still think we have a long ways to go, because everything, whenever it comes to people of color, that issue that's always brought to the forefront. remember the black person it's ng about something, always the color aspect is interjected. and i would like to say finally, lastly, as far as african-americans treating one another, i think this also goes slavery. i mean, the way that we were disciplined as kids, we were always beaten. we were never taught different. you know, and that seems to be exists in t that african-americans that, you know, you have to be more orceful with our children than with any other children. it's sad. and i just sad, don't -- i really don't know. generation is a lot better than ours, but i hope they continue not to listen to the older generation. i called on the wrong line. i'm sorry about that.

i'm 52. ut i think this younger generation kind of has it, you now, they're headed in the right direction. host: that's john in jacksonville, florida. poll, one in five blacks report unfair dealings month.olice in the past that's a november 30 story on cnn. carol who tweets as gop kicks ass, i never thought that after seven years of obama's hope and in ge that race relations america would be this awful. rush predicted this. toledo. calling in from el vin, go ahead. this is yeah, i feel -- my opinion. african-americans americans, white people, the are the most -- i think most -- i don't know how to

explain it, but i think we are that love each races,more than any other nd i believe it's just a few billionaires and millionaires from, you know, we just person, and stop, you know, ll this division between us, and stop it, all this hatred, you know, it's just getting us nowhere. host: that's calvin in toledo, and this is mike in evanston, illinois, ages 31-49. mike, go ahead. aller: yes, you know, i've been listening. i would say that, you know, living on the outskirts of chicago and growing up in a going to ea and school, growing up, it was you

a child that race relations were decent. but as you get out of high school, going to college, and you go out into the real world, is, and it's acism institutional. along.k people get i don't think it's as much racism as people think as far as how we treat one another, but the institutional racism, by a harvarda book law professor who gained tenure harvard, wrote, we are not justice,cept for racial spoke about what happened with brown. nd i also look at economic racism that's going on as well as the industrial prison complex. and also, how the courts have been treating african-americans with the help of the police department. e e police are doing what th courts want them to do. it'se blame the police but the laws and the court and the

police following through. nd until those things change, nothing is going to change because, one, is white america s country, as our country is progressing, african-americans are lagging behind, and these are a lot of the reasons why happening.n so at one point, we're saying, well, we have a black president. we as a group are not really progressing. and for young people, and that's why you see a lot of issues with a ng people, i live in diverse community, but if you go right across the border to hicago, it's the most segregated city in the country and you see what problems they're having there, and you the ook at education, criminal justice system, and how they're being treated in the courts. just to give you an example, i'm 45. and i don't know -- in the entire city of chicago, it starts on the north side, i don't know what african-american store s that that's a that has a cigarette license, a bar license. lottery t even sell

tickets. so it's a lot of institutional racism, cues that tell you those things are going on, that black sing e aren't progres economically. if we can't progress conomically and there's no equity in the in capitalism, we're going to fall short and fall behind, and you're not sitting at the table of the american dream, and that's been problem, is that a lot of african-americans are doing their butts off, the next right thing, and of course there's a lot of other eople in the same boat but it seems to me that the african-americans are the ones getting the short end of the stick. host: mike in evanston, illinois. this is the "new york times" lead editorial this morning: cleveland's terrible stain. tamir rice of cleveland would be alive today had he been a white toy ar-old playing with a gun in just about any middle class neighborhood in the country on the afternoon of

november 22, 2014. reflection: other disregard for the city's black residents, says the new york times, about cleveland, that disregard pervades every aspect of this begins with the fact that the police department even review officer loemman's work history before and g the power of life death over cleveland. in addition to portraying the tragic as a result of a misunderstanding, prosecutors have also suggested the tamirr's decision to kill was shaped by the fact that the surrounding neighborhood had a and that theolence boy appeared older than 12 because he was big for his age. these arguments side-step the history of violent police actions that led up to this boy's death, the "new york times" writes. they also have the reprehensible

effect of shifting the responsibility for this death onto the shoulders of this very young victim. in maryland, ages 31-49, sherene is on the phone. caller: hi. my comment was i agree with many of the points of the last and i do agree that institutionalized racism is alive and real. t's been that way for quite some time. but the biggest thorn in my side african-american, relatively young, is that it's more of a causeism issue, from my perspective, because the people that irritate me the most, that cause me the most embarrassment, that harass me on a daily basis are not people from a different nationality or race. they're people in my own community, african-americans. gas er have to go to a station and worry about being creamed obscenities at for no apparent reason if i go to a nicer white suburban area, but et that's what i have to deal with from my own people, quot

quote-unquote. it's just unfortunate that with the black lives matter movement, overshadow the fact that we kind of look at the we ce as the bad guys, but kind of in the black community, it appears to me, have own aggression with our own community, and i've with some of my other young professional black it's way o say that worse when a police officer does this to someone, but they just that as black ct people, we are allowed to or to attacklized for us each other, and that's just a product of slavery. of really kind of tired issues that all of our are due to slavery. it's frustrating because i'm trying to get ahead and do the that we've all been taught as americans, to work hard and be successful, but it's painted ng that i'm with the same brush as other people who are -- don't have

those values at all, but they just look like me. fayetteville,is in north carolina. 50 and over line. grady, you're on the "washington journal." relations in ace the u.s. today? caller: it's terrible, terrible. god we trust." we say that we're a christian are finding out from the -- all three branches f our government down to the lowest level with our people, it's just filled with hate. have seen soht i'd many christians say so much hate nd spreading and being divisive. your president, why he's up there before he's sworn in, you got the men of the senate up to make him fail. that's mutiny. it don't make sense. and then we said there's no racism. ur congress got a 14% performance rating, but we say

there's no racism. why? because they spent eight years sure this president failed. this country was failing, and president in black there, put him in there, and all reagan, about is mr. mr. reagan. this country was going down the about t you never hear all the stuff that president obama has done for this country right now. and -- host: grady, do you think the president has been effective relations?mes to race caller: yes, he has. host: why? caller: he has. but do you know who handles the purse strings for america? congress. most black people don't have sense enough to realize how the know.nment works, you the president don't make the laws. the congress controls the funds and stuff like that. they got job bills right now.

you want to change america? i heard the lady talking about men.oung black you want to change our lives, put some money in their pocket. when people are talking about taking america back, that means taking jobs from somebody. now you are finally getting out, so they ing want to take you back because you are taking jobs from their stuff.d they can care less. and you're just like being in a neighborhood. they're always going to put the guns, they're going to put the drugs, they're going to put the alcohol down there. host: all right. that's grady in fayetteville, north carolina. well, it was in june that nine eople were shot in the mother emanuel church in charleston, south carolina. sang "amazing grace." we all saw that. whole event on c-span. it was a couple of hours long. of south vernor

carolina came out after that and spoke. winners or declare losers here. we respect freedom of expression. to show the wish flag on their property, no one will stand in their way. but the state is different. and the events of this past week look at this in a different way. 15 years ago, after much cont t contentious debate, south carolina came together in a bipartisan way to move the flag the capital dome. today, we are here in a moment of unity in our state, without ill will, to say it's time to move the flag from the capital grounds. [applause] host: in altamount, new york, line, james, your view of race relations today? caller: yes. thank you for giving me some time here.

i believe race relations in this country are terrible. wedge drivenm is a deep down the middle of this ountry, and until we overcome it, it'll tear this country supreme court judge saying that maybe black people ught to try a lesser college instead of harvard, but to this prosecutor yesterday that openly admitted that he recommended the charges.y not bring he forfeited his paycheck yesterday. and all the way down to -- i upstate new york. you've got people driving around here with giant rebel flags back of their pickup truck. until the white man, which i am 57 years old, and conclusion e to the that we have to step forward, he white people have to step

forward and crush this thing before it tears this country apart, just look at what's going on, all the way down to the most in the world, our corrections officers and police officers. they feed each other jobs, they littlech other their own economy. look at ferguson. they were trying to run a police force down there by ticketing black people, and when they couldn't come up with the money, they put them in jail, because that was a bigger body count for prisons. i mean, until we face this honestly, this will always be a all i have that's to say. here in acula is washington d.c., ages 31-49. you with us? caller: yes. well, what i have to say is me this for giving

time, and about the racism that's going on. it's ridiculous. can you hear me? listening.are just go ahead and talk. caller: okay. people, they are i am sorry to say that. 2008, i had lost my kids. , they get mybed mother could help me, and that the network out. i was in court, crying and did not know what to do. because of my situation, nobody would care to help me and keep my children together, nothing like that. came up to mey and hugged me and told me everything was going to be ok. i was in the core building women, all of those black

were walking past me and do not see me. stopped white lady just to take her time and comforted me in showed me that everything will be ok. do you understand what i am saying? saying why people don't like black people, that is bogus. there are a lot of that apples and good apples. if the bad apples move out -- there would be good people. indianais is bill from ages 31-49. what is your view on the race relations in the u.s.? caller: i agree about the young lady who spoke earlier about it being a classist issue, more than a broader aspect.

