Transcripts For CSPAN2 Tonight From Washington 20130730

Important contributions of senior negotiators on both sides. Particularly both of whom released the and stood strong in the face of criticism at home and whose unwavering commitment may belong to these talks possible. I look forward to beginning work with them tonight. Going forward its no secret that this is a difficult process. Its no secret that many difficult choices lie ahead for the leaders in the negotiators as we seek reasonable compromises on very tough and complicated and emotional and volatile issues. I think reasonable compromises have to be an effort and another negotiations will be tough, but i also know that the consequences of not time could be worse. To help the parties navigate the path and avoid its many pitfalls, we are very fortunate to have on our team on a daytoday basis and at this crucial time as the u. S. Special envoy for israeli and palestinian negotiations, insisting martin indyk will be important. It will be, as his deputy, and as a mere advisor to me, it will be Frank Lowenstein who has been working with me on this process since the beginning. In 2. 5 hours, a deficit reduction in the economy and then after that senator john mccain eulogizes his late conrad including retired chief officer george but they. The first lady reflects the United States and what we are supposed to do today. We as was to be mother in chief and to navigate that if the president is supposed to be out of state and out of government, is the first lady supposed to be the ideal fashion as to, is she supposed to be the mother in chief or the first help me, at the same time, if shes going to be first help me, just understand what is going on in the administration and what is going on in the country and she must understand her husbands local agenda. So you cannot really separate for the first lady presents herself in the conflicting expectations that the country still has poor working lives and working mothers. Consumer conversation on first ladies, historian and need a black and Richard Norton smith and others talk about the role of first lady and its move from Traditional Home and family to activism on the half of important issues and the transitioning from public back to private life. Objects, new Health Care Law and how it is being implemented and what it is decide content designed to do. The first of the program of the series of discussions focusing on health care. From washington journal, this is a little bit less than 2. 5 hours. We are focusing on the federal Health Care Law and we kick it off today with a series and we are joined by three Senior Correspondents who helped to guide us through the law. First up we have mary agnes carey. We have jay hancock, thank you as well. Both have been at the table before. We are also joined by sarah varney. Thank you for being here you can call us at 202 5853881. What with the original goals of the law . To have more people covered in to make the Health Insurance covered more than it currently does. We are talking about copays, deductibles, preventative screening and mammograms for women. There are no more lifetime limits on coverage which means if heaven forbid someone had cancer, there is no lifetime limit on recoveries. Also seniors have seen the costs go down for prescription drugs. So several of those benefits are already up and running. As we look at costs, what we know . There are concerns of adding additional benefits and some of these coming in for this exchange, enrollment starts october 1, either run by the states or the federal government and states. So the cost picture continues to emerge. If we look at the elements that have changed so far, these are for people who currently have Insurance Plans. He mentioned adults up to age 26. Closing the medicare doughnut hole is also on the list. It is significant. Because over time it has left them until they hit eight catastrophic gap. It has left them until having seniors are covering 20 of their costs in 2020. Many of whom were on fixed incomes or many who dont have a large income to begin with. This has been quite helpful for them. We are also seeing things like coverage cannot be canceled. Sumac wreck. This had been a problem several years ago. Then he wouldnt have this front element. Some people potentially lie. If we were actually talking about cancer treatments and an Insurance Company actually had internal departments that were set up to find errors on peoples applications. You can see that this person actually had acne when youre 16 and you had your appendix out and he failed to note that. So you could say he had a couple of highprofile cases where people were in the treatment and lost their coverage. We saw couple of weeks ago when the Obama Administration delayed implementing the and enforcing Large Businesses and having to venture their employees. It was significant because it was one of the major pillars of the law, which is youre going to get everyone insured and one is expanding medicaid for poor folks and the other is the individual mandate. Everyone over a certain income has to have Health Insurance. The other was employers are obligated to cover this or pay a fine and the delay was seen as a setback for obamacare for republicans it is very difficult to implement this will lock one of the things that is going on with this law is the number was passed in 2010 and it was supposed to be for years to implement it in with all of the challenges, it squeezed the time to implement. The time to get all this out, the rules kept coming out, the rules are still coming out, even as we are sitting here today. Employers were trying to figure out how they were going to comply with the law and they have to be in compliance starting january 1. The administration decided that we will give them a years break. We can all take a breather and try to figure how we are going to do that. I was actually at a seminar for employers that was done by Southern California. And it was eclectic about this. This was a week before it they made this announcement and he had this list of dates and by october 1 you have to give a piece of paper to every single employee, know what package they will offer and they were going to have to update their Computer Systems. Many of these employers did not have Computer Systems to track this to the level that they needed to. This was a man that i was talking to and he now said im having to buy a 100,000dollar Computer System on top of this. It is very believed, he was so glad he had more time. Now he has until next year. This october they do actually have to send out notice to their employees. If they have to buy insurance as of january 1. He has until next october to offer up in the moment was employees. Kaiser health news has launched a partnership today to explore the federal Health Care Law. I guess, the stories like usa today, the washington post, it can be part of this news. We are part of the Kaiser Family foundation which is known for its Health Policy research and all nonpartisan. As you mentioned, our stories to run and partners throughout the country. The editorial independence element means that the newsroom looks and works at all of the newsroom so it worked throughout our careers and we have decided we write them and pitch them to partners throughout the country and it is important to note that neither the Kaiser Family foundation is affiliated with the assurance that it implements. Okay, lets take some calls. Judy is joining us from work, illinois. Caller hello. Host go ahead, youre on the air. Caller and love your show. I am noticing right off the bat that a lot of them lawyers talk about this. I have been employed since 2009. It went from fulltime or parttime work in a lot of areas. And i just found this in the last 35 days. What im finding is a lot of them was actually trying to avoid getting fulltime hours even though the demands of fulltime work. They are actually going to the point where they are writing people up. To meet the demands of their customers. What can you do to report it. I think employers should do the american thing. They should get in if its just the same. They are trying to hide the so they dont have to pay. Guest one point to be made is that if your employer is asking you to work more than 30 hours a week and not paying you were not asking to pay for what you are putting in, that is against the law and they are not solicited. And you should talk to your supervisor about it. If you dont get any sense action and i talked to the Illinois Labor department or its equivalent. I dont know the exact name. The other point to be made is the big one, which he notes something that is a that of a trend going on and that is a the number of parttime jobs has been growing and this is given something of a talking point republicans because they claim that the growth of parttime jobs and the relative lack of growth in fulltime jobs they blame it on obamacare. And they employ people for over 30 hours per week. We are trying to give employees is under 30 split we are talking about. The question is will the economists blame the growth in parttime jobs on recovery from the recession and general and there is something going with globalization has to do with it. Many republicans are blaming it on the Affordable Care act. We will be watching the job numbers in the coming months as he was going on. Here is a story that was recently filed. Host this has indicated that we have in recovering from a bad economy and he expresses relief about the decision to enforce the portal tracts requirement for Employer Health Care Insurance we will talk about what this means for employees with me talk to jonathan. Caller i believe it was 20 or 26, up to the age that they would have an employer cover you as a student. Once you turn 18, time to get your own coverage for your own health care. These kinds of things. So its like i have health care until 26 years old under my mothers plan. But theyre not really allowing kids to be accountable to get their own jobs and their economy going for their own health care. I am 17 and i really want to know what you guys thought about it. Whether you agree or disagree that this is covered under the plan. Host you have a game plan for when you turn 18 years old imap we plan to continue your education or get into the workforce . Caller i plan to get a secondary education. You know, it might be difficult for me to afford my own health care, but that is part of life. To find a way so that i can afford my own health care. Host take us to this under 25 cut off and what it means. Guest the reason behind this is that so many Young Americans that were getting out of college with the economic slowdown were having difficulties getting the job of finding a a job with coverage. So that is why this provision was created. It has helped millions of Young Americans get covered. I think the callers concerns are ones that have been echoed on capitol hill. This adds expense that these individuals should go out and get coverage. And the Health Care Law does have larger deductible plans as kind of a larger deductible for individuals but he may find a good policy for him when it is time for him to go into the Health Insurance world. So there will be options for younger folks. They are called the young invisibles in the Health Care Law and there will be options for them. But if those arent there, this is sort of a tax top to help kids getting out of college who need coverage and clued those who need this, they are very happy to have it. It was a study that i did a story on a couple of months ago. We are asking the obvious question and having this tattoo from catastrophic issues. And of course it does. It looked that things that send you to the hospital bar none, poisons, traumatic brain injury, things he has to go to the hospital, before this provision was implemented and what they found was there was something around 100 and 7 million was uncompensated care and was not being paid out by Insurance Companies. So the question worked for a lot of legitimate economic reasons. Students were left uninsured and they would have gone to the hospital and would have been sued for claims or the hospital would have a clean that was uncommon. Host is set in the Washington Times today that republicans pushed obamacare funding. 