My colleagues across the aisle speed of the committee will come to order. I now recognize mr. Rokita with the purpose of a motion. Thank you, madam chair. I have a motion at the desk is. The clerk will read the motion spin t motion offeredy mr. Ita, the committee on the budget direct its chairman to express the support of the Committee Prior to the consideration of the rule for the American Health care act for state disability in the design of the Medicaid Program. Mr. Rokita is recognized for gamers with one minute resort to close spirit i think the chairman. Ladies and gentlemen i want to commend the energy and Commerce Committee and the ways and Means Committee for bringing this bill to our attention today. However i want to address a glaring, the glaring absence of something that we as, as republicans come as a conference at work very hard on over the last several months. And that is to give to choice to the states when it comes to how they want to develop and implement and otherwise execute their Medicaid Program. And weve seen all of us really hold up this document, right away we call or come to describe to the American People come and visit before the election dated june 22, 2016, to describe to the American People what we wanted to do with regard to a lot of policy positions, including medicaid. What we decided at the time that federalism insisted that instead of a onesizefitsall Medicaid Program, we would have a choice as states, as governors, state legislators and as individual citizens on what kind of plan we wanted. And we coalesced around to make your choices a two medicaid block grant that gives the federal, largely if not altogether out of the business of medicaid including the energy and Commerce Committee, and per capita caps which puts caps on individuals and how much a state could be allotted for each individual. The linchpin per capita cap is that the federal government still decides for states and individuals who has to be covered. Instead of letting the governors, state legislative and local leaders decide who in their community is truly poor, is truly in need of services in terms of health care. Of the concept. I want to bring this to the committees attention, part of this instruction, have our budget chairman bring this to rules so it can be corrected. In that respect i want to introduce not only the better way plan. Without objection. A letter from the state of maines governor, paul lepage, said he would pick medical medicaid block grants over per capita caps any day of the weekend i am sure there are other governors as well as i would like to welcome into the record our last budget from fiscal year 2012 especially the line where it talks about the house of representatives that a whole adopted medicaid block grants, and treated fairly, at the top of t list in terms of services and helped us save the same amount of money if not more than per capita caps do for us. I would like to yield one moment to the chairman from alabama. One of the single greatest struggles over the last several years, managing the budget, medicaid. The lack of flexibility and lack of ability of the state of the program is what we have seen over the last few years is a growing drain on state budget, and the block grants gives the state ability to innovate, give state ability to make sure the Medicaid Services go to people who need them the most, the elderly and disabled, get us in a position where we can find out what works. With that, mister vice chairman i wholeheartedly support your motion. Gentleman from arkansas. The gentleman from indiana, thank you for yielding. Madam chairman as we work through this process, we had good enhancements to make and this lays the groundwork for the best enhancement and that is to create an option for a true blocgranfor states that would rather have that option. I would like to talk about what a block grant is not, not a program that maintains federal control over certain areas, states flexibility in areas approved by cms. A true block grant is total flexibility on the front end with an auditing function that makes certain funds are going to provide medical services in the state, and a block grant is not a global waiver, and the term waiver defines the block grant. And it asks permission of the federal government to do innovation in their program and true block grants does not have fluctuating rates that change the economy even though you could build in a growth factor for inflation or population. The premise behind a true block grant is a state assumes more responsibility in exchange for total flexibility. We have seen hints of the success of the block grant modal in the 10 of Program President clinton and the Republican Congress put in place. Although not a block grant the state of rhode island received a 5year global waiver in 2009s are tremendous benefits and Health Outcomes, saving 3 billion of the 12 billiondollar program they signed up for. In the state of maine the state had to go to court to get a sliver of flexibility but as a result they were able to create high risk that help their citizens lower costs and impred Health Outcomes because the state had that tiny bit of flexibility. We need to give states the true flex ability with a block grant. We have this option in a better way and need it in this bill. State, expansion and not expansion want the option for block grants. I look forward to working hard to help them have that option. We have been told by cbo they would not support block grants because they assume no state wants them. I would like to submit for the record a letter requesting the block grant option from paul lepage, the letter of maine, who is from a nonexpansion state. Without objection. I would also like to submit a letter requesting the block grant option from the honorable Asa Hutchinson from the great state of arkansas, which is an expansion state. This is a good motion. I hope we pass it in the rules committee will take it up and put the amendment in and i yelled back. They will be submitted for the record. Gentleman from missouri mister smith is recognized for the remainder of the time. I support this resolution wholeheartedly. As former state legislator i was constantly frustrated by the federal requirements that permitted us from running our own decayed program and tailoring it to missouris unique needs. I am encouraged by the motion because we havto give states the flex ability they need to administer the medicd program and provide care for lowincome individuals not how bureaucrats from washington say it should be done. Obamacare put washington in between patients and their doctors. Obamacare put washington in thrall. I support the mall for state block grant in designing the Medicaid Program because it will allow states to restore the doctorpatient relationship. Our bill creates a patient and states ability fund, responsibly scaledback obamacares medicare expansion and a fair funding formula strengthens medicaid for the long haul. Most and portly by yielding control to the states we assure medicaid will be used effectively to serve patients who are most in need. We have to get washington dc bureaucrats out, Thomas Jefferson said the government closest to the people serves the people best. I yield back. I recognize the opponents of the motion, Ranking Member, the only member of the committee from kentucky. I will yield 2 other members throughout the process which and in medicaid, states have amazing flexibility for eligibility, benefits, cost sharing and the Delivery System and to better tailor the program and in indiana, just wavered to change the program, flexibility is not what we are talking about. Cant do more with medicaid when cutting 900 billion from the program so when my republican colleagues say flexibly they mean doing less with less, if you are covered and fewer benefits people need. Kentucky is a prime example. Matt bevan has applied for medicaid waiver that by his own estimates would immediately take healthcare away from 17,000 kentuckians over a five your period, 75,000. Those that continue to receive medicaid, the most Vulnerable People in