30 years, part affairs. so whether it happened 30 years ago or 30 minutes ago, find it in c-span's croo library at wha in this measure? >> this is really the republican's last ditch effort at trying to repeal the affordable care act, the promise they made voters for 7 years. this would change the existing

system of the affordable care act and change it into a block grant. states would get a set amount whatever they wanted care act, they could go single whatever they wanted in their health care system. they would take the dollars and implement a plan similar to the ffordable payer, or they can go a conservative route and undo some of the parts of the affordable care act particularly the consumer protexases that some folks like. the preexisting conditions, things like that. governors would be able to undo those things and have this pot of money. >> take a look at some of the details offered up by senator graham and we'll come back to our discussion. >> we keep medicaid in place as it is today. we try to give more flexibility because indiana is a good example of what can happen if you give states flexibility to help poor people.

one thing about medicaid, is you get a headache you run to the emergency room. i want them to have some ownership. if you smoke that's something that ought to be considered. i like copayments. i want to treat people low income and poor fair but all of us need to be responsible for our health care. rather than having a medicaid program that just wrilingts checks no matter what the outcomes are we're going to in year 8 again to slow the growth of medicaid down it grows faster than medical inflation. medical inflation is what it costs for you and your family. we have prove than the state level you can get a better bang for your buck. so the bottom line is the first block grant begins to sloy the growth of medicaid to make it affordable. and incentivize innovation. in year eight. if we don't do that here is what happens to the country.

y 2038 all the money you spend in taxes to washington goes to pay the interest on the debt, medicare and medicaid and social security. there won't be one penny for the department of education and defense. that's how quickly these programs are growing. so we do two good things. we put medicaid on a more sustainable path because it's an important program, and we allow in flexibility to get better outcomes for the taxpayer and the patient. what a novel idea. the second block grant, money that would have been spent by a bureaucrat in washington. under the first proposal you would get a refundable proposal you would gret a tax credit and we would give insurance they ies money so wouldn't collapse on the obamacare exchanges. instead of giving a tax credit to the individual to buy a product which is going to go away. instead of giving money to insurance companies, we're going to take that same amount

back to nd give it the states so that by 2026 they all get the basic same contribution. what did we do? we repealed the individual mandate. the back to the states so that by 2026 they all get employer mandate. states can reimpose if they like. that's up to the states. we repeal the medical device tax because that hurts innovation. we left the other taxes in place. there's no more taking from the poor giving to the rich. i wish we didn't have to do that but we need the money to transition in a fair, sound way to a state centric system. so to my friends on the other side we leave the taxes in place, we just give the money somebody else called state control, local control, not washington-based health care. and we do it in a way where basically everybody somebody el same contribution from the federal government. what a novel idea. now, to prumple. without you we can't do this. your pen will be the one that signs the law if we can ever

it to your zesk. you said today you would veto bernie sanders care. let me tell everybody in america don't worry, single it . ou said today payer health care will never get through the republican-controlled house. we have the majority in the senate. going to need you going to nee veto single payer health care. what we need you to do is put in place a new system to stop the march towards single payer health care. because payer health care will if we go government is going to own it cradle to grave. on your watch cradle to grave. on your watch you can stop that. once we get the money and the power out of washington that is the end of single payer health care. once people know they have somebody to respond to their needs at the state level versus some bureaucrat they will never meet there's no going back to washington-based health care. so 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 parrot, innovation, versus bureaucracy. what a legacy it would be. but for that to happen -- and i know you're busy with hurricanes and north korea, you're going to have to get on the phone. i believe you will. you can. i'm asking you to do it. to senator nk connell thank you for what you said today. thank you for being willing to push this you can. i'm asking you to do it. forwar. to my colleagues on this side, there's three options left for america. propping up obamacare which will never work, bernie care ich is full-blown single payer health care, or the 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 is with a i believe. send the money home. send the money back to where the patient payer health care, lives. put it in the hands of doctors and hospitals, in the community, and make sure that the people in the state are sp responsive to the needs of the individuals in that state. replace the bureaucrat with an elected official. you'll improve quality, and outcomes will be better, and it will be more physically sustainable. at the end of the day, those governors whoever he or she might be that can figgier out ality 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's never going to be any innovation, it's always going to be more money. it only works for the 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 it will take us off the path of becoming greece. this is where we're headed. c-s. 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 latest >> the cassidy graham proposal we heard about live monday morning at 10:00 eastern. now more on the plan senate republican leaders were joined by senators graham and cassidy. later we'll hear from democratic leaders.

