House Public Health Committee
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Bills discussed (1)
| Bill | Title | Sponsor | Status |
|---|---|---|---|
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HB1053
· 8 mentions in chapter, transcript
Matched: “HB1053”
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Pre-2017 bill |
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Representative Linda S. Tyler
Unverified
0:00
Good morning. Let's go ahead and take a seat. And the chair sees a quorum, as a matter of fact. I don't think we'll have any problem with that today, and I appreciate everyone being here. We do have some constraints, as you can tell, with this room and space. and we've already been the chair has already been
reminded that there's a certain amount of capacity that the fair marshal does allow in this room so if for some reason any of you who are standing by the last step outside I promise you it is because we're trying to take care of the safety of the health room I just didn't want anyone to be nervous about why we might do that I think the room is supposed to hold about 135 people, and I think we have about 135 people here.
I wanted to remind our members that we are going to be taking photographs of our committee on Thursday, and we've been asked to be here at 9.45 in the morning on Thursday, and we'll send out a note to remind you of that. We have once bailed to here today, and it's a special order of business. And Representative Meeks, I see that you have already taken your seat at the end of the table. And if you will go ahead and proceed and present your bill, sir.
Representative John W. Walker
Unverified
1:32
Thank you, Madam Chair. To the committee members and other honored and distinguished guests in this room, I do appreciate you allowing me to present my bill today. Before I begin, I would like to say that I talked to the chair, and she has asked me to focus on this particular bill and not some of the other extremities that might get discussed as far as health care is concerned. I have agreed, and I have asked the chair that if I go off on a rabbit trail to make sure that you put me back in,
and of course I would ask that if anybody else that is speaking goes off on an unrelated issue, that the chair pull them back in as well. Let me begin by emphasizing that this bill that I presented today does not manifest the national health care law passed by Congress. nor does it call on the governor or the attorney general to join the current legal challenges. In fact, if our state legislature does pass this bill into law, it would leave very large portions of the health care bill in place.
So what does this bill do? The Freedom of Choice and Health Care Act will preserve and protect the right of all Arkansans to make their own health care and health insurance choices. Specifically, it would prohibit any individual or employer from being penalized for not purchasing government-defined health insurance, and it would protect their right to pay directly for medical care. First, it protects citizens who buy health insurance that the federal government doesn't like. Under current law in 2014, every one of us who buys health insurance
that is now approved by the federal government, and everyone who doesn't have health insurance is going to have to pay a $95 fine. In 2015, the fine will be $325, and in 2016, the fine will be $695.
Speaker 5
3:19
That's the minimum. Some people will pay more than that. My bill is going to protect people who want to make their own health insurance decisions and don't want to be forced into letting the federal government make health insurance decisions for them. Similarly, it protects employers who want to make their own health insurance decision,
protects the right of health care providers who want to accept payment for health care service, and protects the workings of a private health care market. Second, it would protect your health insurance choices. Under current law, the mandates will eliminate many people's health care choices in just a few years. In fact, the Obama administration itself predicts that more than half of all employers and as many as 80% of small businesses will have to give up their current coverage because they will lose their right to buy their children's health care by 2013
just because their existing policy does not comply with the mandate. The National Federation of Independent Business predicts that the Affordable Care Act's employer mandate will result in a loss of 1.6 million jobs by 2014, with 66% of those lost jobs coming from small businesses and an economy shrinkage of approximately $200 billion by 2013. Those mandates do terrible damage, not only to our own freedom to make our own health care choices,
but to the American and the Arkansas economy. Perhaps just as importantly for the legislators who are sitting in this room, the mandate is going to force more people into Medicaid in Arkansas who are currently qualified but are unenrolled, and the federal government isn't going to pick up one penny of the state's cost. Although the federal government will fund the people who enter Medicaid because of the new eligibility changes, the federal government will not fund the state's share of the entrance into Medicaid who are currently qualified but unenrolled, nor will it fund the administrative cost created by the army of new Medicaid clients.
By estimates, it will cost Arkansas at least $100 million more per year in Medicaid costs. If this goes into effect, chances are that's going to shoot our state budget on what we want to do with roads, with prisons, with education. This is not a partisan bill. In fact, the Democratic-controlled state Senate in Virginia and the Democratic-controlled state legislature of Louisiana has passed this bill, and I urge this committee not to get bogged down into party politics.
Six states have passed this measure as a statute, including Missouri, where 71% of Democrats, Republicans, and Independents voted for this bill. On top of that, two more states have amended their constitutions to include it. many more states are considering this bipartisan measure now because it has substantial support from both sides finally I would agree that we do need health care reform and I hope that over the course of this session we can take a look at ways that we can do it on the state level however as I've pointed out
already forcing people to purchase health insurance is bad for Arkansas and not a majority of what they want I respectfully ask for your support for exactly the same reason that the many legislators of both parties have passed this measure through their own state legislator. It will protect the rights and protect the health care choices of the citizens of the state of whose interests we are sworn to serve. At this time, I would be happy to take questions or listen and respond to comments. I have former representative and attorney, Dan Greenberg, and also Professor Robert Steinbuck
of UALR, who will help to answer some more of the legal questions if you have any. Thank you, Madam Chair.
Representative Linda S. Tyler
Unverified
7:05
Gentlemen, if you will, take your seat at the end of the table and identify
Speaker 9
7:11
yourself for the record. My name is Dan Greenberg.
Dan Greenberg
Unverified
7:14
I'm an attorney living here in Little Rock. Robert Steinbuck from
Representative Linda S. Tyler
Unverified
7:22
the UALR Bowen School of Law. Thank you very much. Committee, do we have any questions, please?
Speaker 17
7:28
Representative Hyde. Thank you, Madam Chair. I'd like to make a motion. I'd like to move in order that we manage this and we get out of here a reasonable
Representative Linda S. Tyler
Unverified
7:46
time, don't lose our committee, that we limit debate
Jean Block
Unverified
7:49
by the public as 30 minutes each side. All right. Mr. Hyde has made a motion that we limit debate on
Speaker 21
8:01
the public once we have answered questions from the committee, 30 minutes on either side.
Representative Linda S. Tyler
Unverified
8:09
Limit debate is non-debatable. All in favor indicate by saying aye. All opposed? No. Ayes have it. So once we get to the public comments, we'll limit to debate to 30 minutes on either side. Any other questions of Representative Meeks and his guests? Okay, seeing none, then we will be taking public comment.
And we'll be doing it in those who want to speak against the bill and
Jean Block
Unverified
8:43
then those who want to speak for the bill will be doing it in alternative order. So I would ask, and we have a sign-up list up here, and of
Representative Linda S. Tyler
Unverified
8:53
course keep in mind that we've got limited debate. So those who want to speak for the bill, we have Jean Block and Dennis Hangen with the Attorney General's Office first on the sign-up list. If you'll take your place at the end of the table, please. Representative Meeks, you and your guests may want to step aside or move to the side for a few minutes.
Against. Speak against the bill. Did I say four? I probably did. If you all will introduce yourself for the record, please, and then go ahead with
Jean Block
Unverified
9:39
your information. Please turn your mic on and speak closely to the mic.
Thank you, Madam Chair. My name is Jean Block. I'm the Assistant Attorney General
Speaker 27
9:48
with the Arkansas Attorney General's Office. And I'm
Jean Block
Unverified
9:55
Dennis Hanson, Deputy Attorney General. As I indicated, I'm an Assistant Attorney General with the Arkansas Attorney General's Office. I'm in charge of the Attorney General's Health Care Bureau, which assists thousands of Arkansans with health-related issues every year. here with me is Deputy Attorney General Dennis Hansen. Mr. Hansen has served. Ms.
