anything that is against the law. know anything about it until two hours ago. >> unfortunately that is it. thank you very much, congressman clyburn, r ding time with us. >> thank you very much for having me. >> please do it again. if you want to hear more, visit our website, washingtonpostlive.com. i'm the national political reporter forchael scheer. that is it. we will see you next time. ♪ announcer: since 1979, in partnership with the cable industry, c-span has provided complete coverage of the halls of congress, from the house and senate floors, to congressional briefings, and committee meetings. c-span gives you a front row seat to how issues are debated and decidedwimentary, no interruption, and completely

unfiltered. c-span, your unfiltered view of government. ♪ continues. host: julie rovner joins us, from kff health news, to talk about the latest enrollment under the affordable care act. a little clarification, i made kff health news, explain what that is. guest: kaiser health news is now kff health news. host: my apologies. over 20 million people signi up for the affordable care act, why is that number significant? guest: it is up 5 million from the previous year. the largest nber ever to eopen e closed in a handful of states. if you live in california or new york or new or connecticut, you still have a

day or two to sign up. yeah, this was a big surprising number. host as far as the reasons why, how would you describe that? guest: a number of reasons. probably the biggest reason is that in 2021, congress expanded the subsidies for people who were buying their own insurance on the marketplaces. the subsidies go much higher in income, over $100,000 for a family of four. for lower income, subsidies are more generous and you can get most people under 150% of poverty can get a zero premium plan with a low deductible. the insurance itself is much more attractive. th biden administration has been a lot more in terms of outreach and navigators and helping people signed uplus, thd of something called the family glitch where if you had employer-provided insurance and it cost more than 9% of your

income, if you were the individual, you could go on the exchange and get a subsidy. if you had a family, you couldn't. for lots of people, employers will subsidize the cost of the person but not their family. for many people, they were stuck because employer family coverage costs way more than 9% of the income but could not go to the marketplace and get subsidies. now, they can. we can talk about medicaid separately. differently.e divided the lin for those who have insurance under aca, give us a call at (202) 748-8000. if you have private insurance, (202) 748-8001. if you are not insured, (202) 748-8002. ■

about half the national growth in five states. what is the common denominator? guest: the common denominator of texas, georgia, and florida, they are the three biggest states that have not expanded medicaid to low income adults without children, which were up to 40 states now. those are the three big ones that arefm still holding out. a lot of people in those states that were eligible. it is a bigger universe to choose from to get insurance. also, lots more people in those states. it was notable that those were the that still have high insurance, partly because those states have not expanded medicaid which people might remember was originally when the law passed i 2010 was supposed to be mandatory. but when the supreme court ruled in 2012, no, the state can opt in or out. it was such a good financial deal for the states that we now

have 40 of the 50 states having opted in. those three states have been under republican consistently ao far opted not to do it. host: you talk about subsidies. how long will people getsubsidi? guest: the base subsidies in the affordable care actexpanded subd 2025. congress would have to act to extend them or let them expire. if they extend them, they will have to find a way to pay for them. we are expecting another fight after this election. host: if subsidies go away, what does that look like? guest: the people right now, you can get subsidies up to $120,000 of income for a family of four. that would drop back down to probably 60,000. lower income people would still a subsidies and still be able to get low

deductibles, but not as low -- not as big subsidies and not as low deductibles. those e th extras -- it is not just getting the insurance that is more affordable, it is getting health care that is more affordable because there's lots of ins get for low premium but if you need care and have a $6,000 deductible, insurance is not that helpful. host: what is the scope of care someone can get under the aca? guest: it is pretty comprehensive. it has to be. this is one of the things in the affordable care act, the 10 essential benefits that have to be offered. it is basically the same benefits of many employer plans. it originally, it has always been the same benefits. it has been more expensive over the years than most employer plans. large employers have been able to negotiate better deals for some things. it has always been --■u i cove'g to be covered. host: if someone already has a

