income people together to stitch neighborhoods together. clergy and laypeople. and the work was hard. and there were times where it was disspirited. we had plenty of set backs there were times where i felt like quitting. where i wondered if the path i had chosen was too hard. despite these challenges i saw how kindness and compassion and faith can change the arc of people's lives. i saw the power of faith. a shared belief that every human being made in the image of god deserves to live in dignity. and all children, no matter who they are or where they come from or how much money they were born into. ought to have the opportunity to achieve their god given potential. that we were -- are all called in the words of his holiness pope francis to satisfy the demands of justice fairness,

and respect for every human being. and at the time when i just moved to chicago the cardinal there was cardinal burndy an extraordinary man. and he understood that part of that commitment part of that commitment to the dignity of every human being, also meant that we had to care about the health of every human being. and he articulated that and the church articulated that as we moved at the state level and the illinois legislature once i was elected there later on in life to advance the proposition that healthcare is not a privilege, it is a right. and that belief is at the heart of the catholic health

association's mission. for decades your member hospitals have been on the front lines, often serving the marginalized the vulnerable and the sick and the uninsured. that belief is at the heart of why we came together more than five years ago. to reform our healthcare system. to guarantee that every american has access to quality affordable care. so i'm here today to say thank you. for your tireless efforts to make health reform a reality. without your commitment to compassionate care, without your moral force, we would not have succeeded. we wouldn't have succeeded had it not been for you. and the foundation you had laid. and pursuing healthcare reform wasn't about making good on a campaign promise for me.

it was -- remember in the wake of an economic crisis with a very human toll. and it was integral to restoring the basic promise of america. the notion that in this country if you work hard and take responsibility you can get ahead. you can make it if you try. everything we've done these past six and a half years to rebuild our economy on a new foundation from rescuing and retooling our industries, to reforming our schools, to rethinking the way we produce and lose energy. to reducing our deficit. all of it has been in pursuit of that one goal. creating opportunity for all people. and healthcare reform was a critical part of that effort. for decades a major barrier to economic opportunity was our broke bn broken healthcare system. it exposed working families to the insecurities of a changing economy. it saddled our businesses with sky rocketing costs that made it

hard to hire or pay a good wage. it threatened our entire nation's long term prosperity. was the primary driver of our deficits. and for hospitals like yours, the fact that so many people didn't have basic care, meant you were scrambling and scratching every single day to try to figure out how do we keep our doors open. leaders from teddy roosevelt to teddy kennedy wanted to reform. for as long as there were americans who couldn't afford decent healthcare. as long as there were people who had to choose between paying for medicine or paying the rent, as long as there were parents who had to figure out if they could sell or borrow to pay for a child's treatment a few months more and beg for god's mercy to make it work in time. as long as those things were

happening, america was not living up to our highest ideals. and that's why providers and faith leaders like you called for expanding access to affordable care. every day you saw the very personal suffering of those who go without. and it seemed like an insurmountable challenge. every time there was an political will to alleviate that suffering and reform that system whether it was under democrat or republican presidents special interests, and keeping the status quo in place. each year in the past without reform the staked kept getting higher. by the time i took office, thousands of americans were losing their health insurance every single day. many people died each year because they didn't have health insurance. many families who thought they had coverage were driven into bankrupt by out of pocket costs.

tens of millions of our fellow citizens had no coverage at all in this the wealthiest most powerful nation on earth. despite being the only advanced economy in the world without universal healthcare our healthcare costs grew to be the most expensive in the world with no slowing in sight. that strained the budgets of families and businesses and our government. so we determined that we could not keep kicking that can down the road any longer. we could not leave that problem for another generation to solve. or another generation after that. and, remember, this was not easy. there were those who thought healthcare reform was too messy and too complicated and too politically risky. i had pollsters showing me stuff. and 85% of folks at any given time had healthcare. they weren't necessarily

incentivized to support it. you could scare the heck out of them even if they weren't entirely satisfy would the existing system somehow it would be terrible to change it. all kinds of warning signs about how tough this was bad politics. for every politician and pundit who said we should wait, why rush barely a day went by when i didn't hear from hard working americans who didn't have a moment left to lose. these were men and women from all backgrounds. all walks of life, all races all faiths. in big cities, small towns, red states blue states. middle class families with coverage that turned out not to be there for them when they needed it. moms and dads desperately seeking care for a child with a chronic illness. only to be told no again and again. or fearful as their child got older, what was their future going to be? because they weren't going to be able to get insurance once they

left the house. small business owners forced to choose between insuring their employees and keeping the open sign hanging in the window. and every one of these stories tugged at me in a personal way. because they spoke about seeing my mom worry about how she was going to deal with her finances when she got very sick. i was reminded of the fear that michelle and i felt when sasha was a few months old and we had to race to the hospital and the emergency room learning that she had meningitis. that we caught only because we had a wonderful pediatrician. and regular care. never felt so scared or helpless in my life. we were fortunate enough to have good health insurance. i remember looking around at that emergency room and thinking what about the parents who aren't that lucky? what about the parents who get hit with a bill of $30,000 and have no idea how to pay for it? what about those parents with

kids who have a chronic illness likeaths muand have to keep going back to the emergency room because they don't have a regular doctor and the bills never stop coming? who is going to stand up for them? behind every single story was a simple question. what kind of country do we want to be? are we a country that's defined by values that say access to healthcare is a commodity, awarded to only the highest bidders? or by the values that say healthcare is a fundamental right. do we believe that where you start should determine how far you go, or do we believe in the greatest nation on earth everybody deserves the opportunity to make it. to make of their lives what they will. the rugged individualism that defines america has always been bound by a sheer set of values. of enduring sense we're in this

together. that america is not a place where we simply turn away from the sick. or turn our backs on the tired, the poor the huddled masses. it is a place sustained by the idea i am my brother and sister's keeper that we have an obligation to put ourselves in our neighbor's shoes and see each other's common humanity. after decades of trying after a year of sustained debate we finally made healthcare reform a reality here in america. [ applause ] >> and despite the constant doom and gloom predictions the unending chicken little

warnings that somehow making health insurance fair and easier to buy would leave to the end of freedom, the end of the american way of life lo and behold it didn't happen. none of it came to pass. in a lot of ways the affordable care act worked out better than some of us anticipated. nearly one in three uninsured americans have already been covered. more than 16 million people driving our ininuninsured rate to its lowest rate ever. ever. [ applause ] >> on top of that tens of millions more enjoy protections with the coverage they've already got. the 85% who had health insurance, they may not know they've got a better deal now than they did but they do. americans can no longer be denied coverage because of

preexisting conditions. from you having had cancer to you having had a baby. women can't be charged more just for being a woman. and they get free preventive services like mammograms. [ applause ] >> and there are no more annual or lifetime caps on the care patients receive. medicare has been strengthened and protected. we've added 13 years to its acchew wearulate life. the financial difference for business owners trying to invest and grow and the family trying to invest and spend. healthcare prices have risen at the lowest rate in 50 years. the average family premium is $1,800 lower today than it would

have been if trends the decade before continued. in the years to come, countless americans who can now buy plans that are portable and affordable on a competitive marketplace will be free to chase their ideas. knowing they'll be able to by health insurance. here's the thing, that security won't just be there for us, it will be there for our kids as they go through life. when they graduate through college, they can stay on our plans until they're 26. when they start a family pregnancy will no longer count against them as a preexisting condition. when they change jobs or lose a job or strike out on their own to start a business, they'll still be able to get good coverage. they'll have that peace of mind all the way until they retire goo a medicare that has cheaper prescription drugs and wellness visits to make sure they stay healthy. while we were told again and

again that obamacare would be a job killer, amazingly enough, some critics still pedal this notion, it turns out in reality americans experienced 63 straight months of private sector job growth. a streak that started the month we passed the affordable care act. [ applause ] >> the longest streak of private sector job growth on record that adds up to 12.6 million new jobs. so the critics stubbornly ignore reality. in reality there is a self-employed single mom of three who couldn't afford health insurance until health reform passed and she qualified for medicaid in her state. she was finally able to get a mammogram which detected early stage breast cancer and may have saved her life. that's the reality. not the mythology. in reality there are parents in

texas whosea tistic son couldn't speak. health reform meant they could buy a secondary form that covered therapy. today that little boy can tell his parents he loves them. that's the reality. [ applause ] [ applause ] >> in reality there's a self-employed barber from tennessee who happens to be a republican who couldn't afford health insurance until our new marketplace opened up. once he bought a plan he went to the doctor and was diagnosed with esophinggle cancer. now he's now cancer free. so five years in, what we are talking about is no longer just a law it's no longer just a theory. this isn't even just about the affordable care act or obamacare. this isn't about myths or rumors

that folks try to sustain. there is a reality that people on the ground, day-to-day are experiencing. their lives are better. this is now part of the fabric of how we care for one another. this is healthcare in america. which is why once you get outside of washington and leave behind the beltway chatter and the politics, americans support this new reality when you talk to people who actually are enrolled in a new marketplace plan, the vast majority of them like their coverage. the vast majority are satisfied with their choice of doctors and hospitals and satisfied with their monthly premiums. they like their reality. now, that doesn't mean that we don't have more work to do. sister caroline were talking we know we got more work to do. like any serious attempt at change, there were disruptions in the rollout, the policies we

can put in place to make healthcare work even better. the secretary is talking about the things we have to do together on the delivery system reform. we have to protect the coverage that people have now and sign even more people up. we need more governors and state legislators to expand medicare. we have to continue to improve the quality of care. we know we can still bring down costs. none of this is going to be easy. nobody suggests that somehow our healthcare system is perfect as a consequence of the law being passed. but it is serving so many more people so much better. and we're not going to go backwards. there is something -- i have to say just deeply cynical about the ceaseless, endless partisan attempts to roll back progress.

