information, go to our website. >> c-span's washington journal. live every day. coming up this friday morning, we will look at president trump's voter fraud commission. bauer, as will be bob former cochair on election administration. professora history will share his thoughts about the trump presidency. be sure to watch washington journal. join the discussion. the story talks about a measure being offered by

bill cassidy of louisiana and bill graham. what is in this measure? >> this is the last ditch effort therying to repeal affordable care act. what it will do is change the existing system of the affordable care act into a block grant. ttates would get a se amount of money. they would take those dollars and implement either a plane similar to the affordable care act, they could go single-payer or a conservative route and undo some of the parts of the affordable care act. particularly the consumer protection some folks like. these are the pre-existing conditions, things like that. governors would be able to undo those things and have this pot of money to implement their own system. >> we will take a look at some of the details offered up i senator graham on the senate floor.

medicaidraham: we keep in place. we try to get more flexibility because indiana is a good example of what can happen if you give states flexibility. one thing i don't like, you can run to the emergency room and we pay a big bill. i want to put medicaid people into managed care. i want them to have some ownership. i like copayments. i want to treat people who are or fair, butnd po all of us need to be responsible for our health care. eight going to in year begin to slow the growth of medicaid down. it grows faster than medical inflation. medical inflation is what it costs for you and your family. medicaid is beyond this. it is on efficient -- inefficient. you can have proven at the state level, you can get a better bank

for your buck. innovation. year eight, if we do not do that, here's what happens. by 2038, all the money you spend in taxes in washington goes to the debt,on medicare, and medicaid. that is how quickly these programs are growing. we put medicaid on a more sustainable path. we allow flexibility to get at are outcomes for the taxpayer and the patient. the second block grant, money that would have been spent by a bureaucrat in washington. block grant, this is money that would have been spent in washington. you would get a refundable tax credit to buy insurance somewhere, and we would give insurance companies moneys said they would not collapse on the obamacare exchanges. what we have decided to do,

instead of providing a tax credit, instead of giving a bunch of money to insurance prop them up, we will take that same amount of money and give them back to the states so that by 2026 they get the same contributions. what do we do? we repeal the individual mandate, and fully mandate. the states can reimpose if they like. the medical device tax as that hurts innovation. there is no more taking from the poor, getting to the rich. we did not have to do that, but we need the money to transition in a fair way to the state hundred system. -- state centric system. it is called state control, local control, not washington-based health care,

and we do it in a way where basically everybody gets the same contribution from the federal government. to president trump, without you, we can't do this. your pen will be the one that signs the law if we can never get into your desk. you said today you would veto bernie sanders' care. let me tell everybody in america, don't worry, single-payer health care will never get through the republican-controlled house. we have the majority in the senate. mr. president, we are not going to need you to veto single-payer health care. what we need you to do is put in place a new system to stop the march toward single pair health care. -- single-payer health care. we areon't change what doing, the federal government is going to own it all from cradle to grave. mr. president, you can stop that . once we get the money and power out of washington, that is the end of single-payer health care.

president trump, you have the chance, in your first term, to set us on a new path, health care closer to the patient, money based on not where you live, but parity, innovation versus bureaucracy. what a legacy and would be. but for that to happen, and i know you are busy with hurricanes and north korea, you will have to get on the phone. i believe you will, i know you can, and i am asking you to do it. the senator mcconnell, thank you for what you said today. thank you for being willing to push this forward. to my colleagues on this side, there are three options left in america, popping up obamacare, which will never work, bernie-care, which is full-blown single-payer health care, or

this block grant approach. i ask a question, who are we and what do we believe as republicans? our democratic friends are pretty clear on who they are and what they believe when it comes to health care. here's what i believe -- send money home. send the money back to where the patient's lives. -- the patient lives. make sure the people in the state are responsive to the needs of the individuals in that state. replace a bureaucrat with an elected official. it will improve quality and outcomes will be better, and it will be more physically sustainable. at the end of the day, those governors that can figure out quality health care in a sustainable fashion will not only get reelected, but other people will copy what you do. if we leave the money and power here, there is never going to be any innovation.

there is always going to be more money. siegel payor health care only works with a printing press. unlimited dollars. just keep printing the money. a block grant will bring out the best in america. it will create better outcomes for patients, and in will take us off the path of becoming grief. this is where we are headed. all of senatorh graham's remarks about his proposal to change the current health care law at c-span.org. just type the names of the ofponsors -- type the name the cosponsor, cassidy graham, into the search bar. president trump tweeted his support. "i would not sign graham cassidy include coverage of pre-existing conditions area it does area a great -- pre-existing conditions. it does. a great bill.