>> good afternoon, everyone. >> good afternoon, everyone. we spent lunch talking about graham cassidy. lots of interest in the bill they have been working on and i've asked them to join us today and lead off. >> number one i've never felt better about where we're at. it's pretty well clear to me where the country is going under obamacare and bernie care. it is going into further bankruptcy. it's more decisions further away from where you live. in 1996 we block-granted money for welfare reform and it worked like a charm. we put governors in charge of the program. we held them accountable. so here's the choice for america.

socialism or socialism or federalism when it comes to your health care? four states get 40% of the money under obamacare. new york, california, massachusetts, and maryland. they represent 20% of the population. our goal is by 2026, to make sure that every patient in every state gets the same contribution roughly from the federal government and allow people in your states to make decision which is would have been made in washington. the most beneficial aspect of this bill, if you don't like obamacare who do you complain to? you can complain to me but 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. if you don't like your health are, somebody will listen to you. your governor and your state house of representatives. you can go to the state house of representatives who most

likely goes to the same hospital you do. you can go to your governor and state house of representatives. you can go your governor who will listen to you because they're care about your vote if nothing else. i'm trying to take the money and power in washington and send it back closer to the patient. if you believe government closer to the people is the best government why not health care? and finally, we know how this movie ends if we don't change. going to have a single pair health care system in this country that will bust the budget and we're going to start rationing care. failing for a reason. it's a bad idea. state control of health care will work because failing for a charge will be accountable to you unlike obamacare where the person in charge could give a damn of what you think. >> for 25 years i treated patients in louisiana's charity hospital system. it's been my life's work to try and bring health care and coverage to those who do not have. so when a fellow back home with

a special needs child tells me he is paying over $40,000 a year in premiums plus the $5,000 deductible, we know that the system is failing. i spoke to the jimmy kimmel test where those who have needs would have needs address, his family is almost beyond the reach. he has a job but cannot afford his coverage. what we attempt to do is take all the dollars here in washington, d.c., doled out at state, jumps through a hoom, and return it down to the states for the states to do that which is bess best for that state. if you are in a state which has not expanded medicaid you are going to do great. and all those lower income texans, floridians, mainers, will have dollars in their states that -- they will get health insurance that they do not currently have. to -- we don't

want to hurt those. i heard no one complained about that ship program -- the chip program. , on as something that bipartisan basis, has been recognized as an effective way to provide quality health care to those in need. we continue patient protections. state wisheser a to have, they must assure the secretary that they provide adequate and affordable coverage to those with pre-existing conditions. we preserve mental health parity . but ultimately, we give the money to the state. in maine, there can high-risk, which obamacare put out of business, lowered premiums by lower income hoosiers to be empowered to purchase their

own services, they found that cost went down and outcomes improved. years,doctor for 25 caring for those who do not have coverage. my goal continues to bring them coverage. any questions on the i would like for senator cassidy and senator graham to handle the echo -- to handle. -- we might be a little higher than that now, but that's not much better. why is that different? >> at the end of the day, we need 50 votes. if you are a republican, chances are you believe in federalism.

last effort to repeal and replace obamacare was better than obamacare, what it did not embrace the concept the bill was talking about. i believe that most republicans like the idea of state-controlled health care versus washington, d.c.-controlled health care. employee assessments are going out by the end of 2017. businesses will get a notice from the federal obamacare -- a lot of republicans would like to stop that from happening. the best way to do that is repeal the employer mandate nationally. states can reimpose it. we've come across an idea that is uniquely republican, but over time has proven to work in other areas like health care reform. i would hate to be the democrat that voted against more money for my state and more power, and

keep the status quo. ,f you are a democrat in, say missouri, you are going to get far more money under this proposal than obamacare, and your state would have more control over the money. controlt that money and means that you believe that somebody in washington cares more about people in missouri then people in missouri. you believe it's ok to have california, new york, maryland, and massachusetts more than missouri. if you are a republican and you vote against federalism, you've got to explain to people back home why washington knows better , and almost every state except the four i described, do well under this approach of taking the money out of washington. i think the idea is more powerful, the substance is more

day, and at the end of the i believe we are going to get 50 republican votes, and i predict a lot of democrats will struggle with a no vote. , who least eight of them states to better in terms of funding -- that's going to be a hard know. no. hard -- thehe coverage will be on cash aspect, the financial aspect of it. we will have a chance to look at that. >>\indistinct >> you understand we would have to deal with this before september 30. 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 are in the process of discussing all of this. opportunityows the expires at the end of the month. >> can i say something about that? repealork as hard to obamacare as they did to pass it. the leadership has done everything we asked and then some. italked to paul ryan, he said like it, send it to the house it's going to pass. every republican out there believes this is a fundamental reason we have -- we are in charge. have been the biggest benefit

-- the biggest political beneficiary of obamacare. would we try again? i would argue yes we should. i want to go back to south carolina and say i did everything i could to repeal of obamacare and believe it in my heart. paul ryan told me to my place--to my face, if you pass it, we pass it. >> this plan has been out there for a couple months. americans convince you truly think this will lead to better health care and not just a last-ditch attempt to do something before the deadline. >> i think you've heard the arguments -- it's better than the status quo by far. -- with limited time left in the calendar year, how concerned are you about time? >> i think will be fine.