i mean i understood folks being skeptical or worried before the law passed and there wasn't a reality there to examine. but once you see millions of people having healthcare, once you see that all the bad things that were predicted didn't happen you'd think that it would be time to move on. let's figure out how to make it better. it seems so cynical to want to take coverage away from millions of people to take care away from the people who need it the most. to punish millions with higher costs of care and unravel what's been woven into the fabric of america. and that kind of cynicism flies in the face of our history. our history is one of each generation striving to do better and be better than the last. just as we'll never go back to a time when seniors were left to languish in poverty or not have

any health insurance, in their golden years there was a generation that didn't have that guarantee of healthcare. we're not going to go back to a time when our citizens can be denied coverage because of a preexisting condition. when tens of millions of people couldn't afford decent affordable care. that wasn't a better america. that's not freedom. the freedom to languish in illness or to be bankrupt because somebody in your family gets sick. that's not who we are. not what we're about. debra lee orrin of pennsylvania knows that. she suffers from osteoarthritis that was so severe it put her in a wheelchair. for years she couldn't stand or walk at all and was in constant pain. through no fault of her own, just the twists and turns of

life. and without health insurance to get treatment, it seemed as though she might never live a life that was full. today debra is enrolled in affordable health coverage. was able to have surgery to replace her knees. she's back on her feet. she walks her dog, shops on the grocery store. gets to her doctor's appointments. she's cooking exercising regaining her health. she couldn't be here today but she recently wrote to me and said i walk with my husband michael, and hold hands. it's like a whole new world for me. just walking and holding hands. something that one of our fellow americans for years could not do. every day miracles happen in your hospitals. but remaking debra's world didn't require a miracle it just required that debra have access to something that she and

every other american has a right to expect which is healthcare coverage. while there are outcomes we can calculate the number of newly insured families the number of lives saved. those numbers add up to success in this reform effort. there are outcomes that are harder to calculate. in the tally of the pain and tragedy and bankruptcies that have been averted but also in the security of a parent who can afford to take her kid to the doctor or the dignity of a grandfather who can get the preventative care he needs. or the freedom of an entrepreneur can --. in the end that's why you do what you do. isn't that what this is all about? is there any greater measure of life and liberty and the pursuit

of happiness than those simple pleasures that are afforded because you have good health and you have some security. more than five years ago i said while i was not the first president to take up this cause, i was determined to be the last. and now it's up to all of us the citizens in this room and across the country to continue to help make the right to healthcare a reality for all americans. and if we keep faith with one another and keep working for each other to create opportunity for everybody who strives for it. then in the words of senator ted kennedy, that dream will be fulfilled for this generation and preserved and enlarged for generations to come. it couldn't have happened without you. thank you. god bless you all. [ applause ] thank you so much, thank you very much. ♪

before the end of his current term the supreme court is set to decide king v burr well. the case challenging subsidies for healthcare. next is discussion on the case. this is 40 minutes. he is editor and chief of host: health affairs. he's joining us on a day that of president obama will speak on the affordable care act. as the clock ticks down on the burr well decision. the case about the subsidies that are under the healthcare alth c law. about how many people could beow impacted who use the federal subsidies if this case comes these down and it is decided not that the administration's way? >> the direct effects are about

6.4 million americans who receive subsidies for coverage ceive that they get through the federal health exchange. if they're getting the subsidiesral heal in a state exchange they're not at risk. the ripple effects are potentially much larger. and we may get into that. if you eliminate the subsidies nd it could destabilize the insurance market for millions ies, more. >> remind us how one qualified for these subsidies? >> so under the affordable care act, if your income is between po 100, 400% of the poverty. you can purchase insurance based on your income. it's a higher if you're close to close 100%. it's lower as you get to the higher middle income level. you can only take sub that to a exchange. we thought when it was set up that the states would set up o

their utown. it's the subsidies through thoseral gove federal exchanges that are at risk in this lawsuit. fe >> thedera average tax credit for enrollee in the united states comes out to about $272 for -- according to stats compiled by the kaiser family foundation. we can talk about what's happening in your individual states if you want to join this conversation. give us a call republicans 2027488001 democrats 7027048000 independents 7487028002. president obama was asked about the case in his press conference yesterday at the g 7 summit. he expressed confidence that the administration would win that case. here's c a bit from that press he press conference. >> it's not something that should be done based on a

twisted interpretation of four words in -- as we were reminded repeatedly a couple thousand page piece of legislation. what's more, the thing is he working.work part of what's desirable about this whole thing is we haven't is we had a lot of conversation about the horrors of obamacare because none of them come to pass.ors of you have 16 million people who have gotten health insurance. overwhelming majority of them arens satisfied with the health em are insurance. s it hasn't had an adverse effect on people who already had n health insurance. the only effect it's had on people who already had health insurance is they now have an assurance they won't be not be prevented from getting health insurance if they've got a preexisting condition and they e heal additional protections.ome in the costs have come in stlsh substantially lower than our ost. estimates bout how much it would cost. healthcarera inflationll over all

has continued to be at some of the lowest levels in 50 years. none of the predictions about how this wouldn't work have come to pass. and so i'm -- i'm optimistic opt that the supreme court will play it straight when it comes to theon interpretation. if it didn't congress could fix this whole thing with a one sentence provision. >> the president expressing his optimism there. but for the 6 point roughly four million people who make use of the subsidies through federal s marketplaces, what is the white house doing to prepare if this case goes the wrong way?case g >> the white house has been quiet about their preparation. i don't think they want to play into any sense thabet it would be okay if the decision went be

adverse to them. i'm sure there are discussions behind the scenes. diver we actually have a recent blog post on the health affairs blog some terrific work by others whos and interview people at the state tervie level asking them how they're preparing. similarly, they're tight lipped.are ti the politics as everyone knows po of this law are complex. and it's hard to talk about what you'll do it's better to plan and hope for the best. and i think that's what we're it is seeing from bothbe sides. d >> we're taking your questions both s about theseid federal subsidies in the marketplace under the affordable care act. allen wile is with health f affairs he's here to break those down and explain how they work and how states are preparing if the challengers do win that f supreme court case in king v burr well.the republicans, 2027488002. democrats 8002. independents 2027487002. we'll be talking about this for

the next half hour or so on the is washington journal. give us the examples of one of those states and how they're ve me an preparing.eparing. >> well i can't go too deep into any individual state. into the blog refers to five different states.blog ref north carolina, michigan are a . couple of the ones. they're designed to not represent the whole country, but to look at the different igned politics around the country.erent utahpo is another. the complicating factor here is that no one really wants to be held politically accountable for in people losing health insurance. they don't want to take steps tohe sta shore up a law theyte oppose. the ones who rely on the s exchange are the ones who didn'tof in a want the law. you don't want to fix a law that you think is fundamentally ed. flawed. >> it's health affairs.org that

you can check out the work of allen wild. tell us about health affairs. >> it's the leading health policy journal in the united states. we publish peer reviews. we have a blog where we cover the segments of the day. >> grace, on the line for democrats. >> caller: it's a g terrible shame terribl that the men in washington, mostly menen a enjoy the very best of healthcare. on our taxpayer dimes. but they do not want anyone to have healthcare if they think it comes out of their pocket.f they i think this is a terrible shame. it's america. what are we doing here? thank you. >> well, i think it's important to note that although this ote th lawsuit is about language in the

federal law, there is a quite a dynamic between what the federal there government is i deciding here he fed since the caller referred to washington. and also what's happening at the state level.r refe there are some easy fixes, if ite are weren't for the politics of thistics issue.e. congress as president obama said in the clip could change the ss, as four words that are the basis of the challenge. similarly, states, although it's much more complicated than simila changing fourlr words could move their decision about an insurance exchange to operating nce their own. where there's no question that subsidiessidi would flow. this isn't just a washington issue.on this is about different opinions opini about what the healthcare system s should look like and who should receive assistance. >> and those who have challenged the subsidies in the federal host: exchanges also say this is a pretty simple case as well. chall here is michael carven who argued on behalf of the supreme

court, david king. here is him testifying. >> the real issue is a rule of law. is this going to be a nation rule bide laws. or is it going to be governed bynt to co the policy preferences of unelected bureaucrats. and i think that that's exactly what happened in this case. i think this is an happ extraordinarily simple case. i think the irs has not interpreted the law, but very t dramatically revised the law. and that's because the law vised simply says that you receive subsidies on exchanges ubsidi established by the state under section 1311. and the irs is transformed that into something that we receive subsidies on exchanges established by hhs under 1321.subsid and anyone who speaks english aks knows that's not a reasonable interpretation of that language.

