the lead excited about a proposal. he wanted to work on a bill that was very narrow. it was aimed at stabilizing the insurance market for next year, making sure premiums were not out of control. earlier this week, he said all the attention on graham-cassidy, he also put some blame on bernie sanders, he said all the partisan attention put the steam -- took the steam out of their efforts and it became clear the house speaker set up the house told not bring up a bill what senator alexander wanted to do. he said they were calling off the talks. hankeringook at the -- the hearings. one involved state governors. this is about 50 minutes, and then we will return to you in our discussion. >> this hearing is about taking

one small step. the small step on a big issue, which has been locked in partisan stalemate for seven years. it is a step congress needs to take by the end of this month. big to 18not so million americans. get healthon't insurance from the government are on the job, they buy them from -- that is the individual market. nearly 300 million americans have health insurance. from a market.

-- buy it from a market. 9 million of those 18 million have no government help. they're the ones most hurts. most hurt. let us take someone in tennessee. would receive no tax benefit to cover his 71 hundred dollars per year premiums. this does not include detectable's or co-pays. next year, the tennessee department of insurance's premiums will go up as an increase between 1500 and $3000 and in premiums next year that doesn't include increases in deductibles and co-pays. she will have to pay a fit of your income on health insurance fifth of her- a

income on health insurance. at the end of september, blue our largest insurer, pulled out of the individual market in knoxville, nashville, and memphis. forjust in tennessee but everybody. that could happen again at the end of this september and congress doesn't act -- if congress doesn't act. if that happens, millions of americans could literally be left with zero options to buy insurance in the individual market. last year, only 4% of american counties have one insurance commissioner on the exchange. this year, 36% have one insurer. 50% of the counties will have one insurer only on the exchange .

if we do act, we can limit increases next year. 2018. we can continue support for co-pays and untouchables for many low-income families. we can make certain that health insurance is available in every county and lay groundwork for future premium decreases. i would suggest we do this by taking two actions, although there may be others. appropriate cost-sharing payments through the end of 2018 to help with co-pays and deductibles for low income americans. the section 1332 waiver in the affordable care have moretes can flexibility to devise ways to provide coverage with more choices and lower costs. on the first, payments are extra subsidies or discounts for low income individuals who receive

premium subsidies under the law. they help these individuals pay for out of pocket costs like co-pays and decibels, but their overall effect is to lower premiums and individual markets. section 1332 wingers are already written into the affordable care act under some circumstances. they will allow states less ability from certain elements of the law, such as essential health benefits. they do not produce the patient protections most of us support, including protections for those with pre-existing conditions and ensuring those under 26 may remain on their parents arents' insurance and have no lifetime limits. for the 1332ply waiver. seven state applied. two states have received the

waivers so far. democrats will, have to agree to something. more flexibility for states. some may be reluctant to support this. republicans will have to agree to something, additional funding through the affordable care act, that some may be reluctant to support. that has caused a compromise, and much smaller but similar agreement to the compromise that created the senate in 1789. with the founders created a senate with two members from each state and a house based on population, that was a compromise. this was a compromise that we ought to be able to accept. cautionary's were included in bills tuberculin replace major parts of the affordable care act. this section is already in the

affordable care act, but it is a difficult old to you -- l to use. tooo bige were able to take the steps i mentioned earlier, we ought to be able to take this small, limited, bipartisan step on health insurance. if we don't, millions of americans will be hurt. timing is a challenge, so i propose we come to a consensus by the end of next week. when our hearings are complete so congress can act on what we recommend before the end of september. otherwise we will not be able to affect insurance rates next year. the department of health and human services require insurance companies to submit their final 20, and thetember department plans to put the rate online by september 27. we can do it here because we're

plowing familiar ground. our goal is a small step, and so many americans will be hurt if we fail. if we do not do it, it will not be possible for republicans to - blamingical claims democrats. the winner will be on everyone of us, and deservedly so. we're beginning to conversations at an important moment. there is a lot of work that needs to be done to undo the damage the administration caused the health care system because the administration is still trying to create some care by sabotage. our health-care system is more stable than president trump's tweets would have me believe that it is weaker as a direct result of steps being taken. the president has undermined outreach and consumer assistance efforts and put forward executive orders, seemingly uncertaintyobject into the market. last week, the administration cuts funding for outreach by 90%

