specifically, medicaid. is it a good idea?e want to get your thoughts on all of this. 202 is the area code. 585-3881 for the republicans. 202-585-3880 is our democratic line. you can also join us at facebook or send us an e-mail. a couple of issues dealing with health care and the elderly. a cover story, "increased -- a crisis in plain sight." and this cover story from time magazine called, "why medical billsa re killing us." and from "the new york times," -- there is the story of one of a number of republican governors -- he said ohio would reverse this decision if the government failed to cover all the cost of the expansion. here are some details for ohio -- last year the supreme court ruling that they have the ability to tap in and out of the system. medicaid covers 2.2 million people in ohio. it is the single largest program in the state with a two year budget. it accounts for roughly $18.7 billion, or 32% of the more than $55 billion budget. junkies to talk about medicare and medicaid as a way to deal with the issue that

medicaid reimbursement rates set for the state. medicaid has tremendous latitude for the states.'s a basic package required. the eligibility, optional benefits package and the reimbursement rate all determine ted state level. it squeezed providers so you have reimbursement rates lower than private insurance. unlike medicate where reimbursement rates get fixed in the federal government. >> by the way, in florida, governor rick scott slashed the compensation that went to public hospitals because he wanted to favor private hospitals. and he has been running this experiment in medicaid managed care. people don't like having the hmo experience. at least to your point, when you compare people who have no insurance at all, those are people getting care in the emergency room, by and large. they're not going for mammograms or screenings. sure, doctors do a good job of treating people in the emergency room, but that doesn't mean that's where you get health. >> given the political economy, that the hospital is grabbing the dollars which i think is a fair enough way to stay in florida. i'm f

governor of late to accept the medicaid expansion.zona's jan brewer, ohio's john kasich and michigan's rick snyder have also reversed their decision recently. scott's move is also significant because florida has one of the nation's highest level of uninsured residents. more than a million people could be added to the state's medicaid rolls, potentially funneling an estimated $73 billion in federal money to the state over a decade. medicaid, the joint federal and state program that provides health coverage for low income families and those with disabilities, is key to the president's affordable care act. the congressional budget office projects 12 million americans will gain coverage through medicaid expansion. starting in 2014, the federal government will pick up 100% of the cost. by 2017, the government's share starts to ramp down, so that by 2020, moving forward, washington will pay 90% of the tab with states picking up the other 10%. but many republican governors said this summer they would not opt into the medicaid expansion after

terrible idea to expand medicaid.do it here if florida because we are going to do the right thing. money has spoken to him. he has changed his mind. bad decision and politically cowardly. hypocritical. >> he is selling it to the legislature it will only last three years, that is the time the administration picks up 100% of the tab. he is saying he is going to put in avoucher system in florida. what is your take? >> this shows the limit of the republican position on healthcare. what is the a terptive? you say it'ser thible that he is doing it but he is providing healthcare to poor people. the problem is if he didn't take the money -- florida are paying taxes for this, federal taxes. so you reject money that people paid in to help poor people who need medicaid. so there is no alternate plan offered to provide healthcare to the people. so i think this is testify it inly, you know, shows the strength of obamacare in my mind. >> bret: point out seven states have accepted it. but 2 have not. 26 states turned it down. >> fir

medicaid is mountains of literature have shown that patients on medicaid have worse health care outcomesn any health insurance program in the developed world so they are selling out. they are intimidated, and i fear that if we the patient versus politicians who are motivated by money and power and self-preservation. neil: david, to that point, small business guys on the front line of this stuff, they feel that, well, better we have input in the system, better the skyrocketing costs we deal with in our state for medicaid, the feds save us some money with this so it sounds tantalizing much like that too good to be true in the trip to the stars episode, are they entering their own twilight zone, is that the risk? >> they could, neil. there's extraordinary amount of pressure, and up like washington, they don't have a federal reserve to buy bonds and print money. they are trying to weigh the costs, costs and benefits of dealing with the federal government. should they take money to have it to use because if they don't, are they having bumming tear pressures later and on the hook anyway? one o

