Serving a fairly lengthy prison sentence of a one appeal. And mr. Steinberg was convicted but then later overturned after an Appeals Court made a ruling that made a much harder to convict someone for insider trading. The next panel will be underway promptly fell. It is about repeal and replace with what . We have a little bit larger Panel Moderated by 1n of the Staff Writers that specializes in health care. Bill cassidy is a republican senator from louisiana who authored his legislation jill barton is a republican congressmen from texas the former chairman and currently the vice chairman of energy and Commerce ExecutiveVice President for Public Affairs at Americas Health insurance plans and of principle you may have heard his name spoken recently as the former hhs secretary during the bush administration. Thanks for being here today. We have a fantastic panel with of politics of epo and replace it is a busy time but think we are waiting just a moment for congressman barton and unfortunately dr. Mcclellan could not make it today but we have a lot to talk about for by want to jump right then it is the very busy time in washington for those working in health policy. Only a week ago they put out the legislative text of their plan and monday 24 Million People could do lose their Health Insurance coverage under the plan. Thinks speaker wright and said he is planning to bring this to the floor for a vote next week so it is a timely panel part of the first question is the of burning question. Can this pass the house . Clearly i m on the beach team. As the speaker likes to say there are two more committees with their are concerns clearly. Dino these they are my patients and that current structure of making 60,000 does not get the adequate assistance under the house plan and i am sure that is one of the concerns on the house side because also some things on the senate side. Sitting there will be an opportunity to speak on the medicaid side and there is some concerns expressed for the Freedom Caucus and other members with the lack of work requiremes as well as ending the match for the expansion population. But they still intend to move forward next week but the idea that the rules committee cannot make changes and improve the bill that is part of the legislative process. So that sausage making process but what they are trying to do is improve the bill. Is good for everyone trying to undertake the exercise. Can Talk Health Care without politics but we look at it as an opportunity the individual market has been challenged that is why it has been addressed in the first place. A Good Opportunity to bring shortterm stability. We hope it can move forward. I would like to dive deeper into what is going on with the moderates and the conservatives. But dr. Cassidy, half dec the fight play out . Changes to medicaid to freeze new enrollment from 2020 up that 2018 is that something moderates can accept . I know there are changes to the tax credits to make them more generous to lowincome or to the seniors. Howdy find that balance that both groups can except . I will push back of a little bit how you frame to that question. Because it is implicit that once inside as a conservative approach and the other has a moderate. Conservatives are about fiscal responsibility. So whatever we come forward with must have fiscal responsibility. Had an author that i authored there are three myths about obamacare but i will tell you the truth. Number one americans are already entitled to health care. Congress has established that. And we will pay for it for a climate doctor working in the hospital for the uninsured and as long as those doors were open asthmatic come as schizophrenic, diabetic, ove rdose, a car wreck, a beach reach. We would treat. It is not free. It is passed to somebody in day he made the policy over here in acknowledged that. So congress has already entitled people to care that will be paid for. Then is it better to give coverage where diabetes is managed as an outpatient that they come to the e are episodic the . Plywood say that the conservative responsible solution is to give coverage. The only way to control cost is appropriate coverage. This is something which empowers the patient. So why push back those of the fiscally responsible conservative approach. I do think that we will find Common Ground but just have to come to a common understanding of the fax. That is a process we are working through. I am glad that you made it congressmen. For once i am later than the senate. [laughter] we are talking about whether the house package to replace the Affordable Care act to pass the house seven like to hear your perspective. We have a lot of what this is why have to be careful what i say. And television cameras. I am part of the with team with a team going to the Budget Committee today and i have to say that there are a lot of undecideds. It decides what the president decides to do and to support the package as is. If we dont make changes then it will not pass the house. What type of changes quick. There is a division, uh the conservative faction that thinks we need to strengthen the bill and restrictedicaiexpansion program not allowed continued expansion with an amendment to do that and those that think there should be a requirement and there is a lot of concern at as figured would eliminate the essential benefits package. So those are the three big things. Concerns about Medicaid Expansion, the requirement for work and healthy adults and what was the third one . Laugh laugh the restrictions or elimination. Nobody in the house on republican side that does not want to send a bill to senator cassidy and his colleagues. We were talking about the balance between some more moderate or conservative members of the conference. So coming to that medicaid amendment i was speaking last