guest: it's interesting that we talk about ending a medicaid expansion. what we're really talking about is ending the current funding mechanism for medicaid for certain population. you might remember that in order to get affordable care act through the senate, special deal had to be cut with then senator ben nelson from the state of nebraska. he didn't want to pay for the medicaid expansion in needier ned -- nebraska. he wanted it to be free for them. the cornhusker dick kick back the federal government would pay for 90% of the cost. not for the disabled people or pregnant women or the poorest of the poor, only for the people who were in the medicaid expansion population. which is mostly between 100% and 138% of the federal poverty level. if you were below 100% or disabled or pregnant woman the federal government would give less money to the state than they would give if you were in that expansion population. what the gop trying to do is phase that aspect of it out. if the state wants to cover people who are higher and currently be in expansion population

the question is there are 5 million people who have not done a medicaid expansion. cvo says they will do a medicide expansion. they didn't say which states they would be. i think we should focus on 4 million people who cbo said are currently covered by medicaid. they are going to legitimately need help. the question is would the subsidies available to them under this gop bill, would they be sufficient? i think right now there's a robust debate going on in the united states senate over whether or not it's enough money and it's doubtful to me that a piece of legislation could get through the senate unless and until they put enough money into the actual credit. >> medicaid in its piece on the hill, the senate gop is seeing a path towards obamacare repeal. there are major obstacles ahead. critically senate moderates say they can add that albeit on a slower timetable. a compromise would remove one of the biggest obstacles for the bill. the moderates want to phase out of the medicaid and take seven years while the majority leader mitch mcconnell said two. a little bit of a

the medicaid expansion population those that are working. hoose not to participate in medicaid. people want their own health insurance. >> sir, working and affording health care are two different things. if people lose coverage they should go out and get jobs, people have jobs, it doesn't mean they can afford their health care. >> listen, there's people out there working two and three jobs, because where i represent, people that i grew up with, still don't have the means to pay for their health insurance and kids -- they are going to lose out in having health insurance. let me tell you about hiv positive man who is work, not making enough to pay for his anti-retrovirals but because of medicaid expansion now able to pay for his hiv medicines that have kept him alive. he's extremely concerned that with the repeal he's going to lose his health insurance and unable to pay for his medicine. this can be applied to many people who have chronic illnesses. >> let me ask you something, you are on the diabetes committee. i wantouote you fm a huffington

if she has had a lapse in coverage for medicaid expansion coverage will be gone. against insurance companies,, sm denying coverage for people with pre-existing conditions she may never be able to get insurance or surgery. mr. president, public schools and schoolchildren will be hurt by trump care. schools are now eligible to receive funds for necessary services for children with disabilities. schools are reimbursed for vision, hearing and mental health screenings. these help children get services early so they can be ready to learn. right now new mexico schools are reimbursed $18 million a year on medicaid. but under trump care states woul schoolsas eligible providers and the cost would be on the schools. the problem as the schools cannot take on these kind of costs. and that might mean hundreds of schoolchildren each year will go without vision, and mental health treatment because no one else will be able to provide them. the superintendent of the district in new mexico says, and i quote, medicaid funding is vital to our continuum of care and service to the major

some may be on medicare and medica medicaid. >> that's one of the biggest changes to the health care delivery system in the house and a roll back of the expansion and funding in the funding for medicaid in general. so you could still be impacted by some of the potential cuts that the senate is planning to make in the long-term. >> we were hearing that the cuts in the long-term would be deeper. >> yes. it's a very economical way that happens based off of inflation and how you plan to spend money but the reality potentially could be less real dollars spent in medicaid that. means that states are going to have to make really tough decisions about what services they cover and what populations get the most benefit from medicaid. >> so in a state like virginia for example that did not buy into the medicaid expansion would there be a lesser impact on those that are low income, seen yors, disabled, then places like maryland and the district that did buy into the medicaid expansion. >> yeah. i think considering what the greatest impact would be on the greatest impact as they expanded their medicaid enrollment and population. maryland had a growth of alm