the commonwealth would see increased outofpocket costs and fewer benefits under his waiver. Kentucky has historically had the worst rate in the country when it comes to oral health and access to dental care. One in four kentuckians over the age of 65 have had all their natural teeth extracted. Prior to enactment of aca, medicaid eligible children had seen the dentist, 15 . Steve bashir expanded medicaid to 400,000 kentuckians as part of the aca which included coverage for oral care, the rate of dental visits, and double for children. That is what we are about to lose. Governor bevans waiver will cut dental coverage of the stated benefit for hundreds of thousands of kentuckians. That is not progress, it is a Public Health crisis. This is about improving care through flexibility, jeopardizing healthcare of millions of low income men, women and children. I now yield three minutes. This motion says state flexibly when it is really allowing states to rent medicaid coverage from those who need it most. Lets let states keep Medicaid Expansion. No question Medicaid Expansion is expanded from middleclass americans struggling to make ends meet, revealing expansion is dangerous and shortsighted. And the Healthcare Plan is to destabilize the Medicaid Program as a whole. And per capita state Medicaid Programs, and 8 billion in additional costs or begin rationing care. They plan to medicaid funding, will inevitably lead to waiting list address and healthcare with 6 people facing long delays and substantial barriers to the care they need, i heard care about this proposal from seattle childrens hospital, university of washington medicine, Skagit Valley hospital and Washington State medical association and so many others in my state. I ask unanimous consent to insert into the record a letter from our goverr and insuranc ission expressing deep and well thought out concerns with this bill. Ithout objection. It reads part,uote, 700,000 people in our state will be at risk of losing coverage unless we can find 2 billion by 2028 to continue medicaid coverage for 600,000 of these people, and unrealistic amount to raise in the first book the current fiscal climate. It also states, quote, if Medicaid Expansion were to end today, 20,000 people would have their cancer care disrupted and 30,000 would lose critical treatment for Substance Abuse disorder. Tens of thousands of people with mental illness, a recipe for disaster with outcomes. Everyone has delivered the same message to me, this would do irreparable harm to middleclass families in Washington State especially children. Just yesterday i heard from the university of washington and harvard you Medical Center that this bill means 518 million cut to their lifesaving work every year. It is staggering. I implore you to consider consequences before allowing this illadvised plan to move forward. Of my colleagues are truly concerned about states rights they should allow Medicaid Expansion to go forward uninhibited. In addition to regular doctor and hospital visits medicaid covers Longterm Services like Nursing Homes and home care allowing people with chronic conditions the ability and peace of mind to live independently. 31 states and the district of columbia have expanded medicaid so far. The expansion combined with acas of the reforms have lower the nations uninsured rate below 19 the lowest level ever recorded. States Like Washington have thrived under reforms like this which are helping millions of working families, seniors and children. States rights arguments only used when it is convenient. I urge a no vote and yield back. I think the gentlelady and yield two minutes to mister kautsky from illinois. Flexibility, flex ability, flex ability. Kicking billions of people off medicaid and threatening care to seniors and children and pregnant women and the disabled is not the same thing as flex ability. It is a fantasy to think you can cut 880 billion from medicaid and think nobody is going to get hurt. It is Common Knowledge states can use several waivers to design their Medicaid Program in ways that meet their needs as well as federal standards for coverage and benefit so those are not hard to get. What republicans mean when they talk about flex ability is drastically reducing funding for states for their programs, imposing a per capita and allowing states to impose regressive policies such as work requirements, blackouts, benefit cuts and enrollee costsharing that only serve to deny people access to medicaid who distantly need coverage. We heard from republican governors including my governor in the state of illinois, governor browner, and concerned about the effect of medicaid cuts. Brian sandoval in nevada said all along work with governors, it should be a governor led effort and for congress to rely on governors. He went on to say lost that. He went on to say nothing governors had recommended was actually put in place. Simply put, this would undermine the effectiveness of medicaid for thousands, millions of people, cutting budgets and punishing a vulnerable population. Yield the remainder of our time to Debbie Wasserman schultz of florida. I hear my republican colleagues asking flex ability for states but make no mistake that is good for deep cuts. Republican puzzles convert medicaid into a per Capita Program attended to achieve large growing cuts to medicaid spending shifting costs to the state. Considering the leeway state authority have in running their business under the gop will be only result flex ability will be further limiting enrollment, cutting benefits, low income americans for the what they need. Shifting is the billions of dollars of medicare costs to states will erode the progress the delivery of healthcare ing services to vulnerable populations. States like my home state of florida, 3. 7 Million People to receive healthcare coverage through medicaid cannot afford the cuts this budget proposes, three of 7 kids in our state they need to stay healthy thanks to medicaid, deserve better. If republicans spend more time learning about medicaid instead of investing meaningless catchphrases like flex ability they would know states can already do everything outlined in this motion. States already have likability to definedbenefit plans best for the residents, they have flicked ability on eligibility, and the delivery of payments of care. What is outlined, states cannot pursue today under existing flex ability standard states have improved the quality and delivery of care, flexibility the only way states have reception drugs, physical and Occupational Therapy and new Preventative Services to drive down the cost of care. The entire bills health care plan, nothing but huge taxcut for the rich, the expense of millions of hardworking American Families including millions of children, no matter medicaid flicked ability is going to change that. I yield back the balance of my time. The proponents of the motion is recognized. The reason i introduced the document entitled cbo scores of task grant proposal is to show that the savings of the block grant proposal generally matches per capita so there is no reason it should score 0, explicitly want to do. We could have that choice and it wouldnt change the cbo score, states would have per capita caps, block grants would not need the score and introducing the record a letter from mister price, former budget chairman. Without objection. Exhibit a. I got caught by my own. Agreeing to the motion, all those in favor signify by saying i. Those opposed no. In the opinion of the chair the eyes have it. Recorded vote, the clerk will call the role. [rollcall vote] [rollcall vote] [rollcall vote] [rollcall vote] [rollcall vote] [rollcall vote] [rollcall vote] are there any members who have not voted a wish to change their vote . If not a collection report. On that vote the is are 21 and the nays are 12. The eyes have it in the motion is 3 too. I now recognize mister gates from florida for the purpose of a motion. Have a motion. I have a motion at the desk. Clerk will read the motion. The motion offered by mister gates, mister gates moves the committee and budget