Transcripts For CSPAN House Oversight Committee Hearing On The Affordable Care Act 20240714

Rising tensions between the u. S. Eastern. At 2 00 p. M. Forre congress adjourned summer recess, the House Oversight Committee Held a theing on the future of Affordable Care act as certain provisions were being challenged in courts. Witnesses included advocates and a. C. A. Ast of the well as patients who have benefited from the law. Hours. Der four rep. Cummings committee will come to order. Objection, the chair is recesszed to declare a of the committee at any time. Full Committee Hearing is convened regarding the administrations attack on the a. C. A. I now recognize myself for five openingto give an statement. Because on today the trump2019, administration filed a letter with the United States court of appeals for the fifth circuit reversing its own previous position in the texas vs. United states in asserting for the first time would not defend any the Affordable Care act in court. The Trump Administrations the entireevails and a. C. A. Is struck down, there electric catastrophic oflications for millions americans and the entire United States Healthcare System. Voting forsaid that the Affordable Care act was the important vote of my career. Why. Et me tell you when Congress Passed the a. C. A. We enshrined into law the promise that all americans the right to accessible, Health Insurance coverage. The a. C. A. Established new protections to end legalized againstnation approximately 130 Million People the United States with conditions. C. A. Authorized states to expand their Medicaid Programs 17 millionmately americans gained coverage as a result. A. C. A. Created Online Market to purchaseonsumers insurance with financial through premium tax credits, cost sharing reduction and today nearly nine million individuals receive Financial Assistance to obtain coverage through the individual market. The a. C. A. Improved the quality of coverage for millions more by a seting the plans cover of essential health benefits, for preventivee services such as immunizations and screen tests and allow young adults to stay on their parents they turn 26. If the Trump Administration is successful, all of these federal will disappear. People with preexisting conditions, like diabetes, cancer, h. Mr. Isasi hiv, asthma, Substance Abuse disorder could be charged more. Babies born with Health Conditions could be uninsurable for their entire life and the Insurance Companies in the groupdual and small markets would not have to cover essential services such as preventive care, hospitalizations, emergency services, Maternity Care and Prescription Drugs. Trumpr, since president took office in january 2017, Neither Administration nor Congressional Republicans have to replace the preventhat would coverage losses or the elimination of consumer protections. House republicans have voted 69 repeal the a. C. A. Their last proposal which failed in 2017 wouldnate have increased the number of uninsureds by 21 Million People. Theres something wrong with that picture. 2016 campaign, President Trump promised would come upt he with a plan to replace the did. But never never did. That hes running for president again, he promises returned. Es have now youll be hearing them shortly if you have not already heard them. In april he promised to release quote, a really great, end plan. After the 2020 election. Unfortunately, nobody has seen it. Ironically, if the Trump Administration is successful in striking down the entire a. C. A. , would directly undermine many policy goals, opioidng tackling the epidemic, lowering prescription ending the hiv epidemic. Hear from the administration about why they suddenly reversed their position litigation. We wanted to know what the plan is forons millions of people if they went court and invalidate the entire a. C. A. Directord the acting of the office of management and russell vote, to testify hetodays hearing but declined. Apparently he did not want to answer these crucial questions that affect so many millions of with something thats very personal, and thats their health. Proteges, said to my the one thing that we must day,s ask ourselves every i think, and that is what is the enemy of my destiny . Of my destiny . My what will stop me from reaching where god meant for me to go . And theres one common denominator that ive noticed that applies to all of us health. Health. And enjoying a life where you truly pursue happiness. So although the trump to answertion refuses these basic and critical fortuneate toare have a panel of legal and policy patient witnesses who can tell us exactly what it if the Trump Administration is successful in eliminating the Affordable Care act. Our committee not to be blinded by what we see. Blinded. The experts are here. Theyll let you know. They are the witnesses, theyre on the front line. They deal with these matters every day. And then there are others who gone through and continue to go through difficult circumstances. Can relate, now that im on a ive learned what it is to be disabled. A tremendous task in my instances just to get dressed. I got it. And i often say to our witnesses have come to share with us their personal stories, thank you. Thank you for taking your pain, into a passion to do your purpose. Pain, passion, purpose. Fromo, theyve traveled across the country, from utah, pennsylvania, new york, to share their stories with us. To tell us what life was like for them and their ones before the a. C. A. Was passed. So i thank you again. With that, i yield now to the very distinguished gentleman from ohio, Ranking Member of our mr. Jordan. Rep jordan thank you, mr. Chairman. We could have a discussion about Real Solutions that will make the lives of better, talkicans about the cost of healthcare, healthCare Coverage, preexisting conditions. Theres no one on this committee who would support denying coverage to americans with preexisting conditions. We could focus on those issues but unfortunately like so many other hearings committee, were not. Rather than working towards bipartisan solutions, this scoretee is looking to political points by attacking anything the Trump Administration does to improve for americane people. Next door in the judiciary we reported out multiple bills that would have had meaningful impact on the Prescription Drugs. Judiciary committee spent months on working on ideas to cut down improve howand affordable jeb generic drugs to market. Those bills were all bipartisan and i was pleased to vote for them. We could be talking about bipartisan substantive issues today. Were going to talk about why the democrats are administration thinks americans deserve Something Better than the failed ideas of obamacare. Obamacare, americans saw premiums skyrocket and healthcare choices reduced. The majority title for todays toring is trumps efforts undermine the a. C. A. A. C. A. . E the think about what we were told when this bill passed, now, nine years ago. Ofall them the nine lies obamacare. If you like your doctor, you can keep your doctor. Remember that one . If you likee one your plan, you can keep your plan. We were told by the president of the United States, premiums were going to go down. Specifics, more premiums will go down on average 1500 dollars. He said deductibles would decline. Five false statements right there. This one. This is in the fall of 2013. They told us the website was going to work. They told us the website was secure. Your information would be secure there. Coopsld us that these were wonderful, endall, beall creations. Created. Guess how many are still in existence . Four. Bankrupt. 19 went and the ninth lie, first they told us its not a tax. Then went to court and said it they said theow individual mandates gone and theres no penalty. Different lies we hear about obamacare and the hearing trumps efforts to undermine how can you undermine something thats failed . Administration has worked to increase competition, transparency and quality of care our healthcare market, increase competition and transparency and quality of care are goals we all should share. I dont know if theres anything the Trump Administration could that would satisfy my colleagues on the other side of the aisle. Timing of this hearing is also particularly troubling. Fifth circuit began oral arguments in a case that could invalidate obamacare due to recent changes to the law. The administration close not to defend obamacare in this appeal. That decision is consistent with similar actions taken by other administrations in the past for other laws but here we are, democrats wanted the director of o b this morning to testify about how the Trump Administration made this decision. Could have had a witness from h. H. S. From have had a witness d. O. J. But, no, they wanted someone from omb. This is about trying to manufacture a controversy based Anonymous Sources and news reports. This hearing is just another on President Trump and its disappointing. We could have had a productive about realtoday healthcare policy. Hopefully we can still do some of that. I hope we can. Our side is going to try to do. We could have had a real discussion about making more competitive, transparent and Cost Effective with better quality of care. Some point this committee will stop relentless political attacks on the administration and focus on makes ag that difference in the lives of our constituents and i thank our witnesses for coming here to tell your story. Country deserves Something Better than the lies we were told. Namee remember the Jonathan Gruber . Remember that name . New york times called aim the architect of the Affordable Care guy who was the caught on tapes a few years later, remember, calling us all stupid, calling americans stupid for buying the lies that the Obama Administration told us they passed this thing, the words of Jonathan Gruber, architect of obamacare but somehow the majority says this is a hearing on efforts to passedne a law that was with so many false statements made about it. Back. Airman, i yield rep. Cummings we look for constructive solutions. I ask that my witnesses stand in a minute. Them first,duce abbe gluck is professor of law, director of the Solomon Center for health, law and policy, Yale University law school. Thank you. Executiveisasi, director of families u. S. A. Balat is director of right initiatives, texas Public Policy foundation. Of our patientne consumers from west valley, welcome. Casey dye is another Patient Consumer from monroeville, pennsylvania. Stephanie burton is another one of our Patient Consumers from city, missouri. Thei will now yield to distinguished gentlelady from of herk to introduce one constituents. Thank you so much, mr. Chairman. Is my honor and pleasure to introduce my good friend and constituent peter morley. Peter is an outstanding patient onecate, the most effective i have ever met in my entire life. Twotime cancer survivor living with lupus. Peter is an extraordinary advocate for the millions of cant come to congress to advocate for themselves but are living with whoseisting conditions, es depend on consist consistent healthCare Coverage guaranteed under the Affordable Care act. I had the him on twitter when he ask what heto me to could do to save healthcare. He depended on it. What can i do. I never dreamed how far he could go. He is a true example of how one a difference. E peter, i said, become an advocate. The city of new york going to forums, press conferences, meetings. It to coming to congress over 21 times including today, testifying before congress. He has held over 150 meetings and members of Congress Senators on both sides of the aisle and he is incredibly effective. Is a voice for many people whatsed to know happening on social media. Following and uses this platform to lift up the hopes for so many struggling with healthcare issues and his goal is to save the affordable act. Thank you for your dedication. Recognizengs i mr. Horry for an introduction. Welcome david balat who is e, recently a in constituent in texas 21 and the Public Policy foundation. Activelya longtime dstled in the Healthcare Industry and administration and health, a great expert on health. Thank you for representing texas 21. Texas rep. Cummings thank you very much. You who stand and state the oath. Do you swear or affirm that the testimony you are about to give is the truth, the whole truth and nothing but the truth, so god . You let the record show that the witnesses answered in in the affirmative. Thank you, you may be seated. I just want to let you know that microphones are very sensitive. Speak directly into them. Make sure theyre on when you speak. Nothing like testimony that we cant hear. And without objection, your be madestatement will part of the official record. Professor gluck, you are now recognized to give an of yoursentation testimony. And i want to remind the have yourthat we all official statements. We want to try to limit this to five minutes. Iknow, i know. Its hard. But we you see all these people here. All of them want to the ask you all questions. So i just want you to give a statement, summarizing, stay andin that five minutes there will be a light that comes on to let you on to let you know you need to end. Gluck. Or ms. Gluck chairman cummings, Ranking Member jordan, members of the committee, good morning. Toppreciate the opportunity testify here today. Is unlike any other major case involving the Affordable Care act. This is the first major where there has been a consensus among legal experts a. C. A. Ng prominent opponents that the Lower Court Decision was dangerously wrong. The stakes are enormous. 20 Million People will Lose Health Coverage immediately. More will be adversely affected. The a. C. A. Reaches every aspect of the Healthcare System, not just those with preexisting conditions. 10 million got healthcare exchange. 17 million through Medicaid Expansion. Billionsn medicare got of benefits and also losing will be anyone who wants vaccine, care, substantive abuse treatment and much more all gone. Appreciate theo overreach of the texas decision that the entire a. C. A. Has to go administrations decision to support it despite opposing legal consensus. Brief inle, i filed a this case with jonathan adler, the most influential critic of a. C. A. During the last Supreme Court case. Twoher brief filed by republican attorneys general. Many other prominent conservatives, filed briefs or wrote to oppose the case because thancase is about more just obamacare. It is about the violation of a legal principle that safeguards congressional law making power. The principle is called severability and unlike the legal issues in other cases, severability is settled, ninelitical law, all justices apply the same test. The doctrine addresses what a court would do if it finds one part of a statute invalid, the entire statute or the offending provision. Involves the 2017 tax law in which congress made one change to a. C. A. And reduced zero the penalty for failing to obtain insurance. Not beingsion is enforced. Whats causing the crisis is theyre also arguing the entire go down with it. That conclusion is at odds with unbroken Supreme Court precedent severability. There are two parts to the test. We save, presume that not destroy. Chief Justice Roberts and kavanaugh wrote that courts must sever to the extent possible. Second, legislative intent. Alito wrote that unless it was evident that congress rest,not have enacted the the remainder of the law remains standing. Is not difficult and that makes it different. Courts do not have to and are permitted to guess whether congress would have wanted the stand because here congress itself not a court eliminated the penalty and left the statute standings. By leaving a. C. A. Intact, as clear ase possible its determination that a. C. A. Should continue. That some matter members of congress wished to appeal the law. It doesnt implement the preferences for those who want overturnould be what they wanted to repeal. Thats what the texas court did. Attorney generals said the law is capable of functioning without the mandate. Over, the texas court had to ingnor the tension and focus7 congress on the 2010 congress but the 2010 congress is irrelevant. Congresses are allowed to amend statutes passed by earlier are notes and courts allowed to give one congress more power than the next. The judgmenty of is not undermined by the fact that an earlier Congress Might something different. Ive alluded to the enormity of the consequences. Kidswould be imposed, couldnt stay on parents plans until 26. Women could be charged more than men. Subsidies to make insurance affordable. We would lose Maternity Care, Prescription Drug coverage and screenings and drug benefits for seniors. The administration itself cant initiates its own whether ending the hiv crisis or without thes, a. C. A. s reforms. It is not every day that adversaries take a joint position. This case is more than the a. C. A. Or dire consequences but power andtion of limits on judges. Rep. Cummings thank you very much, ms. Gluck. Chairman cummings, Ranking Member jordan and members of the committee. Thank you for the opportunity to testify today. Isasi, executive director of families u. S. A. For nearly 40 years we have served as a leading National Voice for healthcare consumers. Mission is to allow every individual to live their greatest potential by ensuring health and healthcare are equally accessible and affordable to all. Work represents needs and interests of families and are toud of our bipartisan work adjust medical bills, improve pricing transparency. With bipartisanship possible it saddens me to discuss the impact of this lawsuit. Youve heard and it bears repeating, if the a. C. A. Is 20 Million People in america will lose health period. E coverage, that includes more than 300,000 state,in your home maryland, chairman cummings, and more than 700,000 people in the of congressman jordan. Beyond that, final consumer be strippedwill from people with preexisting conditions, women, older adults. Of us who receive Health Insurance from employers, hundreds of millions of subjects, we could be again to annual or lifetime limits in our policies meaning lose access to coverage when we need it most. Cut thee a. C. A. , weve national uninsurance rate for adults and children by almost half including gains for families in Rural America, veterans, older people, premedicare and many others and a. C. A. Included a host of improvements including lowering seniors cost in medicare, increased solvency of the trust fund and created drugsway for affordable to treat Breast Cancer, leukemia and diabetes. The will try and shift focus of todays discussion from the vast improvements created by to focus instead on the impact of the a. C. A. On Health Insurance premiums. We at families u. S. A. Share deep concern about premium costs and make healthcare more affordable. Data are clear, it is wrong to say that the a. C. A. Is the cause of high insurance premiums. First, despite all the rhetoric, ownrding to the president s actauraries, premiums in the grown morerket has slowly since 2014 and in the familiesl market, most in the marketplace are paying less for coverage. Havethers we know costs increased but this is important largely because the a. C. A. For bids discrimination against preexisting conditions. Many more people with complex healthcare needs can get access to insurance because costs are shared. Despite the truth that the a. C. A. Has lowered premium costs that premiumsgree were rising too fast before the rising tooare still fast. They primarily reflect the cost of the care paid for by example, for Prescription Drugs, hospitals, physicians. As we know, the underlying cost have increased far in excess of our paychecks for decades. Because healthcare prices are skyrocketing. No one in this chamber or this. Ng from home doubts as a nation, we have to get a handle on healthcare costs. Forto blame the a. C. A. Outofcontrol healthcare costs is like say drowning man blaming preserver for getting them wet and members of the committee, the public does not want the a. C. A. To be overturned. For well over a year, a majority of americans support the law and polling on individual coverage elements of the a. C. A. , the public support goes overwhelmingly both among democrats and republicans. Weally, lets not forget how got here. Republicans leaders in congress and President Trump failed to they passed. C. A. So a law that zerod out the mandate. L as weve heard, both conservative and progressive scholars believe the litigation is groundless and the president has failed in constitutional duties by choosing not to defend the healthcare law. Result, our basic healthcare hangs in the balance and this is why one of the broadest groups of healthcare seattle our history in supports the a. C. A. Including the American Hospital association, American Cancer Society, american heart association. As families u. S. A. , we hope the protections of the a. C. A. Will remain and that tens of millions families across the country can breathe a sigh of relief and know if they or their children need healthcare, they wont lose get care. To thank you for the opportunity to testify. Rep. Cummings thank you very much. Mr. Balat. Mr. Balat thank you for all the members of this committee. Balat, director of the right on healthcare initiative. Like to thank others that are here to testify. Believe we all want affordability, accessibility in healthcare but have different there. Ow to get for those patients here today, who may have benefited from the a. C. A. , thank you for your bravery in telling your story because i know the difficulty you face in dealing with this broken system. Healthcare is an american issue, not a political one. Not partisan. My experience as a healthcare executive, hospital patientrator and advocate precedes my work in health policy. My journey coming from the industry into the realm of policy came because consistently conflated and confused Health Insurance with healthcare. Im here to confirm that coverage is not care. A hospital administrator, ive seen people use the for basicdepartment care because theyre unable to deductibles. The a. C. A. Sought to reduce Emergency Department services but the