NM First- Senator Bingaman #2; NM First - Senator Bingaman #2

So that all of you have an opportunity to speak, all of you have an opportunity to be heard, and to help shape the questions that are being asked. So that's a quick snapshot of what's been accomplished so far. What we're going to do for the process, as we move into the town hall portion, is we are going to go from room to room. We're going to let those of you that develop to position of advocacy, share those first. I'm going to ask you to do that quickly when we get to that point. We'll share those. And then we will go table to table to ask, so that you ask your questions at the Senator. Does that make sense to everybody? All right. Well, then I'm going to quickly turn the microphone back up to Jamie and I got up to introduce the Senator. And then we want to just remind you again we're sure honored by your presentation today. Good afternoon. Thank you so much for being a role model in democracy and action. I'd like to give you yourself a round of applause for David. Thank you. I have

the distinct honor to introduce someone very important to our state and someone I get to know more and more in my new job. The Senator Mingly grew up in Silver City. And he became our Senator in 1982, but first time he was elected in his fifth term. That's five terms. That's all I'm talking about. Good term in 2006. It is really keen to have senior Senator of our state involved in education, health care, and also to go to policy. I actually have a list of all of the different committees, but I'm not sure which committee will not part. I would like to introduce and ask you to get Senator Mingly to warm welcome. Thank you very much. Let me start my course on elected Mexico First, Heather, and all the folks who worked for the Mexico First World. For

organizing this and with the other good work they did in our state and trying to help people formulate lists of public policy. It's been a big assist to me in many years. Some of you know the history of the Mexico person, the Ministry and I, worked together to get an established several years ago. And it has proven to be a very, very important asset for public policy making in Mexico. Let me also thank all of you for taking your afternoon to participate in this. It's not completely, I understand that, but I make sure some here what you can come up with. I can shed light on some of the things going on in Washington, but more than that I hope I can hear suggestions from you that we can incorporate into our thinking. I wanted to just mention four objectives of reform, which I've given the sheet, which has the pie charts on it, and the back of the first pie chart is a thing called

four, four objectives of reform. You may have it with you there. You know it's not a big problem. Let me just mention very briefly and then we can go on with the presentation or advocacy statements that Heather referred to. First objective, and these are, this is not an exclusive list, this is sort of four important objectives, and there's at least from the perspective that I have working on this legislation there on the Senate. One is the reform, health care, and church markets. A lot of the discussion and a lot of the debate has centered on this to ensure that in the future, if people have policies that they like right now that can people, they can renewal, they can have family members, but for a new policy issue, after this law became effective, we would require the new policies to be certain requirements. And those would be that they could not refuse

coverage because of the existing conditions. They would have to be available for anyone to purchase. The policy could not just be reserved for a particular segment of the population that they would have to be renewal, that the person who bought the policy wanted to have renewed. You could not have annual limits in the policy, you could not have lifetime limits in the policy. You would have to come up with preventive services, with a very minimum copay or a cost sharing requirement, and it would have to come for a basic benefit package. So that's the reform of the health care and church markets, and hope is that would help all Americans to be able to get decent health care, but it would allow us to expand the coverage and it would allow us to prevent it from reducing the amount of under insurance that exists. The second is expanding coverage while reducing cost shifting. I think as you've seen on some of these other charts,

38 % of the people in Mexico have private health insurance today. There's 26 % that have no coverage. And unfortunately, much of the cost of covering the folks with no coverage lines on being added to premiums of those who do have coverage. So we're trying to solve that by reducing the number of people without coverage, eliminating it. We do it in two ways. We do it in the first five. Expanding the eligibility for Medicaid. Medicaid would have to be available for anyone up to 133 % a part of the way it's being considered at least in the finance community. And we also significantly expand access to private coverage for all Americans. Either private coverage or coverage is provided through some kind of public entity under the idea of public option. And we do that. We

provide that expansion of private coverage or coverage through a so -called public option by establishing these health care exchanges. We have one in each state. The health care exchange would allow people to compare the cost of the different policies available, hopefully allow more competition. And it would also be the place that your income was 300 % of poverty or less. And you were not able to buy the basic policy that you needed for your family. It would be the place where you would get what we call an advanced refundable tax credit, which essentially is assistance from the government to supplement what you were able to pay to obtain health care coverage. The final objective on this list is that we want to reduce the growth in health care costs in our economy. And we want to reduce the growth in health care costs in families and individuals, or the federal and state government, because clearly we've heard this from the last

day or two, the enormous additional cost that the state of New Mexico was looking at by virtue of Medicaid. The cost of federal government, of course, is experiencing this. The rate of growth in health care costs is more than the double of the rate of growth in pretty much everything else you buy. And that's been the case for a vote over a decade. I think the commonwealth just came out with a report of Lee yesterday, which is writing saying that they expect to be doubling in premiums, the cost of premiums in the next 10 years if we don't do something to rank in the cost growth. So that's a major objective as well. That's the end of my fellow Wester. I'll go ahead and turn it back together and cheat the duty which everybody want to receive. Thank you. Thank you. Okay. We're going to start with your points of advocacy. And it looks to

me as though we have at least six of the group that came to agree with on a point of advocacy. So I'm going to let you go each one at a time. When I get to your table, if I screwed up that you have one, and I didn't know what you raised your hand in point of view. All right. So let's start with group one. And I understand that Susanne Defayan is going to share that position. Good afternoon. I'm Senator Feliz. I'm Senator Defayan. I'm Mrs. Laker, resident of Aldrug. Our group advocates that insurance companies must get the practice of rescission, gender bias in costs, and must provide mental health therapy. And if it's okay with Houston, they're working

