research of economic taxation just brought a study a couple of days ago suggesting that this 3.8% tax on capitol is more damaging than any other tax that has been floated as to how to pay for health care because what it does is it raises the after-tax rate of return on investments and one of the problems we have in this economy as we are low on estimate. we are not going to have an economy that is consumption led. our hope is we have an investment led recovery in this economy and when you raise taxes on investments as this does do, it makes it harder to have an investment led recovery. investment taxes make us less productive. it raises the after-tax rate of return or lowers the after-tax rate of return on income and makes us less productive and that results in more jobs lost in lower economic growth. >> i would point out that initial 5% surge up in the house bill applied to investment income.

that is now a lower rate. >> mr. post could i comment on that? i do think the threshold is at 250 is lower than the threshold you advocated in the letter, but on this issue, so in that sense i would say this is not an improvement over the position you had. >> kicks in at a lower rate but again it is a lower rate in and of itself and does not apply to operating income. a lot of my initial concerns around small businesses. >> this is 3.8 on 200 or 250. or a raid at a much lower income. >> small businesses that pay taxes s. corporation and llc's would have had a higher rate or go under this proposal they will not pay additional tax in this regard. final comments are with regard to immigration. getting back to this concept of-somethings are better better in the senate will and some

things are better in the house bill. i was very disappointed that our undocumented population is barred from purchase a painting in the health insurance market. this unfortunately means there is a subset of our undocumented population that given the ability to would like to buy insurance with their own money. unfortunately they will not be able to end as a result taxpayers will have to subsidize their rent subsidized care. county taxpayers, federal taxpayers etc. and that that is very unfortunate. i plan to try to find out about how much this cost taxpayers. i will be working on a letter to see po to find out what their assumption is with regard to how much it cost taxpayers to have the undocumented immigrants who would otherwise be participating in the exchange and i would like to see if any of you would like to join me in that effort to find out that number in the weeks ahead? anybody interested? we can work with your office on

that. and then finally,--. >> i wanted to see if mr. barton. >> i did not see him. go ahead. >> it is not the point that i want to pay a complement to the committee for the openness of this process and apparently you all have decided not to use the deem and pass rule and i really want to tank of the chairwoman and chairman waxman and congressman cardozo for that, because you all have maintained the integrity of an institution bite choosing to. that in at least tomorrow our debate will be on the policies and it will be up and down and i want to tank of the gentle chairwoman on the rules committee. i have one request, that when you decide on time allocation that you give the committees of jurisdiction sometime that each committee controls. i know that this is coming out as a reconciliation package, so the budget committee will be primary on that, but on the senate though i would hope the

jurisdictional committees would have some time to control the debate and i again thank you for the openness of this process. >> i am drilling down in my final question is again, with regard to the undocumented immigration. looking at preliminary estimates from the cbo, it it incorporates in an assumption of a growth in the population of undocumented immigrants. you can't discern exactly what that is because it doesn't carry out the numbers to several digits but it looks like about a 50% growth in our undocumented population during 2010 and 2019 given it will cover 81% of all residents, 83% including unauthorized immigrants today and 92 and 95 sows there is a 3%. the real answer with regard to this issue as having zero undocumented immigrants and to do that congress needs to take on immigration reform. i would like to submit for the at a recent article by charles schumer and lindsay ran with

regard to the right way to amend immigration which i would encourage my colleagues to take a look like. submitted to the record? >> without objection. >> i would encourage my colleagues to look at the potential for cost containment and savings within health care and unsubsidized care that we can gain by passing comprehensive immigration reform and i will yield about. >> thank you. before we closed the hearing i would like to ask unanimous consent to insert in the record an alphabetical list of three and hundred 25 organizations representing millions of americans indicating their support for the health insurance reform legislation. very good. mr. diaz-balart if you would help me there. that will close the hearing for today. well, it has been a long 17

months. as i stated this morning, i thought ms. eshoo's, it was so important. i want want to thank all of you for your patience and for your knowledge. it has been a good hearing. it has been really enlightening. i think to everybody. i appreciate all the work you have done here. i appreciate all the members of this committee for their patient's. >> madam chair? when you finish i would like to ask one quick question if you before you close the hearing. >> alright. we are not going to close the hearing. >> close the panel. >> i'm going to let the panel go but thank you all very much. >> thank you madam chair. >> see you all tomorrow. >> without objection. [inaudible conversations]

dr. fox, i believe you wted. >> i wanted to get a clarification. >> one of the panel is? >> no, from you if i can. i meant to bring this up when my time was here but it is, we keep talking about the thousands of hours that have been spent on talking about these bills, but is it not true that except for the budget committee, this is the only committee in congress that has dealt with the senate bill, and the reconciliation bill, all those thousands of hours of hearings were on the house bill. >> actually there were thousands appearing on the house bill as you pointed out, which was our main objective. the only-- after we have passed it out of the house and we are ready to complete the process.