who else is supporting this? >> ron johnson from wisconsin and dean heller from nevada. he has the toughest reelection race of all senate republicans in 2018, but he jumped on board with this bill right away and introduced it to the senators. also, former senator rick santorum from pennsylvania. he has taken a bit of credit for this bill, saying he is kind of comparing this to welfare reform in the 1990's, which was considered a big conservative win. he says he went to senator failedafter the senate to reveal the affordable care act in july and said, why did you do something like welfare reform fiasco -- welfare reform? really, senator graham and cassidy are kind of the brain children behind the span -- behind this plan, and that's why it is called graham cassidy. >> what are you hearing from the

states, from the executives themselves? jennifer: the republican governors are pretty split. we have seen some republican governors saying yes, we love the idea, give us control. we want that authority, we want those dollars, and we can do the system that is best for our states, but other republican governors are very skeptical. they want a national system. they say they don't want their money to be cut, because many states would have their money cut in some way under this plan, particularly massachusetts, ohio. they have been very upfront with saying this is a bad idea. most democratic governors don't like this idea either. republicans are generally split, democrats and really opposed. -- generally opposed. host: at least one republican enator says he does not support cassidy graham. why does rand paul oppose it?

notifer: he says it is repealing enough of the affordable care act. would setis bill obamacare in stone. the money going out would be stamped with fruit -- stamped with approval from republicans, and he does not want to see that happen. he has left some wiggle room and talks about how he likes associated health care plans, the idea that people can have their own health care and by their own health care insurance together. he has indicated that is something he would like to see. host: what about democrats. what are they saying about graham-cassidy, or cassidy-graham? jennifer: they are opposed, period. , the moste manchin conservative democrat, said the present -- said the vice president tried to get his

support for this, and it was a pretty short conversation. democrats say they are ready to fight tooth and nail to stop this. of course, if mitch mcconnell has the 50 votes, there is very little democrats can do to stop the bill. host: democrats rallied this week outside the capitol. we will take a look at that and get back to our discussion. >> people in power! -- people of power have stopped trump terror so far, and people of power will stop him again next week! [cheers] notolitical change does start in washington, d.c., and been trickled -- and thin trickle downd then

to the grassroots. political changes bottom-up -- political change is bottom-up! this is not a complicated fight. we are fighting for seniors who are walking on an economic tightrope because this cassidy bill dropped their protection. we are fighting for kids, fighting for the disabled. let me tell you one thing -- we are not going to let cassidy turned back the clock and allow people with the existing conditions to face discrimination. down. not going -- thee raging democrat ranking democrat on the senate finance committee area and we deal with medicaid and medicare and funding women's health -- i

am the ranking democrat on the senate finance committee. we deal with medicaid and medicare and funding women's health. let me tell you, anyone preventing women from the right to see the health care provider of their choice will have to run over me, and women are going to win! [cheers] >> my colleagues are in the middle of a vote, so you will have a number of others coming out. i know what this means. i know what people in power means. we did not win last fight by osmosis. we won it because of all of you. we've got something like 11 days to make sure that once again, people power prevails over special interests and the powerful. we are banking on you.

let's make sure that once again, people power does not allow turning back the clock on our people. thank you. [cheers and applause] >> let's hear it again for senator ron wyden! [cheers and applause] >> senator wyden said they are coming after seniors. make no mistake. seniors in nursing homes facilities, most of them rely on medicaid for support. this is an attack on women, on young people, or disabilities, or who love someone who might get sick in the united states of america, and that's all of us! >> he's right. these delays did not happen through osmosis. it's because we resisted. when we started this fight, planned parenthood alone day and over one million new supporters. people are fired up.

are we fired up or what? [cheers] are we ready to go? [cheers] let's give it up for our next durbin. senator [cheers] >sen. durbin: thank you. good to see you all. just when you thought it was safe to go home, just when you thought it was safe to go back to the office, just when you thought you could take some time off, here they come again. are you ready? [crowd chants "yeah"] americans whot can't be here today, folks who can't afford to come to washington, people who can't afford lobbyists, folks who need basic health insurance and access to health care are counting on us. i know we went home after our victory a few weeks ago, took off the fighting shoes, put the jersey back on the shelf, said,

well, there is another big win for us. guess what? we are back on the field and ready to fight. we are going to win this because we have to. the question i have asked is this -- the american hospital association stands with us and stood with us when we beat back trumpcare last time. are they with us again this time? yes, they are. and the doctors across america .aid trumpcare is terrible are the doctors going to be with us again? nurses? health care clinics? haease advocacy groups -- a, can'trt -- heart, cancer, lung, all of that? and how about planned parenthood? [cheers] as soon as this week is over,

