sick, they drove up the costs -- they drive up the costs of premiums. if we have everyone who is eligible with access to affordable health care in the insurance pool, it brings down the costs for everyone. host: if you were not injured, how often is that fine assessed against you? guest: once per year. you must file with your income tax to demonstrate whether or not you have health insurance coverage. host: and the guy said the bell $259? guest: i believe he said $292, the penalty in the first year of the implementation of health reform. right now i believe it is about $900. host: still, the thing that would be enough of an incentive?

some folks might say $900 for health insurance premiums and the first three months of the year -- and spend way more than that on health insurance premiums were they could just knocked out the $900 and be done with it. guest: right. there are many people who suggested the penalty is not steep enough. . .

guest: they found that they were too high, given that data that was presented to the state to justify those rates. they have asked them to go back and refile, while they are waiting to go through the process to review the rates again, of the rights that they have had back in 2009, are in effect.

this suggests that the division has over-stepped its authority by rejecting their rates, but it is very clear that they have the authority to review rates before they go into effect and reject them if they find that they are on reasonable and that is what the division has done. host: we are talking about massachusetts' health care and its comparison to the national program with dr. judyann bigby. she has a bachelor's degree from lesley college. back to the phones. washington, d.c.. on our line for democrats. wayne. see, i am glad that is it caller: i am glad that -- seek out -- caller: i did not have

health care before the obama plan. the hope of having it is wonderful. not having health care is irresponsible. we are lucky to live in this country. people need to stop whining. thank you. guest: i appreciate the perspective from someone who is one of the nearly 40 million people in this country without health insurance. you raise very good points. number one, we are a country that should be able to make sure that everybody does have access to health care. we have among the best institutions in the world. we know that when people have access to health care, we deliver among the best health care of any nation. it is true, however, that often

times when people do not have insurance and develop a condition, they cannot get insurance because of this rule about pre-existing conditions. this bill gets rid of that. i think that a lot of people will benefit. we have seen a lot of people in massachusetts come forward in the first two years of implementation. there were many people that had cancers that were discovered simply because for the first time in 20 years they have access to insurance and went to the doctor and get a checkup or have their symptoms evaluated. before they were afraid to go because they did not think they could afford it. host: gainesville for the -- gainesville, florida. our line for republicans.

caller: dr., thank you for coming on the show. i have two questions. i am fiscally conservative. i think it is fiscally responsible for universal health care. i know that i am at odds with my party. i believe it brings the best benefits for americans. my two questions are, what kind of changes will take place in states like yours that have set -- that have similar systems set up, and my second question is have you personally seem mitt romney sit on the death penalty? > -- , mel. there are no death penalty. no one is sitting on them. massachusetts will actually

benefit a lot from the national bill. there were provisions in the bill that actually increased subsidies for low-income individuals. right now, in massachusetts, we provide state subsidies for individuals of 23 green% of federal poverty level. -- of up to 300% of the national -- of federal poverty level. those people now will be eligible for tax credits and will pay less out-of-pocket to have affordable health insurance. we have also seen a benefit to our state medicaid program. that will get more subsidies for the children's health insurance program and other provisions.

one of the biggest benefits of this bill will be seen by seniors. we have about 88,000 individuals in massachusetts who, right now, have to pay for their drug benefits during that time called the doughnut hole where medicare does not cover right now prescription drugs and seniors have to pay that out of their pocket. this bill closes that gap over time. we know that about 80,000 seniors will benefit from that in massachusetts. host: the caller made a joke about the death penalty. explain where that came from and what in this bill or the massachusetts health care plan might be misconstrued as 8 "address panel." -- "death panel."

