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PRESIDENT OBAMA spoke first.
- my hope is we’ll discuss how to lower costs, how to make insurance market work, how do we deal with deficits
- i will start by discussing areas in which we agree, then we’ll discuss stuff we disagree about, who knows, we may not resolve any of those disagreements by the end of the day
- “i hope that this isn’t political theater”
- people still want to see change, if we go about this with an open mind we might be able to make some progress
SEN. LAMAR ALEXANDER (R-TN)
- “we believe we have a better idea”
- our idea is to start over, and make lowering h/c costs the primary target
- “we want you [Obama] to succeed, because if you succeed then our country succeeds. but we want you to take hcr in a different direction.”
- told a story about a friend who asked him to kill hcr bill, but also said that something does need to happen to reform the system
- Obama’s plan is a lot like the Senate bill, with more taxes, Medicare cuts, and new spending on new entitlement programs, will cause premiums to go up, mandates will cause premiums to go up, too
- dumps low-income Americans into Medicaid, which is bad
- Obama plan spends $2.5 trillion a year, and still contains “sweetheart” deals
- GOP’s view is this a recalled car that can’t be fixed
- don’t hold your breath for GOP to roll in a 1200 page bill in a wheelbarrow. “we don’t do comprehensive [bills] well”
- GOP is used to solving problems step by step, not all at once
- GOP supports allowing ppl to buy insurance across state lines, support medical malpractice reforms, getting states to lower costs, expand health-savings accounts
- Alexander requests that Obama renounces the idea of “jamming” hcr bill through reconciliation
- reconciliation has been used before, but it wouldn’t be right to use it to pass hcr, cited Byrd, who said doing so would be an “outrage”
- cites author who wrote tyranny of the majority is the biggest threat to American democracy
- says if we can start over, we can pass a hcr bill
SPEAKER PELOSI
- “i’ve seen grown men cry” because they or someone they know didn’t have health insurance
- this hcr bill will create hundreds of thousands of jobs
- this bill is about wellness, but most Americans haven’t heard about that
- this bill is about affordability, accessibility and accountability for the insurance co’s
- we must cut waste in Medicare, “we owe it to our Seniors, we owe it to our country”
- quotes Ted Kennedy by saying “healthcare is a right, not a privilege
HARRY REID
- told a story of a Hispanic man from Nevada whose wife gave birth to a baby with a birth defect, got a huge insurance bill four months later.....”this shouldn’t happen,” said Reid
- Reid to Alexander: “you’re entitled to your opinion, but not to your own facts...let’s talk about the facts.”
- cited a Kaiser poll that showed that 58% of Americans would be angry if nothing got done on healthcare
- said “donut hole” is really hurting Seniors
- “no one is talking about reconciliation”
- “of course [reconciliation] is not the only way” to pass hcr...said Republicans have used reconciliation a lot, accused Alexander of distorting truth about reconciliation
- said there are a ton of Republican amendments in senate bill, “has significant input from the Republicans.”
- cited Harvard study which shows 45,000 Americans die each year from a lack of health insurance, said thousands of bankruptcies are caused by people lacking health insurance
- “health reform shouldn’t be about political parties fighting with each other...this debate shouldn’t be about where ideas came from”
- "if you have a better plan for making health insurance more affordable, let’s hear it!”
- said CBO scored the Senate bill very favorably
- “[Democrats] are ready to listen”
POTUS
- “everyone went over their time limit, which is not surprising”
- POTUS taking a much more friendly tone. reid much more abrasive
- i dont know if we can bridge these differences, i hope we can
- let’s talk about how to help Americans deal with costs, “we might surprise ourselves” [in terms of what the two sides agree on.
- “we have to deal with costs, i haven’t heard anyone disagree with that”
- discusses how 20% of businesses have reported premium increases in the past year
- hcr is needed to protect businesses from paying huge insurance costs
- discusses his idea of setting up national health insurance exchanges
- “if you join one of these exchanges, you’ll have choice and competition...you’re gonna be able to get lower costs
- disputes Alexander’s claim that costs will go up under the current hcr bills, Alexander interrupts, then POTUS interrupts him.
