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you can watch every when a student can online at studentcam.org. c-span is your unfiltered view of government, we are funded by these television companies and more including charter communications. >> charter is proud to be recognized as one of the best internet providers and we are just getting started. 100,000 miles of new infrastructure to reach those who need it most. >> charter communication's supports c-span as a public seice along with these other television providers, giving you a front row seat to democracy. with dr.avenal joseph. remind viewers what your foundation is and what is your

mission? >> the robert wood johnson foundation is the nation's largest philanthropy dedicated to health. we recognize that help is not the absence of bad health but where you work and play. we address structural barriers to helping putting racism and other forms of discrimination. we fund research, develop data and analysis that helps inform systems and policy change and cultivate leaders that work individually and across sectors to address issues of health equity. our mission is that everyone in america has a fair and just opportunity for health and well-being no matter where they live, work or play. host: medicaid certainly fits into that mission. today we are talking about potential changes to that system. medicaid enrollment in this country, 48 million adults on medicaid, some 35 million children. tell viewers who qualifies for

the medicaid program? guest: medicaid is the nation's largest public health insurance program for low and no income americans. eligibility for who is and rolled varies from state to state. generally, low income children, seniors, pregnant women, people with disabilities do qualify for medicaid. it's very tightly connected to income level and what the threshold is for low enough income varies from state to state. as you said, the popular program, over 85 million people are enrolled today which is one in five americans. host: the numbers jumped significantly during covid, why? guest: primarily because the federal government passed a law requirement for states to maintain continuous coverage. which means that when the income level of an individual or family

fluctuates during the year, doesn't automatically kick a person off of medicaid. people have to remain enrolled in some form of coverage on the federal government gives states money to make it happen. that means about 18 million americans got coverage during the pandemic. we are now at the lowest uninsurance rate of the kind -- in the history of the country. host: continuous coverage, the key provision came to an end, why? guest: because congress passed a law and the president signed it that decoupled it from the public health emergency. on april 1, continuous coverage requirement ends in the states can begin to disenroll people from their medicaid rosters and they have up to one year to do that so there is no rush. there is lots of support the federal government provides to states to do this in an equitable and thoughtful manner. host: do states want to do that? guest: yeah, they need to figure

out who is eligible and remain on medicaid versus who has other insurance options that would be more affordable for them. generally speaking, working adults enrolled in medicaid or people who are working in positions or employers in an affordable option for health care coverage. these people are in medicaid but if they are employed differently, the states have to determine whether they are eligible or should be on another insurance program. host: who gets flagged for disenrollment and what are the options for someone who gets flagged for that? guest: it varies from state to state based on eligibility but the concern and the baseline is that we want to make sure everyone in america has an affordable comprehensive access to health insurance. when people have access to health insurance, is better for their individual health, better for the community health and the nation's health. having people not covered is --

should not be an option. the states should be providing individuals their options if they are not enrolled in medicaid were no longer eligible, what the other options are for coverage so it doesn't come as a surprise for individuals or families. host: how many states are doing that? is anybody doing that? guest: there are some states doing this thoughtfully. there are other state examples that are rushing to the process. arkansas has said they want to do this entire process of reenrollment for medicaid and a couple of months. we know when you rush through processes like this which is the largest shift and help insurance since the passage of the affordable care act, people will fall through the cracks and we don't want to see people who are left with no insurance. host: changes to the medicaid program is what we are talking about so here are the phone numbers.

the robert wood johnson foundation, what have you found how aware medicaid recipients are about these changes that are coming up and about this program in general? guest: surveys have shown us that people are not very aware. people currently enrolled in medicaid, less than 25% know the changes are coming and fewer are getting help to figure out what their options are. the redetermination process can be very complicated. it's overly burdensome for some individuals and families. it requires information that may

be difficult to find. it takes a long time to receive and some states are requiring that eligibility happens electronically which for many can be convenient and for many who don't trust the internet, they will have access and it will be an additional barrier. host: was this happening before the continuous enrollment, this yearly look rolls? is the process onerous? guest: that's fair. host: was it an onerous process before covid? guest: absolutely, that's why we know this will be a very late boreas process going forward. states need to take their time. before the continuous requirement coverage requirement, states today determination process and up some states did it more than others and people turn in and out of medicaid frequently which causes disruption in care for people and their families who