we go into the final week under the senate rules for them to bring up this latest version of trumpcare. this much i can tell you about the latest version of trumpcare. it is worse than any version .ver brought before it is terrible. it is meaner. it cuts back on medicaid. we know what that means. half the children in illinois are brought into this world because of medicaid. .isabled people so many people count on one program to make sure they have quality health care, and that program is medicaid. when it comes to school by state, half of the school districts get assistance for children who need special

education, counselors, assistants, feeding tubes, from -- >> medicaid! seniorsbin: and helping who need medical care later in life, there is one program they turned to. >> medicaid! we are fighting for justice when it comes to health care, which this senator happens to believe is a right, not a privilege. [cheers and applause] sen. durbin: now i am calling you, let's get ready to win again. fight to make sure we protect health care for all americans. thank you, everybody. [cheers] >> all right, let's give it up for senator durbin! [cheers] we are as a moral crisis in this country. people should not have to die due to a lack of access to care. that is currently happening, and

it will get worse if this bill should pass. health care is a human right. say it with me. health care is a human right! health care is a human right! health care is a human right! what is health care? >> a human right! y'all.right, you sound great and loud. thank you. >> the republicans are divided, and i'm not just talking about the senators. republican voters do not like this repeal. they are not representing anyone but the billionaires who want to shred public programs. but you know what? our site is united. congresre democrati -- our entire democratic caucus is united. give it up for our next speaker, senator bernie sanders of vermont! [cheers and applause] sen. sanders: one thank you all

for being here. republicans the when they wanted to throw 23 million people off of health insurance. we beat them when they run -- when they wanted to throw 22 million people off of health insurance. the experiment -- we beat them when they wanted to throw 60 million people lost health damnance, and we will well beat them today when they want to throw off 30 million people! without saying that in 2017, we should be talking about health care as a right for all people, not a privilege. and on a personal level, on a moral level, i have a very difficult time understanding -- how it could be

that any member of the united votes senate could cast a to throw people off of health insurance when today they are struggling with cancer, with diabetes, with heart disease, with parkinson's disease. what happens to you and you have a life-threatening illness and you are suddenly thrown off the insurance that keeps you alive, that gives you access to your doctor? what happens to you? thousands of people a year will die if that legislation becomes law. and i have a hard time oferstanding how any member the senate could vote for legislation that would take insurance and support away from disabled children who are now on .he medicaid program what happens if you are a kid

with down syndrome, if you are a child with autism, if you are a kid with asthma, if you are a kid with some very difficult disease? what happens to you and your family is medicaid is stripped away from you? >> it's a disaster. sen. sanders: brothers and sisters, this is a profound moral issue, and the truth is, as you have already heard, that the overwhelming majority of the american people, democrats, independents, and republicans, understand that in the united states of america, we must not of healththe lifeline insurance from millions of our people. [cheers and applause] sen. sanders: that is what the american people understand, and time for my republican

colleagues to start listening to theamerican people and not billionaire class and their wealthy campaign contributors. keep up the fight. we are going to win this. [cheers and applause] right!th care is a trumpcare is wrong! health care's a right! trumpcare is wrong! thank you, senator sanders! [cheers and applause] texas, beatty, founded planned parenthood. [boos] thate seen personally what looks like, friends looking at me in the eye and wondering what they are going to do with their health care.

for women, getting annual exams and having access to birth control is a vital part of our health care. i have seen a lot of politicians strip that away from thousands of women in my state. >> it's misogynist. >> it is misogynist, and politicians here at our capitol are trying to make a replica of taxes across the united states, and i came to taxes -- i came from texas to d.c. to stop that from happening. are you here to stop that from happening? [cheers] >also, texas has one of the infant mortality rates in the country, equivalent to a lot of developing countries. we don't want to see that spread across the country. as a black woman, someone like me has a higher percentage of dying from birth, and i am here to protect as women, and we are here to protect those women. also, our next guest is your to protect those women.

