CQ Transcriptswire

SPEAKERS: REP. CHARLES B. RANGEL, D-N.Y.

REP. HENRY A. WAXMAN, D-CALIF.

REP. GEORGE MILLER, D-CALIF.

REP. JOHN D. DINGELL, D-MICH.

REP. PETE STARK, D-CALIF.

REP. FRANK PALLONE JR., D-N.J.

REP. ROBERT E. ANDREWS, D-N.J.

[*] MILLER: Good afternoon. I’m Congressman George Miller , chair of the Education and Labor Committee and co-chair of the Democratic Policy Committee. And today I’m honored to be joined with Chairman Charles Rangel of the Ways and Means Committee, Chairman Henry Waxman of the Energy and Commerce Committee, Chairman John Dingell, and our respective -- our respective subcommittee chairs, Pete Stark from the Ways and Means Committee, Frank Pallone from Energy and Commerce, and Rob Andrews from the Education and Labor committee.

President -- today marks a historic moment in America’s urgent quest to fix our broken health insurance system. For the past six months, our three committees -- the committees that have jurisdiction over health care -- in the House have worked together in an unprecedented manner to develop and present a health care reform discussion draft for Congress and the American people that embodies President Obama’s call for fundamental change in our health care system.

President Obama’s asked us to draft the reform bill that will control cost, guarantee choice, and ensure quality and affordable health care coverage for all Americans.

I believe that our draft lives up to those essential principles. Our discussion draft reflects months of hard work and the views of many of our colleagues.

We’ve met with our respective Democratic and Republican committee members, with our Senate colleagues, with the CBO, with the administration and other stakeholders in an open and collaborative process.

To further -- to further this open and collaborative process, our three committees will hold hearings on this draft starting next week. After the July 4th district work period, our committees will then work to make refinements to the draft, to vote on it, and send it to the House floor. This is truly exciting news.

The House decided to use this unified approach because we recognized that our ability to succeed in health care reform rests on our ability to work together. We know that inside-the-Beltway turf battles will not advance reform. We believe that, in order to change America’s health care system, Congress itself must change.

When the voters elected Barack Obama president, they did not only send a message to the White House that the White House must change; they sent an equally strong message to the Congress that we must work together for the common good for our nation.

They told us that we will not be rewarded for standing on the sidelines or raising every conceivable argument against taking action. Americans will judge us -- and rightfully so -- by our willingness and our determination to cooperate and to focus on the ultimate and necessary goal of reforming our health care system so that it works not just for a few, but for everyone in our country.

That is why the approach that the three of us have taken in this process is one of the key factors that makes this year the year that we will finally fix our broken health care system.

The current path of rising health care costs is unsustainable. No one disagrees with that. Health care premiums have spiraled out of control, dealing a crushing blow to families and businesses alike and placing our fiscal future in peril.

President Obama is absolutely correct when he says that health care reform is essential to the health of our nation and the strength of our economy. In fact, health care reform is the single greatest tool to reduce runaway budget deficits.

Our discussion draft is the first step in building a truly American solution that will reduce costs, offer real choices, and guarantee access to affordable, quality health care for all.

In the coming weeks, our committee will continue to seek input from all of the stakeholders, the American people, and members of Congress. We must and we will continue to move forward. If there is one thing that is off the table, it is saying “no” to health care reform.

There is not one child, not one worker, not one employer, nor one taxpayer who can further bear the cost of doing nothing. I am confident that we will have the ability to respond to their needs.

And I’d like to thank Speaker Pelosi, Majority Leader Hoyer, the rest of our Democratic leadership, and all of our caucus, and all of the members of this Congress for giving us the support and the input that we’ve needed to develop this uniquely American solution to finally bringing quality, affordable health care to our country.

The next speaker will be Chairman Henry Waxman.

WAXMAN: Thank you very much.

I am Henry Waxman, chairman of the Energy and Commerce Committee, and I’m pleased to join with my colleagues and our respective committees that will have jurisdiction over this health care matter in presenting a draft proposal from -- from which we seek further comment by the public and our colleagues as we fashion the legislation.

