get a little bit dark. so let me turn to the secondary where i think that we need to improve, and that is manufacturing. would it upset you to learn that lithium-ion battery technology was invented in the united states back in the '70s, but in terms of manufacture, until very recently there was no scale manufacturing of lithium-ion battery in u.s. that was done in korea, japan, china. it should not be that way. so we need to fix these two things. creation of large home markets and the establishment of domestic manufacturing. because here's where i could become quite concerned as we move forward. and this is a very important point. a number of people at making the consumer electronic show in las vegas. i was there on friday. when you look at that show you realize the following observation.

at the center of manufacturing and other initial consumer adoption or international adoption of new clean technologies is outside the united states, the focus of innovation will follow. in other words, as he these an associate devices gain broad consumer adoption, in the next few years, we will receive so much data about how consumers actually drive, batteries actually charge and discharge, and how consumers will modify their vehicles, and that's what they see as was all about. that the next technologies will spring directly out of that feedback loop. and if you are not sitting in the geographies where that feedback is taking place, you will lose your innovation edge. so having made a picture a little bit dark, how to resolve this? i've got a couple of ideas, and by the way, this doesn't

necessarily have to involve government money. outside clean technology, i will give you the example, remind you of the example of seatbelts and airbags. this is decades ago when they were to new technologies. initially to some extent, opposed by the industry because they were said to be expensive, and because consumers, it was said, would not favor them. what we did in this country is introduce a sustained federal policy, and use that policy to drive volume, and use that volume to drive costs down. and the result as we all know has been the savings of tens of thousands of lives. so, putting issues as bruce has counseled, to speak in the world of the real, putting possible federal clean tech subsidies aside and putting aside taxes on carbon, although i will note that other competitor countries

have decided those policies are worthy of exploring, they have been enacted in various forms already buy competitor nations in the e.u. and asia, and they are already having an effect in those nations of adjusting innovation and commercial behavior, consumer behavior. toward a future more free from future oil that our future will be. but putting those aside let's talk about a couple near-term things that could be done to foster innovation in the ev and battery every in this country. i will go in great depth, bruce, but you and am a result -- but q. and am a result. time of day, if you drive electricity usage, in the afternoon to spreading it more evenly over 24 hour cycle, utah's renewable technologies and a whole series of smart grid devices and you will learn in

this country which innovations are most profit. secondly. i credit system. there are zero emission credit vehicles operating in california and about 13 other states. those have been, those involved no tax dollars at and what they do is draw money from people producing all the gasoline burning cars, and move that money through a series of calculations to those producing clean energy cars. you could do that. has also been discussion of a rebate, apply to new cars. feebate are generally discuss for cars out in the vehicle fleet now. finally, acceleration of corporate average fuel economy standards. this has been something where the u.s. has made significant

strides in the last few years in regulation we now include, for instance, the lincoln navigator as a car, but as you know the largest vehicle in the u.s. are the ford at 150 truck et cetera. those only recently have been included in this regime. and it's a good development, not on the numbers, all of our competitor nations are ahead of us. they are using that type of regulation to drive fuel economy and to drive clean technology transportation forward. we can do better there. i will stop, bruce. there's a lot we can do. >> michael, you can talk about the full spectrum on this. building on the last panel in, but i want you to focus on the effects of this transformation on american workers in this regard. and it really builds from what jeff said. when people hear green economy, what they generally here is,

well, that's about the environment, or potentially, that's about tax. we are going to basically raise either specific taxes to lower consumption, or we're going to raise taxes to invest in certain kind of infrastructure. what they don't here are the benefits, potentially, from jobs created or for certain kinds of jobs created that a certain wages and incomes. what is the folder opportunity picture as we sort of talk about the transformation of the economy? >> you know, i was going to pick up on jeff's economy that green is too precious. i think two of the most urgent problems this country faces, although is not the topic we have been talking about, the first is american competitiveness. and it's not at risk of tomorrow. it is today and it has been at risk for the last three decades.

spent we are living up to go live to the white house for the daily briefing. you're a spokesman robert gibbs. >> -- here is spokesman robert gibbs. >> mr. feller? >> thanks, robert. an op-ed this week, when you look at the timing of this, the intent here is that also tap into the widespread concern spread by the tea party, republicans, about government intervention? >> known. this is something that the administration and elements of omb had to work out for quite some time. and i think it sets out what the president believes should be are very commonsense approach, which is to ensure the health, the

safety, the security and protection of the american people, as well as understanding that we shouldn't do anything unnecessarily limits our economic growth. that's been our approach. i think if you look at the history, look at things like the rules around fuel mileage standards, i think you get a pretty good, you make a pretty good case of the administration working with all the stakeholders to improve the situation to save us as mentioned, i think in the op-ed, billions of barrels of oil over the course of a lifetime of this rule. and ensure again, the health and safety and welfare of the american people. >> and let me -- let me look at it in a different way, in essence this is a call to

government to make sure that regulations are strengthen. why has that taken to your? >> again, we have had an approach since coming into office that ensures that what we are doing makes common sense. this is, this is what the president wanted to do to outline, to outline in providing our approach to ensure that we look back and make sure that the effort that we are undertaking and the efforts that have previously been undertaken from the federal government are done so in a way that makes sense. that protects against the health and safety of the american people, and balances, balances the important need for economic growth. looked to my ensure, as it happens in this town, to add a

political label to this or that. the president believes it best to find a commonsense approach. >> do you think that balance is happening right now be? well again, understand that in the op-ed we're asking that could be a process where we look back at what is on the books and ensure that there has been an analysis as to the cost of the benefits, given where we are. and the president believes that is necessary and appropriate. >> i wanted to ask you one quick thing on health care. the storyline on the houses efforts to repeal the health care law is pretty much include is not going to go anywhere in the senate, and, therefore, not become law. but i'm wondering is there a negative consequence to the very fact that the house is aiming to do this, would impact the public or the debate is?

>> well, on one hand, ben, i do not, i would share the belief of many, including i think and enunciated by those are going to vote for repeal tomorrow, that this is a serious legislative effort. i think first and foremost they have largely acknowledged that. secondly, i mean, let's not misunderstand though one in essence the mood says biggest is let's put insurance cover his back in charge of making health care assistance. and with that, the option to deny health care coverage, drop health care coverage, limit health care coverage, or cap health care coverage, let's understand the practical impacts as the congressional budget office said just a couple of weeks ago, the impact to several hundred billion dollars on our deficit in the short term, and

then over a 20 year period of time, a significant increase in the cost to the federal government. and understand the practical impact on what this means for seniors, dramatically increases their out of pocket costs. no longer will they get the help that they need, or that they got through the affordable care act, with a prescription drug costs falling in the donut hole, falling and that sort of great area of not getting any help until they spend a certain amount of money. having to pay out of pocket now for preventive health care costs, right that is now guaranteed for free in the legislation. so, i don't think it's going anywhere. i do think it's an important symbol to the american people about what, but some, who some people think should be in charge of making health care decisions. not families our patients or doctors, let's put health insurance companies back in charge, giving them the ability again to drop, deny, limit or

cap your health care coverage. and i would point, as i'm sure many of you read the articles today, the notion that almost 130 million americans have, according to the department of human health and services, a condition that would either trigger a loss of health insurance coverage, or an increase in the amount of money you pay to get that, to get that covered. that has real impact on the american people. spent a couple questions on the chinese summit. president hu jintao in response to questions and newspapers over the weekend suggested that he was resistant to u.s. pressure, and let their currency rise when tackling inflation. how competent the administration on that, they will get positive move it from the chinese on the currency issue? and -- >> first and foremost, i think this is a relationship that has

come as you heard secretary geithner and our national security adviser tom donnelly talk about last week, it has certainly generates positive economic benefits for the american people, to the tune of $100 million, soon to pass more than $100 billion in goods and services to china this year. at the same time, we believe more must be done in terms of their currency. obviously, with inflation there are some impacts on the real value of the currency. they have made some, they have taken some limited steps despite the answers do we value their currency. and i believe treasury secretary geithner in your just friday say we believe that more must be done. that is an opinion that is felt

not just by this country but by many countries around the world. >> and also, corporate deals are expected to come from the summit. [inaudible] >> are you expecting one to come down the pipe on that? >> i would direct you to what tom said on friday. this is, this is a little different from our trip to indy in a sense that, as i said, the economic relationship that we have with the chinese is different on a scale with what we do with india, which is why some of the commercial diplomacy around the indian trip was so significant. so look, obviously we continue to believe that american companies produce the best products in the world, and that they have a demand from china.

i have not been told of any big deals that will be rolled out tomorrow, but i'm certainly all years if anything happened. >> some concern in the u.s. aircraft industry that some deals, specifically the boeing order might be held up by political friction, if other areas of progress -- is any truth to this? from the chinese. >> look, i think it's important. look, we have a relationship as i said that yield substantial benefits, at the same time we have some, we have some direct and difficult challenges. some of those will be discussed. most of those will be discussed tomorrow. you heard against secretary geithner discuss the steps as you have for many months on currency that need to take

place. the role the chinese have to play in dealing with countries like north korea, just as they've been helpful in getting with sanctions with the u.n. on previous sanctions on north korea, as well as sanctions around the islamic republic of iran. so, there are a whole post of issues and topics that we anticipate that the two leaders will discuss tomorrow before meeting with you. >> the administration, the president has talked quite a bit about pressing china, and secretary clinton advance a trip also said that will be a major topic of conversation. has there been any success getting them to move on any human rights issue is? >> well, look, obviously that is a topic of some significance that the two leaders will talk about. president obama was, put out a

very forward leaning statement upon the awarding of the nobel peace prize, that he should be free, a survey should be free to go to oslo and accept his prize. we will continue to have difficult conversations, but necessary conversations that had to be had with china, and we will do that again tomorrow. [inaudible] >> again, i think this is, this is, this is a long road. and whether we are dealing with economic discussions, whether we are dealing with those in the security realm, or whether we are dealing those with human rights, i think this is an argument that we have and will continue to make with the chinese, and push them to do better. >> you said earlier that the

efforts of repeal health care in the house, he mean it can't pass the senate and the president would veto? >> i did something is it's going anywhere. i'm quoting some of the many members, new members of the house that has said this isn't a serious bill. >> there's a new poll i'm sure you've seen it has some nice things with the present in it, but also in that poll is the fact that the president and republicans are tied on trust to handle health care. so whether or not this repeal effort actually has any hope of actually becoming law, which it does not currently, their public relations, they're talking about this issue has been good for the cause. >> except for -- i think you should be clear that that question though does not matter repeal. and when asked specifically in other public polls, we've seen

repeatedly, and recently about repeal, there's a significant number of people, and some of them i presume are republicans, that did not want to give up the very benefits that i outlined a minute ago, but want to see -- maybe going to see something that is work on that is improve. that certainly -- were you pick a or b. so i think if you bring some of the question now, you see that the notion that there is some vast widespread support for doing away with the affordable care act, raising the deficit, putting insurance companies back in charge, there are a whole host of things that even republicans don't find suitable and tenable. >> i'm not taking -- i'm not talking about that specifically. i'm talking about the fact that republicans seem to be gaining ground when it comes to the public support on the issue of health care.

and the president is losing ground. just moving forward on health care issue. >> again, i think the question doesn't measure the breath of opinion, certainly even around the health care issue. >> defensive end response to -- [inaudible] >> obviously this is an important and crucial time for the people of haiti. and we would -- [inaudible] >> haitian officials took him into custody. >> i would mention that any political leader or any former political leader should focus, not on him or herself, but i'm making progress towards a set of important elections, and dedicate their time and energy to the reconstruction of the country. thank you. >> robert kahn human rights question. does china have to make significant steps in addressing

that issue before this relationship with the u.s. any in a significantly? >> again, i think, again, i think as you heard others talk about, again, as you heard geithner and tom donnelly talk about actually, there's a series of baskets i think as tom call them, or things on issues, that will be part of the discussion here tomorrow. human rights is certainly an important aspect of that. the economic relationship we have, and then this security of that region of the world, and of the entire world, are important in the role that chinese most play as world actors. so i think it is, i think again, there are a whole host of issues that will be on tomorrow's docket that the two leaders will work through.

>> give more weight to the human rights issue? >> i think there are a whole host of important issues that will be discussed, and we hope will be ultimately addressed. >> you talked about the process of looking back, can you explain more about how this process will work and a timetable? >> let me check on see when a timetable again. but this is for the relevant agencies to go back and ensure that the regulations that are currently on their books, again, go through a process that measures the costs and benefits that ensures, again, i think the very commonsense idea that we must protect the health and safety of the american people, and not impeding our economic growth something i think, i think we can get a large number of people in this country to

agree. >> improving the relationship with the business community? >> this is something that has been long in the works. >> thank you, robert. secretary gates, clinton, and geithner all have speeches which some described as kind of a shot across the bow with some fairly tough talk. how tough is the president going to be compared to previous meetings with who is going to be more assertive, more confrontational with him on the past like currency and human rights, north korea and iran? >> look, i think all those, chip, on the docket. all those are issues the president has brought up with president hu in the past and will continue to do so. i think speed is the more confrontational side and he has in the past. >> i think it is pretty safe to assume that some of those issues are not issues that china wishes to speak about, and the president brings up, because

there are important to our standing in the world and our relationship with the chinese, and i expect him to do so. this is, again, we have a cooperative but a competitive relationship with china. and as in many bilateral relationships, we see the benefits of that, and we understand the difficult challenges that lie ahead. you mentioned iran and north korea and the security basket, security is important. i would say currency and trade in the economic basket, and the very important issue and real issue of human rights. >> let me put it this way. will the president continue what he is the doing and of his previous meet our with the ratchet up the pressure? >> i think you have an opportunity, one, to talk to the two leaders tomorrow, and i

think the president will be firm in outlining the important beliefs of this administration and this country. >> president hu's end of his term is on the horizon, and they're that with the fact that there are a lot of reports out there that he simply doesn't have the power that the previous leaders of china had. does that change how the united states deals with china and the president deals with -- >> let me not speculate on that. i think that, you know, i think this is the eighth meeting between these two. we believe, again, this is an important venue with which to raise some of the concerns that you talked about earlier, and i don't, i've not heard the concern that we are not meeting with the right person here. >> does the fact that the

president is last year's nobel peace prize winner give him different -- give him pause about holding this peace prize winner in -- >> i think it would if we hadn't spoken out so forcefully about that, but it doesn't because again, our response both on the day of the awarding of the day of the ceremony were to call directly for the chinese to release the award recipients so that they could rightfully claim that prize. and i have no doubt that that would be a call again tomorrow. >> on a different matter, republicans have made clear that they want commitments to cut spending in addition, in exchange for raising the debt ceiling. is the president willing to go, go to basically, in exchange for

raising the debt ceiling? >> well, the president is happy to have a very serious conversation with all those involved, about the path to get us, about the path we must take to get us back to some semblance of fiscal responsibility. this didn't start either vision or even two years ago. we didn't get in a situation -- we didn't get in a situation, in the short term. we got in this situation over a series of many years. so i think you'll see serious proposals, as you have in the past when we froze nonsecurity discretionary spending. you'll see serious proposals in the budget to do that. i also think we have to balance that against important investments that need to be made, and ensure that we don't see draconian cuts in things

like, particularly and innovation and education. >> and finally, the state department commented about christians in iraq, egypt and nigeria recently. has the president briefed on this? does he have -- >> look, i have not heard the overarching theory. again, i would point you do what state has on a number of occasions responded to this, and obviously, the series of events that has happened, the president has, is aware of, and i know both at state and that nsc they are closely monitoring. >> the platform of a state dinner to the head of the country his human rights violation, units of his human rights record is one that as a

country with consulate criticize, and it's one thing to other bilateral relationship, that sort of -- was there any pause inside the white house about getting a state dinner platform? >> no. look, i will say this again. i think the president had occasion to meet with, late last week, again, those that express, as he does, reservations about their human rights record. ..

somehow giving them symbolic state dinner, almost, it gives them a little bit of a, like, well, we bring it up, you can do that with the same type of meeting. you've met with the premier without giving him -- >> chuck, we have met with them on many occasions. we had a state dinner in china. it was brought up before that. we've had bilateral meetings at economic summits like g8, or g20 where it has been brought up. i think the president's belief is it is posh to speak out as he has done and important to bring this up directly with them. >> at a state dinner? >> i think the president will bring it up inside the oval office and bring it up inside of the cabinet room where the expanded bilateral will be. that is, that has been what he's done on every other

occasion which he has met with either president hu, premier wen or others in, in the chinese government. >> i want to follow up with this question because we've asked this question before and you guys have no problem answering it on pakistan, which is the whole who is in charge question. well the whole of government. how would you describe sort of the power, when you're asked, when you're giving a briefing when you ask, when you get a briefing, how is the power structure of china described to you? could you share that with us? >> well i, again i would refer you to the answer i gave chip. i think we, i think we're meeting with, with the right group of people. i think it's important to understand you may have causes and concerns that you take up with a broad array of people. i think president hu clearly is, we're meeting with the right person. >> finally has the president

spoken with senator conrad? did he find out, did he get a heads up that senator conrad was going to announce? >> i got an e-mail on it. several of us were on it. i do not believe he has had an occasion to speak with senator conrad yet but i'll double-check on that and, see if that has -- [inaudible] >> going back to the regulatory initiative, the health care reform, the wall street reform law, the law to give regulatory power to the fda over tobacco, all very recent. are they going to be part of the review on cost benefit analysis and perhaps more importantly, are they going to be part of this new effort to try to see how small business can be either exempted or given, basically cut more slack for the new regular, under this new regulatory regime? >> again, let me, i think

that the op-ed outlines areas that the the president has directed age his to look at either going backwards or going forward. either rules that are on the books or proposed rules. so obviously some of that, john, i think some of what hinges on your question is whether or not those are in existence or if they're being promulgated that the idea of cost and benefit analysis in a way that ensures that common sense, that common sense rule that i outlined, is important. i would point out that small businesses get, for those that will offer health insurance to their workers, a healthy tax cut. and i think that would certainly show up in any analysis that's done of anything going forward. >> right. a lot of these rules, especially in the wall street bill, a lot of these rules are being

promulgate and and they will really be critical to how this legislation actually comes out. is the president asking the regulatory agencies to ricci think the way they approach the signature issues of the president. >> the president is demanding, not asking but demanding as we set forth rules that implement legislation that we take into account, again the common sense notion of balancing the safety and security and the health of the american people with, with the, with whether or not that makes sensenbrenner or drags on our economic growth. but again this, that is that's what the president expected us to be doing. that's what the president expects as we move forward with, with any rules. do these make common sense? i will say that, i think you can point to financial

reform as the cure for a massive, massive regulatory failure. i have no doubt that the cost benefit analysis of what we have gone through and continue to go through over the past two years is one that would find both health care reform and particularly financial reform on the positive side of that. >> robert is there a final agenda for tonight's dinner? >> i do not have one. i think, again, i think you understand the topics. i think the president believes, as he has done with other leaders throughout the world, that this provides a bit of an informal setting in which to have some of these discussions the president will be joined by secretary of state hillary clinton and national security adviser and obviously an array of interpreters and i think he believes this is an important, an important

venue in which to begin making some of the points we expect to come out over the next couple days. >> will we get a reedout? >> i don't know we're planning a readout. we might have a photo that pops out on this, roger. i'm sorry. >> speaking directly to the chinese, is the right way to raise issues of concern, why does that policy not apply to cuba? >> i'm sorry? >> why does the issue of speaking directly to the governments we have concerns with not apply to cube bat? >> i, look, i think, i think the cuban government knows many of the steps that it needs to take to make progress over the course of many years that that are important and the american people demand. obviously we want to insure an engagement with the cuban people and and that's why you saw the president has

over the course of a couple of different times in his administration taken steps to insure that that engagement happens directly with the cuban people without propping up a government that that continues i think in the opinion of many, to fail the cuban people. >> is that what friday's directives were about? >> speaking of china there is a meeting with ceo's tomorrow as part of the agenda. can you talk a little bit about that? what is on the agenda? about how many ceos will be there? >> i think we'll get a list out there. we'll get a list out to you tomorrow. as i mentioned we enjoy economic benefits through the export of, being on track to export more than a $100 billion in goods and

