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tv   Key Capitol Hill Hearings  CSPAN  July 29, 2014 5:00am-7:01am EDT

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civilians and easing the suffering of innocent people everywhere in gaza, in israel, in the west bank. today we are continuing to work toward establishing an unconditional humanitarian ceasefire, one that could honor -- and enable -- the threat imposed by tunnel attacks and to be able to do so without having to resort to combat. that is what could come from a cease-fire. we believe the momentum generated by a humanitarian cease-fire is the best way to be able to begin to negotiate and put in placeou can
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a sustainable cease-fire. one that addresses all of the concerns, the long-term concerns as well, begin to talk about the underlying causes of the conflict in gaza, although they will not be resolved in the context of a cease-fire discussion. to try to build, to begin and move in a process and that is what we are trying to achieve. that thehe only way conflict is going to be resolved. if we can make some progress, the people in this region, who deserve peace, can take one step towards that elusive goal by stopping the violence which catches innocents on all sides in the crossfire and begin to try to build a sustainable way
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forward. any process to asolve the crisis in gaza in lasting and meaningful way must lead to the disarmament of hamas and all terrorist groups. we will work closely with israel and regional partners and the international community in support of this goal. we continue to have these discussions. in discussions succeeded putting a 12 hour humanitarian cease-fire in place. for thatllover time occurred, regrettably, there was a misunderstanding about 12 hours versus 24 hours. we are trying to work hard to see if these issues can be clarified in a way that will allow the parties, israel and , thealestinian authority
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other countries involved, working through the egyptian initiative, to be able to find a silence the weapons long enough to be able to begin to negotiate. >> coming up, the house had a committee on health insurance provider subsidies. the medalobama awards of arts and humanities. recipients include linda ronstadt. >> on our next "washington talk aboute will roger wicker about the veterans health-care bill and the debate about immigration and border security. beto o'rourke will also weigh
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in. we will discuss federal workforce training programs with anthony carnevale. journal" at 7:00 a.m. eastern on c-span. years, c-span brings public affairs events directly to you, putting you in the room at congressional hearings, white house events, briefings and conferences and offering brief gavel-to-gavel coverage of the house, as a public service of private industry. we were created 35 years ago and brought to you as a public service by your local cable or satellite provider. like us on facebook and follow us on twitter. on the health care law and federal subsidies for insurance providers. this is an hour and a half.
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>> come to order. the chair will recognize himself for an opening statement. today's hearing is, once again, about protecting taxpayers and consumers from the consequences of the affordable care act, namely, a giveaway of taxpayer dollars to insurers under the aca and another round of planned cancellations in the group market. first, section 1342 of the affordable care act created risk corridors -- a mechanism that will protect insurance companies from some of the losses under the affordable care act. it works by increasing those with healthier than expected enrollees and redistributing those two plans that exceed
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projections. the risk corridor is in effect from 2014 until 2016. if done in a budget neutral fashion, taxpayers would have little to worry about when it comes to risk corridors. while they have paid attention to it being budget neutral, they have also indicated, "regardless of payment and receipts, they will remit payments as required under the affordable care act." opening the door to what would essentially be a taxpayer-funded bailout of health insurers. according to the congressional research service and a reading of section 1342, the law does not provide an appropriation of these payments. in the absence of congressional
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appropriation, any payments are illegal. the idea of risk corridor wars -- risk corridors insures there will be winners and the insurance industry whose gains can be shifted to the losers. the presidents decision to increase was projected -- could cause industry-wide losses, putting the taxpayer on the hook for billions of dollars. the committee will consider legislation today to protect taxpayer dollars from being unlawfully given. as we have noted in previous hearings, the president promised numerous times if you like your health care plan you can keep it.
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millions of americans experienced cancellations in the individual market last fall, and millions more will likely lose their employer-sponsored plans in the future. hr 3522, the employee health care protection act, would currently grandfather all group plans issued by insurers that were in existence in 2013, allowing consumers to keep the coverage they like and giving small businesses better options. i would like to thank all of our witnesses today. i yield back the balance of my time. i recognize the ranking member. five minutes for an opening statement. >> thank you. i want to reiterate what i said an hour earlier.
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we have two bills that are the subject of the hearing. , is already hr 3522 designated for the full committee markup on wednesday without having been marked up in subcommittee. i want to object to the fact. this is not an issue where we can stop the hearing, but i want to object to the fact we are proceeding to markup the committee without regular order having a subcommittee markup based on what has been noticed. beyond that, today's hearing is nothing more than a series of republican attacks on the affordable care act. this time it is even harder to take seriously the words the gop has decided to include. in legal bailouts.
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-- illegal bailouts. it's quite ironic because the provisions being attacked are the same policies republicans have supported in the past. no one is surprised. since the passage of the aca -- remember the original mandate was a republican idea as well. as we get close to the election we're going to hear more about how the aca must be repealed. i am still waiting for the alternative. corridors are not a made-up to insurancee company. no democrat has any desire to bailout insurance companies. only within the aca are the controversial and considered in this negative light. let's recap. in order to keep premiums stable and costs low, it's critical to spread risks.
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-- spread out risks. these mechanisms are not a new phenomenon. they use all types of systems. one great example is the use in the medicare part d program. they were modeled after the program. if republicans have their way, they would repeal this program and it would effectively create chaos in the marketplace. there is a new study published last week that estimated 10.3 million adults gain health care coverage following the first enrollment period. the uninsured rate for adults fell from 20% to 16% in april of 2014. these do not include the 3 million young adults who gained health insurance coverage through their parents' plan. we have done something pretty remarkable with the aca.
