get informed straight from the source on c-span. unfiltered, unbiased, word for word. from the nation's capital to wherever you are. because the opinion that matters the most is your own. this is what democracyooks like. c-span powered by cable. announcer: congress returns from its summerecess in september wi a busy legislative floor schedule ahead read the house d senate are expected to take up funding tho fding the government through next year during the goveren shutdown. current government funding exreseptember 30. end of the month -- will have the faa preparedness programs. the senate will work with the judicial nominations including the federal reserve. watch live coverage of the house on cpan, the senate on c-span two, and a reminderit can watch all of our congressional

coverage with our free video mobile app c-span now or online at c-span.org. a correspondent for kaiser health news and host of the podcast "what the health?" can you walk us through the big tidbit items we should be watching in the next few months? guest: what has to be done before october 1 is the appropriations, the spending bill for health and human services. food and drug administration is in the agriculture appropriations bill, for reasons i have never quite understood. host: we will do that on american history tv. guest: if there is not a continuing resolution or something, they will come to deal on the spending bill, parts

of health and human services will stop to -- stop functioning until they figure out how to fund them. but this usually continues in the absence of appropriations because so much of the spending is mandatory spending, and that is not affected by the appropriations bill fund. host: what is in this, to help people understand these 12 big bills moving through and what they should be watching for? guest: the big pieces are the national institutes of health, centers for disease control and prevention, all of the mental health organizations, organizations and parts of it that provide medical care through community health centers and other places. there are a lot of what we call discretionary spending that runs through that bill. it would be impacted if congress does not come to some sort of funding agreement by the end of september. host: this might be time to do

some 101 between the difference of mandatory spending and congressional -- discretionary spending. guest: mandatory spending continues unless congress changes it. they go until congress affirmatively stops the funding. medicare and medicaid, social security, the obamacare subsidies, most of the chip program, the children's health insurance program, those are mandatory and would continue even if there is a spending impasse, which it looks conceivable that there will be. host: is congress trying to it affirmatively -- to affirmatively stop funding for any of these programs? guest: not in the next two months. they might end up there at some point, but we are talking mostly -- the fight currently is about

spending bills, mostly, and about some of these authorizations for some of the spending programs that are going to expire at the end of september. important difference, the authorizations are not finished at the end of september. that does not mean that funding stops for those programs. my favorite factoid, the federal family planning title x has not been were the authorized -- reauthorized since 1984. they had never managed to agree since the 1980's on how the federal family planning phone -- program should be authorized. host: can we do a 101 about authorizations versus appropriations? guest: authorizations is putting money in the checking account and appropriations is spending the money from the checking account. the authorizations set the outline for what things, what federal funds should be spent for what types of things. policy is supposed to go in the

authorization bills, and that's often why they get bogged down. there are fights about policy. the spending bills are supposed to be just for the money, but there are ways to put policy writers into spending bills, and that's what gums up the works, when spending bills do not get done in time. caller: what policies are you tracking that could be gumming up the works? guest: the main one is the hyde amendment, which has been in the bill since the 1970's, but thereby delaying henry hyde, a republican of illinois, a famous antiabortion member of congress, barring federal funding for abortion. it has been amended sometimes to allow exceptions for rape and incest, sometimes not, so there have been various iterations where the bill has carried the hyde amendment since the 1970's, since neither side has had the votes to change it.

there have been efforts to make it stronger and weaker, take it out, but you would need 60 votes in the senate to do that and there have never been 60 votes on either side of this issue. host: another issue we have talked about is efforts to stop federal funding for transgender care. where does that stand right now? caller: that's -- guest: that's one of the writers this year. there are hyde amendment languages in several different appropriations bills. gender affirming bands in several different appropriations bills, because you can see how some of the spending bills go to other departments, but they are giving health care adjacent services or actual health care services that are sometimes funded through the defense bill or the veterans affairs bill that had their own health care program. there are things being attached to some of these other bills, not just the hhs bill.

