Transcripts For CSPAN3 Senator Ben Cardin Town Hall Meeting

Tonight we are hoping to have a town hall meeting where we can have a discussion about healthcare. I want to welcome thank you. Free speech for all. Also lets just have a discussion for all. So, good evening, welcome to everyone who came this evening. My name is tom louis. Im the Vice President for government and Community Affairs for Johns Hopkins. And i want to welcome you to the Johns Hopkins montgomery campus. For 30 years we have been offering graduate Level Education courses here. I want to say a little bit about the speaker tonight. Before i introduce him. Senator carden served for 20 years in the maryland house of delegates. He was the youngest speaker ever elected to lead the maryland house of delegates. He was also after that spent 20 years in as a u. S. Congressman from maryland. And had a very distinguished mark there. He was elected to the u. S. Senate and in the senate he is the highest ranking democrat on republican dominated Foreign Relations committee. And he also serves on the committees on environment and public works. And also finance. He has a long and very distinguished record on a number of healthcare issues. Hes a great champion of nih. And medical research in general. I want to just take a couple moments for housekeeping before we get into it. Number one, if everyone just as a courtesy could please silence their phones. Also, as a courtesy can you please not hold up signs. It blocks people behind you. We want to have a nice discussion where everyone can see and hear. And that part of the democratic process. I appreciate that. If anyone needs restrooms theyre out to the door and to the right. We are going to have a short presentation by the senator. And then an opportunity for questions. I would say just one last thing on healthcare before i introduce the senator. He has a very long and distinguished career in healthcare. When he was still a speaker of the house, i had the great good fortune to be the Committee Lawyer for the committee in the maryland house of delegates. That deals with healthcare dealt with healthcare in the environment. And while i was there, senator carden then speaker carden championed a group a package of about six bills which constituted a major reform of healthcare in maryland. It helped to preserve the maryland medicare waiver. Which has been a great boom to the state. It has helped maryland, although hospital rates seem very high, i will say maryland since that time has had a lower rate of increase than the National Average in every year since that time. So, he has great expertise in the area. This is again a time of great uncertainty in healthcare. And we are very fortunate to have a u. S. Senator who has the breath and depth of experience that senator carden has. So very pleased that we are all very pleased that senator carden chose this location. I want to take one more moment and introduce elected officials who are here. I know senator roger. Delegate barkly, i think also is representing congressman ras kin. Recently a state senator. Also here. And with that, i want to introduce senator ben carden. Thank you. Tom, thank you very much. Let me thank tom and the Hopkins Family for allowing us to use this opportunity for a town hall type meeting. Which i always enjoy. I thank you all for being here. Its an honor to represent you and the United States senate. I want to start by first acknowledging our collective concern for the people of texas. On this flood. It is of historic proportions. The damage is incredible. And our country are needs to respond in a very aggressive way to help the people of texas. Congress will return on tuesday. And i can assure you that ill be working with my colleagues on both sides of the aisle. To provide a very robust relief to the people today. Who are lives have been up ended. As a result of this storm. I know i speak for marylanders. We understand First Responders from Montgomery County have gone down to texas to help. Thank you. We thank the county for that. We have marylanders who joined in National Efforts to provide relief to the people of texas and this will be continuing. Im always proud of how marylanders respond to the types of tragedy. I want to first explain that starting in january, i became the senior senator. Which means which senator retired, and i miss him. We all miss her. She calls me frequently. She tells me she doesnt miss being in washington these days. And when the president issued one of his morning tweet, she will sometimes call me and say ben, now what are you doing to do . Hes very much engaged in the process. But i want to make sure we use all ten members. All ten members of our congressional delegation. To work on issues that is are priority for the state. So, during this time the congress is not in session. I have been traveling through maryland. To listen to peoples concerns. To explain how i see things occurring in washington. And to get your input. I work very closely with your federal delegation. I thank you for giving me chris van holen. From Montgomery County. Who is doing a great job in the senate. Hes on the appropriation committee. And other important committees and part of leadership. Hes been engaged in effective way from day one. Replacing him in the house of representatives, jamie ras kin. Hes joined with john. Who represents this area. Very well in Montgomery County. On a environmental issues. The chesapeake bay, john delayny who has been sensible in bring our country together in economic policy. We have a strong federal team that i work with in Montgomery County. I want you to know that. Its team beyond. I work with the state officials, county officials. So we can utilize the talent of all ten members to help the people in maryland. Tonight i want to talk about healthcare. I know theres people want to talk about other issues and we will. Im more than happy to talk about whatever is on your mind. Give me a chance, first to talk about the healthcare issues. I am still deeply concerned. Admittedly eight months ago most of us felt the appeal of the Affordable Care act was a foregone conclusion. It did not happen. And it didnt happen because the power in our country is not with the president of the United States, its not with our Traditional Branch of government, and i would con fez its not with the congress of the United States. Its with we the people. You all have the power. And you spoke out against the efforts to repeal then repeal and replace the Affordable Care act. I was with a group in regards to immigration changes this morning. In Montgomery County. They said what can you do to make a difference . Well when healthcare you put a face on the issue. We talked about tens of millions of people losing healthcare, you gave us the specific examples of people who would be at a tremendous disadvantage if the republican bill in the house became law. Or the bill in the senate that was offered by the Republican Leaders leadership became law. We heard about families of children born with severe disability that would have reached their caps within the first couple months of life. We heard stories about people who would not have been able to get the preventive healthcare they need. We heard stories about how peoples lives would have been very much disrupted and they couldnt get the it was a matter of life and death. Im a strong supporter of the Affordable Care act. Im proud to have supported it. I am proud to be part of congress that passed it. [ applause ] the results of the Affordable Care act, tens of millions of people who did not have Health Insurance now have Health Insurance. The results of the Affordable Care act, you now have quality coverage. The coverage which you need. Preventive health care. It provides pediatric dental. We know the tragedy of the driver here in prince georges county, in 2007, who lost his life because he couldnt get dental care. It covers addiction. It covers behavioral health. It covers the services that people need. Its quality coverage. It eliminates the abuse of practices of private Insurance Companies, such as preexisting conditions. Being a woman is no longer a preexisting condition. [ cheering ] you no longer have caps, caps that meant, if you had cancer and you needed the treatment for cancer, you could see the caps within a matter of your first month of treatment. That no longer is the case. Major dramatic improvements to the Health Care System. Now, there are issues that we have to deal with in health care. But the bill that passed the house of representatives would have cut tense of millions of tens of millions of people out of coverage. It would have denied the protection we had an private Health Insurance. It was moving in the wrong direction. Im frequently asked, why didnt you come forward with some proposals with the republicans to improve it . Well, the train was moving in the wrong direction. I wasnt going to get on a train. There wasnt anything in their bill that i could support. I spoke out against it, and we were able to stop it. [ applause ] the same thing with the senate bill, including the skinny bill they put out. It wouldnt have been 20some million, only 15 million. But it would actually have been worse, because the cap they put on the medicaid system was more severe. Im just going to applaud we the people as to how you spoke out, because we the people you know, they tried to divide you. They said, look, well make an exception for children that have very difficult conditions. And the advocates for the children recognize that that was no bargain that they wanted to get on, because if you cut the medicaid system, youre not going to have the facilities in our community to treat our children. System and they knew that if you cut the medicaid system, the states would not be able to maintain the coverage. So you stayed firm. You didnt bend. And we