Focusing on the Congressional Budget Office report that has a big focus this week, the big numbers this week. BeMillion People would without insurance from the senate plan. That is what the Congressional Budget Office projects. Explain how they, up with that number and what it means in the 10 years the cbo report covers. Guest they have a collocated and sophisticated peter model. Sophisticated computer model. They will offset the gains and losses, they ended up with 15 million you are people would e medicaid after 10 years 50 million fewer people would have medicaid after 10 years. There would be a lot of constraints on medicaid from the federal government. It would be capped for the first time. States would get less money. There would be fewer people. Help would go further down the income scale. The insurance they could buy would be less generous. People would not find it valuable to spend money for insurance that they would not be able to use because their deductibles and outofpocket spending would be so high. Those are the big top lines. This is compared to current law. The number with the insurance would double. The cbo did not like down did not break down the individual penalties would go away. They would pay a tax penalty for not having insurance. Some people would voluntarily drop coverage, we do not know how many would how many it would be. Host this is assuming the aca is sustainable over the tenyear period . We hear a lot of discussion that the aca is not stable. Guest the Congressional Budget Office said it would remain stable. Coming intorers markets and left other markets. Fore is an examination example, the number of people who enrolled. Have they got it enough have they gotten enough younger people . There are a lot of variables. The senate bill will take it in another direction. Host how accurate is the Congressional Budget Office when it comes to the projections . Guest it is not uncommon for the party in charge to dislike the Congressional Budget Office estimate. It is an estimate where they have some things right and some things wrong. With the Affordable Care act, the estimated more in florida would drop coverage. That did not have that did not happen. The Congressional Budget Office has been solid. They have complicated methods. The are doing the best they can to protect what to project to predict what happens. Is people who no longer want to buy insurance . Guest some of the people who no longer want to buy insurance. Reading through what the office said, a large number of people would be priced out of the market. Sicker people, older people, seemedicare people would enormous increases in their premiums. Another piece of the bill changes how much you can charge people. Withuld be people low incomes would be affected. That is what the Trump Administration is fighting over. To get helpe able with your premium. They would not have help with their cost sharing because they would change how much the race plan days of your how much the base plan pays of your coverage. Now, the premium help would be based on a plan that pays 58 of your health cost. They would be responsible for 32 of their health cost. A lot of people would not be able to afford that. Host another big number influencing the debate is the andscore, 321 billion curative deficit and mulative deficit. Talk us through that. Taxes andknow many fees would disappear in the all caps relation. Calculation. The insurance sector, medical devices, that kind of thing. Is the interesting here Senate Republican bill has achieve at least what the house did in deficit reduction, 119 billion. Host why did they have to do that . Guest the budget regulation the budget reconciliation rules. Because they are skipping the committee, they have to make the houses target. Money tomcconnell negotiate votes. Host what have we seen from how he is using that cushion he has . Guest we have not seen anything yet. Storyis a this morning, we are up to nine republicans who will not vote for the bill in its current form. Most of them have not been contacted by the later yet. He is thank you would like to negotiate a deal by the end he is saying he would like to endtiate a deal by the of the week. Host we will split our phone lines differently in this segment. If you get your insurance through the Affordable Care act 202 7488000 if you get your insurance through medicaid, a thousand won 202 7488001. All others, 202 7488003. They will take your question on the future of health care. We can dig into the details. We will start with bob in arlington, insured through the Affordable Care act. Caller hello, can you hear me . Host yes, sir. Caller my daughter had Breast Cancer. She had to get one of her breasts cut off. I cannot believe trump put millions of dollars of tax breaks to the rich. It is i just cannot believe it. Mott. Are, my daughter, thank god i worked since she was eight years old. I cannot believe trump pushed this bill. I just had to say this one thing take your saudi arabian, and go live in russia and saudi arabia. That is all have to say. Host Mary Agnes Carey you are taking notes as you work as bob was talking. Guest i hope your daughter is doing well, i am sorry she had the Breast Cancer issues. There are two changes in the laws. There is a higher percentage on medicare taxes under 1 . There is a 3. 