"washington journal" continues. host: we welcome julie rovner back to the washington j the chief washington correspondent for kaiser health news and getting reaction to president biden yesterday on his remarks on lowering the cost of social security and strengthening those programs where the reactions to that and how did the president say he would it achieve those efforts? >> this was a victory lap there was a lot of provisions that congress passed inn august

thatat especially for prescription drugs there is a new cap and an overall cap how much seniors can be asked to spend for prescription drugs and yesterday was the day the government announced that medicare out-of-pocket premiums and adaptable's for next year in 2023 they are going down for the first time that's for complicated reasons we could get into that has nothing to do or at least not directly amend the president while he was that it decided to take a swipe at republicans for those taking a more stringent budget left as they went control oneou or more houses of congress. >> so that gives us a chance to look at the state of

medicare and social security how do you describe those programs right now? >> they are little bit different shape medicare has problems because ofem the cost of healthcare in the continued cost in the last couple of years have been bumpy because of the pandemic and people using less care and then more care were not sure of the trend and is more of the straight demographic problem more then to support the baby boomers as they retire. >> so that's how we are splitting up the calls from the first hour when we were talking about social security and medicare the president

taking a swipe at republicans proposed to strengthen these programs senator scott of florida headed the senate campaign committee has a choice lee suggested a periodic sunset of medicare social security to be we knew by congress but they were to continue but i should point out they are examined pretty much every year they make changes large and small but they continue on unless congress tries to do something else. there have been republicans in the house that suggest going even further but neither can continue indefinitely

undercurrent financing and that's one of the big issues that over arches the most everything washington talks about right now medicare part a trust fund is six years worth of solvency it doesn't go broke but p starts to pay out more than it is taking in the social security trust fund is solvencyci. >> the five-year sunset are there other programs that happens with looking at such a massive program what is that like with the's efforts to tweak the efforts or to monitor? >> that is every year but has every five years are the user fees with thehe fda.

and that's right on the edge of letting them lapse and then to send out pink slips to thousands of prescription drug reviewers that everybody should keep their jobs that comes with thehe deal to be new this in the spending bill but that's at the very last minute. >> you talk about a victory lap talk about the inflation reduction act and what that did to medicare specifically in prescription drugs. >> a couple of things it reformed part d the prescription drug portion of medicare that was passed back in 2003. there are limits so with that catastrophic cap you had to pay 5 percent of the drug cost

indefinitely so at the time in 2003 there were not that many drugs that 5 percent would cause a huge problem but that's not true anymore now they cost ten and 20 and 5 percent of those can be tens of thousands of dollars. the one of the things the inflation reduction act did was cap at $2000 for drugs in a single year. but to cap insulin cost at $35 a month democrats wanted to cap it for everybody not just medicare but that was blocked byan the republicans and they could t do that for a complicated budget willdg reason. one of the bigger issues is that the government for the first timeat can negotiate drug prices at the beginning it's only a very few drugs but also

drugmakers would be charged penalties t is a very beginning of doing something with drug prices so to be among the top if not the top health issue for americans right now. >> kaiser health news is keeping track of all of the issues talk briefly what it is in the relationship to the kaiser family foundation. >> we are an independent project neither kaiser health news or the family foundation is affiliated with kaiser permanente we just shared a relative a long time ago. we are not a branch we cannot help you with your hmo problems. but we just it with policy.

>> from a very long report on it the cbo estimates the inflation reduction act medicare inflation rebates would increase medicaid spending by 15.$7 billion of her tenure. explain what that means in putting in context. >> medicare or medicaid quick. >> i'm sorry. the cbo estimate that medicare inflation rebates will increase medicaid spending by 15.$7 billion over the next ten years. >> that is the rebate rule it is complicated you probably do not want to know. congress gets budget credit for canceling something everybody agreed needed to be

canceled basically through gets to achieve the savings from doing it. >> kf f.org khn.org is kaiser news. new jersey is up first on the line for over 65 years old. >>caller: good morning. i thought social security and medicare was paid into from people who work and they take it out of their paychecks isn't it illegal to give it to people who do not pay into it? >> you have to be eligible to

get social security or medicare you can buy into medicare people did not pay social security taxes why they were working many did not pay federal they paid into their own pension system so you campaign for medicare part a that comeses to you you are eligible for a few paid into the requisite period of time but social security and with those payments from social security but generally people who are working the social security and medicare tax pay the expenses of those who are collecting social security and medicare. >> that is why there are premiums and thes premium part d there is a subsidy that people pay their own premiums for that coverage. >> down to the lone star state

under 40 years old good morning. >>caller: good morning. the question about demographics it is interesting you say i am referred to as a millennial but what do i expect and given that the millennial's will soon be larger in population than baby boomers, how might that affect the system even though millennial's will pass population wise they might not vote it's much different expecting them to vote in the same numbers. do you have any thoughts on

that demographics split between the largest generation of baby boomers then the millennial's and to compare and contrast? >> yes. this is what is studied pretty closely. but large in terms of years i'm one of the younger bb boomers i'm not retired yet there are many who are in their eighties. baby boomers eventually we will die off of old age and in the millennial's have to worry about who wille work and support them so the demographics are ath matter of making sure they are working people to support the people who are retired there are a lot ofth millennial's you are worried if medicare and social security will be there when they reach the age of