won the vote. And i want to thank the courageous republicans who joined us in that effort. [ applause ] they showed a lot of courage in their votes. Now, several months ago, i introduced legislation because im going to acknowledge the Affordable Care act is not perfect. It can be improved. I would also acknowledge that we never passed a major bill in the United States congress seeing how it works and seeing where you can make it better. I have said that from the beginning. Im a proud supporter of the Affordable Care act. It has done a lot of good. We can make it better. We can improve it. And my legislation deals with two major problems in our in the Affordable Care act. One is the lack of competition. Particularly in the individual market. Now, i want to define the problem so we understand its a serious problem. But it affects a relatively small percentage of the overall market. The individual marketplace, and thats the one where we have significant problems, where we had the rate increases that were Just Announced, is about 6 of our market here in maryland. About 6 . And the premium increases are way too high. And i can explain the reason for it, and theres ways that ways that we can make it better and my legislation does that. And about twothirds of the people in this group get subsidies. So youre really talking about one to two percent that are really in trouble as a result of these changes. Thats too many. Youve got to help them. [ applause ] we gotta make it better. So what does my bill do . First, more competition. So i put back in the one part of the Affordable Care act that we lost that i thought was a tragic mistake. Thats putting a public option in the plan. [ applause ] so that you know there will always be, always be a government plan available. And its always its not going to go any place. Not going to discriminate. Its going to always be there for you, to protect you. The other parts that we do is that if you look at why we had large increases in the individual marketplace, its because of three major factors. The first is that sicker people are joining the plan, whereas Young Healthy people are not. The president has announced hes not going to enforce the mandate. That means younger, healthier people are not going to join. Youre going to have adverse risk selection, which is a pool that is going to be more expensive. President trump could fix that by just enforcing the law. But maybe were asking too much for the president to enforce the law. [ applause ] the second thing is the law provides what we call cost sharing expenses, recovery for the Insurance Companies. Thats so they can reduce their copays and deductibles. That was supposed to be a required payment, but it fell on government to keep the premiums more reasonable in the individual marketplace. But there was a Court Decision that raises question as to whether its mandatory or not. Well, for president obama, that was no problem. Hes going to make the payments because thats part of the plan. President trump is raising questions as to whether hes going to continue those payments or not. Those costsharing payments were made for this month but we dont know if theyre going to be made for the month of september or october. And the insurance premiums reflect higher premiums because of the uncertainty. We can fix that. My legislation mandates those payments very clearly so we know those payments will be received. The third thing that could be done, and this is not too much on maryland but its important in the country, is to use the reinsurance programs in markets that are relatively small. The reinsurance will spread the risk in small groups so that you have more reasonable premiums. It was originally used it has not been used. The Trump Administration is not using it. The legislation i filed would require the use of reinsurance, which would also bring down rates. Now, thats one part of the problem. Theres a second part of the Health Care Problem. And the second part of the Health Care Problem is the cost of health care. Its too expensive. Weve got to bring down the growth rate of Health Care Costs in america. So my legislation looks at several issues that could dramatically reduce the growth rate of Health Care Costs. First on my list is Prescription Drug costs. You cant justify americans paying twice what canadians pay for the exact same pills that are manufactured right here in america. Its well past time for that to change. So my legislation requires the same discounting in the medicare system that we get in the medicaid system and the collective bar cannigaining tha get in the medicaid system so we can use the full market to bring down the cost of prescription medicines. That would be it saves hundreds of billions over the 10year window. Thats a major cost saving. The other is just as dramatic. And were doing a lot of this in maryland and i applaud our maryland legislators who have really taken the lead on this. And that is [ applause ] they deserve a round of applause. [ applause ] they stayed in the medicaid program. They provided coordinated care. They had a small market plan, a payer waiver. We dont have charity hospitals. Maryland has taken the lead in health care and we thank them very much for their leadership. Those in the state legislature. So what we want to do, though, in order to bring down costs is to use more coordinated integrated care models. So if you have a drug problem and you end up in the emergency room in the middle of the night and they give you drugs to keep you alive. And they then tell you to go home and seek treatment the next day, and the person never seeks treatment. Youve got to have the treatment available on site. We have programs that do this in maryland. We have the coordinated program in maryland between schepper and mosaic that does this. But we have to have more coordinated programs. I was partly responsible for the bill that passed the congress, the cure act that provides this integrated care model for addiction services. We got to use this more aggressively in differentiated fields. In kidney care, we can now do telemedicine so people can get their renal treatment at a convenient spot rather than having to travel a long distance. We can use telemedicine. Psycho telepsychic medicine. We can use these different ways of bringing down the cost of health care. So improving the Delivery System is very important to bring down the Health Care Costs. Thats what we should be talking about. So i come here tonight on health care. To tell you, we, the people, have made a difference. We are not out of the woods. I dont believe for one minute that Mitch Mcconnell wont try to bring this bill back up if he thinks he has the 50th vote. So we may see this again. I am encouraged we have chairman alexander and Ranking Member murray, and we have the chairman and Ranking Member of the Senate Finance committee that i serve on, that are calling on bipartisan hearings and working together. Thats what we need to do. But i also listened to Vice President<\/a> for government and Community Affairs<\/a> for Johns Hopkins<\/a>. And i want to welcome you to the Johns Hopkins<\/a> montgomery campus. For 30 years we have been offering graduate Level Education<\/a> courses here. I want to say a little bit about the speaker tonight. Before i introduce him. Senator carden served for 20 years in the maryland house of delegates. He was the youngest speaker ever elected to lead the maryland house of delegates. He was also after that spent 20 years in as a u. S. Congressman from maryland. And had a very distinguished mark there. He was elected to the u. S. Senate and in the senate he is the highest ranking democrat on republican dominated Foreign Relations<\/a> committee. And he also serves on the committees on environment and public works. And also finance. He has a long and very distinguished record on a number of healthcare issues. Hes a great champion of nih. And medical research in general. I want to just take a couple moments for housekeeping before we get into it. Number one, if everyone just as a courtesy could please silence their phones. Also, as a courtesy can you please not hold up signs. It blocks people behind you. We want to have a nice discussion where everyone can see and hear. And that part of the democratic process. I appreciate that. If anyone needs restrooms theyre out to the door and to the right. We are going to have a short presentation by the senator. And then an opportunity for questions. I would say just one last thing on healthcare before i introduce the senator. He has a very long and distinguished career in healthcare. When he was still a speaker of the house, i had the great good fortune to be the Committee Lawyer<\/a> for the committee in the maryland house of delegates. That deals with healthcare dealt with healthcare in the environment. And while i was there, senator carden then speaker carden championed a group a package of about six bills which constituted a major reform of healthcare in maryland. It helped to preserve the maryland medicare waiver. Which has been a great boom to the state. It has helped maryland, although hospital rates seem very high, i will say maryland since that time has had a lower rate of increase than the National Average<\/a> in every year since that time. So, he has great expertise in the area. This is again a time of great uncertainty in healthcare. And we are very fortunate to have a u. S. Senator who has the breath and depth of experience that senator carden has. So very pleased that we are all very pleased that senator carden chose this location. I want to take one more moment and introduce elected officials who are here. I know senator roger. Delegate barkly, i think also is representing congressman ras kin. Recently a state senator. Also here. And with that, i want to introduce senator ben carden. Thank you. Tom, thank you very much. Let me