policy and bailing out, if you like, the financial sector so it didn't midwest down completely, and to -- didn't melt down completely, and the stimulus. i thought when i testified in '09 on the stimulus, i said roughly what doug just said. it should have been much quicker, the phrase then was targeted and timely. that meant more increases in food stamps and things that people needed and sent out quickly, and less of the longer run things that would spend out slowly. in hindsight, i'm not so sure. i think maybe we should have done more total, and more of it in longer run investments, as in infrastructure. now, that is spent slowly if you do it well. there's no such thing as a

shovel-ready project. if there were would would have done it. i if we had invested more in modernizing our infrastructure, it wouldn't -- some of it might still be spending out but that's fine. >> maybe we might have been a little bit -- could have spent a little more. >> could have spent more and i'm not so sure we were all right that it all had to be timely. this was going to be a long slog, and we did need the longer run investment. >> i think this debate has gone on for a long time but the fact that so many people placed so much of the emphasis on the recovery, and the single bill actually revealed the flaw. growth is not a bill. greg -- greg is a commitment to the kinds of incentives that get people to invest, to hire people and to want to spend money.

it's not a bill. if we look at the economy today, the striking feature has always been that the business sector had the financial wherewithal to spend more and just didn't. think harder about better incentives, including doing things we need to do, like getting the corporate rate in line with the rest of the world and tax rules up to the 21st 21st century. doing them then, and getting enemy place in a permanent faction, would have been a very wise step, and we didn't do that. and unfortunately we actually were -- there are shovel-ready projects, some one done all the prep work for and decided they weren't a good idea and then we went and built them. >> so in just a minute we'll collect the cards and take a couple of questions. i want to ask one more. you have sort of previewed your answers on this, but there are some folks that think maybe

given the complexity and the size of our economy today, that the fiscal stimulus may not be an effective tool. it's almost so big, too big to stimulate, tbts. our own version. have we got then with this economy? fiscal stimulus still works if applied the right way? >> i would make that argument, and the automatic stabilizers still work. remember that the biggest things that helped right this economy were not passed in 2009. they were passed in the great depression, and we had this cushion of a big tax system that is at least progressive enough so that win incomes go down, we take in a lot less tax money, and that's good. and the social security

continuing to pump out money and medicare continuing to pay health costs, and unemployment compensation, whatever the argument about how long it should be, it helps people get over -- get through a period when you are losing a lot of jobs. and so, yes, i think stimulus work -- one more point. i am always astonished that, although conservatives often say government spending kills jobs, if you are talking about military spending, they don't believe that. and i sent a -- doug elmendorf and i spent a nice session with some of the western governors, almost all of whom were republicans and quite conservative republicans, and

you would have thought we were going to kill their states by closing a few military bases. if that's not stimulus work, i don't know what it is. >> i want to pick up where alice -- not with the military closures but the automatic stabilizers. so the extent we want to learn something from this episode and build a better regime, it's focusing on the automatic stablizers and getting them right. the ui system needs overhaul for the 21st century. we don't want to have the fight we have had, length of benefits. we need to fix it. but the stabilizers are a great thing. i lock back at that's era and what i see is an economics profession that lost the lessons of history. in the '60s and '60s we decided we are were clever enough to fine tune bins cycles and manage them from d.c. and

with clever tax increases and spending cults and cushioned downturns and targeted unemployment rates and it was a disaster, we finished the 70s with chronically high unemployment and high inflation. we swore off that and said we should put fiscal possible on automatic stabilizers with inventives for growth and that was lesson that served us quite well in the '80s and '9s so, and then collectively we did discretionary fiscal policy, and for years and then we got political gridlock. we just unlearned the lesson of history and have to get back to a better regime. there will always be a place for there to be a discretionary response and there is no administration that wouldn't have done something like what the obama administration did. that was imperative.

i think, thinking more about the focus on the automatic part and less on the discretionary part would serve us well. >> let me ask one more as we get the cards up here. i know there's a lot of folks want to ask some questions. but chairman of -- the former fed chairman alan greenspan this morning mentioned a number of interesting things, one of which was the issue of income inequality. and which maybe -- income inequality may not be a bad thing. maybe it's more economic mobility. there's talk about increasing the federal minimum wage. the cbo released a study that said while increasing the wage to 010.10 would lift a million americans out of poverty it would result in a loss of a half million jobs estimated by the end of 2016. so to jump into that conversation, is raising the federal minimum wage something

that we should be doing to address income inequality? is it good for the economy, bad for the economy? what is your view? >> i would raise the minimum wage maybe in a couple of steps, go to nine dollars or something first, and index it. that's the main thing. the reason those minimum wage is so far below other wages, median wage or whatever now, is that we don't index it, and we should. so i would favor an increase, may be some job losses at the margin, but it doesn't -- the job loss is not nearly as important as the huge number of people that would be helped and pulled out of poverty if we racessed the minimum wage. >> i think this is silliness of the highest order. we raised the minimum wage

during the great recession and we have teenage unemployment over 20% right now. we have priced them out of the labor market. did an enormous disservice. we could do it again and hit more low-skill workers if we want, the cbo's estimate, 500,000. that's a pretty good estimate. and what will we get for it? we'd get 900,000 out of 40 million americans a tick above the poverty line. that's a pretty small payoff. and the incomes that are redistributed in the process only 19% go to poverty households. this is a terrible antipoverty too much it's not targeted on poverty. it's not, if you're a poor household we'll do something for you. ipc gets people into jobs. the dividing line between poor and not poor in america is

having a job. poverty rates among those working, seven percent, poverty rates among the rest, three times that. don't understand why we have these puny little policy at the center of a debate over a real phenomenon -- itch you did the minimum wage you couldn't change the fundamental trends in wage inequality that have been going on since '80s where the high end prospers and the low end has fallen for a decade and a half and stabilized at a low level. and i fine this a distraction from what might be a serious equity issue. >> congratulations you found i finely found something we disagree on. but not that much. i would certainly agree with doug that the earned income tax credit is by far the superior tool to raising the minimum wage, although i would go with a wage increase and indexing. >> well, another interesting question that you may or may not

have different perspectives on. but it prefaced with let's put the nail in the coffin now, is austerity during a down cycle of economic growing, a bad idea, yes or no? >> yes but we survived it. >> i don't think we had any austerity so that's in the eye of the beholder. we certainly -- there was a big stimulus response. and for the record i think the fundamental policy response made the biggest difference was the initial fed action. that stablized the fall more than nye single policy action. the t.a.r.p. and stimulus pale in comparison, and i would very much have liked to have seen quick moves toward changing the permanent growth innocenttives as opposed to continued target, quote, austerity kinds of discussions. so we can't relive that history.

>> on health care, a couple of questions. is the affordable care act helpful or harmful to the long-term fiscal picture and why? you sort of both touched on that. but specifically to thes affordable care act, helpful or not. >> broadening coverage to include more people to have insurance is bound to mean spending more money. if we do it, as i think there is a good chance we are doing it, in conjunction with reforms, both in the public and private sector, that change the incentives in the healthcare system, moving away from fee for service, and so forth, then i think we can compensate and indeed override the increase that we have from covering more people. but no question that covering more people will cost more

money. >> i think this is a bad thing for the long-term outlook. no doubt about it. we will spend more. my concern is that we'll spend a lot more because the insurance subsidies are sufficiently generous that for anyone up to 300% of the poverty line, employers can get out of this by providing health insurance, pay the penalty, provide employees with a raise that after tax plus subsidies gets them better insurance than they were offering, and that's a come boundaried incentive for the two groups to figure out how to get that done, and i have great respect for the ingenuity of those two groups, and so this could be -- if we start getting twice the number of people we expect in these exchanges over the long term it's very expensive and very bad. i don't think we'll get the spending reforms that alice referred to that would be great, but the aca has in it just a wish list of pilots and demos.

