both the medicaid expansion and also the traditional medicaid program. the bill likely would have ended the medicaid expansion over time and placed a funding cap on the medicaid program. in the wake of the failure of that bill the question before us now and the panel and for all of you is what's next for medicaid. to set us up i will focus on the medicaid expansion, refreshing about where the states stand and taking a look at the latest research on the effects of the expansion on coverage as well as other key indicators. as of today 31 states and the district of columbia extended medicaid. of those six have used 1115 demonstration waivers granted by hhs. these six states have struggled to reach political consensus and found agreement in alternative approaches there are currently four states that are actively discussing expansion, the kansas legislature although the governor vetoed that bill the legislature is attempting to override it. governor deal has expressed interest in expanding medicaid. in maine it is a proposition on a november ballot this year.

medicaid expansion and also, the traditional medicaid program. the bill, likely would have ended the medicaid expansion overtime and would have placed the federal funding cap on the traditional medicaid program. in the wake of the failure of the bill, the question before us now on the panel and for all of you is, what's next for medicaid? to set us up for the discussion, i will focus on the medicaid expansion, refreshing memory about where the states stand on their decisions to expand the program, and looking at the latest research on the effects of the expansion on coverage as well as other key indicators. as of today, 31 states and the district of columbia have expanded eligibility for medicaid. of those, six have used demonstration waivers granted by hhs. these six states have struggled to reach political consensus on expansion, and found agreement in alternative approaches like enrolling medicaid beneficiaries in market place plans and in the case of arkansas imposing responsibilities like higher premiums on beneficiaries. there are currently

perform like medicaid. you know, small discretionary grant programs don't perform like medicaid and commercial insurance can't perform like medicaid. it's not built to carry the kind of burdens that medicaid carries. the first role is the one that really was brought into focus by the affordable care act, and that is medicaid as an insurance system for the working population and their families. they -- the normal mechanism by which medicaid achieves that level of coverage, of course, is through enrollment in imagined care plans. i'm not sure but i suspect that that sort of initial bump-up was because states and plans had a tough time, just like in the commercial insurance market, in figuring out exactly where and how to set rates for newly insured population that includes some -- a lot of young healthy people but also older, sicker people, entitled to alternative benefit coverage. second, the program is really -- and you know, part of it is that i'm in the school of public health, so i think about this. but

this next panel takes a look at the challenges facing medicaid. there's also a discussion on health care trends. this is an hour and a half. ♪ ♪ >> >> the failure to pass the bill in congress, some states are looking to expand medicaid, some additional states, many are talking to cms about what might be possible in the way of -- they're talking about waivers, what can be done. and so to today we're going to k about, our goal for this panel is to both talk about where we are going into this next year, so writer we are, what the aca did, where we are with medicaid, what's under discussion, and we're going to talk about the considerations and possible implications moving forward. so we are lucky to have with us today three exceptional panelists. you'll notice there is one empty seat, and that belongs to trish riley. unfortunately, because of the crazywet we had in d.c -- weather we had in d.c., trish is not going to be able to get boo town, so she will not be with us. but fear not, our three other panelists watch what's happening in the states very c

so i think this gets at a bigger issue about medicaid.it health insurance or is it a welfare program? and depending on how you answer that question is how you think about how you design it. so you have a lot of republican governors in particular -- although you have some democrats, the governor in west virginia comes to mind -- where they look at it a little bit more like a welfare entitlement9 program. so if you're going to follow that logic, then things like work requirements, time limits become things you want to look at for certain populations on medicaid. so i think there's actually a decent amount of research on other welfare programs showing for certain populations it's tremendously, influential. we've done some great research on that. but if you view it more like health insurance, then you're going to want it to look a little bit more like health insurance. so this discussion about plan design, deductibles, premiums, co-pays that when you show up to the emergency room and it's not an emergency, you have some financial skin in the

