tv House Oversight Committee Hearing on the Affordable Care Act CSPAN July 10, 2019 10:40am-12:00pm EDT
on the effort to address this horrific epidemic. i thank them and the many others across our community who are working together to make a difference. thank you, mr. speaker. i yield back. the speaker pro tempore: the gentleman yields back the balance of his time. pursuant to clause 12-a of rule 1, the chair declares the house noon today.til >> when the house returns at noon for legislative work, they'll begin debate on the 2020 defense programs and policy bill. it authorizes $733 billion in pentagon programs for the next fiscal year. when the house is back in session, live coverage is right here on c-span. now we'll take you over to the house oversight committee for a hearing under way on the future of the affordable care act. two witnesses at the hearing are the executive director of the health care advocacy group called families u.s.a., and a
yale law school professor of health law. got under way about 40 minutes ago. live here on c-span. >> move to mr. gibbs. let me say to our patient witnesses, again i want to thank you for being here. i think your testimony is so important. mr. cummings: so often here on capitol hill we look at and we read about problems. but there is nothing like having people who go through it second of their lives. mr. gibbs. thank you. mr. gibbs: thank you, mr. chairman. thank you, members of the committee, for giving me the opportunity to speak today. today i have heard this law referred to as commonly is by the names either the affordable care act or obamacare. for me it's important to call this law by its full name, the patient protection and
affordable care act because the patient protections of the a.c.a. have been a gift from god for people like me and families like mine. my health care story begins in 1974 when my twin brother and i were born with serious medical conditions. he had a condition called hersch brung disease which caused him to need 17 surgeries by the time he was 5. i had nine surgeries on my kidneys for a condition called bilateral reflux which meant that urine was going back up into my kidneys instead of down where it belongs. now, the costs of that were severe. my parents never got out from the financial burden of those health care costs for my brother and me. within the past 10 years they passed away with virtually nothing material to their names but with a great legacy of caring for their family as much as anyone ever could. it was in november of 2008 that my doctor told me in a routine
visit, i thought a routine visit, i was in end stage kidney failure and needed a transplant as soon as possible. i was working, i was going to school, i was doing my best to be a contributing member of society, but i had no insurance coverage. now, coverage may not be care, but when you need a $79,000 surgery, there is no care without coverage. i am a member of the church of jesus christ of latter-day saints, a church that's very well-known for its again rossity in taking care of its members. my church couldn't pay for a $79,000 surgery. i needed two sidgeries, my kidneys were in bad enough shape they were considered an infection risk for the new kidney. they had to be removed first 10 years ago this week. i have heard opponents of the a.c.a. say people don't die in america for lack of health care because they can go to the emergency room, you can't get a kidney transplant at the e.r.
now, i was fortunate. i fit the fairly narrow qualifications for medicaid before a.c.a. expansion, and i also fit qualifications for medicare coverage. those allowed me to have that life saving surgery 10 years ago this suggest. but the expenses didn't end there. every day i have to take immunosuppressant medication to keep my body from rejecting the kidney. and i also have to take other medications which the side effects caused by that medication, and i also, because my doctors later discovered a chronic distended bladder may have caused my kidneys to decline to begin with, i have to use these catheters five or six times every day just to be able to empty my bladder. without the a.c.a. it would be an expensive prospect for me to urinate. all these expenses together add
up to almost schts per month as my -- as much per month as my mortgage payments. i hear talk of protecting pre-existing conditions and other plans everybody wants to protect pre-existing conditions. the previous plans that have been put forth include things like pushing people like me into expensive and unreliable high risk pools. those are not protects for pre-existing conditions. potential lockouts for having continuous coverage are not protections for a pre-existing condition. i hear talk we want to -- relentless attacks on the administration anti-a.c.a. people like me feel relentlessly attacked by this administration and by the members of committees like this one who keep attacking the a.c.a. old , peter, five months this week, was born with a kidney condition similar to
mine. he, like chairman cummings talked about, is one of those babies who could be shut out for life. had he a kidney surgery two weeks ago -- he had a kidney surgery two weeks ago. without the a.c.a. he wouldn't have the protections to ensure that he can receive the follow-up care he may need his entire life just for being born with a bad kidney. he is one of two sons i have who have the chance to be born because of the wisdom of the patient protection and affordable care act which gave me this coverage. in conclusion, i want to say that we are guaranteed in the eclaration of independence the unalienable rights of life, liberty, and pursuit of happiness. life comes first because without life all other rights are meaningless. being subject to insurance companies being able to deny us coverage and make it prohibitively expensive because
we are sick is not liberty. and without those protections, without the access to health care, there can be no pursuit of happiness. my sons deserve the right, they deserve the right to be born, they deserve the right to stay alive. and they deserve to have a father who has access to the care he needs to stay alive for them. thank you very much. chairman cummings: thank you very much. congratulations. is >> thank you, chairman cummings, and the committee for letting me talk today. over the past nine years my family has faced a lot of challenges, but i hope you hear my story and recognize i'm not some unique one in a million story. the challenges my family has faced are like so many families who work hard, play by the les, face as they go through
life. ms. dye: as parents we want to make sure we can do the most essential thing for our kids and keep them safe and healthy. we also want to know as they go through their own journeys they will also overcome challenges and continue to pursue their dreams. in august of 2010 my husband lost his job. we couldn't afford cobra. between august and november of that year, he and i went uninsured. our 1-year-old daughter got coverage through chip. in 2016 my husband lost a second manufacturing job and thanks to the a.c.a. we did not have to worry about going uninsured again. my employer's health plan would cost $1,175 a month, that's just for the two of us. we pay $60 a month for our son, max, who is on chip, and our daughter is covered under the
p.h.-95 medicaid loophole for her disability. after my husband lost his job in 2016, we wanted to move closer to family and your state, mr. jordan, of ohio, in florida, and arizona, guess what, mr. jordan? your state told me my daughter wouldn't get the services she needed. so therefore we have to stay in pennsylvania. we also had to it have our life around our daughter. my husband went back to college to swit careers in the health care field which doesn't require us to move them from state to state to find a job. thanchings to the a.c.a. in 2018, i was able to get a mammogram. it showed i had three lumps in my left breast. bay yopcies were done and thankfully they were benign, but what if i was uninsured and the results turned out differently? this could have been financially disastrous for my family. before the follow-up this year in may, i looked at my husband
and i was joking and being serious, actually just have the doctor remove both my breasts because i might not have -- if i get cancer, i might actually be uninsured. this is my reality. this is the reality of millions of families in america. the fact is i don't trust the republican party to say that you care about me and my family and the rest of the families in america to cover pre-existing conditions, to cover those with disabilities. also had decided to get a pelvic exam two years in a row. when the doctor asked me why i scheduled it this way, because you know you can go three to five years, i told her the truth. i'm worried i'm not going to have coverage next year. she looked at me and said she was glad i made that choice to come in. i'm actually an l.p.n. who works in a pediatric home care, so a lot of the kids i take care of, they are on medicaid.
