that afternoon a quorum being present in the committee on education labor will come to order today and tomorrow we have one item scheduled for markup h r thirty two hundred america's affordable health choices act we expect to hear opening statements today and will begin with the members of the committee meets today to begin marking up historic legislation that will guarantee that all americans have access to quality affordable health care no one can argue that our nation's current health care is sustainable premiums and health care costs have skyrocketed for families businesses and government and the costs are crushing families businesses and government americans with insurance are increasingly concerned that their employer will scale back coverage or drop it altogether they're also terrified about what happens if they lose their job families often have to fight insurance companies who routinely deny coverage and delay treatment based upon some notion of preexisting conditions usually unknown to the insured at the time they take out the insurance and the forty seven million uninsured are threatening the health of our nation and that enough unsustainable costs on everyone else all of these factors are driven the system out of control for families businesses and our nation's future the america's affordable health choices act h r thirty two hundred will set a new more sustainable course it will in the sure that all americans will never have to worry about losing their coverage this bill reflects years of open and collaborative process and debate and discussion all across the nation and all across the congress it reflects put of our colleagues and over seventy witnesses in the three committees of jurisdiction have heard from it here release in our discussion draft three weeks ago the america's affordable healthcare act embraces the desires of the american people to meet the goals articulated by president obama to lower costs to preserve choice to expand access to qualify an affordable care what's broken in the bills own and what works in our current system it addresses our nation's economic and fiscal health by reducing costs we made two things clear from the start one health care reform is fundamental to ensuring the long term fiscal health and two we must be responsible and pay for these reforms rather than pass on the costs to future generations has been done by previous congresses and previous administrations when enacting significant legislation let me be specific about what our bill means to the average american our bill will lower costs for health care and means or be no more co pays or deductibles for preventative care no more rate increases because of  preexisting condition or because of your gender or where you happen to work an annual cost there will be an annual cap on out of pocket expenses there will be guaranteed affordable dental hearing and vision care for our children our bill will provide choice of care you can keep your doctor in your current plan if you like your choices will be protected and enhanced and if you will have access to a wide variety of choices for quality and affordable plans including a high quality public health insurance option to compete with the private insurers our bill will increase the quality of care you and your doctors will make health care decisions not the insurance companies more family doctors and nurses will be able to enter the workforce access to better treatment that meets apparently the patient's needs our bill will offer stability and peace of mind never again will americans go without health insurance you will never lose your coverage if you lose your job  switched jobs or you start a new business you will never be denied coverage because of preexisting conditions and you won't face any lifetime limits on how much insurance companies will pay me that you'll never again be one treatment away from bankruptcy our reforms will cover ninety seven percent of americans by the year two thousand and fifteen contrary to his claims that the employer based coverage will drop estimates of our bill actually increasing employer provided care also estimates  thirty million americans will get their health care through the exchange in twenty ninth two thirds of those people will choose a private plan not only will the bill before us today provide a piece of mind to all americans struggling to pay for health coverage it will also drive down costs to our government and businesses in addition to the revenues our bill will raise over in addition to the revenues our bill will raise it will directly save over five hundred billion dollars in future outlays of medicare and medicaid to reforms that change our system from one that is based on the one to one that is based on the quality of care and not one that's based on utilization and  fact the bill also has billions of dollars in savings of unfortunately that cannot see their way to scoring and dealing with prevention and other logical changes in our in our system the current system rewards rewards prescribing the necessary test and more invasive medical procedures directly increases costs that we all bear and increases the chances of medical errors in fact the center for american progress just released a report that calculates that our nation some seven hundred billion dollars a waste in inefficient care that's where our bill along with the investments made in the recovery act will ensure that health spending is based upon outcomes and not just simple utilization our nation's future economic competitiveness depends upon real health care reform businesses are less competitive because of the skyrocketing health care costs and as a result we see companies hiring shifting more cost onto employees and even ending coverage because of these rising costs real health reform will not only save jobs it will create millions of new careers and it will be millions of new customers looking for primary care clinics doctors and nurses over the next few days our committee will be marking up in the areas of this legislation that in our jurisdiction including an employer's responsibility for providing health care and the health and the health exchange i look forward to what i'm sure will be a vigorous debate on these provisions but let me acknowledge how far we have come we have taken another momentous step in our journey to finally fix a broken health care system of this nation i'm confident we will get our bill passed in the house on schedule by the august work period let me just end by saying that we must and we will we must and we will continue to move forward and say that the only thing that is off the table is not moving forward and say under different circumstances just about twenty four hours ago we first laid our hands on this it turns out to be one thousand seven monstrous bill as a potential drop in our entire health care system i've done my best as have other members on the side of the aisle to examine the bill and understand its consequences but in a day or even a week we can only hope to scratch the surface i know the majority will tell us and we've had about three weeks to review the june new pages no doubt address the very legitimate concerns raised by members on the democratic side of the aisle never mind the concerns on the side of the which i suspect have been largely ignored because we haven't been given a seat at the drafting table in fact will be among them was critical choices any of us will ever make health care accounts for one sixth of our nation's economy it affects jobs and family incomes it represents one of the most trusted and sacred relationships in our society the bond between patient and doctor mr chairman it is no exaggeration when i say that health care is a matter of life and death we've had precious few opportunities health care reform during the hundred eleventh congress but when we have i've tried to be absolutely clear in my intention i believe health care reform is increase in our country can afford i meant when i said those things and i continue to feel the same way today that's why i'm so disappointed that we're here to debate a proposal developed behind closed doors that aims to give the federal government developed by the democrats and only by the democrats fails to solve these problems indeed it stands to make health care problems far worse with a system of federal mandates limitations a massive tax increases that will cripple our economy while degrading the quality of health care at the heart of the bigger more intrusive federal government in anoints health choices commissioner whose role can only be described as orwellian looking over the shoulder of health care practitioners and if the name is any indication making choices that would be better left to patients and doctors the legislation empowers federal bureaucrats benefits that are and i quote it also calls for comparative effectiveness research a transparent attempt to ration care and limit access to life saving treatments the track record for government controlled health care is frankly not a good one we've heard the story of a couple in canada forced to deliver their own child because no one answered the ring at the door of the government run run health care medicare medicaid and veterans care and while these programs certainly provide essential services i don't think anyone would hold them up as a model for the future the medicare hospital trust fund will be insolvent in two thousand and seventeen payment that's not fair competition in reality the government will make the rules play in the game and act as referee a level playing field i think not the so called public option is nothing more than a trojan horse intended to quietly into the for your tireless work on this issue it's an honor to serve with you on this committee the next couple days that we had some discussions about people who are ordinarily not in this room because they're the ones that this bill is really about it's about a business person who is doing everything she can to provide health insurance for their employees but can no longer do it because iraq any premiums at fifteen or twenty percent are killing their ability that don't usually sit in rooms like this bill designed to help them and it's why we need to pass the reason that we have such a problem in the country is that health care costs health care out of pocket costs premiums deductibles co pays for families have gone up three times as fast as wages and as a result people are in trouble and we need to do something about the problem  talk about this problem it's time to do something about you want to hear a lot about what's wrong with this bill and we look forward to that but i would say to all those who want to say what's wrong with this bill tell us what you think is right that would fix the problem come to the table with a solution here's our solution we understand that costs have to be brought under control for the american people for families for businesses for unions for government  encourage such behavior that move from sickness to wellness we want competition for the first time in the insurance marketplace we do not want insurance companies to dictate the terms of cost and coverage for american families we want them to compete for the right for your business and when they do we believe that quality will go up and costs will go down and finally we understand that uninsured people this country covering the uninsured is one of the most powerful ways to control costs in this country and this bill does so we would all those that want to participate in this debate bring your ideas to we do the right thing and pass this bill jimmy is back in time mr price thank you mr chairman i left the practice of medicine i left caring for patients for over twenty for precisely this moment in public policy i cared for literally thousands of patients as an orthopedic surgeon each and every one of them a privilege the actions being taken here are part of an attempt to fundamentally alter our health care financing and delivery structure it's an historic occasion and remarkably consequential to all americans because of the very specific decisions that we will make that may in fact adversely affect how they are able to ensure the health of themselves and their families as a physician has been my steadfast desire for us to achieve full access to affordable quality health care while preserving the patient doctor relationship without governmental interference and yet the proposal before us today takes us very far from the american people's vision of reform let there be no doubt after nearly a quarter century as a practicing surgeon know one thing had a greater negative impact on my ability to care for my patients and the manner in which medical services are provided than the intrusion of the state the federal government in fact for new medicare patients it's virtually impossible to find a doctor will be able to see them due to the ridiculous rules and the inappropriate reimbursement for them or patients of mine are on a bill on able to find a doctor to care for them because of the intervention of the federal government ask your constituents you know it's true i know that medicare didn't allow for the most effective treatment for many of my patients for whom i cared for years medicare patients received second class care due to the decisions from the bureaucracy and successive congresses just like this one this has severely eroded the ability of patients and their doctors to make independent health care decisions some of the most personal decisions that we make the day an american turned sixty five years old they become a second class citizens regarding medical care if doctors are honest with you they will tell you this and the doctor patient relationship wants sacrosanct is being trampled by coverage rules inflexible regulations and one size fits all policy when you pour through this proposal that we have before us and you conduct a critical analysis a critical analysis one appreciates that we are transferring the worst of our current public health care systems to the health care to be provided for every single american permanently institutionalizing failures of our current government payment system into the