Transcripts For CSPAN3 House Oversight Committee Hearing On The Affordable Care Act 20240714

Committee will come to order. Without objection the chair is authorized to declare recess of the committee at any time. This full Committee Hearing will convene regarding the administrations attack on the aca and i now recognize myself for 5 minutes to give an opening statement. We are here today because on march 25, 2019 the Trump Administration filed a two sentence letter with the United States court of appeals of the fifth circuit reversing its own previous position in the case of texas versus United States and asserting for the first time that it would not defend any portion of the Affordable Care act. If the Trump Administration position prevails and the entire aca is struck down there will be catastrophic implications for millions of americans and the entire United States Healthcare System. I have often said that voting for the Affordable Care act was the most important vote of my career. Let me tell you why. When Congress Passed the aca in 2010 we enshrined into law the promise that all americans have the right to assessable Affordable Health Insurance Coverage. The aca established new protections to end legalized discrimination against approximately 130 Million People in the United States with pre existing conditions. The aca authorized states to expand their Medicaid Team program and approximately 17 million americans gained coverage as a result. The aca created Online Marketplaces for consumers who purchase insurance and Financial Assistance through tax credits and costsharing reduction payments and today, nearly 9 million individuals receive Financial Assistance to obtain coverage through the individual market. The aca improve the quality of coverage for millions for by requiring to cover a set of essential benefits provide coverage for Preventive Services such as immunizations and screening tests and allow young adults to stay on their parents plan until they turn 26. All of these federal protections will disappear. People with preexisting conditions like diabetes, cancer , hiv, asthma, Substance Use disorder or even pregnancy could be denied healthcare coverage or charge more. Baby is born with Health Conditions could be uninsurable for their entire life. For the small Group Margins but not after coverage Central Services such as preventative care. Since President Trump took office in january 2017 Neither Administration or Congressional Republican have offered a plan to replace the aca that would prevent coverage losses or the elimination of consumer protection. They have voted 69 times to repeal the aca. It failed to pass the senate in 2017 would have increased the number of uninsured by 21 Million People. There is something wrong with that picture. During the 2016 campaign President Trump promised repeatedly that he would come up with a plan to replace the aca and never did. Never did. Now, that he is running for president again he promises have now returned you will be hearing shortly if you have not already. In april he promised to release and i quote a really great plan. After the 2020 election and unfortunately no one has seen it. Ironically the Trump Administration is successful in striking down the entire aca it went directly undermined many of their own policy goals including tackling the Opioid Epidemic, lowering Prescription Drug prices and ending the hiv epidemic. Who wanted to hear from it about why we suddenly reduced the position in litigation, we wanted to know what the administrations plan is for millions of people if they went in for it and invalidated the entire aca. We invited the acting director of the office of management and budget and he declined. Apparently, he did not want to answer these crucial questions that affect so many millions of americans with something that is very personal. I have often said to my protigi the one thing that we must always do every day, i think and that is what is the enemy of my destiny. What is the enemy of my destiny . What will stop me from reaching where god meant for me to go and there is one common denominator that i have noticed that applies to all of us. Health, and enjoying a life where you can truly pursue happiness. Although the Trump Administration refuses to we will have a panel of policy experts or patient witnesses who can tell us exactly what it will mean if the Trump Administration is successful in eliminating the Affordable Care act and i asked the entire committee not to be blinded by what we see. Dont be blinded. The experts will let you know they are on the front line and they deal with these matters every day. There are others who have gone through and continue to go through difficult circumstances. I can relate. Now that i am on a walker and i have learned what it is to be disabled and it is a tremendous task in most instances just to get dressed. I got it. I often say to our witnesses who have come to share with us your personal stories, thank you , thank you. Thank you for taking your pain and turning it into a passion to do your purpose. From utah or missouri to share their stories with us. Have yet to tell us what life was like for them and their loved ones. I yield to the gentleman from ohio thank you for making the trip here and being willing to share your storypreexisting conditions, there is no one on this committee who would support denying coverage to americans with preexisting conditions. I was hoping we could focus on those issues. Like so many other hearings on this committee we are not. Rather than working toward bipartisan they are looking to score political points by attacking anything the Trump Administration does to improve healthcare for American People. Nextdoor on the Judiciary Committee we reported multiple bills that would have meaningful bills i would have impact on prescription bills and working to make improvement to affordable generic drugs come to market and those were all bipartisan and many pass the Judiciary Committee unanimously. We could be talking about bipartisan substance issues and instead we will talk about why the democrats are upset that the administration thinks the americans deserve Something Better in the failed ideas of obama. Under obamacare the premiums skyrocketed and their healthcare choices reduce. The majority of title is trumps efforts to undermine the aca. Undermined the aca . Think about what we were told when this past now nine years ago. I called the nine lives of obamacare. For this one if you like your doctor you can keep your doctor. Remember that one . How about if you like your plan you can keep your plan. We were told by the president of the United States premiums were going to go down. He got more specific they would go on average 1500. He said deductibles would decline, five false statements right there. Remember this one acts this was in the fall of 2013. They told us the website was going to work. They told us the website was secure and they told us that these coops were wonderful, endall beall creation. 23 were created guess how many are still in existence . Or. The other went bankrupt. They told us it is not a tax because you cantthere is no penalty. How can you undermine something that has already failed . I dont expect my democrat colleagues to acknowledge it but they have worked to increase competition and all the of care and increase competition, transparency and quality of care are all goals we should all share. I dont know if there is anything the Trump Administration can do that would satisfy my colleagues on the other side of the aisle. Time is troubling, just yesterday the fifth circuit began oral arguments in a case to invalidate obamacare due to recent changes to the law. The administration chose not to defend it in this appeal, that decision is consistent with similar actions taken by other administrations in the past for other laws. Here we are. Democrats want to have the director to testify about how the Trump Administration made this decision. Could have had a witness from hal for witness from doj, no, they wanted someone from wednesday. This is about trying to manufacture a controversy based on Anonymous Sources and news reports this is just another attack on President Trump and it is disappointing. We could have had a productive discussion today about real healthcare policy and technically we can still do some of that. We couldve had a real discussion about how to make it more competitive and transparent and with better quality of care. I hope at some points this committee will stop it was attacks on the administration and focus on something that makes a real difference in the lives of our constituents. Want to think you for coming here and tell your story. I think the country deserve Something Better than the lies we were told. Anyone remember the name Jonathan Gruber . Remember that name New York Times called him the architect, the architect of the Affordable Care act and he is the guy that was caught on tape a few years later calling us all stupid and americans stupid for buying the lies that the americans bought that obama told us. That was the architect of obamacare and somehow the majority says this is a hearing on efforts to undermine a law that was passed was so many false statements made about it. I yield back. Thank you very much. Let me be clear to the witnesses, we want constructive solutions, believe me and life is short i sure dont waste my time and peoples time. I would ask that our witnesses in a minute stand in a minute. Let me introduce them. Professor of law director of the Solomon Center for health law and policy you University Law school, executive director of families usa, david director of rights on Healthcare Initiative texas Public Policy foundation, paul gives is one of our consumers from west valley, welcome. Another Patient Consumer from monroeville, pennsylvania, Stephanie Burton is another one of our asian consumers from kansas city, missouri and i will now yield to the distinguished gentle lady from new york to introduce one of her constituents. Thank you so much, it is my honor and pleasure to introduce my good friend and constituent peter morley. He is an outstanding patient advocate the most effective one i have ever met in my entire life. He is a twotime cancer survivor living with lupus, peter is an extraordinary advocate for the millions of americans who cant come to congress to advocate for themselves that are living with preexisting conditions whose lives depend on consistent and sufficient healthcare coverage that is guaranteed to them under the Affordable Care act. I first met peter two years ago on twitter when he reached out to me to ask what he can do to save healthcare. He depended on it, many of his friends depend on it, what can i do, i never dreamed how far he could go, he is a true example of how one person can make a difference. Peter, i said become an advocate and he started in new york going to press conferences, meetings and expanded it to coming to congress over 21 times including today, testified before congress, he has held over 100 50 meetings with members of congress and senators on both sides of the aisle and he is incredibly effective. He is a voice for the many people that need to know what is happening on social media, he has a huge following and he uses this platform to lift up the struggles, hopes and dreams of so many people who are struggling with healthcare issues and his goal is to save the Affordable Care act. Thank you for your dedication. I want to recognize an introduction. I want to welcome david who is here, he has recently a constituent in texas 21, he works for the policy foundation which is also in the 21st Congressional District in austin. Is a long time actively involved in the Healthcare Industry and administration and other areas of health and glad to have you here think you for representing the great state of texas. Thank you very much. Those of you that can stand please do. Do you swear or affirm that the testimony youre about to give his truth, the whole truth and nothing but the truth . Let the record show that the witness answered in the affirmative, think, you may be seated. I just want to let you know that the microphones are very sensitive, speak directly into them and make sure they are on when you speak your written statement will be made part of the official record. You are now recognized to give an oral presentation of your testimony and i want to remind witnesses that we have your official statements. We want to limit this to five minutes. I know. It is hard. You see all these people, all of them want to ask you questions so i want you to give us a statement summarizing stay within that five minutes good morning. I appreciate the opportunity to set testify here today. Texas versus and are is unlike any other major case involving the Affordable Care act. This is the first major challenge where there has been a consistent about legal experts including opponents at the Lower Court Decision was dangerously wrong. The stakes are enormous. 20 Million People will lose their healthcare and millions more will be adversely affected. It reaches every aspect of the Healthcare System not just pre existing conditions. 10 million got healthcare, 17 through the Medicaid Expansion, seniors got billions of dollars in benefits also losing what anybody that wants a vaccine, Substance Abuse treatment all gone. It is critical to appreciate the overreach of the decision against the act and the Administration Decision to support it despite opposing legal consensus, for example, i filed a grief with the most influential critic of the act another brief was filed by two republicans attorney general. Many other prominent conservatives includingfiled a brief post the case. That is because this case is about more than just obamacare. And is about a violation of a centuriesold legal principle that safeguards congressional lawmaking power. Unlike the legal questions severability is nonpolitical law. All nine justices apply the same test. The doctrine addresses what a court would do if it finds one part of a statute is valid does it strikeout the entire statute or just the offending provision. The texas case involves a 2017 tax law in which congress made one change it reduced to zero the penalty for failing to obtain insurance. The plaintiffs argues that is unconstitutional, but that is not what is causing the crisis. That provision is not enforced, what causes the crisis is a include at the entire aca has to go down with it. There are two parts, first, we presume we save not destroyed, both justices recently wrote that they must sever to the narrowest possible and legislative attempt. Justice wrote unless it is evident that congress would not have enacted the remainder of the law remain standing. Sometimes a test can be difficult. It is hard to know what congress wouldve wanted, but this case is not difficult and that is what makes it different. The court does not have to and not permitted to guess whether congress wouldve wanted the act to standeliminated the penalty and left the statute standing and leaving it intact congress made it as clear as possible in the text the discrimination that the continuation. It doesnt matter to implement to be for the court to accomplish what congress could not over two years of trying to repeal. That is what the texas court did. The excerpt congress 2017 amendment establishes a law capable of the mandate and congress preferred a lot to know law at all. To get the results the court had to ignore the intention of the 2017 congress and focus on the 2010 congress, the 2010 congress i must emphasize is irrelevant. Later they are allowed to amend statute passed by earlier and courts are not allowed to give one congress more power than the next. The legitimacy of the 2017 judgmentit is not under the fact that an earlier congress mightve said something different. Ive alluded to the consequences. You would again be charged with caps and kids couldnt stay on parents plans, Prescription Drug coverage, preventative screening and major drug benefits. They cant accomplish their own initiative whether indian the Opioid Crisis without the reform. It is not every day this case is about much more than it or about dire consequences. It is about separation of power and the limits of judges. Thank you. Thank you for the opportunity to testify today. I am the executive director of families usa. For nearly 40 years we service when the leading voices within d. C. And on the state level. Our mission is to allow every individual to live their greatest potential getting the best health and healthcare are accessible to all. I work is representing needs and interests of family. We are proud of our work, just this year addressing medical bills and drug costs and improving drug pricing. With bipartisanship possible it saddens me to be here today to discuss the impact of this lawsuit. Have you as you have heard is the aca is struck down 20 Million People in america will lose Health Insurance coverage. That includes more than 300,000 people in your home state of maryland and more than 700,000 people in the