consequence has been the opposite particularly in states that expanded medicaid. Americanhe departments, access to care has been an issue under our Current System. Better prior to the introduction of the a. C. A. But problems have been exacerbated its passage. The number of providers which accept the plans is minimal and shrinking leaving patients waiting for appointments to see mr. Physician. When they see their doctor, they may be referred to a specialist be difficult finding one in their region. The Administrative Burden created by the a. C. A. Has limited choice for the most vulnerable. A study this year titled the Health Insurance on mortality, analysis and what we learn from the Affordable Care coverage expansion demonstrated there was no reduction in mortality for those the a. C. A. ,pated in demonstrating that the enrollment in the a. C. A. Had the impact in having other forms of coverage or no coverage. A. C. A. Tients on the exchange whose premiums are subsidized are left with a sizable deductible, often leaving them in the position of theaccording to to go to doctor and often waiting until they have to go to the emergency further driving up cost of care. Insurance coverage under the up thethat has driven cost of care has hurt patients with preexisting conditions, not helped them. As an adviser, i have been called to help families and complexityvigate the of hospital care or how to read and understand explanation of benefits. A Common Thread in their frustration. They dont get to decide. Get less. Ore and needless to say we have a full of perverse incentives. Government resolutions have empowered Insurance Companies to charge. The patient and doctors have limited decision power. Are made bys government administrators, Insurance Companies and middle men. Lack of affordability and inefficiency because there are too many middle men who are doctor and patient. The medicare bureaucracy sets prices for services and Insurance Companies enforce the fixed prices on everyone else. We need a system in which everyone has a choice and the Government Role is limited to a safety net. The Current System is failing because it is unaffordable and unreliable. Americans understand the problem is the high cost of healthcare and they want to be empowered to for themselves and their families and have peace of mind. This doesnt come from government mandates but is evident when people are participating in their Care Management with their doctor. About the number of uninsured in this country but not all are without care. Among that statistic of the uninsured. Betterould assert i get healthcare as a patient because to repeat my point, coverage is not care. I use direct primary care and medical cost sharing for my coverage for myself and my family. These models, in addition to the others that have been promoted by the Trump Administration do not have preexistingr conditions and are demonstrating a higher degree of accessibility and affordability. The high cost of care in the country increased significantly during the the a. C. A. Cost of care is the single biggest reason healthcare is less accessible. Care is what of American People care b. The high cost of care is the direct result of the federal government attempting to fix healthcare and failing. And competition, not one plan is what we need for as personal as healthcare. We need a landscape of choices personal. Iverse and thank you very much and i look forward to your questions. Rep. Cummings thank you. We now move to mr. Gibbs. Let me say to our patient witnesses, again, i thank you for being here. Think your testimony is so important. On capitol hill we readat statistics and we about people having problems but theres nothing like having who go through it every second of their lives. So mr. Gibbs and thank you. Mr. Gibbs thank you, mr. Chairman. Thank you, members of the committee for giving me the today. Nity to speak ive heard this law referred to names the Affordable Care act or obamacare. For me its important to call full name, the Patient Protection and Affordable Care act because the theent protections of a. C. A. Have been a gift from god for people like me and families like mine. My healthcare story begins in twin brother and i were born with serious medical conditions. Hirscha condition called bruns disease in his intistens which caused him to need 17 by the time he was 5 years old. Surgeries on my kidneys for a condition that going up into my kidneys instead of down where it belongs. Severe. Costs were my parents never got out from ofer the financial burden the healthcare costs for my brother and me. Within the past 10 years, they passed away with nothing to their names but a great legacy of caring for their every as much as anyone could. It was in november of 2008 that routiner told me in a visit that i was in endstage adney failure and needed transplant as soon as possible. Going to school, doing my best but had no Insurance Coverage. Not be caree may but when you need a 79,000 surgery, there is no care without coverage. Im a member of the church of jesus christ of latter day saints, very well known for its generosity and taking care of churchbers but my couldnt pay for a 79,000 surgery. Two surgeries. My kidneys were in bad enough shape, they were considered an newction risk for the kidney so they had to be removed first. Ive heard opponents of the say people dont die in america due to lack of healthcare because they can go the emergency room. You cant get a kidney transplant at the e. R. Fit the narrow qualifications for medicare before a. C. A. I also fitnd qualifications for mediCare Coverage which allowed me to lifesaving surgery 10 august. O this but the expenses didnt end there. To takey i have immunoexpressant medication to my body from rejecting the kidney and other medications with the side effects immunosuppressant medication and my doctors later discovered a chronic distended bladder may have caused my kidney decline to begin with i to use these catheters five to six times a day to empty my bladder. A. C. A. , it would be expensive for me to urinate. Expenses together add up to almost as much per payments. Y mortgage now, i hear talk of protecting preexisting conditions in other plans that everybody wants to protect preexisting conditions. Previous plans put forth include things like pushing people like me into expensive and unreliable highrisk pools. Those are not protections for conditions. Potential lockouts for not having coverage are not protections for preexisting conditions. Talk that relentless the administration and a. C. A. People like me feel relentlessly attacked by this administration the members of committees like this one who keep attacking the a. C. A. Son, peter, 5 months old this was born with a kidney condition similar to mine. He, like chairman cummings talked about, is one of those who could be shut out for life. He had a kidney surgery two weeks ago and without the a. C. A. The protections to ensure that he can receive the followup care he may need entire life just for being born with a bad kidney. Of two sons i have who has a chance to be born because of the wisdom of the Patient Protection and Affordable Care act which gave me this coverage. To saylusion, i want that we are guaranteed in the independence the right, inalienable rights of liberty and the pursuit of happiness. Life comes first because without life all other rights are meaningless. Being subject to Insurance Companies being able to deny us coverage or make it prohibitively expensive because liberty ands not protections, without that access to healthcare, there can be no pursuit of happiness. My sons deserve the right, they be born,he right to they deserve the right to stay alive and they deserve to have a father who has access to the care he needs to stay alive for them. Thank you very much. Rep. Cummings thank you very much. And congratulations. Ms. Dye . Thank you, chairman cummings and the committee for today. Me talk over the past nine years, my family has faced a lot of but i hope you hear my story and recognize that im unique oneinamillion story. The challenges my family has many families so who work hard, play by the rules, face as they go through life. As parents, we want to make sure we can do the most essential thing for our kids and keep them safe and healthy. We also want to know as they go through their own journeys they were will also overcome challenges and pursue their dreams. Of 2010, my husband lost his job. We couldnt afford cobra. Between august and november of that year, he and i went uninsured. Our 1yearold daughter got coverage through chip. 2016, my husband lost a second manufacturing job and notks to the a. C. A. We did have to worry about going uninsured again. Health plan would cost 1,175 a month and thats just for the two of us. We pay 60 a month for our son, on chip. S and our daughter, chessy, is ph95 medicaidthe loophole for her disability. Lost his job in 2016, we wanted to move closer to family in your state, of ohio, in florida and arizona. Guess what, mr. Jordan, your told me my daughter wouldnt get the services she needed so therefore we had to in pennsylvania. To tailor our life around the needs of chesy. Is going back to college to switch careers in the healthcare field which doesnt from state toing state to find a job. Thanks to the a. C. A. , in 2018, i able to get a mammogram that showed i had three lumps in my breast. Biopsies were done and they were all benign but what if i was uninsured and results turned out differently . This could have been financially family. Us for my before the followup this year in may, i looked at my husband was joking and being serious. Have both removed i mightif i get cancer, be uninsured. This is my reality and the reality of millions of families in america. The fact is i dont trust the say that yourty to care about me and my family and the rest of the families in preexistingver conditions, to cover those with disabilities. Also had decided to get a years in a row and when the doctor asked me why i scheduled it this way because go between three to five years, i told her im worried i wont have coverage next year so looked at me and she said she was glad i made that choice to come in. I am actually an lpn who works care so atric home lot of the kids i take care of are on medicaid. My job but the lives of my patients are at risk you make cuts to these vital programs. Our daughter, chessy, who is the white with a little pink headphones. Rep. Cummings where is she . Oh, ok. All right. Seems to be listening to your testimony. Ms. Dye shes 19 months old and has been in therapies for o. T. , and she learned sign language so she could communicate with us. Everyday lifein from watching tv, listening to music, reading books, talking to friends, socializing and work. Was seene of 3, chessy by three doctors, two diagnosed developmental language disorder, a condition where children have problems spokenanding or using language. She will have this in adulthood. Herother doctor diagnosed on the autism spectrum but all doctors agree that she needs intense speech therapy. Speechol, she received three times a week and o. T. Once a week and gets speech and o. T. Week outpatient. She has a mobile therapist that pers to our house two hours week. A mobile therapist helps chessy to appropriately express her thoughts, feelings and work on socialskills, practicing skills and all. Chessy gets six therapies a including mobile therapist. If chessy loses medicaid and we would have to pay, it would cost over a thousand dollars a month for her current therapy. Never afford that. The hard work of her therapists improved her life. Today she talks a lot and to her friends on her own. Has made significant academic progress. This year at the age of 10 she one b. As and in math and reading, shes two years behind. To make it clear, break it down a tripod andgine chessis on top of that tripod. Legs represent one, us, her parents, two, her therapist and a third is her teacher and aides. If you guys cut medicaid, youre down that tripod and take away and knock down all the progress that she has made. The only chance of her being a productive member of our society andable to get a job hopefully make minimum wage, are those crucial programs in place right now so i want you to realize what you guys are doing of my familythink and my daughter but millions of families around the United States you will affect. Thank you. Rep. Cummings thank you very much. Ms. Burton . Ms. Burton chairman cummings, Ranking Member jordan and distinguished members of the committee, good morning. Burton andstephanie i live in kansas city, missouri. My jobst of 2008 i left as a probation officer to attend law school. Not afford Health Coverage so i was uninsured throughout school. Upon graduating in december 2010, like many of my classmates, i was unable to find work and was forced to hang my passing theafter bar. Starting my own Legal Practice healthcare. L had no as a single mother of four young children, that was devastating. Diabetes went untreated for five years. When my health got so bad i not tough it out, i was forced to seek medical care in the emergency room only. As a mother, i felt i had let my children down. Had done everything that seemed right by furthering my education, yet i still couldnt even afford a routine doctors visit. Was terribly wrong with this picture. The Affordable Care act changed that. On january 1, 2014, i enrolled in a Health Insurance plan i thehased through marketplace for less than 100 a month thanks to a subsidy. I no longer had to decide between paying my mortgage and going to the doctor. Myave been able to manage diabetes and get the medications i need it stay healthy for my kids and my clients. A huge load off of my mind. I have been covered through the beginninge since the of the first open Enrollment Period and i found the coverage affordable and easy to use. When taken a flight, the if youresays traveling with small children in the event of emergency first place the oxygen mask over yourself and then over the small child. Every parent to every parent this is counterintuitive consistently put our children first. However, if we do not take care healthelves and our first, we will not be around to care for our children. The Affordable Care act was like that oxygen mask. It allows me to have healthcare to keep myself healthy so i can continue to work and provide for my children. Until march 7 of this year, i was selfemployed without the option of employer provided Health Insurance. Upon accepting this new position eight years after having to hang own shingle, im now offered Health Insurance from my employer. Though the benefit option is great, i can still say the policy that i have through the marketplace is better. I have had the same team of enrolled ine i 2014. Although the need isnt as as it was me today eight years ago, i can honestly say that the Affordable Care act saved my life. The last five years of coverage have kept me the healthiest i have been in the 11 years since started law school. One of the requirements of my torent employment was undergo a health physical. I have no doubt that i would healthy have been enough in 2014 to accept the position i have now. Maintaining preventive healthcare through routine visits thanks to my a. C. A. Coverage has allowed me to continue to treat my diabetes without fear of being turned away. To healthcare should be a fundamental human right to all people. Be no choices when it comes to healthcare and housing. During this administrations i wonder what would happen if i lost my coverage and what would it mean for my children. To return toi had private practice, would i be able to afford my insurance my subsidy, would i be lucky enough to last without the treatment that i receive. Not a partisan issue. This is a what happens to families without Health Coverage issue. Its a why are we turning back the hands of time issue. Should a single mother of four children be forced to choose between housing healthcare issue. Another undueted burden on society if we cant keep parents healthy enough to raise their children issue. So i ask you and urge you all, away thes, dont take coverage from 20 Million People. Dont return to the crisis, the we enduredis that before the a. C. A. Thank you. Rep. Cummings thank you very much. Mr. Morley . You, chairmanank cummings, Ranking Member jordan and members of the committee. Am honored to speak with you today. Morley. Sell peter in 1997, i had an injury during Insurance Coverage. All treatment and medication of my own paid out pocket. When i later needed surgery, my company considered my injury to be a preexisting my claims werell denied. It was the financial burden tens of thousands of dollars. Permanentlys disabled from an accident. I was spared the costly medical bills of four spinal surgeries because i had continuous Health Coverage. Survived Kidney Cancer and fought my way into remission after losing part of kidney. In 2013, i was diagnosed with causes me severe fatigue and most days its a of bed. To get out i now manage over 10 conditions, take 38 different medications and infusions toologic slow the progression of my disease. Financialthe brink of ruin and only live modesty thanks insurance and the fact i cant be discriminated against because of a condition. G preexisting conditions are a way of life preexisting conditions are a way of life for me as well as millions of others. Thanks to advances in science and medicine, most people like me with chronic diseases can live happy and productive lives, but only if we are provided access to Health Insurance that cant be taken away because an Insurance Company decides its in their best interest not to cover something or if congress decides to repeal our healthcare or the single greatest threat we face to our health today, the trump ministrations refusal to defend the Affordable Care act. As someone who spends the majority of my waking hours in doctors offices, the aca has meant focusing on healing, not bankruptcy. I used to be very private about my health. But once President Trump was elected and set to repeal the aca, i could not longer be silent. In december, 2016, i decided to foster awareness for lupus and advocate for healthcare. My congresswoman has taken up my cause and those of people like me. The Trump Administrations reckless support for the texas versus azar lawsuit to tear down the entire aca, terminating it as the president has said, is a grave form of subversion. In the last two years, i have traveled to d. C. 20 times to advocate for thousands of people who shared their healthcare stories for me. I have met with democratic and republican members of congress alike. My message is simple if you think people dont get hurt when the administration doesnt defend the aca, think again. We do. I do. Millions do. If you think preexisting conditions arent important, remember, someone you love could have an accident, be diagnosed with cancer or lupus at any time, and that will change how you think about this. I know firsthand your healthcare can change in an instant. And if you think the aca isnt perfect, your job as our representative isnt to tear it down, its to make it better. I appreciate the committee holding this hearing today. If the Trump Administration can choose not to defend the aca, citizens like me understand that future administrations can do that with any law. I put my health at great risk to travel here and share these stories. I never know if this is the last time im healthy enough to come to d. C. I would be remiss if i did not mention my friend and advocate of medically fragile children, natalie weaver, whose own daughter, sofia weaver, passed away in may. Sofia suffered from rhett syndrome and many other preexisting conditions and endured 30 surgeries in her short 10 years of life. Natalie spent precious time away from her daughter for the betterment of Healthcare Access for all children. She will never get that time back. These are the sacrifices that we make as advocates. That is why i am here today, to ask you to protect the Affordable Care act and to hold the Trump Administration accountable for not defending Health Insurance for all americans. Thank you for allowing me the opportunity to testify, and im happy to answer your questions. Thank you very much. Passion, purpose. Pain, passion, purpose. I will now yield to ms. Maloney. Thank you, mr. Chairman, for calling this meaningful hearing. And i am so proud that one of my constituents, peter morally, was invited to testify. He has been a fierce defender of the Affordable Care act. Peter, thousands of patients and their families have reached out to you to share their stories and asked you to bring those stories to congress. Can you share what some of these stories are like and is there anyone that stand it is out to you . Absolutely. There are many that actually stand out to me. The most the hardest stories for me to listen to are the people who could have been saved had the aca been enacted, and also the patients who would have like some of these people these patients have testified here today, they would have been diagnosed sooner. Their conditions would have been more under control, and in some cases, healed. I hear from patients who excuse me,cuse rathee, rather, s who are they have medically fragile children, and they get their Health Insurance because of Medicaid Expansion. I hear from people in states such as texas, florida, north carolina, and tennessee who dont have that same luxury because their states have not expanded medicaid and they are denied that type of coverage, had they lived in a separate state, and they cant afford to move to another state to receive that type of coverage. Those are the stories that keep me up at night. And of course, since i have lupus, anyone who reaches out to me, who suffers from lupus and tells me thank you, peter, for going to d. C. , i dont know where you get the energy to do it. And truthfully, i dont know either. Im grateful to be here. Its that energy as these patients have testified. It takes a lot of guts and a lot of courage to come here and share something so vulnerable and so personal. I know. I know you suffer from chronic diseases, and i know personally from our exchanges that