Transcripts For CSPAN Washington Journal 20131008

Go to our facebook page. Journal cspan. Org. We will get to our republican colors only here in a minute. Ed okeefe is joining us on the phone of with the washington post. Let me show your story along. What is the latest from Senate Democrats . Guest we are looking at the possibility of the senate moving on a clean debt increase. Temporarily raise the debt limit for two weeks in use that time to sort out the other fiscal matters in the country. Senate democrats are trying to put it together. If the senate can move something out with decent republican rick ports that we decent republican support, that can be used by john boehner to pass a very clean debt limit increase. We asked republican senators if they would be willing to do this. Nobody said no but nobody said yes just yet because they want to see more of the details. I have a feeling by the end of the day we may have a better sense of who is willing to possibly engage on this. Senatorsbe people like john mccain, kelly ayotte, susan m the diners club. We will wait and see if there is enough support. We are asking republicans only to call in on this first 45 minutes. We divided lines by mainstream, tea party, moderate. Those senators you just named, which category would you put them in . Mainstream,are more more moderate republicans. They have been willing to engage democrats and the president on the fiscal deal. Theyre most concerned about what tea party backed republicans are trying to do when it comes to defunding the partffordable care act is of these negotiations. Theyre very concerned that doing that while holding up the government is a bad idea. This shows you how divided the party is, dividing the lines on cspan. I think that is notable. Openly discussing different strategies. Host how have Tea Party Conservatives responded to this latest from Senate Democrats . Guest were still gauging that. This is something they are not likely to support. This would be people like senator mike lee and ted cruz, possibly marco rubio and rand paul. We only have our first shot of seeing it last night. Groupwill be a certain who do not like it. The question is how Many Republican senators might be willing to go along with this. Not so much because they do not agree with obamacare, they certainly dont. But they are eager to reopen the government and want to see it working once again. They dont believe holding up a government operation over this is something that should be. Host one to this vote take place . Guest at the earliest later or later next week. Is probably closer to november 1 that the government truly runs out of cash. Theyre using october 17 is a deadline rick now. There are some conservative republicans that are skeptical of that deadline. Why did it suddenly get close to the middle of the month . We will wait and see. We know that House Republicans a to default. Theyre trying to convince rank andfile republicans to respect that deadline. We will see what happens in the coming days. Host what do House Republicans do republicans want to do when it comes to the debt ceiling. Guest they would tell you they are still seeking some kind of give or negotiation by the white house in order to raise the debt ceiling, whether that is something related to obamacare or Keystone Pipeline and getting that authorized, whether it is repelling that repealing the device tax, those are options that are being considered. The think theyre beginning to realize that this fight over the continuing resolution is pretty much moot. They are going to use the debt ceiling deadline now as a way to not only reopen the government but raised borrowing limits. New consensus emerges this week. House republicans are meeting this morning just as they do every tuesday morning. Perhaps new proposals coming out of that meeting, we will see if theyre willing or not to negotiate on something the white house might consider more practical. The speaker over the weekend suggested a clean government clean debt limit increase. Caucus is so splintered that they have different sets of priorities. On this issue of defaulting, newspapers reporting that a breach does not have to lead to a default. Born quoted coe here you also have wall street journal, bankers are warning on s, saying. Ou cannot prioritize it will make the markets jittery. I think if anybody is going to speak most effectively the republicans to the republicans in washington it is going to be wall street. Theyre the ones who are going to have to lay out what the potential consequences are. Is itts if the answer is not going to be as bad as one might suggest they might be willing to do something. If we see the stock market rise up and expressed concern, that might compel them to act more quickly. Is true, does not getting it done by the end of the day on october 17 mean the world will and . Not necessarily. But once again the u. S. Might risk destroying its credit rating. We know how poorly that went back in 2011, even though the deadline was met. You could see it get it you could see a credit downgrade, which could be catastrophic. The closer you get to november 1 after that october 17 deadline the more grave the situation will become. Let me go back to the note should and to the notion of a clean continuing resolution. Are there enough votes to capacity e we go back and , i think it is best to understand what is going on here. The problem is in doing Something Like that and bringing forth something, they have to go back into the file and find a. Ecent bill there was a bill that was apparently introduced by an to push republican forth a clean cr. Republicans have said that they do not want to do it that way. A clean cr would be you write an new kind of bill and push that forth. It is what it is. They dont want to use this legislation against them. There is a quote by a moderate republican from pennsylvania who said he would vote for a clean bill but he is guest that saying is what it is, a discharge petition. You probably do not have enough support. This is kind of a moot issue. They take about three weeks to matriculate. We do not have three weeks. This has to be done as quickly as possible. At this point, something that washington should focus more on, is using that october 17 deadline to strike a deal both on raising the debt ceiling and possibly doing it for more than a few months. Going to turn to my viewers in a minute. The washington knows the washington post, abc pulled guest they got worse for republicans. Republicans51 of that are very concerned about how they are written porting themselves. Republicans are still chiefly responsible for this. The president s numbers are improved ever so slightly. 51 disapprove of how he is handling the situation. The sober lining is those numbers are better than they are for Congressional Democrats or congressional republicans. Generally the nation is still blaming congress primarily. Either republicans are seen now is the chief cause. Edt if you want to follow and his reporting at twitter, edopost. Lee in Sterling Virginia defines himself as a mainstream republican. Caller thanks for taking my call. In the short term, closing the government is not going to be that much painful. Term, to say in the long i think every day we have this shutdown it is going to take at least a week to catch up and we are going to be spending more money to do that. Veterans affairs have been able to crack the backlog by 30 . Is deeply appeals affected by the shutdown. Its going to take such a long time to pick up the pace, to get the gains that we have read we have veterans and many others that are deeply effective. This is what gets me, the republicans is to want to pass the veterans bill. Are relying only the v. A. Part, they are relying on many other services as well. The notion for my party to tell me, we are just going to fund the v. A. , that is ridiculous to me. Term, ithe long think the 17th is going to be the critical part. Every day we go on people will hurt. Front page of the boston globe this morning james from North Carolina, tea party republican, what are your thoughts on day eight of the republican of the Government Shutdown yucca shutdown . Caller i am a newly converted tea party member. Theway i see it is democrats, republicans, and tea party, i do not blame any of those people. Realize that when we select a person for business or a person to run anything, they have to come to the table regardless of their point of view. It is called leadership. I turned to the tea party because obama never ran hething, he never was mayor, was never governor, and now he is hosting now he is holding the americans hostage. Youre doing things that are basically unamerican. Can i jump in and refresh your memory about the poll numbers come of the abc news 70 of republicans disapprove of the way republicans are handling the negotiations. A you concerned . I am not because that is mainstream polling. Things are actually changing. Nobody is polling what i am seeing. There are a lot of minorities the jumped ship on obama. Polls msnbc, all of those , those are mainstream. If it werent for the Mainstream Media, obama would be done. Lets move onto oklahoma city, also considering themselves a tea party conservative. Go ahead. Caller thank you for taking my call. President obama is the one that walked away from the table. The one who walks away from the table is the one who is