[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]


                    EXAMINING PATHWAYS TO UNIVERSAL
                            HEALTH COVERAGE

=======================================================================

                                HEARING

                               BEFORE THE

                              COMMITTEE ON
                          OVERSIGHT AND REFORM
                        HOUSE OF REPRESENTATIVES

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             SECOND SESSION

                               __________

                             MARCH 29, 2022

                               __________

                           Serial No. 117-73

                               __________

      Printed for the use of the Committee on Oversight and Reform
      
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]      


                       Available on: govinfo.gov,
                         oversight.house.gov or
                             docs.house.gov
                             
                               __________

                    U.S. GOVERNMENT PUBLISHING OFFICE                    
47-267 PDF                 WASHINGTON : 2022                     
          
-----------------------------------------------------------------------------------   
                            
                             
                   COMMITTEE ON OVERSIGHT AND REFORM

                CAROLYN B. MALONEY, New York, Chairwoman

Eleanor Holmes Norton, District of   James Comer, Kentucky, Ranking 
    Columbia                             Minority Member
Stephen F. Lynch, Massachusetts      Jim Jordan, Ohio
Jim Cooper, Tennessee                Virginia Foxx, North Carolina
Gerald E. Connolly, Virginia         Jody B. Hice, Georgia
Raja Krishnamoorthi, Illinois        Glenn Grothman, Wisconsin
Jamie Raskin, Maryland               Michael Cloud, Texas
Ro Khanna, California                Bob Gibbs, Ohio
Kweisi Mfume, Maryland               Clay Higgins, Louisiana
Alexandria Ocasio-Cortez, New York   Ralph Norman, South Carolina
Rashida Tlaib, Michigan              Pete Sessions, Texas
Katie Porter, California             Fred Keller, Pennsylvania
Cori Bush, Missouri                  Andy Biggs, Arizona
Shontel M. Brown, Ohio               Andrew Clyde, Georgia
Danny K. Davis, Illinois             Nancy Mace, South Carolina
Debbie Wasserman Schultz, Florida    Scott Franklin, Florida
Peter Welch, Vermont                 Jake LaTurner, Kansas
Henry C. ``Hank'' Johnson, Jr.,      Pat Fallon, Texas
    Georgia                          Yvette Herrell, New Mexico
John P. Sarbanes, Maryland           Byron Donalds, Florida
Jackie Speier, California            Vacancy
Robin L. Kelly, Illinois
Brenda L. Lawrence, Michigan
Mark DeSaulnier, California
Jimmy Gomez, California
Ayanna Pressley, Massachusetts

                      Russ Anello, Staff Director
         Miles Lichtman, Deputy for Health Oversight and Policy
           Elisa LaNier, Chief Clerk and Operations Director
                      Contact Number: 202-225-5051

                  Mark Marin, Minority Staff Director
                               
                               ------                                
                               
                         C  O  N  T  E  N  T  S

                              ----------                              
                                                                   Page
                                                                   
Hearing held on March 29, 2022...................................     1

                               Witnesses

Panel 1

Christopher Willcox, MSW, St. Louis, Missouri
    Oral Statement...............................................     7
Nicole Lyons, New York City, New York
    Oral Statement...............................................     8
Chris Briggs (Minority Witness), Woodburn, Virginia
    Oral Statement...............................................    10
Bishop Walter Starghill, Jr., Inkster, Michigan
    Oral Statement...............................................    13
Leslie Templeton, Boston, Massachusetts
    Oral Statement...............................................    15

Panel 2

Uche Blackstock, PhD, Emergency Physician, Founder and Chief 
  Executive Officer, Advancing Health Equity
    Oral Statement...............................................    16
Sara Collins, PhD, Vice President of Health Coverage and Access, 
  The 
  Commonwealth Fund
    Oral Statement...............................................    18
Grace-Marie Turner (Minority Witness), President, Galen Institute
    Oral Statement...............................................    20
Jeffrey Sachs, PhD, Director, Columbia University Center for 
  Sustainable Development, President, United Nations Sustainable 
  Development 
  Solutions Network
    Oral Statement...............................................    22
Jamila Michener, PhD, Associate Professor, Cornell University 
  Department of Government, Co-Director, Cornell University 
  Center for Health Equity
    Oral Statement...............................................    25
Ady Barkan, JD,Founder, Be a Hero
    Oral Statement...............................................    27

 Opening statements and the prepared statements for the witnesses 
  are available in the U.S. House of Representatives Repository 
  at: docs.house.gov.

                           INDEX OF DOCUMENTS

                              ----------                              

  * List of All Hearings with Federal Agencies held in the House 
  Oversight Committee since January 2021; submitted by Chairwoman 
  Maloney.

  * University of California - San Francisco Study on Single-
  Payer Proposals; submitted by Chairwoman Maloney.

  * Questions for the Record: to Ms. Grace Marie-Turner; 
  submitted by Rep. Comer.

The documents listed are available at: docs.house.gov.

 
                    EXAMINING PATHWAYS TO UNIVERSAL
                            HEALTH COVERAGE

                              ----------                              


                        Tuesday, March 29, 2022

                  House of Representatives,
                 Committee on Oversight and Reform,
                                                   Washington, D.C.
    The committee met, pursuant to notice, at 9:05 a.m., in 
room 2154, Rayburn House Office Building, and via Zoom; Hon. 
Carolyn B. Maloney [chairwoman of the committee] presiding.
    Present: Representatives Maloney, Norton, Lynch, Connolly, 
Krishnamoorthi, Raskin, Khanna, Mfume, Ocasio-Cortez, Tlaib, 
Porter, Bush, Brown, Davis, Welch, Johnson, Sarbanes, Kelly, 
DeSaulnier, Gomez, Pressley, Comer, Jordan, Foxx, Hice, 
Grothman, Cloud, Sessions, Keller, Biggs, Clyde, LaTurner, 
Herrell, and Donalds.
    Also present: Representatives Jayapal, Omar, Bowman, and 
Jones.
    Chairwoman Maloney. The Committee will come to order. I am 
told we need to restart the opening because of the stream was 
not there.
    Today, I am convening the Committee on Oversight and Reform 
to examine a subject that touches the lives of every person in 
the United States, our Nation's healthcare system and 
Americans' access to affordable, high-quality medical care. 
Democrats in Congress have spent decades fighting, and 
succeeding, to expand access to healthcare in the United 
States.
    In 2010, under the leadership of President Obama, we passed 
the Affordable Care Act, a landmark law that made affordable 
healthcare accessible to more than 30 million people across the 
United States. That includes 14 million people with lower 
incomes who finally received high-quality health insurance, 
thanks to the Affordable Care Act's Medicaid expansion. This 
also includes millions of people who had previously experienced 
obstacles to obtaining healthcare, including people with 
preexisting conditions, older Americans, and women.
    Unfortunately, my colleagues on the other side of the aisle 
not only opposed this law, but over the last decade, they have 
voted more than 60 times to repeal it or weaken it. Republican 
Attorney Generals sued in Federal court, trying to strike it 
down, and the Trump administration refused to defend the ACA in 
court. Despite these relentless attacks and thanks to the 
tireless work of patients, caregivers, and community advocates, 
the ACA still stands.
    Since President Biden took office, congressional Democrats 
have continued to strengthen and enhance the ACA to make 
healthcare more affordable and accessible for every person in 
the United States. Last year, we passed President Biden's 
American Rescue Plan, sweeping legislation that expanded the 
ACA's financial assistance for patients and families working to 
make ends meet.
    But our work is not done yet. Today, more than 27 million 
people in the United States remain uninsured, and even for some 
who do have insurance, it is not enough to insulate them from 
the significant cost of getting healthcare in this country. 
congressional Democrats have proposed and advanced many 
different reforms to close these coverage gaps and move our 
Nation toward universal health coverage. We have voted on 
legislation to close the coverage gap left by Republican States 
that failed to expand Medicaid under the ACA, as well as 
legislation to expand Medicare benefits for older Americans and 
to further reduce out-of-pocket costs for patients with 
commercial coverage.
    And more than 100 of us have cosponsored the Medicare for 
All Act, as proposed by my colleague Congresswoman Pramila 
Jayapal and championed by numerous members on this committee. 
Medicare for All, a comprehensive proposal to transition our 
healthcare system to a national single-payer model, offers a 
bold vision for an America where no patient is denied necessary 
medical care because it is too expensive and no family has to 
decide between putting food on the table or paying their 
medical bills. This proposal fulfills a promise that I have 
long fought for, the promise that healthcare is a human right.
    Medicare for All would contain skyrocketing costs across 
our healthcare system and provide a sustainable path to more 
equitable and accessible healthcare, especially for communities 
where access has historically been pushed out of reach. I have 
proudly supported Medicare for All since it was first 
introduced in Congress nearly two decades ago, and I will 
continue to push for this vision of the American healthcare 
system.
    At the same time, my Democratic colleagues and I will 
continue to fight for every bit of progress we can make in 
moving our Nation toward universal coverage. While Republicans 
raise barriers to affordable healthcare, Democrats will 
continue working tirelessly to ensure that no person's 
financial circumstances keep them from obtaining quality 
healthcare.
    Let me conclude by taking a moment to recognize the 
leadership of several of our committee members in bringing 
renewed energy and urgency to the fight for universal coverage. 
Congresswoman Cori Bush, Ayanna Pressley, Alexandria Ocasio-
Cortez, and Rashida Tlaib, all members of this committee, have 
been some of the most powerful voices in Congress for an 
America where healthcare is a human right, and I am grateful to 
partner with them.
    Before I recognize the distinguished Ranking Member for his 
opening remarks, I would like to recognize Congresswoman Bush 
for an opening Statement.
    You are now recognized, Congresswoman Bush.
    Ms. Bush. St. Louis and I thank you, Chairwoman Maloney, 
for your partnership in convening this historic hearing on the 
urgent need for comprehensive and universal health coverage in 
the United States. The committee's exemplary leadership, 
tireless advocacy, and commitment to genuine health equity will 
rightfully bring this conversation back to the forefront of 
public health policy.
    I must acknowledge the tremendous work and contribution of 
Senator Sanders and Rep. Jayapal for putting forth the boldest 
legislative proposal to date, the Medicare for All Act, and to 
my sisters in service on this committee for their partnership 
and steadfast leadership in our effort to protect healthcare as 
a human right.
    Thank you to our seeing witnesses, a comprehensive range of 
patients and researchers, healthcare professionals, who have 
come together today to passionately advocate for universal 
healthcare.
    Medicare for All is transformational policy change that 
would implement a national single-payer universal healthcare 
system that guarantees comprehensive healthcare coverage to 
every person in America and end the for-profit, privatized 
broken system we have in place now.
    I have personally bore witness to the stark inequities 
faced by uninsured and underinsured patients during my tenure 
as a registered nurse. For some people, it is hard to imagine 
rationing expensive medication like insulin, skipping dialysis 
appointments, forgoing surgical procedures, or refusing medical 
care entirely. People are having to choose between their life 
or a lifetime of medical debt, and that is not OK.
    And I know because I am one of those people. Until I was 
sworn in as a Member of Congress, I was uninsured for over a 
week, and actually, I have spent the better part of my 
adulthood lacking access to health coverage, overburdened by 
medical debt, and unable to receive regular preventive and 
routine medical care. It shouldn't have taken a job for me to 
be able to access affordable medical care. Healthcare is a 
human right, and we should guarantee it for everyone.
    Providing every single person in the United States with 
healthcare is a powerful anti-poverty mechanism. Medicare for 
All would help low-income households save over $38 billion 
annually on medical out-of-pocket expenses like deductibles, 
copays, co-insurance, and self-payments. Research has proven 
universal coverage will help reduce poverty rates by over 20 
percent.
    In St. Louis, our communities are facing systemic threats 
to their health from all angles--from poverty, substandard 
housing conditions, environmental destruction, overdose and 
mental health crises, pollution, to over policing. Lack of 
affordable healthcare has resulted in millions of preventable 
deaths before the pandemic, and the situation continues to 
rapidly deteriorate as COVID-19 claims over 1 million lives and 
counting.
    While Democrats have a majority in the House, Senate, and 
the executive branch, it is imperative lawmakers seize this 
narrow opportunity now to enact transformational public health 
policy and poverty-reductive policies like Medicare for All. 
Taking strides toward universal healthcare coverage is the only 
path forward to reversing troubling trends in U.S. population 
health.
    I urge my colleagues on both sides of the aisle to 
earnestly consider the lethal consequences of continuing to 
prioritize big pharma profits over human life and health.
    Thank you, and I yield back.
    Chairwoman Maloney. The gentlelady yields back.
    I now recognize the distinguished Ranking Member, Mr. 
Comer, for an opening Statement.
    Mr. Comer. Thank you, Chairwoman Maloney, and I want to 
thank our witnesses for your testimony here today.
    Keeping with the majority's pattern this Congress, today's 
hearing is not an oversight hearing. It is not a hearing that 
will bring transparency or accountability to the executive 
branch. It is not a hearing to find ways to save taxpayer 
dollars, especially as Americans toil under inflation.
    Instead, today's hearing is an attempt to find more ways to 
spend taxpayer dollars and expand the reach of the Federal 
Government. It is a hearing to grow massive entitlement 
spending, this time by pushing for Government-run healthcare.
    With inflation at a 40-year high, Americans are struggling 
to afford essential items like food and medicine. Since day one 
of this administration, President Biden's policies have 
crippled America's energy independence. Gas prices have 
skyrocketed. In California, gas prices are over $6 a gallon.
    Meanwhile, fentanyl is streaming across the Southern border 
unchecked. According to the Centers for Disease Control, 
fentanyl overdoses are now the leading cause of death for 
adults age 18 to 25. Children are also being hit hard by the 
fentanyl crisis with reports daily about accidental overdoses.
    Yet my Democrat colleagues refuse to look into any of these 
issues. The mission of the Oversight Committee is to root out 
waste, fraud, abuse, and mismanagement in the Federal 
Government, but Democrats keep finding new ways to use the 
tools of the committee to spend even more taxpayer dollars.
    Instead of looking for ways to expand Government, Oversight 
Committee Republicans have been conducting our own 
investigation in the healthcare space on Medicaid improper 
payments. And what we have found is very disturbing. Documents 
obtained during the investigation show that Democrat policies, 
such as Medicaid expansion and removing eligibility checks, 
have increased improper payment rates in the program.
    In fact, improper payments are so rampant, the most recent 
data shows that more than 1 out of every 5 Medicaid payments 
are improper. That is about $87 billion in taxpayer money being 
misused in one Fiscal Year alone. Why aren't we holding a 
hearing on that?
    Instead, this hearing is about further expanding Obamacare 
and moving the United States closer to socialized medicine. 
Medicare for All will gut quality healthcare coverage in favor 
of waiting lines, rationed care, and stalled medical 
innovation. Medicare for All will cancel first-rate health 
plans for millions of workers, children, and seniors in favor 
of giving D.C. politicians unlimited control of your 
healthcare.
    Evidence around the world shows socialized medicine causes 
long lines for treatment, decreased innovation, and empowers 
the Government to decide who lives and who dies. It also 
enables systems that benefit the rich who can afford private 
insurance to bypass Government waitlists.
    Democrats have seen the polling and know the American 
people don't want Medicare for all. So Democrats have worked to 
hide their end goal from the American people, using terms like 
``Medicare for all who want it'' and ``public options,'' when, 
in reality, these are just steppingstones to socialized 
medicine. But no amount of Washington spin can change the fact 
that socialized medicine is a bad deal for the American people.
    Americans recognize the frightening attempts at Government 
takeover of healthcare for what they are, bans on good 
healthcare plans that work, eradicating Medicare for seniors as 
we know it, and doubling everyone's taxes. And voters will 
reject it. When they do, Republicans stand committed to working 
together to improve the broken status quo and lower healthcare 
costs for families and small businesses.
    Republicans, through the Healthy Future Task Force, are 
already working to develop common sense proposals to increase 
competition, encourage investment in new cures and therapies, 
protect access to care for all Americans, and ensure patients 
remain in control of their care. But Republicans know 
centralizing control in D.C. and continuing to limit access and 
choice for patients is an awfully bad starting point for 
Democrats.
    Republicans will continue to fight Democrats' takeover of 
healthcare through common sense solutions to increase the 
availability of affordable care for all Americans while 
ensuring we remain the global leader in healthcare innovation.
    And with that, Madam Chair, I yield back.
    Chairwoman Maloney. The gentleman yields back.
    We have very important witnesses today, and I want to focus 
on getting to their testimony. Let me briefly say that 
President Biden has unified our allies in Asia and Europe. He 
has restored trust in American leadership. He has swiftly acted 
to move against the aggression of Russia against the Ukraine. 
After the COVID crisis, he has taken steps to help our economy 
and has had record employment, the most ever in the history of 
our country.
    I would like to place into the record a list of all the 
Federal hearings that we have had in Oversight and address the 
other attacks on the Biden administration and respond very 
simply to the claim that our hearing today is too expensive.
    The truth is we cannot afford our current healthcare 
system. We pay more for healthcare than any other comparable 
nation, nearly 20 percent of our GDP and rising yearly. 
Americans go bankrupt because they don't have health insurance, 
and that is a national disgrace. And studies show that the 
reforms we are discussing today would actually save money over 
time.
    I would like to submit for the record a study from the 
University of California San Francisco, which analyzed 22 
single-payer proposals and found that every single one would 
result in long-term financial savings.
    Without objection.
    Chairwoman Maloney. If my Republican colleagues were really 
worried about inflation, they would support policies that bring 
down healthcare costs instead of voting 60 times against the 
Affordable Care healthcare plan that has expanded healthcare to 
30 million Americans.
    Finally, in terms of the deficit, I don't hear my 
Republican colleagues complaining when President Trump pushed 
through $1.9 trillion in tax cuts for the very well off. I 
invite my Republican colleagues to stop playing politics and 
let us work together on real solutions, all kinds of ideas that 
we will be discussing today, real solutions so that working 
families can get the healthcare they so justly deserve at an 
affordable price.
    And before we move on, I would like to ask unanimous 
consent that Representatives Omar, Bowman, Jones, and Jayapal 
be allowed to participate in today's hearing.
    Without objection, so ordered.
    Now we are going to introduce our distinguished first panel 
of witnesses who are all patient advocates. The first panel 
will not be taking questions, but we welcome their experience, 
their perspective.
    I now recognize Ms. Bush to introduce the first witness.
    Ms. Bush. I am proud to represent a witness in this hearing 
from St. Louis, Mr. Christopher Willcox, who will share his 
testimony as both an underinsured patient and a relentless 
advocate for Medicare for All.
    Chris is currently the mutual aid and policy advocate at A 
Red Circle, where he helps connect St. Louis County residents 
with community resources. As a social worker who is passionate 
about healthcare, housing, and freedom from police violence, 
Chris has extensive experience helping patients navigate a 
fragmented healthcare system.
    I am confident his testimony will lay bare the true human 
cost of the brutal for-profit healthcare industry.
    Chairwoman Maloney. Thank you.
    Our next witness will be Nikki Lyons, who is a pre-med 
student from my district in New York.
    After that, we will hear from Chris Briggs, who is a 
patient advocate from Woodburn, Virginia.
    I now recognize Ms. Tlaib to introduce our next witness.
    Ms. Tlaib. Thank you so much, Chairwoman Maloney, for your 
incredible courage in having this hearing and, of course, to 
all of my other sisters in service for helping us bring so many 
of our families into the halls of Congress as they express the 
dismay of our broken healthcare system.
    I have the honor of introducing Bishop Walter Starghill 
from Inkster, strong in Thirteenth congressional District. The 
bishop has already had personal experiences himself, almost 
going blind because of our broken healthcare system, but he 
also serves in one of my amazing federally accredited clinics. 
He serves as the vice chair of an all-volunteer board of 
directors of Western Wayne Family Health Centers, whose goal is 
to provide high-quality, affordable care for all of our 
residents and our communities, regardless of insurance status.
    I want to thank him so much for his courage and for him 
providing this testimony that is so critical. As the bishop 
will tell you, in our district, we are not about just 
surviving. We are also about thriving. And that is why we need 
to get closer to passing Medicare for All.
    Thank you so much, Chairwoman. I yield.
    Chairwoman Maloney. I now recognize Ms. Pressley to 
introduce our final witness.
    Ms. Pressley. Thank you, Madam Chair, for your leadership 
and heeding our calls, working with my colleagues and I to hold 
this critically important, historic, and timely hearing. It has 
been a long time coming.
    I thank Rep. Jayapal for being undeterred in this justice 
fight, and of course, I want to recognize my colleague and 
sister in service, Representative Bush, for spearheading this 
effort.
    The fight to make Medicare for All a reality is 
intrinsically a fight to center people with disabilities once 
and for all, and that is why I am proud to introduce Leslie 
Templeton, constituent of the Massachusetts Seventh, a resident 
of Boston, who from a young age has navigated the world as a 
disabled person and uses her experiences to advocate for 
others.
    Thank you, Leslie, for your tireless dedication to 
advancing disability justice in the Commonwealth and across the 
United States. You make the Massachusetts Seventh and the 
movement very proud.
    Chairwoman Maloney. The gentlelady yields back.
    The witnesses will be unmuted so that we may swear them in. 
Please raise your right hands.
    Do you swear or affirm that the testimony you are about to 
give is the truth, the whole truth, and nothing but the truth, 
so help you God?
    [Response.]
    Chairwoman Maloney. Let the record show that the witnesses 
answered in the affirmative.
    Thank you. And without objection, your written Statements 
will be made part of the record.
    With that, Mr. Willcox, you are now recognized for your 
testimony. Mr. Willcox?

   STATEMENT OF CHRISTOPHER WILLCOX, MSW, ST. LOUIS, MISSOURI

    Mr. Willcox. Great. Thank you for the kind introduction and 
thank you for inviting me to speak.
    My name is Chris Willcox. I'm an organizer with St. Louis 
Mutual Aid, and I work for A Red Circle, which is a nonprofit 
that serves North St. Louis County.
    My history with healthcare systems in America comes from 
the perspective of those receiving services and from providing 
them. I was first diagnosed with anxiety and depression in 
college before I graduated in 2011 at the peak of the Great 
Recession. Getting treatment for depression suddenly made a lot 
of struggles in my life make sense.
    The thing about depression is that the simplest things, 
such as getting out of bed, can feel incredibly difficult, and 
it can be hard to even imagine that there is anything worth 
getting up for. Adding to that, failing to overcome challenges 
makes it all the easier to gather what feels like a cumulative 
body of evidence of your own worthlessness.
    We deal with arbitrary disruptions in healthcare because of 
our dependence on private health insurance companies and 
struggles with precarious employment. I've had to change 
therapists at least three times because the ones I was working 
with was no longer in network.
    When I was temporarily uninsured or had to start with a new 
insurer, I've had to go through withdrawals multiple times 
because of denials or delays, prior authorizations, or any 
other bureaucratic headaches we spend hours and hours of unpaid 
time dealing with.
    In my experience working in social services, the 
limitations of existing public health insurance left many of my 
clients' needs unmet. Many agencies operate by churning as many 
billable services as possible from underpaid and poorly 
supported staff. Imagine being worried about making your 
numbers while trying to be present for a client that is telling 
you about their suicidal ideation.
    One client I work with is particularly ill-served. She had 
to borrow money from her brother to get her medications while 
she waited on Medicaid to establish her coverage. I was advised 
to reschedule her appointments so that I could pick up others 
to get my numbers up because she would frequently have to 
reschedule. Understandable for someone needing treatment for 
serious mental health challenges.
    The very day I was given this advice, this same client 
texted me a call for help as she was struggling with suicide. 
After I intervened, she went to the hospital for the second 
time for suicide before she was finally granted coverage by 
Medicaid. This was while I was having my own thoughts about 
suicide related to the conditions of my job, but I had put off 
seeing a therapist for several months because during that time, 
I was hired late in the year, and I would have to pay entirely 
out-of-pocket, have the deductible reset in January.
    These problems exist simply because we choose not to make 
the commitment to care for every person who needs it. This may 
be even more the case in mental illness, which can be every bit 
as lethal. It takes courage and resolve just to seek treatment, 
as fear of being seen as weak or as making it up in your head 
only adds to the barriers we already put between people and 
care.
    Without getting the care I needed, I might not even be 
alive today, let alone speaking to Congress about finally 
getting the support our people need and deserve. We know what 
we need to do to make sure that everyone gets the care that 
they need, Medicare for All now.
    Thank you.
    Chairwoman Maloney. Thank you. The gentleman yields back.
    Ms. Lyons, you are now recognized for your testimony. Ms. 
Lyons?

