[murmuring]

>> looking at what is happening in congress, the house returns today a new dniester and then veterans- 2:30 where spending and military construction will be considered as well as energy and water projects, and changing the definition of a full-time employee from 30 hours a week to 40 hours a week. the u.s. senate is also back today at 3 p.m. to continue the debate on the irs commissioner nominee. that vote will be taken and later they will work on the

opioid crisis in allowing pharmacist to ride prescription drug information. watch the house live here on c-span and the senate on c-span two. join us for a marks on ruth bader ginsburg who is expected to talk about diversity in the legal profession in a discussion hosted by the george washington university law school and the national asian american pacific farmers association. is on our companion network, c-span3. and the atlantic council hosted an event looking at russian usedent buttons --putin's of propaganda. we have the entire program tonight on c-span two at 10:00. host: kimberly leonard joins us from the washington examiner, she is the senior health policy reporter here to talk about the future of the affordable care act. specifically, efforts by republicans on the act. what is going on? guest: they are looking at a bill that would repeal or undo certain taxes and obamacare.

-- in obamacare. what would happen is aspects like the employer mandate signs would go way. -- -- would go away. there is a tax on tanning salons that would go away. the house will be meeting to discuss whether to move forward with that. host: when it comes to the overall efforts, why are republicans still making these efforts on the affordable care act? guest: they did make a promise to voters that they want to follow through on, but it is important to note that a lot of these taxes have been delayed before, in a bipartisan way. so there may be room for democrats to jump onto this. of course, they won't frame it as repealing obamacare. they are instead likely to talk about a fix to obamacare. being packaged under the save american workers act, walk us through that. guest: that's right, essentially they are trying to help small , businesses when they look at the impact that obamacare had on

them. they would change the definition of obamacare's full-time worker from 30 hours per week to 40 hours per week. they would, as i mentioned before, lift the signs that come with the employer mandate. if youloyer mandate says have 100 employees you have to provide them with health insurance. that was supposed to go into effect and the fines were supposed to occur, but under this, the fine would be lifted over the course of 2015 to now. those fines would go away. it is just another effort to show voters that they are still responding to some of these needs, and seems like a follow-up to a lot of what you were talking about earlier on this program, with the tax cuts. host: is this a response from employers, something they've been lobbying congress to change? guest: one of the things that small employers say, and when i say small employers, i'm talking about restaurant owners, retail. they are concerned that a lot of the mandates in obamacare are

causing them to have to lay off workers or give them fewer hours. if you say that 30 hours per week is full-time, what if an employer moves there hours to 25 hours per week? then they aren't getting health insurance. so there's been concern about some of the unintended consequences of these mandates, would result in job difficulties. host: kimberly leonard is joining us to talk about the efforts in congress. if you want to ask questions, you can do so. if you receive health care from an employer, call (202) 748-8000. if you get health care via the aca, (202) 748-8001. everyone else, (202) 748-8002. even as you talk about this, a couple of things happening overnight, one takes a look at costs. tell us what happened. guest: if they were to put this bill into law, the congressional budget office, it looks at

different bills and scores them, has said it would cost the government about $52 billion over 10 years. that is because the government would not be taking in a lot of these taxes that are meant to ultimately pay for obamacare. like i said, there have been a lot of delays in the taxes before. one of them that is included in this package, that i neglected to mention, is called the cadillac tax, which is supposed to apply to especially expensive health insurance plans. what has happened is that so many health insurance plans now qualify as expensive, cadillac plans, that really just apply to your average, middle income worker. a have been pushing that back -- they have been pushing that back along bipartisan lines for years. it is set to go into effect in 2022. under the house bill, it would go into effect in 2023. host: sometimes legislators poo-poo the numbers from the cbo, and other times they

support it. what has been the reaction? predictions are difficult, whenever numbers come out, especially with obamacare, which had predictions that came off a little bit when they came out. they are always used as a political tool. you could argue that there is this large bill that has been passed for health care that is not being paid for, or you can also say, the government is saving all of this money, the industries are saving all of this money. or you could say the cbo score has been incorrect before. that is what a lot of members and up pointing to. to theeing so close november elections, what has been the reaction? this has less controversy than other parts. the senate has already said it won't be taking another swing at obamacare repeal this year, so even if the house moves forward, it is doubtful the senate will take it up.

