take the house of representatives to reinstate him. >> we will do that. >> i want to be on the record. we feel very suspicious -- not suspicious, that's a bad word. we feel anxious that what we are about to under take. this is the day that we read the constitution. i do want to be in risk of doing anything that we would violate it. :

>> i know mr. andrews has been sitting in that place -- >> he's had no food since breakfast. >> oh, no food since? he's had a sandwich. i promised him he would be heard. we went through the regular order of the house. your concern, mrs. slaughter is absolutely right in that the full house will address this issue, and we will include it in the rule considering on the floor tomorrow, but we are -- we have all these witnesses members that are here, so we are going to proceed, and i suppose what i should do is go through

the list now because we have a lot of witnesses, and we keep updating this with the members here. >> make it clear, we are the minority, and you are the chair. you can make that decision, and we respect that. we want it known we are not clear on the constitutionality of what we are doing. >> apparently this was within jefferson's manual. >> i don't know approximateties, but you -- >> the standard of collegiality states in jefferson's manual that the member must be within proximity of the speaker, and that is the reason why mr. sessions took the oath of office this afternoon and the only concern is the votes taken yesterday, and we'll address that in the rule. >> let me make another concern i have. it was announced today that peter took the os this morning,

and it was stated from the chair that that gave us the full complement of 435. obviously, it didn't. >> right. >> but i think to any reasonable person that raises the question is are we sure we're through here? we would like -- >> let me just say, mrs. slaughter. it is true peter took the oath of office this afternoon. >> he did, but that's before the recess. >> he took the oath of office today. >> that compliments the 345 members of the house. it did not because we have two more now. >> let me just say, e appreciate -- i appreciate that. if there are other members, democrat or republican, who were recorded as having taken the oath of office and in fact did not take the oath of office, that issue will be addressed when it comes forward.

i don't know if there are democrats or republicans who did not take the oat of office, but i do believe that we have found this instance of two members who felt that they did take the oath of office, signed the oath, they were, you know, in the building, but they were not on the floor itself which is something i just learned today. i did not know you absolutely had to and that that was in this standard of collegiality which is not in the constitution, but jefferson's manual, and that's why we are proceeding as we are. i assure you that the issue of the announced number will be addressed in this rule making an order of resolution so as you said at the outset very correctly rather than having this committee, the full house will address this issue, and i appreciate that. >> there's a problem with that. i would like the full house to address it before. >> before? >> so that we understand and go on. >> well, there is no reason that

we can't in this committee. nothing that has taken place in this committee has in any way been violated. no standards have been violated. >> we know that. >> i checked with the staff and nothing violated as far as the actions of this committee, and we are planning to rectify this in the rule, and then so it will be addressed. >> i understand that, but we really felt that since it takes full house action to make you a member of this house, that we should not pretend that that's been done and go ahead without that. we're very much concerned that that violates the constitution. >> well, let me just say, you do not want to proceed at this juncture, but let me just say that mr. sessions and mr. fits patrick have both taken the oath of office. they are both seat the members of congress. they took it earlier today on

the house floor. >> but they voted yesterday. >> yes, and this rule -- >> they voted on the floor of the house. >> this rule is going to address the issue which will will officiate. >> i'm saying -- >> there is nothing preventing us from proceeding with the witnesses here who have waited for a long period of time. i appreciate very much your cooperation and support and understanding. your spirit of cooperation is greatly appreciated, and i'd like to recognize mr. mcgovern. >> i think the only concern about this hearing that we've had is the fact that mr. sessions technically was a nonmember presiding over the proceedings here, and i guess that's to me is the question. is that okay? >> we will -- if that needs to be addressed in this rule, it will be addressed. >> well, the votes on the floor, yes? >> that will be addressed obviously. >> all right. >> all right. >> you know, we really do want

to cooperate here. >> i can tell that. i very much appreciate it. i can't imagine any other support of cooperation here than what you've provided. >> we feel we are on shaky ground simply because i did not understand he had to go before the house of representatives or get this thing ratified by the house, and i think that puts a different light on it. you can go on with the hearing and leave that decision up to you. >> thank you very much, and out of respect -- >> [inaudible] >> i very much appreciate that, and your position is you want to cooperate, and i appreciate this very, very much. >> and do this under the constitution. >> that's what we intend to do. >> in an effort to be cooperative, you're going to need to go through everything that pete participated in. for example. >> yes, thank you for that. >> he was vice chair. >> absolutely. we are going to address every

single one of those issues. no, let me just say after we looked at this, we will closely scrutinize every single action that was taken yesterday and today and we will ensure that all of those are addressed, and i appreciate very much the gentleman -- >> it would be helpful, for example, my antenna goes up, and not only do you have parliamentary problem but there's a possibility of it being a justice problem. you need to be cautious, and that's what mrs. slaughter is saying. >> i want to ask my friends who want to cooperate is if you have any specific recommendations as what should be concluded in the resolution that addresses this, i mean, raising these issues, i appreciate that. we will look through these, and we would like your input on anything coming forward, and now with respect to our witnesses we

should proceed, but thank you all, very, very much and for understanding. we begin now with mr. andrews. let me go through with what we have at this point. i would like to state since we just reconvened. this is the latest version just provided to me because as you know it's unusual. members make a request to the rules committee that they are going to testify and we go by the list by seniority. that's the rule of the house. committees are to recognize as the house floor does, and they are clearly exceptions to that when we have just a few witnesses in the room. right now it's our intention to proceed. i'll just read through the names i have before me. andrews, woolsey, davis, courteney, chu, tonko, nadler,

jackson lee, ted johnson, and ted doich, and mr. van holland, and the list of others, captor, moore, scuts, conley, edwards, chu, and let's see sisilene, and i mentioned chu's name already. i will not save you for last. i know i said your name already. that's the intention. >> oh, my gosh, i didn't see your name. you're going to have to wait again. i just want you to know that. we just want you to know you have been widely anticipated,

and so i look forward to mr. payne, my good friend and traveling companion. >> thank you very much. i have been here the least amount of time so i will be brief. >> take all the time you'd like. >> oh, wow. >> yeah. >> first of all, let me congratulate you on your chairmanship of this committee again. you served with distinction previously and i know that you will continue to serve in that bipartisan way. >> thank you very much for that. >> we, of course, are very concerned about the so-called job killing health care act repeal. i think that it's just the reverse. it's a people living health care

bill, however repealing it is certainly going to make it difficult for people to have a quality of life that they deserve in a developed country, and the question about job killing as a matter of fact if you would look at the job statistics, largest growth to be truthful in jobs happened in the health care industry so you know the name of the legislation kind of baffles me. i will be brief, and i just simply would like to state the repeal of the patients and affordable care act would be a very costly mistake. in addition to the estimated $230 billion the cbo cost estimate of repealing health care, it will cost families a

peace of mind that was afforded by the recent enacted health care legislation costing taxpayers billions of dollars in uncompensated health care to come out of the dark ages as wop of the only three developed countries in the world that provide universal health care. we are slipping in education. we are slipping in people's feeling that the country is providing for them, and we will go back and slip again down to having health care once again being a privilege for the privileged few like us who have it, and i listened to one of our new members from florida who said he's not sure he's going to take the health plan we have because he has the military plan, and he's trying to decide between which one is best. he's very fortunate. he has two choices as we know

many people have none. on a perm note, i have a 23-year-old grandson and you know what i'm going to say about that because he can conclude his schooling and intends to complete it, but right now he's out of school and has a part time job, therefore we were getting ready to sign him up for his own personal health care, however, because the new health care reform is very personal to me, that he will continue to be covered by my daughter's health care plan who is a teacher, and he will be able to remain on her basic health care plan, and so i know that if that's affecting me personally, how many other people around the country are in the same boat? of course, i'm more privileged and it would not be a problem for me to provide the care,

however, how many other people are in that same position, and so many times we go from the particular to the universal, and it should be just the reverse because we can do it, we need to think about those others. however, as a result of the dependent coverage provision in the health care law as i mentioned, he can remain on my daughter's health care, my grandson's story counter the narratives i received from constituents who experienced great relief from the provision of the repeal. they will be very disturbed if this went through. the fact that repeal would take away the peace of mind of millions of seniors that experienced relief from expenses by the donut hole and the idea

of having annual checkups provided under current law. repeal takes away the peace of mind from million of americans who are denied coverage with this repeal and impose deep cost sharing on seniors that try to use medicare and mammograms and smoking programs and cancer screenings. there is a persistent argument that the cost of our enacted health care law is too great, but i contend as i mentioned earlier the cost is greater to continue it allow the country's taxpayers to bear the cost of uncompensated care, and quite frankly, mr. chairman, the cost of having countless fatalities on the hands of this country for deaths due to illnesses that could have been managed or avoided with preventative and

wellness care is too great. the state of arizona had its second death which is directly related to the fact that the state decided not to have health care, so as i conclude, i come before the committee to support the amendments of my colleagues to preserve the access of quality health care, especially the provisions that provide that prevent discrimination again individuals with preexisting conditions, closing the donut hole, providing benefits to our seniors, allow young people to maintain health coverage on their parent's plan until 26, and maintain the health care cost, and other many important provisions in this bill. with that, i yield back the remaining balance of my time. >> thank you, mr. chairman, congratulations on your chairmanship. we thank mrs. slaughter and everybody who puts in many, many

hours in this committee, bizarre hours of the day and night so the rest of us can function. >> [inaudible] >> yeah, well, i know that they will see long hours, so let me thank them in advance for what they will do. there are 15 million americans who are officially on unemployment in this country tonight. i think most americans and most of them would agree we have the wrong bill in front of the house. there is a fierce ideological struggle over health care, and that's what politics in part should be, but the crisis for so many american families is so deep that it should defy normal politics and we should be working together to create jobs for the american people, not sustaining a long standing ideological argument. the majority chosen to initiate its stewardship of the house by continuing this argument, and so it is, and the speaker of the house who was my classmate, and

i'd like to thank my friend and someone i respect very much within 24 hours when i was about to start this, but not anymore, said yesterday, openness will be the new standard. speaking directly to the minority, and i'm quoting, "you will not have the right to willfully disrupt the proceedings of the people's house, but you will always have the right to a robust debate and open process that allows you to represent your constituents, to make your case, offer alternatives, and be heard." we were told that we will always have the right to offer alternatives. here's some alternatives i would urge the committee to let the full house vote on tomorrow. we think that someone who has diabetes or breast cancer should not be denied health care or forced to pay more for it, so

the alternative that was put forward should be heard. we think that because someone is female they shouldn't be charged higher premiums or denied certain care, so we think the alternatives put forward should be heard. we think that if you pay premiums your hole life faithfully, and now you have to use the coverage because you're on the way to the hospital, that the insurance company should not be able to deny your coverage. the alternatives offered up should be made in order. we think that if you are just a few months or years out of college, and you have not yet found the first full time job that offers health care, a lot of young americans in that position, that you should be able to be covered by the policy of your mother or father if you're 26 or under which is why

the alternative being offered by mr. larson and mr. walls should be made in order. we think that what i think was the central promise i heard from the new majority in the campaign should be honored. so many of you ran and were elected on the idea that the national debt is crippling the country, burdening our children, and stifling our economy. it is. it is. so even though we have some disagreements apparently over whether the congressional budget office is right or wrong in the estimates, it's always been the rule through i believe 47 years of congressional precedent under republicans and democrats that the c berk o is the -- cbo is the authoritative arbiter whether the bill add or subtracts to the deficit. today the cbo says # the bill

you would repeal reduces the deficit by $230 billion, so i think that you should make in order the amendment for mr. van holland that says the repeal should not take affect if it increases the deficit. now, you may disagree with the merits of the proposals. many of you actually said you agree with the merits of a lot of these proposals, but i don't think you should disagree with the literal words of the speaker of the house who said yesterday, and i will repeat, "you will always have the right to make your case, offer alternatives, and be heard." now, unless we are going to deem we tomorrow's rule a new definition of the meaning always, i think that some of these ideas put forth by the minority should be made in order to ensure that promise.