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these millions of people are not just a number. they are actual people. they can see a doctor. they can treat an illness that was going untreated or, better yet they can remain healthy and , prevent illness in the future. women will no longer be charged more than men for insurance. if republicans had their way we would go back to the days when insurance companies could drop someone for pre-existing condition. almost all of the aca's keys reforms are working. it's not perfect, but gutting the provisions is not a way to perfect it. it's a way to score political points. i am going to urge my republican colleagues to stop trying to dismantle the aca's success. to encourage its
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protections. going to yield to my colleagues? did you want some time? i will yield to mr. green. >> i was hoping over the last few months we had a vacation from efforts to attack the affordable care act. we were doing things i think we could work up across party lines. these bills today it seems like we're back to -- how many times do we need to try to repeal the affordable care act? maybe it is just election fodder we need to have. i don't mind. there are a lot of successes over the last few months because of the affordable care act. we are seeing it every day. i would hope we would not throw a roadblock up in front of it. i appreciate your time. >> thank you, mr. chairman.
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>> we recognize the chairman of the full committee. >> thank you, mr. chairman. we have three bills before us today. all three bills are intended to undermine the affordable care act. that's exactly what they will do. i just want to point out we have had over 50 votes on the house floor to repeal or undermine the affordable care act. votes on the house floor to repeal or undermine effectively repeal in the affordable care act. so we have a thing better to do? we would promise that by the republicans they would come up with the replacements. there were going to do that in 2011. then we heard it would come in 2012. since 2013. in early 2014. and we were sure there would be a vote this summer. then it was the fall. now we hear we may not see a replacement until 2015 or 2017.
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it is clear that they don't have any productive ideas of there own to offer. appears that they decided to add to their 50 votes to repeal or undermine. they certainly are working hard to secure their place in history as the least productive congress in the history of this nation. i suppose all three of these bills before us today. the first bill says that any group health insurance plan on the market could be sold the -- sold in perpetuity. they don't have changed. now, they would not have to adopt all of the key protections for consumers and they're affordable care act. protections that went into place this year such as the ban on annual limits. insurance companies used to do that, put a limit on how much you can spend each year.
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after that letter and you pay for it all. we want to go back and continue those plans. want to continue to allow plans that would charge a small business a higher premium because an employee has a pre-existing condition. those were changes we intended to make or did make in the affordable care act. if you want to keep your plan you can keep it. we provided for grandfathering in existing individual insurance plans. if they liked that covers they could keep it even though that insurance might be inadequate. it covered all the things that were required. earlier this year mr. president went a step further. if change plans a premium
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stabilization program known as the risk corridors. this is modeled after the nearly identical program and medicare party that distributes a portion of profits and losses between the insurance companies. this was drafted by the republicans on this committee as part of the party legislation. the bush administration's praised it repeatedly. helps keep party premiums stable
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and save taxpayers money. now that it is being used by the affordable care act we cannot continue these risk corridors. let's repeal them. before the administration announced that they would implement the risk corridors and a budget neutral fashion the cbo said that program would save taxpayers nearly $8 billion in just three years. the provision of law makes sense. it will keep premiums stable. we should not repeal it. well, mr. chairman, i think warm words scene is more politics. maybe it saves you in primaries from the extremist in the so-called tea party, whatever, but we ought to do something worthwhile instead of passing bills that just undermine the
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dca. it is working finally. dahlia as a people have insurance. we ought to leave it alone. >> the gentleman's time has expired. the chair thanks the gentleman. as huge a memo from the congressional research service to the committee. an article from bloomberg dna. without objection so ordered. on our panel today we have three witnesses. let me introduce them. first, dr. stan, resident scholar at american enterprise institute. dr. john only. mr. edmund coulson meyer, senior research fellow at the heritage
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foundation. thank you for coming. appreciate your time. your written statements will be made part of the record. >> mr. chairman, ranking member, members of the committee, would like to thank you for giving me the a virginity to discuss health insurance plan cancellations the materials changes pursuant to the protection and affordable care act. when obamacare became law four years ago the central claim made by opponents was not just that it would make some better off through redistribution of resources and more stringent regulation but would do so without harming others except her new forms of income and capital taxation. presented the public but president obama and many other
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prominent members of a political party, the full committee ranking member just now. if you like your plenty can keep it. if you like your doctor you can keep him. a problem with the promises that it is not true. i will discuss a few of the more salient consequences of the legislation that undermine the veracity of that claim. in a certain sense no one is and it will keep their 2010 plan. they can no longer sustain limits on lifetime reimbursements. it drives up the cost of health insurance policies. in a very narrow sense the claim you can keep your plan if you like it is completely false. more central to the discussion today, i think, our plans that have incorporated some of the more popular provisions like the
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ban on adjusting for pre-existing conditions or the lifetime reimbursements, the annual limits. the plans that are still being used and paid for. first of of want to note is no i think everyone realizes that the individual market millions of people who start out buying insurance they're received cancellation notices that may bear up -- their way will be as many as 9 million people losing the plans they had. it does not stop there. many of those plans will change or disappear as well. of these covered workers about
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18 percent work for firms other smaller than 50 employees and will not be subject to the employer mandate. in total is about 35 to 40 million covered workers in small group plans. the remaining 130-1 are and 35 million workers work for larger employers. all of those plans are affected in different ways. while the most obvious way is very similar to what happened in the individual market, many fully insured plans that have changed a little bit since the law was passed no longer insure grandfather status and so they -- the firms that use to offer them all now be forced to purchase plans that are subject to new requirements.