Representative Linda S. Tyler
Unverified
10:13
Block, I have some members who still can't hear you. Will you try to speak into the mic, please? Yes. Mr. Hansen
Speaker 29
10:22
has served in a senior leadership position for four attorneys general, including Attorney
Jean Block
Unverified
10:27
General McDaniel, Governor Mike Beebe, Senator Mark Pryor, and Winston Bryant. He is also an adjunct law Professor at the William H. Bowen School of Law. HB 1053 was filed in response to concerns
with the Patient Protection and Affordable Care Act of 2009. I do not intend to testify to the merits of the federal law. My office takes no position on whether the law is good or bad policy. I am
just here to assist this committee evaluate the legal consequences should HB 1053 become law. It is important that you understand the legal effect of HB 1053. The Patient Protection and Affordable Care Act of 2009 was signed into law on March 23, 2010. As of today, that law remains the law of the land, and portions of that law are being implemented as we sit here today.
To date, despite the legal challenges filed across the country, the U.S. Supreme Court has not yet ruled on the constitutionality of the federal law. So every provision of the Act, regardless of the effective date, is presumptively valid federal law. As you know, the constitutionality of the individual mandate has been challenged in various federal courts. These courts have considered the arguments and all applicable law and reached opinions
on the issue. In four instances, the courts dismissed the cases. In two instances, the courts reached opinions on the issue that were diametrically opposite. One court upheld the constitutionality of the individual mandate as a legitimate exercise of Congress's authority under the Commerce Clause. The other court held that the individual mandate was unconstitutional because it exceeded Congress's authority. The first decision has been appealed.
The second decision is expected to be appealed soon. Given the split of authority, it is widely expected this issue will be decided by the U.S. Supreme Court. Turning now to HB 1053. In short, this bill attempts to nullify or invalidate a provision of the Patient Protection and Affordable Care Act of 2009. Passage of this bill would create a conflict between federal and state law.
Under the Supremacy Clause of Article VI of the U.S. Constitution, it is clear that if there is a conflict between federal and state law, federal law prevails. Accordingly, it is important that this committee understand that passage of HB 1053 will have absolutely no legal effect on whether the individual mandate applies to Arkansas. However, it will have three significant consequences. First, it
will virtually guarantee that the state will be sued. Second, it will open the state to the risk of paying huge sums in attorney's fees. Third, enactment of a state statute in conflict with the federal law will create confusion and attendant expense for individuals and businesses. The Attorney General specifically asked me to assure this committee that if this bill becomes law, he will defend it in court.
To that point, going back to the mid-1800s, the U.S. Supreme
Court has strongly rebuked states who have attempted to ignore or undermine federal law. As
recently as 2009, the Supreme Court in Haywood v. Drown noted, and I quote, Our cases have established that a state cannot disassociate itself from federal law because of disagreement with its content or a refusal to recognize the superior authority of its
source. The court further noted, quote, states lack authority to nullify a federal right or cause of action they believe is inconsistent with their local policies. Barring the reversal of long-standing legal precedent, the outcome of any litigation is virtually guaranteed to be unsuccessful for the state of Arkansas. Putting the state in this position would be ill-advised. My testimony today is
offered in the form of legal advice and counsel. Without regards to the merits of a policy debate, the Attorney General's Office respectfully submits that the passage of HB 1053 would not be in the state's best legal interest. In In conclusion, we believe this is a federal issue to be decided in the federal courts using federal, not state dollars. I greatly appreciate the committee's time and for allowing me to appear before you.
Thank you. Thank you. We have questions. Representative
Representative Butch Wilkins
Unverified
15:52
Wilkins. You said that the passage of this bill would guarantee the state being sued. what are you basing that on? I'm hearing both sides of an issue that I want to get to the bottom of. Representative Wilkins, we
Representative Linda S. Tyler
Unverified
16:05
cannot hear you. I apologize if you would speak into the mic. We go through this
Representative Butch Wilkins
Unverified
16:12
every time. I look the other way. Did you hear the question,
Jean Block
Unverified
16:16
ma'am? Yes, I did, Representative. You asked about the guarantee of lawsuits. Going back to the
Speaker 32
16:28
mid-1800s, the Supreme Court have issued rulings on the issue of states or when states have attempted to nullify a state law. So we can look at a long line of cases going back to the mid-1800s.
Those opinions, those Supreme Court opinions, are the result of cases brought by the federal government against states who have attempted to pass a law or have passed a law that nullified a federal law. So in short, there is a long line of Supreme Court cases that we can look to. Representative Wilkins, are you done?
Speaker 51
17:22
Of course, your attorney general's office, who
Representative Butch Wilkins
Unverified
17:27
actually hired to represent us, represents the state of Arkansas on these matters, do you have an idea
Speaker 51
17:34
of what these lawsuits, if they were brought, what they would cost the state?
Speaker 32
17:43
at this time what the cost would be to the state. There is no question that the litigation would last for at least a year or two
Jean Block
Unverified
17:55
and require significant state resources.
The other concern is, the other reality rather, is the attorney's fees that the state would be required to pay when this suit was ultimately, when it's deemed, when we're unsuccessful essentially. Thank you, ma'am. Thank you, Madam Chair. Representative King. Thank you, Madam Chair. For the record, when the
Representative Bryan B. King
Unverified
18:23
health care bill was being debated, was Attorney General for the health care bill while it was debated in Washington, D.C.,
Representative Linda S. Tyler
Unverified
18:31
or was he against it? Representative King, we have said we're going to stay focused on the scope of the bill, and the bill is on the federal mandate, not on the health care bill in general. Would you try
Speaker 54
18:45
to keep your question to that, please? Yes, fair question. When it comes to issuing an opinion, you're giving legal
Representative Bryan B. King
Unverified
18:51
advice, but wasn't the Attorney General's earlier advice on this issue when there was going to be challenges in court that they would be frivolous? Is that correct?
Speaker 32
19:00
The Attorney General did not file suit because he believed the individual mandate would be
deemed constitutional based on existing legal precedent. But did
Speaker 64
19:09
he also not use the term that any challenge in
Jean Block
Unverified
19:14
court would be frivolous? I believe he's
Representative Bryan B. King
Unverified
19:17
since retracted that phrase. Okay. Because certainly the judge in Virginia, but he did retract that, that he
Speaker 32
19:24
thought it was frivolous, correct? The Attorney General has evaluated the legal precedent. Based on his evaluation, he initially believed and continues to believe that the individual mandate will be deemed constitutional based on that legal precedent.
The focus of our testimony today is on HB 1053 and our concerns with the state's passage of this bill and the legal consequences for the state. I understand that, but you're giving legal advice, and
Representative Bryan B. King
Unverified
19:51
his earlier opinion was that this was a frivolous lawsuit, but he has since retracted that, correct? My opinion, my
Jean Block
Unverified
19:58
testimony today is focused on HB 1053. Okay. You talked about the
Representative Bryan B. King
Unverified
20:02
attorney fees and what it would take to defend the state, But do you also recognize there's consequences that if this law is implemented,
that some of the figures that we hear is $200 million in extra what it's going to cost the state. So the alternative is if this goes into effect, it will cost the state more money on another
Jean Block
Unverified
20:24
side, correct? The Attorney General has not evaluated those issues. Okay,
Representative Linda S. Tyler
Unverified
20:30
thank you. Thank you. Any further questions? Ms. Block, thank you very much. Now we'll be looking for, I'm sorry, Representative Mayberry, I did not see you. You're recognized.
