won't be very fast as the old saying goes if you seed fund medicaid program you've seen one medicaid program. this is obviously an issue in the national conversation and it does hit home for many people for that speak to the need for continued respectful dialogue on the different perspectives that are brought to the medicaid program and that is what the alliance for health policy is all about and what the briefing is up about, and we are pleased to have a terrific panel here today to help us with this discussion. let me go ahead and introduce the panel and i will turn it over to melinda. cindy is joining us today, a partner at phillips she's been a deputy administrator for the centers of medicare and medicaid services.ca she directed the center for medicaid and chip services at cms as well. next to my left is josh, senior fellow at the foundation foren government accountability and prior to joining the foundation he served as the director of the center for healthcare solutions and program manager for the middle cities initiative is the pioneer institute and served as the legislative

so this slide shows you the impact of medicaid on medicaid -- aca impact on medicaid case loads and thisis from the state budget and so you can see where the medicaid expansion happened in 2014 and between 2014 and november of 2016, case loads grew and two groups that cindy talked about new eligible parents, parent caretaker and new eligible adults represent 230,900 and that's 900 of the total population but what's interesting here is that not only did those two case loads increase, the new eligibles but we saw pretty substantial increase in the case loads of age, blind, disabled and moms and kids and why did that happen? primarily because of the wood work effect. i'm eligible for medicaid and so are my kids or my disabled parent or sibling is now eligible or spouse. it was the message they got out there that had the people apply and they relatable as a result of the traditional program and so any cuts that occur in the state are going to have -- and i will say cuts, i will talk about that in a bit are going to have to come not only from new eligibles but traditional populations. next sl

are actually in medicaid. so mr. chairman, it's really hard for me to see how we can have a bipartisan reauthorization of c.h.i.p. by the end of september without a strong bedrock foundation of . medicaid. i yield back. >> the chair recognizes mr. walden for an opening statement. >> i thank the chairman. today marks a really important step forward in this committee's work to strengthen our health care safety net by examining the extension of two very important safety net programs. both the children's health insurance program, c.h.i.p., and the community health center program, have enjoyed strong bipartisan support for many years. under current law, congress needs to renew funding for these programs since the current funding streams will soon expire. we recognize that c.h.i.p. and community health centers play a significant role in the nation's safety net for millions of americans. for millions of american children and pregnant women who are generally low to moderate income, and millions of individuals who may be medi

with different medicaid programs? >> there's a great deal of flexibility in medicaid. in fact, often you hear from members of congress and others, oh, my god, it is such a complex program, in part because there are 56 jurisdictions that administer it and there's quite a bit of differences and distinctions among them because of the flesibility accorded states in the program. states have a lot of flesibility to design their delivery system, is it managed care, accountable care organizations, they design their payment system, they design their care management system. the area where medicaid is clear however is on the benefit protection for children. it is actually 50 years almost to the day where congress adopted the early periodic screening and diagnostic treatment program to make sure all kids in medicaid are screened for vision, hearing, developmental delays, other problems, and if they have a medical problem the benefit requirement in medicaid is that they get treated. >> i'm almost out of time. texas received 1150 w

i think there is a lot of its fbility in medicaid -- o flexibility in medicaid. some of the problems have been chronic underpayment in certain areas. sense, wecause, in a have used prices to control supply. i think the advantage of managed care, apologies to chuck, is that it allows greater electability on that front -- flexibility on that front and allows a delivery system in the medicaid program. >> i will accept that criticism. i think if i had a magic wand and i could wave it and fix medicaid and the rest of the health system, that is just one answer. you have to look at the most economical and efficient systems we have already operating in the u.s., and that is medicare. i think bernie sanders said it. i will go right there. if i had a magic wand, we will need a single parents is that if we will be able to provide coverage for everybody. >> all right. josh? >> i will take a slightly different attack. if i had a magic wand, i would hope our conversation about medicaid would stop assuming it can fix all of our problems and actually take a critical eye to say i