>> with the gentlelady yield for one second? i would just remind dr. fox that we could have a conference committee if the republicans in the senate would not have threatened to filibuster the conferees. >> i would like to come back and say i have noted, i started writing down every time that somebody on your side said we can't do something. therefore, and blamed it on the republicans. i found it kind of intriguing but just a clarification that on terms of how many hours are being spent on this particular legislation in hearings, that is what i wanted to clarify. thank you. >> of course and let me clarify to you that it is a republican problem that we don't have conferences. i don't think there is any question about that. the first person i saw here was mr. you are. i believe you were first. let's start with you mr. lear.

thank you. >> thank you. is this on? thank you very much. what i'm about to cover deals with the issues on veterans, veterans health. and so we are moving fast, so i wants to completely be open on what i perceive that is happening at the moment. so, when mr. skelton had a chance and staff to examine the senate bill that came over, the reason we had just voted on the suspension is because when the senate drafters sought to cover tricare, i really believe they sought to cover tricare, they said tricare for life would be a minimum essential, the minimum essential health program. and excluded was tricare, and that is an error.

so mr. skelton then sought to do that, but what was also not in the senate bill and what you voted on in the house version of the bill, we also sought to fence off and give authorities to the secretary of dod and va to make sure that they run their health program, so so in other words the health commissioner or someone else can't come in, migrate into their authorities and you voted on that. that is not in the senate version. i also immediately went to mr. skelton after he dropped the bill and learned it was on suspension, that i immediately have dropped the bill to grant those authorities and also there is an error with regard to veterans programs. in the senate bill, it says that veterans health programs under chapter 17 would be considered minimal essential health programs that but we have other programs. the other programs are in

title xvii at the end that are not, therefore that were not covered so i seek to correct that, and the other programs would be for persons other than veterans. these are the survivors and the orphans. and i don't believe you meant to exclude them, and so this amendment seeks to correct that. and so, the secretary has authorized to provide medical care for these distinct groups, a spouse or children of a veteran who is alive but totally disabled are eligible for health care. you have got surviving spouse or child of a service member who died with a service connected disability. they would be covered. and then you have the surviving spouse and child of a person who died on active duty military naval or air service in the line of duty. they would be covered but they are excluded in the senate version you are about to vote on.

i think that is is the real error in drafting so that is why i am seeking to help. now, there is also-- these are programs covered under what we call champ va, so this amendment would cover that. there is also no grams under chapter 18, which is not mentioned at all, and the chapter 18 would be the spina bifida, the spina bifida program sale of the korean and vietnam veterans of whom children with spina bifida because of agent orange we created a program and that is not mentioned at all in the senate bill. what my amendment is attempting to do here is to ensure that the bill in which you have voted on in the house senses of the authority and jurisdiction of the secretary of the department of defense and out of the va that they have the authority over their programs and that we

make sure that we covered the widows and the orphans and the spina bifida program, and that is what i have done. now, on the floor, what occurred on the floor when i brought this to the attention of chairman levin, i try to see if we could either amended at the time or if he would withdraw mr. skelton's bill and we fix it and do it all at once. he preferred to progress in regular order. i've been conferred with chairman levin and he agreed that let's go ahead and have mr. boehner meet with mr. hoyer and the speaker and let the policy staff do their due diligence and maybe we can then bring this also up on suspension. so i guess what i'm asking here is we have an amendment i think to correct into right. dates-- we have got two tracks going at once and that is why

wanted to bring it to your attention. >> i appreciate that you have mr. buyer but the response we have already in anticipation if you of your amendment the experts informed us that veterans are taking care of in the bill, that in the care responsibility, those covered by va health care or tricare for life meet the individual responsibility requirement and therefore exempts veterans and service members and their dependents from any penalty. when preserving tricare in tricare for life benefits, no provision in the proposed legislation that would lead to increases in co-pays, and changes in à law elegy-- eligibility requirements are in any way bona fide a tricare is administered. the department defense would maintain the sole authority to operate tricare. presuming preserving the va health care, veterans eligible for va health care would remain

eligible under health reform. nothing in the proposed legislation will affect the veterans access to care they are currently receiving. legislation made clear that the department of veterans affairs will retain full authority over the va health care system. i hope that cleared it up for you. i appreciate you bringing the amendment and we certainly appreciate its. >> maam, the fact that you have made that statement is excellent legislative history but it is not in the legislative language. that would be my point so i'm glad you have set it on the record. it is great legislative history but it is not direct that language. with regard to tricare for life, you are correct in what we just voted on, mr. skelton was trying to protect tricare itself four please understand that, in the senate language when it sought to exclude, actually excuse me, sought to take care of veterans

benefits under chapter 17 they have left off the other persons of whom are eligible who were not veterans. those are the spouses and the children and it doesn't even mention chapter 18 which is the spina bifida, so i don't know who provided that counsel to you but i would disagree with that. i am hoping that we would take care of this. ..

we appreciate your doing it. i think that you were here next. >> no ma'am -- [inaudible conversations] >> thank you, steve. good point. >> i was going to go ahead as we usually do in here from -- >> the judge was going to be a nice guy end let me go. >> why don't think we are going to let you go. we've only been here -- >> alright i love you. i will stick around.

