Senate plan. That is what the Congressional Budget Office projects. Explain how they, up with that number and what it means in the 10 years the cbo report covers. Guest they have a collocated and sophisticated peter model. Sophisticated computer model. They will offset the gains and losses, they ended up with 15 million you are people would e medicaid after 10 years 50 million fewer people would have medicaid after 10 years. There would be a lot of constraints on medicaid from the federal government. It would be capped for the first time. States would get less money. There would be fewer people. Help would go further down the income scale. The insurance they could buy would be less generous. People would not find it valuable to spend money for insurance that they would not be able to use because their deductibles and outofpocket spending would be so high. Those are the big top lines. This is compared to current law. The number with the insurance would double. The cbo did not like down did not break down the individual penalties would go away. They would pay a tax penalty for not having insurance. Some people would voluntarily drop coverage, we do not know how many would how many it would be. Host this is assuming the aca is sustainable over the tenyear period . We hear a lot of discussion that the aca is not stable. Guest the Congressional Budget Office said it would remain stable. Coming intorers markets and left other markets. Fore is an examination example, the number of people who enrolled. Have they got it enough have they gotten enough younger people . There are a lot of variables. The senate bill will take it in another direction. Host how accurate is the Congressional Budget Office when it comes to the projections . Guest it is not uncommon for the party in charge to dislike the Congressional Budget Office estimate. It is an estimate where they have some things right and some things wrong. With the Affordable Care act, the estimated more in florida would drop coverage. That did not have that did not happen. The Congressional Budget Office has been solid. They have complicated methods. The are doing the best they can to protect what to project to predict what happens. Is people who no longer want to buy insurance . Guest some of the people who no longer want to buy insurance. Reading through what the office said, a large number of people would be priced out of the market. Sicker people, older people, seemedicare people would enormous increases in their premiums. Another piece of the bill changes how much you can charge people. Withuld be people low incomes would be affected. That is what the Trump Administration is fighting over. To get helpe able with your premium. They would not have help with their cost sharing because they would change how much the race plan days of your how much the base plan pays of your coverage. Now, the premium help would be based on a plan that pays 58 of your health cost. They would be responsible for 32 of their health cost. A lot of people would not be able to afford that. Host another big number influencing the debate is the andscore, 321 billion curative deficit and mulative deficit. Talk us through that. Taxes andknow many fees would disappear in the all caps relation. Calculation. The insurance sector, medical devices, that kind of thing. Is the interesting here Senate Republican bill has achieve at least what the house did in deficit reduction, 119 billion. Host why did they have to do that . Guest the budget regulation the budget reconciliation rules. Because they are skipping the committee, they have to make the houses target. Money tomcconnell negotiate votes. Host what have we seen from how he is using that cushion he has . Guest we have not seen anything yet. Storyis a this morning, we are up to nine republicans who will not vote for the bill in its current form. Most of them have not been contacted by the later yet. He is thank you would like to negotiate a deal by the end he is saying he would like to endtiate a deal by the of the week. Host we will split our phone lines differently in this segment. If you get your insurance through the Affordable Care act 202 7488000 if you get your insurance through medicaid, a thousand won 202 7488001. All others, 202 7488003. They will take your question on the future of health care. We can dig into the details. We will start with bob in arlington, insured through the Affordable Care act. Caller hello, can you hear me . Host yes, sir. Caller my daughter had Breast Cancer. She had to get one of her breasts cut off. I cannot believe trump put millions of dollars of tax breaks to the rich. It is i just cannot believe it. Mott. Are, my daughter, thank god i worked since she was eight years old. I cannot believe trump pushed this bill. I just had to say this one thing take your saudi arabian, and go live in russia and saudi arabia. That is all have to say. Host Mary Agnes Carey you are taking notes as you work as bob was talking. Guest i hope your daughter is doing well, i am sorry she had the Breast Cancer issues. There are two changes in the laws. There is a higher percentage on medicare taxes under 1 . There is a 3. 8 tax on unearned income. When you get rid of those, it goes to the richest those, the tax break go to the richest people. Guest the recent it is coming out the reason it is coming , the democrats wanted to tax the rich and the Health Care Industry. Because more people would be covered, the industry would make more money, in theory. It was a trade for them. Those were the taxes in the Affordable Care act. There is a lot of things they cannot do in this budget bill. One thing that they can do is make the taxes go away. That is what they are doing. Host we are taking your questions this morning. Mary agnes carey and julie rovner are with us until 9 30 this morning. One question we got this morning. A caller asked our members on obamacare . Guest yes, it is funny eric they have to give up it is funny. They have to give up their insurance. It was a big deal, it is a good plan. Generally, members do not get a that much. Staff get paid less. A senator asked an amendment that said members of congress and staff will also be on the Affordable Care act. Most of them are in the d. C. Exchange. They have had this disruption and be under obamacare. They seem to not get credit for it. Giveee at the town halls, up your insurance. They already did. Host in washington, clarence. Go ahead. Concerningquestion to the 15 to 20 Million People program that is being discussed, what is to happen with them and why are there that number a fixed number of people that will never be a part of any Health Care Program . Host youre asking about the people who remain uninsured, despite whether it is the Affordable Care act or projections of will happen under the house and senate bills . Caller yes. Host why those people do not get insurance . Caller yes. As i understand it, the option they will ever have is to beg for health care. They have to go to the emergency room and say help me, i am sick, but i do not have money. I willary agnes carey, let you take that up. ,uest the Medicaid Expansion the Affordable Care act is optional for states. It would allow individuals up to 16,000 of income to be covered under the Medicaid Program. It has been a benefit for single , childless adults. The key thing is to look at we talk about the 22 Million People who would be uninsured in 2026 under the Senate Republican plan. 50 million 15 million of those folks would lose their coverage. That is a key population. They picked up the cost of the expanded population. The money goes away after time. Julie talked about it earlier, but it is important to talk about the entitlement nature. It would change under both the senate and house plans. It is matched by the federal government on a percentage basis. The average percent is 55 to 57 . It would shift to a set amount of money. Over time, it would rise with the increase in Consumer Price index. Concern that not only the change and entitlement capping of the money would push states into tough choices. Do they reduce benefits . Do they lesson the number do they lessen the number of not people who can be on the program . It is a major shift. The Medicaid Program covers 74 Million People. It covers two thirds of Nursing Homes. Be know anything about fraud waste and abuse in the Medicaid Program . People in thes in most of the abuses coming from the provider side and there has been a lot of exposes over the