Examining Pathways to Universal Health Coverage — House Hearing, Serial No. 117-73
Summary
Printed record of a March 29, 2022 hearing of the Committee on Oversight and Reform, House of Representatives, on pathways to universal health coverage, Serial No. 117-73, with Chairwoman Carolyn B. Maloney. The first panel includes Christopher Willcox, Nicole Lyons and minority witness Chris Briggs. The second panel includes Uche Blackstock of Advancing Health Equity, Sara Collins of The Commonwealth Fund, Grace-Marie Turner of the Galen Institute, Jeffrey Sachs of Columbia University, Jamila Michener of Cornell University and Ady Barkan of Be a Hero. A closing statement says Medicare for All would guarantee high-quality healthcare to every person in America. The committee adjourned at 1:52 p.m.
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[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]
EXAMINING PATHWAYS TO UNIVERSAL
HEALTH COVERAGE
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON
OVERSIGHT AND REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTEENTH CONGRESS
SECOND SESSION
__________
MARCH 29, 2022
__________
Serial No. 117-73
__________
Printed for the use of the Committee on Oversight and Reform
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available on: govinfo.gov,
oversight.house.gov or
docs.house.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
47-267 PDF WASHINGTON : 2022
-----------------------------------------------------------------------------------
COMMITTEE ON OVERSIGHT AND REFORM
CAROLYN B. MALONEY, New York, Chairwoman
Eleanor Holmes Norton, District of James Comer, Kentucky, Ranking
Columbia Minority Member
Stephen F. Lynch, Massachusetts Jim Jordan, Ohio
Jim Cooper, Tennessee Virginia Foxx, North Carolina
Gerald E. Connolly, Virginia Jody B. Hice, Georgia
Raja Krishnamoorthi, Illinois Glenn Grothman, Wisconsin
Jamie Raskin, Maryland Michael Cloud, Texas
Ro Khanna, California Bob Gibbs, Ohio
Kweisi Mfume, Maryland Clay Higgins, Louisiana
Alexandria Ocasio-Cortez, New York Ralph Norman, South Carolina
Rashida Tlaib, Michigan Pete Sessions, Texas
Katie Porter, California Fred Keller, Pennsylvania
Cori Bush, Missouri Andy Biggs, Arizona
Shontel M. Brown, Ohio Andrew Clyde, Georgia
Danny K. Davis, Illinois Nancy Mace, South Carolina
Debbie Wasserman Schultz, Florida Scott Franklin, Florida
Peter Welch, Vermont Jake LaTurner, Kansas
Henry C. ``Hank'' Johnson, Jr., Pat Fallon, Texas
Georgia Yvette Herrell, New Mexico
John P. Sarbanes, Maryland Byron Donalds, Florida
Jackie Speier, California Vacancy
Robin L. Kelly, Illinois
Brenda L. Lawrence, Michigan
Mark DeSaulnier, California
Jimmy Gomez, California
Ayanna Pressley, Massachusetts
Russ Anello, Staff Director
Miles Lichtman, Deputy for Health Oversight and Policy
Elisa LaNier, Chief Clerk and Operations Director
Contact Number: 202-225-5051
Mark Marin, Minority Staff Director
------
C O N T E N T S
----------
Page
Hearing held on March 29, 2022................................... 1
Witnesses
Panel 1
Christopher Willcox, MSW, St. Louis, Missouri
Oral Statement............................................... 7
Nicole Lyons, New York City, New York
Oral Statement............................................... 8
Chris Briggs (Minority Witness), Woodburn, Virginia
Oral Statement............................................... 10
Bishop Walter Starghill, Jr., Inkster, Michigan
Oral Statement............................................... 13
Leslie Templeton, Boston, Massachusetts
Oral Statement............................................... 15
Panel 2
Uche Blackstock, PhD, Emergency Physician, Founder and Chief
Executive Officer, Advancing Health Equity
Oral Statement............................................... 16
Sara Collins, PhD, Vice President of Health Coverage and Access,
The
Commonwealth Fund
Oral Statement............................................... 18
Grace-Marie Turner (Minority Witness), President, Galen Institute
Oral Statement............................................... 20
Jeffrey Sachs, PhD, Director, Columbia University Center for
Sustainable Development, President, United Nations Sustainable
Development
Solutions Network
Oral Statement............................................... 22
Jamila Michener, PhD, Associate Professor, Cornell University
Department of Government, Co-Director, Cornell University
Center for Health Equity
Oral Statement............................................... 25
Ady Barkan, JD,Founder, Be a Hero
Oral Statement............................................... 27
Opening statements and the prepared statements for the witnesses
are available in the U.S. House of Representatives Repository
at: docs.house.gov.
INDEX OF DOCUMENTS
----------
* List of All Hearings with Federal Agencies held in the House
Oversight Committee since January 2021; submitted by Chairwoman
Maloney.
* University of California - San Francisco Study on Single-
Payer Proposals; submitted by Chairwoman Maloney.
* Questions for the Record: to Ms. Grace Marie-Turner;
submitted by Rep. Comer.
The documents listed are available at: docs.house.gov.
EXAMINING PATHWAYS TO UNIVERSAL
HEALTH COVERAGE
----------
Tuesday, March 29, 2022
House of Representatives,
Committee on Oversight and Reform,
Washington, D.C.
The committee met, pursuant to notice, at 9:05 a.m., in
room 2154, Rayburn House Office Building, and via Zoom; Hon.
Carolyn B. Maloney [chairwoman of the committee] presiding.
Present: Representatives Maloney, Norton, Lynch, Connolly,
Krishnamoorthi, Raskin, Khanna, Mfume, Ocasio-Cortez, Tlaib,
Porter, Bush, Brown, Davis, Welch, Johnson, Sarbanes, Kelly,
DeSaulnier, Gomez, Pressley, Comer, Jordan, Foxx, Hice,
Grothman, Cloud, Sessions, Keller, Biggs, Clyde, LaTurner,
Herrell, and Donalds.
Also present: Representatives Jayapal, Omar, Bowman, and
Jones.
Chairwoman Maloney. The Committee will come to order. I am
told we need to restart the opening because of the stream was
not there.
Today, I am convening the Committee on Oversight and Reform
to examine a subject that touches the lives of every person in
the United States, our Nation's healthcare system and
Americans' access to affordable, high-quality medical care.
Democrats in Congress have spent decades fighting, and
succeeding, to expand access to healthcare in the United
States.
In 2010, under the leadership of President Obama, we passed
the Affordable Care Act, a landmark law that made affordable
healthcare accessible to more than 30 million people across the
United States. That includes 14 million people with lower
incomes who finally received high-quality health insurance,
thanks to the Affordable Care Act's Medicaid expansion. This
also includes millions of people who had previously experienced
obstacles to obtaining healthcare, including people with
preexisting conditions, older Americans, and women.
Unfortunately, my colleagues on the other side of the aisle
not only opposed this law, but over the last decade, they have
voted more than 60 times to repeal it or weaken it. Republican
Attorney Generals sued in Federal court, trying to strike it
down, and the Trump administration refused to defend the ACA in
court. Despite these relentless attacks and thanks to the
tireless work of patients, caregivers, and community advocates,
the ACA still stands.
Since President Biden took office, congressional Democrats
have continued to strengthen and enhance the ACA to make
healthcare more affordable and accessible for every person in
the United States. Last year, we passed President Biden's
American Rescue Plan, sweeping legislation that expanded the
ACA's financial assistance for patients and families working to
make ends meet.
But our work is not done yet. Today, more than 27 million
people in the United States remain uninsured, and even for some
who do have insurance, it is not enough to insulate them from
the significant cost of getting healthcare in this country.
congressional Democrats have proposed and advanced many
different reforms to close these coverage gaps and move our
Nation toward universal health coverage. We have voted on
legislation to close the coverage gap left by Republican States
that failed to expand Medicaid under the ACA, as well as
legislation to expand Medicare benefits for older Americans and
to further reduce out-of-pocket costs for patients with
commercial coverage.
And more than 100 of us have cosponsored the Medicare for
All Act, as proposed by my colleague Congresswoman Pramila
Jayapal and championed by numerous members on this committee.
Medicare for All, a comprehensive proposal to transition our
healthcare system to a national single-payer model, offers a
bold vision for an America where no patient is denied necessary
medical care because it is too expensive and no family has to
decide between putting food on the table or paying their
medical bills. This proposal fulfills a promise that I have
long fought for, the promise that healthcare is a human right.
Medicare for All would contain skyrocketing costs across
our healthcare system and provide a sustainable path to more
equitable and accessible healthcare, especially for communities
where access has historically been pushed out of reach. I have
proudly supported Medicare for All since it was first
introduced in Congress nearly two decades ago, and I will
continue to push for this vision of the American healthcare
system.
At the same time, my Democratic colleagues and I will
continue to fight for every bit of progress we can make in
moving our Nation toward universal coverage. While Republicans
raise barriers to affordable healthcare, Democrats will
continue working tirelessly to ensure that no person's
financial circumstances keep them from obtaining quality
healthcare.
Let me conclude by taking a moment to recognize the
leadership of several of our committee members in bringing
renewed energy and urgency to the fight for universal coverage.
Congresswoman Cori Bush, Ayanna Pressley, Alexandria Ocasio-
Cortez, and Rashida Tlaib, all members of this committee, have
been some of the most powerful voices in Congress for an
America where healthcare is a human right, and I am grateful to
partner with them.
Before I recognize the distinguished Ranking Member for his
opening remarks, I would like to recognize Congresswoman Bush
for an opening Statement.
You are now recognized, Congresswoman Bush.
Ms. Bush. St. Louis and I thank you, Chairwoman Maloney,
for your partnership in convening this historic hearing on the
urgent need for comprehensive and universal health coverage in
the United States. The committee's exemplary leadership,
tireless advocacy, and commitment to genuine health equity will
rightfully bring this conversation back to the forefront of
public health policy.
I must acknowledge the tremendous work and contribution of
Senator Sanders and Rep. Jayapal for putting forth the boldest
legislative proposal to date, the Medicare for All Act, and to
my sisters in service on this committee for their partnership
and steadfast leadership in our effort to protect healthcare as
a human right.
Thank you to our seeing witnesses, a comprehensive range of
patients and researchers, healthcare professionals, who have
come together today to passionately advocate for universal
healthcare.
Medicare for All is transformational policy change that
would implement a national single-payer universal healthcare
system that guarantees comprehensive healthcare coverage to
every person in America and end the for-profit, privatized
broken system we have in place now.
I have personally bore witness to the stark inequities
faced by uninsured and underinsured patients during my tenure
as a registered nurse. For some people, it is hard to imagine
rationing expensive medication like insulin, skipping dialysis
appointments, forgoing surgical procedures, or refusing medical
care entirely. People are having to choose between their life
or a lifetime of medical debt, and that is not OK.
And I know because I am one of those people. Until I was
sworn in as a Member of Congress, I was uninsured for over a
week, and actually, I have spent the better part of my
adulthood lacking access to health coverage, overburdened by
medical debt, and unable to receive regular preventive and
routine medical care. It shouldn't have taken a job for me to
be able to access affordable medical care. Healthcare is a
human right, and we should guarantee it for everyone.
Providing every single person in the United States with
healthcare is a powerful anti-poverty mechanism. Medicare for
All would help low-income households save over $38 billion
annually on medical out-of-pocket expenses like deductibles,
copays, co-insurance, and self-payments. Research has proven
universal coverage will help reduce poverty rates by over 20
percent.
In St. Louis, our communities are facing systemic threats
to their health from all angles--from poverty, substandard
housing conditions, environmental destruction, overdose and
mental health crises, pollution, to over policing. Lack of
affordable healthcare has resulted in millions of preventable
deaths before the pandemic, and the situation continues to
rapidly deteriorate as COVID-19 claims over 1 million lives and
counting.
While Democrats have a majority in the House, Senate, and
the executive branch, it is imperative lawmakers seize this
narrow opportunity now to enact transformational public health
policy and poverty-reductive policies like Medicare for All.
Taking strides toward universal healthcare coverage is the only
path forward to reversing troubling trends in U.S. population
health.
I urge my colleagues on both sides of the aisle to
earnestly consider the lethal consequences of continuing to
prioritize big pharma profits over human life and health.
Thank you, and I yield back.
Chairwoman Maloney. The gentlelady yields back.
I now recognize the distinguished Ranking Member, Mr.
Comer, for an opening Statement.
Mr. Comer. Thank you, Chairwoman Maloney, and I want to
thank our witnesses for your testimony here today.
Keeping with the majority's pattern this Congress, today's
hearing is not an oversight hearing. It is not a hearing that
will bring transparency or accountability to the executive
branch. It is not a hearing to find ways to save taxpayer
dollars, especially as Americans toil under inflation.
Instead, today's hearing is an attempt to find more ways to
spend taxpayer dollars and expand the reach of the Federal
Government. It is a hearing to grow massive entitlement
spending, this time by pushing for Government-run healthcare.
With inflation at a 40-year high, Americans are struggling
to afford essential items like food and medicine. Since day one
of this administration, President Biden's policies have
crippled America's energy independence. Gas prices have
skyrocketed. In California, gas prices are over $6 a gallon.
Meanwhile, fentanyl is streaming across the Southern border
unchecked. According to the Centers for Disease Control,
fentanyl overdoses are now the leading cause of death for
adults age 18 to 25. Children are also being hit hard by the
fentanyl crisis with reports daily about accidental overdoses.
Yet my Democrat colleagues refuse to look into any of these
issues. The mission of the Oversight Committee is to root out
waste, fraud, abuse, and mismanagement in the Federal
Government, but Democrats keep finding new ways to use the
tools of the committee to spend even more taxpayer dollars.
Instead of looking for ways to expand Government, Oversight
Committee Republicans have been conducting our own
investigation in the healthcare space on Medicaid improper
payments. And what we have found is very disturbing. Documents
obtained during the investigation show that Democrat policies,
such as Medicaid expansion and removing eligibility checks,
have increased improper payment rates in the program.
In fact, improper payments are so rampant, the most recent
data shows that more than 1 out of every 5 Medicaid payments
are improper. That is about $87 billion in taxpayer money being
misused in one Fiscal Year alone. Why aren't we holding a
hearing on that?
Instead, this hearing is about further expanding Obamacare
and moving the United States closer to socialized medicine.
Medicare for All will gut quality healthcare coverage in favor
of waiting lines, rationed care, and stalled medical
innovation. Medicare for All will cancel first-rate health
plans for millions of workers, children, and seniors in favor
of giving D.C. politicians unlimited control of your
healthcare.
Evidence around the world shows socialized medicine causes
long lines for treatment, decreased innovation, and empowers
the Government to decide who lives and who dies. It also
enables systems that benefit the rich who can afford private
insurance to bypass Government waitlists.
Democrats have seen the polling and know the American
people don't want Medicare for all. So Democrats have worked to
hide their end goal from the American people, using terms like
``Medicare for all who want it'' and ``public options,'' when,
in reality, these are just steppingstones to socialized
medicine. But no amount of Washington spin can change the fact
that socialized medicine is a bad deal for the American people.
Americans recognize the frightening attempts at Government
takeover of healthcare for what they are, bans on good
healthcare plans that work, eradicating Medicare for seniors as
we know it, and doubling everyone's taxes. And voters will
reject it. When they do, Republicans stand committed to working
together to improve the broken status quo and lower healthcare
costs for families and small businesses.
Republicans, through the Healthy Future Task Force, are
already working to develop common sense proposals to increase
competition, encourage investment in new cures and therapies,
protect access to care for all Americans, and ensure patients
remain in control of their care. But Republicans know
centralizing control in D.C. and continuing to limit access and
choice for patients is an awfully bad starting point for
Democrats.
Republicans will continue to fight Democrats' takeover of
healthcare through common sense solutions to increase the
availability of affordable care for all Americans while
ensuring we remain the global leader in healthcare innovation.
And with that, Madam Chair, I yield back.
Chairwoman Maloney. The gentleman yields back.
We have very important witnesses today, and I want to focus
on getting to their testimony. Let me briefly say that
President Biden has unified our allies in Asia and Europe. He
has restored trust in American leadership. He has swiftly acted
to move against the aggression of Russia against the Ukraine.
After the COVID crisis, he has taken steps to help our economy
and has had record employment, the most ever in the history of
our country.
I would like to place into the record a list of all the
Federal hearings that we have had in Oversight and address the
other attacks on the Biden administration and respond very
simply to the claim that our hearing today is too expensive.
The truth is we cannot afford our current healthcare
system. We pay more for healthcare than any other comparable
nation, nearly 20 percent of our GDP and rising yearly.
Americans go bankrupt because they don't have health insurance,
and that is a national disgrace. And studies show that the
reforms we are discussing today would actually save money over
time.
I would like to submit for the record a study from the
University of California San Francisco, which analyzed 22
single-payer proposals and found that every single one would
result in long-term financial savings.
Without objection.
Chairwoman Maloney. If my Republican colleagues were really
worried about inflation, they would support policies that bring
down healthcare costs instead of voting 60 times against the
Affordable Care healthcare plan that has expanded healthcare to
30 million Americans.
Finally, in terms of the deficit, I don't hear my
Republican colleagues complaining when President Trump pushed
through $1.9 trillion in tax cuts for the very well off. I
invite my Republican colleagues to stop playing politics and
let us work together on real solutions, all kinds of ideas that
we will be discussing today, real solutions so that working
families can get the healthcare they so justly deserve at an
affordable price.
And before we move on, I would like to ask unanimous
consent that Representatives Omar, Bowman, Jones, and Jayapal
be allowed to participate in today's hearing.
Without objection, so ordered.
Now we are going to introduce our distinguished first panel
of witnesses who are all patient advocates. The first panel
will not be taking questions, but we welcome their experience,
their perspective.
I now recognize Ms. Bush to introduce the first witness.
Ms. Bush. I am proud to represent a witness in this hearing
from St. Louis, Mr. Christopher Willcox, who will share his
testimony as both an underinsured patient and a relentless
advocate for Medicare for All.
Chris is currently the mutual aid and policy advocate at A
Red Circle, where he helps connect St. Louis County residents
with community resources. As a social worker who is passionate
about healthcare, housing, and freedom from police violence,
Chris has extensive experience helping patients navigate a
fragmented healthcare system.
I am confident his testimony will lay bare the true human
cost of the brutal for-profit healthcare industry.
Chairwoman Maloney. Thank you.
Our next witness will be Nikki Lyons, who is a pre-med
student from my district in New York.
After that, we will hear from Chris Briggs, who is a
patient advocate from Woodburn, Virginia.
I now recognize Ms. Tlaib to introduce our next witness.
Ms. Tlaib. Thank you so much, Chairwoman Maloney, for your
incredible courage in having this hearing and, of course, to
all of my other sisters in service for helping us bring so many
of our families into the halls of Congress as they express the
dismay of our broken healthcare system.
I have the honor of introducing Bishop Walter Starghill
from Inkster, strong in Thirteenth congressional District. The
bishop has already had personal experiences himself, almost
going blind because of our broken healthcare system, but he
also serves in one of my amazing federally accredited clinics.
He serves as the vice chair of an all-volunteer board of
directors of Western Wayne Family Health Centers, whose goal is
to provide high-quality, affordable care for all of our
residents and our communities, regardless of insurance status.
I want to thank him so much for his courage and for him
providing this testimony that is so critical. As the bishop
will tell you, in our district, we are not about just
surviving. We are also about thriving. And that is why we need
to get closer to passing Medicare for All.
Thank you so much, Chairwoman. I yield.
Chairwoman Maloney. I now recognize Ms. Pressley to
introduce our final witness.
Ms. Pressley. Thank you, Madam Chair, for your leadership
and heeding our calls, working with my colleagues and I to hold
this critically important, historic, and timely hearing. It has
been a long time coming.
I thank Rep. Jayapal for being undeterred in this justice
fight, and of course, I want to recognize my colleague and
sister in service, Representative Bush, for spearheading this
effort.
The fight to make Medicare for All a reality is
intrinsically a fight to center people with disabilities once
and for all, and that is why I am proud to introduce Leslie
Templeton, constituent of the Massachusetts Seventh, a resident
of Boston, who from a young age has navigated the world as a
disabled person and uses her experiences to advocate for
others.
Thank you, Leslie, for your tireless dedication to
advancing disability justice in the Commonwealth and across the
United States. You make the Massachusetts Seventh and the
movement very proud.
Chairwoman Maloney. The gentlelady yields back.
The witnesses will be unmuted so that we may swear them in.
Please raise your right hands.
Do you swear or affirm that the testimony you are about to
give is the truth, the whole truth, and nothing but the truth,
so help you God?
[Response.]
Chairwoman Maloney. Let the record show that the witnesses
answered in the affirmative.
Thank you. And without objection, your written Statements
will be made part of the record.
With that, Mr. Willcox, you are now recognized for your
testimony. Mr. Willcox?
STATEMENT OF CHRISTOPHER WILLCOX, MSW, ST. LOUIS, MISSOURI
Mr. Willcox. Great. Thank you for the kind introduction and
thank you for inviting me to speak.
My name is Chris Willcox. I'm an organizer with St. Louis
Mutual Aid, and I work for A Red Circle, which is a nonprofit
that serves North St. Louis County.
My history with healthcare systems in America comes from
the perspective of those receiving services and from providing
them. I was first diagnosed with anxiety and depression in
college before I graduated in 2011 at the peak of the Great
Recession. Getting treatment for depression suddenly made a lot
of struggles in my life make sense.
The thing about depression is that the simplest things,
such as getting out of bed, can feel incredibly difficult, and
it can be hard to even imagine that there is anything worth
getting up for. Adding to that, failing to overcome challenges
makes it all the easier to gather what feels like a cumulative
body of evidence of your own worthlessness.
We deal with arbitrary disruptions in healthcare because of
our dependence on private health insurance companies and
struggles with precarious employment. I've had to change
therapists at least three times because the ones I was working
with was no longer in network.
When I was temporarily uninsured or had to start with a new
insurer, I've had to go through withdrawals multiple times
because of denials or delays, prior authorizations, or any
other bureaucratic headaches we spend hours and hours of unpaid
time dealing with.
In my experience working in social services, the
limitations of existing public health insurance left many of my
clients' needs unmet. Many agencies operate by churning as many
billable services as possible from underpaid and poorly
supported staff. Imagine being worried about making your
numbers while trying to be present for a client that is telling
you about their suicidal ideation.
One client I work with is particularly ill-served. She had
to borrow money from her brother to get her medications while
she waited on Medicaid to establish her coverage. I was advised
to reschedule her appointments so that I could pick up others
to get my numbers up because she would frequently have to
reschedule. Understandable for someone needing treatment for
serious mental health challenges.
The very day I was given this advice, this same client
texted me a call for help as she was struggling with suicide.
After I intervened, she went to the hospital for the second
time for suicide before she was finally granted coverage by
Medicaid. This was while I was having my own thoughts about
suicide related to the conditions of my job, but I had put off
seeing a therapist for several months because during that time,
I was hired late in the year, and I would have to pay entirely
out-of-pocket, have the deductible reset in January.
These problems exist simply because we choose not to make
the commitment to care for every person who needs it. This may
be even more the case in mental illness, which can be every bit
as lethal. It takes courage and resolve just to seek treatment,
as fear of being seen as weak or as making it up in your head
only adds to the barriers we already put between people and
care.
Without getting the care I needed, I might not even be
alive today, let alone speaking to Congress about finally
getting the support our people need and deserve. We know what
we need to do to make sure that everyone gets the care that
they need, Medicare for All now.
Thank you.
Chairwoman Maloney. Thank you. The gentleman yields back.
Ms. Lyons, you are now recognized for your testimony. Ms.
Lyons?
STATEMENT OF NICOLE LYONS, NEW YORK CITY, NEW YORK
Ms. Lyons. Hi. OK, thank you so much for giving me the
opportunity to speak today, members of the House committee.
Just give me one second. I'm having a little technical
difficulty right now.
So, as the speaker said, my name is Nikki Lyons. I'm here
to speak today because the second time in my 20's, I am waiting
for an organ transplant due to kidney failure.
This loss of control regarding so many aspects of my life
and waiting for an organ transplant has had me thinking many
times about what I would say to you guys with the power to make
changes in this place where decisions are made. Like so many
Americans, Medicare for All would have changed the course of so
many aspects of my life and provide comfort for my future.
The first time I found out I was sick, I was at a hospital
in the middle of college midterms week and waking up from an
emergency appendectomy. The diagnosis was not adequately
explained, and there is no followup care that one would expect.
As a struggling college student, I didn't have the luxury
to see a doctor anywhere besides the emergency room. Because of
this, I didn't know how truly sick I was, and because of my
illness, I ended up failing out of school, which further
delayed my career and cost thousands and thousands of dollars.
Years later, I found out at that time I already should have
been looking for a transplant because I was in the end stages
of kidney failure, not told just to watch my sodium--or not
just to watch my sodium, as I was told. Had I had regular
access to healthcare, blood tests, anything like that, the
extent of my organ failure could have been stalled or even
prevented, had it been caught early enough.
While waiting for my first transplant, instead of resting
and conserving the little energy I did have, I was working 50-
plus hours a week on my feet at a bar and at a gym to afford my
doctors' appointments and medication. For those who don't know,
potential transplant patients are evaluated for stability as to
not waste the gift of an organ. They look at your housing, your
economic status, your compliance with doctors. Not being able
to afford medication or appointments could have disqualified me
for the organ I needed to live at any point.