entire american health care delivery system this means more federal supervision and administration leading to a system built on mandates rationing bureaucracy and taking health care decision making away from patients and their physicians this bill continues to be wedded to a government run health care plan known as a public option that will force over one hundred million americans out of their personal health care coverage and into the government run plan this is wrong and warranted and destructive to the quality care for my former patients and all our constituents i'll take the newly created health benefits advisory council comprised mainly of federal bureaucrats and presidential appointees it's a stand simply being established to make recommendations on minimum health benefits standards and call sharing levels and what it will really do is destroy independent physicians from being able to determine what specific care individual americans may receive when i was practicing medicine my bristle when they understood that i was handcuffed and making independent decisions and this is what we will do for every single medical decision if we adopt this proposal this is a plan to fundamentally alter the relationship between government and it citizens turning the people in the rewards of the state but there is hope as there are alternative positive solutions which trust patients and doctors because the status quo is unacceptable and to my friend from new jersey we believe the status quo is not acceptable reform must be built however up on dual pillars a tax structure in which care is accessible to all americans everywhere every single person understands that it makes financial sense for them and their family that h insurance and secondly have that health coverage truly owned and controlled by patients that is what we ought to be doing not forcing every single american into a system that of necessity will betray those health care principles americans hold their accessibility and affordability and quality and responsiveness and innovation and choices in the end to health care reform package should empower americans with the opportunity and allow free people the right to make free decisions achieving this positive type of change will be only possible by embracing in a bipartisan manner a fundamental rethinking of our health care delivery system a system which champions personal ownership and coverage the alternatives available to us are not just a health care system run by an oppressive government or a monolithic insurance industry we have an opportunity to truly empower those most affected by all treatment patients and their families so that our system rep respects them and recognizes the remarkable personal decisions made by each and every american family in their personal health care so in closing mr chairman i challenge each member of congress to recognize and appreciate that the action they take on this proposed bill may be the most important they take in there and to hire public career for those of us who spent our professional life fighting for and caring for patients i implore you to think about what will help improve our system not simply check a political box that says we fixed it when in reality the box being checked will say we destroyed it generally is back to committee will recess for the purposes i believe we have a total of five votes and will return to continue opening statement r thirty two hundred america's fordable health choices act like to thank chairman motor subcommittee chairman andrews and the committee staff for all the hard work on this legislation taking as many years to get to this point when i first came to congress in one nine hundred seventy seven universal access to health care was one of my top priorities just mark up today is a giant step for meeting the goal of guaranteeing that every american has access to affordable high quality health care again i thank the chairman for moving this bill signed this bill into law and then she lived to be ninety four years of age benefitting from medicare and that not only gave her good health it gave her a peace of mind and that's what we can give to the american people very important thank you pass you know she was walking one room into another and she enjoyed both rooms access to quality affordable health care coverage however i strongly believe that any reform must be based on a few important principles first that must give everyone access to quality and affordable health care all americans should have equal opportunity to access medical care for far too long individuals such as those with preexisting conditions or small business owners have been priced out of the current system secondly any reform should ensure a patient centered system patients in consultation with their doctors should be in control of their health care decisions and not government bureaucrats or insurance agents your child or parent is sick they should have access to timely tests and treatments and not be subject to waiting lists or treatment decisions dependent on anyone other than their doctor third and importantly any reform should aim to reduce the cost of health care the majority of americans have some kind of health insurance that they are generally satisfied with but what they're really worried about is rising costs spending on health care services already accounts for about seventeen percent gross domestic product and expected total of some two point six trillion dollars dollars in two thousand and nine health care inflation is general inflation by approximately two and a half percent a does little to reduce overall health care spending reforms that bring consumers more information and control over the cost and quality of health care would facilitate a more efficient delivery system we should be encouraging and not eliminating consumer driven health care delivery systems which give the benefit of cost savings to consumers responsibility over ones own health care third party payer systems do not do this and they also offer an effective means of cost control consistent with quality health care and patient control furthermore changes to the health care payment system and medical liability structure in the united states  reward high quality care and discourage health providers from ordering more and more on necessary services health care our health care system must do a better job of emphasizing prevention and wellness chronic diseases account for seventy five percent of our nation's health care costs by implementing wellness programs to encourage healthy living will not only  afford to multiply the number through a government takeover of our entire health care system we need to priorities prioritize transparency and results united states leads the world  medical innovation accounting for five out of six important medical innovation is over the past twenty five years lifesaving treatments and cures priceless for the millions of americans who benefit but also bring great monetary improvements to the entire health care system make sure that this culture of medical innovation is preserved very concerned that the bill before us today does little to achieve any of the above principles and instead will put health decisions in the hands of government bureaucrats impose costly new taxes on businesses and individuals and do little to reform the fundamental problems in the system that currently drive health care costs government mandate mandated changes in health care will have enormous consequences for our economy and for the way that we live here in the united states any comprehensive reform should be crafted in a bipartisan and thoughtful manner we're taking a big risk if we rush through this legislation mr chairman i think we need a second opinion moving forward a comprehensive health care reform bill that will reduce out of pocket costs improve choices and competition for consumers and expand access to quality affordable health care for all this year i strongly support the america's help choice act two hundred because it addresses the following core principles that i strongly believe will enhance and expand our nation's health care system access to quality health care must be available to all regardless of ability to pay or health conditions bless you to the extent that health care is paid for by insurance premiums i believe that subsidies should be available to those who are unable to afford premiums and scale progressively based upon income under this bill insurance companies will no longer be able to engage in discriminatory practices or exclude coverage or treatment for preexisting health conditions the united states spends more than any other country per capita on health care yet it ranks thirty seventh among industrialized nations in health care outcomes therefore health care reform must be comprehensive and cannot live coverage in the effort to make it more affordable i believe reimbursement rates to healthcare providers must be reasonable and should not vary depending on whether an individual has a medicare medicaid or different types of private insurance as i mentioned earlier that public health insurance option has been at the forefront of health care reform debate i believe that a public option will create a new choice in many areas of our country that is dominated by just one or two private insurers who will operate on a level playing field and will be subject to the same market reforms and consumer protections as other private plans more importantly the public option will make health insurance more affordable by opening many market areas to new competition which would increase efficiency and transparency we must reduce and contain costs to assure our affordable coverage currently twenty five to thirty percent of all health care spending is on administration health care reform will already be successful if it is effect cutting costs i believe that health care containment must be achieved by consolidating administrative overhead rock purchasing prescription drugs and durable medical equipment and implementing insurance reforms that require that increases in premiums are limited to increases in cost only prevention and wellness programs are critical in health care reform we know that minor health conditions that go on treat it can become larger and require catastrophic care which is much more expensive than preventive care studies show that when people forego treatment due to it's an affordable cost society and taxpayers often wind up spending more in the end instead help community health centers and a creation of a community based program to deliver prevention and wellness services will help control health care costs finally the legislation expands the health care workforce to address the needs of millions of uninsured americans uninsured americans the legislation includes more training of primary care doctors an expansion of the pipeline of individuals going into health professions including primary care nursing and public health it scholarships and laws for individuals in the needed professions and shortage areas and provides greatest support for workforce diversity i believe this comprehensive bill is a move in the right direction and i look forward to recognize for five thank you mr chairman the thank you for yelling let me begin by saying that i do not believe that maintaining the status quo in our health care system is an option we need to reform our healthcare system to greatly increase access accountability  and savings to consumers the house republican health care solutions group has been working on these goals and stands ready to operate alternative that will accomplish all of these goals without raising taxes or allowing for the federal government to take over the american health care system unfortunately the introduction of this health care legislation before us makes it clear that the goal of the house democrats is to have a full government takeover of our nation's health care system where bureaucrats determine what medical treatments americans receive it's regrettable that the majority refused to foster bipartisan legislation and rushed introduction of a mammoth one thousand eight hundred page bill with a trillion dollar price tag that increases taxes rations care and will hurt the economy this bill takes direct aim at small business owners by adding new taxes are hurting the middle class and putting additional stress on an already weakened economy based on the dollar amount of payroll for example let's say you own a small business if you have a payroll of three hundred fifty to four hundred thousand dollars and you choose not to or simply cannot afford to enroll in a plan approved by the federal government your taxes will be raised six percent if your payroll is over four hundred thousand you'll be hit with an eight percent tax this will result in at least thirty two thousand dollars in new taxes this strong arming of our nation's small business at a time when we need them the most is completely responsible and inexplicably small businesses create two thirds of the nation's new jobs and ninety eight percent of the new businesses in this country are small businesses i know firsthand the difficult choices a small business owners face every day having owned a small business for years many in this room may never know what it's like to have to meet payroll every week to ensure that hard working men and women get paid the wages they learn if i am a small business owner who can afford to buy into one of the government sanctioned health insurance plans why is it that i can afford another thirty two thousand dollars in taxes either way this is a small  tax on small business not to mention the two and a half percent tax that will be levied against individuals who opt not to take part in a government approved health plan your craft in washington dictating the terms of what qualifies as an acceptable health plan equals a lot of freedom for all americans pay or play mandates on business and individuals a public plan option all of this will lead to rationing of health care it will truly be a sad day when american citizens who used to enjoy the freedom to choose their own doctor must wait weeks or months to get the treatment they need