medicaid and expanded. my colleague from washington state was kind of extolling how much obamacare has lowered costs. well, when kentucky originally implemented it, they expected the long-term costs of the medicaid expansion to be only a 4% increase in their current state spending on medicaid. after only one year of the expansion, updated projections show that the expansion cost the federal government more than half a billion dollars more than governor bashear had projected for 2014, and this will double in the coming years, meaning that the medicaid expansion will cost a billion dollars more per year than expected. again, this was the projected cost. this is actual cost. now, if this is saving money, oh, my gosh, let's not -- what would happen if we actually lost money? by anybody's calculation, this is losing money, and this has been the situation across the country. states that have expanded medicaid, it has turned out far more expensive for the federal taxpayer than originally anticipated. it isn't just

that where the money in medicaid is. that's what the medicaid program does.ave to understand that in order to make changes and you have to understand that when you start to open up the hood. so those are the questions that are going to be going on. those are the conversations that are going to happen. i view our role as being educational and informative p. trying to lay out the reality of the world.. trying to lay out the reality of the world. without getting into very high level above my pay grade political questions about should you or shouldn't you. because again, that will be for other people. so let me stop there. turn it over to david and then we would be happy to take questions from all of you. so, david? >> thank you, matt. my name is david salisbury. i've been chief financial officer in various health care organizations, large systems, mainly academic and or public health systems for 25 years.or health systems for 25 years./or health systems for 25 years. and for the past two to three years, about three years, i crossed over to the dark side to do he

and for the poorly insured, folks like medicaid. now, let's just talk about medicaid. why would we see patients on medicaid at a hospital for the uninsured? if they wanted to see an orthopedic -- orthopedist in private practice, does medicaid pay a provider well enough to pay costs of seeing an orthopedic patient? >> oftentimes it does not. as you well know, as i mentioned before, one out of three physicians who ought to be able to see medicaid patients in this nation, do not take any medicaid patients. there's a reason for that. whether it's reimbursement or whether it's hassle factor or regulations or the like. but that's a system that isn't working for those patients. and we auought to be honest abo that, look at that and answer the question why and then address that. >> now, i'll note that when the house version of the aca passed, robert pear in the "new york times" wrote an article about a michigan physician, an oncologist, who had so many medicaid patients from michigan medicaid that she was going bankrupt. she had to discharge patients from her practice. now, th

the problem that we're seeing in medicaid is more and more doctors just won't take medicaid. because they lose money on medicaid. it's so over regulated and so bureaucratic that physicians just won't take medicaid patients so our concern is, that people on medicaid can't get a doctor and if you can't get a

but last april, before she had medicaid, robin showed up at the e.r. uninsured and had to undergo gallbladder surgery. >> reporter: before you had insurance, how much did you rely on the emergency room? >> i was probably having to go there for a little while. i was probably having to go, like, two or three times, like, a month. >> reporter: for your basic health care. >> correct, yes. >> reporter: after the medicaid expansion, kentucky hospitals saved more than a billion dollars in uncompensated or charity care from 2013 to 2014, according to a state- commissioned study. kentucky's waiver, if approved by the trump administration, could provide a glimpse of what a republican replacement for obamacare might look like. brian blase, a former staffer for congressional republicans, now works as a health policy analyst. >> we have 50 states. they're often referred to as laboratories of democracy. let them figure out some of these problems, and learn from each other. >> reporter: blase favors a repeal of the medicaid expansion, and says that in states like ken

