campaigns, and more. plus analysis -- informative podcast. c-span now available at the apple store and google play. download it for free today. he spent now, your front rows to washington anytime anywhere. c-span washington journal every day we are taking your calls on and off the air -- on the news of the day and we will discuss policy issues that impact you. coming up friday morning we will discuss the fallout of the speaker nancy pelosi's trip to taiwan and what it means for u.s. china relations with tina chang. at the heritage foundation. and then emily's list executive director emily kane on a portion. -- on abortion. and we will talk about the prime minister speaking at the 2022 cpac conference with alliance

for security of democracy -- david -- washington journal live 7 a.m. eastern friday morning on c-span or c-span now our free mobile app. -- text messages and tweets. >> this is sarah call and she is with the -- vice president of coverage and access to talk about health care in the united states. and ms. collins think you for joining us. >> thanks for having me. about the fund, what is it as far as the thing you do when it comes to health care? >> we are a nonprofit nonpartisan foundation, we support independent research on health care issues and promote better access and improve call -- quality and efficiency and health care. >> so we invited you on to talk

about issues in the senate when it comes to health care. before that6 million people. we have seen an uptick in the number of uninsured and it is a significant downward trend. it's on a path for universal coverage. that we are down -- this is a new low and new high in coverage for people over six billion people have coverage since 2019. this is including more than 5 million -- women and children that we have seen an uptick in the number of those insured after 2016. and this is a significant downward trend -- that is cut back on a path. and universal coverage but we are down significantly from the

peak of 33 million uninsured in 2019. and, the insured occurred among people with low and moderating cuts. >> and he made that point, from the statistic, about half of the 4 million adults aid in insurance 2020. they got the marketplace can you elaborate on that? >> that is right. the gains we are seeing our concern -- concurrent with policy changes we've seen in the last three years including implementation of the american rescue plan act. those brought

premiums down substantially in the marketplace. coverage in the marketplaces, the ac marketplaces bringing enrollment thereto a short high. in other major change that happened in 2020 with the family first coronavirus response act was that states maintain maintained people enrolled in medicaid. this is also sent medicaid and rolling to record highs. third the states expanded their medicaid programs from 2019 and 2021. this significantly reduced insurance rates. a final factor, substantial enrollment efforts advertising special aroma periods by both the biden administration and also a major effort to increase awareness of their coverage operate -- >> and help them get that coverage. >> is there a general sense to think about those getting assistance under the aca how many of those are getting that because of federal or subsidies of the federal government? >> the majority of people are

getting subsidies from the federal government through marketplaces. one major change in the american rescue plan act was lifting the threshold about 51,000 for an individual. people about that income level weren't getting subsidies. all of a sudden the income went up to 51000 and you wouldn't have access to subsidies. this allowed people in that income reached to get subsidies. so that was also a major change in the increase to help people. just right under that threshold got subsidized coverage. -- reduce premiums as a result. >> our guest joining us until 9:30 and if you want to ask questions about health care particularly under the aca you can call us and let us know. (202) 748-8000 if you live in the eastern and central time zone. (202) 748-8001 if you live in the mountain pacific time zones. if you get aca coverage or are insured under the aca you can call and give us your perspective at (202) 748-8002. you can also text us at (202) 748-8003. sarah collins you talked about the subsidies, do those subsidies have an end date of sorts?

>> they absolutely do. they end at the end of this year. so if that happens, we are expecting about 2 million people to drop their coverage and become uninsured. and the other major impact of that, i mentioned the much lower premiums for people people will see and improve -- increase in their premiums so this is -- it would be a very significant change. if this were to happen. >> with that in mind, there is an effort in the senate to prevent that from happening can you explain that. >> that's exactly right. inflation reduction act would include an inspection -- extension for three years. so that would prevent people from losing their coverage and save people in the marketplace thousands, thousands of dollars.