and deserve so i would urge my colleagues on the other side of the aisle to take a step back look at how this legislation will impact american workers and families and include republicans in the process of drafting needed health care reform legislation that encourages innovation reduces the burden on small business and gives families struggling to make ends meet some needed relief one way we can do this is by authorizing the creation of small business health plans to provide increased access to health insurance particularly for workers and small businesses by allowing small businesses to band co ops or local plans that dilutes the power of the public option to deliver lower cost higher quality care the public plan must be based on current medicare provider network infrastructure by the  medicare provider network also will ensure that there are providers already in the network which will offer the most and best access to care for those who would like to be on the public plan we will continue this part of provision that will prohibit public plan is not perfect because it isn't a single payer plan will make a big difference in the lives of very very many and we look forward to working with chairman waxman and rangle  in our leadership to ensure that the public plan remains robust and offers real choice to the american people back joel meals back in time mr class thank you mr chairman rank member  kline over the next two days our committee will be marking up the america's affordable health care choices act as we consider health care reform let me begin by stating i believe that most if not all of us readily agree that reining in health care costs and expanding access to health care system for all americans must be top considerations when discussing any proposed reforms however we must also must also abide by the physicians guiding principle first do no harm first do no harm and that must be our guiding principle in choosing the particular forms that we embrace i'm deeply concerned about many aspects of this over one thousand page piece of legislation including its cost to employers and the very strong likelihood that it will move countless americans in voluntarily from private health insurance to a government run program there are a number of amendments expected to be offered by my colleagues on this committee that aim to protect aspects of our current health care system that are working for many many americans more than sixty percent of american workers are covered by an employer provide health care plan and many of these individuals are very pleased with their current health care coverage is absolutely imperative that these workers are able to maintain their coverage without consequences resulting from the federal government  the employer provided health care structure we must also be sure that small businesses can afford health insurance for their employees currently approximately twenty three million of the uninsured in america work for firms having fewer than one uniform regulation economies of scale and administrative officials that large companies currently enjoy throughout the country automatically as we move forward we must aim to build upon these health care system expanding it to more employees and families rather than imposing one size fits all health care system that jeopardizes the care of those who already have good health care coverage there is no single silver b to address health care needs we must approach with health care issue in a comprehensive manner but always remain mindful of the unintended consequences that can follow good intentions thank you chairman today marks the first day of public consideration of this monumental piece of legislation it is both ambitious and reach congress has had over two dozen hearings and i believe it is prepared for this long overdue undertaking however it is vital that amid all debate over policy and ideology we stay true to our duty because it is our privilege to serve the people of the united states and address their need for good health care reform through our faithful representation of our constituencies we should  consensus and begin and begin to fix the problems of our fragmented healthcare system so that the people of the united states can enjoy healthier and more productive lives i would like to address several issues with the bill and although many of these are not within the committee's jurisdiction it is important that i bring them to your attention the bill must lower the cost of care help small businesses cover their employees provide mechanisms to lower the high rate diabetes and obesity and culturally sensitive care professionals and provide cover to undocumented workers the high cost of health care is attributable to many factors many can be cured with legislation others cannot cost however is an area where we can exercise a great deal of control through reforms to medicare and medicaid we have been able to control costs without sacrificing the quality of care i hope this bill will rural populations it would be disastrous if we amplify the existing disparities for example in my district there are state of the art health facilities which provide the best quality of care to the poorest of the poor this bill should make taking care of the indigent easier not harder how this bill affects small businesses will be an important indicator of overall success many of the uninsured are employed by small burden upon small businesses to the extent that it will restrict growth and make it harder for those to operate my congressional district like many others in the united states suffers from high rates of obesity many of my constituents face the challenges of rural communities like travelling far distances for basic services or having a life threatening event and relying on ambulance services because they do not have a car in  addition there is a shortage of primary care physicians and specialists even in urban areas and raises costs and other important aspects of this health reform is increasing the number of health care professionals in order to provide more preventative care and i think it is also important that we encourage cultural and linguistic training for these workers so they can better serve their communities  undocumented workers in our country to participate and purchase insurance is something i am also interested in not only because it's a basic human right and there exists an obligation to provide  medical care but also from a pragmatic approach if one documented workers are not able to receive preventative care they will continue to show up at hospital emergency rooms with life threatening conditions this puts a stress mcclintock thank you mr chairman as we begin deliberations on this measure i think we need to be mindful of the law of unintended consequences is well beyond the jurisdiction of the united states congress and we would do very well to be careful chairman before i came to congress i spent thirty two years as a nurse and when i hear people saying that we haven't spent enough time going over this i've been working on health care issues for thirteen years and there are many people here in this congress who have been working on health issues for a long time very body remembers we've been trying to do something about health care since the early sixty's and has kept going to put off put off put off now is the time now is the time to be able to say that we're going to help the forty to forty five to forty seven million people in this country that need health care there is no doubt that the health care reform is badly needed in the united states when it comes to health care america is full of contradictions we are a nation of brown brown but a branch ground breaking cutting edge research and treatment but we all saw the nation of over forty million uninsured with the access problem and let me say for someone that's just been going through the health care system in the last several weeks patients already waiting hours  patients are already waiting to go to the emergency room that is not right that is what we need to change our country depends on a strong well functioning health care system if you want to have a productive workforce a successful educational system be the leader in innovation and technology and have a strong national defense you must first have a high quality health care system and we will have that health quality health care we also are going to be taking care of our children it is a disgrace a disgrace that so many children cannot get health care if we as a nation cannot take care of our children who is supposed to we have the opportunity at this moment to make substantial fundamental improvements to health care in this country that could benefit generations to come the goal is to achieve a basic standards of quality affordable health care to which all americans will have access to compromises and sacrifices will have to be made but we must not compromise with the quality integrity of our system and we must not sacrifice our patients or the providers this if it were quiet all parties all parties working together and thought in order to accomplish this goal when i think about all the years that so many people have been working on the health care system today i was at the white house with president obama and was surrounding me all of the nurses they were down here representing the millions of nurses country saying we need health care we need to have better access to take care of our patients we need for primary care doctors so they can go into the communities and take care of those that don't have access to good health care this should not be employed pinioned those those and have those that have health care and those that we begin the debate on this bill today is the day where the bill was introduced into congress where we said we're no longer going to have private student lending it's now going to be a government function in the early one nine hundred ninety s government is going to provide a public alternative to private lenders don't worry it may be five years it may be ten years it may be fifty but sometime in the future the health care that many of america i want the health insurance coverage that they appreciate that's been provided them that they know how it works will be gone there's no question about whether you will lose the opportunity to choose private sector health care you will lose that opportunity it will be eliminated the only question is when we've seen it before and now we're seeing it again we don't believe we're going to see bureaucracy and that that control is going to move away from individuals to washington just read the bill the commissioner shall specify the benefits the commissioner may not enter into a contract the commissioner shall establish the following standards the commissioner shall stablish a permissible range the commissioner shall stablish standards shall certify the chemist or commissioner shall solicit shall based upon a review of such shall enter into contracts the commissioner stably term is information as a commissioner may specify the commissioner shall establish the commission or may terminate a contract the commissioner determines that such provider network works and that's all in about seven or eight pages of this health care bill we're moving control yes an imperfect market markets don't always work well there emperor factions there are sometimes gaps but markets respond and markets modify markets adapt markets involve creativity to solve the needs that are out there you know was two thousand and one and we established in another major government program you know we taken away now we're working on taking away the opportunity for the private sector to choose where they will get their student loans in two thousand and one we took another opportunity away from the american people we took away the opportunity for the american people at the local level to control their local public schools we had a massive  transfer of authority from our local parents our local school boards our local educational boards to washington d c and we now have bureaucrats in washington d c deciding who's a qualified teacher and what's a qualified school they don't even know where half the schools in america are used to go to the department of education and ask them  can actually understand the differences in each of those communities and now what we're going to see here is who knows who knows mary who knows bill what their health care needs are the bureaucrats in washington d c well the local doctors will local nurses and local hospitals will know about those patients but when they come to treating their patient they will no longer be looking at the patient and determining the level of care and the appropriate type of care for that patient what they're going to be doing is we're going to be looking at a manual that as many times in a bureaucrat in washington d c will outline for them the type of health care for all americans there is growing disagreement over cheating and paying for these girls you see the differences in these opening statements as details of the such they should have checked out the clips almost all other concerns frankly i don't understand how this committee can consider adding another trillion two point two trillion dollars on health care but the sixteen percent of g d p exceeding any other industrialized country projections suggest spending would rise to twenty five percent of g d p in two thousand and twenty five with no changes  before should be paid for by lowering costs within our health care system not outside sir taxes on certain tax payers which could end up harming small business owners and taxing employer sponsored health benefit benefits are not seen deficit neutral is not just a gimmick  it reflects a need for larger reform and choices so some savings and focusing on prevention and chronic disease management are essential to understand the problems we face and must draw down on the forty six million uninsured only twenty six million americans are uninsured for an entire two year period over nine million uninsured are not u s citizens and twelve million uninsured americans are eligible for public programs there are over one hundred thousand