there's one thing i think both leaders of both parties have done for too long. it's the reason of corruption of trust by the public in this constitution against both political parties, and that is that things that are said during a campaign very often have no meaning after the campaign. this is your chance to give those words of your speaker of yesterday meaning. when he said, when he promised that the minority would always be able to offer alternatives, hold that commitment high, and let's put these commitments in order. i thank you, and yield back. >> [inaudible] >> thank you, mr. chairman. i also want to express my congratulations to you as the new chairman for this committee, and one that has lots of experience and also thank

ranking member mrs. slaughter and other members of this committee for your hard work. i'm here to talk about two specific amendments before this specific committee which would save two important provisions of the affordable care act. i'm talking on mr. larson's amendment, that allows 26 year olds to stay on their parent's plan and number 27 that protects small businesses from tremendous harm that the repeal of health care reform would have. as was pointed out by congressional donald payne from new jersey in his testimony, i also am against the repeal of health care reform without these two amendments being adopted because they would hurt young adults, especially in the ages of 18-26 and their families.

also, it would make running a small successful business even harder. i come to congress from a small family business that operated for 60 years, and i know the importance to our employees to have health insurance. this legislation that was passed in march and the reconciliation section passed in august and signed into law says that we are making changes that are very important to those community. my distribute has roughly 66,000 young adults who benefit from the provisions of the affordable care act that prevents insurance policy companies from dropping young adults under 6 off of their parent's health plan. reveal of -- repeal of this provision would

cause extreme uncertainty to members in my district and all over the united states. in 2010, 1.2 million received coverage through their parents plan, and most graduated from colleges looking for work in today's challenges economy. young adults are the largest segment of the uninsured population. they come price a huge portion of any growing district which from 1990 to 2000 grew by 48%. from the year 2000 to 2010, we grew approximately 45%. i am here to say that my area is in a situation that needs this kind of coverage because we have 40% of our population up ensured compared to 16% nationally. you can see why they have called and said you've got to get up

there and take against this repeal. repeal in this provision would hurt them and their families struggling to get a foothold in the economy. according to the la times in the six months after the health reform law was signed in march, a company by the name of united health group up corporated, the country's largest insurer, added 70,000 new customers who work for companies with fewer than 50 employees. another company, cove venn try health care incorporated, and insurer here in the state of maryland, that focuses on small businesses, signed contracts to cover 115,000 new workers in just the first nine months of this year, a 9% jump. blue cross blue shield of kansas city, the largest insurer in the kansas city, missouri area,

recorded a 58% jump in the number of small businesses buying insurance since april, the first full month after the legislation was signed into law. a recent small business majority found that a third of surveyed small employers are more likely to offer health insurance because of the new law's tax credits and the establishment of exchanges. mr. chairman, i want to say that it is my hope that this panel will incorporate these two amendments in order to help small businesses and the many families that i mention that still face great economic uncertainty. i yield back the balance of my time. >> thank you very much. [inaudible] >> thank you, mr. chairman. thank you mrs. slaughter and all the members of the committee who spent painful and long hours as some of you are about to find

out before you get off the commission. i want to thank all of you for giving us the opportunity to speak here today, and i want to discuss an idea that we're going to talk about that was first reached in 1912 by then republican president, thee dore roosevelt. i think it's unfortunate that this new majority uses its first opportunity to try to undo health reform, and to do that in that way that is actually beginning to increase our deficit by $230 billion in the first ten years and $1.2 trillion in the second ten years which is # going to incredibly enrich insurance companies and prescription drug companies beyond their wildest dreams. before i start speaking directly to the specific amendment i'm offering, i want to acknowledge many of my colleagues put forward amendments i believe should be put in order and considered under the rule. my colleagues maintain important aspects on the foornl care act

that preserve important common sense consumer protections that insure the necessary assistance to seniors and small businesses and families can continue. these prevent companies from having lifetime caps and dropping coverage once people get sick, and they stop them from denying coverage based on preexisting conditions. these benefits help young people to remain on their parent's insurance plans until they reach the age of 26. that's critical today as we know the unemployment for youth is just shy of 20%, record numbers of college graduates are forced to move back in with their parents. this ensures seniors are not denied a 50% increase on prescription drugs, something that was actually resuscitated by the 2003 drug bill that was almost passed entirely on republican votes and left us with a donut hole and enriched

many prescription drug companies. there's a pa tent there. these reserve the tax credit which allows small businesses to cover up to 5% of their health insurance cost through 201 and 50% beginning in 014. mr. chairman, the bill that is expected to come to the house floor repeals, as you know, the act in its entirety. i sported the affordable care act, and i still do, but those of you who don't and didn't, you are likely to like some of the parts. we continue to beep fit from the parts, and i ask that you retain the parts specified in these and other amendments offered today. now, the amendment i'm offering in a file holds insurance companies accountable and ensures consumers they receive the health services for which they obtain top dollar. we worked hard to get this into the educational labor portion of the bill originally and then through the house, and were pleased when it sustained the

bill coming through both chambers as it was signed into law. it retains a provision in the affordable care act related to the medical loss ratio bill requirement. as you know, the medical loss ratio represents that portion of premium revenue that ensures # payout to doctors, hospitals, and other health care providers, in other words, it represents what they pay for actual health care. insurance companies spend every-growing portions for premiums on salaries, profits, advertising, marketing, and other overhead. according to reports, prior to the passage of the patient protection affordable care act, there was little to no protections to ensure consumer's health premiums were used for services rather than bonuses, salaries, and advertising. it shouldn't be a novel idea that they go for health care opposed to in large part those costs.

since 1993 in particular when non-for-profit plans went to for-profit status, the releaptless consolidation in the industry left consumers with diminishing choices and subject to industry overreach. recent data on the ten largest for-profit industries show a whopping $9.3 billion in profit with just the first three quarters of 2010. they are $2.1 billion higher than the first 9 months of 2009. on average, the profits of the insurance companies went up 41% since 2009, so when you are asked why premiums are going up, there's in large part your answer. history has shown us clearly that insurance companies care more about their salaries and bonuses and using premium dollars or marketing and other costs rather than putting the money back into health services for their consumers.

as one prom inapt advocacy group noted rnlings the provisions of the act related to the medical loss ratio standards, and i quote, "critical to ending the industry's anticonsumer practices to control rising costs, squeezing value out of prices paid by private and public customers and ending profiteering by the health insurance companies." i believe the health provision in the act is extremely important for consumer protection for americans, specifically starting in january 1 of 2011 this year, the law requires insurance companies in the individual and small group markets to spend at least 80% of the premium dollars they collect on medical care and quality improvement activities. insurance companies must spend 85% in the large group markets on quality care. if the insurance companies don't meet that requirement, the law says they will be required to provide a rebate to customers starting in 2012.

if the law was in the books in 2009, they would have refunded $1.9 billion. the law requires that insurance companies public ri report how they spend our premium dollars. this information provides siewrps with meaningful information on how their premium dollars are spent clearlying thing for how much mop goes towards care and activities to improve health care quality opposed to how much money is spent on expenses like those i enumerated before. this will make the insurance market place more transparent, easier for consumers to purchase plans that provide better value for their money. now, unless you think that the medical loss ratio standards in the act are unreasonable, know that in 1993 before privatization of the formally non-for-profits and consolidation and concentration that took place in the industry, # they spent 9 5% of the dollars on health care. in 2009, the facts showed they

could beat the standard when they paid only 15% on costs. most spend only 10%, and medicare spends just 3%. the typical insurer under the benefits plan spends 95% on health care, and only 5% on overhead. unfortunately, the industry found if they get away of using the premium dollar as a profit center, studies found companies spend .60 cents on every dollar of health care. a 2009 report determined some mlr's as low as 57.3%. that was in the state of georgia. in fact, according to the department of health and human services, the medical loss ratio provision protects americans and estimates indicate that up to 9 million americans could be eligible for rebates starting in 2012 worth up to $1.4 billion.

the total average rebate could total $164 in the average market. unfortunately, one the major consequences of the bill is it ends the medical loss ratio requirement. those who support the bill, among other things it means insurance companies could again charge high premiums to individuals and spend a low amount of those dollars on health care services. that should be unacceptable to all of us. we'll find out if this is debated on the floor, whether members stand on the side of consumers or stand once again with insurance and prescription drug companies. i had some other remarks here, and i'll pass it on to my colleagues. they were pertaining to the promises that mr. andrews clearly but forth and mr. dreier you made them and others made them about an open process, an opportunity to debate, an

opportunity to vote on the floor. i hold you all to that in just saying you give us one senate's bill on this side doesn't count and won't fly with the american public or your colleagues. i yield back. >> [inaudible] >> members of the committee, let me begin with the summary. the health care reform is already providing secure coverage to many americans giving families and small businesses more control over their health care adding already improving medicare for seniors. the health reform is totally paid for and will lower the deficit by more than $100 billion in the first 10 years

and more than 10 times that in the following decade when it's fully in effect. now, i'm here to speak on behalf of several amendments here before you. number one, number 2, number 3, and number 8. let me underscore something they may have been lost to you as he used the term medical loss ratio over and over and over again. medical loss ratio is what an insurance company unbelievably that insurance company says is lost revenue, lost ratio is the fraction of their premiums that must be spent on medical care, medical loss ratio. yes, indeed, we should make sure those requirements are not lost should there be a repeal of this law. more than 100,000 new jersey residents in the medicare donut hole already received additional

assistance in paying for their medications. some of those medications life saving. i heard from many vimgs in my district. individuals on fixed income making difficult decisions between being able to afford their life saving prescription drugs, and their light bill and other expenses. closing the donut hole will allow people like howard from monroe township in my district to be able to afford his prescriptions. if he does not get them, he might lose his battle as would others with their illnesses. health reform ends the discriminations of individuals with preexisting conditions, and many in my districts who do not have health insurance because of preexisting conditions are in tough shape. one of those,ed to wrote to me saying i broke my back two years ago, and went on to explain that he had, but lost coverage.

he continued, "i need one more surgery to get back to work, unfortunately, no insurance company will touch me because of my preexisting condition. i just want to be a productive member of society." if health reform is repealed, todd will not be eligible for insurance or be able to return to workment the other benefit is the ability to add dependents as we heard until the age of 26 to their insurance plan. many young adults in new jersey have received health care through this. one is anna. she is a 24-year-old son attending school. this gives anna a way to provide health insurance for her son who is working to do just as we would want him to do. if health reform were to be repealed, seniors and people with disabilities would lose

prewellness visits and preventative care including cancer screenings, revenue would be loss, and the elimination of credits on lifetime and annual expenses by the insurance company, that protection would be lost. instead of having this discussion on repealing health care, we should be focusing on how to improve the health reform law through addition, for example, of ms. woolsey's bill. in the past century, congress will continue to revisit the health care reform law and to adjust it to changing conditions and to improve it over the years to come. repeal now would only benefit insurance companies, not tax payers. the existing law benefits taxpayers.

