i met with some physicians in my district, ambulance operator in another part of the state of oregon who talked about some of the fraud and waste they saw occurring in medicaid. where somebody could call an ambulance, so get to the emergency room to go to a shopping center nearby. medicaid gets to pay for it. i heard that from three separate instances. what are you doing? is the federal government doing enough? we are talk $20, $30, perhaps $60,000 in waste identified by the gao and others. >> one the things we have done, we try to manage the program. we reduced our error rate to 3.47 which is the fourth lowest. our eligibility is one tenth by one percent. just by reducing our error rate, we are saving the people of

mississippi tens of millions on medicaid. if you got the national rate down to ours, and got the national rate of medicare down to ours, it would be tens of billions of dollars that the taxpayers would save. just by managing the program. >> i think i'm out of time, unfortunately. i'd welcome your responses, perhaps in writing afterwards when my times expire. thank you. >> mr. green. >> thank you, mr. chairman. first, i want to mention again and i know here at the health reform is not necessarily obamacare, this committee spent many years dealing with health care and it said earlier whether it would be expanding community based health clinics, or the hours we spent over the last two years drafting that legislation. the testimony today sounds like the states want the federal government to write them a blank check and allow them to be left to their own devices to manage the health care without any guidance from the folks here in washington who have to vote for the money on how the federal tax

dollars should be spent. i spent 20 years as a texas legislator, state house and senate and sat on that side many times and watched what happened. let me give you some examples of what may not work. in 2003, texas had a budget crisis much like we see now. at the time, the spate decided to drop 145,000 children because they couldn't come up with the state match. state of texas gets 65% federal dollars for schip, and 70% for medicaid enrollment. it provides coverage at the minimum levels required by federal law for those eligible populations. texas medicaid is granted for six months, they must really and continue to meet. the problem is every six months they have to show up at our state department of human services. texas has been trying since 2008

for section 115 waiver, but it was even denied in 2008 by president bush, because it wanted to shift medicaid eligibility individuals to private plans. i know those private plans are going to have to make a profit to be able to do that. we'll end up with scar medicare dollars going to profit, instead of going to help our citizens. we have not discovered from the schip in 2003, and texas still has the highest uninsured rate in the country. i'm a strong supporter of 12 months continuous eligibility to use childrens as budgetary problems. governor patrick, can you explain the benefits that you see in the medicare program under health reform? >> well, first of all, congressman, i agree with almost all of the observations that you make in terms of how we experience it in massachusetts with the one exception of the private insurance. we have -- our health reform is

a hybrid. so we emphasize private insurance, including for medicaid recipients. and so we are -- it's very much a market-based kind of solution, i guess, is what i'm trying to say. which maybe why -- why i keep coming back to the point about how across the market whether for private or public payers, we have to focus on increased cost and what's happening with premiums, and what that is doing to our competitiveness. this program has worked very, very well in massachusetts. the fact that we have other 98% of our residents insured today with reliable health care and that it had been maintained and improved in a time of enormous economic uncertainty, it's something i'm proud of. i think it's been a real help for us in our recovery. but the broader question of the

cost of health care, not the cost of medicaid, i do respect, that is a secondary question. the cost of health care for which in this country we spent 17.6% of what we spent has got to be addressed. and the affordable care act gives us some tools to do that. you were trying some others on the state side as well. >> well, let me let the other governors answer. like i said, i've been on both sides of the coin. i watched there were times we could bring down medicaid programs in texas, and we would get 80% and only come up with 20%, and yet we still couldn't do it in the state. texas does not have a rich medicaid program by any means. >> first, let me say, i don't mean any offense. but ppaca doesn't go out too go in my accent for the name of the law. ppaca. i didn't mean any offense by

saying obamacare. it just easier to say. >> it's really the affordable health care act. it's called health reform. i don't have any problem with your accent from where i come. >> i figured if there was one guy to understand, it would be you. we are concerned about keeping providers rate high that they'll see our medicaid patients. >> okay. mr. kerry? >> thank you, mr. chairman. and with my accent, i still call it obamacare too. [laughter] >> it's easier. my question is for governor herbert and patrick, very quickly. the state exchange issue i think is an interesting issue. and how states when you do it yourselves can be a lot more innovative. particularly i want to ask