and funding for consumer assistance by over 40%. another example is the threat to cut off payments to reduce coverage costs for low income people. should these out-of-pocket cost reductions be discontinued independent analysis suggests premium to be an average of 20% higher next year for the most popular plans on the exchanges. there will be more uncertainty in the market and patients and families will likely have fewer options when they pick their plans. that is unacceptable and avoidable. congress can act right away to confirm once and for all that out-of-pocket reductions will continue and we will have a very narrow window to do that as the chairman said before insurances finalize their plans for 2018 later this month. i'm very glad there are members on both sides of the aisle who agree that we do need to take and it is critical we

work toward a multitier solution in order to provide the kind of certainty that will have the 'ost impact on families premiums. months to develop rates. if we do not find a multitier tryingn, we will be back to solve the same problem a few months from now. that is not with certainty looks like. this discussion around strengthening the system is exactly what democrats have hoped for over the last two -- few years. as i said before, if we were together i am more than ready to consider additional ideas on the other side of the aisle to make our system work better for families. to be clear, that means moving forward, not backward unaffordability affordability, coverage, and quality of care. family have rejected the damaging approach on it with

and gotten ridts of protections for pre-existing conditions. i think we are all -- i think we all agree threading the needle will not be easy, but i believe an agreement that protects families from higher cost and maintains the guardrails of our current system is possible. this agreement will not only make a real difference of the patients and families that we serve, but it could provide a bipartisan foundation for future work. this work did not end when the affordable care act passed. it did today. there is more to do to lower extend coverage, and improve quality of care. we should be able to work together on these issues in a bipartisan way. i hope with today's conversation, we continue to turn the page away from trumpcare and partisanship that andave seen too much up

start working on health care policies to help our patients and families up for the care they need. that is the goal we should be focused on. >> i am the insurance commissioner for the state of washington. i want to thank you for your bipartisan commitment to address the challenges that we had insurance commissioners are facing but also you are facing in the coming months. this is especially true for the individuals and families who buy their own health insurance, some 330,000 people in the state of washington. are thelly are -- they canary in the coal mine. if there's a problem in the individual market, it is a problem for all of us. early retirees, self-employed, people who work for employers who do not offer health insurance. the individual market is a critical safety net.

there are relying on us to find a path forward. it offers a great deal more certainty than what we have right now. washington state has fully embraced the affordable care act in the very beginning. sincee a stable market 2014. our uninsured rate has plummeted from 50% down to under 6% in the - 15% to washington - under 6%. there have been two counties in the state of washington who did not have health insuraers. i am nervous about what will happen next year. because of the growing uncertainty and actions by the administration, our individual markets are in peril. the proposed average rate increases that we have seen for 2018 are 23%.

in years past it has been under 10%. counties have only one in sure -- insurer. weeks will be very telling. will be making final decisions as to whether they will participate in the marketplace or not. congress must act quickly to address these growing uncertainties. you must permanently fund the cost sharing reduction payments. that is something that will help a great deal in our marketplace. in effect some 72,000 people in the state of washington.for a low income family in the state of washington, the delectable is the difference between being $1200 with the csr's are $14,000. a federal to create

insurance program this year. this would show your commitment to stabilizing the market. it works very well the state of washington for the first three years that we had a reinsurance program. we would like to see a continuing. another way of reassuring the insurance market that the insurance carriers don't get help financially because of predictability and helps us hold down rates. make sure you maintain the coverage inaffordability guardrails in the 1332 waivers. we want it by the rules but we don't want to see the health benefits, guarantees on out-of-pocket costs are loaded away. as a consumer protections we don't want anyone to see with the marketplace. let me think you must take bold action now for the markets. peoples of hard-working are counting on us.