to do is let each of the groups go and share those and then we'll write into our questions. Okay? Great. All right. Thank you, group one. Group two. You don't have one, right? All right. And what we want to know about what's interesting about the groups that don't have that, don't have a point about it. What you can see is that that really represents great diversity and perspective in that group. And it's not that you didn't get something important, something you didn't get you worked on because then you all hadn't really diverse perspectives and we recognized and appreciate that. So, group three. I'm a rock song live, I believe. Did you do a switch? I'm going to have, oh, here we go. You do not look like a rock song. I'm going to have two of them in our group and they were much prettier. I mean, it's my first and again, our group had consensus that there is a real need for a strong, efficient, affordable public option. And I know that it's in your

literature and I think there was consensus that we would really like for you to fight for that in your money. Group four also had diversity of perspective. Group five. Did you guys have a position of advocacy? Please share your name with us, ma 'am. Sure. I'm Sharon Schaefer. We have a lot of diversity, but we also picked out a little advocacy statement right at the end here. There should always be multiple options for our care available for everyone, including a private option and a public option. Group

six, how about you guys? Hello, I'm Ted Cloper, Mel Kirkene with representing Group six. Group six broadly comes out with a bold statement that every American should have access to affordable quality healthcare. And I understand Group seven also had diversity of perspective. Is that the accurate statement there? All right. Group eight. Mark Siemens is going to present his point, right, for your group's point of recommendation. Thank you. Good afternoon. My name is Mark Siemens. I'm a registered nurse. I've been a public health worker for 15 years. And so this particularly is balls under our group advocacy statement was that we need to assure an adequate healthcare workforce, including versus dentists and physicians to care for the victims, especially those of rural

communities and family population. And Group nine. Kathy Hoover, right? Hi, I'm Kathy Hoover. We had a strong agreement in our real government statement. It is that. We believe that a strong public insurance option is the only way to contain costs and provide equitable access to quality healthcare. Last but not least, Group 10. Good afternoon, Senator. On behalf of Group 10, we would advocate that access to universal healthcare is a right and the public actually is essential. I know that we also have

a number of people in the room for whom the position on public option is appointment agreement. I think that that's reflected in many cases in the groups that didn't have a position of advocacy or a position agreement at the table. We want to acknowledge those positions as well. So having said that, what I'd like to do is now let's go into our questions. We're going to start with table one. And I'm going to let the spokesperson for one introduce yourself and present your first question. Hello, Senator. Good morning. Howdy. We actually have some of this stuff going on. One of the things that we have agreed about is that one of the reasons that there are so many problems in terms of discussion is that the American People's Civil Information and having said that, what we're asking is that, would you request that Medicare for all be scored by the Congressional budget office? And the reason we ask that is, is that our individual pieces are going to be, no one understands

the actual cost. So we're going to give them little basic pieces. If we could actually see what Medicare for all would look like, I think it'd help all Americans improve your work. You get a better understanding. Okay, let me address that and say, I'm glad to inquire from the Congressional budget office. They've done any such analysis and are so good that you know they should get back to you and every participant here. I don't know how extensive, if they haven't done the analysis, I don't know how extensive the effort would be. And so I can't assure you that we'll get done here real quick. Let me just clarify something that may be obvious to everybody here. But I find a lot of confusion as I'm more on the Mexico about what is public option. Public option that we have proposed in the Health and Education Committee, and the one that's in the House Bill too, is not Medicare for all. In court of Medicare is supported primarily by dedicated

payroll tax. And although people pay something in the way of premiums on Medicare, they don't begin to pay the cost of Medicare with those premiums. The cost of Medicare is covered through the Medicare trust bond, which is funded by the payroll tax that is involved. Now, there's nobody in any of the deliberations I've been involved in in Washington who is suggesting that we should have an dedicated tax to provide another program of health insurance for people who are eligible for Medicare. Nobody is suggesting that. But we put into the Health and Education, the Health and Education Committee, Bill. There's a proposal for the Secretary of Health and Human Services to set up a non -profit entity which would be directed to go from state to state to state and get licensed to sell health insurance in those states.

It would have to operate pretty much on the same basis as health insurance providers today operate. That is, it would have to charge enough of the premiums for anyone who wanted to buy one of their policies. It would have to charge enough of the premiums for offset the cost of any claims that are made and the service provided the cost of administration. The Secretary of Health and Human Services would have funds that could be made available to this non -profit to allow them to begin operating a newly business. Those would be in the nature of a loan to provide the necessary reserves that could have to be paid back by the entity with interest and that's specified in the proposal. That's both in the House Bill and in the Senate Bill. That's the so -called public option. That's something which, I mean, there are a lot of folks in favor of the public option who want something much more

like Medicare for everyone. But that's not being discussed in either the House and the Senate. And there are some who oppose the public option who think that it is Medicare for everyone. But again, it's not being discussed. Anyway, that's a long answer to a short question. Okay, so now we're going to hear from Group 2. I believe it is Stuart Heady. That's going to offer this question on co -ops. Yeah. How could a co -op actually drive constant and provide comprehensive policy as a care for all compared to public policy? Well, that's a great question. And the proposal for a co -op about Senator Conrad has come up with this idea. Essentially what he's offered at the essence. We've got a sort of a stance in the Senate where I believe

