guest: first off, again, everyone has a strongly felt views about this issue. what i am focusing on this public policy and a woman's right to determine her own future and control her own body and health. i would like to say that this is absolutely an issue of women's rights. we cannot use economic coercion to change women's rights. host: erin matson is the action vice president for the national organization of women and has been our guest talking about title x family-planning programs. thank you for being on the program. we want to tell you a little bit about who will be on "washington journal" tomorrow. we will be discussing the developments in the politics up on the hill and at the white house as well as the cpac convention which has been in town most of this week with

stephen dinan, david mark, senior editor of "politico." we will be talking about the budget process as it unfolds with robert bixby of the concord coalition and samer shehata talking about the muslim brotherhood and the priorities as egypt seeks to forming a government after the recent uprising. that is coming up tomorrow on "washington journal." we went to you know that we have been covering the cpac conference for most of the week and one of the articles talking about that conference is in "the new york times peacoat "gop hopefuls offer criticism of all things obama." they will conduct a straw poll in late this afternoon they will be releasing the numbers. we will have live coverage of that on c-span starting at

about 5:15 p.m. if you want more information about c-span's coverage of cpac, go to our website, c-span.org. thank you very much for watching this edition of "washington journal" and we will see you again tomorrow at 7:00 a.m. eastern. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2011] >> this morning, a couple of house hearings. the first one was for federal

funding for abortion. next, financing for the new health-care law. later, our coverage of the conservative political action committee starts with governor haley barbour. >> every weekend, listen to historic supreme court cases on c-span radio. today, the court considers government employment and free speech. >> the core function of the agency is to teach the republic about the law. first-aid the main sad and undermines it -- her statement s that. >> i think that is not only one of the major challenges facing

higher education in the country, but also facing our country. that is, how we maintain a healthy lifestyle and to have the strength and the judgment to say no. >> the president of southern methodist university. sunday night, he will discuss today's college students. his university is the site of the president bush library. sunday on "q & a." >> now i house judiciary subcommittee hearing -- a house judiciary subcommittee hearing. you will hear from anti- abortion and abortion-rights groups. this is about one hour and 30 minutes.

welcome to all of the >> side-note here. rule 11 of the house rules provides that the chairman of the committee make breaches of order and decorum gi senses you'res in the hearing. presently we have people standing and makes the order not -- in order in the hearing room. so members of the room must behave that in an orderly

fashion and i say that respectfully but otherwise they will be removed in the hearing room so hopefully you will sit down. okay. all right. it was once said hold on, my friends to the constitution and to the republic for which it stands. for miracles do not cluster and what has happened once in 6,000 years may never happen again. so hold on to the constitution for if the american constitution should fall there will be anarchy throughout the world. our founding fathers wrote the words of our constitution down for us because they do not want us to forget that their true meaning or to otherwise fall prey to those who would deliberately undermine or destroy it. this has always been the preeminent reason why we write down documents, declarations or constitutions in the first place. to preserve their original meaning and intent. protecting the lives of innocent

americans and their constitutional rights is why those of us in this room are all here. and indeed this is why congress itself exists. the phrases and the fifth and fourteenth amendments capsulate our entire constitution when they proclaim that no person shall be deprived of life, liberty, or property without due process of law. those words are a crystal clear reflection of the proclamation of the declaration of independence that all men are created equal and endowed by their creator with certain unail i can't believe rights, those being life, liberty and the pursuit of happiness those words are the essence of america and our commitment to them for more than two centuries has set america apart as the flagship of human freedom in the entire world. and yet unspeakable suffering and tragedy have occurred whenever we have strayed from those words. our own united states supreme court ruled that millions of men, women and children were not

persons under the constitution because their skin was black. it took a horrible civil war and the deaths of over 600,000 americans to reverse that unspeakable tragedy. and we saw the same arrogance in 1973 when the supreme court said the unborn child was not a person under the constitution. and we have since witnessed the silent deaths of now over 50 million innocent little baby boys and baby girls who died without the protection the constitution gave them and without the protection this congress should have given them. h.r. 3 is a bipartisan bill that takes a step to turn america away from that tragedy. the bill forms part of the new majority to new america codify the hite amendment currently funding taxpayer abortion in all federal programs. it protects health care workers right of conscience so they cannot be coerced to participate in abortion procedures as a condition of their employment.

[inaudible] >> the capitol police are in the process of restoring order here and we're going to go ahead and continue. the speaker of the house, john boehner directed that this bill receive the designation h.r. 3 as, quote, one of our highest legislative priorities. h.r. 3 is intended to continue the same policy as the hite amendment. the hite amendment prohibits taxpayer funding of abortion excluding rape and the mother's health. this will not be a departure of the decades of implementation of the hite amendment and to assure lawmakers that funding policy as it relates to cases of rape will not be altered by this bill. the second part of this bill provides necessary protection for health care workers who will not perform a refer of abortions as a matter of conscience.

those who believe that a pregnancy is a circumstance which presents with two patients, the mother and the unborn child cannot in good conscience do harm to that unborn child and, therefore, should not be coerced into performing abortions as would be required under the current health care system. neither is said that government is what it spends. planned parenthood alone boortz a quarter of a million unborn babies every year, all the while it receives hundreds of millions of dollars in federal, state or local taxpayer funds. this legislation is really about whether the role of america's government is to continue to fund a practice that takes the lives of over 1 million little americans every year. even some of those who do not consider themselves pro-life strongly object to their taxpayers going to pay for abortion, their dollars. i believe the intensity of this debate has something to do with our collective conscience. perhaps it's because ultrasound

technology has begun to demonstrate to all reasonable observers both the humanity of the victim and the inhumanity of what is done to them. we are beginning to realize as americans that somehow we are bigger than abortion on demand. and that 50 million dead children is enough. and we're beginning to ask the real question, does abortion take the life of a child? if it does not, then all of this here today is a nonissue. but if it does, then those of us sitting here in the chambers of freedom are in the midst of the grateful human genocide in the history of humanity. thomas jefferson said that the care of human life and its happiness and not its destruction is the chief and only object of good government. and, ladies and gentlemen, using taxpayer dollars to fund the killing of innocent, unborn children does not liberate their mothers. it is not the cause for which

those lying out under the white stones in arlington national cemetery died, and it is not good government. abraham lincoln called upon all of us to remember america's founding fathers and, quote, their enlightened belief that nothing stamped with the divine image and likeness was sent into the world to be trodden on or degraded and imbreweded by its fellows. >> he reminded us those he called posterity that when in the distant future some man, some faction, some interest should set up the doctrine that some were not entitled to the life, liberty and the pursuit of happiness that, quote, their posterity, that's us, ladies and gentlemen, their posterity might look up to the declaration of independence and take courage to renew the battle which their fathers began. may that be the commitment of all of us today. i look so forward from hearing from the witnesses and i now recognize the ranking member of the subcommittee, mr. nadler, for his opening statement.

>> thank you, mr. chairman. i first want to note that this is our first subcommittee hearing of the 112th congress and your first as chairman. i want to congratulate you. although our jurisdiction includes some of the most difficult issues before the congress, some of which have historically been very contentious, i look forward to working with you in the spirit of comity to give what we both know strongly and sincerely-held views the fair hearing that they deserve. having chaired this subcommittee for two congresses, and having served as the ranking -- as the ranking member, rather, for several congresses before that, i appreciate what a challenge this subcommittee can be and i look forward to working with you. today's hearing concerns what may be the most -- the most difficult and divisive issue we will have the opportunity to

consider. a woman's right to make decisions about her own body, whether to become pregnant, whether to continue a pregnancy or whether to terminate it has long been a right protected by the constitution. whether or not people think that it is a good idea or a fair reading of the constitution or morally correct, it remains the law of the land. congress has for more than three decades used economic coercion to try to prevent women from exercising their constitutionally protected choice by prohibiting use of federal funds for abortions. the only legal health care procedure subject to such a ban. until now, that coercion was directed against the poor and against women dependent on the government for health care, military personnel and their dependents, prison inmates and federal employees. we have thus developed a two-tiered system which people with means have the right to choose but members of vulnerable

populations do not. now comes the no taxpayer funding for abortion act h.r. 3, which is really misnamed but it really has to do with taxpayer funding for abortions because way beyond that question in places government in the middle of private choices by families and businesses about how they wish to spend their own health care dollars. this legislation represents an entirely new front in the war against women and their families. after two years of hearing my republican colleagues complain that government should not meddle in the private insurance market or in private health care choices, i was stunned to see legislation so obviously designed to do exactly that. it seems that many republicans believe in freedom, provided no one uses that freedom in a way they find objectionable. that is a strange understanding of freedom. even more stunning, this bill contains a huge tax increase on

families, businesses and the self-employed if they spend their own money. let me repeat that, their own money on insurance that covers abortions or services. the power to tax is the power to destroy and here the taxing power is being used quite deliberately to destroy the right of every american to make private health care decisions free from government interference. a republican tax increase, a republican support for government intrusion of private health care choices -- you're supposed to say you heard it first but if you read the bill, you saw it there first. i'm equally surprised to find out that my republican colleagues think that a tax exemption or credit is a form of government funding. what happened to all the rhetoric about it being our money? or does that only apply in certain circumstances. do we have to call every tax exemption or credit a form of government funding for the recipient?

i'm sure there will be many businesses, charities and religious denominations that will be along to find out that they are being -- that they are receiving government subsidies. i also join many other americans in being absolute horrified -- well, before i get to that. let me say among others who should be horrified, the churches and the synagogues and mosques that will now have to presumably give up their tax exemptions because of tax exemptions are government subsidies and that's a direct establishment of religion. and the logic is inexorable. either a exemption is government funding in which case we cannot give tax exemptions to churches, synagogues or mosques or it is not in which case this bill has no claim on anything. and i also join many other americans being absolutely horrified that the sponsors of this bill seem not to know what rape and incest are. rape according to this legislation is only forcible in

quotes rape. date rape drugs, sex with minors with the mentally impaired are sponsors of this bill are not really rape anymore. incest is no longer incest. instead, it is now only incest with a minor that we have to be concerned about which means, i guess, that incest with a high school senior doesn't count. have the extremes really taken such a hold on this debate that we cannot even agree to help children and teenagers or the victims of predators? is there no compassion left in this capitol? i have heard that the rape and incest provisions are going to be removed from this bill or modified because of the outcry it has raised -- they have raised. but first we have not seen such an amendment yet and second, what this position -- even if the amendment what does this provision in the first place say about the mindset and the intent of the legislation? there's also a provision in this bill that in the name of conscience of health care providers would allow any health

care provider or institution to refuse to provide an abortion to a woman who would die if she doesn't get the abortion. it would refuse to -- it would be allowed to refuse to provide an abortion in the emergency room even if the medical judgment is that without that abortion, she would die. they would let that woman die right there in the emergency room and the government would be powerless to do anything or penalize it or prevent it. under the provisions of the bill insist that the hospital not let the woman die, section 311 of the bill would allow the hospital to sue the government and in the case of a state or locality strip that community of all federal funding until the jurisdiction relented and allowed women to die if they needed an abortion to prevent the death. that's the new definition it seems of pro-life. so, mr. chairman, let's start off on the right foot. the no taxpayer funding of abortion act is not really about taxpayer funding.

it's about government interfering with private health care decisions. it is not about protecting the innocent. it is about creating appalling even life threatening situations for women. it is a tax increase of historic proportion. finally, if passed, it would eliminate the private market for abortion insurance coverage. the chief sponsor of this legislation, the gentleman from new jersey, mr. smithers has been very clear about his purpose. when he introduced this bill, he cited a study by an institute that showed a decline in the rate of abortions of approximately 25% when funding is cut off. what that proves, if it proves anything, is that economic coercion works. in the remarks we just heard from the chairman made crystal clear that the unashamed purpose of this bill is to use economic coercion to prevent women and families from exercising their constitutional right to make a choice of abortion, even with their own funds. it is an unprecedented attack on

women, on families, on the constitution and for that matter on the private insurance market. let's not pretend this bill has anything to do with government funding. it does not. i yield back the balance of my time. >> thank you, mr. nadler. and without objection, other members' opening statements will be made part of the record. >> mr. chairman? may i be recognized for unanimous consent request? >> yes. >> thank you, mr. chairman i ask unanimous consent request -- i'm sorry. i ask unanimous consent to place into the record testimony submitted by our colleague the gentlewoman from the district of columbia, miss norton. the gentlewoman be requested that she be presented testimony at this hearing because there's a provision in the bill that specifically pertains to her district, the district of columbia and to no other who we are told the chairman of the full committee has denied that request. i'm sorry. i regret she was denied the permission to testify.

and i hope that this has been a misunderstanding and that the future members of congress will as is the practice when i was chairman of the subcommittee would be permitted on request to testify as witnesses especially if there's something to do specifically with their own district. and i ask unanimous consent to place her statement and my statement in the record. >> without objection, your statement and hers will be placed in the record. >> thank you. >> just to clarify the issue, mr. nadler, chairman smith has decided that as a general policy the judiciary committee and its subcommittees will only have one panel of witnesses for each hearing and that the panel will consist of no more than four witnesses. and the minority is able to select a witness and if they would like to invite a member to testify, that's certainly something they can do. the chairman did not refuse ms. norton's ability to be here. she just had to be chosen as one of the minority witnesses. there may be times where the committee is not able to

accommodate every individual who wishes to testify, however, the record always remains open for five legislative days for others to submit testimony if they wish. this is a bright line rule that is not meant to discriminate against any particular potential witness. it's meant to ensure that hearings are succinct enough so that members are able to hear all of the witnesses and participate in a meaningful way. >> mr. chairman? >> mr. nadler. >> thank you, i'd simply like to comment on that. i have never objected -- some committees in this congress have three and four panels. i certainly never objected and sometimes i welcome this committee generally only has one panel. it makes life easier and more succinct. i'm not objecting to that. now, however, when the minority has only one witness, which has been the practice under democrats and republicans and certainly that's not a change here, but in certain circumstances it presents a quandary. here we have a bill dealing for the most part with a broad issue of taxpayer funding of everything that i talked about.

and a specific provision dealing with the district of columbia. to say that the minority could have ms. norton as the witness to talk about d.c. is to say we couldn't talk about the basic provisions of the bill. and if we choose to have one witness on the basic provisions of the bill then you can't talk -- then ms. norton is denied the opportunity to talk about her specific application to her district and that is why when i was chairman -- if a member desired to testify, especially if there was something to do with his or her district, we would always provide a separate panel for that. and for partisan purposes you might say, if it's a republican we'll have a democrat. but it allows that flexibility in the general rule and i would hope in the future that flexibility would be attended to. >> thank you, mr. nadler. if the witnesses would come forward and be seated. we have a very distinguished panel of witnesses today. each of the witnesses' written statements will be entered into

the record in its entirety. and i ask that each witness summarize his or her testimony in five minutes or less. to help you stay within that time there's a timing light on your table. when the light switches from green to yellow, you will have 1 minute to conclude your testimony. when the light turns red it signals that the witnesses' 5 minutes have expired. our first witness is mr. richard m. doerflinger, associate director of the secretary of pro-life activities, united states conference of catholic bishops. he has worked for over 30 years. his writings on medical ethics and public policy made -- include contributions to the journal of law medicine and ethics, duquesne law review, the kennedy institute of ethics journal, the national catholic bioethics quarterly and the american journal of bioethics. the may 22nd 2004 journal featured mr. doerflinger as one of the twelve experts whose ideas are shaping the national debate on the use and abuse of

biotechnology. our second witness is cathy ruse, senior fellow for legal studies at the family research council offices. mrs. ruse worked previously as frc's legal director zest a legal council and national center for children and families. we're proud to note that mrs. ruse -- ms. ruse served as chief counsel of this very subcommittee. "wired" magazine has called her one of the most influential opinion-shapers in the country. our third witness is professor sarah rosenbaum, the harold and jane hearst professor of health, law and policy and chair of the department of health policy at washington university school of public health services. professor rosenbaum also directs the hearst health law and policy program and the center for health services research and policy and holds appointments in the schools of medicine and

health sciences and law. and without objection, all members will have five legislative days within which to submit materials for the record. it is the practice of this subcommittee to swear in the witnesses so if you'll all please and stand and raise your right hand. do you swear or affirm that the testimony that you're about to give will be the truth, the whole truth and nothing but the truth so help you god. thank you and please be seated. i now recognize our first witness, richard doerflinger for five minutes. sir, would you turn on that microphone. >> is that it? >> yes, sir, thank you. >> thank you, mr. chairman, for this opportunity to present our views in support of the no taxpayer funding for abortion act. this bill will write into permanent law a policy on which has been strong, popular and congressional agreement for over 35 years. the federal government should not use tax dollars to support or promote elective abortion. that principle has been embodied in the hite amendment and other

provisions governing a wide range of foreign and domestic programs and has consistently had the support of the american people. even courts insisting on a constitutional right to abortion had said that alleged right, quote, implies no limitation on the authority of a state to make a value judgment favoring childbirth over abortion and to implement that judgment by the allocation of public funds. in 1980 the u.s. supreme court said the hite amendment is an exercise of the legitimate, congressional interest in protecting potential life. adding, quote, abortion is inherently different from other medical procedures because no other procedure involves the purposeful termination of a potential life. in our view, the courts only mistake that with the phrase potential life in our view unborn children are actually alive until they are made actually dead by abortion. while congress' policy has been consistent for decades, its

implementation and practice has been piecemealed, confusion and sometimes sadly inadequate. gaps or loopholes have been discovered in this patchwork of provisions over the years highlighting the need for permanent and consistent policies across the federal government. last year, congress passed major health care reform legislation with at least four different policies on abortion funding ranging from a ban on such funding on one section of the bill to a potential mandate for such funding on another. as h.r. 3 has been enacted before that debate began. the debate would not have been about abortion. to support by catholics and pro-life americans would have been removed and the final legislation would not have been so badly compromised by provisions that place unboon human lives at grave risk. h.r. 3 would prevent problems and confusions on abortion funding in future legislation. ..