uninsured people in the state of delaware and twenty seven thousand are already eligible for existing programs like medicaid highlighting the need to ensure qualified americans get enrolled and not convince the public insurance option is the best immediate solution keeping the health insurance is a promise of president obama and all americans should have good choices i remain concerned that a public plan is currently in position to compete on fairly eroding coverage of one hundred seventy million working americans i also have concerns about the employer mandate  requiring employers to provide health care for their employees or pay a tax could be that employers shop coverage altogether or that the cost force them to make difficult choices regarding hiring and retention decisions in my home state of delaware i've heard stories of people struggling with costs and access a nonprofit with fifteen employees is paying close to one hundred thousand dollars annually to ensure its employees is set up a year toward carrying out its mission in the community a recent college graduate with type one diabetes w employer doesn't offer health insurance cannot purchase insurance because of a preexisting condition and a woman recently diagnosed with cancer is facing such high out of pocket costs that she simply cannot afford to continue with treatment we must find solutions so people can have peace of mind i support a system where every american can access health care where individuals are not denied coverage based on preexisting conditions or put in financial peril because of out of pocket medical costs but a one size fits all solution will not succeed universality we want to retain choice including the choice to keep our current coverage if we so choose as we make the transition to power by dividing this universal coverage we must continue to rely on state federal health programs like s chip and medicaid and community health centers and the safety nets which the neediest americans rely pension and wellness and chronic disease management deserving police attention and resources to encourage healthier lifestyles i look forward to discussing the role prevention in employer sponsored plans during consideration of my men and finally americans must have confidence in what is put forth by the congress for this to transpire the process something more bipartisan than it has been while there is momentum for me for reform disappointed with the direction the legislation currently takes we must move forward with great care to balance the needs of all americans and receive the access to the best and most affordable health care options and i would just point out as part of the process that we have here a thousand and seventeen page bill that was first put together sometime yesterday and we are expected to as we call mark it up tomorrow i just think more time is needed for the purpose of everybody understanding and perhaps working medicine in the united states is a profit driven market commodity distributed according to the ability to pay rather than a basic human right distributed as a public service according to medical need no wonder that the united states ranks forty seventh in life expectancy and twenty third in infant mortality in this profit driven private insurance system there are over fourteen hundred managed care organizations overseeing five thousand health insurance plans we have the most expensive health care in the world sixteen percent of our gross domestic product two point four trillion dollars a year goes to health spending one out of every three dollars goes to the activities of the for profit system for corporate profit stock options executive salaries advertising marketing the cost of paperwork fifty million americans remain uninsured and another fifty million under insure i submit there's a direct relationship between the for profit health care system and the uninsured and the under insured we can no longer look the other way as the uninsured and under insured continue to grow the e we can't ignore the growing share of all bankruptcies that is attributable to medical bills now over sixty percent we can no longer live with a system that is by most indications among the lowest quality in the developed world and we can't afford the rising costs indeed rising cost of the essence of the problem health care stakeholders are sinking more and more money into efforts designed to make someone else pay the bill it's profitable to do so insurance companies doctors hospitals and patien fighting over who pays what the insurance companies are winning where they focus on their stock market value on their financial profits and their investments in tobacco on their strategy to restrict or deny service which increases their profit they've set up massive redundant highly profitable bureaucracies that deny care when we buy their services we don't pay for their infrastructure we pay for a second infrastructure which results doctors have to hire more staff to fight with insurance companies just to protect themselves consider that the growth in the number of professionals who actually deliver health care since one thousand seven hundred three hundred percent but the increase in administrators those who do not deliver care is upwards of twenty four hundred percent the insurance companies have wedged themselves between the doctor and the patient it's easy to see why our cost of spiral out of control and the health insurance industry is consistently shown to be one of the least trusted industries in america there are many models of health care reform which was around the world the vast majority of which perform far better than ours the one that has been tested here and abroad a single payer under a single payer system everyone in the us would get a card that would allow access to any doctor at virtually any hospital doctors and hospitals would continue to be privately run but the insurance payments would be in public hands by getting rid of the for profit insurance companies we could say four hundred billion dollars per year and provide coverage for all medically necessary services for everyone in the united states it would cost no more than what we are paying now for health care this is a consistent conclusion report by the government accountability office the congressional budget office and several independent analysts organizations like the lewin group cost is just one reason that support for single payer is growing so quickly h r six seventy six the united states national health care act now boasts five co sponsors it's been adored by over five hundred fifty million organizations the u and weeks that will make us proud in the coming decades and generations as we consider health care we form a set of proposals i believe that we must strive toward a couple of core concepts we need to provide all americans with affordable health care coverage and we need to move toward a system that is cost effective and which rewards quality not quantity we must consider innovative approaches that take into account the different ways that medicine is practiced and the different rate at which it is reimbursed throughout this country our nation's fiscal health has suffered in part because of over expenditures for health care before too long this country families businesses and government have paid way too much as the president points out we are spending over two point four trillion dollars a year on health care twice as much per person as the next most costly nation without reform the cost of health care for the average family is expected to rise eighteen hundred dollars every year in the years to come in this economy we can't afford to wait i believe that the tenets of this plan are sound for the american people if you like your provider you can keep it a robust public option will help drive down the cost of health care emphasize quality care in reimbursement instead of the status quo and ensure a considerable savings to the medicare system over what we are paying for today mr chairman i believe that we should continue to look at ways in which we can create more incentives for doctors to adopt health information technology health has the potential to reduce costs and medical errors bring greater efficiency to the health care system it is the backbone and essential component of our efforts to reform health care however to use most effectively we must address three barriers to its widespread adoption the first is the need for technical standards and interoperability doctors hospitals and pharmacies are reluctant to invest in health  until they can be certain that the computers can talk with each other and that they are not for industry pain health of the healthcare industry the second barrier is the need for more well trained health i t workers the irony here is that health compare with other sectors of our economy has jobs in the field that already exists and well paying jobs but we lack the trained individuals to fill them depending on which numbers you use upwards of two hundred thousand workers crane workforce and health care without a trained workforce will be unable to build out operate and maintain health systems on the scale that will support real health care reform the third barrier to health i t adoption is that it's associated costs and benefits are not real equally between health care providers and healthcare pay or the challenges of implementing health greatly from large health care systems to smaller medical practices the financial benefit of health accrues to the mostly to the pay or the insurer providers are the parties that bear the cost small medical practices which may have have to incur initial costs of over two hundred thousand dollars for a health system make little if any financial benefit from its application so it's no wonder that health has a deployment rate of less than twenty percent in the smaller health practice environments i believe that we have the rare opportunity to effectively address barriers to health in this bill and provide a sound in the backbone for future health care reform efforts the road upon which we embark is a long one this bill is a good start and we will be working on this for the rest of our professional and personal lives that the balance of my time mr thompson is recognized for five minutes you mr chairman ranking member kline we began marking up the tri committee health care reform bill i'm hard pressed not to bring up the fact that we've only had a copy of this proposed legislation since yesterday and this seems to be the standard in the house which has been working a lightning fast to russian push through legislation and while i do believe we have the immediate need to control costs in our health care system i believe good policy comes from a series of hearings and thoughtful debates the american people deserve as much having worked in nonprofit community health care for nearly three decades face to face with patients i can tell you that the united states has one of the greatest health care systems in the world and while we do in fact have serious problems and cost and affordable body of health insurance that is often confused and wrongfully so with the level and quality of care individuals received on monday night at a tele town meeting for about thirty thousand constituents and during the question answer portion of the program i randomly took a comment from a woman constituent a canadian american who had done her homework she was confused as to why the health care system t differ so much from our home country was going to be dismantled and replaced with something similar to what she experienced growing up the woman went on to reference a u s census report published in august of two thousand and eight which provided a breakdown of the numbers of on a short in america report found that in two thousand and seven just less than forty seven million americans lack health insurance the census bureau reported that nearly thirty percent thirteen point nine million of the  or families with incomes under twenty five thousand dollars many of these individuals may be eligible for public programs like medicaid but not roll similarly the children these families may be eligible for public programs like s chip which i voted in favor of an expansion back in january this federal program is modeled after the pennsylvania children's health insurance program and creates market based incentives for families general their children and well the commonwealth of pennsylvania has a great outreach program to make families with on and your children aware of their eligibility there are still millions nationally to fail to enroll because they're not aware that these programs exist do not know how to enroll or some fear being linked with a publicly finance program i believe before this committee contributes to a new program costing the american taxpayers upwards of one point three trillion dollars there must be further incorporation of marketing and outreach from the existing programs t target those vulnerable populations for coverage according to the sense of date census data vigils making over seventy five thousand dollars make up nearly one fifth over nine point one million uninsured with nearly another eight point five million uninsured making more than fifty thousand dollars a year but less than seventy five thousand dollars let's look at that number again nearly fourteen million families with incomes under twenty five thousand dollars that may be eligible for existing coverage add nine million individuals making over seventy five thousand dollars another eight point five million making over fifty thousand dollars that's thirty three point five million out of our forty seven million without coverage more than one fifth another nine point seven million of the on and shorter foreign born and lack citizenship this category which includes both legal residence and on documented aliens contains the highest percentage of uninsured people forty three point eight percent of any race age or income group forty three point two million over forty seven million estimated have been accounted for so that leaves about three point eight million that we don't have accurate data on let's assume that the remainder of the