years about providers inventing and then billing. That happens there is a lot of money and health care. Has less a less fraud than a lot of other programs. The biggest complaint about medicaid is that it is to lean. It doesnt pay enough so sometimes it is hard to find a doctor or specialist who will take medicaid. Now we have more medicaid plans. Those access problems have been a little eased. On important, what the color was asking, who are the uninsured . People, who have periods of uninsurance. They will be in between jobs. They were on medicaid but they got recertified and now they are earning too much money so they lose insurance that way. And out of being insured or uninsured or being on medicaid or evident sure and read one continued group who. Undocumented people are continued uninsured. And senate and they would not be eligible. Host new polling that came out on health care and medicated in particular, 74 of the public including a majority of democrats, 84 of independents, all have a favorable view of medicaid. That report from the Kaiser Family foundation. Explaining what this foundation is, and how it is different from Kaiser Health news . Guest Kaiser Health news is a not for rocket news service, not for profit news service. Fromes appear on our site other sources. We have a very vibrant partnership with National Public radio where we work with reporters all over the country. The newsroom that julie and i work in is like all the newsrooms we have worked in our career. Writeour reporting, we and there is no editorial interference. You might pick up the Washington Post today and see this column on why the Senate Health care plan would work in the real world. We are taking your calls this morning. For the here for us next hour. Marks been waiting in michigan four insured through medicaid. Mark, good morning. Caller hi, how are you. I have a question for the ladies. Why are people so shocked that obamacare doesnt work . If you go back from the beginning, how it was introduced, the speaker of the house at that time said that if you want to know what is an obamacare, you have to pass it she should have been fired on the spot for saying that. If you look at obama who created it, if you like your doctor, you can keep your doctor. That was alive. Lies that was a more were involved in that then you look at what obama has done. He makes a deal with iran that throws israel under a bus or it funder ofe number one terrorism. Host were going to stick to health care today. A lot of other topics. Julie, talk a little about the history and the does it work question . The interesting thing about the Affordable Care act is that great in a great some places and not so well and others. Anything this large would get tweaked as it goes. Right after the bill passed republicans took over the house, they couldnt do any of those. Republicans have vowed to get rid of it. It has been difficult to make midcourse corrections. Places the exchange did not roll out very well in 2013. People had trouble signing up because they didnt do a good job getting the computers to work. Host what is the key reason why would work in one place and not in another . Guest states just decided to take this on an adopted and try to make it work. California has an active exchange. They have a director of exchange. They manage the types of plans that come in. Well. Ks in many of the states, Congress Expected the states want to run their own exchanges. That was supposed to be a bone to the republicans. What happened was, opponents went around and said there is a way to strangle this at its inception. Dont participate. That is what the federal government is running in the majority of the states. What is interesting is, democrats did overpromise. That president said if you could like your plan you can keep your plan. He was trying to make your it was trying to make the plan the point, if youre in the individual market you could not keep your plan. You probably couldnt keep her doctor because plans dealt with this by making narrower networks. The republicans are doing the same thing. It is surprising they have not learned. They think they can decrease premiums and deductibles. That will be hard. There is nothing in this bill that lowers the cost of health care. Host to reston, virginia. Uninsured. Good morning. Caller good morning. There is no Republican Party anymore. These people who call our fake republicans. They need to take that party back from whoever these people are. This Health Insurance will sabotage from the beginning. The first thing they did to sabotage it was calling it obamacare. They realized because of racism in all this nonsense, you could get people to go along with this. This whole thing, the republicans can fix this thing all night if they want to because they screwed it up. They know how to fix it. Theyre the ones that screwed it up and they did it on purpose. Host what is the best way to fix it . We lost them. Maybe you can talk through that mary agnes . Saying this could be fixed overnight . That is probably too optimistic but to his point, when the Affordable Care act was created, the chair of the Senate Finance committee worked hard, we were there waiting for him, he tried to get republicans on board. He worked hard at that. It did not happen. There were no republican votes for the Affordable Care act went d in 2009hen it passe and 2010. That set the table for intense political opposition. That is continued. Than 60e has voted more times to repeal all or part of the Affordable Care act. If the republicans walk down that lane a are getting no support from the democrats. Said, if you has stop talking about repealing it, ripping it out, we can talk about changes. We can talk about adjustments. But this deep partisan divide is not only between republicans and democrats but it is within the Republican Party as well. Host in terms of what Chuck Schumer comes to the table with, what about cuts to medicaid . That would be huge. Exactly. Rob portman for ohio and on and on. Thatuld have to be would have to be off the table and subsidies would have to be more generous. As you pointed out earlier, they are going to cover less the cost of the coverage than what is currently in the aca. Pushing more deductibles, out of pockets, more copays on to people, which is exactly what republicans have complained about one thing they could fix fundight as they could costsharing subsidies, which they have been arguing about. 2. 5 timese less than poverty, you get help paying premiums and adaptables. Those people have difficulties with 6,000 deductibles. Money wasaid the never actually formally appropriated. That lawsuit is still in progress. That is what President Trump keep saying every month, we can does not pay these. What we have seen is that the insurers, who still dont know if they will get the money, they are passing through. They are giving discounts to low income people. The federal government is supposed to pay them back to the federal government every month decides whether it will make these payments. What we have seen is that when these insurers are filing for next year they are adding 20 of their premiums to make up for the expectations. Just in case the money doesnt come. If congress were to appropriate the money, that is all they have to do immediately. Everyones premiums would go down next year by 20 . Host dayton, indiana. Margaret, good morning. Caller medicare actually. Thank you for taking my call. I have some observations. Plan is an insurance very difficult. Naturally, Everyone Wants to have complete coverage for families no matter what is happening. That is impossible for many. People are lacking proper care. They are speaking in generalities of this group in that group. Hear them getting down to what the extra cost would be for full coverage for a family of four. Their premiums, deductibles each year, that would be very difficult for many people. People know this. By some of thed president ial candidates. , using the care present medicare model this could be financed with a 10 or whatever amount needed in tax along with a nominal premium and the doctor will amount for everyone which would be the same for everyone. Protect all equally and the consumer tax would hardly be noticed by the users. Host thank you for the call. Guest i thought there were interesting points. Allowing people to buy into medicare who perhaps could not find coverage for them. It has been discussed. I remember it, you might remember it it