The draft is a very practical one, and it’s a uniquely American proposal. It builds on what works and fixes what needs to be fixed.

First, we encourage the retention of insurance provided by employers, which is the way most people have their insurance. In other words, as the president has said on many occasions, if you have insurance and you like it, you get to keep it. Secondly, we’re going to address difficulties individuals and small businesses face in the current market. Today, people can’t get coverage if they have a pre-existing medical condition.

Secondly, too many people are charged higher premiums, even if they can get insurance, because of their health status. And small businesses go into a completely dysfunctional insurance market when they try to get insurance for their employees or even for their loved ones. The market’s dysfunctional, and they face unaffordable rate increases. That kind of discrimination will end.

Third, people who don’t have employment-based insurance or who change their jobs will always have access to affordable coverage. And they can take it with them wherever they may go, from one job to another. Even if they’re out of work, that insurance will be there for them.

With that coverage, they’ll have the protection from the catastrophic cost that is faced by many who need care and don’t have coverage. Choice is the key. Choice is the key for consumers to pick which plan they want, whether it’s a private insurance plan or a public insurance plan. Choice is important for patients to be able to pick their own doctors.

Fourthly, we’re taking comprehensive action to make sure that everyone gets more value for their health care spending. We’re moving to get costs under control through payment improvements and delivery reforms. And we’re taking a number of steps to improve quality and reduce ethnic and racial disparities.

And under this proposal, at least 95 percent of Americans will be covered, which helps us proceed on both the cost and the quality front.

Fifth, we’re improving Medicare. People who have Medicare will have that available to them, and they’ll even have a better Medicare system. We’re going to take substantial steps to phase out the donut hole, that so-called donut hole that people face when their pharmaceutical costs are too great.

And we’re going to address one of the major concerns of physicians around this country, and that is that we are going to permanently reform the unfair physician payment cuts under current law. We’re going to fix the sustainable growth rate, or the SGR.

Sixth, we’re making major investments in the workforce. We’re making sure that physicians and nurses and other health providers are available to meet patients’ needs. And there is an even stronger network of community health centers that will be available, as well.

And, finally, we’re going to enhance prevention and wellness programs that are absolutely essential to a true health care reform. So we’re assuring coverage of preventive benefits and investing in major community prevention initiatives.

We are now ready to proceed. This legislation -- and I want to stress it -- is important for the health and the financial security of all Americans. We’re going to seek helpful input from our colleagues, from citizens, from interest groups. We’re going to hold hearings starting next week, and we’re going to keep on the schedule that the president set out for us.

We are going to be proceeding to figure out a final proposal to present to the House of Representatives by the end of July.

Let me be clear: The time to act is now. The one choice we can’t make is to just delay, because the status quo is unacceptable. We can keep the status quo, or we can move to a new system. And this new system will be based on the vision of President Obama, the vision he’s set out in his campaign, the vision for which he had a mandate to move forward, and the vision for which we stand ready to be of assistance to him.

We’ll now hear from chairman of the Ways and Means Committee, Charlie Rangel.

RANGEL: Thank you, Henry.

It’s been a real pleasure for me to work with the chairmen of Energy and Commerce and Labor in putting together this plan. It hasn’t been easy, but it’s been really an educational process for all of us.

And to be working in the shadows of John Dingell’s dad and recognizing the historic work that he’s done over the years in the health reform system just reminds me of how many politicians, members of Congress, and presidents have said that they’re going to do something about reforming our health system.

And now, for the first time, the president has pulled together all of the stakeholders, all of the people that -- that have fought against this over the years to come together and to recognize that we have to do it for our country, we have to do it for our citizens, we have to do it for our economy, and we have to do it if we’re going to remain competitive.

Everybody has a story, a horror story of somebody that was underinsured, didn’t have insurance, didn’t know the cost of the insurance. People refused to leave their jobs because they can’t afford to lose their insurance. Bankruptcies, foreclosures, all of these things because of the high cost of health insurance.