Medicare for All would have meant not deciding if I needed
to skip meals to qualify for a kidney. I wouldn't have had to
work myself to the bone while incredibly sick.
I was lucky enough to receive a transplant in 2016, but I
am again in organ failure. This round of organ failure I can
say with 100 percent certainty would have been prevented by
Medicare for All. I wasn't able to get regular transplant
checkups because of the resources I had allotted for healthcare
went toward mitigating the symptoms of long-term COVID. Because
of the lack of care, I had no idea my body was rejecting my
transplant as a complication of said long-term COVID.
I haven't been able to properly work or attend class
adequately since winter of 2020. The COVID symptoms
transitioned into kidney failure symptoms so seamlessly to the
point I didn't realize what was happening. All I had needed was
a simple blood test, and the rejection would have been caught
earlier. When rejection is caught quickly, it is very
treatable.
I, unfortunately, wasn't that lucky. It was amazing I was
alive for the second time in my life. Since June, I have had
six long-term hospital stays, with the longest being seven
weeks; travel 12 hours a week 3 times--12 hours 3 times a week
for dialysis for 3 1/2 hours; blood transfusions, chemicals
similar to chemo to try and save the kidney and prevent
anything from getting worse, and that just ends up making me
feel significantly worse. I've had days I'm only able to be
awake for four hours. There's no way for me to work, finish
school, or thrive at all in this condition.
On top of this, I had no insurance when this first started
until Medicare kicked in, which took six months from the time I
applied. I was told their online system never got my
application several times, and then after that, several times
the local office had lost my paperwork and never filed it.
So, for those six months, I couldn't access care unless I
went to an ER. I ended up going into heart failure as well
during this time, which took four ERs to catch. But had I been
able to see a cardiologist for something as simple as an
ultrasound of the heart or an echo, it would have been spotted
immediately.
I was also told peritoneal dialysis would have been a much
better option than the standard hemodialysis that I had to
endure because no surgeon would place the right catheter if I
didn't have insurance to pay for said surgery. So I have spent
the past six months getting the entirety of my blood taken out
through a tube in my neck, cleaned, and returned to my body
while often going into shock when there's a loss of fluids
because it makes your heart unable to pump blood through the
body, having horrible insomnia, deep pain, and fatigue.
Six months of suffering due to a lack of access to care for
a medical situation that should have been prevented in the
first place. Medicare eventually kicked in, and now 229 days
after my first dialysis session, I am finally switched over to
in-home peritoneal dialysis that I should have gotten in the
first place. Two hundred twenty-nine days of my life were
robbed from me for reasons out of my control, but preventable
for the next person by the elected officials sitting in this
room.
The experiences I briefly shared are but a drop in the
bucket compared to my full story. I wanted to take the time to
thank everybody for listening to me, and I implore you to take
the time to fully absorb what the words I said meant.
This situation is happening across the country, and
Medicare for All would prevent it. It is inhumane to present
any human being in a situation where they must choose between
eviction, a lack of food, or their healthcare.
Thank you.
Chairwoman Maloney. Thank you.
Mr. Briggs, you are now recognized.
STATEMENT OF CHRIS BRIGGS, WOODBURN, VIRGINIA
Mr. Briggs. Chairwoman Maloney, Ranking Member Comer,
members of the House Committee on Oversight and Reform, please
allow me to thank you to testify before you today. And just a
point of correction, I do, in fact, live in Northern Virginia,
and I am a patient advocate, but I also am public affairs
counsel for Independent Institute, which is a think tank in
Oakland, California.
In November 2015, my wife got the most dreadful call a
parent can get. The doctor knew why our daughter, Colette, then
2 1/2, hadn't been feeling well. Bloodwork had revealed
leukemia, cancer. We raced Colette to Inova Fairfax Hospital,
the only one in Northern Virginia, where we live, that treats
pediatric cancer and got there just in time.
Thanks to Obamacare, we were already in difficult straits
regarding healthcare. In 2014, that law had eliminated a plan
we had had for years.
Before the ACA went into effect, the private marketplace
consistently and reliably had offered us a wide variety of
inexpensive plans that covered specialist care even out of
State. After the ACA went into effect, however, all that was
left were increasingly costly plans with fewer benefits,
including fewer doctors and fewer hospitals.
Thanks to Obamacare, we were, and still are to this day,
basically restricted to medical facilities within a short
radius of our zip codes. Obamacare, in a word, has made us into
medical serfs. We're tied to the land on which we live, unable
to leave it, even to save a little girl dying from cancer.
Which is why, when we tried to take Colette to Johns Hopkins,
just up the road in Baltimore, we were denied. Under our pre-
ACA plan, which didn't geofence sick children from the care
they deserve, she would have been admitted.
Our predicament was made all the more painful by swelling
premiums, as well as by skyrocketing deductible and maximum
out-of-pocket expenses. They can go as high as $16,500, as it
has been for my family.
But things were about to get much worse than expensive for
our family. In mid-2017, President Trump merely suggested the
scrapping of the massive Obamacare payments to insurance
giants, which were delivering worse care at ever greater cost.
And in response--because Obamacare, for some reason, permits
this--every insurer in Northern Virginia with a family plan,
including the one we had, pulled out for the following year,
2018.
Except one. Cigna Connect, however, wouldn't cover my
daughter at Inova Fairfax, the one hospital in Northern
Virginia, as I say, with a pediatric cancer ward. So under
Obamacare, our daughter was effectively without coverage for
cancer. Not the common cold or a broken bone, but cancer.
We went through another terrifying event in 2020. In mid-
March of that year, with COVID sweeping the country, Anthem,
the plan we had for that year, announced suddenly that on April
1, it would no longer cover not the hospital this time, but the
clinic where she received most of her doctor-administered
chemotherapy. So we called the marketplace. Perhaps it would
grant us a waiver to buy the Cigna plan still available for
sale in our zip code. Not a chance, we were told.
The failure of the ACA to cover our daughter battling a
terminal illness was not considered, we were told, a
``qualifying event.'' So once again, thanks to the ACA, we were
left without coverage for our daughter, recovering from cancer
at the clinic, the only one she could go to in Northern
Virginia.
Now in both cases of systems collapse, we were forced to
turn to the author of these failures that is to the Government,
to all of you. Specifically, we had called Senator Mark Warner
for Virginia, one of our Senators, so he could bully a private
company--Cigna in the first instance and Anthem in the second--
into covering, respectively, the hospital and the clinic. And
in both cases, the threats from the State drove the insurance
giants back into the marketplace.
But I do hope all of you can see how these successes that I
achieved were actually failures. Ad hoc exercises of Government
power to ensure proper functioning of the ACA means we are not
dealing, despite the rhetoric, with a marketplace, but rather
with a closed web of insurance companies and medical providers
at the mercy of the police powers of a complicit government.
Now perhaps to solve the instability of Obamacare, which is
inherent to it, the Government could just take over all medical
facilities. But everybody in the country at that point would be
at the mercy of the same Government bureaucracy that has been
brutalizing my daughter and her parents for years.
The high costs of Obamacare would go higher. The rationing
of care that we've already experienced would be even more
pronounced, and here is why. It's very simple. Bad ideas don't
get better just because you make them bigger. They get worse.
Twice in a three-year period, the most important problem
that we faced wasn't high costs, bad as they were, but the
terrifying reality that high prices in a planned, closed
economy always signify that we are on the way to scarcity.
Twice in three years we found ourselves with no insurance
product to buy for any amount of money that could save a little
girl battling cancer.
And here's the thing that's the main point of what I want
to say. Scarcity doesn't go away under universal coverage or
single-payer, whatever word we want to use this week or next
week to describe it. Under full Government control of the body,
that is under full Government control of the body by all of
you, scarcity wouldn't be, as it is in my case now,
circumstantial. My family was effectively a canary in the coal
mine.
Scarcity under such authoritarian medicine becomes policy,
and by that, I mean this. Those long wait times that everyone
can read about for cancer screenings in Great Britain or
Canada, that is scarcity made institutional, universal, but in
a very bad way. And if you want an example closer to home, try
the Government-run hospitals of the Veterans Administration,
where people die in line waiting for care.
In other words, if we unfortunately get more managed care
from all of you, the Government, my daughter will be everyone's
daughter. And every mother and father will experience what my
wife and I have experienced. We watched our daughter battle
cancer while the institutions of medicine, thanks to the ACA,
colluded with the disease against her.
There is one correct long-term answer in my view. We must
prohibit the Government, that is to say all of you, from
further interfering in the acquisition by private citizens of
their preferred medical care, and we do that by repeal of the
ACA and placing back into the hands of Americans real,
actuarially sound, automatically renewable insurance products
curated to individual needs. That is the kind of universal
coverage this country deserves because it's the only kind that
works.
And now a word for my Republican friends. Obamacare, as you
may know, has very little to do with actual insurance. It is
essentially a giant scheme. Some would say, I would say a giant
Ponzi scheme to pay for each other's medical bills. And since
my daughter, thanks to the ACA, got very, very sick under a
non-insurance regime, she is now permanently uninsurable.
If we ever come to our senses in this country and give back
to the citizens real insurance, my daughter will never be able
to have one, and here is the logic. You cannot buy auto
insurance after the car accident. My daughter managed to get
sick with cancer. She's had that accident. She is permanently
uninsurable.
However, if I had been allowed to keep my pre-ACA plan, as
President Obama promised, things would be very different. My
daughter today would have insured, durable access to medical
care. In essence, Obamacare turned an insurable illness, one as
grave as cancer, into a permanent preexisting condition from
which my daughter will never escape.
But my daughter is not alone. Millions of persons have
gotten sick under Obamacare, and everybody in this room, in
this entire country, will someday suffer a serious illness,
such as we'll call it fate for the purposes of this discussion.
And soon enough, the number of permanently uninsurable will be
so large that you won't be able to repeal Obamacare.
Obamacare, in a word, is creating right now a nation of
preexisting conditions. The Democrats know this. All they have
to do is wait, and we will be forced to go full State takeover
of the body. So how about it? When you Republicans get into the
majority, you win both houses and possibly get the presidency
back, will you give us back our bodily autonomy and repeal this
law?
Your doing so, however, won't help my daughter. For her, it
is too late. She and the other victims of Obamacare will need
Government healthcare for the rest of their lives. But the rest
of us and for those yet unborn, it is not too late.
And to put this another way, and this may sting, but when
you come back into power, please, for the love of God, no more
Paul Ryan-style tax cuts, which the other side will just
eliminate or destroy by inflation as they're doing now. The
State takeover of the human person by authoritarian control of
medicine is far more worthy of your attention than any tax cut,
no matter how deep.
I thank both sides for the time given me to air my
concerns.
Chairwoman Maloney. Thank you.
Mr. Starghill, you are now recognized for your testimony.
STATEMENT OF BISHOP WALTER STARGHILL, JR., DETROIT, MICHIGAN
Mr. Starghill. Well, thank you for allowing me to be part
of this testimony and this great information that needs to be
given out.
I'm Bishop Walter L. Starghill, Jr., Eastern Michigan
pastor of Face-to-Face Outreach Ministries. Thank God for
Congresswoman Tlaib allowing me to be a part of the solution or
the answer to bear witness what has happened to me.
One of the things back in 2009, I was uninsured, pastoring.
During the great migration out of the Michigan area, my
membership dwindled. So, therefore, we didn't have the proper
funding to make sure that I had insurance. So, therefore, I was
uninsured.
I had a condition which is called shingles that I didn't
know I had, and at the time, I was feeling very bad. I went to
actually one of the major hospitals at about 1 or 2 in the
morning, which was an emergency, and I told them I didn't have
insurance.
They saw me, but they gave me the bare minimum. They
checked my pulse. They checked my blood pressure and told me I
may have shingles. But after that, they gave me a bill of $800.
Now I couldn't afford it. It took me almost 6 to 7, 8 months
just to pay that money back.
But as a friend of mine told me that they had a clinic,
which is the Western Wayne Family Health Center. It's a
federally funded clinic, and could you possibly come up to them
and see what they can do for you? So as I got worse and worse
and as a person that didn't have insurance, you are very
susceptible to just worry, worry, worry. And I was worried. So
that made the condition even worse.
So I finally went up to the clinic and filled out all the
paperwork that they had to do for me, and they gave me a $20
copay. So as they were doing that, filling out my paperwork, I
had--over the time from the emergency room to the actual
clinic, I had rashes all over the right side of my face, all
the way going down my nose, and my eye, my right eye started to
close. I was like Worf from Star Trek. I was in a bad
situation.
And as they gave me a shot, immediately that actual shot
started to move everything back. So I thank God for that. And
before that happened was, like I say, if I didn't have that
clinic, I might have lost the sight in my eye. Yes, sight in my
eye.
Again, I had a scenario as a pastor. We went to Niagara
Falls with our church. Fifty-six people went there, and we
enjoyed ourselves. The weather was quite hot that day, and on
the way back, one of the mothers fell ill. So we called 911--we
were in Canada--and they came, picked her up in the ambulance,
took her to the hospital, and ran every test that they had to
run. And as they were doing that, we started to wonder how much
the bill was going to be.
And after they got her stabilized and everything up and
running so she was able to travel back with us, I asked the
doctor, well, how much is this going to be? The doctor said, as
I was holding my breath, that it was $70 Canadian, which was
$40 American. I quickly paid the $40 and got back on the road.
Now, I don't know. America is the greatest country in the
world. Yes, we do have some issues with affordable healthcare.
Yes, we need to fix it. That's why we're here today.
But the bottom line is I am one of the 30 million people
that was not insured. I'm not talking about underinsured, but
actually had no insurance. Now I'm able to live life and go to
the doctor, go to the dentist, go to specialists now. So,
therefore, I can live a confident, great life, yes, myself. But
the bottom line is that we got to look at doing things better
for the people.
I thank you for this time, and I want you--I feel for the
man that his daughter had these issues. But again, that's why
we're here today is to talk about both sides where you can come
with solutions that will help all of us obtain affordable
healthcare.
Thank you for my time.
Chairwoman Maloney. Thank you. The gentleman yields back.
And we now hear from Ms. Templeton. You are now recognized
for your testimony. Ms. Templeton?
STATEMENT OF LESLIE TEMPLETON, BOSTON, MASSACHUSETTS
Ms. Templeton. Good morning, everyone, and thank you for
having me.
My name is Leslie Templeton, and it's a pleasure to be
here. I am a 25-year-old disabled person, and some of my
diagnoses
include epilepsy, kidney disease, ADHD, familial
hypercholesterolemia, and depression.
Being 25 and sick is extremely funny. While many of my
friends are worried about their careers, finding life partners,
and what they're doing next week, I have the added worry about
what my future holds regarding my health. I wonder if I'll
always be able to access my healthcare and treatments. If,
heaven forbid, something goes wrong, and I don't have access to
healthcare, what will happen to me?
Sitting before you, I'd be lying if I said there aren't
nights I cry about this, scared of it all--of my diseases, of
my future, of losing my healthcare. With Medicare for All,
these wouldn't be concerns I'd have to live with every day of
my life.
I'm fortunate enough to be able to access the lifesaving
healthcare I need right now. That is a privilege that has given
me the ability to be here today. Before I was able to access
treatment, I struggled to do most things or fully participate
in life.
I don't know if you'll understand how deeply I mean this,
but having access to healthcare has allowed me to be a 25-year-
old. My Wellbutrin, an antidepressant, has given me the ability
to enjoy life. My kidney medication is slowing, if not
preventing, further progression of my kidney diseases, ensuring
I feel well enough to live my life the way I want to.
And there's so much more. I am fortunate enough to be able
to afford these interventions currently due to my income level,
a privilege not everyone has. Being sick is expensive, and that
expense makes treatment inaccessible to so many people. Being
able to access healthcare is not enough. It's being able to
afford it, too.
As long as I can always have access to healthcare and I can
afford it, I will be able to hopefully live a long life. I'll
get married. I'll see my kids graduate from college. I'll grow
old and watch my body age gracefully. Without Medicare for All,
that outcome is not guaranteed, just as it's not guaranteed for
millions of Americans right now.
What people don't talk about enough is the cost of staying
alive. My ability to live is based on whether I can afford it
or not, and that thought keeps me up at night. So many people
are in a similar situation to me. Just look at GoFundMe. People
shouldn't have to rely on charity to stay alive.
To put it bluntly, I don't want to die. I want to live a
long life without constant worry of whether I will be able to
afford my meds each month or I'll have insurance to cover my
doctors' visits. Medicare for All would give every American
that peace of mind, especially those who rely on the healthcare
system the most in order to stay alive.
No one should go broke because they have a life-threatening
illness. No mother should have to choose between getting her
medication or her kids'. No child should have to watch their
parents suffer through pain and ailments because they are not
insured.
We Americans are counting on you to change this reality for
us because, again, to put it bluntly, we don't want to die.
Thank you.
Chairwoman Maloney. Thank you, and I would like to thank
all of the witnesses for their powerful testimony today. You
are now excused, and we will welcome our second panel. Thank
you so much.
We will pause a moment as we make a transition.
[Pause.]
Chairwoman Maloney. I would like to introduce our second
panel of witnesses.
Our first witness today is Dr. Uche Blackstock, who is an
emergency physician and is the founder and CEO of Advancing
Health Equity.
Then we will hear from Dr. Sara Collins, who is the Vice
President of Health Coverage and Access at the Commonwealth
Fund.
Next we will hear from Grace-Marie Turner, who is the
President of the Galen Institute.
Next we will hear from Dr. Jeffrey Sachs, who is the
Director of Columbia University's Center for Sustainable
Development and is the President of the United Nations
Sustainable Development Solutions Network.
Next we will hear from Dr. Jamila Michener, who is an
associate professor at Cornell University and is the Co-
director of Cornell's Center for Health Equity.
Finally, we will hear from Ady Barkan, who is the founder
of Be A Hero.
The witnesses will be unmuted so we can swear them in.
Please raise your right hands.
Do you swear or affirm that the testimony you are about to
give is the truth, the whole truth, and nothing but the truth,
so help you God?
[Response.]
Chairwoman Maloney. Let the record show that the witnesses
answered in the affirmative.
Thank you. Without objection, your written Statements will
be made part of the record.
With that, Dr. Blackstock, you are now recognized for your
testimony. And please, let us all try to keep within our five
minutes.
Dr. Blackstock, you are now recognized.
STATEMENT OF UCHE BLACKSTOCK, M.D., EMERGENCY
PHYSICIAN, FOUNDER AND CHIEF EXECUTIVE OFFICER,
ADVANCING HEALTH EQUITY
Dr. Blackstock. Hi, can you hear me? OK, hi, everyone.
Thank you, Chairwoman Maloney, Representatives Bush,
Pressley, Tlaib, Ocasio-Cortez, and all of the members of the
House Oversight Committee here today. It's an honor to be
invited to testify during this very important hearing, a key
step toward addressing racial health inequities in our country.
I'm Dr. Uche Blackstock, an emergency medicine physician
with over 17 years of clinical experience, a second-generation
black woman physician with lived experience with injustice, and
the founder of an organization dedicated to advancing health
equity. I have worked for years in communities where far too
many of my patients were either uninsured or underinsured,
mostly black and brown Americans who have sadly been
disregarded by our country.
They are not only dealing with mental and physical health
issues, but also with systemic afflictions like bias and
racism, housing insecurity, economic instability, and lack of
access to reliable transportation. These are what we call the
social determinants of health, the factors which influence the
health and health outcomes of communities and people.
Lack of access to healthcare is one of the primary social
determinants of health. I've taken care of thousands of
patients over the years, many I could never forget.
The 40-year-old black man with a history of high blood
pressure who came into my ER unconscious on a stretcher after
he collapsed at home in front of his family. The paramedics
were performing CPR on him. The CAT scan of his head showed a
brain bleed, a complication of untreated high blood pressure.
He had been unable to afford to pay out-of-pocket for his blood
pressure medication since he lost a job a year prior and, as a
result, his health insurance.
The 55-year-old Latina woman who came into my ER
complaining of bleeding and swelling from her left breast for
several months. She explained that she did not have health
insurance and did not have a primary care physician.
After we spoke, I examined her and found a foul-smelling
mass protruding from her left breast. It was advanced breast
cancer.
As Black people and people of color, just living in this
country is an act of survival, let alone being able to access
quality and culturally responsive health care. The ongoing
COVID-19 pandemic and the country's presumed reckoning with
racism has only exposed the deep preexisting fissures in our
health care and public health system.
Despite advances in health care innovation and technology
over the last 75 years, Black men still have the shortest life
expectancy, Black women have the highest maternal mortality
rates, and Black babies have the highest infant mortality
rates.
Overall, Black Americans have a six-year life expectancy
gap compared to white Americans, the widest gap since 1998 and
widened even more by the pandemic. This pandemic should have
been a wake-up call to help us understand the urgency of
identifying a path toward making universal health care a
reality, among other critical strategies to improve health
equity.
I have had a front row seat to the tragic loss of Black and
brown life from COVID-19 and racism. During the height of the
pandemic in New York City, I noticed my patients' demographics
quickly shifted to more racially and socioeconomically diverse
patient population to mostly Black and brown patients.
They were essential workers, service workers. Some had
underlying medical problems. Others were left with no choice
but to use public transportation and many live in crowded
multi-generational housing.
I vividly remember an elderly Black man who came into my
urgent care with shortness of breath and fever. He was in a
wheelchair and his oxygen level was shockingly low. He lived
alone.
I was very worried that he had COVID pneumonia and asked if
I could call an ambulance to bring him from urgent care to the
closest ER. He refused. He didn't want to die in the ER, he
told me. He didn't think he would receive good care because he
didn't have health insurance. He felt safer at home.
For many years, I worked in two ERs in New York City,
Bellevue Hospital, the oldest public hospital in the country,
and Tisch Hospital, a private institution that is part of NYU
Langone Medical Center, among the wealthiest hospitals in the
country that have gotten hundreds of millions of dollars richer
after Federal bailouts.
At these two ERs that, literally, sit next door to each
other, I experienced firsthand deep inequities in our health
care system, one that is separate and unequal. Patients were
divided up based on insurance and race.
Nationally, at private academic medical centers, Black
patients are two to three times less likely than white patients
to receive care, while uninsured patients overall are five
times less likely than patients with insurance coverage to be
treated.
In cities across this country the top-ranked hospitals do
not treat as many patients of color as white patients, even
when they are located in diverse communities.
This is the definition of systemic racism. People who look
like me are living this every day. But it should not fall
solely on us to always have to call out when something is
wrong.
Now is the time to protect our most vulnerable and
underserved communities and identify a pathway to ensuring
universal health care for all Americans. We must work to break
the cycles of trauma and injustice, to foster generational
progress for more people, especially people of color because it
is cruel to talk about an American dream when only a select few
live to see it.
Thank you.
Chairwoman Maloney. Thank you so much, Dr. Blackstock.
Now we will hear from Dr. Collins. You are now recognized
for your testimony.
Dr. Collins?
STATEMENT OF SARA R. COLLINS, PH.D., VICE PRESIDENT OF HEALTH
COVERAGE AND ACCESS, THE COMMONWEALTH FUND
Dr. Collins. Thank you, Chairwoman Maloney, Ranking Member
Comer, and members of the committee for this invitation to
testify on past universal coverage.
My comments will focus on gains in coverage since the
passage of the Affordable Care Act, the effects of the pandemic
and Federal relief efforts on coverage and policy options to
cover the remaining uninsured, and lower consumer costs.
The ACA brought sweeping change to the U.S. health system,
expanding comprehensive and affordable health insurance to
millions of lower and middle income Americans and making it
possible for anyone with health problems to buy insurance.
The number of uninsured people fell by nearly half after
the ACA became law, dropping from 49 million people to a low of
28 million in 2016. There has been a slight uptick since then.
Research shows that the ACA lowered financial barriers to
care and improve people's ability to afford health insurance
and get needed care. Despite expectations that the pandemic
would leave millions uninsured, the latest Federal data
indicate that the uninsured rate is actually declining. This
decline is due in part to the ACA's coverage expansions which
provided safety net coverage for those who lost insurance and
Federal COVID-19 relief bills that provided enhanced
marketplace subsidies and a requirement that States keep people
in Medicaid continuously enrolled in exchange for enhanced
Federal matching funds.
The result was record enrollment of nearly 15 million
people in the marketplaces and nearly 84 million in Medicaid
and the Children's Health Insurance Program.
There are four risk factors that could reverse these gains
and limit the ability of Americans to afford their health care.
The end of the Medicaid continuous enrollment requirement and
the enhanced marketplace subsidies could trigger extensive
enrollment losses in Medicaid as States redetermine enrollee
eligibility and in the marketplaces as subsidies decline.
Twelve States have yet to expand eligibility for Medicaid.
Millions of people are eligible for the ACA's coverage
expansions but are not yet enrolled. Growth in health care
costs is outstripping growth in median income, leaving millions
of people under insured and with growing premium burdens.
There are several targeted policy options that might
mitigate these risks including extending the marketplace
subsidy enhancements at the end of the public health emergency;
requiring States to conduct Medicaid eligibility
redeterminations gradually; fill the Medicaid coverage gap;
maintain aggressive, targeted, and consistent outreach
enrollment efforts to reach the remaining uninsured and keep
people covered; enable people to automatically enroll in
coverage; address the high provider prices that drive most of
the health spending growth in private insurance and, by
extension, growth in worker premium contributions and
deductibles, such as through a public option.
Allow more workers in expensive employer plans to access
marketplace subsidies. Fix the family coverage glitch. Rein in
deductibles and out-of-pocket costs and marketplace plans. Ban
non-ACA compliant policies like short-term plans.
