went to do a better job of helping to hold on health care costs. helping to stabilize that health insurance market. pulled downwould be the cost increases we are seeing in prescription drugs. that is the number one driver right now in the plans they came forward to us for 2017. another from a national perspective, make sure those 19 state that not expanded medicaid to so. in washington we have 5995 -- i would also say we got to make sure those states that have nonconforming plans out there so you have a breakup of the risk pool by virtue of nonconforming plans and conforming plans to the of what will care act, they all need to meet that same standard. washington is working diligently to make sure we fully embrace

the affordable care act and then provide those to the people in the state of washington. they are holding down premiums, the next big factor to stabilize the private market. immediate steps needed to be taken to a compass this -- to accomplish this. we've got to address this second part. stabilize the market. thank you. >> let me start with you, you said 18% increases? >> 13.5. >> you said that was no surprise. you heard obama say his health care plan would reduce remains by $2500 per family. did you believe that? >> there were a number of claims that were made that i did not as a professional regulator necessarily embrace the totality.

>> it is difficult trying to figure out what these average increases are. i know manhattan institute has done a study by state. six different demographic groups in the state of wisconsin. our biggest cost increase was in the first year, but as i put the numbers together, based on the expected increase after this year, the lowest increase on one of those demographic groups since the inception of the obama care is -- $1.80 for insurance coverage. i want to go to the point in terms of what would happen to the state of wisconsin -- i want to raise the issue on a national ftc -- in the office of the commissioner, what would you do, because i know we have laws in wisconsin that you

are authorized to reinforce proceedings that engage in unfair market practices -- that is defined as misrepresentations, unfair inducements which are a tax penalty. unfair discrimination -- i don't know about that. when bobby straining competition. that's what about restraining competition -- what about restraining competition? extra charges, things like the cadillac tax. undo to -- the attempt to influence employers. going back to the question i asked, is there an insurance company that made those claims -- health care plan, your doctor, what would you do as deputy insurance commissioner in the state of wisconsin echo >> -- wisconsin? >> i don't know we will let the

insured do that because there would go insolvent because they would not be of to meet their obligations. those promises are not deliverable. i think we have a concern if the .nsurer filed those of us from an advertising standpoint, i think we would consider that in unfair trade practice. we have concerns and we would take action against the insurer because those are promises that an insurer cannot deliver. we had a number of carriers who want to make some sort of promises overtime, and in fact we do not allow them to do that. -- in fact, we did not allow them to do that. it would be a fraudulent advertising. >> in the private sector, that is unlawful. i guess when it is passed by the federal government, it becomes legal consumer fraud. >> it appears so. i was shocked by couple of your stories. describe again the federal

recovernt forced you to under charged premiums. >> we have the order that we can get you a copy of, in particular insurer made a mistake in their great system. -- there rate system. money was pulled out of their accounts, and incorrect amount. >> stop. so -- had that just occurred with a private company, with that private company be allowed --go back in and put money and pull money out of those accounts? >> it would not have asked us. most companies are good companies. they would not ask the regulator if they could go back eight months and pull money out of a consumer account. they would not ask that question. >> that is what i am talking about with auto moment. -- auto enrollment.

this speaks to that. talk exactly about what is going to happen with individuals without the approval, what is going to happen with auto enroll? planconsumer which is in a with a health insurer that is exiting the market will have their information sent by an by the federal government and enrolled in that plan and will get an 834 transaction. that information will be sent to the insurer will then contact the consumer and ask them for premium. >> aren't there laws against unauthorized transfer of medical information from one party to another? >> we have made that argument to our good friends in the federal government. indicating all of the legal arguments including federal laws

that we feel were broken in sending people's private medical information from one insurer and financial information -- to another insurer. >> without coercion from the federal government, and insurer would not have gift -- without the insurance permission. that insurer would be breaking the law. >> absolutely. >> this is legal -- >> we don't think it is legal. isthe federal government doing it on their own account. >> correct. about theto talk reduction in choice, because that is pretty stark. 60 companies down to 11? that was not supposed to happen under the aca. wasn't competition supposed to flourish. monopolists to be

-- because competition. competition is best realized when you have a lot of competitors. that is not what is happening here. we are seeing consolidation across the board. in your state, you have an example. >> absolutely. unfortunately we are seeing consolidation nationwide. we know there are a couple of cases pending regarding mergers of large insurance companies. when you look at who is still left in the market, selling on the federal exchange in ohio, we had 60 companies prior to the aca. you could choose to purchase their insurance from versus we are going into 2017 down to 11. testimony the starker fact is when you look county by county, i spent all ohio and theyin

are one of the counties which will have one insurer. i don't call that a choice. person -- i met with a lot of people and different variety of audiences and crowds, it seemed to me everyone knew that that was going to happen under obamacare starting in 2017. they are concerned. one gentleman asked me isn't there something you can do or your national association which we are all members of? unfortunately no. >> you mentioned, he you have an average amount since obamacare that your insurance has increased? >> 91%. >> 91%. >> inks mr. chairman. -- thanks mr. chairman. let me start by saying a number thisates have devastated have demonstrated fully embraced

the ultralow that same benefits for most of most of their resident -- most of the residents. and requested statements from insurance commissioners and health secretaries from several states including rhode island, california, virginia and delaware. all of these -- all of these statements make two points. one point is the afford will care act is working in their states, lowering the uninsured rate in improving their insurance marketplace. medicaid expansion has been critical to lowering the costs of private insurance and improving health of their residence. that is a point that we have not made very well here today. i will return to that later. a little bit later, i will

respond to some of what my friend senator mccain said. i will hold at all for now. -- what percentage of your preparation was uninsured before the affordable health care act was passed? >> as we look back over time, over at least a decade or two, at the time of the passes, we were at 14%. where for reduced that to nearly 50% -- we have reduced to that down to nearly 50%. >> were individuals with pre-existing conditions able to purchase reliable health insurance for reasonable cost? >> no, they were not able to purchase it.

it was a high-risk pool that was available to them. but there was a pre-existing condition waiting peel. -- waiting peel. >> in those days were women charged more? >> in the state of washington, we have a state law that prohibited unlike a number of other states. there could not be a different in the rates charged between men and women. >> ok. my republican colleagues recently introduced legislation to roll back the individual mandate. if enacted, how would this affect the risk pools in your state? >> it would devastate those --ls, because you have the until they get sick and then opting in or open they could when they started to become ill. problem.in a row

for the rest of the individuals, it would be one where you would have a sick pool of individuals, very dependent on health insurance. insurance doesn't work well when you're only going to ensure the people who really need it and allowing them to come in at some later date. >> one of my principles in life is to find out what works and do more of that. governor of the national governors association, delaware, wein in were trying to wrestle with a problem. some of the states do with this successfully, maybe in insurance commissioner has dealt with this issue. let's find that who did it, how they did it and whether they're not as whether or not their trance -- their ideas transferable.

