three series -- senior correspondence join us -- correspondents join us to answer questions on insurance. "washington journal" is next. ♪ host: good morning and welcome to "washington journal," on this monday, july 29, 2013. we are looking in the federal health care law today. be joined by federal correspondence from kaiser health news. we will get started by asking you what you think the impact of the federal health care law is on you. have you felt its effects so far gecko what are you looking at -- so far? what are you looking at in the future? here are the numbers to call --

you can also find this online come a send us your tweets by or join us onj, the conversation on facebook. you can also e-mail us, journal@c-span.org. what do you think the impact of the federal health care law will be on your life and fiscal situation? here is gallup looking at what americans are saying the healthcare law's impact will be. 22% said they believe it will make it better. 33% said not much of a difference, 42% said they believe the health-care law will make there family health care situation worse. looking at the larger picture,

34% believe it will make it better. different. much work.y it will make it this data is from a gallup poll conducted as obama administrators are trying to raise awareness of the affordable care act. we are asking you what you are seeing and feeling so far. we hear the stories in the news today, this one from "usa today" --

our first caller is on the line. gayle joins us from topeka, kansas and is a democrat. good morning. caller: good morning. host: what are your thoughts this morning? how do you think the health-care law is impacting you? caller: it is impacting our family a great deal. my mother-in-law is -- the donut hole is going to shrink as far as her prescription drugs are concerned. to findter will be able a job with insurance, with previous health care concerns. my granddaughters, one of them was able to stay on her parents' health care insurance

until she found a job. i have another granddaughter who is on her parents' healthcare insurance. it has affected 3 generations. stanley is in san diego, california, also a democrat. caller: good morning. i am from california and i was calling to find out when the new tell -- when the new healthcare -- i was given information that i would qualify because i am receiving california's medical. i would like to see if i would qualify and would be able to get government subsidies.

with we will be talking senior correspondence from kaiser news later. we will find out more from them. how are you getting information so far? how are you learning about it? caller: i've watched c-span , the situation with bush-gore. i have been an advocate politics watcher. i watch c-span on a regular basis. i am recording at this moment in time. regular basison a programs. those

host: are you hearing information locally about what california is looking at in terms of the health-care law? severali contacted people to -- i contacted several people to give me that information. they tell me they have no information at that time to provide to me. once they have it they will be able to give it. right now, over the past several months -- i even contacted medical, they said they have no information. are the ones that told me i would not qualify because up -- i am not satisfied with it. i think i can do better if i was to check with the exchange area and i am retired now. i retired at 62 years old.

betterlike i could find doctors under the exchange and a better insurance provider. what i am being told is i would not qualify because i have been receiving medi-cal and i have been receiving it for the past 15 years. host: we will get more information on that from our guest. here is a review of what is happening over the next coming months. mentioned, stanley, that health insurance exchanges or marketplaces, places where people can shop for insurance. october 1 open an woman begins and it starts at january 1 next year. we are seeing state-based exchanges. some states defaulted to federal exchanges. and then we are seeing some partnerships also launching. killingans pushed

obamacare funding support. sunday --ke leon on mike lee on sunday -- let us get an independent caller on the conversation, gregory from oklahoma. caller: thank you for taking my call. as far as this health care thing, i have always been a healthy person. i never went to a doctor unless it was an emergency. i get involved in this healthcare stuff. doctors are in business to make money and these drug companies out there, they got drugs for everything.

quit seeing doctors, i quit taking any kind of drug, legal or illegal. i don't even take aspirin. it works just as fast. it keeps my metabolism straight. i believe our bodies were made to fix themselves. these doctors scare you up. might have this, we have to run some tests. tests."-- these they are like vampires, sucking out your blood. i find out i have hepatitis be and my brother died from hepatitis c. they sent me to three other doctors. come to find out i don't have anything. us go to north

carolina, jerry is a democratic caller. we are asking you what you think the impact of the federal health care law is on you. go ahead. morning, i finally have gotten into the journal after a couple of years. a medicare advantage program for about three years now. fraud, andwaste, abuse, and accountability under obamacare, my medicare advantage program premium went down $1000 this year. republican a big money campaign against letting people know what obamacare is all about. i used to be offended by the name obama care until obama said he it because he cares.

afraid thatare so just like medicare, people will begin the program emma they will find out how great it is, -- the program, they will find out how great it is, and we won't go any other way. obamacare is better than what we have. if the republicans -- republicans have no options. they wanted to repeal its 38 times but they offer no substitution and no way forward area did -- and no way forward. they are so out of touch with reality. host: here are the phone numbers to weigh in --

some comments on twitter -- republican senator mike lee was on the talk shows yesterday. he spoke on fox news sunday. the washington times tells us that mr. lee and other senate conservatives are seeking support to reject the spending bill that includes money to implement the affordable care act. the senators, who includes marco rubio, ted cruz, and rand paul say the party needs to draw a line in the sand when it comes to obamacare. --

let us take a listen to senator leahy on fox news sunday. [video clip] >> americans, by a margin of two to one, believe this will make their situation worse, not better. it,nesses do not like individuals hated, union beater say it will be bad for workers. even state laws and the principal author in the senate described as a train wreck. the law certainly is not ready to be implemented and we should not fund it. news senator lee on fox sunday. independent caller, hello. caller: i am under obamacare. i have a very good heart doctor. it took me two years to find him. two years to find this dr.. he apologized. he called me into his office and

sorry, but i am going to close my office ergo -- my office." he could not practice medicine under obamacare. that is the effect obamacare has had on me. i no longer have my cardiac special test. was talking about the joys under obamacare, i do not know where he is. it is not working for me. i think we should pay attention to what is going to happen under obamacare. host: that is rooted in connecticut. let us go to marry in foss pirg, maryland, and independent. fosberg, mary in maryland. a rurali live in

county. we were one of four cost the in toyland that was used experiment with obama health care. i very quickly found out that i not keep my own doctor. he can no longer admit me to the hospital. we can now only be admitted through the emergency room, evaluate to you even if your doctor wanted to be admitted. if they want to observe you for while they will put you in a 23 hour observation unit where you are only seen by a licensed practitioner. most insurances will not pay. i was admitted to the italian ration unit -- to the evaluation unit. i was never seen by a doctor, i

was never seen by a doctor in the emergency room, but a licensed practitioner decided to put be in the observation unit. i was sent home. i was severe asthmatic and respiratory arrest at that point. over the past several months we wee now -- they have now -- have a lovely hospital. 500 employees. the hospital is going under. we have only one hospital. going toand they are try to combine our hospital maybe with three other counties and their hospitals so we do not know what is going to happen. a lot of the people in our area are trying to go to ruby memorial in west virginia or the winchester hospital in for genia. winchester hospital in

virginia. we are not getting the proper care here. from morris inar san diego. how this am not sure will affect me, i am 62 years old. since president obama has been in office i have lost my job and been put out of work for 2.5 years. i am hoping in three years that when medicare kicks in i will be covered by that. if not then i will be in real trouble. thats interesting to hear lady from connecticut. she lost her cardiologist and my dad is lost his cardiologist. she said she was going to be raising her family instead of practicing that, i think it might have something to do with the affordable care act. hoping medicare kicks in.

the gentleman from california, the county medical services is a state program. how obamacare can compete with this, it covers everything. i do not even have to pay any kind of deductible or co-pay. the best.hoping for i think you can only impact me in a negative way over all. independent,s, and hello. taking careve been of two elderly relatives. both of them are on medicare. recently both of the doctors at this specialty clinic told me that my aunts had due pay upfront, seeing as they're medicare service was taking too long to pay. the administrator said because of obama care this is what they are going to start doing. here's the problem with that. the doctors are charging $160 up front.

medicare only pays 103. my aunts are obligated to pay the rest. i am just appalled of what people think of obamacare. over 45een working for years and i just got my job hours cut down to 30 hours so my employer could take away my health care, which was fantastic. i did not even have to pay a co- pay so they could put us on obamacare. the other thing i am going to say is i think all of these younger people over 26 years old, they are going to find out that they are going to be paying progressive taxes over the years, which are going to be inflated due to hospitalize asian and increase of medical care costs -- hospitalize asian increaseslization and of medical care costs.

a lot of people don't realize they are left out of the system. and i amlong democrat, thinking of switching parties, i am appalled at this nation of -- everybody i know is working and they are still getting obama phones and link cards. we have become a nation of welfare and handouts. we should go back to the kennedys and say don't ask what the government can do for you but what we can do for the government. host: on twitter --

press,"eet the secretary jack lew defended the policies and cited the affordable care act as part of president obama's successful record. >> we have been through budget debates over the past four years and sometimes you have the sense that people are starting all over again. we are not in the same place that we were in 2011. we have seen several pieces of legislation that reduce the deficit substantially. we are seeing the most rapid reduction of the deficit since the end of world war ii when we he mobilized. mobilized. de- we are controlling healthcare costs. host: jack lew on meet the press and let us hear from sammy in maryland. i am recently retired. i retired in 2011.

i have been working for the local government. fractured her neck six months later. i became her advocate. gettin ght einformation on the -- if getting the information on the healthcare program is anything like medicare, they assume you have a computer or you can use a computer. -- now i ample that having major issues with going through the internet and trying to get the information on medicare. it is an example of how the obamacare stuff is going to be. that is not enough time and in a readily enough format that everyone can use. republican -- a

far as theou seen as impact of the federal health care law? caller: i am retired. we have our own health care. i am on medicare. gentleman on before saying the unions were against obamacare, that was not true. the units are trying to get a program where everyone can have health care. the only problem i have is when you go to the hospital, automatically you have to use their doctors that are on call. you are treated in that hospital by their doctors. your choice of cardiologist or whoever the doctor may be, you

do not have anything to do with it because they are in charge. hospitals are the bad part of the whole system. whoever it mayh be. blue cross,to use blue shield, or any of the other programs to supplement my health care. but it is paid through my benefits. my co-pays are eating me up and it has nothing to do with obamacare. i think republicans need to suck it up and get with the change and help build on it. thank you. national journal looked at what people's opinions are on the federal health care law. even supporters of obama care are ambivalent about the law. looking at the "national journal" piece --

dan tweets in and says -- susan, greendale, wisconsin, a democrat, hello. caller: hello. my big concern is that everybody is against it and it is not even an effect yet. parts that are but not all of it. i think what is going to happen over over time is it is going to change a little bit. we do not know the full impact of it. how can people condemn it? not only that, i am a retired nurse and i can tell you one thing, that these doctors are not going to like taking a cut in anything. they were against medicare, they were against everything that the elderly or the government tries to do. they want to make their money.