. >> to improve medicaid. >> to block grant medicaid. what that means is states will have to decide whether or not this child gets the medicaid that he deserves. that's what happens. so you push it back to the states and hope it work out. one estimate by senate and budget priorities long before you were named said -- here is the headline of a chart. house budget chair's plan would slash medicaid by one third by 2026. this wasn't developed because you're now in front of this committee. that's what they're saying, that medicaid would be cut by a third and by way of the number, a trillion dollars. let me ask you this question -- >> may i respond? >> let me get this question in. can you commit to us right now that no person with a disability who is currently covered by medicaid, that's everyone, that's rowan, that's everyone else, that no person with a disability who is currently covered by medicaid will lose healthcare coverage, not access, coverage, under the block granting plan that the administration now embraces as of sunday. >> what i

medicaid, and the bedrock guarantee of social security. they are now linked in the public's mind and subtracting or manufacturing any part of that changes the whole argument. >> not a lot i can add to what the previous speaker said but someone i suspect i will not often be quoting. on may 7, 2015, donald trump "i was the first and only potential gop candidate to state there will be no cuts to social security, medicare, and medicaid. he didn't just say this in passing or in the middle of the night or in a particular interview. this was a cornerstone of his campaign. he said it over and over and over again. he will not said cut social security. he will not cut medicare. he will not cut medicaid. therefore, one of two things are true. liedr donald trump simply to the elderly and the working people of this country and just made campaign promises he had no intention of ever keeping -- that is one reality. , congressght now wastes an enormous amount of time and donald trump got to come forward. maybe he will tweet and say clearly that donald tru

if you're a senior, you know, medicaid -- almost half of medicaid is about long-term health care. you want grandma living in the guest room? repeal the affordable care act. you go along was part of an initiative that is part of the right budget that says right budget that says we are going to voucher is medicare and block medicaid. this has a tremendous assault on the security and financial security that goes with what the affordable care act has done for the american people. make america safe again? is that what republicans want to do? i certainly hope not. hopefully we can work together to find a path, but not to undermine economic assurance to the american people. it stands right there is social security which they want to undermine. medicare and medicaid which they want to undermine the affordable care act. if the president asked us are you ready to have a fight in you? you didn't need to ask us this question. what back on the yield to patty murray. >> thank you so much, leader pelosi. republicans have made all kinds of empty promises about how ripping apart the health care sy

if you're a senior, you know, medicaid, almost half of medicaid is about long-term health care. you want grandma living in the guest room? you repeal the affordable care act. if you go along with -- this is part of an initiative that is part of the ryan budget that says we're going to voucherize medicare, we're going to block grant medicaid. this has a tremendous assault on the health and health security and the financial security that goes with what the affordable care act has done for the american people. and so, make america sick again, is that what the republicans want to do? i certainly hope not. hopefully we can work together to find a path to address some of the concerns they may have. but not to undermine this pillar of economic and health security for the american people. it stands right there with social security, which they want to undermine, medicare and medicaid, which they want to undermine, the affordable care act. so, the president asked us, are you ready? do you have the fight in ou? he didn't need to ask us that question, i don't think. with that i'm pleased to

it expanded medicaid. this is very important to america's families. in this case, all politics is personal. talks about the 75% of the people who get their benefits in the workplace -- that is so. they are affected. the increase in premiums is the lowest it has been in the 50-some years they happen tracking. it has contain costs. it has increased the best package in terms of pre-existing conditions. no lifetime limits, no annual limits. being a woman is no longer a pre-existing condition. .he package is better the rate of growth of costs decreased. many more people in short. the 20 million people did not have access before. most every person in america has better health. the republicans say repeal and replace. the only thing that has going for it is alliteration. they don't have a replacement plan because they don't have the votes for a replacement plan. to repeal and then delay, that is cowardice. it recognizes that the consequences to them of just straight out repeal without some replacement. so, we have a values debate on our hands. it is very pers

folks like medicaid. let's talk about medicaid. why would we see patients on medicaid at a hospital for the uninsured. if they wanted to see in orthopedics and private practice, does medicare pay a provider well enough to cover costs to see an orthopedic patient is mark. >> often times it does not. as you know, one out of three physicians who should see medicaid patients do not take them. whether it's reimbursement or regulations, but that is a system that isn't working for those patients. we are to be honest about that and look at that and answer the question why and then address that. >> i will note that when the house version of the aca past, they wrote an article about a michigan physician who is an oncologist who had so many medicaid patients that she was going bankrupt. she had to discharge patients from her practice. now the ranking member said we can have alternative facts. i agree with that. we also know new internal medicine articles, speaking about medicaid expansion in oregon and how they expanded in oregon, outcomes di

