tv Washington Journal Andy Slavitt Discusses the Future of Medicare and... CSPAN March 13, 2017 8:03am-8:50am EDT
of sitting on decisions for six months to year before they have to make decisions. watch the communicators tonight at 8:00 eastern on c-span2. >> washington journal continues. we are joined by andy slavitt, former acting director of the centers for medicare and medicaid services. he had in that organization until the obama presidency. thank you for joining us as we talk about the republican efforts to bring a new health before the congress. let's focus on medicare and medicaid. a piece in the wall street journal over the weekend said medicare would become a block grant tied to the size of each
state's medicaid population beginning in 2020. a big shift from the current approach. tell us what medicaid's current approach is and how you see the changes republicans are proposing. i think that's probably longost significant and lasting change in this proposed legislation. the way medicaid works today is a state will essentially be funded according to the needs of the state. epidemic,e an opioid ,eeds and concerns in the state the medicaid program is a partnership funded by the federal government and states. it gives you rough parameters. half of the births in this country are financed by medicaid. about 45% of medicaid taking care of people with
disabilities. it's a program that many americans depend on. what they are proposing to do now is instead of funding those and fixedut a cap amount based on the number of beneficiaries in the state and say this is the amount of money the federal government is going to provide and the rest is going to be up to the state. or if the state doesn't have the resources, up to the individual. you were with the organization that is responsible for administering these programs. guest: those programs as well as the affordable care act. children's health insurance program and also the marketplace exchanges. host: let's take a look at the numbers. just a baseline of where we were in june of 2016 with 71 point one million people covered under
medicaid. of adultss expansion under the affordable care act, 9.5 million. the care coverage as of june last year some 56.5 million people. nearly 38 million with original medicare. , 41prescription drug million. and the medicare advantage and other health plan enrollment, 18.9 million. the expansion of medicare and medicaid, the total numbers under the affordable care act was what? guest: probably 120 million people that are covered by which wered medicaid the original promises made to the country in 1965. i think this will probably amaze your listeners because it amazes me. in 1965 before medicare and medicaid, one in three seniors
lived in poverty. since those programs have come to bear and the promise has been made, that is less than one in 10. guest this morning, andy slavitt. former director for the center of medicare and medicaid services. we are talking about the effect of the republicans plan on medicare and medicaid. (202) 748-8000 for democrats. republicans.1 and) 748-8002 independents others. let us know if you are on medicare or medicaid or how you are getting your health insurance. talkingington post about the size of the spending in medicaid services. medicaid represents one dollar in every six the nation spends accounts care but it for 50% of spending on long-term care such as nursing homes in
the united states and 9% of the prescriptiveations -- prescription drug spending. that's quite a big chunk. guest: that's right. most of us tend to think of medicaid as a program that serves the lower income population. we forget that for half of us when it comes time to plan our long-term care for ourselves, medicaid is picking up the bill. a healthy medicaid is something american families are very dependent on. host: we go to our independent or.e to hear from tib you are on the air. medicaid am in the age. i'm past 65. much talk isat so about comparing america to other countries like canada or europe
and there was only one candidate in the election who advocated that there should be a medicare for all. itpredict it that in the end would be medicare for all. --t is amazing to me is that here is an example. we had medicare and yet the politicians are not analyzing. neither the democrats nor the republicans are analyzing what does medicare show us? think it medicare was for all, a lot of the problems would just disappear. for example the age discrimination for children being on the parents. it would disappear. the precondition issue would disappear if it was medicare for all. it's amazing to me that all of this discussion over the years has ignored the analysis of the
medicare which is an american are not payingwe attention. not analyzing its success. host: andy slavitt. guest: that's a really great call and important point. it reflects a lot of people's thinking. not so much about medicare for all so much as when you talk to people over 65 you hear how satisfied they are with the program. i think the satisfaction rates are over 85%. it's a promise that people live through their career and their lives. there's a lot of uncertainty about health care. once they turn 65 medicare has been there for people. added a dozen years to the medicare trust fund. the proposal we are looking at now from congress shortens the
medicare trust funds life to 2025 which is something that should make us all a bit nervous. it is such a vital program. host: andy slavitt, former director for the center for medicare and medicaid services under the obama administration. you have run health care organizations in the past. decades inent couple the private sector and i ended up doing government service in 2015 as part of the effort to turn around the aca implementation when it was going poorly in 2013. i came in as an outsider and was asked to leave the whole effort. host: how hard is it for organizations like the one you may have worked for seeing in 2010 and potential major changes again in 2017?
