mr. holtz-eakin, and then we will work our way from our right to left and you're left to right. hank you. mr. holtz-eakin? >> thank you, chairman ryan, a ranking member schwartz, members of the committee. it's always a good day to be back at the budget committee. and i had my written testimony. i want to be labor the points. the are four simple points that ought to be made. the first is that to my eye, the ipab was a error that should be reversed. the existing reimbursement problems for providers of medicare system, and as a result, the in pete access by medicare beneficiaries. it is likely to stifle innovation. it is incentives are such that it will target the most innovative and newest therapies and that the ipab as part of the status quo for medicare is dangerous to the beneficiaries, the interest to the federal budget, and dangerous ultimately to the economy because it is part and parcel of a broken a social safety net system whose spending threatens to drive debt to levels which would harm the u.s. ability to compete and grow. .. >> it's something we'll see again, and we kno

mr. zandi was one of many advisors to my campaign. the key advisor was douglas holtz-eakin, former head of the c.b.o., who had no brief whatsoever for that proposal. please go ahead. mr. durbin: the second point i'd like to ask the senator from arizona, i think one of the real bedrock beliefs among republicans is that if you cut taxes particularly on the healthiest -- wealthiest people in america the economy will pros puss. didn't the debt of the united states double under the president and he left a shambles behind him? 2.3 million jobs lost in the first three months of president obama administration because of this failed economic policy which you continue to espouse, that if we cut taxes on the rich, america is going to get wealthier. haven't we tried it? where are the jobs? mr. mccain: could i take a little trip down memory lane with my friend from illinois who i had great privilege many years ago -- i don't know if i should mention the 1982 election, he and i came to the house of representatives together. you might recall that one of his own, then a democrat congressma

mr. zandi was one of many advisors to my campaign. the key advisor was douglas holtz-eakin, former head of the c.b.o., who had no brief whatsoever for that proposal. please go ahead. mr. durbin: the second point i'd like to ask the senator from arizona, i think one of the real bedrock beliefs among republicans is that if you cut taxes particularly on the healthiest -- wealthiest people in america the economy will pros puss. didn't the debt of the united states double under the president and he left a shambles behind him? 2.3 million jobs lost in the first three months of president obama administration because of this failed economic policy which you continue to espouse, that if we cut taxes on the rich, america is going to get wealthier. haven't we tried it? where are the jobs? mr. mccain: could i take a little trip down memory lane with my friend from illinois who i had great privilege many years ago -- i don't know if i should mention the 1982 election, he and i came to the house of representatives together. you might recall that one of his own, then a democrat congressma

holtz-eakin? >> i guess i would echo the firm level cost that mr. vaughn mentioned, i think i would echo the firm uncertainty in the growth levels mr. dennis highlighted, but if you step back and look at the affordable care act, it says, let us spend $10 trillion over the next five years and finance that by raising $5 billion in taxes, most of it paid by insurance and let's make insurance rates more expensive, and let's cut roughly $5 billion out of medicare, something they said is economically unrealistic and will make hospitals unable to serve those beneficiaries. so i take that with a grain of salt. what you have in the end, then, is higher taxes, much larger deficits in a recovery that's utterly unsatisfying, and i cannot conclude that's going to be beneficial for the hiring practices of small businesses. >> thank you, dr. eakin. i now yield to mr. altmire for questions. >> thank you, and i'm glad our panel brought up the subject of taxes and the burden it places on small businesses. i want to ask mr. dennis and mr. vaughn, as you are aware, cur

holtz-eakin, of and others. thank you for its contributions to this debate and would they do offer joining in this conversation. i yield to the ranking member, mr. van holland, for any opening remarks he may have. >> i want to join chairman and rhyming immelt -- brian in joining in on -- chairman ryan in welcoming you to the committee. the rules and guidelines that you recently released to govern the changes which will open the door to millions of more americans being able to have affordable health care in the united states of america. the other there receive less attention was your announced initiative to improve the coordination of care for individuals were both on medicaid and medicare called the dual eligibles. as you have pointed out, using some of the innovative approaches in the affordable health care act, we can improve the quality of care and save money through some of the changes were proposing there. those are important parts of the affordable care at that together will strengthen health care protections for the american people including provisions that have already taken into effect including making sure that insurance companies can

mr. altmire, do you have any? i have a couple questions i would like to ask starting with dr. holtz-eakin. you have said in the health care law that it's a threat to the health of small businesses and the mandates and penalties are a financial burden. do you think small firms disproportionately affected by the various mandates, penalties, and taxes in the law, will this affect their ability to increase employee wages, purchase equipment and hire new workers? >> absolutely. if you think of the smallest of the small businesses that the proponents of the law like to say, look, they get the credit and they're exempt from the mandate, so it's all going to be good. the reality is they will face the upward premium pressures that inevitably come from the benefit mandates that already have begun to be implemented and have drawn premiums up. the taxes that will be imposed on insurers and others, i've walked through the arithmetic of this, this is $5,000 for a family in five years. every time those premiums go up, they come up at expensive wages. there's no way around that. so even those ostensibly s