Representative Andy Mayberry
Unverified
20:41
Thank you, Madam Chair. You mentioned the almost guarantee of a lawsuit if this were to pass. Can you tell me, is there any bill that our legislature could pass that there would not be the possibility of a lawsuit? Representative, the Attorney General has
Jean Block
Unverified
21:02
not evaluated that issue. So there may be
Representative Andy Mayberry
Unverified
21:06
bills that are passed that there could never be a lawsuit filed over? Is that?
Speaker 73
21:12
Representative, there could always be a lawsuit, of course, over any bill filed. Our concern is about the likelihood that our defense here would be unsuccessful.
Representative Andy Mayberry
Unverified
21:26
So regardless of what the bill is, it is evaluated through the attorney general's office in essence by whether or not what the likelihood of a lawsuit would be, whether or not that bill is something that everyone could agree upon.
It was a perfectly good thing. Is that
Speaker 73
21:46
correct? We take no position on the policy of it. We're just giving you our advice that if the law is passed, it will draw a lawsuit and it will be difficult to defend. The prevailing party, the plaintiff who brings the suit, can then ask that we pay their attorney's fees. That's the result if the lawsuit is unsuccessful on our side. Okay. Thank
Representative Linda S. Tyler
Unverified
22:09
you. Thank you. Seeing no further questions, we have signed up to speak for the bill.
Mary Kathleen Waldner, if you'll take your place at
Jean Block
Unverified
22:29
the table please. Introduce yourself for the
Speaker 78
22:34
committee and proceed. Mary Kathleen Green Waldner from Conway. Within the government health care bill includes mandated public-funded abortions.
Thirty-five years ago, I took a roommate of mine to get an abortion. She asked
Representative Linda S. Tyler
Unverified
22:55
me. I thought I would lose her friendship. Ms. Waldner, if you would, please keep your testimony confined to the nature of 1053, not the
Speaker 78
23:07
health care bill itself. Well, within the health care bill that this stipulates I pay for, with my taxpayer money, that means I am paying for abortions.
So it's all the same to
Representative Linda S. Tyler
Unverified
23:22
me. Ms. Walden, I truthfully respect that, but the bill, the nature of the bill has to do with the mandate mandate that provides individuals and corporations from purchasing insurance. So if you would,
Jean Block
Unverified
23:37
keep your testimony to that, please. Okay.
Speaker 78
23:42
I'll just simply state, it is my constitutional right not to be forced to pay for something that's immoral to me,
a public citizen. This is immoral and it's unconstitutional. Every citizen should be able to have the right to say, no, I don't want to pay for this. I don't like this health care bill. Not every federal law is right. There are bad bills. And it makes no sense to me just because something comes down the Pike from Washington, D.C., to say we have to condone it. That's bad law. That just doesn't
make sense. You're here to represent the people of the good state of Arkansas. 70% of us do not want government-funded health care. So I ask you, I request, I plead with you on behalf of unborn children, please do not allow, make me pay for something that's immoral to me. Please allow this to go through committee so it can be voted on. Thank you.
Jean Block
Unverified
25:11
Seeing no questions, we have next to speak against the bill Mr. Bo Ryle
Representative Linda S. Tyler
Unverified
25:17
with Arkansas Hospital Association. If you will, take your place at the table. Introduce yourself
for the record, please, and go ahead and
Speaker 84
25:31
proceed. Thank you, Madam Chairman. I'm Beau Ryle with the Arkansas Hospital Association. Arkansas Hospital Association, we represent more than 100 hospitals across the state and employ more than 44,000 people in this state. The
question here I think you're going to discuss a lot today is whether government can require someone to have, an individual to have health care insurance. Our position is, yes, it should because health care is a much different and broader market. Health care is not something that you can just opt out of. Health care is not a consumer good like a car or a cell phone. You can choose not to buy a car, but eventually you're all going to need health care, whether you choose it or not. When a person has a medical crisis, when they're in a car wreck, when they fall off a ladder and break their leg, they cannot simply say
they want to exit the market. They're going to be taken to the hospital and they're going to be given care. The choice they face is how to pay for the care they inevitably receive. By choosing to forego insurance individually, individuals simply shift the burden of their health care payment to others. The Federal Emergency Medical Treatment and Active Labor Act of 1986 in the hospital industry, we call it EMTALA, requires hospitals to provide emergency services to anyone regardless of their ability to pay.
So along with the hospital's charitable mission, hospitals are bound by law to provide care to the uninsured. Hospitals are different than other health care providers because of this law. The uninsured are even more costly to health care market because they do not seek preventative care. The uninsured put off their care until it's absolutely essential and are more likely to be hospitalized for avoidable conditions. For example, skipping their hypertension medication can lead to a stroke and costly rehabilitation. The decision to avoid the market in the short term means these patients entered the market
in the medium to long term, which is costly to the health care system, again driving up the cost of health care
Speaker 85
27:29
for everyone. In Arkansas, our uninsured patients receive health care services regularly, and the cost to hospitals is extraordinary. The uncompensated care cost for Arkansas hospitals has grown from $300 million in cost in 2003 to $382 million in 2008. That's a 27% increase over those years. Hospitals, for example, are reimbursed for care from four different areas,
Medicare, Medicaid, commercial insurance, and self-pay. That's where the uninsured are categorized. Medicare and Medicaid reimburse at or below the cost of care, and self-pay patients or the uninsured reimburse at pennies on the dollar. So commercial insurance has to reimburse more to make sure
Speaker 84
28:10
that the hospitals can keep the doors open. This drives up the cost to those who have insurance. The insured pay for the uninsured. Insured patients end up effectively paying some portion of the bills generated by their uninsured counterparts.
As hospitals and other providers absorb the cost of uncompensated care, they have fewer funds to reinvest and to cover their ongoing expenses, and that in turn drives costs higher. In short, the vast cost of health care for the uninsured is of necessity borne by the rest of the nation, and it affects prices in the health care and health insurance markets. To say that the uninsured won't be participating in the health care market is turning a blind eye to the reality. The uninsured still obtain health care, others just pay for it. So the decision of whether to purchase or decline health insurance
is nothing more than a decision of how they will pay or make others pay for existing or future health care costs. If we focus exclusively on the insurance itself, we miss the other broader market of the health care industry
Speaker 87
29:11
and its cost. Thank you very much. Thank you, Mr. Ryle. Representative
Speaker 88
29:18
Gary Smith. Thank you, Madam Chair. Bo, can you
Representative Garry L. Smith
Unverified
29:22
tell me, I represent a rural part of the state, what will this bill actually cost the rural hospitals, or can you give me a figure if this bill should pass?
I mean, if we should allow this bill to go into law, what will the impact be on the rural hospitals in South Arkansas? I'll just
Speaker 91
29:40
do that. I can give you a monetary impact on that, but I can say
Speaker 85
29:45
that the more people that are insured that come through the doors of the hospital, the more coverage they have, the more that hospitals are reimbursed. As I said, uninsured costs, uncompensated care has risen to $382 million in cost, and that's significant. You spread that amount around to all the hospitals
Speaker 88
30:00
in the state, you've certainly got significant amounts there.
