of medicaid. she's been there for most of the time that the funds have been there and she's been working very hard on it and i want to welcome her and her delegation to town. >> thank you. i will now recognize the ranking member for introduction of her. >> thank you mr. sablan. i would love to introduce miss angela b lee, executive, puerto rico state health insurance administration. we held a panel yesterday and she's the one provided the data related to help our system in accordance with the secretary of health of puerto rico. >> all right. and miss plaskett, recognize mse witness from the united states virgin islands. >> thank you, mr. chairman. it's an honor and a pleasure to be here under your leadership, mr. grijalva, i'll have you know i call the leadership of the subcommittee for mr. sablan, so please be careful. [laughing] this is a really important issue and i'm really grateful to have ms. michal rhymer-browne who is the assistant commissioner of the united states virgin islands departmen

everybody can't be on medicaid. and medicaid in kentucky is free health care. and that's a great deal for the people that have free health care. but somebody's paying for the free health care. and the people that are paying for free health care are the people that are in the private market. and they're very upset because the premiums continue to skyrocket. so we have a problem with the affordable health care act. mr. balat, the reason i asked the question about extending health care to illegal immigrants because i watched the democratic debate the other night and there were ten on the panel. they were asked a question how support extending health care, free health care to illegal immigrants. and if i remember correctly, all ten raised their hands. that's potentially millions of new americans on what i would presume would be medicaid. what happens to the current health care system in america if my friends on the other side of the aisle and those running for president from the other party get their wish and extend free health care to millions and millions of ille

>> i would say medicaid expansion. >> medicaid expansion. in other words, medicaid, you're down in texas. but how much is the reimbursement. how much does the government pay people to provide medicaid compared to medicare and compared to what the private sectors charged. >> medicaid is typically your lowest reimbursement whether you're a physician or a facility. it's just below medicare rates typically. >> ok. >> and medicare is about 60% of what private reimbursement is. >> ok. so you're maybe saying half. >> just north of half. >> so in other words as we change the system to put more and more people on medicaid what we're doing is, we're driving up the cost for people not on medicaid. is that true? >> yes, absolutely. >> ok. and is the reason therefore the cost of people who aren't eligible for a.c.a., the reason they're being punished and just put in such an impossible position, is because the change in the way, he huge number of people now who are expected to get their health care through medicaid type plans who before may have gotten he

it's not medicaid because medicaid is sharedwith the state.edicaid is a different kind of program .you could do a medicaid for all and there is talk of that because the medicaid benefit package is much wider and there's less cost-sharing because it's for people who don't have a lot of money so they can't afford healthcare costs so there are variations on how to do this but i agree, it's confusing to call it medicare for all because they start stumbling over themselves because it's not going to be medicare. >> host: how did the proposal to prescription drugs then? >> guest: they would be covered. medicare, the idea of freestanding medicare prescription implants because it was the republican congress, that put the drug plans together and they wanted a role for private insurance created these private prescription only drug plans. >> on the sidebar note, the president, the administration announcing efforts to import drugs from canada. any sketch out what that proposal is and how do the canadian government do that ? >> canadian government is not gr

many of whom rely on medicaid to have access to services and because of medicaid can recover and work and become productive citizens. we really need to look at the big picture. host: how involved were you with expanding medicaid through the affordable care act? guest: we strongly supported expanding medicaid and we have continued to fight for access to medicaid including being involved in lawsuits. the challenge to proposals in restricting medicaid and we will fight hard for medicaid because it is finally important. host: joe in south dakota, independent. good morning. caller: good morning and thank you. can you do a blood test to see if you are mentally ill? who is to determine who is mentally ill? the red flag laws will create trouble. and as far as anybody being determined mentally ill or challenged, a non-attributed quote, if all the thoughts of anyone person could be revealed, they would deserve hanging 10 times over. i will hang up and listen. host: two points you made. with regard to the blood test regarding mental illness, we cannot take one, the brain is a complicated organ o

to go back to the.about medicaid. what we have seen we have medicaid expansion. the survival of rural hospitals where as in states that have not expanded medicaid, many of those hospitals are closing. there is a real urgency around directing resources to rural health. >> for s our department of human services and department of education have been convenient especially in our rural areas. with the practice can look like it does look like, not only for our traditional our medicine but mental health services as well. in working with our superintendent and their teams, then understanding what their needs are, how they have been most successful in how we have been able to utilize some type of hybrid model so we are not leaning too heavily in one area versus another. they've been informing other policy recommendations but also with some of the contract language. so our county knows and does much of that funding is sometimes dispute is alondra item budget instead of a mission driven budget is one of the areas we are trying to change right now. >> one final question. >>

it is not really medicaid because medicaid is shared with the state. medicaid is a different kind of program. you could do medicaid for all and there is talk of that because the medicaid benefit packages much wider and there is less cost sharing because it is for people who do not have a lot of money so they cannot afford to help pay costs. there are variations in how you do this. i agree. it is confusing to call it medicare for all because they stumble over themselves. it is not medicare. host: how do proposals treat prescription drugs? guest: they would be covered in the public option. the idea of freestanding medicare prescription drug plans, because it was the republican congress and republican president in 2003, that put the doctrine together and they wanted a role for private insurance, so they created these prescription only drug plans. the administration announcing efforts to import drugs from canada, can you sketch out what that proposal is and how does the canadian government do that proposal? guest: they are not thrilled. there are 37 millio

i have medicaid.i wasexcited able to get it through the affordable care act. -- i agree with the caller. she was talking about dental. that if ourief government actually cared about dentals health then coverage, dental insurance, working on teeth and making sure there are no cavities in the aluminum and these things that old-school dentist do that they updated, that or we they focus on your teeth and occlusion. such -- it is the biggest part of your health. if our government was concerned, which they are not really our country is set up there has to be a start about a homeless people and lower-class. in order for all that to be in play -- i'm a sociology major, by the way. i graduated in 2010. i study systems and everything. dental insurance is the most important. doctors.holistic i have an uncle who is a holistic doctor and i see a holistic doctor. of course underneath the there is zeroe tolerance for many holistic approach. -- for any holistic approach. do insurance has a lot to with money and profi

illegal immigrants have access to wics, some emergency medicaid, and other support. generally it is a small fraction of all welfare state spending in the united states. host: let's talk to callers. jerry in new jersey you are a first. -- you are up first. caller: i have two questions. one, i heard democrats over and over on c-span say that the illegals do not get welfare and benefits. evidently that was not correct. it seven -- it sounds like trump a merit-basedo system which is been talking about for a couple of years. people, are these illegals, supposedly paying taxes if they cannot get a security number? how is this working? this is such a fraud. how are they paying taxes? where are they getting social security numbers? guest: great question. generally democrats who say that about welfare and illegal immigrants, true but some small exceptions but true some illegal immigrants have some small access to welfare programs. it is important to understand that the rule put in place is not about stopping welfare in the united states by immigrants but about reducing the nu

you have medicare and medicaid. half the money for health care in this country is paid for i the government. secondly, the center for american progress is really -- it is really a place for future biden appointees. she keeps on talking about the public option. is one realption -- in washington state it is not working too well. canada, has all, very effective system. it is very popular, 90% approval rating. half ofta costs are what is in the united states. they do have some private insurance. it is very limited, very expensive. medicare for all, it would be a very lucrative world for private insurance. this thing about a middle-class -- cut, tax hike, it is sanders offers options on how to pay for it. this person who talked about the middle class, the middle class is a broad range. his income is a lot more than the average income of a person in the middle class. the average worker earns $60,000. host: thanks for that. i will let you respond. you served at the department of health and human services, correct? guest: y

we've seen this happen in medicaid as well. what she seems to have stumbled on a bit is actually i think a more plausible version of the world where basically, the sick private insurers, here's money, you figure out how to provide these benefits. then we'll go from there. the details of course are important for that but i would say that is much closer to a more plausible support. >> i think that is correct. one of the pieces that is interesting about that, it goes back to your first question about what medicare for all means. it's a current medicare system that is both public and private. what's important about her plan is that she would impose stricter rules on private plans and to make sure they would get the benefit of a lot of the influx of people they would have to place by the terms of who will be covered and things like that. the devil is in the details as always. it's a good thing to have though in healthcare is such a huge part of our economy that having variations of people thinking about these issues more and more is

i recently signed into law the reauthorization of medicaid expansion in montana. yes, montana. i was able to get -- work with a trump republican majority legislature to reauthorize medicaid -- something the purple states, wisconsin, florida, and north carolina have yet to be able to do. and we got it done even after tobacco companies spent $26 million killing that renewal by ballot initiative only two months before the legislative session began. here's how i got passed in 2015 and how we renewed it in 2019. i made the case unless we expanded medicaid, folks would lose their rural hospitals, our economy would suffer, companies that are unwilling or unable to provide health care will lose that medicaid coverage for their employees. you see, the winning argument on health care has often been you're going to lose what you like. that is how the right defeated hillarycare in 1994. how democrats blocked newt from cutting medicare in 1997. and it is why despite 70 attempts, the republicans have been unable to repeal and replace obamacare. even though the trump administration continues

nothing like what medicaid pays but very limited long-term care. we got more hours than anybody we know for medicare because we were activists so we know how to fight for what we want. we got the right agency but still, it was not enough. we had to spend a lot of money paying for the other hours that we needed. [applause] almost six years, six and a ha half, i always thought the reason medicare at that time will pay is because they figure if you are homebound and if you are in need of services but your not going to live that long, and he fooled them by living thousand years. we managed to go through quite a few demonstrations. so that's how we got married. now that money is gone and when i start needing services, i may be in trouble, i don't know yet. thank you for asking that question. >> i think that we are out of time. >> we've got one? >> all right, one more question. >> are you or have you, or are you going to read the audiobooks? >> you think i should do it myself? >> absolutely. [applause] >> with my accent? [laughter] >> [inaudible question

interesting, elastic embrace medicaid, 1982, arizona.hey were 17 years after the majority of states before the final embrace medicaid. when the affordable care act past and there was now a medicaid expansion option, where did arizona fit? they were one of the first in, with two republican houses, with the republican governor. what do realize is what do they get by being the caboose on medicaid? what did they get by waiting for 17 years? what they got what's worse health care for hundreds of thousands of people over 17 years. they were not going to be the caboose the second tiger we have now had 35 states have done expansion. don't compete to be the caboose. if you want to rural hospitals to be, have a fighting chance of thing a lot, or other things that have to happen medicaid expansion will keep these pillars of rural health care from closing in many, many instances. mr. nickels, you wanted to comment on this? >> yap. totally agree. there's a crisis in role america a crisis with rural hospitals and no question from our members, the went

if we look at the medicaid program, medicaid program that started out -- i would say not a huge portion of the state's budget and now it is the number one or two budget item for every state. states are struggling to pay for the program and if we look at this large investment we have made, where are the outcomes? we don't actually know because the government hasn't collected data and hasn't helped states accountable for what they have produced in the program. it is costing more. doctors won't even see patients on the medicaid program and outcomes are unclear. there has been a lot to be said about the medicare program. we do have a lot of high satisfaction but the medicare trustees report is telling us the medicare program is not sustainable and that in seven years, it is going to run out of money. while people are calling for medicare for all, that program in and of itself is not sustainable. our administration wants to strengthen the program, protect the program, make sure it is sustainable over the long term so we need to work toward that instead of forcing so many more people on the p

about 15 million of them are in states that have not expended medicaid. the other 10 million by auto enrolling other things into the exchange you can do. i think the public option drive down costs. that is all attainable to get accessible and affordable care for all. the biggest problem when i look at this debt system when it comes to dark money really is gibson drug side of it. -- is prescription drug side of it. at least by adding that sunshine and transparency, it will be a big first step. >> ginger gibson with reuters. right now our political system seems largely dominated cycles of outrage from both sides, one side people get outraged and then the other side gets outraged and they get mad and yell at each other. this is not a partisan tactic. sides.nded on both you, on the other hand, are talking about principled pragmatism and cooperation. can you win an election in the era of outrage with a message that is not outrage? in is your party driving part or doing their part to drive the division in our country by participating in the cycles of outrage? g

is paid with medicaid.nybody in your know somebody who had a baby that ran up big medical bills in the first couple of days? even if the parents have the best insurance in america, it is medicaid that provides a special breeding equipment, the special feeding equipment, the occupational therapist, the speech therapist, the physical therapist, so that baby has a chance. so here's how i see this. in america. isdo not know whose grandma going to outlive her savings. we do not know whose beloved friend is going to need access to health care and cannot pay for it. we do not know whose beloved nice is going to give birth to the baby that runs up a million dollars in medical bills. but here's what we do know. we are all going to pitch in some money today, so that if it happens to your family, or to ,our family, or to your family the rest of us are all going to be there for you. that is the best in america. that is the best in america. [cheers and applause] sen. warren: so yes, in case anybody missed it, i believe

medicaid?ou are on caller: i went on medicaid when i was declared disabled at 25.bout seven years ago. i went off disability last year, but they allowed me to stay on medicaid. , and i startedng to check out health insurance plans. but there are a lot of employers that are not -- that will not offer full-time hours to employees, so they don't have to offer insurance. at least people without health care -- that leaves people without health care. and god for medicare for me, which -- thank god for medicare for me, which other taxpayers are paying for. if not for that i would be in a back in the erbe being treated instead of having a primary care physician. host: next up, alan, in pennsylvania -- alex, in pennsylvania. caller: i've been a machinist my whole life, worked up big and small companies area everyone i know -- companies. everyone i know in pennsylvania pennsylvania, has that health care. nobody can retire -- has bad health care, nobody can retire at 62. the bottom line is they get everything. your home, everything. i don't know where these people work, that

when you talk about people who are using medicaid 59300000 u.s. born citizens or about one in 6 people in the united states are enrolled in medicaid so that gives you a sense of. the scale of the use of these programs and how broad this application could be when you put this likely standard as opposed to you know the previous standard on you know when you're going to be completely indigent in the hands of immigration immigration official when they understand the message coming from the top right now every cent adds up when uncle sam is 22 trillion in the hole but to qualify or disqualify from the green card as opposed to the h. one b. work visa what's the difference right so the key point here is that the h. one b. acts as a kind of international temp agency run through the immigration system that is you're granted a visa and contingent on a specific job offer and your boss actually is the legal sponsor one of the legal sponsors of your visa application and a green card by contrast is simply a status you are granted the status of a permanent resid

people in the united states illegally are not eligible for things like medicaid and food stamps.hese are people in the legal process to become citizens. the president of the united states is betting that his move will help him at the ballot box especially when he couples it with things like this. >> raise your hand if your government would provide coverage for undocumented immigrants -- >> they're all the same. >> and they all raise their hand. president trump is betting he can scare voters trying to appeal to his base just like he did when he made this baseless claim. >> when mexico sends its people, they're not sending their best. they're not sending you. they're not sending you. they're sending people that have lots of problems. and they're bringing those problems with us. they're bringing drugs. they're bringing crime. they're rapists. >> that claim resonated with some, and it did not matter that it also was not true. one study out of texas, for example, found native born residents were much more -- when it comes to immigration, facts have not been the driver for president tr

his wife divorced him after he bill disabled and he was eligible for medicaid. for 20 years we did not get married because i didn't need that kind of help, until now, with increasing difficulty, i am able to attend to my personal care. therefore, because i didn't need that kind of help and was not forced to get on medicaid, i was able to work and make as much money as i could. didn't make that much because after all teachers don't make that much money, but i was able to save for retirement, whatever it is that the you are supposed to do in the u.s., whatever they call the american dream. and i had little savings. i had income and resources that would have immediately made him ineligible for medicaid, so for so many years we did not marry. we lived in sin. in 2013 -- this was after "occupy," "occupy" made us so bold if we thought we could do everything. we got married. it wasn't just that we were bold. certain things changed and the one -- the main thing that changed was that danny's multiple sclerosis has progressed to the point where he now was considered home-

back to whenthen medicare and medicaid was fought.became one of the most popular programs in the united states, and then your own trajectory, what you were doing as a top executive at cigna and humana, what you were saying about medicare and medicaid. wendell: my first career, i was certainly saying, that't's privatatize medicare and see wht we can do to get as many people into private plans as we can. when i went to work for humana in 1989, they were selling private managed care plans in the medicare program. that has become a big cash cow for the insurance industry. what happened after the medicare program was enacted in 1965, we kind of stopped. it was the intent to bring everyone into the medicare program eventually, but what happened instead was that we allowed private industry to create and construct what has become a root goldberg contraption that exists to make money for big corporations like the ones i used to work for. the reason we have ever increasing prices in this country is because all the players are working symbiotica

technically by law it's supposed to be capped at 3 percent price rises per year for medicaid but they introduce some loopholes and it's allowed to be 6 percent increase per year from the taxpayer to the health insurance and health racket industry hospitals and doctors and stuff and pharmaceuticals but in fact this year 2019 the prices are projected to go up 15 percent on medicaid spend so is draining from those people who are paying those obamacare unsubsidized raids they actually have to pay those rates where they have $7000.00 deductible so they can't use their health care they're paying $25000.00 a year the taxes are going up to pay for this other part of the racket here where it's just draining more and more of the tax revenue 15 percent a year because of course obama did not introduce any caps there's no regulation on spending at all so it could go up and up and up and up and up until every single last penny you possibly could save so you got to keep on running faster and faster to stay in the same spot and lower rates make the situation worse it's like the economy blew a tire an

if you satisfy those conditions, then medicare comes in and pays for very limited, nothing like medicaid, but very limited long-term care. that's when we got married because we were able to get these hours and we got more than anybody we know because we are activists and we know how to fight for what he wants and we got the right agencies, but still it wasn't enough. we have to supplement so we spent a lot of money paying for the other hours that we needed. gabriel is back here. do you want to stand up. he was a home health aide for the last five and a half years of danny's life, six and a half years? i always thought the recent medicare at that point will pay is because they figure if you are homebound and in need of skilled services that you are not going to live that long but he fooled them and they were good years. we managed to go to quite a few demonstrations. that's how we got married. it cost us a lot and now money is gone and when i start needing those services, i may be in trouble. i don't know yet. thank you for asking. we are out of time for questions. >> one more. okay. one

i am currently on medicaid myself because i am disabled and i am still not able to get what i need on i would still, if i were to have -- if i were to become, you know, infected with cancer or if i were to become infected with some other disease, i have done research and i have found that i still would not be covered in the ways i would need to be to be able to afford out-of-pocket because i only work part time. there's no way in heck i could afford the costs that come with that based on what i'm currently getting from medicaid. guest: i'm sorry about the challenge, your challenge, like those faced by millions of people in this country. the fact is that people are cutting pills in half, they're skipping doses, they're literally mortgaging their houses. we have patients who have gone bankrupt. and the tragic -- there's so many tragic elements to all of this. but people taking insulin, for example, have died because they try and stretch their insulin because they can't afford to take the required dose. and this is something that should not be happening in this country, should not be hap

it is not really medicaid because medicaid is shared with the state.edicaid is a different kind of program. you could do medicaid for all and there is talk of that because the medicaid benefit packages much wider and there is less cost sharing because it is for people who do not have a lot of money so they cannot afford to help pay costs. there are variations in how you do this. i agree. it is confusing to call it medicare for all because they stumble over themselves. it is not medicare. host: how do proposals treat prescription drugs? guest: they would be covered in the public option. the idea of freestanding medicare prescription drug plans, because it was the republican congress and republican president in 2003, that put the doctrine together and they wanted a role for private insurance, so they created these prescription only drug plans. the administration announcing efforts to import drugs from canada, can you sketch out what that proposal is and how does the canadian government do that proposal? guest: they are not thrilled. there are 37 million

centers for medicare and medicaid services.he now sits on the board of directors for the center for medicare advocacy. he is at and shoot at the university of pennsylvania and received his masters in public health at johns hopkins. that or benedic ippolito is an economic research fellow at the american enterprises institute. he focuses on health economics and health policy. a lot of his recent work contains price regulation specifically surprise medical billing. he graduated from emory before receiving his masters and ph.d. of economics at the university of wisconsin-madison. tom nickels is executive vice president for public policy of the american hospital association represent approximate 43,000 individuals and had served nearly 5000 hospital and health care systems and health care providers. mr. nickels has been with american hospital association since 1994. he was director of the american college of emergency physicians in the washington office before that. senator collins would you like to introduce mr. mitchell? >> thank

i will work with you to stop the of medicaid in this state. there are only 54 mental health in the state of iowa. i'm talking about it because it's what i'm hearing about from you. we cannot do any of this if we cannot win. dot of what i have tried to and i know that maybe i haven't had a viral moment, but what i've tried to do is to not take it to the other democrats. part of what you have to do is to vet the candidates. not go for the richest candidates, or the one who has the biggest pot of money. you vetted candidates that were unknown before. who were theecide best candidates to move forward. i am asking you to do that. getting record is things done. i have passed over 100 bills where i am deleting democrat. i think that matters. matters.hings done i have won every race every time going back to elementary school where my slogan was all the way with amy k. you know in this state there are moderate republicans and independent watching those debates and they are thinking they are tired of donald trump. they don't like a president where when

includes emergency medical systems, disaster relief, national school lunch programs, wic, chip;, medicaid received by people under the age of 21 or pregnant women as well as foster care and adoption subsidies, student and mortgage loans, energy assistance, food pantries, homeless shelters, and head start on stop it'working to .ot this will fly to applications and petitions starting on october 15 of this year. once this rule is implemented and effective on october 15, the career immigration services officers, will generally consider aliens current and past receipt of the designated public benefits well in the united states as a negative factor when examining applications. however, receipt of certain non-cash and received before october 15 will not be considered as a negative factor. the underlying statute, passed on a bias -- on a bipartisan basis also requires officers to assess at a minimum each applicant's age, health, family status, assets, resources and financial status and their education and skills as well as other factors set forth in the rule in the totality of the circumstances.

it's medicaid.nyone knows a someone that had a baby that ran up a million dollars in medical bills in the first couple weeks? even if the parents had the best insurance in america medicaid provides special breathing equipment and feeding equipment. occupational therapist. and so that there is a chance for that baby. we don't know if granda is going to outlive their savings. we don't know. and give birth to a baby that ends up with millions in medical bills. but we do know, we're all going to pitch in money today so if it happens to your family the rest of us are going to be there for you. that is the best in america. it's the best in america. so i believe health care is a basic human right. we fight for basic human rights. i'll fight for medicare for all. so everybody covered. because i believe in the worth of every human being and i believe we can build a government that reflects that value. that is what i want. so thank you for the questions. there are things we'd love to talk about. we've got som

for the folks who get their health care throughthousand medicaid. 30,000 dot mental health treatmentvailability as well. this was in montana, and then we will take it bigger -- we started a program to address folks see their primary care doctor, so we go through screenings for mental health perspectives. of the day,he end within 40 days of committing puicide -- algorithms come u and they will be connected with licensed psychologists. we have done more of telemedicine. we passed a law through the legislature so that mental health parity and physical health parity and insurance has to be the same. as a president, you need to lead and take both federal dollars and investing in the challenge of rural areas. if we don't have quality access to mental health care, you can't -- i as commander-in-chief of national guard, i have lost nine soldiers in six years all to suicide. if we don't have access in rural areas as well, you can't live in those communities. sir? gov. bullock: the question is republicans always talk about the deficit until they get elected, then they get a $1.6 trillion not t

armed forces and their spouses and children, as well as medicaid benefits for emergency medical services. lastly, under the final rule, uscis can permit an applicant seeking a green card from inside the united states as inadmissible only on the public charge ground to adjust their status to that of a legal permanent resident if they will post a public charge bond. so to conclude, i would just note again that generations of immigrants strengthen the foundation of our country and make positive contributions today. and we expect that to continue in the future. through faithful execution of our nation's long-standing laws, president trump's public charge inadmissibility rule better ensures that immigrants are able to successfully support themselves as they seek opportunity here in america. throughout our history, americans and legal immigrants have pulled themselves up by their bootstraps to pursue their dreams and the opportunity of this great nation. as president trump delivers on his promise to uphold the rule of law, this administration is promoting our shared history and encouraging the