Rep. George Miller joined BlogHers for a health care reform discussion that ranged in topic from the public option to pre-existing conditions.
You can listen to the call with Rep. Miller -
You can also read the transcript below:
Nancy Watzman: Welcome everyone. I’m Nancy Watzman of the Sunlight Foundation representing Blogher today and their community journalism initiative on healthcare policy.
The Sunlight Foundation is a non-partisan, non-profit dedicated to using the power of the Internet to catalyze greater government openness and transparency.
As CEO Lisa Stone announced Blogher has been sponsoring a bipartisan series of telephone conference calls to connect women bloggers directly with legislators.
Today on the call we have Representative George Miller. He’s been Congress for 35 years and is Chairman of the Influential House Education and Labor Committee.
He’s a key champion of HR3200, America’s Affordable Health Choices Act. So let’s begin the call and take some questions. Well actually the Chairman would speak for - introduce himself.
George Miller: All right, thank you very much. I appreciate the opportunity to talk to the Bloghers and I’ll just take a couple of minutes here to kind of outline where we are and then open it up for your questions.
I appreciate the invitation to speak with you. There has been no issue that I have been involved in in my public career in the Congress of the United States that has had more intensity and debated more extensively than the issue of healthcare and healthcare reform.
And I think that overall has been very good for the country. I think it’s been good for the members of Congress to hear from the constituents. I was disappointed at some of the activities that took place this summer with the incredible misrepresentations and the efforts to try to scare Americans away from this bill and keeping members of Congress from, you know, talking with their constituents about what was in the bill.
But I think we’ve passed that stage for the most part and since the August break the leadership and the Chairman of the Committees and Democratic leadership have been meeting on a daily, ongoing, regular basis every day that we’ve been back in Washington with the members of the Democratic caucus, with the members of our Committee, with the members of the various caucuses within our Democratic caucus, with the progressive caucus, the Blue Dogs, the new Democrats, people who are concerned about regional disparities, people who are concerned about public option, no public option.
And those meetings continue today. But I think we’re really coming toward the end of that process for - at this stage which would be to finalize the last remaining decisions on the cost of the bill, some options to pay for it or not.
But - and then to send it off to the Congressional Budget Office where they can give us a score as they’re now doing for - or they will be doing shortly for the Senate bill.
We think that may take as many as ten days for them to do that and then we would - when we have that score if it requires additional changes to be made because of some finding by the Congressional Budget Office we will take time to do that.
Those will have to be scored and then I think we will be ready to introduce a bill that is the product of the three - the work of the three Committees, the Ways and Means Committee, the Energy and Commerce Committee and my Committee, Education and Labor.
We started out with probably about 75 to 80% of the bills being in common from the three Committees and then there were amendments that were offered in the various Committees and we’ve been walking through some of those, and also listening to the members after the August break.
I think the product that we’re going to end up with will reflect the work of those Committees and it will also be consistent with the goals of - that President Obama has laid out.
And some of you are familiar with those. First and foremost of course is in the long history of insurance company discrimination based upon pre-existing conditions to deny either families coverage because of one individual in that family may have a pre-existing condition or to deny an individual coverage because they have a pre-existing condition.
We also are working very hard to introduce competition into that insurance market with the introduction of the public option. If you have a robust public option and this is the discussions going on now - we have two different versions of the public option we reported from the Committees. A robust public option saves you about $110 billion.
That savings comes from the lowered premiums that people would have to pay for their insurance plans in the national insurance exchange. We believe that and CBO tells us that that public option would drive competition. Those lower premiums that people would have to save would save families money and individuals money.
It would also save the government money in the subsidies that it has to pay to help families and individuals pay for that coverage in the national exchange. We expect that we will be able to cover about 97% of the people in the current program.
There will always be some people who just, you know, won’t sign up, won’t do this and over time we also - we expect that we’ll find them but they don’t necessarily show up the day you open up the new plan or even in the first year.
And again the choice and the competition we think is important. The other one is that never again will people lose their insurance because they’ve lost their job, because they switched jobs or because they’ve decided they wanted to go out on their own and start a small business.
They will be able to stay in the exchange. Their premiums may change. Their subsidies may change but they will always have coverage. Their family will always have coverage if they have a family.
Many, many people, you know, Congress looking at the business rule, you know, really think we pay huge prices in the nation for that job lock; people who can’t leave a job for another opportunity because of the need for insurance or the absence of insurance in the next job or people who don’t start businesses because they don’t - they would not be able to have insurance for themselves or for their family.
We believe that we’re going to provide the incentives to shift to a - instead of reimbursing everybody for activity in the medical field for outcomes in the medical field and we have a number of studies to - for the Institute of Medicine on how that can be done.
