shield, cigna, it was so high that i just disconnected the phone call. guest: that is an issue. all the time, we have to see what happens with premiums. but that is one of the things that has driven the whole debate, how will slow the growth of premiums, especially for small businesses like yours. host: here is an employer who did look into it but saw that it was economically not feasible. 2014, you say the exchanges began, or the subsidies. .

the reason for this is the medicare advantage plans, currently on average, pay about 14% more than traditional medicare. with the additional payments, the insurers often offer additional benefits that are not required by the law. things like vision care, dental care, free gym membership, low or premiums, or zero premiums. some parts of california, some folks don't pay premiums at all. some of that may change. you may see your premium, if you don't have a premium, you receive premium. you may see option of benefits but they can't cut your required medicare benefits. so, we will see. i don't know if you remember back in the late 1990's and early 2000's there were cuts to medicare and at that time that it ravenna's plans were called medicare plus choice. there were a number of insurers who pulled back or dropped out of certain areas and some raise

premiums. .

she just wet and medicare. -- went on medicare. host: what exactly was your question? caller: how can we get prescriptions paid for? host: thank you. let us sit in definite answers. >> she could sign up for part "d"would cover prescriptions. for you, there are some programs through some of the drug

companies that can help with free or low-cost prescription drugs. you can apply for those. it tends to be a lot of paperwork. there are some programs like that. you may be able to qualify for health insurance when it changes in 2014. you may want to try some of those things. host: what is the relationship between kaiser permanente and kaiser health? guest: there really is none. we are a program of the family foundation. host: the next call from

florida. caller: this is my first call and i am a little nervous. i am a construction worker. i own my own business. i have catastrophic health-care coverage. i go to the doctor once a year to get checked out. i pay for all of it myself. that is how i have decided to live my life. the question i have is will it change now? will i be forced to buy health care coverage? i am a male. i probably will never get ovarian cancer. will i have to buy that type of coverage that i do not need or do not want? host: a couple of questions. how old are you and how much you pay for your catastrophic? 36

caller: 36 years old and about 230. i have employees. five of them. host: to you offer them catastrophic health insurance? caller: i do not. i pay them well enough. i feel that if they wanted, they can go out and get it themselves. stay on the line in case she has any questions. guest: what is your deductible? caller: i am not sure. guest: if you want to keep your plan, you can keep it. the plan is not going to change. caller: will i be forced to buy a health care? i have catastrophic health care. i do not have anything that covers going to the doctor. a little over a couple of years ago, i got a bit of mercer in my leg.

i went to the immediate care center. it cost me a little over $200 and another $200 for the lab. it came back, and they gave me an antibiotic. it ended up costing $800 because i am allergic to keflex. and in other antibiotic. the pharmacist found something for me that was cheaper. i do not want to pay for a health insurance that covers ovarian cancer, which is something i will not get. it does not cost more in the long run? guest: overtime you may want a different policy. you may go to the exchange and bought a policy. after 2014, you may have to buy a policy that will cover more

than what you have now. the policies that will be available on the exchange, the minimum coverage will cover 60% of your average medical costs. you would pay the rest. it may be more generous than the plan you have now. it may cost a bit more as a result. you may choose to buy it. here is what will change for you in 2014. if you get sick between now and then -- if you get a disease or herself on the job. insurance cannot reject you. you would be able to change plans. that is not true today. if you were to get ill and try to change plans, they could reject you today. that is one of the big changes happening in 2014. if you decided you did not like the current plan or wanted a different type of coverage, you could change it. you will not be forced to buy

something you do not want. insurance is a risk pool. you are paying in case something happens to you. it cannot be ovarian cancer, but it may be something else. nobody knows what is going to happen. that is the idea behind insurance. host: why did the pre-existing get delayed until 2014? guest: a lot of the economists say to make that work and to say to insurance companies, you have to cover everybody and you have to require everyone have insurance. people may wait until they are sick to buy insurance and that would raise the cost for everybody. that is why we are seeing that happen together. given all that has happened, it

would be really hard. that is why they're waiting until 2014. host: is getting hit by a truck a pre-existing condition after 2014? guest: you could get insurance if you wanted to change plans. host: staten island. caller: my comments to the host. -- complement to the host. [unintelligible] you have been so clear and concise in providing information. you should be in congress. my question, real quick. as far as the health insurance companies are concerned, is there any information on the breakdown as far as what they

get and the services they provide? you have answered most of my questions. guest: i think your question is what of the insurance companies. to be required to do and pay. there are a number of things that affect them. they will not be able to reject you anymore in 2014. this year, they cannot cancel your policy which is a fairly rare occurrence it can be a big deal if you are in that 1%. that is going to be a change. they have to report how much they are spending on direct medical care such as administrative costs. some of it is disease management.

there are salaries and profits. they will have to tell this secretary how much they are spending on each of those things. starting next year, if they do not reach a certain targets, they have to give some of that money back to consumers. if you are in a small group plan or individual plant next year, 80% of the revenue must be spent on medical care. that is if you are with a small group plan. a 5% if you are with a large group plan. and that is immediate. -- 85 cent% if you are with a le group plan. and that is immediate. caller: my question is about medicaid. i was disabled.