pre-existing condition, they can still get covered? guest: right. noor women than men. those things are not allowed. host: what has it done for dental care, eyeglasses, etc.? how much of that is covered? guest: not much. for kids, it's required. for adults, it is not. optometry and footcare, they are not mandatory benefits. i have not actually looked in a while. some of the plans might offer them to get people to join. that is more something you tend to get in the private medicare he vantage plants -- advantage plans. host: the biden administration went through great lengths to tell people about it. describe what they did in order to reach out to more people about what the plans offer. guest: the trump administration cut back deeply in terms of budget for outreach for

advertising, for having people in community health centers to help sign up, having fairs. so, that outreach had gotten much smaller. the biden administration not only brought it back to where it was un obama, but expanded it even more so there's even more help. medicaid has been shedding people all year. who got medicaid anytime during the pandemic were required to be left on by the states. starting last april, states had to start reevaluating people to see whether they were still eligible. we know about 15 million people have lost medicaid coverage since last april. we think about 5 million of them are somewhere along the line have gotten other coverage, not necessarily affordable care act coverage, but that may have eligible for employer coverage, their kids may have been eligible for the children's health insurance program, government program that serves children in families with a

little bit higher income than those who qualify for medicaid. we do know a number of people who have been taken off of medicaid are still uninsured now. host: one of the questions asked about the obama administration in developg ld cost the american people. what have we seen since its inception this far as cost? guest: i don't have the total numbers in front of me, but this is the first year the number of people who have signed up was what the congressional budget office estimated in 2010. the enrollment was slower to happen. one reason is there was an expectation insurance and send people to the marketplaces because they could. that didn't happen for a variety of reasons. ■employers like to offer health insurance. it is enticement to get good workers. as i mentioned, the affordable care insurance was considerably more expensive. even though it would cover the

same benefits, and might have narrower networks and it would cost more. a lot of employers kept their insurance and that is one of the reasons it took a while. people still don't know about it. host: you can call on the line that best represents you. whether you get insurance under the aca, private insurance, not insured, and the line for others. jason starts us off in hawaii. a receiver of private insurance. thanks for calling. go ahead. caller: how are you guys doing? yes, we come from the land of a where it has been like this forever. we have the medicaid. from the land of obama, he enacted this. my question -- i will give you a question and an anecdote and my question is, this aca was

supposed to be simple. it does not seem simple, but it seems accessible. but, it does not seem simple. i would like your comments on that, julie. an anecdote. i was on quest, medicaid for a while. this is a situation i had. i had to have a dental procedure. it was basically totally free. undermined-planned, i have got to pay n, so figure that out, and i will listen to your answer off the air. thank you. guest: sure. last first, many medicare and medicare do cover -- medicare plans do cover dental. private insurance don't. people who have lower income

probably cannot afford their dental care, and that is why it tends to be covered. i will gently correct the caller. the aca was never supposed to be simple. it was supposed to be a lot of things, but simple was never one of them. the whole health care system, particularly the government health care system, what ended up happening is, you watch c-span, and you s■xñ@ee how cons worked. they ended up compromising, they ended up taking one from here and one from here and putting them together, and that makes things probably more complex than if they didn't move the bargain so much. so if you end up with the medicare, medicaid, and aca, very complicated. the consumer-facing part is supposed to be simple. i was just on the medicare website, which used to be simple and is not anymore. to buy a drug could not do until 2006. things have been added, but they have added to the complicity.

host: another receiver of hello -- kathy, hello. caller: good morning. i cannot understand why in the year 2024 that we do not have national health care, and that includes dental. we have plenty of money in this country, and the american people pay a lot in taxes, and i'm quite certain that the people that are elected and supposedly represent us in congress and the president of the united states and the vice president have. comprehensive health care. . they don't worry about medical bills. i have priva, and it is very inexpensive, only $38 a month. it is through the county here. host: ok. michigan, thank you. guest: actually, members in

congress, this is a requirement, they have to buy affordable care act plans, and also their staff. also, it was the same but other federal workers had, but now congress has put itself in a unique situation. i have been at this since 1986, covering health care, covering the problems of the uninsured, the problems with the expense of our health care system, and there is basically a big drift between democrats, who file government should -- who feel like government should play a large role in the health care system, and republicans, who feel like the industry should play a large role in the health-care system. we have never been able to choose one or the other. host: has that has it shrunk, as providers under the aca? guest: it shrunk and then it