home state of congressman jordan. Yawned that vital protections we strip with preexisting conditions, women, older adults. For those of us that receive employer Health Insurance hundreds of millions of americans we could be subject to annual or lifetime limits in our policy meaning we could lose access to coverage when we are our sickest and need it most, since then we have cut the Interest Rate by almost half including gains for families in Rural America, veterans, older people and many others. The aca included other improvements as we have heard it lowered senior cost in medicare and increase solvency of the Medicare Trust fund. Even created a pathway for biological drugs to treat devastating diseases. As you have heard, many will try and shift the focus of discussion from the vast improvements created to focus instead on the impact of it on Health Insurance premium. We at families usa share the deep concern about premium cost and working to make healthcare much more affordable, however, the data are very clear, it is wrong to say that the aca is the cause of high insurance premiums. First, despite the rhetoric according to the president s own actuaries premiums in the Employer Market have grown more slowly since it took effect in 2014 and in the individual market most families in the marketplace are paying less for their coverage, for others we know cost has increased and this is important, this is largely because they forbid them from discriminating with people of preexisting conditions. Many more people both kids and adults with Health Problems can get access because of the aca and their costs are shared. Despite the truth that they have lowered premium cost for most we can all agree that Health Insurance premiums were rising too fast and premiums are still rising too fast. Premiums primarily reflect the cost of care paid for by the insurance for example the cost of Prescription Drugs, hospital, physicians. As we all know the underlying cost of healthcare have been increasing far in excess of our paychecks for decades. Most recently because prices are skyrocketing, no one in this chamber and as a nation we have to get a handle on it. The aca for out of control healthcare costs is that the drowning man blaming the life preserver. Members of the committee, the public does not want it to be overturned, for well over a year a majority of americans support the law and when polling on individual coverage elements the public support was overwhelmingly both among democrats and republicans. Finally, lets not forget how we got here, Republican Leaders in congress and President Trump field to repeal so they passed a law that the road individual mandates and they filed a law to say without that the entire law should fail. Both conservative and legal scholars believe the litigation is groundless and many also believe that the president has failed in his constitutional duties by not defending the healthcare law. As a result the basic healthcare and in the balance and this is why one of the groups in our nations history support the aca. The american medical association, arp, the American Cancer Society, the american heart association, we hope this traveling hour will pass and the bedrock protections will remain and that tens of millions of families across the country can breathe a sigh of relief. They will know that because of the aca if they or their children get sick or they need to get healthcare they wont lose their own or the other things they have worked for. Thank you. Thank you very much. Thank you for having me today. I am the director of the right on Healthcare Initiative of the texas policy foundation. I would like to think the others that have come here to testify. I firmly believe we want the same thing we want affordability and accessibility and we just have different ideas on how to get there. Those here today may have benefited thank you for your bravery and telling your story because i know the difficulty you face. Healthcare is an American Issue not a political one, it is personal, not partisan. My experience proceeds my work in health policy, my journey comes from the Healthcare Industry came about because lawmakers consistently inflated and confused Health Insurance with healthcare. Im here to confirm that coverage is not care. As a Hospital Administrator ive Emergency Department for basic primary care because even though they may be insured, they are unable to afford their deductibles. Particularly in states that have expanded medicaid. Outside the Emergency Departments, access to care has been an issue as well under our Current System. It was no better prior to the introduction of the aca, but the problems have been exacerbated since its passage. The number of providers that accept the plans is minimal and shrinking. When they do get to see their doctor, they may get referred to a specialist, which can prove difficult. Effect of Health Insurance on mortality. It demonstrated that there was no reduction in mortality for those who participated in the aca. Had the same impact of having other forms of coverage or no coverage at all. Even those patients on the aca exchange whose premiums are subsidized are left with a often leave them in the position of not being able to afford going to the doctor and often waiting until they have to go to the emergency room. Insurance coverage under the aca that has driven up the cost of care, it has hurt patients with preexisting conditions, not helped them. As an adviser, ive been called to help families and patients navigate the complexity of hospital care. Theres always a Common Thread in their frustration. They dont get to decide. They pay for more and get less. Needless to say, we have a corrupt system in every segment of the industry. Rather than the patient being in charge of very personal decisions, government regulations have empowered insurance agencies to be in charge. They have limit decision power. The decisions are being made instead by government administrators, the Insurance Companies and a number of middle men. We have a lack of affordability and inefficiency because there are too middle men that have come between the patient and the doctor. Even in the private market. 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 what they want is to be empowered to make decisions for themselves and families. This doesnt come from government mandates. This is efdent when people are involved in participating in their healthcare with their doctor. I am among the statistic of the uninsured. But i would assert i get Better Healthcare as a patient because to repeat my point, coverage is not care. I use direct primary care and medical cost sharing for my catastrophic coverage for both myself and my family these models in addition to the many others that have been promoted by the Trump Administration do not have exclusions for reexisting conditions. The high cost of care in the country increased significantly during the time of the aca. The high cost of care is where the high cost of care is what American People care about. The high cost of care is the direct result of the federal government attempting to fix healthcare and failing. Choice and competition, not a one size fits all plan, is what we need for something as local and personal as healthcare. We need a landscape of choices that are as diverse and personal as all of us. Thank you very much. I look forward to your questions. Thank you. As we now move to mr. Gibs. Let me say to our witnesses, again, i want to thank you for being here. I think your testimony is so important. So often here on capitol hill, we look at statistics and we read about the people having problems, but theresing in like having people who go through it every second of their lives. So mr. Gibs. And thank you. Thank you, mr. Chairman. Thank you, members of the committee for giving me the opportunity to speak today. Ive heard this law referred to as it commonly is by the named the Affordable Care act or obamacare. For me, its important to call this law by its full name the Patient Protection and Affordable Care act. Because the Patient Protections of the aca have been a gift from god for people like me and families like mine. My healthcare story begins in 1974 when my twin brother and i were born with serious medical conditions. He had a condition called hersprungs disease which caused him to need 17 surgeries by the time he was 5 years old. I had 9 surgeries on my kidneys for a condition that meant that urine was going back into my kidneys instead of where it belongs. My parents never got out of the financial burden of those healthcare costs for my brother and me. Within the past 10 years theyve passed away with virtually nothing material to their names, but with a great legacy of caring for their family. In november 28, my doctor told me in a routine visit that i was in endstage kidney failure and needed a transplant as soon as possible. I was working, going to school, doing my best to be a contributing member of society, but i had no Insurance Coverage. Coverage may not be care, but when you need a 79,000 surgery, there is no care without coverage. I im a member of the church of jesus christ of latter day saints. But my church couldnt pay for a 79,000 surgery. And i needed two surgeries. My kidneys were in bad enough shape they were considered an infection risk for the new kidney, so they had to be removed first, 10 years ago this week. Ive heard opponents of the aca say people dont die in america for the lack of healthcare because they can go to the emergency room. You cant get a kidney transplant at the er. I was fortunate. I fit the narrow qualification for medicaid before aca expansion. And i also fit qualifications for medicare coverage. Those allowed me to have that lifesaving surgery 10 years ago this august. But the expenses didnt end there. Every day, i have to take immunosuppressant medication to keep my body from rejecting the kid no. I also have to take other medications. And i also because my doctors later discovered a chronic distended bladder may have caused my kidneys to decline to begin with, i have to use these catheters 5 or 6 times a day to be able to empty my bladder. Without the aca, it would be an expensive procedure for me to urinate. All of these add up to almost as much a month as my mortgage payments. I hear talk of protecting pre existing conditions in other plans and everybody wants to protect preexisting conditions. The previous plans put forth include things like pushing people like me into expensive and unreliable pools. Potential lock outs for not having continuous coverage are not protections for pre existing conditions. I hear talk that relentless attacks on the administration and aca. People like me feel relentlessly attacked by this administration and by the members of committees like this one who keep attacking the aca. My son, peter, 5 months old this week, was born with a kidney condition similar to mine. He, like like chairman comings talked about, is one of those babies who could be shut out for life. He had a kidney surgery two weeks ago and without the aca, he wouldnt have the protections to ensure that he can receive the followup care he may need his entire life just for being born with a bad kidney. Hes one of two sons i have who had a chance to be born because of the wisdom and protection of the Affordable Care act which gave me this coverage. In conclusion, i want to say that we are guaranteed in the declaration of independence the rights of life, 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 maybe it prohibitively expensive because were sick is not liberty. And without those protections, without that access to healthcare, there can be no pursuit of happiness. My sons deserve the right they deserve the right to be born. 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. Thank you very much. And congratulations. Thank you. Thank you, chairman and the committee for letting me talked it. Over the past 9 years, my family has faced a lot of challenges. But i hope you hear my story and recognize im not a unique story. The challenges my family has faced are like so many families 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 will also overcome challenges and continue to pursue their dreams. In august of 2010, my husband lost his job. We couldnt afford cobra. Between august and november of that year, he and i went uninsured. Our one year old daughter got coverage through chip. In 2016, my husband left a second manufacturing job and thanks to the aca, we did not have to worry about going uninsured again. My Employers Health plan would cost 1,175 a month. And thats just for the two of us. We pay 60 a month for our son. And our daughter is covered under a loophole for her disability. We wanted to move closer to family in your state of ohio, in florida, and arizona. Guess what, mr. Jordan, your state told me my daughter wouldnt get the services she need. So we have to stay in pennsylvania. We also had to cater our lives around the life of tessie. My husband is going back to college. Thanks to the aca, in 2018, i was able to get a mammogram. It showed i had three lumps in my left breast. Biopsies were done and thankfully they were all benign. What if i was uninsured and the results turned out differently . This could have been financially draftrous for my family. Before the follow up, i looked at the husband and said i should just have the doctor remove both of my breasts so i might not have cancer next year. If i get cancer, i might be uninsured. This is my reality and this is reality of millions of families in america. The fact is i dont trust the Republican Party to say you care about me and my family and the rest of the families in america to cover preexisting condition, to cover those with disabilities. I also had decided to get a pelvic exam two years in a row. When the doctor asked me why i scheduled it this way, i told her the truth. Im worried im not going to have coverage next year. So she looked at me and said she was glad i made that choice to come in. I am actually an lpn who works in a pediatric home care. So a lot of the kids i take care of, theyre on medicaid. Not only is it my job, but the life of my patients are at risk if you guys make cuts to these vital programs. Our daughter who is right here in the white with the little pink head phones where is she . Oh, okay. All right. She seems to be listening to your testimony. Im not as important as plants versus zombies. Since shes been 19 months old, shes been in therapies for ot, speech and she learned sign language so she could communicate with us. Speech we use in everyday life from watching tv, listening to music, talking to our friends, socializing and work. At the age of 3, she was seen by three doctors. Two diagnosed her with developmental language disorder, dld, a condition where children have problems understanding or using spoken language. She will have this in adulthood. The other doctor diagnosed her on autism spectrum. But all doctors agree that she needs intense speech therapy. In school, she received speech three times a week and ot one time a week. She also gets speech and ot once a week outpatient. She has a mobile therapist that comes to our house two hours per week. A mobile therapist helps her to appropriately express her thoughts and feelings and work on coping skills, practicing social skills and all. She gets 6 therapies a week and not including mobile therapists. If she loses her medical it would cost over a thousand dollars a month to keep her current level of therapy. We could never afford that. The hard work of her therapists have improved her life tremendously. Today she talks a lot and talks to her friends on her own. She has made significant academic progress. Last year she was a c student. This year she got all as and one b. In math and reading, shes two years behind and in support room. Just to make it clear, imagine a tripod and shes on top of the tripod. The three legs represent parents, therapists and a teacher and her aides. If you guys cut medicaid, theyre going to knock down that tripod and theyre going to take away and knock down all the progress she has made. The only chance of her being a productive member of our society and be able to make a job and hopefully make minimum wage is these crucial programs you guys have in place right now. I want you to realize what you guys are doing and not just think of my family and my daughter, but the millions of families around the United States you guys are going to affectment thank you. Thank you very much. The distinguished members of the committee, good morning. Good morning. My name is stephanie and i live in kansas city, missouri. In august 2008, i left my job as a probation officer to attend law school. I could 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 own shingles immediately after passing the bar. Starting my own Legal Practice meant i still had no healthcare. As the single mother of 4 children, that was devastated. My diabetes went untreated for 5 years. When my health got so bad, i was forced to seek medical care in the emergency room only. As