bill passed, a lot of times it helps to have some quid pro quo, this for that. this rider, this court project, these earmarks or that earmark, you get more supportive votes. that is logrolling. >> reporter: watch cram for the exam on saturday, may 4th at 9:00 eastern on c-span. >> julie rogner continue the conversation about medicare for all of the affordable care act, the status of it, what may be ahead for the affordable care act. folks a little bit on medicare for all, why do you think it continues to be top of the democrats agenda going into 2020? >> it is the top of the public's agenda going into 2020.

exit polls coming out of the 2018 election said there was a big issue for a lot of voters, healthcare with all the changes made by the affordable care act, healthcare is too expensive for many people including a lot of people who have insurance and they're worried what will happen if they get sick. our healthcare system is considered dysfunctional, different people believe it is dysfunctional in different ways. i have been covering healthcare in washington since the 1980s and it has retained its status as an issue the voting public cares about. >> host: what is the status of the affordable care act legislatively on capitol hill? the leadership wants to take some steps to bolster it contrary to the moves we've seen in the past number of years out of the republican house, to aluminate the affordable care act. >> it is a struggle within the

democratic party. they want to spend their time and effort fixing the problems with the affordable care act and there are some problems with the affordable care act. it is not generous enough for a lot of people who either can't buy insurance or can buy insurance but can't afford the parts they are expected to pay themselves, the deductibles and copayments. or do they want to spend their time talking about medicare for all and a bigger expansion and bigger change to the healthcare system? house democrats know that whatever they pass is unlikely to get through the republican senate and unlikely to be signed by a republican president so they are messaging for the next time they are fully in power and there is a struggle going on. there are a number of democrats including president of candidates who say let's fix the formal care act now and get on a glide path to more expansive changes. >> the overall fate of the law itself is in the balance with the court case in texas, tell us about that.

>> it is still, some questions in 2018, a number of republican state attorneys general and governor's filed suit saying when congress passed the tax bill in 2017 that got rid of the penalty for not having insurance, tax penalty, that rendered the entire law unconstitutional because in 2012 when this up in court upheld the constitutionality of the aca chief justice roberts who wrote the opinion can get on congress's use of taxing power, no tax, no law. they found a judge in texas who agreed with them. that case is on hold as it goes to the court of appeals and there is every expectation no matter what happens the court of appeals it will go to the supreme court, but there is still this sort of doubt hanging in the air about the legal future of the portable care act. >> host: for the moment it appears the president has set aside his ideas tweeted out and mentioned several weeks ago about being the party of healthcare and coming up with

an alternative plan to the affordable care act but from what we know of republican efforts, what would be the quintessential republican plan to counter the affordable care act. >> guest: republicans, like democrats, are not united on what to do about healthcare but one of the places they seem to be in at least semblance of agreement is turning a lot of money the federal government spends on healthcare particularly the medicaid program back to states and let the states decide what to do. that was the last bill that was not able to pass the republican senate in 2017 and a version of that is in the president's budget plan given to congress. there was work going on in the white house to put flesh on the bones, to come up with something more robust in the way of a plan but senate

republicans who did not fare well trying to repeal and replace the affordable care act, in pretty uncertain terms they do not want to readdress this this year. they found no success and don't think things have changed enough. what senate republicans are working on are pieces of the health system. high drug prices, things where they think they might find some bipartisan agreement, democrats working on these things. >> donald trump if he is nominated in 2020, might the campaign be forced based on the fact whoever gets nominated by the democrats there's going to be some sort of medicaid for all, government's role in whatever healthcare plan a democrat poses seems to be increased. >> guest: republicans are having one place they all agree, they thought they agreed on the formal care act in

saying no, they don't like the formal care act. they have not reached agreement what they would like instead that they all say they don't like the affordable care act. similarly they don't like medicare for all. that is the republican party line literally, medicare for all is socialism and that is not something they have any intention of ever supporting so i think that will probably be the strategy going into 2020, rather than have their own proposal just make sure they pin what the democrats are proposing as something they don't like. >> host: we have broken up our phone lines can if you are healthcare from the affordable care act that line is 202-748-8000. if you're getting employer insurance, 202-748-8000. and all of this 202-748-8000,

and and and there are many proposals out there. does it surprise you on the broad range of plans, >> whether there is general consensus, medicare for all is bad. general agreement among democrats, expanding coverage in the a formal care act would be a good thing. the healthcare system is large, sprawling, touching different people in different ways and you have to figure out how you will be here to there, various plans for doing that. the house democrats medicare for all plan will be the most dramatic. it would shift everybody to a new programming two years. bernie sanders has a for your transition. we could offer a public option

