Transcripts For CSPAN2 Phillip Klein On Overcoming Obamacare

I just wanted to start with an brief opening comments to frame todays discussion. When it comes to health care, those on the right are often defined more by what they are again then by what they are for. The truth is there have a lot of plans that have been offered on the right of alternatives to obamacare. But there hasnt been any agreement on any single proposal. That may be about to change. A combination of the republican takeover of the senate, a looming Supreme Court decision in the white house race are putting more pressure than ever before on republicans to offer some sort of alternative to obamacare. Before they could get to any sort of agreement, there are some in the mental, philosophical disagreement that need to be worked out about how to get into the country into a more freemarket direction. That is why i wrote my book, overcoming obamacare. I looked at the flurry of plans that have been offered as alternatives to obamacare. I sorted them into three basic approaches. The first school of thought i called the Reform School and this is comprised of people who say at this point it might be unrealistic to fully repeal obamacare and hold it not for full repeal shouldnt be a barrier to instituting reforms to the overall system double move things in a more market oriented direction. The second approach i describe as the replaced code. This is comprised of people who think obamacare does need to be repealed but that it can only be done that way if opponents offer a credible alternative that in some way but the changes that obamacare have made in the beneficiaries they created. Last but not least is what i call the restart school. This is comprised of people who think obamacare it needs to be repealed and fully wiped off the books and the only way you can create a true freemarket alternative is starting from scratch and focusing on lowering cost rather than just figure another way to expand coverage. So we are fortunate today to be joined with three very forceful advocates for these various approaches. I want to start with avik roy at the Manhattan Institute who has authored his own plan as an alternative to obamacare. He also was recently named as a policy advisor to rick perry. Next we have just a understand who is the director of the 2017 project. He has also authored an obamacare alternatives that is very close to some of the plans that have been offered on capitol hill with some changes we should talk about. Michael cannon of the Cato Institute has been described as obamacare single most relentless antagonist and he has gained notoriety recently as one of the intellectual architects of the Supreme Court challenge to obamacare is federal Insurance Exchange subsidy. I wanted to start with a philosophical question. You have country and avik, you have written the days that goal. Michael, youve been the author of the entire universal manifesto. I just want you to get to fight about this. Why do you explain why you think from a freemarket dead they should be the governments role to provide universal coverage . Guest i would put it slightly differently. For example, we would never say when you hear a number of people say we cannot outbid the left uncovered in people with Health Insurance. We shouldnt try to outbid them. It is politically accessible somewhere in the middle. We would never say that about smartphones. We would never say free market cant outbid the government of every american is a smartphone. We would say free market cant outbid the government and giving People Better jobs and more Economic Growth. Why is that we accept the premise that the only way to expand access to highQuality Health care is through government. I would argue that you can expand more people at a lower cost through Market Center government. The goal of expanding access to coverage and care and when did we get trapped we get that trafton is we live in this progressive debate where it is all about what the government can do. We dont actually embrace the policy goal. The policy goal of expanding access to care and that is what we should be striving to do. Host michael, what would you say . Im trying to exaggerate the differences. We cant outbid the left when it comes to making Health Care Better and more affordable. Bringing it within the reach of poor people not as though we should be doing. The problem is expanding coverage, if you make that your policy for the goal, interferes with Higher Quality coverage for everybody because at a certain point, as even Kenneth Arrow has acknowledged, the seminal article uncertainty in the welfare economics and medical care that everyone at to justify whatever Government Intervention they want, insurance is pointless and certain situation because the cost exceeds the benefit. When i say and people like me say we cant outbid the left when it comes to covering people with Health Insurance, it is because the left can always say will have a singlepayer system in the government will cover everyone. Whereas we are going to Produce Market principles. After a certain point people will buy it not as much coverage at a certain point people by not as much coverage. Some people wont buy any coverage at all. That is not only healthy, that is crucial for the operation of a highperforming Health Insurance market in health care market. But well never get universal coverage. If we just allow people to make their choices. We make expanding coverage or universal coverage our goal, the left will say you are a failure because you havent delivered universal coverage. And then advocate interventions to make Health Care Workers and more expensive and take it out of peoples reach. That is why we shouldnt even concede the goal of universal coverage or the government expanding coverage because it frustrates what is our shared goal of making Health Care Better and more affordable and more secure. Two points in response to that. There is no reason wished except the last definition definition of the term. The traditional understanding when we think about Car Insurance or homeowners insurance. If you crash your car you are protected from catastrophic financial loss. The fact that the left is sort the meaning of the word insurance to mean prepayment for all Health Care Services doesnt mean we should simply accept it. We should say its a noble goal for every american to have the ability to afford true Health Insurance that protects them from bankruptcy due to injury or illness. Thats a noble policy goal of free markets can achieve it. You are making it easy to exaggerate a different days. Another criticism i have of the way a lot of conservatives approach health care and Health Care Reform is the idea they are trying to sell the public that insurance should only be for catastrophic illnesses. If you buy a health finish in the 5000 that the bowl. I think they lose a lot of people when they talk like that because people are risk averse than they might want more coverage than not. They should be free to buy. Theres also a lot of Value Health Plans can provide below the 5000 to dr. Bull. Sifting through medical literature and finding out what Preventive Care is Cost Effective and cover it not so diabetics take care of their illness and down and up with complications later on. It is very important that we not try to offer people any definition of what insurance should be. We should leave that to individual consumers as well. This is another way conservatives get themselves in trouble. What do you think . Should it be a it be appalled conservatives to move towards universal coverage . I certainly dont think its the government duty or obligation to provide universal coverage. Its a free country and for allowed to live freely they will not all choose Health Insurance. Its also a worthy goal to make it as possible as it can be a lowering costs, having a vibrant market where people can choose to buy coverage if they want. Is a practical matter if we want to repeal obamacare we have to offer an alternative that focuses on cost and coverage as a political reality. I would fall somewhere in between in that i would agree i dont think there is any need to outperform liberals find testaments of the number of people who would be covered under an obamacare alternatives. I think you have to at least make a goodfaith effort. You can get absolutely clobbered if you want to win politically. Now i think that one area where aviks plan differs from what jess and michael have talked about is when it comes to repeal an obamacare. You have released a plan that is fully compatible but that it could be implemented without the need to repeal obamacare. That puts you at odds with a lot of people on this issue. Why did she make that decision . Just to be clear about what the plan does the plan can repeal obamacare and replace it with a replacement approach or you can get the same end result by repealing large chunks of obamacare but take what is remaining in changing it to end up in the same place. The reason why that option is important is because any replacement plan do we as republicans or conservatives propose have to get to the united defendant. We dont have 60 votes in the United States senate. This is something we dont talk about it all in the obamacare at all. Even if you did have 60 votes republicans will agree with each other and everything. The democrats demonstrate its not so easy. They last the public option because Joe Lieberman said out of the public option. Howard dean said we should burn down obamacare because it does not public action. We dont have 60 votes. If we dont have 60 votes and if we have to pick off six republicans and 54 votes lets assume they maintain a majority in 2017, which is no small thing because they have a lot of seats up for grabs in the next election. If republicans are lucky enough they are still going to have to find democrats to go along with whatever they want to do to replace obamacare. It is hard to find democrats to support repealing every single word of obamacare. I do think there is bipartisan support for a market oriented plan that achieves a policy goal. Given this political realities, where are you for repeal in 2012 . Subsidies havent gone into play. If we could repeal obamacare fully before obamacare went into place we would have a lot more options. Host how would you do that . Theres a difference between replacing and repealing. A lot of evidence to believe we could repeal obamacare for reconciliation which requires 51 votes. Probably replace obamacare can be done to reconciliation. Because of the regulatory changes you have to make the budgetary process allows you to make certain changes to the law that have to do with the budget. They have to have a Material Impact on revenues are spending. The challenge of health care is a chunks have to do with revenue and spending, but how you regulate insurance and what you do about preexisting conditions, things like that. The reality is that it president obama second term there have been 181 polls taken on obamacare according to real clear politics in all 181 showed it to be unpopular so to give up on repeal at this point seems to be politically totally unnecessary and at the same time rather fatalistic as you believe that i do that repealing obama cares the most important thing we can possibly do in the political realm. I am in support of repeal of obamacare. We have to make sure whatever we propose and get 60 votes in the senate. So if we can get 60 votes in the senate and repealing obama cared replacing it with what i have proposed grade and we have to do Something Different and get to the same end result, great. The plan keeps a lot of elements of obamacare. You have a preexisting condition and a lot of the Insurance Regulations that are not as stringent as obamacare. You have the tax credits. They dont quite come arent quite as generous as obamacare but even the sort of replacement if you want to call it a sort of still has a lot of elements. I think if you are arguing that any plan that attempts to offer tax credits to the uninsured is somehow obamacare like there are half a dozen to nine different plans that republicans