       STATEMENT OF NICOLE LYONS, NEW YORK CITY, NEW YORK

    Ms. Lyons. Hi. OK, thank you so much for giving me the 
opportunity to speak today, members of the House committee.
    Just give me one second. I'm having a little technical 
difficulty right now.
    So, as the speaker said, my name is Nikki Lyons. I'm here 
to speak today because the second time in my 20's, I am waiting 
for an organ transplant due to kidney failure.
    This loss of control regarding so many aspects of my life 
and waiting for an organ transplant has had me thinking many 
times about what I would say to you guys with the power to make 
changes in this place where decisions are made. Like so many 
Americans, Medicare for All would have changed the course of so 
many aspects of my life and provide comfort for my future.
    The first time I found out I was sick, I was at a hospital 
in the middle of college midterms week and waking up from an 
emergency appendectomy. The diagnosis was not adequately 
explained, and there is no followup care that one would expect.
    As a struggling college student, I didn't have the luxury 
to see a doctor anywhere besides the emergency room. Because of 
this, I didn't know how truly sick I was, and because of my 
illness, I ended up failing out of school, which further 
delayed my career and cost thousands and thousands of dollars.
    Years later, I found out at that time I already should have 
been looking for a transplant because I was in the end stages 
of kidney failure, not told just to watch my sodium--or not 
just to watch my sodium, as I was told. Had I had regular 
access to healthcare, blood tests, anything like that, the 
extent of my organ failure could have been stalled or even 
prevented, had it been caught early enough.
    While waiting for my first transplant, instead of resting 
and conserving the little energy I did have, I was working 50-
plus hours a week on my feet at a bar and at a gym to afford my 
doctors' appointments and medication. For those who don't know, 
potential transplant patients are evaluated for stability as to 
not waste the gift of an organ. They look at your housing, your 
economic status, your compliance with doctors. Not being able 
to afford medication or appointments could have disqualified me 
for the organ I needed to live at any point.
    Medicare for All would have meant not deciding if I needed 
to skip meals to qualify for a kidney. I wouldn't have had to 
work myself to the bone while incredibly sick.
    I was lucky enough to receive a transplant in 2016, but I 
am again in organ failure. This round of organ failure I can 
say with 100 percent certainty would have been prevented by 
Medicare for All. I wasn't able to get regular transplant 
checkups because of the resources I had allotted for healthcare 
went toward mitigating the symptoms of long-term COVID. Because 
of the lack of care, I had no idea my body was rejecting my 
transplant as a complication of said long-term COVID.
    I haven't been able to properly work or attend class 
adequately since winter of 2020. The COVID symptoms 
transitioned into kidney failure symptoms so seamlessly to the 
point I didn't realize what was happening. All I had needed was 
a simple blood test, and the rejection would have been caught 
earlier. When rejection is caught quickly, it is very 
treatable.
    I, unfortunately, wasn't that lucky. It was amazing I was 
alive for the second time in my life. Since June, I have had 
six long-term hospital stays, with the longest being seven 
weeks; travel 12 hours a week 3 times--12 hours 3 times a week 
for dialysis for 3 1/2 hours; blood transfusions, chemicals 
similar to chemo to try and save the kidney and prevent 
anything from getting worse, and that just ends up making me 
feel significantly worse. I've had days I'm only able to be 
awake for four hours. There's no way for me to work, finish 
school, or thrive at all in this condition.
    On top of this, I had no insurance when this first started 
until Medicare kicked in, which took six months from the time I 
applied. I was told their online system never got my 
application several times, and then after that, several times 
the local office had lost my paperwork and never filed it.
    So, for those six months, I couldn't access care unless I 
went to an ER. I ended up going into heart failure as well 
during this time, which took four ERs to catch. But had I been 
able to see a cardiologist for something as simple as an 
ultrasound of the heart or an echo, it would have been spotted 
immediately.
    I was also told peritoneal dialysis would have been a much 
better option than the standard hemodialysis that I had to 
endure because no surgeon would place the right catheter if I 
didn't have insurance to pay for said surgery. So I have spent 
the past six months getting the entirety of my blood taken out 
through a tube in my neck, cleaned, and returned to my body 
while often going into shock when there's a loss of fluids 
because it makes your heart unable to pump blood through the 
body, having horrible insomnia, deep pain, and fatigue.
    Six months of suffering due to a lack of access to care for 
a medical situation that should have been prevented in the 
first place. Medicare eventually kicked in, and now 229 days 
after my first dialysis session, I am finally switched over to 
in-home peritoneal dialysis that I should have gotten in the 
first place. Two hundred twenty-nine days of my life were 
robbed from me for reasons out of my control, but preventable 
for the next person by the elected officials sitting in this 
room.
    The experiences I briefly shared are but a drop in the 
bucket compared to my full story. I wanted to take the time to 
thank everybody for listening to me, and I implore you to take 
the time to fully absorb what the words I said meant.
    This situation is happening across the country, and 
Medicare for All would prevent it. It is inhumane to present 
any human being in a situation where they must choose between 
eviction, a lack of food, or their healthcare.
    Thank you.
    Chairwoman Maloney. Thank you.
    Mr. Briggs, you are now recognized.

         STATEMENT OF CHRIS BRIGGS, WOODBURN, VIRGINIA

    Mr. Briggs. Chairwoman Maloney, Ranking Member Comer, 
members of the House Committee on Oversight and Reform, please 
allow me to thank you to testify before you today. And just a 
point of correction, I do, in fact, live in Northern Virginia, 
and I am a patient advocate, but I also am public affairs 
counsel for Independent Institute, which is a think tank in 
Oakland, California.
    In November 2015, my wife got the most dreadful call a 
parent can get. The doctor knew why our daughter, Colette, then 
2 1/2, hadn't been feeling well. Bloodwork had revealed 
leukemia, cancer. We raced Colette to Inova Fairfax Hospital, 
the only one in Northern Virginia, where we live, that treats 
pediatric cancer and got there just in time.
    Thanks to Obamacare, we were already in difficult straits 
regarding healthcare. In 2014, that law had eliminated a plan 
we had had for years.
    Before the ACA went into effect, the private marketplace 
consistently and reliably had offered us a wide variety of 
inexpensive plans that covered specialist care even out of 
State. After the ACA went into effect, however, all that was 
left were increasingly costly plans with fewer benefits, 
including fewer doctors and fewer hospitals.
    Thanks to Obamacare, we were, and still are to this day, 
basically restricted to medical facilities within a short 
radius of our zip codes. Obamacare, in a word, has made us into 
medical serfs. We're tied to the land on which we live, unable 
to leave it, even to save a little girl dying from cancer. 
Which is why, when we tried to take Colette to Johns Hopkins, 
just up the road in Baltimore, we were denied. Under our pre-
ACA plan, which didn't geofence sick children from the care 
they deserve, she would have been admitted.
    Our predicament was made all the more painful by swelling 
premiums, as well as by skyrocketing deductible and maximum 
out-of-pocket expenses. They can go as high as $16,500, as it 
has been for my family.
    But things were about to get much worse than expensive for 
our family. In mid-2017, President Trump merely suggested the 
scrapping of the massive Obamacare payments to insurance 
giants, which were delivering worse care at ever greater cost. 
And in response--because Obamacare, for some reason, permits 
this--every insurer in Northern Virginia with a family plan, 
including the one we had, pulled out for the following year, 
2018.
    Except one. Cigna Connect, however, wouldn't cover my 
daughter at Inova Fairfax, the one hospital in Northern 
Virginia, as I say, with a pediatric cancer ward. So under 
Obamacare, our daughter was effectively without coverage for 
cancer. Not the common cold or a broken bone, but cancer.
    We went through another terrifying event in 2020. In mid-
March of that year, with COVID sweeping the country, Anthem, 
the plan we had for that year, announced suddenly that on April 
1, it would no longer cover not the hospital this time, but the 
clinic where she received most of her doctor-administered 
chemotherapy. So we called the marketplace. Perhaps it would 
grant us a waiver to buy the Cigna plan still available for 
sale in our zip code. Not a chance, we were told.
    The failure of the ACA to cover our daughter battling a 
terminal illness was not considered, we were told, a 
``qualifying event.'' So once again, thanks to the ACA, we were 
left without coverage for our daughter, recovering from cancer 
at the clinic, the only one she could go to in Northern 
Virginia.
    Now in both cases of systems collapse, we were forced to 
turn to the author of these failures that is to the Government, 
to all of you. Specifically, we had called Senator Mark Warner 
for Virginia, one of our Senators, so he could bully a private 
company--Cigna in the first instance and Anthem in the second--
into covering, respectively, the hospital and the clinic. And 
in both cases, the threats from the State drove the insurance 
giants back into the marketplace.
    But I do hope all of you can see how these successes that I 
achieved were actually failures. Ad hoc exercises of Government 
power to ensure proper functioning of the ACA means we are not 
dealing, despite the rhetoric, with a marketplace, but rather 
with a closed web of insurance companies and medical providers 
at the mercy of the police powers of a complicit government.
    Now perhaps to solve the instability of Obamacare, which is 
inherent to it, the Government could just take over all medical 
facilities. But everybody in the country at that point would be 
at the mercy of the same Government bureaucracy that has been 
brutalizing my daughter and her parents for years.
    The high costs of Obamacare would go higher. The rationing 
of care that we've already experienced would be even more 
pronounced, and here is why. It's very simple. Bad ideas don't 
get better just because you make them bigger. They get worse.
    Twice in a three-year period, the most important problem 
that we faced wasn't high costs, bad as they were, but the 
terrifying reality that high prices in a planned, closed 
economy always signify that we are on the way to scarcity. 
Twice in three years we found ourselves with no insurance 
product to buy for any amount of money that could save a little 
girl battling cancer.
    And here's the thing that's the main point of what I want 
to say. Scarcity doesn't go away under universal coverage or 
single-payer, whatever word we want to use this week or next 
week to describe it. Under full Government control of the body, 
that is under full Government control of the body by all of 
you, scarcity wouldn't be, as it is in my case now, 
circumstantial. My family was effectively a canary in the coal 
mine.
    Scarcity under such authoritarian medicine becomes policy, 
and by that, I mean this. Those long wait times that everyone 
can read about for cancer screenings in Great Britain or 
Canada, that is scarcity made institutional, universal, but in 
a very bad way. And if you want an example closer to home, try 
the Government-run hospitals of the Veterans Administration, 
where people die in line waiting for care.
    In other words, if we unfortunately get more managed care 
from all of you, the Government, my daughter will be everyone's 
daughter. And every mother and father will experience what my 
wife and I have experienced. We watched our daughter battle 
cancer while the institutions of medicine, thanks to the ACA, 
colluded with the disease against her.
    There is one correct long-term answer in my view. We must 
prohibit the Government, that is to say all of you, from 
further interfering in the acquisition by private citizens of 
their preferred medical care, and we do that by repeal of the 
ACA and placing back into the hands of Americans real, 
actuarially sound, automatically renewable insurance products 
curated to individual needs. That is the kind of universal 
coverage this country deserves because it's the only kind that 
works.
    And now a word for my Republican friends. Obamacare, as you 
may know, has very little to do with actual insurance. It is 
essentially a giant scheme. Some would say, I would say a giant 
Ponzi scheme to pay for each other's medical bills. And since 
my daughter, thanks to the ACA, got very, very sick under a 
non-insurance regime, she is now permanently uninsurable.
    If we ever come to our senses in this country and give back 
to the citizens real insurance, my daughter will never be able 
to have one, and here is the logic. You cannot buy auto 
insurance after the car accident. My daughter managed to get 
sick with cancer. She's had that accident. She is permanently 
uninsurable.
    However, if I had been allowed to keep my pre-ACA plan, as 
President Obama promised, things would be very different. My 
daughter today would have insured, durable access to medical 
care. In essence, Obamacare turned an insurable illness, one as 
grave as cancer, into a permanent preexisting condition from 
which my daughter will never escape.
    But my daughter is not alone. Millions of persons have 
gotten sick under Obamacare, and everybody in this room, in 
this entire country, will someday suffer a serious illness, 
such as we'll call it fate for the purposes of this discussion. 
And soon enough, the number of permanently uninsurable will be 
so large that you won't be able to repeal Obamacare.
    Obamacare, in a word, is creating right now a nation of 
preexisting conditions. The Democrats know this. All they have 
to do is wait, and we will be forced to go full State takeover 
of the body. So how about it? When you Republicans get into the 
majority, you win both houses and possibly get the presidency 
back, will you give us back our bodily autonomy and repeal this 
law?
    Your doing so, however, won't help my daughter. For her, it 
is too late. She and the other victims of Obamacare will need 
Government healthcare for the rest of their lives. But the rest 
of us and for those yet unborn, it is not too late.
    And to put this another way, and this may sting, but when 
you come back into power, please, for the love of God, no more 
Paul Ryan-style tax cuts, which the other side will just 
eliminate or destroy by inflation as they're doing now. The 
State takeover of the human person by authoritarian control of 
medicine is far more worthy of your attention than any tax cut, 
no matter how deep.
    I thank both sides for the time given me to air my 
concerns.
    Chairwoman Maloney. Thank you.
    Mr. Starghill, you are now recognized for your testimony.

  STATEMENT OF BISHOP WALTER STARGHILL, JR., DETROIT, MICHIGAN

    Mr. Starghill. Well, thank you for allowing me to be part 
of this testimony and this great information that needs to be 
given out.
    I'm Bishop Walter L. Starghill, Jr., Eastern Michigan 
pastor of Face-to-Face Outreach Ministries. Thank God for 
Congresswoman Tlaib allowing me to be a part of the solution or 
the answer to bear witness what has happened to me.
    One of the things back in 2009, I was uninsured, pastoring. 
During the great migration out of the Michigan area, my 
membership dwindled. So, therefore, we didn't have the proper 
funding to make sure that I had insurance. So, therefore, I was 
uninsured.
    I had a condition which is called shingles that I didn't 
know I had, and at the time, I was feeling very bad. I went to 
actually one of the major hospitals at about 1 or 2 in the 
morning, which was an emergency, and I told them I didn't have 
insurance.
    They saw me, but they gave me the bare minimum. They 
checked my pulse. They checked my blood pressure and told me I 
may have shingles. But after that, they gave me a bill of $800. 
Now I couldn't afford it. It took me almost 6 to 7, 8 months 
just to pay that money back.
    But as a friend of mine told me that they had a clinic, 
which is the Western Wayne Family Health Center. It's a 
federally funded clinic, and could you possibly come up to them 
and see what they can do for you? So as I got worse and worse 
and as a person that didn't have insurance, you are very 
susceptible to just worry, worry, worry. And I was worried. So 
that made the condition even worse.
    So I finally went up to the clinic and filled out all the 
paperwork that they had to do for me, and they gave me a $20 
copay. So as they were doing that, filling out my paperwork, I 
had--over the time from the emergency room to the actual 
clinic, I had rashes all over the right side of my face, all 
the way going down my nose, and my eye, my right eye started to 
close. I was like Worf from Star Trek. I was in a bad 
situation.
    And as they gave me a shot, immediately that actual shot 
started to move everything back. So I thank God for that. And 
before that happened was, like I say, if I didn't have that 
clinic, I might have lost the sight in my eye. Yes, sight in my 
eye.
    Again, I had a scenario as a pastor. We went to Niagara 
Falls with our church. Fifty-six people went there, and we 
enjoyed ourselves. The weather was quite hot that day, and on 
the way back, one of the mothers fell ill. So we called 911--we 
were in Canada--and they came, picked her up in the ambulance, 
took her to the hospital, and ran every test that they had to 
run. And as they were doing that, we started to wonder how much 
the bill was going to be.
    And after they got her stabilized and everything up and 
running so she was able to travel back with us, I asked the 
doctor, well, how much is this going to be? The doctor said, as 
I was holding my breath, that it was $70 Canadian, which was 
$40 American. I quickly paid the $40 and got back on the road.
    Now, I don't know. America is the greatest country in the 
world. Yes, we do have some issues with affordable healthcare. 
Yes, we need to fix it. That's why we're here today.
    But the bottom line is I am one of the 30 million people 
that was not insured. I'm not talking about underinsured, but 
actually had no insurance. Now I'm able to live life and go to 
the doctor, go to the dentist, go to specialists now. So, 
therefore, I can live a confident, great life, yes, myself. But 
the bottom line is that we got to look at doing things better 
for the people.
    I thank you for this time, and I want you--I feel for the 
man that his daughter had these issues. But again, that's why 
we're here today is to talk about both sides where you can come 
with solutions that will help all of us obtain affordable 
healthcare.
    Thank you for my time.
    Chairwoman Maloney. Thank you. The gentleman yields back.
    And we now hear from Ms. Templeton. You are now recognized 
for your testimony. Ms. Templeton?

      STATEMENT OF LESLIE TEMPLETON, BOSTON, MASSACHUSETTS

    Ms. Templeton. Good morning, everyone, and thank you for 
having me.
    My name is Leslie Templeton, and it's a pleasure to be 
here. I am a 25-year-old disabled person, and some of my 
diagnoses 
include epilepsy, kidney disease, ADHD, familial 
hypercholesterolemia, and depression.
    Being 25 and sick is extremely funny. While many of my 
friends are worried about their careers, finding life partners, 
and what they're doing next week, I have the added worry about 
what my future holds regarding my health. I wonder if I'll 
always be able to access my healthcare and treatments. If, 
heaven forbid, something goes wrong, and I don't have access to 
healthcare, what will happen to me?
    Sitting before you, I'd be lying if I said there aren't 
nights I cry about this, scared of it all--of my diseases, of 
my future, of losing my healthcare. With Medicare for All, 
these wouldn't be concerns I'd have to live with every day of 
my life.
    I'm fortunate enough to be able to access the lifesaving 
healthcare I need right now. That is a privilege that has given 
me the ability to be here today. Before I was able to access 
treatment, I struggled to do most things or fully participate 
in life.
    I don't know if you'll understand how deeply I mean this, 
but having access to healthcare has allowed me to be a 25-year-
old. My Wellbutrin, an antidepressant, has given me the ability 
to enjoy life. My kidney medication is slowing, if not 
preventing, further progression of my kidney diseases, ensuring 
I feel well enough to live my life the way I want to.
    And there's so much more. I am fortunate enough to be able 
to afford these interventions currently due to my income level, 
a privilege not everyone has. Being sick is expensive, and that 
expense makes treatment inaccessible to so many people. Being 
able to access healthcare is not enough. It's being able to 
afford it, too.
    As long as I can always have access to healthcare and I can 
afford it, I will be able to hopefully live a long life. I'll 
get married. I'll see my kids graduate from college. I'll grow 
old and watch my body age gracefully. Without Medicare for All, 
that outcome is not guaranteed, just as it's not guaranteed for 
millions of Americans right now.
    What people don't talk about enough is the cost of staying 
alive. My ability to live is based on whether I can afford it 
or not, and that thought keeps me up at night. So many people 
are in a similar situation to me. Just look at GoFundMe. People 
shouldn't have to rely on charity to stay alive.
    To put it bluntly, I don't want to die. I want to live a 
long life without constant worry of whether I will be able to 
afford my meds each month or I'll have insurance to cover my 
doctors' visits. Medicare for All would give every American 
that peace of mind, especially those who rely on the healthcare 
system the most in order to stay alive.
    No one should go broke because they have a life-threatening 
illness. No mother should have to choose between getting her 
medication or her kids'. No child should have to watch their 
parents suffer through pain and ailments because they are not 
insured.
    We Americans are counting on you to change this reality for 
us because, again, to put it bluntly, we don't want to die.
    Thank you.
    Chairwoman Maloney. Thank you, and I would like to thank 
all of the witnesses for their powerful testimony today. You 
are now excused, and we will welcome our second panel. Thank 
you so much.
    We will pause a moment as we make a transition.
    [Pause.]
    Chairwoman Maloney. I would like to introduce our second 
panel of witnesses.
    Our first witness today is Dr. Uche Blackstock, who is an 
emergency physician and is the founder and CEO of Advancing 
Health Equity.
    Then we will hear from Dr. Sara Collins, who is the Vice 
President of Health Coverage and Access at the Commonwealth 
Fund.
    Next we will hear from Grace-Marie Turner, who is the 
President of the Galen Institute.
    Next we will hear from Dr. Jeffrey Sachs, who is the 
Director of Columbia University's Center for Sustainable 
Development and is the President of the United Nations 
Sustainable Development Solutions Network.
    Next we will hear from Dr. Jamila Michener, who is an 
associate professor at Cornell University and is the Co-
director of Cornell's Center for Health Equity.
    Finally, we will hear from Ady Barkan, who is the founder 
of Be A Hero.
    The witnesses will be unmuted so we can swear them in. 
Please raise your right hands.
    Do you swear or affirm that the testimony you are about to 
give is the truth, the whole truth, and nothing but the truth, 
so help you God?
    [Response.]
    Chairwoman Maloney. Let the record show that the witnesses 
answered in the affirmative.
    Thank you. Without objection, your written Statements will 
be made part of the record.
    With that, Dr. Blackstock, you are now recognized for your 
testimony. And please, let us all try to keep within our five 
minutes.
    Dr. Blackstock, you are now recognized.

         STATEMENT OF UCHE BLACKSTOCK, M.D., EMERGENCY 
        PHYSICIAN, FOUNDER AND CHIEF EXECUTIVE OFFICER, 
                    ADVANCING HEALTH EQUITY

    Dr. Blackstock. Hi, can you hear me? OK, hi, everyone.
    Thank you, Chairwoman Maloney, Representatives Bush, 
Pressley, Tlaib, Ocasio-Cortez, and all of the members of the 
House Oversight Committee here today. It's an honor to be 
invited to testify during this very important hearing, a key 
step toward addressing racial health inequities in our country.
    I'm Dr. Uche Blackstock, an emergency medicine physician 
with over 17 years of clinical experience, a second-generation 
black woman physician with lived experience with injustice, and 
the founder of an organization dedicated to advancing health 
equity. I have worked for years in communities where far too 
many of my patients were either uninsured or underinsured, 
mostly black and brown Americans who have sadly been 
disregarded by our country.
    They are not only dealing with mental and physical health 
issues, but also with systemic afflictions like bias and 
racism, housing insecurity, economic instability, and lack of 
access to reliable transportation. These are what we call the 
social determinants of health, the factors which influence the 
health and health outcomes of communities and people.
    Lack of access to healthcare is one of the primary social 
determinants of health. I've taken care of thousands of 
patients over the years, many I could never forget.
    The 40-year-old black man with a history of high blood 
pressure who came into my ER unconscious on a stretcher after 
he collapsed at home in front of his family. The paramedics 
were performing CPR on him. The CAT scan of his head showed a 
brain bleed, a complication of untreated high blood pressure. 
He had been unable to afford to pay out-of-pocket for his blood 
pressure medication since he lost a job a year prior and, as a 
result, his health insurance.
    The 55-year-old Latina woman who came into my ER 
complaining of bleeding and swelling from her left breast for 
several months. She explained that she did not have health 
insurance and did not have a primary care physician.
    After we spoke, I examined her and found a foul-smelling 
mass protruding from her left breast. It was advanced breast 
cancer.
    As Black people and people of color, just living in this 
country is an act of survival, let alone being able to access 
quality and culturally responsive health care. The ongoing 
COVID-19 pandemic and the country's presumed reckoning with 
racism has only exposed the deep preexisting fissures in our 
health care and public health system.
    Despite advances in health care innovation and technology 
over the last 75 years, Black men still have the shortest life 
expectancy, Black women have the highest maternal mortality 
rates, and Black babies have the highest infant mortality 
rates.
    Overall, Black Americans have a six-year life expectancy 
gap compared to white Americans, the widest gap since 1998 and 
widened even more by the pandemic. This pandemic should have 
been a wake-up call to help us understand the urgency of 
identifying a path toward making universal health care a 
reality, among other critical strategies to improve health 
equity.
    I have had a front row seat to the tragic loss of Black and 
brown life from COVID-19 and racism. During the height of the 
pandemic in New York City, I noticed my patients' demographics 
quickly shifted to more racially and socioeconomically diverse 
patient population to mostly Black and brown patients.
    They were essential workers, service workers. Some had 
underlying medical problems. Others were left with no choice 
but to use public transportation and many live in crowded 
multi-generational housing.
    I vividly remember an elderly Black man who came into my 
urgent care with shortness of breath and fever. He was in a 
wheelchair and his oxygen level was shockingly low. He lived 
alone.
    I was very worried that he had COVID pneumonia and asked if 
I could call an ambulance to bring him from urgent care to the 
closest ER. He refused. He didn't want to die in the ER, he 
told me. He didn't think he would receive good care because he 
didn't have health insurance. He felt safer at home.
    For many years, I worked in two ERs in New York City, 
Bellevue Hospital, the oldest public hospital in the country, 
and Tisch Hospital, a private institution that is part of NYU 
Langone Medical Center, among the wealthiest hospitals in the 
country that have gotten hundreds of millions of dollars richer 
after Federal bailouts.
    At these two ERs that, literally, sit next door to each 
other, I experienced firsthand deep inequities in our health 
care system, one that is separate and unequal. Patients were 
divided up based on insurance and race.
    Nationally, at private academic medical centers, Black 
patients are two to three times less likely than white patients 
to receive care, while uninsured patients overall are five 
times less likely than patients with insurance coverage to be 
treated.
    In cities across this country the top-ranked hospitals do 
not treat as many patients of color as white patients, even 
when they are located in diverse communities.
    This is the definition of systemic racism. People who look 
like me are living this every day. But it should not fall 
solely on us to always have to call out when something is 
wrong.
    Now is the time to protect our most vulnerable and 
underserved communities and identify a pathway to ensuring 
universal health care for all Americans. We must work to break 
the cycles of trauma and injustice, to foster generational 
progress for more people, especially people of color because it 
is cruel to talk about an American dream when only a select few 
live to see it.
    Thank you.
    Chairwoman Maloney. Thank you so much, Dr. Blackstock.
    Now we will hear from Dr. Collins. You are now recognized 
for your testimony.
    Dr. Collins?

 STATEMENT OF SARA R. COLLINS, PH.D., VICE PRESIDENT OF HEALTH 
           COVERAGE AND ACCESS, THE COMMONWEALTH FUND

    Dr. Collins. Thank you, Chairwoman Maloney, Ranking Member 
Comer, and members of the committee for this invitation to 
testify on past universal coverage.
    My comments will focus on gains in coverage since the 
passage of the Affordable Care Act, the effects of the pandemic 
and Federal relief efforts on coverage and policy options to 
cover the remaining uninsured, and lower consumer costs.
    The ACA brought sweeping change to the U.S. health system, 
expanding comprehensive and affordable health insurance to 
millions of lower and middle income Americans and making it 
possible for anyone with health problems to buy insurance.
    The number of uninsured people fell by nearly half after 
the ACA became law, dropping from 49 million people to a low of 
28 million in 2016. There has been a slight uptick since then.
    Research shows that the ACA lowered financial barriers to 
care and improve people's ability to afford health insurance 
and get needed care. Despite expectations that the pandemic 
would leave millions uninsured, the latest Federal data 
indicate that the uninsured rate is actually declining. This 
decline is due in part to the ACA's coverage expansions which 
provided safety net coverage for those who lost insurance and 
Federal COVID-19 relief bills that provided enhanced 
marketplace subsidies and a requirement that States keep people 
in Medicaid continuously enrolled in exchange for enhanced 
Federal matching funds.
    The result was record enrollment of nearly 15 million 
people in the marketplaces and nearly 84 million in Medicaid 
and the Children's Health Insurance Program.
    There are four risk factors that could reverse these gains 
and limit the ability of Americans to afford their health care. 
The end of the Medicaid continuous enrollment requirement and 
the enhanced marketplace subsidies could trigger extensive 
enrollment losses in Medicaid as States redetermine enrollee 
eligibility and in the marketplaces as subsidies decline.
    Twelve States have yet to expand eligibility for Medicaid. 
Millions of people are eligible for the ACA's coverage 
expansions but are not yet enrolled. Growth in health care 
costs is outstripping growth in median income, leaving millions 
of people under insured and with growing premium burdens.
    There are several targeted policy options that might 
mitigate these risks including extending the marketplace 
subsidy enhancements at the end of the public health emergency; 
requiring States to conduct Medicaid eligibility 
redeterminations gradually; fill the Medicaid coverage gap; 
maintain aggressive, targeted, and consistent outreach 
enrollment efforts to reach the remaining uninsured and keep 
people covered; enable people to automatically enroll in 
coverage; address the high provider prices that drive most of 
the health spending growth in private insurance and, by 
extension, growth in worker premium contributions and 
deductibles, such as through a public option.
    Allow more workers in expensive employer plans to access 
marketplace subsidies. Fix the family coverage glitch. Rein in 
deductibles and out-of-pocket costs and marketplace plans. Ban 
non-ACA compliant policies like short-term plans.
    But how can the U.S. reach universal coverage? Can we get 
there by building on the ACA or will it take a single-payer 
approach? This question was debated during the 2020 
Presidential election. The Urban Institute tackled it at the 
time by modeling reforms that built on the ACA in two versions 
of a single-payer approach.
    The ACA approach included auto enrollment and a public 
option that lowered provider plant prices close to Medicare 
rates. Urban found that it was possible to reach near universal 
coverage with this ACA approach as well as with the two single-
payer approaches.
    They also found that the ACA approach and one of the 
single-payer approaches reduced national health expenditures, 
even though nearly everyone is covered. This is because both 
approaches reduce private insurance prices paid to providers 
closer to Medicare rates.
    The debate at the time focused not on this fact but on the 
increase in Federal costs under a single-payer approach. But 
what commentators failed to point out was that this higher 
Federal cost was not because the single-payer approach was so 
much more expensive than our current system but that all of the 
responsibility for financing that spending shifted away from 
employers, households, and State governments to the Federal 
Government.
    We need to have reasonable discussions as a country about 
how to share our healthcare spending responsibilities. But it 
is not just about who pays but also about how much we pay and 
why and what we are getting for our spending.
    The U.S. has one of the most expensive health systems in 
the world and, yet we rank last among high income countries on 
most measures of health system performance, including access to 
care.
    Prices paid to providers in private insurance is one of the 
primary reasons we spend so much more. As we consider 
strategies to expand health insurance coverage and lower 
consumer costs, and as we weigh the benefits of those 
strategies against their Federal costs, it is critical that the 
prices paid to providers in private insurance be part of the 
discussion. Thank you.
    Chairwoman Maloney. Thank you, Dr. Collins.
    Ms. Turner, you are now recognized for your testimony.