We require bundling so that hospitals and providers can look at the overall medical care that they provide to an individual and figure out how to get the best outcomes at the lowest cost.
So we’re really taking medicine I think into an area where many of us had believed that it should go for a long time. The simple fee for service creates huge expenditures that really don’t reflect in the better health status of Americans.
And that’s really what we’re after. We’re really after improving the health status, not just health insurance coverage but the health status of Americans. We believe that we strengthened Medicare and I think that’s important.
There’s been a lot of rumbling back and forth for that. The changes that we make in this system we believe and CBO tells us will extend the solvency of Medicare by an additional five years.
And yet we think we’ll provide better care for seniors. We will be closing the doughnut hole that - after seniors exhaust part of their benefits for prescription drugs in Part D they’re then on their own for quite a while and then they get help again.
We’re hoping to be able to close that very rapidly with this legislation. There’s still some discussion about how rapidly we’ll be able to do that. A lot of that pertains to the cost of doing that.
The President said that on the coverage part of this legislation and the reforms that he wanted a limitation of $900 billion that we believe we’ll be able to meet that.
He said he wanted a deficit neutral over ten years. We believe it’ll be deficit neutral over ten years and that’s why - we’ll see what CBO says but that’s our goal and that’s what we will bring to the floor.
And we also wanted them as they talk and hear Washington bending the curb we want to look out over an additional 10 or 15 year period and know that we’re - we have policies in place that will help us reduce the long-term healthcare costs because that’s what our economy needs.
That’s what businesses needs, that’s what families need is to understand that we cannot continue to absorb these dramatic increases in health costs or insurance premium costs that are crushing businesses and crushing families.
It’s a big list. It’s controversial but I’m very encouraged by the attitude in the caucus and I think the progress that’s being made in the Senate is very helpful. They’re not the same bills but we - I do believe that we will pass them in both the House and the Senate.
We’ll have a Conference Committee and we’ll have a bill to the President’s desk before the end of the year. So I’m really quite encouraged but it’s been a long effort.
You know, we’re changing the system in America that sort of grew up haphazardly over a 50, 60-year period and it’s a very complex process to do it and to try and do it right.
And I think we see many of the people who have been engaged in the study of the medical system, economists and providers and medical experts and others think that we’re really dealing with the right pieces here.
Do they agree with everything we’ve done? Not necessarily so but we’re on the right track and we’re making changes where we can get the best deal hopefully for the taxpayer, for the - for families that have to buy coverage and for the economy. So thank you again and I’d be happy to answer a few questions.
Nancy Watzman: Well thank you. Yeah let’s turn it over to our callers and if you’d like to introduce yourself to the Chairman please do so. So let’s take the first call.
Operator: Ladies and gentlemen, if you’d like to register a question, please press the 1 followed by the 4 on your telephone. You will hear a three tone prompt to acknowledge your request.
If your question has been answered and you would like to withdraw your registration, please press the 1 followed by the 3. If you are using a speakerphone please lift your handset before entering your request.
One moment please for the first question. And our first question comes from the line of 296N as in November. Please proceed with your question.
(Jaelithe Judy): Hello Chairman. Nice to hear from you today. My name is...
George Miller: Thank you.
(Jaelithe Judy): I appreciate you coming to speak with women Bloghers. My name is (Jaelithe Judy). I live in Missouri. I write for monocaps.com and I have a son with a chronic health condition so I’ve been following this debate very closely because I’m an independent contractor.
And if my husband were not currently employed by a big business there would be no way we could get individual insurance that would cover our own family that would - our whole family that would be affordable.
George Miller: Right.
(Jaelithe Judy): My question for you is I understand that you’re a supporter of the public option.
George Miller: Yes.
(Jaelithe Judy): And I know that the House bill included the public option and in the Senate there’s been a lot of debate about the public option. I’m wondering what is the plan in the House if the Senate passes a bill with no public option or with a very weak public option or with a public option trigger?
What is the House going to do during reconciliation to try and preserve a strong public option in the final plan?
George Miller: Thank you. One, correctly we believe we will pass a public option in the House. Whether or not the Senate will or not remains to be seen. A number of my colleagues in the Senate tell me they think that when they get to the floor they may very well pass a version of the public option.
We’re hoping to pass a robust, strong public option. That’s still in debate in our caucus. We’re counting votes and people in support of one proposal versus another are going through the caucus and counting the votes and talking to the members.
And we’ll know that result probably here within the next couple of days. But I do believe that we will take a plan with a public option. The question is whether we have negotiated rates or whether we have rates that are based upon Medicare plus 5%.
There’s a lot of concern that if you have Medicare plus 5% that perhaps providers will not accept patients from the exchange, from the public option. Others believe that that’s not - that’s really not an issue and that that could be fine.