the road to health care was paved with pilots and demos and it's hard to gift it done. so i'm less opt mystic on thatfront. the real place where reforms could have been made to fundamentally change fee for services was medicare. but by intertwining meds care into financing the aca they paralyzed reform. so i'm more pessimistic about the spending projections. my bigger concern is also hits the denominator. there's no progrowth about the affordable care act. if you asked -- a variety of regulations that touch the economy? i don't think so. so this has been, i think, part of the growth problem, is a

failure to recognize that what was ostensibly a healthcare discussion has growth consequences and so we're hurting the spending eanymore rater, the growth deknock rater and i'm not a big fan. ... i am more hopeful but not just

because of demonstrations. clearly we have got to take the things that are working and moved them into the mainstream but i think that is actually happening. the big payers, the big insurance companies and medicare are moving toward incenting value rather than just volume. >> how about a tax question? the chairman of the house tax writing committee david camp is scheduled to announce this week an overhaul of the tax code on wednesday. what are your general thoughts about do we need a rewrite of the tax code and how badly do we need it, what should it look like in when will it end been and will it happen? >> yes we need a rewrite of the tax code. [laughter] both the individual and the corporate income tax in the same direction to broaden the base

and lower the rates and i would have preferred to do it as part of some grand bargain. we are not going to get the grand bargain anyway and i don't know what dave camp will come up with but we could hardly have a worse tax code. let's see if we can't make it better. [laughter] >> i think it's, there are some things that i think are obvious and the need for a big tax overhaul is one of them. i did do some polling and actually did some focus groups on tax reform in my think-tank and just for those who want this to get done know that there are two words that you cannot use when discussing tax reform and the public absolutely turns their back and those words are tax and reform. [laughter] they hear tax reform and they hear it's a track --

trick. you have to talk about something else and i have yet to find exactly what it is. we need a big mattress here. and i think the core of that is the corporate and international tax provisions i mentioned earlier but if you are doing good tax policy you have to recognize this is tax in two ways and somehow maintain a unified code. that gets me -- gets you into political hot water because you are trying to get the top individual and corporate rate to come into some kind of alignment. a lot of pressure to push the individual rates up and that's the tax policy box of this era. and being pessimistic about getting it done quite frankly. the tax code turned 101 on february 3 and we have had a handful of major tax reforms.

that tells you the getting it done is hard. it's growing in opposition and i want to congratulate the chairman for pushing forward to this effort and i think it's not a 2014 issue. i don't know if it's a 2000 it teen, 16 or 17 issue but they can't wait forever and it puts her postals on the table and start having a sensible discussion about them would he a good step. students will be the last question and a chance at put everyone in a great mood before they go off to enjoy their lunch. you saw i guess it would be dug the seventh. if you saw doug's presentation in the cbo sharply reduced reductions for gdp over the next decade does that change your optimism about the economy generally and the prospects for the future? spain know. we knew this was coming. it's largely demographic and i

think there are lots of things we can do to increase productivity and a mentioned infrastructure investment. i think they're lots of different kinds of investments including the skills of the labor force, getting older people to work longer in terms of which they can function productively. all of those things are important things to do and it might raise the potential gdp a little bit but no question it's going to go down as our population shifts. >> i am fundamentally optimistic the reality is that all of our potential problems are self-inflicted and we control our destiny. there simply no doubt about that and to my eye there is a handful i mean literally five core reforms that if we got seriously done the skies the limit for the 21st century and that means do entitlement and tax reform trade to immigration reform for a

variety of reasons including economic policy get serious about economic reform and undertake a real regulatory reform so that for the first time this country ask the question is this regulation still a good idea so we will weed out some of the existing rags. if you do those things we are fine. >> can i throw in one more? energy and climate change. when we talk about tax reform we don't generally say we need a carbon tax. we do need a carbon tax. >> let me just ask you all to join me in a round of applause and thank doug holtz akin and alice rivlin. [applause] and alice happy anniversary. [applause]

[inaudible conversations] [inaudible conversations] [inaudible conversations]

>> i think there are some myths out there. i think people think the maraschino cherry is summer carelessly preserve roberts and it's really not. it's no different then like i said it tickled cherry and the brine process is no different than the types of sulfate cheese and making wine so really i wouldn't call it a healthy product that i would call it something that is a tasty treat. see what you see here is cherries in various stages of process. the cherries that come in even though we put them in water they will still have brine so they will go through an extensive washing to get the brine the sulfur in the calcium suds back out of the fruit. the process of making maraschino is basically you're taking the brine and soaking it in a

progressively stronger and stronger sugar and color solution. it's over the course of that syrup schedule you will see the color intensity picked up as the sugar content picks up. you can see here are some fruit that is very early in the process. it's lightly colored. you can see how much darker color it is much further along. it tends to give you an idea on a normal day it was the yellow, pink and deep red. it's just that cycle of the infusion and where it's at in the process.

next a look at calls to create a tracking system for the health care law. this is from "washington journal." it's about 35 minutes. post your guess for the segment is jonathan easley health care reporter for the hill. thanks for joining us this morning. >> guest: happy to be here. >> host: one of your recent articles the report 20% failed to pay obamacare premiums. what does that mean? >> guest: when you go on healthcare.gov or any of the state of the state run health care exchanges you can select a plan unfair but the final step you don't have insurance until you pay the insurer so what we are finding out with industry executives are saying 20% of the people that selected a health care plan have not paid for it

and gone through the final step so when the obama administration read lisa's enrollment numbers in january 3.3 million people had in bold you have to shave 20% off of that it has 20% have them pay their premium. >> host: the obama administration has been touting that number so what is the meaning it's 20% less if you listen to industry execs? >> guest: is going to be something democrats will be on the defensive about. one of these days cms will have to own up to the fact that our enrollment numbers are lower than what we reported. there's a big push by the insurance industry to get people to make that final payment. right now it's only about 80% of the that 3.3 million. >> host: is a possible if i sat down at my computer that i think i have gotten through the steps and i'm done but i haven't made the final step. is that something people are concerned about? >> guest: absolutely and a lot of people are getting healthcarhealthcar e for the first time through obama obamacare and they haven't been

through this before. they might think of a select a plan that's the last thing you need to do. it's not all police the consumer's fault. when healthcare.gov stumbled out of the gate they left the backend in development. so a lot of the information that was going from healthcare.gov to the insurers to notify them who was signing up never got there or got bad information so there has been a delay in insurers billing these consumers. it's not always the consumer's fault. sometimes they're still waiting in the bill. >> host: how do you know the insurer has gotten through all the steps the need to be covered? >> guest: you will get an insurance car in the mail. they are encouraging people to call their insurer to to make sure that but if you have paid your premium you likely have health care but it's good to call your insurer to doublecheck. >> host: arts guest is jonathan easley health care reporter for the hill. if you'd like to join the

conversation conversation republicans 2025853881 and for democrats 2025853880 and for independents (202)585-3882 and if you are an enrollee for a plan you can give us a call at (202)585-3883. the first call this morning is byron and louisiana on the line for democrats. >> caller: yes, the guests there and all republicans why are they so afraid of the middle class and the poor people in this country? what do they have against them? whenever they can announce something against the affordable care act, they realize if it ever goes through and when it goes through they are finished. nobody will vote republican ever again. good light.

>> guest: yeah well i guess what i would say his republicans are walking a fine line right now. they are coming up with their own health care plan an alternative to obamacare that focuses more and free-market fixes. but also you are kind of right. it leaves them in the position of when they are not -- knocking the health care law health care law they have to be careful politically not to make it seem like a callous argument against obamacare and make it seem like they do actually care that the people are getting health care for the first time. >> host: i want to look at some of the numbers on this if you break it down by insurance companies create as many of 30% of customers fail to pay premiums ,-com,-com ma 25% from humana and 24% from wellpoint, 20% from blue shield of california and 16% from independence blue cross philadelphia. what are you hearing from these companies about these numbers? >> guest: they are concerned. i think earlier in the process

we were getting estimates of only 50% had paid. it could be worse. 80% is not ideal in a lot of their focus right now is on reaching out to these people that haven't made a payment. there are other reasons some of these people haven't paid. maybe they'll wait until the march 31 deadline to pay. but these insurance companies are doing is reaching out individually to these people and really pushing them and letting them know that if you want to be covered you have to make a payment. >> host: the next caller is becky in baltimore maryland and independent and signed up for the aca. >> caller: hello? >> host: hi becky. >> caller: ia spent three months to enroll my husband in the aca. took three months and now that i've have enrolled him i haven't