8 tax on unearned income. When you get rid of those, it goes to the richest those, the tax break go to the richest people. Guest the recent it is coming out the reason it is coming , the democrats wanted to tax the rich and the Health Care Industry. Because more people would be covered, the industry would make more money, in theory. It was a trade for them. Those were the taxes in the Affordable Care act. There is a lot of things they cannot do in this budget bill. One thing that they can do is make the taxes go away. That is what they are doing. Host we are taking your questions this morning. Mary agnes carey and julie rovner are with us until 9 30 this morning. One question we got this morning. A caller asked our members on obamacare . Guest yes, it is funny eric they have to give up it is funny. They have to give up their insurance. It was a big deal, it is a good plan. Generally, members do not get a that much. Staff get paid less. A senator asked an amendment that said members of congress and staff will also be on the Affordable Care act. Most of them are in the d. C. Exchange. They have had this disruption and be under obamacare. They seem to not get credit for it. Giveee at the town halls, up your insurance. They already did. Host in washington, clarence. Go ahead. Concerningquestion to the 15 to 20 Million People program that is being discussed, what is to happen with them and why are there that number a fixed number of people that will never be a part of any Health Care Program . Host youre asking about the people who remain uninsured, despite whether it is the Affordable Care act or projections of will happen under the house and senate bills . Caller yes. Host why those people do not get insurance . Caller yes. As i understand it, the option they will ever have is to beg for health care. They have to go to the emergency room and say help me, i am sick, but i do not have money. I willary agnes carey, let you take that up. ,uest the Medicaid Expansion the Affordable Care act is optional for states. It would allow individuals up to 16,000 of income to be covered under the Medicaid Program. It has been a benefit for single , childless adults. The key thing is to look at we talk about the 22 Million People who would be uninsured in 2026 under the Senate Republican plan. 50 million 15 million of those folks would lose their coverage. That is a key population. They picked up the cost of the expanded population. The money goes away after time. Julie talked about it earlier, but it is important to talk about the entitlement nature. It would change under both the senate and house plans. It is matched by the federal government on a percentage basis. The average percent is 55 to 57 . It would shift to a set amount of money. Over time, it would rise with the increase in Consumer Price index. Concern that not only the change and entitlement capping of the money would push states into tough choices. Do they reduce benefits . Do they lesson the number do they lessen the number of not people who can be on the program . It is a major shift. The Medicaid Program covers 74 Million People. It covers two thirds of Nursing Homes. Be know anything about fraud waste and abuse in the Medicaid Program . People in thes in program . From most of it comes the providers sides. They invent patience and invent patients and charge them. It is a lean program in most states. The biggest complaint about medicaid is that it does not pay enough. It is tough to find a doctor or specialist that accept medicaid. Something that is important to say that the caller was asking who is the uninsured . It is not the same people. There are people who have periods of uninsurance. It will be in between jobs or they get recertified and earn too much money on medicaid. People cycle in and out of being insured and uninsured. When continuing group who are undocumented. Those are the people who live in the country and meet health care. Actr the Affordable Care and the senate and house plants, those people would not be eligible. Ont new polling came out health care in medicaid. People 61 percent hold a favorable 61 hold a favorable view. The kaiser medication is. Guest Kaiser Health news we are a nonprofit new service. Our stories appear on our site. Are stores also appear on usa today and on npr. Our stories also appear on usa today and on npr. We do our own reporting. The site with the story is going to be. There is no editorial interference at all with the Kaiser Family foundation. Host this column on why the Senates Health care plan would not work in the realworld. Who is he . Guest he is the president and ceo of the kaiser foundation. Host we are here with Mary Agnes Carey and julie rovner. On thes been waiting line for insured through medicaid. Caller i have a question for the ladies and the general public of america. Why are people shocked that obamacare does not work . If you go back to the beginning, the speaker of the house at the time said if you want to know what is in it, you have to pass it. Obama created it and said if you like your doctor, you can keep your doctor. That was a lie. There were six or other lies that were engulfed in that. You take a look at the things that obama has done. He made a deal with iran that through israel under the bus. He made it legal for a man to carry a man host legal for a man to marry a man. Host we will focus on health care. Guest be does it work question the does it work question it works well in some places and not well and other places. Anything this large would get tweaked as it goes. Because after the bill passed, the republicans took over the house. They cannot do any of that. It is difficult to make midcourse corrections. In some places, the exchanges not roll out in 20 well will out well in 2013. They did not do a good job to get the computers to work. Host what are the key reasons why it works in one place and not in another . Guest some states decided to take it on and adopt it and work with it. S primenia is everybody example. They have active exchange, an active director of the change. In many of the states, Congress Expected the states would want to run their own exchanges. It was a bone to the republicans. Some of the proponents went around the law. They found a way to strangle it at its inception, do not participate. That is why the government is running a majority of it in the states. The democrats overpromised. The president was talking about people with employer in surance. That itaking the point would not affect people with employer insurance. Right now, the republicans are doing the same thing. It is surprising they have not learned. Theyre promising they can decreased premiums and deductibles. It will be hard because theres nothing in the bill that lowers the health care. Host from virginia, jay, uninsured. Caller there is no Republican Party