a mother, i felt i had let my children down. I had done everything that seemed right by furthering my education, yet i still couldnt afford a routine doctors visit. Something was terribly wrong with this picture. The Affordable Care act changed all of that. I enrolled in a Health Insurance plan i purchased through the marketplace for less than a hundred dollars a month. I no longer had to decide between paying my mortgage and going to the doctor. I have been able to manage my diabetes and get my medications. Its a huge load off of my mind. Ive been covered through the marketplace and i find the coverage affordable and easy to use. When taking a flight, the attendant always says if youre traveling with small children, in the case of emergency, place your oxygen mask over yourself and then on your child. To every parent, this seems counter intuitive because we consistently put our children first. However if we dont put our health first, we wont be around to take care of our children. It allows me to keep myself healthy to so i can continue to provide for my children. Until march 7th of this year, i was self employed without the option of employerprovided Health Insurance. Upon accepting this new position, im now offered Health Insurance through my employer. Though the benefit option is great, i can say the policy i have through the marketplace is better. I have had the same team of doctors since i enrolled in 2014. Although the need isnt as urgent for me today as it was 8 years ago, i can say the Affordable Care act saved my life. The last 5 years of coverage have kept me the healthiest i have been in the 11 years since i started law school. One of the requirements of my Current Employment was to undergo a health physical. I have no doubt that i would not have been healthy enough in 2014 to accept the position i have now. Maintaining preventive healthcare through routine visits, thanks to my aca coverage, had allowed me to treat my diabetes without fear of being turned away. Access to healthcare should be a fundamental human right to all people. There should be no choices when it comes to healthcare or housing. During this administration, i wonder what would happen if i lost my coverage and what would it mean for my children. In the event i had to return to private practice, would i be able to afford coverage without a subsidy . This is not a partisan issue. This is what happens to families without coverage issue. Its a why are we turning back the hands of time issue. Its why should a single mother of 4 children be forced to choose between housing and healthcare issue. Its if we cant keep parents healthy enough to raise their children issue. So i ask you and urge you all, both sides, dont take away of coverage from 20 Million People. Dont return to the crisis, the Health Crisis that we endured before the aca. Thank you. Thank you very much. Thank you, chairman. Ranking member jordan and members of the committee, i am honored to speak with you today. My name is peter morally. In 1997, i had an injury during a lapse of Insurance Coverage. All treatment and medication costs were paid out of my own pocket. When i later needed surgery, my Insurance Company considered my injury to be a preexisting condition and all my claims were denied. It was a financial burden totaling in tens of thousands of dollars. In 2007, i was permanently disabled from an accident. I was spared the costly medical bills of 4 spinal surgeries because i had Continuous Health coverage. In 2011, i survived Kidney Cancer and fought my way into remission after losing part of my right kidney. In 2013, i was diagnosed with lupus, which causes me severe fatigue and most days its a struggle to get out of bed. I now manage over 10 pre existing conditions, take 38 different medications and receive 12 biologic infusions to slow the progression of my disease. I live on the brink of financial ruin and only live modestly thanks to insurance and the fact that i cant be discriminated against because of a preexisting condition. 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 Administrations 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 Congress Woman 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 dc20 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 first hand 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 dc. 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 pre existing 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. I will now yield to miss 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, rather care givers 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 dc, 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, Congress Woman, 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 friend, the patients and families youve spoken to, if protections for people with pre existing 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 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. 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. Does not work, 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 cusps 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, 6 out of 7 are democratic witnesses. Where are the 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 greens borrow, 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 3500 deductible. Both of those have in fact, he now pays has nearly 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 dollars 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. 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. Let me ask you, what would what can we expect from a government single payor 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 those resources continue to decrease the more burden we place on the individuals who are delivering the care. 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 youre mic. Sorry. 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. 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 point of order. 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. 6 out of 7 is not given a fair hearing. Come on, man. We want a fair hearing. 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 for giving us both sides. Miss norton. Thank you very much, mr. Chairman. It took a lot of 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. They 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. 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. 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 4 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, 82 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 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, that but 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. 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. The 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. I asked they were asked the question how many support extending free healthcare 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. Were going to see our ers continue to be flooded and increase 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. Obama 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 pre existing conditions, which is a priority for me and i think every member of this congress. I yield back. Thank you very much, mr. Chairman. Professional let me start with you. You said something extraordinary, which is that your partner in filingan 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. 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 unravel the entire act; is that 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. 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. Instead, they passed this one provision zeroing out the penalty on the compulsory purchase of a policy. Some people thought it was a great thing, some people thought it was a terrible thing. Now there,s the proposition being pushed by i dont even want to say conservative republicans. 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. 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 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. 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. Thats what the wall street journal said, nobody hates obamacare more than we do, but this is a ropings corruption of the 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 the 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 dropped out of the legislature. Courts are not allowed to do that. Courts are not allowed to presume 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 thank you. Miss miller. Thank you chairman and Ranking Member jordan. Before i begin, i would like to read a testimonial 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. Without objection. It has been over 9 years since the aca has been signed into law. We all know 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 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 cited high deductibles as a reason for going uninsured. We need to solve this problem and a single payor system is certainly not the solution. Mr. Bell on the, 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 . Its been significant and its 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. Outside of the change or within the change . Within our constituents. Inside the exchange or outside the exchange . Are you okay. Whatever listen to me, your healthy is number one. Whatever you need, let us know. Thank you, mr. Chairman. The premiums within the exchange have been they gone up closer 60 to 70 , outside the market much more. It sounds like what the goals for the aca intended to be have not been enacted. How has it insured 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. Opioid and hiv and kidney initiatives. The white house is 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 that may be in transition longer than the amount of time initially prescribed, helping people losing jobs, moving, going through a divorce, allowing time for that time period. And the association put another solution out there that experienced Great Success double digit savings and people able to pool together and buy employer styled business healthy plans. That was another good innovation and hras, healthy arrangements that will allow the individual market to come back because that went away when aca was first implemented. Employers will be able to dedicate defined amounts of funds part of their Compensation Plan for their employee to find what fits them and their family the best. Thank you. Mr. Chairman, ill yield back the rest of my time from the gentleman from texas. You have five seconds. Sorry. Could you expand on your concerns talking about medicare for all and coverage in the extent 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. Weve seen lots of technology and iphones that arent 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. His comments about the federal government, that would come as news to 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 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. But mr. Gluck says to the horror of my colleague on the other side of the aisle, 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, premiums werent going up before the Affordable Care program. Everything was stable and hunky dory and 35 Million People didnt have healthcare coverage. Somebody has to suffer. Professor. The Affordable Care act has given care to a lot of people. It has provided care to the administration and and the american congress. And congress itself. We do everything to sabotage the law and 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 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. Youre in the United States congress. We know the answer to this question. We know what happens to premiums post aca. We surveyed the American Public and the percentage of people reporting they couldnt afford historia 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 well less. Its empirical and well documented. As you pointed out, there are a lot of dynamics in play. The number one reason because of the premiums 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 their majority in the house and congress, were they succeeded back 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 threw dramatic instability into the Insurance Market and attempt to reduce enrollment on the exchange, reduce 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. Youre saying there is an effect, but not the Affordable Care act, its the gutless drive to gut the Affordable Care act they couldnt do legislatively but to the 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. 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. 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 unfortunate the other side wouldnt work with us to make that bill better. Its interesting 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, people talk about the do y deductibles are so high they cant afford them and why there are 30 Million People still insured because the deductibles are so high and talking about how the 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 on friday 4 00 had severe chest pains, 11 00 at night had a quadrupling bypass. What would happen if that was in canada or anywhere else, would that person get that care that fast in a system we have medicare for all, single payer system . In an emergency situation, that would be different. That would certainly be considered an emergent situation. If it were a planned procedure, the wait times would be longer than in this country. It amazes me. We talk about research and medical research has come a long ways with higher expectancies and longer life, what happens if the private sector is being innovative, what do you see happening . I dont know 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. The insurance payments went up because of the risk corridor payments. The risk corridor payments were in place to artificially increase 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 made an executive Order Association plans go back in effect because obama did away with association plans. One of my neighbors was one of the things that helped her get insurance was association plans. Can you tell me what happened to association plans . They were growing at a good clip. 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 what happened with the federal suit in aca versus viazar. 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, government set. Because it functions like an employer plan, has a bigger base and more options. They can choose among different types of solutions and not just traditional insurance. We know healthy savings account help with that. I have a Health Savings plan and gives me Better Options to direct my own healthcare. I have 20 seconds left, the friend from texas. With all this time, what can i do . I guess 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. I for the life of me not understanding why were focused on insurance and the colleagues on the other side of the aisle are more focused more on insurance than care. Can you explain about that versus doctors. Your time has expired. You can continue. I use something called primary care. Insurance has ill say it this way. The reason healthcare has become more ip efficient and more affordable is there is 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, video chat and the like. Thank you very much. Thank you, mr. Chairman. I want to set the government backed single payer 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. 31 have healthcare and nine do not, the United States of america. When the government is involved in providing healthcare insurance it drives prices up. Those 39 countries who have universal healthcare spend about half what we spend. We spend about 18 of our gdp on healthcare. While it 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 of 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 Medicare Trust solvency would be immediately weakened. It would have a negative effect on medicare at large. In addition, the entire pathway, lowcost, high value to treat leukemia, lupus, some of the most devastating injuries in this country would disappear. That was part of the law. It would have a negative effect. This discussion of other forms 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 them to play tricks. We have done a lot of work. The American People are fed up buying insurance andot getting financial protection. What were hearing is a description of Insurance Products that would exclude hospital care or exclude Prescription Drugs all together. It is letting Insurance Companies pay tricks again. 