in the affordable care act exchange. you could allow a buy-in for older people for whom private insurance is very expensive. it might start at 55 or 50. there are some proposals that propose to enroll children as they are born so we move the age up. there are various ways to do this and all of them are on the table. >> a fellow on the west coast, a veteran who is happy with his finance choice program, relatively new feature in the veterans administration. anything similar working in a medicare for all program? secondarily is that program working for most veterans? >> most programs would exempt the va because they talk about medicare and social security being the third rail of politics, there are a lot of problems with the va but

veterans who use veterans facilities are pretty help -- happy with them. whether they retain standalone status, it might, something that needs to be discussed but it is important to remember that the va is different from medicare, more like the british health system where facilities are owned by the government, health professionals are paid a salary by the government. that is not the case in the medicare for all medicare program where the government sets prices but the healthcare system provide services in private. >> host: back to a piece in the new york times, in terms of funding for this. bernie sanders estimate over the course of the year was $2.8 trillion and a number of other economist and organizations looking at the cost of it. how would it be paid for. what is the generally accepted

way how this new plan would be paid for? >> guest: the generally accepted way is taxes would be raised. how? who would pay? how much? is all up for debate. none of the people who produce medicare for all plans have produced their own financing system. that, when congress was doing the affordable care act as complicated as it was, purely democratic effort, the republicans sat on the sidelines. they agreed among themselves, it doesn't need to be paid for so there was a lot of work figuring out sources of revenue. the same will be true with any expansion and further expansion to the healthcare system but all this talk about how much it would cost, the real question is costume? will it be all federal taxpayers? just the wealthy?

will people be expected to kick in some money for their healthcare? some proposals say we will give you all the healthcare you need but you will not pay for it at the time of service but how you pay for? who will pay more, who will play less? it is as complicated on that side. >> host: we have calls for you talking about the affordable care act, healthcare in general, medicare for all proposals. let's go to maria in fairfax, virginia. >> caller: the a formal correct in 2014, i had a great experience. before that i was keeping my job because of insurance. it is amazing. it went up this year but better to have insurance than not to have it at all. after my divorce i worked 3 jobs and didn't have insurance and suddenly, $15,000 back into the industry. i do believe in the affordable care act.

the people against it have never experienced to be without medical insurance or never read a page of the formal care act. i'm a cancer survivor. the premium was extremely high when i was working for the state of virginia. now i work privately. they don't cover insurance but i do have the affordable care act and i believe everybody should have insurance. >> host: thank you. >> guest: thank you for the call. this is one of the things you for the care act did that everybody should say and that is to enable people with preexisting conditions to get coverage. prior to the for the correct a lot of people did not get job-based coverage could not buy coverage at any cost. they recently declined or if they were lucky enough to find coverage it would be dramatically more expensive than coverage for a healthy person and that was one of the big things the affordable care

act changed, republicans would like to keep. it is hard to keep that without many of the other changes made in the affordable care act particularly the subsidies to help people purchase insurance because you need at least in healthy people to buy their own insurance. only the sick people will buy insurance and premiums. >> host: we are eight or nine years into the formal correct. >> guest: the main part, starting in 2014, we are five years in. >> host: two years into the presidential campaign. how are the numbers of the affordable care act? how many people use aca? >> guest: hard to tell how many gained insurance because at some point the health system becomes the entire health system but we do know people on the exchanges, less then many experts were predicting but one of the reasons, smaller businesses who offer insurance stop offering it and send people to the exchanges but the

exchanges have been not very secure. there were a number of supreme court challenges and all kinds of changes. the system to sign up didn't work when it launched in 2013. a lot of people who were expected to end up on the exchange have not. we also know a large number of people ended up on medicaid. probably 14 million. hard to tell. a number of state of not expanded medicaid. some are looking at it now. those who did a large number of people got insurance through the expansion of the medicaid program. >> host: let your from west chester, ohio. deborah its employer insurance. good morning. >> caller: i am retired. regardless of the type of insurance we all have, unless

we address high risk cost associated with high risk choice none of us are going to have reasonable healthcare cost. as an example, treating trauma associated with driving under the influence is $35 billion a year. children who are born to a mother who is addicted to drugs, the cost to that child, a new citizen coming to the united states is $400,000 per child. totally all the nonconformance associated with these high risk costs and high risk behaviors is $500 billion a year which is $1500 per adult in the united states per year. the idea is we have to start talking about personal choice and personal behavior and their needs to be compassion but monetary consequence. if we were to take those

behaviors and set them aside and allow them to be considered a tax which is what they are because it is a society's choice, put that in a separate account within each state and let the people of each state pay a tax with a personal behavior of each state. no doctor, no politician could ever get their hand on that money. in terms of the doctors, the doctor what apply for reimbursement for his services within that state. if the state of colorado was extremely healthy, then the people in colorado would split that cost and it would be a lower cost but if people in kentucky were heavy smokers and their costs were higher, the people within kentucky would pay that cost. we are going to have to change, it has to be a radical change because our medical costs right now are $9000 per person within the united states. >> host: thanks for that.