are enrolled in the program. host: just as i understand it, is it a cost-saving issue to get people off of medicaid? guest: many states will say that, that they want to make sure those who are enrolled in medicaid and the resources put forth are for people who are truly eligible for medicaid. i want to be clear that people who are eligible for medicaid, more than 30% of them, will fall through the cracks because of the redetermination process, because of the paperwork and bureaucracy it takes to re-enroll a person in medicaid. they are eligible but millions will fall through the cracks. host: let's bring in some calls for you including lucy in new york, republican. caller: i was aware that illegals could get emergency medicaid when they go through the er because they get a lot of

that care from the emergency room. i was doing some work for my employer and the medical records indicated they not only get emergency medicaid but they had medicaid for everything, psychological services, prosthetics. it was incredible how much free medicaid they get. guest: what the viewer is pointing to is a larger issue of our health care cost system. the u.s. currently sends 4.5 -- spends 4.5 trillion dollars in health care costs. everyone who goes the emergency room regardless of immigration status can get care through the emergency room. that's why having health insurance is a cost saver for the states and the nation. when people do not have coverage in they go to the emergency room, the hospitals have to pick that up in the hospitals pass that cost on. host: this is sandy,

independent, good morning. caller: good morning, i am a senior, social security and medicaid. i'm in ohio so i was wondering if that's going to change. i was just reviewed recently and i'm still eligible. if it's under $2000 a month, you are still eligible and for ssi recipients. guest: yes, thanks for calling. i'm glad the processes work for you and you know you are still eligible. for others who don't know whether they are eligible or not or what their options are, i would direct you to the medicaid.gov where you can check with the options are in your state for coverage. host: this is a twitter question --

guest: yes and no. the affordable care act does provide subsidies for people to afford health care on the health-care exchanges in the state that every state is different in terms of what insurance programs are available on the exchanges and where your medicaid at office. there is such a thing called the medicaid coverage gap which are people who make slightly too much money to be eligible for medicaid. they make too little money to be eligible for subsidies on the insurance exchanges and these are people who are literally left in a coverage gap. it's why medicaid expansion in the remaining 11 states is so fundamental. host: vanessa in virginia, democrat, good morning. caller: good morning, glad to finally get through. talking about arkansas which is one of the poorest states in the

nation and the fact that they want to kick as many people off of medicaid as possible. i don't think people realize that many of the rural hospitals depend solely on medicaid and medicare to keep their doors open. plus, many people sitting in the nursing home complaining about who's getting medicaid have their elderly parents in nursing homes. i would like to hear the speaker talk about that. guest: thank you so much for raising this important point. rural hospitals across the country are shutting their doors , creating an access issue for millions of americans. you are right, those are hospitals who primarily rely on insurance coverage through medicaid. seniors at nursing homes are a large recipient of medicare -- medicaid dollars, more than 60% of nursing home costs are covered by this so thin

incredibly important program. more than 85 million americans are covered by medicaid which is one in five americans, the largest health insurance program in this country. we want to ensure that everyone in the country has access to affordable health care coverage so they can get their medicines and see their doctors and maintain their healthy selves and families in the health of their community. host: you talk about the 11 states that have not adopted medicaid expansion. this is from the kaiser foundation. what was the medicaid expansion and why 40 states have adopted it? guest: when the affordable care act was passed, there was a provision in that law that required all states to expand medicaid. that went to the supreme court and the supreme court essentially said states can

decide on their own whether they want to expand medicaid or not. what resulted in some states decided that this was an important economic move as well as a moral imperative to cover their residence. they expanded medicaid well some states chose not to do that, they chose to turn down millions of dollars in federal resources and not expand. it left a bit of patchwork across the country. it's dependent where you live and whether you have access to affordable health care coverage and there are about 2 million people across the orange states who are stuck in what's called the medicaid coverage gap. they make too little money to afford coverage in the affordable care act exchanges and too much money because they are working adults to be eligible for those medicaid programs. host: dallas, texas, one of the states that has not done the

medicaid expansion, kelly, republican, good morning. caller: thank you so much for taking my call. i am 65 years old and i lost my job last august. i have been a license escrow officer for 25 years. i have been unemployed for seven months. i am about to run out of my unemployment insurance. i am a breast cancer survivor as well as diabetic. i have had to give up one of my diabetic drugs because i am on obamacare. however, i just can't afford it. a1c and i've been practically eating a vegan diet i went for may 5 pointa to 6.3.