it's not as has been presented to us and as was campaigned and so forth, a repeal and replace. no, that's false billing. there is nothing in the bill before you, committee members, that has replacement language. attempts were made in the past to repeal social security and medicare. now, medicare is widely seen as a successful program for helping americans access to health care, but it was very controversial when it was past, but the same arguments we hear today were made then. some leaders from bob dole to gerald ford fought the program and votes against its creation and sought repeal. medicare gave insurance to older americans, and today only a fraction, a tiny fraction of those 85 and older lack health insurancement more than 40 years ago, congress and the president

were right to enact medicare. i predicted in the future today's uninformed cries of social medicine and political chatter of imagined burdens will have faded. instead, it will be noted that we did the right thing by finally ensuring that all americans have health care security and good affordable health care, a goal that had alluded this nation for a century. >> thank you very much, mr. holt. mr. davis. >> thank you, thank you, mr. chairman, and to all of you and all the patience everyone has shown today. i certainly appreciate that. you know, the issues that we're talking about here today, i don't want something to get lost, and that says that we stand ready. we stand ready and able to work with you and to improve on the

patient and affordable care act. i don't think anybody who came here said everything is as exactly as we think it should be. however, i want you to know because until these discussions began, i don't believe that the american public, and i don't think frankly any of us appreciated how much discrimination exists in health care today. people just don't appreciate that. they were surprised by it. what i want you to know is that this repeal legislation will be harmful to women's health, and it will ensure that insurance companies can discriminate against women. it will allow insurers to not only charge women higher premiums, but also to deny women coverage all together because they've had breast cancer, because they have been a victim of domestic violence, or they've

had a child. imagine that. because you've had a child and become pregnant, an insurance company can deny you coverage. a lot of people were surprised by that, but that exists today until we've been able to move forward with this legislation. the bill would also prevent women from having direct access to their ob/gyn as well as birth center services. now, you may not appreciate this, but i actually authored the law in california that allows women to have direct access to their ob/gyn. back in the 90s, a woman could not do that. they had to get a letter from their primary care provider to go to an ob/gyn. you probably know who signed

that legislation. governor pete wilson signed that legislation. it was interesting to me because one of the things that we had to do was to educate a lot of our colleagues about it. partly staff members went home to their wives and asked questions about that. would you like to ride along to the ob/gyn. of course, they said yes, and had been denied the opportunity to do that. while we have protections in a number of states, california, of course included, but others, nationally, women still have that burden up until this legislation. many women and children who have insurance are already unable to even seek the care that they need including services like mammograms, and we know this because they cannot afford the copays and deductibles. my colleague talked about the medical loss ratio. i have a constituent, her name is also susan, who following

having breast cancer was denied reconstructive surgery from our health plan which was an absolutely good health plan. they didn't want to go forward with that kind of support for her, and we intervened, department of managed care intervened, and got it done, but that's the kind of thing people have had to deal with for years. i coauthored the women's health insurance fairness act and markets can't charge women higher premiums than men. that was a common practice. in these particular plans, women who were pregnant were denied care. california had these protections in place, but there were no federal protections to stop these unethical practices. as the patient protection and affordable care act e eliminated all of these obstacles, and it would be a travesty to take such a huge step back for women and

maternal health. women have the most to gain in the passage of health care reform, and now they stand to lose the most. health care bills should make unfair and inappropriate health care practices a thing of the past. it shouldn't encourage these practices, but hope to eliminate them. health care bills should certainly guarantee that this doesn't happen again to women in our country. the amendment that i am suggesting guarantees that repeal to not go forward unless the office of management and budget consultation certifies that repeal will not take away these key protections for women. if the omb report back that repeal reports back that they would be denied coverages or will be charged more because

they have children and live longer, which is why they are discriminated against, this amendment stops the repeal from taking effect. women shouldn't have to get a permission slip to see an ob/gyn, and not have to worry whether the birth of their child will be covered. they shouldn't be charged more or denied insurance coverage simply because they have two x comsomes. i urge this committee to accept this amendment to prevent insurance companies from discriminates against women. >> thank you very much, ms. davis. >> thank you, mr. dreier, and members of the committee for this opportunity. like my colleagues today, i am for retaining the essential substance of the health care reform that i'm proud to have volt -- voted for. those are representatives of

what my colleagues submitted today. today i submit a language that grants a reauthorization of indian health care, the i indian health care improvement act which has not been dealt with since 1992. these vital components of law violates the federal government's commitment to honoring its trust responsibility to indian tribes. that trust responsibility was established in 1987 when the u.s. government in exchange for resources and land told indian country, tribes, and peoples, that we have a responsibility for the delivery of health care to your people and the delivery of education, and that has been defined in the u.s. constitution, that trust pont, been defined in treaties, in statutes, and supreme court

decisions. today as we celebrated the sanctity of our constitution, i hope there's some consistency and also celebrating the commitments we've made through that document through a significant portion of this nation. the affordable care act moves our nation towards a health care system that is accessible, covers more people, and this new law has a critical component of promoting health care equity for all peoples, and i think we should not ignore that equity quotient in there, and despite their legal right to health care as established in the trust responsibility, american indians and alaska natives face dire health conditions. over 30% of native people in this country have no access to health care. they are faced with chronic

disproportion diseases involving diabetes, heart disease, and stroke. this bill finally begins to address those unique needs of indian country. indian health services have been historically underfunded, not been able to keep up with the demands of indian country, and in addition health care improvement act has not been reauthorized, and i would as these disperties continue to expand, and i think that this is essential to retain this portion of that health care reform act because it does two things. it brings equity and attention to a first americans that's been denied for many, many years through the history of this nation, and it reaffirms our

trust responsibility that is in the law and constitution. a repeal of this health care reform law would be punitive over all, and it would be destructive specificically to indian country. i would ask for your consideration of this amendment, and that would assure that our trust responsibility is honored and that first americans have a rightful place in accessing health care as it was promised and yet to be delivered. the health care reform act was the most important document to deal with indian health care needs in this country in over two decades and to repeal that is to repeal the commitment made to a significant portion of the first americans of this country, and i would ask for your consideration, mr. chairman. >> thank you very much. mr. courteney. >> thank you, mr. chairman and ranking member slaughterment i'm in awe of this committee.

that movie, they shoot horses, don't they? reminds me of this. you are incredible. >> sir, we didn't start until ten o'clock this morning. we didn't start early. >> you got more to go, i understand. i want to focus on an issue that's important to the education work force committee, and again, representative slaughter mentioned there's been positive job growth since the bill was enacted with new private sector jobs and adp announced in december there was 297,000 more jobs created, and tomorrow, we get the december fingers. we have an economy that is healing, and this law, i just think that the burden sits heavily on others to point how it has in fact prohibited job growth since last march. one of the two definitely

pro-employer components of this law are the focus of an amendment that myself and congressman peters presented. number one, to protect the small business tax credit, and secondly, also the early retiree insurance fund which i want to spent a moment on because it's not got much discussion today. in our committee, we've had many hearing about the fact that the frame have been collapsing. they offered retirees health benefits, and that figure again has totally collapsed to 29% in 2009. what that does, the work force first of all puts a burden on those who have retired from 55-65 to absorb health care costs, and the demographic with the highest exposure to illness and high unitization, and also affects the elasticity of the

labor market. when people have to work to hold on to their benefits, they're not going to leave their jobs even if they are high risk jobs, high labor jobs that frankly younger workers if given the opportunity would fill those places. the risk that exists is an issue which again, our committee has worked on for many years, and this bill addressed that in a way the employer community all across the country has clearly shown as a resounding success. we set up a reinsurance fund that says employers can apply if they participate in the fund, claims for former employees that exceed $15,000, the taxpayer, the federal government, steps in and provide 80% of the cost up to $90,000. it does not subsidize premiums because the upfront cost is still with the employee and former employer, but it provides a backstop for the retiree

insurance programs. again, it's a tried and true system we do for the nuclear power industry. we provide a backstop for insurance, for the construction of nuclear power plants and their operation. we do it for flood insurance and a whole variety of activities that there is a public good, but the government needs to sub -- supplement the market. what's happened with that fund? we have 3,000 employees that stampeded into this fund. over haver of fortune 500 companies have joined. general electric, across the board we have taft heartly plans, and again a lot of those labor plans, these are workers who need to retire at age 55 that can now get that backstop to make sure the benefits are not going through the roof, and lastly, looking around the

circle right now, the state of florida, colorado, new york, florida, california, georgia have all applied and are now participating in this early retiree health insurance. i come from connecticut which also participates. my favorite fact is the company out there is a participant in this program. there's a legal document called reliance that the law sets out an expectation for its citizenry that, you know, people should be able to rely on that expectation, and for us to just shut down the early retiree insurance program which clearly addresses a need that has been identified over and over again in which is not a government takeover. it is a true government private partnership to maintain employment based private health insurance. we should not shut that down. again, the employer community across the country has spoken

loud and clear that this works. the other item which again our amendment talks about is the small employer tax credits. many talked about it here. i won't be labor the point. i was at a health care round table before the election. there was a family physician there who was frankly very pleased about the medicare changes they were going to make to give her the tools to care for the her patients. she said, i'm getting killed on health insurance premiums. i said did you look at the small business tax credit? she had a doctor's office of 5 or less. she goes what are you talking about? as we all know, it's a pattern out there. many didn't know about the as aspects of the bill. there's a tax calculator that businesses can pumpleg in the number of their employees, payroll, spits out a tax refund and she called me a couple days later and she's getting a $4,000

tax credit. she was ease tattic. these were things set in the 2009 market. ..

>> it's something that we at least owe that basic level of decency of the country. i hope you will give our amendment consideration. >> thank you. >> thank you, chairman dreier, congratulations on assuming the role of chair. i wish you well. to our former chair, louise slaughter, thought for your work as chair during the last several years. i also thank the entire committee for the opportunity to address you this afternoon. i heard one message from the american public very proud and clear over the past few months. they said we want congress to focus on creating jobs and growing the economy. certainly, repealing health care will not create jobs. in fact, it may produce the opposite result. and serve to continue to widen the gap between the comfortable and the struggling. with that in mind, i think we've been issued a charge, a challenge by the american republican. to work in a collaborative, to work in a bipartisan spirited

way to make certain that we build upon progress, not go backwards, only move forward. take foundations that can serve us well and make them better. the president and the last congress worked hard to develop health care opportunities, accessibility, and affordability. my concerns here today are to encourage that you look tremendously focused at the amendments that are being produced by the minority. i think they speak well to the issues out there, and they are motivated. my mindset is motivated by many of the anecdotes that have been shared in the district about health care. and i'll share some of them with you. take, lisa, for example, who is a small business own in lathem, new york. she was forced to drop the health insurance for her employees when rates rose too high. rates are nearly $12,000 of a year. her premiums had tripled since

1995, and she told me that reform would allow her to remain competitive, and be able to recruit top-talented employees by offering health care again. because she would be receiving tax credits as just was mentioned by representative crowley that would offset much of these costs. lisa will go from struggling to growing as an employer. or the message from andre in my district from albany who wrote me desperate for help for his sister who is going through a second fight with cancer is some $100,000 in debt from her old medical bills. she couldn't afford health care, but can get coverage through the preexisting insurance plan that was enacted by this very reform. andre's sister is going from mayhem to piece of mind, which i think has no price tag on it. it's well beyond what we could ever calculate. then there's katherine from hudson. katherine contacted me pleading

to stop attempts to repeal this reform. her 23-year-old asthmatic daughter is looking for work. the weak economy has found her efforts falling short. however, she's able to remain covered under her parent's plan, instead of going without coverage. katherine's daughter has gone from uncertainty to getting the absolute care that she needs. lisa, andre, and katherine have real stories with real consequences. whether it's a senior citizen planning for retirement, or a small business owner attempting to manage his or her company, stability, and predictability of the health insurance marketplace are indeed important. by playing short term political games, that's stability will be deeply jeopardizeed. 00 reform was enacted to ensure that medical considers are made between a doctor and patient.