i feel loved. >> now we will hear from mr. shimkus. >> i wasn't next in order. i'm drinking on the health subcommittee but dr. green greek so i want to be respectful of them. >> mr. terrie, you are the one. we try to be fair. >> it's nice to be early. [laughter] >> yeah. >> madame chairwoman i appreciate the opportunity to be here to read i have several amendments, for amendments at the desk and i will discuss them with other six dingley. first and foremost, is the number 21 and this is an alternative that i frankly have support from some democrats in fact anthony wiener gave a floor speech on time on the concept of providing the same health care that we have to all americans

and so this is doing exactly what that says and providing that alternative to the american public to get into the exact same system we have in fact managed or at least has to be the same rules of our system so it allows individuals and small groups and small businesses to get into this pool creating millions of people, ten, 15 million people when private sector comes in and competes and bids against themselves to try is a good system. mr. wiener, the cadillac plan were gold-plated plan and so i just want to make sure that people have access to the gold-plated plan is a good one. they should have it, too. so that's one amendment that's available for this committee,

the rules committee to adopt and let us have it both on that amendment. the others deal in more lynch areas. i'm concerned about some of our not-for-profit hospitals in omaha the deal a lot with indigent emergency situations, children's hospital that deals with dramatic childhood disease from cancer to trauma, heart and they rely on the disproportionate share and that's being cut by 39 million in our hospitals are very concerned specially those with, trauma that these cuts will be sick of the kid to them and they will have to find ways to deal with it by cutting services or trying to shift the cost even more to the private pay.

then there's another amendment that i have filed where it is medicare taxes, the 3.8% medicare tax on investment and income that should be deposited in trust only for the hospital trust fund what i fear is what's happened with social security in general over the last 40 plus years is that excess social security has been swept into general revenues and spent medicare dollars should stay with medicare period and that is one thing would be universally supported, bipartisan lee supported. next is another area of concern for skilled nursing facilities and hospitals and home health care. those are on the chopping blocks to be cut, skilled nursing facilities, home health care and

what even though i represent an urban area as i say in part of nebraska that has marcy -- more cemented in dirt but out of omaha a of linking these small nursing facilities and critical care hospitals and home health care services really live on the edge right now and so if we cut them as proposed the issue is in the health care and skilled nursing have said they are likely to have to force closing the doors and especially home health care so this takes those cuts and says we are not going to make those cuts that we will protect those skilled nursing facilities, but health care and critical care hospitals so they will not have to choose to close their doors. that covers the entirety of my

amendments. >> thank you. since the chairwoman left me in charge to burba, i'm going to need per audit to see if anyone has any questions of you. we appreciate you coming before us. thank you. >> dr. gingrey was next. are we on? >> wiltz german mcgovern and be as alert both majority and minority party, thank you for giving me the opportunity to visit with you. i have four amendments i will try to be brief as i know you're getting weary kicked. most of these were presented to the commerce committee which i am a member when we first marked up h.r. 3200. i'm going to try once again and hope springs eternal. i will be glad to the brief presentation to answer questions

the members may have on any one of the four. the first amendment pingree 06 would simply require any savings that are gleamed from the medicare program and we all know that in this bill but we are going to be voting on tomorrow something like $500 billion worth of cuts. i keep hearing over and over again the emphasis on much we are going to cut waste, fraud and abuse again hope springs eternal but i don't think we're going to get 500 billion out of waste fraud and abuse in fact the bulk of the cut some $120 billion is as you all know from the vatican advantage program i think that equates to about an 18% cut per year from the program about 25% of our seniors choose in favor because they get wellness and preventive care and screening and i care and hearing aids and things not

covered under medicare fee-for-service so you essentials the in this bill gut the program by the year 2014. so the first amendment gingrey 06 basically says look any savings out of the medicare program should go back into the program. we are talking about a program that's not a wash in fact it has an unfunded liability is all of you know $35 trillion over the next 50 years is just as dustin genius to program so that's my first amendment. the second amendment, gingrey 04 has to do it medical liability reform. the president has said many times indeed in his speech to the annual meeting of the american medical association back in chicago year ago a year-and-a-half ago he promised that there would be significant and meaningful liability reform and i am paraphrasing of course but the president said this was

very important that we address this issue. he repeated that in the state of the union address. cbo calculated a $54 billion savings over ten years. quite honestly members think that is the most conservative estimate. the rand corporation and others say as much as $100 billion on an annual basis. i have submitted this is my eighth year, fourth term, at least two of the previous congress when the republicans were in the majority we've republicans i had the honor to offer the bill, the health act think it was 1086 and this year i resubmitted h.r. 4072 seóul gingrey number four is once again the health act which calls for significant and meaningful liability reform not just $50 million we are talking of $50 million in a 1 trillion that we are creating it is a drop in

the bucket what we need and what the state of florida and state of georgia my own state, state of texas, mr. burgess want to speak to that as well. what works is caps, a reasonable cap on pain and suffering and to have collateral source disclosure in ending the idiocy, the nonsense of joining several liabilities when every person, every physician that is named in a medical liability suit no matter whether they even just walked by the patient's room and said hello i'm covering dr. jones he will be here to see you later this evening. the deepest pocket is paid. we need to eliminate that and have only several liabilities. so amendment number four is my second amendment regarding liability reform put a thing would cut all of this defensive practice of medicine that

members you must know and i want to quickly before a good amendment number three mr. chairman musette and chairwoman slaughter said a few minutes ago that this bill would have no need for reconciliation if it wasn't for the mean republican minority threatening to filibuster there for you have to do this thing called the american people don't understand reconciliation quite honestly this bill that i just described my tort reform bill passed the house on three different occasions and when it got to the samet of course it would stop by those mean old democrats and minority would threaten a filibuster so it kind of worked both ways and i am regretful now that my colleagues on the republicans i didn't use reconciliation in those days. but they chose not to. amendment number three. let me take just a quick sip of

