the hen house" approach to health insurance reform. so what it would do is give insurance companies more leeway to raise premiums, more leeway to deny care. it would segment the market further. it would be good if you were rich and healthy. you would save money. but if you are an ordinary person, if you get older or sicker, you would be paying more. i do not believe that we should give the government or insurance companies more control over health care in america. it is time to give you, the american people, more control over your own health insurance. .

this is like a patient's bill of rights on steroids. [laughter] within the first year of citing health care reform, thousands of uninsured americans with pre-existing conditions will be able to purchase insurance for the first times in their lives since they got sick. [applause] insurance companies will be banned forever for denying coverage to children pre-

existing conditions. [cheers and applause] this year under this legislation, insurance companies will be banned from dropping your coverage when you get sick. this practice is well and. -- this practice will end. with this reform package, on the insurance plans would be required to offer free preventative care to their customers starting this year. free checkups to catch preventable diseases on the front end. that is the smart thing to do. [cheers and applause] starting this year, if you buy a new plan and there will be -- there will not be a lifetime or

annual restricted limits on the amount of care so you will not be surprised by the fine print that says they suddenly sought -- stop paying. that will not happen. [applause] i see some young people in the audience. if you are an uninsured young adults you will be able to stay on your parents' policy until you are 26-years old. [cheers and applause] #1, insurance reform. the second thing that this plan

we want you to have all the it's the one to to have all the borrowing power that the big companies have so you'll be able to buy into this pool. that will lower rates spurted it is an estimated 14-20 percent signed. that is money out of pocket. what my proposal says the is that if you still cannot do that, then we will offer tax credits to do so. that is what we're going to do. now, when i was talking about health care, some of you solve the whole thing. . some folks said the we cannot afford to do that. i want everyone to understand.

the wealthiest among us could already by the best insurance there is. the meese -- of the least well among us, they get their health care to medicaid. it is the middle class that is getting squeezed and that is who we have to help and we can afford to do that. [applause] now, it is true that providing these tax credits to middle- class families and small businesses will cost some money. it will cost about -- but most of this will come from the $2.50 trillion per year that americans already spent on health care. right now is being spent badly. right now and this plan, we will make sure the dollars to spend on health care will go to make insurance more affordable and secure.

we will eliminate wasteful subsidies that go to insurance companies. there are making billions of dollars on subsidies from you, the taxpayer. if we take those subsidies the way we can use them to help people like if notoma get health insurance so she does not lose her house. [applause] yes, we will put a new fee on insurance companies because they stand to gain millions more customers who are buying insurance. there is nothing wrong with them getting -- giving something back. here is the bottom line.

this is more than can be said for our colleagues on the other side of the aisle when they passed that big prescription drug plan that cost about as much as my health care plan and they did not pay for any of it. now they are up there on their high horse talking about how we do not want to expand the deficit. this one does not expand the deficit. their plan did. that is why we pay for what we do. that is the responsible thing to do. [applause] now, let me talk about the third thing. that is my proposal to bring down the cost of health care for families, businesses, and the federal government. americans buying comparable coverage to what they have today, i already said this, would see premiums fall by 40%

to 24%. that is not my number. that is what the nonpartisan congressional budget office said. for americans to get their interest to the workplace, how many people are doing that right now? raise your hands. all right. a lot of those people, your employer would see premiums fall by as much as 3000% of which would mean they could give you a raise. [cheers and applause] we have incorporated most serious ideas from across the political spectrum about how to contain the rising costs of health care. we go after the waste and abuses of the system, especially against medicare. our cost cutting measures would reduce most people's premiums and bring down our deficit up to $1 trillion over the next two decades. those are not my numbers. there are determined by the

congressional budget office. they are the referees. that is what they say, not what i say. the opponents of reform try to make a lot of different arguments to stop these changes. first they said it was a government takeover of health care. well, that was not true. then they said, what about death panels? that did not turn out to be true. yet, the most insidious argument they are making is the idea that this would hurt medicare. i know we have some seniors here with us today. i could not tell. you guys look great. [laughter] i would not have guessed. i went to tell you directly that

this proposal adds almost one decade of solvency to medicare. [applause] this proposal would close the gaps in printer -- a prescription drug coverage called the doughnut hole. it sticks seniors with thousands of dollars in drug costs. this will help overtime to help reduce the cost of medicare that you pay every month. this proposal will make preventive care free city do not have to pay out of pocket for tests to keep you healthy. [applause] so, yes. we are going after the waste, fraud, abuse in medicare. we are eliminating some of the insurance subsidies that should be going towards your care. these dollars should be spent on care for seniors not on feeding the insurance companies through sweetheart deals.

everyone should know there is no cutting of your guaranteed medicare benefits. . . , no ifs, ands, or buts. period. this proposal makes medicare stronger, the courage better, and the finances more secure. anyone who says otherwise is misinformed or trying to misinform you. do not let them hoodwinking. we do -- hoodwink you. [laughter] ohio, that is the proposal. i believe congress owes the american people. they owe the american people a final up or down vote. [applause] we need an up or down vote. it is time to vote. as we get closer to the vote, there is a lot of people by hammering. we hear people in washington talking about politics, what this means in november, the poll numbers for democrats, republicans. we need courage. [applause] that is what we need.

that is why i came here today. we need courage. [cheers and appaluse] -- applause] we need courage. in the end, this debate is about far more than politics. it comes down to what kind of country do we want to be? it is about the millions of lives that would be touched and in some cases saved by making health insurance more secure and affordable. it is about a woman who is lying in a hospital bed and just wants to be able to pay for the care she needs.

the truth is what is at stake in this debate is not just our ability to solve this problem but our ability to solve any problem. i was talking to dennis kucinich about this. i said, you know what? it has been such a long time since we made government on the side of ordinary working people. where we did something for them that relieves some of their struggles, that made people who work harder every day and looking out for their families contributing to their communities to give them a little bit of a better chance to live out their american dream. the american people want to know if it is still possible for washington to look out for their interests, their future. what they are looking for is -- for is for courage.

there are waiting for us to act. they're waiting for us to lead. they do not want us to put our finger out to the wind, reading polls. they want us to look and see what is the best thing for america and then do what is right. as long as i hold this office i intend to provide that leadership and i know these members of congress are going to provide that leadership. i do not know about the politics. i know what the right thing to do is. i am calling on congress to pass these reforms. i'm going to sign them into law. i want the courage.