i think the thing that went on in ferguson is a terrible deal, it is in a bad neighborhood and all of the upperclassmen have blown it out of proportion by glorifying the thugs that started the whole thing. all of a sudden, we want to jump on his side because he is a black man and he was shot by a wide cop. if a man does something wrong, he does something wrong. i am a white guy and i've been pulled over for not driving the vehicle that i look like i should be driving. i have been targeted because i had long hair, called a redneck, whatever. of mine black friend recently told me that i was privileged and did not have a clue what he went through. everything he said he went through, i had the same issue. just because i grew up in the kind of neighborhood such as ferguson. i group on the west end of

louisville -- louisville kentucky. whatw a little bit about it is, our neighbor was not as bad as ferguson, but there are still thugs. host: -- from durham, north carolina. caller: good morning. what i am hearing a lot of, is a lot about race. relations,es to race i think it is important for the individual to get involved in a community to monday social economical -- to learn the social economical issues. i do not see how we can relate to one another if we are not involved with one another. a lot of the conversations that have been help us morning, i've been pulled over by the police, i have been having the issues on and the education to get it, but not the opportunity.

" her for me to learn and grow from that, i have to be able to learnate -- an order to and grow from that, have to be able to correlate with people in my community. i think that is lacking in the communication. people are lacking with getting involved with the community. in order to help the community and the government to grow. host: we want to thank everybody for participating. we look back at some of the major issues of the past year. another one of the issues we have heard about all year is the affordable care act. health care in the united states and that is what we will delve into. we will have a roundtable on to reporters who cover this issue. we want to talk to you about what happened to health care and 2015, and where it is going in 2016, get your viewpoints, and etc. that will be the next two hours.

♪ , two-timenday night pulitzer prize cartoonist, michael on his career and recent books of satirical cartoons. >> i have this figure that is a conglomeration of extremists israeli settlers and a palestinian figure the vast issue -- who has issue. he is on a prayer run, but he has his shoes on. both of these figures are utilizing a false religion for a political purpose. it just proves that once again, i am an equal opportunity

offender. >> sunday night at 8:00 eastern and pacific. this new year's weekend, booktv brings you to of nonfiction books and authors. said a evening at 10:00 p.m. eastern on afterwards, all, forward -- former white house chief of staff look at williams campaign. by the election of 1986 still matters. he discusses the political environment in 1986, including political gridlock and mckinley's expansion of the republican base. republican party has been beaten in the 1892 election. grover cleveland has come into office. mckinley has been the governor of ohio and has seen the country descending into a deeper depression. -- he wants to be the nominee.

he is not the front runner or the favorite. >> directly following, joint big -- booktv for carl. sunday, author david will be live with your calls, e-mails, and text from new until 3:00 p.m. eastern. he spoke about his most recent release, once in a great city, a detroit story. as well as a biography of bill clinton, and barack obama the story. ,ooktv this new year's weekend two days of nonfiction books and authors on c-span2, television for serious readers. >> "washington journal," continues. host: we are going to talk about the affordable care act and health care in america. we have two working reporters who cover this issue. jennifer haberkorn is with

"politico" and kimberly leonard is with "u.s. news & world report" where she also covers health care. let's begin, kimberly with health care 2015. what happened with regard to the affordable care act? some of it was brought into question by republicans and the supreme court. most of the lot remained intact, but some parts of been pushed back. certain taxes that were supposed to go into effect, now have about a two year delay. that will cost the country billions of dollars, but because the law is cheaper than what we thought it would be, it will even out. , in: jennifer haberkorn question. jennifer: this year, congress passed -- host: what is the cadillac tax?

plans,cks on health care to discourage this superhigh plans that draw -- was that if you tax them, there will be fewer of them and people would pay more for their health care. if you are paying for the first dollar of your health care, you are more willing to act the dr., do i really need that or take a test, things like that. labor unions were hit hardest by this tax. they have been lobbying for years to get this delayed or eliminated. they were successful. this was supposed to go into effect in 2018. this past year, they were able to get it delayed until 2020. the question is, will they continue to be delayed? it is a lot of money. this was supposed to be one of the drivers to reduce health care. host: it was supposed to be a funder? it was supposed to do

something to change the way we consume health care. unions were lobbying very hard and democrats, the ones who care about this law, or willing to get rid of it. it was a sign to me, democrats want both. they want the health-care coverage that is expensive, but they do not want to have to pay for it. law is changing a little more than what i anticipated. host: did the uninsured rate drop? jennifer: yes, it did drop. it is continuing to drop. a far, they have signed pointer million people -- 8.3 million people. we talked about the deadline for open enrollment, those who wanted insurance to begin january 1, when he designed up by december 15. they ended up pushing it back to

the 17th. people have until january 31 to sign up for health insurance through the marketplace. the department of health and human services is working really hard to target the remaining uninsured. host: senator jeff sessions talked about some of the political aspects of appealing the affordable care act. here he is. ago, there -- clearly the republican people did not favor this legislation. they resented it. the democratic leadership, president obama, they were determined there were going to pass it no matter what the people said. we are going to get this done. they ran it through christmas eve 2009, even though scott brian was elected one month later in massachusetts on a campaign to kill the bill. had he been here at that time, there would have been only 59

toes -- insufficient votes shut it off and the bill would not have passed. the one in massachusetts, one of our most liberal states on a campaign that i would veto to kill this legislation. i would say first and foremost, the american people knew this would not work. they opposed it from the beginning and they opposed the philosophy of that, and they knew we were going to have a mess on our hands. now, we have a majority of republicans in both houses, 54 republicans in the senate when there were 60 democratic senators at that time. we are going to move this reconciliation bill. it will end the effectiveness of obamacare, according to the rules of the senate and what we can do when it passes. we know that president will veto it.

i would just say this, colleagues, this is a historic moment. this is a moment of great importance. six years after this bill passes, and you can be sure to the people who put this passage were absolutely confident. the people that opposed it then, they get used to it and go along with it, it could never be repealed. that has not happened. the voters have elected members of congress to oppose this legislation. the polling data shows continuous strong opposition to this legislation. what we are going to do, is established that the elected congress of the american people, the majority of both houses, incredible this piece of legislation. host: jennifer haberkorn of politics of 2015

when it comes to the affordable care act. jennifer: i think it has changed, democrats love it and republicans hate it. that will remain and i do not see it changing anytime soon. had tothe republicans take steps to prove how much they do not like the law. that is in anticipation for the 2016 election. they have been promising for years to come up with a replacement, but have not come up with something that the whole party can get behind. it took some steps through the -- the bottom line is, they only need 51 votes in the senate, which they have. major partsepealed of the law for budget reconciliation and they will send it to the president desk when signals back to the house. is in like all of this anticipation of 20 16 so that republicans can say if you elect to the presidency and the majority of the senate, we would take steps to undo this law and here's what we would do to

replace it. so horrible for these populations that are getting health care coverage and the people who dislike this idea that this country should do something to encourage people to have health insurance. picture, we did see that both sides softened on the politics of the aca. we were saying that democrats were willing to delay the cadillac tax. republicans were willing to make little tweaks of the law that did not get a lot of attention, and frankly do not have real significance, but they were willing to pass those easily. think in 2016, they will harden again because of the presidential election and both parties need to campaign on this law. maybe long-term, i think both parties would take their foot off the gas a little bit. , we: that said, kimberly are going to put up the phone numbers. we have divided them a little bit differently because all of

our segments "washington journal," your participation is vital. 202 is the area code for all of our nobles. if you have health care insurance through the preferable care act. we want to hear from you at 202-748-8000. if you are insured through your employer, 202-748-8001. if you are uninsured, 202-748-8002 is the number for you to call. said, thisonard that new system -- is it here to stay? can't it be gotten rid of? kimberly: i think it is really interesting that things have softened this past year. few things that democrats and republicans managed to agree on. they agreed to repeal the medical device tax which is a tax on hospital beds, artificial

joints, pacemakers. tax credit was pushed back for a couple of years. that is going to cost the government about $4 billion. it was something that the republicans wanted to repeal. they immediately brought it up as something that they wanted to tackle. democrats agreed with them on that. it was something that they were able to compromise on. host: has health care costs gone or atstantially in 2015, the same rate they have gone up in the past? >> we have data from 2014, that that healthgrowth care has has got up again. the cost of health care has gone up year-to-year. but we had swelling after the recession and the lingering effects of the recession. at the time, the obama

administration said that the affordable care act was responsible for the slowing. it depends you ask on that. we are starting to seem a growth again. budget actuaries say that the growth is occurring because we are covering were people through health care, through medicaid, and also through private insurance bought through the marketplace. we are also spending more on prescription drugs. 2014 saw a rollout of significantly expensive prescription drugs. host: what is happening in the state? the states are interesting because it is almost a different story in a -- saw several states at the end 2014, they tried to set up their own exchange. some states, it did not go well, so they joined healthcare.gov

and told the feds to come in and do it. v has now, healthcare.go been working. is just easierit for the federal government to do it. they are trying to manage so many pieces of their health care puzzle, it is these for the feds to do it. story in theiggest states right now. secretary told me that you brought up the cost of prescription drugs. here is a little bit from secretary burwell earlier this year on that issue. of patients, i will care system, and our economy, we must simultaneously support affordability. today, we know that too many americans struggle to afford the medications they need.

