miller, your testimony reflected some of the medicare extenders and writing and these programs congress needs to address and determine whether we should extend them or not. many of these programs have been extended several times in the past without any policy modifications. and by the way, for members, that's a vote that's occurring and there are two votes, my belief is, so we're going to begin asking questions and mr. miller's agreed to sit tight while we go vote and come back so i'm going to begin the questioning. if you feel you need to get over there, please do and please come back after the votes. yeah, we'll come back. so mr. miller, can you talk through each of the extenders and what medpac has concluded about each one of them? dr. miller: in five minutes that's a little bit difficult but i'll -- what i do want to say really quickly is all of this has analysis and detailed work behind it but i'll just try and hit you with the top line. special needs plans. we've made recommendations for each of the categories. we've recommended continuing the institutional special needs plans. wi

miller, your testimony reflected some of the medicare extenders and writing, and these programs need addressing and determined if we should extend them or not. they've been extended several times in the past without any policy modification. for members, that's a vote that's occurring, my belief is. so we'll begin asking questions and mr. miller has agreed to that. if you need to skedaddle over there, please come back after the vote. so, mr. miller, can you talk through each extender and what med pack has concluded about each one of them. >> in five minutes, that's a little bit difficult, but -- what i do want to say quickly, all of this has analysis and detailed work behind it, but i'll just try and hit you with the top line. special needs plans, we've made recommendations for each of the categories. we've recommended continuing the institutional special needs plan. with respect to part d special needs plans, we've recommended that you continue those, but you have a requirement for integrated care between medicare and medicaid. for the chronic care special needs plans, we have said th

>> i am hopeful over the next few months we continue to examine and explore and address the medicare extender policies, the therapy exceptions process, ambulance and payments, it is critical we ensure there is not a disruption, those critical services provided to seniors around the country that rely on strengthening the overall program in the future so thank you, yield back. >> doctor miller, thank you for your testimony today and the good work you and your staff doing the report we submit, i will follow up with my friend and colleague from minnesota, appreciate his interest in and appreciate the report as far as the benchmark caps and what you are recommending. from my colleagues edification, hr 40 to 75 along with mike kelly, mike doyle, get that this issue so we are glad to see you focusing additional tension on the benchmark issue and interested in following up what we have. to benefit us from the legislature moving forward. also along those lines, you are aware we introduced a reform bill that would begin the conversation and start getting feedback, appreciative of the effort medpac and

that over the next few months we'll be able to also continue to exam -- examine and explore the medicare extender policies in place such as the therapy cap, exceptions pros serks ambulance add-on payments. think it is critical we ensure it is not a disruption. those critical services provided to seniors around the country and rely on as we strengthen the overall program in the future. i yield back. chairman tiberi: thank you. mr. kind, you are recognized for five minutes. mr. kind: thank you, mr. chairman. dr. miller, thank you for your testimony here today. and good work you and your staff do anti-report you submit to us every year. just to follow up with my friend and colleague from minnesota. i appreciate his interest in it and appreciate the medpac's report as far as the benchmark caps and what you are recommending. from my colleagues' edification, introduceds legislation last year, h.r. 4275, along with our colleagues, mike kelly, mike doyle, and brett guthrie that gets at this very issue as well. we're glad to medpac focusing additional attention on the benchmark cap issue. we would be inte

miller -- that over the next few months, we'll explore the medicare extender policies that are in place, such as the therapy cap, exceptions process, the ambulance, add on payments, i think it's critical we ensure there's not a disruption, that those critical services that are provided to seniors around the country as we strengthen the overall program in the future. i yield back. >> mr. kind, you are recognized for five minutes. >> thank you, mr. chairman. dr. miller, thank you for your testimony here today and the good work that you and your staff do and the support that you submit to us every year. i appreciate your colleague's interest in it, and also appreciate the med pack's report as far as the benchmark caps and what you're recommending. for my colleague's edification, i introduced legislation last year, with mike kelly, mike doyle and brett guthrie, that gets at this issue as well. we're glad to see med pack focusing additional attention and we'd be interested in following up with you as far as any type of cost impact that is going to have with the data that you're looking at th

medicare trust fund extended for nine years. >> eric: i have pages and pages of this.m mid-level benchmark plan, healthcare.gov states we are up 25% in premiums in 2017. blue cross blue shield just warned the affordable care marketplaces are in their early stages of a death spiral. >> let's go to what you said. the two things he said. both congressional budget office and standard & poor's evaluated the exchanges and said they are stable. they are going to go on. there are some things, three or four things republicans could do that would stabilize the marketplace. enforce the mandate, give the cost-sharing subsidies. >> kat: the mandate is not incentive. >> eric: peter, in virginia. 50% rate increase for maryland. northern virginia. 29% increase for the district of columbia next year alone. >> i told a friend i was going to come on and talk about health care. it's like playing pickup basketball with lebron, ezekiel. if you lose bill clinton, the war is lost. bill clinton said last fall that obamacare is crazy. what -- >> he did not say that. >> a crazy system. the examp

