Transcripts For CSPAN2 Key Capitol Hill Hearings 20240622 :

CSPAN2 Key Capitol Hill Hearings June 22, 2024

To the physician payment reform i think lance for the optimism to my belief that they will be avoided change the way that there going to get in such a way that help to close some of those even as new people become eligible. And, of course, we will also be bring in more people who better coverage throughout the lifetime. I think we have reason to believe that can make a difference and helping us of the people who are becoming eligible for medicare which also has an impact. The ben keating Preventive Care their entire lives, not even getting access to the kind of care they need to prevent hospitalizations. That will make a difference. Weve also made huge strides in quality of medicare. And the past few years reduce the admissions rate by 10 , reduced hospital record conditions by i think 17 . All of those things make me optimistic that we were able to Work Together to deal with the next changes are we need to make to accommodate the bulk of the senior to be joining medicare. Talk for a few minutes, medicaid. In this video i talked about before the did for the Kaiser Family foundation, its been updated to effect the changes over the past decade, Available Online if any of you want to see it or use it at conferences our classrooms. But [inaudible] makes the point about medicaid that for many years weve seen medicaid synonymous with welfare. The words are almost interchangeable. That linkage has really been broken in recent years. So i would first like what you to take that issue on and give us an long view of how medicaid has transformed itself quite radically. Bruce was the head between us. If you think back about how medicare was set up, it was explicitly tied to the receipt of welfare. So its not an accident that people thought about medicaid and welfare as being synonymous. It was a major reason good medicaid. When i was around, im sure when nancyann was around also, people would complain to me about all of the low income people, sometimes poor, very poor depending on their state and with the income cutoff was, as to why medicaid was such a bad program like that. My response was that its not fair to criticize medicare bring something nobody structured it to be, which was a java program to support people because they were both income. That they can to change noticeably in the late 1980s very active work by henry waxman who was head of the Health Subcommittee of energy and subcommittee, commerce, a passionate supporter of medicaid, to use and what was regard as not a very friendly hospital period. All the strategies he could think of to break some of the linkages. Initially by having women who became pregnant become eligible for medicaid up to very high income level. Having all the children who were under 100 of the poverty lines become eligible for medicaid coverage. Its that gradual change with a big push during the time that nancyann was there was what is called a tanf program, the welfare reform for program the president clinton signed into law in 1996 where that for the changed between welfare and eligibility. But its obviously the Affordable Care act which expanded medicaid coverage to those who are 130 of the poverty line, the respective of other characteristics to be eligible for a program like medicaid that really most transformed this to the program that is not in the books for people because theyre looking come. I would have personally preferred that as a senator one point allowed to people about the pakistan have a choice about whether to be on the exchange or in medicaid be able to take their money. But the fact that we now as a country allow for coverage if the state buys in, then surely the file decoupling of medicaid and welfare reform, welfare receipt as i see it. The other thing that happened, less ago stock interested in was writing his dissertation about medicaid, was writing about 1115 waivers which the people in the show know what they are but just to explain, its a provision of the law that allowed for states to give experimentation in consultation with approval of the hhs, the agency running medicaid. That provision was around since the beginning of the law. It was in there in 1965 but it really wasnt used until the 99. It allowed states to quite a bit of experimentation which they used to build on some of these changes, and expanded the coverage. Medicaid dollars were used in tennessee to cover more uninsured people, got pushed to the eligible for medicaid. That led to things like massachusetts connector and that health care reform. You can draw a Straight Line between that and the Affordable Care act your service take experimentation, the state laboratories of health care really was enabled by the medicaid program. That is part of what led us to where we are today with a much Broader Program that is really an indelible part of the fabric of a great society. What are the implications of ethnic secretary sebelius never forget as a twotiered system, with some states expanding medicaid under the aca in about 20 or 22 other states choosing not to. What are the implications of having a system like that in place . Especially for the recipients. We had Something Like that with the beginning of medicaid in that it took, its only been a volunteer program for states to decide whether not they can decide whether to adopt the medicaid. They had a financial stake in. It took 10, 15 years for all states define decide to have a medicaid program. Even with the state Childrens Health Insurance Program thought helped to put was passed while i was there. That took a handful of years for every state to find decide they would adopt an epic Childrens Health Insurance Program. So some of this is just what happens with these new programs. Its part of the passions around the issues, around health care that you talked about. But look, it