eligibility that is something washington has to cope with the has to be changes of how bothrt programs are finance particularly on the healthcare side but also the social security side it will be continuing political issue pretty much forever as long as these programs are around. >> kaiser health news was on a weekly basis during the implementation of the affordableim care act we had a lot of segments with you back then so what is the status since thetr joe biden administration as strong as it has a ever been something with the inflation reduction act continuing from extra subsidies with the american rescue plan the first that congress passed to increase

help for manyy people to buy their own insurance under the affordable care act and those subsidies will continue through 2024 another couple of years that helps people of all end of the spectrum and that from those that were getting very little help. that was something biden was very proud of passing it as vice president. >> it was called a big deal ff. >> he did. >> on the line between 40 and 60 years old. >>caller: good morning good to see you back on the show. do you have an update of

what's going on? and then does a deep dive. >> a direct contract entity. it is pretty much the privatization of medicare like medicare advantage part c. >> she knows everything we letl her jump in. >> and the latest of the whole direct contracting that the quality side of medicare but it was one of the experimental efforts to figure out if there are better ways to incentivize and pay providers not to

provide too much care or not enough care. there have been a lot of complaints from the liberal side and we have yet to find the exact program that works the affordable care act created the center for medicare medicaid innovation to test out better ways to basically pay for or deliver or organize care and there's a lot of experiments many have not worked very well they are wringing their hands because it has not works but this is what it was for to try different models of providing healthcare and to find the ones that work the best in terms of giving people the care they need when they need it and the patients who were consuming it. we are not there yet that

people are still looking add a widely academic community trying to figure out how to do this. [inaudible] but what is so bizarre so how much? what is the premium so what happened. >> are you talking about medicare advantage specificallynt quick. >> .

>> this or answer is they are making a lot of money off of medicare advantage and patience are doing well it's very popular because insurers did not want to cover seniors because they were too expensive. in the eighties and private insurance companies toom offer managed-care and those type of plans within medicare that basically saying we can do this more cheaply if we only take 95 percent of what you would have paid medicare basically that was the law and they got a little more popular there was the new extra benefitssa but if you pay us more we can have extra benefits to the medicare beneficiaries because if they are not in a medicare

advantage plan by private supplemental insurance to pay deck on —- deductibles and out-of-pocket copayments and that is a whole separate portion. in 2003 it included big increases how much the medicare advantage plans are being made. the insurance companies can still make a lot of money is that tractive to those benefits that don't normally get covered like dental coverage or eyeglasses or hearing aids and that is very much needed by an older population not covered by traditional medicare. so if you go into medicare cannot see any

doctor or go to any hospital you have to go into the trade-off but almost half are making that trade-off going into those plans and we're still seeing howse that plays out so that it explains. and we are about to get those are standard dates every year if you are in a private plane you can join one or change one. >> wide and then to be careful of medicare at age 65 or get penalties later and even with

a former employer. >> those rules are complicated. if you are still working, part a is what comes automatically based on what you paid and when you are working. that is the part you paid for and that covers hospitals and that is the outpatient part it's notot paid for by the trust fund and then tell people weight when they are 70 or 75 and need more care but then if you are firstst eligible for part b it's in the first has to become eligible for social security so i will not wait if i'm getting employer insurance i don't have to sign up for part b. my mother retired at age 67 but the inside up not until

she joined. there are a lot of complicated rules you have to be careful because ifse you miss your window and sign up late it is the additional premium that you pay for the entire time you remain with medicare part b. >> at the same. >> we take you to the senate side of the capital or the senate foreign relations committee hearing and with your phone calls mrs. from bedford texas between 40 and 65 years old. good morning. >> good morning.

but then if we go into the same name and if that happens. >> that the $20 million of the cr has been added to address the water crisis. so the senate will have to but then to go through mid-december the house would also pass that as well. anything to add on this topic

quick. >> they have $20 million in the continuing resolution but he is the governor when presented presumes he will have say over how it is spent that there will be a federal oversight toen ensure that. but gray injunction colorado, good morning. >> i am medicare but i do think the seniors get a break because less than $300 a month for part b? but thenn picking up the cost of part b so that it point it would always be but now 226

but that is the $500 i apologize to my partners business because i needed be pack on —- picking up the vast majorities of thank you for your time. >> and then to decide what the shares would be that the call on —- the color has stated three quarters the other quarterup comes in but next to you and but tentatively we approved what was hopefully to be a blockbuster drugs for alzheimer's and medicare was worried it would get such widespread use and it was so expensive and then it turns out would not work out is

helped in the drugmaker lower that price inhofe so there was an excess of premiums and that's one of the main reasons they were going down. >> grand junction colorado. for those over 65. o >>caller: social security used to send out a document that gave you your estimated retirement. is important to remember social security was never intended to be your only source of income when you retire. and then they list the sun a document.

we haven't gotten this type of document in years i have not received one. what do you think about that? >> i have gotten mine every year. that is a ath requirement. that was a requirement of the eighties or nineties to make sure people though how they are doing. i from them moving away from their own pension plan and do-it-yourself retirement was a way to remind people to adjust social security because that probably won't be enough you are supposed to get one of those every year. >> we will and it they are. we will see you again down the road thank you for your time.