tv Washington Journal Tom Scully Discusses Medicaid Expansion CSPAN March 30, 2017 8:05am-8:34am EDT
is such a political hack, i just can't figure out which party. [laughter] and smiled and i took that shared it with my senior staff and said that the greatest complement. we confuse people because a lot of people can't imagine people who aren't considering side. we are not fools, i know what i make a hard decision, a storm follows. honestly, i don't care. if i've thought about it carefully and in doing the right thing, making the right judgment, it does not matter. >> washington journal continues. ust: tom scully is back with , a former administrator of the centers for medicare and medicaid services. we want to discuss the future of medicaid in the weeks after the failure of the aca repeal and replacement deal -- bill that included changes for medicare and medicaid.
his medicaid sustainable or does it need major changes? guest: how many hours you have on that one? popular -- a great, popular program that isn't going anywhere. the question is whether it expands or what stays. the 25% of americans are in medicaid program. it's a huge program in the issue is will it get a lot bigger or stay the same size? obviously it's very politically controversial, a huge piece of the health care restructure of every state. it is a legitimate, massive policy debate that's a big piece of the budget debate, the second-biggest program and federal government. a $600 billion a year program. it has grown massively in the last 15 years. i first got involved in 1989,
the program is $50 billion a year now at $600 billion a year. when i was at cms in 2001, it was $200 billion a year. it is a massive program with a lot of structural complications which should be fixed. it is also a huge piece of health care infrastructure and critical for a lot of americans and a legitimate public policy. if you caps on with the aca over thethe next 10 years you will add another 10 to 15 million people to the medicaid program. the issue is the spending would be cut, it go from growing to about 950 billion a year or do want to go from $600 billion a year to $750 billion year.
and aler rate of growth rough freeze of where it is or do you want to keep expanding it. that's a real public policy debate and an obviously huge one with implications for the budget and society. host: despite the failure of the house bill we were talking about, the debate over medicaid continuing this week. yesterday, tom price was of before the appropriations committee and here's what he had to say about the future of medicaid. >> we believe it is broken. there are individuals who need to have coverage and care. if we are not -- we are not measuring the right things. if we are only looking at how much money we are putting into it but not measuring the care being provided and whether or not folks are improving their health status within a program than we are not doing a service to the folks provided resources and certainly not to those receiving the care. host: you heard the health and
human services secretary testimony talking about a broken system and yet in light of the health care bill, some states are reconsidering the option of expanding medicaid in their states. is this a system that could include more states that have the financial resources to allow that to happen? caller: states want the cash, that's the issue. under the aca, the states have the option, the supreme court says the states couldn't be forced to an expansion, they have the option. money,es took the including ohio and indiana. a lot of seven states do not take it. -- southern states did not.
some southern states are thinking they better get in before the door closes because the expansion money was originally a lot of percent federally funded, it would now go to 95% and 90 permanently under the law. a lot of southern states that we don't care if it's 100% or whatever it is, this is more money, we don't want to expand the program and we won't do it. .hey are rethinking that is it obligated issue. , it'sw about the program a great program with a lot of great services. is it broken structurally? state-by-state it does a lot of wonderful things. the reason it is broken is because the financing mechanism behind it is broken. it is a matching program in every state so to get a bit different match based on a private -- poverty levels.