medicaid is one of the three major entitlement programs, and now we spend roughly $400 billion on medicaid in this country. our friends across the aisle don't want to do anything that would keep that from growingps higher and higher and higher to the point where basically the system collapses. we believe that's not responsible choice. so what we have proposed is to spend $71 billion more on medicaid over the budget window and to work to transition though states that it expanded medicaid and offer their people a better option in the private insurance area. but i just want to mention, i should a number of stories about, for example, a small business owner who was forced to fire their employees so they could afford to keep the doors open and provide health insurance to the remaining lead people. you have to ask what in the world could lead us to a system which would discourage people from hiring more folks and basically put them in a positior where they had to fire them in order to make ends meet.er but that's what the employer mandate did under obamacare. if you have more than 50 employees y

medicaid recipients once a year. but a lot can happen in period of a year somebody can get a job. they may no longer be eligible based on the income qualifications for medicaid. but if you can only check once a year, then people remain on role even though they no longer qualify so regardless of whether somebody gets a job or moves -- or passes away or no longer needs medicaid they're still in the system and there's nothing states can do about it. well, we would like to change that. while it sound like a simple matter when the average medicaid patient coast the state more than $9,000 each and high as almost 12,000 per elderly individuals it adds up. now one of the things we saw that obamacare did in the states that expanded medicaid coverage is that those states decided to cover single adults who are capable of working. well, what this bill would also do is what would be allowed the states to experiment with a work requirement as part of the eligibility for medicaid we're not mandating it. you have to do it. but if st

program and medicaid program. they set rates and adjust rates based on the acuity and the needs of the population that are served. they take into account policy changes, health care cost changes, and they're constantly re-examining their rates. >> well, does it -- >> what we have in the cap in the bill is it is set based on spending from years back, moved forward, adjusted by a national trend rate that is not related to the actual needs and costs of serving people in that state. it doesn't adjust based on acuity of the needs, it doesn't adjust based on the health care cost in that community. >> so what is going to happen to benefits and provider revenue with a cap to broad medicaid program? >> well, states have three major levers to do significant reduction of spending in the medicaid program, enrollment, provider payment rates and benefits. i think likely with the kinds of changes that are proposed all three will be -- will be relied on by states. if you think about going to provider rates, which is maybe the fir

s medicaid expansion. another 30,000 individual native americans have private insurance, thanks to the a.c.a.'s individual marketplace and the native cost-sharing subsidies. in my home state of new mexico alone, medicaid expansion has ensured an additional 45,600 native americans. thanks to the medicaid expansion and increased access to the individual insurance market, 63% of i.h.s. patients have health care coverage that allows them to receive care above and beyond the level of life and limb. because of a.c.a., i.h.s. now receives almost $1 billion to supplement its health care delivery, and that is an increase of 21%. we can see the results. not only are people healthier, but they are more productive. health insurance has allowed native americans to finish school, to return to work, and lead productive lives instead of worrying that their next illness could lead to an i.h.s. referral denial or ruin them financially. and it has improved the economy in indian country. the a.c.a. has created new health care

on medicaid who we are going to cut the spending on c medicaid. 25 to 35% will be cut. that's like governors of both political parties scream bloody murder you can't do that. they're cutting the federal contribution to medicare in oury state. who's going to pay for that baby? who's going to pay for mom? in district and who will take care of the folks in nursing homes? why did that make that cut in medicaid that so important to so many people?ade that cut was made in medicaid so republicans and their health care proposal could include a tax break for the wealthiest people in america or healthet insurance companies and get this for pharmaceutical companies. to give them tax breaks they had to cut medicaid coverage for all the people i just described.d do they wonder that many republicans backed away from this? senator heller of nevada talked to is governor sandoval both republicans and said he couldeec support an early version of the bill because of the deep cuts in medicaid. if this is supposed to be an improvement over the affordable care act puts part of it is an impro

fix medicaid. but right now it's subordinate standard health care for -- subordinate standard health care for the reasons i mentioned and the doctors in my state refused to see a medicaid patient because it pays them so far under the standard of private insurance or even medicare. but by providing low income americans access to private insurance instead of medicaid, we can assist those who were previously left out of the health care market and will now be able to purchase a plan of their choice perhaps for the first time. but unless we act, we're going to continue to see skyrocketing premiums and deductibles and lost coverage. as i've said, the american people were told time and time again that under obamacare, costs would go down and they would be able to keep their doctor which ha was proven not o be the case. i mentioned before on the floor of the senate that in my previous life as attorney general of texas, we had something called the consumer protection division. and if some business made fals