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 everyone would support the view the president supports for preexisting conditions. Let me point out i dont believe that. Actions are greater than words. If the aca were struck down in its entirety 100 million americans would lose preexisting coverage . Thats right. By the way, almost half the people that went before the aca tried to get coverage and couldnt get coverage. Its important. This has been answered. Republican leaders passed legislation the alternative to the Affordable Care act. The cbo told us 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. Professor, it looks like youre chomping on the bit to Say Something as well. Could you Say Something as well . Turn on your microphone. I was nodding in agreement the number was 52 Million People were denied insurance because of preexisting conditions. Thats a statistic you have there readily accessible and 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 prescription you need to treat your disease, does nothing. If you dont have medicare or medicaid for the coverage, the coverage does nothing. The preexisting is important but just the tip of the iceberg. Thank you. I yield back. Thank you, mr. Roy. Thank you, mr. Chairman. A couple 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. There is no such thing as a mandate. The Supreme Court found it not unconstitutional as the commerce power but was 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. It means the tax does not exist. Correct . No tax. Is there a tax today . The tax is zero. Theres a mandate in the legislation and the tax is zero. The Supreme Court said they do not have the mandate to purchase it in commerce. The tax is zero and the tax no longer exists. Therefore, where do we sit today . The very thing that saved it was 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 justice is in the opinion did find it to be inseverble. Is it not true the District Court in this case found it to be inseverble . 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 . Its very important about the previous Supreme Court opinions. Those opinions were based on the courts perception of the 2010 congresss view of that. Whats at issue is the 2017 congresss amendment. To hold otherwise is to undervalue the power of the 20s 17 congress visavis reclaiming my time, four Supreme Court justices said its unseverable. The District Court said its unserveble and shade is into twined saying the mandate is essential to the aca. Scotus described the mandate as a threelegged stool 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. There were Great Questions from the judges on the panel asking the questions and why frankly the carter appointee didnt ask a single question because this is a very legitimate litigation and we will see what unfolds. With respect to my colleague from california, making the comment that quote about single payer, that we have medicare and v. A. Im interested we have bipartisan agreement on the Veterans Affairs committee im proud to serve we need to make changes to make it better, one of those rely on marketplace, mission act and go out in the marketplace to get access to care. A single payer solution isnt meeting the needs of our veterans serving this country with valor. We talk about the wealthiest and greatest country in the history of the world, were the one outstanding that doesnt have single payer healthcare, i would argue the reason we shunned the statism my colleagues on the other sized of the aisle would dare to put on the backs of American People, forced to pay for premiums they cant afford and forced to have those they had before and forced to be put in a system subpar and forced to say there is coverage for 20 Million People when the vast majority is medicaid coverage driving out the very people medicaid was designed to take care in the first place. This is a 32 trillion medicare scheme to blow up a system affordable for the vast majority of the American People. With that, i will yield back the five seconds i have left. Thank you very much. Miss wasserman schultz. I think its important to point out he came out against what the veterans are wanting to continue. That said i want to enter this article from stats magazine into the records. Without objection. Name the much criticized Program Saved the u. S. 2 trillion. Hint, it starts with affordable. One month after the aca passed the office of actuary of department of Health Human Services had a report that said financial acts of the Affordable Care act as amended. The healthcare costs would reach 1 1. 4 trillion a year in 2017 ad constitute 20. 17 of gross economic product. Back to 2018, notably during the Trump Administration, when that same Office Released the tabulation, bottom line, 20102017, aca reduced healthcare spending a totaling of 2 2. 3 trillion. Health expenditures kept healthcare spending 20 over gdp a tad over when it was passed. All of this expanding to 20 more percent of americans and the medicare bill was 10 , 70 less and the childrens Health Insurance program was a whopping 250 billion below expectations partially but only partially due to failure of some states to expand the program. The actuary predicted it would cost 1 1. 2 trillion in 2017 but actually came in at 1. 1. 04 trillion. Put another Way Healthcare spending was less than projected to be. For the 126 million americans who have private insurance sponsored insurance their lower premiums averaged just under a thousand dollars a person. I could go on but we entered the article into the record. Essentially we need to be dealing with the facts and why we have these hearings. Healthcare costs have been lowered and premiums lowered and we add twenty million to the healthcare roles. That said some of you know i am a Breast Cancer survivor, something i live with and live in fear. Miss dye, i understand your concerns and thought process about potentially having a prophylactic mastectomy, no matter how assured i was 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. Taking care of your healthy and making sure 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 before the Affordable Care act is paramount and what this debate is all about. Mr. Chairman, id like to ask unanimous consent for this letter from 17 advocacy organizations plus the American Cancer Society into the record. Without objection. The letter. F before the aca the patients represented by the organizations were asked to forego necessary healthcare unacceptable, the world the Trump Administration would like to take us back to. Is it true before aca more than 20 of americans that applied for coverage were denied and ask about the impact of seniors. Nearly onefifth in my district are seniors and havent talked about the coverage gap known as the donut hole reestablished if we go back to the bad days preaca. What would happen if this administration succeeds in overturning the aca. Sure my time will run out. To your first question on the impact of aca on preexisting conditions, youre staff is right. We had almost half applying denied coverage because of a preexisting condition. Its important to note in this country we get coverage by employ sponsored coverage. When they get sick they dont have anything. Its about every Single Person in this room watching from their homes right now. May i answer . If the chairman is okay with that my remaining time. Congresswoman, youre exactly right the Affordable Care act has been widely unappreciated. 60 million got it without a copay and 5 million benefitted before the Affordable Care act you only had prescription up to 2,000 and then a large gap until the coverage kicked back in, we call the donut hole seniors paid outofpocket and more than 5 million seniors benefitted from that and medicare had a negotiation that lower costs by 26 billion in drug costs over the life of the bill. I would say all of that will be gone if this decision is upheld. Thank you. I yield back. Before we go to mr. Norman, i try to make sure i run a fair hearing. Mr. Roy, im going to recognize for a minute because he wanted to clarify something. I would ask my colleague miss was ser man schultz to refrain your comments i was calling for a change for the v. A. And theyre seeking on a bipartisan choice for products to supplement Veterans Healthcare. I hockey she mischaracterized what i said a little bit and ask her to acknowledge that is not what i said. I appreciate the gentlemans request. If the gentleman is willing to say he is opposed to privatizing healthcare at the v. A. And making sure the v. A. Can continue to provide the Excellent Healthcare Services it provides the overwhelming majority of veterans support continuing, sure. I wont get into back and forth about characterizing. Whoa. Mr. Chairman then ive characterized your position correctly. You mischaracterized my position and you did so blatantly. Reclaiming the time the chairman gave me we have a bipartisan agreement that adding Market Forces is a good thing, bipartisan agreement on that. That is a mischaracterization characterizing what said to fully privatizing the v. A. We should inject Market Forces for veterans. Mr. Chairman, since the gentleman has now addressed me and taken his time back and wants me to correct 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 healthcare at the v. A. If hes not willing to say that, then the direction 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 healthcare coverage at the v. A. By the way, i chair the military subcommittee and im responsible for the budgeting for the entire v. A. And budget colleagues if you dont do that, i will not i wont engage in an inquisition from the gentle lady. Hello. Hello. Why do you say you pennsylvania privatizing the v. A. And you say you opposed mission and choice. 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. He talked about choice. His characterization by the gentle lady from florida is he said he was for privatizing the v. A. He did not say that. The transcript will be clear. We all heard it. Thats all hes saying to clarify that simple fact. And he wont say he opposes it. Right now, were going to get ready to go to mr. Norman. I tried to work things out. Sounds like i couldnt do it. I did the best i could with what i had. Mr. Norman. Thank you, mr. Chairman. I sincerely want to thank the panelists that had preexisting conditions. And the 6 of the 7, the intent was to trash this president and advocate medicare for all. Miss dye, i take issue with what you said about all republicans being against any type changes in the healthcare. I take issue, mr. Gibbs you singled out mr. Jordan state is not covering your particular problem, but 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. The fact that where we have a difference, different world view, all of you raised your hand, i think, for health comp for every illegal in this country, every one of you, except mr. Blott. Everybody else. Mr. I didnt raise my hand for anything because i was uncomfortable with the whole the majority of you take mr. Blott out of it, raised your hand for healthcare for everybody. Im sorry we have we dont know how many illegals are here just as the 6 of the 7 are predisposed to an opinion. I could fill this room with everybody behind you with that single mom who takes issue with obamacare. They cant afford the premium jump from 400 to in many cases, 6,000. I could bring the gentleman in who happens to be 75 years old who doesnt want a mandated maternity healthcare having to pay for in his policy. I wish we could have had a more balanced panelists because 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 it if each of you had a single provider for lets say drugstores, one drugstore to shop from, im sorry, the prices you couldnt afford as we cant afford healthcare now. Im in the private sector, im a businessman. I will say it has not worked for the majority of businesses. Look at the physicians that are leaving, if theyre make doing much money, look at them leaving, we will not get the specialists each one of you have had if it keeps going as its going. I leave my balance of my time. Excuse me, mr. Chairman, can i acknowledge mr. Norman . He brought up my name in his questioning or stance. I will reclaim my time. I will 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 i did not raise my hand and i have never mentioned 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 most of this has been about medicare for all. I didnt raise my hand in support for medicare for all. Im not talking about medicare for all. Why do we keep come back to medicare for all . This is supposed to be a hearing for Affordable Care act. Id like to yield my full time but i think it was over, right at two minutes to congressman roy. Thank you, mr. Chairman. Let me ask you a question. Was it not true in 2013, the lie of the year, if you like your Healthcare Plan, you can keep your Healthcare Plan . Yes. Thats correct. Millions were kicked off their plans because the obama plan requires essential benefits. While 20 million gained coverage, 6 Million People lost the coverage they had before obamacare, correct . Thats correct. 600,000 transitioned from medicaid to uninsured. Of those who gained coverage, of the 20 odd million was that about half and half medicaid and through the aca, obamacare . Medicaid expansion. Is it not true that is crowding out people who are the original purpose for medicaid are those most vulnerable. There are studies saying in illinois studies said 762 people died while on a waiting list because they were trying to get care because medicaid was getting crowded out by healthier individuals shoved onto the medicaid rolls . I have not seen that particular study. Thank you. As we go to mr. Let me say this. It seems our republican colleagues would like to distract us, mr. Gibbs you asked the efforts of sabotaging aca to medicare for all. But youre right, it is about protecting the law of the land and the threat this administration is posing to healthcare for millions of americans. Thats what this is about. My colleague from maryland, mr. Sarbanes. Thank you, chairman cummings and for inviting these witnesses. I want to thank the witnesses for coming. Professor, welcome. I think a few minutes ago you were saying the 2010 war was being fought rather than the severability and i appreciate you doing that and mr. Roys decision voluntarily to go back and fight the last war is his to make. Whats not fair is to force some of the witnesses, who represent millions of patients across the country is to go back and fight the last war. Thats what the Trump Administration, republicans in congress are doing. I remember, chairman cummings, when you and others were part of and helped to lead hearings in 2010, where we heard all of these stories but we were hearing them from the perspective of people to get coverage they did not have. We made a promise we would do everything we could to try to deliver that coverage to them. We did that with the Affordable Care act. Now, theyre back again telling the same stories from the standpoint of being terrified they could lose the coverage that has been made available to them under the Affordable Care act. I want to thank you for that testimony extremely powerful. I dont know why my republican colleagues think it is 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. Its clear from what the polls show americans dont want to throw away the aca. We can debate what we do from here but the great majority of americans want to hold onto the coverage theyve been given. By the way, no evidence whatsoever that theres any kind of cogent coherent meaningful replacement plan for the aca, not with standing 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 protection and Healthcare Programs that would ask sphere if t ask disappear if the aca was struck down, does this include preexisting conditions . Yes, it does. What about charging older adults more than younger enrollees. Would that go away . Yes. What about premium tax across that make coverage more affordable for middle income families . That would also be gone. What about the Medicaid Expansion . Gone. What about Public Healthcare Fund . Funding for essential public Healthcare Programs that support safe drinking water, childrens immunizations and smoking cessations. All those would be eliminated. To a point i was talking about earlier has the Trump Administration or republicans put forward any meaningful replacement plan for the aca to provide the same coverage gains we just went through . No. Nothing has come even close. Why are preexisting condition protections on their own, without the acas other provisions not a sufficient replacement plan . Republicans, i give them some credit. They figured out nobody in america wants to lose the coverage now available for preexisting conditions. So they keep invoking that, saying well hold onto that even as were jettiesing automated the others. Can you explain why its affordable protection . Youre absolutely right. Not just get insurance. You have to afford the insurance and it has to cover those things for which you are sick. Having the ability to get insurance doesnt stop insurers from charging you more if you are sick from creating benefits that dont include your say, hiv drugs and give you Financial Assistance to make that affordable like subsidies or Medicaid Expansion. Thank you. I want to close by thanking our witnesses and our chairman for bringing those witnesses forward today and i yield back my time. Thank you. Id like to get a handle on current problems were having. Could you describe what is happening for people fending for insurance on their own, both the size of insurance and size of deductibles over the last five or six years . I can share with you that premiums have absolutely talking about in the private market, premiums have gone up for employerbased plans when theyre available. Dramatically . Considerably. Where they used to be 300, on the order of 1500 for a family, 2,000 a month. Devastating. How about deductibles . Deductibles, when hsa came into being they were coupled with High Deductible Health plans. They were 3500 because that was considered a High Deductible Healthy plan. Today on average of 6, 7,000 but i heard one recently of 14,000. Devastating for people not eligible for medicaid, correct . Without question. With the majority of people in this country that dont have a thousand dollars in their savings accounts, its an unreachable number. Unbelievable what people up there have to put up with. Ive heard stories of healthcare problems i wouldnt have believed 10 years ago are possibly. It amazes me and i wasnt around when the Affordable Care act was passed or unAffordable Care act, whatever they call it. It amazes me when people get elected to congress and theyre so smart and think they can take over a big segment of the economy and make it better. Lets look why those costs have gone up so dramatically. First of all, how Many Americans are on the Affordable Care act despite the hoopla over it . Just over 8 million. I think its 11 million . On the exchange . Between 8 and 9 million. Youre talking under 3 of americans are on it for all of the hoopla. What is the big increase in government since obamacare kicked in . Medicaid expansion. Medicaid expansion. Youre down in texas. How much is the reimbursement . How much does the government pay people to provide medicaid compared to medicare and what the private sectors charged. Medicaid is typically your lowest reimbursement whether a physician or facility. Its just below medicare rates typically. Medicare is about 60 of private reimbursement is. Youre maybe saying half about . 