three point eight million is also one  we'll add them to the thirty three point five million before the on documented or added now we have thirty seven point eight million on insured and this numbers comprise of individuals who either own fifty thousand dollars per year or up to seventy five thousand dollars per year for low income families could be identified for existing programs this is a little less than twelve percent of our population of three hundred million mr chairman the goal of universal coverage is a noble one and we live in a country where the quality of life is higher than most and we should be making strides to make sure that everyone has the opportunity to receive some form of coverage but we're also a country of choice for those individuals making over fifty thousand of those making over seventy five thousand sometimes have made their choice also many younger americans are now worried about the immediate consequences of not having health insurance and others just believe insurance is too expensive and those individuals who believe that you are just too expensive are correct yet there are several measures that we can be looking at to mitigate those costs such as proposals to improve health outcomes increase the availability of information about high quality health care providers and establish disease management systems above all as we advance we must look at all the aspects of health in america as there is an interconnectivity of each aspect one having a direct effect upon another we must also promote policies that will encourage small business growth so that entrepreneurs can continue to employ the majority of america's workforce these are not robber barons or corporate tycoons as are often demonized as rather they're your neighbors who know their employees and know there are those employees and know that those employees are the businesses most powerful asset in today's market we must encourage more choice for individuals in terms of the cost and coverage and to raise the cost consciousness encouraging a preference for more affordable plans and better decision making about one response in the affirmative mr chairman this tells me that above all we need to ensure that those who are currently covered have the opportunity to stay on their health insurance plan a truly appreciate the opportunity to share my thoughts with the committee and i yield back affordability of the access to health care in this country to have the opportunity to help reduce the skyrocketing cost of health care in this country and template for health coverage for all americans in time rose recognized for five minutes thank you mr chairman when i first started thinking about running for congress two and a half years ago i was energized by the opportunity to come to washington and work to reform health care most people i've seen over the years as a physician like the quality of care they receive but don't like the cost they won't take care they need an affordable price well unnecessary interference from insurance companies or government bureaucrats we're trying to fix the system for patients like the one in my district one day he woke up and had a lump in our neck found a law without health insurance she couldn't afford health insurance and had to rid herself of assets to go on medicaid our goal should be making health insurance more affordable so that patients can get the care she needs rather than to have to give it away nearly everything she has to qualify for government plan everyone in this room is committed to helping that patient and millions like that's good news we have agreement on both sides of the aisle but there is waste in how we spend our health dollars and then we can very easily get more bang for our buck by reforming the health insurance industry and incurring encouraging healthier earlier in the year i laid out a series of principles i would use to evaluate any health care reform proposals this congress considered principles include preventing government run health care preventing the destruction of a system that works for eighty percent of americans to extend coverage to the remaining americans ensure that doctors and patients are in charge of making medically necessary decisions making quality health insurance more affordable to achieve universal access protecting catastrophic costs giving patients more ownership to improve portability making sure everyone has skin in the game eliminating the insurance industry's ability to profit by avoiding the proposal before us and they fall short of meeting the additional record unemployment and mounting debts and deficits this proposal sets the stage for more job losses by requiring small businesses and entrepreneurs to foot the entire bill for this health care is a basic element principle says that if you increase employer costs of up to eight percent as this bill would do employers will cut cost by cutting jobs and salaries today we will hear from some on the other side of the aisle who for years have advocated the dismantling of our current means of delivering health care to patients in favor of a single payer or government run system at least they have the honesty to be upfront about their desire for government run health care today's bill that so called public insurance option is an exercise in subterfuge this misnomer given to this government run health care plan has been word smith and poll tested to mislead people into thinking they have a choice between government run health care and the health care they receive today but the bill sets up a process in which only the government plan can survive unbiased studies all indicate many employees who have coverage president's promise to allow you to keep the coverage you like what you won't hear from the other side of the ali is how the exact same program being advanced and they failed in tennessee fifteen years ago when we tried to achieve universal coverage and national cost as much for our program unbelievably low and as for ten years we watched our medicaid programs cost go from unsustainable to crippling the budget skyrocketing cost for our democratic governor to a reform package that expands access reduces cost and improves quality meaningful health care reform is long overdue today system does not cover forty seven million americans many more whose plans don't cover all of their needs we spend approximately two point four trillion dollars a year on health care and yet our results do not compare favorably with most other advanced nations we have a system that thrives on an over utilization of services that doesn't produce better health outcomes one thing we should all be able to agree on in this very contentious debate is that the status quo is unacceptable we talk of entitlement reform and putting this country on a sustainable budgetary path we must do what we can't do either without tackling the skyrocketing cost of health care which increases the rate of ten percent reform and health care reform a future fiscal responsibility while there are some provisions of this bill that give me pause i support many of its provisions including the effort to establish a public plan on a level playing field with private  insurers say this because a public plan option will not only inject a degree of competition that has been lacking in the health care industry but it will keep private insurers honest both in the sense of providing reasonable well priced premium and in the way they work with hospitals doctors and other health care providers let me cite an example from my district illustrate this point in my district three small community hospitals are in stalled negotiations with the largest commercial payer this insurance company has broken off talks because it believes the reimbursement hospitals are requesting is too high even though it would match reimbursement rates offered by others i'm sure other insurers in fact if the hospitals accept the last best offer of the insurance provider they will lose approximately five hundred dollars per day on the standard admission no reasonable person can argue that this is acceptable this is an intolerable case of corporate giving patient wellbeing to the insurers bottom line it also makes strongest concern for health care reform because there's little competition and since these hospitals are smaller they're being bullied into a position where they may have to ultimately choose between a reimbursement rate that puts their budget on an unsustainable path or terminate the contract and go out of network which would result in patients being told critical surgeries and treatments a public option would force insurance companies who have a stranglehold over markets and hospitals to play fairly and if not patients would have an alternative option so they can have security and stability this bill is not perfect and there are differences must be worked out not just within this committee but in other committees as well however it is important that this legislation not be held up in committee preventing it from moving on in the process does not do the american people any good and it only makes the reform which ultimately must come more expensive and more difficult we must allow this process to move all of us who represent people on both sides of this issue today march our first conversation about this legislation following formal introduction yesterday proponents of this proposal argue that a public option will increase competition in the private destroying the coveted doctor patient relationship i have talk to my constituents as all of you have it as well as experts in the field of health care and the economy and remain convinced that comprehensive but sensible health care reform is critical to our economy and the viability of our health care delivery like everyone here i also believe every american should have access to affordable health care coverage were garlits of their financial situation or preexisting conditions and i know that all of us here agree on those points with that said i have concerns being modest in light of any historical cost analysis it's a sad reality that this legislation when pointing to these costs will increase the tax burden on businesses and families in one of the biggest recessions we've had in decades most problematic is what happens to the health care system itself as prices rise health care providers including the government in this case that this is passed will likely react by rationing care and denying americans a life saving treatment and access to the most basic care it also concerns me that this proposal favors taxing or penalizing consumers and businesses that don't subscribe to government mandates this could have a devastating effect on families and businesses everywhere according to various studies the estimated number of jobs likely to be lost as a result of this mandate range from one point six million at the low end to as high as four point seven million once again one of the largest recessions we've had in decades most of this job loss would occur among small business that would have a damaging effect on our economy and those businesses and workers representing the small business community preferably i would like to see the public option an off the table but that's not going to happen comprehensive health care reform is one of the most significant national debates nearly a decade the course that we take here whether it's consistent with public opinion or not will impact each and every one of us in some way the time to act is now i will families want stable health care coverage that can't be taken away they want more choice and they want to know that if they get sick they won't be forced into bankruptcy this bill does take significant steps in that direction and it contains numerous provisions which i strongly support i do however believe that in order to claim we must have a comprehensive bill that truly reform the current system this means addressing geographic disparities in the medicare system again want to thank chairman miller and staff for helping for meeting with me and working with me to try to remedy this problem i know that the medicare payments i do however want to take a few minutes to geographic issue according to a recent dartmouth atlas report in two thousand and medicare spent over sixteen thousand dollars per enrollee in miami florida which is about twice the national average why does miami have such health improvements sales care so that more people may have more of the health care that they need while still maintaining current control over their own health care i suffered from serious chronic asthma during my childhood and i fully understand that all people need access to excellent doctors nurses and hospitals we should focus on prevention of finding cures and ensuring that americans have accurate information about their health well receiving the best health care in the world in addition i support combat in fraud waste and abuse in health care so that taxpayer funds are wisely invested in providing health care that people need i also believe that the state and federal governments have a role in providing health care access and payment especially for vulnerable populations frail elderly people with disabilities and those w income in fact i've supported many proposals over the years to expand health care coverage for example i voted in support of providing low income children with health care under the state children's health insurance program better known a nd i supported providing access to prescription drugs for people enrolled in medicare but even though the government has a responsibility to ensure access to health care that does not mean the government has to provide a must take care in defining the role of government especially given the role the private sector plays in michigan two out of every three non elderly people with health insurance of health insurance agents from their friends and health plans under the exchange system americans will no longer have access to the valuable advice of their trusted advisors moreover a government run public plan likely will create an unlevel playing field pricing private health insurers out of business and this is an issue that particularly concerns me