i had a lump ectomy a week before christmas in 2021. i lost my health insurance for my job. i have been trying for five months to be able to get a 3d mammogram. obamacare will pay for the old-fashioned x-ray but it doesn't pay for a 3d mammogram. they found my tumor when it was 9mm. it did not spread or metastasize. i was one of the lucky ones. however, i've been trying to get the 3d mammogram and they said because obamacare only pays for preventive. if you've had breast cancer sorry, you are not covered. host: thanks for sharing your story. guest: kelly, i appreciate you calling in. i work for more than 10 years at

the capital staffer and we heard about the importance of medicaid and health insurance coverage from constituents every single day. your story eliminates how critically important it is to have comprehensive and affordable health insurance coverage for the health of you as an individual but also of your entire family. i appreciate you calling in and sharing your personal story. that's echoed across this country by tens of millions of medicaid recipients. host: carolina, democrat, good morning. caller: good morning, you were talking about medicare and medicaid and the food stamps . how can they take the emergency food stamps away from us and the food prices are going up and up. gas prices are going up so how

do they expect us to get by with a little bit of money and by food? you have to decide whether you will buy food or pay bills. it's ridiculous. every country except our own, we need to do for ourselves. how are you going to help other people if you can't do it for yourselves? host: he was speaking about the snap program. guest: it illuminates that health coverage is not the key to healthy this country and that's why the foundation works on things like stamps, paid leave, economic policies that can help support an individual and the family who is trying to make ends meet. often, the lack of health insurance coverage and one illness can be the difference between complete bankruptcy and devastation and health.

as a bare minimum, we have to make sure everyone in this country has health insurance coverage. you are right, eligibility for other assistance programs like food or rent or transportation are also desperate. host: bringing it back to the medicaid program in the 85 million americans on medic paid, if someone is listening now and is concerned they may be caught up by the end of the continuous coverage provision, how can the wind out they will be? is there a place to check and make sure? guest: the best place to go is medicaid.gov. they can look for their state in which they live and there will be information about who to contact in your state what the steps might be to determine your eligibility. every state has a different program so there isn't one place to go where they can find

information at medicaid.gov. host: atlanta, independent, go ahead. are you with us? then we will go to chris in illinois, democrat, good morning. caller: good morning and thanks for your work on c-span and for having such a knowledgeable guest who is giving a lot of good information on this topic area i have two quick questions -- why is there a medicaid gap between medicaid and aca? this is a recent program that was developed and i can understand why they would put such a gap in that to create so many problems. my second question is just -- can she speak about what is being done to inform the people who may not know about these

changes that they can be helped earlier? guest: thank you for that question. the gap does not make any sense. it's because it wasn't designed that way. the law was designed to cover every american with health insurance coverage or recognizing is a fundamental, basic acquirement for everybody in this country to have coverage for health insurance to take care of their needs so they can get health care. unfortunately, because of politics, because of challenges in the legal system, it remained optional about whether states could cover everybody or leave the lowest income people in their state behind. there are some states who chose not to expand medicaid and not to cover the lowest income people in their state. it has repercussions for the states economy. it means those states are less

healthy me know medicaid expansion reduces related deaths and increases economic prosperity of the state and increases the economic viability of family. we know it's important and we know this is a basic requirement that everyone should have health insurance coverage but everybody -- but unfortunately, politics got in the way. in terms of how to find out more information, every state is approaching this differently. there are some basic tenets they should follow like proactive, empathetic and multiple forms of communication. relying on just the mail will not work for people who have moved during the pandemic. frequent and multiple forms of communication are necessary.

doing so in multiple languages is necessary, doing so in a way that's easy to understand and makes the process. for with four recipients makes the process straight -- makes the process straightforward for recipients. some states are just not doing it. host: what would be a reason someone would be kicked off this program? you said each state has their own rules but can you specifically focus on work requirement rules and the difference between some states of what's required? guest: there are only a handful of states that come to mind that have working requirements and place. -- in place. the people who have been kicked off of medicaid typically because of work requirements is not because they are not employed or not meeting the number of minimum hours, is