one of many conscious provisions beginning with the church amendment in 1973 named after senator frank church of idaho, which has tried to protect the rights of health care providers, not to be coerced into abortion. the amendment was recently reaffirmed unanimously as part of the house version of health care reform legislation in congress and waxman health subcommittee was approved by a voice vote without dissent. it did not survive in the final legislation. federal agencies and state and local governments receive federal funds do not discriminate against health care providers because they do not take bad teeth apart and

abortions. this is a modest bill that has the federal government essentially policing itself, a government restraining itself from coercing abortion. it does not reach out and to private actions. it is long overdue for the hyde wheldon policy to receive a more secure status. congress's policy has been clear for 38 years that the mechanism for achieving it has suffered from drawbacks and loopholes including a failure even to specify where or how providers may go to have their rights in force. h.r. 3 writes the essentials civil-rights protection and permanent law allows for modest and reasonable remedies to ensure compliance, provides for private right of action, and designates the hhs office of civil rights to hear complaints. the need for more secure protection is there. the american civil liberties union has been urging the federal government to force catholic and other hospitals to

violate the moral and religious convictions by providing with the aclu calls to emergency abortions by which it means all abortions to serve women's life or health. they surely know it has been interpreted by the federal courts to mean socially or emotional well-being. this is an obvious threat to access to life affirming health care. catholic hospitals alone care for one in six patients in the united states each year and provide a full continuance of health care for more than 2,000 sponsors, systems, facilities, and related organizations. they have been shown to provide higher quality and more effective care including care for women than anyone else in the various studies. if congress wants to expand, rather than eliminate access to life test shaving health care including a live-saving health care for women and particularly for the poor and underserved it should be concerned about any effort to attack the rights of

these providers and undermine their continued ability to serve the common good. just to give a short answer to some questions raised about h.r. 3 with wonder answers in our prepared text, h.r. 3 does not eliminate private coverage for abortion, but specifically allows such coverage would be purchased without federal subsidy. does not -- does not create an unprecedented policy of denying tax benefits to abortion, but follows the recently enacted an affordable care act in this regard, which i believe had some democratic support. it is that act which said use of tax credits for abortion is federal funding of abortion. that simply follows the precedent. this bill does not depart from precedent by saying that the law does not compel states to fund abortions. in this regard as well it follows a policy actively supported by the democratic in the last congress and stated no

less than three times in the affordable care act. finally its conscience clause does not place women's lives at risk, but places women's lives at risk, as recently land from the story in philadelphia which is only the tip of the iceberg, but placing women's lives at risk is the abortion industry itself as well as that same industry attacking the continued viability of the most effective providers of life-saving care and the world. my prepared text provides additional details on these points, and that would be happy to answer questions. >> thank you, mr. richard doerflinger. we now recognize mrs. ruse for five minutes. >> thank you for inviting me to provide testimony this morning, this afternoon on the funding for abortion act. it is nice to be back.

a little less work on this side of the days, but not much. thirty-five years ago something of a consensus was reached between those who support legal abortion and those who oppose it. whatever our differences on the underlying question of legality, a majority of americans can together in support of the proposition that the federal government should not subsidize abortions. that consensus took the form of the hyde amendment of 1976 which limited abortion funding appropriated under labor hhs to cases where eight abortion was necessary to save a mother's life and later involving rape and incest. the supreme court upheld the constitutionality of the amendment in harris the gray and in so doing made a sharp distinction between abortions and other medical distinctive up procedures. in the words of the courts no other procedure involves the purchase purposeful termination of a mature -- potential life. that abortion is scandalous to

many is understandable. it is exceptionally controversial in the united states is beyond dispute. for these reasons it is entirely appropriate that abortion's not be subsidized in any way by the federal government. that no taxpayer funding for abortion act implement this legal and political consensus on a government-wide basis. over the years the hyde amendment and others like it have been included in various appropriations bills renewed annually by congress. what has been lacking is a single, simple law prohibiting government funding of abortion across the board wherever federal dollars are expended. we, taxpayers, paid for 425 abortions and fiscal year 2008. 220 last year. without the hyde amendment and the patchwork of other appropriations, that number could skyrocket to as many as

675,000 government-financed abortions every year, according to the cbo. now, two measures passed in the last congress also threatened to escalate the number of government-funded abortions dramatically. the d.c. appropriations bill opened the door to federal funding for any and every abortion in the district of columbia. and the patient protection and affordable care act known popularly as obamacare authorized federal funding for elective abortions directly and through private health insurance plans. a detailed accounting of the abortion subsidies is included in my written testimony. because these programs are directly appropriated and not subject to further appropriation under labor hhs they are not subject to the hyde amendment. as for the executive order purporting to nullify abortion

and obamacare last month former white house chief of staff admitted that he can up with an idea for an executive order so that the abortion fundings restriction would not exist by law. , on this he and i are in agreement with each other and also with planned parenthood who issued a statement calling the executive order a symbolic gesture. it is axiomatic that when government subsidizes conduct it encourages it. our tax code is replete with pertinent examples. the supreme court acknowledged to the truth of this proposition in the context of abortion. most abortions in america are purely elective. the 92 percent of abortions every year are performed on healthy women with healthy babies according to the alan good marker institute. in light of this fact the

abortion funding question is quite literally a matter of life and death for many thousands of american children. now, president obama has urged americans to find common ground on the controversial issue of abortion. americans have come together. 67 percent of us, and what may be the only truly bipartisan agreement possible. whatever our differences on the issue of abortion, we can agree that the federal government should not subsidize it. this is the common ground issue on abortion in america today. h.r. 3 would make that common ground statutory law. did you. >> thank you, mrs. ruse. we would now recognize professor sara rosenbaum for five minutes. >> thank you very much for inviting me today to appear before you. i would like to make three points in my testimony.

i have submitted an understatement for the record. the first has to do with a baseline from which we are working and considering h.r. 3. the second has to do with the changes in the bill. the third has to do with the impact of these changes. insofar as the baseline is concerned, i'd think it is very important to understand what the affordable care act does and does not do. the affordable care act where tax credits are concerned allows women to obtain tax credits, to use those tax credits to buy insurance products and if they choose to use their own money to buy additional coverage for abortion. if they make that choice and use their additional funds, their own funds to buy abortion coverage the tax credits remain completely available for the abortion product. i emphasize this because it underscores the unprecedented nature of the bill. the bill would actually for the

first time move the hyde amendment far beyond where we have known it for the past 30 years directly into the tax code. its reach in the tax cut is extremely broad under this bill. it reaches the deductions, credits, advanced tax credits, even when they have to be repaid at a later date. it reaches held savings accounts, flexible spending accounts, money that we as individuals but aside for our medical care needs. it even potentially reaches employers and employees deductions for insurance because of a critical ambiguity in the drafting of the bill. it is unclear, actually, where the bill stops. the impact of the bill in so far as tax policies are concerned is enormous. the first fallout is on the irs which heretofore has not played a role in implementation of the hyde amendment.

the irs is going to have to implement extremely complex provisions of the tax code that regulate tax favored a health benefit plans and medical care payments. we are going to need a rash of implementing policies, the internal revenue service to find a rate, a potentially and forcible rape, incest, potentially incest involving minors as opposed to not involving minors, physical conditions endangering life and the spoken dangers -- conditions that don't endanger life. the irs would have to tell us what evidentiary standards would be required for individual claimants and employers who choose to buy products or make expenditures that wander into these areas. there will have to be exchanged review process. for example, is a spontaneous abortion or miscarriage an allowable expenditures under off its fund? does it cross the line? what will be the appeals procedures? how will plans be allotted -- audited to make sure coverage

stops at the elbow points under the statute? the fallout on plans is equally serious. my own analysis, both of the spill and previous spills that attempted to do that similar things in terms of the impact on the insurance industry leads me to conclude that what we will see, in fact, is a complete exodus of health plans from the market of abortion coverage. i realize that maybe the long term goal here, but, of course, because there are not a lot, but a small number of very serious medically indicated abortions, this would be an enormous problem. the third fallout is on the women themselves, not only because they can no longer get coverage for abortions that are medically indicated, but because the typical practice in the health plan is to exclude not only specific procedures. here it would be required under law. but follow-on procedures and

treat as related to the original excluded at treatment. so to use the example, a woman who needs an abortion because she has eclampsia, stroke-level hypertension who then needs subsequent treatment for hypertension could find that she, in fact, is disqualified for treatment for that hypertension because the hypertension and rose as the result of a condition that led to an excluded abortion. there is no stopping point. i would finally note that with the conscious clause provisions of this law to be enacted it would recommend the first grade unraveling and the absolute duty on the part of hospitals to provide a live-saving treatment regardless of the underlying medical condition. >> thank you, professor. thank all of you for your testimony, and i will now begin the questioning by recognizing myself for five minutes. i'll start with you, mr. richard

doerflinger. absent the enactment of h.r. 3, what does a health care provider risk if the provider of base his or her conscience and refuses to perform an abortion? >> i don't want to overstate this because in my view h.r. 3 basically codifies and makes more permanent protection that has long been in law. the problem is that -- this was illustrated in one case in new york very recently. the existing conscious laws are not very clear on what it is you do to actually protect your rights. gainers by the name of the carlo at mount sinai medical center recently found that although she was forced to participate in a late-term abortion after having her statement accepted by the initial -- initially by the hospital staff that she would not be required to assist in these abortions. she was forced anyway. she was given the job of

reassembling the body parts on the table in the operating room to make sure they got all the pieces of the baby and has had nightmares ever since. had a terrible time. she was told she would be fired if she did not do this. what she found was when she went to court, because the conscious, the federal conscious laws don't have anything in them that say you have a private right of action to go to court she had no recourse. all she could do is file a complaint with the department of health and human services, and a year-and-a-half after the abortion she still has not heard from them. the cases in which there continue to be efforts to get governmental bodies to discriminate against pro-life health care providers occur every week. there was a recent case here in my hometown, montgomery county in which holy cross hospital seems to be on course approved by the state of maryland to build a new hospital in northern montgomery county because it had -- it made the best case for being able to provide excellent care to the women and men of the

county. there was a serious effort fight abortion activists to say you must not give this contract to holy cross hospital, but someone else, even if it did the general health care proposal is not as good because if you give it to holy cross he will not have access to abortions through the hospitals up there. these efforts to discriminate against health care providers occur all the time. we are trying to make sure the protection is actually there and working. >> mr. doerflinger there was a controversy in 2007-8 concerning the concerns of conscious protections for health care workers, specifically changes in the ethics guidelines. changes in the certifying criteria for the certifying agency of ob/gyn, that is abog. all of these acronyms. the american board of obstetrics and gynecology. it calls into confusion whether

it can result in the certification, ending their career. would you explain this controversy and have led to the regulations put in place at the end of the bushes ministers in? >> yes, the ethics committee companion came out and 2007. despite all the controversy it was reaffirmed by the organization in 2010. what really sent a chill of fear across many ob/gyn throughout the country he did not perform abortions is that very often the ethical principles articulated by a acog become a standard for certification by the partner organization, the american board of ob/gyn. this was one of the reasons why the bush administration decided to try to clarify regulations who -- to uphold these providers rights and regulations, which the obama administration has proposed to rescind. but the acog document is

breathtaking in its disregard for any ob/gyn that does not want to do abortion. they say that these ob/gyn must nonetheless be willing to refer for abortions. if there is no one to refer them to they must do than themselves. they even say that if you are an ob/gyn that does not do abortions he should make sure you look it your practice near an abortion provider to make sure it is easy for everybody to get from you tell the abortion. so you have -- one talks about the tail wagging the dog. this is the tip on the tale of the dog wagging the entire health care system saying people have to disrupt their lives and livelihood and change even with a practice to make sure they are as close as possible to an abortionist. >> i'm not going to try to get a question in here. my time is gone. i will yield to the distinguished gentleman for his questions. >> thank you, mr. chairman.

ms. ruse, you take the position the reduction of taxation is a form of government subsidy. this is flatly at odds with what the organization of family research council stated in the context of tuition for religious schools. if it isn't -- where you said there is no government spending on religion here, and people's private money that they sent to various organizations. isn't it federal funding when people used to have it isn't federal funding when people use their private money at a parochial school and see the tax deduction or credit for doing so. how is it when people use their private money to pay for their medical care or insurance coverage? >> as a general proposition tax reduction is a form of government subsidy. >> and bike tax subsidy you meaa reduction. >> that's right. i will direct it to come and get to these addition, if you need it, but obamacare itself makes this distinction. it calls tax credits for buying

insurance on state exchanges, it calls those a creature of federal funding. >> i'm asking you, it seems inconsistent. either it is or isn't. how can you say that for religious schools it is not and for health insurance it is? how do you make that distinction? >> well, i appreciated your opening statement where you said it is our money, and that is what the republicans often say. i think it -- >> in which case he should not be what you are arguing with respect to health care. it is our money. if it is our money than it is not a government subsidy. as you said in the -- as the organization said in the arizona case. if it is not our money and it is the government subsidy, both things can't be true. >> i was a your argument is with president obama. >> that may be, but i'm asking you how you justify saying it is a government subsidy here but not their? which is it and why is it

different? >> as a general proposition tax reduction as a form of government subsidy, as a general proposition. >> but not with effect to religious schools? okay. mr. doerflinger. let me ask you, as a general proposition government tax exemptions, tax subsidies are attacks -- what he called government spending? you said it was -- what did you say as a general proposition it is a form of government subsidy. if tax exemptions are a form of government subsidy how do we justify tax exemptions for the catholic church, the jewish synagogue, the protestant church, or any other -- >> the first reason why churches are not taxable is simply that they don't make a profit. nonprofit organizations. >> wait a minute. they are exempt. what about the individual who

gives money to the church? that is not taxable. isn't that under your definition a government subsidy for the church? >> if the federal government has made a policy decision a very long time ago that charities and churches -- >> it's not a question of policy decision. if it is a public to the church is unconstitutional because of the establishment clause. so it's a tax credit to the individual to reading to the church is not a government subsidy in these things aren't government subsidies. if it is then you have an establishment problem with the first amendment. >> it is not unconstitutional to give public subsidies to a charitable or church organization as long as you are serving the legitimate and secular purposes. >> excuse me. wait a minute. we are not talking about that. we are not talking about that. our policy, we -- if you give --

i'm sorry, if i give a contribution to my synagogue, it is not for general purposes, but religious purposes. >> right. >> and that is -- and i take a tax deduction for that. under your definition that is a government subsidy of the synagogue where church and it should be there for a violation of the first amendment. >> that is not my definition, sir. i disagree with your basic premise which is -- >> all right. >> all of these things are the same and it went think. >> are trying to have your cake and eat it, too. other a tax exemption is a government subsidy, or it is not. if it is not then the whole point -- excuse me. i am talking. the whole point of this bill is wrong. if it is a government subsidy, then this bill may be right, but then we have to not just a question, but tax subsidies, government subsidies, of religious institutions are probably unconstitutional as violations of the establishment