director express support of the Committee Prior to consideration of the rule for the people on medicaid to 12 billion on medicaid products. They couldnt raise taxes fast enough to cover the focus on medicaid so what did they do . They cut reimbursement rates and when that happened provide is left the market and people couldnt get healthcare they ended up back in the emergency room. Medicaid expansion in many ways is a cruel joke. Gives people a car that tells people they have Health Insurance coverage when in reality access is illusory. It is not just california. In colorado there were Nursing Homes that are reductions in reimbursement rates. Think how irresponsible that is, thinning the soup in our Nursing Homes the consequence of these liberal policies. And illinois reimbursement rates were cut to hospitals and prescription drugs, limited to four a month. That is resident care. In louisiana primary care with cut, Mental Health care was cut, Dialysis Centers saw a reduction in reimbursement rates, in maryland Nursing Homes and hospitals were the victims come in New Hampshire hospitalss rs and karen reductions in reimbursements to the tune of 160 million. In the last motion democrats demonized russian care. They double down on rationed care because when we overload the medicaid system intended for the vulnerable with ablebodied childless adults who do no service to the vulnerable and ultimately dont you better healthcare outcomes for anyone. When we promised medicaid to people i often think of the story of a driver who was 12 years old, he thought he was going to get more than a wish sandwich, he thought he would get medicaid and be covered. He had a tooth abscess and because the Medicaid Program was so overtaxed, so stressed, couldnt get to see physicians, such long waits that this 12yearold boy died on medicaid because we were not taking care of this vulnerable population. It is morally wrong and financially irresponsible to tax the system irresponsibly. States expanded medicaid. That is a reality we have to deal with and i am modestly sympathetic to arguments made by my colleagues that expansion states there are to be a glide path to adjust to various market forces. And current enrollees spill over to new enrollment. That is what the motion deals with. The organizing principle of this bill is people are better off with tax credits, and medicaid, it is ludicrous to spend the next two years by allowing additional states to expand medicaid and allowing expansion states to add new enrollees to the Medicaid Program. The provision that embrace Medicaid Expansion for two years archaeological. If our goal is to have your people on medicaid lets not start by putting people on medicaid for two years. This is like a diet strategy, if i needed to lose weight, on a diet two years now up to that point eat everything in sight. The gentlelady from texas mentioned earlier this was a plan to bust medicaid. It is not. It is a plan to save dedicated. For children, the disabled, the vulnerable, people like my mother who have been in a wheelchair for 31 years. I think every day when we talk about health care about how people like my mother would be affected, constrained and require additional assistance. The way to save medicaid is not to explode it, not to put people on micaid that dont belong there. We should pass amendments consistent with this motion, we should similarly pass amendment consistent with mister westermans motion allowing flight ability to be directing resources to those virtually in need. I would yield to Mister Arrington such time he may consume. Thank you, i support your motion 100 . Obamacare created a perverse incentive for states to use medicaid, a Program Designed for the neediest as a vehicle for adding ablebodied adults to the healthcare roles. At 100 federal funding, 31 states were convinced it was too good a deal to pass up. Now we have Something Like 8 million ablebodied adults on medicaid. Many of the states were opposed to Medicaid Expansion but they didnt want to leave any money on the table. They subscribed to the take our fair share argument. Dont know that i can blame them but what about our childrens fair share, our grandchildrens fair share. I am proud my home state of texas refused to perpetuate the false notion that we have an Endless Supply of money to pay for all this. The American Healthcare act is a good start at reigning in runaway federal spending. Medicaid was intended to cover our most vulnerable. Low income children, blind, disabled, elderly and pregnant women, ablebodied adults above the poverty line should not have been included on medicaid. There are three reasons why. First, we dont have the money to do this, the current trajectory with current policies in place from obamacare have a spending 1 trillion a year on medicaid. Weill be 3trillion in debt in ten years. It dilutes service and takes the focus away from our most vulnerable. Third it disincentive rises, we must stop this unnecessary and fiscally irresponsible expansion of ablebodied adult now. I stand with my colleague mister gates to freeze new enrollment immediately instead of exacerbating the problem of Incentivizing States to stuff medicaid with new ablebodied enrollees over the next two years as we move forward with the aac a. I you the remaining time to mister johnson. I think my colleague and stand in support of this motion. We definitely should be building into that policy a glide path to get people off of medicaid, give them a choice for the healthcare they want. I would be remiss if i did not mention many states that took Medicaid Expansion did so because people in their states had no other choice. Has a chance to recover and rebound before we take strong action on repealing Medicaid Expansion. Theime ofhe geman has exred. Iow recognize the Ranking Member for ten minutes. Thank you, madam chair. I now yield three minutes to ms. Jackson lee of texas. Thank you so very much, and thank you for your leadership. It strikes me as such an interesting proposition to hear my good friends talk about their concern for those who are on medicaid. Their concern for not piling up the roles of people who are obviously ask rating and misrepresenting their need for medicaid. The need for lifesaving, lifesaving medical care. Well, i refer again to senator cardins townhall meeting where this woman argued vigorously that obamacare has helped save her husband with heart disease, heart failures, openheart surgeries suffering from dementia and all times, paying 29 a month, and she paying 39 does a month. I think that headline rate angry ark of someone screamed at senator tom cotton over obamacare, claiming she pays 29 a month. And i bet she does. Governor snyder said this plan doesnt reflect the comments that we made as governors. And then that number keeps coming up in this very important document. 2026 an estimated 52 Million People will be uninsured. I always love reading Winston Churchill who reminded me of the real idea of where we are today. He reminded me of the information given by the americas essential hospitals that said that they will lose 40 plus 5 billion under this. These are rural hospitals. And let me cite for you individuals who, from the state of the proponent of this particular motion, if you will. What about sherry and florida . Lost her Health Insurance after divorce and immediately sign for coverage in florida through a secret she didnt underwent two major surgeries including openheart bypass. The Affordable Care act saved her life. Or ileana ross lightened his that i cannot vote for this. Im from florida. Because of not take care of my constituents. So lovely put put into the record, individuals who i guess my propeller, my dear friend is arguing against Susanna Moore from ohio who would have died at you not had opportunity for interest on obamacare that she had a stroke, or ruth from oregon who has cancer devastating cancer, young woman who got off of her, aged out of her parents insurance, or Debbie Linda Smith from las vegas nevada. By asking and its consent to put that in the record. Finally let me say without objection. There