holding the negotiations hostage. He is the one who shut down the government. , the way the new studio reported that the republicans are willing to negotiate. He is the one who wants 100 of obamacare. That is the basic fact. What we really have to talk about is everything, and that includes interest on the debt. That means that the bankers that hold the debt have to be part of the negotiation. There is no such thing as nondiscretionary congressional spending. On your point about the ers, next, youo terrance call yourself a mainstream republican. Why is that . Caller i think the mainstream are becoming more honest with the newer republicans coming in. Becauses have a problem the more honest republicans are moving in and they have put obama in the corner. They will always pay their debt. Obama cannot go to china and say we cannot use our bombs because i want health care. He has to give up some things, republicans have to give up some they both have to come off and compromise. The banker still get their 85 billion unless they allow anyway on the issue of asia, let me show you the front page of the Financial Times this morning. This is the headlines. You can see secretary of state john kerry meeting with leaders during a summit that was happening. As many of you know, he didnt president obama did not go. Another headline back to the Financial Times, the front page, china and japan warned on dangers of the u. S. Default. Lets go to carrollton, georgia, also a mainstream republican. Why do you call yourself that and what you think of day eight of the Government Shutdown . Caller i tend to agree with congress. They hold the purse strings. And they pay the bills, the president does not want to negotiate so they need to leave it shutdown. Also because of the president s failed policies, you have lots of people out of work. How are they going to afford to pay insurance or pay the fines of obamacare when they do not have a job . That is my comment. The president needs to learn how to negotiate. Angeles, tea los party member, hello. Unfortunately i think that president obama ruined the country. They control all of the american property. The streetscome to and organize the big protest against this policy. Andave go to their street organize a big protest against theseicies read policies. Host on the divide in the Republican Party, a piece was posted online saying we split the lines a the republican parties, the different factions. Republicans, Tea Party Conservatives, as well as moderates. We want to hear from you. The numbers are on your screen. Incy in florida, and florida, mainstream republican. Caller i agree with 1 i agree 100 with the shutdown. Like the government has been shutting us down for over a decade now. People who fund the government and we have a right to say how the government spends our money. I agree with it 100 . I think they should keep the shutdown until obama is on his knees. He has provided terrible leadership for this country and he is put us in this horrible shape. We will go to dave in california. A tea party member. What a your thoughts . Caller the caller just called in and said that if it werent for Mainstream Media obama would be dead. Or, hed be done. I dont want or need anything from the government and as far as it is concerned i hope they will keep it shut down for good. This country has been going in the wrong direction. Surveillance, society, control, control, can control. I am personally sick and tire of it. As far as the people working for government, lying about whining about being furloughed. I have not talked to one federal employee ever that said they trust u. S. Government. Take an entity that they do not trust and work for and ended up and it ended up biting them in the asp. In the ass. Our next caller is also a tea party conservative. Shutdown isink the because of tehe bad policies that our politicians follow. [indiscernible] should care about our nation, not other people. Host front page of the New York Times features charlie dent of pennsylvania, a so called moderate. It reports he said he would not pass a partition on a continuing resolution to open up the federal the federal government. He and others would not sign on the democrats do that. Charlie dent featured on the front page of the New York Times as a moderate republican. TheWashington Times for second day in a row, featuring ted cruz. Control the story goes on to say we are hearing from republicans only this morning. Mainstream republicans, tea party republicans, and moderates. Mainstream republican line, what are your thoughts . Caller my thoughts are that the shutdown should continue, number two, there is something very wrong with the president that is not willing to set down to sit down and talk about his congress. I just dont understand why he would not be willing to sit down and talk. Host let me play for you what Jean Sperling what Jean Sperling had to say. [video clip] the president has made clear and has shown he is willing to negotiate you keep saying he wont. Let me finish. He is willing to negotiate on he ister replacement willing to negotiate on how to strengthen the Affordable Care act. He is notid is that going to sanction negotiations with any faction that are using threat of default as a way of extracting policy in our democracy. The president has made clear the era of threatening the fault has to be over. Said that if has we can get by this threatening , of course the president has shown time and time again he is willing to negotiate on the budget. Let me go back to rome in columbus, ohio. Before they even did this shutdown, he would not talk to the republican house. Host House Speaker john boehner went to the floor after those comments were made. Here is what he had to say. [video clip] the president had us all down to the white house last week only to remind me that he was going to associate to negotiate. The president s refusal to negotiate is hurting our economy and putting our country at risk. This morning a senior white the u. S. Icial said would rather default then sit down and negotiate. A senior white house staff this morning said that the president would rather default on our debt then sit down and negotiate. The American People expect when their leaders have differences, we are in a time of crisis, that we will sit down and at least have a conversation. Really, it is time to have that conversation. John boehner on the floor reacting to what the president had to say yesterday. Jean sperling talking about negotiations. Jonathan allen tweeted out from alitico, the vp has not been dealmaker on this round of budget talks. , senator reid asked barack obama to ban him. That is a story written in politico. Lets go to john next in pennsylvania. Caller great topic this morning. Definitely the shutdown is one of the best things that has happened in the last couple of years. Theres no question that republicans have a civil war in their own party. I am a conservative. They have left me a long time ago when they started acting like democrats, boating like democrats, spending like democrats. Is about time they stand up and say no more. We have to take a look at what we can afford to spend money on. Jobs, half the nation does not like the program, and we cannot talk to the president. It is time our republican stands up and does their job and does with the constitution says they are there for. It is going to be democrats for the next 50 years. I am proud of the Republican Party and im glad this is continuing. Host here is the Washington Times and then hear from the Financial Times, fear of default sparks liquidity drain warning. Heard that earlier when you are reading the newspapers. The issue of default has been on the table for decades. This isnt something new. Republicans at some point there has to be a National Discussion as to whether this makes any sense. Leasticans are at addressing whether or not this make sense. The democrats are saying no, just keep raising it. That has got to stop and i am proud of the Republican Party. Mail frome is an e gerry connolly, it democrat from virginia erick in compton, california, mainstream republican. What are your thoughts . I consider myself a lincoln republican. That is a form of slavery. There is a system that was given to is that every 50 years we should reset the economy, we are not doing that. 2013 was the 150th anniversary of the emancipation proclamation. We should be having jubilee. Every 50 years we should reset the economy. Everything gets wiped out. Start all over. I am agreeing on this shutdown that we should shut down because in the system a sabbatical year gives us time to count everything. We as a people should take this time to sit down and take a look at what we have as a country. As a people, see what property the United States went on and brought forth. Propertyerly what to we own around the world . We are rich. We can do whatever we want to. Jeff from florida, a moderate republican. What do you think . Caller i agree with gerry connolly. I am a 20 year veteran. My government my wife is working for free right now. This healthcare bill is the wrong thing. For the president to go out and give concessions to big business and delay getting into this healthcare thing for a year, the same thing with congress and leaving the American People out there, it is criminal. As far as the shutdown goes, the only Silver Lining that can come out of this is the