crystalsiolating are allowed to occur and they are occurring right now. we saw this in the 1990's and we saw the individual market in the state of washington totally collapse. that is something no one wants to go through. -- hardwarehardware harbinger. in washington have been for the whole country in the individual market. our life depends on it and rest on your bipartisan efforts. thank you, mr. chairman. has experienced difficulties, but our individual market is not collapsing. insurers file for an average assuming no2018

changes. i am pleased to report the insurers are seeing improved experience with this market, and that is reflected in the rate increases. i'm concerned it is on battleground because of the uncertainty surrounding the future of the aca and payments for cost-sharing reductions. i cannot stress how difficult this uncertainty is on our markets.the payment have a significant impact on rates . this will hurt the web percent 2% of 1% to pennsylvanians who do not receive subsidies. rate have to be finalized based on finite assumptions. consumers will be left to bear the burden of premium increases bychoices necessitated uncertainty. congress should allocate funding

until at least 2019. >> >> oklahoma has been worrying for too long. i look forward to seeing how congress will finally address these problems in time to meet their 2018 deadlines. the implementation of obamacare in oklahoma has been a failure. chose4, are citizens plans from five different carriers under the federally facilitated marketplace. carriers sustained heavy losses, and by 2016 that number had dropped to only one carrier. what is happening now cannot be sustained. we can expect oklahomans will eventually have no market with no options. over the past four years, rates on her marketplace have .ncreased by 130%

studies estimate that approximately 30,000 individuals who do not qualify for premium exited the nongroup market in oklahoma between 2016 and 2017. small business owners are suffering. , manymiums have spiked people in oklahoma, where the average per capita income is just above 25,000 annually, are being forced to pay higher premiums for a policy they cannot afford to use. further, carriers have sustained large losses in the marketplace. they have responded by narrowing their provider networks. it turns out you can't always keep your doctor. many other states are facing similar issues. unfortunately, all efforts to repair and amend obamacare have failed. i am encouraged by the trump administration priorities, particularly in a correcting state flexibility and autonomy.

in oklahoma, obamacare gives us no other options at this point. oklahoma submitted a 1332 waiver application under the obamacare framework. this focuses on a market stabilization program using federal funding and state used assessments. this will create a regional program for carriers operating in the marketplace. subsequent writers -- waivers will gain state worker -- state control over obamacare requirements. however, i am not convinced obamacare waivers will be the solution to our problem. we need an innovative solution that returns power back to the states, to implement ideas tailored to fit each state's specific needs and health insurance. that's why i have encouraged the proposals out there like the ones from senators ram and cassidy, which would repeal the individual employer mandates, block grant dollars to the united states.

if some states one to keep their regulations from obamacare, that's great. that works for them, but it is not working for oklahoma, and we should have the opportunity to face something different, or else we face an uncertain future. >> let me ask about the issue of cost sharing that has been raised by everyone. i think we recognize that uncertainty within the market is deadly. accuracy. move with there have been some that have suggested -- i believe the chairman said we need to extend the cost sharing subsidies through 2018, 2019 is another day that has been out there. i think the governor is, in fact , asking for an extension at least through 2019. if we were to do it at least through 2018, does that provide

sufficient certainty, or does it , 2019 ore longer beyond, to give the certainty? right now we are giving month-to-month and we know that does not work, so could you speak to that? >> i believe it has to be at least two years. there is enough consternation in the market that the insurers looking -- the insurers are looking for more than a one-year commitment. >> i have seen two have-nots area of at least 2019 -- two head-nods. at least 2019? >> senators are already planning 2019. it is two years out already. in order to give perfect ability, you have to give more certainty going into the future that it is going to be there so they don't leave the market, and that is the biggest concern i the yelling fire

in a crowded theater and they all leave. we have seen it happen in washington state in the 1990's, and it should not be replicated for the rest of the country. announcer: the second senate health committee hearing on the individual insurance market featured a bipartisan group of governors. republican bill haslam and of tennessee, democrat steve bullock of montana, republican charlie baker, massachusetts, democrat john had the -- democrat john hickenlooper of .olorado here now are the governor's opening statements. it is an honor to be here with this group of governors who i consider friends and no to the problem solvers. my request to this committee this morning is that you do two things. first, you move quickly to destabilize the individual insurance marketplace. second, that you undertake an effort to work together to