how hard is that for their business models? that's a great question and people don't ask that question enough. industryh care represents about 1/6 of the u.s. economy. it employs one of the major drivers of employment across the economy and small towns and hospitals and nursing homes. it's an industry that doesn't take well to shocks. when it gets shocked i think it is safe to say the u.s. economy gets shocked with it. we have gone through our largest period of private-sector job growth. right now we are dealing with uncertainty. about how the laws are going to work, whether people are going to have access to coverage, whether it's going to drive up
bad debt for hospitals. i think it throws a little bit for hospital systems and communities and organizations that have to plan and budget based on a set of assumptions that they don't know if they are going to be true any longer. this uncertainty is a big challenge. i think the adjustment time period is easily several years before people really are able to move their businesses forward. int: let's hear from marie richmond, virginia. republican line. good morning. good morning. i'm just calling to ask him if he knows, why is medicaid is possible for births? for paying for them? why is the individual not responsible for that? ok.t:
pay forvery few people their health care directly out of their own pocket. maybe only 10% of the time are people paying. to deliver a baby if all goes well may cost $10,000. if you end up needing a cesarean section it could cost $15,000 or $20,000. if something goes wrong and you have to have a premature baby, it costs hundreds of thousands if not $1 million. the purpose of our insurance system where it is private or public is to help people manage those costs by spreading them out over many other people. most people couldn't afford to have children if it wasn't covered by insurance. thankfully we have programs that help make sure that not only for the mother and the family that we have healthy children and
healthy communities and pay for those costs. i think it's a great thing for our country. host: approximately how many pregnancies are covered annually by medicaid? guest: i couldn't tell you the number but i can tell you percentagewise you have about half of all births and i think it varies by state are covered by the medicaid program. that differs by state and there's all kinds of very terrific and innovative programs that states run to help deliver healthy children. pride that the great a lot of states have with their medicaid program. host: jonathan is in iowa city on the independent line. i am an adjunct faculty
and recently my health care lapsed. uninsured and pursuing medicaid right now. my question for the guest is if you could briefly sketch the differences between medicaid and medicare for listeners who have been unsure. and maybe speak to some of the strategies for reducing the cost because the cost seems to be the central problem. we know that we need to provide health care for people who are in need of it but strategies for reducing costs. thank you very much. host: andy slavitt, did you. his question? guest: i did. it's a great question. that is by a program and large for two sets of individuals. people when they reach the age of 65 and people who are living
with disabilities. formedicaid program is several groups of individuals. children, families, low income adults in certain states as well as people who are age blind and disabled. and there is. people who get their care paid for by both programs. they tend to work just like insurance programs. about three quarters of medicaid today is covered by a private insurance company. sot of a managed care plan the difference isn't really felt by the individual. the second question is a really important one. it's one that we really grapple with as a country. how do we manage the long-term costs of health care? it's one of the greatest obligations that we have and the
costs have been growing at fairly significant rates. under the bush administration those costs through at about 6% per capita and during the obama years we had a period of lower growth. costs grew at 1.7%. there are starting to tick up a little bit now. what keeps those costs down? we have to look at things like prescription drug costs. the cost of hospital stays. how do we make sure we are getting value for what we pay for as a country? it's very important that we begin to pay for outcomes. that we don't just pay for more and more services. that's one of the big changes going on around the country today. people are changing how hospitals and doctors get paid