they on medicaid? one perfect exam is that children a under 26 on parents insurance that do not have a job, that covers them with insurance. those grandchildren, ie, the grandchild of the person providing the insurance, that grand chooi grandchild has no access to insurance if it were not fors medicaid. that's onene example. anotherrt example, you pointed t that nonemergency transport. who is to say and when what is nonemergency. is it after the fact. elderly person in a wheel-chair withrg oxygen. do they call the ambulance, do they not? are they charged when somebody else determines it wasn't an emergency?g >> that's another question. the third issue you brought up was people staying home caring for people for free. nobody is doing that for free. they are either giving up a job, taking lower hour force themselves, forfeiting future medicare o for themselves. it is not for free. those are all issues that have muchch deeper layers. >> thank you for your comments. i'm not trying to be glib. i don'tpl thi

just on the medicaid side, the money and the real issues are in medicaid expansion. i was at omb in 1989, we had 20 million people in the program that $50 billion a year. before the aca, before it passed, we had 55 million people in the medicaid program in 2010, and i think it cost about $400 billion a year. today we've got 77 million people in the medicaid program, and it's about $600 billion a year, ok? so what's the real difference in the next 10 years, if you look at what the ryan bill does, you'd have 75 million people in medicaid in 10 years, so you basically freeze it in place. you'll lose a few million people from the phasing out, you're assuming the governors will drop some people, but the growth goes to $750 billion in the next 10 years. and the republicans' attitude is this thing's grown too fast, we're going to freeze it in place. if you continue with the aca, you go to $950 billion. and you go from 77 million people to 99 million people. if you don't look at that, if you look at it from purely a republican view, you'd say this thing's too big, it's out o

the issue is do we want folks to move off of medicaid? is that a goal? is that success or how many people are on the program is the bowl goal. you'll get different answers. one say we want to know how many people get back goo labor force. betts way do get the into the force, encourage them to work or volunteer or get education. we learned that folks can work their way off the -- that are able. not should apply to everybody. i don't want anybody to say kids should have a work requirement or something like that but for the populations -- the expansion population in ohio, 60% report no income in the expansion population. shouldn't we look close center do we want them to remain on medicaid? i don't think so. i think we ultimately want them on tax credit or employer based insurance. how do we make our program point in that direction for the populations that should? but your points right. this is one subset of the population. another discussion to have, chip reauthorizing is coming up. some governors want to move pregnant women and kids off the program. you ha

the medicaid system is broken. there's not a human being in the united states that can tell you what the match rates are for the 50 states and territories. think about that. if we looked at it, new hampshire puts not 1 penny into the program. romney care which everyone is very proud of, you know how much massachusetts money is in them romney program, zero. it's all funded through medicare scam. the point is, the program is broken. it doesn't just have to do with saving money, it's what's get rid of the musical chairs and we will give you what you have today and. capita for recessions for the rest of time adjusted for inflation so the financial games can stop and people can focus on writing good care. i think the governors are looking for flexibility. you can discuss how much you want to put in or take other program. one of the problems is that if you are a medicaid director, you spend more of your time trying to figure out how to cost shift. i think the program is a great program, but for $600 million you are not o

in ohio, republican governor john kasich recently said "thank god we expanded medicaid because that medicaid money is helping to rehab people. and in fact, february 6, 2017 . february 6, 2017 pew report noted that ohio added 700,000 medicaid recipients under its expanded program and roughly a third were diagnosed with a substance abuse disorder. according to the cbo, the republican aca repeals proposal will cut $880 billion in federal medicaid over the next ten years. would you disagree with any of those figures? certainly, weell are interested in research that can look at changes in the health care system. study thetnering to implementation. rep. degette: would you disagree by example, that ohio added 700 and medicaid recipients under its expanded program? a third were diagnosed with substance abuse disorders? dr. compton: those figures sound reasonable. rep. degette: what i'm worried about is if you reduce the medicaid expansion that in states like ohio, kentucky, west virginia, other states that have been hard hit by fentanyl, opioids, and heroine, that will reduce the treatment programs

