misrepresentations. >> we are to determine the applicant didn't know about a specific condition we would not rescind. >> okay. ..

they were being treated for acne? does not bother you? >> yes sir, it does and we regret the necessity that that has to occur even a single time and we have made suggestions that would reform the system such so that would no longer be needed. >> well, i haven't heard your opening statement. i glanced at them and nyet not heard the first round of questions. we understand the need to verify that people are telling the truth. we are not asking you guys or the insurance industry to automatically take somebody's word for it. i understand that. but, when i see advertisement at fur advertisement about, be a part of the family and we

treelike our own family, and then somebody that doesn't have group coverage that takes out an individual policy and runs into some situation where they have a healthcare issue that requires a major claim early in the policy, if they operated in good faith in taking out the policy and you approved of them, i really don't think it is good business practice to go back and try to figure out a way to rescind that policy. if nothing else, it is a false trade act, of falls trade practice truth in advertising. and, one of the duties of our constitution is a little thing called federal preemption. we have the authority on this committee to preempt state law if it is an interstate commerce

and we can't preempts state law in intrastate commerce but we can in interstate commerce, and i don't think there is one vote on this committee for the practice of retroactively reviewing its policy to try to rescinded if you have a woman like my constituents, ms. beaton, who discovers that she is that breast cancer or you have somebody who needs a stem cell transplant, or even the young lady from california who just needed some blood work done. i mean, we will back you up on fraud and misrepresentation but i don't think you are going to get a vote at all on rescissions that are not material to the claim being processed. i don't know that that is a question. it is just a statement, so if you would like to comment on

that, i would certainly like to give you the opportunity to do it. >> no one cares to insert? >> i would just reinforce that rescission would only occur when the information was material to the initial, if the situation, if the information was material to the underwriting decision. >> only in that case. >> mr. chairman, i am going to yield back. >> could i follow up on that? if it is material to the representation, let me ask you this. in your policy mr. hamm, and it is question number 14 on your questionnaire. your enrollment questionnaire. now tell me how you get a misrepresentation. within the last ten years, because you say you are insurance health enrollment questionnaires are simple, easy

to understand, straightforward language so people can accurately report their medical history so, your question says within the last ten years as any proposed insured had any diagnosis, receive treatment for or consulted with a position concerning phlebitis, dia, cystitis, or glandular disorder? tell me, what is dia? >> i am not aware. >> how-- if you don't know what it is how would anyone filling out their application know what it is? you don't even know what it is then idid the why. how about phlebitis or lympho then the path the. what is that? >> i don't know the answer to those questions. >> buse sincerely believe an average of the that would know what these words mean if you don't know and i don't know? >> sir i believe that is an application that is not

currently used at this time. >> it is last year's application last year's application and, last year's application. have you change the application from last year? >> i am sorry sir. >> this is last year's application for goode did you change it in the last year? >> i am not aware if we have chains that the application. >> so as far as you know that is your current application. >> i believe our current application asks questions back to five years of the ten year might be different in mogadishu today. >> it is the same question, dia do you don't know what it is. >> i do not know what that is. >> mr. deal. >> mr. barton i took your time. >> if this is the hypothetical but i just want to figure out what the answer is. i had a mild heart attack three years ago so i now take six different medications every day

and i'm going to probably have to take those medications for the rest of my life. i am covered under a group plan, blue cross/blue shield of texas and it is available to every federal employee who lives in texas and mike coverage has been good. i have never had a problem. but let's say i quit the congress, and i going to business for myself and i try to get a private health plan like ms. beaton got when she switched jobs from being a nurse and went into business for herself. on the application, i have to list the medications that i am taking, the fact that i had a heart attack, give the doctor that time, the location, but i broke my leg playing football in high school. i got a 250 lb-- i with a

linebacker. if i forget to put all my application with your companies that i had my, this small bone in my left leg broken playing football in 1967, but i do put all my medications and my history of my heart attack, the fact that i omitted breaking my leg in 1967, is that a grounds to resent my claim, my policy later on? under your policies right now that your company has issued? >> i admit that my big problem, tell you the medications, all the stuff but i flat forget that i broke my leg and was treated by dr., paid by the school district in 1967. >> congressmen barton, r underwriting guidelines really