governor herbert, you would think that's the traditional pronouncuation -- [laughter] >> because nebraska and utah are similar in population. and demographics. would it be beneficial in a state exchange to have the opportunity to combine with other states and form a regional and let you go first and then governor patrick. >> yes. i think it would be. i think he'll increase purchasing power and the ability to have more competition and the consumer will have more options and better options for their own unique needs. again, without beating a dead horse here, it's not a matter is my approach better than governor patrick's approach. again, mitt romney is a friend of mine. in fact, we looked at the

massachusetts nod the -- massachusetts model when we started out. it didn't work for utah. it one in the best interest. there's probably pros and cons. it's not a matter of he's right and i'm wrong, as we work together as states, we can find solution. of we talk about what does the health care reform message? what is the issue? i don't think the public understands. universal access, quality of care, affordability? probably all of the above. we are attracting with the affordable health care act with one area. i don't know that it helps with the cost controls measures. >> well, and i appreciate that answer. and governor patrick, and then governor barbour. >> i'm really interested in that idea, congressman. we have about 220,000 who get

their coverage through our connector, our version of the exchange. i think that compares to about 1500, am i right in utah? >> about 1,000. >> about 1,000. so it's a slightly different scale. because we are trying to -- because we made different choices. and i agree with my colleague, governor herbert, i'm not sure that every state in the context of the exchange needs to make the same choices. but i think that's flexibility is allowed under the affordable care act. i am very intrigued about how we do more regional pools. because frankly, economically, our people are moving regionally. so, you know, -- and the idea of having portability of their care i think is very responsive to their needs. that's, i think, what has to be. >> i just wanted to briefly comment on your question. my state senate just passed an

exchange bill for three years running and the house has not. both of them passed a bill this year. we want an exchain. -- exchange. ours wouldn't be anything like massachusetts. it would be market voluntary and modeled on utah. so there are -- i just wanted you to know. some of us don't have exchanges think they are useful. but not the act the federal act would require it. >> all right. dr. burgess, may i yield a minute to you? >> thank you. governor patrick had a question, and so rudely would not yield the time. i'm happy to yield the time to answer the question. >> i'm good. >> you know, i seriously, mr. chairman has changed. i am going to -- i'm going to have to step away in order to get a plane, so unless you have a question for me, dr. burgess,

i don't want to. >> i was dying to answer your question. i didn't want to leave the audience unfulfilled with you unable to ask me a question. >> thank you very much. if it's appreciate, mr. -- appropriate, mr. chairman, if there are other questions i would be happy to respond in writing. i have to make the plane. >> the chair thanks the gentleman. >> let me in the remaining time that i have, one the issues that we lost out in the health care reform was the issue of liability reform. i know i have other the years interviewed several doctors from massachusetts who moved to texas even before we fixed the problem there. how are you dealing with this within your state? >> we have -- i mentioned earlier that we filed health care reform ii in massachusetts, which is the next chapter. it's really around cost control and cost containment. and there is a feature of this which is tort reform, it's not

because we have found analytically that defensive medicine is a big contributor to health care cost, but it is a contributor. and so we -- we used a model actually from michigan. which is not capped, it's an apology and prompt resolution model. it's been piloted at the general hospital in boston. they have had fantastic results. it's a model that works for us. i'm looking forward to working. >> gentleman's time expired. the chair thank's governor patrick for comes. thank you, you will respond to any questions from writing. >> i would be happy to yes. i hope they will excuse me please. >> thank you, governor. the time goes to the gentle lady, ms. cass. >> thank you. i had a good question for you,

governor deval. i understand that you are leaving. if there's a way you would stay, i appreciate it. you've been an excellent testifier. >> do you want to it quickly? >> yes. if you can sit back down. >> your answer was supposed to be no governor. i have other questions to ask your colleagues. first of all, thank you for coming. you know, we seem to be used this opportunity to scapegoat medicaid and -- because real bottom line is that some people don't like the health care law. you have been a success story in reducing the number of uninsured and helping everyone who wants to get any access to the health care system. my other questions are going to be about children. your state has the lowest rate of uninsured children. i think that is really an achievement. i want to ask you, you can be quick and run up. i don't want you to miss your