to cover people under medicaid. we were debt -- we were just -- we were rejected by cms. do you believe, during this replacement time, we should be covering people under medicaid expansion, but moved to a program that is more flexible to provide more care under medicaid? rep. price: i think there ought to be better ways to provide care for the people on medicare. we are listening to the governors and the state insurance commissioners who provide care. senator bennett: i want to thank my colleagues from ohio for his graciousness and not going to o over. the goal hereice, is access to the highest quality coverage and the high school he health care from americans. i think that is a worthy goal. just piggybacking on wet senator portman was asking about, i am worried today, whether it is the affordable care act are not therefore do care act -- or not to the affordable care act. rural parts of this country or the state are not getting access to high-quality choices in terms of insurance. -- and ilittle bit think it is inc

we are going to block medicaid. so this has a tremendous assault on the health facility and financial security that goes with what the affordable care act has done for the american people. so make america sick again? is that what the republicans want to do? i certainly hope not. hopefully we can work together to find a path to address the concerns they may have, but not to undermine this pillar of economic and security for the american people. instead, right there with social security which they want to undermine. medicare and medicaid which they want to undermine in the affordable care act. the president now says are you ready, to have the site and you. with that, i am pleased to yield to the leader of the fight, patty murray. >> thank you so much, leader pelosi. now, republicans have made all kinds of empty promises about how ripping apart the health care system with no plan to replace it somehow won't hurt anyone. but i would like to focus on just one promise that the republicans made, that if they repeal the aff

that's the important of medicaid. we have not paid a lot of attention to it, medicaid has become a middle class benefit because of the notion of long-term care. the idea of the growth of dementia recognized as earlier stages now and alzheimer's disease louisiana now provided the whole notion of security. the edicare, that is argument that is coarsing through the american political system and they are now linked in the public's mind in subtracting or fracturing any part of that guarantee change he whole argument. >> not a whole lot that i can add to what the previous speakers have said but let me quote somebody who i suspect i will not often be quoting. on may 7, 2015, donald trump tweeted, "iffers the first and only -- i was the first and only g.o.p. candidate to state there will be no cuts to social security, medicare, and medicaid. " now, the point is trump didn't just say this in passing, he didn't say it in a particular interview. this was a cornerstone of his campaign. he said it over and over and over again. don

medicaid spending nationwide. nearly 60% of nursing home residents are covered by medicaid. think about that. 60% of all nursing home residents need medicaid. the next time you hear someone casually suggest drastic cuts and changes to medicaid, think about that. those cuts will work their way back to nursing homes throughout your state, and those families of those seniors, they're not all people who have been poor, on their minds all their lives, they are our neighbors and they will feel it. in rhode island over 30,000 seniors access health care coverage through medicaid. and my colleagues across the aisle want to make drastic cuts to medicaid. make no mistake, custom -- cuts to medicaid means cuts to services for seniors and return to premedicaid times when the elderly had few options. in 1950's, 1960's before medicare and medicaid, your grandmother or grandfather was in your living room in a hospital bed being taken care of by typically your mother. that's the way you grew up back in the 1950's and 1960's and mo

the medicaid program is one where the states know best how to care for in the best way their medicaid population. >> you look forward to working with you. >> likewise. >> thank you, mr. chairman. representative price. i hope you can understand our frustration around trying to divine the nature of this replacement plan. we hear you and president trump praise all of these aspects of the affordable care act and lay out goals that sound eerily familiar to what we've been living with for the last six years. you've said that you don't want there to be a gap between the repeal and the replacement, that at least as many people will have coverage with the goal of more people having coverage. sick people won't face discrimination. young adults will get to stay on their plans until age 26. yet, we don't get any specifics as to how that is going to occur. it seems as if you and the president-elect want to do everything the affordable care act does, but just do it in a totally different way. and so i'm going to kind of give up on trying to get at the specifics of this secret replacement plan, and