a recent survey shows that almost a quarter of americans have skipped filling a prescription over the last year. costs for medicines are up, and even more pronounced in specialty drugs. of spending on new drugs over the last two years was for specialty drugs. we have also recently seen slight increases for drugs that are not new. nationwide, our spending on specialty drugs was about $87 billion in 2012. that is roughly 25% of our total drug spending. that is also a little more than 3% of national health spending. it has been estimated that it could quadruple by 2020, reaching about $400 billion. that would be more than 9% of national health spending. host: kimberly leonard, your response or reaction.

kimberly: this is one of those things for economy -- the economist to predict. we do not know how much they are going to cost. much of the increase that we saw in 2014 was actually due to the israeli -- they are expensive to produce and expensive to afford. when you look at the budgets, looking at medicaid budgets and medicare, the strikes that treat hepatitis c have shown to drop some of the costs of prescription drug spending. a reminder, if you have insurance through the affordable care act, want to hear from you on 202-748-8000. if you are insured or your employer, you can call 202-748-8001. if you are uninsured, home 202-748-8002. of guests jennifer haberkorn "u.s. news & world report" and jennifer haberkorn from

"politico". let's hear from james that is insured through an employer. caller: good morning. a friend of mine works for a company in indiana. he just got a letter stating that the company will only the workers independents. spouses will not be included. i do not know what the spouses are going to do. is that legal? that is my question. >> yes, it is legal. it is part of a larger trend we have seen, and even prior to aca . employers are producing their coverage of employees and dependents. i do not think i have heard of an example of employers dropping spouses, but keeping dependents. it is certainly within what the employer can do. they might face scrutiny in

2016, depending on the size of the employer. --2016, much of the employer part of the employer mandate is going to go into effect. they do not provide employees of coverage on -- that depends on the size of the company. in general, employer coverage is what the vast majority of americans get their coverage. situation,y in this it has gone down in recent years. for: obamacare is no care the working poor. kimberly leonard, large corporations with a lot of minimum wage workers, including fast food restaurants, often -- offersurance insurance only they have 100 employees. that number is going to drop 250 as of january 1.

>> right. it was supposed to reach 50, but it was pushed back by the administration. even hillary clinton has admitted that certain parts of the law, including this part in hash the employer mandate forced some workers and two part-time work because of some of the mandates of the law that only apply to certain hours and employees. tohink this might be an area watch in 2016 because employers have been vocal about their frustrations on the employer mandate. day, thatl the other the ministrations delayed some of the reporting requirements for the mandate, a two-month delay. employers are worried that are going to have to count the number of employees to get insurance. if you are working at a place with a lot of turnover, how you count employees starts midway through the month.

there is a lot of paperwork requirements that seem very complex. the employer community so far has been very vocal was sharing their frustration with the administration. host: susan is calling from florida. you have aca insurance, is that correct? caller: all of my kids do. i am on medicare myself. it was a godsend for them because my daughter has a hard condition -- part condition rob bishop -- while she was pregnant. 2009ad been laid off in after a great fall out. just about when everybody was bottom out, things haven't came along. they actually own their own business. their consultants can do that because -- otherwise, either one

of them would have to go find a job someplace just to get the insurance covered. in florida, premiums went down this year. they are very affordable. how many people call into shows all the time saying they have $5,000 deductibles per family member? i used to work in the industry, and i know that this is not possible even on the private market. it seems that we need a lot more education about how to sign up and choose the right plan. i think as people find the right meetsto be at, and what their needs, i cannot just imagine anybody being unsatisfied. we can pick any option we want. it is working out very well. host: she spoke about the platinum, silver, and gold plans. what are those? plans, lesse

quality coverage. the silver plans are more expected to be standard. the gold plans, obviously, courted -- color-coordinated as the best planes. one of the frustrations about they --ze plans, premiums are low, so they sound enticing. then, you have to use your coverage for "face at the pluggable that are pretty high. what i have heard from consumers the bronzey took plan and decided that it was not good enough think of the silver plan the next year. if you are someone that does not go to the doctor very often, and you are just looking for coverage to avoid paying the mandate and just have insurance if you had a catastrophic illness, the bronze plan is probably the right policy. ,he silver plan is the standard

where subsidies are set at. the gold plans are the best coverage. host: from the kaiser family foundation on health care average out of pocket limit, you can see the bronze plan is $6,600, $6,100 for silver. $4700 for gold and platinum plan is $2400. who gets the platinum plan? >> those who can afford the higher monthly premiums. host: have both of you gone to andfederal health exchange typed through that to see what it was like? what was your experience? >> whether the improvements they have made, they have listened to people's complaints and they did not realize what they were buying and how much it would cost me. it allows you to search for drugs, doctors, hospitals. it allows you to say, when i am

getting this plan, what am i actually getting for my money at what will actually be covered. it will show you a sheet of different prices of what you will be paying for all of these different things and here estimate actual cost for the year. it is important not to just look at the fact that most people are only paying $100 a month for premiums. it is all the other costs that go into health care that people need to be concerned about. that just comes with educating yourself as a consumer. host: anthony from rochester, minnesota. sorry, for michigan. caller: rochester from michigan. and morning kimberly jennifer and peter. i'm calling to say i have the state medicaid because of low income. my doctor -- i did not hear you peter. anthony, we are listening.

when you get through, europe to turn down the tv because there is a delay. tvler: yeah, i have the turned down. let me take off the speakerphone. host: we are simply speaking to you. i think anthony or tony is gone. monique is in washington. caller: i just wanted to say that i had to educate myself because i was on the side where the premiums were so high, i cannot afford them. that was because i did not do my job. with paying $500 a month united health care. my job, they made it their business to educate their employees of the different plans that were available to us. i saw thatround, and they had the same thing. -- for half of the price.

now, i'm paying $250 a month for my premium, as opposed to $500 a month in getting the same service. i want to apologize to the lawmakers from a educating myself over the options that i had. monique, you are currently insured to your employer, correct? caller: yes. host: how many options were you offered? , i say i was offered about almost 20 options. because you had the basic, and then the high. host: do you work for a large employer? caller: i work for united states postal service. not only that, when i look more to it, i looked at the different states and how they price bid.

some states were under one, some were under two, they went up to four. what i looked at the different of the blue and red states. a lot of the red states' insurance are cheaper than the blue states. i think a lot of people need to educate themselves on what is going on and the costs of the different plans. if i had paid attention last year, i went not have ended up paying a $500 premium. i could have been paying half of that. my fellow americans, educate yourself. .ost: jennifer from "politico" jennifer: i think we're going to continue to see for a wall that insurance is confusing. you are not going to the store and buying shoes and a cd price is 3999. insurance is far more complicated, particularly for people who have never had

insurance before. re.gov, even ifca you are not next to a counselor, it is confusing. you do not know what your health care demand is going to be this year. you do not know if you will be healthy or get a catastrophic illness, or injure your knee and need therapy. all of these things cost different amounts of money. consumers are going to the website or an application counselor, they are facing questions they had never been asked before or never thought about. if you want to pay a higher premium, and not pay as much when you go to the doctor. or if you want to do something different. i think for the next couple of years, we are going to be seeing this with people who are frustrated when they go to the doctor and find out they have a $5,000 deductible on their plan. people respond to this this year. s said they will put more into

education, but it will be a slow process. that, education does not just occur when you are buying insurance. >> it occurs when you are using it. thatrly: you need to know every question the doctor asks you is a preventive question, and not one that can turn into a diagnostic visit. i spoke with some patients who ended up spending hundreds of dollars without they were just going for their annual checkup. with preventive care in particular, it is difficult because it is something that the administration has said, look what a great benefit this is. people decided to take advantages of that, are finding that it is more expensive than it needs to be. in addition to that, doctors do not charge the same thing for the same service. if one doctor gives you a prize, he might be in your interest to go elsewhere and see what someone else will offer you. host: when we were putting the segment together, along with the

searchers i was doing and etc., i saw a lot of article saying that hospital stocks are up in the health care services stocks are up because of the aca. why is that? >> people are consuming more health care. when you have insurance, you can go to the doctor. you can argue that that is a good thing, they are going for their preventive health care visit. drive up the cost of health care because you are consuming and more. hospitals are doing well in the stock market and wall street. i think that will continue. it is an hospitals'interest to have more people insured. it means more people who walk in the door are backed by people who can pay their bills. if you come off the street and you do not have insurance, it is a sign to the hospital to go after that guy. and they can go after united for etna, they would much rather do

that. in that sense, this is good for the industry. it does not mean that the whole story is good. there are problems and health care, consumers are frustrated. some providers are telling patients that when they come in, you are coming for your preventive visit. if we find anything wrong, that is not going to be a preventive care visit. it will not be free. we are in this learning curve of people getting to know health care. providers getting to know how to cover people who have not had insurance before. it will be a process that will probably take years. host: victor tweets, seriously, that is legal? that goes back to the employer not having to offer insurance to his spouses and kids.