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30 million workers in the small group market to buy 75% of workers and medium-sized firms. 25 percent of large firms. in total that is about 45 to 50 million people. how large changes introduced is hard to establish it is unclear to what extent there will be materially affected. will we do know is that only very few plans are shielded from new rules and regulations. there are direct reasons why. for example, the costa plans will increase due to new taxes. even though when millions of people receive their cancellation notices the
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individual claims that that will be it. it is a small, tiny portion of the population. it is certainly not true. there will be dozens and millions, if not more people who will see their plans change. >> the chair thanks the gentleman. five minutes for an opening statement. >> thank you, mr. chairman, ranking member, members of the committee. i am a research professor and i appreciate the opportunity to speak to the committee on issues relating to the affordable care act. two times in recent history that congress has introduced new health insurance programs. 2003 and medicare modernization act. the prescription drug program. in 2010 the affordable care act created the program of health
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insurance exchanges and operates as part of a grant to a broader initiative. in both cases congress is building a new kind of insurance program out previously in operation. also in both cases policymakers were uncertain about how many plans which used to participate in the new program and how many americans would sign up for coverage, specifically policymakers were concerns that plans would be less likely to participate when they were unsure of how many enrollees the mine attack -- attract. if the plan did participate their will likely see higher premiums. to address these uncertainties the congress included a set of risk mitigation measures for more risk adjustment, reinsurance and risk quarters. these measures were designed to out the new markets to run more predictably encouraging new insurers and stabilizing premiums as a program to cut
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started. here is a quick review. risk adjustment as a way to adjust payment to plan based on the health status of the individual and release. the idea is to make sure plans and enrollees are not penalized or rewarded. the effective risk adjustment avoids people being chosen. a means of ensuring the insurers up providing extra payments such as having more accidents or cancer diagnosis than the average plan. as with risk adjustment the intent is to make sure plans are not penalized for rewarded based on how many high-cost people they enroll and reduce incentives to avoid high costs individuals. this quarter risk sharing involves the creation of funds of the plans with unusually high gains payback some of those gains and plans with unusually high losses are partially
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compensated to keep premiums affordable and reduce the risk base as the plans when from experience how to price themselves accurately. they are designed on a two sided pages to limit losses and gains. they underestimate cost to receive payments from the government to reduce but not eliminate loss. they overestimate caustic and make payments to the government to reduce but not eliminate the gains. plants maintain its share of the risk as accurately as possible. these risk mitigation measures have been used for nine years now. have they worked or we have had time to look at the data? the best measure of their success is there participation by both health plans and medicare beneficiaries. the program is popular. ..
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>>
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>> the continued affordable care act with three insurance has short-term measures although one could argue their reinsurance could be eliminated after nine years we could make a good case to establish a functional sustainable than robust market from both the first years. >> and of the chair recognizes five minutes for the opening statement. >> fake you. i and the senior research fellow for health policy at the heritage foundation and the key for the opportunity
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to testify if today. the comments are my own not reflecting in a position. what we need to do is step back to look at the three programs to understand these are different tools for different purposes. if you have a mechanic or a builder there with have the tool box is using different tools depending on the job so of the bike to follow-up on the comments to clarify what i see is a different task that these are designed to address the reinsurance is designed what we might call market selection risk of a choice between those are insured or not sure devil not going to great length but to say it is
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premised on the idea of the way the legislation is designed berry is the expectation those will of gravitate to the market and therefore impacts the existing market and transfers on to the new expanded individual market of that selection risk expectation. but the risk adjustment is really about individual selection risk. everything could be fine otherwise but with the ability to pick and choose as you do in the program and that that could influence people's decision u.n. insurers touche try to avoid people who are sick or what not. so there is a risk
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adjustment mechanism. it is not new but has been around before elsewhere. less third in the subject of your hearing is the question what is the risk this is designed to address? it was observed this was designed to hold down premiums not necessarily. it is not designed to make the market balance out or spread that risk evenly that is what the other 02 or there for but this is processed and a loss to say we don't know and neither do you what the real cost will be and we pay for most of it. that was the significance we
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could be off the mark so the government pays three-quarters has the profit is and las cahow sharing -- profit and loss sharing agreement. that did make sense with party because it was entirely new product with prescription drug -- drug coverage had not been done before there was no real relevant or suitable example for insurers to work off of because that was integrated and not stand alone and on the elderly consume the drugs out 1/5 of rage as the elderly. said mr. hoadley was right but part d was also a new-product looking at this is a new program but the
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product is very old so at the end of the day i am not sure there is a rationale for this profit and loss sharing it is not hard to get to any tolerable rate but given the transfer of funds is more than adequate to cover egregious over under estimation if you look at the magnitude of the funds being transferred relative to the size of the market in 2014 was $28 billion and in potentially in 2014 that is the huge amount of money even if you assume the market is substantial so those programs are more than
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adequate for those risks in the new program and there really isn't necessary for that program. think you know, . >> thank you to the witnesses for their testimony i will begin the questioning. should taxpayers be concerned that they will be liable for some insurance company losses under they see a program and please explain. >> the issue mr. chairman is of mike the reinsurance program that is a definitive set amount of money or what is required to operate on a neutral basis with does not spend more a day and it takes it but this program is not explicitly required to
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operate on that basis so yes that is a concern the taxpayers should have. >> the congressional research services issued a memo questioning the ability of the administration to make payments under the risk corridor program for valid appropriation''. since it is congress's job to make law of the president's job to implement the law if it needs to be changed it is our job, given that the administration has tried to rewrite the health care law over dozens of times through regulations and executive orders and delays should taxpayers be concerned the administration would once again ignore the rule of law to prop up the president's health care law? >> the administration has taken such different
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positions at different times on this provision at one time they said it would be budget neutral then they said they would not. so there is ambiguity that is congress's job to clarify >> thank you. at the end of 2013 millions of americans recede to notices from health insurers they could not renew health coverage under the aca many said it was restrictive only to the individual market and would not affect employer sponsored coverage. would you clarify if american workers could be subject to a non renewals by employer sponsored plans also known as a plea and cancellation under the affordable care act?