and changing costs of medicaid. it is a myth to believe the matching rate of federal dollars leads states to spend more in medicaid. when you put a budget together with governor and legislators, the next dollar into medicaid, they want education and economic development. states have worked, combining lower cost outcomes. do not want to take on the responsibility of being counter cyclical. >> what is not likely to happen, the eca, they will go away, whether they are on the other side on the programmatic side remains to be seen. as senator collins put out a proposal rand paul did too. we will see what comes of that. healthcare is tough, tough to do whatever your background because taxes are important. the employer, deduction for employer-provided health care is wrapped up in that, 80% of americans, a huge majority get their healthcare through their employer. step one is the decision to you change that or keep it the same? it is a very different decision. the healthcare experts i talked to don't like that, it works dec

that's the point of medicaid. medicaid is their only option. and now, i have heard some people say well, this is going to expand local control. this is preposterous. the truth is that block granting medicaid, which is the same thing as cutting medicaid and giving a fixed amount to the states gives states less control, not more control. they force states to choose between seniors and kids, between people with disabilities and women, or between health care and education. look, it does not matter who you voted for. american voters, left, right and center, have been sent, and what we do in washington is we run for office saying one thing, and then we get in office and we do exactly the opposite. and, frankly, the congress has earned that reputation. this is another instance where a party has promised not to cut medicaid, but here we are week one, day five debating cuts to this important program. this is a deal breaker for me and many of my colleagues, and it will be a disaster for millions of americans. i call on everyone on both sides of the aisle

we have talked about medicaid of it. medicaid, i have seen numbers recently and correct me if i'm wrong, but it's growing and state budgets about four to 5% a year and it's crowding out everything else and may be just more evident about how the aca has not effectively been a cost service. something that has not been mentioned on the panel at all, which i think is a fundamental thing and if you take anything away from what i say is this, economic growth is the underlying issue because if the economy continues to grow at one or two or 3% a year you can complain all you want about how the feds are not getting 7% a year or revenues are not growing six% a year or the feds are not providing more money and all that because if income and sales and property value and everything are only growing up the pace of the economy there's not more money to spend on these services and these programs. the pie is stagnant and everyone has to fight over the crumbs, so we can talk all we want about how do we restructure these or complain get th

these are all medicaid patients. folks say, oh, my gosh, health savings accounts, per-beneficiary payments can never work for the poor. in this case, 70% of those enrolled in this program were below the federal poverty level. and yet nonetheless they contributed to their own has. they continued making those contributions and altered their behavior to become more cost-conscious, better consumers of health care. i say, don't underestimate patients. i woirked in a hospital caring for the uninsured. although the uninsured don't have some of the advantages in life that others have, they can take care of themselves. they know what is right and what is wrong in terms of their own interests. so let's make those per-beneficiary payments. let's not be distracted by those that somehow make this a bad thing. let's believe in the american people that they can handle their own health care and that they don't need a washington bureaucrat to tell them how to live their health care lives. mr. president, i yield back. the presiding of

see medicaid patients. if we're honest and severe about addressing this problem we ought to step back and say why, what are we doing wrong? one out of every eight positions is eligible to see seniors no longer sees medicare patients. if you are a new medical patient trying to find a position, a new physician that sees medicare patients, it's almost impossible anywhere. >> i am are with you on fixing challenges and going forward, more coverage, more affordable speed if that's what my proposals have tried to do. >> we shouldn't harm people by doing things that would increase the cost, correct? >> i think we need to dry down the cost for everybody. >> we shouldn't harm people by creating an exciting about the most important thing in their lives, healthcare and healthcare of the family. we shouldn't be doing that in congress? >> one of my goals in this debate, i appreciate to bring this up, is to lower the temperature about what we're talking about. this is real stuff for folks. these are the lives. >> can we l

