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tv   Washington Journal James Capretta and Topher Spiro Discuss the Affordable...  CSPAN  January 19, 2017 1:15am-2:15am EST

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the family comes together in the rise over there? >> i know think the family. >> and the four of them rise together? >> most probably they will go to the white house, spend 30 minutes there or so and then go together. it is a great moment. >> thank you so much. >> thank you. >> watch the 58th presidential inauguration live on friday on c-span,, or listen on the free c-span radio app app. next, a conversation on the affordable care act from "washington journal," this is an hour. for our next hour on "washington journal, we will be talking with etta and topher spiro about the affordable care act. you worked on the team in
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congress that helped draft the health reform law. are we still fighting the same battles or do you think the debate surrounding what people should and shouldn't have with health care in this country has progressed? guest: in many ways, we are still fighting the same partisan battles. it is very tough to enact the law. democrats worked very hard with republicans for a number of months. what we saw was the tea party in the summer of 2009 and republican senators who had been working with democrats on above partisan law -- a bipartisan law like senator grassley and senator snowe, start to withdraw from that collaborative spirit. we saw wasn what very partisan opposition to the law. we have seen republicans do anything and everything they can to sabotage of the law. republican governors have refused to expand medicaid
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left a lotich has of people uncovered. they have brought lawsuit after lawsuit. that is why i think you are still see that public opinion is very divided on the law. where things have changed, i think, is that the affordable care act has clearly set a new benchmark, which is now you have even republicans talking about wanting to cover people, making sure that no one loses coverage, and that was just not something that republicans cared about before the formal care act. host: i went to get your thoughts as well on how this debate has changed. is there some agreement now on goals and just disagreement on how to get there or are we still debating on the goals? guest: i thickens important to put on the record that republicans in various cycles have proposed to make sure everybody in the united states has health insurance prior to president obama taking office. in 2008, senator mccain
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when he ran for the presidency of on part of the platform the universal tax credit for everybody the united states. by the way, senator obama attacked him on that proposal for a variety of reasons. it is not true that republicans have never been for making sure that everybody in the united states has health insurance. during president bush's term in office, he proposed a tax credit for health insurance basically every year he was there. it never got enacted largely because there was a lot of democratic opposition to doing it the way he wanted to do it. there is a lot of water under this particular bridge, ok. at this point however, i think after sevenrue that years after the affordable care act was made law, things have changed and there are things on the ground that have to be recognized.
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someyou move forward with new legislation, you cannot erase the last six and a half years. you will have to deal with the reality and try to make sure that everybody's arrangements are at least as good as they are now. what do you think the successes will be of the obama administration moving forward here? guest: i do think he will get credit for pushing through some legislation that made it much easier for people on the very low end of the income scale to get health insurance. he deserves credit for that. it took a lot of money. he was want to push the financing to make that happen and he will get credit for that, and i think rightly so. that probably is a legacy that will last for some time, at least i hope it does in some context. i think it will change and probably for the better, but the basic proposition that you needed to do something relatively big to get a lot of
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lower income people and to help insurance, he took that on and made it happen. host: mr. spiro, do you agree with that? guest: i agree. i think you for the care act changed -- think the affordable care act changed the benchmark. this is a big fight we are in, but a believe that there is going to be a good resolution where 22 million people will not be thrown off their health coverage. it's going to take a lot of fighting and the american people are going to have to rise up. we are starting to see some of that. some of the tea party like parties to save health care are happening around the country and people are starting to angrily confront the republican congressman i think we are at the beginning of that fight. i feel confident that the legacy of obama will be protected here. host: we're asking our viewers to join in the conversation as we are talking about the
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affordable care act, the legacy of health care reform under president barack obama. the phone numbers are a little bit different in this segment. if you get your insurance through the affordable care act, the phone number for you is (202) 748-8000. all other viewers, the number for you is (202) 748-8001. we are talking with james capretta and topher spiro and we will do it for the next 50 minutes. you mentioned polling on the affordable care act and i want to show the latest poll that came out from nbc news. the poll is showing that as republicans are getting closer , thepeal it, obamacare affordable care act has never been more popular. the poll is showing that about ,alf of americans, about 45% say it's a good idea that the health care law is a good idea. than thatess th with 40% saying it's a bad idea.