American People will, when they go to vote, will vote based on competence and not and vote based on what is true out there right now in america and not based on emotion. Host who do you vote for . Caller honestly it is a tossup. The republicans have passed all these bills over the last week. To me it is smoking glass. They know it is not going to get through the senate but the government needs to remain open. We have soldiers in afghanistan that are fighting and not having the civilian support because those guys are getting furloughed and laid off. It is criminal. Host are you part of the military . Caller i am a retired veteran. Host we divided the lines among the Republican Party. We will get more phone calls. Front page of the wall street journal this morning has the story of the nsas aida center. Data center. It is headquartered in utah. The front page says there have been 10 meltdowns in the past 13 months that have prevented the nsa from using computers at its new storage center, slated to be the agencys largest. One official calls the trical trouble front page of the New York Times this morning has this story about detroit. Those are some of the other stories in the paper this morning. Back to your phone calls, republicans only. Stephen in missouri, in stream republican, hello. Caller good morning. I have been following this very closely. I am a furloughed government worker. Quite frankly i think it is time for, as Thomas Jefferson would that have thecans responsibility to act to do so. I really think it is time for the American People to start requesting the resignation of members of congress. I think they account they are holding the country costed the country hostage. I am tired of the whole situation. Donna in ohio, a moderate republican. What do you think . We have to realize this is no longer an issue of who is right, who is wrong, this is an issue of can we afford this . We cannot. We cannot continue to borrow money from other countries. You are giving away our independent. We already fought for that. We are dependent on foreign oil. Now we are becoming dependent on foreign money. Sayave to step back and this is how much money we have, this is how much we spend. We need to cut all of this extra spending out. I live in ohio, companies are already laying off workers. Medical companies have laid off thousands of workers. These people are on employment. Why arent they collecting unemployment . We have got to step back and say we do not, stop and want to be dependent on china for our economy. His is what we have and i praise the speaker of the house. Somebody needs to stand up. We have to balance this budget. I say stay shutdown until we get it right. We cannot keep giving money away and expect to grow as an economy. Heres a tweet from the Associated Press that came out this morning the New York Times has a q and a on the United States seizing the leader of al qaeda a q and day with what is happening on the two raids a was happeningt with the two raids in capturing that libyan citizen. We are going to turn our attention to the new healthcare law and the policies within it. The office of Health Reform will be with us. Mike leavitt. We will be right back. During booktvs coverage of this Years National book festival, david nassau spoke about joseph kennedy. Whether church hill was teasing him church hill was teasing him or forgot that kennedy couldnt drink. They dislike one another intensely but the war was over. There had been intense suffering. Winston churchill said it to i am so sorry for your loss. Joe junior had died during the war and Winston Churchill was sincere. Tod to church hill Winston Churchill, what good was it all . World war ii had destroyed mussolini and hitler and the dictators. It has saved the mocker see, it had saved western schism western civilization. Booktv is the only National Television network devoted exclusively to nonfiction books every weekend. This fall we are marking 15 of booktv. We put you in the room at congressional hearings, white house events, read things, and conferences, and offering complete apple to gavel coverage of the u. S. House, all as a Public Service of private industry. We are created by the cable tv industry 34 years ago and funded by your local cable or satellite provider. And now you can watch us in hd. Washington journal continues. Nancyann deparle is joining us. She was the White House Office of health the form of Health Reform director. She is currently a partner at Constance Capital partners. Welcome to the conversation, thank you for being here. Let me start with your role in the Affordable Care act. What did you do when you are at the white house . Guest mainly i went up to capitol hill. As you know the president decided not to draft these. Egislations in order to make sure that all members of congress have an opportunity to work on it, he asked the congress to draft it. There were five committees in the congress, three and a house, two in the senate who worked on versions of the legislation. We worked with those committees as they were doing their drafting. One thing i think is important to know that is lost in the context lately, people talk about Health Reform as though it began and ended with barack obama. That really is not the case. Starting with the end of the demise of the Clinton Health 90s,slation in the mid there were bipartisan efforts going on from that point forward for almost 20 years to work out what are the problems we need to fix, what are the possible solutions . There was a considerable a partisan consensus around setting up marketplaces, requiring everyone to have insurance, reforming the Insurance Markets. All those things were identified as the problems. Worked on in were a bipartisan way from of 20 years. That is where the congress started, with the work they have ton doing over those years craft a bipartisan solution to this problem. A lot of focus on the marketplace exchanges. Enrollment started on october 1. Who came up with the idea echo the idea . It dates back to the mid 90s. What do we do to make a solution, to bring costs down the echo the idea of marketplace is originating in that time. But the best news was that it was not just an idea. We had a model and with the state of massachusetts had done in the early 2000s to try to cover all of its residents and had been quite successful. Also in utah, in the state of utah, have been experimenting with the same thing and set up a marketplace. It was an idea that republicans and democrats alike could see the work. It is important to remember that as we launched these marketplace is a week ago, the marketplace is designed for people who do not have insurance or for the relatively small group of americans who by their insurance through what is called the individual market read a do not have insurance through their employer and they have to go on their own to try to buy insurance. Those individual markets have been characterized by high rates , the ability of Insurance Companies to deny coverage if you have a preexisting condition, or to charge extremely high rates. People who are older are charged considerably more. Women are often charged more and often a lot more. Peoples the market that were trying to fix. On a bipartisan basis i think there was broad agreement that that market was broken. That is the market that these marketplaces are replacing. That in there is a separate market called a shop extreme being called called Stock Exchange should shop exchange. Theres something out there for everyone. If you have employersponsored insurance, you continue to get insurance through your employer, you dont have to do anything else. Although your insurance has become more secure, you have benefits. You know if you have a pre existing condition you there will be a place for you to find affordable coverage. There are benefits for you but you do not have to go to the new marketplaces. Is what you see now what you envisioned when you put this together the echo together . My former colleagues are working aroundtheclock to make her. There is robust insurer participation. There are a number of insurance plans that are offering carriers offering plans in these exchanges. I think the average coming to the market should place will have a choice of at least two interiors, to insurance plans. That has not been the case in any country in the past. That is what a marketplace is, offering a lot of different choices to consumers. Of thiswhat the framers legislation wanted and what the president really wanted. That is one thing. The price being charged we hoped in the marketplace the plans are competing with price and quality. In fact, the premiums being offered in these exchanges so thanre around 20 less what the Congressional Budget Office projected they would be. Why is that . We know that competition works. Having transparency works. These plans are competing for large numbers of uninsured americans. They want to be in there and they are being very aggressive about getting good prices and offering good prices. That is effective. Some of the insurers came back and said can we lower them because they saw what the competition is offering. That is the market we need to bring we need to bring costs down. Part that isnt working perfectly is Customer Experience. I am proud of what my former colleagues have done. This is unprecedented. It is very hard. The experts have said this kind of effort would tax the best minds. It is tough. Some of the challenging news the third thing that is working so far in the way that we hope is that people are really interested. There has been a lot of news over the past few months that 40 of americans have never heard of this and do not know that insurance reform is coming. That has taxed the system. I think it is making it better and better. For the uninsured people that are going to the marketplaces to compare plans and figure out what they want to do, they have until december 15 to sign up for coverage to start on january 1. Time to plenty of figure out what you want. Onlinefriends who went and found insurance to their employer. Theres a lot of curiosity. Host she helped spearhead the Affordable Care act for the Obama Administration and was a director from 2009 22011. 