will discuss the feasibility of a government-funded national health insurance program. also, washington times political editor's talk about the trump administration's request for voter information and reaction from state officials nationwide. watch c-span's washington journal live at 7:00 eastern monday morning. join the discussion. this week on newsmakers we are joined by the president and cto of the american hospital association, rick pollack. thank you for being here. rick: thank you for having me. greta: we have anna edney and peter sullivan covers health care policy for the hill. let's begin with the affordable care act. does it need to be repealed and replaced? rick: it certainly needs to be repaired for certain. anytime you and act legislation of this magnitude over a period of seven years or so, there are things that need to be corrected. even when it was enacted people

knew from the day he was enacted they would need to have changes. you think about medicare and medicaid, how many times it has been amended and changed. it certainly is in need of repair. we havee repeal of it, concerns in that regard. as the house passed a bill in the senate is working on one, is there anywhere near preparing the pieces you like to see fixed? rick: the senate bill perhaps goes in the direction of dealing with private market stabilization and dealing with the cost-sharing reduction issue, which i think would address some of the instability we see in the exchange part of the insurance market. that is certainly something. the large-scale productions that would result from medicaid cuts as it relates to coverage, those are things we have great

concerns about. peter: you have made some strong comments against running current bill is going in the senate and the house. on the senate bill, maybe you can go into what kind of negative effects to see if the bill passed. you can see hospital closing? what with the effects, of that affects you see? rick: we look at it through coverage. what this means in terms of coverage for the uninsured. when they say first pass was intended to cover 32 million people, and ended up covering much less than that because of the supreme court decision with regard to medicaid expansions. for us the concern is coverage and the coverage losses that would result. relate toly as it the medicaid program. medicaid serves the most foldable population. so many kids are on it that are learning disabled and have disabilities. one in 10 veterans are on the

medicaid program. two thirds of the money goes to taking care of elderly folks in nursing homes. that cuts to the medicaid program, which in both bills are rather dramatic, over $700 billion and one over $800 billion and the other is a great concern to us. and the coverage estimates that go beyond the coverage losses and medicaid are also pretty substantial according to the congressional budget office. for us the big issue really is all about coverage losses that would result from the legislation, both in the house and senate. that is why we have been opposed to it. anna: that is really bad for patients, doesn't need the coverage that will rely on it. as far as hospitals go, how are the hospitals affected? bottom line, with what could happen on the medicaid cut? patientsst, it's about

inpatient able to get coverage for care. that is the number one priority. in terms of hospitals, when the aca was created, we redeployed $155 billion at the time towards helping coverage from will we hope would be millions of people. there were two pieces the funding that coverage, the revenue side and a series of reductions in spending. from us, if we are going to see increased uncompensated care given the fact we gave reimbursement coverage, that puts us in a real tension. -- pinch. medicaid reductions would put us in a real pinch. medicaid currently pays hospital less than the cost of providing services. if we are going to see reductions on top of a we have already contributed, plus the new ones, it will make it very difficult for us.

what does that mean? the potential of making tough choices. it means certain services may not be able to be provided. it means they could be job losses because roughly 60% of the hospitals'budgets relate to unemployment. -- employment. we may see delays in the ability to upgrade our facilities or purchase new technology. those of the tough choices that would result from reductions of this magnitude. again, the biggest concern for us really is the whole issue of getting people covered so they have access to care and they get it in the right place at the right time and that our emergency departments don't continue to be the family doctor for people. peter: given these concerns, what is your strategy in terms of trying to oppose it or change it? are you going to run ads? are you having meetings on the hill? what is your strategy?