services to china this year as i said it is an important economic relationship. you will see those in business that have, an important role to play that helps create jobs here in america. as we talk about trade, as we talk about intellectual property rights, as we talk about currency, all of those are things that this administration, along with american business, want to see progress on in china. and that's, that's what, that's what we'll be discussed between ceo's from both countries as well as, as well as the two presidents. >> let's talk about breakdown of barriers meeting?. >> i think you'll see important commercial relationships that our ceos have and want to expand in china the president believes is important to make a forceful case in front of

both the ceos from china as well as president hu? >> will any of that be open or -- >> there is, there will be a pool spray before that and i think you'll hear, i know you will hear from president obama. in that pool spray i don't have the schedule in front of me to indicate whether that is at the top or at the bottom of that meeting. >> just one other thing back on the regulations, can you, robert, can you think of any particular regulation that is the administration had in mind that agencies are being ordered to review that have hurt growth in the economy. >> yeah. >> can you name an example or two? >> i think the president talked in there about regulations in the op-ed that lack common sense. i think what he wants us to do, and i'm not going to prejudge that review because i think it is important for that review to happen, that we go back and look at and

make sure that the test that the president wants exercised on regulations going forward meets that test on those regulations that are are already on the books. i think, i think that glen, that is not what the ask is asking us, that is the what the president is demanding on agencies and departments. i'm not part of the review team. i have no doubt that that review team will find regulations that lack and do not fulfill the test we've outlined. you know the, look the one outlined in the, the one outlined in the op-ed, you can put saccharin in your coffee and the epa asks you to treat saccharin as dangerous chemical, a regulation the epa dropped last month. as the president said if you can put it in your coffee you probably shouldn't handle it as a dangerous chemical. so i think the question is whether or not the regulations anybody made

find burdensome meet a simple common sense test. >> on the saccharin example, groups of the executive order the money spent on waste is negligible. if that shows the best example, that the regulation really isn't burdensome. >> i think it is important the president is outlinedding a executive order, not agency and department review of all those regulations. that's, that's, the important test here. i think, i think what's important most of all is that, again, we meet a very important and common sense test. can, which balances the very important need for health, for safety and for security of the american people. we understand. go back 20, bo back 30 years. go back to the late 1960s

when rivers were on fire, when there were very, very few rules that didn't allow the emitting of the types of pollution that caused asthma or threatened the health of the american people. we don't want, we're not going to go back to that. there is a reason why those are in place but let's go review and insure that as we're protecting that health, that we're not sacrificing unnecessarily economic growth. but at the same time, let's not, let's not forget the important reason why a number of those, a number of regulations are likely in place and that is to protect the well-being of the american people. >> advocates say unless you give more money to the agencies asking them to go back and review all the regulations is taking the resources from mine

inspectors, oil inspectors, the people that are keeping them. >> i don't see why that would be true. >> well, if there is a limited pie, do this thing with the amount of money you have before that you were going ought and doing before. >> that might by definition indicate a burdensome regulation f a significant portion -- >> what agencies that are doing that? >> if the significant portion of modeling whether what you were doing 20 years ago, 10 years ago, five years ago, two years ago, one year ago, takes away your ability to do that, my guess is that a pretty good place to start. i don't know if that was overly simplistic example that was meant in order to elicit a response that didn't have anybody go back and look at what they were saying. i don't see how that would normally or logically meet the test of what the president's asking, asking people to do. >> is it essentially for new members of congress on monday the president will attend, can you talk about what the intention is and

what you hope to achieve through that? >> obviously there are a host of new members and the president, to have simply to have an occasion to get to meet them, to have them come here, come to the white house, i think all in a larger effort to, hopefully understand not what divides us but what brings us together. i think the president and the team here look forward to, look forward to that reception and to meeting new members and finding again ways in which we can work together to make progress for the american people. >> robert? >> yes, ma'am. >> back again on the state dinner, the president has used state dinner in differing ways and differ approaches to them. president bush likes to reserve them for very close allies to celebrate strong ties. i wonder if you could talk about president obama's approach to this particular state dinner and what his reason for wanting to honor president hu with it?

and also if you could just address speaker boehner's decline of your invitation? >> well, on the latter one, i, i would point you to, i don't know what their response was in declining the invitation. we, we have invited, and this goes to previous state dinners, invited leaders from both parties. and we hope that because of their importance of the relationship that they would attend. i don't know why he declined on this occasion. i again point to you that. >> [inaudible]. >> i let me check and see what the -- >> her stance on that. >> i don't have the list in front of me who is coming. on the first part, look, this is the third state dinner and i think the, two of those three have with

india and now with china, as you heard tom talk about last week, the fastest growing region of the world and one that, india enjoys, india enjoys a very personal relationship with the united states and has through the administrations of president clinton, president bush and now president obama, all taking important steps in visiting in visiting that country. obviously whether it is the secretary of state's first trip to, in her tenure to asia, our visits back and forth to china, to korea, to japan, indonesia, india, other countries in that region, this is a, again, this is a dynamic region of

the world, one that is growing faster than any other and one that needs to have the full engagement of the united states of america. that hasn't always been the case. in this region of the world and given its growth and its dynamism that is something our country can't afford. we would, we have been able to, in sanctions against north korea or sanctions against iran, place the toughest, place the toughest sanctions on those two respective countries because of our ability to bring diverse set of countries on the security council to an understanding of the importance of those sanctions and we want to build on the cooperative part of the relationship with china and deal directly with some of those very

difficult challenges. >> just two really quick ones. >> sure. >> the last time the president came here the ceremony was interrupted. are there any extra precautions being taken to prevent this? and -- >> i think in that case obviously, obviously, i think, if memory serves i think that was largely because the newspaper representing them was at the arrival ceremony. the, obviously we want it we want to insure that we have, the arrival ceremony is important. that it be, that it be respectful but at the same time i think the president again will bring directly up with president hu in his many interactions his direct

concerns on the issues of human rights. >> the other question was just, was it incumbent or did the president feel it was incumbent to have the state dinner because the chinese gave him a state dinner, that you had to reciprocate? >> no. i think this had more to do with what you outlined in the beginning which is the important, the important place that asia and this region of the world represent in, as a growing part of our important foreign policy. yes, sir? >> robert, last week the justice department held a briefing with the first court of appeals the defense of marriage act. president obama says it is discriminatory and it should be repealed. that isn't expected anytime soon because of the current makeup of congress. is there any indication by the president to call the law unconstitutional? >> we can't declare the law

unconstitutional but i'm just trying to make sure i understood that portion of the question correctly. obviously i think, if you look at what was written, i think the president enumerates in there, the administration enumerates in there our belief on, on this law as we balance the obligation that we have to represent the federal government. the president believes, as you said, that this is a law that should not exist and should, should be repealed but, but we at the same time, have, have to represent the viewpoint of the department. >> do you still see legislative repeal of doma happening in the obama administration?

>> i think as the president said that is, given the current makeup of the congress, inordinately challenging. i think he said so in interviews. >> one last question, any regrets about not pushing for when democrats had more control of congress? >> i think we are enormously proud of and grateful for the progress that we have been able to make. "don't ask, don't tell", was an achievement of, i think will be thought of as an achievement not just for this administration but for all those involved, a monumental achievement in bringing equality and justice back. so i don't think, obviously we didn't get everything we wanted to get done done but we're proud of what we did get done. yes, ma'am? >> i have a question following up on the thursday where president hu is going

to meet house leaders. a couple of senators including senator schumer and are proposing that the pass a bill to reprimand china or for currency manipulation. does the white house have position on that? do you even want that and is there any coordination between you and senate leaders when -- [inaudible] >> i would point you to those individuals for some discussion on their legislation. i think, as it relates to currency, i think you heard secretary geithner outline while they have taken some limited steps that more has to be done and that's the message that the president will bring to his meetings. >> has the president ordered the legislative effort -- inches he is mem or through the member of the democrat leadership?

>> the message that the president will bring to his meetings with president hu is exactly what others have outlined. yes, sir? >> thank you, robert. two brief questions, first to follow up on jake's question regarding former president duvalier's return to haiti. you said any former leader coming back should concentrate on human rights in rebuilding haiti, correct? >> uh-huh. >> does that policy also apply to former haitian president aristide? >> i think we're in a period of some uncertainty in haiti. current or former political actors and their supporters should be focused on not what is best for them but what is best for the people of haiti. and that goes for, that goes for anybody, either as i said, in power or, or, formerly in power that first

and foremost, we should be thinking about peace. we should be thinking about prosperity and we should be thinking about what is in the best interest of the people in haiti as we continue to deal with more than a year later the impacts of a devastating earthquake. >> so you have no problem, the administration has no problem with duvalier or aristide returning if they meet that criteria? >> again, it is not for me to divine who travels where on a haitian passport. again, it is, it is our strong belief that the test is not, not a focus on themselves but a focus on the haitian people, particularly in a time of uncertainty as we point toward an election. >> my last question is regarding one of the president's recessed appointments, that of william board man, a former official of the communication workers of america, as the public

printer, now, his appointment came a few months after the president named former top official of the service employees international union to the nlrb. does the president consult with some of the presidents of major labor unions before he makes appointments? >> sure. >> robert, haitian thing one more time. i'm confused. do you support the government's decision to bring him into custody or not? that is where i was confused. i'm sorry i didn't mean to interrupt. >> mine wasn't, look, we're, obviously for somebody to come into the country haiti requires a passport for the country. i'm not going to get into that. i'm not going to get into particular i diplomatic developments that happened while i'm standing up here. mine was a broader answer to whether it is duvalier or anybody else, again, whether in power or out, coming into

the country in a time of uncertainty, it is important that we focus on peace and we focus on the people of haiti. >> does the american government's position stand behind the haitian government on what is, how it conducts its business if that's what they ask? >> i'm sure the haitian government has not asked us or is, we're not on a checklist on what they decide to do in terms of, in terms of arresting people and i'm, again, this happened while i was out here. i have not had a long discussion since i've been out here as you can understand with the national security council about developments have happened while i'm out here so. >> can you see -- [inaudible] >> thank you, robert. according to yesterday, 53% of the chinese think u.s. china relations are getting worse. so how will this state visit promote better relationships

between the u.s. and china? >> again i think, i think that some of that may, may be somewhat dependent on what i just discussed in terms of, there are, there are, there is cooperation between these countries on different aspects of our bilateral and multilateral relationship. there are challenges. there are benefits. and, there are things that must be worked through. so, i know that in order to make progress on certain issues you've seen the two countries work together, despite, again, continuing to have differences on things like continued economic growth and human rights. and i think at that's, i think that's what you will see the president and the two presidents discuss tomorrow. >> and will there be any joint statement after the state dinner? >> just at the press

conference. there will be coverage of the oval meeting. there will be the coverage of the ceos, and there will be coverage obviously, well obviously the arrival, some sort, depending, obviously there is weather-balancing concerns that we're working through for tomorrow's state arrival. but obviously the, the press conference and the questions tomorrow. yeah? >> following up on that in terms of a joint statement. shouldn't we expect some form of deliverables for the united states out of this visit given that the chinese are getting the whole formality of the state dinner and all the objects they desire? tom donilon steered us away from expecting that on friday. >> i steer you back to what tom said. >> say that there is any prospect of announcements of positive developments in any of those baskets and one would be more likely than

another? >> i think we're hoping for, i think we're hoping for and i think the president will outline, president obama will for president hu the steps that we believe need to be taken. whether or not, those happen on a deliverable schedule, we have a relationship with countries that that isn't simply marked by a visit and a series of deliverables. our relationship is one, as you heard secretary geithner and national security advisor donilon outline that our, that are vast and that are broad and that require constant engagement which this administration will be focused in on. tom. >> thank you, robert. i have three quick questions. first i notice in the president's op-ed he talks

about baby formula regulations and saccharin. there is nothing about guns in there, specifically the ban on high-capacity magazines. does the president support that? >> i don't think that's addressed in rules, rules and regulatory system. as i said last week, i'm sure there will be many proposals that will be made out of the events of last week. and, we will certainly examine and look at what those proposals are but i don't have anything additional on that. >> second question, was recently the president told jake that his personal view on same-sex marriage is evolving. i want to know if he reached any new personal opinion on that? if that something weill hear about at the state of the union? . .

apparently i skinned a 15-year-old today. you are asking why not. -i am like old year. bobblehead. >> how essential is the success of this business to be part of this state of the union address? >> this is an important relationship. we have relationships all over

the world. this is something that comprises economics, security, human-rights which are important to the american people. these other issues the president will bring up. the progress the president continues to hope to see as we move forward. this is an important part of our new engagement in the world as you heard, say on friday and we look forward to the visit tomorrow. [inaudible conversations]

>> this afternoon house republicans begin their debate to repeal the health care bill passed last year. seven hours of debate have been set aside with a vote on final passage affected tomorrow. see live coverage on c-span as they gavel in. health care debate begins at 3:00. in a couple minutes legalized at the capitol visits center, get underway a hearing of the republican health care repeal and the future of health care being held by the steering and policy committee. among those speaking will be patients who benefit from the new health care law to look at what they stand to lose if it is repealed. live coverage on c-span2. it will start any moment.

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>> the visitors center and capital hill waiting for the meeting and republican health care repealed and the future of health care under way is held by house democratic steering and policy committee. we will hear from patients this stand to benefit from the new health care law and also talk about what they stand to lose if it is repealed. live coverage will start on c-span2.

a [silence] >> good morning, everyone. let's see if we can get this to -- do you know how to turn this on? >> we don't indicate -- >> can you hear me? it is on. no green light necessary. good morning. this is a very special day to us because we have some very special guests coming to tell us their story. in the course of the morning our members will be coming and going as we prepare for the debate that we have in the next 36 hours about health care reform. i am pleased to be here and thank the chairs of the steering and policy committee, chairman george miller and chairwoman rosa they lauro and vice shares debbie watson schulz and vice

chair henry clay are. we will be joined by our house democratic leader stanley. we are joined by our system leader, health democratic week -- with steady we're. i want to offer a special thank you to people who came here today to take the time to tell us their story. in the wake of the recent tragedy in tucson we come together with a renewed commitment to civility. we returned to work of congress, let us do so with respect and dignity for public discourse. the best way to understand the impact of the legislation we are facing this week, repeal of patients' rights is to understand how it affects individual families. once again we welcome our special guests today, vernal

branch, lori bresnan, ed burke, dr. odette cohen, alexander lataille, ed burke claudette therrault stacey and daughters hannah and madeleine. our first responsibility as we say over and over again is to create jobs and we are willing to work with republicans to achieve this goal. we believe health-care reform does just that. we are here today to highlight the impact of the repeal, americans already benefiting from the health care law. today we learned district by district impact of the repeal ranking member henry waxman's committee, energy and commerce committee, those figures are available. what we have also learned is 1 twenty nine million americans, 1

twenty-nine million americans have pre-existing conditions and could lose their health care coverage. those under 65, 1 twenty-nine million americans under sixty-five. seventeen million children have pre-existing conditions and could lose their health insurance benefits. in short, they already have, went into effect in december. we will hear the voices of parent, children, students at small business owners, the real places of reform and the one and only hearing where the americans can share their concerns before the vote to repeal their rights. republicans have closed off the processes by not having hearings. the stories we will hear today will highlight the cost, at a time when children with

pre-existing -- people with prostate cancer could be thrown off the -- these stories will remind us of repeals costing the american taxpayer $250 billion added to the deficit in the next decade. on behalf of these americans liberal democrats have made a firm commitment we will judge every proposal that comes before us whether it creates jobs, strengthens the middle class and reduces the deficit. and patient rights sale of all three counts. i can't thank you all for coming together to share your story and stand up for the sake of the well-being and economic security of all americans. now i am pleased to yield to the

distinguished democratic whip of the house, stand a holier of maryland. >> thank you very much. [inaudible conversations] >> i am pleased to be here. this will be the holy hearing where the american people have a chance to testify about -- [inaudible] -- people with pre-existing conditions, small business owners--the most powerful argument is those who won't be heard. >> is it on now? anybody care about what i said previously? george miller says is in the

record. we talking about people with pre-existing medical conditions. small business owners and seniors. the most powerful arguments keeping these new freedoms won't be heard on the house floor. at least from those they affect most directly. they're being lived today. by millions of americans and small businesses benefiting from the reform bill we passed last year. they are our families. our neighbors. our fellow citizens. and they all deserve health care that is more affordable, more secure and more just. just today, h h s released a new analysis showing as many as 1 twenty-nine million americans have some type of pre-existing conditions. they are all under age 65 and could be denied coverage if the

new health reform law where repeal. this is giving americans more freedom in their health care choices. freedom from the worry they will lose their benefits if they kept their coverage. freedom for children with disabilities or pregnant women from being discriminated against by insurers. freedom for seniors to get the prescription drugs that they must have. freedom for small business to make employee coverage more affordable. republican patients' rights appealed bill would take away these freedoms and put insurance companies back in control of their care. and it would dramatically stifle opportunities for our children as well. by piling new debt on them, the

appeal would add $230 billion to the deficit over the next ten years. and $1.2 trillion over the succeeding decade or almost $1 trillion of new debt if appeal were to be affected. we owe it to the people we hear from today to protect these new freedoms or stand against the repeal. i thank all of you from your participation today in the past or in the future. thank you very much. >> the assistant leader. >> thank you. is this working or do i need it? [talking over each other] >> yesterday we celebrated the

legacy of dr. martin luther king jr.. as we look back at his life, we realize that contrary to the notion the personal dr. king was more than a dreamer. he was a visionary. in 1966 speech to the medical committee on human rights. it is concerned about this issue. of all forms of any quality, in justice in healthcare is the most shocking and inhumane. i often think about the constituents from south carolina who told me about our 8-year-old daughter who has cancer and her family had already reached her lifetime benefits limit. what could be more in humane

than repealing patient's rights under this law and telling that mother that the life-saving treatment for her daughter must end? dr. kane also taught us the time is always right to do right. after nearly a century of debate, last march the time was right for congress agree to get rid of these discriminatory practices was the right thing to do. i spoke on the floor, calling it the civil-rights act of the twenty-first century. i did so because it is reminiscent of the era in 1964 and 1965 and we are hearing some of the same rhetoric around patients's rights that we heard regarding voting rights.

does this mean s should not be made? absolutely not. when the civil rights act was passed in 1964 it did not cover public employees. when another act became law in 1965 if did not cover congressional redistricting. the fair housing law wasn't perfect when it was passed and bipartisan changes were made to all of these measures. has we go to the floor tonight and tomorrow to debate this issue, i hope we can look at five policy changes and modifications that will increase efficiency and effectiveness but do not repeal the fundamental rights. thank you and i yield back.

