and medicaid expansion. panelists warned that the rollback of medicaid would be devastating to tribal members. and a representative from san phillipe pueblo reminded us that indian health is not an entitlement. it's an obligation. but now the republican leader and the president are moving in an even more dangerous direction. they're pushing to repeal the a.c.a. with no replacement, which would strip health care from over 30 million americans. it would devastate anyone who is sick today, anyone who relies on insurance, they get through the medicaid expansion or the affordable care act. and it sets up a disaster for anyone who might get sick after repeal because it would destabilize insurance markets and would throw our economy into turmoil, killing up to 50,000 jobs in new mexico alone. and as often happens with policies that hurt the most vulnerable, indian country would be hit the hardest. traditionally the senate has worked on a bipartisan basis to address native american issues. that tradition must continu

i wanted to ask about the medicaid expansion. north carolina did not expand their medicaid program and my sister is a director of patient management at shelby hospital and most of the doctors around here do not take medicaid, so the patients end up in the emergency room anyway. why is there such a fight over the expansion of medicaid when i do not know they have done a study or what, but most doctors refuse to take medicaid and -- etiquette patients in the end up in the emergency room, which obamacare was supposed to take care of that? guest: this is a huge problem, as well. the supreme court in 2012 a desk eight states the option of expanding medicaid. 2012e supreme court in gave states the option of expanding medicaid. obamacare was supposed to expand medicaid all over the country and it became an option. every governor had to decide whether to expand medicaid and embrace the affordable care act or do i not? state like dr. lannett but not expand medicaid, there are folks in a gap. they do not qualify for medicaid, benefits of th

>> correct. >> secretary tilly, recent ap analysis show that medicaid expansion accounted for more than 60% of the total medicaid spending on substance abuse treatment in kentucky. between 2012 and 2014, there's been more than 700% increase in substance abuse -- there has been more than 700% increase in substance abuse treatment provided to kentucky residents due to medicaid's expansion. so i guess i want to ask you, it looks to me like medicaid has been particularly helpful in kentucky's fight against the opioid crisis. would you agree with that? >> let me say this. i will tell you unequivocally of our governor's commitment and again, exampled by the 1115 waiver and our effort at thisvery moment to expand our treatment options there that -- >> let me ask you my question. would you agree that medicaid has been particularly helpful in kentucky's fight against the opioid crisis? >> i would agree -- >> thank you -- >> i'm sorry. i would agree that through a number of sources of funding we would increase treatment dating back to 2004, 1100%. >> let me ask you this. let me ask you this. if t

because as you know, the republicans are still trying to repeal the aca's medicaid expansion in making a lot of changes to the program. so what role has medicaid played rhode island's effort to provide medicaid treatment in your state? >> medicaid assisted treatment is both for the disabled and the expansion populations all medicaid coverage. individuals. are able to receive three forms of fda approved medications for opioid use disorders. the director of medicaid is a member of our opioid task force and has been active in working with managed care organizations that manage the medicaid product to do things like remove prior authorizations for medicaid assisted treatment. it is fully funded through our medicaid program. >> and my colleagues on the other side of the aisle often characterize the medicaid program inflexible for states. we hear that a lot, that it's inflexible. to the contrary, i think it is a great deal of innovation and how states respond to the opioid crisis. would you please tell us about the health home program in your state and how medicaid granted rhode island the f

it is medicaid expansion that's putting at risk the sustai sustainability of traditional medicaid. let me first take up the first two amendments dealing with premiums. i've got a few charts. unfortunately in washington,d.c., there's not a whole lot of people that understand the problem-solving process. let me describe it briefly. it starts with information. it starts with defining the problem, doing root cause analysis, having the courage to recognize and acknowledge the truth and reality. and then based on that reality, you try to set yourself achievable goals. from my standpoint, the achievable goals of our effort should be to bring down gross premium levels back to a reasonable level where they were prior to the implementation of this completely faulty architecture of obamacare and preserving and sustaining traditional medicaid. this chart i realize are a little busy but let me walk you through it. this shows the trend line of obamacare in terms of what we've experienced from 2010 through 2017, plus the estimates of the congressional budget office as it relates to the senate bil