you know, the next priority is tax reform, and i think were fine. senator graham has raised concerns about how this was working, moving through. an important vote in july. given the compressed timetable, do you think you will adequately addressed senator mccain's -- concerns?echo side friends on the other like process when it advantages them. there will be a public hearing, which i've been asking for. you can have different opinions about the quality of this bill. this isnd of the day, the only process available to stop the march toward socialism.

we have to debate whether this 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've talked to the president five times in the last two days. he is focused like a laser. he told me he is not going to throw good money after bad. he is excited about this state centric health care system. is that thell you process left to us is that the democratic party is never going to give us anything that fundamentally changes obamacare. ande had weeks of talking, the only time they've gotten serious is when they are afraid my bill may pass. here is what the speaker of the house told me. 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 or what our majority wants to do. the president of the united states is committed to repealing and replacing this bill, not propping it up. >> ok, i am proud to be joined by my colleagues. hey, folks, take it somewhere else.

i'm proud to be joined by my colleagues, senator durbin, senator wyden, senator stabenow. first, we heard a lot of talk about the states and governors. just-released was a letter. 10 governors, five democrats and five republicans, opposed to trumpcare, to the so-called graham-cassidy bill, and more in favor of a bipartisan -- i just heard our republican colleagues speak. there was a word missing. people. patients. care. all this stuff -- how about how this affects people? millions will lose coverage. no guarantee of pre-existing conditions.

and and and to medicaid as we end to -- and an medicare as we know it. people who desperately need services will lose it. republican colleagues don't seem to care about how this affects the average american. that's why the previous trumpcare bills were so unpopular, and why this bill is. that is why, despite their efforts, they are struggling, because their own senators know that the public dislikes this bill. the latest version of trumpcare may live under a new name, graham-cassidy, but no matter how many ways they try to dress it up or hide it, it's even more dangerous and reckless than the previous bill which was the seated. simply put, trumpcare is a sham.

they are crafting it in the dark of night. one hearing on a one day without the cbo score and only two witnesses against the bill? that's a hearing? come on. they are ashamed of this bill. they are afraid to find out what it actually does. so we get another bill in the dark of night. the process is awful. our republican colleagues -- we've heard of justice being blind. republican colleagues should be walking around with blindfolds. they don't want to see what is in the build they are being forced to vote for. with all the cuts, all the unpopularity, the basic meanness in this bill. they don't want to go home and tell him him who learns that her daughter son has cancer, that an insurance company can make

insurance unaffordable for them. tell an't want to middle-class family in the suburbs that mom or dad in the nursing home may no longer get coverage. tell an't want to 23-year-old young man who desperately needs opioid treatment that it may go away. simply making decisions at the states. they make the cuts here in washington that hurt average people, then tell the states to figure out who to cut. thatis not a neutral bill simply devolves power to the states. it ends medicare as we know it and lets the governors do the dirty work. 10 central governors from the states of colorado, ohio, alaska, montana, pennsylvania, virginia, louisiana, nevada, massachusetts, and vermont --

five democrats and five republicans -- have said don't do trumpcare 2. don't do graham-cassidy. according to the center of budget and policy priorities, it will result in about $700 billion in cuts to health care at 2027. it would cause millions to lose coverage. it would radically restructure and deeply cut medicaid. to thed bring us back days when insurance companies could discriminate against people with pre-existing rid of the get consumer protections that gives americans access to maternity care, substance abuse, prescription drugs, and throw the individual markets into chaos, resulting in 50 million people losing coverage. work,y let the cbo do its if they weren't pressured to put fewsomething that is just a

lines, this would all be told by cbo. how do we know? similar bills in the past have been scored by cbo with similar provisions. they are afraid. that the public will hate this bill, so they are trying to rush it through in the dark of night. all, a bill that protects average americans, not slashing the health care they need, whether the governor of washington should try to do that is wrong. we want to work in a bipartisan process to make things better. , thent the house president, republican leadership, to stop pressuring those who want to come up with a bipartisan solution to refrain from doing it. we can make this work in a

bipartisan way. the final thing, we have seen some very hopeful sprouts of bipartisanship in the last month, going back to this trumpcare 2, graham-cassidy, which shut down that bipartisanship that america urines for. i'm going to call on senator stabenow could she has to go to a hearing. to my colleagues and everyone who has now , to call, toemail be involved in this effort one more time to pass a form of trumpcare, which is actually worse than the last one. as senator schumer said, we don't have and won't have a full cbo score for weeks. but most of the provisions have been scored in different ways. so we know what is coming. we know that it is disastrous

for people in michigan, for people across the country, and disastrous when we talk about the loss of essential, basic health care provisions for people. let states, it would give insurance companies, who we are really talking about making decisions -- a bright green light to put profits for patients. and when does health care stop being health care? is it health care that doesn't cover prescription drugs? is it health insurance if it doesn't cover maternity care? is it health insurance if it doesn't cover emergency room's? people with pre-existing conditions? mental health or substance abuse treatment in the middle of an opioid epidemic? remind republicans