  STATEMENT OF GRACE-MARIE TURNER, PRESIDENT, GALEN INSTITUTE

    Ms. Turner. Thank you, Chairwoman Maloney, Ranking Member 
Comer, and members of the committee and Representative 
Jayapal--lovely to see you again--for your sponsorship of the 
legislation we are considering today.
    So I would like to emphasize what I believe are widely 
shared goals for health reform and achieving universal access 
to care, coverage that is affordable, protecting the--
protecting quality and choice, and especially providing a 
strong safety net for the most vulnerable.
    There is no question that Americans are frustrated with our 
current health care system. Millions remain uninsured, and even 
for those who do have insurance, coverage and care cost too 
much. Many face deductibles that are so high that they say they 
might as well not be insured.
    But the more government gets involved, the more that we see 
the health sector is forced to comply with countless rules and 
regulations rather than innovating to respond to more choices 
of more affordable care and coverage for patients.
    Wharton Professor Mark Pauly, University of Pennsylvania, 
explains that the government exerts great control over our 
health sector with government affected spending, totally nearly 
80 percent and part of that, of course, is actually the 
government direct spending, which is nearly 60 percent, on 
public programs. Medicare for All and its derivatives such as 
Medicare buy-in or a Federal public option would take us 
further toward government control of our health sector with 
fewer choices and where, I believe, vulnerable patients, as we 
see in so many other countries, with the greatest health care 
needs would have to fight even harder to get access to the care 
that they need.
    In proposing policy solutions, I believe it is important to 
begin by clearly defining the problem that we want to solve. 
The Congressional Budget Office reports that 29.8 million 
people were uninsured in 2019, two-thirds of whom were eligible 
for existing public or private coverage but were not enrolled. 
Most of the remaining one-third were not lawfully present in 
the United States, a problem for immigration and citizenship 
policy, rather than health policy.
    Medicare for All also would mean that virtually everyone 
would lose the plans they have now and there would be no choice 
but the one government-run health plan for 173 million 
Americans who value their employer-based health insurance 
including millions of union workers and 64 million seniors with 
Medicare, including 26 million with private Medicare Advantage 
plans.
    The CBO found that establishing a single-payer system would 
be a major undertaking that would be complicated, challenging, 
and potentially disruptive, and that the changes could 
significantly impact the overall U.S. economy.
    Three States--Vermont, Colorado and, recently, California, 
as I describe in my testimony--came to similar conclusions in 
shelving their plans for single-payer.
    So rather than dramatically expanding the role of 
government through new or expanded taxpayer-supported programs, 
I believe we need targeted approaches to address the specific 
needs of those who are uninsured, underinsured, and especially 
focusing on those of marginalized communities.
    Uninsured rates continue to be higher in certain 
populations, as we have as we have heard other witnesses say, 
including Latinos, Blacks, those with incomes below the poverty 
level, and residents in States that have not expanded Medicaid.
    Tragically, it is often the most vulnerable who are left 
behind when demand for services outpaces resources. Just five 
percent of the population accounts for more than half of U.S. 
health spending. Those who are the sickest with the greatest 
health care needs are most often disadvantaged, as political 
leaders inevitably have to balance then in between them and the 
great majority of healthier constituents.
    Medicare for All will restrict access to new medicines and 
treatments, lead to dramatic increases in Federal spending, and 
really turn back the clock, I believe, on innovations in 
personalized care.
    I concluded my written testimony and will conclude here 
describing the experience of Janet, a patient from Colorado 
with multiple health challenges. Janet received coverage under 
the ACA but said her access to care was far worse than the 
State-run high risk pool that she had participated in before, 
even though her premiums and co-payments were much higher.
    I worked with a number of policy experts through the Health 
Policy Consensus Group to focus on policy recommendations for 
patient-centered reform and I also commend the Healthy Future 
Taskforce that is underway here with a number of solutions to, 
again, move toward solutions but in a patient-centered way.
    I would welcome the opportunity to work with you to achieve 
the goals of access to more affordable coverage for everyone, 
better protection for the vulnerable through targeted 
solutions.
    And thank you for your invitation to testify. I look 
forward to questions.
    Chairwoman Maloney. Thank you, Ms. Turner.
    Dr. Sachs, you are now recognized for your testimony, and I 
understand you are testifying from Berlin.

        STATEMENT OF JEFFREY D. SACHS, PH.D., DIRECTOR, 
          COLUMBIA UNIVERSITY CENTER FOR SUSTAINABLE 
DEVELOPMENT, PRESIDENT, UNITED NATIONS SUSTAINABLE DEVELOPMENT 
                       SOLUTIONS NETWORK

    Dr. Sachs. I am, indeed, Chairwoman. We have multiple 
crises in the world and one of them, unfortunately, is nearby 
here.
    Let me proceed expeditiously for you. Thank you for the 
hearings. If you could move to the next slide.
    [Slide.]
    Dr. Sachs. The U.S. system is completely broken. This is 
the main point. We are spending a fortune, unlike every other 
country, and we are getting worse outcomes. This is what needs 
to be understood beyond the ideology, beyond the anecdotes. We 
are going broke from a system out of control, and this is from 
the wonderful Commonwealth Fund report. I think you are going 
to have a witness from Commonwealth Fund. They do great work.
    And what you see is the top line is the U.S. spending 
percent of GDP. This goes up to 2019, about 18 percent of GDP. 
Now we are almost 20 percent of GDP in the most recent data.
    Look at all the rest of the countries, all of them. We are 
broken. If you move on, it is the same story. We are broken. 
Here, all of the other countries have higher life expectancy 
than the United States and the gap is widening dramatically. We 
are broken. We spend far more on health care, we get far less, 
because we don't even have a healthcare system. We have a 
hodgepodge of private overpriced monopolies, whether for profit 
or not for profit. I will say a word about that later on. But 
this is a broken, unfair, out of control costs system that 
doesn't deliver.
    Next, please.
    [Slide.]
    Dr. Sachs. So I referred to the Commonwealth report. You 
could go on to the next slide.
    [Slide.]
    Dr. Sachs. We rank last--last--in our health system 
performance and we rank last in access to care, last in 
administrative efficiency, last in equity, last in health care 
outcomes.
    Let us stop with the individual anecdotes and just look at 
our system compared to the rest.
    Next slide, please.
    [Slide.]
    Dr. Sachs. This, again, we spend more--that is on the 
horizontal axis. On the vertical axis is performance. The U.S. 
is that little dot on the bottom right, expensive and poorly 
performing. All the rest of the countries less expensive and 
better performing.
    Next, please.
    [Slide.]
    Dr. Sachs. We spend a fortunate in administrative costs. 
When you go into a doctor's office or a hospital, you spend 
hours, in the end, either before or during or after, filling 
out forms trying to get reimbursed, trying to figure out what 
is covered, who is in the network, who isn't in the network. I 
can tell you even with a physician and Master's of Public 
Health, Ph.D. degrees, it is almost impossible to navigate the 
U.S. system now and the result is administrative costs out of 
control, unlike any other country.
    Next slide, please.
    [Slide.]
    Dr. Sachs. Again, we are spending 10, 15, even 20 percent 
of outlays on administration, people that are working--hundreds 
of thousands of people employed to move between different 
accounts because it is private this, it is private that, who is 
going to reimburse this, who pays for that. It is unbelievable 
the amount of time we are burning in order to run this 
ramshackle nonsystem.
    Next, please.
    [Slide.]
    Dr. Sachs. The expenditures continue to soar, and in 2020 
we reached almost 20 percent of GDP, basically, twice what 
other high income countries are spending that are getting the 
same or better outcomes than in the United States.
    This is what I would plead for the committee. Look at the 
rest of the world. Not at our own internal, ideological, 
bizarre discussion, but at the comparison with what is 
happening elsewhere because there are so many solutions abroad.
    Next.
    [Slide.]
    Dr. Sachs. Life expectancy stopped rising a decade ago. It 
is falling in the United States. When will we understand we are 
falling apart in this country and our health system doesn't 
deliver? It doesn't deliver preventative health.
    This tragic story of Dr. Blackstock of the patient who 
comes in with advanced breast cancer who couldn't afford to be 
seen beforehand, that is a system? That is the United States of 
America?
    It is shocking and it shows up in the most basic measure of 
societal performance. No, not GDP, life expectancy, which is 
falling in the United States because we are becoming completely 
dysfunctional.
    Next, please.
    [Slide.]
    Dr. Sachs. We are at the top of avoidable deaths. Again, 
from the Commonwealth Fund, if you look in detail at what the 
cause of deaths are, these are preventable deaths. But the 
United States has the most of them and it has the least 
reduction of them of all of our peer countries.
    Next, please.
    [Slide.]
    Dr. Sachs. Costs for low income populations. Well, we have 
heard this repeatedly--out of control, unlike all of our peer 
countries. We are the country all the way to the right hand 
side. We look different from all of the rest of the countries.
    Next, please.
    [Slide.]
    Dr. Sachs. We have, as you know, an epidemic even before 
COVID of deaths of despair. We have soaring deaths from 
suicide, from substance abuse, opioid overdoses, and so forth, 
for people who are battling economically as well, and so you 
see the biggest rises for the white population with no college 
degree. This is an absolute shocking epidemic in the United 
States of America without a health system to address it.
    Next, please.
    [Slide.]
    Dr. Sachs. We have vast differences across the States. 
Typically, as is true in U.S. politics, the States farthest 
behind are the ones most defending the status quo. Very sad. 
But this is how our politics is absolutely upside down.
    Instead of a system that could work, we have an opposition 
to State control, as if we have a functioning market system.
    Next, please.
    [Slide.]
    Dr. Sachs. What we have is a scam going on. Please 
understand. We have the most high-priced high-cost system and 
we have a system that is filled with its sense of success 
because they are making a fortune.
    This is what I clipped from the Wall Street Journal list of 
our CEOs of our pharmaceutical industry. What do you want, $20 
million salary? Twenty-five million a year salary? Thirty 
million a year salary? That is the game of the United States of 
America health care system.
    Chairwoman Maloney. Dr. Sachs----
    Dr. Sachs. Yes?
    Chairwoman Maloney.--you are way over time. It is 
fascinating. Way over time.
    Dr. Sachs. I am sorry. Can I come quickly to an end? I will 
come--just next slide. I will come very quickly to an end.
    [Slide.]
    Dr. Sachs. Our not for profit hospital administrators are 
making millions and millions of dollars.
    Next, please.
    [Slide.]
    Dr. Sachs. I will just do--forgive me, Chairperson. I just 
want to make two more points.
    Chairwoman Maloney. Please--OK. All right.
    Dr. Sachs. This is an incredibly profitable industry. That 
is where the high prices go.
    Next slide.
    [Slide.]
    Dr. Sachs. This is the biggest lobbying industry. I don't 
have to say this in congressional testimony. Everybody knows 
it. This industry lobbies a fortune and makes a fortune. It is 
a scam, and we should compare with the rest of the world and 
see what we are getting. We are wasting a trillion dollars a 
year that is going into administrative costs----
    Chairwoman Maloney. Thank you.
    Dr. Sachs [continuing]. High costs for products, for 
prices, for devices----
    Chairwoman Maloney. Thank you.
    Dr. Sachs [continuing]. For hospital care. Thank you very 
much, Chairwoman.
    Chairwoman Maloney. Thank you. Thank you. The gentleman 
yields back.
    And now, Dr. Michener, you are now recognized for your 
testimony.

        STATEMENT OF JAMILA MICHENER, PH.D., ASSOCIATE 
          PROFESSOR, CORNELL UNIVERSITY DEPARTMENT OF 
          GOVERNMENT, CO-DIRECTOR, CORNELL UNIVERSITY 
                    CENTER FOR HEALTH EQUITY

    Dr. Michener. Thank you, Chairwoman Maloney, and the 
members of the Oversight Committee and everyone who is here 
today.
    My name is Jamila Michener. I am an Associate Professor of 
Government and Public Policy at Cornell and also co-director of 
Cornell Center for Health Equity. I am going to focus today in 
my comments on underscoring the role of universal health 
insurance coverage, particularly in addressing racial health 
inequities, but also in terms of strengthening our democracy.
    So health equity has never been a reality for people of 
color in the United States. It has never been a reality for 
Black, Latinx, or indigenous people in the United States. 
Notwithstanding changes that have happened over time and some 
improvements that have occurred, we have seen persistent and 
continual disparities.
    Consider just a few examples that are striking and 
contemporary. Black and indigenous Americans live for fewer 
years, on average. Black and indigenous Americans are more 
likely to die from treatable preventable conditions. They are 
more likely to die when there is no need for them to die on 
account of a lack of access to health coverage and health care.
    Black people are at a higher risk for chronic health 
conditions like diabetes and hypertension. They are more likely 
to die from breast cancer and colon cancer. Importantly, this 
is particularly because of late stage diagnosis and 
differential treatment.
    Black and indigenous women are more likely to die during or 
after pregnancy, to suffer serious pregnancy-related 
complications and they are more likely to lose children in 
infancy.
    All of these things, of course, were exacerbated and became 
worse during the pandemic, and the few disparities that I just 
discussed are only the tip of a much, much larger iceberg, an 
iceberg that this country has been crushed under since before 
it was even the United States.
    Crucially, these inequities are a product of systemic 
forces, not individual choices. This isn't about people being 
able to choose. In fact, it is about the lack of options, the 
lack of ability to have equitable access, and much of this lack 
is grounded in systemic racism.
    Systems of racial stratification shape whether you live in 
a neighborhood that will promote your health, whether you have 
access to resources like health insurance to sustain your 
health, whether you have daily experiences with things like 
discrimination that might undermine or threaten your health, 
and importantly--and I will address this shortly--whether you 
have influence over the political processes that can be 
activated to protect your health.
    Inequitable health insurance is a key factor that 
contributes to this range of disparities. So the fact that 
people of color have lower access to health insurance is a 
significant, life-threatening, policy-altering problem. 
Unequal, unstable, unaffordable, and constrained access to 
health insurance contributes to people of color experiencing 
their healthcare system as profoundly discriminatory and 
difficult to navigate.
    People of color are more likely to delay care or forego 
treatment. They are less likely to and struggle to adhere to 
prescribed medication and treatment regimes and, again, these 
disparities are not lessening. If anything, they are widening.
    Access to health care is an ethical and human rights 
principle. It means that everyone has a fair--health equity, 
rather--it means that everyone has a fair and just opportunity 
to be as healthy as possible and, of course, access to health 
insurance is a critical determinant of whether health equity 
could be a reality.
    I want to spend the last bit of my time here pointing 
something really important and often overlooked out. Over and 
above the noted material and health benefits of having access 
to health coverage, which we have heard quite a bit about 
today, that access would provide people who receive that 
coverage with a strengthened position in our democracy. It 
would reinforce their civic status and reinforce our promise as 
a country, as a polity, of full inclusion for all. This 
connection is not obvious.
    But social scientists--political scientists, in 
particular--have established that health and health policy are 
crucial for democratic--full democratic participation. Medicaid 
is a perfect example. Medicaid expansion is associated with 
boost in voter turnout.
    Disenrollment is associated with declines in rates of 
voting. Medicaid beneficiaries and their ability to participate 
in politics is a function of their experience with the program.
    This is not about partisan politics or electioneering. It 
is about ensuring that people with the most at stake, with the 
most to lose here, many of the people we have been using in our 
anecdotes, that they actually have meaningful influence over 
the political processes that determine their ability to thrive 
and survive, and we know that that influence happens when, in 
fact, they have access to the resources that they need to allow 
them to be full and equal members of our democratic polity.
    I want to end with words from a Medicaid beneficiary from 
systematic qualitative research that I did. This is a woman 
from Georgia named Lucy. She says, I think a lot of people on 
Medicaid and without insurance are scared that their voice is 
not going to be heard, at the end of the day, that no matter 
how much you protest or how much you call on those in higher 
upper seats, it is as if our voices don't matter. And people 
think, why should I even say anything? It is not going to 
change.
    But in actuality, it might just be that one vote that 
pushes us to change everything. But to us sitting down here, 
looking at those up there, it is like our voice--what is my 
little voice going to do?
    Lucy and other people who are fighting for health equity, 
especially racial health equity, in this country have voices 
that we ought to be responsive to. Universal health coverage is 
part and parcel of precisely that responsiveness.
    Thank you.
    Chairwoman Maloney. Thank you, Dr. Michener.
    And Mr. Barkan is our last panelist and you are now 
recognized for your testimony.

