Joining us from topeka, kansas, is a Kathleen Sebelius the former secretary of health and human serves from 2009 until, 2014 to help implement the Affordable Care act under president obama. Thank you for being with us. Guest great to be with you, steve. Host lets me begin with the question that many people even on the democratic side of the aisle have said is that the portal care act needed to be repaired, so where do you think that changes should be made if to be made . At guest well, if you look at what the American People wanting healthcare, they wanted affordable, they want it assessable, they want to make sure they can ticket themselves and their family members if anyone gets sick, so more and m more cost whether you work in the obamacare marketplace or in employee plan were being shifte to more outofpocket costs. Everyone wants those costs to go down. They want something done about drug prices. Drugs are an important part of anything whether you are in chemotherapy or getting antibiotics for your kids and people are worried about drugs being able to be priced anyplace by anyone, so those are two features and they want some choice in their plans. Off three of those features, i think, can be fixed. In the Affordable Care act you can actually have ways that you further limit peoples outofpocket cost so that they dont end up with a huge bill at the end of the day. You can certainly give the federal government negotiating power and move more aggressively towards drug pricing which every other country in the world does and i think there are ways to stabilizefforda the Affordable Care market particularly in areas where there is not enough competition by either offering a public option which is on the table and in many states or having a more stable risk risk pool so companies are encouraged. All three of those things are very relatively easy to do, but we actually worked with congress who repealed the bill, voted to repeal that bill 51 times and never even was willing to be helpful in technical fixes going forward. Host so, now they have a replacement plan that presumably could be on the house floor next week or early the following week and as you look at the gop efforts, what are your observations . S i just guest well, the three issues i just talked about, outofpocket costs, drug prices and competition are actually made worse not better. There is an estimate now that immediately about 14 million americans would lose coverage they had and eventually 24 Million People would lose coverage. Thats a huge step from where we are with the lowest number of uninsured we have ever had in this country, soy big step back and i think if you go into the Congressional Budget Office reported even more alarming. Huge cost shifts to states by having medicaid per capita for disabled people, nursing home residents, others. Those folks will go away in the states just pick up the costs and you have Older Americans and certainly lower income americans that have been locked out of the marketplace and thats e why the race avenge ates eventually go down because younger healthier people will be able to stay in pay cheaper rates and older people literally will be driven out of the market. That is not a great profile for america. I think its a veryd alarming way to look at health care for the future. Host you are a former governor. Your dad the former governor of ohio, so the only father daughter ever to serve in state houses in two separate states, but i want to ask you about the impact of this is having on states took a number of publan governors concerned about medicaid cuts that may be part of this healthcare bill. Guest thirtyone jurisdictions, 30 states and the district of columbia who have expanded medicaid under the framework of the Affordable Care act and about two thirds of the country live in one of those estates. In my own state of kansas, the recent legislative changes, changes to a more moderate legislature in november, produced legislators who recently voted to expand medicaid. Kansas was not one of the early states. They think this is a good way to go forward, so you now have a situation where not only will Medicaid Expansion be stopped, but the kind of rule that the republicans are talking about putting in place, the Paul Ryan Grewal would actually ensure ever virtually every expanded medicaid beneficiary, everyone in those estates whether they are opioid users or folks who need Mental Health treatment or alcohol and Substance Abuse and can get help and become productive, those folks will be rolled out the programth in a period of two yearsme because Medicaid Eligibility is income based and people fluctuate up and down. They are workers in the workforce, but often in a job that could change over time where they are Seasonal Workers or they have two or three jobs, so as their income fluctuates and if they would drop out of medicaid they will be gone, so you have a situation where the projection isin a that short time, about two years, everyone in that number is currently about 12 or 13 Million People, everyone who has expanded medicaid, which is Health Insurance for lower income workers, very efficient, very productive, cheapest possible way to get people healthcare in the marketplace, well under commercial insurancens policies, all those people would lose coverage. Host we are talking with Kathleen Sebelius joining us from kansas, the former governor and kansas and 21st said and former secretary of health andal human services. Chester is joining us for democrats. Good morning. Caller good morning. And went