gotten a bill to pay the premium and he is supposed to start on march 1. so i'm not sure how he is going to be enrolled if i haven't even gotten it will to pay the premium. thank you. >> i think that is a common problem in some troubling news for the obama administration. like i said one of the primary reasons that people haven't paid their premiums is that they are not getting their bills from the insurers and that could be because the data from up hasn't been transmitted properly to the insurer. i think you are in a boat with a lot of these 20% that haven't made their payments. i would say contact your insurer and make sure that you have enrolled and in a lot of these cases the insurers are being very flexible with how they deal with these. they will back date your insurance policy. sometimes they are sending people there cards before they have paid with a bill to say hey you can use this as an issue send a payment. unfortunately that's all one of

the main reasons that some of these people have not paid. >> host: let's go to saint louis maggiore and chat on our line with richard. what has been your experience? >> caller: i enrolled in paid a nonbill by calling to find out what the address was. on december 14. halfway through january i give a credit car number to pay my next bill. this week i got my very first bill from coventry insurance. while that was going on i spent many hours on hold with the insurance company trying to get bills, trying to make sure i was covered and when i called they said yes you are covered. when a provider called they said no we have no record of him. >> guest: yeah so this is the democratic line and we just heard from an independent line. this is troubling stuff for the obama administration. ali zanuck does to people who

want these healthcare.gov to work and it's been a difficult experience for a lot of people. you might expect this may be from the republican line people calling in saying this isn't working but that's troubling and we are sorry to hear that. hopefully you can iron out those issues. >> host: i want to ask about an article you wrote how obamacare developers are turning to payment tracking. what problems is that going to solve? >> guest: one of the primary care criticisms of the obama administration during the rollout has been the numbers they are releasing our inflated because they include people who haven't paid their premiums and when you try to find out from them what percentage it is, we have been learning this from the insurance administration and not the obama administration. they say they don't have the capability to track who has paid in the hasn't because people pay their insurers direct with it the backend of the web site that they are building out now than

application that will allow them to track better who has paid their premiums and who hasn't. hopefully will starting -- start getting regular updates on what percentage of people have picked out a plan. right now that is something in the works and i would imagine sometime in the spring april or may that will be finished and we will have a better idea of who has paid in hasn't that it's been one of the things they haven't been able to report on. >> host: next up is karen ann harrison township michigan on the line for democrats. what was your sign-up experiencexperienc e like? >> caller: it was a little rough in the beginning but we got through and we are thrilled with their plan. our premiums are cut in half and our sons as is no longer a problem and we are not stuck with her old policy so i would like to ask mr. easley how much money has been spent by outside group groups of opposing the affordable care act compared to

outside groups that are promoting the affordable care act? thank you. >> guest: that's a good question and i don't have the exact figures to give you right now but i will tell you those sides are spending big on this. republicans have said they are going to make obamacare primary issue in the 2014 election cycle you have all these outside groups in the millions to really make that an issue. and then on the side of the affordable care act you have enrollment activists and other outside groups that are really just starting to ramp up their public relations bids on this. you know when the web site stumbled out of the gate it was pointless to spend money advertising sending people to a web site that didn't work so i think you are going to see that ramp up not just in the next month for the march 31 deadline but also before the 2014 elections. >> host: let's go to new haven

connecticut muriel on the line for democrats. >> caller: good morning everybody. i would like to suggest to the guests and i'm sure he has researched all of this information but the point is this area the obama health care act is going to be a plus for the democrats in particular to families who have had problems trying to get health care for family members who have been turned down because of previous illnesses etc.. now i can tell you this. from my point of view, the republicans had better get on the stick and start discussing issues that are meaningful to the american public out there. they have already voted on the health care act something like

48 times. something that is already law. they need to talk about for example, why are milk prices rising? what is there about this product that makes the price of milk continually rising from week to week? there are so many issues that are not being discussed and may i just say this? i feel sorry for the people in the ukraine and the fact that they are having problems with their government but i am more concerned about what is happening with their our people here in our government and the problems we are having over here >> guest: yeah well you said you think obamacare is going to be a plus for democrats. i think that's an optimistic you

right now. the law is not terribly popular and in fact it's fairly unpopular and this botched rollout didn't help one bit. i think there is kind of an effort by both sides to highlight anecdotal stories of the law either working or not working. you have republicans highlighting cases where someone lost their insurance someone who is gravely ill having changed plans because of obamacare and then you have on the democratic side highlight the stories of people who got coverage for the first time despite a pre-existing condition. that is the battle that will play out in november who is winning that battle but i would call obamacare aide bad idea for democrats. >> host: if we are talking about 20% of people that signed up to didn't pay when they were going to the system how are they responding to that? >> guest: well you know on the republican side you have constant attempts to send letters to cms for health and

human services demanding this information that the obama administration has said they can't supply right now and then you know on the administration side you have a real effort to get the backend of the system up and running. i think it's a real liability for them as long as this remains out there. i think one of the big stories after the march 31 deadline is going to be how big of a hit to these enrollment numbers take when we finally know what percentage of these people actually paid? if you'd administration can close that gap and make it less than 20% they can say they are making process -- progress but they are already going to miss their initial enrollment at march 31. you are looking at five or 6 million if you shave 20% off of that it goes down more. there's a push by the insurance industry who need to want to get paid by consumers and also the

administration to get this up and running. >> host: next that the. >> host: next that the scale and freehold new jersey on line for republicans. >> caller: good morning. the problem is this medical care act as cover of medical care for seniors. you had better watch out people because if you are quite there is no more medical care for you. >> guest: i mean i think i would disagree. i think there is still ample medical care but i think one issue that republicans are going to latch onto and 2014 are these cuts to the medicare advantage programs for private medicare and basically on friday cms announced a decrease payment rate to insurers by 2% so when democrats pass this law medicare

advantage had been a liberal punching bag for a while and i cut 200 million over 10 years to the program in part to pay for the affordable care act. there are ways i think that republicans curse spinning that to say obamacare is hurting seniors and cutting care to seniors. i i think there are still other options available but for some people in medicare advantage they might see their premiums go up or fewer services offered. >> host: the next caller is frank a democrat in pompano beach, florida. tell us what your experience was like signing up. >> caller: i didn't have a problem signing up harriet i am on medicare but my wife is signing up right now. i think they are not giving the government enough credit. people supporting obamacare as

opposed to did not and he did not know the answer. what i'm saying is for a deal this big with up to 30 million americans signing up for health care for the first time, all hands had to be on democrats, republicans and dependents everyone. so for everyone to be on the plate and the republicans do not support it at all. give the government credit. at any point in time even for those who have insurance more than 25% of people have not paid their premiums. i'm talking normally. i'm talking about the veterans of the insurance industry.

20% of the people not having paid their premiums is not good enough for you to join in -- the affordable health care providing americans insurance for their the very first time. >> guest: i think even the obama administration would admit that they health care.of rollout went absolutely horribly. there's the argument argument that republicans have been struck in this law -- obstructing this law every chance they get countless attempts to repeal it and they haven't been on board with helping this law succeed. that's certainly something that democrats are going to be saying and there's some merit there but i don't think the administration called the rollout a success at this point. really i'm not castigating them for saying that 20% of people haven't paid their premiums. it's just something that's out there so when the obama administration is releasing

these enrollment numbers you have to kind of take a step back and say well they are going to end up in lower than what they already are and they are already behind their enrollment goals so i think it's something that's going to be a political issue in 2014 and something that i think insurers and the administration both have a stake in improving. >> host: i want to ask you about the administrations -- and this is something you have written about. the naacp interim president lorraine miller talked about the rollout so i want to listen to this and your response. >> it is not than what anybody hoped for and with that i think comes the persona that maybe this is not something i really want to participate in but once you feel that back and show people the advantages of health care and why that is much better

than using the emergency rooms of our hospitals as the primary care for a lot of people i think people understand it. it helps them plan their health care so it works. i think it takes a lot of education. >> host: you can watch the entire interview on our web site at c-span.org. jonathan easley of the hillyer take? >> guest: i think what we are seeing in the run-up to the march 31 deadline is kind of a more microtargeted public relations blitz by the ministratministrat ion and people that have a stake in the health care law succeeding so on friday a senior obama adviser valerie jarrett did a conference call with reporters and with the mayors of three cities that have large black communities. basically they are trying to coordinate this final push to get members the black community