>> if the aca is built on subsidies and ultimately subsidies might run out what is that mean for the long-term structure? i know we see numbers because of the aca sips rooms, what is it mean potentially for the ability of someone to hold onto the coverage? >> that's a really good question. these changes in the american rescue plan act alongside -- were needed. these updates were not just pandemic related. these are bringing premiums down to a point where people compound towards their premium. these are things that should be permanent. makes premiums affordable, helps people afford their health care that they need. this is a temporary policy that was introduced during the pandemic but it is really needed by lower income families to help them afford their insurance. and help them keep get access to their health care that they need.

>> on the other side of that what is the cost to the united states to provide the subsidies? >> the extended subsidies are about 22 million dollars. $22 billion a year. so it's not an insignificant cost. but it is, it is part of our health-care system it is part of ensuring that people of access to the health care they need. we subsidize employer coverage. i hundred 55 million people get their coverage. all health insurance in the united states, the marketplaces, medicaid, medicare are subsidized by the federal government. >> again sarah collins with the commonwealth joining us. we start off with gwen detroit, michigan. you are on with our guest. go ahead with your question or comment. could earning.

>> thank you for taking michael. ms. collins i was worried about people who are over drivers for a living and their income fluctuates, sometimes it is high, sometimes it is low, but, but he is saying that we are not eligible for medicare. under the affordable care act. he needs medical insurance. and i am trying to find out, what options does he have? >> income fluctuation is always

a struggle. both in medicaid and also in the marketplace. what is important to do is to go to healthcare.gov and enter your income into the website and it will help you understand where you can get coverage, whether it's through the marketplaces, what subsidies you might be eligible for, or through medicaid. but that would be a good first step to figure out whether or not you are eligible at the moment for subsidies. the other thing in the marketplaces if your income does fluctuate during the year, if it goes down for example, you might need to the subsidies are done through the tech system so you might be eligible, you might some of get that that she might get some of that money back or you might have to pay more at the end of the year. but fluctuation is handled through the tax system. what is really important is to first look at what, go to healthcare.gov and find out what you are eligible for. it is very important. >> the information you provided, what determines what you will pay for insurance under the aca?

>> it's really driven by your income. the state you live in, the premiums that are in your state, the state premium varies dramatically across the states. the affordable care act cap's what you pay towards your premium. if you are eligible for a subsidy, regardless of what the variation in premiums is you will pay the same amount as someone in another state. it is determined primarily by your income and your household structure. >> as far as a guide, what is the guide they are looking at as far as how much you have to make before you qualify or not lafayette? -- qualify >> you're eligible right now up the income scale, it used to be

if your income exceeded 51,000 you are no longer eligible, now, your premium contribution is capped at a certain percent of your income. so you will pay more -- no more than a percent of your income. that is as your income rises, that represents a smaller share. and it is a natural phase in that subsidy. you will both pay more than a certain amount of your income. right now under the act. >> let's hear from and in new york. good morning, you are on with our guest. >> good morning. i had a question regarding health insurance companies. i know currently they are talking about exchanging medicare's negotiation for drugs and trying to reduce the cost to seniors. i always find it puzzling that the health insurance companies, which have a stranglehold on the medical system, are not brought up as a topic of raising taxes on them. they are incredibly profitable. it does not make

sense to me. i did not know if this is too much off the point. i was curious about taxes and medical insurance companies versus drug companies. >>that is a very good point. the marketplaces -- the affordable care act introduced new regulations to insurance markets in 2010 preventing insurers from increasing their premiums above a certain point. you are right that right now if we are just talking about the new reconciliation bill, there are provisions that address the regulatory structure of the insurance markets. it is focused mostly on prescription drugs.

>>expand on that a little bit as far as the aspect of negotiating. why is this important? >> if we just talk about prescription drug prices, medicare has not been able to negotiate prices since the new inflation reduction act would allow medicare to finally negotiate high cost drugs starting in 2026. this brings the leverage of the federal government to bear on prices. prices are a significant issue across our health care system. the prices insurers pay through hospitals and other providers in the commercial insurance market, which is what the caller was referring to are the major driver of what we pay for our premiums and what we pay for our out-of-pocket costs, what our deductibles are. getting at those prices and allowing much more leverage, maybe to a public option in the marketplaces, would help wring some of those prices down. this is what we are seeing in the reconciliation bill with prescription drug prices. it is a broad problem in the health care system generally.