that gentleman who just called about doctors going to a hospital and first doctors taking care of you, it in this area the same thing is starting to happen. you go to the hospital and these doctors do not even know who you are. and they're treating you for that small thing you have, and that is not safe. host: the lost to journal has a front page article that says --

laura, troy, michigan, a republican, hello. good morning. i am a volunteer. i drive people to doctors appointments and such. in the last few months i have had two ladies that i took to appointments. they were over 65. apparently there is a complete physical that is available when you are 65. the one lady found out that she had diabetes and another woman had high blood pressure. i think this is wonderful. who talkederson about going to hospitals and not knowing doctors, many hospitals -- employing someone called they work for the hospital and the court to make and also speak to the physicians, often times

doctors don't do that around the hospitals. when i was in the hospital my doctor came to see me, even this coordinator -- even with this coordinator from the hospital. the regards to people talking about the cost of affordable healthcare, most people do not know the benefits created everyone says it is terrible and we hated. because i work with a lot of older people, a lot of people to not even know the benefits. if you hear people say, "it is awful," but none of them know what it means -- i asked a man what was so bad about it. he did not know but he heard on the fox channel that it was

terrible. i am disappointed in my country now because everything is so negative. i would like to see people talk about good things in our country. thank you for listening. indiana, rodney is a democrat. hello. i am 67 years old, i have been on medicare, and i coverage ina 20% medicare. last year the premium came down. my co-pays went away. i am really happy with the insurance. that was overure $93,000. out of my pocket was less than $3000. i am really happy with what is

happening and looking for to getting that completely implemented. i think this is going to be greet for the country. host: bob, in other color -- another caller in indiana. concerned about losing my advantage, which i am very happy with. with doctors and stuff, and i have relatives who are nurses who are worried about this program -- there's no no free ride in this country. everybody has to just look at sea -- look and see what the costs are. the promised what it was going to cost on medicare. to to starty have rationing under old care. there is no way to get around it. thank you and have a great day. host: this tweet coming in from jim --

we have also seen a series of facebook comments. for your questions on the affordable care act. pagean go to our facebook to post your questions. senior correspondence from kaiser health news will join us in just a moment to answer your questions. he lit the five -- we will divide the phone lines up in a minute. oning up next, a roundtable the health-care law. first this update from c-span radio. teamsaeli and palestinian are in washington today for a new round of peace talks. a resumption of talks is made possible by a decision by israel's cabinet yesterday 240 to free 100d --

long-held palestinian prisoners. the talks are the first in five years. state department spokeswoman says the teams will meet today and tomorrow to, "develop a procedural plan so house parties can proceed with the negotiations in the coming months. so talks on a final deal is expected last -- expected to last six to nine months. pope francis says he will not judge priests for their sexual orientation. in remarks earlier to reporters the pope said, "if someone is gay and he searches for the lord and has goodwill, who am i to judge?" his predecessor authored a document saying that people with deep-rooted sexual tendencies should not be priests. pope francis his remarks came

today during his plane journey back to the vatican after his first foreign trip to brazil. an update on the caswell explosion last week, scientists are trying to figure out if it is the well that blew off -- if the well that blew off the .ouisiana coast is harming they also released a long cylinders that would drift with the current, tracking the likely path of any contamination. those drifters have gps and transmitters. private vessels could be seen coming and going from the site. regulators say natural gas detectors and high-capacity water hoses were being installed yesterday on the rig that caught netherst week, and a drake being ready to take a relief well. and a military judge continues deliberating in the court- martial of an army private charged with aiding the enemy for giving usc gets -- u.s.

secrets to wikileaks. the third day of deliberations in private first class of -- deliberations of private first class bradley manning. counts are including computer espionage and theft for sending some battlefield video and and type -- and documents wall working as an intelligence analyst and i rock. the defense betrayed manning as a naive whistleblower who wanted to explodes -- what to expose war crimes. some call him an anarchic hacker and a traitor. he faces a possible life sentence if convicted of the charges. those are some of the latest headlines on c-span radio. the first lady reflects reflects the schism that is in the united states about women --

about what women are supposed to be. are we supposed to be mom in chief? our we supposed to be first mate? -- if thee that president is supposed to be head of state and head of government, is the first lady supposed to be the ideal fashionista? in-she supposed to be mom- chief? is she supposed to be the first helpmate? if she is going to be the first helpmate, that means she needs to understand what is going on in the administration. she needs to understand what is going on in the country, and she has to understand her husband's political agenda. you cannot really separate how the first lady present herself and the conflicting expectations that the country still has four working wives and mothers.

>> as we continued our conversations on first ladies, historians and others talk about the role of the first lady and and its move from traditional to activism on behalf of important issues, and the transitioning from public back to private life. tonight at nine eastern on c- span. >> "washington journal" continues. >> we are focusing the rest of the washington journal on the federal health-care law and what it means to you. we kick it off with a series, with kaiser health news. first up we have mary agnes carey. jay hancock, thank you to you as well. we also have sarah varney in from california. here is how we are dividing up the lines, if you're easternorn call us at02-585-3880.

if you are2 mountain02 or pacific or further west it is- is 202-585-3881. -- to make the health insurance cover more than it currently does. host: what we know about its effectiveness? have: several benefits been added for millions of americans, preventive care, looking at screenings for hype blood pressure -- for high blood pressure, mammograms for women over 40, those are available without co-pays. to 26 are upn up to health insurance plan. there is no lifetime coverage. heaven forbid someone had cancer, there's no no lifetime limits on your coverage. costs goave seen their down for medicare prescription

drugs over the closing of the donut goal -- the donut hole. host: as we look at cost in getting more people insured, what we know on those counts? guest: there are concerns over time that adding additional benefits will increase the cost of health care coverage. in rome it starts in october 1. these are run by the federal government whereby the states were partnered partnered with the federal government and states. some are lower than originally anticipated. look into the elements that change so far, these are people that currently have insurance plans. closing the doughnut hole is also on the list. how significant is that? guest: it is significant. over time the donut hole has less seniors with a lot of costs.

that is going to be faced down to have seniors just cover 25% of their cost. incomesnot have large to begin with, this has been helpful for them. host: we are seeing things like coverage cannot be canceled except in cases of fraud. problemhis has been a several years ago. california had coverage, you would file a claim, and then you would not have it anymore. on yourntentionally lie application, that is the front element, that insurer could counsel. if you do not do that something like rescissions are no longer allowed. guest: we were talking about situations where someone was getting cancer treatment. the insurance companies actually had internal compartments that were said that were set up to find errors in applications. -- you mightinning

be getting cancer treatment and they will look back and see that you had your appendix out or acne when you were 16. they would say you have not given your full medical history. people have lost their coverage. california banned that with a state law. it is part of the affordable care act now. host: we sun news when the obama administration delete implementing and enforcing large businesses having to insure you their employees. why was that change made? it was significant because it was a delay in one of the major pillars of the law, which is the idea that we want to get everyone to get insured.

one pillar is expanding medicaid for poor folks. another is the individual over a that everybody certain income has to have health insurance. the other pillar is that employers are obligated, 15 employees are obligated -- employers are obligated with 50 employees to insure their employees. the delay was seen as a setback by republicans, who keep arguing it is very difficult to implement this law. it was seen as a source of relief by a lot of employers. one of the things going on with this law -- remember it was passed in 2010. it was suppsoed to be, "that gives us four years." what's going on now is the time

to get new rules out are squeezed. rules are still coming out even as we are sitting here. employers were trying to figure out how they were going to comply with the law. decided, weration will give them a year's break. we can all take a breather and figure out we are going to do this. at a seminar by an insurance broker in california. this room was full of employers that were athar plastic about this. there was this list of dates, by october 1 you had to give a piece of paper to every single employee letting them know what their benefits are going to be. they were worried they have to update their computer system because many of these employers i were talking to do not have -- i was talking to did not have a

computer system that would track at the level they needed to. a 100ey need to buy thousand dollar computer system on top of all of these added costs to the system. a week later he was released he has more time. .ow he has until next year this october they do have to send out notice to their saying they have to buy insurance by january 1. we are joined by senior correspondents from kaiser health news. the washington journal is launching a partnership to export a federal health care law with kaiser insurance. their work can be read and publications like "usa today, co. "washington post, "and pr." kaiserwe are part of the

-- our stories do run and partners throughout the country. the editorial independence element of it means that the newsroom works like all of the newsrooms we have worked in throughout our careers. you decide our stories, write them, and pitch them to partners around the country. it is important to note that --ther the kaiser family kaiser foundation -- neither the kaiser health is associated with kaiser foundation. host: let us go to the phone lines, you are on the phone. caller: i have been made off since 2009. findingen, it was from full-time work to almost part- time work and a lot of areas. i am thinking employers -- i just found work within the last 35 days. what i am finding is a lot of

employers are trying to avoid giving full-time hours coming even though the demands of the work is full-time work. are actually going to the point where they are writing people up if they are going over there hours, trying to meet the demands of their customers. is that fair? what can you do to report it? i think americans should do the american thing. -- if youe full-time have part-time workers doing full-time work, they should get benefits just the same. they are trying to hide under this 30 ball -- this 30 hour barrier. i wanted to see if someone could comment on that. host: what reporting heavy done on this topic? guest: quite a bit. two points to be made here. if your employer is asking you to work more than 30 hours a week and not paying you, or not paying you for any hours you are putting in that is

against the law. you are not supposed to do that. it has been known to happen every now and then. talk to your supervisor about it. if you do not get any satisfaction, you can talk to the illinois labor department. is other points to be made the big one, which is you know something that is a bit of a trend going on here. the number of part-time jobs has been growing. something of a talking point to republicans. they claimed the growth in part- time jobs and the relative lack of growth in full-time jobs -- they blame it on obamacare. as you mentioned obamacare revives coverage for larger employers and employees working over 30 hours a week.

tos gives incentives employers to keep employees under 30 hours per week. the mandate we just talked about is giving some employers sometime tooth -- sometime to rethink this. the question is will this continue? -- economists claim the poor the growth of part-time jobs -- there is something going on with globalization. a lot of republicans are blaming it on the affordable care act. we are going to be watching in the job numbers in the coming months to see exactly what is going on. is a story jake hancock filed for kaiser news.

we will talk about what this means for businesses and employees. jonathan is from phoenix, arizona. go ahead. call aboutant is a age in which it covers, say your parents will cover you. i believe it was 26? i do not understand why the age limit is so high. care. pay your own health these kits that are growing up -- onaccountable accountable for what they want