clauses of the first amendment. professor rosenbaum, do you agree with ms. ruse position? >> i do not for the reasons stated in my written testimony. i find section 3032 ambiguous. it specifically refers to any deduction test covering not only medical care but health benefit plans. i think that the ambiguity is critical on this point. >> thank you. my time is expired. >> thank you. just to clarify the point, both tax preferred status and appropriations have been recognized in the courts as being allowed for a public good, and i think that the consideration here is that abortion is not a public good. it really doesn't need to reach to mr. nablus' point, which i think he has some balance to his point, it does not matter if it

is a tax-deferred status are not whether government should still have the right to shape the tax code in favor of a public good or against something that they consider not a public good. with that, i recognize the distinguished cinnamon from indiana before his questions. >> thank you, mr. chairman. let me also join the ranking member in congratulating you on your appointment. mr. chairman of the subcommittee, i think you know that i can think of no one in the newly minted majority in congress who i think is more appropriate to lead the subcommittee that you, and i found your opening remarks powerful and eloquent, and i wish to offer you my congratulations as i do to all the members and the majority of the minority on the subcommittee. thanks for holding this hearing. i appreciate the opportunity to participate in the discussion of h.r. 3, and i commend

congressman chris smith for his on this issue. as our witness has testified with the passage of the patient protection and affordable care act, the need for permanent, government-wide prohibition on taxpayer funding for abortion has probably never been more important to be sadly, congress last year traded in 30 years of testing for protections for taxpayers for a piece of paper signed by the most pro-abortion president since roe v wade. and the need to pass such legislation, i believe, is self evident when we think about the extraordinary subsidies, both direct and indirect in the patient affordable care act for patients across government spending. let me say i also think now is the time to end taxpayer funding, not also -- not only for abortion, but also for abortion providers. that is why i have offered a

bill that would end all title ten family planning funding to abortion providers. specifically planned parenthood is sadly back in the news today. a new undercover video has been released showing multiple violations by planned parenthood in police in new york to go along with the scandalous videos from planned parenthood clinics in new jersey and virginia. the videos show planned parenthood in please prison lovably advising an undercover sex trafficker on how to secure secret abortions, as did the testing and contraception for child prostitutes. i have to tell you, mr. chairman as a father of two teenage girls , i cannot be dispassionate about video evidence of individuals facilitating the

abuse of minor young women in this way. we have introduced this legislation, and along with h.r. 3 i hope that the congress will take up the title to an abortion provider prohibition act. the planned parenthood received over $3,603,000,000 in taxpayer dollars principally through tettleton and in 2008 they performed 328,008 abortions with more than a million abortions performed annually in this country, abortion is a heart-breaking billion dollar industry. it mostly benefits planned parenthood. it planned parenthood is far and away the largest abortion provider and the largest recipient of federal funding under title ten, and i believe the time has come for that to end. with that set let me direct a question to misses ruse, his testimony i found compelling as i do appreciate her on this

issue across the country. it .. with this growing record of planned parenthood believes, is there any doubt in your mind that planned parenthood would be the largest recipients of abortion support if h.r. 3 was not enacted into law? my specific question is if we do not succeed in passing a chart 3 and banding -- passing h.r. 3, would that not be a windfall specifically for planned parenthood? >> i think the word "windfall" is accurate. itted 324,000 abortions in

the united states of america. if you open the doors to federal funding, federal subsidies of abortion in a way that obamacare will do it, there's no question the chief recipient is showing itself to be internally corrupt and unable to handle finances at the minimum given what's happening in california, and more than that, aiding and abetting in the abuse of minors as these videos come out one after another. incidentally, those who try to minimize planned parenthood's, the expose on planned parenthood as a single situation or one bad egg, i just want to remind this committee that these videos, these unrecovered videos have been coming out for the last four years. they haven't got as much play as

recently, and they come from 10 states, alabama, nernlings, new york, virginia. it was suggested there was a system-wide problem with planned parenthood, and they do not deserve $1 million a day of taxpayer dollars. >>y, thank you. this -- why, thank you. this hearing is on hr3 with funding for abortion, and express how the hundreds of millions of dollars that flow into organizations indirectly support the abortion efforts of planned parenthood, but i look forward to that hearing perhaps in another committee, and i commend the members of this panel for your thoughtful comments. i yield back. >> i thank you as always.

>> i hate to disagree with you, but i only suggest for the public good that private insurance is providing health insurance and the incentive is to een courage employers to provide health insurance to everyone possible, but if i can, i guess the fair question to your points is how far does this go with -- since you're the one testifying, i think it's fair, with your particular beliefs, i know the church, i'm not sure about you, believes the use of modern birth control, the pill, is morally wrong, so would you then say we don't want to use

tax subsidies or you could funding to provide to health insurance companies that provide birth control pills for women? >> i think it's a very different moral issue, congressman. >> it's still the same directive from the catholic church, suspect it? >> yes, but we're not against federal funding of abortion because catholic moral teaching is against it. we're against abortion because of the violation of the most fundamental right. it is something rejected not by only catholics, but other religion and the hippocratic oath that gave rise to medicine in the profession. it's the considered moral judgment of millions of americans who have no particular religious affiliation at all and has been seen in the past as a crime, and, of course, today there is at least one abortion procedure that is a federal crime, and it is the killing of children who in any other context are seen even in federal

law as persons who have a right to be protected from lethal harm through the unborn victim of violation. another arbitrary exception of abortion -- >> embryonic stem cell research. >> uh-huh. >> do you believe cang should impose -- congress should impose this? >> i think that's a -- well, let's say it's a very far-fetched thing to have happened. >> you don't think people's lives are saved with embryonic stem research? >> i'm sorry? >> you don't think people's lives have been saved or can be saved because of embryonic stem cell research? >> it's far too uncontrollable, causes for too many tumors when used in animals. you can't tell what they're

going to do once they're in a human body. i think it's an imaginary question, but let me answer. i understand what we're concerned about here is the use of tax dollars, tax subsidies, tax support for something that actually takes life. we are against federal funding of embryonic stem cell research itself when it involves the taking of life of embryonic human beings. in some states, pen is one, the killing of an embryo for experimental purposes is a felony, and yet the federal government is funding it. >> let me turn to the professor. it appears the issue is primarily whether or not this is federal funding, but can you elaborate to a certain extent on the policy implications once it is decided that, i guess it was the supreme court versus the tax commission that the court upheld, once that's crossed,

what are the other implications legally for non-for-profits and not just religious? >> well, i think they are as will already been said by mr. nadler, the conversion of what has been tax advantaged private spending which is understood in society as private spending that is simply not subjected to certain otherwise applicable taxes into an overt public financing of certain activities has profound implications. it has profound implications both for the extent to which has been noted, certain recipients of those exemptions are suddenly receiving federal funding, but

also it has implications for the kinds of conditions that can be attached to entities that do receive exemptions. it becomes a much more government intrusive process in which government is setting the terms and conditions as is the case with hr3 as a receipt for a tax exemption. in this case, you can only receive favorable tax treatment if you do not seek or provide medically necessary care or certain types of care. >> thank you. >> thank the gentleman, and now recognize the former chairman of this committee. >> thank you, mr. chairman, and i want to again commend you. i know you're going to be a great chair of the committee, and did have the honor to serve for six years, and i'm going to a committee where we knew that the problems would be a little bit easier to solve.

i know this is a controversial committee. it always has been, and we're ensured of success on the committee i'm chairing. i'm chairing the foreign chair cheat on the middle east, so that's going to be interesting going guard. >> after this, it'll be easy, won't it? >> i think so. that's right. this hearing itself is showing evidence of that. you know, i couldn't help -- it was mentioned, ms. ruse mentioned there were 329,000 abortions committed by planned parenthood. i happen to represent the first district of ohio, the largest entity, government entity, and abortions in this country almost wipe out the population of cincinnati every year, and it's just amazing when you think how many little boys and little girls don't ever experience the

life we've all had the opportunity to experience because of this procedure which is still allowed in this country. i was struck again going back to my district in cincinnati. i was reading the story of the "cincinnati inquirer" about a doctor in west philadelphia, and the headline was house of horrors, and it certainly was, but i would argue that what goes ob in these abortion clinics all over the country is certainly houses of horror, and we shouldn't be funding that. we shouldn't be funding it at all as far as i'm concerned, but certainly not with tax dollars of people who don't want their tax dollars going to carry out that type of behavior. talking about that doctor, i was -- according to the grand jury report on the activities that were conducted by him at

his clinic, it was called the women's medical society in west philadelphia. on page four of the report, it says, and i'm quoting this, "when you perform late term abortions by inducing labor, you get babies, live, scream babies. by 24 weeks, most babies born early will survive with the appropriate medical care, but that was not what the women's medical society was about. he had a simple solution for unwanted babies. he killed them. he didn't call it that. he called it ensuring fetal demise. the way he ensured fetal dmeez was by sticking scissors in the back of the baby's nick and cutting the spinal cord. he called that snipping. over the years, there were hundreds of snippings, and i would ask you profession

rosenbaum, do you think american taxpayers should have to pay for this kind of activity? >> mr. chabot, i don't really see the connection between what is absolutely a terrible, terrible story and the tax financed issues here. >> let me draw the connection then for you. if he was doing this outside the womb, if he had snipped those spinal cords within the womb, that's perfectly legal in cr country, isn't it? should we use tax dollars to pay for that type of activity? >> i think your question suggests that this bill involves tax dollars. the height amendment is a very

clear -- >> will the gentleman yield? >> i have a short period of time here. a couple other short comments. let me ask the other two witnesses. is that legal? would that be legal say in the first trimester, third trimester, that activity in abortion clinics, or the restricks to -- restrictions to kill a child in the womb? >> yes. the only procedure that's not legal is the partial birth abortion procedures. unless he followed the steps outlined, and my reading of the grand jury report was he was not doing, taking those steps, and what he was doing would be perfectly legal if it was done just before delivering the baby. >> i see my time's expired, mr. chairman. i yield back. >> i thank the gentleman.

it should be noted the gentleman was a prime sponsor of the partial birth abortion and will be a hero to me because of that. i yield to mr. conyers, former chairman of the committee, and we're going to call him ranking member for now. >> thank you very much. my congratulations. i could observe that the view isn't quite as good in the room from this end as it used to be when we were on the other side, but i'll get used to it again, i also wanted to welcome mike pence to the committee and appreciate his coming aboard. what has gone against the planned parenthood people, i have yet to discover. they've done, i thought, a pretty good job, but he is bound

and determined to defund them and i think do a great disservice to a very effective organization that's brought help and assistance to women over the years. now, mr. chairman, we talked about the fact that eleanor holmes norton was not permitted to testify. was the author of this bill prevented from being a witness here today too? >> mr. conyers, that was discussed earlier. the author of the bill could have been a witness here if they had been chosen as the democratic witness. it was just the committee structure of the panel that's here for witnesses. >> you didn't want the author of the bill to testify? >> i didn't have a problem with

that whatsoever, sir. >> well, he asked -- did he ask to testify? >> i'm not sure he asked to testify. i think mrs. norton asked to testify, and if she wanted to be the democrat witness, that would have been all right. >> uh-huh, but the author of the bill who i presume is here today, we're in the first few week of the hearing, of the 112th session, and this is a major piece of legislation, and he's not here. >> mr. conyers, the author made the decision not to testify. we don't know the reasons. >> okay. well, let me ask ms. ruse this question. the title of this bill is no taxpayer funding for abortion act. do you know of any federal

funding for abortion that goes on in this country presently? >> the potential funding of abortion and the potential subsidies of abortion are numerous. the debates last fall over the birth amendment opening up military facilities for abortions to be done then is impacted by hr3. that's still an open question. we may see a reversal under that policy, and under the clinton administration, that was reversed and opened up to elective abortions on military hospitalsment -- hospitals. that's one example. >> and you object to that? >> that's right. >> if you knew of any others, you'd object to them as well?

>> yes, october to the funding -- object to the funding of abortions sponsored with federal funds, that's right. >> you think this is an appropriate title of a bill then, no taxpayer funding for abortion act because women in service may be able or might be able to get an abortion? >> yes, that's one example of -- >> well, that's the only example that i know of, but if you know of others, let me know. >> well, the district of columbia appropriations bill last congress also opened up federal funding for abortions in the district of columbia, so that is currently an area that needs to be corrected by hr3, by employing the long standing principle. the district of columbia often does have that appropriations right or applied. it was just taken off just a few

months ago, so that would be corrected by hr3. >> well, all right, it's my impression that this is a misleading title of the bill, not federal funds, dc taxpayer funds, not funds from fed treasury. well, that's just a staffer. i mean, -- [laughter] you're an expert witness. let me turn to another consideration. as my time -- has my time expired? okay. well, you're so kind. one final question, chairman, and thank you. section 311 of this bill protects individuals who refuse to provide abortion services.

as i read it, ms. ruse, this would mean someone who refused to provide life saving treatment and allowed a woman to die as a result might escape any consequences if that were to happen. is that your understanding? >> no, not at all. what this section of hr3 does is simply stand with the long standing principle of the church amendment. that's been around for 38 years, and in that history of the church amendment, we've never seen a situation where women were dying at the hands outside an abortion clinic because they were not able to have an abortion. now, i'd also like to mention that it's never been used to require an emergency provision of an abortion. that's the emergency treatment

act. the only additional new part of it is allowing remedies, allowing someone who has been discriminated against, like this nurse, to have a cause of action, so that's the new part, but the consciousling itself is just quantifying this long standing policy. >> i'd like to have unanimous consent to put in some articles from the nation magazine, the new york review books as well. i thank you. >> without objection. thank you, mr. conyers, and i now recognized the distinguished gentleman from iowa. >> thank you, mr. chairman, and i welcome you also as chairman of the committee. i've had the privilege to serve on this committee now for my 9th year. i'm happy to see you here with a gavel and current and former colleague mr. chabot back on the

committee. i look back at the debates here in the committee when we were dealing with the terminology called dilation and distractions, a nice term nor partial birth abortion, and steve laid that out in a good and clear way, and it was one significant piece of progress this congress made, and there haven't been many over the last decade or so. that was dilation and extraction, and now we have federal funding for dilation and evacuation which i have asked them to put this poster up here so we know what we're talking about. i recognize there's experts on the law here, but this is human life. i ask that each of you reviewed the process that i ask that you familiar with this, and ms. rose? >> my answer's the same.

>> you are familiar with the procedure where the tool is used to dismember the baby, and pull the parts of the baby apart and as they count the pieces up piece by piece if it looks like you get down to the point where often the head is so well formed and the bone is so structured it has to be crushed and then pulled out, collapsed, and then sanctioned to make sure the bone fragments don't bring about the high degree of hemorrhaging, and for me, i can't see much difference between partial birth abortion and dismemberment abortion. we're here talking about legalities, a tax policy that might be prohibitive for us to prohibit federal funding for a procedure like this, this

dismemberment abortion. i know the physicians, but profession, you have not addressed this from the standpoint of the complications of the taxes, and i just ask should government fund a procedure like this? >> again, i would have to respond that i am not prepared today to answer this question. i was focused on a bill that is dealing with what i don't consider to be government funding. >> but, professor, you understand that -- >> if i could just finish. as far as i can tell, there's no public funding for this procedure right now except in the situations in which one of the three very limited categories has been satisfied under federal law. we are not publicly funding the procedure now, and the bill before us is not a public funded bill. >> i have before me data that shows 142800 abortions taken

place in america just last year. we can go into the disagreement we might have. i ask that you're aware that if your testimony has impact here, then it might bring about this procedure we're looking at now and more funned by public tax dollars. i'm going to ask you then, do you have a moral position on this or just a legal one on taxes? >> i prefer actually to keep my moral positions out of the hearing. i have strongly held religious and moral views on many things. in terms of today's hearing as i said, i don't think that i see any example of public financing for this procedure except in the circumstances. >> then, since you don't, if we can resolve there's public funding for abortions in the country, and there's testimony to that effect, would you then -- if we establish that point or are new a in a position to change your position?