it would in medicaid expansion with no grace period or option for states who like their medicaid expansion and want to keep it. in many ways it's just as cruel if not more cruel to medicaid as the trumpcare bill in a different way. so i would expect that same senators who are concerned about what will be equally concerned about what repeal and dollywood due to medicaid, many of my republican friends rejected roundly the idea of repeal and delay several months ago with the beginning ot the year when president trump first proposed it. it seemed like that was what republicans would do. here are just some of the names back in his head repeal and then replace, later, doesn't work. you're the work of cassidy, alexander, collins, corker, cotton, hatch, isakson, moran, mccain, paul. what i would tell those colleagues and all the others, the idea hasn't magically gotten better with age.n it is still nothing more than a cut and run approach to health care that will leave millions of americans out in the cold and raise costs on everyone, the young, the old, the sick, the healthy, working americans an

>> correct. >> secretary tilly, recent ap announcements show that medicaid expansion accounted for more than 60% of the total medicaid spending on substance abuse treatment in kentucky. between 2012 and 2014, there's been more than 700% increase in substance abuse treatment provided to kentucky residents due to medicaid's expansion. so i guess i want to ask you, it looks to me like medicaid has been particularly helpful in kentucky's fight against the opioid crisis. would you agree with that? >> let me say this. i will tell you unequivocally of our governor's commitment and again examples by the 1115 waiver and our effort at this very moment to expand our treatment options there that -- >> let me ask you my question. would you agree that medicaid has been particularly helpful in kentucky's fight against the opioid crisis? >> i would agree -- >> thank you -- >> i'm sorry. i would agree that through a number of sources of funding we would increase treatment dating back to 2004, 1100%. >> let me ask you this. let me ask you this. if the medicaid expansion went away, would that impair your

now she's a beneficiary of the medicaid expansion. he worked as bank loan officer but became too ill to work and now had medicaid coverage and spending time with grandsons, going to socker games, i go to church, i'm not bedridden, i never want to be in this life without insurance, what's going to happen? now she is not a unique individual in this situation. people who are in our program n our health centers who are expansion eligible, a lot of them are disabled but they don't qualify for ssi, 35% of them have a mental health disorder and substance abuse disorder, many of have chronic conditions and you can't tell me they are all healthy able-body people that will go to work because they struggle already and they do work, and so, you know, i'm wearing my heart in my sleeve but that's important to understand about this population and these are the people that are going to be affected. lastly. and the last thing i want to do is give you an idea what medicaid administrators and governor wills have to do particularly in the state of nevada,

in ohio, the medicaid expansion population, 60% of them are not working. that should be deeply concerning to you no matter what your view of medicaid. we want to make sure that individuals do not get stuck that are able to work. i think that is a bipartisan goal. perhaps not anymore in this country. but i think that is what we need to start to ask ourselves. i know other panelists was a you cannot get everybody to work. i get that. for those violations that we can, we should be focused on that across programs. if you are on food stamps or medicaid, you need to understand that our goal should be to coordinate and get people off of it as soon as possible on to affordable private insurance, which is a whole other conversation. >> richard. sorry, cindy. richard, why don't you go next? >> i am going to speak as an economist here. money is the problem. deepepeople are poor. i want to get to this issue of cut versus growth. looking around the audience, there are three people in the audience who remember ronald reagan. [laughter] thingald reagan had a called the mi

