keep the cbo score down and that meant bumping everyone it's medicaid at the last minute. mr. chairman, you thank you for indulgence and i yield back. >> to recognize the ranking member, the gentleman from california, mr. waxman for five minutes. >> thank you, mr. chairman. today will hear the governors on the impact of the affordable care act and on the nation's critical safety net health program medicaid. medicaid and the aca to return the federal and state government. we share the responsibility for making these programs run efficiently and serve the needs of the populations that depend on them. for this candidate should be a project to dialogue. in my view that does not include rededicating the affordable care act, aca is already delivering the benefits, prohibiting insurance companies when someone gets sick, requiring coverage of

the medicare for no cost and allowing illegals to stay on their parents insurance after the age of 26. three new reports we are releasing today highlight the benefit of the new law in the state is represented by the three governors who will be testifying. they show, for example that in utah 1029 residents are already receiving consumer protection against the worst abuses of the insurance company. in mississippi, over 30,000 seniors have heard he saved hundreds of dollars on medicare throughout cost. these are powers show precisely how much the affordable care act be included in the record. >> the affordable care act allows rate and flexibility for the state to run new health insurance exchanges into continued to run their medicaid

program as a subject of today's hearing. at this time, and like to submit for the record a third letter from secretary sebelius described in the flexibility of the medicaid program. >> again without objection. >> kassim states are having problems with their measures. when unemployment increases, state revenues decline and more people rely on medicaid. medicaid has been working exactly as intended. medicaid is enrolled in the additional 600 million people during the recession. many last other forms of insurance when they lost their jobs. medicaid is the final safety net, but the program is still extremely efficient. as a matter of fact, medicaid spending growth on a current generally basis has been slower than increases in private health insurance previously.

what is healthy years to make medicare programs that are the recession and disasters with additional federal support so states are not stretched beyond their means at a time of economic stress. when medicaid enrollment grows to help people lose their jobs over in a crisis. i want to highlight other important facts about the program. medicaid covers 45 million low and come children and adults in the face 9 million seniors and people with disabilities. it covers 70% of nursing home residents and 44% of people with hiv/aids. it is the nation's safety net program that helps those most severely in need. the program responds to the needs of the population it serves, providing prenatal and delivery care, speech and occupational therapy, case management and community-based

care that helps individuals with disabilities stay out of the nursing homes. medicaid offers saved considerable flexibility in the management and the design of the program. to be clear, they're aspects of the program we can improve. we can reduce cost for 9 million eligible beneficiaries, low-income seniors and disabled who are eligible for medicare and medicaid. this group accounts for just 15% of total enrollment and 39% of total medicaid costs. here's where the aca helps the state. it establishes a federal court in tough iraq is to reduce the cost and increase the quality of care for the individuals. it establishes senator for medicaid and identify policy to improve care and cut costs. these are the changes we need to concentrate on, not radical changes with the number of

others assured. a number of governors such as yesterday dedicate that no standards to coverage or care. the added and the states of adequate funding and remove the federal commitment that will result in the most vulnerable and severely disabled adults and children, people needing nursing home care and poor children and families and they will exacerbate an fair distribution of dollars among the states. all the cut this program under the flexibility and fiscal restraint are shortsighted. i hope as we concentrate today on how we can work together to make our programs run better. thank you, mr. chairman. >> thank you. i would now recognize the chairman of the subcommittee for five minutes, mr. pitts. >> thank you, mr. chairman. right now, states across the nation are struggling to ounce

budgets without sacrificing the quality of care for their current medicaid enrollees. many states have already made deep cuts trying to achieve balanced budgets, but under the meat and fat for provisions and obamacare, the state takes any action that makes eligibility for medicaid were restricted, then the standards in effect put the state's program as of march 23, 2010, that they could lose all federal funding. if states can change the eligibility criteria, governors are left with little flexibility and few choices but to cut payments to providers or cut other parts of the state budget, for instance education and transportation, in order to maintain federal medicaid spending. what does this look like for my home state of pennsylvania? in an op-ed on "usa today".com come pennsylvania governor tom corbett today wrote quote, pennsylvania's medicaid program, for example, has been steady and sustainable increases in the