>>we have a viewer who asks you if you can explain why aca premiums are higher in states that did not expand medicaid? >>there is a significant amount of variation in premiums across states. the fundamental reason is there is just -- variation in prices in a commercial insurance market. prices that are paid to hospitals by commercial insurers in the marketplaces and employer group markets very significantly , even within the same hospital for the same service. that is because there are proprietary negotiations that occur between insurers and providers that end up with prices that may not bear much relationship to their cost. that is the primary reason we see so much variation in premiums across the country, even beyond the medicaid expansion issue. we still see significant variation.

>>you talked about that build -- build -- bill senate democrats were working on. what does that bill dupre states that did not expand medicaid? >>this provision was earlier in the build back better bill, the first iteration of the reconciliation effort. this new inflation reduction act does not exclude a federal fallback option for people who are eligible for medicaid in the 12 states they have it. estimates by the urban institute show such an option would increase the number of insured by 3.2 people. this is a very big disappointment for people affected in these states, not including this option, the federal fallback leaves millions of the poorest people in the country without access to affordable health insurance.

>> we are talking with sarah collins of the commonwealth fund. this is dan in lexington kentucky. hello. >> >>thank you. means testing, subsidies, all of those things is taxation that takes from others -- from each according to his ability, to each according to their need. that is communism 101. the only way you have communism is through taxation so you can take my taxes and give it to someone else and it will never lower the prices on anything because i have no control over that. you do. thank you

>> that is dan and kentucky. anything to that? >> i think that i understand the point. the way to think about insurance coverage is it works best when everyone is in the same pool. the idea of insurance is when you are healthy you pay a premium just like for your house to ensure your house against fire or flooding or your car against accidents and damage. you pay a premium even when you are not experiencing one of those events. the same is true in health care. you pay a premium when you're healthy and it is there when you are sick and need it. the most efficient way to do that is get everybody in the same pool. otherwise people are just buying insurance when they are sick, their premiums will be exorbitant. we saw that before the affordable care act went into place. obviously it cost money to pay a premium, but it prevents catastrophic problems for people when they do need health care. >> from california, this is lyn.

hello. >> is amazing to be talking about the affordable health care , which has devastated so many people. there is help, and if you get some of the subsidies then what happens is the insurance companies still get their full pay, that is subsidized by taxpayers. the taxpayers are footing the bill once again for these subsidies. if you want to give a subsidy, why would you want to charge taxpayers? i pay $1900 a month to blue shield which is the biggest legal corruption on the planet because then they can deny your health care, they can deny what doctor you go to. by the time i even tap into my health insurance i have paid over $30,000 just in premiums before i even get to see a doctor that maybe not be of my choice. between the pharmaceuticals and the insurance, the american people are totally getting screwed. thank you. >>she makes an

excellent point. even though we are on a path to getting everyone covered there are still significant affordability problems. premiums continue to be high and out-of-pocket costs are very high. deductibles are high in commercial insurance. we need to address the costs people are facing, both in what they pay for their insurance and also what they pay out-of-pocket when they go to the doctor. this will be an ongoing challenge for congress, for states, and for families. i would again point to the ultimate driver of these, which are the prices commercial insurers pay. if that is politically difficult we need to continue to try to protect people from these exorbitant costs through expansions in coverage, greater attention to how much people pay as a share of their income, and how much people are being asked to pay when they go to the doctor, for tickly people who have chronic illness who have some of the highest out-of-pocket costs across the country.

