You are on page 1of 37

JAKE TAPPER, CNN: Live from The George Washington University in the nation's capital, this is CNN's

debate night on the future of the Affordable Care Act, also known as Obamacare. Welcome to our
viewers in the United States and around the world. I'm Jake Tapper.
DANA BASH, CNN: And I'm Dana Bash. President Trump has made the repeal and replacement of the
Affordable Care Act one of his top priorities. To certain members of our audience, that legislation has
been a life-saver. To others, it has harmed livelihoods. These defenders and supporters of Obamacare
will get to question two leading members of Congress who will shape what comes next.
TAPPER: So, please welcome the runners-up for the Democratic and Republican nominations for
president, in their first debate, Senator Bernie Sanders, independent of Vermont...
... and Senator Ted Cruz, Republican of Texas.
BASH: Senators, welcome. Please take your positions behind the podiums. Now, before your opening
statements, I want to talk about the ground rules that you both agreed to. You will get 90 seconds to
answer questions posed to you, 45 seconds for responses and rebuttals. Timing lights will guide you. As
we mentioned, a handful of members of our audience, which include both critics and defenders of the
Affordable Care Act, will question you, in addition to questions from Jake and myself. As moderators, we
will guide the debate. And we will begin with two-minute opening statements on what should happen to
health care in America.
SEN. BERNIE SANDERS, I-VT: Let me begin by thanking CNN for sponsoring this debate and let me
thank all of those who are watching.

Let me get right to the point. Senator Cruz, like most Republicans, has said that he wants to repeal the
Affordable Care Act, or so-called Obamacare. Let me tell you what that will mean to the American
people. It means that if you are one of 20 million Americans who finally has received health insurance,
forget about it, you're gone. You're off health insurance.

And that means when you get sick, you ain't going to be able to go to the doctor. And when you end
up in the hospital, you'll be paying those bills for the rest of your life, or maybe you'll go bankrupt.

What the repeal of the ACA means, that if you are one of 10 million senior citizens who today is
struggling with the outrageous cost of prescription drugs, your prescription drug costs are going to go
up on average about $2,000.

What the repeal of the ACA means is that if you are suffering with cancer, with diabetes, with serious
mental illness, you will be put into a position where you may be rejected from any insurance at all,
because you have a pre-existing condition. And by the way, women are considered a pre-existing
condition by the insurance companies because they might have a baby.

Is the ACA perfect? No. Nobody believes that it is. And nobody believes that we do not need to
improve it. But the debate is whether we kill it entirely or we make improvements in it. And I will tell
you: Overwhelming majority of the American people say do not simply repeal the ACA. Make
improvements.

Last point. The United States is the only major country on Earth not to guarantee health care to all
people as a right. I believe we should move in that direction. The ACA has been a step forward. We
have got to go further and join every other major country on Earth and say that if you are an
American, you are guaranteed health care as a right, not a privilege. Thank you.
BASH: Thank you, Senator Sanders. Senator Cruz, what should happen with health care in America?
SEN. TED CRUZ, R-TX: Well, Dana, I think I get an opening statement, as well, so I'll start with that.
BASH: Please.
CRUZ: Which is just simply saying thank you. Thank you, guys, for hosting this. Thank you for Bernie
for joining this. And thank you to CNN for hosting this. You know, often in politics we have debates
that are sound bites, that are 60 seconds or 90 seconds on a topic, and I appreciate CNN devoting real
time to this issue, because it matters.

Health care is personal in a way that is different from most other political issues. Health care affects
our families. It's our moms. Health care is our kids. It's the future. It can quite literally be whether we
live or die.

And this is an issue where Bernie Sanders and I have fundamentally different approaches. Bernie and
the Democrats want government to control health care. I trust you. And I trust your doctors. I think
health care works better when you're in charge of your family's health care decisions, when you can
sit down with your doctor and decide the care that's best for your family without government setting
rules, without government rationing, without wait periods.

And that's the fundamental divide we're having. You know, six years ago, when Obamacare was being
adopted, it's possible that reasonable minds could have differed on whether this was a good idea. But
six years into it, we've seen the results.

We remember Obamacare, a series of promises were made to us by President Obama. Number one,
most infamously, if you like your plan, you can keep your plan. President Obama said that 37 different
times. As 6 million people across this country discovered, that was not true when they had their plans
canceled against their wishes.

If you like your doctor, you can keep your doctor. Again, millions discovered that wasn't true. And
President Obama promised the American people the average family's premiums would drop $2,500.
Not only wasn't that true, but the average family's premiums have risen $5,000. That's why people are
unhappy with this disaster of a law, because it's driven up the cost of health care, it's reduced your
choice, it's reduced your freedom, and this last election was a referendum on Obamacare, and the
American people quite rightly decided this plan isn't working.
RESPONSE: There is a lot to deconstruct just with Ted Cruzs opening statements because it is painted
in a context that best frames the viewpoint he is selling to you. Now I understand his reasoning, facts
can tell many different stories based on the point of view of those who interpret them. But let me
take issue with some of the facts hes put forth here.

When the ACA was introduced, everyone was worried that this was an example of government taking
over healthcare. When Obama said if you like your plan, you could keep your plan, yes this did not
end up happening for everyone. Reasons for this are with new mandates, many plans being offered
did not provide coverage that met what are now considered Minimum Essential Coverage. This means
that these plans did not provide things like preventative treatment, pregnancy procedures, and
contraceptives free of cost. Now Cruz has equated losing your plan to losing your doctor. This is not
the case. We have three general ways of receiving healthcare in our country.
1. Employer-provided
2. Individual plan purchased
3. Medicaid or Medicare
Now just because their individual plans were cancelled this did not mean that these people could not
sign up for insurance plans that would be affordable and accepted by their doctors. People are at a
similar mercy in situations where their employer who provides their coverage decides to switch the
plan that they offer to their employees. In fact, a majority of people in our country get healthcare
through their employer. This possibility exists for all of these people every year. That was true both
before and after the affordable care act.

His next point is that Obama promised a reduction of 2500$ in peoples premiums and instead saw
premiums go up by 5000$. His initial claim is just untrue. The ACA, in Obamas introductory speech for
it in 2009 where he laid out many of its basic tenets, claimed that the goal of this was to address
Healthcare being worth 1/6 of our GDP. In that introductory speech, he stressed the importance to
SLOW THE RATE OF INCREASING COST TO CONSUMERS, going on to say even slowing growth by one
tenth of one percent would result in drastic long term savings for the American people. So to say we
were promised that this would reduce our premiums from the get-go is simply dis-ingenuous. This
was always intended to expand coverage to more people who couldnt afford it and simultaneously
SLOW the rate at which premiums were already increasing. We see now that during the years since
the ACA was implemented, premiums have grown at a slower rate than they did before it was enacted
into law.
TAPPER: Senator Cruz, thank you so much. We have a lot of questions for both of you from members of
the audience, but before we get to them, I want to ask about a pressing matter on Capitol Hill, and I'll
start with you, Senator Cruz. House Speaker Paul Ryan said today that the legislation to repeal and
replace Obamacare would be done this year. On Sunday, President Trump said that a plan may not be
rolled out until 2018. Not that it would, but that it may not be rolled out until 2018. Is anything less than
a full and swift repeal and replacement of Obamacare a broken promise?
CRUZ: Listen, I think everyone agrees there is an urgency to honor the promises we made. You know,
since Obamacare was passed, we've had multiple elections, 2010, 2014, 2016, where the number-one
issue in each of those elections was Obamacare.

And, you know, what we're arguing here was argued in front of the American people. The Democrats
said over and over again, if Obamacare is repealed, all these people are going to lose coverage. Now,
that's not true, and we're going to get into that. But that was the argument that was made to the
American people.

And 2010, 2014, 2016 I believe were a mandate from the voters. They said we're tired of premiums
going up. We're tired of deductibles going up. We're tired of losing our doctors of less choices. So, yes,
should Congress move swiftly to repeal Obamacare? Absolutely.

Now, nobody thinks we're done once Obamacare is repealed. Once Obamacare is repealed, we need
commonsense reform that increases competition, that empowers patients, that gives you more
choices, that puts you in charge of your health care, rather than empowering government bureaucrats
to get in the way. And these have been commonsense ideas, I would note, that for six years
Republicans have been proposing, and for six years Democrats have been fighting, saying no changes
at all to Obamacare, even as people were hurting and losing their coverage. This election is about
honoring the promises we made to the people who elected us.
RESPONSE: I think its interesting to imply that 2016 gave republicans a mandate on Obamacare. Not
only was this issue not rated as the #1 factor for peoples voting decisions according to exit polls, (that
was jobs and the economy) but even if it were the primary motivator behind peoples votes, lets take
a deeper look. Republicans, while expected to lose somewhere between 10 and 25 seats in the house
by political analysts in the months preceding the November elections. There was also a strong
consensus that it was very possible theyd lose their senate majority as well. Now, this did not come
to fruition, but the fact of the matter is they lost seats to democrats in both chambers of congress.
Donald Trump may have won the presidential election through the electoral college, but 2.9 million
more people voted for Hillary Clinton, a strong vocal advocate for maintaining the affordable care act
and improving upon it. So if voters picked democrats, who largely support the affordable care act, in
greater quantities than they did republicans, and backed Hillary Clinton in larger numbers than Donald
Trump (a pro ACA candidate vs a candidate who wants to dismantle it)

And lets look at the non-answer of exactly what this replacement would consist of. He says ommon
sense reforms that introduce freedom and choice. What exactly does that look like? And how is that
done in a way that reduces cost? Maybe well get into that later on, but for now no concrete details
on how this is done.
TAPPER: Senator Sanders?
SANDERS: Well, the truth is that the Republicans are now in a panic, because the American people
have caught on that the absolute repeal of Obamacare without improvements in it, without a plan to
make it better, would be an absolute disaster.

So when Ted talks about giving people choice, here's your choice. You got cancer, and you go to the
doctor, and the insurance company says, "We're not going to cover it. We can't make money on you
because you have cancer. You have a pre-existing condition."

And here's another choice you can have if we get rid of Obamacare. If you have diabetes, and you're
spending a whole lot on health insurance, the insurance companies will say, sorry, we're only going to
spend X dollars, because we've got to make money off you. That's the function of private insurance.

So, do we have to improve the Affordable Care Act? Of course we do. But let us remember where we
came from. Before the Affordable Care Act, as Ted probably knows, if you were a family of four during
the eight years under George Bush, your premiums doubled. So it's not like, oh, gee, just in America
today, health care costs are going up. They went up much higher before we had the Affordable Care
Act.
TAPPER: Senator Cruz, do you want to respond to that?
CRUZ: You know, it is interesting to hear so much of the Democratic rhetoric that government
controlling your health care is always justified by saying the insurance companies are terrible. Now,
this is an example of what John Adams famously said, facts are stubborn things. Let's talk about some
facts.

In 2008, the 10 largest insurance companies in America made just over $8 billion profit. In 2016 --
2015, rather -- those same 10 largest companies made $15 billion in profit. Insurance company profits
have doubled under Obamacare. That was the result. Bernie helped write Obamacare.

I don't think the federal government ought to be passing a law that doubles insurance company
profits and, while those profits were doubling, what happened to the average American family? The
average American family, your premiums have gone up $5,462. At the same time, the average
deductible has gone up $5,000. For families that are struggling, you're getting less coverage, you're
paying more for it, and your deductibles are higher, and you know who's making out like gangbusters?
The insurance companies and those in government whose solution is let's have even more
government control.
RESPONSE: In this instance, Senator Cruz is not wrong. Prices have gone up for consumers and
companies profits have gone up. Both of these are true. However, prices gone up less than they were
projected to without ever passing this bill. Another point Id like to make is that Republicans cant
have it both ways. They cry foul at news stories saying that insurers are leaving the markets because
they cant make money under Obamacare due to these regulations, but what do we see? We see a
doubling of profits in a multi-billion dollar industry over the course of what, 7, 8 years. So is it that its
unaffordable for insurers to provide this coverage or is it that its unaffordable for them to provide
this coverage and continue to raise profits at an insanely high rate off of practices such as increasing
deductibles and premiums, essentially profiting off of raising prices in ways that remain unchecked
legislatively. If anything, it is my view that Ted has illustrated a need for greater government oversight
of exactly how insurance companies put money toward providing quality, affordable care to the
consumers they serve.
TAPPER: Senator...
CRUZ: This thing isn't working.
TAPPER: Senator Sanders?
SANDERS: You know, I find myself in agreement with Ted. He's right. The function of insurance
companies is not to provide quality health care to all people. It's to make as much money as they
possibly can.