Representative Bryan B. King
Unverified
30:03
Thank you. Thank you, Madam Chair. Thank you, Bo. Representative King. Thank you, Madam Chair. You mentioned in your comments that Medicaid reimbursement rates were below the actual cost for hospitals. Is that correct? Yes, sir. At or below cost. At or below cost. Who determines
Speaker 96
30:25
those rates? Your reimbursement rates? Well, the Medicaid division, and. But who ultimately decides that? I guess it would be you to appropriate the money.
Representative Bryan B. King
Unverified
30:34
That's correct. And what you're saying is that, you know, and I agree with you that, you know, the unrecoverable costs are a big problem because basically the people that pay their health care bills are paying for the people that don't pay their health care bills. That's correct. So I guess we just disagree on the solutions. On one side, you say you actually support the health care bill that has been passed in
Speaker 98
30:56
Washington, D.C. That's correct? Our American Hospital Association
Representative Bryan B. King
Unverified
30:59
did support it, yes. So, but on the other hand, you're complaining about the government reimbursement rates. I mean, this bill empowers government more in health care and the reimbursement rates,
but then on one hand you're complaining about the government that they're not reimbursing you at the rates that you feel like at cost. Well,
Speaker 85
31:17
the difference is I understand it that the commercial insurance market
Speaker 96
31:20
would be insuring those newly insured that come online, and Medicare and Medicaid is a different
Representative Bryan B. King
Unverified
31:26
option. But this bill is about empowering government more in health care decisions, basically. I mean, the reason I was against the health care, because I think that private individuals, such as banding across state lines, groups like that,
that there are other solutions out there that could be better than
Speaker 96
31:43
empowering government. I guess the bottom line response to that is hospitals need more people insured because our uncompensated care costs have gone through the
Representative Linda S. Tyler
Unverified
31:53
roof. Okay. Thank you. All right. Seeing no further questions, we'll go to the next person on the list to speak for the bill, and
that's Mr. Paul Calvert with Liberty and Justice. If you will take your place at the table and introduce yourself.
Paul Calvert
Unverified
32:15
My name is Paul Calvert. I'm from Faulkner County. I'm not
a paid lobbyist. I'm here to promote liberty and justice. For Liberty, I wish to have the choice to buy what I want and not buy what I don't want with my own money. When it comes to health care, I am pro-choice. For justice, in this free country, the government gets its authority from the people. Before the people can grant authority to the government, the people must first have the authority themselves.
I do not believe that I, as an individual, have any authority to make my neighbor purchase health insurance. Therefore, I don't have the authority to delegate
Representative Butch Wilkins
Unverified
33:02
that power to the government. Representative Wilkins Mr. Calvert thank you for being here and I'm glad to
hear your testimony but you said just now and kind of going back to what Representative King said do you mind paying for other people's insurance
which is exactly what you're doing if them people don't have insurance so so in your
Speaker 52
33:25
presentation if you what you mean their health care or
Representative Butch Wilkins
Unverified
33:32
their insurance health the health care insurance their insurance you are paying for people who are uninsured right now do you agree with that um at times yes yes our insurance is much higher right now because a lot of our arkansans don't have don't have insurance my insurance that was said by brian
Paul Calvert
Unverified
33:51
king and i completely agree with one of my insurance is less than five hundred dollars a year i
Representative Butch Wilkins
Unverified
33:57
pay it myself well i have a mind to but there is a portion of that going to play for a people
Paul Calvert
Unverified
34:03
that that don't have it understood that as i understand i think my insurance
Representative Butch Wilkins
Unverified
34:08
would go up considerably with this well no one of the open open inside that i don't know thank you thank you madam
Representative Linda S. Tyler
Unverified
34:18
chair Representative Walker, you're not a member of the committee, but I will go ahead and recognize you for just a moment, please.
Representative John W. Walker
Unverified
34:28
Speak into the mic, please. I'd like to know if you believe the state has a right as a condition of driving a motor vehicle to require that you purchase insurance before you do
Paul Calvert
Unverified
34:40
so. I personally think that is actually an affront to the judicial system because the judicial system is there in place to hold people accountable when they create property damage or harm to others. And I think that's a – if it's functional, we shouldn't need liability insurance. Thank you.
Representative Linda S. Tyler
Unverified
34:59
Seeing no further questions, we'll go to the next person on our list who will speak
against the bill. And it would be Dr. Joe Thompson, the Surgeon General of Arkansas. off, you will take your place at the table and introduce yourself
Speaker 115
35:18
and proceed. Thank you, Madam Chair, Vice Chair Woods, members of the Committee. I respectfully regret the fact that I'm before you today speaking against one of your members' bills. I would like to share the reasons for that. I would also like to offer we are in this
nation and in this state going through a serious debate about the social compact we have to take care of each other when we are ill or where we fall upon injury. Health care is one-sixth of the gross domestic product. That's why there is a lot of attention to it. It's probably more than that of the Arkansas state product. So this is an important issue that I would offer to come back to you at your discretion to discuss where our health care system is now. not in good shape, where it may be in the future if we don't make drastic action, and
where the Health Care Reform Act offers both risk and opportunities for us to do better. I would also like to caution and say that some of the representation here is not accurate, and you need to know the facts about the Affordable Care Act before you actually make judgments going forward about its risks and benefits to the state of Arkansas. And specific to House Bill 1053, I would like to just put forth and echo Deputy Attorney General Block's comments and add, I think it is likely that we will be sued if this
bill passes. I think the costs by the Attorney General's office are not my costs, but they're our costs that we will pay. And it will create confusion in our system as we wait to hear what the federal judiciary says the answer is. courts have decided on both sides of this issue. It is going to go to the Supreme Court. There will be an answer. When that answer is made by the U.S. Supreme Court, it will be clear whether this bill should be reconsidered in this committee or whether it is moot.
If this bill passes, let me share a fourth thing that will happen. A majority of our citizens in this state are at least in part covered by and supported by the federal government. Our seniors, over 99 percent, are covered by the federal Medicare program. We have another 750,000 individuals, including most children and most pregnancies in the state of Arkansas, that are covered by the Our Kids program or the Medicaid program. Those are partnerships with the federal government.
If we take premature action and polarize the collaborative relationship we have with the federal government as we try to deal with our Medicaid shortfalls, they are not going to be very receptive to helping us. So my advice to you at this point in time is that this bill be held in committee, that we await the judicial system at the federal level to decide in the U.S. Supreme Court about whether we are obligated to each other to have people have health insurance or whether it's a freedom to choose whether you want to or not.
In conclusion, I would draw your attention to the top of the business section today where last year, over 10,000 individuals declared bankruptcy, and we know that the major cause of that is unpaid medical bills, and we know that the unpaid medical bills that cause bankruptcy then affect the bank, the mortgage, the auto company, the furniture salesman, and we have 500,000 individuals in our state today that do not have health insurance coverage. They're not healthy, but they don't have a way to pay for the hospital bills that Mr. Riles was talking about when they go into the hospital.