anymore. Voted needs to take their party back. This Health Insurance was from the beginning. They have been against our Health Insurance. They have been sabotaging obamacare. Because of racism and the nonsense, a lot of people go along with them. This whole thing the republicans can fix it. They are the ones who screwed it up. They know how to fix it. They are the one who screwed it up and did it on purpose. Host what is the best way to fix it . We lost him. Mary agnes carey, maybe you can talk through it. Guest fixed overnight is a little optimistic. When the Affordable Care act was we were waiting for a man and members for weeks. It, therehard for were no republican votes for the Affordable Care act when it passed. For intenseable political opposition from the Republican Party. It has continued. House of representatives has voted 60 times or more to repeal the Affordable Care act. They are getting no support from the democrats. Check cymer has Chuck Schumer has said if you talk about not repealing it and ripping it up, we can talk about changes and adjustments. Is withinan divide the Republican Party too. Host in terms of what Chuck Schumer needs to talk about, is it just that . What about cuts to medicaid . Guest it would be huge. Rob portman it would have to be off the table. It would have to be the the subsidies would have to be more generous. The cost would have to be less coverage. They need to push more deductibles and copays on people, which is what republicans complained about. Guest they could fund the cost sharing subsidies that they have been arguing about. If you make less than 2. 5 times less than poverty, and those people have difficulties with 6,000 deductibles. Congress said the money was never formally appropriated. The suit is still in progress. They keep saying we could not pay these. We are seeing the insurers are passing through. They are giving the discounts to the low income people. The federal government is supposed to pay them back. The federal government, every month, decides if they will make the payments. Is paying for next year, theyre adding on to the premiums in case the money does not come. If congress appropriated the money, that would make everybodys premiums go down, at least by 20 . Host margaret in indiana, insured through medicaid. Caller medicare, actually, thank you for taking my call. I have some observations. Picking and choosing an Insurance Plan is difficult. Everyone wants has complete coverage for their families, no matter what. It is impossible for millions and they are left bankrupt. They are speaking in generalities. This group and that group, i do not hear them getting down to saying what the cost would be for a family. For instance, a family of four their premiums and deductibles. It would be to focal for many people. It would be difficult for many people. It was advocated by some of the president ial candidates. The only thing in Fair Health Care would be a singlepayer medicare modelhe. It can be financed with a 10 or whatever amount needed. A nominale with amount. The consumer tax would hardly be noticed by the users. Host thank you for the call. Guest this idea of allowing people to buy into medicare, who perhaps could not find a coverage as affordable has been out there and discussed. Guest they were one vote away. Guest it was very close. The point she makes, she talks about the taxes, the funding of it. The amount, what would have to would be the funding the beneficiary who got in with pay the whole share got in would pay the whole share. It would be 25 government and 25 beneficiary. To her earlier part of our commentary about how much getting how much a family of four would pay is an interesting and important calculation. The Affordable Care act, you can buy a bronze plan or a platinum plan. If you get the platinum plan, which covers 90 of the cost, it also costs more money. It is not one number. It was part of the thought. They wanted to give consumers options to look at them. If you get a premium subsidy, it would help you. If you got the cost sharing subsidies, it would help you. It is a complicated regulation. It is some of the problem of the Affordable Care act. Guest medicare is a federal program. The Affordable Care act was supposed to be. Private insurance it is run by private insurance. It is run by private insurers. It will differ according to what the market is like. Even within states, it can be much more or less expensive. It is attaching itself to the existing insurance market. Host in terms of the complicated calculations, explain what the coverage gap is. Guest it is the folks within states who did not expand medicaid. The way the Affordable Care act was written, if you are if you qualify for medicaid, you are supposed to get coverage or the Medicaid Program. For example, folks in the state of texas have a low cap to qualify for medicaid. They did not expand medicaid. You do not qualify for the subsidy and your state not expand medicaid an. That is one thing about the plan that would drop the subsidies down. To 400 of poverty, which is around 48,000. The republican plan would take it down to zero. It is one benefit that people have pointed to. Guest the cbo said even if they got help playing their premiums, they would be responsible for their own health expenses, it would not help them that much. Host you can find more on Kaiser Health news. These guests and the staff at Kaiser Health news have been writing about it for years. Kerry is in wisconsin, insured through medicaid. Because m calling for one, it infuriates me that they talk about the health care bill. It is not about health care. It is about Health Insurance who gets paid, how they get paid. It has nothing to do with health care other than access to it. To be able to get it, you have to afford it. The problem as i see it right now, a lot of people i know are on medicare. They are working at laces at ces Convenience Stores a are working as nursing assistants. They work at places like walmart. The jobs do not pay you enough to pay for your own health care very how can you