was very close. She talks about taxes and the funding. The amount, what would have to the funding of it would initially be the beneficiary who got in and not qualifying for medicare would pay the whole share of what the premium would the. Split. It is a 7525 this is an idea that has been out there and could be discussed again. But to her earlier commentary about how much getting down to what a family of four would pay, that is really an interesting and important calculation that people have to look at. In the Affordable Care act you can buy a bronze plan or a platinum plan. Premiums are less and the coverage is not a substantial and the copays are more expensive. You can get a platinum plan which covers 90 of the cost but that also costs a lot more money. There is not one number. That was part of the thought. They wanted to give consumers options to get it. Look at them. If you got a premium subsidy that would help you. If you have costsharing subsidies that would help you. Copays and outofpocket, that would help you. It is a complicated calculation which has been some of the problem with the rollout of the aca. Is a federalre government program. Every year it comes out. This is how much the deductible, the premium is. The Affordable Care act was supposed to be private insurance. It is run by private insurance. It would differ around the country because Health Care Costs different amounts around the country. It would differ according to what the market is like in each state. In each locality, even within states it can be much more or much less expensive. It is attaching itself to the existing insurance market. Host it is complicated. Explain what the coverage gap is . Guest it is the folks who live in states that did not expand medicaid and the way the Affordable Care act is written is, if youre under the set if the subs if you qualify for medicaid you are supposed to get coverage. 2. 5 Million People that might live for example in texas. At the very low cap to qualify for medicaid. And if you have a guest they did not expand medicaid. You dont qualify for the subsidy of the acas written and your state to expand medicaid and the state rules on medicaid mean you dont qualify. That is one thing about the republican plan that would drop those subsidies down to 0 of poverty. They start at 100 of poverty for the aca which is around 14,000, went to 14 of property, which is a poverty. The republican plan would take it down to zero. That is one benefit that people appointed to. Some of these people that have been left out might get coverage. Ifst but the cbo said even they got help paying premiums, the plans would cover so much less and they would be so responsible for their expenses, it would not help them that much. Host this discussion, you can find more on Kaiser Health news. Stafftwo guests and their , have been writing about it for years. , if youealth news. Org want to check it out online. Erri is in wisconsin insured to medicaid. Good morning. Caller good morning. For one it because infuriates me that they talk about health care bills, this is not about health care. This is about Health Insurance. Who gets paid. How they get paid. It has nothing to do with health care other than access to it. To be able to get it, you have to be able to afford it. Things, a lotth of people i know are on medicare. Y are working at places convenience stores. Home health nurses. Walmart. These jobs literally do not pay you enough to afford your own health care. How would you expect someone who can barely pay their Living Expenses and then ask them, by the way, pay another few thousand dollars for health care when you dont make that much . Great i think she makes a point. Many people on the Medicaid Program for the working poor, they have jobs, but they work at stores, we had a fabulous story on our site about nursing aide, here they are giving health care to people and they did not have Health Insurance themselves. How the aca has changed their lives. She makes a great point. There is a discussion in the senate and the House Republican plans about work requirements and medicaid. The point of it is many of these people, there is Something Like eight or 10 beneficiaries on medicaid that are already working. If they are not working they are taking care of a disabled child or elderly parent. Guest or they have their own health problems. Issue, these people are working but they cannot afford these premiums and the Medicaid Program has been a lifesaver. Guest this really isnt a bill about health care. It is about insurance. What all of washington is pays, and at is who lot of people think they should be arguing about how much are we paying as a society . Theyre trying to pass this hot potato of rising cost without looking at why they are rising. Host richard is in colorado. Caller good morning. Im a veteran and i am concerned about my brothers and sisters. I have heard very little to no talk about how this is affecting veterans except for our veteran organizations. 400,000 toying 500,000 veterans will be adversely affected immediately 1. 5 million and 2 million down the road. We know there are problems with that the a and we are not with the va and veterans are getting angry. We would like to know how this will affect us. I have to say, i will last julie to jump in because i am unclear. There is Nothing Specific about veterans in this bill. If they are on medicaid or low income they might be affected the same way everyone else would. Congress did just pass a that washealth bill bipartisan. Ironic in all of this. They got something done together. This bill doesnt specifically single out veterans for everything. Host about the involvement of veterans groups, can you talk about the Health Care Industry and their involvement particularly in the senate bill, their reaction to the senate bill . Guest pretty much the same as the house bill. They do not like the bill. Because of the enormous cuts to the Medicaid Program which make it more difficult for them to provide services. They are getting paid not a whole lot to take care of medicaid patients but now they would be getting paid nothing. In a broad array of hospital groups, dr. Groups, social welfare groups, the aarp, all come out against this. You have the National Association of medicaid directors which usually is not a Political Group come out and say, very vehemently, yes the states would get more flexibility but no amount of flex ability would make up for the reductions in actual money that this bill would anticipate. Even the National Governors association, as a bipartisan a group, which does not agree on very much, says the bill was rushed. Talking about the delay of the vote, there was pressure by republican governors and republican members of the senate, saying slow down. Pressure will just continue. Senator mcconnell is talking about negotiating a new packaging getting into the cbo and having a vote. The july 4 recess. There is already protests at the capital. Those are ongoing and that pressure will continue. Host pressure continued from outside groups is welcome continued from outside groups, attack ads. Here is one from out of nevada. Obamacare is rapidly racing towards collapse. Premiums skyrocketing. Deductibles increasing. Insurance Companies Pulling out and heading for the hills. But now with strong leadership and a real chance to repeal and replace obamacare, with patient centered care that protects american families, senator dean heller is saying no. And tell himheller that America Needs him to keep his promise. Host news about that group in that ad specifically about that meeting at the white house. Guest this is approach from group that is attacking senator heller for saying that he would not vote for this bill. Consensus, theby most endangered republican in the 2018 cycle. In a state that is rapidly turning democratic there was a republican governor there who has been outspoken about the medicaid cuts and the the Medicaid Expansion has been important to nevada. A lot of low income workers who work in the gaming industry is not otherwise get insurance are now being able to be insured through medicaid. Dean heller came out with the governor last week and was strongly saying, he cannot see his way to vote for this. Here comes this trump add attacking a republican. Senator mcconnell and leaders in the senate were upset at this group or it they have pulled the ad. That was seen as bad form within the republican family. Reportingblic yesterday that dean