>> truly, i'm having trouble following the question. >> another route then. you've reviewed this procedure. have -- could you step in to an operating room and witness it? >> i am a law professor, so i presume i would never be in operating room. >> you can't answer the question whether you could observe it or no. i'm going to ask if you could conduct the procedure, you'd answer the same way. i just make this point that this is a ghastly gruelish procedure. it is dismemberment abortion. i have known people who could not vote for a death punishment because they couldn't conduct it themselves, and they took that position. i understand that psychology. when we look at something that we're asking taxpayers to fund against their will, that's so

gruelish that we can't abide looking at it or watching it or watching a full video of it or listening to the sounds that go on there, and we ask taxpayers to fund this, i think that illustrates what we're up to here, and we should go to all steps to fund abortions. i yield back. >> i thank the gentleman, and i yield back to mr. scott of virginia. >> thank you, mr. chairman, and i join you in congratulating you in your new position and look forward to working with you. >> professor rosenbaum talked about the taxes and the wording is unclear. is it your belief that the tax deduction should still go to the health policy, but not just that portion that pertains to abortion, or should the entire policy lose its deductibility if

it includes abortion coverage? >> congressman, this is one the problems i had with trying to be helpful to mr. nadler. i think there's a lot of different ways in which the tax code gets implicated in this, and there's some cases that are much more straightforward than others. the affordable taxes in the affordable care act, the policy in place was the premium tax credits will not go to directly to an abortion procedure itself, but they are go to an overall health plan that includes such abortions without limit, and then there will be a little accounting procedure within the plan to try to keep the federal and private funds separate. my problem with that is -- >> just in terms of the bill, is it your intent that the entire heads of policy that including abortion coverage, should the employer lose the entire deductibility of the whole policy, or just that portion

that pertains to the abortion coverage? >> my understanding from the analysis of the bill from the congressional research service is that it does not cover employer deduction. >> whatever deductions we're talking about, taxing benefits, credit, are we just talking about the abortion portion or the entire policy? >> i think we have to -- there's two questions. one is whether this is federal funding. >> it's not -- >> second question is if we do consider that, it crosses the line into being a subsidy, whether you ban the subsidies for abortion itself or for a plan that includes it. that policy decision was made many years ago in the height amendment, federal employee's health benefit -- >> professor, you mentioned there's a lack of clarity as to whether the whole policy would lose or whether just the portion

attributable to abortion coverage would not be deductible. you said that's unclear? >> no, actually, i think it's very clear that the entire policy, whatever's affected under this bill, the entirety loses its deductibility, it's tax advantage. what is not completely clear to me because of the term any deduction is whether the deductibility applies to taxpayer deductions or, in fact, could be interpreted to reach employer sponsored deductions, but i do believe it would be constructed in its entirety is it product that includes one the procedures the difficult problems for the irs when the dedoublability standard would be

met. >> we couldn't get an answer, so it must be unclear. should government funds be used for capitol punishment? >> my organization is against capitol punishment, so i think if you are going to have capitol punishment, it has to be tax funded. we're against that. we believe in the abolition of the death penalty. >> should we work together, you and me, to prohibit government funds to be used for capitol punishment? >> unless the intent is to put it out into the private sector, yes. >> could you explain the exception for rape, why that's there? >> this recent debate about rape and forcible rape? >> no, the -- the, why there's

an exception. >> why there's an exception? >> right. >> i think you have to get that answer from somebody who supports. i can understand why they want that exception. they want to be able to say that if the woman had no part in the decision to have sex, to get pregnant, then she should not have to bear this child that was part of no decision by her. my problem with that is that although that's a horrible thing, there's a lot of things that the health care system and the government should do for women who are victims of rape. i can't help thinking there's another person who has a right to live. i met kids of rape, and they and their mothers are great people and glad it was not an abortion. the decision about forceful rape was an effort on the part of sponsors to prevent the opening

of a very broad loophole for federally funded abortions for any teenager. the obvious jex to that which was helpful, the objection was saying it doesn't mean that. rape already means forcible. if you say forcible rape, that's redundant, and courts require a level of violence that goes with rape itself. when congresswoman objected to the phrase of forcible rape, she said, "rape is when it woman is forced to have sex again her will. there is whether she's conscious, unconscious, meantly stable, not mentally stable." i think that's a good definition, and i think the subcommittee could say that's what we all mean. we're talking about cases where force is used or women have been

subjected to this against their will and move on. >> i want to thank mr. scott and all witnesses' testimony on this very crucial issue to humanity itself. the proceed churl question if i could? >> please. >> in your opening statement i believe you talked about respective changes you intended for the legislation, and i believe you talked about what was just mentioned and that was rape. you also -- if i missed it, i apologize as it relates to incest as well. >> i know there's ongoing deliberations and they are trying to deal with it. i'm sure that's being talked. >> without objection, there's five legislative days to submit

to the chair additional written questions for the witnesses, and we ask the witnesses to respond as promptly as they can so their answers are made part of the record. without objection, there's five legislative days to submit additional testimony. i thank the >> sunday, a discussion on the obama administration's response to the crisis in egypt with stephen dinan and david mark. then in the get unveiling the budget with robert -- then a look at unveiling the budget with robert bixby. >> every weekend, listen to

historic supreme court cases on c-span radio. mcpherson.kin v. >> it stands to the cores of the agency that her speech and demeans the that, undermined the, and is inconsistent with the function of the agency. >> listen to the argument on c- span radio on 90.1, xm 132, and on c-span.org. >> i think that is not only one of the major challenges facing this in this country but also facing our country. that is how we maintain a healthy lifestyle and get kids to have the strength and the judgment to say no. >> the president of southern methodist and diversity in dallas and on sunday, discussing today's college students, his

school was the site of the george w. bush presidential library on c-span's "q&a." >> medicare and medicaid administrator talks about the new health care a lot during this testimony at a house ways and means committee hearing. this is two hours and 20 minutes. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2011] >> good morning. i went to extend a special welcome to the administrator for medicaid and medicare services and richard foster, chief actuary for the centers for medicaid services. despite three separate requests from the republicans to our

democratic character parts in the last congress, this is the first time have been invited and have appeared before this committee. we have been especially looking forward to having you here for what i hope will be an informative and spirited discussion about the impact the democrats and health care law will have on medicare, our seniors, and other beneficiaries to depend on the program to meet their healthcare needs. not only do we have a constitutional responsibility but a clear fiscal responsibility to the american people given the amount of tax dollars that you control. a farmer going to pick a subtitle, i would borrow a line from charles dickens, "it was the best of times and it was the worst of times." was a look back at the information, i see two contrasting prospectus from the

same agency. on the one hand we have dr. berwick touting the benefits of the health care law. he stated, "the long term sustainability is better than ever thinks the new resources. on the other side you have mr. foster and his team as the actuary who has a 180 degree perspective on the new health care law. in a report after report, the office of the actor wearing has provided a bleak outlook resulting from the new health care law due in large part to the fact that there are more than $500 million being cut in an effort to change the law which includes massive cuts to home health agencies, hospitals, skilled nursing facilities, and hospice providers. the concern of many is the impact of the small and losing

access to health care services or being forced to pay more for the services they need. that is already happening for those who depend on local hospitals to those who depend on medicare managed, to retirees to seniors who will pay higher prices. for example, the medicare actuaries predict because of the cuts in the health care law, 725 hospitals, 2352 nursing homes, and home health agencies will not be profitable. it is no wonder they warned that a seniors access to care could be compromised. three pennsylvania hospitals had been put up for sale. the cbo has said it beneficiaries remaining in the manicured manager will see their coverage drop of. -- remaining in the medicare

advantage plan will see their coverage drop off. another 1.7 million seniors who have otherwise received an offer prescription drug coverage in the future will no longer have this option. finally, despite the claims that the medicare does not hold changes will help the costs, cbo has predicted that medicare part d will increase 7% as a result of the democratic health care law. these are just a few of the concerns and i'm sure there are more that will be identified including the very fuzzy washington math. given the impact this will have on medicare and the nation's seniors, it is my hope that today we can have an honest and open hearing about how cms plans to institute these costs while meeting the long-term needs of our nation's seniors and

medicare beneficiaries. i yield the two ranking member of -- yield to ranking member levin. >> this will be an opportunity to shatter many of the myths that have been spread about health care reform. for more than 45 years, medicare has offered important health benefits for senior citizens and people with disabilities. it has safeguarded financial stability for them and their families. during the health reform debate and delay the time since its enactment, health reform opponents have relied on mess

and scare tactics to create fear and uncertainty among health- care beneficiaries. what is really most scary is the plan from republicans to privatize medicare through a voucher system. let's set the record straight and we will have more of that today on health care reform and its impact on medicare. the act strengthens medicare's future, improves benefits for senior citizens and people for disabilities, and saves money for taxpayers. fact number one, thus lowers the cost to medicare beneficiaries. thanks to medicare payment reforms and efforts to eliminate waste and fraud, beneficiaries will sit on average almost $200 on their part d premiums by 2019. kashering will go down by more than $200. -- cost sharing will go down.

fixing the got hold is a key improvement. -- facing the adana poll is a key improvement. we will provid 250 million -- provide $250 to millions. by 2020, the donut hole will close. eliminating the cost sharing for services and a creating of a new annual fiscal benefits. fact two, the accident in strengthens medicare's financial footing. they predict solvency by 12 years. the ads modernizes the medicare program. it contains an array of delivery reform systems to insure that the program rewards value over volume. in fact come health-care experts including more than 270 leading

economists agree that this will create a more disciplined and the fact of health care system. fact four, the act includes tough new fraud-fighting tools that are projected to save taxpayers approximately $5 billion. the law empowers cms to stop fraud before happens. there is one more point that needs to be stressed and it is the republican agenda of to repeal reform. the repeal agenda would reverse the progress that we have made. it would raise beneficiary costs and substantially short medicare solvency. it would and delivery innovations and stopping for new fraud fighting powers in their tracks. republicans colleagues want to turn this into a voucher system.

this shifts medical expenditures back of the seniors and their families. when we passed medicare, it was to fix these very problems and ensure that seniors no longer have to spend their retirement in the party or in fear of their next illness. repeal would do more than turn back the clock. it would rip off its hands. that is a fact we cannot ignore and a possibility that we will not accept. >> dr. donald berwick is an administrator and oversees medicare, medicaid, and children's health insurance programs. these provide the care to nearly one in three americans. before assuming leadership, he was president and chief executive officer of the institute for health-care improvement, clinical professor of pediatrics at harvard medical school, and professor of health

policy and management at the harvard school of public health. he is a pediatrician, at junk staff at boston children's hospital and a consultant at massachusetts general hospital. you're full reinstatement will be made part of the record and you have five minutes to address the committee were upon members will question for five minutes each. welcome to the committee and you have five minutes. >> i appreciate the chance to appear here. it is a privilege and honor to serve and be in dialogue with you now and in the future. i am a pediatrician. i am the son of a physician and i am the father of a newly minted physician. almost three-quarters of a century span the time when my daughter just showed up for her birthday is a primary care resident. mount career is a bridge also between them from the charters

of my father used to the computers that just the uses to ignorance about how genetics' worked to the decoding of the human genome from hopelessness in the face of all cancers to cures to many cancers, from the time for medicare when seniors live in fear of medical bankruptcy to now when they do now. the affordable care acting as a bridge and it is our nation's answer to many of the problems that modern healthcare brings along with its successes. it is our answers to the questions about health care coverage. how will we make sure that our neighbors to not need to be afraid that they will lose health insurance when they get sector are not able to get it in the first place. the answer is yes. people with pre-existing conditions will be able to get insurance and insurance companies will not be allowed to withdraw coverage. yes, children under 26 can be covered under their parents' insurance policies. medicare beneficiaries of the drugs they need a price that they can afford and the answer

is now yes. we sent over $3 million and the tax rebate checks to get seniors to the dawn of a whole -- for is a hot dog not hold. hole. the donut william vessel the prevention and not just three them for those that could be avoided? we'll add annual bonus checks and screening tests white colonoscopy to the benefits. the biggest benefit of all is one that concerns you and can we afford to do that. the answer to this also is yes. not only does the affordable care act make medicare fiscally strong but it provides us with the tools to make health care better doing things right as last costly than doing things wrong. can we afford to meet the needs

of patients with families? we cannot afford not to. when a patient gets unavoidable surgical infection or read two different doctors do not have a wave to coordinate care where drugs at ok'd should not be taken together, society and a run of bears the higher cost of the complications when mrs. miller stopped taking her medications because she cannot afford them, she will suffer a stroke that will become her greater burden and hours. the diabetes we fail to detect or treat early will become the heart attack or the habitation or the kidney failure holocaust far more in suffering and dollars to treat later. it is a terrible mistake in my opinion to think that there route to affordable health care is to deny people in insurance, care, and treatment. that is a very bad plan. instead, the patient-centered investments that medicare and medicaid themselves represent are our nation's best hope for the sustainable excellent health

care to which we aspire. better care, better health, and lower-cost to the improvement of care. they are packaged deal. let me focus on one specific case. i do have concerns about the medicare vantage plan. we have some quite exciting new data on romance and premiums. despite earlier projections of enrollment decline and premium increases, the actual data we have what 2011 shows that enrollment in the medicare advantage increase 6% to more than 12 million beneficiaries. on average, they receive a 6% reduction in their premiums and there is a 5% increase on the number of beneficiaries who are now in for an five-star contract this year versus next year. that translates into more beneficiaries in higher quality plans. higher-quality care is one a one for all patients. when i practice pediatrics, i did everything i could to make sure our patients have the best medical and possible.

i fought for bone marrow transplant for one last boy it was the last chance for success. i made sure that kids with asthma got the most modern treatment we had and that their mothers, fathers, and schoolteachers understood how to help them. by major immunizations were up to date and that of these kids knew they had options and you could never underestimate the power of prevention. i get to do the same for all the millions more who will benefit from a healthier private insurance market. if you want to drive do not our way from the problem and do things right. better care, better health, and lower costs. it was my father's plan. it is my daughters plan and every day is our plan. thank you. >> thank you. your time has expired. a false statement will be made part of the record. is the british health-care system a good model for us to

follow here in the united states? >> i have seen and worked in many countries and every country by its own solution to its own problems. america needs an american solution to the american health care problem. it bounces public and private payment and it is a good partnership between the federal government and states. it is the american way to an american health-care system. regarding in the british national health system, he made a statement that it is the tories for rationing care. you said, "i fell in love with nhs." is this still a view that you subscribe to? >> we have a lot to learn from each other, but i say again that the american health-care system needs an american solution and that is what excites me. this is based on the heritage of

our system, the access we have, our best men in the public trust in this extraordinary partnership between public and private care. that is what really counts. >> is that yes or a note? >> we are all struggling with the same issues. i am quoting here be said that that is the only a sensible approach that you can think of. do you still think that a government run single payer system is the only approach? >> said think we found our way to an open door solution which is an investment in better care, better health and a lower cost for improving the care. i see more and more tools that we have to make care exactly what it should be. >> is that yes or no?

i am having trouble understanding whether you still believe that the single payer system is the only sensible approach. >> the affordable care act is sensible for market and we have seen immense progress. i see the potential for helping our country is innovation, improving the quality of care, transparency, putting control in the hands of patients come and we will find their way to a better health care system. >> i could have a simple yes or no answer. you said at one time that competition will help you, not hurt you. now you said exchanges, determining what benefit plans will look like, analyzing premiums. the thing competition in health care is a bad thing? we need clarity from you. is this a yes or a note. >> competition has a place. it is the american way. there are other areas in which providing public support to people for public finance system helps, too. it is not a simple yes or no

answer to your question, mr. chairman. this strikes is a cross between the public and private sector investment and better care. >> to have said any health care funding plan that is just, equitable, and inhumane must redistribute wealth. is this a view you still subscribe to? >> it is a statement of fact that sick people tend reporter and a four people tend be sector. if we are resting in the health of our neighbors and our nation, we need to take care of the sickest and the poor. >> and you think wealth redistribution is the way to go about achieving that goal? >> sig the agenda before and portable tent of the sector. we need to understand and address it. that is where medicaid came from. >> we have heard that this legislation will mean that most preventive care will now be free because of the new health care law. you want to grow that one

demanded services prevention the supposedly help catch diseases early. do you still feel that credit of care is in too high of a mind -- of demand? >> i'm a pediatrician. the idea of taking care of children is to give them effective prevention so that you will later pay pay a price war. the affordable care act is a tremendous investments in getting people be effective preventive services. that is why they cover mammograms and cost to be with no copayment for the patient. it is why we introduced the annual well as physical. effective prevention is the best investment we can make in lower costs. >> said that is a -- so that is a no? you do not feel it is in too high of a demand? >> i do not understand. >> after reading your quote, do you still feel that preventive

care is in too high of a demand? i guess fire answer you do not feel it is not too high of a demand. >> i do recognize your ". i am telling you what i think. >> i am quoting your writings. i am reading it from, "we can cut costs and improve costs -- improve care and cut costs at the same time. >> i believe we can by investing in effective care were certainly includes investing in a preventative services which disallows us to do that for seniors which cannot be protected from complications of diabetes as never before. >> of the answer is no? you do not feel the preventive care is in the to high demand. >> in lead to high demand? -- is too high demand?

this is what the affordable care act does. >> mr. levin? >> is important for everyone to hear your answer is. the microphone will be clear. i am glad the chairman asked to these questions. the air can be clear when it is often, i think, misrepresented so we can move on and you can provide the services that you have been trained to provide. i'm glad those questions were asked because i do not think you were surprised. that me just ask you in terms of separating fact from a myth. in his opening statement, mr.

can talk about $1.50 trillion in cuts to medicare. would you comment on that? . .