expect health care. How can you expect someone to pay another few thousand dollars for health care when you do not make that much . Guest i think she makes a great point. There are many people who are the working poor. They have jobs, they work at Convenience Stores or nursing assistants. We had a story on our site about nursing aides who could not they are giving health care to people and they did not Health Health care themselves. She makes a great point. There is a discussion in the senate and the house about work requirements and medicaid. The point of it is, a lot of folks eight in 10 are already working. If they are not working, they are taking care of an utterly parent or a disabled child. Guest or they have their own health care problems. Guest exactly, they cannot afford these premiums. The Medicaid Program has given them coverage. It has been a lifesaver for those people. What all of washington is arguing about is who pays and people think they should argue how much are we paying as a society . The hot potato of rising costs without twhy it is rising. Host the line for others in colorado. Caller i am a veteran and i am concerned for my brothers and sisters. I have heard little talk of how it is affecting veterans. They are saying 400 to 5000 saying 400,000 to 500,000 are being affected adversely. We know there are problems with and we with the va are not Getting Services that way. Veterans are getting angry and would like to know how it would affect us. Host Mary Agnes Carey. Guest i will have to ask julie to jump in this. Guest theres Nothing Specific to veterans in this bill. Or aey are low income medicaid. A bill that was bipartisan. They actually got something done together. This bill, specifically, is not single out veterans for anything. Host the caller talks about veterans group. Can you talk about the Health Care Industry and their involvement . Guest has been the same in the senate it has been the same in the senate and the house. They do not like the bills. They are getting not paid for teaching care of medicaid patients. Of hospitaly groups, dr. Groups groups, an association is not a Political Group and say the state would get more flexibility. No amount of flex ability would make up for the reductions in money that the bill would anticipate. Even the National Governors association does not agree on much. They say the bill should not be rushed through. You may have to do with why the vote got delayed. Theres a lot of pressure to slow down. Guest the pressure is going to continue. Senator mcconnell is talking about negotiating a new package. Are protests, there are ongoing and the pressure will continue. Host pressure from outside adsp as well, specifically targeting senators. It is from the America First policy pact. [video clip] obamacare is racing towards collapse. Premiums are skyrocketing. Deductibles are increasing. Strong leadership to repeal and replace obamacare with patient centered care to protect americas families. Senator. Host news about the group and the ad specifically after the meeting at the white house. Guest this is a protrump group attacking the senator for saying he would not vote for the bill. Mostheller is the endangered republican in the 2018 cycle in a state that is turning more democratic. There is a republican governor who has been outspoken all year, particularly about the medicaid cuts. It has been very important to know. A lot of low income workers who work in the gaming industry do not get insurance. They get insurance through medicaid. Cannot see hise way to vote for this. Here comes this trump ad attacking a republican. They were upset at this protrump group. It was seen as bad form in terms of republicans in the republican family. Host dean heller complained about it in a playful fashion when he went to the white house yesterday. Guest yes, there was a meeting. President trump had all of the senators all of the republican senators. It is not clear what came out of it. There was reporting at the meeting that the president is not clear on what it would do. It would explain why he is all over the place on what he wants. Host more of your calls, robert is in texas, insured through the Affordable Care act. Inler i would like to weigh with a comment. I look at this mess of new American Health care act whatever trump is calling it. I look at the Affordable Care act and i saw the debate that went on. It is something that democrats have been trying for years and years to get through. 57 votes went up for the republicans saying they wanted to repeal it. Yet, in the seven years they have been fighting over this thing, i do not see any rational way to replace it with something better. My thought this is on the deal about government getting involved. Why cant they all come to some kind of a number to fix the cost of health care to wages similar to what we do with medicaid and Social Security . Come up with a number that meets the budget of what it would take to get everybody in this country under an Insurance Plan. Say ok, now we take the politics out of it. It is a built in thing in your wages. Just leave it at that and get out of this whole mess of bickering about it. Country is in a world of hurt if we do not start addressing the fact that a lot of people cannot afford it. A lot of people can afford it immensely. Yet, we go into anything we do in government and we try to figure how the rich can benefit from this at the cost of the lower people making 15 an hour. We need to get it out of it and put a base rate, 3 , 5 whatever the rate is and say that is it. That is coming out of your wages. It is a done deal. Host thank you for the call. This earlier, i will you jump in. Guest i do not think there is political consensus about the idea of saying we are going to spend that amount of money for health care in this country and it is a tax or in your check. That is one thing i understand where he is coming from. You can never take the politics out of health care. A vast majority of americans get their insurance from employers. 