not only is my job but the life of my patients are at risk if you guys make cuts to these vital programs. our daughter, who is right here in the white with little pink headphones. chairman cummings: where is she? ok. all right. seems to be listening to your testimony. ms. dye: since she's been 19 months old, she has been in therapies. that's for o.t. for speech and also learned sign language so she could communicate with us. speech we use in everyday life. watching tv, listening to music, reading books, talking to our friends, socializing, and work. at the age of 3 she was seen by three doctors. two diagnosed her with developmental language disorder, d.l.d. a condition where children have problems understanding or using spoken language. she will have this in adulthood.
the other doctor diagnosed her on the autism spectrum, but all doctors agree that she needs intense speech therapy. in school she received speech three times a week and o.t. one time a week. she also gets speech and o.t. once a week outpatient. she has a mobile therapist that comes to our house two hours per week. a mobile therapist helps chessy to appropriately express her thoughts, feelings, and work on coping skills, practicing social skills. chessy gets six therapies a week not including mobile therapists. if chessy loses her medicaid coverage and we have to pay it would cost us $1,920 a month to keep her at the current level of therapy. because my husband is in school and one income, we could never afford that. the hard work of her therapist in chessy's life has improved her life skills tremendously. today she talks a lot and she talks to her friends on her own. she has ack democrat inc.
process. also year she was a c student. at the age of 10 she got all a's and one b. in math and reading she is two years behind and she is in support room. just to make it deleer, break it down, imagine a tripod. chessy's on top that have tripod. the three legs represent one her parents, two is her therapist, and a third one is her aides. if you guys cut medicaid, you are going to knock down that tripod and they are going to take away and knock down all the progress she has made. the only chance of her being a productive member of our society and being able to get a job and hopefully just make minimum wage is these crucial programs that you guys have in place right now. i just want you to realize what you guys are doing and not just think of my family and my daughter, but the millions of families around the united states you guys are going to affect. thank you. chairman cummings: thank you very much. ms. burton.
ms. burton: chairman cummings, ranking member jordan, distinguished members of the committee, good morning. my name is steffi burden and i live in kansas city, missouri. in august of 2008 i left my job as a probation officer to attend law school. i could not afford health coverage so ininsured throughout school. upon graduating in december of 2010, like many of my classmates, i was unable to find work and was forced to hang my own shingle immediately after passing the bar. starting my own legal practice meant i still had no health care. as a single mother of four young children, that was devastating. my diabetes went untreated for five years. when my health got so bad i could not tough it out, i was forced to seek medical care in the emergency room only. as a mother, i felt i had let my children down. i had done everything that seemed right by furthering my
education, yet i still couldn't even afford a routine doctors visit. something was terribly wrong with this picture. the affordable care act changed all of that. on january 1 of 2014, i enrolled in a health insurance plan i purchased through the marketplace for less than $100 a month, thanks to a subsdy. i no longer had to decide between paying my mortgage and going to the doctor. i have been able to manage my diabetes and get the medications i need to stay healthy for my kids and clients. it's a huge load off of my mind. i have been covered through the marketplace since the beginning of the first open enrollment period, and found the coverage affordable and easy to use. when taken a flight, the attendant always says if you are traveling with small children in the event of an emergency first place the oxygen mask over yourself and then over the small child. not every parent, seems countser intuitive, because we consistently put our children
first. however, if we do not take care of ourselves and health first, we would not be around to care for our children. the affordable care act is like that oxygen mask. it allows me to have health care to keep myself healthy so i can continue to work and provide for my children. until march 7 of this year, i was self-employed without the option of employer provided health insurance. upon accepting this new position, eight years after having to hang my own shingle, i'm now offered health insurance through my employer. though that benefit action is great, i can still say the policy that i have through the marketplace is better. i have had the same team of doctors since i enrolled in 2014. although the need isn't as urgent for me today as it was eight year ago, i can honestly say the affordable care act saved my life. the last five years of coverage have kept me the healthiest i have been in the 11 years since
i started law school. one of the requirements of my current employment was to undergo a health physical. i have no doubt that i would have not been healthy enough in 2014 to accept the position i have now. maintaining preventive health care through routine visits thanks to my a.c.a. coverage has allowed me to continue to treat my diabetes without the fear of being turned away. access to health care should be a fundamental human right to all people. there should be no choices when it comes to health care or housing. during this administration, i wonder what would happen if i lost my coverage and what would it mean for my children? in the event i had to return to private prackies, would i be able to afford my insurance without my subsidy? would i be lucky enough to last without the treatment that i receive? this is not a partisan issue. this is a what happens to
families without health coverage issue. it's a why are we turning back the hands of time issue? it's a why should a single mother of four children be forced to choose between housing and health care issue. we create another undue burden on society if we can't keep parents healthy enough to raise their children issue. so i ask you and urge you-all, both sides, don't take away the coverage from 20 million people. don't return to the crisis, the health crisis that we endured, before the a.c.a. thank you. chairman cummings: thank you very much. mr. morley. mr. morley: thank you, chairman cultings, ranking member jordan, and members of the committee. i am honored to speak with you today. my name is peter morley. in 1997 i had an injury during a lapse of insurance coverage. all treatment and medication costs were paid out of my own
pocket. when i later needed surgery, my insurance company considered my injury to be a pre-existing condition and all my claims were denied. it was a financial burden totaling in tens of thousands of dollars. in 2007, i was permanently disabled from an accident. i was spared the costly medical bills of four spinal surgeries because i had continuous health coverage. in 2011 i survived kidney cancer and fought my way into remission after losing part of my right kidney. in 2013, i was diagnosed with lupus, which causes me severe fatigue and most days it's a struggle to get out of bed. i now manage over 10 pre-existing conditions, take 38 different medications, and
as someone who spends the majority of my waking hours in doctors' offices, the a.c.a. has meant focusing on healing, not bankruptcy. i used to be very private about my health, but once president trump was elected and set to repeal the a.c.a., i could no longer be silent. in december, 2016, i decided to foster awareness for lupus and advocate for health care. my congresswoman, carolyn maloney, has taken up my cause and those of people like me. the trump administration's reckless support for the texas vs. azar lawsuit to tear down the entire a.c.a. terminating it as the president has said, is a grave form of subversion. in the last two years, i have
traveled to d.c. 20 times to advocate for thousands of people who shared their health care stories to me. i have met with democratic and republican members of congress alike. my message is simple. if you think people don't get hurt when the administration doesn't defend the a.c.a., think again. we do, i do, millions do. if you think pre-existing conditions aren't important, remember, someone you love could have an accident, be diagnosed with cancer, or lupus at any time and that will change how you think about this. i know firsthand your health care can change in an instant. and if you think the a.c.a.