water. you know this amendment pingree seven basically says that no czar health administration czar should have the ability to come between a doctor and his or her patient the final decision on health care is sacrosanct and should remain that way and that's basically what this amendment says and i call your attention to the recommendation that the u.s. preventive services task force made earlier this year regarding a screening mammogram for breast cancer. and their recommendation was it wasn't cost-effective to do that in the decade of the 40's, the time when women are at most risk and we all know and agree that early detection is a way to save lives and cancer and that is why

in fact in the health system in the united states the survival rate for cancer, breast cancer and particularly for prostate cancer is so much higher because we don't prevent the screaming like they do in some of these countries that have a national single payer health care system like was described earlier and i heard comments speaking for the majority of the rules committee that she was very clear in her feeling about that so gingrey 07 says looks like the doctors and the patient decide. as it tries to read from the czarist, administrators, what everyone to agree it is fine but the final decision made by the physician and their patients. gingrey 02. the issue of requiring people in this bill in this legislation if it becomes law that on the penalty of the law that if a

body would be required to have health insurance whether they needed or not in their own opinion whether they could afford or not in their own opinion and in many instances i have great fear we are not only talking about the requirement but a prescription in regard to the type of coverage. first dollar coverage we ought to be encouraging people of course to have health insurance but making it more convenient to them to choose if they would like health savings accounts were they combine that with a health insurance plan that has a high deductible, mr. chairman of a very low affordable monthly premium. a lot of people that are on that road from insured maybe it is 20 million, 25 million people that don't qualify for the safety net programs but if you discourage them for having these catastrophic coverage plans that don't cost them an arm and leg

for the first dollar coverage many of them being that student loans paying for a car, to stock of college or high school, so this basically would say this amendment gingrey number two that we will not require that we will encourage but that anyone that wants to can opt out of this mandate for health insurance. obviously it is something the president worked out with ahip, the american health insurance plan and year-and-a-half ago at the white house but this is not good for the american people. those are my amendment and i appreciate your indulgence and patience. i would be happy to answer any question mr. chairman. >> one question. if you believe it is okay for somebody who could afford insurance not to get insurance and then when they get sick who pays for it? >> well, mr. chairman quite honestly the way that this bill reads to me is people can get

fined if they don't have insurance and i think a lot of people are going to make a decision that is easier cheaper to pay the fine and keep paying the fine every year -- >> in theory one of the points i was making earlier was that in massachusetts we have a mandate you have to have insurance. the problem is we are all paying for our insurance but we are also paying for the people in georgia or texas or oklahoma or wherever who choose not to get for no reason. there are lots of people quite frankly younger people in particular who go for a job i'm told to get a job with health insurance, without health insurance, fuel great, i'm going to live forever, they don't buy the insurance when they get sick or if something happens to them they don't get treated and they get the care they need it goes into the uncompensated care pool

which gets put on the debt. every family please a debt of almost $11 million because their premiums go to cover the cost of providing uncompensated care for the uninsured. in theory everyone has to have car insurance. don't you think -- >> mr. chairman if you will yield back to me i appreciate the question but i don't think it is intriguing analogy quite with everyone having car insurance. everybody does not have to have car insurance indeed they can choose not to drive. there are people including my son and daughter-in-law who live in manhattan and have been there six years and they've never had a car so they are not required to have car insurance. there is no opt out. would they opt out by not having a car. let's the let the american people opt out by saying i choose not to have coverage. >> are there any questions of mr. gingrey? mr. sessions? >> dr. gingrey, the common question comes up about how all

of these evil insurance companies are dividing people in and taking a whole lot of decisions on behalf of people raising rates doing these things but the government is only paying 30% of the cost. who is right and who is wrong because it seems like to me they are both wrong that they both ought to pay their own when a and the government is placing incredible amount of pressure on private pay which causes them to have to increase the amount of premiums because the government doesn't pay what they should be doing. do you see anything in here where the government is going to start paying when they are even opting out of the $500 billion they are supposed to pay

doctors. i'm a little concerned about we beat up somebody but aren't even responsible, il's response will ourselves with what we are supposed to do. can you talk about that? >> i will be glad to. thank you for giving me the opportunity. i was watching the president as he gave his final defeat kaput talk -- pep talk. beating the health industry it's interesting he continues to do that because as you point out the government already controlling 60 person of the $2.5 trillion annually spent on health care indeed some 17 per cent of gdp and reimbursing our providers on the medicaid program it is maybe 60 cents on the dollar and the medicare program it is not much higher than 70 cents on the dollar and of course it leaves about 35% that's covered by the private

market, private health insurance provider some 3000 of them across the country. this for the cost gets shifted by the provider providing the service and that's why probably part of the explanation why add into blue cross of california announced a 35, 40% rate increase. it's important of course democratic majority of the president stressed that's just a perfect sybil why we have to do something about it but he didn't say that of course that increase was in at the individual, the individual market and small employer market. it was not for large companies but coca-cola and delta of the world, lockheed, it was the small individual market and of course mr. sessions, we have submitted the republican minority we talked about it when we went to the blair house for the six and a half hour session with the president democratic majority of build alternative ways of dealing with this and