signed up for obamacare. there has kind have been some fear that some of these minority groups might be missing the administration's message on signing up because the trends in california is that hispanics are liking and signing up. i think what you will see is a coordinate a push to get minorities and blacks to sign up in greater numbers. >> host: you wrote about this in your piece but tell us some of the things they have administration will be doing to target potential enrollees? >> guest: celebrities always help. they have nba basketball players on board magic johnson trying to get the message out and trying to connect well with the black community and i think they do and basically they are working with these mayors to build this infrastructure. each of these cities has a different reason for wide the people in the community aren't signing up. some of the people in the community are very poor and too

reliant on going to the emergency room so anything they pay-fors going to be some sort of a sticker shock for them. so they have to do convincing about why having health care insurance is a better option for them than just relying on the emergency room. >> host: let's go to question from twitter. roger green writes how does the aca help the millions of unemployed/underemployed? don't qualify for subsidies with a part time and i assume he means a part-time job. >> guest: how does that help them? there is kind of big gap in some of the these states that did not expand medicare that is a big issue right now, people who don't make enough to qualify for medicare and oversee federal subsidies. the administration i don't know what the exact percentage of people that qualify for subsidies are but it seems to be a large amount so that is one of the main selling point you here from the obama administration right now. go and check it out and you might get some sort of a tax break or subsidy. >> host: our guest a sub one a

reporter for the hell. let's go to the phone lines and takes more of your calls. next up is frederick from california on our line for democrats and aca enrollee. >> caller: good morning. i'm calling to pick a bit of an issue with -- can you hear me? first of all we didn't spend medicare, we expanded medicaid. as a reporter i would suggest that you reporting keep your personal opinions to yourself. because from the use of the word black and the denigrating way and your use of minorities and your facial expression of humor when you are getting an opinion you don't particularly care for. as far should 20% your investigation should focus quite

simply on an experience that we had. five calls to the insurance carrier to send a bill. and the insurance carrier five-time saying well, we don't have the paperwork. and we knew the question to ask which was the number that we were given by california. oh well we have that. now we have found that the people in the insurance carriers phone room because they did have access to computer, although they found that number and subsequently sent out a bill. so maybe the 20% failure is not so much on the part of the people that signed up or on the federal government. in california it's the state

that successfully managed to cover california. >> host: project you mind if i ask you a quick question about your experience? after all about where you and your family finally able to enroll or is the still process you are going through? >> caller: no, no. the difference is this. if you save 20% are unable to to pay the premium, they can't have a premium if they haven't signed up than if they are getting a subsidy they can't have a the figure to pay the insurance carrier. just like under medicare where you pay a co-pay or if you have an insurance program where you pay a co-pay or an annual fee. medicare, it comes out of social security automatically. so quite frank he if you don't get a bill from the insurance carrier even though the exchange

as already told you how much you are going to have to pay, if you are eligible for a subsidy, if you make too much money and you were not eligible for the subsidy. so those several points i wanted to share with you because they think a reporter should report and we will call it a contributor. i tried not to use the word pundit. we expect personal opinion and though the term was the federal government didn't do too well on the rollout with the affordable care at. i found. >> host: we are little bit short on time so we will give john a chance to respond because you had a lot of stuff that i'm sure he wants to respond to. >> guest: i've would say wasn't laming the obamas for the entirety of the 20% who haven't signed up. a lot of them are still waiting on bills from the insurance company.

part of that i think is the administration's fault but that isn't completely built yet so some of the communications that go between healthcare.gov in the insures isn't going through and i think that's contributed to some of the 20% i think that's probably all i will respond to. >> host: let's go to pittsburgh pennsylvania, william on the line for independence that. >> caller: yes, good morning. my whole thing on the aca is very simply it's so fantastic and it's so great for america how come there are so many waivers issued and how come congressional staffers don't have to be part of that? how come all these people are trying to escape from obamacare? >> guest: well yeah, that's certainly one of the arguments that republicans are using against the law and they have targeted some of these areas where they say they're been exemptions for capitol hill staffers and lawmakers. you have some lawmakers for going some of the subsidies.

they say they shouldn't get any special treatment and that normal americans don't get so that's certainly something the republicans have jumped on and in that same vein there have been so many unilateral moves by the administration to either lengthen deadlines or tweak some aspect of the law to make it work better that you know republicans are saying president obama is overstepping and it's congress's responsibility to enforce these laws. i think that is definitely something that democrats are going to have to be defensive on in 2014. >> host: maddock massachusetts marry is on the line for independents. >> caller: hi. i have to echo fredricks complained about the reporter as well. i think he is almost like promoting the aca over any other alternative payment for coverage for americans. there is never ever a proponent of single payer health care that

is on "washington journal." you never have people who can just explain why the aca won't work and you never, your reporters always explained the aca which is still impossible to understand because it's just an unworkable approach. i would just like to ask the reporter why you seem to be confused -- you're confusing access to health insurance with access to health care and why you don't have a single health care movement which is active at the very much an uncovered by the media. thank you. >> guest: well i mean the media can only cover what's out there. republicans are at some point going to have republicans in the house are going to have their alternative to obamacare. republicans in the senate have already released that in once some momentum builds for that he will probably see a vote on capitol hill.

that's going to be one of the stories and alternative to obamacare. right now obamacare so we have and something that is likely not going to have in the near future and probably why we are not talking about it very much. >> host: jonathan is with a hill and they have an e-mail coming in about the affordable health care act. stephen writes if it's so important for people to sign up for the aca this year why does the enrollment period and done march 31? canopy extended? >> guest: you can enroll for the year but the march 31 deadline is with the insurance companies are going to be using to set premiums and prices for next year so that's the end of 2014 enrollment is march 21 but you should be able to continue to sign up throughout the year. >> host: next on our line for republicans is jeff and also monte springs florida. >> caller: good morning. a couple of things. i have three areas i want to hit number one when you talk about the percentage of people that have signed up the

administration is not released it and it doesn't give us a true picture. of the individuals that have signed up who had no insurance imparted a 30 million that they talked about those are individuals whose companies drop them from their insurance and therefore they had to sign up as well. until you can break those numbers out you're not giving us a complete picture of what this law was intended to do to deal with the people who did not have insurance, not the ones who did. number two we talk about the groups that are opposing this. i think it's important to include the fact that the government itself has spent tens of millions of dollars to run ads to actually go out and talk about this health care which is taxpayer money versus individuals and the third area and talking points again we talk about 30 million people that are uninsured and i'm an individual who has government health care

in my company has sent out a letter in regards to possible changes that are going to be taking place. so you really have about 310 million people in this nation which means you have 280 million who are perfectly fine with their health care or perhaps maybe need some tweaking and the last area before i go maam we are talking about the benefit of this. there are generally four or five talking points for this aca which i agree with. the question should be asked why did it take 3000 pages to talk about health care until you're 26 and pre-existing conditions plus another 20,000 pages of regulations that have come from hhs. we are not talking about that and you're just repeating what democrats and republicans are saying. thank you. >> guest: i think you made a couple of good points. you mentioned the percentage who

had signed up at the 3.3 million that have enrolled or selected a plan. what are centers of them had health care previously and are being covered for the first time is something we don't have the breakdown yet so you can't really use a talking point that says 3.3 million are getting covered under up on the care. a lot of those people might have had insurance previously and are signing up at healthcare.gov for the federal subsidies or something like that but they might have had health insurance and he made another good point about the 30 million uninsured. most people get insurance through their private employer so this was a radical transformation of this health care overhaul was radical and only affects a small percentage of the population. >> host: charlotte carolina, bill is on the line for democrats. >> caller: yes, thanks for taking my call.

thank god for c-span. i have got one question and one question only. if you get a subsidy in this volatile job market if you lose your job do you have to pay the subsidy back wax i know you have to contact them within 30 days but tell me do you have to pay that subsidy back because you don't have a job and you don't qualify for the poverty level so do you ever have to pay the subsidy back into who do you pay it back? >> guest: each specific location is probably going to be different. there are certain aspects of health insurance where if you go through a life changing event, you get married or lose your job or that kind of thing you have other options. i don't know of any cases where you have to re-pay a subsidy that you already received.