expanded again. at the beginning, insurers did not know what to expect. this is what happened with medicare part d also. insurers were not sure what to expect. they came in timidly. they stopped making a lot of money when the enrollment went down, you started getting sicker people, and that is expensive for insurance company. enrollment started to go up, and insurers were like, yeah, let's go back into that market. the plans bng offered, fairly robust. this is one of the things that make it confusing. it is too robust. you have too many choices, and it is hard to tell what is the right choice for you. host: do you have gold cadillac, those designations? guest: silver, gold, yes, there are still those designations, and it is confusing. host: what sets them apart? guest: well, it used to be the silver plan was the one you can get the subsidies for, but that is not always the case anymore.

i believe you can get gold plans with yousubsidies now. the silver plan was whatever -- the cost of the silver plan was when everything else was based around, and that has been changed. i should know exactly what has been changed from above forgive me, i don't. host: let's go to max. caller: thanks for taking my call could i am a retiree from the chrysler corporation 29 82 years old. the big three were running the health care, i was paying the co-pay, and then when the uaw negotiated to take the coverage and the uaw started running the plan and took big corporations out of it, i am paying five dollars for the same prescriptions that i was paying

$70 for. tal care, i have hearing aids. the prescriptions that i get, some of them are only two dollars, and i don't understand why this can't be done. and i'm not sure about this, but i think they had, like, five board, and then they have five individuals that are from, you know, kind of ordinary pele and lawyers or whatever. but i don't understand how people that are paying so much more than i am, for years, and as soon as the union took it over, it is down $65 for a prescription. i was wondering if you could address that. . guest: so, again, i assume you are on medicare, and this is a supplemental plan. that is a different universe about retiree health insurance pretty used to be that when you were tired, your employer would provide you retiree health care.

i went away in the 1980's and 1990's, along with pensions. now some employers offer basically a medicare supplement to go along with your medicare, or if you were a union member "new york times a union -- member, you know, a union supplement■bvw, whether union negotiated is what you pay. how much insurance costs where you live, i mean, these supplemental plansizes and offer different forms of benefits. but yes, it is not uncommon for people with good around medicare and have dental coverage and eyeglass coverage. host: can you explain the reason co-pays exist? is it to dissuade people from using insurance? guest: yes, it is. you will phrase a lot, "skin in the

game." if it is free, people will use it. used to be coinsurance, which you pay a percentage of the service that you are getting costs, was to be problematic when you are getting drugs that cost many thousands of dollars a month, and you are expected to pay 10% of that, which is hundreds of dollars a month, which■5 people cannot afford. now we have mostly co-pays. they were for you go to urgent care than to go to the emergency room. if you go to the emergency room, you may have a $150 co-pay, and if you go to urgent care, it is $50. i steer you to the right place. it is supposed to deter you from getting excessive care. host: this is from stephen. he is in florida on our line for those who are not insured. go ahead. caller: yes, thank you. i have not been insured since the year turned 40, because my premiums were going to triple. over the years, i have had

ktreally, really bad health problems, especially the last 10, 12 years or so. i paid out-of-pocket. by my estimate, you know, i am a physicist and a mathematician -- i keep spreadsheets on stuff like this -- i have saved about a quarter million dollars a year in premiums -- i'm sorry, 30-yei saved something like a quarter million dollars, something like that. the amount of stuff, this, you know, one of the best lines about government i heard was from james schlesinger who once said that government is a form of sophisticated and hidden cheating, where the benefits of what the government does is given to you upfront, but the cost come later. if you remember, after the 2013 shut down, the republicans in congress were down to, like, 8%

approval rating. the next year, barack obama said he was not on the ballot but his policies were, and the democrats were crushed. why? because obamacare kicked in in 2014, and even the people in messages were getting letters. if i remember, the number was 60,000 households got letters, stating that their health insurance no longer, in one of the most liberal states in the country, no longer met federal guidelines. host: exactly what do you want her to address? caller: well, any one of those. host: you put a lot out there, so we will let her pick one and go with it. guest: democrats did not get crushed in 2016. close presidential election. there was a lot of confusion at the beginning of the rollout of the affordable care act. that is absolutely true. many people who had insurance that might not have covered, things they did not know were discovered, did get letters that said, your insurance no longer