I'm accurate that all 40 of the Republicans have said they will not support public option. So sort of Conrad understandably has said, you know, that may mean that we can't get the 60 votes that we need. We may not have all Democrats supporting public option. And therefore, we should see if there's an alternative and he came up with this idea of looking at the co -ops. Now, co -op, the proposal he has that we're discussing with the Finance Committee would be that the Secretary of Health and Human Services would be given $60 million. And would be told that that needs to be made available to provide, again, just like in the case of the so -called public option, on a loan basis so that co -ops that wanted to establish themselves and begin selling health care insurance, could have the necessary reserves to begin operating. And that would be the co -ops, the board of directors of the co -op would be appointed, would

be elected by the members of the co -op. And that would be a distinction between the co -op and the so -called public option and the case of the public option that we have in the health and education committee bill. My preference would be to do the public option that we got in the health and education committee bill, because I think the Secretary would then have an ongoing responsibility to account for how the non -profit operated. But I can see a circumstance where co -ops could operate efficiently, and at least in the discussions that I've heard, they could operate locally, they could operate on a state wide basis, they could operate regionally, they could operate nationally. And they could essentially go into the health insurance business just as any other entity would go into the health insurance business. Now

it's not as good a solution in my view, because once established, the co -op would be much less subject to any kind of control or aggression as policies it would pursue. But some of that could be sort of tried in the way you said that. Thank you, sir. Our next question is going to come from verse 3, and I believe that it's Christine Zuozi, who's going to offer this question on public health function. Thank you, Senator. Thank you, Heather. Our question is, how will the bill that you support add with public health functions and infrastructure and community -based prevention? Not all care prevention, but real community -based prevention. Well, what's, that's not the

main thrust of the bill. The main thrust of the bill is to try to fix some of the major problems in our health care delivery system and not solve, not turn it into a public health bill. But there are various provisions in there that relate to public health, where we are, one of the earlier comments related to the health care workforce. And we have provisions in there to put more money into graduate training and positions, to put more money into training in verses, to do a variety of things, to provide additional incentives for physicians and nurses. And other health care providers to locate in areas of highest need, those kinds of things are in there. That's not right for what you're talking about. But as I say, this bill is not intended to be a public health bill which currently can be configured.

Thank you, sir. All right, we're going to go to room four. And I don't know who will give us that in the questions. So please introduce yourself when you stand. Thank you. So I'm going to pick up my name's Linda Allison. And I've come from room four. We did have some differences in our discussion, but our concern is that the proposed health care legislation seems to be measured in dollars, verses human rights and human life. Do you believe that health care is a human right? And what are you doing to support a bill that acknowledges health care as a basic human right? Well, I do think having access to decent and affordable health care is a human right. The bill is intended to do that. It's intended to dramatically improve access to quality for health care for all Americans. That's a whole

trustable legislation. The idea of providing coverage to the 40, some of the million people in this country who have no coverage today is clearly that. So we are your exactly right, though, in the premise of your question there. We are focused on the dollars. And we are focused on how do we expand coverage, but at the same time reduce the growth of health care costs or affordable? Because we're persuaded, I'm persuaded, at least, that unless we can begin to rain in the growth of health care costs, we're on a non -sustainable course, and we're just not going to be able to. You've got sort of a very negative feedback loop going on here. The fewer people that have coverage, the higher the premiums for those that do have

coverage. And the higher premiums that you get for folks who do have coverage, the fewer people who have coverage. So we've got to break that cycle and expand coverage in the beginning right now, premiums, and see to it that they don't grow at the rate of growth. Thank you, sir. Group five, and I believe this is Keith Franklin asking us a question about Native American. Mr. Franklin. Good afternoon. Good to see you. We're talking Native American now. And we were talking at the end of the group about the non -services, the 3 .1 million unions. That was the trust responsibility of the government that they're not exceeding in our care. Not performing the unions. And our question is, the United States government has a trust responsibility by treating, to affirm self -care, to fall Native Americans regardless of their

residency. We call the Native Americans a pre -payment for their government services. How will the Native Americans begin equal access in quality medical services without cost in regards to those? Well, what we've done in the legislation, of course, all Native Americans, as all Americans, with the eligible for the expansion of coverage and Medicaid, with the eligible for the fundable tax credits and national fundable tax credits that are available through the exchanges so that if they had an income, 300 percent of poverty, in the case of the bill we're looking at in finance, for us, the former percent of poverty, as is the case of the health and education bill. They would be eligible for those subsidies. In addition, we made provision that

there would not be a penalty assessed against any Native Americans for failure to obtain coverage, if they chose not to. In addition, we are maintaining and ultimately increasing funding for the health service. So that's, now I recognize the Indian Health Service doesn't provide animal services for all Native Americans particularly wants to be a reservation. And so I think that Native Americans, once they be a reservation, should have access to any health care services as they have to some extent in the past. And I hope that that could be increased. Thank you, sir. Let's hear from the group six. Good afternoon, same term as James Garis. You touched on this earlier, but our question is, in light of the current budget that is set, and rising cost of health care, how does the government propose to pay for the self

-care reform? Well, that's a very relevant question. And the expectation is that we would do two things. We would find savings in other government expenditures on health care, and a significant amount of that. Those savings aren't going to be required anywhere, in order to keep Medicare from becoming insolvent in the next eight to ten years. And so that's increasing efficiencies in the delivery of care through Medicare. We're also looking at raising some revenue from other measures. I think the largest single one would be to put a tax on insurance companies issuing policies that have a value of almost certain amount. To give you more precision on what we're talking about, the average family policy in the

Mexico current time costs about $11 ,500 for the premium to ensure your family for a year. What we're saying is that if a company issues a policy that is worth more than $22 ,000, it will cost more than $22 ,000. If it's worth $25 ,000, we haven't settled on exactly the right figure, that the amounts of that policy above that $22 ,000 or above that $25 ,000 will be sucking to an ex -house tax. And that would discourage companies from issuing that kind of Cadillac plan, which progression of budget office tells us is a significant addition to those plans. It's a significant contributor to the over utilization of healthcare services, which continues to drive up the cost of healthcare. So we both raise some revenue to pay for the extended coverage in the bill, and we hopefully begin

to bend the cost for down as they come to us tell us in the overall cost of healthcare on our society. Thank you, Senator. Our next question is coming from Matt Ross with Group 7 on the question of informed options. Thank you, Senator. Among the four options, the public option, healthcare co -ops, single payer, and Medicare for All. What are the benefits and drawbacks in your mind of each plan, including the impact each plan we have on overall healthcare costs, and which would you choose and why? We didn't promise you easy, Winston. I think the politics is the art of the possible. And the reality is, when this debate got started, the fact that we're in campaign last year, I think there was general consensus, at least by President Obama.

