security taxes. when social security taxes come in they are supposed to be reserved for more benefits. we have to have a lot of money to run this program. $10 billion to the irs to hire 50,000 irs agents to police the enforcement of this mandate on every american. $55 billion to bureaucracy to run this health-care and the trust fund, all this money through these medicare cutsçç extending medicare. it pays for this new entitlement, $38 billion, coming from medicare to this

entitlement. this is an $454 billion deficit. when you look at the fact that this treats medicare to create new government programs, what we're doing here is imposing a new entitlement that we don't know how to pay for. at a time to create jobs and finally let's look at the architecture of this legislation. it is designed to give the federal government control over what health insurance is available for all americans and mandates americans to buy health insurance that is determined by the secretary of hhs and how much health care is enough and what treatments are worth paying for. i don't think this is what people sent us here to do.

we are up for reelection every other year. the entire body is up for reelection. the framers designed this institution to be closest to the people and i would implore you they want transparent government and accountable to government and bringing forward a rule that deems a 2700 page bill a takeover of the entire health-care sector, creation of a $4. trillion entitlement, beaming this into law without having the courage to have a clean up or down vote in the people's house as representatives of the people is not good government or democracy. one of the cornerstone principles of this nation that our founders created is government by consent, that is not what is coming here. we are turning this principle on its head. don't go down this path. give us clean votes and the

shame of all of this, many of you know this, we have been offering ideas as well. we have asked you to work with us on a bipartisan basis step by step, piece by piece and with pre-existing conditions and work on costs and prices and the deficit. i realize you have a big majority and all the power in washington. you chose to go it alone with one party rule. i want you all to know that we too believe the current system is unsustainable. it is bankrupting families and people with pre-existing conditions. we don't want to have thirty million uninsured or whatever number you choose. we want to fix this but the answer is not to have the federal government take over the health-care sector and impose $569,200,000,000 in tax increases to kill jobs and raid medicare to the tune of

$532 billion to create a new entitlement. that is why we are opposed to this bill. >> we appreciate all that. mr. ryan, i understand you have your own reform plan. would you give us a very brief description of what you plan for medicare? you phase it out and get rid of it completely? >> i couldn't disagree with you more. let me just say there are lots of republican bills on care. [talking over each other] >> that is not the republican budget. i introduced my own long-term entitlement plan and i will tell you what it does for medicare. we realize medicare is the $38 trillion reliability. if we wait until 2013 it is a $52 trillion liability. medicare goes bankrupt by 2017. what my bill does which is scored by the actuaries as

achieving full solvency scored by the congressional budget office as achieving permanent solvency is if you are in or near retirement we are not going to change a thing for you in medicare. you will get a medicare you have organized your life around. [talking over each other] >> let me just finish. we are not going to cut medicare with this bill. we are going to have one out of five medicare providers go out of business or drop patients. we want you to have the medicare you have right now and if you are under 55, it will not be there for us. i say -- [talking over each other] >> let's reform medicare to make it sustainable and the kind of reform i propose is the health care we as members of congress have. i get a payment and a book. [talking over each other]

>> you want me to explain what my medicare reform is. >> may i ask -- >> i was answering question. [talking over each other] >> what i want to know is your aim is to fade out medicare. >> that is not true. >> if you were below 55 medicare would not be there. >> medicare is going bankrupt and running out of money. [talking over each other] >> let me explain what i propose. can i answer your question? >> i hope you will. i am proposing for people under 55 would transform the medicare system to a system that works like what we have in congress. we get a payment like we have in congress and what we get with that payment, we get to pick among a list of certified medicare plan like we do in congress to pick our benefit but i do three things. you are low income we cover all