-- unaccountable for what they want, now they won't be accountable to get up and there own jobs and their own economy going. i am 17 and i grew up with different values. i want to know what you guys ought about it. do you agree or disagree to affect that this age limit is so high? host: do you have a game plan for when you turn 18? do you plan to continue your education or get into the workforce? caller: i plan to get a secondary education. it might be difficult for me to afford my own health care. that is part of life. i am going to stroll with that. i am going to find my own way. i will be happy to participate. host: take us through what this cutoff means and why it is

significant. so many young americans were getting out of college with the economic slowdown and were having difficulties either getting a job or finding a job with coverage. that is why this provision was created. it helps millions of young americans get covered. i think the caller's concerns are ones that have been echoed on capitol hill, that this adds an unnecessary expense. specialth lot does have and larger deductible plans. it is a good policy when it is time to go into the health insurance world. there will be options for younger fulks. -- younger fulks. for those backstop getting out of college that need coverage. many parents as well as little

children out of college are happy to have it. guest: there was a story a couple of months ago i did a story on, asking the obvious question, does having health insurance protect you from catastrophic financial problems? what they found out was it does. ofy looked at in number things that would send you to the hospital, bar none. situations where you would not have a choice. before this provision was implemented and after, what they found was $147 forion in compensated care the hospital is now being paid out by insurance companies. there were a lot of legitimate economic reasons. students who are graduating that were not able to get jobs with

health insurance, whoever wants to phase one of these illnesses would have gone to the hospital. they would have been sued for claims or the hospital would have had to claim uncompensated care. republicans push for killing obamacare funding, this is gaining some support among conservative republicans. as we look at a recent poll by holes sayf those repeal the obamacare act. 67% said expand or keep it. what do you think in terms of the fight? very: it continues and is intense. house of representatives will have the 40th vote to repeal all or part of the health-care law. this will look into defunding the internal revenue service in

having implementation efforts in the health-care law. i think republicans see a lot of good things for them. fact that democrats kept the senate and white house in the november elections, the law is feel that not good for individuals and employers. they are very motivated to he funding it, not only the standalone measures but as we look toward the continuing resolution, the bill that will fund the government beyond september 30, they plan to act on the foot -- on the health- care law. our next caller is jonathan in new hampshire. good morning. caller: good morning.

i had a couple of questions. i have had quite a bit of confusion on some of the information. with regards to the medicare , is that going to be did salt -- dissolved? which of the two are they going to continue? guest: medicare advantage is being reduced overtime. they are trying to equalize with the government pays for beneficiary and traditional services. the program will remain. you talk about supplemental coverage, that is used most

often for a variety of policies. neither one of those programs are going away. i would add that a lot people have been predicting a decline in in medicare advantage coverage because of the funding we let -- the funding reductions. you are seen that anywhere in the insurance industry. these plants are only getting more popular, despite the reimbursement reductions. host: david in new jersey, hello. caller: good morning. i have been unemployed for two uninsuredi have been for that same. of time. i do not want to bash the program but it seems kind of clandestine. they do not want to publish the

thisrs, they talk about gold, silver, bronze package they're going to have. it is very hard for the consumer to wrap their hands for it -- wrap their hands around it. i am hoping for the best. the $240g to pay premium every month but they are offering for this basic clan. i am only doing that because i do not have a lot of confidence in the affordable care act. i am not in the position to even afford this. i was a high income earner for the last couple of years. i just have to take they should insurance now -- the basic insurance now. i don't know if anyone wants to add to that. a couple thoughts. yes it is really complicated.

, ifver, in a few months everything works close to the way it is supposed to, a lot of things will become clearer. exchange -- health these online marketplaces were anyone like you is supposed to go on and sign up for coverage -- if the software is designed right you will be able to go on their and actually get a really clear idea of what your choices are,what the trade-offs the plants, and what the plans are going to cost. those open october 1. people like you have until march -- march 31 of next year to comply with the mandate. one other quick tip, go online and google "obamacare subsidy calculator." this is something our colleagues at the foundation put together. tool that will

show you not only what coverage is available but what kind of subsidy you are going to get based on your income to help base -- help pay those new premiums. if you're unemployed you will most certainly qualify for a subsidy. it should give you more information than you have now. host: one question i have is should he wait? that is a great question. if you have not signed a contract already, wait until october. it is when the subsidies become available. they are not available now. if you bought the plan already you are doing the responsible thing by being insured. you will get financial health if you wait a little bit. you aree calculators talking about was from the kaiser family foundation. it is a way to plug in

information and find out some results. we have seen some tweets come in especially on this question of young people and their health insurance. jan says -- we see this also from don -- for young people who are not on their parents health insurance, they are still facing having to get insurance, whether or not they have a job in the coming months. mary agnes carey, take us through don's question about why 100% of people are supposed to get covered. guest: younger people tend to be healthier and insurance is the

balance for us. you need younger people to balance it out in the risk pool. to jay's point, looking at subsidies that might be available, not only with what your premium and co-pay is, you can get a lot of financial assistance to get coverage and get into health insurance system. it is part of the nature of insurance. it is important to note there are a lot of young old looking is ands and weighing the wondering if i pay the penalty or i get the health insurance. this is the balance they have to make. if you are not covered and you have a catastrophic event, e get bea car wareck, you will responsible for those costs. >> look at what this will be.

% of taxable income, what ever is greater. whatever greater in significant detail? but 1%is not a big deal maybe higher. >> bronx, new york. caller: good morning. i want to thank what he is done for our community and nation. our family.eful for as a human being and a nation we are claiming to respect human rights in different parts of this world, i want to add this. president obama.

if you are caring for our buddies in this country, we want to care about this in different places. host: our guests are answering your questions about the law. look at the out to insurance marketplace. we will share some new -- here are some new phone lines. if you have insurance you can 202585380.

if you lack insurance it is 585-3881. good morning. we have about 30 employees. 30could easily higher 20 or move but we will not do it because of obama care. it is one of the largest hospitals in america. we just laid off it is one of the largest hospitals in america. we just laid off the reasons his he did not institute

policies simply because there were elections coming up in november. that is ready much it. i apologize. that do not get insurance if they get hurt they are going to be responsible. if they do not have the money and there are d getting subsidies, they do not care if they are responsible. there's nobody to get. it looks like we are already paying for these people to start with. a change in the system is the same way i look at it. guest: there are lot of antidotes about employer saying there holding off hiring. isuspect a lot of it because of uncertainty surrounding the law. i think

i met this one man down and brownsville who works full-time in the shipyard. he is uninsured. what he did about the bill. he said i still have it. they try to buy a house or a loan. that will be on his record. this idea that you can somehow go to the emergency room and walk away is somewhat of a fallacy. there are hundreds of billions of dollars of care. the price to the individual and

family is not one of just a clean slate. host: good morning. my question is this. this is strictly healthcare that has to do with big as ms. and money and insurance companies. did any of you people see the hour-long special on public television where they compare healthcare cost from this country to other countries in the world? did anybody see that? it will open your eyes. politicians is just greed and money. tworother had an mri about years ago, $1300. if he can back it will be $2000 for a facial mri. any other country he went to a would've cost of $91. a doctor visit in this country

walk in with $15 and you can see dr.. it is not matter what kind of insurance you have. some countries have a limit on how much money a doctor can make per year. when he hit that limit he is working for free. thatt to know why it is this country, with the politicians and insurance companies who do not care about the elderly or the kids, why is it that this country has to have this kind of a healthcare deal? it is an accident of history. it is true that when other countries are looking at any economist when you asked them if you would design it the way the united states, most people would say no. taiwan was facing a situation where they have many uninsured people. healthoked at different systems and they came to the

united states and left immediately. it is not one that is seen as a model by any stretch or any country. it is an accident of history. during world war ii companies were not allowed to increase salaries for workers. in order to create enticements to keep workers they started offering health insurance. it worked its way into the american healthcare system and it is how we have been set up for 46 years. i do not think there's anybody who would say this is a perfect system. it is one that has been built on. guest: politically it is pretty invulnerable. congress democrats said they wanted universal health care coverage. as the political possibility that made it happen. .t is very complex it is very expensive. one of the things we should mention about the affordable care act is it is designed to

control some of these costs and reduce the unenforceability that the sheer expense of these procedures and the number of signs of thatw happening now. guest: everybody is frustrated with the costs. you go to people in different parts of the system and asked them where they should come out and they always point to somebody else. that is the big problem. how do you get people to agree to take what needs to be about to even begin to match what other developed countries are paying. we are visited by three guests this morning. they have a partnership with kaiser health news.

more aboutlet's talk the exchanges for the marketplaces. what are they? marketplaces is the new term. exchanges was this policy term. they are trying to rebrand them. they think that is more descriptive of where they are. -- onlineainly online places where you can shop for health coverage. you can walk several steps to is.where the design of this it is not an obvious thing.

october 1, you're going to hear more and more about these exchanges opening. you are going to start hearing about this. based on this individual they can sign up get credited with the subsidies we have been talking about on the spot. they will be insured for healthcare after that.

some states are choosing to run their own exchanges. kaiser a map from the family foundation. why is it significant that some states like california are doing faith bait exchanges and others are faulting it to the federal exchanges? the state has decided they will run their own exchange. is coming from california where i have been following what is going on. you see different kind of models. this wasrnia considered an active purchaser. when the legislature passed a law setting up this exchange the authorized them to run

exchange to negotiate strictly with the insurance companies. went to the unveiling of the a month or two ago. it was like a party. everybody showed up. there were 100 people there. you felt like you are going to an art show or something. they cut of the rates on the screen and everyone started hollering. they were participating in the california exchange. i think there were about 13. the rates were much lower than what people anticipated. i think we're seeing that in maryland. we're seeing that in a couple of other states for the rates are coming in a lot lower. an active is purchaser. others are saying we will put up the marketplace and build a website and anybody can sell their wares on this. host: what are some states

having a harder time getting insurance companies marketing their products? guest: mississippi is where there was a wide swath where there would be no insurance options. humana has stepped in. have when youou have a marketplace. it is something where you have to have customers willing to buy a project. you might make a business decision that that is not a market you want to go into. as long as you're having this delivered through private health insurance companies, that is what you are going to get, people making business deals. filedappleby recently

this. consumers may not be offered insurance subsidies. take us up to date with what is happening in mississippi. guest: when he wrote the story there were some banks lot -- blank spot on the map. host: what does that mean? tost: if you were eligible buy in the exchanges in certain counties in mississippi you would have no choice. you would say i qualify. for the subsidies. i want to buy in the exchange. since then the department of health and human services in mikengton as well as cheney had been working really arm twists.e

one of the larger insurers i believe has agreed to come in and offer a plan in these counties where there might not have been any choice before. there are other states where it is thinner than some others in california. sarah mentioned it would have 13 in the marketplace. it is not going to be appropriate. they are not iowa, going to have any empty counties. guest: all health care is local right? in california and in many other bigger states, you have states broken up in different regions.