that health care is not political, it is personal. the way they were just talking about it, standing here, was very political. for all of us, our families and the people in this country, it is very personal. when a young cancer patient can't afford the medication that keeps her alive because her it'sance won't cover it, personal. when a mechanic realizes his lifetime dream of owning his own more forto pay insurance because he hurt his back a few weeks ago, that is very personal. a woman has to pay more for her health insurance just because she is a woman, that is personal. and i take it personally. 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 who represent. >> senator durbin. >> thanks, chuck. we were watching in the other room when the republicans gave their press conference. one of the sponsors of this legislation said that this is about the great national debate twin socialism and states rights. about that, not it's about basic health care for the families of america. forhis is such a hot deal governors across america, how do you explain five republican governors, like the governor of nevada, coming out publicly against this notion of state rights? why are they turning their back on this opportunity to take the money? because they can count. they realize there's not enough money coming from this plan from

washington to sustain health care from their states and keep up with the cost of health care in the future. they are realists. they understand well well. ors a question of whether not we will provide basic care. i don't see people across america complaining about social security because it's a washington program. they realize it has liberated them in their senior years for a good life. the same is true of medicare. raised -- the jimmy kimmel test. member when he referred to that? you know what that is all about. this gentleman 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 is going to happen underilies like mine?

this trumpcare version, it's not a good outcome. if that family happens to be under medicaid, there is a serious question as to whether there is enough coverage. illinoisbabies born in are on medicaid. you want a healthy baby, you want a healthy mom. born, once theis family has a child with a pre-existing condition, under this trumpcare bill, it will haunt them the rest of their lives when they try to build -- try to buy health insurance. that is something we stood for affordable care act, that we will not allow this. survivede someone has cancer care, or has diabetes and their family. they walk away from it in this bill. that's one of the options that insurance companies can play with when they decide your

premiums. a reasonagain, there's they don't want the american people to look hard at it. the rates go up for senior citizens, which is why the aarp is against it. the american hospital organization opposes it. it's not going to provide the quality health care that -- no we need. the battle is going to pick up in steam and importance for every family from this point forward. >> senator wyden. >> i'm just going to make some additional points. the first point is right after graham-cassidy heller passes, health care markets are going to enter a freefall. andreason that is the case, i urge you to talk to state

insurance commissioners about you would is that have a combination of no cost sharing, plus a rollback in consumer protections, so that you will have a particularly large number of people who are frail and vulnerable. about what mistake happens when graham-cassidy passes. a freefall in the insurance markets. the second point i want to mention is that several of the republicans talk in the press conference about how great their proposal would be for chip, the children's health insurance program. you need to understand that chip as upses money-laundering program. reality is you cannot have a strong chip program if you decimate medicated. -- decimate medicaid.

this billhat somehow is going to be good for chip is absurd. this is a bargain basement lock grant. we are going to pull out all the stops to derail it. beat trumpcare before, we will use people power to beat it again. the group's degree in gauging -- are you concerned with the speed? a week ago, this hadn't even raised its ugly head. now, the groups are mobilized. you will find the hospitals, the care,the nurses, cancer the societies that represent -- they are mobilized. i think this weekend, you will see huge mobilization.

in the other press conference senators from missouri, senator mccaskill and others, are you confident this bill will not get any democratic votes? >> it hurts people in every state. insurance deprived of if you have a pre-existing condition. dramatic cuts to medicaid in every state. democrat or ae a republican, if you are representing your people, you don't want to this bill. putenator graham basically out a campaign ad against her democratic colleagues, saying you put national interest ahead of people in your state. what they say. we are talking about the people. their press conference was state, national,

washington, federal, socialism, states rights -- they didn't talk about people. this hurts people and they know it. 2018 election is a referendum on trumpcare, they are going to get clobbered. indicatedsident has -- some of you voted against the iran deal. >> i thought the agreement was a bad agreement, but i also said let's see, once it passed, what seat whether it's working or not. violates the deal, that's bad. if they don't, we can go after them on the other bad things. unlike our republican leadership, where not in a hurry to get out of here.

we are happy to talk about this issue. are you concerned -- he said the bill is no longer -- groups are going to mobilize. as long as there is such a degree of uncertainty, that this was dropped out of midair, why are you seeing -- bill've looked at how the does, and how the cbo has measured -- if the republicans dispute our numbers, they should wait for a cbo score. >> talking about how this came up federally, do you think that was the republican strategy? to let things go quiet for a while? 2, 3, 4 --mpcare 1, they know that while they are being pushed by their hard right

benefactors who want to get rid of all of the safety nets, they know it is unpopular. the last trumpcare bill, not even as severe as this one, fewer than 20% of americans supported it, and a majority of trump voters were against it. really badhis is a medicine, substantively for the american people and politically for them. that's why they try to rush, to to avoid discussion debate hearings. that's why the republican leadership was so quick to get out of here. >> can you talk about the pressure coming from the house and senate about a bipartisan approach -- the talks that senator alexander and senator murray were having -- do you think those talks are now stalled? murray, theo patty

author. she gave to lamar alexander -- he was generous, said it was a good offer. i have a lot of faith in senator alexander's belief in bipartisanship. wouldward breaker moment be to go forward on this, and we know how much senator alexander admires howard baker. -- a hearing is scheduled for monday morning. republican senators lindsey graham of south carolina and bill cassidy of louisiana are expected to testify. live monday, 10 a.m. eastern. .ere is mitch mcconnell he talked about the proposal on the senate floor. -- suffered a lot under obamacare.

collapsing markets, many of us thought our constituents deserved better. that's why we did as we promised and voted to repeal this failed law. the forces of the status quo went up to defeat our effort to improve health care. succeeded,hey have and have failed to offer truly serious solutions of their own. last week, our colleague from vermont rolled out health care legislation that would quadruple down on the failures of obamacare. it is basically a fully single-payern -- system. that would system strip so many americans of their health plans, and take away

decisions over their own health care. it would require almost unimaginably high tax increases. -- a senator's home state of vermont when they tried to do it. apparently -- you can be sure they will do everything in their power to impose it on our country, but we don't have to accept it as our future. that is what senators graham and cassidy believe. a proposal oft their own last week to root -- to replace the pillars of obamacare with a new one allowing states and governors to actually implement better health by taking more decision-making power out of washington. legislatorsd state of both parties would have both

the opportunity and responsibility to help make quality and affordable health care available to their citizens and a way that works for their own states. it's an intriguing idea, one that has a great deal of support . as we continue to discuss that legislation, i want to thank senator ram and senator cassidy for their hard work. hard -- howw important it is to move past the failures of obamacare. opportunityat our to do so may pass us by if we don't act sooner. heard senator mitch mcconnell say he will not bring up a repeal of the affordable care act if he cannot get 50 votes. -- politicod reporting that the majority leader has some wiggle room himself as to whether there is going to be a vote next week. >> the majority leader's office

said on wednesday that he considers that she intends to consider -- next week. it doesn't necessarily mean a vote will be called. maybe senators will be talking about the legislation on the floor. you are right that what the majority leader has said for the last several weeks -- if you find 50 votes, we will vote on a republican repeal of the affordable care act. now, the decision is going to be -- you bring up the bill without tovotes? sent another signal your supporters, donors, the public -- we tried really hard to repeal the affordable care act and we were unable to. or do they get the 50 votes and say they accomplished what they promised to their voters for years, to get this through the senate and see if the house can pass it? and cons either way. a failure is always a failure.

but you can send a message if you don't have the votes. >> why are we seeing this push for another repeal effort now? wonkycause of walkie -- senate rules, republicans have until the 30th to pass a vote. there's 52 senate republicans, in theory, they should be able to get 52 -- 50 votes. but that will expire on the 30th. after that, tough luck. >> cassidy graham is not the only proposal being considered. that would change the individual health insurance markets. what is the outlook for that proposal? senator lamarr alexander, the lead republican on the committee, was very excited about doing a bipartisan

proposal. he wanted to put the top democrat on a bill that was very narrow. making sure premiums weren't out of control. earlier this week, he said that all the attention on graham-cassidy -- he also put some blame on bernie sanders, who introduced the single-payer bill. all the bipartisan -- all the partisan attention took the steam out of their bipartisan efforts. the house speaker said the house will not bring up a bill to do what senator alexander wanted to do. it took the wind out of their sails and they said they were calling off the talks. committee -- hearings. this is about 50 minutes, then we will return to you, jennifer, and our discussion. >> this hearing is about taking

one small step on a big issue that has been locked in constant stalemate for seven years. health insurance. it is a step that congress needs to take by the end of this month. the steps -- the step is not so big to americans. people who don't get their abouth insurance from-- half of them have zero government support to buy that insurance. of thosen is only 6% who have health insurance and america. .hat's the individual market nearly 300 million americans have health insurance. 18 million by it in the individual market. 6% of all the insurers, and 9 million of them have no government health to buy their

insurance. they are the ones most hurt by higher premiums and co-pays and deductibles. the second hypothetical -- a 45-year-old in lynchburg would receive no tax benefits to cover her $7,100 per year premiums. she has an estimated take him pay of $39,000 after taxes, which means that almost a fifth of her take-home pay is spent on health insurance premiums. this doesn't include the duck doubles are co-pays. up by an, a goes average of 21% and 42%, an --rease of 1500 ought not to have to pay the fifth of her income for health insurance.