The other plan is to negotiate those rates somewhere between Medicare rates and the average of plans that are offered in the exchange. That would still continue to put downward pressure on those plans.
If we did the pure robust public option that my Committee and another Committee reported out that saves us $110 billion over ten years. That savings as I pointed out go to families and go to the taxpayer.
If we have negotiated rates we save about somewhere between 25 and maybe $35 billion dollars. So the choice is important and the choice is significant.
And when we’re trying to insert competition into the insurance market you can see what the difference will mean. Do taxpayers and ratepayers save $110 billion over ten years or do they save 25 to $35 billion over the next ten years?
In either case I think we will end up with a public option and I think that in either of these cases we will be able to drive a much more competitive insurance market for the government that provides subsidies for people that go to the insurance exchange and for families that have to pay for part of their policies. But I think the public option will go to the President’s desk is my conclusion.
Nancy Watzman: Okay, any follow up on that with this caller or...? Are you still on the line?
(Jaelithe Judy): Yes I’m still here. Well I guess so you’re confident then that the final bill will have a public option in it?
George Miller: Yes I am. I am. I think it’s very important to the House of Representatives. I think it’s fundamental to building the most efficient and cost-effective system for the - for our country and I think it will prevail.
I think it’s more an argument now of what kind of public option we will have and that’s very different than maybe the argument that we were having back in July and August.
Nancy Watzman: Okay, should we go to the next call?
Operator: And the next question comes from the line of 221N as in November. Please proceed.
Wendy Norris: Hi, this is Wendy Norris and I’m with RH Reality Check. I was wondering more of a political question - why the caucus allowed the debate to be diverted on abortion and maternal health care?
It seems as though we’ve gotten ourselves really tied up in knots over, you know, issues that are quite controversial and we’re losing sight of the bigger picture and the opportunity to really make the case to the American public about healthcare reform overall.
And I’d be interested in your thoughts on sort of the sausage making behind healthcare reform in Congress.
George Miller: Well we’re, you know, obviously we would prefer and making every effort to keep the healthcare reform debate and the insurance reform debate front and center with the American public.
But in the - this is a democratic system and we’re on notice that there will be individuals in our caucus and certainly when we come to the floor perhaps Republicans and Republicans with some Democrats that are - have under discussion amendments or challenges on the question of the use of public funds for abortion.
They want to extend the ban on public funds to include subsidies that are provided to people. The question is whether there will be at least one plan in the exchange that does not - that doesn’t provide for abortion or one plan that does and the others don’t.
I mean, this is all a matter of discussion and I don’t know where it’s going to come out but you can’t avoid that discussion because it’s, you know, obviously of great importance to many members of the Congress on both sides of the aisle.
We’ve been through these legislative battles before on this issue and I - this is going to continue. And there’s a lot of discussions going on on this subject among various members of Congress that have been involved in it many years.
Nancy Watzman: Okay, next caller.
Operator: The next question is from line 207N. Please proceed.
(Karoli): Hi Representative Miller. My name is (Carolee) and I have been unemployed for the last almost year now and my husband is self-employed. And through a series of - well it’s not really important other than to say that our COBRA administrator has managed to set things up in a way that causes our whole entire family to be uninsured.
I’m 51; my husband is 56. I have a 20-year-old who was just diagnosed with diabetes a month ago. And my question is if healthcare reform - if the actual provisions aren’t taking hold until the year 2013 what do we do in the meantime?
We can’t get insurance at our age and employers don’t want to hire us at our age.
George Miller: Sure, sure. We are - or the President in his - when he spoke to the nation on this subject several weeks ago asked us to create in this legislation a plan for people who have pre-existing conditions who do not have insurance.
We’re in the process of doing that as a part of this bill. I - I’m sorry, you know, it’s in the - we’re formulating it right now so I don’t - I can’t give you all of the details on it.
But it’s really designed for those individuals that sound very much like you on how do they get from here to 2013. And to create a fund to address those concerns I think at the outset we’re talking about setting aside $5 billion to help those individuals and families in that situation. And so that’s how we’re trying to deal with it.
Nancy Watzman: Okay, next...
(Karoli): Can I just follow that up with one quick question? Is there any consideration being given to allowing us say over 50 or over 55 to buy into Medicare as an option?
George Miller: That’s been discussed but we haven’t - that’s what I would prefer but I haven’t been able to secure the ability to do that. I think that’s - it’s not completely off the table because people recognize because of the economy and what’s taking place and people that are thrown into that position, you know, because of their employment COBRA may not be an option for them.
So that continues - we continue to have some discussion about that. I don’t want to get your hopes up.
(Karoli): Thank you.
George Miller: That’s all right. Thank you.