because the form they have to do is too complicated. more than 60% of those who have lost medicaid in arkansas after the work requirements as a result of not understanding the former not being able to fill out the form in a way that kept them on the medicaid rolls. there were some missteps that arkansas has acknowledged. generally, working adults who are part of the medicaid program, if they are in medicaid, it's because they are working in jobs or for employers who are not offering an affordable coverage option so medicaid is the only way. host: in the history of medicaid, we had a place where there are many states with work with armand's or where there are -- or were there times in the place where there were more work requirements? guest: we are at a time when

they have more work requirements that are in place, more nuanced and complicated than in the past. like the way in which they have to categorize their working hours. you have to work a minimum of 80 hours a week in the has to be a certain type of job and you have to be able to document that in electronic form within a certain time. there are lots of hurdles for a normal person who is too busy and managing many things in the household to make sure all of the steps are done in a way that continues to keep them enrolled. host: is there one that has 80 hours of work in a week? guest: that's in a month. host: michigan, independent, good morning. caller: i think we need a new change of government. i think this one is pretty much

broken. i think we need to go to something like the parliament in england were you do of vote confidence and if you can't pass it, you are here cabinet are gone like immediately. this could be the best thing for us and people who get in that office will be more serious about what they are doing. thank you very much. host: where are you on the idea of universal health care? guest: we very much support it to achieve a culture of a vision of health, you have to be able to get help care. in order to get health care in this country, you need health insurance. it helps protect and promote health and economic well-being. host: do you think we are closer to universal health care in this

country today than 10 years ago? guest: we are close because we have the lotus uninsured rate after these proficient -- these provisions then we have ever had in the history of this country area that's since we've had insurance program so we are closer in terms of getting more people covered. in terms of having universal coverage meaning everybody has access to the same type of health insurance coverage in the same type of providers and the same type of drugs, we are a long way away from that. host: we have about 10 minutes left. if you stick around on c-span, we will take you to the brookings institution. it's a discussion with general james mcconville about the army's modernization efforts and the war in ukraine. you could see that folks are starting to gather in that room.

that conversation starts in 10 minutes but in the meantime, dr. joseph is the policy vice president, taking your phone calls as usual. go ahead and keep calling in and we will continue this conversation until the top of the hour. this is pennsylvania, good morning. caller: hi, the problem i run into is i've been on disability for the last 15 years. i turned 65 this year and i watched all of my insurance go away. all this stuff and i don't qualify for medicaid because they save make too much money. i believe in $1500 per month. that's a little disheartening there.

you like to see what programs are out there to help you and there's really nothing there. guest: you have raised one of the fundamental points here. you can make very little money per my attitude not be eligible for medicaid depending on the state in which you live. most would say the $1500 per month can barely make the rent and the food and other bills that are needed to run a household area that's way health insurance coverage is so critically important because one disease or one diagnosis can really and truly be the difference between life for so many americans. host: this is from twitter -- guest: it's another way of

answering -- of asking the same question. you have working adults, people were trying to provide for their family. these are not people who are on the couch all day which is sometimes the image portrayed by medicaid recipients. and yet, they cannot afford traditional health insurance coverage on the market places. medicaid really is the backstop to allow health insurance for families. host: california, republican, good morning. caller: i would like to say that i don't think most people realize that one of the main causes of bad health is sugar ingredients added to even infant formula. the first thing on the list of ingredients is high fructose corn syrup. i don't think that will help babies grow healthy. that's why we have so much

obesity in children nowadays. they are putting sugar and baby food, can you believe it? guest: thanks for the call. one of the things you highlight is a broader issue of the resources to be able to choose the type of food they would like to consume. unfortunately in this country, that's not always a choice. resources can be so small that it's impossible to make choices like that. the supermarket only carries certain types of food depending on your neighborhood. you might not only have access to one type of grocer. these are samples of structural barriers to health. it is the mission of our work to

help identify the structural barriers, illuminate them and address them. host: the caller rings up infant formula and you think of last year's infant formula shortage, only a year ago. would your foundation, were they involved in any legislative efforts after that to ensure that another such shortage doesn't happen? guest: we were not but we were involved in making sure families had information related to the shortage to make the best choices they could in a devastating time. host: as far as legislation, what some example of how to get involved in a piece of legislation on capitol hill that addresses health care or the health issue? do you do lobbying? guest: no, as a nonprofit, we do not lobby congress. we can publicly advocate for policies like universal health care but we have limitations on