39 of those polled said repeal the Affordable Care act come out obamacare, 36 that expand or keep it. So where are things that in terms of where the fight of this law. Guest it is continued. It is routed, it is very intense we are going to have the 40th vote to repeal all or part of the Health Care Law. This particular vote will focus on defining the Internal Revenue service from having any implementation efforts in the health laws and we know that there is the irs, the department of labor, the Health Health and Human Services department to implement the law. I think that we be a lot of good things for them and continue to fight the law despite the fact that there is a Supreme Court that upheld most of it and democrats kept the senate and white house in the november elections. They can republicans feel that the health law is not good for america or jobs. But they are very devoted to this, not only in these standalone messages, but as we work towards the continuing resolutions beyond september 30. Including the debt ceiling on the Health Care Law every front that they had. Host we thank mary agnes carey, libby casey and jay hancock and sarah varney for joining us. Lets take the next call. Caller good morning and thank you. There is a lot of information in regards to taking advantage of this. Will this be dissolved and i guess that my confusion is will this continue . Guest Medicare Advantage of reimbursements, the Medicare Advantage plans to cover seniors is being reduced overtime. They are trying to eat allies with the government pays for secret Service Versus Medicare Advantage and the program will remain. You talk about supplemental coverage. That is used most often with medicare coverage. Also stays in place. Guest i would add that a lot of people have been predicting a decline in Medicare Advantage coverage because of the funding reductions. We are not seeing them anywhere and Insurance Plans. Despite reimbursement reductions host david from new jersey. Caller hello, ladies and gentlemen. Good morning. What we have been encountering is for two years we have been unemployed for the same period of time. I have gone to the health and Human Services website to get a feel for how the Affordable Care act was forgetting insurance. I dont want to bash the program but it seems that msn that i dont want to publish the numbers. They dont want to talk about the monthly premium and how much it will be. As gold and silver and bronze package that they will have heard it so hard for the consumer to wrap their hands your hands around it. So what i have done is to go through new jersey Blue Cross Blue Shield and im hoping for the best. Im hoping for the 240dollar premium a month that they are offering for this basic plan. I am only doing that because i dont have one of confidence right now sharing information that i need. Im not in a position to afford this. A relatively high income earner in the last few years and im in a position where really have to take basic insurance. I dont really have a question. Its more of an observation. Does anyone want to add to that . Host you have anything to add . Guest one, yes, it is obligated. However, in a few months if everything works as it is supposed to or close to the way its supposed to, a lot of things will become clearer. New Jerseys Health exchange and help exchanges is are these online exchanges in which this go on for coverage. If the software is designed right you will be able to go on their and actually get a really clear idea of what your choices are in the plans and what the plans are going to cost. As open october 1. People like you have until march 31 of next year to sign up for them to get coverage and comply with the mandate. One other quick tip is to go online cool obamacare subsidy calculator. This is something that are colleagues of the foundation to put together. It is just a great tool that will show you not only what coverage is available, but what kind of subsidy will get based on her income to help pay for those 240dollar premium. If youre unemployed, you almost certainly qualify for the city. So check that out. It should give you a bit more information than we have right now. Host should he wait to try to get his plan until october 1 . And he will actually be able to go into one of these exchanges. Guest that is a great question. If you havent bought a plan and signed a contract already, wait until october because that is when the subsidies become available. They are not available right now. If you have bought the plan already, you are doing the responsible thing by being insured. You will get help if you a little bit. Host our guest is from the Kaiser Family foundation and you can see it here. It is a way to plug in information i doubt some results. We are seeing some tweets come in. Chances i believe most young people dont want to see their parents in terms of the confinement on their own. And then we see this. This is a twitter handle. But it is me saying under 26yearold need to reimburse their parents for their share and it will be cheaper than getting their own insurance. We see this also this point. The percentage of adults get catastrophically injured . Why does this provide us requirements to get insurance . Many parents are facing having to get insurance whether they get a job in the coming months. Mary agnes, can you talk about why they are covered . Guest younger people tend to be healthier. So you may be younger and healthier people in the risk pool to balance it out. Going to the point of jay hancock, looking at subsidies that could be available, not only with premium is, but the copays and deductibles and so on, you can get a lot of financials since to get to the Health Insurance systems and is part of the nature of insurance. This is where the individual mandate comes in. But its also important to know that there are a lot of young people out there looking at this and weighing the penalty which is only about 95 the first year or the 1 of your income and they are saying, do i simply pay a penalty would like it and pay Health Insurance. This is about the have to make. Sarah made a point the point that if youre not covered, you have catastrophic event. You get into a car wreck. You will be responsible for the cost of your not covered. Host you mentioned 95 per person in 2014. What is 1 of taxable income for this. Guest is whatever is greater of significant detail. Host welcome and 95, some people think it is not a big deal. Guest we might think twice about taking that in. Because they need you. Host george from new york. Please go ahead. Caller good morning, everyone. When it comes to this, it is still useful for families. If youre carrying in this country, the United States of america, care about the lives in different places. Host focusing on the federal Health Care Law this morning. Our guests are three senior correspondence from Kaiser Health. Theyre answering your questions about the law. We will turn now to look at the insurance marketplace is a little more specifically and here are some phone lines that you can give us a call on. If you have insurance even dollars to 202585380. If you are uninsured, if you lack insurance, at 202, 5853881. And if you are a Health Care Provider and work in the field, 202585382. We will take a couple more calls on our regional line before we start getting calls and based on whether not you have insurance. Lets hear from donnie in mount juliet, tennessee. Hello pass the three good morning. I work for a transportation company. About 30 employees and we could easily hire 20 or 30 more, were not going to simply because of obamacare. Vanderbilt hospital, one of the largest of america, of 300 people. That gentleman talking about the reasons that obama did not go ahead and institute is policy is simply because there are elections coming up in november for the house and that is pretty much it. My question and no sorry, i apologize. After get her name. The people that dont get insurance and get hurt. If they dont have the money and are ready getting subsidies they dont care if theyre responsible because theres no money to get. So what is the government going to do . Already paying for these people. What is the point of changing the system . It is the same thing. Thank you. Host before you hang up, any followup questions . His story sounds like when you might ever before. Guest is out there. A lot of anecdotes about employers. Holy cow firings. I suspect a lot of it is because of the uncertainty surrounding the rollout of the law. A lot will become clear about what is allowed them was not allowed. It will take a few years and to happen. Host this question is very much out there. If you dont have insurance in the to the emergency room and someone wrote to you and you can walk away handsfree. It is absolutely not at all like that. I met this one man down and browns row, texas. He worked fulltime. Uninsured, 22 years old. He the a couple years ago had to go to the hospital for an emergency. They sent him a bill for 11,000. 15,000 a year is his salary. What to do . I still have it. Somebody you if you wanted to eventually go and try and buy a house or try and apply for loans, that will be on his record. So this idea that you can just some have go to the emergency room instead of walk away, it is somewhat of a fallacy. Of course are hundreds of millions, if not billions of dollars of uncompensated care, but the price to the individual into the family into the financial record is not one of just a clean slate. To meet this is simply health care that has to do with big business and money and Insurance Companies. Did any of you people see the hourlong special on Public Television where they compared Health Care Cost from this country to other countries in the world . Did anybody see that . Because it will open your eyes. Makes this look like it is nothing but Insurance Companies and politicians just agree and money. My brother once had an mri one or two years ago, 1,300 perry told him he had to have a special mri. He had to come back and it would cost and 2,000. Any other country you would have went to would have cost 91. A doctors visit in this country, you walk in with 15 you can see a doctor. Does not matter what kind of insurance you have. Some countries actually have a limit on how much money a doctor can make per your. At the time he is that limit he is working basically pretty much for free. Want to know why it is that this country with the politicians in the Insurance Companies dont seem to care about the elderly or the kids because theres no money, why is it that this country has to have this kind of a Health Care Deal . Host lets get a response. Guest well, other countries are looking. When the Current System the with the United States, as people would say no. Different health systems. They did. End say left immediately. The United States Health Care System is not one that is seen as a model by any country anywhere in the world. It has an academic history. During World War Two companies are allowed to the increase salaries for workers. In order to create enticements to keep workers. And this is something the works its way into the american Health Care System. How we now, 40, 50 years. I dont think that there is anybody who would say that this is the perfect system, but it is one that has been built upon and built upon and built upon. Politically it is pre intolerable. The congress, the democrats said that they wanted universal Health Care Coverage. This is the political possibility that may happen. It is complex. Very expensive. One of the things that we should mention is that to it is designed to control some of these costs. Reduce the on affordability of this year expense of these procedures and the number of procedures. Interested. The problem is to then go into different parts of the health care center. Where should the cost come out. That guy. So that is the