Subchi on healsub c committee on health talked about the health care policy. This is just over two hours. Okay. I want to thank everyone for attending this event today. Im joane antos, for the policyt the institute, on behalf of the Business Group on health i want to welcome everyone here and everyone watching remotely including those watching cspan to todays conference. We are going to discuss the challenges of providing high Quality Healthcare that is affordable for patients, employers and taxpayers. This is clearly a critical topic for government policymakers. The recent election obviously highlighted the disagreements among many people in this country about whats the best way for government to proceed in this area. Obviously, changes are coming. The expansion of Health Insurance coverage under the aca has come at a steep price and the Incoming Administration is looking for ways to get costs under control while insuring people continue to have access to Health Insurance. Employers have long been at the forefront of this struggle for affordable healthcare. About 10050 Million People under the age of 65 are covered by health plans sponsored by employers. The average premium for a family covered by employers was over 18,0 18,000 last year in 2016. A nearly 60 increase in total premiums since 2006. Health benefits are a major component of Employee Compensation and the rising cost of Health Benefits has slowed wage growth for millions of americans. As health costs have increased, large employers have vested in Innovative Strategies to promote value and control cost through patient engagement, provider payment reform and deliver system improvement. We will discuss some of the initiatives undertaken by four large employers, initiatives to promote more efficient Healthcare Delivery and lower cost. What can we learn from their succe successes . What can we do to help resolve the problems they face in dealing with cost and quality problems . What is the role of government promoting effective private sector initiatives and what are the barriers that need to be lowered to make those efforts more effective. These are the themes to be addressed by our two expert panels coming up shortly. To start the discussion we are honored to have dr. Michael burgess, chair of the Health Subcommittee for the health, energy and commerce committee. Dr. Burgess represents the 26th Congressional District of texas. Equally important he is a practicing physician who cares deeply about meeting the needs of patients. From burgess has been a strong advocate for legislation to reduce healthcare costs, improve choices and insure we will have the capacity to provide appropriate medical care to all who need it. He also played a key role for the medicare system for paying physicians intended to create better value and affordability. With that, dr. Burgess, please join us. Thank you for that kind introduction. Thank you for the invitation. Thanks for allowing me to be here. If i understand my task correctly this morning, its to talk about innovation and policy. Does innovation inform policy or does policy inform innovation . The answer, of course, is its both. We might look to a couple examples why it is perhaps more satisfactory when innovation drives the policy rather than the other way around. As we sit here, theres really not much happening right now in washington, right . Not much happening in healthcare, kind of a sleepy backwater policy subcommittee that im going to chair this term. Its a financiphenomenal opporto get things right and provide for people in a way that has never been provided in the past and also an opportunity where things could get much more dangerous in the days and weeks and month ahead. Thats kind of the challenge thats certainly before me as a member of the subcommittee, individual member of congress and someone who represents 790,000 people back in north texas. My life has been in medicine before i came to congress, so when i think of things like game chan changers in healthcare, i typically think of discoveries and devices, drugs that have been developed and how they have changed medicine. But as we take a step back this morning and think about over the last 20 years, two things in my opinion profoundly change providing healthcare for people that actually didnt have a lot to do with things in the laboratory bench. 20 years ago last august the Kennedy Castle balm bill passed. Although there was a lot of things in the bill, one of the little projects tucked into that bill was the ability to provide Health Savings accounts. They were capped at 750,000 of those that would be allowed in the term of the bill. I wanted one. I was afraid i wouldnt get my stuff in in time to get one of those 750,000 Health Savings accou accounts. Turned out i needen the have worried. There were plenty to go around for any who wanted them. They were not all that flexible back in those days, only one or two insurers in my area that would talk to you about that phenomenon of a Health Savings account. When you stop and think medicine is there can be an unlimited demand. I know this. I used to practice medicine. The barriers that should be pla placed, should it be placed by the government . Should it be a waiting list . Should it be rationing . Or do you want some sensitivity, feed pac on, yes, the physician, but primarily the patient i believe should be in control of that situation. The Health Savings account is the perfect model to allow that to happen. Last night in the rules committee we were marking up the budget that will allow reconciliation and allow repeal plus when ever it comes down the pipe from the committees. In that, a question was posed by a democratic member from florida, i