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Paul Ryan Explains Health Care Bill; Ryan Defends Health Care Bill. Aired 12-12:30p ET

Aired March 09, 2017 - 12:00   ET


[12:00:00] REP. PAUL RYAN (R), HOUSE SPEAKER: They had a great risk pool reinsurance system in Utah. A good one in Washington state. All those are gone under Obamacare.

RYAN: Here's how they work and here's how our system would work. We would directly support the people with pre-existing conditions. Let me get you a sense of this.

One percent of the people in these markets drive 23 percent of the costs. One percent of people in the individual health insurance market drive 23 percent of the costs.

So a reinsurance program is to cover more than just the 1 percent, to cover the people who have high health care costs. So by having state innovation funds to go to the states, to set up these reinsurance programs, we would directly subsidize the people who have pre-existing conditions. Direct support for the people with pre- existing conditions, so that everybody else has cheaper health insurance.

What you do when you do this is, the individual market, the people who don't have pre-existing conditions, they have much more stable prices.

Let me give you an example.

Take a small business that has 40 employees. Let's say that four people in that business get cancer. Well, under that business, that business has to pay for all those cancer patients, all those cancer treatments. So the other 36 people in that 40-person pool, have -- get hit with much, much higher premiums to pay for the four that got cancer.

That's how insurance works today. And that is one of the reasons why this thing is going bankrupt.

Here's our solution. Let's make sure we just cover the people who have pre-existing conditions, make sure that reinsurance or risk pools kick in for those four people in that small business that get cancer, subsidize that coverage. And what you do by doing that, is you dramatically lower and stabilize the price of insurance for everybody else. So those other 36 people, in that small business have predictable prices, lower prices.

That brings you more choice, more competition and lower prices for the vast, vast majority of Americans who are not in the pre- existing condition category.

So directly subsidize them through state-based risk and reinsurance pool programs that we would finance with support from the federal government to attack this problem, and let health insurance stabilize, go down in price.

Here's another thing that we think is extremely important.

One of the problems we have is we don't really have a consumer dynamic in health care. People don't always care what things cost or how good care's going to be, because they don't get that information. We actually immunize or block the ability for people to actually see what things cost in health care, or to act like a consumer.

Let me give an example.

Janna and I have three kids. They are 33 months apart. We call them Irish triplets. Our three kids had three tonsillectomies over the course of three years in Janesville, Wisconsin, from the same ENT at the same hospital. At each one of these times, I tried to find out, "What's this tonsillectomy going to cost?" Never could I get that answer to that question.

I only found out what it cost months after those procedures, when I got various bills from the ENT, the ear nose and throat doctor, from the anesthesiologist, from the hospital. And the variation of price between those three procedures from the same doctor and the same hospital within three years was huge.

One of them, the recovery bill, the recovery for my son, he sat in a Lazy-Boy, ate Jell-O, watched "Spongebob" for two hours, that was $1,400.

I mean, this is stuff that's crazy.

We don't shop like this for anything else we buy in our life. Why should we shop like this for health care?

And so what health savings accounts achieves -- this is a law that I helped write in 2003, something that we as conservatives have been fighting for for the whole time -- is we want to increase health savings accounts, which is what we do in this bill, so we have more competition and lower costs.

Here's the point I'm trying to make.

In 2000, I got Lasik surgery. The reason I can see you all so well, is because in 2000, I got this Lasik surgery, which was elective; insurance didn't cover it. And so I knew exactly what the procedure was going to cost up front.

And since then, this excimer laser that does this procedure has been revolutionized three times, and the price is lower. So, in this area of health care, quality went up and cost went down because I cared as a consumer what it was.

So it's not that that dynamic cannot happen in health care, it's that it isn't happening throughout most of health care.

And what health savings accounts does, is it helps hardworking taxpayers get access to affordable solutions to help them pay for their out-of-pocket costs, but it's also their skin in the game, their money.

If they save money by saying to a hospital or a doctor or a health care provider, "What is this going to cost me? Where's the best value for my money?" If we can bring that consumer pressure to bear in health care, we can dramatically enlist the support of millions of Americans to help us fix this health care problem.


RYAN: And that's one of the critical things we're trying to achieve here. Instead of using OPM -- other people's money -- to pay for health care that you don't care what things cost, we want to harness the power of the marketplace, the power of the consumer, of the patient and the doctor to demand better services, to demand better quality. We want transparency on price, on quality, and an economic incentive to act on that thing so that we can bring consumers to the bear.

This what we say -- this is what we mean when we say we want a patient health care system.

OK, here is a really important part of our American Health Care Act: refundable tax credits. I want to explain exactly what we mean when we say this.

