guest: what they are most worried about is all those people for the last week, if you take the numbers apart, it looks like own -- almost half a million people enrolled -- and they extended again to christmas eve, to make sure people who signed up for a plan actually have insurance. they are all the people who want insurance then. if you keep signing up now, you will have insurance, let the people who signed up were really are to have insurance starting on the first of the year. it is now important for the people who think they sign up for a plan actually have a plan. it is not just the front end of their website that works, but the back end, which means all of those get translated to all the insurance companies and the companies are able to follow through with the people who signed up, to make sure the people who signed up pay their premium. that is how you actually finish the process. they extended that deadline as

well, until january 10. recall that two 2006 when the last big one of these rollouts, they rolled out the medicare description drug plan on january 1. a lot of people went to the pharmacy and discovered they did not have the coverage they thought they had. that is the big worry. host: phone numbers on the screen for our guests and viewers to call into our guest. separate lines for republicans and democrats and independents. we are talking about the health law and where things are headed, not only this week, but for the rest of 2014 and beyond. we look forward to your participation. we make sure we are reading those and getting as much information on the table as possible. to the insurers, are they ready? guest: more so than they were. the timeframe between now and

when people are supposed to get insurance is very tight. many insurance companies have been scrambling to ensure the people who they think are coming are the right people, the people that signed up think they signed up are actually on their roles. -- rolls. i think the folks in the insurance industry i talked to are optimistic they will get things worked out, but there were probably be a few more bumps along the way as well as people begin showing up in trying to use the insurance. host: tell us more about the potential problems hanging over january 1. guest: to make sure they are signed up for the plans they

think they signed up for, that they get enrolled properly. most people think it will not be the same types of problems there were with the medicare part d, was people obviously get prescription drugs pretty much every month. it is not like everybody will show up to the doctor january 1 and january 2. the people who really want insurance to start january 1 are mostly considered people who think they will need insurance going forward. people keep talking about how important the demographic mix is, that you want the healthy and the sick and the good mix, they will probably not have that right, until the end of march. the people are the people who think they will need health insurance. will they show up at the doctor in the first week? there is probably more of a grace period here to get this straightened out. it will not be as bad as everyone on the pharmacy in the first few days. host: the key dates, the sign-up is october 1. the sign-up by december 24 to see the coverage beginning at the beginning of the week. the final sign-up date is march 31 of 2014. more insight on those days and

where things are headed? guest: one thing hospitals and doctors and pharmacies are thinking about is while the numbers are relatively small, and we are still talking about a couple of million people, a good portion of the people may not have much experience using health insurance before. health insurance is complicated, even for those of us who write about it. understanding the way networks and deductibles work, we may see a little bit of confusion on the part of consumers who think the health plan they selected includes this doctor or that drug and perhaps it does not and they need to adjust. we will see a little bit of that. the other thing is, as it has been happening in the market for a number of years, deductibles are still rising in a lot of health plans being sold in the

marketplace is. consumers who think they are paying their monthly premium, and now i have to pay $2000 before they get any health insurance coverage, that will be an adjustment. host: speaking of consumers and people, i want to point out this tracking poll, to give you a sense of what folks out there are thinking. holding steady in november levels is the latest we are reading here. you can see three lines here. the reddish line has 48% of people viewing the aca as unfavorable. the line just below it in blue, 34%, favorable. in this line, they are just not sure. they do not know. any more insight into the numbers? guest: it was not a good autumn for the affordable care act. the website failing to launch and people getting policies canceled because it did not meet

the new requirements, there was just a lot of the publicity and that was reflected in all of the polls across the board. host: let's hear from michael on the democrats line. caller: good morning. i'm calling because i just want to know why people keep going around telling people not to buy into this president's insurance. they are telling other people out there not to buy insurance. it is so unfair. at least they can afford some sort of insurance. i am not saying insurance is perfect. it is not. at least it is a hope. it is a hope for people out there who can afford it to get some sort of insurance. over the years, i watched my mom

pay kaiser permanent $8900 a month for insurance as she was only making $6,700 a year. she had to pay $800 every month just to get insurance. that was not top-of-the-line insurance for her. when she got sick and went to the hospital, she did not even have her own nurse there. for all that money for what? people got to wake up and wake up, america, and understand there are people out there telling you not to buy the insurance and they are in short. my mom was telling me there was a republican senator who was elected the other day and came in and started asking about his