And I think by Senator Kenchwell, that we ought to take the current system we've got and improve upon it and fix the problems, rather than throw it out and start again. And that was a decision which was made that time that has been the consensus you've come forward here, and that's sort of what we're dealing with. I mean, I read these articles about what a radical reform and healthcare system is being contemplated. I don't know that that's case. I think that what we're talking about is fixing problems in the current system, expanding coverage, making the current system work better. So that's by the way a breakfast to the fact that single payer, which would be, which would involve the elimination of private health insurance, in our country. That is not being considered either in the House or in the Senate. And I don't think it's politically doable. So that's

just the reality of that. Now, what was the second of the option you mentioned? Public option. Public option. I've said before, I think the public option. I voted for it and I've developed the law and we've put it in the Health and Education Committee bill. And that would be one option. I mean, people are so loose. I'm going to sign that. But it would be one of the choices that people could make in deciding where to obtain their own care coverage. And I think that would be a good thing. And I do think, as the President said, we'll help ensure that the private companies that are selling health care will have to. Have to take into account the cost that the public option is offering, health care coverage for. So that would be good. I think it helps keep down on premium costs. The co -op, I'm also going to address that a little bit. I don't think it's as good, but I think depending on how it's implemented and who comes forward and says, okay, we want to raise the co -op and we won't go for state

to get licensed. And just function as a co -op, I think it could work. It could be effective. You had a fourth. I think a lot of people think that Medicare for all is the public option. It is not. And I don't pick up any real settlement in Washington for putting in additional tax on the American people through payroll tax or otherwise. In order to take those funds and begin a very successfully expanded Medicare to everybody. I don't think that's not in the House bill. It's not in the Senate bill. It's not in the Senate bill. Well, question number eight is an interesting question. Going to be delivered by Ozawa Albert regarding how do you make your decisions?

Well, actually, I'm going to give my name to you. Well, that's no good. Thank you, sir. There's another question about the public option. It's a little bit more of a political side. Can you make clear when you say you have a four -packed worry to stand on the public option and encourage your co -op. I mean, we've seen a lot of local opposition making it to that. The majority of the American public still support the public option. And our question to the group aid is, under these circumstances, why would you not yourself vote for the public option? Well, I have over for it in committee, and I would expect to vote for it again, except in the circumstance where... I mean, if the only bill we can get does not contain that, I would

not expect to vote no on a bill that contains all the other reforms that we're talking about just because they're not contained in so -called public option. I think all the polling about whether the public likes the public option. I don't know how much time they're spending explaining to people what's involved, as I said. There's a lot of confusion. A lot of people think that it's essentially a government's going to pay for all care. And that's not what it's being called. Group 9 is, we think, a bit of rentals, asking about the money benefits. Thank you, Senator Lee. Any other question? And the question is, how and by whom will the level of preventive mental health and alternative medical services be defined? Well, in the health and

education bill, which is the only one that we have forgotten out of committee in the Senate, we direct the Secretary of Health and Human Services, how an advisory panel that makes recommendations to her or to him on what should be included in the package of benefits, the basic package of benefits, and then the Secretary is responsible for making fun of judgment. She or he is not bound by the recommendations made, but they obtain the recommendations and they make the decision. And then, of course, Congress can override that if they disagree. Thank you, Senator. Group 10, what do you all have to throw into this? Good afternoon, Senator Newman. I need to send a room of work and I hope you're representing Group 10. Our question is, are there various options such as cost and the public option to lower costs? Using these and other measures, how will the bill ensure that the

cost in will be passed on to consumers, rather than contributing to the process of preventive insurance? Well, the way I think about it, I think there are, when you look about costs in health care, there are sort of two categories, two big categories in cost. One are the costs that are a result of the fact that health care is being provided through an insurance mechanism. And that's what you're talking about, the requirements and the administration of health care insurance companies. The other big category of costs is the cost of actually providing the health care services. And that's the providers themselves. And there are great inefficiencies in both categories in my opinion. And we're trying to, through this legislation, implement

reforms that will take inefficiencies out of both. And I agree with you that having some kind of a public option will be a significant contributor to causing health care insurance companies to keep their premiums down at a reasonable level. I think also having some kind of standard benefit package and having these insurance reforms will eliminate a substantial amount of overhead that's involved in insurance underwriting today. When I first got involved in these discussions on health care, I didn't understand the definition of underwriting. I thought underwriting meant sort of assuming the risk of taking the risk, it really means spring more than that. It means springing out the people you think might get sick and providing the coverage to the folks who you don't think are going to miss. And we would hopefully eliminate that as part of this reform.

