required of an applicant was to attest to a anyone-digit number, a social security number. it lowers the standard to the point where fraud is anticipated to the point where the congressional budget office's calculations produce that it will open up -- open up health care benefits to as many as 6.1 million illegals. that's c.b.o.'s number. that's a number that's calculated from their estimate, not exactly their number. it's not mine. that's where we stand with the legislation that funds abortion, not so much the senate but the house version of the bill, we're not going to get that language and legislation that funds illegals, legislation that takes away our freedom and liberty but nationalizes our body, that tells everybody in america the federal government can tell you what -- how -- they can tell you how your health care is going to be managed, what health insurance you will -- that you will buy a

health insurance program, what type of care will be provided and what type of tests will be provided and in the provided. this is a great theft of american liberty. never before has the american government produced or approved a product they required every person to own or buy and putting refundable tax credits to some to to the buy insurance and tax others for their insurance policies so we can afford to pay others to buy insurance. and the next argument, there'll be a next generation if this happens in this congress, there'll be the argument that will come from this side of the aisle, it will be, gosh, hand wringers, we're spending so much money on administration writing out checks to people to buy their own health insurance policy, why don't we just provide them free health care and bypass all this insurance business that's going on and put our money directly into the health care because they won't have enough money to provide

the care because of the costs being driven up and that's the next generation of this debate. . mr. thompson: i appreciate my good friend yielding and appreciate dr. burgess showing the "wall street journal"'s statistics. a cnn poll showed that independents said stop the bill. that is independents. 79% of them. i was vivetting a hospital earlier today -- i was visiting a hospital earlier today. i talked to the physicians, newses, secretaries, that was the same message they gave me and these are folks that understand health care and they said stop the madness, stop this will bill and start over. as i talked with patients and

family members and i talked with just visitors, it was kind of interesting, they had no idea who i was and i was riding the elevator. they looked at me and said what are those people in washington doing to our health care? they get it. the people at home get it. we need to stop and do the right things. one of my first principles was to decrease cost for all americans. you mentioned tort reform. the president has acknowledged, those folks, he has come out and said, this is going to drive their premiums up 10% to 13%. that is the opposite of what we should be doing. i appreciate you doing this tonight and i yield back. mr. king: i yield to the the gentleman from texas for any concluding remarks he may have. mr. burgess: what we're doing

now has nothing to do with health care or health care policy. this is all about pure political power and a hold on political power for the next two or three generations. this bill will be impossible to undo. we need to stop up and fix this bill. mr. king: purely political about expanding the dependency class because the dependency class expands the political power of the left in america at the expense of our freedom and our liberty never to be gotten back again. i thank you, mr. speaker for your indulgence and my colleagues. and i yield back. the speaker pro tempore: under the speaker's announced policy of january 6, 2009, chair recognizes the gentleman from ohio, mr. ryan, the remaining time until midnight. mr. ryan: i appreciate the

opportunity to respond to some of the criticisms that have been here unjust as they seem to be to me and try to straighten the record out a little bit. it is our belief on this side of the aisle that the united states government and the government of many of our states have a moral mission, a moral mission to go protect our citizens, moral mission to empower our citizens. and a moral mission to improve the lives of many of our citizens. and the issue of health care reform to us on this side of the aisle is a moral issue and it's an economic issue. and when we see throughout our country the level of abuse that

has been put upon the people of this country through the insurance system, that, my friends, that, mr. speaker, is a moral issue. nobody is saying that this health care reform bill is a perfect bill. nobody says that it's going to be a panacea and fix all of our problems in this country, but this is a major step forward for our country. and we have, as a country, a moral obligation to stand up between what the insurance industry is doing to the american people, somebody has to intervene, and there is nobody left because average people who are in ohio or iowa or some of these other states have no recourse. they cannot battle the insurance

industry. this has been going on for years and years and years. where the industry kicks people off the rolls when they get sick, deny people coverage because they have a pre-existing condition and so can't get insurance at all. and they have created a system here over the past few years, past five, 10 years, where we see 10%, 20%, 30%, 40% for individuals, small businesses and large businesses and the government. so we have a situation where we need to address -- we're that far from addressing one of the great moral issues of our time and we're that from from addressing an issue that will

strangle the united states of america if we fail to act. i think it's very veept for our friends on the other side of the aisle and those in the insurance industry to say let's start again. let's start all over and start from scratch. well, if the insurance industry wants to go back and revoke 10 years of increases that they have bestowed upon the american people, if they want to start over, maybe we'll start over. if they want to eliminate all the increases they have put on the american people, eliminate them all, let's go back to 1994 rates or even just cost of living from 1994 or 1995 when we tried to do this the last time. why doesn't the insurance companies start over, mr. speaker? and go back and erase their

increases that they put on the american people. then we may consider starting over. now for those people, mr. speaker, who have been listening to this debate, they need to recognize that maybe this process isn't pretty and maybe we could have done a better job explaining what's going on and many people and our friends on the other side, we're talking about polls. and at the same time, would lament the fact that we are governing by polls. so when we look at what has happened over the course of the past few years and what's happened to average people, i want to find the poll that we had here, when you pull out the issues from the poll, so the

general consensus is do you want the health care and you hear in the news about the different things going on and they say it isn't a good idea. but when you pull out specific provisions of this bill, of this health care reform proposal, most of those issues -- most of those reforms, polled at 60% or 70% or 80% are in support. are you for getting rid of pre-existing conditions and allowing insurance companies to not cover you because you have a pre-existing condition, 60, 70% of the american people support that. do you support eliminating lifetime caps so when you get sick and need the insurance, you can get it, 60%, 70% of the

american people support that. do you support not being able to deny every child in the united states of america because of a pre-existing condition? 70%, 80% of the american people support that. do you support giving small businesses tax credits to cover their workers, significant support for that. so we are moving forward with a proposal that addresses the major needs of the american people. when you ask seniors, are you for closing the doughnut hole snr more than a majority of seniors say yes, that is something we want included in the health care reform proposal and it is included in here. and many of these reforms will go into effect next year. so when we pass this, mr. speaker, and our friends

campaign in november about repealing this, they're going to have to go to all the moms and dads in the country and say, you know your child, if they get sick or want to get insurance, they can't be denied because of a pre-existing condition, they want to run a campaign that says, no, we want to repeal that. our friends on the other side of the aisle who say, you can't be den i'd coverage for pre- existing conditions, they say we want to repeal that. when we close the doughnut hole and move in the direction of fully closeing the doneut hole, that they didn't pay for and it has a doughnut hole in it and we attempt to close it, our friends on the other side of the aisle are going to run a campaign in november saying, we want to repeal the closure of the

doughnut hole. these are the issues that are in here and in this reform proposal. and these are the issues that are going to bring some justice to the health care industry in the united states of america. this isn't about whether the government is going to run health care or the insurance industry is going to run health care. this is about whether doctors can make decisions. and our friends on the other side want to talk about life and liberty. let's talk about life and liberty, let's have this debate. you want to talk about freedom, how free are you when you're sick and can't afford health insurance. you can't get out of bid to go to work. you have to give up your job because you don't have health insurance. how free are you? i cannot be convinced that the founders of this great country thought that are freedom is

somehow the government not protecting individual citizens from underhanded practices from a corporation. i can't believe it. i believe that the definition of freedom is about being healthy and empowered in 2010 in america. and if there is a corporation or an industry that is limiting your freedom by their underhanded practices, then the government has a moral responsibility to intervene and protect the individual citizen and protect the rights of the individual citizen. let's have this debate all day long, mr. speaker. telling me some bogey man is being created here that is going to come in here to washington,

d.c. and my one friend said, nationalizing our bodies. one of our friends on the other side said that this was about nationalizing our bodies. what? talk about fear monday engineering, mr. speaker. nationalizing our bodies? this is about protecting individuals in the united states of america who can't protect themselves and the government has a moral obligation to do it. if it's a foreign terrorist, mobile obligation to do it. if it's crime in the streets, moral obligation to do it. if it's an unruly industry that has under handed business practices, moral obligation to stop it. that's what we have here. that's why we're here. that's how this country was founded, to protect the

individual freedoms. and to say to small business people, you have to go into the shark-infested waters to get health insurance and have 50% increases and do nothing about it because of some warped concept of freedom that is made up? how free is that business person who takes money continually out of wages, out of capital investments into their factories, into their machine shops, into their businesses, into their technology and training their workers, they're not free to make good business decisions. they probably have all kinds of good ideas about what kind of investments they would rather be making than paying to some health insurance company that doesn't give us value-added.

you want to help united states of america. help some of the burdens that our manufacturers are plagues day in and day out and how many were shuttered because they couldn't make the capital investments because they had to put so much in health care. how many? we have seen the decline, stagnant wages because businesses had to absorb health care costs. while simultaneously trying to compete with china and india and manufacturing all over the globe. our friends on the other side want to start all over and they want to tell these people who are getting denied because they have a pre-existing condition, we need to start all over and wait 100 years to do it or at

least another 15 years. the last time someone had the courage, like president clinton had to try to do this we've got an obligation to fix these problems. we didn't get sent here to take polls. we were sent here to do the right thing. it's my hope that this week, it was great, today, we were in cleveland with the president. he was in the middle of his speech and he said something like, what we need, or we need and there was a pause there and a woman shouted out, we need courage. we need courage. that's what people are feeling. they feel like there's no one there to help them. they get stuck in situations where they don't have anywhere to turn.

and imagine the united states government passing a law that says when you get sick you can't get kicked off your insurance. that's what this -- that's what's in this bill. that's what's in this bill. that's why when you look at the list of faith-based organizations who are supporting this bill, so journers, network, catholic organization, evangelicals for social action, jim wallis at so journers, catholics in alliance for the common good, new evangelical partnerships for the common good. former associate general secretary for u.s. conference of catholic bishops. sisters of mercy of the americas. boston college professors, marquette university professors, on and on and on

and then this weekend, a huge endorsement for this bill, my friends on the other side were talking about -- were talking about the abortion issue, 25 pro-life catholic and evangelical leaders have endorsed this bill. this weekend, catholic -- the catholic hospital association endorsed this bill. do you think the catholic hospital association of america would endorse this bill if this was a pro-abortion bill? this is the pro-life bill. this is -- this may be the most pro-life bill that's passed this house in 20 years. the number -- how do we define life? how many people die too early because they're sick and they can't get the proper care. ? how many people have reduced quality of life because they can't get proper health care. aren't those pro-life issues?

