with you. I think it is a very powerful point. Have we gotten everybody that wanted to speak on this . I want to say one more thing. I never expected to be in this job in the United States senate. I worked as a law professor for most of my adult life, and i researched why people go broke and did studies on bankruptcy. And the data are really clear on this. People who go bankrupt are pretty much like everyone else, pretty solidly middle class folks, people that get a decent education, who at one point have good jobs, who buy homes, who have children, and who get hit hard often with a bad medical diagnosis that just turns them upside down financially. It is one of the biggest reasons that families declare bankruptcy back when i was studying it, was because of Serious Health problems. Since the Affordable Care act was passed in 2010, bankruptcy filings have declined for six straight years. In fact, bankruptcy filing rates are now 50 lower than they were when the aca was first adopted. I dont want to go back to the days where people risked losing everything if they got bad news from a doctor. I think it is immoral for the richest nation on earth to say to millions of our people that if you get a bad diagnosis you could lose it all, your savings, your home, your future. You are the people who came here to put a face on what it means to have health care in america, and im deeply grateful to you for doing this. Believe me, senator stabinow and i and every single democrat in the United States senate will be fighting on your behalf and on behalf of all of the people you have spoken for today. Thank you so much for being here. Thank you, senator stabinow. Thank you so much, senator warren. Im so glad that youre here. As you were talking about bankruptcies, i cant help but share a recent story in my family where my nephew and his wonderful young wife just had a little baby girl and she was born with half a heart, and she spent her first seven months at university of michigan Childrens Hospital with her mom and dad by her side, very it is amazing how life works because her mommy is a pediatric intensive care nurse. And so allies been by her side as well as my nephew, mack. She is now home, but i think about if there were caps on treatment, if there were preexisting conditions that little leyton will certainly she has one more surgery to go through. In fact, my brother who would do anything in the world for his family had to pay for that, he would have and we could very well have seen a bankruptcy, very well in the family, because of the incredible cost of little lewnon w leyton who is now a beautiful little girl, 18 months old, and will have a good life. This ought to be something we celebrate. This is what it is all about. I just want to end just in terms of differences unfortunately in philosophy right now between what we are seeing coming from the republicans certainly in the house and where we are, and then my Wonderful Technology keeps bouncing here. Let me see if i can share this. When they passed this in the house, this is what actually made my hair turn red, on fire here. It was a quote in the paper. Republican u. S. Rep mow brooks of missouri, quote, the bill under consideration would allow Insurance Companies to require people who have higher Health Care Costs to contribute if i can get this back up again. Im sorry this is not would allow Insurance Companies to require people who have higher Health Care Costs to contribute more to the insurance pool, thereby reducing the cost to those who have lived good lives. My little grand niece leyton at 18 months old has lived a good life. Each of you, your daughter, each of you have lived a good life, and those kinds of statements dont belong in our great country when were looking at something that fundamentally is, should be a right, not a privilege for those who can afford it. So thank you so much. We will keep fighting