the proponents of the irs rule have argued they can't dispute the plain language commands the he opposite of what the rule says.nd so they try and change the hey subject. they say you've ripped that ge the language out of context and that language is contrary to the underlying purpose of the statute statute. ip in realityli neither of those is true. in fact, the context in which those words reside confirms in every way that the plain language means exactly what it says. and following that plain . language is really the only way to implement the broader purposes of the affordable care act. >> we'react. talking about the subsidies that are at the heart of that challenge at the supreme court. with allen wile of health idies affairs here to take your affai questions about thatrs provision of the affordable care act. flo is up next in wyoming. line for democrats. good morning. >> caller: hello.ning.

i'm just calling to say that no one ever mentions that it was judas joe lieberman who was the 60th vote. he voted negative. -- he and even though the democrats had 60 senators, it couldn't ld not count because he had the gall to vote no because he was sucking up to the insurance companies and what president obama wanted was the public option. which would have been the wisest be choice for america. so we had to take -- he had to go with what everybody voted on.weil >> your reading of that interpretation of what happened? >> i'm not going to get into the votes of individual members of congress. i think what's important out of t theget caller's comments is that the process by which this bill the proc became a law was not what anyone

expected. the senate with the death of senator kennedy, lost the margin to go back and do revisions.t to the and much of what this case is about in the clip you just showed, is that you know there's not one person sitting down logically constructing a co law. there are. pieces that are floating around, many people involved in drafting. there's an expectation that any ngress ambiguities will be fixed later with technical corrections. neither of those could happen chang because of the compositionin of the senate. we are left with a law that is the law of the land. there is no question but was law o not drafted and didn't go through some of the editing and t go thr revisions that would have been typical for a piece of legislation that's this complex.of leg that leads to the kinds of challenges we're seeing. >> steve is in our line for artins

democrats good morning. >> caller: good morning.ev i'm juste trying to figure out the law. it's my belief that the federal government cannot coerce states to do something. especially financially.do do this or we won't give you the funding. not giv if they interrupt the healthcare subsidies provisions the way the republicans would like it it it see seems toms me that would mean the law says make your own exchange or we won't give you the money. and that's straight up coercion. your opinion? how can they take it away for states that don't have an how exchange and leave it?it away it seems like it puts you in a legal quandary where if they change it, you know to what the republicans interrupt it as they're making coercion. >> well, it's actually a long-standing understanding in the law that the federal government can encourage states g-stan to act indi certain ways by

offering them money if they do something and withholding the they d money if they don't. they can't force them to do it. financial incentives have long played a role in how the federal government gets states to act.vernme the limits of that were tested in the prior big supreme court case about the affordable care act, nfid case where the the medicaid expansion was edicai challenged as being coercive. i think it's important to remember there's a big difference between the medicaid provision and what's at issue in king. king the subsidies flow to individuals who apply for coverage. it's a tax credit to the individual. the state is simply making a to choice about whether or not to a run its exchange. that determines whether or not the individual get s the money.ether the medicaid program it's a matching program where the money flows to the state.tching there actually is no coercion of the state, even an argument of state, coercion of the state.

there are lots of other things that might happen. if this law -- if the case goes certain ways. but the federal government is not forcing states to do nment anything. it's simplngy saying we're going to withhold benefits to the g we w citizens of your stateil if you don't sets up an exchange. se >> let's head to bloomington, illinois where george is waiting. illinois a state that has 232,000 people making use of federal tax credits. some $48 million a month is the monthly tax credit federal dolla dollars that could bers at risk in king this king v burr well case if it goes against the administration. george is waiting on that line for republicans in bloomington. good morning. >> caller: good morning.puer: and thank you for c span. mr. wile's organization the health affairs.org ask a policy oriented organization, as i anizat understand his comment.

and that really prompts my question, and which relates to the comments by president obama yesterday. indicating -- implying clearly, that if the administration does not prevail, then the pending u.s. supreme court case that it would be a twisted interpretation of the law, of the four wordsrd that are key in the decision eminent decision. and attorney michael carvin whose comments were in front of w thehose senate judiciary committee were played a few minutes ago, clearly indicated that any other interpretation than the one the president is not contending -- or is contending -- pardon me,

any interpretation that -- of the kind the president is contending for is not consistentding with the english language. and anyone who knows the english language understands that.langua i think that is clearly the case. and the -- my question for mr. que wile really boils down to whether or not the congress or the president should be making the health policy for the country because the constitution provides that the congress makes the laws, the president executes them. we've had enormous rewriting of the law unilaterally by the president. and in many cases gone unchallenged. >> thank you for the call from all. bloomington. >> without getting too deep into

the legalities here there are two different ways of thinking s here about the question of what the administration has done. when a statute is unclear, we give the administering agency inter discretion to interrupt prit.s part of what the attorney's argument was this is too big a stretch. the law is clear and the tch. interpretation is wrong.law is c but the other issue is whether the law, the words, the four words are as clear as the challengers suggest they are.they a it depends on whether you're looking at the four words or at the statute. and it depends on how you read y depen thing. >> what are the four words?w you re >> established by the state.guest: the issue is that the subsidies only flow to people who have coverage in an exchange that's established by the state. you can pretty clearly see the word state there. you can also look at the structure of the law and see a number of rernsferences to exchanges that have different s takes on whether they include the federal fall back or not.

and this is a, you know, this is a question of whether you look at the words in isolation or you look at them in context. if you look at them in context, how broadly you look at the context. we're not going to resolve that here. i would say with respect to the caller's comment, not just to legality. it is commonplace. congress enacts laws that have lots of ambiguity in them. and administrations execute laws l and they are bound to adhere to the law, but they also have to resolve the ambiguities. congress has passes laws that can't be implements exactly the they w way theyer were written due to time lines that are impossible or other impediments and the executive branch has the the ex responsibility of doing the bestnch has it can with the statute. we can argue about whether or not the administration did the best it could, whether the the ad various interruptions aremi right or wrong. but the notion that sort of t or congress passes things that's are so clear that it's obvious

when an administration is vious diverging from the exactly words of the language, i don't think or that really fits with reality, particularly when we're deal ing with something as complicated with healthcare. >> we're talk ing with allen de wile editor and chief of health affairs affairs.org. he also worked for the n academy of state policy with the mission of helping states achieve excellence in healthcare policy and previously director of the com department of healthcare as well. he's our guest for the next 25 are minutes or so here on the washington journal. don is up next. >> caller: good morning. >> go ahead donna. >> caller: i'm calling about the healthcare law whether the republicans try to take away the take aw subsidies of millions of people ons of that signed up for healthcare and i'm not voting republican inin

2016. i'm going to put the democrats emocra back in thets majority of the house of representatives and in the senate representatives and hillar vote for hillary clinton for presideny t in 2016. and i'm going to get rid of all d i am those republicans and all those tea parties, because the republicans are no good to help the people at all. they are just lying to the people just to get their votes. and i'm not voting for any republicans. >> you're say you're not voting in 2016 for a republican, have you ever voted for a republican?u ever >> caller: well back in 1970 i did vote republican. but it didn't turn out the way i wanted it. so it had been bent and it had been changed. chang i'm now registered as a democrat.

i was registered as independent. but that also had dents in it and had been changed.lso be so i voteen democratic and i'm registered as a loyal democrat. >> that's donna in massachusetts and her voting history. we'll go on to elizabeth, hot springs national park arkansas. line for republican. good morning. >> caller: good morning. what i'm calling about is my sonhat is going to lose his insurance. they have given him till the end of the year. we've called and asked for help.d o and all they can say is you're probably going to have to buy a more expensive one. i go he can't even afford this one. one. if he'se working he can't get subsidies. but myki question is what i'm hearing is those who have gottens, i' subsidies for the last couple of years or year or so they're not even checking if they're status has changed. so they keep getting it.stat and they have to volunteer to

say oh, my status has changed. i'm making more money now. but they keep getting the g more subsidies. and it's the taxpayer who is subsi paying diit. someone has got to pay. so this is a redistribution of money from working people to those who sit around and when illegals get it it makes me upset. because the american people are pay paying for everything for other people and this needs to stop. and this is the worst insurance idea i have ever seen. ever. >> well there are a few things that the caller said that need ere to be corrected. there are no subsidies to people who are undocumented. none at all. actually, the subsidies are designed to target people who are working, the lowest income you can have is the poverty level. if you truly don't have any earnings, you may be eligible

for medicaid.ou may that's another important part of the affordable care act.of t buthe the exchange coverage the marketplace coverage that's at issue in the king case is scare targeted at people who are working. it is true when you apply for coverage you present what your earnings are.s there's a lot of data matching you' behind the scenes to figure out what you're earning.asis o if you don't tell anyone that's changed you'll continue to get that. when you file your taxes you have to true up. yo the irs knows how much you make. that's how it works in this country. and indeed when we just went through the recent tax season, we saw millions of americans who had to refund a portion of the credits they had gotten because had g they had under reported their inm can. maybe not intentionally. people's income have been quite variable. they did have to make payments varia to true up. so with respect to the caller's son, if his income is within the