insurance companies have to go in and form these partnerships with her biters. the net -- with providers. the providers are very local. a regional hospital chain in southern california building around a network of providers. whereould be different there is mainly one hospital. it is the ability to get an insurance package. it depends on who the providers are. host: they ask if you can comment on the number of plans offered in the state marketplace. will it be sufficient in competition? let's hear from our callers. beverly is insured. hello. areer: i am so glad you there today. i am so ignorant about insurance. i talked for years.

we talked for years in new jersey. we are both covered by blue cross blue shield. i have to go out on me. i cannot finish my term. it did not matter to me. i was covered under his insurance. i lost my when i went out. when he passed away and they informed me now my insurance is not free. i would have to pay. ok. it did not bother me. every year my premiums are more and more. are taken out of my pension check. i have to have insurance so it doesn't matter. i heard president obama saying something about if you are insured and you are paying premiums you will get money back this year or something to

that effect. i do not know anything about it. i do not want to upset them. i do not know anything about it. could you answer that for me? i'm very sorry for the loss of your husband and having to deal with this. is talkingesident about is the healthcare law is required to spend 80% of your premium dollar on health care benefits. it does to people who buy their own health insurance. they may get a check back from there and sure. they are spending at least 80% on premiums. if you do not buy it yourself

your employer buys it for you. the moneyyer may get back. that has been confusing for people. encourage you to look at the exchanges. you might qualify for your actual premium. we will see if you can get a better deal. guest: if i was a late mail and my late 20s i should not have to pay a fine. and a story. look for c-span. we will go over again the numbers of what you will pay if you do not get insurance. or 1% of$95 a person

your taxable income goes up from there. it is two percent of a taxable income or over $300 if you do not pay and then it goes up more. it is annually adjusted. would they come knocking on your door? we tracked through the revenue service and it would be your premium. guest: if you do not pay, and the law it is not a criminal offense. no jail time. you cannot be prosecuted. that can the worst

happen, is they could garnish her pay check in the future if you owe the penalties. it will be interesting to see much they have to enforce it. they are the ones that verify your income. they will have a lot of information. the enforcement aspect is one that no one is really concentrating on now. the white house does not want people to concentrate on. guest: this is one reason why the tax companies are interested in the health care laws. will step forward and say we will make this part of our tax coverage process. a lot of people they go to the companies are not high income earners. they are working class families here it the idea that these others have said we will sit

down and figure out what your subsidy will be in how to apply that proactively so that you could potentially have a lower premium month-to-month. people are working with one of the companies. they will most likely be asked to talk about the health insurance. host: for washington, maryland. and uninsured caller. caller: i have been doing a lot of natural taking care of myself by natural means. i am looking for natural doctors now. a lot of people are so ignorant about healthcare. as one of the main reasons the health insurance companies are like that. i would love to see the new healthcare law act work. we need to stop listening to bill o'reilly and fox cable. they have state of the art

insurance care. we need access to the health care. i do not want to go to the doc for and said our naked and get two minutes worth of a doctors time. $10 of that is going to your actual healthcare. could we ever come to a time where we would actually have no employers responsible for healthcare? people need to be able to have their own health care. let's dive into some of those. guest: there is a lot of interest among republicans. health insurance should not eat link to your job. it should be something you take with you. that thought is certainly out there. this is very much based on the system. it would not surprise me is several years down the road you solve that rim unemployment. i do not think it will do

anything to reduce your weight in the waiting room waiting for your position. you will have more preventative care coverage. this is where it is charged and what you have to pay. are certainlyns share by a lot of people. host: why is language important when talking about this russian about this? guest: words carry meaning. be onarry hidden meanings the literal meaning of the word. obamacare started out as being the pejorative term. it was jean to by opponents. it was used by obamacare.

the administration brand. this as a from some of the groups that are trying to promote the law we havinglic ad campaigns examples of benefits of the law. i use it as a shorthand. while some people still will -- still to see this outlier. will this be the affordable care act?

if you like your health insurance policy you can keep it. that has proven not to be true. this offer. host: michigan is up next. hi. -- i want told not thank heiser for the count later. until october 1 to get her policy in place? pool is going to increase. ofis the price increase 125%. i think this may be 700. you will not get that until of

the year. will get that every month. -- you will get that every month. i see a problem. it is a problem given your income. i think it does make sense. he is eligible for the subsidies. if you're not eligible for the subsidies, and we should say .ight now about subsidies subsidies are available for a family of four if you have about $94,000 in change. you can still be eligible for these tax credits with a middle- class income. for a single person it is about $46,000 and change. decent middle-class income you were going to be able to go on the exchange and get these tax credits applied. some of the sticker prices you

are starting to read about in on newspaper, depending your income, will not be what you pay in the end. that is a point we need to make. one.point is a good if you are a family making $100,000 a year and you do not have health coverage, you might want to go in and talk to a broker or some other source now and look at a plan. in some cases that situation might change in october. it might be a better deal for you to lock in now. host: arizona, medicare recipient. hello. caller: good morning. how are you? host: good. thank you. about: i have concerns the republican people. i guess i can call them people. they always try to diminish government. i am for a strong government.

that way we can be governed and accountable. the people that correct the systems that are in charged being held to to something. the republicans keep hollering about too much government. we need to enforce the laws that are there such as epa, healthcare, trying to be good citizens. host: do you have any russians about how this healthcare law is going to impact your coverage in medicare? caller: yes. somebody should answer me. inlready have health care medicare. in the hospital about three or four years ago and i got bills. she was the hospital twice overnight maybe half a day.

i got bills for over $35,000. i paid them. even though we had medicare and we were eligible for that. i think that was crooked. there was another case where he took her to the hospital and i griped over the cost of what i was going to have to pay for being injected with a little bit of juice. i do not know what they call it. she was in there about three hours total. -- i did notfor get a bill. $1400. i showed up in the office. i really griped about it. they say ok, you are griping and now. .- enough we'll put it down to $866. host: negotiating costs. is on medicare?

i'm concerned about the ability are on medicare. i am curious why it was $35,000. if i got a bill like that, i am not on medicare, i would call my insurance company and ask right .way, cautionary note we're are talking about something that sounds very boring about a piece of paper that comes in the mail to try to explain what you have to pay, you should question that before you pay a bill if you think it is too high. that is my number one thought. host: we are seeing some questions coming in on twitter. what the average person needs is . step-by-step it is too confusing. guest: that is what happens

when the exchanges open in october. it might help to explain a little bit in more detail what you are likely to see when you go online and try to buy health insurance through the local exchange or marketplace. state willl, each have a different name. in california it is "covers california." every state will have a different name but you are going to hear about it. the publicist is just starting. you will see at campaigns even if you do not know the name. you are going to go on and you'll do do several things once you're online. the software is designed

software -- intelligently it will walk you through the decision. one thing you need to do is verify your income. they're supposed to be a link with the irs records. you can put in your social security number. askedll say you earned last year. you are eligible for this amount of subsidies. you will see that. once you qualify for the subsidy, you will go through and you will shop for insurance companies just like you shop for a plane flight. you will see all of these different choices. willoftware that is good help you choose. it will ask your priorities. it will ask you if it is important to keep your current. to. if it is you will click yes. you will say who your doctor is.

it will steer you toward plans where your doctor is there. what is more important, the lowest absolute cost? you want to pay the lowest ismium costs, your answer yes, emea be able to keep your current. her. your online doctor. to save costs they are setting up narrow networks. skinny group of doctors and hospitals that will be available to treat you. in return for that narrow access, the costs are down. they say in return for giving you a higher volume of patients will you cut your costs? that gets passed along to consumers true that is one way it is working to try to get providers and insurers on there to give you the best fee.

one thing we should really mention that we have not talked about yet is your hearing a lot now about sticker prices. one on maryland last friday. the typical sticker price you are going to see for the lowest , you're bronze plan going to have bronze, silver, gold, platinum. a bronze plan will have low premiums but you will have a relatively high number of co- pays and deductibles that goes along with those. when you go on the exchange, one of the things you need to do is not just pay attention to the sticker price. the typical sticker price for the bronze plan will typically be in the $200 or $300 range.

in some states we have seen less than $200 a month. it sounds pretty good. i spent $200,000 -- $200 a year for these plans. .- $2000 a year for these plan one thing we need to focus on is looking at your out-of-pocket costs. do not look at the upfront premium. particularly if you have medical issues. if you have a chronic condition, you need to figure out what your total cost is going to be for and you're going for all of these steps. it ought to show you that. i have german through some of the programs. they want to show you the upfront price. they will show you your total cost. host: will a direct you to your exchange of people go there first? if they are first it should happen. one you can go

and see what premiums are costing interstate now. i can't imagine that they would not. guest: you mentioned co-pays. i think it could be as high as about 6300 for individuals and about 12,000 for families. my premium might be a blow but how much am i pay out of pocket throughout of the year. host: we are talking with three correspondence from kaiser news. coming up next we will have calls from business owners, employees, and find out what your questions are. the numbers to call her -- call if you are a business owner. 585-3880. we will be back in just a

moment with our guests. president obama 'they pry -- lunch with hillary clinton. later they speak with lawmakers about updating the voting rights act. they're considering changes to the act. they say the guests will strengthening the act. it is delayed by nearly a year. it is to reduce this. they killed at least 47 people in canada this month. officials begin work on the role more than a year before a train

to railton was put back on july 6. the rule is never put in place. this is intended to fix a dangerous design flaw in a car, used to haul oil and hazardous liquids. this has come understood me for safety experts for its tendency to split open during the romans. the detroit area factory where rosie the riveter showed that a woman could do a man's work i building world war ii era bombers will be demolished that money cannot be found to say that. it is slated to be torn down unless the group can raise report five million dollars pipe thursday. they hope to convert at least some of the structure into a new expanded home for the nearby

yankee art museum. those are some of the latest headlines on c-span radio. the first lady reflects the schism in the united states about what women are supposed to be today. are we supposed to be mom and chief? are we supposed to be first mate? to navigate that if the president is supposed to be head of state and governments is the first lady supposed to be the ideal fashionista? is she supposed to be mom and chief? is she supposed to be first helpmate? that means she really has to understand what is going on in the administration. she has to understand what is going on in the country. she has to understand her husband's political agenda. you cannot really separate how

the first lady presents herself and the conflicting expectations that the country still has four working wives and mothers. historians talk about the role of the first lady and its move from traditional home and and family to activism on behalf of important issues in the transitioning from public back to private life. tonight at 9:00 eastern on c- span. "washington journal" continues. we are focusing on the health care law and what it means to you. being to all of you for here. we are answering the phone lines based on your job, whether you are a boss or employee.