so they can get paid a little more for doing what works and it don't get paid for doing things that don't work. that's a mindset shift that we are beginning to have. medicare is leading the way. it's a long journey. takes a while for people in the health-care system to change because it is such a geographically dispersed industry. host: paul ryan laid out his case for the health care plan last week. i wanted to get your reaction to the speaker's comments on the trouble he finds with the affordable care act when it comes to medicaid. here's what he had to say. >> here's another issue with obama care. it's not just the individual market. of thealso taking over medicaid program. here's the problem with medicaid. medicaid is a program that is washington controlled and it is done in such a way that it stops
innovation and experimentation at the state level. it makes it harder for states to customize the medicaid population to work for their particular state. as a result more and more doctors just don't take medicaid. what good is your coverage if you can't get a doctor? medicaid is also growing at an sustainable rate. ballooning costs are threatening the viability of the program and our fiscal future. we propose to modernize the medicaid program along the lines we have been talking about for years. i think it was ronald reagan in like a 70's when he was governor who said the states should take over control of medicaid. had asudget we have republicans, when i was budget chair every one of our republican budgets said let's get medicaid control back to the states. give the states and the
governors the freedom and flexibility to customize the care for their low income populations. our problems in wisconsin are a whole lot different than the problems they have been new york or nevada or utah or california. during the spending on medicaid to something that is sustainable so it doesn't go bankrupt and have a safety net for the most vulnerable. give local control to states and governors so they can customize medicaid to work for their populations. host: andy slavitt. what did you. the speakers comments? it's important to listen to what speaker ryan said and take it apart and see what he is really saying. it sounds common sense. a lot of it just isn't the case. one, he questioned state ability to innovate.
i think he is making a comparison that all of health care is run out of washington. that's not true. all of health care and medicaid is driven by the states. if he actually picked up the phone and called vice president when he wasuld hear governor of indiana, indiana did some very innovative things very specific to indiana as has tennessee, arizona, california. inre is absolutely nothing the way medicaid is structured that doesn't allow it to be driven by the states and i expect that to continue. what he is really saying when he says he wants to "modernize" medicaid, what he wants to thely is cap and cut program so he can relieve the federal government of additional burden. another word for that would be rationing. if there are additional expenses in the state like an opioid epidemic or zika or many of the
things that confronted us and confront us routinely, the federal government would provide no more money to the state and the state would be in the position of saying, i've got to decide how to cut care. of babies,e delivery do i cut the seniors for long-term care, do i cut care for people with disabilities? it really draws a very hard line. we have never done that in this country. medicare and medicaid have been a promise to individuals and families that if they need them they would be there. he says the costs are growing at an unsustainable rate. costs and medicaid are actually lower than they are in medicare. they are lower than they are for commercial insurance and they grow at a lower rate. medicaid is actually a highly efficient program. driventhe innovation is by the states. what i think the speaker is really saying is, we want to eat
-- we want to cap the federal government's obligation. there's a belief that if you do that, states will somehow get more efficient. to get efficient on the backs of the commitment we have made to take care of people i think is the question we ought to wrestle with when we look at this bill. host: some twitter reaction to the speakers comments. george tweeting my question to arrive, what good is your doctor if you have no insurance under his plan? in my county medicaid spending takes $.70 of every dollar and leaves little for anything else. this one saying, no surprise, the dominant red states love those federal subsidies to do with as they choose matter how ineffective. here is bernice on the republican line. caller: good morning. i am on medicare since 2003.