right range, it's not whether is n you goott it before. you can go in at open enrollment and obtain coverage. she is in a state when the king where case is decided against the govern government there will be issues about how the subsidies flow. >> about 48,000 people use the federal marketplace in arkansas. the average tax credit in $284. douglas waiting in oregon.do line for republicans you're up next. >> caller: good morning.u are and thank you every so much for c span. i have a comment and a question good and one correction.. sir, you stated that the illegals can't get obamacare, but they are getting healthcare. they just go to the emergency room and everybody pays for it.room my comment is this is probably our last chance for a do over on obamacare if the court rules thece for right way. the

there has not been one ules t republicanhe vote to my knowledge for this monstrosity. my congressmen figure out a way to make this work the way it is set up now, if the court rules the right way i'm done with my republican congressman. isn't it true the employer mandate isn't in effect. the independent team and advisory form isn't in effect. the worst things about obamacarethings still haven't even started. >> well, there are elements that have not been put into effect. the payment advisory board that to the caller mentions is a provision designed to provide vide some decisions about how to ons abou contain medicare costs, members of that board have never been appointed. if therere aren't any members it , a can't meet. there have been delays in the em employer mandate and there is currently discussion of changing

some of the rules about which s abou employerst can participate in the insurance marketplaces. so it certainly is the case there are still elements of the se the law marketplaces. so it's certainly the case that e. there are still elements of the are re law that haveal not been put into place. i think it's fair to say that the major, elements are really there. and remember the employer mandate is an important provision, but once you get to offer firms of 100 or more, the vast majority are already offering coverage to their employees, so that the practical effect of that mandate, although not zero, relative to the other changes talk that haveab occurred is quite subj small. >> as we're talking about this subject of the impending king v. burwell decision coming up later this month point to a story today in "the washington times" on what pennsylvania and ton ar delaware are doinge in anticipation of an adverse ruling of obamacare. most of the others are letting the deadline for subsidy that protection pass. the story notes.

if you want to read more on that, that's in this morning's washington times. we've got about 15 minutes left with alan wile of health affairs. marshall is in youngsville, north carolina. line for democrats.marshall you're up next. marshall, you've got to turn down your tv and go ahead with your comment or question. >> caller: yes. i voted both ways.act and i see the affordable health care act as a good thing. of course, it can be tweaked. i i think there's some little nybo things that you candy do to it. but i don't see anybody with a better program coming forth. i do think that everybody needs insurance and everybody should pay a little bit. who those that can't afford it, we ev have subsidies and even that canbott beom tweaked.efore. but the bottom line is, it's better than what we had before.g, we if we're going to correct something, we can correct the sional overcharges that are being made

by the medical and insurance profession. and i happen to knowd $1 this. i've used a million dollars to try to cure headaches. and i have no results, and it's edicat been 15 years, and 51io different i kinds of medication. just a waste of time. so it's not just the people. if we're goingca to have insurance for cars we should do away with that if we're going to do away with the medical insurance, too. i mean, all this stuff goes together. either you're going to try to help each other and do the rightther and thing and improve our schools while i'm here as an ex-schoolteacher, that would be the way to prevent building bigger prisons. just get better schools and better school teachers.but, but back to b insurance it's a good thing. and of course, we can tweak it. >> let me bring those last two comments together, and then talkpoints a little bit about the cost

side.the you know if the court really dismantles the subsidies, the prior caller talked about it ntry h being the last opportunity for a do-over. this country has tried every decade or two for many many decades, to try to figure out how to provide health insurance ze to deveryone. doe something that every other industrialized country in the world does. there is no easy way, and there's certainly no cheap way to do it given the cost of health care. there's no obvious alternative that could achieve the goals of coverage. it doesn't meanerna that the one that we have in place right now is the only option we should consider by any means. but finding political consensus around how to do it has been elusive for coming up on a century. and the thought that we're just going to find another way to do it that everyone will agree uponn the i think history doesn't suggest that's true. just a quick comment on the cost. you know, we spend far more in on

hea thislt country on health care than th any other country in the world. di there's a whole need and this discussion about coverage does need tend to be separate from it. but there is a tremendous need to focus on improving the affordability of care, and i to would actually make not only easier finding agreement about how to provide coverage easier, but it would also free up a lot of money for things like education that the caller talked about, so we have a lot of work to do not just around coverage, but also around the cost and quality of health care.for demo >> toma, wisconsin is up next. michelle is waiting on our line taking for democrats. m good morning michelle. >> caller: good morning. thank you for taking my call. i'm calling because i think affordable care act is a good ins thing for everybody. everybody in our country needs to have insurance otherwise their insurance mark that your premiums just skyrocket and s wi your cost for emergency rooms will keep going up.

i don't understand why the ybody, republicans just r can't work with that affordable care act to tweak it so that it works for everybody rather than appeal it its pl and notac have anything in its place. i also have a second question. plus. here in wisconsin, i had been on badger care plus. my husband got a raise, so we ended up making $8.43, too much. so it kicked me off the badger ce care plus. i have to go into the get marketplace to find out what's -home available. do i go to healthcare.gov to do this? how do i go about doing this since i am a stay home mom. i take care of our son, who's

severe autistic. so everything's so screwed up in wisconsin, i'm just not sure how to do this. if i could have your input on that, that would be great. >> well, first of all, part of you ca the provisions of the law is to set up navigators and other assisters who can help. you can start at healthcare.gov. it should route you ely appropriately when you put your zip code in. wisconsin has a unique history in expanding coverage and so wisconsin's approach to coverage under the affordable care act iso probably too complex to describeout in t in this segment. it's better to talk to someone. i just want to follow up on the first point you made about everyone in.s are at the outset we talked about i how many people's subsidies are at risk with the decision, but i to de do think it's worth spending an disrup extra moment to describe the disruption in health care that peopl occurs not just for the potential 6.4 million. we do in the affordable care act have a provision that's not being challenged in the king lawsuit, that says there are no

preexisting condition exclusions. you can add open enrollment. you can sign up regardless of your health, and you can't be charged a different premium as a result of that. without subsidies. health insurance is quite people expensive, and people who are ofverage modest income and healthy are. unlikely to buy coverage because they can't affordy it. the people who will buy coverage are those who are sick because they know they need it. it's expensive, but it's cheaper than paying the bills on their own. so there's a destabilizing effect for the total individual - health care market that is unleashed if you eliminate subsidies but retain the mandatory coverage of people regardless of health status.onsin, w i want people to understand this is not just about the people who are receiving subsidyies. >> in wisconsin about 166,000 individuals receiving subsidies.$350. the average about $315.t the numbers we've been citing segmen throughout thist segment are from the kaiser family foundation. a report that they've done on

the subsidies around this napolis, country. dan is in indianapolis indiana.er line for independents. dan, good morning.: >> caller: good morning. the i'm curious about what the prediction might be of your e guest as far as how the supreme court might rule.am a i'm a s supporter of the aca, but really more of a supporter for medicare for all. and i'm wondering what his thoughts might be on medicare for all. and y it seems to me it would be h cheaper. you haveav younger, healthier rger people who are on medicare and ement. you could give doctors a larger reimbursement. but itop must have been interesting for the europeans ester sitting in that audience when the president was speaking. probably incredulous at what's going on over here as far as health care is concerned. the president tried to enact a law that basically was a republican idea, a heritage

foundation idea, but the hate and disdain for this president is so great that he could probably find a cure forwo cancer himself and the republicans would still be against it. >> to the first question, i have learned not to predict what the tching supreme court will do. almost everyone, myself included who was watching in the prior case that challenged the overall structure of the law, were surprised by the decision d particularly the medicaid component, which very few of us had imagined would be a serious challenge. then then the way they came up dicted with a rationale for the way the rest of the structure is acceptable. not a line of thought that i would have predicted. i'm going to take my lesson from it th my own poor track record and just leave it there for this go-around. as for medicare for all, i think what's fair to say -- and we at

health affairs at the journal have published many papers over opose the years as people have proposed a broad range of approaches to providing everyone if with health yocoverage. w there are many ways if you look around the world there are many ways with a blend of public and private that medicare for all approach is heavily public, although the british system of the national health service is even more public because they aret. the-- there the doctors work for the government directly, and then you move into continental eme european and other emerging economies where there's much more of a blend of a roll of private insurance, but there's often a super structure of a budget that constrains what's sprent spent by those carriers. i'm not here to pick a favorite, but to say that we shouldn't be in daunted by ace sense that it's impossible to do this. o because other countries around the world have done so.