guest: one of the tenants of reform was that it was tried to address that if a physician were having a conversation with a patient about what they wanted to have happened to them if they became severely ill and it looks like there were no other treatments available, medicare does not pay for a visit where a physician has that conversation with his or her patient. someone simply wanted to allow medicare to pay to have a conversation where people were able to expect -- expressed preferences periodically, over time. the misinterpretation of that i think was purposeful and misleading. from my perspective, i do believe we need to move away

from a system where physicians are paid for each think they do and move toward a system where they are actually paid to take care of the patient. it should be up to that physician and the patient what happens inside the room, what that means in terms of an individual patient's medical condition, their preferences, the input from their family is important, and we need to move toward a system where providers now they will get paid for taking the best care of patients and provide what is needed for that individual. host: we're talking about massachusetts' health care and how the national law uses the massachusetts plan as a model. our guest is dr. judyann bigby. our next call comes from springfield, massachusetts. david, go ahead.

caller: it is a privilege to talk to you. i and a recipient of commonwealth care. i am really pleased that -- with all of the services that i receive. i see the doctor of my choice. i also ride the bus for free. i am a student at a community college. i am actually impressed with the system here. i think our health care should be run by the government. i would like to pay with my taxes to a system in which the government gives me what i need to live. i think that is the way it should be. i am glad that is the way it is now in the united states host: sorry about that, david. thank you for weighing in. guest: i think you raise an important point.

we believe that healthcare is a right. every american is entitled to it. we no longer live in the days where madison was not really that effective. we know, right now, that we can do a lot for individuals, both from treating diseases and chronic conditions, but we also know a lot more about prevention and how to keep people healthy by working together with family and their community to maintain health. the commonwealth care program the caller referred to is the state-subsidized program for people that are not eligible for medicaid that is offered through the connector. we know there are about 160,000 individuals who currently receive health insurance through that program. this is a new program that did

not exist before health care reform. what this program does is provide people with insurance so that they can go to the doctor for checkups and treatment when they needed, prior to the health care reform, these people were not covered. they can get care only when they came to the hospital when they were al. they could not participate that easily in preventive care. host: our next call comes from rebecca in glen burnie, maryland. see tell -- caller: you mentioned that your commission denied a recent request from health insurance companies. can these companies pullout from operating in your state?

a lot of insurance companies to not wish to recover -- to cover florida residents after storms and hurricanes. also, if insurance companies went bankrupt or did not wish to continue businesses that are not profitable, who will give us health insurance? did you see a day were the government will be the only health insurance company, so to speak? caller: -- guest: we do not want a situation where health insurance plans do not operate in massachusetts. most of the plants that operate in massachusetts are based in massachusetts. we do have plans that come in from out of state and interestingly, the number of rates that were rejected by the

division -- it was the out-of- state programs that refiled and proposed different rates. we recognize that we want health insurance plans to be successful in massachusetts, but we cannot have it at the expense of small businesses who are seeing double-digit increases. many businesses were ready to start hiring, but when they get their insurance bill, they decided they could not afford to take and any new employees. what we are trying to do is make sure there is a balance between supporting the health plans and making sure that they are successful and making it possible for small businesses to take advantage of the economic recovery. we understand that insurers are not the only one that need to work with us to get costs down.

providers need to also be at the table. we are, unfortunately, we have only this one regulatory mechanism right now, looking at the rates that insurers charge. we all providers will work closely with us and the insurance plans to get cost down so that we have more affordable plans for small businesses. host: in this morning's "financial times" this headline -- it highlights continued difficulties. millions have lost jobs. _ the challenge for president barack obama in overhauling health care actors' timing --

after signing the bill last month. tell us about the situation in massachusetts. as the time put stress on the availability and the distribution of pharmaceuticals in massachusetts? guest: that is an excellent question. one place where we have seen the growth level out as the cost of prescription drugs. before health reform, many of the insurers and the state actually took measures to try to encourage people to use lower- cost drugs that are just as effective as the most expensive ones, and therefore, the rate of growth of prescription drug cost in massachusetts has been relatively small, relative to the cost of other parts of the health-care system, and also relative to what is happening in other parts of the united