>> so when there's a reference to a half trillion dollar cuts in medicare, are these so called cuts relate in most cases to the rate of increase in reimbursements in payments to providers. isn't that true? >> we're on an unsustainable trojebtry. the affordable care act is linking to providers more to the quality that they do. instead of paying for high volume care alone, we're orienting more and more payment in this country on the public and private side for paying for excellence, for reducing the care that we want or need. an example is infections in hospitals. there are hospitals all over this country that have reduced many forms of infections to zero. the question now is if it can be done there, can it be done everywhere? if we invest in it.

every single hospital offering excellence at the level that the best currently do lowers costs and improves quality. that's a plan that will get us to a more sustainable health care system and a medicare trust fund, medicaid system as health care as a whole. >> do you want to comment on this claim that 5.8 million seniors will lose their current drug plan provided by the former employer? also in the statement of our chairman? >> we're in a transitional mode in american health care. the affordable care act helps the retiree drug programs with retiree drug subsidy. businesses will make their decisions about continuing or not continuing the retiree drug plans. and the beneficiaries will choose among the things available to them. i'm sure there will be some shifts. the alternative to the retiree drug program has been

strengthened commensly over the past year or two. we have strong evidence of much better supply in the part d program and we now have 50% drug discount for brand name drugs so that some drug beneficiaries will choose to move over to part d because it's a better plan for them. >> thank you. >> the chairman of the health subcommittee mr. herger may inquire. >> i want to thank you for being here this morning. i appreciate your dedication to creating a high quality health caresome system but i think we have some very fundamental disagreements about how to achieve that goal. chairman camp highlighted your past support for a single pair system and your comment that, quote, competition in short

will hurt you not help you. close quote. doctor, do you believe competition and market forces are good or bad for health care in light of your quote? >> on the whole, good, congressman herger. we can see that in the durable medical equipment bidding system, for example, in which we're using market forces to enhance the benefits to beneficiaries, reduce their costs of durable medical equipment at the same time assuring a supply of excellents. that program alone has reduced the spend for the nine areas that the dme program was tried in by 32%, extrap lating to the country as a whole, that would be a saving over the next ten years of 27 or $28 billion of which $17 billion gets returned to the trust fund and 11 to the beneficiaries. that's very important, increasing excellence,

increasing transparency, decreasing cost and the increasing the well being of the individuals using the services. >> so you don't agree with your statement where you say competition in short will hurt you not help you? >> there are instances where competition is very helpful. i just cited one. there are insf instances where it's probably less useful. but in a rural setting where there's only supply intown, we can't use competition as the major lever for improvement in that. we have to reach out and help that setting and make sure it can supply the goods and services and excellence that community needs. sometimes it helps, sometimes it doesn't. but the answer to your question before is do i think competition can help, yes, absolutely. >> which is directly opposite of what your quote was. the reason that i and many others find your past statements troubling is because america was built on the free enterprise system going back to our founding fathers americans

have always believed that free people working in free markets make better decisions than any king or dictator or government burecrat could ever make for them. and that's what this health care debate is fundamentally about. are we going to stick with the free enterprise system that has brought about the greatest prosperity in the history of the world, or are we going to hand over the keys to the government? will we trust patients's own doctors to determine the best course of medical treatment or will we leave that decision up to a district bureaucrat who has never met the patient? you are now overseeing an agency that provides health care benefits to more than 11 million beneficiaries in medicare advantage and 19

million in medicare prescription drug plans. congress designed medicare advantage and medicare part d to give senior citizens a choice of plans so they can pick the plan that works best for them instead of being forced into a one-size-fits-all government plan. given your repeated statements expressing skepticism about the private health care market, and competition, how will you reconcile your personal beliefs with your responsibility to administer these programs that are built on the principles of competition and consumer choice? >> congressman, i can't think of a better example of american-style competition benefiting everyone than say with the evolution right now of the medicare part c program. look at what's happening.

more transparency, more negotiation, more visible understanding by beneficiaries of the quality of the plans they can choose from. an open market in the medicare handbook on the web where they can search for the plan that they want and then they buy it. and what happens? quality go up and the cost goes down. to make this a transparent environment in which the beneficiary can make choices. we're interested in more choice, not less. >> i couldn't agree with you more. but i hope you recognize that whaw just said in your statement and answers to chairman camp are very different, very different than these quotes that you've made in the past. but thank you very much. >> the gentleman's time has expired. mr. johnson is recognized. >> thank you, mr. chairman. doctor, you know, the administration and democrats here in congress made promises to seniors about their health care, and unfortunately didn't

live up to them. in many occasions the lost provisions are going to harm, not help americans primarily by raising premiums and reducing access. i mean, the medicare act wuries warned that the cuts in the democrat health care law are so drastic that providers might end their participation in the program. probably jeopardizing access to care for ben fishsies. and you know as well as i do there are doctors getting out of medicare now because they can't deal with it. and i don't know if you have a private office or not but most of the doctors i know have to hire two or three extra people just to track the administration that goes along with that junk. they've also expressed concern that it's unclear whether the laws can be sustained and whether the slower rate of

growth will be accomplished or instead reduce access to care or diminish the quality of care for medicare beneficiaries. you know, in texas more than 300 doctors have dropped medicare programs in the last two years. and you're aware of that, i'm sure, including 50 in the first three months of 2010. some doctors feel the only way they can have control over their practice is to stop taking medicare patients. of course, not all doctors drop out of the program. some are doctors are choosing to increase these, reduce staff wages and benefits and reduce charity care. those alternatives don't sound good to me. as a cms administrator, how do you plan to prevent seniors from being denied access to care as a result of the massive medicare cuts in the program? >> tough times for all. everyone is tightening their belt in this economy.

i know that. but let me say i've never been more optimistic about the future of the health care system in our country with the affordable care act in our hands. i'm told now the participation is the highest this year than ever in history among physicians. we're getting the support. the affordable care act was supported by the american medical association, professional societies and trade associations. i don't think they'd be supporting an act that spells doom. >> how do you account for 300 doctors dropping it in texas? >> not everyone agree with it. but they know that the future lies in better care better health and lower costs and i think they're interested on engaging with us in making health care better. that's what they say to me when they meet with me. i've been going all over the country meeting with hospital leaders and professional leaders. we know we've got to navigate

ourselves to a better system. i think we're headed in that direction. >> i don't know how you plan to prevent seniors fom being denied access. what kind of steps are you going to put in place so you can identify the problem before it becomes a crisis? >> more transparency, more knowledge, more linkage of quality to payment instead of paying -- >> and how do you do that if the doctors refuse to be part of medicare? >> 96% are participating in medicare and more than willing to work with us. and they know in the long run better care is the answer for them, for the patients, for the sustainability of the country and we're going to work hard with the providers of care all over this country to make that care better. they know in the long run that's how they'll do the best and that's what counts. the hospitals want to be safer and higher quality. and we'll work with them. in the end, an extra readmission that shouldn't have happened helps no one. we're going to work for better care. that will be why people came into health care in the first

place and why they want to stay there. >> i don't know how you're going to get to the doctors that quit the system, because they can't stand it. thank you very much. >> mr. rangel is recognized. >> thank you very much, mr. chairman, and doctor, thank you so much for sharing with us the knowledge that you have so that our government can do a better job with your and your family have dedicated your life to. i just want to correct the record because the chairman has indicated that n his opening statement that three catholic universities in pennsylvania were closed because of the affordable care act. and they want to make certain that some of us knew that the affordable care act had nothing to do at all with the sale and that they had promised to -- or

had indicated that they wanted to do this long before the act and the president is a roman catholic nun and she is the one that wanted to clarify the record and her support for the act. having said that, it just amazes me as to the opposition to this revolutionary concept of broad national coverage. what's your guest mat of the number of americans that have health insurance coverage? >> the number that have health insurance coverage? >> of some kind. >> i don't know the exact number. i know that we've closed the gap a lot with the affordable care act. >> 30% don't have coverage. >> we're going to be closing that by over 30 million americans. >> these people somehow manage to get health care even though they're not covered by insurance. is that true? >> that's true. >> and normally, not normally

but many of them go to emergency clinics in order to get this health care and it's my understanding that this is a very expensive way to get health care treatment. >> you're absolutely right. you pay me now or pay me later. when the patient comes in and you detect the diabetes early, they don't get kid ni failure later. if they don't have access to care the complications will occur and they'll show up later in the emergency room and they'll be expensive in a different way right ow of our public treasury often. >> when i was a kid, things were that you never went to see a doctor unless you were sick. but now, i think it's abundantly clear that you can prevent so many serious illnesses as you said by being able to go without having enormous costs to prevent these things from happening. >> absolutely right.

we know the director of the centers for disease control has pointed out we can reduce hundreds of thousands of heart attacks and strokes and other diseases in our country >> if you already have coverage and pay your premiums, are not included in the premiums the cost for the people who don't have coverage? >> eventually it comes around. somebody has to pay. >> if those who have premiums can find some way to reduce the costs of those who are not insured, does that not mean that your premiums should be expected to be lowered? >> your premiums can be lowered. and in the long run, the savings will be there because somewhere in the tax system, in wages and in premiums that money will be saved and will come back to the american economy instead of being wasted in ill health that could have been avoided. >> if we can develop a plan that most people would be able to get preventive care, would be able to get some type of care to prevent them from being

hospitalized, h prevent their illnesses from becoming chronic, then everybody not only gets a better quality of care, but the costs per capita is dramatically lower. >> exactly, congressman. >> now, if that is true, i guess, coming from harlem, new york, that those who have coverage probably take the attitude, i've got mine, jack. it's up to you to get yours. because i think we've done a terrible job, and i want to thank the republican majority for giving us a second chance of really showing the benefits of the program. because the law is complicated but if you have a child with a precondition, you can better appreciate it today. if you have a kid that's under 26 and you couldn't get coverage, if you have high costs for prescription drugs, all of these things, the public

is beginning to understand what's in the bill. so i would like to take this opportunity to thank the republican majority for giving us an opportunity not only to defend the bill that this committee majority was so proud of playing a major part in, and giving us an opportunity not just to defend but to point out that in the short and long run this is best for our nation and i appreciate your patience with us. and, mr. chairman, these hospitals that you referred to have sent out a release that i would like unanimous consent to be included in the record and saying it had nothing to do with the law that's before the committee. >> without objection. and the gentleman's gratitude to the majority is dualy noted. his time has expired. and mr. brady is recognized. >> i too am grateful.

republicans oppose this because it won't lower prices for americans. it will drive people out of plans they prefer. we can never hope to afford it. and a lot of companies that provide health care today are going to drop them. none of which we think is the right solution for our health care reform in america. so let's get specific. how many seniors have lost their medicare advantage plan since president obama's plan was put in place? >> congressman, there's always turnover in medicare advantage. i don't know the exact number that have changed. >> these aren't turnovers. how many have been forced out of their preferred medicare advantage plan? >> your agency says 700,000. are they right? >> that's a turnover number. they can choose to be in or not. >> no. now, your act wuries said 700,000 seniors have already been forced out of their

preferred medicare advantage plan. is your agency correct? >> medicare advantage plans are market system in which beneficiaries can choose, and -- >> is your act wary, their report, accurate? >>or what i know right now, sir, is that enrollment is up 6% this year. more people are exercising their choices. >> is that a little misleading since the cuts haven't taken place yet? >> well, we're seeing heavy marketing by medicare advantage, by medicare advantage plans. there's growth in those plans. >> if you could send back to us how many seniors have lost their medicare advantage plan, been forced out by state, i would appreciate it. how many seniors will lose their preferred medicare advantage plan under the president's new national health care plan? >> medicare advantage options are robust for medicare advantage ben fish riss and they choose the plan that needs

their needs. >> your ack waries say 7.4 million. are they correct? >> we're seeing an increase. >> because the cuts haven't taken place. i'm not trying to bankrupt but. >> since you already have these numbers, it would be great to refer to them. >> we'll be happy to. >> how many of those in part d are prescription plan for seniors, how many have lost their preferred plan since the president's plan took place? >> sir, the number of sound options, meaningful choices for medicare beneficiaries in both c and dmb are increasing, and beneficiaries are taking advantage of those. >> your agency says 3 million this past year have already been forced out of their plan. are your right? >> we're seeing turnover as we always do. >> how many seniors in the part

d have been automatically enrolled in a preferred or part d plan that costs them more? >> i don't know the answer to that, sir. >> your folks say 1.5 million. can you provide both for part d and those forced into a higher plan, cost plan? can you provide that to us by state? >> happily. >> the do nut hole, the way that was closed is highly flaugged, creates cost shifting within it. for the 90% of seniors who do not reach the donut hole, can you guarantee that they will not see higher premiums as a result of closing the donut hole? for those who are not in it and not touched by new. >> in the donut hole? >> part d premiums rose slightly this year from i think $29 on average. i'm not quite sure i understand what you mean that their preemyulls will rise as a consequence of closing the donut hole.

>> yes. because you're cost shifting within the donut hole. you're taking the 90% who do not reach it and taking the costs of closing it and applying it to them. yours say their preemyulls will go up. >> what i know is that a patient who gets to the donut hole needs their medications to preserve their life. and if they can't afford them, they get sicker and we end up paying. >> so can you guarantee for seniors not in the donut hole that their preemyulls will not go up? >> -- premiums will not go up? >> it is so important to provide medication. and i think we're seeing much more confidence in the part of seniors that they can get the medications they afford. >> does the deceptive trade practices act apply to obama care? >> does the deceptive trade practices act apply? >> i'm being only halfway facetious. it seems none of the promises made to our seniors under the

president's national health care plan will come true. many are forced out of their plans, will see higher premiums. that is why republicans are serious about coming back with better solutions, for seniors. >> congressman, what i have in front of me is the data. >> the gentleman's time has expired. if you would like to submit a response in writing. >> mr. tee bri. >> thank you for having this hearing today and dove tailing about the comments that republicans want to have better solutions for seniors. it was disappointing to hear the ranking member express concern in the rhett orcal fashion that he did with respect to this hearing and what republicans believe. and why republicans voted to repeal this bill is because we do care about the impact to this bill to real people. and having 500 billion dollars taken out of the system is a good reason to have this hearing today and get

information from the doctor and mr. foster and continuing a discussion, because doctor, thank you for doing what you're doing in being here today. but we represent a lot of people in a lot of different parts of this country. and in my district in central ohio, and mr. 11 has been to my district, there are doctors, there are seniors, there are hospital administering, there's the largest medicare advantage provider in my district is a nonprofit catholic hospital. and they're all very, very concerned about the impact that this bill, this law has with seniors. not insurance companies, not wealthy seniors. i'm talking about real people. my dad has a sixth grade education, my mom has an eighth grade education. they're on medicare. my physician, dr. randy, i'll call him, his father-in-law

lost his primary care physician because he no longer was going to take medicare patients. so my physician said, i'll find you a doctor. i know a lot of doctors out there. columbus, ohio is the 15th largest city in america. this doctor friend of mine could not find a doctor for his dad. his father-in-law. because nobody would take new medicare patients based upon the new law. so he is now taking his father-in-law as a new patient, which he said he would never do. a lady in my district, joanie, came to me tearie ayed because her mother, a medicare patients, first lost her medicare advantage program who had to go into medicare fee for service. i'll give you this as an exafrpbl. and then lost her doctor who said i am done with medicare. we have a large city, we have