medicaid, though, as well. there is a great success story, i would share, in michigan on the medicaid front. and, of course, in medicaid -- talking about seniors as well -- three out of five michigan seniors in nursing homes, alzheimer's, or other kinding of challenges get their health care from medicaid. medicaid is there for middle-class seniors, low-income seniors, and so on. there is another piece when the senior senator from oregon talks about saving dollars, michigan -- an interesting thing has happened by expanding medicaid health care to minimum-wage working people, we are actually saving money. 97% of our children can now see a doctor in michigan. great. they cut in half the number of people who walk into an emergency that can't pay. we all pay when somebody walks in, right, and gets the most expensive treatment in the emergency room. and the state of michigan is now saving $432 million in taxpayer money next year because they are focuses on children going to a doctor, people getting preventive care. s

medicaid beneficiary. what we have done instead in the better care act is particularly for the adult, single adult population between 100 percent and 135% of the federal poverty level we said we will give you a refundable tax credit to by private insurance. private insurance is preferable to medicaid because for one thing it reimburses physicians at a higher rate and gives people greater access to physicians and hospitals and greater quality of care. in my state alone, in the state texas, according to the kaiser family foundation, as many as 600,000 new low income texans will benefit from the provisions of the better care act. it will help qualify them for a tax credit not available to them under obamacare. but simply throwing money at medicaid won't help people at all. we need to reform medicaid. make it more efficient and frankly one of the things i did back when we were debating the affordable care act in the senate finance committee, i introduced an amendment that said members of congress would go on m

and the cuts they make in medicaid have really educated america about medicaid. people know social security. they know what that's all about. we all pay into it and wait to receive our social security checks when we reach that age. and they know about medicare. you have to be 65 years of age. pretty good coverage, isn't it. the ones who receive it think it's a pretty good deal to have medicare coverage when they reach the age of 65. but medicaid was one of those mystery programs. people weren't sure, what does it do? the medicaid program in america does the following: in illinois, that program takes care of half of the new mothers and their babies. half of them, paid for by medicaid. prenatal care to make the baby is healthy, the delivery of the baby, mom and baby afterwards taken care of, paid for by medicaid. one out of every two births in illinois. medicaid also sends provisions, money, to your local school district. bet you didn't know that. if your local school district has a special education program -- and virtually all of them do -- they receive medicaid

some people per medicaid. one thing about the aca that has 12 million and rowley's on the exchanges. -- 12 million and rolled on the exchanges. we have this political discussion around that. here is the other point. mitch mcconnell was very clear about it yesterday when he came out of the white house meeting. he said, if republicans can't get an agreement amongst themselves on how to repeal this , which is what robert was talking about, he will have to sit down with chuck schumer and the democrats and that agreement, would be nowhere near what the republicans want to do. guest: as much as the republicans have been wanting to repeal it, we have known for seven years they did not agree amongst themselves. now we are seeing that. there is a large fraction of the republican party, the tea party faction, that doesn't believe the government has any business and health care. the government pays about half of the nation's health care bill now. they would like to get rid of as much -- they want the federal government t

health care medicaid. how about the children's programs that are on medicaid? you start cutting that back to the tune of about $800 billion over a decade, you're going to knock out a lot of these people. that's not something that we want to do. that's why when explained, you've got such low numbers that support what is being attempted as a replacement if you repeal the affordable care act. we should be focused on working together to improve the affordable care act, not to make it worse. and so, mr. president, i pretty well have said it all. the bills that we have seen coming forth as replacements, they changed the age ratio. they change it from the existing law, the affordable care act of 3-1 in the health care exchanges. so an older person, you can charge them three times as much a young, healthy invincible. not in the replacement bills that we see coming up. it's 5-1. what does that mean? that means for those older americans before they turn 65 and become eligible for medica medicare, they're going to be paying more for their insurance premiums. is that what