But how can the U.S. reach universal coverage? Can we get
there by building on the ACA or will it take a single-payer
approach? This question was debated during the 2020
Presidential election. The Urban Institute tackled it at the
time by modeling reforms that built on the ACA in two versions
of a single-payer approach.
The ACA approach included auto enrollment and a public
option that lowered provider plant prices close to Medicare
rates. Urban found that it was possible to reach near universal
coverage with this ACA approach as well as with the two single-
payer approaches.
They also found that the ACA approach and one of the
single-payer approaches reduced national health expenditures,
even though nearly everyone is covered. This is because both
approaches reduce private insurance prices paid to providers
closer to Medicare rates.
The debate at the time focused not on this fact but on the
increase in Federal costs under a single-payer approach. But
what commentators failed to point out was that this higher
Federal cost was not because the single-payer approach was so
much more expensive than our current system but that all of the
responsibility for financing that spending shifted away from
employers, households, and State governments to the Federal
Government.
We need to have reasonable discussions as a country about
how to share our healthcare spending responsibilities. But it
is not just about who pays but also about how much we pay and
why and what we are getting for our spending.
The U.S. has one of the most expensive health systems in
the world and, yet we rank last among high income countries on
most measures of health system performance, including access to
care.
Prices paid to providers in private insurance is one of the
primary reasons we spend so much more. As we consider
strategies to expand health insurance coverage and lower
consumer costs, and as we weigh the benefits of those
strategies against their Federal costs, it is critical that the
prices paid to providers in private insurance be part of the
discussion. Thank you.
Chairwoman Maloney. Thank you, Dr. Collins.
Ms. Turner, you are now recognized for your testimony.
STATEMENT OF GRACE-MARIE TURNER, PRESIDENT, GALEN INSTITUTE
Ms. Turner. Thank you, Chairwoman Maloney, Ranking Member
Comer, and members of the committee and Representative
Jayapal--lovely to see you again--for your sponsorship of the
legislation we are considering today.
So I would like to emphasize what I believe are widely
shared goals for health reform and achieving universal access
to care, coverage that is affordable, protecting the--
protecting quality and choice, and especially providing a
strong safety net for the most vulnerable.
There is no question that Americans are frustrated with our
current health care system. Millions remain uninsured, and even
for those who do have insurance, coverage and care cost too
much. Many face deductibles that are so high that they say they
might as well not be insured.
But the more government gets involved, the more that we see
the health sector is forced to comply with countless rules and
regulations rather than innovating to respond to more choices
of more affordable care and coverage for patients.
Wharton Professor Mark Pauly, University of Pennsylvania,
explains that the government exerts great control over our
health sector with government affected spending, totally nearly
80 percent and part of that, of course, is actually the
government direct spending, which is nearly 60 percent, on
public programs. Medicare for All and its derivatives such as
Medicare buy-in or a Federal public option would take us
further toward government control of our health sector with
fewer choices and where, I believe, vulnerable patients, as we
see in so many other countries, with the greatest health care
needs would have to fight even harder to get access to the care
that they need.
In proposing policy solutions, I believe it is important to
begin by clearly defining the problem that we want to solve.
The Congressional Budget Office reports that 29.8 million
people were uninsured in 2019, two-thirds of whom were eligible
for existing public or private coverage but were not enrolled.
Most of the remaining one-third were not lawfully present in
the United States, a problem for immigration and citizenship
policy, rather than health policy.
Medicare for All also would mean that virtually everyone
would lose the plans they have now and there would be no choice
but the one government-run health plan for 173 million
Americans who value their employer-based health insurance
including millions of union workers and 64 million seniors with
Medicare, including 26 million with private Medicare Advantage
plans.
The CBO found that establishing a single-payer system would
be a major undertaking that would be complicated, challenging,
and potentially disruptive, and that the changes could
significantly impact the overall U.S. economy.
Three States--Vermont, Colorado and, recently, California,
as I describe in my testimony--came to similar conclusions in
shelving their plans for single-payer.
So rather than dramatically expanding the role of
government through new or expanded taxpayer-supported programs,
I believe we need targeted approaches to address the specific
needs of those who are uninsured, underinsured, and especially
focusing on those of marginalized communities.
Uninsured rates continue to be higher in certain
populations, as we have as we have heard other witnesses say,
including Latinos, Blacks, those with incomes below the poverty
level, and residents in States that have not expanded Medicaid.
Tragically, it is often the most vulnerable who are left
behind when demand for services outpaces resources. Just five
percent of the population accounts for more than half of U.S.
health spending. Those who are the sickest with the greatest
health care needs are most often disadvantaged, as political
leaders inevitably have to balance then in between them and the
great majority of healthier constituents.
Medicare for All will restrict access to new medicines and
treatments, lead to dramatic increases in Federal spending, and
really turn back the clock, I believe, on innovations in
personalized care.
I concluded my written testimony and will conclude here
describing the experience of Janet, a patient from Colorado
with multiple health challenges. Janet received coverage under
the ACA but said her access to care was far worse than the
State-run high risk pool that she had participated in before,
even though her premiums and co-payments were much higher.
I worked with a number of policy experts through the Health
Policy Consensus Group to focus on policy recommendations for
patient-centered reform and I also commend the Healthy Future
Taskforce that is underway here with a number of solutions to,
again, move toward solutions but in a patient-centered way.
I would welcome the opportunity to work with you to achieve
the goals of access to more affordable coverage for everyone,
better protection for the vulnerable through targeted
solutions.
And thank you for your invitation to testify. I look
forward to questions.
Chairwoman Maloney. Thank you, Ms. Turner.
Dr. Sachs, you are now recognized for your testimony, and I
understand you are testifying from Berlin.
STATEMENT OF JEFFREY D. SACHS, PH.D., DIRECTOR,
COLUMBIA UNIVERSITY CENTER FOR SUSTAINABLE
DEVELOPMENT, PRESIDENT, UNITED NATIONS SUSTAINABLE DEVELOPMENT
SOLUTIONS NETWORK
Dr. Sachs. I am, indeed, Chairwoman. We have multiple
crises in the world and one of them, unfortunately, is nearby
here.
Let me proceed expeditiously for you. Thank you for the
hearings. If you could move to the next slide.
[Slide.]
Dr. Sachs. The U.S. system is completely broken. This is
the main point. We are spending a fortune, unlike every other
country, and we are getting worse outcomes. This is what needs
to be understood beyond the ideology, beyond the anecdotes. We
are going broke from a system out of control, and this is from
the wonderful Commonwealth Fund report. I think you are going
to have a witness from Commonwealth Fund. They do great work.
And what you see is the top line is the U.S. spending
percent of GDP. This goes up to 2019, about 18 percent of GDP.
Now we are almost 20 percent of GDP in the most recent data.
Look at all the rest of the countries, all of them. We are
broken. If you move on, it is the same story. We are broken.
Here, all of the other countries have higher life expectancy
than the United States and the gap is widening dramatically. We
are broken. We spend far more on health care, we get far less,
because we don't even have a healthcare system. We have a
hodgepodge of private overpriced monopolies, whether for profit
or not for profit. I will say a word about that later on. But
this is a broken, unfair, out of control costs system that
doesn't deliver.
Next, please.
[Slide.]
Dr. Sachs. So I referred to the Commonwealth report. You
could go on to the next slide.
[Slide.]
Dr. Sachs. We rank last--last--in our health system
performance and we rank last in access to care, last in
administrative efficiency, last in equity, last in health care
outcomes.
Let us stop with the individual anecdotes and just look at
our system compared to the rest.
Next slide, please.
[Slide.]
Dr. Sachs. This, again, we spend more--that is on the
horizontal axis. On the vertical axis is performance. The U.S.
is that little dot on the bottom right, expensive and poorly
performing. All the rest of the countries less expensive and
better performing.
Next, please.
[Slide.]
Dr. Sachs. We spend a fortunate in administrative costs.
When you go into a doctor's office or a hospital, you spend
hours, in the end, either before or during or after, filling
out forms trying to get reimbursed, trying to figure out what
is covered, who is in the network, who isn't in the network. I
can tell you even with a physician and Master's of Public
Health, Ph.D. degrees, it is almost impossible to navigate the
U.S. system now and the result is administrative costs out of
control, unlike any other country.
Next slide, please.
[Slide.]
Dr. Sachs. Again, we are spending 10, 15, even 20 percent
of outlays on administration, people that are working--hundreds
of thousands of people employed to move between different
accounts because it is private this, it is private that, who is
going to reimburse this, who pays for that. It is unbelievable
the amount of time we are burning in order to run this
ramshackle nonsystem.
Next, please.
[Slide.]
Dr. Sachs. The expenditures continue to soar, and in 2020
we reached almost 20 percent of GDP, basically, twice what
other high income countries are spending that are getting the
same or better outcomes than in the United States.
This is what I would plead for the committee. Look at the
rest of the world. Not at our own internal, ideological,
bizarre discussion, but at the comparison with what is
happening elsewhere because there are so many solutions abroad.
Next.
[Slide.]
Dr. Sachs. Life expectancy stopped rising a decade ago. It
is falling in the United States. When will we understand we are
falling apart in this country and our health system doesn't
deliver? It doesn't deliver preventative health.
This tragic story of Dr. Blackstock of the patient who
comes in with advanced breast cancer who couldn't afford to be
seen beforehand, that is a system? That is the United States of
America?
It is shocking and it shows up in the most basic measure of
societal performance. No, not GDP, life expectancy, which is
falling in the United States because we are becoming completely
dysfunctional.
Next, please.
[Slide.]
Dr. Sachs. We are at the top of avoidable deaths. Again,
from the Commonwealth Fund, if you look in detail at what the
cause of deaths are, these are preventable deaths. But the
United States has the most of them and it has the least
reduction of them of all of our peer countries.
Next, please.
[Slide.]
Dr. Sachs. Costs for low income populations. Well, we have
heard this repeatedly--out of control, unlike all of our peer
countries. We are the country all the way to the right hand
side. We look different from all of the rest of the countries.
Next, please.
[Slide.]
Dr. Sachs. We have, as you know, an epidemic even before
COVID of deaths of despair. We have soaring deaths from
suicide, from substance abuse, opioid overdoses, and so forth,
for people who are battling economically as well, and so you
see the biggest rises for the white population with no college
degree. This is an absolute shocking epidemic in the United
States of America without a health system to address it.
Next, please.
[Slide.]
Dr. Sachs. We have vast differences across the States.
Typically, as is true in U.S. politics, the States farthest
behind are the ones most defending the status quo. Very sad.
But this is how our politics is absolutely upside down.
Instead of a system that could work, we have an opposition
to State control, as if we have a functioning market system.
Next, please.
[Slide.]
Dr. Sachs. What we have is a scam going on. Please
understand. We have the most high-priced high-cost system and
we have a system that is filled with its sense of success
because they are making a fortune.
This is what I clipped from the Wall Street Journal list of
our CEOs of our pharmaceutical industry. What do you want, $20
million salary? Twenty-five million a year salary? Thirty
million a year salary? That is the game of the United States of
America health care system.
Chairwoman Maloney. Dr. Sachs----
Dr. Sachs. Yes?
Chairwoman Maloney.--you are way over time. It is
fascinating. Way over time.
Dr. Sachs. I am sorry. Can I come quickly to an end? I will
come--just next slide. I will come very quickly to an end.
[Slide.]
Dr. Sachs. Our not for profit hospital administrators are
making millions and millions of dollars.
Next, please.
[Slide.]
Dr. Sachs. I will just do--forgive me, Chairperson. I just
want to make two more points.
Chairwoman Maloney. Please--OK. All right.
Dr. Sachs. This is an incredibly profitable industry. That
is where the high prices go.
Next slide.
[Slide.]
Dr. Sachs. This is the biggest lobbying industry. I don't
have to say this in congressional testimony. Everybody knows
it. This industry lobbies a fortune and makes a fortune. It is
a scam, and we should compare with the rest of the world and
see what we are getting. We are wasting a trillion dollars a
year that is going into administrative costs----
Chairwoman Maloney. Thank you.
Dr. Sachs [continuing]. High costs for products, for
prices, for devices----
Chairwoman Maloney. Thank you.
Dr. Sachs [continuing]. For hospital care. Thank you very
much, Chairwoman.
Chairwoman Maloney. Thank you. Thank you. The gentleman
yields back.
And now, Dr. Michener, you are now recognized for your
testimony.
STATEMENT OF JAMILA MICHENER, PH.D., ASSOCIATE
PROFESSOR, CORNELL UNIVERSITY DEPARTMENT OF
GOVERNMENT, CO-DIRECTOR, CORNELL UNIVERSITY
CENTER FOR HEALTH EQUITY
Dr. Michener. Thank you, Chairwoman Maloney, and the
members of the Oversight Committee and everyone who is here
today.
My name is Jamila Michener. I am an Associate Professor of
Government and Public Policy at Cornell and also co-director of
Cornell Center for Health Equity. I am going to focus today in
my comments on underscoring the role of universal health
insurance coverage, particularly in addressing racial health
inequities, but also in terms of strengthening our democracy.
So health equity has never been a reality for people of
color in the United States. It has never been a reality for
Black, Latinx, or indigenous people in the United States.
Notwithstanding changes that have happened over time and some
improvements that have occurred, we have seen persistent and
continual disparities.
Consider just a few examples that are striking and
contemporary. Black and indigenous Americans live for fewer
years, on average. Black and indigenous Americans are more
likely to die from treatable preventable conditions. They are
more likely to die when there is no need for them to die on
account of a lack of access to health coverage and health care.
Black people are at a higher risk for chronic health
conditions like diabetes and hypertension. They are more likely
to die from breast cancer and colon cancer. Importantly, this
is particularly because of late stage diagnosis and
differential treatment.
Black and indigenous women are more likely to die during or
after pregnancy, to suffer serious pregnancy-related
complications and they are more likely to lose children in
infancy.
All of these things, of course, were exacerbated and became
worse during the pandemic, and the few disparities that I just
discussed are only the tip of a much, much larger iceberg, an
iceberg that this country has been crushed under since before
it was even the United States.
Crucially, these inequities are a product of systemic
forces, not individual choices. This isn't about people being
able to choose. In fact, it is about the lack of options, the
lack of ability to have equitable access, and much of this lack
is grounded in systemic racism.
Systems of racial stratification shape whether you live in
a neighborhood that will promote your health, whether you have
access to resources like health insurance to sustain your
health, whether you have daily experiences with things like
discrimination that might undermine or threaten your health,
and importantly--and I will address this shortly--whether you
have influence over the political processes that can be
activated to protect your health.
Inequitable health insurance is a key factor that
contributes to this range of disparities. So the fact that
people of color have lower access to health insurance is a
significant, life-threatening, policy-altering problem.
Unequal, unstable, unaffordable, and constrained access to
health insurance contributes to people of color experiencing
their healthcare system as profoundly discriminatory and
difficult to navigate.
People of color are more likely to delay care or forego
treatment. They are less likely to and struggle to adhere to
prescribed medication and treatment regimes and, again, these
disparities are not lessening. If anything, they are widening.
Access to health care is an ethical and human rights
principle. It means that everyone has a fair--health equity,
rather--it means that everyone has a fair and just opportunity
to be as healthy as possible and, of course, access to health
insurance is a critical determinant of whether health equity
could be a reality.
I want to spend the last bit of my time here pointing
something really important and often overlooked out. Over and
above the noted material and health benefits of having access
to health coverage, which we have heard quite a bit about
today, that access would provide people who receive that
coverage with a strengthened position in our democracy. It
would reinforce their civic status and reinforce our promise as
a country, as a polity, of full inclusion for all. This
connection is not obvious.
But social scientists--political scientists, in
particular--have established that health and health policy are
crucial for democratic--full democratic participation. Medicaid
is a perfect example. Medicaid expansion is associated with
boost in voter turnout.
Disenrollment is associated with declines in rates of
voting. Medicaid beneficiaries and their ability to participate
in politics is a function of their experience with the program.
This is not about partisan politics or electioneering. It
is about ensuring that people with the most at stake, with the
most to lose here, many of the people we have been using in our
anecdotes, that they actually have meaningful influence over
the political processes that determine their ability to thrive
and survive, and we know that that influence happens when, in
fact, they have access to the resources that they need to allow
them to be full and equal members of our democratic polity.
I want to end with words from a Medicaid beneficiary from
systematic qualitative research that I did. This is a woman
from Georgia named Lucy. She says, I think a lot of people on
Medicaid and without insurance are scared that their voice is
not going to be heard, at the end of the day, that no matter
how much you protest or how much you call on those in higher
upper seats, it is as if our voices don't matter. And people
think, why should I even say anything? It is not going to
change.
But in actuality, it might just be that one vote that
pushes us to change everything. But to us sitting down here,
looking at those up there, it is like our voice--what is my
little voice going to do?
Lucy and other people who are fighting for health equity,
especially racial health equity, in this country have voices
that we ought to be responsive to. Universal health coverage is
part and parcel of precisely that responsiveness.
Thank you.
Chairwoman Maloney. Thank you, Dr. Michener.
And Mr. Barkan is our last panelist and you are now
recognized for your testimony.
STATEMENT OF ADY BARKAN, JD, FOUNDER, BE A HERO
Mr. Barkan. Good morning, Chairwoman Maloney,
Representative Bush, and members of the committee. Thank you
for holding this hearing and inviting me to testify.
My name is Ady Barkan and I am the co-executive director of
Be A Hero, an organization whose mission is to win health
justice in America.
As you can see, I am currently in bed. I live in California
and it is rather early here, and because I am living with the
neurological disease ALS, which has left me almost completely
paralyzed, it takes me a very long time to get ready in the
morning. So I am grateful for your grace in permitting me to
participate from bed.
But I am even more grateful that it is my bed in my
bedroom, in the home I share with my wife and our two young
children. I am able to live at home because I have 24-hour home
care. Without it I would be forced to live in a nursing home
separated from the people I love.
I don't know if that would be a quality of life that I
would be willing to tolerate. Home care is, literally, keeping
me alive.
Three years ago, I came to the Capitol to testify in the
Rules Committee as the first ever hearing about Medicare for
All. I was emaciated, weighing about 100 pounds, down from 160.
I had trouble breathing and was sweating even though the room
was cold. Every month, my body deteriorated further. I felt
like I was dying.
Later that year, I had to decide whether to get a
tracheostomy, a procedure to implant a breathing tube into my
windpipe to compensate for my failing diaphragm. But I didn't
know how I would be able to pay for the care that would allow
me to stay alive.
My insurance had already denied me a ventilator, stating
that it was experimental, and then two weeks after that, they
rejected access to an FDA-approved ALS drug. Even good health
insurance, which I have, does not cover the long-term home care
I need to survive. Paying out of pocket would have left my
family bankrupt quickly.
And so for too long after my diagnosis, my wife, Rachel,
and I tried to get by without homecare, which put the burden on
her to care for both my young son and me.
We eventually secured 24-hour home care after suing my
health insurance company in Federal court. Home care has been
life changing, allowing me to participate in my family's life
in ways I thought were no longer possible for me.
My daughter, Willow, was born six months after I gave my
testimony and now I am a father to two beautiful wild children.
But it shouldn't take a seasoned activist, a team of lawyers,
and the generosity of strangers and friends to get the health
care you need to survive. The reliance on crowdfunding to
afford healthcare is a uniquely American tragedy. My outcome is
the exception. But the challenges we face fighting insurance
companies for services we are rightfully owed are not.
We spend such absurd amounts on health care and we get such
bad outcomes for our money. The high cost of care and
infuriating bureaucracy burdens all of us, including nurses and
doctors, working families and small businesses.
The only people who benefit from this absurd system are the
corporate executives who profit off of our pain and spend
inordinate amounts of money trying to stop you from making life
much better for your constituents.
We have allowed greedy health care corporations to set the
parameters of what we can expect of our health care system, and
because of it, we have been forced to normalize the fate of
bankruptcy, illness, and death.
It is shameful that in the richest country in the world we
choose to inflict so much suffering. Since that first hearing
about Medicare for All, our country has been through the worst
public health crisis in a century.
The pandemic has revealed and exacerbated the existing
inequalities in our profit-driven health care system. It has
hit hardest on disabled people, poor people, Black, Latino, and
indigenous people, and especially people who live at the
intersections of these categories, and one out of three COVID-
19 deaths in the U.S. are related to gaps in health insurance.
Nearly a million Americans have already died from the
coronavirus. How much more is necessary to shock our
legislators into action? When we lost 3,000 lives on September
11th, we responded by reorganizing our national security
system, launching a global war on terror, and conducting two
massive invasions and occupations.
Three hundred times more people have died in this pandemic
but we have not marshaled our national energy to build a better
health care system. It is a scandal and it is a shame.
But in the last two years, we have also seen glimmers of
what is possible when our government takes action to prioritize
people over profits and works to guarantee care for all.
Congress subsidized the Affordable Care Act marketplace
plans, leading to unprecedented enrollment, and paid States to
keep millions more people on Medicaid. As a result, more
Americans have health insurance than ever before.
Taxpayers funded vaccine research and then our government
made vaccines easily accessible to all at no cost, and
recently, our government made rapid test kits available to all
Americans who requested them free of charge.
These programs and many others are at risk of ending if
Congress does not fund them and when the pandemic emergency
policies expire. Instead of returning to the status quo, which
fails all of us and especially our most vulnerable communities,
we should build on the progress we have made during the
pandemic.
The American people deserve so much more and so much
better. Our seniors and disabled children and adults deserve to
live at home, not be warehoused in institutions. Working people
deserve high quality care, regardless of their income or their
employer marital status.
The people of rural America deserve good mental health care
options, good community clinics, good accessible hospitals, and
so do the residents of poor urban America and the people who
live on Indian reservations. And seniors on Medicare deserve
care also for the parts of their body above their necks, which
means their teeth and eyes and ears and minds.
We can and must do better. We know what the solution is, a
system that brings everyone in and abandons no one, where we
are patients and people, not opportunities for profit. The road
to reach the better world of our imagination may be long and
there are many obstacles in our way.
But our North Star is clear. It is time for America to
guarantee comprehensive, affordable health care to all. The
best way to do that is by enacting Medicare for All. If each
one of us continues to demand better, if, together, we build an
even more powerful movement for health justice, then I know
that someday we will get there. Thank you.
Chairwoman Maloney. Thank you so much for your testimony. I
now recognize myself for five minutes for questions.
In 2010, President Obama signed the Affordable Care Act
into law, laying the groundwork for over 30 million people to
achieve affordable and available health care. Republicans not
only opposed this law, but in the past decade have voted over
60 times to repeal or weaken it.
Dr. Blackstock, you gave very moving examples of health
care challenges. As an emergency physician who sees patients
directly, how does access to health care coverage affect a
person's health?
Dr. Blackstock. Thank you, Chairwoman. Well, I mean, access
to health care coverage is key. Unfortunately, what I often see
in the emergency department, especially working in the
communities that I work in, are people who, because they do not
have insurance, will come to the ER sometimes for treatment of
chronic medical problems or come for issues like advanced
cancer, as I described with the patient that I had, with
preventable diseases that have essentially become chronic and
even late stage.
And so they are at the point in their disease process
where, you know, it is very costly for them to even be able to
afford to pursue treatment. And so access to care, essentially,
results in improved health for my patients and enables them
to----
Chairwoman Maloney. Thank you. Reclaiming my time----
Dr. Blackstock [continuing]. Utilize primary services.
Chairwoman Maloney.--because I want to get to Dr. Michener.
You have studied the relationship between access to coverage,
health equity, and racial justice. How did coverage gains under
the Affordable Care Act advance health justice in the United
States?
Dr. Michener. Well, coverage gains advance health justice,
in particular, in relationship to racial justice by allowing
more Black and Latino people to have health coverage than had
before and we see this in particular in Medicaid expansion
States where the increases in terms of access to health
insurance were most striking among Black and Latino Americans.
And so that is a key factor. Of course, it is more challenging
in nonexpansion States. So that gives us like a kind of primary
lens into the importance of access.
Chairwoman Maloney. Thank you so much. And in this
Congress, I was proud to join over a hundred of my colleagues
in reintroducing Congresswoman Jayapal's Medicare for All Act,
which would transition the United States to a national single-
payer health care system.
So, Dr. Sachs, how would the Medicare for All Act expand
access to health care while controlling skyrocketing costs that
you pointed out in your testimony?
Dr. Sachs?
Dr. Sachs. Chairwoman, ACA expanded coverage but it did not
control prices. We need Medicare for All to do both, to ensure
coverage and to ensure a system in which highly concentrated
highly monopolized service providers don't charge an arm and a
leg--literally, don't charge prices that are twice what other
countries pay.
For each procedure--diagnostic, medicines--we are out of
control in price. So Medicare for All would ensure coverage,
control prices, and, by my estimates, save about a trillion
dollars a year for the U.S. economy.
In my world, a trillion dollars a year is not small change.
We could use the savings.
Chairwoman Maloney. Thank you so much. Let me conclude with
you, Mr. Barkan, and thank you for your bold advocacy and for
your powerful testimony before us today. You remind us all why
we are all in this fight.
Why is it so crucial that we achieve universal coverage in
the United States?
Mr. Barkan?
Voice. OK. Just a minute while he writes his answer.
[Pause.]
Voice. OK. He is writing.
Chairwoman Maloney. He is writing it. It takes him a few
minutes, if everybody understands.