Thank you very much. I look forward to
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coming back and would enjoy the opportunity to help with you plan the future
Representative Linda S. Tyler
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of our health care system in
Representative Fred Allen
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the state. Thank you, Dr. Thompson. Representative Allen. Thank you, Madam Chair. This question is for you, Dr. Thompson. Is it true that the federal government would pay for 100 percent of the Medicaid expansion in our state through 2016? MR. Under the
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current law passed in the Affordable Care Act, yes, the federal government
pays 100 percent of the expansion required under Medicaid through 2016, and then it scales down to where in 2020 they pay 90 percent for every year thereafter. MR. Okay. So that means that in 10
Representative Fred Allen
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years the cost to the state of Arkansas will be roughly around $200 million. Is that true?
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MR. are, and, again, it depends on uptake and whether the mandate stays in place and other things, that the Medicaid expansion will represent approximately $2 billion in new health care
coverage each and every year, of which the state would have 10 percent of that in 2020 or $200 million going forward. So $2 billion in
Representative Clark Hall
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outlay, of which the state
Representative Clark Hall
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Thank you. Representative Hall. Thank you, Madam Chairman. Dr. Thompson, under the healthcare system's definition, does that definition include workman's
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comp? Does the definition of the healthcare system, yes, the healthcare system does provide care through workman's comp, a separate
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insurance system than the acute medical care insurance that people
Representative Clark Hall
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have most of the time. Does it also include communicable disease
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reporting? Yes, sir. All providers are required to report communicable diseases to the State Health Department for identification and tracking
Representative Clark Hall
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surveillance. One other question, if I may, kind of changing directions.
Our primary health care providers in the rural areas of Arkansas, what would be your estimate of the percentage of non-pay that they are incurring? MR. You know, this gets into some of the issues around the challenges for
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our system. But for our state, we provide coverage through the Our Kids program
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for kids. Medicare provides it for those over age 65. But in the rural parts of our state where we have small, low wage employers and lower
income families, there are major sectors of our state where up to 30 percent of the 19 to 64 year old population does not choose to buy or is not able to buy health
Representative Clark Hall
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insurance coverage. So our primary care physicians that treat these citizens are just doing it out of the pro bono? You know, I think
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it's not only the primary care physicians, it's the rural hospitals, it's the safety net. This is
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why it's hard to get new graduates of our medical school to relocate in rural
areas. When one-third of the individuals that live in those areas don't have health insurance, it's not the business opportunity that people think about when they
Representative Clark Hall
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go into opening a practice. And one question, Madam Chair, if you'll let me. If the citizens that we're targeting here, the underserved and the low-income, they're Are there other ones at issue on this bill?
If they have the opportunity to purchase insurance at a reasonable rate, do you see or would you be able to say that the overall healthcare of the state would be improved and it would create a potential economic growth for these areas that are underserved and economically deprived? I think
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there are major components in the health reform law that will give us an opportunity to knock down the financial barriers people have had to buy or obtain health insurance,
that we would never have come up with the $2 billion I mentioned that the federal government is going to allow us to use to get coverage. At the same time, the mandate in House Bill 1053 before you, if passed, would allow people to choose not to participate. We need to let the U.S. Supreme Court decide whether we are socially obligated to each other to participate in the insurance mechanism so that when we need care, it's there.
That's the issue, I think, before you in 1053 is to let the U.S. Supreme Court decide whether health insurance and a mandate. We're all paying Medicare taxes out of our checks, okay, for a program that seniors need. Do the rest of us need to have a requirement that we also participate in the health
Chair
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insurance compact? Thank you, Dr. Thompson. Thank you, Madam
Representative Billy W. Gaskill
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Chair. Representative Gaskell, you're recognized. Thank you, Madam Chair. Dr. Thompson, thank you for being here.
I don't always agree with you, but I always respect you. So you're basically saying let's just leave this thing alone until the Supreme Court acts, right? I'm saying this bill
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is premature and puts the state at risk if passed until the Supreme Court acts. Once the Supreme Court acts, you on this committee will have a much clearer picture of what the federal position is to know how to guide state action. Well, you know,
Representative Billy W. Gaskill
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let's don't put all our eggs in one basket on this Supreme Court. You know, any time those thugs get into a problem, they bring up the Commerce Clause,
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and then you can bet it's going to be constitutional. Thank you, Madam Chair. Representative Lee. Thank you, Madam Chairman. Following your logic on that, that we need to wait until the Supreme Court makes this decision, would you then agree that we should take the billions of dollars that the federal government's given us and put it in a separate account and hold that out until the
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Supreme Court makes the decision? Well, the law is that if we don't implement this change, the federal system will come
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in and do it for us. This administration and I think the leadership of the legislature really believes that local control, state control of what we are able to be in control of is the most important thing to do. The fiscal resources that are going to flow represent an opportunity for us to serve your constituents that have not been able to afford health insurance. Okay, thank you.
Speaker 148
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So you do not think we should wait to spend the billions of dollars we've been given by the federal government? Is that your testimony? You think we should
not put it in a separate account and wait until the Supreme Court
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makes the decision? The issue before the Supreme Court is the mandate requirement between the two federal issues.
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Correct. I'm following your logic, though, of saying we shouldn't discuss this until the Supreme Court makes a decision. So I'm just asking if then you think we should take the money the federal government's given us and hold that out until the Supreme Court makes the decision, or should we just continue spending the federal money? The other
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components of the federal money are not being questioned in the Supreme Court
decision. The Medicaid expansion, the expanded on the tax credits. Correct, but parts of it are.
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Let me ask another question, if I may, Madam
Representative Linda S. Tyler
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Chair. You do, you have less than one minute to ask that question because we're
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running out of time on the... Correct, which is why I voted no on limiting debate. You're using the term. You said that there are states that are being sued that have enacted this, you and the woman from the Attorney General's office. Can you tell me which states are?
Speaker 115
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I didn't say that states were being sued over their action to date. As the Deputy Attorney General said, there's a long history of when state law is in conflict with federal law, that that ends up in legal action that the states routinely and uniformly end up on the short end of the stick. Thank
Speaker 23
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you, Mr. Thompson. Thank you, Madam Chair. All right, thank
Jean Block
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you, Mr. Thompson. Representative Hyde, do you have a question? Madam Chair, I don't have a
Speaker 17
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question. I was just asking as a courtesy if we might be able to state what the time remaining for
Jean Block
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each side is. We have no time remaining for the opposed, and we have 25 minutes remaining for the four. Thank you, Madam Chair.
Representative Linda S. Tyler
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47:46
Thank you, Dr. Thompson. Next on our list, we have Judy Behrens. if you'll take
your place at the table introduce yourself for the record please
Judy Behrens
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48:18
my name is Judy Behrens and I'm from Conway my big question about this is If people don't have the money to buy health insurance now, how are they going to magically come up with it when this becomes activated? And I guess that's pretty much what I have to say. I don't understand
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how they're going to come up with money that they can't come up with now.
Representative Linda S. Tyler
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48:49
Ms. Behrens, thank you very much for your testimony. I see no questions, and I really do appreciate you being here. I know it's daunting to come before this table, so thank you. I think next
on our list is Fran Nichols. If you'll take your place at the table and introduce yourself for the record.
Fran Nichols
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49:17
Good morning, and thank you for your time, Madam Chairman.
My name is Fran Nichols, and I am from Conway. As a senior, which is most obvious to most of you, and in my many years, I think I have never seen quite such an overreach of my government as I feel the health care bill is. As Americans, we expressed to Congress in at least a 60-40 ratio and margin that we did not want this particular bill. I do believe that we need health care reform, yes, but perhaps not as massive a bill as
we've got, and certainly not the mandate that we have before us. To me, it's a loss of freedom, and half of the states or some number of states, as we've talked about, have actually provided lawsuits that they feel are protective of their citizens, And I just would like to request that Arkansas do the same to protect our citizens. And I thank you for your time. MS. Thank you, ma'am.