they most certainly are. and to have the catholic hospital association endorsing this bill and to come out and fear monger, mr. speaker, on the abortion issue, is wrong. it's wrong. 25 pro life catholic and evangelical leaders, strong, nationally recognized, endorsing this bill. because this is a pro-life bill. and we should support it as a pro-life bill. you know, we talk a lot about freedom, too. how many people in america today are out there locked in a job that they probably don't like all that well, that they'd probably rather go work somewhere else or maybe even better, start their own business. but they can't leave their current employment because they know if they go out into the

free market and they try to get their own insurance, that they won't get covered because maybe they have a pre-existing condition or maybe their spouse has a pre-existing condition or maybe one of their kids has a pre-existing condition, so our friends on the other side have said, start over, don't do that. don't give that person who got an idea and wants to start a business in america and take a chance, don't help them. are we providing the kind of environment for someone to express, have the freedom to express their energy and their talents in america? no, we're limiting it if we don't fix this health care system. we're limiting it. and we have a moral obligation, as a country, as a country, to

allow each and every individual in this country to express their talents and their skills in this country. we have the opportunity here in the next week or so to make this happen. we've never been so close extending insurance to 30 million americans who currently don't have it. a lot of people say, too, as we talk about this bill that they don't want to pay for these 30 million people. it's important that we recognize that we all are already paying for these people who don't have health insurance. and you see, our friends on the other side, and i sat here and i watched them, and i listened very carefully, and they were picking these fringe issues to try to incite, they were

talking about abortion, which is ok. sure they believe strongly in that. i do as well. i have a pro-life voting record. but when you have the catholic health association and you have 25 national catholic and evangelical leaders supporting this bill, it becomes very difficult to scare the american people about that issue. they don't want to talk about pre-existing conditions. they don't want to talk about making sure kids don't get denied. they don't want to talk about small tax cuts, tax credits for small businesses to provide health care insurance. of course not. they don't want to talk about how the democrats are going to close the doughnut hole. they don't want to talk about how seniors will not have to pay for any preventive care at

all in medicare. they don't want to talk about how this bill is deficit neutral, how it reduces the deficit. they don't want to talk about how this bill extends the life span of the medicare program. they don't want to talk about any of that stuff. it -- it goes back to the original memo that one of their top pollsters gave them in the spring that said, do not let obama pass health care reform. do not let him. you'll be in the minority for a long time. so they will do anything they can, anything in their power to try to prevent this president from passing health care legislation. it's good to know, mr. speaker, because they're rooting against the president. they're rooting against the president. the president fails, we all fail.

he has extended his hand, taken all the republican ideas, put many of them into the health care reform proposal, and there's still a republican -- and there still are republicans that won't vote for it. just like the stimulus package we had to put $300 billion in tax cuts in the stimulus bill because that's what the republicans wanted and we didn't get any republican votes. because there's no benefit from the republican side to support the president. to support the american people. politics has gone -- has gotten in the way. we have all these issues that are going to go into effect within the year. within the year. small business tax credits. up to 35% of premiums will be immediately available to firms that choose to offer coverage. closing the part d doughnut hole. immediate help for the uninsured now to create an

interim high-risk pool and rescission so insurers can't drop people from coverage while they get sick no discrimination against children with pre-existing conditions. you're going to vote against that? go ahead. extends coverage for young people up to the 26th birthday. so all the young people in our country will now be able to stay on their parent's insurance until they're 26 years old. if you want to go to grad school, you'll be able to stay on your parents' health insurance. times are tough now. you may not be able to find work, or at least find work with some decent health care. you can stay on your parents' insurance until you're 26 years old. ban lifetime limits on coverage. ban restrictive annual limits on coverage. free preventive care under medicare. this is a reform proposal we should have passed 30 years ago. that's -- those are the moral issues. but the economic issues are

just as profound, just as great. small businesses have seen 126% increase over the last five or six years. and the projection as we move forward are even higher. for families and small businesses up, up, up and away. will their health care costs go if we do nothing. and as we said, they want us to start over. how about the insurance companies start over. how about the insurance companies repeal 10 years of increases and they start over. maybe that would be fair. wouldn't that be nice? we want to start all other in this country, come together and figure something out, repeel 10 years of our health care increases. free preventive care under all the new health care plans. new independent appeals

process. help for early retirees, which is huge in highway. creates a -- in ohio. creates a program to help offset the cost of health claims for employers that provide health benefit for retirees ages 55 to 64. it increases the number of primary care doctors by making huge investments. the republicans didn't do anything to address any of these issues for 10 years. now all of a sudden they're late to the game. and they still won't support it. they say, we're for repealing pre-existing conditions. they're not going to rote for this bill. they're for tax credits for small businesses, they're not going to vote on this bill. we're for closing the doughnut

hole, they're not going to vote for this bill. we're against pre-existing conditions, making sure any child doesn't get denied coverage because of a pre-existing condition, they're going to vote against this bill. we're for increased competition. they're going to vote against this bill. because they've been told by their -- the people who guide their political decisions, their pollsters, that the cottage industry in washington that tells political parties what to do, they have been told, do not let the democrats succeed at this. and we've asked time and time and time again for their suggestions, the president has taken many of them. implemented them into this bill and they keep moving the yardstick further and further down. because they don't want to

support this because they're -- their political leadership, their pollsters, their lobbyist friends, say, we can't do it. . this isn't about the democrats winning but about the people in our district who are getting hurt, getting hurt, by the current practices. and when you see the number of faith-based organizations supporting this legislation, evangelical, catholic, jewish, muslim, buddhist, i mean the spectrum of faith-based

organizations in the united states of america are supporting this and they all say is it perfect? no. of course not. this is a body of human beings who are flawed and make mistakes. but this is a tremendous step forward in our country, monumental, historic. i'm proud to be here today. i'm proud to support this bill. i'm going to be even prouder after it passes and we can point to x, y and z exactly what's in here and what the benefits are. i'm excited to run a campaign in november talking about this. i want to see the campaign where all of the stuff that i just listed is the debate in the fall and our friends on the other

side and our tea party folks, who haven't done anything in 10 years to try to address any of these problems are going to want to repeal a ban on pre-existing conditions for kids, children, a ban on pre-existing conditions for adults, saying you shouldn't be able to stay on your parents' health insurance until you are 26. they are going to run a campaign saying we should expand the doughnut hole, instead of close the doughnut ell hole. they will run a campaign that says we want to repeal the tax cuts that we have given to small businesses to try to make this happen. we want to repeal the subsidies that people are going to get to help them pay for insurance. it's going to be a heck of a campaign and they're going to

scream socialism like they have done it for seven years. i mean, this is the same party, mr. speaker, that just a few years ago when i got into congress, wanted to privatize social security. you don't hear anybody saying they want to get rid of medicare. i remember, we sat on this floor, congresswoman wasserman schultz, kendrick meek and myself, started, when we first got in congress and the first issue we were addressing was president bush's idea was to privatize social security. imagine a year and a half ago if you had dumped your 401k or your social security was looking like your 401k and you had nothing to draw upon.

that's the kind of vision we're getting from the other side of the aisle when we're talking about tax cuts for small businesses and individuals so that employers can provide health care and jobs. that's what this is about. and our friends on the other side did not act and they led to what is happening to what is happening here today and we have the consequences of their action, that we're forced to deal with today. and we have a lot of issues to talk about. this is not going to be the last time we're on the floor. we're going to be here all week talking about these issues. but, again, our government has a moral mission, a morgs

responsibility to protect our citizens and to empower our citizens. and this health care reform bill is about protecting our citizens . it's not about government-run or not about insurance-run. that's a false debate. this is about making sure that doctors, patients and families make their own health care decisions. that's what this is about. this is making sure that seniors have an extended medicare program by making sure we rid of it waste, fraud and abuse. this is making sure that our seniors have prescription drug programs. this is making sure that our government protects individuals from the practices of the insurance company being denied a pre-existing condition. that we protect our citizens

from when they get sick, the insurance company says, i can't cover you anymore. that's what this reform bill is about. and those protections will empower and stimulate and allow the american people to express their talent in the marketplace. how many business people are going to have more money in their pocket to re-invest back into their business, into the technology, into the capital improvements? how many families are going to have more money to send their kids to college, go on a family vacation? to make sure their kids can go to graduate school. how many people who are locked in the jobs they have now? i don't know. but there are thousands of them. who's the next bill gates who has a spouse that may has a

pre-existing condition so they are stuck in a cubic call some where and can't start their own business. how many children have been denied health insurance because they have a pre-existing condition? how many people in the hospital right now, right now, because they didn't get the proper health care that they needed? and so their problems, health concerns got worse and they ended up in the hospital. we have a moral obligation to step up to bat and to make this happen. and this reform bill is a good piece of legislation and i recognize that there are some outlets and some people who want maybe not be quite as straight forward with the facts that are

presented here in this bill. and they want to touch upon those same issues of abortion and immigration, all the issues that have been addressed in this bill. and when you have 25 national pro-life catholics and pro-life catholics and evangelicals endorsing this bill, when you have the catholic hospital association endorsing this bill, you can honestly say that the abortion issue has been taken care of, and that this is a pro-life bill. because the idea of pro-life is a very broad and should have a very broled interpretation. the quality of life, shortened life spans, those are pro-life issues.

shortened and reduced because they don't have the proper health care. freedom to invest in your business to start your own business, those are issues that our founding fathers talked about a great deal. and so we do have a moral obligation to pass this piece of legislation. the american people, when we pull out all of the parts of this bill, you will see that the american people support this. and the american people want this legislation -- here it is, i'll read it more quickly, more likely to support the reform if it has tax credits -- these are all issues that are in here, if it has tax credits to small

businesses. 73% more likely to support. if it hats insurance exchanges, 67% more likely to support. if you can keep what you have, which is exactly how this is set up, 66% more likely to support the reform. if you ban pre-existing conditions and denials, 63%. medicaid expansion, 62%. dependent coverage through 26 years old, 60%. close medcarle doughnut hole, 60%. subsidy assistance to individuals, 67%. these are all things that are in the bill. these are all things that are in the bill and all the reasons why we need to pass it. this is a basic human rights issue. this will be the most significant pro-life piece of

legislation that will have passed this house. mr. speaker, i thank you for staying up and we'll yield back the balance of my time. the speaker pro tempore: does the is gentleman have a motion? mr. ryan: i move we do now adjourn. the speaker pro tempore: the motion is agreed to. accordingly the house stands accordingly the house stands adjourned until >> possibly this week, extending federal aviation programs. member six attended a tax benefits bill. live coverage of the u.s. house when members return hear on c- span.

senate banking committee chairman chris dodd released financial regulation proposals yesterday. we will hear from senator dodd next on c-span. after that, a panel of governors talk about health care legislation, and then president obama travels to ohio to discuss health care. on tomorrow morning's "washington journal," we will talk about health care with john the curio. after that, a representative from the european union. later, an update on our recent report on a u.s. embassy in kabul. and then that two year anniversary of the collapse of bear stearns.