medicaid went from 10% in 2000 of medicaid managed care. it is now, over 80% led by california and other primarily democratic states. i think the move to private health care is happening. the reason i like it and have always liked it is because i don't like to pay for service. price fixing has never worked in the history of mankind any place any time. i was very involved? creating the fee for service 1989 thing we did. at the time, i thought it was a great idea. in hindsight, paying every doctor in every hospital the same thing has turned out not to be a problem. as long as it is well-regulated and instead of the government fixing prices and give it to kaiser and etna, here is $15,000, call me next year. you can make a 4%-5% margin. having a little bit of market coming to bear, that's roughly what's happening. these are big programs. things happen relatively slowly. if you asked anybody in 2001 if they thought we would have a third of the program in medicare advantage and the same with medicaid. if kaiser wants to build a couple more hundre

medicaid is a source of help for them. for my home state of illinois, medicaid has been vital. to address substance abuse. medicaid expansion has provided coverage to 650,000 low-income adults in illinois, nearly one whom have mental health or substance abuse disorders. that's just the typical percentage all over the country. without medicaid, these individuals will be marked lead to end up in emergency rooms or jails which are drive up costs for states and local budgets. it's clear that in illinois we need to be further expanding access to substance abuse treatment. i'm sure that's the case in many other states around the country. until 2015, illinois a 20% increase in the number of deaths from drug overdoses. so yet the republican childcare proposal would decimate the medicare program which serves one in four people in illinois. one in four. the republican bill would have medicaid expansion and propose a cap on funding. i want to go more on about that. doctor thompson, wouldn't you agree, solving the fentanyl and opiate addiction problem requires that we also ensure that peop

andweeted, i remain no reviewing changes and see of no medicaid reform. guest: he is concerned about the medicaid refund -- reforms and i think they are good and passed a lot to the state with crafting policies that are good for state spree i tell people, what is good in maryland will not be good in mississippi. let's have people create policies that is good in their states. host: will pre-existing conditions continue to be covered? guest: absolutely. it is slightly different. some states will opt out of some of the mandates and what they have to do is have a higher risk pool. ,ust like we had in maryland people go into a high risk pool, these are subsidized. state can set where the premiums are going to be. most states set it at no more than 50% and the normal pool. even if it was at 50%, it would be lower than where they are today. host: do you think you will get enough votes in this time? guest: i sure do hope so. i think we have improved as a bill. i speak for the freedom caucus, get the premiums down and i think we do it in the mechanism that gets it

let's deal with medicaid first. really when you talk about medicaid reform, it is wrapped up in the discussion where having about the health care bill, the american healthcare act, the repeal and replace for obamacare. it deals with reforming medicaid for savings.ry does doing so in a way that makes complete sense. i was in the state legislature for a brief time before washington, d.c., and we used to cringe every single year of at the size of the line item in our state budget for medicaid. no one talked to governors and asked them whether popping up when line item is and it's most likely in all states medicaid. it was one of these one size fits all would come and say look yet either use plan a brc to provide healthcare to your need is citizens. are like that looks really great if you live in new york or chicago or los angeles but we have a rural more population in south carolina. we got other ways that we think we can provide for our neediest citizens and do it in a much more efficient fashion that can cost the sta

fundamentally the medicaid program. though the cancellation of this vote on the house floor is a reprieve the white house and congressional leadership have indicated their desire to continue with the repeal effort. in fact, i was in washington dc just last week with our community clinic consortium and we had the privilege of meeting with leader pelosi. the leader had indicated to us that the reason that the american healthcare act was so important to the leadership is because they needed the savings from the repeal and replacement to fund the tax reform package that there are intending to take up next. so that is among the reasons why it's still important for leadership and congress and in the white house to look at some changes to the affordable care act. so it is unclear now what will happen exactly, whether the american healthcare act will pass, or, if it does pass it may look different than the current version looks now. in many details would be also up to the administration when she implements the legislation if it