getting involved in the legislative process and the way you are thinking. host: what does policy due at the foundation? guest: we help identify what is happening in terms of state and federal policie and of opportunity. we use the voice of ourselves and our partners to change the national conversation about what's possible as it relates to policy change. we help to elevate the research and the data and the system changes we don't have worked in our best practices can be scaled to larger. time for a few more calls come about five minutes until that event starts at the brookings institute. houston, texas, democrat, good morning. caller: good morning. what is the breakdown of my paycheck versus business

contribute into medicaid? i live in texas so i know we don't have it but it's important for me to ask that question. where does medicaid get its money? i'm involved in getting more people voting and watching where their money is going. thank you very much for your answer and i will listen on the television. guest: this is a question about medicaid financing and how it works. medicaid is a partnership between the state and the federal government. the federal government provides anywhere from 50-75% of the cost of covering a medicaid individual. the state takes in the rest. if you are a state that it tasted as, there are laws that have been passed where the federal government kicks and

more, sometimes 90%. host: so what they don't have in texas is the expansion? guest: they have medicaid and who is eligible which may be limited and they don't have expansion and because like texas is so large, it's one of the states where there are the largest number of people who fall in that coverage gap so expansion in texas would be a huge boon to the state's economy and the states health. i medicaid who are the people responsible for leaving the poor people in the dark? guest: it's the governors and the legislators of those states. the elected officials in those states or who is making the decision about medicaid expansion. there are number of statuses since 2024 that have passed medicaid expansion brace on they

have put the question of whether to expand medicaid to the people and they have decided and overwhelmingly in the states where ballots were presented for expansion, people decided that yes, we should expand. host: where there states guest: guest: that were against? an example -- he just escaped my head. host: we've got barbara roy -- waiting until has a, florida, good morning. caller: i want to make up point about the state of florida and medicaid. my son was diagnosed in 2020 with cancer. he was a full-time student getting his masters degree. he was turned down for medicaid repeatedly. we kept trying to get obamacare or they call it florida blue in the state of florida. the only way we could get him

obamacare was for me, i'm 74, to make him a dependent because in the state of florida, if you make less than 16 as those were year, you cannot get obamacare. that made me an independent. we pay $10 per month on the hospital bills and doctor bills we could pay. he is -- he has beaten cancer but in the state of florida, you have a republican governor, republican legislature and they continually refused to expand medicare. -- excuse me medicaid. we have a problem here. there is no way to fix it as long as we have what we have here.

it's very unfair to the poor people out here. that's my story. if you live in florida, look out. thank you. guest: thanks for calling. florida is similar to texas. as a result, there are millions of people between those two states who fall in the medicaid coverage gap. that's what our caller is illuminating. in her case, she was mentioning that if you make $16,000 per year, you are not eligible for subsidies on the aca exchanges. because of the lack of medicaid expansion, they also make too much money at $16,000 per year to be eligible for medicaid in florida. the state of -- if the state of florida expanded medicaid, it would be available for many who

make salaries such as that. host: just about a minute or so left -- i wanted to give you a chance to talk about some of the other work you do and the key initiatives for the robert wood foundation. guest: we recognize a person doesn't live without health coverage. you need a fair and just opportunity for health and well-being so we work on things like housing policy in getting people affordable, stable places they can live area on issues like paid leave, person cannot use the health insurance to go see a doctor if they have to choose between a paycheck and seeing a doctor. we work on issues such as ballot initiatives and informing the democratic process so that individuals can choose things like medicaid expansion for their state. there are a couple of examples

-- we work on snap, the food of -- the food assistance program. host: let's see if we can fit in another caller from maryland, line for democrats. thanks for waiting. are you i think we lost susan. for those who have been following this conversation throughout, if they are concerned that they will be one of the people who may be kicked off medicaid, how do they figure out whether they may happen -- that may happen? guest: i instruct you to go to medicaid.gov. this provision ends at the end of this march. we do not want that to come as a surprise to anyone. at -- no time is a good time to lose help and serve -- health

insurance but losing it suddenly can be devastating. host: for folks who want to learn more, is there a resource available at the foundation -- if they can remember the robert wood johnson foundation as a resource for these books? guest: rwjf.org, and you come from ruth all work our organization does. -- you can peru's all of our work our organization does. >> i appreciate your >> c-span's washington journal. we are taking your calls on the news of the day. we will discuss policy issues that impact you. coming up wednesday morning. the president of judicial launch

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