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you can see how the numbers have changed over the years. i want you to interpret that polling. why do you think those numbers are changing right now? guest: i think part of it is simply the fact is obama leaving office and trump coming in. it is no longer perhaps obamacare. it is just a change in the way that people think about it. a lot of the opposition to the law had been opposition to obama and not really to the law i think. we are also seeing people peopleg to rise up and starting to really fear that their coverage is going to be taken away and that their benefits are going to be eroded. that kind of fear and anger is something that is a direct plan tof the republican repeal the affordable care act. if we were not in this sort of crisis situation, you would not
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have seen all these uprisings starting to happen. i think that is in part why you see public opinion turning. host: i want to get your thoughts on public opinion. does it have to do more with the politics of the situation or people discovering what's in the affordable care act and they are liking it more? what is your reading? guest: i sort of doubt that. nothing much has changed on the affordable care act front. the reality is that there is probably more reasons to be worried about it than there was a year ago because of instability in the insurance exchanges. there are more people unhappy about the arrangements they are and that a year ago -- they are and then a year ago. i think the political mood and the changing of the presidency that people's attitudes shift a bit taste on their perception of what they want to say to a polling question based on who they think is going to be in power. they were unhappy with some elements of the affordable care act and did not see a lot of effort to change it during the obama years.
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now that president trump is coming in, they say we want some changes, but don't go too far. host: we want to dive deeper than the polling numbers with the help of your calls. jerry is up first. go ahead. caller: i'm wondering why we are even discussing health care insurance or insurance of any kind. help aver seen one suit patient. those things are provided by health care providers, and yet, we are sitting here giving a large portion of our money to bookies and get wares on wall street rather than taking care of people that are hurt. i think the system stinks from the very base of the idea of insurance. if you look at what is happening in our country and you look at health care, we are slipping every year. other countries that have
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socialized medicine -- i know that's a horrible word to some people, but other countries that have socialized medicine are doing a much better job taking care of their citizens that we are. it is almost like we are third world country. to know why like we're even discussing insurance. thank you a much. host: topher spiro, i will start. guest: those countries in europe , they do provide universal insurance and it's very affordable. you may likes why those systems. in general, the value of health care insurance is twofold. number 1 -- it's all about financial security. so making sure that if you half to go to the hospital and have a $100,000 thatosts it does not send you into medical bankruptcy. people before such
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episodes happen their peace of mind instance of security that they do not have to worry about if what if i have a stroke tomorrow and i cannot afford to pay for it? secondly come i think there is some evidence that insurance coverage itself helps to improve health. there are some studies that it helps to reduce mortality i think it's pretty common sense that if you provide free access to preventive care, things like mammograms,: cancer screenings screenings, that will have many effects in the future where you will start to see lower incidence of cancer and things like that. say thats safe to socialized medicine is not going to the part of the replacement plan that republicans put forward here. you talked about what needs to be in those plans. what are some of the key concepts that republicans should
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put in the replacement plan? guest: they should start from the premise that everybody in the united states should have health insurance. we do have an open system. we are not like europeans or other trading partners that have a unified government approach. because of our political history and culture, we have a different approach and it would be difficult to undo what's in place. everybody should have it could and shoul. it should be competitive not just at the insurance level but at the provider level. there should be competition the key processes down and efficiency up so that the consumer gets what they want out of the system. fromget the kind of care the place they want to get it and the doctor they want to get it. that means choice and competition need to be a big element of the structure, both at the insurance level and when they are picking their own providers. host: greenwood, missouri is next.
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jessie gets help insurance from the affordable care act. good morning. caller: i would just like to say that my aunt is able to get health insurance. she signed up this year because her husband had been working for a steel company for a long time. he recently lost his job. he lostse the plant and his health insurance, so they were able to go through the affordable care act to get the chemo she needs. it has extended her life drastically. last year she was given three months. timess made it about four as long and that's really what socialized medicine is all about. i'm just wondering with obamacare being repealed, is this going to affect urban areas more rural areas more? or is there going to be no difference? host: topher spiro, i will let you start. guest: thank you first for the story or the testimonial. i think you are starting to see
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such stories pop up all over the that has a think role in changing the public opinion that you mentioned earlier. i think that it will affect and perhapsa lot red state areas that voted for trump. one thing that trump promised was repeal and replace, not just repeal. i think a lot of people who are benefiting from the affordable care act in those areas maybe didn't believe that he would go through with repeal. that's going to be interesting politically for trump, i think. , the if it is just repeal congressional budget office looked at one of those repeal bills that was proposed by
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republicans a couple years ago. here's what they found. the reports coming out yesterday that the number of people uninsured what increased by 18 million and the first new year following enactment of the repeal bill later after the elimination of the afford will care act -- affordable care act's expansion of medicaid eligibility and of subsidies for insurance purchase through the aca marketplaces, that number would increase to 27 million, and then 32 million in 2026. premiums would increase from 20% to 25% relative to projections under the current law in the first new plan year following the enactment. that is the nonpartisan cbo with their report that came out yesterday that getting a lot of headlines. james capretta, i want to get your reaction to that cbo report. guest: as far as it goes, it is probably directionally right. i would not characterize the numbers as being exactly accurate.