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 costs for people not on medicaid, is that true . Yes. Absolutely. Is the reason therefore the cost to people who arent eligible for aca, the reason theyre published and put in an impossible position, is because the change in the way the huge number of people now who are expected to get their healthcare through medicaid type plans, who before may have gotten healthcare 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 healthcare through medicaid, people who in the past would have got healthcare either through their employer or purchasing on their own, is that accurate . It is. In other words, this dramatic rocket up in costs people who arent eligible for medicaid for didnt just happen, it was by design almost or maybe people were so stupid, i cant believe people were so stupid they wouldnt realize thats whats going to happen, thats what happened, right . I will give you one more question. Were almost out of time. We now hear people talking about picking up healthcare for all the Illegal Immigrants flowing through the country. Id like you to describe who really is picking up the tab for that one . The american taxpayer. The taxpayer or anybody paying for insurance on their own . Whoever is paying into the system currently and the taxpayer are the ones paying for everybody thats benefitting. A word was used earlier, talking about being forced into a situation they dont want to be in, that was being patient should the aca be repealed, but were being forced as citizens to participate in programs that we dont want. Thats an act of force currently with the aca in place. Gentlemans time has expired. Mr. Welch. Thank you. I want to thank the witnesses. Welcome to congress. The debate continues. The heart of this is about patients who need healthcare 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 acas preexisting 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 declined, that he would have absolutely no guarantee of any rights to healthcare. 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, and i do believe the access to healthcare 100 is a fundamental right, something we cannot exist without. I mentioned life, liberty and pursuit of happiness. Without healthcare, you dont have that access to life. Right. Its not a choice that you made to have this condition for your son . No, it is absolutely not a choice. Luck of the draw. Yes. Miss burton, how about you . What would it mean if to your family if the aca preexisting protections are no longer law . It would mean i wouldnt be able to afford coverage. I have an extensive hobby of having four children and i simply could not afford to pay 895 a month for Health Insurance. Before i would do that, i would go without like i said previously. I have limited resources and i use those resources to raise the four kids i brought into this world so they dont have to be a burden on the American People and society. Ive done everything i can to be responsible. Thank you. Miss dye, how about you . Thank you for the question. Jessie is 10. For her speech, her expressive and receptive, she is two to three years behind her peers. It will never go away. She will have this in adulthood. Her speech therapy, she 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 they kind of left, the republican colleagues, they want to talk about employer insurance, a lot of employer insurance does not cover speechality all. The ones that do only have 10 session as year. How will that 10 session as year help . I dont think any of us that are fortunate enough we dont have a preexisting condition, at some point a lot of us will, if you have children and worried about how they will be affected, its existential. Just emotionally, 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 it was my fault. What did i do not taking care of myself during my pregnancy. I also felt like my country, congress, was saying my daughter doesnt matter, her life doesnt matter, her future. Thats hard for me to take, especially when they kept saying we are the greatest country in the world yet the greatest country in the world is telling my 10yearold daughter she doesnt matter. Its heart breaking for me. Well, go ahead. Ive got just a little time here. For me, i when my son was born, the aca was in place. Part of me felt like it was my fault because i had a kidney condition and i felt guilty that he may have inherited from me. 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 healthcare. An irresponsible choice is being made but not by me. Thank you. I want to thank all the witnesses. Mr. Chairman, what we did here is there are life circumstances that none of us can control. If you cant get a fair shot thats about justice not personal responsibility. Theres a lot of choice we do make, thats on us. Circumstances you cant control, you cant get healthcare because the law wont allow it, thats on us. And people get sick and people die. Mr. Green. Mr. Chairman, Ranking Member, i think most everyone knows im an er physician, cancer survivor, the father of a cancer survivor and founder and ceo of a Healthcare Company that when i left employed over 1,000 medical providers and saw 1. 5 million patients or so a year. I love caring for people and being a doctor so much so i started free healthcare clinics in clarksville, tennessee and memphis, tennessee. My opposition to the aca is going to crash the country system todays witnesses have praised. First, i want to tell everyone about a shift i had in the er. My first patient was gang member shot in the abdomen and yelling at us all and were trying to save his life. I walked out, at least with government payer id get paid for the risks of taking care of this patient. Near the end of my shift i had a woman a few days prior gotten her dose of chemo and afebrile as it had lowered her immunitity to a point the infections threatened her life. With her was two children and a husband. The woman was only 35 years old. She didnt have insurance. As i stabilized her i realized Early Detection saved her life. In europe socialized medicine delayed Early Detection where care is rationed and why detection rates are far better in the United States as they are in canada. That woman would not have received Early Detection there and chances for care was significantly left in a socialized system. I meat ceo of a Major Corporation in conditianada, ha laceration. He hopped on his personal jet and flew to my er because he could be seen faster on a jet than waiting in canada. True story. In canada, you can get a free mri for your dog that day because of veterinary care. You cant get one there. You have to wait six months. Socialized medicine is not socialized medicine. What it does, is it takes money from taxpayers at increased rates for Small Businesses. Yes, it has raised rates. I was on the Insurance Committee a Tennessee State senate. We had to improve those insurance increases. Hundreds of percent. It takes those cost shifted dollars and use that 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 from their employer or out of your pocket. But unfortunately, that is not going to last. You have given great testimony about how it works. It is not going to last. You see, either by intention or accident, the aca creates pressures on the Healthcare System that are crashing the very system that the Witnesses Today were praising. You like your aca insurance base care and i appreciate you sharing it today. But aca is driving the cost shift thing to a point that Small Businesses cant afford it and morepeople are shifted to government systems. As this dynamic pushes people onto the government care, medicare, medicaid, all of that, we moved to more and more socialized medicine. At some point, the shifts cause the system to crash. That means the insurancebased system that the aca is providing you and you have given great testimony on today, is going to go away. It cant last. But maybe thats exactly what the leaders of the Democrat Party want. Medicare for all will be abysmal. It will be akin to the va. A veteran. I know. Ask your veterans. 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. It doesnt get up. The aca is driving us toward that system. I repeat, either intentionally, or accidentally. The government is not the answer. Government healthcare is rationed care. Late detection and worse mortality. We need solutions to help you. And my plan, i have written and it is a bill this year, to create a healthcare swipe card. Unlike what mr. Saar baines said emma would fix the problem and allow us to provide help even more people. And i encourage, particularly my freshmen democrats to look at my plan. I think the people that i have talked to love it. Even democrats. But, the healthcare you are 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 player. You. Seems like you are shaking your head. Thought you were going to shake it off. No men i respond to something . I think, again, it is important that we actually have information and facts in this conversation. What we know in this country, theres a few things. 1, if you look at the information, comparatively, compared to other country, our babies are dying a fast race. Monza dying. We have more preventable medical injuries occurring than other countries. Thats the truth. Thats what the data shows. 2, right now this country, the reason that healthcare is so expensive, and the studies are super clear on this, is not because we have brought everyone in and given them access to Health Insurance. It is because the Health Insurance sector is increasing prices at rates. We know this. The American People know this. They see it happen to Prescription Drugs. They see what happens when they get. That is why the system currently is unsustainable. The notion that ensuring, that everybody has a shot at getting healthcare when they need it is breaking the bank, is preposterous. Mr. Chairman, if i could he brings up a point that kind of contradicts of the. If i could just come i will take 30 seconds. 30 seconds. Yes, sir. You have to make sure you compare apples to apples. When we compare lifespans and things like that in our country versus others, we may eat less fried chicken. In europe. Okay . They smoke less than us. It is not just the Healthcare System. It is the Healthcare System plus lifestyle and all that. So go out some of the stuff that was just mentioned about cost of drugs and other stuff. I get it. But you can compare apples and oranges. You have to compare apples to apples. You got respond to that point . No. No. No. No. Im not trying to be rude. Just trying to move the hearing along a bit. Thank you mr. Chair. 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 i have been here, no democrat thought that was the perfect will. But i have known since i had been here, we have never been given a chance to work on the bill. Especially when president obama was the president. All we had a chance to do is, you know, repeal, repeal, repeal, repeal. I know that, he put a lot of things in the bill. He wanted more 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, he spent, i think over 63 times trying to repeal it. And also, im glad you mentioned about Maternal Mortality and infant mortality. It was safer to have a baby 25 years ago. And its not just from people eating fried chicken. That is not the reason. I know you are going there. But, so, i just want to add that for the record. I wanted to ask you, mr. How do the uninsured rates in states that have expanded their medicare programs compared to those that have not . An important point to make. What we do know, we actually know, is earlier, the witness cited that said access to Health Insurance had no impact on mortality. That study actually says, in the published study, it says our results should not be interpreted as evidence that Health Insurance has no effect on mortality. What we do know, from the iom, and it was published in the journals of medicine, that when people have access to Health Insurance, what people have access to medicaid, they live longer lives in their healthier. That is true. I will also say that we have heard a lot about this question of hospitals closing in districts. And people losing access. Before working at director, i ran healthcare for the national association. Work with governors, republican democrat across this country. The number 1 way to make sure the hospital doesnt close is to expand medicaid. And the congressman was speaking about, is hospital closing is an in a state that did not expand medicaid. And how has Public Health improve in states that have expanded medicaid . What we know is that not only are people healthier. Not only are people able to get the care they need, but we also see Larger Movement from people from public insurance into him as they get jobs. Its all connected. Its all interlinked. I want to thank the witnesses for sharing your personal stories. I know its not easy to do. And i really appreciate it. Also, i am married to a doctor. He is an anesthesiologist. And, he supports the aca. I think its important, as i said in my opening statement. This is, it is supported by the american medical association. Is supported by the medical and hospital association. The heart association, the cancer society. So, we have one doctor who says. But all the associations that represent providers are saying, this is really important for the American People and for us. Also, i mean, they are right in the fact that, yes, you can find someone that believes this and some of that believes that. And his personal experiences. But we have to work holistically and overall. That what is the greatest benefit . Professor don, what happened to Medicaid Expansion of the Trump Administrations position prevails in court . It would end. And all those people who got insurance would be thrown off the rolls. And on the chair of the collection when you look at African American men, the rate of Prostate Cancer has gone down significantly. Since many more had va ca. And also, Breast Cancer in women and black women, has also gone down, because of access and care, because of the aca. I recently learned disparities in cancer care across races and geographic regions. And it has been found that their portable air care act has been done more to reduce disparities in cancer than anything else in recent memory. Part of that is because of the covered early screening and check us. Incredibly important for Health Justice in our society. With the young lady yield . Yes. Thank you. A little earlier, mr. Ice from georgia mentioned that some of his rural hospitals were closing. That i dont think georgia is one of the states that accepted the medicaid under aca. Because it doesnt, if they did, i think it was different. Thing. Can you comment on that . And comment on compensating how has it been affected by the aca . What we know, if you look at hospital closures in Rural America across his country, almost all of them, and im in almost all of them, i think its north of 80 , are occurring in nonexpansion states. States that choose not to expand medicaid, they have that ability. They dont do it the rural hospitals in the closing. So, it is the number and i was part of a lot of negotiations with governors, trying to expand medicaid. This was the number 1 issue. It is the reason why hospitals they know, when you have a group of people, and small communities that do not have Health Insurance, they cannot keep the doors open. Health insurance provides access. And it allows for the economics of that community to survive in the hospital to survive. Mr. Higgins . Thank you mr. Chairman. I think all our guests here today for your courage and being here. The stores, your stories are touching. In the telestory, too. My wife has ms. 