to tell a brief story, briefly hit myve husband is a teamster, so im lucky enough to have insurance or his job, but where i worked there was a girl i worked with who had insurance through that company and when she was diagnosed with type 2 diabetes they did not treat her. The Insurance Company told her that disease was preventable and itss your fault we want to ensure you for that. Thats whats coming. The other thing im worried about is the collapse of socalled collapse, Insurance Companies leaving the market. Is because they cant make the prophet they want. Thats why they are leaving. Host thank you, karen. T a we will get a response. Guest karen, you make some excellent points and i as part of my past life i was a insurance commissioner for eight years in kansas, so i know this marketplace pretty well. I was regulating Health Insurance companies on before the Affordable Care act was passed and i saw person after person tried to get coverage who had an insurance policy and part of what we did in our Office Every Day was fight to get people the benefits they had already paid for that they deserved. There were lots of blockades to provide treatment and the more pense the treatment, the more difficult it was, so your friends situation with benefits being denied is not unusual. I worry a lot about people without a policy that has full benefits. A lot of people thought they had Health Insurance only to find out that the fine print in their policy said we dont pay for ambulance coverage. We only pay for two days in the hospital. We have pregnant women who were literally exited from the hospital within 24 hours after having a baby because that save money for the Insurance Company, so thats what the old market looked like andnd they were medically underwriting everyone. They could deny coverage based on a condition or they could underwrite a condition. D i dont think those days were good for anybody. With very high levels of uninsured folks and a lot of people who were socalled underinsured who just didnt have the coverage that they thought they had. Who ju thats a very dangerous place for a person to be if they get a serious diagnosis or a serious illness. Host karen, good morning from massachusetts. Independent line. Caller good morning and thank you for having me. E with t i agree with the previous caller and with kathleen. Thank you, regarding the Insurance Companies. Its basically all about money, all about makingmp money for the Insurance Companies. Or mor its about making money hand saving money for more of the republicans in the high income bracket. Having a healthy savings account doesnt do anything for people that are only making 10 or 15000 a year. Of the republican plan with shifting anything back tthe states means that people are only going to be able to afford essentially a taco type of medical plan. The people that have the money are going to be able to fly anywhere and they want in the country to get the treatmentthey w they went and what we should do is have a health plan for everyone thats based on a percentage of their income, pure and simple. If you are making a lot of money, you can afford to pay a lot of money for your insurance picked if youre not make a lot of money or you are retired or savings, you should be able to say, so thank you for your time. Guest again, i think that is a great point. In the Affordable Care act there was a graduated assistance for individuals who are buying their own insurance, so their employer isnt making a contribution to their coverage which a lot of people have in the workforce, that a hundred 67 Million People have employerbased coverage. Of their employer pays a share and they pay a chair. This is people buying on their own, so the government was paying a share, but it was income based. Knowing someone who made 25000 a year probably needed more help to buy insurance policy then someone making 75000 a year, graduated help. You can debate whether or not thats top and it was too stiff, whether or not the ceiling was o too low, whether peoplean needed more help and assistance, but the republican plan throwsn that out the window. They get rid of all the taxes that pay for the Health Care Plan that actually did this graduated help for individuals and as taxes were paid by wealthy americans and mostly by Insurance Companies and drug companies. That money august back into the pockets of corporations and wealthy americans and there is really no income based help offered in the republican plan. What they say is, we will offer subsidies based on age. What i heard secretary price say, one of my predecessors is that he knows that age is the best correlation to illness, so as you get older you are likely to be sicker, but the republican plan also allows Insurance Companies to charge Older Americans five times but they charge younger americans. That was not in place in the older plan, so theres a little more subsidy, a lot less than they could get under the Affordable Care act or to theres no help for anyone at the lower end of the income ladder, so if you are a 60 year oldldso if making 25, 30,000 dollars a year, you now get charged five times as much and you lose enormously in the subsidy, so they will be dropping out of the market place p they will out of the market place and we will suddenly have a situation wherewell ha Older Americans, lower income americans working americans lose their Health Coverage across the board. Thats where the 24 Million People comei in and that, i think, is a very dismal place for this country to be 111,000 people a day they we