traditional medicaid will spend $4 trillion. medicaid expansion, almost $1 trillion. medicaid expansion would have been cut -- reduce add fair amount. under what i call my sustainability amendment, traditional medicaid would actually increase in spending slightly, not harming anybody, not children, not disabled, not the elderly. obviously medicaid expansion just by allowing it to phase out through attrition, not pulling the rug out from under anyone, in the end you'd be spending the same amount in the senate bill and from my standpoint i think we preserve and sustain medicaid. so again i urge my colleagues to support all three of mys. i hope to -- to support all three of my amendments. i hope to get a vote. if not a vote, i hope this goss a house-senate conference. with that, i yield the floor. the presiding officer: the senator from wyoming. mr. enzi: mr. president, i want to thank my colleague from wisconsin, my fellow accountant, for doing a good job of accounting there and providing some charts that very explicitly show what he's been working on, what he's been en

they did not take medicaid. she paid into -- it for years. why do doctors not take medicaid? thought i would have to take her to an emergency room to deal with this. i have been exposed to nursing homes. he was in a nursing home. they paid into the system all of their lives. once they went through their -- why, withgh the private to profit nursing homes, the last one she was in was $10,000 of that per unit per bed. he is a world war ii veteran. care.d $2400 of his the rest is paid by medicaid. why would the government -- why when the government is paying, why can't we put a cap? why can't nursing homes be paynded to hire more aides, them more? the ratio is at port. that is why you have the falls and breaking hips. she raised a lot of fantastic points. on the medicaid issue, beneficiaries have problems getting access to specialists. the medicaid reamers that rates below private insurance. homes.ked about nursing we are talking about long-term care. it is not unusual to have the 100,000 dollars a year or higher. placing caps on how much nursing homes could charge you for care,

medicaid pays for nursing homes, medicaid helps special needs students get their needs met. medicaid does things for families and covers them in a way that goes far beyond just showing up for the doctor, being sick. it's those issues which i think is why a lot of republicans are worried about taking away medicaid because they realize medicaid can be a safety net for other things. i wrote a story about a young man having seizures because he couldn't get health insurance and doctors partnered with housing to get him an apartment and use medicaid and section 8 together to get him in an apartment and his seizures stopped immediately. if you're homeless and stressed out and can't get access to medicaid because you don't understand it, the moment you get someone to help you understand what the programs can do for you, your life can change. this is a guy in his 30's who can now work. that is wi think people worry about when they talk about medicaid. >> that's part of the reason so many democrats and some republicans are wondering why is medicaid on the chopping block in this debate

without medicaid, he can't afford it. one of nevada conscious one -- one nevadan traveled from lass s vegas to talk to me who have cystic fibrosis. in total, over 631,000 people in nevada are covered by the medicaid program. that is low-income children, pregnant women, seniors, and people with disabilities. and it's -- and it's why i have -- i have said since the beginning of the health care debate that i will only support a solution that protects nevada's most vulnerable. the house bill didn't go far enough to do that and neither the senate's bill. and that's why i voted against it last night. nevada faces unique challenges when it comes to health care. i spent the past few months trying to find ways to protect the nevadans who depend on medicaid, protect those with preexisting conditions, all the while bringing down costs and improving quality and access to care. i had discussions with nevadans in washington and back home to hear from them how potential changes could impact their care. whether it's a mom in reno with a

medicaid assisted treatment. it is fully funded through our medicaid program. >> and my colleagues on the other side of the aisle often characterize the medicaid program inflexible for states. we hear that a lot, that it's inflexible. to the contrary, i think it is a great deal of innovation and how states respond to the opioid crisis. would you please tell us about the health home program in your state and how medicaid granted rhode island the flexibility to develop its own person-centered care opioid treatment program? >> there are probably two innovations. and we work with the medicaid office for a period of 18 months to develop the comprehensive care management function for opioid treatment programs to provide to their clients in addressing physical health issues as well as their addiction issues. and the process with medicaid was thorough but one that allowed us to use a monthly rate to support the work that was really improving the health care of individuals in opioid use disorder. and we know that people w