>> guest: the main reason the united states pays more healthcare than other industrialized countries are not high risk behaviors but the prices charged by the healthcare system, hospitals and doctors, nursing homes and physical therapists and everyone charged are dramatically higher. we don't use that much healthcare as a society than many other industrialized nations. we just pay more for what we use. all of that said, obviously there has been a robust debate over a long time about the extent to which people should be responsible for their own healthcare particularly things like high-risk behavior. that is why there are laws mandating the use of helmets and seatbelts. the affordable care act did indeed about premiums to very for smokers and non-smokers and that was very controversial. this is something that has been addressed over the years. it is hard to know where to land.

it continues. >> host: is smoking a preexisting condition? if you're a smoker - >> guest: in some states, not in every state. it is a preexisting condition, personal choice but also addictive and can be hard to quit. >> host: on the issue of costs, prescription drugs came up before a house hearing. the washington post page went to cunningham writing about it, house leaders buying a vote for lowering the high cost of prescription drugs as democrats and republicans alike try to prove they are serious about taking on troubling issues this year, the potential a debate package withdrawn from a slate of bills recently passed by the ways and means committee and the energy and commerce committee, the top two congressional panels, with healthcare jurisdiction, how could congress legislate

prescription drug prices? >> guest: there are a number of things they're looking at like transparency. getting inside that black box to see how much of various players in the healthcare system are paying for these drugs and how much is left for the patient to pay, we don't know, there is a list price and it goes through these middlemen and distributors and comes out of the pharmacy and you have no idea how much anybody paid for that except you so there are a lot of causes for that. a number of proposals to help generic copies that are generally cheaper of drugs to market and brand-name manufacturers managed to block those. there are efforts to get rid of some of those roadblocks. there is a push among democrats for medicare to negotiate prices when medicare additives drug benefits in 2003. they were explicitly not permitted to negotiate prices. that is also controversial because if medicare is going to

actively negotiate prices they will say no to some drugs, some people might not be able to get the drugs they wanted because medicare negotiated better price for different drugs. that is also an issue. how that would happen. nothing in healthcare is easy. drug prices are particularly complicated. it is an issue republicans and democrats in the president want to work on. >> host: let's hear from oliver next in trumbull, connecticut. good morning. c-span2 >> caller: good morning. listen to the conversation i sometimes wonder when we are going to get away from debate and start talking about compromise. democrats want affordable healthcare for all and i see that as being a noble thing. the republicans want borders that are secure from the other

side of the aisle. if you look at the countries most people are talking about when they call in, denmark and places like that. i lived in australia for three years and i can tell you while in australia they have a healthcare system that works very well at low cost for medical care and drug prescriptions. the reason these countries are able to do this is money in versus money out. the money that comes in from taxpayers is used and there is a small amount of folks in those countries that are not paying taxes. comparatively speaking the united states where we have a number of people in our country that are not paying taxes or paying into the system, sucking off of that money put into the system to support those people on healthcare the do pay taxes. compromise in my estimation when you look at it, we say all right, democrats want

healthcare, got that, republicans say we are willing to compromise on that but at the same time close the borders off. that is my opinion. >> host: compromise on healthcare. >> guest: compromise is in increasingly short supply. there was a lot of compromise, people didn't run on it. there was an enormous amount that could and was done particularly on medicare because that was the main thing, and medicaid that congress oversaw at that point and after bill clinton made a huge push to change the nation's healthcare system, it gets a little more politicized and got more politicized as years go by and democrats did the 4 or corrected 2009-2010 republicans decided they were not going to participate because they wanted to keep it as an electoral issue.

the more you want to run on it the harder it is to get people to sit down and say we should give a little and take a little. there is the primary becoming a verb. democrats are afraid if they moved to the center they will be challenged from the left and republicans are rate of they moved to the center they will be challenged from the right and they are not incorrect. >> host: the administration staking their position in a case in texas, supporting the attorney general opposing the aca. the attorney general on capitol hill for a hearing in the past week or so, was asked why the justice department is making these efforts to strike down the aca. >> have you conducted or viewed an analysis to evaluate the effects of doj's litigation position to overturn the aca, the effects on consumer cost and coverage? have you done that analysis or have you reviewed one? >> when we are faced with an illegal question, we try to base our answer on the law.