>> medication-assisted treatment is covered by medicaid for both the disabled and the expansion populations, all medicaid coverage individuals are able to receive all three forms of fda approved medication for opioid use disorders. the director of medicaid is a member of our opioid task force and has been active in working with the managed care organizations that manage our medicaid product to do things like remove prior authorization for medication assisted treatment. it is fully funded through our medicaid program. >> my colleagues on the other side of the i often characterize the medicaid program as inflexible for states. we heard that a lot, that it is inflexible. to the contrary though i think medicaid has provided for a great deal of innovation in a state that responded to the opioid crisis. could you please tell us about the health home program in your state and how medicaid granted rhode island the flexibility to develop its own person centered care opioid treatment program? >> that are probably two innovations and home health will be one of them where we worked with the medicaid of

the medicaid expansion has been a lot of money for louisiana. let me describe house that has worked -- how that has worked. for the first few years, the federal taxpayer, which is us through our federal taxes, have been paying 100% of the cost. that begins to change, i think it is next year. senator urging barrow, thank you for being here. i think it is next year we begin paying 5% or maybe this year. by 2020, we louisiana taxpayers will be responsible for 10% of the cost for the medicaid expansion. period, . when the federal government decided to pay 100%, predictably, state spends a lot of money. it was not their money. it was the federal government's money. the way to illustrate that come in traditional medicaid, what we have before the expansion, the combined amount of money at the state and federal government put up was $4300 per person. under -- under the medicaid expansion, the combined amount of money that a stage typically puts up -- a state typically puts up is $6,300. it is 50% more than the traditional medicaid. many of those in the

republican senators, democratic senators, one, if there is going to be medicaid expansion taken away,ch happened under the affordable care act, republican senators in states where medicaid has helped, especially with the opioid situation, they want money put into whatever they vote on to address the situation. that initial provision was part of a bill voted on earlier this week and failed. a clean repeal, by senator rand paul, failed yesterday. now, there is talk of a so-called "skinny repeal." that would do away with the individual mandate, and some taxes under the affordable care act. not a full repeal. it would take out portions of it. that would allow, according to senate republicans, allow them to meet with the house members and conference, negotiate, on a bill that would then have to to both chambers. senate minority leader chuck schumer, democrat of new york, came to the floor to talk about this option of a skinny repeal. what he said about how democrats , their strategy going forward. [video clip] this evening to announce the democrats will offer no further amendments to the p

are saying, which is quit beating up on medicaid and focus instead on fixing the individual market. the individual market is 7%. what we found with the expansion of medicaid that has been done by both democrat and republican governors is great success. i hope my republican colleagues will heed the warnings of our nation's democratic and republican governors. in june they sent a letter to senate leaders, places like ohio, montana, louisiana, colorado, massachusetts, and pennsylvania shows the diversity of both our nation and political parties in saying, quote, we believe that first and foremost congress should focus on improving our nation's private health care insurance system, end quote. then they say, quote, medicaid provisions included in this bill proposed by the house are particularly problematic. instead we recommend congress address factors we can all agree on needing fixing. end quote. the message was clear from these governors, including republican governors, and i hope my colleagues will listen to them. the nation's governors know because they had to provide and be a partner on medicaid for their citizens. they know how it affects th

medicaid expansion in louisiana is paying blue cross rates. as a woman told me, her daughter is on expansion and would like to continue. she said, i have a hard time finding doctors that will see a medicaid patient. that is because medicaid rates paid doctors typically less than their cost to seeing patients. so she struggled to do that. that said, if we can take patients who are currently on medicaid and put them on private insurance, frankly i think that is better. secondly, some of the patients who have been on the medicaid expansion are actually employed and have the option to have insurance through their employer. in this case, taxpayers are paying for somebody's health insurance when they could, indeed, be getting it through their employer. we has taxpayers may decide we -- we as taxpayers may decide we want to give a subsidy to someone who could get their insurance from their employer, but we will pay higher taxes and there will be less money for roads, drink, higher education, and secondary education. [rowdy crowd noise] sen. cassidy:

