subsidies. let's start on the subsidies and and how hat they are this is going to impact the affordable care act. guest: the same and how this is going to impact the affordable care act. subsidies have been hearing about for months now, since trump took office. the subsidies, they help cover things like co-payments, deductibles, out-of-pocket costs for low-income people. the funny thing here with the subsidies, insurers have to give them to enrollees who are below a certain income level. the problem is that republicans had a lawsuit saying congress didn't authorize the payments to be made to insurers. so the question has been is the administration, start with the obama administration, is the administration making these payments illegally since congress never passed a law saying, ok, these can be paid. so then when trump came into office, it was republican versus republican, so trump -- the court case has continued to be delayed. it seems that yesterday trump timely made the decision he's going to stop paying these. which means that low-income people that are entitlemented to these payments, they'll still but e cautionary relief, are not going to get the money. what happens then is it's reflected in premiums. host: democrats say this is going to collapse the marketplaces set up under the affordable care act, explain the concern here. how many people does this impact? how much money was being given out in these subsidies? guest: i think it was estimated somewhere between $12 billion-ish, a year. could be off are not going to g the money. what happens then is it's reflected in of dollars. this feakts everybody on the individual market. as i said if insurers there. it's billions aren't getting these subdies, the lack of money will be reflected in premiums. premiums rise for everybody. but the problem is here, too, insurers, they have already been required to file their rates for 2018 for next year. and the issue is some insurers some assumed they wouldn't get it and some did. can insurers pull out? what's going to happen? host: the headline from axios this morning, trump takes a sledgehammer to affordable care act. caitlin owens is health care reporter with axios. we talked about the subsidies. what was in this executive order that the president signed yesterday just a few hours before the stories came out about the subsidies? guest: this is different. plans to offerng best comprehensive insurance to be offered either in the small business markets or on exchanges. there are two different pieces to it that were important. one is the association health plan piece, which is the idea is it allows small businesses to do the same thing, or even self-employed to be in together and effectively act as a large employer. so with that that means they can go on the large group market. they are not subject to the same rules t could take healthy people out of the small group market, which could raise premiums on the small group market. the second part of that executive order was also allowing short-term insurance plans to be sold. right now they are only allowed for three months. this is for people in between jobs. just for whatever reason don't have health care for a couple months. the administration wants regulations that goes to about a year. those are really bare-bones. the ink about 26-year-old 26-year-old and you don't need a comprehensive plan and also healthy, you'll probably go into the plan that's cheap for you. that also runs the risk of this exodus of the young healthy people from the individual market, which then would raise premiums. host: the president yesterday at that signing ceremony for that executive order said this should have it, if you are a been done why wasn't it done very early on in the trump presidency? why wait until now? guest: i think a lot of it was republicans were throwing these ideas around as part of repeal and replace. those efforts died. and for now at least. i think there was a lot of pressure on the president to act unilaterally here. host: we're talking with caitlin owens, axios health care reporters. taking your questions and comments for about the next half-hour this morning on the "washington journal." do you want to call in. epublicans 202-748-8001. independents 202-748-8002. very busy past 24 hours on the health care beat. we'll try to continue to walkthrough all of it as we get your questions. starting with bill in johnstown, pennsylvania. inddents. how you doing down there. question is this, i use the a.c.a. it's very good. -- is want to know is how you this subsidy going to be gone? gone, then to be my insurance will be probably unaffordable. i just want to know some details and specifics. are they available yet? is this going to affect 2018? this is putting stress on eople. host: thanks for the host: thanks for the call. caitlin owens on the timing on this. guest: i think that you raise a really good question. the caller does about subsidies. i think something to know here there are premium subdies in the a.c.a. oes directly to your premiums. your income qualifies you. up to a certain -- it's proportional to how much you make up to a certain percentage of the poverty line. then there's the cost sharing subsidies which is what we're talking about. the cost sharing subsidies is what the administration will stop paying. subsidies, those keep being paid. that's what's interesting. premiums are increased without the cost -- because of the cost sharing subsidies with those ending. but for people who still receive the premium subdies, a percentage subsidies, those premium thatid. of their those cover, that's not going to change. what really happens here is people who receive the subsidies, they might see premit those cover, some increase what they are paying. but it's really people who don't receive subdies that will take the real brunt of these prume um -- premium increases. which means the government is paying more which is the interesting thing here. host: what are the estimates here in here -- estimates here n terms of the impact on premium prices and how much more the government might end up paying on that end? guest: a couple billion. it's not chief. as far as the -- cheap. as far as the price tag to the government. with the marketplaces, with premiums, insurers file for a spect