>> i want to turn the meeting of to the co-chairs of the steering and policy committee and thank them for bringing us together this morning as we look forward to hearing from our witnesses. >> thank you for recalling today's hearing. the democratic steering and policy committee meets for the only forum to examine the impact of repealing patients' rights and benefits will have on average americans. the consequences of repeal are real as we will hear from our witnesses today and as we heard from people in our district about the troubles is repeal means for them and their families and their economic security and health security. we will hear from a wide range of but thises across the country how this republican repeal bill would take away new rights and freedoms, the insurance companies back in charge and balloon the deficit. repeal takes us the wrong direction and will cause harm to

workers, small-business owners began to women, children and seniors. this will detail how the patient's bill of rights we enacted last year improves people's lives. our witnesses represent tens of millions of americans with new securities and new rights under the health care legislation. just as a woman from my home town has a young daughter born with epilepsy, under the old law she would reach her lifetime insurance limit at age 4 and her mother would not be able to afford her daughter's costly treatment. the affordable care act is keeping this young woman alive because of the ban on arbitrary lifetime benefits. these stores are repeated over and over across the country. that is what a rush to repeal by the republican majority is so terribly troubling when we recognize the new security this legislation is offering families the opportunity to be crystal small businesses, hundreds of thousands of people have extended the opportunity to have

insurance or working for small businesses for the first time. that is the purpose of this hearing today to make sure people fully understand the real consequences of these hearings on workers and their families and our children. thank you for the opportunity. >> please yield to the distinguished co-chair of the steering committee. >> thank you very much. thank all of you who are here today. is good to be with you. this is a conversation. this is a hearing that deserves everyone's attention. the chair noted we are here to examine the impact the republican plan to repeal health care reform which will be voted on this week will have on millions, millions of american families. we have with us a number of citizens who tell us how the affordable care act has helped them already.

who can explain what the repeal will mean to them? how it would affect their household, how it affects their lives, how it affects their economic security. we look forward to hearing your stories today because it is those personal stories that need to be heard in order for the people in this nation to understand what is at stake. the fact of the matter is the health care reform law helps americans of all ages, young children, college students pick original grandparents, what is a critical time in our economy. and be given back to patients and doctors. you have access to coverage so people get the care that they need and lower costs for everyone. these reforms give americans the freedom to make their own health care decisions while creating jobs and reducing the deficit.

yet the new republican house has me repealing this law its first priority. even though we know for effect that repeal will severely hurt job creation, add to unemployment. it doesn't predict -- protect the middle class to repeal this legislation. in addition to which it adds substantially on to our deficit. according to a recent report by the center for american progress reducing health care reform would add almost $2,000 a year to family insurance premiums, it would destroy 250,000 to 400,000 jobs a year over the next decade and according to the congressional budget office repeal would add $145 billion to the end of the decade and $230 billion by 2020 one. repeal takes away job, causes premiums to rise, adds millions to the deficit. this is not the direction we ought to be moving in as a

nation. we should be working to further strengthen our health-care system, not rolling back of the hard-won progress that we have already made. we look forward to today's testimony and gives me great pleasure to call on the vice chair of the steering and policy committee, representative henry quao quaoar, to say a few words. >> the matter is very simple. we can talk about abstracts or real people. legislation, the attempt to repeal today is to talk about real people. what does it mean? let me give you the district i represent. i represent in south texas progress little a minority of 80%. the tenth most uninsured district in the whole country.

445 -- let me see if i can simplify this in the name of a gentleman who came to my office some time ago. he came into the office scared and a greek. he was suffering from cancer because the former health care system forced him to make a horrific choice. would he lose his home or would he lose his life? he had to make a decision. a lot of constituents have to face that every day. he was diagnosed with cancer. he was head of hassle of a middle-class family. after many years of working hard he had no insurance and he had to pay for this costly treatment out of his pocket and his home would be lost to foreclosure. he was told at that time that there was no solution to his

situation. then the law was passed and from there the pre-existing condition rule was established and therefore now he is receiving the highest quality cancer treatment and after working hard, finally receiving the treatment he is receiving right now. the choice like many americans is do you lose your property or do you lose your life? that is the decision a lot of folks have to look at. we are looking at not only health care but the american people want this to create jobs. i know that the majority is saying this healthcare is losing jobs -- destroying jobs. i would ask you to look at a couple pictures. there was a report that came out that said about 1-third of small businesses that are not providing health care right now

are saying they will now provide health care because of the tax credit and if you repeal that tax credit, that is a tax increase on those small business owners we had. that affects jobs. also there was a report the research foundation came out a year ago that says the health care reform bill will create 890,000 new jobs. specifically, this is the area we're looking at. healthcare related sectors. ambulatory health care, practitioners will increase by 330,000 jobs. an additional 327 will be required in hospital. some 150,000 mourners as will be needed. doctors' hospital, provide locations. even the payroll will be expanded by 76,000 jobs.

those are jobs that will be created by health-care. it creates jobs but more importantly it allows an ordinary american to beside do i lose my life or do i lose the property i have been working so hard and that is the decision. final point, we can either repeal everything, that is the wrong approach, but we all understand the way to address this is fine the points that we all agree and the republicans agree with us there are a lot of points we can go on but if we need to find in the legislation let's sit down like rational adults and work out those points we need to make fine-tuning on. >> i would like to turn to the vice chair, debbie watson

schulz. >> thank you, mr. chairman. [inaudible] i appreciate the opportunity to hold the only hearing that is going to be held on this entire issue on whether or not we repeal health care reform lock stock and barrel and hear from real people who are going to be impacted by the potential repeal of health care reform in the entire process. that is after thousands of hours of hearings on passing health care reform. no hearings except for this one posted by the democratic caucus and shared by the democratic leader. only one hearing. we appreciate the opportunity to hear from real people who will be dramatically affected by the potential repeal. ..

>> face of skyrocketing, astronomical health care costs. and as result of health care reform happening, she cannot stay at her parents insurance and not be kicked off. and her family will not face the threat of lifetime and annual caps on their health insurance

costs that would have potentially bankrupted their family. that's the kind of impact that repealing health care reform would have. is unacceptable, and i'm truly pleased to be able to be here to hear other stories from real americans who would be dramatically impacted by the repeal of health care. thank you, madam chair,. >> i think all my colleagues and i would now like to introduce our panel. we will begin with vernal branch from richmond, virginia, a 15 year survivor of breast cancer who struggle to find health insurance. because of the affordable care act, ms. branch and others breast cancer survivors will never have to worry about being rejected by health insurance company. nextgov.com lori bresnan from ballwin, missouri. she is the mother of a 20 or college students -- a 22 year old college student. because of the affordable care act her son can be covered under health plan until he's 26. and you will never have to worry

again about being denied coverage due to his preexisting condition. ed burke is from palm harbor, florida. he suffers from hemophilia. while he has his health insurance through a large employer he is worried his treatment could surpass the plants lifetime caps. the prohibition on lifetime capsule within the affordable care act will mean mr. burke will not have to worry about deny treatment or dropped from his coverage. [inaudible] >> alexander -- alexander lataille from rhode island is like many students on the 2010 graduating class was been able to find a job that offers health care benefits. fortunately, because of the affordable care act disabled is the on his health -- parent health plan. claudette therriault is from sabbattus, maine. she and her husband was a significant savings in their prescription drug costs as result of the affordable care act. in addition as result from the

paris preventive care included in the law, they are not able to access lifesaving preventive services which they had previously cut off due to cost. dr. odette cohen is a small business owner from willingboro, new jersey. dr. cohen runs a small practice and as result of a small business tax credit included in the affordable care act she will be able to hire another nurse practitioner which means she will be seeing more patients and growing her business and the economy. >> thank you. ms. branch, we will begin with you. >> i would first like to thank chairman miller, chairwoman delauro, leader pelosi, democratic leadership and committee members for this opportunity to share my story. my name is vernal branch and i'm proud to say that i am a 15 year breast cancer survivor. i was diagnosed in 1995 and was

fortunate to have good health insurance coverage through my husband's employer. that same year i underwent a mastectomy. shortly after treatment i begin my work as an advocate for the national breast cancer coalition and for health care reform. since 1995, i have been without a recurrence of the disease. that sounds like a great story, doesn't it? a story with best outcome -- with the best outcome you could hear, when learning a family member or a friend is faced with breast cancer. well, as most aspects of why it was not that simple. in 2000 my husband lost his job and in turn health insurance coverage for our family. he decided to open his own consulting business and elected to continue health coverage through cobra. we remain covered for 18 months, the maxim time that was allowed

for this type of insurance. calvin and i began shopping around for new insurance plans. once we found one that seemed to be a good fit, we applied. calvin and my only son of three still at home at the time were approved. and covered immediately. coverage will be on the other hand was delayed. i was then asked to submit my health records. i supplied the information, but did not hear back for too much. i tried to find out what the holdup was, but did not get a straight answer. a total of four months went by and i found out definitively i was denied insurance. when i asked the insurance representative point-blank if i was denied coverage due to my breast cancer diagnosis years ago, i was met with heavy silence. the best they could offer me was a recommendation to find an employer who would offer me health coverage.

i live without insurance for three years. during that time i broke my foot twice, had to visit the emergency room each time, anytime i had a cold or needed treatment for common ailment, and it is a walk in clinic, all these expenses have to be paid out of pocket. at one point while uninsured i had a mammogram. the technician found a suspicious mass and recommended a biopsy. thankfully, the mask turned out to be just scar tissue but i still have to pay full price at pocket for this costly screening and surgery, which turned out to be a false alarm. i wish i could explain to what it is like every day with the knowledge that breast cancer could come back. and to couple that fear with reality and being uninsured is devastating.

after three years without coverage, my family and i moved from california to virginia. we wanted to start over and look for new opportunities near where my husband and i both grew up and had family support. calvin and i was then able to find work and health coverage through his employer. but for three years i never knew if he would be a recurrence and i would not be able to afford the care that i needed. i lived in fear that cancer returned i would not have insurance to help pay for the treatment to enable me to beat the disease again. and continued living as a healthy rest after survivor that i have been for the last 15 years. for years, i've been a team leader advocate for the national breast cancer coalition. i have fought for health care reform last year. i proudly celebrated the passage of the patient protection and affordable care act. for me, this blog represents

protection from the uncertainty and fear that came with being denied health insurance coverage because of my past disease. it represents freedom for my husband and me to make important choices about our lives and careers without this factor a preexisting condition hanging over our heads. and it means that no other breast cancer survivor will be forced to walk in my shoes. removing these protections would bring a halt to the progress and mean a huge step backwards for all of us. thank you. >> thank you very much. thank you for taking the time to share your story with us this morning. i would like now to recognize lori bresnan. welcome to the committee, and begin thank you for your time and for your willing to share your history with us. >> i want to thank chairman

miller, chairwoman delauro, leader pelosi, democrat leadership's and committee members for this opportunity to testify. my name is lori bresnan and i'm here today from st. louis, missouri. my 22 year old son as a full-time college student, works part-time, and is also a hemophiliac patient with allergies that come with that disease. his condition required periodic testing and leaves them vulnerable to more serious complications and conditions. prior to new consumer protection, he could not have stayed on my family's insurance past this coming june when he turns 23. we were quite concerned about the options that we had at that time, which were for him to go uninsured, hoping for the best, or give a huge premiums if we're able to find coverage for him at all. we now have the right to keep it on our insurance until age 26.

giving him time to finish college and get a full-time job. this law also assures that when that time comes he will have the insurance options available to him, even with his preexisting condition. repealing important new consumer rights means not only that my son won't be allowed to stay on our insurance policy until age 26, but they won't see the day when preexisting conditions don't dictate your ability to get health insurance and they can't charge a astronaut coal prices for conditions you have no control over. many students find themselves in this exact position. well educated youth often have not completed their education by age 23. this legislation is very helpful to support building our country intellectual capital necessary to move us forward in the global economy. allowing us to keep in on our insurance until age 26 came at the perfect time. by 26 we hope you will have a graduate and have a job.

we are thrilled we have the option to keep them on our insurance when families so often struggle to keep their kids covered or left worry about the health of an uninsured child. thank you. >> thank you. i'd like now to recognize ed burke. thank you for joining us. >> , okay? >> i think so. [inaudible] spirit they are not picking up your sound. just hit it once and bring it a little closer to you. thanks. >> house that? >> that's good, thank you. >> i want to thank chairman miller, leader pelosi and my fellow floridian ms. wasserman schwartz -- wasserman schultz.

my name is ed burke and i'm a 52 year-old factory hemophiliac. hemophilia is a bleeding disorder that can be inherited or it can become for me spontaneous gene mutation. i oppose the patient rights repeal legislation being considereconsidered in the house of representatives this week simply put, i will lose the freedom to keep my job. its efforts to repeal my protections are successful. i grew up in the suburbs of philadelphia, pennsylvania, with an older sister and brother and a younger brother. and all three of us boys had hemophilia. in the 1960s when we were boys, the or treatment for an internal bleeding disorder was an infusion, accompanied by a few nights in a hospital. when the medical bills arrived, the folks at blue cross and blue shield would routinely and for my parents that my brothers have a preexisting condition.

and, therefore, the ensure would not cover any medical costs. this denial seems audacious given that both my parents worked full-time job specifically to receive ample income and adequate health benefits for their children. even as my parents paid a monthly premiums for a family of six, the insurance company kept the money without providing any assistance with the mounting medical bills. to me, and the millions of americans with a chronic disease, this was blatant discrimination. but our new protection into this practice, protecting individuals with preexisting conditions and providing families with the security they deserve. there are approximately as you said earlier 120 -- i had 125 million, roughly for more already -- individuals and united states who have a chronic disease, disability, or functional limitation.

these americans account for three quarters of the nation's health spending, nearly all medicare, and more than 80% of medicaid spending is attributable to chronic disease. i bring those statistics to your attention for the following reason, in the mid 1970s a medical breakthrobreakthrough that hemophilia treatment was discovered. hemophiliacs like myself could receive an infusion of a very protein our bodies did not make and we could control our bleeding episodes. unfortunately, this new medicine was and still is very expensive. for me at 64 4 250 pounds -- [laughter] >> looking good. i inches 3000 units, approximately three times a week at a dollar a unit. that's $18,000 a week. so just to factor i need cost me

$1 million annually. this has been highly problematic due to the health insurance industry creation of lifetime caps. on average most americans through their employer have a $2 million cap on insurance claims. and a healthy american with no would have been able to get by for a long time without reaching this cap. but for someone like me, this can be devastating. did i say something wrong? once you have reached your lifetime debt, you would be forced to pay the rest of your health care out of pocket, or to change jobs, sometimes even careers in order to have health benefits and a new cap. in the end, lifetime caps force you to make tough decisions for you and your family. often forcing the individual like myself onto a federal or state insurance program that

other taxpayers like yourselves will pick up the bill for. however, our new patients rights prohibit insurance companies from having such caps. and even remove annual limits so that any insured american can receive all the care they need without fear. leaving them to focus instead on living as healthy a full life as possible. when elected officials are buried repeal patients rights legislation, they are in reality forcing americans like myself, a working taxpaying citizen, back to a world where health insurance coverage is constantly an issue, life-saving care is often out of reach. just so that health insurance industry can continue its multimillion dollar for-profit industry. that, my fellow americans, it's about what's to occur in the halls of congress.

so i stand here today, or sit here today, in front of my representatives come and ask them not to play politics with our lives. i recall last wednesday when president obama regarding the tucson tragedy said he's happy to share with us representative gabby giffords had opened her eyes. i welcome and hoped that the rest of congress will do the same. thank you very much. >> thank you very much, mr. burke. one point i want to ask dr. odette cohen to speak next, but if you listen to people and to know my colleagues, the sector of preexisting condition and its return, i'm a cancer survivor, ovarian cancer survivor. my colleague, debbie wasserman schultz as a breast cancer survivor. and maybe others here who have had similar illness but the fact of the matter is the specter of those recurring illnesses is always there if you have gone

through it, and the notion you couldn't get care if you can't get what you need and it beat and paid for is pretty intimidating. dr. cullen, we would like to hear from you. >> good afternoon. i stated before my name is odette cohen. i'm the owner of son light pediatrics, a small medical practice in willingboro, new jersey, and i'm also a member of the new jersey main street alliance. i thank chairman miller, chairwoman delauro, leader pelosi and members of the committee for inviting here today to testify. small businesses are the backbone of our economy is in new jersey, we account for 98.5% of the states employers. and another 590,000 new jersey residents are self-employed. on behalf of the new jersey small businesses, i thank you for the work you've done, enact legislation to make health care

work better for us. as a small business owner, i oppose efforts to roll back the protections and benefits of the health care law. both my business and my patience stand to loose important benefits if the law is repealed or ordered down. as a small business owner, when i start my medical practice 21 years ago, i was not able to afford medical coverage for my employees. i was therefore not able to compete successfully for the most qualified applicants. i therefore lost many of them to larger companies that were able to offer better benefits. now that i do offer health insurance coverage, i dread my renewal states every year. in 2009, my premiums went up 33%. last year, my premiums went up 50%.

50%. i was forced to change my plan to a less quality plan with higher copayments. waiting for my renewal quote every year felt like being in a sinking ship, but all that has changed now because, because of the new health care law. it has come in handy as it is throwing a lifeline to small businesses like mine by protecting us from unreasonable rate hikes. my business is one of an estimated 144,000 businesses in new jersey that could benefit from the new health care tax credit. the monies that i will get from these tax credits gives me the option of being able to absorb the increased rates that my employees would be responsible for, or pay benefits on additional employees. as these credits and other

incentives expand over the next four years, i am hoping that i will be able to hire one more provider and some support staff. repeating these credits would prevent me from expanding my practice and creating jobs in my community. i am also looking forward to 2014. this is when the state insurance exchange is expected to be up and running. through the exchange, my business will be able to pull together with thousands of other small businesses across the state to be able to access quality, higher quality insurance plans or lower costs. about to scrap these exchanges is a vote of discrimination and a lack of bargaining power small businesses face today in the insurance market. as a physician, i am keenly

aware that health care consumers are not getting fair value for their premium dollars. insurance companies use premium money to pay for things that have nothing to do with health care. things like executive bonuses, lobbying activities, and expensive political advertising, but now thanks to the health care law, small businesses and other consumers can count on having a basic level of value for our premium dollars. and if insurance covers don't meet the minimum standards, we will get rebates starting next year. i think it's about time. small business owners and our employees should have the same right of protections as everybody else. but that's not how things work before the new law was passed. i know this from personal experience. in 2008, two of my cousins,

first cousins, were diagnosed with cancer about the same time. my girl cousin, her name is rhonda, 25 years old, she worked for a large corporation and get health insurance coverage through her job. as soon as she found out something was wrong, she sought help. despite the fact that she was diagnosed with the most aggressive breast cancer for young lady, she is well and alive today because she was able to seek care early. this is not so for my other cousin, roger. who was 35 years old. roger work for a small family business that simply could not afford health insurance. uninsured come he did not seek the care he needed early on. when his pain became unbearable, he went to the emergency room. he had got a couple of times but

this time the pain was quite unbearable. within a couple of days he was diagnosed with end-stage metastatic cancer. roger died a couple months later. the choice to work for a small business versus a large company should not between a choice of life and death in the united states. but it was the choice for my cousin. the new health care law changes that, getting small businesses and our employees the basic security and protections we deserve. these lifelines, tax credits, stronger rate review, new consumer protections, and the insurance exchange is, these all help give small businesses a fighting chance to gain access to quality, affordable health care. as a small business owner and as a physician, i believe we must

continue to advance policies aimed at providing quality care for everyone. we must also advance policies that puts health care decisions back into the hands of patients and physicians. and also, for rewarding quality care. we must not step back into the broken health care system of the past. i urge you to stand with those, main street small businesses and oppose parents, patients rights to repeal legislation. thank you so much. >> thank you, doctor cohen. thank you for your powerful remarks. we will now hear from alexander, our student. >> thank you. chairman miller, chairwoman delauro, leader pelosi, democratic leadership, and committee members, thank you for having me here today.