of your costs. if you are sick you get more money to make sure you get affordable care and if you are +t(p' afford more so that tests the benefit. what that does is gives everybody who goes into medicare, younger than 55, it gives them the kind of benefit like we have in congress with additional support for the sick and low income people doing it that way by giving competition so plans compete against each other for our business according to the congressional budget office makes the program permanently solvent and medicare still continues. it is still an entitlement and the medicare system for everybody over 65 but run in a way that is sustainable. it is done in a way that pays off our nation's debt. >> as i understand it -- hold on a minute. you are saying that in the future the elderly will be given

a voucher. the and mentally ill and critically ill, all these people covered by medicare will be given a public market. >> they will have a -- [talking over each other] >> just like it has for you and me -- >> they buy their own insurance. >> medicare approved >> [talking over each other] >> i understand you don't like the plan but what is your plan? >> we have got our plan. >> this isn't the medicare plan. it hurts medicare. >> one of the major differences i want to discuss with you is this plan we are proposing to vote on tomorrow covers 95% of all americans. >> the under 65 population. >> you will cover three million more people. we cover thirty two million. >> you are talking about a

different bill, not my bill. you are talking about -- i have a bill -- there are lots of different republican bills. >> you wanted to comment. >> i hope we get back to talking about the bill that will be passed for the american public but it is important to recognize mr. ryan's plan is legislative language. he will eliminate medicare for anyone who is 55 or younger and maybe paul doesn't call it a voucher but it will be a ticket that loses value every year to keep up with the cost of medical inflation and seniors hoping they can afford to have health insurance will find it more difficult but more than that what we should examine more closely, those of us not yet receiving medicare is the fact that this republican proposal

raises taxes on 90% of americans to pay for the cost of his proposal. that is because this will tax employee benefits that people through their insurer received. the tax on every american who works today and receive his or her insurance through the employer, mr. ryan's proposal would tax heavily. there are ways to pay for his plan. >> tell us what they are. >> to find a way to pay with the plan, tax every american, they receive their coverage through their employer. >> in your opinion his plan does away with medicare and leaves people with a voucher to find -- >> medicare as we know it -- [talking over each other] >> it is very easy to find

savings by essentially instead of guaranteeing everybody coverage like we do today under medicare give them a voucher and at the difference between the cost of medicare and the value of the voucher all you have to do is make it lower and use save more but you undermine health care for all people who are seniors. the basic premise of medicare is every senior is guaranteed health care. mr. ryan's proposal does not guarantee -- it doesn't. it doesn't. purely -- [talking over each other] >> we disagree on that. you want to talk about your own legislation that is not only clear to me -- let me say two

things. i find it interesting that you are saying we are growing the increase slower than health care. that is what you are doing in this legislation. you have two things you claim bends the cost curve. put this in the reconciliation bill which is your subsidy for americans in the exchange slows down in the out years to get savings. you yourself are basically saying we want the same thing. we want to slow down the subsidies at a lower rate in health inflation. taxing health insurance benefits. you are taxing health insurance benefits in this bill but unlike your taxing them to another government program. you will take it from the job and give it to you. that tax money doesn't go for a new program like you are doing. sea-tac money says if you got laid off, if you work for yourself you will get the same

tax benefit everybody gets. we a discriminating against people who did not have health insurance for their jobs and instead of having a tax benefit tied to your job let's tax it to individuals. it is not a tax increase is an exchange of one for the other. i am simply saying you have endorse those concepts in this legislation alone. let's be consistent if we could. >> do you want to address that? >> talk about our bill and ask about the difference between our bill and his. >> use the microphone. >> congressman andrews in new jersey, thank you. let's take a person who drives a truck and makes $50,000 a year whose health insurance plan is worth $18,000. is that person taxed under our

plan? >> $50,000 in what year? >> the answer is no. [talking over each other] >> there are plenty of other -- [talking over each other] >> is that person tax under your plan? >> he gets an average tax of $1,400. [talking over each other] >> i have run these numbers. [talking over each other] >> under your plan, are the health benefits of that truck driver taxed? >> yes and he gets a cash benefit of $57 which is more than he gets under the current code. >> i am pleased to be here but if we're going to debate back and forth between witnesses -- >> it is so important that we