qualifies, because a lot of people did not have real insurance. i'm in for one particular case, a woman in florida who was very upset because she wasnly paying $50 a month for her insurance, and it turned out she only had five dollars worth of coverage. so she would have been in serious trouble. a lot of people had low premiums but very lowi, benefit. that is one of the things the affordable care act did was standardize those benefits. as i mentioned, sometimes it was expensive, sometimes it was in their network, so the doctors might not have been part of it, or their local hospital might not have been. part of it. nobody is suggesting this is perfect, but i t■ihink it is moe ingrained into the system, and august with medicaid expanded in 40 states, i think it would be a lot harder to try to roll the aca today, even thant was in 2017 when president trump came in. host: because it is an election

year, is the aca still up for debate in an election year? guest: less so, but yes. former president trump has said that he would like to get rid of it and replace it with something else. never shown us with something else would become easily promised repeatedly during his term in office, that he would have a much better plan, and that everybody would like it, but we have yet to see it. so to some extent, yeah, i think the aca is on thllobviously pree is elected, wants to review the subsidies, and perhaps add to the affordable care act. host: has nikki haley address the aca at all? guest: i don't think so. i haven't heard it. i'm sure she probably have, but i have not heard it. host: brian in new york, receives insurance under the aca, you are on with julie of kff health news. caller: i am currently on medicare, because i just turned

65. but prior to that, i was through the affordable care act. my statement is that the afrdable care act is not affordable for the people who feel the brunt of the higher premiums, and that is opare, buh businesses less than 60 people. i am a singleractitioner, i'm a single person in a corporation, and, you know, i make a decent living, and my premiums were just, you know, outrageous for myself and my family. and, you know,■>riend who had a business, was income -- his income decline. we had the exact same coverage, and he was paying like 10% of what i was paying. that means guys like me, who hasn't success, you know, had to

bear the brunt of premiums for, you know, people who could not afford them. so it just seemed extremely unfair to me. now, i am, you know, i have a family, i have a younger wife, so she is now through the affordable care act, i'm on medicare. my premiums, between the two of us, are higher than they were before. medicare, i thought it was going to be a relief, but it is not a relief. host: thank you, brian, for sharing your experience with us. guest: medicare has gotten expensive. i noticed that myself. and used to be premiums and deductibles and medicare were decided -- word to minimus for a long time, and then congress decided they should pay more for it, a separate part b deductible, if you want drug coverage, you have to buy a separate part d plan.

it can turn into a lot of money really fast, and that is why so many people go to medicare advantage, which are these private plans that sometimes offer these extra benefits. generally the trend is you have a narrow network, so your doctor might not be in the plan, your hospital might not be in the plan. so if you are trying to just get by with regular traditional medicare and no supplement now, it can cost a lot of money. st: this is a viewer off of x who asked the question, how many americans are still without insurance? guest: i think we are down to 7% , which is an all-time low. i can't remember how many that translates to people. i think somewhere around 20 million. is much lower than it s been. we will see what happens this coming year. we know a lot of people were disenrolled from medicaid, not becauseigible because they weret

found, they either did not return their forms or their forms did not find them. 75% were disenrolled for disenrolled for procedural reasons, not because they were actually, eligibility was re-examined. so, again, from the large numbers we have seen on the affordable care act, certainly some have moved over and gotten the affordablecoverage, some ofe gotten c.h.i.p. coverage. host: we will hear from helen next on our line for others in california. go ahead. caller: hi. i was going to get people tips that when they the internet, d't expect to talk to a person. call the 800 number, so you can talk to somebody. find what networks you are using, like if you have a favorite doctor you like to see.