we should have our own approach, and the politics are calls complicated. technically, this is not a particularly difficult thing to do. >> sandy is in north charleston south carolina. line for democrats. daug sandy, good morning. >> caller: yes. in south carolina my daughter had a job she just got out of w high school. she worked and onlyer made $600 and we were paying out of pocket for health care, and unfortunately, she had a preexisting condition that en didn't -- wasn't w covered and we were so happy for the obamacare, and then we found out that our governor refused to -- to take the subsidy for the poor. so she was just left out completely.ision, you know had to get her own

insurance. i'd like to knowma if the supreme court makes a decision not for nditions obamacare, will it go back to preexisting conditions? >> the prohibition against insurers excludeing people for ssue preexisting conditions is not at issue. that's in the law, unless congress and the president were to repeal it and that doesn't he sta seem likely.te the caller refers to another irkine major issue at the state level that goes back to the prior court case which is that as designed, the affordable care act expected that all states ge for would expand medicaid coverage pover for those below 133% of poverty and then there would be exchange up to t coverage above. the court said that's coercive to states and states get to a choose. as in thendhe caller's state there es tha are states that have said we're not going to provide that coverage. so here we are with a supreme court controversy over coverage for people above poverty, but there are millions of people around the country who are below poverty, many of whom are working, who don't have coverage

because the state has chosen in that option to not do the medicaid exchange., mich >> igdan's waiting in hastings, michigan. line for democrats.ama heal dan, good morning. >> caller: good morning. thanks for taking my call. all the people that call in complaining about obama health od t care, none of themhi look at all the good things that are in it, compared to the old system that we had. this is like the previous callerme just mentioned the preexisting conditions. that will go away if we got rid of obamacare. and also another big thing i like about the law is that cy. preventative health care is not ot part of your h policy. it's covered. you don't have to pay a mericans deductible, anything like that. and that gives americans incentive to be healthy. you want to save money? get healthy. your physicals are covered. your blood tests, cholesterol, all that is covered. mammograms, whatnot. so if you can manage to stay healthy, there's an incentive there. you can save a lot of money.

you don't have to pay the high deductibles. under the old shot, you wanted to go to the doctor, no matter what it was for, you were paying every bit. one other thing about the employer mandate, that people don't realize, it's not in full swing yet, but under the old plan, as soon as the cost got high, the employer either passed it on to you, or dropped you completely. there wasuld no law that said if u. you work for them for 50 years e you even that they have to provide health care to you. ld not f >> alan weil, i'll give you the s last seconds here. >> i couldn't find a question, but it's always good to look at these laws with both their pluses and their minuses. what i think i would do with the last moments is to say that if the decision is adverse to the government, the politics are e going to dominate. as i said at the outset no one really wants to take coverage't away from peoplewa but there are a lot of people who don't want to support and bolster a law that they think is fundamentally

flawed.ve i would encourage your viewers blo to take a look at the information we published. we have an active blog. i assure you when the court opinion comes down, we'll summarize it. as congress and the states figure out how they're going to respond, we'll report on that at the health fair's blog as well. what >> i'll point to one story on that block. the ongoing series that you have and what states are doing to prepare for king v. burwell part two published yesterday. you can check that out at healthaffairs.org. appreciate your time this morning. alan weil is the editor-in-chief at health affairs. coming up up tonight on c-span 3, a look at health care issues. first, the senate judiciary subcommittee on oversight examines federal subsidies for health insurance. then the house veterans affairs subcommittee on oversight holds a hearing on non-v.a. supplied health care services. that's followed by a panel discussion on the emerging online medical care industry.

later, health analysts offer recommendations for preventative health care strategies. the supreme court is set to decide king v. burwell a case challenging federal subsidies for the purchase of health care. next texas senator ted cruz, republican presidential candidate, chairs the judiciary subcommittee on oversight hearing on the health care law. he criticized treasury department officials for not testifying before the committee. this is an hour and 45 minutes.

before we get to the substance of the hearing i want to take just a few minutes to discuss the empty table before us.a few it's a symbol for how little mi regard the obama administration seems to have for the american people. two weeks ago, this committee how sent a letter to three current employees of the u.s. treasury o, this department. requesting their attendance hereployee at this hearing. the talk about treasuries role in developing the obamacare at exchange's subsidy rule, which h is hurting millions of people ss this across this country, and which is dir is directly contrary to the statutory text of the underlying bill.ng specifically, this committee de sent letters to mark mazer, assistant secretary for tax policy and treasury, emily, the deputy assistant secretary, and serving as the acting assistant

secretary when the rule was written and finalized, and cameron, who was the deputy tax legislative counsel for treasury. after these invitation letters were sent, the treasury department reached out to my staff. and indicated they did not intend to send any witnesses. you know i would note our former attorney general, eric holder, the first attorney general in the history of this country to be held in contempt of congress.ngress. these three empty seats erican demonstrate the ongoing contempt for congress.ll the u and for the american people that is manifested by the obama administration. for the treasury department to answe tell the united states senate

they have no time, they will not even answer questions about how they created rule making and direct conflict with statutory text is the height of arrogance. the beginning of this hearing t was to give them an opportunity to come and answer questions, to recognize the oversight responsibility given to the ke it th senate, given to congress by the united states constitution. by their absence, i take it the t th administration is saying they ican peo are not subject to oversight.versight and yet, at the end of the day, the american people provide the ultimate oversight. given that the administration refused to cooperate in this hearing, it is my hope that the full committee will take it to the next level. of invoking compulsory process, ill

so that members of the executive branch will be made to answer, whether they tried to follow the law or whether they were instructed by political th operatives to disregard the law in the interest of a political outcome. that's a question the executive needs to answer. and the purpose of this hearing is to begin getting to the no bottom of it. now, i can understand why the administration is reluctant to engage in this discussion.en that i can understand why both in substance, after over five years of obamacare, we have seen that promis millions of people are hurting under it.u can ke the american people were promised by the president, if disc you like your health insurance plan, you can keep your health insurance plan. well, millions of people discovered that promise was

false.ican peo that it was knowingly, deliberately false. as millions of americans had their health insurance plans cancelled.ur d the president promised the american people, if you like your doctor, you can keep your doctor. that, too, we now know was a statement that was knowingly, deliberately false.rtnce, los today as a consequence of obamacare, millions of americans have lost their jobs, have been forced into part-time work, lost their health insurance, lost their doctors and are facing skyrocketing insurance premiums.undead i can understand why the administration would be reluctant to defend that record of merits. i can also understand why the th administration does not want to e fo answer questions about the underlying legal question.and the statutory text is straight forward.

and if the end of the day, it is not a complicated question, what the administration did is took statutory language of an exchange established by a state, and through transmogrification that would make harry houdini shake his head in wonderment, defined the federal government's exchange as an exchange established by a state. the question this hearing and the next panel hopefully will get to is was that an attempt bynstituti an executive agency to follow aws be the law? to carry out the president's constitutional obligation to take care that the laws be faithfully executed? or was it a deliberate effort to ignore the law, driven by political and partisan objectives, from political appointees at the treasury department and the white house?

this was a question of exceptional importance. if the executive refuses to implement the laws that are passed by congress, then the basic protections of our constitution become afebrile. -- ephemeral.his that's the purpose of this hearing.hear i'm disappointed that the administration has chosen not even to engage in this conversation.oiten to en with that, i'll recognize the ranking member, senator coons. >> thank you.ns. senator cruz, i thought i'd open by commenting in this same room earlier today, we had a lengthy three-hour mark up on patent r cruz, litigation reform. compell at the conclusion of his remarks, i was compelled to to my whisper to my staff counsel that i thought senator cruz got it right. >> i hope that comment is not used against you in your next

campaign. campa >> hopefully it will not.ig >> i hope it's not used against you in your campaign. h >> i just mentioned at the outset, by way of saying while we found agreement on issues of hope the constitutionally protectedit right this morning, we will approach today's discussion and this hearing with a somewhat different perspective. i find it unremarkable that the ght this witnesses requested for today did not appear.ll the administration has ongoing litigation, litigation before pectiv the supreme court which is expected to be resolved very soon.oing and it's my understanding that is they were not comfortable sending a witness to the hearing under the circumstances. i find that unremarkable. congress has a way of compelling cooperation with oversight, which it has not done. so the simple fact is, we are left with a so-called hearing f today about the rule making process in a senate judiciary fa subcommittee with witnesses who are not involved in the rule making process.who

it is my hope we'll move past are this political theater and on or proce back to the substance of the judiciary committee. thank you. >> all right. we'll go ahead and give each senator a chance to make a brief opening statement before we move on to the next panel.on to the senator on this side of the e sena aisle, who was here next, was r sess senator sessions. ch >> thank you, mr. chairman.itione as a long-time practitioner in federal court, 15 years practicing before federal judges, i developed such a great respect for those men and women who lead those courts. the judicial process that we do through, the legal process that we go through, and in states all over the nation, we presume laws

are past, juries are told that executive enforces the laws, andameric the people expect that.ully that's the whole essence of the american legal system. my ti and the president of the united me states is, in fact, the chief law enforcement officer in america. he has an absolute duty to see that laws are faithfully executed. i've seen in my time here presidents of both parties in policies they don't like. i don't believe we have ever seen a president of the united states who is so willing to just ignore plain law to advance a political agenda. this threatening law in america. american people acquiesce in court decisions every day. many of which they strongly disagree with. but they acquiesce because that's our system.