we are going to look at what means for the workplace. let's start with a call. this is what sharon has to say in minneapolis. hello. taking myank you for call. i have two questions. i have been working since the age of 15. i will be 65 on friday. social i started getting security/disability. i also have a subsidized insurance, maepd. it has been great for me. i've been seeing the same. does that i have had for 50 years including some specialists. i have to work. $60 a month,ake

which is not much and i'm glad to do that. i've been working in order to have the maepd. i work for a school. when school is out i am in limbo about my insurance coverage through the state. plan i am the kind of on. if i am not working, i have a spend down of $1000 from the medical assistance part of my insurance. i cannot afford that. i was wondering if the affordable care act is going to help me in any way so that if i am not working that i could still have coverage through the state? host: an employee about to turn 65. guest: my first thought is that you should go to medicare.gov

or call the number and find out how medicare my sync up with the current coverage you have appeared you say you will be 65 on friday. that would be my very first thought for you. know yourers probably stay program very well and how it may or may not work with medicare. host: hope is self-employed. caller: good morning. thank you for taking my call. i have a two-part question. the offeringanges dental and mental plans? is on part b. will i be able to get care from him even though he is on

medicare? host: are you getting insurance not yourself? are you paying for insurance out-of-pocket? caller: i am. i am part of a self-employed plan through the state of arkansas. i pay a premium every but of dirty five dollars. -- premium every month of $35. that gives me six visits to any dock or a network -- doctor in any network. i pay 15% of the total charges to the doctor. it has really been quite affordable for me right now. bet program is going to ending on december 31. i will be on the market place here in arkansas after they are set up october 1.

i'm really excited about that. let's get jay hancock to respond. guest: it is a great question. i do not know whether it dental and vision will be on it. only pediatric dental coverage. i think if you had a problem with your retina, a medical issue, he might get some coverage. will be the same on the exchanges. it sounds like the exchanges may be a very good option for the color. guest: you are shaking your head yes. in california we have been going through the bidding process for the pediatric dental plans. adult dental is still considered an orphaned organ. offered in thee packet or it can be a stand- alone. most of us get dental coverage

through standalone packages. if you want to buy that for co- child you have separate pays and deductibles. it has been a bit of a problem for democrats on capitol hill. isis something that hhs watching. are self employed with a small business, how do you approach this law? i forget that i am a business. i go shopping to the consumer that is where the subsidies are likely to be the best. that is where your options are likely to be the most as you point out there are two products that will be on the exchanges. andis for individuals families buying directly from insurance companies. the other is for small businesses. small businesses under 50

employees will be able to go buy coverage for their workers on the exchange. it is taking a little bit of time to get ramped up. i want awas that say car -- run a car repair garage. i had 25 workers. couldsion was that i sign up on the exchange and that's my workers could go on and sort of shop in the same way individuals would be able to shop to go through these sources of multiple insurers that we have been talking about. if that is not going to happen. that was one of several pieces of the law that was too complicated to get up and going this year. exchanges for small

businesses will be in business. there will only likely be one choice for employees when they go on. in other words, you will offer coverage to your employees as small businesses have traditionally. host: we see the plan choice element has been delayed. as you mentioned, most employees will only have one plan option. by 2015 there will be more of a choice element. guest: that is the idea. aca is about choice. it is supposed to be about diversity. if everything goes as planned, you will go on and you will have choices that look somewhat similar to what the individual going on the exchange will do.

right now if you are a small business that is your pool. when you insurance broker tries to sell you a plan, whether it is at the or humana are what ever, that is the affordability act. everybody is there together. you pool your resources and it gives you better partner. better able to offer a deal. >> >> and it is rich sharing. the summer camp where the average age is 23 will the same but a similar premium as an employer with an older work force and higher healthcare costs. sue is in cleveland, ohio. 23 employees.e we have always provided medical insurance for them.

in the last recent years we have splitted where we pay 75% and they pay 25%. beginning january 1 there is andg to be federal fees taxes on the insurance policy ther. there's 18% per insured. .25 per person 2% or three percent as the market share fee. for a family of four that is like $59 a month. if we switch to the marketplace we will have to pay these federal fees, too? is it just for private insurance? the fees will be leveled on all insurance products.

we have not talked about self- insurance. this is something that has traditionally been practiced with very large companies. self-assurance is basically when the employer has enough revenue that they can agree to pay the based onills directly the risk that employees will have very high medical expenses the basic idea is that your employer is paying the bills directly. the others toith pay the claim. even employers as small as your company are looking at shelf insurance. or one of the reasons these taxes are not levied on self- assurance is because it is not a licensed insurance rodarte. that is where the rubber hits the road.

what is going on is that it's these are self insuring and they are going out and ensuring from insurance brokers to sort of hedge their risk. for example, if you go self- insured you can buy insurance that will kick in if any single employer of years has healthcare bills of more than $10,000 you are not be for that afterward. looks like insurance to you and your employees. not only do you not pay that tax but you are also exempt from some of the required health benefits that the law offers. it is controversial. it too many employers do this it shrinks the risk pool we were just talking about.

it puts it across everybody. do this.hem for firms like yours it might be an option why it is still a loud. i would talk to your broker and see what he has to say. join thiscan conversation by looking for c- span on facebook here it what exactly does the federal health care law change for people who ineady have health insurance addition to those without it? you are probably having more preventative care with no deductible. when we took our children to the pediatrician i did not have a co-pay or deductible for the services i have before. we are talking about more screenings, blood pressure for everyone. that is one thing that may be

changing for you. if you have an adult child of 226 who either does not have a job or an offer of coverage from their employer you could pick that adult child on your health insurance policy. beename things we have talking about with no lifetime limits starting january worst. there will be no annual limits for adults. you cannot be discriminated against for a pre-existing medical condition. not only treating the subsidies to help people that do not have coverage, if they're helping people with coverage to have more benefits. what does that due to the price of insurance? >> we should probably mention that employers and their insurance companies are making changes in their coverage and dependent of the affordable care act. the hallmark of what is going on are the consumer directed

health plans known as high deductible health plans. i would bet that a lot of people watching now are seeing this in your workplace. asking you to pay much higher to that tuples, almost as much as $1000 dollars or $2000. there is a philosophical idea behind it. of thet more responsibility for payment is on your shoulder and not the insurance companies it is supposed to turn you into a savvy shopper. you're supposed to start comparing prices. you're supposed to start calling when you have an expensive procedure coming up. there is a problem there. the transparency of medical prices isn't nearly what it is

for airplane tickets. if a doctor says you need an mri test, you have a bad act, -- mri prices vary hugely. they're asking you to shop around. cost sharing is going on to a much larger degree among employers of all sizes. typically used by small businesses. the premiums are cheaper and they can afford them. are the largest employees having high deductible plans with health savings accounts. put pretax money into these accounts.

this has little to do with the affordable care act. to thehe counterweight aca. everybody focuses on what the affordable care act is given to consumers or taxpayer subsidies. they have been pushing this. what is flying under the radar is that conservatives are getting health care policy. the washington journal is launching a series of visiting with kaiser health news

reporters. watch the federal health care long roll out. our guests are mary agnes carey, a longtime reporter who has reform. health care law she watched it as it became law on capitol hill. she worked for congressional orderly prior. jay hancock was a longtime reporter for "the baltimore sun ."rich we also have a sarah varney, who comes to washington for the special show we are doing today. she worked for a long time at kqed public broadcasting in san francisco and she did health- care coverage and is filed for the monthly magazine "health dialogue." john doe tweets in --

is that a fair assessment, sarah varney? guest: certainly. the primary goal of the affordable care act is to inure millions of people the united states, and there is a whole bunch of other things the affordable care act does. medicare, trying to reduce inspections, the list goes on and on good primarily at its 50e, absolutely, we have million uninsured people and how do we get them insurance? guest: we are talking about financial security and peace of mind. by far the largest cause of bankruptcies in recent years, recent decades, it's been health-care costs. one of the reasons behind the aca was that nobody should have to go bankrupt we does they get sick. -- because they get sick. objectivedo th

reporting. is the goal to market health- care law or to educate and learn about it? guest: no, the goal is to explain health-care policy and politics. we cover things other than the aca as well. we write about hospitals, the insurance industry, providers, every note and cranny of the health care system we have folks dedicated to that. no doubt the implementation of ,he law is a great niche for us but we are not here to promote anything. andrew is self-employed go ahead, andrew. caller: hi, how are you? your guests are excellent this morning. thank you all for showing up and being so professional. i am self-employed. i don't make very much money. i'm a handyman, kind of a carpenter, painter, roof repair stuff. may sleep make it

than $17,000 a year. thanmostly make less $70,000 a year. am i going to be put on some kind of total subsidy thing here? if i got insurance outside of this whole obamacare thing, do they then say you don't have to apply, or am i wrote into this thing a mentor what? -- am i roped into this thing no matter what? host: sarah varney? ofst: you are the type person the exchanges are meant for. you are eligible for a fairly large subsidy -- i'm sorry, what's the -- what state did you say you are in? guest: new york. guest: you are in a state that is expanded medicaid. poverty level,he $50,000 a year. if you were to be below that, you would qualify for medicaid in the state of new york. but since you are above that, ,ou will go on the exchange

and because of your income you will be eligible for what is most likely the largest subsidy. i have not seen the new york numbers, but in california, obviously another big state with a lot of people, most likely new york will have a fairly robust exchange, we are seeing in some of the markets, we are factoring in the subsidy of $90 a month. in some cases less than that. you are exactly who the exchange is built for, and i think you will see that you would qualify for a fairly large subsidy. guest: we should mention, andrew, that the exchanges are for medicaid enrollment as well. if it works as it is supposed to, it shouldn't matter -- you don't know whether you are eligible, which one you are eligible for, when you go to the website, and you shouldn't have to know. in theld steer you right direction no matter what the case is based on income numbers and other information

you put in. host: kaiser family foundation has this map showing which states are running their own exchange is and which are defaulting to the federal government exchange. federal exchanges are in the lightest color. those who are doing a partnership are in the midrange blue. some states have launched ad campaigns to let people know about what is happening in the coming months. let's take a listen to an ad airing in the state of connecticut. [video clip] >> now, thanks to access health connecticut, just about everyone can get health insurance and nobody can be denied due to a pre-existing condition that you may qualify for a discount on your monthly insurance bill. later tosavings captivate how much. -- use our savings calculator to calculate how much. access health connecticut -- see how much you might save.

