4:00 eastern, house energy and commerce subcommittee hearing examining the health care laws impact on the medicaid program. directorer, former cia discusses energy >> coming up next, newsmakers. biannual debate in toronto with the newt gingrich and former greek prime minister on the issue of taxing the rich. after that, q and a. >> joining us this week on "newsmakers" is dr. ardis hoven. here in the studios to ask

questions are two journalists. first question. >> we would like to talk first about the affordable care act implementation. there are no shortage of predictions that it may fall. when the medicaid expansion starts next january. from your perspective and that of the ama, what is the obama administration doing on implementation and what is it doing wrong? >> that is a very important question. clearly, there are many elements of the affordable care act already in play that are working quite well. that is what is so important to us. clearly, we have to work through many of the initiatives. you mentioned the exchanges, how they're going to run.

a lot of that is in play right now. we're waiting to hear what will happen with those. we will be able to inform our patients as to what we expect from these exchanges, how to be enrolled, what they can expect to move forward. there is work underway. it is very meaningful. clearly, we need to continue with transparency, communication, making this available to individuals so they can access exchanges and get the coverage they need. >> to follow-up on providing information to your patience, has the white house approach you about any sort of partnership on getting the word out on the affordable care act? >> not directly. we have been in communication with many individuals in the administration about our role as positions and what we can help them do and what we can do to help our patients get the kind

of information that they need. we will do what ever we can to make this happen. >> what do you see as role of doctors? it is a pretty polarizing law. what do you see as the role of physicians in terms of doing outreach and enrollment? >> clearly, as he moved forward, our responsibility will be to our patients. my job will be to communicate with my patients and their family going forward. physicians come together on many things. the american medical association has brought doctors together. we set policies together. this has good work about outreach. a good reach about transparency

and how we can help our patients access the kind of care they deserve and need. >> is your advice that they do not like the affordable care act, this is the law of the land and they should do what they need to do to get people coverage? >> that is a good point. there was decision-making on both sides. some support it. some do not. they came together and it is the law now. there are things in play now which are helping the american public during our job will continue to be to get our patients the kind of care they need at the right time in the right place by the right provider. >> wanted to ask about the people will health insurance now. what happens when we add

millions of people? wondering if you could talk about what patients can expect and what you will ask people? >> let me comment on that. it is important to realize that the patients already exist out there. they are already in the healthcare delivery system. when they have insurance coverage in their hand, our job will be to teach them how to get wellness care on the front and, how to be healthy and stay healthy. this is very important. this is the work that not only physicians need to be in but communities need to be involved in. we're going to have to work together publicly and privately to get this to happen. there are shortages of positions there are now.

there are shortages of nurses and other allied health professions. what we must do is we must work together in teams. we must utilize all care providers at their highest level of competency and training and working together. >> what about medicaid expansion? that may bring in people who do not access the system on a regular basis. while the reimbursements will be raised for two years, we are talking about primary care services. will there be enough doctors for those medicaid patients? >> there will be enough doctors. we had to practice the care. we will have to be more efficient of how we work

together in teams. we will have to let everyone work together in a meaningful way. that is what patients want. they want this care. they want to access the nurse practitioner. they want to be able to access their physician. 85% want to get it in a physician-led team. >> how does that team system come into play? does a team have to come from the doctors themselves? >> a team can be as few as two people. that is our definition at the ama. they can reflect the type of practice whether it is a solo practice or an integrated system. it will be up to the physicians. they decide who will be in the team and how it will work best

with the patients they need to take care of. >> do you expect wait times to increase? >> i missed your question. >> i was wondering the wait times to see doctors, whether you expect them to increase? >> it is hard to know now. we have to look at that. we have to be very careful how we work at getting patients into our practices. we need to utilize the infrastructure of our practices to allow those patients to get the kind of care they need and want in a timely manner. we are going to have to work on it we will have to make an effort. it is doable. i'm confident we will be able to manage the new folks who now have health insurance who will be accessing the system. >> there are some that would like to change the elements of the affordable care act.

what with the ama want done differently? >> clearly, there are many issues we need to address. we have to deal with the whole issue of sustainable growth. we must get and repeal it. we must look to were transitioning the delivery models that meet the needs of practices in this country and most importantly the patients they serve. that is item number one. item number two, we need to continue to work on medical liability reform. it is very vexing for physicians. it cost this country billions of dollars per year. it is ultimately an access problem. then we need to continue to look at what we're doing on medical education, the financing of graduate medical education, another issue.