Representative Linda S. Tyler
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50:26
I appreciate you being here very much. Next on our list is – MS. Madam
Representative Tracy Pennartz
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50:35
Chair, point of order. MS. Yes, Representative Penartz. I don't mind our media covering this, but that sign says they're to be back of that pillar so we can get in and out of our seats. I would ask
the chair, too, if she could help us out on that. Ladies and gentlemen
Representative Linda S. Tyler
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50:53
of the media, if you could move your way back
beyond the pillar, that would be great.
Thank you very much. Thank you, Ms.
Pornarts. Next person that's to speak for the bill is Mr. Glenn Gallus. And please forgive me if I've mispronounced your name. Introduce yourself for the record, please, and tell us who you represent. Glenn Gallus You
Glenn Gallus
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51:20
did fine. Thank you very much. My name is Glenn Gallus, and I am a member of the Garland County Tea Party. I'm also representing an organization called Citizens for the American Agenda.
And before I read my prepared notes, I'd like to make a couple of benchmark statements. Number one, I believe this issue right now, as it currently says, as you appropriately said, it's not about the health care bill. It's whether or not we want to see our state allow mandatory purchase of insurance and fines if we do not. That's what this issue, HB 1053, essentially is about. It's not about whether or not health care is important or health care is needed.
I don't think there's anybody in this table nor in this room that believes that health care is not an important and major issue today. The second thing is that we are now making this decision, and the arguments that I hear are based on whether or not we go to court. Folks, it ought to never be the fear of somebody suing us whether or not we're going to make the right decision or not. that should never be come into consideration. We should base our decisions on what is right or what is wrong.
Too often we get lost in making the decision what is right and what is right. This issue is clearly about what is right and what is wrong, and that's what I want to address today. So if you don't mind, I'll just kind of read my prepared statement, and we'll go from there. First, again, I want to thank you all, ladies and gentlemen, for serving, for taking up this mantle, and understanding that we understand that every day you have to make tough decisions. I've heard and read the arguments from both sides of this, and the bulk of those against say that it would be best to wait on the states
and best to wait on the courts to decide whether or not we make this decision. The thousand-pound elephant in this room is if we wait, it is a foregone conclusion, or at least the pundits say it's going to be two years before it reaches the Supreme Court. If this measure allows to go forward and be placed on the burden of the state, Arkansas and its citizens we're not going to get a decision for two years from now are you willing to tell everybody that we made mandatory health care insurance and everybody mandatory to pay for it
that no harm no foul we're gonna go back to square one we know that that's not possible and we know that that won't happen so today is the day where you really have to make the decision should we allow this to happen to the state of Arkansas I'll make two points for you to consider. And the first is, would it be good for the citizens of Arkansas? While affordable health care is a noble goal, mandatory health care is a violation of the Ninth Amendment. The Ninth Amendment is about the rights retained by the people. The enumeration in the Constitution of certain rights shall not be construed to deny or disparage others retained by the people.
That means we the people have the right to decide what we can and cannot do and what we should and should not do based on the laws of this land. The second point is that I have to say is that the second, which is more important than the first, is that the powers not delegated to the United States, which is the Tenth Amendment, by the Constitution, nor prohibited by it to the states, are reserved to the states respectively or to the people. So while our federal government has handed down this mandate, it is your duty, yea, I say your responsibility, to say, is this good for the state of Arkansas?
Is this good for the citizens of Arkansas? This is not about whether or not the federal government is right. This is not about whether or not health care is an important issue. This is an issue that is based on what is important or what is right and what is wrong. James Madison wrote in the Federalist Papers, The powers delegated by the proposed Constitution to the federal government are few and defined. That means the powers of our government are few and defined.
It says, but those which remain to the state's governments are numerous and indefinite. And so the power or the authority and the responsibility of this decision is ours. And we need to stop relying on the federal government to have a big picture idea of this issue. The people in California live a vastly different life than the citizens of Arkansas. The people in New York live a vastly different life than the people in Arkansas.
The people of Arkansas are hardworking, dedicated people who work very, very hard for their money. And they ought to be given the right to spend their money as they choose. And we should never listen to special interests, the hospitals, the health care industry, the insurance industry. While everyone talks about it, it's not about the money. The people who are representing or talking for it represent the people who are in the business of health care insurance, in the business of health care provision.
And so we've got to make a real decision here. And I would just ask you to make the right one, to think about 1053 and its passage. I believe we have an opportunity here to continue the process of restoring America back to its foundational principles and constitutional roots. You have the opportunity to make that statement right here in this committee. And I would urge you, I would beg you, to vote yes for HB 1053. Thank you very much. We have a question from Representative Allen.
Representative Fred Allen
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56:55
Yes, sir. Thank you, Madam Chair. This question is for Mr. Gallus. Mr. Gallus, would you agree that several years ago the state of Arkansas ran in front of the federal government and took on an issue that we should not have taken on, and would you agree that we're still paying for it today? And what issue would that
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be? With the school system. Well, see, the problem with the school issue was not whether or not we made the wrong
Glenn Gallus
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57:23
decision. It's we failed to make a decision. If you understand the history behind Lakeview and that, it was because our government, you, or not necessarily you, but your people who were in the past, those representatives, failed to make a decision, which is why we had that lawsuit.
And by the way, which is why we are asking another $55 million this year to pay for that. It's not good enough to say I'm afraid about the lawsuit. It's what is right and what is wrong. And always, it's your job to protect the rights of the citizens and the sovereignty of this state. And I believe that voting against this goes against that. Representative Hyde, you have a question? Yes, thank you, Madam Chair.
Speaker 17
58:10
Sir, I appreciate your statement that it's an opportunity to make a statement here today. But you see, we don't really have an opportunity to make a statement today. The mechanism used in this body to make a statement is called a resolution. And so what we have before today is not a resolution, it's proposed law. And there is a marked difference. And actually, for what your purpose is, your stated purpose, to make a statement to the world, a statement to Arkansans, and a statement to the federal government,
is not through passing a bill. It is through passing a resolution. Thank you, Madam Chair.
Speaker 173
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The passage of this bill is indicative of your thought or of your principles about
Glenn Gallus
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58:46
whether or not you think health care insurance should be mandated by the federal government. It is a test, and it is a way to evaluate whether or not you believe the citizens of the state of Arkansas have the right to choose to spend their money as they see fit. Thank you,
Representative Linda S. Tyler
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59:14
Mr. Gallis. Thank you. Next on the list is Sarah Scottie Keller.
If you will take your place at the table and introduce yourself for
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the record. Ms. Keller, thank you for being here. Thank you. I'd like to give my time to Dan Greenberg. David, just ask me if I could turn that over.
Representative Linda S. Tyler
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59:43
Certainly. Thank you. Mr. Greenberg, take the place at the table and introduce yourself for the record. Thank you.
Dan Greenberg
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59:52
My name is Dan Greenberg. I'm an attorney here in Little Rock, and I imagine some of you
remember me, a former member of this body. And I want to begin by saying I thought the talk that introduced this bill by Representative Representative Meeks really covered a lot of ground, but I was disappointed to see that for some people who spoke after him, it was as if he never spoke, because he made it pretty clear that this is not really an issue that is going to cause constitutional problems.
