The Affordable Care act. We want to hear from those in the medical field about how this has impacted your job and patience. For the first 45 minutes we will have a special line for doctors 202 7488000. Nurses, special line for you, 202 7488001. All other medical professionals can call in 202 7488002. You can catch up with us on social media, on twitter. On facebook it is facebook. Com cspan. You, we areng to talking about the Affordable Care the current state and future of that law. We want to hear from doctors, nurses, other medical professionals this morning. We heard from the speaker of the house over the weekend about obamacare as he refers to it. Here are a series of tweets from paul ryan. Obamacare is giving americans another doubledigit premium increase, and fewer choices. Obamacare, millions of americans only have one choice for Health Insurance, which is really not a choice. It is a monopoly. Mitch mcconnell, the republican leader in the senate on twitter last week. Americans deserve better than the failures of obamacare. With tom price leading health and Human Services, we can deliver on our promise to replace it. From senator tim kaine of virginia, tweeting that it is imperative that the new administration and Congress Move forward on health care and not erase the gains made by the Affordable Care act. He tweeted that it would be reckless to repeal the aca and have a drastic impact on the American People. We want to hear from doctors, nurses, other medical professionals about how the aca is impacting your jobs. One of those medical professionals that is commenting today is richard friedman, a columnist in the new york times. He is a professor of medical psychology at the wells cornell medical college. He writes a column today titled mentally ill without obamacare. He goes on to say, if president elect makes good on his promise to repeal the law, he will strip millions of americans of the most medically rational and humane benefits they have ever had without giving them any indication what will replace them. The consequences will be quick and devastating. Psychiatrically ill americans lose coverage will be worse to be treated in emergency rooms, causing a meteor rise in Health Care Costs. To read his full column, it is in todays new york times. Doctors, nurses, and other medical professionals. Doctors, 202 7488000. Nurses 202 7488001. Other medical professionals 202 7488002. Last week on this program we were joined by a Republican Congressman who is a surgeon. He talked about the burden the Affordable Care act places on doctors. Here is what he had to say. I hear from doctors every day. I spend a lot of time staring at a computer screen and not talking to my patients. That is because the federal government has so many mandates and demanded so many things through the Affordable Care act, including what is called meaningful use, where physicians have to record all this data, it is almost impossible not to spend a lot of time at the computer screen. Congressman larry bush on. He joined the washington journal last week. The Christian Science monitor in one of their lead stories this week, the headline, how the gop may reshape health care. Tomsing on congressman price, who was nominated to head health and Human Services. There is a picture of him there. The challenge has always been to agree on a replacement. That is the challenge for republicans as they look at repealing and replacing. Republicans have not come to a consensus in the house. They seem to be generally settled on a series of points that were outlined in a document called a better way, which congressman price supports. It supports having preexisting conditions covered and allowing young people to stay on their parents insurance. It would drop state and federal marketplace exchanges. Under the new plan, people would be able to purchase insurance on the open market with the help of refundable tax credits. They all favor Health Insurance as available across state lines, and there would be greater incentives for people to put away the tax dollars in Health Savings accounts. This calls for specialized high risk pools. Belth care rates would awarded to the states in the form of block grants. We want to hear from medical professionals, doctors, nurses, and all others that have current or past medical experience. We want to hear your thoughts on the Affordable Care act, how it has impacted you, your job, your patience. Doctors 202 7488000. Nurses 202 7488001. All other medical professionals 202 7488002. Chicago, a first this morning on washington journal. Guest caller i was licensed in 1981. I have seen a lot of changes. I have been a registered nurse, and i have been a patient. I look at it both ways. The patient, i dont think care is getting better. I think it is getting worse. Pushed. F is just being as a practitioner, i left nursing as an administrator. I think that more and more the emphasis continues to be even with the Affordable Care act to create profits. I dont think that health care. Hould be a Profit Sector i think we should look at it as something that society has to provide for people to maintain health and wellness. Host when you say the staff is being pushed to the limit, are they being pushed because of new mandates and rules placed on them because of the Affordable Care act, or is it a staffing issue . Caller it is both. The Affordable Care act provides havinge what i consider to use it fairly often in my provides someone with a mediocre Health Care System. Graduated, i had probably the full