tv Washington Journal Noam Levey Discusses the Future of the Affordable Care... CSPAN September 17, 2017 2:01am-2:31am EDT
shredding documents, isn't it? see you can later say you didn't remember. >> the reason for shredding documents and the reason the government of the united states gave me a shredder, i mean, i didn't buy it myself, was to destroy documents that were no longer relevant, that did not apply or should to be divulged. ask for the past 30 years, the video library is your free politics and public affairs. whether it happened 30 years or 30 minutes ago, find it in c-span's video library at c-span.org. c-span, where history unfolds daily. now, a discussion on congressional have come proposals on the future of the affordable care act. this is about 30 minutes. continues. host: our guest is known leave the.
-- naoam leavy. want to do an update on the affordable care act. we wanted to start with the chairman of the senate health committee, lamar alexander. he has been holding a series of hearings. here is the senator talking about the goal. [video clip] >> our goal is to come up with in a census -- consensus early next week. hopefully we can have senator mcconnell an agreement congress can pass by the end of the month that will limit premium increases next year and begin to lower premiums after that and prevent insurers from leaving the market. that is our schedule. what happens if we don't succeed? last year, or percent of american counties had one insurance company on the
exchange. this year 36% have one insurer. of counties half will have one or zero counties on the exchange. we have heard from state insurance commissioners that this monopoly in so many .ounties drives up premiums without cost-sharing reductions, the congressional budget office, the joint committee on taxation, and as our witnesses have said, premiums will increase 20% in 2018. host: four hearings by the committee, what did it learn, and what contours are materializing? guest: first of all, it is important to take note of how remarkable these hearings are.
if you don't follow the ins and outs of health-care regulation, this was not must see tv. if you do, it was. congress has a productive discussion about health care reform. senator alexander and patty mori of washington are talking about passing a limited set of steps that can help control health insurance premiums for the subset of americans who buy health insurance on their own. they do not get it from an employer or government program. host: so much of the conversation recently had to do with 51 votes versus 60 votes. what would be the threshold on this bill? this is presumably a 60 vote threshold. this is regular order. we've heard a lot about that in the original obamacare debate.
this is using the committee process to develop legislation, taking testimony from a wide range of stakeholders, and then crafting the bill to take to the senate bill where it would be subject to a filibuster. host: explain the concept of doing this by the end of the month. why is that important? by the end of the month health insurers have to finalize rates for the federal health insurance market place. a lot of health insurers haven't struggling in this marketplace -- have been struggling in this marketplace. this has been a rocky road. that will not surprise many of your viewers. the thing that has added uncertainty is the trump administration rather famously or notoriously threatening to let these markets collapse.
the administration has taken a number of steps that are seen as destabilizing, including refusing to commit to paying these cost-sharing reduction payments, which are of federal funding stream that reimburses insurers for lowering out-of-pocket costs. that has caused insurers around the country to say we have to increase premiums to account for this uncertainty. host: questions or comments for our guest, you can send a tweet, and phone numbers for democrats and republicans and independents. if you're interested in watching those hearings, you can watch them at c-span.org. maybe not must see watching, but to us it is. here is susan on the line from new jersey, democratic caller. good morning. caller: good morning.
usingently started medicare. i cannot tell you how surprised i was about what i go to a doctor's office, they say to me, is that all you have? yes, that is all i have. hello? host: you are on the air. keep going. caller: that is all i have. medicarent to see part d, i cannot believe how much this is. i don't know what it is, but i called the medicare people up, and you can filter things through who takes your medicare or they take partial. i called these doctors up, and they said it is not really -- you still have to pay. i called medicare, and they said that is not really what it is what you see on the computer.
is this going to be told to the bigle that there is a behind medicare part d? i am sure it is going to go up. it has to be discussed because people have to be aware that they think they are getting this medicare, and they are not. thanks. host: thank you for calling. guest: i think a lot of people are surprised to learn medicare is not always as generous program as most people think. most people on medicare by supplemental health insurance because medicare requires a fair amount of cost-sharing for beneficiaries if they don't have a supplemental plan. that is one of the complexities of senator bernie sanders medicare for all proposal and worries some of those who have talked about this historically.