improve the cost of health care. our unemployment rate is the lowest in history. it became the first state in the nation to offer two three years of community college to our citizens. is among thecapita lowest, if not the lowest, in the country. but the crisis of health care and the uncertainty of its future threaten our citizens and budget. the primary difference between , andning tennessee now when a very young governor lamar alexander led the state, is the impact that health care has on the state and everything else we do. today, tennessee finds itself with only three carriers offering a ca compliant coverage . in over 80% of our counties, citizens have only one insurance option, and these are provided at substantial cost. future choicesof at higher costs is not sustainable. we are on a path where citizens will not have an option to

purchase from the insurance marketplace or can't pay for the limited options that are available to them. either way, the system fails. congress should take steps now to prevent the total collapse of the health insurance market by, number one, funding cost share reduction payments, two, creating a short-term reinsurance program, and three, providing flexibility to the states. in tennessee, about 60% of our -facilitated marketplace participants are enrolled in csr plans. failure to fund csr payments will increase premiums significantly, create even more uncertainty around the future of participating carriers, and actually increase the federal deficit due to higher premium tax credits. this is not a recipe for success . it is also important to understand that our marketplace was facing collapse before this current discussion of csr payments. other actions and reforms will be needed to address the crisis.

second, congress can take additional action to stabilize markets by funding a short-term reinsurance program that would limit losses to carriers that provide coverage in the marketplace. this should produce lower premiums, which should attract new, newer healthier individuals to the marketplace. a third way to offer flexibility is to offer it to the states to address their unique challenges. a waiver process should be expedited, and the guard where else currently -- guardrails currently placed upon waiver requirements should attract younger individuals to the marketplace. i realized some of the things i just outlined around stabilization cost more money, and i am asking for this at a time when many governors including myself are emphasizing the skyrocketing cost of health care. but the reality is that failure to address the immediate stabilization needs while congress works on the bigger issue of cost will almost certainly result in collapse of the market.

some may say the only way to ensure legislative action on cost and realize real reform is total collapse. i don't subscribe to that. i think every governor here and those back home believe that we can move to stabilize the market now while we work to take on the issue of health care costs. having health destabilize the hopet, it is my strong that this committee will turn sights to the cost of health care, which is crippling businesses and families and overwhelming all the other needs that should be addressed in state and federal budget. we must all recognize what has been missing in the argument over the affordable care act. the law was supposed to solve two critical issues around health care in america. the first was the large number of people who did not have health insurance or cannot afford coverage. secondly, the affordable care act was supposed to make health care affordable. unfortunately it has provided coverage for government subsidies for millions of people

to have coverage of the same exorbitant costs. one of the criticisms of the affordable care act is that it , saying that part it would provide free or subsidized insurance to more people without simultaneously addressing the hard things addressing cost. addressing cost is difficult politically and otherwise. one of the drivers of health care costs is the misalignment of incentives that are created when we compensate providers based on the volume of care they provide, rather than on outcomes or efficiency. in tennessee, we are working to change the way we pay for and deliver health care so that providers are compensated based on value, and congress should make a clear commitment to this type of payment innovation. all of us, republicans, democrats, and independents, should agree that our current path is not sustainable. debate about the affordable care act, there has been a lot said about how immoral it would be to have millions lose health coverage.

i understand the argument. i am a republican governor who proposed a conservative plan to increase medicare coverage in our state. however, can we all in knowledge that it is just as morally questionable to cover everyone with health insurance and put the bill on a credit card to be paid by our grandchildren and not do everything we can to make health care affordable now? thank you again to the entire committee. as governors, we stand with you to partner and strengthen the individual market and our entire health care system. >> governor bullock, welcome. >> chairman and members of the committee, thank you. first, thank you for inviting , democrats and republicans, to appear before you today. whatever comes out of washington nor does not come out of it, we're on the frontlines of dealing with it. recognizing -- your recognizing of the importance of