thank tom and the Hopkins Family<\/a> for allowing us to use this opportunity for a town hall type meeting. Which i always enjoy. I thank you all for being here. Its an honor to represent you and the United States<\/a> senate. I want to start by first acknowledging our collective concern for the people of texas. On this flood. It is of historic proportions. The damage is incredible. And our country are needs to respond in a very aggressive way to help the people of texas. Congress will return on tuesday. And i can assure you that ill be working with my colleagues on both sides of the aisle. To provide a very robust relief to the people today. Who are lives have been up ended. As a result of this storm. I know i speak for marylanders. We understand First Responders<\/a> from Montgomery County<\/a> have gone down to texas to help. Thank you. We thank the county for that. We have marylanders who joined in National Efforts<\/a> to provide relief to the people of texas and this will be continuing. Im always proud of how marylanders respond to the types of tragedy. I want to first explain that starting in january, i became the senior senator. Which means which senator retired, and i miss him. We all miss her. She calls me frequently. She tells me she doesnt miss being in washington these days. And when the president issued one of his morning tweet, she will sometimes call me and say ben, now what are you doing to do . Hes very much engaged in the process. But i want to make sure we use all ten members. All ten members of our congressional delegation. To work on issues that is are priority for the state. So, during this time the congress is not in session. I have been traveling through maryland. To listen to peoples concerns. To explain how i see things occurring in washington. And to get your input. I work very closely with your federal delegation. I thank you for giving me chris van holen. From Montgomery County<\/a>. Who is doing a great job in the senate. Hes on the appropriation committee. And other important committees and part of leadership. Hes been engaged in effective way from day one. Replacing him in the house of representatives, jamie ras kin. Hes joined with john. Who represents this area. Very well in Montgomery County<\/a>. On a environmental issues. The chesapeake bay, john delayny who has been sensible in bring our country together in economic policy. We have a strong federal team that i work with in Montgomery County<\/a>. I want you to know that. Its team beyond. I work with the state officials, county officials. So we can utilize the talent of all ten members to help the people in maryland. Tonight i want to talk about healthcare. I know theres people want to talk about other issues and we will. Im more than happy to talk about whatever is on your mind. Give me a chance, first to talk about the healthcare issues. I am still deeply concerned. Admittedly eight months ago most of us felt the appeal of the Affordable Care<\/a> act was a foregone conclusion. It did not happen. And it didnt happen because the power in our country is not with the president of the United States<\/a>, its not with our Traditional Branch<\/a> of government, and i would con fez its not with the congress of the United States<\/a>. Its with we the people. You all have the power. And you spoke out against the efforts to repeal then repeal and replace the Affordable Care<\/a> act. I was with a group in regards to immigration changes this morning. In Montgomery County<\/a>. They said what can you do to make a difference . Well when healthcare you put a face on the issue. We talked about tens of millions of people losing healthcare, you gave us the specific examples of people who would be at a tremendous disadvantage if the republican bill in the house became law. Or the bill in the senate that was offered by the Republican Leaders<\/a> leadership became law. We heard about families of children born with severe disability that would have reached their caps within the first couple months of life. We heard stories about people who would not have been able to get the preventive healthcare they need. We heard stories about how peoples lives would have been very much disrupted and they couldnt get the it was a matter of life and death. Im a strong supporter of the Affordable Care<\/a> act. Im proud to have supported it. I am proud to be part of congress that passed it. [ applause ] the results of the Affordable Care<\/a> act, tens of millions of people who did not have Health Insurance<\/a> now have Health Insurance<\/a>. The results of the Affordable Care<\/a> act, you now have quality coverage. The coverage which you need. Preventive health care. It provides pediatric dental. We know the tragedy of the driver here in prince georges county, in 2007, who lost his life because he couldnt get dental care. It covers addiction. It covers behavioral health. It covers the services that people need. Its quality coverage. It eliminates the abuse of practices of private Insurance Companies<\/a>, such as preexisting conditions. Being a woman is no longer a preexisting condition. [ cheering ] you no longer have caps, caps that meant, if you had cancer and you needed the treatment for cancer, you could see the caps within a matter of your first month of treatment. That no longer is the case. Major dramatic improvements to the Health Care System<\/a>. Now, there are issues that we have to deal with in health care. But the bill that passed the house of representatives would have cut tense of millions of tens of millions of people out of coverage. It would have denied the protection we had an private Health Insurance<\/a>. It was moving in the wrong direction. Im frequently asked, why didnt you come forward with some proposals with the republicans to improve it . Well, the train was moving in the wrong direction. I wasnt going to get on a train. There wasnt anything in their bill that i could support. I spoke out against it, and we were able to stop it. [ applause ] the same thing with the senate bill, including the skinny bill they put out. It wouldnt have been 20some million, only 15 million. But it would actually have been worse, because the cap they put on the medicaid system was more severe. Im just going to applaud we the people as to how you spoke out, because we the people you know, they tried to divide you. They said, look, well make an exception for children that have very difficult conditions. And the advocates for the children recognize that that was no bargain that they wanted to get on, because if you cut the medicaid system, youre not going to have the facilities in our community to treat our children. System and they knew that if you cut the medicaid system, the states would not be able to maintain the coverage. So you stayed firm. You didnt bend. And we won the vote. And i want to thank the courageous republicans who joined us in that effort. [ applause ] they showed a lot of courage in their votes. Now, several months ago, i introduced legislation because im going to acknowledge the Affordable Care<\/a> act is not perfect. It can be improved. I would also acknowledge that we never passed a major bill in the United States<\/a> congress seeing how it works and seeing where you can make it better. I have said that from the beginning. Im a proud supporter of the Affordable Care<\/a> act. It has done a lot of good. We can make it better. We can improve it. And my legislation deals with two major problems in our in the Affordable Care<\/a> act. One is the lack of competition. Particularly in the individual market. Now, i want to define the problem so we understand its a serious problem. But it affects a relatively small percentage of the overall market. The individual marketplace, and thats the one where we have significant problems, where we had the rate increases that were Just Announced<\/a>, is about 6 of our market here in maryland. About 6 . And the premium increases are way too high. And i can explain the reason for it, and theres ways that ways that we can make it better and my legislation does that. And about twothirds of the people in this group get subsidies. So youre really talking about one to two percent that are really in trouble as a result of these changes. Thats too many. Youve got to help them. [ applause ] we gotta make it better. So what does my bill do . First, more competition. So i put back in the one part of the Affordable Care<\/a> act that we lost that i thought was a tragic mistake. Thats putting a public option in the plan. [ applause ] so that you know there will always be, always be a government plan available. And its always its not going to go any place. Not going to discriminate. Its going to always be there for you, to protect you. The other parts that we do is that if you look at why we had large increases in the individual marketplace, its because of three major factors. The first is that sicker people are joining the plan, whereas Young Healthy<\/a> people are not. The president has announced hes not going to enforce the mandate. That means younger, healthier people are not going to join. Youre going to have adverse risk selection, which is a pool that is going to be more expensive. President trump could fix that by just enforcing the law. But maybe were asking too much for the president to enforce the law. [ applause ] the second thing is the law provides what we call cost sharing expenses, recovery for the Insurance Companies<\/a>. Thats so they can reduce their copays and deductibles. That was supposed to be a required payment, but it fell on government to keep the premiums more reasonable in the individual marketplace. But there was a Court Decision<\/a> that raises question as to whether its mandatory or not. Well, for president obama, that was no problem. Hes going to make the payments because thats part of the plan. President trump is raising questions