mandates which have worked. a recent study showed that people more likely support any change in health care at all of us chipped in. our individual mandate and our employer mandate have worked. most of our residents approve of the reform. there was no paper plates system in tennessee. -- pay or play system in tennessee. that was mentioned earlier. we need to keep money for the employers to put money into the system. the individual and employer mandate appear to have worked in massachusetts. we have many more ensured in

less than three years. of those, on a 91,000 were paid by employers or individuals buying -- 191,000 were paid by employers or individuals buying insurance. that is very important. your plan would do that. the system doesn't 3, the number of employers providing insurance was up -- since 2003, the number of employers providing insurance was up. we have proved that by having such a mandate, there is more success. you look at higher payrolls. we do not want to hit a low and some employers -- low income employers. reform of mandates must help businesses and individuals.

we must build a safety net so that individuals and small businesses that did not have access now can have access to affordable insurance. we believe your draft bill is a good step forward, and we support it. >> thank you. >> we are privileged to be here today. president obama and many congressional leaders and many people we have heard from today have all said that health care reform should ensure -- if people are not helping -- if people are happy with their healthcare coverage, they should be allowed to keep it. over 160 million americans

receive their coverage from employer sponsored plans. it cost employers over five under $30 billion per year. two-thirds of americans -- $530 billion per year. two-thirds of americans want to keep the coverage they have. to give meaning to president obama's pledge, it is essential to retain one's coverage. the employer sponsored system must continue. this system that employers want to continue to participate in, a system that does not skew individuals' choices as to whether or not they should remain with their plan or seek their coverage elsewhere.

to respond to a question asked earlier, we are not interested in trapping employees in an employer plan, but we do not want the structure of the system changed so that they will be induced to leave their plan. let me briefly share some of the key concerns that employers have as they examine emerging health care today. the pay or play mandate is first. one concern is that even if employers can meet the financial obligations of the mandate today, over time it will grow and become unaffordable. that is only one part of the concern. the other concern is that the regulatory structure that would accompany a mandate of this type would lead many employers to pay rather than to play. employers believe in the value added by employer sponsorship

that they are concerned the structure could erode rather than build upon the employer base system. the federal from work is essential to maintaining a consistent set of benefits. -- the federal framework is the essential to maintaining a consistent set of benefits. congress might make substantive changes to the framework that will expose employers to substantial financial liability. it is not enough to have uniform federal rule. the rules have to be administrable and reasonable. we cannot induce employers to exit the system. we do not want to cause them to pay rather than play.

three different penalty regimes could result from this bill. for employers and individuals obtaining coverage in the new insurance exchange, state remedies would be commended. for the new public plan, the uniform federal rules that currently apply to medicare would prevail. this does not create a. the public plan, many assume the employer system is opposing the carry plan. that is not the case. there are proper and the proposals on reforming the health-care system. there are important roles for the government to play.

public plans are resentful to help the lowest income individuals where the employer base plan may not be the best plan. the government can facilitate and regulate the system where people can select from a variety of different competing private plans such as the role of the government to operate these exchanges. people can select among different private plans. the concern about the public plan option emerges from decades of concerns about massive cost shifts. the government says the reimbursement rates, other purchasers pay more. there is no cost saving and chief. it is moved from one player to another. my time is up.

i was going to get to the part of the bill that i like. it will not take very long. the public plan -- if they will operate by different rules, it would not be fair to compete with the private. if they operate by the same rules, what is the point? on a positive note, employers want to make sure that they will improve quality outcome. if health reform only result in expanding coverage for the uninsured, it would be a magnificent achievement but a missed opportunity. we want to commend you for recognizing the need to address quality issues in the legislation. i will answer any questions. >> thank you. >> thank you for inviting me to testify. the independent non profit publisher of consumer reports -- we do not just test tires, we tried to help people with good

medical products. we are ienthusiastic about comparative research. will allow people to get the safest drugs. we will go with the $20 generic over the purple pill, because they are scientifically the equivalent. what is the purple bill? ok, anyway. for a long time we have advocated healthcare for everybody. we have written to our subscribers saying that it is obvious that people want the whole population to benefit from discovery to modern medical science. the only question is how soon? that is our 1939 auto issue. you were saying 50 years. i would argue 70 years. if we had reform.

