Given update on syria, afghanistan, and iran. And we will get perspective on u. S. French relations. And the french president s visit to the united states. Plus your phone calls, emails and tweets on washington journal on tuesday the new chair of the Federal Reserve delivers her first monetary report to the House Financial Service committee. We will have live coverage on cspan 3. Saturday, booktv is live in georgia at the georgia book festival. We will continue all throughout the day a look at efforts from doctors and Insurance Companies to block programs our guest is sam baker this morning. Thanks for having me. We are talking about the Medicare Advantage program. Explain what that is for people who are not familiar. Medicare advantage is privately administered coverage. Instead of the traditional program, these are private plans you can buy. They have a little bit of supplemental coverage and they are administrated by private Insurance Companies and reimbursed by the federal government. How is that affected by the Affordable Care act . It cuts Medicare Advantage relatively significantly. Democrats in particular have always felt this was paying Insurance Companies more to provide basically the same service that the government was already providing. So the Affordable Care act cuts this. We saw last year we are afraid we will see more this year. So you have a chart that looks at the cuts. You can talk about what percentage of the cuts are to the program, but what does it mean for a person involved in this program . To some extent we are still figuring that. Insurance Companies Say there is no way for us to cut the cost without passing that on to someone else. So that means plans with fewer benefits or it will have to include certain doctors from their network so people might lose a doctor they like. Sam baker of National Journal is our guest. We have the republican number on the screen now for democrats and independents explain why the cuts are going on . The cuts included in the Affordable Care act were included because they felt the program was oversaving and people needed savings. You are looking at an administration that is trying to expand coverage and pay for that and trying to cut cost where it can. So that is why the administrative cuts were proposed. Insurance agents were able to turn it into a pay increase. That doesnt affect the Affordable Care act and this cut was going to be layered on top but that is why you are seeing it. No one is having a great time in terms of getting paid to provide health care. Our first call is from pittsburgh, illinois. Peter for democrats is on the line raise the taxes on the rich so we can get the country back in shape. They are so far out we have 137 billionares last year. That is the only way to get out of the mess. As far as Medicare Advantage, it should have never been in there. They took it away. And it needs to be brought back in and get medicare back up where it is supposed to be. And i dont think the people making 1000 up to 50,000 shouldnt be taxed. If you tax them to death they will bring the cost down because they dont want to pay the tax. You see, this is the debate in congress do you raise taxes and create revenue or do you cut . Paul ryan wants to cut inEntitlement Programs like medicare. So you will see balance between the two. This is a form of cutting medicare. These were some of the cuts during the president ial campaign there was that whole to do over romny and ryan attacking president obama within the cuts that includes this. Ken is on the line for republicans. I would like information first about what sam baker said he was that the government will pay for it. Well, you know, i am 64 years old. I have been around and i remember when medicare separated from Social Security and we have been paying this. Not the government. We. And the seniors that are being forced back down into the below poverty levels. 3. 5 trillion in the Social Security and 1. 5 million out of the medical trust fund. And we put the funds in ourselv ourselves. For every dollar we put in, our employer matches that fund. So there is twice as much money that is supposed to be in there and they have never shown the other dollar for ever dollar we put in. I think when you use the word entitlement it sound like welfare. We have been working all of our lives and most of the baby boomers that have been and there is a lot that have already died and their money absorbed into the system. I think it is time that everybody starts investigating into what is really theirs. Very simple to do. Simple math. And i just like to see that, you know, what is ours. It is pretty pitiful when Senior Citizens have to eat dog food to make up the difference between rent and their electric and since 2009, they did away with the cost of living adjustment, the way it should have been by taking out electric or utility cost and the food cost. And to bring the cost of living adjustment down. These people worked all of their lives and are deserving of it. The caller mentioned the medicare and Social Security trust funds that gets back to this intention we were talking about before. No body likes a pay cut. Any of the stakeholders we have in the health care system. But because of some of the cuts Affordable Care act, the Medicare Trustees are saying that program is solevant for 12 years. You want a program to last longer that means painful cuts for somebody. I want to talk about the Medicare Advantage and get your take medicare ad vantage makes or our medical care worse. Without Medicare Advantage, i dont think what i would do. I am not sure about all of this. We will talk and spread the world no more cuts to Medicare Advantage. Explain that ad and the group behind it. That is being run by the insurance agency. Here and in some districts back home for lawmakers to see. This is ramping up right now because it is time for the Medicare Program to set payment rates for next year for Medicare Advantage. These are the same ads that worked last year when the Program Proposed significant cuts in the Medicare Advantage payments. A similar ad campaign started running and a huge group of bipartisan lawmakers sent letters to the Medicare Agency saying you have to reconsider. So there is president for these to work. Gale in florida is on the line for democrats. Good morning. I am calling from florida. I am a nurse and a longterm care provider as well. I feel the best thing with eliminating the Medicare Advantage program. It benefits the Insurance Companies not the Senior Citizens because most of the seniors that need it longterm care were in such limited amounts of services that could be provided to the senior system through the program. The Medicare Advantage program the insurance providers profit. Not necessarily the longterm care seniors who need the assistance and care to maintain daily living. I was so happy to know they were going to eliminate that. We did very well prior to Medicare Advantages coming on the scene. They do restrain providers as far as giving certainly amount of care and services because it is all about profit. So i applaud the Obama Administration for eliminating that because it is about profit for the Insurance Company. I think the Obama Administration would differ with the conclusion they are trying to eliminate it. But they are rolling it back. The democrats do feel like it is give away to the Insurance Companies especially the way it is structured now. That is why