night with the congressmen who said that moving vat 2020 days up at 2018 was a nonstarter. They both used the same board. How do you bring them on board quick. I would explain what theyre really does berger doesnt take anybody currently on medicaid as a healthy adults, off. Id just says in the states and have expanded medicaid they cannot continue to expand their population beyond this calendar year berger does not kick anybody off but as of january 1st january 1st, 2018 you cannot continue to add people to help the adults healthy adults. But as state surgery go back to the traditional match 58 42 under that the federal government paid 100 percent of the cost until this year is that 95 percent in phases down at 90 but then stays there in perpetuity. So the healthiest group of adults on medicaid get 90 percent match with traditional recipience disabled, women and children , the states pay on average 42 and the feds pay 50 percent. It is not the draconian program that some of the opponents proclaim it to be. No republicans voted for this when it came to the house and senate. Why we think we have to protect the Program Better essentially was a bribe to the states texnd t population to young and healthy adults is beyond me. Cinch to help last night bush uc more hesitation from those conservatives or both greg. Theyre only four people and we are two of them laugh laugh so its not like diane flogging volcker congress. Bill whole congress. But we all wanted to pass some of us want to see it improved first. There is a lot of good will for the of leadership. We enter stay and their dilemma and want to work with our president with basic principles. I want to last. You have a senator right here. I will get to him but one more question with the house where the action is. How big of a role does the lighthouse play right now or should they be to bring this through to the vote . I think the white house is key and were very fortunate that to of the key white house intermediaries time prices former Services Committee and director omb is one of the coaches on the Congressional Baseball Team and a key member. Most presidencies to that extent have experience on the senate side did in this case even the Vice President are house members. We have a lot of interaction which i think speaks well for a the end came when it comes time to make the final decisions. They know the rhythm of the house and the president can intervene in a wave with a positive result. The Campaign Said he had four goals to continue to cover folks those with preexisting conditions without mandates that is what he was elected on and said repeatedly. Said the president is committed those that have suffered over the last eight years in the economy that has not worked for them. But then come up with a good product. Now have to press you on this the congressman has been pretty optimistic getting this through. Will lead makethroug the senate quick. We dont know what they are sending over first. There is more concern on the senate side that coverage continues. It is hard in our country to offer folks something given time to adjust then withdrawal. I also point out to the we have lots of programs to help people get health care. Medicare and medicaid veterans, and try care, disproportionate hospitals, i could go one. But there is a group tom price calls of all burbles for economy to much to qualify for medicaid but if they make 15,000 per year they dont have the money to put up as the contribution to sponsored insurance. So the president speaks about the vulnerable slows are there. There is concern on the senate side they have the same advantage as somebody making 180,000 per year with the tax code subsidizing the premium. The employer sponsored insurance benefit is only five case of will begin that benefit as well to those who are lower in complexnd feel thad to have 20,000 per year. So the senate would amend this and with the deadline getting this before the april o recess. It is not going through committee. May have judge gorsuch in the interim but senators are putting their amendments together n speaking among ourselves to get support and understanding. It will be amended and go to conference the leader has told us if we dont get it done and plan on staying over easter sometimes that is ready advice will sharpen their mind. What he as outlined so will day pick that back up to make it happen quick. Were always optimistic in the house but to see the senate act is refreshing spectacle. If they do make changes that is the normal process over half the senate was including senator cassidy somebody that served on the committee we want to get this done as they decide to participate in a positive way and if that happens in the American People will be much more comfortable with the Affordable Care act. Want to give them a chance to take a breath so under this current plan what happens to the Insurance Markets. Before i get to that hearing here reminds me of what Newt Gingrich used to say to the freshmen democrats are the opponents but this senator is our enemy. [laughter] but as i said before we are very optimistic we can have both shortterm stability and longterm improvement so working together collaboratively can fix the of market with any Company Needs is certainty and clarity and one thing that health plans need is that lovell of certainty because the Product Development cycle is fairly well set in the window is closing very rapidly for products to be introduced to the market in 2018. A lot of troops to jump threat the state level and Actuarial Research that goes into pricing and planning products for the market there a number of positives so looking at the proposed rule from a few weeks ago into bringing stability to the markets to close the loopholes to drive up the cost for everyone. With the employment market