have some idea. >> it seems to me -- [talking over each other] >> your proposal would shift the cost to the elderly, when they get to the elderly and that is how the government will save money but most americans want medicare to be there when they are eligible. medicare is a benefit you are entitled to after you have paid in all those years. you would take it from the next generation and say go out and buy private insurance policy. if you could afford more you would get more in if not you would get something. you get the poor people's 8 m 0 but that is not what we want for medicare or what the american people want but that is not up tomorrow. our bill that is up tomorrow would expand medicare, make that trust fund more solvent for logger period peterson will

close the doughnut hole and people paying for prescription drugs, make presentable benefits without co-pays and keep people healthier longer. that is keeping the promise of medicare. you want to change the promise it is a different philosophy. [talking over each other] >> rather than use it -- he is not a member of the panel. >> we ask mr. ryan to discuss his plan. he is very proud of his work product and what we have just seen here is this is the most

compelling argument for an open and free wheeling and transparent debate on the florida house of representatives. we have the chairs and ranking members of four committees working diligently on this issue for a long period of time and the idea has mr. barton began discussing an pointed to so well and supported so well in this effort, it is essential in what was promised as the most transparent and open congress in the history of the republic that we on this issue which everyone acknowledges is landmark legislation, we have that kind of open debate we were promised at the last congress and the beginning of this congress. i want to take a moment to touch on what sandy levin raised, the very important personal aspect

of this. sandy was handing out fliers for john's fatah reminding all of us we are not as old as he is. by pointing--was reminding all of us how much older than we are he is but the fact is what was being done to focus on this issue and make sure people have access to health care is a very important thing. two instances of californians who are neighbors of mine and the challenge they face. there is a sense that going back to teddy roosevelt, president after president have been trying to deal with this and my friend regularly says scott we as republicans when we bring in the majority did nothing. we ignored this issue. i would like to disabuse people

of that notion by a pointing to a couple issues. recognizing we could go along way towards increasing the number of americans who have access to health insurance and in light of the argument we have made, mr. martin and mr. ryan made share the economic growth of $569,200,000,000 tax increase that will slow economic growth, i am hard-pressed to believe we will see health insurance made available for thirty-two million americans for our proposal will make health insurance available for three million americans. i don't accept that notion. if we actually see the economic growth in this country resources

will not be there. in response to this argument, we were not working on this issue, i am proud of the fact that we initiated 23 years ago the existence of medical savings accounts and those who played a role in increasing the access to health insurance for people in this country and i know the argument of incentivizing people through taxes is not possible for those at the lower end of the economic spectrum but we have been able to increase that access and i am proud of the fact that there are seniors today who have access to affordable prescription drugs because of the program we put in place but there are couple issues the president has said he supported in the health care

summit. unfortunately -- there were associate health plans. that is what he was supportive of. trying to allow businesses to have an opportunity to have lower rates. when we were in the majority we sent legislation to do that to the united states senate and it was blocked. it was blocked by the democratic minority at that time. the second issue to go hand-in-hand with that was the issue of meaningful lawsuit abuse reform. when the president address this in the joint session of congresi he said he was supportive of doing that and guess what? when we were in the majority we worked on that in a bipartisan way and sent it to the senate and the democrats in the senate blocked that. it is true for decades and decades there have been efforts

being made to try to ensure that more americans have access to quality health insurance we have tried and we will continue to try and if we are successful at killing this legislation, defeating this legislation, the only thing bipartisan about this will be those who are in opposition to the legislation, if we are successful in doing that, monday morning we will come together to not only work on real of lawsuit abuse reform and associated health plans but we can expand medical savings accounts, creates an opportunity to deal with the important pre-existing conditions that the two individuals mentioned are there, and the president supports the notion of allowing for the purchase of insurance products across state lines. those are five things we can work on in a bipartisan way.