heller complain about this. In a playful fashion when he went to the white house yesterday. Guest yes. There was a meeting, President Trump had all the senators, all the republican senators that wanted to go to have this meeting. It is not clear what came out of it. There was some reporting that the president himself is not clear on what the bill would do. Which would explain why he has been all over the place about what it is that he wants. Host more of your calls. Robert is in greenville, texas area insured to the Affordable Care act. Caller a comment. Of ak at this whole mess new American Health care act or whatever trump is calling it. I look back at the Affordable Care act and i saw the debate that went on. Democrats of trying for years and years to get through they got it through. Or 57 votes went up for the republicans saying they wanted to repeal it yet, in those seven years they have been fighting over this thing, i dont see any rational way to replace it with something better. In my mind, this is my thought on the whole deal about government getting involved. Why cant they all come to some fixed costumber, a of health care, to wages similar to what we do with medicaid, and Social Security, come up with a number that meets the budget of what it would take to get everyone in this country under an Insurance Plan and just say, ok, now we have taken the politics out of it, its a hilton thing, its in your wages, its done . Just leave it at that . Get out of this whole mess of recurring about it. Attach it to peoples wages. This country is in a world of hurt if we do not start addressing the fact there is a lot of people out there that cant afford this thing. There are a lot of people that can afford it immensely. We going to anything we doing government and we try to figure rich can benefit from this at the cost of all the lower people that are down there making 10 an hour. Rate,d to put a base three percent, 5 , whatever the rate is, and say thats it. That is coming out of your wages, it is a done deal. Host robert, thank you for the call. Can you talk you talked about this earlier. There isdont think any kind of political consensus and possibly not nationally either about the idea of saying, we will spend this amount of money and health care on health care. Hes coming where from but i dont think you could get politics out of health care. Most of us get our Health Insurance from our employers. That is the vast majority of americans. We have people 65 or older, and disabled get from medicare. Some people per medicaid. One thing about the aca that has 12 million and rowleys on the exchanges. 12 million and rolled on the exchanges. We have this political discussion around that. Here is the other point. Mitch mcconnell was very clear about it yesterday when he came out of the white house meeting. He said, if republicans cant get an agreement amongst themselves on how to repeal this , which is what robert was talking about, he will have to sit down with Chuck Schumer and the democrats and that agreement, would be nowhere near what the republicans want to do. Guest as much as the republicans have been wanting to repeal it, we have known for seven years they did not agree amongst themselves. Now we are seeing that. There is a large fraction of the Republican Party, the tea party faction, that doesnt believe the government has any business and health care. The government pays about half of the Nations Health care bill now. They would like to get rid of as much they want the federal government to withdraw from dissipation in health care. You have other parts of the Republican Party that see there is value in it that they would like to fix it. You have factions within the Republican Party. Just as there was within the Democratic Party when they were trying to put the aca together. There are different legislations within the Republican Party. The Better Care Reconciliation Act that is the senate plan. The House Republican plan, the American Health care act. Then there is the democratic plan. The Affordable Care act from the democrats. Called obamacare. Ron is in florida. Uninsured. The morning. Caller good morning. I was wondering why create such a giant bureaucracy . Why not have an acrosstheboard salestax . You can increase it on luxury weddings for the on luxury items for the people that have done the best in the country. You could also have people who are in the country illegally pay into the system. Walk into Emergency Rooms and get health care on our cost . You wouldnt have to demand that 17 euros kids coming out of High School Start paying into a system they wouldnt use for sixth the years. 60 years. It seems like they just want to create your rocker c and make jobs for a heads that want to have that dont have a concern about health care. Host time tax reform to health care. Guest bureaucracy is not that big. It exists in the offices of the Health Care Providers which is one of the things that is driving up costs. And the Insurance Companies. They are in an arms race. Most of thee bureaucracy is. Is important to remember that most other countries do what these other callers have been talking about. They dont all have singlepayer systems but they largely collected money from the populist who taxes and use it use it toe people and fund the system. Host dill is an illinois. Are you with us . Caller oh yes. I am. Was, likewondering your last two callers, i have to agree with them. I am for more of a singlepayer, why do we like why dont we lift the cap off of social i think we would just have plenty of money to take care of health care. And Social Security. You get a raise. More of a believer of singlepayer. Im on medicare, im a veteran, the other odd thing is that i sell insurance. Ive gone through the health care gamut over the years and it hasnt changed. It is just different through the aca. That is all i have to say. Host in what way . On the change in you selling insurance . Caller for years, insurance rates would be higher, my wife and i would pay about 1400 a we would have a coated optical, and then maybe a 1 million cap. Care, youin health could spend 1 million in a hospital quite quickly if you are in an icu or some like that. Your thank you for perspective. Wanted to ask him if he was trying to sell plans on the aca exchange, but he is off the line. This is a very, very popular thing to protect consumers. Given to thee Central Health benefits, this is benefits that are covered by services that offer things like maternity care, prescription drugs, health services. If there is a waiver on a plan offering that, it impacts the annual and lifetime benefits. There is an interchange there, so that is something very important to look at. He talks about singlepayer, i know there are a lot of singlepayer fans out there. They that a lot of examination of looking at this, particularly in the state of california, which have had some issues on it. The problem with singlepayer is always cost. It has always cost a ton of money. Italy comes down to the financing because it is really expensive. Illuminatingtioned the cap on Social Security. The Medicare Part on that tax has been eliminated already, that happened in the 1990s. But people who are were it about the future of Social Security or worried about the money lifting the cap on security. Host go ahead. Caller Insurance Companies exist not to provide insurance for health care, they exist to provide profits to their investors. Get theg to do is to Insurance Companies out of the chain. There is a comparable thing here. Back in the 30s during the national 30s during the depression, they found that forprofit Energy Industries could not provide Electrical Service because they cannot make money on it. So you have cooperatives, which are funded by low interest or no interest loans from the federal government. All in the country got there he that way. We have a similar situation with health care now. There is so much need for health care in this country, that the Insurance Companies cannot make a profit off of it. Lets get the Insurance Companies out of it and go to a singlepayer system, like most of the developed world has. Host most about the single tear this morning. Bucks i want to point out that a lot of Insurance Industries i want to point out there are a lot of Insurance Industries that are profits, but there are also that our nonprofits. They were also sabotaged coming out of the gate. The republicans in congress had a lot of the money, but there are