>> so the answer is no. here is the thing. i can't imagine that you would take that kind of a dramatic drastic action without even trying to evaluate the consequences for the american consumers, the people using the healthcare, the people for whom these premiums are paid. if you are successful in this lawsuit that you are supporting and the entire patient protection and affordable care act is struck down, millions of americans who currently receive health insurance coverage under the law are at risk of losing that coverage. am i correct in that? >> the president has made clear he favors not only preexisting conditions but would like action on a broad health plan. so he is proposing a substitute for obamacare.

>> the one it will come after the next election. >> the one that will come down if and when. >> let me be the one to inform you should the law be struck down, millions of people who get their coverage through the aca marketplace would lose their coverage and tens of millions more would see their premiums skyrocket. in addition, if you are successful, 12 million people nationally and 750,000 people in my home state of pennsylvania who have coverage under the medicaid expansion would also likely lose their coverage. am i correct in that? >> do you think it is likely we are going to prevail? >> if you prevail, you are devoting scarce resources of your department for that effort, are you not, attorney general? >> we are in litigation. >> the answer is yes. you are trying to get it validated and if you succeed, that many people will lose their coverage nationally for medicaid and 750,000 from pennsylvania alone, right? >> if you think it is such an outrageous position you have nothing to worry about.

let the courts do their job. >> host: let the courts do their job one way this could wind up at the supreme court, with the administration in a similar position of not backing a law that has been in effect for five years. >> that is right. this came as a shock to legal scholars, a change in position from the justice department its original position they took last summer on this lawsuit which is when they said we don't agree with the attorney general that the entire law should be struck down but we do agree that some of the provisions most closely tied to the tax penalty which is what the issue his here should come down. interestingly the issues tied to the tax penalty are protections for people with preexisting conditions because that, when the tax penalty was put in the law, it was intended to make sure healthy people signed up too so insurance could afford to cover the people who were sick or. what has been discovered now that the requirement has gone

away as of this year, the tax penalty has gone away. it is mostly the subsidies, the ability for people to afford that coverage that is helping healthy people sign up. of the tax penalty not to make that much of a difference, what the justice department did was decided in december is at the appeals level and the attorney general said the justice department had to take a position on the appeal and they said since district court found this was the case we are going to side with them. they not only are now signing against a law which is unusual for the justice department, their job is to defend federal law in court and they are not defending the law but they changed their position. reporting from a number of outlets both the attorney general and secretary of health and human services did not wish for the justice department to come out with this position as

were over -- a fairly tense white house meeting. the attorney general not so much in this exchange with subsequent changes was pretty clear that this was not his idea to take this position but as far as he was concerned it was legally defensible because that is what a lower court said. >> host: if court finds in their favor that would end of preexisting conditions. >> guest: it would end the entire law following the appeal. >> host: this is the first year that they tax, the tax penalty was in effect. it is gone. not on the tax returns for 2018. >> guest: it is on tax returns for 2018. 2019 is the first year it is gone. >> host: a significant loss in revenue in that or an incentive for people --

>> weather was encouraging people to sign up for coverage, people are now signed up for 2019, first year with no penalty, almost as many people signed up for 2019 that signed up for 2018. obviously we can demonstrated didn't have a large effect. there was not a huge drop off of no penalty so i'm not going to buy health insurance. >> guest: the administration reduced that window for sign up at the end of the year. >> guest: they cut 90% of the outreach to encourage people to sign up so even in the wake of all of those things that would tend to the press sign up and sign-ups were pretty robust. >> larry, good morning, go ahead. >> caller: good morning c-span. this reminds me of the dog chasing its tail and i don't

think the dog can catch its tail. i have blue cross blue shield, i had va, i have medicare. medicare does not they, blue cross blue shield will cover and then i also have tricare. ..tri-care. my son is a primary care doctor. he says that medicine is a privilege, not a right. if you have medicare for all, it will become a right. it will not become a privilege. you do not want your doctors all being paid the same. a primary care doctor, all primary care doctors would be paid the same wage. an anesthesiologist, they would all be paid the they would all be paid the same. we used to put federal prison inmates into rochester, minnesota, the mayo clinic.