this will cause yet another layer on physician cuts. done by unaccountable persons. that is not how we need to be handling healthcare in this country. let us pay for what we need for our patients and look at what is best for them in the process. >> what would you replace the sustainable growth with? >> in concert with our physician colleagues throughout the united states. they look at the various models of care, be they an aco, bundled payments, in some places a fee for service animal. there will have to be different

models. they are going to be balanced with how well physicians work to improve the care they provide to their patients. each one of these can be used depending on whether or not they can be needed. there is a large integrated system that may not work necessarily. it has to have a model that meet their needs but at the same time can do the improves outcomes and cost reduction that we all want in this country. >> i want to follow up on mary agnes get into the politics of moving forward. this tends to be a one-year fix, a very difficult thing to find to shore up this whole.

i was wondering whether you felt with the reduced price tags it would be an easier list or if you are still expecting it to be a challenge to do a permanent fix? >> i think it will be an easier list. we have seen demonstrated bipartisan support in repealing it and replacing it with other models and transitioning to those models. it will cost the country much more money than if we go ahead now, repeal it, and get along with what we were going to do. i am very optimistic about this. >> would you say you expect congress to come to a revolution? what are your expectations for where this issue goes the show?

>> my cup is always half full. it will continue to be that way. we had received rave bipartisan support for that. when it is in place we can imagine that they will work to get this accomplished. they have also seen that the cost of this if it continues the way it is unaffordable. they have to make a change. i am optimistic. we will see they can get this resolved. america's patients need this. the instability must not continue. >> what is the instability?

do you have solid numbers on physicians who left because of the sgr? >> we know that one in four seniors are having difficulty finding a primary care physician because of issues about instability. when you reflect back to 2010, what that meant were practices cannot depend on getting payment for providing care to the seniors and their this. they have to keep the lights on. they have to pay their employees. this cannot take place. they were frozen. they did not know what to do. they had to turn away patients which was very different. they are getting us out of that mode again.

when i see instability, that is what i think that. >> any ability to finance the pay for? that is a big issue. what are some of the ideas on financing? >> financing is something we specifically cannot get into. if you will let physicians do the type of work that we want to do in changing delivery models that we can in fact see reductions in the cost of dollars that are being spent right now but do not need to be spent. this is something that we can be a major piece of. we can help in terms of how many dollars are being spent out there. >> our guest is the new

president of the american medical association. >> i was hoping you would tell us a little bit about your main priority. you're coming in an important year for healthcare. what do you see as one of the key things you want to accomplish? >> i am very excited about this job i have this year. it is a voice for america's physicians. i will concentrate on three main areas which are the three main focus areas of the american medical association. the first is improving health outcomes for patients. we're going to address issues around cardiovascular disease and around diabetes. i'm very excited about this. i think it lends itself to something that is very important for this country.

secondly, accelerating change in medical education. we have been talking about changes for decades. now the american medical association has put together very strong effort to change the way we're going to teach young men and women how to practice medicine. it is going to be competency based on a not necessarily time base how they are going to take care of patients in the 21st century. how we are going to sustain physician practices in these days of change as you have alluded to. what is it going to take to make a practice sustainable? what will it take to make them happy with what they are doing? this is a great piece of work that we are undertaking. these will be my three areas of focus for their coming year. >> can you spend a little idea on the idea of changing medical

education? how will medical students be different in their day to day work with patient than doctors currently in practice? >> that is what we're going to find out. 11 medical schools are now part of this program that we have initiated. they're going to answer that very question. what do we need to do to change it? what will make a difference? where are they going to practice? what kind of information do they need to practice better? we are going to learn from this initiative we have undertaken. >> one of your other priorities, what do you see happening to doctors offices around the country? it is increasingly hard to have a one or two doctor practice. that can be a challenge in rural areas. what does it mean to have more

doctors consolidating and working for hospitals? >> we are doing some work right now and studying about 30 practices in the united states. there is great quality outcome for their patience. high level of patient satisfaction and physician satisfaction. what we are going to learn from this information is what are the key elements, the things that make the practices kit? how do we translate that into work that will be good for doctors and practices right now. i am a strong supporter of maintaining private practice of medicine. we will look at this carefully so we can enable physicians and

their patients to be on the side of care that they want to be in. stay tuned. you're going to see more out of this. >> can you give us a preview at all? do you feel like you have learned so far? >> we know the relationship between the physician and the patient is at the crux of this. it is at the center. we will see this evolving. i have not seen any of this information. it should be coming out in the not-too-distant future. >> talk to me about how this works in silos. you have the pharmacy, the government and so on. how do you change that to a more unified conversation, where they