Ted, let's work together on a Medicare for all, single-payer program, so we're finally going to get
insurance companies, private insurance companies out of our lives.

As you know, as the American people know, we are the only major country on Earth that allows
private insurance companies to run the system. But it's not only the points that Ted made about the
insurance companies. What he forgot to tell you, even adding insult to injury, is many of these CEOs of
the insurance companies make outrageous compensation and get all of these severance packages, in
some cases over $100 million.

Ted, let's work together. We're going to get those insurance companies out of health care. We'll move
to a Medicare for all health care program, guaranteeing health care to all people.
BASH: Thank you, Senators. Unless you want to agree to a single- payer system...
CRUZ: Look, I would love to respond.
SANDERS: You're not going to support that. I know that.
CRUZ: Well, actually, what I will say, Bernie, is I would love for us to work together going after big
pharma, and in particular taking on the FDA. Right now, it takes $2 billion to approve a new drug.
Now, I've introduced legislation to reform the FDA process so that new health care -- so that we can
be curing diseases and we can be helping people. I would encourage you to join me in that legislation.
SANDERS: I'll tell you what...
CRUZ: Join me in right to try, so that if someone has a terminal disease, the government won't tell
them, you can't try this life- saving medicine because we forbid it.
TAPPER: Gentlemen, we could do this all night. We're going to get to pharma.
SANDERS: I'm willing to look at it, if you are willing to look at taking on pharma, which is the greediest
of many greedy corporate interests in Washington. And I'll tell you what, I'm going to introduce
legislation to have Medicare negotiate prices with the pharmaceutical industry. I'm going to
introduce, again, legislation to allow Americans to buy less expensive medicine in Canada, the U.K.,
and other countries. Let's take on the greed of pharma, substantially lower prescription drug prices.
CRUZ: And, Dana, let me make a response to this, because this is a good discussion. The whole point
of having an extended discussion is to say, as you know, with drug re-importation, bringing in drugs
from Canada and other countries, just a couple of weeks ago, on the Senate floor, I voted with you...
SANDERS: You voted for my amendment, that's correct.
CRUZ: ... in support of that, in support of allowing drug re- importation. It was the right thing to do.
But I'll tell you, a much bigger barrier than that is the fact that, you know, in the last 20 years, the FDA
has approved only three child cancer drugs? In 20 years, because the burdens are so great.

I introduced legislation that said if a drug is approved in another major country, if it's approved in
Europe or Japan or our major respected partners, that the FDA has got 30 days to approve it here. We
shouldn't be telling people with life-threatening diseases you can't do everything you can to save your
lives. That would be a great thing.
RESPONSE: This specific example of a way to reduce barriers and how regulations may be
unnecessarily contributing to increased healthcare costs, but let us be clear that the FDA does do
essential work in ensuring the safety of the drugs that go to market. We already, even with the FDA all
see commercials that go on and on with fast-speaking narrators that list terrifying possible side effects
of drugs. Ensuring safety is absolutely necessary and maintaining the FDAs ability to do this
adequately is also of the utmost importance. However, yes, it could be sensible for us to set up a
timetable to approve drugs for use in our country that are already approved in major developed
nations such as the UK, Canada, etc.
CRUZ: We'd make news if you and I joined up on that.
SANDERS: We'll need to look at it, but that is not the major problem. The major problem with the
pharmaceutical industry is, you know what, they could double or triple the prices you pay for
medicine tomorrow...and there is no legislation to control that.
BASH: So good to see you. We do want to talk more about that later, but I want to get to some of the
questions from our audience. One of the most popular parts of Obamacare is -- as you mentioned
earlier, requiring insurance companies to cover people with pre-existing conditions.

If Obamacare is repealed, 52 million Americans could lose that guaranteed coverage because of their
medical histories. One of them is Neosho Ponder, who is fighting breast cancer and currently undergoing
radiation treatment. Neosho? QUESTION: Senator Cruz, if Obamacare is repealed, is there anything you
can do to ensure that provisions are in place so that half of my paycheck won't be spent on health care?
I didn't ask for cancer. I never smoked; I never drank a lot. I lived a pretty healthy lifestyle. I fear that -- I
fear that if I don't have Obamacare, if I'm not covered, then my pre-existing condition of breast cancer
and remaining treatments will make it difficult for me to afford insurance. Senator Cruz, what can you
do to protect people like me who are alive because of Obamacare?
CRUZ: Well, Neo, thank you for asking that question. And how long -- how long have you been
diagnosed with breast cancer?
QUESTION: I was diagnosed on April 25, 2016.
CRUZ: Wow, well, you're doing great. You know, our prayers are with you. I'll tell you, my mom had
breast cancer, and -- and my mom was diagnosed in 2000. I sat by her hospital bed as she went
through two surgeries, and it's a horrible disease, but 16 years later, thank God, she is a survivor. And
I will tell you, our medical innovation has been incredible dealing with breast cancer. So all of us -- our
prayers and thoughts are with you. You know, you asked about people who get sick and not wanting
your insurance canceled, not wanting your premiums to go up, that's absolutely right. That is
absolutely right.

And if you look at every proposal that's been submitted, every significant proposal that's been
submitted to replace Obamacare, to fix the problems in the health care system after Obamacare is
gotten rid of, all of them protect people in your situations. All of them prohibit insurance companies
from canceling someone because they got sick. They prohibit insurance companies from jacking up
the insurance rates because they got sick or injured.
Look, the whole point of insurance is none of us know if we're going to wake up tomorrow, like you
did earlier last year, and discover we have a terrible disease. And we buy insurance, we pay our
premiums, just so we know that we'll be able to take care of that situation. So, absolutely, we've got
to fix it, and I'm confident that we're going to.
BASH: Senator Sanders, response?
SANDERS: Senator, I cannot believe what you just said. It's in direct contradiction to everything you
ran for president on. What Ted has said is, he wants to get rid of all federal mandates. Did you say
that a hundred times?
CRUZ: I didn't say it once.
SANDERS: I will -- said Ted Cruz, I will get rid of every word of Obamacare. Excuse me. The only way
that we are going to make sure that you -- and we all wish you the best -- are able to get the health
insurance you need with a pre-existing condition is to make sure that no insurance company in this
country can say no to you or to anybody else.

Now, Ted thinks that's a terrible government intrusion. I think it is the moral and right thing to do. So,
when you hear Ted and other Republicans say we're going to get rid of all of -- we're going to leave it
to the states. Well, what do you think the states are going to do? You think they're going to maintain
the ability to protect people with pre-existing conditions? They're not. We're going to go back to the
obscenity of where we were before Obamacare was passed.
BASH: Senator Cruz, your response. And then could you just clarify, will you support anything that
doesn't mandate people with pre- existing conditions continue to have coverage?
CRUZ: Look, my response is, I said hundreds of times on the campaign trail, yes, we should repeal
every word of Obamacare. But if you listen to the next sentence, I always said, we're not done yet
with health care reform, and we do that.

We need health care reform. And the principles of health care reform, they should expand
competition, they should empower patients, and they should keep government from getting between
you and your doctor. And I talked about all sorts of commonsense ideas to do just that. And as I said,
a proposal that is consistent in virtually every one of the pieces of Republican legislation that's been
filed is a prohibition on insurance companies canceling people because they got sick.

And, you know, Bernie, it's easy to say to people, gosh, you're going to lose your coverage. What do
the Democrats say to the 6 million people who had their health insurance canceled? What...
SANDERS: Ted, Ted, you're a good lawyer, and you use words well.
CRUZ: Thank you.
SANDERS: What you just said is "cancel your insurance." "Cancel your insurance," OK? That's good.
But what happens if tomorrow you wake up and you go to the doctor and you discover that you have
cancer? All right? You just discovered it. And the insurance companies say, hey, you're not a good deal
for us, we can't make money off of you, you will not get that health insurance.

So I think when people like Ted talk about repealing Obamacare, repealing government mandates --
this is a government mandate, and it is a damn good mandate and a humane mandate.
BASH: And, Senator Cruz, if you would answer Neosho's specific question.
CRUZ: Yeah, I did. Multiple times, Dana.
BASH: OK. So you are saying that she will continue to have health care...
CRUZ: Yeah.
BASH: ... she and others who have pre-existing conditions? And you're going to make sure that that is a
mandate and a requirement in whatever legislation you support?
CRUZ: What I've said is, is virtually all of the Republican legislation that has been filed that the
Democrats have opposed maintains a continuity of coverage so that insurance companies can't cancel
policies.

And, you know, the question I asked a minute ago that Bernie chose not to answer is, what do the
Democrats say to the 6 million people who had their insurance policies canceled, who got a
notification in the mail that you don't get to see your doctors anymore?

And not just the people who were canceled. There are people all over this country who can't afford
health insurance because of Obamacare, who the deductibles are so high, the premiums are so high,
they say, you know what, my family, we can't make it on this? And, you know, you talk about the
people covered by Obamacare. Here's something most people don't know. Most of the people
covered by Obamacare are on Medicaid. They jammed a bunch more people on Medicaid. And I'll tell
you what happens. People on Medicaid have markedly worse health outcomes than people with
private insurance.
RESPONSE: Again, those people had to pick from new plans, which came in at rates that were
comparable to the rates of their old plan and offered just as, if not more, comprehensive coverage. So
to say that they couldnt see their doctors anymore is disingenuous as there were alternatives on the
market that offered arguably better coverage for a similar price. It was just a matter of those people
finding plans that their doctors were still considered in-network for.

Yes, Medicaid expansion was a large piece of Obamacare. And lets talk about that. The coverage that
people get on Medicaid is phenomenal coverage. People who qualify based on income have no
premiums, have low fixed co-pays on visiting their doctor, often 10$ for their personal doctor, and low
fixed co-pays on their prescription drugs: between 1 and 4$ if there is a generic brand available. Now
he brings up health outcomes for people on Medicaid. These are people that up until the Affordable
Care Act could largely only qualify for if they had some form of disability. Now its been expanded to
be available to people of low income, we have to realize that these people may have health insurance
for the first time in their lives, and this bill was only passed in 2010. Many of its provisions were
implemented slowly as well. First open enrollment was in 2013-2014. Not only has it not been long
enough to see the full extent of good health coverage improving conditions and health outcomes for
people on Medicaid, but you have to realize that people of low income also have other factors in their
lives that contribute to health problems. Access to food, access to quality housing, being able to pay
utility bills for things like electricity, heat, running water. Health outcomes do not happen in a vacuum
and correlation does not equal causation, but yes sometimes putting two semi-related facts together
can be a good way to sell an argument that doesnt hold water.
BASH: Senator, we're going to get to these issues...
CRUZ: I would like to see a lot more people on private insurance, able to be insured for health care...
BASH: We're going to get to these issues of Medicaid and others....
CRUZ: ... rather than -- but it's relevant to -- he's saying people are going to lose their health care. If
you want health care, we want as many people as possible to be able to afford insurance policies that
protect you when you get sick.
SANDERS: I want to just -- very briefly.
BASH: Go ahead.
SANDERS: If you listen carefully to what he's saying, if you go to the doctor tomorrow, and you are
diagnosed with a terrible illness, the insurance companies do not have to provide you insurance. That
is what Ted said.
What he also said, if you have an illness, it has to be kept. But really, we are moving into an era where
millions of people who develop terrible illnesses will not be able to get insurance. And God only
knows how many of them will die.
TAPPER: So, Senator Sanders, you just heard Senator Cruz bring up an issue that a lot of Americans have
out there, especially a lot of middle-class Americans, who say that the Affordable Care Act has made it
so that their insurance is unaffordable. One of them is in our audience right now. Her name is Melissa
Borkowski. She's a nurse practitioner from Florida. She is a mother of four. She and her husband are
paying more than $1,000 a month to insure their family for a plan with a $13,000 deductible. Melissa?
QUESTION: Good evening, Senators. Thank you for your time. As you said, I'm a nurse practitioner. I've
worked in health care for over 25 years now. But under Obamacare, I'm not able to get the health
services I need for myself or my family.

Last year, I had a very abnormal pap smear and needed additional tests. But our plan has a $13,000
deductible before it will cover anything, so I wasn't able to afford to get those tests done. So now I sit
here wondering if I have an undiagnosed cancer that will eventually take me away from my four
children.

My plan premiums plus deductible cost over $25,000 for the year and it covers little more than basic
preventative services. Senator Sanders, my question is, why should we, my family, be forced to pay so
much money for an insurance plan that is essentially useless and doesn't do anything for me?
SANDERS: Pam...
TAPPER: Melissa.
SANDERS: Melissa, I'm sorry. Melissa, you ask a great question, and the answer is, it is totally absurd.
It is totally absurd. But the real question we should be asking -- Melissa is talking about an outrageous
deductible, right?
QUESTION: Yes.
SANDERS: So it prevents you from going to the doctor when you should be going. The real question,
which is never talked about or very rarely talked about, is why we end up spending as a nation twice
as much per capita on health care as do the people of any other country.