74 Million People get it from medicaid. Affordablebout the care act is the universe of people in the exchanges, 12 million enrollees. It is a political policy about it. It is important, but interesting. Here is the other point. Mitch mcconnell was clear when he came out of the white house meeting. He said, if republicans cannot get on agreement, he will have to sit down with schumer and the democrats and that agreement if they ever got to 1 would be nowhere near what the republicans if it ever got to one would be nowhere near what the republicans want. Guest now that they have a chance to do it, we are seeing it. A large fraction of the Republican Party does not believe the government has any business in health care at all. It is difficult the cause the government pays half of the Nations Health care bill. They want the federal government to withdraw from its participation. The other parts of the Republican Party that the value in it. You have different factions within the Republican Party, just as there were different factions within the democratic party. Host just like there are different legislations within the Republican Party. The better care reconciliation act, the House Republican plant, the American Health care act, and the democratic the Affordable Care act. A note on names. Ron is in florida, uninsured. Whyer i was wondering create such a giant bureaucracy . Why cannot have an across the board sales tax. You can increase the sales tax on luxury items. You can also have people in the country illegally pay into the system that walking to Emergency Rooms and get Free Health Care at our cost. We would not have to demand the 17yearold kids coming out of High School Start paying into a system that would system they were not used for 50 years. There is no concern for health care. Host time tax care reform to health care reform. Guest the bureaucracy is not that big. It is in the office of the Actual Health care providers. That is driving up the cost. The Insurance Companies are at an arms race with the providers wanting more insurance wanted to pay less. Most other countries do what the other callers talked about. They collect money from the from the population. Host dylan is insured through medicaid from illinois. Are you with us . Caller yes, i am. Likei was wondering was your last two callers, i agree with them. More for am singlepayer why dont we just lift off the cap . We would have plenty of money to take care of health care and Social Security. A lot of out there understand get a raise. I am more of a believer of a singlepayer. I am a metal care i am on medicare and am a veteran. I have sold insurance and have got through the health care gamut over the years. It has not changed. It is just a little different through the aca. That is all i have to say. Host i want to get your perspective, in what way . Caller on the aca . Host on the change of you selling insurance. Caller insurance rates would be high. My wife and i would pay 1400 a month would pay 1400 a month. We would have a deductible, maybe 20 to 5,000. We would have a 1 million cap. Today in health care, you could ickly in alion qu hospital. With the aca, it is unlimited. Host thank you for your perspective. Guest i wanted to ask if he sold plans of the aca exchange. We about it to protect consumers. In the republican proposal, if laborers were given essential health benefits, it would be things like Maternity Care and Mental Health services, if there is a waiver on a plan offering that, it impacts the annual and lifetime benefits. It is something important to look at. He talks about singlepayer, i know there are a lot of fans out there. Our sister website has done a lot of examination on this in california. The problem is cost. It costs a time of money. It costs a ton of money. It is really expensive. Guest the caller mentioned in limiting the cap on Social Security. The medicare cap with a limited was cap was eliminated in the 1990s. Host paul from montana on the line for others. Caller Insurance Companies exist not to provide insurance and health care. The exist to provide profits for their investors. They exist to provide profits for their investors. It is to get the Insurance Companies out of the chain. In the 1930s, during the depression, they found forprofit Energy Industry cannot provide Electrical Service in rural areas because they cannot make money on it. By lowtives are funded interest or no interest loans from the federal government. All the rural areas in the country have it that way. We have a similar situation that way now in health care. There is need for health care in this country that Insurance Companies cannot make a profit off of it. Lets get the Insurance Companies out of it. Lets go to a singlepayer developed most like most of the developed world has. Host another singlepayer, i appreciate your call. Guest a lot of the Insurance Industry is for profit. There are also a lot of nonprofit. They were hampered coming out of the gate. There are still some robust and vibrant Nonprofit Community health plans. That is theroup most outspoken in opposition to this. They cover a significant percentage of people. Host elizabeth is insured through the aca in las vegas. Caller thank you for accepting my phone call this morning. What i want to say to you and everyone i listen to cspan every morning. One of the things that is not being taking into consideration is we are now a global world. What is happening is people are crossing our borders, flying in and out of airplanes and ringing in terms and diseases, things we cannot see planes and bringing in germs and diseases, things we cannot see. My younger sister came in from mexico. She did not what down her in her did not white down did not wipe down their airplane seat and got sick from it. In regard to the health care, you are not care, they are not taking into consideration the global factor. We can equate it to the fact that when the europeans came in from europe to america, they brought in smallpox. Native americans were killed because they were not immune to the small packs to the smallpox situation. It is much bigger than just