it has been gained over the years and if i were the governor of states, i would do the same thing. financially there is no one in the u.s. will tire the actual match rate is. we've is $600 billion program with the rules are different at its simply scrambled eggs state-by-state and there is no consistency. that's what needs to be fixed. the actual services medicaid provides i think generally most states, this a lot more managed care and critical health care service. the issue is running a $600 billion program like this. that's what the house bill and i president clinton was for the idea of a cap. the real issues to end the silliness of the program management and financing of this thing. -- erent people, different
there a lot of reasons to fix medicaid and you can debate who should get what spending where. the department is in need of financial reform. i think it provides good services. every state is different. the current programs structurally is completely and totally indefensible as a federal financing mechanism. host: we can get to these reform plans in the segment of the washington journal. special lines in this segment, a line for medicaid recipients, 202-748-8000. all others, 202-748-8001. you can start calling in. tyrone, good morning. hower: i was wondering did the over 30 stays the decided not to expand medicaid
affected the affordable care act but also how to the fact that the government wanted to reimburse the insurance agencies -- how badly that affected the affordable care act because of the was sabotaged? guest: hard as it is to believe in this environment, most republicans and democrats are trying to do the right thing. the formal care act has some flaws and i think democrats agree. one is the southern states that didn't take medicaid reimbursement in the medicaid program if they were to take it, if they showed up in took the money, that would be $150
billion in additional spending being spent of the next 10 years. so should the states get the money? some republicans would prefer not to have the population of going from 77 million today to about 88 million. some people don't want see that happen. the caller asked about insurance mechanisms. poverty, medicaid is a federal state program that covers above that. obamacare provided insurance subsidies in the exchanges. the exchanges which included whole different group of people, they've melted down for a variety of reasons including the fact, this is accommodated issue , that there were some, located subsidies in there for the insurance companies that basically were not carrying out
the way they should have. the money was pulled out for a variety of reasons if you want me to torture you. it caused a lot of insurance companies to drop out. ofwas a bizarre set insurance subsidies that are probably not appropriate, and the people who bought those plans expect them to cause pain and higher premiums if they disappear. one is medicaid and the other is the exchanges, the both have flaws the people picked on. ,ost: on the medicaid expansion deep red kansas, one of those states is considering whether to expand medicaid. the lawmakers their voting to do that. the governor who has long opposed obamacare not expected to sign it into law. we will see what happens in kansas. on the line for medicaid recipients, eddie from north
carolina. caller: good morning and thank you for c-span. wife has pancreatitis and is a diabetic. she is only 48 years old and she has medicaid. her doctor won't take medicaid, he is a little clinic, we live in a small town and it cost $49 and he and $20 a visit takes care of everything except one just to go to hospital. pricectors jack the because they know the government will pay it. you go to the emergency room and you are in there 20 minutes and the doctor charged in $905 and you haven't done anything but .alked for 10 minutes i'm a vietnam veteran so i'm disabled, i get all my
medication and dr. through the fee a --va. if they take away medicaid, my wife full dive. mr. scully, on price gouging for medicaid recipients? caller: a lot of issue -- guest: a lot of issues there. first of all, good luck to your wife. 66% ofd pays about commercial insurance. when you go to the hospital, the doctors don't like it, and some doctors won't take medicaid because they get paid a third less. so they just try not to see medicaid patients. every hospital in the country is to take medicaid.
medicaid patients usually have low or no co-pay. the odds of his medicaid disappearing is zero. what happens is you go to the hospital in the hospital charges $930.0 -- they know the medicaid will probably pay you that paid him $200. nobody is ashley paying that amount under the bizarre circumstance of health-care system. states tend to underpay medicaid on purpose because they can. that is the way most states work. host: you are the cms and ministry of 2001 two 2004, can you explain what that job does and how much reform can they accomplish on their own without any sort of legislation from congress? guest: it depends.