challenge any one of you on this rules committee to point to me a year where your Health Insurance premium went down. Ill be happy to. Its the day i got a health s e savings account. My Health Premium dramatically reduced. If i had the discipline to put some of that money im not sp d spending on a premium into a tax deferred savings account, that was 20 years ago, over that time span, theres the ability for me to garner a significant nest egg against medical expenditures, i would argue whatever we do next i would like to see expansion of Health Savings accounts as a not for everyone but a fundamental part of policy i would like to see that happen. One of the things were hearing a lot right now, another issue that came up yet late last night in the Rulings Committee markup, another democratic member from massachusetts said 20 million, 30 million, whatever the figure of the day is, are losing their Health Insurance. I dont recall that individual being terribly concerned when i was one of the 6 Million People that lost my Health Insurance at the end of calendar year 2013. I had a Health Savings account and high deductible policy. The president told me it was a junk policy and i had to get rid of it. He knew better. This is what i had to buy there were 10 essential Health Benefits that were covered and might not have been covered in the policy i had. Where was the concern to people losing those policies when the Affordable Care act happens in january 1st 2014. I will tell you as it was implemented there was a special deal for members of congress. I thought that was wrong. The special deal for members of congress was we could take a subsidy and walk it into an exchange as long as we were willing to purchase in the d. C. Shop exchange. Number one, my doctors are not in d. C. , theyre back in texas. That was of no real value to me. The other thing was i knew my constituents at town halls back in texas would not understand why i as a member of congress not a special subsidy untaxed i could walk into an exchange. I said, i cant do it, no thank you. I went to healthcare. Gov and signed up just like so many people tried to do that october, november, december, it was one of the most miserable experiences ive ever had in my life. I was worried i would get signed up by the time the deadline expired at midnight on december 31st. Remembery they extended it a few days. It was a tense time for people buying in the individual market. It was an appropriate thing to do because my constituents i represent who are in the individual market are going through the same thing. Ive heard from a lot of them over the course of time with the Affordable Care act. Two or three days ago the president gave a beautiful address in chicago and talked about how great things were with healthcare. You almost feel like youre in a dickens novel, its the best of times, its the worst of times. Look, people are struggling right now under the constraints of the Affordable Care act. I view myself as on a rescue mission here to try to help people who have in fact been hurt by the federal policies that have been imposed. Again, the other thing that happened over the last in fact 10 years ago, 10 years ago last week, the introduction of the iphone. Now, you dont think that is a startling medical discovery but my iphone can take my ekg. Cant yours . This morning just to make sure because i read a lot of twitter reports on the rules Committee Last nighty this guy has no heart, i thought i better assess whether there in fact was local activity in the myocardium. Im happy to report there was. In fact, on my watch that talks to my phone, theres a little icon i can actually click on that icon to get the ekg function of the phone, except when i do that, it says, this function is not available in your country. So maybe thats something we ought to work on from a regulatory standpoint. Think how life has changed in the last 10 years because of the handheld devices, smartphones we all carry with us. Mine will take my Blood Pressure, take my assessed blood sugar and check my weight. Im worried the nsa has hacked into that and altered it on me. I practiced obstetrics. Back in the days i practiced obstetr obstetrics, it never failed, 4 30 on a friday afternoon a patient would come in her last two or three weeks of pregnancy with a Blood Pressure just enough elevated over what it had been before to cause some concern. Heres the problem. Most people who have that, it will turn out to not be a problem, may have been because i didnt have enough parking pl e places close to the office or she was mad at me at the time the Blood Pressure was measured. Bad things can happen. If you go the ultra careful route and say you have a Blood Pressure measurement higher than it has ever been before. I need to put you in the hospital and monitor that. We did that a lot. Late in pregnancy, in order to assess or make sure that preeclampsia would not lead to eclampsia and all kinds of bad things down the road. If you guessed wrong, your Blood Pressure is a little up, let me see you fist thing monday morning and get this checked again and make sure its not a problem. 