how do we expand medicaid? medicaid have expanded under the affordable care act and many of those are red states. is one of the reasons why the previous legislation proposed was not going to get anywhere in the senate and didn't even get there. the other side is if there is this pool of money, how is it paid and how do we make sure it doesn't continue to grow? there are these weird aspects of the payment system, so if you were to get a knee replacement and a hospital outpatient department, what medicare will is three times what they would pay for an independent, not hospital owned surgical facility. why is that? i would argue that it has something to do with almost every member has a hospital in their district, so there becomes a lot of pressure to be willing to pay for that. >> can i jump in on the medicaid question? secretary prices obviously going to look at the ability to regulate. i is very focused on the medicare program and came from a -- from indiana. under mitch daniels and mike pence, now our vice pre

and medicaid is what's known as a -- it's on high alert. in other words, a lot of reforms that need to be made. there is abuse that we're not validating those, right now the self-certification process in medicaid. there are reforms that need to be done to make sure our country is on a fiscally stable path but also making sure we're providing health insurance for all americans. host: we have 10 seconds. do you think the house and senate will reach agreement on a c.r. before april 28? guest: yes. host: congressman ryan costello you meet the deadline. republican from pennsylvania thank you very much for being with us. guest: nice to be with you. thank you. host: we'll take it to the floor of the house. it is now 9:00 in the nation's capital and live coverage of the floor proceedings before a two-week recess. the senate in session today as well. thanks for joining ounce this thursday. chaplain conroy: let us pray. eternal god, we thank you for giving us another day. send your spirit upon the members of this people's house to encourage them in t

on the medicaid side of things, i am not for expanding medicaid. states a wayg the to manage medicaid to get more money to the people who need it. last year we set out $33.6 billion in improper payments on medicaid. two days ago, it was reported that it is not working. can you hear me in the back? is that good or bad? [laughter] we may want to turn this off. is this on? is this better? we're going to wear out one lady with a microphone, i am afraid. it was reported to her three days ago that a woman was just sent to federal prison for medicaid fraud. we cannot afford to waste 36 alien dollars a year in mismanagement and fraud inefficiencies when there are people who need it here and that is my position on it. yes ma'am, in the blue? her.lly, the lady behind yes? >> thank you so much for being here. roll tide. rep. palmer: roll tide. but my kids went to auburn. and that is not a political statement, that is what happened. my beautiful phd candidate otter had to get the emergency room because she had cut herself so badly that she needed stitches. rep

through medicaid expansion. these are the walking for.ore than 77,00 77,000 of these individuals have received preventive care services since coverage began last july first, meaning seeing doctors for the first time in years. [applause] these numbers include more than 6206200 patients receiving breat cancer screenings, resulting in 95 cancer diagnoses, 7500 colon cancer screenings resulting in nearly 2200 patients having precancerous polyps removed, and 74 diagnosed with cancer. and nearly 6400 patients being hundred patients being diagnosed with diabetes or hypertension. louisiana's uninsured rate has dropped from 22% in 2013 to below 12.5%, and nearly 43% drop in the uninsured rate. [applause] one of the greatest drops in uninsured rates in the entire country, and it is at the lowest rate on record here in louisiana. in the process of doing all this, louisiana is projected to save nearly $200 million in the first year alone, and where projected to save more than $300 $300 million in the next fiscal year because of medicaid expansion. th

how do we expand medicaid. 31 states have expanded medicaid under the affordable care act. many of those are red states. that is one of the reasons why it may be -- that the previous legislation that was proposed was not going to get anywhere in the senate and didn't even get there. but then the other side of it is then, if there's this pool of money, how is that paid and how do we try to make sure it doesn't continue to grow? and there are. there's these weird aspects of our payment system so for instance, if you were to get a knee replacement in a hospital outpatient department, the what the government will pay what medicare will pay for that outpatient facility is three times what they will pay for an independently owned nonhospital owned outpatient surgical facility. why is that? well, i would argue it has something to do with almost every member has a hospital in their district. and so their becomes a lot of pressure to be willing to pay for that. >> can i jump in to on the medicaid question? because one thing we're going to see secretary price is obviously going to lo

