f job creation and some fiscal discipline to bring down the annual deficit and the long-term debt of thefederal government, and that will help to restore the public trust. >> last question, and it is a short one. if you can put a single word to your emotion as you leave this place, what would that be? >> nostalgia. >> and now i need to say, why? >> because i love what i have worked for and accomplished, seeing people go back to work in my district, with a steel or iron ore processing plant that was shut down because of a lack. engaging a steel mill in china to commit and be a partner

putting people back to work, creating jobs, and a new business such as aviation aircraft seeing the jobs created. this was a time when you made a difference in people's lives and i won't be able to do it in the same way, so there is a feeling of accomplishment. i worked to the fullest of my ability every day. it is the greatest honor to be conferred on you, to be elected by your peers to serve in the public arena in this greatest democracy on the face of the earth, and to believe that is difficult. but i had intended to in the next two or four years to wind it all down and have another

pursuit of my energies and interests, so it is the end of a chapter, not the end of a book. >> thank you for talking with us. we appreciate it. [captions copyright national cable satellite corp. 2014] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] >> coming up on c-span, a discussion of the health care law, then regarding israeli and palestinian land issues, and then ted leonsis on attracting sports events to the d.c. area and later, a discussion on funded spaceflight. >> on the next "washington journal," looking ahead to the 114th congress and the largest gop majority since 1928. then, more about the new congress, discussing the liberal

and progressive agenda. plus, your calls, facebook comments and tweets, all on washington journal, live at 7:00 a.m. eastern on c-span. >> wednesday night, we remember celebrities who died in 2014 including actor and comedian robin williams, author maya angelou, and civil rights activist ruby dee. that is here on c-span at 8:00 p.m. eastern. >> the c-span cities tour takes book tv and american history tv on the road, traveling to u.s. cities to learn about their history and literary life. its weekend, we have partnered with time warner cable for a visit to austin, texas. >> in a private suite of lady bird johnson, a private headquarters of the first lady, and i do mean that.

this is not part of a tour that is offered to the public. this has never been opened to the public and you are seeing it because of c-span's special access. the ip is come into this space just as they did during lyndon johnson, but it is not open to visitors on a daily basis, and they were mockable thing about this space is it is really a living breathing artifact. it has not changed at all since president johnson died in january of 1973, and there is a document in the corner of this room signed by the archivist of the united states and lady bird johnson, with my predecessors myself and my predecessors that nothing in this room can change. >> we are in austin, and to my left just down the block is the river, the colorado river, and this is important in the city's history because this is where waterloo was.

it was just a cluster of cabins by four or five families, and i am actually standing in about the spot where this was, and this is where the men got wind of this big buffalo herd, so they jumped on their horses. congress avenue, or it was not really an avenue, and in those days, it was just a muddy ravine, and the men galloped on their horses, and they dust their possessions full of pistols, and they were shouting, and they shot this enormous buffalo, and from there, at the top of the hill where the capital is, this is where he told everyone that this should be the seat of the future empire. >> watches saturday at noon eastern on c-span two book tv and sunday afternoon at 2:00 :00

on american history tv on c-span3. >> now, a discussion on the affordable care act with the changes coming to health-care coverage in 2015. guests on washington journal. this is 90 minutes. >> "washington journal" continues. host: we are continuing our conversation on the affordable care act. two longtime reporters are here with me to help with the conversation. margot sanger-katz is the upshot health correspondent for the "new york times." julie rovner is a senior correspondent with kaiser health news. julie, i have a question that might be difficult to answer precisely, but is the affordable care act working? guest: of course, it depends who you ask. if you use metrics by the congressional budget office, how many people be expected to sign

up for medicaid and for the exchanges, then, yes, it is. right now, as of today, the numbers are hard to parse because we're halfway through the sign up for 2015 coverage. the last numbers that the administration reported were about 6.5 million people in the federal exchange those 37 states. those include people who were automatically reenrolled who did not come to the exchange and put in new information. they were automatically reenrolled in their existing plan or one similar to it. i think there is a little under 2 million new people so far, and that is for coverage that starts january 1. more people can sign up until february 15. and the penalties for not having insurance in 2015 go up a considerable amount to $300.5 or 2% of your income, whichever is greater. host: one of the metrics that people look at -- has the rate

of the uninsured fallen in this country? guest: that is something we can say with certainty. the number of people without insurance has gone down substantially, and that is a result of the affordable care act people have signed up for medicaid and for these new insurance exchanges. some people have signed up for employer coverage that they turned down before because they are now required to have insurance. the best estimate is somewhere in the neighborhood of 10 million people have insurance that do not have it before. that is just for 2014. the people signing up for next year they may bring that number down even more. host: will the exchanges get as many people with insurance whether they are federal or state or medicaid? guest: a major goal was to try to reduce the rate of uninsured and make insurance acceptable and affordable. some of those people cannot get

insurance because of a pre-existing condition and no one would give them insurance am a so the exchange has, to some degree, solved that problem. insurers cannot dems -- cannot discriminate based on health and just -- based on health history to some people cannot inch -- cannot afford insurance before. the expansion of medicaid and the availability of federal subsidies on the exchanges has made insurance accessible to more people. is 10 billion a big enough number? is that the right number? it is hard to know. he we know more people will sign up in the coming years. even after fully implemented estimates are that there will still be tens of millions of americans who lack health insurance. that is a problem. host: julie rovner, is health care insurance affordable? guest: for many people but not for everyone. one way to look at it was through the way supreme court wrote the law, not the way it

was written. congress intended medicaid to be expanded in every state for everybody up to 133 percent of poverty. everybody above that would have access to subsidies on the exchanges. the supreme court decided that that medicaid expansion was voluntary. we now have a little more than half the states trying to expand medicaid. some of the states that have not are some of the states with the largest, potentially, eligible population states, like georgia, texas, and florida. so a lot of people have fallen into what we call the coverage gap, and those are people who have incomes that are too high to qualify for regular medicaid. if you are a tireless at old chances are you are not going to qualify for medicaid no matter what your income is. for parents with low incomes but not so low that they qualified for medicaid but not more than 100% of poverty, which is the threshold at which you can get onto the exchange, all of those people are caught in the gap.

several million people who were supposed to be eligible for affordable coverage under the law and who are not. plus, there are people who do not earn a lot of money you are finding not that great a value in some of these plans. it is depending on where you live. it depends how much competition there is. in some cases, the premiums, even with the subsidy, the premiums may be low but they have very high deductibles. some people have said, i will just pay the penalty. host: what has been going on a 2014 with premiums and deductibles for people getting into the exchanges? what do you expect in 2015? guest: people are signing up now for 2015. one of the things that has been pretty remarkable is the number of insurers who have come in experts that have decided that, yeah, maybe we should get into this after all. so there is more competition in a lot of places, particularly

where there was not much competition before. that has reduced premiums. obviously, premiums are all over the place. it depends how old you are. so your individual situation may vary. in general, they're looking at the silver plan, the second from the bottom plan, the one in which subsidies are based. most analysts are finding that where there had been very little competition, that tended to be the most expensive plans. where there is more competition the premiums have come down. in some cases, those premiums may still be higher than some other premiums, but at least we're sort of coming closer to an average. we are sort of taking off the very top, if you will hear it's of the various -- if you will. in general premiums have not gone up as much as they do normally. the individual market tends to

be a market with a lot of fluctuation. premiums do go up a lot each year. the idea that the average increases each year, some are in the low single digit range, is really surprising. host: margot sanger-katz, what about deductibles? what do you expect? guest: the health law restricts the amount that health insurance can charge people in sort of total out-of-pocket costs. the total amount you spend including your deductible and your copayments and other kinds of payments, are capped, so the deductibles are not really changing very much. some individual plans are tinkering with, you know, you pay a little more deductible you pay a little less in copayment, and you come up with the right formula to make the product most profitable for them. in general, deductibles are kind of staying put. host: according to kinsey and company analysis, the nationwide median deductibles if you have a bronze plan, about $5,100 you're

it for a silver plan, $2500. let's walk through the plans and what you can -- what are they? remind viewers. guest: they list the tiers by me dals. bronze, silver gold, and platinum is the deluxe plan. they have to do at the percentage of an average person' s medical costs that the insurance will pay for. if you are a typical patient and you buy a silver plan insurance is going to pay for about 70% of all your medical costs and you will be responsible for about 30% through deductibles and other payments. the bronze plan, the least expensive plan, covers about 60%. the platinum plan, the deluxe plan, pays 90% of your expected medical costs. host: let's get to calls. william has been waiting in louisville, kentucky, and independent. caller: i do not have obamacare

