what are the big differences? >> one of them is this amendment that has been proposed by senator ted cruz. if you have an insurer that covers the plans, like essential health benefits that include maternity care and mental health, if they offer those they can offer plans that are not as comprehensive. there is concern about that in particular that healthy people will go to those plans. there is about 70 million more in the bill to help insurers do. a lot of sick people came at the beginning and drove up the cost. additionalthe major medicaid che made. there are conditions. additions.ere are instead of it being a matched federal state program, or states, no matter what they spend, will get a federal match. >> it would go a capped allotment. the new version allows if there is a zika outbreak or hurricane or something where they had to spend more on medicaid. it could be excluded from the cap spending. and another key change is the senate bill would allow penalties of tax and deferred money you use for health care and team it with a high deductible plan to pay your premiums. that is one change that is important. >> if you are the governor of a state and receive a cap grant and cap what out happens to those individuals? >> if you have more expenditures, and dip into next year's allotment do you reduce the number of beneficiaries or services offered? there is 17 million americans in nursing home care. this idea of making it be of great concern. >> one of the key reasons we are facing a $20 trillion debt? at. guest: it has grown. there has been a need for it. that is what the advocates would explain if you have two thirds of people in medicaid, how do you meet the need? would you do with it? growth in federal spending on health care programs and entitlements, is one of the drivers of the deficit. it is what what people want to look at. >> host: this is from the washington post. in the essence of the story, more than 400,000 state residents in colorado receive some form of medicaid assistance. where does that put a key republican senator's politics behind the needs of those folks in colorado? the governor will have to foot a part of the bill? >> guest: it is difficult. the governor is part of the senate leadership. the writer talks about how yes to to this hand. that is the difficult choice. do you want to support the party and put yourself back home? host: our phone lines are open and we are defining them a little differently so we can include all of you in this conversation. if you are currently part of the health insurance plan put in place but barack obama,(202) 748-8000. for those who are medicaid recent recipients,(202) 748-8001. uninsured,(202) 748-8002. others,(202) 748-8003. we will get your calls in a moment. what is the source of the money for heroin addiction? guest: the repeal of the -- to be in place some of the taxes on higher income individuals. if you make over $200,000 as an individual or $250,000 as a couple, they have a tax on it would increase your medicare tax by 0.9%. they haven't repealed of the republican -- they have repealed it -- generate money for that kind of program and giving more to states and insurers. it is a big chunk of the money. the medicaid changes are going to take her on 770 billion dollars. for continuity sake, if we are talking about taxes, some of the taxes repealed on the device makers, does repeals stay. host: for those participating in the informal care act, what would -- in the affordable care act what would stay in place? >> guest: you would still have your health insurance exchange. it is your menu of options. you may still get federal assistance, subsidies, tax subsidies. if goes to 400 percent of the poverry line and that is 90,000 for a family of four. some could stay but what could change since affordable care act was implemented or if the house or senate bill becomes law is the menu of choices may change and the may plan you have now may or may not pea there. host: how do people currently have insurance? how many get it through the informal care act? how many get it get through their employers? were uninsured in the second quarter of 2017. you have about 150 million americans getting insurance under their employers. the medicare program is around 58 million. the medicaid program is around 78 million. one thing that has been constant is the affordable care act and the legal wrangling has been for a fairly small group of people. it is about 24 million folks who have gotten their coverage through the medicare expanse or exchange. host: our guest is mary agnes carey. we will get to your phone calls. in kentucky with senator rand paul opposing the bill. we go to dean, uninsured, in kentucky. good morning. >> caller: good morning, i am uninsur uninsured and i go to the va and they only have three choices. >> thank you, dean. >> dean sounds like he is getting coverage from the va. he is a veteran and talks about how he has a limited drug coverage. one thing the va does is they have a more limited formula and that is the list of drugs covered. they do this to help control prices but sometimes patients and physicians don't like it. >> david in georgia. >> caller: on c-span i seen a wonderful segment on this subject, female doctor. and a man from cato institute and the man from cato kept throwing out all this conservative conversation and the female doctor said we are wasting half a trillion on paperwork alone trying to satisfy the insurance companies. and we are paying who knows how much to the insurance companies for paperwork. i wonder if you could comment on the comprehensive health care program which was started back in '46, '47 when truman was having the big debate and see why can't we go to a universal thing where the government does it. i have met many in the county and state that do the health care and do a great job. >> host: david, thank you. >> guest: when you talk about inches at the county or state level it is delivered and administered by private insurance companies. the point he raised earlier about the amount of paperwork and administrative costs and could