and of the health care. I did not need it, i was young. I had it. I was coming from a pool of people who were generally healthy. Now with the Affordable Care act , i feel like i am a charity case. Everybody is a charity case. You are better off having enough money of your own to be able to move around the Health Care System the way you see it. More importantly, you have to self advocate, which was not something that was true in the 1980s. Thank you for your work as a nurse. Elaine is from michigan. Thank you. Calling because hospitals are getting bunches bonuses for getting patients out of the hospital early. What is happening is patient that should be staying longer are being shuffled into longterm care facilities before they are ready, and this is causing the patients to suffer because they really need the acute care, but they are being pushed out early so the hospitals can get their extra money. If they are admitted back to the hospital within 48 hours, they get penalized for that. What is happening is patients theyuffering because really need acute care facilities to take them in longer. It is a circle going around and around. Patients are not being cared for properly. Thoughs this is as worked differently before the Affordable Care act . Caller absolutely. It was never like this before. Hospitals now with their reimbursement are directly tied to patients satisfaction. If the patients are not happy, then they get different reimbursement. They are trying to juggle that along with this cuts in the reimbursement as far as patients getting out of the hospital to get that bonus money. If the patient has heart disease, if they can get the patient out of the icu and into a longterm care facility, they get extra money for that even though the patient may need something. Host how that may i ask how that Patient Satisfaction is such a key factor in their reimbursement . How is that determined . Is it just a survey they fell out after leaving the hospital . Caller correct. They have a nurse call them with a written survey to fill out. Leaving thes hospital are sick and not happy. They are not happy about it. They are not happy about being shuffled out before they are ready. They are not given a choice about it. Up. Are told their days are out herebeing shuffled the satisfaction scores have diminished. So have the reimbursements. These sorts of surveys were never in place before the Affordable Care act . Caller not tied to reimbursement. Now it is. It is a mess because the wages. Re stagnant for nurses as far as nursing assistants, they are cutting back. They are outsourcing the dietary departments portrays for trays. Hospital hass the to do to save money for profit. I dont see how they can unless they come up with a different way of reimbursement for the Affordable Care act. It is really going to be hurting. Host thank you for the call from michigan. 202 mber for nurses 7488001. Doctors 202 7488000. Professionals, we want to hear from you as well, 202 7488002. These are the people inside the system that have seen the impact of the Affordable Care act. Daniel is on that line from indiana. Caller good morning. A direct Service Professional for about a year until the end of the year last year. I saw a lot of the changes get implemented while i was working. One of the things i noticed. Host what does a direct Service Professional do . Provide services to people with intellectual disabilities. We do a lot of different things. Onfocus on counseling, also taking care of household chores, hygiene, all kinds of stuff. We want people to be independent, cognizant people. The impact of the aca was more promotional along the lines of the parent situation. I really got to see how the Health Care System affected patients trying to get services. This happened to be with the parent. This person really focused on wanting a smarter, simpler process. Anytime you have the federal government involved with anything, the process is more stringent. The Affordable Care act seemed to bring families closer together. With 14 Million People being given insurance with the Affordable Care act, the staff takes on more patients and it certainharder to focus specific patient needs. I saw that with the staff and my job. One thing i was able to do with these few days i work in this job every week was to put impact into their life. This is something that got thrown at me sporadically. It has not been a very good impact. People are not happy with the outcome of the Affordable Care act. I saw this. She mentioned the state needs to be quicker. With the federal government giving states money, that is not happening. It has not been the greatest impact we would have wanted to see. That is all i have to say. Host thank you. Call from indiana. Post, abraham as palm is the chief Education Officer and a professor of psychiatry at the university of colorado. In his column yesterday he writes, in colorado the Medicaid Expansion halved the number of uninsured. Now receivepatients medicaid, which has enabled us to add positions, integrate Behavioral Health to primary care, and add quality jobs. Even though many private petitioners refused to accept medicaid, safety net systems stretch these modest payments into a network of benefits. In the 19 states that have not expanded coverage, the system is different. The Kaiser Family foundation observed that accounts for more than three fourths of that population. Doctors 202 7488000. Nurses 202 7488001. Other medical professionals 202 7488002. How has the aca impacted your job . Amelia is a nurse in georgia. Good morning. Caller good morning. Thank you for taking my call. When i have noticed over the that we noars is longer have a lot of patients that come through the emergency room without insurance. Over the years, before the Affordable Care act, hospitals had to absorb the costs of patients coming to the hospital without any insurance. Gethe backend they would passed on to the taxpayers. Now we have a lot of people with coverage. One of the things, i am a nurse, i have worked in the hospital setting and also for eight years at the Insurance Company. One thing is that most people do not understand that our medical costs are passed on directly to the employers. Any changes people have suffered recently to the Insurance Benefits is directly due to employers changing and choosing bad packages for the employees. It has nothing to do with the Affordable Care act. The employer, who is responsible costs,ing your medical not the Affordable Care act. If you work at a particular company and you notice any changes to your benefits, it was your employer that made that change. It has nothing to do with the Affordable Care act. They have spread a lot of misconception and lies about the Affordable Care act. We will be talking about a lot of the issues that you bring up throughout our program today. Most of our program will be devoted to the current state and future of the aca. We will have a roundtable with a wall street Journal Health care policy reporter, Washington Post policy reporter. Well have two former administrators of the agency now known as cms, which helped oversee the implementation of the Affordable Care act. That will be our second panel this morning. Dr. Butler is calling in from portsmouth, virginia. Good morning. Caller i have worked in both the private sector and public sector. I think the critical question is how much medical care reaches ts. Patien you will see our country compared with 21 other countries, and we do not do so well. It is worth reading the work of senator Charles Grassley about thatbecause he thinks nonprofit hospitals have to be carefully examined in our that theo be sure money intended for the patient reaches the bedside, so to speak. Host can you talk about your hospital in virginia and how that is playing out . Caller i have worked in private hospitals and other states as well as in army and Navy Hospitals. That is why i recommend reading the healing of america. In the Navy Hospital and some of the va hospitals i have ccasionally been in, but particularly the military hospitals, it is quite clear in accounting how much money reaches the patients. You dont have problems of exotic administrative salaries, or 4. 666. 4 million million going to someone who is running a private hospital. Under the law in the commonwealth in virginia. There is one comment i would make about virginia. Law,u look at the virginia you will see it is the only commonwealth or state which has tax credits for charity care, which applies not only to doctors but to dentists and lawyers. If you google donations of professional services, you will see the virginia law which gives people a direct tax credit for taking care of people who cannot pay. If you want to fix obamacare, that is one way to do it. There are other ways to do it. Way to do it state by state and very quickly. Host thank you for the call. Stephanie isdiana, waiting on the line for other medical professionals. Caller good morning. Thank you for taking my call. Host go ahead. Caller i have been in a Physicians Office for 15 years. I have seen the benefits of health care, the good and the bad. With medicare patients, the reimbursement rate is so low that i have seen my doctors have to triple their workload just to pay overhead and employees. I dont understand why people think this medicaid plan is a good idea. We have doctors in our local area who turn medicaid patients away starting in january because they cannot afford it anymore. On twitter, as we were having this discussion, his doctor is cutting a patient list of 600 people, now he has to pay monthly to the doctor. Is that something you are seeing . Caller i have not seen that in my area. Members who work outside of the state who have seen that happen. Doctors have literally tripled their workload. They are spending less quality time with the patient. With all of the electronic documentation they have to do now, they dont have a chance to look up and speak with the patient. Longeres are working hours. They cannot afford higher pay. It is not a good situation. The time spent on paperwork is something that the congressman on our program last week talked about. Dr. From maryland. Actis the Affordable Care contacting you . Caller i am a medical oncologist at Johns Hopkins in baltimore. With a cancer diagnosis, patients often need more than a diagnosis. There are some disadvantages. I think it needs some fixes. The ability and the health care a lot to allow our patients to receive not just oncology care, but fiscal therapy has been a real need for our patients. Host care and coverage very important when we have this discussion. So our costs. On twitter, costs are the problem here. Do you have any ideas for driving down the costs . My understanding of what has happened with Health Care Costs is that we have been able to control Health Care Costs better under obamacare that has been done previously. Itave been satisfied with for my patients. Reimbursements have gone down for many reasons. I dont think it is only obamacare. There is a prev