"washington journal" starts every morning at 7:00 a.m. eastern. >> c-span -- our public affairs content is available on television, radio, an online, and you can connect with us on twitter, facebook, and youtube, and sign up for e-mails at c- span.org. >> senate banking committee chairman chris dodd spoke with reporters about his new bill. he intends to bring the legislation to the full committee for markup soon. this is about 20 minutes. >> good afternoon. sartre to be a couple of minutes late. thank all of you for being here this afternoon. we are printing are built on financial reform for the country. three years ago today, on the

15th of march, 2008, bear stearns, a fixture of the american system, collapse. six months later to the day, lehman brothers filed for bankruptcy. today we see that as the beginning of a crisis that cost jobs, retirement savings, and trillions of dollars of american wealth. the crisis that has led to so much economic hardship was caused by longstanding failure of a regulatory structure to adapt to our changing financial system and prevent the sort of risk-taking that let us there. the economic damage tears at the

very fiber of our middle-class. while some of the most prominent americans and financial institutions have been destroyed or badly weakened, the far worse damage has been done to millions of american families who did nothing wrong at all. a staggering 8.4 million jobs have been lost and the unemployment rate remains nearly double digits in many areas. nearly 7 million have lost their homes to foreclosure over the last several years, and millions more have lost their retirement funds or their small businesses in our country. americans are frustrated and angry as we all know. they have lost faith in our markets and they wonder if anyone is looking out for them. worst of all, as i stand before you today, our regulatory structure constructed in piecemeal fashion over many decades remains hopelessly inadequate. there is not been financial reform on the scale i am proposing this afternoon since

the 1930's. let me be clear -- we're still vulnerable to another crisis. and neither i nor anyone else can tell you with any degree of certainty that the american economy would survive if another crisis of this magnitude. it is certainly time to that. some have suggested that we should wait all little longer. to them i say, how long can we leave our economy and middle- class as vulnerable as they are? how many more jobs lost, forms -- homes for clothes, retirement savings diminish? we've just finished our first set of hearings on the wave of home foreclosures. since then, our committee has held dozens of hearings and spent literally thousands of hours on this legislation. we've listened to hundreds of experts in a wide variety of fields, we have examined and reexamined proposals sent to us by the administration and many

others, and we worked in a bipartisan fashion to reach as much consensus as possible, and the bill i will present today will reflect the effort and ideas of my friends and colleagues, senator shelby of alabama and many other members of our committee, republicans and democrats. i want that my committee members, all of them for their hard work in these past many months, but our bill must go forward. the legislation i am offering today is comprehensive in its scope because the crisis it aims to solve is comprehensive in its scope has all the tragedy of its consequences. we must restore confidence in our economy, accountability to our markets, and stability to our middle-class. this is not to punish the financial services industry. i know how am angry people are at the mismanagement, but that

is not the way to solve these problems. this legislation has three main goals. first, we must plug the gap and eliminate inefficiencies that allow this crisis to happen in the first place and still exist today. second, we must look to the windshield. there will be shocks to our system in the future, and we need an early warning system that when the next crisis of merges, we are prepared to do with it. and third, we must protect american consumers and honest businesses so that they and we can restore confidence in our economy and institution, restore credit -- capital to institutions, and rebuild a strong foundation for jobs and prosperity for all americans. many of the titles represent

bipartisan consensus. let me discuss the major reforms. first, the legislation will end too big to fail bailouts. never again will the american people be asked to write a check because of the implicit guarantee that the federal government will bail out a company when it collapses and friends the stability of the whole. no business should be that big or that complex. and we will discourage that for the new capital requirements and other protections. meanwhile, when large, complex companies do fail, they will be shut down in a way that does not threaten the rest of our economy. senators mark warner of virginia and tennessee have been invaluable in shaping this part of the bill, and a one i think both of them for their tireless efforts.

second, this legislation will create a strong and independent consumer protection watchdog. this crisis started when people were given loans that they could never afford. we need to strengthen not only the bark but the bite. this new watchdog -- that is not the important part. the important part is that the consumer protection watchdog has the independence and the authority it needs to get the job done. the watchdog in this bill will have an independent board appointed by the president of united states and confirmed by the senate. there will be independent to assure that it cannot be smothered by a refusal to provide the resources it needs. it will have autonomy to draft rules and the ability to enforce those row. it will be there to protect

consumers from the abuses we have seen become almost an operating procedure, skyrocketing interest rates, checking account fees, predatory lending by mortgage firms and much more. third, this legislation will create an early warning system to look out for the next crisis which will surely come. it will create a systemic risk council but the job of expanding the economic radar to identify products are practices that could threaten our economic stability and the authority to stop them when they occur. we were caught off guard with a subprime lending crisis. we cannot allow that to happen again. and fourth, this legislation will bring transparency and accountability to exotic instruments like hedge funds and derivatives that have lived for top bar to long in the shadows of our economy. -- for far too long in the

shadows of our economy. this must not. the discussion draft that i introduced in november brought transparency and accountability to the sectors our financial system. the legislation i have today include similar language. two senators have done tremendous work over the past number of months and they are continuing their work on this section of the build at they try to reach consensus. it will be incorporated if they are able to do so in the legislation when and freddie. -- when it is ready. i want to commend senator chuck -- chuck schumer of new york for his efforts and drafting the

reforms that are included in this proposal. he creates a new program at the sec to encourage whistleblowers. it poses more accountability on credit rating agencies to crack down on conflicts of interest at the federal served, making the president of the new york fed a position appointed by the president. our goal for the legislation is to create a system more honest citizens large and small can drive on a level playing field, where middle class families can find work and invest with confidence, and the legislation represented de has bipartisan ideas, and as a result, it is a bipartisan effort. we do need to act and i will add. every day we delay is a day we

are unprepared for what is around the corner. today, when americans have lost so much, a day when we are refusing to confront these very real threats of our economic way of life, and so as i continue to work with my colleagues, i am moving forward today. the stakes are far too high and the american people have suffered far too greatly for us to fail in this effort through this legislation will not stop the next crisis from coming to read no legislation can. but by creating the regulatory structure for 21st century economy, we can acquit coming generations with the tools to deal with that crisis and avoid the kind of suffering we've seen over the past number of years. let me conclude on this note. we will have financial reform this year in the congress of the united states. i am happy to take your questions.

>> [inaudible] >> i do not have that in this bill. it could be considered but it is not in the bill. >> when will the full legislation be available? >> it should be now. it should be up any minute. >> [inaudible] >> let me just say that over the last several years, we've learned that kind of situation we were in because we did not have regulation or the regulators that we had were not doing their job. we want to see to it that those entrusted with these responsibilities will disappear part of the problem is the clarity in the regulatory structure. what is the f e d responsible

for? what is the fdic responsible for? too often in the past we have a variety of agencies that have claimed some jurisdiction over various areas. the consolidation is not as much as i offered in november. but it does provide consolidation and a lot more clarity which i think is an asset for our lending institutions. it cannot be seen as a burden but clarity and accountability. [inaudible] >> we exclude institutions under $10 billion. we will not be regulating small entities.

not a dry cleaners or so for that some have suggested. we want to deal with the mortgages and the brokers that were at the root of some much of the problem. but also the non-bank, but larger entities as well. the payday lenders and other operators -- that is how it is going to work. people talk about safety and soundness. i don't see this being threatened, but there is a way to resolve these conflicts. the idea that somehow we were told that our institutions were safe and sound and yet what happened was the lack of consumer protection. we all know that. it was the subprime mortgages without lending standards, all of the various consumer protection divisions were supposed to be watching out for those and did not.

this bill provides that independence -- with the four principles i outlined. appointed by the president, confirmed by the senate, funding authority, and the ability to enforce rules. this bill does all of those things. >> this bill would seem to increase their power. >> i know that there were those thinking that this was punitive. i said in a statement here, legislating anger does not seem to get you very far. we had a debate that went back and forth and i certainly raised issues about the federal reserve going back to its core function. it has a super up -- the supervisory function over our largest institutions. they needed to reform their

monetary functions. i am not agnostic about that idea. initially we had a single regulator, and then we had the issue of dual banking raised. we continue to move in that direction. and therefore i feel we have a good system in place for those institutions and bank holding companies, with assets in excess of $50 billion, they will have that jurisdiction over them. for foreign banks with subsidiaries in the united states, that will have jurisdiction over that as well. i don't see that as punishing the federal reserve but getting back to the clear lines of authority. >> you've been trying for months to get republicans to vote for this.

what gives you any confidence that they will? . we will begin the markup next week to move forward. for those of you who covered the legislative process over the years, you know at any stage of the bill, you can develop that

consensus. ideally it happens before you write it. sometimes it happens well you do write it. sometimes not until you get to the floor of the united states senator and sometimes further when you get to a committee. i cannot emphasize enough. it is not as platitudes. this product you will be looking at today reflects a lot of work but has gone on between democrats and republicans on this committee, and i do not say lightly when they express my gratitude to senator shelby, senator corker, senator reid, as well as senator warner, who have worked so hard to get this to that point, so i am optimistic about that consensus. >> what about the idea of party rancor over reconciliation of health care and the chances of a bipartisan bill? >> there is always that chance, but i hope not.

these are separate matters. i do not believe i am the only guy or the small labor party that cares. -- or this is only party that cares. i believe what is going on in the country, the level of unemployment, the loss of homes, the loss of health care, the loss of small businesses -- all across this nation. this was not just about the collapse of financial institutions. we have been focusing on that, but there have been people in rural america who have suffered from the economy, and i believe all of us have a shared interest in giving on our feet again. there is a broad consensus we need to reform the financial system. we need to protect consumers. we need to provide more transparency in our lending institutions, and i believe we can get there. >> if the investment banks came

out and will forever be treated -- [inaudible] >> i know there is a song that bob corker deserves credit for including. >> they seem to have prohibition against proprietary trading. >> i support the idea that we need to have a real discussion on proprietary trading and related activities that occur, but i have always felt the banking committee is not good at writing regulations, and our job is to set guidelines, which we have regarding the volcker rules, and they were charging those responsible for doing so not if the report back but they must report on how they would accomplish that. we have laid out some guidelines

without specifying exactly what the guidelines said. >> [inaudible] >> they would on certain activities, but how to do that requires a more sophisticated answer then we can provide. that is why we are delegating with clear authority and accountability to come back with rules in that area. >> can you talk about auto dealers? >> i do not want to be in the business of carving out -- you talk about large financial providers, and that could fall into one of them, but i am trying to allow the agency itself to make determinations so we do not get in the business of picking winners and losers based on political clout, so i have stayed away from that. >> will the fed be given the

power to determine the budget? >> absolutely not. they do not determine if. it will be determined by statute. the fact that this institution would be housed at the fed does not mean it has authority over the budget of this agency. >> will you address more broadly some consumer advocates who have said they have fallen down on the job in the path. >> they have done a better job in the last couple years. the citizens well deserve it. the problem is meeting the four principles. where can i achieve the independence? i believe the independent budget authority, the rulemaking authority, and the involvement in enforcements are clearly in this bill.