are millions of individuals in texas if we had expanded medicaid. My friends it is from texas to New Hampshire that makes the argument that 120,000 people would lose coverage in New Hampshire where federal data shows a nearly 200 increase in overdose death in the last five years. Have republicans been at the forefront of health care in the last 60 years, medicare, no. Childrens Health Insurance, no. The Affordable Care act, no. I would rather stand on the side of individuals who again want to save lives. I believe that Winston Churchill is right. Never has so much been taken away from so many to benefit so few. Congratulations to the 1 richest in the nation. You are getting a Birthday Gift today. I want to stand with those whose lives are in the gap and in jeopardy and provide them with the medicaid and the Health Insurance that they need. I thank the gentleman for yielding. I yield back. Ideals myself such a mess and they consume. Im having a hard time understanding this motion. The underlying bill already in the Medicaid Expansion in 2020, and i know that there some thought and think it in 2018. I didnt hear any of those republican members who are speaking on the motion give me, give us any examples of what there might be some kind of incentive to enroll in medicaid might be. The only incentive is if you cant get health care anywhere else. And when i hear all these complaints about ablebodied people and so forth, and i think sure, if somebody is able to work and can get a job, they should probably do that. And the fact that they want to. But what happens if you are a 50 year rate old man and youve lost your job and you can have a job come if youre a coal miner, say, a kentucky and all of a sudden now you have an option at getting a 4000 credit but credit but your insurance is going to cost you 19,000 per year according to cbo. Where are you going to come up with the 14,000 . It seems to me that also many of the arguments weve heard, mr. Gaetz was tight but all these cuts and rations and so forth your those to mere indications of the flexibility that you are wanted. States did that. I dont like a lot of the thosppe the exibility to do it just seems that this motion would restrict lacks ability. So if you had estate, for instance, new york state has been very generous in medicaid. If they wanted to ensure people up to three times the Poverty Level or four times the Poverty Level, this amendment the way i read it probably wouldnt allow them to do it. Im just having a hard time grasping what this amendment would do. Again, you are already a limiting the Medicaid Expansion. Are you telling states at that point that they can do anything even if they want to be generous to incentivize people who otherwise might not have insurance to enroll in medicaid cracks we have 440,000 kentuckians who have enrolled in medicaid since the expansion. Of the 440,000, 70,000 actually were eligible under prior medicaid, standard medicaid rules in kentucky and they only were prompted to enroll because they had navigators out in the field say hey, you are eligible for medicaid. They had no knowledge of a worker is that kind of activity prohibited by this kind of provision cracks beckons and a great deal. Again i dont understand what the need for this is. I never heard an example of what kind of incentive might be. I just think this is unnecessary. Does anybody else on my side want to speak on this amendment . If not i will yield back the balance of our time. Thank you, mr. Yarmuth. Mr. Gaetz, the proponent of the motion is recognize for one minute to close. Thank you, madam chair. And certaiy states ought to have the flexibility to meet the needs of the vulnerable in the state. But flexibly doesnt translate into a blank check from the federal government to continue have the federal government pay for everything because special when we nearly 20 trillion in debt and obamacare has given us essentially a trillion dollar spending program. Id like to yield the remaining time to mr. Rothman. Well, aint you. Just one other point thank you. This is among other things a spending bill. We are approaching 20 trillion in debt. If you look at the second and third years out we are spending significantly more than if this bill had never been introduced. I think part of that can be attributed to the Medicaid Expansion, particularly the federal government pay 95 or 90 of of an expansion. I believe if Hillary Clinton were elected she wouldnt even get 95 or 90 match. We shouldnt be 90 matching with the state government. And i think now is the time for leadership to step up and before this things get to the floor to make some adjustments to this high match so that we will not be passing another all time as expert. The question on agreeing to the motion offered by mr. Gaetz. All those in favor . Those opposed . In the opinion of the chair the ayes have it. Recorded vote has been requested. The clerk will call the role. [roll call] [roll call] [roll call] [roll call] [roll call] [roll call] are there any members have not voted or wish to change their vote . Mr. Rokita is not recorded. Mr. Rokita, imac. The clerk shall report. On that vote the ayes are 22 and the nos are 13. The ayes have it and the motion is agreed to. I now recognize mr. Palmer for the purposes of a motion. Madam chair, i have a motion at the check. The clerk will read the motion. A motion, mr. Palmer moves the committee on the budget direct its chairman to express the support of the Committee Prior to the consideration of the rule for the neck and Health Care Act for encouraging ablebodied working age adults without dependents to meet and work requirement while enrolled in medicaid. Mr. Palmer is recognized for a total of ten minutes with one minute reserved to closed. Thank you, madam chairman. When medicaid was greater it wasnt intended to become an entitlement for ablebodied adults. Instead it was meant to be a temporary safety net to protect the most vulnerable. It was meant for seniors and individuals with disabilities, pregnant women and children. The Affordable Care act led to the explosion of the program into a permanent welfare benefit for anyone, including the ablebodied and childless. The population, this population is ineligible for temporary assistance for needy families and jelly for food stamp benefits. The Medicaid Expansion created a perverse incentive for states to provide benefits to ablebodied adults that expense of the elderly, blind and the disabled. Under the aca come states receive 100 match phasing down to 90 for the expansion which has resulted in making the ablebodied eligible. This is according to the kaiser foundation, this has led to over 582,000 disabled and elderly citizens on a waiting list. In this way the aca has discriminated against the most vulnerable in our society. The work requirement would help limited resources on the truly needed. I like to point out that a report that i received for medicaid recipients, it shows that 44 of those receive medicaid currently do no work at all. And only 32 do seasonal parttime work and only 24 work fulltime. A National Bureau of Economic Research did a study that found passed Medicaid Expansions to ablebodied childless adults reduced employment and earnings among those expansion of populations. In alabama over 40,000 people were estimated to leave the workforce. The Congressional Budget Office estimated that the ac would reduce the number of hours worked by one and half, 2 , almost entirely because workers will choose to supply less labor given the new taxes and other incentives. I would also like to point out that the aca expansion is over budget and costs are way above the cbo projections. In fact, the cbo projected in this latest score, the cbo reported that, that the costs are 40 higher than the estimated. And it would also like to point at that states have exceeded the maxim enrollme targets and have enrolled twice as many ablebodied adults as expected. With that said, madam chairman, i urge my colleagues to support this and i will yield two minutes to my colleague from wisconsin, mr. Grothman. Thank you much. As