our involvement in the discussion is significant. second, thank you for working together. as we learned from the passage of the aca, meaningful and lasting reform will be hamstrung if implemented over the uniform objection of the minority party. i applaud the chair and members of the committee for doing all you can to ensure that congress of thet repeat errors past, or even errors of the past month. we are all familiar with the old adage, the only way to eat an elephant is one bite at a time. my thanks to the single or focus on the immediate steps congress can take to stabilize premiums and help individuals in the insurance market. anymore governing ndc may seem like a zero-sum game, a few win-win scenarios. add greater stability to

the overall health care system and individual markets, i do believe that your efforts will read -- will reap political rewards on both sides. some may call me a dreamer, but it might even prove to be a model for further efforts. following the eating the elephant analogy, it may be only one bite that this committee is sinking, but it is important. the last time i was with chairman alexander, again with bipartisan governors, he handed out his pocket died to the basics of health care -- pocket guide to the basics of health care coverage. the exchanges on only represent 6% of all those insured,4% of thpose but stabilizing the individual market impacts all areas of coverage and also has a highly pronounced impact on places like where i lived. ns and rurala i americans are less likely to

have that option of employer-sponsored insurance. 80% of those insured amount cannot are on the individual market. three out of four enrolled in a marketplace planner for rural or frontier areas of our state. montanans enrolled in a marketplace land have received tax credits to make the payments affordable. i do believe we can find common ground in driving down costs, stabilizing the marketplace, and the time to do it is now. while health care may be complex, it does not take a brain surgeon to figure out how to stabilize the individual market. the effort i have been involved a roadmap and member of actions that this committee can take. perspectives of the five governors appearing before you this morning are certainly of diverse landscapes, we are uniform in insisting the cost

share and reduction payments be continued. all of it in her testimony urged you to create a temporary stability fund. toall agree that you need make sure both a healthy and unhealthy continued to be covered in order to read the risk -- spread the risk. committee will work across the aisle with one another to undertake even those four measures, you will accomplish your name and stabilize the individual market. if you just get the csr payments, you would take significant steps to do so. it also does not take a brain surgeon to sabotage our current system. the interaction and messages coming in from d.c. are doing it now. in montana, our largest insurer has proposed a rate increase for next year 10 times higher than it would be, because of the uncertainty that the president

has created. finally, more important than being governor, i'm inherent. -- i am a parent. ago, address five days irish policymakers to act like our kids are watching and learning from our behavior, are, and our deeds, because indeed they are. i implore you to do the same. in a time of seeming dysfunction, this committee and congress can work together to destabilize the individual market, beginning to eat the elephant one bite at a time, and who knows? we might all find that working together is not only good for congress, but it is good for our country. ask for having me and my colleagues here. i look forward to the conversation we will have over the next couple of hours. >> governor baker, welcome.

>> thank you, chairman alexander , ranking member murray, and members of the committee. i want to thank you for this opportunity to testify on stabilizing premiums in helping individuals in the insurance market. the governors testifying today deal with these issues every day, and we want to work with congress and the federal government on health care reform. massachusetts has achieved nearly universal coverage with the highest percentage of individuals insured in the weion, and a nice because have -- and that is because we have been working at reworking it for 10 years. reason for our bipartisan success is the believe that health care coverage is a shared commitment, not the singular responsibility of government. i would like to emphasize four key points. first, bipartisan cooperation is essential to achieving polity,

affordable health care coverage and stabilizing any market. second, congress should take affirmative steps to resolve the cost-sharing payments until longer-term reforms are enacted. carriers, providers, and needyers, and people all certainty about what premiums are going to be. costs should be maintained for at least two years. as future reforms are considered, the key to market stability is the presence of younger and healthier people in the market. when massachusetts launched its universal health care law in 2006, we included an individual mandate, which i support. for starters, no one knows when they might get sick or have a tragic accident, and once it happens, they will seek care and it will be provided. in many circumstances, they will

be unable to pay for it, and that means everyone else who has insurance will be paying for the health care services rendered to those without coverage. in addition, if people have unlimited access to purchase coverage, many will purchase health insurance only when they --ded and the drop it when need it and then drop it once the care is provided. coverage with incentives and consequences is a critical element in ensuring everyone is treated fairly. if we want to make sure insurance is affordable for ,eople who do not have access we need to nudge everyone into purchasing coverage and then keeping it. third, congress should establish broader parameters for insurance market reforms and include greater latitudes for states that meet the needs of their health care residents and marketplaces.