i had surgery on my back that was a failure. -- and i was. i only take two medications. both of them are pain medications. unfortunately one of them is oxycodone, which is getting terrible press right now because of people that are abusing it. there are millions of patients that do not abuse this drug. i would not be able to get out of the bed or have any type of functioning life without this medication. and now medicare has decided not to pay for this medicine. they have always paid for it. refilledwhen i prescription i was told no. who made that decision? i was told by my pharmacist that it was a bureaucrat, not a position that made the decision. me who makes the
decision on what medicines you pay for? guest: i awfully sorry to hear about your surgery and your back. broader -- as a country, we have two problems to deal with. we have people who live in chronic pain and for anybody who has lived in chronic pain, that's a really horrible circumstance. anything that we have to do as a country is let -- make sure we help people. prescription opioids work for some people. we also have learned from the cdc that prescription opioids are far more addictive than we in somew and in fact cases people dealing with pain
take prescription opioids and end up worse off than they did before. i'm not suggesting that is the situation with this caller. it is something there is a new awareness of and physicians are toing a greater reluctance prescribe prescription opioids for minor kinds of pain that can be dealt with in other fashions. i can assure you that the medicare program does not make decisions. pharmacists, if there are new or experimental or other kinds of new there are private companies. not the government, private companies that the government contracts with. there are medical directors that
help make those decisions. there is nobody sitting in washington getting involved in people's health care decisions. nor should there be nor is there a loud -- that allowed. in charlottesville, virginia on the democrat line. caller: good morning. thanks for being here with us. i paid into social security for 48 years. 30 plus years of that working as an electrician. two shot knees and my shoulders have gone out and a bad hand. i have had to go on full disability. i am living currently below the poverty level. i'm just wondering if they decide they are going to cut medicare and medicaid, where's that going to leave people like us that worked all our life who were promised this and then you get the rug pulled out from under you? angry much -- thank you very much. guest: thank you for the call.
best with your health and your recovery. caller'say that the question represents exactly the type of concerned that i hope speaker ryan as well as all of the elected representatives really listen to and understand. because when we say we have a medicaid program that we want to cap, what that means is the state of virginia in this case would be getting a select amount of money. and if people like this caller's medicare increased what the -- medical care increased beyond itt is officiated, then doesn't come at all and it becomes incumbent upon the individual to decide how they're going to pay for whatever care they need. way of working. that's a different way than our
medicaid program has ever worked going back to 1965. while we are looking for fiscal balance and it's important that we have efficient programs, i would argue the medicaid program is highly efficient and people who are dependent on it don't have a lot of other choices. it's not as if they are sitting back saying, i could spend all of this money that i have that i was going to use for some other purpose. we know that because before the affordable care act medical bills were the leading cause of personal bankruptcy. fearow that people live in of a big medical bill. they are not cheap when somebody needs the kind of surgery or treatment for cancer or heart condition or prescription drugs that people like your caller have. has beenaid program able to be efficient and effective in taking care of people. host: about 15 more minutes with
andy slavitt. talking about proposed changes in the medicaid program under the proposal by house republicans. recap what republicans in the house have proposed so far, what their legislation would do. it would phase out the affordable care act expansion of medicaid. states would receive extra funding only for people who were enrolled before 2020. once those beneficiaries leave, hire funding ends. the proposal would end the open-ended match states receive for all other medicaid beneficiaries and states would receive instead a set amount of money based on the number of 2016 and rowley's. what is so important about this 2020 date? guest: let me make sure to complete what you said.