host: this is airing in connecticut. mary agnes carey, who pays for them and what are they trying to communicate? guest: they are trying to get people interested in the health- care law. there are people who oppose the law, who are in favor of the law. one poll i thought was interesting was a kaiser family foundation poll from april, talked about 42% of the people they talked to were unaware that the affordable care act was still a law. connecticut is moving forward with his exchange and wants people to be aware and to get out there and to sign up. if you haven't really paid attention to the affordable care act, you can tune back in now because you will hear a lot about it in the month ahead. guest: the question of the at strategy, when you start launching these ads, because we have been to the movies and we see the preview of the new tom cruise film that is not going to come out until next april and you think, how and ours am i supposed to remember that -- how

on earth am i supposed to remember that? there is the question of when you start to air these things. we have a lot of callers who go to the website and cannot sign up, because you cannot sign up yet. when should a bulk of the ads to the airwaves? we should tell people about the law even though there's nothing nothing we can do about it right now. in some states where they have the money and resources, they can can get out there early. in california you have not seen a lot of ads just yet, and america, one of the big organizations we can talk about, they are saying we are not going to watch a major ad campaign in the fall either. host: a comment from james on twitter, a question but with in- flight commentary. -- in-flight commentary. guest: no. the it will do is increase health of these risk pools that we keep talking about.

people who are really going to be bombarded by these ads, publicity, if it does the job, are the young invincible's we mentioned earlier. the exchanges open for business -- the coverage they provide is available january 1, and we all know that people who have medical needs, who have ongoing chronic conditions, and see doctors regularly, are going to be first in line to sign up for these plans. that they -- but if they are the only ones who sign up, the premiums you are seeing quoted won't turn out to be realistic. the cost per beneficiary will turn out to be too expensive. this is what has happened again and again and again with attempts to expand health insurance in the past. the difference now is we have these mandates that require everybody to be in the pool or take these penalties -- or pay

these penalties could what you will see a lot of his ads targeted at people in their 20s, people in their 30s, to get them in the pool and answer the implied commentary is no, that won't cure anybody, but it will , make thesexchanges insurance pools sustainable. it will spread the costs around, which is the intent of the act, and make it sustainable. if we see insurance professionals call it a death spiral, which is the technical term, adverse selection, when you get too many sick people in the pool, your costs per person go way up and even people who need coverage cannot afford it. the ads are supposed to prevent that from happening. "planet money" i

sat down with this adamant in new york city, a viral market expert. i was saying to him, just imagine if you have any budget in the world and you have got to get the young people into the pool, how do you do it? he is thinking not just television, but internet advertising, embedded ranting and "-- embedded branding in "jackass" videos on mtv. [laughter] and you look at the geico ads, they are completely wacky. thehave flo, the lizard -- gecko. could health insurance ads go that way eventually? he seems to think so. host: byron, retired. hi, byron. caller: thank you, c-span, and thank all you folks. i appreciate it. i have a unique situation. i am a retired federal employee, i recently went on medicare age, but i still work. i'm a trucker.

and when i am working, i am under the teamsters insurance and under -- and at times i am under different locals' insurance and i cannot up to three insurance plans plans going. i have my federal and maybe two different teamsters plans. and i am a vietnam veteran so i for agent orange checkups. -- how isn is this this going to affect my federal insurance? train i kind of lost my of thought -- how is it going to affect my federal insurance? army premiums going to go off the chart because my wife and i are on my federal insurance? and also, why is it that when i have the three insurance plans going, nobody wants to pay for anything? poor at times and i have all this insurance. i would love to be able to take these teamsters' plans and say,

give the sort of my brothers and sis -- did this to one of my brothers and sisters. but i can't do that. i am hamstrung in that. i think that the industry is hamstrung in that type of thing, too -- host: byron, stay on the line with us in case our guests have any questions for you. mary agnes carey. guest: when you file a claim, who is your primary insurer? if you are married to someone may say, date of birth, for example, just images who is the primary insurance carrier, who was born first. -- her it is va or ,aller: ok, generally speaking when i am not working for the teamsters and i don't have enough hours to carry the teamster insurance, i am under blue cross. i havee for myself when to have to checkups for the agent orange.

there's no charge their bank -- there's no charge there. when i i have enough hours working to pick up the teamster insurance, they become the primary, and if i go to another local at the same time and i pick up enough hours on that insurance, they would then become the primary. i can have blue cross federal, blue cross massachusetts, and cigna in new hampshire all at the same time, and it is either going to be cigna or blue cross mass if i work for the teamsters. guest: it sounds like you kind of got that down, you know where to go and who your primary payor is, depending on the particular circumstance. the question of what this does to your federal coverage -- i want to say that open enrollment is this fall for the federal government and you will have to wait and see what their choices are good there is no particular reason why it would change much. but insurers always make want tos whether they

offer federal employees -- a pretty vibrant pool. you can see that happening this fall and see what your options are and see what your costs on that would be. you're definitely right, you would have a lot of insurance insurance and overlap there. complicated case am a very interesting. taiwan did not choose the united states is a model. host: good morning, kelly. caller: thank you so much for taking my call. our situation has been a little bit different. my husband was full-time but paying in the affordable care act, my moved many ofoyer their employees to what i guess you would call 1099. the irs basically forces you to claim as self-employed. at that time we picked private

insurance. however, due to my pre-existing condition, no one would cover me. i was just awarded disability, and thank goodness, i received medicare. however, in our town, as i am trying to finally get a doctor, no one -- there is no doctors that will cover a medicare patient. those are just basically a few comments. i am having a hard time finding a doctor. my husband, however, his private , his premiums continue to go up and up and up and up and up, to where we finally had to drop it due to me waiting nearly four years trying to get disability. now that we are trying to look at the affordable care act, georgia is a little bit

different because they have not wanted to participate in the exchanges. as we look at trying to get him on insurance, it has been a debacle trying to figure it out. kellyas our caller mentioned, georgia is defaulting to the federal exchange. tell us why that is a significant and then we can get to her questions, sarah varney. guest: even in states like georgia that are not doing their own state exchange, there are exchanges available and you will be able to go on october 1 to this website. what it will because, i don't .gov, but on health care - you should get some kind of link and figure out essentially throughout calculate or whether or not you, or your husband, i guess, would qualify for one of these subsidies. it will not be until october 1. guest: i thought her medicare question was interesting.

you hear a lot of anecdotal evidence from people -- maybe they have access to a primary care physician or specialty obviously, she -- this something she may look beyond her hometown where she has coverage to get a physician that -- to take care of her. this is something that as somebody who covers medicare you hear a lot about all the time. host: we will hear from more of our medicaid recipients and also we would like to hear from -- if you are insured or uninsured. we will change up the phone lines a little bit for the rest "washington journal." host: let's get one more business owner in on the conversation. mark is in norfolk, virginia. hi, mark.

caller: good morning, and to all your guests. i can self-employed -- i have been self-employed since 1987, and i have seen health insurance just skyrocket completely through the roof. as the gentleman who called in is in theork who construction business, my business is also linked to the construction industry as well. i can tell you and most colors shis thing -- most caller listening will certainly affirm that in most industries like construction, we are working as far as90 pricing labor, while we have watched everything around us like materials and services continue exponentially up. i think a big problem -- i would like to have your guests expound -- we basically have a new economy, where i think corporate america has gotten to a point where what used to be

good profit in the 60s and 70s has gone on steroids. if you are part of the corporate industrial complex, you can continue to get -- to push your rates, push or profits, and because you only -- you could be unaffected. the second part that i have an issue with is the simple fact -- i think some kind of way, we have got to find a way to be able to connect your academics to what actually physically happens to the people in the undercurrent. that disconnect is further causing an issue in the healthcare industry, and i'm thinking, why do we need a broker to get me healthcare, if the doctor who is in business is moneying my health care,

would be better spent if we could give doctors or other care professionals the wherewithal so they could house their own administrative processes to be able to care for patients. host: let's get a response, starting with the jay hancock, the insurance industry and their role. guest: one of many complaints about the u.s. system. one of the reasons why taiwan and lamented not a u.s. -- elected not to implement a u.s.- style system is the hi administrative costs you are talking about. when the u.s. implements the affordable care act, we will have all these different layers of administrators, managers, above thes over and caregivers who are there on the ground making people healthy and tearing them of disease -- curing them of disease. we have employers, insurance

companies, people in washington administering all of this, we will have the exchanges now, we have state exchange organizations, and one of the big arguments about health care and we will continue to hear it in years and i daresay decades to come is why are we spending all this money on the administrative superstructure when we could be spending it on caregiving? as a practical matter, however, it is a moot point. the country has chosen based on the inertia that sarah was talking about, the historical coincidence that we have employer-based healthcare, and the idea is to deal with a acaem that we have, and the answer to that and we will see how it works. you are referring primary to how expensive it is and the cost of the system.

aca that parts of the are meant to address the cost. we are supposed to start paying providers, doctors, and hospitals to keep people healthy, not to put them to the hospital. put them through the hospital. we will see if that works or not. host: there is a conversation going on on twitter. asked --eclerk thoughts on that? one of the things critics point to about the affordable care act is the rising cost. we are seeing premiums go up on average in individual policies and exchanges we are talking about, probably talking about .et increases in the cost what people forget to talk

about is that society is paying for this care anyway. we see enormous amounts of taxpayer costs that go into pay for medicaid, incredible bills and hospitals that write off uncompensated care. people are being taken care of expensiveal ways and ways. one of the things in the aca is to shift costs inside the system and deliver care more intelligently, and if we can do that people will be healthier and the cost will be better control. guest: how can insurance be used -- if you can help reduce the epidemic of childhood obesity, if you can get to someone who prediabetic as an adult and get them to control their food intake and get exercise and get off certain medications -- i'm not saying it is a panacea.