under the aca unsure -- comes in prices great guy. there's a lot you can do under the aca because obamacare give a huge amount of discretion in changing things to the secretary and with secretary burwell, when he administration changes in prices while discretion in the aca. hhs.s part of that is medicare, medicaid and all the exchanges. it gives you an idea of more than double the size of spending at the pentagon. it's a huge agency. all the people who run it in last 15 years, it's kind of a small community. it's not that partisan. when you get your big issues like passing obamacare, my big job there was pushing through
medicare part d and medicare advantage which is the managed care program. those are very controversial. you have to go to hell to pat -- hill, it's very controversial. if you look to massage my friends who pat -- worked for president obama they agree. time you'rethe running a massive agency. social security is the biggest, medicare is barely -- they affect a lot of people and there are a lot of things going on. every doctor and every hospital. 77 million people in the medicaid program. another 40 million and medicare. ?ost: why is it cms caller: when i came it was
called the health care -- administration. it was run by a very good friend. forever -- thompson let's change the name. we went through a lot of names and we came up with the centers for medicare and medicaid services. because the cdc was most popular part of hhs. we decided cm ms was too much of a mouthful. we just shortened it to cms. i get some heat about it once in a while but i think it's ok. host: back to the line for medicaid recipients. caller: good morning. recipient and i
time i see the doctor, they would tell me the next month he would only give me the data my operation. after 24 months went by, he called me because i was hiv-positive he wasn't going to give me the operation. medicaid steel -- he said next week i'll see you again and. -- ut a metal on metal host: thank you for sharing your story. let's go to lori in vallejo, california. morning.ood medicaid, ihave wouldn't get any medical care at all. even with having medicare and
medicaid, i have really poor doctor care. they send me a specialist and in the specialist doesn't want to work with me, they send me back to my primary care who sent me to another specialist. i just wanted diagnosis and find out what is wrong so i can get well, but it seems like they are just playing revolving doctors stores with me. host: mr. scully. specific patient dishes are tough to know. i would say california has a massive program. warning 26 -- a huge program that is incredibly large. i think it is a pretty good job for comp rancid managed-care. i think it's a well
run program. obviously we have problems any places. my own insurance i get shopped around and it's a fundamental problem in the health care system. i think generally california has , you can debate whether they cover too many people, but they well run program. host: phil is in summerville, south carolina in the -- on the line for all others. caller: it seems to me mr. scully that what we keep doing is we keep taking the existing system and try to pass a 200 page bill here and there and tweak things a little bit to make it a little bit better, but it only seems to be worse. what i think we need to do is start operating under the assumption that we need to throw out the whole thing.
get rid of the system that exists and think about how should this work. i would have a system set up where we have regional medical center's where people can go and it is free. you walk in for a free or nominal co-pay. i would have those staffed with doctors trying to pay off their student loans and in exchange for paying those off, the government kid -- could provide service for help will student loans. when you get out into the rural areas, you set up a system where those people that have doctors, if you don't have a regional center, some form of compensation for the local guys. what we do is we keep trying to throw money at the problem and say i've got a great idea and hundreds of pages that don't solve anything and really results in people in washington being able to take
their cut of the pie is the money comes in and distributed as they see fit. guest: i respectfully say and i to stand your frustration, i used to work in washington for years, i think it is gotten marginally and incrementally better as hard as it is to believe. we can't start from scratch. i sent it to the house members last week who didn't like voting for the bill. starting from scratch is not an option. we are in a system where we have to compromise. we've gotten marginally better over the years. for doctors to pass off at his member -- for 77 night americans on medicaid, it is virtually free. when i just by start from scratch and design these differently? that.ably would do
is with theon now lack of discussion sanely of policy issues. i spent a lot of time cutting deals with senator kennedy and senator wyden as well as senator daschle. everything doesn't have to be a fight. i understand politics is politics, but health care is a massive part of our economy and you're not going to get a far left single-payer and you won't get health savings accounts on the rational discussion generally comes about what we have marginally. academically at the great -- it would be great to design a new system, but it is not going to happen. we marginally make it better by the day. host: only about a minute left,
your predictions of what happens with health care overhaul in the trump administration. reports coming out that house republicans may not be done with the repeal and replace efforts. the house gop may be another try these thingst: always go down once or twice. the george bush no new taxes blew up before it pass. this is a giant budget bill and i think republicans ran for eight years on repeal and replace and will have to do something. the conservatives who didn't like it, they don't have a lot of options. it will probably go to the senate and be moderated significantly and moved towards the middle which those guys won't like, but the real issue
is do you want to take the medicaid program, which is now $400 billion a year, if you do nothing and will be $750 billion a year. do you want to restrain it or keep going? i don't think it's an option for republicans to do nothing. it's a big piece of the budget. i think it's going to be ugly and painful, but i think skipping it is not an option. i expect we will be back at it. i'm sure most my democratic friends would like obamacare to go untouched and that won't happen. some republicans would like to be completely eliminated and that not going to happen either. host: tom scully, i was appreciate your thoughts. thank you for talking with us. up next on the washington journal, we will be joined by maryland congressman john delaney. we will talk about his proposal to tie infrastructure spending to tax or form. that's coming up in a minute on washington journal.
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