those be examined trimmed. it will help those individuals in the market who could not afford it before or find a policy that covers their preexisting conditions. this is about the role of insures and government. it is ongoing. and >> host: the caller making reference to a discussion we had monday debating the single payer institute. all of our programming is available online. check it out at c-span.org. sandra is joining us and she is part of the affordable care act. >> caller: yes, i am. i love it and i am glad it is in place for working people who could not afford insurance in the past. i just want to say my brother is part of the aca bill and he has a lot of medical problems and he used to just go to the emergency room when he had a flare-up or crisis but now he is able to go to doctors because of the affordable care act. he worked minimum wage at a restaurant and everything. and i could not afford health care. but my question is this: what is the profit or the loss of money that insurance companies have suffered as being pulled under the aca? it seems like a lot are in rural areas which i am in a rural area. a lot of them are pulling out of rural areas. so, they are justifying that by sago, they are loosing this money. but i want you to explain or tell us the amount of money as a whole they have lost or are they just using this to keep the things has they were? just one other thing this new plan is nothing what chuck schumer said. they are trying to sell us a bunch of junk. there is nothing in there that will help us. if you have access, you can have access to anything but having access to a bunch of junk is not doing anything for the service of the american people. host: we will stop you there, thank you. mary agnes carey. >> guest: she asked a lot of good questions. i want to talk about her point, you have insurers in rural areas and markets that have decided not to offer obamacare coverage. in particular, arizona, iowa, tennessee are having issues. it varies by county. it depends on the insurance company. the general theme is when the affordable care act came in, people like her brother, got coverage. it would help him get out of the because he comes into the system sick, it is expensive initially. insurance had people sick people coming in initially where the affordable care act did not attract the young, healthier people want to get. insurers getting in may have under price their products. now, they have to make up for the factors we are talking about, sicker people coming in and not healthier people coming in. insurances are trying to figure out what this means. in an urban market, you tend to have more competition with providers. insurances can get a better deal. in the rural markets, you cannot do it as much with providers setting prices at a certain level. insurers have been concerned about the trump administration has not committed fl ully. some insurance are saying to to the's are today, we are increasing our prices. i would point them to our health policy research colleagues. the kaiser family foundation put out a report that they are starting to benefit for the first quarter of 2017. it is an interesting read. >> host: we welcome our listeners on c-span radio, are conversation with mary agnes carey. she covers health for kaiser health news. -- she began her career -- two things. under this senate republican bill, you could keep your child on the plan until the age of 26. >> yes. that does not change. it has been very poplar and republicans kept it. >> in terms of over the age of 26, catastrophic care insurance. what is that? guest: it is a provision of the affordable care act that is a more limited coverage. three doctors visits a year, preventative care, that sort of thing. is open to people 30 and higher and you can use a tax credit to access the coverage. this is a way to get a plan that may suit your needs and get a subsidy to do that. it is an interesting development. i do not have the numbers of whom it in role. >> what about wellness programs? we talked about insurance when you are sick and if you are older americans that need health care. is there enough in this plan to keep you healthy? >> most insures want to have those programs for the reasons you site. if you are a diabetic, you have high blood pressure or chronic condition they want you in a wellness program to monitor it and the affordable care act allows some linkage of premiums if an employer wants you to participate. it is an important element. >> host: debra is joining us. he is -- she is on medicaid in florida. >> caller: i have been on disability since 1989 -- am i on? >> host: tell us about yourself. what is your disability? how long have you been on medicaid? >> caller: i have been on medicaid since 1989. and then the medicare kicked in two years later in 1991 because i get social security disability, like $600, and then because that is not really that much money i get ssi that is like 60-something dollars. i have two heart valves in my heart. it doesn't pump normally and also i have agoraphobia and post-traumatic stress disorder so mental and physical. like, today i an appointment, which i have ever month, i have to go out of the county i am in because the state gave, you know, options -- they don't offer it in this county so my son is driving me out of the county to see someone. i am wondering will the trump care -- will i not have medicaid coverage because i need the medicaid to help. >> i think you are talking about the caps that could be put in place in florida and other states. thank you for the call. we will get a response. >> guest: she has raised the ongoing discussions. he was not on the medicaid expansion for it she has been on it a while. it seems that she is on it medicaid managed care program. yet on the point, if florida, if other states have a cap allotment and their needs increase, what happens to people like deborah or other people on medicaid programs? medicaid programs, but what does that mean? do you have to cover fewer services? would you require higher co-pays? states would have to make the decisions