as to whether hes going to continue those payments or not. Those costsharing payments were made for this month but we dont know if theyre going to be made for the month of september or october. And the insurance premiums reflect higher premiums because of the uncertainty. We can fix that. My legislation mandates those payments very clearly so we know those payments will be received. The third thing that could be done, and this is not too much on maryland but its important in the country, is to use the reinsurance programs in markets that are relatively small. The reinsurance will spread the risk in small groups so that you have more reasonable premiums. It was originally used it has not been used. The Trump Administration<\/a> is not using it. The legislation i filed would require the use of reinsurance, which would also bring down rates. Now, thats one part of the problem. Theres a second part of the Health Care Problem<\/a>. And the second part of the Health Care Problem<\/a> is the cost of health care. Its too expensive. Weve got to bring down the growth rate of Health Care Costs<\/a> in america. So my legislation looks at several issues that could dramatically reduce the growth rate of Health Care Costs<\/a>. First on my list is Prescription Drug<\/a> costs. You cant justify americans paying twice what canadians pay for the exact same pills that are manufactured right here in america. Its well past time for that to change. So my legislation requires the same discounting in the medicare system that we get in the medicaid system and the collective bar cannigaining tha get in the medicaid system so we can use the full market to bring down the cost of prescription medicines. That would be it saves hundreds of billions over the 10year window. Thats a major cost saving. The other is just as dramatic. And were doing a lot of this in maryland and i applaud our maryland legislators who have really taken the lead on this. And that is [ applause ] they deserve a round of applause. [ applause ] they stayed in the medicaid program. They provided coordinated care. They had a small market plan, a payer waiver. We dont have charity hospitals. Maryland has taken the lead in health care and we thank them very much for their leadership. Those in the state legislature. So what we want to do, though, in order to bring down costs is to use more coordinated integrated care models. So if you have a drug problem and you end up in the emergency room in the middle of the night and they give you drugs to keep you alive. And they then tell you to go home and seek treatment the next day, and the person never seeks treatment. Youve got to have the treatment available on site. We have programs that do this in maryland. We have the coordinated program in maryland between schepper and mosaic that does this. But we have to have more coordinated programs. I was partly responsible for the bill that passed the congress, the cure act that provides this integrated care model for addiction services. We got to use this more aggressively in differentiated fields. In kidney care, we can now do telemedicine so people can get their renal treatment at a convenient spot rather than having to travel a long distance. We can use telemedicine. Psycho telepsychic medicine. We can use these different ways of bringing down the cost of health care. So improving the Delivery System<\/a> is very important to bring down the Health Care Costs<\/a>. Thats what we should be talking about. So i come here tonight on health care. To tell you, we, the people, have made a difference. We are not out of the woods. I dont believe for one minute that Mitch Mcconnell<\/a> wont try to bring this bill back up if he thinks he has the 50th vote. So we may see this again. I am encouraged we have chairman alexander and Ranking Member<\/a> murray, and we have the chairman and Ranking Member<\/a> of the Senate Finance<\/a> committee that i serve on, that are calling on bipartisan hearings and working together. Thats what we need to do. But i also listened to President Trump<\/a> and i see what hes trying to do. And it concerns me that there could be additional tactics used. I want to say one more thing about health care. That was outrageous. And that is the manner in which this bill was considered. And you should be concerned about this. [ applause ] you should be concerned about this. We saw the bill we voted on about two hours before we voted on it. Ha and it was released in the middle of the night. I forget exactly what time it was. And we were expected to have a debate on that. There was not one effort for a committee hearing, not one opportunity in committee to offer amendments to change the bill. Unlike the Affordable Care<\/a> act that went through numerous hearings, months of hearings, months of markups, many, many amendments, by democrats or republicans, that became part of the bill. Process is important were a democracy. Process is important. [ applause ] so, as we return to washington on tuesday, as Congress Comes<\/a> back into session, theres a lot of issues that are going to be coming up. I mean, theres a lot of issues. We have not passed the fy18 budget yet. I know thats a surprise to my friends in the state legislature who passed their budget months ago, and the county council that passed their budget. We are on a fiscal year that begins october 1. We have less than four weeks by the time we come back, as to the end of the fiscal year. Were also running into the risk of not paying our bills because of this arbitrary debt ceiling that we have that could cause much higher Interest Rate<\/a> costs for the federal government and we wont be paying some of our bills. All that is coming to head as well as President Trump<\/a> asking us to pass tax reform. And the Republican Leaders<\/a>hip has indicated they may use the same faulty process that they use for health care for tax reform. If they do, theyre going to run into the same type of opposition in the United States<\/a> senate. [ applause ] so we have a full agenda. We have a lot were going to talk about. I really enjoy town hall meetings. And i promise i know people want to talk about different issues. If we could, lied id like to first, if we could, start with questions you might have on health care. But i assure you there will be time to ask other questions. I guarantee that. On health care. Theres mikes there. Give him this mike. Yes, sir . Is it time for us to move to a Health Care System<\/a> similar to canada where [ inaudible ] where health care is a right simply by being a citizen . [ applause ] okay. Ill repeat the question. We do have mikes around here. The question is, is it time that we go to a Health Care System<\/a> like canada, where everyone is guaranteed Health Coverage<\/a> and health care is a right, not a privilege . [ cheering ] so let me explain the three options that have been talked about that move in this direction and let you know the status of all three. The proposal that you hear frequently known as medicare for all woo is to guarantee that theres a Health Care Plan<\/a> available for everybody. That doesnt change the current way we finance health care. Medicare for all does not. Medicare for all allows for a public option for everyone. Ill get to single payer. Give me a chance. We also have a proposal thats been introduced to deal with the 55 to 65yearolds, because they are the growth that are discriminated against under the current funding laws. They pay three times as much as the younger people pay for the same coverage. And were looking at a medicare for 55 to 65yearolds. Just want you to know, these are two proposals that are very much out there. The single payer proposal is a proposal in which the government will pay for the cost of everyones Health Coverage<\/a> and we will have everyone covered through private carrier Insurance Private<\/a> providers. Private providers. But no Insurance Companies<\/a>. So its all paid through the federal government. Yeah [ applause ] i am committed to universal coverage. I am committed to everybody in this country having health care as a matter of right. I am very much sympathetic on the single payer as a way of getting there, because it saves money. It is much more efficient on its administration. There is a concern that i need to see worked out. And that is, with federal budgets as tight as they are right now, i need to know that there will be sufficient funds appropriated so we dont jeopardize the quality of health care in this country. I think that can be done. So to answer your question, im going to continue to advocate and vote and legislate to make sure that we have truly universal coverage and that health care is a right in this country. Absolutely. [ applause ] yes . Thank you. Thank you. What id like to know is, what is passable . A majority, whether theyre republicans or democrats, we all have great ideas. Weve all been frustrated with health care and benefited from it. But what do you believe its going to take in the senate and in the congress to get a majority to move forward on any of these specific proposals that you put forth . Thank you for that question, because i think that is a very important question. But i want to divide that. Im going to answer your question. But i dont think we should ever lose our vision as to what should be the Health Care System<\/a> in this country. So i want to make it clear. We might not be able to pass a truly universal coverage bill in this congress, recognizing the president of the United States<\/a> and the control the two houses of congress. But im going to continue to advocate for that, speak out for it, because i think its what america needs. The people of this country need a better deal on health care. They need to know they have Affordable Health<\/a> care. Let me just underscore the point that some here have made. The average cost for someone to have Health