the only way we can insure that we immediately not in 2014, drive the cost of health insurance to defeat this bill and an opportunity for the process which clearly undermines the open as we were promised but we will do everything we can to make sure more americans have access to quality health insurance. >> maybe we should go on. i respect -- hard to tell from the light when this is on. >> make sure you speak. >> it is like a ways and means committee. whatever it is.

i very much respect the sentiment but what has come before the ways and means committee on two of the issues if there are many more, no proposal came before us from the republican minority that would cover more than three million people. that is just the fact. in terms of pre-existing conditions, no proposal came before us that would address this basic issue. no republican proposal came before our committee. so i understand the sentiment. you are in control for lots of years. when you were in control the number of uninsured grew and grew and the number of people who were penalized for pre-existing conditions. the inability to get control of

health-care costs, that inability has grown and grown. >> there were proposals -- [talking over each other] >> when we were in the majority. we tried to do that and as we have gone through this process it has been a difficult one. >> we have shown one in four have not lacked health insurance. over a million people don't have health insurance and we will do something about it and pre-existing conditions -- >> what i said is the five issues i raised dealing with pre-existing conditions,

creating greater competition, the cost of those premiums is something i believe will happen immediately if we were to legislation. [talking over each other] >> we start pre-existing conditions with children right away in six months and take care of that problem. >> could i comment as well? your bill and our bill have similar treatment of pre-existing conditions because -- we differed -- >> there is no proposal to deal with pre-existing conditions. [talking over each other] >> it was in response to this notion that there was no proposal whatsoever. >> we have taken a different approach than the democrats. they want to do one big bill

that does these things and we felt we should follow on the paths -- putting wellness in medicare and all of the step-by-step approaches that made sense and the problem with that approach is premiums go up and the reason people lose their insurance and don't have insurance is they can't afford it and if you look of the congressional budget office score of the senate democrats' bill premiums go up 13% in 2016. we don't have a score of this reconciliation bill because they haven't had time to do it and democrats won't give them time to give us the information as to when premiums are going up so we have no information. let me just talked again on the coverage issue. half of their coverage is from expanding medicaid. that is a program that is not sustainable in the long term and

what they had to do is cut special deals with states to get people to go along with it. so they extended the federal share so this was a match program paid by the federal government. if anyone thinks the federal government will pay 100% of medicaid in the future, obviously they are not being very realistic about this program. so at huge cost in a program that needs reform that is unsustainable they are expanding and they do that by a huge tax increase and the reductions in the medicare program. there's another way to do this and the way could have been forward with this smaller approach beginning to address the issue of cost. bring costs down in health care and address the issue of expanding coverage as we did to millions of people in our bill. we could move forward once we

begin to get costs under health-care. >> in reconciliation there is no special deal on medicaid. >> the special deal -- [talking over each other] >> the federal government is paying 100% of medicaid. >> call that a good deal for coverage of people with health care. >> it is 11:40 now and we have been going for an hour and a half. that is 50% logger than the entire debate time that will be allowed not on the legislation but simply on the special rule that will be brought to the floor for consideration of this and i think what we have seen here demonstrates very clearly that we should be having an open and transparent debate on the house floor on this issue. >> i want to thank the witnesses for being here. i appreciate the tone you

brought to this debate. all of you including my republican colleagues are serious about trying to approach this legislation. let me say something about the process. the fact is this has been an open transparent process. i don't know of any legislation that has received as much scrutiny as this legislation has. president obama began the process with the health care summit in 2009. republicans and democrats participated and over the past year and a half the house held 100 hours of hearings in 83 hours of committee markups. we heard from 181 witnesses both democrats and republicans. 239 amendments were considered at 121 were adopted. the notion that there wasn't a process in place is absurd. we are now in a difficult

situation because the republicans -- the republican leadership has made it their mission to use every parliamentary maneuver and hetrick available to try to block this legislation. .. there is a lot of abuse in the insurance industry.