as a medicaid expansion state, new mexico has seen dramatic gains over the last five years in coverage for the folks that need it the most. stories like annamarie's illustrate just how important medicaid can be for hard-working new mexicans. medicaid currently provides affordable health coverage to over 900,000 new mexicans, including many schoolchildren,ci seniors in nursing homes and long-term care facilities, people with disabilities, and people who need treatment for mental health and addiction. just one example of the wide-ranging consequences of the republican health plans drastic cuts to the medicaid program would be the end to any possible progress we've made so far in fighting the opioid and heroin epidemic. the opioid addiction epidemic has been deeply felt in communities across the state of new mexico. a for years without adequate treatment resources, our state has suffered through some of the highest ratesof opioid and heroin addiction in the nation. and i would just note that todat a story came out about how we hospitalized in the er long-term care, or hospital care, 1.3 m

nevada is one of the states that second the medicaid expansion. he didn't just align himself with sandoval's opposition to the gop effort to slash medicaid, he also said republicans are lying about the bill, about cutting premiums. >> we have 200,000, those were mental health, disabilities, mothers with children that today have insurance that they probably would not have had five years ago, six years ago. i'm tell you now, i cannot support a piece of legislation that takes insurance away from tens of millions of americans and hundreds of thousands of nevadans. if this bill passes, the second biggest lie is the premiums going down. there is nothing in this completion will lower premiums. >> mcconnell can only lose two votes and still pass the bill. yesterday a group of four senators said they would oppose it but left open the possibility. >> well, they're also four good guys and four friends of mine. and i think they'll probably get there. we'll have to see. i've been here only five months. people are saying where's the health care? where's the heal

obviously the medicaid expansion, the opioid issue are the areas of greatest concern for me. if it moves in a direction that

and trumpcare, by proposing to repeal medicaid expansion, hurts many of the hardworking people served now by that expansion program whose care depends on the expansion program being continued. this includes people like joe from portsmith. i met joe at a round table earlier this year. joe has a painful pre-cancerous disease that eats at her abdominal organs. she's had it for most of her life. and require -- and prior to the greagreat recession, she a job t had health coverage. but in 2009 jo was laid offer from her job. then unable to find reliable full-time work, so she worked several part-time jobs, but they didn't offer health insurance. in 2012, she desperately needed surgery. she didn't have health insurance. she couldn't get the surgery. her health declined. the recession continued. and her ability to support herself also declined. in 2014, after new hampshire came together and passed its bipartisan medicaid expansion program, she was able to get health care coverage. the medicaid expansion program helps her get eight to 12 prescriptions, necessary medical tests, physical therapy

if you shut down medicaid expansion too fast or you starve medicaid, there's not enough money. the problem is the resources are not there to run the program. if they would be willing to keep the resources there for an extended period of time, and that's all about discussions and negotiations, and make the exchange more solid, right now on the exchange, you know, under the house bill, and i think under the senate bill -- we haven't seen the numbers under the senate bill, but under the house bill, you can get a tax credit for 3 or $4,000 to buy health insurance. what can you buy for 3 or $4,000 for a year to buy health insurance? if you can, you can't afford the deductible. if we can get away from the political sloganing that we see and we can get reasonable people in a room -- because i've been there. i was there when we balanced the budget, i was there during welfare reform. you get reasonable people in the room, we can stabilize these symptoms and then we can, on a bipartisan basis, begin to deal with the primary cause of rising health care korscosts. right now we're not there

one of the big questions we had, the medicaid expansion, how and when it is phased out.t and longer -- more gradual phase out than with the house bill. >> that's right. what they do is under obamacare it's 90% the feds put in 90% and state puts in 10. what this does is in 2021 that lowers to 85 and 2022 goes to 80% fed coverage and 2023, 75% but the house bill went cold turkey after that. this is a longer phase-out which will make people happier with the bill, whether it convinces them it's a good bill, i don't know. but it will make him happier it is a slower phase-out. >> in plain english, this is a more gradual phaseout but deep cuts to medicaid in this bill based on our understanding. nancy pelosi is talking about medicaid now. let's listen in. >> we don't call that access. that's the most expensive kind and detrimental to the health and well being of the american people. back to the jobs lost by the health care bill, it is -- we haven't seen a budget. the budget we have seen from the president would lose 1.4 million jobs. some of that is overlap with the health care

as a medicaid expansion state, new mexico has seen dramatic games the past five years and coverage for the folks that need it the most. stories like this illustrate just how important medicaid can be for hard-working new mexicans. currently it provides affordable health coverage to over 900,000 new mexicans including many schoolchildren, seniors and nursing homes and long-term carh facilities. people with disabilities and people who need treatment for. mental health and addiction. just one example of the wide-ranging consequences of thh republican health plan drastic cuts to the medicaid program would be the end to any possible progress that we have made so far fighting the opioid and heroin epidemic.on the opioid action epidemic has been deeply felt in communities across the state of new mexico., for years without adequate treatment resources our state has suffered through some of the highest rates of opioids and heroin addiction in the nation. and i would note today a story came out about how we hospitalized long-term-care, 1.3 million americans last year because of this epidemic. ho

