democrats lost the filibuster proof majority in the senate in january 2010, they werethe version that had already passed the senate that used the word penalty. even if they wanted to change the wording they couldn't without running a republican filibuster, they were stuck with using the word penalty and that may come back to penalize them when the supreme court rules on the law. >> everyone born is automat automatically entered. it you have none someone paying your medical bill, pa exempted medical responsibility. the this is the key argument in the health care law. that's his opinion. let's hear from paul in new york, independent line. good morning. >> caller: good morning. i have two questions. assuming that this is upheld by thcourt, what are the long-term ramifications as far as states' rights, and number two, since the federal government can't seem to balanc

fiscal house in order, this would add another program. so i'm concerned aboutncg the budget. thank you. >> emily etheridge? >> well, actually, it's not necessarily a new government-run insurance program. all of those things will be run by the states, and it's private insurance you'd buy through a state exchange program and, yes, the federal government is helping fund giving money to states to set it up. states paying into buy insurance from private insurance companies unless you choose to go into medicare or qualify for medicaid that are already set up. >> good morning. >> caller: good morning. please excuse my voice. i'm in my 80s, but i have beeno president obama say that the illegal aliens won't be covered by this. i heard him say it myself.

insurance. still paying -- i i carry supplemental insurance with my medicare, and we'll still be paying for those people's health care. now, people couldn't pay for their homes. they bought homes they couldn't afford. does anyone believe they're going to pay a penalty? or buy insurance? >> let's ask emily etheridge. two questions esther is raising. one about illegal immigrants, the other whether or not people would actually pay the penalty. wrap would be the reaper cushions if they don't? >> in the penalty starting at beginning it would only be for an individual about $700 a year. a lot less than what a lot of people pay for insurance now. some may actually choose to make that economic decision, because it could be cheaper not to have insurance, if you're young and healthy, don't foresee getting hit by a bus or having other problems befall you. we expect some people might

choose to take that that option, which they are able to do. illegal immigrants that is true. they would not be required to have insurance. they're not supposed to be parting in that program and when the congressional budge program many will still be uninsured once think law takes place, a big chnk of that portion, population is people who are here illegally. >> jess brevin on twitter. finding this health care act unconstitutional, must the court overturn precedent? if so, which case? >> well, probably not. there is no -- because there has nerve are ban program designed exactly like this, there is no precedent on point. that's one reason it's been such an exciting case for legal in other words to follow, anerds f they're going into uncharted territory. there are presidents that point in both directions and both

sides of season but nothing that is exactly right. so it is very unlikely that the court are overrule any existing cases. what they will do, if they do block this mandate, is that they will clarify limits that they have inferred from prior cases. so i think it is unlikely they will explicitly overrule any existing cases. >> joy, democratic caller in san clemente, california. welcome. >> caller: good morning. >> good morning. >> caller: i have a couple of comments here. i've heard a couple of callers, both from yesterday's "wall street journal" and today's, about republicans saying that we actually all really do have health care. we can just go to the emergency room. and that, you know -- people usually go there when they're in extreme pain orthis and that. but if i was to go -- i'm 52 years old.

if i walu in my breast this morning and i go to the emergency room, they're not emergency room. they're going to send me off to a gynecologist, oncologist or whatever, and then medicaid would step in, or if i was of age, medicare. and so cost does shift to the state or the federal. so it's not -- it's not -- you know -- it's not health care in broken leg and they fix you there. >> emily etheridge? >> a good point people are making. we do somehow all pay for health insurance and often when people go to the emergency rooms, maybe they're getting treatments that they might not be able to rd there's not many people in the country who could probably pay all out of pocket for a cancer treatment that might go for years and years and years. and allprocedures that it entails and things that go

along with it. that's part of the issue here this law would have starting in 2014, which the court will discuss today. that's one of the arguments that this might actually lower costs for states because people will be getting more care earlier. they won't be ending up in the emergency room once they're very, very sick. you can have preventative care. people, lower incoqueoify for m doctors earlier. get them treated earlier. that ultimately preventing more serious illnesses. >> let's hear a little more of the oral arguments from yesterday. thisice antonin scalia. the mandate, whether it takes over the power given to the states. >> the amendment says the powers not given to the federal government are received. not just to the states but to the states and the people and the argument hire is that the people were left to decide whether they want to buy insurance or not. >> but -- but, your honor, this is what the court has said, and i think it would be a very