>> the white house or an independent agency? >> of code. >> [inaudible] >> the presumption is the regulation goes forward. there are some who argue you could run into some conflict. there were some consumer regulations into safety, and yet you have anyone identify what they mean, nevertheless we provide that if there is such an issue raised. we would then make a determination as to whether or not there is any validity to that claim, but the presumption would be the regulations under consumer protection agency would go forward. yes? >> do you think you can reach a deal?

>> we talk all the time. we are great friends, so we talk not necessarily on a daily basis, but i stayed in close touch with him. he knows the door is open. i thought his statements today were very positive. we identified we were there. and for not letting politics get in the middle of this, i could not agree more. this is important to provide the insurance and confidence people need in the financial system, so we can say on that track, as we have, on the resolution mechanism and too big to fail, the systemic risk council, where i think we can get derivatives on the agreement

section, and corporate governance issues, and we have achieved a lot of closure. those are all issues where we have what i perceive to be consensus. on other pieces, we do not, so i am still optimistic we can get a final consensus. >> [inaudible] >> i was talking to them about where we are and soliciting their ideas, and my hope is there will be supportive of this. it is not to say everyone of them will disagree. this is a large, complex piece of legislation, but i try to listen to my colleagues. 22 members, so i have got to be sensitive to their interests and concerns. this is not a decision where one

person can make a determination i know this notion of waiting a while. by my calculation, we have 68 days in congress. they will probably adjourn around the first of october for the election. there is a sense of urgency. we have not exhausted the subject matter. you could go on for years and never exhaust the subject matter, but we do need to act. it is time to make a decision. are we going to go forward? are we going to do the things outlined here. i believe the will exists to get the guests that we can get this bill adopted. i thank you all -- we can get the yes to get this bill

adopted. i thank you very much. >> tomorrow morning, treasury secretary tim geithner, peter or zag and the president calls economic advisor, christina rumor are on the hill to testify about - -- to testify. later in the day, eric holder will lay out his budget priorities for the department of justice. he is also expected to get questions about terrorism detainees. live coverage at 2:00 p.m. eastern. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2010] the national governors' association held a meeting to talk about health care legislation congress is working on and the effect it could have on states. we will hear from the governors of oregon, west virginia, and south dakota. this panel is led by gov. jim

douglas of vermont. it is an hour and 25 minutes. >> good morning, everyone. welcome to the summit on health care reform. it is great to see you all here gathering to talk about reform in health care, the great works states are doing and what lessons we might offer to our policy makers in washington. i have always found in meetings with the national governors association that the opportunity to get together and share experiences was so important in deciding what works best in our great faith, and i know you will benefit in the same way by interesting with your counterparts today and tomorrow. as a share of the national government association, i want to welcome you to this summit.

we are taking a look at ways we can reform our health-care system to develop more of efficient health care and improve health care outcome. this meeting could not be more timely. just a few weeks ago my colleagues and i met for a meeting. we had a robust discussion about to make health care more affordable and accountable. we talked about over the past few years many states have launched their own efforts and your seeing the positive impact these types of changes can have not so for patients before providers, payers, and even state budgets. during the conversation, i was amazed we agreed on quite a few things.

democratic and republican governors had a serious discussion about the system and the vital need for action to improve system performance. we talked about how states are leading the way in health care approaches for the unique needs of our residences -- are residents, and regardless of what happens, states are where the rubber reef of -- rubber meets the road. whether leading national reforms or our own initiatives, states can and must have a role in transforming healthcare. on the heels of the winter meeting, we have invited you all here to continue the discussion on how to reform health care. with key policy makers and potential in -- implement ares of health care reform, each of you has a unique perspective and experience valuable to each other and will help serve as a model for congress for reform is already taking place across the country. in addition to holding the summit, we will be releasing a report highlighting the

background, evidence, and options for improving state delivery systems. the end of my initiative, we will kick off a series of meetings over how states can implement reform send the cutoff states are similar across the country. this would not be possible without our funders. without your help, i would not be able to offer my colleagues resources to help him land health care reform, so we would like to thank our supporters, health resources and services administration and the center for disease control of the apartment of health end -- department of health and human services, the commonwealth fund. all these supporters for the summit. the other initiative funders are pharmaceuticals, blue cross blue shield, and a pharmaceuticals, hewlett-packard, intel, kaiser

permanente , and merck. we have are working group of officials from 49 states and territories. we have governors, chief of staff, policy advisers, and insurance commissioners. i am relying on you to share your experiences, best practices, and innovative ideas about how to improve our health care system. there will be a lot of discussion on the challenges, and i hope we will be a will to share potential solutions to overcome those barriers. at the end of the next two days it is my goal that each of you understand the critical a fifth of decision making in any potential health reform implementation as well as your own reforms to improve our system for all americans. while the outcome of federal efforts remains unclear, we have the opportunity to lead the way in addressing and improving the

quality of our system and providing better access and care. i would like to welcome someone to the podium who knows a lot about improving the health and health care of americans. it is a pleasure to introduce the ceo of the robert johnson foundation. the foundation this dedicated to delivering a more performance- based system. by relying on her commitment in combination with your training that demands results and accountability, she is in a unique position to lead innovation's towards this important goal. please welcome her to share a unique perspective on health reform. [applause] >> thank you, governor. it is indeed a pleasure to be

here. i want to thank you for inviting me here and also for your foresight and wisdom. i would also like to recognize colleagues, some of them who we are here, and organizations who have been so important in this partnership. our state coverage initiative, the national academy for state policy. over the years, the foundation has work with governors, agencies, organizations, and communities in every one of your states, because we share the same goal -- to improve the health and health care of our people. the foundation is proud to have worked with in g8. we have a long history of working together on a wide range of issues, including substance- abuse, tobacco reduction, childhood obesity, and child care coverage, so it is not

unusual to come together from time to time face to face with -- to deal with important issues, but this has an a for divergency, -- this has particular urgency because it is all about ambiguity. there is a revision to fix our broken health care and the certainty we must act now. we've also -- must also address what it truly takes to improve health care for all americans. i am talking about changes in the marketplace, the role of medicaid, controlling costs including quality and value of care, and a focus on prevention. that is taking actions that will help us from getting sick in the first place. i am inspired by the governor's initiative that has brought us together, and it gives me tremendous confidence 2010 will be the year that history records

we made the tough choices to fix our broken health care system. as challenging as things seem today, if we do not fix them, they will certainly get worse. today is part of the eighth annual cover the uninsured we. they are releasing a report from the cost of inaction around reform. for those of you who are not unfamiliar with cover the uninsured week, it is the largest nonprofit mobilization to secure affordable health care coverage for every man, woman, and child in america. it is the community movement that is supported by former presidents, nine former secretaries or surgeons general for. since 2003, if has brought together business, labor, health professionals, business leaders, soon, faith leaders, and many

people in towns and communities in every state and community across the country. why? because health care coverage is growing less affordable and forcing more americans to join the ranks of the uninsured, which means they forgo needed and sometimes life-saving medical treatment the record we release today as part of a cover the uninsured week 2010 shows if federal reform is not enacted, the cost of failure will be live. within 10 years, the number of uninsured will increase to morgan 67 million. employer-sponsored insurance will the road, and the rate of employer coverage will drop to 48% in 2020. enrollment in spending on public programs we know so well in this room will balloon. premiums for a single family policies increasing from 5 to

$10,000.40 family program from $12,000 to $25,000 for reagan middle-class families and the votes with in terms in poverty will increase 15 to 20%. that is an increase of 7 million working -- middle-class people. i the ninth need to tell you that an -- i do not need to tell you that schip will increase substantially that is almost 13 million people. medicaid and schip spending for the non elderly will double to 576 billion over the same time. the price paid by states, governments, communities,

families, and neighbors is almost all the weekend region more than we can comprehend. we will all suffer needlessly. i am a doctor. i am not a political pundit for partisan psychic, so i do not know what is going to happen this week with reform, but i do know what matters most to american -- knowing they will have the of virginity to lead healthier lives with health care of it is available if needed and that people will get the best quality and value of care for the dollar they spend. i know politics like health care is local, and you know it, too, because across every state in this country, you are addressing the challenges of the dressing rising health-care costs and increases in the uninsured. i also know these realities in

your states means whatever happens in washington, you are going to have to deal with it, and you have a proven track record of innovation and leadership, and that is it so often with the country needs of this time, so i know your efforts with and without reform are going to be difficult but probably more difficult without federal reform, soda institution is please fill a post office. we are grateful for your leadership as you go there to prepare for the challenging times ahead of course we know -- times ahead. of course we know you will be looking at every scenario, and we want to do know we will be there with you. we hold a commitment to both sides of the health and health care equation. as a major independent nonpartisan philanthropy, our

job is to provide our leaders with the resources and tools they need to support health system reform. we want reform that not only achieved average and high quality but also helps create a shared vision for america. we know by providing objective policy research, testing solutions, and testing them in real communities, weekend bring people together towards common solutions. i am a doctor. i am a mother. i am a ceo, but i know one thing that is very important -- pushing our society to be more healthy and healing is one of the most satisfying steps we can do. i hope you agree, and i also know it will be you who truly makes the difference in improving our health-care system. thank you for inviting us and for your very good work. [applause]

>> thank you so much for your support, for your fine and inspiring words and your great work the foundation goes throughout the year. we are going to continue with the conversation among some of my gubernatorial colleagues with their perspective of health care reform. those of you who pay attention to these things notes today is the eyes of march. more than two centuries ago, julius caesar did not need much in the way of health care. he was this customarily, but i hope rather than be wearing the i aids-- bewaring the ides, we will have reasonable reform, and i am hopeful we will give us to accomplish that. it is a pleasure to introduce our moderator. karen is an award winning

"times" magazine political correspondent. she has covered congress, the white house, and politics since 1994. she has researched and written extensively on the country's health care crisis and the public debate about health care reform, offering two "time" cover stories on the topic. we look forward to the discussion of opportunities and challenges of the state end federal levels. also, the vice chairman of the national governors' association. welcome. gov. michael rounds of south dakota, who chairs the health and human services committee, and gov. ted kulongoski from oregon, a state that has been out front in health care reform for a number of years, and i

look forward to this conversation among my colleagues. let's welcome our moderator. [applause] >> thank you so much. you may think of it as the ides of march. i am thinking of it does st. patrick's day eve eve because you're going to need a lot of the irish to followed author regan when this was scheduled, everybody thought we would even know whether there rosa health care plan for bill in place because how could it be possible in march we would still be talking about this thing, of but here we are in this crucial week. i think for the purposes of this discussion, we ought to start by assuming something passes of the end of the week, and we do have some great perspectives to democrats, to republicans, to

people all over the country, stays in very different places when it comes to health care reform, and it really is going to be up to the states -- if this is going to work, it is going to be because the states make it work, so the first thing i would like to ask each of you is as you look at what is keeping you up at night. >> i am happy to start. this is the broader context of the fiscal challenges the states are facing very good we are in the longest and deepest recession since the end of the first world war, and one problem is health care. with health care costs rising at

multiples in the last decade or so, and there is not much relief in sight, the budgetary impact is quite difficult in this economy, so we are concerned about what the impact of federal reform might be. we believe states are different. one size does not fit all. states are in different economic conditions. they are at different points along the way in health care reform, so flexibility for states to do their own thing, to meet the needs of their people is keyed, and i do not know if what passes will have that flexibility or not. >> how do we come out of this recession, and basically, how do we balance our budget?