under obamacare, the medicaid expansion cost 50% more. at this very moment, medicaid is one of the largest and fastest growing budget i tempts items in every state budget. as medicaid grows, there is less and less money for schools, roads and public safety. medicaid's been a broken system that has been fundamentally unsustainable and the expansion that occurred under obamacare only made the system worse. this just can't continue. that's why the senate health care bill puts medicaid on a budget for the first time in history, ensuring for the long run that medicaid will be there for the neediest in our society. obamacare has put far too many able-bodied adults on the rolls leaving disable people at the back of the line. i know governor kasich isn't with us, but he is troubled to know that in ohio, 60,000 disabled citizens are stuck on waiting lists leaving them without the care they need for months and years. just a few weeks ago, i met such a family from a state that expanded medicaid. they are a beautiful family but a heartbreaking family

to take medicaid patients. in some parts of the country that is particularly true. host: there's this from roger in regards to insurance companies, didn't the affordable care act ensure that insurance companies have a 15% profit margin? guest: no, it did not. there is a requirement that insurers have to spend 85% of what they take in in premiums on health care. if it is more -- less than that, the patient we get a rebate. that might be what he is talking about come over that 15% is for administrative costs in addition to profit, not just profit. host: brenda is next, st. louis, missouri. democrat line. caller: good morning, jennifer. guest: good morning. caller: my question is i read in the new tax bill they are trying to pass for health care that the senate, congress and their employees are excluded from having the same insurance we would have. guest: that was an issue in the house bill. the house did not -- it would have essentially undone what obamacare did, which made members of congress get the same insura

he showed true backbone himself in indiana when expanded medicaid for his citizens. so he understands the challenges that we as governors face to make sure that we are providing that quality care pics with my honor today asked chairman of the national governors association to bring to the podium to work with the governors in a bipartisan way the vice president of united states of america mike pence. [applause] >> [inaudible conversations] [inaudible conversations] [inaudible conversations] >> .. >> ... [applause] thank you all, it is wonderful to be here. prime minister trudeau, governor mcauliffe, thank you for that warm introduction and that warm welcome, to governor sandoval, all the governors of the us and especially our host, gina raimondo, all the guests with us today, it's an honor to be back in rhode island at the 109th annual summer meeting of thenational governors association . [applause] i bring greetings from my friend, a champion of federalism who is fighting every single day to restore power to the states and people, the 45th president of the united sta

about medicaid. the would change the structure. instead of being a state program maybe a zika outbreak or .urricane or something in and there are also medicaid, some other changes that include, changing a formula that would provide more money to help provide uncompensated care. say. it is one change that is important. host: let me talk to about medicaid. it is a fundamental issue. if you are a governor of a state and you receive a block grant and you cap out, what happens to those individuals who the health care? guest: that is a decision you and your legislature have to make. if you have more expenditures than the cap level, do you reduce the number of beneficiaries? do you reduce the services offered? do you require beneficiaries to pay more? these are tough choices that have caused concern for folks. vacate covers 70 million americans -- medicaid covers 70 million americans. making it a cap allotment and exposing governors and legislators to the -- you are talking that is a great concern. the repu

medicaid is not perfect, no program is perfect. it's evolving, changing, growing, it's developing but what seems pretty clear to me having experience in the program for quite a number of years is that coming off expansion funding that has supported the growth of people being able to get coverage. >> you can watch the rest of this on c-span.org, now to a hearing on opioid abuse. officials will testify about their efforts dealing with the problem, this is live coverage on c-span2. >> it's affecting every core of our nation. in 2015 there are 2000 deaths from drug overdoses in the us, 33,000 deaths involving opioid. 24 percent increase in the private previous year. the rate was seven times the death from the 1970s. the 2016 we learned from the new york times we've lost roughly 60,000 people to drug overdoses. that is more in one year that all the names on the vietnam veterans memorial wall and likely, that number is underestimated because much of the data will not be in until the end of this year, 2017. it's staggering. for every fata