And where was America? Behind all industrialized countries, paying twice as much for insurance and not getting access, not getting quality.

When the committees get together, it’s no small task. And we haven’t finished our work. But we thought it was important enough to the members that they know, what are we thinking about?

We’ve had hearings. Every committee has had a half-a-dozen hearings. And yet there are still members on the floor that have problems in understanding the difficult decisions that have to be made in -- the modernizing the system and paying for the system.

But we thought that America should not have to wait, that we want to get this discussion draft out there. We want to get the maximum support for this so that doctors and health providers would know that we’re sending all of these resources out there in order to have a healthier and stronger America.

There is no question that we will be saving trillions of dollars in the industry, stopping the hemorrhages there, having employers to feel that they can do what they always wanted to do, and that’s to give some assurances that their workers will not have to worry about the health of their health or the health coverage for their families.

Small employers that wanted to do it but couldn’t afford to do it will be productive incentives. Poorer people and working people that are underinsured and have no insurance that are dependent on emergency rooms will now know that they can negotiate a health system.

And then to have a public health program, an option so that they’re not captive of the large insurance companies, but able to talk with them and compete and say that, if you can’t give me what I need, I can go to the exchange, I can go there and deal with the people that perhaps would give us a better chance.

Is this going to bring down the cost of health insurance? You bet your sweet life. I can’t wait to talk to anybody that’s fighting against this public health insurance program. It’s going to be competitive.

The health -- the health information technology is going to force them to provide more options for people. We’re sending out there 48 million people that had no insurance, and they will have in their negotiating hands for the insurance companies to compete with subsidies in order to get insurance. Half of the people who’ve been underinsured will be able to negotiate.

So what does that mean? It means providers will be able to know that the government is a friend and a partner of everyone seeking health insurance.

And so the industry is going to provide new jobs for the providers, nurses, doctors, primary care doctors, centers so that communities that never had access to health care would be able to do it. It’s going to mean a stronger financial country. It’s going to mean a stronger health country. And it’s going to mean a strong moral standard that we will be setting in order to do what we should have done a long time ago.

What an honor it is for me to present to you John Dingell, because I told him this afternoon, his dad has to be looking down on him saying, “John, it’s just about time,” because for all of the years that he’s spent in this Congress, he can tell you the numbers of presidents that have said, “We’re going to do it.”

But this time, on his watch, the Dingell bill will be coming out. And it’s my pleasure to present my mentor to you, John Dingell. DINGELL: I love you, Charlie. I love you, Charlie. And thank you.

Dad I think is looking down, smiling, not only on the fact that we’re going to do this, but that I’m associated with such wonderful people. And I’m proud to be here with my colleagues and tell you about how exciting this day is.

I’ve worked 50 years on health care reform. And the release of this discussion draft is a first step towards getting a bill passed this year.

What we have come up with is an American solution. Much planning has gone into the discussion drafts that you and the rest of the nation will see today.

But now the real work begins, the work of explaining to our colleagues in the Congress and making the proposal available to the American people. We offer greater choice to the American people. People will have the option to choose between plans, to keep that which they have now and to keep their doctor or to make such changes as they wish as free Americans to do.

We will also give the people the choice of a high-quality public health insurance option that will compete fairly and evenly with the private companies so as to provide a yardstick and a measure for people so that they can know what there is out there that will give them the best choice of health care.

On Tuesday, I was a part of a hearing in which Chairman Bart Stupak asked the heads of three insurance companies what they would do to stop the terrible process of rescission, which has left thousands of Americans burdened with costly medical bills, despite paying their insurance premiums in the fashion that they’re supposed to, and they all said they had no intention of doing that.

Rescission is simply where you wait until a guy is sick and then you cancel his policy on him. This is something that’s got to stop, along with some of the other abuses, use of non-community rating systems, and what they call pre-existing conditions.

There will be no rescissions in the public option, and there will be none of the other abuses which we are seeing in the insurance practices that are now offered to the American people. And consumer protections will be established in that option that private companies have so far refused to do.