medicaid comes to the top of my mind. medicaid, i think most governors will tell you is the budget buster of all. it is dramatic challenges. what originally started out a decade ago, 9% of my budget is up to 20% and the next decade is 30% of our budget. it takes away from education, infrastructure, other health and human service needs. so medicaid and the need to have flexibility is something we are go to go watch as we go forward. let me finish where i started. we need to address the rising costs of health care. i don't think the affordable care act does that. we have provided an opportunity with our health care exchange in utah is a model based on good principles that allows businesses to provide as a benefit and health with competitive forces and consumer control to, in fact, have an impact on the rising costs of health care. it may be imperfect, but it's a step in the right direction. again, the fundamental position i'm taking and we're taking in utah is that the free market works if you allow it. and takes politician

if you look at medicaid it is really interesting the rate of growth in medicaid services has gone up rapidly but not all of them. the things that you can do high-volume, testing, certain types of procedures have gone through the roof. what we think of as more care takes a lot of time and expertise and i think what you see in medicaid is an industry response of the reimbursement if i have a business model that lets me do volume of and if i don't i won't. again this sounds a very wonky but think of what it means for the patient if we think of health care as the single good can we get your health care? the affordable health care act has put more people into medicaid. if in fact what we are doing is driving the different types of surface then we have an issue. we were talking about our future intelligence were left so medicare will cost $600 billion this year. seniors are the best customer for the health care system. i think this probably 5,000 in the country. how is this possible? it is possible because the way that you reimburse says you can get this type of care but not this type of c

medicaid coverage is perilous. for example, surgery patients on medicaid are 50% more likely to die after surgery than surgery patients on private insurance. in fact at it even riskier to be on medicaid than to have no insurance at all. >> neil: sounds like the president is getting his way in the end. it wasn't about a single pair system, but in the end it's going be to uncle sam and only up kell sam. >> i'm very disappointed to see what -- >> neil: many people say he just hates -- >> let's face it. for politics, medicaid is a verb. i minds spend, spending, spending, on more benefits in the hopes the federal government will pick up the tab. he suggested the legislature expand medicaid as the law, because the federal government has promised to pay 100's for three years and 90% afterwards. but the federal government generally breaks its promises. >> neil: having said that, i there this was the notion -- the same thing governor brewer in arizona -- they didn't want city control from the federal government so they felt

medicaid west bank $335. sounds like a great deal for medicaid.ow, many of you have been in the cheeseburger markets. you can buy a cheeseburger at mcdonald's 4909 cents. you go to the cheesecake factory, sit down, have a more leisurely meal, and by a cheeseburger for $11.95. you can go to our neighbor, the bistro, a by cheeseburger for $32. now, if you lived in health care, what you would say is this cost shifting between mcdonald's and db bistro. here's my fear. my fear is we're seeing three different health care systems. the reason that medicare providers can sell their services at a loss is because they do make enough profit. a package but it's one of the reasons that seniors are getting ever and ever more care. as you drive prices down you get an industry to find ways to sell more to those same customers. and if you look at medicare carefully, what is being sold to patients, it's hard to believe, they are not more in mcdonald's business. mcdonald's actually makes more money than db bistro. they will sell you five but they will give you much s

arizona's medicaid program access is not the problem. it is part of the solution, as the nationally recognized old standard for cost effective care in this country -- gold standard for cost effective care in this country. i will weigh the evidence, and do the math. with derail it is facing us, taking advantage of this federal assistance is a strategic way to reduce pressure on the state budget. we can improve arizona's ability to compete in the years ahead. [applause]i am committed to doing this, and i want you on my side. let's work together in an atmosphere of respect, and do what is best for arizona. [applause]of all the subjects we tackle at this capital, we must recall the facts and figures and spreadsheets never tell the whole story. for that, we must go back to the people we serve. maybe things happen in arizona when we work together as leaders. marshal available resources, and encourage innovation and partnership. for someone special i would like you to meet today. her name is shelby. she is 12 years old. it wasn't long ago that

