so that is what is going to happen. we are heading for single-payer. we make obamacare work in the market or we are going to go single-payer. no question about that. you're going to live a long life, tim. argumentpart of your is that because of the benefit requirements, plans are having to spend more for benefits people do not want. they're having to add features people do not want, like narrow networks. particular, what benefits are required that are at existential into the cost? -- adding substantially to the cost? is there enough money to allow for less narrow networks?

>> that is where tim always challenges me as well. go back to the section in the law that has the benefit requirements. you have to have a hospital, dr., lap, prescription drug benefit. drugan have a prescription benefit with a threshold adoptable. you can have a hospital benefit that pays 70% of the first 30 days and 100% of the next period of time. it is not that you were going to take benefits away. you are going to do different co-pays and different things with what can be delivered on those. you can restrict certain drugs that generics are available. there is flexibility in how you provide those benefits. employers provide 70% actuarial benefits, but they do it efficiently for a lower cost. a number of variables in the way you package benefits. is a get me wrong -- this

zero-sum game. you take something away when you do that. but i think the difference is healthy people want different things than six people -- than sick people. everybody wants catastrophic insurance but i want different things on the up front. the part d drug benefit is a good example. drug benefit right now, cms runs a computer program -- you put in your drugs and figure out which plan pays you the best. if that is not and has election, i have never seen anti-selection. that is very efficient. there is always been antiselection. yes? seth, a physician and health policy fellow at gw.

you mentioned how 30% of the dogs liked the food. >> ok. smallare seeing a percentage of people previously uninsured by -- >> we do not know, it is a monopoly, is the only doctor they were served. >> jim touched on the point about churn. we see churn in the medicaid market, the uninsured pool. 67% or 77 people who were areiously insured tomorrow's uninsured but for the insurance. are the numbers that scary? we are mitigating the future uninsured by making the people currently uninsured have insurance. >> there is no reason to believe people will be in the market tomorrow. kaiser polldo the and the gallup poll in the rand

paul, you just did a poll of 29 million people eligible for the exchanges and 30% showed up. that is a good predictor of future performance. the back. >> laura with the heritage foundation. i wanted to ask about the back end. so, we were assured everything was going to be fine about obamacare and then the curtain listed and there was a lot of disasters. there is this mysterious back end. what are you hearing from insurance companies about those systems working? drop? going to have shoes >> the problem was the 834

transactions that came on enrollment. they are generally working ok, we're still having unacceptable error rates for high-volume performance. it is in the single digits now. it is something the carriers are able to keep their heads above water on. it is not what it should be but it is workable. is rest of the back end, the ability of the fence to pay insurance companies their premiums. and the ability to do reconciliation. to compare that list between the insurance companies and the feds. there is a meeting next week between cms and a number of insurance companies they are focusing on to talk about some of the issues for what the back end should look like. the back end is not close to being able to be tested yet. i am hearing if we are lucky we will have the back end by

september. that would be one year later. it should have been tested by september of last year. do not discount this -- we are talking about what our insurance companies going to do with rates. the insurance companies do not know whether premium is. they know what their claims are, they have no idea whether premium is because they have not been able to do reconciliation. one ceo told me you know the good thing about the affordable care act -- we send them a bill for what they think they os and they send us the money. [laughter] what are the subsidies worth a month? $10 billion? we are now into the fourth or fifth month of insurance companies billing $10 billion a month with no back up and no reconciliation. let me assure you they're good for it. but we have the mother of all reconciliations coming. this is one of the problems with the 8 million -- you live by that sword, you will die by that

sort. i would not be pushing that to o hard. >> this might be our last question, running up against the deadline. >> this is a follow-up question. insurance companies are getting paid, can the 8 million go out and use the benefit, who is on the hook? our providers going to be rendering care? what happens? >> the provider end up being on the whole, not the insurance complete. if the first month's payment comes in, the insurance company cannot take them off the system for two more months -- they have three months with one month's payment. if the person goes to the doctor and does not pay the premium in the second and third month, the insurance company can pend or suspend claim payments. but the doctors providing treatment. with some positions yesterday.

one of the big questions or one of the points he made, one of the big differences with obamacare as we are collecting upfront. we are not sure if they're going to be covered or not. these deductibles are so high, particularly for specialists. just because the person has got insurance, they have a $2000 deductible. they have got catastrophic insurance, a specialist is not certain he or she is going to get paid. i do not know how i would have done that differently. these are the complicated moving parts. i don't mean to say obamacare is a screwed up, i don't know how i would have done it differently. it is one of the things that has to be fixed and is going to be a mess. not havethat we do reconciliation has the provider more than the insurance company. the insurance company -- they are going to get their money. the provider is not necessarily going to get their money. >> spoke too soon, we have time

for a couple more questions. yeah? state medicaid expansion. given the likelihood that the obama administration will not ,old to that 90% match rate would it not be responsible for governors to accept the expansion of this time -- would it not be a responsible for governors to expect the expansion? >> the federal government is paying 100% of the expansion of the first year and it drops to 90%. when a jobs to 90%, the state is on the hook for a lot of money. don't tell me the cost of does not havesion the state on the hook. mr.esponse to this --

republican, you are telling me that you do not know how to make market-based reforms. 10% moreaid market, efficient. you are telling me you cannot sweat 10% out of this system? you cannot run your medicaid program for $.90 on the dollar" cuomo is running it dollar.cents on the put up or shut up. [laughter] some of us have to believe in the market, even the people who claim to believe in the market say they believe in the market. some of us actually spent their life in the market. i can manage medicaid in any state for $.90 on the dollar. >> i went to get your comments, after three years in the long term, what is risk adjustment look like?