Under the current Obamacare system, we have a Washington- controlled system with skyrocketing premiums and dwindling choices. It's a death spiral. It's collapsing. The government makes you buy what you want to buy. And it's an open-ended subsidy for a lot of Americans.

Our solution is a portable monthly tax credit. This is why we believe this is the right way to go.

We want a market-based system which will give us lower cost, more competition, and more choices.

There's a real problem in the tax code today in that the tax code discriminates against people who don't get health care from their job. If you're working and you're not on Medicaid, and you have a job that's paying you 10, 12, 15 bucks an hour, and that job does not give you health insurance, there's nothing that the tax code does to help you buy health insurance. If you do have health care from your job, you have an open-ended tax benefit.

So, what we're saying is that's really kinda not fair to the -- to the man or woman who is working at a job that doesn't get health insurance offered to them. Let's equalize the tax treatment of health care and give people the same kind of tax benefit to go buy health insurance if they don't get it from their job. And giving a person a monthly portable tax credit gives them the ability upfront to go buy health insurance of their choosing.

And here's the key: You buy what you want to buy. If you don't want to use your tax credit to go buy health insurance, you don't have to. If you don't want to buy this plan, you want to buy that plan, go for it.

It's your choice. It's freedom. It's called free-market health care.

The states get to set up their own health insurance systems. The states get to set up their own regulations so that you can buy whatever you want to buy where you live.

That is called patient's choice. That is called a patient- centered system.

And that is one of the biggest tools we believe can be used to replace Obamacare. This is part of replacing Obamacare with a system that works to give everybody universal access to affordable coverage.

Now, here is where we stand.

The current system is riddled with endless regulations that are driving up costs and limiting choices for consumers. And you see how the collapse is occurring.

Our solution: greater consumer options.

The patient is the nucleus of the health care system.

We don't want insurance companies becoming monopolies, looking for favoritism in a cronyistic way at Washington. We want health insurers, hospitals, doctors, all providers of health care benefits competing against each other for our business as consumers.

That is how the great American free enterprise system works in all other aspects of our lives and our economy. That's what should work in this system as well.

So, the result: You choose the plan that meets your needs. You buy what you want to buy, not what the government tells you to buy.

So, our goal here is -- final -- is this: lower costs, more choices, patients in control, universal access to care.

There are two points I would make in conclusion.

We, as Republicans, have been waiting seven years to do this. We, as Republicans, who fought the creation of this law and accurately predicted that it would not work, ran for office in 2010, in 2012, in 2014 and in 2016 on a promise that we would -- if given the ability, we would repeal and replace this law.

How many people running for Congress and the Senate did you hear say that? How many times did you hear President Donald Trump, when he was candidate Donald Trump, say that?

This is the closest we will ever get to repealing and replacing Obamacare. The time is here. The time is now. This is the moment. And this is the closest this will ever happen.

It really comes down to a binary choice. We now have the ability, through the budget rules that we have in the Senate, with our three- pronged approach, to actually make good on our word.

We told people in 2016 what it would look like when we had the chance to replace Obamacare. That was our Better Way plan. That's what this is.

So we said in 2016 to our citizens, to the American people, to our constituents, "If you give us this chance, this opportunity, this is what we'll do." Now is our chance and our opportunity to do it.

RYAN: Questions? Chad (ph)?

QUESTION: Thank you, Mr. Speaker.

You say this is a binary choice. A two-part question: Why would somebody not believe this is take-it-or-leave-it when you hear from members of the Freedom Caucus and conservatives, say, take your bill or change it?

And number two, when the Democrats approved cap-and-trade in the summer of 2009, there was much criticism of a manager's amendment which was put in at the end to make that bill ripe for passage on the floor. When we hear these criticisms from Republicans, why would we expect something like that not to emerge in this case to make that bill OK, to pass, and get their votes?

RYAN: So, I would answer it in this way.

What people are talking about -- there's a lot of frustration, a lot of confusion, frankly, out there among conservative groups and even among members -- is reconciliation has certain limits. So there are folks who would love to see us put in this reconciliation bill all these other ideas.

One conservative group is saying by golly, you better put shopping across state lines in this bill or else we're not going to support it. Guess what, Chad? If we did that, we wouldn't be able to pass this bill. It would be filibustered in the Senate. It wouldn't even come up for a vote.

So, the last thing we want to do is prevent our ability to actually get law made. So, it really is a conversation about the third prong approach -- the other bills we're going to pass outside of reconciliation, which in the House we're a majority body we can pass -- that go the Senate.