she received medicaid approval after her surgery. without medicaid coverage she didn't know how she would have paid for all the medicines and treatments that she would need. monica couldn't be here today with us because she's undergoing an mri scheduled by her doctors. you should note that these are the testimonies i hear every single day when i'm visiting with folks across our great state. these stories would it be possible without medicaid expansion. the same catholic, christian faith that leads me to be pro-life on the issue of abortion, also informs my position on medicaid expansion because in a very real and significant way it is literally saving the life of our working for brothers and sisters. [applause] we have reaped many benefits from medicaid expansion. were getting more people the treatment they need and it just doesn't bet benefit the individuals, it benefits their families too. i want to recognize, rebecca d, secretary of the department of health and act the way she's handled medicaid expansions rollout. [applause] our

fundamentally the medicaid program. though the cancellation of this vote on the house floor is a reprieve the white house and congressional leadership have indicated their desire to continue with the repeal effort. in fact, i was in washington dc just last week with our community clinic consortium and we had the privilege of meeting with leader pelosi. the leader had indicated to us that the reason that the american healthcare act was so important to the leadership is because they needed the savings from the repeal and replacement to fund the tax reform package that there are intending to take up next. so that is among the reasons why it's still important for leadership and congress and in the white house to look at some changes to the affordable care act. so it is unclear now what will happen exactly, whether the american healthcare act will pass, or, if it does pass it may look different than the current version looks now. in many details would be also up to the administration when she implements the legislation if it

talk about the best way to treat medicaid and should it have been a consideration? guest: you have to be honest about the outlook for all of our entitlement programs. they all need some reforms. they are not performing as well as they should for a country as great as the united states. medicaid is going to be reformed at some point. the question is what will those reforms look like? the idea of having a fixed amount of funding from the federal government to the state for each type of beneficiary medicaid is an old one. it's not a particular shocking development. it's a devil in the detail story about how much money, how fast does it go up over time. have properly been the focus of attention and they are still working in a. it out. host: douglas holtz-eakin joining us for this discussion. (202) 748-8001 for republicans. (202) 748-8000 for democrats. s, (202)pendent 748-8002. i will show you the headline from "u.s. today" as their turn to get the package ready. a forum sponsored by politico that talk about what they were looking for particularly when it came to change

on the medicaid side, i am not for expanding medicaid, i'm forgiving the state's ability to manage medicaid to get more money to the people need a. last year we sent out $46.3 billion in improper payments of medicaid. two or three days ago for the it's not working. can you hear me in the back? we may want to turn this off. anyway, it was reported two or three years ago that a lady was sent to federal prison for medicaid fraud. we cannot afford to waste $36 billion. year in mismanagement and fraud to medicaid when there are people who need it. yes, ma'am, in blue, the lady behind her. yes. >> thank you so much for being ten days ago my beautiful page the candidate daughter had a go to the emergency room because she cut herself so badly she needed stitches. >> is she okay. >> she is, thank you. from that she is okay. five years ago after repeated hospitalizations including two for attempted suicides she was diagnosed with bipolar disorder. in two months she turns 26 and comes off of my employees insurance and will join the ranks of one and half million alabama with pre-existing conditions. so

in regard to the healthcare bill. >> medicaid expansion. >> i do not support medicaid expansion but in the event of a hurricane or disaster congress will take action as we have done in other cases to meet the needs of the community. as far as providing insurance for people, what we have done with this bill puts us on a path where it will be accessible to everybody, premiums will come down and there is more work we need to do to bring down premiums so we can get back to a health care system where people can have the insurance they want and can afford and can afford to use it because right now you have millions of people who chose not to get insurance, 20 million people, chose to apply for hardship waivers through the irs. simply paid the fine but millions more have insurance and can't afford to use it and the premiums are driving people out of the market. >> the individual mandate was inelegant but some solution, nobody likes the current bill either. i wonder -- >> that is not true. you will see a lot of people like the new bill. >> you publish a letter saying you would only want to sup