plane. but what is the roll that medicaid has played in this? >> it's been enormous. the proportion of children insured is 99.8%. >> that's stunning. i want it to be on the record. just say it ago. >> 99.8% of massachusetts children have health insurance. >> yeah. >> i have very, very proud of that. governor barbour made a point, which is true, children are relatively inexpensive to cover. and it's a very efficient kind of coverage for medicaid. it's made a big difference for us. >> thank you. you were worried about you catching your plane. i appreciate your taking the time. i wanted to ask unanimous consent as i begin or continue my question. thank you, governor. to insert a letter from the march of dimes for the record which explains the importance of the medicaid program for women and children. i also unanimous consent if that

could be entered. >> without action. -- objection. >> thank you. : he the flexibility to reduce medicaid coverage for pregnant women up to age one to global 185% to 133. mississippi also has the highest

rate of preterm birth of a state in the united states and our country doesn't on this topic is not trying to pick on mississippi. nearly 19% of live births in mississippi are preterm. preterm infants are at a much needed under an greater risk. newborn deaths in even higher health care costs. anyone who believes that our countries into mortality rate even during the bush administration in 2006, hhs had programs to improve access to the prenatal and pre-born access and it specifically cited -- i could ask you a yes or no question. do you agree with this assessment of the bush administration that medicaid can help address into mortality? >> a little bit. >> a little bit, all right. >> man, if i could respond, the biggest problem we have in my

state is we have an extremely high rate of illegitimacy. we have a lot of children being born to mothers who are themselves in bad health. life choices like drugs, alcohol and it is not the health care system that is the principal driver. >> but actually, if people receive -- if these mothers received adequate prenatal care, some of these underlying issues could get dressed and that's another feature. >> we offer of 285%. >> well, that's another issue, but the flexibility to raise it is going to make it tempting for state to do something that will be in the long run costly. cos they not only in life, but also to the bottom in the state budget. >> the majority of the people on

medicaid, our children, pregnant women and it's up to 185% of poverty. we're not interested in lowering it, but the biggest problem for sick children at birth, low weight births. it's not the health care system. >> gentlelady's time has expired. the chair recognizes dr. murphy for five minutes for questions. >> thank you, mr. chairman. good to see you. i'm going to go for a couple things about medicaid expense in your state. in my state, governor corbett estimates that 600,000 to be added onto medicaid and it's going to cost the state and initial 100 million. the both of estimates in your state what those numbers might be? >> it is below $443 million. >> one year, okay. >> ours is 1.2 billion over 10

years. it's a 50% increase. >> is the full cost of medicaid? >> that's the increase. >> we also know the congressional budget office, which admittedly can only deal with what they're given, but based upon the data they were kidding, they estimate about nine low-income employees with coverage due to some of the exceptions that occur. the lewin group says it could be as high as 85 million. and some questions are that if employers are fine $2000 per employee for not offering health insurance, they might actually serve as an incentive to expand those numbers to the upper level at 85 million or so. are your numbers feature states have based upon some of the higher or lower numbers? countries in terms of the extra population you think might pick

up. how confident are you in the accuracy of those numbers and might even be higher? >> well, i know about the numbers you've given there, but our estimates are based on the fact that will increase eligibility to 133% of poverty. we're not covering that much in utah. the benefit package will have to be changed and modified them want to more. >> my question is what happens if anybody's looking your state is more employers dropped coverage of the people of medicaid. the mac is more employers dropped coverage, the eligibility will entice people to become his medicaid as the insurer. i don't know what the percentage that will be. >> i am concerned that we underestimate the actual increase in cost. as i said earlier, we have a lot of small businesses that offer insurance to their employees right now that won't meet what we fear the standard benefits

package. for a lot of people will pay the $2000. >> let me ask you in another area. i know governor barbour, your written testimony talked about the delay in wafers being taken caregivers unconsidered terminal. you mentioned the big middle-school. if this money came to the states inside if you could design medicaid, granted it was designed in 1865, that speck in the era when the hospital was considered a modern. but which are states want that authority? teasing you could modernize things and deliver better health care quality, more people at a lower cost? >> would have a better fit for our state. we could move towards an insurance kind of model, but you know, we don't think it would just be better quality care. we could save you money as i

