The state of texas defaulted to a federal exchange to the Kaiser Family foundation. Senator ted cruz, does he have to support this . Guest increasing support has been one of the interesting surprises. Theres a lot of stories about republicans whove lost their zeal for repeal and complete defunding because they understand the political reality. You see the effort by senator cruise and senator rubio who brings the profile to it and i believe senator mcconnell is on board. He came out with a strong statement saying we want to get rid of this law. These are reinvigorated effort. Host senator cruise is offering this amendment to the continuing resolution to keep it funny, which the senate is taking up today . Guest yes. Post a republican in gary, indiana, europe next. Caller i surgically speaking at first about a couple comments here about expenses and expenditures. I go to several. Yours and one of money current doctors they went to out of the Clear Blue Sky incentives see him every three months for medicaid, he wants me to come, not just me, every patient that comes in the door once a month for an office visit and to get on medication refill. Were talking about costs here. That will put the bottom out of the whole thing. I mean, what are people supposed to do . People dont understand it. I talked to people in the doctors office. Nobody has the same answers. A lot of the moneys going to come out of my pocket, the governments pocket. Where is the justification of this . Guest you know, i cant speak to monthly doctor visits, but the Affordable Care act, one of the things thinks the white house and president talk about his preventive visits better copay free. A certain number be to access and they hope that they visit your doctor for regular checkups, that actually reduces cost in the long run because people are getting things caught earlier. They are not waiting until the last decade to see someone. I cant speak to the specific situation, but the idea of regular visitors what they want to encourage. Host church as an independent. Bradford, massachusetts. Caller my question is i and my medicaid rate now. Does this make up the difference they do not pay linux guest there wont be much interaction between medicare. They will still operate on their assistance as medicare for 65 and up is typically people of their working age and because they are geared towards young people. They are the target if anyone until they are medicare eligible would be eligible for the exchange. Host are they paid for in some way for the Affordable Care act . Guest the states have been getting grants for a couple years now to set up exchanges. Tens of millions if not hundreds of millions of dollars to construct and exchanges. The setup costs are affected by sequestration to a degree, but experts everywhere say the white house is going to move dollars around, make sure the financing is in place to get the exchanges going. Host the Affordable Care act had a new tax put in it. Is that tax helping to pay for these exchanges . Guest not yet. The tax has been paid yet. Theres multiple taxes that took effect this year that does impact their expert patients this year. But the longterm tax down the road will pay for coverage expansion, which hasnt begun yet. Host dan, democrat until such, oklahoma. Host i have a union contract. So much of it goes to my wages. So much of it goes to my pension. So much of it goes to my Health Care Insurance and so much goes to humility. I have a really good package. What i hear about this Health Care Act is something im not sure it is. Maybe you could explain to me. What weve got to eca go out out in a year and i want these repair jobs and that 50,000 that year. This is just an example. Say that my Health Care Insurance is in my contract is valued at 15,000. While i have to pay taxes and 65,000 at the end of the year . Thats what i was sure have. Ill hang up that much to answer my question. Guest im not sure the Affordable Care act of love and there. If you have a private company to Purchase Health insurance for taxdeductible for your employer and what you pay towards your insurance is negotiated through the union with the employer. I cant speak to specific changes brought by the Affordable Care act, so i dont much of a difference there will be. Host i have heard the true cost of obamacare rather than the claims 900 billion will be 2. 7 trillion. Is this true . Guest there is endless debate about the real cost of the Affordable Care act days. You talk to the Congressional Budget Office and i talk about the deficit reducer over the long run because despite the expenses up front to get it going, there will ultimately be coverage to reduce pressure on things like medicare and other alleman the law touches. Republicans scream from the rooftops this law will break the bank even if your democrats say this isnt how we break the bank. We dont break the bank. Host independent in hague, north dakota. Caller yes, sir. My name is joe frank. A few questions if you can explain to me. You were just talking about breaking the bank. We lost our dad when i was 12 years old. One brother nine months old, my mother was 34. She never took a dollar from the government. We have Three Sisters and we stuck it out. Ive been paying Health Insurance are hoping my mothers and spent 12 years old is when i bought my first callous or earned them. And now im 75 and im an educator. They say medicare is breaking the bank and my wife and i have 12,607 a year for our medicare. You tell me, sir, why that should be breaking the bank because everybody has to pay that man or why we even take these medicaid patients along. Did they pay their Hospital Insurance all their life . I understand these people that cant work for mentally ill or something, but we are protect dean this country, sir. I