Hello, welcome back. I’m here at day 2 of the state Chamber of Commerce’s annual Business Summit. We’ve got several presentations lined up before lunch, and I hope — HOPE — to be able to live blog all of it. Apologies to those who tuned in yesterday. The Wi-Fi access died mid-afternoon and I lost my ability to post. You can check out the main Daily Mail site for a wrap-up of some of the highlights.
Well, that wraps up the Chamber’s morning session. Nothing on the agenda for the afternoon, and there’s some receptions later this evening. The live blog will resume tomorrow morning, Gov. Tomblin to return tomorrow around 10:15am to make what Richard Adams announced to the crowd as “a very important announcement.” No specifics on what that will entail at this time.
Manchin: No Labels is not trying to reinvent the wheel, it’s about finding commonality. He said a key is getting individuals involved in keeping elected officials accountable. Said if donors started getting tighter with their pocketbooks things could change too, but said if the money keeps coming to the plate toward people who aren’t held accountable, things will continue to get worse.
Huntsman on No Labels, said the most important part of the effort will be the grassroots component, by asking current representatives about what they’re doing to solve problems not just oppose things. “It’s about elected officials putting country before party…that’s how we’re going to change things.”
Manchin: Said the economy should be taking off like a rocket that you’re trying to hold on to to ride it. Said with low interest rates and low energy costs yet still high unemployment and lagging growth is a product of the government’s own making. Said he argued with the president for over an hour regarding energy policy, said the president comes at it from a moral policy on climate change whereas the Chinese developed technologies (though they do not use them) to use coal cleaner because they looked at it as a business problem. He said if the president could focus on striking a balance and working in partnership with industry they could come up with a better energy policy.
Huntsman on energy policy: “It will be the engine of growth if we handle it right over the next century.” Said if the country strikes the right balance with policy the US will have “blue sky” ahead of it. He said there needs to be some sort of understanding between the president, federal agencies and governors about how land will be used and developed. Said the costs for domestically produced shale gas and oil is a game-changer and the country is just beginning to look in to how it can reform US manufacturing.
Huntsman also said there was a structural mismatch in higher education where the country isn’t educating enough students for the high-paying careers of tomorrow and graduating too many people in other careers that are saturated with candidates.
Huntsman on how No Labels could affect debt situation: Said the organization doesn’t take official positions, but rather encourages finding common ground in debate. He said personally the number one position the country faces is debt. Said it’s not about political party, “It’s about basic math.” He said the country will have to cut essential programs in the future because they won’t be able to finance it. Said governors were required to balance their budgets, even if it took sacrifices. “Personally I think that would be a good thing for this country is to have a balanced budget amendment, but I don’t think we’ll ever see that day.” Said the way forward was to frame the debate as the best way to create jobs, which deals with tax reform and how the country is going to spend. Said the absence of long-term policy is keeping corporations from being able to properly plan future spending and capital investments. “The uncertainty is hurting our private sector.”
Manchin asked about gun control compromise and how a group like No Labels would help push that compromise along: Manchin said he knew a state like West Virginia would hate the original proposal offered by Sen. Chuck Schumer. Said the compromise had commonsense reforms like having checks to make sure people who buy guns at gun shows aren’t insane. But he said he needed liberals to understand how state’s like West Virginia feel about guns. “You can’t look at me like I’m a criminal if I own a gun,” he said he told them. But he said groups like the NRA fought everything, “And when they started going crazy, that’s basically when they shut everything down.” Said he took leftover campaign money to go back out and educate people about the facts. Said today they need five more votes to pass the compromise. Until they get those, they will not move it forward. “The only thing I’ve said to the gun supporters and gun lobbyists, God forbid if we have another massacre or shooting our babies, then God help you if you want to stem the tide then.” Said for him to speak out coming from a strong gun support state gives him credibility on the issue, and if he’s afraid of getting defeated in an election over it, he shouldn’t be there.
Manchin: “Let me tell you one thing, there’s not many of us left in the middle anymore.” Said it’s been easy to recruit people on the extremes, but hard to get people who support common ground.
Manchin: Said the easiest vote to make is “no,” because you can always say there was something, no matter how small, wrong in a bill. But he said the biggest risk was voting yes and going back to defend that. Said people shouldn’t be satisfied with just knowing a politician is against something, but asking what their alternative to fix it is.
Huntsman said his and Manchin’s experience as governors help with bipartisanship because they’ve learned how to broker deals with parties that do not agree on an issue. He said the mood of American politics has shifted from one of anger in politics, like a few years ago, toward seeing the potential of America and starting to see the need to work together to address problems like debt.