congressman palmer pointed out this is become an entitlement program. Like many entitlement programs when you get entitlement is make sure you dont have a lot of income. The result is a perverse incentive. Our people unquestionably out there in order to get this benefit either are working not at all or working less than it would otherwise to get this plan. While i understand that there are perhaps some things that cannot be done because of waiting lists which are inevitable on medicaid, it is also true in medicaid in a lot of ways it is superior. Most people today and including people who are on obamacare a sizable to taxable. They are big copays for individual procedures. Medicaid does not have these big deductibles or much of a copayment procedures. So as a result we have a situation which not just to get the coverage but getting superior coverage, you are encouraged not to work at all or to work less. The result is i think with more people on these programs than is necessary. Its one of the reasons why we have in the second third year the cbo estimate an actual spending increase in this plan. One way we can make this not such a seductive entitlement is to put some sort of work requirement in this plan, which i think miraculoly as th other entitlements will result in less and less people sign up for the program. Thank you. Thank you, mr. Grothman. I now recognize the gentleman from texas, mr. Arrington, for two minutes. I wholeheartedly support my colleague on his motion to ensure that the American Health care act includes work requirement for ablebodied adults, any responsible Welfare Program must include such a provision. The American People are generous and compassionate. And i believe the majority of our countrymen want to help those who are truly in need, but expect of those who are recipients of the goodwill to do their part. At a time and went out of five people in their prime years are not working in welfare rolls are at alltime high it is incumbent upon us as members of congress in fiduciaries on behalf of taxpayers to incentivize work for those who can come to encourage a culture of responsibility, and to protect our limited resources for the most vulnerable among us. We must apply the most basic principles of stewardship and accountability on behalf of the taxpayers and require ablebodied adults to work. The very fact that we are still having this conversation at this point in the process is disheartening to me. The scripture says in second thessalonians chapter three, if anyone is not willing to work, let him not eat, for we hear that some walk in idleness. Lets prevent idleness. Lets encourage personal responsibility. Lets require work for the sake of a taxpayer and for those on medicaid. I yield back. I think the gentleman from texas. Madam chairman and members of the committee, i just want to point out that health and Human Services projected, and this was during the obama administration, that by 2022 there will be 29. 7 million ablebodied adults on medicaid. I think we do these people a tremendous disservice by not requiring work, giving them the opportunity to join the workforce and lift themselves out of poverty. With that, madam chairman, i yield back. I reckon its the opponent of the motion the Ranking Member mr. Yarmuth for ten minutes. Thank you, madam chairman. I would now yield two minutes to ms. Schakowsky from illinois. Thank you for yielding. I oppose this motion because work requirements actually dont do anything to improve the Medicaid Program, and only see to take away muchneeded health coverage. Work requirements on medicaid families who are generally living on a budget of less than 15,000 per year are not only punitive but also counterproductive in the long run. Most people on medicaid who can work, work. For people who face major obstacles to employment, work requirements are not going to help them overcome, are not going to help overcome them. Many of these individuals have severe mental illness, are suffering from drug addiction or have disabilities or chronic illness that make it impossible for them to hold steady employment. In addition many people on medicaid have lost their jobs and need medicaid to keep their families afloat while they are unemployed. The last thing these people need to worry about is losing their health coverage. Moreover, theres no evidence the work requirement would increase employment among poor families. Republicans are not proposing to couple work requirements with programs that actually help people find work like job training, Financial Assistance for Higher Education or child care assistance. Its clear their ultimate goal is to simply tick people off medicaid and that actually help them find employment. I urge my colleagues to oppose this motion. And let me just say, i just wonder, of the 600 billion that goes to the richest americans, i wonder how many of them go to work everyday . Just saying. I yield back. I now yield two minutes to ms. Jayapal from washington. Thank you for yielding yet again with a motion grounded in alternative facts, another solution in search of a problem. This motion seeks to lock into place the principle of stripping health care from low income and working families in the guise of work requirements and in whom is an insurmountable barrier for many. And throwing of these berries to coverage does nothing. Americans affected by this requirement are more likely to be uninsured in poor health and less likely to participate on the workforce. Often, adults were enrolled in medicaid have disabilities or other primary caretaker for a Family Member or even more have lowwage jobs that do not offer health coverage. Only 13 of the Medicaid Expansion population are not disabled, working in school or seeking work. And that 13 , nearly three out of four are out of work to care for the Family Members. Leonardo quell a contract of Health Policy for National Health program says his work requirements will likely be challenged in court saying that quote and individual needs to be healthy to work and work requirement may prevent them from getting the health care they need in order to be able to work. I urge my colleagues rejected this motion and offer something that really helps people. I yield back. I think the gentlelady and now yield two minutes to the gentlelady from california, ms. Lee. Thank you. Thank you for yielding. I am strongly opposed to this are harmful motion to this moti is yet another seless attacks on the floor, on struggling families and onhe unemployed. As i said rlier there are winners and losers in this bill. Added an unnecessary work requirement would be at barry to coverage and leave millions of struggling families without Health Insurance. Of course are the losers. It also flies in the face of facts. The fact is that the majority of individuals on medicaid are seniors, children and people with disabilities. Whats more, work requirements are just one more way this plan takes coverage away from those who need it the most. Cbo estimates 14 Million People will lose medicaid with this dangerous republican bill so really this motion tells us what we have known all along. Republicans want more vulnerable families and individuals to be blocked from even accessing medicare, medicaid. These are also the losers. They want to throw struggling families out in the cold with nowhere to turn. Madam chair, millions of adults on medicaid of disabilities or are caring for a Family Member. And millions more have lowwage jobs. These are also the losers. This republican bill will take us back to the days when millions of individuals have no Health Insurance. One of my very brave constituents sadly suffered from multiple strokes but was able to access medicaid because of the Affordable Care act. He cant work and he is alive because of the Affordable Care act. He probably would be dead under this bill. Its stories like these that we should be uplifting and celebrating. We should ensure that all americans have high Quality Health care. Sadly this motion does just the opposite. Once again we see who the losers are. You are dumping access to health care from the most vulnerable. This plan really is not trumpcare. For me it is child dump care and this motion makes it very clear. I yield the balance of my time spirit i now yield two minutes to the gentlelady from texas ms. I thank the gentleman. I remember the welfare reform debate, and it was clearly with the same signals of this one, that poor people are bad. I remember the result of it, and that was that lactating mothers was thrown off of welfare, while babies needed loving care. Completely different from others with resources are able to stay home with their children. Now we come some years later and the same old same old. The same stale arguments that poor people, medicare recipients are simply deadbeats. There are 43. 