Now, if you were in Canada, you know what, you would get the health care that you needed. If you
were in the U.K., France, Germany, Scandinavia, you would get the health care you need as a right of
being a citizen in this country.

The idea that we have policies like that, like the one you describe, is clearly an outrage and should tell
every American that we've got to join the rest of the industrialized world and guarantee health care to
all people as a right. And when we do that, by the way, for a vast majority of the American people,
their family incomes will go up.
TAPPER: Senator Cruz?
CRUZ: You know, Melissa, I'm sorry for the challenges you're facing. There are many people in
America struggling with exactly what you are, in the wreckage of Obamacare, with skyrocketing
premiums, with deductibles that are unaffordable, and with really limited care.

And I will commend Bernie for his candor. I mean, his view all along was that we need government-
run and government-controlled health care for everyone. And indeed, as he's said here tonight, he
thinks other countries do it a lot better than America. He often points to Canada, the United Kingdom,
he says why do we pay more?
Well, there's a reason we pay more than those countries. We get a lot more and a lot better health
care.

Let me give you some basic facts. As I noticed in all the Democratic primary debates, there was no
discussion of the facts on the other side. The United States, population controlled, delivers three
times as many mammograms as Europe, two-and-a-half times the number of MRI scans, and 31
percent more C sections. We provide more health care.

Not only that, in the United Kingdom, for example, wait times, in 2013, you waited 72 days for
cataract surgery, you waited 89 days for hip replacement, 95 days for knee replacement. There are 3.7
million people in the United Kingdom right now on a waiting list, waiting for health care.

Whenever you put government in charge of health care, what it means is they ration. They decide you
get care and you don't. I don't think the government has any business telling you you're not entitled
to receive health care.

That's why I think the answer is not more of Obamacare, more government control, more of what got
us in this mess. Rather, the answer is empower you. Give you choices. Lower prices. Lower premiums.
Lower deductibles. Empower you and put you back in charge of your health care.
RESPONSE: The affordable care act is not perfect. It was designed to slow the increase of premiums
and deductibles for consumers, it was not able to do this to a degree to where insurance is affordable
for all real people in our country. And its a damn shame, and is something we need to work on
finding solutions for, but let me just re-iterate again without the ACA it is very very likely that youd
find yourself with a plan that has even higher premiums and an even higher deductible. Drug
companies are making more money and people are purchasing plans that often dont help them and
being forced to pay more and more for it. That is wrong and we need to find legitimate ways to find
huge savings. Weve found some small ways to be able to do this, such as giving negotiating ability to
medicare, allowing us to import drugs from Canada for cheaper prices that they pay, and possibly
even Senator Cruzs proposal to make a swift decision on drugs that other countries approve for use
within their borders here in America as well in order to increase competition in pharmaceutical
industry.

But Senator Cruz also made a point to list off some facts in attempt to paint a picture that our health
care is better in America, citing things such as wait lists for surgeries and us providing more screenings
for people than UK citizens receive. Look at the types of care he gives wait lists for, surgeries that
often arent what a medical professional would say are medically necessary and are already big
decisions for people to make in order to improve mobility. These are often not life-saving procedures.
And another issue I have with the Senators most recent statement is the inclusion of 3.7 million
people on wait lists in the UK for some form of medical treatment/procedure. 3.7 million out of a
country of about 65 million people is somewhere around 5% of people being told, youll get the
healthcare you need but you may have to wait, with examples Senator Cruz provided of up to around
3 months for some surgeries. Yes, this is a problem. Every country has problems. However, we have
28 million people still uninsured in our country. Uninsured vs. waiting to get a health procedure done
that they will not have to pay a bill for, they know that the taxes they pay mean that theyll be taken
care of in a couple months. Whereas these 28 million people in our country (about 9-10% of our
population) often forgo treatment at all, and if its an emergency and they cant pay the bill, then that
increases our tax burden. So its a case of a system having 5% of people have to wait a couple months
for care that will be within their means to have taken care of, VS our system, where 9-10% of people
have no form of insurance, may not have a doctor to even have an idea of what treatment would look
like, not for a couple months but indefinitely.

Another thing he pointed out is that we provide more healthcare and pointed to us, per capita, having
more screenings as far as MRIs and mammograms go. Now this may be true, but one has to realize
that screenings for these are often done excessively by hospitals and doctors in order to get
reimbursed by insurers in order to keep hospitals and doctors offices above water as the cost of
providing healthcare is very high. There is a lot of research thats been done that shows more
screenings are performed here due to financial incentive for the hospitals and not because they
significantly improve health outcomes.

Senator Cruz said that we have better healthcare outcomes than these countries, but lets look at
average life expectancy of our country compared to any of these developed countries with single-
payer systems. Not only do we spend more per capita, we dont live as long! How can you say we have
better healthcare because we administer more costly tests if it doesnt help us live as long, If we have
worse child mortality rates, all while paying more money for the service we do receive.

Are costs increasing? Yes, but lets not act like Obamacare is the reason costs are increasing. They
have always increased and are increasing slower today than they were before Obamacares passage,
and our healthcare system, according to many independent organizations, lags behind the rest of the
developed world both in outcomes and efficiency of money spent.
TAPPER: Senator Cruz, thank you. Senator Sanders, let me ask you, just as part of Melissa's question,
Florida, the state she's from, now offers fewer insurance options through Obamacare through the
insurance exchange. There was a nearly 25 percent decline in the number of insurers in 2017 nationally
compared to 2016. There are five states that only have one insurer providing insurance on the
exchange. What would you do to ensure that consumers have both choice and manageable cost?
SANDERS: Fair question. Let me get back to Melissa, and I'll get to you.
TAPPER: It's part of the question, because the competition is down.
SANDERS: I know it is. I know it is. Well, Ted talks about the problems that exist in other countries in
terms of waiting lists. He talks about rationing.

We have enormous rationing in this country. When you have 28 million people who have no health
insurance, that's rationing. When you have people who can't afford to go to the doctor or can't afford
to buy prescription drugs, one out of five Americans can't afford the prescription drugs their doctors
prescribe, that's called rationing. Except there's no rule on that; there's no law on that. It's just people
don't have the money to buy what they need in terms of health care.

To answer your question, Jake, what I have long supported within the context of Obamacare, as we
move toward a Medicare for all single payer program, is a public option. There should be a Medicare-
type public option available in all exchanges, in all states in this country. And I think that would
substantially lower the cost of health care in this country and provide real competition to the private
sector.
TAPPER: Senator Cruz?
CRUZ: Well, Jake, I think the question you asked is a very good one. And you're right, that choices
have gone down dramatically. Indeed, I don't know if the cameras can see this, but in 70 percent of
the counties in America, on Obamacare exchanges, you have a choice of one or two health insurance
plans, that's it, 70 percent of the counties in America.
It's interesting. You look at this map, this also very much looks like the electoral map that elected
Donald Trump. It's really quite striking that the communities that have been hammered by this
disaster of a law said enough already.

Now, Bernie likes talking about a public option. That's another way of saying government control of
your health care. It's socialized medicine. And what does it mean? Every country where it's been
applied, you've seen rationing, you've seen government deciding, especially seniors. Seniors, you
don't get the health care you need.

Now, Bernie mentions Canada quite a bit. I know quite a bit about Canadian health care. I was born
there. You know, Bernie, that may be the best argument against your position, you know, look what it
produced.
SANDERS: Look what it...Yeah, that's right.
CRUZ: But, you know, people vote with their feet. In 2014, over 52,000 Canadians left Canada to get
health care in the United States and other countries. I'm reminded of a comment Ronald Reagan used
to say about East Berlin, about the Berlin Wall. He said the funny thing the leftists never seem to
notice, the machine guns all point one direction. Everyone was fleeing communism and coming to
freedom.

If you look at socialized medicine, people leave there, tens and hundreds of thousands every year,
leave socialized medicine countries because they want to get a hip replacement, a knee replacement.

You know, the governor of one of the Canadian provinces came to America to get heart surgery, and
he was a governor in Canada. And, by the way, in your home state of Vermont, your hospitals
advertise with Canadian flags, "Come to American hospitals, you'll get better health care." I don't
want to mess up our health care. I want patients, all of us to be in charge of our health care, not
government deciding what health care we get.
Response: 52,000 people came to America (and other countries so this isnt even a direct indictment
of our own healthcare system) to presumably receive healthcare more quickly than they would in
Canada, that sounds like a big figure. Lets dissect that a little though. Come into this with the
understanding that Canada, unlike us, DOES have a single-payer system. Just by virtue of being one of
Canadas 35 million citizens, you are guaranteed to get healthcare treatment. There may be a wait for
that. Now 52000 people chose to come to America In order to receive services that are considered less
of a high priority in their home countrys health care system. Not only does this statistic not state
whether or not they stayed in America afterwards or whether they purchased insurance to help pay
for the cost of these procedures or not, but lets assume that all of them did permanently move, vote
with their feet. 52000 people out of a country of 35 million is not even close to one tenth of one
percent of the population of Canada making this move, meaning over 99.9 percent of the country was
content to continue to utilize their own national healthcare system for their needs.
SANDERS: Government deciding? No, government doesn't decide in Canada or anyplace else. And, by
the way, as you well know, Canada had for many years a conservative prime minister.
CRUZ: Conservative is relative.
SANDERS: The United Kingdom had for many, many years a conservative prime minister. I don't see
those countries junking their health care systems in which, by the way, poll after poll shows not that
though don't have problems. Of course they have problems. Every health care system in the world has
problems.
But I am not seeing those countries junking their universal health care system, which provide health
care to all of their people at one half the cost per capita that we do. I don't see conservative prime
ministers doing that to go to the American health care system.

Our system is wasteful, it is dysfunctional, it is incredibly bureaucratic. You talk about choice? You
have people who have to argue with insurance companies for days before they can get the care that
they need.
CRUZ: See, Bernie, you say wasteful, and I say people exercising free choice. You're right. We could cut
costs here if we do like Europe and cut the number of MRIs, the number of mammograms. If we cut --
you know, you look at the elderly in much of Europe. The elderly here, when the elderly face life-
threatening diseases, they're often treated in the intensive care unit. In Europe, they're often put in
palliative care, essentially doped up with some drugs, and said, "Well, now is your time to go." I don't
expect the government to be saying that. And let me give -- since you laughed at that, let's actually
talk facts, because facts matter. So let's talk about, for example, a couple of stories from the United
Kingdom. In Glasgow, Scotland, the Queen Elizabeth University Hospital was so overburdened this
past January, it turned away three women who were in labor because they couldn't take care of them.
In Worchester, England, a man was left on an ambulance gurney for five hours before his heart attack
was diagnosed, and he waited seven hours before he received a stent and angioplasty.

In a hospital in Essex, doctors twice canceled a life-saving -- potential life-saving surgery for a patient
with esophageal cancer, because there were no free beds in the intensive care unit. One more
example. In Wales, an 82-year-old woman who had fallen waited eight hours on the floor before an
ambulance arrived. Her daughter sat beside her in the ordeal, described it as one of the longest nights
of our life.

This is what happened when government takes over health care -- every example on Earth -- the
result is rationing and waiting periods, and you, the citizens, being told, no, you can't have the health
care you want and deserve.
RESPONSE: (NOTE : I think Bernies response is on point so Ill make mine brief and simply refute his
argument with something very short and simple) No healthcare system is perfect, but to cherry pick
and list off examples of a healthcare systems failures through anecdotal evidence is absolutely
disingenuous when, even with their rationing, they have just around 5% of people subject to some
kind of wait list for any medical procedure at all. Now, when government is the provider of
healthcare, it comes to them to weigh decisions on how to prioritize care because yes there is no
perfect system where everyone will be able to be treated perfectly every time. So these systems are
designed to prioritize things like pregnancy and life-threatening situations where I guarantee there
are more instances of non-essential surgeries and procedures being waitlisted than there are these
types of extreme examples where you dont use numbers, but personal stories because the numbers
likely arent on your side to provide a compelling argument. So you resort to extreme examples of
very isolated failures of healthcare systems that the world over agrees we are doing a worse job than
when it comes to the efficiency and health outcomes of our respective health care systems.
SANDERS: And in America, we do rationing in a different way, Ted. The way we do rationing is, if you
are very rich, you can get the best health care in the world, I believe, right here in the United States.
We should be proud of that.