Okay, we're doing all right on time. We'll touch point. We've got 45 more minutes. And what we're going to do is now work our way back around. So our fellows over here in Group 10 get to go first this time. And so Robin, this microphone goes back over to Lisa's table. And Bill, are you asking this question? So Bill Dawget is asking the next question on behalf of Group 10 again on an access. Thank you. Thank you for joining us today. Given that the health care reform led 47 million people to the pool of insured individuals, all the health care system being able to address the inequities and access, give them the shortage of funding and distribution of providers and facilities that are inevitable with this increase in the coverage population. And most importantly, how quickly can that be addressed? Well, that's a very good question. I think realistically

it's going to take several years, maybe most of the decade to train up the people we need, the additional people. And the health care field to meet the needs, the experts that have talked to us in our committee said that folks who are unsure today get about 60 % as much in the way of health care services as people who aren't sure. They just get to get the health care through emergency rooms or some of the way that in most cases is not paid for. So there will be an increased need for health care services. If we cover more, there will be an increased need for health care providers and all kinds. And clearly there are shortage areas that need to be given priority. And that's going to take a lot. It's a little bit of a check in today situation. Some folks have suggested well, why don't we solve that problem before we expand the coverage well. Well, I think you got to know both

side of the things. We're going to go to group nine. And if I've been reading the sign language from that table correctly, we're going to hear from Mindy Grosberg on Medicare Medicaid. Thank you. Thank you. Thank you. How will reform that Medicare Medicaid and other public programs? Well, as I say in the bill, we're working on finance committee. We're going to great lengths to not adversely affect Medicare beneficiaries with cuts. There are going to be some consult to providers and essentially the some of the savings that would be involved in this legislation would be implementing some of the recommendations that meant back. The meant back is the advisor panel that makes our recommendations every year on ways to maintain quality and improve

quality and cut costs in Medicare. They make our recommendations every year. They've never been given that much attention in the Congress and we are trying to implement quite a few of those. So that's Medicare Medicaid. The plan would be that more people would be government Medicaid. And the question of whether there is additional financial burden on the states as a result of that is not been cited. I think as many of you know, New Mexico all states, I think on average, the federal government pays about 57 % of the cost of the Medicaid and the states pay the remainder. In the case of New Mexico, it's over 72 % most of the time. The federal government pays and the state pays the remainder. And as to this expansion population that would be involved and it would pass this legislation, clearly the federal government would pay the line of chair

of any cost involved with that. But the decision as to whether the federal government should pay all or should pay 90 % or should pay some other percentage has not been paid. Thank you, sir. We're going to hear from David's group. I can't see your number. I'll 7, 8, and it's going to be more of a ration. I can't get you guys right. Just go for it. My name is Los Alamos. I was going to ask the interesting question around here. So we've heard a lot today about some of the pressures to address health disparities and this one in particular is the rest of the room. How will you ensure that comprehensive reproductive health is part of any health reform package, which would include STD pregnancy vaccinations, abortion and contraception? Obviously the issue of abortion

in particular is extremely controversial in Washington as it is around the country. What the House did in their bill was to say that once you set up these exchanges where insurance is offered, the secretary would have responsibility to ensuring that just as today people can buy comprehensive, that doesn't include abortion. As they choose, and that would have to be the case going forward. I think there's a consensus at least in the moment that senators and I have been talking with that we don't want to try to change the law as regards abortion as part of health care reform, about being where it is. And most of the health care policies issued today new cover abortion. I told that in your aid by folks who have been studying this, some do not. And do you think there ought to be a choice available for folks? In

addition, we think to the extent that there is a federal government subsidy of any kind or assistance provided, provisions should be made to ensure that that assistance is not used to provide abortion. Which is consistent with the high amendment and current law. Thank you, sir. Group said, is this Patricia Morris? Thank you. I have a short question for you. What is the cost of health care reform versus no health care reform? Well, that's a short for the very good question. And again, we get all these experts coming in to tell us what the answer of that is. Most of them agree that the lack of failure to enact health care reform is going to resolve

in the cost of health care continuing to grow at the rate it has been growing. And another 10 years of that and the federal budget will be severely strained. State budgets will be severely strained. The family budget will be severely strained. I think this Commonwealth study just came out said that the average cost of a family policy nationwide today is over $12 ,000. They expect it to be about $22 ,000 10 years from now. That begins to be a burden on families. So, that's what we're trying to hit off of. Is that kind of continued near double digits of increase in cost of health care? All right.

Group 6 is next Senator and your question is going to be offered to you by Kathleen Whitfiger. Thank you very much. Thank you Senator for doing this and next to Mexico for support of you. I mean, I accomplished this. From Group 6, how are American health care reform plans currently being considered by Congress making use of best practices and avoiding any pitfalls from other countries? Well, the sort of best practices goes. I mean, when you're talking about best practices and providing them health care, I think we've been very careful not to get the government into the business of specifying what those best practices are. What we obviously need to do is to have the various professional organizations, specifying what those best practices are and then provide incentives in Medicaid and Medicare for folks to follow those best practices.

So, that's what we're trying to do in that regard. I think that's the right way to go. I think, you know, you get an awful lot of opinion all over the board as to what we ought to be learning from the experience of other countries. And I don't know if there's any real consensus on that. I think what we've sort of come down to is trying to take a hard look at what is the configuration of our health care and delivery system today. Where are its biggest problems? How do we fix those problems? How do we expand the average? How do we control costs more effectively? And that's what we've come up with. This is not a reform proposal that's patterned after any other country that I've aware of in these different ways. Thank you. Maybe you should be. Accountability is your

next subject and it is being presented to you by your five Dolores Waller. Thank you for your service. Thank you. As a member of the Senate Finance Committee's gang of six, please share with us the major hot topics of disagreement in your committee and tell us what your position is on those issues. I would say that all of the gang of six are trying to find a way to come up with something that both can enjoy the support of all six. There are questions about how to do that. There's questions about whether, you know, clearly the public option issue is one where, I think I've indicated, I don't think any Republican,

the three who are the working with us or any other Republican, the Senate has said they would support a public option. So that's a point of a disagreement. Another question is affordability. We're trying to design a reform package which would then allow, if we're going to be requiring people to go out and get coverage, which is part of this. We have discussed it here explicitly, but that's part of it is that people would be required to either sign up for Medicaid, if they're eligible, sign up for Medicare, if they're eligible, or go out and get some amount of coverage, based on coverage. And then the question is how do you make that affordable? And you can do that either too much, you can, you can shrink down what you're requiring to actually attain, or you can

provide work government assistance to help pay the cost. And so a lot of our discussion is circling centered around this affordability issue. We don't want to pass something and then find that we're requiring people to obtain coverage, you can't really afford to do it. Well, as we've been going through this, we've been trying to introduce the speakers because we feel it's a plenty of respect. We introduced you, and we're trying to also introduce the speakers, but I'm going to apologize in advance, and there's no way I'm going to get this right. Most of you are shook, and the question for us is about the public option. It's a washed version. Senator, this is being a great afternoon. You have said you support a government sponsored public option. How am I working to support the public option with a versus co -ops?