you have to find out what networks they are income and usually the bookkeeper has that information. . when you signed up, tell the person you want to be in that network, so you compute your doctors. . that was the one question people did not know or they did it online, and they got whoever showed up. you have to find out what network your favorite doctor is in. it makes it much easier. you can also ask questions, like when i signed up, i knew i was going to have cancer treatments, an questions, if i would be covered for this and that, and i was. also, when you do sign up, they are going to ask you how much you make a year. don't overestimate your income, underestimate your income, because when you do your taxes, they are going to give you, you know, the subsidies, but if they give you more subsidies than you are due, then you're going to have to pay back probably a penalty and also pay back the money that they gave you, that they overpaid you. that ihost: someone has done thr

homework. guest: yeah. good advice. you can probably find out about the networks online, but you can also call some buddy. there are people who are not that comfortable really digging in. some of the websites are nf there are lots of people now -- this is one of the reasons that enrollment has gone up, that the biden administration make sure there were more people available, to help people work through this complicated decision. host: another californian, this is marlon, hello. caller: hello. the costs have been going up considerably since 2008. and it being not national, like canada as top health care, like "futurama," the suicide booth, for in the u.k., a medical condition, so a panel decides to make sure she dies. o to our country

to have a baby, but the antilife won't let her do that. look at the cost of insulin 2008. host: can you expand on that, where we are with the cost of health care overall? guest: insulin, because that has been a big issue. the caller is absolutely correct, because of insulin has been skyrocketing. some of that is because they were new insulins, who work slightly differently, so they are patented, and companies make them charge a lot -- at least in this country. legislation that was passed in 2021, the inflation reduction act was to cap the cost of insulin at $35 for medicare, not for everyone. there is still an effort to cap it for people who are not on medicare. one of the reasons is that we saw a lot of particularly young people, a lot of stories who, you know, they were trying to ration their insulin, which is not a goodhing to do, and people were dying for lack of

insulin, because they cannot afford it. host: health care costs overall? guest: also still going up. drug costs. people are very sensitive about drug costs. it is one of the few campaign issues that is quite bipartisan, that democrats and republican both want to do something about drug costs, not necessarily the same thing, but, you know, pretty much every country, other than the united states, has some kind of price control on the cost of drugs, and united states basically doesn't. we rely on negotiations, so congress is now working on at least making that negotiation part better. it is complex legislation that is, think, almost ready to come to the senate floor, but there's also, you know, there's still a lot of fighting about things that could be done to lower the price of prescription drugs in this country. host: i asked about health care costs, because the "washington post" columnist megan mcardle wrote this in light of the a,

"the affordable care act took ape years ago. it' architects started looking for savings in earnest. somewhat skeptically, i started calling this the magic pot of money that could be used witt making anyone worse off. now years later, we have still not found that magic money pot." guest: the idea was they would try to find the silver bullet to get people the care they wanted and save money at the same time, and there have been lots of acronyms that have been tried, aco's, bundled payments, none of them has worked as well as people had hoped. a lot of people say this whole experiment has failed, because we have not found the magic bullet, but actually it is done in small parts and that was the whole point was to try these

different techniques and see which one of them worked. just because we have not found the right onye it is not out there somewhere. host: let's hear from john in illinois, who receives interns under aca. good morning. caller: good morning. i wanted to voice my voice, medicare for all, i have not heard anyone talk about medicare for all this whole time. it is the simplest solution. everything makes it super complicated, but it is super simple. have one government pla. everybody else in the world doesn't accept for us. it is so silly. iin terms of controlling the present medication, for joe biden, whichever act lets him -- our tax money went to, like, the research and development of these drugs, so we should be able to control the prices. that is my main medicare

for all and negotiations on prices. guest: there's also something called march-in rights, that julie talked about on the podcast last week, that if the government did pay for some of the research, r&d, then we could go in and break the patent, but it has never been used. there are people on capitol hill that have been talking about medicare for all, the thing about medicare for all is it is very popular but not with a majority of voters, which is why he has never really gotten anywhere. it would definitely be simpler. other countries, not every country has a medicare for all type system. some duke and some have purely socialized medicine. some are private pays,ometimes the government pays the republic system, but a lot countries have hybrids. with private insurance, germany does, switzerland does, france does.