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, through my years as a police officer. Including reconstructed eye socket. As a cop, cops earn in louisiana, 12, 13, 15, 16 per hour. As a captain, when i resign, my commission to run for office, i was earning 20 per hour. My wife was receptionist. She earned 12 per hour. Health insurance for many years before the aca was always the same. 300 400 500 per month. The aca came along, insurance premiums one up to unaffordable. 800, 900, 1000 per month. The doctor bills were always 500, 600, 1000. For the doctor bill. Went up to two, three, four, 5000. Having a healthcare card from the aca does not mean having healthcare. One of my colleagues mention that we want to destroy the aca. We were told, you can keep your plan. You can keep your doctor. Your premiums will go down by 2500. You will have more access to care. Those are preexisting conditions will be protected. At the aca had manifested well and americans had not suffered incredible increases in premiums, and the doctor bills, we wouldnt be having this conversation. President obamas crown jewel would be safe. But, the fact is, we much represent the interests of the american citizens that we serve. In business before the aca, it was common for three, four, five, six Insurance Companies to compete for a 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. For the coverage providing their employees. My coverage expense after the aca went up every year. It was quickly over 1000 per month. Couldnt afford it, man. Do the math. Youre a cop burning 15, 16 per hour. The wife of a cop earning 12. Very quickly. You had to make a decision. Buy groceries . Or Health Insurance. What do you think we did . We bought groceries. That was never an issue before the aca. The aca expense was not a distraction. As my colleagues said. Was a disaster. Having an aca policy card is not having healthcare. And unaffordable policy, for regular working americans at 1000 per month, just had the privilege of paying cash for your healthcare all your. Because you have a five, six, seven, 14,000 deductible that you never hit. Thats not healthcare that we need to provide to our nation. That is not real. My wife and i had to buy nine aca policy. That was reality, man. We had to buy a nine aca policy and we were subject to punitive fines from our own government whom we served. And im a veteran as well. Because the fines were down the line. Seizure of a property from the irs, of all places. Because we had the audacity to buy a nonice aca policy. That seizure of our property was down the line with groceries are not. I am not opposed to the aca because it was president obamas crown goal crown jewel. Im opposed to the aca because it has been an abysmal failure. And a massive seizure of american property. And american freedoms. Mr. Bola, you mentioned, i thank you all for being here. You mentioned reasonable postures. And you, my felder children of god, my fellow americans, have shared meaningful tory stories that touch our hearts. Help us fix this thing, man. Thats what we seek. Mr. Chairman, il. Just a brief statement. Which is, you know, first of all, this is our organization. We want all americans to have high Quality Insurance. Were with you 1000 18 increase in premiums. 18 and when youre. Thats what year that was. That was 1987. A, c, 11 increase in Health Insurance. That was 2002. Okay . What we know for sure is that after the aca was enacted, the increase in premiums for employersponsored coverage was most americans get coverage was slower. It was 2 . It was 1 . These are the actuaries on facts and figures. Thats what were looking at right 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 with you. We have to solve this problem. But to blame the Affordable Care act because in 1987, 30 years before it was even conceived, there was an 18 increase. Seems this. Thank you mr. Chairman for committing todays here meant and for shining a light on what a critical lifeline the aca has been. For millions of families. I want to especially thank all of you for bringing the expertise of your experiences here. And i know, just your advocacy alone will save lives. Ultimately, the aca will save the lifetime. 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, instead of the gap. I believe that this thing will be true again. Thank you for your courage and for being here today. And certainly, in my district, the massachusetts my Congressional District, almost half of the residents are living with one or more pre existing conditions. I am grateful for the leadership of the Massachusetts Attorney general, mara healy. And a dear friend, who has been leading this fight on the front line, helping to protect the aca. And affirming that healthcare is a fundamental right for all of us. Mr. Morley, i am paraphrasing. But, it was very pointed and resident when you said that, instead of fighting to stave off bankruptcy, because of the aca, you got to focus on staying well. And staying alive. The fact that, in this, we find ourselves at a time when people have to ask the questions, such as do i feed my family or pay my rent . Or do i go start a Gofundme Campaign . Or do i risk forgoing to lifesaving insulin my child needs to stay alive . I want to focus my line of questions on the persistent inequities and disparities, a rollback to the aca would cause for the 67 million women and girls who live with a pre existing condition. Saved countless lives in undermining and attacking it puts the health and wellbeing of our nations families at risk. Professor glock, could you explain for the committee, what Health Insurance coverage was like for women before the aca . Women have benefited enormously. Thank you for the question from the acas protections. According to kaiser, the uninsured rate on women dropped from 19 to 11. Under the law. Before the aca, only 12 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 aca under that discrimination and pricing based on gender. It also significantly helped womens health, because it now covers, without a copay, significant Preventative Services that are very important to women. And i mean much more than contraception. Me Breast Cancer screening. Colon cancer screening. Hiv. The hpv vaccine. Much much more than that. The Medicaid Expansion is also worth noting, helps women have healthier pregnancies and keeps women healthier before they are pregnant, which in turns results in healthier pregnancies. Thats i. So, women were paying outofpocket. Yes. Okay. All right. So, is there anything else you would like to elaborate on professor, as far as how the aca put a stop to those kinds of discriminatory practices . With this case pending in texas right now, all of those protections would be gone. That we would once again have not have basic coverages that most people take for granted like Maternity Care, for huge part of the population. Ms. Bergen, as a woman with a chronic guilt illness, you spoke of the stress of having to deal with being uninsured for so long before the aca, women could be denied coverage for things like pregnancy, Breast Cancer, or treatment for sexual or domestic violence. Also admits to represented kelly alluded to, national Maternal Mortality crisis. Women are no safer giving birth today than they were 30 years ago. How important was it to you and your family that you were able to have courage for Maternity Care during that time . It was definitely very important for me. I have had four csections. I did not have natural birth with any of my children. My pregnancies were all very high risk. My youngest child, i gave birth to first semester of my second year of law school. And, 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 that i needed. Case in point, in 2014, i 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 the time. Thank you mr. Bergman. Just really quickly, one in four residents of my just to fit from the acas requirement that allows him to remain on the parents plan until the age of 26. Would anyone like to elaborate on why this is important . The gentle ladies time has expired. But you may answer the question. It is important for me because i, as mother for children, my older two children are 19 and 18. They work jobs, but the jobs dont provide healthcare. So, through the healthcare i have, i have, my kids are still covered. It is important that, when we have, we have kids and we expect them to continue their education, go to college, but we dont have a means for them to be insured during that time. While we want to have these safety nets in place for them, we put impossible choices in their way. So, by allowing that coverage until they are 26 years of age, it 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. Chair. So, 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. And we passed Medicaid Expansion at a state level. We have done all of those things. But, considering that we are a lot of Small Businesses, a lot of small family farms. What we have done, is shipped to the burden of the economic food chain. If you are small family from her, youre not employed so you can get insurance through your employment. You dont qualify for medicaid and you dont qualify for Medicaid Expansion. So, one of the Major Concerns with obama care, regardless of the outcome of any litigation, is the lack of Insurance Products to Small Business owners, sole proprietors, farmers, and people who have largely been priced out of the market. I guess my first question would be, mr. Bullock, can you elaborate on it proposals that actually could increase coverage in Rural America . I had suggested earlier, what is happening with Rural America, many of the farm co ops that exist have been taking advantage of the Association Health plans. And i understand earlier, the witness to my right was saying that that was an opportunity for Insurance Companies to play tricks. People are walking into these things with eyes wide open and they are shopping responsibly. And, addressing the big needs for themselves and for the groups that they represent. That has been a good solution. Again, for those that are in transition. They are using the shortterm plans. But more importantly, most importantly, is, we are looking at a dressing hsas and personal accounts that people can start to use their own money, rather than having it, having the government pay directly into the Insurance Companys coffers, allow us to purchase our own insurance for ourselves. And that would be a big boon to the rural community. And also, i would also add, the use of telemedicine and the technical advances that we have had that is really been a big help for very remote, rural areas. I think part of that is, outside of insurance or anything, its how we deliver medical care. People, i mean, people drive 100 miles now. As a state, we have done a great job over 50 years putting out picket fences for licensing of those type of issues. 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 actually be brought into Rural American. Those are independent of obama care or any of those things. So, i appreciate that, and i would just also say, we did not have a lot of choice before. We had a state of 750,000 people. The markets adjust for that. But over 10 years, we have seen insurers flee our markets. Now, to say that we have stabilized after 10 years, like that some kind of accomplishment, is really not the point. Because it was unsustainable to go any farther than actually stabilize at some point in time. I think its also important to say that i have been part of the Healthcare Industry for 20 years. While what we are talking about is not going back to pac. Its not a binary choice. Is not a ca today or preaca. Those those another two choices. What we can do is create an environment thats better. That will help address the real problems that people have. For themselves and for the children. Give people choice. I want to add one more thing. One other issue that nobody has brought up about the Affordable Care act. Is that the Kaiser Family foundation has said that 20 of all in Network Claims in the aca are denied by the Insurance Companies. Thats not protecting people. I appreciate that. And hope whatever we do moving forward give states like north dakota and our governor and our insurance commissioner, more ability to make decisions and the federal government was. With that i yield to my friend from texas. Mr. Moore. Thank the gentleman for yielding. Mr. Bullock. In 2009, cbo j ct report said by 2016, the new law would cause premiums to increase an individual market by 1013 . Does that sound right . I believe so. Dont recall. The obama care regulations in fact turned out to cause premiums more than double from 2013 to 2017. In fact, the first four years of the aca, every age group and household type experience an increase of between 56 and 63 . Does that meet with your understanding of what occurred . In the exchange. Yes. In 2013 2017, premiums increased an average of 16 . Now, go back. And four years before the aca, every age group and family type, either experienced premium increase, decrease, or an increase of 9. 2 or less. The dollar amount of the increase varied from, you know, 2500 to a different dollar amount. But my point is, if you look at this chart back here, the redlines are post obama care. The blue lines are immediately proceeding obama care. And heres the deal. We dont have witnesses here testifying for all the people who lost their insurance because of obama care. We dont have families are testifying who were paying the premiums reflected in those red bars. That is the reality. That is what we are dealing with out throughout the country. We have 330 million americans. Were talking about 20 million. 10 or 11 million of whom are covered by the medicaid extension. 10 or 11 million of those are covered to the aca. And im glad that everybody who has a coverage does. Im just trying to figure how we can make sure all of america is not getting stuck with insurance, or the inability to get the healthcare of their choosing because we created the system is too expensive. Thank you. Gentlemen, your time is expired. But you may answer that question. In spite of what happens with the aca, my role is to help with research and educating lawmakers defined as many choices and find as many options and find as Many Solutions that work well, regardless of the geography here in the United States. In texas alone, my home state, south texas is so different from north texas and weston each in central. Is culturally, geographically, very diverse. And going back to my hospital days, my primary service area was 13 miles. That was my community. It is absurd to think that we can manage the healthcare Insurance Coverage of the health care for people states away. It must be done at the state and local level. Thank you very much. Missed to leave. Thank you mr. Chairman. Thank you all so much for being here. Ms. Burton, i was very touched by your statement. I wasnt 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. That it is about what happens to families without health care coverage. What should a single mother of four children be forced, why should a single mother be forced to choose between housing and healthcare . And, is that we are better as a nation if we keep our people healthy issue. I really 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 a report from georgetown university, center for children and family states, that have expanded medicaid under aca have seen sharp declines in the rates of uninsured populations. For example, the percentage of those without insurance, in michigan, decrease from 12. 9 in 2013 to 6. 