this is the old bill. if we had passed that, i think some of the auto plants of northern ohio and michigan would still be making the great models that are in this issue. we think this would be good for the industry, but the institute of medicine has noted that each year about 18,000 people die prematurely and unnecessarily because of not having health insurance. since this magazine issue, about twice as many people have died from not having health insurance as be killed in wwii and all of our conflicts since. it is past time to do something. this will be one of the great converses as of all time if you can pass this bill. we think the draft bill is such

a bill. we are pleased to endorse its principles. we assume there will be some more savings and progressive of financing to make it budget neutral and sustainable. this is a bill that would bring health security and peace of mind, affordable and comprehensible -- and copper has of care to american families. -- and comprehensive care to american families. baby care was mentioned. that is a benefit on page 25. the other doctors who take on medicaid patients -- for primary care, you will be paid a lot more. i think that is important. major nursing-home reforms for

quality, exposing the flood of drug and device money to doctors and medical schools that can distort medical practice. promoting primary care and the training of new doctors, the bill is filled with these kinds of provisions. our testimony lays out our health reform principles from our august magazine and how well the bill matches with those. it is a great match. we thank you. a bill this size would be shocked if we did not have a few suggestions for small improvements. health consumers drive towards quality more. a l 52 fellow americans have died of -- about 52 fellow americans have died of hospital acquired infections in the time we have been here. we need to know more about how

hospitals do in fighting these infections and help consumers with that kind of public information. the other thing is both the chamber and eric spoke about consumers being better shoppers. we are lousy health insurance shoppers. we leave a lot of money on the table. we are confused by the whole process. if you give us a exchanges where there is insurance definitions that are identical will we can compare how opposite -- compare hohospitalization, and to make e plan more like medigap policies of people can shop on identical plant, then we can drive prices and move toward equality. thank you very much. good luck on this wonderful project you have started. thank you. >> thank you. >> thank you. i wish to express to you my deep appreciation to present my

views this afternoon. the views i expressed are solely my own. they do not necessarily represent the views of heritage foundation or its officers or trustees. you and your fellow committee members are considering an ambitious and comprehensive health care reform proposal. the draft bill contains employer mandate. an individual mandate on american citizens to purchase health insurance is unprecedented. i understand and appreciate the rationale for that mandate to offset the cost shifting and address other problems. individuals have a personal best of ability to protect themselves and pose no unnecessary costs on the rest of us. an individual mandate is a restriction on personal liberty.

given the fact this is such a restriction on personal liberty, i think we should look at other opportunities to excel and coverage such as positive incentives to facilitate the ease of enrollment in health insurance. that will achieve a dramatic reduction in health insurance. i suggest alternatives sending policy review. i'd like to submit those for the record. >> we will make that part of the fall of the committee. thank you. >> we do not want to impose such a mandate during a recession. i like to focus my remarks on some key areas of the bill. the national health insurance

exchange, the public plan, and federal regulation. the concept as a health insurance exchange is fairly new. it has limited application of the state level. some may argue that the program is analogous to an exchange or a national exchange. there is no government sponsored health care plan in thesfhb. the former governor of massachusetts and state officials developed an exchange. one of the key advantages called the connector was that it would allow employers and small businesses to get access to

portable health insurance cash free. the coverage would be available during the exchange. it would be considered group coverage and would enjoy the powerful advantages. the health insurance exchange is an excellent idea. should be promoted as a state institution at the state level. with regard to the public plan, the bill proposes the secretary of the department of health and human services deal with the plan which is to play on a level playing field. medicare payment rates are set below the private sector. the public plan would enjoy an advantage over competing private

health plans. analysis shows the use of medicare payment rates would result in an erosion of current insurance. it has been said confidently that it you are serious about a level playing field, all rules and regulations that apply to private health insurances must apply to the public plan. if congress wishes to achieve a level playing field, then the other actions -- options should be allowed to compete and failed. that means without being kept on artificial life support through an infusion of taxpayer money. with regard to federal benefit settings, every american would be required to have health

insurance coverage that congress would define as acceptable. there are various standards. my concern about the federal benefit steading is that it may undermine the creativity in the insurance market reform of state. states are culturally and politically different. some experimentations' and innovations should be encouraged. thank you. >> i am honored to be here today. thank you for inviting me. i am an operations manager for my father and small-business. i am a member of a coalition of small businesses in iowa looking for solutions for health care.