any medicaid patients. there's a reason for that. if we're honest with ourselves, we would be asking the question why. >> well, if that's the case that one in three don't treat medicaid, you have to ask yourself, is that because medicaid reimbursements are so low? and since provider reimbursements are set at a state level, won't cutting federal funding and hitting states with higher costs only lead to lower provider rates? and how many doctors would actually treat former medicaid beneficiaries when they no longer have any coverage or ability to pay? so even if there's only one of three, there's still two of three that are providing the services. imagine if you don't have coverage, which goes to my next question. you have advocated to, in essence, block grant medicaid. the essence of medicaid is an entitlement, which under the law it means, if i meet these ci criteria, i have the right to have that coverage under the law. when you move to a block grant, you remove the right and make it a possibility, subject

is an assault on medicare and medicaid. both of these programs can be dismantled through the language in the budget that congress is debating right now. the president-elect and congressional republicans might be willing to break their promise to the american people. instead, i, along with my like-minded colleagues, will do whatever we can whenever we can to protect these social safety net programs. i'm fighting for seniors like ann and lanny brewer from hawaii. lanny is 80 years old but is still working three jobs in order to make ends meet after losing the family home during the 2008 home crisis. ann has glaucoma and pays what she called a ridiculous amount for eye drops. lanny surrrived a heart attack and has two artificial knees. like many of our seniors living on a fixed income, they simply could not afford the extra $6,000 a year they would be forced to pay if republicans succeed in their effort to privatize and voucherize medicare. i'm also fighting for young people like anne who walked into a clinic three years ago.

medicaid for working families. medicaid for seniors. middle-class seniors who have paid down assets. nursing homes, medicaid is there. everyone is affected by it and now with the opioids is one example of a crisis, the governor of ohio, thank god for medicaid in fighting -- the republican governor of ohio. that is so very important, as well. the power of the stories that you have told is multiplied by the statistics and the facts. the facts. the real, true facts. don't take it from me. the facts coming from the congressional budget office. the director appointed by a republican speaker. stated that repealing the aca will double premiums for americans on individual market by 2026, would increase the , and surgedinsured to 32 million people by 2026. the congressional budget office. now, as you mentioned, your situations with hospitals, hospitals will also be devastated. michael talked about this. by aca repeal. because they would be left with an concentrated care. to the tune of billions of dollars. oneknow, hospitals are the entity, wher

medicaid patients. there is a reason for that. if we are honest with ourselves we would be asking the question, why? >> if that's the case that one in three don't treat medicaid, you have to ask yourself, is because medicaid reimbursements are so low? and since provider reimbursements are set at a state level, won't cutting federal funding and hitting states with higher costs only lead to lower provider rates? and how many doctors would actually treat former medicaid beneficiaries when they no longer have any coverage or ability to pay? so even if there is only 1 of 3, there are still 2 of 3 that are providing the services, imagine if you don't have coverage, which goes to my next question. you have advocated to in essence block grant medicaid. the essence of medicaid is entitlement, which of the law means if i meet these criteria my have the right to have that coverage under the law. when you move to a block grant, you remove the right and you make it a possibility subject to whatever funding there is

the affordable care act, medicare and medicaid. the republican plan to cut health care wouldn't make america great again, it would make america sick again. and lead to chaos instead of affordable care. republicans would create chaos in the health care system because they're stuck between a rock and a hard place. they have no idea what to put in place of the affordable care act. for years they've talked about repeal, but for five years now they have had nothing to put in its place. it all starts with the a.c.a. as we all know, the a.c.a. is a delicate balance. president-elect trump even expressed support for the three most popular parts of the law. pre-existing conditions, allowing young people to stay on their parents' insurance until age 26, equal treatment for women. but republicans will soon learn that you can't keep the good parts of the a.c.a. and remove the rest of the law and still have it work. that's what they're struggling with and that's why they're not getting anywhere. what they would do would throw the entire insuranc

we also talked about medicaid and medicaid is a health program that crosses the economic spectrum. and some people think of it as a poor people initiative. the long-term health care is paid for by medicaid. at least a large percentage of medicaid is spent on long-term health care for our seniors. so obviously, seniors cannot be cared for under medicaid. they are going to be moving home. it will impact the ability of families to invest in their children's future to sustain their home, their own plans for dignified retirement. this is a very bad thing. that's why at least five of the republican governors who have expanded medicaid are asking for that not to happen, including the governor of ohio. again, medicaid comes into effect and talking about opioidses and addiction and one of our best tools to address that. the other part is what it does to jobs. 3 nt estimates are between million to 3.5 million jobs will be lost. this is a bad move on the part of the republicans. repeal and icies, replace, it's not real, so far we have seen the replacement as cut and run. the republicans are c