oppose including obamacare. I would contend you that republicans and conservatives for a long time have said that the best way to reform the Health Care System is to let patients control the dollars and not the government. Let people buy whether his Health Insurance or hsas are generous Health Insurance plans or catastrophic plans large hsa is as michael has advocated let people have those options and let people buy plants that make sense for them. The question is not the end result which we all share but its how you get there. Again within a replacement plan requiring 60 votes in the senate we have to be intellectually prepared for the possibility that we can do we do when republicans control 60 votes in the senate so ive been trying to do is say here are some options. We can do it the repeal and replace way. We can do it by migrating to the system but whats important is having that end result and having different ways to get there so we can put together the majority to get it done. I think what you are hinting at theres a colossal difference between keeping the architecture of obamacare. It took 27 or pages delay this architecture out. Keeping it in trying to arrange it some are scrapping it is a huge huge difference and i think youre glossing over that a little bit. I think you are misrepresenting the plan. The plan doesnt do that. You have called a lot of these plans obamacare like so i wanted to get your thoughts on this. Republicans conservatives and notice i say republican conservatives and i dont say we because im not a republican and im not a conservative but republicans and conservatives have got themselves in trouble over health care in the past because the right doesnt spend as much time and energy on health care as the left so they have fallen for ideas like an individual mandate because they didnt think these things through enough and realize wait a second and individual mandate this is a force of power in government to provide people with Health Insurance the same way as the singlepayer system does so there are really two different the two breeds are the same animal. They end up endorsing that in the early 90s and 20 years later we ended up with 60 votes for that in congress because republicans werent following their principles. I think the same thing is happening now when it comes to Health Insurance tax credits. I do call them obamacare like because they involve a lot of redistribution like obamacare does. Its because they function exactly like an individual mandate where how you buy a government to find Health Insurance plan and pay less money and you dont or you pay more money to the government. Its effectively a penalty for not obeying the mandate that you purchase Health Insurance and gives the government as much control over what your Health Insurance plan looks like is the individual mandate does. So these are obamacare like and its why i dont think why think we should repeal obamacare and dont worry about what will get 60 votes in the senate because im afraid of whatever plan republicans are going to throw together in order to get 60 votes in the senate at this point because they think these obamacare like proposals are the way to go. If they repeal obamacare and replace it with Something Like obamacare we basically still have obamacare except it will have bipartisan support and we will never get them. On the flip side about 60 votes in the senate you will never get 51 votes through reconciliation for the repeal of obamacare to look like there is no alternative on the horizon. There all sorts of alternatives. I think you have to let forward some sort of alternative that deals with coverage in michael and i were testifying yesterday in the senate and he made a similar point or a claim that a tax credit is roughly akin to the individual mandate in obamacare that the tax rate mandates that you buy insurance. By that logic the Child Tax Credit effectively mandates that everyone have a child. Who would make that argument . Childless couples are a little annoyed that. You can take everything to the theoretical extreme but theres a profound difference between the government mandating that you buy a product or service the federal government doing something for the first time in American History and offering a tax break in whatever form to people who choose to buy the products. Theres a tax credit for childcare and a lot of stayathome families of the stayathome parent are really offended that they are effectively being penalized by the tax code because they make that choice to stay at home and raise their children. E if i could make a factual comment about something that mike said. Mike said the tax credits are a mandate to buy insurance. Thats not true because you can structure the tax credit so its entirely deposited in a Health Savings account which means you dont have to buy insurance with it. You could use it to just save your compound interest and have it roll over for your Health Care Needs so its not necessarily true that a tax credit is only for the purpose of insurance. Its not a Supreme Court<\/a> decision in the white house race are putting more pressure than ever before on republicans to offer some sort of alternative to obamacare. Before they could get to any sort of agreement, there are some in the mental, philosophical disagreement that need to be worked out about how to get into the country into a more freemarket direction. That is why i wrote my book, overcoming obamacare. I looked at the flurry of plans that have been offered as alternatives to obamacare. I sorted them into three basic approaches. The first school of thought i called the Reform School<\/a> and this is comprised of people who say at this point it might be unrealistic to fully repeal obamacare and hold it not for full repeal shouldnt be a barrier to instituting reforms to the overall system double move things in a more market oriented direction. The second approach i describe as the replaced code. This is comprised of people who think obamacare does need to be repealed but that it can only be done that way if opponents offer a credible alternative that in some way but the changes that obamacare have made in the beneficiaries they created. Last but not least is what i call the restart school. This is comprised of people who think obamacare it needs to be repealed and fully wiped off the books and the only way you can create a true freemarket alternative is starting from scratch and focusing on lowering cost rather than just figure another way to expand coverage. So we are fortunate today to be joined with three very forceful advocates for these various approaches. I want to start with avik roy at the Manhattan Institute<\/a> who has authored his own plan as an alternative to obamacare. He also was recently named as a policy advisor to rick perry. Next we have just a understand who is the director of the 2017 project. He has also authored an obamacare alternatives that is very close to some of the plans that have been offered on capitol hill with some changes we should talk about. Michael cannon of the Cato Institute<\/a> has been described as obamacare single most relentless antagonist and he has gained notoriety recently as one of the intellectual architects of the Supreme Court<\/a> challenge to obamacare is federal Insurance Exchange<\/a> subsidy. I wanted to start with a philosophical question. You have country and avik, you have written the days that goal. Michael, youve been the author of the entire universal manifesto. I just want you to get to fight about this. Why do you explain why you think from a freemarket dead they should be the governments role to provide universal coverage . Guest i would put it slightly differently. For example, we would never say when you hear a number of people say we cannot outbid the left uncovered in people with Health Insurance<\/a>. We shouldnt try to outbid them. It is politically accessible somewhere in the middle. We would never say that about smartphones. We would never say free market cant outbid the government of every american is a smartphone. We would say free market cant outbid the government and giving People Better<\/a> jobs and more Economic Growth<\/a>. Why is that we accept the premise that the only way to expand access to highQuality Health<\/a> care is through government. I would argue that you can expand more people at a lower cost through Market Center<\/a> government. The goal of expanding access to coverage and care and when did we get trapped we get that trafton is we live in this progressive debate where it is all about what the government can do. We dont actually embrace the policy goal. The policy goal of expanding access to care and that is what we should be striving to do. Host michael, what would you say . Im trying to exaggerate the differences. We cant outbid the left when it comes to making Health Care Better<\/a> and more affordable. Bringing it within the reach of poor people not as though we should be doing. The problem is expanding coverage, if you make that your policy for the goal, interferes with Higher Quality<\/a> coverage for everybody because at a certain point, as even Kenneth Arrow<\/a> has acknowledged, the seminal article uncertainty in the welfare economics and medical care that everyone at to justify whatever Government Intervention<\/a> they want, insurance is pointless and certain situation because the cost exceeds the benefit. When i say and people like me say we cant outbid the left when it comes to covering people with Health Insurance<\/a>, it is because the left can always say will have a singlepayer system in the government will cover everyone. Whereas we are going to Produce Market<\/a> principles. After a certain point people will buy it not as much coverage at a certain point people by not as much coverage. Some people wont buy any coverage at all. That is not only healthy, that is crucial for the operation of a highperforming Health Insurance<\/a> market in health care market. But well never get universal coverage. If we just allow people to make their choices. We make expanding coverage or universal coverage our goal, the left will say you are a failure because you havent delivered universal coverage. And then advocate interventions to make Health Care Workers<\/a> and more expensive and take it out of peoples reach. That is why we shouldnt even concede the goal of universal coverage or the government expanding coverage because it frustrates what is our shared goal of making Health Care Better<\/a> and more affordable and more secure. Two points in response to that. There is no reason wished except the last definition definition of the term. The traditional understanding when we think about Car Insurance<\/a> or homeowners insurance. If you crash your car you are protected from catastrophic financial loss. The fact that the left is sort the meaning of the word insurance to mean prepayment for all Health Care Services<\/a> doesnt mean we should simply accept it. We should say its a noble goal for every american to have the ability to afford true Health Insurance<\/a> that protects them from bankruptcy due to injury or illness. Thats a noble policy goal of free markets can achieve it. You are making it easy to exaggerate a different days. Another criticism i have of the way a lot of conservatives approach health care and Health Care Reform<\/a> is the idea they are trying to sell the public that insurance should only be for catastrophic illnesses. If you buy a health finish in the 5000 that the bowl. I think they lose a lot of people when they talk like that because people are risk averse than they might want more coverage than not. They should be free to buy. Theres also a lot of Value Health Plans<\/a> can provide below the 5000 to dr. Bull. Sifting through medical literature and finding out what Preventive Care<\/a> is Cost Effective<\/a> and cover it not so diabetics take care of their illness and down and up with complications later on. It is very important that we not try to offer people any definition of what insurance should be. We should leave that to individual consumers as well. This is another way conservatives get themselves