Mr. Barkan. We deserve dignity and health. Because we
deserve dignity and health.
Chairwoman Maloney. Thank you. Thank you for your Statement
for equity in health. And, in conclusion, as we will hear
today, Democrats have proposed a number of different policies
to move us toward a universal coverage, including Medicare for
All.
Our party has a diverse set of ideas on how to reach this
goal. But we stand unified in pushing to make healthcare more
affordable and available for every person in the United States.
I thank all of our witnesses for their testimony this
morning. I yield back, and now I yield to the gentleman from
Georgia, Mr. Hice.
Mr. Hice?
Mr. Hice. Thank you, Madam Chair. We all realize this is a
complicated issue but the solution is not government takeover
of the health care. It is returning power to the patients, not
overwhelming doctors and hospitals with regulations. This is a
disastrous pathway to go down.
Ms. Turner, I would like to begin with you, if I may. And I
realize it is extremely difficult to try to take the cost issue
out of the debate discussion, but I want to try. OK.
So if we were in some magical land where money was no
object, in spite of that, are there still problems that exist
with a government socialized healthcare system?
Ms. Turner. Congressman, there will always be resource
constraints. That is the world we live in. There are only so
many physicians, so many hospitals. They have to be paid. The
people that I worry about most in a system like that are the
most vulnerable.
I had a father write to me after Medicaid was expanded in
his State and he said that there is so many people now on
Medicaid that it is almost impossible for him to find a
urologist to treat his daughter with multiple health problems.
He has to wait sometimes six months for an appointment.
So when you see the people who are most vulnerable having
to struggle the most for care, it is because of resource
constraints. The studies that have been done on Medicare for
All, Congressional Budget Office said that we would likely see
physicians paid 40 percent less, hospitals 30 percent less.
Many of them wouldn't be able to keep their doors open.
The American Medical College says that they expect at least
to have 120,000 fewer physicians. So when we think about
putting everybody in the same system, the people who need care
the most are the ones who have to fight the hardest for it
because the resources are constrained.
Mr. Hice. And what would happen to those who currently have
coverage that they like.
Ms. Turner. I think that is really a major issue. We are a
diverse country and your health--our health sector really
represents that diversity. And as I said in my testimony, about
175 million people have employer coverage, either employees,
retirees, or dependents, they value, including many union
workers, 64 million people on Medicare, including about 26
million with Medicare Advantage plans that they have chosen,
among many others.
So the disruption of having one single plan following the
same set of rules, I think, would find--as diverse and often
complicated as our current system is it is because people are
responding to top-down rules rather than responding to patients
and what they want and I think they want choice and control and
diversity.
Mr. Hice. So there is a problem on both sides of the
equation. So is it fair to say, in your opinion, that even
those who would be--that those currently who need health care
that they themselves through the long lines, the waiting
periods, all these things--some of the things you mentioned a
moment ago--would they be satisfied with a government-run
socialized health care system?
Ms. Turner. Well, you see in the Medicaid program today too
many people are forced to go to hospitals--hospital emergency
rooms for even routine care and that is because often
physicians are paid so little for providing care for Medicaid
patients.
I had a physician write to me one time and he said he had
taken care of a patient with relatively complex pulmonary
problems. When he got his check from Medicaid, after going
through all the paperwork, he got a check for $0.06. He said, I
can only see so many Medicaid patients.
Mr. Hice. Wow. OK. And there are problems with this type of
system all around the world where it has been attempted. What
about right here in America in Vermont? What went wrong with
Vermont's attempt?
Ms. Turner. So Vermont wanted so much to be able to be the
first State to be able to produce the single-payer system and
they invested an enormous amount of time, energy, and money in
coming up with the--with a plan they thought could work for
their State.
And, ultimately, it was rejected because they realized, as
happened also in Colorado, that it was really going to tank the
economy with the taxes and the resource-forced constraints and
that people were going to have fewer choices than they do
today.
Mr. Hice. And it will tank our economy if we go that path
and provide fewer choices as well. So I thank you for your
testimony. I appreciate it a great deal.
And with that, Madam Chair, I yield back.
Chairwoman Maloney. The gentleman yields back.
The gentlelady from the District of Columbia, Ms. Norton,
is now recognized.
Ms. Norton. Thank you, Madam Chair. This is a very useful
hearing. We are learning what the Affordable Health Care Act
has achieved so that we can evaluate what more needs to be done
to improve it until we get universal health care. This is,
certainly, far less than what it is that we want in the long
run.
When I look at last year, 11 million people used the ACA
marketplace. Fourteen million people--and this one is
particularly important--have enrolled in Medicaid as a result
of the ACA's Medicaid expansion, and I think it is important to
note that millions of people have benefited from the ACA's
protections for people with preexisting conditions. So it has
done a great deal.
But, Dr. Collins, let me ask you how the ACA has improved
the economic security of families in the United States,
particularly those who have historically struggled for access
to health care.
Dr. Collins. Thank you very much, Congresswoman. Lots of
research has shown that we have not only--the ACA has not only
led to enhanced insurance coverage and dramatically reducing
uninsured rates but it is also lowered financial barriers to
care, reduced people's medical debt burdens, reduced out-of-
pocket spending for a lot of people who have had preexisting
conditions, for example, prior to the Affordable Care Act's
reforms.
So this has been a substantial change both for coverage
rates but also for reducing--for improving people's financial
security.
Ms. Norton. How much, Dr. Collins, have people in the
United States saved in out-of-pocket healthcare costs since the
passage of ACA?
Dr. Collins. It varies quite a bit by States and the type
of coverage people have. But there has been a significant
improvement in premiums, what people faced prior to the
Affordable Care Act.
When you went to get coverage in the individual market you
had to pay the full premium. You do not have to do pay the full
premium anymore. There are subsidies to help you if your income
is under 400 percent of poverty.
Medicaid expansion has been substantially important for
people with very low incomes, reducing premium costs to zero,
very low--very low out-of-pocket spending and cost exposure in
those two expansions.
Ms. Norton. Finally, Dr. Collins, you could help us a great
deal. What steps can Congress take to build on the ACA and move
where we want to go to universal coverage?
Dr. Collins. The Urban Institute has analyzed a set of
proposals that shows that we can get to universal coverage by
building on the Affordable Care Act: Medicaid expansion in
every State, an auto-enrollment mechanism, public options
addressing the high provider prices that I talked about in my
testimony.
We can get to universal coverage by the building on the
Affordable Care Act. It is critically important that we have a
way of auto-enrolling or people have a way of auto-enrolling in
coverage.
Keeping people on the Medicaid experience of the last--
during the pandemic shows how much more enrollment you can get
in Medicaid if people can stay on Medicaid rather than having
to get on and off all the time. So but it is, certainly,
possible to get there by building on the law.
Ms. Norton. Well, we do know that if it weren't for the ACA
millions more people would face catastrophic medical debt or
the choice between paying for their medical care or, perhaps,
for groceries.
But I do think it is time to build on the progress
Democrats secured with the ACA by enacting policies that move
us toward universal coverage. That is where we need to go.
Thank you very much, Madam Chair, for this hearing and I
yield back.
Chairwoman Maloney. The gentlelady yields back.
The gentleman from Wisconsin, Mr. Grothman, is recognized
for five minutes.
Mr. Grothman. Thank you. There, obviously, are many reasons
for the high cost of health care in this country. But as the
ranking member on the subcommittee dealing with Homeland and
being on the border quite a bit, I always talk to the Border
Patrol and they tell me at least one of the draws for people
coming here illegally is promises to pick up their health care.
Obviously, nothing is free.
Ms. Turner, maybe you could comment a little bit on the
effect on health care costs in the private sector as more and
more people come here illegally and who is paying for their
health care?
And, again, I will remind you that the Border Patrol have
told me that they feel that some people are coming into this
country not just because the administration, obviously, has
somewhat of an open door policy but because they feel they are
getting free health care. Who is paying for that health care?
Ms. Turner. A number of different programs are paying for
their health care. They are disproportionate share hospital
payments to hospitals that have more patients who cannot pay
for their care. You actually see employer plans paying more for
coverage because private--because public plans and
uncompensated care drives up the cost. So in many cases, it is
taxpayers and it is also people with coverage and private
plans.
Mr. Grothman. Right. How many of these people are paid for
by a government program and how many directly have to be eaten
by the providers?
Ms. Turner. You know, I was interested to see when I was
looking at the CBO study on the uninsured that about half of
the uninsured actually--of illegal immigrants actually have
coverage. So I think there are different ways for people to get
coverage than through----
Mr. Grothman. Right. If somebody comes here and, I suppose,
to get coverage from an employer, right?
Ms. Turner. I would presume employer but they may have
actually some private plans that they buy--short-term limited
duration plans, other private plans.
Mr. Grothman. OK. When people don't have plans and the
number of illegal immigrants in this country--different people
argue about 10 million, 20 million, we don't know.
Let us say there are 15 million people here illegally.
Obviously, that is going up every month considerably and it is
particularly going up in significance if the Border Patrol is
right in telling me that some people come here specifically for
the free insurance.
Does that cause private insurance or insofar as individual
hospitals bill out their billing to go up to compensate for the
people that they are--that they have to pay for health care
that they are not being compensated on?
Ms. Turner. Yes, and they--price negotiations are very
opaque and complex among hospitals and plans and private
payers.
Mr. Grothman. Right, but somebody has got to eat it, right?
Ms. Turner. Yes. Somebody pays for it.
Mr. Grothman. At the end of the day, the hospital, to pay
their mortgage, to pay their employees, if people are coming
into that hospital and they don't have insurance but they have
to have something being taken care of, and at least I am told
that if they have a serious problem at the border we will
deliver them to the local hospital and, of course, other people
are being shipped all around the country. Those costs are being
eaten by the private sector or the individuals who are being
billed on an individual basis. Isn't that true?
Ms. Turner. Correct.
Mr. Grothman. Do you know--does that happen in other
countries? Do you know--do you have any idea, like, in European
countries where they have----
Ms. Turner. Actually, other countries have very different
ways. There is really no one way that you can say other
countries deal with it. But that is--it is a problem everywhere
and it rises cost--increases cost for those who do pay for
those from those who don't pay or cannot pay.
Mr. Grothman. OK. And I want to talk a little about
pharmacy benefit managers. I am under the impression right now
a lot of times there are rebates. A lot of times the pharmacy
benefit managers wind up eating those rebates.
Could you comment on the fairness and the kind of who is
getting the benefits and who is the intended beneficiaries of
the rebates offered by the pharmaceutical companies?
Ms. Turner. Yes. There are large rebates that go through
the pharmaceutical benefit managers and they say that that
reduces insurance costs across the board. But there are policy
proposals that would have those rebates go directly to patients
at the pharmacy to actually reduce their costs. I think that
would be better policy.
Mr. Grothman. I have a bill like that. So you think that
would be a good idea if we care about the individual to make
sure that the--and the rebates are intended to go to the
consumer, right? Not the pharmacy benefit manager. Is that
true?
Ms. Turner. And we need more transparency so people
understand that those rebates are going to the PBMs--and
because of the transparency--lack of transparency we don't know
where--rather than to the patient.
Mr. Grothman. Thank you.
Chairwoman Maloney. The gentleman yields back.
The gentleman from Maryland, Mr. Raskin, is now recognized
for five minutes.
Mr. Raskin. Madam Chair, thank you so much. This is an
extraordinary and surpassingly important hearing and I hope it
will be an historic one. I want to thank you and Representative
Bush and Representative Tlaib for your leadership in bringing
this forward.
Dr. Sachs' remarkable testimony shows that we are first in
health care costs in America, first in administrative costs,
first in CEO salaries, and last in access to care, last in
equity, and last in health care outcomes, and our colleagues
across the aisle just don't want to deal with any of these
realities and are now trying to blame the systemic failures of
our health care arrangements on undocumented immigrants, which
is just an absurd and irrelevant distraction from the real
nature of the problem.
Another sign of the sickness of our system is the
staggering levels of medical debt that our constituents have,
not just constituents of Democratic members but constituents of
Republican members, too.
Americans, collectively, owe an astonishing $195 billion in
medical debt and this is a leading and, in many places, the
foremost reason for bankruptcy that persons and families go
into.
Dr. Collins, let me start with you. What are the leading
factors that cause patients and their families to fall into
this extraordinary abyss and quicksand of medical debt?
Dr. Collins. First, being uninsured is the primary risk
factor. So people who are uninsured have the highest rates of
medical bill and debt problems.
Second, being underinsured--having a health plan that face
really high deductibles or maybe you have a non-ACA compliant
policy that doesn't protect you from catastrophic health care
costs. That is a second major source of medical debt. But we
just have a lot of cost exposure in this--in our health system
both through uninsurance and also through underinsurance.
Mr. Raskin. Around one in five American families are
struggling with serious levels of medical debt, and for many
people with lower incomes their fear of coming under crushing
medical debt becomes a major deterrent to their obtaining
critical medical care or even just normal regular checkups.
How does medical debt pose a threat to the health as well
as the economic security of families that are working to make
ends meet?
Dr. Collins. Now, I do find that people who have faced high
out-of-pocket costs whether or not they have medical debt or
just face really high deductibles make decisions that are not
in the best interest of their health.
So they tend to delay care, delay filling their
prescriptions, just not getting care until it is--until it
becomes very, very serious. And when they do get care they
have--incur a lot of debt and have a lot of downstream
financial problems like ruined credit ratings.
Mr. Raskin. My family lived in France for a year, and just
in our first month there our youngest daughter came down with
just a piercing earache. She began to scream and we called some
French friends and asked what to do. They told us to call a
service that is connected to their national health care
program.
In 20 minutes, somebody knocked on our door. It was a
doctor. Came in, diagnosed Tabitha as having strep throat,
wrote a prescription that we were able to fill downstairs. And
asked if we were citizens. We said no. Asked if we were a
member of the national health care plan. We said no.
They said they would have to charge us as strangers and
that would be 20 euros that we had to pay. And they had a
certain number of pediatricians assigned to each neighborhood
that worked with us.
So when people talk to me about universal health coverage
it sounds pretty good. But what are the statistics? What do
they show about whether millions of people in France and other
countries are facing crushing medical debt the way tens of
millions of our people are facing crushing medical debt? Does
that exist in countries with the dreaded universal health care,
or what our colleagues are denouncing as socialized medicine?
Dr. Collins. No. People in other high income countries
have--face much lower out-of-pocket costs. Just a striking
difference between here and--there and the United States.
Mr. Raskin. So, Dr. Sachs, let me ask you about this. You
know, they called Social Security socialism. They called
Medicare socialism. They called ACA socialism. So, of course,
they are calling universal health coverage socialism. So but
hasn't the progress of our system been about taking public
responsibility, for making sure that everybody has access to
health care?
Dr. Sachs. Every other high income country, Congressman,
has found the solution to the problems that we are grappling
with, and all of the stories that we hear avoid the most basic
point, which is all the other countries have solved these
problems. We have not.
The reason we have not is that we have a system that is
geared toward not just private profits, massive profits of the
hospital system, the pharmaceutical system, and massive waste
of administrative costs unmatched by any other country in the
world by far.
We are wasting hundreds of billions of dollars of billing
time, of churning, of not in the network, in the network, can't
cover this, dispute this. Nobody does this.
And I would say to Congressman Grothman we are spending
$4.1 trillion right now. How much is that--is undocumented
aliens on the border? A pittance. It has nothing to do with
that.
It has to do with prices that are out of control in the
U.S. And with all the benefits of ACA, which brought people in,
it did not create a system of cost control. We need a system of
cost control.
And, Congressman, I have had the same experience----
Mr. Raskin. And thank you so much, Dr. Sachs.
Thank you, Madam Chair. This system is irrational. It is
costly. It is unjust. We should move forward with----
Mr. Hice. Madam Chair, his time has expired.
Chairwoman Maloney. Thank you for your Statement. His time
has expired.
The gentleman from Texas, Mr. Cloud, is now recognized.
Mr. Cloud. Thank you. We keep saying we are having a
national discussion on health care and the truth is over the
last few years we haven't really had a national discussion on
health care.
Too often health care and health insurance get conflated as
if they are the same thing. Indeed, the chair, in her opening
remarks, claimed that Obamacare expanded health care to 30
million people. That is not exactly true. You could maybe make
the case that it expanded health insurance coverage to 30
million people.
But anytime you mandate something by law and say you are
going to fine them if they don't have it, there is a probably
good chance you are going to see an uptick in the usage of
whatever that product is.
But that doesn't mean that it was better. We saw some
people who were over insured who didn't need that much
insurance. For most Americans, we saw over--a steady decline in
what health insurance covers.
Meanwhile, premiums have gone up. Too many times families
would even not be able to afford the health care because they
are paying for mandated health insurance.
And so it is important for us to remember that health
insurance is the middleman in the process and health insurance
never--a middleman never decreases a cost. It always increases
it. Now, in isolated incidences, it, certainly, should save
money and everybody should have some sort of health insurance.
But when we are looking at systemic ways to save money, we
probably need to go a different approach than what we have been
doing, and what happens too often here in Congress is we,
first, pass a program that breaks a system and then we come up
behind it and try to be the solution to what we already broke.
We definitely need a discussion but the discussion should
center on how we provide actual care, how do we open access to
care as opposed to mandating insurance for everybody.
Ms. Turner, I would like to ask you why are health care
costs increasing in the United States?
Ms. Turner [continuing]. That.
Mr. Cloud. I am sure there is a few of them but if you
could touch on----
Ms. Turner. A lot of reasons for that. A lot of it has to
do with the lack of transparency. Nobody has any idea how much
somebody else is spending on their care and Americans, they
want to know those questions.
But to--just to take the ACA as an example, the recent
increase in subsidies through the American Rescue Plan put
$17,000--every newly insured person in the American Rescue Plan
costs about $17,000 for--in taxpayer dollars.
But many of those people are dropping private coverage
because the subsidies are more attractive to go on the public--
to go in the public plan. So I think that we need to look at
what are the incentives in the system. Are there incentives for
people to get better care, better coverage, more affordable
care, get higher quality?
But we don't do that. We run it through rules and
regulations, through Federal and State and local spending
programs, rather than really trying to engage the same forces
that work in the rest of the economy to give people more
choices and more affordable products and services.
Mr. Cloud. It is interesting. You mentioned--we talked
about regulation in this committee hearing being a major driver
of healthcare costs, but it is interesting you mentioned price
transparency in the sense that for elective procedures, for
example, we see technology being a driver and when costs are
transparent and people are able to price compare, we actually
see those procedures in the market actually decreasing over
time, where we see, by and large, most of the industry
increasing over time because, as you said, what makes
capitalism work is the fact that you can shop. And then so we
have removed that ability--that accountability metrics--from
the system. And so I would agree that anything we could do to
put accountability back in the system would help.
We talked about some of the ways that health care costs are
increasing. What are some of the ways, maybe some technological
breakthroughs, different ways that prices could be lowered in
healthcare--that we could lower the costs and, thus, provide
access to more people?
Ms. Turner. I have reported in my testimony about several
States that have used a provision in the Affordable Care Act
called Section 1332 to be able to repurpose some of the money
that is going through the ACA to be able to figure out how can
we do a better job of taking care of the most expensive
patients who need the most care but they are not able to see
the physicians they need because of--everybody is a one-size-
fits-all plan.
They make this a much more--a much more focused plan, doing
a better job of taking care of the vulnerable. What that has
done is reduced prices across the board for everybody else and
that brings more people into the market, just as one example.
Ms. Cloud. One other thing I would like to ask your opinion
on in the short time I have left is what nation produces the
most medical innovations?
Ms. Turner. That would be the United States of America.
Mr. Cloud. So we definitely have some issues we have to
fix. But if we were to adopt the same system that does not lead
to innovations, the world at large would really suffer.
Ms. Turner. The world relies on us for innovation--for
medical innovations.
Mr. Cloud. OK. Thank you. I yield back.
Chairwoman Maloney. The gentleman yields back.
The gentlelady from Ohio, Ms. Brown, is now recognized for
her questions.
Ms. Brown. Thank you, Chairwoman Maloney and Ranking Member
Comer, for holding this important hearing. Most--across the
United States, most people of color are most likely to be
uninsured and live in communities with higher rates of
uninsurance or underinsurance.
As a result, people of color are more likely to be able to
afford critical medical care and more likely to go into medical
debt trying to pay for it.
Dr. Michener, let me begin with you. How does uninsurance
and underinsurance put people of color at elevated risk for
adverse health outcomes and what does this mean for health
equity in the United States?
Dr. Michener. Yes. So uninsurance and underinsurance
through many different mechanisms put people of color at risk.
One mechanism is through delayed care, through inadequate care,
because not only is care delayed but when you do receive care
without insurance it is difficult to adhere to care protocol
and regimens. It is difficult to get prescriptions and so on
and so forth.
One of the things that I think is important to point out in
some of the conversation that has emerged around things like
choice and innovation is that when we are talking about
disproportionately people of color and people who don't have
insurance, in fact, they lack choice in a profound way, and to
the extent that we are innovating they are the very people who
are not benefiting from any of those innovations.
So if we can have the latest technology and the best
procedures but you lack health insurance, you are not able to
have access to those procedures or to have access to that
technology, and those kinds of circumstances are
disproportionately encountered by people of color.
And so when we are thinking about choice, innovation, and
other things like that, the question is who will have the
choice and who won't? Who will be excluded from that? Who will
benefit from the innovation and who will not?
And I think that when we take equity into account it
really, I think, undermines the overemphasis on some of these
things and, at the very least, point out the importance of
balancing that with an emphasis on equity so that we actually
have full inclusion.
Ms. Brown. Thank you very much. So achieving universal
coverage is necessary to address those structural inequities in
our current health care systems that have historically
afflicted communities of color.
So, Dr. Blackstock, how would achieving universal coverage
help ensure that patients of color receive high quality care
before they become seriously ill?
Dr. Blackstock. Thank you so much for that question. You
know, as I mentioned in my earlier testimony, there are other
social determinants of health that are very key in influencing
the health of communities of color, but lack of access to
health care is so incredibly important because we need our
patients to be able to access primary and preventive health
care services.
They need to be connected with primary care physicians and
other types of health care providers so that initial diagnoses
are made so that they are placed on the proper protocols and
medications and so that they are really cared for and managed
in a way so that they don't develop these significant chronic
medical problems that will impair, really, their ability to
live a full life.
Ms. Brown. Thank you very much. It is clear throughout the
testimony today that universal coverage will help eliminate the
entrenched health inequities experienced by people of color in
this country and, importantly, it will help eliminate many of
the barriers to care for people of color that they so often
face because of their employment or immigration status.
So universal coverage will create healthier communities so
that every person in the United States can thrive and that is
what excites me most.
And so with that, I yield back.
Chairwoman Maloney. The gentlelady yields back.
The gentleman from Pennsylvania, Mr. Keller, is now
recognized for his questions.
Mr. Keller. Thank you, Madam Chair, thank you, Ranking
Member Comer, and thank you to the witnesses for being here
today.
Socialized medicine is not only the wrong approach, it
would be detrimental to our healthcare system and the patients
who rely on it. Americans are the ones who are best equipped to
make health care decisions for themselves as well as for their
families, not the government.
I want to talk a little bit about a personal experience.
But before I do that, two names--Alfie Evans and Charlie Gard,
a toddler and an infant in the U.K., whose doctors said they
would not survive.
So the doctors took the parents to court and were forced to
remove their children from life support. One child could have
gone to Italy and one could have come to the United States for
care. But their government didn't allow them to do it.
I want to talk about 1994 when my son had a brain injury,
and he was life-flighted to Geisinger Medical Center, and they
performed brain surgery and he came out of the surgery and the
doctors told us--they said kids in his condition aren't a 50
percent mortality rate. It is not a 98 percent mortality rate.
It is 100 percent mortality rate. And over the coming weeks, we
were told to remove him from life support because he was not
going to survive.
But we had control of our health care decisions, not the
government, and because of that the following year it says
Freddie Keller of Kramer is Geisinger's poster child for 1995
in northeastern and central Pennsylvania. He is now 31 years
old and works for the health care industry in supply chain,
because we had choices over his care, not the government.
So that is socialized medicine. That is universal health
care. That is someone, a bureaucrat from the government,
deciding what is best for you and your family, not you, and
that should never happen in the United States of America.
Never.
So I did want to just ask a question to Ms. Turner. Might
these policies affect patient wait times for treatment in which
patients would suffer most from the increased wait times?
Ms. Turner. Very powerful story, Congressman. Thank you for
sharing that.
We do have evidence of what happens when systems operate
under a global budget in other countries and, as you say, you
wind up with government making decisions about whose life
matters and they do that in sometimes very subtle ways,
something called quality adjusted life year, where they decide
whether or not your life is worth getting a new medication that
may be on the market.
So I think the choice and control issue is profoundly
important because it also focuses the system on the patient
rather than on bureaucrats making decisions about people's
lives.
Mr. Keller. Just another question. In addition to
restricting choices and access to care, would a single-payer
public health option truly lower health costs for Americans?
Ms. Turner. My colleague, Merrill Matthews, from the
Institute for Policy Innovation actually looked at the
administrative cost savings, and when he made an apples to
apples comparison, he said it is not going to save any money
administratively because the government is still going to have
to make sure that a procedure was provided.
The documentation will have to be there. The person will
still have to be paid. There will still have to be all of the
paperwork that we have now. It just runs through a different
system.
So it is not clear to me to see how it would save, and
Chuck Blahous from Mercatus Center says that it would actually
cost $32 trillion over 10 years.