turns 65. We are a older and greater nation that we were even seven years ago when obamacare was g passed and we are going to literally lock people out, price people out of the market and you are correct about Health Savings account. Its great for my husband and me. We have very good insurance coverage, so having healthy savings account, which my husband has available in his work allows us to p put aside some Additional Resources and pay for some of the features that arent ine our insurance plan, pay some of our copays, it pays some of our deductibles, but if you dont have a good underlying plan a Health Savings account Means Nothing because all it is is your own money tucked in a tax package. If you get a cancer diagnosis, if you have to buy expensive medication that Health Savings account doesnt go very far at all to making sure that you are healthy and productive into the future. Host let me remind our cspan Radio Audience that we are talking with Kathleen Sebelius, former secretary of health and human services. Among her other duties today she serves on the board how is your bracket doing by the way guest well, it hasnt really started yet, but i was with xavier. My grandfather was the first volunteer basketball coach at xavier, so i like that upset last night. Host we are covering it all here on cspan. You are also on the board of the Dole Institute and we will go to tom on the republicanr, time with secretary Kathleen Sebelius. Caller yes maam. You knew i was going to ask you a very hard question and thats just why you put that caro through my heart with xavier. D guest im so sorry, not really, but i feel your pain. Caller it was a good game. L yo guest it was. Ur caller maam, do you ever wonder and was there much discussion because i find itit conspicuously missing in the discussions that whear today relative to healthcare, was their discussion about the constitution and its enumerated powers and the fact that the federal government was never given the power of creating such a huge creation as this Healthcare Initiative . Guest actually, the discussion about the constitution was raised a number of times and as tom will knows, i think that that bridge was cross a minimum of 50 years ago with Congress Moving in 1965, to create medicare, which is a massively Popular Program that now has 53, 54 million beneficiaries, older and disabled americans help to run exclusively by the federal governments singlepayer plan that actually works extremely well, has the most most administrator cost of any Insurance Program in this country and at the same time created medicaid, which at its origins was the Health Insurance for people who actually got past assistance with welfare that has long since stopped and medicaid itself has become unInsurance Program. Largest number of children in that country injured in medicaid, pays for about half the births in the country. Pays for nursing home care, largest payer, so older adults are often beneficiaries of medicaid. Now, has been expandedkers to adults who are lower income workers who need income threshold and there are about 73 Million People in medicaid to the issue of whether or not the federal government should be involved in healthcare again was something that was long decided in the 60s and debated long before the happening back in the roosevelt days when he proposed Health Reform but could get past. Host also on the republican line in elizabeth is next. Good morning. Caller good morning. How are you . On the fine. I would like to know if you are the lady that refused to let that young child have met organ transplant because he was too young . Are you the same lady . I dont think that was a rights. I dont think its right [inaudible] caller im just me, little old thing, but i was just wondering how you thought about that . Host thank you, elizabeth. Guest elizabeth, i think that is a good question. I am the lady who was the secretary of health at the time that the issue came up about Organ Transplants and we dont directly you will be pleased to know the government does not run the decisionmaking about who gets an organ and who doesnt. I dont think anyone would ever want that to happen. What happens is a group of doctors who are actually transplant surgeons make the rules and we, unfortunately, because too few americans choose to be organ donors, we dont have enough organs to go around so there are people on waiting lists all over the country and there is a rule made by the surgeons who do the organ transplant who continue to believe that this rule is right that children are not good candidates to get an adult organ because their bodies are too small and they dont work, so while there may be an adult organ available a long, a heart, a liver that if you try to put that organ for my body into an 8year old or 9year old it does not work. The body cannot make it function. This decision went too the doctors saying there is a little girl who needs an organ. She had been in a situation where she had actually had a couple of transplants that had failed. Her parents wanted to know if she could actually have access to a adult organ. The group of surgeons looked at this and said this is not a good idea,a, not because we arent really anxious to get this child the organ she needs, but we think this is doomed for failure and she would have one more surgery that is likely to fail, so they made the decision. Congress asked me, some members of coness said you really should intervene. You should reach in and make the decision those overruled those doctors. Again, i can imagine anythi