open enrollment period. We would need. So i think in the next month or so if there is a package folks can plan on him to start the ane process with the review, we will see i think some positive movement. So, the calendar moves is one of the biggest concerns at this point. Some of the things we look at it that can be improved, senator cassady mentioned one of them on the tax credits side is a ageadjusted and that certainly can be effective for some but when you look at actually affording health care coverage, if you only have it on age, there is a block of the population that will hit consumers when they cant afford it. They are too much to be eligible for medicaid and tax credits simply cant cover the policy that they choose, so we hope at some point there can be an improvement that is ageadjusted but also has an income component and we think that will deliver the resources folks can use to purchase effective coverage. Coverage. Can i comment on that . One of the things he said i dont think many people realize is we had an election this past november and all republicans i think without exception were promised if they one and we controlled the government that we would repeal at a minimum repeathe minimumrepeal obamacars said we also wanted to replace or reform it. So, when people go to vote in the off president ial elections next year, their health care and cost of coverage if they have Health Insurance are going to be a key decisionmaker on who they vote for that as he pointed out, Insurance Markets dont operate on election cycles and so i take is pretty well baked on what the Health Care Costs if you have Health Insurance coverage is going to be and the political system simply cant operate as quickly as the consumer decisionmaking when you go to the polls next year youre going to say am i better off or worse off with my healthcare insurance and the components are the costs to you and whether the plan meets your needs. X. Cheers healthcare costs are going to be based on the Affordable Care act, not on all of these reforms in the things that we are working on right now. So we probably hopefully are going to have a much more affordable and much better quality access to care system but its not going to be for another three years or two years at least for the minimum and the election is going to intervene before that happens. Figure is another positive provision in the bill that can affect the race very quickly. The Health Insurance tax that was in the Affordable Care act originally, 110 billion in premium taxes on many Health Insurance plans, so small businesses, seniors on medicare. That has been delayed for a year but is now repealed in the package moving through the house and on average that is about a 3 increase in premiums just on that alone, so that is something that can deliver shortterm benefits but another. And if the requirement that has to be provided, so some of the things are going to have an immediate effect. Let me ask one followup and that is about the continuous coverage required and there are some discussions on the hill about potentially dropping that provision from the bill. But obviously it is important when you couple it with preexisting condition protections and im curious what would happen if that were dropped from the package. Its no seek with the mandate is one of the most unpopular pieces of legislation weve seen in a long time. How effective if one is to bring people into the market is under some debate. Some people think that it was defective and some people think it didnt have an impact. What we know whether it is Health Insurance or Car Insurance or home insurance, you cant have folks that just by coverage when they actually need care. Its like buying Auto Insurance after you have had a wreck so to keep the cost down for every one you have to utilize. Someone who needs treatment for whatever behavioral ailment, whatever they need you need folks that have insurance to cover the cost then you also need folks that have insurance in case they need to seek care at some point. That is how you balance out the risk pool and lower the cost for everyone. So if you have a system where folks dont have the mandate but can still sign up for coverage when they need it, its going to raise the cost for everyone, so there has to be some type of a continuous coverage incentive. The 30 premium charge for not having continuous coverage is a start. We think it can be effective and help mitigate the mandate, but we think we can be constructed and find solutions that do work because we share the same goal as the congressman and the senate that we want lower cost and better quality and more affordable coverage for every american and we know that in order to get that, you have to have more people, those that utilize kerry and those who dont, so we think that provision is important, though we certainly want to have a constructive dialogue. There is another way to get back by the way the patient freedom act the plan in Susan Collins eyes, and i am blinking on the other person, it is to allow the states to automatically enroll folks and in the house plan, it appears that provision is allowed. They could say listen we are going to give you credit for the premium and you will be enrolled unless you call and say you dont want to be. No one says it is that as a mao just end up on part and a few cranky folks call up and say i dont want it. But as a rule, you do that. We had an Insurance Company model what i would if we had the automatic enrollment and they said that by itself with over the premium by 20 even still keeping those that are less healthy so there is a mechanism that is both in the patient freedom act and by the way just endorsed i think it was on the Health Affairs blog post they said it should be looked at as a way to restore the balance without