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a prediction of what would happen when you repeal it may not be right either, but if you got rid of the affordable care act, the number of people without health insurance would go up. with an analysis colleague where we said if you do ever appeal without replace, in the interimse in the transition, which is what the cbo confirmed. i think they are in the ballpark of what would actually happen. that's hopefully not what's going to happen. is repeal and replace. you have leaders on all corners of the saying they are not intending to just repeal. they are talking about moving forward with a new reform plan, a new structure. there is potential here to do better. there is potential to have even more health insurance coverage . for all the talk of the afford will care act dividing insurance, there are still 29 million people without coverage.
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there was talk of universal coverage when it passed in 2010. it's not. it's also not socialized medicine. it's built around the insurance system. there is a little bit of misinformation about what happened and where we are and some of that needs to be corrected so we can say, yes, we can do better. host: several republicans taking thisitter and saying doesn't include our replacement plan. i know you wanted to talk about the cbo report. guest: that reaction you are mentioning misses a cam key point, which is what happens in the interim between the time you enact a repeal bill and the day two or three years later when that goes into effect. republicans are using this "repeal and delay" strategy to try to reassure people that we
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are going to repeal the bill but it won't go into effect for a couple of years. that will allow us time to come up with a replacement plan, which would they have had 7-8 years to come up with and still haven't. meantime is in the that the uncertainty of that, the risk of that, once you put an expiration date on the law will actually cost some insurers to flee the market. cbo's report put a number on that. country 10% of the would have not a single insurer. you start to see the effects of it pretty soon. host: we are taking your calls as we are showing you that article from "the washington times," talking about the cbo report. dave is on georgia on the line for those who get insurance through the affordable care act. caller: good morning and thank you for c-span.
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for clarification purposes, i'm retired and am on medicare. i'm speaking on behalf of my son who saw his premiums go up 500% as an unemployed person. now let's get real. the numbers should be like this. before 42% tax on every dollar made pays for universal health care. that's how other countries have attempted it. they are used to $.42 of their dollars been taken away. i really appreciate the cbo report and i appreciate capretta's explanation of the realities of it. what i see is too much. we could say let it go and explode on itself and it will implode.
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nevertheless i think we have wiser people in congress. they know that's not the way to go. that will leave virtually everybody either taxed to where they cannot have any money themselves or they want have any health care at all. i think tom price had just a little bit of tweaking in his plan. i'm sick of hearing democrats say that republicans brought nothing to the table. tom price had a good plan and just takes a little bit of tweaking to ensure just as many people at better coverage and at a cheaper rate. host: let's talk about that. capretta, let's talk about the plants brought to the table. guest: i would spo start with he speaker paul ryan and their plant called a better way health care plan.