-- at the end of september last year, blue cross, our largest insurer, pulled out of the individual market in knoxville. , butust for tennesseans for everybody. at the end of this september, if congress doesn't act -- if it happens again, up to 350,000 tennesseans and millions of americans could literally be left with zero options to buy insurance from the individual market. year, only 4% of american counties had one insurance commissioner on the exchange. sureyear, 36% had one and -- had one in sure on the exchange. -- in tennessee, it's 78 of our 95 counties. if we do act, we can limit

increases in premiums next year. foran continue support co-pays and adoptable's for many low income families. we can make certain health insurance is available every county and lay the groundwork for future premium decreases. i would suggest we do this by taking two actions, though there may be others. one is appropriate cost-sharing payments. theugh the end of 2018, help with co-pays and adoptable's for many low income americans. section--waiver in the affordable care act so that states can have more toxibility to devise ways create coverage with more choices and lower cost. cost-sharing payments are extra subsidies or discounts for many low income individuals who receive premium subsidies under the law. individuals pay

out-of-pocket costs like co-pays and adoptable's, but their overall effect is to lower premiums in the individual market. waiver, as i32 said, are already written into the affordable care act. under some circumstances, they allow the state certain flexibility, such as essential health benefits, but they do not in any way reduce patient protections that most of us support, including protections for those with pre-existing conditions and ensuring those that remain -- ensuring that have -- can stay insurance.rents -- seven states have applied, two states, alaska and hawaii, have received the 1332 waivers so far.

to get a result, democrats will have to agree with something. more flexibility for states. some may be reluctant to support it. republicans will have to agree to something. additional funding through the affordable care act, that some may be reluctant to support. that is called a compromise. a smaller, similar agreement to the compromise that created the senate to 1789. when the founders created the senate from two members from each state, and house of representatives aced on population, that was a compromise. cost sharing -- were included in both. section 1332 waiver is already in the affordable care act, but it hasn't been appealing to states because it is a difficult tool to use.

we hope to hear more from our witnesses today. if we were able to take the big steps i mentioned earlier, fixing no child left behind, we ought to be able to take this small, bipartisan step on health insurance. timing is a challenge, so i propose we try to come up with a consensus by the end of next when our hearings are complete, so congress can act on what we recommend before the end of september. otherwise, we won't be able to affect insurance rates and the availability for insurance next year. that's because the department of health and human services requires insurance companies to submit their file rates by december 20. byon healthcare.gov september 27. i believe we can do it here because we are plowing familiar ground. and sol is a small step

many americans will be hurt if we fail. if we don't do it, it will not republicans to make political hay blaming democrats, or vice versa. >> an important moment for patients and families. a lot of work needs to be done to undo the damage this administration has caused to the health care system, because they are trying to create trumpcare by sabotage. our health care system is more president trump's tweets would have you believe, but it is weaker due to steps that have been taken. the president has put forward executive orders seemingly designed to inject uncertainty into the markets. this administration cut funding for outreach by 90%, and funding

for consumer assistance by over 40%. another pressing example is the threats to cut off a minsk, reduce coverage costs for low income people. -- be these out-of-pocket discontinued? premiums could be an average of 20% higher fear then the most populous plans on the exchanges. that is unacceptable, and avoidable. congress can act right away to confirm, once and for all, but out-of-pocket reductions will continue and we will have a narrow window to do that. as the chairman said, before insurances finalize their plans for 2018 later this month. i'm glad there are members on both sides of the aisle who agree we need to take this step, and i think it's critical we

work toward a multi-year solution, toward the kind of certainty that would have the most impact on family premiums and the marketplace. if we don't find a multi-year solution, we are just going to be back in this room trying to touch the same problem a few months from now. that is not what certainty looks like. discussion around strengthening our health-care system is exactly what democrats have hoped for. we've what forth a number of ideas that would help stabilize markets and lower cost in the near term. i am more than ready to consider additional ideas from the other side of the aisle to make our health care system better for families and patients. but that means moving forward, not backward, on a ford -- on affordability, coverage, and quality of care. trumpcare would have raised the arelies' cost -- i think we

this needleding will not be easy. i believe in an agreement that protects patients and families from higher costs, and maintains the guardrails rails of our current health care system, i think that is possible. it would make a difference for the patients and families we serve and provide a bipartisan foundation for future work. his work when the affordable --e act past, and there is to expand coverage and improved quality of care. these are the issues that we should be able to work together on in a bipartisan way. --wepe that with today's turn the page away from trumpcare and partisanship which we've seen too much of, and instead start working on health care policies to help our

patients and families get the help they need. i'm the insurance commissioner for the state of washington. i want to thank you for your bipartisan commitment to address that we hases insurance commissioners are facing, but that you are facing in the coming months. the is especially true for individuals and families who buy their own health insurance. the health of that market is really the canary in the coal mine. if there is a problem in the individual market, it is a problem for all of us. this is made up, as you pointed out, chairman alexander, early retirees, self-employed, people who work for employers who don't offer health insurance. the individual market is a critical safety net. relying on us to find a path forward, because it offers