substantial departure from what the court has said, is that when congress is regulating economic activity with a substantial interstate commerce that will be upheld. >> as the solicitor general with justice scalia, larry tweets, how can the federal government as the creator of the states -- rather, as the creation of the states become the dictator to the states? jess bravin, take us through the argument of stay power versus federal power. >> well it 13 states did precede the federal government and did establish first articles of confederation and replaced that with the united states constitution in 1789. and subsequently thee union. but the constitutional structure does make federal law supreme to that of the states, and th signl change following the civil war with the enactment of the reconstruction amendments, particularly the 14th dm

government extensive supervisory powers over the states to prevent states from trampling on individual rights, but that's all beside the point, because the question here is whether or not under article 1 section 8 of the constitution congress can require people to carry health insurance under its power to regulate commerce or perhaps through its taxing power, and that does not really directly implicate the states. in fact, the states most lower federal courts have found, in fact, all lower federal courts have found, the states have no whatever regarding the individual mandate because it does not affect them. it affects individuals and the courts have said that states have no interest in trying to prevent citizens, their residence to fighting what the federal government, which the same citizens elect, has decided to do. the states only interest is in the medicaid program in which they have a financial stake. it's interesting to note at least 13 ss of the brief side wig the

government saying they like this program because it helps them carry out their own unable to do on their own, because they are all part of a much bigger nation. >> and we'll get to hear more about medicaid later in the program today. we'll hear more arguments as well as the justices tackle that issue. jess bravin before we let you go, you're sitting in the court during these oral arguments. been a reporter a long time cover the supreme court. what is it like for you? is this a difference experience than covering it to go to case? >> it is different t importance everyone is placing on it. the room is fill and the often filled at the supreme court. the expression on people's the difference of seeing a live play and watching it on tv. no offense. but, you know, it is definitely a moment that everyone understands is important, and that's because we come into that the over the past two years, over the past four years, we can

count the presidential election, over the past decades as t in country proceeded and as the debate over federal power proceeded. and when the court is so divided so evenly ideologically, there is a tension there and justices and advocates are clever people and they keep in quite entertaining and interestinbravin, spreerm court correspondent for the "wall street journal." thank you so much. you'll be in there again today. emily earth risch, health care reporter, thank you to you as inll for s we look forward to having you on again and talk to throughs what happens next. >> thanks a lot.today's oral ar coming up in just a bit starting here on c-span3. 1:00 eastern, they have wrapped up the first argument from this morning. the argument looking at the severability issue, whether the health care law can stand in the individual mandate is found unconstitutional. we think that oral art right

about an hour and 45 minutes, we posted that now on ourat c-span. we'll have it for you at 1:00 here-sn3. also this afternoon, should be underway in about 20 minutes at the court, the second half and final oral argument that the t medicaid and the constitutionality of expanding medicaid in the states. we'll have that for you at 3:15 be here on c-span, c-span.org and c-span who rao. remember, c-span.org/healthcare all other oral arguments from monday and tuesday and lots more, too, we're tracking some of the supreme court reporters. nina totenberg of npr tweeting necessary quote, it looked like today there are five votes to strike down the mandate. there might be five votes to strike down the whole law. go to c-span.org/healthcare. oral argument number one coming up at 1:00 leerc-span3, while we wait for that from this

morning's "wall street journash our guests are charlene, ument foerdministrator at the centers for medicare and medicaid services. thank you for joining us. >> thank you. >> and marilyn serafini with kaiser health news, special correspondent. thank you as marilyn. to just break down the difference between medicare and medicaid, two words that so often get confused and coed the accidentally say one when they mean the look, medicare is the program that everybody ages into at the age of 65. there are 47 million people in that program. and parts of it you get automatically. sparts parts you have to sign up for, but it's the program for seniors, and for many disabled people as well. who are under the age of 65. medicaid is a program for the poor. it's for people who are below,

or at a certain level of poverty or close to poverty. it varies by state. it's a joint program between the federal government and the es it does vary. states -- federal requirements that certain income levels must covered, but some of the states exceed those guidelines and they cover more people. bigger program than medicare. medicaid currently covers 60 million people. >> the court hasing oral arguments in the mornings this week.ning today two issues, though, looking at severability andondrd of oral arguments when the court looks at medicaid and whether the affordable care act's expansion of the medicaid program violates the constitution. let's go now to charlene. take us through what the affordable care act does to medicaid. >> so i know it sounds very complicated to a lot of people,