think you explain that to me. Guest its interesting point you make. I think theres a debate going on, the state level and state houses about who should be eligible for medicaid. Should we really make an effort to get people who are employed on medicaid but cant afford Health Insurance versus people on holy and looking for a hand out. The debate is happening around the country on that. In fact, in florida yesterday they had a lengthy debate on this or they mentioned about 70 of people who are medicaid eligible are employed. They wanted to emphasize the point to show a lot of people who do seek medicaid are hardworking people who cant make ends meet and afford health care. Under point i medicare, it is to get medicare cost is slow. You can see this is breaking the bank as much as it must be a entitlement costs look like they could be a major budget buster down the road and are driving project deficits. That is why theyre looking for a solution there, too. Host out of the debate of expanding medicaid fit into this conversation . Guest exchanges are for people above the medicaid special. If you leave the lowest income people in the states are eligible for medicaid. Under the Affordable Care act, states have the choice to expand to people earning up to 138 of the poverty level, roughly 16,000. Still a very low income residents. I think the goal of the Affordable Care act was lets cover as many people as possible. That said this horrible population to utilize this health care the most enough for the lease. Host what did the Supreme Court decided this expansion . Guest this is why battles are played in the states. Washington cant force states to expand medicaid with the threat of saying if you dont do this will pull your medicaid funds. Every states biggest side in this medicaid. If you lose your medicaid funds, every state is pretty much broke. What the court said was states can expand medicaid, but washington cant hold this hammer if you dont have funding. This is not a state of choice in the last year or so to say are we going to expand medicaid are not . Host they spent eight or so governors who have agreed to expand medicaid. Jan brewer and arizona, Chris Christie in new jersey. You can see the list there. Why did they agree to this . Guest it is some of the most interesting developments in the last couple of months. Theres a lot of reasons why. We cant pinpoint one. Look at states like arizona or president obama won lake new jersey and say the political make up their with and supported the Affordable Care act. Then you look at the dollars involved. Even though its a choice for states, theres billions of dollars to accept it. By the conservative elements on the right dont want to grow government, we are trying to balance the budget and have billions of dollars on the table that could bolster your economy and expand coverage to hundreds of thousands of vulnerable residents. Its hard to turn that down. Host next to the wind come a republican in oregon. Go ahead. Caller in front of me right now i have from white sending me paperwork on health care plan. You are not telling the people what is going to cost them. 2014 will cost 95 per adult, 47. 50 per child. 162. 50 per child. 34750 per child. After that it chomps for 40,500 to a single person. And that is a bronze and there must be tears to the the coverage nor the costs. We will pass it and then figure out what it means. This is exactly what youre doing i get calls all the time because they know. They are scared because they know they can afford this. You people are telling the people the truth of what is going to cost. Host you got that information from senator wydens office . And you are a dog with a bone. What are you doing . Are you organizing people against the Affordable Care act . Caller i have a lot of people ask me what i want to do. Ive also call some different people in different things. This isnt the only thing i check to find out. This is from the kaiser foundation. People are scared and people out here who think the obamacare does the greatest thing and representatives said at voted. When they voted this in because then they find out theyre not going to get the care they were promised at the 2. 3 even on a bandaid at the hospital. Craig wrote them down here said we have shut down because the tax coming down. If you tax a companys coming your text to the people. Thats why they will not allow this to be thrown out because it was classified as a tax. President obama has light and so have republican. Host a lot there. Are her numbers correct . I think youll see some debate. Theres no one making any aleutian there will be premium increases. Theyre envisioning at least shortterm premium increases because of the laws impact on ones. The question is what does it mean for consumers. A lot of them will be eligible for tax credits to pay for the cost of care they didnt have before, so care could be more affordable for them. It has been well talked contrary to the point, is a lot of discussion of what will happen in a letter they send out. They are convinced premiums will skyrocket and see that public support for the love will evaporate and we will all become unworkable. Host if that happens, when we might see those headlines . Guest well see the beginnings over the next year was the coverage expansion stars and people start paying those initial premiums in the Affordable Care act area. Once solana officially takes effect, you will start seeing the real impact. Host robert cometh in the seat from. Hi, robert. Caller thank you for taking my call. I fed the whole thing rather confusing and i think its because we have been American Public understand basically for systems we use currently, medicare, medicaid private insurance and veterans. What is unclear to me is given the four