changing the federal environmental permitting process. a vote on that resolution set for about 1:45 p.m. eastern today along with a vote but the judge to the u.s. court of appeals of the ninth circuit. by the end of the week, possibly into the beacon chamber is considering a policy health care and climate change package, about to start an act that could happen as early as today. live coverage of the senate here on c-span2. >> the vice president for coverage access to talk about healthcare in the unitedd states on a variety of fronts. thank you for joining us. >> thank you for having me. >> the commonwealth fund, what is it as far as the things when it comes to healthcare, what do you take? >> we are not prophet, we support independent resource and welfare issue in rent that

promotes better access and better healthcare particularly for society most audible. mightt issues in the senate when it comes to health care but before that i want to ask you about this new survey that came out that shows health care in the united states particularly for those under the affordable care act. 8% in the first quarter of 2022, that previous number was 9% in 2016. what is the number tell you? why is it significant? guest: it is really as historic moment in our progress. we saw a drop after the affordable care act and this is a new low, a new high over 6 million people have had coverage including 5 million including children we have seen an uptick in a number of the insured and this is a significant downward

trend in universal coverage but we are down significantly on the uninsured in 2019. the biggest occurred among people with low and moderate incomes. statistic about the survey half of those they got insurance from ac marketplaces can you elaborate on that? guest: these gains we are seeing are concurrent with several policy changes we have seen in the last few years including the implementation of the american rescue plan act. those brought premiums down substantially in the marketplace. coverage in the marketplaces, the ac marketplaces bringing enrollment thereto a short high. in other major change that

happened in 2020 with the family first coronavirus response act was that states maintain maintained people enrolled in medicaid. this is also sent medicaid and rolling to record highs. third the states expanded their medicaid programs from 2019 and 2021. this significantly reduced insurance rates. a final factor, substantial enrollment efforts advertising special aroma periods by both the biden administration and also a major effort to increase awareness of their coverage operate -- options. host: for those who get assistance under the aca, how many of those are getting that because of federal or subsidies from the federal government?

guest: the majority of people are getting subsidies from the federal government through marketplaces. one major change in the american rescue plan act was lifting the re about 51,000 for an individual. people about that income level weren't getting subsidies. all of a sudden the income went up to 51000 and you wouldn't have access to subsidies. this allowed people in that income reached to get subsidies. so that was also a major change in the increase to help people. just right under that threshold got subsidized coverage. host: our guest joining us until 9:30 and if you want to ask questions about health care particularly under the aca you can call us and let us know. (202) 748-8000 if you live in the eastern and central time zone. (202) 748-8001 if you live in the mountain pacific time zones.

if you get aca coverage or are insured under the aca you can call and give us your perspective at (202) 748-8002. you can also text us at (202) 748-8003. sarah collins you talked about the subsidies, do those subsidies have an end date of sorts? guest: they absolutely do. they end at the end of this year. so if that happens, we are expecting about 2 million people to drop their coverage and become uninsured. and the other major impact of that, i mentioned the much lower premiums for people people will see and improve -- increase in their premiums so this is -- it would be a very significant change. if this were to happen. host: with that in mind, there is an effort in the senate to prevent that from happening. can you ask play that? guest: that's exactly right. inflation reduction act would

include an inspection -- extension for three years. so that would prevent people from losing their coverage and save people in the marketplace thousands, thousands of dollars. host: if the aca is built on subsidies and ultimately subsidies might run out, what does that mean for the long-term structure? i know that we have seen low numbers but because it's built on subsidies what is it mean for the ability for someone to hold onto that coverage? guest: that's a really good question. these changes in the american rescue plan act alongside -- were needed. these updates were not just pandemic related. these are bringing premiums down to a point where people compound towards their premium. these are things that should be

permanent. makes premiums affordable, helps people afford their health care that they need. this is a temporary policy that was introduced during the pandemic but it is really needed by lower income families to help them afford their insurance. and help them keep get access to their health care that they need. host: on the others of that, what is the cost of the united states to provide the subsidies? guest: the extended subsidies are about 22 million dollars. $22 billion a year. so it's not an insignificant cost. but it is, it is part of our health-care system it is part of ensuring that people of access to the health care they need. we subsidize employer coverage. i hundred 55 million people get their coverage. all health insurance in the united states, the marketplaces,

medicaid, medicare are subsidized by the federal government. host: again sarah collins with the commonwealth joining us. we start off with gwen detroit, michigan. you are on with our guest. go ahead with your question or comment. could earning. caller: hi, pedro. thinks for taking my call. i was wondering about people who are like cooper drivers for a living -- uber drivers for a living and their income fluctuates. sometimes it's high, sometimes it's low. we seem to not be eligible for medicare under the affordable care act. he needs medical insurance and i'm trying to find out what options that we have.