this billrt of opposed by the republicans are really a couple of big things. credits andto tax to the medicaid program which i think we'll hit millions of people and make health care more expensive for millions of people. what's happening on the other end there is a $600 billion tax cut. early to people who are making over $250,000 a year. the ghost insurance companies, pharmaceutical companies, tanning salons and medical device companies. law ande changes to the how the insurance markets work. those going comparison to the big cuts are more minor in my opinion. the real story here is that i
2020 or sooner if others in the house have their way, the medicaid program would be changed in a permanent way. changed in a way we have been talking about this morning were there would be a cap on what the federal government pays and in return there would be tax breaks for the individuals and corporations i mentioned. host: gary on the democrat line. caller: good morning, c-span. i have been watching you guys a lot lately. disability and i'm on the medicare and i pay extra to have the extra coverage. right now i'm really nervous. beennk other callers have too. it sounds like we're going to in 2025 orre
whatever. maybe i will be dead by then. government andhe it doesn't matter republican or democrat, they have all robbed from social security and medicare. and they make it our problem. i paid into it for over 40 years. my last job i had for over 30 years. i'm not lazy or nothing. i had cancer. i went through the surgery, the chemo and the radiation. it did damage to me to where i can't work. would look atcans the people and not numbers, it's like everybody is one catastrophe from being in the shape i'm in. and i think they need to take a look at that when they are making up whatever kind of policies or whatever the they
are trying to do right now. and that's all i got to say. that was very articulate and i appreciate you sharing that story. the part of what you said that really sticks with me is how we are all one catastrophe away. medicare really is a promise that the country made to us that if we work hard our whole lives, when we get to be of age when health starts to catch up with we can focus on our health and not have to worry about going bankrupt. before medicare, one in three seniors lived below the poverty level. which is astounding if you really think about the country and how far we've come. we still have too many people
living below the poverty level, but it's fewer than one in 10 seniors. when we make the kind of changes that are being proposed here which would take money away from the medicare trust fund by the equivalent of about three years, it's a dangerous thing to do and it needs to be talked about. it needs to be part of the debate. one of the things i worry about with this legislation is we are not really debating those issues. -- tends tos are focus on the political hot buttons. the things that really affect people and will affect generations of people going forward are the kind of shape it's going to leave the medicare and medicaid programs in. in myrtle beach, south carolina. republican line. and thankod morning you for c-span. i would like to ask you a question about this. i just recently received a check for my plan b.
i'm retired. october.65 last forst received a check $740. i'm afraid i have just made a bet with the devil here. therk part-time during summer. i qualify for medicare now. i'm wondering next year if i don't qualify for medicaid will i be able to get back on medicare? thank you. caller'sdon't know the individual circumstances and i'm not sure whether or not he is talking about the medicare or medicaid program because he referred to both. that i thinkhing you were asking about is this phenomenon that you qualify for medicaid based on your income and if your income increases to the point where you go off
medicaid but then something happens trust your income is you end up back on medicaid. that has historically been how the medicaid program works. ist is being proposed different. what is proposed in the current draft of the legislation is that in states that have expanded medicaid coverage, once people lose their eligibility for medicaid they wouldn't be able to get back on after 2020. that i think has many of the governors up in arms. we saw governor kasich making that point on some of the sunday shows. people who qualify for medicaid are people with very varied incomes.
their lives and incomes are so unpredictable that they may know how they're going to pay for health care one day and if they lose coverage they may not be able to pay for the care they are getting. host: this is from the washington post this morning. the elderly and people with disabilities would be especially vulnerable. you are either consigning the seniors to less care, pennsylvania to spend more money, or a combination of both. issue, they write oft an official assessment the medicaid program will be part of the widely anticipated estimates the congressional budget office is due to release as early as today forecasting the house gop legislations impact on federal spending. you have seen a number of these before in your time as
administrator. what is your sense about what the congressional budget office will say dealing with costs of medicare and medicaid? isst: what's very important since 1974 the congressional budget office has been the one that has taken politics aside and helped us understand what it is that we are voting on. is it going to cause the federal government more money and if so how much? is it going to benefit people by giving them more coverage or is it going to give them less? if the congressional budget office says the proposal from the republicans is going to cover more people and it's going to do it more affordably and with high quality coverage and in a way that's budget neutral or better, those are the kinds of things we ought to be willing
to support. and say peoplet are going to lose coverage that it's the kind of thing we all ought to take seriously. at a timeat we live when it's fashionable to question the numbers. it's fashionable to shoot the messenger if you don't like what you are hearing. is a republican appointed leader at the congressional budget office. very high integrity. very smart people. nobody gets an estimate exactly right. that's not the point. point is they are always close. with the affordable care act the congressional budget office said we would ensure record people and we would do it in a way that was fully for and that is in fact what happened. did they get the numbers exactly right, of course they didn't. able to do all of
the assessments that all of the callers have asked about around what happens when people's tax credits are reduced, when premiums changed, when all of these changes are made. at the end of it, how many people are going to be covered? right now people are expecting it's going to be a lot fewer people. i really hope the republicans and democrats take a hard look at this legislation. doing something just to do it that hurts people certainly not the direction people want to go in and it's not what the voters have expected. from lynchburg, virginia on the independent line. question is twofold.
