Thanks for being with us. Thanks. Keep us in your thoughts and prayers. Health care also the topic at ben cardins town hall. He reveals efforts to repeal and replace the law and the future of health care. Tonight we are hoping to have a town hall meeting where we can have a discussion about health care. I want to welcome just thank you to. Free speech for all lets just have a discussion for all. So good evening. Welcome to everyone who came this evening. My name is tom lewis, im the Vice President for government and Community Affairs for johnson hospital kiJohns Hopkins and i want to welcome you to the Montgomery County campus. I want to say a little bit about our speaker tonight before i introduce him. Senator cardin served for 20 years in the maryland house of delega delegates. He was the youngest speaker ever elected to lead the maryland house of delegates. He also spent 20 years as a u. S. Congressman from maryland and had a 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 the environment and public works and also finance. He has a long and very distinguished record on a number of Health Care Issues. He is a great champion of nih and medical research in general. I want to just take a couple of moments for some 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 is part of our democratic process. So i appreciate that. If anyone needs restrooms, theyre out 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 health care before i introduce the senator, he has a very, very long and distinguished career in health care. When he was still speaker of the house. I had the good fortune to be the Committee Lawyer for the committee in the maryland house of delegates that deals with health care dealt with health care and the environment. And while i was there, senator cardin, then speaker cardin, championed a group, a package of six bills that helped to preserve the maryland medicare waiver, which has been a great boone to the state. It has helped maryland although hospital rates seem high, i will say that maryland since that time has had a lower rate of increase in the National Average every year since that time. So he has great expertise in this area. This is a time of great uncertainty in health care and we are fortunate to have a u. S. Senator who has the depth of experience that senator cardin has. So very pleased we are all very pleased at hopkins that senator cardin chose this location. I wanted to introduce elected officials here. Senator man know, delegate barkley. I think jenny funt, representing congressman raskin, is also here. With that i want to introduce senator ben cardin. Thank you. Tom thank you very much. Let me thank tom lewis and the Hopkins Family for allowing us to use this opportunity far town hall type meeting which i always enjoy. I thank you for being here. Its an honor to represent you in 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 needs to respond in an 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 whose lives have literally been upended as a result of this storm. I know i speak for marylands, we have First Responders from Montgomery County who have gone down to texas to help. Thank you. Thank you for that. We have many m. Arylanders who have joined in national efforts. And this will be continuing and im proud of house marylanders respond to these types of tragedies. I want to first explain that starting in january i became the senior senator. Which means that when senator mccull ski retired, i miss her. We all miss her. She calls me frequently. She tells me she doesnt miss being in washington these days. When the president issues one of his morning tweets, she will sometimes call me and say, ben, now what are you going to do. So she is very much engaged in the process. But i want to make sure we use all ten members of our congressional delegation to work on issues that are priorities for our state. So during this time that congress is not in session, ive been traveling through maryland to listen to peoples concerns. To explain how i see things occurring in washington and get your input. I work closely with your federal delegation. I thank you for giving me Chris Holland from Montgomery County who is doing a great job in the senate. He is on the appropriations committee, on other very important committees and hes part of the leadership and been engaged in an effective way from day one. Replacing him in the house of representatives, jamie raskin is doing a fabulous job. Hes joined with john sorbet, who represents this area very, very well in Montgomery County on environmental issues. John delaney whos been sensible in bringing our country together economic policies. We have a strong federal team that i work with in Montgomery County, and i want you to know that. Its team maryland. 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 health care. Im more than happy to talk about whatever is on your mind but give me a chance to talk about the Health Care Issues because i am still deeply concerned. Eight months ago i think most of us felt that the ree repeal of the Affordable Care act was a fore gone conclusion. It did not peal of the Affordable Care act was a fore gone conclusion. It did not happen. It didnt happen because the power in our country is not with the president of the United States. Its not with our Judicial Branch of government. I would confess 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 replace and repeal obamacare. I was with a group with regards to immigration changes this morning in Montgomery County. And they said, what can you do to make a difference . Well, in health care you put a face on the issue. We talked about tens of millions of people losing health care, 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 Leadership became law. We heard about families, children born with severe disabilities that would reach their caps in the first couple months of life. We heard stories about people who would not have been able to get the Preventive Health care they need. We heard stories about how peoples lives would have been very much disrupted and they couldnt get the health care services. It was a matter of life and death. Im a strong supporter of the Affordable Care act. Im proud to have supported it, im proud to be part of congress that passed it. 