but my daughter is a registered nurse. i do a lot of volunteer work with her. i take people back and forth to a clinic some and they are on obamacare but they do not have any way to get down there. i help my daughter out with it. i drive them back and forth. i take them down to a family clinic ok? these people do not see a doctor. they see registered nurses. i do not think they have ever seen a doctor. the place is filled with a lot of poor people. i am sure there are a lot of immigrants and many are illegal. but they all -- they do not see physicians been my physician who is from vietnam is threatening to leave the country, because he said he did not come to america to get involved in socialized medicine. my doctor -- my daughter hates it. she's is the nurses are not

qualified to make accurate diagnoses. i realize people do not have anything. i can afford to pay for my insurance be a i know people who cannot. they then if it from it. but people who do not needed are not being benefited by it because premiums and deductibles are going up. while i feel sorry for the people that i have to bring down there and that she takes care of i also feel sorry for those people who have to pay for it. it is a two-way street. host: julie rovner? guest: on the question of seeing nurses rather than doctors, this is one of the ways the health system is working to bring down the costs of health care. there are lots of different kinds of nurses. there are less trained and more trained nurses, advanced practice nurses, nurse practitioners. it has been shown through a series of academic studies that they do a very good job doing a lot of general primary care. a lot of doctors work

hand-in-hand with nurse practitioners. a lot of nurse practitioners work on their own. the idea of sort of making the health care system more efficient is that everyone works up to the limits of their license. they do that highest level they are trained to do. nurse practitioners are seeing people who have primary care needs, and then they send others to the doctor. the idea is that everybody is practicing the most efficiently. it is supposed to be the future of health care. it is just now starting up. seeing nurses is not necessarily substandard care. in many cases, it is considered the top level of care. they refer you to the doctors the way your primary care doctor will refer you to a specialist when you need one. it is not true that nurses are not trained. nurses get very upset about that. host: margot sanger-katz, he talked about a physician who wants to leave the country because he did not sign up for social care.

when are we hearing from doctors? guest: one thing that is often confusing in this moment is that the affordable care act is happening and that is changing a lot of rings about the medical system and about the health insurance system, but our medical system has been in flux for a long time. a lot of the problems people are experiencing now are things that have been simmering and going on for a long time. i think there are a lot of ways in which it is hard to be a doctor now, or harder than it was in the past. it is more expensive. there are more complications having to do with insurance. those things are really true. they are not necessarily, or even really at all, because of the affordable care act. a lot of times you hear from doctors about frustrations with the way the business is working with the with the practice is working, and they feel they have less autonomy than they used to have. there are people retiring or complaining or throwing of their arms in frustration.

doctors say they would not recommend that their children enter medicine. but that is not necessarily because of the health law. things are changing about how the medical system works, and that has been going on for a long time. host: what about the industry as a whole, have they benefited from the affordable care act? guest: in general, yes, the insurance industry is doing well. it depends, some were counting on medicaid expansion, because the hospital industry serves everyone who shows up at the emergency room. many of those people do not have insurance. many of them would have been and are eligible for medicaid now. they were really planning on having that -- even at a low payment, having medicaid pay for people for whom they were providing free care. that is a big concern in the states that have not expanded medicaid. there is a big push by the hospital industry -- in those

states that have not expanded medicaid yet -- to do that, to make sure some of those people who are eligible are covered. host: lisa is watching from shreveport, louisiana. caller: thank you. i am having a major problem. i signed up on december 8 for united health care, and i am from louisiana. and if they told me the paperwork. i never received it, and now i called back yesterday and they told me that i had to get back online and make a payment and i do not have a credit card. i'm on my dad's account, and he does not want to give his account number. i do not know what to do is stop i do not know what doctor to go to. i have no paperwork. i do not know what to do. can somebody help me, please? guest: i think the problems you

are describing are problems a lot of people are facing. the way the exchange works is definitely better than last year. you can select a plan on the website. a lot of the communication between the exchange and the insurance companies is not perfect. some of those insurance companies, sometimes the processes can be flawed. i would recommend to go back to the website and perhaps contact united health care again. host: she said she will not receive the insurance until she makes a payment. that is a crucial step. guest: that is true, and it is important for everybody to remember. even though the deadline is the 15th of the month before you want the coverage to start, the coverage does not start until you make that first payment. sometimes people do not know where to send the payment, how to make the payment. as she said, sometimes the information-passing is a perfect between the exchange and the insurer.

on the front page of healthcare.gov, there is a button easy to find that says "bfind health near you." it is good to find someone locally to intercede on your behalf. guest: i think for the long-term insurance companies, they generally do want a credit card or a bank routing number for automatic payments. my understanding is that for the first month, there is more flexibility. you may be able to pay with a check or prepaid debit card. host: good to know. we are dividing the lines by republicans, democrats, and independents. we have a fourth line for those of you enrolled in the exchange, whether it is the state exchange or a federal exchange. josh's calling in on that line in charlestown, indiana. caller: we were on the exchange, and our premiums tripled. basically, everything that we found for a cheaper plan, none

of our doctors were in the coverage. so everything we found, you know, if something does happen and we go through our deductible and premium, everything will add up to about $20,000. so we're just going to go without. we are automatically reenrolled, but we are going to try to cancel that and pay out-of-pocket. it is a lot easier that way. host: are you healthy? you are assuming your expenses will not be that high? caller: yes, we are all healthy. host: do you know the penalty increases in 2015? caller: yeah, it will still be a heck of a lot cheaper than getting the insurance. we do have the funds available if we have to. we can pay up to the $20,000 out-of-pocket. but what we would really like to have is a catastrophic plan something where we pay everything out-of-pocket up until a certain point, and then

let it kick in. host: why is that not available? caller: it is. it would be one of the biggest you know, for maybe $1500 a month, but that is just crazy. we are healthy. host: ok, i thought your finish. julie rovner? guest: there is a catastrophic plan available. it is not part of the tier levels we were talking about. it started out, you had to be under 30 two qualified to although, last year, with all the problems and planes being canceled, they added a number of people who can get into that catastrophic plan. if you cannot afford plans there were a number of exceptions that allowed people to leak into that catastrophic plan. in general the regular plans are almost catastrophic plans.

-- the bronze plans are almost catastrophic plans. one thing that tends to happen for people who see dramatic premium increases, that may be because the plan on which their subsidies were based changed. it is entirely possible that there is another plan that might be closer to what they had that would be considerably less expensive. sounds like they did explore their options. guest: if you look around the country, we did an analysis and particular plans that were popular in 2014 for people who were new, some of them are facing an average increase close to 10% for the very popular plans from 2014 14. for the premiums. if you stay on the same plan, you're looking at a pretty big increase. if you are willing to switch plans and shop around, the increases are much lower. you can get something at a 3% or

4% increase, on average. in general, it is a real advantage to looking around. if you like your plan and want to keep it and are willing to pay more, by all means. but the way this is supposed to work is by having the plans compete on prices. there are people who lower prices, so there may be better deals. the department of health and human services estimates that more than 70% of people can get a better deal if they are willing to switch. host: what is going on with subsidies? how do they work in 2014 and what will happen in 2015? guest: subsidies are based on a person's income. they are also based on the price of the second least expensive silver plan in the market. if you buy that plan, you'll have to pay a certain percentage of your income to buy insurance. if you buy a cheaper plan, that you can pay a smaller amount. for more expensive plan, you have to pay more. it is pretty complicated. there are reasons to go back to

the marketplace, even if you are going to renew into your same plan. that allows you to recalculate what your income is, like if you got a raise or changed your job. as julie said, some of these lower-cost silver plans are shifting around of the market. that will affect where your subsidy is, and it is worth looking at that. host: julie, how does it work when you go online? how do you know that you're going to get a subsidy? guest: the good news for people who did not sign up for 2014 is that there is a much shorter application process. unfortunately for people who did the writing and signed up in 2014, they still have to go through sort of the longer form to re-up. but it is probably worth it because starting next april or whenever you do your income taxes next year, you'll have to reconcile the subsidies you got this year with the income taxes for next year. you could end up paying some -- it depends how close the

estimation was to your income and the subsidy hear it but if your income has changed, you do not want to be getting a subsidy that is too much or too little. you will be cheating yourself and will have to pay the government back at the end of the year. it is worth going back in, and yes, it is a little bit of a headache, but walk through it again. a lot of people had trouble at the front end. they forgot their password or their password does not work. that has been a little bit of an issue. the system is still new. host: yes, and after one full year of implementation, there are still some things to work out. that is our conversation with all of you this money joined by julie rovner correspondent with kaiser health news and margot sanger-katz, health care correspondent for the "new york times." we are taking your questions, comments, and concerns for the affordable care act. we will go to sally next in

michigan, and independent. caller: hi, i am totally opposed to this obamacare thing. it is all great, in theory. i would love it if everybody got good health care and everybody -- everything was pleasant. but he is robbing peter to pay paul, and it is doing terrible things to our liberty. it is another law. it is another law. the government has no business being there -- another law. that lady that called earlier -- i will not give them a credit card number. i will not give them an e-mail number. they will not be taking things out every month -- heck no. they're going to have to take a money order in the mail every month if i decide to allow them to force this law on me.