when when america and the  similarly now if we are advocating that everyone have health insurance why do we assume that the federal government has to provide it all we have a complete industry health insurance we have private agents who are well known in their community well versed in the issue and they know what they are doing and how to explain it to the public we should make use of them and not plan a public plan where the government basically takes care of it all also must insure that health legislation boost our economy not harm in michigan we have been struggling economically for too many years the unemployment rate in my state is currently fifteen point two percent the highest in the nation and the total number of unemployed an unfortunate historic seven hundred forty thousand in june i am concerned that new mandates and taxes will cost my state and our nation jobs at a time when we can least afford to lose them in addition we must foster a workforce equipped with the knowledge and skills needed to innovate and transform medicine i'm a strong supporter of improving our the world our medical innovation our technology capabilities anything available anywhere else in the world but it costs way too much we spent two and a half trillion dollars this year that's what we're going to fifteen hundred dollars higher because of the cost of health care it costs more to provide health care in making a car than it does to provide the steel that goes into the car and when you think about the supply chain in this country and how it affects all of us the people who manufacture the goods the people who ship them the people who stock them and the people who sell them at every level have health care costs and we're paying the bill for that and the cost of the uninsured is one of the largest drivers of health care in this country as we all know and i hear every time i go home and i'm sure every member of this committee hears someone will say i don't want to take my money to pay for those people who don't have health care because that's their problem i have insurance and they will say i'm not worried about the people who don't have insurance and what they don't understand is they're already paying the cost of the people who don't have health insurance because they show up at the emergency room and they get treated and they send the bill to those of us that have health care and that's the way it works currently we need to do it in a more efficient and a more cost effective way by bringing everybody into the system and health care costs as i said affect everybody in this country and americans are one accident or illness away from losing everything even if they have coverage so doing nothing is not an option we can sit here all day and talk about all the flaws with the bill and i'm going to mention a few but in the end we have to make this work the concerns that i have are that this bill could do more to reform our delivery system i think that's job one we can expect to bring fifty million people into a flawed system we're going to bring the uninsured into our head but we have to also fix the system and fix the problems with our healthcare delivery system i want to make it more cost effective i want to make it more efficient and i want to squeeze the savings from our current system because there's a lot of inefficiencies before we ask for increased revenue because the burden of the taxes are going to have on families and business across this country are unsustainable as this bill is currently written in my opinion small businesses want to offer health care to their employees but less than half of them are able to do so because they simply can't afford it and adding more cost to the bottom line of small businesses who already can't afford health care isn't going to solve the problem so in my opinion this bill does not strike the balance in preserving what works in our current system and fixing what doesn't but this is a first start and i congratulate the chairman for bringing this bill forward and beginning this discussion and i'm confident through the amendment process and through the legislative process this bill is going to get better and in the end we're going to win this and we're going to bring health care reform to every american in this country because we all have constituents and every one of them has had a bad experience or knows somebody who's had a bad experience in the health care system whether it be spending an hour on the line with an insurance company that's trying to deny your claim or having a bad experience with a nursing home with a grandparent spending six months waiting for an appointment with your dermatologist a small business owner that wants to offer health care and continue offering it but has to make that decision they can no longer do it because of the cost that's why we're going to succeed because we simply cannot  better in to address many challenges many of the challenges that kentucky families are facing our current health care system is a challenge to many families in my district and across america whether it is paying for visits to the doctor getting access to care i agree that our system is need to reform but i'm sad to say that this bill does not overcome these challenges the american people have made it clear that putting a government bureaucrat between patients and their doctor is not the solution we should have worked together in a bipartisan  health care costs and expand access without compromising the quality of care bankrupting our country or leading us toward a government run health care system before i was elected to congress i worked for my family small business we did what we thought was right provide individual health care coverage for our employees where they pay a dollar a month but now with this legislation our small business will have bureaucrats in washington telling us what kind of coverage we can or cannot offer and if we don't offer what they say will penalize without raising taxes and are employees will be forced to participate in a government run option raising taxes on small business is not the way to create jobs during a time when we desperately need more of them i know what it's like to some both sides of a paycheck and i can tell you that small businesses will not create more jobs if they are forced to pay even higher taxes for their i'm extremely concerned about the more than one trillion dollar price tag that comes with this plan but i came to washington from the kentucky state senate i had to learn how to speak in billions of dollars instead of the american people deserve better than this plan and i look forward to continued debate on this important issue and hope that we can work together to make the necessary story health care system without jeopardizing the high quality of care we now enjoy or for the mortgaging our go this government took my son's life because for fifteen years they didn't have the courage to do one single thing to enact health care and as far as i'm concerned bill said my son to be alive today if congress had had the courage to do the right thing mr chairman these hardworking americans lost their son to a system that's been hijacked by insurance companies more committed to their bottom line the public and the fair family is not alone over forty five million americans are uninsured and even businesses proportionate burden of our health care costs and live in a rural america should not be a sentence for lower quality care this act these principles establishes a new health insurance exchange a marketplace for individuals families and small businesses option because i believe it is the only way we can have a can have competition among insurance companies in my view health care reform without a public option is like a car with no motor it may look very nice but it isn't going to go anywhere additionally a public option allows for portability of coverage when someone loses jobs at a time when our nation is confronted with high unemployment rates the public option provides a safety net for workers mr chairman another important focus of this bill is the elimination of preexisting conditions that have been used to deny care or care for millions of americans not only does this prohibition protect patients rights but it also ensures that people who suffer from diabetes or women without a serious birth will not be coverage when their not cover their expenses when they become ill or suffer catastrophic catastrophic accident by promoting shared responsibility this this bill ensures near universal coverage for the first time in the history of this nation it provides tax credits to small businesses the economic engine for rural america the current health care system is on affordable accessible and unsustainable for far too many americans if we continue along this path this is one of the americans affordable health care moves us in a different direction it will reduce costs thirty seven million americans and lastly let me point out one thing in this bill it will close once and for all the donut hole the medicare part d prescription bill  that in my humble opinion was one of the worst piece of legislation ever to come out of the house of representatives i applaud the president as states for having the courage not only to campaign on this bill and campaign on health care for all americans but having the courage and tenacity to introduce this legislation and yes i want to pass this bill before we go home in august because i want to be able to tell them that their son and other people like their sons are not going to have to go through this and by the way that family mr chairman to the markup if it we do get it done tomorrow that will be making many more points but my district is unusual in many ways i'm the number one manufacturing just read in the united states we have been hammered my best county allen county has a temp oint seven unemployment rate in that county we have the largest pickup plant in america we have our number one probably taxpayer junk them all under general growth properties in bankruptcy we have the  but one of our biggest employers a financial company has applied for three point five billion in tarp funds that we have all sorts of auto parts we have defense industries that are being cut back and that's my best county kalb county of fourteen point point two my mean unemployment rate in my district is fourteen point seven percent the best health care coverage for these people is to get a job and even if you favor this plan i don't understand why are we are doing it at a time when our business and industry are flat on their back that the pay for is in this include taxing the top three percent sixty percent of the people over three hundred fifty thousand are small business owners sixty eight percent of manufacturers file taxes as an individual so those very people who need to call people back including in my little hometown where i grew up of now just under a thousand people they just had a manufacturing auto parts person closed indefinitely waiting to call back the employees if and when the auto industry recovers now the question becomes if they get and don't have health insurance and they have to do an eight percent on the cost of their personnel their odds of calling back the personnel are minimized furthermore to the degree you can reduce labor costs you will benefit under this bill so the motive under this bill will be to have less employees which in one hand is good for a fish unsee but in many cases some businesses view it as a they'll take different employees the family members they won't necessarily reduce down as part of what they see as their social responsibility to the communities that says we're going to happen here the more we increase the cost of having an employee the greater the chances are they won't be employed who doesn't want for insurance in america well those who are in the most competitive environment and those businesses least can afford with this bill is proposing to do auto parts suppliers r v park suppliers in my district right now do not have a margin with which to take an eight percent or whatever the equivalent other options are plus a tax on their best in order to survive now i ran a couple of different industries to see how this would play through home furnishings retailers which i our family had for many years nationally have a cost of sales of fifty nine point zero three their salaries and wages average fourteen point six eight percent which means an eight percent would be a one point one seven percent six additional tax their net profit margin is four point two one which means they'd be roughly running about a two point eight percent profit margin if you're in the motor vehicles part it works out their net profit they work on is two point zero six percent were taken down to a one point five clothing retailers when it would take them down to about four now companies aren't going to stay in business or have employees or be able to hire people back if they can't even make a profit to equal the cost of money other problems with this bill is well i believe the government takeover we don't need any more running this committee has no credibility in public private options as we see in student loans we drive out the private option because eighty percent of the people chose a private option i'm very concerned have a number of members coming on abortion that this is going to lead to mandatory abortions and or the biggest one the public funding of abortion that we've ever seen in america other pro life concerns i'm concerned about the ever increasing minimum i thank you mr chairman and i think chairman andrews for your leadership and willingness to work with our members to press this very important reform to our health care policy of our nation i find it disgraceful that our country one of the wealthiest most innovative countries in the world has nearly forty seven million americans lacking health insurance thirteen point five percent were new yorkers last year alone new york city's health spittles spent one point two billion dollars in charity caught additionally a study by the department of health and human services found that seventy point one million americans under the age of sixty