insurance and they are telling him his insurance will not kick in until one month after he is on the job and he is raising hell that he can't live without insurance. host: michael, thank you for calling from maryland. any thoughts? guest: buying health insurance is a personal decision. some people do not want the protection that comes with the insurance. the law establishes now a penalty for people in many cases if they choose not to do that. on the other hand, i think many people look at health insurance and they will make a decision it is something they want to invest in, and the law make that available and it is important to keep in mind before the law was passed, buying health insurance was not an option for many people if you are sick and would not have an easy time getting it. guest: there is a concerted effort by opponents of the law to make it fail and encourage

particularly younger and healthier people to not buy health insurance and pay the fine instead. there are people who suggested not only that is a bad thing for the law, but it may be a bad thing for people who do not buy insurance. for many people in the early years, it will be cheaper to pay the fine than to have insurance. but if something happens to you, you do not have health insurance. host: any number of stories in the paper today, even on a quiet day like this, "the wall street journal" writes -- any reaction to that headline? guest: if you already paid your deductible for the year, you do

not want to have to start over again in january. another reason is because of flexible spending accounts a lot of people have, where you put money aside tax-free, and it used to be if you did not spend that money before the end of the year, you lose it. now the treasury department has changed his will that you can roll over some of the money. a lot of companies are not allowing that for this year. for many, it will start next year. opticians tend to have a lot of specialties. a lot of people buy glasses at the end of the year so they can use that money. again, as you mentioned, in some cases, it is not just these plans under the affordable care act, but a lot of employer plans are tightening up networks and cutting hospitals and specialists out of their network. a triple whammy about people trying to fit things in at the end of the year. guest: the story speaks to something the caller alluded to, which is the affordable care act is a huge law. it is making major changes to the health-care system. for some people, the changes will be positive, and for some

people, their health plan will be more expensive or the network may be smaller. one thing to keep in mind when reading headlines and thinking about the news about the affordable care act is that, like anything that changes the system as dramatically as this law does, there will be people for whom it is better and worse. some people may have a smaller network than before. some people may pay a higher deductible. other people may get health insurance for the first time and never had it before. or they may end up paying less. that is an important perspective to keep in mind. host: a republican caller named al. caller: i hope you give me a few minutes here. i want to tell you first off, about two months ago, i got notice from an insurance company and was thinking about getting additional insurance, just major medical. let me tell you this. i have got medicare.

i am 71. i had it since 65, i never used it. i am a decorated veteran. i have v.a. insurance. the woman called me and gave me a spiel about how you got this and it will not cost me anything. it will not cost me a dime. as i got into it, i found out you have to pay for this and that and this. i do not want anything to do with it. i have plenty of insurance and do not need any more. day before yesterday, i got two packages and are now. not one, but two of the same package for my insurance. they enrolled me and i will call someone. these have 375 pages of insurance in these packages. it is disgusting. now i have so much for birth control. i am 71 years old. i will tell you what this

program is primarily for, for the minorities. 30 years ago, they passed a law where you have to take care of people going to hospitals. it is what happened. these people kept going to emergency rooms so hospitals -- cost of insurance went up for everyone else. let me tell you michael's mother was making $67,000 a year. she probably had a family. what is wrong with her paying for that when everyone else has to? host: let's hear from our guest. any response? guest: if you are on medicare, you are not allowed to enroll with the affordable care act. let's start there. the aca plans are only for people up to age 65. right there, i do not know what kind of plan he was enrolled in, but it is not for people on medicare. if you are on medicare, you can get supplemental insurance, but you cannot get an affordable care act plan. host: catherine is calling from new hampshire, independent caller. hey, there.

are you there? caller: affordable care act. i would have preferred a single payer, but i'm excited about having health care for all americans. if one wants to see what a free market health care world looks like, i suggest viewing the dvd "as i lay dying," a william faulkner story. it is positively grim. i suggest all republicans and young people watch it. thank you. host: let's hear from salt lake city, democrat. hi, there. caller: yes, good morning. i am really happy for this on c- span, objectively. i want to make more comments about health care. this has been a problem in

america for as long as we can remember. there are sets of problems related to the affordable health care act. number one -- [indiscernible] late in his first campaign, and also subsequent efforts to make the legislation go through the congress, from different stakeholders. i think obama made a mistake from the beginning because they made it so difficult, so difficult, that it was not easy to explain and it has lost all of its weight because it has been gutted during the