through private insurance and through medicaid expansion. trumpcare hurts the most vulnerable, the elderly, the disabled, and those with fewer resources. the consequences of gutting the a.c.a. and restructuring medicaid are enormous for our economy. one-sixth of which is related to health care. they're enormous for hospitals that rely upon third-party reimbursements under the a.c.a. and medicaid expansion. these hospitals need those revenues. and even more so for rural hospitals that keep their doors open thanks to the a.c.a. and the indian health care services facilities that have reduced wait times and added services because of the a.c.a. but the majority in congress refuses to hold hearings, and they are blocking all public participation. this is unconscionable and it's undemocratic. before republicans -- before democrats voted on obamacare, the senate held 100 committee hearings, roundtables and walk-throughs. the final senate bill included 1477 republican -- 147 republican amendments. the majority leader has missed an opportunity for pol

there will be a change to medicaid expansion. it will be rolled back but in a much more gradual way than is expected in the house bill. they cut it off in 2020. the senate won't even begin the process until 2021. white house staffers were briefed on the bill last night here on capitol hill, and i spoke to mark short, white house legislative director, as he was leaving that meeting. he stopped short of saying that the president is ready to endorse this bill but said in h mind we are all one step closer to end the nightmare that is obamacare. it will be a busy day on capitol hill. >> yeah. >> okay. thank you very much. >>> as we mentioned, the senate gop health care bill will delay the rollback of medicaid expansion to at least 2023, but millions of americans may lose coverage even sooner that that. and that's because many states won't have the money to keep running the program. it has to do with the federal match rate. the expansion covers 11 million low-income adults in 31 states, and the government covers 90% of the cost. that's

now, 98% are. >> reporter: what did medicaid expansion allow you to do? >> it allowed us to get people into treatment, which was key. otherwise they would be on watting lists. >> reporter: the opioid epidemic claimed 4100 lives in ohio last year, 308 here in akron. what would you say to the folks in washington who are talking about cutting back on medicaid? >> please, don't do it. you're going to have the blood of a lot of innocent people on your hands. >> reporter: the body count is so overwhelming here that the medical examiner's office had to call in a mobile morgue to help house victims. it will be here through the july 4 weekend, anthony, when another surge in deaths is expected. >> mason: adriana diaz in ohio for us tonight. thanks. when we come back, if you want to prolong your career, change it. yet up 90% fall short in getting key nutrients from food alone. let's do more. add one a day 50+ a complete multi-vitamin with 100% daily value of more than 15 key nutrients. one a day 50+. when this guy got a flat tire in the middle of the night. hold on

>> people will move off of the medicaid expansion on to the private health insurance market. can be a good thing. it isn't so much whether we are spending lots of money on medicaid, it's whether or not people are covered. i have concerns about the bill, but let's acknowledge as folks would move off medicaid, they would go on private insurance, coverage would continue, and in some cases that gives the patient more options for doctors they can see than does medicaid. so i think coverage will continue. >> dickerson: will you support this bill, senator? >> right now i am undecided. there are things in this bill which adversely affect my state that are particular to my state. a couple things i'm concerned about. if those can be addressed, i will. if they can't be addressed, i won't. so right now i'm undecided. >> dickerson: senator toomey, on this question of people moving off of medicaid into the private market, the concern from critics is this puts them in a market where they will be unable because the subsidies are going away or are low nerd this bill or the tax credits are shr

and they come from medicaid expansion states. if you look at people like rob portman from ohio. here is that the medicaid growth rate on the one hand might slow down, might square moderates. if you delay the rollback for the bill compared to the house bill, that could be a pot sweetener. it will be critical to determine managementer they can rope -- whether they can rope together the swing vote across the finish line. >> right. of course, we wish this morning, we were talking about how many americans will lose coverage. will this bring down the cost of health care, premiums, things like that. we don't know. we've seen the bill and the cbo -- we haven't seen the bill, and the cbo hasn't scored it. we're talking about a number, 50, and how they get there. you have rand paul, mike lee, conservatives, then on the other side, lisa murkowski, susan collins. you almost have to say for mitch mcconnell i'm going to sacrifice one end of this. who is it, and can they cobble together 50? >> that will be in the eye of the beholder, terrific question. there will be a lot of points of pressure