sensed that he was not going to be able to go the whole nine yards, wasn't going to be able to extend medicareall, to turn the american health care system into a national health, that was not going to go in the american grain. so he fought for what he could, and got out quite a lot, but he was -- he was more measured, and centrist in certain i was on policy than some people realized. the left wing of the democratic party realized it. to some extent they're chafing it at his legacy now. he would argue and does argue eastern eastern i think history will support him in this that he got as much as possible at a time when the republicans were swearing up and down that their main objective was to make him a one term president. he didn't get any republican support for the health care law, and now that failure to make it bipartisan and he tried, initially, he tried, coming back and continuing to unsettle american politics, kind of like a thread that has gone through this whole generation about health care. and i thought barack obama, don't forget, when he became editor of the harvard law review, he di

well, while medicare may be good for you for trips to the doctor or not only that, but for hospitalization, it won't cover long-term care needs. >> what i mean by, we refer to it as extended care needs. if you need nursing home facilities, assisted living, or home care. that won't be covered. by your medicare plan. >> the other part of that is social security. it's something that we have seen taken out of our paychecks for decades. >> forever, it feels like. >> and then we wonder, can i count on this? will it really be there? >> right. so while they made some adjustments to social security in the '80s which was trying to help the longevity of it, the long-term viability, what we have to focus on is while social security may be a piece of your retirement income, it won't cover all of your expenses. so when planning, you have to have other income sources available to you to supplement your needs. >> and i've heard my own parents say, i'll just keep working. is that a viable plan for post 65 to 85 years old? >> so when we are planning for retirement, the important thing to remember is a lot of early retirement. 50% of people are forced to retire early because of disability o

medicare cuts of more than $500 million. these funds were intended to expand coverage by extending coverage. spitals will retain revenue necessary to retain our staff and clinicians despite the medicare reduction. they will continue to experience reductions in reimbursement, and patients will lose coverage, and accessible health care services will not be available for our communities. since 50% of our operating at fences -- operating expenses are for salaries and benefits, it's obvious we cannot afford to find adequate savings at this tragic financial impact. this is an economic impact for the region. we are vested in a healthy community and the ability of our patients to maintain access to health care services when they need it is critical in economic county. ackinaw county. it is not a wealthy area, as noted earlier. one illness can bankrupt the family. one family's bankruptcy can mean the end of a small business. that puts pressure on the overall economy. the ahca threatens coverage and threatens our health care system. it is that simple. thank you. >> thank you very much for that testimon

this should be seen as part of a broader effort that could extend to other entitlements, including social security and medicare mika, for small market conservatives, the correct answer is not doing this sort of frankenstein bill where you do a little bit here and a little bit there. you don't bend the cost curve. we've got a big problem. the big problem is we spend more money per patient than any country in the world on health care. and we have a system that has all of these perverted incentives. it's not geared toward wellness. it's geared toward procedures. it's geared toward testing. until we turn the tables over in the temple and have a real market-driven approach, where doctors are rewarded for their results and not for cutting into people and hospitals are rewarded for getting people out of their hospitals healthy and not just running a lot of mris, we're going to continue to have a failed system. and this bill does nothing in the long run to really curb the cost of this health care system in any fundamental way. there's going to have to be radical reform of the health care system and these republicans w

extending coverage. hospitals will retain revenue necessary. despite the medicare reductions. accessible health care services will not be available for our communities. since 50% of our operating expenses are for salaries and benefits, with cannot afford to find adequate savings to offset this tragic and financial impact. we are vested in a healthy community. and the ability of our patients to have access to health care services when they need it and it is critical. it is not a wealthy area. bankrupt a can family, one bankruptcy could mean the end of a small business, job loss, more downward pressure on the overall economy. the ahca threatens coverage and our health care system. it is that simple. thank you. sen. stabenow: thank you very much for that testimony. and we will not turn to questions and we will call on colleagues in order of them coming into the room. myself, then senator murray, and then other colleagues. i want to welcome people who have been live streaming, we are glad to have you with us. we have had several thousand so far tuning in and we would welcome you t

extending coverage and monitoring. ,edicare is behind the curve however. limiting access for millions of seniors. imagine the impact the technology could have if medicare would allow its most vulnerable beneficiaries to use something like remote patient monitoring. i am confident the success in mississippi could be replicated for patients across the united states. -- uponact meant of the enactment of the chronic care health act. we are still looking for cosponsors and we will not stop until access to quality care is realized for medicare patients. the chronic care act is a step in the right direction. we have more work to do in this space and i look forward to continuing to work with each of you. thank you. eggs i think i am a cosponsor but if not, put me down. ok? senator schatz, thank you. we will turn to senator warner who has played a significant role in this. >> thank you. thank you for holding this important hearing on bipartisan legislation. i am happy to cosponsored the chronic care act, a bill that can help improve outcomes and disease management for people on medicare who have chronic illnesses. right now progress in modern technology has not