i want us to do the right thing, ohio. with your help we will make this happen. god bless you and god bless the united states of america. [cheers and applause] >> the house budget committee finished its work on legislation which cleared its first hurdle on monday when they passed a reconciliation bill. the measure now goes to the rules committee to set the parameters. for more information, this is the health care hob. >> coming up, senate banking committee chairman chris dodd talks to reporters about the release of a new financial market regulations bill. earlier, the house budget

committee voted to move a bill to the help stage. here is a portion of that committee markup. >> if everyone will take their seats, we will begin the budget meeting for the the budget committee meets in a ministerial role that is part of a larger process of sharing the cost of being sick in our society. part of a larger process of deciding how we share the cost of being sick in our society. our task is to vote on reporting the recommendations submitted to the committee under the reconciliation instructions and the concurrent budget resolution for the year. fiscal year 2010. our role in this process stems

from the reconciliation directives in section 202, the budget resolution, dealing with health care reform and higher education. our committee's main contribution to that process was to require that the spending and revenue changes made for health care reform and education reform not just be deficit neutral but actually improve the deficit. the president subscribed to that principle and so have the house and senate. the budget act asigns us, our committee, the role of packaging the reconciliation bills and transmitting them to the house, quote, without substantive change. the rules committee has the authority to make substantive changes and report reconciliation rules, bills as amended to the floor. i'll briefly describe your purpose and make an opening statement limited to ten minutes followed by an opening statement limited to ten minutes by the ranking member mr. ryan. without objection, other members wishing to make a statement may have it included in the record at this point.

after opening statements, the committee will take up a motion to report to the house the recommendations sent to us by the authorizing committees in response to the reconciliation instructions that i've just side. after its passage, we'll move to consideration of a maximum of ten motions on each side. all nonbinding, subject to our mandate which is to finish before midnight tonight. or turn into pumpkins. these motions request that the chairman of the committee go to the rules committee and ask that certain amendments be made in order. i will outline that process in greater detail when xhi to the point. i would remind all members of the chair is authorized to declare a recess at any time based on the agreement we made at our organizational meeting earlier this year. now i am on the ten-minute clock. the budget act calls for this ghot combine the lifth legislation sent to us in october in response to reconciliation restructions that were included in the budget

resolution for last year, passed last year. and then report the product to the house by way of the rules committee. the budget act bars us from amending the bill. we're told to assemble it and report it without substantive change. in response to the reconciliation instructions in last year's budget resolution, we have received and we have before us legislative language sent to us in october from the ways and means committee and from education and labor dealing not only with health care reform but also with higher education. the budget committee cannot amend the language the authorizing committees have sent us. the house of representatives can amend it and intends to do so. any reconciliation package that the house passes and sends to the senate is going to look very different from what is before the committee today. we're taking the next step in a long arduous process to resolve the debate on health care reform. critics may suggest the process is moving too fast, but congress has been considering how to reform the health care system and expand coverage for more

than one year. during this congress the house held nearly 100 hours of hearings and heard from 1 81 witnesses, democrats and republicans. during the mark-ups, the three house committees with jurisdiction over health care considered 239 amendments from democrats and republicans and accepted 121 amendments, including some republican amendments. it's hard to understand how anyone can claim this bill is being rushed or rammed through the house in view of those facts. by most measures we have, bar none, the best medical system in the world. but it is also by a wide margin the world's most expensive system and not readily accessible to millions of americans. each member here has tales to tell about what is wrong, what is right and what needs to be fixed. there is the views expressed today are likely to be collide scopic, but no one will say that health scare increasingly affordable, unaffordable, especially for millions who lack insurance and rising costs are

unsustainable. not only in househole and business budgets but in the federal budget as well. higher premiums are putting health insurance out of risk for more and more americans and even those who have insurance have no ironclad guarantee of protection. annual and lifetime caps can leave the city with astronomical bills that can wipe a family out, sfrn they have insurance. even if they have insurance, they may not have the coverage they need do to riders that preempt coverage of pre-existing conditions. the final takes of the reconciliation bill that the house will consider now is not before us but it is clear the health care provisions will uphold principles that a majority of people, i think, support and that a majority of this congress should be able to support and agree upon. for starters, we need insurance underwriting reform, restriction denial of coverage due to pre-existing conditions or due to raising renewal premeiums when insurance is needed most after the insurance suffers a major illness. second we need a far more

competitive marketplace for insurance, where consumers benefit from choice and competition. third, we need affordability credits to individuals and small businesses so they can afford insurance offered in these new marketplaces. fourth, we need to strengthen medicare by closing the doughnut hole, so-called by limiting overpayments to medicare advantage and we need payment reforms that encourage doctors and hospitals and other providers to stress quality of care over quantity of care. all these and more -- all of these needs and more are addressed in the comprehensive bill coming before the house. everybody's own perspective on why reform is needed. let me use facts from my own state to make my point. according to statistics provided by the department of health and human services in my state, south carolina, 764,000 residents kushtsly lack health insurance. 290,000 residents with nongroup coverage would be able to get affordable coverage through the health insurance exchange we're

promoting in this bill. seniors would have their brand name drug costs in the part d doughnut hole cut in half. 49,300 small businesses would be helped by small business tax credit to make premeiums more affordable. they make up about three-quarters of all businesses in south carolina, but only 40% are able to offer health coverage. we'll also hear today that reconciliation will not intend for this purpose. in fact, reconciliation has been used 22 times in prior years, and on 20 of those occasion, republicans were in the majority and at least one house or in the white house. in 2001 our republican colleagues used reconciliation to pass massive tax cuts that worsened the bottom line of the budget by 1,350,000,000 over ten years. the second round of tax cuts using reconciliation added $350 billion to the deficit. by contract, the clinton administration used reconciliation in 1993, the deficit was reduced by $496

billion over five years. and when reconciliation was used in the balanced budget act of 1997 it was used to create c.h.i.p., children's health insurance, med pac for oversight and med var advantage. what we do today lies well within those precedence. i've devoted all of my remarks to health care reform. but before closing, i should add that the legislative text before us today also includes higher education, student loans, pell grant provisions and if the house passes the higher education provisions in the reconciliation bill, we'll take up later this week it will result in a landmark investments in higher education, making higher education more affordable and more successful. in doing so without adding to the deficit. a productive economy requires demands education that is accessible, affordable and of higher quality and the higher education provision being considered today will help us advance that goal. so today the budget committee

meets to rer form the important but limited role and vision for the committee under the budget act. in taking our next step we begin the process of bringing to fruitful conclusion our work on these vital issues. i now turn to the ranking member, mr. ryan, and recognize him for ten minutes for his opening statement. mr. ryan? >> thank you mr. chairman. before discussing health care reconciliation, i want to begin by thanking you for continuing this committee's tradition for allowing a full and fair debate and give the minority the opportunity to offer motions in committee to modify this reconciliation bill. you've always been a gentleman, and i want to say the beginning of this process, thank you for continuing to be one. today in this committee, we begin what might be the final chapter of this health care debacle. my friends in the majority claim that what we are doing here is simply paving the way to fix a mildly flawed senate bill. they argue it is a simple, frequently used procedure to move legislation through the senate. but that's not what's happening