current ways we receive health care, how is that going to change . Lets take the private insurance payer. Will they continue to pick that up or the percentage of private person pays be the same . With medicare, seniors often have to pay for an extra insurance supplement program. Will they continue to have to buy that extra program . So on and so forth. We would like to know how given the current payments being made, how that is going to change. Or if you will at all. Guest on private coverage, one of the fears for the opponents if its a job coverage and not symbol for his people into exchanges, which is private roles or medicaid or so forth. The Affordable Care act is built to run an expansion of private insurance on the exchanges. As much discussion as a government takeover of health care, the the law is predicated on private insurance that they have a time on the law. And on medicare, i hate to say it, but it always remains to be saying that there are some changes to medicare in the law in terms of enabling seniors to get preventive visits at no cost and close the door the whole on prescription drugs. I dont know how much that will do to set seniors from seeking supplemental plan. There may be additional after its indicted again is up in the air. Caller from my cat misty city. Currently going on eight months actively seeking word. My question is how is the unemployed be paid for the insurance plans. I understand there is a fine to occur if youre unable to the insurance. If youre unemployed and looking for work and cant find a job, who is going to pay the fine . Theres also word about if you are unable to pay for the fine, if you cannot pay, thats your spouse will have you paid. Can you respond . Guest im not familiar with unemployment. States have their own, so im not sure if you have a specific Arizona State unemployment plan there. The Affordable Care act and the penalties are designed to be tailored to peoples income. If you make under a certain amount, the minimum penalty is 95 in the first year, which some people say is too low, but its never going to leverage anyone to get coverage. With the lowest income threshold would be a penalty at all. Its aimed at people who have an affordable option for insurance. If you dont have an affordable sharing, you can get a waiver from the government for irs. Host johna, democrat of South Carolina. Caller good morning. I am a veteran of the United States army and i worked with the department of social services, sane people can and must without Health Insurance. So this is the Health Care Act. It extends to those in poverty. Those who couldnt afford health care. A lot of times their family members came in, whether it be the mother or father were out of work because of health care they didnt health care because of the clients. Now that the help is coming back, these people are able to go back to work. Its South Carolina. I think we need to develop what it would do for country. Host d. Of health and insurance . For your job . Caller i do. Guest South Carolina as you mention we. Governor haley said wed want no part in the medicare expansion is unaffordable in a release date, huck at the end of the day, even though Washington State for the first three years and then pay 90 thereafter. Theres a fear among opponents of the health care a lot that washington will not live up to that commitment. Somewhere along the way the night before to give you 90 and the states to pay for the massive expansion. But as you mentioned, the expansion is there for people who are vulnerable and who are sick and otherwise couldnt afford insurance. Host kyl, speak about obamacare shift from quantity of care to quality of care within medicare. Our projections following . Visit to turn analyses. If the programs are incentivizing providers from this feeforservice care, which is for every time a doctor doesnt ask for your test, the doctor gets paid and the notion universally is considered obsolete or outdated and driving up costs. But people are starting to move towards is a notion of Global Payments are finding a way to say. Or should pay for the healthy outcome of their patient and making sure they dont end up in the hospital again or that there are medical errors driving up costs. Host vivian shepherd says how can the cost of insurance skyrocket if theres a cap on how much Insurance Companies can raise the premiums . Guest it is not so much a cap. States are allowed to have mechanisms to reject premiums that rise to what is considered a nonreasonable or unjustifiable way. I think you are seeing frustration where they say we see Companies Raise rates on individuals or Small Businesses by doubledigit percentages. The Affordable Care act within a mechanism that is unreasonable or premium rates to expose and show the public whos raising rates in a lot of states have mechanisms to reject the race outright and considered them unreasonable. Host next to stafford texas. Caller yes, from dealing with interns with my daughter before she passed away and everything else, what is the big deal about obamacare . Wife and the government brief scene in the. Reason hospitals and pharmaceutical companies and regulating them instead of forcing this on us . Guest im not 100 sure i understand the question. The idea of the Affordable Care act is to make the system work better and then well have disagreements about whether this is the right approach and may spend 10 over the last few years. The atf of reaching to doctors and hospitals and Insurance Companies is part of what the supporters hope as a way to streamline the system and make it more effective. Host chris is next in Nebraska Democratic collar. Caller i was under the impression 80 of premiums are for health care. Last year at approximately 3000 in health care premiums. Who is responsi