i am getting really upset about this. host: sounds like you are. caller: and the insurance companies -- oh, my gosh. what a legal mess. smoking is definitely going to become illegal. and then the sugar thing -- they will be in your houses and more. everything is going to become more illegal because you have got to be healthy. host: margot sanger-katz, can insurance companies put restrictions on what you can and cannot do if they're providing you health care insurance? guest: there are some rules that allow them to do that. if you smoke, you can be charged a higher premium. it is really the only category besides your age that can affect what you pay. employers, outside the exchanges, employer plans which is where a lot of americans get their health insurance, they are allowed to institute wellness programs. they will charge penalties or pay you bonuses depending on whether or not you comply with various rules. there is a lot of flexibility in

how employers can set those up. it is true to them if you do not exercise maybe or lose weight or meet some sort of standard, you may be charged a higher premium. host: tabak, florida, republican. you are enrolled debbie. what has been your experience? caller: i can tell you, i just used the plan the night before last. i was in the emergency room, and i had not paid my premium yet. when i signed up, i was told that i do not have to pay until the summer -- until december. i got the invoice in the mail that said if i did not paid by the 15th, my insurance was canceled. i called the nurse to ask if i was ok to go or if i should go to the hospital. i went and everything was fine. i was seen by a nurse's assistant. they gave me prescriptions for

medication. i went to the plan pharmacy walmart, and that is where it got really confusing. i was supposed to have a tiered plan were certain prescriptions, if they are generic, they can only be $10, you know, up to $25. first, they give me the bill. and i said, i do not think you applied my insurance. and she said, no, and sent me to another lady. the lady said you have not been active since 1999. i was like, i was just issued this insurance in november november 10, and i assure you it was not since 1999. then they send my coverage did not start until january 1. now i do not even know if my hospital stay was covered. on my invoice, when we talked about how premiums went up prior to this, i had insurance

and paid $185 a month, single and with obamacare, it was $384 a month. now i get my notice that because i do not pay november and december, which i was told i do not have to start paying until january, i do not even know if i can retroactively pay. it has gone up to $470 a month. i am going to have to let it go. i'm going to have to pay this month and try to pay retroactively for december and hope that they cover the hospital visit. then i am going to have to go on my own. i mean i am an independent contractor and do not make a lot of money. i get child support and try to supplement that with working as much as i can. host: what did you go to the emergency room for? caller: i have asthma and i thought it was either pneumonia

or bronchitis and likely, it was bronchitis. i needed a breathing treatment. i did not have any medication and was having trouble breathing. host: julie rovner, what do you make of her story? guest: a little bit confusing. generally through open enrollment, the plants do not start until january 1. i am not sure if there was a december 1 start. but if you have certain situations, you can sign up in the middle of the year like if you meet certain criteria like losing a job or getting married or diverse -- divorced. but during open enrollment, the plans start january 1. in general people have confusion with their insurance companies all the time. it is what it is people have them with medicare medicaid, and with private insurance companies. host: with her doctor visit, it turned out to be bronchitis to

the cdc this morning or yesterday announcing that the nation is at the epidemic threshold for the flu. is that typical of er visits? what does that mean for health care insurance? if you are going to the er for seasonal things like the flu how does that impact the industry, the providing of health care, and how does that factor into the affordable care act? guest: this is looking to be quite a bad flu season this year. i was looking at the statistics yesterday. the flu comes and goes. there are different strains each year. some years we get a really bad flu season and some years are mild. when there is a mild flu season, we take credit for maybe having taken better care of ourselves or for the vaccine being more widely distributed. but when you talk to the scientists, a lot has to do with the actual flu virus.

this year, it is pretty bad. the flu can be quite a serious illness, especially if you are in a vulnerable population, older people and children. it is not uncommon for people to require hospitalization as a result of the flu. in general, things like asthma aggravation, it is thought that if you are getting really good care from your primary care doctor and you are taking the right medications and doing what you should do for your health, you should not have to go to the emergence room very often for things like asthma. but if you have asthma and get the flu, it would not be uncommon that you might need to seek hospital care. it is an unfortunate thing that we have this disease that comes around every year and can be very serious. guest: one of the ways that the health system has changed over the last, not just decade, but the last two truck or three years is the emergence of the urgent care clinics and the minute clinics. their primary care clinics just

about everywhere. it is a place to go for people with the flu. the caller that just called in, she has asthma, a respiratory problem, so she should go to the yard. that is what the er is for. but if it is just a garden-variety, you feel terrible, they do not want you cluttering up your doctors office and giving everybody off the flu. urgent care clinics were created for that sort of thing. there are medications for the flu and if you take them early on, you can reduce the severity of it. it is good to see a medical professional. these are sort of places that are less expensive, a more appropriate level of care than going to an emergency room. emergency rooms often get so many people with the flu in the

winter months. that happens every year. host: san mateo california, mary democratic caller. caller: i'm 65 and on medicare now. i just turned 65 last year. i do have supplementary plans. i have glaucoma and i also have a syndrome where you do not have enough moisture in your eye and you also do not have enough saliva. so i have two sets of eyedrops i have to use, and only one of them was available through any plan i could find. the other one -- i am also a veteran, so i did have some help from the veterans administration. i get one of the eyedrops from the v.a., and i get the other drops from the health care that i pay for. the second problem i have is it

is a multiple sclerosis-type nerve damage that has caused nerve old the rock that these and i take medications for that and have been for 20 years. with the affordable care act has done is they limit the number of pills that you can take. they do not care about the dosage. they care about the number of pills. you can have 180 pills no matter what the dosage, and that is all that is paid for. after that, you pay for them. last year, even with medicare and with the two health plans that i pay for and with the veterans administration, i paid 29% of my income on drugs. host: margot sanger-katz? have you heard this, that there is a restriction on the amount of pills?

guest: i am not familiar with that restriction. it seems plausible to me. the benefits are administered through these programs, and it is similar to the insurance exchanges set up by the affordable care act. seniors engadget's marketplaces and choose from the stiffer private plans. each of them covered every kinds of drugs and they have different structures in terms of how much you pay out of pocket. overall, seniors are pretty satisfied the cause they have been enabled to get prescription drugs more affordably than before, but there are certainly limitations and a lot of rules. it may be that someone with complex health needs may need to shop each year and make sure that the particular drug plan they have chosen is appropriate for their needs. host: john from florida, and independent. caller: how about religious beliefs -- will this be on your income tax return about why you

do not have my health insurance and religious beliefs? guest: there is a religious exception purity cannot be, you know, i belong to a church and my car needs extensive repairs. but there is something called religious sharing ministry. people basically come together and give money to pay for a group's medical expenses. that started before the affordable care act. that is an allowable exception. there are some religions that do not believe in traditional medicine, and they are exempt. but that is not sort of an open -- you cannot just say that my religion does not believe in this. you have to follow that up if you want to claim that exemption. host: what recourse is there if

millions do not pay the fine? guest: the recourse that they have -- all the people that say you can be put in jail, you cannot be put in jail. they can basically attach your income tax refund -- that is the main thing. they're not going to come after you for anything more than that. you could the radically game the system by changing -- you could theoretically in the system by saying you do not have a refund and then not having health insurance, and then there is nothing they could do it but if you had a refund the next year, they could attach it the next year. the most you'll get for punishment is they will withhold what you are owed in a refund. theoretically, they are not allowed to buy insurance on the exchanges at all, you must be in the u.s. legally. host: another tweet -- why not