part of their acquiescence is a grudging belief that somewhere, somebody is following through onis a res legal procedures and what's happening to them in the courtroom is a result of a fair're n and decent process.ship r i do believe, senator cruz, thatig we're not in a healthy relationship right now. and if we get to the point where the american people believe that the supreme court, five members out of nine, on the supreme court are just advocating and the fo imposing their views instead of faithfully following classical interpretive policies of law, then i think we have threatened the foundation of this republic. my full and firm belief is that the strength of this republic is t founded on the anglo american

rule of law which we basically inherited.heni we just celebrated the 800th anniversary of magna carta, and or hea that's different from a lot of people.rithiseve the so, mr. chairman, thank you for do wha hearing -- having this hearing, and i don't believe the president is entitled to do what he wants to no matter what the law says. >> thank you, senator sessions. senator blumenthal? >> thank you, mr. chairman, and i want to join with my colleague, senator coons, in expressing my appreciation for your very eloquent remarks this ons,in morning even though we voted on opposite sides of the issue. havin and for your having this hearing because i think it's a topic ts atten that well merits attention and scrutiny. if i had been asked for my advice by these witnesses, and i wasn't, i would have probably given them counsel that appearing here to talk about

these issues literally on the eve, or perhaps a few days before the united states supreme court rules on almost directly related questions of law and possibly fact, would have been imprudent. and even foolhardy and might have been perceived as improper.e of the timing of this hearing in relation to the united states supreme court decision predetermined the outcome of their appearing here. and i would respectfully suggest, mr. chairman, that cess sho these same witnesses be invited at a at some later point, certainly consideration by the full judiciary committee of any compulsory process should await another invitation at a different time, and i do not mean to suggest that the empty

table was used as a prop for an argument that may be misperceived but i would strongly urge that this committee revisit the potential testimony from these witnesses on another occasion.this law on the issue at hand, contrary to the arguments of many partisan opponents, i firmly believe that the right decision n of p will be to uphold this law, bothe its na the act, itself, and plainly overwhelming evidence from its ybody consideration of passage demonstrate its nationwide scope.ssed tha everybody involved understood when it was being debated and when it was being passed that tax credit would be available way. regardless of which government entity set up an exchange. the act simply would not have worked any other wayg.. the financial support for universal coverage would not and have been there without this understanding.

and so i welcome the scrutiny and oversight and hope that we s work t will find a path where we can really on a very bipartisan basis work together. thank you, mr. chairman. >> thank you, senator blumenthal. senator hatch? >> well, thank you, mr. chairman. let me begin by thanking the chairman for convening what i consider to be an important hearing.el i also want to say i'm disappointed by the first panel's decision not to appear here today and testify. here we are investigating a hugely important issue, whether cision n obamacare authorizes subsidies for federal health care plans her purchased through the federal es exchanges, and the s administration's representatives won't even talk to us.puges, and you would think the administration would jump at this opportunity to tell the public how a determined that theow a det text of obamacare means the tax of exact opposite of what it says. how determined that established

by state means established by the federal government. i can only conclude the administration's refusal to participate today means it has refusal no good explanation. decided early on subsidies o be a needed to be available in va federal exchanges if law was to fe work the way the president envisioned and didn't particularly care what the statute actually said. so many things about this whole process are disturbing.ole you have a congress that passes process a hugely consequential bill through a backwards legislative legisl process after the people of ublican massachusetts, massachusetts, elect a republican senator to stop the bill from moving mo forward. yo you have a president that then decides to rewrite the law through administrative fiats to say what he wishes it said rather than what congress actually wrote. now you have senior administration officials refusing to show up to explain how they arrived at their an anti-textual reading of the statute.

these are not the actions of an executive branch accountable to the rule of law. these are the actions of an executive branch willing to bend the law to suit political purposes. i've spoken many times about president obama's disturbing disregard for the rule of law ofrule which the obamacare subsidy rule is just one example. last month i published an explai article with the ucla "law ni review" explaining how the president's rewriting of obamacare contravenes important constitutional checks on his authority. thes article is entitled "king v.t burwell and the rule of law."ay after the court case challenging the president's action. i'd like to quote from that article. "what's ultimately at stake here is president's obligation to follow the law. faced with a statute that doesn't operate quite the way heenlit envisioned, president obama decided to disregard the parts the pres of the law he doesn't like and unil instead implement a different statute.t is bou the constitution doesn't give the president leave to unilaterally rewrite laws. the power to amend laws lies with congress and until congresssk

amends the statute, the president is bound to the text congress passed." now, i ask consent for the article to be entered into the record. >> without objection. >> i'm glad we have a second panel with us today who can talk about the administration's path glad we to determining that subsidies el wit can be offered on federally established exchanges. even though obamacare provides no such authority. now, i wish the administration would take this as seriously as we do. let me just say that that whole obamacare matter, and heard all lved i sides and really got becaus tremendously involved in it naturally because i've done an awful lot of health care legislation over my 39 years in the congress.e h cagi and i have to say that one of the principal arguments by some was that -- that, you know, that the -- the people would have to t

go. the exchanges would have to be set up by the state.e that's where the money goes. an argument was used on more mb than one occasion. all i can say is i'm very concerned about this whole issue. the statute is unambiguous. it's amazing to me that we've come this far without somebody admitting that, hey, they made a mistake.o and that we would have to rewrite the law so that you can do what they've just unilaterally decided to do without any real legal authority to do it. thank you, mr. chairman. >> thank you, senator hatch. senator whitehouse?se >> thank you, chairman. i want to echo the comments of house: my colleagues about the empty chairs here. senator blumenthal and i have both been the attorneys general of our states and we have had the obligation to provide advicen the at to government officials on how how

to respond when their agency is the subject of ongoing a litigation and i concur fully lly with the remarks of senator nd i co blumenthal and i concur fully on that with his recommendation that on once that impediment is lifted havi the chairman should consider ve hea having the witnesses return. i think it could be a constructive hearing if it were not for that impediment which i think is a real and genuine one.t in rhode island we aren't very affected by king v. burwell because we did set up a state exchange and our state exchange are has been quite a success. we've just hit 500 businesses having achieved health care through our exchange which has a business plan as well as the individual plan. thousands of families have achieved coverage or major primary care practice groups arehe affor adapting the way in which they practice to take advantage of ey are some of the innovation programs s

in the affordable care act. they are seeing better care for their patients. their patients are are seeing longer hours, simpler processes, more support for prevention and other types of less costly ways of dealing with people's health. so we're seeing really better care delivered in a less costly way that is simpler and clearer, less bedeviled by the confusion and duplication that had been we a the hallmark of our health care re system. through savings.s put through the innovation center as an approved nationwidethey wer process because they were able to demonstrate to the actuary hundreds of millions of dollars in savings all accompanied by better, simpler care for the

individuals whom they serve. so i think we have a continuing process that we're obliged to pursue to make sure that the american health care system, which remains by 30% to 50% moremore expensive per capita than all of the companies -- countries that we compete with, the other industrialized countries and i our think that gives us an obligation to really try to keep the our eye on the ball and to make are sure that we're reducing the cost of care while maintaining or actually likely even improving the quality of care that our people receive. there's absolutely no reason that we should continue to be the country that has the highest per capita costs in the developed world and yet has health care outcomes as measured by things like length of life ece

that equate to countries like greece and croatia. we can do a lot better. the affordable care act is a tool that's already being proven to do a lot better, and in my view, the exchanges are a tool for continuing to drive the health care system in that direction. away from duplication, away from fee for service, away from confusion. unfortunately, behind the political language that -- and the political fights that have act, t accompanied the affordable care act, there are just an awful lot of americans who, particularly those who have had a loved ones or who, themselves, had a very serious illness and had to deal with the american health care system and they've seen firsthand what a complex, burdensome, inefficient, i th bedeviling system it was, and i in think that particularly in this

area of lowering costs by improving the quality of care, the affordable care act has made important breakthroughs. we want to encourage those breakthroughs to make us more internationally competitive and to provide a better human, humane result, frankly, for the y people of the country, and at least in rhode island, i think state exchange is helping our e sta state manage that problem and steer itself in that direction. so thank you very much for the time, and with my time expiring, i'll yield back. >> thank you, senator whiteh whitehouse.ssion i'll make a couple of observations and then we'll welcome the second panel. you know, one, when it comes to discussions of cost and limiting health care and health insurance cost, i think on the merits, obamacare has been an abject failure. president obama promised the american people if this law passed the average family would see a $2,500 decrease in health ressed

insurance premiums. i think you'll be hard pressed to find many families for whom that is the case. indeed, the average family in america under obamacare has not seen any health insurance premium decrease, rather the average health insurance premium increase has been over $3,000. that's $5,500 difference out of hardworking americans who are struggling to pay the bills and they're discovering that under they obamacare, they're getting less coverage for that.ar they have higher deductibles, higher co-pays, less coverage, ying m and they're paying more.or i would also note that the administration's justification ote for not being here is the pendency of king v. burwell and t yet miss mcmahon, one of the ha three witnesses who was called miss here today testified before the house oversight committee on july 31st, 2013, while the case with the same underlying issue was pending. the record was open in that case, yet the administration sent a witness.th and yet, here, they're unwilling

to answer those same questions about whether the administration is willing to comply with the law. the letter this committee sent to treasury secretary jack liu on may 27th without objection, i'm going to enter that letter r into the record and i'll hold the record open for a week for any additional material senators would wish to enter. with that, i'd like to welcome the second panel to the table and we'll start immediately as soon as -- as soon as you can be seated. the

pan i'd like to introduce briefly the members of the panel. we have mr. michael carvin, a partner at jones day. he is the lead lawyer in king v. burwell. and he has the ignominious distinct of being my very first pr boss in private practice which i'm sure many will hold him to to account for all of the mistakes i've made since then. we've got mr. michael cannon who is the director of health policy studies at the cato institute. he's a learned and well-respected scholar on questions of economics and health care. we have professor andy grewal