and employer can justify to not cover spouses, just to kids? wow, talk about a morale boost at work. an employer can offer just the end loyalty insurance, correct? >> it depends on the employer. small employers do not have to provide insurance. if you work for a very large company, they do have to provide insurance. this year, we are seeing a group of employees -- no, they do not have to provide for the spouse and dependents. that is what democrats are calling a family glitch in the health care law. yet it was yes, you would have to cover the entire family. the way the law is written, employers do not have to. democrats are hoping to fix that in another version. i could see employers being a poster that because that would drive up their cost. i do not see that changing anytime soon, but for now that is legal.

from rents them new jersey and is on medicare. caller: hello. can you hear me? host: we are listening. aca, we hadr to the an earlier health care law that still exists, although it has been updated periodically. it is called the mental health -- act. i am under 50 and i have been on medicare for a while because i am disabled. it is a terrible flaw in the long. you happen to live in a county where one of the health insurers will sell you a medicare supplement plan and it is a good plan. you can get a good part, if not all of your services, reimburse at the same rate.

medicare original would pay for them. , and no oneoo young is offering a supplement plan or if what they do offer is low in where you do not get much coverage, you end up using an advantage plan. these are hmos and provider organizations in some cases. what happens with these plans, i have seen with private employer plans, once upon a time, i worked in a mental health service provider as a night receptionist. people had all kinds of different health insurance, but there primary insurance was bodily health care. they would contract out the mental health care to any number . there are just a few in new jersey that are big and all around they might be few. host: we are going to let it stand there and see what you really are jennifer has to say

about that. >> in terms of the mental health portion of the law, just like with other parts, we are seeing a few loopholes and lack of clarification in terms of what is covered for mental health. when you say parity, what does that mean? should a one hour appointment with a therapist has the same as a 10 minute obama with a doctor? these are questions that have come up with regard to how mental health should be treated equally under the law. that is one of the big provisions under the law. it is considered an essential health benefits that is to be covered by all health insurance plans. host: the population of the u.s. is about 320 million before the affordable care act, up to 47 million of those folks were uninsured. million% of the 11.4 who got insurance through the aca are getting some form of cost assistance.

how do they qualify for that? >> if you make up to a certain , the government will subsidize your monthly premium. we are talking only about premiums are not deductible and other out-of-pocket costs. , iy are receiving assistance think eight out of 10 are paying hundreds in premiums per month or less. host: what was the cost of the aca in 2015? is there a figure? >> there is, but i do not have it in front of me. because we saw some of those taxes the late at the end of the year, the cost of a bit. those funders and taxes are going to be going away. overall, i should save in 2016, the cost will go up. is in florida who is

insured through his company. caller: good morning. is the affordable care act effective? concerned, i am 65 years old, and i'm -- in my going to be forced to buy maternity insurance? >> the aca is in effect now. we already talked about the cadillac tax that will go in effect in 2018 and will be delayed until 2020. there is medicare that will go into the -- independent advisory board which has faced a lot of criticism that is not yet been activated. that is a board design is medicare spending reaches a certain form, how do they reduce those costs.

that being said, the vast majority of the eighth a is an affect. if you are 65, you should qualify for medicare. your wife would be on it in two years. this is a common criticism that people who do not need maternity coverage or do not want maternity coverage, they are being forced to buy it. i assume it is expensive because it is expensive to have a baby in a hospital. that is part of the essential health benefits. awaynot see that going anytime soon because maternity care is so expensive. i think lawmakers are going to keep that is one of the requirements under the law. host: kimberly leonard, what is the difference between the medicaid and affordable care act? kimberly: originally, when the lawless past, it was supposed to apply to every state. governors took that to the

supreme court and states could decide on their own if they want to extend medicaid. so far, 30 of them have done so. those who have not, it is strange, but those were not extended it are also concerned about what is going to cost them. the federal government is supporting expansion of medicaid for a few years, but then states will have to pick up 10% of the cost. concerned because states have already cut back education, infrastructure, public safety, in order to fund medicaid. will it be another mandated expense? that is one of the reasons why they are picking -- not picking it up? statesy: i do not see taking away health care for the poorest americans once they have provided it. it will come down to the

legislators deciding whether it is something they want to do. >> we have an interesting case study of that right now in kentucky. red state ind a the south, he was very active on implementing the aca. he saw it not only as a policy reason, because he could save state money, but also more reasons to provide health care to his residents. i'm sure you saw the story. kentucky was a huge success on the aca. a republican i just won the governorship and he is promised to take apart the aca. he has backtracked a little bit on undoing the expansion of medicaid there. he has to submit his budget setting. it will be interesting to see what he puts in their. he has said that 2017 is the year to do it to give people some time. kentucky is interesting. when i went there to write about

this, you have people talking about the affordable care act obamacare and connect, which is what the kentucky aca exchanges called. totallyaw that as two different things. they hated obamacare and loved connect. as the government moves ahead, he will have to be critical of the people who got coverage and what happens to them. whether they view it as a political liability. kentucky is an interesting state republicansause will see what happened and take lessons from it. host: michael is in columbus, georgia. caller: good morning, thank you for having my call. host: we are listening. caller: i do have a few points to make. as far as affordable care, my fiance had affordable care in a red state in louisiana. she was not working. of was paying a high premium $85, even though she was unemployed. state,ved to another red

borderline blue state in georgia, it was a lesser cost. it seems like there is some discrepancy there. the second point, how does compliance track employers who have employees over 100. she became employed in georgia, but a company that has over 100 employees, they do not offer any type of health care benefits. she had to eventually apply for affordable care act. the next, i will make, with blue cross and blue shield working for the state in two different states, it is interesting how the partisan plan changes, even though we can have a high premium to authorize mitigation. thank you. state-by-state, it is interesting because they have different marketplaces. the offerings you have been state are determined by which insurers want to be there. variesar, it

state-by-state and year-to-year. some states, south dakota, iowa, they have very few offerings. you have situations where people have one or two options. then, you have other states who have other -- a ton of options. you can have a similar blue cross plan in louisiana and go to georgia with a similar plan but with a different price. that is up to the individual insurers to price their insurance plan market to market. that is why we see some people and some said -- states they like it better because the pricing is different. in terms of compliance, employers have to tell the irs and the federal government how many employees have offering of insurance and have taken insurance. are set by the number of employees who go to the exchange to try to get subsidies. you could have a situation where

employees do not get covered at work, but if they do not go to the exchange, the fine is not triggered. it they do go to the exchange, the government sees that this person works at x company and they should get an offering of insurance, then the fine gets triggered in the employer has to pay to each of person i was affected. 2015%.n as of this year, it is at 12%. tracy is uninsured and living in cambridge, maryland. caller: yes sir. i am 42 years old, married with and theage kids, 114 other 17, a girl and a board -- boy. i've been on insurance for the past year. i have no look filled -- i was receiving 15 to 20 calls a day, some of them arrogant

trying to push their insurance. when it comes down to it, to cover my family and have a semi-affordable anything, as far as what people are not asking about your major medical or hospital organization. i hear congress talking about mental health, but none of these insurance companies offer mental health for children or anything like that. , $10,000 of debt bubble thousand dollars deductible. that, maryland being a democratic state, they do not offer subsidies for me to of my family to get affordable health care coverage. host: tracy, are you employed? caller: yes, but my employer does not offer insurance because me and my wife are his only employees. i work as a property manager. host: you have -- as maryland

have -- are they using the federal exchange, or do they have a state exchange? i guess you would call it a state exchange because it is a maryland exchange. there is nothing deal with obamacare or aca. it directs you write to your and youare companies have to buy the regular plans. they would tell me that my fine is almost $1000 this year. they know that, but they cannot give me any way to get insurance for my family under $500 a month and not have a $1200 a month but the best deductible. month. was sick last in theory, it is not worth me buying insurance when i pay so i still have to come out of pocket when i am sick in the prescription drug costs. it does not offer the stuff we

need for children, especially coming up in a society where we are coming up and with so many mental problems and things going on. view, it should be straight across-the-board. every state should be the same. if i go from one county to the next county, why should their medical costs be more than the previous county i was in? we are not buying cars, we are trying to be healthy. there is a lot more that people need to take a look at. the affordable care act is affordable when you pay $40 a month, but when you have kids, need clothes, things and to do, it is not affordable anymore when you actually get sick. host: that is tracy from maryland. talk abouthen you whether people should have insurance or pay the penalty, it depends. if you do not have many health issues that you, you might end up spending less than if you had

bought health insurance. people end up in these disastrous consequences that they do not anticipate with their health. in terms of a state offering the same plans, the aca and a lot of ways aims to give state some freedom in establishing their own exchanges and things like that. most states have opted to go to hcare.gov, most states -- 30 states use it. how can somebody like tracy find out if he and his family are eligible for a subsidy? jennifer: we will give you that information. subsidies are available in maryland, anywhere, regardless of where you live if you hit the

certain income levels. i am not sure if tracy does, but they are available. that is something worth checking out. host: thomas is from florida, you have insurance through the exchange, correct? caller: yes. host: what was your experience like thomas? but better than nothing. i am looking at a graph from a peterson foundation. it shows that per capita in the united states, $8,713 is what it averages out to per-person. canada, looking at $4351 per person. switzerland $3600 -- host: we have the point, where are you going with this? don't you have some

people from these countries that have so the american people how bad we are getting screwed. another point i want to make, the affordable care act is a republican plan. it was a republican idea to the heritage foundation. it is meant to protect insurance companies. you are going to get just a little bit better deal, but you're are never going to get the right deal -- they always want to talk about free market and capitalism and all of this. you are never going to have that here because you have a monopoly. host: we have the point thomas. the u.s. spends twice as much per capita on health care as the average developed country does. this idea of having some representatives from other

countries is good. we start with you kimberly leonard, then jennifer haberkorn , why do we spend more per capita on this country than other nations? >> we have a much more complex it -- system. we have medicaid, medicare, we do not have a single-payer system. we do not negotiate the costs of drugs. what is paid for various significantly by hospitals, doctors, health care facilities. you end up spending a lot more with nothing in place. that is why you are seeing the cost of health care rise every year. --t year, he was even higher it was even higher, close to $9,500 per person in total spending. .ennifer: i agree if you want to spend $100,000

for an elderly relative's they in the hospital, they let you do that. decidedcountry have that we were not stop you from doing that. as we saw during the debate on the aca, nobody wants that. thatnk if you apply through the health care system in a less dramatic way, some insurers will allow you to going -- go to as many doctors as you want. doctors will order an mri for your need that if you go for another doctor they will also order an mri. there is a lot of things going on during the health care system that does not take place in other systems. source of there is a frustration for the health care providers and consumers. host: mary from atlanta, good morning. caller: i would just like to

describe -- i am a union member. living make this very clear that i am not an employee. i work for somebody makes it clear that i'm not there employee. i am a member of the union economy. because of the contract my union made for the people we work for, abortion i pay goes towards health and benefits. -- i have onegh choice for health care through the union. how it goes is, i never know how .uch i'm going to work i never know how much i'm going to make. me,way they bill mean -- contributions are made in the get posted at some point. every quarter, they sent me a

bill for the health insurance and they say you all $1200 to keep her health insurance you have to pay in 10 days before goes away. you cannot do it again until open a roman. mary, do you get it through the affordable care act? or is it sponsored by your employer? caller: i am not anybody's employee, however because i am a union member and i get my work or the union, i am subject to their union health care. host: what kind of work you do -- do you do? caller: i work in the theater. they do not play -- amy as an employee.

so, i get a bill and it will say you oh $600. pay within 10 days or you lose insurance. usually, i do not just have that laying around. said i will just try to go on the exchange. for 10 years as contributions that are made might be a couple thousand a year. i cannot get that back from the union. i cannot say that i'll spend this money on other health care. if i do not goes union health care i lose that for the year. i decided last year that i would just do without that money and go on the exchange which i did. up so that isent too expensive for me to do. i think we have got the idea. host: this is from usa today. talk about people who are

falling into the health care netherworld. their employers classify them as part-time or independent contractor therefore avoiding any obligation to provide health care. there stayed to has not expanded medicaid to include lower turners. and government mandates have a standard for affordable coverage that is not affordable at all. the idea was that everybody was supposed get health insurance coverage no matter your income or where you live. that was the goal and we are saying that that has not really taken place. there are a lot of cracks in the system one huge one is medicaid expansion. in 2012 the supreme court said they do not have to expand medicaid. some states have not. we see people falling in the gaps. fall in gapspeople going from medicaid saying that maybe they have a good job and they lose the job. churn or you're

going to different health care systems. people inevitably fall through the cracks in and end up not having coverage. it is an issue. will be think it repaired right away because of the political dynamics. fors a real liability people who find themselves without coverage. whether it is affordable or they simply do not have access. that now that the aca is fully in effect and has been around, we see cracks in coverage. have not we talked about this morning that we need to talk about about health care in 2015? can talk with the year ahead. we can talk about the election and what proposals are being made. what is interesting is that both parties, they have different doingge for what they are

. some of the goals and upping the same. both parties seem to agree that drugs are too expensive. how they will tackle that is a little bit different. hillary clinton said she would propose a plan or medicare selected negotiate drug prices and she also said she would cap out-of-pocket spending for individual beneficiaries. jeb bush said his plan would ands on prescription drugs focus on moving regulatory processes. they make it difficult and expensive for drugs to get to market. it would be the cost of purchasing the drugs would be less. we'll see what will happen. there does seem to be some concern that we have certain where people can be under parents plan until age 26. people cannot be denied coverage

because of a pre-existing condition. of thewill be happy coverage they're getting. host: what would that due to our overall system? guest: repeal is a more complicated term because even one the catalog was pushed back, republicans call that repealing obamacare. it is more looking at repealing portions of obamacare. away, portions were to go if we were to roll back medicaid , that means that people who make the least of anyone else wall not have access to affordable health care. the question becomes what do you do to cover this people? it will have to pay for their health care expenses. people would do it as they come into coverage.

they will get there early, they will get there as they go. guest: i think things will be healthier. it is a presence last year in office. this bears his name in the unofficial lignin for obamacare. i think that the white house is going to try to take some steps to shore up the legacy. that one of the biggest liabilities right now is that exchanges the premiums and insurers. saidme of the callers have , they are frustrated with the cost of these plants. i think the white house will be looking at what they can do to and bring downrs

the price. it is called a formal care act, but people do not think it is affordable. for the next couple years when the fine for the individual -- $695, people are really looking at that money and compared it to their plan. if they think the mandate is cheaper, they will go with that. that is going to ruin the idea behind this legacy. if we look at the presidents a good picture of domestic policy, this is his biggest achievement. the white house wants to make sure that the law is set up as best as it can be. regardless of who the next president is. if it is a democrat, they have less to worry about. republican, they will do the opposite. that is something to watch for in the next year.

the deal with prescription drugs will be very interesting. at the end of the server saw bad pr for a lot of drug majors -- makers. the cure for hepatitis c was great and wonderful, but states are concerned about the cost of that drug and how much it will impact state medicaid budgets. that is something drugmakers have to address. kiraly --w martin's he is in trouble with the fcc. he got negative publicity for the drug industry when he raised the price of an important drug for hiv patients. so, drugmakers, in general are facing a lot of pressure to do something about price. you can argue that it is a little unfair that they are curing hepatitis c but facing criticism for it. that is still something that has to be addressed. like i said, we saw hillary clinton talk about that word we're seem republicans talk about it.