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>> thank you mr. chairman. many american workers will be subject as i described with detail in my testimony tends of millions in this small group plans that will see those plans phased out as very few will continue to have grandfathers' status by the time the employer mandate kick san. the administration midrange estimate was by 201688% of all small employer plans would have lost grandfather status hit impressible would receive the same treatment as the individual market plans received last year. so the problem -- to go to the employer not the individual it would be the same thing at what the
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market had but i am surprised honestly so many supporters of the law are not living up to the if you like your plan you can keep that promise but then to continue with the same story for these plans that ultimately suffer the same fate. >> some advocates of the aca said they were surprised about the planned cancellation issue at the end of 2013. wasn't that a central feature to impose federal requirements that many plans simply did not need? should it be wine have been surprised about the cancellation issues? >> certainly not. to some extent beyond income redistribution one of the central goals of the
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legislation precisely was to impose wrote - - imposes requirement on as many as possible those requirements are very popular among the general public. some of them make a community features for example, are much less but it was always the intention those rules and regulations it shows how insincere the promise was. >> my time is expired. >> i want to say at the outset mechanisms used insurance systems this would not even be controversial if not under the aca so that bothers me anytime the matter how normal its is it just becomes controversial
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with an effort by the republicans to destroy the aca. the driving principle is that they will cost taxpayers money but there is no evidence so they figure they can scream they allow enough it is true but the cbo shows just how silly those claims are the cbo looked recently and said the collections that the program would save 8 billion in just three years not even counting the savings of premium tax credits they said they implemented the budget neutral fashion so i just want to ask dr. hoadley for their concerns of the taxpayer money and what can you tell us about the impact
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of taxpayers and what does that tell us? >> when the law was originally drafted it was done symmetrically. the ability could be wrong in either direction with that experience is every single year for which we now have data which is the first seven years of the program plans have made payments back to the government we're talking about a total of $8 billion so it as represented a protection to the taxpayer in the way it has played out. >> again that is why this republican bill argument is flat wrong and a waste of this committee's time and the republicans don't have the facts on their side.
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the aca and medicare party boats have programs in seem very similar the republican friends seem to hate that program they claim it is un bailout but the and others say it made the government money and are more generous to the insurers and of course, the corridors are permanent although the other is the last three years in this is to the point where this is not controversial if not apply that aca so could you say more about the differencesyzíl3&ñy
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though they were still in valuing can see the bow you and potentially right now, with some of the uncertainties around some of the new drugs that are on the market and it is that count of uncertainty that those risk corridors are deciding to do during the reels same system us -- is of the aca. there is an interest in directions,n both protecting the government from errors and one directions and setting premiums to protect the plans and the other direction if that is the way worse out. the republicans say that they
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are illegal and it is a surprise since they are wasting tax dollars and they have designed on impeaching him as well. the department of health and human services has provided the committee with specific answers to questions about its legal authority to implement the risk corridor program. the law authorizes the collection and payment of user fees to and from health insurers to operate the risk corridor program. that aligns with omb and j o guidance. bottom line is the aca is the law of the land and this should not be a controversial program, mr. chairman. >> the gentleman's time is expired. the gentleman from new jersey, mr. lance. >> thank you very much, mr. chairman. i am the sponsor of the legislation to repeal the risk corridors. i do this because i believe it is bad public policy and i certainly do not do it as a matter of some sort of intellectual exercise. policy and i would be
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deeply concerned about it. >> mr. haislmaier go into detail the difference between this program and medicare part d. >> be essentially the risk corridor program is between the government and the ensures that we share the profits and the losses we see deals like that of the time as a joint venture but the question in my mind is that appropriate? i think a stronger argument is if that is appropriate medicare part tv and hear a and based on the following have medicare part d the
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insurers were doing something they had never been asked to do before with a totally new product that customers never bought anything like that. it is a different world then which these were applied and making adjustments to the market that has been around for decades them the government is adding subsidies for those who do that. so should the taxpayer at that point be involved in profit a and loss in did issa ahmad elevated the the normal profit and loss wrist.
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>> thank you i am willing to give the another panelist time to respond to my question. >> i would argue the uncertainty was greater than the affordable care act with medicare part d over prescription in drugs people use those from one time period to the next great the need for broader health insurance is much more volatile i'll. there with some of the same questions from part d who will enroll? will there be pent-up demand? and those boys without treatment to come in for treatment those kinds of uncertainties make it hard to set premiums.
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>> avaricious similar of a prior to arriving and understanding volatility for some time. from what mr. haislmaier has said. and respecting the views of all interested i want to ensure the public my sponsors of the legislation have deeply held beliefs that risk corridors should not be permitted in this situation. >> with the appropriations a share, of medicare part d has the wrist corridor program that has a source of funds as you read the health
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care legislation it is not the case was a lack of appropriation but it is my legal judgment the administration cannot make payments with losses under the risk court your program. >> of a bite to submit for the record. >> i only have 15 seconds in december i ask for a secretary of hhs if it was legal to make subsidies to the federal exchange as opposed to the state exchange than she did not answer the question. that is not the topic this afternoon but now we have to do have the split on the significant issue in the supreme court will eventually address the issue and in my judgment with
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statutory lot to move forward with the appropriation that has not occurred. >> now recognizing the gentleman from texas. >> dr. hoadley i know that you answered about the affordable care market in this the new prescription in drug program that aca informs the market so they are fundamentally different so the insurers can no longer discriminate based on pre-existing conditions that they can no longer offer with choate coverage the does not cover hospitalization or disappears when they needed the most. and this means when pricing
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for a market coverage but could you go into more detail the wrist corridors necessary with part d and why they're also necessary for the affordable care act? >> one of the things that but if it is not needed if the plans could estimate their premiums accurately been no payments would need to be made then there is no cost in either direction there is the 3% court or for going higher or lower if they stay within that estimate but the other point is you could make the argument that they were well