basically when you get a subsidy what you do is you pay the reduced amount to the insurer and the insured goes to the federal government for the balance of that plan. i don't know where any assist where he have to repay the subsidy but every occasion is going to be a little different. >> host: randy from missouri on the line for democrats you are on with john from the hill. >> caller: i have a few quick points to make. you are a right-wing mouthpiece so that's a given. the first caller about the republicans and the right-wing papers and their colleagues you researched -- he wasn't only referring to the republicans. you are referring to people like you. why isn't the administration responsible to make sure people pay their --

the aca is a vehicle in which people can gain access to insurance. the final responsibility for paying it is on the individual no matter what. my last point is a person goes to a realtor to get access to a home to purchase a home. a realtor gets them in the house and the first mortgage comes and they don't pay it. do you hold the realtor responsible for that nonpayment and if you don't you cannot hold the administration responsible because people don't pay. what you done is turn the conversation around this right-wing talking point. you really need to back up on that. >> host: are guesses your talk about the 20% of people that fail to failed to pay premiums under the aca so we are going to stick with that today is our topic. >> guest: i would like to respond to that. i didn't say was the governments

responsibility to the chain the payments. what i'm saying basically is we are really at a stage in the health care law where there is a dearth of really solid statistics about how the health care law is working in one of the primary statistics we have is how many people have enrolled in the law. the administration when there has been this uptake has been quick to really promote in say hey luck x number of people enrolled in the end of december and we had another great month in january. there's likely going to be a large number of enrollees march 31 so what we are talking about is looking at the number we are getting from these administrations saying hey look enrollment has improved but also you have to take a step back and take it with a grain of salt, there's a 20% that hasn't enrolled. it's not the governments responsibility, it's not. it's the insurer's responsibility but is just one aspect of the numbers we are analyzing.

>> host: jonathan easley is health care reporter and you can find his work on the hill newspaper. thanks for being with us. guess thanks.

>> what we are told both as students and as a nation in terms of popular imagination is there all kinds of sedans and marches and demonstrations that occur but they are done by these famous iconic people. basically it's rosa parks who was so tired that she refused to get up from the bus in montgomery alabama and sparked the bus boycott in basically a young preacher who even the president referred to during the election as this young preacher from georgia which is dr. martin luther king jr. who sort of leads the masses of african-americans from racial oppression. so this notion that rosa sat and arden could do this stuff and jesse could run and barack, all these things sound good but they

really simplify a much more complicated history and that complicated history really involves so many african-americans women and men who proactively dismantled racial segregation including rosa parks. rosa parks was an activist. she didn't just refuse to give seat by accident. it was a concerted strategic effort to try to transform democratic institutions. arkansas governor mike beebe discuss the health care law in medicaid funding in his state.

his remarks were part of an event hosted by kaiser health news. this is about an hour. >> i speak for all of us i believe in thanking governor mike beebe for being our featured guest today. since taking office in 2007 governors beebe has focused on improving arkansas's educational system expanding its economy and with his wife ginger championing the elimination of childhood hunger. in the context of today's breakfast governor beebe has championed the first in the nation private option plan to win federal approval as an alternative to expanding the traditional medicaid or graham. while the governor's plan in

arkansas has its skeptics among republicans not all republicans in arkansas, it is serving as a model that other states are considering. only yesterday tennessee's republican governor bill haslam was scheduled to meet with the health and human services secretary sebelius in an effort to hammer out a flexible arrangement similar to that of arkansas. with states assuming new roles by virtue of the affordable care act and the supreme court's decision declaring it unconstitutional the united states is entering a new era of federalism with states assuming a larger place in shaping public policy. governors beebe does not have an opening statement that he will entertain our questions. now i will turn it over to our

moderator this morning mary agnes carey of the kaiser health news who will pose the first question. >> thank you so much for then it should action. i will open it up for anyone who wants to ask questions but i wanted to talk a little bit about the week you had in the week you're going to have. the senate did approve continued funding for the private option on four different votes. you were just a handful short. sometimes it was three and sometimes it was five votes. you have another vote set for tuesday. what is your strategy and how are you trying to get those votes? >> i think everybody needs to understand first of all the hurdle that has to be overcome in the sheer numbers. 75% and that is really the story the "washington post" and "the new york times", the public

broadcasting service ,-com,-com ma all sorts of different things have inquired about all of this and in many instances they say how come there's so much opposition? there is not so much opposition. 75% voted in 75% has already been obtained. that is not much opposition. in the house we think the vote as it stands today is 73-25 with two undecided so if you get those two you get 75 traded i think people need to understand that because of a peculiar quirk in the constitution appropriation bills which is really what this is ,-com,-com ma this is just the authorities the approval for the program required 51% and if we were talking about 51% we wouldn't even be talking. so if it doesn't pass and a small minority people, the

strategy is telling the truth. what we did last time was we determined through various means that by utilizing the private option which was the ability to take public medicaid money and buy right insurance with the exactly the same population requiring the minimum requirements that we were able to save roughly 86, it 88, $89 million general revenue that otherwise would have been spent had we not accepted medicaid expansion from the private option. the legislature wanted to and decided to give that money back to the taxpayers. so they passed and i supported tax decreases comparable to the amount of savings generated by the private option. they are not going to repeal the

tax. politically that's not going to happen so the ramifications would be that you would have an 86 million-dollar hole in the budget. what is the strategy? tell them the truth. what is going to happen to the budget? k-12 is sacrosanct so you aren't going to touch k-5 funding. that's roughly 50% of the budget which means 100% of those cuts can make up that $89 million will come from 50% of the budget. the ramifications are significant and i'm sure if there is 135 legislators there will be 135 different approaches to how you would make up through cuts in the budget that loss of that 86 to $88 million in revenue and once they look at that it seems to me the choices are going to be very difficult. we just keep telling them there

is no difference in terms of any negative reason why they would vote against it and in fact they're more positive reasons this year than last year. last year when we passed if they were still granting the specific waivers. a lot of the work done was contingent upon the federal government to grant that. the uncertainty that existed at the time it was originally approved by 75% all those questions have been answered. as i indicated we have passed the tax savings onto voters subsequent to that and now you have got 100,000 or more people that are on health insurance that didn't have it before that would now be taken off of health insurance.

it seems to me it would indicate a positive continuation would be warranted in order are there and then some. so the good news is that the speaker is willing to keep voting. at some point i guess you have to figure out if you are not going to make that last one vote or last two votes. let's throw out another -- and let's talk about budget cuts we have other significant things and my proposed budget addresses those but it goes away. that is where we are. >> all right. let's open it up to the audience. please state your name once you get the microphone, your outlet and your question. go ahead, right here in front. why don't you get the mic.

>> phil galloway. nice to see you again. if this doesn't continue in arkansas how much do you think this will affect other states that are looking at this and you think this will put the brakes on it in other states that are considering this? >> it depends it seems to me on whether or not they analyzed -- it doesn't go forward it won't become because of the overwhelming number of republicans think it should move forward as i have already indicated. in the senate we have got 23 republicans, 12 democrats yet they voted 27-8 for this. it's totally bipartisan support. in the house we have 51 republicans and 48 democrats and the green party and the caucus so i counted as 51-48 and 73 to

whatever depending on where those two and a. so again it's a majority bipartisan overwhelming majority. if other states recognize that if it doesn't go forward it's because a small minority stop that i don't think it will have a negative effect. the substance of what's going on is going to be appealing. it's not going to be changed whether this passes or whether doesn't pass. probably there are very few states in very few legislatures that are facing this kind of enormous hurdle. i joke all the time it's hard to get from motherhood and apple pie at much less something that can be controversial. i think other states are pursuing it and there a lot of things happening in other states that are, how should i put this,