some robust and vibrant Nonprofit Community health plans, the group that represents them has been one of the most outspoken and oppositions to this. But they cover a significant percentage of people on nonprofit plans. Host elizabeth is insured to the aca. Good point. Caller good morning. Thank you for exciting my phone call the sorting. What i wanted to say to you or everyone i have not heard i listen to cspan usually every morning one of the things that is not seriously being taken into consideration in regard to health care is that we are now a global world. What is happening is people are crossing our borders, flying in and out of airplanes, and bringing in terms and diseases and things that week germs and diseases and things we cannot even see. I was on a channel about the invisible germs that are crossing the borders. My younger sister just came in from mexico, did not wipe down they didfriend not wipe down their airplane seats, and both of them got very, very, very sick from that traveling thing. Care,ards to the health you are not taking into consideration the Global Factor and the fact that diseases are coming into all dish in from in from all over the place. It is like the europeans coming from europe and coming over to america and bringing in the smallpox situation and substantial native americans were killed because they were not immune to the smallpox situation. It is so much bigger than just america, because we are no longer just america, we are a global world that are traveling. Host i got your point, lisbeth. I think that is a great point, and one thing is the coverage of zika. We have had a lot of great reporting on the impact of families who have a baby born with that, what the Public Health cost would be, and of all kinds of viruses coming in to the United States can create problems for the healthcare system. This is more of what Health Issues and an insurance issue, but there are cuts to Public Health in both bills. There was a big cut a new portal care act which pays for a significant portion for the budget of centers of Disease Control and prevention, which is in charge of not letting those diseases come across the border, and this bills these bills would cut that significant. Host and we also talk a lot about the opioid crisis. Could you talk about the legislation on funding for treatment for opioid addiction . The senate has 2 billion for opioid endemic epidemic Addiction Treatment, and many senators, like rob portman, for a couple, are saying it is simply for example, are saying it is simply not enough. It has become a very major issue, and when we talked earlier about the horse trading that Mitch Mcconnell might be able to do with members, all of that 200 billion in deficit reduction, it would not surprise me if a revised version of this bill targeted more money for that. But they would need that because the medicaid cuts would take way enormous amount of coverage owing to people with opioid troubles. About 30 of opioid addiction are actually covered by medicaid , it pays for about one third of all of the opioid treatment in the United States. If there were such deep cuts to medicaid, that would take away the opioid Addiction Treatment for a significant number of people who need it, and basically everybody in the state looks at the number in the senate bill and says that is not even almost enough to offset the cuts that would be there otherwise. This is not money in addition to what is being said, spence, this is in lieu of what is being spent, and it is a lot less. Alex rogers talks about the wish list that could doom the obamacare repeal. Here is the article from yesterdays National Journal and opioid addiction, and more funding for opioid addictions brought up in several parts of that. He goes senator by senator on what they are looking for from the bill. Rob portman and Shelley Moore areto of West Virginia requesting more money to response to the opioid crisis. As we look at this horse trading youre talking about, looking at what each senator might want or request. Pennsylvania, insured through medicaid, good morning. Yes. Good morning. Ifwould help a great deal they stop ripping off Insurance Companies so bad as well. My mother law is 100 years old, and my first month, i paid 10,000. After that, it was over 6,000 a month. Every friday, they would charge 109. Every week with 89 for occupational therapy. Works, butw how it it was charged. She needed about two weeks. Chargede bills, she was for two months of oxygen. I brought her home, and about six months ago, they brought her oxygen and she was perfect. This is ridiculous what theyre charging. Inc. You. Host thank you for sharing your story. The cost of nursing home care . On target, very spencer, north of 100,000 a year, and if the medicare deduction to the cuts that are into the house and senate bills went into place, there is a great impact on what it would have for Nursing Homes, because medicare is about two thirds of nursing home care. We have a great story on our website. We looked exactly at this intersection. What with the change of medicaid funding and vision for both the house and Senate Republican mill bill me for nursing home care . Blow throughsily their personal savings. And then they turned to medicaid for that funding. Host you can go to the Kaiser Health medical site Kaiser Health news site to check out these stories that we are talking about. Gary, go ahead. Caller good morning everybody. Alone, and there are thousands of them appear that are so, so bad that you can drive down the street and know who is on it and everything else. What miss o is asking for mrs. Capito. And i know you were talking i haveinglepayer, and friends in australia, and if they pay through it, everybody pays into it. And all of the hospitals are owned by australia. Not all of these overpaid anditals like we have here, that is why it works so good down there. They are all very health the healthy and happy. When i was there with my buddies it was fantastic. And along with my mother here in a nursing home she passed away last year but i agree with the gentleman before me. It was ridiculous. But i did have to end up going through medicaid because there was not enough money. And thank you all for listening to me. Have a good day. Host gary describing the exact situation you are just talking about. Is there anything on the opioid side of that you want to pick up on . Talked about that before. Medicaid does a lot. It pays for half of all words, it pays for two thirds of nursing home care. Opioid addiction to me. It is a last resort, but it is so much bigger than the individual market that we have been used to talking about with the Affordable Care act. We are talking a total of haps 1820,000,000 people 18 million to 20 Million People in the market. Jasons insured through medicaid. Good morning. Caller i am not insured through medicaid, i am a provider. I have been a provider for 16 years, and watched preAffordable Care act and post portal care act, and i wanted to make a comment on the benefits of the Medicaid Expansion. Host what is up jason, and stick around. Our guests might have questions but your experience. Go ahead. Caller i have questioned what is the alternative if they cut Medicaid Expansion or take it away, what is the alternative for people who are now going to be uninsured because they do not have medicaid. Preverbal care act, in my office, i saw people devastated by Health Care Costs. People would come in, 225,000 bills for a twoweek hospital stay. Hasmedicare expansion really taken that away, and it has provided care for so many people that otherwise really would have gone bankrupt not having insurance, not being able to afford outofpocket cost or private insurers. So what exactly is the alternative after they take away 800 billion from the medicaid pot . He asked the most important question. What are they to do . Earlier, the medicaid directors have said well, republicans are advocating more flexibility to it minister medicaid, the medicaid directors have said you cannot come back from this level of a cut. The baseline will continue to grow, but this is a 26 reduction over the next decade. What to do states do . They have very important decisions. Etiquette is one of the most expensive budget areas for estate, right up there with education and Public Safety and a variety of other factors. What do they do . Do they have to keep people on their Medicaid Programs you could do they reduce their benefits . Jason is