Let me just address some of the things that have already been said by other speakers here. Ms. Block from the Attorney General's Office said this measure would have no legal effect. Let me tell you the legal effect it will have. It gives standing to citizens of Arkansas to take up this issue in court and pursue a rapid remedy such that we can get this thing resolved and we don't have to wait around in legal limbo for four years or eight years or however long it's going to take to get to the Supreme Court. It's going to eliminate the uncertainty or move towards eliminating some of the uncertainty that we face.
And, of course, standing up for the rights of Arkansans to be protected in our courts is a central job of the citizens of Arkansas as represented in their legislatures. I want to say just a word or two also about the Supremacy Clause. Ms. Block brought up the Supremacy Clause. The Supremacy Clause is not applicable when the Congress does something that it's not empowered under the Constitution to do. law only trumps state law when federal law is constitutional. The whole question is whether
a mandate is constitutional, so there's no supremacy clause issue. I also want to say a few words about the significant state resources that Mrs. Block talked about that might be involved if we went to court. You know, two and four years ago, I remember a great deal of discussion about the Equal Rights Amendment, which was another piece of constitutional litigation, and I never heard any – I followed the debate closely – I never heard any discussion of the cost of the Equal Rights Amendment. There were some supporters of the Equal Rights Amendment. I think that at least one legislator who is a supporter is actually in this room,
and I believe another supporter of it was our Attorney General. I never heard any discussion of the cost of this constitutional litigation except by one person when I actually asked Dean DePippa what the cost of it would be. He said, and I'll just repeat what I recall that he said. He said, you know, the cost of this litigation would be very minor because this is constitutional litigation. It's not the sort of litigation that involves a lot of scientific tests and expert testimony and so forth. It's just basically, you know, constitutional litigation is basically a couple of lawyers sitting around the law library writing and thinking. That's all constitutional litigation is. It doesn't require a lot of scientific
tests and expert testimony, so it's relatively cheap. And of course, it's also budgeted for in our current budget. So I think the cost argument is a, and to say it's a red herring is perhaps over-complimenting a little bit. I want to say a little bit about what Mr. Ryle said. I believe he said that, I believe he portrayed this whole debate as kind of a contest between this federal legislation we're talking about and no legislation at all.
Of course, that's a mistake. The state legislature has done a great job in the past of working to make sure that we're moving towards everyone having access to health coverage and everyone having appropriate insurance. I'm thinking the CHIP program, which has done, I think, an excellent job of making sure that everyone has an insurance option. And, of course, as we all know, in about four years, Obamacare is going to destroy CHIP. It's going to walk over all sorts of insurance programs that the state has already set up. CHIP is, I think Arkansas is one of 35 states that
have a CHIP-type program, and the concern that this bill addresses is that Obamacare is going to eliminate all these state measures, and it's going to throw everyone into one larger system. Representative Ryle? Excuse me. Mr. Ryle? Excuse me just a minute. Mr. Greenberg.
Representative Clark Hall
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1:03:56
reference to the bill should be by the title, not by its use of the the President's name as the labeling of this bill. I'd appreciate it if Representative Greenberg would stay on the, if he wants to call it
by the health care bill, that would be appropriate, but not to use the President of the United States as the label. Thank you, Mr.
Speaker 185
1:04:21
Walls. Mr. Greenberg. Noted. What exactly is the term you'd like me
Representative Clark Hall
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1:04:27
to use? House Bill 10-53? 53? 53. 53. I thought you wanted
Dan Greenberg
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1:04:30
me to talk about the – you want me to use the appropriate term for the President's health care bill? I'm sorry, what term is that – what term would the appropriate
Representative Clark Hall
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1:04:40
bill be? We're not debating the health care bill, Representative Greenberg.
We're debating this bill on 1053. Okay. I think we've noted that.
Speaker 87
1:04:48
If you'll just move on, Mr. Greenberg. Thank
Dan Greenberg
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1:04:51
you. So if you look at the experience of a mandate in Massachusetts, you can see that the mandate in Massachusetts didn't decrease ER usage. And so a mandate is not going to have, you know, if you take the experience of Massachusetts seriously, which has a mandate, then there's some question about what Mr. Ryle said,
which is that he's concerned about increasing use of the ER. I just think that's not borne out by experience. I liked what Representative Meeks had to say about how we need to make health care changes here in the state. And I'm sad to see that in some ways this is being framed as either we have to accept federal legislation and do nothing at all, or we can – those are our only alternatives. And that's a sad thing to see. That's what 1053 is trying to avoid. I do want to say something about what Dr. Thompson said, and then I will close.
I believe that Dr. Thompson explained that under PAPACA, the federal health care provision, the new entrance to Medicaid will be fully funded. I think that that is not correct. I think that that's a mistake. In fact, the people who currently qualify for Medicaid but are not enrolled is going to, according to the estimates of some, cost the state north of $100 million a year in Medicaid. who are currently qualified right now who are not enrolled, the federal health care
program is going to force all those people into Medicaid. And when you talk about adding $100 million into our state budget, $100 million worth of liabilities, I don't see that you have breathing room for anything else in the future. And that's not at all covered by federal health reform. That new expense is not covered in the slightest. We often hear from doctors about the importance of preventive medicine, I myself am very concerned about waiting for four years until 2014, until the implementation of PAPACA, the federal legislation. I'm very
concerned that in four years it's going to shut down the measures we have, like CHIP, which guarantees everyone an insurance policy here in the state. And instead, we don't really know what's going to happen. This bill, 1035, it's an attempt to avoid that kind of uncertainty. It's an attempt to solve the problem. It's not an attempt to sit around and wait to see what's going to happen four years from now. And so, when we're counseled by a doctor that we need to avoid taking preventative measures, let me tell you the situation that we're in right now. We got a Medicaid reimbursement system that pays doctors 56 percent on average of what
they're entitled to by market rates. And the proposal is that we're going to load about 100,000 more Arkansans into the system. It's going to be completely uncompensated on the state rate by the federal government. It's an overburdened system, and many doctors, two-thirds, according to one poll that I've seen, are having serious doubts about whether they want to participate in government-funded health care. And so when you're loading a whole bunch of people forcibly in Arkansas into an already leaky boat, I think that there are legitimate concerns about that. Thanks very much.
Representative Bryan B. King
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1:07:59
I'd be happy to take any questions. Representative King. Thank you, Madam Chair. You know, I had a retired teacher talk when the health care debate was going on that the doctor she had been using all her life, that once she went on Medicare, that he would no longer accept her because of government. You know, as you talked about, the overburdening of the system. So I think we have that problem out there. The other part is about the cost of the lawsuit that got talked about. We talked about what this is going to cost the state. I hear estimates of $200 to $600 million.