there are good and bad insurance companies and the mr. dreier talks about the grand initiatives the republicans have. well, you were in charge a long time and not much has changed in the practice mr. levin and pointed out there are tens of millions who don't have insurance. there are countless people who are discriminated against because of pre-existing conditions and some of them are courageous. people have been denied insurance because they have a bad case of acne. in some states domestic violence can be considered a pre-existing condition. a woman who gets beat up by her husband or boyfriend has a pre-existing condition and can get the health insurance? that's insane, that's not. that has to change and i didn't change mr. dreier, for all the years you were in control but we're going to try to change it now. we are going to try to change it now. the fact of the matter is i think we are on the cusp of

making history. you know, ted kennedy -- i'm from massachusetts -- kennedy -- elected in 1962 and said he will fight to make sure everybody has health care. 1972 of my old boss the former chairman ran for congress and his slogan was that both for me and i will help ted kennedy get everybody insurance. when iran for congress in 1996i said i'm going to help get everybody insurance. now, i think tomorrow if this bill is brought up we will have that opportunity to fulfill their dreams, i only wish they were here to witness it. but what we are trying to do is ensure 32 additional -- 32 million additional americans who want to provide more choices, more protections than they have right now. i mean, every american should have what members of congress have. it should have choices and

protections that we have and that's what this bill is about. we want to control cost for small businesses. i think everyone of us here has gotten calls from small businessmen and women that say they would like to expand the number of employees but they can't because the cost of insurance is so high. this bill has subsidies and relief for small businesses and individuals who can't afford insurance, that's a good thing. we want to extend the life of medicare. you know, i'd want to go back into mr. ryan's budget alternative, but i think what the chairman was pointing out there is a philosophical difference between democrats and republicans on the issue of medicare. we don't want to go to a co-chair system and want to privatize social security either. so there are philosophical differences and those are worth debating on the floor. it reduces the deficits. you know, in contrast quite frankly to the prescription drug bill that was run up to the

rules committee at midnight to win my friends of the republican party were in charge and it wasn't paid for. judge read -- senator judd gregg republicans said the part d added and $8 trillion unfunded liability to the federal deficit. i mean, you know, we are paying for our bill here. not only are we paying for it but it going to cbo we are going to reduce the deficit by well over a trillion dollars. i think that's a good thing. and i think it's a courageous thing that we are actually putting this together and bring it before the floor. you know, for many years when my friends on the other side were in charge, their prescription for health care was essentially take to tax breaks and calling in the morning. it didn't work. in fact, the bush tax cuts alone

added $1.6 trillion to the dead in the first 10 years. so when you want to talk about deficits and debt, this is one way to get it. help control health care costs from assisting our 17% of our gdp is health care. we are told if we don't do anything in the next decade or so it rises and rises up to the point where you get to 50% of our gdp, that's unsustainable. we are spending an awful lot of money and not getting the biggest bang for our buck. everybody in this country should have access to good quality health insurance. nobody in this country should be discriminated against because of pre-existing conditions. we need to figure out to control costs so that individuals and small businesses can afford it and that's what this attempt is and there are philosophical the rinses and ideological differences, i get it and we will debate its but i will tell you and i want to commend the chairwoman and the speaker, the goal here was two have a transparent and open process.

i think we did back. we are running into a situation now where the republican leadership is trying to block this so i don't know the rule is going to be but the fact is i think people are tired of us giving speeches and are tired of the rhetoric and they're tired of excuses of what they want as action. my hope is tomorrow we will have action and i look forward to speaking on this bill in voting for it and i think this is an historic moment and i'm very proud of everybody who participated. thank you. >> thank you, mr. diaz-balart. >> thank you, i think all of our colleagues before coming before us in their presentations this morning. adding sensitively there has been a summary of the proposals that has been able to be heard by virtue of the contrasts of opinions and the discussion that we have had.