So we’re going to create competition, and we’re going to create choice, and we’re going to see to it that the public option included in this bill will not only see that people are treated fairly and have the option of having the kind of policy that they might want available, public or private, but it will also establish benchmarks regarding fair pricing and drive innovations that will help reduce long-term cost growth.

The public option will ensure competition in areas where there are few private plans. The only alternative to this that I see is counting on the insurance companies to fix the problems. Well, they’ve had 50 years to do it -- and more -- and I can tell you that that’s a terrible thought to me.

While there may be some differences in opinions on the specifics of the public option, we share the same goal, and that is to fix Americans’ broken health care system, something which used to be a matter of only humanitarian concern, but now which is a matter of desperate urgency, not just to American businesses who can’t afford this anymore, but to the national economy, which is going to go broke doing this.

What we’re releasing today, I stress, is a discussion draft. And I look forward to working with all parties as we move forward so that we can end up with the best bill possible.

And, again, I want to repeat how proud I am to be with my colleagues up here. We’re going to give the American people what they need, what they deserve, and what they want: a good, practical program of national health care.

Thank you.

STAFF: If members have some time, we’ll take your questions.

QUESTION: The American Medical Association, which President Obama addressed on Monday, had a fairly robust debate at its annual meeting about its point of view on a public option. Some of its members didn’t even want the term in a resolution that would describe how it would approach the bill. Have you gotten any assurances from the AMA that they -- they agree with the concept that you’ve put forward today about a public option that would compete with private insurance?

WAXMAN: I -- I don’t know what the AMA position is. I want them to look at our draft.

I think there’s a lot of misinformation about the idea of a public option. Some people think it’s going to be a government takeover of health care, a single-payer system. That’s not what we intend.

We want to give people a chance to choose their own insurance plan, just like federal employees get to do, just like members of Congress. We get a list of available insurance policies that we can choose, and one of the choices that will be available to those who go into this exchange or marketplace to look at the choices will be a public plan that will be on a level playing field, it will be a choice, no mandate for anybody to be in it, and it will be for a lot of people who want to make sure that the -- they can rely on it, where they feel uncomfortable with the insurance companies and the way they’ve handled insurance over the years.

But I hope when the AMA looks at our -- our proposal and when we hear from them in our hearings, they’ll give it a fair evaluation, and we hope they’ll be there. If not, we’ll agree on what we can agree on.

(CROSSTALK)

RANGEL: Let me just respond to that, because I’m anxious to take on those people who are opposing the public option. I cannot think of any doctor that’s being told that hundreds of millions of dollars are going to be out there in research and development that we will be providing nurses and doctors a real support team. Doctors who are concerned about practicing medicine will be able to say that we, this president and this Congress, have presented them an atmosphere where that’s what they can do.

For those people who are afraid of competition, they shouldn’t be in this business. This is what we’re trying to do: make it an even playing field for all professionals to say they’re getting better than a fair shake in what we’re doing.

So I have talked with a lot of doctors who’ve said, “Thank you for giving us an opportunity to do what we decided to do when we went to medical school, and that is to practice medicine.”

QUESTION: Mr. Chairman? You’re standing up there united (OFF- MIKE) public option here, but there are a lot of divisions within your own party, most noticeably in the Senate. Are you concerned at all about health care reform losing momentum? And given these divisions on the public option, are you (OFF-MIKE)

MILLER: We set out in this -- in this joint venture among the three committees to try to put language to what President Obama had campaigned on in front of the American people, what he has said since coming to office. And as you saw, he’s continued to -- to stress the need for a public option, to defend a public option.

We’ve put, again, a draft of a public option in this legislation for all of the reasons that Chairman Dingell outlined. Today, health insurance for most American families is just one big surprise. When you go to use it, you find out it’s not quite as it’s represented, and you spend hours on the phone with exclusions and discussions and -- and referrals to other legal documents that you didn’t have at the time that you purchased it.

And we just think there ought to be a level playing field. There ought to be honest competition. And the benefits ought to be as they’re stated and there when families and businesses need them.