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into the program to be phased out and there is legislative authority to make the decision for cms to decide if that has been extended with the aca to have the last just for the three years. but there are ways of both programs to protect both the taxpayer against that uncertainty. >>. >> and in 2009 in the trust fund could not pay its bills through 2017 only three years from now. but the report goes on to explain this improvement is on part of the reforms with
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the affordable care act so reflects broader trends through much slower growth policies through 2014 since the affordable care act the prices have risen as lower rates than any other period those 50 years. and better benefits and health care cost could you comment with medicare and aca? >> the one thing to take from that lesson coming out today with the trustee report is that turns out to be true to the broader health care system as well why plans major now making plans back to the government so there is a linkage
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between the savings with health care costs generally and the potential to protect the taxpayer to make sure it benefits from that lower costs trend rather than the benefit going to the plan. >> i want to reiterate over the 15 months prices have risen at a slower rate than they have over the last 50 years. i will yield back my time but i hope we can work on legislation if there are problems with the ac a fix it let's don't strangulate after we see success after only 50 months of low law. i yield back my time. >>. >> i appreciated. mr. haislmaier and the
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payment that would be made up bin year number two or three butted by year's three they are less than total payments owed the administration said people establish the new and future guidance how to calculate risk payments if they do not now ask -- match the payments in the final year of the program extra funds come from taxpayer funds where will hhs come up with it? >> i don't know where they will find the money it will either come not use the extent to transfer from other accounts there is some revenue hhs received directly for user fees like clinical laboratory and things like that but you have to ask them. i don't know where they will
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get the money. >> when the rules for the wrist corridor were published the administration was willing to pay more than they collected subsequently changed to a budget neutral position is an anything again in the lottery interpret to not keep the budget neutral? >> that is why you have this issue there is nothing that prevents them in the authorizing statute there is the appropriations question it does not explicitly have this budget neutral in the authorizing statute spirit does the president's health care law required to pay the muffled amount. >> i do not understand. >> does the president's health care law require hhs to pay the full risk
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corridor amount regardless of any shortfall? >> it could be interpreted that way. yes, sir,. >> does the risk court or incentivize plans to underbid those premiums in your opinion? >> that is one scenario where you could see losses in the program with a significant underbidding and the concern is the pressure on carriers to keep that down. yes. >> the administration claims the wrist corridor is nothing more than the user fee. is it a user fee? >> no. the user fee is a different animal governed by different statute -- statute. it is a fee charged for a
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service the government provides to the user that is not generally provided to the public. the exampled you are most familiar with when companies go before the fda to get a drug approved they get the benefit of that regulatory approval so they charge of a user fee there is a statute in the books to encourage
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to do that sort of thing. that is how the department of health and human services has come up with funding for the federally-facilitated exchange for which there is no operating funding, by charging a user fee. it is at 3.5%. but this does not, in my view -- i am not an expert on that, but from what i can see, this doesn't seem to fit any of the criteria on the federal user fee statute. >> i tend to agree. thank you, mr. chairman. i yield back. >> now the gentleman from virginia, mr. griffith. five minutes for questions. >> thank you, mr. chairman. i would say that some of when we talk about the rates on the affordable care act, they may be growing, the insurance increases, they may be growing slower, maybe be growing faster, we will have to see what happens as fall. but that certainly they are growing and it is not the reduction that was promised when this bill was passed with $2500 per family, per average family in the united states. so yet it is another promise that was made that has not been kept by the affordable care act. with that, mr. chairman, i would like to yield the remainder of my time to dr. cassidy of louisiana. >> thank you. several things to go over, first, the legal aspect of it. it was said initially that the cbo said that this would return
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$8 billion to the treasury and then glossed over the fact that now it is not going to return money to the treasury but rather it will be "budget neutral" except as subject to appropriations, we don't know from whence they come. that is a far cry from being $8 billion to the government. cbo, in their writings, it said that the reason they initially called $8 billion was because as you mentioned in the medicare part d, there are payments back. but as it turns out, not only is it i guess now not going to be money back to the treasury, but i'm told before mr. issa's subcommittee or committee, it is now estimated that insurers are going to request over a billion dollars more than they anticipate paying into the program so far from returning 8 billion back, now they will require a billion dollars more and it is not clear or that money comes from. and as regards the memo, which supposedly hhs justifies with, it is interesting. they say they will call this a fee but in the president's budget, he doesn't call this a fee.
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interesting they will call this a fee but then the president's budget he does not call this a fee. also of interest and never in the legislation is a call a fee but now it is called the fee. of the into a revolving fund that is not set up so there is no subject of a revolving fund in the legislation nor the fee but now we're told is toughie but the revolving fund does not exist but through the legal opinion but if the other side could do away with congress prerogative to appropriate and designator a revolving fund that is set to the exercise i suppose that comes from being loyal to one's president. a shame. i am loyal to the constitution.
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and requires a authority for a revolving fund that the aca specifically does not include. so let me now conclude with another statement and now mr. -- mr. veuger. it is interesting. [laughter] the president and my congressional colleagues that if you like the health plan you can keep it. 93,000 louisiana residents lost their plan because of obamacare and the
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president's promise to put a euphemistically brandon order to provide relief for those individuals the house passed keep your health plan act. the house must react to business is a and employees the health care protection act allows millions of workers in the crude market to keep the plan they like and i also think my colleague to introduce the bill while it is important with those mechanisms for companies in the private market or asking to follow the constitution they have decided to ignore the of law and make payments to insurance companies without congressional approval the risk corridor program to
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make sure it is not a vehicle to ignore the constitution by the administration. i yield back. >> will recognize the of vice chair five minutes for questions. >> i want to thank our witnesses for being here. and also for the chairman to make time for us to have this hearing. and to bring this bill for word it is amazing to me with the legislative process for obamacare and the launch of obamacare and the failed rollout now the implementation where the cost will be. as dr. cassidy was mentioning we're now hearing it is not really a tax but is a fee.
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dick goes to a fund but it seems what they're doing doing, they're not sure who to blame and i find it so interesting one of the biggest complaints we get is about insurance cost and access and an era networks and everything costs more then people will say now we hear the insurance companies want to you to bail them now. don't you dare bail them out. if you were with me in my district that is what you would hear. much of this is based on the failed program.