isn't perfect, your job as our representatives isn't to tear it down. it's to make it better. i appreciate the committee holding this hearing today. if the trump administration can choose not to defend the a.c.a., citizens like me understand that future administrations can do that with any law. i put my health at great risk to travel here and share these stories. i never know if this is the last time i am healthy enough to come to d.c. i would be remiss if i did not mention my friend and advocate of medically fragile children, natalie weaver, whose own daughter, sofia weaver, passed away in may. sofia suffered from ret syndrome and many other pre-existing conditions and endured 30 surgeries in her
short 10 years of life. natalie spent precious time away from her daughter for the betterment of health care access for all children. she will never get that time back. these are the sacrifices that we make as advocates. that is why i am here today to ask you to protect the affordable care act and to hold the trump administration accountable for not defending health insurance for all americans. thank you for allowing me the opportunity to testify, and i'm happy to answer your questions. mr. cummings: thank you very much. pain, passion, purpose. i will now yield to the distinguished lady from new york, mrs. maloney. mrs. maloney: thank you, mr. chairman, for calling this very meaningful hearing. i am so proud that one of my
constituents, peter morley, was invited to testify. he is the most effective patient advocate i have ever met and he's been a fierce defender of the affordable care act. peter, thousands of patients and their families have reached out to you to share their stories and asked you to bring those stories to congress. can you share what some of these stories are like, and is there anyone that stands out to you? mr. morley: absolutely. there are many that actually stand out to me. the most -- the hardest stories for me to listen to are the people who could have been saved had the a.c.a. been also the patients who would have, like some of
these people, these patients have testified here today, they would have been diagnosed sooner. their conditions would have been more under control, and in some cases healed. i hear from patients who -- excuse me -- rather -- -- have who are medically fragile children, and they get their health insurance because of medicaid expansion. i hear from people in states such as texas, florida, north carolina, and tennessee who don't have that same luxury because their states have not expanded medicaid and they are denied that type of coverage had they lived in a separate state and they can't afford to move to another state to receive that type of coverage. those are the stories that keep
me up at night and, of course, since i have lupus, anyone who reaches out to me who suffers from lupus and tells me, thank you, peter, for going to d.c. i don't know where you get the energy to do it. and truthfully, i don't know either. i'm grateful to be here. it's that energy as these patients have testified, it takes a lot of guts and a lot of courage to come here and to share something so vulnerable and so personal. mrs. maloney: i know. i know you suffer from chronic diseases. i know personally from our exchanges that it's very painful for you physically to come here. why do you make these trips? mr. morley: because, honestly, congresswoman, i never expect to sit, whether it's a democratic or republican
legislator, i never expect to change anyone's mind, but what i -- what i have learned from coming down here is it brings me hope, hope that there is a chance for change, hope that one person will listen because it really only takes one person. and the hope that the people who follow me on social media, they receive and they say to me, you know, peter, thank you, thank you. i can feel that, you know, something positive may come out of all this sabotage that we have witnessed. mrs. maloney: peter, the trump administration's recent attack on the affordable care act in the form of the texas vs. united states court case really threatens health care for millions of americans. what would it mean for your friends, the patients and
families that you've spoken to, if protections for people with pre-existing conditions are eliminated? mr. morley: in some cases, it might limit their access to medications and to lifesaving infusions and to cancer treatments and it could -- i mean, it very well would mean death. mrs. maloney: what about if medicaid was eliminated, what would that mean? mr. morley: medicaid expansion. a lot of theme would lose coverage and access. mrs. maloney: what would it mean to the parents of medically fragile children who have reached out to you if the entire affordable care act, what would happen to them if the affordable care act was eliminated? mr. morley: i honestly don't know but i do know they experience just even if that didn't happen, they experience an incredible deal of stress
and this -- this even having to focus on that has caused them undo stress and it's stress, as we all know, if we have a chronic illness so it's stress upon stress. mrs. maloney: my time has expired. i am proud to be in this fight with you. i'm proud of you. mr. morley: i'm' proud of you. mr. cummings: i now yield to mr. hice. mr. hice: thank you, mr. chairman. i think there are two basic reasons why we're having this hearing today. number one is just come up, it's an opportunity to trash the president, to impugn the president for not defending obamacare. i get where our witnesses are coming from from that perspective. but that is the purpose, one of the purposes of this hearing. but the reality is, obamacare is failing. and the president is not defending a failing policy.