do we stay with a medicare advantage type system? is a bigselection problem. >> 2017? >> and beyond. >> according to the statute, it is the old market, the three r's go away. >> two. >> risk adjustment stays, yes. all that means is that if you are a health plan unlucky enough to get sick people, itself adjusts. you have some players who are too small. the training wheels, the subsidies, go away. regulatedave is the market. that is what insurance companies are used to. that is what they have an part d and medicare managed. in that is what they have part d and medicare advantage. their biggest customer is the federal government.

>> there is still some antiselection, free gym membership and stuff. >> clearly, the risk adjustment formula -- that is why you hear these people say these companies are nothing more than cherry pickers. read the law. it is a zero-sum game. you can bring all the healthy people and it will not do you any good. the sustainability of the law and for the industry is getting an adequate spread of risk for the affordable care act. that is what sustains the law. you can be the best cherry picker in the world, i was a pretty good one, it is not going to do you any good today. time youthat the next talk about insurance company cherry pickers screwing it up. i will use the prerogative of the moderator to ask my question. you were very adamant about

coburn-hatch going backwards before it goes for. enactnot possible to something like that with a transition? think it is a semantic thing republicans have a problem with. republicans have got to figure out how to get around this appeal part of it. anytime any legislation that you pass to fix obamacare is, in a sense, repeal and replace. the perspective has to be going forward -- some of the problems ch-coburn, that is a serious republican bill. i wish they had proposed it in 2009. now if you pass bur r-hatch-coburn, you eliminate the medicaid expansion. 30 states will have expanded medicaid, that is 60 senators, you are going to limit that? >> they replace the medicaid

expansion with a uniform credit, everyone would have insurance. i remind you that coburn proposed this in 2009. >> what we are talking about is going forward. >> sometimes to go forward you have got to do a lobotomy first. [laughter] are going to get hung with the notion they want to go backwards. that is going to be the wrong political move to make come november. it might win some tea party primaries but that is going to be a terrible thing for them to have to kerry come november. the vast majority of people want this fixed. they don't care about the backroom problems and there is no reconciliation system. they want it fixed. ch-coburn has a lot

of good ideas. >> join me in thanking bob. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2014] >> the q&a with high school students talking about the participation in the week-long senate program. i've at 7:00 a.m., "washington journal." today, the israeli ambassador to

the u.s. and deputy secretary of will speakam burns at the national leadership summit in washington dc. they will discuss the challenges of the israeli-palestinian cover nflict. c-span2. on point ofhstanding this order, i urge passage of the userlying role and for to go forward with health insurance on behalf of of the 21% of my states constituents under the age of 65 who are uninsured. they are too young to qualify for medicare or two middle-class to qualify for medicaid. , or eulogyl oration could more eloquently honor his the earliest possible passage of this bill

long, hishe fought so heart and his solar in this bill." refer toe could easily my father and the context could easily describe this health care debate, these words were spoken on theather as he rose senate floor to honor his brother president kennedy during the debate on the 1964 civil act.s the parallels between the struggle for civil rights and the fight to make quality, affordable health care accessible to all americans are significant. it was dr. martin luther king jr. who said "of all forms of inequality, injustice in health care is the most shocking and inhumane." is not only a civil right, it is a moral issue.

you, madam speaker, for your political and moral leadership for helping those to secure a more advanced protection and benefit, especially in the area of mental health and election. -- interdiction. -- and addiction. thank you, president obama, for providing the politics of hope, rather than the politics of fear. >> find more highlights from 35 years of house floor coverage on our facebook page. by america'sed cable companies 35 years ago and brought to you today as a public service by your local cable or satellite provider.

>> this week on "q&a," a talk with participants in the 2014 united states senate youth program, held at the renaissance mayfair hotel in washington dc. >> tell me your name, where you are from, and what his group is all about. >> my name is catherine and i am from the state of michigan. we are at the 2014 u.s. senate youth program. students come together to experience leadership in this nation's capital. >> what did you want to add? >> it is sponsored by the hearst foundation. two delegates from each state are chosen to represent the states at the capital. over 5000 alumni are in this country and they have become stars in law, politics. >> tell us your name and where you are from. >> i am albert, i am from

maryland. >> what was the high point of the week for you? >> seeing the president of the united states yesterday. to see him as an individual and a person was an incredible experience and just being in the room with the president was surreal. >> what is the first thing you thought of that you did not know you are about to think of when you saw this man standing in front of you? >> i was telling myself to keep my composure and keep it cool. seeing him approach on the red carpet in the white house was so surreal and i started tearing up. it was actually quite embarrassing. just being able to experience something like that that so many youth across the country are not able to experience is so unique for us and we will take this experience for a lifetime. >> and your high point? >> definitely meeting justice scalia. i have always been interested in law. one of the most insightful things that he said was that courts should not be named after the chief justice of the time. they should be named after the