in trouble. What do you think . Should it be a it be appalled conservatives to move towards universal coverage . I certainly dont think its the government duty or obligation to provide universal coverage. Its a free country and for allowed to live freely they will not all choose Health Insurance<\/a>. Its also a worthy goal to make it as possible as it can be a lowering costs, having a vibrant market where people can choose to buy coverage if they want. Is a practical matter if we want to repeal obamacare we have to offer an alternative that focuses on cost and coverage as a political reality. I would fall somewhere in between in that i would agree i dont think there is any need to outperform liberals find testaments of the number of people who would be covered under an obamacare alternatives. I think you have to at least make a goodfaith effort. You can get absolutely clobbered if you want to win politically. Now i think that one area where aviks plan differs from what jess and michael have talked about is when it comes to repeal an obamacare. You have released a plan that is fully compatible but that it could be implemented without the need to repeal obamacare. That puts you at odds with a lot of people on this issue. Why did she make that decision . Just to be clear about what the plan does the plan can repeal obamacare and replace it with a replacement approach or you can get the same end result by repealing large chunks of obamacare but take what is remaining in changing it to end up in the same place. The reason why that option is important is because any replacement plan do we as republicans or conservatives propose have to get to the united defendant. We dont have 60 votes in the United States<\/a> senate. This is something we dont talk about it all in the obamacare at all. Even if you did have 60 votes republicans will agree with each other and everything. The democrats demonstrate its not so easy. They last the public option because Joe Lieberman<\/a> said out of the public option. Howard dean said we should burn down obamacare because it does not public action. We dont have 60 votes. If we dont have 60 votes and if we have to pick off six republicans and 54 votes lets assume they maintain a majority in 2017, which is no small thing because they have a lot of seats up for grabs in the next election. If republicans are lucky enough they are still going to have to find democrats to go along with whatever they want to do to replace obamacare. It is hard to find democrats to support repealing every single word of obamacare. I do think there is bipartisan support for a market oriented plan that achieves a policy goal. Given this political realities, where are you for repeal in 2012 . Subsidies havent gone into play. If we could repeal obamacare fully before obamacare went into place we would have a lot more options. Host how would you do that . Theres a difference between replacing and repealing. A lot of evidence to believe we could repeal obamacare for reconciliation which requires 51 votes. Probably replace obamacare can be done to reconciliation. Because of the regulatory changes you have to make the budgetary process allows you to make certain changes to the law that have to do with the budget. They have to have a Material Impact<\/a> on revenues are spending. The challenge of health care is a chunks have to do with revenue and spending, but how you regulate insurance and what you do about preexisting conditions, things like that. The reality is that it president obama second term there have been 181 polls taken on obamacare according to real clear politics in all 181 showed it to be unpopular so to give up on repeal at this point seems to be politically totally unnecessary and at the same time rather fatalistic as you believe that i do that repealing obama cares the most important thing we can possibly do in the political realm. I am in support of repeal of obamacare. We have to make sure whatever we propose and get 60 votes in the senate. So if we can get 60 votes in the senate and repealing obama cared replacing it with what i have proposed grade and we have to do Something Different<\/a> and get to the same end result, great. The plan keeps a lot of elements of obamacare. You have a preexisting condition and a lot of the Insurance Regulations<\/a> that are not as stringent as obamacare. You have the tax credits. They dont quite come arent quite as generous as obamacare but even the sort of replacement if you want to call it a sort of still has a lot of elements. I think if you are arguing that any plan that attempts to offer tax credits to the uninsured is somehow obamacare like there are half a dozen to nine different plans that republicans oppose including obamacare. I would contend you that republicans and conservatives for a long time have said that the best way to reform the Health Care System<\/a> is to let patients control the dollars and not the government. Let people buy whether his Health Insurance<\/a> or hsas are generous Health Insurance<\/a> plans or catastrophic plans large hsa is as michael has advocated let people have those options and let people buy plants that make sense for them. The question is not the end result which we all share but its how you get there. Again within a replacement plan requiring 60 votes in the senate we have to be intellectually prepared for the possibility that we can do we do when republicans control 60 votes in the senate so ive been trying to do is say here are some options. We can do it the repeal and replace way. We can do it by migrating to the system but whats important is having that end result and having different ways to get there so we can put together the majority to get it done. I think what you are hinting at theres a colossal difference between keeping the architecture of obamacare. It took 27 or pages delay this architecture out. Keeping it in trying to arrange it some are scrapping it is a huge huge difference and i think youre glossing over that a little bit. I think you are misrepresenting the plan. The plan doesnt do that. You have called a lot of these plans obamacare like so i wanted to get your thoughts on this. Republicans conservatives and notice i say republican conservatives and i dont say we because im not a republican and im not a conservative but republicans and conservatives have got themselves in trouble over health care in the past because the right doesnt spend as much time and energy on health care as the left so they have fallen for ideas like an individual mandate because they didnt think these things through enough and realize wait a second and individual mandate this is a force of power in government to provide people with Health Insurance<\/a> the same way as the singlepayer system does so there are really two different the two breeds are the same animal. They end up endorsing that in the early 90s and 20 years later we ended up with 60 votes for that in congress because republicans werent following their principles. I think the same thing is happening now when it comes to Health Insurance<\/a> tax credits. I do call them obamacare like because they involve a lot of redistribution like obamacare does. Its because they function exactly like an individual mandate where how you buy a government to find Health Insurance<\/a> plan and pay less money and you dont or you pay more money to the government. Its effectively a penalty for not obeying the mandate that you purchase Health Insurance<\/a> and gives the government as much control over what your Health Insurance<\/a> plan looks like is the individual mandate does. So these are obamacare like and its why i dont think why think we should repeal obamacare and dont worry about what will get 60 votes in the senate because im afraid of whatever plan republicans are going to throw together in order to get 60 votes in the senate at this point because they think these obamacare like proposals are the way to go. If they repeal obamacare and replace it with Something Like<\/a> obamacare we basically still have obamacare except it will have bipartisan support and we will never get them. On the flip side about 60 votes in the senate you will never get 51 votes through reconciliation for the repeal of obamacare to look like there is no alternative on the horizon. There all sorts of alternatives. I think you have to let forward some sort of alternative that deals with coverage in michael and i were testifying yesterday in the senate and he made a similar point or a claim that a tax credit is roughly akin to the individual mandate in obamacare that the tax rate mandates that you buy insurance. By that logic the Child Tax Credit<\/a> effectively mandates that everyone have a child. Who would make that argument . Childless couples are a little annoyed that. You can take everything to the theoretical extreme but theres a profound difference between the government mandating that you buy a product or service the federal government doing something for the first time in American History<\/a> and offering a tax break in whatever form to people who choose to buy the products. Theres a tax credit for childcare and a lot of stayathome families of the stayathome parent are really offended that they are effectively being penalized by the tax code because they make that choice to stay at home and raise their children. E if i could make a factual comment about something that mike said. Mike said the tax credits are a mandate to buy insurance. Thats not true because you can structure the tax credit so its entirely deposited in a Health Savings<\/a> account which means you dont have to buy insurance with it. You could use it to just save your compound interest and have it roll over for your Health Care Needs<\/a> so its not necessarily true that a tax credit is only for the purpose of insurance. Its not a Health Insurance<\/a> tax credit. Its a tax credit used to purchase Health Insurance<\/a> or health care or both. Were a lot of people its a government cash payment from the government into their Health Savings<\/a> account. I think the key thing to point out here is that there is this distinction between a tax credit and a tax production and basically if its a tax credit it means that i can probably be extended to more people because people at the lower end of the income spectrum that dont have a high Tax Liability<\/a> could still get the same amount of money whether its 2000 or 3000 or whatever. In which case its not a 2000dollar cut. Anything beyond whatever the Tax Liability<\/a> is of that person becomes the equivalent of a flatout subsidy as opposed to a deduction which just remits somebodys income Tax Liability<\/a> but that doesnt benefit a lot of uninsured people who dont have much of a liability. What we need to do for them is the most important thing we can do is to get everyone else controlling their Health Care Dollars<\/a> in spending everyone of those Health Care Dollars<\/a> is that they own it because we get 159 people spending Health Care Dollars<\/a> more wisely thats the single most important thing we can do for people of modest means because that will spark a revolution in Cost Containment<\/a> and drive prices downward and make health care reachable to more people. The point you make is important and this is a criticism i have have gotten and governor jindals standard deduction for Health Insurance<\/a>. I think thats a better step or a better proposal than Health Insurance<\/a> tax credits because it doesnt involve redistribution. Anytime you have government conditioning of benefit of the subsidy or a tax cut on x it has to define what x is so people know theyre eligible for that Tax Deduction<\/a>. A standard deduction for Health Insurance<\/a> lets the government define what your Health Insurance<\/a> plan looks like because it gets to fund what insurance qualifies for that deduction so i have said before and im not saying its because its here. What i said before his governor jindals Health Care Proposal<\/a> is the best that i see among republican candidates but i think it still has that very serious flaw. I want to move on to another topic. Did biggest difference among the right there