from the standpoint of thee medicaid expansion picks the able-bodied adult that is part of the expansion population against the traditional medicaid population. with the explain it. the federal government put extra money towards the medicaid expansion population to get the states to expand. the challenge with that is if i am a state budget writer and i have to balance every year which by the way they do, unlike here in washington. if they have to find 1 dollar of savings to determine where they will try to take the 1 dollar of savings is a few different options. i will tell you first and foremost when it comes to medicaid, it comes out of thehe traditional medicaid population, the elderly, kids, the disabled. because if they lose less dollars if they do so if you doesn't come ouitdoesn't come on it comes out of education spending, public safety, infrastructure. we can spend the same dollar twice. second, as far as the status quo is concerned, we can assume federally we can actually sustain the spending that we have. if you look at the gao, cbo, look at any of the reports historically bee

it's pretty clear somehow rescinding the medicaid expansion, that the support is not there. so what's realistic? what do you ask congress to do now? what is one thing that you want congress to do right now that's doable, that's realistic? that can help you implement the affordable care act better? >> well, what we want congress to do is to go home and talk to their constituents. talk to the families out there that are losing their coverage. talk to the families who are making $50,000 a year and have an insurance card through obamacare but they don't have any care because they can't afford the deductible, talk to the small businesses that are having to end their health care coverage for their employees because of the rules coming from obamacare, talk to the large businesses who are having huge challenges affording the health coverage for their employees. this is a system that is imploding and has failed the american people. that's where the president's passion comes from. that's where my passion comes from, to move us in a direction that we actually put in place a system that

expanded they accepted aca and expanded -- accepted medicaid expansion. ey are down to 4% expansion. the median wage is still $40,000 a year. , working people. the same thing in kentucky. a you ask me, mitch is genius. he knows what he is doing and he understands. he knows how to play this game and he understands that donald trump cannot, will not defend the gop. threatening toy primary out of nevada. ago,happened a few days vice president pence is out there trying to gas light the governors at this meeting in rhode island, straight up lying about medicaid. maybe vice president pence doesn't know the details. he seems like a smart guy, but that was a complete spin on the truth. ohio expanded aca, medicaid. the: i have a map here of current states that took the medicaid expansion. this is from the kaiser family foundation just to show our viewers a little bit of what you are talking about. the blue states on the map are states that took the medicaid expansion. take us to today. where do we go from here in the wake of what happened last night? to mclean,let'

they drove up the cost of everybody and then they said they finally got this person on the medicaid expansion and guess what, they don't have the costs anymore in their hospitals and facilities andan they've driven down the cost. se i don't want to see people get kicked off of medicaid or see it cut in a declining budget. i want it to improve medicaid and make it more cost effective and utilized to support. estimates on this proposal are that the colleagues on the other side of the i/o medicaid cuts would be 772 billion for medicaid over the next decade and the federal investment would be cut by 35% in the next twooj decades relative to the current production. so that is a lot of consequence for the medicaid population and i think that's why we have so many groups and organizations here anxious about this proposal and where we go. we definitely want to talk to our colleagues. as one former cbo director said, the junk insurance is a recipe for a meltdown. this is someone who served in the past republican administrations and i take theie word seriously. i think what we need to do his work toget

it's not just the medicaid expansion. one of the things that hasn't been fully debated because i think it hasn't been presented to the american people is that under the senate plan and in a different way under the house plan, after 2025, it's not just the medication expansion that goes away. it's that medicaid, as it has existed since 1965. changes. the way it has existed is you pay for someone and the federal government will match the amount paid. under this plan, after 2025, the money is capped. they cap it in slightly different ways and it's indexed to regular inflation and that's really important because that means over time, healthcare costs are going to keep rising faster than regular inflation. over time, the medicaid program shrinks more and more so these governors, when looking at this, are not just thinking about the people who've gained insurance. they're thinking about, ok, in 10 years or five years, i've going to be faced with trying to tell people they can't be in nursing homes or trying to tell sick kids wh