22011. At 11. Will this a tweet no, it is built on private sector plans and the private sector model of getting insurance. That is why this new theyaces deal with are there to help people who are who arere uninsured. Everyone in that market would agree this is broken. To make it work better you have to give get everyone into the system. Insurance, go in there and buy it. If you cant afford it, you can purchase a plan with the help of the government. That is why that is important. I dont think it leads to thing go pair singlepayer. On twitter guest first of all, i want to be sure what is looking at is the same high deductible plan he has before. Minimume plans at that actuarial value that will be offered on the new exchanges. If he has one already, i am sort of wondering if you can that individual market or says he is getting it from his employer. I dont know why it would have doubled from his employer, but i can tell you in the individual market where people are purchasing these or high delectable plans, the only reason why it would have increased is because youre Getting Better coverage. You can no longer buy a policy that doesnt cover hospitalization. If you are a woman, i was just with a breastcancer doctor here in new york who said he was china find help for young woman who purchased or who has breast cancer. Unfortunately, she is come to see him. She thought she was ok because she had insurance but it excluded breast cancer. Limitsill be no lifetime , so people cant go bankrupt because they have a huge medical bill they werent expecting. Were donethings that to strengthen the insurance that people get, and that might have increased the premiums lightly, but it should out of priest it that much. I went encourage them to call the interest apartment North Carolina who might be able to answer that question. Host elizabeth, independent color. You did clarify some of the logistics. My husband is a Small Business goer and our premium if we on the exchanger, 658 a month, which is not unreasonable for our coverage, but it is unreasonable because i am underemployed in my 22yearold son is underemployed. Before, yes, we were uninsured. My son was injured under the state of illinois. I am disturbed because i dont want to be a burden of the state. It goes philosophically against my grain. I am looking for jobs night and day, full time for insurance. I keep wondering, how many people, especially also in the south where i spent time with my elderly mother in some of these dry injured states, how will they be able to afford it . And there are result differences. We have more competitions and some of these northern states states, isouthern think that is where we are getting a lot of the friction. I dont think there are enough Insurance Companies to keep the competition. What is the timeframe that you think this is sustainable at the family level . Two years, three years, four years where were not borrowing money from overseas and putting our country even more in debt to foreign countries. Guest first, i appreciate your concerns and the president was concerned about some of the same things, which is why this law is fully paid for. Was very difficult, but he insisted and the members of congress who are leaders on his insisted to be fully paid for, unlike things like Medicare Part paid for. Was not this was paid for through savings in the health care system, which meant, for example, hospitals will have lower reimbursements to cover people who are uninsured. Right now there are payments made to hospitals to cover the cost of people who are uninsured. The theory was, once people have coverage, hospitals wont need to get as much reimbursement for uncompensated care from medicare. Those things will reduce and there were many other changes made to save money. This law not only didnt cost additional money, it actually saves money. So far, i would have to say in response to the question, it is working even better than we had hoped. When he asked what is working and what is not working, right now healthcare costs are increasing at the lowest rate in more than 50 years. The economists who have looked at as a part of it is because of the recession, as our caller is talking about. People have cut back a cousin of lost jobs or are afraid of losing their jobs. Part of it relates to the other deductiblet a high plan. I think most economists think having consumers have more skin in the game has also to help lower the rate of Health Care Cost growth. Economists that ive seen that look at it like david cutler have concluded more than half of the reduction in cost can be attributed to the changes in the Affordable Care act, to the things that are helping to bring down costs and lower costs. And these marketplaces are going to be a part of that. They are offering premium packages to people that are lower than what they would be facing today if they were trying to buy insurance. Hopefully, that will help the caller with her insurance needs going forward. We have seen more robust, edition already. We have seen plans injuring markets, injuring markets, so there is more competition. Even in the southern states, i would have expected perhaps to see less competition there, fewer plans, and we have seen more. For example, texas. The premium rates down there are going to be quite good in some of the areas of texas, in part because theres a lot of competition. The plans are eager to come in and try to get those uninsured and insured. I think it wont be three years youll have to wait, extra think youll see better rates. Host what about the role the medical device tax is playing in supporting the Affordable Care act and allowing it to be paid for . A lot is made on capitol hill about whether to repeal that tax. Why was that put into the legislation, first of all, and what impact could that have if it is removed . Guest well, when the legislation was being developed, and this is in the Senate Finance committee where the finance committee both did the authorizing legislation for the various pieces of the plan, so the marketplaces and the tax credits and subsidies that make this work, but also paid for the law. That is part of the responsibility, to come up with ways to pay for it. The president and members of congress and the senators felt strongly that it had to be paid for, that they did not want to add to the deficit. So the theory the committee had, and this was a bipartisan them committee was working on a bipartisan races for really more than two years on this, was that all parts of the Health Care Sector would benefit from having. Very american having coverage and being required to have it. So youre not earning other people, as the caller said, by showing up to the emergency room and not having coverage and adding to the premium cost of other families. The theory was, every part of the healthcare sector will benefit from the so every part of the healthcare sector should help to pay for it. So as i mentioned, the hospitals will have lower reimbursement for what is called uncompensated care, charity care. The theory is, their reimbursements will go down, they will be getting people coming in the door with coverage and that will help to balance that. Similarly, first pharmaceutical copies were required to pay an excise tax in essence to help cover the care beneficiaries to make sure the socalled doughnut hole in coverage under the part d benefit was filled. Right now beneficiaries have faced this hole in coverage or they get to a certain point and their drug utilization and not covered anymore until it gets much higher. For many seniors, that meant they just quit taking the medication, which is not good at all for them or the health care system. Pharmaceutical industry was required to participate. Every part of the health care intor had some participation this. And for the medical Device Industry, what they came up with the was this notion of an excise tax. I the finance committee, believe it was 40 billion or 50 billion over 10 years. By the time he got to the senate floor, it had been reduced to half that, i think around 20 billion. The Device Industry and the devices they sell in the u. S. , this tax would be applied. Working foroned, three years now to get that repealed. The problem with repealing it is, first, the principle that everyone participated in, which was that all parts of the healthcare sector are going to have moreand reimbursement coming in the door through the fact people are being required to have coverage. And secondly, if you start repealing parts of the law that helped pay for the law, then you have the problem that