        STATEMENT OF ADY BARKAN, JD, FOUNDER, BE A HERO

    Mr. Barkan. Good morning, Chairwoman Maloney, 
Representative Bush, and members of the committee. Thank you 
for holding this hearing and inviting me to testify.
    My name is Ady Barkan and I am the co-executive director of 
Be A Hero, an organization whose mission is to win health 
justice in America.
    As you can see, I am currently in bed. I live in California 
and it is rather early here, and because I am living with the 
neurological disease ALS, which has left me almost completely 
paralyzed, it takes me a very long time to get ready in the 
morning. So I am grateful for your grace in permitting me to 
participate from bed.
    But I am even more grateful that it is my bed in my 
bedroom, in the home I share with my wife and our two young 
children. I am able to live at home because I have 24-hour home 
care. Without it I would be forced to live in a nursing home 
separated from the people I love.
    I don't know if that would be a quality of life that I 
would be willing to tolerate. Home care is, literally, keeping 
me alive.
    Three years ago, I came to the Capitol to testify in the 
Rules Committee as the first ever hearing about Medicare for 
All. I was emaciated, weighing about 100 pounds, down from 160. 
I had trouble breathing and was sweating even though the room 
was cold. Every month, my body deteriorated further. I felt 
like I was dying.
    Later that year, I had to decide whether to get a 
tracheostomy, a procedure to implant a breathing tube into my 
windpipe to compensate for my failing diaphragm. But I didn't 
know how I would be able to pay for the care that would allow 
me to stay alive.
    My insurance had already denied me a ventilator, stating 
that it was experimental, and then two weeks after that, they 
rejected access to an FDA-approved ALS drug. Even good health 
insurance, which I have, does not cover the long-term home care 
I need to survive. Paying out of pocket would have left my 
family bankrupt quickly.
    And so for too long after my diagnosis, my wife, Rachel, 
and I tried to get by without homecare, which put the burden on 
her to care for both my young son and me.
    We eventually secured 24-hour home care after suing my 
health insurance company in Federal court. Home care has been 
life changing, allowing me to participate in my family's life 
in ways I thought were no longer possible for me.
    My daughter, Willow, was born six months after I gave my 
testimony and now I am a father to two beautiful wild children. 
But it shouldn't take a seasoned activist, a team of lawyers, 
and the generosity of strangers and friends to get the health 
care you need to survive. The reliance on crowdfunding to 
afford healthcare is a uniquely American tragedy. My outcome is 
the exception. But the challenges we face fighting insurance 
companies for services we are rightfully owed are not.
    We spend such absurd amounts on health care and we get such 
bad outcomes for our money. The high cost of care and 
infuriating bureaucracy burdens all of us, including nurses and 
doctors, working families and small businesses.
    The only people who benefit from this absurd system are the 
corporate executives who profit off of our pain and spend 
inordinate amounts of money trying to stop you from making life 
much better for your constituents.
    We have allowed greedy health care corporations to set the 
parameters of what we can expect of our health care system, and 
because of it, we have been forced to normalize the fate of 
bankruptcy, illness, and death.
    It is shameful that in the richest country in the world we 
choose to inflict so much suffering. Since that first hearing 
about Medicare for All, our country has been through the worst 
public health crisis in a century.
    The pandemic has revealed and exacerbated the existing 
inequalities in our profit-driven health care system. It has 
hit hardest on disabled people, poor people, Black, Latino, and 
indigenous people, and especially people who live at the 
intersections of these categories, and one out of three COVID-
19 deaths in the U.S. are related to gaps in health insurance.
    Nearly a million Americans have already died from the 
coronavirus. How much more is necessary to shock our 
legislators into action? When we lost 3,000 lives on September 
11th, we responded by reorganizing our national security 
system, launching a global war on terror, and conducting two 
massive invasions and occupations.
    Three hundred times more people have died in this pandemic 
but we have not marshaled our national energy to build a better 
health care system. It is a scandal and it is a shame.
    But in the last two years, we have also seen glimmers of 
what is possible when our government takes action to prioritize 
people over profits and works to guarantee care for all.
    Congress subsidized the Affordable Care Act marketplace 
plans, leading to unprecedented enrollment, and paid States to 
keep millions more people on Medicaid. As a result, more 
Americans have health insurance than ever before.
    Taxpayers funded vaccine research and then our government 
made vaccines easily accessible to all at no cost, and 
recently, our government made rapid test kits available to all 
Americans who requested them free of charge.
    These programs and many others are at risk of ending if 
Congress does not fund them and when the pandemic emergency 
policies expire. Instead of returning to the status quo, which 
fails all of us and especially our most vulnerable communities, 
we should build on the progress we have made during the 
pandemic.
    The American people deserve so much more and so much 
better. Our seniors and disabled children and adults deserve to 
live at home, not be warehoused in institutions. Working people 
deserve high quality care, regardless of their income or their 
employer marital status.
    The people of rural America deserve good mental health care 
options, good community clinics, good accessible hospitals, and 
so do the residents of poor urban America and the people who 
live on Indian reservations. And seniors on Medicare deserve 
care also for the parts of their body above their necks, which 
means their teeth and eyes and ears and minds.
    We can and must do better. We know what the solution is, a 
system that brings everyone in and abandons no one, where we 
are patients and people, not opportunities for profit. The road 
to reach the better world of our imagination may be long and 
there are many obstacles in our way.
    But our North Star is clear. It is time for America to 
guarantee comprehensive, affordable health care to all. The 
best way to do that is by enacting Medicare for All. If each 
one of us continues to demand better, if, together, we build an 
even more powerful movement for health justice, then I know 
that someday we will get there. Thank you.
    Chairwoman Maloney. Thank you so much for your testimony. I 
now recognize myself for five minutes for questions.
    In 2010, President Obama signed the Affordable Care Act 
into law, laying the groundwork for over 30 million people to 
achieve affordable and available health care. Republicans not 
only opposed this law, but in the past decade have voted over 
60 times to repeal or weaken it.
    Dr. Blackstock, you gave very moving examples of health 
care challenges. As an emergency physician who sees patients 
directly, how does access to health care coverage affect a 
person's health?
    Dr. Blackstock. Thank you, Chairwoman. Well, I mean, access 
to health care coverage is key. Unfortunately, what I often see 
in the emergency department, especially working in the 
communities that I work in, are people who, because they do not 
have insurance, will come to the ER sometimes for treatment of 
chronic medical problems or come for issues like advanced 
cancer, as I described with the patient that I had, with 
preventable diseases that have essentially become chronic and 
even late stage.
    And so they are at the point in their disease process 
where, you know, it is very costly for them to even be able to 
afford to pursue treatment. And so access to care, essentially, 
results in improved health for my patients and enables them 
to----
    Chairwoman Maloney. Thank you. Reclaiming my time----
    Dr. Blackstock [continuing]. Utilize primary services.
    Chairwoman Maloney.--because I want to get to Dr. Michener. 
You have studied the relationship between access to coverage, 
health equity, and racial justice. How did coverage gains under 
the Affordable Care Act advance health justice in the United 
States?
    Dr. Michener. Well, coverage gains advance health justice, 
in particular, in relationship to racial justice by allowing 
more Black and Latino people to have health coverage than had 
before and we see this in particular in Medicaid expansion 
States where the increases in terms of access to health 
insurance were most striking among Black and Latino Americans. 
And so that is a key factor. Of course, it is more challenging 
in nonexpansion States. So that gives us like a kind of primary 
lens into the importance of access.
    Chairwoman Maloney. Thank you so much. And in this 
Congress, I was proud to join over a hundred of my colleagues 
in reintroducing Congresswoman Jayapal's Medicare for All Act, 
which would transition the United States to a national single-
payer health care system.
    So, Dr. Sachs, how would the Medicare for All Act expand 
access to health care while controlling skyrocketing costs that 
you pointed out in your testimony?
    Dr. Sachs?
    Dr. Sachs. Chairwoman, ACA expanded coverage but it did not 
control prices. We need Medicare for All to do both, to ensure 
coverage and to ensure a system in which highly concentrated 
highly monopolized service providers don't charge an arm and a 
leg--literally, don't charge prices that are twice what other 
countries pay.
    For each procedure--diagnostic, medicines--we are out of 
control in price. So Medicare for All would ensure coverage, 
control prices, and, by my estimates, save about a trillion 
dollars a year for the U.S. economy.
    In my world, a trillion dollars a year is not small change. 
We could use the savings.
    Chairwoman Maloney. Thank you so much. Let me conclude with 
you, Mr. Barkan, and thank you for your bold advocacy and for 
your powerful testimony before us today. You remind us all why 
we are all in this fight.
    Why is it so crucial that we achieve universal coverage in 
the United States?
    Mr. Barkan?
    Voice. OK. Just a minute while he writes his answer.
    [Pause.]
    Voice. OK. He is writing.
    Chairwoman Maloney. He is writing it. It takes him a few 
minutes, if everybody understands.
    Mr. Barkan. We deserve dignity and health. Because we 
deserve dignity and health.
    Chairwoman Maloney. Thank you. Thank you for your Statement 
for equity in health. And, in conclusion, as we will hear 
today, Democrats have proposed a number of different policies 
to move us toward a universal coverage, including Medicare for 
All.
    Our party has a diverse set of ideas on how to reach this 
goal. But we stand unified in pushing to make healthcare more 
affordable and available for every person in the United States.
    I thank all of our witnesses for their testimony this 
morning. I yield back, and now I yield to the gentleman from 
Georgia, Mr. Hice.
    Mr. Hice?
    Mr. Hice. Thank you, Madam Chair. We all realize this is a 
complicated issue but the solution is not government takeover 
of the health care. It is returning power to the patients, not 
overwhelming doctors and hospitals with regulations. This is a 
disastrous pathway to go down.
    Ms. Turner, I would like to begin with you, if I may. And I 
realize it is extremely difficult to try to take the cost issue 
out of the debate discussion, but I want to try. OK.
    So if we were in some magical land where money was no 
object, in spite of that, are there still problems that exist 
with a government socialized healthcare system?
    Ms. Turner. Congressman, there will always be resource 
constraints. That is the world we live in. There are only so 
many physicians, so many hospitals. They have to be paid. The 
people that I worry about most in a system like that are the 
most vulnerable.
    I had a father write to me after Medicaid was expanded in 
his State and he said that there is so many people now on 
Medicaid that it is almost impossible for him to find a 
urologist to treat his daughter with multiple health problems. 
He has to wait sometimes six months for an appointment.
    So when you see the people who are most vulnerable having 
to struggle the most for care, it is because of resource 
constraints. The studies that have been done on Medicare for 
All, Congressional Budget Office said that we would likely see 
physicians paid 40 percent less, hospitals 30 percent less. 
Many of them wouldn't be able to keep their doors open.
    The American Medical College says that they expect at least 
to have 120,000 fewer physicians. So when we think about 
putting everybody in the same system, the people who need care 
the most are the ones who have to fight the hardest for it 
because the resources are constrained.
    Mr. Hice. And what would happen to those who currently have 
coverage that they like.
    Ms. Turner. I think that is really a major issue. We are a 
diverse country and your health--our health sector really 
represents that diversity. And as I said in my testimony, about 
175 million people have employer coverage, either employees, 
retirees, or dependents, they value, including many union 
workers, 64 million people on Medicare, including about 26 
million with Medicare Advantage plans that they have chosen, 
among many others.
    So the disruption of having one single plan following the 
same set of rules, I think, would find--as diverse and often 
complicated as our current system is it is because people are 
responding to top-down rules rather than responding to patients 
and what they want and I think they want choice and control and 
diversity.
    Mr. Hice. So there is a problem on both sides of the 
equation. So is it fair to say, in your opinion, that even 
those who would be--that those currently who need health care 
that they themselves through the long lines, the waiting 
periods, all these things--some of the things you mentioned a 
moment ago--would they be satisfied with a government-run 
socialized health care system?
    Ms. Turner. Well, you see in the Medicaid program today too 
many people are forced to go to hospitals--hospital emergency 
rooms for even routine care and that is because often 
physicians are paid so little for providing care for Medicaid 
patients.
    I had a physician write to me one time and he said he had 
taken care of a patient with relatively complex pulmonary 
problems. When he got his check from Medicaid, after going 
through all the paperwork, he got a check for $0.06. He said, I 
can only see so many Medicaid patients.
    Mr. Hice. Wow. OK. And there are problems with this type of 
system all around the world where it has been attempted. What 
about right here in America in Vermont? What went wrong with 
Vermont's attempt?
    Ms. Turner. So Vermont wanted so much to be able to be the 
first State to be able to produce the single-payer system and 
they invested an enormous amount of time, energy, and money in 
coming up with the--with a plan they thought could work for 
their State.
    And, ultimately, it was rejected because they realized, as 
happened also in Colorado, that it was really going to tank the 
economy with the taxes and the resource-forced constraints and 
that people were going to have fewer choices than they do 
today.
    Mr. Hice. And it will tank our economy if we go that path 
and provide fewer choices as well. So I thank you for your 
testimony. I appreciate it a great deal.
    And with that, Madam Chair, I yield back.
    Chairwoman Maloney. The gentleman yields back.
    The gentlelady from the District of Columbia, Ms. Norton, 
is now recognized.
    Ms. Norton. Thank you, Madam Chair. This is a very useful 
hearing. We are learning what the Affordable Health Care Act 
has achieved so that we can evaluate what more needs to be done 
to improve it until we get universal health care. This is, 
certainly, far less than what it is that we want in the long 
run.
    When I look at last year, 11 million people used the ACA 
marketplace. Fourteen million people--and this one is 
particularly important--have enrolled in Medicaid as a result 
of the ACA's Medicaid expansion, and I think it is important to 
note that millions of people have benefited from the ACA's 
protections for people with preexisting conditions. So it has 
done a great deal.
    But, Dr. Collins, let me ask you how the ACA has improved 
the economic security of families in the United States, 
particularly those who have historically struggled for access 
to health care.
    Dr. Collins. Thank you very much, Congresswoman. Lots of 
research has shown that we have not only--the ACA has not only 
led to enhanced insurance coverage and dramatically reducing 
uninsured rates but it is also lowered financial barriers to 
care, reduced people's medical debt burdens, reduced out-of-
pocket spending for a lot of people who have had preexisting 
conditions, for example, prior to the Affordable Care Act's 
reforms.
    So this has been a substantial change both for coverage 
rates but also for reducing--for improving people's financial 
security.
    Ms. Norton. How much, Dr. Collins, have people in the 
United States saved in out-of-pocket healthcare costs since the 
passage of ACA?
    Dr. Collins. It varies quite a bit by States and the type 
of coverage people have. But there has been a significant 
improvement in premiums, what people faced prior to the 
Affordable Care Act.
    When you went to get coverage in the individual market you 
had to pay the full premium. You do not have to do pay the full 
premium anymore. There are subsidies to help you if your income 
is under 400 percent of poverty.
    Medicaid expansion has been substantially important for 
people with very low incomes, reducing premium costs to zero, 
very low--very low out-of-pocket spending and cost exposure in 
those two expansions.
    Ms. Norton. Finally, Dr. Collins, you could help us a great 
deal. What steps can Congress take to build on the ACA and move 
where we want to go to universal coverage?
    Dr. Collins. The Urban Institute has analyzed a set of 
proposals that shows that we can get to universal coverage by 
building on the Affordable Care Act: Medicaid expansion in 
every State, an auto-enrollment mechanism, public options 
addressing the high provider prices that I talked about in my 
testimony.
    We can get to universal coverage by the building on the 
Affordable Care Act. It is critically important that we have a 
way of auto-enrolling or people have a way of auto-enrolling in 
coverage.
    Keeping people on the Medicaid experience of the last--
during the pandemic shows how much more enrollment you can get 
in Medicaid if people can stay on Medicaid rather than having 
to get on and off all the time. So but it is, certainly, 
possible to get there by building on the law.
    Ms. Norton. Well, we do know that if it weren't for the ACA 
millions more people would face catastrophic medical debt or 
the choice between paying for their medical care or, perhaps, 
for groceries.
    But I do think it is time to build on the progress 
Democrats secured with the ACA by enacting policies that move 
us toward universal coverage. That is where we need to go.
    Thank you very much, Madam Chair, for this hearing and I 
yield back.
    Chairwoman Maloney. The gentlelady yields back.
    The gentleman from Wisconsin, Mr. Grothman, is recognized 
for five minutes.
    Mr. Grothman. Thank you. There, obviously, are many reasons 
for the high cost of health care in this country. But as the 
ranking member on the subcommittee dealing with Homeland and 
being on the border quite a bit, I always talk to the Border 
Patrol and they tell me at least one of the draws for people 
coming here illegally is promises to pick up their health care. 
Obviously, nothing is free.
    Ms. Turner, maybe you could comment a little bit on the 
effect on health care costs in the private sector as more and 
more people come here illegally and who is paying for their 
health care?
    And, again, I will remind you that the Border Patrol have 
told me that they feel that some people are coming into this 
country not just because the administration, obviously, has 
somewhat of an open door policy but because they feel they are 
getting free health care. Who is paying for that health care?
    Ms. Turner. A number of different programs are paying for 
their health care. They are disproportionate share hospital 
payments to hospitals that have more patients who cannot pay 
for their care. You actually see employer plans paying more for 
coverage because private--because public plans and 
uncompensated care drives up the cost. So in many cases, it is 
taxpayers and it is also people with coverage and private 
plans.
    Mr. Grothman. Right. How many of these people are paid for 
by a government program and how many directly have to be eaten 
by the providers?
    Ms. Turner. You know, I was interested to see when I was 
looking at the CBO study on the uninsured that about half of 
the uninsured actually--of illegal immigrants actually have 
coverage. So I think there are different ways for people to get 
coverage than through----
    Mr. Grothman. Right. If somebody comes here and, I suppose, 
to get coverage from an employer, right?
    Ms. Turner. I would presume employer but they may have 
actually some private plans that they buy--short-term limited 
duration plans, other private plans.
    Mr. Grothman. OK. When people don't have plans and the 
number of illegal immigrants in this country--different people 
argue about 10 million, 20 million, we don't know.
    Let us say there are 15 million people here illegally. 
Obviously, that is going up every month considerably and it is 
particularly going up in significance if the Border Patrol is 
right in telling me that some people come here specifically for 
the free insurance.
    Does that cause private insurance or insofar as individual 
hospitals bill out their billing to go up to compensate for the 
people that they are--that they have to pay for health care 
that they are not being compensated on?
    Ms. Turner. Yes, and they--price negotiations are very 
opaque and complex among hospitals and plans and private 
payers.
    Mr. Grothman. Right, but somebody has got to eat it, right?
    Ms. Turner. Yes. Somebody pays for it.
    Mr. Grothman. At the end of the day, the hospital, to pay 
their mortgage, to pay their employees, if people are coming 
into that hospital and they don't have insurance but they have 
to have something being taken care of, and at least I am told 
that if they have a serious problem at the border we will 
deliver them to the local hospital and, of course, other people 
are being shipped all around the country. Those costs are being 
eaten by the private sector or the individuals who are being 
billed on an individual basis. Isn't that true?
    Ms. Turner. Correct.
    Mr. Grothman. Do you know--does that happen in other 
countries? Do you know--do you have any idea, like, in European 
countries where they have----
    Ms. Turner. Actually, other countries have very different 
ways. There is really no one way that you can say other 
countries deal with it. But that is--it is a problem everywhere 
and it rises cost--increases cost for those who do pay for 
those from those who don't pay or cannot pay.
    Mr. Grothman. OK. And I want to talk a little about 
pharmacy benefit managers. I am under the impression right now 
a lot of times there are rebates. A lot of times the pharmacy 
benefit managers wind up eating those rebates.
    Could you comment on the fairness and the kind of who is 
getting the benefits and who is the intended beneficiaries of 
the rebates offered by the pharmaceutical companies?
    Ms. Turner. Yes. There are large rebates that go through 
the pharmaceutical benefit managers and they say that that 
reduces insurance costs across the board. But there are policy 
proposals that would have those rebates go directly to patients 
at the pharmacy to actually reduce their costs. I think that 
would be better policy.
    Mr. Grothman. I have a bill like that. So you think that 
would be a good idea if we care about the individual to make 
sure that the--and the rebates are intended to go to the 
consumer, right? Not the pharmacy benefit manager. Is that 
true?
    Ms. Turner. And we need more transparency so people 
understand that those rebates are going to the PBMs--and 
because of the transparency--lack of transparency we don't know 
where--rather than to the patient.
    Mr. Grothman. Thank you.
    Chairwoman Maloney. The gentleman yields back.
    The gentleman from Maryland, Mr. Raskin, is now recognized 
for five minutes.
    Mr. Raskin. Madam Chair, thank you so much. This is an 
extraordinary and surpassingly important hearing and I hope it 
will be an historic one. I want to thank you and Representative 
Bush and Representative Tlaib for your leadership in bringing 
this forward.
    Dr. Sachs' remarkable testimony shows that we are first in 
health care costs in America, first in administrative costs, 
first in CEO salaries, and last in access to care, last in 
equity, and last in health care outcomes, and our colleagues 
across the aisle just don't want to deal with any of these 
realities and are now trying to blame the systemic failures of 
our health care arrangements on undocumented immigrants, which 
is just an absurd and irrelevant distraction from the real 
nature of the problem.
    Another sign of the sickness of our system is the 
staggering levels of medical debt that our constituents have, 
not just constituents of Democratic members but constituents of 
Republican members, too.
    Americans, collectively, owe an astonishing $195 billion in 
medical debt and this is a leading and, in many places, the 
foremost reason for bankruptcy that persons and families go 
into.
    Dr. Collins, let me start with you. What are the leading 
factors that cause patients and their families to fall into 
this extraordinary abyss and quicksand of medical debt?
    Dr. Collins. First, being uninsured is the primary risk 
factor. So people who are uninsured have the highest rates of 
medical bill and debt problems.
    Second, being underinsured--having a health plan that face 
really high deductibles or maybe you have a non-ACA compliant 
policy that doesn't protect you from catastrophic health care 
costs. That is a second major source of medical debt. But we 
just have a lot of cost exposure in this--in our health system 
both through uninsurance and also through underinsurance.
    Mr. Raskin. Around one in five American families are 
struggling with serious levels of medical debt, and for many 
people with lower incomes their fear of coming under crushing 
medical debt becomes a major deterrent to their obtaining 
critical medical care or even just normal regular checkups.
    How does medical debt pose a threat to the health as well 
as the economic security of families that are working to make 
ends meet?
    Dr. Collins. Now, I do find that people who have faced high 
out-of-pocket costs whether or not they have medical debt or 
just face really high deductibles make decisions that are not 
in the best interest of their health.
    So they tend to delay care, delay filling their 
prescriptions, just not getting care until it is--until it 
becomes very, very serious. And when they do get care they 
have--incur a lot of debt and have a lot of downstream 
financial problems like ruined credit ratings.
    Mr. Raskin. My family lived in France for a year, and just 
in our first month there our youngest daughter came down with 
just a piercing earache. She began to scream and we called some 
French friends and asked what to do. They told us to call a 
service that is connected to their national health care 
program.
    In 20 minutes, somebody knocked on our door. It was a 
doctor. Came in, diagnosed Tabitha as having strep throat, 
wrote a prescription that we were able to fill downstairs. And 
asked if we were citizens. We said no. Asked if we were a 
member of the national health care plan. We said no.
    They said they would have to charge us as strangers and 
that would be 20 euros that we had to pay. And they had a 
certain number of pediatricians assigned to each neighborhood 
that worked with us.
    So when people talk to me about universal health coverage 
it sounds pretty good. But what are the statistics? What do 
they show about whether millions of people in France and other 
countries are facing crushing medical debt the way tens of 
millions of our people are facing crushing medical debt? Does 
that exist in countries with the dreaded universal health care, 
or what our colleagues are denouncing as socialized medicine?
    Dr. Collins. No. People in other high income countries 
have--face much lower out-of-pocket costs. Just a striking 
difference between here and--there and the United States.
    Mr. Raskin. So, Dr. Sachs, let me ask you about this. You 
know, they called Social Security socialism. They called 
Medicare socialism. They called ACA socialism. So, of course, 
they are calling universal health coverage socialism. So but 
hasn't the progress of our system been about taking public 
responsibility, for making sure that everybody has access to 
health care?
    Dr. Sachs. Every other high income country, Congressman, 
has found the solution to the problems that we are grappling 
with, and all of the stories that we hear avoid the most basic 
point, which is all the other countries have solved these 
problems. We have not.
    The reason we have not is that we have a system that is 
geared toward not just private profits, massive profits of the 
hospital system, the pharmaceutical system, and massive waste 
of administrative costs unmatched by any other country in the 
world by far.
    We are wasting hundreds of billions of dollars of billing 
time, of churning, of not in the network, in the network, can't 
cover this, dispute this. Nobody does this.
    And I would say to Congressman Grothman we are spending 
$4.1 trillion right now. How much is that--is undocumented 
aliens on the border? A pittance. It has nothing to do with 
that.
    It has to do with prices that are out of control in the 
U.S. And with all the benefits of ACA, which brought people in, 
it did not create a system of cost control. We need a system of 
cost control.
    And, Congressman, I have had the same experience----
    Mr. Raskin. And thank you so much, Dr. Sachs.
    Thank you, Madam Chair. This system is irrational. It is 
costly. It is unjust. We should move forward with----
    Mr. Hice. Madam Chair, his time has expired.
    Chairwoman Maloney. Thank you for your Statement. His time 
has expired.
    The gentleman from Texas, Mr. Cloud, is now recognized.
    Mr. Cloud. Thank you. We keep saying we are having a 
national discussion on health care and the truth is over the 
last few years we haven't really had a national discussion on 
health care.
    Too often health care and health insurance get conflated as 
if they are the same thing. Indeed, the chair, in her opening 
remarks, claimed that Obamacare expanded health care to 30 
million people. That is not exactly true. You could maybe make 
the case that it expanded health insurance coverage to 30 
million people.
    But anytime you mandate something by law and say you are 
going to fine them if they don't have it, there is a probably 
good chance you are going to see an uptick in the usage of 
whatever that product is.
    But that doesn't mean that it was better. We saw some 
people who were over insured who didn't need that much 
insurance. For most Americans, we saw over--a steady decline in 
what health insurance covers.
    Meanwhile, premiums have gone up. Too many times families 
would even not be able to afford the health care because they 
are paying for mandated health insurance.
    And so it is important for us to remember that health 
insurance is the middleman in the process and health insurance 
never--a middleman never decreases a cost. It always increases 
it. Now, in isolated incidences, it, certainly, should save 
money and everybody should have some sort of health insurance.
    But when we are looking at systemic ways to save money, we 
probably need to go a different approach than what we have been 
doing, and what happens too often here in Congress is we, 
first, pass a program that breaks a system and then we come up 
behind it and try to be the solution to what we already broke. 
We definitely need a discussion but the discussion should 
center on how we provide actual care, how do we open access to 
care as opposed to mandating insurance for everybody.
    Ms. Turner, I would like to ask you why are health care 
costs increasing in the United States?
    Ms. Turner [continuing]. That.
    Mr. Cloud. I am sure there is a few of them but if you 
could touch on----
    Ms. Turner. A lot of reasons for that. A lot of it has to 
do with the lack of transparency. Nobody has any idea how much 
somebody else is spending on their care and Americans, they 
want to know those questions.
    But to--just to take the ACA as an example, the recent 
increase in subsidies through the American Rescue Plan put 
$17,000--every newly insured person in the American Rescue Plan 
costs about $17,000 for--in taxpayer dollars.
    But many of those people are dropping private coverage 
because the subsidies are more attractive to go on the public--
to go in the public plan. So I think that we need to look at 
what are the incentives in the system. Are there incentives for 
people to get better care, better coverage, more affordable 
care, get higher quality?
    But we don't do that. We run it through rules and 
regulations, through Federal and State and local spending 
programs, rather than really trying to engage the same forces 
that work in the rest of the economy to give people more 
choices and more affordable products and services.
    Mr. Cloud. It is interesting. You mentioned--we talked 
about regulation in this committee hearing being a major driver 
of healthcare costs, but it is interesting you mentioned price 
transparency in the sense that for elective procedures, for 
example, we see technology being a driver and when costs are 
transparent and people are able to price compare, we actually 
see those procedures in the market actually decreasing over 
time, where we see, by and large, most of the industry 
increasing over time because, as you said, what makes 
capitalism work is the fact that you can shop. And then so we 
have removed that ability--that accountability metrics--from 
the system. And so I would agree that anything we could do to 
put accountability back in the system would help.
    We talked about some of the ways that health care costs are 
increasing. What are some of the ways, maybe some technological 
breakthroughs, different ways that prices could be lowered in 
healthcare--that we could lower the costs and, thus, provide 
access to more people?
    Ms. Turner. I have reported in my testimony about several 
States that have used a provision in the Affordable Care Act 
called Section 1332 to be able to repurpose some of the money 
that is going through the ACA to be able to figure out how can 
we do a better job of taking care of the most expensive 
patients who need the most care but they are not able to see 
the physicians they need because of--everybody is a one-size-
fits-all plan.
    They make this a much more--a much more focused plan, doing 
a better job of taking care of the vulnerable. What that has 
done is reduced prices across the board for everybody else and 
that brings more people into the market, just as one example.
    Ms. Cloud. One other thing I would like to ask your opinion 
on in the short time I have left is what nation produces the 
most medical innovations?
    Ms. Turner. That would be the United States of America.
    Mr. Cloud. So we definitely have some issues we have to 
fix. But if we were to adopt the same system that does not lead 
to innovations, the world at large would really suffer.
    Ms. Turner. The world relies on us for innovation--for 
medical innovations.
    Mr. Cloud. OK. Thank you. I yield back.
    Chairwoman Maloney. The gentleman yields back.
    The gentlelady from Ohio, Ms. Brown, is now recognized for 
her questions.
    Ms. Brown. Thank you, Chairwoman Maloney and Ranking Member 
Comer, for holding this important hearing. Most--across the 
United States, most people of color are most likely to be 
uninsured and live in communities with higher rates of 
uninsurance or underinsurance.
    As a result, people of color are more likely to be able to 
afford critical medical care and more likely to go into medical 
debt trying to pay for it.
    Dr. Michener, let me begin with you. How does uninsurance 
and underinsurance put people of color at elevated risk for 
adverse health outcomes and what does this mean for health 
equity in the United States?
    Dr. Michener. Yes. So uninsurance and underinsurance 
through many different mechanisms put people of color at risk. 
One mechanism is through delayed care, through inadequate care, 
because not only is care delayed but when you do receive care 
without insurance it is difficult to adhere to care protocol 
and regimens. It is difficult to get prescriptions and so on 
and so forth.
    One of the things that I think is important to point out in 
some of the conversation that has emerged around things like 
choice and innovation is that when we are talking about 
disproportionately people of color and people who don't have 
insurance, in fact, they lack choice in a profound way, and to 
the extent that we are innovating they are the very people who 
are not benefiting from any of those innovations.
    So if we can have the latest technology and the best 
procedures but you lack health insurance, you are not able to 
have access to those procedures or to have access to that 
technology, and those kinds of circumstances are 
disproportionately encountered by people of color.
    And so when we are thinking about choice, innovation, and 
other things like that, the question is who will have the 
choice and who won't? Who will be excluded from that? Who will 
benefit from the innovation and who will not?
    And I think that when we take equity into account it 
really, I think, undermines the overemphasis on some of these 
things and, at the very least, point out the importance of 
balancing that with an emphasis on equity so that we actually 
have full inclusion.
    Ms. Brown. Thank you very much. So achieving universal 
coverage is necessary to address those structural inequities in 
our current health care systems that have historically 
afflicted communities of color.
    So, Dr. Blackstock, how would achieving universal coverage 
help ensure that patients of color receive high quality care 
before they become seriously ill?
    Dr. Blackstock. Thank you so much for that question. You 
know, as I mentioned in my earlier testimony, there are other 
social determinants of health that are very key in influencing 
the health of communities of color, but lack of access to 
health care is so incredibly important because we need our 
patients to be able to access primary and preventive health 
care services.
    They need to be connected with primary care physicians and 
other types of health care providers so that initial diagnoses 
are made so that they are placed on the proper protocols and 
medications and so that they are really cared for and managed 
in a way so that they don't develop these significant chronic 
medical problems that will impair, really, their ability to 
live a full life.
    Ms. Brown. Thank you very much. It is clear throughout the 
testimony today that universal coverage will help eliminate the 
entrenched health inequities experienced by people of color in 
this country and, importantly, it will help eliminate many of 
the barriers to care for people of color that they so often 
face because of their employment or immigration status.
    So universal coverage will create healthier communities so 
that every person in the United States can thrive and that is 
what excites me most.
    And so with that, I yield back.
    Chairwoman Maloney. The gentlelady yields back.
    The gentleman from Pennsylvania, Mr. Keller, is now 
recognized for his questions.
    Mr. Keller. Thank you, Madam Chair, thank you, Ranking 
Member Comer, and thank you to the witnesses for being here 
today.
    Socialized medicine is not only the wrong approach, it 
would be detrimental to our healthcare system and the patients 
who rely on it. Americans are the ones who are best equipped to 
make health care decisions for themselves as well as for their 
families, not the government.
    I want to talk a little bit about a personal experience. 
But before I do that, two names--Alfie Evans and Charlie Gard, 
a toddler and an infant in the U.K., whose doctors said they 
would not survive.
    So the doctors took the parents to court and were forced to 
remove their children from life support. One child could have 
gone to Italy and one could have come to the United States for 
care. But their government didn't allow them to do it.
    I want to talk about 1994 when my son had a brain injury, 
and he was life-flighted to Geisinger Medical Center, and they 
performed brain surgery and he came out of the surgery and the 
doctors told us--they said kids in his condition aren't a 50 
percent mortality rate. It is not a 98 percent mortality rate. 
It is 100 percent mortality rate. And over the coming weeks, we 
were told to remove him from life support because he was not 
going to survive.
    But we had control of our health care decisions, not the 
government, and because of that the following year it says 
Freddie Keller of Kramer is Geisinger's poster child for 1995 
in northeastern and central Pennsylvania. He is now 31 years 
old and works for the health care industry in supply chain, 
because we had choices over his care, not the government.
    So that is socialized medicine. That is universal health 
care. That is someone, a bureaucrat from the government, 
deciding what is best for you and your family, not you, and 
that should never happen in the United States of America. 
Never.
    So I did want to just ask a question to Ms. Turner. Might 
these policies affect patient wait times for treatment in which 
patients would suffer most from the increased wait times?
    Ms. Turner. Very powerful story, Congressman. Thank you for 
sharing that.
    We do have evidence of what happens when systems operate 
under a global budget in other countries and, as you say, you 
wind up with government making decisions about whose life 
matters and they do that in sometimes very subtle ways, 
something called quality adjusted life year, where they decide 
whether or not your life is worth getting a new medication that 
may be on the market.
    So I think the choice and control issue is profoundly 
important because it also focuses the system on the patient 
rather than on bureaucrats making decisions about people's 
lives.
    Mr. Keller. Just another question. In addition to 
restricting choices and access to care, would a single-payer 
public health option truly lower health costs for Americans?
    Ms. Turner. My colleague, Merrill Matthews, from the 
Institute for Policy Innovation actually looked at the 
administrative cost savings, and when he made an apples to 
apples comparison, he said it is not going to save any money 
administratively because the government is still going to have 
to make sure that a procedure was provided.
    The documentation will have to be there. The person will 
still have to be paid. There will still have to be all of the 
paperwork that we have now. It just runs through a different 
system.
    So it is not clear to me to see how it would save, and 
Chuck Blahous from Mercatus Center says that it would actually 
cost $32 trillion over 10 years.
    Mr. Keller. OK. Thank you. You know, this is something that 
I always say--changing who pays the bill does not make 
something affordable. All it does is remove choices from 
people.
    Not only would socialized medicine offer patients fewer 
medical options, limited number of qualified medical personnel 
in the midst of a healthcare worker shortage, and discourage 
medical innovation, proposals like Medicare for All would cost 
the taxpayers an estimated $32 trillion over 10 years. The cost 
of government-mandated universal health coverage is simply too 
huge.
    And I tell you what, the cost of my son's life under a 
system like that that had to be endured by the parents of 
Charlie Gard and Alfie Evans, I don't want to see that happen 
to any family in America. The government should not be telling 
you whether or not your child can receive life-saving medical 
attention.
    And thankfully, here in the United States of America, I 
didn't have to face that choice in 1994 when I was 28 years 
old, struggling to make ends meet, and my son is still alive 
today.
    Thank you and I yield back.
    Chairwoman Maloney. The gentleman yields back. The 
gentleman from California, Mr. Khanna, is recognized for five 
minutes.
    Mr. Khanna. Thank you, Madam Chair. Thank you for your 
leadership on Medicare for All and holding this historic 
hearing.
    Let us be very clear that private health care insurance is 
a crushing tax on working families in this country and on 
businesses. Working families have to pay a tax of almost 
$12,000, if not more, on the premiums that they pay to private 
health care insurance and on their out-of-pocket costs.
    And businesses in this country are competing with one arm 
tied behind their back. What is the tax that private health 
insurance is putting on businesses? Sixteen thousand dollars 
for a family that businesses are having to pay. That is why 
they are having to compete in a total disadvantage to many 
companies and businesses and manufacturers overseas.
    In fact, if you talk to CEOs they say the biggest burden on 
their payroll often is this tax that they are paying to private 
health insurance. On top of that--and I want to just talk about 
the economics here--on top of that you have over 23 million 
Americans in medical debt because of the tax that they are 
paying to private health insurance.
    You have 78 million Americans not able to get the health 
care they need, not able to treat their kids for the medicine 
they need or get, in certain care, life-saving treatment--
68,000 Americans every year dead because they aren't able to 
have health care that they need.
    This is the current system, and what we are saying is have 
a tax cut for working families. Have a tax cut for businesses 
by eliminating the excessive profits of the insurance 
companies, of the pharmaceuticals, and off the hospital 
facility fees.
    Let us get those deadweight costs out to cut taxes, cut the 
private insurance tax for working families at a time of 
inflation. Bring the costs down, bring the costs down for 
businesses. This would be actually deflationary and it would be 
one of the largest tax cuts in putting money back in the 
pockets of working families and businesses.
    Dr. Sachs, let me ask you. You are an economist. Can you 
just explain from a commonsense perspective, if you take out of 
the system the excessive insurance costs, the excessive 
pharmaceutical costs, the excessive hospital facility fees, 
aren't you going to reduce the amount that ordinary Americans 
are paying and the American businesses are paying, from an 
economic perspective, into the system?
    Dr. Sachs. Congressman, of course you are. It is just 
bizarre, this discussion that it would be too expensive to 
lower the health care costs through universal coverage. We just 
heard it would be an extra $32 trillion.
    This is phony numbers because it doesn't count the saving 
that comes from eliminating the private premiums, which, as you 
say, that is a tax on household income. It is all verbiage. The 
United States is paying twice what any other country pays for 
health care.
    I wish there was some--I wish the opposition--the ranking 
members would ask me some questions, not just their witness 
some questions, so we could actually have a discussion.
    We are paying nearly 20 percent of GDP. We are paying 
$12,000 per person, more than twice what other countries are 
paying. Shame. It is just absurd. And where is that? It is 
procedure by procedure, it is hospital stays, it is doctor's 
appointments, it is devices, because our system is rigged.
    From all the campaign contributors that make this the No. 1 
lobbying sector in this country, it is rigged for an overpriced 
health care system. We could save about a trillion dollars a 
year for our country to do other useful things.
    Mr. Khanna. Dr. Sachs, I totally appreciate that and, you 
know, this is why I strongly support Bernie Sanders' Medicare 
plan, which is a very reasonable plan.
    I guess my last point is this. I am not a Ph.D. economist 
like you but I don't think you have to be a Ph.D. economist 
understand that if you are--if you have a system where everyone 
can go to any doctor they want because everyone now is in 
network under Medicare and you eliminate the middle people--you 
eliminate the people who are charging the insurance fees, you 
eliminate the pharmaceuticals who are making their profits in 
terms of having to negotiate with Medicare, and you eliminate 
hospitals from just being able to charge whatever they want 
because they have to negotiate with Medicare, that as a common 
sense perspective you are going to bring costs down because you 
are going to not have all those profits.
    Am I missing something in that simple explanation?
    Dr. Sachs. No. Not only are you not missing something, it 
is not even hypothetical. It is proven. It is proven in France, 
in Germany, in Norway, in Denmark, in Netherlands, in Sweden, 
in Finland. Go look at the data. I live in these countries. I 
see these countries day by day. It is the demonstrated daily 
reality.
    So it is not theory. It is proven, and the United States is 
the single outlier because we are driven by greed and by a 
system of lobbying that imposes this completely overpriced 
system, which is not a system actually.
    And what you said, Congressman, is exactly right. The 
hospitals charge whatever they want, and we all know that the 
pricing is a game, completely nontransparent. They charge what 
they can charge because they are discriminating monopolists. 
They charge what they can get away with where they can get away 
with it. There is no market here at all.
    Mr. Khanna. Thank you, Dr. Sachs.
    Madam Chair, I yield back.
    Chairwoman Maloney. The gentleman yields back.
    The gentlelady from North Carolina, Ms. Foxx, is now 
recognized for her questions.
    Ms. Foxx. Thank you, Madam Chair, and I want to thank our 
witnesses for coming today.
    I have to say that listening to this last interchange, 
there are some people on this committee and some of our 
witnesses who live in a Never Never Land--a Never Never Land.
    Ms. Turner, today, we have heard a lot about government-run 
health care such as Medicare for All but we have not heard much 
about the quality of care. This is not surprising, though. I 
cannot think of one thing the government does that is both 
affordable and of high quality.
    What would Medicare for All do to employer sponsored 
insurance and how would this affect the 155 million Americans 
currently enrolled in employer-sponsored coverage, something 
that Americans overwhelmingly support?
    Ms. Turner. Well, the Medicare for All would abolish 
employer-based health coverage and all other current health 
care programs so that we would all be under one single plan. 
And you see--you know, you see employers trying so hard to 
innovate--providing wellness programs.
    Wal-Mart, before the Affordable Care Act was implemented, 
had computer rooms to help their employees tailor a plan that 
worked best for them. That is the kind of innovation that we 
would lose, the kind of patient focus, the kind of energy from 
the private sector that leads to innovation.
    Ms. Foxx. How would Medicare for All affect the nearly 64 
million seniors who are currently on Medicare? Would they 
receive better coverage?
    Ms. Turner. Sixty-four million seniors and disabled 
patients on Medicare, 26 million of them have chosen Medicare 
Advantage private plans. That shows that they believe that 
there is more value to having a private plan that can manage 
their care. They can pick the plan that provides the best 
network in their area.
    So they are--and some, we believe, could be focused care. 
If you have diabetes or heart disease, you will get the 
specialist in that care. So I think that there would be a lot 
of innovation lost and I don't think seniors would be nearly as 
happy as they are now.
    Ms. Foxx. Yes. As I understand it, our friends on the other 
side of the aisle want to do away with Medicare Advantage and 
the kinds of things you have described.
    Also, under Medicare for All or another universal health 
care system would Americans have wait times to seek care that 
are similar to those in Canada and the U.K.?
    Ms. Turner. Absolutely, because you--there are lots of 
different ways for people to pay for systems and one of them is 
in care that they don't get and, oftentimes, they don't even 
know the care that they are not getting.
    I talked with a physician from the U.K. and he saw both 
private sector patients as well as those on the National Health 
Service Plan. And he said, I can't even tell my public patients 
about new medications that would be better for them because it 
is not covered under the system. Patients who are going to have 
to wait for two years to get a knee replacement surgery pay out 
of pocket, if they can, to go to the Mayo Clinic if they live 
in Canada or someplace else. So they--patients pay in other 
ways, especially those most in need of serious medical care.
    Ms. Foxx. Thank you.
    Ms. Turner, another question. The Mercatus Center 
calculated the costs of Medicare for All and found that under 
the best case scenario it would increase Federal budget 
commitments by $32.6 trillion over the first 10 years of 
implementation.
    Thirty-two point six trillion is triple what the Federal 
Government spends on our defense and domestic discretionary 
programs over 10 years. Even doubling the corporate income tax 
could not cover that.
    Since our government is consistently overspending and 
running large deficits each year, is a massive new government 
spending program like Medicare for All financially feasible or 
sustainable?
    Ms. Turner. It is really hard to see how that could work. 
As I said in my testimony, that Colorado, Vermont, and, most 
recently, California have tried to figure out how they could do 
just on a State basis a single-payer system.
    In California--even California saw the price tag of $450 
billion a year and they said that is really not something we 
can afford.
    Ms. Foxx. Thanks. And my last question--what lessons can we 
learn from the implementation of Affordable Care Act, or 
Obamacare, and how should that inform our expectations for 
further government involvement in health care?
    Ms. Turner. Running a top-down system is really difficult, 
especially from Washington, in a country as diverse as this one 
is, and one of the reasons there have been so many changes to 
the ACA is because some things worked for some States and 
others didn't work for other States, and for different sectors 
of the economy you need to have local control bottom-up 
decision, making not top-down decisionmaking that could have 
the same catastrophic effects as healthcare.gov did.
    Ms. Foxx. Thank you, Ms. Turner.
    I yield back.
    Chairwoman Maloney. The gentlelady yields back.
    The gentlelady from Michigan, Ms. Tlaib, is recognized for 
her questions.
    Ms. Tlaib. Thank you so much, Chairwoman, and thank you so 
much to my good colleague from St. Louis, Congresswoman Bush, 
for really leading us to making sure that we bring our 
residents to Congress and make sure that they are seen and 
heard.
    As Bishop Starghill from my district said in his testimony, 
and it was very clear, lacking access to health insurance not 
only causes financial hardships but it puts millions of 
Americans' lives at serious risk every single day.
    I represent the third poorest congressional district in the 
country. Very limited choices when folks talk about choices 
when it is convenient. But today, whether or not a person has 
access to high-quality medical care depends, largely, on 
whether they are insured or whether--what their income is, 
whether or not they are wealthy enough to pay for it.
    Medicare for All will guarantee access to high-quality 
health care for every person in our country, regardless of 
their ability to pay, and we have heard a lot of misleading 
claims from my colleagues on the other side.
    But Medicare for All--what we are talking about and what 
they are saying is simply not true. But what we are saying in 
regard to making sure it is accessible and making sure folks 
are covered is true. It simply says you don't have to be rich 
to have access to quality health care.
    So my question to my good friend, Mr. Barkan--and, you 
know, thank you so much for being here today and getting up so 
early--your activism has helped put a face to so many people 
that really don't lack--lack the access to being here but also 
the fear that comes with being this vulnerable and talking 
about not being able to access health care.
    So I want to hear from you and whether or not you believe 
we would have universal health care today if we didn't allow 
those who profit by our broken health care system to make 
political contributions.
    [Pause.]
    Voice. Mr. Barkan is writing.
    Mr. Barkan. I think it is crystal clear that we have a 
corporate corrupted system and it needs to change.
    Ms. Tlaib. Thank you, Mr. Barkan. Do you believe in the 
work and the advocacy work that you are doing that our system 
is rigged? If yes, how have you seen it so clearly in your 
advocacy work?
    Voice. One moment.
    [Pause.]
    Mr. Barkan. Medicare for All boils down to the simple 
question of whether or not you believe that health care is a 
human right. Those against Medicare for All will call this 
policy various names to distract the public from the truth that 
you and me, nurses and small businesses, all of us, would fare 
far better under a system that guarantees comprehensive, high-
quality, affordable health care to all.
    The only people who benefit from our for profit system are 
the multimillionaire healthcare executives who profit off our 
illness, their corporate lobbyists, and the elected officials 
who take campaign contributions from health care corporations 
and, therefore, their policy views from them.
    Ms. Tlaib. Thank you so much, again, for your courage and 
for helping, again, put a face to this broken health care 
system. I know I have said it over and over again, and 
Chairwoman, you have probably heard me, corporate greed does 
kill in our country and Medicare for All would address the 
disparity and reduce the health inequities associated with our 
current broken system while preserving patients' ability to 
make the best medical decisions for themselves and their 
families no matter their income.
    So for those reasons, I am incredibly proud to support 
Medicare for All, and, again, thank you so much, Chairwoman 
Maloney, for your courage in having this hearing.
    I yield back.
    Chairwoman Maloney. The gentlelady yields back.
    The gentleman from Arizona, Mr. Biggs, is now recognized 
for his questions.
    Mr. Biggs. Thank you, Madam Chair.
    You know, preventing individuals from making personal 
health care decisions, and then we have heard a lot about how 
important that is, and ceding those decisions to government 
bureaucrats is really the violation of fundamental human 
rights, and one must acknowledge that inherent in President 
Obama's Statement that if you like your health plan you can 
keep it was that recognition of that human right to make your 
personal choices. I mean, that is why he said that, because he 
knew that is what we want. We want to be able to choose our 
health plans.
    But that was a lie and he told that lie because he wanted 
to get his Obamacare, ACA, whatever you want to call it plan 
out there. Which is interesting to me because repeatedly I have 
heard colleagues across the aisle say today the system is 
broken.
    This is the system you designed. This is the ACA. We are 
all living under it now one way or the other. It is your 
system. Dr. Sachs said it is broken. It is unfair. It is too 
expensive. There is too much administrative costs.
    I agree with everything you said there. You are exactly 
right. But this is the system that my colleagues across the 
aisle made. Even in the private industrial sector--in the 
private plans, the administration costs are too high.
    They are way too high, and part of that is because of the 
regulatory environment that mounted on the previous unworkable 
regulatory environment that was imposed through the ACA.
    The good doctor repeatedly mentioned peer countries. But 
when you talk about single-payer systems or socialized systems, 
although we don't--apparently we are not supposed to call it 
that--there really isn't a peer to the United States. Just the 
size of the United States mediates against that.
    The peer countries in population size or cost of health 
care and expenses paid are not comparable. There is no peer 
country on the charts that you were putting up there. Go back 
and take a look.
    The scale of a Medicare for All plan will be unlike 
anything you have seen in the history of the world. And, you 
know, scalability is a problem but the inherent problems can be 
even in small States.
    I mean, so when Vermont tried to implement its single-payer 
experiment that failed under the cost. Now, we all say, hey, 
yes, everybody should be able to have access to their health 
care. We want it to be affordable.
    But Medicare for All would make our ability to buy private 
insurance even more difficult than it is to buy private 
insurance in Canada, and it wouldn't necessarily guarantee that 
you are going to reduce cost. I mean, let us take a look at 
Medicare and pharmaceutical costs. They are way up. They still 
remain high, even under Medicare.
    So I think so much of what I have heard today is talking 
around the issue for political purposes. If you want to solve 
problems, I am willing to talk and let us solve problems.
    But I am told today that all the other countries have 
solved their problems and I don't know that I believe that. 
There are lots of studies and science that indicates that is 
not true.
    Dr. Sachs. Congressman, could I respond?
    Mr. Biggs. Let us take a look at one specific--let us take 
a look at one specific issue. And I don't know who is 
interrupting me.
    Dr. Sachs. That was me, Professor Sachs. I was wondering 
whether I could respond.
    Mr. Biggs. Yes. Yes. I am not asking you a question, sir. I 
am not asking a question. Please don't interrupt me.
    Dr. Sachs. OK.
    Mr. Biggs. In 2009, Medicare cut payments to independent 
cardiologists. This is what we call--this is what we call an 
unintended consequence, for people who don't understand 
economics.
    2009, Medicare cut payments to independent cardiologists 
for common tests but left untouched their payment for 
cardiologists employed by hospitals. So what do you think what 
happened? Some imaging services Medicare paid hospitals nearly 
twice as much as they paid independent physicians for the same 
service.
    The effects were predictable--were predictable. The percent 
of cardiologists employed by hospitals rocketed. People 
received many more cardiac imaging from hospital outpatient 
departments and less from freestanding physicians' offices. 
That is an unintended consequence.
    So I will turn to you now, Ms. Turner. What effects would 
Medicare for All have on patients' ability to receive care in a 
timely, affordable fashion?
    Ms. Turner. I can't agree with you more about the 
comparison. The Swiss system works fine for Switzerland. It is 
the size of Massachusetts. That is not something that we can 
impose on this whole country.
    We must have diversity, and I think people value not only 
diversity of places to get care but they also--they value 
diversity of how that care is going to be paid for and giving 
people more options than they have today.
    As we see, fewer and fewer because so much of the spending 
is controlled by government--Federal and State government--
rather than by patients and rather than seeing what innovations 
could come to provide people with more options of portable 
coverage that they own and take with them and that they can 
afford to keep with a strong safety net for the vulnerable.
    Chairwoman Maloney. The gentleman's time has expired.
    Mr. Biggs. Thank you.
    Chairwoman Maloney. Thank you. I now recognize the 
gentlelady from California, Ms. Porter. She is recognized for 
her questions.
    Ms. Porter. Dr. Collins, what percentage of revenue do 
private insurance companies spend on administrative costs?
    Dr. Collins. Between--about 17 to 18 percent of spending in 
private insurance plans.
    Ms. Porter. So if I pay my insurance company $100, 1, 2, 3, 
4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, $17 go to 
administrative costs. What about Medicare? What do they spend 
on administrative costs?
    Dr. Collins. That range is about, you know, 3 to 5--3 to 5 
percent of Medicare spending.
    Ms. Porter. 3 to 5--3 to 5 percent. About 3 to 5 percent 
right here, and if we look at just billing costs, just billing 
in insurers' costs, Medicare is at one percent. Private 
companies spend 17 times more on administrative costs than 
Medicare?
    What are private insurance companies spending on that 
Medicare is not? Does Medicare spend hundreds of millions of 
dollars on television advertisements like private insurance 
does?
    Dr. Collins?
    Dr. Collins. No.
    Ms. Porter. Does Medicare spend millions of dollars on 
stock buybacks to shareholders?
    Dr. Collins. No.
    Ms. Porter. Does Medicare spend money on marketing? Private 
insurance likes to put its name on stadiums and PGA 
tournaments? Is there a Medicare Arena?
    Dr. Collins. No.
    Ms. Porter. Does Medicare spend $23 million on executive 
pay like private insurance companies do?
    Dr. Collins. No.
    Ms. Porter. We know how much it costs to run a high-quality 
health insurance program--one dollar. Out of $100, research 
shows that Medicare spends 1.1 percent on administrative costs.
    We spend $4 trillion on health care every year. We could 
save $200 billion dollars on administrative costs with Medicare 
for All and those savings, they could go to expand Medicare. We 
could spend that money to let patients see dentists.
    We could spend that money and let patients pay for hearing 
aids, to help older adults afford eyeglasses, to bring down the 
cost of prescription drugs, to finally pay mental health 
professionals for the work they do.
    Instead, all this money is wasted. We are not talking about 
paying to keep the lights on in operating rooms or improving 
the quality of care. All this money is used to pay big 
insurance to push paper. It is death by 200 billion paper cuts.
    Dr. Sachs, what is it about the U.S. market that leads to 
these sky-high administrative costs?
    Dr. Sachs. Congresswoman, there is no market. These are 
local, concentrated providers that have tremendous power to set 
their prices and to set extraordinary salaries. We should 
contemplate that the so-called not for profits in this country 
pay their hospital directors $5 million.
    This is unbelievable, and so this is why these costs are--
why the prices are so high. The administrative costs are so 
high because we don't have a system because we spend 20 percent 
of our spending just to funnel money between organizations, 
which is something that other countries don't spend. And I 
would like to say--I would like to----
    Ms. Porter. Dr. Sachs, I wanted to ask you----
    Dr. Sachs. Sure.
    Ms. Porter. Reclaiming my time for one second, Dr. Sachs.
    I wanted to ask you specifically about standardization and 
what role that might play in reducing some of this waste that 
we could reallocate to health care costs.
    Dr. Sachs. Well, when you go in for billing there is no 
standardization on anything, on the information technology, on 
the systems, who is in, who is out, what is going to be 
reimbursable.
    Everything is completely opaque. Everything is completely 
discriminatory depending on who is being involved. So 
standardization is a big part of all of this because when you 
lack standardization you put in resources to suck out whatever 
rents you can and we end up, as you counted those $17 out of 
every $100, basically, lost--basically, wasted.
    Ms. Porter. Reclaiming my time. Reclaiming my time, Dr. 
Sachs.
    We heard today about the cost of Medicare for All but there 
is a cost to letting insurers paperwork patients and providers 
to death and that cost of inaction is $200 billion on 
administrative costs.
    Now, administrative costs waste money but they also waste 