not by health insurance or wall street c o'. -- ceo. now is not the time to ignore the will of the people to repeal a law that has yet to take affect. repealing the lawyer, a measure that tooks years of debates, hearings, mark ups, hearings, town halls, and impact to reach it's final version simply will not create job. what it will do is blow a massive hole in our nation's death and jeopardize the seniors and middle class at a time when they can least afford it. i'm also offering an amendment because i believe in competition. i believe in a transparent marketplace, and i believe in protecting our middle class americans by giving them affordable health care options. my amendment is simple and straightforward. it requires omb in consultation with the cbo to certify to congress that the repeal of the health care law will not decrease the number of people

expected to gain health insurance because of the affordable care act. it also requires certification that repeal would not affect the enactment of the exchanges and available coverage choices for all of our american citizens. it is then further enacts the public health insurance option to compete with private health insurance plans in the exchanges. the public option is a government-managed alternative to private health insurance plans with it's payment rates tied to medicare and fully funded, fully funded by it's own premiums. americans with health insurance are seeing their premiums rise each year, more than doubling over the last ten years at a rate three times faster all while the profit columns of insurance companies have risen in historic fashion. we operate in a free market. the best way to drive down out of control premiums is by increased market competition. the public health forces

competition in the health insurance market to drive down proceed -- premiums for everyone. it provides competition in public and private in the marketplace, lowering cost for everyone. it's similar to social security and private pensions existing side by side. each one has it's own strengths and weaknesses, but public choice can keep the private options honest and cost competitive. the repeal bill will deny americans protections under the new health care reform law and will again subject our health care system to the whims of powerful health care and pharmaceutical interest leaving families and small businesses vulnerable to skyrocketing premiums and unfair practices that deny coverage to millions. my amendment is aimed at protecting against just that. just this morning, cbo released an estimate that the underlying bill, hr2 will increase the deficit by some $230 billion over the first ten years and

more than $1.2 trillion in the second decade. they also estimate that hr2 would result in 32 million more unsured people in 2019 for a total of some 54 million people lacking health insurance coverage. this is an unsustainable outcome. if this bill were enacted according to cbo, many people would end up paying for more health insurance. my amendments protects against that because our nation simply cannot afford repeal. thank you very much. >> thank you very much. ms. shoe. >> thank you so much, chairman dreier. i'm here to express my strong opposition to blanket repeal of the health care reform law and in particular to speak to amendments number one and four. one thing i know is that repeal would certainly hurt real people, real americans who deserve better from their government. it will hurt americans like my own young staff member eric who

told me that he was diagnosed with cancer of limb much nodes at age 24. the greater crisis which he eached the age 24 and was kicked off. when he tried to buy his own plan, he got denied because of a preexisting condition. his cancer at a time when he needed the safety net the most was not there. thank got -- goodness that we hired him. there will be great harm. families across california will lose a piece of mind that the affordable care act provides by making sure that young adults like eric can stay on their

parents plan to age 26 if they don't have coverage of their own. repeal will also hurt real americans like my constituent, scott, who had insurance all of his life but changed jobs and became self-employed. he wanted to buy insurance, but found to his shock that he was denied because of a preexisting condition. he was denied not just once, not just twice, but three times. that despite the fact that he was an active tennis player and only 44 years old. and here's why he was rejected. the care rejected him because he was a expecting father, blue shield because he was bitten by a spider, and the last company because he had asthma. well, scott did indeed have asthma. but he's managed it well for more than 20 years with $150 a month in medication. and even though it was

manageable, he was denied health care insurance. let me tell you, he's not alone. in 2006, 52 million americans looking for individual health insurance found themselves in scotts shoes. they didn't get it because it was made to be too expensive, or they were turned down. and that's almost 90% of everyone who applied. scott and millions of other americans breathed a sigh of relief when congress passed the health care bill. it includes life-saving provisions to protect americans from being denied coverage just because they had a preexisting condition. the affordable health care act takes care of these vulnerable americans. if the health care reform bill is repealed, thousands of americans across the country will be abandoned and left out to dry. it is for eric and scott that i strongly oppose this repeal and

a rule that would hurt the american people. thank you. >> thank you very much, mrs. chu. >> thanks to all of you for your testimony. i will say that we are looking forward to a vigorous debate. we appreciate your coming forward and offering your to poa -- proposals. ms. fox? >> i have no question. >> ms. slaughter? >> we want to thank you for your patient through our saga up here and everything. i certainly says to me that you are dedicated to health care and saving health care and all of the hard work that we put in on it that would you come up with these amendments that are quite extraordinary. and stay here all day to do that. that's a -- really quite a tribute, i think. we don't always see that. so thank you so much. and my guess, rob, you can several times; right? >> i like it here. >> you are always welcome. [laughter] >> that must, you know, because

of the work i've spent a lot of my life on women's health. i think susan's amendment would be tragic. it'll be a tragedy of major proportion if that were to be repealed and women had to go back to second class medical patients. thank you all very, very much. >> thank you. >> very thoughtful. >> mr. hastings? >> mr. chairman, i'd like to ask unanimous consent on that that d i recognize that we have not gotten the full questions and in of the process. i believe as you see, request will save staff on both sides and time. i ask unanimous consent to have an amendment and co-sponsored added and sponsors changed as specified. it's a very long list. >> without objection, it will appear in the record. we appreciate that. thank you very much. >> mr. nguyen, thank you.

mr. polis? >> i have a statement to appear in the record. >> without objection. >> secondly, i think with some of this testimony, at least brought to my attention, is the difference between -- here we are. i'll pass that through. stopping -- sort of the pause button and the rewind button with regard to the legislation. and with this most expensive one page bill in history would do is rewind rather than pause. and when i hear about elements of the bill that i was not an expert on, but had heard about but were described with regard to retirees, we talked about high-risk pools with which there seem to be agreement on the other side of the aisle. we should have some kind of pool for people with higher risk. that's happening under the bill. we saw it as a transitional step. it sounds like it's an transitional step you agree.

some might agree it's an end point. we see it as a transitional step. what it does is rewind to before we instituted federal support, putting people with preexisting conditions back to where they were two years ago, rather than where they are today which some might see as an end point, and again, some might see as a transition piece. had i timed to properly prepare an amendment. i see this as going through -- i didn't have the time to do that having been in rules committee meetings most of the day yesterday and today. i think one consideration would be why don't you consider a pause rather than a rewind with regard to this legislation? allowing pieces that have already entered and that people have states and counties and individuals are counting on and that have generally speaking support with regard to what they accomplish from both sides of the aisle to continue. and rather than discussion the rewind, discussion where we want to go going forward. whether it's trying to improve

some of the efforts that are scheduled to occur, make them work, have different ideas about what we need to do consistent with the principals that chairman dreier has laid out orally, the five principals, and then the principals included in house resolution 9. >> mr. polis, i want to say one thing. your point about the high-risk pools goes to one the earlier points i think mr. woodall made. my state, new jersey, has set up a high-risk pool contract with horizon blue cross, blue shield to operate. the state is obligated to pay the insurer. it's received some of the funds necessary to do that. but one the questions that i would wonder about the repeal, if it became law what would become of the obligation of the state of new jersey? who would fund them? my sense is the contract is still binding and the obligation would have to come from the state taxpayer and state

treasury as one of the questions not simply a technicality when you do push the erase button, which i think what they are pushing, there are some consequences that would be difficult for taxpayers. >> what you are saying, mr. andrews, your state has already made decisions and entered contracts under the expectation that this is the law. >> our state is signing people up for health insurance coverage under this fund. >> yeah, with regard to the high risk pools, everything i've heard, they want to see more of this concept. they don't want to see the mandate with the price discrimination. some of us are more realistic to accomplish the policy goal of allowing people with preexisting conditions to have insurance. moving away from something that many have said they want to get to, after contracts and policies have been changed at the state level seems that it would be a huge step backward not only for

people with preexisting conditions and states and others. >> let me point out one other very important real life problem under the early retirement fund that mr. courtney talked about. there are employees in both the republican sector that have signed up, assumed they are going to get the money, and induced their employees to retire, by making what is a legally binding promise to provide health care benefits to people 56, 57, 58. they made the reliance that the funding from the existing law would be in tact. when that funding is erased and repealed, i would assume the employers are still legally obligated. i assume the funds would have to come from their shareholders or other resources to pay for them. >> i think that could be called a tax. so in the most expensive -- >> i'm not sure what you call it. i think it goes back to the point that you made frequently.

these are the kind of questions that hearings answer. these are the kind of questions that markups that -- these are the kind of questions that the regular legislative process bright -- brink bring -- bring to light. >> thank you, i yield back. >> if i may on that subject. apart from the contracts, there is the expectation. tens of millions of seniors on medicare have been calculating their costs this year and figuring that they are going to get additional assistance in paying for their medicines. and they've been told by their doctor they will get brand name medicine at 50%. those things are included. and, you know, i can't emphasize too strongly that everybody in this room can find something they'd like to change in this law. but there are so many good features it would be a shame for

millions of americans to repeal it. every year since 1965, there have been changes to the medicare bill. it didn't include end stage renal disease, it didn't prescription medicine, it didn't include flu shots. it's been perfected over time. some people did say throw it out. it's terrible. that would have been a mistake. america didn't do that 40 years ago. they've made improvements in medicare over the years. >> thank you, i yield back the balance of my time. >> thank you, mr. chairman. thanks. >> your patients? and i would like to without objection include to the record two photographs that were mentioned in mr. braley's

testimony, and the statement that we will also see as included in the record. now what we'd like to do is include a nice large panel that will consistent of the members that we have before us. so i see mr. baldwin, mr. edwards, mr. deutsch, mrs. edwards, mr. deutsch, mr. johnson, mr. davis, and mr. sicily. i'd like you all to come forward. we will go by seniorities, then the judiciary, and ways and means committee, and other members. >> thank you, mr. chairman.

ranking members, thank you for allowing me to testify in an amendment that i've offering with my colleagues susan davis and nicki tongus. it would ensure the end of discrimination by health care are not cast aside to repeal the affordable care act. i've long been a supporter of widespread health care reform. last march i had the extreme pleasure in voting for the health care bill which achieves many of the goals that many of us have been fighting for many, many years. for example, enactment, we guarantee that more than 32 million americans would have access for the first time. we laid the ground work for the bankruptcy clause and inadequate coverage. but banning the preexisting conditions barred to insurance, by banning annual and life time coverage caps, and by capping annual out of pocket expenses,

this law ensures that nobody will go broke because they get sick. it will help save the lives of approximately 45,000 americans who die each year because they lack health insurance. we did all of this and more while reducing the deficit by what cbo now estimates to be $230 billion in the first ten years and $1.2 trillion in the next ten years. in addition to the remarkable achievements that will easy the lives of millions of people, the affordable care act extents rights to the american women which brings me to the amendment. before the passage, women were routinely and intentionally discriminated against in the health insurance market. approximately half of all american women do not have access to employer-sponsored health care. because of a practicalled gender rating, insurance companies can charge women and men different rates for the same coverage. in the individual market, this

amounts to women paying 48% in premium cost than men for the same coverage. the affordable care act put an end to the unfair practice and vastly expands access to health insurance for america's women. additionally, women face being denied coverage or charged more for so-called preexisting conditions that include pregnancy, c-sections, and being the victim of domestic violence. let me sate that again. insurance companies can and do discriminate against women simply for having a child, or for giving birth via is cesarean section. the women's old misdeed was the nerve to be a victim of domestic violence. this is a scandalous blight in our country and often that deserves remedy. it's done by the american care

act. women lack coverage. key to ensuring the women gives her baby the best chance for a happy, healthy future, as well as other preventive services. the affordable care act prevents other coverages as part of the benefits package and eliminates all co-pays and deductibles for preventive services. this is a tremendous victory for women and children and one that must be safeguarded. another key benefit in the essential benefits package is coverage for yearly screening mammograms after the age of 40. mr. chairman, for several years now, i have pursued legislation that would guarantee coverage for women age 40 and older, and screening mris for women at high risk of developing breast cancer. for many insurance plans cover diagnostic mammograms, mammograms used to develop a mass or tumor that has been detected is cancerous, many do

not cover screening for the existence of tumor. for what we know about breast cancer, this is unacceptable. women and families deserve better. mammograms do not detect every tumor. for women at risk, who have a strong family history, where a women's mother, grandmother, sister, or daughter was diagnosed with breast cancer or those women who have a genetic predisposition to developing the disease who have been diagnosed with the brac one or brac two genetic gene, mri help detect more tumors at early stages. for this population of women who are particularly acceptable to developing breast cancer, access to mammogram and mri is critical. as for coverage with mammograms, they do not cover the screening mris for the high risk population of women. in 2010 alone, approximately