But if you are working class, you are going to be having a very difficult time affording the outrageous
cost of health care. That's what Melissa just told us a moment ago.
Now, estimates differ, but let's be clear about this. Every single year, tens of thousands of our fellow
Americans die because they don't go to the doctor when they should. You gave some examples about
the U.K. Let me give you some examples here in the United States.

I talk to doctors in Vermont, all over this country, and what they tell me, patients come into their
offices very, very sick. And they say to the patients, why didn't you come in here a year ago when you
felt your tumor, when you felt your problem, when were you sick? Why didn't you come in here? And
people said, "I didn't have any insurance." Or, "My deductible was so high, I couldn't go." We just
heard that story a moment ago.

And some of those people die. And others end up in the hospital at outrageous costs for illnesses that
could have been treated initially at far less cost. So, please, don't tell me about rationing. This country
has more rationing than any other industrialized country on Earth, except the rationing is done by
income. And working-class people and poor people today are suffering as a result of that rationing.
TAPPER: We're going to take a very quick break. The debate will continue right after this with Senators
Ted Cruz and Bernie Sanders. Stay with us.
BASH: Welcome back to the CNN debate on the future of health care in America, with Senators Ted Cruz
and Bernie Sanders. Let's now turn to the effects of Obamacare on small businesses, and with us to
discuss is LaRonda Hunter, who owns five hair salons in Texas. LaRonda?
QUESTION: Hello. Under the controls of Obamacare, my business has been restricted from expansion.
I'm from Fort Worth, Texas. I own five Fantastic Sams hair salons. We employ between 45 and 48
employees. My original plan was to open more salons and employ more people. However, under
Obamacare, I am restricted, because I -- it requires me to furnish health insurance if I employ more than
50 people.

Unfortunately, the profit margin in my industry is very thin. And I'm not a wealthy person, so it's
impossible for me to grow my business. My question to you, Senator Sanders, is how do I grow my
business? How do I employ more Americans without either raising the prices to my customers or
lowering wages to my employees?

SANDERS: Ronda?
QUESTION: LaRonda.
SANDERS: LaRonda, OK. You own five salons?
QUESTION: That's correct.
SANDERS: And you employ close to 50 people?
QUESTION: Just under.
SANDERS: And what kind of health insurance do you provide for them?
QUESTION: I don't -- none.
SANDERS: You provide no health insurance to them?
QUESTION: Correct.
SANDERS: Let me be -- let me give you an answer you will not be happy with, and that is I think that
for businesses that employ 50 people or more, given the nature of our dysfunctional health care
system right now, where most people do get their health insurance through the places that they work,
I'm sorry, I think that in America today, everybody should have health care. And if you have more
than 50 people, you know what, I think -- I'm afraid to tell you -- I think you will have to provide
health insurance.
QUESTION: So my question is, how do I do that without raising my prices to my customers or lowering
wages to my employees?
SANDERS: You see, the difficulty is also is -- and I'm not much of an expert on hairdressing in general,
and certainly in Fort Worth...
QUESTION: I'm just one of small businesses.
SANDERS: I know. But my guess is, one of the problems that we have is there may be somebody else
in Fort Worth who is providing decent health insurance to their employees, and they are in an unfair
competitive situation regarding you. You can compete and maybe charge lower prices, get business,
while they on the other hand may be providing decent health insurance. I don't think that's that...
QUESTION: I think you'll find in profit margin in my entire industry...
SANDERS: I certainly don't know, you know, about hair salons in Fort Worth. But I do believe, to be
honest with you, that if you have more than 50 people, yes, you should be providing health insurance.
BASH: Senator Cruz? CRUZ: LaRonda, thank you for sharing your story, and it's good to see a fellow
Texan here. And, you know, I've got to say, I've got a very different view than Bernie. I think actually
what Bernie told you is the same thing President Obama said, it's the same thing Democrats have
said, which is that you, the small business, you're apparently a bad actor, because you're not allowed
to manufacture money.

You know, let me introduce you all to two terms that have become really common, 29ers and 49ers.
29ers are the millions of people across this country that have been forced into part-time work that
used to have full-time employment and are now working 29 hours a week because Obamacare kicks
in at 30 hours a week. And a lot of them are people that are single moms, they're teenagers, they're
immigrants, they're people who are struggling.

And then 49ers, there are millions of small businesses in the exact situation you're in. You know, a
couple of months ago, I was out in west Texas, was visiting a dairy farmer, driving around the dairy
farm. I got to say, interesting smells on the dairy farm. Kind of reminds me of Washington.

But the farmer brought up, he said, you know how many employees I have? I said, no. He said I've got
49. He said, do you know why I have 49? And I said, yes, I do, because Obamacare kicks in at 50. And
he said, I could hire 20 or 30 more employees right now, but Obamacare would bankrupt my business,
and that's millions of small businesses.

So we're here at GW. Let me speak for a minute to all the young people. When you come out of
college with way too many student loans, my guess is you'd like to get a job. And millions of small
businesses being told by the Democrats, tough luck, we don't care if it drives you out of business,
that's taking away opportunity and it's hurting in particular the most vulnerable. It's one of the most
damaging things about Obamacare.
Response: There are issues with Obamacare, and this is one of them. It has reared its head over the
years since implementation. Some small businesses find the cost of providing their employees health
insurance, and so they keep their payroll at 49 people or lower, often preventing expansion. I do, take
issue with the likelihood of Senator Cruzs claim that millions of small businesses are refusing to hire
more that 50th worker or beyond.

29ers doesnt make much sense to me as theres been no increase in part-time work since
obamacares passage, and the economys only grown and added jobs since then.
BASH: Senator Sanders?
SANDERS: LaRonda, let me ask you a question. What happens if one of your employees becomes ill?
What happens? What happens if one of your employees, as happens in every part of the country, gets
diabetes, gets cancer? What do they do if they don't have any health insurance?
QUESTION: I can't really answer that question, but I can tell you that because the premiums have gone
up so much this year and because I don't qualify for any kind of government subsidies, I don't have, for
the first time in my life, insurance. It's just not affordable. Unfortunately, the prices of my services just
don't warrant it.
SANDERS: Let me just say this, two things. Number one, as I mentioned earlier, it is absolutely true
that the cost of premiums are going up. No argument. They went up even higher during the period of
George W. Bush. So it's not like, oh, gee, for the first time in American history, premiums are going up.

Number two, Ted mentioned part-time work, the 29ers. Well, there are fewer part-time employees
today than there were before Obamacare, OK?

So here is the point. The bottom line is with -- the situation you've described is honestly absurd. You
should not be going around without health insurance. Your employees should not be going around
without health insurance. We should not be spending twice as much per person on health care as do
the people of any other nation.

Please join me and fight for a Medicare for all program. Are you looking forward -- by the way, I'm not
going to ask you your age -- won't do that -- but are you looking forward maybe when you get to 65 to
get Medicare? Would that be of help to your family?
QUESTION: I expect that that will probably happen.
SANDERS: Good. Well, I certainly hope it does, and I hope Medicare is still there, despite the efforts of
Senator Cruz and others, so that when you reach at least 65, you will be able to get a decent health
insurance program.
CRUZ: Well, Bernie, since apparently I've now tried to kill the elderly... let me ask you a question.
When you heard that her premiums had skyrocketed, that she can't afford health insurance, you kind
of said, well, premiums always go up. I mean, let me ask you. Why did President Obama look in the
eyes of the American people and promise LaRonda that her health insurance premiums would go
down $2,500 a year? Was he telling the truth when he said that? And were you and the other
Democrats telling the truth when you echoed his promise to the American people?
SANDERS: Well, Ted, first thought, as everybody knows, health care is pretty complicated. I think
President Obama is an honest person, and I think, based on his assessment, that's what he believed.
CRUZ: Was it true?

SANDERS: But let me -- turns out not to be true, but it turns out to be that under Bush premiums went
up higher. Not a new thing. Then the real question we should be talking about is why we do spend so
much money on health care.

And that means that we have to appreciate that we are spending hundreds of billions of dollars every
single year not on health care, but on administration and bureaucracy. Do you know how much
money it costs to bill you? You've got people -- hundreds of people in large hospitals, they're sitting
around not providing health care, they're working on paperwork, driving you crazy when you bring
forth a claim.

So we have to figure out how we have a simple system that guarantees health care to all people.
When we do that, you and your employees will all have health insurance.
CRUZ: Well, there is an area actually where we agree, which is there is way too much paperwork with
health care. There's way too much complexity. I'll tell you, when you talk to doctors, when you talk to
nurses, they say, I don't get to practice health care anymore. I spend all my time filling out paperwork.
All my time -- now, where the paperwork comes from is the government. It comes from Obamacare.
In fact, there's some amazing stats I'm going to go back and get, because -- because they're really
quite powerful. If you look at the paperwork impact, Obamacare's rules alone -- and by the way, the
Obamacare rules are 20,000 pages. They're taller than seven feet tall. They generate $51 billion in
costs and more than 172 million hours of paperwork compliance.

And let me put that in perspective. What does that mean? That would take 86,200 employees,
working full-time, 2,000 hours a year, to complete one year of new paperwork under Obamacare.
That's roughly the entire population of Miami Beach, Florida, doing nothing but filling out Obamacare
forms. If you want your doctor to get back to caring for you, if you want to drive down costs, get
government out of the business of dictating and controlling health care.
SANDERS: Well, Ted is right. There is far too much paperwork. Some of it is government. But you
know what some of it is also? It is insurance companies.

Every American who has filed a claim has the experience of fighting with the health insurance
companies to make sure that they get what they are entitled to. Doctors have to spend half of their
lives arguing with the insurance companies as to whether or not they can prescribe the medicine their
patients need or provide the therapy that their patients need. Huge amount of waste.

That is why we need a simple system. And, as Americans, we're going to have to make a very
fundamental decision. Very simple. Is health care a right of all people? Is it or not? Ted doesn't think it
is; I do think it is.

And then if we agree, and I think most Americans do, that it is a right, how do you provide health care
to all people with high quality in a cost-effective way? I happen to believe that Medicare is a popular
program. It works well. Right now, you get it at 65. I think every American should get Medicare.
BASH: Senator Sanders, I want to pick the discussion up right there if I may. Senator Cruz...
CRUZ: Yeah, let me make a real quick point, just because I think...
BASH: Real quick. Real quick.
CRUZ: It's nice having the back and forth and the...
BASH: It's lovely, absolutely.
CRUZ: One thing Bernie said that I think suggests maybe an area we could work together, you were
talking about paperwork from insurance companies. I agree, there's way too much paperwork for
insurance companies. I'd like insurance companies to have less power and patients to have more
power.

So maybe you and I could agree on a commonsense reform of allowing LaRonda to purchase health
insurance of any of the 50 states. Right now, she's a Texan, it's illegal for her to purchase health
insurance anywhere else. That would give her choice. If she doesn't like what the Texas companies are
offering, she can go to Oklahoma, she can go to Florida, she can go to any other state. That creates a
50-state national marketplace. It drives down cost. It increases choices. Why don't we stand together
against the insurance companies and agree on that reform?
Response: Purchasing across state lines is a suggestion weve heard for decades from Republicans. Its
not new. Theres a reason it hasnt been implemented. It would not be nearly as cost-efficient as they
say. Say they passed a law under Obamacare to be able to allow people to purchase plans from other
states, its not the individual state regulations that makes the plans costly, what is costly is setting up
networks of hospitals and providers that these plans can utilize. When you have a plan in your home
state, that plan would not be accepted by doctors in other states, or it would be and youre stuck
paying an out-of-network cost, which is built in to be much much higher, because PPOs have been a
trend that have increased as the method of delivery of coverage. They have smaller networks of
providers that the plan covers at the low rates that are advertised as the default.

If this is implemented in a post-repeal world as their only cost-saving mechanism, then people will be
able to pick plans that arent mandated to cover a lot of very common, very costly procedures like
treatment of diseases like cancer, ALS, diabetes, pregnancy, and many others. Wed see plans with
less covered and still see higher premiums and deductibles coming out of consumers wallets. And
they may still be subject to higher costs than they think theyre signing up for due to no providers in
their state being considered in-network for plans that they buy from other states in the country
because thats not how insurance plans are set up.
SANDERS: Well, I think standing together for a Medicare for all single-payer system is a lot better idea.
BASH: OK.
SANDERS: Because -- OK, because when you have the idea that Ted was talking about, this is a race to
the bottom. And what you are going to end up with, some insurance company in Mississippi or
someplace, they're going to provide you insurance. But you think your deductibles are high now? It
will be a lot higher. Look, Ted, and you're right. This is a good discussion, all right? And here is the
issue. Ted, let me ask you a question.
CRUZ: Sure.
SANDERS: Is every American entitled -- and I underline that word -- to health care as a right of being
an American? Yes or no?
CRUZ: You know, I'm glad you asked that. You know, right is a word you use a lot. Let's talk about
what rights are. Rights mean you have a right for government not to mess with you, for government
not to do things with you. If you look at the Bill of Rights, the Bill of Rights, free speech means the
government can't silence you when you're speaking. Religious liberty means the government can't
control who you worship, what your faith is.