kind of dictate that. but it is my understanding of how are underwriting guidelines work is that since that condition would not be material and are underwriting decision because it happened so far in the past and was a non-serious nature that that would not have factored in to the underwriting. >> i understand you might not cover me because of my heart attack. i understand that, it would be totally within your company's right to say congressman barton had a heart attack in 2004 or 2005 and therefore we can issue him a policy. i understand that. my question is about my leg injury from way back when, at i don't disclose that does that disqualify me potentially on down the road? mr. collins? >> sir, the application is looking for information billington years back. >> so that without the material? >> mr. hamm? >> the same answer is mr. collins. >> thank you mr. chairman. >> mr. deal for questions

please. >> thank you mr. chairman. we are talking in the private insurance company and mr. sessions said that this summer in the 50 million ranch, is that correct? to you three gentlemen to you also have policies that extend to erisa tutt coverage plans? dewalt three view-- >> wellpoint insurers one in nine americans. the beth majority are covered under erisa plans. >> mr. collins. >> yes sir, the majority of our membership are in group insurance plans which are covered under erisa. >> mr. him. >> the majority are individuals however we have some customers under erisa. >> does the same problem retained in the rest of the marketplace as in this private insurance marketplace, ms. pollitz you indicated that you think it does. >> there is recision-- >> i am sorry, i can't hear you.

>> there is recision in the small group market. it operates a little differently because it is a guaranteed but a similar process, if they claim is submitted during the week period, it is largely the eligibility of the members of the group and the family members of the group that will be reinvestigated to see if there is any way that the people who made the claim should have been on the policy in the first place. >> but the state period is like two years, do not apply because it is the nearest the plan? >> your are much tighter in the small group market so congress has said that these questions about ten years ago, five years ago, those don't matter in the small group market. you are only allowed to apply and insurers are only allowed to apply preexisting conditions for something that was treated or died nest in the six month window prior to cover its stake

in effect so anything that happened before that isn't even allowed to be considered and that the person coming into the policy had prior group coverage that gives credited against the pretext so that cannot be considered either so it is mostly eligibility. >> i am going to try to be real quick here and i apologize for cutting you off. with regard to what needs to be done, in the event we don't get the major reform that you will have been talking about and anybody else was talking about, in the event it becomes something of trying to narrow a time window in which insurance companies have the right to review medical records, would it not be feasible that if we have electronic medical records, that that would facilitate a more timely review? i would assume common sense would say that it would. ms. pollitz do you first see

that consumer protection groups would oppose making those kinds of personal medical records available for insurance companies to review in a timely fashion, so that we would not hopefully have these situations develop? >> they are already available for review. >> we don't have the extent of electronic medical records that we all hope we will have. >> but the privacy rules you have been forced to the under hipaa say that medical underwriting is permissible reason for disclosure of medical records. >> you would see no reason to raise that issue? it is already permitted under current law. >> the last thing in this is more of a comment than anything else. i think the issue that dr. burgess discussed with you about those who are now being excluded because of preexisting conditions etc., i think we all know that are high risk pools that have not effectively

operated answered by another assisted in states like mine for example. i think we need to be looking at a policy where we would maybe take those funds that are available for high-risk pools, some of which are not being utilized with them into an environment in which we could perhaps with the sharing of some of those costs with the insurance industry bring these individuals into the pool with the additional revenue that would be available for available sources. i just simply suggest that is something we all need to think about in thank you mr. chairman. i yield back. >> mr. burgess do you want to question now or do you want to come back? you only have five minutes so i will have to hold you tight. >> i can be very brief. >> i have not seen it yet but go ahead. >> we have heard the discussion of the public option plan. what is your opinion of that? >> i oppose the public plan

option. >> mr. collins? >> sir, i believe the reforms that have been proposed we can make the market work much better without a public plan. >> mr. sassi? >> we also oppose the public plan. >> i don't want to be the one to have to break this to you but the reality is you are very likely to get a public plan and not likely to get a deal struck by a hip at the white house. i would urge you to think outside the box on this when there are ways that we can solve this problem without going to a public plan, in my opinion and without leaving so many people uninsured inlet bell leaving so many people that fall to the cracks. clearly the situation as it stands now is unstable and untenable and we cannot continue it but you guys of that to be able succumb to the table with some innovative thinking on how we provide coverage to that segment of the population that is full mobile. we don't need to turn the whole system on its head is to cover