210,000 women were diagnosed and nearly 40,000 women lost their lives to the disease. the devastating reach of breast cancer has touched my personally as my wife learned and was forced to sit by it she grappled with the disease. breast cancer kills women. it steals them away from the children and families. it's time that we say no more to this disease. that's why i was thrilled and relieved to know the affordable care act would entrench the right to the prevention methods like mris through the essential benefits package. for all of these reasons, my colleagues and i have offered this amendment. the discrimination against women that was the standard in the preaffordable care act insurance market that made women routinely pay substantially more for the same insurance cover as men must not be allowed to return. this amendment says that the repeal bill, should it pass, did not go into affect until it's

certified that it would not -- certified by the director of the congressional budget office and director of omb that the appeals brought into effect by the repeal bill would not permit health insurance issuers to discriminate against women in the manner that i've talked about. mr. chairman, thank you for giving me an opportunity to testify in our amendment and i look forward to a favorable disposition by the committee. >> thank you very much, mr. nadler. mrs. jackson-lee. >> thank you. i'm delighted to join my colleagues in what i think is a deeply held difference of opinion to the cancer legislation introduced, having been produced that will repeal the health care bill. let me just offer the backdrop to the amendments that i've introduced.

and this was mentioned earlier. but i think it's important to note that states have, in fact, begun to implement the regulations under this affordable care act. but more importantly, what has occurred is we have already generated money as flow to the states causing them to utilize these dollars to begin to implement this particular legislation. we read the constitution today and in particular the 14th amendment indicates that there must be an equal protection of all citizens. frankly, if we repeal this health care bill, one the issues behind it was it is unequal. in my state of texas, because of the budget crisis, my governor is considering eliminating a medicaid. we know that medicaid is some 60%, i believe, from the state from the federal government and 40% from the state. with that elimination, there will be millions of texans

without health insurance. but more importantly, those who will not now have insurance under this bill that is attempting to be repealed will then create a pool of people who will not be protected equally by the law. so i have three amendments and i will briefly comment on one -- i will yield to my colleague when she speaks because i've joined in her amendment, congresswoman edwards will be speaking. i'll make these comments. the quality of the law, i think, requires us to ensure that insurance rates are not raised. those individuals who cannot afford it will be unequality protected because they will go into a pool that may not allow them to secure health insurance. compounding the lack of coverage will be the cost that will ensure the federal government some $445 billion, $250 billion

in the terms of additional dollars we would need to repeal. compounded with insurance rates, states eliminating medicaid and individuals not being able to secure insurance either because of the rates or because of preexisting disease or because they are pregnant and they are a woman argues vigorously against the repeal of the affordable care act. i will join in the amendment of my colleague. amendments that i would like to speak more extensively about are the amendments that i offered on community health clinics that, in fact, really argue vigorously against the repeal. you can see pictures of

individuals who need care. that's a neonatal unit in one the intercity hospitals in my district. there are patients who go to community health clinics who are referred to those hospitals in the inner city but they get primary care from the community health clinics. community health clinics cover screenings, checkups, patient counseling to prevent illnesses, disease and other health problems. under the affordable health care bill, we expanded that to some 350 community health clinics across america. with the elimination we will then knock out if you will, start up of the federally qualified health centers particularly those in harris county and you can see families with babies being examined and i think we have another friendly physician or nurse practitioner examining someone in an

affordable health clinic. i have heard much accolades that say to allow me to walk down the street, to be able to ensure that i can take care of my family. so it's a neighborhood center. it's a neighborhood physician. it's a neighborhood nurse practitioner. under the appeal, this will be eliminated. many of these started up. the second amendment says nothing in repeal should prohibit the building or establishing of federally qualified community health center of which the congressional black caucus worked extensively on and fought to ensure that those centers would be spread around the community. i ask my colleagues to consider the impact of eliminating those clinics in urban areas. i'd like to take note of the

south houston and legacy which have been one the major proponents but also servers of community health clinics. let me conclude on that amendment by saying a young mother in my district in texas which is a birthplace of barbara jordan in february will have their 75th anniversary or birthday. all of us miss that eloquent voice. but she said something that i think is important to this discussion. she said that all americans want is the promise of this land. i paraphrase it, the opportunities and the benefits of this land. community health clinics were part of that benefit of which we thought were so very important in the affordable health care bill. one example is the iris williams who had no health care but was able to go to the clinic when he needed a physical, something as simple as that. many of you know you cannot go to school without a physical. parents were arguing or saying

even in our health meetings in town mall meetings, i can't get a physical. this is what the bill cures. soon after the, the soon had an injury. he was treated in the emergency room, but the ongoing hair was in a community health clinic. or joey who covered he had hiv, and hepatitis c. he was a drug user and developed hiv and hepatitis. he did not receive any health care until he was able to go to a community health clinic. i know there's a comment being made that as this bill is repeal in it's totality, then we'll have the hearings. well, it will be too late. many will have died already by the time we stop this action of the bill now in law and put a stop to it and then believe that we can recoop the losses. i think that is sorely mistaken. and again in reading the

constitution, we really don't comply with the 14th amendment on that repeal. my last amendment is distinctive from one that was discussed earlier. that's the question of medicare and medicaid fraud. this is not just an amendment to say that we want to make sure that we prohibit medicare and medicaid fraud. what this is an amendment is not to under fund the agencies that have already started to begin the oversight of the question of fraud. we recognize that the cbo has indicated for every $1 invested, it yield $1.75 in savings. the department of justice civil division and u.s. attorney office have recovered nearly $16 billion in matters of fraud. if we repeal and under fund the u.s. department of health and human services and the department of justice in the work that they are doing, we will contribute to the increased deficit of this nation.

the department of justice has created a serious of hedgal health care, along with the secretary of health and human services, secretary sebeilus. that is under the affordable care act. if the act is repealed, it's not the question of prohibiting fraud, waste, and abuse, it's the underfunding of those agencies fully engaged in the oversight which i think is important. so i ask my colleagues of the rules committee their graciousness and courteousness of their rules anden sure that we -- and ensure that we have a moment to stop and believe what i will be major violations that will cause major loss of life. i don't know what we'll say to the state and those pending on the services that have been

offered. >> thank you very much, mrs. jackson lee. mr. johnson. >> thank you, chairman dreier and ranking member slaughter for allowing me to testify today. i'm here to unequivocally oppose the rule and appeal of health insurance reform. mr. chairman, repeal of health care reform will be one small step backwards for the congress, but one giant deep backward for all americans. repeal will allow insurer to discriminate against people with preexisting conditions, women, and older individuals. repeal will balloon the deficit by $230 billion over the next ten years and $1 trillion over the next two decade, according to the congressional budget office.

repeal will deny health care to 32 million americans. repeal will end tax credits that help small businesses provide insurance to their employees. repeal would throw many seniors back into the dark depths of the donut hole and increased prescription drug costs. repeal would also eliminate cost savings and medicare's ability to root out waste, fraud, and abuse. i must ask, mr. chairman, why would the congress consider such a cold-blooded piece of legislation? opens -- opponents argue they do have the mandate to purchase

health insurance. through the mandate, we have implement the ban on americans with preexisting conditions. it's necessary, it's proper, and it falls squarely within the powers of congress enumerated under article i. the mandate is essential because without it, americans could choose not to purchase insurance until after they got sick. insurers would then be required to recover or to cover the sick and only the sick would get insurance. that would in the be profitable for the insurance companies and doctors and hospitals would have no way of getting paid. a ban on denying coverage based on preexisting conditions, therefore, cannot work without the individual mandate in place. because it would not be profitable for the insurance

companies. mr. chairman, this repeal will have an adverse impact for georgia. repeal would strip 23,500 young georgians of health insurance through their parents health plans. repeal means that more than 5 million georgians with private insurance would suddenly find themselves vulnerable again to having lifetime limited placed on how much insurance companies decide to spend on their health care. even worse, repeal would allow insurance to rescind coverage when someone has an accidental or becomes sick because of a simple mistake made on their application. this would leave 387,000

georgians at risk of losing their insurance at the moment they need it most. i'm a former judge and a defense attorney. and as i see it, mr. chairman, health reform is a defendant and the process that we are going through is imposing a sentence on the defendant before we've even had a trial. there is no doubt that this effort to repeal health reform will fail and will be followed by an even more cynical effort to break apart reform piece by piece. i assure you, mr. chairman, that i will oppose this effort every step of the way. when the house is dispensed with the clearly symbolic and political charade, we can get to work on policies that will create jobs and spur economic growths for all americans. i understand that this repeal

legislation is called repealing the job-killing health care law act. i must ask if the chairman or another supporter of this bill can produce any evidence that health care reform has killed a single job. on the contrary, reform is expected to create 4 million new jobs to service the 32 million americans who will have access to health care as a result of our passage of this legislation. repeal would eliminate those jobs. i'd like to close by reminding the committee where we were before reform. in 2007, 60% of bankruptcies were reported to be related to medical costs. before reform, families paid a hidden tax of more than $1,000

in additional premium cost each year to cover the cost of uncompensated care for the insure -- for the uninsured who would report to the emergency room when their sicknesses became unbarable, and before reform, eight people were -- either denied coverage, charged a higher rate, or otherwise discriminated against every minute because of a preexisting condition. knowing that, my colleagues and i and their 111th congress got to work and delivered a historic law that ended these abuses and finally gave middle class americans the freedom to take full advantage of our economy. instead of repealing this historic achievement, i urge my colleagues to nuture it and to invest time in shaping the policies as they are implemented. mr. chairman, i want to thank you again for the opportunity to

testify. >> thank you very much, mr. johnson. >> before mr. johnson, i'd like to say something personal. i hope he won't mind. >> yes. >> it does me a lot of good to see how wonderful you are looking. i know you've been ill. you made a wonderful comeback because you had extraordinary health care. if you were to leave the congress, what happens if the health care is gone. if you were to leave the congress and go back into the private market, mr. johnson, you have an preexisting condition. >> i would not be insurable. >> right. >> or i'd have to be a gazillionaire to afford it. >> thank you. thank you, mr. chairman. i lay before the committee an amendment to protect seniors with disabilities from the

politics of health care repeal. i understand the election has talken place and the bill is a priority of our new republican majority. however, now is the time to have an adult conversation and their impact on real people's lives. the amendment that i present simply states that the congress must certify to the american people before this repeal takes affect that we will not raise costs for seniors, that we will not eliminate preventive care for seniors, and that we will not increase medicare fraud. whatever else we do, i believe we must protect seniors in the donut hole from massive prescription drug bills, allowing them free checkups, and protect the new tools given to cms and the fbi to fight medicare fraud. mr. and mrs. glassman of dell ray beach are seniors in my district to fall into the donut hole despite faithfully paying

their premiums, their prescriptions having skyrocketed. the affordable care act is sparing them from bearing the full brunt of runaway prescription drug bills. my amendment would protect them and the reopening the medicare donut hole. i'll never forget standing in line in a elderly gentleman in my district before i was a member of congress. the pharmacist prepared his prescription, bagged it up, and put it on the counter. as the prescription was run up, the man asked if the price was correct. he said it was. he pushed the bag across the counter, turned around and walked right out of pharmacy, without his drugs. pharmacists explained he didn't know he hit the donut hole and his monthly prescription price had quadrupled. this gentleman would go without his heart medicine for the rest of the year.

this tragic scene far too common in pharmacies across the country will end as the affordable care act closes the donut hole. every time a senior foregoes, the risk of more serious and more costly illness increases. seniors cannot afford reopening the donut hole. my amendment also protects the popular provisions in the affordable care act, providing seniors with free checkups and screenings from primary care doctors. this is good policy, plain and simple. because it promotes wellness and it will lower health care cosby catching illnesses before they get serious and potentially life threatening. this benefit which began just this week will save lives. we must spare our seniors from the politics of health care repeal. finally, the south florida community that i represent is home of the some of the worst abusers of medicare of america.

these people prey on our seniors opinion they disguise themselves as medical suppliers, they bill medicare in services never provided, they deprive the elderly of needed care. no americans believe that we should be subsidizing fraud. yet, that's what the body will be condoning if we repeal. just last month, officials uncovered a drug scan that's sold over 30 million from our taxpayers. they were flagged for billing medicare quantities of the medicare that far surpassed what the drug company had. perhaps administrator from cms said it best commenting on the latest scam. we are now enhancing the tools and technology to say ahead of the criminals and identify their patterns of behavior early instead of waiting until a fraudulent payment is long out the door, then trying to chase

it down and recover the funds. under the affordable care act, cms will be able to prescreen, and see red flags before criminals walk away with taxpayer dollars. why strip our law enforcement officials of the new tools just as they are making real headway. medicare fraud cost $60 billion a year. if we end all fraud and abuse tomorrow, our ten year deficit would be produced by over $1 trillion. this amendment would protect fraud prevention and deficit reduction from the political speck call of repealing health care. an opportunity lies before this committee to keep the donut hole closed, protect preventive care for seniors, make medicare more efficient and effective, safeguard taxpayer dollars, and reduce the deficit. i urge the committee to make my amendment in order. >> thank you. we're going to go to mr. davis and mr. van hollen to complete. mr. davis.