adjusting the lack of coverage, they adjusted. the plan as i recall really insured a lot of people got covered. what they did not do well was address costs. you mentioned there was a time in your state. one of things i learned from massachusetts, and i'm going to ask you to learn -- to share with us. the penalty for people who did not sign up like my kids, my sons, 26 and 28 years old. those who do not sign up to it while for the penalties to rise up to a level for them to say i might as well go ahead and get coverage. there were angs lot of people who do not have health in massachusetts. they are not in good shape. once they have health care for

the first time, maybe in their lives, they are using it. that has had an impact on utilization, cost for insurers. they are trying to recover those. they do not know what it would be. trying to play what the rates would be without any kind of real experience. anything you can share? lessons that might guide us as we go forward? >> a number of us have looked to massachusetts and their experience since they had a running start under governor romney. one of them certainly was having an adequate multi-so you incentivize people -- adequate penalty so you incentivize people. you have to minimize the ability to get in health insurance coverage outside of the enrollment. -- enrollment period.

you don't want to have to wait months before to have the coverage that you need. that was an important part. interesting massachusetts did too and that was there was a prediction that the emergency rooms would be -- wen once the expansion had the same prediction. the actual impact was it was the opposite. we had a 10% reduction. people entering emergency rooms in the state of washington. that was reflected in massachusetts. the reason is when you go there with a non-emergent issue, you are told, if you go down to the clinic down the street, get your care there, it is going to cost you a lot less. it is remarkable how people are sensitive to that price indicator. there were a number of lessons like that never were learned it >> you mentioned in your testimony, the need to promote

competition. give us one of two good ideas that might've worked in your state. >> number one, you got to stabilize the market. some things came out of the affordable care act having the essential health care benefits come out of pot this out-of-pocket expenses. you got to try and consolidate the risk pool. insurers need stability. they are going to gravitate to that. it looks predictable, they going to be more willing to enter a market. that is where you start to get more competition. unlike a number of states, we went from 11 insurers to 13. it.ink that is a part of we embrace that part of it. even if it meant taking some respect, such as those cancel policies that we had, rather than trying to apply cpr to them to bring them back, when -- we

wound up saying no, those are out the market. i think those of the kind of changes that insurers are looking for and he gives us the predictability we like to see. >> thank you. chairman and this is been an interesting discussion. wasn'tlth care system perfect before the affordable , ie act but as was indicated appreciate your saying this, many of the pledges that were made have not been kept. you can say that is because of what we are promising and it still means this is an improvement. for a lot of my constituents, it is not an improvement. it is not just higher costs, it is people losing their insurance. we even talked about the co-ops. this committee has done some good work on that. we got tens of thousands of ohioans have lost coverage

because it pretty much every few weeks under the co-op goes under. this has been tough for people. i've got 30 specific examples of constituents i bought with me today -- i brought with me today. i got a portal on our website where people can tell us their experience. all i can say is it is not just this theoretical issue that is a debate of health care policy, it is about people's lives and their inability to get insurance that covers them. i think you have done a good job , lieutenant governor, talking about the numbers. here is chad from archibald, the .lan we had was canceled the company said no longer able to do it due to the law's passage. promised we could keep the plan if you like it, promised lower rates. our premiums have risen 92%.

we keep raising deductibles to keep it from going up. i hear that a lot. i have health care coverage but really i don't because my deductible is a $5,000. one thing i think we should , we need to do this on a bipartisan basis. that was not done under obamacare. we've got to figure out how to deal with this issue of not just the cost but quality. competition is going to help with that. let's talk about competition. you have given us some troubling testimony today. you talked about the fact that you are seeing a big increase in next year. you said these rates are about 12% or 13% increase in next year.

91%said it has gone up since the 2013, 2014 time period . what easy happening in the future? what is a going to be in 2018? or five years from now? what you think is going to happen if things don't change? >> it is hard to predict the future. if you look the past, my biggest concern for the next couple of years is we still are not going to have a stabilize the market. -- have a stabilized market. a federal exchange that creates turmoil within the market in that particular region, and that creates a lot of chaos. where there is chaos, it is hard to price products. the consumer in the end gets harmed because they are going to have to pay more. shrinking provider network as we

are seeing in ohio where we just on have a provider networks that consumers in ohio are used to. my concern over the next couple of years, where our early study that we commissioned in 2011 may have predicted the market would stabilize by now. that has not happened. i am not certain that is going to happen in the next year or two. >> it has not stabilized. it is an worse good very recently, it has gotten worse. -- it has gotten worse. very recently, it has gotten worse. only 11 have decided to offer plans in 2017. you expected some stabilization and you have just the opposite. ohio,hat 88 counties in how many only have one insurer echo -- one insurer? think itng the math, i

is about 25% of our counties. >> 19%. know, again it is a complicated area. there is a lot of debate about what we do, but just the lack of choice and the lack of competition. it relates to quality of care. recently there was a group of the kaiser foundation that put out estimates on this and they are saying next percent of enrollees could have a single insurer by next year. top of the increase in cost, double-digit increases. it is 6% of obamacare premiums were subsidized by tax dollars -- 86% of obamacare premiums were subsidized by tax dollars did it does affect all of us because we are all taxpayers.

the other thing that is happening in ohio and around the country is these insurers who cannot make a profit under the exchanges, because of the way they were structured, are doing what? they are staying in business by , that they arees also cost shifting. if you are a person in an exchange plan, the bad news your costs are going up dramatically. being subsidized by that, that helps you but the taxpayers are paying that. also, we have this situation where you are in an employer placed -- employer-based plan, you are seeing an increase in yours because these companies are going out of business. do you have any evidence of that in ohio that there is cost shifting from the insurance companies who cannot make it on the exchanges because of their losing money -- i know anthem

loses money in ohio and other states. these companies are not in trouble, because they are cost shifting onto private employers. that is a concern that is outside all of what we are talking about today. >> right. whoink it was edna -- aetna announced they were pulling out. think using that number clearly there are some insurers that are finding it difficult, the populations are sicker in the pools than they expected. they are having a hard time with the premium increases to keep up with the cost. one of the things that has not been said, what has not been done with is the cost of health care.

premiums are driven by the ultimate cost of health care. where we thought that the affordable care act was going to place emphasis on adjusting the cost, reinforcing healthy behavior and getting people healthy and keeping them healthy and fit of only treating them when they are sick, that is not what we are seeing happen in the market lease. the exchange business, there are --urance companies victor more than not are finding it is a loss. they are making a decision. is it such that they can continue to offer health insurance on the federal exchange, even though they are writing it out and laws. how could long can they continue to bear those losses before it is a decision they can do it any longer? >> my time has expired. i appreciate your expertise and understanding how insurance works.

dynamics ofbroader health care. that is what we have to do in this place. we got to do it on a bipartisan basis unlike last time. we have to come up with something that makes sense in the real world. you have the ability to provide people with affordable health care. >> thank you for raising the cost shifting issue. it has been going on for decades. governments taken over more more reimbursements. they don't reimbursed providers should one of the reasons they put pressure on premiums to begin with. you talked about the hundreds of letters you have gotten. we all have. talking about individuals being harmed. they are being harmed by obamacare. i hear more and more people on these individual markets take the risks. they said they can't afford the premiums, they look at the high

premiums on the insurance they're getting with high out-of-pocket's are going what is the point? they're taking the risk. i am not sure you have seen that in ohio. a year and a half ago, i -- my to my daughters dr. daughter possible dr. and asked him point-blank, why are you longer practicing medicine after this year? why are you closing your office? for 2.5 yearsid in a row, we have tried to make this work. for the lastmonth 2.5 years, we have lost money. i can't keep their practice open to do this. the new compliance costs, the things that are happening, we can't stay open. so one of the great doctors in oklahoma city who has years of experience retired.

he is not the only one, there is a lot of others. it is not just my family, it is a lot of families. governor, i can very much appreciate ohio experiencing since 2014 and 91% increase in the premiums. i can understand that because currently border to border in oklahoma, 77 counties, we now have one insurance carrier. one. every other carrier has left. requested the premium increase for next year of 75%. from this year to next year, one-year increase. if cms does not approve it, they could just withdraw. the hard part about it and the

dirty secret of the process right now in the affordable care act is that certainly cms will improve the 75% increase because then we will have no carriers in the entire state and we will move from one to nine. when they approved the 75% increase, it will change it dramatically for people who are 201% above poverty. for everyone to hundred percent poverty and below, the subsidies will kick in, the taxpayers will cover the increase but everyone from 201% to 400%, their subsidies will not be enough to cover them and those at 400% and up will face the full brunt of the 75% increase. more people in my state will say they cannot afford the one policy that is available. penaltyl go pay the tax when they would like to buy insurance that literally insurance now is so expensive in the state, even those who want

to buy it cannot buy it anymore. very direct effect on what is affecting the families in my state. for those that are on the subsidies, a will not feel the that those only 200% of poverty and down. there is a new perverse incentive to say if you are 250% poverty, find a way to get to 199% or you will not get health care. that is the wrong direction to be able to direct our country. with only one option that is out there and my entire state, we are in a bad place. now our state used to run something called insure oklahoma. we were told we could not do that anymore. plan to be able to take care of those in greatest need. that is being pushed out.

there are other solutions out there and other ways to be able to take care of this. supposedly the co-ops were supposed to rush into that space and provide the option. of the 23 co-ops that were started, $1.7 billion in taxpayer funding, only seven are left and all seven are in trouble. no way the taxpayer will recover that money. we have made it incredibly difficult for people to be able to get insurance on the insurance market in my state because it is so incredibly expensive they cannot afford it. either they have to go into poverty to get health care insurance or find some employer, but if you are self-employed you are stuck. it is a tough cycle we are already in and in some ways, oklahoma is the canary in the coal mine. we are raising our hand and saying, this is really serious for us. this is what everyone said would happen.

we are experiencing now. , you talked aally lot about state solutions and things wisconsin has done in the past. we have done a lot of things in our state in the past and are no longer allowed. if you were given the ability for your state to be able to say , here is some flexibility to be able to take care of people, is it your assumption your state would say, only the federal government cares about people in my state, we do not care, or is it your assumption your state would step in and say, give us the flexibility and we would be glad to fill that void? >> i think the leadership that governor walker and the state leadership have shown is that we absolutely would want to take care of our state. we are a different expansion state. time, forrst

wisconsin everybody in poverty is covered under our medicaid plan. wisconsin has started down that road and we would love more flexibility to be able to do it fully. >> what would that look like practically? >> we would need to take a look at what the options for but i think we would probably, to a large part go back to the sort of high risk pool that we had in the past. it did a good job of taking care folks that had medical conditions in the state, and a good funding procedure for subsidies. we had a good program to provide coverage for those folks in need. and i think if you look at the testimony, if you move them back down to a more reasonable level. if a 21-year-old does not get a 75% increase in the first year and a 21-year-old and milwaukee does not, they are likely to

join the risk pool. >> there are a number of things that would lower the rates and increase the competition? in ohio we have 15 carriers and have expanded service areas and where folks are covering has been in turbulence for the last several years. despite the fact that we have a highly competitive market, we have more insurers in wisconsin than most states, it is in turbulence. more carriers are offering coverage off exchange than on and that is an indication it does not work. haven exchange carriers lost millions of dollars in value from surplus. so eventually they are going to be at even greater risk. >> we have dropped down to one carrier. at the same time several of our rural hospitals have closed. others are on the brink of that. it is a very difficult time for

them to be able to manage what is happening right now and the requirements put on them. as we watch rural hospitals close, positions retire early, other positions merge into hospitals, other hospitals merge and watch insurance companies merge, we are not watching a healthy future for where we are in health care. we can say we are sustaining where we are now but we can see quickly where things are going, and it is not a healthy market in the days ahead. i appreciate all of your testimony. >> thank you. i cannot tell you how many doctors in wisconsin told me they are retiring early and they are telling their kids who always wanted to follow in their footsteps, do not go into medicine. some of you have paid them incentives not to do so. a pretty sad state of affairs. senator ernst. >> commissioner gearhart, thank you for being here today.

it is great to have someone representing iowa and sharing some of our concerns. testimony only because it is the same thing that i've heard over and over again as i'm traveling across iowa. what i do not enjoy about that is the fact the stories that are being shared by our wonderful iowa families are stories of hardship and what the aca has done to their families. we all have very serious concerns about how our families will be able to continue to ,fford the affordable care act those insurance policies. i hate to say that i agree with and folks across the country have been placed in situations where they are attempting to decide, do i pay or purchaseage health insurance? i have heard that time and time again, it is either a mortgage payment because the insurance

, iss are so much more now it a car payment, a truck payment, a tractor payment. there are so many considerations that families are now making that they did not have to make a number of years ago. a family of three in kossuth county county, iowa reached out to my office to share that they are currently paying nearly $8,000 annually for two policies, one with a nearly $6,000 deductible and another with a $2500 deductible per person. based on initial rate requests they received notice that one plan is expected to go up 30% -- leading other 146%, them over $10,000 in premiums next year. one family member took a part-time second job off of the the that barely covers $8,000 premium expense now.

the family has had very few medical costs so far this year and rightly asked me, why as healthy participants do they keep facing these increases? you mentioned some pretty shocking statistics. we know that aetna found 5% of spenders drive 60% of costs. can you explain a little more in detail what certain federal policies are driving this? >> carriers have to have one individual risk pool for their individual market and again, if you have a catastrophic claim or a series of them that drives the whole pool. in iowa have had significant claims of one family driving upwards of 10% in one individual pool. we had a functioning high risk for and the industry used to treat that pool of $220 million annually. now that pool is driving a lot of the rate, and in my public

hearing on these issues i heard were senators were upset. to give them an idea, a family sex, if ioon-to-be were to buy a plan in des moines, iowa the cheapest -- , if i were to buy a plan in des moines, iowa, the cheapest one is $26,000 a year. mentioned, iowa families are paying a lot for these premiums and they still have this high deductibles and other out-of-pocket costs. one thing i hear commonly from folks that reach out to my office is they did not realize what their deductible meant when they bought the plan. others ask why they are paying all this money in premiums and they will likely never reach the deductible. i understand that lower premiums on the front end generally will

mean higher out-of-pocket expenses and costs when accessing services, but can we help consumers look beyond the price and focus on the benefits and network associated with the this high premium environment, is there a way we can do that? is difficult and we have done a lot of consumer education around the issue. iowa family does not have $13,000 in their insurance to write that check so it is a really difficult issue. we tell folks to shop around and in some counties there are only one option. the plans are more narrow in network. those might be cheaper. we have some that are kind of ,ike an accountable care system where the doctors have some skin in the game to keep the patient well. we have to look at prescription drugs, cost transparency. insurance was fixed through

obamacare and now a carrier has to pay out 80% or more but we did not look at the actual cost. until we look at the entire system of health care we are going to be having this dialogue a long time. >> i have shared this story with you about a young beginning plan was canceled, a $300 plan which was perfectly acceptable to him, it was canceled. it did not meet the requirements and was replaced with a plan, the cheapest he could find was $700. a $400 difference every month which he was very angry about because that was his truck .ayment and his deductible was $10,000 and he said, i do not have $10,000. if something should happen, i do not have it. it is hurting our families and hurting those just starting out in the workforce, especially if they are self-employed, and it targets many of our farmers and

ranchers across the state. it has been very difficult for us. we could go on and on. i know you had mentioned a solution for the high-risk pool. you mentioned the particular family that has had about $12 million of costs, which is a significant concern. can you explain a little bit more about what that risk pool, your solution to that risk pool would be? >> my idea would be, given the carriers, predictability of pricing is critical and a carrier with no lifetime limits, you get a catastrophic claim and your whole balance sheet could be disrupted. our theory is if those folks went into some other pool, whether state or federal backed where their coverage was still continue in some fashion, they still pay the premiums. if you told the carriers,

economics pick a number, it does not matter what the number is. you are on the hook for $500,000 or $1 million and after that it goes to another pool that is more of a societal spend, it makes sense. in iowa the risk pool is just not big. if you get a cast traffic -- a catastrophic claim it is going to disrupt the risk pool. >> thank you very much. >> thank you, senator ernst. i'm not quite sure whether every state's high-risk pool is funded the same way. believe wisconsin's was just a surcharge on everybody's insurance, correct? >> it was a surcharge paid by the insurer's in the medical providers agreed to a discount. have theher than adverse effects as commissioner

gearhart is talking about, you pool everybody that is basically allowed to operate insurance in the state, are paying premiums into that, and the system worked great. when i was running my business we would go to renewal and there would be somebody with maybe cancer or something like that. they were never dropped coverage that they were never offered coverage. they immediately qualified for the high risk pool. there is a menu of different types of coverages, different deductibles and out-of-pocket. we could almost always come up with one that was identical, with pretty comparable prices. risk poolomplete sharing and nobody had to raise their rates astronomically to protect themselves so it actually worked. it is just true, and you are literally,tal cost $1400 per month, you are getting

up into the $15,000 and $16,000 a year plus you have got your $7,000,les of $6,000 or you have literally got to pay $20,000 or more before you get any insurance. when i'm seeing in the state as people are just dropping coverage. people that always have health care coverage, always wear responsible, just simply cannot afford it and are willing to take the risk because what is the risk other than the catastrophic incidents? i would like all of you to talk about that phenomenon in your own states. starting with you, lieutenant governor. in ohio the high-risk pool that existed before obamacare was fully implemented was subsidized by the federal government and set up and run by the federal government. it was subsidized by the federal government so it is a little different it sounds to me then maybe what was explained in wisconsin. >> how did you get that done?

>> that was before my time. it is different. we did regulate the insurance side of it because it was basically underwritten by an insurance company in northeast ohio. i will tell you it was a unique arrangement but we also had disputes with hhs. there were two disputes during the time since i have been in office, one related to pre-merry levels. our actually -- premium levels. refused to accept what we believed was actuarially justified. we believe that puts the high-risk will at risk and the consumer ultimately is harmed. the second disagreement we had with regard to the high-risk pool was whether or not certain individuals would be eligible for coverage under the high-risk rule. old -- high risk tool. ultimately we disagreed

and they had to file a lawsuit against us and hhs to make a determination which way to go. >> there are only strings attached to federal funding but i wanted to speak to the phenomenon of people on the individual market with such high premiums and deductibles, they are not taking insurance. how big of a problem is that? >> i talked to an individual about a year and half ago, a small business owner in central ohio and her comment was, premiums are what they are but she said, if i get sick it is going to cost me $12,000 out-of-pocket in addition to what i have already paid in premiums in order to receive coverage. i do not have $12,000. i cannot afford to get sick. >> we are also seeing the same thing with people subsidized by obamacare because of the high deductibles a still do not

access care because they cannot afford it. >> first i would note the uninsured rate, the methodology that the census bureau used has changed and i think that is a concern of mine when we look at those numbers. wisconsin traditionally has had a very low uninsured rate and we landed this time in six. that is where we typically landed, in six or higher. insurance, 94% had in 2004, 94% had insurance. it has not changed. >> it has been very consistent and we are for that because of our competitive market which is becoming less competitive. the individual market has grown because of obamacare but i think the scary thing is, the large group market and small group market have shrunk.

we expect the large group market to shrink because they are moving into unregulated plans which is their prerogative. the small group market has shrunk by 30,000 folks. if you factor in our changes in medicaid and the loss of a high risk pool, that is probably in fact not any gain as far as enrollment goes and is actually a drop. >> are you talking about employers self funding and starting their own with their own operations? >> correct. there were about 200,000 folks who were in fully insured plans who moved from that to self-funded. why were theys, in fully insured before and why did they moved to self-funded and obamacare is the reason. .here may be reasons for that we are supportive of employers providing coverage so i do not want to imply by any means that is necessary, but when you see that shift that is caused by a

federal law change, i think that is where we are concerned. as far as folks going without coverage, we are seeing this pretty consistently in wisconsin and hearing that people cannot afford coverage. we are hearing about it from our legislators and consumers. we do not have any good numbers on that but we are hearing this as a phenomenon. based on what we see have not seen the individual market grow as much as you would expect, given the subsidies, 8% in subsidies, etc., that would indicate there has been real movement in getting private coverage. >> having insurance is not the same thing to having access, bottom line. >> correct. >> senator carver. i think we are going to, and and we willle conclude around noon or so. .hank you for joining us

i have a question for the record that i'm going to submit for you, governor taylor. if you could respond to that, that would be great. ask theg to ,ommissioner just to commissioner, think out loud. we have heard a fair amount about risk pools. give us a short list of things that you would recommend that when the elections are over and we are in a new year, what are some things you recommend we do at this end? what are some things the state could and should be doing at your and? >> i appreciate this question because i think when i have noticed even in the discussion we have been holding this morning is that there is more of a focus right now on what we can wind up doing to make the system work better, and one of them

certainly is that the concept here of having some form of reinsurance for a risk pool that would help to mitigate the risk exposure insurance companies would have so they do not wind up the particularly very sick people, or much of their people are -- many of their people are much sicker. they can predict their exposure and have the benefits of a much larger risk pool rather than just the people that have bought their policy, that is a step in the right direction and that is starting to look at what we can do better than what we have right now. just nod your head yes or no if you think that makes any sense? thank you. senator, you also made mention about massachusetts. i think one of the areas that told help a lot, and it goes the questions that have been raised about affordability that we have heard. i think everybody is very

sensitive, especially those of us who are regulars because we are on the front lines and when people have problems they are calling us. that is something that massachusetts has, which is the ability to move into what is referred to as active purchasing and standardized plans, value plans as they are sometimes called. >> what does that mean? >> we were just at a national meeting and had a professor from harvard who was on the exchange board in massachusetts, and it really is trying to make sure that those medical services that value, meaning you do not want people to delay, whether it is hypertension or diabetes or whatever, you want to make sure they are getting the services. bring down the out-of-pocket expenses, make it easier to get the services as they have such a profound impact on the level of help to that individual.

i think the states are in a unique position to be able to experiment along these lines. california is moving in that direction. i'm hoping i can take that issue to my state legislature this january so we have the ability to do it. both california and massachusetts have their own state exchanges. we do too. i would like them to have the power to explore what they can do in proving the value of those plans by making sure the important services are not impeded by the out-of-pocket costs. >> give me one more good idea for the federal government. >> from a federal perspective, i would strongly encourage because of the impact it has, principal medical driver and the rates i'm looking at in the state of washington, that is pharmaceutical. the more that can be done to address that very tough, ticklish issue, and i understand it profoundly. at the same time we are really

out of line with other countries. we really need to bring down this costs. stabilizing the market is ,ependent on bringing down bending down that cost curve down so what does not rise as fast as it historically has, if we will beo that, back to what we had before the affordable care act, a whole system that is failing. we need to bring down the cost of health care. >> i want to go back to something that my friend john mccain said during his visit to our hearing today. mentioned, senator mccain mentioned we passed the affordable care act on a partyline vote and i think what he did not say is we had the longest markup in history on the finance committee. prior to that we voted on literally dozens, i think scores of amendments, republican and democrat.

two did not mention that senators spent over a half year together with their colleagues to try to find a bipartisan compromise. three of those people, republicans, had an inordinate amount of pressure applied not to find a compromise. did not helply find a compromise. i was there and there are three very fine republicans and three real good republican -- democrats as well. there is a lot of pressure on my republican colleagues not to find the middle. committee that spent a full month liberating the law on a bipartisan basis. the house held 79 bipartisan hearings on markups in the health reform bill over the entire year. the senate held dozens of

meetings in both the finance and health committee and accepted hundreds of republican amendments. the health education labor pension committee held 14 bipartisan roundtables, 13 bipartisan hearings on health care reform. consideredmmittee many amendments, then he offered by republican colleagues. the finance committee held 17 roundtables, summits, and hearings on health reform. 38 meetings and negotiations for a total of 53 meetings on health reform. our committee, the finance committee held a seven day markup of the bill. i think that is the longest finance committee markup resulting in a bipartisan vote to approve the bill. the finance committee markup resulted in 41 amendments to revise the bill, including 18

unanimous consent without objection. as to the liability of the insurance plans, i friend senator mccain did not mention that consumers regularly lost their insurance rates when they did get sick and when they needed it the most, and premiums did go up as much as 10% or 20%. i just want to put those things on the record. i want to go back to the issue of competition for our witnesses, if i could. one of my early mentors when i was state treasurer was a very successful businessman in delaware and he is the chairman of the pension plan. danneman.as ernie he ran a very successful fabrics business in our state and he used to have a staying, competition, first it makes you sick then it makes you better.

i think what we need is competition. we have some ideas how to do that. we have to make sure that insurance companies can afford to insure, and make sure it includes a mix of people, healthy and unhealthy people. ofdown the row in terms competition. one good idea you can put enhanced competition. very briefly. regulation.ay less the type of write coverage that consumers want to purchase. >> thank you.

>> same thing in wisconsin. that is a bit of a problem. similarstructures, provider network issues with narrow networks, and they are doing that do deal with the risk pools. finding a way to get better competition would bring more carriers inot the market. >> thank you. >> that the states have more flexibility. another is the organization and the alignment of the providers to keep the patient well and healthy. >> ok. thank you. in your states, are they being

formed? iowa.have quite a few in >> thank you. thank you. >> what has been taught about -- changesbout is to make without being impeded. they maintain respective standards. you do not want them gaming the system at the expense of the less well. that is harmful to the market. it is starting to have some standardization on standards. you have to allow them to innovate. works to narrow net

provide the services for the policy, allowing them to go them to go to highly managed plans. it needs to make sure they do not game the system inappropriately. >> all right. i want to say this again. we compete with a lot of different nations on earth. economic competitor is japan. i remember learning this in my second year on the finance committee. japanese,ng with the for were spending 8% of gdp health care cost.

we were spending 18%. the japanese were getting better results. money andg less getting better results. we at 40 million people going to coverage.ht with no nothing. you try to get something. we have had some heart wrenching individuals having a hard time with premiums and making sure they can have coverage. 40 million people, not just one or two, in a situation like that. we cannot forget them. we do not want to do that.

we are not smart enough to figure out how to take a good idea and make it an even program that details the partnership with the government and the states, not just the governors, but the providers, insurers. an opportunity for an all hands on deck moment. that moment is going to come sometime in january. folks, is a lot of people will be new in the senate, and will answer that call, as well. we will do what we do best as a

country, and that is to work together. we need to do it again. we did it to clean up medicare prescription drug care. thank you so much. youroks like he went over time. appreciate you holding down the fort here. along similar lines with these iormous premium increases, want to talk about people gaming the system. we heard reports of this. you go through the open enrollment and sign up for health care. never pay a premium. you have coverage for three mont hs, and then quit.

is that something you are seeing in your states? quick answers. >> i do not have a specific example of that. a rural hospital who had filed bankruptcy. those kind of issues are significant. they have less ability to absorb those types of absorb. >> we have heard from the insurers. >> this is a growing problem? >> yes. >> we have heard that and also with the special enrollment period. about 100% or 200% on average.

the system can be gamed. >> i am not seeing it in the state of washington. special enrollment has an issue. you say, if you want to stabilize your market, you cannot allow people to have multiple opportunities to go into the market. and said we do not like special enrollments because it is harmful to the quality of the overall market. >> one of these signs of a market stabilize the prices declining. in wisconsin, enormous price increase for the first year. , a study in between

-- some rate increases 12% to 13%. now between 24% and 25%. that is going in the wrong direction. anybody want to talk about that? good,is so hard to get solid metrics. things are all over the maps. >> i talked about, i thought we would have a stable market. 100% of rate increases. ,000, and now it is 184,000. peopleseeing fewer poe

buying coverage. >> it makes it a less stable system. >> that is correct. this is typical with certain types of reform. you are moving into the fourth year. look back at a number of reforms in the state. you start to see the spike in the third and fourth year, where the rates are increasing the risk pool is getting worse and worse. >> i like to speak about the group market. group market can operate and is not seen -- you have seen the cost shifting, because they cannot recover, and shift that over to the group market.

people moving plans into plans, completely leaving the markets. dynamic and what is expected in 2017 beyond. >> i do not have numbers to speak specifically as far as numbers. nature to it is human move to the path of least resistance. we have not seen the trend you are commenting on with regard to employers going to self-insured plans. i do think we'll see more of that going into the future. increase, which is

significant. if we thought we could stabilize premiums, we're still not stabilizing the market. you have 19 counties with one carrier. you are still not stabilizing your market. we have the stability of the market. are you cost shifting? es.t is what a pool do i do not think we can give you with how it is shifting to the group or vice versa. ofa number of the provisions inmacare were implemented delay fashion.

will it affect that group market? >> the president is promising you can have your plaln and keep it. he allowed some policies. we allowed that wisconsin. there is twice as many individually in transition policies and in grandfather policies then there are in obamacare single risk pools. will go the way of the dodo, unless they do another extension. that will create a big sea ch ange. increasell see a price . all in one year. >> any consumers who have not

participated -- we have about 46,000 folks. they will see the rates in their counties. >> based on the numbers from the manhattan institute, the lowest group, the highest, more than three times. all of a sudden, just hit them like a ton of bricks. >> they are going to have significant increases. same thing in the individual markets. >> that is something people need to understand. >> i have a question for theh gr group. t.appreciate all the inpu hopefully we can unravel this. i joined my colleagues to

provide affordable health optio ns. in an are a family where you do not have you can go outside of the exchange to buy insurance. to me, it is not the ultimate solution. i think the solution needs to be reformed. we need to give some of these a little bitsent of choice. moreand quality comes with choice. that asyou think about a concept? let's let people go outside of

the network to get insurance when the choices are so constrained. >> thank you for the question. the more choice we can give, the better. the more we can allow the free market to work so consumers can choose the type of plan they want to purchase, i think the better off we are. i would support an option to give consumers more choices. >> governor walker asked for this in 2013. we're very supportive. it doesn't make any sense why the consumer should run everything through an exchange to get subsidy, insurance

subsidy. that might be something we can look at broadly. we do not do this for anything else. >> it sounds like something we would support. ofm concern would be one making sure that the market is not compromised, and what that would do to the integrity of the pool. the idea is to get as many people covered, whether they are in a rural area. inis an ongoing challenge rural communities. we want to make sure they are not second-class citizens. s.at is a task for all of u >> that is the objective, to

avoid that. i didn't know how washington is looking at the exchanges going forward. we are seeing fewer and fewer choices. there are some counties where there are not insurance companies willing to write at al l. there may not be one in ohio yet. we may have that situation in our state, too. it is getting dire. it would provide people with flexibility. did you want to comment? thank you very much. i appreciate all of the information. senator peters. >> thank you for providing good

testimony as to what is happening. i appreciate comments on my colleagues. i appreciated how we need to be bipartisan and figure out how to deal with some of these complex issuees. om the we can get away freom partisan divide with the health care system. people think we just repeal. we're beyond that debate. that does not mean it is perfect. we should celebrate what is good good.x what is not so dol pup out sleeves to that. the health care system was no

that great for the affordable care oact. significant columns in terms of access, cost. was up 15 times faster than wages. the health care system was not on a sustainable course. you had large numbers of people who did not have health insurance. folks knew if they got sick, that might mean personal bankruptcy and ruin their family. how can we accpet that kind of system? healthbody can get the care. that is where the american people are, a popular option.

if they leave the job and have a pre-existing condition, they can still get health care coverage. people.free up you are not locked into a plan. your family is still protected. dear children -- youchildren are protected. between medicaid and the marketplace, somewhere around 700,000 now have health insurance. they did not have it before. that is significant. they now have coverage and protection. nothing is perfect. i have never seen a perfect bi ll.

i do not think one exists. you have to go back and try to find those changes. a lot has been talked about with competition. the lack of competition how it does not bring prices down. you have been outspoken about the reduction of competition. we need to make sure that he continues to the robust. and you hold public hearing? >> yes, in some cases. >> where you ask to hold any public hearings about the merger? >> yes, we were. >> did you hold any of those public hearings? >> i did not. >> we have two major insurance

companies in your state, combining, which means less competition. we have to keep rubust competition. a number of groups did ask you to hold public hearings. cost anding to raise hinder success. why did you choose not to hold hearings on the merger? >> thank you. the law would not have permitted us to hold a public hearing. they had met the requirements under thelaw to proceed. there is no specific statute

that would have said we should have held public hearings in the situation. >> are you working to change that law? >> no, i am not. >> do you think it would be good to have public hearings? e dealsou know, each stat with these types of mergers differently. they impact states in a different way. wehrhere you may have a merger f two large insurance companies being reviewed by the department of justice, whether there are competitive issues, states deal with this individually. lessere ohio maybe impacted by the merger, you

might speak to another commissioner where they would express more concern because of markets andf the the type of business that they write how it might impact competition. >> sounds like a good reason why you should have public hearings. i would think that people will be interested to have that kind of transparency. we're talking about consolidation. i am concerned about what is happening with drug manufacturers. do have a drug, epipens, which has not changed much, but we increase a 400% cost

by the drug company. they need to charge a fair price. when you have a drug that has 400%hanged and you see increase that is passed on to the individuals or the insurance groupies-- i just had a that said they were seeing 400%, creams.reases in basic things were now several hundred dollars for a tube of cream. the drug companies are increasing the prices. what should we be doing to reign in these price increases from the drug companies?

they are just profiting. the ceo's are getting huge bonuses. >> we are over time. you had a quick comment? >> two minutes to respond, please. >> two minutes, max. >> two minutes to respond. >> you could have started your question with that. chairman? >> you want to have more time then you are allotted to. i appreciate you want to get an .nswer to your question

have the ability to do what you claim she should have done. i am happy to stay. i hope we can keep to our time. hear from these experts. >> i was here and heard the testimony. i did leave to vote. to vote.y i left >> i will give you two minutes. spond?y want to repo >> we do not regulate health care. >> anybody else want to comment? >> it is the same in our state. >> prescription drugs is a major

issue. >> i would agree. keep in mind, we were seeing rate increases were going up faster before the affordable care act. it has been well stated. we need to start the focus on how we can make his work better. >> i would suggest fda reform. it would take about 10 years. now it is $2.5 billion. there would be a good place to start. do you have additional questions? ofwe talked about the value having states increased their coverage in the medicaid in terms of making the marketplaces work better.

on from afar.goes i applaud him for having made your testimony to acknowledge theimportant role that affordable care act played. i would ask, to support medicaid expansion in your state of ohio? >> to address the reason -- >> you do not have to go into depth. is that something that you support? ini support the government the decision that he made. >> thank you. >> again, i want to thank all of the witnesses. he would be my solution for a little fix. the generale

mandate, left the states regulate. it would return choice to the american public. i'm happy to repeal the cadillac tax. you want to do some bipartisan reform to fix this, sixth the individual mandate, but the the states back in charge. a the cadillac tax. that would be a good place to start. for consent to enter the statement by christina without objection. with that, the record will remain open for 15 days until september 30. this hearing is adjourned. [captions copyright national cable satellite corp. 2016]

[captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org]

>> former republican presidential candidate and ohio governor john kasich and atlanta join case and read will president obama along with national leaders to discuss the transpacific partnership. they will join white house todayperson josh earnest to talk about tpp. that is life at 11:45 eastern. donald trump and vice presidential nominee mike pence outlined their economic policy yesterday. this is about one hour and 15 minutes.

>> we want to personally members ofhe now 234 the centennial society. these club members continue to make an extraordinary contribution to ensure that club.ial stability of the programmes are in the at the front. welcome students from the stern school of business. after the convention, the club invitation to both

theidates to present economic platform. this afternoon, we are honored ,o welcome the guest speaker theld trump, presidential nominee. i'm delighted to say, to introduce them today, we are pleased to welcome mike pence. [applause] governor, the podium is yours.

mr. pence: thank you. thank you to members of the board. it is a great honor for this smalltown boy to be in the big apple and to introduce today the next president of the united states. particular honor for me to be here at the economic club of new york, a historic and storied place. and a place where men and women who drive not only this great city but much of the dynamic american economy over the decades of our nation's history

in so many different ways, each one of you makes an extraordinary difference. i'm honor to be before you today. the also great to be back in new york city. i've been on the campaign trail now for the last couple of months. this is my first time back since i accepted my runningmate's invitation to run and serve as the next vice president of the united states of america. [applause] i was humbled to accept that invitation. with my wife as my side. but i did it in a heartbeat. because our party has nominated a man for president of the

united states who is the embodiment of this great city. and this great nation. he's a builder, he is a dreamer and i believe when he becomes president he will make america great again. [applause] we find ourselves on this day in the middle of september, 2016, in the midst of the weakest economic recovery since the great recession. at this historic forum, the republican nominee for president of the united states will do what so many other american leaders have done from this very podium. he will take this moment to outline a new economic vision, a vision to make this country great and strong and prosperous again and it is truly my privilege to introduce him today. you all know him well here in new york city. i've just gotten to know him over the last few months. but i got to tell you, i had someone walk up to me the other day and they said, i've known donald mr. trump: for the last 30 years and i really like him. i told him, i've known him for the last 120 days and i really like him. this is a good man who loves his family and loves this country and he will be a great president of the united states. [applause] we've become fast friends. for all the world it seems like i've known him all my life. like so many other builders and entrepreneurs, he's a dreamer, he's a driver, he's a man who

speaks his mind. but i have to tell you, what you may not know here in the big apple is that clear-eyed vision and that leadership has literally inspired a movement of people all across this country. i was in scranton, pennsylvania, last night. he was in ohio. everywhere i go campaigning with donald trump or for donald trump i see firsthand that he's given voice to the aspirations and the frustrations of the american people, like no other president in my lifetime since ronald reagan. i think the key is that donald

mr. trump: has never forgotten the men and women in this -- who built this country. men and women who worked with their hands, who grow our food, who build our roads and bridges and protect our families. and they know it. this is a challenging time. for working families all across this country. the truth of the matter is, as i stand before you today, not only are we in the midst of the weakest economic recovery since the great depression, but we're -- we also have an economy that in the last quarter only grew by 1.1%. we have the lowest labor participation rate since the 1970's and most heartbreaking of all, from 7 1/2 years ago to today, there's nearly seven million more americans living in poverty than there were in 2009. you know, for all the world, these days remind many of us of the 1970's. then as now we had one candidate who spoke of a national malaise and of accepting a status quo.

and then there was another candidate who spoke with confidence of a boundless american future and the american people chose that optimistic future and i believe they will again. [applause] the other party tells us this is the best that we can do. that the american people know better -- but the american people know better. it's nowhere near the best we can do, it's just the best they can do. when donald trump becomes president of the united states of america, we're going to get this economy moving again for every city and every town and every state in the nation. [applause] today you'll hear donald mr. trump: again describe that vision that will unleash the bounledless potential of the american economy -- boundless potential of the american economy. an american economy that will be driven by empowering working families and businesses large and small. encouraging entrepreneurs to invest, to build and to grow and to produce right here in america again. and so let me say it is a joy for me, it is a privilege for me. but it is also a distinct honor to introduce to you the next president of the united states

of america, donald trump. [applause] mr. trump: thank you very much, ladies and gentlemen. it's a great honor to be with you. we had some really incredible things happen today. the polls are coming out, we're leading in so many polls. i can't tell you, i don't know where to begin. but that's a good feeling.

we are, i guess cnn just came out, we're leading nationwide with cnn. we're leading in ohio and we're it's leading just -- i think it just came out, we're leading in north carolina, florida, we're leading and we're having a lot of fun. we're having a lot of fun on the campaign. and on the trail. i just wanted to say that the always a lot of fun when you come up and the people don't have the teleprompter working, but that's ok. lucky i brought some notes. today i do want to outline a plan for american economic revie value. it's a bold and ambitious and forward-looking plan to massively increase jobs, wages, income and opportunities for the people of our country. great people of our country. i will tell you. my plan will embrace the truth that people flourish under a minimum government burden and will tap into the incredible unrealized potential of our workers and their dreams. right now 92 million americans are on the sideline outside of the work force and they're not a part of our economy.

it's a silent nation of jobless americans. and look no further, and i mean no further, all you have to do is look at flint, where i spent a lot of time, the city of flint. and what a disaster has taken place. the jobs have been stripped from the community and its infrastructure has totally collapsed. in 1970 there were more than 80,000 people in flint working for general motors. today it's less than 8,000. that's going down. and they're making very, very little and people are trying to go down to that $8,000 mark. what we're doing is ford, ford has announced just yesterday that they're moving their small car production facilities to mexico. and i've been talking about this a long while and i think that's

maybe one of the reasons that we're doing so well in ohio and michigan and lots of other places where cars and parts are involved. to think that ford is moving its small car division is a disgrace. it's disgraceful. disgraceful that our politicians allow them to get away with it. [applause] really is. it used to be cars were made in flint and you couldn't drink the water in mexico. now cars are made in mexico and you can't drink the water in flint. [applause] we're going to turn this around . my economic plan rejects the cynicism that saves our labor -- says our labor force will keep declining, that our jobs will

keep leaving. and that our economy can never grow as it did once before. and boy, oh, boy, did it used to grow. we reject the pessimism that says our standard of living can no longer rise and that's all there is really left to divide because frankly we're looking at an economy now of no growth and redistribution of wealth. and that's not going to work. everything that is broken today can be fixed and every failure can be turned into a truly great success. just look at the way i just melded into the teleprompter that just went on.