1 Million People in poverty as of 2015, and this bill is an assault on hardworking lowincome americans that accomplishes nothing because medicaid beneficiaries include poor seniors, children, their families, people with disabilities and other income. Again the Republican Leadership has said we dont want a nanny state, but yet the comments today are we want a culture about work. Those are signals, those are dog whistles. Who is not working . Who would want to raise their hand to become a recipient of medicaid if they did not need it for dignity . Im reminded of galatians that says, and let us not grow weary of doing good. Adults enrolled in medicaid often have disabilities or are the primary caretaker for their family. They have lowwage jobs. They in fact, may be young people. The amateur rape of people in the 30s and 40s with incomes below 20 of poverty the region 38 in 2026. I remind you of the 52 million uninsured by 2026. So let me just say to you that the importance of what we are saying today is that i want to defend hardworking recipients of medicaid. I want to defend Rural America and rural hospitals. They are my friends. They live in texas, and i believe that this legislation does such a damage to the dignity and humanity of these people that two of your outstanding senators from West Virginia and i believe alaska have indicated their constituents cannot suffer the loss of medicaid. I assume they are hardworking. I asked my colleagues to oppose this motion, and i yield back. With anyone else like to speak in the opposition of the motion . Ms. Wasserman schultz. Thank you. I find it ironic that republicans actually want to that states would need to find funding in their budgets for job training, for retraining programs. But this bill cuts 880 billion from federal medicaid funding and will force states to rob peter to pay paul, not just to make up for the shortfall in medicaid but also by taking money away from programs like job training and retraining. Because of their responsible. So put your money where your mouth is instead of just talking. I yield back. We will yield about our last 56 seconds. Mr. Palmer, the proponent is recognized for one minute to close. Thank you, madam chair. I just want to remind the college after stick to your talking points with the substance of the bill, the motion is a work requirements for ablebodied adults without children. Kansas did this on Welfare Benefits and it resulted in 133 increase in average income of ablebodied childless adults enrollees. 168 increase in work participation, and when a 27 increase in the average income among increase in the average income among those who cycled off the program. Yoknow, this is not a medicaid was intended to operate. We should not be encourang people, we should be encouraging people to enter the workforce, not giving them an incentive to stay home. I grew up pretty much a dirt poor in a house that had cardboard between the floors in the bedroom i should with my brother. I can tell you, work meant everything for me. I moved to have support for adding a work requirement for ablebodied working age adults without children, working ablebodied adults without children to be added to this bill and to urge my colleagues to support this notion. I yield back. The question of agreeing to the motion offered by mr. Palmer. All those in favor tax those opposed . Independent of the chair the ayes have it. With the gentleman like a roll call rex spin i request a roll call. Spirit a recorded vote is requested. The clerk will call the role. [roll call] [roll call] [roll call] [roll call] [roll call] [roll call] are there any members who have not voted or wish to change their vote . You are not recorded . Mr. Westerman aye. Mr. Rokita, aye. Are there any other members who wish to change their vote . Did he vote . If not the clerk shall report. Madam chair, on that vote the ayes are 21 and the nos are 13. The ayes have it and the motion is agreed. I recognize mr. Mcclintock for the purpose of a motion. Thank you, madam chair i have a motion at the desk. The clerk will read the motion. A motion offered by mr. Mcclintock, the committee on the budget directs the children to express the support of the Committee Prior to the consideration of the rule for the American Health care act for policies that ensure the personal tax credit are afforded to the population they are intended to serve. Mr. Mcclintock is recognized for a total of ten minutes with one minute reserve to close. One method that still need to be addressed is to assure that low income working families are not subjected to cost prohibitive increases in Health Care Costs as result of this legislation and that the tax credits are structured to ensure that at least a basic health plan is within the financial reach of every family. This has always been integral part of conservative alternatives. In fact, predating the price plan and drawing from the workout Milton Friedman decades ago. The success of this plan requires that we delete anyone in the lurch. Im not satisfied the current structure of the tax credit achieves this objective, and if this is left unaddressed could do it to fairly brief instructions i propose are intended to direct the rules committee to hear an act of affecting amendments to achieve this transition. The genesis of obamacare was the fact that low income working families in the indidual market could no longer afford basic health care. A lot of this was because of anticompetitive measures in current law that trap people and ever stickered strict markets which we hope to address in this and followup legislation. But the hard map of the matter is that until and unless that happens, a 40yearold earning 26,500 is going to see a dollars is going to see a 24 subsidy decline and a 41 increase in net premium. 64yearold will see a 64 subsidy reduction and a 759 increase in net premium. As our friends on other sites as ill the aisle have rightly pointed out, that takes their outofpocket Health Care Costs from 1700 to 14,000. There are 45 million American Families who filed tax returns between 15,000, 40,000 of income. The impact of this price structure is simply not defensible and not sustainable. Threatens enactment of the bill and if enacted i think friends and abrupt repeal. It has to be addressed. The way these tax credits are structured, the current bill also creates a tax clip that discourages the transition for medicaid to employment. I realize some of my colleagues oppose any kind of tax credits for. It creates a permanent entitlement. I think this is a penny wise and pound foolish. Im confident that over time the ahca and other reforms that follow will improve the economy and incomes will rise. Im equally confident that over time Competitive Forces in the Health Care Market that were seeking to create will bring the cost of health carans down. When that happens at the tax credits will naturally receipt as more and more working families earn more income and need to pay less of it for their health care. But we have to create a bridge from the present to the future and we simply cant get there without addressing this glaring defect. I now yield one and half minutes to mr. Sanford of south caroli carolina. I thank the gentleman. I love a movie with a happy ending at it strikes me that this amendment might be this in this Committee Markup and that were at an inflection point. The