his plan is more generous for this very reason. host: we share a clip from senator bernie sanders earlier this week. [video clip] >> the strength of a medicare for all program is not only universality and cost-effectiveness, but also the complexity of the system which adds enormous stress at a time when people needed the least. today we say to those families in vermont and wisconsin and california and across this 10, 15,who are spending $20,000 a year on health insurance that we understand that this is insane and unaffordable to be spending that much money simply to protect the well-being of your family. familiesre to tell us and people across this country that under medicare for all, the
average american family will be much better off financially than under the current system because you will no longer be writing checks to private insurance companies. host: what kind of reception did senator sanders get? guest: i think it was predictable. folks on the left have been talking about medicare for all, a single-payer solution to health care for decades. senator sanders speaks very clearly to that wish. on that, i think he is reflecting a growing amount of frustration around the country, not just on the far left that has traditionally embraced single-payer health care, but shared across the political spectrum about the amount of money americans are being asked to pay for health care. $10,000,000, deductibles for families and
extreme weights -- waits. that said, it drew datable criticism from folks on the right and folks within the health care system, it would be an expensive change. host: let's hear from matt in philadelphia. democratic line. guest: good morning -- caller: good morning. i think this whole thing is a little puzzling. we have the republican party during obamacare that did nothing more than sabotage obamacare, make it allegedly fail. now we have the republicans in control, and what do they want to do? they want to repair obamacare because they could not repeal it. another thing is how do you think anything that comes out of the senate is going to fail in the house with the freedom
caucus and these other people? the republican party does not care if people in this country have health care, bottom line. if you can afford health care, you get it, if you cannot, too bad. host: mr. levey. there is clearly a partisan divide over the obamacare. it remains. as we talked about earlier, one of the interesting things in the senate now is the fact that there is recognition by some republicans that the strategy the party has pursued, which is all or nothing, we need to get rid of obamacare, sweep it from the legislative books, get rid of this monstrosity. there is the recognition on the part of some legislators that that was unrealistic and ahistorical. that is not the way our system has worked.
people work to change legislation to move the left or right depending on their political views. there is some hope that there might be a breakthrough on this. on the other hand, the gop has been promising to get rid of obamacare four years. .hat impulse remains strong host: sen. cassidy: louisiana says he is close to having the votes for an obamacare repeal. how significant is the support for what he is putting out there? what is he putting out there? guest: he is proposing something that is more radical than the repeal bill the senate have a house republicans debated for much of this year. in broad strokes what sen. cassidy: senator graham are proposing is to shift hundreds of billions of dollars in federal assistance that
currently goes to states and individuals who get health insurance, shift that all to states and give states broad authority to redesign their health care system. i don't think it is hyperbole to say that this would be the largest change in federal financing for states in at least half a century, not just for health care. it is a very sweeping proposal. it is one that just emerged a couple days ago. we are waiting on a congressional budget office evaluation of it. said he hasdy has nearly 50 votes. the last few votes have been problems for republicans all year. so that is not surprising in some ways. the wrinkle is republicans in the senate only have until the end of september, two weeks, before the budget authorization.
they have to pass this through reconciliation with the lower threshold expires. if sen. cassidy: cannot get this enormous bill through the senate and house by september 30, republicans have to start all over again. twitter, trump will not sign an obamacare repeal without replacement. don't tell me on this. you are on with noam leavy. good morning. i don't get the doctors care i need because i am on i am very told from doctors that the state or government will not pay for surgery that i need.
i feel like i have no health care at all with medicaid and everything else. it is ridiculous. i have gone to several different doctors, and they have told me i need surgery done on my neck. i cannot get the surgery done on my neck because the doctors say we not going to get paid for. -- for it. i would like answers. this is ridiculous. i am on disability. i cannot afford to pay for the surgery. it is ridiculous. thank you. host: thank you for calling. races an important issue, vis-a-vis not just medicaid but medicare and
private insurance. many of us probably have had the experience where we think we get something with our insurance and it is not what we thought. medicaid historically has paid less, doctors and hospitals less, then other health thatance programs could has created problems in some states for accessing medical care for people on medicaid. that has fed some of the criticism of the program. i don't know the specifics of tim's situation. i will say medicaid at the same time is more popular than many people realize. most people on medicaid are quite satisfied. it is a challenge for states and the federal government when we talk about how to make the system better is how to build a system that is affordable to
taxpayers and that the same time pays physicians and hospitals a sufficient amount of money that they will agree to take these patients. this is a balancing act that we have been trying to strike for decades, and it continues to be a challenge. host: the u.s. census bureau has no numbers on health care. i want to get your perspective. in terms of who has health care, 91.2% of americans have health insurance. 37% have government coverage. numbers, willse perspective would you add? guest: it is worth noting that we don't appreciate often enough how remarkable coverage expansion has been since 2014. the affordable care act has helped 20 million previously uninsured americans get health insurance.