a provider, a medical provider. Today pay people like him less co ike a beneficiary of think this is why you are seeing such outer pressure for this now in this discussion about changing the fundamentals and the funding nature of the Medicaid Programs. Host and to put a number on it, by 2026, the senate plan would cut medicaid through reductions in terminations of federal matching funds and the per capita base the capital base cap on medicaid by 772 billion over the next two years. The house version would be 444 billion in reduction. Chart. Is a misleading the senate cut 30 per, but they do not take effect for a longer. Are deeper, but they do not take effect for a longer amount of time. They are deeper than the house cuts, even though that looks larger within those 10 years. Host jason, thank you for your call this morning and letting us chat about that topic. Peggy, new york. Good morning. Caller good morning. Im from new york, i have been under the Affordable Care act. I have had a medicaid managed plan, and now i have insurance through my employer. Which im grateful for. I do believe that what we need in this country is a change. Repeal and replace, yes, but we need to repeal and replace the premiums, the deductibles the cap on what pharmaceutical companies charge. I cant. We need to create guidelines and reliable charges for procedures and treatments. We need to replace this business businesssal based with universal health care. All other civilized countries have this. We are all human here. Not just in new york, but in the world. Systemneed to not have a where i respect and them grateful to all doctors, but we need to have a system where doctors do not pick and choose who they serve by the type of insurance that we have. Host thank you for the call this boring. You heard the comments for about Drug Companies. Another caller earlier on asked dont Drug Companies need an incentive to keep creating new drugs . That is the classic and give and take, write . Pharmaceutical directors will tell you about how much they spend on drugs, any of them do not make it to market, but they need to recover those research and Development Costs and you do not want any disincentives to do that. On the other hand, some of the prices of drugs and price increases and so on have gotten a lot of attention. I think what is really happening here, and she crystallize it. It is the theme we are hearing over and over again with colors or they singlepayer, want a cap. But how much government regulation is necessary . Should the government mandates what benefits should be covered . Should they have a premium subsidy . Should insurers be able to come in off of whatever plan they want and the free market have total rain without government regulation . That is the classic tug and pull here. Continued throughout the discussion over the Affordable Care act. Republicans and democrats arent in very different philosophical places. The key will be obviously, if you have the votes on the republican side and can change this, but as we hear from colors like peggy, there is a very solid, powerful emotional reaction to this. That is one of the reasons julie and i have covered health care for so long, it is so personal. It is one of those things about washington that covers peoples lives. Both off you listen to them, republicans and democrats are hearing the same thing from their constituents. They cannot afford it and are paying too much. The disconnect between what people earned and Health Care Cost has gotten to be so much they cannot think about it, but they cannot agree on how to solve the problem. They agree on what the problem is, but not on how to solve it. We have another 20 minutes in this segment. Twitterld mention your handles, where you show a lot of your reporting and links to your reporting. They are with us until about 9 30 to answer your questions on health care, the future of health care, and these very big bills that we have been talking about for the last couple months here on the washington journal. Mike and valencia, california. Aca insurance, go ahead. Caller thank you for having me on. Basically, i do not think it is a republican or a democrat issue. Back, i do notng understand why the government got involved to begin with other than there were preexisting conditions on certain medical situations and insurance caps on procedures and covered and so forth. So the lady from new york she has it right. Mandates a bunch of regulations and rules, except they cannot figure out how to bring down the halls cost of health care. The premiums of pharmaceuticals, so forth. You have all of these lobbyists in washington that are going after these Insurance Companies, and the Insurance Companies should be regulated by the states. The states concerns commissioner. He should be able to insurance commissioner. He should be able to tell the insurance cup and is how far they can go with their premiums, and regulate that to the point where it is affordable. I do not know what the government has to do with it. Primarily, it is a race between how much can the doctors charge and how much can the Insurance Companies cut down on their fees . Is a battle between the doctors and the Insurance Companies. Insurance companies are basically winning. Host would you agree . We talk about why i think he is trying to go back his iks at the beginning think they are about the beginning of medicare. I was thinking originally this idea at the beginning of the debate, talking about these people who could not get Health Insurance because of their preexisting conditions . Had been priced out of the market. They had worn through their lifetime cap with a terminal diagnosis. Kindthe thought is of steers it to help these people to find coverage on their own, something affordable, and is a formal,t cover heads up, and you can debate that in the eyes of the holder. But why did they get involvem involve and tried to do this to help people find affordable Health Insurance . As we know, the Affordable Care act did not attract enough younger and healthier people to balance the risk pool. We also talked about premium rates jumping, that kind of thing. And the do have a lot of power. They did before, the Affordable Care act insurance regulators had more power to regulate rates. Democrats were trying to attract republicans when they were doing this, so they really did give the states a lot of authority. Think theon and i color has a point. When there is this competition between the insurers and the Health Care Providers, not just doctors, but hospitals and Nursing Homes and physical therapists and everybody else involved in making their living off of the health care system, or as a continual fight, but there has also been an effort in the United States to keep the Health Insurance industry private. The reason medicare came about is because the Health Insurance in the street did not want to sell to old people because they were bad risk. That is why we got medicare. Trying toerms of sustain the system, obviously the Affordable Care act had an individual mandate. Can you run through the different ways the senate bill and house bill would replace that individual mandate . The individual market is a place where people pay their entire premiums. You want insurance to go into the individual market. The way Insurance Companies dealt with the risk of that, only six people signing up before, was to say we are not going to charge the sick people or we will tell six people that we will double or triple their premiums. Everybody agreed that was not a good thing, most people had preexisting conditions and should be able to afford health care. If you are going to do that, you need to ensure that there is a way that Healthy People will sign up as well. The individual mandate they chose in the Affordable Care act idea and a republican first and lamented in 2006 in massachusetts under governor mitt romney. Are other ways to encourage and people to be in the market. The house bill has sort of a punishment if you do not. The house bill says is if you have a break in coverage that is they wentys, which back to a 1996 law about employer coverage, you need to pay 30 surcharge on your premium for a year. Officegressional budget and actuaries say that is not very strong. And they could go another way, saying you have a sixmonth lockout if you have a break in coverage. You could sign up for coverage but not be able to get it for six months. Again, the cbo says that is not very effective