rick: all of the above. in a situation like this obviously we work to try to shape the legislation and urge the medicaid cuts not be a part of it. we urge that there be assistance to the non-expansion states, of which the house and senate have done limited things in all objectivity. we urge they maintain the minimum benefit requirements. but those provisions are still in the bill. and that is why we are against it. in terms of strategies, grassroots. our members are speaking out providing the data impact is crucial. and a been advertising variety of other techniques to make sure our voices are heard. anna: to you feel like any of that is getting through? have you been able to sit down with leadership in the senate and convey these concerns and feel like they get it and maybe

there is some changes coming? rick: we have had the opportunity to convey our concerns to leaders in the house, leaders in the senate, people in the administration. they have listened to our concerns, but i don't know that they really hurt them which is why we are where we are and having a real problem with the legislation having to oppose it. peter: how did you -- there was a lot of attention on the relative secretive nature of the process. now we have a bill that has been released but that was only a week or so ago. did you feel that before the bill was released there was enough input gotten from stakeholders like aha or did you feeling the process was open enough? did he wanted to be more open? rick: for stakeholders like us, you can never have enough input and anything going on. been theess has not textbook of how to build -- how a bill becomes a law. that is the prerogative of the

leaders to go through. they have clearly run into problems among their own membership relative to the process they have gone through. we are where we are. asfact the process continues congress will be returning this coming week. we will continue to the efforts on the senate side to cobble together enough votes to see if they can pass it. again, it will be out there expressing our concerns. anna: we have seen a few republican senators come out against the version that is out there now and looking for changes. have any of this specifically talked about hospitals are there concern for rural communities? rick: absolutely. we have heard from people expressing a lot of the concerns that we share. the need to maintain the medicaid expansions and provide coverage for people and ensure

we don't lose that coverage. we have heard a lot of people mention that. in terms of expressing concerns. l issue andthe rol hospital closures. there are a lot of different responses you will see as a result to some of the reductions in the loss of coverage. closures could be one of many. we have heard senators express those concerns from various states. the idea of before repealing and replacing obamacare, and even before obamacare closure of hospitals was a big issue. 50 a -- did the aca help that? were people able to close the gap a little bit? rick: over the last five years we have seen about 187 hospital closures. about a quarter of those have

been in rural areas. some of that is the result of budget pressures. others are the result of reconfiguring or redefining. one of the things we are in the process of doing in the field is trying to provide care in a variety of different settings, not just in the buildings we know and love and people depend upon. trying to coordinate care in various settings. some of that is the result of reconfiguration. some of that is the result of something not being able to survive in tough budget environments. hospitals have been in general more outspoken than some of the areas of health care injury -- industry. .nsure -- insurers when you're talking to colleagues do you ever say, we wish you would be a little more outspoken.

would you oppose this one that we are? rick: we focus on those and the provider community that share the same position and where is the american medical association and several physician groups, the double erp, -- aarp, the march of dimes, the american heart association. we've been working with coalitions and have held three forms in different cities in cleveland and in denver just over the last couple of weeks together as a coalition. it is significant that the provider organizations on the front line of delivery, nurses as well, have the most concerns with it. some of the other factors of the health care field have different types of concerns. a lot of their concerns tend to be on the pac side and went to see certain taxes repealed. in fact they do in a house and then it bills -- senate bills.

i think the provider side that delivers the care on the front lines in the patient side significantly have been aligned. it iswhy do you think that site is not getting what they are looking for versus that he mentioned taxes are being cut and house and senate bills. rick: it is always popular to cut taxes. that is something that has been a part of the discussion and that is something that those sectors are big beneficiaries from. that is where their interests ay. focuses tend to l peter: under other chances that have a particular chance of happening you are pushing for, or is your attitude that we need to start over with a whole new bill? rick: when we look at the

packages before us and we look at some of the tweaks that are being considered, we don't think they go far enough. we would say let's reset and restart. we have a list of concerns which we wish they would address, but they don't seem to be moving in that direction. they are pretty big as it relates to the medicaid cuts and as it relates to the issues around people maintaining the same level of coverage we have now, but it appears as if the focus will be more on tweaking the existing bill as opposed to a restart. that is why we are where we are. anna: senator ted cruz has proposed in a to the senate bill that would deal with obamacare regulations, one being pre-existing conditions. what are your thoughts on that? rick: we have concerns about that approach. fully understand that proposal would do, and of course we had not seen any paper on a yet, but