>>sara collins, a viewer offers this. one of they put more -- why don't they put more effort to bring down drug prices in hospitals? subsidies to hospitals to ensure cheaper pricing across the board for all patients. are there other ways to control costs? is there enough effort to do that? guest: that is a really good question and is a major policy challenge, both at the federal government and the state level. we are seeing a lot of activity of the state level trying to get costs under control, passing legislation to put in place a public option. other efforts at the state level . i would point out in the inflation reduction act, the bill we have been talking about that has been introduced, it does finally address the drug pricing issues and problems we are seeing in medicare and also the commercial market. the bill imposes inflation caps on drugs which limit pricing for drugs every year. inflation caps can apply to medicare and the commercial market. this is expected to dampen prescription drug price growth. we are seeing a major effort in this reconciliation bill to address the growth in

drug prices people are experiencing, both through out-of-pocket costs with respect to drug cost, but also in premiums they pay.

>>for those of you in the eastern and central time zones (202) 748-8000, if you live in the mountain pacific time zones, (202) 748-8001. if you get insurance under the aca, (202) 748-8002. holly in michigan. hello. >>my question is right along the lines of the other caller working on getting the down for people. i currently reduced my job from full-time to part-time to an early retirement so i could afford health insurance as my premium was my employer was well over $1000 a month. working for health care myself, i am pretty well aware of insurance incentives to providers. thousands of dollars of year to drum up business, keep your patience in, meet a quota, and get an incentive. to me that is a way of reducing costs to us who have to have health insurance. companies pass on an incentive to insurance companies who pass it on to providers. the more people that get their immunizations, there is another incentive. why are we doing that?

>>you make excellent points about the highly variable way that we are handling health insurance and health care costs in the united states and we see so much variation. there are administrative costs, there are efficiencies, and then the pricing between commercial insurers and hospitals and other providers, pharmaceuticals often do not bear much relationship to the actual cost of producing services for us. consumer patients bear the burden. they are ultimately responsible for that. we see growing rates of medical debt, problems paying medical bills, people cannot continue to afford the health care costs they are being asked to pay. >>there is another viewer who offers this off of twitter. the most efficient way of paying for the services as a

medical savings account where you build savings to cover a high deductible. your savings build up and then at the end without any serious illness it is a huge retirement fund. the idea of medical savings accounts? >> more and more people do have this. what we have seen over time is

that people who tend to take that option in jobs tend to be higher income tax benefits or health savings accounts and it is targeted towards people with higher income. so it has been working as a savings for people with high income and it is less effective for people who do not get tax benefits. if you do not actually have the money to put towards their savings. so there are probably more efficient ways to get the cost down for people with lower incomes. >> let's hear from john in illinois. high. >> i just wanted to basically ask and would it be disabling if we had a single payment medicare for -- losses. we are talking about how much they spend on insurance companies, and socialism and

whatever. what it actually save us money in the wrong -- in the long run? are are we pushing insurance companies --? >> thank you for your question, that is one of the quintessential questions. it is how we ensure everybody has been promised. and it worked -- urban institute shows you can get coverage by the affordable care act and you can also get universal coverage by a simple pair option. the thing that really matters in both approaches, it goes back to the prices -- it really in single-payer and all types of medicare proposals is getting prices down. the prices we pay providers for services most medicare rates would save money and the model that has been done of single-payer options does save money if those prices would come

down to medicare rates but it also depends on what is included in the plan. how much people have to contribute what the cost sharing is. if you build on the affordable care act, what would be important is having an automatic -- role -- enrollment act -- enrollment taken is in. the price is what is important. paying providers medicare rates through the public option would also lower costs. so it comes down to the services covered and the amount that people and employers contribute to health care. under a single player -- payer. in the health care system. that is a great question. it is something that was >> c-span is your unfiltered view of government funded by these television companies and more.

>> the world changed, internet traffic soared and we never slowed down. schools and businesses went virtual and we powered a new reality. we are built to keep you ahead. mediacom supports c-span. >> next we hear from some of the headliners from date one of the conservative political action conference is summit in dallas, texas. gary and prime minister viktor corbyn --orban.