host: how big is the hhs bill? guest: i have not looked, many billions of dollars, but it is a small segment of hhs spending. so much is mandatory. host: defense spending is the biggest discretionary part of the bill. what are you tracking at kaiser health news? guest: we are tracking this for not just the spending bill, but change in policy by the biden administration to allow servicewomen and family members stationed in states where abortion is barred, they would be allowed to pay for the travel and time off to get that care. senate -- senator tommy tuberville is holding up every promotion coming through the senate, so i expect that

authorization bill will come through the house and the senate and tie up the defense spending authorization bill. what host: your read on the standoff host:? guest: i don't know. this is a new issue, because this is the first year we have had abortion band in many states . that had not been an issue. there had been an issue with some overseas spending about and women -- servicewomen in countries where abortion was banned, this will obviously affect many more people who will be seeking those services because there are now so many states where members of the military and people do not have any choice about where they are sent. host: a lot going on on the health care front in two months when congress returns ahead of the some timber 30th deadline ahead of the fiscal year. helping us breaking it all down

is julie rovner. if you have questions on federal health care policy -- i'm sorry, we are splitting the lines regionally in this segment, central and eastern time zones is (202) 748-8000. if you are in the mountain or pacific time zones, it's (202) 748-8001. she is with us for the next half-hour this morning, so go ahead and start calling in for "what the health?" viewers who have not picked up that podcast yet, what will they find? guest: i have about a dozen and a half female health reporters from around d.c. and around the country. we get together every thursday and talk about's health policy news. it's fun and a good listen. host: what are you talking about this week? guest: much of what we are talking about here, where congress stands on health issues that need to get done or congress would like to get done.

there is a lot of effort on drug prices right now, and a number of congressional committees in the house and the senate are working on this issue, something they would like to get finished before this session of congress was done host: and where would you suggest viewers and listeners to go? guest: anywhere they get their podcasts. host: 127.3 billion dollars was what hhs asked for on the discretionary side, but $1.7 trillion in mandatory spending. explain what the much smaller number is and the bigger number is? guest: the big number is mostly medicare and the federal part of medicaid. the discretionary part, again, national institutes of health, centers for disease control and prevention, the fda, which is in the hhs budget request because

the fda is still part of the department of health and human services, but gets -- funded through the food and drug -- agriculture appropriation. host: so they see that number and get surprised by it -- do you break it down by mandatory and discretionary? guest: right. host: valerie in saginaw, michigan, you are on with julie rovner. good morning. caller: good morning. i hope i am not off-topic, but i think it is almost criminal to expect women to keep themselves in good condition to fight for our country when we are taking their right to get paid for travel -- not for the abortion, but for travel. to be reimbursed for their travel. i would like to know how much

money is being diverted out of medicare into medicare advantage, if she knows anything about that. because that is a program that needs investigating. it has nothing to do with medicaid. it is private insurance companies. can you answer that for me please? host: two different issues there. guest: two different issues. a good description of the fight going on in the military over abortion and health care. it's not just abortion bands, but different kinds of health care that women cannot get because doctors have left the state, or pregnancies have gone wrong and it is difficult, doctors do not know if they could be prosecuted for care other than abortion. that is a big issue. and that is being thought out in several different menus in congress. the medicare advantage issue,

that is a private alternative to medicare, not to medicaid. there is medicare and medicaid, but it medicare advantage is increasingly popular because medicare people are used to being in managed care plans, and medicare advantage offers extra benefits to people, like vision care and dental care. a lot of people want to join it, although we at kfs health news have investigated this a lot. companies are making profits off of basically a government program -- they are not just giving extra benefits to the beneficiaries, they are keeping some for themselves. guest: about houck -- host: about how big is medicare advantage versus medicare? guest: it's about half. creeping right up in terms of

what is spent. there was a big fight in the late 1990's and early 2000's because there was so much payment going on -- overpayment going on, congress cut it back and the plan started leaving the program because they were going to lose money. the republicans in 2003 when they did the medicare prescription drug bill started to give them enticements, but started overpaying them. there has been an overpayment-underpayment, trying to get it right, really the past 25 to 30 years. host: is that how long medicare advantage has been around? guest: it has been around in some way, shape and form since the 1980's. host: why did they create it? guest: republicans created it in the 1980's, hoping managed care could provide better care at a lower cost. in some cases it can, but in many cases it hasn't. the idea that we should let these companies see if they can

originally -- they were paying 95% of what patients would have spent in a regular medicare program. companies were saying, we can make the care so efficient that we can make a profit and save medicare money. that has not always happened, but that is the origin of the program. host: in kentucky, this is sandra. good morning. caller: good morning. i don't know if she knows about this, but i would like to ask her about prescription costs, anything has been done, or are they doing anything at all in congress about prescription costs? i am on xarelto, i am 78 years old, and it's costing me over $400 for sir -- for a blood

thinner to keep me from getting blood clots. i don't make that much penn sion or social security, and it is costly for me. i am not -- sure it is not just me, but other people in my shoes. they talk a good story but never do anything about it. thank you. guest: the caller is exactly correct. this is a big issue, prescription drug prices. this is always near the top, talking about health care. we have seen some action this year from a number of committees , mostly looking at the pbm system, the pharmacy benefit managers. again, they were created because they said they could negotiate with the drug companies and get a better deal for insurance companies, but everything pbm do