the $45 billion is focused on those who would not continue to be covered under the medicaid expansion and that skinny package you're talking about of course would not include dealing with medicaid expansion. so some would argue that that would continue the coverage that's out there now and that might be better. i don't think that's better for the country not to have a replacement for the affordable care act. i don't think that it's wornging for ohio or our country. in terms of the affordable care act, to back up on that, we now have 19 counties in my home state without an insurance company in the individual market. this is the exchange market another 27 counties with only one insurer. that's not competition. that's why prices have gone up dramatically in my state, about double for individuals, about 82% for small businesses. this is premium of course, and then we've also got skyrocketing deductibles. so a lot of people who have health care it's like i don't even have it because my deductible's so high. these are issues that do have to be addressed. and the package you just talked abou

medicaid expansion under obamacare remain as is. eric: there is a threat from the president another tweet, the subsidy.

, the recent expansion of the medicaid program, but actually addressed the underlying traditional medicaid program. so, it is timely to say what's next for medicaid. before we discuss the implications and here are the range of data and perspectives, it is good to be reminded of some of the basics. next slide. thank you. so, the ones that are being projected by the way are not as good as the ones in your folder. so if you want to pull out your folder and then you can see some of the members. just to be reminded it is a federal and state program. there are federal standards but states have banned enormous amount of discretion on the design and the administration of the program and it currently covers more than 74 million people and it can be roughly four groups, infants and children, people of all ages with disabilities, low income seniors, elderly and then other adults. children represent the largest group. in terms of what it covers medicaid covers a broad range of services to meet its very diverse population. it can be covered but it's importa

expansion,edicaid the combined amount of money that a stage typically puts up is $6,300. it is 50% more than the traditional medicaid. many of those in the expansion are working. they are healthy about the work. they are not sick or. it turns out, state paid a lot more. put a lot of people into the program, too. why do i go through that explanation? to establish that when the state of louisiana begins to have to put up 10% of the cost of the expansion, it is going to be a lot of money. it will be $310 million a year. to be in addition to the amount currently spent. not just our state. is $2.2ornia, their 10% billion a year. that is just 10%. the point i make two folks is that our status quo is not really sustainable. arkansas, a blue state and a red state, both expanding medicaid, state legislators have met amended -- have recommended either completely getting rid of the expansion or pulling it back to 100% of the federal poverty level, the eligibility, because their states cannot afford that have percent them will be required in 2020. >> [inaudible] [applause] again, if we can be civil. >> [inaudible] again, sir, i

thereh medicaid expansion are tens of thousands of folks participating in the extension in particular. the medicaid program itself in new york is not sustainable. our taxpayers were one of the few states where on the local tax bill, taxpayers are footing the bill. people are leaving. they can't keep up with their mortgage payments or putting rooms over their heads and this is not sustainable. tohink it's time to give it the issue of health care costs. what we've been talking about is a great deal with a replacement stuff is health insurance. maybe is a time where we look at what is driving insurance premiums up and i'm rick -- and to reach common ground on how to drive cost down. an early ande vocal supporter of president trump as he ran for president. do you agree with his assessment we should let obamacare fail. guest: i think that's the reality of where we are. if the senate cannot take action and i said that when we got the first heck of a in the house that may be will take the collapse of the market and have senators go back home, house members go back home and phase people adver

the rolling back of the medicaid expansions and the cuts to the medicaid program by virtue of going to a per capita caps really are moving in the opposite direction as it relates to taking care of those types of populations that have a lot of -- this is the coverage vehicle to help them. providing money for opioid programs as opposed to getting people access to a comprehensive care package, we think is the way to go. that is not just throwing more money toward state programs for opioid abuse. when you give people the full comprehensive set of services and the medicaid program is probably the most effective way to do that. , president pollack and ceo's merrick and hospital association, we appreciate you being on "newsmakers." rick: thank for having. -- having me. greta: clear back with our reporters, anna edney with bloomberg and peter sullivan with the help. let's begin -- the hill. was security american hospital association. they are obviously not for complete repeal and replace. them with like repair the affordable care act. where does this group stand as opposed to the other major p