it would further bifurcate the insurance markets and essentially say you will have noncompliant plans -- aca plans and compliant plans. we are concerned the sick folks who went up in the compliant plans, the younger and potentially healthier folks will end up in the noncompliant plans. the noncompliant plans will presumably be cheaper because they won't be compliant with the essential benefits. they will be covering the essential benefit requirements you have in the compliants. you will have a lot of the high risk folks in the compliant plans and the premiums will go up for them. we don't think that is a good solution. i know that is something people have been discussing. greta: what does it need for hospitals? rick: for hospitals you have a lot of people with what we tend to call potentially skinny plans

that have very high deductibles. that needs trust will have a lot more people coming through that may not be able to meet those deductibles and those copayments. for us it becomes uncompensated care. we are special when it comes to health care. we take care of everyone that walks through our doors by virtue of either federal law for our mission. for us a lot of that will become uncompensated care. uncompensated care means private premiums for everyone else goes up. if you are paid less than your cost on medicaid, paid less in your cost on medicare, and if you are providing a significant amount of charity care which we do, then more uncompensated care means we have to charge everybody else more. i think all of this just increases premiums. peter: one of the things

obamacare did that sometimes less covered was set in motion programs about how payments work. you are paying for the quality rather than the quantity of services. with these repeal bills do you see that damaging those efforts? with that change those efforts? is there anything in the senate bill that you think what actually go after these sort of core drivers of health care costs and make things more efficient, for with the bill set back those efforts? rick: that interesting question. one of the things part of the aca was this notion we would move towards coordinated care, integrated delivery. people would focus on reimbursement more for value than volume, more on quality than quantity. those are all things we support. those are things headed in the right direction. the tools to do that never in the aca, whether they were bundling or care organizations or medical homes, you can get on

the list, all those things are good things. they had in the right direction. are the perfect? no. did any improvements? yes. should we be looking accretive options? yes. this goes back to the question of a corsini to be modified as you go along, but the important point you raise is none of this is being discussed. why? it really isn't on the table. a lot of these techniques are by and large things that enjoy part -- bipartisan support. i have not heard people say let's get rid of these things, let's appeal these things. frankly i don't even know if you could under the rules of reconciliation. these are things that we continue to be focused on because they are the right things to do to improve care, create efficiencies, and in the midst of all this unpredictability, we try to stay focused on moving in that direction. peter: you think those efforts

can continue even if the bill passes? it would leave a lot of that untouched? rick: on the regulatory side, how some of these things continue to be implement it at the speed in which they may be limited is certainly open for discussion. we have been pleased that hhs has said that on some of the projects they would do them on a voluntary basis rather than on a mandatory basis. we think that the better approach. i think that is the direction that again will continue to move. that really has not been a parse point. greta: here from viewers that we went to the hospital, was there for an hour and i got a bill for x amount of dollars, thousands of dollars. the public does not understand what costs so much when they visit the hospital. rick: a lot of time and people receive these bills is a

statement of what a charge might have been. it is not exactly what they are liable for out-of-pocket because very often an insurer has negotiated a rate with the hospital. it is much lower than what the charge may be. tickets every complicated, i know. you would get medicare or medicaid. they just pay hospitals a rate. there is no price, there is a rate. we get what it is they provide us. there really is not much of a negotiation. that is roughly 45% of the hospital's revenue. when you see those there is a real delta between what may be on the bill versus when you are out-of-pocket exhibitors. the other part is the hospital perspective we provide care for everyone that walks in the door. again, for a lot of people there is a hidden tax to pay for the

uninsured. the 23th the aca and million that are covered under it, there are still tens of millions of people that are not covered under it, even under its best day. we are still in that situation where you have that proverbial cost shift or hidden tax which raises the cost for everyone because at the end of the day there is no free lunch when you are taking care of everyone. greta: five minutes left. to bewould be a good idea more transparent about what those costs are in the actual payment would be if they did not have insurance? or if there is someone who was to compare having knee surgery or something, with that be something the aha would be behind? rick: the whole price transparency is something we understand and we support. in fact, if you get to our government site,