Expenses<\/a> today i dont know the exact number but somewhere around 5,000 per capita in this country. Think about that for a moment. Depends on your age. Depends on your age. Follow me for one moment. If its higher, that makes the point even stronger. Thats about 20,000 to 25,000 for a family of four. Okay . If a family of four does not have an employer that provides health care for them and they have to pay for their own maybe theyre a Small Business<\/a> owner, an individual that works for a Small Company<\/a> and theyve got to pay for their own insurance. How many people can afford 25,000 a year for Health Coverage<\/a> . Its not affordable. We need a more aggressive way to make sure universal coverage really means universal access to care. Thats why i tell you im going to continue to advocate for it. We are unlikely to get that in this congress. I wanted to make that clear about my position. What can we get in this congress . [ laughter ] were gonna i hope to prevent bad things from happening. I hope, part of the bill i introduce can pass, including the pharmaceutical costs, because President Trump<\/a> said hes for that. So well work with him on that. Dealing with the costsharing payments. I think we can get that done. We may be able to get reinsurance done. My bill also increases subsidies for lowerincome families. I dont think we can get that done. I should have mentioned that. Because, as i said, right now we provide subsidies up to 400 of poverty. If you have no one helping you with health costs, its not affordable for you. So we need to be more aggressive. I think we can get some of that done. But i am not overly optimistic that we can get to a truly universal, affordable Health Care System<\/a> under the current makeup of washington. Tax the rich so how do you pay for it is another story. Look, i can get to tax reform, and i will before we end. Ill give you my spiel on tax reform. So i have a question about your israel boycott act. I want to put aside the constitutional issues. I know theres some debate about it. Im going to ask this question, and you cant stop me from asking this question [ yelling ] free speech please, please, everybody im asking this question now please respect him. [ yelling ] lets be respectful. Lets hear your question. Go ahead. Let me okay. I want to put aside the constitutional controversy about your israel boycott act and ask you simply your intent about the bill, not about different peoples constitutional interpretations. Im going to give you an example. Suppose theres a person from rockville named joe [ yelling ] suppose there is joe, who lives in rockville, who has a Construction Company<\/a> and he sees that the unhcr has put out a blacklist of companies that profit from the settlements. Suppose he sees that cater caterpillar tractor is on that list. Suppose he says, oh, i need a tractor, but because of this list, im not going to buy a caterpillar and he puts out a statement on his website saying im buying john deere instead of caterpillar because i saw this on the website. Their blacklist. Do you believe that he should go to jail for up to 20 years . Do you believe joe should go to jail for up to 20 years . I think you misread the bill. He would not be in violation of the legislation i followed. So give me a chance to answer. 40 years ago Congress Passed<\/a> the antiarab boycott legislation, which was a statement that, as far as Foreign Policy<\/a> is concerned, were not going to let foreign governments control our Foreign Policy<\/a>. So well protect companies that we will protect companies from being coerced into supporting a boycott in order to do business in that country. This is not coercion. Let me finish the answer, please. Let me answer your question. That was tested in the courts. And found to be constitutional. The legislation i filed builds on that legislation. It does not change the sanctions. Does not change any of the standards except it says that if you are being forced to require to comply with an International Organization<\/a> boycott the same as a foreign country. Its a simplification but its basically the bill. Therefore, if you as a businessperson in this country want to speak out against what israel is doing, if you want to boycott israel as a sign of your protest, if you want to encourage other people to boycott other businesses that boycott israel, you have the absolute right to do it and theres not one thing in my legislation that would change that. Not true [ applause ] i just urge those who have any doubt to read the bill. Ive read it next question. Thank you. I have an issue. Theres people in the line right now. Okay. Senator, first of all, let me thank you on behalf of many people here for your leadership on health care issues. [ applause ] in the senate. We greatly appreciate it. [ applause ] you may have heard that the Trump Administration<\/a> is Just Announced<\/a> has Just Announced<\/a> that they will be reducing the amount of funds that are going to be put towards enrollment for the Affordable Care<\/a> act this fall. Clearly, thats going to have a negative impact on the numbers and, in turn, create a spiraling story of how the aca is going down. The congressional delegation, for the most part, not completely, but for the most part has been great on this issue. But you yourself have indicated that theres only so much you can do. What can you, as a u. S. Senator, and us as representatives of this great state, do to push the Hogan Administration<\/a> to fill those gaps that the federal government, led by the Trump Administration<\/a>, is refusing to do, to ensure that everyone who is eligible for the Affordable Care<\/a> act to get coverage, to get coverage under medicare, et cetera, knows about it and gets the health care they need . Great question. I have so many friends here. Youre absolutely correct in that President Trump<\/a> has taken steps that jeopardize the viability of the Affordable Care<\/a> act. Hes done that by the cost sharing. Hes also done that by not funding those who assist people in enrolling and getting information out about enrolling. Hes also done that by not enforcing the mandate and not giving education to younger people particularly to sign up and that its in their interest to do it. All of this has made the Affordable Care<\/a> act in jeopardy. Insurance companies are less likely to participate, because they dont know about the cost sharing. And individuals are less likely to join because they dont know the facts. They dont get the information. Out of sight, out of mind. And they are not enforcing the mandate. The state of maryland can do things. The state of maryland has been active and tried to fill some of the void. The tragedy is, money has been appropriated for the federal government to get facilitators at the state level to get people enrolled. The federal government has stopped releasing those funds. We have found that over and over again, the Trump Administration<\/a> has not only ignored the law, they have ignored congress. We will continue to be forceful. I think in this case, we might have enough support from republicans to get some language in the appropriations bill to assist taxpayers in the exchanges. But the states could help fill some of the void. Good evening, senator. I am from health care now. I am wondering if your proposed legislation is a molar to or this same as bill 676 in the house, submitted by john conyers. My guess is that is medicare for all. Yes. As i said, i am going to be supporting legislation i have no believe that the Republican Leaders<\/a>hip is going to take my bill and use it as a vehicle for Health Care Reform<\/a> in congress. I will continue to speak for universal coverage. I support improvements in the health care law, whether it is getting people enrolled, or taking on pharmaceutical cost. I do support medicare for all and i do have medicare for all in my proposal. I am not clear on whether your bill is similar. Is it a singlepayer Committee Method<\/a> or opening up the medicare plan . If thats what it does, then its similar. Its a singlepayer . Thats different from what i thought. Thank you. Thank you, senator. I stay in touch with you on a regular basis. Thank you. You have always done the right thing as far as i am concerned. My question is about selling the Affordable Care<\/a> act. I find that so many people dont understand what its about or understand the economies of scale. You are talking about the entire population of this country as opposed to 40 of it or 30 of it. That, and for pharmaceuticals as well. I get prescriptions that say ok, you pay 10, but what is the price of this . 