each one of us has the same concerns and the same challenges, and every year we have to balance the budget. with that being said, we have a different set of dynamics. in west virginia, we are taking pro-active preventive care, and if you do not have an educated and healthy work force, you're not going to be able to take advantage when we do recover from this recession of the opportunity. people will come to your state. they will make investments if they think they can sustain that kind of commitment. if there is an educated and healthy work force, so we have done everything from trying to have healthy lifestyles wellness -- healthy lifestyles, wellness, trying to give people incentives and awards, and i think what we are really saying is something have to be done,

and i think the democrats and republicans will talk about that. we recognize you cannot have the status quo and expect to get better results. also we talk amongst ourselves. they have got to give us the flexibility to be able to manage and balance our budget. medicaid has never been mandated by the federal government, and the majority of the states do not cover all other eligible medicaid recipients. that would tell me the benefit plans are not one size fits all. why should we be mandated to give the same blanket coverage to someone who is 4 and healthy to someone who might be for an

very unhealthy it -- someone who is poor and held it to someone who might takbe poor and very unhealthy. >> it is a matter of how you implement it on a day-to-day basis. we are concerned by the economy and the lack of jobs very good everybody would tell you if we had people back at work, we would not have near the concerns about the economy and our current budget that we do, and our state is no different. the biggest thing that keeps us awake at night is how we balance the budget where we know we have the requirements? we either cut or have to raise taxes, so when you're talking about health care costs going up, it is a challenge between where you want to spend the money and were you have to spend the money. i think our state has a budget in which 49% is on education.

the next biggest, 36%, is on medicaid. when the federal government identifies what the requirements are and they start analyzing the cost of health care for the state budget, even when they are paying a large percentage of it, it really impacts how we have to be dealing with the state. education, civil services, and medicaid take up 85%. i think if the governor is right when we talk about this, and we all believe there are good reforms that could be done. take a look at what the states have done already a lot of them offer guaranteed reliability. -- have already done. a lot of them offered guaranteed

renewable. we talked about how you cannot have a healthy groups were you give a low rate to end the sickly group were you given a higher rate with no comparison between the groups. we think there are reforms which if put together on a national basis, but really impact on a day-to-day basis the cost of health care to a lot of people in the united states. i did we are concerned with an overall mandate and what the cost would be to the state on an annual basis as the federal subsidy proposed for medicaid starts to go away, and i think judges fit. >> i agree with my colleagues, but on the health-care issue, for things worry me. one, i do not think in listening to this debate for the last year -- i do not think this is

the one set of the time process. i think you have to take two steps, and you have to address the issue of coverage, but you also have to have the issue of cost address. you have to do them together. one is not sustainable. the second thing is i wake up worried about how i am going to get from 2010 to 2014 a great deal because there is a hole in this whole process at the state level about how we're going to be a will to provide the coverage we are suppose to be -- how we are going to be able to provide the coverage we are supposed to be. the other issue that worries me is long term care, which is not being addressed. we are going to get in a position with the baby boom generation and the fact that this recession has cut heavily into retirement savings for a lot of seniors, and the states are going to be required to pick

up more of the costs, and i think this is the next great thing the next thing mike was saying is the issue when the federal government looks at it, and they set the floor and give the states responsibility to do more >> thank you, -- to do more. >> thank you, and of the issues raised one that gets most discussion is medicaid and how much it is going to cost, and the way the house and senate bills are scored by the congressional budget office -- the assumption is that medicaid reimbursement does not change, that somehow you are going to

bring 16 million new people into a system where in some parts of the country you cannot find doctors for the once you have already got, and you're not afford to have to change the medicaid reimbursement. is that realistic assumption, and the way they dealt with you guys if they said, we're going to help the new people, but if you have to raise everybody's reimbursement, what is that going to do to your budget? >> you are exactly right. whether it is 15 million in medicaid or 30 million additional insurers into the system, there are not enough primary-care physicians to meet the needs we have now. in my home town, a man who retired cannot find a primary- care physician. this is going to be a problem

for a research standpoint very good second, we have the woodwork affect. if there is a mandate as there appears to be in this legislation and everyone has to have insurance coverage, a lot of people who have not signed up are going to do so. to be honest, -- if yes, there are some features we would all take issue with, but there were a couple of features like the ones in massachusetts that have been out for a number of years committing huge amounts of a are owned resources, and we think it is fair there be some recognition for the leadership if it comes out without the recognition, we are going to half of this agreement as well

we are concerned about the impact, especially at the time when they are slashing human services. to ed amended like this of this point in our economic history is a problem. >> i would say if there is four years, they are going to take 100%. i would assume what the government is saying is we're not going to hurt your budget, but we're going to pay for anything. i would assume there are going to be assessments to figure out what is going on. in my little state of west virginia, we have only 40% of the people that are eligible to receive medicaid that we are

able to provide it to. that is an awful big gap. we want to cover everyone. we are trying to make them responsible. i do not think there is any value to health care in america because the consumers do not shop. they are not in the market, and they could not care less. if you do not know what your bill says, you cannot read your bill. you do not care as long as you meet your deductible, and it is someone else costs responsibility. that is the private payers. can you imagine the people who have to go wherever they want. the research raising payments -- raising questions like why is it so expensive. people should be held accountable, and they should be rewarded. that is how the economy works, yet we want to socialize and make it every one size fits all

of and people should have unlimited access. there is not another service for you can have a card and get unlimited access, and until that changes, in the four-year time they say they are going to pay for everything, and they are going to have to make adjustments. >> another part of medicaid i think sometimes we do not get fifi nothing to to recognize, if there was a real achilles heel to the plan, it was the assumption that the use of medicaid is an efficient delivery of health care service, and i think the premise is wrong. we use medicaid, and when we look at it, remember, we pay providers a significantly discounted rates.

it is identified between 50% and and 52% of charges it is an efficient way to deliver health care, but what we do not see is if you only pay half of your bill, somebody is going to pay a higher price because there is a hidden cost, and this is what we do not talk about. >> there will not be as many opportunities for cost shifting. >> what is the alternative? if you're the provider, you can accept all individuals, and for those who pay half of the going rate or 2/3 of the going rate, if you add more people, you will of some states have to, if you're providing a discounted

rate, collect a higher rate from someone else. i know one provider gave it -- provider that had a high rate of medicaid patients who was required to pay the same amount, so the practice literally could not make it anymore. the part we forget about is if you can discount for one side, other people will pick up the remaining portion, and there is one more step in this legislation that is being considered, and that is a provider inflation, because if you looked at what most states have and talk to the governors of people responsible, there is a part of every year were you try to add something to pick up more possible providers. otherwise, you lose providers. i cannot find where we will get

a higher percent. that is not built into the cost projected for medicaid. that will be significant when you start talking about adding on a significantly larger part of the population. i do not think that identifies the actual cost of medicaid. >> i think regardless of the payment structure, we have been so focused on bringing more people into the system that no matter how we pay for it -- we are going to be broke regardless, so that is why we have to focus on that. we stand more as a percentage of our gross domestic product, so you have to get those things out of control. that means keeping people healthy in the first place. >> governor, every health

economist says keeping people healthy does bring down costs in the long run. you guys are going to leave looking -- to be looking at problems in the short term. for many concepts, we already have a gigantic pilot program, and it has been going since 2006, and the name of the pilot program is the state of massachusetts. we are hearing governor patrick talking about possibly having to get rid of the cheaper service model, to deal with costs, that they are proposing and forcing insurers to come to the state to justify ratings increases, but at a time when you had the increasing consolidation among the providers, a lot of insurance companies do not have leverage. if you thought one hospital in your big area, they are going to call for two, so what are you

going to have available in the short term to bring costs under control? >> first, i am going to put the first question and this together. i emerging folks with the view we were making strides -- i am urging folks with a view we were making strides to insure the federal government came through in 2009, and it started 10 years ago with the health plan, and i am in a business for plagiarism is just another thing, so we copy a lot in vermont with jim and what he is doing. first, we created the oregon health authority, which combines all the public dollars around health care into a single governmental agency that is -- instead of spreading them out to different agencies. we bring them together into one who called the oregon health authority. we are in the process right now, trying to look at issues,

whether it is an insurance exchange, mandates for employers, mandates for individuals. the truth is the face of the problem sometime ago. we have a plan called healthy kid with a provider tax paid by hospitals and insurers that we will actually provide health insurance for every child in oregon under 19 years of age, so we're moving forward for those kids who actually need health care. second, we have a waiver, and we were providing health care for the adult population below the poverty level. we have not been able to do it because of the cost involved, but because of helping kids, we will cut the number down in half for adults, so we will be providing on our own system health care for many more adults

in oregon, but at the same time, we recognize what jim said about the issues of cost. we have insurance reform. we have a system that will take effect on april 1 that will have the greatest transparency of many states with a steady rate by health-care insurers. we have public involvement. the insurance commissioner is on the web. they get all the information with a public comment. we are going to bring reform within insurance field to give the public more access to information. we are trying with medical health records to get the system in oregon set up to be able to have access. i am a subscriber to kaiser. i actually think if you want to look at something that is a good model of how they do it, look at

kaiser, because i think ultimately that is the way health care will be in this country at a particular time, but oregon has not waited for this. it is always a cost factor, but we understand the issue you cannot just have access and get more people involved unless you cut the cost on the system. is just will not work. we're moving on that anyway. >> i think the frustration you will hear when we start talking, because it is all the same problem. the national governors' association is the laboratories. if everybody knows that, and we have to make it work in a short time frame to balance the budget. were we really asking to be if -- really us to be involved i -- really asked to be involved in this process of what did they really us to find out what did and did not work.