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. It covers what you need. Preventative health care, provides pediatric dental. We know the tragedy of monty driver here in prince georges county, who lost his life because he couldnt get dental care. It covers addiction, behavioral health. It covers the services that people need. Its quality coverage. It eliminating the abusive practices of private Insurance Companies, such as preexisting conditions. Being a woman is no longer a preexisting conditions. You no longer have caps. That meant if huhuh had cancer, and you needed treatment for cancer you could exceed the caps within the first month of treatment. That no longer is the case. So weve made major dramatic improvements to the Health Care System. Now, there are issues we have to deal with in health care. But the bill that passed the house of representatives would have cut tens of millions of people out of coverage. It would have denied the protection we had on 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 anything about their bill, not anything in their bill that i could support. I spoke out against it and we were able to stop it. The same thing is true with the senate bill, including the skinny bill they put out. It wouldnt have been 20some million, only 15some million. But it would have been worse because the cap they put on the medicaid system would have been more severe. I want to applaud we the people as to how you spoke out. We the people they tried to divide you. They said well make an exceptiontofor children that have difficult conditions and the advocates for the children recognize 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. They knew 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. I want to the thank the republicans who joined us in that effort. 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 weve never passed a major bill in the United StatesCongress Without revisiting it and seeing how it works and see where you can make it better. And 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. Legislation deals with two major problems in our health 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 its a relatively small percentage of the overall market. The individual marketplace, thats the one where we have significant problems where we had the rate increases that were just announced, is about 6 of our market in maryland. About 6 . And the premium increases are way too high. I can explain the reason for it, be. Theres ways we can make it better and my legislation does that. And about two thirds of the people in this group get subsidies. So youre really talking about 1 to 2 that are really in trouble as a result of the changes. Thats too many. We have to help them. We have to make it better. 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, putting a public option in the plan. So that you know there will always be, always be a government plan available, and its always its not going to go any place. Its not going to discriminate in its marketing. Its going to be there for you to protect you. The other parts we do is 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 healther people are not going to join. President trump could fix that by just enforcing the law. But maybe were asking too much from the president to enforce the law. The second thing is the law provides for what we can 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 by the federal government to the Insurance Companies to keep the premiums more reasonable in the individual marketplace. But there was a Court Decision that raised the question as to whether its mandate or not. For president obama that was no problem he was going to make the payments, because thats part of the plan. President trump is raising the question whether hes going to continue those payments or not. Those cost sharing payments were made for this month but we dont know nayre going to be made for september, october. And the premiums represent higher premiums because we dont know if were going to get them. My legislation fix that is. It mandates the payments. The other thing is to use the reinsurance programs in markets thaf that are relatively small. They spread the risk in small groups so 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. Thats one part of the problem. Theres a second part of the health care problem. The second part 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 americansplay paying twice what canadians pay for the exact same pills manufactured here in america. Its well past time for that to change. It requires the same discounting in the medicaid system and collective bargaining for pricing to bring down the cost of prescription medications. It saves hundreds of billions of dollars over the tenyear window. The other we dont get scored as much but its just as dramatic. We do this in maryland, i applaud our legislatures who have taken the lead on this. They deserve a round of applause, they expanded the Medicaid Program. They provided coordinated care. They had a small market plan. Maryland has an all payer waiver. Maryland has taken the lead in health care and we thank them very much for their leadership, those in the state legislature. What we want to do is use more coordinated integrated care modules. So if you have a drug problem and end up in an emergency room in the middle of the night and they give you drugs and keep you alive and they then tell you to go home and see a democratic you have to have the future available on sight. We have a program in maryland. The senator was introduced by a leader of the nearby Johnson Hopkins university and brief remarks on a field effort for the Critical Care act and. In kidny care we can now do tell medicine, so people can get their renal treatment in a convenient spot rather than travel a long distance. We can use tell medicine, tele psychic medications. 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 that are calling on bipartisan hearings and working together. Thats what we need to do. But i listen to President Trump 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. You should be concerned about this. You should be concerned about this. We saw the bill we voted on about two hours before we voted on it. And it was released in the middle of the night sometime. I forget exactly what time it was. 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 act that went through numerous hearings, months of hearings, months of markup, many amendments offered by democrats and republicans. Process is important. Were a democracy, process is important. So as we return to washington on tuesday, as Congress Comes back in session, theres a lot of issues t