medicaid has been growing at a shocking rate for years.n 1980, medicaid spending was only 2.4% of our budget. half a percent of our economy. by 95 is almost 6% of our budget and today it is 10% of a our whole budget. 17% of all healthcare spending. so, this is happening because medicaid is growing much faster than our economy is growing. the fact is, no federal program can grow faster than the economy indefinitely because the economy has to fund the federal government. hopefully that's only a portion of what our economy isro doing. the main purpose is to provide a livelihood for the people who created. medicaid, as you can see is very this summarizes the very definition of an unsustainable federal program. consumi as it continues to grow at a rate that's much greater than our economy, it necessarily is consuming an ever grading percentage and portion of our economy. nothing can grow faster than the economy indefinitely. this is the very essence of what is unsustainable. you don't have to take my word for it. i'm certainly not the first per

are financed by medicaid. to the working poor, many of whom are hit hard by the opioids epidemic and are eligible for medicaid for the first time through the aca's expansion, medicaid is the only affordable health insurance available. and state medicaid programs are at the center of the opioids epidemic. in the house passed trumpcare cbo determined 23 million americans would lose coverage, the majority covered through medicaid, with 834 million -- billion dollars in cuts to the program. the senate's version cuts medicaid by a full 35% over the next two decades. the cuts could not come at a worse time from the perspective of the opioids crisis, for states and people who depend on the coverage medicaid provides. there is no substitute for coverage for our states or for people that need the care. as the senate continues to make cosmetic changes to its bill with one goal in mind, passing any bill out of the senate, let's be clear. no one time amount of funds, whatever the amount may be, whether replace the sernlt

medicaid is one of the three major entitlement programs, and now we spend roughly $400 billion on medicaid in this country. our friends across the aisle don't want to do anything that would keep that from growing higher and higher and higher to the point where basically the system collapses. we believe that's not the responsible choice, so what we have proposed is to spend $71 billion more on medicaid over the budget window, and to work to transition those states that have expanded medicaid and offer their people a better option in the private insurance area. but i just want to mention, you know, i have shared a number of examples about a small business owner in texas who was forced to fire their employees so they could afford to keep the doors open and provide health insurance to the remaining people. now, you have to ask what in the world could lead us to a system which would discourage people from hiring more folks and to basically put them in a position where they had to fire them in order to make ends meet, but that's what the employer mandate did under obamacare. if you have more tha

ask the american public if they want to do away with medicaid. do away with medicaid. yes, 60% of the money in medicaid supports seniors and nursing homes. want to do away with that? i don't think so. but that's what it would do. now the affordable care act does need to be improved. and the democrats have been trying to do that for some time. how can we do it? many ideas have been proposed. and the legislation was heard in committees here, the democrats proposed several amendments to improve the affordable care act. the first amendment was to do away with the repeal, but of course that didn't pass in committee and certainly wasn't on the floor. so, how do you deal with improving the affordable care act? let's start with drugs. we know that for the medicare system that the federal government cannot negotiate the price of drugs and for the exchanges, the fed ex changes. we cannot negotiate the price of drugs. it was a law that was written with medicare part b back in 2002 and 2003. so why can't we negotiate the price of drugs? we ought to be able to do that. let's negoti

rhode island fight this epidemic. >> so medicaid funds in rhode island cover medicaid assisted treatment. all approved medications. and injectable and support opt health homes and that's a comprehensive program to integrate health care within individuals receiving methadone treatment as well as all other forms of treatment. there is full treatment from in-patient treatment to outpatient treatment to residential treatment to the use of medication assisted treatment as well. >> thank you. have you looked at these bills that house republicans have passed and that the senate republicans are looking at which would severely reduce the -- well, would severely reduce the medicaid aid to the states? >> i have. >> how would those impact your state of rhode island? >> so. any bill that would reduce access to medicaid and medicaid expansion or reduce access to affordable health insurance would have negative impact on rhode island as 77,000 lives are -- >> 77,000 in rhode island covered by the medicaid expansion? >> correct. >> secretary tilley, recent ap announcements show that medicaid expansion ac

a partial medicaid, why did doctors not take medicaid? i got to the point where i thought i meant to take her to an emergency room just get this out with. and then i was very exposed to nursing homes, we try to bring my dad home but it didn't work out.savings i dad was a teamster, worked hard all his life. once they went to the savings at the nursing home he would've croaked if he had heard that part of his bill was being paid by medicaid at that point. why, with the private profitst s nursing homes, the leslie susan was $10000 per bed per person, 10000. so's teamsters pay of 2400 bucks in his world war ii vet is well pay 2400 bucks of his care. the rest is paid by medicaid. why, when the government is paying for 70% of cost nursing s homes, why can't we put a cap why can't nursing homes be pay demanded to hire more aides, pay their more because the ration to nurses rates to patients is a part. that's why you have all the high false in those places. >> host: thank you. good luck in taking care of your mother. >> caller: she raises a lot o