you look at all the planes on tarmac and look at all the different flags on the tales of those planes that are from foreign countries that apply to the mayo clinic to rochester, minnesota,. >> host: will get some response. >> guest: its import remember most of what's being proposed is that what they have in england. as i i said that's more like te v.a. it is sort of a true socialist system. i will add the risible for private insurance in england, not much butmu there is one. what steve proposes more like canada and more like the current medicare program where as the government does that or negotiate prices but they do not, they dow not own and he did not employ people to work in the healthcare system drama what's the future of americans being able to get their prescriptions in places like canada and from england? it seems like certainly the

resources and canada are not there like they used to be. we can't get as much choice from candidate from what i understand. >> guest: the big problem is that everybody were to get their drugs from canada, canada would run out of drugs. candidate does not exist to provide lower-cost drugs to the united states. this is ated an float over the last 20 years when medicare added its drug benefits, the pressure to be able, for your citizens to buy their prescriptions and other countries went down and now we're seeing this spike in prescription drug spending, seeing the desiren there. bottom line is every country except the u.s. has some sort of price control on their prescription drugs. that's why they're cheaper in other. countries. manufacturers don't like it, that they sell there. what the drug company site is the use is the biggest market, and if they were required to

sell and use of spices basil and some of thesear other smaller countries, they would go broke. they wouldn't have enough money to create new drugs. this is the back-and-forth tension that's been going on about the ability of u.s. citizens to buy their drugs elsewhere. most people agreed sort of the best solution to this would be do something about drug prices here rather than some people to other countries. >> host: b so by from foreign countries, the net effect is buying from a country that supports the reduction ofts prie and that country, england or candid or elsewhere on that american-made prescription. >> guest: that's right. >> host: julie rovner discussing the affordable care act, your calls and d comments welcome.

we've been talking about earlier medicare for all. just a broad look at it from the "washington post", defining medicare for all. they said it would move the u.s. in theay direction of a single-payer system where the government steps in rather than an insurance companies as the intermediary between patientss and providers in healthcare transactions. bernie sanders played introduced last week officially a single national payer medicare system with bass expanded benefits, it would prohibit private plane trump team i can compete with medical, in limit cost-sharing, includes universal provision for long-term care, in-home and community settings. what is cost-sharing? >> guest: cost-sharing is when you pay at the point you could service. your co-pay or your coinsurance for increasing people have coinsurance for the don't have to pay $10 or $20 or $30 but the pay a percentage of what the bill is. for some of these expensive drugs that can be and the thousands of dollars,, even a 1%

co-pay can 10% co-pay can be in the hundreds of dollars. >> host: let's hear from columbia west virginia -- excuse me, clarksburg west virginia. frank on our others line. go ahead. >> caller: julie, how are you today? >> guest: i'm okay. [inaudible] there's a couple things here, of the countries of course healthcare for the people here, okay? are lobbyists running so much money into politicians pockets that this issue is literally and paid for? and to the point that people literally have to file bankruptcy because of medical costs. just seems like everything relies on politics. i never thought there would be anything like this. of the countries tend to be able to do it. are we so backward that we

can't? or is it all about money and politicians pockets? >> guest: there's a lot of lobbying on capitol hill. you had an article up about how the industry is already mobilizing to fight medicare for all. it's particularly the hospital industry. they are concerned, almost to the hospital takes medicare but it pays less than most commercial insurance and they are afraid if congress were to set prices, that would be even lower or perhaps onlys, slightly higher, that it wouldn't be able to afford to keep their doors open. the insurance industry would be dependent on the proposal either put out of business or at least shrunk considerably. they are concerned about this. anybody who makes money and healthcare now wants to keep that money. obviously, we pay trillions of dollars as a society in healthcare costs and people are trying to protect that turf. >> host: what have we heard from candidates like bernie sanders or just numbers like

others have introduced plans that would affect those. workers comp thosese companies, insurane companies, potentially putting databases or reducing their business? >> guest: it's a big concern. what would you do? there's a half-million people who work in the private insurance industry and although they are dwarfed by all the other people who are making lots of money in the current system and creating the tension that's producing this debate, sort of the more money to make, the more money we as society people consume healthcare have to pay. there will have to be some rebalancing of that but indeed it is a concern, would to be some sort of retraining, some sort of transition? that's not an insignificant piece of this debate, would be whate happens to the private insurance industry drama next up is. >> host: next up is bill against insurancece to his employer. >> ililcaller: after listening o