big problem. How do you get people to agree. What needs to be about a 20 20 about 20 of cost to come out to even begin to match what other developed countries are paying for health care. Where that goes from. Visited by three guests this morning. Health care correspondent at Kaiser Health news, washington journal has lost a partnership. Digging into the federal Health Care Law. Ma agnes carey, sarah varney, and jay hancock are our guests. The stock above the exchanges or marketplaces. What are they . Guest the marketplace is the new term. Exchange was sort of the policy term. The administration, trying to read branded as a marketplace because they think that that is more descriptive. Here is what they are. Theyre mainly on line based places where you can go shopping for health coverage. As we say, october 1st is the date that theyre supposed to open. They have been likened to travel loss d or orbitz where you go online and walked through several steps to buy tickets. Hes will be much more complicated. We will be interesting to see how the design of the software is to get people to the right insurance places. It is not so october 1st. You will hear more and more about that the exchanges. You will see reject campaigns by the federal government and the states the sponsoring these changes. You are going to of start hearing about navigators who are sort of consultants who are out there to help consumers sign up through what is going to be a pretty complicated process. And the idea is that based upon this individual mandate the says that individual sub an obligation to us seek coverage and pay a fine, those lacking cover sue their employers, not eligible for medicare and medicaid will go to the exchange , up, get credited with the subsidies that we have been talking about on the spot and they will be insured for health care after that if everything goes right. Host our time line, open enrollment. January 1st, the exchanges began. We are seeing some states want their own exchanges. There are some partnerships. Here is a map. Sarah varney, what are we seeing . Why is it significant that some states like california and nevada are doing state based exchanges. Defaulting to the federal exchanges. Guest this database to exchanges, they have decided they will run their own exchange and even within the state based exchanges, and chicken talk much more about this than i can. Coming from california where been following what is going on with the California Exchange, even within a state based exchange you see different kinds of models. In california there was an active purchaser. When the California Legislature passed this law setting up this exchange, they essentially authorize the folks who run the saints and negotiate directly with the Insurance Company. I went to the unveiling of the race about a month or two ago, and it was a party. This big museum in sacramento. One hundred people were there. You felt like you were going to our shores something. You know, they flashed up the rate on the screen and everybody started duping and hollering. There were very proud of the fact that there were will to get several dozen insurers to bed, participate in the California Exchange and ultimately ended of selecting 13. And the rates were much lower than what people anticipated. And that think were seeing that in maryland. Were seeing it in a couple of other states where the rates are coming in lower. California is the active purchaser who. Others the same we will put up the marketplace and build the website and then anybody can sell their wares as long as they meet certain requirements. Host states that have a hard time getting Insurance Company interested. Guest there was a sort of late swath in mississippi where there will be no Insurance Options for anyone who lives in the delta. And among other places, an Insurance Company, a marketplace mean, it is something where you have to have customers willing to buy a product. If your company and look at the delta or another part of the city or wyoming which only has a half a Million People in the entire stadium might make a business. The companies for the most part. Host j hancock recently filed this story is about a month old now. Thousands of consumers may not be offered insurance subsidies. Take us up today. Since we wrote the story, when we wrote the story there were blank spots on the map. It was the subject of great consternation. Host use a blank spots. What does that mean . Guest if you are eligible for health care and subsidies to by the exchanges, i want to go buy these change. You sign up. No one would have been offering something in your part of the world. Since then the part of health and Human Services in washington as well as the insurance commissioner has been working really hard to persuade some of the Insurance Companies to get in there. Hunan, one of the larger medical insurance, and there are other states where it is thinner than others. Other states, such dakota, the empty county, no choices. They may be substantially thinner than they are in some of the states other really aggressive like maryland and california. All health care is local. In california for instance you have the states that a broken up into different regions. And so the Insurance Companies have to come in and farm partnerships with providers. Those Provider Networks are local, regional. So youre talking about, you know, regional laws will change in Southern California and building around that a network of providers. That will work very different. Maybe only one hospital and it is a public hospitals, so they have to build a completely different network. Seven terms of how that morphs into their ability to offer an affordable insurance package really very much depends on who the providers are in the local areas. Host can you comment on the average number of plans offered in the state marketplace to make you must know whether whether there will be sufficient competition. Lets hear from our callers. Beverly in north carolina. In short. Caller hello. I am so glad that you guys are there today. I am so ignorant about insurance. I talked for years. My husband and i taught for years in new jersey. We were both covered by Blue Cross Blue Shield. I had tech go out on leave. I could not finish my term. Had to go out on leave to take care of him. He had a stroke. But it did not matter to me because i was covered under his insurance. I lost mine and i went out. However, he passed away. And they informed me now my insurance is not free. I would have to pay. Okay. It did not bother me. I went on unpaid. Every year my premiums and more and more. Now is 401 taken out of my pension check. And after have insurance. Does not matter. I heard president obama saying something about if you are in short and youre paying premiums youre going to get money back or something to that effect. I dont know anything about it. Upset them. Maybe they will make i dont know anything about it. Could you just answer that for me . To you give money back to what . Guest of very sorry for the loss of your eyes and then having to deal with all of the insurance issues youre dealing with. With the president is talking about is the Health Care Law that requires insurers to spend at least 80 percent of the premium dollar on health care benefits. Not administrative costs like the salary or other administrative costs. We talk about people getting money back. Really referring to people who buy their own Health Insurance and the individual market and that day may get a check back from their inshore. Then they have already done that if the insurer did not meet the 8020 in their Health Insurance law spinning at least 80 on premiums. One thing about this provision is if you go by yourself, your employer buys it for you. Your employer may get that money back and you dont see the check. That is a little confusing. But to your earlier part of your question about how much you are paying right now, i encourage you to look at the exchanges. I think you said you are from north carolina. Look at those in your state and see what subsidy might qualify for. You might qualify for help with your actual premium. Also your copay and deductible. Youre retired, pension, your income may not be high. You should take a look at that and see if you can get a better deal on the state exchange as part of the Affordable Care act. A comment on our facebook page. If i was a young and healthy male in my late 20s and that did not want Health Insurance, should not have to pay a fine, and a story. We are collecting your comments and questions. Look for that cspan logo. Those numbers of what you will pay if you dont get insurance come of the penalties will work in 2014. Next year 95, 1 of your taxable income, whichever is higher. Because of from there. 2015 we see that amount rise, and then it is 2 percent of the taxable income. 300 if you dont pay. Then it goes up even more in 2016. The numbers rise. After that is annually adjusted for costofliving increases. How is the government actually keeping track of this . How will they know you have not paid your insurance . Where they come knocking on your door or will they in seattle when it comes tax time . They ante up. They tracked through the Internal Revenue service. They will take your premium or a return and other steps to collect the money. Host go ahead. Guest and one thing we should note is that if you dont pay and the law it is not a criminal offense. You cannot be prosecuted. They can, however the worst that could happen is they could garnish your paycheck in the future. If you go penalty. It will be interesting to see how much information the irs has to enforce it in the early. A huge role in this because not only are they enforcing a, but they have to there the ones to verify your income. So there will have a lot of permission. But the enforcement aspect is one that nobody has really concentrated on now. The white house is not really want people to concentrate. They once implemented and lori about the penalties later. The Tax Corporation companies are interested in Health Care Law. Jackson hewitt and a couple of others. Stepping forward and say we will make this part of our tax preparation process. A lot of people go to those companies are not high income earners. Their workingclass families, middleincome earners. The idea that these have is that we will sit down and up the figure out what we think your subsidy will be, help you figure out how to apply that proactively so that you could potentially have a lower premium so i think people are working with one of those companies. There will most likely be asked to also talk about the Health Insurance and be prepared to talk about that. Washington maryland. Hello. Hello. I am running short but i have been doing a lot of taking care of myself with natural means. The main reasons Insurance Companies. I would love to see this insurance. I wish people would stop calling it obamacare. Its going to work. Way to have people stop listen to a fox cable. They hasted of the art Insurance Health care, and that is what we need. Access to the health care. I now want to go to the doctor anymore and sit for an hour naked in gate tyumens worth of the dodgers time. On wondering if the office visit costa hundred 50, 10 a that is going to your actual of your. Also, i will ask the question, can we ever come to a time where we would actually have no employers responsible for health care, Health Insurance . People need to be a will to have their own health care and i hope that this is to that. Host the style van. Guest there is certainly a lot of interest among republicans. Some other analysts say that it should not be linked to your job is something they have that is affordable and the to equity. So that bob is out there. That is not what the luke does. It would not surprise me if several years down the road use of that delinking. Waiting for your technician, but you will have more Preventive Care coverage. That will be interesting for you to look at. Riyadh did these things called explanation benefits are the Insurance Company talks about what was charged and what you