its very painful for you physically to come here. Why do you make these trips . Because, honestly, congresswoman, i never expect to fit whether its a democratic or republican legislator, i never expect to change beens mind, but what i what i have learned from coming down here is it brings me hope. Hope that there is a chance for change. Hope that one person will listen, because it really only takes one person. And, the hope that the people who follow me on social media, they receive and they say to me, you know, peter, thank you. Thank you. I can feel that, you know, something positive may come out of all of this sabotage that we have witnessed. So peter, the Trump Administrations recent attack on the Affordable Care act in the form of the texas versus United States court case really threatens healthcare for millions of americans. What would it mean for your friends, the patients and families youve spoken to, if protections for people with preexisting conditions are eliminated . In some cases, it might limit their access to medications and to lifesaving infusions and to cancer treatments. And it could i mean, it very well would mean death. What about if medicaid was eliminated . Medication expansion . Yeah. What would happen to the families . A lot of them would lose coverage and access. What would it mean to the parents of medically fragile children that have reached out to you if the entire Affordable Care act what would happen to them if the Affordable Care act was eliminated . I honestly dont know, but i do know they experience even if that didnt happen, they experience an incredible deal of stress. And this even having to focus on that has caused them undue stress, and its already stress as we know when we have a chronic illness. So its stress upon stress. My time is expired. I am proud to be in this fight with you, and i am so proud of you. Im proud of you. Thank you, mr. Chairman. Yeah, i think theres two basic reasons why were having this yeah, i think theres two basic reasons why were having this hearing today. Number one has just come up. Its an opportunity to trash the president , to impugn the president for not defending obamacare. And i get where our witnesses are coming from from their perspective. That is one of the purposes of this hearing. But the reality is, obamacare is failing. And the president is not defending a failing policy. Bad policy. And he is right not to defend that. You just look at the numbers. And it is very clear. Obamacare does not work. Has not worked, is not going to work. We were told there would be some 25 Million People enrolled in obamacare by now. It just hasnt happened. The truth, what has happened, insurance premiums have sky rocketed. Sky rocketed under obamacare. Deductibles have soared. Coverage networks and access to providers have shrunk. In some cases, been eliminated. Insurance companies have fled the aca marketplaces. Rural hospitals have suffered enormously. I have a number of them in my district. And they have suffered tremendously because of obamacare. Many rural hospitals have actually closed their doors. And yes, there are people who have benefited. Not going to deny that. And of course, our panel is full of them today. And i appreciate the testimony from our witnesses, our panelists, today. But i can also tell you this. For every person who has benefited from obamacare, we can find tons of folks who have been hurt from it. And, you know, i lookad the panel today, mr. Chairman, six out of seven are democratic witnesses. Where are the ones in fact, i would like, mr. Chairman, to have entered into the record a letter from a constituent back home, ralph, from greensboro, georgia, who talks about how hes suffered. Were told that ill just reverse it somewhat of whats been said today. If you think people dont get hurt by aca, you need to think again. Ralph, for example, before obamacare, he paid 700 a month for insurance with a 3,500 deductible. Both of those have in fact, he now pays has nearly 14,000 14,000 deductible and his monthly costs are about 1,200 a month. Couple years ago, his two children he has 4 children. Two of them were in an accident. Hes still paying for 30,000 plus that had to come out of pocket. Thats before taxes, before grocery, before mortgage, before college. And so, this thing absolutely goes both ways. The second reason were here today is really to play the platform for medicare for all. Lay the platform for medicare for all. And that is the attempt that the democrats are putting forth in spite of the failures of obamacare. The democratic partys going to double down and push for medicare for all at a cost of some 32 trillion. It would totally eliminate employersponsored medical coverage, medicare, medicaid. All of it gone. All of it, gone. Let me ask you, what would what can we expect from a government single payor Health System . Singlepayer Health System . You can certainly expect rationing of services. Thats what weve seen in many other countries that have gone this way. Many politicians have said those are models we want to look for, we want to look toward to emulate. My experience with being in those countries and working with patients ill give you a specific example. My wife and i were on medical missions in costa rica, that has a single payor. The wife of the pastor we were with was diagnosed with cervical cancer. She was approved for surgery, but she had to have an ultra sound first. She couldnt have the ultra sound for 12 months. She said, when will i be able to have the surgery . They said another 12 months after that. She had access. She may never get to the point where she has the surgery. Rationing is inevitable when you have a limited amount of resources. Resources. Those resources continue to decrease the more burden we place on the individuals who are delivering the care. The time is expired. Would you like to respond to that . He said he wants to see both sides, whats the other side of this . I saw you shaking your head. Go ahead. What occurred to me your microphone. Sorry. With respect to discussing the case, just the subject of this hearing, one of the things that i would emphasize is that the case in texas is not a policy referendum. Its not a case about the benefits or not of the Affordable Care act. Its a case about a settled legal principle. And the administration doesnt get to decide whether to defend the law based on whether it likes the policy and the law or not. Thats your job. Congress job is to pass the policies. The administrations decision not to defend is only defendable in the very limited circumstance in which theres a real unsettled legal question. As i said, what is striking about this case is theres a dramatic legal consensus across both sides of the aisle that the legal principle here is settled and that theres no place not to defend the law. I would also note that, you know, weve heard a lot of statistics about the benefits of the Affordable Care act, including dropping the insurance rate by 46 , including getting women covered at record rates. I also would point out the Trump Administration itself is actually relying on the statute for a lot of its initiatives. I heard this morning the Trump Administration announced an executive order about Kidney Disease that depends on the order of medicaid. That would be gone if the Affordable Care act would be eliminated. He hiv Initiative Point of order. Whose time is this . Whose time is this . Im trying to help you, man. You asked the question. Basically, i asked her to finish answering the question. She was shaking her head, and i allowed her to do that. I know you want a fair hearing. I know you want to hear both sides of that. Six out of seven is not given a fair hearing. Come on, man. We want a fair hearing. Youre getting it. Are you finished . Yeah, thats the point. The Opioid Crisis as well. Virtually all of their own healthcare policies rely on the statute, as well. Its important to recognize that and were talking about the benefits and what the statute has to offer. Thank you very much. Thank you for giving us both sides. Ms. Norton. Thank you very much, mr. Chairman. It took a lot of chutzpah to hear my friend on the other side go down the list of the cost going up of healthcare, deductions going up. When that is a direct result of actions that the Republican Congress took when they controlled this house. [laughter] the complaining about actions that they took to diminish the Affordable Care act. Well, one of those actions was to take away the mandate and the district i represent, the nations capitol, the district of columbia, has a rate of about 96 coverage. Which means that virtually everybody is covered, thats people going from one side to the other who may not be covered. Thats because as my republican friends took actions, just detailed by my colleague on the other side, that undermine the healthcare act. In my district, they simply made up for them themselves. For example, as i indicated, by reinstating a dc mandate. [laughter] so, almost everybody has healthcare. I was interested in your testimony, because it looked to me as though you had done all that anybody could be expected to do. You finished law school. You found you couldnt find employment, and then you did what is really difficult for someone just out of law school. You opened your own practice. Your children were covered, you said, by medicaid. But you could not get coverage in the individual market. I understand, because of a pre existing condition. Is that true . Thats correct. What would be any idea what the purchase of Health Insurance would have been for you before the aca . It was 895 a month. Which is more than my mortgage. I was going to ask you, compared to what other expenses. You indicated your mortgage. So you chose to give up coverage for yourself in order to pay the rent and provide for your children. Did that take any toll on your health . Absolutely. As a single mother of four kids, you do what you have to do to maintain. You do what you have to do for their interests, even if it means you sacrifice your own. I worked in private practice 8200 hours a week. I took time away from my kids to make sure they had everything they needed. I dont have any regrets about that. Id give anything to make sure theyre okay, but im all they have. If im gone, theres not somebody else willing to step up and take over that burden. Then came the Affordable Healthcare act. Yes, maam. With the marketplace. What kind of coverage were you able to get and how much did that plan cost . My plan with my subsidy cost 62 a month, and it was compared to . Remind us. The 895 that i would have had to pay for an hmo coverage. The plan i got through the marketplace was ppo coverage. I was able to choose a doctor. Ive got a great doctor and a great team of doctors. Because i have so many conditions. I have narcolepsy. I have asthma, diabetes, sleep apnea. Because of that, i have a team of doctors. And my now, you work for the District Attorneys Office. Now, thats a Government Agency. Correct. The Government Agency we work for, the United States government, provides healthcare for everybody whos sitting on this podium. You have what we would have. So did you take your healthcare that was provided by the District Attorneys Office . My healthcare that i have through the das office, its supplemental. Its not federal. So, it doesnt cover what the benefits you guys might have. My policy through the marketplace is still better than the insurance my employer offers. I did take it for my children. So, you have Health Insurance offered by your employer, you compared that to the aca, and you decided to stick with the aca coverage . Thats correct. Time is expired. Did you finish answering the question . Yes, sir. Thank you very much. Thank you, mr. Chairman. Im over here. Like to welcome all the witnesses here today and just have three quick general questions id like to ask the entire panel just with a show of hands for the sake of time. Do you all support how many support eliminating employer sponsored insurance. Sponsored insurance . Second question, how many on the Panel Support the current version of medicare for all, which i believe, if my math is correct, 17 members of this committee on the other side of the aisle support . Anyone support medicare for all . Last question do you support extending Healthcare Benefits to Illegal Immigrants . Couple. This is one of of the areas that i find troubling. Because i represent kentucky. I represent a poor district. I represent a district that has a High Percentage of people on medicaid. And before the Affordable Care act, kentucky had a high medicaid population. After the Affordable Care act, kentucky expanded medicaid. And what happened when they expanded medicaid, a significantly a significant number of new people got on medicaid. What that did was it cut the pie into very small pieces. In fact, 30 of kentucky is on medicaid now. There are so many people on medicaid, that the providers continue to get cut. And people on medicaid are finding a hard time finding a provider who will actually take them. So, medicaid hasnt been cut in kentucky. The fact that so many people are on medicaid, the services are automatically getting cut. Everybody cant be on medicaid. And medicaid in kentucky is free healthcare. Thats a great deal for the people that have free healthcare. But somebodys paying for the free healthcare. And the people that are paying for free healthcare are the people in the private market. And theyre very upset, because the premiums continue to sky rocket. So, we have a problem with the Affordable Care act. Mr. Ballot, the reason i ask the the question about extending free healthcare to Illegal Immigrants. Because i watched the democratic debate the other night, there were 10 on the panel. They were asked the question, how many support extending Free Health Care to Illegal Immigrants . And all if i remember correctly, all 10 raised their hands. Thats potentially millions of new americans on what i would presume would be medicaid. What happens to the current Healthcare System in america if my friends on the other side of the aisle and those running for president from the other party get their wish and extend free healthcare to millions and millions of Illegal Immigrants . Thank you for the question. Im a child of immigrants. Its important what we do in this country for the people that are here. We, as americans, have always taken care of our communities, and thats our focus. Thats who we take care of. What it would do to healthcare, what it would do to our communities, what it would do to the medical professional community is it would strain it even further. Let me tell you what happens in medicaid today. Its very difficult to get in and see the doctor. The wait times are exceptionally long, as i said in my testimony. If they do get in to see their doctor, getting a specialist referral is even more difficult. Then, getting the medication they may need. The doctor i hear all the time, the doctors dont like to take care of medicaid patients. Nothing could be further from the truth. They dont like the Administrative Burden that is consistent with how we deal with medicaid and the aca exchange and so on. Its going to stretch it out. Were going to see less people participating on those panels and it will leave people without care. We are going to see our ers continue to be flooded and increased in population. All right. I think thats an important part that needs to be mentioned in this hearing, is that everyone cant have free healthcare. And, weve got a problem with the Healthcare System in america. We had a problem before obamacare. It got work after obamacare. Worse after obamacare. Theres no way to fix the obamacare situation, especially in kentucky, with the massive expansion of medicaid. So, hopefully, well have a discussion in the future in congress about ways to make healthcare more affordable to the working people that are paying while at the same time protecting people with preexisting conditions, which is a priority for me and i think every member of this congress. I yield back. Thank you very much, mr. Chairman. Let me start with you. You said something extraordinary, which is that your partner in filingan amicus amicus brief in an attempt to is a person who was opposed to the Affordable Care act and was your nemesis essentially, your counterpart on behalf of the Affordable Care act back in the burrwelcase. The burrwel case. Is that right . Yes, it is. It is extraordinary. Youre talking about a distinguished lawyer who was opposed to the Affordable Care act and thought it was originally unconstitutional, but he thinks it would be absolutely absurd and outrageous to use the invalidation of one provision, which zeroed out the penalty for not purchasing insurance, to act, is thatntire right . Correct. And you cite a bunch of other conservative legal scholars who are on that side. Theres republican attorneys general from montana and ohio. Judge mike mcconnell. Judge mcconnell . Yes. Professional chambray. Professor kevin walsh. In what judge mcconnell taking a position against the administrations point of view here . He authored a brief arguing that theres no jurisdiction to decide the case and filed a brief not on behalf of either party, but on behalf of the blue states. I want you to underscore this point for our colleagues. Obviously, we have a difference about whether or not 20 Million People should be stripped of their Health Insurance and the general progress weve made under the Affordable Care act. Lets go to the point of legal severability. In 2017, there were efforts to repeal the Affordable Care act. I was in congress then. They voted 69 different times to repeal the Affordable Care act in its entirety. They werent able to do it because there was a mass uprising around the country. People went to the town Hall Meetings saying dont do this. Dont do this to our families, and they werent able to get enough republicans to do it even though republicans controlled the majority. So instead, they passed this one provision zeroing out the penalty on the compulsory purchase of a policy. Of insurance policy. Some people thought it was a great thing, some people thought it was a terrible thing. But now, theres the proposition being pushed by i dont even want to say conservative republicans. Because there are a lot of our side, but by an extreme faction, apparently, within the Trump Administration. Theres a position that the invalidation of this one provision, where i dont know if its the passage of this one provision, but undoes the entire act. It undoes everything. The protection for 26 year olds, preexisting condition coverage. All of the medicaid provisions, all the provisions that expand peoples access to Prescription Drug benefits, closing of the doughnut hole, everything thats in there, theyre saying is now toppled because this one provision is gone. Now, what does that do to the power of congress . When we thought we were passing one thing and now the courts say well, because this one provision is out, were going to strike down a 2,000 page piece of legislation . I think one of the reasons you see this unprecedented consensus, this case goes to the power of congress. To let the court do what it did here, the court is taking over congressional lawmaking power. Its usurping congressional lawmaking power. Separation of powers. They value separation of powers. I wouldnt even want to win that way. In other words, if i thought the Affordable Care act was the creature of the devil himself and i wasnt able to get it through congress, but we were able to chip off a piece of it and later, judges say, hey, were going go ahead and destroy the entire act, i wouldnt support that. That is a net salute the legislative power, isnt it . Thats what the wall street journal said, nobody hates obamacare more than we do, but this is a corruption of the rule of law. I dont think it can be overstated, the reach of the statute. We have medicare Prescription Drugs, no discrimination based on health status. We have fda approvals. They were invited to believe that we all knew that when that vote took place, that we were going to essential undo it if one phrase or sentence dropped out of the legislature. Courts are not allowed to do that. Courts are not allowed to presume the courts have to presume that. The courts have to interpret statutes. Thank you for what youre doing and for reaching across the aisle to bring people in and work with them on this critical principle of the severability of provisions. Thank you. Miss miller. Thank you chairman and Ranking Member jordan. Before i begin, i would like to read a portion of a testimonial from a constituent from madison georgia. She writes i coown a Small Business in madison, georgia. When obamacare was first passed, we were one of the businesses that lost our healthCare Coverage. When finding new coverage, my insurance went from 385 a month to 643. Due to the fact that im a female, which is an increase of 67 . Im beyond child bearing ability, but i still have to have maternity coverage. Mr. Chairman, i ask for the unanimous consent that the testimony be entered into the record. That the full statement be entered into the record. Without objection. Thank you all for being here today. It has been over nine years since the aca has been signed into law. We all know that when a law is enacted, often there are kinks or problems that need to be worked out and issues that need to be resolved as we move forward. However, the obamacare has had countless issues since its enactment and has harmed healthcare for citizens across the United States. Republicans have been saying for years that we need a fix for this program to decrease the premiums, stabilize the market, increase access to care, and protect those with preexisting conditions. Now, my colleagues across the aisle have decided to abandon this program completely and chase after a single payor system, which would further increase healthcare costs on taxpayers and inevitably decrease access to care for people who need it the most. In west virginia, enrollment in our exchange has decreased. While many are now enrolled in employer insurance, many have insurance due to the booming economy, many