is some disagreement there. Are. I think its very clear politically that if we want to repeal obamacare we have to have an alternative. The American People<\/a> have to wait and see about obamacare his place. The biggest disagreement on the right has been between a Tax Deduction<\/a> approach and a tax credit approach. Philosophically the 2017 project plan offered a tax credit. Philosophically we were operating in a political vacuum i would have no problem with the tax production waste approach that we are not operating in a political vacuum. We are in a world where there are families the vast majority of the middle class gets nothing under obamacare and kaiser calculated a typical 40yearold woman who makes 35,000 a year does not get a penny under obamacare that they are relatively low income families to get over 20,000 in subsidies under obamacare. Its politically unrealistic to say you take a 20,000 subsidy and replace it with a Tax Deduction<\/a> of nothing and that would be the result because the sort of family thats getting 20,000 to not does not pay any taxes on that includes payroll taxes a total tax effect. They would get nothing into bielat to try politically to say you will go from 20,000 to nothing and like it to me thats a recipe we talk about obamacare thats obamacare forever. We will have obamacare for the rest of her days if thats the case. Theres a political reality we have to give a tax credit route which means these folks would get the same things as everyone else. The 2017 project plan a 3000dollar tax credit simply depending on their age but i think a way to bridge the seemingly impassable gap is that the tax credit should be as conservative as we can possibly make it. What i mean by that is lets get the tax credit to individuals and families and not have it via subsidy to Insurance Companies<\/a> like obamacare. Lets not income test at which would make it simpler to get the irs out of things removed the marriage penalties. Make it a very conservative tax credit. Michael would say im never conservative enough and i respect that but we can get close enough and repeal this monstrosity while still putting things on a glide path towards a genuine free market restoring americans liberty. So, i think before we go further into this sort of broader comprehensive alternative right now we are facing a more immediate question which is that the Supreme Court<\/a> is going to soon decide on a major case involving the legality of subsidies that have gone through federal Insurance Exchange<\/a>s and if that happens there are millions of people who will lose insurance subsidies and will have difficulty paying for insurance. Right now a lot of republicans are talking about various contingency plans as to what to do. So i want to get the panels perspective on what you think the best approach for republicans to take and i will start with michael since you have been the most directly engaged on the Supreme Court<\/a> case. I think theres a lot that congress should be doing right now primarily investigating how this even happened. The irs is taxing and borrowing and spending tens of billions of dollars without congressional authorization contrary to clear limits congress put on the agencies of power in the Affordable Care<\/a> act. I think if they have a proper investigation that will drive, that will show them what they should be doing if the court rules and the challenges favor and drive their if the subsidies disappear and its important to point out that if the court rules for the challengers then it will have two effects. First it will exempt 57 million employers and individuals in 38 states from the individual employer mandates that was a huge tax cut. Those people are being subject to illegal taxes right now. They will be freed from most taxes. There are also 6. 7 Million People<\/a> in those federal Exchange States<\/a> receiving unequal subsidies and those illegal subsidies will dissipate. Under a ruling for the challengers so the question then becomes what should congress do . A lot of people in congress are talking about providing some to those people because they are victims. A clarifying point is in order here. If you think someone who has lost an illegal subsidy is a victim and deserve to get that back maybe you have been in washington too long. They are victims yes, victims of a false promise. They are victims of the rest of obamacare. The Affordable Care<\/a> act provision may be too expensive to them. We should remedy the fact that the court follow that law and stop the massive breach of the law and a breach of the trust we put in government. What should congress do . The first thing they should do is hold the repeal vote this repeal is really then the vast majority of people who are the true victims here the people whose Health Insurance<\/a> premiums were increased by the aca to the point where the subsidies were necessary. You repeal obamacare and get rid of those mandates and regulations and let people get their own health plans back. You might want to put in there some sort of highrisk poll because there will be people who are low income and the political reality will dictate you do something for them. You dont have to create a new system of redistribution. It could be Small Program<\/a> like the preexisting program in the original aca. Then the president will veto that. If it gets to his desk he will veto that. Then what do you do . No one really knows but you have to lay down the marker not negotiate with itself by proposing a half measure least of all that ratifies or baptizes the illegal subsidies that the president has initiated for the past year and a half. He lay down on marker and you do what you do to get too close enough to 67 votes and the president will get nervous and be willing to compromise. I think theres an ethical line that Congress Must<\/a> not cross and one of them is we cannot reward the irs for breaking the law by baptizing those illegal subsidies. I think republicans will fold in a matter 48 hours and try to come out and say its a tax cut for some people so these millions of people who are now going to lose their insurance and kids will go off with her parents care these other people get tax cuts. Im not entirely unsympathetic to your view that there would be improvements in terms of liberty and the court should absolutely stop the payment of illegal subsidies but i think republicans have to have again is sort of a microcosm of the larger thing. This is the perfect time to put one forward and say all right 37 or whatever state that lose their illegal obamacare subsidies we would effectively repeal and replace obamacare or give the state an off ramp to choose to repeal or replace obamacare and substituted conservative alternative with a simple flat agebased but flat tax credit to use to buy insurance of your choice and the biggest selling point would be the American Public<\/a> and in one better site greatly underestimates the political potency of that is there would be an opportunity to say the biggest problem in health care for seven years is to get a great tax break it to get insurance through your employer but if you buy Health Insurance<\/a> on your own you get no tax break whatsoever. Finally we would get a tax break in the form of a credit for most people in middle class would be a pure tax cut which would be a bonanza was saving colossal amount of money and this wide swath of the middleclass left out under obamacare would be receptive to this message. It would be harder than you think of president obama to sam going to let you have this tax break that your nextdoor neighbor gets. It would be nice if republicans could unite about the proposal. You mentioned senator sachs then sass position of basically allow assistance to go to only those people who are our to getting subsidies under obamacare know new people and it wouldnt be based on the subsidy formula and only for a limited trade of time. Thats a big a good fallback position and those are our thoughts on the 2017 project. Avik what you think . I think michael has done incredible work on this. Theres no question that the rule of law at dictates the Supreme Court<\/a> to cite the challenges because it was illegal for the Treasury Department<\/a> to let the subsidies flow through the federal exchange. I want to make a fanatic pointed him relates to the obamacare of repeal and replace debate and that is you have a lot of people people asians a lot a lot of people, a small number people who have appointed themselves the popes of conservatism and say unless you agree with me you are a rhino. Its obamacare its rhino and youre not a conservative. Governor jindal this is any plan that covers tax credit is obamacare like and every plan that would raise taxes on people who have employerbased coverage to equalize the tax credit thats obamacare like except for the fact that Bobby Jindals<\/a> plant is exactly the same thing and we can get into that later if we want. In fact what a lot of people have done is say you are a rhino unless you agree with me. We are always going to be a dysfunctional movement of people agreeing on 90 of the issues are the enemy and we will only drive average americans who are relatively political in into the hands of Hillary Clinton<\/a>. I think we have to focus more on what we agree on and i think we have to articulate a vision of how to expand access to Health Care Health<\/a> care and Health Coverage<\/a> using free markets because for the people dont agree with us on every single item that is how we will win them over by focusing on how our policy will make life better for people. Too often we get caught up in a scholastic arguments about how many tax credits you can fit on the head of a pin instead of discussing how to make life better for people using free markets. I want to see if there are any questions from the audience at this point. We could start with a microphone coming around. Hi im john bremer the National Association<\/a> of health underwriters. Just through quick first on hsas you have to have a plan to contribute so you have to have insurance and the other thing is if the subsidies go away republican government is going to be very nervous and i think the president has a plan slide a piece of paper havenstein something. Why dont we reduce and expand the waiting vans. Its a simple message to say to the American People<\/a> we are going to adjust the marker rules to make things cheaper for you so that reduces the cost of the subsidies. And allow people to use subsidies outside the exchange and give them a special enrollment right to use it. Its really simple. We can talk about the other things we might do later but on day one you have got to do something and you have got to do something dramatic to changing the rating bands will expand the rating bands if you make it cheaper and thats an important day one thing. Its pretty simple. I totally agree with you. Thats one of the things i highlight is the fact that one of the biggest things about obamacare that i think a lot of people dont realize is the degree to which its expansion of government power and control isnt so much the taxing and spending though thats important to repeal and rollback that its actually the regulations that are the biggest driver of how obamacare transforms health care in this country particularly for Healthy People<\/a> who work hard and play by the rules and had premiums that are low to show for it who will pay more because of things like rating bands and things like that so thats an extremely important thing to repeal about obamacare. Just again to reiterate the point i think all of us support repealing obamacare. In my plan i have a number of different ways to get their into your point about day one thats exactly right. Thats what you want to do. He wants to do everything to get your executive action and everything youve got to do through legislation. Do whatever you can all of the above using all the tools you have. On the point about hsa hsas its true today you have to have a certain type of Insurance Plan<\/a> in order to deposit money in your hsa taxfree. Thats because Congress Passed<\/a> a law imposing those requirements. Theres