guest: income fluctuation is always a struggle. both in medicaid and also in the marketplace. what is important to do is to go to healthcare.gov and enter your income into the website and it will help you understand where you can get coverage, whether it's through the marketplaces, what subsidies you might be eligible for, or through medicaid. but that would be a good first step to figure out whether or not you are eligible at the moment for subsidies. the other thing in the marketplaces if your income does fluctuate during the year, if it goes down for example, you might need to the subsidies are done through the tech system so you might be eligible, you might some of get that that she might get some of that money back or you might have to pay more at the end of the year. but fluctuation is handled

through the tax system. what is really important is to first look at what, go to healthcare.gov and find out what you are eligible for. it's very important. host: the information you provided, what determines what you will pay for insurance under the aca? guest: it's really driven by your income. the state you live in, the premiums that are in your state, the state premium varies dramatically across the states. the affordable care act cap's what you pay towards your premium. if you are eligible for a subsidy, regardless of what the variation in premiums is you will pay the same amount as someone in another state. it is determined primarily by your income and your household structure. host: as far as a guide, what is the guide they are looking at as far as how much you have to make before you qualify or not lafayette?

-- qualify. guest: you are eligible right now, you are eligible on the income scale so even if your income, it used to be if your income exceeded $51,000 a you are no longer eligible for subsidies. now your premium contribution is capped at a certain percent of your income. as your income rises that represents a smaller share. the natural phase that on that subsidy. you will both pay more than a certain part of your income. host: let's hear from ed in new york. good morning, you are on with our guest. on with our guest. caller: good morning. i had a question regarding

health insurance companies. i know currently they are talking about exchanging medicare's negotiation for drugs and trying to reduce the cost to seniors. i always find it puzzling that the health insurance companies, which have a stranglehold on the medical system, are not brought up as a topic of raising taxes on them. they are incredibly profitable. it does not make sense to me. i did not know if this is too much off the point. i was curious about taxes and medical insurance companies versus drug companies. guest: that is a very good point. the marketplaces -- the affordable care act introduced new regulations to insurance markets in 2010 preventing insurers from increasing their premiums above a certain point. you are right that right now if

we are just talking about the new reconciliation bill, there are provisions that address the regulatory structure of the insurance markets. it is focused mostly on prescription drugs. host: expand on that a little bit as far as the aspect of negotiating. why is this important? guest: if we just talk about prescription drug prices, medicare has not been able to negotiate prices since the new inflation reduction act would allow medicare to finally negotiate high cost drugs starting in 2026. this brings the leverage of the federal government to bear on prices. prices are a significant issue across our health care system. the prices insurers pay through hospitals and other providers in

the commercial insurance market, which is what the caller was referring to are the major driver of what we pay for our premiums and what we pay for our out-of-pocket costs, what our deductibles are. getting at those prices and allowing much more leverage, maybe to a public option in the marketplaces, would help wring some of those prices down. this is what we are seeing in the reconciliation bill with prescription drug prices. it is a broad problem in the health care system generally. host: we have a viewer who asks you if you can explain why aca premiums are higher in states that did not expand medicaid? guest: there is a significant amount of variation in premiums across states. the fundamental reason is there is just -- variation in prices

in a commercial insurance market. prices that are paid to hospitals by commercial insurers in the marketplaces and employer group markets very significantly , even within the same hospital for the same service. that is because there are proprietary negotiations that occur between insurers and providers that end up with prices that may not bear much relationship to their cost. that is the primary reason we see so much variation in premiums across the country, even beyond the medicaid expansion issue. we still see significant variation. host: you talked about that build senate democrats were working on. what does that bill dupre states that did not expand medicaid?

guest: this provision was earlier in the build back better bill, the first iteration of the reconciliation effort. this new inflation reduction act does not exclude a federal fallback option for people who are eligible for medicaid in the 12 states they have it. estimates by the urban institute show such an option would increase the number of insured by 3.2 people. this is a very big disappointment for people affected in these states, not including this option, the federal fallback leaves millions of the poorest people in the country without access to affordable health insurance. host: we are talking with sara collins of the commonwealth fund. the u.s. seven is gathering ands now for the federal environmental permitting

process. a vote on that resolution is set for about 1:45 p.m. eastern today along with the vote to confirm a judge to the u.s. court of appeals for the ninth circuit. by the end of the week, and possibly into the weekend, chamber plans to consider democrats tax policy health care and climate change package. a vote to start debate on that could happen as early as today. as always, live coverage of the senate on c-span2. will lead the. the chaplain: let us pray. eternal father, our souls long for you, for we find strength and wisdom in your presence. guide our lawmakers to put their trust in you, seeking in every undertaking to know and do your will. when they go through