allowing people to purchase individuals and small businesses to pull together and formed associations with health plans, individuals to not go across the state lines but to get on and purchase across state lines on individual base is a policy that the need that fits the needs of them or their family but not something that is prescribed that this is a policy that you have to have and we the federal bureaucrats can decide which mandates are important and which ones you will pay for that you don't want and you don't need. >> thank you bea dividing quinby the white house six and half hour summit. thank you. i appreciate you being here. mr. more i think was next. -- before, mr. sherman. i want to thank this distinguished panel. i'm sorry -- >> again i want to think this distinguished panel for

reseeding and hitting me this evening. i am pleased to be here on this occasion on the eve of passing comprehensive health insurance reform that would expand health insurance coverage to 30 million people. it's really exciting to be counted among the members of 111th congress that will go down in history in terms of creating access to health insurance for americans. i would ask, mr. chairman that you placed on full and complete testimony in the record. >> without objection. >> thank you. and i will just sort of emphasize a few points. i have two amendments at the desk. i think one is designated as an amendment, moore amendment number one and the other is moore mendicant number two. my amendments both of them would do the same thing in part eight of the amendment that it was

literally shift the effective date of the medical loss ratio requirements to synchronize with the opening of the exchange's. now mr. chairman for the record i want to be clear that laid understand the purpose of the medical loss ratio requirements given the cow watching of consumers that we have seen even as recently as about ten days ago when we did as dr. pingree noted that there was a 39% increase suddenly with no explanation and insurance premiums. the $24 billion compensation package that we have seen given to the insurance company executives and this is why i support other initiatives in this bill put forward by many of my colleagues to have a health

insurance review process and to actually give the secretary of 40 to disallow insurance companies to participate in the exchange for the to have these are egregious insurance premium hikes and prices and i certainly welcome the competition that the exchange's promise so that we can literally root out these bad actors. what brings me here to the rules committee today? what brings me here is all i want to prevent some unintended consequences by the other wise sage policy. there is a company in my town for example that deals with exquisitely the individual and small group business industry.

and they fear that there may be an immediate loss of several hundred employees and ultimately they would be forced to shut their doors if in fact the medical loss ratio or to be in place three years before the exchanges were up and running. they say that they could work very well and in the individual and small business model with exchange's running but prior to the exchanges' open the but not only incur the very costly sales force, the intense a sales force payment of independent agents that cost about 7% of the medical loss ratio but at the same time, they would be entering a liability each year for that 7% medical loss ratio but would not be provided to the benefits so they say they operate flexible at 870.2%

medical loss ratio now and with the 80% medical loss ratio the 7% of the b with the kind of business model that's required to market individual in small business that they would find themselves in a situation on a monthly basis even with a 3% profit were they to get word defeat to where they would be liable for about $9 million for every month that they were to operate before the exchange's open and so the second part of both of my amendments, amendment 1 to comply with the byrd rule provides that the rebates that are collected, i try to narrow it so that would just take care of the problems with the small independents but

i couldn't do it without violating the byrd rule, so the way that i try to treat this was to say that all of the rebates that were to go to the enrollees that go to the treasury, and this is based on a very rough estimate we try to get the estimate back but a rough estimate indicates this would reduce the deficit for about as much as $4 billion having a budgetary impact. more amendment number two would again sent the rebates to the treasury board would have been earmarked for affordable the credits. again i do appreciate the hard work all of the committees of jurisdiction have done in this distinguished panel. i look for tomorrow to voting for the beginning. it's not a perfect bill and i am not asking you to perfected by masking that my one or the other

of my amendments to be made in order because i am trying to protect jobs particularly in my district these jobs in my district 65% of them are women they are not fat cat insurance ceos who make $24 million a year and with that i would yield back and ask if there are any questions. >> thank you. does anybody have questions of ms. moore? thank you very much. you may go. we appreciate you being here. saxby for three >> mr. shimkus. islamic it's great to be with you, an old freshman next-door neighbor, we've come a long way haven't we? >> i agree with ms. moore three we are going to go down in history tomorrow but i'm not sure in the manner that she is hopeful. i've got four amendments the i want to address and i will do those briefly. one is with the chairman's

deliberation which i found interesting and there is a philosophical difference about markets and government intervention so the first amendment, just provides an opportunity for people not to be trapped in a decade but would allow them through the premium assistance into the individual market because it would also keep to the president's promise supposedly if you like the insurance you have, if they like medicaid they can stay in their but really a competitive market with that stated exchange you would want them to have access to that so we believe in markets. that is what the first amendment would do. the second amendment just talks about the safety net. the promises that have been made as insurance will not go up, insurance costs will not go up. the first five picks of ms. moore served on commerce. we went through the big brutal

markups and we believe insurance rates will go up to ensure that doesn't happen and we have this amendment in the safety net would say if the individual policies club that a dismal and void and we will go back to the process where people will not have to pay more insurance because of the government policy. the last two deal with the federalist system a form of government and i think what we see and we saw today and again ideological debate on still believe we have a federal system and the tenth amendment. i still believe states have rights identified by the constitution that the citadel has rights under the constitution and it's not listed in the constitution it's the right of the state's so all that of the people protesters saying where is this ebal to the debate?