Mr. Keller. OK. Thank you. You know, this is something that
I always say--changing who pays the bill does not make
something affordable. All it does is remove choices from
people.
Not only would socialized medicine offer patients fewer
medical options, limited number of qualified medical personnel
in the midst of a healthcare worker shortage, and discourage
medical innovation, proposals like Medicare for All would cost
the taxpayers an estimated $32 trillion over 10 years. The cost
of government-mandated universal health coverage is simply too
huge.
And I tell you what, the cost of my son's life under a
system like that that had to be endured by the parents of
Charlie Gard and Alfie Evans, I don't want to see that happen
to any family in America. The government should not be telling
you whether or not your child can receive life-saving medical
attention.
And thankfully, here in the United States of America, I
didn't have to face that choice in 1994 when I was 28 years
old, struggling to make ends meet, and my son is still alive
today.
Thank you and I yield back.
Chairwoman Maloney. The gentleman yields back. The
gentleman from California, Mr. Khanna, is recognized for five
minutes.
Mr. Khanna. Thank you, Madam Chair. Thank you for your
leadership on Medicare for All and holding this historic
hearing.
Let us be very clear that private health care insurance is
a crushing tax on working families in this country and on
businesses. Working families have to pay a tax of almost
$12,000, if not more, on the premiums that they pay to private
health care insurance and on their out-of-pocket costs.
And businesses in this country are competing with one arm
tied behind their back. What is the tax that private health
insurance is putting on businesses? Sixteen thousand dollars
for a family that businesses are having to pay. That is why
they are having to compete in a total disadvantage to many
companies and businesses and manufacturers overseas.
In fact, if you talk to CEOs they say the biggest burden on
their payroll often is this tax that they are paying to private
health insurance. On top of that--and I want to just talk about
the economics here--on top of that you have over 23 million
Americans in medical debt because of the tax that they are
paying to private health insurance.
You have 78 million Americans not able to get the health
care they need, not able to treat their kids for the medicine
they need or get, in certain care, life-saving treatment--
68,000 Americans every year dead because they aren't able to
have health care that they need.
This is the current system, and what we are saying is have
a tax cut for working families. Have a tax cut for businesses
by eliminating the excessive profits of the insurance
companies, of the pharmaceuticals, and off the hospital
facility fees.
Let us get those deadweight costs out to cut taxes, cut the
private insurance tax for working families at a time of
inflation. Bring the costs down, bring the costs down for
businesses. This would be actually deflationary and it would be
one of the largest tax cuts in putting money back in the
pockets of working families and businesses.
Dr. Sachs, let me ask you. You are an economist. Can you
just explain from a commonsense perspective, if you take out of
the system the excessive insurance costs, the excessive
pharmaceutical costs, the excessive hospital facility fees,
aren't you going to reduce the amount that ordinary Americans
are paying and the American businesses are paying, from an
economic perspective, into the system?
Dr. Sachs. Congressman, of course you are. It is just
bizarre, this discussion that it would be too expensive to
lower the health care costs through universal coverage. We just
heard it would be an extra $32 trillion.
This is phony numbers because it doesn't count the saving
that comes from eliminating the private premiums, which, as you
say, that is a tax on household income. It is all verbiage. The
United States is paying twice what any other country pays for
health care.
I wish there was some--I wish the opposition--the ranking
members would ask me some questions, not just their witness
some questions, so we could actually have a discussion.
We are paying nearly 20 percent of GDP. We are paying
$12,000 per person, more than twice what other countries are
paying. Shame. It is just absurd. And where is that? It is
procedure by procedure, it is hospital stays, it is doctor's
appointments, it is devices, because our system is rigged.
From all the campaign contributors that make this the No. 1
lobbying sector in this country, it is rigged for an overpriced
health care system. We could save about a trillion dollars a
year for our country to do other useful things.
Mr. Khanna. Dr. Sachs, I totally appreciate that and, you
know, this is why I strongly support Bernie Sanders' Medicare
plan, which is a very reasonable plan.
I guess my last point is this. I am not a Ph.D. economist
like you but I don't think you have to be a Ph.D. economist
understand that if you are--if you have a system where everyone
can go to any doctor they want because everyone now is in
network under Medicare and you eliminate the middle people--you
eliminate the people who are charging the insurance fees, you
eliminate the pharmaceuticals who are making their profits in
terms of having to negotiate with Medicare, and you eliminate
hospitals from just being able to charge whatever they want
because they have to negotiate with Medicare, that as a common
sense perspective you are going to bring costs down because you
are going to not have all those profits.
Am I missing something in that simple explanation?
Dr. Sachs. No. Not only are you not missing something, it
is not even hypothetical. It is proven. It is proven in France,
in Germany, in Norway, in Denmark, in Netherlands, in Sweden,
in Finland. Go look at the data. I live in these countries. I
see these countries day by day. It is the demonstrated daily
reality.
So it is not theory. It is proven, and the United States is
the single outlier because we are driven by greed and by a
system of lobbying that imposes this completely overpriced
system, which is not a system actually.
And what you said, Congressman, is exactly right. The
hospitals charge whatever they want, and we all know that the
pricing is a game, completely nontransparent. They charge what
they can charge because they are discriminating monopolists.
They charge what they can get away with where they can get away
with it. There is no market here at all.
Mr. Khanna. Thank you, Dr. Sachs.
Madam Chair, I yield back.
Chairwoman Maloney. The gentleman yields back.
The gentlelady from North Carolina, Ms. Foxx, is now
recognized for her questions.
Ms. Foxx. Thank you, Madam Chair, and I want to thank our
witnesses for coming today.
I have to say that listening to this last interchange,
there are some people on this committee and some of our
witnesses who live in a Never Never Land--a Never Never Land.
Ms. Turner, today, we have heard a lot about government-run
health care such as Medicare for All but we have not heard much
about the quality of care. This is not surprising, though. I
cannot think of one thing the government does that is both
affordable and of high quality.
What would Medicare for All do to employer sponsored
insurance and how would this affect the 155 million Americans
currently enrolled in employer-sponsored coverage, something
that Americans overwhelmingly support?
Ms. Turner. Well, the Medicare for All would abolish
employer-based health coverage and all other current health
care programs so that we would all be under one single plan.
And you see--you know, you see employers trying so hard to
innovate--providing wellness programs.
Wal-Mart, before the Affordable Care Act was implemented,
had computer rooms to help their employees tailor a plan that
worked best for them. That is the kind of innovation that we
would lose, the kind of patient focus, the kind of energy from
the private sector that leads to innovation.
Ms. Foxx. How would Medicare for All affect the nearly 64
million seniors who are currently on Medicare? Would they
receive better coverage?
Ms. Turner. Sixty-four million seniors and disabled
patients on Medicare, 26 million of them have chosen Medicare
Advantage private plans. That shows that they believe that
there is more value to having a private plan that can manage
their care. They can pick the plan that provides the best
network in their area.
So they are--and some, we believe, could be focused care.
If you have diabetes or heart disease, you will get the
specialist in that care. So I think that there would be a lot
of innovation lost and I don't think seniors would be nearly as
happy as they are now.
Ms. Foxx. Yes. As I understand it, our friends on the other
side of the aisle want to do away with Medicare Advantage and
the kinds of things you have described.
Also, under Medicare for All or another universal health
care system would Americans have wait times to seek care that
are similar to those in Canada and the U.K.?
Ms. Turner. Absolutely, because you--there are lots of
different ways for people to pay for systems and one of them is
in care that they don't get and, oftentimes, they don't even
know the care that they are not getting.
I talked with a physician from the U.K. and he saw both
private sector patients as well as those on the National Health
Service Plan. And he said, I can't even tell my public patients
about new medications that would be better for them because it
is not covered under the system. Patients who are going to have
to wait for two years to get a knee replacement surgery pay out
of pocket, if they can, to go to the Mayo Clinic if they live
in Canada or someplace else. So they--patients pay in other
ways, especially those most in need of serious medical care.
Ms. Foxx. Thank you.
Ms. Turner, another question. The Mercatus Center
calculated the costs of Medicare for All and found that under
the best case scenario it would increase Federal budget
commitments by $32.6 trillion over the first 10 years of
implementation.
Thirty-two point six trillion is triple what the Federal
Government spends on our defense and domestic discretionary
programs over 10 years. Even doubling the corporate income tax
could not cover that.
Since our government is consistently overspending and
running large deficits each year, is a massive new government
spending program like Medicare for All financially feasible or
sustainable?
Ms. Turner. It is really hard to see how that could work.
As I said in my testimony, that Colorado, Vermont, and, most
recently, California have tried to figure out how they could do
just on a State basis a single-payer system.
In California--even California saw the price tag of $450
billion a year and they said that is really not something we
can afford.
Ms. Foxx. Thanks. And my last question--what lessons can we
learn from the implementation of Affordable Care Act, or
Obamacare, and how should that inform our expectations for
further government involvement in health care?
Ms. Turner. Running a top-down system is really difficult,
especially from Washington, in a country as diverse as this one
is, and one of the reasons there have been so many changes to
the ACA is because some things worked for some States and
others didn't work for other States, and for different sectors
of the economy you need to have local control bottom-up
decision, making not top-down decisionmaking that could have
the same catastrophic effects as healthcare.gov did.
Ms. Foxx. Thank you, Ms. Turner.
I yield back.
Chairwoman Maloney. The gentlelady yields back.
The gentlelady from Michigan, Ms. Tlaib, is recognized for
her questions.
Ms. Tlaib. Thank you so much, Chairwoman, and thank you so
much to my good colleague from St. Louis, Congresswoman Bush,
for really leading us to making sure that we bring our
residents to Congress and make sure that they are seen and
heard.
As Bishop Starghill from my district said in his testimony,
and it was very clear, lacking access to health insurance not
only causes financial hardships but it puts millions of
Americans' lives at serious risk every single day.
I represent the third poorest congressional district in the
country. Very limited choices when folks talk about choices
when it is convenient. But today, whether or not a person has
access to high-quality medical care depends, largely, on
whether they are insured or whether--what their income is,
whether or not they are wealthy enough to pay for it.
Medicare for All will guarantee access to high-quality
health care for every person in our country, regardless of
their ability to pay, and we have heard a lot of misleading
claims from my colleagues on the other side.
But Medicare for All--what we are talking about and what
they are saying is simply not true. But what we are saying in
regard to making sure it is accessible and making sure folks
are covered is true. It simply says you don't have to be rich
to have access to quality health care.
So my question to my good friend, Mr. Barkan--and, you
know, thank you so much for being here today and getting up so
early--your activism has helped put a face to so many people
that really don't lack--lack the access to being here but also
the fear that comes with being this vulnerable and talking
about not being able to access health care.
So I want to hear from you and whether or not you believe
we would have universal health care today if we didn't allow
those who profit by our broken health care system to make
political contributions.
[Pause.]
Voice. Mr. Barkan is writing.
Mr. Barkan. I think it is crystal clear that we have a
corporate corrupted system and it needs to change.
Ms. Tlaib. Thank you, Mr. Barkan. Do you believe in the
work and the advocacy work that you are doing that our system
is rigged? If yes, how have you seen it so clearly in your
advocacy work?
Voice. One moment.
[Pause.]
Mr. Barkan. Medicare for All boils down to the simple
question of whether or not you believe that health care is a
human right. Those against Medicare for All will call this
policy various names to distract the public from the truth that
you and me, nurses and small businesses, all of us, would fare
far better under a system that guarantees comprehensive, high-
quality, affordable health care to all.
The only people who benefit from our for profit system are
the multimillionaire healthcare executives who profit off our
illness, their corporate lobbyists, and the elected officials
who take campaign contributions from health care corporations
and, therefore, their policy views from them.
Ms. Tlaib. Thank you so much, again, for your courage and
for helping, again, put a face to this broken health care
system. I know I have said it over and over again, and
Chairwoman, you have probably heard me, corporate greed does
kill in our country and Medicare for All would address the
disparity and reduce the health inequities associated with our
current broken system while preserving patients' ability to
make the best medical decisions for themselves and their
families no matter their income.
So for those reasons, I am incredibly proud to support
Medicare for All, and, again, thank you so much, Chairwoman
Maloney, for your courage in having this hearing.
I yield back.
Chairwoman Maloney. The gentlelady yields back.
The gentleman from Arizona, Mr. Biggs, is now recognized
for his questions.
Mr. Biggs. Thank you, Madam Chair.
You know, preventing individuals from making personal
health care decisions, and then we have heard a lot about how
important that is, and ceding those decisions to government
bureaucrats is really the violation of fundamental human
rights, and one must acknowledge that inherent in President
Obama's Statement that if you like your health plan you can
keep it was that recognition of that human right to make your
personal choices. I mean, that is why he said that, because he
knew that is what we want. We want to be able to choose our
health plans.
But that was a lie and he told that lie because he wanted
to get his Obamacare, ACA, whatever you want to call it plan
out there. Which is interesting to me because repeatedly I have
heard colleagues across the aisle say today the system is
broken.
This is the system you designed. This is the ACA. We are
all living under it now one way or the other. It is your
system. Dr. Sachs said it is broken. It is unfair. It is too
expensive. There is too much administrative costs.
I agree with everything you said there. You are exactly
right. But this is the system that my colleagues across the
aisle made. Even in the private industrial sector--in the
private plans, the administration costs are too high.
They are way too high, and part of that is because of the
regulatory environment that mounted on the previous unworkable
regulatory environment that was imposed through the ACA.
The good doctor repeatedly mentioned peer countries. But
when you talk about single-payer systems or socialized systems,
although we don't--apparently we are not supposed to call it
that--there really isn't a peer to the United States. Just the
size of the United States mediates against that.
The peer countries in population size or cost of health
care and expenses paid are not comparable. There is no peer
country on the charts that you were putting up there. Go back
and take a look.
The scale of a Medicare for All plan will be unlike
anything you have seen in the history of the world. And, you
know, scalability is a problem but the inherent problems can be
even in small States.
I mean, so when Vermont tried to implement its single-payer
experiment that failed under the cost. Now, we all say, hey,
yes, everybody should be able to have access to their health
care. We want it to be affordable.
But Medicare for All would make our ability to buy private
insurance even more difficult than it is to buy private
insurance in Canada, and it wouldn't necessarily guarantee that
you are going to reduce cost. I mean, let us take a look at
Medicare and pharmaceutical costs. They are way up. They still
remain high, even under Medicare.
So I think so much of what I have heard today is talking
around the issue for political purposes. If you want to solve
problems, I am willing to talk and let us solve problems.
But I am told today that all the other countries have
solved their problems and I don't know that I believe that.
There are lots of studies and science that indicates that is
not true.
Dr. Sachs. Congressman, could I respond?
Mr. Biggs. Let us take a look at one specific--let us take
a look at one specific issue. And I don't know who is
interrupting me.
Dr. Sachs. That was me, Professor Sachs. I was wondering
whether I could respond.
Mr. Biggs. Yes. Yes. I am not asking you a question, sir. I
am not asking a question. Please don't interrupt me.
Dr. Sachs. OK.
Mr. Biggs. In 2009, Medicare cut payments to independent
cardiologists. This is what we call--this is what we call an
unintended consequence, for people who don't understand
economics.
2009, Medicare cut payments to independent cardiologists
for common tests but left untouched their payment for
cardiologists employed by hospitals. So what do you think what
happened? Some imaging services Medicare paid hospitals nearly
twice as much as they paid independent physicians for the same
service.
The effects were predictable--were predictable. The percent
of cardiologists employed by hospitals rocketed. People
received many more cardiac imaging from hospital outpatient
departments and less from freestanding physicians' offices.
That is an unintended consequence.
So I will turn to you now, Ms. Turner. What effects would
Medicare for All have on patients' ability to receive care in a
timely, affordable fashion?
Ms. Turner. I can't agree with you more about the
comparison. The Swiss system works fine for Switzerland. It is
the size of Massachusetts. That is not something that we can
impose on this whole country.
We must have diversity, and I think people value not only
diversity of places to get care but they also--they value
diversity of how that care is going to be paid for and giving
people more options than they have today.
As we see, fewer and fewer because so much of the spending
is controlled by government--Federal and State government--
rather than by patients and rather than seeing what innovations
could come to provide people with more options of portable
coverage that they own and take with them and that they can
afford to keep with a strong safety net for the vulnerable.
Chairwoman Maloney. The gentleman's time has expired.
Mr. Biggs. Thank you.
Chairwoman Maloney. Thank you. I now recognize the
gentlelady from California, Ms. Porter. She is recognized for
her questions.
Ms. Porter. Dr. Collins, what percentage of revenue do
private insurance companies spend on administrative costs?
Dr. Collins. Between--about 17 to 18 percent of spending in
private insurance plans.
Ms. Porter. So if I pay my insurance company $100, 1, 2, 3,
4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, $17 go to
administrative costs. What about Medicare? What do they spend
on administrative costs?
Dr. Collins. That range is about, you know, 3 to 5--3 to 5
percent of Medicare spending.
Ms. Porter. 3 to 5--3 to 5 percent. About 3 to 5 percent
right here, and if we look at just billing costs, just billing
in insurers' costs, Medicare is at one percent. Private
companies spend 17 times more on administrative costs than
Medicare?
What are private insurance companies spending on that
Medicare is not? Does Medicare spend hundreds of millions of
dollars on television advertisements like private insurance
does?
Dr. Collins?
Dr. Collins. No.
Ms. Porter. Does Medicare spend millions of dollars on
stock buybacks to shareholders?
Dr. Collins. No.
Ms. Porter. Does Medicare spend money on marketing? Private
insurance likes to put its name on stadiums and PGA
tournaments? Is there a Medicare Arena?
Dr. Collins. No.
Ms. Porter. Does Medicare spend $23 million on executive
pay like private insurance companies do?
Dr. Collins. No.
Ms. Porter. We know how much it costs to run a high-quality
health insurance program--one dollar. Out of $100, research
shows that Medicare spends 1.1 percent on administrative costs.
We spend $4 trillion on health care every year. We could
save $200 billion dollars on administrative costs with Medicare
for All and those savings, they could go to expand Medicare. We
could spend that money to let patients see dentists.
We could spend that money and let patients pay for hearing
aids, to help older adults afford eyeglasses, to bring down the
cost of prescription drugs, to finally pay mental health
professionals for the work they do.
Instead, all this money is wasted. We are not talking about
paying to keep the lights on in operating rooms or improving
the quality of care. All this money is used to pay big
insurance to push paper. It is death by 200 billion paper cuts.
Dr. Sachs, what is it about the U.S. market that leads to
these sky-high administrative costs?
Dr. Sachs. Congresswoman, there is no market. These are
local, concentrated providers that have tremendous power to set
their prices and to set extraordinary salaries. We should
contemplate that the so-called not for profits in this country
pay their hospital directors $5 million.
This is unbelievable, and so this is why these costs are--
why the prices are so high. The administrative costs are so
high because we don't have a system because we spend 20 percent
of our spending just to funnel money between organizations,
which is something that other countries don't spend. And I
would like to say--I would like to----
Ms. Porter. Dr. Sachs, I wanted to ask you----
Dr. Sachs. Sure.
Ms. Porter. Reclaiming my time for one second, Dr. Sachs.
I wanted to ask you specifically about standardization and
what role that might play in reducing some of this waste that
we could reallocate to health care costs.
Dr. Sachs. Well, when you go in for billing there is no
standardization on anything, on the information technology, on
the systems, who is in, who is out, what is going to be
reimbursable.
Everything is completely opaque. Everything is completely
discriminatory depending on who is being involved. So
standardization is a big part of all of this because when you
lack standardization you put in resources to suck out whatever
rents you can and we end up, as you counted those $17 out of
every $100, basically, lost--basically, wasted.
Ms. Porter. Reclaiming my time. Reclaiming my time, Dr.
Sachs.
We heard today about the cost of Medicare for All but there
is a cost to letting insurers paperwork patients and providers
to death and that cost of inaction is $200 billion on
administrative costs.
Now, administrative costs waste money but they also waste
health care workers' time. A recent study found that a majority
of doctors--56 percent--support a single-payer health care
program.
Why? Because today doctors spend only one quarter of their
time with patients. What are they doing with the rest of their
time? Paperwork.
Ninety--and I want to also--I want to add not only would 56
percent of doctors support Medicare for All but patients would
have the most choice under Medicare for All. The health
insurance coverage with the biggest network is Medicare. No
private insurance comes close. Ninety-nine percent of
pediatric--nonpediatric doctors participate in Medicare.
So I want to recap. Medicare for All would save money on
administrative costs, $200 billion a year. Medicare for All
would give patients the most choices, 99 percent of
nonpediatric providers, and Medicare would let doctors practice
medicine.
Not surprisingly, given these three things, what do we get
with Medicare for All? Better health outcomes, and that is why
I support Medicare for All because they support patients over
paperwork.
I yield back.
Chairwoman Maloney. The gentlelady yields back. But before
we continue, as mentioned at the beginning of the hearing, Dr.
Sachs has a hard stop at 12 o'clock. We thank you for your
participation, Dr. Sachs. You are excused. Thank you.
Dr. Sachs. Chairwoman?
Chairwoman Maloney. Now the gentleman from Kansas, Mr.
LaTurner, is recognized for five minutes.
Mr. LaTurner. Thank you, Madam Chair. I appreciate it. Dr.
Sachs, I will give you--we don't agree on this but I will give
you 30 seconds. I can see that you wanted to say something.
Dr. Sachs. Thank you very much. I want to say there is no
economic cost to Medicare for All. It is pure saving. The $32
trillion reference is about the increase of Federal finance.
But there is a larger decrease of private finance. The net
is a large saving. We need to take that talking point out of
the discussion so that we can solve the problems. We also need
to understand we do have a peer. It is the European Union. Life
expectancy is 81.3 years for their 440 million people.
Mr. LaTurner. I am going to have to reclaim my time.
Dr. Sachs. Congressman, thank you. Thank you very much for
letting me say those words.
Mr. LaTurner. You are welcome. In the name of
bipartisanship, Madam Chairwoman.
Dr. Sachs. I appreciate that very much. Thank you.
Mr. LaTurner. Yes. My questions are for Ms. Turner. Much of
the money that Americans pay for health care is going toward
its administrative costs, whether that is for hospitals,
pharmacy benefit managers, or insurance companies.
Many proponents of Medicare for All strategies say that
administrative savings would offset some of the costs of the
government-sponsored health care program.
Do you agree that Medicare administrative costs are or
would be significantly less burdensome that administrative
costs for private insurers? If not, where do you think that
misconception comes from?
Ms. Turner. Thank you, Congressman. I quoted in my written
testimony a study by Dr. Merrill Matthews of the Institute for
Policy Innovation in Texas, who is saying that when you compare
apples to apples, when you compare the actual cost of making
sure a procedure was performed, deciding who your--what your
patient population is, making sure the doctor gets paid, all of
the other procedures, you wind up with about equal cost.
One of the things that the Federal Government is able to do
is to be able to shove the cost of collecting payments off to
other agencies or not do the kind of due diligence that many of
the private plans do to make sure that the revenues are
connecting and premiums from the customers are able to be--are
spent properly.
So you see much--you see less waste in private programs
because they are spending some part of that administrative
money on due diligence. We need to see more of that in the
Federal Government.
Mr. LaTurner. I am going to stick with you, Ms. Turner.
Committee Republicans have discussed how the expansion of
Medicaid and the elimination of eligibility checks have
contributed to government waste through improper payments.
According to CMS, total improper payments for Kansas in 2021
amounted to nearly $290 million.
Can you provide any further insight into why 20 to 25
percent of all Medicaid payments are disbursed improperly and
whether fixing these improper and wasteful payments would
change how you feel about a Medicare for All policy?
Ms. Turner. Well, I already don't think that a Medicare for
All policy is the right approach for such a diverse country as
this is that values innovation. If you wind up with
standardization you get rid of a lot of the innovation.
My colleague, Brian Blase, who--with Paragon Health
Institute, also a senior fellow at the Galen Institute, has
done a deep dive into the study that you referenced about
Medicaid waste, and he assumes--says that in one year Medicaid
had improper spending of about $100 billion that was, largely,
for people who were on the program and weren't eligible.
There are a number of other ways in which people are taking
advantage of the system and it is not being properly monitored.
The inability of the Federal Government to be able to contain
hundreds of billions of dollars in wasteful spending with a
program that would cover 330 million Americans seems to me an
in comprehensible task.
Mr. LaTurner. You highlight the burdensome Federal
regulatory demands that providers must respond to. Often it is
at the expense of their patients. Can you describe further how
increased government involvement in the health care sector
reaches a point of diminishing return when it comes to
addressing patient needs specifically?
Ms. Turner. Well, writing one more regulation to solve one
more problem is when we are going to add more paperwork to a
physician's backlog.
The former head of the Mayo Clinic one time looked up the--
had his staff look up the number of regulations that the Mayo
Clinic--had pages of regulations the Mayo Clinic had to comply
with in order to treat Medicare patients. He said, we lost
track at 100,000 pages, and that was two decades ago.
So the more regulatory compliance--and we are not going to
get rid in this country of demands that taxpayer dollars are
spent on this service that is promised. We are going to have to
have paperwork trails. People are going to have to follow those
trails.
That money is going to have to then go to the provider
after it goes through other administrative checks. That--we are
not going to get rid of that with Medicare for All. The only
way we can get rid of that is through innovation, to give
people more choices so that they are--the marketplace is
responding to those needs rather than complying with all these
hundreds of thousands of pages of rules and regulations.