are you going to care about people who are on medicaid? do you want to block grant medicaid or not? know, they're establishing a storyline here with all of the nominees they're going through. and it's something that's going to continue as you go through the legislative process, particularly as it applies to obamacare because the democrats believe, and i was saying this before, that they have a new third rail here. and that when republicans touch it, it's going to hurt them. >> sean spicer is starting his briefing over at the white house. let's go there. >> as you know, we've had a tremendous amount of activity here in the last 24 hours. really focused on the american worker, buy america and hire america is at the core of the president's plan to create an economy that works for everyone. i think by every indication you've seen that focus in the past 24 and 36 hours before we begin going through the events of today, i wanted to start off with a quick rundown of all the president and his administration have done with just one official working day under our belt. i don't know about ever

one out of every three physicians who ought to be able to e see medicaid patients doesn't see medicaid patients. if we're honest about addressing these problems, we ought to say why is that. what are we doing wrong? 1 of every 8 physicians to e see seniors no longer sees medicaid patients. it's almost impossible. >> i'm all with you on fixing challenges and going forward. more coverage. more affordable. >> that's what we're trying to do. >> we shouldn't harm people to increase their cost. >> i think we need to drive down the cost for everybody. >> we shouldn't harm people by creating an anxiety about the most important thing in their laifs, health care and health care of their families. we shouldn't be doing that in congress. >> one of my goals in this entire debate, i appreciate you bringing this up, is to lower the temperature about what we're talking about. this is real stuff for folks. these are their lives. >> can we lower the temperature in russia at the same time? >> i think we can move a pace, but lower the temperature. and provide stability to folks out there. people need to k

medicaid program. it is a federal state partnership as you know. it is one that we absolutely that individuals do not fall through the cracks in whatever transition occurs. whatever -- whether it is providing the same level of medicaid, or providing for something else that allows coverage that suits their needs, we are committed and adamant that that coverage be able to be continued. they have our assurance that we will work with you to make sure that happens. the murkowski: what about concerns that were expressed by the tribal health organization, that perhaps if there is a block grant approach utilized, that it could impact some of the assurances and benefits that the tribal health organizations have seen? in its earlyhis is stage, obviously. it is a legislative decision that occurs. it is not a department decision. we would look forward to working with you to ensure that individuals, especially in the indian health services which have had challenges, we need to make sure and -- certain the metrics a

long term cost of care in hospital facilities is medicaid and medicaid for working families seniors, middle class seniors who have paid down their medicaid ising home there for them so everyone is it.ected by of course with the opioid as one example of a crisis, the god for of ohio, thank medicaid in fighting off the ohio.lican governor of that is so very, very important as well. that wer of the stories you have told is multiplied by facts.tistics and the the facts the real, true facts. it from , don't take me, facts coming from the congressional budget office is a pointed by a republican speaker a.c.a.that repealing the will double premiums for individual the market by 2026, would increase uninsured by 18 million people in the first year and surge to 32 2026, the ople by congressional budget office. you have mentioned the situation with hospitals. hospitals will also be talked aboutichael this, by a.c.a. repeal because hey would be left with uncompensated care to the tune dollars.ns of entity s are the one where you have to provide care if someone comes in, even if compensated for i

states of spending pressure and medicaid grows. most of the state t the states d pension systems and in some fo form. medicaid has gone from 14% of the state's general fund to almost 20% in the last 20 years. that is crowding out other spending on higher education has declined in terms of the share of the state spending but good news is occurring. the states stocked up a savings account in the rainy day fund since the great recession on average they are about 5% of the revenue, which is a little bit higher than where before the last recession. so the states have taken lessons from the great recession. >> so, what can you tell us about what the federal government is about to bring into this forecast? >> this is either an exercise in optimism or pessimism thinking that we know something about what is going to happen based on what people have proposed befo before. what i did with my colleague at the tax policy center is the went through some of the things proposed before by president trump and speaker ryan and people in congress to fi