so much to the partner, it's like i sort of lost track of what he wanted to say. for me my entrance is pretty good because i work in the industry for over 30 years northwestern indiana. i saw a lot of my friends that some people that i was working with my neighbors and relive any filthy place, u.s. steel come in and steal. into coke,e turned coal cancers with children and adults. i saw so many of my friends kicked off of insurance because of cancer, pre-existing conditions. i got sick in 2009, was in the hospital for seven weeks, close to death. feet,00 later, i am on my i'm up on my feet but in disabled. sort of funny come at the hospital this one jim stuck his head in there, i don't know he was but everyone he said,

escamilla, how aremo you feelin? i went how much you charge to stick his nose in the door and say how are you feeling? if you want to find money for medicare for all, there's a big pink elephant called the military. they can't even audit what they do. when you fly over parts of arizona, new mexico, california, there's thousands of airplanes just sitting there. they haven't been off the ground ever. we've got congressmen who insist on building army tanks that no one wants. that has to stop. our congressmen are mostly wealthy. pay yourst own insurance, get yr own hair kit, take your nails done at the salon down at the street and also things like that, then we have trump flying away every weekend, $20,000 an hour00 to fly air force one. stay home, take care of your wife and kid into the business of the state. these are things we can do to create money to give medicare to all. for to work through insurance

companies to save money. again when i was in hospital, here, take this. don't worry, you're not paying for it. somebod' is. people need to be aware. then stepping back three callers, as to the gentleman that was concerned about closing off our borders. i'm from pennsylvania. mushroom capital of the world. mushroom houses are closing because there's no workers. they are mexicans, some -- not so much puerto ricans anymore. >> host: thanks for that bringing bring up the issue partly of transparency and medical, certainly hospital cost. >> guest: yes. that is a big issue. is walking around the edges of why we spending so much? why are we spending it on and how much of it getting for what we're spending?pe all the answers to the extent we can tell, , we're spending more and getting less and many of our

international competitors, and something really needs to be done. >> host: one to bring up a chart from the kaiser family foundation that looked at the single-payer medicare for all. the chart on support over time, if ais look it, modest increasen support for single-payer health care over time about the time late getting to the time of the passage of the affordable care act.g essentially 46% in favor to where we are now in march 2019 at 56% in favor. what do you think is driving even if it's a modest increase, isri driving that supporter increase in support for an single-payer or medicare for all type plan? >> guest: frustration with the system as it is as we've been talking about for the last two hours of people feel like they are paying more and getting less. we need something different. what's's interesting about medicare for all debate, medical for all as concept has been around since the 1980s, before that but in its current form it's been around since the late

1980s. ask people, like medicare, she would give medicare for a one? a medicare for all we're talking about isn't necessarily the current medicare program. it wouldn't be the current medicare program but when you start asking people journey like that concept because they know that their parents and grandparents like their medicare. when you start adding things to them saying we just do one if you had to pay more? would you wantve to admit you to give up your employer-provided insurance? then support drops their were still in that forum to state what people like the slogan but they don'tor know what would go into a cheating that. >> host: we touched on, not people on medicaid. where are we with the states expanding medicaid coverage? >> guest: the blue states, democratic states were very quick to expand medicaid. the affordable care act allowed states, required states at that part was struck down by the supreme court and make voluntary. it allowed states to expand medicaid, prior to the aca in

order to get medicaid had to be not only someone with a low income but yet if it into a category, to the pregnant woman or a child or a senior or with a disability. so you had to meet those silo requirements. what theo aca did is it set a national floor for medicaid qualification at 133% of poverty. poverty. that's higher than it was for some populations in both states. you had to have was on income. you didn't need to meet the other requirements. this is where we have gotten to the debate about able-bodied people on medicaid. in most days able-bodied people, people were not in one of those other categories, were not ever eligible for medicaid. most of the states have expanded their were starting to see more republican states expand. however, what we'reep seeing is their expanding butey they wanto make these able-bodied people do something to get their medicaid coverage, some sort of work requirement which has been struck down two of them have

been struck down by district court in washington. there are still -- >> host: federal district court. >> guest: arkansas and kentucky proposals have been stopped. the administration is continuing ' look at and in some cases approve these proposals saying they are different fromso the oe thing that struck down. there is litigation going on about whether this is okay, but what we saw last november is several very republican states, notably utah and idaho, cast ballot measure to expand medicaid and yet what's happened in the republican legislatures in the states have scaled it back. in montana with the intent to temporary expansion now they're saying we should continue it but we're going to requirement. lot of negotiation going on amongst these dozen and at or so states. >> host: , that allowance for work requirement, that was under the trump administration said health and human services said you can add this as a requirement to your expansion for medicaid. >> guest: that's right and so