negotiations with conservative and other stakeholders -- it was almost bare bone. the easiest thing was to keep the public option. that was the basis for the whole program. because i am a liberal, and liberals are known to be inconsistent. they do not stand for anything. as soon as they see something coming, everyone else's digging the heels, then they start changing. [indiscernible] conservatives are those people who do not like from day one and kept suggesting -- [indiscernible]

big government is becoming involved in our daily lives and a big section of the economy. host: thank you for calling . a lot of points. let's hear from our guest. guest: very complicated. the process was a long and arduous legislative one, and i do not think anybody would say was perfection. the president may have noted that one point that the only perfect law was handed down on mount sinai. there is no question the law has a lot of flaws. under normal circumstances, some of the flaws might have been and might still be addressed. it is very difficult because the law has been polarizing as it has been over the last 3 1/2 years.

it has been very difficult to make the kinds of adjustments one would normally at from a piece of legislation this size. it is part of the reason we are where we are. host: an editorial cartoon showing the president with a bunch of contraptions generally called obamacare and he says, no, i don't want to return this and he just wants it repackaged. what do you think he is trying to say here? guest: one of the difficulties, he has laid a very complicated health care system and laid something even more complicated on top of it any wonder why people do not understand it or why it is difficult for health supporters to explain it. to make it more complicated, you have a polarized congress who cannot even do the smallest fixes to it. it is not even a matter of repackaging. there are a lot of small things both sides would like fixed and they have not been able to because congress is so gridlock. one of the things congress --

one of the things mentioned about the gridlock, they could have gone with a public option. one of the things we are really seeing around the country is that the prices really differ depending on your family size and age on how much you earn because there are subsidies. we are also seeing the prices differ markedly depending on where you live because of just how much insurance costs and how much competition there is. it is turning out to be kind of the luck of the draw. in some places, people are saving a lot of money because they happen to be lucky enough to live in a sweet spot for the insurance agency, and in new hampshire, where there is one insurer, insurance policies, they tend to be expensive. host: a tweet asking how taxing insurance plans lowers the cost of insurance. guest: it does not. the law is funded by a number of different mechanisms, including a couple of new taxes. that was in part driven by a

desire to ensure it would not add to the deficit. it is quite expensive to extend coverage to millions of people. one of the taxes is a new tax put on the insurance plans to help offset the cost of expanding coverage. there was some rationalization that the insurance industry stood to gain a lot of new customers and they could make a contribution at the office, if you will. but i do not think anybody believes if you add a tax on to insurance that that will not be passed on. host: moving on to pennsylvania, a republican, hi. caller: hi. i know 90 million people will lose insurance for --

[indiscernible] applying for the insurance is too expensive, and the only other recourse is medical assistance. i am wondering how many other people have been transferred and are now going to be stuck applying for medical assistance, something that i would never want to do and i want to know how many other people do it. the second question is, in regard to taxes, i understand a rental tax, 3.8%, can you please explain and i will listen after i hang up. guest: i do not think there is a 3.8% tax on rentals. there is a tax for high income people, a number of taxes, that you have to make more than a $250,000 dollars for most of those taxes to kick in. there are not a lot of good numbers about how many people lost their insurance. again, remember this is only within the individual market this year about people whose policies were canceled because they did not meet the

requirement. it seems the majority of those people got other insurance. many of them got cheaper insurance, and we are mostly hearing from people who did not because those are the people complaining, or they were getting subsidies. there are a number of people looking or there will be some people who end up paying more. it depends on where you live and how much insurance costs. that is still sorting itself out. host: this story from reuters. the u.s. government named ceo for obamacare. coming under increasing pressure. the chief executive to run the federal marketplace and to lay the concerns of insurers after a rocky rollout. guest: the white house heard some of that criticism. after the botched rollout, the president named essentially a

rapid response rescue man to come in and take it over, and he has stepped aside now and the former executive from microsoft agreed to step in to take over oversight of the further implementation of healthcare.gov. it is not clear whether or how long he will stay. he pledged only to stay into next year. there is discussion about whether he may stay longer. clearly, one of the real weaknesses of the implementation of healthcare.gov and the enrollment process was a lack of clear leadership in the obama administration. it is a fairly broad consensus having someone who has strong leadership and particularly private sector experience is not such a bad thing. click yes. i think generally all the senators calling for somebody to head this were happy with last

appointment last week. host: roanoke, virginia. good morning. caller: good morning. i wanted to ask, i have not done anything about the affordable health care act yet. as i go through the process, are you required to have identification? guest: yes. generally, when you go through the process, you are required to have a number of things, proof of citizenship, some proof of income, and the website, or if you do not want to go to the website, you can find someone to help you in person, will go through the things you actually need to have in order to actually apply for health insurance. host: why are you asking about i.d.? caller: why do you have to have i.d. in order to get insurance?