Manchin: Said he still can’t believe the government is continuing to operate without a budget. Said that hurts the ability for long-term infrastructure planning.
Huntsman: Said he was never more optimistic about the state of economic growth with regard to energy, but not optimistic about the political environment, which gets in the way of that growth. Said a country like China has a government that is moving forward with an agenda on energy programs and other economic development initiatives. “But for a political barrier of hyper-partisanship, we’d be able to go out and get a lot more done.”
Huntsman: Said he couldn’t stomach passing on to the next generation a culture that is more dysfunctional and divided than the one before it.
Huntsman said the concept of No Labels was unprecedented in the modern era. Officials come together and talk not about what they disagree on, but issues where they have common ground. While they might not be the dominant issues of the day, but it helps build relationships and gets people to work together. “It’s about creating trust, which this political system today is running on empty on.”
Huntsman: Said he sought Manchin’s advice when there was a mining accident in his state, it helped him in that situation. Helped forge the relationship between them. They eventually would call each other on different things like tax policy. “It’s the way the world should function to work for the better of your states.” Said it was disgusting that the status quo was that division is okay in politics.
Huntsman: Joked about his presidential campaign, said it was going well until Bill Clinton went on TV and said, “Hey, that Huntsman guy — there’s a Republican I can support.”
Manchin talking about the “No Labels” bipartisan initiative. “I’m an American before I’m a Democrat, and Jon’s an American before he’s a Republican.” Said the litmus test for service in No Labels was if politicians are willing to put country ahead of party. Said Huntsman also agreed with that. Said the group was up to 83 – 40 D’s, 40 R’s — get together once a month to talk and find common ground on legislation. “Now we’re finding ways to make government work. Problem solvers — that’s who we are, that’s why we were sent (to Washington).”
Panel now beginning with Sen. Joe Manchin, D-W.Va., and former Utah Gov. and Republican presidential candidate Jon Huntsman.
On sequestration, said Sen. Reid wants to go back to old spending levels to start negotiations. McKinley said Republicans like him don’t want that. Said the country is $17 trillion in debt, a number so large that most people can’t really grasp the enormity of a trillion in cash. Said a stack of $1,000 bills would be 64 miles high if stacked on top of those. And the country owes 17 of those. Said the country can’t afford that.
This fall will also deal with climate change. Said he took the president seriously that if Congress doesn’t do something about climate change, he will. “That was a clear shot across the bow for states like West Virginia.” Said Congress has spoken against cap-and-trade. Said as an engineer he looks forward to talking about “I concur that there is climate change. What I don’t concur with is that it’s anthropogenic, that it’s manmade, that it’s from the burning of coal and other natural resources. That’s a part of ot…it’s not all driven by fossil fuels.
IF we ban all fossil fuels, the total globe temperature would only drop 0.5 degrees Celsius. Said the only ones suffereing would be Americans by losing their job. “We have to be very careful with how we proceed on climate change. It deserves a good discussion.”
ON Food stamps. 1 in 7 americans on food stamps, twice what were on it five years ago with costs increasing dramatically. Adding 11,000 new recipients a day because of the changes in eligibility criteria. Said Congress will continue debating that matter. Said they may look at work requirements that were brought up during Clinton adminstration.
Said there will be a lot more discussion about invasion and intrustion by federal government with NSA. It’s not an easy decision….because too many of us are too adherent to this constitution we know and love.
McKinley also said he never took Congressional health care plan, he stayed on the one he provides employees to his company.
This fall, said they will deal with the budget. Said he did not think they will get to the point of a government shutdown. Said that will take more appropriation bills passed. Believed a short-term continuing resolution will be needed to stave off the shutdown while committees work on the individual budget aspects.
Said the debt limit will likely be a challenge in September. “I think you’re going to see a real donnybrook over this.” Said he thought the debt ceiling was a good way to force leaders to closely examine things that need to be addressed.
Said “since Obamacare is not really ready for prime time,” maybe a delay can be worked into a debt limit bill to make sure exchanges and the individual mandate is implemented in a proper manner.
On the ACA, said the House will continue working on it. Said the president knows there a problems with it. “But we’ve got to have a replacement product.” Said the nation can’t go back to the old way. Said Republicans had not had an alternative in prior years, but believed some representatives have come up with a reasonable alternative now that can lower costs.
Said he was one of only 48 members of Congress with a small business background when he was elected. One of two engineers, but said there were 242 attorneys in the House. He said who better to deal with infrastructure and roads than an engineer. “I get excited about it. It’s a perfect fit.”