bad policy. and he's right not to defend that. i mean, just look at the numbers. it is very clear, obamacare does not work, has not worked, is not going to work. we were told there would be some 25 million people enrolled in obamacare by now. just hasn't happened. the truth what has happened, insurance premiums have skyrocketed. skyrocketed under obamacare. deductibles have soared. coverage networks and access to providers have shrunk. in some cases been eliminated. insurance companies have fled the a.c.a. marketplaces. rural hospitals have suffered enormously. i have a number of them in my district. and they have suffered tremendously because of obamacare. many rural hospitals have
actually closed their doors. and, yes, there are people who have benefited. i am not going to deny that. and, of course, our panel is full of them today. and i appreciate the testimony from our witnesses, our panelists today. but i can also tell you this. for every person who has benefited from obamacare, we can find tons of folks who have been hurt from it. and, you know, i look at the panel today, mr. chairman, six out of the seven are democratic witnesses. where are the -- where are the ones -- in fact, i would like, mr. chairman, have entered into a record a letter from a constituent back home, ralph from greensboro, georgia, who talks about how he's suffered. mr. cummings: without objection, so ordered. mr. hice: thank you. and we're told -- i'll just reverse it somewhat of what's
been said already today. if you think people don't get hurt by a.c.a., you need to think again. ralph, for example, before obamacare, he paid $700 a month for insurance with $3,500 deductible. both of those, in fact, he now pays -- has nearly $14,000 deductible and his monthly costs are about $1,200 a month. couple years ago, his two children -- he has four children -- two of them were in an accident. he's still paying for $30,000-plus that had to come out of pocket. that's before taxes, before groceries, before mortgage, before college. and so this thing absolutely goes both ways. the second reason we're here today is really to lay the platform for medicare for all. and that is the attempt that the democrats are putting forth in spite of the failures of
obamacare, the democratic party is going to double down and push for medicare for all at a cost of some $32 trillion. it would totally eliminate employer-sponsored medical coverage, medicaid, medicare, all of it, gone. mr. balat, let me just ask you. what would -- what can we expect from a government single payer health system? mr. balat: you can certainly expect rationing of services. that's what we've seen in many other countries that have gone this way. many politicians have said those are models we want to look for, we want to look towards to immolate. but my experience in being with those countries and working with patients, i'll give you a specific example, if i may. we were -- my wife and i were on medical missions in costa rica that has a single payer and the wife of the pastor we were with was diagnosed with cervical cancer.
she was approved for surgery, but she had to have an ultrasound first. she couldn't have an ultrasound for 12 months. she asked, well, when will i be able to have the surgery? they said, probably another 12 months after that. she had access. she may never get to the point where she has that surgery, but the rationing is an inevitability when you have a limitted amount of resources. and those resources continue to decrease the more burden we place on the medical professionals that are actually delivering the care. mr. cummings: the gentleman's time has expired. dr. gluck, can you respond to that, mr. hice said he wants to see both sides. i saw you shaking your head. go ahead. ms. gluck: what occurred to me -- mr. cummings: your mic. ms. gluck: the case we're discussing in this hearing, one of the things i would emphasize is that the case in texas is not a policy referendum.
it's not a case about the benefits or the affordable care act. it's a case about a settled legal principle. the administration doesn't get to decide whether to defend the law based on it likes the policy in the law or not. that's your job, congress' job is to pass the policies. the administration's decision not to defend is only defensible in the very limited circumstance in which there is a real unsettled legal question. as i said in my testimony, what is striking about this case is that there is a dramatic legal consensus across both sides of the aisle that the principle at issue here, the legal principle, semblet, is settled and -- searchibility is settled, and there is no place to defend the law. i would also note, we heard a lot of statistics about the benefits of the affordable care act including dropping insurance rate by 46%. including getting women covered at record rates. i would also point out the trump administration itself is actually relying on the statute for a lot of its initiatives.
i heard this morning that the trump administration announced an executive order about kidney disease that depends on the center for medicaid. well, that would be gone if the affordable care act is eliminated. the h.i.v. initiative requires -- >> point of order, mr. chairman. whose time is this? mr. cummings: i'm trying to help you, man. you asked the question, and i -- i asked her to finish answering the question. she was shaking her head. i allowed you to hear that. i know you want a fair hearing, you want both sides of that. my time. mr. hice: six out of seven is not a fair hearing. mr. cummings: c'mon, man. mr. hice: you -- we need a fair hearing. mr. cummings: are you finished? ms. gluck: the opioid crisis. i think that is important to recognize that when we're talking about the benefits and what the statute has to offer.
mr. cummings: thank you very much. thank you for giving us both sides. ms. norton. ms. norton: thank you very much, mr. chairman. it took a lot of chutzpah to hear my friend on the other side go down the list of the costs going up of health care, deductions going up when that is a direct result of actions that the republican congress took when they controlled this house. they're complaining about actions that they took to diminish the affordable health care act. well, one of those actions was to take away the mandate -- the district i represent, the nation's capital, the district of columbia, has a rate of about 96% covered. which means virtually everybody is covered.
that's going from one side to the other who may not be covered. and that's because, as my republican friends took actions , just detailed by my colleague on the other side that undermined the health care act, in my district, they simply made up for them themselves, for example, as i indicated, by reinstated a d.c. mandate. and so almost everybody has health care. ms. burton, i was interested in your testimony because it looked to me as though you had done all that anybody could be expected to do. you finished law school. you found -- you couldn't find employment. then you did what is really difficult for someone just out of law school. ou opened your own practice. your children were covered, you said, by medicaid.
but you could not get coverage in the individual market. i understand, because of a pre-existing condition, is that true? ms. burton: that's correct. ms. norton: any idea what had the purchase of health insurance would have been for you before the a.c.a.? ms. burton: it was $895 a month. hich is more than my mortgage. ms. norton: i was going to ask you, compared to what other expenses, you said your mortgage. so you chose to give up coverage for yourself in order o pay the rent and provide for your children. did that take any toll on your health? ms. burton: absolutely. as a single mother of four kids, do you what you have to do to maintain. do you what you have to do for their interests. even if it means you sacrifice your own. i worked in private practice
8,200 hours a week. i took time away from my kids to make sure they had everything that they needed. i don't have any regrets about that. i'd give anything to make sure that they're ok. i'm all they have. and so if i am gone, there's not somebody else willing to step up and take over that burden. ms. norton: well, then came the affordable health care act. ms. burton: yes, ma'am. ms. norton: with the marketplace. what kind of coverage were you able to get and how much did that plan cost? ms. burton: my plan with my subsidy cost $62 a month and it was -- ms. norton: compared to -- remind us. ms. burton: the $895 that i would have had to pay for an h.m.o. coverage. the plan i got through the marketplace was a p.p.o.