states are moving on individual pieces of legislation so the third amendment would be addressing and highly individual mandate portions of the bill and insuring if states decide on their own to opt out from that the they will be about to do so. what i find curious in this health care debate is states have a huge part in this debate and we have just disregarded them. the of the state insurance commissioners from state like illinois we don't have mandates on the cost, we don't price of insurance. we allow the market to do that although the state insurance commissioner is highly involved no stevan put in that aspect about this and really no state in put in the aspect of this incredible medicaid expansion so the fourth amendment deals with medicaid expansion and ability for states to opt out if they

feel because of the expansion of medicaid it's going to break the bank and free states like illinois we are a very generous state as far as the criteria for medicaid but this bill still expends more people in medicaid which will add $2 billion additional cost the state of illinois the and as i sit on the floor last night, we are already $11.5 billion in debt. we are as in trouble as california with the state indebtedness and now the federal government is placing additional mandate, the federal government is placing an mandate on the states that the states are making decisions of whether they want to accept that or not and i -- the fourth amendment will save the states decide to the legislative branch signed by the chief executive to opt out of this expansion they should.

i appreciate that and i am willing to take any questions and yelled back my time. >> thank you for your testimony. dr. foxx. >> but would like to ask mr. shimkus if he would about the issue of people being able to keep their insurance and about the price going up. i don't think we adequately dealt with this with the panel that we had but i have several pieces of information from cbo on counting the fact that the president has said if you like what you have you can keep its and i wonder if he might expand on that a little bit in terms of what you are aware of in that regard because i have some

numbers and at least 5 million seniors will no longer be able to keep medicare advantage a lot of people in my district are going to be hit with that. hsa and high deductible plans. i wonder if you could expand on that. >> i appreciate that. that's why we will make history tomorrow because every individual policy will change. the president is incorrect if you have a policy will keep it because they will all fundamentally change. they have to change. we are imposing new rules and regulations and participants and they will all adjust to the market so it's just not correct to say you're going to keep the same policy that you have. they will all change. >> thank you mr. chairman pete i have a piece i would like to put in the record that would back up what mr. shimkus is saying.

>> any other questions mr. shimkus? thank you. you may go. >> thank you mr. chairman. ms. blackburn, i'm sorry. thank you to all of you. >> we appreciate your patience and appreciate the opportunity to be here and present our amendments. i have six amendments and then one that i will make on behalf of congressman shadegg and oipt is not quite make it to the committee but blackburn amendment number one which you all have deals with section 1006. this deals with protecting and maintaining the current health care coverage. we were just having a discussion about if you like what you have you can keep it and the importance of that, and mr. chairman my amendments come because of the experience we have had in tennessee which was the test case for public auction

health care and it went on to place in 1994 and indeed the recurrent governor who is a member of your party said and the health care when that is before us now that action will be taken on to marlo it will be the mother of all unfunded mandates and has the potential for bankrupting the state's. having been in the state senate in tennessee and as we looked at the historical data and fault with the public auction experiment there there are lessons learned. they should be put on the table and i was before this committee back in june as we debated h.r. 3200 with the same amendments. we discuss these amendments and the energy and commerce committee and it's important we do consider them. amendment number one which is section 1006 deals specifically with protecting your current

coverage. .8 the hhs secretary must certify that no american will lose access to his or her current health care insurance due to the establishment and operation of health plans offered through a state exchange. this will be an annual certification to make certain that the president's goal of keeping what you have is achieved. until certification is made no state is required or penalized for the failure to establish plans and in exchange. amendment number two would be title three, section 3001. it prevents increased cost of private health insurance. we brought this one for word because of the concern. they're again from our experience of the accelerated rate of increase in private health insurance plans it prohibits the exchange plans from being established until the

hhs secretary certifies that the establishment of the exchange plans will not either directly or indirectly cause the cost of the average price of private health insurance premiums to increase. this is because, there again, lessons that we learned with the process of implementation in our state. item number three, amendment number three is that it deals with rationing. it is a section to roel construction regarding provision of authority to ration health care. would prevent rationing through the federal government is precluded from passing any law that would give authority to ration health care for the american people. this we discussed in the kennedy and we think it's important because of what we saw happening with limited access or

restricted access to certain specialties and needs for health care in our state. amendment number four prohibits excess spending. this is when the cost of the reforms made under the bill comes within 20% of the federal budget than the bill is repealed repealed and returned to the system that was in place before the bill was enacted. the reason for doing this is in placing this amendment before the body mr. chairman is because in our state of tennessee as the plan was put in place it was to never be more than ten to 15% of the state budget within a decade had quadrupled in its cost but by the time the plan had been in place for five years it consumed more than 25% of the state budget and then eventually after

it was at 35.4% of the state budget, the governor decided that it was time absolutely had to be restructured and reformed in the weaver had to be revisited. amendment number five maintains the right to keep and fund hsa and dp. these have been particularly popular with the american people. nothing shall preclude an individual from purchasing or maintaining insurance qualify you for health savings accounts deposits and nothing shall interfere with their ability to continue to make deposits according to the schedule created in the 2006 health savings account legislation. then number six prohibits unfunded mandates to the states. this is because of the concern of our governors that this will be a plan that is going to be tremendously costly to them to implement if the bill imposes an

unfunded mandate on the states then the bill is small and avoided if the states are not required to comply. part be the legislation would mandate an unprecedented expansion of the welfare program medicaid ballooning the size of the program to well over 90 million americans by 2029 and our concern there is with expanded medicaid what has happened with. it's tennessee, massachusetts or million when it you are taking on a lot of near-term expenses and gambling against future savings of the savings never, which they did not in tennessee and they haven't in massachusetts then you've run into a lot of problems with how you are going to fund that. so this would give our states some protection. amendment number seven with congressman shadegg is the interstate purchase of health insurance in this amendment it would allow that activity to take place between states.