themselves. it is part of the -- proponents talk about state flex ability -- flux ability -- flexability. spending will still increase every year. over a 10 year period, the cut is a 26% drop in what was expected. legislators and the governor of florida and all over the country will have to be looking at their medicaid allotments and asking the questions. >> host: let's take florida as an example. do you know how much they get approximately for medicaid recipients? with a -- what they would potentially get if he was signed into law? >> i do not know that. but i bet if you went to kff.org you can find that. >> host: we will look for that. i didn't mean to put you on the spot. you are the expert on all things health care. >> i failed. >> kathleen from st. augustine, florida, good morning. >> caller: good morning. one of the things i never hear discussed is hmo programs. i have been on hmo programs since i was a young girl and i am in my late 70s now. when i hear people talking about the free care offered in other countries they don't understand that in those countries, all of my family live in a country in which there is universal or whatever you want to call it, the government takes care of the education of the doctors in exchange for which they gave so many years. in england, ireland and scotland, countries which i am familiar with they get their school paid for. people don't understand there is another component nobody talks about. i think the hmo and clinical system are fine. it isn't fair for us to confuse that. i think some thought should be put into a good clinical system and the idea you have to have your own doctor what nonsense. i know in england and ireland it is a clinical pursuit and you have the doctor who is on call to treat you. you don't have the luxury of going to private doctors and private offices when you are on what so many american people feel is free care. >> thank you very much for the call. guest: she's done them a close facilities. doctors get treated at their hospitals. versus the idea, you may get your own personal physician, you need a particular x-ray or mri, you go to a radiology center to get that. the test is sent back to your doctor. she talked about the clinical system where you see the dr. on call. that is how -- the doctor on ca ll. that is how it works. there is a lot of preference for people to individually see their doctor. it is something that is common here. >> host: we went to a kaiser foundation map and there is an interactive map. this is what it looks like if you go to your own state. we talked about florida. it shows the total medicaid spending is $12 billion in the state of florida. there are lists here. $485 million in tax credits for the marketplace enrollees in the state of florida. >> right. it is all there so people can go, look and see how these particular provisions and bills affect them. >> host: let's go to kathleen from st. augustine, florida. >> caller: oh, i just was on. >> host: yes, you were. steve in troy, michigan. >> caller: i would like to say three quick points and i will do it quick because you will not like them. in december 2015, you heard of ezekiel emanuel? he said the only way the affordable care act can work is if everyone in the country is on it. that is what he said. two obamacare and any bill of the republicans is never going to work because it will take up more money. all the nurses and doctors went to the white house and obama made deals with them. everything that happened is because of the affordable care act. giving more money to the insurance companies is where the republicans cut that off and if the affordable care act has been going up because it was designed to do that. >> just a couple things. to the first thing about emanuel. this plan was never designed to have every american involved. they worked hard to preserve the employer health care system. you are correct in what that i believe the summer of 2009, the insures and other entities went to the house and talked to president obama and negotiated to get a deal because as you might know if you look back at that point in time the affordable care act was on track. it was in hearings and negotiati negotiations. you want to get out in front of legislation and cut your best deal. we had a scoop at kaiser health news about hospitals going in. that is true. >> this is the headline from the latest health care bill allows insurers to sell the bear bone policy. what is the principle behind this? guest: there are complaints that the package of 10 benefits all plans have to cover is too much for some people. if you do not have told you, you may not care about pediatric care. if you are a man and are not married to anyone who has a baby, you may not care about maternity care. that is too much -- the plans are too big. why is the government mandating what has to be covered in your health insurance plan? should not be that way if you do not want that much. you should not have to buy it. the issue analysts are concerned is the segmentation of the risk pool. all the healthy folks go to the limited plans and the sicker individuals are people that need mental health services or maternity care go to the other plant that you do -- other plans, you do not have the balance. the insurance industry is talking about that. they are concerned about amendment. this bill could still change, this could be dropped. it is -- it could not be the final product. into the next week, it is important to watch what is happening in the senate. different provisions of the bill can go in and out. >> what would it not cover? guest: it depends on what you pick. let's say you picked a plan had a cap a hospitalization. maybe a $50,000 cap, you would still be covered. if you costs beyond that point, they may fall on you. >> who ends up paying? >> the hospital will try to get you to pay that and can't you may be able to negotiate with them. if it went to a debt collection agency there may be issues liens and other things against your house or issues on a credit report. i know they are making chains -- changes on credit records and