1 in 2017. Mr. A saucy. Why has medicaid x pension been so effective . Thank you so much for that question. One of the things that before the aca was passed, it was a misperception in the American Public and a lot of lawmakers that if you were poor, if you were poor enough, you got medicaid. And that was not the case. Medicaid expansion did was it said, that there is a group of people for whom nothing exists. And i will give you an example. In the morning i walk my dog in circle. There is a gentleman that has a severe mental and illness. He was a. Hes homeless. Before Medicaid Expansion there was nothing different. There was nothing. This whole group of americans who had access to nothing. No insurance whatsoever. Medicaid expansion said, if you are poor enough, if youre struggling enough in your life, going to give you access to Health Insurance. And that is why it has been such a successful and important part of the Affordable Care act. The acas Medicaid Expansion is one of the many reforms that would disappear if the jump administration prevails in court. Is that correct . Yes, it is. Our communities stand to lose if the Trump Administration wins. Including 87,000 people alone in my district. And the 13 Congressional Districts. It is not just medicaid coverage that will be loss. Currently, 79 million americans live in what we call primary Care Health Professional Shortage areas. Meaning, there is less than one physician for every 3500 people. Michigan has the third highest number of shortage areas for primary care in the Metro Detroit area has over 20. This equals the individuals already have to travel further to receive healthcare coverage. Many communities where hospitals have closed in recent years, they have to travel even further to receive emergency medical services. Mr. Sic under the aca, patients do not have to pay copay if they go to an outofnetwork emergency room, correct . And, would that change go if the Trump Administration prevails in court . Under the aca, the protections for outofnetwork billing are not but they are there. At the trumpet ministration succeeds in striking down the aca, millions of american risk losing healthcare coverage. But this will not mean that these americans will not steed stop needing emergency medical care. Instead, havel be forced to provide more uncompensated care. Is that correct . What is likely to happen . Particularly the hospitals and shortage areas like detroit, if the number of individuals required uncompensated care increases . Will this help or hurt their stability or ability to keep the doors open . There is no question whatsoever, in every state in the country, every hospital say, without that coverage, we could risk closing our doors. And the aca has also helped address provider shortages through something called the Community Health center fund. Professor or mr. I saucy, can you explain what that fund does . Could you ask the question again lease . So, the fund is called Community Health care center fund. Anybody on the panel familiar with that . If you explain that. It was, so gaia was a significant increase in the funding. The qualified healthcare. Community Health Centers that operate in Rural America, inner cities. The most important sources of primary care in this country. Before my dad worked for motorcoach, we find that access to healthcare thanks to his union. I went to one of those clinics. Clinic in southwest to try. I remember just going in do all those things. Air is required for us to be able to even get access to schools, right . To do the medical exams. I mean, think about those kinds of things. I really believe, the Trump Administrations refusal to defend the aca threatens to widen existing healthcare gaps, and make it even harder for americans to access care if they needed. On a road medicare for all, crossing my fingers. We must continue to work to close our healthcare gaps and expand vital care for all americans, not dismantle it. Represent the third, fourth Congressional District in the country. And i can tell you, at the front line, when i speak to so many of my residents, healthcare is always at the forefront of them choosing, like miss burton talked about, between, you know, taking care of the children, groceries, and those everyday issues to healthcare. So, i think you again for your panel. Thank you mr. Chairman. Thank you. Mr. Jordan. Thank you mr. Jordan. Mr. Sozzi, saucy . Is aussie. Its a lot like the former chairman stay. So i think ive kind of no less than four times he said it is wrong to say that obama care is the cause of increased premiums. You said that several times. But, with all due respect mr. Is aussie, i dont think that was the promise. The promise was, obama care was going to lower premiums. We didnt say when democrats voted for this. President obama wrote a rolled it out, he didnt say, pass the Affordable Care act, pass obama care, and your premiums will go. But dont worry, it wont be the cause. I would dispute, even if we take your assessment is accurate it is not the cause. I think mr. Roy just offered some numbers that show that it may in fact have been. Mr. Bloch, in the past decade, what is the single biggest change to healthcare policy in this country . The healthcare policy. At. That would be the aca. Obama care, right . So lets go back to the basics. What obama care was passed again, the single biggest healthcare change in the obama care policy in the last decade, projections were would have 24 Million People enrolled in it today. How many are enrolled in obama care today . In the exchange. Not counting Medicaid Expansion. Just bought care. Between eight and 9 million. Not even a third of what was projected. When obama care passed again, the single biggest healthcare problem to change in the last year, we were told if you like your doctor you can keep the doctor. Is that materialized . Was that statement to mr. Bloch . That was not true. When obama care passed, again, the single biggest change in American Healthcare in the last decade, we were told if you like you plan you can keep you fine. Was that true . No, sir. It was not. And of course, as we started here, what obama care passed, we were told premiums were going to decline. Again, just nice and again for the record. Did that happen mr. Bloch . No, did not. For everyone, premiums in the exchange out of the exchange, single, individual market, employersponsored plan, everybody, costs went up. Is that right . It did. But the cost of the premiums went up. However, with the subsidy, it wasnt felt by those that were part of the exchange. We think we will i do when this bill passed back in 2010 mr. Bloch . Congressman, i dont want to speculate as to what the intent was. You dont have to, because the architect of, mr. Gruber, said this. Jonathan gruber. Mit professor, New York Times of the architect of obama care, going to the white house several times and meeting with all the key players who are putting this policy and the spine to get us at this. If any american really believes that obama care is going to control costs, ive got some real estate in whitewater arkansas i would like to sell them. So, the guy who put it altogether told. It was going to drive up costs. And it certainly has. The coops worked. They were part of obama care . The data shows that they have. The few that are still left have the cops. Coops under obama care. No, i was referring to the others outside of. A second. The ones that in the private sector have it. Thats a lot different than. Only 4 the. 19 banquet. Are there more healthcare choices today . Again. Obama care passed single biggest healthcare policy change in this country in the last decade. The more healthcare choices today than they were in 2010 . There are not. Many of the carriers have left. Our individual market in texas. Provider networks of smaller or larger . Narrow networks . Much smaller. Which is contributing to the surprise billing issue. But what happens when you only got one for insurance provider in the market . What happens to cause then . Premiums go up. You can go outside of healthcare. You got one supplier of the product in any market. Typically, you dont have the kind of price consumers would prefer, do you . No. You typically dont. Last thing im can ask you this. You said in your opening statement, mr. Bloch, that the aca hurts families with pre existing conditions. Thing that stuck out in my mind. I actually wrote it down several hours going we started this hearing. Can you elaborate on that . Well, it really is a function of cost. When people do have insurance, lets talk about insurance. The reason preexisting conditions is even a thing. Is because, insurances coupled with employment. The fact that we dont have more portable, personal insurance plans causes us to jump from place to place. And it creates a preexisting condition issue. Now, in healthcare, we just call and conditions. Preexisting conditions is an insurance term. But, how it has affected families, as as hes premiums has increased, as deductibles have increased, to such high levels, theyre just priced out of the market. And when they have to, if they have had a plan that they have had, in some cases, talk to people, ive had my insurance for 15 years. I just cant afford it anymore. And now that they have to look for some of the product, or go to another solution, they have a preexisting condition. That was not an issue so long as they had their plan that they had for 15 years. Thank you. Thank you very much. This guild. Thank you mr. Chairman and thank you all for being here today. When i speak to people in my district, whether they are Community Health centers and clinics, physicians and nurses, hospital associations, oral patient groups, i hereby a large that we must focus on increasing access to Critical Services like treatment centers, not greasy decreasing those services and incentives. The Affordable Care act massively expanded Mental Health and Substance Use disorder benefits and federal parity protections for 62 million americans. And the arguments we heard yesterday from the Trump Administration posed an imminent threat to the well being of america. I would like to first focus on how the aca is helping to address the Drug Overdose academic, which bind over 70,000 lives in 2017. With opioids, accounting for nearly 48,000 of those deaths. In california, is going a population popularity during two regulatory changes physician training another initiative. The met rate of medical employees have been offering nearly quadruple from the end of 2014 to the Third Quarter of 2018. The counties that make up my district are part of 40 california counties taking part in the drug medical odiase organized delivery system, pilot program. And had joined californias effort to expand coming from, and reorganize treatment of stds in medical under californias medicaid section 1115 waiver. In that vein, mr. Is aussie, what tools does the aca provide to help us fight the opioid academic . So, this really cannot be stated strongly in a. The number 1 tool in this country to combat the Opioid Epidemic is the Medicaid Expansion. Appeared. I work with governments in this country who are trying to stop this terrible plague in this country. Governor bashir from kentucky could speak so eloquent. Kentucky is one of the worst hit states in this country. And it was the Medicaid Expansion that helped him save lives. Provide medication people need. Envious in the therapy they need to deal with their addiction. Anyone else want to add to that . I would add to that. I think before the aca, 45 of usual plans to not cover Substance Use Disorder Treatment. Which with respect to the Opioid Crisis, you need treatment both before and after. So you need insurance access. You need to have coverage to cover you for your pain treatment that is not necessarily a pill. The lessee is a behavioral therapy treatment. And you need that Insurance Coverage on the back. If you are addicted. Is nothing more important to combating the Opioid Crisis then getting more americans covered. Absolutely. This is something that we here. We need additional attention to an Additional Resources for, not the opposite. So, lets focus on medicaid for mom. The has the unmet need for Substance Abuse treatment. According to some estimates as much as 18 . You noted in your written statement the medicaid is the largest payer for Addiction Treatment in this country. And in fact, you both have said that. And according to the Kaiser Family foundation, medicaid provides comprehensive coverage to nearly 4 and 10 non at the aca is overturned, what happened to people who have gained access to treatment to the Medicaid Expansion . They would lose it. And the crisis that we are dealing with now in trying to solve would get even worse. Its sensible. There is no plan i have not been made of aware of a plan. The administrations own plan to combat the prices depends on that Insurance Coverage being in place. There are other aspects of the aca that a facilitated expanded access to treatment. In your written statement you mentioned the importance of providing tax subsidies to help people purchase insurance through the market place. The aca also expended parity for Mental Health substance disorder coverage, meaning insurance plans are now required to cover the services, just as a cover medical and surgical benefits. How would a limited list provisions, and connecting people with Substance Abuse treatment. These people who now have access to Mental Health and Substance Abuse Disorder Treatment and would lose it. Go back to a time in which they were out there by themselves, may be relying on pills and not getting the kind of help the treatment that we need to combat the crisis. You believe that Insurance Companies without the aca would cover these kind of things . These kind of services . Federal law requires Mental Health parity. But we know that mental Health Conditions have not been adequately enforced. , there are different ways to get this kind of treatment. So, you dont want insurers just covering the cheap pill. You want insurers covering the canopy of treatment to get people off pills and get the kind of pain and Mental Health with anthony. Of any deeper Insurance Coverage to a competent. We received a statement for the record from pennsylvania insurance commissioner, just call me, crediting the Affordable Care act existent for preexisting conditions and expanded coverage of Mental Health and Substance Abuse disorders for helping the state fight the Opioid Epidemic. She listed overturning the essay would come medical, effectively undo a decade of progress made towards ensuring those with Mental Health and Substance Use disorders have access to crucial, effective evidencebased treatment services. I would like to enter commissioner allmans statement into the record. We are truly facing the worst public Health Crisis in a generation. And, this administration is doing everything in its power to get Health Insurance coverage away from those who need more. Mr. President ially wants to tackle the Opioid Epidemic, it starts at protecting and spending rather than taking way health care for the millions of americans battling Substance Use disorders. That i you back my time. Thank you. Mr. Club. Thank determined. Thank you witnesses for being here today. I appreciate the time that you are taking to be here and to share your stories. Especially the witnesses who are here with the personal stories. Mr. Bilotta, your fellow texans appreciate you being here from the great state of texas. I wanted to ask you if this sounds familiar . My insurance went from 345 a month to 1200 per month. My premium increased drastically. Premiums increased from 247 per month to 1024 per month. Deductible went from 1500 to 6000. My 225,000, 225 dolomite catastrophic plan was declared illegal and premiums double. My insurance tripled and cost. It cost more and has fewer benefits. Premiums increased, deductibles increase. 