why do you have to have identification for insurance but you can vote and you do not need identification? host: do you want to take a crack at that? guest: i do not know much about voting, but my experience with most things know is that you need identification. bear in mind this makes millions of dollars of insurance available to those with low or moderate incomes. there's obviously an interest in trying to ensure the people are who they say they are. guest: there's not much medical condition involved because

there's no preexisting conditions, but there's a lot of concern about fraud, and that this program is only available here in the u.s. legally, so they want to make sure that you are who you say you are. host: how do you think the politics will change after january 1 with health care here in washington, and around the country? here's one headline -- speak to the gop's approach at this point, where have they been, and where they are going. guest: they have been on the repeal, or the delay, and i think those things are probably going to have to evolve, if you will, because it is going to be once you get several million people -- one of the things we should go back to talk about 1.1 million people who are signed up in the states. they're not quite as far off as

they were saying, the 3.3 million expected for january 1, they are guessing it is about 800,000. there aren't about 2 million people have signed up for the plan, and somewhere over 4 million people have now gone coverage through medicaid and the children's health insurance programs. we're talking somewhere in the neighborhood of 6 million people who are going to have coverage starting january 1. if you're going to repeal the law, you're going to take insurance away from 6 million people. that is something for the republicans to think about. now they are talking about delaying the mandate. it is the next things coming down the pipe. it is really march 31, if you do not have insurance, you would have to pay this fine. or the employer mandate that to put off a year. they're looking at things that have not taken effect yet. you'd expect those types of arguments. or a wholesale revision of the law, but i think we are kind of past repeal point because once

you get people getting insurance and having it were, then it becomes harder to take it away. host: noam levey, delaying the mandate, what effect would this have on the overall process? guest: one of the things is how much these plans operated through obamacare actually cost. if not enough healthy people show up because there is no penalty if you do not get health insurance, does that change the risk pool, as it is called, does that makes it more expensive in 2014? i do not think that the law is probably in any danger of being repealed before president obama relieves office, but clearly, if there's a republican president in 2017, and the law is not working, if the premiums that the people are paying are too

high, or if a lot of employers decide to stop offering health coverage, we find a point when healthcare.gov was as disastrous as it was, would be public publice thwhere the perception was that this thing cannot work. at that point, the republican critique of the law gave the a lot of steam. i think we might see a change in 2017. guest: until now there republicans have not had an alternative, they have complained about the affordable care act. they will probably put something out there in 2014. it will be interesting to see what the republicans have as a comprehensive alternative. host: there is a tweet -- has that been a problem? guest: yes, it has. there've been a fair number of fake aca websites.

host: are they ask for money, personal information, both? guest: both, all of the above. places what to charge people to sign up, and that is not the way it is. guest: i just wanted to add to our earlier conversation, the california republican party actually put up a fake website. they ultimately took it down, coming under a lot of criticism. host: a call from mike. caller: i represent this. my wife is 68 on medicare, and she is in a skilled nursing facility. she has been there for only 26 days, and because she is not showing recent progress,

medicare is cut off as of tomorrow. therefore the supplement is also discontinued. she is entering a cancer study at the lombardi cancer center in georgetown. so what can we do? can we get any kind of insurance to cover this? host: let's hear from our guests. guest: i believe medicare now covers clinical trials in some cases. you might want to explore that, and call medicare's 800-number and ask. the supplemental will not cover anything that medicare will not cover. host: david, you're on the air.