, trying to calm fears about the future of medicaid. under obamacare, kentucky expanded medicaid and cut the uninsured rate from 14% to almost 6%. but right now, the bill calls for significant cuts in federal funding of state medicaid programs. to make up for the loss, kentucky governor matt bevin has proposed changing the state requirements to qualify for medicaid, which could cause people to lose coverage. at louisville's shandy christian healthcare center, 70% of dr. brent duncan's patients are on medicaid. >> folks may have to decide between a doctor's visit and being able to put food on the table for their family. >> reporter: collins, a republican who voted for both senator mcconnell and governor bevin, is now truly worried about losing her coverage. >> i'm sure mitch mcconnell don't have to worry about his medical bills or governor bevin, but real people have to. >> reporter: omar villafranca, cbs news, jenkins, kentucky. ♪ ♪ no, please, please, oh! ♪ (shrieks in terror) (heavy breathing and snorting) no, no. the running of the b

sec.125.medicaid expansion. (a)in general.-title xix of the social security act (42 u.s.c. 1396 et seq.) is amended- (1)in section 1902 (42 u.s.c. 1396a)- (a)in subsection (a)(10)(a)- (i)in clause (i)(viii), by inserting "and ending december 31, 2019," after "2014,"; and (ii)in clause (ii), in subclause (xx), by inserting "and ending december 31, 2017," after "2014,", and by adding at the end the following new subclause: "(xxiii)beginning january 1, 2020, who are expansion enrollees (as defined in subsection (nn)(1));"; and (b)by adding at the end the following new subsection: "(nn)expansion enrollees.- "(1) in general. in this title, the term 'expansion enrollee' means an individual- "(a) who is under 65 years of age; "(b) who is not pregnant; "(c) who is not entitled to, or enrolled for, benefits under part a of title xviii, or enrolled for benefits under part b of title xviii; "(d) who is not described in any of subclauses (i) through (vii) of subsection (a)(10)(a)(i); and "(e) whose income (as determined under subsection (

to medicaid. to medicaid. i expect the senators will be equally concerned about the repeal and delay due to medicaid. many of my republican friends rejected the idea of repeal and delay several months ago at the beginning of the year when president trump first proposed it seems like that the republicans would do. there are some of the names back then who said repeal and then replace, later, doesn't work. here they were: alexander, collins, corker, cochran, well rakowski, paul. i would tell those colleagues and all the others the idea hasn't magically gotten better with age. it is still nothing more than a cut in run approach to healthcare that will leave millions of americans out in the cold and raise cost on everyone, the young, the old, the sick, the healthy, working americans and middle-class families. everyone will be hurt but with very, very wealthy. mr. president, every day the republicans spent on trying to pass there now failed partisan care bill, every day they sent cooking up new tricks

relate toly as it the medicaid program. medicaid serves the most foldable population. so many kids are on it that are learning disabled and have disabilities. one in 10 veterans are on the medicaid program. two thirds of the money goes to taking care of elderly folks in nursing homes. that cuts to the medicaid program, which in both bills are rather dramatic, over $700 billion and one over $800 billion and the other is a great concern to us. and the coverage estimates that go beyond the coverage losses and medicaid are also pretty substantial according to the congressional budget office. for us the big issue really is all about coverage losses that would result from the legislation, both in the house and senate. that is why we have been opposed to it. anna: that is really bad for patients, doesn't need the coverage that will rely on it. as far as hospitals go, how are the hospitals affected? bottom line, with what could happen on the medicaid cut? patientsst, it's about inpatient able to get coverage for care. that is the number one priority. in terms of hospitals, whe