3 00 in the morning with a pl e platelet level low and baby in stress, all kinds of bad things happening you guessed wrong. How great is it this day and age someone can have a Blood Pressure cuff, record it on their iphone, email it to their doctor and that monitoring can occur in an out of hospital event and people can go on about their business. You significantly reduce undernecessary hospitalizations. Important to me as a physician who practice defensive medicine you also can significantly reduce the unfortunate sequel lie if you incorrectly assess n incorrectly at the time of that event. The development of the savings account, put the patient back in charge and the iphone or handheld device gives the person the opportunity to participate in the monitoring of their affair. It is something that will change the future of compare. Certainly, it would if i were still in practice i would be incorporating those activities on an ongoing basis. As i mentioned, my smart watch wont communicate with my smartphone about the ekg because theyre not available in my country. One of the other tasks if replacing the ing thing the aff act was not enough for the subcommittee im chairing now this term in congress we have the user fee agreements that are expiring. American enterprise are inter t interested what happens at the fda because ive heard from some of you. Im interested as well. We just went through a big legislative effort for the 21st century and there will be ongoing work done on the regulatory side in the user fee authorizati authorizations. This happened in 2012, a tough year to get a bipartisan agreement and we did and the bill got signed into law three months later. You dont know that because the president signed it in a broom closet. It was three weeks before the election. He didnt want to be seen with us and we didnt want to be seen with him, that got done ahead of schedule. The same thing will happen this year, what ever time with the Affordable Care act is being marked up in the secretary of health and energy and commerce and ways and means and happening on the food drug authorization. Thats critical work. The aca reform is something that will happen right now and fda reform are things that happen years into the future. I know that because of when we did our last one, it was very rare that a week went by that there was not someone in my office with a tale of woe how they had difficulty dealing with getting things through the fda. We need to make that a more straightforward. Im not saying anything needs to be shortened or curtailed but we need to make it more straightforward and the agency cannot change the rules late in the game and send everyone back to the starting gate and say we decided on a different set of parameters that have to be shown for this and you have to start all over again. Let me in the next couple of minutes talk to you more from the my role as a member of congress being on the subcommittee doing a lot of this work on the Affordable Care act. Three big pieces of Health Policy have happened in my brief tenure in congress which started in january of 2003. 2003, you may recall, was the year medicare modernization act, bill thomas chairman of the ways and means actually worked very closely with counterparts in the senate. Senator ted kennedy was involved with that and ultimately came up with the part what is now known as part b, Prescription Drug benefit in medicare. President bush, when he was running, said i will get this done so there is no question whether or not it would be done and it got done. Arguably bipartisan although certainly there are people on the democratic side of the subcommittee say it wasnt really bipartisan, you held the vote open for 4 1 2, five hours. That may be true but we were just waiting for david woo to vote and when he did it was over pretty quickly. There were tough spots. January 26th, the date it all began. Phones were ringing because people were having problems. I would argue because it was bipartisan, because both president bush and senator kennedy were interested in this thing working right, you had secretary mike leavitt at the department of health human services. Those were interested in fixing those problems and those questions were quickly worked on and by the end of valentines day, they were old news or ancient history. The Affordable Care act passed in 2009 and 2010. The Affordable Care act was a single party in charge of that. So when trouble occurs, do i want to step up and help . No. My fingerprints arent on that. Why would i get involved at this point . So the lack of bipartisanship, if you will, i think, was dam e damaging on the when the Affordable Care act got into trouble with the implementation, it was not just distracting, it was damaging for the future of the law. Then, in april of 2015 we passed a bill called the medical access and chip reauthorization act. I like to call it the sgr repeal because it solved a problem although created by congress, it solved a problem that had bedevilled doctors, patients and policymakers for 49 years. It took 17 years. It took us 13 years to solve it, which we did. That vote was strongly bipartisan. 3. Aye votes in the house and 92 yes votes in the senate. 392 aye votes. It scared everyone to death. What are you doing to small practi practices, will people be able to continue in a one or two person practice because of some of the things that have come out in the cms rule interpretation. A valid question. Because of the bipartisan nature of that bill when it passed the administrator of Medicaid Services heard from republicans and house members and it was changed and was vastly different. A lot of flexibility was built into that process. Ill go one step further, andrew said he will leave the Comment Period open on comments coming in on the macro rule that was published in october. Thats exactly the oversight you want. Even with all the other stuff happening this year and next we will continue to have oversight hearings on the implementation because it is so important it be done right. Obviously, there will be changes at the agency that may affect for better or worse how things happen on the implementation side. Regardless whos the head of that agency i want them to know the Sub Committee still feels very stron