the amendment is john and i think most members of this body are familiar with how the congressman has approached this through the years. it allows the states and the state regulatory agencies to take the lead and make certain that the selling of policies in the secondary state meet the insurance regulators rules and regulations for application within the state. it also has in him this bill the ability for addressing grievances and recruitment and with that i yield back. >> thank you for your patience and forceful testimony we have great respect for mr. shadegg as well and are there any questions? we appreciate it and you being here and you may go. [laughter] >> thank you. >> or you can stay if you want. [laughter]

i would like to ask unanimous consent the testimony of, sheila jackson lee be put in place in the record. on three amendments. thank you. mr. burgess, thank you mr. chairman. i have three amendments of my own and for i would offer on behalf of mr. barton. first is burgess cero to. this is an amendment would require medicaid payment to be 75% of the state plan for the federal employee health benefit plan. for four to many of our citizens who rely on medicaid medicate turns out to be nothing more than an empty promise made by the federal government to cover our poorest citizens. those with medicate themselves are unable to access services because medicaid pays less for comparable services than private insurance, insurers or medicare.

they soon realized what many of us have been saying for a long time, coverage does not equal access. medicaid payment shortfalls providers to cost shift or reduced charity care at best for the worst providers to reduce to accept medicaid patients or limit the number they treat. we should reform health care in this nation of the first step of very first step would be to fix what we have already known to be broken and that is our sole responsibility which is the medicaid system. we heard testimony a little earlier i think the comment was made there was the cost on a family of $1,100, the health insurance to cover the uninsured. that is actually not correct of the 9% surcharge that all of us pay for the cross subsidization of the system about 2% is for the uninsured. the remainder is because we don't cover the cost of

delivering care in medicare and medicaid and schip, so it is in fact the tax we are putting on everyone who has private health insurance in this country and we really ought to correct that. we do control at least 50% if not more of every health care dollar that is spent in this country and right now people are not getting value for those dollars that are spent. time and time providers cite lower reimbursement of paperwork concerns as the two most important reasons for limiting participation in medicare and schip. while doing business with the government they are always been to have the paperwork concerns. i don't know how we fix that but we can fix the very big issue of low reimbursement. research has shown medicaid enrollees face significant challenges of finding a health care provider that will accept their medicaid coverage and let me just give you a with real world of civil of that. i practiced ob/gyn 25 years back home. we took medicaid patients in our practice but not everyone in

town took medicaid patients. if i had a medicaid patient who had problems beyond her pregnancy that quite frankly i did not have the expertise or the talent to treat it was the occult to find a specialist would then come in on that case and i can remember some very serious cases i had in the hospital where literally i was begging people to come by and help. it shouldn't be that way. it shouldn't be that way for our patients, it shouldn't be that way for the primary care doctors who do agree to see the medicaid patients even though the reimbursements are low. we shouldn't require that they have to resort to that in order to get good care for their patience. a 2006 report by the center for the system change found nearly half of all doctors polled said they had stopped accepting or limiting the number of new medicaid patients that they saw. in contrast over 95% of the doctors polled in the same survey said that they were accepting patients who were covered through private health insurance plans.

the associates contender for a tenure period medicaid payment rates have increased 13% while the cost of delivering the care increased 33%. my amendment is fairly simple payment for all services under medicaid must be paid 75% of the rate of the state employees' plan or federal employees health benefit plan most often chosen by families. in the case of vision and dental 75% of the state and we supplemental plan or the fe hbp supplemental that is most often chosen by families. nearly one-third of pediatricians reported that they would accept more medicaid patients and practices if reimbursement rates for modernized. the michigan state medical society fund medicaid pays less than half of all private insurance pays for the exact surface. in fact michigan medicaid pays $29.93 for a typical office visit while traditional blue cross plan $67.95 and as a

result of the substandard payment rates, the number of michigan doctors willing to accept medicaid patients to straub from 80% to 99 to 64% in 2005. instead of typing greeks to medicare, and we all know medicare his reimburse the issues of its own, let's try linking to the private rates if we ask our doctors which way they would prefer i don't either is any question with the would rather have. 75 present of marketing for 100% of medicare easy choice any day. at the end of the day this amendment asks one simple question are your needy constituents those congress identified as most in need of a health care safety net worth 75 cents on the dollar of what we spend on federal employees? second amendment burgesses 03 staying on the subject of medicaid, and i guess i would also say that it was made that this vote tomorrow will make this congress go down in history and if we don't go down in

history we may go down in november. we will see how it turns out. what how about this, medicaid with expanded medicaid in the senate bill that we are going to be passing and we all need fundamental medicaid reform and the bill doesn't do that. the bill doesn't accomplish the goal of reform and medicaid but what if members of congress were to get off the sidelines and walk the talk of health care if all 500 could be five members actually knew what it was like to be in medicaid patient perhaps we to be more creative and successful in making meaningful reform to the country's health care system the would be a step forward for america if we actually knew how many americans see the nation's health care system? the amendment would allow members of congress to sign up for medicaid just like any other low-income constituent and see what a medicaid patient subject to. members of congress would not be