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and i know mr. haislmaier you have look dash up that program and i know that it thrills he has grown weary with me. the failure of that program with the democratic governor to take it down it was too expensive to afford some mr. haislmaier who pays all these taxes and fees or regulation tax is zorach says fees and who eventually pays all of this? finigan consumer does when they purchase through their tax bill. >> in those letters showing the insurance costs to the consumer would be reduced
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2500 you find this anywhere? >> my colleague published a paper and we will update with new data and as expected the only states where you saw any measurable decrease of premiums where states that already made a worse mess of their market before it was enacted like new york is the prime example. when you made things worse i guess this is an improvement but everybody else saw increases. >> in tennessee we had had cost estimates of 18%. as you can imagine when we are busy with festivals and farmers' markets people are not happy with that at all. talk for just a minute on the record as dr. hoadley mentioned part d have a bike
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you to talk about the difference of the wrist corridors for a see a and part d. >> it is very similar. the issue that i pointed out is simply whether it was appropriate to for the government to affect the underwriting profit loss risk in this market where someone could make the case given medicare was three-quarters government-funded as the totally new venture you could make the case that underwriting the profit and loss risk might make sense but frankly the problem here is there is so many ways in the legislation were subsidies are hidden through
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the back door with little trust of the administration to implement this legislation that a lot of people with some degree of legitimacy are concerned this is another way for the back door deal looking at how this sets up insurers to reduce the copays and deductibles it is not transparent or accountable so the safest thing to do is make it pleded neutral by statute and if it is needed they will use it and if not they will not. >> we now recognize the gentleman from louisiana. >> go through once more how they see a treat small
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businesses differently than those whose health insurer? >> small businesses that go into the marketplace to buy larger companies that sell venture to protect themselves from the rest. >> they protect themselves from the rescue imply there is a risk delving into the regulated market to upsize the costs that comes with the regulated market. fair statement? >> they're mobile sides but if you are self ensuring it is under that aca as well. >> this seems it strikes me
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in general the cost increases of the mandated benefits in the non aca market. >> is more limited. that is fair. >> so the cost is greater on the smaller employer? >> that is fair to say so they are getting hammered the most? >> yes with the exception of microbrews that want to use a small that is fair to say. >> the cbo recently put out a study that they have lower the cost of coverage be coz there is wage reductions under obamacare and this was by design.
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mr. haislmaier can you tell us the amount of money that is available through the reinsurance program relative to the size of the market that is in the exchange's? >> the reinsurance program makes available as much as $10 billion. >> $10 billion? >> $10 billion through 2013 that aggregate premium for the medical market was $28 billion. >> with the $10 billion subsidy? >> if you make various assumptions of the increased costs and enrollment or you double that market he would give us $50 billion market spinning so 30 percent of that loss already covered.
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>> that is my point. looking at us situation of uncertainty there is that the insurers did not know how sick they would be. my point is there is the appropriation of ready in there and in the fact it will go to that individual. >> it is with that constitutional fashion. >> i am sorry i did not finish with my conclusion but the problem of the aca disproportionately has cost on smaller firms that we hope the does none seem reasonable as a remedy to allow them to keep the policy if they like making keep better go to the regulated market. >> there is something to be
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said for that especially with the promises made to them when the legislation was presented and approved and not ruled out yet. >> so asking the president to keep his word to keep your plan would be reasonable. >> that is fair to say. >> we now recognize the gentleman from georgia. >> mr. chairman.mó$ró$vs
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those would have been aware >> collect me interrupt you for a follow-up. that is that great segue. under the democratic majority. there was knows the committee markup of the affordable care act there was also no legislative
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hearing, no subcommittee markup for full committee markup of the senate bill do you think it was responsible for washington democrats with something of this magnitude and could it have helped members realize that the law would lead off to plan cancellations for millions of americans if they just followed regular order? >> given us since it was reasonable to fast-track legislation it would not have passed otherwise regular order would have kept it from doing that. >> of course, as we know the 41st senator require them to invoke reconciliation which has never been done before or since.
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if we had done things in the right way for every member of congress had read every single word, every line, every page of the 2700 page bill we would be more likely to get their right. health insurance companies and the exchange expect nit - - net payments of $1 billion from the american taxpayer. isn't it true while the affordable care act and medicare part d contains risk for programs that is much more likely they have to pay for some losses under the a affordable care actress corridor program has to that modernization of 10
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years ago? >> it is too early to draw a conclusion but that the information that they have after a few months of operation is to have realistic expectation it just remains to be seen. >> you told us with the medicare part d that the taxpayers the essentially have benefited to the tune of $8 billion over 10 years? >> not the exact arithmetic more back at $8 billion. >> blesses it is predicted and reported by health insurance companies they expect they get net payments from the taxpayer of the
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least $1 billion it is appropriate an opportunity to talk about the bills that my colleagues representative cassidy and others have to eliminate that risk corridor program to do something about if you like your health insurance plan you can keep it. period. no exceptions to say yes in that small group market that 2013 policy the people that like them that is very appropriate legislation i hope we pass in both houses and obama will sign it into law. >> i now recognize the gentlelady from california. >> dr. hoadley i want to go back to your testimony the
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exchange across the aisle the differences between medicare part d and the affordable care act. is that mandatory or not? >> for people to sign up? >> it is a mandate. >> is medicare part d a mandate? >> it has the penalty that has the incentive. >> but it is not a mandate it is a personal choice every senior can take? also you pointed out that initially the risk corridor was a three year temporary brisk corridor when put together? >> no. it was set up as a permanent part of the program but the
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amount of payments was greater in the first three years than the left the department with the option but to do after. >> then it continued? in your opinion you see the same thing happening with the affordable care act considering it is supposedly temporary? and an equity affordable care act it is good just for those three years. >> but they could make that change. >> know they could not. >> i want to point something out to day darrell i submit these to report obamacare taxpayer bailout with the white house involvement in
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includes showing senior adviser to president obama valerie tear it directly intervene to to an insurance companies see a threat to increase premiums so must the white house acted. soap to this i would like to add this e-mail and report to our report today. >> i have not seen this report. >> cavelike to submit if possible. >> sure. but never like to reserve the opportunity to object. >> we will wait until it comes down. >> so my point is this a subject based on how the program is going and mr.
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haislmaier as far as the risk corridor goes, you had mentioned some of the risk with the back door deal trying to keep it budget neutral as with medicare part d with a program that worked very well is that the effort to keep premium costs down? could this be a risk corridor? >> it is a legitimate concern clearly it is the administration as it tries to keep premiums down this is an avenue to make up that money that is a concern and the way the statute is written they could exploit that ambiguity so that is
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why you could get rid of it so that it is not a budget neutral and clearly the potential is there but we don't know yet until we see the results. >> we can look back and look at how it is played out. >> in that 25 seconds that i have looking with dr. cassidy what members of congress may or may not have known to keep the health care plan do you believe the president knew they could not keep their insurance plan? >> i don't know but i would hope that he knew. >> thank you. i yield back.