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providing protection for people with pre-existing conditions as long as they stay , which they would do because everybody would be able to get insurance through a tax credit if they did not have employer coverage. is a structure that make sure everybody the united states can get insurance and keep it if they want to. there's also a plan directly introduced by tom price, presumably the next secretary of hhs, and senator hatch senatored a bill with richard burr from north carolina that is very similar to a better way. you can see the beginnings of a structure that they might be able to put together that has a safety net in it that provides an insurance tax credit for everybody outside the employer system, that leaves the employer system in place, but with cost discipline associated with it so we have better choices, more efficiency, and lower cost. price, weking of tom will be going to him live here on c-span when he appears for
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his confirmation hearing for secretary of health and human services. that is happening at 10:00. you can watch it on c-span and listen to it on the rea radio. those plans depend on the repeal and happening first republicans in congress going through that process through the budget reconciliation process . what can and can't be repealed from the affordable care act through the budget reconciliation process? guest: the budget reconciliation process can change anything budget related. you can change the taxes of it, the spending provisions of it, the medicaid structure, the financing of it or taxes and changes in the medicare program. all that with some exceptions, but basically all that can be done through the budget reconciliation process. they can pass it in the senate with a simple majority if they can hold the people together. on the other hand, one of the
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big lessons of 2009 in 2010 is that something that is really bipartisan and has some stability politically to it is more likely to last them something done just with a partisan vote, especially in this very contentious area. is trymmendation to them to make a bipartisan and really make a bipartisan. a lot of people say president obama tried, but he set the terms in such a way that it was very unlikely that a large number of republicans wherever going to join the bill back in 2010. host: mr. spiro, i will let you jump in. guest: on the last point, i agree with the moderate democrats. they sent a letter i think to mcconnell. we aretance was -- look, willing to work with you and a bipartisan way to improve the law, to fix any problems there are, but if you are going to rush forward with this partisan repeal basically putting a gun to our heads and taking hostage millions of american people, we
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are not going to work with you on that. that will just poison the well. i think the first step really to get to a place that jim is talking about this for republicans to take reconciliation off the table. that is what will earn goodwill and trust and help achieve a bipartisan outcome. host: let's head to virginia as we have about half an hour left with our panel. patrick, go ahead. caller: good morning, gentlemen. this is definitely a big issue. i want to preface my comments by saying i have compassion for everybody, but the problem i have is that i really don't feel health care is a right. this comes from zombie who lost her brother to cancer and has for young children. the people who are pounding the drum for this wrapped everything up and a right and i just don't think that's the case. i think we are really becoming a welfare state. we have 90 million people unemployed.
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who is this affordable for? all the business owners i know are dying and struggling. they have to closer businesses because they can afford this. kind of a red herring out there is a legal immigration. i know we don't want to talk about it, but we have how many a illegal immigrants in this country? they are getting health care. there was a sign that says we cannot refuse you no matter whether you have insurance or not. those costs are being recycled somewhere and they are going out to the people working their tails off to support their family and their offsetting the cost. who affordable for people don't have jobs, but it's not affordable for people who do. host: tougher spiro, i will let you start. guest: i think it is important the internal relation of cost. when people go uninsured to the , because we are compassionate people, we say that should be paid for. that shows up elsewhere in the system.
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making sure that everyone can afford health insurance is a way to spread those costs out and make sure that people are taking responsibility for their own .ealth care costs in exchange for that, making sure they can afford to buy insurance. color thaty hear the some of the premiums right now are out of reach. we need to do more to make the premiums more affordable, but the answer is not to throw out the baby with the bath tub. host: to those viewers who may have turned in late, we're talking with tovar sure spear -- topher spiro. james capretta is a resident fellow at the american an enterprise institute. he studies help your
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entitlements and u.s. budgetary policy as well as global trends in aging health and retirement. tom is in duluth, minnesota. he gets his health care through the affordable care act. tom, good morning. caller: yes, thank you for taking my call. don't, but my brother and a lot of family members do. i'm a veteran and usually get my v.a. through the v.a.. now i am on social security and all that. what a mess. my point is that you all talk about these tax credits and stuff and that's going to help . tell me how a tax credit is going to help a single woman with three children who is below the poverty level and a struggling to pay her rent or whatever. how are your tax credits and all this going to help her when she needs to take her kid with a 103 fever to a doctor? how are we going to fix this problem? it's the rich some of the poor,
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the black come of the white. we are all americans. i served for everybody. i didn't serve for just -- host: we were losing the call their, but do you want to start? --st: the premier premium credits are tax credits basically. the affordable care act is providing subsidization for health insurance, it's true, but they were structured tax credits. a new tax credit can be built roughly on the same structure, payable through the internal revenue service that's how they get their money. true that tax credits are not helping people. and tell the people under you for the care act. the question is can you design one even better? that is what they're going to be working on. remember when you are getting a
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refundable tax credit, even if you have zero tax liability, you essentially get a check in the mail that goes directly to your insurance company that pays for your health care. it's a way of designing something in washington that actually delivers tangible financial support to people to make sure they get health care. i think that's what the caller wants. host: is there a better way? guest: under the affordable care act, the tax credits are very targeted toward lower income and moderate income people. they are what we call income-based tax credits, based on how much income you make. under a better way or tom price is's way, those credits are flat tax credits. they we give bill gates a tax credit to buy health insurance. so there is waste at the top. since it's giving everyone, even rich people tax credits, that means there is less money to go to lower and moderate income
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people. it will be much less affordable, very meager tax credits. it's not a better way at all. wisconsins head to and clark is waiting on the line for all of this. go ahead. caller: yes, the reason why isublicans don't have a plan one. the aca is a republican concept. romney was the first one to implement it. this was never about trying to repeal it to make health care more accessible. it was about obama's legacy. that's why they don't have a plan. if it was about affordable access, they would have a plan by now. they really just want to deny him the credit for the aca.