what did and did not work with massachusetts? did they would get all the waivers we about for over the years and said, west virginia, you have got this waiver here? did do what you said it was going to do, or did it not? if you think they are going to sit and -- sit in washington and work this out without us at the table? if they were going to say, what do you think -- let me tell you what i inherited. i inherited unlimited access. i had to come in with a tremendous deficit and had to work that down. they said, but about -- what about your waiver? what would you like to expand on? the same thing with the like being an expert in the insurance arena and what we did with my being an expert in the insurance arena and what he is able to do. we think we can bring a lot to

the table. we just have to see what comes out, and they will say, you states go do what you do best and make this work, and we will give it our best shot. >> i believe it does not work, and you have heard some examples from my colleague and other states are represented here, but first, it does not happen overnight. we are talking about changing the direction of the proverbial battleship. it is going to take some time to change a sixth of our economy, but we know it does work. later in the summit, director jones is going to be on the panel and thought about how we focus on wellness, how we -- talk about how we focus on wellness, how we pay primary care providers and do things that really make a difference with cost and payment, and

instead of the waivers in terms of reform, we would like the flexibility so we do not have to come to washington and plead with ombs to do things and with it makes sense. we have a big medicaid waiver, see and we project over five years a quarter of a billion dollars from what we were going to pay because we're spending money on preventive care, and on long-term care, we have saved a few millions, keeping more people at home and not requiring them to go to nursing homes. things are happening in the states that are really exciting, but we need the federal government to give us flexibility to be a good partner so we can continue these reforms. >> the you think it is possible to pull this off and make the numbers work without some kind of government-run cost control system? >> not possible.

it is a two-step process. you cannot have one without the other. >> i am talking about over the next six or seven years. >> you have heard us say, in four years, if the adjustment is not made in the four year window, and you take it from 40% of my medicare eligible to 133 and say i only have to pay 5% of it, and that is on a 93% increase, i think that is what we are all talking about. >> our state governments going to have to step in and start setting up hospital reimbursement? the kinds of things with the insurance companies we're seeing patrick talk about now? >> we are using the carrot rather than the stick, and i think that is better and it works. we pay, and we got private insurance companies and

medicaid, we hope based on secretary sebelius's announcement that medicaid would be there as well -- we pay a couple extra dollars per patient per month to adopt our strategy, that incentive is making a difference. we see a decline in the number of medicaid submissions to hospitals, a decline in your visits. it really does work. >> -- a decline in er visits. it really does work. >> there is a difference between price control and leveling the playing field. i think most states would suggest to you that rather than saying we are going to put a price control on what you can charge for a particular item, i think if the states have the ability to step in and continue on reform, more states will look at incentives to provide -- i know it is not a popular word -- but management approach where you can provide value in terms

of taking care of people before they get ill, providing on a group basis the assistance to go in and actively fine people subject to diabetes, obesity, and so forth, and work with them to save them money but also save the system money in the long run. those are the types of things that will work, but if you cannot take care of people -- if you are going to take care of somebody's heart surgery, it is probably going to be $40,000. it is a whole lot less expensive to provide the appropriate pharmaceuticals and eliminate the problem for years before you actually have heart surgery, and that delay and cost is what we are talking about, and those are doable today. it is a matter of laying out expectations for people who are experts in the health field and what we expect of them in the delivery of health care in the

future, rather than simply waiting until the accident happens. eliminate the process in the first place. if we cannot do that in terms of controlling price control, we really are in trouble. >> i am always hesitant in this debate to get them vs. us, and then being the provider sent us being the government. the cost of compensated cost sharing is so acknowledged by everybody in the industry -- they know it -- and i think the reason we had success in getting the industry and providers to the table is that they had a self interest in addressing this issue of uncompensated care as much as the states did, and i do not think they need a -- i need a club to get them. i to see to get some of the table and sit down with them because we all -- i need to get

them to sit at the table, because we all have the same goal. it is good to have a typhus sometimes when negotiating with people, -- a tight fist sometimes when negotiating with people, but i think it is best to have a plan of what you want to accomplish, and i think you can get everybody at the table. we will cut costs in our system to provide the money to be able to get through difficult times. that is how we are going to do it. >> in west virginia we ask for a waiver of schip, and we ask whether it would be expanded or not. at the time we have for a waiver. the direction you are giving us, we ask for our waiver to basically pay for the screening. you are giving me money to pay for a child if the child gets critically ill, and i said, why

don't you let me use some of that money so i can start screening every kindergartner that comes into our education system. i went back to when we were kids, most of our health care as kids was delivered in the schools, and if we started getting where weighted to the for a child and basically see if they are going -- getting where we can do that for a child and basically see if they are going to get diabetes and start changing those habits -- i cannot teach an old dog new tricks, especially if that is the parent, but i can teach a new dog to maybe teach old dog. we started with a kid. our goal is to screen every child. you let us watch the child, and we will give you a healthy work force, and we might reverse some unhealthy habits, but that is basically using the money you

have already given us. >> that is pretty far in the future. >> i am going to go back, because i do think it is a cost issue you are asking. .

>> you bring up the exchanges. they are the basic architecture of the bill, setting up these exchanges. as much as we have heard about this bill being one size fits all, it seems particularly in the senate bill that the governors really have it paramount flexibility in how they are going to set up these exchanges, how they will structure them -- it is the system going to look eye difference in taxes than it does in vermont or wyoming? how're you are approaching the issue of setting up these basic building blocks of the bill? >> we're looking for the state

to put forward a plan itself. that is the first thing you have to realize. the rest of it, at least in oregon with the purchasing power we have, we can structure a benefits plan -- >> you are going to have a public option. >> we are talking about whether the state will provide that option. one thing that this language does not provide enough flexibility to verify the parameters of the exchange that they set out. we come back to the theme of flexibility in all of these areas. i want a follow-up on the point that had made, purchasing power can be keyed to a number far states, the first being michigan and vermont seven years ago, were there was a drug purchasing tool, so there are great opportunities. and i think there will be a panel on information and help

technology. we have one panel focused on this for several years. i will give you one example. in the hospital in vermont, a woman came into the emergency department with severe of donald payne. they had a pilot project so that everyone in the area of come up their history was on line in the emergency department. if it were not there, this woman might have been subjected to expensive test or exploratory surgery. but the emergency room doctor pulled up and read it online and saw she was taking a medication for her all sir. she said she had not taken it in a while. mission accomplished. there are a lot of things they can reduce the cost of care if we implement them.

>> with the exchanges, d.c. the mets' public interest the -- do you see them as public entities or is there flexibility? >> that is the direction i think we have to go. in our local states, you're close to d.c. and virginia and kentucky system. >> it would make sense to pull all that. >> you're going to have to. the borders don't separate were the care might be given. i have five different borders. we need to make the best investment in the economy that we can. i think what tavis said, if we

take our pooling and we strike the best deal, [unintelligible] you've got a good guarantee for paycheck, your benefits are guaranteed, and your retirement. it is so well guaranteed that it is protected. we will make the rest of society suffer for that, but by golly, we're not going to make a government employee suffer -- we will not let that happen. >> i suspect one of the reasons for the changes in this federal legislation was the way that you could actually identify the products that were going to be marketed. the states have done that through basic for standard health care plan.

the national association of insurance commissioners studied this in the 1990's. but the idea was to identify what the products were, so that they could be compared. i know that you're talking 850,000 people that you could put in the poll. i only have 850,000 people in the entire state. but we've got to that point a couple of years ago where we only had three plants. there were reforms in the way that we allow people to compete with one another. i think the exchange has its merits in terms of allowing companies to come in and say that these are the products that we have available, but do not limit them to only those. and then individuals who may not be able to afford a product in the individual market, at least they know if they buy one of

these products, both they and the taxpayer know what they are buying or subsidizing, and individual can find out whether or not he has gotten a good deal in where he is placing his dollars as well. another term for it might be the marketplace, but opened up so that you know what you are buying. and in that respect, it can be a very healthy addition in the industry itself. >> the purpose of the exchange for me, is around individuals and small employees. -- small employers. giving them the ability to pool is a critical part of the legislation. there are more and more people looking for health care. if you're going to actually have a system that covers over 300%

of poverty level, you have to have a subsidy of some time. if you're going to have a mandate, whether employer or individual, if you have to have an exchange. it could be nothing more than a marketplace of different plans that individual could come to and purchase insurance if they cannot find others, because they have children or whatever, and there's a subsidy involved. i necessary part of health care reform is to give the public options to purchase what they think is necessary. i don't think it is the answer to health care reform but i think it as part. >> do you think oregon will do its own? >> yes, we will. >> i think the of identify let trident medical records, the oversubscribing, the misuse, the fraud, and if there's one thing

to do right now, one thing that could save tremendous amounts of money and better services and better reimbursement his if we had real time information. about 76% of our hospitals are up and running sharing this information in west virginia. if we can get all of them in the system, so that we know that this person on a medicaid card was over at dr. smith's on friday, dr. johnson, and then they come to dr. jones, if you have a situation where there is a pattern going on. and we have a hard time with that right now. from prescriptions, we see what most states are prescribing now. we can share that information and work back and forth. so you asked me the greatest

ability for us to save for this government would be in the i.t. agreement. -- a reno. >> your former colleague howard dean who brought the statistic that i thought was interesting. he claims that of the medical school graduates in 2008, only 9% for going into primary care. everyone agrees that there's a huge problem and we have 30 million people more coming into the health-care system, and we need people to treat them. how're you going to deal with this in the short run? is it going to be empowered and nurses? >> what you do -- you are on

target on where we're going to have shortages. why become a practicing doctor and rural community where you are on call 24 hours a day, seven days a week without a break? where are you going to specialize and come in closer to office hours, get paid more, never getting a break? so unless you have those individuals being able to join together and to have back up, which means doctor's assistance come it means nurses taking on all larger role in the rural communities. those are issues that we've based in south dakota for years. we created the first doctor's assistance program in the

nation. we could not get the primary care doctors to stay here anymore. >> there's been a nursing shortage as well. we have to be careful about the personnel across the board, but this is a good suggestion. howard is exactly right. not only are you're going into primary care, but we have fewer going to medical scare -- medical schools in general. we have to pray -- pay our primary care doctors more. [unintelligible] we believe and we've shown that in the long run it will save money if we can pay money for preventive care, for screening, for early detection of disease, for chronic care, and it is not immediate, but are medicare waiver is 4.5 years old now and we're seeing real change in

utilization by medicare patients. we also a couple years ago, when we adjusted medicare rates, we increase the more for primary- care doctors than others. i think that that can work because it is working. >> we all know that the health- care issue is an economic issue as well as a social issue. we've all been talking about this at one time or another. but the issue that you asked about, primary-care doctors and nurses, in our state for a pyre -- haitian and our community colleges, along with our business develop leaders, they have made this one of their core missions, expanding educational opportunities to train more health care professionals. our medical school is doing the

very same thing, trying to reach out to get more students then. >> how are they succeeding? >> they went to an osteopathic hospital about 60 miles, only 200 students, so i think we're going to meet the demand on that, but it is a serious issue around primary-care doctors, because the issue particularly in rural areas -- doctors have of particular trouble staying in business if they cannot attract good staff. they have asked us to address this in hospitals. >> you talk about a lot of this not happening before the next election. but a lot is going to happen on the political front. could you talk about what you think the politicians of this

are going to look like in your legislation? will lot of states move the way of virginia, you are exempt from the individual mandate? what is the next year going to look like politically in terms of this? >> the american people are not happy with the process in washington. most people want republicans and democrats to work together. i." can see the clear difference between the level of cooperation in congress and among the governors who still good ideas and implement them. we need to get the job done within a limited amount of time. a number of people in washington are very dissatisfied. i think we're going to see exactly what you have suggested,

karen. there are now 38 states where they are refusing to comply with some feature of the individual mandate in it has not even passed. we will see. i feel good about what we're doing. if we have a health care reform measure slammed through on a partisan basis, and a lot of states are not liking it, i think we will see the same resistance against no child left behind. the american people want to see health care reform as a balanced measure. >> the american people believe that it is a continuing increase of an entitlement program.