how long have you been on medicaid? >> caller: i have been on medicaid since 1989. and then the medicare kicked in two years later in 1991 because i get social security disability, like $600, and then because that is not really that much money i get ssi that is like 60-something dollars. i have two heart valves in my heart. it doesn't pump normally and also i have agoraphobia and post-traumatic stress disorder so mental and physical. like, today i an appointment, which i have ever month, i have to go out of the county i am in because the state gave, you know, options -- they don't offer it in this county so my son is driving me out of the county to see someone. i am wondering will the trump care -- will i not have medicaid coverage because i need the medicaid to help. >> i think you are talking about the caps that could be put in place in florida and other states. thank you for the call. we will get a response. >> guest: she has raised the ongoing discussions. he was not on the medicaid expansion for it she has been on it a while. it seems that she is on it medicaid

medicaid has been growing at a really shocking rate for years. in 1980 medicaid spending was only 2.4% of our budget. a half a percent of our economy. by 1995 it was almost 6% of our budget. today it's 10% of our whole budget. 17% of all health care spending. so this is happening because medicaid is growing much faster than our economy is growing. and the fact is no federal program can grow faster than the economy definitely because the economy has to fund the entire government. the main purpose of our economy is to provide a livelihood for the people who create it. but medicaid, as you can see, is growing at a staggering rate compared to our economy as measured by g.d.p. this picture right here summarizes really for me the very definition of an unsustainable federal program because as it continues to grow the a a rate that's much greater than our economy, it necessarily is consuming an ever greater percentage. an ever greater portion of our economy and our federal budget. nothing can grow faster than the economy indefinitely. i mean it's just ar

i also want to talk about medicaid medicaid, as we know it, is not sustainable. the federal government and states spent $553 billion in medicaid in 2016. that amount is very close to $593 billion spent on the number one responsibility of the federal government: our nation's defense. every decked since medicaid -- every decade since medicaid started, it has grown faster than the economy. medicaid now unmatched as a driver of the deficit of our country. we cannot sit by and leave this kind of debt to our children and grandchildren. but dollars are not the only metric by which we measure medicaid. medicaid is a program that should supply health care to diverse populations and should have quality measured, but it does not. medicaid dollars should be spent efficiently, but they are not. activists in washington, d.c. are fighting to preserve the status quo, and of course in the process scaring the daylights out of the american people. yet, iowans tell me that there are waiting lists for medicaid waivers to obtain services for children with disabilities. others tell me

the medicaid -- the need to maintain the medicaid expansions and to provide coverage and to ensure we don't lose that coverage. we've heard a lot of people mention that in terms of expressing concerns. talk about the rural issue and the issue of hospital closures. there are a lot of different responses that you'll see as a result to some of the reductions in the loss of coverage. closures could be one of many. and we've heard senators express those concerns from various states. i know before the idea of repealing and replacing obamacare and even before obamacare the the closure of was a big issue. did the aca help that? did that law actually -- were you was a big issue. able to ma gap a little bit? >> you know, over the last i guess five years we've seen about 187 hospital closures, about a quarter of those have been in rural areas. some of that is as a result of budget preshrs. others are as a result of reconfiguring or redefining an h because one of the things that we were in the process of doing in the field is trying to provide care in a variety of different settings, not just the

rob portman has led a group of republicans from medicaid expansion states to stop the medicaid expansionill back or the pointer it is further into the future. he will be a hard vote to get to. host: you do not expect a vote this week? guest: no. the congressional budget office is not back with scores on some proposals. i think the republican leaders want to do both this week. i think maybe the week after is a possibility, but i think we will be back before august recess starts may be talking about a health care bill. host: we will follow your reporting at politico.com. jennifer haberkorn, thank you. health care will be the topic of our morning in the debate over a single-payer system. our guests include dr. flowers, a physician for the national health program and michael tanner of the cato institute. later, stephen dinan on the request for voter information, and what it means for states and how big of a problem is it? tomorrow morning, 7:00 a.m. eastern time, 4:00 a.m. on the west coast. check out c-span2 book tv and c-span3 enjoy the rest of your weekend. have a great week ahead. ♪ [cap