i think mr. barton and for emphasizing the issue of process. we are the process committee and i guess the question that i would have for our distinguished friends, the chairman who are here, has to do when i recall has to do with process because when i recall when we passed -- attempted to pass the line-item veto that the supreme court said if the president before he signs a bill changes in any way even by taking out one line is not the same bill. that was passed by the house or the senate and the sign in. so if we do and demon the senate

bill passed in a rule, obviously then there will be some additional words. how do you over, the requirement of exact language. mr. waxman. >> thank you very much. i was one of the plaintiffs of the lawsuit that knocked out the line item veto for the president. it was knocked out because it was a delegation of authority to the congress to the president that the congress has, the congress has obligation to pass a law and the president can sign it or veto it's not selectively pick out what he would veto. the situation here is different. we're not going to deal with the senate bill passed, we're going to pass the senate bill. we're going to pass it by a vote of the house, that's the way a bill becomes law. you'll figure out a way to do the role but when you establish the rule we will be required to vote for the rule, required to

vote for the amendments, an eminent will have to be approved before its carried and the rule approved before it's approved, that's the way we operate. i would be against the away -- against dean, we either pass or down and i think the rule ought to say that we pass this when we vote to do this, pass that when we look to do that and that's the way we saw that. >> mr. barton and. >> i hope we are making news here. i hope that what chairman waxman just said, the rules committee is going to pass a rule that gives us a vote on the senate-passed bill. is that which you are saying? it is, praise the lord. hallelujah. >> of course, we are going to vote. >> you'll have to have a vote, the rules committee can it as all have done under democrats and republicans fashion what goes in and what goes out when there's a particular boat that is before. >> henry waxman and i are together, we are like twins on

this. chairman waxman is and he's going to insist or request a rule that is a vote up and down on the substance of the senate-passed bill, that is news. not a self executing role, not bad teams -- no, it is not the same mr. miller, it is not the same. >> mr. diaz-balart has the desk. >> you have two separate issues. we have a 2700 pages senate bill and we have a large reconciliation bill, there are two different pieces of legislation. okay, you're going to have a vote on a roll number one, and then if you do what chairman waxman said you're going to have a vote on the senate-passed bill number to it, and if that passes then you'll have a vote on this reconciliation. if you don't do it that way is is a version of the process. >> do you have a point?

>> mr. diaz-balart, they do raising the point because we have to go through a process of due policy so to respond, what we are doing is we are passing a legislative package which you knew having sex on the rules committee for so many years and many now that we oftensput together a package of proposals into one bill that is passed on the floor. i give the example that i've heard from some of my colleagues that best explain this. you have purchased a house and i have, when you make an offer on a house you have now signed a contract that says it will buy that house. typically ask for contingency, inspection contingency and take a look at the house and have inspector who can tell if there's anything wrong. if he comes back and says you didn't know it but the roof is leaking pretty badly you say i still will by the house because i signed on the dotted line but you have to fix the roof where give me money so i can fix the roof because it was an obvious. you then have a terrific storm

money provided to you to fix the wrath. and that's exactly what we're doing this legislation process. in the senate passed a bill, we are taking that bill, we are going to pass that bill, we're going to pass it by making the corrections, fixing the leaky roof with this correction, this correction bill called for reconciliation bill and that will pass. >> but you know that if in that role of that vehicle by which the senate bill is passed, that it then becomes law. in the other contingencies are remedies to be sent to the santa -- to the senate so they may be passed in may not speak. what i want to say because i think it would be ironic if this signature issue, this landmark legislation of this president

and his majority, it's going to reach the supreme court. on the issue that i thought in the clinton vs. city of new york is clear, if there's any change whatsoever, even one word in legislation in any of the three facets than a dozen satisfy. that's how ironic it would be if your signature issue is thrown out and mr. diaz-balart as the same. >> if you believe your purchase and found out she bought a shack and said you're going to be upset. >> can i answer that. i'm sorry. >> we are passing the senate bill. the president will have that that he gets to sign in a clock. we are passing in this package reconciliation bill that includes the corrections to the senate bill. i