far into states, no, you can't. >> host: jim in texas. gonn ahead. are you there? >> caller: yes, i am. >> host: you're on the air. go ahead. >> caller: thank you. question is, medicaid buy-in. the merits of it and they can be based on a percentage of your income. i think in colorado part of the issue is which i think i believe colorado has medicaid buy-in, that once you start working, you would lose it. is there some way that medicaid buy-in has a future solution to these problems? >> guest: there's both medicaid buy-in and medicare bite. there's a lot of states look at

a medicaid by medicaid is a program that's basically financed jointly by the states and the federal government. some of these states can't attach to medicare because medicare is a purely federal program. they can't attach to medicaid. new mexico in particular in nevada are bothev looking at the possibility of letting people by medicaid coverage rather than medicare coverage. that's ara separate proposal. a lot of people look at buying into medicare early as the usual at 55 or 60 they can get on early by paying for it. >> host: so does that buying basically become like a high deductible buy-in program? >> guest: no. just opposite. of lowd, , people medicaid income. medicaid is more generous than medicare. itid covers many more things can sometimes it covers transportation to the hospital. it covers more types of home care. in some ways medicaid is a more robust in a fit package. the problem with medicaid is

that providers tend to be paid even less than medicare sometimes dramatically less than medicare. it can be hard to find someone who takes your medicaid, who will provide you care. there's these trade-offs sort of whichever you look at it but there are medicaid by proposals out there and having looked at. senator schatz from a wide has introduced a medicaid buy-in proposal in the senate. >> host: you've been covering healthcare for many years. several news organizations. what first got you interested in healthcare? >> guest: i was first assigned to it i had always been interested in it. i was looking through some of my old college clips and realized i had writtenme an editorial about medicare. medicare member what it was quite was like i been writing about healthcare a long time. it's interesting, the things about it change so what you're debating changes, so there's always something new. i never imagine when i started doing this i would be covering

stem cell research and cloning. >> host: havee you ever been tempted to gote on staff on the hill or go to a medical organization or candidate and do their healthcare? >> guest: no. i've beent: asked, but no, i actually i like being a reporter. i like being able to interpret it for the general public. >> host: hears nashville. we go next in nashville and hear from troy. go ahead, tour. also gets his employer, insurance to his employer. go ahead. >> caller: i just wanted to say that doctors no longer get paid enough tohe keep their doos open. that is number one, two and three the biggest problem in medicine and healthcare today. president trump is supporting medicare for all my proxy and what that is is the so-called

fix the so-called surprise building. surprise buildingg is basically the insurance companies don't pay doctors enough anymore. not everyone can be in contract with the insurance companies. if you go to hospital or doctor you can't depend on your insurance paying the bill because the insurance companies control the system. we have total regular to recapture by the insurance companies. they are driving the debate. they are the ones who are diabetic for all, not bernie sanders loving the middle class. insurance companies love nothing more than to force mergers and acquisitions. wall street would love it. all the people at the top make so much money from medicare for all. they want to dictate doctors being paid nothing. do you think doctors are going to work if you're not being paid, if they're going bankrupt because they can't pay their bills? if the system is unsustainable now, medicare for all is not sustainable there any so-called

fix too surprise bills is going to crash the system completely. >> host: what does thatt pipeline of people getting educations andk becoming doctors look like? he's talking about potential when it might look like under a medicare for all program. what do you think? >> guest: i am seeingr more support for medicare for all from doctors and from any other of the healthcare industry. doctors get paid different on what kind of doctor they are and where they practice and what sort of business relationship they are in. lots of doctorsrs were making ls of money. there are lots of primary care doctors who are not making lots of money and they're frustrated by having to deal with multiple insurance companies. i been saying a lot would like to sueke for peace and just do with the government. >> host: do you think their support -- >> guest: it's not universal support. it's just if you look at the pieces of healthcare industry whowh are in the least bit

sympathetic to it, doctors tend to fall into that group. there are some doctor groups thatou are maybe grudgingly supported medicare for all. what's interesting is one of the issues in medical education right now is student debt among medical students to . with thedi increasing number of medical schools go and see the tuition free for their least wealthy students. one of the issues free to to -- tuition free, they are basically subsidizing the students were going to go on to make an enormous amount of money. there are a number of programs that pay off student loans for medical students who agree to serve as primary care physicians. it is this grappling with like everything else in health care medical school has become