1500 more per month. Was forced to go on obama care lost all my doctors. Now, healthcare went from 125 per month provision and full medical to 375. I cannot afford it. My dad had to get obama care and they denied him the meds he needed. Denied him the surgery he needed. And meds became beyond expensive and his premiums and deductibles are ridiculous. He is limited on doctors, too. Have been without insurance for seven years because its cheaper to pay the fee. And have the medical insurance. To the stories sound familiar . I hear the stories all the time. And many from the patients outcome and to my own facilities. One of the reasons the sound familiar is because we ask, how has obama care affected you. And this is the response we have gotten. And, while i appreciate the testimonies of the witnesses who are here, and i do disc, i do not discount them at all, it would have been nice if the community when the lot is more than one witness, so we could have had a more wellrounded understanding of how this is affecting American People. Because, the point is, the a one size fits all approach does not work for the American People. One thing that hasnt happened over the last decade, is everybody keeps talking about healthcare, but we have not had a real discussion about healthcare. Obama care, as it was dubbed, shouldve been more dubbed as obama coverage. All the testimonies we are hearing is not how many people are covered. What i think, the real question should be, how do we get better access to care. The goal for all of us, regardless of what side of the aisle you are on, is care for the American People. Not more coverage. And so, i think it would help us all if we could work our policymaking toward that objective. And, do so in a way that brings into light a well rounded, understanding of how this is truly affecting American People. Can you tell me . There has been some talk about socialized medicine, whether or not obama care is or isnt that. One of the Major Concerns when the aca was being debated, as to whether it would be a first step to socialized medicine. Universal healthcare. Could you explain the similarities, i believe my understanding is over how the Democratic Committee members have in most medicare for all. So, putting these two together, is there a similarity . Is it not . Will, the similarity is governmentsponsored healthcare versus individual choice. That is what the distinction is. In its most purest level. What we want is to have people that have the freedom to use their own money the way that they wish. And have some kind of coverage that protects them in a catastrophic fashion. But, we are not in a place where we have that kind of relationship with her medical professionals anymore. Because, insurance has been, what we have been pushed into. And insurance, youre right. Coverage is not what healthcare is. And i would say, those folks that, you read the stories. The increases in those premiums, many of them, the ones that i have talked to, are still in search day. They had good insurance. They were able to take care of their chronic disease. They were able to buy the medications. They were able to go see the doctor. And today, they are uninsured. And they are having a challenge. Getting to see, getting all kinds of coverage because of a now preexisting condition. Directly because of the aca making things more expensive. You believe Market Forces can work to help provide more access to care . Ive seen it happen, without question. I yield my remaining time to the current sitting Ranking Member. My friend from texas, mr. Thank you my friend from texas. I asked my other friend from texas, mr. Blot, just expanding a little bit on what mr. Club was talking about. I believe that the number is somewhere in the vicinity of 17. My colleagues on this committee have in fact supported medicare for all. Would be happy to correct that number if its not right. But i think thats right. Thats a sizable number. Could you expect to make why, if obama care is working so well, so many of my colleagues are racing to go change it and offer a new approach in the form of medicare for all . Particularly after we were promising promised that ac was not a medical path, press, path. I dont know that i could explain for them. However, it does seem as if they are advocating their support of the aca by going to this plan. It is a show of, that the current plan does not currently meet the needs of the people of this country. Thank you mr. Chair. Im going to start by saying this meeting is not about medicare for all. And as hard as others have tried, were not going to dilute this debate. I want to thank my chair for holding this hearing. The aca has 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 the congressional caucus for women issues in the congressional caucus on foster youth, i believe 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 pre existing condition. I would like to ask unanimous consent to enter into the record, a letter for the march of dimes highlighting how important the aca is to the health of children and women. Without objection. Thank you, mr. Chair. The letter notes that before the aca, women with highrisk 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. Mr. How did the aca pre existing conditions protections and on annual lifetime women, change the outcomes of such individuals . Its one of the most critical protections in the Affordable Care act. Really important, this is not just for people buying coverage in the market place. This is for all of us. Most americans who need coverage get through employers. They see band the employees of the abilities of those employers, the ones your employees are going with from limiting putting lifetime or annual caps. In particular, for moms who have given birth to complex babies. Babies they could exhaust their entire benefit for their lifetime in a matter of just a few months. 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 this discussion. And if you want to say, it is insurance, you cant discuss the insurance if youre not talking about healthcare. And healthcare alike. 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. Outofpocket maximums. We also have a return to a time in which insurers could refuse to ensure you for Maternity Care. Before the aca, only 13 of plans life was good before aca, covered Maternity Care. And women in 11 States Capital cities could not purchase maternity coverage. Until something changes, the only way that we can continue as a human race, is through birth and pregnancy. And it is an insult for us not to provide the care for women who are giving birth. Now, mr. Ice, is that correct . Insurers are now required to cover Preventive Services, including Maternal Health visits , without cost savings . Thats exactly right. This bergman. We talked about being a mom, a four beautiful children. Before aca, you are uninsured for years. Except for when you briefly qualified for medicaid, medicare, during your pregnancy. How important was it for your help as a mother with a pre existing Health Condition . And the health of your daughter, to have insurance during that time . It was critical. I mentioned previously, all my children, for that were born via cesarean. So, if i wouldnt have had the insurance to be able to cover that, i still would not have come from under those bills. I have had very high risk pregnancies, that were very difficult. And it is utterly necessary that i am there to be able to take care of my children. Its not enough to just have them. Ive got to raise them. Exactly. My closing comment is, that when we talked about aca, we are talking about, for me, such a passion i have for children and women and pregnancy, that we not allow this shade is ineffective and it can happen. Because the women protecting them in this country to say that we are leading 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 very much. Missa cassio cortez. Thank you mr. Chair. There has been a lot of talk today about how improving Health American families will lead to outcomes. This idea that we are going to be rationing care. So, i am curious for those of us here to raise your hand if you have been uninsured in your life. Keep your hand raised. And also, raise your hand if you have been insured, but your deductible was exceedingly expensive. So you almost rela rarely went to the doctor got care you needed. Thank you. I have been there, too. I was uninsured less than a year ago. I was uninsured seven months ago. And, so, i want 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 you are going to slip on a curve. If youre going to find something on your body that you want to get checked out. If your knee starts to ache. Everything becomes a spiral of anxiety because you dont know how you are going to afford it. So, when we talk about rationing care, and a for profit Healthcare System with no guard rails, with the wild west we are allowed to profiteer off of insulin, off of peoples lives. How many of you in your time of being uninsured, or having healthcare that was too expensive delay getting a prescription, or delayed going to the doctor . Delayed going to the doctor . So, you rationed your own care. Zach grech misprint . Yes. Absolutely. The cost of a forprofit Insurance Company forced you to ration your own care. Correct . Absolutely. I know exactly was that flight. I ration my own health care for 10 years. I was on a selfimposed waitlist for 10 years. Not going to an ortho the he just when my knee hurt. Not going to seek Mental Health care or counseling when my father died. All of those things. You shared with us when you had the courage to share with us miss burton about your miscarriage. About the fact that you are forced, that you had a miscarriage in the middle of an emergency room. You said you are uninsured in that time, right . Thats correct. You are uninsured, so you miscarried in the emergency room. And you never were able to get the followup care that you needed. You never knew what happened to your baby. Correct . Thats correct. Because insurance was too expensive. Correct . Thats correct. Because ceos needed to offer a profit margin. Correct . Correct. This right here is a complete , complete condemnation of the forprofit healthcare Insurance Industry. Because, while they are talking about how socialized medicine, how of public guaranty to the right to healthcare will force us to ration care, we are rationing our own care. We are not talking about month long waiting lists under the system we have now. We are talking about years long waiting lists. For the system that we have now. I will move on quickly. Key part of the faca, mr. A saucy, is Medicaid Expansion. Correct . This allows people of lower incomes, Medicaid Expansion allows low people of lower incomes to essentially, get covered by medicaid. Correct . The very most Vulnerable People in this country. That is a core part of the Affordable Care act. Yes. There are some states that have not opted in to this expansion. I have looked in some of these states, the states that have chosen to not cover, to not expand care to our lower income americans, americans that are most vulnerable, include alabama. Is that correct mr. A saucy . Florida. Kansas. Thats correct. Mississippi. Missouri . North carolina . South carolina . Oklahoma. South dakota. Tennessee. Texas. Wisconsin. Wyoming. These are the states that have chosen not to cover the most vulnerable americans. Correct . Thats right. And these are the states that are also, we are seeing a lot of the representation trying to combat the aca, when they are not even buying into it to protect their own. Correct . Were talking about two, 2. 5 Million People. Who dont have coverage because they have not expanded medicaid. Why do you think they are doing that . Will 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 the states for political reasons. Thats your assessment . Absolutely. Thank you very much. Thank you. And miss ocasiocortez. People are dying. And getting sick. I will now go to mr. Kosar. Thank you mr. Chairman. Mr. Bloch, youre from texas, right . I am. Are you familiar with Health Centers . I am. Now, let me review. I unders, my understanding is that first come first serve, you are seeing on any basis, and your requirement for payment is a sliding fee scale. Is that true . Is great. , technically, there is coverage. Yes, sir. For these populations. Interesting. So, let me ask you another thing. I have heard a number of things today in regards to the aca. Who are the three groups that actually benefited from the aca . Let me explain. Hospitals. The Insurance Industry. And pharmaceuticals. In fact, if you invested prior to the aca and all of those, you are a very wealthy individual. Because, one of the things we have overlooked, is a lack of competition. The incentivize Insurance Industry to gobble each other up. I you have regional monopolies. Then we had no competition in regards to the hospitals. Then, we had a blowout in the pharmaceutical industry. So, these are the common denominators here. I also know that you had a conversation, we had a conversation about the va. And im from arizona. So, the veterans that were dying in my state, i also represent, have represented over 85 of the geography of arizona. So, a lot of rural areas. And, it is the implementation, the Choice Program that has actually saved us. So, it actually helps those members that are out in the rural areas to pick and choose those providers. So, it makes a big difference. Can you elaborate a little bit more in regards to the veterans administration, as a single payer type apparatus . And why it is insufficient for the veterans . I can. I also serve as the chairman of the veterans charity. We build specially adapted housing for disabled veterans. And, quite a few connections to the veteran community. I dont hear a lot of positive things about the va. They talk about rationing. Talk about long wait lines. There was a time when i seen veterans in their homes that have said, my ptsd is so bad, i cant even come out the front door. It took them five minutes just to come talk to me. But the only reason he came out to talk to me was to say, we need to fix the va. So, they are a wonderful example of what a singlepayer would look like. You have got limited choices. You have got 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, until after something catastrophic happens . Or until you have been living with pain for months and months and sometimes years. Sophia. It is problematic. It is very similar to how the other industrialized companies countries operate. Thats not what i want for the people in this nation. Now, getting back to pursuing , how do we take care people . One of the biggest problems, just for clarity here, i was no fan, by the way, i was a dentist in a previous life. I know little bit about Healthcare Industry. I was no fan of what was prior to obama care. And i am no fan of obama care. I think theres something else. But my point is, some things are going awry here. The problem is, that there is no real gatekeepers. We put them out of business. Is that true . Oh, yes. So, to stay in practice, you basically have to sell your soul to a hospital in order to stay as a general practice. That is the unfortunate case. More than 50 of all of primary care physicians are currently employed by hospital systems. So now, i also heard today in the conversation, that were providing healthcare for all sorts of individuals, here illegally. And at the same time, what we are doing is, we are actually stealing their welleducated people for medicine. For the doctors, or not . A lot of our physicians here are from overseas because nobody in the United States is really going into that discipline. It is becoming less and less. But we are also, 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. You. I want to yield an estimate on to the gentleman from texas. Okay. Let me, toward the end of this hearing. But i have just a few questions i have not asked questions. Let me before i conclude todays hearing, i want to let you entered into the record, six letters the committee has received in recent days. Including some from the lobbyists. The National Partnership for women and families. The National Womens law center on the Veterans Health and advocate. All of these letters express about the grave impact that the Trump Administrations position in texas lawsuit that could have on millions of americans. And the u. S. Healthcare system. Its unanimous so ordered. As i sit here and listen to all of this, i ask myself, mr. A saucy, first of all, healthcare costs are going to go up no matter what. Am i right . Absolutely. And, i have for at least seven years, been fighting with many of my colleagues to bring down the cost of Prescription Drugs. How much does that play in the cost of healthcare going up . The cost that we see in premium increases are mostly because of the prices being paid for the services that people get. So, if Prescription Drugs go up in price, premiums got. Hospital prices go up, premiums go up. That is what drives the vast majority price increases in Health Insurance. No doubt about it. No doubt about it whatsoever. Wow. So, it is very difficult, as you probably know, to get the congress to move in a 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. That was two years ago. And, the price of Prescription Drugs had gone up. Not come down. And so, but you know, the thing that i am sitting here thinking. I have listened to mr. Malott. You will never convince me that the aca is perfect. But, nor can you convince me that it could not be fixed, so it is most effective, so we are covering our people. In this country. Would you agree with that . 100 . We could do it. Absolutely. We can make coverage more affordable. We can increase subsidies for people who are high are they can scale. Or suffering right now because theres not support for them. Theres a lot of things we can do to really strengthen and make the essay a much more effective program. No question. And it does seem to be a strain in some of the questioning that sort of blames the. I dont like that word. But, the person who is going through some difficulty. As if to say, oh, it is your fault. Today theres been discussion about an appearance before congress. Any testimony before this office would not go beyond on a report. It contains our findings and analysis and the reasons for the decisions we made. We chose those words carefully and the work speaks for itself. And the report is my testimony. I would not provide information beyond that which is already public in any appearance before congress. Former special Counsel Robert Mueller is set to appear before two mitties of congress on wednesday july 15th. At 9 00 a. M. Eastern, he gives testimony to the house Judiciary Committee. It will be live on c span 3, online at cspan. Org. If youd like to hear the complete reading of the mueller report, listen. Volume one airs friday and saturday at 7 00 p. M. Eastern and volume 2 will air monday and tuesday, also at 7 00 p. M. Eastern. Now a hear