that are interesting. one of the cornerstones of which the federal government did to help pay for this and instantly one of our arguments is we are going to pay for it whether we take it or not. everybody's going to pay for it whether you take it or not but one aspect of how you pay for the federal health care and the proposed medicaid expansion as well as other aspects of the health care act is that medicare reimbursements to hospitals have been reduced. those reductions in medicare reimbursements to hospitals are going to occur with or without medicaid expansion. what happens is those hospitals take a hit without any corresponding offset and even with the offset in most instances they are still actually projected to lose more money than the offset with a medicaid expansion with uncompensated care. the other day we had a couple of

our colleagues on the other side have an epiphany i suppose about the potential harm to the hospitals in their states and decried i guess the ramifications of the federal health care act on reductions to the hospitals for medicare reimbursement. everybody is known as i suppose or should have known this for some time. i have taught -- been talking about it in arkansas so the solution apparently was not to take medicaid expansion. but to give more state tax dollars to those hospitals. it seems to me like the taxpayers are paying twice. there are a lot of arguments. we utilize the potential penalties on businesses that will be reduced significantly

depending upon what the business was and how many employees qualified etc.. in arkansas it was about a 38 million-dollar estimate for small businesses that would be otherwise have a penalty imposed that would be relieved. that wasn't destined that could very. it's hard to put a precise number on it but it's a significant number. certainly the effect on the hospitals just on our medical teaching hospital loan was $28 million a year different to take medicaid expansion versus not to take medicaid expansion so i used to the oversimplified analogy. we are paying 18.5 cents a gallon or something in that area for federal gas tax that everybody in the country pays. the states get federal highway money back in some donor and joni states that we all get some degree of money back from the federal government and it would be like paying the federal gas tax and telling the federal

government don't pay enough our money back for it our roads are fine and we don't need it. all of that and then some and albeit for the fact that it's arithmetic as clinton called it. it's arithmetic. it's not even math. [laughter] as a result of that different folks for different reasons and of course you have the basic altruistic reason that you will have people with health care coverage than ever had health care coverage before. i will also point out i was on the hospital board for 10 years and i had a real job in real life making real income. and we saw what uncompensated care does. there's a cost-shifting. hospitals can stay open if they continue to get 10, 12, 18, 25% of their goods and services away

free and not be compensated for it so you should costs on the rest of this. those of us paying health insurance premiums are paying for these medical bills and that paying more to offset the losses and the taxpayers end up doing that to a certain extent. as was part of our savings because we were able to reduce the tax dollars we were sending to various providers for uncompensated care. we didn't have to do that anymore or at least not as much. all those reasons and then some and probably more than we have time to talk about. >> i'm wondering if you have any tips for governors negotiating waivers with hhs? how difficult was it for you to do it and what advice would you give other governors? >> guest: this is what all the governors are united on. they shouldn't have been hard to negotiate with the national

government. it's already been afforded to someone else. they shouldn't treat anyone any worse and if you are asking for something significantly different he might have to go to the progress. the executive committee that with the president last month as many of you may have uncovered. one of the things we talked about was the fact that waivers need to be streamlined particularly where they are waivers that are virtually identical to waivers that have been afforded to somebody else. instead of starting from scratch arkansas as a way to cover abc and utah wants a waiver comparable to abc. don't start over, streamline and i think they're receptive to that. i think other states, i think the attitude of this administration and kathleen sebelius is very easy to work with on this issue. i think what they will do is try to accommodate and less a

totally violates the basic principles of the statute calls for in terms of who is covered. >> okay, next question? julie? >> they're all kinds of hands up >> julie rovner from npr. medicaid expansion wasn't technically on the agenda this weekend for the governors but this is something that came up privately and informally? >> that is where did. he came up privately. the nga is notorious for trying to stay way from controversy. you are sitting there and you have a republican governors and democratic republic -- democratic governors. there are things that you can agree so there is enough business to do without getting into the things that you have such a huge division on. but privately i was approached and don't ask me names because

fired he told a couple of reporters. i'm happy for you to ask them if you can figure out who they are and i will confirm if they confirm but if they come to me talking privately about what we did and what they might want to do and what they are thinking about doing that i will honor that sidebar. >> can you share with us generally the kinds of things governors are talking about? >> how did you do it, what are the advantages? there are a couple of substantive advantages that immediately pop up. first of all the issue that occurs with those folks who are close to the upper limits on the poverty level creative problem back-and-forth between what you get off of medicaid or on to subsidize insurance so that issue is significantly resolved with the way we did it. that is one issue. secondly and this is a big thing for some governors. we have a tax in our state.

some states do in some states don't but one of the concerns by everybody as we can afford this when the feds start making us pay our share of it notwithstanding the fact that it maxes out at 10% in 2020. we can't afford it so that is an argument against it. what we have is an interest tax so without raising any taxes at all we now have an influx and by the way we did it by buying private insurance of new revenue that can be set aside to help offset the states share of the obligation going forward. that is certainly appealing to some of those folks particularly if they are to have some form of tax so they don't have to quote raise taxes. then you have the added benefit of increasing competition because what we saw was the had more insurance company with folks that would potentially be involved.

we had more insurance companies coming to the state for competition than we have before so it's not just cosmetic. it's truly, there is truly a substantive difference between what we did but the basics are the same in terms of the population that is covered how they get covered and what they get covered by or for and with those income guidelines are. that is the kind of question that i get from our governors and virtually i don't know anyone who has a hurdle yet. i think they have to give me a medal. >> maybe they will, who knows? right here in front. i will get back to you later john. >> just a quick arkansas focus question. speaker carter has says -- has said he is 100% and certain he will get the private option passed again but you aren't willing to say it.

is there reason you aren't as hopeful? >> no, no, it's just my style. to be a little bit more guarded. you know speaker carter has a good handle on his body and he is a good man and a good judge of what's going on. it's just more my style to be a little bit more guarded about what i say about stuff like that for a lot of reasons. first of all i don't want to antagonize anybody. i don't want a buddy to think i'm taking it for granted. i served 20 years in the senate i know how governors can irritate legislators and as governor i know how legislators can irritate a governor. those are individual legislators that have all sorts of things in mind and oftentimes the less said by the executive branch on the controversial issue that haven't declared themselves the

better. so part of that strategy intact it to not try to throw gasoline on the fire. so don't take my reticence to come out just about rejecting anything other than me trying to just hold my power. >> right there in the back. >> good morning. ricardo alonzo with ap. governor this is connected to the rest of your budget and what happens if you can't resolve this impasse? what happens to the rest of your budget? in virginia they are talking about a possible government shutdown over medicaid. is that something that would happen in your state also? >> i certainly hope not. there is no telling what kind of hard all somebody could play. i think that kind of hardball

inevitably backfires on everybody. so i would hope we wouldn't do that. i have got democratic colleagues in the house who talk about that they liked that approach. i think last year republicans in congress figured out they don't want to do that anymore. i think the voting public, the voting public would be very irritated at everybody. it would be hard to figure out who they are going to blame. i think the more realistic possibility is a severe and draconian budget cuts in some central services is likely to be a result if it passed. by its very nature i think that part to show -- particular remedy might be one of the reasons why speaker carter and perhaps others have more optimism about the passing, including me. ..

you got a couple-vote switch. a couple of those folks are running for other offices, including congressional offices, where this is an issue, where the antiobamacare attitude is an issue in a primary. and some of their announced

opponents are opposed to the private option. that don't have anything to do with understanding what the private option is. these aren't people that have been involved in the debate. they're just running for congress that have never been in legislature. i'm talking about the others. they come out against the private option, really without understanding what the private option is. they're just against obamacare, and its caused some people to change their vote. i would argue that that's because of a political race. i don't know any other reason for that. and that's just enough to tilt the spectrum. but everything that was promised, it happened. labor was obtained. everything that was outlined what it would be, ended up being that way. so -- then you have some people that are against it that were always against it, and they're just philosophically opposed to

additional taxpayer subsidized government programs, period. so, some of those folks philosophically that were against it before are still against it. but look at it this way. and realize this. we had 77 votes in the house before. by last count. we have 73 now. you had four people change for whatever rope. -- for whatever reason, the count is creek and to the reasonses could be political, i don't know. i know at least a couple. i know one in the senate was fairly political. but then the other one flipped so it offset it. >> in the middle. go ahead. who had their hand up here? >> i think -- >> robert.