you are seeing the cuts taking affect. The other side of that, the argument Insurance Companies make, seniors have a lot of coverage and buy additional coverage outside of medicare to pay for other benefits that the program doesnt cover. Medicare advantage included them so it comes at a higher price but sometimes you are getting more coverage. Going to a question from twitter. David larson writes explain how medicare had a subsidy increase last year . That is a program that has been staying predy affordable. Medicare part d has been doing good as well. That is Prescription Drug coverage. So you are not seeing them translate into the benefits yet. So you can argue week do another cut or two we can gale is on the republican line this morning. I have a degree in Health Care Administration and i see huge problems with the Health Care Act that has taken place. But i want to hone in on Medicare Advantage and i think the bottom line as the lady earlier said from florida, it did and is a kickback to the Insurance Companies. However physicians are not going to order or give the best treatment they can to a patient knowing they will not get reimbursed for that particular type of care. Therefore, what we have done, in my opinion, as an rn, and we have decreased our level of care to the elderly. We are sorry you can not have this because we cannot afford it. We cannot pay for you and therefore it isnt covered on the insurance so we are not going to do it. The doctors have to guesstimate what he feels the problem may be. That is main concern with the health care that is occurring. Our health care has become more of a third world establishments. The Affordable Care act care is trying to change the way that medicare pays doctors, hospitals and other providers. You get paid right now for each service you provide. So one test, you get paid for that, another test and you get paid for that. And that is what the caller is referring to. There is a shift to say this isnt a good way to have the payment structure set up. Maybe it would make more sense to pay based on had health. If your patient is healthy you get paid more. If they come in with a problem, rather than paying for the xray and drug and such we will pay you one lump sum to make that patient healthy. Sam baker, we are hearing doctors are being dropped from this program. Why is that . That is a step Insurance Companies are taking as they see their payments from the federal government come down. They are pushing out providers and doctors to cost them more. It is way to absorb a payment cut on their end without directly cutting the benefits they offer to seniors. You are seeing doctors suing to get back into Medicare Advantage networks. So you have the doctors suing the Insurance Companies but they are protesting the same thing. Lets go to florida where steven is on the line for democrats. Okay. Can i ask me question . Go ahead. You are on with sam baker from National Journal. Thank you. I am wondering and i think maybe this was already answered. When do the cuts take place . Have they taken place already . So the cuts in the Affordable Care act are phased in over a number of years. Some have taken affect and some have yet to take affect. What you are seeing the Insurance Companies lobby on are possible cuts that could take effect next year we have brenda from tallahassee and on the line for republicans. I am a Senior Citizen and i am on Medicare Advantage. I can tell you from day one, president obamas first speeches was i am going to get rid of Medicare Advantage. And i will tell you why because it is a good deal for the people and Senior Citizens and obama wants to make sure that retirees have to work until their 80s. This provides more income for welfare clients. I pay 130 a month through medicare for my Medicare Advantage. I have had my heart worked on. My heart was worked on prior to be on Medicare Advantage. I was under chp prior to Medicare Advantage. That was 97,000 worth of work on my heart. And then a year ago, i was diagnosed with Breast Cancer and that was under the Medicare Advantage. And the Medicare Advantage, my treatments, without insurance were 700 for the radiation. After all was said and done, what i owed was my total amount that was due from me was 3200. That is what i paid that i was made to pay. But as i said, obama and pelosi and harry reid would like to see all of the Senior Citizens work right up through their death so we can continue paying in until we die for all of the welfare clients that get free medicaid and free food stamps and free housing. And help on their electric bill. And this is where our obama stands. We are hearing that the Insurance Companies are making claims that people with Medicare Advantage like it. Seniors who get their coverage through Medicare Advantage rate the program pretty well. The point the insurers were saying if you cut this enough it will trickle down. And in north carolina, we have gerlean on the line for democrats. Hi. Hi, there. I was calling in about the Affordable Care act. I tried to apply for it a couple weeks ago. They told me i had to make at least 11,000 before i could even apply for it. Now i was one those that was effected by the unemployment shutdown. I worked for 36 years. I am 59 years old. And i have been out to look for a job and i can just not find one. I tried to get food stamps and i was told i could only get 15 for a whole month. I want to know i have no income now. This is a real problem a lot of people are running into. Because of the supreme courts decision upholding the Affordable Care act, there is a discrepancy about the states expanding medicare. Some states are expanding and then the subsidy picks up. But in the states that are not you have a group of people that are telling them they are too poor to qualify for the benefit. This is the Administration Arguments in trying to pursway other states to take up the policy. Host i am curious what you think is the overall impact of the Affordable Care act on seniors . It is possible too early to tell. There are reductions in Medicare Advantage. But there are also new benefits added to medicare. The donut hole we are heard so much about in Prescription Drugs is being closed. New benefits for costfree Preventive Care that has been added and the lifespan of the program has been expanded. But there is an argument fewer doctors will provide fewer services. Albany georgia, johnny for democrats is on the line. I want to talk about Medicare Advantage. In my point of view, Medicare Advantage is another form of welfare. And that is all it is. Because i am 79 years old. Every Senior Citizen paid the same amount into Social Security programs. And the Medicare Program as well. And those people who are on Medicare Advantage that is what they get an advantage. They dont have to have a secondary to pay that 20 medicare doesnt cover. I have to have it. I would not go around saying i would not like welfare when i am accepting it on the Medicare Advantage. And the lady from jacksonville is getting welfare. Medicare certainly is an Entitlement Program that seniors pay into and the government also funds so it is as a publicallyfunded insurance plan. One of the arguments for or against Medicare Advantage cuts is the critics feel like it is costing too much and costing extra for the same care. That in a sense it is welfare for Insurance Companies. Obviously, Insurance Companies would reject that and Medicare Advantage does o