here, and we all know it. this is, in fact, an extraordinary and unprecedented abuse of the budget reconciliation process. reconciliation has never been used, never, to push through a $1 trillion expansion of government and to seize control of one-sixth of the u.s. economy. no one has ever employed the process to leverage such a vast social change based upon a token $1 billion in savings. while we're facing a $1.5 trillion budget deficit this year alone. and doing it on a deliberate, purely party line vote. the only bipartisanship in this procedure is in the opposition to it. never before has the house committee process been so grossly exploited that thousands of pages of legislation reported by the committees of jurisdiction are irrelevant. even before we vote on them. we will report these provisions

right here as the process requires and then they will all be stripped out, discarded, tossed on the ash heap and then the real legislation will get written under the cover of the rules committee. in other words, we are right here creating a legislative trojan horse. in which a handful of people hidden from public view, will reshape how all americans receive and pay for their health care. and then it will be rushed to the floor and members will be forced to vote on it to beat another artificial political deadline. we've also learned that the house might try to pass this 2700-page senate bill and send it to the president without actually voting on it. it appears that you are going to deem passage of the senate bill in the rule. last week, in a stunning and revealing statement, speaker pelosi said and quote, we have to pass the bill so that you can find out what's in it, end quote. this is the vaunted transparency

that the president promised? the arrogance, the paternalism, the condesension to the american people is just breathtaking. this is not just a simple fixer bill either. this is the linchpin for health care. it's the vehicle for the back room deal that will buy the votes so the house can pass the senate health care bill which then supposedly will be amended by this bill. to put it another way, if this process fails, the whole health care house of cards collapses. of course, the real reason we are all sitting here in this room is because of one man, scott brown. we are here because scott brown won his election and got elected to the united states senate, sent there by the people of massachusetts. you can't pass this health care bill the right way and so now you pass it the washington way. we are not governing here today. we are greasing the skids for an abuse of the budget procedure intended to control the size of government, not expand it.

but the stakes here go beyond the details of the legislative process, and even the integrity of our constitutional duties. let's consider the underlying health care legislation itself. using the president's proposal, because it's built upon the same philosophy as the house and senate health care bills, first, the most fundamental problem is that this legislation is not about health care. at the base, essence of it, it's about ideology. it moves away from the american idea and toward a european-style welfare state that will leave millions of americans into becoming more detendent upon the government rather than upon themselves. even though it's not single payer, and even though without the so-called public option, this is still a government takeover of health care. and here is why we keep saying that. the entire architect surdesigned to give the federal government control over what kind of insurance is available for patients, how much health care is enough and which treatments are worth paying for. this plan assumes that

everything is connected to everything else. you can guarantee coverage for pre-existing conditions only if you have healthy people in the insurance pool to spread costs.@ >> it further strips power from patients and doctors. it creates a health insurance authority set prices. it would regulate insurance premiums and it would further smother normal market forces that would otherwise encourage innovation. it empowers washington to decide what kind of insurance will be available. the proposal gives the secretary of human services new committee. committee and unelected group of federal bureaucrats, unprecedented, washington-centered power to create and change the

requirements for acceptable coverage. it gives the u.s. preventative services task force new powers to further limit patient choice. allowing the secretary of hhs to unilaterally deny payment for prevention services contrary to task force recommendations. empowers a comparative effectiveness board created by decisions about what treatments are best for their patients. let's take a quick look at the price tag. as i point out at the blair house summit a few weeks ago, the reality of this bill violates the president's promise that this legislation will, quote, not add a dime to our deficit, close quote. my friends will say the cbo has scored this overhaul and said it reduces the deficit. here in this committee, we work with cbo every single day. they are a great, hard-working people. very good professionals. and they do their work very, very well. but let's be very clear. cbo's job is to score what is placed in front of them. the authors of the bill have

gained the system themselves. writing the smoke and mirrors right into the bill. when you strip away the gimmicks, the double counting and the faulty assumptions, it is clear that this overhaul does not reduce the deficit and it does not contain costs. this charade, both today's blind mark-up and the entire fast year of desbat disspiriting in so many ways. there are real problems that need to be fixed in health care, and we could have done so in a bipartisan way. that's the shame of all of this. we agree on the key problems and agree that real reform is needed. skyrocketing health care costs are driving families, businesses and government to the brink of bankruptcy. and leaving millions of people without adequate coverage. we agree on the need to address pre-existing conditions. realign the innocentives of insurance companies with patients and doctors and weed out waste, fraud and abuse. we agree on the problems and on many of the same goals. yet the past 12 months have

crystallized. the differences in approaching to fixing what's broken in health care. it didn't have to be this way. and it doesn't have to stay this way. at the blair house shumit, vice president biden claimed we haven't qualified to speak on behalf of the american people. i respectfully disagreed then and i respectfully disagree now. we are representatives of the american people. we communicate every day with those we serve and it's clear they are engaged. the people we represent and i suspect most of us here, passionately believe we need to fix what's broken in health care. but i don't believe that this is the way to do it. the abuse of the legislative process, the abuse of the constitution, a massive government takeover of health care in america. this process is not worthy of your support. this is not worthy of your vote. let's start fresh and let's work seriously to address this issue and let's do it together. mr. chairman, before we move on to the motions, i'd like to ask for the 48 hours to submit

minority views. >> so ordered. now under section 310 of the congressional budget act of 1974, budget committee will proceed to report the reconciliation act of 2010 to the house without any substantive revision. this process means that the consideration of the amendments of the bill is prohibited by law and any mo@@m@ @ @ @ @ @ @ drr without recommendation, the question comes on the ordering of the reconciliation act of 2010. to be reported to the house without recommendation. all those in favor, say i. all of those in -- opposed say no. >> no.

>> the roll call has been requested and the clerk will call the roll. >> miss swartz, aye. dogget, aye. mr. bloomenaur? aye. mr. barry? >> aye. >> mr. berry, aye. mr. boyd? >> no. >> mr. boyd, no. >> mr. mcgovern, aye. miss longis? >> aye. mr. etheridge? >> aye. >> miss mccollum? >> aye. >> mr. yarmouth? >> aye. >> mr. andrews? >> aye. >> mr. andrews, aye. miss deloro. aye. >> mr. edwards. >> no. >> mr. scott? >> mr. scott, aye. >> mr. larson? >> aye. >> mr. larson, aye. mr. bishop? >> aye.

>> mr. bishop, aye. miss moore? miss moore, aye. mr. colonelly? mr. conley, aye. mr. schroeter? mr. moore? mr. moore? aye. mr. hensarling? mr. hensarling? mr. garrett? mr. garrett, no. mr. diaz ballard? >> no. >> mr. simpson? >> no. >> mr. mchenry? >> no. >> mr. mack? mr. mack, no. mr. campbell? mr. camp bel, no. mr. jordan? >> no. mr. jordan, no. miss llamas? >> no. >> mr. austria? >> no. >> mr. adderhalt? >> no. >> mr. adderhalt, no. mr. nunez? >> no. >> mr. harper? >> no. >> mr. latter? >> no. >> mr. sprat? >> aye.

>> mr. spratt, aye. >> mr. ryan? >> no. >> mr. ryan, no. >> are there members who wish to record their votes who have not voted or change their vote? if not, the clerk will report the vote. >> mr. chairman, on that vote, the ayes are 21, the nos 16. >> there being 21 ayes and 16 nos, the motion is agreed to and the reconciliation act of 2010 is ordered reported to the house without recommendation. i would note for the record that a quarom is present. without objection, the question of reconsideration is laid upon the table. the request is note forward the record. i recognize the gentlewoman from pennsylvania for another

request. >> mr. chairman iask unanimous consent with respect to the reconciliation legislation just reported that the chair be authorized to offer such motions in the house as may be necessary to go to conference with the senate on the reconciliation act of 20 penn pursubt to clause one of house rule 22. that the staff be authorized to make any necessary technical and conforming corrections prior to filing the bill and the motion be -- to reconsider be laid on the table. >> without objection it is so ordered. this concludes the procedural portion of the markup that's required by the 1974 budget act. the committee has reported the reconciliation bill to the house

without revision. we now turn to the consideration of nonbinding motions or recommendations to instruct the chairman to go to the rules committee and request certain amendments be made in order. we must conclude this part of the meeting before midnight tonight. that's our mandate and we intend to keep it. within that limitation, each side will be allowed to offer a maximum of ten nonbinding motions to instruct. but as i said, we must finish before midnight tonight. by agreement with minority, the time for debate on motions in instruct, if offered, shall be limited to 20 minutes with the time equally divided between the proponent and the member in opposition. and when each member offering a motion completes his or her opening statement, the members should have the right to reserve one minute to close or rejoin. without objection, we are prepared to consider motions to obstruct. who seeks recognition? mr. mack.

>> thank you mr. chairman. and i also would like to thank the ranking member. i think we all recognize the importance of today's markup and the gravity to which decisions that are being made here today and certainly no one is new á/@r >> this first motion to instruct would restrict medical professionals from providing the care that they believe but unnecessary. this really goes to the core of a lot of the frustration that your feeling or hearing from the american people.

the american people want the relationship between themselves and their doctor to be preserved. they do not want to see the federal government bureaucrats and politicians making decisions that would have a negative impact on themselves families a. decisions that would have a negative impact on themselves and their families and their lives. the idea that somehow a bureaucrat or a politician knows what's best for a patient is absurd. and what we're saying is let's preserve that relationship, that doctor/patient relationship. and let's think about this for a minute. and if i may, i am just going to give you a little family story here. i had an uncle mike who passed away of cancer at a very early age. and it was -- it was his doctors that really provided the care, and it was that -- it was the

family meeting with the doctors that we could talk about what's best for him and how to get through his illness and what procedures to take and what tests and what medicine and it was very personal. later on down the line, my grandfather died of cancer. and again it was that relationship between my grandfather, our family and the doctor that helped set a course that we used to fight -- try to fight cancer and try to win and try to extend his life. later on, my mother got breast cancer. and she survived. and again, it was that relationship with her doctor that she was able to -- and as a family, talk with the doctor about what is the best course of action. now imagine if somehow there was a washington bureaucrat or a

politician that was in the mix. that is not -- you know, the last thing in our mind when my mother was fighting her breast cancer was the idea that government somehow was going to control what kind of procedure she could have, what medicine she could have, what the proper course of actions were. it was the doctors. and my mother. and our family who made those decisions. again, later, my father ended up with melanoma, and he survived. and he survived because of the relationship between my father, our family and his doctor. later on, my sister got cancer. and again, it was that relationship between the doctor, my sister and our family, not a washington bureaucrat, not a politician that made those

decisions. the american people are saying loud and clear, hands off. stay away. we do not want you involved in the -- our health care decisions. this is a very personal decision for many people. and lastly ijust would like to say this. i have a young daughter, and a uggnw@ >> i am afraid it is going to be the washington bureaucrats and it will be politicians that will decide the care of my children and your children. the american people have said loud and clear that they do not want government involved in the

decisions that are being made on their health care. they want to preserve the for the doctor, for themselves and for the doctor. this is an important motion that goes to the heart of what frustration and fears affect the american people. i would hope that all of my colleagues on both sides of the aisle recognize the importance of this and will support this motion to instruct. at this time, i would like to ask the congressman to make som. i'd like to ask the congressman austria if he'd also like to make some comments. >> i thank the gentleman for yielding. and i thank you for offering this motion because it's very important. let me go back and just kind of re-emphasize that the fact that this bill does certain things and has certain measures that empowers. one of those was in the stimulus

bill referred to as the federal council for prepared and effective research. i want to close some language in the stimulus bill in the direction that we are going with this. knowing what works best in presenting this information more broadly to patients in health care professionals, those items, procedures, conventions that are most effective to prevent control and treat health conditions will be utilized while those that are found to be less effective and in some cases more expensive will no longer be prescribed. this health care plan empowers this competitive effectiveness board and create news bureaucracies. these are measures that take away the ability of doctors and their patients to decide together what is best for the patient. and i will also want to share a story if i may, very quickly. my father was a physician. my mother was a nurse. had a brother who was a doctor a sister is a nurse. a sister who is a doctor. we had v a lot of health care professionals in our family.

big family i come from. but we grew up in a small town. just a typical small town. but my father had that same relationship that the gentleman from florida talked about with every one of his patients. he lived with them, went to church with them, cared for their well-being and trusted them. and when he made a recommendation on care, they needed, it was because that was the care that that individual required, not because statistically it was a cheaper option on some government scale. allowing the government to make health care decisions on behalf of patients will fundamentally change the relationship between an individual and the federal government. we need to reform health care reform while preserving the doctor/wairbt relationship with common sense reforms that give individuals maximum control over their health care decisions, not more government interference. if in any way this bill limits an individual's right to choose their own health care provider or coverage or limits a patient's try to choose their own doctor and whatever treatment that patient or doctor chooses for themselves or their

family, it's wrong. this motion to instruct will ensure that even if there's any uncertainties in this bill that this 1,000-page bill would preserve the doctor/patient relationship, which is extremely important. with that, mr. chairman, i will yield back to the gentleman from florida. >> thank you. and i think we'll wait to close. oh, wait. i'm sorry. >> i'll take the last 40 seconds. you want me to close? >> no, take the last 36 seconds. >> look. the whole point we're trying to make with this motion to instruct is this. the architecture of this idea if you could bring up chart 4 is the government is becoming the dominant player in health care under this legislation. the only way to contain costs under this kind of policy is to deeply and systematically ration care. that's why these bureaucracies are being put in place. we read about the man in canada who was denied hip replacement

because at age 57 he was deemed too old to get it. if my mother-in-law couldn't have gotten the treatment she needed right now, she wouldn't be alive today. in canada you can't get it if you have ovarian cancer. we oppose this. >> mr. bishop and mr. laurel. >> mr. chairman, thank you very much. let me start off, and let me thank mr. mack for offering this motion because it gives us an opportunity to have t@@@@@@@ @ $ nothing >> would tell a doctor how to practice medicine. there is nothing on the bill that would give the government the ability to say what treatment someone would receive. nothing in this section cell -- shall be construed to mandate

coverage, reimbursement or other policies. under the heading of protecting the position, a patient relationship, and nothing shall be construed to authorize t relationship. aprile nothing in this section shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine. that's pretty clear. next page, research may not be used to deny or ration care. that's pretty clear. senate bill. and their comparative effectiveness research section. comparative effective research shall not be construed as mandates for the practice guidelines, coverage recommendations, payment or policy recommendations. so there is nothing that is contemplated or suggested in the language of any of the bills before us that would allow for the -- this sort of nightmare scenarios that are envisioned by the legislation. let me say a couple of other

things. comparative effectiveness research has been -- has had bipartisan support up until this year. the 2003 medicare modernization act, which was written by a republican-controlled house and republican-controlled senate and passed largely with republican votes, required -- required the department of health and human services to conduct research on the, quote, outcomes, comparative clinical effectiveness and appropriateness of health care items and services. i'm quoting from the legislation. president bush supported comparative effectiveness research. in fiscals '06 and '07, he requested $15 million for comparative effectiveness research. in fiscal '08 and '0930 million. and in '08, $50 million in '09. so we have a long history of supporting comparative effectiveness research. physicians support comparative effectiveness research. the ama has endorsed comparative effectiveness research.

let me tell my own anecdote. not with my family, but this july ireceived a call from a cardiologist in my hometown, a guy that's practiced for 30 years. and he said he needed my help. he needed my help with an insurance company because he had a 35-year-old patient who had gone to the emergency room on a sunday afternoon complaining of chest pains. the emergency room gave him an ekg. it was normal. they sent him home. he came back to the cardiologist later in the week because he was still experiencing chest pains. the cardiologist wanted to have him undergo what's called a thallium stress test or nuclear stress test. he fought with this gentleman's insurance company for five weeks to get the insurance company to provide approval for this procedure to take place. five weeks. he then calls me and asks me if i will please intercede with the president of the insurance company to get that insurance company to acquiesce and provide this coverage. now we have a

government-provided health insurance program in this country. it's called medicare. if that had been a 75-year-old patient complaining of the exact same symptoms, that cardiologist would have offered the test and the test would have been approved in a heartbeat, no pun intended. so we clearly have -- we are envisioning a system here in which we are returning control of health care decisions to where they belong. and that is they belong with patients and they belong with physicians, not with the bureaucrats who administer health care insurance companies and their -- with their principal focus being maximization of profit, not protection of patients. and with that, i will yield to miss delauro. >> i thank my colleague and --

okay. this one sounds okay. i'm in opposition to the motion because once again, i think it seeks to frighten and mislead the american public. our republican colleagues choose now to attack health care quality research out of one side of their mouth while on the other side they defend the insurance companies who are the real ones who are interfering with patients and with their doctors. that is at the core of this. not comparative effectiveness research. that isn't it. imagine being told that your doctor thinks you need surgery for cancer or another condition and then your insurance company says they don't cover the procedure or you have a lifetime cap and you cannot afford that care. or you get into an awful, horrible car accident and are told your insurance company is dropping you because you failed to disclose an unrelated illness

a couple of years ago. that happened to jennifer latham, a former preschoolteacher and mother of four in colorado. what our plan does is sets new common sense rules of the road for insurance companies to protect consumers from these abuses. and my colleague, and i was pleased ed td to hear from my colleague mr. mack because insurance company interference in patient care is one reason that i introduced several years ago the breast cancer patient protection act. and i was joined this year by our republican colleague joe barton, and i want to applaud my colleague mr. mack because you are an original co-sponsor of that piece of legislation. over the years, countless stories from women who say that they are thrown, literally kicked out of hospitals after surgery for mastectomy and they are kicked out within 24 hours or less when they are not ready to go home, either physically or psychologically. that bill passed in the house by

bipartisan support. 421-2. and the insurance companies killed it on the senate side. we can't be in the position of agreeing to setting some basic rules for mastectomy and not want to help people with other -- with other efforts. that's why we want to move forward. there is nothing in this bill -- nothing -- that would get in the way of the patient/doctor relationship. what gets in the way of the patient/doctor relationship are insurance companies and, yes, indeed, yes, indeed, there are insurance company reforms in this bill. and that's why my colleagues should support the health care and be opposed to this motion. i would like to yield now to our colleague mr. andrews. >> i thank the gentle lady for yielding. i want to thank mr. mack. i'm a philadelphia area baseball fan. and your family has done an

awful lot for philadelphia area baseball. so i appreciate the story. there's none of white house wouldn't want our grandfather or sister or whomever to get the care you discussed. that's why the bill expressly says that comparative effectiveness research can't be used to set reimbursement rates under medicare. comparative effectiveness research is really about the best minds in health care and medicine and research coming together and figuring out what works. and then to encourage people to use what works. but there is not a word, not a word, in this legislation that would permit anybody to be denied care because of it. and i just want to join what miss delauro says. there is rationing of health care in america. it is rationed by insurance companies who decide they would rather fatten their bottom line than provide care to people. and i think everyone in this room has had constituents or family members or others call them and talk about these

problems. members of congress should not have to be making phone calls to presidents of insurance companies to ask them to provide chemotherapy or heart surgery for people who pay their premiums. the purpose -- one of the purposes of this underlying legislation is to make sure that doesn't happen anymore. this is not a government takeover of health care. it's a consumer takeover of health care, and it's long overdue. i yield pack to my friend, mr. bishop. >> i thank the gentleman for yielding. i yield 30 seconds to miss mccollom and then 30 seconds to congresswoman captor. >> of course, government should not interfere with the doctor/patient relationship. we all agree with that, but we do know that insurance companies are the ones interfering with it right now. in fact, the american medical association and many other health groups vendorsed this comparative effectiveness research, and with that i yield back to mr. bishop. >> yielding back and to close, congresswoman captor. >> i thank the gentleman for yielding and will put up a chart

on the boards here to show you when the insurance companies stand between the patient and the doctor, what they do with the money that they take by denying care, it is unbelievable that companies like wellcare, their ceo makes over $23 million a year. aetna, over $18 million a year, cigna, over $12 million a year. that doesn't count their vested stock options and their regular@ this is private coverage for all the american people. . .