more certainty than what we have now. washington state has fully embraced the affordable care act . from the very beginning, we have a stable market. 2014. our uninsured rate has plummeted from 15% down to under 6% in the state of washington. there's been a serious joke in the system. initially, we had two counties in the state of washington without any health insurance. problem, but i'm nervous about what's going to happen next year. because of the growing uncertainty and actions by the administration, our individual health care markets are in a barrel. as opposed to average rate increases that we've seen for 2018, or -- in years past, it's been less than 10%. largely pulled--

back in our states, completely from western washington. .here most people live the next two weeks are going to be telling. insurers will be making their final decisions as to whether they will be participating in the marketplace are not. congress must act quickly to address these growing uncertainties. you must permanently fund the cost sharing reduction payments, something that is going to help a great deal in our marketplace. it affects some 72,000 people in .he state of washington for a low income family in the state of washington, the deductible is the difference of with full hundred dollars the csr's, or $14,000. or $14,000. doing this would show your commitment to stabilizing the

market. it worked well in the state of washington for the first three years that we had a reinsurance program. we would like to see it continue. it's another way to reassure the insurance market -- it doesn't help them financially, but it gives them predictability and helps us hold down rate. they maintain coverage and affordability guard rails and the 1332 waivers. don't want to see the guarantees on out-of-pocket -- erodeded away away. say you mustet me take bold action now to shore up these markets, so millions of hard-working families and individuals--they are counting on us. in washington state, we have what-hand experience and

happens when violating basic insurance principles is allowed to occur. it is happening now. we tried this in the 1990's and saw the individual market in the state of washington totally collapse. that's something no one wants to go through. andme be a harbinger here say that it can and will happen now.u do not take action that's how critical it is in the insurance market, to make sure we don't have the kind of collapse in washington happen to the whole country. us.s depend on our lives rest on your bipartisan efforts. -- our individual market is not collapsing. our individual market insurers all for an average increase of 8.8% for 2018, assuming no changes to the affordable care act. our insurers are finally seeing

improved experience with this market, reflected in their rate increases. this --cerned that payments for cost-sharing reductions. i cannot stress enough how difficult this uncertainty is on our markets. these payments have a significant impact on rates, and failing a long-term commitment will drive up costs for consumers. this will affect the 125,000 people who don't receive subsidies. those who do will be shielded increases, ifum their insurance stayed in the market. pennsylvania consumers will be left to bear the burden of , or choiceseases necessitated by continued uncertainty. congress should allocate payments through at least 2019 to give insurers the -- of they

need. spiking rates, narrowing networks, general market instability for too long. my mornings have been ignored at the congressional level. of thelementation obamacare and oklahoma has been a failure. in 2014, our citizens chose plans from five different carriers on the federally facilitated marketplace. those carriers sustained heavy losses, and by 2017, it dropped to one carrier. eventually that oklahoma will have no market and no options. not only do they only have one marketplace carrier to choose from, rates in the marketplace have increased by 100 and 2%. -- betweenviduals

2016 and 2017, small business owners and self-employed individuals, the backbone of oklahoma's economy, are suffering. the doctor will shock, can't afford coverage. many people in oklahoma, where higherrage income -- premiums for a policy they cannot afford to use. carriers have sustained large losses in the marketplace, they have narrowed their provider networks. it turns out you can't always keep your doctor. all recent efforts to repeal and amend obamacare have failed. states like man -- like mine have been left holding the bag. i'm encouraged by the trump administration's priorities. in oklahoma, obamacare gives us no other options at this point.

it has submitted a 1332 waiver application under the obamacare framework. it -- a market stabilization -- this actual plan, estimated to reduce premiums and increase enrollment in the marketplace and 2018 -- subsequent waivers will receive -- what weol over really need is an innovative long-term solution that truly returns powers to the states. to implement ideas tailored to fit each states specific needs and health insurance. i have been encouraged by ones by senators graham and cassidy. it would put that it would block grant dollars to the state. states want to keep

their regulations from obamacare, that is great, if it works for them. but it is not working for oklahoma. we face an uncertain and difficult future on this current block path. >> let me ask about the issue of cost sharing, raised by everyone. i think we recognize that uncertainty within the market is deadly. you cannot move with accuracy. there have been some that have suggested, i believe the chairman, and his remarks, that we need to expand the cost necessities through 2018, 2019 is another date. i think the governors asked for extension through 2019. if we were to do it just through 2018, does that provide sufficient certainty, or does it

need to be longer, 2019 or even beyond, to give the certainty. now, we are going month to month, and that doesn't work. >> i believe it has to be at least two years. i believe there's enough confirmation in the market that the insurers looking to remain are looking for more than a one-year commitment. at least 2019. having we need to go further than that. insurers right now are already planning for 2019, going to -- to givears out them predictability, you have to give them more certainty going into the future that it's going to be there, so they don't leave the market. concern, butgest someone will yell fire in a crowded theater and they will all leave.