caller: the problem with the affordable care act is that it has never had the support of the american people. the majority of the american people feel like they are being bullied into doing something they did not want to do, which is an unfortunate situation because the relationship between the people and the government that the founding fathers had in mind was that the government should be subservient to the people, not the other way around. host: what does that all that mean then with the january 1 law? caller: the lady said the republicans have a plan, and i am a republican. three steps you could have done. step number one, malpractice litigation reform to address the soaring malpractice insurance costs and defensive medicine

that doctors now have to practice. step number two, allow people to buy state insured policies across state lines to increase competition. as that number three, have a website that works, where people can go compare the various plans and caused, if they want to pay a little but more to keep their own doctors and hospitals, that would be their choice, instead of the government dictating what doctors they can choose from the what hospitals they can choose from, what plans they can choose from. host: thank you for calling. have we heard any of these plans before? guest: reforming the medical malpractice is a longtime goal to the conservative health policy folks. as is deregulating health insurance and allowing health insurance to be sold across state lines. i think there is a general consensus that the medical malpractice system could use

some changes, but the problem is that it does not do all of the things that some proponents of it claim. it may help reduce some of the unnecessary tests that are done, and free doctors to practice differently, but it does not solve the problem of tens of millions of people who do not have access to health insurance, it does not help change the incentives for practicing medicine in one way or another. very briefly on selling health insurance across state lines, even health insurance regulators will say that that becomes very complicated. think if you buy a health plan in iowa, but you live in new york. what if you have a problem, who do the you go to? do you go to the regulator and i wasn't supposed to be responsible, or do you go to the

federal government? it is opening the door for even more federal involvement? guest: most of these plans, for better or for worse, have networks that are pretty broad. it is implausibe to buy a plan in iowa if the person lives in new york. most plans, for better or worse, about are not national. there are national, multistate plans in the affordable care act. there are supposed to be more going forward. i think they are in 33 states now, and they are supposed to be in all 50 states by next year. host: a "usa today" headline about mental health care. access still lags, and is a cry just cannot accept insurance -- many sick i just do not accept insurance.

guest: missing a lot of what is going on. people complain that i lost my plan, now i have to buy these plans that have all of these things that i do not want or will never need, but the institute of medicine was the one that went in and to send what these plans will have to cover. many of the things that people think they will never need may in fact be things that perhaps you will someday need, and mental health care is one of them. a lot of people do mental health care, or perhaps substance abuse treatment, and it is an issue that a lot of doctors who do not take insurance. sometimes they have a problem with difficulty in getting providers, and getting providers into networks. the process of picking the lock, the health care system that we have is not a big one.

there is still a lot to ironed out. guest: getting that balance right is a challenge. with anything the government does the as this law is being implemented, one of the things that we will have to keep an eye on is the degree to which that balance between the market doing the things that we want, and government regulating coverage of mental health, or other types of requirements for the government is placing on health insurance, or on doctors. that is going to be an evolving balance. host: brad, independent caller, from iowa. caller: hello. i have a subcontractor

individual plan. my plan was grandfathered, i'm not being forced to buy maternity coverage, and a bunch of other stuff i do not need. i'm a 51-year-old single man. as far as insurance costs across state lines, i have blue cross cross blue shield policy in iowa, and my providers are nebraska. everything works just fine. let's go over some of the numbers. when they passed this law, they said 40 million were uninsured, and now there is 50 million uninsured, and 6.1 million individual policies have been canceled with an average of 1.7 people on each plan.

so that is somewhere between 10 million and 11 million people that have lost their insurance. this is a communist takeover of our health insurance company. host: one opinion there from brad, in iowa. a tweet here -- do we know that figure? guest: right now there are more people getting medicaid than are buying plans. that was always expected. remember, people keep talking about this 7 million that are expected to have private insurance but that is the cbo projection. the first projection was always 9 million, so it was always the thought that would be door people getting medicaid the second year than signing up in the health exchanges. host: this opens the doors to medicaid coverage on its own terms. what is the story going on in iowa with medicaid coverage? guest: i forget exactly how iowa is doing, but half the states

are expanding. originally, every state was supposed to extend medicaid to the underprivileged sector, but now only half are doing it. some doing it not exactly as it was anticipated, doing it slightly differently. i forget exactly how iowa finally decided how to come in, but it is not a straight expansion, they are doing it with some strings attached. host: iowa is one of the handful of states that are negotiating with the federal government to customize their federal funding. we are also reading in "the new

york times" that two states that have the same lead contractor to hold the online marketplaces and had some problems and delayed that they withhold payments to the company and seek to recoup the funds. guest: the contractor for healthcare.gov was the contractor in several state run marketplaces that have problems. i think hawaii may have had this as well. not surprising that states would seek some redress. host: taylorsville, kentucky, you're on the line. caller: i am in the network for kentucky.net, and a friend was