there is great debate about what could or could not reduce healthcare cost, but it could change the trajectory of trends we're seeing seeing in the market public that are not positive for good health. guest: one of the things that jay is alluding to is the accountable care organizations, the new version of an hmo, basically, or a managed care organization. i went and saw one of these in riverside a couple years ago. pre-aca.e--- this is they took on the risk of all of their patience and form relationships with the local doctor or hospital and a group of specialists and they got money directly to care for these patients. what is interesting is the doctor who reads this is very pragmatic -- some years i make money, some years i don't make money. the positions have to be willing -- and physicians have to be willing to essentially take a pay cut in the years when they have a lot of expenses if the model is going to work, and

a lot of physicians are unwilling to do that. one of the positive things that is happening, in my view, is that properly constructed, accountable care organizations and similar setups known as patient-centered medical homes are actually increasing compensation for the primary care quarterback doctors the supervisor care at the expense -- order back doctors who supervise your care at the expense of specialists. metaidea is to keep people healthy, keep them out of the hospital, let's not focus on doing procedures. the way the system is setup now is is people make money for doing procedures, whether they are needed or not. primary care physicians, who, by the standards of medicine, are underpaid compared to their neurologist or anesthesiologist colleagues, some of the better aco's are seeing

significant increases in income if they can manage care the way that sarah is talking about and keep people healthy. host: another conversation on twitter. host: so questions on how twitter feed, and you can tweet in your thoughts by writing @cspanwj. another state that has launched a campaign to raise public awareness is oregon. let's look at oregon's latest tv ad. [video clip] the cold mountain snow where i am free to be healthy and happy and strong and live long in oregon long live our oregon spirit

long live the oregon way everye each one, daughter and son live long oregon ♪ , sarahhe oregon ad varney. who is this made for, what is the message it is trying to communicate? guest: i think what we heard from the people who made this ad is they wanted to get out this idea that the organ exchange is for the health of all oregonians, that this is something we are doing together, we are in the same a lot. much has been written about tweead in that it is very and could have come off of the set of "portlandia," but it is trying to appeal to a younger demographic, most likely in the urban portland area.

i don't know if there are people in easton rural oregon who identify with the message. i just love the little kids with the cutout trees. it is very creative and does not seem to be selling a product but is trying to sell an idea or feeling about this thing that is coming. host: so, on twitter -- host: so at what point, sarah varney, does the education campaign turned to here is what you do and here is how you do it? guest: we will see a lot of that at the end of september and certainly by october. here is the exact website you will go to. you will see a lot of ad campaigns where there is click and point. the ads will get much more specific as we get closer to the launch dates. host: let's hear from scott, uninsured, living in oceanside, california. caller: good morning, and thank

you to c-span and your knowledgeable guests. i am 53 years old, uninsured, but also an air force veteran. i recently suffered a heart failure and i'm consider 30% service connected disability through my va. my question is, with the new act that is going to take place, what i be required to have insurance as well, even though i have my veteran -- right now they are taking care of me and the only thing i have to pay for are my medications. guest: you are fine, you are covered. if you have the va system or tri-care which fulfills the individual mandate, you have coverage and you are fine. the kaiser family foundation looks at the status of state actions on the medicaid expansion decision. take us back to the supreme court's decision about the of a double care act last year, what they decided about the medicaid expansion -- the affordable care act laster, what they decided about the medicaid expansion. guest: that day and every day

that followed, everybody was remarking on the decision to uphold the law in general. what did you get a lot of attention right away but rightly now has is the question of whether or not medicaid can be mandatory. i think there is a lot of surprise that this came out of the decision. and now that so many states have chosen actually not to expand medicaid, the way the commerce design of the medicaid expansion in its -- it was seen as a dipped in a lotrrot of sugar. the medicaid expansion of the three-year window when the fed picks up the entire cap -- picks up the entire tab starts january 1. people are surprised that so many states have not signed on, that it is continuing to be this political question, that if you

do the medicaid expansion you are somehow endorsing obamacare and president obama, and governor rick perry has sort of made this an issue in texas. it is in his mind un-texan. host: so texas is not doing it -- guest: there are 24 states that are expanding, and it is the west coast, the northwest, nevada, arizona, the southwest, and then along the eastern standard board, most of new england, many of the states in the mid-atlantic. that is about 9 million people who are currently uninsured you will get insurance through the medicaid pension. -- through the medicaid expansion. , 21, that are not spending also about 9 million people, and this is essentially texas, the most number of uninsured people in the united states, primarily

through the midwest, the entire south, the deep south, montana, idaho, miami, and utah. there are some states that are still debating -- michigan, indiana, pennsylvania, a few others. i was thinking, where i want to be on january 1 is the four corners and with one arm in new mexico, another i'm in colorado -- i'm getting this wrong -- arizona, new mexico, colorado, utah, and utah is the only one that does not have the medicaid expansion. host: there are differences depending on what side of the border you are on -- guest: unlike the subsidies, available to any buddy in the united states, the medicaid expansion will only be available to those states that have chosen to do so. host: one of our followers on facebook says -- be as expensive as car

insurance if it could be sold across state lines." guest: there is a provision in the federal health law that allows for insurance plans to be sold across state lines as long as the states sign the contract with one another. that is actually an option. liverms of medicaid, you in the state you live in and you qualify for your state medicaid program or you don't. there is a lot of confusion around medicaid and you actually qualifies for it. i think there is a general sense that if you are poor in the united states to get medicaid, which is not the case at all right now. , youave to be pregnant have to have dependent children, you have to be disabled. it doesn't matter how poor you are if you don't it into one of those categories. the medicaid expansion does away with the categories and says that if you earn a few 100 hundred 38% of poverty, $15,000 , your for one person don't have to prove you are pregnant or disabled.

ast: sarah varney is correspondent with kaiser health news could we are also joined by mary agnes carey and jay hancock, also with kaiser health news could we are launching a partnership to dig into the federal health law and find out what it means for you. caller: thank you for taking my call. i feel that the fact that colonoscopies are going to be covered under the affordable health care act is a huge benefit. i don't hear that much being said about it. but right away i feel most people who are injured are going 1500y -- save possibly dollars a year. that is what my husband and i will be saving, agent of -- each of us. in addition to that, my husband was seeing his doctor at a medical building and he was complaining about his answering -- complaining about his hands hurting.

they sent him for x-rays at a place affiliated with the hospital and for taking a couple x-rays of his hands, we got a bill for $750, which flabbergasted us. i was so upset. but once it was submitted to our insurance plan the bill came back to $450, which is an example of how outrageous our healthcare system is in the sense that it is involved with it. we are currently paying, we have a family of three, about $900 a month. not self-employed, making much -- maybe $500 a month. income is close to $80,000 a year. two years ago, in order to save money, i went on a catastrophic plan, but it ended up not saving us money because we saved $100 a month reviews to what we were paying on his family plan. but my deductibles were so high that all of a sudden it was really a bad decision to go that route.

,y real question for you is will the family of three be allowed to -- if my husband can ,et discounted insurance rates himself being on his insurance plan, and if i were to go on a separate plan and bring my son with me and be self employed, -- i am trying to figure out how we can save money. we are paying about $900 a month, which is a lot. host: let's ask a sarah varney to start. guest: for a family of three, if you went onto the exchange them if you earned less than $8,000 zero, you would qualify for a subsidy on the exchange. but if you went the small business route, i would ask jay. .uest: they can separate out you should explore all alternatives. i suspect your best options are going to be on the exchange. as i said, small business exchanges are developing a slowly than the individual

policies on exchanges. but more to the point, i think the subsidies would be more favorable to you looking at the individual policies. again -- i've mentioned it before -- go on google, type in ,"bamacare subsidy calculator and you will go to the kaiser family foundation software that you can go through different scenarios, you can include only yourself, you can include your husband, you can do scenarios where you might file separately on taxes, and you can see what all the numbers would be. guest: can i away and quickly on the call lasted the -- can i weigh in quickly on the colonoscopy western? i want to -- i want you to do a little reading. it is a screening, they're covered. if it is diagnostic, sometimes they are not covered.

if you go to our website, our columnist did a great column explaining some of the confusion that is out there. if you want to read more, the kaiser family foundation did a great paper, i think with the american cancer society, on colonoscopy coverage and the affordable care act. do a little reading and talk with your doctor about how the order will be written because that will affect the coverage. host: 2 questions on twitter that are related. guest: let's take the first one first trade if you are 100% of poverty or above, you are eligible to go on the exchange. 100% of poverty for one person is 11,000 $500 a year. go onto exchange exchange and qualify for a pretty hefty subsidy. here is the problem -- we are not anticipating that the supreme court is going to say

that the medicaid expansion was optional. if you are below 1000 -- sorry, below 100% of poverty, you are not eligible for the exchange. there is a new doughnut hole in the united states. if you are between zero percent and 100% of the poverty level, there is no option for you. guest: it reduces the cost of the lot people into medicaid versus exchanges. this is one of those things that if you had a health -- house- senate conference, which typically happens when chambers passed different bills, you would have the kinks worked out, but we never had that with the affordable care act due to the charged political environment and it was an unintended consequent. guest: i was doing a story for npr in the rio grande valley in texas -- one of our big partnerships is with npr could i spend time with a community clinic in brownsville where a lot of people qualify for the medicaid expansion, and i sat down with the woman who runs

this, and she brought up on her computer a list of 4000 patients that currently go to her clinic. quite a number of these community clinics in the area. in south texas would qualify for the medicaid expansion, which she asked the director could get reimbursement for. -- which she as the director could get reimbursement for. they don't have any reimbursement method for them. host: our guests are all journalists with kaiser health news, and stories air on npr, national public radio. our guests also file for publications like "the philadelphia inquirer," "usa today," "the washington post." we are starting a partnership with kaiser health news exploring the health care law and what it means to you. let's hear from vince in minneapolis, was on medicaid. caller: hello.

i wanted to go off of medicaid and since then my social security payments because i want to go back to work to the bankruptcy court. i know from bankruptcy that there is a lot of people who filed a medical debts because of uninsured accidents. the aca does not address that at all. host: what happens to people who have had catastrophic medical situations the mechanics pay the bills, have to declare bankruptcy? kenneth still haven't -- can that still happen? guest: yeah, absolutely. the hope for those who support the act is that it will happen a lot less when employers are mandated to offer employees coverage, and individuals are mandated. this should go a long way

towards reducing medical bill- caused bankruptcies. nothing in the bill would preclude bankruptcy from happening. guest: or nothing that, if you have had a situation where he racked up a lot of bills, there is nothing that wipes out the debt. guest: not like mortgage debt, unfortunately. host: john in huntsville, tennessee, uninsured. john, you are on the air. john, are you with us? rodright, let's move onto in plainview, indiana, was private health insurance. caller: i have just two questions that i thought i heard somewhere that in the bill, the government has direct to i think it was the insurance companies -- i don't know if you would call it bank accounts, but faster payments, claims, some of someone files a claim, there cannot be any denials by health insurance companies to maximize profits.