>> governor, has the state legislature -- >> plies please identify yourself -- robert, "new york times." >> has the legislature passed authorization of the state-based insurance exchange and too you think arkansas will have a state-based exchange by 2016? >> that's a great question. they're headed now in the direction of a state-based exchange. i tried to get them to do that to begin with, win all this stuff first came out. and they didn't want to do it. legislature did not want to do it. i guess i could tell the story, matt. >> sure you can. sure. >> i mean, after all, this is just between us. right? >> you got it. >> last year we were riding over to the white house on monday morning, as we'll do here in a minute, as always do, to have a couple hour really intense session with the president, whoever the president is, and i

sat down on a little minibus we go over there in, and butch otter, republican gov of idaho was with me. nice fella. philosophically there's some differences between us. former member of congress. he said, what y'all doing on the exchange? y'all doing a state exchange? i said, no, we did a federal exchange but we actually did the hybrid partnership kind of thing. i tried to -- oh, you can't do that, he said. you got to do a state exchange. obama wants everybody to do a federal exchange. that's howl they're going to take it off over. i said you need to come to arkansas and tell them what i've been telling them. so the irony is the very republicans, antiwashington, healthcare contingent, when all this came out, that didn't want a state exchange, now has come to the conclusion that they want

to reverse their position and do the state exchange. so, yeah, we're headed in that direction to answer your question. >> okay. john ryder. if the vote doesn't good your way on tuesday what are the opportunities for a vote? >> they'll vote again wednesday. >> wednesday. >> and then they'll vote again thursday. >> okay. >> everytime you have a vote doesn't that open the door for a lawmaker to say, to keep my vote you need to do x? >> well you've about run out of xs, first of all, it's not fair to the 73 or 71 or 68 or 52 that have always been there. it's not fire start making deals with somebody at the 11th 11th hour, unless it is something that benefits the entire state, that is not specific to a specific legislator, because if you start that stuff, then the folks that

have always been with you that didn't ask for anything, just trying to do what they thought was good public policy, will -- you'll lose some of that sport. that's a fine line. you can't just start trading stuff away. don't have anything to trade. >> in the back. >> from bloomberg radio. governor, what do the insurance companies stand to lose? what are they doing to help you? how about other companies in the state, like wal-mart, tyson, low-wage workers who qualify -- what are they doing to help you, and one other thing. medicare advantage costs the government more money than made care. how did your insurance cost you less money than straightout medicaid? >> well, let me go book and take the first part of that question. the private sector is doing a lot, and depends on who in the

private sector's ox is getting gored the most. all the hospitals are working -- the board members and the private sector that support hospitals and local chambers of commerce and folks that acknowledge and recognize the ramifications of not continuing this for their individual hospitals, particularly rural hospitals, are working very hard. the chamber of commerce statewide is working very hard. they get the math, too. so, i mean, what we're seeing is what i called the extra -- traditional republican business community, aligned with the democrats. how do you like that? that's how you got three-fourths, and traditional republican business interests are totally supportive of continuation of the private option. talk about medicare advantage. you're talking about something

i'm not even messing with. so i don't have to ask somebody about that. i can tell you that part of what we did with regard to the labor was to keep the costs pursuant to the interest rates for medicaid expansion in our case, call it if the private option, had to be within the parameters of what was anticipated by expenditures by the federal government, and that's where we are. we have been able to do that. and we've been able to do that to some extent with some additional competition. >> with the philadelphia inquirer in pennsylvania we have a governor is who trying to out- beebe you, sir. going to require work search, trying to changes to the medicaid recipients. >> we haven't done all that. >> pardon me? >> we haven't done owl -- all

that the the private option. we have not required the work stuff, and we haven't changed the existing medicaid requirements. >> right. so what do you think the prospects for success are? >> you'll have to ask -- you're a better judge of that than i. i love philadelphia. i'm mad at you, you closed one of my favorite restaurants in all of north america. >> we can send you takeout. >> i can't answer that question. i think what -- i think corporate -- as a lot of other governors have, looked at the pure math. their people are going to pay for this whether they take it or not. their taxpayers. their hospitals are going to pay for this whether they take it or not. they are not going to impact the federal deficit or change what is going on with our national debt whether they take it or not.

and they -- a lot of them have awakened to that. i hate to be repetitive and give too much credit but it is arithmetic, really, people. and the logic of it permeates most of these people. i'm not calling out names so you'll have to judge who it doesn't permeate yet. but -- i mean, i don't knoll any -- look, most of our people in the legislature do not want and do not like obamacare, as they call it. this is not an endorsement of obamacare in arkansas. if you took a vote in arkansas it would be 68-70% of the folks would be opposed to the federal health care agent and if you took a vote in the legislature whether they would vote up or done whether this continues nationally, they'd vote against it. they have been able to separate the fact they can't control in little rock or not going to kole in harrisburg what they do in

congress. it is -- if you don't like it go to congress, vote. run for congress, win. in the meantime, you have an obligation to your people in your own state to do what is best for the people in your state with the cards that are dealt you, and so these cards have been dealt the entire country, and the entire country is dealing with it in different ways but most of these governors now have recognized that there are major advantages to their state and to their people to take it if they're paying for it anyway. and so that's what the fight is right now. how do you get there? a lot of them are constrained by the pure politics of their own situation, and my argument is, -- we're all supposed to do what our people want. we're representatives. i get all that. but a governor has a responsibility to lead, too, and to educate, too, and sometimes

it seems to me -- it's easy for me to say i'm not running for anything else -- i would like to think i've been this way all my life, and part of my responsibility, and i think part of anybody's responsibility, is to help educate your own people about what you believe is appropriate good public policy, and i think a lot of them are now starting to do that and trying to do that. including a lot of republican governors. a lot of republican governors who -- did anybody see jan brewer pointing her finger in obama's chest a number of months ago? anybody think she is a big fan of the president or what's going on? she took it. and then she said if they don't keep it, it wrecks your budget. it's arithmetic. >> you think it's just a matter of time before the governors that haven't accepted the medicaid expansion do so? >> there's some i don't think they'll ever do it. i'm not going to go there.

but i think more and more are trying to find a way to do it. you all have reported on some of it. you have asked questions about the specific names. i certainly have been asked by many of them about ways to do it so, yeah, think it's incremental there will be more and more. >> okay. >> i know that's what y'all want to talk about but let me throw throe something else out that is important, maybe a bigger deal than what you're talking about. in the long run. if y'all are healthcare reporters, and maybe something that i've been asked about by members -- other governors as much or more than medicaid expansion/private option in our case, and that is payment reform. we are actually leading the country in a methodical, logical, and reasonable way to reform the way we pay for healthcare in this country, and

i think that's going to be ultimately the huge story before it's all said and done, and it's -- we got to get away from fee for service, and we're doing that. but i don't make public policy in arkansas in a backroom with a bunch of staff members. i think you involve the actual frontline people that have to implement whatever that policy is, as you're formulating the policy, not after you have done and it said, here it is. so we had the medical community, hospital community, insurance community, patient advocates and all sorts of folks from the beginning, over a couple year timeline, and incrementally and slowly shift away with various episodes of care away from the old fee-for-service model into something -- this is hard to do. it's a balance. how do you reward quality? how do you ensure quality and

efficiency, cut costs? almost -- you would thick that would be mutually exclusive. it's not. let me give you one quick anecdotal story i keep telling over and over because i love it. one of the first episodes in the way this works -- i've got surgeon general here and a medicaid director here if you got real questions that i can't answer. you have a baseline of, say, what it's normally going to cost for a certain procedure. has to be safety net for unforeseen consequences, but one of them was pregnancy and labor. and a normal delivery, and hires the baseline. when we're establishing this stuff we had a fine ob/gyn who just raised cane. you can't do that. all of my deliveries are way over this line. i'll lose money on every delivery. can't do that. well, unbee meant to to him and with at built of self-examination as this was

occurring, in every pregnancy in every delivery, his office was sending every placenta to a pathologist. whether it was called for or not. whether there was any reason to be doing that or not. and so the pathologist is making a little money. he didn't know that. the office was doing it as a matter of routine. when they stopped that and decided to send only placentas that required to be sent for pathological examination, his base line droppedle and he is going to make more money. and what's going to happen? the taxpayers, insurance companies, everybody in general are going to be paying less. so, i mean, that is where this country has to go, and everything we talk about, we have bernanke there yesterday for the governors-only thing, and people kept talking about the gdp and where the country is going and what the economy is going to be like, and consistently healthcare costs, both public and private

healthcare costs, continue to be the unknown factor, including with the into it. ment programs, -- entitlement programs that posed the greatest threat to the stability of the economy. and if everybody is going to talk about healthcare coasts be unpredictable and we don't have any better outcomes than other western industrialized nations, that are doing it differently, then we better do something different and we started it in arkansas, and more and more folks are starting to do that. i'm sorry that wasn't what y'all wanted to talk about but you need that in your radar. that's the next big story, and ultimately maybe the bigger story overall. >> okay. i saw two hands up here. >> i wasn't making -- >> start back there. i'm jeffrey hess with the mesothelioma -- mississippi broadcasting.