think6, i do not legislation will pass in congress. if the pressure on the drugmaker continues, it could be if the nextto see president makes it an issue. host: we are fed several callers saying this is a republican idea. guest: what they actually mean by that is that the marketplace was a republican idea. one thing that was not a republican idea was requiring insurance to cover a range of coverage -- was to provide a range of coverage. republicans do not vote in favor of this at all. so, the portion of that one health reform is being discussed , the portion that was attributed to republicans was the marketplace plans where consumers can go and make choices about their health care. insurance companies have

under whats democrats set up to provide a range of services. we talk about maternity care. it is one of the essential services and that all health care plans are supposed to include. because they're a clue more services, prices will go up. host: next call. from and in lake charles, louisiana. uninsured line. you're on the washington journal. caller: hello. good morning. this is directed to kimberly because, i see she is supporting the government more than the other lady. but, this is the issue i am having. my husband has insurance on the job. giveyers are allowed to any kind of insurance that they want to offer. any kind.

my husband has insurance in the job where the deductible is $5,000. before they show up, your insurance company has to come out of the pocket for the deductible for 5000. listen to this, who is going to see a doctor yet go -- dr.? they will come out of the pocket before his time to renew your insurance. that'll be another 5000. you'll see the doctor over and over. you or yourch do husband paying premiums you go -- premiums? $49 deducted out of his check every week. there wasn't any need to come in on this kind of insurance. i have health issues. i had to resort to the charity hospital again.

i have high blood pressure. i have arthritis. i have skin issues. my husband told me that there was not any need for me to come in on the insurance. what is the issue? if this be affordable health care plan is designed to protect the government and not the people. your point. kimberly, i think you probably take issue with that because you support the government plan. guest: there are a lot of things to talk about in regards to the affordable care act and people have different views about what works and what does not. my job as a reporter is just to look at what people are saying. a lot of people complain about high deductibles. if you have an employer plan, a lot of them are anticipating the cadillac tax. they are anticipating that they are going to be taxed higher to provide more expensive plans. the cadillac tax will supposed to apply only to the wealthiest

americans. those receiving plans that were so expensive and high that it would just apply to the wealthiest people. however, because the cost of health care is going up because of premiums deductibles most things are going up that means that middle-class people, teachers nonprofit workers, technically it will have a cadillac plan in a few years just because these overly generous definitions and up apply to some more people. host: mary in maryland. hello. caller: thank you for taking my call. good morning. i am a little angry at utilities right now. you're not really telling the colors the things that they really need to hear. let me tell you what i went through. i'm on the aca. i just got the letter from blue cross blue shield. a $74 a month plan. my deductibles 1500. i'm in the cross sharing. network,within your

your insurance company will pay the other half of your deductible. is 700.tible you're not really supposed to pay on the deductible. that goes to the doctor. i never wents online. i went to a navigator. ton it man for maryland, go a navigator. there's credit for you. is $555. i went to a navigator and explained. he said the insurance company will close the plan, move people to another plan without informing them. you get the bill saying your mount has tripled. go back to navigator. even if you need a gap. go back and say you cannot afford that. it will find a better plan. when you -- about aen you talk navigator, what is that? caller: it is --

it is a person who knows the website. i want on that in the bill i cannot with the was $200. when i went to the navigator and made an appointment she found a plan at blue cross blue shield. the silver plan is what everybody needs. my navigator move me over to the silver plan hmo my cost will be $65 a month. my co-pays five dollars and $10. you do not worry about paying your detectable. people talk about the $5,000 deductible. the should of got to a navigator. the insurance company wants you to have a high plan, they do not want to work. host: thank you. guest: the navigator has become very popular. my understanding why set down with the navigator watching the navigator help the consumer, they were not hard to make sure it people are getting the best value or find a plan that fits for them. so, navigators are great. she is right.

the caller mentioned cost-sharing. that is different than the premium subsidies available. the premium subsidies are available for people who make 400% of the federal poverty level. it is a metric the government uses to make things more confusing. that is something you get that takes up the cost of your premium. so if your premium is $150 and the government gives you $50, your out-of-pocket premium cost is $100. the cost-sharing subsidies are for people between 100 to 250% of the federal poverty level. so, a portion of the people to get the premium subsidies. that is designed to help people the out-of-pocket cost. reduceductible would be because these cost-sharing subsidies are available. some people argue that they should be available to more people. they are very costly to the federal government because it is

my they are handing out to help people pay for insurance. so the caller mentioned the other car have for maryland. perhaps if he qualified for cost-sharing subsidies here find that plan a lot more affordable. host: justin in nebraska. hello. caller: hello. how are you guys doing? now,my comment is, right think the problem with health care and affordable care act and everything is that right now, health care in america is a huge business. when a person goes and they create a product or something like that, they're selling the product. wrong, they are trying to solve an issue, but they want to help themselves. we have health care is a

business. insurance companies are going to drop people. as a business. they're are trying to make money. they are not tied to help. host: health care is a business. guest: insurance companies are under the law. they cannot just drop someone. they cannot just not accept because of a particular illness. they have managed to look at loopholes in different parts of the law. arguee cases, some would that mental health has not been covered. there has been a a lot of discussion over what kind of contraception is for women are covered. the administration has had to clarify what it means every so often when it looks up law. yes, we meant contraception to be covered. then, it takes public comments and looks at what people are saying.

going back to prescription drugs is a business, there is not a lot of transit baird see -- transparency. drug companies say it is -- it is expensive to develop a drug. most drugs that work on never make it to market. they pay all this money for drugs that fail. in addition to that, we have to recoup the costs from drugs that do make it to market. also have to have enough money for innovation in the future. how do you set a price on that? that is their argument. however, we are seeing all these high costs. rise seeing drug prices more than any other part of health care spending. double that in 2014. so, looking at that will be a big part of how we ran in the costs.

when the aca began, we talked about co-ops. what is that and what is the status? to be an was designed alternative to a private insurance company. it was going to be a group of people together in a state or region. have them insure each other. the same weight insurance works at a private insurance company. get all of the people together at a nonprofit. be an alternative to the health insurance company. it ended up being one of the biggest failures. found that there was one significant factor in their demise. , which was arridor risk mitigation tool, it was designed to adjust to the market. the theory was that they would change everything, change risk rules.

you get all the coverage you need. if you have a hard time adjusting to that, this risk program was supposed to help you recover. politically, republicans lashed onto it as a bailout of insurance companies. 2014, a provision was inserted into a law. marco rubio has taken a lot of credit for it. there is disagreement over whether he was the head of the provision or not. to make the program's budget neutral. to take money out of it. the co-op was the newest insurers. they said they needed the most help adjusting to the market. they did not get the money to fix their cost. they said this led to their demise. the problem for consumers is that they had these co-ops for insurance in 2014. now, they will go away. so, in some states the co-op was

a major insurer. colorado had a huge co-op. consumers of all find new insurance coverage. they do not have the promise that the president made of keeping the insurance that you like. so, the co-ops were a quirky idea. something new to try. to increase competition. cliff, in new york. calling on the uninsured line. you are on the washington journal. caller: thank you for having me. it is important to remind everybody that the poster child for co-ops, kentucky, is in the process of going down. we all have to admit that none of the promises that were made bringing health care superlow, keep your doctor and insurance,

none of them have been kept. when the slow was being made, there was a joke that if you do not have a seat at the table, you are on the menu. i'm sorry to my democrat friends, this was a giveaway to the insurance companies in the drug companies. of course their stocks are rising. of course they are. of course the prices are going up. now, it is subsidized by the government. why anybody would think putting the federal government between the patient and the doctors's going to bring down prices is beyond me. it is beyond the pale of the aca. it is neither affordable or about care. it is not about health care. it is about insurance. host: kimberly. guest: when obama was running for the presidency, and when he was touting the law for passage,

he did say that people would be of the keep their doctor. that turned out not to be the case. has named that statement as the biggest lie of 2013. the problem was that in making that promise there were almost not looking at the unintended consequences. when you're asking insurance companies to cover more people and services. we have to find a way to rein in costs. one way to do that is by providing a narrow network of doctors and hospitals. these plans will not necessarily have the doctor you're used to. they will not necessarily cover all of the physicians and nurses and other health care providers that you're trying to visit in the hospital. making that kind of a promise was not rooted in fact, because it was already occurring pre-aca. and regulations arguably made it worse. guest: what have an interesting

dynamic and that we have two truths about the aca. the democrats are trying to say that the uninsured numbers reducing. becausee being saved they're getting a cancer screenings and they're catching diseases early. all that is true. then we have the republican narrative which is the broken promises from president obama. rising premiums. all that is true. so, i think that's why the politics have been so severe and so harsh for these last six years. we have two stories that are true. both parties have some truth behind their political arguments. i think that is why the aca will be as volatile. oft: it is christmas eve 2009 when the senate passes the affordable care act. it is in march of 2010.