five were under insured of which nine point three million had employer based insurance tragically people in situations often n this the twenty first century every american must have a basic right to adequate physical and mental health care and i believe that our government has a responsibility to its citizens is the curing quality healthcare i support this historic bill because it will provide quality health care not only to my constituents in brooklyn eleven congressional district but to every district across the nation this bill will provide health care coverage to ninety seven percent of all americans by allowing those who already have coverage to keep it by spending medicaid eligibility a stablish a public option and a health care provider marketplace known as the exchange those americans who cannot afford the total cost of health care insurance and small businesses on their own will be subsidized preexisting conditions will no longer be excluded from coverage catastrophic costs will be limited by a cap on out of pocket spending no longer will health insurance force americans to pay higher premiums because of their health status gender or race there will be a commitment to community health centers a robust commitment to limiting eliminating health care disparities in communities of color tribal community and rule community we will finally move forward in a quantum leap that is a thirty two hundred shift the paradigm to rewarding lifestyles of wellness and prevention as opposed to the current cost bracket of emerges the illness and disease management finally while i share in the sentiment of some my colleagues and constituents that are for single payer health care system which i believe is the best way to cover all americans it brings me some comfort to know that all americans at least have now access to or robust public health plan option the public option polls show that seventy six percent of the american people want this choice which will help drive down story health care cause and make private insurance providers more competitive and i repeat more competitive in the marketplace if you're good at providing health care insurance in your private then you will be a part of the twenty first century health care health care insurance marketplace if you cannot then perhaps you don't deserve to do so health care is a fundamental human right rather than a commodity and i applaud this committee and i applaud its leadership in its efforts to extend basic human rights to all americans mr chairman thank you for the bill before us and and then fourteen i have not had a chance to finish reading it yet but from what i've read so far i am troubled by a number of provisions that i'm afraid will impose impose severe hardship on businesses that create jobs and on constituents living in my district the first is the pay or pay or play mandate which will require businesses to offer health insurance that is deemed acceptable by the new health benefits advisory council or pay eight percent payroll tax increase only one member of the council that will be recommending what health insurance coverage will all receive is required to be a health care professional the only employers that are exempted from this p tax are those with payrolls of less than two hundred fifty thousand dollars i know many small business owners with payrolls of over the two hundred fifty thousand dollars that simply cannot afford to offer the kind of coverage mandated by this bill the only way they could attempt to meet the mandate is if they are given the opportunity to join with other small businesses and obtain health insurance at the competitive rates that larger businesses can unfortunately thirty two hundred is tellingly silent on this point even employers that offer a plan deemed acceptable by the government will be subject to an eight percent tax on the wages of each employee that chooses to buy coverage through the new government run the exchange this means that small businesses that  shop around for a full of fordable qualifying coverage can still be forced to pay an eight percent tax on the wages of an ever changing number of employees i can imagine having to deal with this budget a nightmare as a small business owner the mandate also violates the majority's promise that americans like that like their health insurance plans can keep them it's a health benefit advisory council and the secretary of health and human services determined that the plan offered by an employer does not offer enough coverage and employers will be forced to find a new plan or pay a large tax cost will lead to the loss of roughly four point seven million american jobs a price that we can ill afford in our current recession i'm also concerned that the government run insurance plan in this bill even though medicare doesn't reimburse doctors and hospitals enough to cover all of their costs this bill will initially set reimbursement for the government run insurance option at medicare's rate plus five percent medicare's chronic under plame and drives up the price of health care for everyone who has private insurance and creating a public health insurance option along the lines of medicare will exacerbate this problem either physicians will limit the number of patients with government health insurance that they see or they will have to charge patients with private insurance even more the former is rationing and the latter will increase cost everyone who is not in the government run plan neither is an acceptable outcome this bill also fails to take sufficient steps to combat waste fraud and abuse in the health care system session two twenty six of h r thirty two hundred would apply medicare's fraud and abuse protections to the government run insurance plan these are the same protections that allow over ten billion dollars ten billion dollars in waste fraud and abuse in the medicare program each year and that failed to detect a provider who had been billing from an address on a runway in the middle of the miami and standards of participation and reduce enormous payments while the medicare program is unfortunately biljana the jurisdiction of this committee i would encourage the majority to include provisions for my bill in h r thirty two hundred before it goes to the floor that's not to say that i disagree with everything in this bill i was pleased to see that it includes a revision to the medicare sustainable growth rate formula which will help ensure that doctors are are paid fairly i support providing premium assistance to lower  income individuals so that they can purchase insurance for the first time or leave it or leave the deeply flawed medicaid program and i like the idea of an exchange for health care that increases transparency and competition even if that one included in this bill will not accomplish those objectives and i wholeheartedly agree with the president that health care this country needs reform all americans should have access to affordable quality health insurance and right now millions but this reform must be patient centered not washington dictated protecting the doctor patient relationship this bill best coverage decisions in an unelected bureaucratic council and rather than commonsense improvements like medical liability reform and  health plan until every american has access because it is such a galling bitter pill for americans to have a situation where they are excluded in many instances from buying health insurance or are punished in terms of higher rates  than the people who rule them in washington d c and that at the end of the day should be the measuring stick for how well our product is sent to the president i would contrast that to what i heard back home in the district recently during the july fourth break a sixty two year old woman who suffered a heart attack at age fifty four whose husband lost his health insurance because car dealership went out of business she tried to shop around in the insurance marketplace the patient  driven marketplace and what she found was that insurance companies would even talk to her when they heard about her heart condition when she went to the high risk pool which exists in the state of connecticut to buy a health plan to quote that she got thirty thousand dollars a year to get health insurance and that's what we have today in the status quo she would love to have the ability to do what members of congress do which is to be able to buy their insurance through a purchasing exchange at an affordable rate blue cross in the state of connecticut just announced its rate increases in the individual marketplace thirty two percent increase requests for the state of connecticut department for individuals the individual market can you imagine what would be happening in this in this congress we had food prices going up thirty two percent energy costs going up thirty two percent but for some reason we have individuals who want to defend the status quo and that we that we should not move yet in terms of reforming the health care concerned the notion that somehow what we're doing is going to hurt people by offering exactly what members of congress today are entitled to and giving a public option which the men and women who wear the uniform  this country presently are allowed to have is hogwash we are doing is using tried and true methods and systems and market principles to spread risk to eliminate again the harshness presently exist for people who are out in the private health insurance marketplace by themselves at the end of the day the members vote on health care reform in my opinion have to be able to look to the people of this  almost five hundred dollars a month because i could i did pay for it but i was sorry for her and i was sorry for the young people who have no coverage and parents who cannot help many of my friends and constituents have a far far worse friend whose only child committee and all of congress must not waste this opportunity to boldly reform the health care system to care for all americans and i'm honored to begin this noble work today when this legislation passes the forty three point six million uninsured americans will have access to affordable quality health care and all others will have real choices in selecting the health care plan that is best for their family i am especially pleased to address t issues of concern to me that is health care for the poor and the mentally ill i believe that america's affordable health choices act has been drafted on a matter that takes the health care of the poor and mentally ill into consideration in a way that we have not addressed in this country for preventive care measures and improve mental illness coverage to meaningful financial assistance the poor and the mentally ill will have greater access to quality health care service employees international union sci you reported that in two thousand and four half of all people filing for bankruptcy cited medical costs as the reason and in two thousand half of all home foreclosures were due in part to the high cost of coverage  due to the high cost of health care coverage one in six or almost forty four million americans under the age of sixty five do not have any type of health care insurance this is reported by the center for disease control the children  the children's defense fund reports that nine million children are still uninsured in america today minority and low income americans are much more likely to suffer from chronic and debilitating illnesses then mom minorities and are far less likely to have the kind of coverage that would ensure quality care nearly half or forty eight percent of all black adult suffer from some form of chronic condition compared to thirty nine percent of all adults yet one in every five black americans lack health care or health insurance compared to one in every eight be america's affordable health choices act takes affordability and access for minorities and the poor entered into consideration affective in two thousand and thirteen affordability credits will be available on a sliding scale for individuals and families that fall between one hundred thirty three percent to four hundred percent of poverty the sliding scale credits will limit individual and family spending on premiums to no more than one point five percent of income for those in the lowest income and capping at eleven percent of income for those of four hundred percent or more also effective two thousand and thirteen people with incomes added below one hundred thirty three percent of property will be eligible will be eligible for medicaid and that is all people further our seniors by eliminating cost for preventive services therefore seniors will not pay for any preventive services improving the low income subsidy programs  address part of the health care needs of minorities and the poor prevention and wellness measures are also necessary included in the america's affordable health choices act prevention and wellness planning this bill ways cost sharing both co insurance and deductibles for preventive services therefore people now will not have to pay for cancer screening for adult and child immunizations  vision screening and for hypertension or treatment of hypertension according to the bureau of justice statistics at midyear two thousand and five more than half of all prison and jail inmates had a mental health problem including more than seven hundred thousand inmates in state prisons approximately eighty thousand in federal prisons and almost five hundred thousand local jail we know that health mental health care is a major issue in health care in general it is especially a problem for those who have been incarcerated or for the poor and i just want to congratulate all who took into consideration the needs of persons who especially have mental health issues and the poor and i would just urge all of my colleagues to support this legislation and with that m terrific committee arena's legislation through our committee given our current economic climate with americans losing jobs and struggling to care for their families this health care reform could not come at a better time for our country and for our people it's estimated that in my home state of colorado one hundred people are losing