said at the beginning, we would take a 50% reduction in the annual increase and not a lot of money over time in savings for the american taxpayers. if we could cut the rate of medicaid spending going up in house and we would take -- we be willing to vote block grant. if we were able to cut the rate of increase, it would come out of our pocket. >> governor barbour, in your testimony about acquiring medicaid, what benefits you feel that what has? >> for so many people they would've a better understanding, particularly older people have a better understanding of what their health risks were and are. they will learn more and we try to give them a briefing about their medicines that they could

get much further along on that. a lot of them would find out things they don't know. if you go to the emergency care, as the worst place of primary care. it isn't just expensive, it's not designed for primary care. a lot of people have a better quality. >> governor, what about in years date of utah? >> i think we can do it better. the innovators and creators of success. do you trust the states? teach us the governors to do that? they're turning the reins over to the state. and i think we've proven the ability to in fact provide good service and balance budgets were out there in the economy and i respect his states. i have young state. it's only 28.8 years of age. i have a different demographic

to deal with on health care and other states that may have a more aging population. let's see some governors deal with that. i think that would define success that we otherwise would not pass. >> the gentleman's time has expired. the chair recognizes mr. doyle. >> thank you, mr. chairman. was nice to hear about the economic impact on health care coverage in massachusetts. he seemed well we all know providing our most vulnerable access will save individual families from extreme economic hardship. there's apparently also a larger economic growth in health plays. look at the massachusetts model after they ruled out their extensive plan, the number of 2.7% statewide, and uncompensated care costs went down by 38%. that hardly seems like a filter

of care program to me. in 2009, nationwide uncompensated care cause for $40 billion. if massachusetts is an example of the nationwide effect we are talking about a potential savings of $16 billion has a lower the rate of uninsured in the country. similarly, it seems to me coming back on medicaid and maybe more people without any type of insurance is shortsighted at best and more likely flat out dangerous. as we all know, 1 dollar cut from medicaid means $2.33 cut from the state's economy. it is discouraging that the majority continues to spend time arguing over taking away health care from our most vulnerable and what we really need to focus on is creating jobs and incentivizing economic growth. in my state of pennsylvania, where the uninsured rates are 20%, we could save hundreds of millions of dollars at.team in

massachusetts model, hardly in my opinion a failed health care model. mr. chairman, i went to yield the balance of my time to mr. for questions. >> i think the gentleman, mr. barbour. so you can understand my brooklyn accent and i can understand yours. i want to ask you a couple questions. i didn't cheer you respond about tort reform. you don't want federal tort law as he perceived her lap. >> about the question was what happened when they did this in our state? and it's been very, very beneficial. >> would you agree, i assume you would you don't believe there should be a federal tort, do you? >> i think federal cases or if it's about federal law. >> there's a federal survey now.

state law prevails. >> medical malpractice is the state. you don't want federal law to supersede state this. >> i didn't think you did. from the conversation we're having here, you think you have any additional cost of the 42017? are you aware you have no additional cost before the year 2017? >> that's why i said when i was trying to say what the costs were, they are so backloaded. >> to anticipate in the future you have more or fewer for people with u.s. governor? >> advises that the economy we've got now, we're going to have more -- >> it is that your policy to reduce the number of poor people in your state? >> the policy of our state is to grow the economy enough more people working. >> that should be the resume.

>> of course you endeavor to have fewer poor people that would make more successful governor may be the candidate for higher office. if you had fewer poor people, winter medicaid costs go down? >> we have 60,000 employees may first three years. people when asked about an medicaid costs costs were better. >> after 2017 u.s. fewer poor people than today? your medicaid costs will go down. >> l. actually go out because i'm going to put all these people on medicaid until the affordable care act that are not on it now. >> let me put it in terms of law. under the affordable care act, people eligible will have a family of four with the maximum coverage under the increase under the affordable care act. starting in 2017 when the federal government stops absorbing 100% and is worth 95% of that. if your number of poor people

goes down a sufficient amount, if you're a good governor, your medicaid costs will go down down down >> definition of poor and eligible for medicaid are two different things. the number of people eligible for medicaid will go up. >> 30,000 for a family of four will be the new limit. if it goes down, fewer poor people, lower medicaid. i would endeavor that. not gentleman's time has expired. >> that's exactly the number eight gave you. >> the gentleman's time has expired. the chair recognizes dr. burgess for five minutes for questions. >> i think the chairman for the recognition. of course governor barbour, thank you both for being here. i just want to clear up your concerns about what we call this law and i was, too. in fact, i