[laughter] who else could have pulled that off, ok, who else. [applause] jobs can stop leaving our country and they will just absolutely start poring in. failing schools can become flourishing schools. crumbling roads and bridges can become gleaming new infrastructure. inner cities can experience a flood of new jobs and investment and rising crime can give way to safe and prosperous communities. all of these things and so much more are possible. but to accomplish them we must replace the present policy of

globalism, which has taken so many jobs out of our communities, and so much wealth out of our country, and we place it with a new policy of americanism. america first. remember that. [applause] under this american system, every policy decision we make must pass a simple test. does it create more jobs and better wages for americans? the test. if we lower our taxes, remove destructive regulations and we have to do that, unleave the unleash the vast treasure of american energy and negotiate trade deals that put america first, then there is no limit to the number of jobs we can create and the amount of prosperity we can unleash. america will truly be the greatest place in the world to invest, hire, grow and to create new jobs, new technologies, and entire new industry. instead -- thank you.

[applause] instead of driving jobs and wealth away, america will become the world's great magnet for innovation and job creation. my opponent's plan rejects this optimism. she offers only more taxing and her tax increases are unbelievable. more regulating. more spending. and more wealth redistribution. a future of slow growth, declining incomes and dwindling prosperity. the only people who get rich under hillary clinton are the donors of the special interests. but bad for our country.

and hillary clinton's america, we have surrendered our status as the world's great economy. and we have surrendered our middle class to the whims of foreign countries. we take care of them better than we take care of ourselves. not one single idea she's got will create one net american job or create one new dollar of american wealth for our workers. the only thing she can offer is a welfare check. that's about it. our plan will produce paychecks and they're going to be great paychecks for millions of people now unemployed or underemployed. in the course of this campaign, i've traveled all across the country and i've met the most amazing people.

every day i've seen the good theness and character of our country -- goodness and character of our country and brave citizens proudly fighting through hard times and difficult circumstances. i have been all over this country, for example. and we have unbelievable -- country, folks, and we have unbelievable people. but they need leadership. the country needs leadership. in many parts of our country, the hard times never seem to end. i visited cities and towns in upstate new york where half of the jobs have left and moved to mexico and other countries.

the businesses are gone, they've been taken away, like taking candsy from a baby. politicians have abandoned these places all over the country and the people who live there are just there. no hope. worst still, politicians have heaped scorn and disdain on these wonderful americans. my opponent described tenses of millions of american citizens as deplorable and irredeemable just last week. so how can hillary clinton seek to lead this country when she considers its citizens, tremendous, tremendous numbers of them, beyond redemption? the hardworking people she calls deplorable are the most admirable people i know. they're cops. [applause] and soldiers. teachers and firefighters. young and old. moms and dads. blacks and whites. latinos. above everything else, they're

americans. some are rich americans, some are poor americans. they're americans. they love their families. they love their country. and they want a better future. these are the forgotten men and women of our country and they have been forgotten. people who work hard but don't have a voice. i'm running to be their voice. and to bring prosperity to every part of this country. too many of our leaders have forgotten it is their duty to protect the jobs, wages and well-being of american workers before any consideration. we have to do that. i'm not running to be the president of the world. i'm running to be the president of the united states of america. [applause]

and as your president, i will fight for every last american job and every american company, which really a lot of companies in this room. we are going to be fighting for you. you are bringing the jobs. we are a nation that paved the way, dug out the panama canal and won two world wars and put a man on the moon. it's time to start thinking big once again. that's why i believe it's time to establish a national goal of reaching 4% economic growth. my great economists don't want

me to say this, but i think we can do better than that. they're upset, will be very upset. but i think we can substantial by do better than that. in working with my economic team we have a plan to put us on track to achieve that goal. that under our plan, the economy will average 3.5 frs growth and create a total of 25 million new jobs. you can visit our website. just look at the math. it works.

mr. trump: mr. trump: this growth means that our jobs and plans including our child care reform that ivanka mr. trump: is involved in -- i like her, too, i agree. will be completely paid for in combination with proposed savings. it will be deficit neutral. if we reach 4% growth, it will reduce the deficit. it will be accomplished through a complete overall of our tax regulatory energy and trade policies. right now under the obama-clinton policies, the economy grew 1.1% last quarter, a number that was shocking to people that do this professionally and for life. it translates into millions of lost jobs and certainly millions of lost good jobs because we don't have good jobs anymore. those jobs are gone and going. this is the weakest so-called

recovery since the great depression. over the last seven years, the economy grew 2.1%, the slowest period, 70 years. had the economy grown at the same rate as reagan, it would have meant 10 million more jobs. perhaps most shockingly, most men aged 18-34 are either in jail or out of work. two million hispanics have been added to the ranks in poverty. the obama-clinton policies have doubled the national debt. it took more than 130 years for the united states to accumulate its first $10 trillion in debt. it took president obama less than eight years to add another $10 trillion. now, it will be one thing if that money had been used to completely rebuild our nation, our military, our infrastructure , but that didn't happen. instead, the opposite happened. we doubled our debt and in return, we have bad

infrastructure and schools. badly depleted military and they have a badly depleted equipment, old and tired. and another 14 million people who have left the work force, never has so much money been spent so poorly and so unwisely. but we are going to turn that all around and here's how. it begins with bold new tax reform. [applause] mr. trump: don't worry, they are going up, not down. thought you were concerned, they are going up. as outlined in detroit, our tax plan will greatly simplify the

code and reduce the number of brackets from seven to three. the new bracket will be 12, 25 and 33%. lower income americans will pay no income tax at all. our plan will remove millions and millions of workers from the income tax roll entirely so that all of that work that we do in washington can be discontinued. they'll pay tax. they'll pay tax, but pay tax when they start making a certain amount of income. by lowering rates, streamlining deductions and simplifying the process, we will add millions and millions of new jobs. in addition, because we have strongly capped deductions for the wealthy and closed special interest loopholes, the tax relief will be concentrated on the working and middle class taxpayer. they will receive the biggest benefit and it won't even been close. they have been forgotten. we are not going to forget them. they have built our country. we will not forget.

thank you. [applause] this is a working and middle class tax relief proposal. the tax relief for these workers will be expanded by my child care proposals that i have worked on with my daughter ivanka. these proposals are central and are very, very powerful central element of our comprehensive tax reform and economic growth plan. families will be able to fully deduct the average cost of child care from their taxes, including