have to pay. That will be worth watching. The frustrations that you expressed with getting your own health care are shared by a lot of other people. Why is the language important . We have heard both of our callers as well as you use the word obamacare in the Affordable Care act. Why is that significant . Words carry meaning and they carried hidden meanings beyond the literal meaning of the word. Obamacare started out as being a pejorative term, the basic protection and Affordable Care act. Trained by its opponents, used as a obamacare. A complicated law. Last year, maybe before, i cannot remember express precisely the administration started to embrace the term as a brand. The president said i do care. And from some of these groups that are actually trying to promote the long. The public at campaigns, thanks obamacare. Examples of benefits. And now i sort of just use it as a shorthand. Basic protection and Affordable Care act. And i think that is overseeing now. Some people still see political meaning in a, but journalists on both sides are using it. Headline. We tended toward out. Will it reduce the cost of health care . They have said things like if you like your Health Insurance policy you can keep it. And has proven not to be true because employers make those decisions on what is offered. It goes machine is up next. Health care provider. The question, could your policy in place. One hundred, 125 bid i can take a guy right now 55 years old getting covered. That may be 700. It is a problem depending upon their income. At think it probably does make sense to wait until whatever because he is eligible for the subsidies and it will be available. You are not eligible for the subsidies we should say that right now we keep talking about subsidies. Subsidies are available for a family of four. You have any, up to about 94,000 change. You could make a fairly substantial middleclass income and still be eligible for the tax credits of were talking about. For a Single Person is above 46,000 insurance. Again, the middleclass income, youre going to be able to go on the stains and get these tax credits applied. Some of the Sticker Prices are starting to read about in the newspaper now, depending upon your income, again, it will not be what you pay in the end. Your point is a good one. 100,000 per year. The get a plane because in some cases that situation might change starting in october. Might be a better deal for you to go in and locked in now. Hello. Good morning. How are you . Good. Thank you. Quite a bit of concern about the republican people. I guess i would call the people. Always trying to diminish government. I am all for a very strong government because that way we can be governed. We can be accountable. You know, the people that corrupt the systems can be held so be liable or criminally, you know, charged with something. But you know, the republicans keep hollering about too much government and stuff. And we need to enforce laws that are there such as the epa, health care, you know, trying to be good citizens. Host de you have a question . How this Health Care Law will impact coverage and medicare. Caller yes. Somebody should answer because i already have health care in the medical you know, medicare. But my wife was in the hospital three or four years ago. I have bills. She was in gospel twice for just overnight, maybe half a day. Bills for over 35,000. We have medicare. We are eligible for that. So here is another case. The hospital. I really, really drive cover the cost. I would have to pay for being injected with the little bit of juice, you know. I dont know what they call it. Anyway. She was in their two and a half, three hours total including the weight and time. I got a bill well, i did not the bill. I was being billed on the spot. May be added get a bill be read 1,400. I showed up in the office and correct about it. Okay. You are gripping enough. In that sense. They tell me, well, we will put it down to it under 66. Caller okay. Negotiating cost. Guest i dont know if your wife is still on the line. Im a little concerned about the bill if your book on medicare. Im curious about why, 35,000. That is if i got a bill like that, not on medicare but private insurance, i would call the Insurance Company and ask. This is a cautionary note. We are talking ross something this sounds really boring. Your explanation of benefits, that piece of paper that comes in the mail. When ec online. Try to explain was being charged and the you have to pay. You should question that before you pay a bill if you think it is too high. That is my number one spot. Host we are seeing questions comment. Here is what bob right spirit with the average person needs is a stepbystep instruction. All the impression is too general and confusing. That is what is supposed to happen when the exchange is open in october. And it might help to up explain a little bit in more detail what you are likely to see when you go online and try to buy Health Insurance through the local exchange or market place. First of all, each state will have a different name. In maryland is the Maryland Health connection. In california. Cover california. Cover california. Every state will have a slightly different name, but you are going to hear about it. The publicity is only starting to read you will see ad campaigns, even if you dont know the names, go online. It will,. It will have a website that will look Something Like these travel web sites. Hotels. Youre going to go on and do several things on strong mind. Again, software design, it will walk you through these decisions one thing that you need to do is verify your income. There will be a link with the irs records, you can go wind and put in your Social Security number and say okay, mr. Smith, you earned x last year. Youre eligible for this amount of subsidies. If you want advanced notice of what that will look like, go on the Kaiser Family foundation subsidy calculator and you will see that. Once you qualify for a subsidy, then you will go through and shop for insurance coverage, just like you shop for a plane flight. You will see all these different choices, and the software that is good will help you choose. It will help you to ask your priorities. For example, is it important to keep your current doctor . If it is you will. Yes, and say who your doctor is. When his lawyer borden . Below is the absolute cost. You want to pick the lowest premium possible to be the answer is yes sir. You may not be able to keep your current doctor because of a lot of these plans that are being sold to the Online Marketplaces are doing is to save costs they are setting up what are called their networks where is a relatively skinny group of doctors and hospitals who will be available to treat you, but in return for error that narrow access to these providers the costs are down. A thousand doctors and say your return for this, giving you a higher volume of patients. Cut your costs. That gets passed along to consumers and islam with the competition is working in a big way in trying to get trying to get everybody, providers, insurers to give you the best deal. One thing that we should really mentioned that we have not talked about yet about these exchanges is your ear and a lot now of about Sticker Prices for these plans. We did one on marilyn last friday. And the typical six price, you are going to see for the lowest benefit, bond plan, but technical, but bonn plan, you will see these on every exchange. Bonds, silver, gold, platinum depending upon the level of benefits that deliver. A bronze will have lower premiums, but you will have a relatively high number of copays and deductibles. When you go on the Exchange Floor of the things you need to do not just Pay Attention to the Sticker Price. A Sticker Price for a bronze plan will probably be in the 200, 300 range, made 200. In some states less than 200 per month. Sounds pretty good. Less than 2,000 a year. One thing you need to look at them one thing the exchange released its focus on, steering people through this, look at your outofpocket cost. Dont just look at the premium, particularly if your medical issues. We need to figure out what the total cost will be for the year. Exchange software, go through all the states. The programs and thats what the good ones to, they show you the upfront price. Show you your total cost. Directory to your state Exchange People go there first . You can go now and see what premiums are costing the state now. And i cannot imagine. Because you mentioned the out of pocket stuffed with the copay. Make sure my numbers are right. Can be as high as about 5300 for an individual and 12,000 for families. To your point, you really have to figure out. My premium might be low, but how much am i expected to pay and a pocket . The federal health care line in answering the question. Three senior correspondence from Kaiser Health news. Thank you for being here. Letting of the phone lines based on your job and whether you are a boss, employee. We are going to look now what what it means for the workplace. If you are a Business Owner, call us at 202 5853880. If you are selfemployed, 202 5853881. Employees 202 5853882. Thus the star with a call says we are getting some coming in. Hello. Hello. Thank you for taking my call. I have two questions. I have been working since the age of 15. I will be 65 on friday. And in 2008i started getting Social Security bins disability. I also have a subsidized insurance through the state. And it is called a epb. And it has been great for me. I have been seeing the same doctors that i had for 15 years. But i have to work. If i dont make 60 per month, which is not much, and im glad to do that because i have been working since i have been able to parttime in order to have the in a ped. I work for a school. When school is out then i am in limbo about my insurance covers to the state because of the kind of plan that i am on. If i am not working and i have a spin down of 1,000 per month for the ma, the medical assistance part of my insurance. And i cannot afford that. So i just was wondering if the Affordable Care act is going to help me anyway so that if i am not working that i can still have coverage through the state. And employee about to turn 65, you said. Yes. So lets get a start. My first thought is that you should you can either go to medicaid or call the it hundred number and find out how medicare might sink up with the current covers the you have. Sixtyfive on friday. So that would be my very first offer you. Also, the providers you are currently using probably know your state program really well on how it may or may not work with medicare. Lets hear from jonesboro, arkansas. Selfemployed. Yes. Good morning. Thank you so much for taking my call. I have a question, a 2part question. Number one, will the exchanges, will they be offering dental and vision plans . Number two, my husband is on medicaid. He is on part a in part be. Would i be able to get dental and vision care for m even though he is on medicare . Will take my question of fair. Before we let you go, insurance now yourself, selfemployed . You paying for insurance on a pocket . Yes, i am. I am part of a selfemployed plan. Through the state of arkansas. They are health networks. I pay a premium every month of 35. That gives me six visits to any doctor that is a network. Redeem 50 of the total charges to the doctor. As really being quite affordable for me right now. And that program is going to be ending on december 301st. And now i will be shopping and the marketplace here in arkansas. Really excited. The. Guest to respond. It is a great question. I dont know whether dental and vision will be on this exchange. That is only for children, pediatric dental coverage, and i believe vision not in the sense of you go to the optometrist to get glasses. If you have a problem with your redneck, medical issue, you might get some coverage, but not as many. I dont think it will be the same on the exchanges. Sounds like the exchange might be a very good option for the caller. Eurus shaking your head. Just to say that in california we have been