she's off of medicaid expansion. and i think it's really important that we also, to acknowledge the comments we've had about the importance of community response, thank the people who have this disease who have stood up, who have identified themselves as people suffering from addiction, have done the hard work of getting better, and then have turned their efforts to make sure that they help with the prevention recovery efforts that we need to undertake. i'm going to keep ashley in my thoughts today. she's about 17 or 18 months in sobriety now. she continues to get treatment for recovery. she's going to be reunited with her 3-year-old son soon. there is hope if we go at this with the all of the above approach. thank you so much. >> thank you, senator. thank you again. there are stories like that that we all can share, attorney general dewine has shared many with me as he's on the front lines. i appreciate, and i think this entire panel, if you couldn't tell, appreciates the time you put into this testimony. you all co

we need to come to the table and negotiate, and i do think that medicaid expansion program can be givenp. caller: -- it up inn you say give terms of expansion to the cuts 231 states,ans -- the cuts the republicans are willing to make, that is something you are willing to negotiate away as a democrat? that is something senate democrats have brought up a lot of focused on this week. caller: yes, but i said the expansion part of it, where they want to get new money to put people on. not the new medicaid program, but the expansion, and the gop needs to give up the tax breaks. if they want to reduce the deficit, instead of reducing it $200 million -- $200 billion, $300 billion, the need to cut what they want at of medicaid. it is imbalanced on both sides. host: so if the cuts do take place, the cbo report came out on the senate bill points to some 15 million americans losing health insurance under that. you are ok with that, as a democrat? caller: -- caller: no, no not necessarily. i have a personal thing that happened and i knew a person on the medicaid expansion who happened to be an opioi

it's tough unless you do something to the medicaid expansion.the crux of the fight right now. >> gregg: i want to see if you take issue of the cbo report that says people with pre-existing conditions would lose coverage under the house bill which has passed. now senators are looking at it. i looked at that bill, does not say that at all. people with pre-existing conditions would be covered, but only those who allow their coverage to lapse would have to pay a higher premium, but only for a short period of time. >> that is the case. they're also talking about creating risk pools for those who have a difficult time obtaining insurance because of illness or pre-existing conditions. the republicans have ways to deal with the issue. the pre-existing conditions is one of the reasons why premiums were so high for everybody. it is a great talking point for democrats though, they are sticking with it. i think it has been successful. if you look at the polls people say they don't like the republican solution. the democrats are good at making the case, true

how many people get health care through medicaid and obamacare's medicaid expansion?en. 35 million. two in every five kids in america and also 27 million adults adults, 11 million part of the medicaid expansion program. and there are nearly 19 million disabled or elderly. moment of the money is spent on the disabled or elderly. more than 60% of all medicaid dlarps go to care for these two groups. >> checking the numbers and running the facts. context, that's critical as we know for a number of republican senators especially from states that didn't used medicaid expansion to add people to health care rolls. look at the numbers. is inevitable. have a philosophical argument and part of it is about the role of government in health care but inevitable if you scale that back that the numbers, the access to health care goes down. >> i would add one more number to your list here. that is, that two out of three residents of nursing homes are medicaid beneficiaries and we have a population that is aging as baby boomers get older. this goes to the point that refuting kellyanne c

shows the percentage of insured and uninsured americans in medicaid expansion states as well as those in non expansion states from two thousand and thirteen to twenty sixteen uninsured people in the expansion states year over year were able to get insured either through a public option or private now from twenty thirteen the first year the a c eight opened and roll it all the way up to twenty sixteen the number of uninsured in expansion states were literally cut in half that is a very significant shift under the a c. a even those in non expansion states saw benefits with the number of uninsured seeing a slight drop there too and across the country states who participated in medicaid expansion under obama care all saw a huge drop in the rate of uninsured bringing their number whelm below the national average of twelve point four percent states like california washington minnesota iowa wisconsin all across the rust belt benefit from that expansion states that didn't participate in medicaid expansion have numbers significantly higher than the national average states like texas oklahoma g