we're not going to expand medicaid. we're going to dot right thing. >> florida led the charge against obama care, challenging it until the law was upheld by the supreme court last year. governor scott later used inaccurate information to claim medicaid was 2,500% more expensive than it actually is. scott now joins six other republican governors who will accept obama care's medicaid expansion, including governor jan brewer of arizona and governor john kasich of ohio. so far 23 states have decided to participate in the medicaid expansion. many republican governors went out of their way to drum up opposition to obama care, but their rhetoric melted in the face of reality. florida's uninsured population is 20%. it's time for the fourth worst in the country. governor scott's former supporters in the tea party, well, they were very quick to criticize his decision. you can imagine what they said. it's this. "this is just another example of republicans lying to floridians," said tea party activist everett wilkin son. he called

medicaid was paying $335. sounds like a great deal for medicaid.ow, many of you have been in a cheeseburger markets. you can buy a cheeseburger at mcdonald's 4909 cents. you can go to the cheesecake factory, sit down and have a more leisurely meal and buy a cheeseburger for $11.95. you can go literally to our neighbor, mr., by a cheeseburger for $32. now, if you lived in health care, what you would say is this cost shifting between mcdonald's and bistro, here's my fear, my fear is we're seeing three different health systems. the reason they can sell their service as a loss is because they do make it up to a package. it's one of the reasons seniors are getting ever and ever more care. as you drive prices down, you instance and industry to find ways to sell more to the same customer. and if you look at medicare customer carefully, what this means is it's hard to believe, they are not more in mcdonald's business. mcdonald's makes more money than db bistro. they will sell you but they won't give you much service to medicate him of a ton else is having.

they're taking medicaid money.ly should be to me a conservative -- >> what do they have in common? they have in common a lot of them are running for re-election in 2014. that point they realize the tea party brand is down. they're pragmatists at the end of the day. >> what if the house doesn't need the money? a lot of these guys are rejecting the exchanges, the obama care exchanges but they're dipping into the medicaid program. >> let me first say that the wisconsin governor scott walker who is up for re-election next year, he is also taking a look at these medicaid dollars and saying no thanks and doing it in a smart way. i think chris christie made a mistake. i am disappointed in the medicaid decision. he called it extortion and now he is voefring for the extension. i think he is in an election year and fields like he is in the process of reforming medicaid in the state and can win conservatives over. i am a fan. i think this is a mistake. the point you made is so important here and i love cpac and looking forwar

. >> we're not going to implement this medicaid expansion. >> rick scott will expand medicaid. >> he is joining a group that clouds jan brewer. >> gop governors accepting the law. >> also about the power of free federal money. >> this will be devastating for patients. >> this will be the biggest job killer ever. >> i know there will be a lot of discussion today about the politics of this, about who won and lost. >> obama care is the law of the land. >> when we look back, we'll be better off. >> one week from today, the sequester spending cuts go into effect. it happens. president obama's unwillingness to put a plan on the table. >> the president laid out no plan to eliminate the sequester and the harmful cuts that will come as a result of it. it is incumbent upon the president and senate democrats to show us their plan, to stop the sequester from going into effect. >> march 1st, the day that the devastating sequestration cuts, the president's sequestration cuts take effect and we've yet to hear a plan from the president. we need the president to lead and come forward with his proposa

he has wisconsinites who say -- why can't we get access to medicaid? >> because scott walker wants to be president. if you look at the governors that are saying no -- look, states like louisiana, how poor is louisiana or mississippi or texas? texas, which has one of the highest rates of uninsured. look at the governors who are saying no. scott walker who is thought to have presidential ambitions. bobby jindahl. nicki hailey thought to have presidential ambitions. it's much more than the fiscal sanity that you would think would govern. they're giving this money to california. that's what they're going to do because their voters, their -- the poor in their state are still going to be poor and still going to go to the hospital and still going to get treated. they're going to be treated as free riders, and the federal money that should be going to wisconsin and louisiana, mississippi is going to california. that's all they're doing. the money isn't going to be -- >> here's what you can say about scott walker. he is true to his principles, and his principle