So much of the conversations are about moving this other agenda on the same track around the same time to get these things done. The last point is, as you know the process, but a lot of people don't,

we're going through four different committees. That's how legislation works in the regulator order. We just did the Ways and Means Committee last night. We're in the middle of the Commerce Committee. Next week, it goes to the Budget Committee. And then it goes to the Rules Committee before it goes to the House floor. The bill will be out there for three weeks to be looked at. Go to readthebill.GOP. It's a 123-page bill. It's not 2,000 pages of something that they just whipped together and flipped to the floor like they did. They didn't -- we didn't write it in Harry Reid's office on Christmas Eve. This was written by our committees.

And let's back up a second even further. This bill has been worked on for a year. This bill was worked on from January to June last year so that we could offer our constituents and the American people, in our Better Way agenda, what we'd replace Obamacare with. We offered it up in June. We ran on it all through the election. And now we've translated it into legislation.

And even backing up further, these two key components -- block- granting Medicaid back to the states; de-federalizing entitlements; putting a cap on it -- that is something that conservatives have been talking about and dreaming about for decades.

And repealing another entitlement, Obamacare -- its mandates, its subsidies, its taxes, and replacing it with Republican free market health care tax policy. If you told me two, 10 years ago where we would be, I think I'd be in a dream. I'd be doing back-flips.

To conservatives who've been fighting for health care reform, this is so exciting. And so what's happening now is members realize this the chance. This is the once-in-a-lifetime opportunity.

So naturally in the legislative process, people are saying, well, I'd love to have this in there; I'd love to have that in there. That's the legislative process. That's what we're going through. And what people are sort of learning is this reconciliation tool is pretty tight. There's a lot of stuff we would love to put in the bill, but unfortunately the Senate rules don't allow us to do that.

And that's where you see a lot of confusion and a lot of frustration, understandably so. But that's also why we have a three- pronged approach: administrative actions by Tom Price at HHS; and the additional legislation that we're going to move as well.

QUESTION: So just to clarify, not to belabor the point, so you're saying that this bill was crafted in a way so it would meet the reconciliation Byrd test in the Senate.

RYAN: Correct.

QUESTION: Ergo, there couldn't be much change to this...

RYAN: Correct.

QUESTION: ... and you (inaudible) other options. So (inaudible) not many changes...


RYAN: Well, we'll see -- we'll see what we have to do when we get our score. Because as you know, you don't -- when you go to authorizing committees, you typically don't go with your score ready. When we get our score, I'm sure we'll probably have to make some tweaks and adjustments. That happens every time we do reconciliation.

But yes, this is written -- this bill is written so that -- it's called privileged. This bill is written so that it can't be filibustered; so that they have to bring it up and vote on it in the Senate. And if we put things in this bill that take that privilege off of it, so that it's not reconciliation, they won't even vote on it. They will filibuster it and they won't even vote on it.

So that's what I mean when I say this is the closest we've been to repealing and replacing Obamacare. And let me just say it again. This is the closest we will ever get to repealing and replacing Obamacare.


QUESTION: Mr. Speaker, how did you come up with the amount that you would give out in tax credits? And why should a family that makes $140,000 a year get the same amount as a family that makes $40,000?

RYAN: That's a really good question.

So, the amount of the tax credits is based upon the way insurance works. And it's modeled after the Tom Price legislation, which he had last year, which is adjust for age and family size. Because, the older a person gets, the more costly their health care is. That's how insurance is written.

So the tax credit adjusts more tax credit for the person's age, and obviously, if you have a bigger family you have more health care costs, so a bigger tax credit.

Now why is the crap (ph) set where it is? And that's something -- by the way, 12 members of the Freedom Caucus, for example, were co- sponsors of the Price legislation just last December, which is this kind of a tax credit situation.

A lot of our members through our feedback -- we had seven member listening sessions in February, four conferences, getting feedback from our members on this draft of this legislation, getting their ideas. And one of the concerns was, we should cap this credit. So, like a millionaire, that doesn't get health care from their work, but is a millionaire, doesn't get a tax credit.

So that was something that everybody agreed with and the Ways and Means Committee made that adjustment.

But the reason it's set where it is is, we don't want to have a job penalty. Go back a few years ago and when CBO said Obamacare produces job lock. Obamacare says that the equivalent of 2 million to 3 million people will not go into the workforce, will not take jobs, because of the way the Obamacare subsidies work.

What I mean when I say that is, if you set that credit limit too low, and a person loses their credit by getting a raise, or -- or -- or advancing in life, you don't want to disincentivize that.