the senate republican bill, like the house republican bill, will end medicaid expansion in new mexico for people like ealn -- elana. mr. president, this bill cuts medicaid overall more deeply than the house version. when president trump said that this -- the house version was a mean bill, this is a meaner bill. they are not necessary. these cuts are meaner and they are not necessary to repeal the affordable care act. they will hurt millions of americans. they are also devastating to our state economies. new mexico can't afford to pick up the tab for those cuts so the state will be forced to cut services and reduce payments to doctors. hospitals might close, and that would mean health care jobs will dry up. elana's story is one of millions. every senator has hundreds of thousands of constituents with these stories. we all need health care at some point in our lives. i urge -- i implore my fellow senators across the aisle to reject the mcconnell trumpcare bill. work with democrats on a bipartisan basis to improve america's health care system so that every american has access to affordab

comparable coverage for mental health and substance abuse disorders with medical surgical care, the medicaid expansion and essential health benefits that includes substance abuse treatment all have driven medicaid to a growing role. together these provisions have resulted in large increases in the use of medication-assisted treatment.th a number of states have beenea using medicaid as a central para of the attack on the opioid epidemic. the state of i recently reported substantial increases in access to care with disorder and inpord ohio medicaid now pays for nearly half of all the people in orphan prescriptions in the state which is one of the key drugs and medication-assisted treatment. let me turn to private insurance. private insurance covers aboutut 42% of people with an opioid use disorder. recent changes their have bolstered the building of private insurance to shrink the treatment gap. they are the parity act apply tr private insurance, essential health benefit provisions in the small group and individual market and availability ofsu subsidized insurance company a insurance policies for low in

what we cannot do, however, is end medicaid expansion and institute deep and irresponsible cuts to the traditional medicaid program. this crisis is a public health and law enforcement issue. but it's also an economic one. i believe the investments in helping people recover are a far better use of our dollars than the long-term cost of addiction. both in terms of state budgets, but also in ensuring that individuals are healthy enough to contribute to our economy. i'm pleased that we're having this hearing today. i'm very grateful to the chair for calling it, but we need to continue to hold hearings on how proposals made here in washington would affect our ability to stem and ultimately reverse the tide of this epidemic. this is an issue that rises above partisanship, and this is the work that we need to be doing, because the lives of our people in our states depend on it. i'm going to continue to work with my colleagues on solutions while standing firm against any policy that will pull us backwards. with that, i thank you and i look forward to hearing from our witnesses. >> thank you. l

medicaid cuts. it was 48% of the people in expansion medicaid there.his is such a tell of wll they talked about what they're doing take. a liberty. >> so medicaid. sending it back to the states. dapg growth rate. we've been dreaming of this since you and i were drinking out of a keg. >> i was thinking about something else. i was thinking about reforming medicaid. >> i was. i've been thinking about it for a long time of the until that shows what you this is really about. which is nothing to do with the aca. >> there is a consistent vision every where in this bill. and what it is, is that poor people should pay more for less care. i heard it before. a lot was getting alighted. there are states that have refused to expand medicaid by choice. they don't want poor people to have that. if you move all the people who could get medicaid on to these private plans and the. cheaper plans, what they get is health insurance much worse. they have to pay quite a bit more for it. there is this piece that people won't report this much on it. it is really important. the

we have a printing press up here the federal reserve so we borrow money to pay for medicaid expansion you are welcome to. but you got to pay for it. then we would have a discussion f. kentucky, if we double our state physical tax to pay for medicaid, we might lose business and jobs to tennessee, because they have no income tax. >> that would be an honest debate. have you as to weigh the pros and cons of higher taxes versus higher spending. >> that would be honest government and deliberatetive debate. >> i think everybody would like to see 95% of the people working instead of being on medicaid. but the reality is, they're not. there is unemployment, there is a lot in your state. >> we only have about 4.5 to 5% unemployment. we have institutional employment. we have to fix that. i who you would say we have differences between republicans and democrats on how we get there. >> right. >> as a republican, we believe less regulation, lower tax, smaller federal government leaves more money in the marketplace, um have more jobs. democrats want more debt, more taxes, more regulations, that's wh

medicaid program? should the expansion be discontinued? caller: no. i think something that we very rarely hear about, which is important, is how premature babies get medicare -- medicaid, excuse me, regardless of the preemies parents, born, i i forget how many weeks, regardless of how much insurance the families have and how much income the families because the costs are outrageous and today with all fertility programs, thank goodness, that are happening, multiple ng lots of births and young parents desperately are going to need from medicaid and i am sure that when medicaid is cut, is, young families are going to be impacted. glendale, , anita, arizona, medicaid participant, you are on the air. my wife passed away a couple years ago, she was on access, a state federal program, with medicaid expansion. e had to go on it, i mean, $6000 a month for a nursing home ridiculous, it was you know, the affordable care was self-employed and charge $40,000 a year for and there was nowhere to go. you had to pay for it. all of our income was going there. retire, sh