it is no secret that massachusetts is continuing to provide access to high-quality, affordable health insurance to all of our residents. a waiver would allow us to more effectively made that commitment. -- three changes were 1332 waivers would be significant to stay are -- massachusetts is a strong benefits state. we support essential health benefits. however, even in our state, and was a challenge to adapt to the overly strict federal framework of the aca. fourth, congress should take enforce health-care costs, and one critical driver is rising pharmaceutical costs. among other actions, safely expediting the fda approval process, increasing competition by ensuring generic drug availability, and creating greater opportunities for public barriers to negotiate prices should be pursued. as we consider these and other

reforms of our health-care system, i would ask that if any -- i would ask that any legislative changes occur on a gradual timeline, ideally with state flexibility in order to prevent market shocks and to improve market stability. , as governors, we are responsible for the fiscal health of our states as well as the physical health of our residents. any reform should not shift greater financial burden onto states. how plex requires fine-tuning and adjustments. in massachusetts, we have repeatedly revisited a health care reform as we have learned from implementation and its conditions have changed, and our commonwealth is better for that. i urge congress to commit to returning to the table in a bipartisan fashion to review and revise any reforms in the coming years. you for the opportunity to

provide testimony on this important issue, and we look forward to working with you and other members of congress. i have submitted written testimony that goes into greater links on these issues, and would be happy to take lessons on that or anything else. -- questions on that or anything else. thank you. >> governor hickenlooper, welcome. governor hickenlooper: good morning. you, chairman alexander, ranking member murray, and all the members of this committee. i appreciate the opportunity to testify and briefly share our bipartisan plan for stabilizing the individual insurance market. brandeisjustice louis popularized the idea that states are critical to democracy. may serve asstates a laboratory and try social or economic experiments without the risk of the rest of the country.

implemented we have the affordable care act for seven years, as long as i have been governor. for many coloradans, it has been a success. we expanded medicaid and created a state-based marketplace. around 600,000 coloradans now have care because of the aca, that's 10%. but many people are angry, and they have the right to the. the united states is on a lonely island of our high income nations. we spent almost twice as much for worse care, and this has been the case long before the affordable care act. we need to move toward a system that, -- that compensates quality and good health, not quantity. for the coloradans in the marketplace, many continue to struggle. --orado has 14 counties almost 25% of our counties -- with only one insurer on the

exchange. it is also home to some of the highest premiums in the country. in rural colorado making less than $15,000 will .ay over $12,000 in premiums that is simply unacceptable. insurance premiums are projected to increase by as much as 27%. that's a big problem areas are bipartisan -- that's a big problem. our bipartisan governors have been working on a common sense set of solutions to help make insurance more affordable and markets more stable for this crucial 7% of the population. we can do a lot more at the state level, especially with congressional support. our plan asks you to explicitly fund cost-sharing reductions at least through 2019.

funding through 2018 alone will only put us right back where we are now in a matter of months. it will foster uncertainty, threatened to drive a premiums, and force insurers out of the market. we also need your support by creating a stability fund that will help us set up reassurance -- reinsurance or similar programs. tax incidenceing for insurance companies to enter counties with only one insurer, while getting americans to live in these counties the opportunity to buy the same insurance that federal workers have. the aca givesf states the ability to innovate to lower costs, while ensuring that certain basic guidelines are met. existing regulations limit our ability to come up with creative solutions. that's why we are asking for a streamlined way for submission and approval process, and additional flexibility in applying the budget neutrality provisions of this section.