but put very simply, the let reform really juan cover more people under the medicaid program. so there's a federal poverty limit now, and states cover people up to level. what this does, it expands that and requires that under the medicaid program than they currently have to cover. here are the numbers to calm. republicans -- and independent callers, 202- 628-0205. d issue here today. what are the states concerned about? >> it's all about money. the health care law is estimated to cover 16 million people who did not before qualify for medicaid, and that costs money. now what's interesting is that at the beginni, years of the health care law

starting in 2014, the federal government picks up 100% of the cost for these newbies, but after that two years, they gradually start to cover a little less. by 2020, the federal government is still covering 90% of the cost. but the states are in tough budget situations. and they're saying, enough is enough. it's -- that puts us over the line from being a shared program that we choose to participate in, and it is a choice for the states to participate in this program, to being coerced. that's the word you're going to hear a lot. coercion. the states are saying, if we have to cover 16 million new people that's going to put us in a place where we have no choice in the matter. we cannot do without this federal money, and it's going to be more coercion. >> charlene, if the medicaid mandate is overturned, if we find out in a few months' time the supreme court saysth

not fly, will past expansions of the program be lost? >> no. past expansions won't be lost. you know, the mandate really is separate from the medicaid expansion issue. so that cou place, and they still could mandate thprram cover more peop. the question really is, the whole goal of the health reform was to cover all verye had insu. what it does, it breaks that circle of continuity they everybody has some kind of insurance. it will now put a bigger burden on the a lot of people they didn't have to cover before. >> go to the phones and hear from linda in t our democrats' line. good morning. >> caller: hi. i have two questions. first being, if the individual mandate is severed, and struck down, doesn't this,othe provisit this really ultimately hurt the private insurers that are going to be a part of the exchange? and my second question is --

it's broad. but we don't have a constitutional right to food. we don't have a constitutional right anything else. if we can strike down health care based constitutionalism, why not food stamps? why not public schools? why not anything the government provides that's not in the constitution? thank you so much, and y'all have a great day. >> marilyn serafini? >> you know, if the individual mandate is struck down, one of two things could happen. actually, many things could happen. it's possible the whole law could disappear. that includes medicaid expansions. it includes everything. and it includes the exchanges. the exchanges are said to take place to go in 2014, and the insurers as part of this law have a lot of new requirements placed on them.

for instance, they can't pick and choose who they cover. there would be no pre-existing condition that they could deny people insurance or cut people off. so if the whole law goes away, that goes away also. so the pressure on the insurance industry would not be, you know -- increased. however, if the court decides that the individual mandate can go away, but the rest of the law stays in place, then the insurance industry is going to be screaming bloodyng t be very unhappy with the idea that they would have to t sicker people, but the healthier people might decide not to come in and that makes it a lot more xpensive for them. looking at here that says, insurers at risk in the challenge to the health laws a supreme court decision striking down the health care laws expansion in medicaid,

might po laws to challenges stopping that surge anticipating more than $600 billion in new spending ov reported by amanda crawford. marilyn serafini what aout far implications of what could happen next? >> well what could happen next, if the law goes away? >> uh-huh. >> well, that's a very good question. you know, all along rubb e republicans have been talking about repeal. few of them have beenout replac way. what they would replace it with. my instinctve been around washington about 30 years is that when a law -- when a law like this goes away, it's often -- it often takesen years position to deal with this again. now what we do have coming down the road that can't be ignored is the budget.

because we are on this deficit reduction aan republicans are both now talking about the cost of talking about the cost of these entitlement programs to thegovernment, i would imagine that we would then turn to a discussion about medicare and reducing spending in medicare. >> this bloomberg story says the decision by the supreme court to review the constitutionality of the medicaid expansion came as a surprise. it was upheld by the 11th circuit koufrt appeals. the issue is the sleeper issue of the health care challenge said wyedra. the aurmths have the to open pandora's box. while they want to limit the mei think the consequences of their argument are more extreme than that. one of the positions looking at this case. a republican caller in pilot point, texas. good morning.