have cited high deductibles as a reason for going uninsured. We need to solve this problem problem, and a single payor system is certainly not the solution. Has the aca lowered monthly premiums for americans . No, they have not. In fact, how much have premiums gone up for americans on average since the law was enacted . It has been significant, and it has been a range depending on the part of the country theyre in. 200 to 400 in some cases. Thats terrible. How has the aca kept the deductibles the same or lowered them for our constituents. Constituents . Outside of the change or within the change . Within the exchange. Re ok . Are you ok . Whatever listen to me, your healthy is number one. Whatever you need, let us know. Alright, ok. Thank you, mr. Chairman. The premiums within the exchange have been they gone up closer to 60 or 70 . Outside the market, substantially more. It sounds like what the goals for the aca intended to be have not been enacted. How has the Current Administration help ensure americans to have increased access to healthcare . Some examples have already been given. People talked about fixing the aca. Some measures already mentioned are attempts at fixing it. Such as the opioid and hiv and kidney initiatives. The whiteo be that house and administration are looking to improve upon the acas foundation. Theyve done other things, as well. The executive order the president pout in 2017 would expand the already existing Short Term Limited Duration plans. Extending those for those that may be in transition longer than the amount of time initially prescribed, helping people who are losing jobs, moving, going through a divorce, allowing time for that time period. That transition period. And the association put another solution out there that experienced Great Success double Great Success. Some reports showed double digit savings and people able to pool together and buy employer styled business healthy plans. Health plans. That was another good innovation the hras, healthy arrangements that will allow the individual market to come back january 1, because that went away when aca was first implemented. Employers will be able to dedicate defined amounts of and a part of their Compensation Plan for their employee to go out and be a consumer to find out what fits them and their family the best. Thank you. Mr. Chairman, ill yield back the rest of my time from the to the gentleman from texas. You have five seconds. Sorry. Could you expand on your concerns earlier . You talked about medicare for all and expanding coverage, that that would drive up costs for healthcare. Time has expired, but you may answer the question. The cost of healthcare continues to go up. The more we have the government involved trying to fix this entity, this industry, the more weve had the costs go up. We see the same thing in higher education. The more the federal government has gotten involved the higher tuitions have become. The more the federal government has gotten involved, the higher tuitions have become. Weve seen lots of technology and televisions and iphones that heavily regulated. Prices go down. When the government is involved, prices come up. The reasons theyre there, regulation, Administrative Burden, shackles we put on the people on the front line trying to help the patients, were hurting ourselves by doing this. Mr. Connolly. I thank the chair, good lord. The comments about the federal government, that would come as news to the colleges and especially the for profit colleges, get government out of the way and stop regulating and prices will gone and cheating will stop and people wont be embezzled or defrauded with phony credentials or credits. That logic escapes me. Professor gluck, have you looked at the economics of healthcare insurance premiums . To the extent a law professor can. Im not an economist. To the horror of my colleague on the other side of the aisle, ever since the aca, premiums have skyrocketed. Is there a correlation . You can answer, as well. Is there a correlation between the adoption of the Affordable Care act and inexplicable premium increases . Which apparently were unprecedented and didnt happen before. Premiums werent going up before the Affordable Care program. Everything was stable and hunky dory and 35 Million People didnt have healthCare Coverage. But you know, somebody has to suffer. The Affordable Care act has made insurance affordable for many people. And the Republican Congress. And congress itself. This strikes me as amazing. We do everything to sabotage the law, and we are horrorstruck there is gambling here, it has impact on the cost of insurance because the mechanism we put in place to try to keep those down and keep it affordable were destroyed in the eight years the republicans controlled the Congress Even before mr. Trump took office. Would that be a fair statement . Yes, it is. Now, youre shaking your head. We need to talk facts. Now, youre talking crazy. [laughter] youre in the United States congress. But all right. We know the answer to this question. We know what happens to premiums post aca. Post aca. We surveyed the American Public and the percentage of people reporting they couldnt afford historians Health Insurance in the individual market was cut in half after the aca. One of the central parts was support to make sure it was affordable. Most people in this premium are getting that and most people paying for less. Its empirical and well documented. In addition, as you pointed out, there are a lot of dynamics in play. The number one reason because of the number one reason for the premiums going up is not the Affordable Care act, the prices are out of control. We know were paying too much for Prescription Drugs and doctors too much, we know that. Blaming the aca is a drowning man blaming his life preserver because he is wet. It is preposterous, not the reason we have high prices in this country. Can you and professor gluck remind us of the successful efforts by my friends during republican friends during their majority in the house and congress, where they succeeded in gutting certain revisions of the Affordable Care act directly related to keeping pressure down on premium increases . Sure. As you know, congress turned off Three Streams of important stabilization payments for the Insurance Industry. There was a lawsuit about the continuing ability of the administration to pay Cost Reduction payments, and it sowed dramatic instability into the insurance market. And attempted to reduce enrollment on the exchange, reduced money for navigators, critical bridges between producers an enrollment and an attempt to split the Insurance Markets and make healthcare more unaffordable for those still in the healthcare aca markets. Lord oh mighty, i was convinced the aca drove up prices mindlessly. Now, you tell me there is a cause and effect, but not the Affordable Care act, its the insidious, gutless drive to gut the Affordable Care act they couldnt do legislatively but to the laws that made it much but through laws that made it much harder for protections and bumpers from the price increases. Thats exactly right. The largest increases we saw was after the risk quarter payments were stopped. That is when that happened. Time is up, but thank you for both illuminating my understanding what really happened. Mr. Gibbs. Thank you, chairman. I dont think anybody in this room or the president doesnt support preexisting care. Preexisting conditions. Its a tragedy when somebody cant get it because of preexisting conditions. Unfortunately, we had a bill out of the house that addressed that and it is unfortunate the other side wouldnt work with us to make that bill better. Its earned to sing it is interesting to look at whats going on, talking about the costs. I had a neighbor come to me about a year ago, my county was down to one insurer on the exchanges. She was going to lose her Health Insurance because that was going away. The other thing i hear about, is people talk about the do you the the doubles are so high, they cant afford them. And why there are 30 Million People still insured because the deductibles are so high and it is a problem. Want to mention the comments theier about how Affordable Care act is failed. Most people on the other side of the aisle arent running on obamacare, running for medicare for all i think would be a really big disaster. I will give you an example. We had a good friend four years ago that on friday at 4 00 have severe chest pains. At 11 00 that night, she had a quadruple bypass. What would happen if that was in canada or anywhere else, would that person get that care that fast in a system where we have medicare for all, single payer system . In an emergency situation, that would be different. That would certainly be considered an emergent an emergency situation. If it were a planned procedure, the wait times would be longer than we would have in this country, exceedingly. It amazes me. Research,talk about and medical research has come along way with higher life expectancies, better quality of if we have a singlepayer system, what happens if the private sector is being innovative, what do you see happening . I dont know that i could actually speak to that. The one thing i do want to say, even when we talk about all these other issues, we keep going back to insurance and we talk about insurance and we dont talk about the patient. The real victim in this is the patient and cost of care itself. The insurance has contributed to it. Of course, the premiums went up after the risk order payments were ordered. They were put in place to decrease the aca to make it look like it made sense and it did not. Look at the payments and the real tragedy and how we take care of our citizens in this country. President trump did an executive Order Association plans go back in effect because obama did away with association plans. One of my neighbors was one of ed withs that help association plans. Can you tell me what happened to association plans . They were growing at a good pace. They had a great deal of popularity, and there was a suit and a federal judge essentially said the association plans were an end run around the Affordable Care act. Theyre still in operation, no injunction much like with what happened with the federal suit in aca versus viazar. Azar. Theyre not proceeding further because they dont know what will happen. Association plans give individuals the ability to have options . Absolutely. Because of the exchanges, theres no competition there, just government set. Because it functions like an employer plan, it has a bigger base and more options. They can choose among different types of solutions and not just traditional insurance. Health savings accounts are a big part to help that. I have a Health Savings plan that gives me Better Options to direct my own healthcare. Leftl yield my 20 seconds to my friend from texas. With all this time, what can i do . I would ask one question, describe a little bit what you say, what are some of the alternatives with respect to empowering patients versus Insurance Companies . Understand why we are focused on insurance, and the colleagues on the other side of the aisle are more focused more on insurance than care. Your time has expired. You may answer the question. I will give an example. I use something called primary care. Insurance has ill say it this way. The reason healthcare has become more inefficient and more unaffordable is because there has been a wedge driven in the relationship of doctor and patient. Healthcare is a very personal situation. I think all the witnesses here have talked about their team. It should be looked upon that way. Direct primary care is a membership model type of plan. I pay on the order of 60 a month for unlimited 24 7 access to my primary care physician. No exclusions on preexisting conditions. I can communicate with him via electronic means, text, secure video chat, and the like. Thank you very much. Thank you, sir. Thank you, mr. Chairman. There has been talk about abouthas been talk governmentbacked singlepayer systems. We are have two single payer systems in the United States called Veterans Affairs and medicare and i hope theyre not alluding that we should eliminate them. There are 39 industrialized countries in the world. 39 of them have universal health care and only one does not, the one in the greatest world, the United States of america. When the government is involved in providing healthcare insurance, it drives prices up. In fact, those 39 countries who have universal healthcare spend about half what we spend. We spent about 18. 5 of our gdp on healthcare. We know we have an inefficient system. While the aca may not be perfect, it has brought Quality Insurance to a lot of individuals who did not have it. I did want to touch base with you on a couple areas with the litigation going on in texas and the potential were facing the aca could be eliminated as we know it and protections under it and other key areas, talking about the donut hole a lot of seniors face in prescription prices. Can you talk about what the impact would be if the aca was thrown out in totality as the impact on Senior Citizens and prescription prices in general . You bet. First of all, if the aca is repealed by the judges, for the seniors, medicare costs would go up and cost share would go up and the Medicare Trust solvency would be immediately weakened. Andould have a specific negative affect at large. In addition, the entire pathway, provide lowcost, high value to treat leukemia, lupus, some of the most devastating illnesses in this country, would disappear. That was part of the law. This discussion about other ,orms of new kinds of insurance lets be really clear. What were talking about there is hurting people with preexisting conditions and letting Insurance Companies play tricks on consumers. The only reason theyre cheaper is because it excludes people and allows Insurance Companies to play tricks. We have done a lot of work. The American People are fed up with buying insurance and not getting financial protection. What we are hearing today is a description of Insurance Products that would exclude hospital care or exclude Prescription Drugs all together. Altogether. It is letting Insurance Companies play tricks on consumers again. That is not a pathway for Affordable Access to the American People. It is a pathway for tricks and hurting the Financial Stability of our nations family. When we heard a member on the other side say that everyone here would support the view the president supports for preexisting conditions. Let me point out, i dont believe that. I believe actions are greater than words. If the aca were struck down in entirety, tens of millions of americans, over 100 million americans would lose preexisting coverage . Thats right. Almost over it is half of the people that went before the aca tried to get coverage and couldnt get coverage. Its important. This question has been answered. Republican leaders passed legislation that was the alternative to the Affordable Care act. 6. 3 million americans with preexisting conditions would be paying much more for Health Insurance coverage or not be covered. They answered this and hurt people with preexisting conditions. That is the truth. Professor, it looks like youre chomping on the bit to Say Something as well. Could you weigh in on this as well . Turn on your microphone. I was nodding in agreement because before the aca, the number was 52 Million People were denied insurance because of preexisting conditions. Thats a statistic you have there that is readily accessible and furthermore, to emphasize reenacting just preexisting conditions alone would not do nearly enough or anything for people with serious medical conditions. If you have coverage and it is priced prohibitively, it does nothing, or if it doesnt cover the benefit of the Prescription Drug you need to treat your disease, it does nothing. If you dont have medicare or medicaid for the coverage, the coverage does nothing. The preexisting condition discussion is important, but just the tip of the iceberg. Thank you. I yield back. Thank you, mr. Roy. Thank you, mr. Chairman. A couple of quick questions for professor gluck. With respect to the litigation, did the Supreme Court find the mandate unconstitutional originally, the mandate . Yes or no . No. The mandate was not found unconstitutional. The mandate itself . There is no such thing as a mandate itself. The Supreme Court found it not as theitutionally commerce power, but as a tax. Thats right. The mandate is unconstitutional. Thats what the Supreme Court said. It was unconstitutional. If you didnt have the power under Commerce Clause and the only power is the taxing law. The tax was zero now. It means that tax does not exist. Correct . No tax. Is there a tax today . The tax is zero. There is no tax today. Theres a mandate in the legislation, it is unconstitutional, the Supreme Court said they do not have the mandate to purchase it in commerce. The tax is now zero. The tax no longer exists. Therefore, where do we sit today . The very thing that saved it was the mandate, the tax which is now zero, doesnt exist. This is the theory that underlies the District Courts opinion and this is why were in front of this, not because its a policy choice as some colleagues suggested, this is because it is a constitutional question, a question about the power of this body and whether this body can mandate individuals buy something in the marketplace. When it was determined to be a tax, the penalty, then you have a taxing power question. Now, we dont have a taxing power question. This is where we now stand today. Is it not true that with respects to severability, four justices in the opinion did find it to be an severable . Inseverable . Is it not true the District Court in this case found it to be inseverable . I appreciate that question for two reasons. First, the mandate, the severability is not the issue in the case, not being enforced. Whats at issue is the District Courts application of the next question, what happens without that provision . Does the whole statute get struck down . With regard to your second question, it is very important about the previous Supreme Court opinions. Those opinions were indeed based on the courts perception of the 2010 congresss view of that. Whats at issue is the 2017 Congress Amendment in this case. Otherwise is to undervalue the power of the 2017 congress. Reclaiming my time, four Supreme Court justices said its unseverable. They said the mandate is thential to the aca and scotus described the mandate as a three legged stool with that which without which the aca shouldnt stand. This is at the heart of the litigation in question, why it is before the fifth circuit and why arguments were held yesterday. This is where yesterday, there were Great Questions from the panel on the judge. The judges on the panel asking the questions. This is a very legitimate litigation. Well see then what unfolds. With respect to my colleague from california, making the comment that, quote, about single payer that we have medicare and we have v. A. Im interested that weve got bipartisan agreement in the Veterans Affair committees, on which im proud to serve that we need to make changes to the v. A. To make it better and one is to rely on Market Forces, to have more Market Forces and choices for veterans to go out in the mark place and get access to care that a single payer solution isnt meeting the needs of our veterans who are serving this country with valor. When we talk about the wealthiest and greatest country in the history of the world, when we compare ourselves to other countries, that were the sing pailer t have health care, and i would argue that were the greatest because they werent they werent forced to be in a system thats subpar, forced to say theres coverage for 20 Million People when the vast majority is medicaid coverage which drives out the very people medicaid is designed to care for in the first place. Were talk about a 22 trillion medicare for all scheme, which will ble up the opportunity for thus to have a Health Care System that is affordable for the vast majority of the American People. With that, i yield back the five seconds i have left. Ms. Wasserman schultz. Thank you, mr. Chairman. I think its important to note for the record that mr. Roy just came out for privatizing the v. A. Which the overwhelming majority of our veterans oppose and are quite happy with the health care theyre receiving and want it to continue. That having been said id like to ask unanimous consent to enter this article from stats magazine into the record. Without objection. The headline says name the much criticized federal program hat sthaved American People 2. 3 billion. One month after the a. C. A. Passed, the actuary of the department of health and Human Services projected its Financial Impact in a report. The governments official Record Keeper estimated that Health Care Costs under the a. C. A. Would reach 4. 14 trillion in 2017 and constitute 20 ppt 2 of the gross domestic product. Fast forward to december, 2018, notably during the Trump Administration, when that same Office Released the official tabulation of Health Care Spending in 2017. The with the tom line, cumulatively from 2010 to 2017 the a. C. A. Reduced health care spend 2. 