188. Those kind of things. If a Pharmaceutical Company<\/a> can sell it to me for 10, then if we have an economy of scale, that never happens. Those are one of the issues i have. How to go about selling the Affordable Care<\/a> act to the population, especially those out on the west coast to seem to have no concept of what economies of scale mean. Thats my first question. My second is i am a retired fed. As a retired fed who negotiated with boeing, lockheed, the whole 10 yards, economical terms of collective bargaining agreements, all of that, i want to know what can be done to stop the Trump Administration<\/a> from trying to roll back what we have earned as employees. First, on the Affordable Care<\/a> act, during the height of the debate on the Affordable Care<\/a> act, there were surveys that were done, and if you asked americans how they felt about obama care, it was pretty evenly divided. If you ask them what they felt about the Affordable Care<\/a> act, they love it. During this debate, as you know, it has been described as the repeal of obama care. When you describe what its in the limits of Insurance Companies<\/a>, preexisting coverage, people love it. You are working with working families, veterans, older people. They love it. We have found a great deal more understanding of the medicaid system. Your point is well taken. We need to do a much better job on educating the public on the Affordable Care<\/a> act. And look, anything obama did, trump is going to be opposed to. That, to me, is very regrettable. Our federal work force i am very proud to represent our federal workforce. The missions they do are more complicated than ever before. The work done here in Montgomery County<\/a> at some of our federal facilities is incredible. And the work is unbelievable. Fda, i visit them frequently. Some of the most talented people in the world working as federal workers, and they are completely attacked over and over again during the budget process. There have been freezes, government shutdowns when they havent been paid, adjustments to retirement. Its outrageous. I am proud to have been selected by the Democratic Caucus<\/a> of senators to keep the caucus informed. I work closely with chris van hollen, mark warner, and tom tim kaine to make it clear we will fight every effort to hold the federal work responsible for the debt that was accumulated tax cuts and irresponsible policies, but not our federal workforce. We will make sure you have time. I appreciate the work you have done, and you know, the aca has 10 an important step has been an important step towards getting killed care to millions of people, but its not sustainable. Universal coverage is guaranteed health care. What i would like from you is for you to declare health care as a human right and that everyone should have coverage from birth to death, or prebirth to death, and that we should join the 56 or more developed countries that do provide singlepayer health care to their citizens for a fraction of the cost. Their citizens live longer and have Better Health<\/a> outcomes. Let me be clear. I believe health care is a human right and that universal coverage is absolutely essential. We should have Seamless Health<\/a> care, affordable to all people. I agree with you. Just having coverage is not enough. One of the real achievements of the Affordable Care<\/a> act is if you go to prince georges county, they are now providing much more comprehensive care than they ever have. People who didnt have access to mental health, dental care, ophthalmology, a lot of these services, now are getting these services. The Affordable Care<\/a> act moved us in a giant step toward having this available in addition to being affordable. I agree with every one of your points and may very well support your last point. I just want to make sure that in doing this, we dont compromise our commitment to Quality Health<\/a> care. I am a proud democrat. I believe government is there to help people. I want to see government continued to work in an aggressive way to provide those services. But i also know the government does things in tough times that can be counterproductive. I want to make sure with health care there are certain protections. Will there be mandatory spending or permissible spending . A level guaranteed by law or not amendatory level guaranteed i law . How will a mandatory level guaranteed by law . These are questions that must be answered. Yes, i believe we have a responsibility, that health care is a right, not a privilege, that every person should have full access, that we maintain facilities that guarantee access like other countries, yes, all of that i support. Ok. Click senator cardin, earlier you said it was not your intention to criminalize boycotts. I looked into the israel antiboycott act, and you invoked upon any individual who attempts to violate the act action 206 of the emergency economic powers act. Section 206 of the economic Emergency Powers<\/a> act paragraph c designates that any individual in violation can be given a criminal penalty of up to 1 million or sent to prison for up to 20 years. This indicates that you are in fact criminalizing boycotts. I would like to ask you, in order to remove any danger of that occurring, will you remove all references to the International Emergency<\/a> economic powers act . And section 11 of the export Administration Act<\/a> of 1979. I think you described that absolutely accurately. The legislation i filed is based on current law. The penalties you are referring to our current law penalties. There has never been the use of criminal sanctions in this law, as i explained when the bill was first debated. I dont seek to have criminal penalties in regards to these activities. I dont think its necessary, and im willing to clarify the legislation in that regard. But its not something i put into the law. It has been in the law for 40 years. I just want to point that up. I dont want to i just want to clarify that. I am prepared to look at modifications that make it clear that we are not seeking criminal sanctions. So remove references to this law from the israel boycott act. There are a couple of ways you can draft this. I dont know if we will go back to the original law because i am not sure of the consequences of that, but in regards to what i have filed in regards to International Organization<\/a>s, we are not interested in using criminal sanctions. Thats a lie. Thats reassuring the question, i think asked we do one at a time. And i really appreciate the way the question was asked because i did not put criminal sanctions on the activities that were expanded. That was existing law. That was existing law. There has never been the use of criminal sanctions. And i am agreeing with you that we dont need criminal sanctions in that regard. How about torture . You will do that . I will take questions and answers. Will you remove the reference to this law from your bill. I said i will clarify the bill. [ crowd shouting ] i think i answered it. Next question. [ crowd shouting ] skipping the line because apparently human rights are not in gaza or the west bank. Its only in the United States<\/a>. Please dont use that language. Thank you. We are all americans, please treat each other more kindly. [ applause ] senator cardin, i applaud your efforts to advance health care, and i am not going to rebut them point by point because i feel that the Public Private<\/a> option proposals you have articulated in your bill are bound to fail and i wont address them. What i would like to address is the issue of leadership. You are our senator. We have elected you. And we, the people here, i believe, would probably unanimously like to have a singlepayer Health Care System<\/a> for reasons you articulated. Please, if you are for medicare for all or a singlepayer system, please raise your hand so you would send a message to the senator. Thank you. The other issue i would like to address is this. While you may not be able to get universal singlepayer health care through this congress and through this administration, were looking for leadership. Were looking for leadership for the future. Americans in poll after poll have shown that they would like the government by vast majorities, particularly in the democratic party, to have a medicare for all system. Why are you not on board with that . Well first why im not on i dont know how to articulate this any stronger than ive said. I want to make sure we have universal coverage. You can get to universal coverage through a singlepayer system. I can support a single payer system but i need to know how its financed and to make sure that it provides adequate assurances that there will be sufficient resources committed by the federal government so that the quality of health care is not diminished. I have seen incredible results from health care. Some of its pretty expensive. People that used to get death sentences now have useful life. I want to make sure we continue that Cutting Edge Health<\/a> care in america so that a woman who has Breast Cancer<\/a> survives, so that a child born with difficults will get health care throughout their life. I want to make sure the plan i endorse includes that. I believe in universal coverage. Health care is a right, not a privilege. Every american should have full coverage from prebirth to death. And that i will support those proposals that carry that out. But i would just hope you all would understand that there is a concern. America does have the highest technical quality in the world. And i invite you to visit our medical centers and see how many foreign guests we have receiving health care treatment. See how many foreigners we have that are trained in our medical facilities. This is good. I am not saying this as a negative. I want to make sure that our system provides cuttingedge, Academic Health<\/a> centers like Johns Hopkins<\/a> so they can continue to do their leading work. When you put all your eggs in the federal basket i want to make sure the protections are there. I am not against what you are suggesting. In terms of leadership, i assure you, i assure you that i will be in the forefront of the health care i have been in the forefront and will continue to be from my days in the state legislature on marylands allpayer rate structure, to the pediatric dental to the Minority Health<\/a> and Health Disparities<\/a> are all issues i started and i will continue to be a leader on health care for all. [ applause ] my name is eric. I am with physicians for National Health<\/a> program. I guess what i would like to see in this country is true Health Security<\/a> and i dont any of us really dont know what that is or most of us dont know what that is. Were just one firing from our job away or one stealing of our pension benefits away from not having health care. And when you live in a country that really guarantees health care and not Health Coverage<\/a>. Health coverage is a business term. Its not what we are after. We are after access to health care. And so i would like to see a system where people didnt have to worry about losing their Health Insurance<\/a>. I