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where are in the place something bad is going to happen during the time before they come up with a solution. firster you care to hear -- heard it here first. have a good day. host: on this issue of partisanship and the politics surrounding health, you were talking a little while ago for the need for bipartisanship in any sort of replacement package that gets put forward. i want to take viewers back to that christmas eve vote that happened back in 2009. this is the press conference that democratic leaders in the senate held after that vote where all 60 democrats joined together in passing health care reform. senator chuck schumer, now the minority leader in the senate, spoke about this issue of partisanship and his discussion of what democrats had accomplished with health care reform. this is what he said. [video clip] >> the bill can be described in a single sentence.
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st the same time, it cut costs and duplication intimate to our system and at the same time it covers 31 million people. who would've thought we could do both in the same bill? who would've thought we could do it with not a single republican vote and getting everyone of the cit 60 democratic votes? who would've thought that we could finally get a handle on the thing that is driving our budget deficit to great heights, which is health-care care costs, and at the same time do so much good by covering so many people? this is an amazing compliment. it would be under ordinary times. it's even more amazing under x-ray times. this is a happy day. mitch mcconnell said on the floor that we are going to go home and here are constituents rail against this bill. i don't believe that. i believe that the negativity leader mcconnell and others
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have continually displayed on the floor has peaked. and now when people learn what is actually in the bill and all the good it does, it's going to become more and more popular because it is good for america, good for the amerco and people, and a true symbol of what we can do if we all pull together. host: james capretta, i want to get your thoughts on looking back on that nearly seven years later. the negativity had pete is what he said in that moment after that vote. was he right? guest: no, i don't think so. [laughter] insident obama got reelected 2012 in a pretty close election, but he won a fairly sizable electoral vote. and 2014 and 2016, people who ran against the affordable care act did fairly well. i think the politics of it are than the now mona
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lordy leader was hoping -- minority leader was hoping when he said those comments. having said that, i think there's some truth to the fact that people -- when the president says they like individual elements of it even though they may hear the label, i think there is some truth to that. people need to be protected from pre-existing conditions. i think the big failing here politically and other people can disagree is that they did a great deal on the low end of the income scale. it did a lot for people with existing health care conditions, but with people working and paying on their own, there's a lot of people out there who see the premiums pretty high and the coverage pretty skimpy. i think that is driving a lot of the underlying political angst about this, even people who are actually paying for their own health care. there is a system that has been set up and it doesn't look that
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attractive, which is why the number of people who want to go into the exchanges and by their exchanges through this structure are pretty much isolated to very heavily subsidized. if people have to pay it on their own, it's not so attractive. host: as we can show our viewers that new nbc news-wall street journal poll that asked whether the health care law was a good idea or bad idea, the bad ideas the red line. you can see a dropping below the blue line at the end of 2016 and the beginning of 2017. guest: and that overall kind of polling masks some other polling , which is when you ask other people about individual provisions of the law, do you for youraving coverage dependent under age twice six? do you like protections for pre-existing conditions? do you like the medicaid expansion? those things all poll overwhelmingly favorably.