fundamentally the medicaid program. though the cancellation of this vote on the house floor is a reprieve the white house and congressional leadership have indicated their desire to continue with the repeal effort. in fact, i was in washington dc just last week with our community clinic consortium and we had the privilege of meeting with leader pelosi. the leader had indicated to us that the reason that the american healthcare act was so important to the leadership is because they needed the savings from the repeal and replacement to fund the tax reform package that there are intending to take up next. so that is among the reasons why it's still important for leadership and congress and in the white house to look at some changes to the affordable care act. so it is unclear now what will happen exactly, whether the american healthcare act will pass, or, if it does pass it may look different than the current version looks now. in many details would be also up to the administration when she implements the legislation if it

for under 17,000 the vigils have received health coverage through medicaid expansion more than 77,000 procedures -- have receive preventive care services since july 1st. this is the first time in years. [applause] these numbers include those receiving breast cancer screenings with cancer diagnosis, 7500:cancer screenings resulting in 2200 patients having precancerous polyps removed and 74 diagnosed with cancer. 6400 patients diagnosed with diabetes or hypertension. louisiana and uninsured rate has dropped from 22% in 2013 to below 12-point 5% near the 43% drop in the insurance rate. [applause] and the lowest rate on record in the louisiana. it is projected to save $200 million in more than 300 million over the next fiscal year because of medicaid expansion that is money that we have to use of higher education. but at the end of the day it is not the numbers that makes medicaid expansion the right choice it is the people. like a student i expected to introduce you to monica today she is studying music in new orleans after suffering through severe headaches she learned she had abrade ma

and will you promise to preserve medicaid as an entitlement to bring medicaid expansion to the state? [applause] >> first of all, let me explain what we will bring in to the american health care act it is not a risk pool better risk sharing arrangement modeled after the state of maine to bring premiums down if you apply for insurance to be treated like any other person they do not distinguish if a pre-existing condition or not. if you do you by your insurance to put that policy into risk sharing arrangement with the federal government. so the insurance has been in the game so the insurance companies exposure is limited at tenth thousand dollars. to add a catastrophic illness your bill will be paid but it will be brought in tandem with everybody else. can you hear? can you hear me? maybe turnoff those microphones while i try to talk? does that help? we're getting no little feedback. number of people insurance went up so that means under people were buying insurance so we'll trying to do is set up a risk sharing arrangement they are contributing to this we have added another 15 billion

on the medicaid side of things, i am not for expanding medicaid. i am for giving the states a way to manage medicaid to get more money to the people who need it. last year we set out $36.3 billion in improper payments on medicaid. two days ago, it was reported not working? can you hear me in the back? no. is that good or bad? [laughter] we may want to turn this off. thank you. on?his 's is better? we are going to wear a lady with the microphone am afraid. ladyy, it was reported a was just sentenced to federal prison for medicaid fraud. we cannot afford to waste $36 billion a year and mismanagement and fraud and inefficiencies in medicaid and there are people who need it. that is my position on it. yes, and the blue? the lady behind her. yes? >> thank you so much for being here. and roll tide. rep. palmer: roll tide. but my kids went to auburn. and that is not a political statement, that is what happened. >> this is kind of hard. 10 days ago my beautiful phd candidate daughter had to get the emergency room because she had cut herself so badly that s

that is one of the criticisms of medicaid. too often, you end up in emergency rooms or ordinary care and that is an expensive location to do that. there are problems with people showing up in emergency rooms. there is the reality that the united states has a commitment to providing people with care. no hospital can deny an individual from care if they want into a hospital, that is a ruling of the supreme court. there is going to be some of this uncut -- uncompensated care that hospital space. host: we are talking about republican efforts to make significant changes to the aca. there are questions of why not just fix what is currently wrong. is it easier to fix what is currently wrong? guest: i have never been able to participate effectively in this debate. think about repeal and replace or fix. imagine having the aca and then you could pass a law that got rid of the independent payment invite a report and fix the aca. or you could pass a law that repeals and replaces the aca and has everything that the aca had for the independ