>> medicaid and the road signs are exempt from sequestration. are you concerned that any negotiation to sidestep sequestration will put those funds back on the table? >> the gene sperling said with respect to medicaid, many of us made the decision to expand and it was based on the deal on the table at the time. 100% for three years. it is pretty clear that this will not change. >> there is going to be a bipartisan messages shou to the president. >> a couple of months ago a total delegation of three democrats and republicans came to washington. we met with the president and vice president. we met with john boehner and his leadership team. we met with harry reid and his leadership team. our message was we think it is very important that governors have a seat of the table -- at the table. we are partners. we wanted to make sure there were a few principles we could lay out. one is to the extent money is taken off of federal spending but he shifted to state spending, that is not accomplished much for our constituents. my view is that that they unders

a primary example is medicaid. in this budget, tenncare costs will be 350 million dollars more this year than last year. that increase takes into account the higher cost of medical care, more people who qualify for medicaid in tough economic times, and primarily, the impact of the affordable care act. expanding medicaid is not reflected in this year's budget. i am hesitant to commit additional dollars to medicaid when it's already eating up so much of our budget, and we have to remember what the state went through seven years ago when it made the difficult decision to cut a lot of people from the tenncare rolls. we have to be very deliberate about making a decision to add that many and more back to the rolls, but i also understand that the decision isn't just as easy as standing here today and saying, "we're not going to expand medicaid." there are hospitals across this state, many of them in rural communities, that are going to struggle if not close under the health care law without expansion, and that's not somet

in fact and it is not unusual for physicians to lose money in medicaid patients.effective for physicians to provide free medical care that it is to provide care to a medicaid patient. so the reason it is cause for concern is that adding a million additional people to the medicaid system means that there needs to be some sort of incentive for physicians and other health care providers to see those additional people. melissa: it makes perfect sense, and when you're trying to dig at the stats for this camino, we found that it is anticipated right now that the state is going to be about 752 dr. short in the near term, but i also saw that it is estimated that primary care physicians make about $226,000 in florida. that isn't enough money to attract more people into the field to be primary-care physicians? does that number right to you? it seems like a lot of money. >> that does seem like a lot of money, and it seems a little bit high to me based upon the figures that i have seen. i think there may be some conflicting data on that. primary-care physicians in general are

medicaid expansion is federally funded, so if montana does not expand its medicaid program, then our tax dollars will be used to help patients in states like arizona, nevada and north dakota, states where republican governors are leading the effort to expand medicaid. let me make that point abum adaptly clear -- abundantly clear. if we fail to act, montana taxpayer dollars will be used to provide health care to citizens thousands of miles away while our rates will continue to go up year after year. it's time we set the politics aside on this issue. poll tucks won't -- politics won't treat diabetes. extremism doesn't create jobs. and intransigence won't provide health care for those whocan't afford it. [cheers and applause] under access health montana, though, it's also doing other thinning. i also proposed by increasing by 25% the number of -- [inaudible] in the whammy program which allows montana med cool students to attend medical school with other students in the northwest. the program's been extremely successful in encouraging our montanans to come back to our cities and our town

emergency medicaid.his country, for many years since 1980's, congress has passed laws that require hospitals to treat people in emergency rooms, to treat people who show up and need treatment. they are not allowed to turn them away because they don't have insurance and they're not allowed to turn them away because they're not in the country legally. >> and they're not allowed to ask. >> exactly, not allowed to ask. so if a woman comes, she's in labor and she take care of her and they find out through the process of asking for information and stuff that she's there illegally, but they treat her. so, that's what happens. and some states are more generous than others in the kind of treatment that they will give out, and under this emergency medicaid. and as a matter of fact, that 2 billion dollars that you mentioned, a large, large part of it. much more than half is spent in new york, in california, which offer the most generous benefits, chemotherapy is covered by emergency medicaid, kidney dialysis is cov

federal government could ratchet it down to 80%, to 70%, to 60%. >> medicaid currently covers 60% of americans earning less than $23,000 a year for a family of four. it would increase that for families up to $31,000. cost, trillion dollars. >> people say it's free money. that is yours and mine tax dollars. >> there is one pot of money and he spends 12 million more on medicaid. >> chris: thanks for that. the head of the postal service says saturday mail delivery will end in august. postmaster predicts the move will save the agency about $2 billion a year. he says saturday packaged delivery will continue. postal service reported a record loss of almost $16 billion last year. some in congress are asking how the agency can decide to suspend saturday delivery without their approval. >> should your tax dollars go to give smart phones to job seekers? that is later. up next, a new government regulation that could force your local grocery store to shut down it's salad bar and bakery. hitting the streets to tell real people about our new 15 under $15 menu! oh my goodness... oh my gosh, this lo