the caller mentioned a few minutes ago, which is that this becomes a program that isnt paid for, that adds to the deficit, which is something members of congress and surly the president what dont want to do. Upt a lot of people lining to a lot of questions about the Affordable Care. Ron, illinois, republican. I have to take issue with her comments about the bipartisan nature of the bill. 2009,emember it in march the republicans try to schedule a time with the president in the white house to begin talking about this bill. They refused. They were not allowed to come. Also, i would see i think it was senator sessions on the business channel saying he had tried to call, written letters and would never get any response. If i am remembering correctly, the only republican idea that was adopted in this legislation was one that came from the february 2010 meeting when, finally, the president sat down with republicans to talk about the bill after it had artie been voted on and passed. Liked theecided they republican idea about secret shoppers. Is there any tort reform in this bill or anything else that was a republican idea that was incorporated into this bill in a bipartisan way, by any republican . Host Nancyann Deparle . Ofst there are a lot bipartisan ideas. The Senate Finance committee beforefor two years 2009. There was a white paper that chairman baucus and the Ranking Member of senator grassley put out, literally, the day after the election in november 2008 saying, here is our white paper, here are the things we think should be in Health Reform and included the marketplaces and tax credits. It had a question mark about the socalled public plan, because that was very controversial. It had medicaid expansion. A lot of the central ideas that ended up in the Health Reform bill were worked on over a long period of time on a bipartisan basis. Even up to the Senate Finance committees markup of the bill in the fall 2009, march 2009, which are bringing up as a time when republicans were not invited to the white house gosh, my memory couldnt be more different. I started on the job in march 2009. My first day at the white house even before i started, the president asked me to come down because he was having a summit at the white house. It was a full afternoon there. There were dozens of republican lawmakers there as well as democrats, as well as other stakeholders from the hospital industry, from the pharmaceutical industry, various others, consumers, who have an interest in trying to do something about the problems we were facing with our health care system. If there was an effort to not listen to or exclude republicans, i sure didnt get the memo. I spent hundreds of hours myself going from office to office on capitol hill, meeting with anyone who would meet with me, meeting with some of the Republican Leaders multiple times. Really, we had constructive conversations and did include a lot of their ideas. I am thinking of one of particular that came up the other day, senator grassley had a lot of concerns about and costscy of prices that people have the healthcare system. We agreed on that. There is a provision in the law that requires hospitals to publish the rates of the most frequently used chart medicare billings,re hospital at least on an basis. That information was put out for the first time for thousands of hospitals across the country. That was senator grassleys idea. I have to give him credit. It was not just for medicare, he wanted it for everything, but we havent had that information cms put it out because that is what they have. He wants hospitals to put it all out more transparently. It is a good idea. There are many ideas that senator Olympia Snowe have. For example, she wanted to make sure that Small Businesses received some tax credits to be able to help defray the cost of coverage for their workers. Taxthere are Small Business credits, millions of dollars of them, because that is work that senator Olympia Snowe did, who is very concerned about Small Business. There are dozens of republican ideas in here. If i have one regret, it is that people do have the impression that this caller has, that the president did make a big effort to reach out and work with lawmakers on both sides of the aisle, because he really did. I saw that. Host a couple of tweets for you guest first of all, remember, this marketplace is for the relatively small group of people who purchase their insurance through the individual market. 10 million, not 150 million. The vast majority of americans theget coverage do so in commercial market. In other words, not through medicare or medicaid, get it to their employer. That will stay the same. Secondly, the marketplaces are disposed to be enrolling people yet. They are open for enrollment. But what we expect his most people are going to want to go on and look, compare their choices, talk to friends, and really make a reasoned decision about it. Some people have enrolled. We know that because, remember, some states are running these exchanges are marketplaces on their own. In techie has announced a already have kentucky has announced they already have a few thousand people enrolled. Some people are making a decision and enrolling. But they have until december 15 to get coverage that starts january 1. Under the law, the open enrollment will extend until march, the end of march. They really have six months to get this done. If they want coverage to start january 1, they need to be enrolled by december 15. I think it is too early to pronounce this a failure. I think i many of the important qualities, it is a success. If i could respond to the first tweet about risk. Yes, it is true, some people have more claims than others. Im not sure im not an actuary, so i wont make a pronouncement about who that is. But the weight employer sponsored insurance works is, it when you have a broad group, you spread the risk. So one person doesnt have a much higher premium than another person just because they happen to be a woman. It is true women use care, use Maternity Care. That is a fact of life. But this law evens out those kinds of differences so that women arent charged more than men so that older people can be charged more, but the amount of age rating is limited. It is not 50 times as it was in some states before this law was passed. That enables everybody to get coverage, which else everyone. Host dorothy, baltimore, independent caller. Caller i have a couple of things to say. I got a 20 rebate on my copay when i go to the clinic and all that with insurance from my job, and i did get two checks back. That was great. It wasnt a lot, but i didnt have to pay it, so it was great. You,ne thing i want to ask i hear peoples saying about the insurance going up. They cant be an exchanges, because they just came up. So these would be outside Insurance Companies, not exchange Insurance Companies. I wanted to say something. Is this is going to work, if exchanges make the prices lower which the outside company not in exchanges, if they want to be competitive, theyre going to have to try to compete. Justam thinking this is my thinking, but the insurance exchanges to my once they get up and people people are looking , shopping. If this lower, and i just changed jobs, and if it is lower, im going to take exchanges because we have a choice at this new job whether to take theres i guess i could pay whoever i wanted to. It is not mandatory i take it. This is what im thinking. That those exchanges, and once we start getting into it and people see the prices, the other insurances that went up are going to have to come down where they will lose customers. Be onto think you may something there. First, on your point about the rebates, that is another provision of the law that was added, which is to require Insurance Companies to spend at least 80 of your premium dollars on actual medical care as opposed to administrative costs. And because of that provision of the law, millions of americans have already received rebates like the one you talked about from their insurance company. Insurance companies are being more careful about the premium increases they put into place because they dont want to pay those rebates. The expense of the marketplaces having an impact on the rest of the market , and employersponsored insurance. The reason i say that, there are private Sector Companies that are starting up exchanges or marketplaces for large employers. Large employers right now cant come into the exchange of purchase coverage on behalf of their workers, but they want the same benefits of having more nsparency, of seeing panic plans competing. Some of the large employers are going into these socalled private exchanges where they will purchase insurance for their workers alongside other companies. I think the principle at work here with the marketplaces that are being set up by the federal government and by the states will also work in these private exchanges, which is that were transparency, competition on price and quality is going to make a difference. It will bring the cost and the prices down. , for people have heard these exchanges to work, it is dependent on young people to sign up. The number thrown out total is 7 million is what the administration is aiming for that will sign up for these insurance exchanges. And that 7 million figure, how many need to be young people in order for this to be successful . Guest i dont know