i think the difference is they have a system, and we still have kind of a patchwork, and everything the u.s. has put covd cover that, and on and it really works together, which i think is why callers are so confused. host: our guest is a podcast host, as you mentioned. guest: we have a podcast called what the health? we have a panel of repters every week and talk about the will depend very much on who is elected president. host: that is julie roberts mort will depend very much on who is elected president. host:you get your podcasts, and also at our homepage, pfs.org. host: let's hear from chris from illinois to line for those not injured. hello, chris. caller: hello, good morning. thanks for taking my call. i have a couple of topics. one is the big driver for aca was cost, and although a lot of people, this items have not been

as fast as people expected it, do you know if there is any assessment that has been done on how a number of enrollees and these people having access to health care have, you know, affected the cost, in terms of the access and the benefits they get from it? and what is the opportunity cost for those who are not getting it, especially in those red states, where they are still trying to block it? the second topic is,y kind of ee critical mass to people signing up for the aca would be, so that we can then say, let's on to a universal health care? guest: the last question is, it would have to be a lot bigger than 20 million. but we are at the point where, you know, medicare and medicaid and c.h.i.p. and the aca, we are getting toward kathy population that are sometimes government funded and subsidized

in health care. to say we have a mixed system, there's a private insurance and public insurance. the caller is correct, the affordable care act was supposed to do something about cost, but all the thing d cost and it of going away, because they were unpopular. things like the individual mandate to have insurance, various taxes on various parts of the health system, drug companies, hospitals, those all have basically been removed, so what we have is the cost part without the savings part. i would also say the aca, while it was ori=fginally the affordae care act and patient protection act, and a big chunk of it was about what we had seen as managed care abuses throughout the 1990's and early 2000's, to get care that they wanted to get, so that was also a big part. the aca did a lot of different things. host: leonard is in

massachusetts, a holder of private insurance. hello, leonard. good morning. caller: good morning. you■ know, you are talking about the cost of medication. back in the 1990's in springfield, massachusetts, there was a man the who wanted to get his employees to be able to buy medication from canada, because his son was on insulin. and the thing is, there, they went to the federal board of drugs, and about two or three years later, they came out and they said that canada's medication is not as good as the united states. i remember that. the mayor actually came down to lobby congress, to get permission to do that. this is one of the big sort of

ideas that has been floating around, since the mid to late is, well, let's get our drugs fromecause it is cheaper. and it is true, you can go to canada, get your drugs, and bring them stop you, most of the them at the border, for personal use. the problem is, canada does not have enough drugs to supply the united states. florida has just gotten permission, for the first time, to import drugs from canada. the problem is, the fda did not tell springfield the drugs from canada were not as good. when they told them as they could not guarantee the safety in the supply chain. they did not know -- at that point, there were a lot of companies that were not in canada, putting up websites, saying, you know, "buy your canadian goods here." the problem was getting to just fine canada drug store drugs back to the united issue. it cannot be a long-term plan.

canada has 22 million people. we■k 330 million people. it does not work. host: we are running short on time. go ahead with your question or comment for the guest? caller: question. if any of you going to do anything about dental coverage and dental health? there are people like me who have been injured, and the prices to replace a tooth or something like that are thousands and thousands of dollars, and the dental insurance system is completely different. dentists harvey highest-paid and orthodontists, and nobody does anything about it. and it has been proven that your dental health has a lot to do with your heart health and everything else. when is somebody going to address this?

we really need help with this. host: got you, caller. guest: the surgeon general put out a big report on oral health in 2010 or sometime. this is not an issue that it is not expensive, it would be even more expensive, it is more expensive now, so, again, it is under discussion. some states are trying to do some novel but it is clearly a problem not being addressed right now. host: those who sign up for a plant in the nem years, is there a trend happening. guest: bunch of people signed up in the middle of the year, and that was probably from medicare. that was before so many subsidies took effect. unclear, you know, how many people coming off medicaid will

now get on the affordable care act. this is one of those things, our health care is morphing, and it will depend very much on who is elected president. host: that is julie roberts with -- jul >> c-span's washington journal, our live forum involving you. from washington dc and across the country. wednesday morning we will discuss the attack on u.s. forces in jordan, immigration, u.s. aid to ukraine and israel with armed services committee member don bacon and new mexico congressman gabe. vivian talks about allegations against the united nationsrepell employees were linked to the

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