four healthy hospitals, three of which are very concerned about the new law. we have a doctors association unlike the american medical association, the ohio state medical association, who opposed the bill, who support repeal, they want reform. don't get me wrong. they want reform. but they're very concerned about what this legislation does. and so i understand what the minority has said. i appreciate your testimony. but the reality on the ground that i see as the son of seniors, as someone who wants to improve our health care system, who wants better access, who wants lower costs, who really wants people to keep what they have, which was one of the president's goals, a wonderful goal by the way. i thought the president was spot on, on that. but the reality on the ground, at least in central ohio, is people aren't being able to keep what they have. seniors are frightened that

they're losing coverage in reality that they had and they liked that they chose. seniors are frightened that they're losing doctors. my mom lost her doctor. and when you're 70 years old and you had a doctor for a long time, you build a really good relationship with that doctor. you're frightened that, to face a situation where now you have to go on to another doctor that you don't know who that's going to be. but you're talking to other seniors. my mom and dad walk every morning at a local mall, it's a senior's club. and you know what they're talking about? are are there going to be any doctors left that take senior citizens? and this is a year after this bill went into effect. and doctor, you're a physician. these physicians talk to their patients and they express concern about the new health care bill. many of whom support it when it first was talked about but opposed it in the end. so my question to you is let's

not talk about the statistics. let's talk about what i say, what you say, what the chairman says, to constituents who on the ground are seeing a reality that's much different than the rhetoric of when this bill passed and what the goals were. people are losing the coverage they had and they're losing their doctors, and their doctors are blaming the bill. >> and your question? >> if you want to respond briefly. the gentleman's time just expired. i'll give you a few seconds to answer and then you can supplement it in writing. >> i will do that. i'm meeting all the time with doctors and i have the same objective you do. we need a strong support to that profession. we're commited to that. i'm hearing a different story. the physicians want to participate. they're actively engaging in issues relating to changing the form of care to make it sustainable, better for them and their patients. and i think we can get there. i think the act provides us a very strong foundation for

that. >> thank you. >> mr. stark is recognized. >> thank you for being here. thank you for holding this, mr. chairman. affordable care act has a variety of initiatives to modernize the medicare program. and, make sure that i hope recognizing value more than volume. what has your, as you move among the provider community across the country, what is the reaction you're hearing? >> to the modernization of health care? >> yes. >> excitement everywhere. we're seeing it first in some of the information technology work. we're finally at the threshhold of really modernizing

information technology for the providers of care and the beneficiaries of care in this country. it's going to make a tremendous difference. physicians can be very frustrated by the fragmentation. people move from place to place and get dropped. the affordable care act has the opportunity to reward and support continuous, seamless care so the patient with diabetes that is seeing three or four different doctors knows that her journey is being crafted, will be able to build accountable care organizations, move payment to bundle payment, link payment to quality of care for both plans and hospitals so that continuity gets established. doctors and providers are quite excited about this progress into a better care system. and congress in its wisdom has given us these gifts of the innovation center in the affordable care act and the federal coordinated for dual eligibles. i can't tell you how important this is to liberate all the

information around the country to provide better ways to deliver care. and when a hospital in nebraska or maine develops a better way to make patients safer or develop a better way to care for someone with multiple sclerosis. we're on the threshhold of a tremendous boost in innovation, creativity and spread of better care around this country and the doctors know that. that's what they're talking to me about. >> would it be your understanding that i guess this isn't a yes or no. but that there is a positive role for government to play in the delivery of medical care in this country? and that that could be led by the members of congress if they decided to work together and do it? >> well, you're already doing it. it's a cat litic role. you've set the stage for the

health care system to do what it wants to do for doctors to thrive and commit themselves to patients. you do that as you provide the resources to make it more continuous and safer. but let's make no mistake about it. government has no role at all in the eent counter between the doctor and the patient honoring the sanctity of that consulting room is really key. i'm totally commited to that. but we set the stage for those two people to meet each other and work together when things are done right. so it's a combination of government support, encouragement, reward, and the confidence and the commitment that professionals have when they encounter patients, and the patients have when they are confident in the professional. it's a balance. >> thank you very much for what you're doing. and i look forward to, as i know members of our committee do, to working with you over the next couple of years to see that we can improve the system and with your cooperation. i appreciate it very much.

>> thank you. >> mr. davis is recognized. >> thank you, mr. chairman. your comment being liberated, we have private sector has been innovating for decades and sharing common information among the professions. and i just find it hard to believe to talk about innovation in the context that we have in a variety of issues from programic perspectives to the issue just recently discussed. i didn't go to harvard, i went to west point. and the one thing i would have to say at the beginning of this listening to this hearing, having watched my mother and a half gate through the system that was managed by your agency, and we talk about affordability and innovation. in the world where i grew up both academically and professionally, these answers would be called equivocation. there are strait yes or no answers on kits. and i think it's important to share the truth and avoid the posturing for the lives that we say we want to save.

successful physicians that i know are known for their candor and their bedside manner. i have not heard one doctor, save one who is in a different place politically than the entire kentucky medical association whose head i met with yesterday who has not said this is going to limit their capacity, increase overhead, increase costs and is going to cause a very serious problem for senior citizens. when you talked about competitive bidding being a good thing. it's not pay me now or pay me later. it's pay me now and pay me later. directly, i have a long-term vm nch provider that's long established lost their ability to bed. a california company won. and coming on the back side of this because they had no local capacity to deliver, guess who they subcontracted with? a company that had been doing the business at a lower cost than before. let's say counter intutive answers are not here. and admittedly i'm not a doctor. one of my opponents son's

played one on television. but i'm most disappointed in the lack of candid answers on these issues because we want to help you improve this system. it's been made more complicated by the bill and in my other life it would be read the problem. if you read the bill it does not connect the dots by creating 162 new agencies, commissions and boards, cutting direct benefits and increasing taxes is not a resipe for improved capacity. i want increased access. and coming to that many of my constituents are on medicare advantage. do you know how many people are on the program? >> about 12 million. >> it's about 12 million people. do you know how many people were in the program in 2005? >> i don't, sir. >> it was about 5.3. so the market working competitively, seniors were moving to this as a preference program of choice. and i think the numbers say something about the popularity. don't you? >> yes. i mean medicare advantage has tremendous opportunities embedded in it as well as significant problems.

>> well, i would say that the customers tend to vote with their feet no different than the doctors pulling out of medicare in droves. i'm seeing the same thing happening in the ohio valley. we're seeing that happen in the medical professions. it's getting to a point because of this bill, to i have have a zaurt who wants to go to medical school has been told by several doctors not to go because of the complication in the health care system placed on future physicians. but coming back. your own act wary said last year that 7.4 million seniors would lose their coverage in medicare advantage. is yours correct? >> making predictions of the future, sir. what i have is the evidence before us today. >> i didn't ask you that question. i asked you, is our actuary correct? >> i can't judge whether he is correct or not? what i can if he will you are the facts. >> i'll go back to the academic

education. i'm not interested in the academic salon answer. is your actuary correct in the assumptions that your department submitted to this committee? >> sir, i'm not the commander. >> you're the leader. you lead a budget larger than the defense department, sir. please answer the question. >> i lead an agency in which the growth rate of medicare advantage is 6% and the actuary predicted a decrease. so the prediction was incorrect. our medicare advantage is healthier now. >> so it's a good program then why would he say that the people are going to be cut out of the program by the very legislation that you're advocating? >> what i'm saying is that i have the facts on the ground before me now. and the facts are that medicare advantage is looking stronger and stronger. we're seeing plans in expansion medicare advantage, we're seeing robust choices, 26 choices per county on average in this country. average premiums going down 6%, enrollment going up 6%. and these are smart businessmen

out there, people who run the plans are investing in a future that looks pretty bright to them or i don't think they'd be investing like we're seeing them invest. >> thank you. the gentleman's time has expired. mr. reich ert is recognized. >> thank you, mr. chairman. doctor, thank you for being here today. i'm not a doctor, either. but i've been a patient many times. so i'm looking at the system as most americans would from that side of the issue. we had -- i'm disappointed, too, as mr. davis' stated in the way that you're answering or not answering some of the questions, so i hope that you understand our frustration here with some of your responses. you know, most americans are just trying to figure this thing out. they need your help to do that. a lot of people are listening

today. this is streamed live c-span so there will be a lot of americans listening to your words. you obviously support the affordable health care act. we had a witness in a couple of weeks ago whose name is austin goolsbi. do you know him? >> yes. chairman of the council of economic advisory. he said that the health care bill would increase access, decrease costs, increase benefits, reduce the deficit, and people would be allowed to keep their health care if they wanted to. would you agree with those statements? does the bill accomplish those things? >> it appears to be. yes. >> is that a yes? >> yes. >> is there anything at all in the bill that you would change? >> we're going to learn over time. that's a complex question. >> but you've had some time to read the bill and look at the bill. is there anything that stands

out in your mind that you would change? >> i'm -- >> what don't you like about the bill? or is it all good? >> it's a very complicated bill, sir. >> is there anything about the bill you don't like? >> you know, right now i'm complemtteding. >> no. yes or no i guess because i'm not going to get a straight answer. is there anything about the bill that you would change? yes? no? >> over time, we're going to learn about this bill, sir. and -- >> from what you know today. from what you know today, sir, is there anything that you would change? >> there's in the whole -- >> sir. can you tell me when the $206 billion cuts to medicare advantage begin? >> well, right now the payments are stabilizing. >> when do the $206 billion cuts begin? what's the target date, the set date? what year? >> the cuts are phased in over

time. >> when do they begin? >> it depends on the plan. >> what year do the cuts begin? can you give me a year? >> it's variable depending on the plan and the area. >> 2017, $206 billion in cuts will begin to take place. your actuaries say, as mr. davis has asked you, that there would be 7.4 million seniors losing their health care. so the statement that you agreed with earlier that mr. goolsbi also agreed with, you can keep your health care if you want to. isn't a true statement. even the president of the united states has said in a public forum, which i was present at, he said there may have been some, in regard to the statement that you can keep your health care plan if you like it, he said there may have been some language snuck into the bill that runs contrary to that premise.

now, if there is language in the bill that runs contrary to this premise, and according to the president it does, would you change that language? >> sir, medicare advantage -- >> would you change the language if there's language in the bill, as the president says there is, that got snuck into the bill, would you change the language that prohibits people from keeping the health care they like? >> people -- >> would you change the language, sir, if there's language in the bill? there's that's a yes or no question. >> i would love to be able to answer the question. >> why can't you answer the question? it's a simple question. if there's language in the bill that says, as the president has said, that runs contrary to the promise that you can keep your health care if you like it, why would you not say yes to that question that i will change that language because we believe and we have said over

and over again if you like your health care plan, you can keep it. why would you not change that language? >> congressman, to me -- >> why would you not change that language? >> you're asking a hypothetical question, sir. what i can tell you is our jobs -- no, sir, i'm not. the president of the united states has made this statement. there's language -- >> mr. chairman, i need to object. >> it's my time, mr. levin. >> if the gentleman from washington state would suspend. mr. levin. >> i will find a way to object. i think we have to let witnesses answer questions, sir. >> i agree. >> this -- >> back to regular order. the gentleman from washington's time is about to expire so you have about two or three seconds left. and then we'll leave a few seconds for the witness to answer the question. the gentleman is entitled to answer answer to his question. mr. chairman. i would just ask for a straight

answer from the witness. >> you have a few seconds, asive done to the minority, to respond to the question. >> i'm not aware of any such language in the bill and the question to me sounds hypothetical. >> all right. thank you. mr. mcdermt is recognized. >> thank you, mr. chairman. doctor, you've given -- well, your performance in political theater, you've been brought to a stage today and put into a play that you really don't want to be in. you want to be doing your job. this is a stage being set to get rid of medicare. the republicans have never liked medicare. when harry truman proposed it in 1946, the republicans started talking about socialized medicine playing on the fears of what was going on in the soviet union. they have used these fear and misinformation tactics then and they're using them again here today. now, when medicare passed in

1965, most republicans voted no. and what we are really doing here today is trying to poke holes in the bill. but we've been here 100 days and the committee has laid no proposal on the table to make it better. everybody is talking about what's wrong with it. bill frist said, don't repeal, make it better. so all we have in front of us is one plan that's on the table. paul ryan's roadmap. he wants to give a voucher to every senior citizen in this country. now, let's be serious. the point of that is that the republicans believe that seniors need to put more skin in the game. and i want to be crystal clear here. seniors already spend one-third of their income on health care. they can't afford any more skin in the game.

so whatever i hear here is really about the paul ryan plan. i would like you to take the time here to tell us what you think will happen when they repeal or begin to undercut and destroy this and work toward putting a voucher plan. because that's the only thing they would put on the table. and i believe that all the republicans are for it because none of them have stood up and said we don't want a voucher system. we want to make this system better. we hate obama care. we want to get rid of it and put in the voucher system. so tell us what a voucher system would do to seniors in this country. >> it would put them at risk. people, they already have skin in the game. their bodies are in the game. the whole idea here is to give seniors security so they don't have to wake up in the morning, wondering whether they can get to the care they need and that will help them preserve long and fruitful lives. >> do you think seniors could

take a 6,000 or $7,000 voucher out at age 75 and get a health care plan? >> not a senior whose act warle risks. they're worse if they get something, a worse disease than that. we're partners with the seniors in medicare. we've got their backs. i wake up every day thinking about how to help these beneficiaries make sure they can get the care they want and they need. i think that's an important role to fill. and my colleagues in cms have the same commitment. sending them out on their own to go navigate this very difficult system, which isn't always friendly to their needs, is not the right answer. and taking the law down strikes me as a terrible answer. it means taking away the wellness visits we just added, removing access first to preventive coverage. it means putting the people in the donut hole back at risk so the lady i met in atlanta who can't afford her medications right now is going to have her blood pressure rise and get a

stroke as a result of that. it means that we decrease our focus on quality. because this law has in it tools for transparency and improvement of care through measurement, support, to quality, rewarding quality. in this bill we now can reward hospitals for making their care safer. we couldn't do that before. because of this bill we can reward medicare advantage plans that reach four, five star levels with more reward. that's going to focus the whole industry on doing better for the medicare beneficiary. when that goes away this goes away. >> this gives u us tools to fight fraud and abuse. do we want to let the criminals get out scott free? that makes no sense to me. the bills is transparency ben firries and the public at large can profind out much more because of their own performance. >> do you think that if seniors understood what a voucher plan really meant, they would be in favor of as opposed to the medicare plan that we have and

we're trying to amend and make bet sner >> i don't think i know. i've been out talking to seniors. and when i go to senior centers and explain this bill, they applaud. they want this. they understand how this bill works in their interest and how when i go to work i have their interest in mind. a voucher says go out on your own. >> can i clarify one other thing. >> the gentleman's time has expired. i think it's important to note for the record that the republican plan was the only plan that was scored by the congressional budget office that reduced premiums across the board, did not cut medicare, and did not increase taxes. and with that i would recognize the gentleman from louisiana. >> mr. chairman, i hope mr. chairman that if we're going to be allowed to comment in between outside of regular order. >> when you're the chair you'll be allowed to comment. >> we'll ask for regular order. >> thank you. >> mr. boustany has the time. >> thank you for holding this

hearing. doctor, i too come from a family line of physicians. i'm a cardiac surgeon and know of the importance of the doctor-patient relationship. how do you reconcile your views on provider oversupply? you've made multiple statements with regard to oversupply and markets and so forth. which are concerns about shortages which are real, and the prospect of those shortages getting worse with the current reimbursement rates, that inevitably will be cut. i mean, we are seeing reimbursement pressures on physician practices. we already have shortages. would you agree that we have a shortage in primary care physicians in this country? >> we have a shortage of primary care in this country. yes. >> physicians? >> physicians and nurses. yes. >> do you agree that we have a shortage of general surgeons in this country? >> in some areas we do. >> what about rural areas? >> some rural areas are having

trouble with access to general surgery. i know that. >> i think it's more widespread than you seem to be suggesting, sir. but how do you reconcile your view of this? because your statements seem contrary to what you're act waries are saying. >> sir, please explain to me what contradiction you see. i'll be happy to address it. >> that we're going to see shortages and worsening shortages, which will hurt access to care for seniors in particularly folks who live in rural communities. >> again, the act wary is making a prediction here. what i see is an investment in expansion of primary care and primary care services. and i think over time it will have that effect. >> but without -- reclaiming my time, sir. without fixing the reimbursement system, we're going to see more and more opting -- more and more physicians opting out for early retirement, we're seeing fewer people going into medicine.

how do you reconcile? >> i agree. the president has commit to fixing the sgr problem which we're absolutely commited to working with you and your colleagues on. that's a serious looming problem in the health care system for sure. >> absolutely. and -- >> and that leads me to my next question. because you've talked often about rewarding quality versus quantity. and yet, in your testimony, i see nothing but plat tudes and nothing specific to suggest the path you're going to take on this. and i suggest that there's going to be a lot of work that this committee is going to have to do to dig down working with you on this issue. >> i've be happy to work with you. within the in the affordable care act and other legislation there's very specific ways quality will be linked to payment. value-based purchasing. >> but we've seen no specific. those are plat tudes. i understand what needs to be done in terms of quality. i've done that in hospitals. i took a community hospital from being sort of average to

top 100 hospitals in cardiac surgery. i understand those things. but we have to get beyond the platitudes on changing this reimbursement system because it's at the heart of access problem for seniors and particularly for rural families because we are going to see access problems. this reimbursement issue is causing physician shortages. >> congressman, i assure you the specifics are there. they're out there. and i would be happy to work with you at any point afterwards to explain what those specifics are. and i welcome your comments and improvements. >> with regard to technology, you've made a number of statements that seem to be of concern to me, obviously, about downplaying the importance of new technology and innovation in health care. we have an innovation tax in this bill that's going to hurt innovation, i believe, in the long run. but you've made statements, i'll quote one. one of the drivers of low val in health care today is the

continuous entrance of new technologies devices and drugs that add no val to care. can you explain that? >> of course. yes. some new devices, drugs, are miracles. they save lives and they add tremendous value to care. others do not. >> who should decide? >> professions. the scientific community. >> so when you suggest that there should be a national policy, who is going to make those decisions? >> a national policy? >> national policy. that's what you referred to national policy. your quote is if we had a strong national policy it would allow us to know the difference. >> investments in supports to the scientific community to allow us to understand more and more about what works and what works better than other things is very important. >> let me ask you this. back to 1950s when a surgeon saw a patient die from a pulmonary embluss he put his mind to work and he came up with an idea. and working in his garage he put together the first

heart-lung machine. would that have fit into national policy? what impeppedments would -- impedments would there have been? >> i'm exithe about that. we now have the ibet to help them invest further. >> we've seen nodsing further. >> the gentleman's time has expired. mr. he willer is recognized. >> thank you, mr. chairman. doctor, i appreciate your being here today. and i am going through some of your quotes and i know we've heard some of them already today but frankly i think they're worth repeating. quotes like the nsh is not a national treasure, it's a global treasure. the decision is not whether or not we'll ration care. the decision is whether we will rash care with our eyes open. quotes like competition in short will hurt you not help you. another one. i admit to my devotion to a single payer mechanism as the only sensible approach to the

health care finance i can think of. and finally, any health care funding plan must redistribute wealth from the richer among us to the poorer. sometimes reading your quotes, doctor, i wonder what country we live in. having said that, i have a significant large district and as you know that this health care bill significantly reduces the funding for the medicare advantage program nearly one third of all medicare ben fish riss in my district are enrolled in the medicare advantage and that's more than 100,000 seniors in my largely rural district. you just made a comment that you go to these senior centers and you talk to them and they applaud you on what this new program, this new care provides for them. i go to senior centers in my district and try to explain the new health care system to them and i assure you, i don't get a

round of applause. you just said that it's a good model. i guess my question is, how you in your mind say that this is a good deal for seniors if the net medicare savings is 575 billion in this piece of legislation and yet the amount reinvested in the medicare benefits is $24 billion. if you're going to take $575 billion out of the medicare system, what benefits do seniors have with only $24 billion put back in? >> the projections, as you heard earlier, say that copayments and parts a and b are going to go down by $200 a year by 2019, fee for service preemyulls will be down. the donut hole will have closed and seniors will no longer be afraid of losing their drug benefits. out-of-pocket costs are projected to go down. this is a good deal for seniors and america.

>> do you believe protecting the patient-doctor relationship is the goal of this health care bill? >> definitely. >> do you believe that patients families, doctors, should be the ultimate authority for the individual health care decisions? >> i believe -- yes, i do. >> do you believe one of the goals of the health care bill is stream lining the system so patients can navigate it more easily? >> yes, i do. >> if that is the goal of the health care bill, wouldn't a reasonable person think that 100 new boards, agencies, and programs would violate all three of those questions? >> i think the health care bill will accomplish all of the goals you just articulated, a smoodser more seamless care. i can name the parts of the bill that will do that. we can see how quality will be improved as a result of this bill and costs will fall as a result of the improvement of quality. people will be better off because of this bill. >> maybe in another country thank you. thank you, mr. chairman. .

, for your great service. >> i cannot say how big of an honor is to be with you. >> thank you. >> a doctor, what would happen

to cost sharing for medicare beneficiaries if the reform was repealed? >> costs would go up for beneficiaries if the reform was repealed. seniors are dependent upon access to their medications. if this bill was repealed, more and more seniors would lack access to the trucks that they need. they would not be able to get the preventive services they need to keep them healthy overtime. this bill invests in the delivery system reform. they can get care better and smoother. asked a senior who has seen four or five different doctors what her life is like in a fragmented health care system? it is a nightmare. she cannot be sure that her lab tests will go to the right place.

the delivery system reform, improvement on care, is what is behind this bill. that is where we will end up. we can make care safer. if this bill goes away, we do not have a plan anymore for crafting the kinds of journeys that our seniors really want. quality will go down. the bill is an open door to the new american health-care system that we really want and all need and can afford. >> dr., if the affordable care act was repealed, with those 3 million seniors who received it $250 from the government would have to pay that money back? >> we are looking at the right now. i hope we do not have to face that question for real. >> like mr. ranger and others,

when i was growing up as a young child in alabama, i never saw a doctor. i never went to a doctor. tell me what is in this bill that would help children growing up, poor people, in rural america. black, white, latino, asian americans, who are growing up and happen to be poured. the family cannot afford a doctor. do you think this is a major step toward providing health care to all of our people, and especially young people? >> yes. high-quality health care begins with health care. this bill ensures the old and young, millions of people, that they can get access to the care that can be made great for them.

this -- if this bill goes away, people will wake up in the morning wondering whether they are going to lose their health care coverage or be able to get it. we are talking about a bill that has a guaranteed issue of insurance with children despite pre-existing conditions. a kid who has asthma cannot be denied access to health care insurance as a result of this bill. if you take this away, you heard that child. >> thank you very much, dr.. >> cindy for testifying today. to switch gears a bit -- thank you for testifying today. it was interesting to hear the president in his state of the union indicate his support. do you support medicare

liability legislation? >> yes, i do. i support and exploration in the country as to which forms of the system would work to the benefit of patients and the quality of the system. i do not know exactly what they would be. >> are you aware of the state statutes in california and in texas that have a cap on losses? >> it is not my specialty but i am aware of them. >> so you are open to legislation that would support caps on non-economic loss? >> i am not in a position to comment on what i think about on a set of solutions. the agency has a project underway right now but we need more. i was happy to see that in the president's language. >> you have a sentence in your

testimony. what new tools does the agency have to really get out the waste, fraud, and abuse? >> two big tools will allow us to identify patterns of abuses of public trust and criminal behavior. we are engaging in more and more enforcement with quite a bit of return. i think the return on investment shows something like 6.8 to 1. the other part, very exciting to me, is prevention. why do these people get into the system in the first place? we have rules out there that will allow us to pre-qualify people by screening them in advance. that will keep the criminals out of the system in the first place. >> i had a constituent come to

me, seeking medical care for a knee problem. the doctor prescribed a knee brace for him. a knee brace was then provided. under medicare, the provider was provided $686 for a knee brace. my constituent went online and found that same knee brace for the cost of $194. how is it that medicare is reimbursing $194 knee brace for $686? >> , i would be willing to look in that case -- i would be willing to look into the case. >> i keep getting bureaucratic answers as to why the schedule is the way it is. i would like to have a specific answer of what we are paying

$194 for a knee brace. >> i think the system will allow us to get much more better deals for our beneficiaries. i think it is really important for us to be acting in a market system on behalf of beneficiaries to find the best deals for them. >> thank you, dr.. >> welcome, dr. berwick. my father and grandfather were doctors. and i really think you missed your calling. i think you would make a great lawyer. for all of the reasons that we can imagine. the issue here is between democrats and republicans is not whether or not republicans -- americans have access to the highest quality of care. the issue is whether or not patients and families will be in

charge of the care or if the government will be in charge of that care. you and your answers have confirmed that you basically believe the same thing as well, that the government needs to be in place to be able to make these decisions for people because clearly they would not be able to make them themselves. who is going to decide these fundamental questions about health care? in the sale of this bill, the president said and many of our friends on the other side said do not worry. if you like the health care coverage that you have, you can keep it. is that true? is it true that if you like what you have, you can keep it? >> i do not understand your question. >> arthur and the americans who have lost coverage -- because of this bill, are there americans

who have lost the coverage that they want and cannot have the coverage that they like? >> there is turnover always -- >> that is not responsive to the question which is why you have seen the frustration appear. there are millions of americans who have had health care coverage, and that coverage is going away because of this law. many of them were out on ilan on the capital for the past two years expressing this frustration. were they wrong? >> what i in hearing from the beneficiaries is they have more choices -- >> you are hearing from beneficiaries who are selected from individuals to come and give you a story that is not reflective of the real world. the real world are reflected by the individuals here who are coming -- who are going home and hearing from their constituents.

i want to move to quality. equality is the pivotal issue in this. who is going to decide what quality health care is? as you know, what is right treatment for one patient even with the same diagnosis is not necessarily what is right for another patient, because patients are unique. do you believe that is the case? >> yes, i do, sir. >> who ought to make that final decision about what treatments that patient receives? >> the doctor and patient. >> if i were to tell you that this law violates that principle and your agency has the power to negate a decision, which you agree with me? >> no, i would not. >> if we could demonstrate that is the case, he would be supportive of changing this law

so that doctors, patients, and families will be given the right to make that decision? >> i honor the encounter between the doctors and patients. >> dr. berwick, i will show you line and verse of this law that i believed removes that. there are many who believe you support rationing. do you support rationing of care? >> my entire life has been fought rationing. >> i appreciate that because we will be able to demonstrate for you how this bill provides rationing of care in this nation. i welcome your participation in making sure this is overturned. i want to get to the physicians trying their hardest in this country. many are concerned about the likelihood they see coming down the pike that there licenser

will be tied to participation in this plan. can you state unequivocally that it ought not be tied to participation in any health care plan? >> i am not aware of the issue your question refers to. >> do you believe the -- >> i do not understand your question, sir, and i apologize for that. >> i look forward to that. thank you. >> you will be able to answer in writing at a later time if you so we showed. >> dr. berwick, first of all, a word of thanks. your medical dna is in massachusetts. i think that any state would be envious of the first class hospitals that we have,

including the teaching hospitals which are evenly distributed across the entire commonwealth. the law that is under assault this morning has high customer satisfaction. 78% of the people are satisfied with the delivery they have witnessed. the term actuary has been thrown around here frequently. can you tell us what an actuary does? >> he looks at the financial situation of the agency and of the trust funds and he advises us on what he thinks about them and the future. >> at rotary clubs and chamber of commerce get-togethers, our friends on the other side are going to be asked do you favor a ban on pre-existing conditions. i can tell you that the answer from them is going to be yes. do you favor keeping children on

their parents' health care? the answer is going to be yes. do you offer and support more preventive care? yes. how about more women's? yes. do you favor based upon the actuarial reference is made today getting there through the mandate which the insurance industry would say is the only way it can be done? , you respond to that? >> -- how might would you respond to that? >> i agree with all of the above. why would we have a system in which if you need the care you cannot get the care? that makes no sense at all. you have to have an individual mandate of some form or the whole thing unravels. people who do not need insurance will not buy it until they get sick.

it is simply a logic. it is mathematically true. >> something and actuary might assert? >> absolutely. >> would you talk about what you intend to do with waste, fraud, and abuse and the cost saving mechanisms being put into place? >> there are actually two parts with that. there is more fraud and abuse then i thought. i know we can root it out and find it. we will stop the criminals and the abuse and the waste. we are diligent about that. my deputy is doing a great job, and the administration is fully committed to it. there is the other area of error. there are honest errors that get in because of the building and coating systems. the president has set a goal of reducing the medicare rate by

half. we are on track and we will do that. that will help us have been much more better stewardship. >> so that number we have seen, $50 billion annually, could be contributed to fraud, is that an accurate number? >> that number is a rough estimate of fraud and abuse costs of the system as a whole. that is a large number. >> thank you very much. >> mr. buchanan is recognized. >> thank you for the opportunity for the hearing today. dr. berwick, i represent a part of florida. we probably have more seniors than any other district in the country. i do a lot of town hall meetings. what comes up at a lot of them is the whole thing on medicare advantage. we have 30,000 that have been on medicare advantage.

the general perception in all of these places is that they are going to do their medicare advantage. you are saying that is picking up. i do not see it or hear it. it is something that you have to deal with. he will have a heck of a public- relations problem. >> i agree with you that we have a communication problem. people have a lot of misconceptions about medicare advantage. there are quality measurements now that apply to it, bonuses that will be awarded to stronger plans. enrollment is going up. >> i have a couple of other questions. so you disagree with richard foster and his assessment that millions of medicare recipients would lose their coverage. >> he is making a prediction and

that is his job. he predicted a decrease in medicare advantage this year. it is not going down. it is going up. he is doing his best prediction. i can see the facts. the plants are behaving as if this is a good area to be in. >> give me the facts of how many people have dropped off and how many people are adding critic he also mentioned two-thirds of hospitals are already losing money in terms of medicare patients. obamacare is going to make it much worse. what is your response to that? >> i meet with hospitals in the industry all the time now. they know and i know that the solution for them and for medicare and the country is better care, to move the forms of care delivery toward higher and higher quality, reducing costs, improving care, and

making them more robust -- >> i got an e-mail yesterday from denver health where they have now documented $100 million of savings while making -- >> let me get to the last key point. let me just mention to you that i met with a large company in our area. his health care cost this year went up $1.5 million. another pharmacist talked about issues for small pharmacists. his bill went up 22%. i was chairman of our local chambers. i can tell you that small businesses to of florida and throughout our region, it is going up 20% a year. they are not seeing -- are you out talking to any people in business? everybody is very, very

concerned. substantial increases are across-the-board. how do you respond to that? >> i see it all the time. it is the state of american health care that is doing that. it is fragmented and not paid for correctly. there are high levels of lack of coordination, injuries and -- >> people see this as another big entitlement program. they are not seeing it -- they are not seeing anything coming down the road. is this another big entitlement programs? >> i would be happy to meet with them and you, sir, because the answer lies in the affordably -- >> , down and meet with our business people in. >> i can show them and would be

happy to talk to you about the elements of the bill that would allow us to move our country toward a better and better care. >> let me make one other point. our cardiologists would love to meet with you. many are concerned about staying in business because of the substantial cuts in medicare. what are you doing about it? >> i am talking with physicians. they know that if they can work together with us and with the private sector to make health care more streamlined, costs will go down, making the system more sustainable. >> thank you. >> mr. smith is recognized. >> thank you for being here today. i do want to touch on the issue -- my concerns are the complexity of health care is

compounded with this new legislation and therefore in rural areas the job of medical professionals even more difficult. the last roles have included provisions requiring a physician be on-site indivisible whenever an outpatient procedure is being performed. i understand cms takes the position -- the fact is, the rule was not impacting hospitals until it was a restated in 2010. the people who will suffer, the patience and a small communities, hospitals, the distance between the facilities is very great. this would further compound it. i will ask in writing for the

record my questions relating to that so we can get to some specific responses. but when you look at this new legislation that is now law, i am concerned that the addition of over 100 new agencies adds to the complexity. do you see any mechanism in a law that does not centralized discretionary authority in these agencies rather than out among the health care professionals in the country? >> let me go back to your point about the rural households. i think it is very important for us to remain mindful of giving care around the country. that is one of the reasons why we delayed implementation of the direct supervision rule and why we reconsider those requirements for hospitals. we also included rural

hospitals. the more general issue of complexity is a serious concern. we need to make sure that every step we take in implementing this lot is making things easier for patients -- >> over 100 new agencies -- do they not have some discretionary authority? >> i am committed to simplification, sir. what i want to have no matter how many agencies are involved, the beneficiaries needs are addressed and the doctors and hospitals are feeling that when medicare takes an action is something they understand and not just bureaucracy. i am committed to that. >> i just want to bring the message that many health-care professionals, almost all of them that i talk to, are very nervous about this, about the power of the government's