makes a huge difference. Im not going to go to fight all the study but we are already seeing evidence that makes a difference if you live in a state that has expanded medicaid and you are getting early lab test to determine whether you have diabetes or not. That makes it different in your life. It makes a difference for hospitals insurance other uncompensated care. Thats why im confident that over time all the stitch going to have this program. Program. It sounds like that which you believe, that over a period of time all the states will sign onto this. Do you think in a decade, dangers . I dont think it will take 10 years. We are clearly seeing more states that are signing on. I thought as angry as governors and republicans were, i think is almost impossible to understate the level of anger. Ive been in a few meetings what it is bubbled over and i was somewhat taken aback. That i assumed it was so much money on the table they would take it but i was wrong. In 2014 came and went and but you are seeing in their own way a number of the red states. If the legislation as well as the governor is willing to find ways that are acceptable, and i agree with nancy and i think youll see this continue and it will depend a lot on what happens in 2016, after which i would assume most people that look out will trigger some significant modifications that are going to happen to the Affordable Care act. Not necessary bad, but modifications, or they are not depending on what the election produces. And maybe then settle down and looking at things as they are. But not have it expanded coverage is a problem. Its a problem for the people who are uninsured. Its a problem for the communities where they live, for the physicians and hospitals that ultimately provide and services because among other things medicare says to a hospital turn someone away and are not medically stable and we will teach you. Medicare doesnt enforce all of its rules but the socalled, which is what is under, thats one of the ones they vigorously enforce. And trying to get coverage in we can debate how much coverage and where you should buy it and who should fund it, but the coverage is really important. And i think that is becoming more accepted with a lot of debate about how either it should be or should have been, but at some point it is now clearly the law of the land and people are going to move on. Spirit you asked what we learned from the original medicare and medicaid. The one thing was the flexibility those built into medicaid to allow state extreme edition and you see that happen with a number of republican governors who are choosing to try to work with the British Asian to expand coverage. Asking folks to do things like italy whether come and democrats, whether its offering private plans or some variation in copay and that kind of thing. I think thats healthy and that will continue. Give the admission credit for being more flexible in some of the requests that come your way that i thought might be the case. Trying to encourage interest. Sometimes republican governors take the rap. People ought to look in some cases the governors would like to make expansion by the legislatures are adamantly opposed. Fact to be responsible for 10 , this tempest in a big expansion . Thats not a relevant issue. The question will be can you find a way to expand coverage as much into as many people as possible. I want to open it up to the audience right after this question. You mentioned 2016. We are entering an election season. What are your expectations about whether parts of medicaid, parts of medicare would become part of the political discourse of the next year . Of course. They always have been. One of the guarantees that anybody has been involved in running medicare and medicaid has is when an election comes up this will be an issue. It has been as long as i can remember. Its hard to accept that we are already into the 2016 election cycle quite as much as we are. Theres no question that medicaid, Affordable Care act, the Health Care System in the u. S. Will be an issue. Whether its as much a niche in the primaries as it becomes in the final election, the regular election or not, that depends on the parties as to whether not thats really whats motivating their candidates and how this up in court both. Thats no small issue about what happens theres going to be a scramble in washington if the Supreme Court supports to defend the plaintiffs. And if not there will still be a lot of response but it will be a somewhat different nature. I guess i disagree a little bit. Health care is always an issue in an election. Its just something that people care about and it will be an issue. I dont think that the candidates once spent a lot of time talking about medicare. I just dont. I think except to say they support. Look, give a program that has on with the Approval Ratings are but theyve got to be two or three times any politician recently. Its a very Popular Program. That is a low bar. Perhaps. Is a very Popular Program and should be. People have stable, affordable for the most part coverage. Provided a changing in ways that i think are helping to bring down the rate of cost growth. The program is solvent until 2030. There is no house on fire here. We need to Work Together on a bipartisan basis to make sure that we are improving and strengthening medicare for the future. And i believe we will. Medicaid could be an issue and agree with gail, the Affordable Care act seems always be the issue of the day. I dont think medicare except to say i am for it. Any questions . Very quiet audience. You ill need some lunch i think. No . Okay, then let me wrap up and ask you each a final question. The Previous Panel speculated about what folks would be sitting on this stage be talking about 50 years from now. I think thats too far out. Lets talk about 10 years from now. What do you think will be said about these two historic