a lot of people in west virginia believe that if you are poor enough, you have something called medicaid. if your child, you can get on s- chip or medicaid, so we have almost all that children taking care of. and if you are prisoner, we get the state to take care the only people not covered are working people. and you do not hear much talk about that. massachusetts tried to say that this was the same as workers compensation. you have to buy insurance. it was a novel approach but it seemed that it worked a little bit. let's try that. but every person in west virginia gets up and goes to work, we want to make sure that we cover them and make sure that all the rest of society gets

covered more efficiently and -- and we are doing today. >> when we started this, we had 91% of our people taken care of. >> but that is an old state. [laughter] [unintelligible] the average age was about 72 and one of our communities. >> are you are covered. -- so you are covered. >> one segment of our population that i hope throughout this whole discussion would come up is the native american population. 90% of our state's population -- 9% of our state population is native american.

we do not include them in the health care because honestly, if they have money, then the have the coverage for it if they do not, they may wait a while. the administration has taken this up and others to try to find a way to improve health care. if nothing else occurs, a hopi indian health service is reform in terms of providing them with additional assistance that they need or finding a way said that native americans can participate in some of the same facilities and practitioners as the rest of the american population. >> thank you. the old adage is something we have to be aware of. the fact is i commend the president, because something has

had to be done for the last 20 or 30 years. you cannot have this country spend so much money and then it goes to 30%. he addressed the problem. it is a quantum leap country -- is a quantum leap lord for this country. is it everything that think i would like to say? no. do i think it is an answer to all the problems? no, but we are moving forward from the spot, and after this passes, i think we will finally knowledge the role health care place in this country but economically, socially, and morally. and i think that is what it is about. >> let's have a lightning round. if you were a house member standing on before the house this friday and saturday, you can go up on the senate bill or down on the senate bill, how do

you vote? >> well -- [laughter] as i said earlier, we've got to find some common ground and there is common ground. i was at an association meeting and after discussion, they listed about 10 issues on which everyone agreed. it gets to the point where we can embrace it, and i guess i am not sure whether it can contain the cost as much as we need to in order to make our economy liable for the future. -- viable for the future. i do not think i would be for it. >> i would be for it. you have to move the ball forward. right, wrong, or indifferent, since i have been governor, i

have never gotten a perfect bill, it just the way that i wanted it. but i kept working on it. usually we're trying to make something better. either we improve on it or we make a mistake and we have to fix it. you need to praise this president and his administration for sticking with this as long as it has. i have not seen this much commitment in anything else that we have done in the political process. he could easily folded his tent and say, i've done the best that i can. i've expended more political capital on this one issued than any president or group of presidents, and i'm going to continue to spend everything i've got to move the ball for it, but let's try to bring ourselves in and make this work. and maybe we can get you to help us. >> we have one more.

>> you and i could write it. >> i commend the president for sticking with the project but it does not mean that they have the votes. we've put together a plan here in which it does not have a short time relief that the state level. it long-term shifts the cost on to everybody else and there is a hidden cost which is not being identified. from my perspective, i would say -- a for effort. but i do not know it will be sustainable for the long term, and i don't find that cost the limiting or the reduction of cost in the bills that it should have appeared from my perspective, i would say and no, because it cannot afford the bill long term. >> you can certainly identify to a democrat and who was republican.

>> just like the house of representatives. you brought up native americans. there's an enormous population here that is going to be in tyler left out this bill, illegal immigrants. -- entirely left out of this bill, illegal immigrants. >> i think that raises another question. we need immigration reform. we have a challenge in our state in every state does, and i honestly believe the couple of years ago when pat leahy and george bush had exactly the same proposal on the table that we would get it through, but we did not. i think there has to be a recognition and respect for our laws, but also an opportunity for these folks who are part of our community to have a path to be legal immigration. the congress needs to solve that issue.

a whole lot to say. >> we've not seen the big influx that other states have seen in west virginia. she has been leading this fight for a long time. a lot of the border states have been leading it. and you have more of a concern, and we just need to work to get a policy. >> they are here because they are looking for work. and they are doing jobs that people born here in this country simply are not interested in. they have the opportunity to send money back to their families. that will be here until we have a national plan that recognizes that those individuals are going to continue to get into the country. in terms of health care, it is true. our health care facilities will always respond to someone who is

in need. does that mean picking up indigent care, and others say, we will not take care of them because there another country? today gets passed on to everybody else. >> i come at this differently. i see a child and i say, if that child into health care, are you telling me that as a people we're going to tell him, if you cannot prove your citizen shot -- your citizenship, you cannot get health care? i don't think anybody would, and i think the same thing for their parents. it is an immigration reform issue, but i do not think that the should be joined again of the way that they have been. it is pitting us one against the other, and we're going to have to treat them. i cannot imagine that a child comes to the emergency room, that we're not going to do it.

>> but they are showing up at the emergency room. you see the political will in any of your states -- or is there even flexibility in this bill to do something besides the emergency room? >> we have free clinics in our states. and we use federal dollars and we should encourage that, but it comes to the whole question of the legality. maybe a clinic could, and the policies for states could be adopted accordingly. >> the free clinics, that is something that bernie sanders is probably deserving a lot of the credit for. there is money in this bill to build the new ones. how do you see that working out? >> it is working very well.

bernie is our senator, and we have federal qualified health centers in many of our state. we provide that safety net for folks who do not have coverage, who cannot be seen under the circumstances. it seems to work for us. >> you have three states that have less than 2 million people. so he is over the 2 million are. this is a primary delivery for most of us and our rural areas, how we deliver health care. $1 of the things that oregon is looking at is integrated health care. it's the way the judge talked about preventive care, but what it really does is integrating physical and mental health, integrating all the issues are brown every aspect of health care the chicken have so that we

can direct people to them and put providers into those situations, which provides a broad system of health care, which i think is-with the clinics to -- they try to reach out and treat them all. you have to recognize the integration of mental and physical help if you provide a full health care system for this country. and that is what we try to do. >> dental care is a big thing, and if you look at the delivery of medicaid, for adults, they do not get dental care unless it is pain and suffering. you have to really justify that. we try to expand on that, because it is all part of preventive care. it is expensive but it is an especially needy part. there penny of places that we can disperse that. -- there are plenty of places that we can disperse that. >> we ask lower income

americans with their big concern was, and it was oral health, because it was not only pain, but self-esteem and employability. >> we had the problem with dentist participating in our program which as they say, they can take so many but then they have to be of the bill in the rest of their schedule people that are paying a closer percentage to full rate. we had a increase the rates that we were reimbursing. we had a larger number of dentists, and that most not participate one way or the other -- and now most are participating in one way or the other. but it was underpricing the product was being delivered. >> we just had a few minutes.

of want to ask each of you quickly, what if this bill does not pass? what is the first thing on your "to do" list? >> that is why we're having the summit. we did not know whether it would pass or not. but states are the laboratories of democracy. that is where innovative ideas began, where reform efforts are initiated to improve the lives of people we serve. the goal of the nga and the summit is to make sure to share these experiences, and get everybody's ideas, and continue to reform the way we deliver care as we already are in many states across the country. my commitment to improving the health outcomes for the people of vermont will be just as strong as it was before this debate began, and i'm going to keep doing everything i can to do that within the resources we

have available. >> i believe exactly what jim has said. it is our responsibility to reach out in compassion, and also keeping our population base healthy. i have the four women with me who are responsible for health care in west virginia. and you notice that i say women. the women, i truly believe, take the compassionate role. they do not just look at the bottom line in >> and cents, but how they keep their children -- that children under that. you can say that we have to do this in a responsible manner but how can we reach everybody? how do we engage? we have to move forward and we cannot sit back and wait for the federal government. i do not want the federal government to be my provider. i want them to be my partner. i tell all of my counties in my state that i do not intend to be your provider but i will be the best partner. you have to meet me halfway.

in nga, that is what we have always said, we think that we are on that front line. what have you pass, we have to implement it. we cannot wait five or 10 years to see if we can afford it and not. we're going to tell you by next june 30. we are planning and we will be planning with what we have learned today, and the engagement -- i want to thank all of you for coming and for bringing your expertise. i know our delegation is looking forward to interacting with you and learning how we can do better in west virginia and make the country stronger. >> their 49 states represented here. there are 49 different ideas and groups here that have put together their plan about how to reduce the cost or provide more coverage for less money.

many individual ways of making a commitment in the health-care system on a state-by-date basis. we come here to learn and find out how waiver support, what modifications to the existing medicaid programs are available right now that we are not utilizing in our state, finding out which new approaches to modify and change it, who is taking a different approach to group insurance, to allowing for more competitive individualized market? the risk pools that are out there. we placed a limited liability on our risk pools for up to $2 million and we use the same thing is this state employees plan. those types of things -- we're going to find out from other states which are here which ones

work and which ones do not. the vast majority of americans have a plan for health care. it is not perfect. how do we make it better and how can we make it sustainable for the long term? the real challenges the future. you have more and more of us getting older and living longer, and yet you have young people that we truly recognized that you have to give them quality education. their challenge will be our state is spending money on educating children are taking care of people who have nowhere else to go for their health care needs. >> said it some form of health care does not pass, it will be a lost opportunity for us as a country. but nothing will change what i've told you we were talking about, the oregon health -- i believe oregon has a very versatile program.