my name is alexander lataille. this past may i graduated from one of the state colleges with two bachelor degrees, one in atmospheric science, the second in social science. even before graduating i was looking for a job. but as you can imagine the economy has made it harder for companies to our new people are however by graduation day i had to leave but i thought i seek a great prospect would with a great company contracted with the federal aviation administration. nevertheless, due to budget issues, timing and other factors out of my control, the date for employment has been progressively pushed back. although i could find a temporary job, i chose instead to go back to work for a professor at the university of rhode island that i previously interned with. much of his funding has been lost and he is no longer able to pay me as he had in the past. i am currently volunteering there as a research assistant, working with weather balloons, ozone monitoring and data

processing. honing skills in gaining experience, that will expand my career opportunities as atmospheric scientist. the research assistant position like many such jobs does not offer health care benefits, but under the new law i was able to stay covered by going back on my mother's plan after graduation. in my current situation, if i lost my protections under the law i would be faced with a choice. either to pay my student loans or to get health insurance. actually, the truth is far different. i would have little choice in the matter. i need to pay down my college loans first and go uninsured. yet i know how important having health insurance is even for healthy young person like myself. if perhaps i get cancer or get hurt in a car accident, what happens to me? my parents can't afford to bankroll such catastrophic health care costs. i could decide to tip her job and use that income to buy private health insurance. but to do this i would have to

leave my position at the university where i'm currently gaining a wealth of insurance, education, and career mobility. no doubt any future job opportunities will arise because of my experience in turning right now. if i were not able to stem my parents plan i would need to make a sacrifice. by either sacrificing my future career or my health. that's a choice that no one should have to make. with this new law i can stay on my parents plan up until 26 and feel safe as i navigate my career choices and this economy. so again, thank you for your time and this opportunity to speak on behalf of young americans. while my political views on different issues fall across a wide range from the political spectrum, this issue isn't partisan to me. i believe that allowing young people to stay on the parents insurance gives us a new and real freedom to work towards a career goal without going uncovered. i also want to say thank you for giving me this chance to stand

for something i believe in. to make my voice, the voices of other young americans heard on this critical issue. >> thank you very much, alexandralexander. claudette therriault, we can hear from you. thank you. thank you for being here. >> thank you, chairman miller, chairwoman delauro, leader pelosi, committee members, for this opportunity to testify. my name is claudette therriault and i am from sabbattus, maine. my husband, richard and i, are both on medicare. a major new protection for seniors just started this month. medicare now pays for preventive services, but no out of pocket cost to us. last year we made a decision to put off preventive care, waiting until this year to make appointments for my mammogram

and for both of our colonoscopies. the last time richard, my husband, had an endoscopy and i mammogram, we were left with co-pays we could not afford. i was diagnosed with precancerous cells in my breast a few years back, and i was told that i should have a mammogram every year. i'm going on two years right now. i've also had colon polyps and was told i should go every three years. i'm going on five years right now. richard takes a number of brand name medications for diabetes, chronic pain and gastric problems. he enrolled in medicare in may of 2010. june 1 of 2010 he reached the doughnut hole. and i'm holding here, this is just part, this is a pen for insulin. this alone costs $993, for a 25

day supply. and he has been a diabetic for 15 years and have tried different diabetes medications. this is the one that works for him. so after three months of paying 100% of his bills out of pocket, we reached the maximum and started paying 95%. however, we had to spend $4550 out of pocket. we didn't foresee this and it was devastating. this is for house payments for us. we had to choose between defaulting on our loan or my husband's health. we chose my husband's health. fortunately, local charity, and i'm not volunteering there to pay back the loan, but changes made are starting to in the doughnut hole so families like ours are not forced to choose between staying healthy and paying their mortgage.

this year, seniors can get a 50% reduction on the cost of name brand drugs in the doughnut hole. this assistance could have saved us thousands last year. in the past, i have spoken with a few members of our community and i wanted to hear their stories. there is don who just retired last year and hit the doughnut hole in september. he had no idea this was coming. he is no longer retired. he is working two jobs to pay for his medication. then i ran into larry and rita. larry has rheumatoid arthritis. she has cancer, and they wanted to retire at the end of this year. they are counting on the doughnut hole closing so they can survive when they retire. pauline, she is 61 and was hoping to retire in four years. she never heard of the doughnut hole. and as i explained it to her, i could see her face fall, and she was a, oh, my gosh, if this

reads -- if this is repealed i won't be able to retire. just as we can i post post on facebook i was going to d.c. to speak against the repeal of these new consumer protections. the response was tremendous from my facebook friends and from their friends and families. jenin, a former classmate of mine e-mailed me, and this is one that's been single all her life. she is 66 years old and she has raised foster children. she has adopted most of them. a really, really good woman. she still has a child at home. early last year she lost her family, her family home to foreclosure. and is now struggling to continue working to support her child, to pay for her doughnut hole expenses, but she's looking forward to at least sing her doctor for a physical this year and getting preventive care.

these are the stories from my community and other stories of countless others who wanted to choose between the medical care they need, are keeping a roof over their head. if these new life-saving protections are repealed, people will not be able to get the preventive care they need. thank you. >> thank you very much, claudette. and now stacie ritter. please, let us hear from you and your two beautiful daughters. >> m-i on? i would also like to thank chairman miller, chairwoman delauro, leader pelosi, and the rest of the democrats -- student, democratic leadership for the opportunity to testify here on how important it is that this bill not only stays in place but progressives and those forward.

our twin daughters whom i brought with me today our childhood cancer survivors. they were diagnosed with a rare form of leukemia for children at age four. they then had stem cell transplants at the children's hospital in philadelphia. they are 12 now. and very shy so i'm sure they don't appreciate this. stem cell transplants, cancer treatment in general is all very, very expensive. we were very fortunate at the time, my husband had full coverage through his employer, but because we had a younger son at home and i was pregnant, we need to take turns going back and forth from the hospital to be with the twins. my husband and family medical leave. while he was on family medical leave, we can pay cobra to maintain our insurance, and also -- excuse me.

with the cobra payments and our mortgage and your usual bills that you have, nothing extravagant just electricity, food, all of that combined when you're lacking income can run pretty high. we paid just as much for arc over a month as we did for our mortgage on our townhouse. so, in the end we ended up bankrupt. even with full insurance coverage. so for the people who think that i have full coverage, i'm good, don't count on it. because you never know. madeleine and hannah survived, they are here with us today, thank god. but, unfortunately, the treatment for childhood cancer is very antiquated. there's not a lot of money that

is investigated. it's the least funded of all cancers. they endured chemotherapy, total body radiation, and that has left them with a few medical issues that they will have for the rest of their lives. one being growth hormone failure. so there is damaged or pituitary and hypothalamus gland. the treatment for that our shots of growth her moans. they are very expensive. not as expensive, but very expensive. they were covered by first insurance company, but my husband's company was up to renew like every company, and they didn't want to give that same great plan again because we it costs them so much money the year before. so they switch to another insurer, and that insured decided that they knew more than my doctor, who is a world renowned pediatric and a chronology chronologies at the children's hospital in

philadelphia. he prescribed the growth hormone for them. that first aetna covered and insignia said no, not necessarily. experimental. we will not cover it. we don't care what the previous insured. we have looked at and we don't feel it necessary. so, i had to continue to fight with cigna. went to the appeals process and all the things that were there for me to do, and he denied, denied, denied again. my doctors at conferences within. they approved it, and then when their office would follow through to have a built they said no know they should have never approved that when they spoke. denied. so through shame and speaking out in public constantly about this evil practice that the insurance industry seems to

have, i shame them into covering it. but fortunately in the time that we went, i don't have that i was fighting cigna over this, eli lilly, the manufacture of the growth hormone that we receive, they have a bridge broke and set up. the pharmaceutical industry knows the insurance industry doesn't want to have to cover these expensive drugs, so necessary or not, what do you do? they actually have things in place. so not only are we subsidizing the insurance industry, so are the pharmaceutical companies. granted, they are not all, you know, kind of free of guilt but at the same time i am very grateful to eli lilly for helping us with that during that process. so even sometimes someone can still be someone else's friend. for lack of a better way to put

that. i'm sorry. i tend to go off track. [inaudible] >> thank you. in the fall of 2008, i read part of then senator barack obama's health care proposal to my then 10 year old daughters have especially the part about cancer patients in research. and my daughter madeleine began to cry. she said, bob, barack obama really understands. he is really going to help us. her eyes lit up. it is a 10 year old girl who knew that what he had in the state it was the right thing to do for people. she was 10 and she knew. so our new health care rights and freedoms really address what people like us need. our lives would have been much easier when my kids were going through this had this been in place at the time it.

and for the 12,500 children plus diagnosed every year with cancer, this is what it means to them. the health reforms included in the landmark health care act advance critical protections for individuals fighting cancer, provisions in the law prohibit insurance copies from limiting or deny coverage to individuals participating in clinical trials. and as many cancer patients, clinical research is key, is key to finding better treatments. and clinical research is never really covered by insurance. so a lot of great research goes by the wayside because it's underfunded. the cornerstone of cancer research, is what his clinical trial our and he deserved to be covered. after recovering from cancer, children can no longer be denied

coverage due to preexisting conditions. that's one of our biggest fears. so now for our kids and my husband were to lose his job, nobody will want to take us. you know? and in the future, what are they going to do? do they deserve to worry if they will be able to be insured or not? not in my country, no, not acceptable. and also requires all new plans to provide preventative services without charging copayments, deductibles, or coinsurance increasing the access to write a check of that can help detect and treat childhood cancers earlier. because with all cancers, early detection is key to survival. we pay right now over $500 in just co-pays because we see a series of specials every year when they go for their survivorship. so for a family of $6500 in one pop up co-pay is rather expensive. the affordable care act eliminates the annual lifetime caps on coverage.

that helps eliminate one road to bankruptcy for many people. cancer is very expensive. oftentimes kids are caps before people had to cast before the evenly the hospital. -- before they even leave the hospital. they will also prohibit copies from dropping coverage if someone gets sick. giving patients and families that peace of mind that the interval cover the procedures their doctors recommend because just because you have insurance, just because your insurance doesn't cover something, doesn't mean they can't deny it and say no, we're not going to pay for it because in my plan that cover the growth hormone, but they could also refuse to pay for even though they cover. and any other aspect of like, would that be a breach of contract if you're paying for a service? and the company you're paying for that service up and says, no, i don't think so.

they can do that. we let him do that. not under this law. we finally are protecting ourselves from that. it is vital. i'm almost done. i remain convinced that if americans could just hear my story and understand why these protections are so important to millions our fellow citizens they would oppose the patient's right to repeal legislation. my children now have protections from insurance discrimination based on the pre-existing cancer condition. they will never have to see the recession of their insurance policy their insurance policy if they get sick. they can afford to lower health insurance costs and preventative care. no one who understands how important these and other provisions are to so many of us to endorse legislation that repeals these important patient's rights. i am so proud to be here once

again to tell our story, and the story of hundreds of thousands of other americans who have stories much, much worse than this. and i would like to thank all of you who had the courage to stand up and do the right thing, vote for this bill initially, and thank you so much. you have no idea how much it meant to a lot of people. i know you only got to hear the bad because that's all the news seems to want to play. but believe me, it was greatly greatly appreciated. thank you. >> thank you very much. thank you for your testimony and thank you to matt and hannah for a company you today. getting your mom support and that testimony. upon that. >> we are glad you joined our hearing through your right, your stories are never sitting here today, we encountered this in

our district all of the time. that's why we are so passionate about making sure that, as you point out, you are protected now for the first time as are your daughters. so thank you so much for your testimony. dr. cohen, i wanted to say but apparently you are not alone. i notice in a recent story in the "l.a. times" that unitedhealth group indicates that they've added 75,000 new customers who are employees of businesses that employ 50 people or less, and also coventry health care out of maryland reports 115,000 new workers have been extended, possibly of coverage for small businesses. of blue cross blue shield of kansas city, the largest insurer in the kansas city area has a 58% jump in the number of small businesses by insurance since the first full month the legislation was signed into law with a tax credit becoming

available to those businesses. so this is a real opportunity for those employees who are working every day. so you're kind of leading the way. so thank you so much. i would like now to recognize mr. enters, a member of the education and labor committee. >> thank you chairman, like to thank our leadership for this opportunity, and we thank ladies and gentlemen and young ladies who came in today to speak. it takes a lot of character and integrity to come to the public forum and tell your story and bare your soul in such a compelling way. we thank each one of you. mr. lataille come you said you all step -- ready step into job. of a father correctly. if we had a choice tomorrow between voting on repeal of the health care bill for voting on a bill that would help small businesses and other employers create jobs throughout the

country, which of those two bills do you think we should be taking up on the house floor? >> well, i am going to get the job and in need of health insurance right now. if i get that taken away from the and i get into a car accident i'm not going to be looking for jobs. i'm going to be looking for that health insurance. health insurance is more important to me than my job, as important as a job really is. i need to know that i'm not going to die. that takes precedence for me. >> do you think that we should be pursuing repealing the deal that gives you the rights that you have? or do you think we should be pursuing helping employers create jobs across this country? which is a better use of our time? >> we should be helping employers find more jobs. >> i would like to give you a voting card and get you on the floor tomorrow. i want to ask ms. branch, thank you for your very powerful, compelling testimony.

you told us a really powerful story about being three years without health insurance as a breast cancer survivor, and worrying about what the mass was on the test that you had. and thank god it was benign and not a problem. if you have chance to tell your congressman what you would like him to do or her to do tomorrow in this repeal bill, based on your experience, what would you tell them? >> i would tell him to do the right thing. he voted for the health care reform, so i know he would do the right thing. he will not repeal this law. and i expect him, all the constituents in our district, is to make sure that we are all covered and that we are not discriminated against because we had breast cancer in the past. >> and finally, ms. ritter, and your young ladies who are so good to be here today, what would you say to your

representative in congress if that person would say, we have to repeal obamacare, that is going to be a job killing bill for our country, what would you say to you represented you want him or her to do on that bill? >> you might be sorry he asked me to pick my representative is congressman joe pitts. >> very glad i asked you. >> i can what would you like to say to him. >> well, i would like to say as passionate as he is about abortion, i wish he would be as passionate about my children who are already here who deserve and need the same kind of care and love and support, for someone else who doesn't even exist. not to sound crass, but they are here. they need us. they are our children, and they are our future. i implore him to stop the game,

start representing everyone in the district. when i wanted help for health care, i left my district are i would go to congress and suspects district to ask for help because they were not willing. >> we thank you. thank you, mr. chairman, for this opportunity. >> thank you, mr. chairman. thank you all for being here for sharing these very personal and compelling stories. and i have a question out there for you. it sounds as if what you're describing in terms of your work experience, would actually enhancer put to also a become a meteorologist and get a good paying job. and i just wanted if you know other young people who face the same kind of choice you have faced in this act were repealed and you would no longer be able to be on your parents insurance plan and even not have insurance or have to quit what seems like a pretty solid career path. >> there's a lot of people in my

position. unfortunately that's the way the job market is right now. a lot of people i graduated with our working internships because that's the only way they can get more experience because you need something to put yourself above everyone else at this point because there are so few jobs. so they're working at at jobs but there eating very little money. and repealing it would mean that they had to make a choice. they have to choose to continue that, what will be a ladder to a future job, or just sit around and make sure their health is okay. >> thank you. and mr. burr, you describe the anxiety of reaching a cap for your coverage, which this legislation eliminating so that you never have to worry about that. this is a practical sort of sequence. what would happen to you if this were repealed and that cap

reached? as a practical matter, how would you access what you need and the costs that are attached to it, it will be the consequences if you couldn't access back your? >> the consequences have occurred before. like i said earlier, it's almost a crime to have a chronic disease in this country. so that you can get health care to take care of it, and benefits to take care of it. instead of helping a working taxpaying citizen, they want you to leave her job, so your car, sell your house and become a ward of the state, and then and only then will we give you benefits for health care. and now that i am a parent and i have a 10 year old, when i was single, okay, we'll deal with us, we will figure it out. as i said earlier, my parents, all through my entire life, health insurance industries as we really need you to go away.

regardless, regardless. i once worked. i want to own a home. i want to be successful. and the thing holding me back, disease you are born with, and to call it a preexisting condition set you back once, and then coming up with lifetime caps at a million dollars a year, i was capping out every two years. because of the health care industry i was in, or an end, the acquisition emerge is of the companies every two years i have somebody else i was working for doing the same work. that's the only reason i wasn't forced to go on medicare and medicaid. so that's what i try to present here is not forcing people who want to work for living. i don't want you or anybody else here to pay in your taxes for my health care. i want the insurance industry to ensure us. >> thank you.

>> mr. waxman. >> thank you very much, mr. chairman. i want to thank each of you for your presentation today because you put a human face on the problems that congress is dealing to solve. these are problems that didn't just start now. these are problems that are real and faced by millions of people. they are denied care by insurance companies because you have a lifetime cap, they are denied insurance coverage because you're a pre-existing coverage or you threaten across the insurance company more money, to be denied insurance because you don't have a job, to be denied insurance because some insurance companies decide your gender as a woman might be considered a preexisting condition. these are the kinds of things that insurance companies have been doing, and it shocks me when i hear those who want to repeal this bill, talk about how they want to give people more

freedom. how could you consider yourself free if you have the nightmare of not having health insurance available to you? some people say government is too big. well, government shouldn't be involved in this is the insurance companies were spreading the risk. you did need government to do this, except to protect the american people from the insurance companies are when people want to repeal this bill, the ones they want to make free are the insurance companies are to carry on these kinds of practices. i want to ask the question of ms. therriault, i hope i'm pronouncing her name correctly, you're on medicare? >> yes, i am. jesting on medicare doesn't make you feel you're doing anything wrong because the u.s.

government established the medicare program, and it's a government insurance program, or you could go to the private doctors and hospitals. do you think government shouldn't be involved in that area of providing medical care procedures? >> i don't have a problem with that. >> i don't think most americans have a problem, those who are on medicare tell me they love it. in fact, they would be lost without it. those who are not on medicare are paying into the system so that when they are eligible they will have access to that as well. but medicare, even without assurance, the cost of drugs. town with the cost of drugs again, you said in your testimony. tell us about the cost of drugs a summit on medicare. >> $4550, and for the both of us, i just started medicare in january, it would be $9100 out of pocket.

and because of my husband and son, he gets into the donut hole within a month. i mean, there's no saving money at a time for this. >> but don't hold which was created for the republicans adopted this medicare part d. plan, they should've made just like a regular medicare benefit. instead, they wanted to get the insurance companies to run the pharmaceutical plan. and they also wanted to be sure the pharmaceutical companies came out okay. so when they created it, you have to go buy an insurance policy, and then after you pay a certain amount of money, injured countries make you pay for the rest of it. the doughnut hole. that makes no sense to me. can you see any rationale for such a thing? >> no, i don't. but in speaking to people, not too many of them know about the doughnut hole. and they go on medicare and then they are very surprised, and devastated by this.