[cheers and applause] sen. booker: i feel like it is nightmare on capitol hill, part five. we know that every ground we gain, every stake we -- every step we take that we fought for and work for and sacrificed for, and here we are again, the history of our country, we have constantly worked to expand opportunity, to expand our conception of justice, to expand our conceptions of freedom, sacrifice, and struggle. and here we are again, at a moral moment in our country, after working 50 plus years ago to expand access to health care .ith medicare and medicaid

after just a decade or so with the affordable care act, 20 million more people got access to health care, justice and equality that comes with having that security. here we are again where we have people who are trying to take our progress and drive us back. , as yourve to now ancestors before us, stand up and say no, we will not go back. we will not go back. -- you can say it again, we will not go back. [chanting "we will not go back! "] want to tell you this right now. there are a lot of people who do not understand the urgency of the crisis we are in.

at the end of the day, the biggest enemy we face is not just the cruel bill that has been proposed, but ultimately it will be the silence and inaction and indifference of all of us. woke tot to get folks the crisis we have right now. we've got to awaken people to the urgency of this moral moment in our country. we, now in this country, have witnessed how this congress can work. just yesterday in a bipartisan way, we passed a national defense bill worth billions of dollars. you saw people come together to protect the national defense. but we have learned in the last weeks that the national defense is not just threats from abroad from north korea or iran. the national defense also involves the hurricanes in our

country. we saw were republicans and democrats responding in a unified fashion for the national defense. i will tell you right now, cancer does not care if you are rich or poor. diabetes does not care if you are rich or poor. autism affects families of all backgrounds. when it comes to the conception of our national defense, it is not only important that we have the world's largest military, we in america should have the world's best health care. [cheers and applause] in a country this wealthy that can afford nuclear weapons and aircraft carriers, we should be able to stand up and say that every american has a right for affordable, quality health care. [cheers] in a nation that has the best

military, spending more money than the next nine countries combined, we should be able to fit the united states of america can make sure every child born in our nation is born with quality health care. [applause] a nation where our senior citizens do not fear that they will not be able to afford a nursing home. we should have a nation where we know that if someone have a condition or illness that their only access to a doctor is not an emergency room. that our know veterans, someone who stood up for their country, that when they are home, their family members, cousins, or neighbors, we should be sitting for them as well. in this world moment in our nation, we have to remember the determination of this moment will be decided by the people because the power of the people is greater than the people in

power. [cheers and applause] it is time we look up to our nation thatcome a has life, liberty, the pursuit of happiness for everyone and it -- in our nation. you cannot have a if you do not have health care. [applause] it is time that we live up to the oh that this should be a nation of liberty and justice for all, but you cannot have justice in a country where health care is accessible only to the wealthy few and not for the all of us. we have to have liberty in the country and you cannot have and peopleamerica are chained to fear because they cannot afford basic medications and coverage. you cannot have liberty if you are shackled to the uncertainty of not knowing if your child sick, later family be

thrown into bankruptcy because you cannot afford health care. we and america must become the truth that so many people in other nations now enjoy. a that says we are strong enough, wealthy enough, noble enough to have a system of health care that serves everyone one of our people. we are at a crossroads. will we go forward to the day where every american has access to health care or will we allow a republican bill that tries to back?s i think we will not go back. we must go forward and we must fight every day until we have justice in this country for all. thank you very much. [cheers and applause] committeeate finance hold a hearing monday on the caret republican health plan. that is like monday morning at 10:00 a.m. eastern. more on the plan senate

republican leaders were joined by senators graham and cassidy. [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] >> good afternoon, everyone. i suspect you already know we spent lunch talking about graham cassidy. but the interest in the bill the senators have been working on. i asked them to join us today and lead off. how about it? >> i have never felt better about where we are at. it is pretty clear to me where the country is going under obamacare and berniecare. it is going into further bankruptcy. more decisions further away from where you live. lost money for

welfare reform and it works like a charm. we put governments in charge of the programs. socialism or federalism because your health care? 4% of the money under obamacare. they represent 20% of the population. our goal is to make sure every nation or every state gets the same contribution roughly from the federal government and allows people in your state to make decisions that would have been made in washington. the most beneficial aspect of this bill is as follows. if you do not like obamacare, who do you complain to? you can complain to me that i sure as hell don't run it. if i can get south carolina in charge of this money that would have been spent in washington by a bureaucrat who is unelected, i promise every south carolinian

the following, someone will listen to you. your governor and your steakhouse representative. if you go to the statehouse representative, who likely go to the same hospital you do. you can go to your governor who will listen to you because they care about your vote nothing else -- vote if nothing else. i'm trying to take the money and power in washington and send it closer to the patient. if you think government closer to the people is the best government, why not help you -- why not healthcare? we will have a single-payer health care system that will ration the budget like you have never seen. obamacare is feeling for a reason. it is ba. it is a bad idea. state-controlled health care because the people in turkey will be accountable to you, unlike obamacare with a person in charge could give a damn of what you think.