marketplace. just depends on your plan. as i said for 2018, immediately some insurers are higher. some didn't plan on that. they are going to have to keep pricing. host: can they go back and change the pricing on their plans at this point? guest: no. 2018 rates are final. unless there is some administration action that reopens it. i don't know. i don't know how that would work. these are final. too, insurers didn't price right, correctly according to this, can they still pull out? are people going to have insurance options? host: leo here in washington, d.c., line for republicans. go ahead. caller: my question is congress did too, not authorize the cost sharing payments to the insurance companies, how was the previous administration legally able to give the insurance companies that money? guest: that's a great question. what happened was this is getting into a lot of washington speak. ese payments are going to be made to consumers. there is an authorization, which is like the legal -- there is an authorization, which is like the legal -- this is going to a and there is an appropriation. this is getting into a lot of details. basically there was an argument. the obama administration said yes. these payments were appropriate. they can be made. and then the republican house said no. they weren't. they can't be made. as this case was pending and the payments kept going. ast year decided, they sided with house republicans saying these are unconstitutional. while the case was appealed. things were delayed. there was nothing stopping the payments for the time being. but then what happens, essentially trump said he's going to stop fighting the case. host: could congress step in and override what the president did? guest: absolutely. democrats -- democrats have been doing -- it's a tricky issue. when obama administration was president they said these payments were legal. there is no need for an appropriation. there is an effort in the senate in the health committee right now to make these payments to appropriating them. the question is, a, do republicans have this appetite -- rop up the law while also, what are democrats willing to bring to the table to strike a deal. host: taking your calls this morning with caitlin owens of axios. keith in reed city, michigan. line for democrats. go ahead. caller: yes. the previous question just runs right into what i was going to ask, too. the constitutionality of the president writing executive rder over monetary issues. congress is supposed to control the pursestrings. president toow the appropriate or unappropriate moneys towards anything, why bother having a congress? the only thing left would be declaring war and we haven't done that since december 8 of 1941. i'm just pretty much reiterating what the last person called why even bother having a congress. host: greg is in princeton, new jersey, line for democrats. go ahead. caller: yeah. would just like my republican [inaudible] host: you are going in and out. put you on hold while we go and talk to norman in tennessee. see if we can get back to you. line for independents, go ahead. caller: hello. am i on? host: yes, sir. caller: i just want to know how much we would save as an individual and as a country if we want to the canadian health care system? host: any estimates on that? guest: i don't know exact estimates. it's tricky. there is a lot of ways to do single payer, which is what we're skirting around here. there are so many different ways to do t it's hard to put a price tag on it until you flesh out the policies. if we want to move to single payer, are we doing medicare for all? medicaid for all? individual contracts with the government. how much will we charge for different services? how will we tag on it until you pay for it? will taxes be raised? on who? these are questions as democrats keep talking about single payer, like countries like canada and europe, these are questions that are going to have to be answered at some point. host: democrats certainly talking about it more and more since the failure to repeal and replace the affordable care act. what do you think would happen -- what happened yesterday in terms of the subsidies, executive order, what does that do to the single payer debate? guest: i would assume it puts it on hold for a while. it's hard for democrats to keep talking about single payer when the trump administration has effectively just blown a hole through obamacare. i don't know how democrats make the argument that we're going to keep going for three years of this i.n.s. stability. talk about single payer the whole time. at least until the next presidential election. that would be the first chance there was even a glimmer of hope of single payer passing. i think we'll have to talk more about these marketplaces for now. host: how enthusiastic are those democrats at the front of the single payer push, how enthusiastic are they going to be to fight this subsidies battle, to fight any battle to push back against the executive order yesterday? guest: i think they'll be really involved. again the a.c.a., the democrats passed it. they really believe in the principle of making sure people have affordable health care coverage. this idea of universal coverage, or access. i don't think that they want this program to have a hole in it. host: we talked about the cost increase involved with ending the cost sharing subsidies what that's going to do to premiums and how much it could impact federal spending. one estimate from the congressional budget office, sam-s stein of msnbc, put this out this morning on twitter switecrithing a c.b.o. report from ending the subsidies increases the premiums by 20% in 2018. 