- thinks GOP idea of letting ppl buy insurance across state lines is “interesting,” said he included that idea in his proposal
SEN. TOM COBURN (R-OK)
- said there is too much waste in healthcare industry right now, brought on somewhat by unnecessary government regulation
- cost is what keeps folks from getting healthcare
- said there needs to be more focus on prevention -- “we don’t do the good job of prevention”
- cited studies that show anywhere between 15%-20% of healthcare spending is fraud
- “we outta go for where the money is”
- said doctors ordering too many tests that aren’t for patients, said hcr bill needs tort reform to prevent defensive medicine
- cited Thomson-Reuters study that shows billions of dollars of wasteful healthcare spending
- “we can come together” on those two issues
- access would increase if everyone’s costs go down
- said the bill needs to provide incentives for wellness and prevention
- let’s improve student lunch and food stamp programs
- we need medical malpractice reform
- said private sector fraud rate is much lower than that of Medicare system
- we need to “look at where the money is,” not by creating new government programs, but by incentivizing people
HOUSE MAJORITY LEADER STENY HOYER (D-MD)
- told a story of a woman who left him a message saying she needs to pay for an operation, but it’s too expensive
- started out talking about cost-containment
- said Democrats have tried to incorporate free-market solutions into their hcr bills
- “we certainly agree” with Sen. Coburn about waste and fraud...”you speak eloquently and correctly” about eliminating waste
- we’ve addressed wellness in the House bill
- we need to incentivize coordination of care
- briefly mentioned the public option
POTUS
- HHS Sec. Sebelius working on defensive medicine issue
- said he wants to hear from GOP about what they think about small businesses being able to buy into a large insurance pool...”i know some of you have agreed with this in the past”
REP. JOHN KLINE (R-MN)
- we should allow small businesses to band together and purchase insurance, the same way large companies do...it will lower premiums for them
- “small businesses have been asking for this for years,” GOP likes this idea better than the national health exchanges
SEN. MAX BAUCUS (D-MT)
- both parties are actually a lot closer than we think on hcr
- discussed “Shop Act” within the senate hcr bill, which allows small businesses to participate in their own exchanges, which is akin to pooling
- senate bill also would provide tax incentives for small businesses to purchase insurance in the health exchange
- said senate wants small businesses to shop around and buy plans at affordable, competitive prices
- senate also wants to reform physician reimbursement system...says Sen. Coburn agrees with Democrats on that
- compared health exchanges to Orbitz online travel agencies
- “we basically agree, there’s not much difference here”
REP. DAVE CAMP (R-MI)
- cutting Medicare to fund new entitlement is a “step in the wrong direction”
- said CBO believes lawsuit reform would reduce costs, added that PriceWaterhouseCoopers issued similar report on potential savings
- camera panned to POTUS, who had a half-smile on his face
- said Democrats’ bills give too much authority to unelected buraeucrats
- POTUS interrupted and asked Rep. Camp to get back to addressing costs, said other stuff would be addressed later
REP. ROBERT ANDREWS (D-NJ)
Democrats don’t agree with allowing insurance companies to dictate how long patients should stay in the hospital
SENATE MINORITY LEADER MITCH MCCONNELL (R-KY)
said Democrats are getting much more time than GOP’ers
REP. PAUL RYAN (R-WI)
let’s not regulate insurance, that would reduce competition and drive up costs, said GOP wants to decentralize federal regulation of the healthcare industry
“do we distrust insurers?”
POTUS
it’s not true that everyone will have to sign up for a government insurance plan, House and Senate just want to set up some regulations
SEN. JOHN KYL (R-AZ)
said GOP has a hard time supporting hcr bills because it gives Washington more control over healthcare system
cited a CBO letter to Sen. Bayh that said the individual mandates within the bills would drive up premiums
said GOP doesn’t support raising Medicare payroll tax, called it a “job-killer”
all the taxes and fees in the bills would raise costs, said GOP wants a bill where the objective is not to raise a lot of money
said bills would raise taxes on middle-class Americans
bills “end up hurting the very people we’re trying to help”
POTUS
said folks will pay 10%-13% more because they’ll be purchasing better insurance
discussed desire to have minimum baseline coverage for customers, that’s “not some radical idea”
without a baseline minimum benefit, there won’t be protections for customers who are less healthy than others
a baseline would allow interstate commerce and would prevent a “race to the bottom” for insurance co’s at the same time
let’s set up some baselines, and then let the free market take things from there
HOUSE MAJORITY WHIP JIM CLYBURN (D-SC)
- no matter what kind of plan we develop, there will be some ppl uncovered, we need a safety net for those people
we need an expansion of community health centers, to help lower-income people receive care
told a story about a Senior who needed treatment, but couldn’t get treatment for more than 3 years because he was on Medicare, Clyburn called for Medicare reform
POTUS
this has so far “been a very helpful conversation”
told Boehner that anyone with a private insurance plan could keep that plan under the legislation
we all agree that insurance co’s can’t drop ppl for no reason, we all agree on lifetime caps
REP. CHARLES BOUSTANY (R-LA)
we need to look at streamlining paperwork for doctors
GOP proposal would bring down cost of premiums, Democrats’ bills would do opposite
I ran a small medical practice, i dealt with insurance co’s and was offered very limited choices, small business help plans would take care of this
glad that Democrats agree that enabling people to buy insurance across state lines would promote choice and competition
we need to promote health savings accounts, “it won’t solve all the problems,” but he said it would help
my arthritis meant that i had a preexisting condition, so i know how that works, high-risk pools would help that
new entitlements won’t bring down costs, families want a step-by-step plan
“we have a duty to reform healthcare, but we have an obligation to get it right”
REP. GEORGE MILLER (D-CA)
preventative care should not carry a co-pay with it
we should allow HSA’s to continue
i have a kidney stone and have had hip replacements, i’m screwed when it comes to buying insurance
back pain is a preexisting condition, stuff like that means that a lot of people go without insurance
56 million people in US have insurance policies where preexisting conditions could “knock them out” at any moment
high-risk pools don’t work because they trap people -- once they’re in that pool, they stay in that pool forever
SEN. McCAIN (R-AZ)
the Democratic bills were produced behind closed doors
blasted the exemptions for 800 Florida senior citizens from cuts to their Medicare
“people are angry...we promised them change in Washington, and what we got was a process that you and I both said we would change”
PhRMa deal was outrageous, their lobbyist was in the White House, that deal stipulated that they wouldn’t have to compete, and it also stipulated that White House would oppose provisions to import drugs from other countries
my constituents want us to start over on hcr, they want “unified treatment of all Americans”
POTUS
POTUS clearly annoyed with McCain
POTUS to McCain: “we’re not campaigning anymore, the election is over”
can we just focus on the issues of how we get a bill done?
“we can have a debate about process, or we can have a debate about how we’re gonna get this done”
HHS SECRETARY SEBELIUS
right now there are too many insurance monopolies where markets should instead exist
common areas of agreement are high-risk pools, House and Senate bills would use these pools as stop-gap measures to get sick people into better plans
we need consumer protections within high-risk pools
- let’s give people private sector choices, but at the same time make private sector work better
let’s get a handle on rates by putting pressure on insurance co’s to spend more money on coverage, and less on advertising, executive compensation, waste, etc.
HOUSE MINORITY WHIP ERIC CANTOR (R-VA)
Cantor had the complete Senate bill laid out in front of him
“we don’t care for this bill, I think you know that”
if Democrats think Washington should define health benefits, we think that is a problem
there are too many taxes on investment and income within the Democrats’ bills
cited CBO letter that said 8-9 million people could lose their insurance under the bill
people won’t be able to see the doctors they want under these bills
POTUS
said yes, people might lose coverage, but only because they will have better options to choose from under the bill
we could make food cheaper if we got rid of all regulations, same thing for perscription drugs, “but we don’t do that”
“we make decisions to protect consumers in every aspect of our lives”
we try to avoid situations where people think they’re getting one thing, and instead they get another
we need laws in place to make sure people don’t get randomly dropped from their coverage
told GOP that they agree with the Democrats on having at least some regulations in the insurance industry
pooling works because it spreads risk around
“we insure ourselves by making sure we’re also insuring others”
we want to make sure that everyone has insurance so that people don’t game the system by waiting until they are sick to buy insurance
REP. CANTOR
“we have a very difficult bridge to gap”
“we just can’t afford this” (referring to mandates)
“that’s why we say go step-by-step”
let’s lose the individual mandates
VPOTUS
“we don’t have a philosophical difference”
REP. CANTOR
government should not define what a health benefit should be
POTUS
yes, but only in the exchange
REP. LOUISE SLAUGHTER (D-NY)
preexisting conditions have to go, “all Americans should be treated the same”
we need to think about economic benefits of passing hcr, think about our trading partners who want us to prosper as a nation
proposal to turn Medicare into a voucher system is unfathomable, we’re better than that
***LUNCH BREAK***
SEN. MIKE ENZI (R-WY)
Medicare -- seniors are really nervous
“this summit would’ve been helpful if we had it 9 months ago”
GOP has problems with individual mandates, said if 26 states adopted mandates, the other 24 would follow
Federal employees have HSA’s available to them, everyone in US should have them too
“i like the exchanges...because it’s kind of a form of bidding”
Congress should mark which plans in the exchanges have minimum benefits
SEN. TOM HARKIN (D-IA)
we’re a lot closer than we think to agreement on hcr
read a letter from a constituent who saw his rates increase almost 15%
both bills have a lot of GOP ideas
we can’t do hcr incrementally, every provision is complementary...“it all hangs together”
states tried to do this in the 90’s, it didn’t work out, look at Massachusetts
“an incremental approach is like a swimmer who’s 50 feet deep drowning, and you throw him a 10-foot rope”
we still allow segregation today on the basis of people’s health
insurance co’s are flawed because they have to segregate people in order to have good ratings
said he used to sell insurance and learned one rule: the more people in the pool, the cheaper things are
REP. CAMP
GOP wants state universal access programs
States are pushing back on federal government over health insurance mandates
POTUS
you need pools with sick and healthy people, if it’s just sick people their premiums will be higher
only about 200K people in 20 or 21 states use high-risk insurance pools, it’s not beneficial
“if everyone is in it, then that drives prices down for everyone”
SEN. JAY ROCKAFELLER (D-WV)
WellPoint CEO wrong to say she won’t cut down employee salaries, including her own, we’re gonna end that, but we need a bill
insurance co’s can just kick people off their plans, it’s legal in 44 out of 50 states
insurance co’s don’t have enough oversight, no antitrust rules, “they can do what they want and they do!...it makes me sick”
“the public option, i like that a lot, but it’s not gonna happen”
“this is a rapacious industry that does what it wants”
individual mandate not in the bills because government wants to control everything, it’s in there because you need a big pool of customers
when you make everyone participate, you create a bigger risk pool and it’s better for everyone
“it’s good public policy” to require everyone to buy insurance
REP. MARSHA BLACKBURN (R-TN)
we need to let people purchase insurance across state lines
Senate bill requires federal approval to allow states to do compacts
Democrats’ bills also doesn’t implement any of the big reforms until 2016
“states have stop-lights up” right now in terms of selling across state lines, Governors support reforming this
POTUS
insurance pool has become older and sicker, way to solve that is to broaden the pool, that’s what the exchanges do
how about a national exchange with minimum standards? that would be a way to bridge difference between Democrats who don’t want purchasing across state lines and GOP’rs who do
I was opposed to the individual mandates when I ran for President. After kicking and screaming, i supported it, because it’s about responsibility
one reason i changed: cost-shifting -- ex: if someone without health insurance goes to the emergency room, we all pick up the tab
we’re not saving money by not asking people to be responsible and buy their own insurance
REP. BLACKBURN
asked POTUS to “free it up”
POTUS
that’s not the problem. the problem is that there isn’t competition. “we want competition, but we also just want some minimum standards”
VPOTUS
Biden thinks he knows what people thinks but doesn't want you to think he thinks too much about thinking.
costs have doubled over the years for healthcare -- that wrecks budgets
we’re spending too much on Medicare and Medicaid
Biden read from notes, spewed a lot of numbers, not very inspiring, nor helpful in my opinion
WH proposal closes Medicare donut hole, extends Medicare trust funds
Biden blabbered and rambled and yammered for roughly 10 minutes, phone started ringing -- a presidential-sounding themed ring tone -- as he wrapped up....continued ringing for about 2 minutes into Rep. Paul Ryan’s remarks
REP. RYAN
bill placed in front of CBO is full of gimmicks
hcr bill raides Medicare, cited CMS Actuary report, which said doctors who rely on Medicare payments will go out of business in the years to come
the philosophical difference is that Democrats want the government to be in control of healthcare, while GOP wants the American people to be in control
main point is that the Democrats/Obama plan is a massive government takeover of healthcare, and the majority of the public is against that
POTUS
we’re not talking about cutting Medicare benefits, we’re talking about Medicare Advantage
REP. XAVIER BECCERA (D-CA)
little back and forth disagreement with Rep. Ryan over CBO numbers
called the CBO “the referee,” said CBO had scored Democrats’ bills very favorably
said the bills closed the Medicare donut holes and produced savings at the same time
we’re working with GOP to eliminate waste and fraud
coordinating care will reduce costs, to the tune of as much as $100 billion
Sen. Chuck Grassley (R-Iowa)
If you're going to make cuts to Medicare, you need to make sure there is still a system left.
Sen. Kent Conrad (D-N.D.)
"The biggest unfunded liability of the United States in Medicare."
-Says the idea we don't need to revamp Medicare is unrealistic, dangerous.
By doing nothing, it is guaranteed Medicare will go broke.
5% of Medicare beneficiaries use half of all Medicare funds. They are the chronically ill.
The system is characterized by chaos.
JOHN BOEHNER (R-Ohio)-HOUSE MINORITY LEADER
"The thing I've heard more than anything ... the American people want us to scrap this bill."