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health authority 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 this difficult time. that's how we're going to do it. >> in west virginia we ask for a waiver for chip, whether it would be expanded or not. so at the time, we asked for a waiver. what you're already saying is why don't you give us some flexibility. we asked for our waiver. for us to basically pay for the screening. you're giving me money to pay for a child if that child gets

critically ill. i said why don't you let me use some of that money so i can start screening every 5-year-old child that comes in our education system. i went back to when we were a kid. most of our health care was delivered in the schools. if we start getting to where we can do the e.m.i. test on the child and see whether they will be susceptible to diabetes, start intervening and changing some of those habits. i can't teach an old dog new tricks, especially when you're feeding them the same thing you always have, which is the parents but i can teach the new kids, the pups. our goal in west virginia is to screen every child. k, 2,5 and 8. we'll give you a healthy workforce and might reverse some

of the unhealthy habits that we have. that is basically using the money you're already giving me. >> that is pretty far in the future. you guys have a -- >> i do think it is a cost issue, what you're asking for all of us. one advantage the states do have and soaring utilizing this policy. counting our public employees and our medicaid population totals about 850,000 people in oregon. we are able to get all of the public sector employees into a single unit for health care. i have the medicaid population. it gives us tremendous market power to be able to go to the carriers and say i have this block of people. this is what we would like you to do. they are receptive to that and that's why i think the exchange is going to be very doable in

oregon because we have already taken the steps to get there. the states have purchasing power with their public dollars is a critical factor in actually bringing about the forms to the system because people will comply to meet the demand where the dollars are at. >> you bring up the exchanges. they really are the basic architecture to have bill, setting up these exchanges. as much as we have heard complaints, this bill being one size fits all, it looks like it is going to be basic bill, the governors really have a fair amount of flexibility, don't they? in how they are going to set up these exchanges and structure them. is the system going to look a lot different, say, in texas than in vermont or wyoming? how are you guys approaching the issue of how you set up these basic building blocks of the bill?

>> the first thing is that we are looking at whether the state will actually put forth a plan toiths compete in the exchange. that's the first thing i think you have to address. the rest of it, at least in oregon, with the purchasing power we have, we can actually structure -- >> your saying basically a public option in oregon? >> yeah, we're looking at that whether the state will provide that option itself. >> one of our colleagues said that the language doesn't seem to provide enough flex to believe the satisfy theñit( parameters of the exchange they have set up already. we again come back to the theme of flexibility in all of these areas. i want to follow up on a point that ted made. purchasing power can be key. a number of states got together in the medicaid drugó[xñ purch pool to leverage our power in theçó÷n marketplace there. so there are great

opportunities. another key, i think, and there is going to be a panel on this later is health information technology. i'll give you one example. in a hospital in vermont, a couple of years ago, a woman came into the emergency department with severe abdominal pain and they have in that area a medication history pilot project so that everyone in the area's medication history is online in the emergency department and if it weren't there, this woman might have been subjected to a lot of expensive tests or maybe exploratory surge, who knows. this doctor said let's see, you're teag such and such for your ulcer. she said actually i haven't taken it in a while. well, mission accomplished in a very inexpensive way. there are lots of things that i think really can reduce cost of

care if we implement them across the country. >> do you see these as being public eptities or a private thing? are many states likely to band together? >> in our state -- if you're in north-central, you're close to the pittsburgh area, if you're in the eastern part, you're close to -- and -- >> you think it would make sense to sort of just -- >> we're going to have to. you know why? the borders don't separate where the care might be given. i have like five borders. with that we're going to be able to workñixd in conjunction with fellow governors really to make the best delivery system that we

can. if we take our ability to -- and we strike the best deal, how about all the people that are not in the -- you know, i say today if, you've got a government job. you're a pretty privileged person, you've got a good guarantee far paycheck. your benefits are guaranteed and your retirement. it is so well guaranteed that the -- is protected. we'll make the rest of society suffer for that. by god, we're not going to let a government employee lose one penny. >> i suspect that one of the reasons for the exchange in the federal legislation was a way in which you could actually identify what the products were that were going to be marketed and we -- most states i think, have done that through a basic or standard health care plan.

that has been available since the mid 1990's but i think the idea behind the exchange was to be able to identify what the products were that were being sold. in our state, you were talking 850,000 people to be put in a pool. i only have 800,000 people in the state. we got to the point from a couple of years ago and did it by making some reforms in a way that we allowed people to compete with one another. i think the exchange has its merits in terms of allowing companies to come in and say these are the products that we have available but don't limit them to only those and if you're going to subsidize individual who is may not be able to afford a product in the market, at least they know if they buy one

of these products, both the public taxpayer know what is they are buying or purchasing or subsidizing and the individual can go in and find out whether or not he has a good deal in terms of where he is placing the dollars that he is investing as well. i think another term might be the marketplace but opened up a little bit so you know what you're buying. and in that respect it can be a very healthy edition of -- in the industry itself. >> the purpose of exchange for me. it was around individuals and small employees. given the small employer the ability to spool a critical piece to have federal legislation. but ultimately, because of the cost in the health care system, there are more and more people looking for health care. if you're going actually have a system that covers over 300% of

the poverty level you to have a subsidy of some kind. if you're going to have a mandate, you have to have an exchange. it is nothing more than a market place of different options that an individual could come to and purchase insurance, if in fact they can't bite because they have got two children and there is a subsidy involved in it. i think it is a necessary part to give the public options to purchase what they think is necessary for them. i don't think it is the answer to health care reform. but i think it is part of the answer. >> will you in oregon do it own? >> yes, we will. >> the redundancey, the over subscrike, the misuse and abuse and the fraud.

if there is one thing that i think could save tremendous amount of money, better service and get reimbursed for that is if we had realtime information. we're getting incentives to our hospitals. sharing this information. and to me, if we can get the physicians and all the -- tied into this system so we know that so and so on the medicaid card on friday was over at dr. smith's and friday night they come and dr. johnson and saturday morning they come over here to dr. jones. you've got a situation. wait a minute here. there is a pattern going on. we have a hard time with that now. the way the system is set up. being able to share that information and work back and forth. so you asked me the greatest ability for us to save, not just

for ourselves but for this government would be the i.t. arena. >> i was talking yesterday to one of your former colleagues, howard dean. who brought up the statistic that i thought was pretty sobering. he claims that of the medical school grattons of 2008, only 9% were going into primary care. which, i think everyone agrees points to a huge problem as we have 30 million plus more people coming into the health care system is again, people to treat them. how are you going deal with this in the short run? how do you get -- is it going to be empowering nurses perhaps more? >> what you do and look, you're absolutely -- you're on target

in terms of where we're going to have shortages. why would a person become a -- a practicing physician. let's just take a rural community where you're on call in our own practice 24 hours a day, seven days a week without a break. or you can specialize and come in and have something close to normal office hours, get paid more and not have the issue of never having a break or a weekend off or having to hire someone to come in -- never getting a break. so unless you have those individual physicians being able to join together, and having a backup, which means physicians assistants and nurses taking larger role in the rural communities. our state actually created the first physician's assistant program in the country.

because we couldn't get the primary care physicians to stay there too. >> of course there has been a nursing shortage too. we have to be careful about personnel across the board. i think this is a good suggestion. not only are fewer going into primary care. we're having fewer graduates. what we have zone pay our primary -- done is pay our primary care docs more. >> money again. >> because we believe that -- and we have shown in the long run that it will save money if we can pay money for early care, early detection for disease and chronic care, it is not immediate, not before the next election. our medicaid waiver is 4 1/2 years old now and we have seen a

real change in utilization by medicate patients. also, a couple of years ago, when we adjusted medicaid rates, we increased them more for primary care physicians than others. i think that can work because it is working. >> we alm know that the health care issue an economic and social issue. all of our companies are talking to us at one time or at about it. but the issue you asked about, primary sfgses and primary care sfgses and nurses and other health care providers. along with our business development people have made this one of their core objectives to expand educational opportunities to train more health care professionals.