anticipating practice for the pediatric dental plan. Adults rental is still considered, the mouth as the orphan norden. The interesting thing about dental. Can be offered in the medical package or it can be a standalone. Most of us get dental coverage for standalone packages, but if that is the case and you want to buy that for your child you have separate copays, separate deductibles. It has been a bit of a problem. A democrat of maryland has been very concerned. It is something that hhs is watching. A Business Owner, selfemployed, very Small Business or oneperson shop, how do you approach this . If i am of oneperson shop i forget that i am business and go shopping as a consumer. That is where the subsidies are likely to be the best. That is where your options are likely to be the most. As you point out, there are two products that will be on the exchanges. One is for individuals and families buying directly from Insurance Companies as we talked about. The other one however is for Small Businesses. Small businesses under 50 employees will be able to go buy coverage for their workers on the exchange. It is taking a little bit of time to get ramp up. The idea was that i am by ron a car repair garage. I have 25 workers. I the vision was that i could signup on the exchange. My workers could go on and sort of shopping in the same way that individuals allele was shot. They go through these choices since become a multiple ensures that we have been talking about. That is not going to happen. That was one of several pieces, just too complicated. The socalled shock exchanges, Small Business will be in business, but there will only likely be one choice for employees. You will offer coverage to your employee at a Small Business sector the contract with one Insurance Company and that is your carrier. We see that the plants torus element has been delayed and as you mentioned most employees will only have one plan option. By 2015 there will be more of a choice. Says. Yes. That is the idea. Joyce presuppose to be about competition. It is supposed to be about diversity. And joseph horizon 2015, your employee will go on. You will have choices that looks somewhat similar to what individual going and the exchange and shopping would do. And the reason why it is important is because right now obviously a Small Business, when the Insurance Broker that is all were looking at. The shop exchange, everyone is in together. You pull your resources and they give you better Bargaining Power the Insurance Companies are it will offer a better deal. And it is risk sharing. The employer, you know, the kids summer camp with the average age of the employee is 23, they will pay about the same, a similar premium as an employer with an Older Work Force in higher Health Care Cost. Lets hear from a Business Owner in cleveland, ohio. Go ahead. The insurance, 75 percent. Going to be a fee, a tax on the insurance policy. There is 0. 18 per person in search for the patients average institution. Five to five per person transitional insurance fee. To 3 percent of your premium. Its market share feet. We figured it out for a family of four that is like 59 per month in federal fees. If we switched to a marketplace, they going to have to pay federal fees . President is this for private insurance that has to pay the federal feet . The fee will be levied on all insurance products. With this exception. We have not talked about Self Insurance, and this is something that is traditionally practiced in very large companies. It is basically when the employers, the medical bills. The employees will have very high medical expenses. Paying the bills directly. Contracts with the administration to pay the claims and then the employer writes the check. What is going on now, smaller employers, even employers as well as your company, soup, are looking at Self Insurance. One reason is that the access you are talking about is not levied on Self Insurance because it is not really an insurance product. Sort of the rubber hits the road. And what is going on is that businesses, even smaller than yours ourself and shoring and then theyre going out and buy reinsurance from Insurance Brokers to has the rest. For example, if you go self insured you can go by reinsurance that would kick in if any single employee of yours as Health Care Bills of more than 10,000, you would not be liable for that afterward. Again, it looks like insurance to you and your employees. Not only do not pay that tax, but youre also exempt from some of the the required Health Benefits that offers an it is controversial because there are too Many Employers that might do this. It sort of shrinks the risk pool that we were just talking about. It spreads the risk across and lets everyone share expenses and it is a concern of the Obama Administration. They have not talked a lot about it, but for firms like yours it might be an option while it is still allowed. I would talk to your broker and see what he has to say. Questions coming in. What does the federal Health Care Law change for people who have Health Insurance . Questions about that. You are probably having more Preventive Care with no copay a deductible. One thing i noticed in our house is ride took our children to the pediatrician for their annual well child as an added not have a copay for deductibles for those services. Again, perhaps screenings, mammography for women, cholesterol with the, that is one thing that may be changing. Again, if you have an adult child up to 26 in your house why does not have a job or does i have an offer of coverage you could put that on Health Insurance policy i beg your pardon, the same thing we have been talking about, no lifetime limits, no annual limits for adults. You cannot be discriminated against based on a preexisting medical condition that is also kicking in. The thought is that there not only creating these changes and subsidies to help people that dont have a insurance theyre helping people that have coverage of more benefit. The big question is what does that do . We should probably mention while they are on the subject of people who already have coverage with their employers, employers and their Insurance Companies are making changes in the coverage independence of the Affordable Care act. In the hallmark of wars going on is what is called Consumer Directed Health plans, more colloquially known as High Deductible Health plans. And i would bet that a lot of people watching now are seeing this in your place. Your employer is asking you, much higher deductibles, often as much as 1,000 or 2,000. You go out and seek medical care the ida is not just that it saves the employer money. They like that part, but theyre is a philosophical idea behind it which is that now that more of the responsibility for payment is on your shoulders, that is supposed to serve to a savvy shopper. Youre supposed to start comparing prices, start calling when you have an expensive procedure. Suppose to start calling. What will this cost the will you charge me . The problem. If your doctor says you need a colonoscopy bad example. But the doctor says you need an mri test, you have of that mri test. One of the callers pointed out, the prices for mri tests are huge. Your Insurance Companies are asking you to go shopping around now, but the larger point is that the cost sharing is going on to a much larger degree among employers of all sizes. These high deductible plans once upon a time or typically used by Small Businesses because of the premiums being cheaper. They can afford them. It offers some coverage. Now even the largest employees are having high deductible plants often with what is called a Health Savings account which is sort of what your retirement. Pretax money into these accounts and then use those to pay these higher outofpocket expenses. A lot of times your employer will kick into that pot, but not all about. But this has little to do with the Affordable Carex that is going on. And it is actually sort of a counterweight to to the political ac a. Everyone focuses on what the Affordable Care act is doing to consumers. A lot of taxpayer subsidies. Republicans have been arguing for more consumer and put into health care for years. What is flying under the radar year is very interesting. And servers conservatives are getting a lot of what they want. The health care policy. The Health Care Law rules out. And our guests are mary agnes carey, a longtime reporter who has covered the Health Care Law, Health Care Reform, she watched as it became law on capitol hill. She worked for Congressional Quarterly fire and also has worked at pyrogens newswires. Casein is a Senior Correspondent for Kaiser Health news, a longtime reporter for the Baltimore Sun and he worked for a newspaper in virginia. We are joined by sarah varney. She comes to us from california visiting washington for this very special show were doing today. She worked for a long time kqed public broadcasting in San Francisco and a lot of Health Care Coverage as part of the california report and has also filed for the monthly magazine help dialogue. We are taking your calls. Is that health care. It is insurance. Certainly. The primary goal of the Affordable Care act. A whole bunch of other things. So were talking about the mechanics of security and by far the largest filing for bankruptcy in recent years and recent decades. Health care costs. And one of the reasons behind the dca, nobody should have to go bankrupt because they get sick. And again, Kaiser Health news , objective reporting. Is the goal to market Health Care Law or educate and learn about it . The goal is to explain policy and politics. We cover things other than the dca. Hospitals, insurance, providers. Every neck and cranny of the Health Care System. We have folks dedicated. There is no doubt. We are good at explaining the law, but we are certainly not here rochester in new york. Go ahead. How are you. Your guests are excellent. Thank you all for showing up in being so professional. I am a selfemployed. I dont make very much money. I am a handyman carpenter and painter. We prepare stuff. And often i make lessons. Mostly i make less than 17,000 a year. Am i going to be required am i going to be put on some kind of subsidy thing here . If i got insurance outside of the whole obamacare thing to then say, well, you dont have to apply . Am i roped into this matter what . You are exactly the kind of person, the exchanges are meant for. Youre right on that line. A subsidy in these chains. So you are in a state that has expanded medicaid. Were talking about there, up to of hundred and 30 percent of the level which is about 15,000 per year. If you were to be below that qualify for medicaid us sit in new york. Sensor just above that you will go on to the exchange. Go through this process. Because of your income you will be eligible for the largest subsidy. I have not seen in new york members, but in california which is another big state that has a lot of people, mostly in the york. A fairly robust exchange. We are seeing in some of the markets factoring in the subsidies about 90 per month in some cases a little bit less. And so id you are exactly who the exchanges bill for. And i think you will see that you would qualify. We should mention, andrew, that the exchanges are from Medicaid Enrollment as well. It should not matter. You dont know whether you are eligible or which one youre eligible for when you go to the website, and you should not have to know predations year steer you in the right direction a matter what the case is based on the income numbers and the other reformation. Kaiser Family Foundation as this man showing as with states are running their own exchanges and which are defaulting to the federal government is changed. The state based changes are in the darkest blue. Federalist changes in the latest color, and those are doing a partnership in that midrange blue. Some of the states have already launched their ad campaign. To let people know about what is happening in the coming months listed to listen to an ad that is airing in the state of connecticut. One poll i thought was interesting