just lie about your income? debbie from arkansas democratic caller. caller: i just called in yesterday and canceled my silver plan. i could afford it when i first got it. then they wanted to start charging me, like, $88 a month $40 per prescription that is non-generic. the problem is, i am asthmatic and have diabetes, and everything i have is not on the plan. so i would be paying like, $380 a month for my medicine and $50 to see my specialist and $25 to see my doctors, and i do not make that much. i told them that there is no way i can afford this. host: margot sanger-katz? guest: this is a good example of a person who should go back to the online marketplace and look

at other options. it sounds like the particular plan she chose for 2014 is changing and does not meet her needs anymore, but there might be another plant that does not charge such high copayments for the drugs she needs or the visits she needs or may have a lower premium. the news organization propublica as a really useful tool that compares how much you have to pay for java kind of drugs and doctors visits. it is a really easy tool on their website, propublica.org and you can compare the plans. that might be a first step for her. then she can go back to the exchange and see if she can find coming affordable. host: we are talking about the affordable care act, dedicating the whole show this morning to it, after the first full year of implementation of this law. julie rovner is in your correspondent with kaiser health news. margot sanger-katz covers health

care for the "new york times." i want to show our viewers this tweet from a representative -- for 13 million americans, $65 billion in tax credit are at risk in and political attempt to undermine aca in court. when is this going to be brought up? guest: on march 4, the supreme court will hear this case. that was a surprise. everybody expected it would probably go to next term. there was not a split in the circuit yet. the appeals courts were not yet in disagreement on this. it is a very arcane case if you will. it hangs on wording in the affordable care act and where subsidies will be available. there are a couple places in the law where it says tax credits will only feel ball -- available

in an exchange established by the state. the question is, does congress really mean that only state-run exchanges could provide subsidies or did they assume that subsidies would be available everywhere? it is pretty clear from the rest of the law that they assume subsidies would be available in all 50 states. even if the states do not establish their own exchange then the federal government well. we were talking about this with medicare part d. that is with the federal government did. it created a fallback. is that if there were not enough plans, the federal government would do it, but there were plenty. other never have been sort of the federal government needing to step in. in this case, the federal government did need to step in. it is now running the exchanges for the 37 states but what people pushing the case are arguing is those subsidies being provided in those 37 states are illegal, therefore, people should not be getting them. the case will be heard at the supreme court on march 4.

a decision is expected in late june. people expect that this will be the last case that the supreme court decides. it is the most controversial. host: any indications on the decision? guest: there was concern that because the supreme court did not have to take it but it did, it takes at least four votes to accept the case, so there are at least four votes and one would assume that there are four justices that think the court needs to decide this sooner rather than later and publicly because they think this is illegal. the question is, is there a fifth vote to make a majority? it would create all manner of chaos, not just for the people who might lose their subsidies, but for the entire individual market in those 37 states. because all of these at it people would not be a what to afford their insurance. the healthier people would drop their insurance. the sicker people would keep it. suddenly, your market is only full of sick people. premiums would go up

dramatically. we would have a spiral where the hell is people drop out to the sickest people stay in. becomes a really big mess host: quickly. -- host: there are lawsuits about the affordable care act. are they going anywhere? guest: many say it is illegal because it is a tax law that started in the senate. they took a bill and stripped out all of the text and then inserted the health law. that happens pretty much every day. if that were the case, an awful lot of tax-related laws would be illegal. that one seems pretty unlikely to go anywhere. there is also the continuing fallout from the hobby lobby case from last year, the case about religious freedom. last year's case decided for-profit organizations

they're so concerned about what will happen to the religious organizations that are not exempt cover religious colleges and universities, in particular, and hospitals, and what they are obligations are for making sure that contraception is provided. at this point, they do not have to provide it, but they are supposed to report to the government who their insurer is so that the government can arrange for it to be provided. that is making its way to the court speared that probably will not be heard until next term. host: other new provisions of the affordable care act in 2015 that take -- they go into affect -- this losses physician payments are tied to quality of care they provide. employers who employed a certain number of employees will need to provide a minimum level of insurance coverage to full-time employees. the penalties of not having insurance, they go up in 2015. margot sanger-katz, from that list, what are you watching for in 2015?

guest: the employer mandate is a pretty big change, something that was supposed to happen last year. it was postponed a couple of times because, i think partially for political reasons, but it turned out to be pretty tricky to implement. for it to work, the government has to know who is employed by various committees and whether they are getting insurance and how many hours a week they are working. if you are a business with more than a certain number of employees and you have workers who are full-time, anyone who works more than 30 hours a week needs to be provided with a minimum level of health insurance or you have to pay a penalty. there is a lot of administrative behind-the-scenes things to happen before that goes into effect. it was considered an important part of the law, because most americans who are working age get their insurance through work. i think there was a concern that if there was no requirement that employers provide insurance to their workers that maybe they would drop them and everyone

would have to get their coverage through medicaid or the exchanges. seeing how this plays out will be interesting. seeing how the government does it in the behind-the-scenes parts of it, but also what it means for employers. most employers do provide insurance to their workers, but there are employers, particularly in certain kind of low-wage sectors where providing health insurance will be a financial hardship for them, and the ways they decide to comply will be interesting to watch. guest: one of the ironies is that if the supreme court were to rule that subsidies were not allowed in the exchange run by the federal government, it would actually also make the employer mandate unenforceable, because the way the employer mandate is enforced is only if you do not offer coverage and someone who you employed goes to the exchange gets coverage and gets a subsidy. if there are no subsidies, there is no enforcement for the employer mandate. it would take away the individual subsidy, but it would

take away the enforcement powers for the employer mandate. guest: the supreme court takes this up on march 4. a decision is expected in june. host: alexander in miami, florida, an independent. caller: the problem i have is i applied for the affordable health care the first year, and they told me i was not qualified, i did not qualify like, last year. that only i did not qualify and they would give me an exception for the whole year. my girlfriend applied to choose a very low income, only makes light $800 to $1000 a month. they dropped her off medicaid. he said she had to apply through healthcare.gov. she applied, and i do not know why they denied her subsidies. she has four kids, and they're

trying to make her pay up to $250 a month. there are still all the bills to be paid. i do not understand, why is that like that? host: why didn't she try medicaid? caller: she tried and they dropped her off medicaid. they told her to apply it healthcare.gov. and she is only making $800 a month and you have to pay $250, so you're better off just paying the one-time payment of the penalty. just be without insurance for the rest of the year. host: ok. julie rovner? guest: florida is one of the states that do not expand medicaid. because she is a parent, she is eligible but a lot of those eligibility levels, particularly in the south for parents -- i think in louisiana, it was 15%

of poverty, you had to earn less than that to qualify for medicaid as a parent adult. as a non-parent adult, you are not eligible at all. so you're generally not eligible for medicaid. so she may be in that gap. it sounds like she earns enough. but if she earns enough to make it to the exchange, then she should get a subsidy. she may be in the gap and they're trying to get her insurance, but she does not earn enough for subsidy. her kids should be covered by, if not medicaid, then chip. host: pennsylvania, democratic caller. caller: good morning. i have a thing i would like you to write down, to ask all the congressmen you have on the show, ask them what they're going to do about the pre-existing conditions that are allowed in the medicare supplement insurance program.

they can deny you coverage because of pre-existing conditions. let me verify this -- the affordable care act did wave pre-existing conditions. that is the law, and it is a criminal offense to do that. but there is a provision in the affordable care act that allows the insurance companies to keep doing this the cause -- keep doing this because it was drawn up in the law. all these insurance companies with medicare can deny you with pre-existing conditions, and they have the right to ask you -- there are about 20 questions they can ask you that have to do with pre-existing conditions. they can verify and accept you or deny you because of pre-existing conditions. host: turn off your tv so you can hear the answer. margot sanger-katz? guest: i actually do not know about these enough.