so what are these people supposed to do when the medicaid expansion goes away? when this bills additional massive medicaid cuts go into affect? what are they supposed to do? what are their families supposed to do? opioid one issue around this, digging on opioid induced. this is a problem that is growing around the country. last year we lost 2000 people in massachusetts alone.ts i hear from parents who have lost children from brothers and assisters who have watched a loved one disappear. i get from people who are desperate because their child or sister or brother can't get into a treatment facility. i hear from dedicated doctors and nurses and counselors who need more resources so they can expand treatment programs. rep and now the republicans propose a bill that is like throwing gasoline on the bonfire. one in three people struggling with an addiction are counting on medicaid, and the republicans plan to cut nearly $1 trillion on the program. i do not understand. i cannot understand how the republicans could turn their backs on literally millions of people who ne

after looking at medicaid expansion and talking with the folks in tom price's office and asking them to talk to the nevada medicaid folks, you know, it's interesting, because in our state basically what the proposal was, this, nobody gets kicked off unless you make more than 138% of poverty. or unless you choose to get off because you've got a job. our governor, and rightfully so, is bragging about the way jobs have increased and the unemployment rate is going down. richard, over half the people in nevada get their health insurance through their employment, and that includes public employee, city, county, state, federal, like myself. so when you talk about that, you have to say, listen, we need to do the right thing by those 7% or 8% of the folks on expansion, but you've got to keep your eye on the rest of it, and by the way -- >> really quick, i only got a certain amount of time, representative, because you talked about getting your insurance through those who employ you. in the bcra, they will not guarantee low cost -- i should say affordable health care insurance for large companie

medicaid expansion doing this to 2024, 7 years from now. and i have to say republicans need plan b. if you want to rip this away rip it away like a band-aid, rip it away like a band-aid, what incentives can get insurers to serve 2 people? neil: the vote is still scheduled for the july 4th research, unlike speaker paul ryan, mitch mcconnell doesn't care whether the votes are there, he is sending a message to donald trump, i will be here long after that. he will go through with the vote whether the votes i there were not. what do you think? >> the way i looked at mitch mcconnell he was getting away from i'm done. after that, this thing is going to get carved up like a smoked sturgeon. the biggest thing we have going forward, we spent $574 billion last year and higher this year, next year, the year after, i spent a little time reading the bill, the words grants, waiver, tax credit, subsidies were all over it, government centric and never going to end. the new york times telling you, that is not going to happen. >> a lot of democrats say this is heartless and mean. we have a government

let's take "the new york times," medicaid expansion. theacare raised eligibility cutoff. llars per single person. the federal government paid 90% of the cost for newly eligible beneficiaries. in the senate bill unveiled yesterday, they allow 31 states who expanded medicaid to continue getting federal funding through 2023 with reduced 2020 one. it sharply cartel to federal support for medicaid expansion in 2024, probably causing many to end the expansion. future spending per enrollee based on how much each state has spent historically. states have the option of receiving a lump sum block grant for beneficiaries. the budget office estimate similar policies passed by the house will cut 800 billion over a decade. a budgethe program on that substantially reduces future medicaid spending. here's what "the new york times" editorial says. it will be devastating to older americans. contrary to what many think, the program does not only benefit the poor. many middle-class seniors depend on it after they have exhausted their savings. medicaid pays for 2/3 of people in nursing homes.

about treating the mentally ill, the drug addicted, the chronically ill, particularly under medicaid expansione entire medicaid pie, there are huge challenges to it. the resources are just not there. i think we'll find over a ten-year period, medicaid funding will be significantly curtailed and not accompanied at this point with the kind of flexibility that we need, particularly as it relates to the pharmaceutical companies where we need greater flexibility. we will be looking at not just affecting those who are drug addicted, but children, seniors, the disabled. on the other side, the exchange side, where i just heard the secretary talking, he said there are counties that won't be served by insurance companies. the problem with the bill in the senate is that it eliminates the subsidies to the insurance companies after two years, which creates more instability and more confusion. nobody is saying -- nobody, not my colleagues on the democratic side -- no one is saying that this doesn't need to be fixed. of course it needs to be fixed. but cannot do it in a way where you deprive people of the re