3 trillion. In 2017 alone, the article continues, Health Expenditures were 650 billion lower than projected and kept Health Care Spending under 18 of g. D. P. Basically a tad over where it was in 2010 when the a. C. A. Was passed. All this while expanding health Care Coverage to more than 20 million previously uninsured americans compared to the 2010 projections, the governments medicare bill was 10 , 70 billion, less an spending for medicare and the children east Health Insurance program was a whopping 250 billion below expecting as, par lrble partially, but only partially due to the failure of some states to expand the program. The actuary estimated that employersponsored would come to 110 billion. It was 2,000 less per person than expected to be and for those who have private employer sponsored insurance their lower premiums averaged just under 1,000 per person. I could go on but weve been through the article weve entered the article into the record. Essentially we need to be dealing with the facts. Thats why we have these hearings. The fact is Health Care Costs have been lowered. Premiums on average have lowered for people and we have added 20 million to the health care roles. With that having been said some of you may know im a Breast Cancer survivor. I talk about it openly. Its something i live with and live in fear, i understand all of your concerns, and the thought process you went through about potentially having a prophylactic mastectomy or other prophylactic surgery no matter how assured i was that i did as much as i could do to prevent that cancer from coming back i think about it every single day. Like every single cancer survivor i know. So taking care of your health and making sure that you have the ability to go to the doctor when youre sick and not worry about how youre going to pay for it, which is what the fear was for every single uninsured american or underinsured american before the Affordable Care act is abchutely paramount and what this debate is all about. Mr. Chairman id like to ask unanimous consent to enter this letter from, we have a letter from 17 advocacy organizations plus the American Cancer Society into the record. Without objection. As the letter notice, before the a. C. A. , patients represented by their organizations, quote, ere oftens fored to delay or forgo health care, which is unacceptable but its the world the Trump Administration wants to take us back to. Sit true before the a. C. A. More than 60 of people who applied for insurance were denied coverage . And i also want to ask with the remainedmoifer time on about the impact on seniors. Nearly one fifth of the residents in my district are seniors. We havent talked a lot about the coverage gap, the doughnut hole, that would be reestablished if we go back to the bad days prea. C. A. Professor if you could tell us what would happen with this provision if the administration overturns the a. C. A. To your first question, your staff is right. Had almost half of people were denied. When we get sick we lose coverage. Without protections for preex we dent have anything. Just nt just about people with preex. May i answer in if the chairman is ok with that congresswoman youre exactly right that the Affordable Care act protections for medicare have been widely underpreeshed. 60 million seniors got access to free Preventive Services, five million benefited from their coverage gap before the Affordable Care act. You only had Prescription Drug coverage up to a low number, around 2,000 and then there was a large gap until the coverage benefit kicked back, in we call it the denut hole. Seniors had to pay out of pocket. More than five million seniors benefited from that the medicare provisions also had a drug negotiation component to it that wound up lowering costs by 26 billion in drug costs over the life of the by i would say that all of that will be gone if the decision is upheld. Thank you, mr. Chairman, i appreciate your indulgence and i yield back. Before we go to mr. Norman, i try to make sure that i run a fair hearing. Mr. Roy, im going to recognize for a minute because he wanted to clarify something. Mr. Roy. I would just ask my colleague, ms. Wasserman schultz, to maybe reframe her comments that i was calling for the privatization of the v. A. When in fact what i said was that the v. A. Needs improvement and the v. A. Is seeking improvement, the Veterans Affairs committee is seeking improvement through choice and mission to improve it allowing private sector options to supplement the Veterans Health care. So you mischaracterized a little bit what i said. I would ask if shed be willing to acknowledge that that was not what i said. I recognize the gentlelady. I appreciate the gentlemans request. If the gentleman is willing to say that he is opposed to privatizing health care at the v. A. And making sure that the v. A. Can continue to provide the Excellent Health Care Services it provides that the overwhelming majority of veterans support continuing then sure. Im not going to get into the back and forth. Hey, hey, whoa. Mr. Chairman. Then i characterize if youre not willing to acknowledge that then ive characterized your position correctly. You mischaracterized my position and did so blatantly. Reclaiming the time the chairman gave me we have a bipartisan agreement that choice and mission are improvements to the v. A. , that adding mark forces is a good thing. Burn agreement on that that is a mischaracterization what you said about characterizing that i said we should fully privatize the v. A. We should inject Market Forces and provide more choice for veterans. That is what im saying. Since the gentleman has now addressed me and has taken his time back and wants me to correct what how i characterized his position and he has refused to acknowledge that he opposes privatization thats a simple statement. I didnt hear him say he opposes privatization. If hes not willing to say that then the direction that the Republican Party has been taking us in with the v. A. , including the Trump Administrations pushing in that direction for more private Market Forces, for health Care Coverage at the v. A. And by the way, i chair the military construction and Veterans Affairs subcommittee, im responsible for the budgeting, you wont say that on the record soy will not recharacterize what i said you said. Im not going to engage in an inquestionization from the gentlelady. I wasnt trying to. You mischaracterized my statement. Hello. Hello. Why wont you say you oppose privatetizing the v. A. Will you say you oppose mission and choice. I did oppose mission and choice. There you go. Please. The committee is not in order. The Ranking Member. We can read the transcript. The gentleman from texas did not say he was in favor of privatizing he didnt say anything about it hsm etalked about choice. His characterization by the gentlelady from florida was that he said he was for privatizing the v. A. He did not say theasm transcript will be clear because we all heard it. Thats all he said, clarify that simple fact. Well take a look at the transcript. And he wont say, mr. Chairman. Right now were going to get ready to go to mr. Norman. I tried. To work things. Couldnt do it. But i did the best i could with what i had. Mr. Norman. Thank you, mr. Chairman. I sincerely want to thank all the panelists, particularly the one that have i assume preexisting conditions to take the time to come here. I will take issue with six of the seven as mr. Hice said were really the intent was to trash this president and to advocate medicare for all. I take issue with what you said about all republicans being against, ai i assume any type of changes in health care. I take issue. I think mr. Gibbs you singled out mr. Jordans state is not covering your particular problem i dont know which one of you did. This is not a partisan issue. This is something all of us want. Democrats and republicans alike. But the fact that i think, we have a different world view, all of you raised your hand, i think, for Health Coverage for every illegal in this country. Every one of you. Thats estimated at except mr. Balat. Everybody else. Mr. Issa i think you mentioned. I didnt raise my hand with anything because i uncomfortable. Let me raise rephrase it. The jerrett of you raised your hand, well take mr. Balat out of it. Weve got anywhere from we dont know how many illegals are here. Just as six of the seven are predisposed to an opinion. I could fill this room with everybody behind you with that single mom who otakes issue with obamacare. They cant afford the premium ump from 400 to 6,000. I could bring the gentleman in who happens to be 75 years old who doesnt want a mandated Maternity Health care that has to be paid for in his policy. I wish we could have had a more balanced panelist. Our intent is to solve this problem. Single provider as it does not work in the private sector will not work and has not worked with obamacare because name me one, if each of you had a single provider for say drugstores. One drugstore to shop from. Im sorry the prices you couldnt afford as we cant afford health care now. Im in the private sector. Im a businessman. And i will say that it has not worked for the jerrett of businesses. And look at the physicians that are leaving. If theyre making too much money, look at them that are leaving. Were not going to be able to get the special is that each one of you have had if it keeps going like its going. I yield the balance of my time to congressman roy from texas. Mr. Chairman can i acknowledge mr. Norman. He actually brought up my name in his questioning or his stance. Ill reclaim my time. Ill talk to you privately. I yielded my time to mr. Roy. Chairman, can i also state i was not in the room when you asked that question. So i want to have that go on record that i did not raise my hand and i have never mentioned that i am for medicare for all. I would also like to make that statement. This seems to have become i came here for a hearing about the Affordable Care act. It seems that most of this has been about medicare for all. I didnt raise my hand for medicare for all. Im not talking about medicare for all. Why do we keep coming back to medicare for all. This is supposed to be a hearing about the Affordable Care act. Mr. Chairman. I yield my full time, i think it was over, right at two minutes to congressman roy. Thank you, mr. Chairman. Mr. Balat, let me ask you a question. Was it not true that in 2013, po lit fact said the lie of the year was if you like your Health Care Plan you can keep your Health Care Plan. Thats correct. And millions of people were kicked off their plans because obamacare required plans to provide 10 essential benefits and while millions gained coverage, six Million People lost the coverage they had . Thats correct. 600,000 transitioned from medicaid to uninsured. 600,000 transitioned from nongroup to uninsured. Of those who gained coverage, of the 20 million, was that about halfandhalf medicaid and through the a. C. A. , through obamacare . More on the Medicaid Expansion. On the Medicaid Expansion is that not true that thats crowding out people, that the original purpose for medicaid was the most vulnerable and we are crowding out people . Theres studies that say in illinois for example 762 people died while on the waiting list because they were trying to get care because medicaid was getting crowded out by healthier individuals shoved onto the medicaid roles. The gentlemans time has expired yusm may answer the question. I have not seen that study. We go on to mr. Sarbanes. Let me say this it seems that my republican colleagues would love o distract us, mr. Gibbs you asked the question from the efforts to sabotage the a. C. A. By focusing on medicare for all. But todays hearing, youre right, is about protecting the law of the land. And the threat this administration is posing health care for millions of americans. Thats what this is about. My colleague from maryland, mr. Sarbanes. Thank you, chairman cummings. Thank you for inviting these witnesses. I want to thank the witnesses for coming. Professor gluck, welcome. A few minutes ago, i think you were trying to point out to mr. Roy that his discussion around some of the justices statements about severability was fighting the last war, the 2010 war, rather than the more current battle thats most relevant to the question of severability so i appreciate your doing that. Mr. Roys decision, voluntarily, to go back and fight the last war, of course, is his to make. Whats not fair is to force some of the witnesses who represent millions millions of patients across the country to go back and fight the last war. An thats what the Trump Administration, republicans here in congress, are doing. I remember chairman cummings, when you and others were part of and helped to lead hearings back in 2010. Where we heard all of these stories. But we were hearing them from the perspective of people that were desperate to get coverage that they did not have. And we made a promise that we would do everything we could to try to deliver that coverage to them. And we did that with the Affordable Care act. And now theyre back again telling the same stories from the standpoint of being terrified that they could lose the coverage that had been made available to them under the Affordable Care act. I want to thank you for that testimony which is extremely powerful. I dont know why my republican colleagues think that its a strong position to argue for taking this fundamental coverage away from millions of americans. I wish them the best with that line of argument going forward. I think its clear from what the polls show that americans dont want to throw away the a. C. A. We can debate what we do from here but the great majority of americans want to hold on to the coverage that they have been given. An by the way, no evidence whatsoever that theres any kind of cogent, coherent, meaningful replacement plan for the a. C. A. Notwithstanding all the attempts, 69 and counting, on the part of the republicans here in congress to repeal the Affordable Care act. Professor gluck, in your testimony you discuss the essential Patient Protections and Health Programs that would disappear if the a. C. A. Were to be struck down. Does this include guaranteed excuse me, guaranteed issue and preexisting condition protection . Yes, it does. What about the Community Rating protech that prohibits insurers from charging older adults significantly more than they charge younger enrollees . Would that go away . Yes, it would. What about premium tax credits an costsharing reduction payments that make coverage more affordable for middle income families . That would also be gone. What about the a. C. A. s Medicaid Expansion . Gone. What about the prevention and public hell fund . What would happen to funding for essential public Health Programs like those that support safe drinking water, children immunizations and Smoking Cessation . All those would be eliminated. Let me come back to a point i was emphasizing earlier. As the Trump Administration or condition gregsal republicans put forward any meaningful replacement plan for the a. C. A. That would provide the same coverage gains and consume brother texts that we just went through over the last few seconds . Nothing has come even close. Let me ask you this, why are preexisting condition protection on their own, without the a. C. A. s other provisions, not a sufficient prereplacement plan . Because we keep i mean, republicans i give them some credit. They figured out that nobody many america wans to lose the coverage now available for preexisting conditions. So they keep invoking that and saying well hold on to that even as were jettisonning all the rest of the Affordable Care act. But can you explain why its important to have other provisions in place in order for that to be an effective protection . Youre right, its not enough to have insurance, to be able to get insurance. You have to be able to afford the insurance and the insurance has to cover the things for which you are sick. Just having the ability to get insurance doesnt stop insurers from charging you more for that insurance if you are sick, from creating benefits that dont include, say, your h. I. V. Drug, an it doesnt give you the kind of Financial Assistance to make that affordable like the subsidies or Medicaid Expansion. Thank you. I just want to close by again thanking our witnesses and thanking our chairman for bringing those witnesses forward today. I yield back my time. Thank you very much. Id like to kind of get a handle here a little bit on current problems were having. Could you in general describe whats happened in this country for people who are fending for their insurance on their own . Both the cost of insurance and the size of the deductibles over the last five or six years . I can share with you that premiums have talking about in the private market premiums have gone up for employerbased plans and individual plans when theyre available. Those dramatically . Pardon . Dramatically . Oh, considerably. Where they used to be 300 theyre on the order of 1,500, per family could be 2,000 a month. Devastating. How about deductibles . Deductible the h. S. A. s were when h. S. A. s came into being they were coupled with High Deductible Health plans and theres a reason why that dollar amount was set at 3,500, that was considered a High Deductible Health plan. Deductibles today are i think on average 6,000 or 7,000. I heard one recently of 14,000. Devastating for people who are not el visible for medicaid, correct . Without question. And with the majority of people in this country that have that dont have 1,000 in their savings accounts, its just an its an unreachable number. Unbelievable what people up there have to put up with. Ive heard stories of Health Care Problems that i wouldnt have believed 150 years ago were possible. Still kind of amazes me. I wasnt around here when the Affordable Care act was passed or the unAffordable Care act or whatever they call it. But it amazes me how people get elected to congress and think theyre so smart that they can take over such a big segment of the American Economy and make it better. Lets look at why the costs have gone up so dramatically. First of all, how Many Americans are on the Affordable Care act despite all the hoopla over it . Just over eight million. Ok. I think its 11 million. Eight snl on the exchange . Its between eight and nine million. Eight and nine million. Talking what, under 3 of americans are on it. Where is the big increase in government involvement in health care since obamacare kicked in . I would say Medicaid Expansion. Medicaid expansion. In other words, medicaid, youre down in texas. But how much is the reimbursement. How much does the government pay people to provide medicaid compared to medicare and compared to what the private sectors charged. Medicaid is typically your lowest reimbursement whether youre a physician or a facility. Its just below medicare rates typically. Ok. And medicare is about 60 of what private reimbursement is. Ok. So youre maybe saying half. Just north of half. So in other words as we change the system to put more and more people on medicaid what were doing is, were driving up the cost for people not on medicaid. Is that true . Yes, absolutely. Ok. And is the reason therefore the cost of people who arent eligible for a. C. A. , the reason theyre being punished and just put in such an impossible position, is because the change in the way, he huge number of people now who are expected to get their health care through medicaid type plans who before may have gotten health care other ways . Is that whats going on . If i could ask you to restate the question, please . Right now the reason the cost is going up is because more people are Getting Health Care through medicaid, people who in the past would have gotten health care either through their employer or purchasing on their own, is that accurate . It is. It is. So in other words this dramatic rocket up in cost, people who arent eligible for medicaid before, didnt just happen. It was by design almost. Or maybe people were just so stupid, i cant believe people would be so stupid they didnt realize thats whats going to happen but thats what happened, right . One more question, were running out of time. We hear people talking about picking up health care for all the Illegal Immigrants flowing through the country. Id like you to describe who really is going to go into picking up the tab for that one . The american taxpayer. The taxpayer or anybody paying for insurance on their own . Its whoever is paying into the system currently and the taxpayer will be the ones paying for everybody thats benefiting. A word we used earlier, talking about being forced into a situation they dont want to be in. That was being patients should the a. C. A. Be repealed. But were being forced as citizens to participate in programs that we dont want. Thats an act of force currently with the a. C. A. In place. The gentlemans time has expired. Mr. Welch. Thank you. I want to thank the witnesses. Welcome to congress. As the debate continues. You know, the heart of this is about patients who need health care. And i want to ask to go back to some of our patients and really thank you for coming. Mr. Gibbs, ill start with you. What would it mean to you and to your son when he grows up if the a. C. A. Preexisting conditions protections are eliminated . Thank you. It would mean that if something went wrong and i lost my kidney or something went wrong and peters kidney decline, that he would have absolutely no guarantee of any rights to health care. Any guarantee that he would be able to receive treatment for that kidney problem that he was born with. It would mean he was born with a sentence to lose a fundamental right. I do believe that the access to health care is 100 a fundamental right, its something we cannot exist without. I mentioned life, liberty, and the pursuit of happiness. Health care, without health care we dont have that access to life. Right. Its not a choice that you made to have this condition or your son. No, it is absolutely not a choice. Luck of the draw. Yes. How about you . What would it mean if, to your family if the a. C. A. Preexisting condition protections are no longer law . It would mean i wouldnt be able to afford coverage. I have an expensive hobby of having four children and i simply could not afford to pay 895 a month for Health Insurance. And before i would do that i would go without, like i did previously. I have limited resources an i use those resources to raise the four kids i brought into this world so that they dont have to be a burden on the American People and society. Ive done everything i can to be responsible. Thank you very much. Ms. Dye, how about you . Thank you for the question. Tressie is 10. Shes two or three years behind her peers. Shes never its never going to go away. Shell have this in adulthood. Her speech therapy, the needs it. In order for her to be a productive member of society. Its almost like life support for her. What a lot of people dont understand and to well, they left, but your republican colleagues want to talk about employer insurance, well, a lot of employer insurance does not cover speech at all. And the ones that do, you only get 10 sessions a year. So if you can please explain to me how my daughter, shes two or three years behind, how is 10 sessions a year going to help . I dont think any of us can imagine if were fortunate enough that at the moment we dont have a preexisting condition, at some point a lot of us will. If you have children and youre really worried about how theyre going to be affected, its really exiss ten rble. All of us can identify with that. I want to ask each of you to think about emotionally what is it like how did you feel before you had that guarantee of protection and you had a child who was sick and you had no confidence you could get it . Did it feel like it was your fault that your child was sick . For me, i felt like that was my fault. What did i do . Was i not taking care of myself in my pregnancy and everything like that. But i also felt like, my country, the congress, was saying that i my daughter doesnt matter. That her life doesnt matter. Her future. And thats hard for me to take. Especially when they kept saying we are the greatest country in the world but yet the greatest country in the world is telling my 10yearold daughter she doesnt matter and that is its heart breaking for me. Well, go ahead. Ive got just a little time here. When my son was born, the a. C. A. Was in place. Part of it part of me felt like it was my fault, because i had a kidney condition. I felt guilty he may have inherited it from me. But part of me also felt it wasnt my fault. When i chose to have that child, the Affordable Care act was in place. I made a responsible choice to have a child who could be guaranteed the right to health care. An irresponsible choice is being made but not by me. Thank you. I want to thank all the witnesses and mr. Morley, too. Mr. Chairman, what he we did here, there are life circumstances that none of us can control. And if you cant get a fair shot, thats about justice. Thats not about personal responsibility. Theres a lot of life choices we do make an thats on us. But when its circumstances beyond your control you cant get health care because the law wont allow it. Thats on us. Justice requires we protect those preexisting condition pr texts. And people get sick and people die. Mr. Green. Mr. Chairman, Ranking Member, i think most of i think most everyone knows im an e. R. Physician, cancer survive york father of a cancer survivor and founder and c. E. O. Of a Health Care Company that when i left employed over 100 medical provider and saw 1. 