Well, let me just say that there are lots of steps in the legislative process. We took one step when we reported the bill out of the Health and Education Committee, and we included the public option there, which I helped develop, along with the other Democrats on Committee. Unfortunately, the bill that came out of that committee came out of a partisan vote. All the Democrats voted for it, all their Republicans voted against it. We are trying in the Finance Committee to come up with something as close to a public option as we can. It may wind up being a column of some sort. There may well be an opportunity if that's the way things develop. It will be out to Senator Reid, who is our Majority Leader, put him to reconcile the two deals to figure out what he's going to bring to the full Senate for consideration, and there again, they don't have to be some choices. What is the nature of the public option

or co -op that is presented in the Senate for a full consideration? And then, of course, on the floor, there's going to be plenty of opportunity for folks to offer amendments. We have a bill to the Senate for, and again, I'm sure if there's not a public option provided for the bill, everyone. Again, the key thing that didn't mean no Senate is you can't pass the bill to the Senate under the rules you have unless you've got 60 votes for it. And we're trying to find a way to get two 60 votes and get a bill that we can bring out to the Senate and pass it to the Senate. And if that will hear from groups three, and we're going to sit down. We're concerned that the current situation and proposals to our knowledge do not allow for bargaining

to get the best rates on pharmaceuticals and drugs. What do you think we need to do in the legislative process to get the best deal for the public on pharmaceuticals and drugs as a nation? Yeah, I think what you're referring to is whether or not Medicare is a good negotiation. That's usually what we've been debating about in Washington is whether Medicare. Is there a question of not having an agreement in the pharmaceutical companies already in place a day going to provide so much in savings? And that would, I guess, for Medicare, but we need to be concerned that we would likely have it for anything. Yeah, and the negotiation of the pharmaceutical industry is something I was not involved in and I'm not involved in.

But I do think that the White House, the President, accept that they have, I believe they indicated that they agreed not to try to accomplish a change in the law to allow negotiation by Medicare for better drug crisis. So, to the extent that there's mining on the side of the bill, I'm sure there are many in the Congress, perhaps myself, included who were not part of that discussion and who would. But I always favor Medicare negotiating for drug crisis. And I think that's an appropriate thing to do. We're going to move to group two, Angelica Regina. Good up to you, Senator. I'm getting out of here. And our question is,

what prohibitions will you support to ensure flexibility for states to protect existing healthcare programs, for new developments, tailored to specific state needs, provided that they will meet or exceed federal plan levels? Well, I don't know exactly which state plan you're thinking of, but we did have a debate in the Health and Education Committee on whether or not to give states the option of developing a single payer plan. And that was proposed. Senator Sanders proposed that in our committee. I voted against it because it contemplated taking the stream of revenue that came to folks in the state, through the various federal programs, and essentially capturing that revenue and then turning it over to the state to be used to set up a single payer plan. I don't think it would make good sense to be saying

the payments that were being made by Medicare into the state should be interrupted so that you could facilitate the development of a single payer plan in the state. I have no problem with states developing a single payer plan, but I don't know that we want to try to do it by funding it through the interruption of various title programs that currently exist under federal law. Thank you, sir. I'm pretty sure that group one's question is Dan Ziegler on the political process. Our group's question is if the bipartisan process continues to stymie efforts at effective health reform, will you support reconciliation

and why or why not? Well, let me just say in defense of the bipartisan effort, I don't think that that effort is what is finding progress. I think that effort might be my preference to come up with something we could get some bipartisan support for and move ahead with that, and that is the effort we're making. And it may well not succeed, but I think it has been worth the effort and we're continuing with it. We had a conference called this last week, among the six of us, and we're going to do that again next week. So we're trying to work through problems and come up with a bipartisan solution. We did provide in the budget resolution. This gets pretty arcane, unless you guys folks really follow the detail of how the Congress works. But earlier in the year, in the spring of the year, Congress passes a budget

resolution and says this is the amount of money that's to be spent in all these different categories. And then later in the year, we pass what we call a reconciliation bill. And the reconciliation bill is a privileged piece of legislation that it's the one bill that you can pass during the year with 50 votes, instead of the 60 votes, 51 votes, instead of the 60 votes. And the reconciliation bill, we make provision by resolution that reconciliation bill could be used to try to enact provisions related to healthcare reform. Now, under the budget act, there are real clear restrictions on how what you can include in that. But if we are unable to do it any other way, that is not. It is a very difficult option

to get implemented, but it's very out of support. Support that, if that's your way. Well, sir, we made you promise that you would answer at least 20 questions, which you have done. So every group in this room has got to ask two. I do know that there's one of you others in the mix. And if you've got a few more minutes, we can round them around the room and take a few more if you're willing to do that. Okay, so raise your hand in any of the groups. We're sticking with folks for the deliberation. If you've got questions left over, I know that group one's got one. Thank you, Senator. My name is Ben. I'm a driver for now. We are just a question senator. Would you ask for a show of hands in this room for supporting a robust public option that available immediately? Thank you. Sure. Okay, all the folks. Very, very few.