coverage. i was able to choose a doctor. i got a great doctor and a great team of doctors. because i have so many conditions -- i have narcolepsy, i have asthma, i have diabetes, i have sleep apnea, i have cataflexy. because of that i have a team of doctors. ms. norton: now, that -- but now you work for the district attorney's office. now, that's a government agency. ms. burton: correct. ms. norton: the government agency we work for, the united states government provides health care for everybody who's sitting on this podium. you would have what we would have. so did you take your health care that was provided by the district attorney's office? ms. burton: my health care that i have through the d.a.'s office is supplemental. it's not -- it's not federal so it doesn't cover the benefits you guys might have. my policy, through the marketplace, is still better
than the insurance my employer offers. i did take it for my children. i -- ms. norton: so you had health insurance offered by your employer, you compared that to the a.c.a., and you decided to stick with the a.c.a. coverage? ms. burton: that's correct. mr. cummings: did you finish answering the question? ms. burton: yes, sir. mr. cummings: mr. comer. mr. comer: thank you, mr. chairman. i'd like to welcome -- i'm over here. i'd like to welcome all the witnesses here today. just have three quick general questions i'd like to ask the entire panel just with a show of hands for the sake of time. do you all support -- how many support eliminating employer-sponsored insurance? second question, how many on the panel support the current version of medicare for all, which i believe, if my math is correct, 17 members of this committee on the other side of
the aisle support? does anyone support medicare for all? last question, do you support extending health care benefits to illegal immigrants? couple. this is one of the areas that i find troubling because i represent kentucky. i represent a poor district. i represent a district that has a high percentage of people on medicaid. and before the affordable health care act, kentucky had a high medicaid population. after the affordable health care act, kentucky expanded medicaid. what happened when they expanded medicaid, a significantly -- a significant number of new people got on medicaid, and what that did was it cut the pie into very small pieces. fact, 30% of kentucky is on medicaid now. there are so many people on medicaid that the providers
continue to get cut and people on medicaid are finding a hard time finding a provider who will actually take them. so medicaid hasn't been cut in kentucky. the fact that so many people are on medicaid, the services are automatically getting cut. everybody can't be on medicaid. and medicaid in kentucky is free health care. that's a great deal for the people that have free health care. but somebody's paying for the free health care. and the people that are paying for free health care are the people in the private market. and they're very upset because the premiums continue to skyrocket. so we have a problem with the affordable health care act. mr. balat, the reason i asked the question about extending health care to illegal immigrants because i watched the democratic debate the other
night. there were 10 on the panel. they were asked the question, how many support extending health care, free health care to illegal immigrants, and all -- if i remember correctly, all 10 raised their hands. that's potentially millions of new americans on what i would presume would be medicaid. what happens to the current health care system in america if my friends on the other side of the aisle and those running for president from the other party get their wish and extends free health care to millions and millions of illegal immigrants? mr. balat: thank you for the question. i'm a child of immigrants. it's important what we do in this country for the people that are here. we as americans have always
taken care of our communities. that's our focus. that's who we take care of. what it would do to health care, what it would do to our communities, what it would do to the medical professional community is it would strain it even further. let me tell you what happens in medicaid today. it's very difficult to get in and see the doctor. the wait times are exceptionally long. as i said in my testimony, if they do get in to see their doctor, getting a specialist referral is difficult because even less specialists participate in medicaid panels. then, getting the medication they need. i hear doctors don't like to take care of medicaid patients. nothing further from the truth. they don't like the administrative burden that is consistent with how we deal with medicaid and the a.c.a. exchange and so on. it's going to stretch it out. we're going to see less people participating on those panels and it will leave people without care. we're going to see our e.r.'s
continue to be flooded and increase in population. mr. comer: well, i think that's an important part that needs to be mentioned in this hearing is that everyone can't have free health care. and we got a problem with the health care system in america. we had a problem before obamacare. it got worse after obamacare and obama -- there's no way to fix the obamacare situation, especially in kentucky with the massive expansion of medicaid. so hopefully we'll have a discussion in the future in congress about ways to make health care more affordable to the working people that -- while at the same time protecting people with pre-existing conditions which is a priority for me and i think every member of this congress. thank you, mr. chairman, i yield back. mr. cummings: thank you very much. mr. raskin. mr. raskin: thank you very much, mr. chairman. professor gluck, let me start with you.
because you said something extraordinary which is your partner in filing an amicus brief against this attempt to destroy the affordable care act and strip 20 million people of their health insurance, is a person who was opposed to the carequare and was your nemesis, essentially, your counterpart on behalf of the affordable care act back in the burwell case is that right? ms. gluck: yes, that's extraordinary. mr. raskin: you are talking about a distinguished lawyer who was opposed to the affordable care act and thought it was originally unconstitutional but he thinks it would be absolutely absurd the utrageous to use invalidation of one provision, which is zeroed out the penalty for not purchasing insurance, to unravel the entire act, is that right? ms. gluck: correct.
mr. raskin: and you cited a bunch of conservative legal scholars on that side. would you mention them? ms. gluck: attorney generals from montana. judge mcconnell. professor bray and sam walsh. mr. raskin: what is he taking against the -- ms. gluck: judge mcconnell argued that there is no jurisdiction to decide the case and filed the brief, not on behalf of neither party but on behalf of the blue states. mr. raskin: ok. i want you to underscore this points to our colleagues. we have a difference of whether 20 million people should be stripped of their health insurance and about the general progress we've made under the affordable care act. let's just go to the point about legal severability. in 2017, there were efforts to repeal the whole affordable care act. i remember that. i was in congress then. and they voted 69 different times to repeal the affordable
care act in its entirety. they weren't able to do it because there was a mass uprising across the country. people went to the town hall meetings and said don't do this. eloquent, riveting testimony that we heard from patients today, don't do this to our families, and they weren't able to get enough republicans to do it even though the republicans controlled the majority. instead, they passed this one provision, zeroing out the penalty on the compulsory purchase of insurance policy, right? that was it. at that point, everybody agreed that the affordable care act should be saved. some people thought it was a great thing. some people thought it was a terrible thing, but now there is -- the proposition being pushed by -- i don't even want to say conservative republicans because a lot of conservative republicans on our side but by an extreme faction apparently within the trump administration, there's a position that the invalidation of this one provision where i don't know if it's the passage
of this one provision, undoes the entire act, the provision for 26-year-olds, pre-existing condition coverage, all of the medicaid provisions, all the provisions that expand people's access to prescription drug benefits, closing of the doughnut hole, everything that's in there they're saying is now toppled because this one provision is gone. now, what does that do to the power of congress when we thought we were passing one thing and now the courts say, well, because this one provision is out we're going to strike down a 2,000-page piece of legislation? ms. gluck: i think one of the reasons you see this unprecedented consensus, you're absolutely right, this case goes to the power of congress. to let the court do what it did here. the court is taking over congressional lawmaking power. the court is being activists. it conservative legal scholars and liberal legal scholars alike value separation of powers. mr. raskin: i wouldn't want to win that way. in other words, if i thought the affordable care act was the
creature of the devil himself and i wasn't able to get it through congress but we were able to chip off a little piece of it and then later some judges say, hey, we're going to go ahead and destroy the entire act, i wouldn't support that because that is an be a sleet defeat of legislative power, -- absolute defeat of legislative power, isn't it? ms. gluck: yeah. it's a corruption of the rule of law. mr. raskin: what are some of the things that would fall if the administration gets its position in destroying the a.c.a.? ms. gluck: i can't overstate the reach of the statute. we have no discrimination based on health status. the indian health program. we have the -- mr. raskin: they would invite us to believe we all knew that when that vote took place, that we were essentially going to undo it if one phrase or one sentence dropped out of the legislation. ms. gluck: courts are actually respectfully not allowed to do that. courts are not allowed to
presume the legislature had the seeds of its own -- they defer to the legislation. mr. raskin: thank you for what you're doing and thank you for working across the aisle on defending this critical principle of the severability of provisiones that are struck down by a court. ms. gluck: thank you. mr. raskin: i yield back, mr. chairman. mr. cummings: mrs. miller. mrs. miller: thank you, chairman come united statesings -- cummings and ranking member. i would like to read an editorial from mr. hice's constituents from madison, georgia. she says, i co-own a small business in georgia. when obamacare was first passed, we were one of the businesses that lost our health care coverage. when finding new coverage, my insurance went from $385 a month to $643. due to the fact that i'm a female, which is an increase of 67%. i'm beyond childbearing ability, but i still have to have maternity coverage.