, it is opaque. nobody knows how much money they keep, whether they are encouraging insurance companies to find more expensive drugs because they get a cut. there is a lot of pbm transparency like deletion -- transparency legislation that is bipartisan moving through, and i think it is one thing congress would like to get done when they come back in the fall. pbm reform is a bipartisan issue and there are still pieces that the pbm industry does not like and the drug industry may not like, so they are still powerful. whether these things make it across the finish line is not a sure thing. host: when did we start having pbm's, pharmacy benefit managers , and when was it created? guest: i think it was in the 1990's. we were aware of them in the 1990's. as they said, they said to insurance companies, we can negotiate separately with drug companies and will get you a

better deal. very much like what medicare advantage said, we can save you money and it is a win-win for everybody and it has not always been that way. guest: -- host: when the pbm executives were on capitol hill earlier this year and sitting alongside the drug company execs, which way were the fingers being pointed? guest: always at each other. it's a big problem and somebody else's fault, all of these problems. host: who did the members seem to agree with? guest: the members were maybe a bit confused. it's hard to tell, and that is why they are working on transparency legislation. it's hard to figure out these business relationships and what we have seen over the years, the insurance companies have bought the pbm's, so they are no longer independent. many of them belong to insurance companies. the largest one belong to insurance companies, so they have capped it there and it is

hard to know what is going on. members of congress in both parties are frustrated about this because they are getting calls like we just heard, people who have drugs that they have to take to stay alive in some cases and they are costing them more money than they have. host: on the disagreement side, we talked about abortion, transgender care, but on the agreements side, anything else falling into that category when we talk about health care issues? host: congress is -- guest: congress is working to reauthorize a program to train doctors for primary care, which there is a shortage of primary care doctors. host: what is community health center, for folks who don't know? guest: it's a popular partisan medical program that offers medical care in underserved areas, places where there are not a lot of health facilities.

they are primary care centers. host: and they do it through medicaid? guest: no, the community health center, which is one of the discretionary programs in congress. again, if the authorization ends at the end of september, it doesn't cease to exist and cease to be funded, assuming there is hhs funding, but congress is working on this as a policy issue and there is a bipartisan bill in the house. there is a partisan bill in the senate, oddly enough, which is an issue going on with health , education, labor, where bernie sanders is taking these bipartisan issues and trying to push them farther than moderate republicans in the senate want to go. host: our next caller, this is terry. you are on with julie rovner. caller: i have a question about prescription drugs and i am a

little confused about it. i have heard the president talk about new legislation that has been enacted to limit out-of-pocket expenses. what i have heard, those out-of-pocket expenses will not exceed $2000 a year. could you tell me a little bit about that? it sounds great, i am very cynical about it, but my out-of-pocket expenses well exceed $2000 a year on a drug that i must have and i would like to know what the horizon is on the meal cap of out-of-pocket prescription drugs expenses. guest: the bill passed last year, the bipartisan bill had the first serious limitations on drug prices that we have seen in a couple of decades because of the power of the drug industry. but there are small steps.

there is going to be some negotiating between the government and drugmakers over some of the most expensive drugs. we are expected to see -- there is a list of 10 drugs by september 1. that's part of this. host: why only 10? guest: they are starting slow. it's 10, 10, and 25. some of the drugs, it will not be hard to find drugs people take that are very expensive. the first 10 will be significant blockbuster drugs from everything that we can tell. there is also an out-of-pocket limit on insulin for $35 a month -- this is just for medicare at the moment. the caller did not say if they were on medicare or not, and there is an out-of-pocket cap under part. there is supposed to be a cap, and the way the program is set up, patients pay 5% of their remaining drugs after they hit what is supposed to be the

out-of-pocket cap for the year. now there are so many drugs that are so expensive, thigh percent -- 5% can be thousands and thousands of dollars. i believe that takes effect in 2025, but i'm not sure about that. host: can you name the 10 drugs that are on that list? guest: [laughter] i am waiting to see. xarelto, the blood thinner mentioned earlier, is likely on there and a couple more will come. host: take your time. we have agnes on southeastern massachusetts, you're on with julie. guest: my question is, how do we get all the financial for-profit middlemen out of health care, so not just the pv -- pbm's, but the for-profit venture

capital firms that are buying up hospitals -- it's everywhere. guest: yes. we have a big project on private equity and health care. there are differences between parts of the health-care system that are intended to make a profit -- for-profit hospitals, for-profit pieces of the health care system, and the drug industry is a for-profit piece of the health care system. but there are private equity companies coming in not so much because they want to deliver health care, but because there is a lot of money and health care and they would like to share in some of that money. there are issues going on in private equity, buying up places in pennsylvania and they closed it down because the real estate was worth more than the hospital. that is a separate issue going on in health care, but it is an age-old problem -- how do you get the profit out of health care?