so much so that those folks enrolled in medicaid expansion, taxpayers are paying 50% more than taxpayers are paying for those under traditional medicaid. and states enrolled roughly 20 million people in the medicaid expansion program. the combination of enrolling so many people in the medicaid expansion program and paying 50% more than for traditional medicaid, means that when states have to foot 10% of the bill, which they will by 2020 -- when states have to foot that 10% of the bill, they cannot afford that 10%. unfortunately, under the affordable care act, state taxpayers will not be able to pay what in california is $2-point it billion extra per year as the state's 10% share. similarly in louisiana, my state, our taxpayers -- me, my colleagues, my friends, my neighbors -- would be on the hook for $310 million per year. our state is having a budget crisis because we can't afford $300 million, now it is a $310 million recurring bill every year. one thing that is not said is that medicaid expansion in its current format is not sustainable. we have to do something -- to preserve the bene

because of medicaid expansion, those on the other side are not. to see the divide. >> reporter: this is the line that divides our community health. the state of texas decided not to. with the medicaid expangsz. they are next door to each other and we are seeing vast differences in health. >> i have a disease. i have congestive heart failure. i have crohn's disease, high blood pressure, fibromial shah, vertigo and probably some are missing. >> reporter: this 59-year-old texas resident is a mother of two. she worked for years filling other people's prescriptions as a pharmacy technician, she doesn't get medicaid. if she lived in arkansas, she would. >> you benefit from seeing them because you have chronic kidney disease. >> i don't have insurance of any kind. >> reporter: what do you say to your neighbors who say, we don't want to pay for your health care? >> it's not as though i never worked a day in my life. i worked. so, you work and you can't get it. you're sick and you can't get it. what is it? >> reporter: she lives on the texas side of the sta

that was on the medicaid expansion before. o in texas where i live, there are going to be millions more with health insurance as a result of this bill because texas didn't expand medicaid, but these tax credits will be available to everyone in texas who is under 100% or 138% of the poverty line. >> how does the cbo get to the fact 20 million fewer will have health insurance? most of that figure, the medicaid expansion if you repeal it, the raw number of people were made eligible for it become ineligible. they lose their medicaid card. so if what you're saying is no, they are just trading in their medicaid card for a different kind of insurance that's a tax credit, how does the cbo get to 20 million people losing their health insurance? >> we don't of course have the score of the senate bill yet. >> the house version is similar. >> right. i think so too. and the vast majority of the cbo's coverage score is driven by one thing, joy. it's the repeal of the mandate of the 23 million who will lose coverage, about 18 million of that

this point will make some people happy on issues if you're a moderate senator caring about the medicaid expansionaseout process than in the house bile. a conservative senator with medicaid spending to slow dramatically, you'll get something for that as well. conservatives who care about obamacare regulations. what you saw from the house bill, the waiver process, will not be in this draft but they'll give another waiver process that already exists in the aca more flexibility for states to get out of certain types of regulations. will that make them happy? it's up in the air. a year of defunding for planned parenthood. abortion, a huge issue as well. they're learning that behind closed doors and crucial over the next five, six hours, once senators digest this and their staff digests it, where do they sit? happy with it, out altogether? the answers leadership is looking for and we are as well. >> fantastic, phil. let you get back to chasing people around that meeting and back to your phone and texting with maybe news from the meeting itself. meantime, president of american action and former director

and generally the big sticking point is medicaid and how long and how far should the medicaid expansion go and should we cap medicaid? offer block grants? medicaid seems to be the biggest issue though there are smaller issues, defunding planned parenthood for one year for example is something senator murkowski said she can't get behind. senator collins expressed concerns behind that. there are some little nuances in the bill as well that could be negotiated this week. >> david, do you expect the cbo score to help or hurt mitch mcconnell as he tries to rally his troops to vote for the bill before the fourth of july recess? >> i do think it'll probably hurt that effort, but i still expect that effort to succeed. mcconnell is a really savvy operate, he knows his caucus really well. that's the dynamic we saw in the house and it'll repeat in the senate? >> what do you think he'll be willing to sacrifice first in order to get the job done? >> well, i think the thing he's going to do to bring in rob portman from ohio, shelley from west virginia, they'r unhappy about the opioid treatment and th