Mr. LaTurner. Thank you, Ms. Turner.
Madam Chair, I yield back.
Chairwoman Maloney. The gentleman yields back.
The gentlelady from Missouri, Ms. Bush, is now recognized
for her questions.
Ms. Bush. St. Louis and I thank you, Chairwoman Maloney,
and to the committee for this--for convening this critically
important hearing, which represents our steadfast commitment to
achieving universal health care coverage in the United States.
For my colleagues on this committee, you have a choice in
front of you today. It is a choice to save lives or a choice to
let people die. Disproportionately low income people, Black
people, brown, indigenous people, die. Because you are a human,
you deserve health care. Because you are a human, you deserve
health care.
In my community, Black mothers die at three to four times
the rate of white women. In my community, Black babies are
nearly twice as likely to die prematurely. I came to Congress
because enacting Medicare for All, it is not a choice for me.
It is a moral imperative.
When I worked as a nurse, I cared for uninsured and
underinsured patients every single day. I am reminded of one
patient with diabetes who was failed by our healthcare system
because she could not afford all the aspects of her care.
Technically, she had primary--she had insurance and a
primary care provider but she could not afford her insulin
prescription, her needles, her test strips to track her blood
sugar levels. The patient--this patient, she was forced to
ration her insulin and she skipped appointments due to
transportation, making it difficult to follow treatment plans.
This patient ended up losing a limb and eventually she died.
One health condition, if left untreated, can be deadly. For
me, after I turned 18 years old, I became an uninsured low wage
worker. I could not afford to retain a primary doctor so I went
to the emergency room for treatment for conditions like asthma,
sinus infections, and tooth aches.
My asthma was exacerbated by environmental pollution and
degradation and continued to worsen without proper medical
care. During the Ferguson uprising, toxic tear gas filled my
lungs, leaving me gasping for air and it worsened my condition.
Even though I was working as a nurse, I was forced to pay a
$900 monthly premium, a $4,600 deductible, and struggled to
treat my asthma.
Dr. Michener, can you please describe the relationship
between health care coverage--a healthcare coverage status and
economic mobility in the United States? How would Medicare for
All reduce poverty and stimulate economic growth in the United
States?
Dr. Michener. Representative Bush, thank you for the
question. I think this is a key dimension.
Oh, I thought it was on. Oh, OK.
Yes, I think this is a key dimension of the--of this
discussion that we, I think that on some fronts has been
willfully ignored, which is that there are gross inequities not
just in our health system but in our economic and social and
political systems, more broadly, and the inequities in the
health system are exacerbating the inequities in other places.
So if we look at all of our anti-poverty programs that we
have in this country, the largest effect on poverty--child
poverty in particular but poverty more generally--comes from
our Medicaid program. Addressing healthcare disproportionately
addresses some of the other core and fundamental challenges we
have around economic inequality in this country. And so what
happens when you provide people with healthcare? We have seen
it through Medicaid. They are less likely to be evicted. They
are less likely to recidivate and go back to prison. They are
more likely in the long term to have positive financial
outcomes.
Ms. Bush. Yes.
Dr. Michener. Less likely to be living in poverty, less
likely to have medical debt, more likely to have positive
educational outcomes, more likely to have employment. We want
to say, ``socialized medicine,'' scare people away with the
scary phrases, right? Oh, the government is going to be making
the decisions.
Ms. Bush. Right.
Dr. Michener. If the government is not making the
decisions, who is? The market, and that is not democratically
controlled.
Ms. Bush. Thank you.
Dr. Michener. It is not something that people can
influence.
Ms. Bush. Thank you. If not three years into the pandemic,
when will we actually address the fundamental flaws and
structural inequities present in our healthcare system, in our
privatized healthcare system? Dr. Blackstock, using your
extensive experience as an emergency physician, can you please
describe what the implementation of Medicare for All would look
like for healthcare providers, particularly those who interact
with insurance companies?
Dr. Blackstock. So what it will do is it will enable us as
health providers caring for our patients to more efficiently
care for our patients, to prioritize the primary and preventive
services that we provide them. It will not result in more
administrative effort and cost. In fact, it will do the
reverse. And so it will help remove barriers for our patients
to seek care, and doing so will enable us to buy the best care
and to do so even more efficiently than we could that now.
Ms. Bush. I will say ``yes'' to that as the nurse that
actually worked the bedside. That is true. Thank you, and I
yield back.
Chairwoman Maloney. The gentlelady yields back.
The gentleman from Texas, Mr. Sessions, is now recognized
for his questions.
Mr. Sessions. Madam Chairwoman, thank you very much. For
those members that are here, I only see one other in the room
that was here in 2008, 2009, 2010 as we went through this exact
same type of hearing about how great the Affordable Care Act
would be. And yet you notice no one Democrat that I see talks
about how great the Affordable Care Act was because it wasn't.
It took $800 billion out of Medicare. Democrats actually took
$800 billion away from seniors to pay for this. Now we have
Medicare for All like it is their newfound answer. Oh, by the
way, I heard one of our persons just a minute ago giving
testimony about how Medicaid works so well. I wonder why we are
not doing Medicaid for All.
Well, ladies and gentlemen, the bottom line is that both
the House bill and the Senate bill under Section 107,
``Beginning on the effective date as in Section 106(a), it
shall be unlawful for a private insurer to sell health
insurance coverage that duplicates the benefits under this act,
and it is unlawful for an employer to provide benefits.'' Well,
Mrs. Turner, I recall it took President Obama several election
cycles before they could even tell us ``what was in the bill.''
And it took them a long, long time, only to discover that their
drawings on a board did not equal success for patients. Why
would they want everybody to go into this system that is
designed for seniors? It is designed for seniors. It is not
designed for children. It is not designed for disabled young
adults. As a matter of fact, I have a disabled, at least one in
my family, a Downs syndrome young man who is my son. They are
trying to take all of America and make it to where we would be
at the same place two years later of trying to say, my gosh,
what did we do.
Ms. Turner, I know the gentleman, Dr. Merrill Matthews,
well. I know the gentleman, Dr. John Goodman, well, and they
have spoken about the excessive impact that this would have. Do
you agree with me?
Ms. Turner. I do, Congressman, and I also agree that we
really have to figure out what the problem is we are trying to
solve since two-thirds of people who are uninsured today have
access to coverage. They are just not enrolled. So I think we
need to look at specifically how do we help get people into the
system who, for a number of different reasons, are not
participating. And we also need to figure out how can we do a
better job of delivering specialty care to people with special
medical needs rather than a one-size-fits-all standardization,
which is ultimately going to work for very few people.
Mr. Sessions. Yes. Mrs. Turner, when I came to Congress, I
had spent 16 years at a small telecommunications company called
AT&T. AT&T was prohibited by the law that was passed by
Democrats and President Obama that said that they would not
allow employers to deduct benefits, money spent on employer-
provided healthcare to retirees. That is against the law. They
wanted to move everybody off of an employer-provided model,
which seemingly everybody was happy with, and to move to a
Medicaid model.
The question I would ask you is, do you think that a
system, let us say, American Airlines or AT&T, that that would
be the model that we want everybody to move to just like
employer-provided healthcare? Because as I read this, I am a
political science major. When the government competes against
somebody, free market that is called socialism. When the
government dictates who can be in the marketplace that is
communism. What do you think this is, given that as a choice?
Ms. Turner. Well, I believe that Medicare for All
definitely is a socialized healthcare system.
Mr. Sessions. Why is it socialized? It doesn't allow
anybody to compete against it.
Ms. Turner. Everybody would----
Mr. Sessions. Wouldn't that be communism? You may not have
been a political science major.
Ms. Turner. I don't have a term for it, but certainly it is
a one-size-fits-all program.
Mr. Sessions. It outlaws anyone else from providing
coverage.
Ms. Turner. Right.
Mr. Sessions. That is communism. I thank the gentlewoman
for being here, and I thank the chairman of the committee for
this hearing today. Thank you.
Chairwoman Maloney. The gentleman yields back.
The gentleman from Illinois, Mr. Davis, is now recognized
for his questions.
Mr. Davis. Thank you, Madam Chairman, and thank you so much
for calling this very important hearing. And I guess I would
say one thing: Pete, I was in the room. I am a strong supporter
of the Affordable Care Act. I was then. The 30 million people
who got an opportunity to get healthcare coverage, I am sure
they are all supportive of it as well.
I believe in a single-payer system of Medicare for All, and
I have spent many years advocating for universal healthcare. As
a matter of fact, I am pleased to know that I come from an area
in Chicago Metropolitan where we have 120 clinic sites for
federally qualified health center clinics. But also, we know
that for many individuals living with less income, being
uninsured and underinsured makes accessing healthcare untenable
and unaffordable. People with less income or more likely to be
uninsured in every State, but most especially in those States
that have refused to expand Medicaid.
Dr. Collins, let me ask you, how has the failure of certain
States to expand Medicaid under the ACA affected uninsurance
rates in the United States?
Dr. Collins. Thank you, Congressman. That is a great
question, and I agree that the Affordable care Act has put us
on a path to universal coverage. And there are things that are
preventing us from getting there right now, and one of them is
the fact that 12 States haven't expanded eligibility for
Medicaid. People are entitled to Medicaid by law, but States
have chosen not to expand. About more than 2 million people are
caught in the so-called coverage gap and unable to be enrolled
in their State's Medicaid program or enroll in the
marketplaces.
Mr. Davis. And people with low income or people who don't
have the resources, for example, to purchase prescription drugs
and pay the rent, they may have a different opportunity. Dr.
Blackstock, let me ask you. You are an emergency room
physician. What differences have you observed in the health of
patients who come to the hospital with health coverage and
those who come without?
Dr. Blackstock. Thank you for that question, Congressman. I
have worked in two different types of hospitals. I have worked
in hospitals where people have insurance, and their health
status and health outcomes are far more superior than patients
I have cared for in public hospitals with patients who were
uninsured and underinsured. I have seen patients who are
uninsured coming in with uncontrolled chronic medical
conditions that compromise their quality of life and that lead
to an early mortality. And we don't see that in the same way in
an insured population.
Mr. Davis. Thank you very much, and, Mr. Barkan, let me end
with you. What can we do and how can we get rid of the barriers
that people without resources have to being able to obtain
healthcare for what their needs are?
Voice. OK. Ady is writing.
Mr. Davis. Yes, I think we are just waiting for Mr. Barkan.
Mr. Barkan. We need to build the social movements to
transform this reality. Thank you.
Mr. Davis. Thank you very much, Madam Chairman. Again,
thanks to this very important hearing, and I certainly want to
commend those who generated the enthusiasm and the need to hold
it and to have it, and I yield back.
Ms. Bush.
[Presiding.] The gentleman from Florida, Mr. Donalds, is
recognized for five minutes.
Mr. Donalds. Thank you, Madam Chair. To the witnesses,
thanks for being here.
Look, here is the deal. We already run a single payer
health system in the United States. It is called the VA system.
The VA system has been plagued with backlogs. It has been
plagued with long lines. It has been plagued with shortages of
care. It has been plagued with overspending. It has been
plagued with fraud and abuse. We have never fixed it. We choose
not to fix it. But what we are going to say is, is that the VA
system, which we know has not provided the best outcomes for
the men and women who have served our country with honor and
distinction, we are going to say instead of fixing that system,
we are going to create a much larger system for every American
where our own experience with the VA system has already proven
what happens when you have universal coverage.
We have another system. It is called Medicare. By and
large, it is one of the most popular systems that the Federal
Government has in the United States. It goes insolvent in
somewhere between 5 to 7 years. I was actually just in the
Budget Committee, and director for Office of Management and
Budget, in the President's own budget, which he just released
yesterday, does not show any slowing down of benefits with
respect to Medicare, but then also no proposals about how you
are going to keep this situation going in Medicare because we
are spending significant amounts of money, providing care to
the elderly who paid in through payroll taxes over decades in
the United States. But there are no reforms to actually make
sure that the benefits can be paid, which means that we are
just going to have to dig into the pockets of every American to
continue benefits when the money that was actually allocated
for those benefits is not even enough to pay the burden going
forward. But yet in his hearing, we are talking about universal
healthcare.
I remember a video. It was a YouTube video from years and
years ago. This was back when I was a fledgling political
watcher, and it was from a member of our body who still serves
here today, who talked about how the Affordable Care Act,
effectively referred to as s Obamacare, was just the first step
toward universal healthcare. What Obamacare has done, what the
Affordable Care Act has done, however you want to call it, it
has led to higher deductibles, and it has led to higher
premiums in the United States bar none.
Of course I am a Member of Congress right now. I am on
Obamacare. I have never paid higher insurance premiums than I
am paying right now. I have never paid higher deductibles that
I am paying right now. And everybody I know in my district and
throughout the State of Florida, and, frankly, across the
United States, their deductibles are higher. Their premiums are
higher. Their access to care is actually less than it was
before the Affordable Care Act. But the answer from the
Democrats in our body is universal healthcare or Medicare for
All, or whatever the amalgam is going to be.
Ms. Turner, you said in your opening testimony that
undertaking universal healthcare in the United States,
according to CBO, would be ``complicated, challenging, and
disruptive.'' The complicated, challenging, and disruptive
would apply to all Americans whether you are Black, or White,
or Hispanic, whether you are rich or whether you are poor. You
know, it doesn't matter. When you unleash a system that is
complicated, challenging, and disruptive, that affects
everybody, and where are they going to go?
Ms. Turner, I have a question for you. Because of all these
situations that we are talking about, can you provide some
specific examples of potential stalled innovation in the
medical field? What products will be most at risk if America
adopted a single payer healthcare structure?
Ms. Turner. What are the advantages today and what would be
most adversely affected, Congressman?
Mr. Donalds. Yes, ma'am.
Ms. Turner. The world relies on the United States for
medical innovation. We saw it in pharmaceutical research with
the vaccines just last year. And when you see the Federal
Government working together to support the private sector and
the incredible resources it has in research and technology,
innovation, flexibility, that is when you get results. When you
have the Federal Government coming in and saying, this is how
we are going to do it that is when you get the CDC with its
failure to be able to come up with a test. We have to have the
private sector if we are going to have innovation, and if we
are going to have innovation, that is what leads to progress.
That is what leads to the miracle cures that we see today, new
surgeries that would have been impossible to envision 30 years
ago.
So having private sector innovators who are rewarded,
through ownership of patents oftentimes, but rewarded
adequately for their investment in that research is what will
solve these problems to give people more choices of more
affordable care and coverage. The Surgery Center of Oklahoma is
a perfect example. It doesn't rely on government funding to be
able to provide the high-quality care it does. It relies on
being able to make the procedures that they do as efficient as
possible with the best procedure, with the best physicians, the
best nurses, and the best outcomes. That is what we need more
of.
Mr. Donalds. Thank you so much, Ms. Turner. Madam Chair, I
know I am over my time. The one thing I would say is this. I
have long said to a lot of students across the country when I
go and speak with them, if the Federal Government was in charge
of the telecommunications industry, we would not have iPhones
and Samsung Droid phones. We would still be on the Motorola
StarTAC, and their response is, what is a Motorola StarTAC, and
I am like that is my exact point. It is that funky phone that
had the orange buttons and the orange screen. There is no
innovation when it comes from the Federal Government. It only
comes from private markets. This is the exact wrong way to go.
And health outcomes in the United States would actually be
worse, and if you don't believe me, look at the VA system. I
yield back.
Ms. Bush. The gentleman from Georgia, Mr. Johnson, is
recognized for five minutes.
Mr. Johnson. Thank you, Madam Chair. For decades, Democrats
have fought to protect and expand access to healthcare, and at
every step, Republicans try to gut our efforts. Ms. Turner, do
you believe that every American has a right to access America's
healthcare system, or is access to healthcare just a privilege
reserved only for those who can afford it?
Ms. Turner. Congress decided in the early 1980's that
anyone who needs care and shows up in a hospital emergency room
is going to get care. Beyond that, we have just a plethora of
government programs to offer coverage to people----
Mr. Johnson. But do you believe healthcare is a right or is
it a privilege only for those who can afford it?
Ms. Turner. I think we have a system that allows people who
cannot afford it to be able to get care and coverage, but you
don't have a right----
Mr. Johnson. OK. And you are fine with the system as it is
now. I get it.
Ms. Turner. No.
Mr. Johnson. You have been involved in the debate over
healthcare reform since President Clinton proposed healthcare
reform in 1995. Isn't that correct, Ms. Turner?
Ms. Turner. That is correct. That was in 1992.
Mr. Johnson. And you opposed the Clinton healthcare
legislation, correct?
Ms. Turner. I did not believe then, nor do I now, that the
government should be in charge of making all decisions in our
health sector.
Mr. Johnson. And since 1995, you have headed up an outfit
called the Galen Institute. Isn't that correct?
Ms. Turner. That is correct, that I founded.
Mr. Johnson. And the Galen Institute is a right-wing
operation funded by right-wing foundations and corporations
opposed to healthcare system reform. Isn't that correct?
Ms. Turner. We work closely with people from both sides of
the aisle, and we advocate policies that put doctors and
patients at the center of our health sector rather than
bureaucrats.
Mr. Johnson. OK. Well, let me ask you this. How many times
have you testified before Congress on the issue of healthcare
reform?
Ms. Turner. Oh, dozens.
Mr. Johnson. And each time you testified, that you spoke in
opposition to healthcare reforms proposed by Democrats. Isn't
that correct?
Ms. Turner. Not always. I am sure that there were policies
that----
Mr. Johnson. You have spoken in favor of some Democratic
policy proposals? Is that what you are asking us to believe?
Ms. Turner. There are some really interesting proposals,
like cash for counseling, that were proposed by Democrats to
give people in Medicaid the option to be able to get----
Mr. Johnson. OK. Well, let----
Ms. Turner. Absolutely, we support it. We are not partisan.
Mr. Johnson. OK. All right. Well, let me ask you this, Ms.
Turner. Let me ask you this. For 27 years, you have made a
handsome living protecting corporate profits while opposing
reforms that would make access to healthcare affordable for
all. Isn't that correct?
Ms. Turner. Our logo of the Galen Institute actually is
designed to focus on those who are marginalized and left out,
people who don't have access to public programs.
Mr. Johnson. And how do you propose for those people to
gain access to the healthcare system?
Ms. Turner. As I said in my testimony, we need targeted
solutions. Who is uninsured?
Mr. Johnson. Tell me----
Ms. Turner. Who is being left behind?
Mr. Johnson. Tell me your targeted solutions to enable
people who can't----
Ms. Turner. Not one government program.
Mr. Johnson. Tell me your solutions targeted toward those
who cannot afford access to the healthcare system.
Ms. Turner. I would like to see States be able to repurpose
some of the ACA money to provide care for people who are not
covered under Medicaid.
Mr. Johnson. So you are in favor of the ACA?
Ms. Turner. And give people the option to use those
resources----
Mr. Johnson. Are you in favor of the ACA?
Ms. Turner. I am in favor of having no one who has coverage
today losing it, but I believe many more people could get
better coverage----
Mr. Johnson. OK. Well, what about those who don't have
coverage? What about those who don't have coverage? That is
what I am trying----
Ms. Turner. What I am saying, if you----
Mr. Johnson [continuing]. Trying to get you to tell us
about.
Ms. Turner. Repurpose----
Mr. Johnson. What proposals do you have that would ensure
that folks who cannot access to the healthcare system can have
access to the healthcare system?
Ms. Turner. If States had more flexibility, they would be
able to use the existing resources----
Mr. Johnson. What about the Federal Government? What is the
Federal Government role?
Ms. Turner. As President Biden said recently, the Federal
Government is really out of its element in dealing with
something as local and private as healthcare.
Mr. Johnson. So you don't believe that the Federal
Government should have any role in the delivery of healthcare,
do you?
Ms. Turner. That is not absolutely what I said. I believe
that States could do a better job.
Mr. Johnson. But I am asking you, you don't believe that
the Federal Government should be at all involved in helping
poor people access the healthcare system. Isn't that true?
Ms. Turner. That is not what I said. Absolutely not true. I
believe that we need a strong safety net, and we need a strong
safety net especially for the vulnerable who find it most
difficult to get care and coverage in a system when they are
competing with people who are dropping private coverage in
order to get onto publicly supported programs. I oppose that.
Mr. Johnson. Well, you are not talking about poor people.
You are talking people who are paying for insurance premiums. I
think the public can see right through your testimony and can
see that you support corporate profits over access to the
healthcare system for all----
Ms. Turner. Absolutely not true.
Mr. Johnson [continuing]. Including those who cannot afford
it.
Ms. Turner. That is not true.
Mr. Johnson. And with that, Madam Chair, I yield back.
Mr. Comer. Madam Chair, that is not what she said. He needs
to be on one of Adam Schiff's committees if he is just going to
make stuff up. That is not what she said. It is very
disappointing----
Ms. Bush. You are not recognized right now.
Mr. Comer [continuing]. That he would badger the witness
like that.
Ms. Bush. You are not recognized right now. The gentleman
from Georgia, Mr. Clyde, is recognized for five minutes.
Mr. Clyde. Thank you, Madam Chair, for holding this hearing
regarding our Nation's disastrous healthcare system. It is long
past time that we address this growing crisis, and I commend my
Republican colleagues and the Healthy Future Task Force for
working on solutions that prioritize innovation and competition
to reduce costs and improve quality of healthcare for our
constituents.
While many of my Democrat colleagues believe a Medicare for
All Program would lower healthcare costs, unfortunately, that
couldn't be further from the truth. Reports estimate a Medicare
for All Program would increase Federal budget commitments by
another $32.6 trillion. That is more than the total of our
growing national debt. As the Nation faces continued inflation
rates, which are now the highest we have seen in 40 years, one
thing is clear: our current healthcare system is inadequate to
meet the needs of Americans. One does not need to look long
before realizing the Federal Government is ill-equipped to
manage a large-scale healthcare program, as my friend from
Florida, Mr. Donalds, pointed out.
It has been 12 years since the passage of the Affordable
Care Act, and the Federal Government still fails to provide
affordable quality coverage for millions of Americans in rural
areas, leaving many communities with only one or two eligible
insurers from which to choose. In fact, Obamacare was so
disastrous that many States, including my home State of
Georgia, filed Section 1332 waivers to exit the ACA
marketplace. In addition, the Congressional Budget Office's
outlook for major Federal trust funds indicates that the
Medicare Hospital Insurance Fund could be exhausted by 2024,
and that is in this particular document, the 2020 to 2034
report from September 2d, 2020, right here. If our government
cannot even ensure the solvency of Medicare for our seniors and
eligible participant recipients which comprise less than 20
percent of our population, there is no feasible way for the
Federal Government to provide Medicare for All.
So, Ms. Turner, knowing the current State of the Medicare
program, do you believe the Federal Government is equipped to
manage a Medicare for All Program?
Ms. Turner. No, Congressman, I do not. I believe that it
has shown over and over that it is very good at spending money.
It is not very good at spending money wisely, and it is not
very good at all at innovating. When you see the Medicare
program, 26 million seniors are voluntarily opting out of fee-
for-service Medicare into private plans----
Mr. Clyde. Wow.
Ms. Turner [continuing]. Because they say this provides
more and better coverage. People want choices. Innovation comes
from the private sector and not from government.
Mr. Clyde. Right.
Ms. Turner. And that is what our health sector needs to be
able to be more affordable and provide more people with
coverage.
Mr. Clyde. Thank you. As a followup, as you know, our rural
communities already face problems with limited insurers and
lack of access to quality care. In your opinion, would Medicare
for All improve or worsen these struggles for patients in rural
communities, like mine in Georgia 9?
Ms. Turner. The CBO has actually shown that it would
significantly reduce access to care because a Medicare for All
Program would pay physicians and hospitals so much less than
they do now, and you would not have the private sector,
particularly employer-based plans, picking up the slack in
order to be able to make these practices and hospitals solvent.
So it is very hard to see how they could provide the same
quality, the same access to care by the numbers that they are
talking about, the savings that they purport to be able to
achieve.
Mr. Clyde. OK. Thank you. Not only is the Federal
Government ill-suited to run a nationwide healthcare program as
we just heard, but we must not forget that it is the poor
policy decisions of lawmakers and executive officials that add
to the problem by continuing to overburden our healthcare
system, stifle innovative technologies, and raise prescription
drug prices. While I am glad that we are holding this hearing
to begin addressing our failing healthcare system, simply
pointing out a problem is not enough. Our constituents need
reliable solutions, not only to ensure the quality healthcare,
but also to address the economic crisis, the hyperinflation
crisis that is causing prices to currently surge. And I
strongly urge my colleagues to abandon a universal healthcare
proposal and work toward competitive market-based solutions
that are truly in our constituents' best interest.
And in the few seconds I have remaining, Ms. Turner, would
you like to respond to anything that my colleague from Georgia
asked of you? Is there anything that you want to add to that as
you were badgered?
Ms. Turner. He is putting words in my mouth, things that I
am not saying. Can I just make a comment?
Mr. Clyde. Yes, ma'am.
Ms. Turner. I really commend you in Georgia and Governor
Kemp for the innovative proposal that you have offered to try
to repurpose some Federal funds to do a better job of taking
care of the vulnerable patients in the State and make care more
affordable and efficient by giving them a wider choice of
plans. So congratulations. I hope that the Biden administration
allows that waiver request to go through.
Mr. Clyde. Thank you, and I yield back.
Ms. Bush. The gentlewoman from Illinois, Ms. Kelly, is
recognized for five minutes.