guest: i know about this one. there is an open enrollment for medicare supplements. when you first become eligible for medicare then they cannot deny you for pre-existing conditions. if you try to buy a supplement later, if you have something else then they can. this was a big issue when they redid the medicare supplement market in the 1990's. there are some issues that one of the big problems is that people leave traditional medicare, go to medicare advantaged and then want to go back to traditional medicare, and they may not be about get their supplement that has they can deny you for pre-existing conditions. there have been issues with this on and off over the years. there are issues with people who have disabilities and people under 65 on medicare. when you first do medicare there is an open enrollment, the way there is an open enrollment in the affordable care act, we

can buy any medicare supplement and they cannot deny you. host: julie rovner did write a book about health care politics. john in 20 legs, wisconsin independent caller. caller: good morning, thank you for c-span. i have a couple quick comments and then a question. in 2012, me and my wife lost our jobs. she got a job for $10 an hour. one of our daughters has a pre-existing condition. insurance was about $650 on the market without obamacare. but in december, we applied for obamacare and got it for $100 a month. well, that worked out good for us. my mother, she is caught in the gap between 60 and 65, and she cannot even get health insurance with diabetes. we sent her on to one of the places where the people help you get the insurance, and they set her up and she has been happy as

pie. she gets everything she needs beer like case, in march, i got a job -- she gets everything she needs. my case, in march, i got a job. i called aca and canceled my insurance when my company insurance kicked in. come to find, we're very busy people -- they kept charging my bank account for the insurance and i did not get it canceled until october. i am wondering, is that going to be a penalty or a problem for me when i go to do my taxes this year? guest: guest: situations like this happens. insurance companies want automatic payments. i don't think it will go into taxes, but think you will have to do some fighting. host: democratic caller enrolled in exchange. go ahead.

caller: happy new year to all you people on the east coast. we are the siberia of america. i will not make any more jokes. i wanted to say __ i'm lucky, i do not make a lot of money, i'm 64. this goes directly to a person from florida, three call to go. minnesota participated in the medicare __ whatever. therefore, i paid $21 a month. my income is just under $16,000 per year. obviously, not a lot of money and year. but, i __ i get a nice subsidy. $21 per month is my premium. luckily, i'm pretty healthy.

i do not need to see a doctor besides two or three minor things. obamacare has worked for me, i guess. i want quick suggestion for a possible topic i have one quick suggestion for a possible topic and that is the complexity of deciding on medicare. in a year i have to decide what to do about medicare a, medicare b, c and d and medicare advantage and i've heard advantage plans are dangerous to get into, that they can deny all kinds of benefits. there was a "60 minutes" exposé on this and medicare, you can get in trouble so maybe that could be a nice show to have. host: all right, tom. guest: medicare is very complicated. people have come to me a lot with questions on medicare. sounds like he has exchange coverage, not medicare coverage and he'll be eligible for medicare soon. those are the people who i think

have the most to gain from the affordable care act, those and people with pre-existing conditions who couldn't get coverage at all, are the pre-medicare people for whom insurance was prohibitively expensive. insurance is still very expensive and more expensive for people who are older and is actually more expensive for people who are younger because they're subsidizing the people who are older but at least it's now affordable for people in that pre-medicare age group many of whom have retired earlier and don't have other access to health insurance. host: the caller saying this is the first time he's had insurance for years. this tweet -- recent tweet by the congressman. margot sanger-katz, who is signing up? who's getting insurance for the first time? >> it's a lot of low income people. we did a great analysis in our

innovation club that looked at the demographic characteristics of who the new insured were and we found it's really the groups that are most disadvantaged in our economy experiencing the greatest gains in insurance so people with low incomes, african americans and hispanics are signing up at higher rates than whites. women are getting insurance at higher rates than men. people who live in rural areas are getting insurance at higher rates than people who live in metropolitan areas and all of these areas are showing who didn't have insurance before, who were shut out of the old system but it also shows in large part the power of the medicaid expansion. julie talked about what's happened because some states have not expanded medicaid and lowest income people in those states have not been able to get insurance and we found a huge disparity between the states that expanded and states that

didn't in terms of who got insurance. if you were a low income person in minnesota, you were likely to get insurance but if you were in florida, your options were more limited. >> in the piece you did, you break down by race, as well. you were talking about the hispanic uninsurance rate, 26% dropped to 16%. for african americans, 24% drops to 16%, as well. you can see more whites more asians with health insurance but that's going down, as well. guest: almost every group saw reductions in the rate of uninsurance. if you didn't have insurance there were new options but certainly the groups most disadvantaged going into the experience were the ones that saw the most substantial gains and starting to catch up. host: to cornelia in idaho republican. cawmpt i would like to make a couple of comments, and maybe a

couple of questions. basically, i believe that our entire medical system in america is broken and obamacare is not helping it. it's making it worse. we need, from the bottom up, things like health savings plans and so on like dr. ben carson has suggested. and our pharmaceutical companies for cahoots with the f.d.a. and talk about a military industrial complex, we have a pharmaceutical industrial complex that is running our medical system in america. host: ok. julie rovner? >> pharmaceutical companies are making -- if you look at who's got the biggest profit margins. the pharmaceutical companies and medical device companies have the biggest profit margins but to go to the broader issue there are many people unhappy with the functioning of the healthcare system. the affordable care act was not

ever intended to fix everything that was wrong with the healthcare system. it was intended to make a start. mostly focused on coverage secondary focus on sort of cost and starting to give a push to a system that was starting to change itself anyway. there are still a lot of people who would like to go far off in one direction or far into another direction. if you look at the difficulty congress had and the country had passing just the affordable care act, it's hard to imagine doing something that would more dramatically reshape the system. the system is on a path to reshaping itself. it's hard to know whether that's going to be better or worse or how much people will like it. host: this is a story that was -- i want to show our viewers, tweeted out by congressman tim huls camp, a republican. there's an obamacare rule change that could mean government re-enrolls you in obama choosing your plan, doctor and coverage. can you tell us more about this?

guest: this shows the complexity and difficult choices regulators will need to make in deciding how to implement the law. right now you sign up for a plan in a given year and you take no action, you don't go back and shop around, you don't update your income information. what the government does is they automatically re-enroll you in that plan and obviously if you don't want to stay, you can cancel but the goal is to keep people continuously insured but as we discussed, what we found this year is that the plans that were really popular in the first year are experiencing some of the highest increases in premiums so if you're automatically re-enrolled in the same plan, you may face a really big battle so the government has proposed giving people a choice, when you sign up first time, you can say if i do nothing i want the default to be i stay in the same plan or if i do nothing, i would prefer to be switched into

a cheaper plan so for people who get that choice, they may end up with a completely different insurance plan that may or may not cover the doctors and drugs they had before. they won't have control over -- it will be an automatic process but i think it's important to note that even if the government goes through with this plan first of all, people will have a choice about which default option exists so if you want to stay in the same plan you wouldn't choose that and also everyone every year has the option to go during open enrollment and shop for the plan best for them. this would only apply for people who took no action and all of the evidence suggests that people are better off going back and doing that kind of hard and sometimes tedious work of shopping for the right plan because the premiums are changing and other parts of the plans are changing, too, and people need to go see what's best for them. host: aunt -- and the people auto enrolled into plans can still change until february 15. they'll get a letter that says,

you've been re-enrolled into your plan or a plan similar to what you had, no matter what, unless everything looks the same but you should make sure maybe that the premium is the same but as margot said, how much you pay for drugs may have changed or your doctor may not be in the plan. so it's always good to look and you may want for reasons other than premiums to go in and change so no matter what, it's good to go in and look at the plan that you're in and you have until, if you're in it now and you've been re-enrolled, you have until february 15 to change to another plant. >> guest: it's also important to say that the plan to change the switching mechanism is not final. they're asking for comments on it now. host: bob is independent in warrentown, west virginia. caller: good morning. merry christmas to you all. i want your opinion on my

opinion. i called in several months ago and made the same point but it seems that in this country anymore we've forgotten what it's like to be a society. the gentleman that called in earlier and was talking about he was paying for reconstructive surgery and such as that, appears to forget that individually i can't build a road or a water sewage system and that sort of thing individually but as a society we can. and i don't have any children but i don't mind paying my taxes towards the education of other people's children and it just seems like we've forgotten what it's like to be a society and i'd like your opinion on that. host: julie rovner? guest: this is the concept of insurance. if you think about fire insurance or car insurance bad things only happen to a few people. if everybody pays in a little bit, you can afford to pay for the big amounts for the few people bad things happen to. in healthcare, one of the problems is that everybody needs

some and that's why it's so expensive. it's very few people who don't ever go to the doctor and eventually everybody's going to need healthcare and healthcare is expensive and that's become the problem with health insurance but that was certainly the idea that having one of the big problems before the affordable care act is with so many people outside the system, there were not enough people inside the system to spread the costs over and what's more people outside the system were getting care and people inside the system were paying for the people outside the system so why not bring as many of the people outside the system in, have them pay something and spread the insurance pool. that's basically the a.c. nampt a nutshell. guest:what has happened to costs of healthcare in this country since the affordable care act? guest: one of the goals was to lower the cost of healthcare or slow down increases. everyone who pays a health