Oh, it's okay. That was easy. Thank you. Thank you. Thank you. Thank you, Senator Raymond for spending time with us. In regards to the political difficulties of passing single -payer, what do you see as the cost and benefits of a single -payer plan relative to other plans? And is there any other reason except for politics that it's not being considered? Well, I think some of the advantages, as I understand it, I haven't made any great study of it. But I think most people would say Canada's got a single -payer system. And the advantage of that is that you don't have to worry about who's paying for the health care that is providing. I do think that there

are other problems that have been pointed out with the Canadian system. And I do think that the reports about delays and waiting times for particular to see specialists of various kinds are real. So I don't know that that's related to the fact that it's a single -payer system. It may be related to other factors. But I think that you're right, though, that the decision to pursue what we are currently considering here, rather than a total rewrite of the system, was based on a judgment about what was possible. And what we could get consensus to do, both in the Congress and also in the country. We're going to jump over here to the side of the room. And I'm pretty sure that Katie is sure that we have the grooms of the seven as much. So there is an archive of my work here. When I start arguing about

any system, tell them that we wait right now for treatment. We wait to see a specialist. Wait, we're doing that right now. So I'm going to make some important. I don't disagree with you. Hi, I'm from table seven. And our question is, how will the reform address the shortage of healthcare professionals? In particular, the primary care role help is caused by a high cost to a health professional education. Most Medicare reimbursed rates and medical liability issues. Well, there's a lot of pieces in that question. There are various provisions in the two bills being considered in the seven. And the one that's been reported out of the health committee and the one that's being considered in the finance committee to commit more resources to the training of healthcare professionals. And to

incentivizing healthcare professionals to serve in areas of greater need. And so that is certainly being done. You referred to a couple other things about the low reimbursement rates. And medical liability. Medical liability. There are discussions going on both in our finance committee, but I'm sure once a bill is brought before the finance committee, there will be proposals to try to restrict liability one way or another in order to deal with that part of the equation. And frankly, I don't know where I'll come in. But that has not been a simple part of the bills being developed, but there are amendments that allow me to offer to address that. And with the best care, low reimbursement, there are a lot of people, lots of people that care. Well, the whole thing

is that by implementing some of the men pack recommendations, we can more appropriately reimburse providers for the services that are provided. But we can get more coordination by by various providers in the delivery of services. So we're not. And one of the problems that has been pointed out by many experts is that since we currently reimburse all the basis of quantity of services provided, quantity of procedures performed, that's not the greatest way to package our reimbursement. And we are the reimbursement people on the basis of episode of the bill and ask people to have providers take the responsibility of trying to get people through episode of the bill that are reasonable. We're reasonable reimbursement rate. We're going to take one more from the side

of the room. Let's go back here and group six. Hello, I'm a little bit nervous, but I heard you say that with regards to single payer, it hasn't been thoroughly discussed in Congress. You think this could possibly be a disservice to the American people to not actually take a closer look at single payer and do more analysis as to whether or not it could possibly work for us. And we're another part of this would be shouldn't the American people have more input into the process being able to, you know, pull more and get a clear picture of what the American people want to be done as opposed to providing the entirety of Congress to make these decisions for us. Thank you. Well, I think there's a lot pulling being done on the American public as with their purposes. And I think that's

appropriate and we need to continue with that. I think we, you know, I have no problem with looking at single payer. I think the judgment was made as I've said a couple of times here. The judgment was made fairly early on that we would not undertake the substitution of a single payer system for our current system for providing health care. That judgment was made months, probably a couple of years ago, but again, it's from American President. I think that judgment was probably the most realistic judgment in the sense that if we are able to enact major health care reform, I think some formulation of what we are currently discussing is our best chance. I think I'm actually getting an act of maybe a neighborhood to be wrong. Others may disagree. I think we are better off just

strap up what we've got and go over something else. I just don't think we can get the votes in Congress to do that. I don't know when we can get the score of the American people. But I think taking a closer look is fine. As I say, the focus of this reform effort has been to fix the problems we've got in the current system, but may take the current employer based health care system to the greatest extent possible. Let's jump over here to this slide again and talk about table three. Good afternoon, Senator. What we need to ensure that all persons including undocumented persons in New Mexico have access to affordable money. Well, first, there's nothing in this legislation. Either the House Bill or Senate Bill is even one of them that would extend coverage to undocumented members. And that was a decision again that was made sort of the beginning

of the process. The American public would not support us doing that, and therefore that's not being done. So I think that's the short answer to your question. Let's take one more. Let's see. You guys already got to ask, too. I want to follow up with the earlier questions. Oh, sorry. We've got some of the jumps over here. Sorry. This is a follow -up to the earlier question that I asked about immigrants and reproductive health for women. While I did hear your opinions about what that would look like for abortion, comprehensive reproductive health will do to a lot more for women. And I would like to know what you would do to ensure that with this current reform to address health inequities and coverage for women in any current or future reform, health care reforms. Including returning to care, pregnancy care, STDs, and contraception. Well, we're all in need.