The Second Amendment means the government can't take away your guns. Those are rights. You
know, what the Declaration of Independence said, we hold these truths to be self-evident that all men
are created equal and that they are endowed by their creator with certain inalienable rights, that
among these are life, liberty and the pursuit of happiness.

So what is a right is access to health care. What is a right is choosing your own doctor. And if you
believe health care is a right, why on Earth did you help write Obamacare that caused six million
people to have their health insurance canceled, that had them lose their doctors, and have people like
LaRonda, who can't get health insurance, can't afford premiums...
SANDERS: For a start...
CRUZ: You're denying her what you say is her right.
SANDERS: Well, two things. You didn't answer the question, although I interpret your question to be
that LaRonda does not have a right.
CRUZ: No, that's not what I said.
SANDERS: Woah, woah, woah, I heard the Bill of Rights.
CRUZ: What I said is access to health care. Access to health care is a right.
SANDERS: She has access. But she doesn't have enough money.
CRUZ: And choosing your doctor is a right.
RESPONSE: Bernies response here is the highlight of the debate for me. It illustrates a point very well
in direct response to Teds noncommittal answer.
SANDERS: Look, LaRonda, you have access right now. Go out and get a really great health insurance
program. Oh, you can't do it? Because you can't afford it. All right? That's what he's saying. Access to
what? You want to buy one of Donald Trump's mansions? You have access to do that, as well. Oh, you
can't afford $5 million for a house? Sorry. Access doesn't mean a damn thing. What it means is
whether people can afford it, can get the health care that they need.
CRUZ: And they can't under Obamacare.
SANDERS: Second of all, let's -- some people have problems, no question about it. I'm not arguing with
you on that, Ted. But don't argue with me when I tell you that 20 million more people did get health
insurance, all right? We used to have 48 million people in this country who had zero insurance before
Obamacare. Now that number, much too high, is 28 million.

Last point. Ted talked to the young people, and he said, I want you to go out with enthusiasm, go out
and go to -- get a job. He's right. But under Ted's ideas, if Obamacare is repealed, right now, if you're
under 26, you can stay in your parents' insurance program. That's one of the things we did in
Obamacare. Good idea. Ted would repeal that. So as you go out into the real world, be very careful
about not having an accident.
BASH: Senators...
SANDERS: Because you don't have any health insurance.
TAPPER: Welcome back to the CNN health care debate with Senators Ted Cruz and Bernie Sanders.
Senators, thanks so much for participating here. I want to ask you, since Obamacare was enacted,
governors of 31 states, plus the District of Columbia, have opted to expand Medicaid through federal
funding, providing insurance to 11 million low income people. One of the Americans who benefitted
from the Obamacare Medicaid expansion is Carol Hardaway of Salisbury, Maryland. Carol?
QUESTION: Thank you. I have multiple sclerosis, but could not afford insurance. Without the treatment
or medications I need, I had problems with walking, with my speech, and my vision. When the
Affordable Care Act was passed, I moved from our home state of Texas -- because they refused to
expand Medicaid -- to Maryland, and within two weeks, I started receiving treatments through Medicaid
and am now well enough to work as a substitute teach.

Senator Cruz, can you promise me that you and the Republican leaders in Congress will have -- actually
have a replacement plan in place for people like me who depend on their Medicaid? In other words, I
like my coverage. Can I keep it?
CRUZ: Well, Carol, thank you for sharing your story. And congratulations on dealing with MS. It's a
terrible disease. And congratulations on your struggles dealing with it.

You know, if you look at Medicaid, more than half of the people who have been covered under
Obamacare have been under Medicaid. And the problem is: Medicaid is a profoundly troubled
program. And so it may be working well with you, but I'll tell you nationally, the health outcomes
under Medicaid are really poor.

Nationally, 54 percent of doctors won't take new Medicaid patients. Nationally, dental care
appointments for moms are denied at a 63 percent rate on Medicaid. The denial rate for private
insurance is 4 percent. And Medicaid patients are almost twice as likely to die from medical treatment
as those with private health insurance.

The solution for people who are hurting, I believe, we should have a system that allows as many
people as possible to be on the private health insurance of your choice rather than Medicaid, because
the Medicaid outcomes are not working and people are suffering.
And what's happened also -- it's really quite striking -- because Obamacare dramatically expanded
Medicaid, many of the people who had been on Medicaid, many of the people who are really
suffering and needy, have found their wait times increasing. In fact in Illinois, on Medicaid, over 700
people have died on the waiting list for care for Medicaid.

So, I'm glad that you're receiving healthcare. I can tell you a great many of the people on Medicaid
aren't. And I'd much rather see a system where we can have millions of those on Medicaid getting
health insurance. The only way we can is if we have competition so that rates are lower so you can
afford to have health insurance.
Response: Medicaid may mean you have a harder time setting up a new primary care physician, but
the care you get is of very very low cost to people and quality care can still be found. The statistic on
dental is somewhat ironic as hardly any private health plans offer any form of dental coverage
whatsoever. Medicaid offers some basic dental services, but this is an area wed likely agree on.
Dental and vision coverage are both woefully underserved by private health plans, and in my opinion,
by Medicaid as well. Using an example of 700 people waiting for Medicaid to kick in after a state
expanded it is an example of growing pains in a new system. And may I add Medicaid expansion was
made more complicated after it was decided that many governors would refuse to expand it initially
and state governments were said it was optional to do it or not. The good done by Medicaid
expansion far outweighs the bad giving comprehensive, premium-free care to the people that
financially need it most.
JAKE TAPPER, CNN DEBATE MODERATOR: Senator Sanders?
SEN. BERNIE SANDERS (I), VERMONT: We heard from a woman who runs a hair salon in Ft. Worth who
can't afford to provide health insurance for her workers and herself. We hear a story now about a
woman who has to leave her own state and go to another state because that state is providing
Medicaid.

My friends, you are living -- I know you don't know this -- by these stories. You're living in the
wealthiest country in the history of the world, where the rich are becoming phenomenally richer
while we have 43 million people living in poverty and the middle class is in decline. These stories are
obscene. They should not be taking place in the United States.

Now, are there problems with Medicaid? Of course, there are. But I will tell you something, to those
Republicans governors around the country who told poor people that they would not be able to, for
the first time in their lives in many instances, get access to healthcare, to be able to go to a doctor
when the federal government paid for the first three years at 100 percent. I hope that those
governors sleep well at night, because I don't know how many people lost their lives as a result of
their decision.

So, once again, what we are looking at is a dysfunctional system. We spend more, we get less. People
who work hard have no health insurance. People have to move from one state or the other.

This country finally is going to have to do, in my view, what every other major country does. And yes, I
believe, Ted, healthcare is a human right. And I believe that this country has got to join every other
major country and say, you can stay home and get quality care because you're an American. You can
run your small business well and get care because you are an American. That is where we have got to
go.
CRUZ: Well, you know, when Bernie says, well, Medicaid has problems. You want to talk about people
who lost their rights, 742 people in Illinois were put on a waiting list for Medicaid after Illinois
expanded its Medicaid, Barack Obama's home state, and they died awaiting care under Medicaid.

Why? Because Medicaid is rationed care. Those wait lists -- you know, Bernie likes to talk about
medical care for all. But let me be clear what his program is. It's Medicaid for all. It is rationed care
nationally.

You want to know what that looks like. He keeps pointing to other countries. Let's look at, for
example, the United Kingdom.

The United Kingdom, a 2001 report noted that 39 percent over 80 in the United Kingdom received
surgery for breast cancer, compared to 90 percent of the women under 50. And that women under --
men and women under the age of 55 were 2 1/2 times more likely than those over 75 to receive
cancer treatments. More than 80 percent of older patients in the United Kingdom believe they're
discriminated against by their government-run healthcare.

You want to know what rationing looks like. It looks like Medicaid. It looks like the people who are
suffering. And if you look at this country, across this country, we have 291 million people roughly that
are covered by insurance. I don't think we should be screwing up the insurance of millions of
Americans and putting them under rationing. That's what Obamacare has moved us down the road to
doing and it's not working
SANDERS: OK, Ted correctly indicates Medicaid has problems and Vermont has problems. All over the
country, it has problems.

You know what Ted's solution is? Massive cuts in federal funding for Medicaid. So, you've got a
problem and what Ted wants to do is make it worse.

You mentioned dental care. Maybe you want to go on my bill, which will provide dental care to tens
of millions of American who can't afford it right now. What we need to do, by the way, is to tell
dentists out there that they may have to do more than just make you have a nice smile. But they may
have to provide real dental care to children and others who absolutely need it.

Furthermore, what we have to do is we need tens of thousands more doctors in this country. We have
a major crisis in primary care. There are areas in urban America and in rural America where people
literally can't find a doctor to serve their needs. And one of the reasons, a number of reasons for that,
one of them is you go to medical school, you can come out hundreds of thousands of dollars in debt.

And then you're going to become a plastic surgeon not doing primary care in an urban area or rural
America, which tells me we've got to expand the program called the National Health Service Corps so
that our young people can get their debts repaid if they commit to serving in under-served areas. Let's
get doctors out into the areas where we need them.
TAPPER: Let me just jump in if I can. Carol, you just shake your head. Did Senator Cruz, your former
senator, did he answer your question?
Question: No, he did not. The question was, Senator Cruz, can you promise me that you and the
Republican leaders in Congress will actually have a replacement plan in place for people like me who
depend on their Medicaid?

She got Medicaid through the Obamacare expansion of Medicaid. We've all heard you criticize Medicaid.
What happens to Carol?
CRUZ: Well, what I said, Jake, is that Medicaid isn't working for millions of people and Obamacare
made Medicaid worse by expanding the wait lists by jamming more people on it. You want to talk
about replacement, there's widespread agreement on replacement plans.

Number one, allowing people to purchase across state lines, giving you more choice. Now, Bernie said
he opposes that. He doesn't want to let you buy insurance in other states.

Number two, expanding health savings accounts so you can save in a tax advantaged way to meet
your own healthcare needs.

Number three, making health insurance portable so that it goes with you from job to job.

I imagine, ma'am, at some point, you had insurance with a job?

If insurance was portable right now, federal tax law incentivizes -- most of us get our insurance from
the government and if you lose your -- or not from the government, from our employer rather. And if
you lose your job, you lose that insurance.

One of the best solutions to the problem of preexisting conditions is making health insurance portable
that goes with you. You know, when you lose your job, you don't lose your car insurance, your life
insurance, your house insurance. There's no reason to lose your health insurance.

And if your insurance is portable, it goes with you. It's affordable. You have choices.

Now, notice Bernie's solution, we want more doctors. We all agree on more doctors. He says, well, the
government needs to hire more.

You know, I can point to something that works on that. In Texas, we passed tort reform. We
fundamentally limited lawsuits and lawsuit abuse. And you know what we've seen -- we've seen the
number of doctors increasing dramatically. We've seen medical malpractice premiums dropping.

Those are the kind of solutions supported at the state level that will result in more doctors. But
Obamacare is discouraging people from going to medical school and training to be doctors.
SANDERS: Well, Ted, I didn't want to raise it, but you brought it forth. You know what state in the
country -- and I don't blame you for this -- but what state in the country has the highest rate of
uninsured in America by far? It is the state of Texas. And, by the way, may I say proudly that Vermont
is number two in terms of the percentage of people who are insured. We have relatively few
uninsured. And, by the way, amazingly enough, you know what state in the country has the highest
rate of people insured? It is Massachusetts with RomneyCare, which was the prototype for the
Affordable Care Act.
CRUZ: Well, you know, the nice thing, Bernie, again, people vote with their feet. And for north of a
decade now, roughly a thousand people a day have been moving to Texas because we have an
environment that allows people to get jobs. And so, people vote with their feet.