>> and 25 years, i treated patients and louisiana's hospital. n louisiana's hospital. when a fellow back home, a special needs child, tells me he is paying $45,000 a year in the system isow failing. i spoke to the jimmy kimmel test. it is almost beyond their reach. they cannot afford his insurance coverage. that is not the way it should be. we attempt to take all the dollar's in washington dc and ou so thet -- doll it statet can take it. if you are an estate that has not expanded medicaid, you will do great.

for all the virginians, missourians, who have dollars in their state -- if you are a state that has medicaid, we do not want to hurt folks. we run it through the chip program. i hear no one complained about this program. it is something on a bipartisan basis that has been recognized to be an effective way to provide access to quality care to those in need. we take it through the chip program. we continue patient protections. that the ensure secretary that they continue to provide adequate and affordable withage for those pre-existing conditions. that is our back style. we preserve mental health parity. we give the dollars to the states. we can look at the things the states have done. some of which were slashed by obamacare. in maine, there is a visible high risk law.

knowing premiums by 20% seems to be the policy going forward. they can the power to purchase their own services. i am a doctor. for 25 years. -- caring those who for those who didn't have coverage. i think graham-cassidy does a better job than status quo. >> i would like for the senators to handle. he said you have never been in a better state with this before. you know almost every repeal and get between 46ll or 47 republican guesses -- y eses.

that is not that much better than july. >> at the end of the day, we need 50 votes. if you're a republican, chances are you believe in federalism. if you don't, you probably are not a republican. the last effort to repeal and replace obamacare was better than a obamacare but it did not embrace the concept bill was talking about. i believe most republicans like the idea of state-controlled health care versus washington, d.c. controlled health care. -- oyer investments assessments are going out next month by the end of 2017. businesses will get a notice from the federal government over is 4.8 billion dollars. a lot of republicans would like to stop that from happening. the best way to do that is to repeal the individual mandate nationally so states can reimpose its. we come upon an idea that is uniquely republican but over time has proved to work in other

areas, like welfare reform. the democratso be that voted against more money for my stay and more power and keep the status quo. if you are a democrat, let us say in missouri, you are going to get far more money under this proposal then obamacare and your state would have more control over the money. to reject that money and that control means you believe that somebody in washington cares more about people in missouri than people in missouri. you believe it is ok to have california, new york, maryland, and massachusetts more than misery. that is what a democrats would have to face if they voted no. and youre a republican go against federalism, you have to explain to people back home andwashington knows better almost every state except for i

four ied -- the described, do very well. i think the idea is more powerful. i think the substance is much more fair. at the end of the day, i believe we will get 50 republican votes. there will be a lot of democrats struggling with the no vote because at least eight of them are staged to do far better then obamacare in terms of funding and they will have more control over the money. that will be a hard know. -- hard no. the coverage will be on the cash aspect of it. they will have a chance to look at that. do all understand we would

have to do this before september 30. that is the answer. we will have to deal with it because the vehicle expires at the end of the month. if we were going to go forward, we would have to act before september 30. we're in the process of discussing all of this. the opportunity expires at the end of the month. >> mitch mcconnell and the did everything they could. i spoke to speaker ryan and he said if he serves as a house it

will pass. every republican out there believe that if a fundamental reason we are in charge. democrats have lost a lot the of seats- lost a lot backing a bad idea. se want to try to make patient -- i would argue yes, we should because i do not want to go back to south carolina and say that i to repealhing i could a obamacare and not believe in my heart. if you pass it, we pass it. display has been out there for a couple of months. had to convince americans this to better health care and it is not just a last stitch attempt? >> i think you heard the

arguments. it is better than the status quo by far. i think that is an argument we are comfortable of making. that would be fine. bigou know, the next priority is tax reform. i think it will be just fine. senator graham is raising a lot of concerns on the process. given the timetable, do you think you'll address the concerns? >> we have a hearing scheduled on monday. objected to the amendment. my friends on the other side love processes when it advantages them. there will be a public hearing.

you can have different opinions about the quality of this bill. at the end of the day, this is the only process left available to stop a march toward socialism. heavens will now be -- we have now and the end of the month to have a bill that is better than the status quo. my friends on the other side are never going to agree to a bipartisan proposal that does anything other than prop up obamacare. i have talked to the president five times in the last two days. he is focused like a laser. excited about this stage-centric -- state-centric health care system. the process left is the democratic party will not give us anything that fundamentally changes obamacare. we have had weeks of talking and the only time they have gotten serious is when they are afraid

my bill might pass. now they are coming to me with what about this and what about that. i will not bring up a bill or a vote in the house that props up obamacare because that is not why i came here and that is not what the majority wants to do. the president of the united states is committed to repealing and replacing this bill, not propping it up. >> three have it, ladies and gentlemen. -- there you have it, ladies and gentlemen. >> i am proud to be joined by my

colleagues. hey, folks. tickets were else. [laughter] -- take it somewhere else. [laughter] ok. i am proud to be joined by my durbin,es senator senator, to talk about health care. we heard a lot of talk about the state and governors just released was a letter. governorsts, five posted the so-called graham-cassidy bill and more in favor of a bipartisan negotiation such as that of senator alexander and senator murray. i heard our republican colleagues speak. there was a word missing. people.