we believe all this can be done in a fiscally responsible way by offsetting costs. we need to address the underlying drivers of health-care costs as well. that's why we are asking federal government to empower consumers with rice and quality information -- price and quality information. we can't stabilize the market without funding priorities of like weight, management, family planning, and injury prevention. governors have proven we can innovate. we are like startup companies. we learn from the states. we tweak, constantly improve. that's part of being laboratories of democracy. in colorado, we are trying to pinch pennies. we are reducing costs and promoting a competitive market while improving care and increasing transparency. we have a lot to be proud of, but recent federal action and inaction is undermining our effort. it is time for the federal government to work with us, not

your --us without against us. without your help, it is like climbing a colorado mountain without a parka or crampons. it can't be done. efforts ine your calling this hearing. lasting solutions that make health insurance more affordable and markets more stable will need support from both sides of the aisle and leadership from states. i look forward to answering your questions. >> thank you, governor hickenlooper. governor herbert, welcome. governor herbert: we are honored to address you on this important issue. the markets for affordable health insurance protect the families of utah's entrepreneurial self-employed. it will be in responsible to allow these markets to collapse simply because of political paralysis. having served as chair of the national governors association, and soon to be the next president of the council of

state governments, i have a broad appreciation of the role that states have in our federal system. i would therefore urge congress to get past the hope karen bass and delegate through responsibly to find solutions to the laboratories of democracy, as governor hickenlooper mentioned. i ask each state to take on the full role of regulating our health insurance markets. you can let the states experiment as laboratories of democracy to determine what policy works and does not work. for your information, the state of utah has one of the lowest health-care costs in the nation. that stems from our local culture and favorable demographics, but it also comes from such practices as evidence-based measures of use ofveness, innovative managed care organization, and

empowering doctors and patients alike to make more informed choices. i believe if you empower the states to determine their own health-care destiny, the states will innovate and create practical solutions for the most complex health-care issues of the day. we will learn from each other, and therefore he will improve. under current law, empowering states means rater flexibility healthining essential benefits, and simplifying the state innovation waiver process. but innovation goes well beyond coming to the u.s. department of health and human services on bid in the and with a hope for favorable treatment. self-determination would mean a block grant of medicaid and affordable care funds that get us to funding parity in the 50 states. before achieving the vision, congress needs to provide immediate certainty to the individual insurance markets.

end, i recommend establishing a defined transition period. tos would allow markets stabilize. this should be done while anticipate the intestines -- the adjustments. i am personally not a fan of cost-sharing reduction payments area nevertheless, in the near term, individual insurance markets need predictability in order to price their products adequately. the csr's was destabilize utah's insurance market, putting at who benefit from this program. funding should be included through at least 2018 or 2019. we should also look for market oriented incentives. for example, congress could immediately reduce the cost of premiums by eliminating the health insurance tax. insurance products can be better tailored to demand by allowing

wider arrayoffer a of products, including more high deductible plans. participation could be incentivize by greater flexibility in health savings accounts. the government should fund a fororary insurance program states to offer their own risk stabilization programs. at the bottom of all this, health insurance needs to be protectingits job in against unforeseen health-care costs instead of being used for some vehicle for social justice reform. to get there, the excessive burden of regulatory reform restrictions that we have placed on insurance policies needs to be peeled back, and that needs to be done with predictability and transparency. frankly, most of america's consumers don't care whether or not a law is repealed or replaced. ns want to know that

they will be able to purchase reliable health insurance to protect them against life's unexpected health challenges. , they need to know that if they experience a medical catastrophe, there is a safety net that will prevent them from spiraling into a financial catastrophe. the states are able to better address these issues for the unit populations and unique demographics than the federal government, which is too often trapped in a one-size-fits-all mentality. i would urge you to consider a health-care future that gives back to the states alliance share of responsibility. this is something that both sides of the aisle can support, giving more authority to governors and state houses. returning control to the state is prudent policy, but also prudent politics. thank you for listening. host: utah governor gary herbert there, saying he wants decision-making to be in the states as far as health care is concerned. joining us is jennifer. that brings us back to the cassidy graham proposal, and