(Karoli): Me too. Thank you.
Nancy Watzman: Okay I know we don’t have too much more time so let’s go to the next call and maybe try to keep it quick so everyone can get their questions in.
Operator: And the next question is from line 274N. Please proceed.
Maria Niles: Hi Representative Miller. My name is Maria Niles and I blog at both Blogher and my own blog called popconsumer. And my question is about purchase mandates.
And what if anything is coming from the House? I know I’ve heard that there are considerations in the Senate to require people to purchase health coverage.
I’m concerned that someone like myself who is self-employed will be required to purchase private health insurance and that it may not be affordable. And I’m just very concerned about being forced to contribute to the profits of a private company.
George Miller: Sure, sure. There is in the House bill an individual mandate. You will be required to have health insurance. At tax time you will be required to provide proof of insurance.
And in that mandate we would expect it again depending upon your situation if you, you know, if your employer provides it that’s one set of circumstances.
If not you would go to the exchange and depending upon your income we would provide subsidies for people of between 133% of the poverty rate and 400% of the poverty rate.
And those subsidies - we continue to work them out but they would obviously be graduated. People at 130% would pay essentially little or, you know, would pay 2% perhaps of the premium and at 400% you would end up paying maybe 97% of the premium.
Four hundred percent is about $88,000 and that’s where people would go to the - there in that exchange they could choose private insurance plan, you know, Kaiser or Blue Cross or they could choose a public plan, whichever fit them better as individuals or as family members.
But there is an individual mandate. One of the things we’re trying to do is to get rid of the uncompensated costs for individuals who don’t have insurance and then encounter a health problem, crises, whatever it is and then the system ends up - the hospital or the providers or others end up paying those costs because that person wasn’t insured.
So there’s an employer mandate on employers to provide insurance. Small employers are exempted along the scale but for individuals there’s a mandate to have insurance.
Nancy Watzman: Okay, next question.
Operator: And the next question is from the line of 958M. Please proceed.
(Erin Koteki vest): Hi Chairman. This is (Erin Kotekivest). I am with Blogher and my own blog, Queen of Spain blog. I wanted to ask you - we’ve got a lot of community members who are very concerned as they hear about pre-existing conditions being applied to victims of domestic violence. Could you speak a bit about that please?
George Miller: Well we will not allow insurance policies to be rated based upon any pre-existing conditions. I - apparently in some states that that’s an allowed pre-existing condition - it’s my understanding. Correct me if I’m wrong.
But in this legislation the insurance policies in the exchange and for employers and else later on but for the insurance policies in the exchange we do not allow any pre-existing conditions. We cannot deny coverage to individuals in the future because of any of those conditions.
Nancy Watzman: Okay.
George Miller: All right?
Nancy Watzman: And I’d like to ask you a very quick question as representative of the Sunlight Foundation which cares very much about transparency in government. I’m wondering what will you see transparency playing in this, you know, in the debate and what role you think it should play?
George Miller: Well, you know, I think it’s a very important part of this debate. As you know when we finally passed the three bills prior to the August break they were up on the Internet.
My Committee site, my personal site got an exceptional number of hits from people who either read it or in fact downloaded it. It was quite amazing the number of - numbers of people who downloaded it.
And I assume the other committees and the speaker site and other sites in the Congress got those same kinds of requests. As we now near the end of this process, when this bill is finalized, I mean, as I said earlier we’re going to go to the Congressional Budget Office, we’ll get new costs and then we’ll have to make changes according to that.
And then when we’re ready to introduce the bill, when the bill’s introduced that bill will be on the Internet for 72 hours. And if there is a manager’s amendment which would be - usually it deals with making relatively small changes but it could be some other issue that pops up.
And if that manager’s amendment - when it is approved by the Rules Committee that will also have to be on there for 72 hours. So in my, you know, ordinarily around here you introduce the bill.
That bill would be on the Internet for 72 hours. During that time you might be putting together a manager’s amendment so - and that manager’s amendment is approved by the Rules Committee.
Another 72 hours would run so you can see here spaces of time, you know, made - whether it’s two 72-hour periods or something - somewhat longer than that. But the final drafts of the bill and the manager’s amendment will both be available on the Internet for that period of time. Speaker Pelosi is committed to that and the rest of the issue is committed to that.
Nancy Watzman: Okay. Well thank you so much.
George Miller: Thank you for the opportunity.
Nancy Watzman: That wraps up today’s call and - with Representative George Miller and Blogher. Thank you for participating and thank you Bloghers for joining us. Please keep an eye on Blogher.com for the audio and transcript of this call and for the announcement of the next call where we give you another opportunity to talk healthcare reform with legislators.
Operator introduction and conclusion has been deleted.
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