fundamentally the medicaid program. though the cancellation of this vote on the house floor is a reprieve the white house and congressional leadership have indicated their desire to continue with the repeal effort. in fact, i was in washington dc just last week with our community clinic consortium and we had the privilege of meeting with leader pelosi. the leader had indicated to us that the reason that the american healthcare act was so important to the leadership is because they needed the savings from the repeal and replacement to fund the tax reform package that there are intending to take up next. so that is among the reasons why it's still important for leadership and congress and in the white house to look at some changes to the affordable care act. so it is unclear now what will happen exactly, whether the american healthcare act will pass, or, if it does pass it may look different than the current version looks now. in many details would be also up to the administration when she implements the legislation if it

first of all, thank you for the medicaid expansion in ohio. >> you qualified for medicaid and you're a mom with three kids and that's helping you? >> that saved my life. >> that saved my life. >> in case these republicans wonder -- no, why did he expand medicaid. you just heard it right here. a mom with three kids. and she's getting some help. now, we want to get you on your feet and we want to get you a job. we have to work at that, right? >> exactly. so right before i was diagnosed, my company downsized and i lost my position. i was in the middle of a job search when i was diagnosed with stage three breast cancer. so this medicaid expansion literally did save my life. i've been in breast cancer treatment for the last 17 months. and i just finished last month. so -- [ applause my question for you is going forward, if the current administration repeals and replaces the affordable care act and slashes federal funding for medicaid, how do you think this is going to affect people across america, people like me that rely on medicaid for life saving care. >> why don't you say how it would

allowing great flexibility for states with their medicaid population. anything it would move is sort of an agreed-upon mechanic. take a state like arizona. for 40 years we have been doing something rather quirky. policies for our indigent population. if you could give a state like arizona more flexibility with our county health care apparatus we believe we could do a series of clinics where you could touch a lot more of our brothers and and population substantially at the same cost. that would require getting away from the command and control model that medicaid and hhs have today. insurance across state lines, fine. i would like to have a little bit more of a revolutionary thought. shouldn't you be allowed to have health services across state lines? that is very controversial if you really think about it. telemedicine. i have severe asthma. should i be allowed to hit the button and talk to an asthma expert who is not part of my state, is not licensed in my state but has true expertise? host: and have your insurance be able to pay for that conversation.

i know you don't like medicaid. i know what you want to do to medicaid.t is 10 million people at minimum. there are a lot of people by your political stripe and the democrats who won't accept that. >> right. you know more than i do about myself. putting words in my mouth isn't helpful. i know medicare and medicaid are insolve insolvent. >> tell us what you will do. >> we have $100 trillion. we have $100 trillion in unfunded liabilities that are medicare, social security, medicaid. nobody has shown any ability to fix the problems we have in the country. we are starting to get it going. this is historic opportunity. >> president trump doesn't want to touch social security or medicare. let's deal with the matter. what will you do on health care that is so important to so many millions of americans? >> there is good medicaid reforms in the bill. the primary onus here is fixing the system in the ditch. obamacare is in the death spiral. now anthem is threatening to leave some states. then you may not have any health care. it is in the ditch right now. we're try

it assaults a program that is the largest provider of health care in america -- medicaid. tois a one-way trip down shift responsibilities to the stated make it harder for people who are deserving of this care to get it. they only have one shot in their entire life. and you become a medicaid goes up and down in terms of eligibility because the economy changes. it is heartless and it is stupid because those people are still going to get care, but it will be in an emergency room, and it will be too late. they are adding provisions to deny the presidential -- to deny the essential protections. and people with pre-existing conditions are not going to be -- turning his back to the states only opens a stored have denial. some of the status of irrational that they had denied care. host: republicans argue that we give states the options that they do not provide essential benefits. first, they cannot do that unless they prove there is a high risk pool. the provision of this bill becomes automatic if the federal government does not intervene. the high risk pulls having tried repeated