the answer to that, but let me give some color around the 7 million number. Is the in year one, that estimates on the actuaries needed to make these exchanges or marketplaces work, is that they get around 7 Million People enrolled, and that is what the administration is protecting. The Congressional Budget Office rejected a similar number. I dont know what proportion need to be young and healthy, but i do know the way this works is the young and Healthy People use less coverage im a so their premiums help to defray the cost for the older people who have more conditions, presumably, and that is what makes the Insurance Market work. That is why large employers are able to get better rates, because they can spread the cost among a lot of people. So that is the principle behind it. Based on interest we have seen so far in getting signed up, that all goes well for having the kind of robust participation that is envisioned in this thing. Host recently written in a magazine, the question is and how many people in role, but what kind of people enroll. Two thirds of the uninsured in america are under the age of 40. What will be the average age of an enrollee on the exchanges . If most were born before or during the nixon administration, start worrying. Guest well, i agree. Avik has written very smart articles. For three years we have heard it whenever happen, congress will appeal it, Supreme Court will strike it down. It is happening now. The good news is, we can look at the facts as opposed to projections, so we will see. So far, things are working quite well. As i said, although i know theyre not satisfied with the Customer Experience of the first week, i am proud of the work my former colleagues at hhs have done over the past three years. There are people there who have worked with me when i was running cms back during the clinton administration, people who work with former secretary leavitt who is going to be on in a few minutes, and helping them to get the Medicare Part d benefit set up. These are tireless professionals who are working to try to make this a good customer express for the American People. I give them a lot of credit. Host the opinion section of usa today Kathleen Sebelius says, engineers are working day and night on upgrades to cope with the high demand. Republicanconfident, caller. Caller good morning. I cant believe some of the b. S. Being put out here. To take a young guy who doesnt have any money in the current economy, i mean, there are so many reasons he is not going to pay for it when he pays on a blondes bronze plan and will have a 4000 or 5,000 deductible is going to have to pay 7,000 before he gets any benefits. And theyre going to try to say, instead of buying a football sosey or that tank of gas you can take your girlfriend out for dinner, instead of trying to get something, we have to put up with the government telling people where to spend their money. By the way, pick up some Maternity Care and every thing else. The photo op obama had with the gluttonous people behind his gluttonous idea of spreading the everincreasing government, more more stuff that you spent and youre getting the special sweetheart deal where you leave the white house, there is this revolving door were you go over and make a big goal sugar daddy bagels sugar daddy salary, just like all the Insurance Companies who set this deal up, it is a big fiasco. As soon as the young people see it, you guys are in for such a big surprise in that election coming up in 2014. It will be a wonderful time. There are two parts. On the policy side, him doubting that young people will sign up with a dont have a lot of disposable income. Guest first of all, the young man he is talking about, lets break this down. If hes younger than 26 and his parents have a plan, under the law, he can stay on her plan. If hes older than 26 and he has a relatively low income, he will get help with purchasing a plan and it will be 171. I dont wear member with the numbers are but a bronze plan is very inexpensive. Or you can buy what is called a catastrophic land. For your he a very young people under 30, they can buy a justtrophic plan that will afraid the cost of a major hospitalization. What i found in talking to young people is there are some that have the opinion that the caller had, that they feel invincible and dont think they should have to buy anything. Many of them, though, say they want coverage, that they just did understand it, didnt understand if they got hurt in a motorcycle accident or broke their arm or leg playing soccer that they would then impose a cost on everyone else. When they show up the hospital, the hospital has to treat them, and that adds to the cost that everyone else pays. The estimates are that families who get their coverage through ink pay premiums that are average of 1000 higher every year to pay for this cost of an, medicare for those who show up at the hospital without coverage. Uncompensated care for those who shop at the hospital without coverage. People expect this is something, this is part of my job as a citizen, to make sure i have coverage. If i cant afford it, if i am someone who cant afford it, i will get help. But if the young person is someone making a good salary, they should be expected to contribute to that. Host Nancyann Deparle, i want to point out for our viewers, this headline. California throws its weight behind Health Care Law. It is a state were 15 of the nations uninsured live. A lot of resources being poured into implementing the new system in that state. On the second part of what the viewer had to say im a Robert Simpson wants to know about your current position. Guest i just started with confidence in september, the day after labor day. Firm,a start up, a new investment firm. This is what i did when i was. Ut of the government before i came and helped on the Health Reform law for the president and spent four years working there at the white house, and now im back doing what i was doing before, which is helping to start out care companies. Host troy, new york, democratic caller. Caller good morning, ladies. I would like to give out some information that i got from c span, because theres a lot of misinformation, especially near opening segment. You guys have a series on every money for but the past month host theres a Kaiser Family foundation and the health news, separate, independent entities. Go ahead, try. And blackhealthtv. Com,. Here is another website there are some interesting facts about obamacare. One thing i want to put out to my rightwing friends listing right now, wall street has plans to make a lot of money off this insurance. If they werent going to make that much money, so why are so many Insurance Companies planning to spend 2 billion on advertising . Another thing host one at a time. Let me have Nancyann Deparle respond to profits will be made from the Affordable Care act. They will. Ink we are building this on the private sector her. The system is built on private health care plans, not the government taking over health care. There are private insurers who will cover more people. The Insurance Markets are being reformed so everybody can get coverage and you wont get locked out if you had a pre existing condition. It should be profitable for firms who know how to provide good coverage for americans who havent had it. Host Nancyann Deparle, thank you for your time in talking to our viewers. Guest thank you. Host our conversation will continue to miss speaking to former utah governor and hhs secretary michael leavitt. Then we will talk to the National Parks conversation conservation association. The partial Government Shutdown. It is also taking a toll on the white house, according to the Associated Press, were they say three quarters of the staff is being kept off duty. Usually there are more than 1700 advisers, assistance, chefs, and landscapers working at the white house but with the shutdown, there are fewer than 450 on the job. President obama is at the white house today and instead of attending the asiapacific economic conference, secretary of state john kerry is at the meeting and the president s place. Where earlier today secretary kerry met briefly with the leaders of russia and china to discuss the situation in syria and other world hot spots. An american official traveling with secretary kerry says he spoke with Vladimir Putin for about 15 minutes in a conversation that focused primarily on organizing an International Conference to help syria create a transitional government. The officials said they agreed on the importance of organizing the conference by midnovember target date set by the united nations. Congress is in session today. Chambers can meeting at convening at 10 00 a. M. The Associated Press reports that Oklahoma Republican senator jim inhofe underwent an emergency quadruple bypass last week and doctors havent yet given him clearance to fly. The senator, who turns 79 next month, tells the. And never feels fine expressed any symptoms. The problem was discovered during routine tests. He expects to return to washington in a few days. The cspan archives are amazing. The Video Library is amazing. You can view and share cspan programming any time. It is easy. The cspan video archive is the true modern record of congress. Cspan archives are amazing. The Video Library is amazing. You can view and share cspan programming any time. Its easy. Heres how. Go to cspan. Org and go to the Video Library to watch the newest video go down to the most recent, click on what you want to watch, and press play. You can also search the Video Library for a specific topic or keyword or you can find a person by typing their name, hit search, and go to people. Go to their bio page and scroll down to their appearances. You can also share washington journal continues. Host our conversation continues on the Affordable Care act. Us. Ael leavitt joins the former hhs secretary under the Bush Administration from 20052009. Many have compared the Affordable Care act, the rollout of a, to Medicare Part d, of which you spearheaded. What was your role in that . Guest as secretary of health, i had all responsibility for its and limitation. I would have done the same thing at this point that Kathleen Sebelius is doing. Obviously, there were tens of thousands and in some cases hundreds of thousands of people involved in it. My job was to oversee it. Host what was the goal of it . Guest to find and educate and inoll 43 million americans the course of just a few months. It was a significant challenge in the same way those implementing the new Health Care Law have to face. Any similarities, but a few differences. 