5 million patients a year. I love being a doctor. I started Free Health Care clinics in clarksville, tennessee, and memphis, tennessee. My opposition to the a. C. A. Is because i think the a. C. A. Will crash the system that todays witnesses have praised. But first i want to tell everyone about a shift i had in the e. R. My first patient was a gang member, hed been shot in the lower abdomen. The guy was punching at the staff and yelling at us all an were trying to save his life. After ge giving this guy world class care i walked out thinking man, at least with government payer, id get paid for the risks taking care of this patient. But near the moivend shift i had a woman who had just a few days prior gotten her dose of chemo. E was febrile, newt ropeenic neutropenic fever. With her were two children and a worried husband. The woman was only 35 years old. She didnt have insurance. As we stabilized her, i realized that Early Detection had saved this young womans life. In europe, socialized medicine has delayed Early Detection, care is rationed and mortality rates for specific illnesses are far better in the United States than they are in europe and canada. That woman would not have received timely detection there and her chances of survival would have been less than a socialized system. I was working at an e. R. , met a patient, a c. E. O. Of a Major Corporation in can. Can dafment he had a laceration. He hopped on a personal jet, flew to nashville, tennessee, because he could be seen faster flying to the u. S. Than seeing in canada. In canada, you can get an m. R. I. For your dog that day but cant get one for grandmas knee, youll wait six months. Socialized medicine does not work. It does not provide better care. Study after studyi has shown medicaid patients have equal outcomes to patients without insurance at all. Those are the real numbers. The a. C. A. Is not socialized medicine. What it does is takes money from taxpayers and increased rates for Small Businesses, yes, it has raised rates, i was on the Insurance Committee in Tennessee State senate, we had to improve those insurance increases, hundreds of percent. It takes those costshifted s and gives money to patients who cant afford care and allows them to do what . Purchase Health Insurance and participate in the incredible care other americans are getting either through their employer or out of their own pocket. Unfortunately that isnt going to last. Youve given great testimony about how it works. Its not going to last. You see, either by intention or accident the a. C. A. Creates pressures on the Health Care System that are crashing the very system that the Witnesses Today were praising. You like your a. C. A. Insurance based care and i appreciate you sharing it today but a. C. A. Is driving the Cost Shifting to a point that Small Businesses cant afford it and more people are shifted to government systems. As this dynamic pushes people onto the government care, medicare, medicaid, all of that, we move to more and more socialized medicine. At some point the shifts cause the system to crash. That means the insurance based system that the a. C. A. Is providing you and that youve given great testimony on today is going to go away. It cant last. But maybe thats exactly what the leads of the Democrat Party pant want. Medicare for all abysmal. It will be akin to the v. A. Im a veteran, i know. Ask your veterans. 32. 6 32. 6 trillion over 10 years. If you tax 100 of income earners at the top levels you only get 700 billion. 700 billion versus 32. 6 trillion. Doesnt add up. A. C. A. Is driving us toward that system. Either intentionally or accidently. The government is not the answer. Government health care is rationed care. Late detection an worse mortality. We need solutions to health care and my plan, i have written and its a bill this year, to create a health care swipe card. Unlike what mr. Sarbanes said would fix the problem and allow us to provide help to more people. I encourage particularly my freshman democrats to go look at my plan. I i think the people that i talked to love it. Even democrats. But the health care youre getting is insurance based. You love it. You want to see it continue. Help us get rid of the Affordable Care act which is driving us to a single payer. Thank you. The gentlemans time has expired. Ms. Gluck, you seem like you were shaking your head. Would you like me to respond o something . No. I think its important that we have information and facts in this conversation. What we know in this conversation if you look at the information comparatively, comparing the u. S. To other countries, our babies are dying at faster rates. Oyou are moms are dying at faster rates. We have more preventable medical injuries in the United States than other countries. Thats the truth, thats what the data shows. Two, right now in this country the reason health care is so expensive and the studies are super clear on this, is not because we brought everyone in and given them access to Health Insurance. Its because the Health Insurance sector is increasing prices at astronomical rates and we know this, the American People know this, they see whats happening to Prescription Drug they see whats happening when they get the hospital bills. Thats why the system currently is unsustainable. The notion that ensuring that everyone has a shot at Getting Health Care when they need it is breaking the bank is preposterous. Mr. Chairman, he he brings up a point that contradicts something. If i could clarify. 30 seconds. You have to make sure you compare apples to apples. When we compare life spans an things like that in our country versus others they eat less fried chicken. In europe. Ok . They smokeless than us. Its not just the Health Care System, it is the Health Care System plus lifestyle and all of that so while some of this stuff that was just mentioned about cost of drugs and all that stuff, i get it. But you cant compare apples and oranges. You have to compare apples to apples. Thank you. Can i address that. No, no. Im not tray to be rude. Just trying to move the hearing along. Thank you, mr. Chairman. I just get amazed every time i come back to this committee. I was not here when my colleagues voted for or against the Affordable Care act but i know that since ive been here, no democrat thought that was a perfect bill but i know since ive been here we have never been given the chance to work on the bill especially when president obama was the president. All we had a chance to do is repeal, repeal, repeal, repeal. I know that, you know, he put a lot of things in the bill, he want masters degree things in the bill but in trying to get one republican to support the bill, you know, he made concessions and then no one wound up voting for the bill, as you guys know. And then we spent i think over 3 times trying to repeal it. Im glad you mentioned Maternal Mortality and infant mortality, it was safe to have a baby 25 years ago, its not just from people eating fried chicken. Thats not the reason. I know you were going there i just want to add that for the record. Want to ask you, how do the uninsured rates in states that have expanded their medicare programs compare to those that have not . Its an important point to make that what we do know, we actually know is we earlier the witness next to me cited a study that said access to Health Insurance had no impact on mortality. That study actually says, in the published study it said our hults should not our rulls should not be interpreted as saying Health Insurance has no effect on mortality. What we do know from the i. O. M. , it was published in the journals of medicine, when people have access to Health Insurance they live longer lives and are healthier. Thats the truth. I will also say that weve heard a lot about this question of hospitals closing in districts. And people losing access. Before working at families u. S. A. As executive director i ran health care for National Governors association and worked with governors, republicans and democrats, adelose country. To make sure the number one way to make sewer a rural hospital didnt close is by expanning medicaid. The congressman who was concerned about the hospital closing in his state was in a state that didnt expand medicaid. How does that affect things . Not only are people able to get the care they need, we see Larger Movement of people from public insurance to employersponsored insurance as they get jobs. I want to thank the witnesses for sharing your personal stories. Im married to a doctor, an anesthesiologist, he supports the a. C. A. I think its important as i said in my Opening Statement this is, its supported by the american medical association. Its supported by the American Hospital association. The heart association, the cancer society. So we have one doctor who says he doesnt like the a. C. A. But the all the soccers that represent providers are saying this is really important for the American People and for us. And also, i mean, theyre right in the fact that yes, you can find someone that believe this is, someone that believes that. Its personal experiences. We have to look holistcally and overall that what is the greatest benefit, professor gluck what would happen to Medicaid Expansion if the Trump Administrations position prevails in court . It wourled end. All those people who got insurance would be thrown off the role. Im the chair they have Congressional Black Caucus health brain trust. Information weve been given when you look at africanamerican men, the rate of Prostate Cancer has gone down sig significantly since many more have the a. C. A. And also Breast Cancer in women in black women has gone down because of access and care because of the a. C. A. I recently read an article about disparities in cancer care across races and geographic regions. Its been found that the Affordable Care act has done more to reduce disparity in cancer than anything else in recent memory. Part of that is because of the covered early screening and checkups. Incredibly important for Health Justice in our society. Would the gentlelady yield . Yes. Thank you. A little earlier, mr. Hice from georgia mentioned that some of his rural hospitals were closing. And i dont think georgia is one of the states that accepted the medicaid under a. C. A. Because it doesnt if they did i think it one different. I think. Can you comment on that . And comment on uncompensated care . How has that been affected by the a. C. A. . What we know if you look at hospital closures in Rural America across this country, almost all of them, and i mean almost all of them, north of 80 , are occurring in nonexpansion states. States that choose not to expand medicaid, they have the ability but dont do it and then rural hospitals end up closing. It is the number one i was part of a lot of negotiations with governors trying to expand medicaid. This was the number one issue. Its the reason why hospitals push for it. They know when you have a group of people in a Small Community who do not have Health Insurance they cannot keep their doors open. Health insurance provides access. It allows for the economics of that community to survive and that hospital to survive. Ok. Mr. Higgins. Thank you, mr. Chairman. I thank all our guests here today for your courage in being here and your stories are touching. Im going to tell a story too. My wife has m. S. Preexisting condition. I have four children, three living. I lost a daughter long ago. To a condition that she was born with. I myself have many, many physical injuries from my years as a Police Officer including a reconstructed eye socket. In cop, cops earn louisiana, 12, 13, 15, 16 an hour. As a captain when i resigned my commission to run for office, i was earning 20 an hour. My wife was a receptionist at parish government. She earned 12 an hour. Health insurance for many years before the a. C. A. Was always the month. 00, 400, 500 a a. C. A. Comes up, insurance premiums went up to unaffordable. 800, 900, 1,000 a month. Deductibles were always 0500, 600. T went up to 2,000, 3,000. 5,000. Having a Health Care Card from the a. C. A. Does not mean having health care. One of my colleagues mentioned that we want to destroy the a. C. A. We were told you can keep your plan, you can keep your doctor, your premiums will go down by 2,500. Youll have more access to care. Those with preexisting conditions will be protected. If the a. C. A. Had manifested well and americans had not suffered the incredible increases in premiums and deductibles, we wouldnt be having this conversation. President obamas crown jewel would be safe. But the fact is we must represent the interests of the american citizens that we serve. In business before the a. C. A. It was common for three, four, five, six Insurance Companies to compete for the group policy. That business of Companies Large and small. Thats gone. You dont have a competitive market anymore. Those companies have to search and beg. Used to be the other way around. Insurance companies would come to american businesses large and small and seek that business. The coverage they provide their employees. My coverage expense after the a. C. A. Went up every year. It was quickly over 1,000 a month. Couldnt afford it, man. Do the math. Cop earning 15, 16 an hour. Wife of a cop earning 12. Very quickly, we had to make a decision. Going to buy grocery or insurance what do you think we did . We bought groceries. That was never an issue before the a. C. A. The a. C. A. Expense does not a was not a distraction. As my colleague said. It was a disaster. Having an a. C. A. Policy card is not having health care. An unaffordable policy for regular working american at 1,000 a month just had the privilege of paying cash for your health care all year because you have a 5,000, 6,000, 14,000 deductible you never hit. Thats not health care that we need to provide to our nation. Thats not real. My wife and i had to buy a nona. C. A. Policy. That was reality, man. We had to buy a nona. C. A. Policy and were subject to punitive fines from our own government who we served and im a veteran as well. Because fines were down the line. The seizure of our property from the i. R. S. Of all places. Because we had the audacity to buy a nona. C. A. Policy. But that seizure of our property was down the line but groceries were not. Im not a posed to the a. C. A. Because it was president obamas crown jewel. Im opposed to the a. C. A. Because its been an abysmal failure. And a massive seizure of american property. And american freedoms. Mr. Balat, you mentioned, i thank you all for being here. You mentioned reasonable postures and you, my fellow children of god, my fellow americans have shared meaningful stories that touch our hearts. Help us fix this thing, man. Thats what we seek. Mr. Chairman, i yield. Just a brief statement, you know, first of all, this is the mission of our organization. We want all americans to have access to high quality afford Health Insurance. We are with you in that fight. An 18 increase in Health Insurance premiums. 18 in one year. Guess what year that was . 1987. A, lets see, 11 increase in Health Insurance premiums. That was 2002. What we know for sure is that after the a. C. A. Was enacted the increase in premiums for employersponsored coverage was slower. It was 2 . It was 1 . These are the actuaries own facts and figures. Thats what were looking at here. So there have been problems with Health Insurance premiums in this country for decades. We are with you. I think everybody on this panel is but you. We have to solve this problem. But to plame the Affordable Care act because in 1987, 30 years before it was even conceive of, there was an 18 increase seems bsurd. Thank you, mr. Chairman for convening todays hearing an shining a light on what a critical lifeline the a. C. A. Has been for millions of families. I want toest pa especially thank all of you for bringing the expertise of your lived experiences here. I know just your advocacy alone will save lives. Ultimately the a. C. A. Will sive was saved the last time not simply for the conviction of lawmakers but for the courage of everyday people who quite literally put their lives on the line, their bodies on the ground and stood in the gap. I believe that the same will be true again. Thank you for your coverage and being here today. Certainly, in my district, the massachusetts seventhing, my Congressional District, almost half of the residents are living with one or more preexisting conditions. Im gratele for the leadership of our Massachusetts Attorney general who is an activist leader and der friend who is leading the fight on the frontlines, afirling that shaq fundamental right for all of us. Mr. Morley, im paraphrasing but it was very poignant and resonant when you said that instead of fighting to stave off bankruptcy, because of the a. C. A. You got toe focus on staying well and staying alive. The fact that in this we find ourselves at a time when people have to ask questions such as do i feed my family or pay my rent or do i go start a Gofundme Campaign or do i risk foregoing the lifesaving insulin my child needs to stay alive . I want to focus my line of questions on the persistent inequities and dispair i ties a rollback of the a. C. A. Would cause for the women and girls who live with a preexisting condition. This would save countless lives, undermining it attacking it, puts our familys health at risk. Professor gluck, explain what Health Insurance coverage was ike before the a. C. A. . Women have benefited thank you for the question, from the a. C. A. s protections. According to kaiser, the uninsured rate for women dropped from 19 to 11 . Before the a. C. A. Only 12 of individual plans covered Maternity Care which is a shocking statistic. Women could be charged 50 more than men for insurance because of the health risks that they pose because of conditions like pregnancy. The a. C. A. Ended that discrimination and pricing based on gender. It also significantly helped Womens Health because it covers without a copay significant Preventive Services that are very important to women and i mean much more than contraception. Breast cancer screening, colon cancer screen, h. I. V. , the h. P. V. Vaccine. Much, much more than that. The Medicaid Expansion is also worth noting helps women have healthier pregnancies and keeping women hellier before theyre pregnant which in turn results in healthier pregnancies. Thats right. Women were paying out of pocket . Yes. All right. If is there anything else youd like to elaborate on as far as how the a. C. A. Put a stop to those kinds of discrim in a tear practices . With this case pending in texas right now, all of those protections would be begun. You would once again not have basic coverages that most people take for granted like Maternity Care, covered for huge s. W. A. T. S of the population. Swaths of the population. You spoke of the stress of having to deal with being uninsured so long before the a. C. A. Women could be denied coverage for things like pregnancy, Breast Cancer or treatment for sexual or domestic violence. Were also in the midst of, as representative kelly alluded to, a national Maternal Mortality cries sis. Women are no safer giving birth today than 30 years ago. How important was it to you and your farmly that you were able to have courage for Maternity Care in that time . It was definitely important for me. I had four csections, didid not have natural births with any of my children my pregnancies were all high risk my youngest child, i gave birth to first semester of my second year of law school. One of the biggest complications was my uterus