was a Kaiser Family Foundation Poll from pill talk about 42 of the people they talk to are uni ware that the Affordable Act was part of a law. Connecticut is moving forward with the exchange. It wants people to be aware and get out there and sign up. So i think its one of the things if you havent paid attend you can tune in now. You hear a lot about it in the month ahead. It has been a question in term of strategy. When do you launch the adds . Weve been to the movie or see the preview of the new tom cruz film that wont come out until next april. How am i supposed to remember that . There are is a discussion when you start to air the thing . Weve had at love callers say i go to the website and cant find where im supposed to sign up. You cant sign up yet. I think theres a question when should the bulk of the ads hit the air waive. Should we talk about the law with people even though theres nothing they did do now . I think some states where they had the money and the resources they can get out there early in california you havent seen a lot of ads yet. People are saying in Rural America which is one of the big organizations that saying were not going to launch a major ad campaign until the fall. Here is a extent from james on twitter. A question that has some implied commentary. Will the money spent on advertise dog anything to cure one sick person . What it will do is increase the health of these risk pool we keep talking about. The people that are really going bombarded by the ads publicity, if it does the job is the young invisible that mentioned early. Exchanges open for business the coverage they provide is available january 1st. And we all know that people who have medical needs, who have ongoing chronic conditions who see doctors regularly are going to be first in line to sign up for the plan. If they are the on ones that sign up. The premiums you are quoted wont be realistic. The cost per beneficiary will turn out to be too expensive. This is what happened again and again and again with attempts to expand Health Insurance in the past. The difference now is we have the mandates that require everybody to be in the pool or pay the penalty. And so we can go to see a lot of is ads targeted at people in their 20s, people in their 30s, to get them to the pool and to answer the implied commentary is no, that wont cure anybody. It will make these exchanges and insurance pools to sustainable. It will spread the cost around, which is the intent of the act, and make it sustainable. If we see Insurance Professionals call a death spiral. Which is the technical term is adverse selection when you get too many sick people in the pool, the cost per person go way up. Even the people who need coverage cant afford it. The ads are supposed to prevent that from happening. Guest i did some i sat down with the ad man in new york city and we were, you know, shooting some idea around. Hes a biomarketting expert and i was sort of saying, you know, imagine you have any budget in the world. You can have to get the young people to the pool. How do you do it . Hes thinking not Just Television but internet advertise. Embedded branding in jack video and mtv and thinking about geico. You look at Car Insurance ads. They are wacky. You have flo, and the gecko, and the question is could Health Insurance ads essentially go that route eventually . He seemed to think so. Host lets here from byron in northbound who is he tired. Hi. Byron. Caller good morning. I have a unique situation. Im a retired federal employee. I went on medicare aid. I also still work. Im a trucker, when im working im under the teamster insurance. At times im under different local teamster insurance at times i have three insurance programs. I have federal and two different teamster plan. I have va. Im a vietnam veteran. I do cva for checkups. My question is this, how is it going to affect my federal insurance, and do i lost my train of thought. Somehow it going affect my federal insurance on my premium going go of off the chart. My wife and i are on my federal insurance, and also why is it when i have the three Insurance Plans going, nobody wants to pay for anything . [laughter] im insurance poor at time. I have all of this insurance. I would love to be able to take one of the teamster plans and say give it to my brother or sister who didnt have enough time to keep it going. But i cant do that. Im ham strung in that. I think industry is kind of ham strung in that type of thing too. So anyhow host byron. Stay on the line in case our guest have followup questions. Guest when you file a claim, who is your primary insurer . For example, when if you are married to someone and they may ask or may say date of birth, for example, distinguished who is the primary insurance carrier. Who was born first. What did your insurers tell you about that va or . Caller okay. Okay. Generally speaking, when i am not working for the teamster. Nordz when i dont have enough hour to carry the teamster insurance. Im under the federal blue cross. The va only use for myself only when i have to have my checkup for the agent orange. Theres no charge there. When i get enough hours working to pick up the teamster insurance, they then become the primary. And if i go to another local at the same time and pick up enough hour on that insurance, they would then become the primary. So i did have a blue cross federal, blue cross massachusetts, and cigar in in new hampshire. All at the same time. And its going to be signer if im working for the steam teamster. Guest it sounds like you have it down. You know where to go and file the claim. The early question what its going do to the federal coverage. I think as you know, the i want to say open enrollment is this fall for the federal government, and youll have to wait and see what the choices are. Theres no particular reason why it would change much. Then again insurers make the decision whether or not they want to offer to central employees. Its about 9 million covered. I think you can see that happening this fall. See what your options and see what your costs on that would be. But you definitely you right. So you at loch insurance and overlap there. Complicated case. Very interesting. Host this is why twine didnt pick the model for the United States. Kelly in georgia and is selfemployed. Good morning, kelly. Caller thank you for taking my call. Our situation has been a little bit different. I my husband was fulltime employee, but the moment they enacted Affordable Care act, my husbands employer moved many, many of their employers overto what i guess you could call 10 0e9. Thers pacifically forces you irs forces you to basically claim selfemployed. We picked up private insurance. Due to my preexisting conditions. Nobody would cover me. I was awarded disability, and thank goodness, i received medicare. However, in our town, as im trying to get a doctor, no one theres no doctors that will cover a medicare patient. So those are just basically a few comments. Im having a hard time finding a doctor. My husband; however, his private insurance the premium continue to go up and up and up and up to where we finally had to drop it due to me waiting nearly four years trying to get disability. Now were trying to look at the Affordable Care act, georgia is a little bit different because they have not wanted to participate in the exchanges. We are trying to get get him insurance. Its been a hassle trying to figure out. Host as kelly mentioned georgia is a society up by the federal government. Tell us why thats significant. Guest even in the state like georgia that are not doing their own state run exchange. There will be a exchange available. You will be able to go online starting october activity starting you go to health care. Gov or tell you a link or what the georgia website is. Youll be able to go on the georgia website and figure out through a calculator whether or not you or your husband, your husband, i guess will qualify for the sub i did. It wont be until october 1st. Host i thought her medicare question was interesting. Its ban concern about the country. You hear a lot of evidence from particular people. Maybe they have access finding pry pair care physician or specialty doctor. She obviously, you know, again its something she may have to look beyond her hometown where she has coverage. Its something that as you hear a lot about all the time. Host we would like to hear from your ensured or uninsured. Were going to change up the phone line. If you receive medicaid call. If you have question about what Affordable Care act or obamacare the federal Health Care Law mean to you. If youre on private insurance you can call it us at 20258533881. If you are Health Care Provider 20258 a 3383. Caller good morning. Good morning to all of your guests. I want to make a comment that selfemployed 1987, and i have seen Health Insurance skyrocket and become completely through the roof. And as the gentleman who called in from new york who basically handed me a Construction Business my business is also link to the Construction Industry as well. I can tell you and most callers listening will certainly affirm that in most industries with especially construction we are still working off of maybe 19 mid 1990 pricing for labor. We have watched everything around us like material and Service Continue exponentially up. I think the big problem. I would like we basically have a new economy if a Corporate America has gotten to a point where it used to be good profit in the 60s and 70s. If your part of the corporate you can continue to get pusher problems, rate, and because you gain [inaudible] you can be [inaudible] in the second part how the issue with is a simple fact if basic sense. I think we have to be able to connect your academic to what happens to the people who are in the undercurrent. That disconnect is further causing problem in the health care industry. Why do we need a broker to get health care if the doctor who is in business is providing my health care. This money would be better spent if we could give doctors or other care professionals the wherewithal to house their own administrative processees to be able to host okay. Lets get a response. Thought about the Insurance Industry and their role. Guest thats one of many complaints about the u. S. System. One of the reasons why way taiwan decided not to when the u. S. Implements Affordable Care act, were going have all of these different layers of administrators, managers, supervisors, over and above of the care giver who are there on the ground making people healthy and curing them of disease. We have employers, we have Insurance Companies, we have people in washington administrating all of this. We have the exchanges now. We have state exchange organizations. One of the big arguments about health care were going to continue to hear it in years, dare i say decades to come is why are we spending all this money on the supervisor structure we could spend it on care giving. As a practical matter, however, its a moot point. The country has chosen based on sort of the inertia. The historical coincidence we have employerbased health care. And the idea now is to deal with the system that we have the aca was congress answer to that. Were going to see how it worked. There are a lot of, you know, you refer primarily to how expensive it is and the cost of the system. There are pieces, part of the aca that are meant to address the cost. We are supposed to start paying providers doctors, and hospitals to keep people healthy not to put them through the hospital. Host we have followup. Theres a conversation on twitter. They wrote in and asked how does insuring everyone decrease the cost of health care . And vivian responded it doesnt. It decreases the cost of insurance. Thoughts on that . Guest one of the things the crit ibs point to about the Affordable Care act is the rising cost. Were seeing premiums go up on average in these individual policies in the exchange were talking about. Were probably talking about net increases in the cost. What people forget to talk about is society is already paying for the