programs. Ten years from now we will know a huge amount now about this tumultuous period in health care than we had just gone through. I think actually in 2018 we were no a lot that we dont know now. In terms of how much of a slowdown that weve been seeing which is very important for medicare as well as health care in general is a drag from this very long, very deep recession, or some early successes, some of the changes being tried. But not necessarily is a sustainable or sustained. By 2018 i think we are likely to of seen three or four years other robust economic recovery. And then well have a much better idea about whether some real change going on. That second thing that we are going to know by the end of the decade is whether or not most of the savings in medicare which are not because medicare cost less but because medicare is being reimbursed at lower rates as a result of the Affordable Care act, it was built into the legislation. Legislation. Adding some and get paid less, does that mean that cost less . Hope is it will drive hospitals and physicians to figure out how to do it for less money with some of the pilots, whatever. But we dont know that. Its why the actuary in 2010 says hes not sure that these reductions that are legislating, are going to be able to play themselves out because you begin to have too many access pressures for seniors that congress will not tolerate. Acid, wont in the future either. So by the time we get 10 years out, we will have had a lot of baby boomers retiring. They would be very impatient demand as they always have been as we have gone through every phase other like putting a lot of pressure on medicare. We will have a much better idea about whether we really have figured out how to slow down in a Sustainable Way the rate of Health Care Spending the most people forget we spent the whole decade of the 90s, 10 years. Thats like a lot longer than since 2008 or 2010 yet, with health care spent at about 13 of the gdp. Very close to spend and robust economy. After that decade it all went away. That was because the kinds of changes that driven out of were not sustainable. We are trying different things. Im hopeful that leaves some of them will, maybe because im older and have been around longer, just want to monitor, i will mention the reason we have the uptick in medicare rates, Medicare Advantage rates announced a week or two ago because medicare, the actuary says spending is going up just a little. Not a big issue. Just a reminder we dont know yet whats happening. I think a decade have nothing much better idea. I assume people have gotten over the Affordable Care act one way or another. We will have modified it until just accept it as effectively. No more repeal though. Exactly. So i think the deal is right that the economic and fiscal issues will still be with us. Celebrity sitting on the stage in 10 years, big years will be talking about that. And also about quality and how we make sure that our Medicare Beneficiaries and our medicaid, the working comes to receiving medicaid are getting good quality care. All these issues will still be here. I cant get the specifics but i will guarantee one thing. We will still all be celebrating the creation of medicare and medicaid and the brilliance and compassion that led president johnson and the other leaders at the time to bring these two programs to be part of the fabric of our society. Think you both so very much. Really appreciate it. [applause] thank you all very much ethics to all of our speakers, panelists and moderators, and to yes, Robert Wood Johnson foundation. Please join us for lunch on the second floor. And thanks most of all to all of you for attempting to be. Thanks again. [applause] julian bond, a leading figure of the Civil Rights Movement and former chair of the naacp died over the weekend at the age of 75. Mr. Bond had a long career in politics serbia and the Georgia State legislature and was cofounder of the southern poverty law center. An interview in 2011 he was asked about the state of Race Relations in america since the election of president obama. What has it meant for the Civil Rights Movement, which youve been involved with, for your entire life, and still are, as chair emeritus of the naacp, to have a black man elected to president of the United States speak with it means the work weve been doing since 1909 has been worthwhile. We were talking together and joked upstairs about the headline in the onion today after obamas election. Black man gets worse job in the United States. [laughter] but it means that the work weve been doing for all these years has paid off. It doesnt mean that work is over. Theres more work to be done, but no one can believe that barack obama would be president of the United States had it not been for the work of the naacp and many of our positions, groups and individuals of the work done by the people in these groups over the last several years. So is like vindication for all of his labor, all of this effort has been worthwhile ever happy to go to do it and see the results of the. He spoke at our convention in 1909 im sorry, 1999, our centennial convention, is that right . 2009, thanks. My wife is here in the front rol [laughter] and she said many, many wonderful purposes. [laughter] one of them is correcting me. Im glad she did it because i couldnt get it rightnl either. At any rate, he spoke to our convention in 2009, and we were so happy to see. He spoke to us as senator obama. He spoke to us as candidate obama running for the presidency. He spoke to us as nominee of the Democratic Party and have him come to us as president was a great quick thrill to all of us. When he was first running and even as he was nominated, there were civil rights veterans, members of yours and mine generation who seem to be resentful. Particularly because he had not lived what th

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