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a lot of this is just, i think, partisan opposition. all you have to do is look at mitch mcconnell's statement, which is well known by now, that to makeer one goal was president obama a one term president. his goal was not to improve life for the american people, to enact a policy. and the single goal of his caucus was to bring down president obama. host: back to the phone's. jerry is in north carolina. go ahead. caller: good morning. host: good morning, sir. caller: mr. spiro made a comment about a $100,000 operation. i wonder if you ever stopped to think that might be excessive charges by the health care providers. why isn't there more talk about
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that and what can be done about that? host: mr. spiro, go ahead. guest: it's a very good question. if you are really serious about bringing down health-care costs, we have to talk about the prices that hospitals charge. there's a lot of research lately that with all the hospital that you have concentrated markets where they have effectively a monopoly. they can charge very high prices. ultimately that is going to take something like regulation of provider prices, which is tough politically to do, but may ultimately be necessary. that can be in combination also with very strong stances on antitrust enforcement, making sure that hospitals can't merge. but the other part of it is payment reform. reforming the way we pay for
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services to make it based on quality and value rather than quantity. there on that front the affordable care act did set in motion a number of experiments that are starting to bear fruit. we are seeing a gradual expansion of new payment models. topic, seven years on, has the affordable care act done anything for clarity, transparency and health care pricing? the people know how much -- do people know how much a broken leg costs now than they did back then? guest: not much. there been minor elements. their regulatory movements to change how doctors and hospitals do their business without making it visible to the patient. i do not think there has been much transparency in the last decade. going back to the question of cost, it's a big complicated system in health care.
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you have massive money moving around in it and it will be disciplined in one of two ways. it will be disciplined through the government, which is what most countries do. the united sits is different. the place where most innovation is taking place in health care. there's a reason why we are not adopting a single-payer system. countriesese other piggyback on new developments that occur in the united states delivery system. then they buy the products in things that have been invested in through a lot of american technology. there is a real problem with the notion that we should just get rid of that and have a totally government run system because much of the promise for better health in the future is going to come from new breakthroughs, new research, new science. most of that is happening in the united states and we want it that way. host: on a totally government run system, sfr has a tweet saying that obama cares only success was its failure. it woke up americans to the
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failings of socialized medicare systems and they always fair. one more tweet -- no one should profit off the backs of the sick and dying. insurance as a for-profit enterprise needs to end. we have about 15 minutes left in the segment, taking your questions about the affordable care act and president obama's legacy in dealing with health care challenges in the country and the future of health care in the country. jim is waiting in littleton, colorado on the line for those who get their insurance to the afford care act. go ahead. caller: thank you. this whole debate really comes that obama issues has put forward and its income inequality and whether medical care is a right where privilege. it is compounded by a third issue t. it is something like 60% of our medical expenses to extend the last five years of life.
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those three competing values are what is at play here. i will briefly share my situation with you. a few years ago, grayson was on the floor and he made a statement that was very controversial that said the republican plan -- and i'm not blaming republicans but he made the point -- that the republican plan is don't get sick, but if you do die quickly. while that was very provocative, i'm one of those guys. my wife is disabled. she got medicare. we got caught in the 2008-2009 when we were uncovered, job loss, lost the house and went through the whole deal. she finally was declared disabled. medicare has now stepped in. about 70% of what comes in from that check is still used to provide her medical care and to take care of medicine and so forth.
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antibioticn is if an and a steroid won't fix me, that's it. if i was diagnosed with cancer today, my question to the doctor is not how do i fix it, it's how long can i work and stay afloat and just stay upright? at the end, what kind of medication do i need to end? because i don't have the money to go spend money on me from a medical standpoint. this is not a woe is me story . there are not enough money to pay for both of us in this situation medically. that is the choice that we make in america today. whether we care about that, maybe we don't. i am not the only person in that position. i thank you for your time. host: mr. spiro, i will let you start. guest: you're not the only person. thank you very much for sharing your story.
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he is not the only person. he is right about that. i will put a plug in for a website at aca you can go there if you have got a story of how you are benefiting from the affordable care act and submit your story could we have collected over 3000 stories since thanksgiving. they have been flooding in. the one thing i have been struck thoselooking through stories is that there is a large number of stories similar to the gentleman's where people are disabled but do not yet qualify for medicare because there is a gap. the affordable care act is really filling a gap for those people. host: what do you want to do with those stories? guest: we want to get them out to the media. we have had some of our stories featured in "the new york times." there was one on "nbc nightly news" last night. they have been attending rallies yesterday.
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today we are bringing them up to the hill to meet with hopefully republican senators. we will see if they let us in. we would love to have them on c-span. host: james capretta, your thoughts on the story. guest: humidity couple interesting points. -- he made a couple of interesting points. the question on whether health care is a privilege or right, i am one who believes that the right. it's a human right. people should be taken care of when they need medical care. there's only so much you can get from just saying that. what do you get? what does society owe you and what are your response abilities? i'm not saying that people are completely without any options. i think society needs to help, but overall, we have to have some balance of what people need to do and what the government can do. the question is how to strike that in a way everybody can agree to overtime. furthermore, i would say on this question of income inequality versus growth.