2006. It when in effect in a proximally 50 million elderly and disabled beneficiaries have access to medicare drug plans approved by the federal government. This information according to cms and the Kaiser Family foundation. How did you prepare for the rollout of Medicare Part d compared to the rollout of the Affordable Care act . Guest both require many many months preparation. We had roughly 18 months to prepare for the actual Enrollment Period theyre going through now. There were systems that had to be cord needed. Nearly 50 medicaid systems coordinating the computer systems. Or was entire country to educate. We had to work with plants in the same way this new benefit is being coordinated so there were plans available. It was a massive logistical, and am i say, social logic exercise to bring about an entirely new way of buying insurance to a population of americans who badly needed it. Host what are the Lessons Learned from the rollout of part d that are germane to the Affordable Care act . Guest primarily, the early preparation would pay off. What is going on currently with the implementation, i think we are seeing some of the same things problems,nced early because this is a very complex set of issues. The Current Administration made a decision that they would, in essence, to for making many of the rules or announcing many of the roles that would government during the election. It put them a bit behind. Therefore, the level of testing and were able to do was not as robust as i think they would have liked it to be. And the consequence was in the early days of his rollout we are seeing some systems problems. I think they have substantial amount of time still to make that work. The way the program works, ultimately, the big and quite heavy implementation period i think will be in midnovember through the end of the year. They need to get it right between now and then. What we saw was essentially, what should have been a dress rehearsal or were they shouldve had a dress rehearsal, the Opening Night really became the dress rehearsal and now theyre having to scramble to fix it. Host in your opinion, is there time to fix it . Guest i think theres time. They have now until january 1 when people will gain coverage. Obviously, we dont know the depth of the difficulty theyre having. Theres not much information about that. What we do know is many people tried to get on and could not. There is nothing truly unusual about that kind of thing occurring with their brandnew system is big and complex as this one. We will see how they do. Obviously, they have teams working on it. And they will do all they can to make it come up. If they dont have it fixed, i would say, in the early part of next month, i think their problems will become more severe. Host in july of this year, you wrote in a piece for washington post, were you laid out risks to implementing the Affordable Care act. Insufficient education, technology breakdowns, subsidiaries, and fingerpointing that could all lead to risks to the Health Care Law. Where are we now here in october . Items weree four lessons i had learned going through the experience you alluded to earlier. Administration, and entire country had to be educated. Early on, not many people knew about it. As is beginning to occur, the news media is focused on it, other peoples wordofmouth is beginning. Putting insufficient effort to build the infrastructure to do that was a risk to them. I still think it is a risk to them. They have nearly 10,000, what they referred to as navigators, people who are assisting others to know how to operate the system. Many of those people are inexperienced. They will gain expense as time goes on. The systems risks i have already alluded to. I think therell be additional problems as we get down the road theyre going to have to work out, some of which will be involved in the subsidies that are available to people who are in certain income categories. That is a very complex system and we have yet to see operate at a full level. The last risk of finger pointing, a lot of sociology is involved. People naturally point at others. They need to have good partnerships with the insurance plans and states and others without those partnerships without those partnerships, they wont give to do what is so important in making this a success. That is good problem solving and coordination. Host lets be clear, do you support the Affordable Care act . Do you agree with the law . Separately, do you agree with the republican strategy on capitol hill to try to defund it or delay it . Guest i did not support the Affordable Care act. I do support the need i think while he held aspiration for everyone in our country to have access to Affordable Health care plan. There were many aspects of the president s approach i disagreed with. It is the law of the land and people are implementing it and were all having to do with it now. That is where my efforts have been focused. Congress is obviously playing out a political process. In my mind, it is not about whether people ought to have insurance, but whether or not our country can afford the level of subsidies in the context of a Large National budget problem that we obviously have. That process is ongoing and playing out. Like most americans, im having no influence on it but watch it with interest. , formerchael leavitt governor of utah, served as president bushs hhs secretary, spearheading the medicaid hard d Medicare Part d. He is also an author of a new book. Independent color, first out. Caller im wondering if the Affordable Care act works as proposed, will it have an effect in reducing the cost of medicaid . All, pam, thef Affordable Care act at somewhere between 15 million additional people and 16 million additional people. I think it will be less than that because a number of states have chosen not to take the option of implementing it, primarily, because of the cost. It would be difficult to say medicaid would be reduced as a matter of expense. That is a great problem in most states because the money say go to pay for medicaid also compete with other important things like Public Education and Higher Education and building of infrastructure. States are struggling right now with the way weight of this and i suspect that will be an ongoing debate. , a tweethael leavitt that is an old discussion that came up at the time. They believe theyre going to implement it, then it needed to have a physical pay for, as they payin washington fiscal for, as they say in washington. I was not actually there when it passed. My job was to implement it. On why as conversant they did or didnt. The truth is, we have a very serious budget problem and there have been actions by both parties that have contributed to that. The impasse were seeing right now, in my mind, is not a question of whether we have a problem or not, but whether we are going to deal with it. Both parties contribute it, and both parties need to be taking part in solving the. Host Nancyann Deparle said it is paid for. What you make of that . Aest Nancyann Deparle is very good friend of mine and there are many things in the world we agree with. In terms of budget scores, there was a plan to pay for it. The reality is, it was paid for in large measure a majority by a group of medicare reductions that have not yet occurred. Pardon me if i seem skeptical about whether or not that will actually occur. We will see people are not inclined to have their medicare benefits reduced, so were going to have to see if another plane comes about. You can mark me down as a bic skeptical. Host another tweet sandra, indiana, independent caller. Caller good morning. Hello . Guest good morning. Caller it was brought to my attention this week about the ,hs in conjunction with the cps if you are ruled a high risk under the exchanges or the obamacare, they can go into your home at any time and check on your children. And if there is a weapon or alcoholic beverages or if you smoke, they can take your children from your home. Is this true . Guest sandra, i dont think that is true under the Affordable Care act. There would be state laws analyst every state that would protect children when there are situations