>> caller: good morning. >> go ahead. >> caller: i was wondering, if the court finds that they can sever out the mandate, and they leave the balance of this law intact, does that mean that the whole other believy of lawsuits are going to be filed to take out, for instance, this proposed panel of bureaucrats that are going to decide whether we should receive health care as a matter of budget. >> yeah, that's a great question. so, you separate the law, there are operations in the law that legislators can change anything in the law they want to. so the board that he was -- the caller was referring to, is called the ipad. there's lots of discussion in

washington about repealing that board. so, legislatively that may happen. they may agree t to get rid of the board so there are two ways that could happen. if that doesn't happen because of legislation, certainly anybody can file a lawsuit so who know what is lawsuits would happen can get rid of some of the more controversial issues through legislation to make it more acceptable for both parties. >> charlenero medicare and medicaid services in 2009 and 2010 so that straddles the bush and obama administras. operating officer and deputy chief operating officer and the deputy director of the center for medicaid and state operations. marilyn weber for kaiser health ne robin toner distinguished fellow there. we're talking about medicaid and this chall b cot today. danny, independent caller in ohio joins us now. >> caller: hi. how are you.

>> good. >> caller: i just have a few comments, ma'am, and that is we get laws down our throat and we over taxes. why don't they quit giving the other countries for a while, giving out bad loans, obama is not a king and congress just -- why don't we have nationwide recall, obama -- or bin laden said one time that if he couldn't destroy us with bombs he'd kill our economy. what has your president done. >> you don't sound like a supporter of the president. the care law? >> caller: i do not because it's taking our freedom of choice. >> what would you like the see happen? do you hope that the court overturns theco ress be the onet decision? >> i think congress should be the one make the decision but

here lately they can't even maky need to eat or sleep. >> i'll leave it there. >> there are a lot ofissue of f of choice and that is -- this law has not reached the kind of hoped that it would. still about half population does not like the law.acss the board have shown. and a lot of the rea people give is freedom of choice. they feel like their choice -- they want to be able to choose whether they should insurance or not and that this takes away that choice. >> charlene frizzera,tem wh do, they deal with case loads if this law is upheld and more people go on medicaid and need to seek their s e health reform is to change the current health care delivery

system. everybody agrees the current system where you get paid more for doing more services doesn't work. the way the primary care physicians are not entering the field, so everybody really does acknowledge that there is some cry sus in the health care system. the goal here is really to redesign the health care system so it's to find different ways to deliver health care using other kinds of practitioners so there's a lot of effort to have nurse practitioners do a lot of the care for patients. there's also a goal to try to change delivery so that you have a continuum of care organization instead of dealing with one part of your care. >> and what charlene is saying is really important about

certain -- underserved areas, to meet the new demand. we saw this in massachusetts when they put their across the board health care, everybody have insurance in place. and there's a lot of concern that there will be a physician shortage, especially at the beginning. when we get there. >> gary, republican caller, good morning. >> caller: hi. how you doing. >> good, thanks. >> caller: i used to work for the state of california and the biggest problem that i could see in government anywhere is waste, tremendous waste. and it's like when somebody gets in the care. they can't fire them. and they waste the taxpayers' money. i used to tell people the reason i work hard is because i'm working for the taxpayer, not the people who are in government

positions. they're just taking whatever they can from the government. and the huge waste that this will create it will over well am us. and it will destroy our economy because of theand on all the prices will p because everybody you know, the doctor will have a guaranteed whatever he can get out of the government, and that's really n this huge waste of money. and money is the biggest thing we need like i said, somebody gets in the easy chair they just i don't have to do sit here all day long, do nothing and collect my paycheck. that is wrong. o quic comment about that. one of the things that the health reform law is trying to do is it's they call risk sharing in the health care community. risk sharing really does then put the responsibility on folks jobto because they will make more money or lose more money depending on how they

work together as a group to manage health care. so we're hoping that that accountability and responsibility where there is some financial incentive at the end of it will make people much more accountable and get rid of a lot of the waste in the system. >> lola, orange county, california. >> caller: hi. how are you. i love your program. and i wanted to make two comments if i may. i feel that a person that can be able to get health insurance is a privilege. i haven't had a chance to get health insurance because i came down with hypertension and just recently i got sugar diabetes and i've been turned down and i'm not poor enough to get aid and i'm not wealthy enough to buy insurance. you understand. i'm caught in the middle. and my little granddaughter was born with her insurance and she

has -- she has problems with her legs. and we didn't beingoay her insurance on time, and they cut her off. if it wasn't for i couldn't get her insurance. but i have to wait a whole year to. >> i'm guessing that you're part of the 50% of the population that supports the health care law because udeng in 2014, you might or might not get some kind after subsidy or qualify for medicaid but would be required to get insurance and you would be able to get insurance. through whatever your state be. they would be prohibited from turning you down because of your hypertension or whatever problems you might havbarbara, republican. >> caller: good morning. i'm just calling because i know people on