that ten of 15% that is right now left out but that is what we are going to do if you don't help us with this and a fallback position i promise you it's a government-run plan and that is what you are going to get if we don't work together on this issue so i appreciate you being here today and mr. chairman i appreciate the extra time and i yield back. >> so you didn't have a question on today's hearing? in all fairness to wellpoint, i said in my opening statement and a key care to comment please do. i said in my opening statement in the committee investigation wellpoint appelee wedded employee performance based in part on the amount of money and its employees say the company through what corrective rescissions of health insurance policies. according to documents obtained by committee one official was awarded a five for exceptional performance based on having said the company nearly $10 million the recisions bill goody you care to comment on that? i figured is there to give you

an opportunity to comment. >> during the process of collecting information requested by this committee we didn't cover the two performance appraisals from 2003 that were isolated to one area within california. that included one line each referring to which the savings in a dollar amount. they were in the context of a part of the performance appraisal with other metric and they were part of a more comprehensive performance appraisal that was i think five to seven pages long. i reiterate my statement that wellpoint does not have a policy. it is not been our policy to systematically reward associates for performing rescissions, for tracking the number of rescission or the dollar amount. >> begin both of those employees receive somewhere between 600 to about 6,000 i think the range

was? >> my understanding is that those associates received within the average compensation that all wellpoint associates received for that given time period. >> oh keizo ury juris-- okay. with their profits i guess you would give bonuses. that concludes our hearing for today. the committee rules provide members of ten days to submit additional questions for the record. i have already had the record book submitted for the record. we will redact with anything that relates to law enforcement said that. that concludes our hearing. i thank gore witnesses for coming and that concludes this subcommittee hearing. >> thank you.

[inaudible conversations] >> we focused on the healthcare issue on washington journal with dr. bernadine healy the former head of the national institutes of health. this is a half-hour. >> host: a lot of doctors yesterday heard with the president had to say about healthcare. what goes on in the mind of the proposals the president's laid out? >> guest: i think what he said yesterday at this speech and of course c-span and everyone else covered it and a chance to listen to virtually every word, i think he pretty much laid out his plan. he stuck to the script and he did a wonderful job in rallying the troops come in addressing an audience that he thought why did ben hostile but who was extremely warm and gave him many ovations, if not standing ovations. i think only one to. i think that he is sticking with the program, which she has to do at this late stage.

>> so, when the doctors here about things such as a public plan, what is their opposition? ultimately how does that affect them? >> guest: i think it's too big issues for the doctors yesterday was the public plan and secondly malpractice, which has been a major platform issue and not that there should be malpractice but in that there should be caps on it. for the pain and suffering part but getting back to the public plan that is truly turned out to be the hottest part of the proposals that appear to be coming in the bills as well as what the president is proposing and i think the concern and the president said it very well is this trojan horse for a single-payer system for the whole country. >> host: do you think it is? >> guest: i really believe what the president said. he said that is not my intention but i think what we have to recognize is once you have created that vehicle and that platform it doesn't just take a

stroke of the next president's ben or the next piece of legislation to very quickly turn it into it. it is really creating something, a large, a huge public insurance company that will be competing with the private. it is kind of gm without going through bankruptcy. i don't see, it is sustainable in a number of ways. certainly politically it is sustainable because it sounds good on paper. where i am not sure it's going to be sustainable is the cost is going to be astronomical and secondly i do think that the american public is not ready, it is not crying out for a single-payer system in which the government is in charge and there is no alternative. even if you go to european countries, countries with socializes tums if anything to encourage people who can afford to get their own health insurance. they all have a pledget system.

we to seven 50/50 blend of government and private. other countries may be 85/15. if we push to 100% or even 85% it will change the dynamics much as for doctors but for patients. >> host: the presence of about keg-- paying for care at the same time agenda as far as malpractices concern do you want to make sure he would not support a cap. ardis things working against each other since most doctors say they have to order these battery of tests to make sure they don't get lawsuits for saying they didn't do their jobs and the most efficient ways? >> guest: the fact is of course there is concern about both under utilization of care which occurs of someone does not have insurance and need to get care and they don't get it because they don't have the means, so that is under coverage but the other is overtreatment commisar you have under treat menengah overtreatment so we are trying to solve both problems. overtreatment is that. there are cultural differences and they can be identified drop