people argue if we take the profit motive out, you will be suppressing innovation. host: about 15 minutes left in our program. julie rovner with us. if you have a question, it's (202) 748-8000 if you live in the central or eastern time zones, (202) 748-8001 for mountain or pacific time zones. you can go on the website to see her story, and her colleagues asking questions -- you were asking questions of previous hhs secretaries about what that job is like earlier. three who spilled the beans talked to you. what did they say? guest: one was javier becerra. we had javier becerra, and alex azar, the most recent hhs

secretary under president trump. even though they were from different parties, what they said was very similar. it is a big job, you are overseeing a budget of trillions of dollars, and there is a lot of moving parts. but it was interesting to see how they tried to zero in on small things that they could get changed. hhs is a gigantic battleship. it's very hard to turn it, but you might be able to tinker with some of the things that are on deck. that's what the hhs secretary tries to do. host: what is their role during this appropriations process? is there such thing as a bully pulpit for the hhs secretary ako guest: there is. there are also people on capitol hill who work closely with people in the department. i have seen hhs secretaries, particularly when the government

gets shut down, hhs secretaries get up and say, here are the things that are not happening. community health centers would shut down if there is no funding. host: would they like to see more of the funding on the discretionary side or the mandatory side? do they feel like their hands are tied on the mandatory spending side? >> there are a lot of changes in those mandatory programs for regulation. they have more impact on the mandatory side, many, many more. sometimes they go too far and it gets challenged in court, sometimes they win and sometimes they lose. there is a lot of discretion in those mandatory spending programs. host: are there cases in the next term of the supreme court you are watching yet? guest: not yet, but i am sure they will come up, assuredly.

host: our caller from north carolina, you're next. caller: i get mine free. my wife and i, we are on social security, and she, her medicine costs about $400 a month. i get $1000 a month and she gets 920 dollars a month to live off of. i can pay for my medicine but she has to pay for her medicine. host: back to the cost of medicine. guest: and it depends on what kind of insurance you have how much you have to pay for these drugs. not just whether you are on medicare or medicaid, or you get medicine through the v.a. or have private insurance, it is all different. that's one of the frustrating things.

every time you go to the pharmacy, people are surprised. i have think everyone has gone to the pharmacy counter to pick up a prescription and walked away because it is too expensive and they do not have the money. host: renee in youngstown, ohio. speaking along the lines of prescription drugs, can we talk about why meds like biologics are never included in price reduction? guest: biologics are different than many other drugs. they are harder to make and you cannot copy them more equally. there have been generic copies of biologic drugs the way there have been of other drugs, we have seen when generic competition comes in, drug prices generally go down. there has been some playing around with some of those, which congress is also looking at. when there is enough generic competition for the prices to go down, you cannot make copies of biological drugs.

there would be not generic copies, but other types of the same drug that do the same thing that biologics do. we know they are extremely expensive -- you mayor is probably the one most people have heard of, for remit -- rheumatoid arthritis. people are about to see the first bio-similar of humira. host: how long have biologics been around? guest: also since the 1900s, 1980's or 1990's. we see more in the last 10 or 20 years. it's a sophisticated way of making medication. host: mike, you're on with julie rovner. caller: i appreciate you taking the time. i have a couple of questions, so i will be quick. do you think the added amount of legal and illegal immigration, along with the way it be economy and inflation is, has added an

extra strain on the medicare and medicaid and even the prescription drug industry? if you go to the hospital and you are uninsured and get a couple thousand dollar bill or a $10,000 bill and you are lower income like i am, eventually prices go up or somebody picks up the bill, so i am wondering if this all together is adding strain on the system. i would love to here what you had to say. guest: probably not financially. people who are not here legally are not eligible for federal health insurance. people who are here legally have a waiting period before they are eligible. people think if you go to the emergency room, you will get treated and everything will get taken care of. the emergency room law from 1980 six only requires that true emergencies be dealt with. you need to be stabilized. they don't have to admit you to the hospital and pay for you. if you have no health insurance,

you can only go to the emergency and get care if it is an emergency. or if you are a pregnant person in labor. those are the two things that are covered. people who have no insurance who are diagnosed with cancer, that is not -- not considered life-threatening care. host: our children treated differently than adults in that case? guest: there is a children's health insurance program. it's easier for children to get government health insurance. community health centers do treat people without insurance and treat people who are not here legally, many of them, but places where there is a large strain of immigrants or people here not without papers, that constrain the health care system for free clinics and other places, and possibly