Said in Washington, “We don’t let people understand and connect with what were doing…to make people understand what are you going to do with this bill, how are you going to affect people.”
It’s not government spending that will create jobs. It will be to get government
Said Congress won’t be the one to create jobs and fix the economy, it will be the private sector. “We can’t cut our way back to prosperity, we can’t tax our way back to prosperity, we’ve got to grow our economy and to do that we’ve got to get government off of our backs.”
McKinley: Talked about bringing the perspective of a business owner to Congress and the House Energy and Commerce committee. Said it gives him a good opportunity to represent WV and the 1st district. “Energy is what drives West Virginia and this country and it comes from coal and gas and we’ve got to fight for it.”
McKinley taking the podium now.
Capito: Said she still believe the core strength of the willingness and want to solve problems is still there, but needed groups like the Chamber to use their weight to get representatives to work together. Said they will go back after recess and rededicate themselves to solve problems.
Capito: Said she felt confident people know that West Virginia delegation as a whole works across the aisle on issues. “That’s just the nature of who we are in this state…we always work with our neighbors and friends to try to meet those challenges.” Said she thinks they are losing young folks, “because they see us bickering…challenging each others lives just to score a personal point.” Said she recognizes the difficulties people have watching elected representatives in Washington.
Capito: Said the sequester went into effect and instead of disaster that was predicted by some, some agencies trimmed inefficiencies. Capito said that shows more can be done if the government is forced to tighten its belt.
Capito: Have a $17 trillion debt. Recent article said they actually did cut spending in Washington, “Hallelujah.” Said people and businesses have been doing that every day. “We make these decisions all the time but the decision is never made like that in Washington, the solution is always we need more money.”
Capito: Said it’s also near September, exchanges are supposed to come online in October but doesn’t think they’re ready yet. Meanwhile, individual insurance mandate kicks in Jan. 1. Said that should be pushed back too. “Push the deadline back. If it’s good enough for businesses, then let’s push the individual mandate back.”
Capito: Other big uncertainty is health care. Bumping up against huge Jan. 1 deadline for people with regard to Affordable Care Act. Said small businesses facing penalty/versus offer insurance, both of which they can’t afford, or cut employee hours under 30 hours a week, or reduce workforce. “These are conversations going on with businesses across West Virginia who are near or at that threshold (of 50 employees)” Businesses with more than 50 are required to provide coverage, that mandate was pushed back one year.
Capito: Said EPA must consider economic impacts of regulating the energy portfolio.
Capito: Speaking now on regulatory burden from the EPA, said that was “being deeply felt all through the energy sectors here in our state and it’s causing a lot of uncertainty.” Said she could go on for 15 minutes on uncertainty, but said let’s talk about solutions. Said Marcellus shale development going on right now is “absolutely game-changing.” Said people in that region were benefitting from a wide and broad development. “So let’s use our energy resources, let’s get serious about an all-of-the-above plan.” Said will support renewable but want to use “common sense” solutions and include all energy resources. “The development in natural gas and the research and development of cleaner uses of coal…these are the positive things that we can use.”
Capito: Said she and McKinley have spent last month on recess. Been to a lot of different places in WV recently getting a feel on what they think of Washington. “Quite honestly, people are very frustrated about the tone, tenor and lack of decision making in Washington” She said she agreed, was frustrated too. Now has a 9% approval rating for Congress (Capito joked that was mainly staff and families of Congressmen). She said a lot of it on the part of business is frustration with uncertainty of laws and regulations.
Capito, who is running for retiring Sen. Jay Rockefeller’s seat in 2014, taking the podium now to speak.
US Chamber now presenting Reps. Shelley Moore Capito and David McKinley with its Spirit of Enterprise Award. Both voted with US Chamber 100% on issues over last year.
Back online with Greenbrier Wi-Fi right now.
About the state’s drug problem? Fred said they are looking at the data they have currently and share data with state agencies to see if there are patterns or trends in the system. Think it goes beyond pure cost of health care. An area where they need to be more transformative.
Litigation a problem driving up costs? Speaking as a former doctor, he said, “Yes it’s a problem, it drives up costs in a significant way. I think it has got to the point where defensive medicine is so embedded in the psyche of physicians.” Said they order thousands of dollars in additional tests to make sure they’ve ruled out even the smallest medical possibilities. Seen studies indicating its as high as 15 percent of total costs spent on defensive medicine, said he didn’t think it was that high, maybe around 10 percent.
Is Highmark looking to acquire hospitals in WV? “No, we are not.” But said they were looking at making more partnerships to create cost-savings. “We want community hospitals to survive. We think it would be a bad outcome if care were centralized in a few tertiary places.”
