Good morning, everyone. Welcome to the newly refurbished i dont want to call it the oversight investigation room. Which is sometimes used by energy and commerce. What a beautiful room. And it will be more conducive to hearings. This is the first of the 115th congress. Welcome here. And welcome to our Witnesses Today. This is our and welcome back to my friend and colleague, Ranking Member from colorado. This is our medicaid oversight hearing on ways to strengthen the problem. The subcommittee convenes this hearing to examine a critical component of the Patient Protection and Affordable Care act. Medicaid and Medicaid Expansion. As the Worlds Largest health program, medicaid provides Health Care Coverage for over 70 million americans, and accounts for more than 15 of Health Care Spending in the United States. In 2015 alone, federal taxpayers spent over 350 billion on medicaid. The costs continue to rise each other. The federal share and medicaid spending is expected to rise significantly over the coming decade, from 371 billion in 2016, to 624 billion in 2026. Ten years. In a time when Medicaid Program costs are skyrocketing it makes sense to ask the question, is medicaid adequately serving our most vulnerable populations. Medicaid was originally designed as a safety net to care for health of some of our most vulnerable populations, lowincome children, pregnant women, the elderly, individuals with disabilities and i know i treated many kids without disabilities without their disability coverage for medicaid, it would be a struggle for them. Far too often medicaids own rules keep it from serving the families it was designed to help. These restrictions surrounding medicaid do not allow doctors and nurses the flexibility they need for the best outcome for patients. They do not use physician focused moeltsds that can improve care and reduce costs. Studies show that medicaid coverage does not necessarily result in Better Health outcomes. One often cited study in oregon shows it increases Health Care Use and selfreported health and Mental Health while having no effect on mortality or physical health. Similarly, the National Bureau of Economic Research found enrollees obtain only 20 to 40 cents of value of each dollar the government spends. Reports by nonpartisan watchdogs, two of which are here today, show that the Medicaid Program remains a target for waste, fraud and abuse. Because of the size and scale of the program, improper payments, including payments made for people not eligible for medicaid, or for service that is were not provided are extremely high. The Government Accountability office estimates medicaid paid out over 17 billion in improper payments in fiscal year 2014 alone. For these reasons, medicaid has been designated as a highrisk program by the gao for 14 years. Since 2003. And despite the longstanding problems of the Medicaid Program, the Patient Protection and Affordable Care act expanded medicaid to a whole new population. Benefits have been opened up to adults under the age of 65, who make less than 133 of the Poverty Level. Since open enrollment began in october 2013, roughly 11 million individuals have signed up for medicaid coverage under the new eligibility parameters. This means that the majority of individuals covered under obamacare have been rolled through the Medicaid Program instead of purchasing private Health Insurance plans. The costs associated with insuring the 11 million new medicaid enrollees have been far more expensive than the Obama Administration predicted. A report released said the cost was nearly 50 higher than projected. Medicaid expansion enrollees average 6,366 in 2015, which is 49 higher than the agency predicted the year prior. This means that not only are expansion enrollees expensive to insure, but the costs are impossible to predict. The vast majority of expenses associated with new enrollees, unfortunately reports show both states and the federal government cannot effectively oversee and implement Medicaid Expansion. The gao found areas in Medicaid Eligibility that could lead to misspending of funds. The Inspector General found troubling evidence that the federal government failed to implement requirements in the Patient Protection and Affordable Care act that would improve integrity. We all acknowledge there are serious weaknesses in how this program operates, we also recognize the responsibility of the federal government to provide a safety net to the most vulnerable among us. That means insuring taxpayer dollars are spent in a way that actually improves Health Outcomes and serves the medicaid population. We want this to work. Not hinder services. I hope we can in a bipartisan way support its strengths, acknowledge the problems, and together find some solutions. Tomorrow the Health Subcommittee will discuss legislative solutions to strengthen medicaid, but as we move forward we must be careful not to repeat or worsen the problems that already exist in the program. We have a lot of work to do and i would like to thank our witnesses for appearing today and look forward to an informative discussion. I recognize the Ranking Member for five minutes. Thank you very much, mr. Chairman. Its good to be back for another session of congress. We have two new members on our side of the aisle on this subcommittee this year. And im so happy to welcome them. Dr. Ruiz is here with us. Hes an actual emergency room doctor, and hell be able to bring us so much great perspective on issues like this hearing, and other hearings. And then scott peters, whos not here at this moment, im pleased hes here. He and i comprise twothirds of the nyu law graduate delegation to congress. So im happy were loading up this committee with nyu law grads. You know, i think id be deceiving myself if i thought that todays hearing was intended, actually to strengthen the Medicaid Program. Although i hope its not so. I fear that this discussion about medicaid is intended to lay the groundwork for drastic cuts to the program, and eventually to repeal the Affordable Care act historic Medicaid Expansion. I would like to talk about the importance of this program and what Medicaid Expansion has accomplished for the American People. Today, more than 70 million lowincome americans, including seniors, children, adults, and people with disabilities have access to Quality Health care thanks to medicaid. And contrary, frankly, to what my colleagues on the other side of the aisle think, the Medicaid Program delivers this care efficiently and effectively. The costs per beneficiary are actually substantially lower than for private insurance, and have been growing more slowly for beneficiaries. Numerous studies have shown that medicaid has helped make millions of americans healthier, by improving access to primary and Preventive Care, and by helping americans manage and treat serious disease. In fact, the Medicaid Program literally saves lives. Research published in the new england journal of medicine reported that previous expansions of medicaid coverage for lowincome adults in arizona, maine and new york actually reduced deaths by 6. 