>> thank you very much, mr. chairman. i want to thank you and the ranking members of the committee for the opportunity to meet here and testify in favor of making an order to the amendment. an amendment that bennett thompson of mississippi and a number of us have co-sponsored. and i guess as i was thinking of the amendment, representative thompson as well as myself as well as former member eva clayton all have had district experience with community health centers. all of us either worked or on the boards of the community health centers. and so we know first hand, the tremendous impact that these programs have had throughout america. as a matter of fact, they were originally part of the old oeo

programs that started in the 1960s as part of the war on poverty. i've had the good fortune to visit them all over the country. big networks. they are the most effective way of providing primary health services to large numbers of low income people this country has ever known. there is nothing this country has developed that has been as proficient as efficient and as effective. they also are economic stimulators in the communities where they are located. i've been in migrant camps where they were the primary employer. i've been in small villages and towns and rural areas where they were the primary economic engine for those communities.

and so to do anything that would reduce the expansion that we are talking about in the new health bill would provide an opportunity to create enough of these to service at least 20 million additional people. we talk about savings, there is no way we could ever save as much money as we do with individuals have in primary care physicians, individuals being able to get care without going to the emergency room of hospitals and individuals who can get care notwithstanding whether or not they have resources of money to pay. and of all of the things that i have seen, and i have personally worked in health care for more than 40 years, i have never seen

anything yet that has done as much to provide primary health care to lower income people in this country. so i would urge the committee to make this amendment in order. i would urge that the committee and other members to make sure that this amendment does, in fact, pass because. when we do, we are really saying to the lowest income people in america that their health does matter. we work for it. i thank you, mr. chairman. >> thank you very much, mr. davis. mr. van hollen. excuse me. yes. yes.

then i will just say that we are going to go to ms. baldwin who is a member of the energy and commerce committee. she was listed for the first committee, and then we will hear from the other members. please proceed. >> thank you, mr. chairman, ranking member slaughter, members of the committee. first of all, mr. chairman, congratulations to you and to all all of the members on the reelection, especially to the new members the committee here. i think we would all agree that this house is a place to have great debates where we can openly air differences of opinion. but we should try in the process to separate the differences of opinion from the facts of the case. and the amendment that i wanted to speak to is one this i'm offering jointly with congressman anthony wiener, he spoke about it a little bit earlier today. it does not address the health policy aspects of the patient

protection bill that was passed last year. it deals with the deficit impact of the proposal before this committee today and before the house next week to repeal that provision. and the amendment is very simple. it says we should be honest with the american people about the deficit impact of repealing the patient protection bill, the health care reform bill, and make sure that we do not increase the deficit as we proceed on that path. i'm just going to read a portion of it, mr. chairman, it says, no increase in the deficit. section two repealing the patient protection affordable care act shall not take effect unless and until the director of office and management budget and consultation with the director of congressional budget office certified to the congress that the repeals affected by such section will not increase the

deficit. very straightforward. i would venture to guess that every individual in this room, every member of congress in this room spent a lot of the last couple of months talking about the importance of reducing our deficit, reducing our debt, and putting our country on the fiscally sustainable footing. this is an opportunity to take an early action for all of us to fulfill that pledge. now yesterday, mr. chairman, there was a troubling indication in the rules as you know that there was an -- i have to set the stage to provide a whole different approach to accounting when it comes to the budget deficit. and in those rules on page 28, there was the section called determinations for paygo. i'm going to read a short portion of it, because it directly related to this amendment. in sees in determining the

budget for the purposes of complying with the statutory pay as you go act, the chairman of the committee on the budget may make adjustments to make into account the exemptions set forth in subsection h. so you ask yourselves what are the sections in subsection h? you go to subsection h, it says we're going to exempt the budgetary affects of measures first one mentioned repealing the patient protection and affordable care act. we are writing into the blueprint of the governing rules of the house. a mechanism to disguise the true budget deficit impact of repealing this legislation. now we all know that we have a nonpartisan, congressional budget office. their job is to let us know what the deficit impact of legislation we pass in this house is.

sometimes we agree with their estimates. sometimes we disagree with their estimates. but the whole budget process will collapse in chaos if we decide to write the political budget estimates of individual members of congress into these bills. and ignore the estimates of the professionals. i mean it is like being at a football game and when the referee makes a call, and you don't like the call, you throw the referee off of the field and think that your team gets to make the call instead. i would encourage every member of the committee to go back and read statements on both sides of the aisle about the cbo in the health care debate. :

>> they indicated the first 10 years the health care reform act reduces the deficit by $230 billion, and over the second 10 years by $1.2 trillion, so over that 20 year period, it's estimated to reduce the deficit

by $1.4 trillion. in repealing that, you are just like that dramatically increasing the deficit in this country. you can say, well, you disagree with that, but if you do that, we're heading down a very reckless road as a congress to say that we don't care anymore about who our referee, our nonpartisan referee says, we're going to make it up as we go. i encourage every member of this committee not to talk us down this road, that road, and i urge you -- >> thank you very much. >> thank you, mr. chairman. >> let's here from -- >> well -- >> no, not yet. >> we will proceed with the other members in seniority. ms. baldwin. >> thank you, mr. chairman. a lot of references of late to having adult conversations, and i guess you could say i'm here

to have a young adult conversation that i appear before you today on behalf of 147,000 young people in wisconsin and approximately 1.2 million young people in the nation who would stand to lose their health care coverage if the where you are considering today to repeal our recently passed health care laws were to come to pass. i'm here specifically to speak in favor of the larson-baldwin amendment that ensures young adults under the age of 26 are permitted 20 -- to remain on their parent's insurance. what i want to inpart is this insurance is critical to provide access to health care for this vulnerable population. last year there 120 million uninsured young people, counting

one-third of the total. by this age cohort is clearly uninsured in america, and young people do get sick and get injured. young adults have the highest rate of emergency department visits due to injuries. one in ten yiewng americans have a mental health condition, and 15% of young adults have a chronic condition. i think about so many of my constituents who shared their stories, but in particular in the course of the health care debate last year, a young man named erikic who -- erik sured his story. he was unable as a young adult to obtain health care because of his preexisting condition. he's khroaes disease.

this amendment is especially important for young americans in today's economy where finding a job after graduation from high school or college can be challenging. in fact, approximately 15% of 20-24-year-olds were unemployed in america in august of 2010. now, if you think about it, it's understandable why young people are disproportionally unensured. you have a child that becomes an adult. high school graduate may seek a job, again, challenging in this economy. those entry level jobs particularly are the ones that don't offer health insurance. they may go for higher education, part time employment, again, those jobs are least likely to offer health care coverage.

this is why almost a third of young people have no health insurance, and i would say in my own experience, i happen to represent a district with a very large public university, 40,000 students strong as well as some smaller and public and private institutions. you can imagine this is a provision and an issue that i hear a lot about, and i have heard incredible expressions of gratitude and relief because these provisions are now law and young people are able to secure health coverage through their parent's policies. we are told that by 2014, 2.4 million young americans are expected to be able to enroll on their parent's insurance plans, and of that, 1.8 million would

otherwise be uninsured but for the passage of our health care law. i urge my rules committee colleagues to allow us to consider the larson-baldwin amendment on the floor so we have the opportunity to debate and vote to protect the young adults in wisconsin and across the nation from losing access to affordable health coverage, and thank you, mr. chairman and members of the committee. i yield back. >> thank you very much. >> thank you very much, ms. baldwin, and now we will proceed to the judiciary committee. we've been joined by three other members from the ways and means committee. we'll go to that following this testimony, and then we'll proceed to the other members. >> thank you very much, mr. chairman, and it's nice to start and end my day with you. >> we have a much bigger day ahead. >> oh, i know that that's true. i'm here today to speak in favor

of two amendments. the larson amendment that allows young adults to remain on their parent's insurance until they are 26 years old and others being denied coverage for preexisting conditions. what i'm really here to do is show the republican majority how shikingly insensitive your attempt to repeal the health care law is to all americans. this made a dramatic difference in the lives of millions of americans. seniors receive discounts on prescription drugs, and this year they get a free annual visit and no longer pay a copay for screenings. adult children until 26 can stay on their parent's health care plan. plain and simple, repealing the health care law would hurt

millions of americans. these are not just abstract, but real people. people i've met, peoples from my district who shared their hopeful stories. i want to share some of those with you. i want to tell you about 19-year-old chastity. she is from miami, and she was diagnosed with lupus, a devra devastating autoimmune disease. she takes four expensive medications every day and spent six months in chemo. this week she was rushed to the emergency room with problems with her spinal cord. she is currently on her mother's health insurance, but without the passage of this law, shu will be uninsurable. the hart family faces sky-rocketing out of pocket costs, but the affordable care act ended the lifetime cap that

can cripple families with chronic illnesses saving them the angst of spending their savings on care. she can remain on her mom's insurance through age 26, and after that, she can purchase her own insurance in exchange even though she has a preexisting condition. i also want to share with you what this means for carol roberts in california. she faced the dual strategy of a cancer diagnosis and the loss of her job. carol was dealing with a divorce and death of her dog and then cancer too. that job provided her insurance, and in the course of just one month, she had her entire safety net yanked from her and her world torn apart. up stead of putting her energy into fighting cancer, she had to find a job that would not see her hair loss and immediately turn her away. this act finally frees our

constituents from the terrible angst of facing illness without coverage. not only can she enroll with a preexisting condition right now, starting in 2014, she can never be denied coverage for a preexisting condition again. recently, i was in the grocery store when i woman grabbed my by the shoulders, and said, debbie, thank you for passing health care reform. they saved $3,000 a year when they passed their two young daughters back on their health insurance plan. she was not the first person to share a success story with me at the store or picking my kids up from school or many places we have had those stories shared with us. after my own breast cancer diagnosis and treementd two years ago, i went public with my own story and i felt it was important to share my experiences and encourage women,

especially young women to learn of their bodies and risk. what i was not prepared for was the deluge of confession i heard from women everywhere i went. i've been approached by complete strainers who confessed to me they found a lump in their breast and they are afraid to have it checked because they are between jobs and they have no health insurance. they are afraid to be diagnosed and then be declared as having a preexisting condition. people told me they are going to have to choose between chemomoe and radiation because i can't afford both or they can't afford to have the surgery, and they have to hope for the best with the treatment that they can afford, radiation or chemotherapy. they are too scared to go to the doctor to find something wrong because they can't afford the treatment. these heart breaking tales are the same sort of hardship that plunges family all across the