And you're right, there are states, Vermont is a lovely state. It doesn't have a ton of diversity. It
doesn't have nearly the populations Texas has that are populations that are just starting -- when my
dad went to Texas in 1957 when he was 18, he couldn't speak English. He was from Cuba.
He had $100 in his underwear. He watched dishes making 50 cents an hour. You know what? He didn't
have healthcare. But he came to go to the University of Texas, he came to get

opportunity. That job enabled him to get another job where he could get healthcare. That's a much
better solution. Create an environment where you don't tax the living daylights out of people. It's why
people choose --
DANA BASH, CNN DEBATE MODERATOR: Senators --
CRUZ: -- to be where they get --
BASH: Senators --
SANDERS: Aren't we all happy that under Obama, we created 15 million new jobs in the private
sector?
BASH: Senators, I want to get to more audience questions. This one is about the fact that the Affordable
Care Act requires that all insurance plans cover what the law calls essential health benefits. This includes
maternity and delivery costs. We have a question on what will happen to that coverage for Maria Shahid
Rowe, who is pregnant with her second child. Maria?
MARIA SHAHID ROWE, NURSING STUDENT, PREGNANT WITH SECOND CHILD: Thank you. I'm a nursing
student at the Medical University of South Carolina. And I'm concerned about the implications that
repealing the Affordable Care Act will have on women's health and specifically for pregnant women. So,
I'm five months pregnant and I'm actually qualified for Medicaid due to being a full-time student. My
husband works for a church. We live in a very modest income at the moment.

Senator Cruz, what policies do you have in place to protect pregnant women from losing their health
coverage either due to being considered having a preexisting condition or from being charged higher
insurance premiums than men?
CRUZ: Well, congratulations on your new baby. Is it a boy or girl?
ROWE: It's a surprise.
CRUZ: Oh, wonderful, and you said you have an older child? What's your older child?
ROWE: We have a 2-year-old son.
CRUZ: What's his name?
ROWE: Samson.
CRUZ: Well, maybe you have Delilah and that would be -- Well, how wonderful and congratulations.
ROWE: Thank you.
CRUZ: Heidi and I have two little girls at home and it is a wonderful, wonderful thing.

Listen, cover -- maternity coverage is incredibly important. But here's how Obamacare worked -- you
had a lot of politicians in Washington who said we're going to mandate every coverage on Earth. And
it sounds really good.

You know, I had a conversation a couple of years ago with a gentleman in Amarillo, Texas, who told
me the story about his 101-year-old aunt who had just had her insurance cancelled. And she said the
reason it was cancelled was that it didn't cover maternity care.

Now, this fellow laughed and said, my aunt is 101 years old. She doesn't really need maternity
coverage right now.

We should have a system, I believe, where you can choose to get the policies that meet your needs.
And the impact, especially for young people, of all the mandated coverage -- you know, it's interesting
the Democrats view -- they're big on talking about insurance coverage. But it's a little bit like giving
everyone a bus ticket when there are no buses.

What we should care about is access to healthcare, not just insurance per se. And what's happened
under Obamacare is that millions of people can't afford it. We should be concerned about people
being able to afford health insurance. And that means giving them the choice in 50 states to choose a
policy.

In your instance, you would choose a politician that had maternity coverage. But someone else who
right now kind of can't afford might choose a different policy.
RESPONSE: If we did not mandate that plans include certain mandatory services, the fear is that there
would be people forced to purchase plans that would not cover services they end up needing. This
happened to a very large degree before the ACA was implemented. There are added costs to having
all plans to have what is now considered minimum essential coverage, these are largely offset by the
cost saving measures of the ACA however and have not found to be the reason for the increase in
healthcare prices weve recently seen.

This woman may have had to pick a new plan, but I guarantee it offered more coverage and youll
notice Senator Cruz did not provide any specifics as to the plans that were available to her afterwards
and whether or not those plans she had to choose from were higher-priced than her old plan or not.
BASH: Senator --
CRUZ: And when government mandates it, those choices go away.
BASH: Senator Sanders, your response?
SANDERS: What Ted is really telling you is that they will not guarantee coverage for you. And not
every pregnancy is planned and if a woman under -- a pregnant woman before Obamacare, you know
what you were considered to be? A preexisting condition.

And why would an insurance company want to provide care to you when having a baby is a fairly
expensive proposition? You don't make money doing that.

And Ted keeps talking about these mandates. So, let's be clear again what Senator Cruz and his
Republican friends want to do. They do not want to guarantee that women who become pregnant will
be able to get the healthcare and the prenatal care that they need -- which is a terrible thing, by the
way, because we have one of the highest infant mortality rates in the industrialized world.

He says to young people who today are on their parents' program -- you're out, you're on your own
after you leave college.

He says that if you come down with a terrible illness and you're ending up spending hundreds of
thousands of dollars, your insurance company can now tell you that there is a limit to what they will
pay.

And he is telling 20 million people who gained health insurance under Obamacare -- sorry, you're out
on the streets.

Bottom line is: once again, the discussion, if you really think about the kind of discussion that we're
having, it is an absurd discussion for the wealthiest nation in the history of the world.
BASH: Senator Sanders, let me follow up on that.
CRUZ: I want to respond to that briefly.
BASH: Please? Go ahead.
CRUZ: You know, it's interesting sometimes the rhetoric that our friends on the left like to say that
anyone who doesn't support government control of our healthcare somehow doesn't like and fit in
whatever population you're talking about.

But let's again go back to facts and let's talk about young people. You know, there's no group in
America that's been hurt more by Obamacare than young people. Young people were left on the
chopping block.

Let's talk about some basic stats. A recent study found that the Obamacare mandates, what Bernie
just sang an ode to, have increased -- the three costliest mandates have increased premiums for
younger people by 44 percent. Without those mandates, the typical 21-year-old would pay $1,100 a
year less. If you're 21, think about whether it would be easier to afford healthcare if it cost $1,100 a
year less.

And let's talk about some specifics. Before Obamacare, the most affordable plan that was available
for a 30-year-old Texan, for a 30- year-old Texan woman was $470 a year. Today, under Obamacare,
the cheapest plan that's available for a healthy 30-year-old woman in Ft. Worth is $3,236. It's gone
from $470 to $3,000, over $3,200.

That's why young people are hurting. And what Obamacare did is it jacked up the rates on all the
young people. Why do you think there's an individual mandate? It's to force young people to pay
really high rates to subsidize the rest of the system.

And if you don't pay it, the IRS fines you. And, you know, over 6 million people are fined each year by
the IRS under Obamacare. That's who -- (CROSSTALK)

BASH: Senator, we're going to get to the question of fines and so forth in a minute. But I want to circle
back to women's health and ask you, Senator Sanders, why should a 60-year-old male or women
beyond childbearing years be required to have health insurance plans that have maternity care?
Response: Sanders response claiming we do rationing through pricing people out of being able to
afford healthcare is absolutely correct. In our current system, we have about 28 million people
without any insurance. Thats almost 10% of our population who have no access to receive any
medical care they need unless they go to a community health center, which are largely continually
understaffed, overworked, and underfunded. Their only other option is the emergency room, which if
theyre unable to pay the medical bills, often cause the rest of the tax base to have to pay this. Now
due to Obamacare helping insure 20 million more people since its passage, weve had the tax burden
of those who cant afford their emergency room bills lessen on the rest of us because there are less
instances of uninsured people needing to go to the emergency room now that the number of
uninsured went from about 48 million to about 28 million.

The tax burden before Obamacare from this utilization of emergency room services was estimated to
be about 1000$ per person, this figure has no doubt dropped several hundred dollars, in amounts
comparable to yearly penalties people have had to pay in fines for not having health insurance under
the individual mandate. Now, the fine for not having health insurance has been made to increase
yearly in order to incentivize young people to buy into the program. This is because our health care
industry before obamacares passage noticed some demographic trends that largely contributed to
increasing premium costs and higher copays, coinsurances, and deductibles.

Young people were not buying insurance. Insurance companies didnt have to provide coverage to
people with pre-existing conditions, and could deny coverage to people who had certain health
conditions that would make them bad risks. Older people generally have higher health risks than
younger people. So we had plans that offered very little in coverage, plans that had high out-of-pocket
costs for consumers even with rising premiums, and this was because insurance companies only
provided coverage to people that either really needed it or could afford it. There was no way to
incentivize young people to buy in, but having them in the market allows money to be made off of
them as their health care needs are on aggregate much less than older, less healthy people. So what
did we do? We created standards for plans so that this phenomenon of a race to the bottom could
not happen, where plans covered less and less for more and more money. In order to help pay for
this, we had to get these younger, healthier people to buy in so that the revenue made off of them
offset the costs of giving health care to the sick and the elderly. In order to defray the costs and
incentivize people to buy health insurance, a fine was put in place that would penalize people who
didnt buy health insurance.

One area of weakness, in my opinion, of the ACA is that if people cant afford a plan on the individual
market and dont qualify for Medicaid or for coverage through their job, they can either elect to pay a
penalty or enroll in what is considered a catastrophic plan. These plans have low premiums, but
astronomical deductibles and higher out-of-pocket costs than any other tier of plan available on the
individual market. Virtually all catastrophic plans have deductibles in the thousands, where people
must pay a monthly premium in an amount that over the course of the year is higher than the penalty
theyd pay at the end of the year to go without insurance. And on top of that because their deductible
is so high, theyd be paying full price for all medical procedures they get throughout the year
(assuming its less than the thousands they need to pay full cost for in order to reach their deductible).
It makes financial sense for many people to simply accept the penalty and go without health
insurance to this day. This is a sign to me that the cost-sharing and advanced premium tax credit
system that help people purchase individual care if their income is a little too high to be eligible for
medicare, needs restructuring in order to better serve working class people who are above federal
poverty line, but not comfortable enough as middle class in order to affordably insure themselves and
their family members.

Now you may say, this is unfair to our young americans, why should they have to pay higher
premiums in order to offset the cost of our older and our sick Americans? Well, these same young
people can still get insurance through their job, if theyre low income, they can still qualify for
Medicaid. They may still apply for tax credits and cost-sharing to help them pay for their monthly
premiums on the individual market. They also have the option of staying on their parents plans until
the age of 26, giving them time to prepare for the added cost of healthcare in their lives as they
further establish their professional careers.

Now all this is to say, we as a country saw that there were almost 50 million people, almost 1 out of
every 6 people in our country were without health insurance before the affordable care act. We paid
the most in the world for our healthcare and didnt receive anywhere close to the best care. Our
premiums were growing at rates that were unprecedented, and our health outcomes had been in
years of decline when compared to health care systems in other countries around the world. We as a
country came together and our representatives worked to make something that gave some basic
guarantees that empower consumers. We have the power to stay on our parents plans until the age
of 26 now, the security of knowing if were diagnosed with a terrible disease, we dont have to fear
being kicked off of our insurance, things like being pregnant or being born with a disease youll always
have like diabetes dont preclude you from being able to be insured if youre in the market for a new
plan. These are good things. Plans guaranteeing to cover essential health services, thats a good thing.
To do this, yes we employed the use of an individual mandate. This was done because we recognized
we had to create a way to limit cost increases while still allowing the tens of millions of people that
liked their current plans to keep those. When most people have insurance through their jobs and are
satisfied with the coverage they get through that job, or theyre satisfied with the medicare they
have, political consensus is that you to have healthcare reform that allows them to keep that in order
to have any traction with reform.

I personally think we should have pushed harder for a single-payer option at the time, but this is what
the centrist dems thought was most politically feasible to get passed. Now a way to transition people
to a single-payer system would have been to show the feasibility of government care to people not
eligible for Medicaid or medicare through the establishment of a public option in order to show the
ability of government to provide quality care at lower costs than private options. This got significant
blowback from the lobbying wings and our bill had to be watered down from what many in this
country believe is the ideal scenario for us.