25% by 2020. the deficit goes up $6 billion by 2018. $21 billion by 2020. your thoughts on those numbers and c.b.o.'s role going forward in this debate? guest: i think those numbers are accurate. because when you think about it, as we keep talking about, premiums will have to go up for insurers to make up the losses from the subsidies. so when premiums go up, premium subsidies that the government has to pay out goes up. the money that they pay out for subdies end up being made more than what they paid for the cost sharing. i think it's going to be interesting. republicans have made this argument in favor of subdies eng made more than appropriating the payment. this is a fiscally conservative thing to do. but they want something in return for that. i think we'll have to wait and see whether the pressure to just pay the subsidies outweighs this desire to extract something from democrats. host: richard in missouri. line for democrats. go ahead. caller: i just wonder, this deal the president made, how many people is that going to kill? that guy shot all them people in vegas only killed 50. how many will this kill? it's another step closer to single payer as far as i'm concerned. we got a moron up there. host: why do you think it's a step closer to single payer, richard? caller: you start cutting more people off, more voters will vote for single payer. they want insurance, health. we want health care. that's what we want. this insurance business is just a big con-s game anyhow. i'll get off the air, thank you. host: any of those arguments being echoed by the single payer supporters here on capitol hill? guest: yeah. you see the argument for single payers. that private insurance isn't working. i think that that's what you're going to see a lot of democrats saying. we tried this. and people still don't have coverage. it's still unaffordable. we have to move on to something else. host: frank in ohio, line for republicans. go ahead. caller: yes. one of the things that hasn't been mentioned is the savings if we were in implement some sort of tort reform. i'm assuming most doctors pay for medical malpractice insurance. let's estimate there's somewhere around a million. and the average premium is somewhere around $50,000 a year. that's $50 billion of potential savings. some states have capped the payout for malpractice. isn't that ng why not on the docket for savings which could more than offset the cost of this recent signature law by the president? guest: i think it's an interesting conversation to have about the cost of health care and isn't that not on the docket for savings which could more than offset th. washington has been talking for a decade about insurance. and who pays for t how to make it affordable. i think that at some point we're going to have to start talking, washington will have to start talking how to bring the costs of health care down instead of how to shift it from one nsurance payer to another. that's part that's part of tort reform. it's part of that conversation. also how do you price medicine, ervices, how do you price -- host: that signing ceremony yesterday president trump called on congress to finish repeal and replace. at this point are republicans any closer to agreement on what a repeal and replace bill that will actually make it through the house and senate, what that looks like? guest: no. i think there was a lot of talk about cassidy-graham, the thing about that, a lot didn't know what was in it or how it would work because it was so fast. there wasn't time to deeply analyze what a bill that size was going to do. host: you remind our viewers the big picture parts of graham-cassidy. guest: what it did it took all the money that went to premium subsidies and individual markets in the affordable care act and medicaid expansion, and just took that money, reduced it a little bit, and redistributed it among states. the thing was, it completely changed how that money goes from the federal government to states. if you are on medicaid expansion state, which were blue states, you end up losing a lot of money. if you were a red state that didn't expand medicaid, a lot of states in the south, you got a lot of money from it. host: what were the lessons there for republicans after the failure of graham-cassidy? guest: i think that they still have the same vote problem, right? where it's maybe four members who will say no on principle. susan collins announced this morning she's going to stay there. that vote will stay. lisa murkowski is still swing vote. john mccain. and rand paul doesn't like the idea of the federal government paying for health care. you still have the same problem to solve. host: rand paul, you mentioned him, why he was at that signing ceremony yesterday. what role he had in this executive order. guest: association health plans forever. this is something he wanted all along. he's been telling reporters for a while he's talking to the president about it. the president wants to do an executive order. i think he was pretty instrumental in getting this done. host: as we show you some of the video from that signing ceremony yesterday, there is the vice president talking to rand paul standing directly behind him there. if you missed that signing ceremony you can watch it on our website at c-span.org. wade in south carolina, line for independents, go ahead. caller: i'm kind of wondering, a federal judge found this law of subsidies illegal and unconstitutional. why can't we just follow the law and do what's got to be done? guest: yes. there are two options here. either stop paying them, as we discussed the consequences of that are higher premiums. or congress can pass a law saying it's legal for these to be paid. there's kind of two options here. i'm not sure what's going to happen. host: explain the politics for republicans, what pressure will they be under to ensure these premiums get paid. why would they want to vote for something like that? guest: with these subdiss not being 12:45 we're going to bring you live on c-span and cspan.org and you can listen to it on c-span radio app. back to your calls for kaitlin owens. diana is in magnolia, ohio. republican. go ahead. >> yes, my question is, how will this affect someone retired on medicaid? >> the executive order in the subsidies don't impact medicaid or medicare at this point. it's just the individual market. it's only people in the individual market that receive these subsidies. and then as far as the executive order, that has -- could impact both the small group markets or the small employers, small businesses, and the individual market. medicare, medicaid, not touched right now. >> i want to pass on a story for

Related Keywords

Alabama , United States , Reed City , Michigan , Tennessee , Missouri , South Carolina , Washington , Pennsylvania , Ohio , Canada , Canadian , Susan Collins , Caitlin Owens , Steve Scalise , Lisa Murkowski , Roy Moore , John Mccain ,