country into if we repeal health care reform. the stability we've worked so hard to put in place is not only saving our country money as many outlined today, but reform saves lives. i am for you not letting americans go back to jobs meaning insurance, or to the days when women avoided treatment because they feared a diagnosis. thank you -- >> thank you very much, appreciate your thoughts and testimony. let me say we are joined by so many other members that i thought the panel would complete it. mrs. slaughter wanted to ask a question of mr. van hollen and we have so many other members from whom we're about to here, and then we'll open the table up. >> thank you very much, mr. chairman. thank you for letting me ask this. it came up in an amendment we

got today from the majority leader. it's paragraphings budget aflght of this act for the purpose of complying with statutory pay in 2010 determined by reference the latest statement titled budgetary effects, i'm lost already here, for this act submitted for printing in the congressional record for the committee on the budget in the house of representatives as long as such statement is submitted prior to to the vote on the passage of this act. this is different somewhat from what you were saying before that passed in the rules package yesterday? >> i have a copy of the language you're talking about which is sort of the standard language that is often offered to rules, but if you take it in conjunction with the language that was passed in the rule yesterday, you create this new

mechanism for the first time that would allow this body to totally disallow the deficit impact of certain legislative acts including repealing the health care reform act. just very briefly under the statutory pay go, pay as you go which is the law of the land now to reduce our deficit, any time the house of representative acts on a piece of legislation that triggers those deficit increase, the chairman of the budget committee submits into the congressional record his or her estimate of what the budget impact will be, and so this language here is pretty typical, but the language yesterday that was adopted, what it essentially has done a authorized in vaps, give a green light in advance to the chairman of the budget committee to abandon the long held practice and tradition of this house in submitting the

congressional budget office estimates for the deficits, and authorizes him to essentially disregard the deficit impact of repealing that bill. now, look, again the question is whether we want to be honest about the deficit impact and whether we want to uphold the practice of taking the estimates from the body that's been charged with the responsibility for doing that which is the congress thal budget office, and as i said earlier, every one of us doesn't like what they say and sometimes does, but this house of representatives will descend into budget anarchy if we end up throwing out their judgment every time, and worse than that, this country's deficits will balloon if we head down that reckless path. >> they will balloon, but we won't know it? >> it's going to be hide the ball. i mean, this is essentially a green light for what we call

enron style accounting practices because you are allowed to throw out the estimates of the nonpartisan account. >> we'll never have a depth of how far we have to go? >> we'll certainly know what the congressional budget office is telling us, but this is essentially a green light to disregard those numbers as a matter of the pay as you go statutory. >> i thank my friend for yielding. i want to say that's right. it's standard language provided as far as the package that was included yesterday. i've submitted into the record the analysis provided by the majority now on the budget committee, and i know that my friend is about to become the ranking member of the budget committee, and there are very, very clear delin nation about

the $#.7 billion cost that goes into this and the smoke and mirrors for the money provided in this measure, and i believe that that is made very clear, and i know that this is a debate that is going to rage on, and as the gentleman proceeds with his work on the budget committee, i know budget committee members will be talking about this, and this is a debate that's important to proceed. are there any other questions for members of this panel? mr. hastings? >> i'll ask this gentle lady to yield. >> i will do that. >> thank you. this is exactly why yesterday when we were discussing the rules package, i raised the question about this particular measure and the fact that we did not have at that time c berk o's -- cbo's order. yesterday, we were operating on the basis that the deficit

impact would be $143 billion that would not increase the deficit, but would decrease it. today in the preliminary analysis, the cbo put forward that it will allow, if repealed, a $230 billion deficit increase. now, i've tried in my meager way to put forward here in addition to the litany of things i began this morning by indicating that florida has already issued substantial grounds. the administration now has issued an administration policy statement that sub stanuates what i was speaking about and assuredly puts forward the fact such things as medicare would be

extended by 12 years, and i pointed out by grants that the administration had already let $320 million of grant around the country. now, there's been substantial talk here about what will happen. how do you get back? ms. andrews had a debate with us pointing out that his state that already has approved for at-risk people have entered into contracts with an insurance company, and he was questioning what will happen to those. my question is what will happen to the people on medicare who thought that we had partially closed the donut hole, and i thought yesterday and think even more today that before we rush into whether it's repealed or any legislation that we ought to have the cbo.

i ask of mr. van hollen, if it is that we can go down this road and throw out the cbo's score as you have put it, it would appear to me that the artifice that's going to be used is the rule that was used yesterday, am i correct? >> yes. >> most of us don't know most of the relationships that any of us have with each other. i personally have great respect for john boehner. i did not reel lish in -- relish in losing the majority, but i did particularly in light of having lost the same, share with him the joy that he and his

family and those who are like-minded with him would have by virtue of his becoming speaker of the house. we broken a lot of barriers around here, and one day we may elect innative american -- innative ash a or an african-american, not in my lifetime, but i believe that will happen. the speaker is atritted of having said today when the preliminary analysis of cbo was made known to him, it is reported that he said that's their opinion. it is true that it is their opinion, but i find it alarming that a group that is hired by

the congress to be a neutral party in all of this rightly partisan stuff that we do here that the american public doesn't clearly understand that we would have the speaker having said that in essence cbo doesn't count. now, i think that's wrong. what do you think? >> well, mr. hastings, i think it's not only wrong, but as you suggested, i think it creates an incredibly dangerous precedent when it comes to honest accounting and budgeting in the house of representatives and has very serious and dangerous consequences for the deficit of this country going forward because if you can invent your own numbers and throw out the estimates of the nonpartisan professionals, you can imagine how quickly we would run up a

large amount of red ink because somebody always going to come up with the numbers not necessarily always in bad faith, but they will get the numbers that support their case. there were times cbo came out with numbers that we thought underestimated the savings. we thought there would be more savings, but we had to live with those estimates, and sometimes there's estimates on the other side and i refer to the members to statements made by the republican leadership last year about the cbo numbers praising them in connection with the preventative care. we would be able to put some reason back into the discussion here and produce for the middle class families of this country. later on he said that the c berk o numbers had -- cbo numbers "validated the

numbers on the bill of something." we can all have differences twt cbo estimates based on arguments we think are sound, but at the end of the day, if we don't have a referee around here, we're going to have a big deficit problem. as you have indicated, there's a long debate to be had both the points you raised. i happen to think cbo addressed those points and still reached the conclusions it has. that's a longer date and could go through point by point, by cbo is not unaware of those arguments and have taken them into account in their assessments, and they are at the end of the day who call the balls, thetgd

>> this is a committee where

members of congress come up and testify. i wish we could fill up the room with people who have been impacted by this new health care law, people who have been protected in terms of insurance, people who are being assured who otherwise wouldn't be because of their preexisting condition, people who benefited from the donut hole. it goes on and on and on, and maybe that would be more moving to my colleagues on the other side of the aisle, but behind all of what we're talking about here, we're a real people, and, you know, when people say, well, the american voters were against obamacare, well, there's two things out there. there's obama care which tens of millions of dollars in special interest dollars were out there to try to mischaracterize what it was, and then there's what we passed. the fact is what we passed when you go to audiences that are initially somewhat skeptical and

go down the list and companies discriminating people with preexisting conditions, are you against people keeping kids on their until they are 26, they are all forit. the final thing i want to say with regard to mr. van hollen is how we are politicizing the budget here which is very, very danger. at the american prize institute who has respect on both sides of the aisle wrote a column. i'll read part of it. "now we come to the rules related to the fiscal policy. i'll address them in another article because there's many. i'll deputize the chairman of the house budget committee to unilaterally create spending and revenue limits and caps by committee and enact them simply by publishing them in the

congressional record. this is breathtaking and demolishes the process in the one fell swoop. it takes away the accountability, openness, and deliberation that a regular budget process provides. this is the opposite of accountability. members by voting in lock step to enact a rule provides a budget they have not seen, and it will be binding in the house. when individual appropriations come up, any proposal that changes the the spending will be ruled out of order, dramatic budget cuts without votes or debate. that's the new open and deliberative house?" with a question mark at the end of that. we are going down a dangerous path. i will say i thought when mr. andrews was not getting a chance to comment, but he raised an important point. everybody is talking about jobs,

getting this economy on the right track, and here we are having this ideological date and not talking about how to put people back to work, and i quite frankly think our time could be better spent on focusing on getting this economy back on its feet. i thank you all for being here. >> thank you very much, mr. mcgovern. i'll respond to say there's one simple reason why it was put into place, and that is for the first time since 1974 budget account was put into place, we had no budget passed, and it is slothly essential -- it is absolutely essential we focus on our efforts to reduce spending, and had we passed a budget last year and done the appropriations work, that would not have been necessary. also, i hope my friend has seen the package coming forward from mr. ryan in pointing to the

double accounting of $525 million ranging from social security agent, class act, the dad fix issue which was removed so in fact there would be an justify set, but a commitment was made to address that, and in fact, that is one of the things we have in h-rez9, and i think it's important that while we look at what happened with the information that was provided to the cbo, that, i believe, played a role in getting us to the numbers where we are, and that comes to a total of $701 billion, and i think it's important for us to do that. are there any other question for the panelists here, and if not, thank you all very, very much for being here. you wanted to add something smit >> yes, i would please. >> i just want to clarify for jackson lee i want to associate myself with the support of the amendment number 20 for seniors, number 26 for insurance, and in

particular to ask consideration of the jackson lee amendment 6 and 7 with the conclusion on the community health clinic to say just one point. 43 million women are living with heart disease and many don't know that it competes, i don't want to say affectively, but it competes with the women who are impacted with breast cancer. most of the women with heart disease have it without knowing it. community health clinics in inner city areas, rural areas, reservations, have the primary care to allow these women to be diagnosed and treated. >> thank you very much for that. what we've talked primarily about hrk r2, we are focusing on hrez9 and there's a number of

provisions raised and i'm very supportive of the wide range of proposals discussed this evening, and it is my hope we don't have the measure that exists now come to an end before the completion of these efforts to improve the measure, so i thank you all very, very much. >> [inaudible] i do think people will die -- >> thank you very much for being here. >> thank you very much, mr. chairman. >> we'll move on to the next panel. the plan is now to proceed. we have had many members who entered the room, and i want to go back to the ways and means committee, and by seniority, the way my list is here right now, people are coming and going. this is a very, very unusual. this is nearly unprecedented in my rears here. mr. mcderrmott and also we would like to add to the panel,

i'll go through the names and the members still here, join us. ms. moore, ms. speer, mr. waltz. we already heard there judy. did i include mr. larson? i did now. there's several lists here, and i keep getting handed a new list. we'll begin with the ways and means panel beginning with seniority. we'll proceed to ms. captor after that. mr. mcdeer mote we are happy to have you here. we are hoping to conclude by sunrise. >> you are an optimist.