insurance premium knows that things go up. that's a problem for the economy and the federal budget because the federal government pays for medicare and that's getting more and more expensive and it's a problem for people's paychecks because if their premium guess up or deductible goes up every year that's a real hit especially without wages rising. so the idea was to slow down the growth in healthcare costs and wonderfully that has been happening and it's been happening all the way back to 2002, sort of the peak growth. we now have years of data that shows we're in an unprecedented period of slowdown in healthcare costs but i think it's possible that the affordable care act is making some contribution around the edges but i think it's more of a coincidence. there are other factors that health economists think explain what we're experiencing right

now but there is a hope among those who support the law that some of the things in the law can sustain that trend and it's a really important trend, something that the country really needs to get a handle on healthcare costs. we hope that it will persist. host: let's talk about the politics of it a little bit. a tweet from marcia blackburn. julie rovner, what's in store when they return in january? guest: budget reconciliation is hardly obscure. really? arcane maybe, obscure, no. it is a piece of the budget process, the way the budget process works is that each house of congress passes a budget resolution they get together come up with one resolution between the two houses and one of the things that budget

resolution has many years but not all years are what's called reconciliation instructions that require the tax writing committees or any committees that control mandatory spending to reconcile that spending to the budget. that's all reconciliation is. it has been used in previous years to do a lot of things that have to do with healthcare with medicare, with medicaid. obviously with the tax code, those are the big mandatory programs. one of the nice things in the senate from their point of view is that it can't be filibustered and you only need 51 votes to get it. host: is it a mandate? does it go anywhere in the reconciliation? guest: reconciliation is not a must-pass bill the way spending bills are must-pass bills in that if the spending bills are not passed, the government shuts down. if the reconcileeration bills didn't get passed, the government doesn't shut down. the first year i was covering congress they were finishing

the reconciliation bill from the year before. sometimes it can take them a long time to get their act together. it's just a way to change the rules for mandatory spending program but the important thing is that you don't need a super majority in the senate and it can't be filibustered. they're saying since the affordable care act was passed using the reconciliation process, they can unpass it using the reconciliation process. there are two problems with that, one is that the act was not really passed with the reconciliation process. the senate lost its 60th vote during the consideration of the bill. when they passed the bill, christmas eve 2009, they had 60 votes and senator scott brown was elected in massachusetts and only had 59 so they basically used reconciliation bill as a way to do a conference report so there are a lot of things in the reconciliation bill that were not in the main law and could not be in the reconciliation bill because reconciliation must

be budget related so i don't think even if they wanted to, they could cause a lot of problems for the law but they couldn't repeal the law. the other thing is, even if they can get it through the house and the senate, the president said this week that he would veto anything that would undo the house law so i think the republicans have some items that they might want to tinker around with but using reconciliation to do sort of full-scale assault seems unlikely. host: incoming chairman of the budget committee, tom price republican of georgia, was our guest recently and we asked him about the press process and what he planned for it. you can watch the whole thing on our website, c-span.org saying he wants the conference to decide and the lawmakers will be getting together for the annual retreat and he will listen to his colleagues in deciding then. guest: i think one of the biggest issues about what republicans want to do with the affordable care act is they have this big dilemma. if they take apart just the most

controversial and unpopular things, that could make the law more popular and they don't really want to do that so the things they could pass things like eliminating the medical device tax, that the medical device industry has been very much against and there is democratic support for, they don't want to maybe end up having a law that is more pol -- pal atable or fixed and they know they can't repeal the whole thing while obama is in office. host: miles calling a republican. go ahead. caller: i was wondering. i'm a republican but since i have been watching obama in office our economy was really, really on the brink of going off a cliff and now all of a sudden our economy is doing better and there's more people getting health coverage. we're a party, we were a party

of family, morals and values. what has happened to our society when we will not even want to take care of the poor, the kids, the family mothers and kids? there's something wrong here. host: part of the consumer spending we saw recently, the numbers go up, consumer confidence, is driven by people spending on healthcare. guest: healthcare is a big part of our economy. i think in some ways it's part of the reason why the law has been so controversial. healthcare is just so huge. it's not a small thing on the margin. it's a lot of dollars that everyone spends, that the government spends. it really matters for the overall health of the economy and also matters in our political system because it's a very big part of what the government spends money on. host: congressman tweeting this out, that a new cbs poll shows that the number of americans who say healthcare is personally unaffordable skyrocketing under

obamacare. julie rovner? guest: that is not true. there was a recent gallup poll -- gallup polls every year and they asked people about whether the amount of money you're spending is affordable for healthcare and they found no change over the last few years. there are people who find it's unaffordable but it's not changing dramatically. host: in chicago democratic caller. hi jerry. caller: a couple of calls ago about medicare. i'm a senior and i have medicare but i have an advantage-plus plan through humana, ok, and i don't need a supplemental plan but i guess it's according to the state you're in. it's like an $8 -- minimum drug coverage through what i have

medicare. and i just want to know to tell people if you have medicare and go to another plan do not cancel medicare b because you're going to need that. secondly, i'm also a tax adviser with a reputable tax firm and last year we informed all our class about the mandate and next week we'll be in the office calling my class up and for all those who have shopped in the marketplace to remind them to bring in their 1095-a form so they can determine whether they'll get the -- i'm glad you ladies are on here to explain all this to the caller and the country because it's very important and thirdly for a country like we are, it's very hard to have insurance for everybody because it's on free enterprise but something that can be done and i wish people wouldn't be so hard on the president, and help the misfortunate because everybody's not a dead beat in the country.

host: joan next in rockville maryland independent. caller: hi, good morning. my husband and i went for an annual preventive exam for medicare in december and i was expecting to get blood work and the kind of exam that former president george w. bush had where they did a lot of testing and they found he had a narrow artery and had to have a stent put in and now he's just fine so we were given this sheet of paper to our medicare patients. the annual wellness visit is not the same thing as what many people commonly refer to as their yearly physical exam. medicare does not cover the yearly physical exam. medicare is specific about what it includes in the annual wellness visit and by the way this is from johns hopkins community physicians. what is included -- talking about your medical history and risk factors with your doctor.

how do i know them if i'm not testing. measuring your weight, height, body mass index and blood pressure and making a personalized health plan to keep you happy and healthy -- based on what? this was, to me, a joke. medicare is going to go bust, according to the statistics i've read in 2026. are we going to be put into the exchanges? what is the plan? and there's also a bipartisan agreement that the itab, which your experts with discuss, the independent payment advisory board, which is a rationing plan non-physicians will be making plans on what you can have and can't have. host: julie rovner? guest: start with the last one the ipaw, doesn't exist yet, and

is very controversial and doesn't exist because the senate would be unlikely to approve nominees but was created to find ways to reduce medicare spending if it exceeds a certain threshold but we were talking about how healthcare is growing at a historically low rate and medicare is leading that historically low growth so nothing is on the horizon to trigger the ipab but they said they would not recommend rationing care. they'll have to find other ways to reduce medicare spending so there's a standoff but it's not being triggered. if i could talk about medicare advantage because something the caller was saying is something people should know. if you want to go into a medicare advantage plan, basically a plan that -- private plan that takes over for medicare, you have to continue

to pay your medicare part b premium because that's what basically pays for your private plan but i misspoke. if you leave that plan, go back to traditional medicare, you can't get a medigap plan without pre-existing condition exclusions. only for some plans if you drop your supplement, going back to medicare advantage, come back to traditional coverage want a supplement you may not be able to get back the one you had. host: david, a republican. caller: good morning. i was listening to the last caller. are you saying that if you have a pre-existing condition you can't get a plan? host: i don't think we said that. margot talk about this. guest: the law says if you go to the marketplace and you want to buy health insurance, can you get it and the price will only be based on your age where you live and what your income is.

the old days where health insurers could say to you sorry, you have diabetes, no health insurance for you or they would say you can have it but you have to pay two or three times as much as a healthy person, those days are over. everyone can get health insurance based on those factors. host: we were talking about medicare supplement plans. to carey in south carolina, democratic caller. caller: my husband had health insurance. he lost his health insurance through his employer because the employer couldn't afford it anymore. so we said ok. my husband is diabetic. but we cannot afford the affordable care act because of what we make because we work a lot. i work 60-plus hours a week. my husband works 50. we have four children. three in college one in high school. and because of what we make on

paper our health insurance would be almost $1500 a month and that only leads two of our children because the other two claim themselves so that is double my mortgage and so we are going to take the penalty. we have to take the penalty. it's just ridiculous. and the fact that my husband now has no health insurance which we had blue cross-blue shield, he is now off his diabetes medicine because we could not afford them because without health insurance we couldn't afford them at all. they were hundreds and hundreds of dollars and believe it or not, he's doing better than when he was on medication. host: julie rovner? guest: i'm sorry for your situation. i assume you've gone and tried to get someone to walk through with you and make sure that's the least expensive insurance you can afford.