health care workers' time. A recent study found that a majority 
of doctors--56 percent--support a single-payer health care 
program.
    Why? Because today doctors spend only one quarter of their 
time with patients. What are they doing with the rest of their 
time? Paperwork.
    Ninety--and I want to also--I want to add not only would 56 
percent of doctors support Medicare for All but patients would 
have the most choice under Medicare for All. The health 
insurance coverage with the biggest network is Medicare. No 
private insurance comes close. Ninety-nine percent of 
pediatric--nonpediatric doctors participate in Medicare.
    So I want to recap. Medicare for All would save money on 
administrative costs, $200 billion a year. Medicare for All 
would give patients the most choices, 99 percent of 
nonpediatric providers, and Medicare would let doctors practice 
medicine.
    Not surprisingly, given these three things, what do we get 
with Medicare for All? Better health outcomes, and that is why 
I support Medicare for All because they support patients over 
paperwork.
    I yield back.
    Chairwoman Maloney. The gentlelady yields back. But before 
we continue, as mentioned at the beginning of the hearing, Dr. 
Sachs has a hard stop at 12 o'clock. We thank you for your 
participation, Dr. Sachs. You are excused. Thank you.
    Dr. Sachs. Chairwoman?
    Chairwoman Maloney. Now the gentleman from Kansas, Mr. 
LaTurner, is recognized for five minutes.
    Mr. LaTurner. Thank you, Madam Chair. I appreciate it. Dr. 
Sachs, I will give you--we don't agree on this but I will give 
you 30 seconds. I can see that you wanted to say something.
    Dr. Sachs. Thank you very much. I want to say there is no 
economic cost to Medicare for All. It is pure saving. The $32 
trillion reference is about the increase of Federal finance.
    But there is a larger decrease of private finance. The net 
is a large saving. We need to take that talking point out of 
the discussion so that we can solve the problems. We also need 
to understand we do have a peer. It is the European Union. Life 
expectancy is 81.3 years for their 440 million people.
    Mr. LaTurner. I am going to have to reclaim my time.
    Dr. Sachs. Congressman, thank you. Thank you very much for 
letting me say those words.
    Mr. LaTurner. You are welcome. In the name of 
bipartisanship, Madam Chairwoman.
    Dr. Sachs. I appreciate that very much. Thank you.
    Mr. LaTurner. Yes. My questions are for Ms. Turner. Much of 
the money that Americans pay for health care is going toward 
its administrative costs, whether that is for hospitals, 
pharmacy benefit managers, or insurance companies.
    Many proponents of Medicare for All strategies say that 
administrative savings would offset some of the costs of the 
government-sponsored health care program.
    Do you agree that Medicare administrative costs are or 
would be significantly less burdensome that administrative 
costs for private insurers? If not, where do you think that 
misconception comes from?
    Ms. Turner. Thank you, Congressman. I quoted in my written 
testimony a study by Dr. Merrill Matthews of the Institute for 
Policy Innovation in Texas, who is saying that when you compare 
apples to apples, when you compare the actual cost of making 
sure a procedure was performed, deciding who your--what your 
patient population is, making sure the doctor gets paid, all of 
the other procedures, you wind up with about equal cost.
    One of the things that the Federal Government is able to do 
is to be able to shove the cost of collecting payments off to 
other agencies or not do the kind of due diligence that many of 
the private plans do to make sure that the revenues are 
connecting and premiums from the customers are able to be--are 
spent properly.
    So you see much--you see less waste in private programs 
because they are spending some part of that administrative 
money on due diligence. We need to see more of that in the 
Federal Government.
    Mr. LaTurner. I am going to stick with you, Ms. Turner.
    Committee Republicans have discussed how the expansion of 
Medicaid and the elimination of eligibility checks have 
contributed to government waste through improper payments. 
According to CMS, total improper payments for Kansas in 2021 
amounted to nearly $290 million.
    Can you provide any further insight into why 20 to 25 
percent of all Medicaid payments are disbursed improperly and 
whether fixing these improper and wasteful payments would 
change how you feel about a Medicare for All policy?
    Ms. Turner. Well, I already don't think that a Medicare for 
All policy is the right approach for such a diverse country as 
this is that values innovation. If you wind up with 
standardization you get rid of a lot of the innovation.
    My colleague, Brian Blase, who--with Paragon Health 
Institute, also a senior fellow at the Galen Institute, has 
done a deep dive into the study that you referenced about 
Medicaid waste, and he assumes--says that in one year Medicaid 
had improper spending of about $100 billion that was, largely, 
for people who were on the program and weren't eligible.
    There are a number of other ways in which people are taking 
advantage of the system and it is not being properly monitored. 
The inability of the Federal Government to be able to contain 
hundreds of billions of dollars in wasteful spending with a 
program that would cover 330 million Americans seems to me an 
in comprehensible task.
    Mr. LaTurner. You highlight the burdensome Federal 
regulatory demands that providers must respond to. Often it is 
at the expense of their patients. Can you describe further how 
increased government involvement in the health care sector 
reaches a point of diminishing return when it comes to 
addressing patient needs specifically?
    Ms. Turner. Well, writing one more regulation to solve one 
more problem is when we are going to add more paperwork to a 
physician's backlog.
    The former head of the Mayo Clinic one time looked up the--
had his staff look up the number of regulations that the Mayo 
Clinic--had pages of regulations the Mayo Clinic had to comply 
with in order to treat Medicare patients. He said, we lost 
track at 100,000 pages, and that was two decades ago.
    So the more regulatory compliance--and we are not going to 
get rid in this country of demands that taxpayer dollars are 
spent on this service that is promised. We are going to have to 
have paperwork trails. People are going to have to follow those 
trails.
    That money is going to have to then go to the provider 
after it goes through other administrative checks. That--we are 
not going to get rid of that with Medicare for All. The only 
way we can get rid of that is through innovation, to give 
people more choices so that they are--the marketplace is 
responding to those needs rather than complying with all these 
hundreds of thousands of pages of rules and regulations.
    Mr. LaTurner. Thank you, Ms. Turner.
    Madam Chair, I yield back.
    Chairwoman Maloney. The gentleman yields back.
    The gentlelady from Missouri, Ms. Bush, is now recognized 
for her questions.
    Ms. Bush. St. Louis and I thank you, Chairwoman Maloney, 
and to the committee for this--for convening this critically 
important hearing, which represents our steadfast commitment to 
achieving universal health care coverage in the United States.
    For my colleagues on this committee, you have a choice in 
front of you today. It is a choice to save lives or a choice to 
let people die. Disproportionately low income people, Black 
people, brown, indigenous people, die. Because you are a human, 
you deserve health care. Because you are a human, you deserve 
health care.
    In my community, Black mothers die at three to four times 
the rate of white women. In my community, Black babies are 
nearly twice as likely to die prematurely. I came to Congress 
because enacting Medicare for All, it is not a choice for me. 
It is a moral imperative.
    When I worked as a nurse, I cared for uninsured and 
underinsured patients every single day. I am reminded of one 
patient with diabetes who was failed by our healthcare system 
because she could not afford all the aspects of her care.
    Technically, she had primary--she had insurance and a 
primary care provider but she could not afford her insulin 
prescription, her needles, her test strips to track her blood 
sugar levels. The patient--this patient, she was forced to 
ration her insulin and she skipped appointments due to 
transportation, making it difficult to follow treatment plans. 
This patient ended up losing a limb and eventually she died.
    One health condition, if left untreated, can be deadly. For 
me, after I turned 18 years old, I became an uninsured low wage 
worker. I could not afford to retain a primary doctor so I went 
to the emergency room for treatment for conditions like asthma, 
sinus infections, and tooth aches.
    My asthma was exacerbated by environmental pollution and 
degradation and continued to worsen without proper medical 
care. During the Ferguson uprising, toxic tear gas filled my 
lungs, leaving me gasping for air and it worsened my condition.
    Even though I was working as a nurse, I was forced to pay a 
$900 monthly premium, a $4,600 deductible, and struggled to 
treat my asthma.
    Dr. Michener, can you please describe the relationship 
between health care coverage--a healthcare coverage status and 
economic mobility in the United States? How would Medicare for 
All reduce poverty and stimulate economic growth in the United 
States?
    Dr. Michener. Representative Bush, thank you for the 
question. I think this is a key dimension.
    Oh, I thought it was on. Oh, OK.
    Yes, I think this is a key dimension of the--of this 
discussion that we, I think that on some fronts has been 
willfully ignored, which is that there are gross inequities not 
just in our health system but in our economic and social and 
political systems, more broadly, and the inequities in the 
health system are exacerbating the inequities in other places.
    So if we look at all of our anti-poverty programs that we 
have in this country, the largest effect on poverty--child 
poverty in particular but poverty more generally--comes from 
our Medicaid program. Addressing healthcare disproportionately 
addresses some of the other core and fundamental challenges we 
have around economic inequality in this country. And so what 
happens when you provide people with healthcare? We have seen 
it through Medicaid. They are less likely to be evicted. They 
are less likely to recidivate and go back to prison. They are 
more likely in the long term to have positive financial 
outcomes.
    Ms. Bush. Yes.
    Dr. Michener. Less likely to be living in poverty, less 
likely to have medical debt, more likely to have positive 
educational outcomes, more likely to have employment. We want 
to say, ``socialized medicine,'' scare people away with the 
scary phrases, right? Oh, the government is going to be making 
the decisions.
    Ms. Bush. Right.
    Dr. Michener. If the government is not making the 
decisions, who is? The market, and that is not democratically 
controlled.
    Ms. Bush. Thank you.
    Dr. Michener. It is not something that people can 
influence.
    Ms. Bush. Thank you. If not three years into the pandemic, 
when will we actually address the fundamental flaws and 
structural inequities present in our healthcare system, in our 
privatized healthcare system? Dr. Blackstock, using your 
extensive experience as an emergency physician, can you please 
describe what the implementation of Medicare for All would look 
like for healthcare providers, particularly those who interact 
with insurance companies?
    Dr. Blackstock. So what it will do is it will enable us as 
health providers caring for our patients to more efficiently 
care for our patients, to prioritize the primary and preventive 
services that we provide them. It will not result in more 
administrative effort and cost. In fact, it will do the 
reverse. And so it will help remove barriers for our patients 
to seek care, and doing so will enable us to buy the best care 
and to do so even more efficiently than we could that now.
    Ms. Bush. I will say ``yes'' to that as the nurse that 
actually worked the bedside. That is true. Thank you, and I 
yield back.
    Chairwoman Maloney. The gentlelady yields back.
    The gentleman from Texas, Mr. Sessions, is now recognized 
for his questions.
    Mr. Sessions. Madam Chairwoman, thank you very much. For 
those members that are here, I only see one other in the room 
that was here in 2008, 2009, 2010 as we went through this exact 
same type of hearing about how great the Affordable Care Act 
would be. And yet you notice no one Democrat that I see talks 
about how great the Affordable Care Act was because it wasn't. 
It took $800 billion out of Medicare. Democrats actually took 
$800 billion away from seniors to pay for this. Now we have 
Medicare for All like it is their newfound answer. Oh, by the 
way, I heard one of our persons just a minute ago giving 
testimony about how Medicaid works so well. I wonder why we are 
not doing Medicaid for All.
    Well, ladies and gentlemen, the bottom line is that both 
the House bill and the Senate bill under Section 107, 
``Beginning on the effective date as in Section 106(a), it 
shall be unlawful for a private insurer to sell health 
insurance coverage that duplicates the benefits under this act, 
and it is unlawful for an employer to provide benefits.'' Well, 
Mrs. Turner, I recall it took President Obama several election 
cycles before they could even tell us ``what was in the bill.'' 
And it took them a long, long time, only to discover that their 
drawings on a board did not equal success for patients. Why 
would they want everybody to go into this system that is 
designed for seniors? It is designed for seniors. It is not 
designed for children. It is not designed for disabled young 
adults. As a matter of fact, I have a disabled, at least one in 
my family, a Downs syndrome young man who is my son. They are 
trying to take all of America and make it to where we would be 
at the same place two years later of trying to say, my gosh, 
what did we do.
    Ms. Turner, I know the gentleman, Dr. Merrill Matthews, 
well. I know the gentleman, Dr. John Goodman, well, and they 
have spoken about the excessive impact that this would have. Do 
you agree with me?
    Ms. Turner. I do, Congressman, and I also agree that we 
really have to figure out what the problem is we are trying to 
solve since two-thirds of people who are uninsured today have 
access to coverage. They are just not enrolled. So I think we 
need to look at specifically how do we help get people into the 
system who, for a number of different reasons, are not 
participating. And we also need to figure out how can we do a 
better job of delivering specialty care to people with special 
medical needs rather than a one-size-fits-all standardization, 
which is ultimately going to work for very few people.
    Mr. Sessions. Yes. Mrs. Turner, when I came to Congress, I 
had spent 16 years at a small telecommunications company called 
AT&T. AT&T was prohibited by the law that was passed by 
Democrats and President Obama that said that they would not 
allow employers to deduct benefits, money spent on employer-
provided healthcare to retirees. That is against the law. They 
wanted to move everybody off of an employer-provided model, 
which seemingly everybody was happy with, and to move to a 
Medicaid model.
    The question I would ask you is, do you think that a 
system, let us say, American Airlines or AT&T, that that would 
be the model that we want everybody to move to just like 
employer-provided healthcare? Because as I read this, I am a 
political science major. When the government competes against 
somebody, free market that is called socialism. When the 
government dictates who can be in the marketplace that is 
communism. What do you think this is, given that as a choice?
    Ms. Turner. Well, I believe that Medicare for All 
definitely is a socialized healthcare system.
    Mr. Sessions. Why is it socialized? It doesn't allow 
anybody to compete against it.
    Ms. Turner. Everybody would----
    Mr. Sessions. Wouldn't that be communism? You may not have 
been a political science major.
    Ms. Turner. I don't have a term for it, but certainly it is 
a one-size-fits-all program.
    Mr. Sessions. It outlaws anyone else from providing 
coverage.
    Ms. Turner. Right.
    Mr. Sessions. That is communism. I thank the gentlewoman 
for being here, and I thank the chairman of the committee for 
this hearing today. Thank you.
    Chairwoman Maloney. The gentleman yields back.
    The gentleman from Illinois, Mr. Davis, is now recognized 
for his questions.
    Mr. Davis. Thank you, Madam Chairman, and thank you so much 
for calling this very important hearing. And I guess I would 
say one thing: Pete, I was in the room. I am a strong supporter 
of the Affordable Care Act. I was then. The 30 million people 
who got an opportunity to get healthcare coverage, I am sure 
they are all supportive of it as well.
    I believe in a single-payer system of Medicare for All, and 
I have spent many years advocating for universal healthcare. As 
a matter of fact, I am pleased to know that I come from an area 
in Chicago Metropolitan where we have 120 clinic sites for 
federally qualified health center clinics. But also, we know 
that for many individuals living with less income, being 
uninsured and underinsured makes accessing healthcare untenable 
and unaffordable. People with less income or more likely to be 
uninsured in every State, but most especially in those States 
that have refused to expand Medicaid.
    Dr. Collins, let me ask you, how has the failure of certain 
States to expand Medicaid under the ACA affected uninsurance 
rates in the United States?
    Dr. Collins. Thank you, Congressman. That is a great 
question, and I agree that the Affordable care Act has put us 
on a path to universal coverage. And there are things that are 
preventing us from getting there right now, and one of them is 
the fact that 12 States haven't expanded eligibility for 
Medicaid. People are entitled to Medicaid by law, but States 
have chosen not to expand. About more than 2 million people are 
caught in the so-called coverage gap and unable to be enrolled 
in their State's Medicaid program or enroll in the 
marketplaces.
    Mr. Davis. And people with low income or people who don't 
have the resources, for example, to purchase prescription drugs 
and pay the rent, they may have a different opportunity. Dr. 
Blackstock, let me ask you. You are an emergency room 
physician. What differences have you observed in the health of 
patients who come to the hospital with health coverage and 
those who come without?
    Dr. Blackstock. Thank you for that question, Congressman. I 
have worked in two different types of hospitals. I have worked 
in hospitals where people have insurance, and their health 
status and health outcomes are far more superior than patients 
I have cared for in public hospitals with patients who were 
uninsured and underinsured. I have seen patients who are 
uninsured coming in with uncontrolled chronic medical 
conditions that compromise their quality of life and that lead 
to an early mortality. And we don't see that in the same way in 
an insured population.
    Mr. Davis. Thank you very much, and, Mr. Barkan, let me end 
with you. What can we do and how can we get rid of the barriers 
that people without resources have to being able to obtain 
healthcare for what their needs are?
    Voice. OK. Ady is writing.
    Mr. Davis. Yes, I think we are just waiting for Mr. Barkan.
    Mr. Barkan. We need to build the social movements to 
transform this reality. Thank you.
    Mr. Davis. Thank you very much, Madam Chairman. Again, 
thanks to this very important hearing, and I certainly want to 
commend those who generated the enthusiasm and the need to hold 
it and to have it, and I yield back.
    Ms. Bush.
    [Presiding.] The gentleman from Florida, Mr. Donalds, is 
recognized for five minutes.
    Mr. Donalds. Thank you, Madam Chair. To the witnesses, 
thanks for being here.
    Look, here is the deal. We already run a single payer 
health system in the United States. It is called the VA system. 
The VA system has been plagued with backlogs. It has been 
plagued with long lines. It has been plagued with shortages of 
care. It has been plagued with overspending. It has been 
plagued with fraud and abuse. We have never fixed it. We choose 
not to fix it. But what we are going to say is, is that the VA 
system, which we know has not provided the best outcomes for 
the men and women who have served our country with honor and 
distinction, we are going to say instead of fixing that system, 
we are going to create a much larger system for every American 
where our own experience with the VA system has already proven 
what happens when you have universal coverage.
    We have another system. It is called Medicare. By and 
large, it is one of the most popular systems that the Federal 
Government has in the United States. It goes insolvent in 
somewhere between 5 to 7 years. I was actually just in the 
Budget Committee, and director for Office of Management and 
Budget, in the President's own budget, which he just released 
yesterday, does not show any slowing down of benefits with 
respect to Medicare, but then also no proposals about how you 
are going to keep this situation going in Medicare because we 
are spending significant amounts of money, providing care to 
the elderly who paid in through payroll taxes over decades in 
the United States. But there are no reforms to actually make 
sure that the benefits can be paid, which means that we are 
just going to have to dig into the pockets of every American to 
continue benefits when the money that was actually allocated 
for those benefits is not even enough to pay the burden going 
forward. But yet in his hearing, we are talking about universal 
healthcare.
    I remember a video. It was a YouTube video from years and 
years ago. This was back when I was a fledgling political 
watcher, and it was from a member of our body who still serves 
here today, who talked about how the Affordable Care Act, 
effectively referred to as s Obamacare, was just the first step 
toward universal healthcare. What Obamacare has done, what the 
Affordable Care Act has done, however you want to call it, it 
has led to higher deductibles, and it has led to higher 
premiums in the United States bar none.
    Of course I am a Member of Congress right now. I am on 
Obamacare. I have never paid higher insurance premiums than I 
am paying right now. I have never paid higher deductibles that 
I am paying right now. And everybody I know in my district and 
throughout the State of Florida, and, frankly, across the 
United States, their deductibles are higher. Their premiums are 
higher. Their access to care is actually less than it was 
before the Affordable Care Act. But the answer from the 
Democrats in our body is universal healthcare or Medicare for 
All, or whatever the amalgam is going to be.
    Ms. Turner, you said in your opening testimony that 
undertaking universal healthcare in the United States, 
according to CBO, would be ``complicated, challenging, and 
disruptive.'' The complicated, challenging, and disruptive 
would apply to all Americans whether you are Black, or White, 
or Hispanic, whether you are rich or whether you are poor. You 
know, it doesn't matter. When you unleash a system that is 
complicated, challenging, and disruptive, that affects 
everybody, and where are they going to go?
    Ms. Turner, I have a question for you. Because of all these 
situations that we are talking about, can you provide some 
specific examples of potential stalled innovation in the 
medical field? What products will be most at risk if America 
adopted a single payer healthcare structure?
    Ms. Turner. What are the advantages today and what would be 
most adversely affected, Congressman?
    Mr. Donalds. Yes, ma'am.
    Ms. Turner. The world relies on the United States for 
medical innovation. We saw it in pharmaceutical research with 
the vaccines just last year. And when you see the Federal 
Government working together to support the private sector and 
the incredible resources it has in research and technology, 
innovation, flexibility, that is when you get results. When you 
have the Federal Government coming in and saying, this is how 
we are going to do it that is when you get the CDC with its 
failure to be able to come up with a test. We have to have the 
private sector if we are going to have innovation, and if we 
are going to have innovation, that is what leads to progress. 
That is what leads to the miracle cures that we see today, new 
surgeries that would have been impossible to envision 30 years 
ago.
    So having private sector innovators who are rewarded, 
through ownership of patents oftentimes, but rewarded 
adequately for their investment in that research is what will 
solve these problems to give people more choices of more 
affordable care and coverage. The Surgery Center of Oklahoma is 
a perfect example. It doesn't rely on government funding to be 
able to provide the high-quality care it does. It relies on 
being able to make the procedures that they do as efficient as 
possible with the best procedure, with the best physicians, the 
best nurses, and the best outcomes. That is what we need more 
of.
    Mr. Donalds. Thank you so much, Ms. Turner. Madam Chair, I 
know I am over my time. The one thing I would say is this. I 
have long said to a lot of students across the country when I 
go and speak with them, if the Federal Government was in charge 
of the telecommunications industry, we would not have iPhones 
and Samsung Droid phones. We would still be on the Motorola 
StarTAC, and their response is, what is a Motorola StarTAC, and 
I am like that is my exact point. It is that funky phone that 
had the orange buttons and the orange screen. There is no 
innovation when it comes from the Federal Government. It only 
comes from private markets. This is the exact wrong way to go. 
And health outcomes in the United States would actually be 
worse, and if you don't believe me, look at the VA system. I 
yield back.
    Ms. Bush. The gentleman from Georgia, Mr. Johnson, is 
recognized for five minutes.
    Mr. Johnson. Thank you, Madam Chair. For decades, Democrats 
have fought to protect and expand access to healthcare, and at 
every step, Republicans try to gut our efforts. Ms. Turner, do 
you believe that every American has a right to access America's 
healthcare system, or is access to healthcare just a privilege 
reserved only for those who can afford it?
    Ms. Turner. Congress decided in the early 1980's that 
anyone who needs care and shows up in a hospital emergency room 
is going to get care. Beyond that, we have just a plethora of 
government programs to offer coverage to people----
    Mr. Johnson. But do you believe healthcare is a right or is 
it a privilege only for those who can afford it?
    Ms. Turner. I think we have a system that allows people who 
cannot afford it to be able to get care and coverage, but you 
don't have a right----
    Mr. Johnson. OK. And you are fine with the system as it is 
now. I get it.
    Ms. Turner. No.
    Mr. Johnson. You have been involved in the debate over 
healthcare reform since President Clinton proposed healthcare 
reform in 1995. Isn't that correct, Ms. Turner?
    Ms. Turner. That is correct. That was in 1992.
    Mr. Johnson. And you opposed the Clinton healthcare 
legislation, correct?
    Ms. Turner. I did not believe then, nor do I now, that the 
government should be in charge of making all decisions in our 
health sector.
    Mr. Johnson. And since 1995, you have headed up an outfit 
called the Galen Institute. Isn't that correct?
    Ms. Turner. That is correct, that I founded.
    Mr. Johnson. And the Galen Institute is a right-wing 
operation funded by right-wing foundations and corporations 
opposed to healthcare system reform. Isn't that correct?
    Ms. Turner. We work closely with people from both sides of 
the aisle, and we advocate policies that put doctors and 
patients at the center of our health sector rather than 
bureaucrats.
    Mr. Johnson. OK. Well, let me ask you this. How many times 
have you testified before Congress on the issue of healthcare 
reform?
    Ms. Turner. Oh, dozens.
    Mr. Johnson. And each time you testified, that you spoke in 
opposition to healthcare reforms proposed by Democrats. Isn't 
that correct?
    Ms. Turner. Not always. I am sure that there were policies 
that----
    Mr. Johnson. You have spoken in favor of some Democratic 
policy proposals? Is that what you are asking us to believe?
    Ms. Turner. There are some really interesting proposals, 
like cash for counseling, that were proposed by Democrats to 
give people in Medicaid the option to be able to get----
    Mr. Johnson. OK. Well, let----
    Ms. Turner. Absolutely, we support it. We are not partisan.
    Mr. Johnson. OK. All right. Well, let me ask you this, Ms. 
Turner. Let me ask you this. For 27 years, you have made a 
handsome living protecting corporate profits while opposing 
reforms that would make access to healthcare affordable for 
all. Isn't that correct?
    Ms. Turner. Our logo of the Galen Institute actually is 
designed to focus on those who are marginalized and left out, 
people who don't have access to public programs.
    Mr. Johnson. And how do you propose for those people to 
gain access to the healthcare system?
    Ms. Turner. As I said in my testimony, we need targeted 
solutions. Who is uninsured?
    Mr. Johnson. Tell me----
    Ms. Turner. Who is being left behind?
    Mr. Johnson. Tell me your targeted solutions to enable 
people who can't----
    Ms. Turner. Not one government program.
    Mr. Johnson. Tell me your solutions targeted toward those 
who cannot afford access to the healthcare system.
    Ms. Turner. I would like to see States be able to repurpose 
some of the ACA money to provide care for people who are not 
covered under Medicaid.
    Mr. Johnson. So you are in favor of the ACA?
    Ms. Turner. And give people the option to use those 
resources----
    Mr. Johnson. Are you in favor of the ACA?
    Ms. Turner. I am in favor of having no one who has coverage 
today losing it, but I believe many more people could get 
better coverage----
    Mr. Johnson. OK. Well, what about those who don't have 
coverage? What about those who don't have coverage? That is 
what I am trying----
    Ms. Turner. What I am saying, if you----
    Mr. Johnson [continuing]. Trying to get you to tell us 
about.
    Ms. Turner. Repurpose----
    Mr. Johnson. What proposals do you have that would ensure 
that folks who cannot access to the healthcare system can have 
access to the healthcare system?
    Ms. Turner. If States had more flexibility, they would be 
able to use the existing resources----
    Mr. Johnson. What about the Federal Government? What is the 
Federal Government role?
    Ms. Turner. As President Biden said recently, the Federal 
Government is really out of its element in dealing with 
something as local and private as healthcare.
    Mr. Johnson. So you don't believe that the Federal 
Government should have any role in the delivery of healthcare, 
do you?
    Ms. Turner. That is not absolutely what I said. I believe 
that States could do a better job.
    Mr. Johnson. But I am asking you, you don't believe that 
the Federal Government should be at all involved in helping 
poor people access the healthcare system. Isn't that true?
    Ms. Turner. That is not what I said. Absolutely not true. I 
believe that we need a strong safety net, and we need a strong 
safety net especially for the vulnerable who find it most 
difficult to get care and coverage in a system when they are 
competing with people who are dropping private coverage in 
order to get onto publicly supported programs. I oppose that.
    Mr. Johnson. Well, you are not talking about poor people. 
You are talking people who are paying for insurance premiums. I 
think the public can see right through your testimony and can 
see that you support corporate profits over access to the 
healthcare system for all----
    Ms. Turner. Absolutely not true.
    Mr. Johnson [continuing]. Including those who cannot afford 
it.
    Ms. Turner. That is not true.
    Mr. Johnson. And with that, Madam Chair, I yield back.
    Mr. Comer. Madam Chair, that is not what she said. He needs 
to be on one of Adam Schiff's committees if he is just going to 
make stuff up. That is not what she said. It is very 
disappointing----
    Ms. Bush. You are not recognized right now.
    Mr. Comer [continuing]. That he would badger the witness 
like that.
    Ms. Bush. You are not recognized right now. The gentleman 
from Georgia, Mr. Clyde, is recognized for five minutes.
    Mr. Clyde. Thank you, Madam Chair, for holding this hearing 
regarding our Nation's disastrous healthcare system. It is long 
past time that we address this growing crisis, and I commend my 
Republican colleagues and the Healthy Future Task Force for 
working on solutions that prioritize innovation and competition 
to reduce costs and improve quality of healthcare for our 
constituents.
    While many of my Democrat colleagues believe a Medicare for 
All Program would lower healthcare costs, unfortunately, that 
couldn't be further from the truth. Reports estimate a Medicare 
for All Program would increase Federal budget commitments by 
another $32.6 trillion. That is more than the total of our 
growing national debt. As the Nation faces continued inflation 
rates, which are now the highest we have seen in 40 years, one 
thing is clear: our current healthcare system is inadequate to 
meet the needs of Americans. One does not need to look long 
before realizing the Federal Government is ill-equipped to 
manage a large-scale healthcare program, as my friend from 
Florida, Mr. Donalds, pointed out.
    It has been 12 years since the passage of the Affordable 
Care Act, and the Federal Government still fails to provide 
affordable quality coverage for millions of Americans in rural 
areas, leaving many communities with only one or two eligible 
insurers from which to choose. In fact, Obamacare was so 
disastrous that many States, including my home State of 
Georgia, filed Section 1332 waivers to exit the ACA 
marketplace. In addition, the Congressional Budget Office's 
outlook for major Federal trust funds indicates that the 
Medicare Hospital Insurance Fund could be exhausted by 2024, 
and that is in this particular document, the 2020 to 2034 
report from September 2d, 2020, right here. If our government 
cannot even ensure the solvency of Medicare for our seniors and 
eligible participant recipients which comprise less than 20 
percent of our population, there is no feasible way for the 