care anyway. Were seeing we see enormous amount of taxpayer cost that pay for medicaid. Were seeing incredible bills and hospitals that write off unexe compensated care. People are being taken care of in optimal cay ways expensive ways. One of the idea behind the aca is shift the cost inside the system in to deliver care more intently. If we can do that people will be healthier and the cost will be better controlled. How can insurance be used . Everybody get a certain preventive screen service. Thats been a debate. If you can reduce the epidemic of Childhood Obesity and get them to control their food intake of diabetic. They get off certain medication. Im not saying panacea. Theres great debate what could or could not reduce Health Care Cost. It could change the trajectory some trends that are not good health. Guest one of the things that jane is alluding to is the Care Organization which is sort of the new version of hmo, basically. Or managed Care Organization. And i went and saw one of these in river side a couple of years ago. Its preaca when the concept was being discussed. It was essentially a threedoc shop. They of course on the risk of the patient. They got money directly to care for these patients. And what was interesting is the doctor who leads this is pragmatic said some years i make money. Some years i dont make money. I think you have to be some of thes physicians have to be willing to take a pay cut in the years where they have a lot of expense if the model is going to work. And lot of physicians are unwilling to do that. One of the positive things that is happened in my view is that properly conducted Care Organization and similar setup known as patientcentered medical homes are actually increasing compensation for the primary care, quarterback doctors who supervisor your care at the expense of the specialists. The idea behind Health Care Reform that the meta idea in, you know, is tolet keep people healthy. Let keep them out of the hospital. Let not focus on doing procedures. The way the system is set up now is people make money for doing procedures whether theyre needed or not. Primary care physicians who by the standards of medicine are underpaid compared to their neurologists and anesthesiologist colleagues. Some of the better product aco are seeing significant increases in their income if they can manage care the way sara is talking about and keep people healthy. Host another conversation on twitter. Matt said if we went to the er for Care Health Care would be much more exinsive than now. Preventive care is cheapest. James responds with some disbelief that. He said a study that proved Preventive Care save money. Its still a debate. Questions on our twitter feet. Feed. You can tweet in your thought. Another one of the state that is already launched the campaign to raise Public Awareness about what is coming down the pike is oregon. Lets take a listen to oregons latest tv ad. Live long in oregon long live oregon long live the oregon place to care for each every daughter and son. [laughter] it makes me want to buy Health Insurance. [laughter] [inaudible] [inaudible conversations] who is it made for . What is the message its trying to communicate . Guest what weve heard from the people who made the ad they wanted to get out the idea that this Oregon Exchange is for the help of all oregon people that this something were doing together. Were in the same lot. And obviously many have written the ad and it could come up. But i think its obviously trying to appeal to somewhat of a young demographic. Obviously probably mostly in urban portland area. I dont know theres a lot of people in eastern rural oregon who really identify with that message. I just loved the kids running in and out with the cutout trees. It seems very creative. It doesnt seem like its essentially trying to sell a product but an idea and feeling about this thing that is coming. So on twitter they where in and ask the mechanic of the exchange. Can you sign up with the internet, phone, mail, do you have to visit a Government Office . At what point does the Education Campaign turn to here is what you do and do it . Guest i think we see a lot of it starting at the end of september and certainly by october. And here is exact website youll go to. I imagine you see a lot of ad campaign you see click and point. Here is the drop down box. I think the ads will get specific closer to the launch date. Host lets hear from scott who is uninsured and living in ocean side, california. Caller good morning. Im 53 years old. Im uninsured. Im also an air force veteran. I recently suffered Heart Failure and considered 30 Service Connected disability through my va. So my question is with the new fact is going take place. Will i be required to have insurance as well . Even though i have my veteran because right now they are taking care of me. The only thing i pay for is the medication . . Guest youre fine. You are covered. If you have the va system or tricare. Thats fulfill your individual mandate. You have coverage. You are fine. Host thats because Family Foundation looks at the status of state actions on the Medicaid Expansion discussions. Sara barney, take us back to the Supreme Courts decision about the Affordable Care act last year. What they decided about the Medicaid Expansion and why were looking at now. Guest if you remember the first day that followed. Everybody was sort of remarking on the decision to uphold the law in general. What didnt gate lot of attention, i think, right away but right now now has was the question was whether or not medicaid could be mandatory. And i think there was at love surprise that this came out of the decision. And now that so many states have chosen actually not to expand medicaid. The way that congress designed the Medicaid Expansion. It was seen as a carrot dipped in a lot of sugar. The federal government is going pay for the expanded medicaid for the first three years 100 . After that about 90 . But the Medicaid Expansion that three year window when the feds pick up the entire tab starts january 1st. The idea was you couldnt wait if you wanted to get the sweet deal. Ping theres been a lot people are surprised that many states havent signed on. Its continued to be a political question of, you know, if you do the Medicaid Expansion sometimes you are endorsing obamacare and president obama and that, you know, governor rick perry has sort of made this an issue in texas. Its sort of, you know, in his mind untexas to expand medicaid. Host texas is not doing that . Guest yeah. Texas isnt doing it. There are 24 states expanding. If you look at the map its basically the west coast. The northwest nevada, arizona, the southwest, and then along the eastern standard board you have most of new england, many of the states in the mid atlantic. That is about 9 Million People who are currently uninsured who will get insurance through the Medicaid Expansion. The states that are not expanding is about 21. Also about 9 Million People. 9 Million People will be living in states where they would otherwise if they lived someplace else would get medicaid. Its essentially texas which has the most . Urm of uninsured people in united. Primarily through the midwest. The entire south, the deep south. Its also montana, idaho, wisconsin wyoming and utah. Theres some states still debating michigan, indiana, pennsylvania, and a few others. I was sort of thinking you know where i want to be on january 1st . The four corners. One arm in new mexico, another arm in colorado or im getting it wrong. Arizona and new mexico colorado and utah and utah is the only one that doesnt have the Medicaid Expansion. Host there will be a difference depending on the which sides of the border. Guest absolutely. The subsidies will be available to anybody that lives anywhere in the united. The Medicaid Expansion will be available to the states that chosen to do so. Host one follower on facebook said Health Insurance would be as cheap as Car Insurance if sold across state lines like geico. An opinion there. But how does it work from one states border to another state . Guest those are two spate issues in term of medicaid and private insurance. Theres a provision that allows for Insurance Plans to be sold across state lines. As long as the state sign essentially a exact with one another. So that is actually an option. In term of medicaid, you do have to live in this you live in the state you live in and qualify for your state Medicaid Program or dont. I think theres a lot of confusion around medicaid and who quality qualifies for it. I think theres a generally sense if you are poor in the united you get medicaid. Its not the case at all the. You have to be pregnant, depend end children, disabled. It doesnt matter how poor you are if you dont fit to the category, you dont qualify for medicaid. The Medicaid Expansion is essentially does away with the category in a sense if you earn to 138 of poverty which is about 15 ,000 a year for one person. You will not qualify for medicaid regardless. You dont have to prove you are pregnant or disabled. Host sara bar knee is a Senior Correspondent. We are also at kaiser. We launching a partnership this morning to dig to the federal Health Care Law to find it means for you. Teresa in illinois who has private insurance. Good morning. Caller good morning. Thank you for taking my call. A couple of quick comments. I feel that the fact that cool on colon os pee are going to be covered is a huge benefit. I dont hear that much being said about it. Right away i felt most people who are insured are going to save probably possibly 1500 a year thats my husband and i are saving. Each of us. In addition to that, my husband was seeing his doctor at the medical building and he was complaining about the hands hurting. They sent him for xray. Its a building that is, again, considered i think its affiliated with the hospital for taking couple of xray of the hand we got a bill for 750 which absolutely flabbergasted us. I was upset. And but once it was submitted to my Insurance Plan then it came back at 450 which is an example of how just outrageous our Health Care System is and the expense that is involved with. Were currently paying. We have a family of three about 900 a month. Im selfemployed making not much. Maybe 500 a month. So my husbands income is around close 80,000 a year. Two years in order save money i went on a catastrophic plan. It ended up not saving money because we saved 100 a month previous to what we were paying on his family plan. And but my deductible were so high all the sudden it just was really bad decision to go that route. So my real question for you is, will a family of three be allowed to my husband get kind of discount insurance rates him as himself being on a Insurance Plan. It if i were to be on a separate plan and bring my son with me selfemployed. Currently we file our taxes together. Im trying to figure out how to save money. We are paying 900 a month which is a lot forest fire for us. 100 of poverty for one person is about 11,500 per year. See would qualify for a very healthy subsidy. Here is the problem. They were not anticipating the report was going to say that the Medicaid Expansion was optional. So if you are below the Poverty Level, it is basically if you are between 0 and 100 of the Poverty Level there is no option for you. It is typically lower than mrs. One of those things if you had a conference when the chambers passed different bills. They wouldve had this and some other things worked out with the portal terra. So it is a consequence. Obviously i was down in texas and this was one of our big partnerships. There were a lot of people would qualify for the Medicaid Expansion. A look of 4000 patients that currently go to her clinic. They have a number of these individuals from the area. They were qualifying for the the Medicaid Expansion and she could actually get reimbursement for. It seems that we dont have any reimbursement method for them. Host as sarah mention, our guests talk about the washington post, usa today, and other periodicals and you can read about it at