increasingly expensive. you can graduate with hundreds of thousands of dollars in student debt. the argument is that forces the students to become that forces the students tode become special so they can pay off their debt. >> host: here's kathleen. we go to texas. kathleen is on the affordable care act in texas. go ahead. >> caller: yes. i've been on medicare for 11 years because of a back injury. i barely make 600 a month. i can't hardly even get groceries. i tried to ge' food stamps. they said the only thing i would get is $13 a month to help me eat all month. by the time i pay my bills. well, medicare has been good to me what i tell you what, all these other people, the hospitals are ripping people off. off. how much does it cost to push a

button? they get millions. people are going bankrupt. they are losing everything. regular insurance companies are screwing us over big time. my daughter is pregnant. she can barely make it. her husband makes good money, and nobody takes insurance that they provide. >> host: we will hear next from bill on our others line. go ahead. >> caller: thank you, julie, and thank you for c-span. i think a problem with medicare for all is a good lead to rationing. i'm wondering if as better approach could be a public option based on one's taxable income like a premium is one percenter taxable income, a deductible is 10% with reasonable co-pays at you meet thee deductible. also require price transparency so nonemergency situations

people can shop around which might help to keep costs in check. >> guest: these are all things that have been discussed and i think the previous caller is a good example of why healthcare continues to be a top of mind political issue because real people, no matter how rich you are, almost nobody can afford their own medical care these days. elected officials are not sure exactly what to do about that but there is increasing demand from the public to do something. >> host: it's interesting the call for a invention public option which were big part of the affordable care act back in the debate in 2010 and now it's been supplanted by medicare for all terminology. >> guest: people pushing aeo public option as sort of a way to get the medicare for all. the idea youge can do a public option and number of ways of what most people are still talking about is offering a

government sponsored health plan on the affordable care act exchanges resume to there's only like 11 million people provide uncovered on exchanges. that would be a small placeon to start but that is considered a place to start trying a couple more calls. we go next to new york city and hear hear from ron. good morning. >> caller: thank you for c-span. it just comes to mind this whole business when you put in a claim for employer-based health insurance, which is what i have, there's a third party administrator is often conflicting with what the doctor is ordering. you have nonmedical people who are making, you know, whoopi goldberg was just talking about it on the view yesterday about her issues that they did want to pay for a machine, but in 2020 the first way for the democrats to shoot themselves in the foot is too talk about free this and free that and bring medicare.

it's got to be a buy-in, if anything, for an option on the aca to talk about free medical, the over ten, 20 years it will cost umpteen trillions of dollars. the democrats haveen to be smart and have to talk about it as something that's going to cost you out of your pocket if you're going to go into the medicare system. thank you-s to c-span. >> host: do you think health care will continue to be the top issue going into the 2020 election? >> guest: i think it will continue to be a top issue. what the caller was talking about is ones of these flash point is what could happen with private insurance.in people hate their private interest because it gets between whether doctor orders and what they think they deserve, or did he want to keep their private entrance because in general there pretty happy withor it? in this last hour we fired people on both sides of the argument for angu great as alwa.

julie rovner, chief correspondent for kaiser health news. thanks as always. >> guest: thank you. >> booktv will be in prime prime tonight with discussions on artificial intelligence and robotics. we will begin with john brockman. >> just remember one thing. turn and the page. never assume anything. turn every page and i can't tell

you how many times in my life that stuck with me. >> when you go to resolve a dispute, what you have i think too much is a site is you say, to problems, one, when people do engage a yale and they say you are ugly or you are fat, or there's what about isn't at all sort non-logical argument that goes on very mean-spirited and terrible and it affects peoples opinions of whole process. as bad as that is with divorce in some ways is the other, any of the problem is people to engage with the other site at

all. >> watch this weekend on booktv on c-span2. >> once, tv was three giant networks and the government supported service called pbs. then in 1979 a small network with an unusually rolled out a big idea. let viewers decide all on their own what was important to them. c-span open the doors to washington policymaking for all to see, bringing unfiltered content from congress and beyond. in the age of power to the people this was true people power. in the 40 years since the landscape as clear a change. there is no monolithic media. broadcasting has given way to narrowcasting. youtube stars are a thing. but c-span's big idea is more relevant today than ever. no government money support c-span. it's nonpartisan coverage of washington is tied as a public service by your cable or satellite provider. on television and online, c-span is unfiltered view of government

so you can make up your own mind. >> we are live on capitol hill for a briefing and analysis of this your social security trustee's report. it's a social security resource for retirees and survivors are going to run out in 2035 unless congress acts. according to this year's trustee's report, however the disability benefit trust fund is solvent through 2052. the committee for responsible budget is leading this discussion. just about to get underway in the rayburn house office building. [inaudible conversations] [inaudible conversations]