>> i'm hoping. hope is e eternal. did i increase ms. moore? >> actually, ms. moore and i have an amendment we're both going to talk about that has conley's name on it, and it really is i think a significant piece that you need to consider it's about how we got to where we are, but it is now in law, the aca, the accountable or affordable health care act is in law and when you repeal it, you are proceeding to repeal the largest middle class tax cut in history. that's what you're doing when you do that. it's, i mean, people don't

really grasp what you're essentially doing by taking, repealing what's there, you are repealing the tax credits for individuals to help them buy health insurance. that's $110 billion a year. now, that's about $350 billion from 2014 to 2019. you are taking that right out of the pockets. it's in the pockets of the middle class now, and by repealing this tax credit, you are simply wiping that out. people say, you know, what do you mean by that? how does that work? let me give you one example so you understand what's in this bill because i remember a lot of people saying nobody had read this bill when we passed it.

well, in fact, some of us actually did read it. we knew what we were voting on. in fact, a lot of us knew what we were voting on, but let me give you an example. let's take a woman named pat. 45 years old, her income in 2014 is 250% of poverty. that means she's making about $28, 700. the cost of the lowest middle level plan in the exchange would be for her estimated at $5700 a year, so that would be her premium out of her $28,000 salary or income. now, under this aca, she would have to pay 8% of her income. that means $2313 to by her

health insurance under the mandate that everybody in the country has to do it. she would have to pay 8% of her income for her health care plan. the tax credit she would get is $3420. she would get that to match what she paid so that she could buy an insurance policy. now, if you say you're going to make somebody buy health insurance, it's clearly not -- it doesn't make any sense not to recognize that some people don't have the money, and so we built into this bill a tax subsidy that's refundable, advanceble, in other words, you can give it to them up front so they can pay for it. one of the problem with tax credits, rich people, you know, we don't have any problem. we pay the bill, and later we get the next year on the 15th or february or wherever, we get the money, but for most middle class people and upper lower class people who will be buying these

programs, they have to have the money up front, so what we are saying is we'll give it to them up front to buy the premium and pay the cost. by a wholesale repeal of this, you will be driving a stake in the heart of the middle classes' ability to by health insurance. everybody knows the premiums are going up. everybody knows that. we're experiencing it as members of congress. everybody's experiencing, and if you are going to have a system in this country that is fair and covers everyone, you have to figure out a way to help people pay the premiums. we did it in this bill, and by this wholesale repeal, you are # simply -- you are simply wiping it out and saying to the middle class, you are on your own. good luck. if you want to repeal the bill,

you're taking away the mandate saying nobody has to pay. we don't care who has insurance this this country, but every single person in this room, almost everybody here is paying about $1500 a year more for their health insurance because they are paying for all the people walking around without health insurance. that's not fair. why should i have to pay for somebody who doesn't have health insurance? why don't we get everybody into this system and get them to pay at a level that they are capable of paying, and this tax credit for the middle class is, it is the bedrock of this thing working. now, you can talk about all the other things that are in this bill about putting your kids on to age 26 and preexisting conditions and rescissions and all of the other reforms that have already gone into place, but this is one that is out there and has not taken hold

yet, but if you take it out, you are basically tipping this bill over and creating all the problems you heard about with the costs in this country. now, we simply have got to control costs, and we have to do it first by getting everybody in the system so that you can then begin to control the costs nationwide. right now we have people riding on the system. we got whatever you want to say, 41 million to 51 million people who are not having any insurance in this country, and you and i are paying for it whether we like it or not, and it's much better if we have a mandate that everybody was in, and then we can figure out how to subsidize those people who don't have the ability. this bill presently has it in place, and you're sticking it not middle class, and i watch

the last couple weeks before christmas while people voted against the middle class again and again and again and said, well, we will vote for the middle class tax cuts if you give cuts to the people who make a million dollars a year. you're worried about those people. well, this is the time to worry about middle class and their health security. you just remember one fact when you judge whether this should go into the mix for tomorrow or next week. 62% of all personal bankruptcies in this country come from unpaid medical bills. it is the biggest siping l worry that -- single worry that middle class people have in this country, and what we did in this by was to take away that anxiety. now, if you think we ought to go back and give that anxiety back

to the people, good luck. i think that is inhuman, it is cruel, it is not a just society, and that's why we're offering this amendment because the middle class needs somebody to protect them and help them deal with what all of us know is going to happen. there isn't anybody in the room who is not going to cruise a doctor between sometime and between the time they die, but we all know we have a piece of plastic in our pocket that we can hand in and get taken care of, but there are going to be 32 more million people covered if we keep this bill in tact, and that's why this is such an important amendment. i thank you. >> thank you very much. mr. thompson, i believe you're next. >> thank you, madam chair and members. i'm going to speak specificically about an amendment before the committee. it's an amendment that i'm a coauthor of along with mr. hien

rick, and he'll be speaking on this later and mr. pollone. there's been many good issues raised throughout the course of the testimony today. every one of them is perfectly valid, and every one of them pointing out a very serious problem that our constituents will all face if this bill is in fact repealed. i do just want to double back on one thing that the previous speaker talked about, and that's the amount of money that every one of our con constituents has to share and pony up because of the people who don't have health care and just to kind of put it in perspective, i represent a large rural district in northern california, and last year alone the uncompensated health care costs in my district alone were

$70 million, and as we all know, you know, the good fairy doesn't come in with that money to back fill. that's somehow spread out amongst the rest of us who have insurance or taxpayers or it's the rest of the community that suffers as a result of that. the amendment that we have is pretty simple. it states that the repeal that you're trying to put forward and you'll bring to the floor next wednesday won't be implemented unless the omb in consultation with the cbo certifies that that repeal will not shorten the life of the medicare trust fund. this is particularly important because the medicare actuary preifly estimated that the -- previously estimated that the bill you want to repeal added 12

years to the solvency to the medicare trust fund. if repeals shorten or ends the life of medicare, members of congress and the people we represent at home should know this, and more important, it shouldn't go forward. medicare is a trust that we have with the voters. people have worked and paid taxes all their life to make sure that they can have access to affordable or more affordable health care when they get older. we certainly shouldn't push that trust over the cliff. i believe that your bill, the repeal will in fact shorten the life of the medicare trust fund significantly, and it will do it by ending some of the important reforms # that we were able to get passed in this bill, reforms that eliminate waste from programs and make medicare more efficient such as the e -- illumination of plans and the

fact that private medicare plans send 85% of the money on medical care, and the expansion of the waste, fraud, and abuse detection provisions as well as the expansion of the payment models # that we've put forward that are more efficient such as the accountable care organizations, our value based purchasing. under your repeal measure, it likes like the medicare trust fund will be insolvent by 2017 threatening our ability to maintain our commitment to our seniors, and putting their benefits at riff. at minimum, those of us in congress, the people that we represent, the health care providers across this great country should know the cost of the bill we're passing. i mean, we should know this. we shouldn't be passing a bill that we don't know what it's going to mean if it were to

become law. you don't do that in anything. we've heard over the last few days how we node to act more like businesses. some of us in this room have an experience in business, and i don't do anything in my business that's a small farm unless i know what it's going to cost and what it's -- and if you do something on one end of the farm, you want to know if it's going to bring about cost on the other end of the farm. you just don't really willie-nilly things without having a complete analysis of the impact, and moving ahead with this, we don't have that full analysis, and we need to know what this means for the people who rely on medicare benefits, and then i'd be remiss as a sole blue dog on the ways and means committee if i just

didn't mention the fact, and you've heard this before, and i apologize for being redun adapt, -- redundant, but the cbo says if you pass your bill, you will add $230 billion to the deficit in the first 10 years and more than $1.2 trillion in the second decade, and that is absolutely contrary to every campaign promise that has been made right leading up to this last election and every promise that's been made after this election. we need to be conscious of how we are spending money. we need to be conscious of our debt and our deficit and this bill flies in the face of that, so i would urge you to make an order this amendment and let our colleagues on the floor on wednesday have an opportunity to pass this to make sure that

medicare folks who rely on medicare, the people who we represent that rely on medicare will know that their medicare will not evaporate if your bill passes. thank you. >> thank you, mr. thompson. >> thank you. thank you, madam chair. i personally believe that all of us in this room, and i do believe this or else i would not say it,ment to -- want to resolve these very serious problems. particularly today we're talking about health care. as members of the ways and means we've talked about it and talked about it as you all know. i'm very proud of what we did, and i didn't like to be very frank with you. in 2009 and in 2010 in going over the numbers that came out

of cbo scoring our bill. well, what else are we going to come up with to save money? that was a favorite line, but a true line because we really wanted to find a way to pay for what we wanted to do, and we changed it. if you look at the bill in the very beginning and what we finalled on, we did listen to a lot of people, republicans independents, intels democrats. it's not a perfect bill by any stretch of the imagination. there were things i didn't like in the bill and things i wanted to have in the bill that we didn't have, but that's how a democracy works, but i hope what comes out all of this, and i realize you have to respond to the commitment you made in your cam pape, u -- campaign, and i respect that. i've talked to my constituents in many forms, and i've asked

them to raise their hand if they were against the following, and i would ask you, and i do this simply in a rhetorical matter. i ask you to think about this and how you answer my question. would you be against closing that medicare gap under part d? would you be against that? people going to the drugstores today and finding out you've reached the threshold, mrs. allen, you and -- and you have to wait until next year. would you be against children being allowed to stay in a family's health plan until the age of 26? many of us had this experience by the way. would you be against helping americans with preexisting conditions by affordable housing? i haven't found anybody by the way, that was against that. maybe you have.

in one of the forms that i was in, it was at the debate with my opponent, and he didn't raise his hand. i was good so far. are you against insuring american families to avoid medical bankruptcy? businesses all over america, 60% of small businesses failed because of health care bankruptcy. couldn't pay the bills. now, we certainly can't, you certainly can't be blamed for what happened prior to health care een actment, but you certainly could blame us as democrats who voted for this bill and made some promises within the legislation whether we liked all of it or not to how it's going to come out, and how it's going to change american lives for the better, and in

debating these amendments today and i'm speaking specifically to the preservation of access to primary care service, and i was very proud of my heart in writing that part of the legislation because if we're going to have more people enter the health care system, which we want, and they are not all poor, madam chair, they are not all poor, they just have no coverage. they can't get it for a lot of reasons. you didn't create those reasons, and i didn't create the reasons, but they can't get it. the amendment i'm talking about is very specific and we made it specific with the creation of the national health care work force commission to provide dollars for states which would comp with the wrong strategies to respond to the shortage of the primary theres, -- doctors, nurses, and primary

care helpers. that's critical. that's in wop of these amendment -- that's in one of these amendments, and in fact, i'll read part of it in section iii. we should not certify in the decreased financial support for work force training, for primary care practitioners including physicians, nurses, and physicians assistants as providing under title v in section 10.5.01 of what you are suggesting unless you think there's plenty of doctors and nurses out there, this forecast makes it worse ten years from now. we need to address it whether we like it or not, whether we have the health care bill or not, we need to address that issue in that shortage. often times in this debate, we have heard over and over again

the opposition suggested that reform would ration health care for our citizens. in fact, that was one of the first criticisms of the plan in the first place. you're trying to ration health care. well, if you repeal these health work force provisions and many other things in the act, you would limit access to care for americans, and if that isn't rationing, i don't know what is. it's kind of like the pothole in the kettle black in these debates, and i'm sure it felt that way on your side as well, so if we want to come together and really resolve this and we don't want to jump offer the backward too soon because once in the water, there may be no one else to help you there, so we need each other. i would have done the process differently, but i'm one vote,

you're one vote, but there's so many great things in this act to simply remove it like been here, get it over with quickly. i do nothing. i do nothing. we won't see the profit of it ever. we while the opposition be willing to raise their hands for the care of americans? that's what you have to ask yourself and what i have to ask myself. there are many other things i would have liked to have seen in this legislation and there's some things i wanted to take out. we can come together if we don't read the script, you or me. if we look at this in a scientific way, an honest way, i think we don't have to be harsh

with each other, and i'm not suggesting we are right now, and i think we can come to a resolution to this matter, and in conclusion, let me say this. you must read the cbo report, not just the synopsis. i ask you to read it, and we should debate it on the floor. thank you, madam chair, for your curtesy. >> i have a copy of it. i think you're next. >> thank you, madam chair, very much. thank you for being here at such a late hour. we express our thanks for the opportunity to put our ideas on the record. i'm here to support the amendments and testify against any rule allowing for the wholesale repeal of the affordable care act. in my view, repeal will harm job creation in our country certainlily in the important

health care sector which is one of the few sectors growing in ohio and in our nation. it will hurt the affordability of health care premiums for the middle class. it will increase the deficit and squelch profitses to allow more affordable plans for everyone. the repeal will destroy jobs and repeal will destroy the components of the bill that were specifically drafted to combat waste, fraud, and abuse and to stop the unfair and irresponsible insurance companies. frankly on premium costs we need more competition in insurance plans to reduce prices in the part of america i come from, and i would goes you too.