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our big problem in the united states is growth. there istension -- huge tension over not being able to pay for things and not getting ahead and falling behind. it is all related to income stagnation and lack of robust economic growth. that's really the fundamental problem. if we were growing at 3% or 4% a year, i will guarantee you the feelings of being lost and falling behind that are so prevalent would not be so prevalent. host: time for a few more calls. lynn is in chattanooga, tennessee. good morning. caller: good morning to you. i am on medicare. i have one question for you. the people that get obamacare, how many of those run medicaid? -- are on medicaid? guest: it's about half of the newly covered people are people who are part of the medicaid
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expansion. it could be a lot more if republican governors would be expanding medicaid programs in their states. host: go ahead. caller: i happen to be in one of the states that didn't and we have what is called 10 care. the 10 care works just like the social security, i think. i am looking at a statement i got for medicare. my doctor's visit was $147. medicare approved $68.52 of that. $.72 -- $53 ofnd the two cents of that $147. medicare is a wonderful thing if you can find a doctor who will take it. if you need a specialist, you better find some money to pull out the difference. makes a goodller point on how many people on the formal care act whose coverage expansion was in medicaid.
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i think carefully to this are between show that about 2013 and 2015, according to the census bureau, about 13 million people got insurance. additional people got it in 2016. a good portion of what is going on is in medicaid. it may not be asked, but it may be more like 60% or 70% of the people who got new insurance in the world -- enrollment was in the medicaid program. it's relatively small, especially relative to the size of our country. you're talking about 1-3% of the whole population. i think we need to keep it somewhat in perspective. with respect to medicare, the caller makes a good point also .bout medicare is paying if a physician wants to participate in medicare, they accept the rates and full most of the time. that means there's an obligation
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to try to make sure you do not bring those rates too low, because if you do, some physicians are going to stop serving the population. we see that already in medicaid. we have to be careful thinking we can just cover everybody with an insurance plan and how the government just lower the price to some low nominal amount. if you do that, you have access problems. host: do you want to follow up? guest: i agree that payment rates are too low under medicaid, but the solution is not what the republicans are proposing. they are proposing block grants that would grow very slowly over time. they would end up being a drastic cut in medicaid funding for states that would otherwise occur. that is not going to leave states in a position where they can increase payment rates. they're going to have to cut rates even more. you will see even more access problems. host: about five minutes left in the segment and about an hour
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and five minutes until the confirmation hearing begins for congressman tom price, who is up for health and human services secretary. that is beginning at 10:00. you can watch it here on c-span. we will be going live to eight at 10:00 and it will also be on and c-span radio. headline from "the washington times" this morning -- tom price's stock trades are raising our hurdle through his hhs confirmation, noting that the congress been issued into the top of list of most embattled trump nominees ahead of his confirmation hearing, as democrats accused him of ethical be usedsaying he may his position in congress to enrich himself. the trump transition team says price did nothing wrong and made the trades as part of a larger portfolio. we want to get your thoughts on what you expect from this confirmation hearing today, starting with you, mr. prather. -- james capretta. guest: i have no idea.
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i don't know anything about that situation to be able to comment on it. i don't know the ins and outs of it to comment on it. i would say that a newly elected president, most of the time, their nominees for cabinet positions get through even though there might be rocky moments along the way. i expect that to be the case, but i could be surprised. host: tougher spiro? guest: we have already called on tom price to withdraw his nomination based on these reports. it is clear that there is some level of corruption going on. if you compare with senator daschle and the way he was treated, also in hhs nominee of obama, who had to withdraw his nomination, he withdrew his nomination for not taking -- paying taxes on a car and driver. there was no actual corruption going on. this is actual corruption. this is not draining the swamp. i expect that more and more democrats will come out saying
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you need to withdraw your nomination. host: we will see starting in hour.bout an let's get one or two more calls in this segment. ed is waiting in jackson, tennessee. go ahead. caller: first of all, if you read the preamble to the constitution, health care should be a right. talked about $.33 of every dollar is wasted in our health care and the third or fourth leading cause of death are medical errors. we spent more than any other country in the world. not everybody is covered. look how many deaths and preventions we could occur. says here a hundred billion dollars is wasted on unnecessary services. i mean, it's ridiculous. $.33 of every dollar at a $3 trillion -- and they talk about balancing the budget. this talked about all
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this money wasted it in our health care? makes a goodller point, but president obama and his team have been in place now for eight years. if there is lots of massive waste in the health care system, there is stuff that they could of done while they were there. it's difficult and it's not always easy to identify what's going to be a useful service versus what is going to be a wasteful service. if you would know that an advance, you would stop it. often times, you are in a system where is complex, confused, and not very well organized. so yeah, a lot of things are being done that probably don't need to be done. guest: i guess i would disagree that obama has not done anything about it. i think under the informal care affordable care act you have seen rates that have brought down the rates of hospital readmissions, which are costly. yet have seen enforcement against fraud in medicaid.