patients. care. all this stuff, democrat, republican, governors, washington. how about how this will affect people? millions will lose coverage. no pre-existing conditions. an end to medicaid as we know it. tens of millions of people could well lose coverage. people who desperately need financial services would lose it. our republican colleagues do not seem to care about how this affects the average american. that is why trumpcare -- previous trumpcare bills were so unpopular. that is like this bill is unpopular. despite all their efforts, they are struggling because their own senators know that the public dislikes this bill. latest version of trumpcare may live under a new name of

graham-cassidy, but no matter how many ways they try to dress it up and hide it, it is even more dangerous and reckless than the previous bill that was defeated. simply put, trumpcare is a sham. they are crafting in the dark of night. pne hearing on one day without a twoscore and only witnesses, that is a hearing? come on. bill.re ashamed of this they are afraid to find out what it actually does. and so we get another bill in the dark of night. the process is awful. we heard of justice being blind, our republican colleagues should be walking around with bibles because they do not want to see the bill we're -- they are being forced to vote for. with all the cuts for people and

unpopularity and meanness. they don't want to go home and taliban who lives or. or son has cancer that an insurance company can make insurance unaffordable. they do not want to tell them that. they do not want to tell middle-class families in the suburbs that mom or dad in the nursing home may no longer get coverage. they do not want to tell whoear-old young man desperately needs opioid treatment that it may go away. this isn't simply making the decisions at the stake. they make the cut. washington that hurts average people and then tell the states to tell who's a cuts. this is not a neutral bill that simply devolve power to the states. it is a bill to end medicaid as we know it and let the governors do the dirty work. 10 governors from

the state of colorado, ohio, alaska, montana, pennsylvania, virginia, nevada, message is in message -- massachusetts and vermont said do not do it. do not do graham-cassidy. our budget and policy priorities will result in about $700 billion in cuts to health care by 2027. it would cause millions to lose coverage. it would deeply cut medicaid. would bring us back to the days when companies could discriminate against people with pre-existing conditions. they could get rid of consumer protections that give americans access to maternity care and substance abuse drugs.

intos her the markets chaos, resulting in 15 million people losing coverage. do its work,he cbo if it were not pressured to put out something that is just a few lines, this would all be told by cbo. how do we know? bills in the past have been scored by similar provisions. they are afraid the public will hate this bill so they are trying to rush it through in the dark of night. we want, above all, a bill that protects average americans, not slashes the health care they need, whether the governor or washington tries to do that. it is wrong. we want to work in a bipartisan process to make things better. we want the house, the

president, republican leadership to stop pressuring those who want to come up with a to refrainsolution from doing so. we can make it work in a bipartisan way. the final thing i say is this. we have seen very hopeful outs of bipartisanship in the last month. andg back to this trumpcare graham-cassidy which set down -- which shut down the bipartisanship. >> thinking for you must all my colleagues. thank you to everyone who has email, to call, to be involved in this effort one more time to have a form of trumpcare, which is actually worse than the last one. said, we willumer not have a full cbo score for

weeks the.post of the provisions have been scored into different ways. we know what is coming. do know it is disastrous for people in michigan across the country. it is disastrous we talk about the law of basic health care provisions for people percent -- people. essentially, it would let states give insurance companies -- because this is who we are talking about making decisions -- insurance companies a bright green light to the prophets before patients. when does stopping health care? -- when does health care stopping health care? when it doesn't cover prescription drugs? when it doesn't cover maternity care? when it doesn't cover emergency rooms? when it doesn't cover people that have pre-existing

conditions? is a health insurance if it doesn't cover mental health or substance abuse treatment in the middle of an opioid epidemic? republicanemind health care is a political, it is personal. the way they were talking about it, standing right here, was very political. for all of us, for our families and the people in this country, it is very personal. when a young cancer patients cannot afford the medication that keeps her alive. because her insurance won't .over it, it is personal when a mechanic realizes his lifetime dream of owning and own shop has to pay more for insurance because he hurt his isk a few years ago, that very personal. when a woman has to pay more for her health insurance just because she is a woman, that is personal. you know what?