how far along are we in the limitation of the affordable care act." -- act? all, therst of marketplace has rolled out. this is the third year of open enrollment. the individual mandate which required people to sign up for insurance or pay a penalty, we have had smaller parts rollout. nutrition guidelines at restaurants. we have had preventative services covered. able to stand their parents plan until 26. a lot of the law has rolled out. for the next few years we will see more. thiss impacted the end of occurring in 2018. so, will see what some of the impacts are there. have been some adjustments along the way that were different than what had been anticipated.

by the administration itself. what is going to happen in 2016? guest: i think we have prescription drugs to watch out for. the president last year will shore up the aca. broadly, we have in 2016, where the second case about the obamacare birth-control benefits. this is the requirement that insurers provide contraception. a 2014 the hobby lobby case would to court. the justice said that businesses do not have to provide birth-control if ever religious objection. now, part two is religious employers, such as cap universities, charities, things like that. they are objecting as well. they will the same exception. thes interesting, because

hobby lobby of the world had no accommodation. they just had to do it. the religious institutions do have an accommodation. the white house said they met the religious objection. as well as a requirement that contraception be provided and health-care plans. so, the religious institutions do not have to provide it directly. what the justices have to decide is if the religious institutions first amendment right and religious freedom right knee protected. situation inhave a which religious universities have to provide contraception. hobby lobby's will not. that is interesting. or, justices could say that none of the institutions have to provide birth-control, if they do not want to. we will probably hear that case in march. we'll probably hear them talk about texas, that is on whether

texas can institute restrictions on abortion access. that is going to be a big story in 2016. host: linda is in florida. hello. caller: hello. many of the thoughts and ideas i have had about this already been met. i hope it is not repetitive. my husband and i were on the afford care act last year. our deductible was $6,500 per person. i really struggled with taking a government subsidy. we're not going to take it this year. we will pay the penalty. , it iseither affordable intrusive, i'm so disappointed in it. we're going to take our chances on not having insurance. understand when people say

they do not have health care. , obviously, wed qualified for subsidy. we're not rich people. but, i do have access to health care. most people do. burden is not greater than the it will be to pay premium. we always carried our own insurance. my highest premium was $500 a month. that is what i have to pay minimum with a subsidy. they have to do something to address this. host: kimberly. guest: this is one of the biggest complaints i'm hearing from users ofd the affordable care act. as she mentioned, struggling with accepting subsidies. i wrote a story in which i interviewed people who said i will not participate in this because i do not want to accept a government handout.

even when you have these plans, often you are not getting everything you need. so, evaluating different plans is another option. every person can choose what is best for their situation and further help. it is difficult to anticipate what needs you will have. having insurance does help protect people from those kinds of risks. debby is in arkansas. hello. caller: i was on the silver plan. i just qualified for the subsidy. so, there are one of my one third of my income. out of the co-pay was $20 for generic. 15% for the00 plus non-generic. i do not make that much. i told him i cannot afford it. they said i'm sorry, get on medicaid. it is still too much to get on state medicaid.

i am totally without insurance until i turn 65. i've called everybody. there is nobody who will help with a premium i can afford. host: wow. guest: she is getting at a gap we talked about in coverage. she is in a really unfortunate spot where she almost qualifies for medicaid. she does not. i think that if a backer of the aca were here, she would say that these frustrations are legitimate. ideas, onerepublican idea that democrats are from republicans was personal responsibility. so, if somebody was uninsured goes to the hospital, is in a terrible car accident and has thousands of dollars of bills, those costs are being paid by every of the consumer. to give everybody insurance

coverage, but reduce the cost and total, that does not do much for somebody who like the caller said, almost qualifies for medicaid, and they're asking for a third of for income for insurance. that is a problem that democrats have to face. they have the good part of the law and expanding coverage. they have the negative part where this is a real story. i do not know how they will marry those two issues. in north carolina. please go ahead with your question or comment. caller: thank you for taking my call. i wanted to mention a plug for the affordable care plan. for 20 years i worked in corporate america. i always had my insurance through my employer. through the last recession i lost my job.

being in my 50's, it is hard to get the high-paying job that i had before. i had to sign up for the affordable care act. i had pre-existing conditions. nobody would sell me insurance. before the affordable care act. i cannot have gotten it. shortly after i got the insurance i was diagnosed with a brain tumor. i also had to have a hysterectomy. i also had other health problems that required hospitalization. all of this was stuff i did not count on. after i wasplace able to get the affordable care act. available, what i want to say to these people who say they do not want the subsidy because they're too proud or they think it is irresponsible are whatever, what is irresponsible is not taking

on insurance. have?which plan do you how much do you pay? what is your subsidy? caller: i would have to give you just the ballpark. i have the silver plan. was $800, my subsidy per year. that might be wrong. somewhere in that neighborhood. by the way, the subsidy comes in the form of a tax credit. that is what i do not understand. cuts, thes like tax subsidy is a big tax cut for everybody. it comes in the form of a tax credit. me and my husband a $130 per month. it is better coverage than i have had through all the years i was employed. coverage,ot had this we would have lost everything. most likely what would have happened is that i would not

have gotten the mri. the doctors would not have done it. it found my brain tumor. i would still be living with a brain tumor and having the impact of that. it could cost me my life. host: thank you. kimberly, u.s. news & world report. guest: we're hearing a lot of the stories also. the variation of experience in this law is so different from person to person. state to state. every situation is different. so, there are cases in which people are very happy. approval of the law in general has stayed the same. host: nearly 50%. guest: yes. nearly 50% disapproval. that is according to the gallup poll. that has not really changed as provisions have rolled out. that is were concerns from the

administration should come. you have these provisions yet people's variability has not changed much. oft: this was susan and four premier, the health care-based company. 3600 member hospital. this is some of her writing about this. it is that the aca has not broken the bank. employers have not dropped coverage for their workers. the aca is alive and well. it is continuously being implemented. arguedgressional office that it will cost $142 billion over the next 10 years. 11% less than the agency had predicted. how do they figure that cost? guest: that comes out of everything. where looking at how much is the nation spending? how much is the nation taking and from these tax

cuts. i just wanted to add to the caller that one of the things 2009-2010hoped for in when the result is animosity, democrats were hoping for callers like this one, she got insurance, and then the doctor found her brain cancer. she had a hysterectomy and had coverage. democrats are banking on these good stories. they want multiple examples of this. found thisters have as well. good stories are out there. it has not changed public opinion. polls are sitting where they were. , it is baffling on one hand. on the other hand, people separate these good stories. with good consumer reports. they have the politics of it. there are some people who do not

like obamacare, but like their plant. there is seen to be a divide on a consumer versus political that people have not overcome. i do not know that they will. host: from 2008-2013 according to this article, the growth in this nation's $3 trillion health bill hovered below 5% in 2014. cost climbed by 5.3%. they will likely rise by 5.8% annually for the rest of the decade due to the aging population. costly diseases. the infrastructure costs of the health care transformation. what are those infrastructure cost? guest: it has to do with changes in health care and new portions of the lobby developing. going back to when you are

talking about how the cost of the aca was less than originally anticipated, it is a little more complicated than that, because it is less than anticipated because not all states expanded medicaid. when they had anticipated the law, that is something they thought would occur. it did not. fewer people signed up for marketplace plans then had anticipated. that could be good news. it could be that people are getting jobs and getting it through their employer. or they are choosing not to enroll in insurance. or, they are on enrolling in some cases. michael in alabama. go ahead with your question or comment on the formal care act and health care in america. well, i'm from alabama. have blue cross blue shield.

i have to go to a new doctor every month. it pays for my psychiatric doctor. i think if you years ago, it has been a while back. this drug caldwell putrid. , they dopposed to be not have a generic for it. was about blue shield 25 or $30. it paid for that. of any otherw health provider in alabama. host: ok. we got your question. what awant to address lot of colors are talking about which is these prescription drug costs. what are we start with choices in alabama. some of the prescription drug costs. guest: i do not know the list of choices in alabama. they are available on healthcare.gov. they vary state to state. the number of insurers go who

chooses for that state. mississippi they only had one insurer in most counties. that is not much choicer competition. that changed. i think that most of the company has many choices. callers can see the number of options in alabama. if other insurers wanted to go there -- i'm sorry i'm forgetting the second half. host: let's see if kimberly wants to address prescription drug costs. guest: one of the proposals been made about these drug prices is to post what they each cost. drugsw that prescription have been a major driver of the growth in health care spending in 2014. at u.s. news we have an interactive we have developed that looks at costs over time. it is called the health care index.

it will show how different factors of health care impact the economy. some consensuss that something has to be done about this drug prices. the center for medicare and medicaid on the last week posted on this dashboard of what they spent on medicare. on the top 80 drugs. that is one way to get consumers to say hold on, this is what we are paying? host: i think 180 $9 billion was spent last year. on drug costs. they said it could reach 400 billion. is 373 billion when you look at what everybody puts into it. host: in prescription drugs? $273 billion. that includes out-of-pocket costs, co-pays.