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you have seen insurance companies with what is called a medical loss ratio, which basically limits the amount of administrative costs and profits that insurance companies can keep. onakes them spend more benefits. there have been a number of things done in the affordable care act and administratively, which is not to say that we shouldn't keep doing more. there is still a problem there and we should keep moving in the direction we are going. host: let's get tom in from new jersey. he gets his insurance through the afford will care act. go ahead. caller: i'm recently divorced and my ex-wife was a teacher. she gets incredible benefits from the new jersey education association. i recently had to purchase my own plan. fairly expensive from the affordable care act.
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after i getlls even fairly expensive coverage. actually there is no option for me to be able to get similar care as she did. therequestion is this -- are only over 100,000 teachers in new jersey yet they get basically the best type of care possible. there are over 11 million subscribers in the afford will care act and yet we cannot get the same level of care. with so many taxes being paid, federal, state, and city, how come we cannot roll out the same level of care that teachers get to everyone? host: mr. spiro, do you want to start? guest: i think the first point is just a note that the importance of unions in getting good benefits for their workers. that has been something that has been very important historically
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did with declining union membership, we have seen some of the safety net frankfurt middle-class workers -- fraying for middle-class workers, which has perhaps lead to the frustrations that led to the rise of trump in some of these areas. the second point is just a note that the affordable care act is not perfect, but it did make very important improvements and insurance coverage. before the affordable care act, insurers often did not cover prescription drugs. they did not cover maternity care. they do not cover mental health care. all those things are now covered by the afford will care act plans -- affordable care act plans. before the affordable care act, on average, plans only covered about 60% of your health care costs. and now the average is closer to 75%. out-of-pocketer costs for consumers.
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the affordable care act prohibited lifetime limits and annual limits on payouts by insurance companies. most importantly, it put in catastrophic protection. it limits the total out-of-pocket cost that you have to pay. host: you get the last 60 seconds in the segment. guest: there has been improvements in these areas, but the reason why that caller ends up paying more than the other people with health care plans by employers is that employers are putting in more money. it is probably a more generous plan in large part because the employer is paying. i think people should understand when an employer pays for health care, it is generally coming out of the worker salary. they get less of a cash benefit and a higher health care benefit . when you have expensive health care, it is contributing really to wage growth as well.
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there's a lot of studies that document this. we need to get a handle on the pace of rising costs and it comes through the discipline of rising mechanisms. that that will be a central focus with the replacement. you can see more work >> c-span's washington journal live every day. news and policy issues that impact you. coming up, economic policy institute research and policy and the codirector will discuss the economic policy of the obama administration and the impact it has had on job creation, unemployment, wages and federal debt.
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be sure to watch c-span's washington journal live at 7:00 a.m. eastern on thursday morning. lastesident obama held his news conference. that is next. tom price testified on capitol hill and was asked about the affordable care act and his personal top -- personal stock holdings. >> sean spicer holds a briefing with reporters as the incoming press secretary. we will have live coverage tomorrow at 9:00 a.m. eastern on c-span3. part ofd pence will be a replaying ceremony at arlington national cemetery that starts at 2:00 -- at 2:45 eastern. live coverage here on c-span.
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♪ ♪ >> the presidential inauguration of donald trump is friday. c-span will have live coverage all day. watch live on c-span and and also live on the free c-span radio app. ♪ now president obama gives his final press conference. he spoke about his future plans, friday's inauguration and his decision to commute the sentence of chelsea manning. >> president obama spoke to donald trump as earl


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