So how do you maintain the current system while also making necessary changes that give consumers
security and peace of mind in terms of being able to attain coverage that actually covers services they
will need? Well, the individual mandate was one way, and this was less of a revenue generator than it
was an incentive to get people to purchase insurance so the risk pool would be better balanced and
slow the rate of growth in premiums, deductibles, and out-of-pocket costs. But how much do people
who are uninsured get penalized? After 2014, they paid a 95$ fee. After 2015, they paid a $295 fee.
After 2016 (when they file taxes), theyll be subject to a 695$ fee. So over those three years the
average penalty amount per uninsured person of about $350. Multiply that by the number of
uninsured to see the tax burden of those fines each year. Youll see revenue of less than 10 billion
from these fines. This is nothing in comparison to the $346 billion in taxes on the top 2 percent that
were enacted in order to fund the tax credits that help people of lower incomes buy individual plans
on the marketplace. So we implemented a fine on the uninsured yes, but to imply that the tax burden
to help pay for the ACA was put on the backs of the poor is much less true when you factor in the 346
billion in taxes we put on the top 2 percent. The revenue generation that comes with this bill is largely
progressive in nature. Does the individual mandate come with its faults? Absolutely, and that is
largely a result of political calculus in making sure the bill did not add to the federal deficit and the
fact that we were not able to get enough votes to pass a version of the bill that opted for more drastic
reform (seen through the absence of an overhaul to a single-payer system and the absence of a public
option)
SANDERS: I don't think they should.
BASH: That's what Obama --
SANDERS: That's one of the things we might want to look at.
BASH: OK.
SANDERS: But I do believe that in the United States of America, where we talk a lot about our love for
children, that pregnancy is not and should not be considered a preexisting condition. That every
woman in this country who gets pregnant should be 100 percent assured that she is going to get the
highest quality care she needs to deliver a healthy baby.
BASH: Senator Cruz, I want to stay on the issue of women's health. Under Obamacare, women pay
nothing out-of-pocket for birth control. So, will that continue under any Republican replacement?
CRUZ: It's going to be a choice for each patient to make. Listen, Obamacare is all about these
mandates. And you know, Margaret Thatcher famously said, the problem with socialism, eventually
you run out of other people's money.

The same is true with the mandates. Every mandate, people will say, gosh, I like the -- imagine if the
federal government mandated that everyone in America must drive a Lamborghini. I've never driven a
Lamborghini. I mean, they look kind of fun.

But you know what? I'm willing to bet most of us, if that was the mandate -- and it would be cool, you
sit in a leather seat, you could go 200 miles an hour, what it would mean for most people is you
couldn't afford a car? If they said, but, you know, gosh, the VW Bug is not fancy enough. You need
everything. For most people who can't afford it, it doesn't work.

That's what Obamacare is doing. I would love for everyone to have maximum coverage on everything,
but there's no magic fairy with pixie dust that gives it away for free. These mandates are hurting
people because it's putting people in a situation like Rolanda (ph) where they get nothing, they don't
get healthcare of any kind. Her employees don't get healthcare because Obamacare has driven the
cost up. That's why people are hurting so much under it.
Response: Largely, see Bernies answer. However, Id add that the result is that almost 1 in 10
americans are rationed. Although thats not necessarily a very good word, because a ration means
you get something just in limited supply. 1 in 10 are flat out left behind. It used to be that 1 in 6 were
left behind. The affordable care act made that fraction dramatically smaller and that is a good thing. If
everyone in the country was insured, the risk pool would be more balanced. We attempted to do that
with Obamacare and are still seeing a decline in the uninsured rate every year. Theyre getting
insurance that guarantees the services they need will be covered, provided theyre able to get plans
with low enough deductibles for that to be feasible. Are there problems? Yes. Id largely blame that
on people lacking the political will and courage to take the steps we truly need to in order to allow our
country to deliver health outcomes that keep pace with the rest of the developed world while also
finding a way to do that while spending similar amounts per capita on the care we receive. Single-
payer systems absolutely have proven to be able to guarantee coverage in a fairly efficient manner.
Virtually all of the top-ranked healthcare systems in the world have some sort of single-payer system,
now whether or not hospitals are privatized or not is much more variable, but a medicare for all
system would bring us closer to catching up to the rest of the world in terms of bang for our buck
when it comes to healthcare.

Healthcare is expensive and only growing more expensive. Its often what is necessary in order for
people to be able to receive they care they need in order to live with a high quality of life. Its cost has
become more and more of a burden for people. We have the right to life, liberty, and the pursuit of
happiness. The government needs to accept that healthcare is a necessity in order to preserve that
right to life and begin to look at healthcare as a right rather than a luxury sports car as Teds so clearly
illustrated he views the subject.
SANDERS: Two points. Our employees are not getting healthcare because in Texas, you did not
expand Medicaid under the Affordable Care Act. CRUZ: No. She has 49 employees. She is not covered
under it. She's not hiring more because -- Lower income people would be eligible for Medicaid.

Second of all, I think that it is very clear that the discussion that we're having when Ted talks about
mandates, I look at it differently. And also, what we should be clear about is Ted says, well, just not
enough money, we can't all drive fancy cars. I think it's a bit disingenuous to talk about driving a fancy
car with getting access to healthcare when you're sick.

Last point on this issues, if we repeal the Affordable Care Act, we are going to provide $346 billion in
tax breaks to the top 2 percent. Ted in other ways goes even further. He wants to repeal the estate
tax which applies to the top 2/10 of 1 percent, the very wealthiest people in this country, and give
them collectively hundreds of billions of dollars in tax breaks.

Ted, we are the wealthiest country in the world. And it's not a question of everybody driving a fancy
car, but it is a question to making sure that every man, woman and child in this country has healthcare
as a right.
TAPPER: I want to bring back to a subject --
CRUZ: Jake, let me respond to that real quickly. I know this gentleman has a question, but I want to
respond --
TAPPER: -- going to talk about the estate tax.
CRUZ: What Bernie said, real quickly, I want to respond to just briefly.
TAPPER: OK.
CRUZ: Which, you know, it was interesting -- in the course of the campaign last year, encounter young
people all over the country. There were a lot of young people supported our campaign. A lot of young
people supported Bernie, and I would talk with different people supporting Bernie.

And I'd say to them, typically young people, I'd say, "You know what? I agree with Bernie." And they
sort of look at me, they'd be startled. They said, "What are you talking about?"

I said, listen, Bernie talks about how Washington is corrupt, how both parties, how both parties are in
bed with big business and big money and it is a corrupt system benefitting special interests. I agree
absolutely and entirely.

And what I tell folks is where I disagree is in his solution. If the problem is government is corrupt, why
on earth would you want more power in Washington? I want to take power out of Washington and
empower the people. When it comes to taxes, what I want a simple flat tax of 10 percent for everyone
and abolish the IRS. That ends the power of lobbyists. It ends the power of Washington. That's a
solution empowers the people.
Response: Aside from the fact that flat taxes are regressive and ultimately disproportionately hurt the
poor, a 10% flat tax would drive revenue so low we wouldnt be able to fund things like medicare,
Medicaid, social security, interstate highway construction and maintenance, airport construction and
maintenance, the military, regulatory agencies that are actually essential like the USDA, FDA, and
without the IRS to collect these taxes and have the power to make sure people pay what they owe,
wed likely see the rich find ways to avoid paying this flat tax as well. Shrinking the power of
government also shrinks the essential functions government does currently provide, while stripping it
of the power to properly keep corporations in check and make sure that they do not become more
rampant with their exploitation of consumers. The power of Washington has been made into a
boogeyman, but there are simply some things we need government for.

We decided as a country in the 1930s and the 1960s that we were going to establish a social safety net
that allows us to help people who fall on hard times, be that with food, retirement, health care, cash
assistance, or many other essential services we provide. Government can be compassionate and it can
deliver care well, but not without the revenue necessary to do that.

There are some necessary functions that private corporations would not be able to fill the service of at
a palatable price because the government does not have profit as its primary motivator. Look at
infrastructure, private-public partnerships only generally fund small roads because the up-front costs
of large roads are enormous to build, but the federal government is willing to build it because its
imperative that people can get from one area to another in order for our economy to function
efficiently for goods to get to where they need to be, people to get to work or to visit family, traffic to
be minimized, etc. Companies arent willing to build huge stretches of highway for hopes of making up
the cost in tolls years later down the line because of how big of an investment itd take and how long
itd take to reap the rewards of said benefit.

Weve seen the need for food and drugs to be regulated to ensure safety of what we consume or are
prescribed. Weve seen the need for banks to be reined in exactly how they lend peoples money
because of instances like the financial crisis and the recent Wells Fargo scandal. Government is how
we keep corporations in check in a capitalist society, and thats a good thing. Stripping government of
its revenue that is vital to be able to protect American consumers, leaves us with more disposable
income yes, but at the mercy of corporations who have shown time and again throughout history that
theyre willing to circumvent the rules and cut corners in products and services all while raising prices
in order to maximize their profits and help their bottom line, whether it hurts consumers or not. It
happens in all industries, and we already have a bevy of data showing the despicable practices
insurance companies would employ against consumers before the added protections of the affordable
care act, all while seeing increasingly skyrocketing premiums and out-of-pocket costs, so we know
what to expect in a possible future where government is stripped of funding necessary to protect the
American people from being scammed by multi-billion dollar corporations in the context of the health
care industry, and we need to ask ourselves, are we willing to accept that as a country?
TAPPER: We're going to --
SANDERS: One second. In the midst of massive unprecedented income and wealth inequality, Ted's
plan according to "Wall Street Journal" would give incredible tax breaks to top 1 percent.
TAPPER: OK, we'll do another -- we'll do another town hall debate on tax reform.
CRUZ: Good.
TAPPER: OK? We're going to take a very quick break. And when we come back, a subject where there
might be some agreement. The debate continues with Senators Ted Cruz and Bernie Sanders in a
moment. Stay with us. Let's turn now to the rise in prescription drug costs. For that, I want to bring in
Cole Gelrod. He comes from Denver, Colorado. He's a father of two whose daughter Juniper requires
medication that would cost $900 a month without Medicaid. Cole?
COLE GELROD, DAUGHTER HAD HEART TRANSPLANT: Thank you.

My 3-year-old daughter born with undiagnosed severe heart defect and required a heart transplant
when she was only at 7 months old. Unfortunately for us and families like ours, our employer-provided
insurance does not cover the most vital of my daughter's life-saving prescriptions.

This luckily hasn't been unbearable financial burden for my family because of Obamacare, and
particularly the Medicaid expansion.

Senator Cruz, regardless of what happens with health care reform, how do you plan to address the rising
cost of prescription drugs? Additionally, how would you like to address a healthcare insurance where
companies can choose to not cover drugs that people like my daughter need to live?
CRUZ: Well, thank you for the question and thank you for the care you give to your 3-year-old
daughter. I know that is not easy. And the question you ask is one of the great challenges facing this

country as we've seen the cost of drugs increasing dramatically. One area Bernie and I talked about,
we agree on, is allowing importation of drugs into this country from other countries where they are
cheaper. There's no reason why we should be subsidizing other countries across the globe.

But another fundamental area is FDA reform, where the costs of getting a new drug approved are
prohibitively expensive. I don't know if you've ever seen, or folks have ever seen the movie "Dallas
Buyers' Club". It's a wonderful movie with Matthew McConaughey about a gentleman in Texas who
had AIDS, and wanted to get drugs to care for and the FDA wouldn't allow it here and he would travel
to Mexico, he traveled to Japan, he traveled all over the world trying to get life- saving drugs.

There are story after story after story of exactly that happening. Life-saving drugs that are available,
that are approved. They're used in Europe. They're used in Canada, and the FDA won't allow it.

That's why I think FDA reform is so valuable that if we lift the barriers, to let people try, give you a
right to try. If it's your life, you have a right to choose. You have a right to try.

The key to it is competition. Listen, the big boys, the big players like government regulation. Dodd-
Frank benefitted the big banks. Tough FDA barriers to entry benefit the big pharmaceutical
companies. Massive complexity in tax laws benefits big corporations.

By reducing those barriers, we have competition and there's opportunity. I believe we can have
innovative cures. To give you a sense, the four most devastating diseases in terms of human life and
dollars, heart disease, Alzheimer's, diabetes and cancer. We ought to be investing everything we can
to cure those diseases. Just curing cancer, an incredible achievement, would save $50 trillion and
countless lives across the globe.
Response: I agree that more funding should be given towards research to curing pervasive, deadly
diseases. I also agree that in some instances regulation has held back some drugs from being put onto
market in our country, and perhaps an adoption of a policy where the FDA does a fast-tracked review
process of drugs that are available in highly developed countries markets that arent currently
available here. That would be a way to increase competition in the pharmaceutical industry and
would help to reduce prescription drug prices. In this instance I dont disagree with you.
TAPPER: Thank you, Senator --
CRUZ: And the FDA is a barrier to doing that. We need to change them.
TAPPER: Senator Sanders?
SANDERS: Here is the simple issue: we pay -- just as the case with health care -- we pay by far once
again the highest prices in the world for prescription drugs.

Fifteen years ago, you know what I need? I took a bus load of women, working-class women from
Vermont dealing with breast cancer across the Canadian border and they were able to purchase
Tamoxifen, it's a widely used breast cancer drug, at that point. It's changed -- for 1/10th the price
they're paying in the United States of America. Tears were coming of these working class women's
eyes fighting for their lives. What's going on? What's going on is the pharmaceutical industry owns

the United States Congress. And in all fairness, I will admit, it's not just Republicans. They have a huge
influence over the Democratic Party as well.
So, right now, the reality is uniquely in the whole world, you can walk in tomorrow to the -- your
pharmacy, the cost that you pay for medicine could be double or triple, and there's nothing anybody
can do about it.