just diagnosed with cancer and she works at a bowling alley. but the employer do not notify her that the employer did not notify her that she would no longer be covered. somewhere sister went to the they kentucky.net program to find her new insurance, and it was going to cost her $300 a month with a $6,700 deductible. that is not cheap for someone who only works at a bowling alley. and then my other question is, does this employer have the right to do that, not that close to where it is time for her to sign up for the new programs? guest: i think employers were under an obligation to notify their employees about the options for coverage through the marketplaces. i do not know about the specific scenario that the caller is referencing. guest: we would need more but

the specifics of that. that sounds about right for how much you have to pay, but depending on how much he earns she might be eligible for still more health. if you're under 250% of poverty you're not only -- for help with your premiums, but your companies as well. host: karen, from arkansas. on the republican line. caller: my main comment is that, with all of this health care being created, the people that are most important and all that were ignored, and those were the physicians. because the physicians who have worked, some of them since middle school to get where they are, are now being told what to do, what they cannot do, what they can charge what they cannot charge.

i guess my comment to the two guests is how would they feel if the government now says to them we are late going to let you make $5 an hour, $6 an hour, or $10 an hour? how would you feel if your personal work was now disgraced, your value is decreased by a government agency? how is this going to affect the patients because i do not think the doctors were considered in this. you can evolve insurance you want, but until you have a doctor to take care of you, you're not going to get healthy again. i predict that the majority of the doctors in the country are going to boycott obamacare, and then what are we going to have but a bunch of nurses when you get really sick. i would like them to respond to how this is affecting the doctors and why they were not considered in this. guest: a lot of people like

nurses, so it might be good for some patients. most of the major medical associations supported health reform, including the american medical association. there are a lot of physicians that are feeling nervous if not outright angry about what the law is doing. they're made to be seen whether or not some of the regulations and requirements that the law puts in place will be things that are beneficial or not for physicians. it should be said that there are a lot of physicians that feel that some of the things that the laws doing to make it easier for physicians to care for patients in a more rational way may help them manage their diseases, is a positive development. we do not want them to have to

take government money, have to pay for medicare patients, medicaid patients. it happens that about 2 million people are on that. guest: and most of the expansions here is coming through private insurance. a lot of private insurance companies are trying to compete by either narrowing their network and having fewer doctors in them or -- to keep the prices competitive. host: here is a tweet --

guest: no, that is not part of this. host: let's go to a democrat in tennessee. caller: good morning, young lady and gentleman. i have a quick story, and then a question. i am retired. three years ago i had co-pays and out-of-pocket expenses on my retirement insurance. at&t started charging me $60 a month, and then this year they miraculously charged me $331 a month. i assume from this is from obamacare, or the greed of at&t. my question is, i've been on blue cross blue shield of

illinois -- if companies are people, how can they buy insurance across state lines? that is a question that everyone needs to know. i want to know who gets drafted, who gets their estate, all of the questions that people have when they die. thank you. have a happy new year. host: noam levey? guest: a lot of issues raised by tony there. let me raise the issue first of cost. clearly the cost of health care in this country continues to rise. i pay a higher co-pay, a higher premium, i wish that were not the case. cost growth is slightly slower now than it used to be a few years ago, but it is still faster than inflation. so every year we are all paying a little more for health insurance.

i do not think it is necessarily the case that obamacare is responsible for that, because it has been going on for many years. one of the things to keep in mind about how expensive health care is come a that we all talk about, how can we do things to change that. the government could regulate the prices, the government could set lower prices for everybody. as karen was just telling us, that is not something that a lot of doctors want either. there is this conundrum of what is the role of government convention government edict getting that we pay less money? i do not think that is the answer, and i do not think it but he knows yet. host: john, in illinois. caller: good morning. i have been a major defender of our president on this health care issue. however, recently, i've been disabled for about seven years now, and my daughter, prior to

being age 19, was on medicaid here in illinois, and then they cut you off at 19. so she is now 20, and i went to the site and was thinking that this was going to be great, the expanding medicaid that she would be able to get on. she is in college, lives at home, and we do not have a very good income here. we found out that because my wife has insurance that she will not be able to be eligible for medicaid. but to put her on my wife's plan would cost more than $500 a month, and we didn't do that to begin with because we couldn't afford it. so now after discussions in my family and with my friends, all lot of them on the opposite side of where i am, it is beginning to be a lot harder to defend this program when my own daughter is not going to be able