mr. chairman, i ask for the unanimous consent that the full statement be entered into the record. mr. cummings: without objection. mrs. miller: thank you. thank you, all, for being here today. it's been over nine years since the a.c.a. has been signed into law. we all know that when a law is enacted that often there are kinks or problems that need to be worked out and issues that need to be resolved. as we move forward. however, the obamacare has had countless issues since its enactment and harmed health care for citizens across the united states. republicans have been saying for years that we need a fix for this program to decrease the premiums, stabilize the market, increase access to care, and to protect those with pre-existing conditions. now, my colleagues across the aisle have decided to abandon this program completely and chase after a single payer system, which would further increase health care costs on taxpayers and inevitably decrease access to care for
people who need it the most. in west virginia, enrollments in our exchange have decreased. while many are now enrolled in employer insurance due to the booming economy, many have cited high deductibles as a reason for going uninsured. we need to solve this problem and a single payer system is certainly not the solution. mr. balat, has the a.c.a. lowered monthly premiums for americans? mr. balat: no, they have not. mrs. miller: in fact, how much have premiums gone up for americans on average since this law was enacted? mr. balat: it's been significant. it's been a range depending on the part of the country they're in. 's been 200%, 400% in some cases. mrs. miller: that's terrible. how has the a.c.a. kept deductibles the same or lowered them for our constituents? mr. balat: outside of the exchange or within the exchange? mrs. miller: within the exchange? mr. cummings: the lady will
suspend. are you ok? whatever -- listen to me -- your health is number one. whatever you need, let us know. all right. ok. all right. mrs. miller: thank you, mr. chairman. mr. balat: the premiums within the exchange have been -- they've gone up probably closer to 60%, 70%. the outside in the private market they have gone up substantially more. mrs. miller: thank you. it sounds like what the goals for the a.c.a. intended to be have not really been enacted. how has the current administration helped ensure americans to have increased access to health care? mr. balat: well, i think some of the examples have already been given. people have talked about fixing the a.c.a. and i think some of the measures that have been mentioned are attempt to fixing it, such as the opioid, h.i.v. and kidney initiatives. it looks to be the white house and the administration are looking to improve upon the
a.c.a.'s foundation. but they've done other things as well. the executive order that the president put out in 2017 that uld expand the already existence short-term insurance plans, health care plans, extending those that will be in transition longer than the amount of time initially prescribed, helping those who are losing jobs, having to move, that are going through a divorce. it's allowing them more time to go through that transition period. association health plans was another solution that was put out there. they experienced great success. some reports are showing there were double digit savings that people were able to pool together and buy employer style business health plans. so that was another good innovation and then the h.r.a.'s, the health reimbursement arrangements that
will be effective january 1, that will allow the market to come back because it went away when the a.c.a. was implemented. employers will be able to dedicate defined amounts of funds that are part of their compensation plan for the employee to go out and be a consumer of what fits them and their family the best. mrs. miller: thank you. mr. chairman, i'll yield back the rest of my time to the gentleman from texas. sorry. mr. cummings: you have five seconds. mrs. miller: sorry. >> mr. balat, can you expand on your concerns earlier? you stated about the medicare for all and expanding coverage in the extent that would drive up costs to health care? mr. cummings: time has expired but you may answer the question. mr. balat: the cost of health care continues to go up. the more we have the government involved in trying to fix this entity, this industry, the more
we've had the cost go up. we see the same thing in higher education. the more federal government has gotten involved, the higher tuitions have become. we've seen lots of technology, televisions, iphones, that aren't heavily regulated. but those prices go down. yet, when the government is involved in an industry, those prices go up. and what comes with those costs, the reason they're there, all the regulations, the administrative burden, the shackles we put on the people that are doing the work on the front line trying to help the patients, we're hurting ourselves by doing this. mr. cummings: mr. connolly. mr. connolly: i thank the chair. good lord, mr. balat's comments about the role of the federal government, that would come as news to a lot of the universities and colleges. especially the for-profit colleges. let's just get government right out of the way, stop regulating it, prices will go down. of course, cheating will stop and people won't be embezzled or defrauded with phony
credentials or credits. that logic escapes me. professor gluck, have you looked at the economics of health care insurance premiums? ms. gluck: yes. to the extend a law professor can. mr. connolly: mr. balat, to the horror of my colleague on the other side of the aisle, said ever since the affordable care act, preemyuments have just skyrocketed. -- premiums have just skyrocketed. is there a correlation? is there a correlation between the adoption of the affordable care act and these, i don't now, all of a sudden inexplicable premium increases? unprecedented. premiums weren't going up before the affordable care act. everything was stable and hunky dore and 35 million didn't have health care coverage but somebody had to suffer. professor gluck?