had completely attached to my abdomen. And i had to my csection was a lot more extensive than it had been for the previous three. And had i not had coverage during that time, i wouldnt have had the followup care i needed. Case in point, in 2014, suffered a miscarriage, 10 weeks in and i did not have insurance. I had my miscarriage in the emergency room and i never got to follow up to see why my baby died or what condition was in place at that time. Thank you. Just really quickly one in four residents in my district benefit fre a. C. A. s requirement that i a lous them to remain on their parents plan until theyre 26. Would anyone like to elaborate on why this is important . The gentleladys time has expired but you may answer. My older two children are 19 and 18. They work jobs but their jobs dont provide health care. So through the health care i have, now through my employer, my kids are still covered. Its important that when we have we have kids and we expect them to continue their education, go to college, we dont have a means for them to be insured in that time. While we want to have the safety nets in place for them we put impossible choices in their way. So by allowing that coverage until theyre 26 years of age that allows them to go through with the comfort and safety of pursuing an education without having to worry about if they get sick, whats going to happen to them . Thank you, mr. Chairman. Thank you. Mr. Armstrong. Right now in north dakota we have the same number of people uninsured as we did 10 years ago. Or prior to the implementation of the Affordable Care act. We passed Medicaid Expansion at our state level. We have done all those things. But considering that we are a lot of Small Businesses, a lot of small family farms, what weve done is shifted the burden up the economic food chain. If you get if youre a small family farmering youre not employed, cant get insurance through your employment, you dont qualify for medicaid or medicare or Medicaid Expansion. One of the Major Concerns with obamacare regardless of the outcome regardless of the litigationis the lack of insurae products to Small Business owners, farmers, and who have largely been priced out of the market. My first question would be, can you elaborate on any proposals that could increase coverage in Rural America . I suggested earlier, what is happening with Rural America is many of the farm coops that exist have been taking advantage of the Association Health plans, and i understand earlier the witness to my right was saying this was an opportunity for Insurance Companies to lay tracks. People are walking into these things with eyes wide open and shopping responsibility responsibly and addressing their needs area that has been a good solution. For those who are in transition, they are using the shortterm plants, but more importantly, most importantly, is, we are hsas and addressing personal accounts and people can use them own money rather than having the government paid directly into Insurance Company coffers, allow us to purchase our own insurance for ourselves and that would be a big boon to the rural community. I would also add the use of telemedicine and advances we big had, that has been a help for very remote rural areas. Out of insurance, it is how we deliver medical care. People drive 100 miles now. As a state, we have done a great job over 50 years putting up ticket fences for licensing and those types of issues, and now in the last several years, we have done a pretty good job of reducing those picket fences so things like telemedicine and those options can be brought into Rural America, but those ofdependent obama care obamacare and any of those things. I would say we did not have a life a lot of choice before. We have a state of 750 thousand people, the markets adjusted but we have seen insurers flee our market. To say we have stabilized after 10 years like that is some kind of accomplishment is not the point because it was unsustainable to go any farther than stabilize at some point. It is important to say i have been part of the Health Care Industry for 20 years. What what we are talking about is not going back to preaca. It is not binary, what we can do is create an environment that is better, that will help address the real problems that people have for themselves and their children. And give people choice. I want to add one more thing. One other issue that no one has brought up about the Affordable Care act is the Kaiser Family foundation has said that 20 of all in Network Claims by the aca are denied by Insurance Companies. That is not protecting people. I appreciate that. I hope whatever we do give states like north ricotta more ability to make decisions. Mr. Roy. I thank the gentleman for yielding. A report said by 2016 the would cause premiums to increase by 10 to 13 , does that sound right . I believe so, i dont recall. The regulations turned out to cause premiums to more than double from 2013 through 2017. In the first four years, every had increased between 53 and 63 percent. Would that meet with your understanding . In the exchange, yes. Premiums increased an average of 60 . And the four years before every age group and family type experienced a decrease or an increase of 9. 2 or less. The dollar amounts varied from 2500 to a different dollar amount. My point is you look at this chart back here, the red lines are post obamacare and the red lines are preceding. We dont have witnesses testifying for all the people who lost their insurance because of obamacare. We dont have families testifying who were paying the premiums reflected in those red bars. That is the reality. That is what we are dealing with throughout the country. Aboute we are talking 20 million, 10 or 11 of whom are covered by Medicaid Expansion and 10 or 11 million who are covered by aca. Im trying to figure out how we can make sure all of america is not getting stuck with insurance or inability to get the health care of their choosing because we created a system that is too expensive. The gentlemans time is expired. You may answer that question. In spite of what happens with help andmy role is to with research and educating lawmakers to find as many choices and options and as Many Solutions that work well regardless of geography here in the u. S. In texas alone, my home state, south texas is so different from north texas and west and east and central. It is culturally, geographically very diverse. Going back to my hospital days, my primary service area was one to three miles, that was my community. It is absurd to think we can Insurance Health Care Coverage and health care for people states away. It must be done at the state and local level. Thank you very much. Thank you, mr. Chairman, and thank you for being here. Your very touched by statement, i was not here but i was able to get the written statement. Something that you said at the end was beautiful, that this is not a partisan issue, it is about what happens to families without health Care Coverage. What should a single mother of four be forced to choose between housing and health care . Is it we are better as a nation if we keep our people healthy issue . I appreciate you emphasizing that. While the Affordable Care act has helped millions of americans obtain health Care Coverage, nationwide areas such as wayne county in my home state of michigan have some of the biggest impacts. According to her report from Georgetown University center for children and family states that have expanded medicare under aca have seen sharp declines in the rates of uninsured populations area the percentage of those without insurance in michigan 2013 tod from 12. 9 in 6. 1 in 2017. Why has Medicaid Expansion been so effective . Thank you for that question. One of the things is the before the dust before the aca was passed there was a misperception in the American Public and lawmakers that if you were poor, you got medicaid and that was not the case. What expansion did is it said there is a group of people for whom nothing exists and i will give you the example. I walk my dog in the morning and theres a gentleman there with severe mental illness, he is homeless. Before Medicaid Expansion he could get nothing. There was a whole group of americans that had nothing, no insurance what so ever. If you are struggling in your life we will give you access to Health Insurance and that is why it has been such a successful and important part of the Affordable Care act. Risk cas Medicaid Expansions is one of the reforms if theuld disappear Trump Administration prevails. Is that true . Yes, it is. Our Community Stands to lose if the Trump Administration wins including 87,000 people alone in my district in the 13th Congressional District. Currently 79 million americans live in what we call primary Care Health Professional Shortage areas meeting there is less than one physician for every 3500 people. Michigan has the third highest number of shortage areas for primary care and the Metro Detroit area has over 20. This equals the individuals have to travel further to receive health Care Coverage and many communities where hospitals have closed in recent years. They have to travel further to receive emergency medical services. Under the aca, patients do not have to pay copays if they go to an out of Network Emergency room, correct and with that change go if the Trump Administration prevails in court . Under the aca, protections are not complete but they are there. If the Trump Administration succeed, millions risk losing health Care Coverage. This will not mean that these needings will not stop emergency medical care. Hospitals will just be forced provide more uncompensated care, is that correct . What is likely to happen to hospitals and in shortage areas like detroit, the number of people requiring . Ncompensated care increases will that hurt their stability. There is no question, every risktal we could closing our doors. Helps address provider shortages through something called the Community Health center fund. What that fund does . Could you ask the question again . The fund is called immunity Health Center fund, could you explain that . It is a significant increase in the funding. All the trinity Health Centers that operate in Rural America and inner cities, they are one of the most Important Health Health Care Choices. I went to one of those clinics in Southwest Detroit and i remember going in and it was required for us to have access to schools, to do the medical exam. You think about those kinds of things. I believe, the Trump Administrations refusal to defend aca threatens to widen an existing Health Care Gap and make it harder for americans to access care if they need it. On our road to medical medicare for all, we must continue to work to close our Health Care Apps and expand final care for all americans. I represent the third and fourth Congressional District in the country, at the front line when i speak to so many of my residence, health care is at the forefront of them choosing like miss burton talked about between taking care of their children, groceries, and those everyday issues to health care. I thank you for your panel. Thank you. Thank you. This looks like a former chairmans name. I counted no less than four times that it was wrong to say that obamacare is the cause of increased premiums. You said that several times. I dont think that was the problem promise. The promise was obamacare was going to lower premiums. Whend not say that democrats voted for this, when president obama rolled it out, he did not say pass the Affordable Care act, pass obamacare and your premiums will go up the dont worry, this bill will not be the cause. Even if we take your assessment as accurate, it is not the cause, i think numbers were offered that showed it may have been. Past decade, what is the single egg is changed to Health Care Policy in this country . The aca. Obamacare. Without question. When obamacare was passed the single biggest change to Health Care Policy projections were we would have 24 Million People enrolled today. How many are enrolled today . Ithin the Exchange Just obamacare. Between eight and 9 million. Not that it was a third of whatas projected. Change, ifbiggest you like your doctor you can keep your doctor. Did that materialize, was that true . It is not true. When obamacare asked the single biggest change to health care in the past decade, if you like your plan, keep your plan, is that true . It was not. When obamacare past we were told premiums would decline. For the record, did that happen . It did not. Andor everyone, premiums the exchange, out of the exchange, everybody, cost went up. Is that right . The cost of the premiums went up but with the subsidy it was not felt by those who were part of the exchange. You think we were lied to when this bill passed in 2010 . I dont want to speculate as to what the intent was. You dont have to because the architect of it said this, m. I. T. Professor, New York Times said the architect, going to the white house and meeting with all the key players who were putting this policy and this plan together said this, if any american believes that obamacare is going to control costs, ive got some real estate in whitewater, arkansas i would like to sell them. The guy who put it together told drive up costs. And it certainly has. Have the coops worked that were part of obamacare . Have, the fewthey that are left have . The coops under obamacare. I was referring to the others. The ones in the private sector have. The ones they set up, only four left. 19 bankrupt. Are there more Health Care Choices . The single biggest Health Care Policy change in the last decade, are there more Health Care Choices in their work in 2010 . There are not. Many of the carriers have left or individual market Provider Networks are smaller, narrower question mark much smaller. Country leading to the surprise billing issue. What happens when you have one provider . Premiums go up. You can go outside of health care, you have one supplier out in any market, you typically do the price consumers would prefer, do you . No, you typically dont. Thing, you said in your Opening Statement the aca hurts families with preexisting conditions. That struck out in my mind, i wrote it down several hours a go when we started this hearing. Can you elaborate . It is a function of cost. Insurance, have lets talk about insurance. The reason the existing conditions is even a thing is because insurance is coupled with employment. The fact that we dont have more portable personal insurance plans causes us to jump from it createsace and that preexisting condition issue. And health care we call them conditions. Preexisting is an insurance term. Is it has affected families as the premiums have increased, as deductibles increased to such high levels, a are priced out of the market. When they have to, if they had a had, i have had my insurance for 15 years and i cannot afford it anymore. Now that they have to look for some other products or go to another solution, they have a preexisting condition. That was not an issue so long as they had the plan they had for 15 years. Thank you. X thank you very much. You, mr. Chairman, and thank you for being here. When i space to people in my district, hospital associations or patient groups are hereby and large that we must increase access to critical services, not decreasing services and incentives. There were federal parity protections for 62 million americans and the arguments we heard from the Trump Administration pose an imminent threat to the wellbeing of america. I would like to focus on how the aca is addressing the overdose epidemic. Opioids accounting for nearly 48,000 of those deaths. In california, [indiscernible] due to regulatory changes, physician training and other changes. Enrollees quadrupled through the Third Quarter of 2018. The counties that make up my district are part of 40 counties and have joined the effort to expand, improve, and reorganize treatment under the medicaid section waiver. What tools have the aca provided to help us fight the Opioid Epidemic . This cannot be stated strongly enough, the number one tool in this country to combat the Opioid Epidemic is Medicaid Expansion, period. I spoke with governors who are trying to stop this terrible plague. Governor beshear from kentucky could speak so eloquently. It was the Medicaid Expansion that helped save the lives. It provides medication and the therapy they need to deal with the addiction. Add tone else want to that . I will add to that. Plane the aca, 45 did not did not cover treatment. You need treatment before and after, you need insurance access, you need to have coverage to cover you for your lets say a behavioral therapy treatment and you need than insurance cover coverage on the back and if you are addicted, there is nothing more important to combat the mored crisis and getting americans covered. This is something we hear, we need additional resources, not the opposite. Decade expansion has reduced the need for Substance Abuse treatment by some estimates as much as 18 . You noted in your statement that medicaid is the largest payer for Addiction Treatment in this country. You have said that. Provides to kaiser, it coverage to four and 10 nonelderly adults dealing with addiction. If the aca was overturned, what would happen to people who gained access to treatment . They would lose it and the crisis we are dealing with and trying to solve would get worse. It is that simple. There is no plan. Members say the plans to combat the crisis depend on Insurance Coverage being in place. There are other aspects that have facilitated express expanded access to treatment. Providing tax subsidies to insurance insurance purchase insurance through the marketplace. Insurance plans are required to cover these services as they cover medical and surgical benefits. How would eliminating these provisions and connecting people affect people in substance treatment . These people who have access to treatment would lose it. We would go back to a time at which they were outside by themselves and not getting treatment. Do you believe companies without the aca would cover these kinds of services . Mentalral law requires Health Parity but provisions have not been enforced. There are different ways to get this kind of treatment. You dont want insurers covering a cheap pill, you want insurers covering a panoply of service that gets them treatment. They need coverage to accomplish that. We received a statement from Jessica Altman crediting the aca theseoverage of disorders. Overturning the aca would effectively undo a decade of progress made toward ensuring those have access to crucial effective evidencebased treatment services. I would like to enter the statement into the record. We are facing the worst Public Health crisis and a generation yet this administration is to trying everything to take away coverage. If the president wants to cover the epidemic it starts with expanding health Care Coverage. I yield back. Thank you. Thank you chairman and thank you, witnesses for being here today. I appreciate the time that you have taken to be here, especially witnesses here with their personal stories. I appreciate you being here from the great state of texas. Soundsto ask you if this familiar, my insurance went from 345 a month to 1200 a month. My premium increased drastically. From 247 ofreased month to 1024 a month. The doctor will went from 1500 to 6,000. Plan was declared illegal and premiums doubled. My insurance tripled in cost, it cost more and has fewer benefits. Premiums increased, the deductible increased, 1500 more a month and i lost all my doctors. A health care went from 125 month provision and full medical to 375 a month, i could not afford it. My dad had to get obamacare and they denied him the meds he needed, denied him surgery, and his meds became beyond expensive and premiums became ridiculous. Ive been without insurance for seven years because it is cheaper to faye does pay the fee. These stories sound familiar . I hear the stories all the time and many from the patients that come into my facility. One of the reasons they sound familiar is we ask how has obamacare affected you . This is the response we have gotten. While i appreciate the testimony of the witnesses that are here and i do not discount them in all, it would have been nice if the committee would have allowed us more than one witness so we could have a more wellrounded understanding of how this is affecting American People. Point is is that a onesizefitsall approach does not work for the American People. Happened that has not over the last decade is everybody keeps talking about health care, but we have not had a real discussion about health care. Obamacare as it was dubbed should have been dubbed obama coverage. All the testimonies we are hearing is about how many people are covered. The real question should be how do we get better access to care question mark the goal for all of us regardless of what is what side of the isle you are on is care for the American People, not more coverage. I think it would be help us all if we could work our policymaking toward that objective and do so in a way , it brings in the light wellrounded understanding of how this is affecting American People. Can you tell me, there has been talk about socialized medicine, whether or not obama is or is not that. One of the Major Concerns when the aca was being debated is whether it would be a first set step two socialized medicine and universal health care. Can you explain the similarities . Over half the Democratic Committee members have endorsed medicare for all. Putting these to bring together, is there a similar manner a similarity . The similarity is governmentsponsored health care versus individual choice. That is the distinction at its purest level. What we want is to have people have the freedom to use their own money the way they wish and to have some kind of coverage that protects them in eight catastrophic fashion. We are not in a place where we relationshipd of with our medical professionals anymore. What we have been been pushed into. Insurance, your are right, coverage is not what health care is. Thatld say those folks read their stories, the increases in those