already under our governor's things he did, i am experiencing loss mostly in prescriptions and restrictions. it seems to make no sense that basically it is treating people as well we are all cookie cutter people. everybody gets the same thing. host: thank you. what about at the state level? guest: in medicaid, there are moneys that are available to health basic health preventative. for people that make too much to qualify for traditional medicaid but not enough for private coverage -- there will be held

for states with those programs. i think they can start applying for that this year. in 2014, it expands to cover more people. if you do not have children, you are not eligible for that matter how little money you make. that will change. they would expand medicaid for that whether or not they have kids. the states will start paying their share in some years. they are concerned. we will see many more people covered by medicaid. host: how much money is being

spent? guest: i do not know what the number is this year, the cost is going to be $9.8 billion over the 10 years. it will reduce the deficit by $124 billion over 10 years. those estimates that far out in 20 years are uncertain. taxes this year, there is a fee this year. if the good to a tanning salon, a 10% additional tax. that goes to help pay for some of those programs. there will be a tax on drug makers.

those happen further out. the taxes are likely to be passed onto consumers. it will happen after the exchange's get going. host: republican, st. petersburg, florida. caller: c-span need an alternative viewpoint. kaiser is following the obama talking points. they are a big cheerleader. they did not find anything wrong with the plan. everything she is describing is going to increase the cost of health insurance. the silver plan which is 7% will cost about $19,000 -- 70% will

cost about $19,000. you save money with an unsustainable and hot mud from the government that as a $38 trillion medicare liability. host: you have a question? caller: i am a doctor. i will be penalized if i go over budget for my patients. they will say, you cann-h spenda certain amount for spine surgery. if he spent over it, we will cut 5% and call you a bad name in the newspaper. patients coming to the doctors will not be able to trust the doctors, because they will get more if they spend less on their patients. why should we ration care that way using government power? host: stay on the line in case she has questions for you.

we did not invite her to be an advocate for an opponent. she is an analyst. that is what we are doing today. talking about the immediate effect. what immediately goes into effect for you as a doctor? caller: i am a brain and spine surgeons. they say some programs save money. but they hurt people. people that get circuit aborted by their doctors because they are afraid of getting a bad report card. guest: some of these things are occurring through insurance companies doing different things in trying to determine which are the most efficient doctors and practices. they are kind to steer patients to use high-quality doctors and whatever they want to label them or call them. he made a couple of points that may or may not be correct.

they talked about what will happen in the premiums. some will go up. there are going to go up anyway. they were going up on average 8% a year already. the hope is that this legislation will slow that premium growth over time. in 2016 when a lot of this is fully implemented, premiums for large employer plans will be about they would if this law had not changed. premiums for small businesses may go down or make up by 1%. premiums for individual policies may go up 10% or 15%, because of these changes. for half of the people, there would be subsidies to offset the cost.

doctors are concerned about this. it depends on what specialty they have. he is a brain in spine surgeons. i do not know if there are perks in there for him. for primary doctors, there are purser medicare and medicaid. they say we need to get more doctors involved in primary care and some of the specialties. there are a few other changes like that. the rationing argument has been raised. there has been debate about that. the bill calls for a preview of comparative substances. it specifically says they cannot use this information to make coverage or payment decisions. for the first few years, and

number of things are excluded from that. host: the board of directors is the association of health care. what is that? guest: a professional association for journalists. host: new jersey, independence line. caller: i have a comment than a question. and want to echo what the previous caller said. this woman has found nothing wrong with this bill. host: we did not invite her to be a proponent or upon it. we are analyzing. if you have a question about the immediate effect, we will take it. otherwise we will move on. caller: my question is, she keeps using these numbers from the congressional budget office. what i want to cite is the fact that they are using bogus numbers, 10 years worth of

revenues and the program only covers six years. host: thanks. a response to that. guest: the cbo is an independent group that does this work for congress. i do not have any other numbers for you right now. host: we are talking about the immediate effect of health care. louisville, ky. caller: police did not cut me off. you gave that dr. a lot of time. julie, thank you for accurate information. i wanted to ask you a question. i am on medicare. i treasure it and i monitor it very carefully. i get a statement every time i go to the doctor telling me exactly what medicare paid.

it has always been on a timely basis. i am pained when hundred $43.50 a month to united healthcare for a supplement. -- 4143.50 and month to united healthcare for a supplement. -- $143.50 a month to united healthcare for a supplement. medicare paid $78. my supplemental pay $14. in the difference. i was livid. i had to call them every time i go to get a statement. host: what is your question? caller: is there going to be any control on supplemental insurance companies? guest: not that i know of.

the doctor has a certain charge. the insurers pay a certain amount. they do not pay the whole thing. it sounds like your supplement is picking up some of the things that medicare does not pay, but not the whole amount your doctor is charging. i do nothing changes in this bill addresses that. host: what percentage of medical care is spent on and of life care? guest: i do not have an exact figure, but it is a lot. it is debated a lot. how do we decide what to spend? it is a big chunk of change. there are a lot of medical problems. we spent a lot, and it varies a lot across the country. there are a lot of reasons for

that. it has more hospitals and doctors. in the last year of life, you get more doctor visits and special visits and spend more time in the hospital. we looked at florida and oregon, and they are very different. is there a way we can try to level that out and it would save a lot of money without compromising quality of care? more care is not necessarily better care. that is where this gets really hard. what is the right amount of care? host: west virginia, republican. caller: i would like to ask, why is obama trying to sell this

health care plan? i cannot understand why he sells this program when the party owns it? thank you. guest: i think he is asking what are they trying to sell right now? the democrats are hoping that this legislation will give them a boost in november when not be a real drag on them and cause them to lose office and seats in the house or the senate. public opinion has been very divided on this legislation. they hope it will swing in their direction when people get these details. it will prove more costly than the cbo as estimated over time. it may