if this keeps on going down this way, medicaid expansion is only going to get bigger. things the president did talk about air traffic control changes and that hasn't happen and you'll remember, stephanie, i think it was going to be a plan to defeat sisis within a month. >> isis is a rather complicated one. it is. >> as is health care. interesting, if it's by parti n partisansh partisanship, they didn't need that to get this thing through. republicans control it all. >> let's join congressman michael burgess, a medical doctor from texas, before congress an ob-gyn for decades. good to see you. thank you for being with us. >> thanks for having me on. >> i don't know if you got a chance to see the description of what happens without replacing, it gets to a situation worse before obamacare was put in which you'll remember wasn't a good situation. >> realistically, and of course the house and senate both voted on such a repeal bill in december of 2015, was sent to president obama's desk and vetoed it in january of '16. and that was the starting point for the repeal efforts t

so medicaid expansion gives medicaid to people who are within 138% of the federal poverty line.hat is a little over $16,000 for 2017. in harry county, the average income is under 15,000, so imagine if they had expanded medicaid. a huge swath of people would have gotten insurance. helenwe're talking to dr. ouyang. if you live in the eastern time zones, call (202) 748-8000. if you have in the mountain and pacific time zones, call (202) 748-8001. and if you happen to live in a rural area and can speak to the issue directly, we would love for you to call in. give us a call. let's go to ron. good morning, ron. caller: good morning. first, i would like to say thanks to c-span. a wonderful, wonderful "washington journal." just an awesome show. one of my favorites. i have a couple of questions. would the aca have worked if it had been implemented as designed? if all the states had expanded medicaid or medicare, if everybody either had insurance or had to pay a fine, would the aca still be just fine right now? edit question is out of the 10 who haver so people ventured under the aca, wha

it ended up covering much less than that because of the supreme court decision with medicaid expansion. so for us the concern is coverage and the coverage lost that would result particularly as it relates to the medicaid program. medicaid serve our most vulnerable population. so many kids are on it that are disabled. one in ten veterans are on the medicaid program. two thirds of the money goes to taking care of elderly folks in nursing homes. so the cuts in medicaid program ich in both bills are rather dramatic, is a great concern to us. and then the coverage estimates that go beyond the coverage losses in medicaid are also pretty substantial according to the congressional budget office. so for us the big issue really are all around the coverage losses that would result. and that's why we've been opposed to it. >> and patients who need the coverage, but as far as hospitals go, how are the hospitals affected? bottom line, with what could happen with the medicaid cuts? >> a couple of things. first it really is about patients and patients being able to get coverage and care. that's the nu

the auto industry and basic medicaid expansion. -- kasich accepted medicaid expansion.aller: i was in fort lauderdale florida. we don't have state income tax here. -- tax isr taxes derived on almost 50-50 basis from property taxes and sales taxes. in 2010, the state passed a the boatsich allowed sold in the state of florida to go from a 6% unlimited sales tax to having it cap at $18,000. during the debate, many people said the state of florida was going to lose significant tax revenue by doing so. the state of florida as revenue estimating committee, much like projectedhington dc, a lost the first year of $1.5 million. said they were going to lose $1.5 million in tax revenue by putting this sales tax cap of $18,000 in place. a year after, little more than a year after, there was a study done of the first year's receipts, not projection. it was survey done of all of those transactions. instead of losing 1.5 million, the state corrected 13,000,406 he thousand dollars in tax 13,000,460 -- 13,000,406 he thousand dollars -- they could come up with ways of correcting more tax