either. And the individual mandate has not been effective either, so it has been very difficult to find a way to actually encourage and co. Healthy people to sign up without being so course of that the republicans and government does not want to do it. As we know, all of these things are seen as coercion and unpopular. Host well take a couple calls here. Tom is in connecticut. The line for those injured through medicaid. Tom, go ahead . Taking myank you for call. This has to do with the opioid problem and medicaid. I am on Social Security disability, i am 61 years old. I got on disability two years ago, and i have been on methadone maintenance for 20 years. It saved my life, because i could not stay off of drugs. This has counseling and medication, all of this good stuff. So after two years of being on medicaid, they changed me to medicare, and all of a sudden they wont pay for the methadone. They will not pay for dental, they will pay for anything. But getting back to the opioids, they will not pay for something i have been on for over 20 years and without it, i am like dr. Jekyll and mr. Hyde. It is scary. It scares me to death. I had to work with some really good people from senator blumenthals office. That helped a lot, to make a long story short. Medicaid just for this one thing. They will pay for it, but i had to go through a lot. Medicaid, there is going to be millions and addicts that cannot get the help they need, so there is going to be a lot more crime, just a lot more misery. I cannot believe that medicare will not pay for it in and of itself, that is bad enough. But if medicaid will not pay for it where are these people going to turn . Thank you for sharing your story. This is a situation we ran into if there is something that you can speak to that . That is how it works. When you are on Social Security and disability, there is a period, but medicare does not usually pay for Health Care Costs. They usually have some way to fill in the gaps for medicaid. Medicare. 60 of costs. Bout there are people who are dual eligible, and that is what our caller finally got. You go from medicaid to medicare, medicare is for everyone. It assumes that most people have some means to pay for some of their health care. Medicaid assumes that you do not. That was interesting. I did not know medicare does not pay for methadone maintenance. How many 65 and up people would need that . But that may be something that medicare will have to start looking at. As more people are aging and the baby boom generations are aging into medicaid and more folks in that demographic have suffered the same kind of things that tom has, you might find a change in the Medicare Coverage pattern to cover that. Injured through the afford book air act, washington. Good morning. Good morning, thank you for taking my call. Im interested in the fact that i am 61 and this is going to, from what i could tell, it will affordable Health Insurance cost to a lot of money. I will not be able to be on gourance if the new changes in. I just will not be able to afford it. And while i have been on the aca, i am a social worker, i work for a high school, and i had to decide to work parttime for a couple of years because i needed drop transition. I have been a longtime social worker. And as i changed jobs, this has helped me but i do pay all of my costs for health care outofpocket. Because if you go parttime at a helpl, you cannot get any from the school anymore for Health Insurance. So one of the things i wanted to say is i am confused about why dental care is so high. That is a big deal to me but most people i know say oh my gosh, my 12 cost me 10,000. And now i cannot complete the process. Gynecologicala medication that i did take, and i cannot afford to pay for that anymore, even with aca. So there are some things that i do think needs to be fixed, but i am really frightened if they change. Thank you for the questions. That is a lot of interesting points. Number one, dental care is not in your medical health care package. That package or paying on dental care is very eccentric, and not corrected with the aca but it is for children. It is required in the Affordable Care act but only for children. And she talks about how she is going to pay more, i think is interesting people look at the Congressional Budget Office report and see how people and things in the republican plan are allowing older folks she would be in that situation at 61 two be charged as much is five times more than a younger beneficiary. States can go permission that get permission to go beyond that cap, and the subsidies are less generous as well. Picking up they are 70 . These plans are picking up 70 of the costs that were dropped down to 50 . That is like a double whammy in particular for older folks in the Senate Republican can plan. A and she mentioned she has medication that she cannot afford to take, which means a plan already does not cover in costs, but or we believe many would become uninsured because they would not be able to afford it anymore. Host joanne, maryland. Go ahead. Caller im calling about the aca,that if you are on the and you can afford it, you get an insurance company. But your deductibles are so high you cannot afford it. Have to drop the deductible to add zero or 100 that people can afford. It should all go through the congress, they should repeal obamacare, replace it with Affordable Care through Insurance Companies. Give them x amount of time to come up with these various plans that people need, not what they tell us the. They need. And hospitals are starting to come up with hmos but i do not know what they cover. You have to be more transparent, and hospitals should also be required to post their fees as well as doctors. Host thank you for the call. That is exactly what a lot of people are talking about. That is getting to what we are paying for health care rather than who is paying for it. This whole issue of Price Transparency has been really infuriating to a lot of people, where they say the consumers should have more skin in the game so they can got shop for care, but you do not know how much anything cost. You can call it provider and sometimes they cannot even give you a cost because it differs. They have negotiated various fees with insurers, and honestly they do not know how much they charge for things. We have a call from california, line from all others. An addiction and Treatment Specialist and provider in california, and i have a question regarding how all of this Health Care Changes and all of that stuff affects the providers who are trying to help people with addiction problems and Mental Health problems . One of the issues that we have is the Insurance Companies three bursting providers here 10, 15 10 , 15 of what that we are charging. And they do not have money. They are on a policy for their parents or somebody, and not have the money to pay for their treatment. And in the providers cannot provide any more treatment. It is kind of a double edged sword here. That is regarding Addiction Treatment in this country. Thereere is a few , but thereonprofits are a lot of cyber Treatment Centers, private Treatment Centers that only except certain icies except certain s. Cept certain policie we are talking above the Medicaid Expansion and how much money that has provided for , but the pointt he was trying to raise earlier is that medicaid does pay providers on average less than medicaid would pay a provider or private insurance, said that has there is anm idea that you do not get it from the insurance provider, and who ever they are, if you go to the patient they do not have it either. What does that treatment say . That is a big issue with these high deductibles. People have 6,000, 7,000 high deductibles and the hospital for ito come after them and they do not have it. So hospitals are getting paying patients, but they are missing a big chunk of money. It is unreasonable to give people the thousand dollar deductibles because they do not literally have the money. That is why theyre supposed to have insurance. And this idea that you could repeal the aca and have policies that do not have these high deductibles the money interchanges what is difficult. And the only way you would have lower deductibles and premiums is to not give coverage to people with preexisting conditions, which everyone kind of agrees they want to do. Host just a couple minutes left in this segment. We want to bring it back where we start with the senate delaying their vote