hospitalcompare.org for the most common procedures, there is information on prices. 44 states require hospitals to forout what the rates are, certain comparisons for the rates. we also have to remember what consumers really want to know is what is the out-of-pocket exposure is. that is something insurers also have to be a part of. we have to recognize we are not dealing with manufacturing widgets. we are taking care of people. people are different, conditions are different, people react to certain situations in a different way biologically, physiologically-wise. we know we have to be more transparent and pricing and we are working to do that as best we can. peter: returning to the aca and our final minutes, if there were going to be some sort of bipartisan effort to fix the aca aside from this bill, what are

some of the big fixes you guys were like to see in some sort of bipartisan effort? rick: we welcome a bipartisan effort. the first is the cost-sharing reduction stabilizing the exchanges. in the exchanges we have seen premiums go up, and again that is the sliver of the individual market. 7% of all lives are in the individual, nongroup market. cap of those are in the exchanges. it is that sliver we have seen real problems with skyrocketing premiums. all the studies suggest that taking the cost-sharing reductions would address that issue. it would give confidence to the insurers to stay in for the next year. that all to be top of the to do list -- ought to be top of the to do list. peter: any more fundamental changes you look forward to? rick: i think that is probably the most significant one for right now. that is stabilizing those exchanges so we can continue to

provide coverage for people of limited means through the mechanism that represents helping people buy from -- private insurance. anna: what are you looking for next? quarter you watching for next is this debate continues on? lawmakers will return from their fourth of july break and it could be a floor vote. what you watching for? rick: we are watching for one of the changes that the majority leader will make to the bill that is out there. as we all know, senator mcconnell is extremely skilled enable and he will in his own words be twisting that rubik's cube to see what he can do to accommodate different folks. there has been talk about trying to address the issue of opioids. there have been other things i have been talking about. senator cruz'a proposal -- cruz's proposal will be out

there. there will be what seeing quite tweaks survive the parliamentary review, whatever the score would be. i suspect the week after next will be one way quebec is seeing a product that is ready to be voted on. everybody will be looking at what changes will be made next week. greta: put in the conversation with the opioid portion of this. rick: i'm glad you brought that up. greta: that is something americans feel across the country and it's important to many of the senators. they have set no unless there is more money to deal with opioid addiction. what are hospitals seeing? rick: i'm glad you raised that because congress passed legislation to address both the opioid problem and the behavioral health problem. here we are dealing with medicaid that has provided care to so many people that are suffering from opioid addiction and from behavioral health problems.

the rolling back of the medicaid expansions and the cuts to the medicaid program by virtue of going to a per capita caps really are moving in the opposite direction as it relates to taking care of those types of populations that have a lot of -- this is the coverage vehicle to help them. providing money for opioid programs as opposed to getting people access to a comprehensive care package, we think is the way to go. that is not just throwing more money toward state programs for opioid abuse. when you give people the full comprehensive set of services and the medicaid program is probably the most effective way to do that. , president pollack and ceo's merrick and hospital association, we appreciate you being on "newsmakers." rick: thank for having. -- having me. greta: clear back with our

reporters, anna edney with bloomberg and peter sullivan with the help. let's begin -- the hill. was security american hospital association. they are obviously not for complete repeal and replace. them with like repair the affordable care act. where does this group stand as opposed to the other major players in the health care debate that happens in washington? peter: they have been some of the most outspoken against the bill, more opposed than other players. the insurance industry has been much more quiet, has not really taken a firm stance either for or against. they are playing their cards close to the chest. the hospitals have been more out there saying we are directly affected by this. we are providing care to people and this would have some damaging costs. costs. greta: his their influence felt on capitol hill? felt beingnk they