he was talking about texas experience with medicaid doctors and finding after the expansion a lot feweri guess si would say doctors were taking medicaid patients because they weren't being reimbursed. are you finding that in new york as well? >> caller: i do know that many doctors here in new york do not accept medicaid patients because medicaid is a very complicated system with reimbursements and it costs a lot of money and terms of office staff and resources to get there. i do know that without these practices that accept medicaid being there are so few of them they are getting essential medical care to people who most need it so they are very valuable resource to the community. post do appreciate your input input. let's go to next to st. paul, minnesota and this is jan on our democrat line. hello there. >> caller: hello. first of all i want to say how much i appreciate c-span. i always tune into it he could they think you are pretty fair as you analyze the news but like your previous caller, i have been watching a lot of the debate and i am very frustrated. i find it hard to watch nu

accurate i think that the political bloc of people on medicaid and it's not just the people on medicaid expansion but their ability to influence others in so yes i think it's a. point but i think the repeal of some of the taxes is also important as we move forward into tax reform next what is the reaction among your caught colleagues on capitol hill the back chatter about this constant pounding the president is giving to jeff sessions what has stashes done wrong yet good good point ed because i think it's for those of us who have who have been stung supporters of the of the president i was as you know an early supporter not as early as jeff sessions no one was in congress i think a fact that we always have to keep on the table it's an uncomfortable situation i don't mind telling you for me personally because it's just there's something of course just unseemly about him being so hard on somebody who is so loyal and who spent some political capital to support the president now that said donald trump does air his grievances rather publicly he moves people a certain direction through his twitter acco

medicaid expansion. 32 states including the district of columbia opted for medicaid expansion. eal without a reform effort, those low income working families are going to have their health insurance threatened. you see republican governors don't want it. republican senators were estates where medicaid was expanded, they are looking at, let's look at a moderate attack. mitch mcconnell, senate majority leader, has said we are not going to split it out. there's a reason for that, because do they get anything done? if they repeal, are the moderate republicans going to roll the dice and think reform is going to be happening a year from now? >> charles: making a problem worse is that president trump was so successful, some former blue states who took medicaid expansion. republicans in the house, governorships, it's a serious mess. it >> jesse: i can't believe where we are at. talking about g.o.p. lawmakers and people opposed to obamacare. seven and a half years to work to come up with something and here is where we are at. i'm going to take the position of john kasich who said you wan

medicaid expansion gives to a little bit over $16,000 for 2017. is underunty average $16,000. we are talking about this piece in harper's magazine. ron calling from west texas. caller: good morning. wonderful washington journal. just awesome show. i have a couple of questions for the guest. ifh the aca have worked implemented if design -- as designed with all the states , if allanded medicare the states had set up the exchanges? would the aca -- would it be running strong right now? million of new10 people who have been insured under the aca what is an approximate amount of those who are african-american? margin betweener african-americans? just 50/50.ically 50% weight folks in 50% folks of color. or is it 90% african-american that was recently insured under the aca? guest: thank you for your question. aca wasthe way that the intended to work and medicaid expansion was a huge part of it would have been a saving grace for a world area. 50% drop in the uninsured which is huge. kentucky has had a two third drop in uncompensated cost of hospital. get writtensts that off as charity

and the agenda is to do some really bad things with medicaid expansion and the block out medicaid, which really hurts rural states. i think it hurts the whole country, and not to address preexisting conditions and lifetime caps. and if that's the direction we're headed, then that's not the direction i want to go. i think that that skinny bill, that bait-and-switch bill, whatever you want to call it, trojan horse, repeal bill, that bill is not where we'll end up at. an i don't think you get the conservatives with that bill. and i don't think you get the moderates either. so i think what's happened here is you've got mitch mcconnell, who got us to vote today on something we don't know where it will end up, and him crafting another bill to put it up to change the bill in conference. that's all very convoluted, but that's where we're headed. >> woodruff: so senator, you mentioned medicaid expansion in your own state of montana. i'm reading an associated press report that talks about the number of medicaid enrollees having far exceeded the number expected. a number of people in you state worr