america. We are now a mobile world a global world. Host we have your point. Guest the coverage of the got virus, we have had the coverage of the zika virus, we have had families with babies born with that. Viruses coming into the United States cant create Public Health problems states can create Public Health problems. Guest in both of these republican bills, there are cuts to Public Health. There is a big fund that pays for a big budget of the Center Disease center of disease control. Both of these bills would cut that significantly. Host another health issue talked about is the opioid crisis. Can you talk about the impact of the house and Senate Legislation on funding for treatment for opioid addiction . Guest the senate bill has 2 billion for the epidemic. Are saying it is not enough. It is a major killer of americans in this country. It has become a major issue. That is when we talked about the course trading that about the horse trading that Mitch Mcconnell could do. It would not be surprising if it increases. About 30 of people with opioid addiction are covered by medicaid. Medicaid pays one third of all opioid treatment and United States. If they were deep cuts in medicaid, it would take away the opioid Addiction Treatment for a significant number of people who need it. Everybody looks at the number and says it is not enough to offset the cuts that would be there otherwise. It is not money in addition to what is being spent, it is money in lieu of what is being spent. , alex rogersreport talks about the wish list that could do the obamacare repeal. Here is the article from yesterdays national journal. Addiction ispioid brought up many times. Senator insenator to what they request in the bill. As we look at this horse trading you are talking about, looking at what each senator may want or request. Can is in pennsylvania, insured ken is in pennsylvania, insured. If iit would help have a mother who is 100 years old. In the first month, i paid 10,000. Every month on every friday, they would charge her 109 for base therapy. Occupationaled for therapy. She needed about two weeks. It was about two months. I got the bills. She was charged for oxygen. I brought her home six months her on theonitored and she was perfect. It is ridiculous what they are charging. Host thank you for sharing your mothers story. Guest he is on target, it is expensive. It can be north of 100,000 a year. It is the medicaid reductions and cuts in the house and senate bills. There is a great concern on the impact it would have on Nursing Homes. Medicaid funds two thirds of nursing home care. We have a great story on our website about this. It looks at the intersection. What are the changes in medicaid funding meaning for personal care . Many beneficiaries and nursing home care is on it. People can easily blow through their personal savings. John Kaiser Health. Org is what we are talking about. We are also talking about the opioid crisis, and from west virginia, gary is calling. Go ahead. Caller good morning, everybody. Ou want to be here there are thousands of them appear that are so bad you can just drive down the streets and know who is on it and everybody else. I know what the lady was asking for and that is just the tip of the bucket. I know you were talking about singlepayer but i got friends in australia and with everything they paid through, it is everybody pays into it while they are working and all of the hospitals are owned by australia. Not all of these overpaid hospitals like we have here. That is why it works so good down there. I have seen the care that they get when i was there with my buddies. It was fantastic. With my mother here in nursing home, she passed away last year but i agree with the gentleman before me. It was ridiculous. But i did have two up going through medicaid because there just wasnt enough money. Thank you for listening to me. John gary describing the exact situation you were just talking about. Is there anything on the opioid side you want to pick up on . No, i think we talked about that before, that medicaid does a lot. Two thirds of nursing home care, it pays for one third of the opioid Addiction Treatment. It is the insurer of last resort but it is so much bigger than the individual market that we have been used to talking about with the formal care act. We are talking about a total of 18 Million People to 20 Million People in the individual market. 73 Million People on medicaid. In michigan, jason is insured through medicaid. The morning. Caller i am actually a provider. I have been a provider for 16 years and i have watched preAffordable Care act and post Affordable Care act and i want to make a comment on the benefits of the Medicaid Expansion. John please do and stick around because our guests may have questions for you. Caller ok, well, i question what is the alternative if they cut Medicaid Expansion or take it away . What is the alternative for people who are going to be uninsured because they do not have medicaid . PreAffordable Care act, in my office, i saw people devastated by Health Care Costs. People came in with 225,000 bills for a twoweek hospital stay. Takendicare expansion has that away and provided care for so many people that otherwise would have gone bankrupt, not having insurance and not being able to afford outofpocket costs through private insurers. So what is the alternative after they take away 800 billion from the medicaid pot . Mostson asked the important question. The medicaid directors had said, while republicans are advocating more flexible he, the medicaid directors have said you cant come back from this level of a cut. Will grow but this is a major cuts, a 26 reduction over the next decade. So what do states do . Medicaid is one of the most expensive budget areas for a state. Right up there with education and Public Safety and a variety of other factors. Do they have fewer people on their Medicaid Program . Do they reduce benefits . Is a medical provider, today pay people like jason less to take a beneficiary . These are going to be very difficult decisions and this is