And so we think that this is -- there are those in our caucus who don’t fully agree with the public option. We’ve had a series of discussions about that. There have been modifications in this -- in this draft.

But we’re at a point now where those discussions should continue in the committees and so that people can make changes to this draft and -- and prepare it to come to the floor.

We understand. We’ve -- we’ve read all the different positions in the Senate. We’ve had discussions back and forth. But we continue to believe that this is an important, important component of real health care reform and an important benefit to American families in the -- whether they choose the public plan or they choose the private plans in the exchange.

They can do whatever they want. This is about choice. They will know that even those private plans will be better because of the public option.

QUESTION: Just to follow up, the president has indicated some flexibility in terms of...

(CROSSTALK)

MILLER: And that’s why this is a discussion draft. That’s why this is a discussion draft. The next steps should be taken by the committees after debate and deliberations and hearing from the witnesses.

(CROSSTALK)

QUESTION: ... why you settled on the 8 percent (OFF-MIKE) 8 percent...

MILLER: Henry, you want...

RANGEL: We haven’t settled on anything. Everything is on the table. This is nothing locked in cement. And I don’t even remember -- that’s one of the ideas that are there. We talk each and every day.

And I just want to report about momentum. I’ve been here a long -- down here a long time, working with three committees. The word “jurisdiction” hasn’t even come up. We’re working with Medicaid, Medicare, and all of these things. So we’ve got the momentum.

(CROSSTALK)

QUESTION: ... figures as far as estimate or guesstimate about how -- how far you could go, so far as the price tag? What’s the limit as far...

(CROSSTALK)

RANGEL: We’re waiting for the numbers to come in.

QUESTION: How -- how do you plan to pay for it?

WAXMAN: Well, we’re going to -- we’re -- we’re working with the Congressional Budget Office. In fact, every time we think of an alternative or we have to have a different score, sometimes the Congressional Budget Office tells us one alternative costs less and another one would cost more. And as a result of that interplay, we’re making our decisions.

So we don’t have the figures of how much this is going to cost, but we’re going to pay for this bill, and we’re going to pay for it in two ways. We’re going to pay for it by cutting down on the expenditures in the some of the public programs, Medicare and Medicaid. We’re going to pay for it by reforms in the system that will hold down costs for everyone, reforms like choice and reforms like an emphasis on prevention and primary care. And we’re going to pay for it by revenues.

We put in our draft today a list of options for some of the cuts that could be made in existing programs. These are based on a menu of options that the president has submitted to us. And we put them out there, and we’ll have them on the table as we consider where to make the cuts.

The revenue parts will be discussed by the Ways and Means Committee. And we’ll -- we’ll make sure that, at the end of the day, we have a health insurance bill that will cover almost all Americans, we’ll hold down health care costs, we’ll provide affordable, good- quality health insurance coverage, and we’re going to pay for it.

(CROSSTALK)

QUESTION: ... can you explain how you get -- I believe I heard you think 90 percent of Americans will have coverage...

(CROSSTALK)

(UNKNOWN): Ninety-five.

MILLER: Well, we think it’s somewhere between -- somewhere around 95 percent. Again, the CBO, depending on the structure of it, that can change. And so that number is not -- not set in concrete.

We know that there’s people who are healthy and remain healthy for a very long time and never encounter the system. They just don’t -- they just don’t show up.

There will be for a period of time people who are not aware of this. There’s people who today are still trying to get TV with the rabbit ears, you know, after all of the hundreds of millions of dollars of ads and rebates and the -- and the rest of that.

So, you know, again, you want to be careful about what you promise. And we think this is in the -- in the ballpark.

QUESTION: (OFF-MIKE) proposal address the Dartmouth data that shows like overuse of medical services in Miami versus Minnesota, but not necessarily any better quality?

MILLER: I think that that’s what Chairman Waxman was saying with respect to the menu of the -- that the president’s suggestions on cost-cutting and efficiencies in the system and reorganization of the system.