medicaid is paying $335. sounds like a great deal for medicaid. many of you have been in the cheeseburger markets. you can buy a cheeseburger at mcdonald's for 99 cents and go to the cheesecake factory and have a more leisurely meal and by a cheeseburger for $11.95. you can go literally to the neighbor and by a cheeseburger for $32. if you were in health care what you would say is there's cost shifting between mcdonald's. here is my fear. my fear is we are seeing three different health care systems of the country. the reason medicare providers can say the service is at the losses because they do make it out and the package. it's one of the reasons they're getting more care. what is being sold to the patients it is hard to believe they are not more in the mcdonald's business. mcdonald's makes more money because they will sell you five and they don't give you much service. medicate i'm afraid of something else is happening. you look at medicaid and it is interesting. the rate of growth in medicaid services has gone up rapidly but not all of them. th

guest: let me explain this whole medicaid expansion issue. essentially what this is all about with respect to the passage of the affordable care act in delaware we made the decision to do this medicaid expansion and what it really means is that the federal government will pick up 100% of the costs for three years, 90% thereafter so long as we're providing medicaid coverage to an additional group of part of our population based on income. now, this does a couple things. first of all it means more people will have access to good care. otherwise, when people get sick if they don't have this kind of coverage they get sick, they get sicker they don't see any kind of health care professional, they probably end up in the emergency room which is the most expensive place of all for them to get care. and this provision will mean that more of these people can get access to less expensive primary care at the right time. in addition to that at least for the sake of delaware, this move made sense. this really was not a philosophical issue, a democratic or

as such, i believe we must ask certain medicaid patients to make a modest contribution toward the cost of their own care. and i will insist that nevada be able to opt-out of the medicaid expansion program in future years, should circumstances change. [applause] beyond medicaid, my budget provides additional funding for our state's most vulnerable citizens. it includes more support for autism and early intervention services, piloting 24/7 mental health care in southern nevada, and increased community based services for nevada's disabled and senior citizens. [applause] we have all been touched by the housing crisis over these last few years and nevadans continue to struggle with home foreclosures. last year, thousands of nevadans attended a free housing assistance event in las vegas, sponsored by our own department of business and industry, called "home means nevada." at the comprehensive event, over 250 representatives from banks met with homeowners and provided help on the spot. while many nevadans received assistance at the event, we must continue to do more. working with attorney gen

we started 2011 with the medicaid budget out of balance and we brought it under control. we started with one of the lowest rates of insured children in the country. we started with mental health and addictive disorders programs hobbled by cuts. we have invested in both. we started with the medicaid program that requires little accountability for " -- for quality and cost. let us ask a simple question, are taxpayers getting the most help for the money they spend on health care? my answer is no, not by a longshot. we spend more money for health services per person than any nation on earth. year after year we devote a larger portion of our paychecks, and payrolls, our state and federal budgets, to health care services. maybe we would not worry about all this spending if outcomes were better. but they are not. the united states has fallen behind the rest of the world in mortality and life expectancy. here in south carolina we have one of the lowest life expectancies and highest infant mortality rates in the u.s.. with such high costs and poor outcomes, why would we throw more

we're not going to expand medicaid because we're going to do the right thing.ot going to do the exchange because what this does is raise the cost of health care for all floridians. it just doesn't work. >> also during governor scott's tenure he pushed to disenfranchise some of his state's voters by limiting early voti voting. before he was governor, the business he founded was involved in a medicaid fraud for which is paid a settlement. scott was not personally accused of wrongdoing but the company's board removed him as ceo. it was all with this in mind we look at governor scott's current change of heart on president obama's affordable care act. charlie crist is the former governor of florida who left the republican party and joined the democrats. he's also frequently mentioned as a candidate for florida governor next time. and jonathan alter is a columnist for bloomberg view and an msnbc analyst. governor, thanks so much for joining us. you're a favorite of this show, as you know. and i want to ask you, explain the 180 here. this guy was one of those -- was i