heard they have gone in and able to save their piece and talked to some of the leaders in their worship, but they don't feel there are changes that they need or put in there. they are trying to elevate it and they have some recent ads the american hospital association has put out trying to work avenues more in opposition to the bill. sullivan, the senate bill under the one drafted by leader mcconnell and is working group, there was no vote. he wanted to make some changes. what it heard about these changes? peter: he has a tough task because he had complaints on the conservative and moderate side he is trying to address. on the moderate side we will probably see more money for

opioid, -- the number is $45 billion to fight opioid addiction. is not clear that is even enough to win over their votes. on the conservative side, the amendment from senator cruz of texas to allow insurers to start selling planted on the all the obamacare regulations. there is a lot of fear from the more moderate members that it might hurt protections for people with pre-existing conditions. that is a big question as to whether that amendment and defend the bill. greta: these proposed changes seven made. the talk about the ted cruz amendment. these have been sent off to the congressional budget office to give them a score. and then whathear happens next? anna: we will probably here sometime next week when the congressional budget office will have finished calculating what the cruz amendment might do for the bill. the idea from senator cruz is to

have premiums go lower. there was some reduction in the original bill. he would like to see that get even bigger. whichsee cbo next week, they having graciously telling us when something is going to come out and possibly it will bring people aboard and we could see a bill the week after. greta: what are the votes looking like right now? peter: it seems like they don't have the right now. they don't have enough to pass it right now. last week it seems like there is many has 10 or so no votes. i'm sure there will be going up as they are making changes. there do seem to be some real hard no's, only three would doom the bill which asked the challenge. senator rand paul, susan collins and dean heller seem like the hardest no's. they all want substantial changes. it will be hard to do enough to

win over some of those people. greta: if it does pass the senate, they have to reconcile the differences with the health legislation. what is the timeline? anna: the idea we have inherent in the house is that they might pass thehead and senate passed. it would be another vote for them on a slightly different bill. they knew that could be coming because when a lot of these house members pass the senate voted for their version,members voted for their, saying they hope the senate makes these changes here and there, some of those changes are in their, so the idea most likely would be they would take it up rather than try and figure out where to meet in the middle. greta: although this before the august break? anna: that is the plan. >> a lot to do in a short period of time. anna: the staffers have been working. there are many days they tell us they don't have legislative text yet, coming out tomorrow, so these guys are working all the time. greta: we thank you both for

your participation, helping us out this week. thank you. [captions copyright national cable satellite corp. 2017] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] " --uncer: tonight on "q&a >> i'm not asking anybody to compromise their values. i'm asking them to open their eyes to other people's so you can figure out your place in this infinite world. announcer: brooke gladstone, cohost and managing editor of wnyc's on the media. ms. gladstone discusses her book "the trouble with reality," in which she looks at what constitutes reality today and how that criteria has changed over the years. >> i set up at the beginning of the book our biological wiring, and i wanted to show how we had evolved a culture that was designed to validate us and not

to challenge us. certainly not to contradict us. it gave us the illusion that our realities were watertight, when really they were riddled with weak spots and places that would crunch in. announcer: tonight at 8:00 eastern on c-span's "q&a." announcer: and's "washington journal," live every day with news and policy issues that impact you. monday morning, a physician for the national health are graham and -- national health program and someone from the cato institute will discuss the feasibility of a government-funded health insurance program. also the "washington post political editor talking about request for voter information and reaction from officials. be sure to watch "washington

journal," vivus 7:00 a.m. eastern monday morning. joined the discussion. announcer: now a look at president trump's meeting with russian president putin in hamburg and the state of u.s.-russia relations. from "washington journal," this is just under an hour. >> we want to welcome back michael o'hanlon, research fellow, out with a new book "beyond nato: a new security architecture for eastern europe." let's talk about russian president putin and the meeting on friday. what is your take away? guest: i think it did what it had to do. there are things that can be critiqued. we will continue to learn more about things that may have been said. we don't know yet if president trump tried to forgive president clinton for election shenanigans. we will learn more about that in the days and weeks to come. i thought what needed to happen was pretty much accomplished your there was