ms. gluck: you're correct, the affordable care act made insurance more affordable for millions of people. to the extend we had premium instability, a lot of that is attributable to the administration. mr. connolly: and republican congress. ms. gluck: and the republican caulk itself. mr. connolly: this strikes me as amazing. we do everything we can to sabotage the law and then we are horror struck, there is gambling here at rick's, that it has an impact on the cost of insurance because there is the mechanisms we put in place to keep those down and keep it affordable were destroyed in the eight years the republicans controlled the congress. even before mr. trump took office. would that be a fair statement? ms. gluck: yes, i think it is. mr. connolly: you have been shaking your head. comment. mr. isasi: we need to talk about facts. mr. connolly: you are talking crazy. mr. isasi: we know what happened to premiums. pre and post-a.c.a.
it's been studied. surveyed the american public. the percentage of people reporting they couldn't afford health insurance in the individual market was cut in half after the a.c.a. one of the extension parts of the a.c.a. is make sure coverage is affordable. most people in the exchange are getting that. most people are paying far less for their premiums than they were before the a.c.a., period. it's impurecal and well documented. in addition, as you pointed out, there is a lot of dynamics at play but the number one reason that premiums are high in this country, it's not the affordable care act. it's because the health care prices in this country are out of control. it's a -- the american people know this. we know we're paying too much for prescription drugs and hospital care. we know we're paying doctors too much. we know that. to blame the a.c.a. for that, as i said in my opening statementses, is blaming a drowning man because of his life preserver is because he's wet. it's preposterous.
mr. connolly: can you and professor gluck remind of the couple successful efforts by my republican friends during their majority tenure here in the house and congress where they succeeded in gutting certain provisions of the affordable care act that were in fact directly related to trying to keep pressure down on premium increases? ms. gluck: sure. as you know, congress turned off the very important stabilization payments for the insurance industry. there was then a lawsuit about the continuing ability of the administration to pay cost sharing reduction payments which showed dramatic instability into the insurance market. there was then an attempt to reduce enrollments on the exchange. reduce money for navigators which are critical bridges between individuals and enrollment. and recently there has been a vigorous attempt to split the insurance pools, divide the insurance markets and make
health care more unaffordable for those still in the a.c.a. market. mr. connolly: well, lord almighty. here i was thinking we're perverse and the affordable care act drove up prices mindlessly. but now you tell me there is a cause and effect but it's not the affordable care act. it is in fact the insidious, relentless drive to gut the affordable care act which they couldn't defeat legislatively but they could do both administratively and through amendments to laws that made it much harder for the protections, the bumpers that protected us and buffered us. mr. isasi: that's exactly right. the largest percentage increase e saw was after the payments stopped. mr. congressional: my time has -- mr. connolly: my time is up. thank you for illuminating what really happened. mr. cummings: mr. gibbs. mr. gibbs: i don't think anybody in this room or the president of the united states doesn't support the -- applying for pre-existing conditions,
having that in the bill. it's a tragedy when somebody loses their coverage for health care because of pre-existing conditions. fortunately, last congress we had a bill that passed that address that had, that protected pre-existing conditions. it's unfortunate the other side of the aisle wouldn't work with us to make that bill better. it's interesting when i look what's going on. we talk about the cost and i had a neighbor come to me a little over a year ago. my county was down to one insurer on the exchanges. she's going to lose their health insurance because that was going away. the other thing i hear a lot about is people talking about the deductibles are so high they can't afford them. one of the reasons i hear a lot of people are uninsured and i believe there are 30 million uninsured is because the deductibles are so high. it's a problem. i do notice, too, there were comments earlier how the affordable care act has failed. most of the people running for president on the other side of the aisle aren't running on obamacare. they are running on medicare for all which i think would be
a really -- real big disaster. and i'll give you an example. we had a good friend here a few years ago that friday at 4:00 in the afternoon had severe chest pains. at 11:00 that night she had a quadruple bipass. what would happen if that was canada or somewhere else, would that person get care at all? >> inage emergency situation that would be different. that would be considered an emergency situation. mr. balat: the wait times would be exceedingly longer than we have in this country. mr. gibbs: it amazes me. talk about research and medical research has come a long way, improving life expectancies, people having a higher quality of life. what is your thinking if we
have a single payer, government-run system, what happens to that research and what happens to the private sector taking -- being innovative, what do you see happening? mr. balat: i don't know i could actually speak to that. the one thing i do want to say, even when we talk about all these other issues, we keep going back to insurance and we talk about insurance and we don't talk about the patient. the real -- the real victim in this is the patient and the cost of care itself. the insurance has contributed to it. of course, the premiums went up after the risk corridor payments were reduced because those risk corridor payments were put in place to artificially decrease the premiums in the a.c.a. so it looked like it made sense which it did not. let's look to see what's going to happen to the patients themselves. that's the real tragedy of what's going to be in the future and how we're going to decide we take care of citizens in our country. mr. gibbs: president trump did an executive order to let association plans come back into effect because obamacare
did away with association plans. ne of my neighbors, help get insurance is through association plans. can you tell us what's happening to association plans? mr. balat: they were growing. they had a great deal of popularity. then there was a suit that -- federal judge essentially said the association plans were an end run around the affordable care act. that -- there's still in operation. there was no injunction. like what happened with the federal suit in a.c.a.v. azar. they're still able to operate. however, the uncertainty has caused many people who want to create those kinds of plans to not proceed further because they don't know what will happen. mr. gibbs: it gives individuals ability to have options? mr. balat: absolutely. mr. gibbs: exchanges, there is a government set.
mr. balat: because it functions like an employer plan, there is no exclusion for pre-existing conditions. you have a bigger base. yes, there are more options. they can choose among different types of solutions and not just traditional insurance. be mr. gibbs: we know health savings accounts are a big part to help that. i have a health savings account. and i think it's a big help. gives me more options and a better ability to direct my own health care. i'll yield -- i got 20 seconds left. my friend from texas. mr. roy: all this time, what can i do. mr. balat, i guess i would ask one question. you know, describe a little bit what you say -- what are some of the alternatives we could look at to empowering patients instead of empowering insurance companies? for the life of me i don't know why we're focused on insurance and my colleagues on the other side of the aisle seem more concerned about insurance than care. can you talk a little bit about care and patient access of doctors? mr. cummings: the gentleman's time has expired.