no reason why that law has to stay in place. We can expand the ability of americans to save for their own health care by changing way the tax treatment of hsa is currently legislated. I agree with avik that the worst thing about obamacare is the regulations. The spending is terrible and the tax is terrible but the worst thing is that coercion. Effectively the obamacare is a debate that comes down to liberty versus coercion and the only solution that is to repeal coercion and decide with liberty. Kind of in that vein i would say with all due respect that the worst thing i think republicans in congress can do is look to make obamacare better and the way you describe or in other ways. The response is we will turn the subsidies back on but only in exchange for letting us make obamacare better. Thats a two for one for president obama. He gets what he wants and he gets obamacare to be a little more bipartisan like it would have been from the start if he would have chosen to work with many of the republicans who had their hands outstretched. We need to remember back in 2000 you may recall the Health Summit<\/a> that secretary sebelius said we want to hear republicans ideas at the Health Summit<\/a> but you have to remember this is comprehensive legislation and all the pieces of the puzzle fit together. He cant tweak one part and plot another part and role those together. A city cop comprehensively repealed and the worst thing we can do is try to fix fix it. Are there any other im Gregory Roberts<\/a> a reporter for the advocate newspaper here in d. C. With newspapers in baton Rouge New Orleans<\/a> and louisiana. I asked this question of the freshmen senators who gave a press conference and i was accused of raising a strong hand which i didnt intend to do. My sense is that the administration or whoever you want to point a finger at didnt sit around four, five or six years ago and say we have a perfect Health Care System<\/a>. Everybody is covered there is no issue with uninsured people. As the most Wonderful Health<\/a> system in the world but lets invent this elaborate program that will be highly controversial and create an enormous huge amount of political capital. I feel that there were issues that there was consensus broad public consensus that needed to be addressed. One of those was the number of people uninsured in this country which was tens of millions of people often compare to other developed countries where thats not the case. We did have a privatesector system in effect not totally because the medicare and medicaid regulations. There were was still a problem that needed to be fixed so how do you solve the problems that this program was intended to solve that were widely recognized as problems without resorting to some of the mechanisms . Thats a strawman. That is what i was told. I think its a great question. Think you highlight something thats very important which is we are here talking about overcoming obamacare. The last time we were in a room together at Cato Institute<\/a> i made the point that obamacare is not the only thing we have to overcome. Its actually the programs installed in the Great Society<\/a> medicaid and medicare with the government takeover of the health system. Therefore the health care was an apple and senator obamas eye half of the Health Spending<\/a> was because of medicare and medicaid. The federal debt we have today is driven by unsustainable spending growth in medicare and medicaid. So some of us argue that obama cares unfixable and theres nothing we can do except to repeal it and burn it to the ground and do something else. If obamacare is unfixable than medicare and medicaid which has been entranced for 50 years are also unfixable but also causing problems and yet we are not shy about saying here is how we would reform medicaid. Here is how we would reform medicare and put those programs in push those programs in a marketoriented direction. One thing is very important for us to understand i think a lot of conservatives have the impression that we had a free Market Health<\/a> care system before 2010 and obamacare came along and it was a socialist takeover of america. That is not what happened. There was a gigantic step change in Government Health<\/a> care in 1965 and that was like this and obamacare is this much on top of it. It goes in the wrong direction but its attitude to that gigantic growth in Government Spending<\/a> and government regulation and course and thats it place in 1965. I think one of the big mistakes that guys like jeff makes and he and i have argued about this a lot as he ignores the larger fundamental problem of medicare and medicaid and says basically we cant do much about them so we should focus on obamacare because thats newer and less entranced. I would argue it doesnt matter if the fundamental thing is we are going over fiscal cliff because of these programs and we have to tackle the mall and use whatever tools we have a available to move all those programs in a marketoriented direction achieve the policy goals of expanding access to health care and making it affordable not just for all americans who are uninsured but for the taxpayers footing the bills. We have to be more ambitious than looking at obamacare. We have to look at the broad sweep of Government Intervention<\/a> in the Health Care System<\/a> and if we dont do that we set our sights too low. It does matter whether they are more or less entranced. Lets go after the thing that has never been popular. Its hugely important to go after medicare and i think paul ryan style may be the second most important thing we can do after peeling obamacare and the 2017 project alternative would take medicaid and put it into private insurance. I agree these are big problems as well. Some of this does come down to a debate over how bad is obamacare and i think its arguably the worst piece of legislation passed in American History<\/a> and it needs to be repealed. The American People<\/a> never wanted it and theres should be stuck with it. In answer to your question i fully agree the Health Care System<\/a> was broken before obamacare was passed and the federal government had created this very unfair situation in the tax code where employerbased incher got a tax break in the individual market didnt so as a result the shriveled up and nearly died. The way to inject life into the market is to get the governments foot off the scale equal lies the tax treatment on two sides and thats at the core of what the project alternative tries to do. You just stole my line. As much as we dislike obamacare we have to keep it in perspective. Thereve been much worse laws in the past. There was a lot of discontent with their Health Care Sector<\/a> before the aca was passed but most of it was not about the uninsured. There was no human cry to cover the uninsured. Jonathan gruber is admitted as much when he said everyone said the public wants their premiums to go down. The reason why Health Care Costs<\/a> were so much before they Health Care Act<\/a> world of previous act that Congress Passed<\/a> including medicare and medicaid and i will tell hipaa in there and something that didnt happen by congressional congressional legislation had its beginning in the 1940s was this tax preference for employersponsored insurance. You call this a private market is though that somehow makes it a free market but this tax preference for employersponsored insurance future employer control over 10,000 of your earnings of family coverage and your employer with your health care plan. Thats not a free market. Thats a Government Health<\/a> plan. The horse the government decided to back with this tax preference is a type of Health Insurance<\/a> that disappeared when you get sick and cant work anymore. This is not a free market and it depends on which day you catch me. Some days you have to reform medicaid and sometimes we have to reform the tax treatment of insurance because i cant decide which one has been more harmful but you are right there were a lot of problems and all the Affordable Care<\/a> act was double down on them. He said we need more government to fix the failures. I dont think its going to work. We will have more failure. We have one last question. John with eHealth Insurance<\/a>. If the lawsuit turns on the question as to whether you get subsidy in a federal exchange one basic question is do we need Government Exchange<\/a>s in the first place . Who are you with . EHealth Insurance<\/a>. Is that private Health Insurance<\/a> . Let me clarify that. We dont need the government to create an exchange and exchange they say is a marketplace for people to come together to buy and sell Health Insurance<\/a>. People were doing that before the government created these bureaucracy called exchanges. EHealth Insurance<\/a> is a web site where you can comparison shop and it existed before obamacare. We are at the had enough insurance which was like expedia. Com. What did he say . It would be like eHealth Insurance<\/a>. At this point i want to conclude this segment of our program but of course there is a very great book that you can read that has expanded treatment of all of these ideas and there are copies of overcoming obamacare in the entryway so thank you for coming out and for engaging comments. [applause] our next guest governor bobby jindal needs very little introduction but i just wanted to highlight a few parts of his biography that would be particularly relevant to Health Care Policy<\/a> in todays discussion. Governor jindal studied Health Policy<\/a> at oxford and he had a very young age served as secretary of louisianas department of health and hospitals. In 1998 he was appointed as as executive director of the National Bipartisan<\/a> commission on the future of medicare and in the Bush Administration<\/a> he was assistant secretary of hhs. More recently last year is policy Group America<\/a> next released its own obamacare alternative and he has been very outspoken about what he thinks is the best approach for republicans. More recently he has been thinking and praying in his words about potentially jumping into the white house race. Without further ado, governor jindal. [applause] thank you all very much. I intend to keep my remarks short. What i would like to do is spend more time with questions. I want to thank the washington examiner. I know this event was rescheduled so i want to thank you for coming back. Maybe the Obama Administration<\/a> found that while we were up to and interfered with the original meeting date. I want to positive things up front. If president obama could go back in time if you were than senator obama or maybe president elect obama if you could tell him if you persist with obamacare you have a majority of the house and 60 members in the United States<\/a> senate. There were a lot of things he wanted to get done capandtrade card check and Immigration Reform<\/a> tax code reform. There were a lot of things that this president campaigned on. If you went to him and said if you insist on doing obamacare the other Major Initiative<\/a> had up to that point was the stimulus bill. If you do this is one of your First Initiative<\/a>s your First Initiative<\/a> to require to lose the majority of the senate lose the majority in the house and you are going to lose the ability to pursue your other initiatives. You may be a twoterm president that he wont be able to pursue these other things you campaign on or cared about. I think he still would have done it. From his perspective and he promised he wanted to be like Ronald Reagan<\/a> as president not that he wanted to be conservative or freemarket wanted to be transformative in the other direction. Getting Obamacare Don<\/a> was the single most important domestic policy they can point to in decades. If your view is wanted to grow the influence of government having the government that are involved in health care something that is up growing important part of our economy critically important to each of us he couldnt think of a better more important policy called the schmidt. So this was a big political mistake or blunder i think they are wrong. If they deserve credit for knowing