happen in that washington state in the 1990's, and it shouldn't be replicated. the second house committee hearing on the individual insurance market featured a bipartisan group of governors. democrats the bowling of montana, republican charlie massachusetts, john hickenlooper of colorado, john hubert -- honor to be here with his group of governors who i consider friends and i know to be problem solvers. my request is that you do two things. you move likely to stabilize the individual insurance market place, and second, you undertake a serious effort to work together to tackle the cost of health care. unemployment is the lowest in history in tennessee.

the first state to offer two years free of community college or technical school to all our students. our debts per capita are among the lowest in the country. but the prices of health care and the uncertainty of his -- the primary difference between governing stadium -- governing tennessee now and when lamar alexander led the state years ago, is the impact that the cost of health care has on everything else we do. three insurers offer affordable care act approved service. these limited insurance options are provided to tennesseans at substantial cost increases. our experience of fewer choices at higher cost is not sustainable. not have anply will option to purchase from the insurance marketplace, or cannot

pay for the limited options available to them. either way, the system fails. congress should take steps to prevent the full collapse by funding cost share reduction payments, creating a short-term reinsurance program, and providing flexibility to the states. tennessee, 60% of our federally facilitated marketplace practice bentz are enrolled in csr plans. morere to -- will create uncertainty, and actually increase the federal debts due higher tax credits. clearly, this is not a recipe for success. it's important to understand that our marketplace is facing collapse. csrre this discussion of payments, other actions and reforms will be needed to address the crisis. congress can take additional actions by funding a

spnspnspn this should attract members to the marketplace. a third way to provide stability iso offer flexibility to states to address their unique challenges and circumstances. the approval should be expedited and guardrails placed on waiver requests should be loosened in a manner to attract younger individuals to the marketplace. i realize some of the things i outlined around stabilization cost more money and i'm asking for this at a time many of nors, including myself emphasizing the high cost of health care. but the need to address the health care needs while congress works on cost will 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 line of thinking. every governor here and those at home could move to stabilize the market now while we work to take on the issue of health care cost. having helped to stabilize the market, it's my strong hope this committee will turn its sights to the cost of health care which is tripling businesses and families and overwhelming all the other needs that should be addressed in state and federal budget. we must 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 didn't have health insurance or couldn't afford coverage. secondly, the affordable care act was supposed to make health care affordable. unfortunately it has provided coverage or government zpwids for millions to have subsidies

at high costs. the care act took the easy part and that we provide it free to some people without addressing cost. we shouldn't kid ourselves, addressing cost is difficult politically and otherwise. one of the drivers of health care cost is the misalignment of incentive this is created when we compensate providers based on the volume of care that they provide rather than on outcomes and 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 a sustainable one. during the debate about the affordable care act there's been a lot written and said about how immoral it would be to have millions of people lose health care insurance coverage. i understand the argument. i'm a republican quonchor who

-- governor who proposed a plan to increase medicare coverage in our state. can't we all acknowledge it's 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 to partner with you to strengthen the individual market and entire health care system. >> thank you, governor haslam. governor bullet, thank you. >> ranking members of the committee, thank you. first thank you for inviting governors, democrats and republicans to appear before you today. whatever comes out of washington, d.c. or does not come out of it, we're on the frontlines of dealing with it. and your recognizing the importance of our involvement in this discussion is significant. will thank for you taking the hard work of working together.

as we learn from the passage of the a.c.a., meaningful and lasting reform will be substantially 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 congress doesn't repeat errors of the past or even errors of the past month. and third, we're all familiar with the old adage, the only way to eat an elephant is one bite at a time. my thanks for a singular focus on the immediate steps congress can take to stabilize premiums and help individuals in the insurance market. any more gomping in d.c. may seem like a zero sum game with few win-win scenarios. if you put greater stability to the overall health care system and the individual markets, i do believe that your efforts will reap political rewards on

both sides and some may call me a dreamer but it might prove to be a model for further efforts. following the eating the elephant analogy, it may be only one bite this committee is taking but eelingts an important one. last time i was with chairman alexander again with bipartisan group of governors, he handed out his pocket guide to basics of health care coverage. sure those on the exchange only represent 6% of all those covered, 4% of the total insured are the individual markets, 6% covered by insurance. but stabilizing the individual market impacts all areas of coverage and has a highly pronounced impact on places where i live. rural montana and rural americans are less likely to have that option of employer sponsored insurance. today 8% of those insured in montana are on the individual

market and 3-4 enrolled are from rural and frontier areas of our state. te. 84% of all montanans receive tax credits to make their premiums affordable and half receive cost sharing payments to reduce their out-of-pocket costs. 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.

♪ host: good morning. it is friday, september 22, 2017. both chambers are set to return to capitol hill on monday for a legislative session. we begin today with the news facebook is agreed to hand over to congress thousands of russian linked social media as that appeared -- ads that appeared 6 election.201 faceb companies like