increasing and telling them what to do whatever the case might be. i just had a very positive experience at my local hospital relating to a family member in the last few months where i stood amazed at how great our current system is. i do not want to jeopardize that british >> we share that in common, congressman. >> dr. berwick, thank you very much for being here and all of your testimony. i would not be surprised that people are confused. a lot of consumers are not sure they can reap the benefits as my colleague pointed out that no longer can an insurance company discriminate against them because of a pre-existing condition. all of a sudden, they are finding their recent graduate child who cannot find a job is still able to stay on the health insurance coverage of that

parent. they are beginning to see the benefits. i do not doubt that some of them are confused because they are hearing all of these anecdotal stories or these projections or they hear about these scare tactics, death panels, and all of the rest. i think you started off your testimony by saying we are told that people should be scared when it comes to hmo medical care, that they are going to lose their medical coverage. can you repeat what the actual numbers show? not the projections or the speculation. >> we are seeing a 6% increase in enrollment. there are now 26 medicare advantaged plans available in every county in this country on the average. we have made this choice is more meaningful. they are gone now. when the beneficiary looks at

their options, they are meaningful options. that is the one i want that meets my needs. >> the other scare tactic is seniors in america be afraid because your costs are going to rise. those are the scare tactics and projections -- what is the actual result on paper? >> on average, premiums are down this year. some people will choose a medicare advantage planned. the average premium went down this year. >> some 3 million beneficiaries under medicare, close to 3 million seniors, got into into $50 tax-free check to help them pay for prescription drugs -- got a $250 tax-free check to help them pay for prescription drugs. hopefully, we will be able to

have you come and testify about what is actually in the bill and not what is projected to be in the bill. you are within the federal government as everyone a macaulay's is so you qualify for the federal health benefits program for your health care. >> i do. >> everything that i understand from the bill and having beckett ejected and knowing how we are going to reduce costs, one of the thing we try to do is give people choices. we have the choice of plans to the federal health employment benefit plan. this new law will give a lot of americans a choice in what plan they decide to select. >> many choices. >> just as other members of the federal government received government support to help pay for the cost of your health care plan, so wonder this new

historic law will americans get support for the cost of those health care plans. >> that is correct. >> some would say that is a government takeover. i think i did a quick survey. that plan as a result of the historic passage of health care reform last year which now gives americans those same choices of options that will be available with some federal subsidies is very similar to what we get each and every one of us members of this committee get for health care as well. the subsidy for members of congress for their health care in the employee health-care benefits plan is actually greater than the taxpayers or there will be provided in subsidies for the new law.

it is that correct? >> i believe so. >> it is interesting. it is not good enough for the american consumer, but it is ok for members of congress to continue to get government- sponsored health care. to give that to the american people seems like we are not quite hearing the full story. i hope we have a chance to hear from you more often. i think you for your testimony. >> thank you for being here. i had a real-life story myself. i had some time with my father which is sometimes rare. he is the family physician. he is 62. he and for me that he is calling it quits much to my surprise. six kids in the family.

five of them are doctors. not a single one of them are convinced this will be good for their profession. so i challenge you that this association or this group or that group supports -- i run into doctor after doctor after doctor who tells me that this is going to be bad for their profession. i just put out that out there as a reality check for me at least in my district and in my family. would you agree that most americans get their health insurance from their employer, private health insurance? >> i think it is about 160 million people. >> is that most americans? >> it is a majority, i think. >> are you aware last year when this bill first past that

publicly held companies, specifically coming back home to my home area, caterpillar and other companies like verizon and john deere had to submit to the fcc what one provision would do to their bottom line? for caterpillar, it was a $100 million hit to their bottom line. >> i was not aware of that. >> you were not aware of that? are you aware that we do let me back up. are you aware -- your assumption is that the bill will lower health-care costs for employers in the long term. >> i believe that improving care in america which this bill takes a long step toward will become more affordable for everybody. >> since most americans get their health care coverage from their employer, my constituents

-- do you believe that the employers' health care that they are paying for will become less expensive? >> the route to tackle -- the route to that goal affects all. the agenda of making care better, safer, reliable and more seamless, that is a benefit to all. i think that is what our country is headed for now. >> i find that interesting because i her that a lot when in washington, d.c. are you aware of any publicly traded company that has to put out to the public their books and projections on costs and the publicly traded company who is predicting their health-care costs going down? >> i would not know that,

congressman. i know it is possible to get there. i want to work with the private sector, employers, hospitals, professional societies, health care plans altogether to make care better. have you ever seen a patient with a post-operative infection that they did not have to get? that could be a privatepay patient or a public pay patient. medicare will get more affordable. and i am not an accountant or a stockbroker. i bet i would see companies are in this country understand that their health lies in a healthier health care system. >> at the end of the day, i think we are interested in the realities. most major companies -- you do not seem to be aware of any. major employers providing health-care coverage see their

health insurance premiums going down -- i have one final question. it is in regard to -- you are aware of the two federal courts that have now ruled that the individual mandate unconstitutional. ok. i am curious if the administration is required by the justice system to stop implementing this law and how you plan on implementing that. >> he will have to speak to my colleagues who are more -- you will have to speak to my colleagues who are more qualified to answer that. >> have there been any discussions in the department -- >> of the gentleman's time has expired. time is very short. >> stinky for your distinguished service in your candor this morning -- thank you for your

distinguished service and your candor this morning. we know that newt gingrich was determined to let medicare with their on the vine and had support of some other republicans. now, they have laid out a roadmap. you have discussed it with another doctor with the ultimate goal is to move seniors to the uncertainty of the vouchers, away from the guarantees that lyndon johnson signed into law in medicare and shift the responsibility to seniors to meet their healthcare needs to fend for themselves with private insurance companies to provide for their needs. that is the longer korngold. in the short term, -- that is the longer-term goal. what they are really presenting to seniors and individuals with

disabilities is a plan to increase the costs of their health care. i would like to go through and itemize how this republican plan would increase the cost of health care for seniors and individuals with disabilities who rely on medicare. under existing law, if the senior needs a mammogram, rectal screening, bone mass measurement, will they have to make any copays? if we are repealed back guarantee of no copayment, seniors will have to pay more for those services. their health care costs will increase. >> for those services, yes. >> let's discuss the effects of seniors and increase costs that republicans want to impose on them right now with a bill that is been passed. the best estimate i have seen is

that the average individual who would reach this doughnut hole gap in coverage created by the republicans with their -- with their prescription drug plan a few years back, when they reached that gap today in 2011, each of those people on average will get a little over $500 in benefits to medicare beneficiaries of about $2 billion in savings this year. does that sound right? >> that is right critics what republicans are proposing is to hike the cost of prescription drugs to seniors in america this year by over $2 billion, over $500 apiece for those who enter the prescription drug gap. do you have a mechanism on to their increased health care bill to demand of seniors that

they give back the $250 that we gave them through this bill last year for prescription drugs? is there any mechanism? i assumed that under their repeal bill, we are going to be asking seniors not only to pay more but to give back the $250 they received. what about on the issue of the part b premium that we asked individuals and seniors to pay. under existing law, want those premiums be lower than if we adopt the republican hire senior cost bill? with a not have to pay more for the premium if republicans are successful? >> yes, i believe they would. >> with reference to the assertion that some premiums could go up for seniors, that is true only to the extent that they get more coverage under

this bill. >> yes. >> finally with reference to the argument that our seniors are going to lose the ability to select their own doctor, is there are actually incentives under the law that they want to appeal to pay our primary care doctors more under medicare than they have received any time in the history of medicare. >> that is correct. >> that gives seniors more choice than they have ever enjoyed it. >> i agree. >> sent you so much for your service and your candid answers. i hope we can work together to ensure this republican plan -- in the meantime, this year, the high cost of every senior with disabilities who relies on the medicare system -- they can call it a repeal or an attack on president obama, but we have to stop this republican plan.

thank you. >> thank you, dr. berwick, for being here. the independent payment advisory board created under the new health-care law is charged to determine whether medicare is spending more than it budget is and to offer fixes to cut back on medicare spending. while i have numerous concerns with this board, including the 15 un unelected bureaucrats and the approval of the recommendations, i am also concerned about whether rule issues will be addressed and protected by it. most hospitals were granted a 10-year exemption from any changes proposed by this board, but critical access hospitals were not included in that

exemption. kansas has one of the largest critical access hospitals in the country and any further cuts or payments could determine whether they keep their doors open. can you please speak to us on this issue and further challenges that medicare patients have accessing care and whether or not he will be protected by this board? >> the board does not lie within cms. the president supports the independent -- the president supports the independent pavement advisory board. i care deeply about that sector. it is crucial to americans and our health-care system as a whole. i think that gives an opportunity to spread ideas elsewhere. that is one of the reasons why i suspended enforcement that i was

asked about before. i want to make sure that we do not do anything that impedes care in rural settings. the act gives us a chance to understand more about input costs in rural hospitals. i look forward to working with you to make it a healthier part of our health-care system. >> are you willing to work with the administration to give critical access hospitals the same exemption? >> i am happy to talk with you .urther on that bridge to >> >> i wanted to follow up with my colleague from illinois about what the supreme court could be asked to do. i visited with many small businesses and large businesses in my district in kansas, and many of them are investing a tremendous amount of money and implementing a law and one of

the cornerstones is the individual mandate. i am curious. do you think it is in the best interest of the american people for us to continue to implement this law, spending a whole lot of taxpayers' dollars before we have a final judgment? >> congresswoman, i am not a lawyer. i think the affordable care act is good for america, and my job right now is to make sure it goes as well as it possibly can. i will continue to do that. >> do you have any idea what the price tag is that businesses having to spend that will be lost should the individual mandate be overturned? >> businesses are a key state colder in the american health- care system.

businessmen can tell you that. we have to solve that problem. " that is with the interests of our public investment and health care lot and that is what i am keeping my eye on right now, better care for everyone. >> so you have no idea how much will be lost in the economy because of businesses? >> i have a better idea if we do not get american healthcare on the track that it ought to be on through better design and services to patients. >> the grant any idea what the cost -- do you have any idea what the cost of cms would be? >> i do not have a particular number. >> how do you suggest that we might recoup any of the loss that you do in kirk should that

happen? >> what we address that downstream? i look forward -- why don't we address that downstream? >> so you do not have any plans to recoup the cost? >> i go to work trying to make care better for beneficiaries. >> mr. thompson is recognized it. >> think you for being here. i agree with one of the previous speakers. anyone watching this is probably wondering what in the world could possibly be going on. has some probably think it is republicans versus democrats. i like to add in a couple of comments that i have that have been made from advocacy groups for seniors. this hearing is on medicare and the effect on scene news. the same groups that work hard to make sure seniors have access to good, quality health care has

spoken out on this. families usa say benefits are improved under the affordable care act. the center for medical care advocacy says that medicare reforms included in the affordable care act do not reduce medicare's benefits. if they improve medicare and help safeguard the medicare -- a improve medicare and helps safeguard the medicare trust fund -- day improve medicare and help safeguard the medicare trust fund. it makes prescription drugs more affordable and provides prevention and wellness screenings as well, which will enhance the quality of life for our nation's seniors. the leadership council of aging organizations said that millions of americans have already benefited because of this bill,

and the economic and a physical health of seniors and their families will continue to benefit as a lot is implemented further. do you agree with them, dr. berwick? >> i agree with all of those, yes. >> in my little district in northern california, what would happen to the 10,300 seniors in my district who hit part do do not hold if my republicans are successful in appealing this legislation? >> i would assume that many of them would have to choose between medicine and other things in their lives. i have seen seniors having to choose between medicine and food. i have seen a senior stop their medicines because of that because they cannot afford it and they are scared. >> you may have answered this

before. those same seniors -- what would happen to the $250 check that they received to help pay for their medicines during the time they are in the doughnut hole? with a half to send it back? >> i believe we are looking at that issue right now. i fear that might be the case. i do not even want to think about it if i do not have to. >> it was mentioned that primary care doctors get an incentive to be able to provide the health care that we all know has been lacking and help lead to the situation where health care in our country was unsustainable. i think it is also important to note that our rural doctors could also get an increase in their reimburse their rates. in my area and in in the rural area of the country this is a huge issue as to how we attract

doctors to provide health care for the many, many seniors that live in rural areas. i just cannot emphasize enough how important preventive health care is, not only good for individuals who received it, but it saves a much money when you can detect a problem early on and fix it. what would happen to the 110,000 medicare beneficiaries in my district who right now today receive free preventive services and a free annual bonus exams? where they lose this under the bill? >> they would have higher co- payments if they wanted it. we now know that colonoscopy allows detection of colon cancer in the early stages and keep you from dying from colon cancer because you find it earlier. there would be constituents in

your district who cannot afford a colonoscopy and would die of colon cancer. >> thank you. one final question. if our republican friends are successful in repealing this legislation, what would happen to the solvency of the medicare program? >> according to the medicare trustees' report, life is extended to 12 years at -- >> so medicare would be shortened? >> and the gentleman's time is expired. we will reassess for 5 minutes and then reconvened for a second panel. >> thank you, mr. chairman. the issue of geographic disparities in medicare payments is a longstanding problem. well documented study shows that payments are not tied to

quality and efficiency. for example, minnesota is on the bottom tier of payments. it measures that indicate high quality of care -- measurements that indicate higher quality of care for patients with chronic conditions, minnesota ranks really high the. how will this new health care law in sure the beneficiaries in my district that they are going to have the same access to care and services? >> i know this issue very well and it is a very important one to make sure pavement is fair and adequate. under the affordable care act, there are three different process sees that i am aware of now. one study will be due back to us in may or june.

the secretary has been required by the law to have a study of geographic variation of cost for hospitals that will be due at the end of the year. there is an important study under way now, on medicare as a whole based on this information and i think will be able to craft more legislation to help make sure pavement is there and respect the costs and different outcomes in different areas. >> i think this is essential to get to the crux of the problem. it has been an ongoing issue. let me ask about one of the fundamental shortcomings. we have a pretty low uninsured rate and a well functioning market place. the costs could rise. for example, the new state exchanges are likely to require new levels of certification, health plans, offerings, and

even network adequacy standards. these activities are overseen by our department of commerce. why do we need washington or the federal government to ensure that minnesota is acting appropriately right now? >> i would be happy to talk with you afterwards about the administrative costs you are talking about. we had the opportunity to help in roman systems. -- to help enrollment systems. and there is 90 cents out of every dollar that states are putting into that a minister process coming from the federal government. i would be happy to talk with you further about the concerns that you have with those procedures. >> i want to make sure the new law will not stifle innovation and raise costs. i will give you another example. there are 250,000 pages of

additional regulations that are going to come out of this law. it will be a challenge on our providers. i hear that from my providers on a regular basis. >> i am as concerned as you are. my attitude is a partnership with providers and states and making things harder for them is not a good idea. i want to major beneficiaries are protected. if you are concerned about the regulatory burden, i am, at t o. , too. am >> mr. foster is coming forward about a 50% reduction in enrollment. when i travel around minnesota, it is very clear that seniors are worried about losing

benefits or the options altogether. for the past year, the administration has been trying to reassure seniors that nothing is going to change. you talk about a 60% rise for 2011. let me just ask you this. i am worried that we will go back to the days that seniors do not have the same options in other states. do you agree that minnesota seniors should have the same options as seniors in miami or in new york city? >> i think they should have a robust options, and i think they are getting them through the improvements we are seeing with medicare advantage programs right now. the choices are more meaningful now and they need to know that. i am committed to their options. >> thank you. >> thank you, dr. berwick, for being here today.

you can see by the member participation that the issues before your department are of great importance to the people representing america's seniors, so thank you for your testimony about america's health-care law. its members would like to, they can submit in writing to you any questions. >> and thank you for recognizing me. do you think in the future we might be able to make this a little more equitable? perhaps those on the more -- sitting in the more expensive seats had four questions -- four minutes to question. those of us in the cheaper seats -- i was very patient to do that. >> what we will do in the second panel is start where we left off. dr. berwick had limited time. dr. berwick had a time limit.

>> of this has happened a few times. it was mr. berwich that i wanted to question. >> with respect to any members that would like to meet with me personally, it is an open door. i would be happy to do that. >> the committee will stand in recess until 12:30. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2011] >> every weekend, listen to historic supreme court cases on c-span radio. c-span radio.