mandatory population in the statute and all acid tests would be waived. you have a republican offering to create a new entitlement program for the members of congress. this is history being made in your committee. the federal government would assume 100% of the cost of coverage members' families would still qualify for the federal employee health benefit plan. a vote against this amendment is a vote against our needy citizens after all again if we walk the talk, if we walk a mile in their shoes and medicaid perhaps we would understand some of the difficulty that i was trying to get to in the earlier amendment on equalizing medicaid rates. finally, burgesses 01. this is an amendment for an internal and external review. very consistent with the language in the patient bill of rights from 1999. now, although we are often accused of it, there is no reasonable to assume that i have

any affinity for insurance companies in fact after 25 years of private practice, i think at some of the actions we have seen a fleet of insurance companies the have earned the disrepair that has affected their reputation. back in the 1990's when i was in the trenches of hmo every set of the way with their unreasonable tactics to do i care to read this amendment before us will ensure that all qualified health and to its plans have a reasonable and accessible utilization review and appeals process so we do not allow insurance companies to buy the needed care and stepping between patient and their doctor. this amendment was accepted unanimously in the commerce committee in july of this year but impose strict out when we moved from 3200 to 3962. i don't know what happened to it in the speaker's office perhaps it was just an oversight and by giving the rules committee an opportunity to correct that this afternoon. the language of this amendment is straight from the bipartisan

consensus on managed care in proof of 1999 and in fact mr. dingell co-sponsored my amendment in committee it against this language you have actually there are members of this committee here in 1999 who voted in favor of this amendment mr. diaz power, mr. pacings, mr. mcgovern, pete sessions luis slaughter. ms. matsui vote in favor in the committee. this language passed the house by a vote of 275 to 151 and six on this committee voted in favor. we owe to the american people to include protection against unwarranted denial of treatment reviewed by medical professionals and not paper pushers have never set foot in an examination room or treatment room. and the amendments offered from mr. martin. march 15th david axelrod state of the president doesn't believe state only notes or the president does not believe the

state only votes should not be in the bill the president said special deals should come out so please allow mr. barton's amendments to be made in order they will help the president keep his word and save taxpayers billions. the first louisiana purchase, the amount is to remove the provision commonly referred to as the louisiana purchase which provides an extra $300 million to louisianans medicaid program. the second is speed 07. it would remove the provision referred to as the you, amendment that provides funds for a medical facility in connecticut. eccr 06 to remove a provision that allows hospitals in michigan and connecticut to benefit from a special wage index classification if it means higher medicare payments in other words hospitals and those states would be able to shift into a higher wage indexing area giving them more medicare dollars than other hospitals and other areas in the area a bit of their employees.

if you don't want to stick to pay for hospitals and michigan and connecticut to get the special material usage support my amendment. and speed 05 negative the frontier force i have amendment to remove the provision for increased medicare payments to hospitals and doctors in front here states. those last four amendments were introduced by mr. barton and i offer them on his behalf. and i would be happy to answer any questions. >> mr. burgess? thank you very much for being here. mr. sculley scum you our next. >> thank you mr. chairman and members of the committee i appreciate. i have an amendment that repeals the individual mandate in the bill that requires american people to buy government approved health care. i don't know of any case in the country's history where we have required people to buy goods and services commission of a lawful president of the country and i would also share the same

concern with millions of americans and legal scholars that there is no place in the united states constitution that gives us the congress the authority to mandate that american citizens have to purchase government approved health care in fact i have a legal document here that i would like submitted to the record and put on bye heritage foundation that goes through a number of cases including going back to 1937 that limit the power of conagra's especially under article section 1 the commerce clause a lot of people use as the reason behind this mandate and they lay out the limitations congress has in terms of commerce calls. in addition this will also repeal the tax would go along with the individual mandate. the tax estimated to bring over $17 billion the would be thrown onto the backs of american people who didn't have government approved health care which also brings up another interesting point, it would eliminate the need for the what cbo estimated to be

10 billion-dollar requirement that the irs go out and hired over 16,000 new auditors to go and implement and carry out this new tax. i don't think there are any americans out there that would consider a jobs bill to be one where congress creates another 16,000 agents to go out and punish people for not abiding the government approved health care. so, the bill is very straightforward. in terms of what it does it gets rid of the individual mandate that is in the bill and that clearly would be challenged on constitutional grounds if in fact this bill were to pass which i hope it doesn't so that is the amendment and i would be happy to take any questions. >> think you for your patience and thoughtfulness. any questions for mr. sculley squawks mr. sessions. >> mr. scalise, we haven't gotten to this very much. i recall when we debated and argued about this months ago it

is a criminal -- if you do not pay what you're supposed to it is against the law. the kid would do criminally liable. is that correct? >> that is correct and that is why if you look at the title of the bill that we to be open for a vote possibly tomorrow it puts the irs in charge of this. this was supposed to be a health care bill and i don't know of any irs agents who went to medical school but the irs would be in charge and estimates are over 16,000 new agents would be hired to implement this provision and this new 17 billion-dollar tax on american people. >> we are going to go through what was an option to now federal, colonel complaint that could be filed against? that is a sad day, sir. >> i would agreeit