i take it personally. people in michigan take it personally. all of my colleagues take it personally. that is why we will fight this in every way possible on behalf of the people we represent. >> senator durbin. >> face, check. we were watching in the -- thanks, chuck. we were watching when the republicans gave their press conference. they said this is about the great national debate between socialism and states' rights. really? it is not about the debate between this. it is about basic health care for the families of america. if this is a hot deal for governors across america, how do you explain five republican governors, like the governor of alaska and the governor of nevada, coming out publicly against the notion of states' r

ights? why would they be turning their back to make this decision locally and be popular for votes? because they can count. and when they counsel they realize there is not enough money under this plan coming from washington to sustain health care in their states and to keep up with the cost of health care in the future. realists. they understand its full well. it is not a question between socialism and states rights. basic't we will provide care. i don't you people talking about social security because it is a washington program. they realize it has liberated them in their senior years. the same is true for medicare. the second issue i want to raise was one raised by the other sponsor of this legislation. the jimmy kimmel test. the member when he referred to that? you know what that is all about. this gentleman with well-known on late-night tv had a tough time.

his baby was born with a serious problem. he raised a question on his tv show. what will happen to families like mine under all this talk about the new trumpcare? under this version, it is not a good outcome. first off, if the family happens to be under medicaid, there is a question as to whether there is enough coverage. born in babies illinois are covered by health care -- medicaid. when you cut back on medicaid, you listen the opportunity. once the baby is born, left the family has a child with a pre-existing condition, under this trumpcare bill it will not them the rest of their lives when they try to buy health insurance. ort is one thing we stood up on the affordable care act and said we're not going to give in on this at all. we do not want people discriminated against because they have a member of their family or with a birth defect or because someone has survived

cancer care or someone has diabetes and their family. they walk away from it in this bill. they say that is one of the options insurance companies can play with when they decide what your premiums will be. when you look at this bill, there is a real reason why they do not want the american people to take a hard look at it. the race will go up for senior citizens, that is why aarp is opposed. the reimbursement that hospitals will go down. that is why the american hospital association and the state chapters of those it. carell not provide quality that nurses and doctors note we need. this is a rally point. many people thought july this battle was over for this year. it is not. it will pick up and team and in importance. >> i am going to make a couple of additional points. my colleagues said it very well. the first point is right after

graham-cassidy-heller passes, health-care markets will enter -- the reason that is the case, and i urge you to talk about state insurance commissioners about trump 2.0. you have a combination of no cost sharing plus a rollback in consumer protection so that you will have a particularly large number of people who are frail invulnerable. make no mistake -- frail and vulnerable. make no mistake with what will happen. the second point i want to mention is several of the republicans talk in the press conference -- talked in the press conference about how great their proposal will be for chip.

a money0 uses chip as program. the reality is you cannot have a young chip program if decimate medicaid. two are that directly links. the idea that somehow this bill is going to be good for chip is just absurd. this is a bargain, basement block grant. we will pull out all the stops to derail it. beat trumpcare before. we will be using people power to beat trumpcare again. about the groups being reengaged, are you concerned about the speed this has regained? >> a week ago, no one solve -- this hadn't even raised its ugly head. now, the groups are mobilized. he will find the hospitals, the aarp, the nurses, cancer care,

and all the societies, they are all mobilized. they realize it is even worse than the last one. this weekend, you will see huge mobilization. >> in the earlier press conference, they said it would be a tough vote for senator it -- for the senator and misery. are you confident this will not get any democratic votes? >> i am. it hurt people in every state. of insuranceprived if you have a pre-existing condition in every state. >there are dramatic cuts to medicaid in every state. whether you are democrat or republican, if you are presenting your people, you do not want this bill. >> senator graham laid out a campaign ad against a lot of your democratic colleagues saying

put natural interest ahead of people in your state. >> i don't even get what they say. we are talking about the people. their conference with simply about state, national, washington, federal, socialism, states' rights. they didn't have about people because the turks people and they know it. we are this because we care about people. a the 2018 election as reference mantra care, they will get clobbered and they know it -- is a referendum on health care, they will get clobbered and they know it. >> to you think the united states should stay in the iran deal? >> i do. i have the agreement was a bad agreement, but i also sent that letter c once it passes -- but i also said once it passes, let us give it a little time to see if it works. if iran violates the deal, let

that is one thing. thank you. by the way, unlike our republican leadership, we are not trying to hurry to get out of here. we're happy to talk about this issue. do you notice? [laughter] because youoncerned say the bill had only raised its head a few days ago? you talked about groups mobilizing this weekend. because there is a degree of uncertainty, do you believe people are so nervous on your side? >> what we have done it looked at what the bill does and then we looked at how cbo has scored previous bills with similar precision -- provisions. we have strong numbers. if they dispute our numbers they should wait for a cbo score.