when it comes to the issue of medicaid expansion, funding for medicaid, which is greatly reduced under the senate version of this bill, vice president mike pence and republican senator susan collins are on drastically different pages. listen to both of them. >> president trump and i believe the senate health care bill strengthens and secures medicaid for the neediest in our society. >> this bill would impose fundamental sweeping changes in the medicaid program and those include very deep cuts. that would affect some of the most vulnerable poeople in our society. you can't take more than $700 billion out of the medicaid program and not think that it's going to have some kind of effect. >> which is it? helpful to the most vulnerable or harmful? >> if you look at the people that took medicaid expansion under obamacare, a lot of them are what they call able bodied, single adults, not the most destitute people for whom the program was designed to help. we talk about repealing back the expansion and turning back to the states, i'm all for it. the states can be the laboratories of innovation.

it would terminate the medicaid expansion that has been critical to siding the opioid epidemic in my state in so many states across the country. according to the nonpartisan congressional budget office, a straight repeal of the affordable care act would result in more than 32 million people losing their insurance coverage by 2026. premiums would roughly double in the individual marketplaces. i urge my republican friends not to go forward with this misguided approach. the idea that they can repeall the healthcare bill now and give us a new bill in two years or whatever period of time is in the bill just doesn't pass the smell test. if we have to haven't seen an attorney to the affordable care act in the last seven years there is no reason to believe that our republican colleagues will be able to produce a bill in two years when there is chaos in the marketplaces. there is a better way forward for the senate in our country. during the fourth of july recess, majority leader mcconnell said that if he can't secure the vote to repeal the affordable care act, he's prepared to work in a bipa

invented in the middle of the night last evening that would supposedly help states who are medicaid expansion states transition their citizens who are currently on medicaid to the private market. now there are reports that that's a $200 billion fund, and that is a lot of money. it sounds like a lot of money, and it is a lot of money. but it would represent 17% of the funds that are being cut to states, and it would only be a temporary band-aid on a much bigger problem. why? because c.b.o. says definitively that the subsidies in this bill for people who want to buy private insurance are so meager that virtually no one who is kicked off of medicaid will be able to afford those new premiums. that's why the numbers are so sweeping in their scale. 22 million people losing health care insurance. and so even if you get a little bit of money to help a group of individuals in a handful of states transition, when that money runs out -- and it will -- they are back in the same place. all you are doing is temporarily postponing the enormity of the pain that gets delivered. and once again this provision b

other individuals are in states that benefit from medicaid expansion and the affordable care act, thesericans will get hurt by what ted cruz is proposing, they are opposed to it. i think that is going to be the number one problem for mitch mcconnell, how does he balance the far right with the more moderate republicans? the truth of the matter is, this idea of repealing and waiting two years for replacement is problematic for the marketplace. we are dealing with private companies needs. what insurance company is going to get into the market when there may be a totally different law that has different regulations on how we provide health insurance to our customers. that is why this is so problematic and why they are really trying to thread a needle here but the threat is invisible. >> julie: the biggest reason this is problematic is because republicans do not have the votes to pass this health care bill. democrats are not going to oblige as long as the g.o.p. wants to repeal. the question is, can they pull it off without a full repeal? how is this for conservative senators who made a prom

all for that. >> and as we look at the senate bill there is the concern about medicaid and medicaid expansionght move forward. don't you have some concern about that and either one of the versions of the bills? >> no. if -- the way medicaid was conceived, it was a majority funded by states and president obama shifted the equation to draw the federal government into it and to radically expand the kind of people that could get it. this is supposed to be a poverty program for people that are at the poverty level and can't afford insurance. if this thing works as hoped, the states could deal with their medicaid populations the way they want with their own taxes and we could focus on the affordable care act or stated equivalent types of choice opportunities for insurance for people who don't have groups. >> what about the states that can't afford it? >> well they have to get their -- they have to get their house in order. those are their people. they are not our people. if florida wants to create jobs that have a lean budget and pay its bills on time and have a good credit rating and have one of t