think most people in this room probably do not like their Health Insurance<\/a> companies. I can probably guess that most people have a story either of their own or somebody elses about fighting with a Health Insurance<\/a> company to get the care we need. Doctors do it constantly. Theyre spending 20 of their time on it. Thats what i would like to see. A commitment not just to universal coverage but true access to care for everybody so theres no barriers to care. You dont have to worry about getting your co pay out when you go to the emergency room. We have 28 Million People<\/a> uninsured in this country. We have more than that who are underinsured and report 40 of people report that they put off getting a medicine, going to the doctor because its that or do i have enough to pay the rent or do i have enough to because a lot of people are just on very tight budgets. I couldnt agree with you more. I want to make sure everyone has access to Affordable Care<\/a> and is able to have the resources, whether it is a copay, a deductible, restrictions, and thats true whether you have the improvement of the Affordable Care<\/a> act or a single payer system. Whatever you have, there could be obstacles put into it that deny people full access to care. Waiting periods, caps, all of those things could be in a singlepayer system. I want to make sure they are not. I agree with you. I agree with you completely. Thats why we fought in the Affordable Care<\/a> act to remove many of these obstacles that were previously in the law. What you have created is a system that is evermore wasteful. I mean, doctors, you know, sometimes they have to figure out what the Insurance Company<\/a> was willing to pay for before they write a prescription. I agree with you. Thats true. But that also would be true we have the same type of concerns in the medicare system. We also have it, by the way, in the v. A. System. I think the problems you have identified we want to make sure that look. I think were all in agreement. What weve done is create a system where we provide care for certain groups of people but at the same time weve taken it away from other people and some of the evidence for that is that our Life Expectancy<\/a> last year decreased. Look, our health care results show that we have significant challenges in the way that we have organized health care in america. I agree with that. Thats one reason we have to design it in a way that works. One of the problems that weve had. Weve had Government Programs<\/a> such as v. A. And weve had major gaps in the v. A. Plans. So we want to make sure that whatever system we have, that it carries out the first three points that you just said, that health care is a right. That theres full not only coverage but access to all Necessary Health<\/a> care that people can afford. Thats what we want to make sure is accomplished. Are there better ways of doing it . Yes. Is singlepayer a reasonable way of getting there . Yes. But we have to make sure there are protections in whatever we do so the concerns you raised do not become a problem. The next question . Senator senator senator, i was asked to address [ crowd shouting ]. You can get in line just like i had to. I know im going to get into trouble with the audience. Can i ask this person ask his question . Go ahead this youll go next. Youll go next. Let him ask his question. Let him ask it. Thank you. Thank you, senator. This is a weird situation in part for me because i am half the way with you in fighting against the republicans and i think its great we kill what theyre doing. And with the people in this crowd who are pushing for single payer now. I want to liquidate Insurance Companies<\/a> and give everybody medicare. I see uninsured people. I believe that passionately. And i believe in what you are trying to do. We dont get a chance to speak is the problem. We dont get chance to talk about what is happening outside these borders. We never get a chance to say what about health care for people in gaza. What about the seeds of our tax dollars that are paying for that deny access to what they need. Will you please do it town hall to discuss over 3 billion in unconditional aid to the state of israel, a policy youve supported for your entire political career that a lot of young people of all backgrounds in this country are opposing . [ applause ] so let me answer this in a couple different ways. I do a lot of town hall meetings. I like townhall forums. We do talk about Foreign Policy<\/a>. We do talk about israel, syria, the palestinians, north korea, russia. Theres a lot of issues. I am the ranking democrat on the senate Foreign Relations<\/a> committee, so i get engaged in a lot of Foreign Policy<\/a> issues and im more than happy to have a general discussion on Foreign Policy<\/a>. Not as many people show up to those area just letting you know that. That i am more than happy to but i dont think attendance more than happy to. In regards to the this is a tragic situation, the israelipalestinian lack of peace. Just give me my views, theres only one path forward, two states living side by side in peace, a palestinian state and a jewish state. I am very disappointed that the leadership have not brought us to that point. I think it has been tragic for the israelis and the palestinians. And the United States<\/a> has tried. John kerry said [ shouting ] john kerry put in more personal time between the palestinians and the israelis, and i have talked, i have been to the west bank, ive talked to palestinian leaders. Ive been to the gaza border. I frequently meet with leaders who come to the United States<\/a>. I meet with leaders from the middle east to travel here from the surrounding countries. Believe me, i understand the frustration thats out there. [ shouting ] the only way you are going to get peace is with the party sitting down and negotiating, and thats going to require leadership between the palestinians and israel. [ shouting ] let there be light. Were not [ shouting ]. Next question . Senator, at the present time, we have the Affordable Care<\/a> act. Whether we will have it on wednesday, i cant tell you. But we do have it now and i would like to make a suggestion of how there may be better methods of doing this, but this is a method of helping to allow people to afford Affordable Care<\/a> act premiums without going to large deductibles or anything else like that. There are counties in the United States<\/a> that have no Insurance Company<\/a> which will supply insurance to them. Thats not true any more. But what we can have instead is a an insurance carriers any insurance carrier from any state could act as your insurance carrier, the persons insurance carrier. We have that im a grandfather. And we had that, for example for our 529 programs. I could go to the state of maryland and give money for my grandchildren to get an education. I could go to the state of virginia and go to their and get the same or similar policy. Or equities. The same thing holds true with Insurance Companies<\/a>. You can have metropolitan life, who does not insure in xcounty in oklahoma, and say, well, were going to allow any of the 30someodd Insurance Companies<\/a> to be able to issue premiums in this in every county in the United States<\/a>. By doing that, you have competition. Youll have lower prices. Youll have a the best policy that we could get. First, as has been pointed out, at least for this round of the Affordable Care<\/a> act, every jurisdiction in the country has at least one participating provider. So we i couldnt agree with you more. We need more competition. I said that from the beginning. We need more competition. I agree with you on that. I think the best way to have competition is to have a public option so you know you have a guaranteed plan that doesnt vary by politics. I think thats the best way to get guaranteed policies. Now what youre talking about basically are the individual marketplace. The other marketplaces theres sufficient competition. And of course if its a big company they have arissa protection under multijurisdictional law already. So they have abilities. The challenge here is that insurance is regulated at the states, not the federal government. We do not have a Regulatory Framework<\/a> to guarantee that an Insurance Company<\/a> is doing business in a safe way. Thats the state insurance commissioner that does that. So we dont have that mechanism at the national level. And if you start allowing national Insurance Companies<\/a> to write in the states without protection, without knowing they have the solvency, the reserves, et cetera youre going to run into a safety issue and a consumer product. I think this is a federalism issue. You need to talk with the states. The states are work out arrangements with sister states. I think thats probably the better way to do it than have the federal government mandate that a Insurance Company<\/a> in texas can write a policy here in maryland. [ applause ] good evening, and thank you for the opportunity. I have lived in maryland since 1982. And i immigrated to the United States<\/a> in 1972. I wanted to thank you very much for supporting the arab American Heritage<\/a> month. Im the founder of that month since 1997. You always send us citations and gentlemen from your staff attend our functions. Now, tonight is a very holy night for the Muslim Community<\/a> and thats why many muslims are not here tonight, my family included. Theyre fasting because today is like a yom kippur to the Jewish Community<\/a> and Christmas Eve<\/a> for the christians. Next time if you do a town hall meeting, please keep that in mind. Our community is also concerned about health care issues. I am palestinianamerican. I was born and raised in palestine. In 1967, i was 12 years old when i was pushed out with my family and my whole entire village. Barefooted in the middle of the