they have a full schedule with the supreme court confirmation, and they want to pass an opioid response bill next week. -- this week. so it is difficult to see this happen before the midterm elections, but these are parts of obamacare, as i've said before, that have been passed on bipartisan lines. host: reaction on this effort from the newest senator in arizona, he was talking about it, tell us what he had to say. guest: not particularly about this effort, but jon kyl, replacing the late senator john mccain, has said that he would vote to repeal obamacare. we don't know if that means he would vote for the repeal and replace bill, the skinny repeal, the different measures that republicans put forward. even if he were to do so, you still have two centrist senators, lisa murkowski and susan collins have essentially said they want to work with

obamacare, want to make it better, or against repeal. republicans, even with jon kyl's vote, don't have enough votes in the senate. host: as far as the timeline, walk us through these efforts and how soon we may see action. guest: with the house efforts, they are meeting later today to discuss how they are going to move forward on it. the senate this week is really focused on the kavanaugh nomination, as well as the opioid package. host: talk about the effort by the senate, what is being done on the front of opioids. guest: they have finally come to an agreement after months of negotiations on what they want to see in this bill. the opioid crisis involves overdoses from heroine, prescription painkillers, and

an especially potent opioid, fentanyl. thousands of deaths every year, sort of an out-of-control public health issue that congress has tried to tackle. they have a lot of things they can do in terms of adding additional funding, removing regulations, speeding up the development of different drugs to treat addiction and pain. they have a giant package of 70 measures that they've cobbled together to try to reach an agreement. so, we are expecting it to get a vote this week in the senate. guest: kimberly leonard reports for all things on health policy for the washington examiner. she is here to take your questions. the numbers on the screen, (202) 748-8000 if you receive health care from an employer, (202) 748-8001 if you receive it under the aca, and others, (202) 748-8002. the first one is from rod in

indianapolis. caller: yes, hello. i have a suggestion. if they really want to help small businesses, why don't they just get rid of the insurance companies altogether and go to medicare for all. we are spending too much money, and all insurance companies do is shuffle money up the ladder into the hands of the very wealthy. doesn't help anybody. guest: there are more senators than ever who agree, the medicare for all act, a bill by senator bernie sanders, has an unprecedented amount of support votes in the house and senate, and is where a lot of the left-leaning democrats are looking to make changes. it would roll everyone onto the medicare program, whether they have private insurance,

medicaid, or are uninsured, to create what is often called a single-payer system. host: julie is in ohio, go ahead. caller: medicare for all is not free. people that have medicare have to pay $150 per month out of their medicare check, so that wouldn't be free. i get my insurance from my employer. our deductible is $5,000. when they changed this, it is terrible. they need to go back to the very beginning. cover the people, have an exception for people who cannot get insurance. my daughter gets aca and she pays zero. we have to pay $100 each week for insurance, it is ridiculous. my question to you is why, when i look up the aca, and says, did

you lose insurance? you can only apply through this period of time. why is that? it seems like you should be able to get insurance anytime you want. guest: the reason it is set up that way is because the law does not want to have a bunch of people waiting until they get sick to sign-up for health insurance. so what they have is a thing called open enrollment, for six weeks. this year, it is going to be six weeks, beginning on november 1, during which people can sign up for health insurance. there are a ton of exceptions. -- exemptions. for example, if you qualify for medicaid, you can sign up for medicaid at any time. if you have a circumstance in your life that has changed, a move, a divorce, the birth of you have the opportunity to sign-up outside of that time. . -- that time period.

the reason they set it up that way is so that health insurance companies can in no who is in their plans and what to expect as far as pricing. instead of waiting until they get sick to enroll. host: does the administration take time and money to educate people on enrollment periods? guest: there's certain money that they spend on things like navigators, and they kind of bring in the private sector to educate people about that. we are reporting on it all the time. but there are certainly ways that people can sort of get around some of the restrictions, and they have, as well. but insurers did look to the administration to say let's tighten some of these orders. in the initial years of obamacare, they initially spent a lot more on people who were enrolled than expected. host: the insurance company, cigna, put out a flowchart. it was on the employer mandate and it works like this, ask do