1 . The acas historic Medicaid Expansion has let states build on this record of success, and provide insurance to millions of americans who otherwise would not have had access to health care. Last year, and we need to think about this more than 12 million lowincome adults had Health Care Coverage because of the Medicaid Expansion. This is astonishing. And combined with other important provisions of the aca, this has helped drive the uninsured rate to the lowest level in our countrys history. Its important to note, these are not people who shifted from private insurance to the Medicaid Expansion, this is people who had no insurance, and were using the Emergency Rooms as their primary care facilities. In colorado, for example, the rate of the uninsured was cut in half since the enactment of the aca, and the expansion of medicaid. Aside from the benefits accrued to the people, medicaid has actually resulted in tremendous savings for the states. Hospitals nationwide have seen their uncompensated care burden drop by 10. 4 billion since the aca became law. Denver Health Medical center which is in my district, this week reported to my office that their uncompensated care claims actually fell by 30 since passage of the aca. This is real savings. And also, we know that medicaid is helping people get access to Vital Health Care services. I had a listening session last week in denver about the aca. I had 200 people show up at this listening session. And most of the people who told their heartrending stories talked about how they were employed, but they couldnt afford private insurance, and due to the Medicaid Expansion, they now had Mental Health services. They had drug treatment and opioid treatment services. They had services for catastrophic accidents that they had had. And on and on. It got to the point where i literally had to take a packet of kleenex out of my purse and put it on the podium. Because everybody, including my staff and myself, were in tears listening to these stories. This is what the majority wants to take away. And this is what were talking about. We can all talk about eliminating waste, fraud and abuse in the program. Were all for that. And i would support that 100 . But taking away Vital Health Care for so many millions of americans is wrong. And we must fight against taking that important benefit away. I yield back. Lady yields back and we dont have anybody else on our side of the aisle to make an Opening Statement. Mr. Wald will come back later. He is in a meeting. Ranking member of the committee is recognized for five minutes. Thank you, mr. Chairman. Its great to be back in our room here today. It looks really nice. For seven years now, Congressional Republicans have railed against the Affordable Care act with a steady drumbeat of repeal and replace. And for seven years, theyve sabotaged implementation of the law. Here we are today, republicans are misleading the public, in my opinion, with falsehoods that the law is failing. That could not be further from the truth. The truth is, after seven years of claiming they could do better, they have no plan to replace the Affordable Care act. The subcommittee should be evaluating the impact that repeal would have on the American People, and the National Health care system. Instead, republicans are holding yet another hearing to highlight their ongoing opposition to the laws Medicaid Expansion, despite clear evidence that the expansion has made Health Care Affordable and available for the first time to 12 Million People nationwide. Tomorrow and thursday the committee is Holding Hearings on what republicans consider the first pieces of the Gop Health Care replacement plan. The fact is, none of these bills will prevent 30 million americans from losing their Health Care Coverage. None of them will reduce the chaos in the Health Care System that will inevitably result if republicans successfully repeal the Affordable Care act. The fact is, republicans are already creating uncertainty and instability in the individual market. This instability will ultimately result in higher premiums and endanger the health and welfare of millions of americans. In other words, the republicanmade chaos in the Health Care System has already begun. Of course, were seeing the same thing with the president S Immigration executive orders. I just hope that at some point our gop colleagues join us against what i consider reckless and rash actions and oppose President Trumps actions. Congressional republicans continue to ask the American People to trust them and they have a plan. Somehow everything will be okay. Theyve repeatedly assured the American Public no one will lose coverage with the republican replacement plan, a claim President Trump and his advisers also continue to make. Recently released audio at a closed door meeting from the republican retreat last week confirms that they simply have no plan. At that meeting, republicans admitted that repealing the Affordable Care act could disarray coverage for the roughly 20 million americans now covered through state and federal marketplaces. As well as those covered under the Medicaid Expansion. In fact, one republican member at the retreat warned, and i quote, wed better be sure were prepared to live with the market weve created with repeal. My republican colleagues are also trying to claim that the Affordable Care act is already collapsing under its own weight and that the replacement plant will rescue the American People from obamacare. Republicans are so scared to own the chaos theyre causing, that theyre trying to pretend that the law is imploding on its own which could not be further from the truth. Americans today have Better Health coverage and Health Care Thanks to the Affordable Care act. The laws Medicaid Expansion improved the quality and affordability of health care for millions of americans. My colleagues would be wise to consider the impact that their actions will have on the millions of americans who are currently benefiting from the Affordable Care act. If my republican colleagues finally took their ideological blinders off, they would realize the Affordable Care act should not be repealed. I say this because i dont really care about the ideology, the fact of the matter is real people are going to be harmed if the Affordable Care act is repealed. I hope at some point my republican colleagues will admit that. And that we can Work Together to improve the Health Care System. I yield back. Well move forward now with our witnesses. I want to ask unanimous consent, however, that the members Opening Statements be introduced into the record. Without objection, the documents will be entered into the record. Id like to introduce our five witnesses. Miss carolyn yo com, welcome, directory of health care. Next, we welcome ms. Ann maxwell, assistant inspector gem in the office of evaluation and inspections in the u. S. Department of health and Human Services office. Next we want to welcome mr. Paul howard, who is a senior fellow and director of Health Policy at the manhattan institute. As well as mr. Josh archambault from the foundation of Government Accountability. And mr. Timothy m. Westmoreland, professor from practice and senior scholar and health law. Welcome all of you. Thank you to all our witnesses for being here today, providing testimony before the subcommittee. We look forward to hearing from you on this important issue. Youre aware that the committee is holding an investigative hearing a