Federal Government to provide Medicare for All.
    So, Ms. Turner, knowing the current State of the Medicare 
program, do you believe the Federal Government is equipped to 
manage a Medicare for All Program?
    Ms. Turner. No, Congressman, I do not. I believe that it 
has shown over and over that it is very good at spending money. 
It is not very good at spending money wisely, and it is not 
very good at all at innovating. When you see the Medicare 
program, 26 million seniors are voluntarily opting out of fee-
for-service Medicare into private plans----
    Mr. Clyde. Wow.
    Ms. Turner [continuing]. Because they say this provides 
more and better coverage. People want choices. Innovation comes 
from the private sector and not from government.
    Mr. Clyde. Right.
    Ms. Turner. And that is what our health sector needs to be 
able to be more affordable and provide more people with 
coverage.
    Mr. Clyde. Thank you. As a followup, as you know, our rural 
communities already face problems with limited insurers and 
lack of access to quality care. In your opinion, would Medicare 
for All improve or worsen these struggles for patients in rural 
communities, like mine in Georgia 9?
    Ms. Turner. The CBO has actually shown that it would 
significantly reduce access to care because a Medicare for All 
Program would pay physicians and hospitals so much less than 
they do now, and you would not have the private sector, 
particularly employer-based plans, picking up the slack in 
order to be able to make these practices and hospitals solvent. 
So it is very hard to see how they could provide the same 
quality, the same access to care by the numbers that they are 
talking about, the savings that they purport to be able to 
achieve.
    Mr. Clyde. OK. Thank you. Not only is the Federal 
Government ill-suited to run a nationwide healthcare program as 
we just heard, but we must not forget that it is the poor 
policy decisions of lawmakers and executive officials that add 
to the problem by continuing to overburden our healthcare 
system, stifle innovative technologies, and raise prescription 
drug prices. While I am glad that we are holding this hearing 
to begin addressing our failing healthcare system, simply 
pointing out a problem is not enough. Our constituents need 
reliable solutions, not only to ensure the quality healthcare, 
but also to address the economic crisis, the hyperinflation 
crisis that is causing prices to currently surge. And I 
strongly urge my colleagues to abandon a universal healthcare 
proposal and work toward competitive market-based solutions 
that are truly in our constituents' best interest.
    And in the few seconds I have remaining, Ms. Turner, would 
you like to respond to anything that my colleague from Georgia 
asked of you? Is there anything that you want to add to that as 
you were badgered?
    Ms. Turner. He is putting words in my mouth, things that I 
am not saying. Can I just make a comment?
    Mr. Clyde. Yes, ma'am.
    Ms. Turner. I really commend you in Georgia and Governor 
Kemp for the innovative proposal that you have offered to try 
to repurpose some Federal funds to do a better job of taking 
care of the vulnerable patients in the State and make care more 
affordable and efficient by giving them a wider choice of 
plans. So congratulations. I hope that the Biden administration 
allows that waiver request to go through.
    Mr. Clyde. Thank you, and I yield back.
    Ms. Bush. The gentlewoman from Illinois, Ms. Kelly, is 
recognized for five minutes.
    Ms. Kelly. Thank you, Madam Chair. Thanks for holding this 
hearing. One thing I wanted to say really quickly, yes, when 
the Affordable Care Act was passed, I wasn't here, but it was 
just the beginning. It wasn't the end. And through the years I 
have been here, we have been trying to improve it but could not 
get cooperation from the other side. And the other side always 
talked about repealing the Affordable Care Act, and when they 
had a Republican President, Republican Senate, and a Republican 
House of Representatives, they did not get it done. So I 
digress.
    Home-and community-based services give older Americans and 
people with disabilities a chance to live freely and 
independently in their homes and remain contributing members of 
their community. Mr. Barkan, I am just going to tell you my 
question, but I am going to move on to others to give you a 
chance to prepare to answer. But I wanted to know from you, I 
would love to hear about the ways in which home-based services 
have impacted your life, but I am going to move on and come 
back to you.
    The Biden administration significantly expanded access to 
Medicaid home-and community-based services to the American 
Rescue Plan. The number of people in the U.S. will need home-
and community-based services is projected to more than double 
by 2050. At the same time, direct care and home service workers 
are in increasingly short supply. Dr. Collins, what work force 
investments do we need to make now to prepare for those 
projected increases in demand, and how can we make sure that 
these investments are equitable?
    Dr. Collins. Thank you, Congresswoman. This is a huge 
burden for families, and everybody is experiencing it both with 
elderly parents and also with disabled children. It has come up 
repeatedly in this hearing today. We do need to improve the 
wages that people are paid who work in these jobs. These need 
to be living jobs that pay people well enough give people the 
care they want and the security that people and these families 
that need them so much need.
    Ms. Kelly. Thank you. Dr. Blackstock, let me turn to you. 
Forty percent of family caregivers identify as Black, 
indigenous, or people of color. The higher prevalence of family 
caregiving occurs in Hispanic and Black families. We also know 
that it is much easier to establish trust with a provider that 
looks like you, and according to the National Academy of 
Medicine, this improves health outcomes. I am a person that has 
worked for the last six years on maternal mortality and 
morbidity and luckily got some bills passed. Why is it 
important that we consider health equity in expanding home-and 
community-based services in America?
    Dr. Blackstock. As you mentioned, by having racial 
concordance in terms of who the caregiver is or who the 
healthcare provider is, we know that that will result in better 
health outcomes overall. So we need to make that investment in 
making sure that home caregivers receive the funding and 
support they need to do their jobs.
    Ms. Kelly. Thank you. We need to build on the successes of 
the American Rescue Plan and provide a permanent expansion for 
home-and community-based services. That is why I support Rep. 
Debbie Dingell's Better Care, Better Jobs Act, which would 
invest $150 billion into funding for home-and community-based 
services through Medicaid and the development of care 
infrastructure and labor force. Mr. Barkan, I will now conclude 
with you to respond to the earlier question.
    Mr. Barkan. Thank you for your question and for giving me 
time to prepare. I get to live a beautiful and full life 
because of home care. Home care saved my marriage as my wife, 
Rachel, and I got to be partners and co-parents again instead 
of patient and caregiver. It is the reason why I get to wake up 
every morning to my wife and two kids and be an active 
participant in their lives, but my reality is the exception. 
Home care is prohibitively expensive, and so when home care is 
not accessible, which is the reality for most, patients are 
forced into nursing homes.
    Nursing homes are unsafe institutions where patients are 
merely warehoused and isolated from their loved ones. Since the 
pandemic began, over 150,000 disabled people have died in 
nursing homes due to the coronavirus. Many of these deaths 
could have been prevented if they had the opportunity to 
receive care safely at home. The loss of these lives are a 
moral failure and a direct result of the for-profit system of 
care that corporate lobbyists, like those hired by the nursing 
home industry, work hard to maintain. It is not exaggeration 
then to say that the difference between being able to receive 
care at home surrounded by the love of family and community and 
living at a nursing home is a matter of life and death.
    Ms. Kelly. Thank you so very much for your response. Thank 
you for being here. Thank you to all the witnesses. Congress 
must act to ensure that older adults and the disability 
community are able to access high-quality care in an affordable 
and inclusive way. Thank you so much, and I yield back.
    Ms. Bush. The gentleman from Kentucky, Mr. Comer, is 
recognized for five minutes.
    Mr. Comer. Thank you, Madam Chair, and, again, I want to 
thank our witnesses for being here.
    Just to begin with, Ms. Turner, we talked about Medicaid, 
and it has been mentioned many times by those on our side of 
the aisle that Obamacare was supposed to be the solution for 
people that couldn't afford healthcare. It was supposed to be 
the great equalizer and solve all of our healthcare problems. 
So with Obamacare, many States had the option to expand 
Medicaid. My home State of Kentucky was one of those States 
that expanded Medicaid to the tune of about a third of the 
State is on Medicaid now.
    Now, you talk to medical professionals and providers all 
over the State, and they will tell you they don't want to see 
Medicaid patients because the reimbursement rates are so low. 
That is because the slice of the pie is a certain size of what 
the States get for Medicaid. The more people that get on 
Medicaid, the thinner they slice the pie. They have more 
slices, so the reimbursement rates continue to go down, so a 
lot of people on Medicaid in Kentucky have trouble finding 
providers who will get them in. Would something like this 
happen with Medicare? If we greatly expand Medicare, which is 
already, as Representative Donalds pointed out, facing 
financial insolvency, would greatly expanding Medicare have the 
same negative impact on Medicare patients that expanding 
Medicaid has had on Medicaid patients?
    Ms. Turner. According to the CBO study, there would be a 
significant reduction in the number of physicians and hospitals 
that could afford to take those payment rates. Either they 
would have to cut back or some of them would even close their 
doors. So you would have fewer providers, which is the 
situation that too many people on Medicaid today face that they 
can't find a provider that can afford to take Medicaid's low 
payment rates. Many do so out of charity, but then they still 
have to go through all the ridiculous paperwork to get paid----
    Mr. Comer. Right.
    Ms. Turner [continuing]. As I said earlier, six cents for a 
complicated pulmonary patient. Very few of them would be able 
to keep their doors open to do that, and I think it would be 
really a decimation of the medical profession.
    Mr. Comer. I have to note I have 29 hospitals in my 
district. I would go out on a limb and say I have more 
hospitals than n just about any Member of Congress. Every one 
of my hospital administrators will say the same thing, and 
these are, by the way, very rural hospitals for the most part. 
They say that they lose so much money on Medicaid. Anyone who 
goes in private pay or has private health insurance, they have 
to really spike the price up on them to cover the cost for 
Medicaid. So many of the arguments that my friends on the 
Democrat side have been making for Medicare for All, I just 
don't buy because a lot of these policies were tried with 
Obamacare, and they have failed.
    Representative Porter mentioned how efficient the 
government was in administrative work. That is a joke. The VA 
is a perfect example of government-run healthcare, and you can 
talk to my case workers in my office in Tompkinsville, 
Kentucky, about how inefficient and unresponsive the VA is to 
the VA patients. Very few VA patients in my district in 
Kentucky are satisfied with government-run healthcare of the 
VA. It was also mentioned by several Democrats about the 
numerous times that Republicans have tried to repeal Obamacare. 
Can you talk about any of the 60 or so times that Republicans 
have tried to repeal Obamacare?
    Ms. Turner. Thank you for that question, Congressman. We 
actually tried to track the number of changes that were being 
made to the ACA as it was happening, and we gave up, over at 
the Galen Institute, 70 changes, 43 of which were made by the 
Obama Administration, some with legal authority, some not. 
Twenty-four were passed by Congress and signed into law by 
President Obama, and three were made by the Supreme Court. So 
the allegation that Republicans have been trying for 60 to 70 
times to repeal and replace Obamacare, the law didn't work, and 
it had to be changed even to marginally work, and still we see 
that it is not nearly serving the patient population that they 
had expected, and millions of people are having to pay such 
high premiums and such high deductibles, that they basically 
don't feel they are insured.
    Mr. Comer. Other thing, and I will close by this, Madam 
Chair. Rho Khanna made a Statement that I actually agree with. 
He said we need to eliminate the middle people, and that is why 
Republicans, with respect to healthcare, we requested a hearing 
on PBMS--pharmacy benefit managers--that I feel like is an 
unnecessary level of bureaucracy in the healthcare system. This 
is something that I believe this committee should have a 
bipartisan hearing on. Republicans had a hearing. We published 
a report from our hearing, and I think that is a very good 
place to start looking if we are talking about trying to make 
prescription drugs more affordable to people, which is a 
significant cost of healthcare for people.
    So I think the Republicans are serious on this committee 
about trying to solve the healthcare problems we have in 
America, but bigger government and government-run healthcare is 
not the solution to the problem. Madam Chair, my time has 
expired.
    Ms. Turner. Transparency would be very helpful.
    Ms. Bush. The gentleman from California, Vice Chair Gomez, 
is recognized for five minutes.
    Mr. Gomez. Thank you, Chair. First, being uninsured in this 
country is daunting, and I know that because most of my life I 
was uninsured until I got a job after college as a child of 
working class immigrants who had no access to employer-
sponsored health insurance, despite them working 4, 5, 6 jobs a 
week to make ends meet. It is something that it is not only 
daunting, but it takes a toll on the family. It takes a toll on 
the children. And when you are uninsured, preventative care is 
definitely out of the question. You only go to the doctor when 
it is the absolute last result resort, and that has devastating 
health and financial consequences that are disproportionately 
borne by low-income individuals, particularly those of color.
    In 2019, the uninsured rate for non-elderly Black Americans 
was 1.5 times higher than it was for white Americans. For 
Hispanics and Native Americans or Alaska Natives, it was nearly 
triple. When people don't have health coverage, they can't get 
regular checkups and screenings, which leads to preventable and 
tragic outcomes, such as Black women succumbing to breast 
cancer at a rate of 42 percent higher than white women, even 
though the incidence of breast cancer is higher in white women.
    The Affordable Care Act helped narrow this coverage gap 
through premium tax credits that have allowed working families 
to purchase quality coverage through the marketplaces. The 
American Rescue Plan built on this key reform through 
provisions in the Health Care Affordability Act, which I 
introduced with Congresswoman Lauren Underwood. We expanded 
eligibility for premium tax credits, which has, on average, 
lowered existing premiums like 40 percent. Over one-third of 
the consumers who have taken advantage of the new lower rates 
provided by the American Rescue Plan have joined plans with 
monthly premiums of $10 or less. Many individuals have seen 
their medium deductible fall as much as 90 percent.
    Dr. Collins, how have the ACA premium tax credits helped 
individuals and families get covered, and how has the expansion 
of the premium tax credit in the American Rescue Plan enhanced 
the program?
    Dr. Collins. We know from our survey data that 
affordability is the main reason people decide to take a 
coverage or not, and so the premium subsidies in the 
marketplace has helped millions of people gain coverage through 
a market that did not work for most people prior to the 
Affordable Care Act. The American Rescue Plan's subsidiaries 
have done what is needed and enhanced the affordability of 
those premiums by decreasing the amount of money people have to 
contribute to them.
    Mr. Gomez. And since the American Rescue Plan has passed, 
since it has passed, more than 1.5 million Americans have 
enrolled in coverage, while an additional 2.5 million people 
who were previously enrolled in ACA Marketplace plans have seen 
their premiums fall by 40 percent on average. And despite this 
success, this relief is temporary and it will expire soon. Last 
year, I introduced the Choose Medicare Act with Senator Murphy 
and Merkley, which would give all Americans the choice of 
buying Medicare as their health insurance plan, and makes 
reforms to improve affordability, including expanding 
eligibility for the premium tax credit, while making it more 
general.
    Dr. Collins, how would changes like these put us on the 
path to universal healthcare?
    Dr. Collins. So I think that we can get to universal 
coverage by building on the Affordable Care Act. It has been 
modeled and demonstrated that we can do it even at lower cost, 
particularly if we add a public option to the marketplaces, and 
also, importantly, develop an auto enrollment mechanism to help 
people get easily enrolled. People who are not currently 
enrolled would have a much easier pathway to get covered.
    Mr. Gomez. Thank you so much for that response, Dr. 
Collins. And as somebody who has been both uninsured and 
insured and seen my parents who were uninsured and insured, 
even in the best scenarios with individuals who have healthcare 
coverage navigating the healthcare system and ensuring that 
people who have language barriers who can't get necessarily 
access to certain types of care, we see that the disparities 
exist. And even under the current system, we need to work on 
making that disparity less and making sure that those who are 
left behind oftentimes by our healthcare system, our education 
system, and so many different systems, that we try to make 
changes that improve their health outcomes so that people of 
color or people who live in certain zip codes are not 
discriminated against because of where they live or the color 
of their skin.
    So this is something that we need to work on. I believe 
that the ACA and the American Rescue Plan have given thousands 
of families a little peace of mind. I know that it is not 
permanent, but the more we work at improving coverage, the 
better people will be able to access quality healthcare.
    So with that, I yield back. Thank you for the time, Madam 
Chair.
    Ms. Bush. The gentleman from California, Mr. DeSaulnier, is 
recognized for five minutes.
    Mr. DeSaulnier. Thank you, Madam Chair. Nicely done on the 
pronunciation. And I want to thank the chair of the full 
committee for having this hearing.
    For too many Americans in need of mental and behavioral 
health, they have been unable to access services for a variety 
of reasons. It was hard fought in the Affordable Care Act to 
make sure we had equity for behavioral health. We are learning 
so much about how the brain works, the impacts of stress, and 
trauma, poverty. That access is a real problem, and I wanted to 
ask a couple of questions about that, also just the capacity. I 
am told that there is a 75-percent increase in requests for 
behavioral health services by Americans since the ACA passed, 
but there are 25 percent fewer young people going into the 
field.
    So access and getting universal healthcare for many medical 
conditions is extremely important, but also for behavioral 
health. This is personal for me. I am a survivor of suicide. On 
April 20th of this year will be 33 years since my father took 
his life, and largely because of that, myself, my family, my 
sons have access to great professionals. But it has been a 
challenge for us, so I can imagine what it is, particularly for 
poor people and people of color as they try to access 
healthcare for behavioral and mental health.
    The Kaiser Family Foundation has studied and said that more 
than half of American adults coming out of COVID report 
experiencing symptoms of anxiety or depression disorder within 
the past two years. Dr. Collins, I want to ask you, how does 
our current coverage system present obstacles to people, 
particularly poor people, seeking mental and behavioral 
healthcare, especially for uninsured? Dr. Collins?
    Dr. Collins. Yes. Particularly for uninsured, if you don't 
have health insurance coverage, it is very difficult to get 
care of any kind, including mental health, behavioral health, 
care for substance abuse problems, so that is one issue. 
Another, if you have insurance, you can't access providers, so 
there is an increased demand that hasn't necessarily been met 
by the available capacity in the system, particularly in the 
wake of the COVID pandemic.
    Mr. DeSaulnier. Thanks. How would, Dr. Collins, moving to 
universal healthcare help with that access, I think, for people 
who are uninsured and are completely without that access?
    Dr. Collins. I think for people who are uninsured and are 
completely without access, particularly in States that haven't 
expanded Medicaid, expanding Medicaid expansion would clearly 
help address the problems in those States. Making overage more 
affordable for people through the ARP subsidies have 
dramatically increased the affordability of marketplace plans. 
Mental health is part of the essential benefit package for 
marketplace coverage. But I think we also need to think about 
integrating different ways to increase capacity, integrating 
behavioral health and substance abuse into primary care, for 
example, expanding and diversifying the behavioral health work 
force by engaging a wider variety of providers to meet people's 
unique needs, and also thinking about leveraging current health 
technology to help improve access.
    Mr. DeSaulnier. Dr. Michener, how about disadvantaged 
communities and communities of color? Clearly, as I said, my 
experience, although different than poor communities in my 
district and the Bay Area where I represent, have even larger 
challenges. So how would universal healthcare and getting at 
these disparities, even though the law says that it should be 
open and we should have equity for behavioral health, how might 
that help? And I will mention I have a bill that allows for 
money for primary care physicians because for people who commit 
suicide, over 60 percent of them see a primary care physician 
within a few months of them attempting to commit suicide or 
being successful at it. Doctor?
    Dr. Michener. Yes. So I think there are few different 
pathways here. One is clearly through providing people who 
don't have insurance presently with insurance, and that means 
that they can see mental health specialists, but they can also 
see primary care providers. And I do think that primary care 
providers are an important sort of first stop, first base, and 
they can screen and, in many ways, direct people toward more 
specialized care that is appropriate for them given their 
mental health challenges and/or conditions. So I think that 
that is critical, and I think it is especially critical in 
communities of color where there are already stigmas around 
mental health and mental healthcare, and where people face 
systems and processes, like discrimination and racism, that 
create even more mental health stressors in their lives and in 
their communities. So I think that there are hardly any places 
where these problems are more acute and more imperative than in 
communities of color, and universal coverage is a primary 
pathway for getting there.
    And I would reinforce this point about the healthcare work 
force. I think one of the places where we see the most 
potential and opportunity for growth in the healthcare work 
force is among people of color and communities of color. And I 
think investing in resources for education and training in 
those communities so that the very communities where these 
struggles exist can be equipped to participate in the work 
force to address them, a work force that can only be robust 
under a system where the maximum number of people have health 
insurance.
    Mr. DeSaulnier. Thank you, Doctor. I yield back.
    Ms. Bush. The gentlewoman from Massachusetts, Ms. Presley, 
is recognized for five minutes.
    Ms. Pressley. Thank you, Madam Chair, and thank you to all 
the witnesses who have shared their testimony today. I do want 
to just take a moment to offer special recognition for 
something that, at least to my knowledge, this is the first 
time in three years that it has occurred while I have been a 
Member of Congress. And I would like to acknowledge our ASL 
interpreters. I thank you for joining us today.
    Mr. Barkan, my forever local progress brother and my 
sibling in the work of healthcare justice, I appreciate you so 
very much, and Rachel and your beautiful children, Carl and 
Willow, for all that you give to the movement. Like Leslie 
Templeton from my district, who testified on the previous panel 
of patients, you have highlighted how universal coverage and 
Medicare for All specifically is a healthcare justice issue and 
a disability justice issue.
    The life and death consequences of our current healthcare 
system have been made tragically clear over the course of this 
pandemic, and it was the disability community, in fact, that 
sounded alarms early on, warning that this crisis would be a 
mass disabling event. With millions now suffering with the 
impacts along COVID, it is clear that they were right. There is 
simply no way we can return to the pre-COVID status quo normal 
because that normal was fundamentally unjust to begin with. 
Across the United States, folks with disabilities and chronic 
conditions, who are disproportionately people of color, are 
more likely to be uninsured and underinsured, creating a 
barrier to critical care. This, in part, is a result of how our 
current healthcare system frequently ties one's healthcare 
coverage to their employment status. For many disabled people, 
in particular, maintaining a full-time job with health 
insurance may not be feasible. And even if you have insurance, 
sky-high co-pays and out-of-pocket costs can keep people with 
disabilities in perpetual poverty.
    Mr. Barkan, how does a system that ties health coverage to 
employment perpetuate deep inequities for people with 
disabilities, and how would Medicare for All help to address 
this?
    Voice. He is writing.
    Mr. Barkan. Thank you. As of August 2021, 1 in 5 workers 
with disabilities lost employment during the pandemic, which 
does not include the 1.2 million newly disabled adults the 
coronavirus has created. For many in the United States, health 
insurance is tied to employment. If you change or lose your 
job, you are likely to lose your health insurance or have to 
start over again and build a new team of providers that exist 
in network. Patients who have medically complex conditions rely 
on continuity and their medical teams to monitor their health. 
The disruptions that result from our patchwork system not only 
inconvenience patients but endangers those of us who most need 
uninterrupted, high-quality care.
    And as you heard from the patient panel this morning, 
critical health needs can make it difficult or impossible to 
work, leaving the people who need the care the most to either 
navigate being uninsured or too often work in jobs that are 
inaccessible or damaging to their health. Additionally, despite 
the ability to and interest in working, disabled people are 
often employed at much lower rates than people without 
disabilities, in part because of discrimination. Barriers like 
ableism in hiring, inaccessible workplaces, and pay 
discrimination all contribute to the lower rates of employment 
for disabled people. By disconnecting healthcare from 
employment, disabled people, who are already burdened by 
ableism and discrimination, would not have to worry for their 
healthcare at the same time.
    Ms. Pressley. Thank you so much, Mr. Barkan. Congress must 
stop enabling a predatory health insurance system, one that 
repeatedly fails our most vulnerable communities. Today in 
America, if you are poor, Black, brown, indigenous, or 
disabled, your ability to live, to survive is jeopardized by a 
broken healthcare system that puts profit over people. We must 
stop allowing the greed of insurance companies to outweigh the 
health of our constituents, of our community members. We must 
ensure that every person has access to quality care when they 
need it and where they need it.
    Babies with heart conditions ending up with parents in 
bankruptcy is not healthcare justice. A grandmother working the 
night shift so she can scrape together cash for insulin is not 
healthcare justice. These are moral failures and policy 
choices, violent ones. In fact, Coretta Scott King reminded us 
that, ``Ignoring medical need is violence. Contempt for poverty 
is violence.'' Healthcare is a human right, and we need 
Medicare for All. Thank you, and I yield back.
    Voice. Excuse me. I am sorry, Congresswoman Pressley, but 
Mr. Barkan was going to add a little more.
    Ms. Pressley. Oh yes.
    Mr. Barkan. One in 4 Americans live with a disability, and 
this number is growing exponentially due to those who have 
become recently disabled because of the long-term effects of 
the coronavirus. Only a single payer system can possess the 
scale and resources necessary to guarantee care for all, 
detached from employment. As one example, Medicare for All 
covers home-and community-based services for all who need it.
    The Federal Government currently requires States to fund 
nursing home care for everyone eligible. This is not the case 
with regards to home-and community-based services. And because 
States manage their own home care programs through Medicaid 
eligibility requirements, the services available vary widely 
across States. It is by default and design that so many 
Americans who require care are forced into unsafe institutions 
like nursing homes. Patients overwhelmingly favor the option to 
receive care at home, but these services are prohibitively 
expensive and, therefore, inaccessible to most.
    The government would actually save money covering the cost 
of home-and community-based services instead of covering 
nursing homes. Under a single-payer system like Medicare for 
All, home-and community-based services would be prioritized 
over institutional care, giving patients the safe and dignified 
care they prefer and deserve.
    Voice. Thank you so much.
    Ms. Pressley. Thank you.
    Ms. Bush. The gentleman from New York, Mr. Jones, is 
recognized for five minutes.
    Mr. Jones. Thank you, Madam Chair, for your leadership. I 
represent a district that people often think of as very 
affluent, and yet there are still too many people who cannot 
afford healthcare. I think of my grandmother, for example, who, 
like so many seniors throughout this country, worked well past 
the age of retirement just to pay for the high cost of 
prescription drugs, dental care, and other medical procedures 
that are not fully covered by Medicare as we know it today. 
Other of my constituents who lack healthcare coverage are 
working middle-class people who make too much money to qualify 
for Medicaid or other subsidies under the Affordable Care Act 
but not enough to afford the high cost of healthcare on their 
own.
    The price of premiums and deductibles is simply too high 
for many families. Still others have experienced gaps in 
coverage at critical times due to job loss. In fact, we saw 
millions of Americans lose their jobs during the COVID-19 
pandemic, and with that, their healthcare. The pandemic made it 
clear that the employer-based healthcare system just does not 
work in our modern economy.
    Mr. Barkan, thank you for your testimony and for your 
dedication to making America a Nation that treats every person 
with dignity and with compassion. You are a leading voice in 
our push to finally realize universal healthcare coverage, our 
push for Medicare for All. We have heard a number of misleading 
claims from my colleagues on the other side of the aisle today, 
so now I would like to give you the opportunity to correct the 
record on what we have heard today.
    Mr. Barkan. Thank you for your comment and your leadership. 
There has been a lot of misleading information today about how 
Medicare for All would take away our freedom of choice, but the 
reality is our for-profit system does exactly this by 
inhibiting our ability to make choices for ourselves and by 
dictating and limiting our experience of care. As I told you 
this morning, my health insurance provider denied the 
ventilator that I needed to survive until I forced him to cover 
it.
    Right now, multi-millionaire healthcare executives already 
make unilateral decisions about our health coverage. There is 
no freedom to be found in a system that tells us who we can or 
cannot see or which services we can or cannot access. Medicare 
for All would ensure that all of us have the freedom to choose 
our healthcare providers and hospitals without worrying about 
whether a provider is in network. It would mean that patients 
would have uninterrupted access to care and that we would be 
able to build long-term relationships with our providers. It 
would mean that seniors and disabled people have the option to 
live safely and with dignity at home instead of being 
warehoused in unsafe nursing homes. Medicare for All would mean 
that Americans would be free of medical debt. Health insurance 
companies and their multi-millionaire executives do not belong 
in the intimate decisions we make about our health. Medicare 
for All is a system designed to empower the people by placing 
the power of choice back in the hands of patients and 
providers.
    A single payer system is, in fact, the only system that 
would allow us the true freedom to make our own decisions about 
our lives. When it comes to waiting times, we already have 
incredibly long wait times for every element of our healthcare 
system. Even prior to the pandemic, which has deeply 
exacerbated this issue, the wait time for the ER takes hours. 
Wait times for specialists can take months or years, and that 