who's an associate professor of law at the university of iowa college of law in iowa city. we have ms. elizabeth b. wydra, chief counsel of the constitutional accountability center here in washington, d.c. and we have mr. robert weiner who is a partner at arnold & porter. i'd like to ask each of the witnesses to stand and be sworn in, please. will you raise your right hand? the t do you affirm the testimony you're about to give before the committee will be the truth, thetruth, t whole truth, and nothing but the truth?e so help you god. thank you very much. mr. carvin, we'll start with you. please turn your microphone on. >> is it on now? thank you. i was just talking about the about

t importance of this hearing, as a number of senators have already indicated while the policy issues here are obviously very important, i think the real issue for this hearing is the rule of law. is this going to be a nation govern by laws enacted by this body pursuant to constitutional ed by co prerogatives or unelected bureaucrats?happen and i think that that's exactly what happened in this case. i think this is an extraordinarily simple case and i think the irs has not interpreted the law, but very dramatically revised the law and that's because law simply says that you receive subsidies on exchanges established by the state under section 1311 and the irs has transformed that into something that we receive e subsidies on exchangesxc established by hhs under 1321. and anyone who speaks english knows that that's not a reasonable interpretation of not that language. the proponents of the irs rule

have argued they can't dispute that the that the plain language commands the opposite of what the rule says, so they try and change the subject.o they say, well, you've ripped th that language out of context, and that language and the ge i language is contrary to the underlying purpose of the statute.her of t in reality, neither of those is true. in fact, the context in which those words reside confirms in every way that the plain language means exactly what it says, and following that plain g that p language is really the only way to implement the broader oses o purposes of the affordable care act. for example, in terms of context, it's argued that this is an unusual place to put a restriction on subsidies, but the reality is that section 36-b is the only provision in the act that deals with the availability of subsidies, and the reality ison that it's the only restriction,

for example, that makes it clear that you need to make a purchase off of an exchange in order to receive the subsidies.ar from so far from being an unusual place to put the restrictions, statutes the only logical place and context makes that clear. in terms of the statutes' broader purposes, the plain text of section 13 11 of the act makes it clear a principle fede --ra principal purpose of the act is is to ensure that states run these exchanges and not the federal government. indeed, it's stated in the mandatory. the states shall establish and e of the operate these exchanges. and one of the main problems hat st with the irs rule is that it dramatically undermines that statutorily stated purpose. since irs rule make the subsidies available regardless ates n of whether states have o established an exchange, it provides the states no incentives to undertake this ake s difficult and arduous task. so the irs rule dramatically ly undermines one of the stated purposes of the aca which is to have states establish the exchanges.

none of the proponents the rule able can explain why any reasonable ould person, reasonable legislature, es would would have thought all the rovided states or most of the states would have done this if they were provided no incentive to do so and they can't explain any other incentive other than conditioning the subsidies. the notion that there's some purpose out there to have ies in a subsidies in all states is simply a fiction invented by the obama administration. there's no text, there's no legislative history anywhere suggesting that congress ing that intended to make subsidies available on exchanges that are established by hhs. therefore, the purpose argument is not any effort to discern congressional intent through anycong of the normal means of slative expressing legislative intent. it is actually a unilateral effort to impose the executive nch branch's own purposes in contra distinction of those to

the legislature. we have a specific statutory provision that tells you what the limitation is in 36-b, we have a specific statutory provision section 1311 that tell s you why they impose that and at there's no legislative history which contradicts either of those statutorily enacted text. so any legislative material that any justice on the supreme courthas has looked at, there is no purpose that would justify the irs' revision of the code. i think my final point i'll make is that the proponents of the act can't even agree on the rationale behind why the irs' hy the revision was okay. the solicitor general invented this term of art theory in the supreme court. you won't see that term of art that te theory anywhere in the irs' discussion of the rule at the ey did time they did it. so this was a post-hoc inventionon by the solicitor general that's th not even consistent with what the irs came up with. the media explanation for all of this is a giant mistake that nobody really understood what

was going on, but neither the solicitor general, nor the irs, has b has bought into this notion thatou this was simply a matter of w oversight. so all of the very rationales that have been offered up for its w this bureaucratic revision of the statutes' plain text are not only unpersuasive, they're actually at odds with each other. thank you. >> thank you, mr. carvin. mr. cannon?ou.nk you. >> thank you, chairman cruz. thank you, mr. chairman, ranking member coons and members of the committee for the opportunity touss what discuss what we do know about how the irs developed its health insurance premium tax credit rule of may 23rd, 2012. that's the rule that's being challenged in king v. burrwell and it's the rule that implements the premium ch assistance tax credit provisionsal imp of the patient protection affordable care act of 2012. two federal courts have found that that rule expanded the reach of the aca's employer mandate beyond the clear limits congress imposed on the irs' authority.the

according to those courts, the irs is unlawfully subjecting more than 250,000 employers and 57 million workers to that tax. one of those workers is kevin pace.ns, mus a jazz musician who is not far n from here in northern virginia. according to the "washington post," pace lost $8,000 of income in the first year the irs unlawfully imposed that mandate on his employer. as a direct result of that mandate. according to one estimate, this illegal tax reduces a typical reduces affected worker's income by nearly nearly $1,000 and has eliminated nearly a quarter million jobs. those federal courts likewise iminat found the rule expanded the the reach of the aca's individual mandate. subjecting an estimated 11 million taxpayers to an illegal tax averaging $1,200 each. whatever good the irs hopes to accomplish with the funds raised by these taxes is irrelevant. the authority to levy taxes and spend federal dollars rests with congress, alone. in king v. burwell, four

virginia taxpayers allege this tax credit rule is subjecting them, kevin pace, and 57 million other americans to illegal taxes. the supreme court heard oral arguments in march. a ruling for the challengers would invalidate that real, create an estimated 237,000 jobs, free 57 million americans from illegal taxes and increase affected workers' earnings by nearly $1,000.$1 now, my co-author, jonathan out ho adler, and i, have written at length about how neither the aca or legislative history provide islative support for the irs' participation of the statute. indeed, both the legislative history and the statute squarely foreclose the irs' interpretation. today for the remainder of my testimony i'd like to discuss the troubling picture that emerges from what little we know about how the irs developed this rule and why we know so little about how the irs developed this rule. the available evidence suggests irs officials recognize the aca did not give them authority to m

impose the taxes yet they impose these taxes anyway.au treasury and irs officials perform little or no analysis of the aca and legislative history. they used legislation rejected by congress in order to support they f their theory of congressional intent and they failed to su consider important dimensions of this issue. the irs' proposal to implement these taxes and subsidies in federal exchange states met tained immediate and sustained criticism including from some members of this committee as far back as 2011. the administrative record offers no support or substantive explanation, no statutory support, the plain meaning of the tax credit eligibility ligibi requirement that recipients mustli enroll in health insurance recip through an exchange established by the state. the administrative record contradicts arguments the government offered before the supreme court and reveals those arguments to be post-hoc rationalizations.rvin men

mr. carvin mentioned the term of art argument the solicitor general made before the supreme court. what little we know about the administrative record shows that dispositively that the irs did not believe this was a term of art. the irs attempted to hide its actions and reasoning from congressional scrutiny. according to an article in the ac "washington post" which interviewed several members -- several officials at the treasury department and irs who lv were involved in the developmented of this rule, one former official said, quote, the overriding concern was not generating negative news stories. the overriding concern of the officials who wrote this rule ember was not feelty -- fealty to the law, but avoiding negative news stories. the irs continues to try to avoid scrutiny. in december of 2011, the then-ranking member of the senate finance committee, a member who's here today, senatoranna hatch, sent a letter to the nc sent a

department of the treasury after the promulgation of this proposed rule and before it was finalized, disputing the legality of the rule and asking the treasury department to turn over all documents related to the development of this rule and the irs' reasoning behind this rule.ent have the irs and the treasury department have been ignoring that request for 3 1/2 years. the irs is taxing and spending the american people's money without permission from or accountability to congress. the american people need to know how this happened and that begins with transparency. i thank you very much for your time, and i look forward to your questions. >> thank you, mr. cannon. professor grewal? >> thank you very much, mr. chairman. i suspect if the irs had shown up today, it would tell you that it tried to carefully obey its statutory authority when it issued regulations under section 36-b. wh i want to explain why that's nearly impossible to believe. at the outset, i'll say i don't take any particular position on n the the king v. burwell issue and

don't know whether obamacare is a good idea or bad idea.s why i that's why i'm sitting here in the middle. but i do want to discuss three ci circumstances where other regula regulations under 36-b clearly contradict the legislative e. language. and if you think established by the state is clear, you'll think these ones are very clear, even offered a case of beer on twitter to anybody who could come up with some colorful counterargument. the in the first circumstance, a statute plainly grants credits only to citizens when their income falls within a particular range. 100% to 400% of the relevant poverty line amount. irs doesn't like that result and potentially expanded credits to several million persons below the 100% amount. c again, if you think established by the state is clear, a statute that refers to 100% to 400% is far clearer. and the second circumstance is wo the aca has two related provisions.