So they're set at such a level that that wouldn't occur. But they're set at such a level so that really is for a middle-income family, or even an upper-middle income family -- so that we never tell a person, "Don't take that raise, don't get that job, don't take that promotion." We don't want federal tax law or tax credits to ever encourage a person not to advance, not to take a job, not to get a raise. That's why.

QUESTION: Where does that $2,000 (ph) figure come from? RYAN: I'm gonna go in the back.

QUESTION: (inaudible) companies on board to provide the (inaudible) talking about, and almost every industry organization has come out against it. The reason why there isn't as much participation (ph) as the customers might like, is because these companies can't offer these products (inaudible).

RYAN: Yes.

QUESTION: How does (inaudible).

RYAN: It's -- it's a great example.

Here's what people are not seeing, which is number two.

Tom Price, for legal reasons, can't tell you what he's thinking about doing. There's -- there's -- there's laws that prevent that.

We can do so much deregulation through the executive branch, by the secretary of health and human services. He actually just put one regulation out the other day which will go a long way toward lowering the cost of health insurance.

So they haven't even seen yet what our secretary of HHS can do in -- in number two, in -- in -- in phase two here, where they actually can dramatically lower the price of health insurance. So those companies haven't seen that yet.

QUESTION: (Inaudible)

RYAN: So let me just finish. Don't interrupt me, if you don't mind.

Here's the other point.

We have basically a few options in front of us.

Number one, do nothing, let the system collapse.

What the insurers are telling us is, if you thought a 25 percent average premium increase was rough in 2017, it's going to be a whole lot more of -- than that in 2018 and more and more insurers are going to pull out.

So the insurers are telling us, if we don't know what's going on come late spring, we're going to have massive premium increases and pull- outs and it will collapse the individual market. What they also tell us, though, is if you only appeal the law, just gut and repeal the law, as some folks are suggesting, then you'll have triple-digit premium increases and you'll collapse the individual market.

You've got to remember, if we just repeal Obamacare, it's not like life and the world goes back to life before Obamacare. Obamacare did so much damage to the U.S. health insurance system, that it's not as if you can just go back to the day before. So that's why we are offering a better way. That's why we are offering the American Health Care Act. That's why we're offering a system that brings choice and competition back into the marketplace, gives people, through the use of risk pools, health savings accounts and tax credits, the ability to go find affordable coverage, and that brings insurers back into the marketplace.

The insurers are telling us, that will bring insurers back into the marketplace. If they can actually offer the plans that people want to buy, not the plans that people are making them buy, they'll have more plans being offered, there'll be more choice and more competition.

That is what brings down cost. And in conjunction with all the administrative things that Tom Price can do, those efforts together can help dramatically save our system and give us low-cost health insurance, better quality health insurance and access to affordable health insurance.

RYAN: Don't forget how all this works together. Subsidize the sick and the pre-existing condition through risk pools and reinsurance. The health savings accounts to bring the consumer in the marketplace, to put pressure on providers to compete for our business based on cost and quality. And then give families who have jobs, but don't have the kind of jobs that gives them health insurance benefits, the same kind of tax benefit everybody else gets, so they too, at the beginning of the year -- at the beginning of the month, can go buy a plan that best meets their needs.

That is how you fix and save this system from the crash that is -- is occurring. And we're very, very confident that will work that way.

Thank for you indulging me. Thank you for putting up with my town hall presentation.

I just think it's really important to try and iron out all the differences, to show that there's folks who say, "Gosh, you should have this and that in this bill." Reconciliation doesn't let you do it. We're doing it here. People who say, "Well, these regulations are so expensive and so costly," Tom Price at HHS can fix those things.

We can fix this problem. We promised the American people we would fix this problem. And the way to fix this problem is to repeal Obamacare and replace it with a patient-centered market-based system. This is something that we, as conservatives, have been dreaming about for decades. This is the chance, and the best and only chance we're gonna get. And that's why I'm really excited.

Thank you very much. Appreciate it.

UNIDENTIFIED MALE: Thank you, Mr. Speaker.

UNIDENTIFIED MALE: Are you willing to speak then off camera with some health care journalists (ph) --

DANA BASH, CNN ANCHOR: What you have been watching is classic, vintage Paul Ryan. This is the reason why he rose through the ranks as a young man because he is a policy wonk and likes to explain the policy that he supports. And in this case, as you just saw, shirt - suit jacket off, shirt sleeves rolled up, going through his PowerPoint presentation, trying to sell his health care plan to, not Democrats, not voters out there generally, but fellow conservatives.

Welcome to INSIDE POLITICS. Thank you so much for joining us. I'm Dana Bash. John King is off today.