we have had for over 20 years, had health care. this is probably a somewhat inconsistent thing, because in my calculations, it's about $5 billion over the next 10 years that oregon would receive. i think all of us like that aspect of the health care reform. the fact is, personally, i believe that there is enough money in our healthcare system that we could provide health care, quality health care program, for all the citizens. it is a distribution issue, allocation, how do we do it. we're trying to define that measure of where we can take the dollars that we have and ashley provide a quality health care for every citizen who deserves it. >> everyone keeps thinking, and

talking more money, more money, more money. i keep saying that money will not fix this problem. money will help cure it once you have the plan to fix it. and i think that is what we're looking for, that plan that the leak fixes the problems that we've identified without us throwing more money to it. that is the pushback from the american people. enough is enough. how much more do you want out of my hide? i have to live with what i've got. i am making do with less. can you do the same? that might be the pushback that you're seeing, as much as anything. we're spending more money than anyone in the world and we're at 37 in the world. don't you think you have done something wrong? >> and there's the $14 trillion of debt that we're passing on to the next generation, and how much more can we spend or

borrow and will this will contain costs? i think that is weighing on a lot of americans are now. >> i think we're coming to the end of our time here. i want to thank all of you. this is an extraordinarily and lightning for me certainly. and i also want to wish you luck. you have at your work cut out for you. thank you very much. >> thank you very much. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2010] >> this week lawmakers are making a final push to get health care legislation to the president's desk and you can follow up the latest on the only network that covers washington gavel-to-gavel, on edited, with no commentary, c-span. and take us on line. see what house and senate members are saying being -- be

it twitter. iphone users, get the lettuce with the c-span radio app. >> next on c-span, we continue our look at the health-care debate. earlier today president obama visited ohio, tried to make the case for changing the nation's health-care system. after that, the house budget committee works on the health care bridges set -- reconciliation markup. changing the original senate bill that passed last december. on tomorrow morning's "washington journal," we will walk -- talk about health care in the 2010 elections. after that, a representative from the european union will talk about that. later, an update with the state department inspector general on a recent report on the u.s. embassy in afghanistan. and later, and author on the

two-year anniversary of the collapse of bear stearns. his book is "house of cards." "washington journal" stars every morning at 7:00 a.m. eastern. up next, president obama at a health-care rally outside of cleveland in the city of strong still. this event is about 35 minutes. -- the city of strongsville. this event is about 35 minutes. [applause] [cheers and applause]

[cheers and applause] >> my name is coning, and i am here to introduce the president. many americans have struggled with the cost of health care insurance. in 2009, premiums increased over 29% and in 2010, her premiums would increase again by 40%. she was simply wiped out. my sister, a self-employed, strong woman, was no longer available -- able to afford health care insurance. desperate for help, on december 29, natoma wrote a letter to president obama describing her situation and urging health insurance reform.

to her great surprise, the president not only read and replied to her letter but also shared it with a roomful of the insurance company ceo's that were as responsible for the steep hikes in her premiums. we cannot allow natoma and the millions like her to go unnoticed. make no mistake about it, we need health care reform and we do need it now. [cheers and applause] we have seen what will happen without reform. premiums will continue to rise, insurance companies will not be held accountable for their abuses, and hard working americans like my sister natoma will suffer. it is now my honor to introduce a man who is fighting every day

for health insurance reform, that will lower cost and restore accountability to the system. president barack obama. >> you did great. thank you. [cheers and applause] [cheers and applause] >> hello, ohio! it is good to be here in the buckeye state. congratulations on winning the big 10 championship. i am filling out my brackets now. [laughter] > > o h i o.

>> that kid turner looks pretty good. you guys are doing all right. it is wonderful to be here. >> i love you! >> i love you back. i do. couple of people i want to make sure i give special mention to. you are already saw him, governor ted strickland in the house. ted is fighting every day to bring jobs and economic development to ohio. so is your terrific united states senator sherrod brown. love sherrod brown. your own congressman, who is tireless on behalf of working people, dennis kucinich. >> vote yes! >> did you hear that, dennis?

you want to say that again? >> vote yes! a couple of other members of congress are here. u.s. representative betty sutton. u.s. representative marcia fudge. u.s. representative tim ryan. u.s. representative charlie wilson. i want to thank mayor tom perciak here in strongsville. please, mr. mayor, you are wrong. that is a good bunch of folks we got here in ohio, working hard. which is why i am glad to be back -- and let's face it, it is nice to be out of washington once in awhile.

[laughter] i want to thank connie who introduced me. i want to thank her and her family for being here on behalf of her sister, natoma. i don't know if everybody understood that natoma is in the hospital right now, so connie was filling in. it is not easy to share such a personal story when your sister who you love so much is sick. and so i appreciate connie being willing to do so here today. and i want everybody to understand that connie and her sister are the reason that i am here today. connie felt that it was

important that her sister's story be told. but i just want to repeat what happened here. last month i got a letter from connie sister, natoma. she is self-employed, she is trying to make ends meet, and for years she has done the responsible thing just like most of you have. she bought insurance. she did not have a big employer who provided her insurance, shows -- so she bought her health insurance to the individual market. and it was important fur-have insurance because 16 years ago she was diagnosed with a treatable form of cancer. and even though she had been cancer-free for more than a decade, the insurance companies kept on jacking up rates year after year. so she increased her out-of- pocket expenses. she raised -- she raised her deductible. she did everything she could to maintain her route insurance that would be there just in case she got sick because she

figured, she did not want to be in a position where if she did get sick, somebody else would have to pick up the tab, that she would have to go to the emergency room, that the cost would get shifted onto folks through their higher insurance premiums or hospitals charging higher rates. so she tried to do the right thing. and she upped her deductible last year to the minimum, the highest possible deductible. but despite that, natoma's insurance companies raised her premiums by more than 25%. and over the past year, she paid more than $6,000 in monthly premiums. [booing] she paid more than $4,000 and out-of-pocket medical costs, for co pays and medical care prescription. altogether, this woman paid $10,000 -- one year. but because she never hit her

deductible, her insurance company only spent $900 on her care. so the insurance company is making -- getting $10,000, paying out $900. now what comes in the mail at the end of last year? >> a rate hike. >> a letter telling natoma that her premiums would go up again by more than 40%. so here is what happens. she just could not afford it. she did not have the money. she realized that if she paid those health insurance premiums that had been jacked up by 40%, she could not make her mortgage. and despite her desire to keep our coverage, despite her fears that she would get sick and lose the home that her parents built , she finally surrendered, she finally gave up her health

insurance. she stopped paying it. she could not make ends meet. so january was her last month of being insured. like so many responsible americans, folks who work hard every day to try to do the right thing, she was forced to hang her fortunes on chance. to take a chance, that is all that she could do. she hoped against hope that she would stay healthy. she feared terribly that she might not steroid help the -- stay healthy. that was the letter that i read to the insurance companies including the person responsible for raising her rates. now i understand natoma was pretty surprised that she found out i had read it to these ceo's. but i thought it was important for them to understand the human dimensions of this problem her rates have been hiked more than 40%. and this was less than two weeks

ago. unfortunately natoma's worst fears were realized. just last week, she was working on a nearby farm apparently, chasing after a cow, when she collapsed. and she was rushed to the hospital. choose a very sick. she needed two blood transfusion. doctors performed a battery of tests. and on saturday natoma was diagnosed with leukemia. another reason natoma is not here today is that she is lying on a hospital bed, suddenly faced with this emergency, the fight of her life. she expects to face more than a month of aggressive chemotherapy. she is racked with worry not only about her illness but about the cost of the test and the treatment that she is surely going to need to beat it. so you want to know why i'm here, ohio? i am here because of natoma.

i'm here because of the countless others who have been forced in their lives with the added burden of medical bills they cannot pay. i do not think that is right. neither do you. that is why we need health insurance right now. health insurance reform right now. [cheers and applause] >> i am here because of my own mother's story. she died of cancer, and in the last six months of her life, she was on the phone in her hospital room arguing with insurance companies and set of focusing on getting well and spending time with her family. i'm here because of the millions who are denied coverage because of preexisting conditions or dropped from coverage when they get sick.

i am here because of the small businesses forced to choose between health care and hiring. i am here because of the seniors unable to afford the prescriptions that they need. i am here because of the folks seeing their premiums go up 20% and 30% and 40% and 50% 60% in the year. ohio, i am here because that is not the america i believe then and that is not the america that you believe in. so when you hear people say, "start over," -- >> no!

when you hear people say that this is not the right time, you think about what she is going through when you talk about -- when you hear people talking about what this means for the democrats or republicans, when you hear people more worried about the politics of it, then what is right and what is wrong, i want you to think about natoma and the millions of people all across this country or looking for some help and relief. that is why we need health insurance reform right now. part of what makes this issue difficult is most of us to have been held -- health insurance, we still do. and so we feel like, well, i do not know, it is kind of working for me. i am not worrying too much.

but what we have to understand is that what has happened to natoma, there but for the grace of god go any one of us. anybody here, if you lost your job right now and after the cobra ran out -- it looks like we got somebody who might have faded down there, so what we got a medic. no, hold on, i'm talking about there somebody who might have faded right down here, so if we can get on that it, it just give her or him some space. >> hope you have insurance. >> so let's just think about -- think about if you lost your job right now.

how many people here might have had a preexisting condition that would mean it would be very hard to get health insurance on the individual market? think about if you wanted to change jobs. think about it wanted to start your own business but you suddenly had to give up your health insurance on your job. think about what happens if a child of yours, heaven forbid, got diagnosed with something that made it hard for them to insure. or so many people, it may not be a problem right now but it is going to be a problem later, at any point. and even if you have got good health insurance, what is happening to your premiums? what is happening to your co- payments? what is happening to your deductible? they are all going up. that money is straight out of your pocket. so the bottom line is this -- the status quo on health care is simply unsustainable. we cannot have --

we cannot have a system that works better for the insurance companies than it does for the american people. and we know what will happen if we fail to act. we know that our government will be plunged deeper into debt. we know that million more people will lose their coverage. we know that rising costs will saddle millions more families with unaffordable expenses. and a lot of small businesses archer's point drop their coverage altogether. that already is what is happening. a study just came out yesterday, a nonpartisan study, that found that without reform, premiums could more than double for individuals and families of the next decade. family policies could go to an

average of $25,000 or more. can you afford that? >> no! do you think your employer can afford that? >> no! >> your employer cannot sustain that. so more and more of them are just going to say, you are on your own on this. we have debated this issue now for more than a year. every proposal has been put on the table. every argument has been made. i know a lot of people view this as a partisan issue, but, look, the fact is both parties have a lot of areas where we agree. it is just politics are getting in the way of actually getting it done. somebody asked what is our plan. let me describe exactly what

we're doing, because we have ended up with a proposal that incorporates the best ideas from democrats and republicans, even though republicans don't give us any credit. that is all right. you know, if you think about the debate around health care reform, there were some who wanted to scrap the system of private insurance and replace it with government-one care. and, look, that works in a number of places, but i did not see that being practical to get help right away for people who really needed. and on the other end of the spectrum, and this is what a lot of the republicans are saying right now, there are those the simple belief that the answer is to unleash the insurance industry, to deregulate them further, provide them less oversight and fewer rules. [booing]