I think sort of a few of you, too. Park partial answers and see if that's addressed to what you want. I think we have provisions in the insurance market reforms that say policies could not determine how the Mexican and policy companies could not be charging different. It amounts based on gender. The amount of the extent of the services provided in the basic package that all policies would have to cover would be established in the health and education bill, would be established by the Secretary of Health and Human Services. And it is stated in that legislation that it would be modeled after the package of services provided by the typical employer insurance program. So to the extent that those services were qualified there, frankly, I think Congress is not at its best when it tries

to get in and micromanage and write in great detail which services out. And I think we're better off assigning that response building to someone who is a little more moved from the media political pressure. I don't think that shows that there isn't a policy based on gender discrimination. I think that that is crucial. Well, I think you raised a good point. Maybe not some exception. You know, to try to assess. I think you raised a good point. We are going to wrap up, but I wanted to, I hope that you

concur with me that this is a pretty smart group of folks out here. We have great comments and questions and I hope people stay in touch with us and let us know where this is a work in progress and it may be several more months in progress. I think that was sort of a goal in the room that some of the groups might be able to come up with a question that would stomp you. And we didn't get that done either, but I'm sure you tried. I'm actually more of a lady's questions. I see your line. Ready. And we're here with Mildred Langston, one of the participants in today's New Mexico first -hand haul. You brought up the issue of end of life care earlier in the day. What's your take on the senator's position on that? Do you agree with me to disagree? Actually, I don't know what the senator's position is because it wasn't

one of the questions that my group decided to ask. On end of life care, what do you think health care reform should accomplish? Well, what I actually think is that health care reform is afraid to even address that. But at the very least, what I think I do think is the provision that we've heard about earlier for providers to be paid for discussing the options. This is what we're seeing with the patient. I think it's important to include them. And meanwhile, of course, there's been a lot of demagoguery on that issue. Death panels is the term that many people may need about. Are you disappointed at all? Or do you expect that that happens in this kind of debate where sensitive issues like that get distorted? I guess I'm a little... Well, I can't say I'm disappointed because I think there's so many important things about this debate that were addressed. So

I'm happy that there were more addressed. I think that it's going to be difficult for us to keep the cost down in health care. But unless we do more, look more closely at the extreme costs that come at the end of life care. Although in some ways, Moody, don't you think that's a good problem to have people living longer? Everyone wants to be healthy. Some people do a better job of exercising and diet than others. But in some ways, that's kind of a high -class problem to have, wouldn't you say? I hadn't thought of it that way, but I guess it is. It's just I personally, in having the experience of seeing someone who's not very happy with their life. And yet, they're able to continue to live and live and live. And I don't feel good about that. Mainly because they're not very happy with their life. Thanks for your time. Help me when we're ready.

Speeding. And we're now with Liz Defantich. She's a San Fei County Commissioner. Of course, used to be a state senator. What did you make generally of what Senator Bingham had to say today? Well, I think he was being very politic. He was trying to answer the questions, but he also knows within how business works in Washington, what can get a councilor, what can't be accomplished. I think that this is not my personal opinion is that it's not going to end up being bipartisan. That this is going to come down party lines. Why not? Well, I think that here is, even for those legislators that might be Republican and moderate and leaning towards a public option, I think there's tremendous pressure from their political parties not to do that in starting all kinds of negative rumors about what a public option means. That the government would be funding public health care for everybody that we're going to go into debt forever and ever about this. That people should be paying for this. That it's not a right, et cetera, et cetera. So I think that already members of Congress are feeling pressure and even our own

senator who has said that he supports public option. He said that if it was not in a bill that was negotiated, he would go ahead and still vote for it, even though public option was not his. Not a deal breaker for Senator Bingham. Right, and so I think that he isn't at this point in a negotiator trying to work to get something accomplished. I also think he alluded several times to the point that the president, Senator McCain, said more or less decided, but would work and not work for the American public. And that's too bad because it's not allowing a dialogue. We were just at our legislative finance committee a few weeks ago and I was just talking to Dr. Wies from the UNM, Robert Wood Johnson, Health Policy Institute, where I'm affiliated with now. And they're saying, let's reform the entire state system. Give us some ideas how we could reform our whole system here. But we're just not ready to grapple that at this national level. Well, let me be able to, quick questions along those lines, Liz, on reforming New Mexico system. Senator

Bingham at one point today said that they had made a decision that the Sanders amendment and the Senate that states couldn't go out and do a single pair if that meant upending the federal monies that come into the state. Does that sound reasonable to you? Should states like New Mexico others be able to experiment? And if they say we want to try a single pair plan, should a state like New Mexico be able to do that? I think so and let me give you an example of the state that tried. The state of Minnesota actually has single pair in about five or ten counties in the entire state. And they went in, what they had to do is go in and change their state constitution. Then they went to Congress and they said, we've changed it so that we can do this. And they did it primarily in the rural counties of the state. Later on, it was working so well that they then went back to Congress and said, give us the ability to do single pair in our entire state and Congress said that. But they had done this model for it and they had done it for more than five years. And I heard this

presentation not too long ago at the National Association of Counties in Washington this last March. And they were just raving about the success of single pair in about a third of the state of Minnesota. But that's off the table now. It's off the table. The last question I was going to ask you, Liz, Medicaid has been in the news this week. Yes. A big shortfall Medicaid, of course, the Senate and the Reagan noted as a federal state match. The feds come up with the lion's chair of that money. But it seems like if you're going to expand the program and get more people in, which many folks I imagine you have included. I think that probably is a good idea. How does the state come up with the match? And it seems like Senator Bingham said today that's not been decided. How could it be decided? What would be the best way to handle that? Well, I actually heard Senator Bingham and say what we would do is put more people in to Medicaid. The only way it would work is for the federal government to pay a higher portion. So even if we're getting 70 % now, he suggested they might have to put in as much as 90%. I think there'd have to be a cost study done here. If we were going to put in any more people and not cut back services for the people that we have, what percentage we would need. 90%,

it's not quite a hundred percent, but it's getting up there. So if you want to put more people in, maybe it needs to be at 90%. We have a good plan here. And I'm afraid that the state deficit is really going to cut back some of the benefits for people. Maybe very last question Liz. Are you optimistic that a few weeks a month or so from now there will be major healthcare reform legislation coming out of DC? I'm very optimistic that something's going to pass. What I don't know, what the cloud of doubt is about, how is this going to translate down to the states? How is this going to be implemented by not only the Secretary of Health and Human Services but then by every state? Thank you. Thank you.