everything. that includes what you get of hospital and which administrative yourself. host: this drug spending cuts for 2014. allen is in alabama. good morning. how are you? i have two simple questions. one is, in your opinion, what you think is affordable about the affordable health care act? second, do you think it is fair? host: what do you think? i -- no, it is unaffordable. i cannot afford it. i work a full-time job. it is not affordable. it makes no sense. host: have you investigated it and done the exchange research? caller: yes sir. host: does your job offer

insurance? caller: no. they cannot afford it due to the way the law is written. over 50, then it will be unaffordable for everybody. as far as being fair, i think it is highly unfair. if you do not sign up for to be penalized. why are you penalizing me for something i cannot afford? that is not right. host: if he does not sign up, what happens to him? he works at a place with less than 50 people. he says he cannot afford it. will he have to pay penalty? guest: yes. will belty in 2016 $695. per individual. host: how will people know that he does not have insurance? honest taxesl be

for next year. he will have to answer question about having insurance. if he says no, he will oh $695. there are exceptions. if you do not make enough money, you get out of it. if you have a hardship in the year, you could get out of it. in 2014 2015 they were pretty liberal exceptions. to can officially say i try sign up and i had a hard time coming you could get out of it. and years to come and be harder and harder to get the exception. it is kind of considered a grace time. if you have a legitimate reason, or if you are covered for 10 months of the year, you will not have to pay the penalty. is a substantial amount of money. the $695 is a lot of money. for a child it is half of that. is 695 dollars

or 2% of your income. whichever is higher. for some people, that 2% could be a lot of money. host: we go to west in chattanooga. good morning. caller: good morning. thank you for taking my call. i like to say that i'm a 66-year-old proud vietnam veteran. i also work at the v.a. until i had heart issues. i am on disability. anyway, to make a long story short, the differences in medication, people being able to contact the government. the v.a. can get one price, it medicaid gets one price. for as all designed capitalistic society. giving the free market a chance. i would just like to say, if we

take the politics out of it all, the latest from north carolina, the man from florida, both of them said the truth. plain and simple. i am a southerner here in tennessee. have this red attitude and blue attitude. it shows. it is sad. it is said because it is called affordable care. it will work. take the politics out. host: we got his point. do you have any response? ,uest: looking at drug prices one of the biggest arguments that pharmaceutical companies make, when you look at some of these prices, some of which reach $100,000 per year. they sate is a listed price. many other institutions negotiate different prices. we do not always know they are, but they might not be listed.

that has given them some room to price things differently. when they price drugs, they take that into account. that has been an issue goaded to drug prices. whether they will be more transparent moving forward, or whether more choice will hit the market. host: george in florida. go ahead. caller: good morning. florida.ng from in fact, i live in austria. weigh in onwould this conversation. i spent most of my adult life in europe. i have national healthcare. in austria. i listen to these discussions and descriptions of what is going on here in the states. i'm kind of horrified. i can give you a few examples. my wife, who taught for 15 years

at a big university of in boston , had insurance through them. she also has national healthcare. she is retired now. -- she had cancer when she was working. sure it through all the things one does. you mentioned your horrified listening to the bait. why's that. -- that? caller: the complications. the politicization's. the hoops that people have to go healthy.o get and stay the prices they have to pay for medication. can you take your austrian national insurance card to france, to england, to anywhere?

caller: yes. , over the years i spent quite a bit of time in france and paris. doctors when iee was in france and in paris. and in germany. in cyprus. host: does your card work here? caller: no. it does not. my wife is retired, i'm a professor, i have more free time than i used to. our kids are here. so come to the states more often. no, we take travel insurance. if something serious were to happen, our insurance would pay to get back to austria. need to bes hospitalized, they would pay for that. they do not have the agreements with the u.s., i do not think

any european countries do. host: 20 think there's a difference? partly i think it is politics. there is a lot of misinformation and lies about national healthcare. how it works. it is very simple. we heard this morning, i have not heard this whole conversation. of not wanting to take government handouts. said, it is a tax break. i think it is basically insurance companies having a stranglehold on health care. host: thank you. they differ your perspective. we go to jennifer. guest: it is interesting. forve heard similar things

people. they like the government run health care system. it is earned popular. of course, you hear criticisms every once in a while. i think that overall, their popular. and the united states we have canadian health care or european health care is negative. we hear about waiting lists and we hear about whether or not you get care. , in the united states, after world war ii there is a development of your job providing your health insurance. that's sprung up, and now the vast majority of people get their insurance from their job. employers like that they can provide it as a benefit. it is enticing to employees. said when he even was campaigning that perhaps, there is a better way to do this. you cannot disrupt a huge

country where over 50% of people get their insurance from their job irish shaping system. they had to build on the private insurance program. where, companies provide insurance. your employer will offer insurance. and, that made up more complicated than just saying that the government will provide your insurance. host: web if human is left. been in pennsylvania. good morning. go ahead. -- ben from pennsylvania. -- we only have a few minutes left. the affordable care act. i'm 42 years old. i've been a democrat my whole life. i will not be a democrat in this next election. before the affordable care act, i had insurance. i did not have to pay this huge subsidy. now, i have a plan that costs five from $75 per month. bull -- $13,000 but dr.

the dr. bull -- deductible. is $140 peridy month. at the end of the year, when i get my taxes done, if i make more money, they will make me pay it back. to say that you will fined six under $95 if you don't have health care, it is like saying ok, if you do have health care insurance, and you do make more money, you will pay more than that. me, this got word was because of lobbying, the health care side, and the government saying look at this, health-care companies when. this constant money going to them. it government winds because is less money they have to get back.

the american consumer loses. host: thank you. kimberly? guest: this is a story we have heard a lot. about deductibles, how can afford to pay them you can i would encourage viewers to really complain to the department of health and human services. complaint to state regulators. say this is how things are going for me. there are people on the other hand working to try to improve the law through the process and clarify some of the guidelines. a lot of consumers do not file these complaints. ,hey might not get money back but, it is important, the system's arm place to help people. so, it is important for people to let their government, state and federal government know what is going on with insurance. host: rudy in california. go ahead. yes, i was on the

affordable care act and 2012. that was after i got unemployed. i page $208 per month. was $485, if it was not for the affordable care act, i would have gone without insurance. so, this is a plug for the affordable care act. plus, i do not hear too many republicans taking their kids off insurance. so, in my opinion, the affordable care act works. maybe people should come to california and they would not have problems. host: thank you for calling. in fact, several million -- i'm looking for the figure -- several million people have stayed on their parents insurance up to 26. the figure not know off hand.

i would say it is the most popular provision. it has a lot of bipartisan support. whenever republicans talk about a replacement plan. they say they would include this. so, i assume it will stay in existence forever. one of theutcome of most popular pieces is that insurance companies cannot deny coverage to pre-existing. host: we have about one minute left. ashley, florida. caller: good morning. i have a few questions. number one, are either of you licensed to sell or speak but health insurance? do either one of you have an aca policy? host: why are you asking these questions? that i liveoint is in florida, i'm 59 years old, i am uninsured. i have sold health insurance for 25 years.

neither one of these ladies on their program speaking about insurance -- they are not even licensed. you called in on the uninsured line. yet you sell health insurance? caller: no, i am unemployed. i saw my license. i do not have insurance. host: thank you, that was ashley in florida. do either of you have an aca plan? guest: no. i go through my employer. it is a large company and it has always provided insurance. throughave insurance your job, you're not allowed to go to the marketplace. quality insurance coverage, you're not allowed to go to the marketplace. guest: even though we have private plans through employers, we are still impacted by some of the rolex of the affordable care act.

we received a lot of preventative benefits, and care that anybody else would. , give us5, health-care your 32nd summary. kimberly. guest: we started to see a lot more consensus about what needs to change. there has managed to be role that in certain taxes. were uphelds through the supreme court. that means no matter where people apply for aca, the matter what state they are rain. they are eligible to receive a tax subsidy. host: what you think will happen 2016? guest: it will continue to be a battle. both sides are lobbying. not just push back, they want things removed. we will need a way to pay for this tax insurance subsidy.

we will need a way to pay for people on the system. they're going to have to find a way to fix these issues. 2015i will remember because the aca survived. it faced a challenge in the court, and it was the law pretty much the same with the cadillac tax. i will remember this year as the year where bipartisan changes became possible. medical device tax, which we talked about. we saw a couple of tiny tweaks that affect expatriates outside the countries. 2016, the attention will shift from capitol hill witches and outside of health care story in election-year, let's focus more attention on what the political candidates are talking about for the aca,