trying to reach out and get more students in. >> how are they succeeding? >> well, they have a competition because they are building a new -- an osteopathic hospital down about 60 miles from it has the going to have about 200 students so we're going to, i think, meet the demand on that but this issue around primary care sfgses becomes an economic position particularly in rural areas because companies have a difficult time staying in business if they don't -- one of the conditions they want to have access to a hospital. >> it just so happens that a lot is going to happen between now and the next election on the political front. could you guys just talk about what you think the politics of

this are going to look like in your legislature? are there going going to be a lot of states moving the way virginia did saying we're exemfrom the original mandate? what is the next year going to look like politically in trying to manage this? i think polls are showing that the american people are no not happy with the process in washington. most people want republicans and democrats to work together. i think as joe mentioned we see a clear difference between the level of cooperation in the congress and among the nation's governors who share our experiences, who learn from each other, who steal good ideas and implement them. who have to balance budgets and have to get the job done within a limited time. i think what people see in washington is very dissatisfying. i think we're going to see exactly what you sulingtses,

karen. there are now 38 states where there is a bill pending that are fuses to comply with the mandate or the reform that hasn't even passed. >> is that constitutional, by the stpwhape >> we'll see what the court tells them -- -- by the way? are >> we'll see what the court tells us. we have to feel good about what we're doing. if we have a health care reform measure that is rammed through on a partisan basis and lots of states are saying no, we don't like this, i think we're going to see the kind of resistance that we saw on the driver's license initiative or no child left behind. if the american people are going -- of course all the polls are showing different readings. depending on who is taking them. believe it is a continuing

increase in entitlement program rather than something that really works. a lot of people in west virginia believe if you're old enough you preach have some form of health care. if you're poor enough you pretty much have something called medicaid. we've got about all the children covered. if you're a criminal, the courts make us take care of you. basically four segments are covered. the only segment that is not covered is working people. they are the most vulnerable in our whole society. you don't hear much talk about that. massachusetts is trying to say basically this thing is workers coverp. -- comp. you to buy the coverage. i basically said that every person in west virginia gets up in the morning and goes to work,

first of all, make sure that we're going to cover them and make sure the rest of the society is covered more efficiently than what we're doing today. >> in south dakota, when we started this, we had about 91% of our people who had plans for taking care of their health care. >> it is a pretty old stalte state. [laughter]ñi >> we were talking earlier in one of our community, the average age was 71. it is a small community but it is true. and they are covered. across our state if you take a look at the whole gambit, about 90% of our population has a plan for insurance. one section i hope comes out with better coverage than they have now.

the native american population. i think there has been some -- on the last year. i think the administration has taken it upon themselves and i know members of the house have taken it upon themselves to try to find a way of improving health care. if nothing else occurs, i hope that the indian health service is reformed in terms of providing them with the assistance they need or finding a way so that native americans can participate and from some of the same facilities and practitioners that the rest of the native population can. >> the olded a thadge politicians kill good policy is something we all have to be aware of. the fact is from my perspective, i demend president because i

think this is something that had to be done for last 25rks30 years. you cannot have this country that spends 16% of its g.d.p. on health care. the senate bill if, that is althat happens is a leap forward for this country in the health care debate. i think it is a good idea. is it everything that i would like to see? no. do i think it is the answer to all the problems around here? no, but we are going to move forward from this spot and after this passes, i think that we will finally acknowledge the role health care plays in this country. i think that is what it is about. >> can i ask the other three of you that same question? if you were a house member standing on the floor of the house this friday or saturday, and you guys, your choice, up on the senate bill or down on the

senate bill, how do you vote? [laughter] >> well, i won't be there. i think as i said earlier, we've got to find some common ground and there is common ground. the governor's association met a few weeks ago. governor grant home listed eight or 10 issues on which just about everybody agrees. until we get to the point where we can embrace it, i'm not sure the right state and i'm not sure whether it is going to contain the cost as much as beneed to make our economy viable for the future. >> i don't think i would be forit. >> i would be for it. you have to move this ball forward, right, wrong or different. i have never got a perfect bill

contactly the way i wanted it but i kept working on it. i said we don't come here every year to work the legislative process. it is because we're usually trying to make something better. eerlt we can improve on it or -- either we can improve on it or we made a mistake. you knees to praise this president 2457bd administration for sticking with this as long as they have. i have not seen this much commitment in anything else that we have done in the political process. he could easily say listen, the american people, i have given it the pest shot i possibly can. i have expended more political capital on this one issue than any other group. for that you have to give him credit. let's try to bring this. maybe we can convince jim to help us. [laughter] >> ok. we have one more.

>> you and i could write it. >> i demend president for sticking with a project but that doesn't mean they earn my vote. let me share why. what we have done is put together a plan here in which they have given a us short time of relief. long-term shifts the cost on the everybody else. sand a hidden cost, which is not being identified. so from my perspective, i would say i give him an a for effort but i agree that the concepts that are found ln within this bill will be sustainable long-term and i do not find costs limiting or economizing in the bill that it should have. from my perspective i would say no, because long-term we could afford the bill. >> we have finally identified who is democrat and who is republican. >> you guys sound just like the

house of representatives. you brought up native americans. there is another enormous population here that is going to be entirely left out of this bill, which is illegal immigrants. what is going to happen with them? they are going to keep showing up at the emergency rooms presumably. >> i think that raises another question, karen. we need immigration reform. we have a challenge in our state. every state does. i honestly believed a couple of years ago when pat leahy and george bush had exactly the same proposal to get it through but didn't. i think there has to be a recognition of respect for our laws but also an opportunity for these folks who were parts of our count in have a path to legal immigration. so the congress really needs to confront that and solve that as well.