In West Virginia, said Highmark intends to participate in state’s health care exchange, also working with the state on the Medicaid expansion. Going forward? “I’m not 100 percent convinced that there’s not going to be changes in the law.” “There’s a real struggle going on right now with respect to how to go forward and I’ve been looking at this issue, talking about it for 3 to 4 years, and my comment is always that I think the health care change in America and the transition to whatever system we use is gong to be a decade long change. I think it will be at least 2020 before we know exactly how the change will go.”
Last thing they’re doing is creating and partnering with hospitals for health care delivery and financing systems. Have Allegheny Health Network that partners with 7 hospitals. What we know about these hospitals and institutions is they deliver a lower cost of care…intend to drive down that cost of care through the partnership between the payment side and delivery side. “Because at the end of the day we should be partners and not adversaries as it has been and continues to be in the history of our nation’s health care delivery.”
Paying for value and risk/reward sharing: Said consumers currently pay the same whether an operation or diagnostic has a good or bad outcome. have a program called quality blue featuring pay-for-performance. said 66% of quality blue physicians use electronic prescribing (more efficient, fewer error rates), will pay doctors more if they use it. 80% of quality blue physicians prescribe generics, versus 76% nationally. Said those are good practices they want to encourage. Also pay hospitals based on quality, estimated it led to 3400 acquired infections averted 1800 fewer hospital days, $56million in cost savings and 200 to 400 lives saved. Said this was an area they are continuing to look at, expand and make more efficient.
Cost/transparency programs for consumers. Said most people know how much it costs for a gallon of gas, but not for services like a CAT scan or colonoscopy. “We know the things we buy and use our dollars for, we know what the cost is for it. When someone else is paying for it, we have no clue what the cost is.”
Highmark creating online health tools that can display a care cost estimator. Shows consumers how much something will cost and what insurance will cover depending on the provider.
“So we try to show people data on not just the cost but the quality, and that’s beginning make a difference on behavior.”
Said essential care is still the decision of the physician.
Said Highmark was doing four things to address costs: first was wellness and prevention, because healthier people have lower costs. Said that will help his company’s bottom line which will help its customers. “Today if you’re a Highmark employee there’s a difference in your cost contribution if you’re participating in these (wellness) activities or not.” Did a study that showed return on investment was $1.60 for every $1 invested on wellness. “There’s a lot going on nationally in this area to try to get people to change their behaviors and find the right combination of incentives to get people to take the actions they need to take.” Four year studies of their covered companies found $330 in savings per person per year through using these programs. Said that wasn’t all of the solution, but would certainly help.
Also said studies say 20 to 30 percent of health care costs are due to overly inflated costs, due to overcharging, over prescribing and other fraud, waste and abuse. Said that was something companies like Highmark can continue to work to address.
Said unhealthy lifestyles key factor driving costs (along with aging population and increasing subsidies.) CDC says chronic disease, like physical inactivity, obesity, tobacco use, and things people can control represent 75% of US health care spending.
“So three quarters of our healthcare spending is theoretically preventable.”
How will ACA affect you? “Younger people are likely going to have to pay more, and sicker and more elderly people are likely to pay less.”
Said more individuals will have a chance to be covered
Said his company can’t charge a sick, or chronically ill person more than 5 times more the rate of a healthy, younger person.
I’m going to be interested to see if more young people sign up because of the way it increases their costs.
I think a lot of young people are likely to choose that $95 one time fine as opposed to paying $200 or $300 a month for insurance. But we’ll see.
Re Highmark: “We intend to be ready and prepared here in WV and every state we operate.”
Why are we concerned about costs? Said they want to be a part of the solution not the problem.
Said “there is no silver bullet for the solution to the cost problem. There are several solutions, some of them involve our company and companies like us and some of them involve us as citizens.”
Winkenwerder says health care spending is unsustainable. 17.5 to 18 percent of economy spent on healthcare, $2.3 trillion in spending.
Said if they were spending what US spent on healthcare in late 70s, 7.5% of economy, then there would be no federal budget deficit today. 1 in 4 federal dollars currently goes to healthcare, he said.
WV spending 760 per person on health care.
“The healthcare law will improve access.” Intended to cover 30 million more, but said it adds considerable cost. Projections were under $1 trillion over first 10 years. “Now if you look forward from 2014, the first ten years of the law, it’s closer to $2 trillion – and that’s added spending, added federal dollars.”
First up is Dr. William Winkenwerder, president and CEO of Highmark to talk about the Affordable Care Act and what’s driving health care costs.
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