health care debt. but that is something people have to think about. if you wanted a bear bones plan they will not have those caps. even this idea that in the senate republican plan and in the house republican plan there are options for states to get waivers and insurers and plans that don't cover essential health benefits like mental health services isn't covered in your plan you are no longer protected with no more of annual cap. to be fair, i have been covering this from the beginning and i heard numerous people call or say i don't want to buy a plan this comprehensive. some of the plans were grandfathered for a bit. host: in the invite our -- let me invite the audience, we are focusing on the republican health care bill. between the joints us from board -- victoria joints us from oregon, go ahead. >> this is in response to my daughter's response with the aca. my daughter lost her job and -- 81 a month is what her insurance was and three weeks after she got the card, she wound up taking a trip to urgent care. it would have cost her more but it isn't a free ride and she had to pay but it was about half the cost. eight months later got a great job with great health insurance and her salary went up double from what she was making. had next year she had to pay the taxes back on those subsidies. it is not a free ride and people think everybody is on the program and it is a hand out. he was happy to pay back those tax because of what her income was and happy to have the care at the time. guest: she is talking about if you are -- if you have an affordable care act subsidy and your income changes, you may be required to pay some of it back. luckily, she was lucky -- you may be required to pay back some of it. i should say, i think she is referring to kaiser permanente. i am aware of the company. kaiser health news and kaiser family foundation are not affiliated with heiser prevented. it is confusing for people, but we do not have affiliation. host: i want to point this out, on the family kaiser foundation, an interactive map breaking down county by county and state-by-state, the differences under the current law versus the current republican bill. dennis from pennsylvania, good morning. good morning, you are on the air. >> i was covered under the aca and my problems with she had just touched on part of this. these people that talk about going to the emergency room. they will end up taking your house because like the company i worked for if they showed up and didn't pay we would not make a profit. the aca was the best insurance i ever had. i would like to mention the cuts to medicaid they are talking about is exactly what paul ryan would like to do with medicare. and that is give you a voucher to pay and tell you to buy your own insurance and it would only go up by regular inflation and as we all know medical inflation has been much higher and you would be responsible for paying the difference that that voucher didn't cover and everything year the amount of money you would pay would increase and increase and increase. so have a nice day and thank you. >> thank you. very interesting. what he raises is this idea that paul ryan who is the speaker of the house and many republicans support is premium support in the medicare. giving beneficiaries a set amount of money and allowing them to chose from a menu of plans. that is something that was tried a few years ago. it landed with a political thud. seniors and groups didn't like it. there was a lot of opposition when they went through it. looking at the medicare changes he mentioned in the senate republican bill and medicare and caps of spending in the house bill. the question is over how fast the amount of money would rise. >> it would be nice to buy their protection only if it catches on fire? >> the nature of insurance is most people want you to get it before you have to use it. it is going to go to bill. there are other periods where if you don't have coverage you may have to sit out and if you are trying to get asked that another way but that has been a key point if you force people to buy insurance. >> and this tweet is this a ponzi scheme for the insurance companies needing new people to always join? >> well, i think that one of the bigg bigger -- this idea they added more to help insurers cover cost. i have seen analysis say because this bill would allow people to by bare bones plans and throw money at insures you destabilize the market. >> burn det from new mexico. good morning. >> i have a few comments to make. in my opinion, no one should have to lose their home in order to have good care. being in new mex kxicmexico, we limited health care providers that will cake medicare. i am not talking about medicaid. therefore leaving us in a lurch. we need improvement. i live here, this is my home, but you know, what we have some of the poorest care. >> thank you. >> i find this interesting. i will look up the problems we are having with medicare. there is a limited number of. if so, for how long? she is not going to vote for a motion to proceed. in some rural areas like the last caller talked about planned parenthood is where you might go to get your birth control or your screening to get the notice to get your mammogram. there are a lot of services women go to in rural areas and if you take that away are you denying them a choice in a provider. >> there is a procedural reason why that is in the bill. >> are you talking about it may be taking out because of the bird rule? >> right. >> the senate considering this under a little package called reconcilation and that means it allows just 50 votes with vice president mike pence coming in to be a tie breaker if needed. everything has to have a jermaine impact on the budget. every single provision. what happens as it proceeds is called the birdbath and they go through and look at every provision. is this germain and some may be taken out. >> and reperance to bird who is a veteran in the senate. we will go to paul in province town, massachusetts. you are currently uninsured? >> caller: correct. i had insurance in the past and put so