medicaid already give states real flexibility today. waivers give states the options to innovate and improve their medicaid programs on a case-by-case basis and in close partnership with the federal government. arkansas used a waiver to integrate medicaid expansion with its health insurance marketplace. we will be approving a -- and just today will be approving a washington state waiver by improving coordination of mental health and physical health services. ironically, block grants and per capita cap proposals could set back the efforts already occurring through these waivers, which often rely on upfront federal investments. block grants and per capita caps leave states on their own to deal with unexpected challenges like natural disasters, spikes in drug overdoses. i want to address the idea that sidesteps most of the tough challenges. last week, congress took a first step toward repealing the affordable care act without any replacement at all. not only does this approach fail to tackle the many trade-offs that come with real health c

, would that be a block grant for medicaid including the medicaid expansion or would you go back to thel medicaid and the women that we saw in that piece just there who got health care through the expansion? they would no longer have their medicaid funded. >> yeah. so, let's talk about that because not every state took the medicaid expansion money. and clearly this is an economic cost we have to figure out as well. we'll spend more next year between state and federal funds for medicaid alone than is spent in the entire defense budget for the country. and by the ten year budget window it will be up to a trillion dollars a year on medicaid alone. so, everybody knows we have to figure out a better way to deliver health care to these people at a more affordable manner. now, there are options out there so that i know this story kind of locked in on one option and that was a block grant. there are many other governors and other members of congress who think there is another way to do it, a per capita. so, each state gets something per person that would qualify. but what they really want is fl

for medicaid law grants would you also support a cap on medicaid law grants? >> i believe that was part of the proposal the housemate in order order to give the states the incentives necessary to drive efficiencies in their programs. >> in your previous life and excuse me for knowing this i came out of state legislature and i can tell you in montana the state does have that balanced budget amendment and you talk about that with the previous senator. they are not going to be able to absorb so is their option would be to cut folks off? >> if they don't have the dough what options do they have? >> we have a program and it was clear that the program for medicaid we were required to use it the same towards providing medicaid care in urban areas. we don't have those in south carolina and we would very much like to come up with their own plan to provide for most needy. to senator rand paul's point we want to provide for those folks as well but we thought there was a better way to do it given south carolina but we did not have that flexibility because of the federal l

i'm glad we did the medicaid expansion in indiana. want to make sure we measure and we see more and more people getting covered. when governor edward in the least anna expanded coverage, we saw the numbers and the sign-ups increased very rapidly. >> can you comment about your path forward air? the governor wants an expansion. the legislature may not want an expansion. how do you proceed? >> with regard to the interpretation of state law, we leave that to the governor. with regard to our role we will process the governor's proposal as expeditiously as possible when we get it. >> thank you a president obama promised the affordable tract would create a vibrant market to lower the cost of insurance. that hasn't necessarily happen. i did not come to pass. >> the question is where it's happening, how much this is happening. for all of us as i said, mostly in this room, the 150 million folks who have insurance through your employer, and five at the last six years coming year premium growth has been the lowest it has been recorded. in terms o

the medicaid program is one where the states know best how to care for their medicaid population of the greatest amount of lexa billet we can give for states to an act those kinds of programs, what indiana has done is really a best practice for many other states to follow and i look forward to working with you. sen. young: likewise. >> thank you senator young, senator markey. senator murphy: i hope you can understand our frustration around trying to divine the nature of this replacement plan. we hear you and president trump praised all of these aspects of the affordable care act and eerilygoals that sound familiar to what we have been living with for the last six years. you have said that you do not betweenre to be a gap the repeal and the replacement and that at least in many people will have coverage with the goal of more people having coverage, sick people will not face discrimination and young adults will get to stay on their plans until age 26 and yet, we do not get any specifics as to how that is going to occur. it seems as if you and the president-elect want to do everything the

