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The Future of Obamacare Debate/Transcript Between Bernie Sanders and Ted Cruz

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Ted Cruz and Bernie Sanders faced off on CNN last night debating the merits and the future of Obamacare. I know that POW residents have caps on video limits, so if I find a transcript of the debate i'll be sure to update it.

Update! CNN Caught Planting Questions During this Debate:




For those who may not be aware, but during the DNC primary CNN was caught colluding with Hillary Clinton against Bernie Sanders by sending her questions ahead of time. Looks like CNN is back to their old tricks....This is why Alternative Media is the future. POW Report is the first to have broken this in Alaska! Either way the debate was pretty good.

The Debate (Starts at 7:25):



The Transcript:

Aired February 7, 2017 - 21:00 ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


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...

(APPLAUSE)

... and Senator Ted Cruz, Republican of Texas.

(APPLAUSE)

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.

Senator Sanders?

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.

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.

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.

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.

(LAUGHTER)

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.

(CROSSTALK)

TAPPER: 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.

BASH: Senator...

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...

BASH: Senator Sanders...

SANDERS: ... and there is no legislation to control that.

BASH: Senator Sanders...

SANDERS: Hi, Dana, how are you?

BASH: Oh, hi.

(LAUGHTER)

SANDERS: Good to see you.

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.

QUESTION: Thank you.

CRUZ: 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.

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.

(CROSSTALK)

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.

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...

(CROSSTALK)

SANDERS: Yeah, that's right.

(LAUGHTER)

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.

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."

SANDERS: Oh.

CRUZ: 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.

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.

(COMMERCIAL BREAK)

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...

(CROSSTALK)

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.

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...

(LAUGHTER)

... 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...

(CROSSTALK)

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?

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.

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.

BASH: I want to tell our audience, we're going to take a quick break. We have a lot more to discuss. More of CNN's debate night and the future of ae Obamacare right after this.

(COMMERCIAL BREAK)

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.

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?

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.

(LAUGHTER)

CRUZ: 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 --

(LAUGHTER)

CRUZ: 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.

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?

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.

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 --

SANDERS: 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 --

(CROSSTALK)

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.

TAPPER: We're going to --

(CROSSTALK)

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.

(APPLAUSE)

(COMMERCIAL BREAK)

TAPPER: Welcome back to the CNN debate on the future of Obamacare.

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.

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 --

(CROSSTALK)

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 the

rich, 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.

(CROSSTALK)

SANDERS: Among many other breaks to billionaires.

CRUZ: I don't want to bankrupt small business owners.

(CROSSTALK)

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.

(APPLAUSE)

(COMMERCIAL BREAK)

(APPLAUSE)

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.

"CNN TONIGHT" with Don Lemon picks up our coverage right now.



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