, you offer coverage? if the answer is no, $2320 for a full-time employee minus the first 30. does the plan offer a minimum value? if the answer is no, the fee is the lesser of $3400 -- this -- for full-time employee. this ultimately adds up to a lot of money for an employer. guest: it certainly does. but there are certain people who say, if you are going to have workers, this is one way to make sure they are covered. the affordable care act was about expanding health insurance coverage to as many people as possible. this is one of the ways they aim to do that, in addition to the plans we talked about earlier where people can sign up from healthcare.gov or in state exchanges. in addition to expanding medicaid to people making less than $16,000 a year. this is just one of several measures, one that keeps getting

delayed. a lot of it has to do with a lot of the activism by folks who say that it is impacting their business. host: this is eric from fort washington, maryland. caller: i don't have as much a question as i do a statement. i think the whole health care program has been a racist conspiracy. if all the states had been required to participate in the affordable care act, if it was never called the obamacare, instead of the affordable care act, there is no other bill that has ever been passed that has been called by a president's name, and the president does not pass a bill. social security is not called roosevelt care. the welfare work right is not called the clinton care. so the whole problem with premiums going up is the fact that states opted out, health insurance companies opted out.

if everyone was required to participate in the plan, premiums would have gone down. host: to that point, there was information this week about premiums under the affordable care act in the coming year. tell us what happened. guest: one of the interesting things that has occurred is that premiums are set to rise at a lower rate than they have in past years, about 3.6% rise, which is pretty low. there have been expectations that premiums would rise by double digits, so this is kind of a surprise. in addition, we have data that shows insurers are either expanding into more states, which will give people more choices about coverage, and show that they are also offering more kinds of plans in the states. all of this is happening despite predictions that said everything would be going in the opposite direction, that premiums would be going up and insurers would

be leaving obamacare. having said that, a small growth in an already high number is still a high number. a lot of people are looking at paying more in premiums next year or paying just as high as they are currently, which is high for a lot of people. however, there are people who fall below a certain income threshold, who, as one of our callers mentioned earlier, are paying nothing for coverage or premiums. but people should keep in mind as well that deductibles are a factor in all of this, and that whenever they take a plan, it is going to come with a certain number of doctors and hospitals, so it may not necessarily be the health providers they prefer. so, there's going to be an effort, i think, to educate people about what their offerings are. host: if there are reasons we are only seeing a 4% growth this

-- is there reasons we are only seeing a 4% growth this time? guest: one reason is that insurers looking into selling plans this year actually ended up overpricing their plans. every year, they apply to work in different states and sell health insurance there. they essentially say, here is what we want to charge in premiums. that is just an opening bid. from there, the health insurance regulators kind of negotiate and figure out what the prices are going to be. and they can't just throw a number out there, they have to show data, for why the plan will be priced the way they are. the plans are price pretty well, insurers are still making money and are not losing a lot, and are still able to make claims. -- cover the claims. host: our guest is kimberly leonard of the washington examiner. timothy from new york, go ahead. caller: yes, i'm currently on medicaid.

medicaid does not pay for everything, ok? i've gone to the doctor, and the chart, you'reour not your -- your insurance is not going to pay for it and there's nothing we can do for you. i find this kind of ridiculous, you know, that people that are on disability and stuff like that cannot afford anything. they are lucky if they can afford where they live. host: thanks, caller. guest: one of the things about medicaid is that it reimburses health care providers at a lower rate than health insurance. so there are a lot of doctors that will say we will not accept medicaid plans. but then some do. it might be worth asking a few different providers about whether they accept medicaid

plans, but because the reimbursement rate is so much lower, there does tend to be a sort of gap for people in regards to what they can access. host: penelope gets her insurance from her employer, calling from san antonio. caller: i think the whole thing should never have been instituted. i think it has been just another way to extend government. all they want is one single-payer, and they are going to get to it by forcing it and forcing it. taxes for the county hospital, where people were treated before this, have gone up and up. so the hospital is still taking the people in, yet in our state, they can't have these little health clinics at the walgreens or walmarts or different small pharmacies, because the state has brought it.

the doctors have brought it. if you have just those little clinics, you could reduce so much. people could pay their own, you wouldn't have thousands of employees and taxes and penalties and all of this nonsense if you just let the market work. host: before we let you go, have you seen changes to how your employer has provided insurance? caller: i am a retired government employee, so of course we get taken care of. i don't worry about myself, i worry about the poor people who can't put food on their table or medicine, or rent because they are spending so much money. guest: san antonio? that was the location? texas has expanded medicaid, it is one area where low income people can access insurance coverage. and the argument she's making, i think a lot of different health