one provision says that if you're a large employer and you offer health insurance to your employees, we want you to automatically enroll all those employees in coverage, and the regula department of regulations will ti issue regulations saying as much. much. if you're going to have a plan, get everybody in there. as a sweetener to this, the persons who are enrolled won't ill ge get credits under section 36-b t because they're going to be getting coverage under the employer plan. with no credits, that means there's no penalties on employers when they automatically enroll employees in their existing plan. the irs does not like that result, and it has issued a regulation saying that in some it circumstances, you will actually get a credit under section 36-b even though you are getting coverage by your employer and your em the employer will relatedly get hit with the penalty. the third category i want to discuss relates to unlawful aliens. congress recognizes that some per very low-income persons who are here lawfully can't get medicaid. some states say, well, all right, you're not a citizen, butbefore y we'll help you, but please wait

five years before you apply for medicaid. the statute section 36-b says te that, okay, we'll help you out with credits on the federal -- sorry, on the state exchanges and arguably the federal exchanges. if you are here lawfully, you, yourself, can get a credit for policies purchased on an exchange. the treasury has issued a regulation saying even if you are here unlawfully and you meet the income requirements, you are eligible for a credit. eetth the statute is very clear that b says you must be here lawfully to get this benefit of this special rule.fi all of these three provisions pro may be good ideas in the ab abstract. i don't know. they seem reasonable on one level, but they clearly violate guage. the relevant statutory language. in closing, i just want to talk ab emphasize that as we talk about the treasury expanding 36-b, we don't give enough attention to the fact that an expansion of 36-b means more penalties from employers. unlawful credits lead to

unlawful penalty collections. irs the fact that the irs in expanding section 36-b is illegally collecting penalties s from private businesses should ties fro receive more attention.d thank you, mr. chairman. >> thank you, professor.rs of ms. wydra?ee >> thank you, chairman cruz, ing ranking member coons, and members of the subcommittee for inviting me here to testify before you today. mou i must take issue, i'm afraid, however, with the substantive st today premise of today's hearing. at least as reflected in its title which suggests that the treasury department rewrote the affordable care act when it ensured that tax credits would a be available nationwide to all s. americans who need them.ewriti far from rewriting the statute, i would assert that the treasury department applied the aca according to its text statute design and purpose when it te interpreted the act and made this rule. similarly, i must take issue, i'm afraid, with my esteemed in. colleague, mr. carvin. what you just heard him describe

a few moments ago is not how statutory interpretation works. how you heard him describe the affordable care act is also not how anyone involved in enacting the statute understood the law to work. republican and democratic members and staffers alike involved in drafting the law have made clear that no one understood the law to preclude tax credits for residents of f states that opted to use the federal fallback provided to them in the law instead of electing to set up an exchange for themselves. to the contrary, statements by rs of members of congress at the time and reports drafted by committees and the cbo all cb assumed that tax credits would avail be available in every state on any exchange without making a distinction between state-run, and federally facilitated exchanges.that did any members of congress stand up at that time and profess the vision of the tax credit provision that we heard mr. carvin and other critics of the treasury rule put forth?

as mr. carvin had to admit when the supreme court asked him this very question? there were none. but i'd like to back up for a moment to talk about the language of the statute, itself, because i think it's important to correct what i see as some mischaracterizations. as justice scalia reiterated a last year, it is a fundamental cannon of statutory construction that the words of a statute must be read in their context and with a view to their place in the overall statutory scheme. pluc in other words, not plucking a forward phrase out of a statute and using it to defeat the very fundamental purpose of the entire act which in this case was to provide affordable health insurance for all americans.to hel to help achieve this aim of broadening access to health care and insurance, the statute provides for the establishment of exchanges on which individuals can purchase quality affordable health insurance. section 1311 provides that, later "each state shall not later that january 1st, 2014, establish an american health benefit exchange." the act clarifies, however, that

there is, "state flexibility in meeting this requirement." a state may elect to set up the exchange for itself or if a if a s state chooses not to establish an exchange or cannot establish es an exchange that meets the act's requirements, then hhs, according to the statute, shall establish and operate such exchange within the state.uses t when the statute then uses the term, an exchange is established by the state in the statute, it refers to exchanges established vel by t at the state level by the state as well as exchanges established at the state level by hhs standing in the shoes of the state. with now, with respect to the eligibility for tax credits allowing individuals to afford to purchase insurance on these exchanges, the act expressly presents income level as the method by which an individual is determined to be eligible or notthe for tax credits, not the entity which runs the health insurance exchange in that state. what about the phrase seized upon by critics of the treasury department's rule found in the - provision for calculating the f

amount of the tax credit from --y who purchased a policy on an ange p exchange established by the ur state?could pl well, you could pluck a forward phrase out of moby dick and say it was a story about a sunday whale watching cruise. that's not how you read a book and not how the supreme court s tells us you read a statute, either. reading the law to provide tax nat credits nationwide on both state-run and federally facilitated exchanges allows theand fe provisions of the aca to work of t harmoniously which is something the supreme court has told us clearly is something that shouldthat i be a guidepost when we're reading statutes. in contrast, the reading asserted by the king challengers would deny effects to the regulatory scheme by subverting b the act structure and design and basic purpose and rendering important provisions absurd. something the supreme court has told us we should avoid when ould avo reading statutes. i believe the interpretation of the law reflected in the treasury rule making tax credits available nationwide to all americans who need them regardless of the state in which

they live, accords with the plain text of the law and allows the law to work in the way that congress intended. interpreting section 36-b in this way allows the fundamental market reforms at the heart of the law to work in the way that they were intended and is the best interpretation of the law when you read the law according to way that the supreme court tells us we should read statutes. i'd be delighted to answer any questions the court has and, i mean, the panel has. delight i'm used to being in front of judges. but thank you for your time and i'd be delighted to answer further questions. >> and i can promise you none of us will be wearing robes.robes. mr. weiner? >> thank you, mr. chairman, ranking member -- ranking member coons, for inviting me to testify today. let me say first i think it is wrong or at least premature to be talking about a violation of the rule of law by the treasury department when the supreme were court may yet tell us, and i

think will tell us shortly that they were right. second, i'd like to say the affordable care act, in fact, is working. 14.1 million americans more have insurance than they did before. the rate of uninsured americans has dropped from 20% to 13%. health care price inflation is at its lowest level in 50 years lowes and the rate of increase in t insurance premiums has declined. the third, the opponents of the aca in the king case would roll back this project, and they contend that the treasury department charged with implementing congress' intent nd should have found that what congress intended to do was to enact a self-destructive statute, one that coerced states to set up their own exchanges by threatening if they did not to

impose a federal backup system that didn't work. now, why would congress have done that when the whole point -- why would they have had a nonfunctional backup as a e threat when the whole point of the backup was to ensure that the statute did work in those jurisdictions?ngress p and why would congress plant a anyway? time bomb in the statute, anyway? well, the argument is that the dep irs and the treasury department, those questions were off limits cause because the language was so clear that there was only one t permissible interpretation. let me answer one more question, and that's why would the states have an incentive without the coercion to establish exchanges? and the states, themselves, asked -- answered that question questi in the very case that mr. carvin handled. mr. when they amended the complaint in the nfib case, the state governments alleged the

exchanges were coercive. why were they coercive? not because they threatened subsidies of the citizens of those states, that they didn't set up an exchange.ey wer they were coercive, the lawsuit e th said, because the states would e regula cede regulatory authority if the federal government established exchanges. that's not my position.that is that is the state's position and that is their incentive along with a lot of grants to establish exchanges. now, the opponents really have to take the position that the statute has one and only one ble permissible reading because there is a strong presumption that you read statutes to be effective, that you read just statutes in furtherance of their evident purpose. justice scalia says that in his says th book, "nonstatutory interpretation." and the argument here is that the

ar this self-emulating i interpretation that the treasury department was so derelict in rejecting can prevail only if it is impossible to construe the statute any other way.way. it's crystal clear, they say, but no one at the time the statute was enacted was aware of it. in fact, it was so obscure that it wasn't discovered, and that's the word that has been used, discovered until months after the statute was enacted by a ke lawyer whose announced mission was to find a statutory glitch that would take down obamacare. nor is this a one and only interpretation except now by an authoritative interpretive, probably for at least four members of the supreme court.

the solicitor general, senate and house leaders and staffers and ho who are involved in the drafting draftin of the bill.nsurers. health insurers. the american hospital association.s. american cancer society. 22 states.statut the former director of the cbo. all of these people interpret the statute the same way the irs does and to say that their interpretation is impermissible is to question either their literacy or their candor and neither is really endowed. let me just say with regard to the irs and their process, truth is a defense, and the irs engaged in a process that produced a reasonable result, reasona one that did not gut the statute, as the interpretation onsist offered by the aca opponentsen would do. one that was consistent with the commonly -- with the commonly

understood meaning of the statute by those who enacted it at the time. thank you. >> thank you very much.th i'd like to thank each of the members of this learned panel. you know, i agree very much with the testimony of mr. carvin, that this is fundamentally about the rule of law.law. this is fundamentally about the an impos question of whether the federal of ta government can impose billions of dollars of taxes upon millions of americans directly ut wheth contrary to the text of federal explicit law. it is likewise about whether the federal government can spend billions of dollars explicitly prohibited by federal law. if the answer to both of those questions is yes, if the administration's interpretation is acceded to, it makes the constitutional law making function superfluous.