to be on any program, and i cannot afford to pay for it. so i think there is a big problem with this, and i'm hoping that it can be fixed, but it is getting harder to defend our president and this aca. host: is that story typical? guest: it is not typical, and it does get confusing, particularly in the situation of young adults and what they can do. it sounds expensive, but i do believe what some employers have said this is a big problem called the family glitch, where they can have their insurance, but the cost of adding family members, it is difficult. multistate employers have always been allowed to offer insurance to employees in multiple states,

and that is what the employment security act does. there are lots of employers that have employees in many states, and they get to offer insurance across state lines. it is only if you are buying fully insured plans in one state. it is individuals who cannot buy insurance in other states. big corporations can always offer. >> it should be noted that to our earlier discussion, those health plans are regulated by the federal government. there's actually a right of the street from here, a very large office. if we're going to expand interstate health insurance, i bet you that office would have to get a little bigger. host: mention more about the functionalities of out the help exchanges in the states. guest: it depends on the state. pre-november, the storyline was

the healthcare.gov did not work, but the states were doing great. now it is healthcare.gov is a great, but the states are having some serious troubles. maryland, you have a situation where the contractor did not do so what were they tried to move to a different contractor, and ended up suing each other. you have oregon which never got its website launched they they have done everything on paper so far. hawaii has had some really serious problems. i think that the states that have done the best of although they have done -- had some problem too -- new york, connecticut, kentucky, they have done really well. even colorado which started out really well has had some stumbles.

kentucky has done quite well, but they had started early and did a whole lot of work. washington state has also done well, but they have had some -- and pretty much everybody has had some issues. host: we have a couple of more calls. victor, a republican. caller: i'm just calling because i just don't believe that this health-care bill is going to benefit a large cross-section of the country like we have been told. i want to make a statement about dr. ben carson, but before i do i want to say that if you -- we were told that if you wanted to keep your plan, you could. none of this stuff about it you're unable to keep it because you are able to pay the increasing price, we were told

this until just recently. i realize that there are a lot of people out there without insurance and people who are underinsured, and there could have been a way that this whole thing could have been fixed so that they are not underinsured and they are not without insurance. the other issue that is about to fall that all of us have been ignoring is the fact that we're would have 30 million plus that is going to continuously increase the cost of medical care is country. dr. ben carson, i think that he would be someone that we ought to really look to, and people like him, who help us in this health-care thing, because

these folks are much closer to dealing with this thing. i think that once we get people in office that are really looking out for us by the iraqi -- the american people, and i mean both sides of the political aisle -- we'd better education in this country, and there's something not happening because we are allowing ourselves to be governed by a politician who really wants to control our lives. host: one last call, silvio from south bend, indiana. independent caller. independent color. -- caller.

caller: as of the end of the year, she is going to be canceled completely. is this example, moving forward, the new death panel? he said his -- her coverage is canceled as of tomorrow. guest: she is a skilled nursing facility and they is being moved to a clinical trial. host: noam levey, what to look forward to in the next couple of days with january 1 as a big deadline? guest: people are going to start using health insurance. do not think it will be people beating down the doors, it is relatively few people, relative to 300 million americans that are going to be getting all the insurance. i expect we will have some or glitches, will have more people showing up they can do things that they perhaps cannot do. maybe they do not have their

health insurance card or so forth. we get to the end of the open enrollment time when people can select health insurance. we will be watching that march 31 deadline to see how many people are actually signing up for help lands. not too long after that we're going to see what of the affordable care act will look like in 2015. the summer we'll will see how much our health insurance plans will be charging in 2015. how many of them will be able to stay in business because they did or did not get the customers they need. that is going to be an important barometer. guest: we are going to see a fair number of sign-ups in january. i think that there's probably a pent-up demand for people to get

in in december, and you're going to sign up now for that february 1 start date. i think we will see that lull, but i think we will also see fights about small businesses signing up that got delayed. they delayed the spanish- language website, because as things come on line, we talk about there is a continuing fight in congress to decide whether there needs to be fixes or an overhaul. host: our guests have been julie rovner and noam levey, thank you for your time and expertise this morning. >> the top stories of 2013. also, your phone calls and

comments on what you think is the top news story of the year. plus i'm a your e-mails and tweets. "washington journal" is live at 7:00 p.m. eastern on c-span. ♪ physicianek on "q&a," and surgeon dr. hessan tettah discusses his metal career, his service in afghanistan, and his new book titled "gifts of the heart." >> dr. hassan tetteh, you told me just before we sat down that you did a heart transplant overnight, explain that.