premiums, many of them, the ones i have talked to are still uninsured today. They had good insurance, they were able to take care of their chronic disease, they were able to buy their medications, they would see their doctor and today, they are not insured and they are having a challenge getting to see, getting other kinds of coverage because of a now preexisting condition. Because of the aca making things more expensive. Using Market Forces can work to provide access to care . I have seen it happen. Toi yield my remaining time the current sitting Ranking Member, my friend from texas, mr. Roy. I would ask my other friend from texas, expanding a little bit on what he was talking about, i believe the number is somewhere in the vicinity of 17. My colleagues have supported medicare for all, i am happy to correct the number if it is not right but it is right. That is a sizable number. Obamayou explain if why obamacare is working so well some of my colleagues are racing to change it and offer an approach in the form of medicare for all . You may briefly answer the question. I dont know that i can explain for them. It does seem as if they are abdicating their support of the aca by going to this plan. It is a show of the current plan does not meet the needs of the people in this country. Thank you, mr. Chair. I want to start by saying this meeting is not about medicare for all. As hard as others have tried, we are not going to dilute this debate. I want to thank my chair for holding this hearing. The aca as increased access to care for every stage of childrens lives. Beginning with improved access to Maternity Care for Better Health outcomes for children. As the cochair of the Congressional Congress on women issues and foster care, the wellbeing of our countrys children is of great importance. Thanks to the aca, the insurers who are no longer able to deny coverage for Maternity Care and treat pregnancy as a preexisting condition. I would like to ask unanimous consent to enter into the record a letter from the march of dimes highlighting how important the aca is to the health of children and women. Without objection, so ordered. Thank you, mr. Chair. The letter notes that before the aca, women with high risk pregnancies could be unable to afford medical health for the rest of the year and babies born preterm, exhaust a lifetime cap before the first birthday. How did the aca preexisting conditions protection and on annual lifetime limits change the Health Outcomes of such individuals . It is one of the most critical protections and importantly, this is not just for people buying coverage in the marketplace. This is for all of us. Most americans getting employers coverage, the aca band the abilities of insurers, the one from limiting, letting and just for the record, america and everyone listening, the United States of america is leading in Maternal Mortality. That is women dying in childbirth. And the fact that we are having a discussion, and if you want to say its insurance, you cant discuss insurance if you are not talking about health care. So professor, if the Trump Administration prevails in court, what would happen to these requirements . Well, all of those caps would be put back in place. Meaning lifetime caps, annual caps, no caps on out of pocket maximum. You would have a return for a time in which insurers could refuse to insure you for Maternity Care. But the a. C. A. , only 13 of plans, knowing life was good before a. C. A. , covered Maternity Care. And women in 11 state Capital Cities couldnt purchase maternity coverage. Until something changes, the only way that we can continue as a human race is through birth and pregnancies, and it is an insult for us not to provide the care for women who re giving birth. Now is that correct, that insurance are now required to vered Preventive Services, colluding maternal visits without cost savings . That is exactly right. You talked about being a mom, four beautiful children. Before a. C. A. You were uninsured for years except for en you briefly qualified for medicare during your pregnancy. How important was it for your health as a mother with a preexisting Health Condition and the health of your daughter to have insurance during that time . It was critical. As i mentioned, all four of my children were born via says is he cesarean. If i didnt have that, i still wouldnt be under those bills. I have had very high risk pregnancies that were very utterly , it was necessary that i am there to be able to take care of my children. It is not just enough to have them. I have to raise them and take care of them. My closing comment is when we talked about a. C. A. , we are talking about, for me, such a passion i have for children and women and pregnancy, that we not allow this shade of saying it is ineffective and it cant happen. Balls the women protecting them in this country, to say we are pleading and women dying in pregnancy, this is a way for us to address that and reverse those trends. I yield back. Thank you so much. Thank you. There has been a lot of talk today about how improving Health Care Opportunities for American Families will lead to all sorts of dystopian outcomes. There is this outcome that we care. Ng to be rationing i am curious to those of us here, raise your hand if you have been uninsured in your life. Keep your hands raised and also raise your hand if you have been insured but your deductible was exceedingly excellencive, so you rarely went to the doctor and got the care you needed. Thank you. I have been there, too. I was uninsured less than a year ago. I was uninsured seven months ago. I wants folks to raise their hand again, because i know what being uninsured is like. It is not just a financial issue. It is the stress and it is the anxiety when you wake up every morning and you dont know if u are going to slip on a curb, if you are going to find something on your body that you want to get checked out. Everything becomes a spiral of anxiety because you dont know how you are going to afford it. When we talk about rationing care, in a forprofit care system with no guard rails, where it is the wild west, where you are allowed to profit off insulin and peoples lives, how many of you in your time of delayed getting a prescription or delayed going to the doctor . You rationed your own care, is that correct, ms. Burton . Yes, absolutely. For profit f of a company. I know what that is like. I rationed my health care for 10 years. I was on a selfemposed wait list for 10 years, not going to own ort pasadenaist when my knee hurt, not going to seek mental hell care or counseling when my father died. All of those things. Would you have the courage to share with us about your miscarriage, but the fact that you had a miscarriage in the middle of an emergency room, and you said you were uninsured in that time . That is correct. You were uninsured, so you miscarried in an emergency room, and you never were able to get the followup care you needed. You never knew what happened to your baby, correct . That is correct. Because insurance was too correct. That is correct. Because c. E. O. s needed to offer a profit margin, correct . Correct. This right here is a come pleat complete condemnation of the forprofit Health Care Insurance industry. While they are talking about how socialized medicine, how a public guarantee to the right to health care will force us to ration care, we are rationing our own care. We are not talking about monthlong waiting lists you said the system we have now. We are talking about yearslong waiting lists for system that we have now. I will move on quickly. Is y part of the a. C. A. Medicade expansion, correct . Yes. This allows people of lower medicade sexacks allows people of lower incomes to essentially get covered by medicade, correct . The very most Vulnerable People in this country. And that is a core part of the Affordable Care act. Righttoleft. There are are some states that have not opted into this expansion. The states that have chosen to ot cover, are lower income makes. Includes alabama, florida, kansas, mississippi, missouri, north carolina, south carolina, oklahoma, south dakota, tennessee, texas, wisconsin, wyoming. Correct. These are states that have chosen not to cover the most vulnerable americans, correct . Thats right. And these are the states also, we are seeing a lot of their representation trying to combat the a. C. A. When they are not bean buying into it to protect their own. We are talking about 2. 5 Million People who dont have coverage because tchopet have expanded medicade. Why do you think they are doing that . I used to work with the governors on this very question , and the truth to that answer is because it was tainted as obama care, and it was a completely political decision. So people are not getting insurance in these states for political reasons, that is your assessment . Absolutely. Thank you very much. Thank you. People are dying and getting sick. I will now go to mr. Gosar. Thank you, mr. Chairman. You are from texas, right . I am. Are you familiar with federally qualified Health Centers . I am. Let me review. My understanding is that first come, first serve. You are seen on any basis and your requirement for payment is a sliding pay scale, is that true . That is correct. So technically there is coverage for these populations . Yes, sir. Interesting. So let me ask you another thing. I have heard a number of things today in regards to the a. C. A. Who are the three grooms that actually benefitted from the a. C. A. . Let me explain. Ok. Big hospitals, the Insurance Industry and pharmaceuticals. And if you invested prior to the a. C. A. , you are a very wealthy individual. Because one of the things we have overlook the is the lack of competition. We incentivized the Insurance Industry to gobble each other up. So you have regional monopolies. Then we had no competition in regards to the hospitals. Then what we had is a blowout in the pharmaceutical industry. There are some common denominators. We had a conversation about the v. A. , and i am astute about that. I am from arizona. So the veterans that were dying were in my state. I also represent and have represented over 85 of the geography of arizona. So a lot of rural areas. And its the implementation of the Choice Program that has actually saved us, so that it actually helps those numbers out in the rural area to pick and chose those righters. That makes a big difference. Can you elaborate more in regards to the Veterans Administration as a single payor type apparatus and why it is insufficient for the veterans . I can. I also serve as chairman for the veterans charity. We build specially adapted hughesing for veterans. I have quite a few connections to the veteran communities. I dont hear a lot of positive things about the v. A. They talk about rationing. Talk about long wait lines. There was a time when i have seen veterans in their homes that have said my ptsd is so bad i cant comment out the front door. It took him five minutes to come talk to me, and the only thing he said was we need to fix the v. A. There are a wonderful example of what a single payor would look like. You have limited choices. You have long wait lines. The care in many cases is good. But getting to it is often difficult. And what does it matter if you have the access if you dont have it until after something catastrophic happens or until you have been living with pain for months and months, and sometimes years . So yeah, it is problematic. It is very similar to how some of these other industrialized countries operate. That is not what i would want for the people of this nation. Now, getting back to pursuing how do we take care of people, one of biggest problems, and just for clarity here by the way, i was a dentist in a previous life, so i know a little bit about the Health Care Industry. I was no fan of what was prior to obama care, and i am no fan of obama care. I think there is something else. But my point is something has gone awry here. The problem is there is no real gatekeepers. We put them out of business. That would be primary care physicians. Isnt that true . Oh, yes. So to stay in practice, you basically have to sell your soul to a hospital in order to stay in general practice . That is the unfortunate case, more than 50 of all our primary care physicians are currently employed by hospital systems. Now i also heard today in the conversation that we are providing health care for all sorts of individuals coming here illegally. And at the same time what we are doing is we are actually stealing their well educated people for their doctors, are we not . Part of our physicians are coming here from overseas because nobody from the United States is really going into that discipline . It is becoming less and less. But we have also contributed to that problem as a government because even in this country, those that are coming out of medical school, we dont have the residency spots for them. I will yield the rest of my time to the gentleman from texas. Let me, with the end of this hearing, what i have are a few questions. I have not asked questions. Before i conclude todays hearing, i would like to enter into the report six letters the committee has received in recent days, including lobbyist. S from the the National Partnership for womens and families, the womens law snsm and Veterans Healthed video indicate, all of these letters express concern about the grave impact that the Trump Administrations position in texas lawsuit could have on millions of americans and the u. S. Health care system as unanimous consent and so ored. As i and so ordered. As i sit her and listen to all of this, i ask myself first of all, Health Care Costs are going to go up no matter what. Am i right . Absolutely. And i have for at least seven with many fighting of my colleagues to bring down the cost of Prescription Drugs. How much does that play in the cost of Health Care Going up . The cost that we see in fee increases are mostly because of the prices being paid for the services that people get. If Prescription Drugs go up in prays, premiums go up. If hospital prices go up, premiums go up. That is what drives the vast majority of increases in Health Care Insurance. No doubt about it . No doubt about it whatsoever. Wow. And so it is very difficult, as you appropriate know, to get the congress to move in the direction of reducing the cost of drugs, Prescription Drugs. As a matter of fact, my first and only meeting with the president was just about that subject. Hat was two years ago. The price of Prescription Drugs ad gone up, not come down. But you know, thing that i am sitting here thinking, i have listened. You will never convince me that the a. C. A. Is perfect, but nor can you convince me that it it is ot be fixed so most effective and efficient in covering our people in this country. Would you agree with that . A hundred percent. We could do it . Absolutely. We could make coverage more affordable, increase subsidies. There are a lot of things we could do to really strengthen and make the naquin a much more effective program, no question. And there does seem to be a string in some of the questioning that sort of blames the victim. I dont like that word, but the person who is going through some difficulty. As if to say oh, it is your fault. I am fine. Tell you i could walk just like you could a year and a half ago. Now i cant walk without a walker. That was overnight. Literally. And as i am sitting and listening to our Patient Consumers, i s, as thinking and god forbid. If more people went through ome of the stuff or had family members go through what you have gone through, they would have a different perspective. There is nothing like suffering, there is nothing like being disabled. There is nothing like having your life change overnight. There is nothing like taking two hours to get dressed. Come on now. There is nothing like sharing your pain. The idea that you would come you and the story that have told are so personal. But you are willing to share them with the world to make. Omebody elses life better in some kind of way there is something in here that i think we are missing, and i think president obama said it best. He said we have in our country , ite often an empathy deficit an empathy deficit. And so some kind of way we have to get around to making sure that all people are taken care of. It is almost like it feels like you are saying well, i cant help you because i have to help this person. Well, i believe that we can help all of us if we have the will, and tampa bay an effective and efficient system, and one that will work for allamericans. Now we talk about the rising Health Care Costs. We should be talking about ways to ensure that all americans have access to Affordable Health care. But we need to remember how far we have come under the Affordable Care act, especially in the individual market. I would like to ask you about when you ual market described in your written testimony, as i quote, terrible prior to the a. C. A. , but now, quote, much, much better, end of quote, thanks to the Affordable Care act. Before the a. C. A. , you state that 60 of consumers in the individual market before the a. C. A. Found that quote very difficult or impossible to find affordable insurance. Now the a. C. A. Has cut that number down to 34 . And more consumers are finding the coverage they need. More consumers are buying insurance. Sir, isnt it a measure of success that more people are able to afford the coverage they need under the Affordable Care act . Absolutely. And more people are spending their own money to buy Health Insurance under a. C. A. As well. And one of the things that has happened in my district and in our state of maryland, when the Trump Administration pulled away the navigator money, do you know who did the navigating . The members of congress. Do you know why . Because we didnt want people to have an opportunity that they did not know about. If you dont know about an opportunity, you may as well not have it. We spent hours upon hours trying to get the word out, the deadlines and all that kind of thing, so that people could be insured. And mr. Chairman, also one of of the most effective ways to get prem uniforms down is to get people to participate. We have seen it in massachusetts and california. No doubt about it. So let me just say this. My republican colleagues have claim the that the a. C. A. Has made Insurance Coverage unaffordable. As the witness has pointed out, the opposite is true. Before todays hearing the Committee Received a letter from the Pennsylvania Insurance Department commissioner, jessica alsoman. In this letter, commissioner describes house the add strigs position in the lawsuit would create chaos in the mark, resulting in higher premiums and out of pocket costs for consumers in pennsylvania and across the country. I requested this be made a part of the record. Without objection, so ordered. And my colleagues were serious about making coverage more affordable for the American People. They condemn the administrations actions. I am going to conclude the hearing, but i again want to thank you. I want to thank all of you for being here, and i especially. Ant to thank our consumers there is something about pain. There is something about it that is a driving force. And as i have said in other hearings, when bad things happen to you, do not ask the question of why did it happen to me, but why did it happen for me . And in this instance, why did it happen for the people of the United States . I want you to keep those three words in mind. Pain, passion, purpose. Did you have something to say . I thank the chairman. I wanted to thank the witnesses, all of you for your time. It has been a pretty good length hearing. Thank you for taking your team. Those of you battling illnesses in your testimony. We appreciate it i am a cancer survivor. Chairman is right. This is something we should agree about more. We have perspective on how to address making sure everybody can afford high Quality Health care. I appreciate you all coming here and testifying. On behalf of the entire committee and including those in mindset arrieta. Thank you, mr. Chairman. Thank you very much. I would like to thank our witnesses for testifying again. Without objection, all members will have five legislative days with which to submit additional written questions for witnesses to chair, which will be forwarded to the witnesses for their responses. I ask our witnesses to please respond as promptly as possible when you get those questions. With that, this hearing is aadjourned. I have to go. [captions Copyright National cable satellite corp. 2019] [captioning performed by the national captioning institute, which is responsible for its captioning content and accuracy. Visit ncicap. Org. ] [inaudible] heres a look at what is live thursday. On cspan, at 11 30 a. M. Eastern, britain secretary of state for International Trade alks about the future of u. S. u. K. Relations. Then at 1 45, we will have live coverage of the iowa state fair where president ial candidates steve burrik and joe biden or speaking. Ater today, the Cato Institution debate about concerns, libertarianism teravainen tism. And more live coverage on use in the morning as the center no strategic and International Studies looks at trade relations between the u. S. And china. That is followed by a decision on the future of ukraine with two former u. S. Diplomats. And later Foreign Policy experts discuss rising tensions between the u. S. And iran. That is at 2 00 p. M. Eastern. In 1979, a Small Network with an unusual name protect out a big idea. Let viewers make up their own minds. Cspan opened the doors to washington policy for all to see, bringing you unfiltered content from congress and beyond. Today that c. D. Is more relevant than ever. On cspan and online, cspan is your unfiltered view of government, so you can make up your own mind. Brought to you by your Cable Service or slight provider. President trump and the first lady traveled to dayton, ohio, and he will pass, texas, to viciedo with survivors and First Responders in the two shootses last weekend. The president spoke to reporters about finding a possible legislative solutions that would prevent gun violence