doesn't include the people who have to ration their own care 
because they cannot afford this. With a Medicare for All 
system, the system would expand. There would be more providers, 
and care would not need to be rationed in this way.
    Mr. Jones. Thank you, Mr. Barkan, for your leadership. 
Madam Chair, I yield back.
    Ms. Bush. The gentlewoman from New York, Ms. Ocasio-Cortez, 
is recognized for five minutes.
    Ms. Ocasio-Cortez. Thank you so much, Chairwoman Bush, and 
to all of our witnesses for being here today. But I have to 
underscore how grateful we are for Representative Bush's 
leadership and determination in securing such a historic and 
unprecedented hearing, not just for this committee, but for the 
country, so thank you.
    We know that private insurance is the primary health 
coverage for two-thirds of Americans, with the majority of 
private insurance being employer sponsored. But what I think 
most people in the U.S., most working-class people need to 
contend with is the fact that the money employers spend on 
health benefits, and particularly for-profit private health 
insurance, comes from the money that they would have otherwise 
spent on our wages.
    Dr. Collins, in 2020, the standard company-provided health 
insurance policy totaled over about $7,000 a year for single 
coverage and over $21,000 a year for family coverage. Is that 
correct?
    Dr. Collins. Yes.
    Ms. Ocasio-Cortez. And with employer-sponsored insurance, 
your employer pays a large portion, and you pay a smaller 
portion, correct?
    Dr. Collins. Yes.
    Ms. Ocasio-Cortez. So in the case of individual coverage, 
if the total cost is around $7,400 and your employer pays, say, 
$6,200, and you pay for around $1,200, now that is thousands of 
dollars more that everyday people could be saving per year if 
it weren't going directly to insurance companies' private 
profits, correct?
    Dr. Collins. Yes.
    Ms. Ocasio-Cortez. Interesting. So one of the things that 
we are really seeing here is that the potential to moving to a 
Medicare for All system could actually give people a raise in 
many circumstances. Now, a common rebuttal to that and a common 
rebuttal to Medicare for All that you will hear from 
conservatives and the right is that we would merely just change 
the way in which that same premium is charged, and that those 
same dollars that are coming out of our paychecks now would 
then just be coming out in the form of taxes. But the truth is 
that Medicare for All actually lowers the overall cost of 
healthcare as well.
    Dr. Collins, isn't it true that Medicare for All would also 
reduce the average total costs for lower-and middle-income 
families by eliminating more medical expenses than they would 
pay in taxes?
    Dr. Collins. How it was structured is there is that 
possibility, particularly in terms of getting provider prices 
down which drive these cost that people are paying.
    Ms. Ocasio-Cortez. Mm-hmm. Thank you. And you don't even 
have to take just our word for it. In fact, that conclusion has 
been confirmed via thorough research by the Center for a 
Responsible Federal Budget. We also know that Medicare for All 
is much cheaper than private insurance. Dr. Collins, public 
options like Medicare actually pay hospitals and service 
providers less than private insurance companies have to for the 
same service. So a single-payer public option would drive down 
costs additionally through its ability to negotiate on health 
services and drug prices. Isn't that right?
    Dr. Collins. That is very true.
    Ms. Ocasio-Cortez. And, in fact, I think the evidence for 
that isn't just theoretical, it isn't just calculated by think 
tanks, but we see it in everyday life. Another case in point 
right here comes from my district. Almost everywhere in the 
world, health outcomes are correlated with a person's income, 
but one of the only places in the world that that doesn't apply 
is in Queens, one of the handful of zip codes where your income 
does not determine the quality of healthcare that you have. And 
the reason for that is our crown jewel of the public hospital, 
Elmhurst Hospital in Queens.
    Years ago, we as a community made a commitment that we 
would never turn anybody away based on their health insurance 
status, their documentation status, their housing, or their 
income. Every single person who enters Elmhurst Hospital gets 
treated regardless of their ability to afford care. And what we 
have found is that it is more affordable to treat everybody, it 
is possible to treat everybody, and people can get higher-
quality care than they ever could under our current privatized 
for-profit system.
    And with that, I yield back to the chairwoman. Thank you 
very much.
    Ms. Bush. The gentleman from Vermont, Mr. Welch, is 
recognized for five minutes.
    Mr. Welch. Thank you very much, Madam Chair. I appreciate 
it. I am a co-sponsor of Medicare for All as well, and the 
incredible challenge we have with healthcare, as many of my 
colleagues have said, it is too expensive. We pay the most and 
we get the least, and we still have 30 million folks who are 
uninsured, and it is unconscionable. It is unconscionable 
because it is not necessary. It is not as though we don't have 
the capacity to provide care, and it is not as though we don't 
have the capacity to save money. But we have a healthcare 
system that is so fragmented, both in the delivery system in 
the payment system that we end up paying the most and getting 
the least. And how we are not all shocked by that from a fiscal 
standpoint, but from a moral justice standpoint, is 
astonishing. It really is. So, Congressman Jayapal, I want to 
thank you for the carrying the torch on this.
    The public option is something a lot of us advocate for. 
The Medicare for All is something we all advocate for. A major 
reason I do is that I think we do have to get the costs down, 
and what we have seen in this pandemic is our frontline 
providers, folks hands-on like our nurses, they haven't been 
paid enough, and they are getting hammered with work 
responsibilities. On the other hand, you have private equity 
finding those seams in the healthcare system where they can 
take over an emergency room physician practice, and then, 
through double billing, make an immense amount of profit. And 
it is exploitation of the fragmentation of the healthcare 
system that is helping to lead to these high costs and low 
access. So that is just a little background.
    The things we have done, I think, that are good is 
telehealth has really worked. That has been incredibly 
beneficial. We have got to bring down the cost of prescription 
drugs, and the House, of course, passed the legislation to do 
that. We have got to have mental health that has parity.
    Just a couple of questions. Dr. Michener, I want to have 
you focus on rural communities because so much of my district 
is rural, but that is true for so much of America. What are the 
particular challenges that rural America has in accessing 
affordable, high-quality medical care?
    Dr. Michener. Yes, this is an appropriate question given 
that I hail from UpState New York. So I think a lot about the 
rural communities there, and I am actually a part of a 
collaborative that focuses specifically on health equity in 
rural communities, and I think there are a range of challenges. 
So one is the basic challenge that we have been talking about 
today, which is access, and I think that because in rural 
communities we see higher rates of poverty and we see more 
difficulty and challenges around having health insurance, 
having just access to being insured, that is a primary and an 
initial barrier. And then I think there are some specific 
barriers that are particularly challenging in rural areas. 
Transportation is one.
    Mr. Welch. Right. Yes, very much.
    Dr. Michener. And that that is an important problem and one 
that is, in part, addressed through a program like Medicaid, 
which has a transportation benefit. We don't see that same 
benefit available in the private sector, and we know that that 
benefit is correlated with all sorts of positive health 
outcomes.
    Mr. Welch. Thank you. Thank you. And I will ask Dr. 
Collins, how would universal coverage improve healthcare 
options in rural communities, and as we work to ensure that all 
in America can prosper, how would universal coverage foster 
economic growth in rural areas?
    Dr. Collins. Well, I think we have seen in Medicaid non-
expansion States, as a case in point, rural hospitals have 
closed. They just haven't had the financing that they need to 
serve people in their communities. And so having a universal 
financing mechanism to make it possible for these hospitals to 
stay in business would be one of the benefits of universal 
coverage in every State.
    Mr. Welch. You know, one final point I am going to make, 
and I will ask you, Dr. Collins, to just respond to it, if you 
have universal coverage, then the challenges that each of us 
faces in access to healthcare become the challenges that all of 
us face. It is not as though having Medicare for All 
necessarily solves all problems. It just means we are all in it 
together to try to solve the problems we face. Does that make 
some sense to you?
    Dr. Collins. That is right, and insurance is the most 
important and it is a necessary condition for people getting 
access to care, but it is not the only factor. And so we also 
need to work at making sure people have adequate provider 
networks, that providers are paid well enough to participate in 
the networks, and we have good transportation systems so people 
in hard-to-reach areas are able to get the healthcare that they 
need.
    Mr. Welch. I yield back. Thank you, Madam Chair.
    Ms. Bush. The gentleman from Maryland, Mr. Sarbanes, is 
recognized for five minutes.
    Mr. Sarbanes. Thank you very much, Madam Chair. I 
appreciate the opportunity to join the hearing today.
    We know that the research shows very clearly that there is 
a correlation between uninsurance or underinsurance and poor 
patient outcomes, and we saw that during the coronavirus 
pandemic, in particular. More than 40 percent of Americans who 
contracted coronavirus in the first year of the pandemic were 
either uninsured or underinsured. And a recent study found that 
a 10-percent increase in the number of uninsured residents per 
county was associated with a 70-percent increase in coronavirus 
cases and a nearly 50 percent increase in deaths from the 
coronavirus. Dr. Blackstock, I would like to ask you, what 
inequities in our healthcare system could explain this 
correlation?
    Dr. Blackstock. Yes. So, you know, we have to think about 
when people lack access to care, they are lacking access to 
primary and preventive services, mammograms, colonoscopy 
screenings, proState cancer screenings, and so that will cause 
an exacerbation of these inequities. And then with the 
pandemic, we saw that our systems were under even increased 
stress, so people, when they lost their jobs, they also lost 
their insurance and were not able to access care. We also have 
seen that, as our government has picked up the slack in terms 
of vaccines and testing, that those gaps actually in terms of 
COVID mortality rates have closed. So we see what happens when 
we are able to provide communities and people to services that 
they need.
    Mr. Sarbanes. You know, the threat from the pandemic, we 
spoke often and we continue to about how that combines with 
underlying conditions to pose a great risk to patients. And if 
underlying conditions are persisting and not being addressed in 
certain communities and populations that is obviously going to 
increase the risk. Can you talk about how universal coverage 
could have improved the experiences of patients during the 
coronavirus pandemic? Let's look at it from the positive side.
    Dr. Blackstock. Right, absolutely. We know that people who 
carry a higher burden of chronic disease were more at risk for 
the more severe outcomes of COVID-19. So if people have access 
to care, if they have access to, you know, care that prevents 
their diabetes, and their high blood pressure, and their asthma 
from worsening, then that could ultimately improve their 
outcomes from COVID-19. So it is really about investing in 
health, investing in people from the beginning to prevent these 
worse outcomes later on.
    Mr. Sarbanes. Dr. Michener, I would love to get your 
perspective as well. How would universal coverage ensure more 
equitable outcomes in the case of a future public health crisis 
because we want to learn our lessons obviously, and adapt, and 
make clear-headed decisions going forward? So if you could 
speak to that that would be wonderful.
    Dr. Michener. Yes, I think universal coverage, in addition 
to providing people with access to care, they get to go to the 
hospital. They get to go to the doctor. They get to get the 
treatments in the medications that they need. They don't have 
to delay. They don't have to forego care. The other thing to 
recognize is that uninsurance and underinsurance are 
concentrated in particular communities, that there are zip 
codes and there are neighborhoods that have disproportionately 
high levels of uninsurance and underinsurance. So when we 
address those problems, we don't just address them among 
individuals. We address them at the community level, which 
means that the solutions and the benefits can really amplify.
    For example, we have research that shows that when you 
insure parents, they are more likely to take their children to 
well care visits. Even if the children were already insured, if 
the parents weren't, they weren't socialized into the habit of 
going to the doctor. And so you see families, and you see 
social networks, and you see communities, and the benefits of 
insurance ripple throughout these levels so that we can see 
amplified positive effects if we have universal insurance.
    Mr. Sarbanes. You know, there are so many connections here 
that aren't necessarily intuitive, but when it is brought to 
your attention, it makes perfect sense. So a lot of the adults 
with less income in our society experienced coronavirus-related 
job loss or pay cuts at the beginning of the pandemic, and then 
had consequential coverage laws that went with that. In 
Maryland, we saw 200,000 people enroll in healthcare coverage 
through our State-based health exchange during the special 
enrollment period that we extended during COVID-19, and nearly 
two-thirds of those people enrolled in Medicaid.
    I am running out of time, but, Dr. Michener, what does it 
tell us about how Federal healthcare programs can support 
people and the ability to lift up communities during times of 
crisis and volatility?
    Dr. Michener. I will quickly say, mindful of time, given 
all that has been said about the government, and Big 
Government, and government inefficiency, this is a really 
important point. There was a time before Medicare, there was a 
time before Medicaid, and it was a dark and dismal time where 
many more people had much worse outcomes. The private side of 
the market could not address the fundamental needs of the 
American people, and that is why we developed these public 
programs. And they are not perfect, but they are absolutely 
saving lives, and the science around that is quite 
incontrovertible.
    Mr. Sarbanes. Thank you, and I will just note as I yield 
back, their administrative costs tend to be much lower than 
what we see in the private sector and other arguments for the 
universal healthcare coverage that we are talking about today. 
Thank you, Madam Chair.
    Ms. Bush. The gentlewoman from Washington, Ms. Jayapal, is 
recognized for five minutes.
    Ms. Jayapal. Thank you, Madam Chair, and thank you for your 
incredible leadership in making this hearing happen, and to all 
my sisters in service that were part of it, and to all the 
colleagues who have been talking about the various aspects of 
universal healthcare. Also, thank you for the powerful 
testimoneys that we have heard.
    My Medicare for All act would provide healthcare to 
everyone in the United States without the financial, racial, or 
demographic barriers that exist in our current system. My bill 
creates a comprehensive, universal single-payer healthcare 
system that provides all the medically necessary care that 
someone needs. Imagine that: a comprehensive care that includes 
dental, vision, and hearing, and for the first time when we 
introduced this bill two Congresses ago, long-term care, 
something that Mr. Barkan has spoken extensively on.
    The bill eliminates insurance premiums, co-pays, 
deductibles, and all other out-of-pocket costs, and removes the 
for-profit insurance companies from the doctor-patient 
relationship, while controlling medical costs to bring down 
overall spending. That is a very important piece of this. And I 
think at the end of the day, I have heard people arguing 
against Medicare for All by saying it takes away choice. I 
would just argue that Medicare for All would actually allow 
people to make choices, like being able to go see a doctor or a 
hospital without worrying about out-of-network costs that come 
later when there are tens of thousands of dollars that people 
can't afford; or the choice to be able to have healthcare even 
when you lose your job instead of 27 million people losing 
healthcare because they lost their jobs during COVID; or the 
choice to start a small business because you don't have to 
worry about your healthcare, it is covered already; or, most 
importantly, the choice to live and not die.
    Researchers have found that Medicare for All will save over 
68,000 lives per year. That means 68,000 more birthdays, 68,000 
more anniversaries, 68,000 more loved ones alive every year 
simply because we transitioned to a Medicare for All system. 
And under Medicare for All, those 68,000 lives saved would also 
see a drastic increase in quality of life.
    Mr. Barkan, you have been an incredible patient advocate 
your entire life, and even now you are still. How would your 
life be different if Medicare for All were enacted? And I am 
going to give you a few moments because I know you have to get 
your answer prepared, and I will come back to you for your 
answer.
    Dr. Blackstock, as a physician and expert in health 
inequities, you have seen firsthand who the winners and losers 
are in our for-profit healthcare system, and we often forget 
the crucial role that Medicare actually played in beginning the 
desegregation of hospitals. We sort of overlook that, but there 
is a lot more to do. So tell me, who do the 68,000 lives that 
Medicare for All would save, the lives that are lost in our 
current healthcare system, who do those lives belong to?
    Dr. Blackstock. Thank you, Representative Jayapal, and 
thank you for mentioning that because I think we often forget 
that Medicare was probably one of the greatest civil rights 
achievements in terms of desegregating hospitals and providing 
or advancing health equity. But the 68,000 lives are people who 
matter, people who deserve humanity. They are mostly and 
disproportionately people of color. They are also low-income 
families. They are predominantly located in the Southern part 
and the Western part of this country. They are people who 
aren't able to afford the out-of-pocket costs, you know, to 
purchase medication or to access insurance. So this is giving 
people with families, low-income families with children, the 
opportunity to have a choice to access the care that they need.
    Ms. Jayapal. Dr. Michener, you have spoken so eloquently 
about racial inequity. Tell us how a Medicare for All system 
would help alleviate those racial health inequities that people 
are facing right now.
    Dr. Michener. One of the main benefits of a Medicare for 
All system is that it is not a tiered system. It is not a 
system that is rationed based on where you live. We know that 
rationing based on geography leads to racial inequities, so 
that people who live in the South or people who live in what we 
call hospital or our public health deserts, have less access. 
We don't have rationing based on income. We know that causes 
racial disproportionalities because people of color are more 
likely to be living in poverty. We don't have rationing based 
on a range of other factors that all bake in racial 
discrimination. Instead, we have access that is equally 
available to all.
    Ms. Jayapal. Thank you so much. Let me go back to Mr. 
Barkan before my time expires and ask you for your answer. Mr. 
Barkan.
    Mr. Barkan. Thank you so much for your leadership. It is an 
honor to be in the struggle with you. I am not the only one 
whose life has been upended, first, by illness and then by the 
moral abomination that is our healthcare system. Right now, 
about 30 million people in this country are uninsured, and even 
more get necessary care denied every year by their insurance 
company. We are richest Nation in the history of the world, and 
yet Americans regularly go bankrupt from their medical bills 
and cut their pills in half because they can't afford the cost 
of prescription drugs. It reveals much about our country that 
we see spikes in cancer diagnoses for Americans aged 65 once 
they become eligible for Medicare. Too many go far too long 
without care because they cannot afford it.
    By securing Medicare for All, we can save thousands of 
lives and free mourning families from the lingering pain of 
asking themselves, what if we had caught this sooner. Americans 
across the Nation and across the political spectrum have been 
harmed by corporate greed. I believe we can overturn our for-
profit system because our power lies in our solidarity. Our 
movement for Medicare for All isn't slowing down any time soon. 
We intend to win our due rights, and we will continue to 
organize for our collective freedom until all of us are free 
from this corrupt system of corporate greed.
    Ms. Jayapal. Thank you so much, Mr. Barkan. We are not 
giving up until we pass Medicare for All. Thank you, Madam 
Chair. I yield back.
    Ms. Bush. The gentleman from New York, Mr. Bowman, is 
recognized for five minutes.
    Mr. Bowman. Thank you so much to Chairwoman Maloney and 
Rep. Bush for holding this historic hearing, and thank you to 
all the members of this committee for allowing me to join you 
today. Thank you also to Rep. Jayapal for her incredible 
leadership on this issue.
    More than 27 million adults in the United States today are 
uninsured. Millions more are underinsured. As a Member of 
Congress, I am more than adequately covered. I can get a 
checkup any time I want. If something is wrong, I can get 
treated on the spot. Those of us who support Medicare for All 
believe that every single person who lives in this country 
should have that level of care. It is very simple. If people 
knew they had exemplary healthcare, they would go to the doctor 
more, but as it stands, millions of people often skip 
preventive and routine care, instead waiting until they are 
severely ill to seek treatment.
    Dr. Blackstock, how do these delays in seeking care affect 
patients?
    Dr. Blackstock. So delays in care result in late or 
misdiagnoses. They also result when a condition is diagnosed 
that is more difficult to treat, it results in higher mortality 
rates. We know that people who are uninsured have about a 40-
percent higher age-specific mortality risk. And so, you know, 
access to care is equivalent to your mortality risk, so we need 
to give people access to care through health insurance so that 
we can reduce their risk and so they can lead full, healthy 
lives.
    Mr. Bowman. Thank you, Dr. Blackstock. My next question is 
for Dr. Michener. As you have mentioned already today, people 
of color are more likely to be uninsured than white people. 
They are more likely to experience severe medical events or 
suffer from catastrophic medical debts. As a Black man, I am 
acutely aware of the specific care needs that Black men have in 
our society. It is well known, for example, that Black 
Americans have the highest rates of hypertension, and Black men 
are least likely to have their high blood pressure controlled. 
Lack of trust in our current healthcare system is one of the 
reasons they are not seeking treatment. Dr. Michener, how could 
we rebuild that trust under a Medicare for All system with 
universal access to comprehensive healthcare? How could 
Medicare for All strengthen communities of color generally and 
improve other social determinants of health?
    Dr. Michener. I think that Medicare for All contributes to 
and can contribute to precisely this problem of lack of trust. 
We can think about lack of trust as sort of an individual 
attitude, right, but it is rooted in experiences with 
structures. So when you go to the doctor or you try to go to 
the doctor and you are not able to get access, or when you are 
worried about whether when you show up you will be able to see 
someone given your health insurance status, when you are 
worried about the cost, these are experiences that are 
disproportionately in communities of color, and they all erode 
trust.
    Over and above that, Medicare for All, a universal coverage 
system, is going to strengthen the healthcare system more 
generally. It is going to allow us to make investments in the 
healthcare work force. Again, this will increase access and 
increase access in ways that, if designed right, can 
disproportionately benefit the very communities of colors that 
are disproportionately harmed by the current system. All of 
these things contribute to repairing what, frankly, is broken 
and has always been broken.
    Mr. Bowman. Thank you so much for those responses. I want 
to briefly share a personal story. Just recently, maybe a month 
or so ago, I was feeling unwell in my office on the Capitol. I 
literally took a 10-minute walk to the healthcare unit on the 
Capitol, was seen immediately, treated immediately, and sent on 
my way to go home and take care of myself. It made me think of 
all the Black men, and people of color, and uninsured and 
underinsured people in this country who do not have that 
privilege and do not have that access. When they don't feel 
well at home, they have to just deal with it in whatever way 
they can using home remedies, which is OK. But imagine if they 
can walk right downstairs or take a 5-to 10-minute walk to a 
doctor right down the street, get seen on the spot, be treated 
on the spot, and be sent on their way with the medication or 
care that they needed, and also, by the way, have unlimited 
access for followup. I can call a doctor on the Capitol 24 
hours a day and weekends to followup on the care that I 
received.
    Everyone in this country deserves that level of care. Thank 
you, and I yield back.
    Ms. Bush. The gentlewoman from Minnesota, Ms. Omar, is 
recognized for five minutes.
    [No response.]
    Ms. Bush. We can't hear you.
    Ms. Omar. My apologies. Thank you, Madam Chairwoman, for 
having me on your committee today, and thank you to all of our 
witnesses for your excellent testimoneys.
    When a person needs healthcare, they should not have to 
worry about whether their coverage status will be a barrier, 
but unfortunately, that is not the case for millions of 
marginalized gender identities in the in the United States. 
Across the United States, transgender people are uninsured at a 
greater rate than their cisgendered counterparts. When trans 
folks who are covered seek care, they experience denials of 
medically necessary services at higher rates.
    Dr. Blackstock, can you speak to how these trends 
perpetuate stigma against trans folks and the broader LGBTQ+ 
communities in healthcare settings?
    Dr. Blackstock. Yes. Yes, Representative Omar. So, you 
know, one thing that we know is that the healthcare system is 
not sensitive enough to the needs of the LGBTQA+ community, and 
that many of our healthcare providers are not trained in a way 
that is needed to provide the best care. But access is so 
incredibly important, especially for these communities, because 
we know that these health inequities exist, and they are 
perpetuated because people from these communities are unable to 
access care. So I think Medicare for All will provide an 
opportunity for members from stigmatized communities to engage 
in access with the healthcare system, and the healthcare system 
also needs to be equipped to provide the resources and services 
in a culturally sensitive way, in a culturally responsive way 
to these communities.
    Ms. Omar. Dr. Michener, what steps can Congress take to 
ensure that people of marginalized gender identities are able 
to access medical that are necessary care and free of stigma 
and financial barriers?
    Dr. Michener. I think the sorts of policies, the commitment 
to universal coverage that we have been talking about here 
today, is the first and critically important step. I think that 
there are barriers that are really concrete around simply being 
able to have access, and that is a sort of first point to 
address. Over and above this, though, I do think that we need 
to think about interventions that are sort of tailored to these 
uniquely marginalized populations. And so we need to be aware 
of what the unique challenges are in those populations, and I 
think part of what that means is talking to those folks, 
understanding better their perspectives and barriers, and 
connecting that information with the policy choices that we 
make going forward.
    So I guess the broad point I am making is to really think 
about how we can improve voice in addition to access so that 
the people who are most affected, who have really unique stakes 
around these particular kinds of barriers, can really help us 
to understand how to engage and move forward in a way that is 
going to address their particular vulnerabilities.
    Ms. Omar. And I wanted to also ask you, you know, as 
someone who supports Medicare for All and serves as the vice 
chair of the Medicare for All Caucus, oftentimes we hear how 
universal access to care can lessen the quality of care that is 
available to people. Can you respond to that sort of critique 
as an advocate for universal access?
    Dr. Michener. I appreciate the opportunity to address that. 
So one of the things that I always emphasize is that quality of 
care, just like access to care, is a choice. It is a political 
choice, and so many of the critiques that we have heard around 
quality to care--look at the VA and its weaknesses, or look at 
Medicare and its weaknesses--those are a reflection of 
political choices: choosing to under fund those services, 
choosing to create administrative burden and barriers, choosing 
to make life for people on those programs more difficult. And 
if we make different choices, we can have government programs 
that are just as well run, just as efficiently run, actually 
more so than private options, and the reason is because there 
is no profit motive.
    We are not trying to maximize what we can gain in exchange 
for what we give in the context of a government program. We are 
trying to maximize what we can give in exchange for improving 
people's lives, saving their lives, and helping them to thrive. 
That is the best context for both efficient and effective 
programs that are going to help people. And to the extent that 
that is not what we have, it is because we are choosing not to 
put the pieces and the resources in place to achieve it.
    Ms. Omar. Thank you. Thank you so much for that response. I 
will just say as someone who has been fully insured for the 
first time in my life here in the United States, I know just 
how much my healthcare has improved, not just having the 
anxiety of worrying about whether I could access, you know, 
what Congressman Bowman was talking about, being able to pick 
up the phone, walk 10 steps to a medical professional to care 
for you. That is the kind of access that we want for everyone, 
and that is the kind of access everyone deserves. So, again, 
thank you all for the opportunity to have this conversation.
    Chairwoman, I yield back.
    Ms. Bush. Before we close, I want to offer the ranking 
member an opportunity to offer any closing remarks he may have. 
Ranking Member Comer, you are now recognized.
    Mr. Comer. Well, thank you, Madam Chair, and I just want to 
reiterate the fact that the Oversight Committee's role is to 
determine waste, fraud, abuse, and mismanagement in the Federal 
Government and try to provide solutions to those problems with 
waste, fraud, and abuse. This hearing, like just about every 
other hearing this committee has had this year, hasn't touched 
upon that. In fact, not only does it not save money and reduce 
waste, fraud, and abuse, it increases the size of government 
significantly, and this is a pattern that we have seen with 
this committee.
    We had an energy hearing where many of the members on the 
Democrat side asked the energy CEOs to pledge to decrease 
production. Now, think about that: decrease production. Now we 
have President Biden going to OPEC, Venezuela, and begging them 
to increase production. I say that because we don't believe 
that the government can efficiently run healthcare. We believe 
that the solution to healthcare problems is with innovation, is 
with competition, and that is where Republicans will continue 
to work to try to find solutions when we talk about healthcare.
    Madam Chair, thank you for the time, and I yield back.
    Ms. Bush. Thank you. I now recognize myself.
    The choice before the committee today, the choice is saving 
lives or increasing profits. It is the quality of life or the 
quantity of yachts. Medicare for All would guarantee high-
quality healthcare to every person in America in the 
prioritizing of Big Pharma over human life and health, and, 
more importantly, it would save lives.
    To the 30 million people in this country who are uninsured, 
to those who are underinsured, and to the Black, brown, 
indigenous, disabled, low-income, and trans people who are 
burdened under the various inequalities of our healthcare 
system, we see you, we know, and you matter. We are fighting 
for you. You deserve life. You deserve care.
    I am grateful to Chairwoman Maloney and to our sisters in 
service for their partnership in this hearing. In closing, I 
want to thank our panelists for their remarks. I want to 
commend my colleagues for participating in this important 
conversation.
    With that, without objection, all members will have five 
legislative days within which to submit extraneous materials 
and to submit additional written questions for the witnesses to 
the chair, which will be forwarded to the witnesses for their 
response. I ask our witnesses to please respond as promptly as 
you are able.
    This hearing is adjourned.
    [Whereupon, at 1:52 p.m., the committee was adjourned.]

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