I think when you read this legislation, you’ll see that it’s a fairly aggressive list of choices and determinations to be made by -- by the -- by the committee. Clearly, we’ve heard these stories, and they’ve been documented, as they were with the Dartmouth study, of these different outcomes, not necessarily superior health care, but tremendous cost. And that’s, obviously, what we want to attack, because that’s to the benefit of families and to businesses and to taxpayers.

QUESTION: Chairman Waxman, you’ve been very vocal about the pharmaceutical industry paying their share (OFF-MIKE)

WAXMAN: Well, we’re simply going to ask the pharmaceutical companies to pay us back the money that was a windfall to them as a result of the Medicare drug bill. You know what happened on that bill? There were people on Medicaid, and we got rebates when we paid Medicaid costs for drugs, because the Medicaid law said that the government would get the best price.

Well, under the Republican plan, they shifted the people who were on Medicaid and Medicare onto Medicare. So the same people got the same drugs, but we, the taxpayers, paid more money for those drugs. It was a windfall of billions of dollars. We’d like the drug companies to give us that money back and stop doing that kind of thing in the future. That’s what we have in our draft.

QUESTION: Who defines what health care is? I mean, affordable and good quality is great, but who decides?

RANGEL: The physician.

WAXMAN: Well, for health care services, the physician will be the one in charge, and people can choose their doctor, and the doctor will decide what needs to be done. But we’re trying to improve the delivery system, so it’s -- like this Dartmouth study indicated and other evaluations have shown, that we have a variation from one part of the country to another.

In fact, there was an article in -- in the New Yorker that showed that even within Texas there was a huge disparity of health care costs for similar populations.

We want to change that. We want to emphasize more preventive services and primary care services and organize delivery in terms that are called medical homes, providers getting together and figuring out the best care.

Too often what we’re seeing is that people go to a doctor who’s overworked, has to see as many patients are possible, giving them as little time as the doctor may have, and then, when there’s a complaint, they’ll just send them out for another test, which, of course, the system has to pay for, or send them to a specialist.

And what we need are doctors to be able to spend time with their patients and find out what’s going on and prevent these problems from getting worse.

QUESTION: You talk about having a level playing field with the public plan. Does that mean that the public plan is going to take private rates as opposed to Medicare rates? And if that’s the case, then how are you going to save money? How are you going to afford savings with that public plan?

WAXMAN: Well, the committees are going to decide all of these issues, obviously, but the way we envision a public plan is it -- it will operate the way private insurance plans do. They will have to work within the amount of money they raise from premiums. There will be no government subsidies for them.

They’ll have to negotiate with the providers of care and see which providers want to give care under that insurance plan, as providers have to decide whether they want to do it under a private insurance plan.

In the beginning, I think the -- the public plan will probably use Medicare as a basis for their reimbursements, but probably higher than Medicare, because they want to be sure that they can attract the doctors and others providers to the public plan.

But the public plan will be open and transparent and I think will be looking to be even more nimble than other insurance carriers, because they’ll try to figure out how to provide care in a comprehensive way, in a preventive way, and hold down some of those costs.

(CROSSTALK)

RANGEL: ... as it relates to the question of rationing and your question. A magic word in all of this is competition. The whole world, the whole country, rather, will be watching how these plans intend to work. And you can bet your life, with the competition, if one of them would get a reputation of not providing that health care or rationing health care, it won’t be the United States government that would be directing it. It would be the government prohibiting it.

So that what Henry said is true: We’ve got to take the best of Medicaid, the best of Medicare, kick it up a notch, but at the same time be able to effectively compete. I hope that many of the AMA doctors will be fighting to get involved in the public health option.

QUESTION: (OFF-MIKE) follow up on the last question about the public plan (OFF-MIKE) shocked to hear that the insurance industry has already issued a statement criticizing the public plan (OFF-MIKE) could you describe (OFF-MIKE) starts out tied to Medicare reimbursement rates and then somehow transitions off into a more (OFF- MIKE) how does (OFF-MIKE) is there a trigger? I mean, how do you get...