Ms. Kelly. Thank you, Madam Chair. Thanks for holding this
hearing. One thing I wanted to say really quickly, yes, when
the Affordable Care Act was passed, I wasn't here, but it was
just the beginning. It wasn't the end. And through the years I
have been here, we have been trying to improve it but could not
get cooperation from the other side. And the other side always
talked about repealing the Affordable Care Act, and when they
had a Republican President, Republican Senate, and a Republican
House of Representatives, they did not get it done. So I
digress.
Home-and community-based services give older Americans and
people with disabilities a chance to live freely and
independently in their homes and remain contributing members of
their community. Mr. Barkan, I am just going to tell you my
question, but I am going to move on to others to give you a
chance to prepare to answer. But I wanted to know from you, I
would love to hear about the ways in which home-based services
have impacted your life, but I am going to move on and come
back to you.
The Biden administration significantly expanded access to
Medicaid home-and community-based services to the American
Rescue Plan. The number of people in the U.S. will need home-
and community-based services is projected to more than double
by 2050. At the same time, direct care and home service workers
are in increasingly short supply. Dr. Collins, what work force
investments do we need to make now to prepare for those
projected increases in demand, and how can we make sure that
these investments are equitable?
Dr. Collins. Thank you, Congresswoman. This is a huge
burden for families, and everybody is experiencing it both with
elderly parents and also with disabled children. It has come up
repeatedly in this hearing today. We do need to improve the
wages that people are paid who work in these jobs. These need
to be living jobs that pay people well enough give people the
care they want and the security that people and these families
that need them so much need.
Ms. Kelly. Thank you. Dr. Blackstock, let me turn to you.
Forty percent of family caregivers identify as Black,
indigenous, or people of color. The higher prevalence of family
caregiving occurs in Hispanic and Black families. We also know
that it is much easier to establish trust with a provider that
looks like you, and according to the National Academy of
Medicine, this improves health outcomes. I am a person that has
worked for the last six years on maternal mortality and
morbidity and luckily got some bills passed. Why is it
important that we consider health equity in expanding home-and
community-based services in America?
Dr. Blackstock. As you mentioned, by having racial
concordance in terms of who the caregiver is or who the
healthcare provider is, we know that that will result in better
health outcomes overall. So we need to make that investment in
making sure that home caregivers receive the funding and
support they need to do their jobs.
Ms. Kelly. Thank you. We need to build on the successes of
the American Rescue Plan and provide a permanent expansion for
home-and community-based services. That is why I support Rep.
Debbie Dingell's Better Care, Better Jobs Act, which would
invest $150 billion into funding for home-and community-based
services through Medicaid and the development of care
infrastructure and labor force. Mr. Barkan, I will now conclude
with you to respond to the earlier question.
Mr. Barkan. Thank you for your question and for giving me
time to prepare. I get to live a beautiful and full life
because of home care. Home care saved my marriage as my wife,
Rachel, and I got to be partners and co-parents again instead
of patient and caregiver. It is the reason why I get to wake up
every morning to my wife and two kids and be an active
participant in their lives, but my reality is the exception.
Home care is prohibitively expensive, and so when home care is
not accessible, which is the reality for most, patients are
forced into nursing homes.
Nursing homes are unsafe institutions where patients are
merely warehoused and isolated from their loved ones. Since the
pandemic began, over 150,000 disabled people have died in
nursing homes due to the coronavirus. Many of these deaths
could have been prevented if they had the opportunity to
receive care safely at home. The loss of these lives are a
moral failure and a direct result of the for-profit system of
care that corporate lobbyists, like those hired by the nursing
home industry, work hard to maintain. It is not exaggeration
then to say that the difference between being able to receive
care at home surrounded by the love of family and community and
living at a nursing home is a matter of life and death.
Ms. Kelly. Thank you so very much for your response. Thank
you for being here. Thank you to all the witnesses. Congress
must act to ensure that older adults and the disability
community are able to access high-quality care in an affordable
and inclusive way. Thank you so much, and I yield back.
Ms. Bush. The gentleman from Kentucky, Mr. Comer, is
recognized for five minutes.
Mr. Comer. Thank you, Madam Chair, and, again, I want to
thank our witnesses for being here.
Just to begin with, Ms. Turner, we talked about Medicaid,
and it has been mentioned many times by those on our side of
the aisle that Obamacare was supposed to be the solution for
people that couldn't afford healthcare. It was supposed to be
the great equalizer and solve all of our healthcare problems.
So with Obamacare, many States had the option to expand
Medicaid. My home State of Kentucky was one of those States
that expanded Medicaid to the tune of about a third of the
State is on Medicaid now.
Now, you talk to medical professionals and providers all
over the State, and they will tell you they don't want to see
Medicaid patients because the reimbursement rates are so low.
That is because the slice of the pie is a certain size of what
the States get for Medicaid. The more people that get on
Medicaid, the thinner they slice the pie. They have more
slices, so the reimbursement rates continue to go down, so a
lot of people on Medicaid in Kentucky have trouble finding
providers who will get them in. Would something like this
happen with Medicare? If we greatly expand Medicare, which is
already, as Representative Donalds pointed out, facing
financial insolvency, would greatly expanding Medicare have the
same negative impact on Medicare patients that expanding
Medicaid has had on Medicaid patients?
Ms. Turner. According to the CBO study, there would be a
significant reduction in the number of physicians and hospitals
that could afford to take those payment rates. Either they
would have to cut back or some of them would even close their
doors. So you would have fewer providers, which is the
situation that too many people on Medicaid today face that they
can't find a provider that can afford to take Medicaid's low
payment rates. Many do so out of charity, but then they still
have to go through all the ridiculous paperwork to get paid----
Mr. Comer. Right.
Ms. Turner [continuing]. As I said earlier, six cents for a
complicated pulmonary patient. Very few of them would be able
to keep their doors open to do that, and I think it would be
really a decimation of the medical profession.
Mr. Comer. I have to note I have 29 hospitals in my
district. I would go out on a limb and say I have more
hospitals than n just about any Member of Congress. Every one
of my hospital administrators will say the same thing, and
these are, by the way, very rural hospitals for the most part.
They say that they lose so much money on Medicaid. Anyone who
goes in private pay or has private health insurance, they have
to really spike the price up on them to cover the cost for
Medicaid. So many of the arguments that my friends on the
Democrat side have been making for Medicare for All, I just
don't buy because a lot of these policies were tried with
Obamacare, and they have failed.
Representative Porter mentioned how efficient the
government was in administrative work. That is a joke. The VA
is a perfect example of government-run healthcare, and you can
talk to my case workers in my office in Tompkinsville,
Kentucky, about how inefficient and unresponsive the VA is to
the VA patients. Very few VA patients in my district in
Kentucky are satisfied with government-run healthcare of the
VA. It was also mentioned by several Democrats about the
numerous times that Republicans have tried to repeal Obamacare.
Can you talk about any of the 60 or so times that Republicans
have tried to repeal Obamacare?
Ms. Turner. Thank you for that question, Congressman. We
actually tried to track the number of changes that were being
made to the ACA as it was happening, and we gave up, over at
the Galen Institute, 70 changes, 43 of which were made by the
Obama Administration, some with legal authority, some not.
Twenty-four were passed by Congress and signed into law by
President Obama, and three were made by the Supreme Court. So
the allegation that Republicans have been trying for 60 to 70
times to repeal and replace Obamacare, the law didn't work, and
it had to be changed even to marginally work, and still we see
that it is not nearly serving the patient population that they
had expected, and millions of people are having to pay such
high premiums and such high deductibles, that they basically
don't feel they are insured.
Mr. Comer. Other thing, and I will close by this, Madam
Chair. Rho Khanna made a Statement that I actually agree with.
He said we need to eliminate the middle people, and that is why
Republicans, with respect to healthcare, we requested a hearing
on PBMS--pharmacy benefit managers--that I feel like is an
unnecessary level of bureaucracy in the healthcare system. This
is something that I believe this committee should have a
bipartisan hearing on. Republicans had a hearing. We published
a report from our hearing, and I think that is a very good
place to start looking if we are talking about trying to make
prescription drugs more affordable to people, which is a
significant cost of healthcare for people.
So I think the Republicans are serious on this committee
about trying to solve the healthcare problems we have in
America, but bigger government and government-run healthcare is
not the solution to the problem. Madam Chair, my time has
expired.
Ms. Turner. Transparency would be very helpful.
Ms. Bush. The gentleman from California, Vice Chair Gomez,
is recognized for five minutes.
Mr. Gomez. Thank you, Chair. First, being uninsured in this
country is daunting, and I know that because most of my life I
was uninsured until I got a job after college as a child of
working class immigrants who had no access to employer-
sponsored health insurance, despite them working 4, 5, 6 jobs a
week to make ends meet. It is something that it is not only
daunting, but it takes a toll on the family. It takes a toll on
the children. And when you are uninsured, preventative care is
definitely out of the question. You only go to the doctor when
it is the absolute last result resort, and that has devastating
health and financial consequences that are disproportionately
borne by low-income individuals, particularly those of color.
In 2019, the uninsured rate for non-elderly Black Americans
was 1.5 times higher than it was for white Americans. For
Hispanics and Native Americans or Alaska Natives, it was nearly
triple. When people don't have health coverage, they can't get
regular checkups and screenings, which leads to preventable and
tragic outcomes, such as Black women succumbing to breast
cancer at a rate of 42 percent higher than white women, even
though the incidence of breast cancer is higher in white women.
The Affordable Care Act helped narrow this coverage gap
through premium tax credits that have allowed working families
to purchase quality coverage through the marketplaces. The
American Rescue Plan built on this key reform through
provisions in the Health Care Affordability Act, which I
introduced with Congresswoman Lauren Underwood. We expanded
eligibility for premium tax credits, which has, on average,
lowered existing premiums like 40 percent. Over one-third of
the consumers who have taken advantage of the new lower rates
provided by the American Rescue Plan have joined plans with
monthly premiums of $10 or less. Many individuals have seen
their medium deductible fall as much as 90 percent.
Dr. Collins, how have the ACA premium tax credits helped
individuals and families get covered, and how has the expansion
of the premium tax credit in the American Rescue Plan enhanced
the program?
Dr. Collins. We know from our survey data that
affordability is the main reason people decide to take a
coverage or not, and so the premium subsidies in the
marketplace has helped millions of people gain coverage through
a market that did not work for most people prior to the
Affordable Care Act. The American Rescue Plan's subsidiaries
have done what is needed and enhanced the affordability of
those premiums by decreasing the amount of money people have to
contribute to them.
Mr. Gomez. And since the American Rescue Plan has passed,
since it has passed, more than 1.5 million Americans have
enrolled in coverage, while an additional 2.5 million people
who were previously enrolled in ACA Marketplace plans have seen
their premiums fall by 40 percent on average. And despite this
success, this relief is temporary and it will expire soon. Last
year, I introduced the Choose Medicare Act with Senator Murphy
and Merkley, which would give all Americans the choice of
buying Medicare as their health insurance plan, and makes
reforms to improve affordability, including expanding
eligibility for the premium tax credit, while making it more
general.
Dr. Collins, how would changes like these put us on the
path to universal healthcare?
Dr. Collins. So I think that we can get to universal
coverage by building on the Affordable Care Act. It has been
modeled and demonstrated that we can do it even at lower cost,
particularly if we add a public option to the marketplaces, and
also, importantly, develop an auto enrollment mechanism to help
people get easily enrolled. People who are not currently
enrolled would have a much easier pathway to get covered.
Mr. Gomez. Thank you so much for that response, Dr.
Collins. And as somebody who has been both uninsured and
insured and seen my parents who were uninsured and insured,
even in the best scenarios with individuals who have healthcare
coverage navigating the healthcare system and ensuring that
people who have language barriers who can't get necessarily
access to certain types of care, we see that the disparities
exist. And even under the current system, we need to work on
making that disparity less and making sure that those who are
left behind oftentimes by our healthcare system, our education
system, and so many different systems, that we try to make
changes that improve their health outcomes so that people of
color or people who live in certain zip codes are not
discriminated against because of where they live or the color
of their skin.
So this is something that we need to work on. I believe
that the ACA and the American Rescue Plan have given thousands
of families a little peace of mind. I know that it is not
permanent, but the more we work at improving coverage, the
better people will be able to access quality healthcare.
So with that, I yield back. Thank you for the time, Madam
Chair.
Ms. Bush. The gentleman from California, Mr. DeSaulnier, is
recognized for five minutes.
Mr. DeSaulnier. Thank you, Madam Chair. Nicely done on the
pronunciation. And I want to thank the chair of the full
committee for having this hearing.
For too many Americans in need of mental and behavioral
health, they have been unable to access services for a variety
of reasons. It was hard fought in the Affordable Care Act to
make sure we had equity for behavioral health. We are learning
so much about how the brain works, the impacts of stress, and
trauma, poverty. That access is a real problem, and I wanted to
ask a couple of questions about that, also just the capacity. I
am told that there is a 75-percent increase in requests for
behavioral health services by Americans since the ACA passed,
but there are 25 percent fewer young people going into the
field.
So access and getting universal healthcare for many medical
conditions is extremely important, but also for behavioral
health. This is personal for me. I am a survivor of suicide. On
April 20th of this year will be 33 years since my father took
his life, and largely because of that, myself, my family, my
sons have access to great professionals. But it has been a
challenge for us, so I can imagine what it is, particularly for
poor people and people of color as they try to access
healthcare for behavioral and mental health.
The Kaiser Family Foundation has studied and said that more
than half of American adults coming out of COVID report
experiencing symptoms of anxiety or depression disorder within
the past two years. Dr. Collins, I want to ask you, how does
our current coverage system present obstacles to people,
particularly poor people, seeking mental and behavioral
healthcare, especially for uninsured? Dr. Collins?
Dr. Collins. Yes. Particularly for uninsured, if you don't
have health insurance coverage, it is very difficult to get
care of any kind, including mental health, behavioral health,
care for substance abuse problems, so that is one issue.
Another, if you have insurance, you can't access providers, so
there is an increased demand that hasn't necessarily been met
by the available capacity in the system, particularly in the
wake of the COVID pandemic.
Mr. DeSaulnier. Thanks. How would, Dr. Collins, moving to
universal healthcare help with that access, I think, for people
who are uninsured and are completely without that access?
Dr. Collins. I think for people who are uninsured and are
completely without access, particularly in States that haven't
expanded Medicaid, expanding Medicaid expansion would clearly
help address the problems in those States. Making overage more
affordable for people through the ARP subsidies have
dramatically increased the affordability of marketplace plans.
Mental health is part of the essential benefit package for
marketplace coverage. But I think we also need to think about
integrating different ways to increase capacity, integrating
behavioral health and substance abuse into primary care, for
example, expanding and diversifying the behavioral health work
force by engaging a wider variety of providers to meet people's
unique needs, and also thinking about leveraging current health
technology to help improve access.
Mr. DeSaulnier. Dr. Michener, how about disadvantaged
communities and communities of color? Clearly, as I said, my
experience, although different than poor communities in my
district and the Bay Area where I represent, have even larger
challenges. So how would universal healthcare and getting at
these disparities, even though the law says that it should be
open and we should have equity for behavioral health, how might
that help? And I will mention I have a bill that allows for
money for primary care physicians because for people who commit
suicide, over 60 percent of them see a primary care physician
within a few months of them attempting to commit suicide or
being successful at it. Doctor?
Dr. Michener. Yes. So I think there are few different
pathways here. One is clearly through providing people who
don't have insurance presently with insurance, and that means
that they can see mental health specialists, but they can also
see primary care providers. And I do think that primary care
providers are an important sort of first stop, first base, and
they can screen and, in many ways, direct people toward more
specialized care that is appropriate for them given their
mental health challenges and/or conditions. So I think that
that is critical, and I think it is especially critical in
communities of color where there are already stigmas around
mental health and mental healthcare, and where people face
systems and processes, like discrimination and racism, that
create even more mental health stressors in their lives and in
their communities. So I think that there are hardly any places
where these problems are more acute and more imperative than in
communities of color, and universal coverage is a primary
pathway for getting there.
And I would reinforce this point about the healthcare work
force. I think one of the places where we see the most
potential and opportunity for growth in the healthcare work
force is among people of color and communities of color. And I
think investing in resources for education and training in
those communities so that the very communities where these
struggles exist can be equipped to participate in the work
force to address them, a work force that can only be robust
under a system where the maximum number of people have health
insurance.
Mr. DeSaulnier. Thank you, Doctor. I yield back.
Ms. Bush. The gentlewoman from Massachusetts, Ms. Presley,
is recognized for five minutes.
Ms. Pressley. Thank you, Madam Chair, and thank you to all
the witnesses who have shared their testimony today. I do want
to just take a moment to offer special recognition for
something that, at least to my knowledge, this is the first
time in three years that it has occurred while I have been a
Member of Congress. And I would like to acknowledge our ASL
interpreters. I thank you for joining us today.
Mr. Barkan, my forever local progress brother and my
sibling in the work of healthcare justice, I appreciate you so
very much, and Rachel and your beautiful children, Carl and
Willow, for all that you give to the movement. Like Leslie
Templeton from my district, who testified on the previous panel
of patients, you have highlighted how universal coverage and
Medicare for All specifically is a healthcare justice issue and
a disability justice issue.
The life and death consequences of our current healthcare
system have been made tragically clear over the course of this
pandemic, and it was the disability community, in fact, that
sounded alarms early on, warning that this crisis would be a
mass disabling event. With millions now suffering with the
impacts along COVID, it is clear that they were right. There is
simply no way we can return to the pre-COVID status quo normal
because that normal was fundamentally unjust to begin with.
Across the United States, folks with disabilities and chronic
conditions, who are disproportionately people of color, are
more likely to be uninsured and underinsured, creating a
barrier to critical care. This, in part, is a result of how our
current healthcare system frequently ties one's healthcare
coverage to their employment status. For many disabled people,
in particular, maintaining a full-time job with health
insurance may not be feasible. And even if you have insurance,
sky-high co-pays and out-of-pocket costs can keep people with
disabilities in perpetual poverty.
Mr. Barkan, how does a system that ties health coverage to
employment perpetuate deep inequities for people with
disabilities, and how would Medicare for All help to address
this?
Voice. He is writing.
Mr. Barkan. Thank you. As of August 2021, 1 in 5 workers
with disabilities lost employment during the pandemic, which
does not include the 1.2 million newly disabled adults the
coronavirus has created. For many in the United States, health
insurance is tied to employment. If you change or lose your
job, you are likely to lose your health insurance or have to
start over again and build a new team of providers that exist
in network. Patients who have medically complex conditions rely
on continuity and their medical teams to monitor their health.
The disruptions that result from our patchwork system not only
inconvenience patients but endangers those of us who most need
uninterrupted, high-quality care.
And as you heard from the patient panel this morning,
critical health needs can make it difficult or impossible to
work, leaving the people who need the care the most to either
navigate being uninsured or too often work in jobs that are
inaccessible or damaging to their health. Additionally, despite
the ability to and interest in working, disabled people are
often employed at much lower rates than people without
disabilities, in part because of discrimination. Barriers like
ableism in hiring, inaccessible workplaces, and pay
discrimination all contribute to the lower rates of employment
for disabled people. By disconnecting healthcare from
employment, disabled people, who are already burdened by
ableism and discrimination, would not have to worry for their
healthcare at the same time.
Ms. Pressley. Thank you so much, Mr. Barkan. Congress must
stop enabling a predatory health insurance system, one that
repeatedly fails our most vulnerable communities. Today in
America, if you are poor, Black, brown, indigenous, or
disabled, your ability to live, to survive is jeopardized by a
broken healthcare system that puts profit over people. We must
stop allowing the greed of insurance companies to outweigh the
health of our constituents, of our community members. We must
ensure that every person has access to quality care when they
need it and where they need it.
Babies with heart conditions ending up with parents in
bankruptcy is not healthcare justice. A grandmother working the
night shift so she can scrape together cash for insulin is not
healthcare justice. These are moral failures and policy
choices, violent ones. In fact, Coretta Scott King reminded us
that, ``Ignoring medical need is violence. Contempt for poverty
is violence.'' Healthcare is a human right, and we need
Medicare for All. Thank you, and I yield back.
Voice. Excuse me. I am sorry, Congresswoman Pressley, but
Mr. Barkan was going to add a little more.
Ms. Pressley. Oh yes.
Mr. Barkan. One in 4 Americans live with a disability, and
this number is growing exponentially due to those who have
become recently disabled because of the long-term effects of
the coronavirus. Only a single payer system can possess the
scale and resources necessary to guarantee care for all,
detached from employment. As one example, Medicare for All
covers home-and community-based services for all who need it.
The Federal Government currently requires States to fund
nursing home care for everyone eligible. This is not the case
with regards to home-and community-based services. And because
States manage their own home care programs through Medicaid
eligibility requirements, the services available vary widely
across States. It is by default and design that so many
Americans who require care are forced into unsafe institutions
like nursing homes. Patients overwhelmingly favor the option to
receive care at home, but these services are prohibitively
expensive and, therefore, inaccessible to most.
The government would actually save money covering the cost
of home-and community-based services instead of covering
nursing homes. Under a single-payer system like Medicare for
All, home-and community-based services would be prioritized
over institutional care, giving patients the safe and dignified
care they prefer and deserve.
Voice. Thank you so much.
Ms. Pressley. Thank you.
Ms. Bush. The gentleman from New York, Mr. Jones, is
recognized for five minutes.
Mr. Jones. Thank you, Madam Chair, for your leadership. I
represent a district that people often think of as very
affluent, and yet there are still too many people who cannot
afford healthcare. I think of my grandmother, for example, who,
like so many seniors throughout this country, worked well past
the age of retirement just to pay for the high cost of
prescription drugs, dental care, and other medical procedures
that are not fully covered by Medicare as we know it today.
Other of my constituents who lack healthcare coverage are
working middle-class people who make too much money to qualify
for Medicaid or other subsidies under the Affordable Care Act
but not enough to afford the high cost of healthcare on their
own.
The price of premiums and deductibles is simply too high
for many families. Still others have experienced gaps in
coverage at critical times due to job loss. In fact, we saw
millions of Americans lose their jobs during the COVID-19
pandemic, and with that, their healthcare. The pandemic made it
clear that the employer-based healthcare system just does not
work in our modern economy.
Mr. Barkan, thank you for your testimony and for your
dedication to making America a Nation that treats every person
with dignity and with compassion. You are a leading voice in
our push to finally realize universal healthcare coverage, our
push for Medicare for All. We have heard a number of misleading
claims from my colleagues on the other side of the aisle today,
so now I would like to give you the opportunity to correct the
record on what we have heard today.
Mr. Barkan. Thank you for your comment and your leadership.
There has been a lot of misleading information today about how
Medicare for All would take away our freedom of choice, but the
reality is our for-profit system does exactly this by
inhibiting our ability to make choices for ourselves and by
dictating and limiting our experience of care. As I told you
this morning, my health insurance provider denied the
ventilator that I needed to survive until I forced him to cover
it.
Right now, multi-millionaire healthcare executives already
make unilateral decisions about our health coverage. There is
no freedom to be found in a system that tells us who we can or
cannot see or which services we can or cannot access. Medicare
for All would ensure that all of us have the freedom to choose
our healthcare providers and hospitals without worrying about
whether a provider is in network. It would mean that patients
would have uninterrupted access to care and that we would be
able to build long-term relationships with our providers. It
would mean that seniors and disabled people have the option to
live safely and with dignity at home instead of being
warehoused in unsafe nursing homes. Medicare for All would mean
that Americans would be free of medical debt. Health insurance
companies and their multi-millionaire executives do not belong
in the intimate decisions we make about our health. Medicare
for All is a system designed to empower the people by placing
the power of choice back in the hands of patients and
providers.
A single payer system is, in fact, the only system that
would allow us the true freedom to make our own decisions about
our lives. When it comes to waiting times, we already have
incredibly long wait times for every element of our healthcare
system. Even prior to the pandemic, which has deeply
exacerbated this issue, the wait time for the ER takes hours.
Wait times for specialists can take months or years, and that
doesn't include the people who have to ration their own care
because they cannot afford this. With a Medicare for All
system, the system would expand. There would be more providers,
and care would not need to be rationed in this way.
Mr. Jones. Thank you, Mr. Barkan, for your leadership.
Madam Chair, I yield back.
Ms. Bush. The gentlewoman from New York, Ms. Ocasio-Cortez,
is recognized for five minutes.
Ms. Ocasio-Cortez. Thank you so much, Chairwoman Bush, and
to all of our witnesses for being here today. But I have to
underscore how grateful we are for Representative Bush's
leadership and determination in securing such a historic and
unprecedented hearing, not just for this committee, but for the
country, so thank you.
We know that private insurance is the primary health
coverage for two-thirds of Americans, with the majority of
private insurance being employer sponsored. But what I think
most people in the U.S., most working-class people need to
contend with is the fact that the money employers spend on
health benefits, and particularly for-profit private health
insurance, comes from the money that they would have otherwise
spent on our wages.
Dr. Collins, in 2020, the standard company-provided health
insurance policy totaled over about $7,000 a year for single
coverage and over $21,000 a year for family coverage. Is that
correct?
Dr. Collins. Yes.
Ms. Ocasio-Cortez. And with employer-sponsored insurance,
your employer pays a large portion, and you pay a smaller
portion, correct?
Dr. Collins. Yes.