the exact what they want to accomplish when it comes to health care. They have been moving in that direction at times and lets not forget Hillary Clinton<\/a> started in the early 90s with hillarycare and last their vision of governmentrun health care. They are not done did what they really want is a singlepayer governmentrun system but too often on the right we have not had the same clarity and persistence. Too often we View Health Care<\/a> as a democrat issue or a liberal issue. I think thats wrong just like they dont think education should be a democratic or liberal issue. Conservative republicans need to go on the offense on health care care. The second thing i would say if the president were able to listen to the debate to herd and other quarters i think you would be pleased. I think if the president can go to republicans and say i will listen to your alternatives and listen to your programs as long as you do three things. One as long as you create a new him titled the program. Secondly as long as we we are using the tax code to redistribute we are going to use massive tax increases and the tax code from one group of people to another and third as long as we measure success by how many people have cars at the end of the day. If you are able to get those three things done i think you could declare victory. I think he has been very successful in having conservatives and republicans to help turn his terms. Interestingly those were the terms he used me as a candidate. When he was a candidate in 2008 then senator obama sounded very much like a conservative. He told then senator clinton had an individual mandate the issue is affordability. He told senator mccain both which by the way ended up in obamacare. So i am one that thinks conservatives and republicans need an alternative to obamacare. I think its great we are repealing it and i think thats wonderful but i do think we need to replace it for a couple of reasons. I dont think we can go back to what health care was before obamacare. Americas Health Care System<\/a> is the best in the world but also had significant challenges. One of the reasons is for too long when we have a chance we didnt address those things. We need to address those challenges. Secondly i think if we dont offer her own alternative i do hope the Supreme Court<\/a> does the right thing and rules the law is but if we dont have an alternative we know whats going to happen. The president s going to stand up and youll have a sympathetic family or group of individuals meet soandso who has cancer needs chemotherapy. They are only able to afford these treatments thinks obama candies means stingy republicans wont take a onepage change in the law. We will fall victim to that if we dont have an alternative and we need that alternative today. Not tomorrow but today. They are are a lot of people thinking about running for president and i would say to anyone thinking about running for president you need to have a detailed plan about how to replace obamacare. I have offered one im happy to talk about it. A lot of folks have plans but i do think anybody thinking about running for president needs to do more than talk about polls or fundraising or consulting. They need to think about what they would do if they were elected president. Im surprised candidates havent done that. To my knowledge where the only candidate that is offering a detailed plan. People may like and people made not like it but at least we have had the courage to say this is what we would do. A 16point plan we can talk about we do at deductions that of a tax credit and we allow interstate purchase of insurance and voluntary purchasing pools and specific on medicaid and medicare reform as well as state licensing reforms in medical liability. The point is as republicans as conservatives we need to say what we are for not just what we are against. I think obamacare gives us a great opportunity before the Supreme Court<\/a> rules to say what we are for and i will close by saying two things. One, we shouldnt fall into this trap of saying we will measure success by these terms. His terms are union but entitlement programs. His terms are not only do you have to have entitlement programs you have redistricting and third count success by the number of cars people have created success is how many people have cars whether they have meaningful access or not. It doesnt matter to us if the networks are such that you cant see the doctor that you want to see but you will declare victory because you have a car. Thats the rationale behind much of obamacare. We are comparing our plans but how many cars do you have . Thats not the measure of success. There were measure of success is what we have to do what then senator campaign senator bond said the campaign. He said the real issue is affordability. He seems to have forgotten that its plan. Theyre all kinds of reasons to be against obamacare. You cant keep your doctor if you want and they cant keep your plan and we are not going to cut your premiums 2500. You will hear a lot of people that have never been elected to office telling you politically we cant do this or we can do that. A lot of people never stood before a voter and told you this is a housing our principle perspective. We can do that is politically its not possible. If we are now willing to accept this new baseline if we are willing to say now that the democrats have created this level of dependency we can never go below that. We are done as a conservative movement but more importantly we are done as a country. If we say we cant take any steps, we cant undo the dependence this president has created this is the new floor no matter what you do. This is the new florida tenneseans to politically tough to fight for independence in this country. 18 trillion in debt record low participation in the workforce with gdp growth of. 2 we have given up on the American Dream<\/a>. That is why i think the obamacare fight is so important. If we need anything we need to stand against government dependency. I think its important to have a full plan to repeal and replace obama cannot dont think that plan can simply be a repackaged redecorator version of government. Im going to stop there and i will be happy to take questions about anything ive said or anything else you want to talk about. Im going to ask a few questions to start off with. You sort of said a lot of the plants republicans have offered in congress are obamacare like or dont represent full repeal. Can you explain or define a policy distinction between what you would consider obamacare like and what would you consider a genuine alternative . This sounds very inside d. C. And for the real world what does that mean thats a lot of these plans of said look the new world is obama cares a lot the land so please spend more than before obamacare then lessen him thats a cut. Obama cares a lot the plan so free raise taxes but not as much as he did the math attacks cut. I think thats nonsense. Full repeal means repealing the spending increases and all the tax increases. Thats the first. A lot of candidates for United States<\/a> senate as well as the house and governors but mainly the United States<\/a> house and senate won elections opposing this president s policies. One of the most popular tv ads was we are going to repeal obamacare. Give us majority and we will repeal obamacare. I cant speak for a lot of candidates. I cant remember the fine points and we are just going to repeal part of it to the rhetoric on the campaign trail was gives the majority and we will repeal it and those candidates one purple red and blue states were says to me people want obamacare to be repealed so a starting point we have to give up the tax increases and get rid of spending increases and then start by saying how do we reduce costs . Thats full repeal and replacement obamacare. Would the argues sort of his look obamacare has been allowed to land in 2010 and 2017 when a republican president perhaps president jindal is in a position to implement an alternative that baseline would have been in place for seven years that is sort of what the assumption is. So they say is that kind of bizarre to go back to what the world would have looked like in 2010 had something never happened . I would wait until 2017. They need to replace it today. The court ruling gives them a chance. When he did to challenge the president to do the right thing and challenged democrats. We shouldnt negotiate against ourselves. Secondly if they meant that they should have been honest with voters. They should have gone to the voters and said we dont really mean it when we savored repeal obamacare. We are just going to modify it. They should give voters an honest choice and i go back to a point made earlier we accept this new level as the norm then we are done. This president has run spending and borrowing to unprecedented levels and i would argue outside of health care but including obamacare if we take this as the new normal we wont see Economic Growth<\/a> we are accustomed to. We wont preserve the American Dream<\/a>. I think its critical if we are going to restore what we want and view is freedom in this country and the American Dream<\/a> and the opportunity to work hard and get a great job we cant can sustain this level of spending and borrowing. Its a fundamental mistake for republicans to concede this is the new baseline and we cant do any better. Its realistic to go back before obamacare what the law of the land and that is what they told us they were going to do. If they didnt mean that they should have been honest enough to tell us. There are conservatives who would challenge you and say you were the one that is surrendering and in getting into the idea that democrats perpetuate that any freemarket plan isnt going to be able to cover and compete on coverage with democrats. They would say you are actually the one thats getting into the premise of the left. How would you respond to that . I think the mistake to measure success by how many cards people have when its not meaningful access. Once you fall into the debate debate democrats will be willing to spend more and once we fall into the debate we are not standing for something way different. I think thats the wrong debate to have. Once you can see that premise of course if the person is willing to use the force on the iris to force you to buy insurance you dont want in willing to count coverage cards that dont have meaningful access including medicaid then you fall into this trap after a couple of years theres no Meaningful Health<\/a> care improvement but we will count it as a success because you have a medicaid card. We need to stand up and by the way he got elected saying things things. He didnt talk about giving people cards. Talk about driving down costs and making health care more affordable. I think as conservatives we need to stand up and say you are right if you want to let the Government Force<\/a> you to buy something you dont want as now we stand for that if an city wants a party who will focus on making Health Care Affordable<\/a> housing people who are vulnerable. I do think you need to help people with preexisting conditions and you dont do it with a massive takeover of health care. Better place to do it is we give the states 100 billion over 10 years and talk about the use of highrisk pools or reinsurance to help people who need that help but we dont need a federal takeover of the Health Care System<\/a>. I think its fundamentally mistake to measure dependence as success and that is what the president wants us to do. On the Supreme Court<\/a> case which you mentioned just to clear it right off the bat Supreme Court<\/a> struck down the federal Exchange Subsidies<\/a> you would not set up an exchange in louisiana . We would not for a couple of reasons. If the laws interpreted that way not only did to the subsidies go away but the mandates for the most part so your individual employer mandates for the most part go away. I have written off that showing if it goes the it goes away or should that is an effective tax cut cut for our economy for businesses and families tens of Million Dollars<\/a> in spending cuts of