host: where would he go to do that? do you call? healthcare do.gov? guest: on healthcare.gov there is a place, if you want local help, there are people who can assist you to walk through your options. these people are trained and sometimes they're much better at parsing out where you might do the best, particularly if you have one family member with a pre-existing condition something expensive and you want to make sure you get a doctor or particular drug and help you work that all out. host: we have a few minutes left. go ahead, margot. guest: this highlights an interesting group of people who benefit the least in this law which is people whose incomes are high enough that they're not eligible for a subsidy but they're not so rich that they necessarily can afford $10 or $15,000 a year for health insurance. most people who didn't have health insurance before the law was in effect were those on the lower end of the income scale

and i think the law is designed to make health insurance affordable for them but for people like this caller where maybe their family earned in the neighborhood of 100,000 a year but they have a mortgage and college tuition, it may be a stretch. host: how many people are this in that situation, do we know? where affordability is a stretch? guest: percentage-wise those are the smallest percent of those without insurance. the number of people in that income threshold but can't afford insurance is fairly low. it's probably people living in very expensive areas or people with kids in college or people who have other expenses. that's the most liable. guest: i spoke with one family in new york city and they said our cost of living is high our rent is high, we have a child in college and the full cost of this premium is out of reach for

us. i think this is not a big problem, there are not a lot of people in this situation but for people in that situation i think this law can make it hard to buy insurance. guest: and the numbers they have to pay per month sounds like a lot. when you hear from those people. we'll go on to brian in northville, michigan. independent caller. hi, brian. caller: hi, how you doing? my question is, i'm in between jobs right now and my girlfriend has medicare because she's on disability for medical reasons and but i can't afford it because i'm in between jobs and it just seems like -- like this fee and everything, like the penalty, is more like just getting money, more from the poor people than it is to help anything. just like another tax.

because i would like to be able to afford medicare, health insurance, because i have issues, too, and i need to see a doctor but i can't afford $300 a month, if i could do that i'd be making payments on a new car or something. host: that's our last phone call for the two of you. i want to end by asking you what are you watching for next with the affordable care act as we head into 2015? guest: i want to see how this enrollment period winds up and what the republicans decide to do about their political issues, whether they want to make a show of opposing the whole law or try to address pieces of it. host: margot? guest: a lot more people are getting health insurance but we done don't know much about the experience without insurance when they can get the care they want and i think that's important for the future and

i'll watch what does it mean for people's budgets and financial health? are more people going into bankruptcy because of healthcare in the way they have in the past or will it provide people with a financial cushion. that's the hope we need to measure and see. host: you can follow her on twitter. margot rights for "the new york times." she has a column. you can find her on nytimes.com and on twitter. thank you both. i appreciate you spending time with us. >> on the next "washington journal," looking ahead to the 114th congress and the new republican majority, the largest gop majority since 1928.

then, more about the new congress discussing the liberal and progressive agendas. plus your phone calls, facebook comments, and tweets. >> coming up on c-span, the un security council meeting on a resolution regarding is really-palestinian issues. then, the state of the nhl. later, a discussion on privately funded spaceflights. wednesday night we remember celebrities who died in 2014 including robin williams, maya angelou, and others. >> this sunday on "q&a," the

president and ceo of the national council -- on immigration reform enter compelling personal story. >> i have had the great privilege of experiencing the american dream here in this country. both in kansas -- my parents actually came to this country in the very early 50's. my parents came from mexico. very little education. my dad had an eighth grade education and my mother a fifth. yet they believed in the promise of this country and they were seeking better opportunities for their children. they worked really hard and sacrificed.

so many latinos and hispanics have done this, because they wanted that better future for their children and believed in the promise of this country. they taught us important values that has been our guide for our lives, my six brothers and sisters. they taught us the importance of family, of faith, of community hard work, sacrifice honesty integrity. all of those were important values. >> sunday night at 8:00 eastern and pacific on "q&a." >> the un security council failed to adopt a resolution tuesday calling for israel to withdraw from palestinian territory. of the 15 member council's, eight members voted for the resolution well the u.s. and australia voted against. five abstained.

next, remarks from representatives of member countries. this is an hour and 15 minutes. >> the security council is called to order. the agenda for this meeting is the situation in the middle east including the palestinian question. the agenda is adopted.

my wish to warmly welcome the minister present and the security council chamber. your participation minister, in this meeting, is an affirmation of the importance of the subject matter under discussion. in accordance with rule 37, i invite the representative of israel to participate in this meeting. it is so decided. i propose, pursuant to -- i propose that the council invite the permanent observer of the observer state of palestine to the united nations to participate in this meeting in accordance with the provisional role and the previous practice.

there being no objection, it is so decided. the security council will now begin its consideration of agenda item two. members have before them document s-2014-916, the text of the draft resolution some more submitted by jordan. the council is ready to proceed to the vote on the draft resolution before it. i shall put the draft resolution to the vote now. well those in favor of the draft resolution contained in s-2014-

916 please raise their hand? those against? abstentions? the result of the voting is as follows. eight votes in favor two votes against, five abstentions. the draft resolution has not been adopted, owing to the lack

of the required -- having failed to acquire the number of votes. i now give the floor to the members of the council who wish to make statements. i give the floor to the representative of jordan. >> thank you, mr. president. thank you very much for holding this emergency meeting of the security council. jordan has submitted on behalf of the arab group the draft of this special arab resolution, setting a deadline for ending the israeli occupation and establishment of the palestinian state. thus implementing the resolution of the league of arab states at the ministerial level. it is our believe that the security council must respond to the legitimate human rights of

freedom and dignity in its independent, fully sovereign viable state within the lines of the 4 of june, and security within secure borders with all states in the region, according to be accepted preferences in this matter, including the various resolutions of this council, including resolutions 242-338-392. jordan has preceded in this process in the security council guidance by the arab consensus. in support primarily of the political decision of the palestinian leadership, represented by president mahmoud abbas.

the palestinian cause and all the rights of the palestinians in the security council and all other international forums because jordan has an interest in resolving this matter and realizing the interests. we had hoped that the security council will adopt the arab resolution because the council there is both the legal and moral responsibilities to resolve the palestinian conflict, which is the crux of the conflict in the middle east. all elements in that draft resolution were acceptable, not only to members of the security council but to the international community as a whole. these elements include the right of the palestinian people to self-determination that ends the

occupation of palestinian territory. the question of refugees leads to establishing a truce in the capital of the palestinian state. fact that this resolution was not adopted will not at all prevent us from proceeding to push the international community, specifically the united nations, to ward involvement in resolution of this conflict. we will continue to resume peace negotiations between the palestinians and israelis. we maintain a committed framework leading to an embodiment of the two states solution within a reasonable time right and toward ending the conflict resulting in all substantial issues, namely, jerusalem refugees, security borders and orders, according to

the acceptable international references and the arab peace initiative and in a manner that is completely addresses and protects the vital interests. the jordanian position on this is very well known and we have submitted this draft resolution without prejudice to our legal positions and without it being interpreted in any way as a change in our position. this draft arab resolution and the fact that we submit it cannot be interpreted as anyway as a unilateral step. it is a legitimate right of the palestinian people that have opted for the path of peace and has been submitted to the united nations as a final solution as israel has blocked all roads leading towards its aspirations.

settlement activities and the adoption of discriminatory laws such as the nationality law in addition to other illegal practices in the occupied palestinian territories which take us away from peace and threaten the future of a two state solution. the international community must address the severity of the occupied palestinian territory. are palestinian brothers in the gaza strip as a result of the most recent war must realize the situation cannot continue and we will push toward -- and will push toward further cycles of violence. the result of our decision here must not prevent us from intensifying our efforts through

consultations, negotiations, and discussions in order to achieve a just and comprehensive solution of the palestinian question leading to the establishment of a continuous viable independent sovereign palestinian state within the two state solution in a manner that the tech for -- that protects the peace for everyone. they must continue our efforts until we achieve that objective. thank you, mr. president. >> i think the representative of jordan for statement. i give the floor to the representative of the united states. >> thank you, mr. president. in recent years, no government has invested more in the effort to achieve israeli-palestinian peace in the united states. peace, however difficult it may be to forge, is too important to give up on.