paul ryan said he wants to roll back on the amount of money the government spends for medicaid and medicare recipients. is that related to the amount of anple or is that related to increased amount of spending for each person? thatunder the belief medicaid and medicare has standard amounts for items and services and whatnot. is that an amount that will come or were they generally leave the consumers to pay the extra cost?
speaker speak for ryan. he has said many times about his vision for medicare and medicaid. is one that he would describe as fiscally responsible and payment entitlements. what that would mean as a practical manner as there would be a capped amount per person that would be paid into these programs and he would like to see the medicare program to something called premium assistance which says, the federal government will pay x and individuals will pay the rest. it has been labeled a voucher or coupon or whatever. of paidp on the amount per person and allow that to cap the program. what happens from there i think there have been various points of view.
in the administration would like to see a balanced billing which is that whatever providers would take upuals the rest that isn't paid for. that's not how it works today. what happens today is if a physician or hospital contracts with medicare or medicaid they agree that's the amount they are going to get paid and they are not going to collect anymore from the patient. if that were to change that would change the burden on the patient. the program we have today is one that is more consistent with fulfilling the promise that people expect from the programs. if we are going to make these kinds of changes is critical that we have open debate, open hearings and people really know what we are talking about. it would be one of the most historic changes in our government over several generations. host: andy slavitt is on
twitter. we appreciate you joining us this morning from neapolis. -- minneapolis. guest: thank you, bill. on healthdiscussion care continues as we welcome grace-marie turner with the galen institute. she's coming up next. we will talk about u.s. antimissile defense systems with jamie mcintyre. ♪ >> here are some clips of c-span's programming this past week.
the senateein before judiciary committee. >> lead to refrain from disparaging people unless it's necessary and justified in a case. if we don't charge them with a crime we have the responsibility not to disparage their character. >> senate minority whip dick durbin on president trump's revised travel than. >> this includes some cosmetic changes, but they don't alter the fact that president trump's travel ban is still unconstitutional and still inconsistent with the values of this nation. >> house speaker paul ryan on the gop health care plan. 2016 if you give us this opportunity this is what we will do. now is our chance and opportunity to do it. >> senator chris murphy. >> trump care is here and you
are going to hate it. this is a dumpster fire of a bill that was written on the back of a napkin behind closed doors because republicans know it's a disaster. nikki haley on north korea's use of ballistic missiles. >> this is someone who is trying to get attention. tos is someone who is trying cause a reaction. this is what bothers us. it hit less than 200 nautical miles of japan. they said their goal is to be able to reach u.s. bases in japan. this is not something we can take lightly. the global community needs to understand every country is in danger from the actions of north korea. energyt engel during the and commerce committee markup of the health-care bill. >> this is one of the most important things that we're going to vote on this gear and
it is rushed through. we don't have all the details. that's why we are so disgruntled. we don't like this being jammed down our throats. c-span programs are available at c-span.org. washington journal continues. host: joining us to talk about the republicans plans to replace the affordable care act is grace-marie turner, president and founder of the galen institute. tell us what your organization is and why it's named the galen institute. a think tank specializing in market-based solutions and we are named after the second century great physician who was very much ahead of his time and very innovative and forward-looking. host: