of lowd, , people medicaid income. medicaid is more generous than medicare. itid covers many more things can sometimes it covers transportation to the hospital. it covers more types of home care. in some ways medicaid is a more robust in a fit package. the problem with medicaid is that providers tend to be paid even less than medicare sometimes dramatically less than medicare. it can be hard to find someone who takes your medicaid, who will provide you care. there's these trade-offs sort of whichever you look at it but there are medicaid by proposals out there and having looked at. senator schatz from a wide has introduced a medicaid buy-in proposal in the senate. >> host: you've been covering healthcare for many years. several news organizations. what first got you interested in healthcare? >> guest: i was first assigned to it i had always been interested in it. i was looking through some of my old college clips and realized i had writtenme an editorial about medicare. medicare member what it was quite was like i been writing about healthcare a long time. it

that's what medicaid has become. it's overwhelmingly, managed care privately and government better off running these verses the government contracting the private risk. that is the big fundamental part of what is debated. i don't think it will happen. you're all on it. somebody is going to pay for it. that's a much bigger issue in this then subsidy issue of what they subsidize, it's been going on for decades. >> thank you. we have a few questions so if you could just -- >> some of the republicans are pushing this idea of allowing primary care physicians to contact with their patients and insurance companies out of it with the idea of having catastrophic plans. i'm not even sure how they are talking about it. how would that system or could this fit in with this system? >> that's accommodated question. the goal would be for -- and i think it's a large primary care practice because they manage the data and risk and directly contact. i think it's one other option, i don't know that is not, i think it's like trying a seri

it allowed states to expand medicaid. to get the aca, you had to be low income, and you had to be a child, senior, someone with a disability you had to meet silo requirements. foraca set a national floor medicaid qualification at 133% of poverty. that is higher than it was for some populations. it just said you had to have a low income. you do not need to meet these other requirements. that is where we have gotten into the debate about able-bodied people on medicaid. in most states, able-bodied people were not eligible for medicaid. most states have expended. we are seeing more republican states expand. we are seeing they are expanding, but they want to make these able-bodied people do something to get medicaid coverage, some kind of work requirement, which has been struck down by a district court in washington. host: federal district court. kentucky'snsas and proposals have been stopped. the administration is continuing to look at and in some cases approve these proposals. there is a lot of litigation going on about whet

not the number of people on medicaid, the people covered by medicaid expansion, who would lose their health coverage if the law is invalidated. >> joining usrehema ellis and also chair of the health policy and management at columbia university's school of public health. rehema, you have been speaking to people on the ground. this is uniquely important to people in that state. how do they feel about this war i guess you could say over there on health care? >> well, those we talked to say they are disappointed. this state went for president trump, but now people are saying they are pretty tired about the arguing going on in washington about an issue that for them literally means a question between life and death. listen to what one person had to say. >> republicans, democrats, i don't care. there is a solution out there. i don't know what it is. but i put him in office to figure that out. look at health care for the just me, but for everyone. just stop and think about what you're about to destroy. >> reporter: i'm standing here right now with angie settle, a ceo of this clinic that we'

underpaid by medicare and medicaid.t has been the hospital's incentive to take advantage of the cost per service fee to pay for things such as executive compensation, capital expenditures and to finance for sure future acquisitions to give the more leverage to push back against private plan negotiations. this war started in the mid-80s and it proceeded through the 90s with insurance companies consolidating and getting the better of these negotiations. the counter reaction was that the hospital system started to consolidate to deal with and negotiate with more aggression and the trump card was buying more than 50% today approximately 50% of the physicians are now employed by large health systems. let's -- if you own the physicians and facility you can control price. insurance consolidation started by drg when the hospital consolidation and today the price for both is out of control. the question is how do health systems get away with driving pricing services? for product that have little to no relationship to their actua

at least we negotiate some of it in medicaid right now. the consumer gets the benefit of the rebates. still not enough. you want to give more power to people, and that doesn't -- i listen to what gary said about pharmaceutical industry. i agree with part of it. part of it i don't agree with is -- gary, i'm sure you're watching. a lot of what you said i agree with, but we don't want to destroy them. they got to operate under the philosophy of pigs get fat and hogs get slaughtered. the most important thing is the great development. you saw about the development of the drug for alzheimer's. two companies spent a lot of money and it came up empty. at the same time, we need to have transparency. that's the order of the day, transparency, transparency, and transparency. in medicaid, in medicare, in the entire health care system, value-based, that's how we have to change. more medicare for all. more government, more price controls suspe controls isn't going to work. let's let the market work so we have a system that rewards excellence and high qu

you can't cut medicaid by a similar way without knowing it will cut family's medicaid. you cannot cut education without knowing it will be impossible tore some kids to go to college. you can't gut the epa by more than 30% without knowing it will make our air less safe and our water less clean. these cuts in the trump budget aren't a tightening of the belt or a trimming of the fat or even a serious attempt at spending. they are at a level that's malicious, a level intended to do harm. that's not all. on top of all the damage done on a note of physical restraint, this budget calls for a trillion dollars in additional tax cuts for the wealthy. this is on top of the tax scam enacted in 2017 that showered tax cuts on the rich and corporations while adding trillions to our deficits. none of it adds up or makes sense which makes sense of some of the more creative aspects of our government. the president uses every trick in the book to disguise its true ramifications. one of the most striking parts of this budget is the inclusion of $165 billion for overseas contingency operati

medicaid money comes out of that social security check, $138, i believe, or somewhere around that. if there is going to be free medicare for all, we are going to get back the money we put in it as working people that contributed to medicare and the other thing is medicaid is different from medicare. i wish they would -- the people that are pushing medicare for all our confusing everything and

services and director for medicare and medicaid innovation. before i introduce the under secretary, i want -- the hhs and cms teams designed this discussion to be informative and inclusive. we have people joining us from leading primary care specialty societies as well as palliative care and home care physicians. we have innovative groups. home care physicians. we have -- [ inaudible ] members of the physician focus advisory committee. we also have a number of journalists. after the senior officials make some remarks, we're going to take questions from the reporters who are here because the media can only be here for a limited time. that q and a will be about 15 minutes. please don't interrupt our speakers. if you're one of the stakeholders joining us today, please hold your questions until the second part of our discussion which will be interactive and allow ample time for any questions you might have. after the speakers and the q and a, the press are going to take a break for 15 minutes and you're welcome to go in the reception area directly

and repealing medicaid expansion. medicaid is the largest source of insurance coverage for people with hiv. and the 37 states that expanded medicaid showed how it can play an important role in addressing the opioid crisis as well. in some states as many as 4 out of 5 people receiving treatment for opioid addiction are insured by medicaid. the centers for disease control and prevention also plays a very important role, yet the trump administration proposes cutting its budget by a tenth. this proposes cutting immunization efforts by $78 million even amid an alarming measles outbreak in my home state and several others. it proposes cutting work on birth defects and disabilities by $44 million and proposes cutting efforts to combat antibiotic resistant pathogens and emerging infectious diseases by $103 million despite the world health organization labeling amr, quote, one of the biggest threats to global health. when it comes to medical research, this budget is a small step forward and a marathon sprint back. i do applaud

medicaid, $623 billion.nd other areas of spending, other health spending, private health insurance. one of the men who is advising bernie sanders, gerald freedman, economist at the university of massachusetts in amherst. if we push this under his cost, here is what the projected cost for medicare for all and you can see a lot of those other expenses go away, but their projected cost for medicare for almost $2.8 trillion. you can find other manifestations about this. it is in one of the upshot pieces they did. let's hear from tom in fort lauderdale, florida. hello there. caller: good morning. the democrats are up to the usual thing, and that is they are playing on the emotions of the american people to sell a fantasy backed by a high school valedictorian speech. let's go through some fantasy versus reality with the democrat arguments for just about everything. number one, this medicare for all would be something new and it would work. the reality is we have had a medicare for all, it is called the v.a. the v.

the administrator for medicaid services. and the director of the center for medicaid innovation. before i introduce the secretary, we are proud to have all of you join us. hhs and cms teams this kind -- design this discussion. we have people joining us from leading primary care specialty societies as well as private care and home care physicians. we have medical groups. home care physicians. we have health care associations of the advisory committee. we also have a journalist. after the senior officials make some remarks, we will take questions from the reporters who are here because the media will only be here for a limited time. that you and a will be 15 minutes. please do not interrupt our speakers. please hold your questions until the second part of our discussion, which will be very interactive. q&ar the speakers and the with the press, we will take a break for 15 minutes and we will go into the reception area outside this room. the remainder of the afternoon will be limited to the stakeholders. about five minutes to 2:00 we will reconvene in two sessions. one in this room a

medicaid programs are covered as well as the cdc, fda and others. he spent his crew working in's senior health care leadership in the public and private sectors. is hisrent tenure at hhs second tour of duty. these are the general counsel from 2001-2005 as deputy secretary. and chief operating officer. during his time, he played key affairs,international global health diplomacy, implementation of the medicare health perception program, public health emergency preparedness, food and drug regulation. now in his second stint, the secretary has four primary objectives. lower prescription drug prices, bringing an end to the opioid epidemic, change the way america's pay for health care, an individual insurance should be made more affordable. we share these goals and work closely with hhs a multiple fronts to benefit patients and physicians including the opioid epidemic. and improving the delivery of care. happy to have a leader of mr. azar to engage in those efforts. please welcome alex a's are -- azar. [applause] much and thank you so thanks to everyone a

it says if you do not provide medicaid coverage the way you should you lose all medicaid , funding. that is trying to commandeer the states and that violates the constitution. i'm just laying out what the challengers were saying. is that clear? brian: yes. let me show you some video of the conference room. you allude to the fact in your book that only the chief justice, you had seven meetings with him. joan: it was eight meetings. you are reading the earlier version. brian: he only took you through the conference room once. let's show that and then tell us why you think he took you through on that occasion. joan: ok. brian: and how important is that room? joan: it is a great room. this is the room where it happens. this is really the room where it happens. no clerks -- can people hear me still? no clerks or secretaries or assistants of any kind are allowed in that room while the conference is going on. if any justice has forgotten his or her eyeglasses, you have to call for them and a little knock on the door comes and a junior justice opens the door. i love the look of that room. b

of the medicaid expansion. four out of ten non-elderly adults that are dealing with opioid addiction today are on medicaid. and so when you put $5 billion in essentially flat funding for specific ipo treatment, next to 1.5 trillion dollars in cuts to the insurance program that actually allows states to pay for treatment, the result is a devastating net negative. a dramatic contraction of federal dollars out of the opioid treatment system and i guess i just want to be honest what we're doing here. i know you may say, well, we're still going to spend more money in real dollars, but this is a $1.5 trillion cut compared to what we expected states to spend and i feel like we should just be honest, what this budget asks is for states to pick up a much bigger share of the burden for caring for people with addiction. and that this national emergency we declared comes with it an expectation that the federal government would do less and states will do more. connecticut will try to scramble to come up with the money when

a lot of 64-year-olds are already on medicare through disability or on medicaid. a great down payment in my view. long and short, i think it's affordable, but we have to be careful how we get there. thank you. mr. mcgovern: thank you very much. mr. cole: thank you very much. miss grace is president of the i.n.s. actual of a public policy organization founded in 1995 to provide and informed debate over free market ideas for health reform. she's been instrumental in developing and promoting ideas for reform to transfer power over health care decisions to doctors and patients. she speaks and writes extensively about incentives to promote more competitive patient centered marketplace in the health sector. >> thank you ranking member cole, thank you chairman mcgovern, members of the committee for the opportunity to testify today. let me begin by saying i believe there are important shared goals for health reform. everyone should be able to get health coverage to access the care they need. it should be affordable. people should be a able to see the doctors they choose.

i'm not going to cut medicaid. i'm not going to cut social security.eople like paul ryan would do that. not me. i won't do it. but i want everyone like i want the people of wisconsin to know, that trump's budget that he brought forth in march would cut medicaid by $1.5 trillion. cut medicare by $845 billion. and the last two budgets he brought forth would make cuts in social security as well. all of you know that medicaid covers 2/3 of the nursing home care costs in this country. i want you to think about the families in wisconsin, in vermont and around the nation who have moms or dads dealing with alzheimer's who are now in a nursing home. when you cut $1.5 million in 1.5 when you are cut trillion in medicaid, i don't know what happened to those $1.5e -- when you cut in medicaid, i don't know what happens to those people or the families who are trying to take care of them. cutting $1.5 trillion in medicaid and over $800 billion in medicare, is not supporting the working families of the country. trump promised when he ran for office here in wisconsin,

there are a lot of home birth practices that cannot afford to take medicaid we need to find a way to create these options because out of hospital birth can be transformative. and as you said trauma before in i don't want to stop is that it can be a very traumatic experience the idea of being intimate i've i've been in rooms of women giving birth in hospitals and it's it's traumatizing to watch i mean it's very it's just close to torture and i mean i mean it's literally scary there's big sometimes legs are up things are there and there's just people yelling and masks and it's not and it's scary for me i can't imagine we're somewhere where for a woman who's having given birth there's alternatives you know i can be sent to hospital midwives deliver we say catch and most of the time i'm not ground up i don't deliver in any position she can stand she's can squat we are the specialists and laboring moms who choose not to have pain medication i don't i thank you for that work because it's really important and i think this is why when we sort of go away from care and patient care that cares

not only to make care more accessible but to ensure the solvency of medicare and medicaid. while some have called for a complete government takeover of our healthcare system i believe in solutions founded in choice, competition and innovation. to that our innovation center is the testing ground for new payment and service delivery models that improve care and save taxpayer money. today's announcement creates innovation in primary care that has the potential to entirely transform our fee for service system which is about 65% of the medicare program into one that drives value. primary care plays an essential role in moving us in a new direction. that is because primary care providers are at the center of our healthcare system. gatekeepers that manage healthcare conditions, coordinate services across multiple systems and providers, responsibilities that have a direct and significant impact on the patient experience, health outcomes and total cost of care. most primary care reimbursement continues to be based on the volume of patients they can't get into their office and they g

we did not expand medicaid in georgia. he said, you hand out all the new medicaid cards you want to if it'll make you feel better, but i'm the only doc in five counties who still sees medicaid patients, and i can't fit anybody else in my waiting room. so we're not going to achieve that goal of providing more care. we'll just achieve a policy goal of feeling better about what we're doing in rural georgia as it sits today. what policy reason is there? if i want to achieve that goal of not seeing folks walk out the door because they can't pay for their care, i don't understand the policy reason to take away all of the dod health care system that my men and women in uniform tell me they love. i don't understand why we have to abolish every union health care system that my union members say back home, i've got the best health care on the planet. why, to achieve the goal of serving the underserved, is the policy solution to take everything away from people who already feel well served? >> i think that's really a crucial issue. w

what has that is created is a -- step above medicaid. what has that is created is a fair amount of angst and questioning about how much it costs to get health care, especially in southern minnesota where you have the mayo clinic driving prices. the thing i will be watching most closely into 2020 is what is happening in my district, the southern district of minnesota. the reason is we barely elected a republican back in 2018. and the year before that, we barely elected a democrat. i think anyone who wins here is going to win on the margins, and i think it is a good indicator of how the rest of the state is going to go. i think the reason why people living in other states would be interested in watching minnesota, especially during the primary season is because i think it could be a bellweather for how other midwestern states will express their vote. if minnesota votes for someone in the primary who is more moderate, that would be an indicator that other midwestern states are feeling the same way. and because minnesota has gained a reputat

s medicaid, we would -- a.c.a.'s medicaid, we would have that as well. we did not do it. texans have no lifetime caps. they have the ability to have their children on health insurance plans. this is a tragedy. i condemn the action of the administration in filing their opposition to the affordable care act. i yield back. the speaker pro tempore: for what purpose does the gentleman from california rise? >> i ask unanimous consent to address the house for one minute, revise and extend my remarks. the speaker pro tempore: without objection, the gentleman is recognized for one minute. mr. lamalfa: thank you, mr. speaker. i rise today to highlight the discharge petition that was signed by myself today on this floor, as well as 189 total members of this house. and a special thank you to representative wagner and scalise for their great work on this issue. this discharge petition is to force consideration of the born-alive abortion survivors protection act, known as hrment r. -- known as h.r. 62, which so far has been blocked by the majority in this house. i'm willing to bet most

coversyou know, medicaid two thirds of the nursing home care costs in this country. want you to think about the families in wisconsin, vermont and around the nation who have moms or dads dealing with alzheimer's now in a nursing home. one point $5 trillion from medicaid, i don't know what happens to those people are the families who are trying to take care of them. cutting $1.5 trillion from supporting the working families of this country. trump promised when he ran for office, here in wisconsin, all over the country, he promised the american people the rich will not beginning at all under his tax plan. remember that one? well, that turned out to be a major lie. 83% of all the tax breaks went to the top 1%. today, we of that is have corporations like amazon, anyone know how much they paid in federal income taxes? that?sane is you have a profitable corporation owned by the wealthiest guy in america not paying a nickel and income taxes? that is true for general motors, chevron. many other corporations. not andtax proposals do working families. campaign, trump promised

i say this despite the fact that 23 states declined to participate in obamacare's expansion of medicaid coverage. their refusal to do so, however, was an exception that proves the rule. having experienced a huge collateral costs of their existing medicaid programs, those states merely declined to compound the injury. in light of this experience, i believe is a chance that the supreme court might reverse its 1937 ruling on the basis that those grants have proven to be inherently coercive. i base this on supreme court's decision in brown v. board of education, which declared that the recent segregation, that racial segregation is unconstitutional. in doing so it overturned its own 57 year old precedent in plessy v. ferguson, that held that racially segregated facilities are permissible, so long as they are equal. the court reversed plessy on the ground that experience had proven that segregated facilities are inherently unequal. accordingly, i can envision the court reversing steward machine company on issuing that the grants are indeed coercive. all that is needed to test this thesis is

more recently we have seen a tremendous bounce in the commonwealth of medicaid expansion. more than 250,000 region unions have healthcare for the first time. [applause] >> our healthcare which should be a universal right is under constant attack from those on the other side of the aisle. sadly we have also seen the fear generated in our immigrant communities. the mere mention of an ice raid, separation of families, the horror of children being placed in cages. in northern virginia the most diverse part of the commonwealth, we embrace this diverse city. [applause] >> in alexandria, our students in public schools speak 100 different languages. it is inspiring to hear that beto from his hometown value respecting and embracing our differences rather than fearing them. like the congressman has said, our families deserve a real opportunity to share in our nation's success. [speaking spanish] [speaking spanish] >> personally i am excited that several of our democratic candidates speak spanish and the latino community is growing every day. [applause] >> more importantly we need to

ll of you know that medicaid covers 2/3 of the nursing home care costs in this country. i want you to think about the families in wisconsin, in vermont and around the nation who have moms or dads dealing with alzheimer's who are now in a nursing home. when you cut $1.5 million in medicaid, i don't know what happens to those people or the families who are trying to take care of them. cutting $1.5 trillion in medicaid and over $800 billion in medicare, is not supporting the working families of the country. trump promised when he ran for office here in wisconsin, all over the country that the american -- he promised the american people that the rich will not be gaining at all under his tax plan. remember that one? well, shock of all shocks, that turns time-out be a major lie. turns out that over a 10-year period, 83% of all of the tax breaks went to the top 1%. and the result of that -- the result of that is that today we have corporations like amazon, anyone know how much am zonl paid in federal income taxes -- amazon paid in federal income taxs? now, how insane is that th

and medicaid rolls by getting them to work.t's reforming healthcare. he may be talking big now about repeal. repeal isn't going to get through the courts. >> he knows and all polling shows us that healthcare costs are one of the biggest issues if not the top issue for most voters out there so by saying yes, republicans are going to tackle this is he trying to flip the script on democrats who said we were going to talk about and he says we are too. >> he could probably take it to nancy pelosi, you have to find out for me what is in. i love the good doctor but with the good doctor is doing is this is all speculation and the reason it is speculation, the reality is we haven't seen it from healthcare plan. we haven't seen republican healthcare plan. we heard bits and pieces here, bits and pieces there but we haven't seen a comprehensive plan from republicans on how they plan to cover the same amount of people, cover preexisting conditions, allow students in college to get healthcare coverage, in the world we currently live in. with

i'm more interested when it comes to medicaid and this issue of work requirements that medicaid's czareen pushing because if you are able-bodied and you are into that medicaid expansion which is very popular in the rural states, why shouldn't you be doing community service or educating towards a job? the idea is the medicaid rules can shrink if you actually end up working. that's such a great idea. i'm very disturbed that in arkansas, it's being contested legally. block grants work, governor huckabee is right. i think states should have more control over it. that part i agree with. >> dr. siegel, talking about innovative solutions, one thing i'm excited about or hopeful for is how jpmorgan, berkshire hathaway and amazon announced they were banding together to find solutions in the private health insurance arena. we haven't heard a lot about that. what's your thoughts on what they might bring to the table? >> i absolutely love that. and i love another thing you didn't bring up, henry ford hospital in detroit is doing this, direct care models, where you cut out the middleman. obviously i

we face a daunting and devastating medicaid cliff on september 30, 2019, an absolute collapse in medicaid. our republican colleagues continue the work to dismantle health care for millions of americans right now. they voted to eliminate protection for pre-existing conditions and to strip the health care coverage. last weekend, the trump administration escalated its attack on americans' health care by supporting a federal judge's ruling that the entire affordable care act should be thrown out. today, i ask my republican colleagues, what side will history find you on, protecting american families or the need to protect partisan interests? a demonstration of this was the republican-controlled senate's failed attempt last week or failure last week to advance a disaster aid package that includes billions for american families still recovering from 2017 natural disasters. be on the right side of history. i yield back. the speaker pro tempore: for what purpose does the gentleman from new jersey seek recognition? without objection, the gentleman is recognized. >> mr. speaker, i rise today because

program, particularly through medicaid managed care. now not all the states have gone there, but the vast majority have. improvements to medicare advantage, the aca is not just about the individual mandate. obviously that is a big component, but it really touches the entire health care system. so we really have been out there, i think, actively trying to make it work for consumers, to make sure that everyone has access to coverage in that way. i take maybe a little bit of issue with the sense we haven't been supportive of it. we obviously believe it can be made better. and we have specific proposals and ideas about how to make it better. i would be happy to get into it with you. christopher: do you think we might see a more out front political message from you, to say, hey, let's fix what needs fixing? matt: we have been out there saying, let's fix what is not working, whether it is in the individual market where premiums are too high and people who don't qualify for subsidies have been priced out, the cost of prescription drugs leading

program, particularly through medicaid managed care.ll the states have gone there, but the vast majority have. improvements to medicare advantage, the aca is not just about the individual mandate. that is a big component but it really touches the entire health care system. so we really have been out there, i think, actively trying to make it work for consumers, to make sure everybody has access to coverage. i take maybe a little bit of issue with the sense we haven't been supportive of it. we believe it can be made better. and we have specific proposals and ideas about how to make it better. i would be happy to get into them with you. christopher: do you think we might see a more out front political message from you, let's fix what needs fixing? matt: we have been out there saying, let's fix what is not working, whether it is in the individual market where premiums are too high and people who don't qualify for somebody's -- qualify for subsidies have been priced out, the cost of toscription drugs leading higher premiums, hospitals conso

despite the fact that the 23 states declined to participate in the obamacare is the expansion of medicaid coverage. the refusal to do so was an exception that proved the rule. having experienced the huge collateral cost of the existing programs that states declined to compound the injury. in light of this experience i believe there is a chance that the supreme court might reverse its 1937 ruling on the basis that they've proven to be coercive. i base this on the decision of brown v. board of education which declared the segregation is constitutional and in doing so it overturned its own 57-year-old precedent that held racially segregated facilities are permissible so long as they are equal. on the ground experience with proven segregated facilities or inherently unequal and accordingly reversing the machine co. and assurin companyg that the grants are indeed coercive all that is needed to test the thesis is that the group of governors to challenge the constitutionality of a particularly aggravating category perhaps just medicaid and any of you have the view please urge them to pay attenti

as we know, those deals would cut spending on n public heah care programs like medicaid, would have cutding for subsidies that make health insurance more affordable for some people. i am skeptical whatever they generate is going to be an iota more friendly than the last bit of vicious proposed legislation. amy: can you respond -- rick scott, now the senate. this is what he had to say. >> i do know medicare for all which senator sanders is a l lin on comome is g going to ruin our health care system. sayet me clarify, did you that you expect the white house to come forward with a proposal first? i know in the end, the white house is going to have to have their plan. i know it is going to be difficult with nancy pelosi. but what i'm going to focus on is how do you drive down cost? the democrats constantly focus on access. the problem is, the cost is too high in this country. amy: he was speaking on "face the nation." dr. gaffney, if you could comment t on what he is saying? >> we know that c countries that actually have universal access also have higher costs. these two things go hand-in-h