their health care every day during this economic crisis as a state we've seen a fourteen percent increase in the number of uninsured since two thousand and seven the colorado economy between two point one and four point one nine billion dollars each year due to lost productivity stemming from the uninsured are losing between one hundred twenty four and two hundred forty eight billion dollars nationwide each year our nation's economic growth is inexorably linked to health care spending as it stands the health of the american economy and health of americans themselves are suffering under the spiraling costs of unchecked and inefficient healthcare spending this bill includes many much needed provisions that fall into the hands of this committee that will help struggling families during this crisis by reducing individual health care costs making it easier to retain insurance coverage while changing jobs and encouraging preventative care programs kids and adults healthy before sickness starts i'm proud to see in option what i feel is a key part to reducing costs and solving our health care crisis a major problem with our current system is that consumers have little choice in health care in colorado only two companies control fifty three percent of the insurance market the creation of a public plan to complement and compete with a wide awake arise over a private health insurance plan can effectively open up the health care industry to millions of uninsured americans while still keeping the health care industry out of the control of the market supply and demand forces the bills health insurance exchange also encourages entrepreneurship critical to america's innovation and economic success by allowing individuals and businesses to shop around for coverage no longer will workers particularly those with preexisting conditions have to at an unrewarding dead end jobs because they or their families are dependent on and tied to their employer provided health care this newfound independence will free up entire legions of our workforce to seek out exciting creative and innovative means of employment and fully contributory kaname i also applaud the bill's effort to bring equality and prevent discrimination in the health insurance industry under the bill insurers will be prohibited from excluding coverage based on preexisting conditions because even the best health insurance cannot prevent you from becoming sick this bill invests in preventative care services to keep our kids in our communities healthy and cut costs before they even happen as a former educator i'm especially excited about efforts to educate students and the greater community about immunizations healthy eating habits anti smoking programs and safety measures simple steps that can save lives and millions of taxpayer dollars when people think of the top one percent of taxpayers they think of movie stars professional sports stars and see what they don't think about as the american business owner unfortunately certain provisions of this bill which i hope will be addressed and corrected by our caucus and various other committees place a large portion of the funding burden squarely on small business two thousand and six five hundred sixty one thousand people were employed by a small business with less than fifty employees twenty nine point five percent of the private sector workforce many of these small business owners want to offer health insurance to their employees and believe it's the right thing to do but escalating health care costs down in the way of american entrepreneurs and hinder their ability to afford health care coverage well i strongly support the vast majority of the bill especially the public option i do have serious concerns over the funding of this bill and how it affects small business small business is the economic engine of the american economy by unfairly raising tax rates on american small business this bill could have the exact opposite effect of our goal and inadvertently deter small business growth this puts successful small businesses as it did a that is to big businesses who qualify for the lower corporate income tax rate they could inhibit economic growth at a time when we're using all of our legislative might to encourage it this long overdue reform can only be possible with teamwork and mellor subcommittee chair and thank you for your leadership as members of this committee we have and historic opportunity to consider the most sweeping health care reform in this country since the medicare and medicaid programs where enacted in the  as a freshman member of congress i am especially grateful for the opportunity to consider h r thirty two hundred for my constituents people of new york state and for the people of this country it is clear that the current system is broken it is a travesty that there are over forty five million americans without coverage two point five million new yorkers and tens of thousands of my constituents fourteen thousand people a day in this country lose their health insurance and in certain economy the uninsured cost our economy between one hundred twenty four billion and two hundred forty eight billion dollars in lost productivity each and every year the system is also bloated we spend substantially more than all other industrialized countries but we do not have better health outcomes to show for it we need to act now to pull ourselves out of this recession and to ensure the health and well being of all americans not just those who can afford the care that they need the america's affordable health choices act of two thousand and nine helps move us in the direction of that goal it establishes a new innovative health insurance exchange for individuals and small businesses to purchase their health insurance and creates a standalone patients option to compete with private insurers to operate consumers real choices and to drive down costs this will revolution allies the way that americans get their health insurance and access the health care system is estimated that these reforms will extend health insurance to some ninety seven percent of the population it is my hope that these needed reforms will go at least this far if not further this bill offers consumers real reform second positively affect all american insurance companies will no longer be able to deny coverage for preexisting condition variations and premiums will be tightly restricted one essential benefits package similar to the package received by members of congress creates a minimum floor policy for insurers and co pays for preventative care will be restricted one of the most important provisions for consumers and it is an annual cap on the out of pocket expenses associated with health care costs set at five thousand dollars a year for individuals and ten thousand dollars a year for families ending those medical bankruptcy mr chair i also want to state my strong support for the manager's amendment inclusion of a minimum medical loss ratio set at eighty five percent i feel very strongly that this provision protect consumers from profit driven insurance companies and will force insurance companies to focus more on what they were created to do their prime mission that is to provide health care to their enrollees this bill also builds upon the work done by my colleague colleagues on this committee and congress patrick kennedy with mental health parity i sponsored a new york state mental health parity law gym at these well while i was in the new york state assembly and i'm looking forward to continuing the fight here in congress for parity of society's most vulnerable members this bill includes explicit provisions for nondiscrimination especially with parity for mental health and substance abuse conditions these provisions ensure that this bill will not supersede paul wellstone and peter dominate the mental health parity and addiction equity act of two thousand and eight in any way i believe the bill should go further with mental health and substance abuse issues and will offer an amendment to that effect tomorrow it is vitally important that we get the doctors and nurses practicing in areas that need them i saw the physicians shortages that people had to deal with across the state border with the neighboring state of massachusetts after they enacted reform we cannot allow allow that to happen nationwide the workforce title of this bill is a good start but we need to remain vigilant i will not stand here and fight for a system in which my constituents finally receive quality health insurance but new high but do not have a primary care physician with which to use it we need the primary care doctors on the ground so that all americans can have a quality medical home these needed reforms do come at a substantial cost but we cannot wait any longer on these reforms we have seen in recent weeks a number of agreements from the industry side to cut costs but i believe we can still do more we have a momentous occasion here to lift up the poor and the most vulnerable those most in need of help more savings need to be found within the system from all the players involved the savings coupled with advancements in accessibility to care are the down payment on the reform we need it is my hope that we see more savings from all groups involved in the coming weeks i have long been a supporter of a single payer system and as a co sponsor of h r six seventy six and to enact such a system i believe though that this is the best way to guarantee universal access to quality health care for all this bill be america's affordable health choices that puts us on the road to achieving that same goal the time to act is now if you have a plan we heard often if you have a plan you like or with which you're happy you get to well think about that this bill provides corrective surgery into the future more and more even those who are insured are finding out that individual and individuals and families are living with a mounting denial of services and procedures with delays created with increased co pays with growing pressure on employers to demand more out of pocket contributions by employ the instant measure before us will respond to the future needs of the uninsured the underinsured and yes the insured in a way that will enhance quality of services reduce costs and grow access the cost of doing nothing is astronomical so now the time is it now the time to act is here we owe it to our constituents and we i want to begin by commending you and your stuff for all the hard work you have done in pursuit of the of the laudable goal of making quality and affordable health care available to all americans regardless of their income or place of residence the bill introduced yesterday represents an important step forward in this vital effort i think we all agree however that this legislation is a starting point not a finished product over the coming days we will have ample opportunity to refine the bill so that he'd achieved its worthy objective although i recognize that this process is ongoing and fluid i would be remiss that is why when it comes to reforming health care it's critical that we do it right i have some concerns as to whether parts of the bill we're going to meet that standard in preparation for our committee's work to improve health care i have held numerous meetings with my constituents from town halls on the telephone to roundtable discussions and individual meetings with small businesses and in the community  there are many parts of them america's affordable health that nevadans support for example i've heard heart wrenching stories from people who were denied care because of a preexisting condition over who are now facing foreclosure of their home because their insurance company had a cap on how much health care they would cover there are also many parts of the bill however that are of concern to nevada and unemployment is at an all time high and small businesses in particular are struggling to stay afloat business owners across southern nevada have expressed concern about the employer requirement and questioned whether the exemptions for small businesses will be enough and i share reservations as we begin the debate on america's affordable health care choices i will keep the concerns of my constituents in my mind at all times while it is clear very clear that we need health care reform it's also system the system has become more expensive color covers a smaller fraction of americans and greater need of reform as the us representative the husband of a primary care physician i've heard many stories about hardworking new jerseyans who cannot from the hospital they return of insurance paperwork even after completing these forms the family still had one hundred fifty thousand dollars of out of pocket costs for the medical care needed to battle her husband's disease we must reform the system and position assistants are in the front line of health care and have the ability to integrate a patient's care i'm pleased the legislation includes several proposals to improve primary care by increasing the primary care workforce and enlarging community he center i look forward to working with my committee colleagues to improve this bill further i'm pleased to support employer benefit which would provide a new way for affiliated small businesses to join together to offer health insurance and other benefits i'm pleased to work to advance this project with representative here who has championed this proposal to help small businesses and whether with representative andrews who has advocated this concept for several years i'm also pleased to work with representative polis to introduce an amendment that would provide additional job training in order to expand the health care workforce the amendment would establish a grant program to increase the number of online health workforce training programs and start a clearinghouse that would collect and disseminate best miller and others here in american public that now understands what i think the table is set for historic reform as primary care providers and patients from central new jersey have told me we must fix our health care system to keep individuals healthy to prevent diseases and to provide health security for all americans