care groups are undergoing this effort to show they can provide health care at a lower price, that they can better coordinate care. it is interesting that you are seeing groups like amazon saying we will create these collaborations with different companies and tried it deliver -- try to deliver better coverage and better care. so there's kind of a rolled out response from the private sector that says maybe we can try to figure this out. host: there's a story in the paper pointing to a federal judge in texas, a decision that might affect the future of the affordable care act. tell us what is happening. guest: is an interesting lawsuit. what happened last year is that republicans ended up zeroing out the fine for going uninsured on obamacare, known as the individual mandate. beginning in 2019, people no longer have to pay a fine if they are uninsured. the texas lawsuit, waged by a bunch of republican states, says

that because the mandate went away, they believe the rest of obamacare should fall away. adding to this complicated scenario is that the trump administration is saying instead of defending the law, we agree with the republican attorneys general, but only to a certain extent. they believe that only two parts of obamacare should fall. the one that requires health insurers to cover anyone regardless of pre-existing condition, and the part that says that if someone has a pre-existing condition, you can't charge them more than someone who is healthy. this has been a nightmare scenario for republicans heading into the midterm election, because the protections for pre-existing conditions are the most popular part of obamacare. and they are essentially running against candidates who are saying they are trying to take away your health care, or charge you more because you are a woman

or had cancer, or have an addiction. so this is a big part of what is playing out. host: is this the kind of case that could circle back to the supreme court, and if it does, what could that mean for brett kavanaugh? guest: for a lot of red state democrats, they really held onto this part of the law and this lawsuit, because they are able to say this is their biggest consideration, when they decide whether to confirm the judge. host: art is in florida. caller: good morning, i have three quick comments. the worst thing about obamacare was the fact that when it was written, the insurance companies and lobbyists were the ones that wrote the bill. so they wrote it in favor of them. so, how can we win on that one?

and republicans have made it their goal to destroy that bill to begin with. i have medicare, supplemental secondary insurance through united health care, which is phenomenal, but as far as socialized medicine, england and canada have wonderful programs that work. the lobbyists and republicans are just trying to scare people into thinking that this is not a good thing. that is total crap. my third point is that, i'm seeing in a lot of bills coming up about the opioid crisis, are any of these geared towards holding the big pharmaceutical companies responsible for the opioid epidemic, because they are the real culprits in why this epidemic even started. host: we will let our guest respond. guest: to backtrack for some

viewers, the opioid epidemic is credited towards the overprescribing of these narcotics that are extremely addictive, meant to treat pain. things like oxycontin. what happened is they were prescribed to patients in abundance, and a lot of people became hooked. once they sort of started petering out because doctors noticed that so many people had become addicted, people turned to a different drug, heroin, to maintain the high or alleviate the pain they are having. there are bills in the package aimed at holding pharmaceutical companies responsible. there are senators who have called for bringing in some of these pharmaceutical ceos to ask questions, hold them accountable in hearings and things like that. right now, a lot more of the measures are focused on giving more funding and resources to

places like the national institutes of health, to come up with nonaddictive treatments for pain and come up with other options for people who have addictions, so they don't have to go cold turkey when they are trying to overcome some of the difficulties of being hooked on these drugs. host: the caller started by talking about insurance companies. if i am the head of an insurance company and i'm looking at what republicans are trying to do with the affordable care act, what is going through my mind? guest: it is not just what republicans are doing but , democrats are doing, not just insurance companies, but hospitals and doctors. they would say they don't necessarily want to go in the direction of medicare for all, because they will be getting lower health insurance rates back. they won't be able to cover all of the services they currently

offer under the plans, and they say, we want to keep the aca. we want to have the senators invest in it, have more funding for it. things like that. i would say that a lot of health industries are pretty united when it comes to what they want. but members of congress are not united in terms of the approach they are taking, not what stakeholders want to see. host: helen from michigan is next. caller: hello, yes. you were talking a few minutes ago about medicaid. now, medicaid, there is one -- there was one time period that my husband was in a medical care facility. $8,500 per month, and i could not pay it. had to go on medicaid, and they are going to take my house.

>> we will leave this discussion at this point and you can see it entirely on her website, we are going live to the house which today is considering 24 bills, including legislation to provide grants to september 11 memorials, a pill to ban the sale of dog and cat mean for human consumption and providing three point $3 billion a year in u.s. aid to israel. live to the florida house. house wie in oer thhair lays be these aommuatiofr ker. peaker's rooms, washgton, d. septe2, 28. mameads to a as spea shgt, d.hieakes ro gned, ulry ear the hou reentatives. the ker pro tempore: pursanto thorf the e of jauary 8, 2018, the chair wl cognize membom