"This bill ... will bankrupt our country."
A dangerous experiment.
Individual mandate: unwise, unconstitutional.
Boehner is bringing abortion back into the health care reform debate.
Claims it allows taxpayer funding for abortion.
OBAMA RESPONSE
This is going back to the standard talking points.
Claims "based on my analyses are just not true"
REP. JIM COOPER (D-TN.)
We've heard a lot of people try to outdo each other in deficit reduction. I welcome that challenge.
Concedes support for McCain complaints about special deals, Ryan arguments against waste.
Brings up deficit panel's failure in the Senate.
If you love Medicare, you have to act to save it.
Too few people are making the tough votes.
Calls for a "new day."
McCAIN
"None of us want to do nothing, but we want to start over."
California/Texas shows tort reform is working.
"Law suit filings are down" so is defensive medicine spending.
McCain: I prefer being in the majority.
There has been reconciliation, but not at an issue of this magnitude.
Process has been "more than offensive"
OBAMA
Malpractice reform a real issue, but not the single biggest driver of inflation as Boehner claims.
I would be interested in incentivizing states to experiment with ways to reduce frivolous law suit as Coburn suggests.
Discussions on coverage is coming up.
DICK DURBIN- SENATE MAJORITY WHIP, D-Ill.
Says he's practiced malpractice law.
As you lose accountability, more people will die says CBO reference to study.
We should focus on reducing medical errors. Incentivize states.
Our jury system should make decisions on malpractice payments.
If you think it's a socialist plot, stop taking federal insurance. Very provocative point.
OBAMA
Make that 4:30.
Coverage- Can America do what every other advanced nation does?
Outlines basics of his plan...again.
Let's not pretend we can get 30 million people covered for free. We can't.
JOHN BARASSO
If you go to any community in America and ask if health care bill will raise health care costs, everyone says yes.
Seniors are most scared. Hospice care will be cut, etc.
Time to start over.
OBAMA
Would you be satisfied if Congress just have catastrophic coverage?
BARASSO
Yes.
OBAMA
What if you were making $40,000?
BARASSO
*Nothing*
Barasso and Obama clash over health savings accounts effectiveness and accessibility.
WAXMAN
Under Republican proposal: People who get break are people who are healthy.
If I heard only Republican rhetoric, I'd agree.
Exchange spread costs, make it so people don't need to pay more etc.
This bill is good for people on Medicare. Without it people will be "squeezed" like crazy.
OBAMA
"We're not making campaign speeches here"
ROSCAM
"The problem with the bill is not the messenger, it's the message"
Medicaid is house of cards
What Congress intends to do is expand Medicaid. Won't work. Bad idea.
Unnecessary Metaphor time: Health care reform is like an etch a sketch!
OBAMA
Very poor have coverage that is superior to those that have a little bit more.
DODD
While everyone is entitled to a lawyer, not everybody is entitled to a doctor.
Hidden tax supplied by the uninsured in emergency rooms.
6-8 will have lost their lives per day due to lack of health insurance.
You can't get to affordability, other issues, without increasing coverage.
BARTON
Never before have so many politicians been so civil in front of so many cameras.
Bills only play lip service to medical malpractice.
OBAMA
Let's wrap it up.
Charlie Rangel next, Republican, Patty Murray, John Dingell, Ron Wyden and more. That's wrapping up?
McConnell
Health care savings accounts are not just for rich people. $60,000 the median income of users.
Points out health care polls showing American opposition, says opinion can't be ignored.
OBAMA
When you poll people about individual aspects of the bill, they are in favor of it.
Obama said he was hopeful there would be meaningful overlap and that people wouldn't run to their predictable positions. Doesn't look like it worked.
COBURN
Key goal is to reconnect purchase and payment, become good purchasers.
"We ought to have another talk like this"
RANGEL
"We are so close"
"We can't start over."
JOHN DINGELL
Current trajectory a recipe for disaster.
Can't start over. Calls to do so are, to quote Schwarzenegger, "bogus" and "partisan."
"Here we have a chance to serve the people."
Dingell defends 51 vote majority.
'The last perfect legislation was the 10 commandments'
PELOSI
"We've come a long way."
Insurance industry left to its own devices has acted shamefully.
I want the record to show two false statements: no public funding for abortion, medicare cuts do not cut benefits to seniors
OBAMA
Wrapping it up an hour late. Says it beats his prediction.
Starting a 10 minute summary.
"We're not being complicated for the sake of being complicated. If we could have a five page bill we would."
Tort reform still holds room for negotiation.