emergency rooms when they have emergencies. but it's not like they are going to emergency rooms, getting care and the cost is being passed along to everyone else. host: cape cod, massachusetts, this is tara. caller: i know three things have been in the health care programs all my life. why is it that congress can't get the same health care as the american citizens? why do they have to have a cadillac plan? why are these 10 drugs that are so non-disclosed from president biden when he gives his ps about doing wonderful work about drug prices lower, when it is only 10 drugs involved, and a lot of things like even insulin, it doesn't affect the average citizen. if it does, you have to be on medicare. the third thing is, how come pharmaceutical companies and try

to sell the drugs, and expensive drug to a doctors practice by giving all of these great tricks and launches, and it is still going on? thank you. host: i try to write them all down, but go ahead. guest: the first one was about congress -- this is not true anymore, that congress has the same health insurance everybody else. congress no longer has the same federal health insurance that most workers had, because when they passed the affordable health care act, they have to get their health care through exchanges. you can say that they have less good health insurance than most other people, because they are employed but they don't have employer health insurance

anymore. they have to go through the exchanges. that is still little-known, although it has been very confusing for a lot of people. not just the members of congress, but their staff who have to navigate other ways to get health insurance. the second question was about drug prices, i think. yes, it's only 10 drugs now, but that was as they could get through congress. that's been very difficult to get anything through congress. there was an effort to make that insulin cap on all people who need insulin, not just people on medicare, but that was taken out at the last minute because they could not get the last vote they needed in the senate to have that in their effort to pass that separately. this is basically hand-to-hand combat in congress to get every last vote to get these things you need passed. there have not been the votes in congress to do this until very recently. what president biden got past or

what congress passed last year's on one hand very minimal in many ways. it will not lower drug costs for everybody, but it is almost congress has done -- it is the most congress has done in many years. host: the numbers of american impacted -- americans impacted by insulin drug pricing from the university of south carolina. 30 million americans with diabetes approximately seven point 4 million rely on insulin to manage their care. guest: it's not a huge number, but for the people that it's for -- we have seen so many cases of people trying to ration or cut back on their insulin and dying. it is a drug that keeps you alive. that is a big issue and has been for quite a while. the last issue was drug company incentives for doctors, which the caller is right, were supposed to have gone away, but

haven't in every case. that is something that keeps health reporters very busy, looking at that, but there is a limit to what drug companies can do. they used to fly the doctors to hawaii and they would go to a two hour briefing and could spend the rest of the time in hawaii -- that doesn't happen anymore. host: julie rovner, joining us now. we will be waiting for a briefing on military readiness that is taking place at the air and space forces later today. we will be taking our viewers there when it begins, but julie rovner is with us until it begins. sue in michigan, good morning. caller: good morning, hello, julie. you are very informative. three quick questions --

canadian prescription medicine is a lot cheaper than the united states? that's number one. and what is congress doing about health care coverage for psychiatric patients. is that improving? are they addressing that? third, my husband is 62 and pays $500 a month for his health care, with a $6,000 deductible. he is south employed. is anything going to lower that price and the future? guest: canadian prescription drugs -- they cost less because canada has limits on how much drugmakers can charge, almost every other country except the united states regulates or caps drug prices, and if they can't make money in the united states, we are being limited in what we can make overseas, so again, back to that innovation argument -- we will be able to make these drugs anymore. we have to make the profits that

we can in the united states. that has been the fight going on for 30 some years that i have been watching. the united states is practically alone in not having price controls on drugs, and people can and duco across the border, particularly if you live in a northern state or if a southern state, you live in a state near mexico, you can get a personal supply for yourself, but there is a concern about people getting black-market drugs or selling mail-order drugs that are canadian but aren't, so it can be problematic. that's the general rule, they are cheaper in canada and other countries too. host: health care for psychiatric patients? guest: this is something congress is working on. the biden administration put out new rules on mental health parity, something congress has been working on for a long time, since the late 1990's.

they passed a couple of laws and we have not seen mental health treated the same as many other medical ailments, and that's something the administration is working on because it is supposed to be law. congress is also working more on mental health care. this is a known issue and it is hard to know how much the federal government can do. by on the mental health parity issue. host: and the $6,000 deductible, looking for ways to lower that. guest: -- we had deductible and co-pays. if everything was free, people would overuse it. the problem is the skin in the game's arm and a leg. -- the game is a arm and a leg.