why you are seeing such counter discussion this about changing the fundamental funding nature of the Medicaid Program. John by 2026, the senate plan would cut medicaid through reductions and terminations of federal matching funds and the per capita based the capital cost on medicaid, 702 billion over 10 years. The house version would be a hundred 4 billion in reduction. That is a misleading chart. The senate cuts are deeper but because they dont take affect of time,ger period they go outside the Budget Office 10 year window so some of the big cuts will come outside of the window but the senate cuts are deeper than the house cuts even though the house looks larger within those 10 years. John jason, thanks for the call from flint michigan from flint, michigan this morning. Peggy in new york, good morning. Caller i am from shirley, new york. I have been under the Affordable Care act. I have had a medicaid managed plan and now i have insurance through my employer. Which i am grateful for. But i do believe that what we need in this country is a change. We need to repeal and replace, yes, but we need to repeal and replace the premiums, deductibles, the cap on what pharmaceutical companies charge. We need to create guidelines on allowable charges for procedures and treatments. This businesslace based with universal health care. All over, civilized countries have that. Here, not justn in new york but in the world, and we need to not have a system where i respect and i am grateful to all doctors but we need a system where doctors do not pick and choose who they serve by the type of insurance that we have. Call peggy, thanks for the. You heard those comments on Drug Companies. Another caller earlier before you are on, asked, do Drug Companies need an incentive to create new drugs . Where is the balance . That is the question. Industryarmaceutical will talk about how many of them dont make it to market and the need to recover those costs and they dont want disincentives to do that. On the other hand, some of the prices of drugs and the price increases have gotten a lot of attention. What is really happening is it is the same we are hearing over and over again with callers who want singlepayer or caps and that is the intersection of the fight on capitol hill. How much government regulation . S necessary what benefits should be covered . Should they have a premium subsidy . Should insurers be able to offer whatever plans they want and the free market has total rain without government regulation . That is the classic push and pull that has continued through this discussion. Republicans and democrats are in very different philosophical places. Becky will be if you have the votes in the republican side and you can change this, but then if we hear from callers like peggy, there is some solid and powerful reactions to this. One of the reasons we have covered health care for so long is it is personal. It really touches peoples lives. And what is frustrating is if you listen to republicans and democrats, you hear the same thing from their constituents. They are paying too much, they cant afford it. The disconnect between what people earned and what Health Care Costs have gotten so enormous it is hard to even think of that and yet they cannot agree on how to solve the problem. They agree what the problem is but not what to do about it. John we have 20 minutes left in this segment with Mary Agnes Carey and julie rovner. We mentioned your twitter handles where you show reporting , d links to your reporting Mary Agnes Carey and atjrovner. With more questions on these big bills we have been talking about for the last couple of months here on the washington journal, mike is in valencia, california, in short through the aca. Caller thanks for having me on. Think it is aont republican or a democrat issue. Why theunderstand government got involved to begin with other than that there was preexisting conditions and situations andal andnsert caps on procedures so forth. So the lady from new york has it right. The government mandates a bunch regulations and rules, except they cant figure out how to bring down the cost of health care. And pharmaceuticals and so forth. You get these lobbyists in washington going after these Insurance Companies and Insurance Companies should be regulated by the states. The state insurance commissioner thet to be able to tell Insurance Companies far they can go with their premiums and regulate that to the point where it is affordable. I dont know what the government has to do about it. It is primarily a race between how much can the doctors charge and how much can the insurance fees . Ies cut down their it is a battle between the doctors and the Insurance Companies and the Insurance Companies are basically winning. John would you agree . Why tryingbout to go back about his remarks at the beginning of the aca, why didnt even happen . I am talking about the beginning of medicare. I was thinking about this of thehe beginning debate, talking about people who couldnt get Health Insurance because of their preexisting conditions. They had been priced out of the market. A caller talked about how they had blown through their lifetime cap. Cancer is a terminal diagnosis. Another terminal diagnosis. You can argue whether they did it right or wrong but they tried to steer the ship to help these people buying coverage on their own, buying something affordable and that was comprehensive. Affordability, copper handedness, you can debate that, but that was covered first. Why did they try to do this . To get a marketplace that was fairer. People were spying on their own to help them find affordable Health Insurance. Didntnow, the aca attract enough younger and healthier people to balance the risk pool. We had julie talking about this earlier. Insurance commissioners actually do have a lot of power. They did before the formal care act made state insurance recommends more powerful to regulate rates. Democrats were trying to attract republicans so they really did give the states a lot of authority. I think the caller has a point. Where