Let's talk about what we just saw. First and foremost, as I said, that's classic Paul Ryan. The fact that they're doing this on Capitol Hill, he's the guy explaining the policy, he's the guy selling in that way, not Donald Trump, what does that tell you?

PHIL MATTINGLY, CNN CONGRESSIONAL CORRESPONDENT: Well, that he understands the policy. And I don't mean that in a negative sense to the president, but the president's team worked with Speaker Ryan's team and Speaker Ryan on the policy.

But this is Speaker Ryan's baby. This was his drive and he was the driving force behind this. His team was the driving legislative force behind what we're looking at right now, that House bill. And his team has really been working on this, as you've noted, not just for a year or two years, but particularly when it comes to the entitlement sections of this, years on end, PowerPoints on end. One story in particular, the president's top adviser, Reince Priebus, Steve Bannon, Gary Cohn, all of those individuals were treated to a similar PowerPoint behind closed doors a couple months ago as this process all started. When they need an explainer in chief, the speaker's the guy.

BASH: He is, explainer in chief, but then the question is, does he - has he wrapped himself up in this to own this issue? I should be introducing you guys. Julia Pace with the Associated Press. Everybody knows Phil Mattingly, our local -

JULIE PACE, ASSOCIATED PRESS: No introduction needed.

BASH: Exactly, no introduction needed. But as I come to you on this, I was told from some conservatives who were in a meeting with President Trump last night that what they're hearing from their grassroots is anger, but not necessarily at the president.

PACE: Right. BASH: They do see this as just yet another move by the Republican establishment, Paul Ryan leading the charge, to not listen to what conservatives really want.

PACE: And you also hear this difference between what Paul Ryan is saying where he says this is the only choice. Not only does he think it's the best choice, but it's the only choice, and what the president seems to be saying in some of these private meetings, which is leaving the door open to negotiation, to having some flexibility around it, that's the dealmaker side of him coming out. But how Ryan and Trump try to close that gap and appeal to these conservatives, you know, Trump wants a win here, but he doesn't want to tie himself to something that's going to be unpopular for the sake of that win.

BASH: And, Laura Meckler, I just want to also add that as he was speaking, I was texting with some people in his office noting, I think what was abundantly clear, but that this is where he's in his element. He feels that he can explain it probably better than anyone. And, most importantly, admitting that they need to sell this to the conservatives who are becoming more and more fiercely opposed to this.

LAURA MECKLER, "THE WALL STREET JOURNAL": And it's not just the conservatives in the House or in the Senate.

BASH: Exactly.

MECKLER: It's a lot of conservative groups that are out there. Think tanks. The kind of support you would expect that you would have for a piece of major legislation. Paul Ryan is really in a bind here. This is his moment. He's been talking about this for so long. They've had years to talk about how they would replace the Affordable Care Act if they had the chance. Now they have the chance. Sort of the all - everything's in place for this legislative action to go forward. And if he can't get it through, that's going to be a - just a huge defeat for him. And I think that it - but it stands in I think real contrast to what we saw in 2009 when President Obama was trying to pass the law in the first place and you saw an incredible effort having learned from President Clinton's failed effort to try to round up supportive groups and really try to keep everybody in the tent. And, obviously, they barely did it, but they did do it. I just wonder, given how difficult it was for Obama to get it over the line, whether when they're starting out -

[12:25:24] BASH: Exactly.

MECKLER: With so much opposition, whether they're going to ultimately be able to do this.

BASH: It's a great question. And Olivier Knox, I want to just say, I think one of the most important things that Paul Ryan said was, this is the closest we will ever get to repealing and replacing Obamacare. Like, listen, folks, you're used to being in the opposition. This is called legislating. This is the best we're going to do in the reality that we're in.

OLIVIER KNOX, YAHOO! NEWS: It's also the core - as Julie alluded to be, it's one of the core messages. It's this or nothing, which is a very interesting argument, especially with - when the president is saying, hold on, well, maybe the - maybe it's an opening bid. It's really interesting to watch how this White House is ramping up its pressure campaign to get this passed. It looks - with the exception of the president's tweets - it's pretty conventional. It is a lot of regional interviews from the White House grounds. It is presidential and vice presidential travel. Vice President Pence is going to Kentucky this weekend. And it's this. This is another - this is another component of this multipronged attack.

BASH: No question. OK, stand by, everybody. We're going to talk a lot more about the meat of this and what has happened overnight on Capitol Hill. High drama, high stakes in the wee hours. Lawmakers, they did burn the midnight oil. Hours and hours of discussion on this Republican plan we just heard from Paul Ryan talking about. And, guess what? They're still going. We'll be right back.