(CROSSTALK)

WAXMAN: Well, we’re going to have to examine these details in our hearing process. But we want to...

(CROSSTALK) WAXMAN: We -- we have some provisions in the draft. But we want these public plans to be able to provide reimbursements as they get started for those who sign up on the public plan. I mean, this is a new plan. Private insurance plans are already in existence. They already have their group of providers. They have their contracts with providers. They often have already negotiated their rates for providers.

But the public plan will have to get started. And there will be a period of time for them to start up. But they will then, at some point, compete, just as every other insurance plan does.

Let me comment on the -- on the statement that the private insurance companies don’t want the public plan. It seems to be what they’re saying is they don’t want competition. They don’t want a plan that can offer services maybe in a more comprehensive way, maybe in a more cost-effective way than they do.

After all, you have to recognize the insurance companies have operated on a simple principle that they’re not just trying to cover those who need the care and then spread the cost. They’ve been trying to exclude people from coverage for individual insurance plans. They’ve been trying to see if you’re sick and then making sure they don’t have to issue an insurance policy to that individual.

Well, that will change, because we’re not going to allow insurance companies to do that, but there are a lot of people who feel that some of those private insurance companies are still going to try to figure out ways to cut their costs by not covering some people.

I remember well the story of how there was a plan that said, “Anybody who wants to sign up can sign up. They just have to walk up four stairs -- four flights of stairs to get the information.” And, of course, if you weren’t physically able to do that, you never got a chance to sign up in that insurance plan.

We want to keep everybody honest, and competition is the best way to accomplish that goal.

STAFF: (OFF-MIKE) last question (OFF-MIKE)

(CROSSTALK)

QUESTION: ... talk a little bit about (OFF-MIKE) Medicaid (OFF- MIKE) Medicaid -- the Medicaid expansion in the bill. There’s obviously a lot of concern among states that the Medicaid right now is not working particularly well. In California alone, many providers are fleeing the program. How do you assure that, if you expand this, you’re not just bringing more people into a dysfunctional program?

WAXMAN: Well, Medicaid is an essential program for Americans below the poverty line, many of whom have very complex problems. They’re not the kind of clientele that the private insurance companies are eager to insure at the present time.

We’re going to keep the Medicaid program in existence. Someday we may talk about them putting -- allowing them to go into the exchange, but not -- not for a while.

And if we’re going to keep the existing Medicaid program, we’ve got to make improvements in that program. Oftentimes in Medicaid, the beneficiaries can’t find doctors, can’t find any health provider that will take the rates, and we’ve got to make sure that they are paid fairly.

And we have to adjust the situation with the states. In some cases, we’re going to have to have federal dollars replace the state dollars, and we’re going to have to work with the states to make the program one that will be affordable and will be there for those who are entitled to it because of the fact that they are below poverty. And when they get sick, they should have access to the care they need.

RANGEL: I think we’ve got to close out now. Even though the chairmen of the committees have been explaining the bill to you, we cannot let this moment go by without telling the chairman of the subcommittees that’s worked so hard on this, Rob Andrews, Frank Pallone, and on Ways and Means, Pete Stark , who for decades has been working on it.

I want to thank the staffs of the three committees. We have relied heavily on them. We would meet. We would decide the direction that we want to go. But they’ve had the responsibility of working with all of the committees and working together. The leadership has worked with us, as well as the staff of the Congressional Budget Office, which we are still waiting on in order to perfect discussion paper.

We have -- want to thank the House Office of Legislative Counsel on this leadership of Jessica Sappiro (ph) and Ed Grossman (ph). And including Megan Renfew (ph), Larry Johnson (ph), Henry Kristof (ph), Wade Baloo (ph), have all helped to -- to work with the president’s office to make certain that we didn’t accept everything, but everything that he has is -- that he wants is on the table.

And this has been a challenge that I can tell you that we as professionals, as politicians feel very proud of the fact that we’ve been working so seamless together and that we’re coming out with this discussion proposal.

Thank you.

END

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Jun 19, 2009 15:53 ET .EOF

Source: CQ Transcriptions

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