So, what do we have to do? We have to tell the pharmaceutical industry which in 2015 made $50
billion in profit for the five major companies where the top ten executives made over $300 million in
compensation, we're going to have to be very loud and clear, and say, stop ripping off the American
people.

Two things that we can do immediately -- Ted is right. I introduced and will introduce and look
forward to your co-sponsorship of legislation to say that pharmacists and distributors and the
American people should be able to buy FDA-approved medicine anyplace in the world. That will drive
down prices in this country, because then you'll have international competition.

Second thing we need to do, and I believe, believe it or not, I think even Donald Trump may be on
board this, hard to believe, but we should be negotiating drug prices through Medicare. Medicare
spends zillions of dollars for medicines. Right now Republicans put language in some years ago which
prevents them from negotiating prices.

I would hope Ted will join me in saying that Medicare should be able to do what the V.A. does. We
can lower prices as well.

But the bottom line here is, you've got 1,400 well-paid lobbyists right now and they are working, if I
may say this, they're working against you. They're working against your daughter. The only thing they
want is more and more profit. And they could care less about the needs of the American people.
CRUZ: Well, but, Bernie, the barriers are also coming from government. And I will give an example. A
Texas constituent Kaci Lay (ph) has a 7-year-old daughter who was put on a feeding tube when she
was 7 months old. And there's a drug called Domperidone that is used all across the world to treat the
condition she has called gastroparesis.

She was put on Domperidone, this 7-month-old girl. She was off the feeding tube. She was living well.
Domperidone is available in more than 100 countries, including Canada and throughout the European
Union. But the FDA has been aggressively enforcing an import ban here.

And I'll tell you what Kaci's mother said, "I fear she will need to get a feeding tube again. How do I tell
her that? She's a little girl who has worked extremely hard to overcome her fears of eating and now
her joy of just being a normal little girl will be taken away."

We shouldn't have the government putting barriers to people getting the drugs they need.
SANDERS: I think that's a fair point. I think if you have a product that has been deemed safe by
countries that have high standards in this area, I think you make a good point.

But I think the more important point is that the government of the United States representing the
American people has got to control the incredible greed of the pharmaceutical industry. Will you join
me?

I do appreciate you coming on board the re-importation. I really do. And we can win it if we got
Republican support. Will you stand with me in saying that Medicare which spends a huge amount of
money for prescription drugs should be able to negotiate prices?
CRUZ: Oh, listen, of course, Medicare should negotiate. But you and I have a different view on how
you control greed.
SANDERS: Will you be on board that legislation?
CRUZ: Hold on. Let me finish what I'm saying.

Your view -- you said before that, gosh, these executives make too much money. I don't think the
government should be in the business of deciding what you get paid and you get paid and you get
paid.

And there are socialist countries on earth. There are socialist countries that you encourage us to be
like.

But those countries are not doing nearly as well as America. You know, the per capita income in
America is over five times the average per capita income in this world. It's 50 percent more than the
per capita income in Europe.

This is a land of opportunity because there is social mobility. In socialist countries, if you are born
poor, you usually stay poor. The advantage of this country, someone can start out a dishwasher like
my dad did and the free enterprise system in this country lets people rise. So, I don't think the answer
is government putting wage and price controls in and deciding --
Response: Once again, these facts are not directly related to healthcare, but there are still issues in
the way youre presenting them. First, yes our average income is higher than many other countries.
Thats a product of being the richest country in the world. However, you have to take into effect the
rampant economic inequality in our country. Its higher than in other countries, to the point of where
if you look at median income rather than average income, its not skewed by how rich our upper class
citizens are. Our median income is right around the median income of these other countries and lags
behind some of the Scandinavian countries like Denmark and Sweden.

Another point, its just flat out false that America has more social mobility than countries that have
socialized services and more comprehensive social safety nets (these are not socialist nations, theyre
democracies that employ some socialized services). There is a metric that measures social mobility
called intergenerational economic elasticity that measures the likelihood of variance between
generations in income across countries throughout the world. Basically, how common is it for kids to
be in a different income level than their parents? Our rating is worse than most other developed
nations, so no, the pick yourself up by the boot straps narrative, while still possible, is far less
common here than in some of these socialist countries. In fact, our intergenerational economic
elasticity rating is about twice as bad as many of these countries, meaning social mobility is twice as
common in these countries.
BASH: Senator Sanders --
SANDERS: The point was that millions of Americans can't afford the medicine while the drug
companies are making incredible profits and paying their CEOs obscene compensation packages. Yes,
that does concern me.

In terms of socialist countries, you think Denmark and Sweden and Finland are terrible places to live. I
think they do pretty well --
CRUZ: I choose to live in America.
BASH: Senator Sanders, let's get back to America and to the Affordable Care Act. Throughout your
campaign, you said that taxes should go up on therich, not the middle class. And yet, millions of
Americans who chose not to get health care are forced to pay a tax penalty. So, families of four are
paying up to $2,000 per year for failing to purchase coverage. Many say that they can't afford the
premiums, so it's just cheaper for them to pay the penalty than get health care. So, is it fair to put this
tax burden on families?
SANDERS: No. It's not.

But on the other hand, is it fair to not raise the revenue that we need to provide the kinds of benefits
that we are providing? That is a way to do it. I don't think it's a particularly good way.

I disagree with Ted, who wants to give, according to the "Wall Street Journal" and many other
publications, incredible tax breaks to millionaires and billionaires. I think in the wealthiest country in
the world, we should raise funds in a progressive way, where the very rich are now doing
phenomenally well -- yes, I do believe they should be asked to pay more in taxes and I think we should
use that money and other mechanisms to provide health care to all people.
BASH: Senator, on that very topic, the top 1 percent are paying a lot more in taxes under Obamacare.
But if you repeal it, will the top 1 percent, the wealthiest Americans effectively get a tax cut?
CRUZ: Well, Dana, let me point out that Bernie acknowledged that 6.5 million Americans are paying
Obamacare tax fines because they can't afford insurance. So, they can't afford health insurance and
then the IRS comes in and fines them. He says, gosh, I don't agree with that.

And yet, throughout the Democratic debate, Bernie says he helped write Obamacare that imposes
these fines on people. I think it's wrong to be fining people.

But let me make a broader point on taxes. Many times in this debate, Bernie has talked about
providing health care for free from the government. You know what? The simplest principle in
economics is TANSTAAFL, there ain't no such thing as a free lunch.

The liberal-leaning Urban Institute scored Bernie's health plan, concluded it would cost $2.5 trillion in
the first year and $32 trillion over ten years.

Now, how much that is? Trillions, it's a big number. It's not clear what that is.

Let me put it in perspective. All of the federal income taxes we pay today are about $1.5 trillion a
year. $2.5 trillion means every one of us paying income taxes would have to about triple what you pay
in income taxes to get an additional $2.5 trillion.

Now, Bernie no doubt is going to come back and say, no, no, no, none of you are going to pay. Just the
rich. Well, how about if we took every person that makes over $1 million a

year and confiscated 100 percent of their income, took every penny that they make. That would raise
only enough money to fund Bernie's plan for five months.

Here's another idea. How about if the government confiscated the assets of Apple, Google, Microsoft,
Facebook and ExxonMobil, if it came in, illegally seized those companies and sold them, that would
pay for one year of Bernie's plan.
If you don't want to see your taxes triple in addition to the wait lists, in addition to the rationing, in
addition to fewer MRIs and mammograms to worse care, then you don't want to see Bernie's
Medicaid for all. You want to see cheap, affordable health care that you can choose that puts you in
control.
SANDERS: Quote, "Wall Street Journal", October 29th, 2015. "Ted Cruz's -- "Wall Street Journal," not
my paper, your paper, maybe.
CRUZ: Oh, no.
SANDERS: "Ted Cruz's new tax plan delivers its biggest benefits to the top 1 percent of U.S.
households, adding about one-third to their after-tax income."

Here is the economic reality facing America. In the last 35 years, there has been a massive transfer of
wealth from the middle class and the working class to the top one-tenth of 1 percent. We are talking
about trillions of dollars. Ted's response to that is he's going to support the repeal of the estate tax,
correct? You're on record in doing that.
CRUZ: Among many things.
SANDERS: Among many other breaks to billionaires.
CRUZ: I don't want to bankrupt small business owners.
SANDERS: The only people who pay the estate tax are the top two- tenths of 1 percent. It would cost
us over $200 billion. And as Ted said, it goes on and on and on.

So, this right wing hyperbole of we can confiscate everybody -- it's not going to do anything.

Here's the basic point: if we pass the Sanders plan, 95 percent of people in this country would have
more after-tax income than they have right now.
BASH: Senators, I'm sorry. It's clear we have a lot more to debate and we can do that at a later time but
we have to take a break. And when we come back, closing statements about health carry.
TAPPER: Now it's time for closing statements. Each senator will get two minutes. We're going to begin
with Senator Bernie Sanders. Senator?
SANDERS: Well, let me thank Ted for being here. Let me thank CNN for sponsoring this debate which I
thought has been a very interesting discussion.

As I see it, the great political problem that we face right now is that we have a Congress that is more
interested in representing their campaign contributors and the very wealthy than the needs of
ordinary Americans.

Ted ran a very vigorous campaign for president. I congratulate him. But Ted also received $36 million
in their campaign from three billionaires, three billionaires. And as a result of Citizens United, we are
now looking at the Koch brothers, the second wealthiest family in America, and other billionaires
literally buying elections. And that translates into health care policy because the end result is that
Congress worries more about the insurance industry and the pharmaceutical industry and the medical
equipment suppliers than they do about the needs of the American people.

If you listen closely to the very fine questions that people here asked tonight, and you take a step
backward, you say whoa, what kind of craziness is this? We are the wealthiest country in the history
of the world and yet we have tens and tens and tens of millions of people struggling with prescription
drugs, struggling with basic health care. Yes, we can do better than that.

And then on top of all of that, we end up spending almost twice as much per capita on health care as
do the people of any other country.

Now, what Ted is proposing is to make a difficult situation even worse. To my mind, Obamacare is a
step forward. We have got to go further. But what Ted wants to do is do away with many of the
patient protection bills, provisions, that were passed, pre-existing conditions, a cap on what you have
to pay, making sure that women are not discriminated against, making sure that young people can
stay on their parents' insurance programs.

Under Ted's idea, all of that is gone. You are on your own. I think that is a very bad idea.
TAPPER: Thank you, Senator. Senator Cruz?
CRUZ: I want to thank Bernie for being here and for being a vigorous and honest debater. He believes
what he believes and he represents it well.

And I want to thank each much you for spending so much time addressing this critically important
issue. You know, I'd like to take a minute and ask the people if the cameras could turn for a moment
to the folks in the audience, I want to ask you how many of you here in the last six years have seen
your health insurance premiums or your deductibles go up?

Let me ask another question. How many of you here know somebody including yourself who has had
your insurance policy canceled in the last six years?

If you look at these hands across the room, this is why people are so unhappy with Obamacare,
because it isn't working, because it was built on an edifice of lies.

When politicians promise the American people, if you like your plan, you can keep your plan, if you
like your doctor, you can keep your doctor, and 6 million people get their plans canceled against their
wishes, those are broken promises.

When the president of the United States promises your premiums will drop $2,500 and instead, the
average premium rises $5,000 and deductibles go up $5,000, people are hurting because of
Obamacare.

And Bernie's solution -- you know, I'm reminded of an old "Saturday Night Live" skit with Christopher
Walken where they are playing in a band and he keeps ringing the cow bell. And every team they
recorded his solution is more cow bell, more cow bell.

It was government control that messed this all up. And Bernie and the Democrats' solution is more
cow bell, more cow bell. Yes, it didn't work when we said you wouldn't get your plan canceled. Yes, it
didn't work when we said your premiums would be cut. But give government even more power.

We can do better. I believe we are going to honor the promises we made to the American people and
we are going to repeal what Bill Clinton called Obamacare the craziest law in the world. Instead, we're
going to give you choice, let you buy insurance across state lines, expand health savings accounts,
make insurance portable, block grant Medicaid to the states so you can have experimentation, health
savings accounts so we can meet your need, put you in charge of your health care with your doctor,
not government.

That's what this election was about, and now, it is incumbent on all of us, Republicans and Democrats,
to deliver on the promises made to the American people.
TAPPER: Our thanks to Senator Cruz and Senator Sanders for joining us here tonight.
BASH: And we also want to thank our audience here, our hosts at my alma mater, the George
Washington University.