night, was forced to live in nowhere, with hunger, for two weeks, many weeks no food or no water just to build an illegal izzi settlement on the land of my ancestors. Where i lived is an illegal settlement. My family the land was stolen from them inch by inch, every day. You honor me as an arabamerican but you dishonor me as a palestinian. I already paid the price. My family has been harassed. Many people in the audience know that. And im sure your staff know that too. We have been paying for that. Now, we have to pay for your bill, the bill that you are introducing . Ever since i heard about the bill. Ive been sick. My Blood Pressure<\/a> is going up as i am speaking right now. My temperature, my sugar, everything is rising. You need to convince me that i do not have a Million Dollars<\/a> to give you, but do you want me to go to jail for being palestinian . For being a Good American<\/a> citizen . For contributing thousands of hours to our School System<\/a> . Volunteering . Please explain to me and convince me that you are not going to penalize me as just because my ancestor and myself as being palestinian . And now im palestinianamerican. Your loyalty should be to the United States<\/a> of america, not to a foreign country. [ applause ] we live in the greatest country of the world. Were a country that embraces diversity and we are stronger because you have come to america from all parts of the world to build a stronger country. You came here because this country offers incredible opportunities. Our grandparents came from the oppressions of eastern europe. They came here. Better life for their children and grandchildren. Now their grandson serves in the United States<\/a> senate. This is a great country and we welcome people coming here. That is why i have been outspoken about President Trump<\/a>s immigration policies. To me, they attack the strength of our nation. The strength of our nation is not in our military although we have a great military. It is not in our economy even though we have a strong economy. It is in our values. Values of respecting and embracing diversity, human rights, good governance, democracy, fighting corruption. All those things. Not only our interest here in network but our global interest in these issues. That is why i support and work very hard in order to protect. I can assure you that i will never support or introduce bills that will have you have such a penalty because of your beliefs. Absolutely not. The bill does not do that. I dont know how else i can say that. Some of the people who have questioned tonight have been very accurate in the way they describe the legislation. [ inaudible ] what this bill deals with is being coerced to comply with a foreignimposed boycott. It has nothing to do with your individual rights to espouse your belief or take action based on your beliefs or your commercial activities. Your speech and your commerce are totally protected. Please the aclu and many others have said the aclu, which i i appreciate everybody having views. But if we could stick to the question and answer format i think it would be better. Let me assure you i have ihave a great deal of respect for the aclu. I strongly support a lot of their positions. I would ask you to go back and talk to the aclu because the initial letter was not accurate and i think they would acknowledge that to you. What about the family he didnt let next question. [ shouting ]. What question didnt i answer . She asked about youre not up there. I thought i answered the question. I thought i answered the question. Next question. Senator, because of the childrens Health Insurance<\/a> program enacted about 20 years ago weve achieved nearly 95 coverage for children in america. Thats extraordinary. The bill that authorizes this program is up for reauthorization in this congress. The question is im assuming youre going to support it but how can we make sure that this legislation for all of our children and reaches that 100 gets passed by this congress . And i have the same question. Good. Thank you. The childrens Health Insurance<\/a> program, the c. H. I. P. Program, was passed by the strong bipartisan support in the congress. It has been reauthorized by strong bipartisan support. I dont believe i dont think there is a risk that it will not receive strong bipartisan support on the next reauthorization. I believe it is a very Popular Program<\/a> and is one that is very likely to be reauthorized in time, during the normal process. I know the chairman of the committee, senator alexander, supports the reauthorization. I know senator hatch, the chairman of the finance committee, these are two republicans that support reauthorization. The Democratic Caucus<\/a> has made this one of our top priorities. It has been a very Successful Program<\/a> and i am optimistic that well have the support to reauthorize that program. [ applause ] senator, i think youre very correct in saying that competition is a key to having lower prices in insurance markets. I would also encourage you to consider the competition we need to bring down Health Care Costs<\/a> themselves. More doctors, more hospitals, more manufacturers of pharmaceuticals. Those will also bring down costs. As whether im paying for my health care myself, insurance, or through the government currently if im sick i call my physician and he tells me come in next week or two weeks from now. I would encourage you that we need more supply to meet the demand of health care also. I think that is true in some cases with Health Care Providers<\/a> but not all. There is a critical need in many communities for Health Care Professionals<\/a>. It is not just doctors and hospitals, it is also the allied health field which are your nurses, therapists, your assistants. And i know in Montgomery County<\/a>, theres a strong effort to train the Health Care Professionals<\/a> in these fields. It is a growing field that has done well. I agree with you. Particularly as it relates to our nurse shortages. We have had licensing issues in some jurisdictions on what allied Health Professionals<\/a> can do. We need to take a look at that. It is not only a matter of having competition and access, but also to be able to make sure its cost effective. And i think questiwe can do a m better job on work force issues. Yes. Senator, i have never attended a townhall hall meeting before and i came tonight, because two weeks ago i was in canada. My husband had an emergency. He damaged his eye. And the wait in the Emergency Rooms<\/a> in canada in rural ontario average about six or seven hours to be seen just for the first part of that. And so tonight i came here to say, okay, where are we in the u. S. . And i think youve explained a lot. And one of the things that is most important is this access issue. And here in Montgomery County<\/a>, we can drive to sibley or suburban. We have shady grove hospital right here. In the rural areas, it is much more difficult. And one of the things that we need to do, and make sure that we have is this is getting something to continue the Affordable Care<\/a> act. And my question is basically, who on the republican side should we be talking to . The reason we have gotten this far, to some degree, is because of the pressure that has been on the republicans. And we have three of them who voted, even against the skinny bill last time. The question is, who should be really be focusing on . That is a question that is asked of me frequently. How do you get engaged . How do you make a difference . The first thing i would urge you to do whether it be health care or immigration or whatever the issue might be, is dont get distracted. This president has an incredible ability to distract. Dont get distracted. Hell come up with something tomorrow. Maybe it will be the crowd size that was here tonight. I dont know what its going to be. Hell claim he had a much bigger crowd than i did. Ill concede that. I dont know what its going to be. But stay focused on the policy you are trying to impact. Secondly, give President Trump<\/a> credit, he has energized people in this country. [ applause ] so, you have people on your side that want to help you. Find likeminded people, and join together. That has happened here in Montgomery County<\/a> and throughout the country. In communities where we never thought we would see this type of grassroots activism. That is very important. So i encourage you to do your own individual work, but work with the energy thats here and do it in a way that youre not distracted because of the changing subjects that the president has been able to do through controlling social media. And then, on the health care issue, to me, it has been the faces. It has been the real stories. We respond to people. Its been i mean, weve had people in our office who have given us heartwrenching accounts of how they survive in our Health Care System<\/a> today. And what it would be like if this bill that was being considered became law. I was telling you, for some people it is really a matter of life and death. And it was. So, being able to personalize this that is one of the reasons we were able to get the c. H. I. P. Program passed. We personalized it to the children who are innocent in all of this. A should not be at a disadvantage because of their parents. They should be able to get care. And so if you make it a more personal story you can get results. And then, look, we did a great job explaining the Medicaid Expansion<\/a> and what it meant. I think at the beginning of this debate, most people thought it was a welfare program. Its not. These are working families that got the expansion. To explain and our state legislators were extremely helpful in that also. Which legislators do you contact . All. You know, in todays world its not that difficult to send social contacts. I would do them all. 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