i am here to share some experiences of an actual small- business desperately trying to provide health care for our employees. my father started the company 20 years ago. it was him and one other person when they started. we have grown to 40 employees. my father is 68 years old and ready to retire for a second time. we're hoping that my oldest brother will help me run the business. i do not want to do it by myself. i am constantly thinking of how to provide health insurance for our employees. we have 33 total employees who are full-time each month. the " i have been given have been for our full-time employees -- the wuquotes that

i got in 2006 were unaffordable for us at the time. we were left offering a small stipend to employees who decided to purchase health insurance on their own to help them out a little bit. most of them could not afford coverage. there are only three people who are purchasing their own health insurance. my father has retiree coverage from working at john deere, and i have coverage through my husband. we are not worried about our personal health insurance, but most of our employees are not in that position. we have a husband and wife team, and other people who are like family members. we really want to be responsive to them and for them and be able to provide them with coverage. my brother who was to come back and held as a family and two small children and cannot afford

to go without health care. a decision that should be easy to come back and help run the family business and the legacy is becoming complicated because they cannot afford it without health insurance coverage. after looking at the draft proposal, i think this is a major step forward in addressing the health insurers problems we face. it meets the priorities identified by the main street small-business owners. i look action will be taken sooner rather than later to help us provide health insurance. what is most important to the reform is the creation of a really strong public health insurance option. we need an option that will compete on a pair of assists -- on a fair basis with the private plans.

we want to have real choices and the leverage that comes with being able to take our business elsewhere if we do not like the plans being offered. as i was looking for plans this past year, i got eight quotes from one company. no other company would provide that for our business in our area. there are only two companies that hold the market share. small businesses across iowa are looking for congress to act quickly on the health reforms to give us some real choices instead of one company with eight plans. we are looking for leadership, and we need your support to help solve this problem for our businesses and families. >> thank you.

>> we thank you. they can for sticking through the process of writing the bill and hearing the testimony associated with it. i am a medical educator. i once read the national health service corps. today i am a professor of health policy at george washington university. this bill comes with context. i want to give some workforce context quickly. in the united states, we have large numbers of health professionals and physicians. we have an adequate number of

positions. we need to " the physicians at the population grows. -- we need to grow the positions as the population grows. rural areas and poor areas have trouble with physicians and nurses and other health workers. one of three physicians in the united states inches -- is in primary care. the commitment to primary-care is flagging in the pipeline. evidence suggests that primary care is associated with better outcomes and less cost. nurse practitioners and physician assistants are important components of our work force today. they need to be grown as this bill suggests they do. in terms of the context, we do very little planning. we have a large help work force.

we do little down stream planning. we need to put more brainpower and data and thoughts of deliberation on what we invest in with regard to the work force. i want to suggest a way to look at the work force. the last rapid action my testimony suggests -- the last graphic in my testimony suggests certain things. the training and medical school in the context of physicians, the post graduate or specialized training, and practice. if we are going to reform the work force and build the work force that is more in line with our needs, we need to do it in all three sectors, the ones i listed above. those are important concepts. i will talk about the bill with regard of those three areas of the work force.

the committees have done a very creative job of putting many ideas to work in the proposed legislation that would move was considerably in terms of building a better workplace. -- work force. increased support for title 7 and title 8 training. diversity is increasing. and use funded slots are repressed for primary care. there is a teaching health center demonstration proposal which would put young doctors to work in community health settings. there are significant payment improvements for primary-care physicians, which is very important in underpaid work forces. there is support for new instruments to organize work force.

there is attention to planning and brain trust, and revisory committee -- advisory committee. the national health service corps has some concerns. many young people in medicine and other health professions are being looked at. teaching health centers are important instruments. they are a demonstration project. many feel of having them as a permanent part of dealing with business along with startup funds to get health centers to hose residencies and other programs. 5% on the basic e &m services for primary care.

there is not enough incentive if we want thousands of our young physicians to choose primary care. if the% of craig which sells a lot would add 25 -- a 50% upgrade sound like a lot, but would be only $25,000 more. it is very modest. a primary care extension program has been proposed. it would help translate new findings in new ways of doing business, including better organizations and practices. it is something worth considering. the final activity i would like to see is a national commission level of an advisory committee. i think this is a great start.