the rate of uninsurance in this country has never been lower. that is a substantial change and accomplishment and one that is undervalued. there is an increasing amount of data that shows that increase in coverage is consequently leading to better access for people, particularly lower-income people. we are beginning to see some evidence that is actually leading to better health, which is what we want presumably as a country. slowed in the last year or two, reflecting probably a number of things, not least of which is that the expansion in states that have not extended medicaid programs through the law have slowed. there are a lot of big states that are not expanding coverage, florida and texas. and there is continued
uncertainty about what will happen to these marketplaces. whether those gains in coverage will continue is unclear at this point. you probably cannot get much below 5%. there are still millions of people who cannot get coverage. host: kathleen in florida. good morning. caller: good morning. i don't understand what the great opposition is to hmos. i have been a member of an hmo long before i was eligible for medicare. i stayed with them. people argued about you don't have the same doctor. i have had the same doctor for 15 years. what is the opposition to hmos? i don't understand it. the care i have done is supper -
- superb. i have never had a problem when i needed a referral. i don't understand why people cannotat when they afford premium care or goal level care, they are entitled to it. i don't understand. i don't understand why our clinics have stopped operating. when i was a nurse clinics where the backbone of health care for most people. i just wonder why. host: thanks. guest: kathleen raises an interesting issue, which is in some ways more important than the political fight over health insurance, which is what is the best way for us to get health care in a way that is responsive. the hmo model was very popular for a number of years. there was a big backlash against
hmos 20 years ago in the 90's in part because these systems of limiting the network of physicians and hospitals were not seen as beneficial to patients. there are a lot of good hmos out there. there are a lot of good systems that are being created around the country that allow personalized care and allow patients to communicate with their doctors. i would argue that is probably where we are going as a country as we talk about how to control costs, how to get people feeling like the health care system is working. i don't know what kathleen's hmo is. it is a system that makes patients feel like they are being taken care of, not surprised by medical bills. host: time for a few more calls.
maddy on the line with no leavy. like the man that called in about medicare that you get with social security, they are going to take away social security. what did they do with all of our money that we worked 25 years for? if they managed that money right, we would not have to be worried. it is not an entitlement. we earned four. we pay for it. earned it. we paid for it. you either keep your lights on or go to the doctor. i am a real that diabetic, --
bad diabetic and almost died in intensive care because i cannot afford buying medicine. i guess the system is right. they don't want you to draw social security too long. they won't link you'd starve to death or die for not getting the medical help when you need it. host: thanks for calling. guest: health care in this country -- medical care in this country so expensive that people like maddy and you and i that are paying our taxes every year, we may have the expectation that what we pay in we will get out after we retire, but the fact is that no matter how much you or i in inayroll taxes -- pay payroll taxes, we will probably spend more.
this is why medicare is not sustainable in its current format. this gets to the issue we were having talking about hmos, which is if we cannot control how much medical care costs, how much prescription drugs cost how much it costs if we ever end up in the emergency room, those underlying medical costs, that drives up the cost of medicare and private health insurance. someone once told me complaining about how much health insurance complaining at the gas station how much gas costs. we assume there are some problems somewhere upstream. in the same way, medical care is so expensive in this country that it is driving everything else. that is the discussion we are not having. host: and richards from
connecticut. thank you. caller: good morning. enacted view that obama affordable care in order to get to single-payer, and that residents like obama and sanders that are willing to pay tens of billions of dollars of taxpayer dollars to create the chaos we have now and ending up with the only viable system left is the single-payer system. host: perspective there. guest: i don't think that is accurate, frankly. i can tell you that having spoken with any number of obama administration officials as well as architects of the affordable care act, none of them wanted the chaos that has followed the enactment of that law. it is true that i think president obama and a lot of democrats would prefer a single
payer system. i don't think the affordable care act was designed to get there. the affordable care act was designed to address a specific and serious problem, which this country faced, which was 50 million americans who did not have health insurance. americans that didn't have health insurance. let's figure out, another way to get there. we were left with the affordable care act with all its flaws. just about out of time but i wanted to ask you about the children's health program which is expiring soon as well. what is the chip program and what is the status? was created 20 years ago by president clinton in a compromise with a republican insurance forvive children from low income families who made a little too
much to qualify for medicaid but could not afford traditional insurance. strong bipartisan support but it needs to be reauthorized periodically. the deadline for that federal reauthorization is the end of september. some 8 million kids around the country rely on this program administered to the state. the federal government has to act to get the money to the states. there is rising anxiety and states throughout the country, congress is months overdue. there is hopeful movement in the senate finance committee that they have an agreement but time is short. a national healthcare reporter for the l.a. times, you >> c-span's "washington journal" live every day with news and policy issues that impact you. coming up sunday morning, andrew
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