I'm sure what would cost the state in attorney fees? Would it be comparable to that, what it would cost the state? I'm not sure I'm following you. Well, I'm saying if they talk about the consequences of attorney fees in a lawsuit, well, the consequences of the bill may be $200 to $600 million. I mean, so the attorney fees wouldn't be comparable to what
Dan Greenberg
Unverified
1:08:57
this bill is going to cost the state, correct? Right. And, of course, when
you start talking about all the costs that this bill is designed to
economize on, when you start talking about all the costs of the federal program, you know, it's – let me look here – I mean, we're not talking about just $100 million extra, you know, but the costs, costs implemented in 2014 start to move into the, you know, the 12 figures, you know, $10 billion, $100 billion. So, you know, if you want to talk about the costs and benefits of things, that's fine, but we need to put everything on the table because the goal of this mandates bill, the goal of this bill to prevent mandates
is to enable lawmakers to make their own decisions about their own states so that we can have 50 different experimentations with healthcare. There's a real danger when we have a couple of brilliant people in Washington who are going to design an entirely new healthcare financing system for us. And so I hope that the committee will give some consideration to the advantages of our record of success in some ways in Arkansas and the record of success in other states, that we are capable of making decisions for ourselves that in
many ways are superior to the decisions that a bunch of brilliant people in Washington can make representative
Speaker 17
1:10:23
hide you have a question thank you madam chair I do Dan welcome
Speaker 199
1:10:26
back good to see you sure have missed you always always the opinions vary well well let me let me take the opportunity to
Speaker 17
1:10:34
speak up and say I'm glad to glad to see you here and Dan is always you know one of my favorite parts of serving down here is all the free legal advice and opinions that we
received down here. As a businessman for 30 years, I enjoyed the free stuff. I'm trying to figure something out, and I thought you might be able to offer some legal opinion
to me. The national reform or health care reform bill is currently making its way to the
Supreme Court now. Is that an accurate statement? it's certainly possible yes that certainly
Speaker 185
1:11:13
is likely to happen yes that's that's probable i
Speaker 17
1:11:18
mean we could probably agree that that's that's more likely than not so and and until it gets to the supreme court it in fact is the
law of the land is it not are you are you telling me it's unconstitutional because because you or or or any group of people think it's unconstitutional or does it not, in fact, become unconstitutional until it is determined to be unconstitutional? As long as it's a law in effect, it may be headed for debate, but it is, in fact, currently the law of the land.
Well, the use of the term unconstitutional... Well, that was your
Dan Greenberg
Unverified
1:11:56
term. I thought you said it in your talk. Yes, and I'll be happy to explain, if you like, I'll be happy to explain what I mean by unconstitutional. When you talk about how things are unconstitutional, the word has several senses. I mean, what the most common sense of the word is, is what five Supreme Court justices think at any given time. And I think that that's a mistake to think of that as always being what constitutional means. What the fundamental meaning of constitutionality is, is what we're supposed to be doing when we come in at the beginning of every session and swear.
We all, as citizens and as government officials, have the obligation to understand the scope and the reach and the limits to the federal and state government. And so there are substantial questions along that line as to whether this legislation is constitutional. And I don't think that I pronounced as to whether it's constitutional
in the first sense. Nobody can, with great accuracy, predict the Supreme Court.
Representative Linda S. Tyler
Unverified
1:12:49
MS. I bet Representative Meeks would like to have an opportunity to close, and we have
Dan Greenberg
Unverified
1:12:55
about a minute left. MR. You bet. And I apologize. You know, you start asking about constitutional law. It's hard to answer. MR.
Representative Linda S. Tyler
Unverified
1:13:07
Thank you, Dan. Thank you, Madam Chair. MS. Representative Meeks, you may take your place at the table
Speaker 5
1:13:12
and close for your bill. MR. Madam Chair, how long do I have? Is it a minute or...? MS. You have a minute. MR. I have a minute. Okay. I think you've heard some good arguments for and against. But let me tell you what President Obama said back in 2008.
He said, when Senator Clinton says a mandate, it's not a mandate on government to provide health insurance. It's a mandate on individuals to purchase it. Massachusetts has a mandate right now. They have exempted 20% of the uninsured because they've concluded that 20% can't afford it. In some cases, there are people who are paying fines and still can't afford it, so now they're worse off than they were. They don't have health insurance, and they're paying a fine. In order for you to force people to get health insurance, you've got to have a very harsh SIF penalty. That's what we're facing here today.
We have been sworn to uphold the Constitution of the United States. We don't have to wait on a court to tell us whether or not it is. You can make your own opinion, and I hope that today you will do that. I hope you will understand that forcing Arkansans, forcing employers to purchase health insurance is not the right way to go about health care reform. I would hope that as we go along that we can discuss ways to go about health care reform. Representative Meeks, you're out of time. Thank you, ma'am.
Representative Linda S. Tyler
Unverified
1:14:29
Thank you very much. We've had great questions and input from the community. What's the pleasure of the committee? Representative Keene. May I make a comment first, Madam Chair,
Representative Bryan B. King
Unverified
1:14:46
think there was a good debate today on this bill, but right now I want to make a motion
Representative Linda S. Tyler
Unverified
1:14:54
due pass. We have a motion due pass on the floor. Immediate consideration is non-debatable.
All in favor of immediate consideration, indicate by saying aye. Aye. All opposed, indicate by saying no. All right, so we will, all in favor of House Bill, the motion to approve House Bill 1053, indicate by saying aye. Aye. All opposed? No. The no's have
Jean Block
Unverified
1:15:26
seeing a roll call. The chair's seeing a roll call. We will call a roll, and let me remind you
Representative Linda S. Tyler
Unverified
1:15:33
that the members will be called by seniority,
and then the vice chair and the chair. The members will be called twice, and even if they're here, if there's no answer, the member will be passed and cannot vote. It takes 11 votes to pass. Okay? Mr. Price, go ahead and begin with the roll call.
Speaker 206
1:15:58
Representative Allen. No. Representative Gaskell. No.
Speaker 207
1:16:05
Representative Lovell. No. Representative King. Yes. Representative Hall. No. Representative Hyde. No. Representative Penartz. No. Representative Wagner. No. Representative Word. No. Representative Lee. Yes.
Representative Smith, No, Representative Wilkins, No, Representative Perry, No, Representative Malone, Yes, Representative Letting, No, Representative Representative Wardlaw? Yes, sir.
Speaker 213
1:17:05
Representative Lampkin? Yes. Representative Mayberry? Yes. Vice Chairman Woods?
Representative Linda S. Tyler
Unverified
1:17:25
Yes. Chairman Tomlin? The bill has failed. Unless there's any other business to come before the committee, we'll stand adjourned.
Agenda
Call to Order
HB1053
Documents
No documents posted.
Speakers
Representative Linda S. Tyler
Unverified
Representative John W. Walker
Unverified
Speaker 5
Speaker 9
Dan Greenberg
Unverified
Speaker 17
Jean Block
Unverified
Speaker 21
Speaker 27
Speaker 29
Representative Butch Wilkins
Unverified
Speaker 32
Speaker 51
Representative Bryan B. King
Unverified
Speaker 54
Speaker 64
Representative Andy Mayberry
Unverified
Speaker 73
Speaker 78
Speaker 84
Speaker 85
Speaker 87
Speaker 88
Representative Garry L. Smith
Unverified
Speaker 91
Speaker 96
Speaker 98
Paul Calvert
Unverified
Speaker 52
Speaker 115
Speaker 116
Representative Fred Allen
Unverified
Representative Clark Hall
Unverified
Speaker 128
Speaker 135
Speaker 139
Chair
Unverified
Representative Billy W. Gaskill
Unverified
Speaker 148
Speaker 132
Speaker 155
Speaker 23
Judy Behrens
Unverified
Speaker 165
Fran Nichols
Unverified
Representative Tracy Pennartz
Unverified
Glenn Gallus
Unverified
Speaker 173
Speaker 181
Speaker 184
Speaker 185
Speaker 199
Speaker 99
Speaker 62
Speaker 206
Speaker 207
Speaker 213