>> you're talking about how this came up subtly. you think that was a republican strategy to let things go quiet for a while then bring this up? >> they have never been willing 4 totrumpcare 1, 2, 3, or have to pay for discussion. they know well they have been pushed with some of their , they know it is a popular. the last trumpcare bill is not even as severe as this one. you are of 20% of americans supported it and a majority of trump voters were against it. they know this is a very bad medicine vote for the american people and politically for them. that is why they try to rush and hide it and they don't want to have the russians -- discussion. s. that is why they were so quick to get out of here. discussiontalk about by the senate?

bigger mcconnell said some senators -- senator mcconnell said they -- using these talks are stalled -- do you think the talks are stalled? >> i spoke to patty murray. the response she said was genuine. i have good faith and senator alexander's believe in bipartisanship. i hope you won't let those partisan pressures get him off course. know how much senator alexander admires howard baker. >> a hearing looking at the latest republican health care plan is getting old for monday morning. republican senators lindsey graham is expected to testify. [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] >>. . senate majority leader mitch mcconnell. -- here is senate majority leader mitch mcconnell. plummeting costs. many thought our constituents deserved better. that is why we did what we voting for a repeal so we can replace it with something better. they defeated our every effort to improve health care. thus far, they succeeded. thus far, they have yet to offer own.us solutions of their last week, our colleague from vermont rolled out health care legislation that would quadruple down on the failures of obamacare. it envisions what is basically a fully government-run, single-payer system. the kind of system that would

strip so many americans of their health plan and take away decisions after their own health care. that would require high tax increases. the already collapsed in the homer -- in the senator's state of vermont when they try to do it. this is a massive expansion. they think this is what it would look like. you can be sure they will do everything in their power to impose it but we do not have to accept it as our feature. that is what senators graham and cassidy believe. they rolled out a health care proposal of their own last week. it would allow states and governors to implement better

health care ideas by taking more decision-making power out of washington. governors and state legislators of both parties would have the opportunity and responsibility to make quality and affordable health care available to their citizens in a way that works to their own particular space. it has a great deal of support. i want to thank senator graham and cassidy for all their hard work. they know how important it is to move beyond the failures of obamacare. they know the opportunity to do .o was passes by --just heard >> we just heard senator mitch mcconnell say he will not bring up a repeal if he does not get

50 votes. the majority leader has wiggle room on whether there will be a vote next week. how so? said he considers him on the floor next week. that leaves little room. it doesn't necessarily mean a post will be called. maybe senators will be talking about the legislation on the floor. the majority leader set for the last several weeks, if you find 50 votes, we will go on a repeal.an notice will be if you bring up the bill without 50 votes, to you send another signal to your public?rs, donors the we tried really hard and we can't do it. or do they up to 50 votes and say they accomplished with a promised to their voters for

years. if they get through the senate they take it to the house. maybe the house can have it. there are pros and cons either way. a failure is always a failure. because in the message if you do not have the votes. >> why are we seeing this push for another repeal effort now? >> republicans have until september 30 two pass the bill votes.ly 50 after the 30th, they would have to have 60 votes. democrats could filibuster it. because there are 50 to senate republicans, in theory they votes.be able to get 50 that will expire on the 30th. after that, good luck. --cassidy graham kathy-graham is not the only proposal being considered. senate health committee have been holding hearings on a bipartisan proposal that would

change the individual health insurance markets. what is the outlook for the proposal? >> is not very good>> -- >> is not very good. 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. >> coming up, a hearing looking at the latest republican health care plan aimed at replacing the affordable care act -- affordable health care act. -- that may be voted on later. we will have live coverage from that hearing monday at 10:00 a.m. eastern on c-span2. sometimes what people call

partisanship is a deep disagreement over a means to a shared goal. we should welcome that conversation, encourage it, enjoy it and be nice about it. [applause] >> it is now my privilege to present the gavel of the united states house of representatives to the first woman speaker and our history, the gentlelady from california, nancy pelosi. [applause] >> for the past 30 years, the your resourceis for politics, congress and washington public affairs. it in c-span's video library.

>> one of the headlines in the chicago tribune, trump files economic action on to his north korean military threats. as he met with japanese and south korean leaders and announcing a new executive order to expand sanctions against north korea and the target of individuals who do business with the regime. here's a look at that meeting.