hundreds of millions of dollars but to preempt what i think the president will do that is why its Important Congress<\/a> not once it happens or purported happened to repeal and replacement plan. On the idea that you outlined that state that scenario. Republicans pass a full comprehensive placement and obama pekosz it and then what . You are left with a situation in which millions of people are losing coverage. Obama has the names of those people. As you said he could put them out and say look at these people who are losing their coverage. Republicans have said they would feel a lot of pressure to do something and i have talked about creating some sort of bridge that would essentially be a temporary patch that would keep people over this until 2017 where you can pass a comprehensive law. Now you are talking to hypotheticals. Lets assume congress do something and lets assume the president does something. Lets go back to the second to third hypotheticals. Lets say Congress Passes<\/a> it. Now its republicans saying thats not right mr. President they we have a plan that helps people who need help if you will sign this bill and not veto it. Thats a very different discussion and debate and i dont know that we know exactly whats going to happen. I think thats a different scenario than if we pass nothing in the president can say here is my onepage bill or even worse heres hhs pretending these federal our statewide. Instead of, now look i know the temptation d. C. In congress is to surrender before the fight starts and we see that time and time again on amnesty and executive orders and the iran build. I dont think congress should surrender. Here we are talking about free stuff that havent happened yet. Lets not talk about it a lets pass the bill and debate the president say we dont want those people to fall through the gaps and thats why we dont want you to veto it. To be clear you oppose some of the alternative republican alternatives that say lets extend the subsidies for people and not allow new enrollees that it they are receiving Exchange Subsidies<\/a> would have some sort of way to keep them. The best thing for congress to do is to pass a full repeal and replace package. Lets pass that and get that to the president s desk and have that debate. So you wouldnt rule it out down the road. What im saying is we repeal the entire plan and replace it and do that instead. Lets have that debate with the president. On your plan another one of the criticisms is you have a plan that moves toward and this is something we talked about in the earlier program that relies on a standard deduction rather than a tax credit and it tells people they can get a standard amount of money that reduces their Tax Liability<\/a> up to that point when they purchase Health Insurance<\/a>. One of the criticisms of that approach is that not only the idea that it cant create broad access but it could unravel the employerbased market essentially because right now you have these pools where employers have a nice mix of healthy and sick and old and young where as if they were a standard deduction people who could get cheap insurance because they are young would take the deduction, get cheap insurance and then you have employers that are stuck with only the older and sick and most expensive customers that would drive up their insurance costs. A lot of people might say we are not going going to keep having employerbased insurance anymore and this is how half of americans get their insurance so how would you respond to that . There are three different positions one could take. On one extreme those who say we are absolutely went to the employer care Health Coverage<\/a> and we dont want to do anything to change us so we are going to lock people in. If you have employerprovided health care you dont get anything outside of that. If you have employerprovided Health Care Available<\/a> you are not eligible for deductions tax credits government assistance. Thats one extreme and we are going to lock people into Employer Covered Health Care<\/a> insurance any of extremists we are going to give everybody money to shop on their own and take away the exclusion and take away peoples ability to get health care through their employers. We have done neither of those. We have said if you provide a high enough deduction the short term based on what people are spending today you allow voluntary purchasing not just through their employers but also through faithbased organizations and they have erisa protections that employers get to make so they get the same protections and you also say by the way employers dont have to exhaust the program before they go into the individual market. You will see a voluntary gradual movement is peopled by health care where they want. You are right there are some people say we want to tell you how you should receive your health care pity either the government will tell it you or you have to buy through your employer or Government Exchange<\/a> marketplace. I think choice is a good thing and i trust the American People<\/a> to decide for themselves and told how they have to get their health care. We either believe the American People<\/a> are smart enough to live their own lives or we dont and join the left. Is there anymore questions . One thing we have been hearing a lot the panic mode, the state lightures and governors saying you held our feet to the fire no exchange 0 no Medicaid Expansion<\/a> and these solutions are federally centric whether its your bill or the Affordable Care<\/a> act. What would be your message to say, we have answers give us control, do you think one with your message and do you think thats a viable option or is the message and the debate too centered in congress. Im obviously going to believe a plot in state flexibility in our plan we give the states more flexibility when it comes to running medicaid programs. Give them flexibility with account ability. Part of the rope you hear this debate in d. C. Is Affordable Care<\/a> act has done damage. Both plans are no v8 because of obamacare. They war cancelled because of obamacare. The problem with stateled effort we cant give them access back their healthcare plans without the federal government get out of the way. Secondly now that hhs has been given the authority basically when you think about what obamacare does at its cower beyond the redistribution,on the mandates and Medicaid Expansion<\/a> it tries to make health insuren whether through the private sector or not basically a public ute and the hhs secretary being empowered to review benefits, review profitability, and overhead expense youch can buy insurance at the state level but you can have whatever color you want as long as its a black model t. The federal government has taken so much power away from the states and regulating benefits design and regulating affordability, and i do believe that states need have more there are things states can do in terms of compacts but the end of the day theyre severely limited because of the powers obamacare gave to the federal government, and part of the reason the debate is centered here we need to repeal that and get the federal government out of the way so they have that flexibility, so they can help their citizen is. The state level you are severely limited what you do. I cant impact the federal tax code as a governor. If i want to help people in my state its hard without congress or administration removing restrictions. Theres a role for states to play but part of the problem is obamacare took iron ash dish dont think this president read the tenth amendment to the constitution. I if he has, he doesnt believe it. Its true in education and many other areas. So i think your message is right but theres a reason to win the fight in to give states the flexibility to respond. Governor, dean clancy, llc. Thank you for your leadership and for your very Detailed Health<\/a> plan. Its excellent. Im thrilled to hear you mention the tenth amendment and i want to pitch you what i hope is a softball question on that theme. Republicans always include in their list of talking points on Health Care Medical<\/a> malpractice reform that usually means the feds are going to override all the state court laws about how you handle medical malpractice or caps, attorney fees, and english rule and all these different things. My constitution doesnt authorize congress to do that. What is your constitution say . So what we did in our plan, we actually did our medical liability reforms in the context of federally paid for programs. We said, the extent that, for example, we pay the federal government is paying for a medicaid or healthcare programs, we said lets do the tort reform within the programs, save the federal taxpayer tens of billions of dollars and there is a federal interest because the government is paying for it. The state level louisiana and california were two of the first states with caps, and in our plan we purposely started with a tort reform in the federally paid for programs. Thank you. Page cunningham on the Health Policy<\/a> reporter at the examiner. Of course, its been noted that the Supreme Court<\/a> could strike the subsidies to the federal exchanges but theres a chance they might not. How are you going to and in your state almost 200,000 people did get insurance on the exchange majority of those with subsidies. How are you going to convince to the people to vote for you ifor running on promises to take the subsidies away. A couple things. Youre right i think a little over 180,000 dish dont know holm of those paid premium its but they made a selection on the web site. But regardless, what the final numbers are the important thing is to say that i foe nat the president loves to say the republicans just want to take things away. Were not saying we want to take something away. We want to give you something better. So instead of the federal government forcing you to buy products that you may not want, that ared inflated in costs were doing what the American People<\/a> said they wanted which is driving down the cost of health care and making health care more accessible so theyre not forced to buy benefits day dont want but also go and join Insurance Plan<\/a>s that may not cover their providers. So some of the complains you hear from folks is that im a 20yearold single mail guy eye. Not paying for ob gyn or joining a network where my childs pediatrician or my specialists arent included. So i know the democrats would love the toe position this as a debate were for more spree stuff did and the republicans want to take things away from you. One point we make, were trying to give you something better, which is access to affordable high Quality Health<\/a> care, and secondly its very important for republicans to take a step back. This is true in obamacare and lets take the proposal for Free Community<\/a> college. Why stop with Health Insurance<\/a> why not a free car free house itch think the American People<\/a> are smart enough to know this isnt sustainable. Somebody has to pay for this. Its over 18 trillion of debt and counting, and the American People<\/a> including the folks in louisiana and other states are smart enough to know we got to get the private sector economy growing again stop stealing from our children and grandchildren. These socalled free benefit is from the federal government are februariesed are were borrowing money from china and making promises you heard earlier speakers speak about obamacare and look at the status of medicare, social security, medicaid. I want the programs to be there for the people of louisiana for my children and grandchildren and theyre not going to be there on our current path. The people are smart enough in louisiana and across the country to know that. I think they realize that this idea that government can be santa claus and give you everything for free is not sustainable and well have to pay the bills and its going to be very expensive. Probably the not us, our children and grandchildren, and the great thing about the American People<\/a>, i dont think i know in louisiana i know this across the country i dont think were willing to mortgage our childrens