states. prescription drug coverage is one of the benefits that the connector board required as a part of minimal credible coverage, and that is a minimal standard for which individuals need to show that have coverage. hopefully, in this day and age no one believes that prescription drugs are not an important part of coverage. my belief is that by mandating coverage for prescription drugs, we have better mechanisms for monitoring the cost of those drugs and making sure that people have access to them. while others will continue to struggle with this until the national bill is completely implemented, one of the areas we know that people are having less difficulty is with coverage for their drugs. host: rachel calls from

massachusetts. north adams, mass.. caller: thank you foresees ban. dr. bigby, i am grateful for massachusetts program. i am partially disabled. i find it amazing that companies make profit over health. i am concerned about -- i know this is a work-in-progress, the hope for continuing ways to cut costs, and this plan has worked for me and i believe it can work for everybody in the united states. for the people who seem to complain about it, they do not realize how many people are uninsured or how fast life and circumstances can change. i have worked my entire life.

i have had employer coverage. i can only take part-time jobs now at this point in my life, because of the disabilities i have. i am extremely grateful. i am grateful for your work. thank you very much. host: dr. bigby. calguest: thank you. you mentioned your concern about health-care costs. it is the biggest challenge that we have right now. of course, mass. has always been a state with high health care costs, even before reform was passed. we are beginning to pull together initiatives that we think will have long-term impact on at least leveling the growth of costs in massachusetts. our goal is to do that while

making sure that people have the access to care that they need to add that we actually will improve the quality of care as well. host: dr. judyann bigby has been our guest. thank you for being on the program. guest: thank you, very much. host: for the next 10 minutes, we will open up the phones and take your calls on a variety of issues. the numbers -- it's called a couple of articles regarding the situation in afghanistan.

lawmakers say karzai threatened. he was threatened over the weekend to quit the political process and joined the taliban. host: also, in the "philadelphia inquirer" --

host: to the telephones. that plant, and our line for democrats. caller: how are you doing? host: good. caller: but i am 26 years old. i support obama to the fullest, man. i had to call and say that i support obama. i do not support rush limbaugh. it has gotten to the point where i am upset with tavis smiley.

let's support obama. let's support what he is doing. there is a lot of stuff that has not made us look too good lately. i want to say that i support obama. finally, he is doing something. for the people that are against obama, let's look at it. why were you not against george bush? host: kathy. caller: good morning. i was a democrat. i am now an independent. i want to say that this will kill the democratic party. they are planning a defensive in can heart. i am telling you. i have had it with him. i have had it with mr. obama.

i have had it. a lot of people by now have had it with all of these wars. host: is that what you're hearing from the constituents? caller: i am de -- i am a county committeewoman. it goes on and on. we are war-weary. i have a friend that is an independent. he voted for obama, too. i want my vote back. host: we will leave it there. "usa today" this morning --

host: birmingham, alabama and our line for republicans. go ahead. see, my name is tiny. i may republican. -- my name is connie. i am calling to say that mr. obama is a good president but you have to look at his policies. i am against his policy. i am against his health care policy. i am at that age where doctors can make decisions about my life style. host: what kind of decisions is your doctor making backs --

making? guest: my doctor told me to quit smoking. h., how long? caller: i quit ford two years. host: thank you for the call. from the washington insider --

host: we want to remind you that we will be covering the state of intelligence reform conference that is being held at the bipartisan policy senator today. if you want to see that, you can find out when we will run it by going to our web site, c- span.org. our last call comes from cincinnati, ohio. caller: thank you. i want to say that i think that a lot that is going on in the minds of people is this change.

change is difficult. i think if we all sit back and listen and process information that is going out, that we will find that the steps to the future will be beneficial for all of us. change is difficult. we have a lot of fear for the unknown. if we just sit back and be empathetic, calmed down, and see the benefit of the various programs, especially health care, i think you'll find it will be very beneficial for all of us. it will not happen overnight, but i think we will find that it is beneficial for all of us. i am a little nervous. thank you for taking my call today. host: thank you for making the call. thank you for participating in our