can they have real-time access at the health insurance company and transferred to the doctor or the hospital? guest: there is the subsidy payments into directly to the insurance company from the federal government, i know of no tovision that does anything make any changes to health insurer pay the provider. that is probably company by company. it is contractual. it depends on the company cost 's agreementy with doctors and hospitals, and i know of no provision where the government can intervene in the process, certainly not automatically on computer, other than the avenues that already exist. insurance is regulated by the states and you can protest of the claims. claims will still be denied. newidea is that under the rules, the denied claims will be

much less than they used to be. you cannot deny coverage for pre-existing conditions. disputes with your insurance company have not been put into the dustbin of history yet. jim wants to know if you can talk about the importance of networking going out of network. if your doctor, health care facility, is considered in network versus of the insurance committee doesn't deem inside the network. something the insurance committee doesn't deem inside the network. -- versus something in the committee doesn't deem inside the network. guest: a network is typically less expensive than out of network, but i don't know of any provision that changes how insurers decide that and what you pay. there is no explicit provision in the law that talks about in network charges versus out of network, but the

incentives in the law are changing for more providers and insurance committees are providing -- are doing. i think the trend is that the difference between a network and out of network are going to keep growing. earlier in the show we mention that a lot of insurers are setting up a narrow networks of doctors and hospitals in the exchanges to get price discounts from them and to pass those along to consumers. it will be really incumbent upon you another consumers to redefine -- read the fine print, pay attention, see what the differences between the in network charges and the out-of- network charges, and when you are seeking care, stay within the networks to the degree that you can't. they're often reports out there where if you go to the hospital and you don't have a choice, you can't shop around for provider, you are in the hospital and a doctor comes to see you and you find out that she is not in your network, that is a problem that will continue to be talked about.

to the best you can, try to stay in network. are seeingthing we and california that is interesting is that i mentioned there are 13 plans are so not offered on the exchange. many of those were considered plans.ounty-run in alameda, where oakland is, you are with the alameda alliance, quasi-government-run plan. in california -- we will see if other states do this as well -- that there are sort of essentially public plans that are offered in many regions in california, and the way they were able to come in so low on prices to create these narrow , and with the local teaching hospital and community clinics, there are sweet spots they are going for. the caller you had just on the line with medicaid, used to going to the medicaid system and the community clinics but now they are in a little bit too much and will be able to stay with those providers.

it is interesting -- and san ucsf, a teaching hospital, excellent hospital that often -- also is a quasi- public hospital, will be included in one of these plans. the options are still quite good but they are very narrow. seeing multiple networks, peer networks, where one is the cheapest and you have mezzaninein -- network that is little more spans of, and one that is really expensive. host: we have a californian on the line. medicaid recipient. caller: good morning -- host: we talked to already, rick? you've either been waiting very patiently or we have talked to you. libby, yeah, thank you,

for taking my call. last time i call i kind of fell apart on the air and i want to thank you for your heartfelt empathy. is,uestion for your guest as a dual eligible person, why caret dental and vision addressed under the aca? guest: my guess is purely cost. -- the currently in the commercial market for a lot of, they are standalone policies. --e employers off of them some employs offer them, some don't. we talked about this a little earlier -- insurance is not forbidden from offering a great it is just not one of the essential benefits -- not forbidden from offering it. it is just not one of the essential benefits, like hospitalization and prescription drugs and someone. my guess is that it is based on cost, but who knows?

some of these companies can offer supplementary policies that would be affordable to cover this for you. host: we see on facebook this " obamacare one tax obamacaree most. -- will affect smokers the most." guest: they pay more. 1.5 times -- jay, do you remember? guest: i do remember the premium. jurisdictions like the sea and others as well have elected not to have smokers pay more. the district of columbia's decision was, look, we want to have smoking prevention ,reatment available to smokers and by charging them a lot more that is a disincentive and it removes access. they made the decision to not penalize smokers. no additional premium for

smokers in california. host: oklahoma city. gregory's uninsured. caller: hi, i am unemployed but i also was an employer. wereands of people designing a health care plan in 2007, talking to people from all over the world, what country has the best healthcare? france was number one. i look at that for a while, and then i decided as an employer, and all of you sitting right there, why are you paying for healthcare on your vehicle more than half the bill on your coverage is healthcare. -- are employers so scared why are we having employers, which i was -- why are they paying the outrageous cuts i had to pay when i was a contractor? paid myy $100 i employee -- why is not included so that way,care

all of healthcare is under one envelope, and we will actually have a lot lower healthcare if you eliminate two things? what is the cost of the advertising the industry is doing massively to the other is the amount of money they paid politicians over those years trying to get rid of healthcare, because remember, they were advertising way before obama started this -- really make 10% profit. yes, but you write up another 10% for advertising and another .0% you paid politicians all of that money, including the people i ask in foreign countries -- why are you paying for healthcare on your car? , hold on a second grade stay on the line in case cap analysts have follow-up questions. jay hancock, his expense as an employer looking for health insurance plans to injure his work force and what he's talking

about? guest: gregory, you expressed the frustration that a lot of employers and consumers have with the system. it is expensive, as we mentioned earlier. i suspect that you and the four of us here could sit down and design much better healthcare .ystems than the u.s. has now but as we said before, we work with the system that we have. there is still a group out there, not very influential, that like to replicate the system come something like france and source -- like switzerland, where they have private insurance companies but they are all nonprofits. that is not likely to happen in this country anytime soon. but in the world there are still people who talk about it. i was going to say that

i was in vancouver looking at the canadian healthcare system, because there were all these ads demonizing the canadian healthcare system, so i said i would check it out and for npr i went up there. we talk about what providers get paid for their services. in canada, they sit down together and they basically hash it out. it is not a pretty process. there are people who win in the spirit but if you walk into any physician's office in canada, -- there are people who win and lose big but if you walk into any physician's office in canada, oh, that will cost $89. everybody pays the same price kind that is one massive difference between the united states system and anywhere else in the world. aboutmore information the exchanges -- is it true that each exchange will have at least two nonprofit countries offering insurance? sarah varney? guest: i don't know the answer to that. guest: the idea is that agent status is supposed to have one.

it is problematic -- each state is a must have one. it is problematic in some states. there are multistate plans, which we haven't mentioned before. the people who designed the law thewho wrote it foresaw chance that in some parts of the country there might not be sufficient competition. there are provisions to have at least one nonprofit of the state plan and one for-profit of the state plan. still being implemented now. not likely to be rolled out on a national basis, as was the original intention. sut there are other backstop intended to bring in more competition into states that made the lacking them. -- that may be lacking them. another is the co-ops. the federal government, the law

provided large subsidies to set a brand-new insurance companies in some states. typically these are blue states like maryland, california -- guest: stopped midstride. they got defunded. guest: so what will be in every state. -- so it won't be in every state. but the point is that there may be limits to competition and that is something that is going to have to be ironed out in parts of the country as time goes on. guest: with insurance the difference between the nonprofit and for-profit insurance is sort of a distinction without it is prince -- is sort of a distinction without a difference. if you look at the difference between anthem blue cross and blue shield of california and the for-profit -- the rates are very similar. they still pay taxes. it is somewhat of a misnomer that if you have a nonprofit participating in the marketplace, somehow they are

not paying the ceo $10 million a year. he is doing pretty well even if he is working for a nonprofit. a few minutes left without gas, all senior correspondent at kaiser health news. littoria, uninsured. caller: hi. i am disabled and on medicare could my question is about my daughter, who is 21 and in college. i am not working. i have no healthcare coverage for her to be on. she has no income outside of the support her -- outside if we supporter. come january we would love for do have healthcare, we have been a great supporter of the law, but our state is not taking medicaid so i don't know what we are supposed to do to get coverage in january. refusing to take the medicaid program. guest: my first question would

be yes or college offer any program -- does or college offer any program for students? she could get coverage through college -- caller: we tried that. didn't work. guest: since she doesn't have income, i'm thinking she would qualify for a subsidy on the health insurance exchange. you say you are disabled, is that correct? caller: mm-hmm. guest: you can't put her on your coverage. she is 22 years old and they have these young invincible plans and i don't think you get a subsidy with those, but they are -- they could be more affordable whether or not there's any kind of other other assistance to help her get that coverage, i'm not quite sure. a good example of why the medicaid expansion is going to affect a fair number of people. it is quite significant. if she does not earn up to -- if she earns below $11,000 a year, she cannot going to the

exchange and cannot qualify for a subsidy. it would be fantastic if she had either a part-time job or some kind of work she could get on campus where she can actually thenup to 11,000 $500 and she would be at 100% of the federal poverty level and go into the exchange and qualify for what i'm sure would be a pretty significant subsidy. host: under the law, her daughter will be mandated to have insurance next year. guest: yes. guest: except if you are in a state where they don't expand medicaid and you are medicaid, you could have gotten medicaid through the expansion. there are exceptions to the individual mandate and that is one of them. undocumented immigrants are exempted if the insurance costs more than eight percent of household income. there are certain carveouts where you would not be penalized for that. are some areas who are watching at kaiser health news for changes, development over the next couple of weeks? guest: we are watching how

states are doing to sign up the young invincible's. the critical task of getting turnout for these pools. we are still looking at how the law is being interpreted. there are a lot of experts out there who suggest that some of the coverage offered by companies on the edge, companies that have not typically insured or given good insurance to their employees -- fast food chains in the hotel years, retailers, their coverage could be less than optimal and the law would allow that, and the record is still being written. that is something i am watching. in thei'm interested states doing medicaid expansion reaching out to people we know -- there are people we know are eligible today for medicaid that are not currently signed up, for a variety of reasons. one is basically don't know. there is going to be interesting work with county jails and state prisons where a lot of these guys who are getting out of prison or jail are not eligible for medicaid.

they tend to have a lot of chronic conditions. i think it will be interesting to see how the states go out who are doing the medicaid expansion reach the population. guest: i will be looking at the limitation process that sarah is talking aboutguest: that is int, given how it is interpreted. of course, that follows capitol hill, so i will be following it. busy. be over 650 comments and questions about health care law. you can see that conversation by .oing over to c-span.org visiting with kaiser health news over the next couple of months regularly on mondays to figure out more about how the health care law is being implemented and what it means to you. that is