republicans' continued efforts to repeal the health care law. why didn't the bipartisan approach work? i think they ran into a lot of trouble early on. we've been talking about the affordable care act for eight years, and it has always been so entrenched in politics. republicans had to line up .gainst the law democrats had to line up saying they were never going to do anything to undermine it. i think it was hard to get out of those entrenched positions, so some thought that when a repeal bill died, you would be able to turn to this discussion, but clearly that was not the case with the state possibility of repeal still on the table. i think in the talk, republicans were ready to give him funding for cost-sharing payments, a part of the health care law that the president has the power to pull at any moment. democrats seemed unwilling to on adding some flexibility

to a part of the law that republicans had been eyeing, which was giving the states more flexibility to do what they can with a plan they want. alexander andr senator murray were able to come to a deal, it is hard to see that it would have gotten 60 votes in the senate. maybe they would have had a chance, but i think it would have been tough. host: looking ahead to next week, what can we expect from capitol hill and congress? jennifer: i think it is going to be a mad -. .it a republica -- a mad dash senate republicans are going all in to get kassie graham passed on the 30th. they are still short of bobo. a vote. of if they do but to talk the floor, democrats will try hard to stop it. they have one tool they can use, , unlimitedrama

amendments. in theory, democrats could offer hundreds of amendments. typically it is not go that long . it is more like dozens of amendments. what if democrats are serious and view this threat as serious, i think we will see them put up a real fight. it is going to be a long week. host: anything that you know ahead of the senate finance hearing that has been scheduled? onnifer: that will be monday, and senator john mccain, one of the folks who is skeptical of this bill, he has made clear that he wants regular order. regular order would mean community hearings. senate finance chairman orrin hatch scheduled a hearing for monday. i expect to see a lot of partisan talk. i think we will see democrats trying to defend the law, republicans trying to say the health-care law needs to be repealed and graham cassidy

means needs to be put in its place. i don't know if we are going to have a ton of substance, but definitely a lot of politics. ont: we will have that c-span next week on monday, and we will follow your reporting at politico.com. thanks for your time. watch more on health care. go to our website, c-span.org. [captions copyright national cable satellite corp. 2017] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] announcer: next week, a look at the latest republican health care plan. republican senators lindsey graham of south carolina and bill cassidy will testify on their bill that may be voted on later in the week. we will have live coverage monday at 10:00 a.m. eastern on c-span two. bus iser: the c-span traveling across the country on our 50 capitals to her. we recently stopped in dover, delaware, asking. what is the most important issue in their state.

what is the most important issue in their state. >> one of the most important issues in delaware is the three casinos. last time i checked, they have a 43.5% tax rate. i know that officials from the casinos are lobbying to lower the tax rate and provide employment for hundreds of people, jobs. maybe the tax burden could be lowered just a little bit on delaware's casinos. >> i am 22 years old, a freshman here at dsu. in nursing, and i believe the most important issue right now in delaware is those dreamers, daca, and the fact that president trump has decided to take that away. i think it is important for us to let congress know that this time they need to look at our motivations. we are students, americans, and we are here to stay. is edwin, and i am a

junior here at delaware state. i think washington leaders should focus on drug abuse. delaware has a lot of issues with drug abuse and narcotics. i think pharmaceutical companies could do a lot better with issues like that, because it is something that has really taken over. i work in a rehab home. i see a lot of this firsthand, so i think it could help a lot. >> my name is emily. i am a junior. i'm 20 years old. my major is math communications with a concentration in tv, radio, and film. i think something that representatives in d.c. could help out with my state is help out with college funds more. not just for sports, but for other areas within the colleges and universities, like art, music, or sciences, because that

would help further our education so we can go in the world and make that a better place in the long run. i'm in mass communications major at delaware state university. i feel one of the most important things the governor can do to is bringing more community involvement and energies. you bring together our youth, the more we will have a positive life, state, and future. announcer: voices from the states, on c-span. announcer: one of the headlines in the chicago tribune -- "trump piles economic action on to his north korean military threats." trump met with japanese and south korean leaders announcing a new border to expand sanctions against north korea, and the treasury department's policy to