as we were reminded this summer in gaza and as we have been reminded to painfully in jerusalem and the west bank -- the human consequences of cycles of violence are two great -- are toog great. we search for ways to support the parties in making progress toward a negotiated settlement. the security council resolution put before us today is not one of those constructive steps. that would undermine efforts to give back -- to get back to a netlist that makes it possible to achieved two states. instead of giving voice to the aspirations of israelis and palestinians this addresses the concerns of only one side. it is deeply imbalanced and contains many elements that are not conducive to negotiations between the parties including unconstructive deadlines that take no account of israel's

legitimate security concerns. in addition, this was put to a vote without the discussion or due consideration among councilmembers, which is highly unusual, especially considering the gravity of the matter at hand. we must proceed responsibly not take actions that would risk a downward spiral. the voting against this this resolution not because we are uncomfortable with the status quote. -- status quo. peace will come from hard choices and compromises and must be made at the negotiating table. confrontation in the un security council will not bring parties closer to achieving a two state solution. we voted against this resolution not because we are indifferent to the daily hardships are the security threats by palestinians and israelis, but because we know those hardships and those threats will not subside until the parties reach a comprehensive settlement, achieved through negotiation.

this resolution sets the stage for more division, not for compromise. it could well served to provoke the very confrontation it purports to address. for decades we have worked to help achieve a comprehensive and to the palestinian conflict and we remain committed to achieving peace. two states for two peoples with a sovereign, viable, and independent palestine living side-by-side in peace and security with the jewish and democratic israel. the united states did not just acknowledge the tremendous frustration and disappointments on both sides over the years in pursuit of peace who share them, and we understand the immense challenges the parties need to overcome to make peace a reality. yet the same time we firmly believe the status quote between israelis and palestinians is unsustainable.

the united states recognizes the role that this council has played before in advancing a sustainable an end. which calls for the creation of a palestinian state's and both living side-by-side with secure borders. ina 2011 speech, president obama elaborated further, saying that the united states believed it should -- based on the 1967 lines with mutually agreed swaps, so that borders are recognized. he made clear that the palestinian people must have the right to govern themselves and reach their full potential in a sovereign and contiguous state. the united states will continue reaching out to the parties in

an effort to find a way forward and we are ready to engage and support them when they are ready to return. we will continue to oppose actions by both sides that we view as detrimental to the cause of peace, whether those actions come in the form of settlement activities are imbalanced resolutions. if they are to bring real and long-overdue change to benefit their change. today's boat should not be interpreted as a victory for an unsustainable status quo. it should serve as a wake-up call to catalyze all interested parties to take constructive responsible steps to achieve these two state solution, the only way to bring an end to the ongoing cycle of violence. we hope those who share our vision of peace, israel and palestine, both secure, democratic, and prosperous will join us at redoubling efforts to

find a path forward that can rally international consensus advanced future negotiations, and provide a horizon of hope for palestinians and israelis alike. thank you. >> i think the representative of the united states for her statement. i give the floor to his excellency the minister for foreign and european affairs of luxembourg. >> mr. president, in july of last year, the u.s. administration achieved an agreement on the resumption of direct talks between israelis and palestinians. we all had hoped. to months later, in spite of discussions in the tie was efforts of john kerry, negotiations once again were at an impasse. in the summer of 2014, with the persistent bombing of gaza, the

cease-fire concluded it but an end to the clashes but the negotiations to left the gaza blockade are still at an impasse. we also saw dangerous tensions on the esplanade of mosques. the tragic pursuit of settlements, cycles of violence among extremists, was indeed the real risk of a new -- the recent rocket fire in gaza has shown once again the volatility of the situation for lack of a political horizon. the time has come to create this political horizon, the time has come to take bold and concrete measures to achieve sustainable peace. it is obvious to us that the security of the state of israel will depend on the establishment's estate of

palestine that is sovereign and democratic on the basis of the 1967 boundaries with jerusalem as the capital of the two states. the two state solution is the only one that is just, politically and morally. there is no other alternative. is to president, in voting today in favor of the resolution resented by jordan on behalf of the group luxembourg has voted in favor of the two state solution. two states, israel and palestine, having side-by-side in peace and insecurity. we voted in favor of a solution that we advocated during our entire term on the security council, a solution that is always among the priorities of our foreign policy. we voted in favor of a peace settlement, which leads the legitimate aspirations of israel and of palestine. to say the two state solution --

to save the two state solution we need to learn the lessons of the past. they will only agree of the international community commits itself in a more determined fashion than in the past. it sets the framework for its settlements with clear parameters and a specific timetable. that is the purpose of a dropped resolution presented by jordan. in spite of the result, we remain convinced that the security council can and must play a constructive role in this context. to be up to its major responsibility of maintaining international peace and security, the security council must assume a more active role to support and maintain the two state solution and to put an end to occupation. mr. president, our vote today is the expression of a conviction the conviction that it is urgent to act now.

the conviction that we cannot indefinitely push back the timeline. keeping a two state solution on track cannot be done forever. today's boat is not against anyone. we are not seeking to divide or point fingers. on the contrary, it is a vote of hope. and voting for the two state solution we are launching an appeal to israel and palestinian political officials but also to citizens that they will choose the path of reconciliation and resumption of the talks. we call on the countries in the region and on the international community overall to make a steadfast commitment alongside israelis and palestinians so that the peaceful coexistence of two states, the state of israel in the state of palestine, will finally become a reality. we regret that it was not possible today to adopt the resolution presented by jordan,

but we hope very much that after this vote it will soon be possible to resume discussions in good faith and to work together for a comprehensive sustainable peace in the interest of israel and palestine and of the entire region. we don't have the right to fail. 2015 cannot be a new lost year for peace in the middle east. thank you. >> i think his excellency for his statement. i now give the floor to be representative of the united kingdom. >> thank you, mr. president. the united kingdom understands and shares the deep frustration at the lack of progress in the middle east peace process and the unacceptability and unsustainability of the status quo. a just and lasting resolution to this conflict is long overdue. we will continue to spare no

effort to turn our ambition, the creation of a sovereign continuous, and viable palestinian state living in peace and security with israel, into reality. we have long believed that a direct negotiations toward a two state solution need to be on the basis of clear, internationally agreed parameters. i recall in february 2011, i set out in this chamber our view of what this should be in a joint, united kingdom, rants, germany explanation vote. we welcome the idea of the a security -- of a security council resolution. however, agreeing to such a resolution requires proper time for consultation and negotiation of the draft resolution, including on its timing. we consider president abbas a

man of peace and understand the pressure the palestinian leadership has been under to act. but we are disappointed that the normal and necessary negotiation did not take place on this occasion. the united kingdom supports much of the content of the draft resolution. it is therefore with deep regret that we abstained. the united kingdom stands by the parameters i set out here in 2011. which were reiterated by the european union in july, 2014. our views on settlements are clear. they are illegal under international law, and obstacle to peace, and seriously damaged prospects for a two state solution. all settlement activity including in east jerusalem, should cease immediately. we call on all parties not to take unilateral steps which would make the search for peace

based on negotiations harder. mr. president, given the fact that this draft resolution has not been adopted today, the united kingdom would like to work with partners to revisit the idea of a parameters resolution on the middle east peace process in 2015. we are convinced that it is possible with further time and effort to secure for the first time ever a resolution which commands fall security council support. i thank you. >> i think the representative of the united kingdom and i give the floor to the representative of france. >> since the april end of the peace talks, the situation has deteriorated. we are facing to threats -- two

threats. on the one hand, the two state solution is about to become a barrage -- a mirage. the public opinions in both states are both accelerating, and there is also the matter of the west bank. the stage is set for things to take flame. we know the heart of the problem -- the absence of a political solution that reflects the legitimate views and needs of both peoples. for the palestinians, the aspirations for a sovereign state, and for the israelis, guarantees of lasting security. these legitimate needs can only be resolved if there is movement toward the solution that we all know we are sharing that allows

for the emergence of two states and two people. mr. president, france believes in the possibility of a definitive and fair solution for both parties. we must allow for the meansthe means are collective. successive failures over 20 years were called to us. it must evolve. the parties cannot take difficult decisions alone that come with the negotiation. the palestinians cannot bear the burden alone of seeking this difficult feat. after 25 years of negotiations it's essential the international community share the