in their lives that put them at risk. But i know of nothing and felt confident there is nothing in the Affordable Care act that would either change what is going on with states, or for that matter, bring that kind of worried to bear. I think the state governments are the ones that pass those the care forrce children. I wouldnt spend a lot of time worrying about that if i were you. In terms of the Affordable Care act. Host tony, democratic caller. Caller good morning. You guys are doing a great job on cspan. I hate to be the conspiracy theorist here, but isnt it we are having so much trouble with this website, isnt it possible that someone know,oding the site, you if you get too many people on there, obviously, nobody is going to get through. Brothersow the koch and other organizations are finding people that go on these bus tours. I think a lot of the republicans are funded by these people, too. It just seems to me, if there, stop these thing this thing, it would be a good way to do it. Guest that is an interesting theory. I think it is not likely. I suppose it is possible. If that were true, it would be in violation of the law and im sure it would be detectable by those who are managing the systems. I have heard nothing of that sort. Iti would guess on balance is likely not true. But thank you for calling. Host guest that is consistent with my understanding. Host can you explain that for people who dont know . Guest the question is, how does a person who was not familiar with or may not have access to the internet, how do they access information . Naturally, the administration has sought many different channels for that to occur. It is my understanding that those who are in the business of providing intermediary or help to the consumer are able to register and become what i referred to earlier as can, inrs, and they fact, be compensated by the government to help consumers work their way through the system in the same way they would help consumers work their way through the private system. Host a lot of attention paid to the website healthcare. Gov. Jim on twitter guest i suspect because it is a very low number. I dont mean that as a criticism. I think the way the program is notctured, the system does accept payment, therefore, they dont get insurance until january 1. I think what we will see is most people during the first several weeks of this and limitation are essentially windowshopping, trying to figure out what it would mean to them. I think if we didnt know that number, it would be underwhelming, simply because most people are windowshopping. Host robert on twitter guest well, i think that is the sold, and ultimately to some extent, it may be true. There is a lot of pressure right now on doctors and hospitals to provide care for lowercost. Lets acknowledge on the surface, that doesnt feel like a bad name, and lesson becomes so difficult to find a medicare physician, someone who will take medicare patients, and that gets harder every year. The more pressure that is put on the system. Frankly,think, hospitals more effective lobbyists than consumers on a oneonone basis, so you can still keep me in the skeptical as to how many of those reductions that were used to pay for the Affordable Care act will actually incur. Host what is your take on a medical device tax, the 2. 3 on all medical instruments, with some exclusions . There is talk about repealing that part, with bipartisan support. What do you think about that . Guest i think the reason there is bipartisan support growing to repeal it is because in very real ways it is a tax on consumers, because it is passed through. The second is, medical devices and pharmaceuticals and others, while there are thought about as big corporations, they employ tens of thousands of people. We have put at risk of very Important Group of industries by imposing it. We have actually just taxed people who maybe can at least afford to pay consumers by causing them to be paying more. We have also hurt the competitiveness of an important american industry. I think was a way for them to get money. I think in retrospect, theres a lot of people thinking it might not a bit better it mightve been better not to have done that. Is quoted inics usa today saying it expects to pay 120 Million Dollars in device taxes this fiscal year. Maryland, democratic caller. Caller hello . Good morning, how are you . I would like to speak to the gentleman because i am 84 years old. In 2003 i lost a kidney. Two years ago i had to have a complete shoulder replacement. Just a year ago i had to have a pacemaker. I look at the bill that i got if i hadnt had the medicare programs, i could not have afforded that bill. Right now i pay 150 for an office visit for my shoulder. Pacemaker. I only get 746 a month Social Security. You tell me how i can afford anything out of that small amount, and i started paying Social Security under president roosevelt. Mr. Levitt . Guest im interested to know how the caller is feeling. It sounds like she is pedro whole lot of difficulty. I hope things are doing well for you now. Host i apologize, governor, she is in on the line. Guest let me respond to her question. Medicare is a very Important Program to all americans. We all have parents, we all look to when we will be in the summer situation when our health to be fragile. We are all very glad we have medicare and should do nothing that would stand between people and having that kind of care. Im glad to hear she received it. I also believe she makes a good point where people make a lot of money, really ought to pay more than people like her who live on a fixed income. I have been an advocate for many wealthhat people with ought to pay a little more for what they get with medicare than people who dont. I have a son who is in his 30s. He struggles with his family to raise his four little girls. Every month he gets a paycheck that money is taken out of his paycheck to pay for people who make a lot more money than he does for getting medicare. That doesnt seem fair. I think that is one of the ways in which over time we can bring medicare back to a sense of balance is beginning to think as opposed toer people who make a lot of money and why should they pay the same thing. Host an individual tweets guest the premiums depend on the nature of the persons age, and to some extent, where they wherend marketplace theyre consuming services. Everyone has a bit of a different situation. That is one of the things that makes it a difficult thing to implement properly. Host florida, independent caller. Caller yes. Host youre on the air, go ahead. Caller i want to know about the copay. 50 for the emergency room. It went from 50 since this has come to a head, and the last time we went to the emergency room it was a 300 copay. I want to know how many doctors are actually signed up for all of this right now. Questionll, that is a that i dont know the answer to. I will say that copays and adaptables have become a bigger part of almost every insurance plan. One of the reasons it is done is not just to share the cost, it is also to make people think before they just run off to an emergency room. In most cases, those charges are waived for situations where preventive health, immunizations and physicals and mammograms and other things that are important for people to have to prevent a serious illness or injury. Host here is an email from one of our viewers guest well, i think he points to a trend that is quite prominent in peoples lives. Funds now areare just dramatically underfunded, meaning that the costs are so much higher than the amount they bring in. It is almost half of all of the funds with medicare actually come from taxpayer dollars. And so theyre just fighting to find a way to balance all of this. Think hanks expresses not unusual. It is probably one we will see it is one of the reasons we have to find a way to deliver manner. A more efficient guest well, i agree with that statement to the extent i believe there is a widely held aspiration among republicans, independents, and democrats that we want all americans to have access to Affordable Health insurance policy. I think that is not the issue. I think the question is, how is it paid for . How much money do we take from one person to pay for another . That is always the dilemma and it is really the case here. Host florida, democratic caller. Caller thank you for allowing me to take this call. I spent my whole career in health care. I was working for one of the largest Insurance Companies in new york state at that time. It was before medicare passed. Something like 650,000 people enrolled at that 4200cular time, and about doctors, nurses and other groups it was a prepaid route to system in new york. There were only a handful of insurers at that particular point. Within five years and our 850,000. T grew to the number of employees jumped to about 6200. To me, this is a Stimulus Program that is proven in the medicare you know, wall street got there stimulus package. This is a stainless package for people to save lives. Guest ofst a very High Percentage employment around the country is related to the healthcare industry. We talked earlier about Device Companies and pharmaceutical companies and Insurance Companies and hospitals. They employ tens of thousands, millions of people. Idea that it is just about healthcare, i dont think we should be spending more on Health Care Just to provide job