work together to improve patient care? >> great question. i am going to use the improved health outcome to explain how this can happen. as we look to issues around hypertension, diabetes and prediabetes, what they're going to be able to do as we work with public and private entities is news that information not only to physician practices but we will have the ability to transform our relationship with insurance, with hospital systems, pharmaceutical companies, even name it. we're going to be able to leverage that. that is how we will begin to break down the silos so so we all begin talking together. we have got to do this. the patients want us to do this. the health care system needs us

to do this. a prime example is what we will be doing with our outcome. it is very dissolving of the silos around patient care. >> is a something they may not have done before? i know the ama recently classified obesity as a disease. you are recognizing it as a disease. does that make the insurance company more open to covering more treatments for obesity? >> i would think so. the ama has said this is something we want to deal with. we want to escalate this to a significant level. we're going to look at the things we must change to make things better around hypertension are whatever we choose to study. i do believe they will be a part of this.

they want to see what is best for the patient as well. they want to help us eliminate so much suffering and reduce the cost. >> a couple of minutes left. >> some people have disagreed with the decision to classify obesity with a disease. what is the debate that led to the decision? was there some disagreement about going forward with this? >> this is a discussion they have been having for some years. clearly as we have seen over the last couple of years, we recognize that everybody recognizes that it is a problem. nothing is happening. the discussion and debate has to do with elevating the concept of

diabetes being a disease so we can begin to manage this complex problem in a more meaningful way. the debate was lively. it was important. at the end of the day they supported this position. is it a perfect answer for everything? probably not. we know we have to do something about it. when a third of americans are obese, a third of americans have prediabetes, a third of americans in this country die of cardiovascular disease, we have a huge problem. we must elevate this conversation and work on the ways and means of correcting it and getting better help for our american citizens. this has been behind us for many

years. i am excited to see is getting to that place. >> i want to talk a little bit about your medical background. you are interested in being a plastic surgeon. when he graduated, had his you make that change? can you talk about how that choice has shaped your life? >> you go to school and i tell them to go in with an open mind. do not click down on something before you try everything else out. you might be surprised what you find out about yourself. my undergraduate degree was in microbiology. in medical school i did pretty well. i was successful at it. i went on to training in chapel hill carolina. what i realized was that i was

good at it. i loved the germs and the viruses. i was around people who love them, too. at the same time i was mentored by people for whom i had great respect. we love our job when we love what we do. for me that was the thing that ring true for me. it was an exciting time. i made the right choice. this whole idea of what i have done has actually led me to organize medicine. >> thank you so much for your time. we are out of time today. she is the new head of the american medical association. >> thank you. stick around. what are your takeaways from the conversation? let start with the affordable care act.

what stood out to you? >> she is so emphatic about the role. it is one of the questions that played a key role to try to help implement the health care act, helping them understand it. you were trying to get more people covered. as she noted, there was some dissent within the ranks. they did come out in support of the affordable care act. there's still a lot of debate from the perspective of the ama. >> i think doctors will be in a challenging situation. the healthcare law is still in a good position. they're saying we're not going to participate after some congressional inquiries. it is a tight rope they are walking. i am guessing they do not want to be seen here.

they want to be the trusting family position. >> how hard is that tightrope? they have been very concerned about other groups like the nfl getting involved in education. how will they be able to thread the needle? >> i imagine it will vary from practice to this. you will see some doctors who are very enthusiastic and some who aren't. i would be interested to see what they can do to talk to their entire membership you're all working in different areas. >> i wonder for example would they go as far to have the computer set up in their waiting room? here is where you drop down to see the exchange, whether they are operating here are on their own. would they have people on site? some will say we cannot afford this.

the key to this people really trust their doctors. we have both seen numerous reports that people can have data and do not do this particular medical procedure or this hospital. they trust the doctor. >> what stood out to you on bsg are? she said she is optimistic? >> for her to hit the reduction is important. there are about $100 billion down from where it was. for her to capitalize on that is a real message to washington. it will cost you less to move forward. congress is having a hard time agreeing on anything. the financing will still be the problem. i respect the optimism. i think it is a tough share.

>> i agree that even though we have this price tag, this is still a lot of money that legislators are going to come up with. this is not an area they get into. this is something they're going to have to dig into. we will need to be offset from someone else's reimbursement. it'll be really exciting. >> what else is you hear that caught your interest? >> i was interested to hear talk about changes to medical education. that is an area she talks a lot about as a focus. we have a lot of respect for our doctors. it'll be interesting to see how these changes are playing out. i was interested to learn about