Ms. Ocasio-Cortez. So in the case of individual coverage,
if the total cost is around $7,400 and your employer pays, say,
$6,200, and you pay for around $1,200, now that is thousands of
dollars more that everyday people could be saving per year if
it weren't going directly to insurance companies' private
profits, correct?
Dr. Collins. Yes.
Ms. Ocasio-Cortez. Interesting. So one of the things that
we are really seeing here is that the potential to moving to a
Medicare for All system could actually give people a raise in
many circumstances. Now, a common rebuttal to that and a common
rebuttal to Medicare for All that you will hear from
conservatives and the right is that we would merely just change
the way in which that same premium is charged, and that those
same dollars that are coming out of our paychecks now would
then just be coming out in the form of taxes. But the truth is
that Medicare for All actually lowers the overall cost of
healthcare as well.
Dr. Collins, isn't it true that Medicare for All would also
reduce the average total costs for lower-and middle-income
families by eliminating more medical expenses than they would
pay in taxes?
Dr. Collins. How it was structured is there is that
possibility, particularly in terms of getting provider prices
down which drive these cost that people are paying.
Ms. Ocasio-Cortez. Mm-hmm. Thank you. And you don't even
have to take just our word for it. In fact, that conclusion has
been confirmed via thorough research by the Center for a
Responsible Federal Budget. We also know that Medicare for All
is much cheaper than private insurance. Dr. Collins, public
options like Medicare actually pay hospitals and service
providers less than private insurance companies have to for the
same service. So a single-payer public option would drive down
costs additionally through its ability to negotiate on health
services and drug prices. Isn't that right?
Dr. Collins. That is very true.
Ms. Ocasio-Cortez. And, in fact, I think the evidence for
that isn't just theoretical, it isn't just calculated by think
tanks, but we see it in everyday life. Another case in point
right here comes from my district. Almost everywhere in the
world, health outcomes are correlated with a person's income,
but one of the only places in the world that that doesn't apply
is in Queens, one of the handful of zip codes where your income
does not determine the quality of healthcare that you have. And
the reason for that is our crown jewel of the public hospital,
Elmhurst Hospital in Queens.
Years ago, we as a community made a commitment that we
would never turn anybody away based on their health insurance
status, their documentation status, their housing, or their
income. Every single person who enters Elmhurst Hospital gets
treated regardless of their ability to afford care. And what we
have found is that it is more affordable to treat everybody, it
is possible to treat everybody, and people can get higher-
quality care than they ever could under our current privatized
for-profit system.
And with that, I yield back to the chairwoman. Thank you
very much.
Ms. Bush. The gentleman from Vermont, Mr. Welch, is
recognized for five minutes.
Mr. Welch. Thank you very much, Madam Chair. I appreciate
it. I am a co-sponsor of Medicare for All as well, and the
incredible challenge we have with healthcare, as many of my
colleagues have said, it is too expensive. We pay the most and
we get the least, and we still have 30 million folks who are
uninsured, and it is unconscionable. It is unconscionable
because it is not necessary. It is not as though we don't have
the capacity to provide care, and it is not as though we don't
have the capacity to save money. But we have a healthcare
system that is so fragmented, both in the delivery system in
the payment system that we end up paying the most and getting
the least. And how we are not all shocked by that from a fiscal
standpoint, but from a moral justice standpoint, is
astonishing. It really is. So, Congressman Jayapal, I want to
thank you for the carrying the torch on this.
The public option is something a lot of us advocate for.
The Medicare for All is something we all advocate for. A major
reason I do is that I think we do have to get the costs down,
and what we have seen in this pandemic is our frontline
providers, folks hands-on like our nurses, they haven't been
paid enough, and they are getting hammered with work
responsibilities. On the other hand, you have private equity
finding those seams in the healthcare system where they can
take over an emergency room physician practice, and then,
through double billing, make an immense amount of profit. And
it is exploitation of the fragmentation of the healthcare
system that is helping to lead to these high costs and low
access. So that is just a little background.
The things we have done, I think, that are good is
telehealth has really worked. That has been incredibly
beneficial. We have got to bring down the cost of prescription
drugs, and the House, of course, passed the legislation to do
that. We have got to have mental health that has parity.
Just a couple of questions. Dr. Michener, I want to have
you focus on rural communities because so much of my district
is rural, but that is true for so much of America. What are the
particular challenges that rural America has in accessing
affordable, high-quality medical care?
Dr. Michener. Yes, this is an appropriate question given
that I hail from UpState New York. So I think a lot about the
rural communities there, and I am actually a part of a
collaborative that focuses specifically on health equity in
rural communities, and I think there are a range of challenges.
So one is the basic challenge that we have been talking about
today, which is access, and I think that because in rural
communities we see higher rates of poverty and we see more
difficulty and challenges around having health insurance,
having just access to being insured, that is a primary and an
initial barrier. And then I think there are some specific
barriers that are particularly challenging in rural areas.
Transportation is one.
Mr. Welch. Right. Yes, very much.
Dr. Michener. And that that is an important problem and one
that is, in part, addressed through a program like Medicaid,
which has a transportation benefit. We don't see that same
benefit available in the private sector, and we know that that
benefit is correlated with all sorts of positive health
outcomes.
Mr. Welch. Thank you. Thank you. And I will ask Dr.
Collins, how would universal coverage improve healthcare
options in rural communities, and as we work to ensure that all
in America can prosper, how would universal coverage foster
economic growth in rural areas?
Dr. Collins. Well, I think we have seen in Medicaid non-
expansion States, as a case in point, rural hospitals have
closed. They just haven't had the financing that they need to
serve people in their communities. And so having a universal
financing mechanism to make it possible for these hospitals to
stay in business would be one of the benefits of universal
coverage in every State.
Mr. Welch. You know, one final point I am going to make,
and I will ask you, Dr. Collins, to just respond to it, if you
have universal coverage, then the challenges that each of us
faces in access to healthcare become the challenges that all of
us face. It is not as though having Medicare for All
necessarily solves all problems. It just means we are all in it
together to try to solve the problems we face. Does that make
some sense to you?
Dr. Collins. That is right, and insurance is the most
important and it is a necessary condition for people getting
access to care, but it is not the only factor. And so we also
need to work at making sure people have adequate provider
networks, that providers are paid well enough to participate in
the networks, and we have good transportation systems so people
in hard-to-reach areas are able to get the healthcare that they
need.
Mr. Welch. I yield back. Thank you, Madam Chair.
Ms. Bush. The gentleman from Maryland, Mr. Sarbanes, is
recognized for five minutes.
Mr. Sarbanes. Thank you very much, Madam Chair. I
appreciate the opportunity to join the hearing today.
We know that the research shows very clearly that there is
a correlation between uninsurance or underinsurance and poor
patient outcomes, and we saw that during the coronavirus
pandemic, in particular. More than 40 percent of Americans who
contracted coronavirus in the first year of the pandemic were
either uninsured or underinsured. And a recent study found that
a 10-percent increase in the number of uninsured residents per
county was associated with a 70-percent increase in coronavirus
cases and a nearly 50 percent increase in deaths from the
coronavirus. Dr. Blackstock, I would like to ask you, what
inequities in our healthcare system could explain this
correlation?
Dr. Blackstock. Yes. So, you know, we have to think about
when people lack access to care, they are lacking access to
primary and preventive services, mammograms, colonoscopy
screenings, proState cancer screenings, and so that will cause
an exacerbation of these inequities. And then with the
pandemic, we saw that our systems were under even increased
stress, so people, when they lost their jobs, they also lost
their insurance and were not able to access care. We also have
seen that, as our government has picked up the slack in terms
of vaccines and testing, that those gaps actually in terms of
COVID mortality rates have closed. So we see what happens when
we are able to provide communities and people to services that
they need.
Mr. Sarbanes. You know, the threat from the pandemic, we
spoke often and we continue to about how that combines with
underlying conditions to pose a great risk to patients. And if
underlying conditions are persisting and not being addressed in
certain communities and populations that is obviously going to
increase the risk. Can you talk about how universal coverage
could have improved the experiences of patients during the
coronavirus pandemic? Let's look at it from the positive side.
Dr. Blackstock. Right, absolutely. We know that people who
carry a higher burden of chronic disease were more at risk for
the more severe outcomes of COVID-19. So if people have access
to care, if they have access to, you know, care that prevents
their diabetes, and their high blood pressure, and their asthma
from worsening, then that could ultimately improve their
outcomes from COVID-19. So it is really about investing in
health, investing in people from the beginning to prevent these
worse outcomes later on.
Mr. Sarbanes. Dr. Michener, I would love to get your
perspective as well. How would universal coverage ensure more
equitable outcomes in the case of a future public health crisis
because we want to learn our lessons obviously, and adapt, and
make clear-headed decisions going forward? So if you could
speak to that that would be wonderful.
Dr. Michener. Yes, I think universal coverage, in addition
to providing people with access to care, they get to go to the
hospital. They get to go to the doctor. They get to get the
treatments in the medications that they need. They don't have
to delay. They don't have to forego care. The other thing to
recognize is that uninsurance and underinsurance are
concentrated in particular communities, that there are zip
codes and there are neighborhoods that have disproportionately
high levels of uninsurance and underinsurance. So when we
address those problems, we don't just address them among
individuals. We address them at the community level, which
means that the solutions and the benefits can really amplify.
For example, we have research that shows that when you
insure parents, they are more likely to take their children to
well care visits. Even if the children were already insured, if
the parents weren't, they weren't socialized into the habit of
going to the doctor. And so you see families, and you see
social networks, and you see communities, and the benefits of
insurance ripple throughout these levels so that we can see
amplified positive effects if we have universal insurance.
Mr. Sarbanes. You know, there are so many connections here
that aren't necessarily intuitive, but when it is brought to
your attention, it makes perfect sense. So a lot of the adults
with less income in our society experienced coronavirus-related
job loss or pay cuts at the beginning of the pandemic, and then
had consequential coverage laws that went with that. In
Maryland, we saw 200,000 people enroll in healthcare coverage
through our State-based health exchange during the special
enrollment period that we extended during COVID-19, and nearly
two-thirds of those people enrolled in Medicaid.
I am running out of time, but, Dr. Michener, what does it
tell us about how Federal healthcare programs can support
people and the ability to lift up communities during times of
crisis and volatility?
Dr. Michener. I will quickly say, mindful of time, given
all that has been said about the government, and Big
Government, and government inefficiency, this is a really
important point. There was a time before Medicare, there was a
time before Medicaid, and it was a dark and dismal time where
many more people had much worse outcomes. The private side of
the market could not address the fundamental needs of the
American people, and that is why we developed these public
programs. And they are not perfect, but they are absolutely
saving lives, and the science around that is quite
incontrovertible.
Mr. Sarbanes. Thank you, and I will just note as I yield
back, their administrative costs tend to be much lower than
what we see in the private sector and other arguments for the
universal healthcare coverage that we are talking about today.
Thank you, Madam Chair.
Ms. Bush. The gentlewoman from Washington, Ms. Jayapal, is
recognized for five minutes.
Ms. Jayapal. Thank you, Madam Chair, and thank you for your
incredible leadership in making this hearing happen, and to all
my sisters in service that were part of it, and to all the
colleagues who have been talking about the various aspects of
universal healthcare. Also, thank you for the powerful
testimoneys that we have heard.
My Medicare for All act would provide healthcare to
everyone in the United States without the financial, racial, or
demographic barriers that exist in our current system. My bill
creates a comprehensive, universal single-payer healthcare
system that provides all the medically necessary care that
someone needs. Imagine that: a comprehensive care that includes
dental, vision, and hearing, and for the first time when we
introduced this bill two Congresses ago, long-term care,
something that Mr. Barkan has spoken extensively on.
The bill eliminates insurance premiums, co-pays,
deductibles, and all other out-of-pocket costs, and removes the
for-profit insurance companies from the doctor-patient
relationship, while controlling medical costs to bring down
overall spending. That is a very important piece of this. And I
think at the end of the day, I have heard people arguing
against Medicare for All by saying it takes away choice. I
would just argue that Medicare for All would actually allow
people to make choices, like being able to go see a doctor or a
hospital without worrying about out-of-network costs that come
later when there are tens of thousands of dollars that people
can't afford; or the choice to be able to have healthcare even
when you lose your job instead of 27 million people losing
healthcare because they lost their jobs during COVID; or the
choice to start a small business because you don't have to
worry about your healthcare, it is covered already; or, most
importantly, the choice to live and not die.
Researchers have found that Medicare for All will save over
68,000 lives per year. That means 68,000 more birthdays, 68,000
more anniversaries, 68,000 more loved ones alive every year
simply because we transitioned to a Medicare for All system.
And under Medicare for All, those 68,000 lives saved would also
see a drastic increase in quality of life.
Mr. Barkan, you have been an incredible patient advocate
your entire life, and even now you are still. How would your
life be different if Medicare for All were enacted? And I am
going to give you a few moments because I know you have to get
your answer prepared, and I will come back to you for your
answer.
Dr. Blackstock, as a physician and expert in health
inequities, you have seen firsthand who the winners and losers
are in our for-profit healthcare system, and we often forget
the crucial role that Medicare actually played in beginning the
desegregation of hospitals. We sort of overlook that, but there
is a lot more to do. So tell me, who do the 68,000 lives that
Medicare for All would save, the lives that are lost in our
current healthcare system, who do those lives belong to?
Dr. Blackstock. Thank you, Representative Jayapal, and
thank you for mentioning that because I think we often forget
that Medicare was probably one of the greatest civil rights
achievements in terms of desegregating hospitals and providing
or advancing health equity. But the 68,000 lives are people who
matter, people who deserve humanity. They are mostly and
disproportionately people of color. They are also low-income
families. They are predominantly located in the Southern part
and the Western part of this country. They are people who
aren't able to afford the out-of-pocket costs, you know, to
purchase medication or to access insurance. So this is giving
people with families, low-income families with children, the
opportunity to have a choice to access the care that they need.
Ms. Jayapal. Dr. Michener, you have spoken so eloquently
about racial inequity. Tell us how a Medicare for All system
would help alleviate those racial health inequities that people
are facing right now.
Dr. Michener. One of the main benefits of a Medicare for
All system is that it is not a tiered system. It is not a
system that is rationed based on where you live. We know that
rationing based on geography leads to racial inequities, so
that people who live in the South or people who live in what we
call hospital or our public health deserts, have less access.
We don't have rationing based on income. We know that causes
racial disproportionalities because people of color are more
likely to be living in poverty. We don't have rationing based
on a range of other factors that all bake in racial
discrimination. Instead, we have access that is equally
available to all.
Ms. Jayapal. Thank you so much. Let me go back to Mr.
Barkan before my time expires and ask you for your answer. Mr.
Barkan.
Mr. Barkan. Thank you so much for your leadership. It is an
honor to be in the struggle with you. I am not the only one
whose life has been upended, first, by illness and then by the
moral abomination that is our healthcare system. Right now,
about 30 million people in this country are uninsured, and even
more get necessary care denied every year by their insurance
company. We are richest Nation in the history of the world, and
yet Americans regularly go bankrupt from their medical bills
and cut their pills in half because they can't afford the cost
of prescription drugs. It reveals much about our country that
we see spikes in cancer diagnoses for Americans aged 65 once
they become eligible for Medicare. Too many go far too long
without care because they cannot afford it.
By securing Medicare for All, we can save thousands of
lives and free mourning families from the lingering pain of
asking themselves, what if we had caught this sooner. Americans
across the Nation and across the political spectrum have been
harmed by corporate greed. I believe we can overturn our for-
profit system because our power lies in our solidarity. Our
movement for Medicare for All isn't slowing down any time soon.
We intend to win our due rights, and we will continue to
organize for our collective freedom until all of us are free
from this corrupt system of corporate greed.
Ms. Jayapal. Thank you so much, Mr. Barkan. We are not
giving up until we pass Medicare for All. Thank you, Madam
Chair. I yield back.
Ms. Bush. The gentleman from New York, Mr. Bowman, is
recognized for five minutes.
Mr. Bowman. Thank you so much to Chairwoman Maloney and
Rep. Bush for holding this historic hearing, and thank you to
all the members of this committee for allowing me to join you
today. Thank you also to Rep. Jayapal for her incredible
leadership on this issue.
More than 27 million adults in the United States today are
uninsured. Millions more are underinsured. As a Member of
Congress, I am more than adequately covered. I can get a
checkup any time I want. If something is wrong, I can get
treated on the spot. Those of us who support Medicare for All
believe that every single person who lives in this country
should have that level of care. It is very simple. If people
knew they had exemplary healthcare, they would go to the doctor
more, but as it stands, millions of people often skip
preventive and routine care, instead waiting until they are
severely ill to seek treatment.
Dr. Blackstock, how do these delays in seeking care affect
patients?
Dr. Blackstock. So delays in care result in late or
misdiagnoses. They also result when a condition is diagnosed
that is more difficult to treat, it results in higher mortality
rates. We know that people who are uninsured have about a 40-
percent higher age-specific mortality risk. And so, you know,
access to care is equivalent to your mortality risk, so we need
to give people access to care through health insurance so that
we can reduce their risk and so they can lead full, healthy
lives.
Mr. Bowman. Thank you, Dr. Blackstock. My next question is
for Dr. Michener. As you have mentioned already today, people
of color are more likely to be uninsured than white people.
They are more likely to experience severe medical events or
suffer from catastrophic medical debts. As a Black man, I am
acutely aware of the specific care needs that Black men have in
our society. It is well known, for example, that Black
Americans have the highest rates of hypertension, and Black men
are least likely to have their high blood pressure controlled.
Lack of trust in our current healthcare system is one of the
reasons they are not seeking treatment. Dr. Michener, how could
we rebuild that trust under a Medicare for All system with
universal access to comprehensive healthcare? How could
Medicare for All strengthen communities of color generally and
improve other social determinants of health?
Dr. Michener. I think that Medicare for All contributes to
and can contribute to precisely this problem of lack of trust.
We can think about lack of trust as sort of an individual
attitude, right, but it is rooted in experiences with
structures. So when you go to the doctor or you try to go to
the doctor and you are not able to get access, or when you are
worried about whether when you show up you will be able to see
someone given your health insurance status, when you are
worried about the cost, these are experiences that are
disproportionately in communities of color, and they all erode
trust.
Over and above that, Medicare for All, a universal coverage
system, is going to strengthen the healthcare system more
generally. It is going to allow us to make investments in the
healthcare work force. Again, this will increase access and
increase access in ways that, if designed right, can
disproportionately benefit the very communities of colors that
are disproportionately harmed by the current system. All of
these things contribute to repairing what, frankly, is broken
and has always been broken.
Mr. Bowman. Thank you so much for those responses. I want
to briefly share a personal story. Just recently, maybe a month
or so ago, I was feeling unwell in my office on the Capitol. I
literally took a 10-minute walk to the healthcare unit on the
Capitol, was seen immediately, treated immediately, and sent on
my way to go home and take care of myself. It made me think of
all the Black men, and people of color, and uninsured and
underinsured people in this country who do not have that
privilege and do not have that access. When they don't feel
well at home, they have to just deal with it in whatever way
they can using home remedies, which is OK. But imagine if they
can walk right downstairs or take a 5-to 10-minute walk to a
doctor right down the street, get seen on the spot, be treated
on the spot, and be sent on their way with the medication or
care that they needed, and also, by the way, have unlimited
access for followup. I can call a doctor on the Capitol 24
hours a day and weekends to followup on the care that I
received.
Everyone in this country deserves that level of care. Thank
you, and I yield back.
Ms. Bush. The gentlewoman from Minnesota, Ms. Omar, is
recognized for five minutes.
[No response.]
Ms. Bush. We can't hear you.
Ms. Omar. My apologies. Thank you, Madam Chairwoman, for
having me on your committee today, and thank you to all of our
witnesses for your excellent testimoneys.
When a person needs healthcare, they should not have to
worry about whether their coverage status will be a barrier,
but unfortunately, that is not the case for millions of
marginalized gender identities in the in the United States.
Across the United States, transgender people are uninsured at a
greater rate than their cisgendered counterparts. When trans
folks who are covered seek care, they experience denials of
medically necessary services at higher rates.
Dr. Blackstock, can you speak to how these trends
perpetuate stigma against trans folks and the broader LGBTQ+
communities in healthcare settings?
Dr. Blackstock. Yes. Yes, Representative Omar. So, you
know, one thing that we know is that the healthcare system is
not sensitive enough to the needs of the LGBTQA+ community, and
that many of our healthcare providers are not trained in a way
that is needed to provide the best care. But access is so
incredibly important, especially for these communities, because
we know that these health inequities exist, and they are
perpetuated because people from these communities are unable to
access care. So I think Medicare for All will provide an
opportunity for members from stigmatized communities to engage
in access with the healthcare system, and the healthcare system
also needs to be equipped to provide the resources and services
in a culturally sensitive way, in a culturally responsive way
to these communities.
Ms. Omar. Dr. Michener, what steps can Congress take to
ensure that people of marginalized gender identities are able
to access medical that are necessary care and free of stigma
and financial barriers?
Dr. Michener. I think the sorts of policies, the commitment
to universal coverage that we have been talking about here
today, is the first and critically important step. I think that
there are barriers that are really concrete around simply being
able to have access, and that is a sort of first point to
address. Over and above this, though, I do think that we need
to think about interventions that are sort of tailored to these
uniquely marginalized populations. And so we need to be aware
of what the unique challenges are in those populations, and I
think part of what that means is talking to those folks,
understanding better their perspectives and barriers, and
connecting that information with the policy choices that we
make going forward.
So I guess the broad point I am making is to really think
about how we can improve voice in addition to access so that
the people who are most affected, who have really unique stakes
around these particular kinds of barriers, can really help us
to understand how to engage and move forward in a way that is
going to address their particular vulnerabilities.
Ms. Omar. And I wanted to also ask you, you know, as
someone who supports Medicare for All and serves as the vice
chair of the Medicare for All Caucus, oftentimes we hear how
universal access to care can lessen the quality of care that is
available to people. Can you respond to that sort of critique
as an advocate for universal access?
Dr. Michener. I appreciate the opportunity to address that.
So one of the things that I always emphasize is that quality of
care, just like access to care, is a choice. It is a political
choice, and so many of the critiques that we have heard around
quality to care--look at the VA and its weaknesses, or look at
Medicare and its weaknesses--those are a reflection of
political choices: choosing to under fund those services,
choosing to create administrative burden and barriers, choosing
to make life for people on those programs more difficult. And
if we make different choices, we can have government programs
that are just as well run, just as efficiently run, actually
more so than private options, and the reason is because there
is no profit motive.
We are not trying to maximize what we can gain in exchange
for what we give in the context of a government program. We are
trying to maximize what we can give in exchange for improving
people's lives, saving their lives, and helping them to thrive.
That is the best context for both efficient and effective
programs that are going to help people. And to the extent that
that is not what we have, it is because we are choosing not to
put the pieces and the resources in place to achieve it.
Ms. Omar. Thank you. Thank you so much for that response. I
will just say as someone who has been fully insured for the
first time in my life here in the United States, I know just
how much my healthcare has improved, not just having the
anxiety of worrying about whether I could access, you know,
what Congressman Bowman was talking about, being able to pick
up the phone, walk 10 steps to a medical professional to care
for you. That is the kind of access that we want for everyone,
and that is the kind of access everyone deserves. So, again,
thank you all for the opportunity to have this conversation.
Chairwoman, I yield back.
Ms. Bush. Before we close, I want to offer the ranking
member an opportunity to offer any closing remarks he may have.
Ranking Member Comer, you are now recognized.
Mr. Comer. Well, thank you, Madam Chair, and I just want to
reiterate the fact that the Oversight Committee's role is to
determine waste, fraud, abuse, and mismanagement in the Federal
Government and try to provide solutions to those problems with
waste, fraud, and abuse. This hearing, like just about every
other hearing this committee has had this year, hasn't touched
upon that. In fact, not only does it not save money and reduce
waste, fraud, and abuse, it increases the size of government
significantly, and this is a pattern that we have seen with
this committee.
We had an energy hearing where many of the members on the
Democrat side asked the energy CEOs to pledge to decrease
production. Now, think about that: decrease production. Now we
have President Biden going to OPEC, Venezuela, and begging them
to increase production. I say that because we don't believe
that the government can efficiently run healthcare. We believe
that the solution to healthcare problems is with innovation, is
with competition, and that is where Republicans will continue
to work to try to find solutions when we talk about healthcare.
Madam Chair, thank you for the time, and I yield back.
Ms. Bush. Thank you. I now recognize myself.
The choice before the committee today, the choice is saving
lives or increasing profits. It is the quality of life or the
quantity of yachts. Medicare for All would guarantee high-
quality healthcare to every person in America in the
prioritizing of Big Pharma over human life and health, and,
more importantly, it would save lives.
To the 30 million people in this country who are uninsured,
to those who are underinsured, and to the Black, brown,
indigenous, disabled, low-income, and trans people who are
burdened under the various inequalities of our healthcare
system, we see you, we know, and you matter. We are fighting
for you. You deserve life. You deserve care.
I am grateful to Chairwoman Maloney and to our sisters in
service for their partnership in this hearing. In closing, I
want to thank our panelists for their remarks. I want to
commend my colleagues for participating in this important
conversation.
With that, without objection, all members will have five
legislative days within which to submit extraneous materials
and to submit additional written questions for the witnesses to
the chair, which will be forwarded to the witnesses for their
response. I ask our witnesses to please respond as promptly as
you are able.
This hearing is adjourned.
[Whereupon, at 1:52 p.m., the committee was adjourned.]
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