Kaiser Health news. Org. We are talking of the federal health care on what it means to you. Lets hear from been in indianapolis. He is limited. Caller i want to spend my Social Security payment because i want to go back to work. The bankruptcy court, i know from bankruptcy but there are lots of people that have uninsured accidents. Guest people who have had medical situations cannot pay their bills and they have to declare bankruptcy. Guest yes, absolutely. And the idea and hope for those indicated it will happen a lot less when employers are mandated to offer employees coverage with a mandate to have coverage. It should go a long way towards reducing medical bills and causing bankruptcy. But there is nothing in the bill that precludes bankruptcy from happening. Nothing where youve racked up a lot of build and tempos. Guest it is kind of like mortgage debt. Host we have another call. You were on the air. Caller [inaudible] host lets move onto indiana. Hello, broad. Caller i have two questions. I heard in the bill that the government has direct access to the i dont know if you collimated counts, but fast claims. And they can no longer be denied to maximize profits. So that way they can have a realtime access to Health Insurance company of the doctor and hospital. Host the subsidy payment would be sent to return from his from the federal government. Guest it is a policy that depends on the Company Agreement with doctors and hospitals. I know of no provision for the government to intervene in that process and insurance is regulated by the states and you can protest claims and it will still be denied. The idea is that under the new rules that deny claims, it will be much less than they used to be. There were disputes with the Insurance Company that have not been put into the history. Host we want to know if you can talk about the importance of networks and then going out of network. Your doctor, your health care, something that the Insurance Company doesnt deem. But i dont know that they have this provision. Guest i dont know if they decide that what you pay. There is no provision that is expressive and the law that talks about and Network Providers and Insurance Companies are doing. And i think that the difference between a network and out of network is going to keep going. In the show we mention that a lot of insurers have relatively Narrow Networks of doctors and hospitals in the exchanges. They pass those along to consumers and its really incumbent upon you and other consumers, and the redefined parents, paying attention to see what the differences between the in Network Charges in the out of Network Charges. When you gain care, stay within the networks to the degree that you can. When you go to the hospital and you dont have a choice. Host i mention theyre there are about 13 plants. Many of those argue what we are considering these county run plans. We have the alliance, the quasi governments run plans and we all talk about public options during this part of the law. There are less public plans that will be offered in many regions and cal in the red way that they were able to come in so well on pricelist create these very Narrow Networks. In some cases a local Teaching Hospital and clinics. They are the people on this one with medicaid. They are used to going to the community clinics, but now they earn a little bit too much red and so they will be able to stay within their providers. Ucsf is a Teaching Hospital as well. The options are quite good. Guest you have a mezzanine network that is a little bit more expensive area but again, you have the fine print and need to Pay Attention. Host we have a californian on the line. Caller good morning. I have been waiting very patiently. Last time i called, kind of fell apart on the air. I want to thank you for your patience. A question for the guest is a still eligible person, how does that work. Guest insurance certainly isnt forgotten from offering it. In my estimate is truly based on cost. That maybe some of these Insurance Companies can offer supplemental policies. This is a person that writes about this. Have you had this from the Affordable Care act. Smokers can be paid more. I think there are some others as well that have elected not to have this experience. We could have the charging of the smokers a lot more, it removes access, they made the decision to not penalize bloggers. Guest there would be no additional premium in california host hello, we have a caller. Caller hello, i was an employer. One of the things that i ask thousands of thousands of people is designing Health Care Plan in 2007. This is talking talk to people from all over the world, what countries have the best health care. Why are we so scared, why are we as employers so scared and having to pay the outrageous costs hundreds of dollars for employees. So that way all the health care is under one envelope. And we would actually have a lot Lower Health Care if you eliminate two things and one is the cost of the Advertising Industry and the other one is the amount of money that they pay for politicians over those years trying to get rid of health care. Because they were advertising before obama started us. We also have another 10 of advertising and another 10 be that way. So why are you paying for health care on your card . Host stay on the line in case our analysts have any questions. Employees and consumers have a system and it is expensive, as we mentioned earlier. I suspect that could sit down and get out the back of an envelope and design it to look like this. We work with the system that we have. We would like to replicate the system and they are all non profit and they have in the world of this idea, there are still people that have this. Guest i was in vancouver and they had this canadian Health Care System in the United States. It is interesting what happens. They sit down and they basically hash it out. But if you watch this, they will have this and they will say, you need to have this and that exam and that will cost 89. Everybody plays the same game. That is one difference. Is it true that each exchange will have two Nonprofit Companies offering insurance . Guest i dont know the answer to that. Guest we mentioned this was problematic in some states. Theyre are multistate plans, which we havent mentioned before, the people who foresaw this competition and they also have at least one nonprofit plan in one forprofit plan they are being implemented, they are not likely to be rolled out on a National Basis as was the original intention, but they are another backstop intended to bring in more competition in states that may be lacking. Another was the coops that the law provided very large subsidies to set up brandnew Insurance Companies in some states. Typically. Guest they were stopped midstride. There may be competition including as time goes on. Is the idea that has a difference and also if you look at the rates in california between blue cross and blue shield of california, the rates are very similar. This will pay taxes. So this idea of the misnomers if you have a nonprofit participating in us, somehow they are not paying to see a large salary per year,. We have a few minutes at the Kaiser Health news. We are going to take another call. Caller hello, my daughter is in college. I am not working, i am on medicare. We have been a great supporter of the law. I think that that could be medicaid. Guest my question would be does your college offer any kind of coverage for the student . It would be my first choice. Guest since she doesnt have income, i believe that she would qualify for a subsidy. Is that correct . You can put on your coverage, that would be my next step and she is 22 years old, they have this young invincible plans. But they are they could be more affordable to help her get that coverage. Im not quite sure. Guest this is a good example as to why this Medicaid Expansion will affect expansion. If she earns below this per year, she actually cannot go into the thing and cannot qualify for this. It would be fantastic if you do parttime job or some kind of work that you could get on campus reschke contend she could actually earn up to 11,500. And she could go into the exchange and qualify what would be a significant subsidy. Guest if they dont expand medicaid and you could never got it to the expansion. There are some individual mandates that were exempted if the insurance cost more than your income. There are certain situations when you wouldnt be penalized for that. Host will be watching for changes and develops over the next couple of weeks . Guest we are signing up the invisibles and the critical task of getting mess. And there was a lot of experts out there that suggested that some of the coverage and their coverage could be less than optimal if the law would allow that. Host we are interested in how the Medicaid Expansion would recess. There a lot of people that are eligible today. In some cases they simply dont know it. A lot of these guys are actually now eligible for medicaid and they had quite a lot of conditions. Their lot to read that population. Guest looking at the implementation process for how it is interpreted. We will have her hands full. Guest we are talking about the debt ceiling and on and on. Host we have over 650 comments and questions about the federal Health Care Long you can see that conversation at facebook. Com cspan. Our guests are here with us. We will be visiting with Kaiser Health and is regularly on mondays through macronix washington journal, we will talk to she will bear about monitoring financial industry. Then former administrator for the centers for medicare and medicaid services. He talks about the eligibility requirements and costs of the u. S. Medicare program. And later bill allison discusses congressional fundraising, plus your phone calls, emails and tweets. Washington journal is live at 7 00 a. M. Eastern on the and. Up next, Debt Reduction and economy. And then we have a discussion about the new Health Care Law and what it is designed to do and how it is implemented. When we have a certain longer be due to color the color of your skin. When did that happen . [cheers] [applause] you know, a reporter once asked me why i didnt talk a lot about race and i said because i am a narrow surgeon. And they thought that was pretty strange. Someone might take i take the scalp off, i am operating on a ring that makes the person who they are. Color doesnt make the person who they are. When will we understand that in ben carson talks about your phone calls and emails and tweets. Sunday at noon on booktv on cspan. The center for American Progress hosted a forum on bill deficit reduction. Panelists discussed the budget and entitlement programs, log. Hello, i am the director for Economic Policy for the center for American Progress and i want to thank you and welcome you. For the past three years, Economic Policy debate in washington have been dominated by one central issue. In 2010, the estimates suggested that publicly held debt was on track to 100 of gdp by 2023 in modern america. We offer a variety of policy solutions to bring the federal budget onto a more sustainable course. Today the budget looks different significantly than what it did a few years ago. Especially ending up in 2023 at about the same levels there was today. Give new budget reality. Are they new, its one question. Should deficit reduction take center teenage . Has it we have accomplished helped or hurt today . How do we move forward to address the nation significant economic challenges. To discuss is and likely disagree about some of the questions, we are were excited and honored to have our distinguished panel. First of all, just in alphabetical order. Jar red burn. From 2009 to 2011 he served as chief economist and economic adviser to the president. A member of president obamas economic team. Prior to joining the Obama Administration he was a senior economist and director of the Living Standards program at the Economic Policy institute in washington. Robert bix by has been with the Coalition Since 1992. And served as executive director since 1999