first half of the hearing the microphones were so loud as we been through this we have heard on the book of matthews, thessalonians, galatians but i want to go back to the quote on matthew at a guess our colleague, congressman jeffries quoted to talk but how you help the least of these. For my democratic colleagues over republicans alike i think at the end of a one all about is saying how do we target aid and help to those who most need it . And fundamentally i think thats what this amendment is about. We talked about a wish sandwich. How do you put the meat in the middle . We talked about any number of different heartfelt stories that are real. We talked about a birthday present to the rich. I think this commitment is making sure we dont give a birthday present to the rich. I think whether were democrat or republican alike come at the end of day were saying again how do we target need to those who really need it. I dont think we can be l things to all people. I think thats one of the many problems of legislation. This is a targeting amendment. I guess im a number of other things to say but if you just do the math, a woman making 30,000 as presley configured we had to go up to about 100,000 before you completely phased out eight. Is i consistent with either democratic or republican ideals . I think thats what this amendment is about and with that i yield back. Im please to yield a minute and half to general bregman of michigan. Thank you. This motion is vitally important to the population that it is intended to serve and a glad were here having a dialogue today. Since the American Health care act has been introduced, ive heard comments about how tax credits included in this bill are going to the wealthy and will help those who dont really need assistance. Thats simply not true. Let me be clear. The purpose of personal tax credits is to provide americans who truly need it the Financial Support to purchase an Insurance Plan of their choice. These credits are for those people who dont already have access to employersponsored or governmentsponsored health care. These tax credits havent income cap so that we are not subsidizing coverage for those people who can afford insurance on their own. It is critical that we provide these tax credits and Financial Support to families like those in my district who have not seen the benefits they were promised under obamacare or under any other policies that the former president supported during the past eight years. Michigans first congressional district, the district i represent concludes Northern Michigan and the upper peninsula. This district is largely rural with the average Household Income much lower than other parts of the country, and even lower than in other parts of our state. Let me be clear. Promises were made to my people and the district, and under obamacare these promises were broken. Weve seen lack of competition, high premiums, etc. I will send it by my constituents to give them a voice in the process and to make sure those who truly need help get it. I strongly urge my colleagues to support this motion. I yield back spirit i now yield a minute and half to mr. Westerman of arkansas spirit i think the gentleman from california for yielding. Trent to the tax cut a provision in the current bill has created confusion and tightly the bill can be amended to symbol by the provision, create parity and help americans purchased more Affordable Health care. When americans Purchase Health care through group plans we get a Tax Deduction because we purchase our plan with pretax dollars. Individuals did not get the same treatment. They do not get to purchase with pretax dollars. The bill curley provides an age when a tax credit is a directory find instead of a deduction for low income people need the credit because they deduction does not help them. If we modify the tax credit to be more generous for low income indiduals and make it means tested and convert the credit to a andard deduction fire him to come individuals, then we can create an equal Playing Field for citizens purchasing in group plans or individually that all income levels that we can create a smooth transition for medicaid to tax credits to Tax Deductions. And finally we would have a mechanism to fully repeal the cadillac tax. I yield back spirit i yield the remaining time to mr. Diazbalart from florida. Ill be very brief. I can think them for bringing up this amendment are very clearly when brought to help the most viable we want to help those who truly help and thats what this amendment does to make sure that we are very clear about it. There could be some debate whether the bill does it right now. Its time to clarify it. This would make a lot of us feel much better. Thats what were supposed to be doing, helping the most vulnerable. I think mr. Mcclintock for bringing this amendment. I yield back. Dynamic and is the part of the bill the Ranking Member for ten minutes spirit thank you, madam chair. I would like to say theres an old saying that you either dont put lipstick on a pig and you dont try to make a bag and bad build better. This is a virtuous and now it and tend to support it. With that i yield three minutes to ms. Wasserman schultz. Thank you. I think the judgment for yielding, and then makes only one of us. This motion to instruct its like trying to apply a banded to a wound that needs the tourniquet. The fact is that this motion will not provide coverage to the toy for my people to lose her health care under trumpcare. Unless this motion is going to restore 880 billion in medicaid funding, than 14 million americans will still be losing Health Insurance coverage. Unless this bush restores 312 million in premium subsidies, then another tingling will Lose Health Care coverage on top of that. Unless this bush restores the Affordable Care act bulletproof protections for the 129 million americans with preexisting conditions, such as Breast Cancer survivors like me and msa preexisting conditions will be grounds for costlier insurance once again. The form we had obamacare, nsa 59. 1 Million People lack continuous coverage for at least part of the previous year. One of thos of the 59. 1 millione was suzanne boyd from sunrise florida with two daughters was just going to realize her dream of owning her own special Events Company as a fulltime job. She had Insurance Coverage for years to her husbands employersponsored health plan. Until 2012 when her husband died of lung cancer. Two weeks lead the family lost their employersponsored Health Insurance. Only five months after that suzanne was diagnosed with hodgkins lymphoma. As she has said, before Bobby Fischer wouldnt even have considered starting a business. She probably wouldve looked for another corporate job with health benefits. But knowing that she would soon be able to obtain insurance under the aca enterprises in condition couldnt be held against her when she applied she started her company in 2013. She qualified for a plan to cost her 192 with substantial government subsidies. Under the republican plan people like suzanne will be forced to pay a 30 higher premium each month in order to receive care. This motion does nothing to address that cost explosion. If this motion was designed to stop the patient from bleeding, from bleeding out, it has failed. Which is why i urge my colleagues to oppose this donothing motion to obstruct. Thank you. I yield back. [inaudible] gentleladys time illinois, ms. Schakowsky. I will certainly consider what the Ranking Member said but i want to take this opportunity to talk about the word access. The American Health care act is described as providing access to Insurance Coverage, and secretary tom price was asked on some tv show on sunday i think it was if americans can it was a simple question. When americans lose coverage under the republican bill, and he started to answer with this pick he said no one would lose he started to say no one will lose coverage. And then he corrected himself and said, no one would lose access to coverage. What i hear from the idea of access to coverage is like accurately saying that everyone has access