>> our state is -- we have not seen big influx that other states have seen. the border states have been leading it. i know out west they have more of a concern. and we just need to work, get a policy this country can adopt. >> they are here because they are looking for work and they are taking jobs in many cases that americans, people born here in this country simply are not interested in. there is a reason that they are coming here. because they think they have an opportunity to go to work and they send money back to families. this will be here until such time that we have a national plan that recognizes those individuals are going to continue to try to get her and get into the country. in terms of health care, our society will always respond do

somebody who is in need. at some stages the federal government steps in and says we're going to take care of them or does it get passed on to everybody else? today it gets passed on to everybody else. >> i come at this a little different. i always look, i say if the child needs health care, are you telling me as a people we're going to tell them, well, you can't prove your citizenship, you don't get health care. we're not going to treat you. i don't think anybody would want to do that. i think the same thing with their parents. it is an immigration reform issue but i don't think that these two should be joined together the way they have been. i think it is the pitting of one against the other and the fact that they are here and we're going to have to treat them and i just can't imagine it. >> that's problem, know.

it is that they are showing up at the emergency room. do you see the political will in any of your states to or is there even a possibility in this bill to do something besides -- >> free clinics. things of this sort that we support. we should encourage that but again, we come to the whole question, back to the legality of -- the policies in each of our states would be adopted according plism >> speaking of the clinics, i think that is something that bernie sanders deserves a lot of credit for. there is the money in this bill to set up new ones andhow 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 two million people. ted has 3.8 so he is over the two million mark. this is a primary delivery for most of us and our rural areas, how we deliver health care. >> one of the things a oregon is looking at is integrated health centers. what it is is doing everything that joe 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 that you can 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 actually what clinics do. they try to reach out and treat them all. i think that what 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 wellness and preventive care. it is expensive but it is an especially needy part. >> there was a survey a couple of years ago that asked lower income americans what their

greatest health concern was and it was oral health, because it was not only pain, but self-esteem and employability. so it is an important part of the well-being of our constituents we have to be concerned about. >> 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 able to fill in the rest of their schedule with people that pay a closer percent tooge the full rate. we had a increase the rates that we were reimbursing. we had a larger number of dentists, as a matter of fact, most of them participate one way or the other in serving the medicaid population. but it was underpricing the product was being delivered.

in terms to have medicaid costs. >> we just have a few minutes. i want to ask each of you rather quickly. what if this bill doesn't pass? what is the first thing on your "to do" list? >> we didn't know whether we would have a bill 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. and the goal of n.g.a. and this 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. if there is no federal bill passed, 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. i really believe this.ñr they don't look at just the bottom line and the dollars and cents but basically how do they keep their children and nieces and nephews 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. i think that's what this is all

about. the n.g.a. is what we have always said. we want to be a part of the federal government. we think that we're 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. if we can afford it. end of the fiscal year. with that, 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. so we're prepared to move forward. >> there are 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.

you can and individual ways of making an improvement in the health care delivery system on a state-by-state 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 or approaches to allowing for a 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 sameçó guidelines we use for our state employees. we use the same managers for both. 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 and yet you have young people that we truly recognized that you have to give them quality education. the challenge will be are states going to be spending money on educating children or taking care of people who have nowhere else to go for their health care needs. >> 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

authority. 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. 2010-2020 that oregon would receive. would i like that? you better believe i would. 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, a quality health care program for all of our since the. it is a distribution issue, allocation, how do we do it. i think that is what oregon is moving forward on. trying to find that mix of where, in fact, we can take the dollars that we have and actually provide that quality health care for every citizen who deserves it. >> everyone keeps thinking, and talking more money, more money,

more money. i've got on the the point in my state that money won't fix the problem. you had better have a plan that will fix the 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 really fixes the problems that we've identified without us throwing more money to it. that is the pushback from the american people. when is enough enough? how much more do you want out of my hyde? 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? >> the broader context is $12, $13, $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 as well. >> i think we're coming to the end of our time here. i want to thank all of you. it has been extraordinaryly enlightening for me and also to wish you luck. you have at your work cut out for you. thank you very much. >> thank you very much. [applause] [captions copyright national cable satellite corp. 2010] [captioning performed by national captioning institute] >> next on c-span, we continue our look at the health care

debate. tuesday, president obama was in ohio talking about the nation's health care system. after that, the house budget committee works on the health care reconciliation markup which would change the original senate bill that passed the senate last december. >> this week lawmakers are making the final push to get health care legislation to the president's desk. you can follow the latest from the white house and capitol hill on the only network that covers washington gavel to gavel unedited with no commercials or commentary. c-span. go to c-span online/healthcare. iphone users get the latest with the crmp span radio a everyone

p. this event is about 35 minutes. [applause] [applause] [applause]

>> hi. my name is connie and i am here to introduce the president on behalf of my sister. she cannot be here today. in 2009, her premiums increased over 25% when she learned in 2010 her premiums would increase again by 40%. she was simply priced out. my sister, a self-employed, strong woman, was no longer able to afford health 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's c.e.o.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. [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. [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] >> 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. first of all,you are already saw him, governor ted strickland in the house. [applause] 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. [applause] your own congressman, who is tireless on behalf of working people, dennis kucinich. [applause] >> 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. [applause]

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. 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. [applause] and -- and i want everybody to understand that connie and her sister are the reason that i'm here today. [applause] 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's 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, so she bought her health insurance through the individual market. and it was important for her to 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 her deductible. she did everything she could to maintain her health 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 in out-of-pocket medical costs, for co-pays and medical care prescriptions. 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? it's 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 couldn't make her mortgage. and despite her desire to keep her coverage and 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, who 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 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 c.e.o.'s. but i thought it was important for them to understand the human dimensions of this problem. her rates had been hiked more than 40%. this was less than two weeks ago. unfortunately natoma's worst fears were realized. just last week, she was working on a nearby farm,q walking outside, apparently chasing after a cow, when she

collapsed. and she was rushed to the hospital. she is very sick. she needed two blood transfusions. doctors performed a battery of tests. and on saturday natoma was diagnosed with leukemia. the 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 to have tests and the treatment that she is 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 to face the most terrifying challenges in their lives with the added burden of medical bills they cannot pay.

i don't think that is right. neither do you. that is why we need health insurance right now. health insurance reform right now. [applause] i'm 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 pre-existing conditions or dropped from coverage when they get sick. [applause] i'm here because of the small businesses who are forced to choose between health care and hiring. i am here because of the seniors unable to afford the

prescriptions that they need. [applause] i am here because of the folks seeing their premiums go up 20% and 30% and 40% and 50% and 60% in a year. [applause] ohio, i am here because that is not the america i believe in. that is not the america you believe in. so when you hear people say "start over." i want you to think about it. when you hear people saying this is not the right time, you think about what she's going through. when you hear people talk about well, what does this mean for the temperatures -- democrat or the republicans. i don't know how the polls are

doing. 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's why we need health insurance reform right now. [applause] you know, part of what makes this issue difficult is most of us do have health insurance. we still do. and so we kind of feel like, well, i don't know, it is kind of working for me. i'm 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. [applause]

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 fainted so if we could get a medic. just give him or her some space. 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 if you 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. for 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 is money straight out of your pocket. so the bottom line is this. the status quo on health care is simply unstainable. we can't have -- [applause] we can't have a system that works better for the insurance company than it does for the american people. [applause]

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 millions more people will lose their coverage. we know that rising costs will burden more families with unaffordable expenses and a lot of small businesses are just going drop their coverage altogether. that has already happened. a study came out just yesterday. a nonpartisan study. it found without reform, premiums would more than double over the next decade. family policies could go to an average of $25,000 or more. can you afford that? you think your employer can afford that? your employer can't sustain that. so what is going to happen is they are basically