patients across the country does not see medicaid patients. if we are honest and sincere about addressing these problems, we should step back to say what are we doing wrong, 1 out of every eight physicians who is eligible to see seniors no longer sees medicare patients. if you are a new medicare patient trying to find a physician, new physician that takes medicare, it is almost impossible anywhere in this country. >> i am all with you on fixing challenges in going forward, more coverage, more affordable. >> that is what we are trying to do, that is what my proposal is trying. >> we should not harm people by doing things that would increase their cost, correct? >> i think we need to drive down the cost for everybody. >> we should not harm people by creating an anxiety about the most important thing in their lives, their healthcare and the health care of their families? we should not be doing that and congress. >> one of my goals of this entire debate -- i appreciate your bringing this up is to lower the temperature about what we are talking abo

medicaid, 80% of medicaid spending is seniors in nursing homes. and we know the majority of those who -- many who have gotten care in addition to the exchanges have been folks working hard every single day in a minimum-wage job who couldn't afford or find insurance before, and now they're covered if their state, if their governor is willing to do that. we have a whole bunch of folks working hard every day at minimum wage who at least know they have access to health care and a doctor. and interestingly, this helps our hospitals, whether it's rural hospitals upstate or up north in michigan or whether it's our great urban hospitals, safety net hospitals in detroit and other areas. instead of people walking into the emergency room and not having insurance and having the costs be put on everybody who does, because of the medicaid expansion, when a working person comes in with medicaid, they are able to pay for their own care rather than having everybody else with insurance carry the brunt of that, which has been the way it's been prior to that. so medi

the people that get obamacare, how many of those run medicaid? -- are on medicaid? guest: it's about half of the newly covered people are people who are part of the medicaid expansion. it could be a lot more if republican governors would be expanding medicaid programs in their states. host: go ahead. caller: i happen to be in one of the states that didn't and we have what is called 10 care. the 10 care works just like the social security, i think. i am looking at a statement i got for medicare. my doctor's visit was $147. medicare approved $68.52 of that. $.72 -- $53 ofnd the two cents of that $147. medicare is a wonderful thing if you can find a doctor who will take it. if you need a specialist, you better find some money to pull out the difference. makes a goodller point on how many people on the formal care act whose coverage expansion was in medicaid. i think carefully to this are between show that about 2013 and 2015, according to the census bureau, about 13 million people got insurance. additional people got it in 2016. a good portion of what is going on is in

thank you for that and thank you for emphasizing medicaid. it's so important to the affordable care act. medicare, medicaid and the affordable care act are wedded together. if you overturn the affordable care act, you have a negative impact on medicaid at a time when people needed more than ever. helping working moms, lower income working moms and families be able to work and have health care for their families, not only about seniors. 50% of the cost of long-term care in hospital facilities is paid for by medicaid. families,or working medicaid for seniors come middle-class seniors who have paid down their assets. everyone is affected by it and with opioid as one example of a crisis that the governor of ohio said thank god for medicaid. that is so very important. the power of the stories you have told is multiplied by the statistics and facts, the real, true facts. don't take it from me. facts coming from the ,ongressional budget office appointed by a republican speaker stated repealing the aca will double premiums for americans in the indivi

. >> let me ask you about medicaid specifically. i'm a little taken back about your answer on immigrant and leprosy. >> one of the most beneficial components of the affordable care act was the expense of the medicaid program that resulted in 11 million people nationwide add over half a million in new jersey gaining coverage, many for the first time. it one of the biggest programs on the chopping block with proposals to not only repa there as no doubt this would result in cat traffic loss of coverage for millions poof and led to tens of billions of losses to safety net and other health care pro-describeders. do you have recognize medicaid to be a valuable program and consider the coverage it provide to 74 million americans to be comprehensive? >> medicaid is a vital program for health care for many people in this country but one who hassing is challenges. if we're honest with ourselves, weetd be asking question why. >> if that's the case, that one in three don't treat medicaid, you have to ask yourself, is that because medicaid reimb