future. We want them every generation has left more opportunities for our kids, and im confident this generation is no different. I think well do the right thing hen it comes to shrinking the size of government and make sure theres opportunity for growth for our children and grandchildren as well. Im rachel with inside Health Policy<\/a> here in d. C. Piggybacking of king burwell im curious what your conversations with other governors on what to do if the plaintiffs win what those have entailed and what your day one plan is. If they decide to strike them down immediately and not wait. I dont want to speak for other governors. Something we talk about at conferences and different governors will take different positions based on what they think is best for their state. For miss, ive been saying this clearly, it comes as no surprise to anybody that we are in last im absolutely against us doing an exchange. We are one to the first states that said we wouldnt do the Medicaid Expansion<\/a> or the exchanges and the reality is that hasnt changed. The federal government this administration does this a lot and say we want you to be our partners. But you have no flexibility or decisionmaking authority. Well tell you exactly what to do but youll be our partners. Thats not a partnership. Theres all the responsibility without any authority in either set up exchanges or method okayed oar other components of obamacare. We made it clear we wouldnt do that. We have to have a replacement plan in place before the court makes a decision. I know there are a lot of hype the s about the court. Up in of us knows what theyll say how theyll come down. And in louisiana we have made it clear were not doing a state exchange. We think obamacare needs to be repealed and replaced, and so i certainly would continue to call on congress to put that in place inch louisiana we are different from other states, and every state delivers healthcare differently. We have not expanded medicaid. We have Public Private<\/a> partnerships a network of Charity Hospitals<\/a> other. States dont do that. We have different mechanisms. Every state has those mechanisms in place and theyll be there for people who need access and we have those safety net mechanisms in place. In louisiana we have ten hospital inside the state and dozen of clinics but the best solution is for republicans to truly pass not just the repeal legislation i want them to do that but pass a replacement bill as well. Can you talk about the sort of lobbying campaign we talked a lot about how the public reacted how president obama might lose the prospect of millions reducing Health Insurance<\/a> to try to get republicans to give in and but the other pressure is going to come from the lobbyists and you now have a lot of powerful industries that are vested in obamacare. The Medicaid Expansion<\/a> one of the ways in which theyve been able to get a lot of republican governors to go along has been through heavy lobbying by the hospitals. And certainly if the federal Exchange Subsidies<\/a> get cut off insurance lobbyists will be aggressively lobbying to set up exchanges. What would you argue to other governors to say to hospital and insurance lobbyists who are pushing them to do this . Thats a great point. This reality is many entitlement programs are entitlement to the providers and theyre the ones that push hardest for the programs for funding for these programs. Lets take the Insurance Companies<\/a>. Lets take the hospitals. Theyve been two of the loudest when it comes to Medicaid Expansion<\/a> in my state and other states and obamacare in general. Look at the hospitals. Ill give you louisianas example. If we had done Medicaid Expansion<\/a> in louisiana we wonting a loss, a im governor 250,000 louisianans would be moved from private insurance to medicaid. My point to hospitals is, thats more than the number of previously uninsured people moved into medicaid. So youd actually have for every previously uninsure person in medicaid youd have more than one person be prevented to be in private insurance now on medicaid. So if youre a hospital youre no longer getting blue cross or blue shied or, youre getting medicaid rates for the 250,000 people Mitchell Point<\/a> is be careful what you ask for. Because the reality is that over time medicaid is increased as a percentage of almost every states budget and the way states respond is they reduce rates, and before, hospitals could when medicare wasnt paying their full share. They wont be able to do that when method okayed becomes 30, 40 of the hospitals patient load. So hospitals need to be very careful of this crowding out in Medicaid Expansion<\/a> under obamacare theres no anticrowdout provision. Theres no ability to say were only targeting people who are previously uninsure. So hospitals may end up i said that part of what obamacare does is turns Insurance Companies<\/a> into public utilities. Hospitals could very much end up being very dependent on government rates and end up being underpaid nor care theyre delivering and then youll see a deterioration in quality and access. If they dont think thats going to happen, look what happened with physicians and the debate going on is in n this city. Now theyve got this socalled fiction. Secondly the Insurance Companies<\/a> are not going to once they become they need to understand where the lift is going with this. At the end of the day insurance becomes a commodity under obamacare. They wont have the margins because theyll be regulated under the federal government. At some point you get to the point where you have de facto single pair government. So to provide efforts those that thing the benefit outweighs the long term wish, id tell them be care what youre wishing for. You have seen Drug Companies<\/a> come to the realization. Well have more patients. Theyre begin fog realize at some point state legislators and members of congress will see they have to balance budgets and generally theyve done two things. Either reduce volume of Services Sometimes<\/a> are trashily how many time wes have seen were going to cap. Only see the doctor this men tames. A one size fits all approach, and secondly they reduce prices, and historically when they reduce prices through administrative pricing the you cant do at that time we were doing medicare reform in the 90s this is another topic, while we need do premium support. We had a democratic economist who said the problem with medicare defederal government is setting thousands prices in 3,000 counties. That is what happens. The the future of American Health<\/a> care if we grow the federal governments involvement in health care. I dont think the future providers really want and they need to be very, very careful straiting that they think are short term gains for having the federal government micromanaging their delivery of health care in the country. Its bad for innovation and bad for quality. I think you said we should not cap by few late to the president s standards for success in Health Reform<\/a>, and you mentioned affordable was a standard that he neglected. He acquiesced to. Do i understand that your definition of affordability is more consumer friendly than obamacare . In other words, i think under obamacare, you have to spend 9. 5 of your income before your relieved of the mandate butow define fortunatability in the block grants to states to help the people who dont qualify for the standard deduction for Health Insurance<\/a>, that the state has to make basic insurance available in that state for i think less than 6. 5 of adjust ode income in that state. So under your vision of Health Reform<\/a> people consumers are treated better in terms of affordability and consumerism than under obamacare. Die have that right and. You do. One tweak. Such a nice question. All my answers have been so long i want to give you a short answer and say yes. The only tweak is in the state grant, its not just based on a consumers income, its always those that may have preexisting conditions or people who dont have enough income or the deduction helps them but also be people mo are priced out i think the president was right to say, look, if you have preexisting conditionit conclude toxic preobamacare. Unfortunately he screws up the regs of the Healthcare System<\/a> trying to help those people. The short answer is yes with a couple of tweaks in terms how we help people with preexisting conditions as well. Just briefly on the obviously we have the president ial race coming up. What role do you think obamacare not just obamacare but alternatives is going to play in the 2016 race . Do you think theres more pressure now for republican candidates to come up with comprehensive alternatives than there has been in the past . Absolutely. As i mentioned up front we spent the last year and a half doing america next. Coming up we idea ons healthcare education energy, and foreign policy, and i think this election is different back in the 90s there was sense maybe even in early 2001ss that the differences between the two parties werent that great. Compassionate conservatives moderate democrats and the idea was maybe a time of peace relative prosperity, won the cold war elects dont really make the elections didnt matter that much. We can have elections based on personalities, who tells the best jokes. This is a very different time for our country. People on the left and the right agree that this is an election about the direction of our country. You have two parties in very different places. I would argue the Democratic Party<\/a> has been taken over by the radical left. So they dont want to do keystone. Theyre frustrating private unions that would get good construction jobs to appease the radical environmentalists. They dont want to do School Choice<\/a> that would help kids from poor and minority families abuse of the teacher onion. They dont want Affordable Energy<\/a> not just the keystone pipeline. Its production on federal lands and dont want to support a host of policies that bring back good paying manufacturing jobs because the radical donors and others in their party. Iard thing eye lex is no longer just about differences. This is two different visions of the future of our country and yes, its different visions in obamacare, different visions on School Choice<\/a>, on Energy Independence<\/a> on foreign policy, and fundamentally a distinction about the American Dream<\/a>. Is it about government dependence or people working and getting a goodpaying job. I challenge anybody thinking about running for president or declared as a candidate to come up with their own detail on obamacare, on repeal and replace, all of these issues. This is an important election and voters will demand that. I think a especially Republican Voters<\/a> all voters will be very interested to hear what potential candidates say about obamacare. Its easy to say you want to repeal it. Everybody says that. The next question is, what are you going to do instead and replace it . You said you were thinking and praying about running. You have a legislative session going through the middle of june. June 11th. This is our third week. We have a nineweeks. I said id make misdecision shortly after the conclusion of the session. Its important whoever we elect has to be somebody who wants to do something not just somebody who wants to be somebody. Thats what is important tougher detailed ideas so that this election is a debate substance. I im biased towards governors. They have proven track records in our state we cut our budget 26 , actually some returning the slunk the size of our government. We measure success in the peoples prosperity, and i think that is what at the heart of the obamacare debate and i dont think healthcare reform can be a debate how many people have card. Its whether we have high quality, affordability. The real question and answer is simple. Who do you want in control . Do you want it to be patients and their doctors or bureaucrats . Government bureaucrats or insurance bureaucrats. Doesnt matter you want the consumer the patient the American Family<\/a> in control. Thank you for coming. 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