there is a competition between the insurers and the with doctors and hospitals and Nursing Homes and physical therapists and ability else involved in making a living off of the health care system, there is this continual fight. There is this effort to keep the industry private. The recent medicare came about is because the healthInsurance Industry did not want to sell to old people because they were bad risk. John in terms of trying to get enough people into the system to sustain the system, obviously, the aca went with the individual mandate. Theyou run through different ways the senate bill and the house bill looks to replace the mandate . The individual market is a place were people pay their entire premiums, where they are not getting help from their employer. You have to really want insurance to go in the individual market. The way in syrian companies the way Insurance Companies do that is they say, we are not going to sell the sick people but we will double or triple the premium. Everyone agrees that is not a good thing. They should be able to afford Health Insurance so if you do that, you need some way to ensure that Healthy People sign up. The individual mandate is what they chose in the affordable. It was a republican idea. It was first implemented under mitt romney in massachusetts. There are other ways to entice and coerce or pick your word Healthy People to get into the market. The house bill has a punishment if you dont, so what the house bill says is that if you have raking coverage of more than 63 96s, which dates back to a a 1996 law about coverage, you have to take a 30 charge on your premium for a year. The Congressional Budget Office says that is probably not strong. The senate decided you are going to have a sixmonth lockout if you have breaking coverage. You can sign up but you couldnt get it for six months. The cbo says that is not very effective either. We have seen the individual mandate has not been all that effective either, so it has been toficult to find a way encourage, entice, coerce, without being so coercive that the government doesnt want to do it. Announcer cspans washington journal live everyday with whose and those issues that impact you. Mccoy onmorning, betsy the republican healthcare reform efforts. The Mississippi Republican senator roger wicker sketches the senates decision to delay the Health Care Vote in where he stands on efforts to repeal the Affordable Care act. The acting administrator looks at how the senate also, Maryland Democratic senator on the senates decision to delay the Health Care Vote. Be sure to watch cspans washington journal live at 7 00 eastern thursday morning. Join you discussion. The discussion. Sunday night on afterwards, Temple University professor examines gender identity in his book, beyond trans. Mr. Davis is interviewed by glaad president and ceo. I think we are really talking about Something Different is about the predicate of those stereotypes. It is not so much about what you should and shouldnt do as a man or woman. But do you belong in the category of man or woman in the first place. I think thats an important distinction to draw. Transgender people just like anybody, experience traditional sexism. When i tried to point out in the book is there Something Else going on we talk about transgender relation, which is sex identity discrimination, which is belonging to the categories themselves. He said in the book that we should eliminate those categories. In a lot of different places. From a birth certificate, to college or professional level and everything in between or most things in between. Announcer watch afterwards sunday night at 9 00 p. M. Eastern on cspan2s book tv. Cspan, u. N. Ambassador nikki haley testifies at a hearing of the House Foreign Affairs committee. Then prime ministers questions from the british house of commons. And from washington journal a look at the status of the republican effort to repeal and replace the Affordable Care act. Also tonight, lawmakers are working on the annual Defense Authorization bill. You can watch our live coverage over on our companion network cspan2. Today, President Trump accepted an invitation from french president Emmanuel Macron to attend bastille day ceremonies on july 14. New channel france 24 reported on the invitation here news channel france 24 reported on the invitation. The u. S. President says he lee flying into markley holiday on july 14. The question remains about whether fireworks of a different if those opposed to trump protest. For more we bring in our White House Correspondent who joins us from pennsylvania. We have already had that superlong handshake between Emmanuel Macron and donald trump in brussels. What can we expect from this event in paris . Maybe another one of those handshakes. In annual macron is seen by many as someone who opposes openly many of Donald Trumps policies. The reason for donald trump going to paris of course is very serious and laudable. Day oing for best deal bastille day. 100tho marks the anniversary of u. S. Troops entering world war i. In paris. Be parading u. S. Troops of the current time will be parading alongside trent french troops. That is a good reason for the u. S. President to visit and see that in person. The relationship between the french president and donald trump is one that is very interesting right now. That very long, dueling handshake between the two. Since then there has been more criticism. He wants to make the planet great again. He says that by making reference to the fact that donald trump decided to withdraw the u. S. From the paris climate agreement. Say,s a trolling, as they something that did not go down well in the white house. It might be awkward. It would be the third meeting between the two because they are currently repairing at the g 20 summits in germany next month. Now to the House Foreign Affairs committee or u. N. Ambassador nikki haley talked about u. S. Policy towards the United Nations and the u. S. Role in places like north korea, syria and israel. California congressman ed royce chairs the committee