much money into it when i was younger and it kept going up and up and like $45,000 into it and never had a claim or anything went wrong was under the deductible. and finally i was like, well, i want a home and i can't do both. so, i stopped the health insurance and what i learned fairly quickly was when i did have a problem, i learned this from the doctor, i would offer cash because not everybody had it and the drop in rate was incredible. a colonoscpy went from 2700 to 900 because i said i have cash. and then eye surgery was $470. very critical eye surgery. i probably mostly should have lost that eye. and i talked to both these doctors and they said so much money goes to the health insurance that made it possible. if you have insurance, that is how much they beat out of us. i am familiar with the guy who used to be the administrator of health in switzerland and most of the countries capped what could be charged for the appendectomy and no more for a night in the hospital and $2 for an aspirin. >> we will get a response. appreciate it. >> he was interesting and brings up and if he doesn't take it. it is a space and in part because insures are trying to negotia negotiate. we are saving $900 and we will take it because no claim has to get processed. it doesn't have to go through the doctor's staff, it doesn't have to go to the insurer no longer take insurance. it is also starting to happen. it is happening more and more. we are negotiating and talking to see if we can get it working. >> you can stay ahead of the game. >> i think that is all that matters. there is no curb on the price of stuff they charge. >> this tweet is from another viewer saying why does an 80-year-old mother need maternity coverage? >> an 80-year-old woman is probably going to be on medicare which i believe unless you were medicare you would not adopt maternity coverage. the bigger point is what we talk about. four plans in a small group market and then the affordable care act market and exchanges. >> this tweet from another viewer and health care. the more money the government throws at it the more it will cost. kathleen from riverside, ohio. you are part of the affordable care act, correct? >> i take care of my 89-year-old mother for the last three years full-time prior to that part-time. again, she worked 47 years and paid into the medicare system. she has been on traditional medicare with the united net. then about three or four years and medicaid in ohio which i believe and she needed to have a better toe nail. it doesn't cover her in ohio. my question is here again, 89, then i want to ask. why with our -- or the private to profit nursing homes, you know, the last place she was in was 10,000. 24 why? when the government is paying? why can't we put a cap and why can't they be demanded to be forced to hire more aid to pay the ratio of aid? that is why we have all these high policies of breaking hips in those places. i witnessed it. >> good luck. >> i think she raises a lot of fantastic points. on the medicaid issue, this idea of placing caps -- on the staff i am not sure what it is in the state of ohio. but as more people age and medicare is paying shuch such a great share of people moving to nursing home. for folks sitting here they would talk about how expensive it was to provide care. >> on the front page of the washington times, two gop votes. senator mitch mcconnell included the version by ted cruz to let insurers offer obamacare plans and cheaper plans and keep the tax and the payroll tax on high earners and maintains obamacare's limits on the amount of executive pay and deduct from one of them. leaders used to add to the stability fund. they will keep the premiums in check and they will invest in heroin addiction treatment. is this enough to get to 50 votes? >> it is unclear and a moving target. you have to hold everybody else to vote next week to proceed to the bill. he would be working diligently on medicare and medicaid services and meeting with a lot of republicans including states that had problems with the opioid epidemic, problems with the price of premiums or insurers coming and go. it is a whole court press and early. we are talking about next week. the house would take the senate bill and pass it. you may see conservatives that are concerned about taxes and you may have some other official concerns on the fact it is a bare bone plans and i don't think conservatives would like that. you can walk into a room and that kind of thing but i don't think that is happening. it is unclear how republicans are going to carry all these changes in the senate bill. that is unknown. >> we will be the only place for the debate in its entirety on c-span. hope you tune in next week. a quick question from joed jody from okay. you are from oklahoma and uninsured. >> caller: good morning. realistic monetary discussion here going on and i understand politics and worked with it for 20 plus years. in four years, i brought home about $1,000 a month and $500 goes into rent, another -- the question is how could someone bring home $1,000 a month and paying rent and pay $150 to the insurance offered by companies i worked for? >> you have to offer your employer most of the time and you will not qualify for subsidy to get assistance. it has been deemed as incredible coverage. even though that is a big -- it is because your employer. >> who are you keeping an eye on? >> a variety of senators that i think senator capito from west virginia is interesting and has been concerned about funding for the opioid epidemic. senator portman from ohio also. the senator from alaska is interesting and what she will do. >> so many states are looking over the bills and not making a final decision. >> they have been really careful. people are trying to -- they know it is closer and closer to decision time. >> mary agnus carry, a health expert who follows kaiser health news. thank you for being with us. >> alex roger is a correspondent with national journal and what are the next steps in the senate as they work to replace the current health care law? >> the congressional budget