on the bill, and the on twisting we had talked about that is likely going to go on over the next couple of days and weeks. You are the chief washington correspondent, in the hallways talking to these members of congress who do you think is going to be the most likely to get on board . At this point, there are a lot of people who are off board. Or are more conservatives were saying no right now than there are moderate saying no right now. The tradeoff though is that anything that mcconnell does to get the moderates back on board is going to antagonize the conservatives, and anything he does for them will antagonize the moderates. Reporter says the republican toughest the republican votes are collins, johnson,tsky, lee, portman, moran, cruise, mccain, poker, and flake. Is there anyone you disagree with or add to that list . No, that is perfect. Moran from kansas was a surprise. After they town to the boats, he came out and said he was not supporting it. He was not on anybodys list. Ron johnson, who was very conservative but has he keeps saying we should work with the democrats. Some people with obvious problems from the moderate point of view, like medicaid cuts, senator cruz says it does not repeal enough of the Affordable Care act, then you have all of these senators who have other problems with the that are not entirely clear. Springfield, ohio. Insurance through medicaid. Go ahead. Caller my concern is there has been a not a lot of medicaid fraud in my town. What will they do about that and the medical plans when they come up with that . I had to go to the hospital three times, and they finally took my blood pressure, and they iund out i had pneumonia when went back the third time. The hospital got paid two times for me not to do anything. My concern is medicaid is paying out money and they do not even do anything. So that could be useful for somebody elses medical care. Got you. Looking at medicaid abuse is always important. Department of health and human an Inspector Generals Office that would love to hear from emma to get these details. That is one thing we talked about earlier there has also among sof fraud that is one of those things washington keeps a dialogue all the time. And in medicaid. The states have their own Insurance Commissioners and medicaid directors who are basically in charge of ferreting out fraud when they cam, dashcam, and they do a lot. They do catch a lot. Host virginia, line for all others. Caller i have a question about costs. I was looking at some of the cost, some graphs on the cost, and it looks like to me that the republican plan will actually increase the money toward medicaid over the next 10 years by around 21 or so, and the increaseca plan will 58 or so over the next 10 years. So my question is is it really a cut, or is it just Like Washington talk where there is a decrease in the overall rate of increase, and if it is, it does not seem sustainable, if we are looking at 50 growth in 10 years. Thats under the aca plan. Thank you for bringing it up. Texas is the ageold fight in washington. It is it a cut if the money keeps going up . It is a cut. Seeing that go up but getting less money, it is a cut. You will get less federal money from the states to pay for medicaid for medicaid. That money is going to be needed, and in order to take care of the patients that will be a little for the Program Eligible for the program, but they can do one of many things. They cut the benefits offered, the number of people covered, raise taxes, or take it from somebody somewhere else in the state budget. But just because it keeps going up does not mean it is a cut. You summarized it perfectly. Host and you summarized it publicly over the past hour and a half, so thank you very much. Our Senior Health correspondents for Kaiser Health news. Come back again, thank you so much. On friday, President Trump suggested that republicans take another approach on health care, saying in a tweet if a public and senators are unable to pass what they are working on now, it should immediately repeal and then replace at a later date. When asked about the president of between at an event in kentucky, said a majority leader Mitch Mcconnell told reporters that despite challenges with the health care bill, the senate would continue on its current path. Tonight on cspan, a look at the impact of President Trumps policies on to domestic and foreign affairs. It is the topic of a recent debate between former obama undersecretary of state Wendy Sherman and michael durand, who worked as a senior director for the National Security council during the george w. Bush administration. Here is a look. We have seen the president deride judges and say they are not important, because they are of one background or another they cannot be there. We have seen the Justice Department tell our mayors that decisions that may have been made to put laws in place and frameworks in place, make sure that Civil Society is civil are no longer good and will all be reviewed. I come from the city of baltimore. Also more has serious and tough programs baltimore has serious and tough problems. They want to move forward but the just part of the saying they cannot. The rule of law, pluralism, democracy it is not part of Donald TrumpsAmerica First. The media and the democrats e now combined together to Donald Trumps americas America First as chaotic please, people. As chaotic. President trumps strike on syria for its use of chemical weapons did more for american deterrence and American Leadership in one short, 65 hour period than anything president obama did in his eight years. Ask that debate was part of a forum, hosted by the American Jewish committee. You can watch the rest of it tonight at 8 00 eastern here on cspan. Coming up over the fourth of cspan twos, on book tv. Author John Mcwhorter discusses his book talking back, talking black. I wanted to see if i could make the general public have a more positive view of the dialect that most black americans use in casual situation. At 7 15 a. M. Sday eastern, author and pulitzer prizewinning historian David Mccullough with his look the american spirit who we are and what we stand for. If you get knocked down, you do not lie there and whimper and wine, you get back up and continue on. I think that is something that we all need to be reminded of and are reminded of by these examples set in the story of our own country. At 1 30 p. M. , utah senator writtenwith his book out of history the Founding Fathers who fought big government. Nobody can know what happened in philadelphia in 1787 if you read both unless you read both sides of the argument. If you read the arguments of the antifederalist, the anti arguments of the federalists tilt toward federal power more than they do. The book sisters first stories from our wild and wonderful life. We felt unbelievably protective of them, and people felt it was odd that we were protective of them. When they left the white house, it was the same age we were when our dad became president. Being a teenager when your dad is president is not easy, but it is incredibly rewarding. At 8 45 p. M. , former secretary of state Condoleezza Rice discusses her book democracy stories from the long road of freedom. Inthey do not traffic soldiers who are 10, 11 years old. They do not traffic in the human sex trade so women end up in brothels in Eastern Europe and southeast asia. They do not harbor terrorists as a matter of state policy. Democracies do not fight each other. We do not know that we know that. It is called democratic peace. Export for a full schedule, go to were a full schedule, go to booktv. Org. And join American History tv for a live tour of the museum of history in philadelphia. The museums ceo and Scott Stevenson college news articles and exhibits throughout the museum, including George Washingtons war tent and peace of the old northbridge from the battle of concord. Hear stories about the American Revolution, and you can participate in a live program with your phone calls and tweets. Watch American History tv, live from the museum of the American Revolution thursday starting at 7 30 p. M. Eastern on cspan3. Next, the Senate Judiciary committee looks at reauthorizing section 702 of the foreign intelligence surveys and act, orrveillance fisa. This hearing included representatives from the office of the director of the national intelligence, National Security agency, fbi, and Justice Department. It is just under two hours. This is an important issue that