>> u.. >> first of all, i wanted to join with our guests who spoke and thank the democratic leadership for giving us the opportunity to have this hearing, and appreciate you very much for taking the time and giving your presentations. i had a couple of thoughts. i listened to your stories.

so many of us in the room have our own personal stories about how we have been impacted on the health care. i know you are probably as surprised when i got the letter when my daughter turned 22. i didn't know once you were 23, you were removed from insurance. i think that was not publicly known. then you go into the panic. mr. burke, it's wonderful to see you here well and healthy. i remember well in the early days in the hiv epidemic, folks with your disease didn't survive. it's with medical search that you are here today. i look at your two daughters, i shared with you i have a 19-year-old stepdaughter was diagnosed with leukemia when she was 6. lost her health insurance last year. i can cover her this year, february 1, because of health care reform.

i listen to you therrirault, if i'm pronouncing your name correctly, if not excuse me. i think you said you are due for your mammogram and colonoscopy. my question is since health care reform has been passed, are you able now to get those tests? are they accessible, are they affordable? >> yes, they are. and there's no copay with the preventive medicine now. >> thank you. >> that's great. >> thank you. mr. ellison. trying to get the -- i think i can hear. all of you gave compelling testimony, and i want to thank you for the courage that each and all of you have exhibited in the course of your personal struggle. but i just have two quick questions, i'll get to them right away. do you think that your friends,

your neighbors, your employers, people who you work with and interact every day know well enough that the affordable care act, and how can we change that so the people know what the reform does so discussions about repeal just become sillier, and sillier? can you help me with that? >> i'll try. >> go for it. anybody. don't be shy. >> no, that's why again, the opportunity to be here today. we didn't have enough opportunity, and i do have friends and colleagues who are misinformed and think this is a government takeover of health care. and i try to present to them,

no, it'ses health insurance taking over of health care if you think about it. there's a lot of rhetoric has we've been talking about the last couple of weeks. there's a lot of misinformation that just stays out there. for whatever reason, we can't get it in front of the public, this is not true. the only deaf panels that i see when the insurance companies says you capped out. we can't help you anywhere. that's where i flawed that panel. not in helping somebody at end-of-life stage with issues in their life. so taking parts of this bill and finding words to terrify people. my own mother is on medicare, and she said i don't want the government messing with my insurance. [laughter] >> mom. we need to talk. you know? there's a lot of people that misinformed. how do we get it out there? you know, people watching -- i just watched this public -- or this talking head pundit, and only the talking head pundit,

change the channel and look somewhere else or go online and get the real information about. it's in its name, patient protection and affordable care act. it's in the its name. yet people are deathly afraid that the darth vader government is going to take it away. thank you, mr. burke, you've been a champion for diseases, thanks, and it's nice to see you, sir. >> i'm with the national breast cancer coalition. we stepped out on this issue with long time ago before the health care reform even came out -- came into -- even before the new administration came into office. >> uh-huh. >> we were talking about it. we had a framework for it, the coalition, and because we knew we had to do something for everyone. and that we -- it wasn't just

about breast cancer, but quality health care for everyone. and we knew that once it was -- once the affordable affordable t affordable care act was passed, that we still had our work cut out for us. because we knew that people did not understand what it was going to mean to them. and we're still working towards that goal. we're not down with our work. we know that we have to continue to have the conversation and we're going to continue to help all of you any way that we possibly can to make the general public understand that this is really a good thing, and not a bad thing. because i think people are afraid that they are going to lose something that they already have. those that have insurance, they think they it's good. but this is really going to be an enhancement of what they already have. so i think that's something that we have to really talk about and

keep having conversations about, and i know that the coalition and all of the grassroots organizations that i am affiliated with, we are still working towards that. >> thank you. thank you, ma'am. >> mr. van hall, then mrs. schwartz. >> thank you, mr. chairman. i want to thank all of you for your testimony. here today. you know, the debate on the republican bill to repeal health care reform will begin probably within an hour. and i really wish that some of our colleagues had taken the time to listen to people like you through the congressional hearing process, as has been indicated. this is the only hearing, an unofficial hearing, because we don't have the power of minority to be able to have an official hearing, to hear from people who have been districtly affected. and i think what's going to

strike more and more americans is the fact that within a very short period of time, this bill has only been in affect now about nine months, it has already made a huge and positive difference for millions of americans. so thank you for being here to be the voices of those americans. now there's been a lot of talk by some of our colleagues about how this is going to be a quote, job killing bill. as if by putting it in the title, and saying it over and over, it makes it true. it's not true. we know that. by my calculation, there's only one job and position that will be eliminated as a result of this bill. and that's the job of the guy at the insurance company who had the duty of looking through the fine print on your insurance policy and coming up with reasons to deny you coverage. even though you've been paying the premiums day in and day out.

but other than that, it's pretty clear this bill will help unlease more people in the marketplace, give them more freedom, as my colleague, congressman waxman, has said. and it will also provide small businesses with great opportunities. and so, dr. cohen, i wanted to just expand a little bit on what you said. we've seen recent reports, including in "forbes" magazine that reported that the number of small businesses that have taken advantage the tax credits is way beyond even the optimistic projections. and you indicated that by taking advantage of these tax credits, it will allow you to cover your employees at lower cost. and therefore be able to hire more people. >> correct. >> so if you could just expand on that as a small businesswoman, how by reducing

those costs and providing some assistance through tax credits, it's going to allow you to build and expand your small business. [inaudible comments] >> i still don't think it's on. press it again. >> is that better? >> yeah. >> yeah, the health care premiums are so high that it takes up a lot of our income. and we -- then we can't give raises to our current employees because we're sending to the insurance companies, or we can't afford to extent coverage to enough people that attracts them to your business. with the credits though, you can -- we can use the credits to help our current employees lower their cost, which effectively is a raise for them. also having more money in the bank, you are able to hire more

people to come and help perform more duties. and really i think a big thing that i'm looking forward to are the exchanges. the state exchange insurance exchange i'm really excited about. because that's where we are going to be able to shop for lower premiums, and quality insurance. which we don't have now. we really don't have a lot of choices. we still have to hang on to what we have, and in my case, like i said, my premiums went up to high that in order to keep the premium at a reasonable level, i had to go down in quality for insurance. so the tax credits are helpful, and because it frees up more dollars for us to employee more people. and to cover more people. >> thank you. thank you very much. >> thank you. it's good to be here.

you it hear me, that's great. i do think that -- i too want to thank you for really answering our questions in advance. you have made it very, very clear from a variety of perspectives what a difference the health law that is already in place is making in your lives. you know, i think -- the fact that representative karen bass and i were talking about we all have our personal stories. thank you for sharing your story. and, you know, i think all of us can -- i can tell you that i have two sons. a wonderful, grown, handsome, brilliant, mothers think they are. one of them had a preexisting condition. his first job out of college, he did not sign up in the first 60 days. he didn't realize in the first 60 days, he would never have access. unless he got married, divorced, some changing. we were fortunate for him to be

able to sign up for cobra. one month my husband being a little late in secking -- sending the check in. it was one of those moments when you shouldn't watch the college, had to plead with the insurance it might be received to my mid night, not 5:00. realizing that if he did not agree, he would not have coverage for his preexisting conditions, inspite of us paying cobra, and being coveraged for the first 23 year of his life. to this day, we remind him that we cannot let a day go by with his health insurance, because of the preexisting condition. you talked about that and what a difference in makes in all of our lives. so i want to thank you, because i also hear from constituents every day in my district who come up to me and acknowledge how important this law -- it's not a bill. the republicans talk about it, it's a bill we're still

negotiating and still talking about. it's a law. if they were successful, and they are going to be successful in the house in repealing all of the protections each of you talked about. and what -- and say they are going to start again. they want to begin hearings and talking about this, maybe take a year, maybe take two, four or five, maybe take ten years to get back to some of these protections, if ever. so i think what i want to say to you, i think you've been really clear about this, but is to really be clear that is it any way that's helpful to you to start all over again? and take away these protections, can't get care -- can't get coverage, can't stay on your parent's policy, can't be able to have the credits for small businesses, seniors won't be able to have the preventive care that you talked about, and those with serious preexisting conditions are really important.

this morning "the washington post" just so you don't feel like you are alone, half of all americans under 65 have a preexisting condition. we think, you know, unique and talked about my son's story. the fact is that each and every one of us know someone if we ourselves don't have it. once you get to 65, you for sure have some preexisting condition, even though you think you are healthy. this is something that all americans share. [laughter] >> that's probably true. exactly. which is why we have medicare. because of private insurance companies didn't want to cover anyone over 65. you know what, they used health services. many of us have fought for children's health insurance programs, or the kind of medical research that is saving lives or medical treatments. but the idea of repealing this law is something that each and every one of you in nodding my

answer to my question understand what a difference it would be make to not be able to have the health coverage. my comment is continue to do what you are doing, speaking out. you pointed out in talking to family members, talking to neighbors, it's not always easy to share your personal stories. but be willing to do that. it's really very help in saying this matters in your lives, it matters in americans lives. just going to the ers not necessarily the answer. former president bush said all americans have health coverage. they can just go to the emergency room. pardon? yeah. i'm sorry. anyway, i just wanted to close by saying that it is not the best health care. it's not the most cost efficient health care. and it's not the way we want to go. thank you very much for making comments on what they said, i'm sure the chairman would allow for it. i'm very, very pleased you took

time to be here and share your personal stories. thank you. >> mr. hoyer. >> mr. chairman, thank you very much, i just wanted to thank all of the witnesses. i'm going to have to leave. but i wanted to thank all of the witnesses for their testimony. and say that our members around the country who have held town meetings talking to the tens. you -- constituents. you are representing millions and millions of people. as each of your stories observed, had we had hearings on this bill would have come to washington, would have written, e-mailed, twittered, been in their town halls saying what you have said about the importance of making sure this legislation not is repealed, but it works as it is intended to do to give the insurances and freedoms that we have discussed. thank you very, very much for being here. your testimony i found compelling, thoughtful, and critical. thank you very much. >> mr. chairman, i just want to

reiterate what all of our colleges have said today. that is your incredible, incredible testimony. thank you for traveling here, for making the personal, political, and for helping us to move our country forward. i just wish the president had had all of you over in the east room starting from the moment that this debate began and day after day after day had all of those cameras focused on you and americans like yourself. because i don't think that we would have any further explaining to do to the american people from a debate that got so distorted and so unfair. and i want to thank our leadership for doing these hearings today. and for the moment to add my few comments to the record. i'll say i'm so impressed with your testimony, i'm going to place it on my web site and recommend to all of our colleagues that they do the same. and that they send your testimony out to every single

paper, and publication in their states. i intend to do that in the state of ohio where there are 18 congressional districts. i also would like to say to dr. cohen, thank you so very much for what you said about small business. i came from one of those families who's lived were transformed forever because their father couldn't get health insurance as a small business person and lost his business. and i understand what it means to have devastating illness affect someone in your family. i never knew that i would have a day in this congress when i would be able to vote insurance for an insurance program that would give small business which represent half of the uninsured in our country an opportunity to purchase a decent plan. you have given voice to these americans. and you are right, they are creating the jobs. over half of the uninsured in our country running small businesses and they can't get

insurance. and most of them have under four employees. >> yes. >> therefore, they are very small, they can't leave the shop, they don't have a lobby, and the lobby that lobbied against health insurance for small business and was active in political campaigns across this country and this past season, i simply can't understand who their members are that they would even support an organization like that. because small business is so very much deserves the rights that big business have. thank you very much for giving rights to them. and to miss ritter, i want to thank you for bringing your daughters here today. you young women are very, very courageous to be here. and you inspire america by your experience. we thank you very, very much hannah and madelyn. you haven't wasted your time. i hope they give you extra credit in school.

[laughter] >> just push it once. >> i did. well, i join everyone in thanking all of you for coming and telling us your stories. i think all of my colleagues, myself included, we are actively seeking stories, like yours, from our own districts. i represent a state that has had for the last 35 years that requires all of our employers, full-time employees to provide health insurance. that makes hawaii unique out of all of the states. even for a state like ours that has such high coverage for insurance, this law is making a difference. i did have a couple of questions. for dr. cohen, you mentioned that your insurance company kept raising your premiums. was this based on usage or some extraordinary expenditures by your employees or employers? they just felt like raising the premiums. >> they did it because they could. >> okay. that's right. and for miss ritter, you know, we talk about preexisting conditions, and we sort of can

intellectually understand it, but to see your two daughters sitting here without a law like this, would your daughters be facing the potential of never being able to qualify for health insurance because of their preexisting condition? >> absolutely. absolutely. one, it protects them. with the law in place, it will protect them to remain covered while they are in college. because they will go to college. >> i think the notion that children with preexisting conditions can face a lifetime of noninsurance because of that, i think it's really powerful. so i thank you for that. thank you, mr. chairman. >> leader pelosi. >> thank you very much, chairman miller, and thank you congressman for bringing us together this afternoon. i want to join in thanking our witnesses today for their generosity of spirit and sharing

with us their very personal stories. for their courage to step forward to tell those stories, for the hope they give us in their optimism about how we should go forward. and, of course, hannah and madelyn, we're very honored by your presence, moved by your story. two young women, two of 17 million children in america who have preexisting medical conditions. 17 million children who no longer can be discriminated against because of this law in terms of their having access to health insurance coverage. that is only part of the up to 129 million americans who have preexisting medical conditions, and maybe denied coverage on the basis of that. and talked to movingly and

incredibly about preexisting condition. and the enormous cost that no one person could absorb what $18,000 a week. amazing. alexander and lori drove home the message of what it means to be able to stay on your parents' plan until you are 26 years old, and what it also means for your freedom. thank you for sharing your story, and others as well, and what this means to them. stacie, your story was very, very moving, stunning. my grandchildren are the age of your children. any one of us know that one phone call away, where it's a diagnosis, accident, whenever it is, it's life-altered in terms of our health and our economic security. and what you had to say about small businesses is both troubling in terms of what went

through, but promises in terms of how you see the possibilities of the bill. we thank you for that, and vernal, no longer will being a women be a preexisting condition. thank you for your leadership with breast cancer, whether it's breast cancer, prostate, diabetes, hard hard -- heart di, you name it, the list is hard to confront. 1/3 of the people in the country have the preexisting condition. many of you have used the term we have to choose. we have to choose between paying the mortgage and insurance. we have to choose about keeping a job or moving on to do something else that enabled us to cover expenses. and having to choose is what we want people to do with the leverage on their side. we want them to be able to choose to stay in a job and not be job locked because they want to follow their own aspirations,

start a business, be self-employed, change jobs, because they have the freedom to do so that this legislation gives them. they have the freedom to choose and in doing so, they invigorate our economy. this legislation is about innovation, it's about so many other things we didn't talk about today in terms of innovation, and medical, electronic medical records enabling people to have access closer to home. which can be an earlier intervention, which can be healthier for them. we pray for roger and your family. what a sad, sad story, and the difference health insurance makes. so again, i wish -- there's some talk about whether democrats should sit next to republicans on the floor. i wish you could be standing up on the floor telling your stories. nothing is more eloquent than your personal experience. i want you to know how much we appreciate what you have been through, what you have been willing to share for us, and as

ed said, hopefully everyone will open their eyes to this, open their ears as well. and the more people who know how it affects them directly, the more successful we will be in pushing back this repeal of this liberation, this freedom, this ability to choose in a positive way for the american people. so thank you so very, very much. we are very proud of you, your voices will be heard across the country. and others will step forward because of your courage. thank you all very much. thank you, mr. chairman. >> thank you, madame. >> thank you, mr. chairman. i have a quick question for dr. cohen and one for mr. burke. dr. cohen, i want to make sure i understand your story as a small businesswoman. you see the opportunity to reinvest the tax credits for providing insurance for your employees and hiring an additional employee. that could apply to your business and many other

businesses, therefore, creating jobs. >> correct. >> yeah, and if those tax credits are repealed, not only might you be in a situation where, of course, you don't have those savings, and you are paying those extra taxes for doing the right thing and insuring your employees. you'll face the dilemma about reducing the quality, the rates are increasing, et cetera, it will inhibit your growth as a business. mr. burke, you said something very fascinating with regard to your plight and those facing life time cap, including people with hemophilia. you are saying if the health care is repealed, you and others like you, could be forced on to government health care. it's not only -- it's actually a question of reducing your alliance on government health care and allowing you to continue being insured through the private sector? >> what our point is, i want to -- and 95% of the hemophilia

population can work and want to. it's the cost of the medicine that once the insurance companies wants to force us on to government programs. and still the government pays the insurance companies the subsidies. they can still make their money. >> and the republican plan to force you on to government health care, not only reduces your choice of health care, but also forces you into destitution before you follow. you losing assets, home, house, and meeting that asset test where you qualify for the social safety net. >> correct. >> yeah, so the plan that now exists would enable you to continue to be insured through the private sector, have that choice, and not have to worry about the lifetime cap and being worried about reducing the assets and following back on a government program. >> that's correct. thank you very much. mr. moran, mr. jackson lee, mr. lewis, mrs. waters, mr. moore,

mr. christensen, and mr. visara. >> thank you for sticking with us. if you have a travel problem, let us know. let us know your time. mr. moran. >> all of us offer the comments of mr. miller. mr. chairman, 15 years ago, my daughter was diagnosed with a massive malignant brain tumor. she got very high quality care at national children's medical. because of the quality of that care, she survived. but it's cost hundreds of thousands of dollars. and in the case of most of my constituents, as well as most of the american people across the country, they would have had to sell their home, they would have

had to liquidate their cost of care. i didn't have to do that. because i was just elected to the united states congress. it's stunning to me that the parent majority of the members of the congress intend to vote to deprive their constituents of the care that they now have. they now know that they have some of the best insurance plans available to them that exist in the country. and yet we'll deprive their constituents of having that same kind of security. now i know each of you had a

unique experience yourselves. you each contribute to this debate. but all of you have experienced that not only the shock of loved ones, or your own care, but of the financial insecurity that immediately comes to mind when you realize that. and in the case of employers, it's that you know the situation confronting your employees. i only make that point if any of you want to respond, that's fine. i do think that needs to be part of that discussion. the responsibility each of us has to put the welfare of our constituents first. and that's hardly what will occur if the majority of the u.s. house of representatives votes to derive their constituents of the kind of care

they now have. thank you, mr. chairman. >> mr. lewis. >> mr. miller, thank you very much. let me make this -- >> i think we need you to punch your mike once. >> yes? >> there you go. >> thank you, mr. miller. thank you each and every one of you for being here. thank you as some of my colleagues said, for having the courage to tell your story. there are hundreds and thousands and millions of our citizens will never have an opportunity to come here and tell their stories. i want to thank you. you've been very moving. and i wish america could hear you. not just our colleagues in the congress. i happen to believe that health care is a right, and not a privilege.

and all of our citizens should have quality health care. there's some people that want to take us back to another period, to another time. but with this law, and i don't need to tell any of you this, we have come so far, and we cannot go back. so continue to speak up and speak out, and tell your story. i don't think any of us want to live in a country that discriminates against people when it comes to health care. i want to thank you for bringing your two beautiful daughters here. i wish each and every one of you well. thank you. >> thank you. mrs. jackson lee. >> thank you very much, mr. miller, and thank you congresswoman delauro, and thank all of you for representing the american people who would tell us that this maybe a question of life or

death. forgive me for calling you by your first name, but i just want to mention all of you, vernal, lori, ed, alexander, claudette, and stacie. you represent to save people's lives. the debate as begun on the floor of the house. i'm reminded of the message of the opponents or those that want to repeal this bill has been carrying. first distortion. but the second is the constitution. and i've been carrying this constitution for a long time. because one of my predecessors was barbara jordan who said that she really believed in the constitution. so i want to ask this question because as we go to the floor, i'm holding in my hand, and i don't read it, this is from texas. it's not from my office not from

the democratic leadership office, it's from the department of insurance. one of my friends from texas will be debating this and saying that they are voting no, we have a report that says this will help -- this bill, the patient protection affordable care act will help texans. there's no reason to vote no. you come from many states. those states have probably said the same thing. i want to start with just the question to dr. cohen and ed and stacie, and her two beautiful daughters. there is something in the constitutioned the 14th amendment. i'm on judiciary, so i've got to hold this very dear. it has something to do with equal protection. dr. cohen, my friends are saying this bill violates the constitution. my question to you, you had two cousins, one -- both deserved the protection of the constitution, the 14th

amendment. did they both get the protection of equal protection? will this bill help them get that? would it help your male cousin that lost his life? >> yes, it will. had his -- had his employer who was the owner of the small family business been able to afford health coverage for him, then he would have had the insurance to cover him. but here's the thing. if you speak to 100 people who don't have insurance, and they have an ailment, and you say, well, you should get that checked out. the first thing they say to you, i don't have insurance. it's a mental state huh don't have insurance, you don't even feel like you can get care. and people without insurance will hold on to a symptom until they can't take it anymore. and then they go to the emergency room.

that's what happened to my cousin. you know, because they just don't even feel like they can go get care. because one the things is that they think, well, if they find something, i can't even pay for the test. if they find something, i can't pay for whatever i need to do to fix it. >> and he died. >> and he died. >> ed, would you be alive, do you think there's something to a constitution that provides you equal protection. would there be many like you as you said want to work but possibly had those lifetime caps. would you be denied your rights under this constitution? >> from what they are trying to do now. >> they repeal the bill, they say it's unconstitutional. this constitution guarantees you equal protection. and you are alive. >> i also think there's a preamble that says we have the right to life, liberty, and pursuit of happiness. >> it does.

>> and the health insurance industries denies me all three. >> right. we are trying to give it to you. beautiful daughters. you see children who don't have a mother that advocates, and have access to health care. your daughters are alive. do you think we've lost children because their circumstances might not have been as good as yours. do they deserve some protection in this bill? >> absolutely. >> in it constitution? >> absolutely they do. and absolutely, i'm sure we have lost many children who were not fortunate enough to get the care because the parents were in fear of not being able to pay. >> those parents then did not have the full protection of this document --. >> absolutely. >> -- which guarantees them equal protection under the law. >> absolutely. >> thank you. >> thank you. congresswoman waters. >> can you hear me at this level? >> there you go. >> i'd like you to excuse my

voice. i have laryngitis, but i could not stay away from this hearing, because it is so important for us to do everything that we can to focus attention on the fact that there's an attempt to repeal the most significant legislation perhaps that this country has seen for many, many years. i wanted very much to be here. and i just want to share with lori bresnan, i'm from st. louis, missouri. i was just there last week to see about my mother. and one of my old neighborhood friends has a car service who helped me to get around. and, of course, we talked about the old neighborhood. and i asked about all of our friends and neighbors, he said almost everybody is dead but us. and i reflected on the fact that

we did come from poor neighborhood, limited resources and none of us had health care. and i wonder if some of them would be alive today if they had access to health care? several things have happened in the past few weeks. i was in my district, just this past week, and i was at charles drew university medical school. where they have a program for under served areas, called the white coat ceremony, where children as young as 3, 4, and 5 years old, get introduced to math and science in a saturday school. and so my heart was lifted because they represented the potential personnel that we're going to need in order to provide these services because of health care reform.

we're going to need 250 to 400,000 new personnel providing these services, and these young people who are going through this program were so exciting. and they were so focused on the idea that they could be doctors and nurses and health care personnel. and that was very, very uplifting. and so when i come here today, and i see all of you, i know that your being here today is extremely important to helping to educate people about health care reform, what it is, and what is it not, the distortions, and the lies that have been perpetrated. so i'm hopeful that the work you are doing, ms. branch will help to get the word out. you are a survivor. i am so proud of what you are doing to help others.

and i thank you for it. do you recognize that african-american women are 10% less likely than white women to get breast cancer, but 34% more likely to die from it? every naacp meeting, every sorority, every convention should have this information. and the work that you are doing will have spread the word because they have helped -- they must help get the word out about now women have access to health care that they did not have. there's no need to die if you are diagnosed early. thank you for what you are doing. and finally, let me just say to ms. ritter, thank you for bringing your daughters here today. i would like to ask the chairman to allow us to ask your daughters to bring their seats

right in front of this panel, and to sit with you because the president of the united states just reminded us with the death of christina taylor green that the children have expectations, and that the grandest thing that we could do is live up to the children's expectations. your daughter cried, and she talked about the fact that president obama understood. and i'm reminded of some of the verses, one the verses in the bible that my great grandmother acquainted me with that talked about, and children shall lead them, or the child shall lead them. and their being here today helps us all to understand that we could be great if we could live

up to the children's expectations. they are not just the twins. they have names. i want to know what their names are. i want them in the record. because they helped to focus on the fact that we hae a responsibility to live up to the childrens expectations. can we get that for the record? >> i think we can do that. >> could they come? >> come on over. bring your chair on over. we should have said this in the beginning. maxine, you should have interrupted us in the beginning. >> move their chairs over and come right in front of the panel. >> move the chairs. >> could we put their name in the record? >> their name is in the record from the beginning. >> but they are doing such important work. >> i don't think they are that shy really. >> what we can't get some of the uninformed and misinformed to

understand in the congress coming from the opposite side of the aisle, maybe the children will be able to do that. could we get their names in the record? >> madelyn and hannah are in the record. >> thank you so much. i certainly aim to live up to your expectations. that would be the highest honor that i could afford to the people who have elected me to come here and serve. thank you so very much. >> thank you. congresswoman moore. >> well, thank you so much, mr. chairman. and before i address this distinguished panel, i just want to revel in praising my colleagues who put together this outstanding panel of citizens because i think one of the most important things to reflect is this entire debate is that

unlike some of the detractors for our health bill, don't leave colleagues. i want to say something about you in just a moment is that these people here are not quote unquote free loaders that are taking advantage of the provisions of the new health care reform bill. they are citizens who have worked hard, due to no fault of their own have had debilitating diseases, having stricken with problems and as americans, and as an american community, this is what having universal health care system is all about. it's about sharing in the pain and in the joy whether it's giving birth to a new american citizen, or letting someone die with some dignity, or saving them from some disastrous

disease. god willing, later on this month, i will be installed as the new chairwoman of the, vice chair of the womens caucus and my colleague, debbie washerman-schultz will be installed as vice chair of the womens caucus. i did want her to remain here so that i could -- as chair and vice chair of the womens caucus, we are very concerned about how this health care bill -- what impact it has on women. and she, of course, shared with you that she's a survivor of breast cancer, very, very brave. and i realize everybody has different schedules. you have to leave. but i just wanted to acknowledge that in case we are missing some votes or something, debbie, we are so succeed in that.

i think this is a distinguished panel. but as a woman, i can tell you how terrifying it would be for this bill to be repealed. because women are desperately uninsured for a variety of reasons. number one, we're twice as likely to be dependent upon men who have health insurance and be dependent on the health insurance policies. and even those of us who have health insurance only 50% of us have health insurance through our jobs, a opposed to 57 and above men who do. and, you know, i have five brothers. and my five brothers, three of my five brothers wives have had breast cancer. and i want to talk about one of them in particular. one of them in particular was

divorced from my brother, had been divorced for many, many years. and he had a great job, had a pension, had health insurance, succumbed to a major stroke and was put into a vegetable -- persistent vegetative state. about the same time, my sister-in-law contracted breast cancer and had no health insurance. and came to the talk to the family about remarrying my brother so that she could get health insurance. and, of course, she can't remarried him. he was a persistent vegetative state. i can't imagine, ms. branch, how you survived in 15 years of breast cancer in terms of the cost, and treatment, and not to

give woman presumptive eligibility for medicaid, which she wasn't working, she's in the situation as so many dependent women were on. she fought cancer without the benefit of health care, and she died three days before her 63rd birthday. so she was not eligible for medicaid or anything. one the things that i am very concerned about, i'm very happy that we passed this bill, because first of all, it takes away this ability to deny people insurance based on having preexisting conditions. and, of course, you wouldn't have to have been twins with leukemia if you have a woman to have been determined to have a preexisting condition. you just need to have reported domestic violence, or have had acne, i'm not exaggerating at all. so the elimination of the gender rating, i think, is extremely

important in this bill. of course, single woman who are raising their kids on their own, and very, very disturbing income disparities really mean that women are at great risk of not having health insurance. so i have a statement more than a question, but i sure would like some response from ms. branch as to how she negotiated and perhaps she's already shared this with us and i was late because of my travel schedule. how in the world did you survive breast cancer for 15 years given all of the obstacles that are placed in front of women to access health care? >> well, in my statement, i said that i had very good health coverage when i had breast cancer. five years after my own

diagnosis, my husband lost his job and started his own business. and we had cobra for a while, but then that was very expensive. so we sought out some other insurance. and what happened was we found some insurance that we liked, they insured my husband, and my high school son, but refused to insure me. and so i did not have health coverage for three years. and i was paying out of pocket, luckily my husband was bringing in some income. but not enough to really cover a lot of these out-of-pocket costs. we were struggling. we went into bankruptcy during that time. but chose to start over, we left california, moved to -- here to virginia. and we were able to start over and find new jobs and get health coverage. but i just felt as if i had been paying into the system for all of these years, and paying for

health insurance, and then no one wanted to cover me. even though i was cancer free during that time. >> thank you so much. and i realize my time has expired. thank you, mr. chair. i yield back. >> mr. christensen. [inaudible] >> is it on now? thank you the policy committee for holding this hearing. the experiences of the panel are things that the american public really needs to hear. i think if they saw the face of what health care, the affordable care act, is in america, we'd have even more support than we are developing right now. i want to thank the panelist as well for sharing your experiences with us, and for the advocacy that many of you do every day on behalf of health care for people that live in this country. i just wanted to -- i don't really have a question.

and i'm going to be brief. like madelyn and hannah, i think about the children in any community who increasingly are having diagnosis, asthma, and the sickle cell parents that i've worked with over the years. up until now not being able to have insurance. so this bill really has meant -- the act, the new law has really had a major impact and benefited them greatly. and as we are hear getting ready to face a bill that's called the job killing or job destroying act, and dr. cohen, you are not even -- you are not only showing that you are increasing your ability to care for more patients, but you are creating jobs and you are able to continue to work. you are in direct contrast on what is being put forward on the floor. i want to thank you y'all for

come, for sharing your experience, for the advocacy that you do. >> thank you. vice chair of the caucus, mr. b. >> there's nothing here. you are not actors or actresses. it's the real deal. they are inspiring stories. we thank you for taking the time to be here. we thank you for making it clear what we are talking about are rights and freedoms that you now have as a result of trying to make our health care system even better. along with thanking all of you, the special thanks go to out hannah and madelyn, and alexander. you only have them by a decade. you still have many, many years

ahead of you. i hope you are watching closer. some of your peers are probably busy doing a lot of important things. but in about a decade or two, we're going to turn it over to you. it will be up to you to try to make this an even better system, not talking about eliminating rights, and repealing freedoms, but making it better. quite honestly, as long as we can try to make it better as the results in the room will make it better, not worse, we'll leave you something to work with so that as you go about it, you'll remember those experiences when you are a little younger. you'll do much more than we were able to accomplish so the kids who come to a hearing when you are adults will look at you and say, wow, i hope one of these days i get to do some of those things. you've all been inspiring. to me it's what we are leaving in place for the next generation of leaders and so i thank all of you for having taken the time. and mr. chairman, i wish we

could have a whole bunch of real people on the floor over the course of the next several hours to watch this debate unfold. because that's -- these are the real stories. and you have done us well. you have rendered a great service to this country by coming to testify about nothing more than just your life. thank you so much. >> thank you. and behalf of the steering and policy committee, and my co-chair rosa delauro, and nancy pelosi, thank you for all of those who participated. i certainly want to thank all of our witnesses. as mr. becerra stated, as reckless as this is to throw on to the floor of the congress without these kinds of hearings, nevertheless, it is, in fact, a very, very serious matter. as each of you have pointed out, and as each of the members of congress have pointed out as they reflect on their families,

their constituents, their neighbors, whether or not this legislation is repealed has huge consequences for millions and millions and millions of americans. for our children, for our seniors, for our business people, for employees, for families, for spouses, however you want to slice this pie, there are millions of people who know have protections who will never have to worry about the rest of their lives about whether or not they will have coverage no matter what happens to them, lose their job, change their jobs, have a divorce, somebody dies, whatever the consequences, they will continue to have coverage. that has now been put at risk. i can't tell you how important it is to have you participate today to tell these stories. i hope that those who were able to see this on the c-span and other media will recognize it. these are not stories that are strange to the people that i remember.

these are the stories that we hear every week. : [inaudible conversations] [inaudible conversations]

[inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] >> this meeting is coming to the close. the house started 7 hours of debate to repeal the president's health care law. before they gaveled in recommendations were released to congress on ten proposed changes to the law discussing why it

should be repealed. analysts and cato institute and the american action forum all who support recommendations. from the rayburn house office building, this is just over an hour. >> good morning. my name is john goodman, president of the national center for policy analysis, and i want to welcome you all here today. we're joined today by the representatives of the heritage foundation, the american enterprise institute, the cato institute, the american action network, and in other think tanks with us in spirit that could not be here physically today, both on the right and on the left. our interest is in the health reform bill passed last spring,

and some major defects in the bill we think are so serious and so severe that congress will have to reopen the health care law and make major changes to it even if there are no critics around. now, i want to briefly go over ten of those major problems in the bill, and then each of our speakers will address certain parts of it. number one is an impossible mandate. all of us are going to be required to have a health insurance plan that is going to be growing twice the rate of growth as our income. you don't have to be a mathematician or an economist to know if you are forced to buy something at twice the rate of your income, it crowds out everything else that you are buying. now, barak obama did not create this problem. this problem has been going on for four decades. for the last 40 years health care costs have been growing

twices rate of our income. the united states is not the worst case in the world. in fact, per capita real growth of health care costs in this country is right at just a little bit under the european average, so this is 1 a problem -- this is a problem for the entire developed world, but even though barak obama didn't create the problem, the bill we pass makes it worse because this bill locks us into that very unsustainable path. if we continue on the path by about mid century, today's young folks retire, and health care crowded out everything else they consume, so when you reach the retirement age, you'll have nothing to wear, no place to live, nothing to eat, but you'll have really great health care. i assume that is not the goal that we all want to reach. the problem with the bill is that it takes away from the private sector many of the tools there to allow you to control

health insurance costs. limiting the package of benefits, more cost sharing, all that goes away, and we are more or less locked into a path that is unsustainable and undesirable. then we have a bizarre system of subsidies. the hotel down the street has a lot of workers making $15 an hour. they are the maids, busboys, cues toadians, the garden folks. according to the congressional budget office, if these people make it over into the health insurance exchange that is going to be set up under the new health law, they will be able to aqair a health insurance plan for a family that costs $15,000, and the government pays almost all the premium, if they have a lot of out of pocket costs, the government reimburses them for those, and the cbo projects the total benefit they get is about $19,000. on the other hand, if these

employees stay with the hotel and get their insurance, the only subsidy they get is that of the law. they pay premiums with untaxed dollars, but since people at this level don't pay income taxes, we are voiding the payroll tax, and that is worth about more than $2,000. if marriott has the insurance, it's over $2,000. if they are over the exchange, for free they get $19,000. where do you think people end up? they will find their way into the exchange, and if the mar yacht employees don't do it but the others do, marriott will find it hard to compete in the marketplace with costs that are higher. i don't know what firms are going to do, but i can conceive of a world in which is

completely reorganized in order to take advantage of these new subsidies. the strange thing is if marriott has an employee who makes $9,000 to $100,000, they get no subsidy if they go into the exchange. if he gets his insurance from marriott, they again get a subsidy now in the current tax law, the ability to pay premiums with pretax dollars avoiding the payroll tax, but also the state and local and income tax and those tax subsidies are equal to almost half the cost of the insurance, so the higher income employee wants insurance from the hotel, the lower income wants to be in the exchange. what are employers going to do? are they going to end their insurance plan for the lower income employees and pay a fine? or create them as independent contractors or temporary

workers? we don't know, but they will be faced with a lot of important decisions that are not going to be good for the job market, not the kind of labor market situation that gives employers confidence that they know what is going to happen. we have a health insurance exchange that creates perverse incentives for the insurers. if you charge everybody the same premium, everybody's incentives are distorted. the person who has health problems and is going to look at the premiums and say, well, health insurance looks cheap to me, they overinsure. the person who is healthy says those premiums are too high. i'm going to underinsure. overall, the provider side, incentives are worse. the incentives for the plans are to avoid the sick and attract the healthy. here in washington at open season time in the late fall,

what kinds of ads do you see in newspapers? ads of young healthy people with children and the message is if you look like the people in these ads, we want you in our plan. yoir the people for us. you don't see ads saying if you have heart disease or cancer or some other expensive condition, consider us. contrast that with the all state ads you see for car insurance. remember you're in good hands? they have a catastrophic scene, something bad happened, and what all state is saying to you, we know you don't care about auto insurance physical you have an -- until you have an accident, but when the really bad thing happens, we'll take care of you. in health care, however, it's the other way around. we give insurance companies an incentive to attract the healthy and say to the potentially sick, we hope you don't get sick, and

if you are, go someplace else. this is like going to a restaurant who you know doesn't want you. you don't want to rack the health care system in which insurers have an incentive to avoid people with problems. we have a model where this works better, and it's the medicare advantage program where we have special needs insurance plans who recruit senior citizens with high health care costs because they will get a premium higher than the premium paid for everyone else. we have in the law perverse incentives for individuals, a fine for being uninsured which is not great enough if you want to make the premium completely independent of people's expected health care costs. in massachusetts today, people are going bear while they are healthy and signing up after they get sick the the number of people who do that is increasing each year. small problem for massachusetts right now, but it would be a huge problem for texas where

they sign medicaid patients up in the emergency room. it doesn't matter for medicaid because it's taxpayer funded anyway. taxpayers pay the care whether they sign up or not. if you sign up blue cross parents in the emergency room, they won't survive in the health insurance marketplace very long. we have made promises that we can't possibly keep. according to congressional budget office estimates, we're going to insure about 32 million people who otherwise would be uninsured. if the economic estimates are correct and those people try to double the amount of health care they have been consuming. we have millions of people, 90 million is the last estimate, there -- that will have access to welcome with now copayment. to imif you an idea of how bad

that is, economists estimated if everybody in america got the preventative care recommended by the task force that sets the standard for the new health plans, and their estimate was that the average primary care physician in the united states would have to work more than 7 hours every working day to provide these services essentially providing services to mainly healthy people leaving little time left over to take care of the sick. u 2340 ring what i'm -- now what i'm describing is a huge increase in the demand for care, but in this legislation we did little or nothing about the supply. early on, there were versions of the bill that had line item expenditures to provide more doctors and nurses and so forth, but that was zeroed out to keep the cost of the legislation down and the cbo guys figured if there's no doctors, we can't

deliver more care and spend more money. what we're having now or going to have is a large increase and demand, no change in supply. that's a huge rationing problem in this country and other countries who don't primarily pay for care with money, but with time. the time is going to go up everywhere at every physician's office, emergency care, the offices of most specialists, and in that kind of environment, it's not good if you're in one the plans that pays below market rates. if you are elderly on medicare or medicaid, or in massachusetts a lot of plans also pay low rates. if you're in one of those plans, you're less preferred and at the end of the line. one of the really strange things about this legislation is that most people in congress who voted for it were left of center, but what's going to happen in my opinion is a redistribution of benefits from

low income to higher income people. this bill forces middle and higher income people to have more generous health insurance than they wanted. once they got it, they'll act on it, and when they do, they'll crowd out the poor, the elderly, and the disabled, the most vulnerable parts of society will have an increasing problem of access to care. seniors in particular are going to have a difficult problem because we have in this legislation a requirement that we cut payments to doctors and hospitals well below what the private sector is paying, and that gap grows over time. according to the medicare actuary ris by the end of this decade, medicare will be paying lower rates than medicaid for poor people. now, in most places including the city where i live, medicaid patients have real difficulty finding doctors who will see them, and they go to community health centers and safety net

hospitals for their care. the elderly is there as well, and if medicare drops below medicaid, the elderly may be behind low income families in getting care. there are large burdens here for the states that will be difficult for them to meet, and i suspect they will respond by trying to game the system. this legislation does nothing to solve the problem of portability which is the biggest problem that most people have. there's nothing in legislation which creates truly personal affordable health insurance, and finally this legislation overregulates both the patients and doctors. if we want to solve health care problems, get rid of waste in the system, higher quality care, then we need patients and doctors who fair out the waste and get rid of it, but they don't do that unless they have incentives to do so, and the current system gives them none,

and the new system makes those incentives worse. if we want lower cost, higher quality health care system, it has to be in the self-interest of every patient, doctor, nurse, hospital administrator to do just that. lower cost and raise quality. now, i want to turn the program over to my colleagues. this program is by the way cosponsored by the heritage foundation and robert who is here today is kind to help us put this program together, but the first speaker is douglas holtz who used to be the director of the iewfs and president of the american action forum, and, doug, will you come to the podium? let's give him a hand. [applause] >> thank you very much for the chance to be here today and throwing this event. obviously, this is a central piece of legislation and one that ought to be examined very

closely. i want to echo the remarks john made about the impacts of the law from the perspective of health policy, but i was taught one looks at legislation, look at it in the context of the nation's problems, and the top two problems the nation faces today is an economy that is badly underperforming and the need to create jobs for americans, and a federal budget outlook that is in and of itself so threatening as to really casen out the freedom of americans, and this legislation is quite damaging from those perspectives. the health care center is moving towards one fifth of the economy and improving incentives would improve economic policy getting higher quality in care for less costs and improvements in efficiency are things to support as a matter of economic policy

in the united states. on top of that, there's spillovers to the rest of the economy, and if you look at the law, it promises to raise $500 billion worth of taxes over 10 years. when asked, gee, you want to create jobs, raise $500 billion in taxes in ten years. i don't think you'll get a yes from anyone. that's a strike against in legislation. some show up in reduced incentives. there's a sir tax on investment income for high income americans. it's a pure increase of marginal tax rates. nothing to do with medicare, just an increase in taxes that will damage exactly the same kinds of entities that were the subject of so much discussion in extending the tax laws. these are the small businesses and entrepreneurs in america who

create new firms and generate job growth. there are taxes on medical devices, insurance companies, on all inputs into health services that will lead to higher costs for those services. when health services are expensive, health insurance is expensive. premiums rise because of the cost and taxes on health insurance companies, and when the premiums get more expensive, you see the bottom line show up in every small business in america. every businessman does the calculation that shows i have to pay workers less to cover the premiums i'm seeing and every worker as a result bears the cost of this bill. there will be some workers, those of minimum wages where you can't lower their cash, and we're going to see those jobs go away. again, it's the low income workers who will be damaged by this bill and the economic

incentives that are in it. this is a recipe for less jobs in america. it's a recipe for slower economic growth. now, that's just putting the $500 billion taxes in. if you layer $1 trillion of spending on top. that makes it better? i don't think so. there's no check that will generate job growth in the united states. nothing about that has ever been a successful path to improve economic performance, and i believe that the nature of those subsidies, i want to echo what john said, in addition to the real efficiency cost and growth impacts of this bill, there's some deep unfairness associated with the way these subsidies are distributed. the example he gave is a real one. two people who are otherwise identical go forward in 2016 and one woman makes $70,000, gets her health insurance from employer who gets only the tax benefit from the employer sponsored insurance.

another woman making $70,000 gets the exchanges and gets $7,000 in federal subsidies? that's so profound, i don't believe it can exist. i'm nervous that a future congress will dpix that by giving everybody $7,000 and making the boll tom line cost more than it already is. i'll turn to the budget implications because it's related to the economic incentives. there are many ways to look at the budgetary implications, but begin with the simplest one. set up two new open-ended programs that grow at 8% a year as far as the eye can see. 8% a year is faster than the economy is going to grow, faster than any notion of revenues grow. two new programs set up that grow faster than the economy for as far as the eye can see, and we're supposed to believe it

reduces the deficit. it is impossible to make that claim with a straight face. now, we have cbo estimates of budgetary impact which show deficit reduction from the bill, but i think it's not widely understood that those particular estimates are thought by the nature of the rules under which cbo is forced to operate. when you tell cbo you're going to pretend an equity is larger than the one i described lasts forever, you have to take it at face value. when you tell cbo you're cutting money out of medicare year after year after year changing nothing in the basic economic model under which medicare services are produced unless somehow have a miracle occur, they have to assume that's true, but if you take away those rules and look at this in any realistic fashion, oh estimates the bill reduces in the first ten years and a trillion and a half in the second ten years. that's a really important thing

from both the future of the economy and a fair nlsz perspective. the reason it's offensive from my view in a fairness perspective has to do with the young people in the audience. this bill is the big e-intergenerational money grab in history. it forces every young american to buy insurance and there by pay for the cost for those who are older and sicker than them, and then when they retire, they inherit the trillions of dollars of debt this bill produces and have to pay that as well. that's simply wrong. it comes at a time when it is all so dangerous. everyone's heard a lot about the budget outlook. regardless of which one of the particular forecasts you look at, the united states is in a fiscal situation that's unprecedented in history. over the next ten years, we are likely to run deficits that

average nearly $1 trillion and average over 6 billion a year. at the end of ten years, it's a trill deficit and 900 million is borrowed. we are borrowing to pay the interest of the that's a recipe for disaster. along there we meet the criteria for downgrade. that was the outlook before we passed this legislation. this legislation makes it worse, and i stipulate that introducing a damaging bill to a dangerous fiscal situation is not going to generate jobs. we have a package that is damages from every perspective and very hard to support. thank you. [applause] >> very good, thank you, doug. thomas mellor is a joint economist commit an now with the american enterprise institute. if you're interested in health

policy and it's hard not to find tom mellor everywhere you look. let's give him a warm hand. [applause] >> thank you vooch, john. there's a lot of repeal and work to be done. i have other material outside on many other issues. you can find them at www.aei.org/repealandreplace. also coming soon, why obamacare is wrong for america. anniversary tim, like for it. today, i'm focusing on something else, how to improve the health care delivery system and quarter through u.s. political and u.s. ways and means. well, first of all, we have to change how we define and talk about the issue. the two key measures should be health outcomes and value. health care quality too commonly

is viewed in process terms or how to execute a predictable less flawed manufacturing process instead of a personal balancing act in determining the best combination in costs and quality for which you as a consumer, patient, or a taxpayer of health are actually willing to pay. there's no single setting that's just right or even unquestionably adequate for everyone. it doesn't mean there are no process no brainers to clean up along the way, but that's not the story on getting better value. we need to reach beyond the con sensual health care -- conventional delivery system because it shapes our health. looking beyond the bias toward dwelling exclusively in most health care policy debates on health insurance financing and benefits coverage and fighting over the political flow of dollars without considering what they actually achieve in terms

of better health outcomes of lower costs. two different individuals could have the same health insurance and differents in health initially and after getting the same diagnosis could be different depending where and who they go to on treatment, how they make decisions as parents, and a host of other factors that brought them to that point. we forget to look at the health outcome keys lost from the health care funding lamp post. let's be humbled about answers, but particularly to the distorting evidence of the national health care politic. the patient protection in affordable care act is only the latest though perhaps the worst incarnation of promising what's unbelievable and what's unpredictable. in the flyover land of the law devoted to the unicorns and health miracles or science fair

projects, we essentially have new reiterations of repackaged centralized commanding control from the usualsources who issued therevious ones that failed outright and aggravated the systems chronic conditions. the latest establishment cliche is about every idea for controlling health care cost is in the law. it's true every bad idea ma it's way in there because who reads that stuff anyway? not members of congress. they managed to leave out important ideas like choice, competition, personal responsibility, truth in labeling, macialt pricing, truth for personal preferences, decision making, double entry bookkeeping, and even arrhythmia tick. most of the health care is selling a message that americans don't believe. yes, we complain about health care costs being too much even though we see just a fraction of

the full expense directly or there's other barriers in the way to getting more of what we want when bewant it -- when we want it, but a vast majority who receive health care think the care is good. just look at surveys from last november. that's why you hear politicians talk more in public about high health care costs or expanding coverage to the uninsured and the health care delivery provisions. the less exciting reality is that our health care system is excellent in many ways, but not perfect, and some very different approaches could improve its accountability and friendliness and honest choices push forward in the marketplace. it's real, unsubsidized affordability. first, throttle back. a good bit of regulation that

gets between the needs and resources of patients and the capabilities of health care providers. two, guarantee a socially acceptable floor of health care services for the less fortunate, but stop subsidizing everybody else's bills when it's wasteful rounds of dollar trading through clogged political filters. three, stop pretending all care can be high quality in providing equally to everyone all the time. instead, let's encourage more competition in seeking and delivering care whose value continues to improve from wherever it is at the moment. we can't just imagine the miracles of a unfree market, although a freer one helps, we have to rely on policy changes that help parties compete in measuring and reporting better how the health care system performs so they are rewarded differently for doing much better or not doing as badly

before. i wrote about this elsewhere. the new health law is not totally moronic in the infrastructure, but it remaining too fixuated on a lengthy politically determined set of consensus standards that by the time they are derived they are too weak, too unrealistic, or too outdated or all three at the same time. while other provisions drive the marketplace that is less competitive but more politically dependent. the short version is patients, providers, and other payers need better information, not more information. it's not perfect. we can't measure everything or not most things, but we should use the best available within limits of current data while acknowledging the limitations and then just shut up about quality when we don't know one

way or the other. inspect the costs, decide what you want to save or spend money on and we need information much more about provider performance than insurancers and the insurance they offer and about physicians not always at the group level but more about big box hospitals varied within them. it needs to be a combination of measurable health outcomes or markets for them and the cost of the relevant episode of care. it's the value combination that matters, not just quality, cost, or price alone, but preferences are important as well in terms the patient experience. it's contentious, revolutionary, full of cautions and caveats, but we ignore it before beginning to engage in it. matters of health care that come outside of government channels, there's basics to do, but we have to allow it to be

accessible to other parties to determine what actually matters. thank you. [applause] >> thank you, tom. michael cannon is director of studies at the cato institute. he recruited a university of chicago professor to show us how we ought to handle the problem of preexisting conditions. we had a discussion of it on my blog and i've asked him to tell you about it today. please welcome michael cannon. [applause] >> thank you, john. thank you all for coming. i may have to leave before the question and answer period, so if there's further questions about my remarks, visit the cato's website. www.cato.org. you may have heard today that the department of health and human services released a study about half of nonelderly

americans have a preexisting condition and repealing the health care law known as obamacare mean those folks have trouble getting coverage, but obamacare they tell us guarantee those folks get coverage and the care they need. there's a couple problems with the study and these claims. the first one is a government survey conducted a few years ago found only 1% of americans were turned down for health insurance. research by the rand corporation looking at lightly regulated individual insurance markets like california's found that lots of people with preexisting conditions get insurance even when they have the ability to deny them coverage or charge them higher premiums. it's a tricky thing really to get people to keep the promises that they make to sick people. this is true whether you're talking about public health insurance programs, private

health insurance, but let's look at the record. in the 1940s. the federal government backed a horse that doesn't make a long term promise to sick people. i'm talking about employers sponsored health insurance. if you know that story, you know that this market is a creation of government. in the 1940s, the government through a series of accidents decided that the employer sponsored health insurance would be exempt from payroll tax and income taxes creating a break for sponsors to if you want to purchase health insurance on your own it can cost some people twice as much for the same or less coverage compared to getting that through an employer. this is the horse that the government decided to back, but if you think about it, you're insurance plan you get through

your employer does not provide you a long term promise to care for you when you are sick. they provide you medical care so long you are connected to that employer. if you get sick and can want work, then you lose that health insurance and you are on your own. in the individual health insurance market, researchers found, only with very lightly regulated provides for secure health insurance than employer sponsored insurance. for people with high cost ill lnsnds, they are more likely to keep their health insurance and not end up uninsured rather than have insurance through their employer. that's the situation that the government created when it decided to make increase the access to health insurance. it shunted nine out of ten people with private hurricane into this employer sponsored health insurance market where you don't have a guarantee from

an insurance company they'll take care of you over the course of a long term illness. how about another government solution? well, we heard about this one today. it's the medicare program. about 20 years later, the government provided secure health insurance to people in old age so they created the medicare program for people over age 65. yes, medicare provides secure access to health insurance for the time being. they do it in part by -- medicare does it by being completely fiscally unsustainable. we can't provide health insurance in medicare that seniors accessed for the past decades. in addition to that, one of the ways that medicare is to financially unsustainable is that one-third of medicare spending goes towards care not providing care whatsoever. it's not making patients happier, and along the way, medicare causes the quality

problems we see in the health care sector. the problems of uncoordinated care, medicare errors that cause tens of thousands of fatalities each year, the problems of a lack of electronic medical records and lack of other technologies and lack of efficientive research. medicare is at the root of the problems. obamacare to the solution on how we keep promises we made to sick people is essentially government price controls. when they e limb nate discrimination against people with preexisting conditions is they mean they tell insurance companies we don't care if the patient would cost you $50,000 to insure. you can only charge then $10,000, the average premium. that doesn't eliminate discrimination against people with high cost conditions. all that does is it creates a $40,000 incentives for insurers to find other ways to discriminate against them, deny

them care, dump or mistreat them so they leave the insurance company's books and go to another competing insurance company and bring that that bottom line. this happens wherever we see the price obamacare style price control. it happens in states like new york who had price controls on the books for a long time. it happens on federal employees books where many of you probably get your health insurance. this happens -- this sort of discrimination reaches you whether you are rich, poor, or anywhere in between. one-half -- instead of what the hhs tells us in the report today, one-half is shared nonnedderly americans hurt immediately by obama care's price controls and 100% is the share of people hurt overtime by the price controls. again, this is a authority problem. how do we keep the commitments

we made to the sick? lightly regulated markets are doing a better job of providing secure health insurance at a lower cost than any solutions the government put forward today, and they can do more through innovations to give patients a total satisfaction guarantee and even if you get sick, you have the freedom to switch insurers and the resources to do so if your current insurer skimps on coverage or care. if it doesn't keep your promises to you when you get sick, but this innovation and others are going to be impossible -- other innovations we cannot foresee are impossible so long as obamacare and the government price control remains on the book. thank you very much. [applause] >> robert moffit is a senior fellow at the heritage foundation and involved in the health care field for as long as any of us can remember. he is a tireless worker.

if you e-mail him at night or on the weekend, he'll answer you. he never quits working. let's give a warm welcome to bob moffit. [applause] >> thank you very much, john. ladies and gentlemen, there's a lot of work to do. we are faced with a great task in front of us. we are now entering really what amounts to today and tomorrow, the second phase the great health care debate that's going to go on for quite some time. let's focus on a couple items on the important issues facing the country which, of course, is the challenge of entitlementings, and at the heart of that is the challenge of the medicare problem. this is january 2011, so this year the first great wave of the baby boomers turn 6 #5, and over

the next 18 to 20 years, medicare is going to experience the largest single demand for medical services like something we've never seen before in terms of the tremendous demand for medical services in the medicare program. the size of medicare will double in the next 20 years really. at the same time, as you all know, it's all public knowledge, nobody disputes it. we are faced with a potentially critical shortage of physicians. not only primary care physicianses, but others as well. the law acknowledges this and starts to pay physicians more in certain overserved -- underserveing areas, but the gravity is greater, i think, than most members of congress really appreciate, and indeed, one the striking facts about

this debate has been the hostility collectively of the medical profession. forget the representatives of the medical profession or the lobbyists, the medical profession itself, the hostility of the medical pefertion of this law. there's a reason for that. physicians and doctors are becoming demoralized because more and more of them recognize they do not have control over their professional life. they are more governed by regulation, faced with an expansion of government payment, and most of the problems like malpractice problems are not addressed. getting back to medicare, there is something else remarkable here. while we see the massive expansion in coverage and at the same time a tremendous addition of public cost in health care,

medicare is at the same time simultaneously undertaken record breaking reductions in payment to doctors and hospitals and other medical professionals? the center for medicaid and service says this will result in a savings of $575 billion in the initial 10 years of the law. what does this actually mean? we've never actually been here before with a tremendous demand for medical services among the large and growing aging population and such a significant reduction in medicare payment, but absent medicare reform, the payment reductions of this mag magnitude threatens senior's access to care. that is the view of the actuary center for medicare. an absent further legislative intervention, the projected medicare savings will not

enhance the program. indeed, there was a wonderful letter addressed to senator jeff sessions of alabama by doug almendorf from last year where the majority of the hj trust funds would be used to pay for other spending and would not enhance the ain't of the government to pay for future medicare benefits. without an escape valve for senior citizens, the provisions of the law are going to guarantee that we are going to see greater access problems over time. the cms actuary does not think, in fact, that these massive record breaking medicare reductions will actually survive, but if we actually were to go down this road, you certainly want to have access for senior citizens to private sector options that many of them

do not have today. it doesn't make sense to cut, for example, medicare advantage my $136 billion and reduce their access to those private plans or to maintain the existing limitation on senior citizens' ability to go outside the medicare program and contract privately for medical services if they need. we have to go in a very different direction. ladies and gentlemen, we are entering, as i said today and tomorrow, the second phase of this great national debate, but one thing we ought to keep in mind is congress has direct responsibility as the board of directors for one of the largest programs, the medicare program, and they have got to figure out a way to get this financial house in order. right now, medicare has an unfunded liability of over $30 trillion. please tell me, is there any member of congress who knows right now how we're going to handle this financial challenge? does anybody know?

the truth of the matter is nobody knows, but rewith faced with it, and if of you are -- many of you are young people and you will pay for the price of inaction in this area. there is a way out. we have to restructure medicare, changing it from the existing open-ended entitlement that exists today to a program which, in fact, is based on real competitive insurance and adjust premiums and subsidies in the medicare programs to income to get away from what we have today which is so costly. we should provide the beneficiaries with a wide range of choice in health care plans and options and at the same time make sure that in future medicare system that we will expand access to physicians and reduce the number of physicians who refuse to take medicare patients or accept new medicare patients. there are ways to do this. my own view is that many of you

are enrolled in a program which is actually quite good in materials of organizing health insurance benefits, the federal employee health benefits programs, but the key element is it's driven by two principles, consumer choice and direct competition. many of you can do what many cannot do. if you are dissatisfied with your health insurance package, you can fire your health insurance plan. that's note a bad option -- that's not a bad option for the senior citizens as well. they're going to have to depend on us to make good decisions to give them access to the quality of care they deserve. thank you very much, ladies and gentlemen. [applause] >> thank you, bob. that was very informative and very good. now, i want to open up the floor for questions, and if you will tell us who you're directing your question to.

let's have a hand up. well, let me just begin by asking this question. do the panelists believe that senior citizens realize what has happened to them under this legislation and what do you think will happen with the medicare provisions? will we go tabard -- forward and carry it out the way the law is written or will it have to be changed? >> i'll go first. >> all right. >> i thought it was interesting that both the actuary at cms and the director of the congressional budget office both publicly stated in formal official correspondence to the congressional leadership that they did not think that the medicare payment reductions were

sustainable over time. both the cbo and the cms actuary. we have never really quite gone here before at this level of payment reductions, so i think that whether this survives or not is highly unlikely in my view these kinds of reductions will survive. >> well, let me address this question to doug. what happens when you have a bill with a huge expense and the way you thought you were going to pay for it doesn't pan out? >> nothing good. [laughter] no, this has been the history of entitlement programs in the united states. they are launched with fanfare that includes their budgetary soundness. over time, enrollments expand over what was originally envisioned, benefits are added more than originally envisioned

and no one is ever going to impose things on programs that cause beneficiaries to save. that wasn't the point. we need bloat the entitlement programs. that's the history in medicare, medicaid, and it's likely the future of this law unless we change the course. we end up where we are today with enormous structural deficits that are so large and so troubling that they literally threaten the capacity of the u.s. economy to provide a higher standard of living in the future than we have now, and that is something we simply cannot do. >> john, you value currencies with economic imbalances, and we can also devalue health care either explicitly or indirectly. >> yes, sir. >> michael cannon mentioned -- [inaudible] it suggests that about 30% of the spending in medicare is

wasteful. it goes -- it's spent on care that provides no particular good to the people it's being spent on. my first question is doesn't that suggest that there is, in fact, a lot of fat to be pulled out of medicare, and if so, how do we do that? the second question following on that, i don't know if you saw the health care study published last month looking at mcallen and texas and looking at variations in medicare spending, and they found that versus variations in private spending, variations that exist in medicare spending don't exist in private spending in those two locations. my understanding is that the administering, a lot of the plans for obamacare for based on the idea that that same fat existed in private insurance. what does this suggest about the future of the reform of the law and how it plays out?

>> it's measured crudely as an aggregate. this was known 15 years ago. people are rediscovering it. there's an older study in the mid-90s baht the program of managed care plans where there's less variation on a regional basis, but the tend sigh of research is you go where the data is. you have medicare data and show the crude variance and concoct a lot of theories around it. it could be true the medicare program leppedz itself to that waste and variation without measurable elements. there's two principle ingredients to deal with this. put the money in the hands of the pieshts and consumers. who's the person who costs and receives the care? we have that distorted. the second is we need some type of -- even though they are

imperfect markers -- what's better, worse, most of the time, not perfect, something in that regard. we have metrics that dent tell us that, but that's the general direction on where to go. is there waste? yes. can you find it on this map and pin point it and get it passed politically? probably not. we need to decentralize that set of equations. >> yeah, let me just add one thing to that, and tom's answer was very good. there probably it 30% waste in medicare, maybe more, but when you have a hospital bill, these items are raised. if it did, it would be easy to get rid of the waste. the problem is we don't know where the waste is. some bright entrepreneur could have done this for 70% of the cost that was actually expended, but unless there's an incentive to do it, they're not going to do it. we're not beginning to get rid

of waste unless it's in someone's self-interest to do it. yes, sir? >> do you believe the new congress should attempt this legislation? is it possible to fix the law or tweaks as a whole can't make a difference and the whole thing has to go. >> anyone want to answer that? >> i'll take a shot at it. i think that the issue here is what is your vision for the future of health care in america? when i think the represents is it represents a very specific provision of health care policy. we know our colleagues very well who disagree with us, and frankly, this is their vision of what the health care system should look like. they believe, many of them very strongly, that health insurance plans should be public utilities and should be heavily regulated by the federal government and the federal government should make key decisions in allocating resources in the health care system and making decisions

about what will be covered and how it will be financed. now, that's not my view, and i think the colleagues here share my view on this, but it -- the bill does represent that point of view. now, having said that, i would say in answer to your question, you actually cannot build a system based on free market principles of consumer choice and competition on a foundation which is fundamental incompatible with that vision. a foundation which is built primarily on central planning and bureaucratic regulation. again, that is not a personal opinion. that's what the law does, and i understand, you know, our friends on the other side, they have a very different vision on this. let me just make one observation before i stop. during the -- in the early 2000, this idea was popular among

health policy analysts. the idea bind that was competition among private health care plans. at the university of california a number of analysts got together and said, look, this is a great idea. we should have a hurricane exchange -- health care exchange with a taxpayer finance public option, and what was the purpose of it? well, it was very, very open, very, very publicly celebrated. it was a way to get to a single payer health care system by basically undercutting private health insurance. that's the image. that's the vision. we have a different one. >> this was a package deal. it was not all you can eat. it's all you can stomach before recourage at a timing. [laughter] you can talk about a few appetizers that are tasty, but you have to have the entire male. pulling some of this, didn't

mean leaving the rest. the danger, though, in pulling apart the most obnoxious features is we are in a game playing for time, and the designers of this legislation want to institutionalize and make inevitable the seeds buying off the health care lot in that regard. that's why this has to be pulled up quickly and get right away then on what we need in its place. it doesn't mean nothing remains, but find things that make sense after we first pull up the weeds. >> this is for the entire panel. after the repeal vote the house is set to vote on a resolution with a list of goals. are you guys confident that that list of goals directing committees to come up with replacement legislation makes structural changing you're talking about on medicare or how

health care is paid for? >> i think there's good reason to be optimistic on that front. what people now forget is that if you dialed the clock back to the beginning of the health care reform debate, there was a tremendous amount of bipartisan consensus about the need for reform. there was a tremendous amount of consensus about what reform should look like, providing incentives to root out low-value care, decentralize, and equalize across the states these cost differences we've seen, provide people with better health insurance options. no one was in dispute. there's no reason to be at all skeptical about the notion of going out and finding common objectives was also the case, but there was a tremendous amount of bipartisan agreement on the delivery reforms on delivering health care in the united states.

.. >> it makes sense for one state to try modeling for some of the laws you've outlawed here at the state level that would even allow not just private insurers, but also medicare to participate in that.

>> the law doesn't allow enough of that experimentation. states are going to have been to be more aggressive than the rules sent down from hhs. you get into the plea bargaining. give me a little bit more slack. few more minutes for prison yard for exercise time. it doesn't turn it around. i'll be speaking tomorrow at the national congress for insurance reform. there's a different way to do exchanges. to some extent, states have to put something on the ground, which isn't going to fit in the parameters what they are told for washington to do. they need to get some of the examples that work in the next two years, and see what they'd actually prefer. something that the works at the state level, or what the rules have been con conducted -- concocted for an entirely different scheme. >> the only thing that i would add, the administration seems desperate to get something to work.

i think that's why they gave waivers to 30,000 mcdonalds workers. they don't want to be embarrassed by bad things, they want to see good things. that makes me think they might be willing to be flexible. yes? >> we will continue to physicians, i think it was mr. miller that alluded to the medicaid physician payment cut. if they are not going to get paid anything, who would want to be a doctor? how are we supposed to fix that and have more doctors? >> anybody want to take that one? >> let me take a shot at it. i think that that -- i honest tk that one the most serious problems facing the country is the demoralization of the medical profession. physicians are disspiritted. it's a great opportunity to talk at the meetings, where members

of the medical profession why gathered. they talk about about the profession, and how they can function in this environment. the environment for independent medical professionals is becoming increasingly hostile. you are expected now to go to work for a hospital. you are expected to join a large group practice. at the same time, you are expected to absorb a massive number of people who are going to be getting care under medicaid. medicaid really, if you want to talk about the big, big change in this bill in terms of insurance coverage, roughly half of all of the people who are going to get health insurance are going to get them through medicaid. talk to physicians, for example, about what that means. it means that every single time the patient walks into the room, the patient is going to incur, you are going to incur a financial loss. it also means that more and more people are going to be end up in

hospital emergency rooms. this has been completely overlooked in this past health care debate, the degree to which medicaid is a driver of hospital room over crowding. so i think the situation is very serious. now the only way to really change that, it seems to me, is to change the fundamental, underlying, financial structure of our health insurance system. where we basically have an opportunity for people to buy the health insurance which is best for them, and enter into the kind of relationship with a physician that used to be the norm. what i'm saying in effect is pretty radical here. i'm saying what we ought to do is make one the goals of health care reform the restoration of the traditional doctor/patient relationship for those who want it. not all people want it. but many of us do. and that's why the president has sent so much time saying in forum after forum if you like your relationship with your physician, you will be able to

keep it. the problem that you and i are all struggling -- we are struck with, you may want to keep your relationship with your doctor, but your doctor may not be able to keep his relationship with you. >> well, i think the goal is one-to-one relationship between the physician and patient. we are moving towards that ratio. you be your own physician now. [laughter] >> how do you say that dr. burgess is here with us today. and douglas holtz-eakin tells me are 20 physicians in the house of representatives. >> 80 new members in the house, 20 are doctors. >> 20 are doctors. i hopefully will hear from all of you in the debate that starts later today. [inaudible comment] >> how hot -- hostile the medical practice has become. [laughter] >> the problems are solvable. >> we're glad to see you there. yes, sir? >> doug, you mention a couple new entitlements, one of which

is the class act. how there's no requirements for reserves, they have two protected classes that only have to $5 in premiums, while others have to pay $240 to make that up. can you talk about the sustainability of a program like that? >> so the class act is a new long-term care insurance program who's basic structure on paper is pay premiums in while you work. once you pay for five years, you are eligible for benefits. we've seen the kind of structure before, social security, medicare, they are in deep trouble given the way they are structured. and, you know, just to quote someone who would know a lot about this, senator ken conrad chairman of the budget committee called it a ponzi scheme. i think that's an optimistic read, the way the program is set up, it looks like it will

amounts of adverse selection, the people that want to claim benefits will have well above average cost. the premiums will become nowhere close to paying those full costs. we'll get into -- in the private sector, it would be a death spiral. the only way the government lets death spirals pay out, shoving your general revenue into it. so this is, i think, on the sort of quality of the policy, one the worst parts of the bill. not one that i see any way to redeem. you have to repeal the class act. it's unworkable and dangerous. >> the surprising thing, we have the commission set up by the president that tells us what to do about unfunded entitlement programs. then we pass a bill creates another one. >> the bowles-simpson commission in the final recorded, recommended repealing the class act.

that's a telling recommendation coming so quickly after the bill became law. yes, sir? >> one the debates that congress has had over the last few years has involved earmarks. one the arguments that lobbyist come up and get special treatment for somebody for an earmark. now we have hundreds of waivers being sought through the department of health and human services. this is another prescription for political favoritism in the granting of waivers, much like we've seen in the corrupt practice with earmarks? >> i find this incredibly troubling. the 220 odd waivers we've seen already, first of all are prime fascia evidence of the unworkability of the law. it can't be implemented as written. more troubling, you cannot figure out the grounds by which these waivers are being decided. they can effect the competitive balance within industries, waivers these insurance requirements for some employers and not others. there appears to be no particular transparent process by which large groups could get

a waiver simultaneously, and keep competitive competition fair. i consider this one the really troubling aspects of the implement face of the -- implementation of the law. >> i'd like to second that. we have time for one last question. >> i was curious about the your thoughts on the delivery aspect of the bill. they spent a lot of focus on coordinated care through acos, and health bills, and i was curious whether you think that focus is good. if so, can a consumer-directed approach deal with those issues? >> all right. coordinated care, managed care, evidence-based medicine, pilot programs, any of this going to work? >> randomly, yes. in an organized political fashion, no. if you throw enough ideas and someone, a few things will seep out. however, it's organized in a way that tends to stunt innovation because you don't have the kind of feedback with real parties determining what works and what doesn't.

you are trying to manage this from on high and thinking that you are calling it innovation. can you get some incremental gains? sure. we also have markets though with incentives with people actually spending their own money, which is the fastest route to innovation. >> i want to second that one brief way. the fundamental problem with our government health programs that we send the message to consumers that they can have all of the highest quality care they want at no cost, and when they turns out to be expensive, we tell the providers cut it out. stop charging so much. we demonize doctors. we don't pay them. you can put all of the acos you want in the middle of that. until you break the mismatch between the promise and capability, it's not going to work. >> here's the last word. for 25 years, we've been doing pilot programs and experiments in the field of education, trying to find out what works so that everybody can copy it. for 25 years, it hasn't worked in education. it's probably not going to work in health care. thank you all for coming.

[applause] [applause] [inaudible conversations] [inaudible conversations] >> new congress and a new way to use c-span. congressional chronicle is a comprehensive resource to follow congress your way. research members, view session timelines, and find video and text of all floor and committee appearances. congressional chronicle at c-span.org/congress. >> white house press secretary robert gibbs said today that president obama will meet with chinese president hu jintao on issues such as human rights and currency values.

we'll also hear about a new executive order calling for a government wide review of federal regulations. this is almost an hour. >> sorry. let me get semiorganized here. mr. feller? >> thanks, robert. a couple of topics. on the executive order and the president's op-ed this morning, when you look at the timing of this, is the intent here at all to tap into the widespread concern, as voiced by the tea party, the business community, and republicans, about government intervention and government overreach? >> no, the -- ben, and to others, this is something that the administration and elements of omb have been working on for quite some time. and i think it sets out what the president believes should be our very common sense approach,

which is to ensure the health, the safety, and the security and the protection of the american people, as well as understanding that we shouldn't do anything that unnecessarily limits our economic growth. that's been our approach. i think if you look at the history, look at things like the rules around fuel mileage standards, i think you get a pretty good -- make a pretty good case of the administration working with all of the stakeholders, to improve the situation, to save us, as is mentioned, i think, in the op op-ed, billions of barrels of oil over the course of the lifetime of this rule, and ensure, again, the health and safety of the welfare of the american people. >> well then let me response to

what you just said. let me look at it a different way, which is, in essence, this is a call to government to make sure that the regulations are striking that balance, then why has that taken two years? >> no, again, we have had an approach since coming into office that ensures that what we're doing makes common sense. that is what the president wanted to do to outline and put in writing our approach to ensure that we look back and make sure that the efforts that we're undertaking and the efforts that have previously been judgment taken from the federal government are done so in a way that makes sense, that protects, again, the health and safety of the american people that balances the important need for economic growth. look, i am, as is everything that happens in this town,

they'll be wont to add a political label to this or that. the president believes it best defines a common sense approach. >> does he think that that balance is happening right now? >> well, again, that's -- understand that in the op-ed that we're asking that there be a process where we look back at what is on the books and ensure that there has been an analysis as to the cost and the benefits given where we are. and the president believes that is necessary and appropriate. >> i wanted to ask you one quick thing on health care. the story line on the house's effort to repeal the health care law has pretty much from the start concluded that it's not going to go anywhere in the senate, and therefore not become law. but i'm wondering from the white house perspective, is there a negative consequence to the very fact that the house is aiming to

do this? does it impact the public or the debate in any way? >> well, there's a -- on one hand, ben, i do not -- i would share the belief of many, including, i think, enunciated by those who are going to vote for repeal tomorrow, this isn't a serious legislative effort. i think first and foremost, they have largely acknowledged that. secondly, i mean, let's not misunderstand, though, what in essence the move says. it says let's put insurance companies back in charge of making health care decisions, and with that, the option to deny health care coverage, drop health care coverage, limit health care coverage, or cap health care coverage. let's understand the practical impacts, as the congressional budget office said just a couple of weeks ago, of the impact to the tune -- bless you -- of

several hundred billion dollars on our deficit in the short term and then over a 20-year period of time, a significant increase in the cost to the federal government. and understand the practical impact on what this means for seniors. dramatically increases their out-of-pocket costs. no longer will they get the help they need or got through the affordable care act, their prescription drug costs falling in that donut hole, falling in that sort of gray area of not getting any help until they spend a certain amount of money, having to pay out of pocket now for preventive health care costs, a right that's not guaranteed for free in the legislation. so i don't think it's going anywhere. i do think it's an important symbol to the american people about what some -- who some people think should be in charge of making health care decisions -- not families or patients or doctors, but let's put health insurance companies back in

charge, giving them the ability, again, to drop, deny, limit, or cap your health care coverage. i would point, as i'm sure many of you have read the articles, today the notion that almost 130 million americans have, according to the department of health and human services, some medical condition that would either trigger a loss of health insurance coverage or an increase in the amount of money you pay to get that covered. that has real impacts on the americans people. matt. >> a couple of questions on the chinese summit. >> yes. >> president hu in his responses to questions from the newspapers over the weekend suggested that he was resistant to u.s. pressure and advise to let their currency rise as a way of tackling inflation. how confident is the administration that they will get some positive movement from the chinese on the currency issue? and --

>> let me take that first. first and foremost, i think this is a relationship that has as you heard secondary geithner and national security advisor tom donilon speak about last week, that has -- certainly generates positive economic benefits for the american people to the tune of $100 billion, soon to pass more than $100 billion in goods and services to china this year. at the same time, we believe more must be done in terms of their currency. obviously with inflation, there are some impacts on the real value of the currency. they have made some -- they have taken some limited steps, despite the answers, to revalue their currency, and our belief, as you heard secretary geithner in here just friday say, we

believe that more must be done. this is an option that is not held just by this country, but by this countries around the world. >> okay. also, a lot of big corporate dealers are expected to come from the summit. a large boeing aircraft order is one of those that has been widely talked about as a possibility. are you expecting one to come down the pike on that? >> i would direct to what tom said on friday, this is a little different than our trip to india in the sense that, as i said, the economic relationship that we have with the chinese is different on a scale that with what we do with india, which is why some of the commercial diplomacy around the india trip was so significant. so, look, obviously, we are -- we continue to believe that

american companies produce the best products in the world, and that they have a demand from china. i have not been told of any big deals that will be rolled out tomorrow, but i am certainly all ears if anything happens. >> because there's some concern in the u.s. aircraft industry that some deals, including specifically the boeing order, might be held up by political friction, might be be held hostage by political considerations if other areas of -- if progress is not made in other areas in the talks. is there any truth to this? >> from our side? >> no, from the chinese side. >> well, look, we have -- i think it's important -- look, we have a relationship, as i said, that yields substantial benefits. at the same time, we have some direct and difficult channels. some of those will be discussed -- most of those will be doesed tomorrow. you heard, again, secretary geithner discuss the steps, as

you have for many months, on currency that need to take place; the role that the chinese have to play in that region of the world and dealing with countries like north korea just as they have been helpful in dealing with sanctions of the u.n. on previous actions of north korea, as well as sanctions around the islamic republic of iran. so there are a whole host of issues and topics that we anticipate that the two leaders will discuss tomorrow before meeting with you guys. jake? >> the administration and the president have talked quite a bit about pressing china on its human rights record, and secretary clinton in advance of this trip also said this was going to be a major topic of conversation. has there been any success in getting them to move on any human rights issues? >> well, look, obviously there -- that is a topic of some significance that the two leaders will talk about. we -- president obama was -- put

out a very forward-leaning statement upon the awarding of the noble peace price with liu xiaobo, that he should be freed. that he certainly should be freed to go to oslo to accept his prize. these will -- we will continue to have difficult conversations, jake, but necessary conversations that had to be had with china, and we'll do that again tomorrow. >> no actual tangible evidence of success yet? >> well, again, i think this is -- this is a long road, and whether we're dealing with economic discussions, whether we're dealing with those in the security realm, or whether we're dealing with those in human rights, i think this is an argument that we have and will continue to make to the chinese

and push them to do better. >> you said earlier that the effort to repeal health care in the house is not a serious legislative effort. do you mean that because it can't pass the senate and the president will veto it? >> i just don't think it's going anywhere. look, again, i'm quoting some of the many new members of the house that have said this isn't a serious thing. >> okay, well in the abc news/washington post poll i'm sure you've seen that has some nice news for the president, but also the poll is the fact that president and republicans are tied on who you trust to handle health care. for the first time ever, the president has gone down nine points; republicans have gone up four points. so whether or not the repeal effort actually has any hope actually becomes law, which it does not currently, their

talking about about issue that has been good for their cause. >> i think you should be clear that the question, though, does not measure repeal. and when asked specifically in the other public polls that we've seen repeatedly and recently about repeal. there's a significant number of people -- and some of them i presume are republicans, that do not want to give up very benefits that i outlined a minute ago. but wants to see -- maybe they want to see something that's worked on that's improved. that's certainly not measured in a question that you picked a or b. so if you think break some of the question out, you see that the notion that there's a vast, widespread support for doing away with the affordable care act, raising the deficit, putting insurance companies back in charge, and there are a whole host of things that even republicans don't find a

suitable or tenable about the effort. >> right -- i'm not talking -- i'm talking about specifically as much gaining support. not on just health care, but moving forward on the health care issue. >> well, i think the question doesn't measure the breath of opinion, certainly about the health care. >> do you have a response to "baby doc" duvalier approving in haiti? >> this is an important and crucial time for the people of haiti. >> do you mind if i follow -- he's been arrested. haitian officials took him into custody, so if you want to update here. >> thank you. i want mention that any political leader or any former political leader should not focus on him or herself, but on making progress towards a set of important elections and dedicate their time and their energy to the reconstruction of the country. thank you. >> on the human rights question,

robert, does china have to make significant steps in addressing that issue before this relationship with the u.s. can really progress in a significant way? >> well, dan, again, i think there's -- again, i think as you heard others talk about, again, as you heard geithner and tom donilon talk about last week, there's a series of baskets, i think as tom called them, or themes oners that will be part of the discussion here tomorrow. human rights is certainly an important aspect of that. the economic relationship we have -- and then the security of the region of the world and of the entire world -- are important to the role that the chinese must play as world actor s. so is i think it is -- i think, again, there are a whole host of issues that will be on

tomorrow's docket that the two leaders will work through. >> you are not giving weight -- more weight to the human rights issue? they are all equally important? >> again, i think there are a whole host of important issues that will be discussed and we hope will be ultimately addressed. >> and on the president's executive order, you talked about this process of looking back. can you explain a little bit more about how this process will work, and is there a timetable to when we'll see some of these >> well, let me check and see on what the tame table might be. but again this is simply for the relevant agencies to go back and ensure that the regulations that are currently on their books -- again, go through a process that measures the costs and the benefits, that ensures, again, i think the very common sense idea that we must protect the health and the safety of the american people without impeding our economic growth, something i

think we can get a large number of people in this country to agree on. >> and again improving the relationship with the business communities did not play into this at all? >> this is something that has been long in the works. chip. >> thank you, robert. secretary gates, clinton, geithner all had speeches, which, you know, some have described as kind of a shot across the bow beforehand with some fairly tough talk. can we expect -- how tough is the president going to be compared to previous meetings with hu? is he going to be more assessive and confrontational with him on issues than he's been in the past on issues like currency, human rights, and north korea and iran? >> look, i think all of those, chip, are on the docket. i think those are all issues that the president has brought up in the with president hu in the past and will continue to do so. i think you outlined . >> with a more