the country. and, i think that some of the overtreatment, not all of it, some of it is a concern about malpractice. malpractice this huge. does not just the finances by the way. we think about these decillion dollars suits but it tears apart a doctor's life. particularly if they are innocent and there are some frivolous suits that go on. i am all for suits that are legitimate and those should be paid out so this is not against malpractice. it is putting a reasonable cap on the 30 million-dollar judgments that may or may not be correct, but more importantly just put some coordination into it. we don't want overtreatment and overtreatment is in part caused by fear of lawsuits, then we had better study that, analyze it and stop it. it is not good for patients. >> host: dr. bernadine healy served as the-- she also writes

the heart to heart plug for u.s. news, which you can see linker december web site. if you want to ask her questions about the president's proposal for healthcare to 02730001 and tewes it-- and independents, 20262805 e-mail at journal at c-span.com and tweet test. borderville california, we hear from lou who is also a position on the democrats line. go ahead sir. >> caller: good morning. thank you for c-span. i have been a physician since 1962 and i have lived through the exception of medicare and all the way up until today. by major point is that medicine is not amenable to profit. positions should take care of people and be paid reasonably, but the insurance companies have

just corrupted the whole concept of medical care by the huge profits that they are making. and they are very difficult to fight. if obama does not get through his government plan, we are going to have exactly the same thing that we have no and it just doesn't work. >> host: dr. healy. >> guest: i think the insurance companies have done a terrible job in terms of not recognizing that the doctors are on the same page. the fact that they make these astronomical profits, some of which come i can't in for-profit organizations and they do so often in hostility with the doctor. telling-- in patient's, disallowing many legitimate treatments, making it impossible, impossible hassles to render care. lot of the administrative cost

the president spoke about in recognize doctors are struggling under come from insurance companies, so i think the insurance companies have really lost an enormous amount of good will. there is concern that they are making a lot of money on the backs of patients and on the backs of administrative hassles, so i think that they have got to be cleaned up. i don't care what happens with the president's plan. the fact is we need major insurance company reform in this country, and maybe, maybe this is time for insurance companies to realize that they are standing up there with not a whole lot of support either from the government or the medical community. >> host: during our half-hour together pheaa skype we will be with students from the national speech and debate tournament taking place in birmingham alabama, courtesy of our c-span civics bus. students are on the bus and they will communicate to west from skype. primmest kidnaper augustin, go ahead. >> i am gabrielle and i'm from

blue fallin north high school. i was actually wondering, you are talking in your recent blog seven ways that health reform will affect the. you said that the new health reform is going to be focusing on wellness and not sickness and i was wondering if you wanted to elaborate on that? >> guest: i think there is always been the concern that madison answered my eye go back a long way in my own education as a doctor, let doctors learn about how to treat people who are sick and most of the money that we spend in the healthcare system is for sickness, not wellness. 80% in that general range, and there is increasingly, over years, if we could only prevent this. loan cancer when it is related to smoking, coronary artery disease, and i make cardiologists by training, when it is related to having high cholesterol and fat diet and

exercise. we must be able to prevent as much disease as possible. weir i have concern that i kind of alluded to in that piece is that it is not either/or. most of what we do when we prevent disease is we delayed disease. the good lord is always going to tapas on the shoulder at some point. we are all going to face illness and often unexpectedly and not necessarily because we are to blame or because we could've done something that we didn't do. so, i think we have to look at this in a more granular way and recognize it is prevention and that is good for patients but there's this huge population that are ill, we must care for them and by the way by the time they get into that hospital bed, if you don't blame them. yes, that is expensive. >> host: sarasota florida ana republican line, mike. >> caller: good morning c-span. i have a question for dr. healy.

dr. healy, i am in a situation where i am required to have government plant and a private plan, which i think president obama is addressing. but come the what i am saying projected in the government plan is the drop in medicare payments. what i am concerned about is this will let that the payments to hospitals. if that is the case, when do expect it to be a corresponding increase in their fees, which would affect those who are covered and the private plan, and what is the solution to that because it just seems to be a matter which way bee, i guess it is the oxymoronic of the century. we see a good plan versus the bad plan and in the best of both worlds. >> guest: i think you put your finger on the fact that right now, we do