you may answer the question. mr. balat: thank you, chairman. let me just give an example. the personal one i use. i use direct primary care. insurance has -- i'll say it this way. the reason health care has become more inefficient and more unaffordable is because there has been a wedge driven between that relationship between doctor and patient. health care is a very personal situation. i think all the witnesses here have talked about their team. it should be looked upon that way. direct primary care is a membership model type of plan. i pay on the order of $60 a month for unlimited 24/7 access to my primary care physician. no exclusions on pre-existing conditions. i can communicate with him via electronic means, text, secure video chat and the like. mr. cummings: thank you very much.
mr. rudea. -- mr. rouda. mr. rouda: thank you, mr. chairman. i want to level set some information here. there is talk of government-backed single payer systems. we have two government-backed single payer systems. it's called veterans affairs and medicare. i hope members on the other side suggesting they shouldn't be eliminated because they are single payer system. there is approximately 40 industrialized countries in the world, 39 of them have universal health care. only one does not. the wealthiest, greatest country in the history of the world, the united states of america. and mr. balat, i take exception to your testimony that we have -- that when the government is involved in providing health care insurance it drives prices up. in fact, those 39 countries who have universal health care spend about half of what we spend on health care. in fact, we spend 18.5% of our
g.d.p. on health care. we know we have a very inefficient system. while the a.c.a. may not be perfect, it has certainly brought quality insurance to a lot of individuals who did not have it. mr. isasi, i hope i am pronouncing it correctly, i do want to touch base in a couple areas. with the litigation going on in texas and the potential we're facing that the a.c.a. could be eliminated as we know it and the protections under it and some of the other key areas, one of them is talking about the doughnut hole that a lot of the seniors face in prescription prices. can you talk a little bit what the impact would be if the a.c.a. was thrown out in totality as the impact on senior citizens and prescription prices in general? mr. isasi: you bet. so first of all, if the a.c.a. was repealed by these judges, the first thing would happen is the seniors' medicare costs
would go up. the premiums would go up, cost sharing would go up and the medicare solvency would be weakened. it would have a very specific and negative impact writ large. in addition, the entire pathway o provide high -- low cost high value, things to treat leukemia, lupus, some of the most devastating illnesses in this country will disappear because that was part of the law. it would have a negative effect. do want to say something. association health plans and other forms of new insurance, let's be clear. what we're talking about there is hurting people with pre-existing conditions and hurting people, letting insurance companies play tricks again on consumers. the only reason association health plans is cheaper is because it excludes people and allows insurance companies to play tricks. we know and we've done a lot of work across the aisle this congress on surprise medical bills. the american people are fed up
with buying insurance and then not getting financial protections. what we are hearing today is a description of insurance products that would, for example, exclude hospital care or exclude prescription drugs altogether. right. it is letting insurance companies play tricks on consumers again. that is not a pathway to affordable access for american -- the american people. it's a pathway for tricks and for hurting the financial stability of our nation's amilies. >> when we heard everyone would support the view that the president supports coverage for pre-existing conditions, let me point out, i don't believe that. i believe actions are greater than words. mr. rouda: if the a.c.a. was struck down in its entirety, wouldn't tens of millions of americans, i believe over 100 million americans would lose pre-existing condition coverage? mr. isasi: we know it's almost half of the people -- sorry --
over half the people before the a.c.a. that went to the individual market tried to get coverage and had pre-existing conditions and couldn't get coverage. it's important, this question has been answered. republican leaders passed legislation that was the alternative to the affordable care act. the c.b.o. told us that 6.3 million americans with pre-existing conditions would end up paying much more for their health insurance coverage or not be covered. they answered this question and they hurt people with pre-existing conditions. and that's the truth. mr. rouda: professor gluck, it chomping at u're the bit. ms. gluck: before the a.c.a., the number is some 52 million american were denied insurance because of pre-existing conditions. that's a statistic you have right now that's readily accessible. furthermore, re-enacting pre-existing conditions alone would not do nearly enough for really anything for people that have serious medical
conditions. if you have coverage, that coverage is priced prohibitively, it does nothing. if you have coverage but the coverage doesn't include the benefit of the prescription drug you need to treat your disease, that does nothing. if you have coverage but you don't have subsidy to pay for the coverage or you don't have medicare, medicaid to pay for the coverage, the coverage does nothing. i think the pre-existing condition discussion is important. but it's just a tip of the iceberg. mr. rouda: thank you for your testimony. mr. chairman, i yield back. mr. cummings: thank you. mr. roy. mr. roy: thank you, mr. chairman. couple quick questions for professor gluck. with respect to the litigation hat's currently texas v. azar. did the supreme court find the mandate unconstitutional? ms. gluck: no. mr. roy: the mandate was not found unconstitutional? ms. gluck: respectfully, there is no mandate. what the supreme court found was the mandate was not -- could not be construed constitutionally of the reach
of the commerce clause power but it's a tax. mr. roy: the mandate is unconstitutional. pure and simple. the mandate is unconstitutional. you didn't have a power under the commerce clause. the only power that remained was the taxing power. the tax was zeroed out. the tax does not exist, correct, there's no tax. is there a tax today? ms. gluck: the tax is set at zero. mr. roy: there is no tax today. there is a mandate in the legislation. the mandate is unconstitutional. the supreme court said this body does not have the power under the commerce clause to have a mandate to make people -- make americans go purchase a product in commerce. the tax is now zero. the tax no longer exists. therefore, where do we sit today? the very thing, the very thing that saved the mandate, the tax, which is now zero, doesn't exist. this is the theory. that underlies the district court's opinion. this is why we are in front of this. it's not because it's a policy choice as some of my colleagues
on the other side of the aisle suggested. this is because it's a question. it's a constitutional question. it's a question about the power of this body and whether this body can mandate that individuals buy something in the marketplace. when it was determined to be a tax, the penalty, then, you have a taxing power question. now, we don't have a taxing power question and this is where we stand today. is it not true that with respect to severability that it four justices in the opinion inseverable, be the district court in this case found it to be inseverable? ms. gluck: i thank you for the question. first of all, the mandate, the enforceability of the penalty coverage provision is really not the issue in the case. >> momentarily the house is coming in for legislative work. you can see the rest of this hearing on our website. members will begin work on the $733 billion
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