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>> has the staff to enable to get the report? >> do you have it? to make the problem i have this might understanding is he has not made this report public until we can see it. >> it was released today. >> until today he had not made them public. >> i believe you adjust have not seen it. >> we will get it to you
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today. [laughter] we are objecting until we have seen it mr. chairman. >> . .
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without objection we will enter it into the record. all right. i remind members that they have ten business days to make -- to submit questions for the record. i am sure the members will have follow-up questions for the witnesses. we will submit those to you. we ask that you please respond properly. members should submit their questions by the close of business on monday, august august 11th. >> thank you very much for your testimony provided without >> on her next washington journal, we will talk to mississippi senator roger wicker about the house and senate deal
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on the veterans health-care deal and the ongoing debate on immigration and border security. later, a professor from georgetown university will discuss workforce training programs. you can also join the conversation on facebook and twitter. washington journal live each morning at 7 a.m. eastern on c-span. tv, formern book presidential senator ron paul. thewritten a book on education system. join the conversation live for three hours sunday august 3 at noon eastern and tune in next month for mary frances berry.
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best-selling author is our guest. american enterprise institute president is our guest. television for serious readers. awarded int obama know ward 227 recipients at a white house ceremony yesterday. recipients included linda ronstadt during this is 30 minutes. ♪ >> ladies and gentlemen, the president of the united states and mrs. michelle obama.
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♪ [hail to the chief playing] [applause] >> hello, everybody. [applause] hello. thank you so much. thank you. thank you, everybody. please have a seat. well, welcome to the white house. it has been 200 years since dolley madison saved the portrait of george washington that hangs in this room from an advancing british army. so i guess you could say that the white house has always supported the arts. [laughter] i'm glad to say that michelle has never had to save any
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paintings that i know of from bo or otherwise. but we do believe in celebrating extraordinarily talented americans and their achievements in the arts and in the humanities. so i want to thank jane chu and bro adams, the chairs of the national endowment of the arts and the national endowment of the humanities, for their outstanding work. and i want to thank members of congress, including a great champion of the arts, nancy pelosi, for joining us this afternoon. [applause] the late, great maya angelou once said, "a bird doesn't sing because it has an answer, it sings because it has a song." each of the men and women that
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we honor today has a song -- literally, in some cases. for others, it's a talent, or a drive, or a passion that they just had to share with the world. to our honorees -- like most creative and brainy people, you did not cultivate your song for accolades or applause. if there were no medal for your work, i expect you'd still be out there designing buildings and making movies and digging through archives and asking tough questions in interviews. but we do honor you today because your accomplishments have enriched our lives and reveal something about ourselves and about our country. and we can never take for granted the flash of insight that comes from watching a great documentary or reading a great memoir or novel, or seeing an extraordinary piece of architecture.
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we can't forget the wonder we feel when we stand before an incredible work of art, or the world of memories we find unlocked with a simple movement or a single note. the moments you help create, moments of understanding or awe or joy or sorrow, they add texture to our lives. they are not incidental to the american experience. they are central to it. they are essential to it. so we not only congratulate you this afternoon, we thank you for an extraordinary lifetime of achievement. i'll just close by telling a tale of something that took place in this house, back in 1862. president lincoln called together a meeting of his cabinet to present them with the emancipation proclamation. but that was not the first item on his agenda. this is a little-known story. instead, he began reading out loud from a story from the humorist, artemus ward. it was a story called, "high-handed outrage at utica."
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according to one often-repeated account, after he finished a chapter, lincoln laughed and laughed. his cabinet did not. [laughter] so lincoln read them another chapter. [laughter] and they still sat there in stony silence. finally, he put the book down, and said, "gentlemen, why don't you laugh? you need this medicine as much as i do." to be clear, i probably will not be trying this in my cabinet meetings. [laughter] certainly not if i'm presenting something like the emancipation proclamation. [laughter] but what lincoln understood is that the arts and the humanities aren't just there to be consumed and enjoyed whenever we have a free moment in our lives. we rely on them constantly. we need them. like medicine, they help us live.
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so, once again, i want to thank tonight's honorees for creating work that i'm sure would have met president lincoln's high standards. in this complicated world, and in these challenging times, you've shared a song with us and enhanced the character of our country, and for that we are extraordinarily grateful. it is now my privilege to present these medals to each of the recipients after their citation is read. so, our outstanding military aides, please. [applause] >> the national medal of arts recipients, julia alvarez. the 2013 national medal of arts to julia alvarez - [applause] for her extraordinary storytelling. in poetry and in prose, ms. alvarez explores themes of
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identity, family and cultural divides. she illustrates the complexity of navigating two worlds and reveals the human capacity for strength in the face of oppression. [applause] accepting on behalf of brooklyn academy of music, karen brooks hopkins. [applause] the 2013 national medal of arts to brooklyn academy of music for innovative contributions to the performing and visual arts. for over 150 years, bam has showcased the works of both established visionaries and emerging artists who take risks
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and push boundaries. [applause] [applause]joan harris. [applause] the 2013 national medal of arts to joan harris for supporting creative expression in chicago and across our country. her decades of leadership and generosity have enriched our cultural life and helped countless artists, dancers, singers and musicians bring their talents to center stage. [applause]
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bill t. jones. [applause] the 2013 national medal of arts to bill t. jones for his contributions as a dancer and choreographer. renowned for provocative performances that blend an eclectic mix of modern and traditional dance, mr. jones creates works that challenge us to confront tough subjects and inspire us to greater heights. [applause] john kander. [applause]
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the 2013 national medal of arts to john kander for his contributions as a composer. for more than half a century, mr. kander has enlivened broadway, television and film through songs that evoke romanticism and wonder, and capture moral dilemmas that persist across generations. [applause] jeffrey katzenberg. [applause] the 2013 national medal of arts to jeffrey katzenberg for lighting up our screens and opening our hearts through animation and cinema. mr. katzenberg has embraced new
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technology to develop the art of storytelling and transform the way we experience film. [applause] maxine hong kingston. [applause] the 2013 national medal of arts to maxine hong kingston for her contributions as a writer. her novels and non-fiction have examined how the past influences our present, and her voice has strengthened our understanding of asian american identity, helping shape our national conversation about culture, gender and race. [applause]
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albert maysles. [applause] the 2013 national medal of arts to albert maysles for rethinking and remaking documentary film in america. one of the pioneers of direct cinema, he has offered authentic depictions of people and communities across the globe for nearly 60 years. by capturing raw emotions and representations, his work reflects the unfiltered truths of our shared humanity. [applause]
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linda ronstadt. [applause] the 2013 national medal of arts to linda ronstadt for her one-of-a-kind voice and her decades of remarkable music. drawing from a broad range of influences, ms. ronstadt defied expectations to conquer american radio waves and help pave the way for generations of women artists. [applause]
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billie tsien and tod williams. [applause] the 2013 national medal of arts to billie tsien and tod williams for their contributions to architecture and arts education. whether public or private, their deliberate and inspired designs have a profound effect on the lives of those who interact with them, and their teaching and spirit of service have inspired young people to pursue their passions. [applause]
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james turrell. [applause] the 2013 national medal of arts to james turrell for his groundbreaking visual art. capturing the powers of light and space, mr. turrell builds experiences that force us to question reality, challenging our perceptions not only of art, but also of the world around us. [applause] national humanities medal recipients -- m.h. abrams.