to a mercedesbenz. You know, if you have the money to buy a mercedes, then you have access. Universal access to a mercedesbenz if you have the big bucks. But if you are a 64yearold that cant pay 14,600 in premiums, then you dont have real access to Health Insurance. Thats the reason by 2026, 52 Million People, more people will be uninsured. Yes, some of them will be because they dont want to purchase insurance but a lot of them would be because they cant afford the insurance. If what this amendment is saying is that, in fact, we would not just do age rating of the subsidies, then if im correct about that, i will check with my Ranking Member, then maybe thats better. But at the end of the day i have to agree with my colleague Debbie Wasserman schultz that this is really a very bad bill in so many ways. While this motion may be beneficial, this is something that at the end of the day we should all vote against. I yield back spirit than thank u very much. I now yield two minutes to mr. Moulton from massachusetts. I want to thank the Ranking Member and also want to thank my republican colleagues for offering this motion. This is a very partisan committee. There are very rare opportunity to work across the but i agree with the remarks that this is wellintentioned and i tend to support it. The reason i do comes back to my own expense with health care, which is at the ba. I made a commitment to continue getting my health care at the va as a member of congress we need to fix the va. Whats unique about Getting Health Care at the va is about when i walk in, and if i walk in with mr. Bergman is a retired general, we get the same care. We are treated the same. We had the same options, the same treatments. We are not discriminate against by our rank, our income, our wealth. That should be the goal of her Health Care Bill as well. My concern is that the overall bill does not achieve that. 880 million in medicaid funding cuts, 312 billion cut from premium subsidies. And all of that to enable over 600 billion in tax cuts. That doesnt get us closer to the kind of equal access to health care that he think all americans deserve. Whether you are born to a rich family or for family, whether you put her life on the line for a country or you dont. You deserve basic access to health care. Everybody deserves that right. So i will probably support this bipartisan motion but i will also strongly oppose the underlying bill. With that i yield back. I now yield one minute to the gentleman from california ms. Lee. I want to thank the gentleman for yieldingnd for the sameas s that our rking member supports this motion, i oppose it. We dont put lipstick on a pig, and i just cant amend a bad bill. This bill still defines planned parenthood. It still is a tax giveaway to the very wealthy. It still imposes work requirements on the disabled. It still eliminates Mental Health care and Substance Abuse care. It still increases costs and decreases benefits for low and middle income individuals and families. Its a terrible, terrible bill. Again, some call it trumpcare. I call it trump dont care. For those reasons i strongly oppose this motion even though i know it was made in good faith. Thank you. I now yield one minute to the gentleman from texas ms. Jackson lee. I think the gentleman very much. I think it is clear if this is branch of what i would accept is a total rewrite of this legislation because everyone knows that this bill has nothing to do with health care in every do with following the republican ideological agenda by giving huge tax cuts to the rich and powerful. The 1 gets 600 billion, tweaking a few tax credits for few people does not change that. The question is, if you are poor you are poor. Tax credits will do nothing because it will not help you Access Health care. Lifesaving health care. It makes the phaseout early but does not make more generous and lower incomes pics on the republicans think that to pay more f less an is too generous. We still hav24 Million People that do have insurance and 52 million that do not have insurance in 2026. I asked unanimous consent to introduce the forbes article house gop obamacare replacement hurts Mental Health. This article there are at least three and i understand there are more. This needs to be a rewrite. Its something does not go far enough to help those hardworking americans who deserve our respect in this committee and deserve our respect in this congress to save lives. I yield back. In closing for our side i would just like to say that while i intend to support this amendment, i have no intention of voting for the bill. I think, still believe the bill is a disaster for the American People and for the American Health care system. And voting for this amendment i think highlights many of the inadequacies and the lack of thought that went into its drafting. And with that we will think the chairman for her courtesy during this hearing, this market. They commenced on both sides for thoughtful and gentlemanly debate, and i yield back the balance of our time. Mr. Mcclintock, the proponent, is recognized for one minute to close. Thank you, madam chair that i want to thank the minority for the kind comments. I realize this is likely to get the support of the raise a very valid concern that we all want to take seriously, that the tax provisions in the bill as strongly worded failed to adequate she low income working families from the very forces that gave us obamacare in the first place. As a practical matter if we fail to correct this i doubt the bill will pass the senate and if it becomes law i doubt itill be very long before it was repealed in t next congress. As a selfevident and practical matter we cannot set in motion events that could push the Health Care Cost of 45 million families out of their reach. Into other measures are enacted to improve the economy, till his reforms produce a dynamic and competitive Health Care Market that we envision, taxpayers will be essential for low income wage earners. This bill cannot leave the house without this problem being corrected and since under the reconciliation rules we cannot amend it here. I believe we need to instruct the rules committee to do so. I yield back. The question is on the motion offered by mr. Mcclintock. All of those in favor . Those opposed . In the opinion of the chair the ayes have it. Are there any numbers who have not voted or wish to change their vote . If not the motion stands [inaudible] roll call vote has been requested. The clerk will call the role. [roll call] [roll call] [roll call] [roll call] [roll call] [roll call] are there any members have not voted or wish to change their vote . Mr. Grothman vote yes. Mr. Grothman votes ay on that vote the ayes are 27 and the nos are eight. The a motion is agreed. I would like to conclude by thank you my ranking the border with me to make this meeting go so smoothly. Were ending at 4 00 pm rather than 4 00 am which im really glad and ensure most of the members of the committee are really happy about that. I want to want to think all the members for being present today and not having as have to go find you, so this has been a really good meeting and great conversation. So we will look forward to the next meeting together. Also want to thank the staff on both the minority and the majority. I know the staff does a young womans job in putting all these makers together for us. I do want to thank them for that. A yeomans job. With that this meeting is adjourned. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] the House Budget Committee wrapping up 5 56 hours of consideration of the republican Health Care Bill, the replacement plan for the 2010 health care law, the Affordable Care act. If you want to see this hearing again we will show you a portion in just a moment. You can also see last weeks ways and Means Committee meeting and the markup in energy and commerce. Go to our website sees ben. Org and type in health care legislation. Todays hearing got underway at about 10 oclock eastern this morning and again we will show you a portion of hearing beginning now. The committee will now come to order