have heard democrats make the same argumented and it's fallen on deaf ears. if you think of the branding of the arkansas plan vs. obama cad will make it easier for republicans to come to the table. >> somebody asked me that question the other day. did you do this because they changed the name of it? it's more than that. it's what we did was substantive as well. and you got to -- i gave lot of our republicans credit. what i call traditional business republicans. because they helped formulate this. they deserve a lot of credit. this was truly a bipartisan approach. yeah, it had a different name and did that have an effect on some folks? you bet. but it's more than that. it was honest to goodness substantive differences that lent themselves to private sector support, and it certainly provide a pathway for folks in our state, even with the 75%

requirement. if i were talking strategy, yeah, i would talk about that in mississippi or alabama or south carolina. i think that there are principles that we utilize that would be appealing to some folks on the other side of the aisle, and i think democrats embraced it pretty wholeheartedly, at least our democrats did. and so if you're asking me, would approach like this help? your state? i think it would. -i think the starting point you got to get a bell cow, whether it's a legislative leader or governor or whoever, that has to embrace it first. and the start trying to sell it. that answer your question? what else do you want? [inaudible question]

>> seems to be it's not quite the answer that people in my state are looking for. >> well, you're probably right. >> all right. right here. >> 22nd? >> i can't see. okay. whoever has the mic. >> hi, governor -- i work for public radio in boston. thank you for your time. >> how are you in. >> i'm great. >> mad at the red sox, they beat my tigers. >> you'll have next year. so, my question is, who, meaning government or someone in the private sector, makes sure that savings, if there are any in payment reform, come back to me, the consumer. >> that's a really, really good question. theoretically, competition will generate some degree of those savings. if indeed healthcare costs are going down, then theoretically

insurance -- health insurance company a a. is going to have to lower some degree of rates to be competitive with health insurance company b. what we also have is the ability to take the data and present the data in our case to our insurance commissioner, and transparently let the world know what the data is actually showing. i frankly dope think this is going cause a lot of reductions. in what we're spending. i think what it's going to do is stop the growth, which is just about as important. the upward spiral of healthcare costs outpacing inflation is -- and outpacing growth in general, has been the huge problem in terms of eating into our gdp. so i wouldn't be overly optimistic that all of a sudden, when we do this and implement

these, we're going to see significant reductions. i hope we see some. we have seen a huge leveling off but the whole country has with regard to healthcare costs. our medicaid projections are much better than they were a year and a half two years ago-but so are everybody else's for that matter. so we have seen stagnation in that inflationary spiral. but you al have any thoughts on any specific ways that the savings are going to actually show up and be realized in somebody's pocket in terms of their healthcare costs? >> let's get the microphone before you answer it. >> give him the mic. >> he -- i just asked him to talk. he's the surgeon general. dent know squat about insurance so won't be dish. >> thompson, surgeon general for the governor. one is increased competition, our marketplace has not been

very competitive so with payment improvement combined with expanded coverage we'll hopefully have increased competition. the second is the savings are equally disbursed between the bayors and at the providers, show to payors will transmilt they savings back to their customers, whether the customer is a business, paying for insurance, or an individual buying insurance. >> i don't mind you being skeptical about this. and i think it's worth watching very, very closely to ensure that it works. but i can tell you what we're doing is not working. where you reward through payments every test, that's not conducive or efficient and doesn't necessarily help for quality of care. and you know what, with the technology we have now, if somebody does an mri in hospital x in a rural area, they can

immediately transmit now and the doctor in hospital y in a metropolitan area can in real-time have that information, and doesn't have to do another mri seven hours, ten hours, 12 hours later, unless it's called for because of some particular thing that's going on with that patient that is different. and so in the past, you get paid for the extra mri whether you needed it or not. now you're not going to. not unless there's justified reason for it. that's across the board with tests and everything else. it also rewards and puts almost an -- the burden and responsibility and the coordinated care effort on the part of the primary care physician. puts the primary care physician in control, and got so much in the way of health care costs -- i don't mean to get off into this because it's different than what you asked -- that a lot of this stuff is manageable if you keep healthcare costs down. a lot of these conditions, whether it's diabetes, or high

blood pressure or whatever it may be, properly managed with a proper primary care physician making sure people do what they're supposed to do, have a reward for being able to follow up on it, can prevent a lot of higher healthcare costs down the road in a more expensive setting. >> we had question right back here. >> dianne weber with kaiser health. i wanted to go back to something you said earlier about small business. you said something like $38 million savings for the private option. is that because people who are working for small businesses would be eligible for that private option, so the small business wouldn't have to -- >> yes. that is the estimate, and, again, part of that has been disease -- has been delayed. they keep delaying -- that is an estimate that was done based upon those folks that fit those

categories. and we got a lot of small businesses, convenience stores and folks that might in the aggregate, because of the way it's imposed, be over a 50 employee threshold or otherwise have to pay penalty but they're not paying the kind of wages that allow them to have subdiesed health care and would fall within that 138 poverty poverty level and that's an estimate of what penalties would be -- would not have to be paid by an amalgamation of those businesses across the state. is 38 right? nobody knows for sure. that as good an estimate as our folks could come up with. and this is private sector estimate. i saw in one -- i don't remember whose publication -- might have been politico -- i saw recently an estimate of something like 300 to $400 million a year is

taxes on small businesses. anybody see that? i only got one that saw it? matt, you saw it. where did matt go? you saw it. i didn't see that? i thought y'all read the newspapers. >> we're going to look it up. >> can i just ask another question? >> sure. a followup. >> how long have you had that 75% -- >> back in '20s or '30s. it's not my idea. >> we have one right here. >> ohio's wcpn public radio in ohio we have had quite the contentious battle over medicaid expansion as well. one question i'd like to ask, cost analysis you. talk about 100,000 people being on there. how are you accounting for cost savings?

you mentioned several ways that costs are being saved. how do you tally that up and how do you report it to the public? >> you're talking about the 80 some odd million dollarss we saved as a result of it. that's a great question, and i'm not doing a very good job of explaining that on the front end, because really we had people running for governor right now in arkansas that asked that same question, which show is wasn't doing a very good job of explaining it on the front en. that has been saved. we were -- it's primarily in two areas. we were giving state general revenue to various providers, including but not limited to the med center and other folks, community health centers, et cetera. we were paying x amount of tax dollars in our annual budget in the form of general revenue to

offset uncompensated care. so, we didn't take all that back. there's still going to be some uncompensated care. the various entities are still going to be treating folks for whatever reason that don't pay a dime. and we didn't do 100% pull back of the dollars we were spending but be did a significant portion. there's a small but important portion of existing medicaid people -- tuberculosis, et cetera, there's a certain population in everybody's existing medicaid program that can legitimately go over to medicaid expansion, all right? so they go from us paying 30% to us paying zero.

and that varies from state-to-state. understand what i'm saying? so a combination of those things saved $89 million that we were spending in our regular budget already before any of this stuff came up. now we don't have to spend that. so that savings was automatically created because those obligations were releaved by the private option. it's not a question of how are we going to track the data, how many are signing up. we already know that data. it was in the budget. you follow what i'm saying? now, if we don't do the private option, then we have -- that $89 million theoretically would be paid somewhere. right? but we already gave it week in taxpayers because we cut taxes -- we cut our overall income and our overall tax policy by an amount of money equalo