number of people cursing the cost of those services. the keystone state's medicaid budget is strained and nearly 20% a year while the commonwealth general revenues have grown by just 3% a year. it is a trend that simply cannot continue, but one that will be unavoidable as long as inflexible federal rules guide state policies, end quote. in may 2010, kaiser family foundation reports on by 2019 pennsylvania's medicaid rolls may grow by an additional 682,880 people and may cost the state an additional $2.04 billion over the 2014, 201910. many governors, including governor of utah, governor barbour for mississippi with us today have already spoken out and ask health and human services to relieve them of some the restricted health care mandates, including the maintenance provisions.

the responses they've received have not been encouraging. so i look forward to hearing from an assisted gamut of first-hand what the impacts for obamacare will be on the state and medicaid programs another state health programs. i'm also interested in hearing ideas to provide access to quality care for greater numbers of people while keeping costs under control. at this time i buy to yield one minute to do your gingrich. >> and yielding, new cbo numbers on obamacare a rat in the news and mrs. devlin i could. cost of increased by four to 60 billion in just two years in state medicaid costs rose by 300%, $20,000,000,060,000,000,000 in state reform programs are doing a better job of screening out individuals who don't belong in the program in order to deal with these crushing halls. no they can't. obamacare spread and tries to build changes that might remove people who are illegally in the program until at least 2014.

welcome states afford to wait until 2014? rhode island sure can't. the city of providence just sent termination letters to every single teacher that has come a 2000 in all, to give himself as much budgetary flexibility as possible. 34 saves for the district of columbia have cut k-12 education programs in 40 states have cut higher education of the last year due to budgetary problems. but today this country is forced to stare at an intermediate question. how can her children's computer in the global economy without quality education? president obama has often said we need to stick with the health reform proposal because it lets children up to age 26 stay on their parent's insurance policy. while mr. president, when your economic policies make our college graduate children was like you to find good job, they are going to need to stay in their parents health insurance policy and i yield back.

>> failed at this time one minute two men's bike or tennessee. >> thank you, mr. chairman. welcome to our witnesses. our chairman mentioned the states were expecting the cost to be twice what the federal government had estimated. i would like to make everyone aware we have had a test case for obamacare. it was in the state of tennessee called 10 care. costs were not quite estimated. there were four times overestimated. mr. chairman, our former governor phillip edison had a great article in "the wall street journal" on this. i think to submit or the record as well as the history ignored by lee pence from world magazine. this place i would have been. 10 care it at 33.5% of the state budget before it was addressed. there was no more money for higher at, no more money for education. if you want a program that is going to eat up every dollar and is too expensive to afford, this event. i'm looking forward to talking

with our governors, governor patrick looking forward to what you have to say about a sales program in your state of massachusetts. i yield that. >> chair will recognize for an opening statement the gentleman from new jersey for five minutes. >> thank you, mr. chairman. today we meet again as her republican colleagues continued their assault on the affordable care act of the many positive benefits it offers americans nationwide. the specific focus on medicaid in this hearing has little to do with our newly enacted health reform legislation. it's simply an extension of republicans decade-long interest in undermining and ultimately dismantling the medicaid program. i point out that under democratic leadership to previous congress understood the dire straits these are facing face seemed in significant federal recovery act to include our safety programs operate as they were designed to provide medicaid coverage for vulnerable

americans when they need it most. this certainly should be contrasted with the recently passed republican continuing resolution which achieved nearly one third of the budgetary spending cuts by reducing critical aid for state and local government. it's no surprise to anyone that medicaid rules spinning right now in the economy is contracting medicaid and vice versa in challenging economic times, the unemployment increases in income strap, fear people receive health insurance from places of employment to more individuals meet the eligible requirements for medicaid coverage. we've been hearing a lot about the need for flexibility in the medicaid program. stay 30 of broad latitude to design the medicaid program after meeting minimum health care coverage benchmarks. they also an medicaid section 115 waiver to amend the program even further. the flexibility of my republican colleagues be more direct and at destroying the medicaid program and strengthening.

medicaid is no panacea to stay. with threatened the medicaid program that it can expand and contract according to need. a change in the federal component of medicaid from a 6% to a fixed dollar amount, states could be left holding the bag of much higher bills at this time of economic crisis. it could be truly catastrophic for season citizens who desperately require medical assistance. we should also be wary of proposals to raise copayments on low-income and working families and medicaid. numerous studies including one conduct by rand health found that even nominal copayments lead to larger reduction in the use of medical care to low-income adults and children and seriously compromised access to needed health care. this allowed for ways to harness the medicaid and what our colleagues on the other side are proposing. the affordable care act of the commonsense philosophy with shared responsibility among individuals, employers and federal state government. the medicaid minutes of effort

with health care for the most formal burrows a state-sponsored build in the near term until full health reform in 2014. after that 100% of the medicaid expansion included some help with her will be sworn by the federal government and faced down to 90% in 2020. furthermore the affordable care act will slow the growth of health care cost for both seats in the federal government and promotes medicaid demonstration and is into delivery, system reform in finance to establish medical and medicaid which will improve care for those with substantial means. we also give the federal government and states a new tool to fight abroad in medicare, medicaid, as chip and the state insurance. we need to think carefully about the profound devastation that medicaid would have on working families in the state health agencies that serve them. i've been here for a long time and its almost every year we see another proposal by the

republicans to dismantle medicaid. they don't like medicaid. i know that. but the bottom line is medicaid has been a much-needed lifeline for the 6 million people enrolled in the program during this recession, many of whom did lose health insurance. i have one minute left, mr. chairman. i'd like to yield that to the gentlewoman from wisconsin. >> thank you, mr. chairman. radio across the country and particularly my home state of wisconsin, we are seeing the effects of unfortunate attacks as some of our nation's governors on the values we hold dear. i'm sorry that wisconsin's governor, scott walker declined the majority's invitation to be on the panel today. governors watsonville would not only strip away workers rights, it would also got the medicaid program. ..

i stand in solidarity with my fellow wisconsin rights to take into the streets to oppose state plans to threaten the health education and safety of the people of our great state. i yield back. >> gentlelady's time is expired. at this point, a quick thing. it's my understanding the democratic defeat could democratic turn in policy has proved donna christiansen to be back with us and even though the full caucus hasn't approved yet, we welcome her back and will

view her as a member of the committee for all intensive purposes of this point and without objection i would now recognize the following gentleman for one minute each to introduce their governors. mr. matheson, mr. markey and mr. harper. mr. matheson. >> thank you, mr. chairman, for holding this hearing today. i want to expend a thank que -- i'm sorry, is mike from on? hello? one to extend a think you to my governor, governor herbert, for providing the experience for performing the health care system. as many of the committee probably know, ut is one of the states that took the initiative before the enactment of health care reform of the federal level to tackle reforms to the health care system at the state level. one of the particular was this a bonnet of the health insurance exchange in utah. our state's experience was certainly testified to the flexibility states need in order to implement this law. i appreciate governor herbert's pettis fusion and want to extend a warm welcome to our committee and look forward to his testimony. i yield back.

>> it's my pleasure to welcome governor deval patrick from the great state here to washington. in 2006, massachusetts trailblazed the path for health care reform we see here on capitol hill just a few years later. our outstanding governor has been the driving force behind successful implementation of the massachusetts law. in november 2010, he was overwhelmingly elected to a second term. under his watch his astounding 90% of massachusetts residents and 99.8% of our children now have good dependable health insurance of no other state comes close. governor patrick proposed legislation to lower health care costs about cutting into our residents' quality health care access to services the legislation focuses on quality health care services over quantity encouraging providers

to better coordinate care for their patience. this means lower cost and healthier patients. experience a massachusetts shows that far from being one-size-fits-all, healthcare and reform efforts provide states with wide latitude. i can't think of a better person than governor patrick to join us this morning to highlight the great work we have done in massachusetts, and i look forward to his testimony. it's our honor to have you with us here this morning, governor. >> i am honored to introduce one of today's witnesses, governor haley barbour of mississippi who has made the tough decisions in mississippi to make sure that we have a balanced budget. money in the bank and has been a true leader on energy issues in this country. governor barbour has promoted a healthy mississippi by providing the to promoting let's go walking mississippi along with marcia barbour. the program's discussed in schools across the state to show the importance the exercise and healthy meals.

under his leadership medicaid changed its prescription drug program to better utilize generic drugs instead of more incentive brand name drugs. he also promoted annual physicals for medicaid beneficiaries to detect all problems early by checking for diabetes and high blood pressure and making sure they are taking the right medication spirited but to truly understand governor haley barbour, look no further than what happened in the aftermath of hurricane katrina to see what his leadership was about and what he and first lady marsha barbour did. they didn't wait around for somebody to come help him. he didn't wait for others. he didn't sit around and complain. he simply will put his sleeves and went to work and the rest of america got to see what it takes to be a great leader. governor barbara, we are honored to have you here today. >> thank you, governors. welcome. if you take your seat at the

table and we appreciate your submitting your testimony in advance. at this point we will recognize each of you for five minutes each and we will begin with governor herbert from utah. welcome. >> is this on here? okay. thank you very much. i am very herber, governor of the state of utah. i would like to thank congressman of ten and other commanders of the committee to testify today. let me begin by stating i am a firm believer in the principles of federalism embodied in the tenth amendment. the balance of power between the states and federal government is not only right and proper but essential to finding solutions to complex problems we face today. justice louis brandeis described as states as laboratories which can engage in, quote come all of social and economic experiments without risk to the rest of the country, and of quote. in utah we began the health system reform efforts five years ago long before the patient

protection and affordable c.a.r.e. arrived on the scene. the lessons we learned in the experience in the health system reform serve as a guide to other states as they begin their own reform efforts. the federal government has taken the lead off approach with a one-size-fits-all decree. the governors, the very people responsible for shoehorned the details of the decree into the agencies and budgets were never invited to the table to get our input or ask for our opinions when the act as proposed by the obama administration to begin to congress. i find that unconscionable. the states can and should find their own solutions pointed to their own circumstances and utah for a simple for employed that do not offer health insurance benefits. utah also has the youngest population in the country many of the uninsured are the so-called young immortal big traditional health insurance coverage to be either unnecessary or too expensive. in order for the health system reform to be effective in utah we had to respond to the needs

and our small businesses and their employees and as part of the health reform efforts utah small-business is of the option of using a defined contribution model. this model allows employers to manage and contain their health benefits expenditures. with the creation of the utah health exchange, utah and please also benefit from expanded access, trees and control over the health care options. employees can now purchase one of more than 100 plants currently offered through the exchange. our figures also show 20% of the businesses participating in the utah health exchange or offering health benefits for the first time. justice henry ford offered his first customers any color car they wanted as long as the choose lack of affordable care act allows states flexibility in implementing the act as long as they do with the way that washington tells them. another challenge for utah is the increasing financial obligation through medicaid. even before the affordable care that medicaid was already a large and growing part of the utah state budget.

in the 1990's medicate took a 9% of the general fund. in fiscal year 2010, it was 18%. by fiscal year 2020, it is estimated to exceed 30% of the general fund budget and that's without the federal remanded expansion of the affordable care act. i've come to washington to present solutions to help ease the burden on the state. first i called on the administration to support an expedited appeals process to the supreme court for the health care of litigation. states cannot be left with uncertainty in regard to the implementation of this act. second, i ask congress to give states flexibility to find healthcare solutions based on each state's unique needs. third, we also propose specific solutions for the reform. these reforms would require that the center for medicare and medicaid services support or waiver request. interest i might include details of the recommendations in my submitted testimony. i will highlight just when it simple here today. in our efforts to be innovative and efficient we develop an

approach which uses paperless technology to communicate with our medicaid clients reducing the cost by the state of utah as much as $6.3 million a year. with this flexibility and this one area alone, we estimate that all the states adopting this technology to save between 600 million a billion dollars per year. the community e-mail seems like a no-brainer. we waited for eight months to hear from the federal government. when we didn't hear something it was in denial, and in the bitter irony it came by e-mail. interestingly when i raised the issue of president obama just yesterday, i leader received this note from secretaries sebelius let me know that we could now in fact proceed with a paperless process. [laughter] weigel i appreciate this response, and i do, i have to ask myself to questions to the first, why did the to get personal conversation between a governor and president of the

united states to resolve this symbol issue? and second, and even more important, why do we even have to ask for permission to make this logical cost-saving improvement? for me the situation is what is wrong with the current partnership between the state and federal government. the partnership that is one-sided and puts the states in a subservient role. in conclusion, i emphasize again that real health care reform i believe will rise from the states. the laboratories of democracy and not from the one-size-fits-all approach imposed by the federal government. from the days of the forefathers, utah has been finding new tall solutions to the problems. i'm here today to assert our rights and responsibility to continue to do so. >> thank you. governor patrick? >> thank you very much mr. chairman to all the members of the committee, think you for the opportunity to be here today and congressman markey for the warm welcome and the generous introduction i am looking forward to discussing with you

the impact of the states of the patient protection and affordable health care act and the next steps in implementing the national health care reform and think you in advance mr. chairman for your understanding about my having to leave by 11:30 to catch a plane to get back home. in the interest of time and with your permission i will simply submit for the record the written testimony that we have provided an offer a shorter statement now. as many of you know the affordable care act enacted last year is modeled in many respects on our own reform measure in massachusetts enacted in 2006. our experience with our own for an massachusetts may forecast with other states expect from the national health care reform and a couple of respects. today, thanks to the effective implementation of the 26 reform legislation more than 90% of the massachusetts residents have health care coverage today including 99.8% of our children as the congressman said we lead the nation in both categories. more people are getting

preventive care instead of waiting until they have to go to the emergency room. workers and their families no longer have to worry about a catastrophic illness forcing them into bankruptcy or being denied coverage because they are already sick. we have not had the problem of crowd out where the companies have abandoned the insurance plans for the employees in favor of publicly subsidized plans. in fact the percentage of the private companies offering health insurance to their employees is increased from 70% before the bill was passed to 76% today. we paid for the expanded coverage just as we said we would by delivering more care and primary care settings than in the emergency rooms. internals of five massachusetts pay over $700 million for health care for the uninsured and the underinsured. in 2011, we spent $405 million, nearly $300 million left. with 98% of the residents covered universal coverage has increased state spending by

about 1% of our work total state budget. medicaid represents 32% of the annual state spending today and his own about 2.7% per capita since the reforms were enacted. it is a hybrid solution like the affordable care act that emphasizes prevention since purchased in the open market is competitive prices and service delivered by private pensions people choose their own doctors. we still have a dillinger of course to a flexible even with the highest per capita ratio of primary care physicians to the residents of the country there are not enough primary-care physicians. the reimbursement rates that provide the hospital is another challenge. but these are challenges all over the country. the point is in massachusetts will stop vomiting or thinking to the same old two choices between a perfect solution or no