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[applause] the 2013 national humanities medal to m.h. abrams for broadening the study of literature. as a scholar, writer and critic, dr. abrams has expanded our perception of the romantic tradition and explored the modern concept of artistic self-expression in western culture, influencing and inspiring generations of students. [applause]
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accepting on behalf of american antiquarian society, ellen dunlap. [applause] the 2013 national humanities medal to american antiquarian society for safeguarding the american story. for more than two centuries, the society has amassed an unparalleled collection of historic american documents, served as a research center for scholars and students alike, and connected generations of americans to their cultural heritage. [applause] david brion davis. [applause]
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the 2013 national humanities medal to david brion davis for reshaping our understanding of history. dr. davis has shed light on the contradiction of a union founded on liberty, yet existing half-slave and half-free. and his examinations of slavery and abolitionism drive us to keep making moral progress in our time. [applause] william theodore de bary. [applause]
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the 2013 national humanities medal to william theodore de bary for enlightening our view of the world. as a scholar of east asian studies, dr. de bary has fostered a global conversation based on the common values and experiences shared by all cultures, helping to bridge differences and build trust. [applause] darlene clark hine. [applause]
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the 2013 national humanities medal to darlene clark hine for enriching our understanding of the african american experience. through prolific scholarship and leadership, dr. hine has examined race, class, and gender, and has shown how the struggles and successes of african american women have shaped the nation we are today. [applause] john paul jones.
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[applause] the 2013 national humanities medal to john paul jones for honoring nature and indigenous traditions in architecture. as the creative mind behind diverse and cherished institutions around the world, mr. jones has designed spaces worthy of the cultures they reflect, the communities they serve, and the environments they inhabit. [applause] stanley nelson. [applause]
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the 2013 national humanities medal to stanley nelson for documenting the stories of african americans through film. by using his camera to tell both well-known and lesser-known narratives, mr. nelson has exposed injustices and highlighted triumphs, revealing new depths of our nation's history. [applause] diane rehm. [applause] the 2013 national humanities medal to diane rehm for illuminating the people and stories behind the headlines. in probing interviews with everyone from pundits to poets
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to presidents, ms. rehm's keen insights and boundless curiosity have deepened our understanding of our culture and ourselves. [applause] anne firor scott. [applause] the 2013 national humanities medal to anne firor scott for pioneering the study of women in the american south. dr. scott's exploration of the previously unexamined lives of southern women of different races, classes and political ideologies has established
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women's history as vital to our conception of southern history. [applause] krista tippett. [applause] the 2013 national humanities medal to krista tippett for thoughtfully delving into the mysteries of human existence. on the air and in print, ms. tippett avoids easy answers, embracing complexity and inviting people of every
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background to join her conversation about faith, ethics and moral wisdom. [applause] >> i think now is a good time for everybody to stand up and give these outstanding winners or recipients a big round of applause. [applause] so congratulations to all of you. we could not be more appreciative of everything
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you've done. i was mentioning, as people were coming up, i've been personally touched by all sorts of these folks. i was mentioning to maxine that when i was first writing my first book and trying to teach myself how to write, "the woman warrior" was one of the books i read. after the book was done, diane was one of the few interviews that was granted. [laughter] i told linda ronstadt i had a little crush on her back in the day. [laughter] and i know all of you have been touched similarly by these amazing people. so we are very grateful to you. on behalf of michelle and myself, as we're taking pictures with the recipients and their families, please continue to enjoy the reception here. thank you very much, everybody. [applause]
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[captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2013] ♪ [don't get around much anymore playing] rx for over 35 years, c-span brings you public affairs directly to you, putting a new the rooms at briefings and conferences in offering complete gavel-to-gavel coverage of the u.s. house, all as a public service of private industry. we're c-span, created by the cable industry 35 years ago and brought to you by a public servant. watch us on hd, like us on
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facebook thomas and follow us on twitter. >> a few live events today about today on c-span three. immigration services will testify at a house judiciary oversight committee. our live coverage starts at 10 p.m. eastern -- 10 a.m. eastern. live from the atlantic council at 1 a.m. eastern. ups truck driver will testify at a truck safety hearing also once he said -- c-span3. talkg up this hour we will with mississippi senator roger wicker about the house-senate deal on the veterans health-care bill and the debate over immigration and border security. weigh inurke will also on that legislation and immigration. someone from georgetown
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university will discuss the aral workforce training programs. you can join the conversation on facebook and twitter. ♪ good morning. it is tuesday, july 29. the housemates at 10:00 a.m. today with afternoon votes expected in the senate. meets at 10:00 a.m. today. the confirmation of robert mcdonald. key lawmakers in both chambers unveiled a $17 billion plan to repair by -- to provide emergency support for veterans. this morning, we break down the deal. we'

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