also for the medicaid program and for out of pocket payments. while spending growth slowed for retail prescription drugs, skilled nursing facilities and private health insurance and the medicare program. from a sponsor perspective, we see that the distribution of healthcare spending has remained relatively unchanged with the exception of the shift from the federal to the state local governments to mainly to the expiration of the ira and temporary enhanced funding. i want to thank you for your time and attention. i will turn the presentation back over to john. >> we'll take your questions if you could identify yourself and your organization, that would be helpful for the panelist. >> jim, of the dallas morning news. wondering if some of the factors you described like one off events. like the declinement in investment and hospitals because of the end of the spending program end of patent protection for certain drugs. yet, we've had a few years now of slower growth. was 2012 a one off because of these specific factors and we should expect more next

also for the medicaid program and for out of pocket payments. while spending growth slowed for retail prescription drugs, skilled nursing facilities and private health insurance and the medicare program. from a sponsor perspective, we see that the distribution of healthcare spending has remained relatively unchanged with the exception of the shift from the federal to the state local governments to mainly to the expiration of the ira and temporary enhanced funding. i want to thank you for your time and attention. i will turn the presentation back over to john. >> we'll take your questions if you could identify yourself and your organization, that would be helpful for the panelist. >> jim, of the dallas morning news. wondering if some of the factors you described sounded like one off events. like the declinement in investment and hospitals because of the end of the spending program end of patent protection for certain drugs. yet, we've had a few years now of slower growth. was 2012 a one off because of these specific factors and we should expect mo

beer recto whole sustainability question with gate at medicaid as a program we have a number of different vegas but we just completed a five-year plan that how health care is delivered the medicaid is a large portion of so that part of the plan is completed and the focus of that is about value. how do we look at that reimbursement system that goes on in our state where most providers pay for service? we don't have the innovative pay the structures to pay for outcomes for accountability to changeup the figgie to be more outcome driven. looking at the community level is what happens is so bereft of the policy tends to be for the delay did but what happens to make health care work with that model that the build of powers the community for what we call collaborative of health into infrastructure with their rich more involved with decisions and much better with the delivery system. then start to focus medicaid differently but what is the thank like housing in a deployment with the health outcome getting away from health care but talk about health if they another roof over their head and are di

program sgr bill. in the extenders provide benefits to americans across the country. especially medicare and medicaid ben beneficiaries. people who have great need of these things. we must not forget about these critical programs as congress moves forward with sgr reform. specifically the qualifying individual program. transitional medical and assistance express lane eligibility. and opponents famous programs must not be allowed to expire. it should be extended as part of the long-term sgr bill. congress should consider extending many of these programs on a permanent basis given the proven track record and the fact that the annual sgr batch will not be available in the future. further more, i hope the congress will consider reinstating section 508 expired in 2012. i believe that the medicare primary care program. in closing i hope we can build on the momentum we generated last year. i look forward to continue working with you and all of my colleagues and the leadership on on the committee and the leadership in the house and senate. to get this bill to the president's desk before the march 31 dlt. mr.

want to remind people that in many instances, this is not just opposition would dislike of the medicaid program were people who would be covered by the expansion but a sincere effort to try to block the medicaid expansion into the existing terrain of private coverage for low-wage workers, which in some states is almost nil but in others, it has more of a presence, as well as what the rules would refer people in the insurance exchanges where premiums and cost-sharing's are very much a part of the picture. there's a substantive balance here. areor the politics, there many who call between the extremes represented here, immediately willing to embrace the expansion as a part of the law and those who opposed it from the outset. lotink what i observed is a of political leaders looking for a way that they can still be against obamacare because they went on record of being against it and they cannot change that view, but starting the season of the dynamics playing out about the dynamic consequences, the human consequences of not doing the expansion. the most common political frame is we want this to wo

now with the expansion of the medicaid program, and by the way there are people going into jails, literallyaid. >> city rather than the county picks intheir cost. >> no the feds pick up the cost. other than medicaid expansion program. >> expansion, so everybody understands the feds give the money to the states and the states give the money to the prisoners because it's a medicaid program. >> medicaid. >> that's a. >> i don't think i said medicare it's medicaid. >> no, no. it's complicated but they are all paying if they get the sniffles in the penitentiary heather and i are paying. >> some states chose not to expand medicaid such as texas, they now have to foot the bill for those prisoners in other states, fascinating. >> mad as hell when i hear commentators talk about what a weaker flawed candidate mitt romney was in the last election. true charitable gentleman. if a flawed candidate does not speak well for the state of our country. look, i think mitt romney is a good man, i think you agree with that. >> certainly handled it so well how that msnbc anchor talked about his grandson. >> in my

another is a program that allows medicaid coverage to be obtained for one year as the income changes. the program helps people to allow for consistent access as well. and i also wanted to highlight to policies that we have implemented in this includes the bonus payment showing that this increases the probability of beneficiaries in at at least one visit to a doctor and this is an important policy that should be part of this because we still need to understand that in your way. including positions such as neurologist and psychiatrist in ob/gyn that are not included in the bonus payment that should be. also an increased enrollment and streamline procedures for medicaid in new jersey was one of 23 states to receive this payment of 2013 through this program. enrolling coverage makes a difference how many children are enrolled each year and also in receiving the medical care they need. i want to mention that it's part of the grant program and this includes the families of children and youth in making informed choices in health care which provide effective treatment. this provides a unique

oregon and its medicaid program. use those existing structures and tools to transition medicaid more broadly across states to this model. the fifth recommendation was to encourage consumer selection of high-value care based on cost and quality data to essentially adopt policies that were fire insurance plans in the state to provide these data so that people really can put together what is health care costs, what does health insurance costs in what is the quality that i get out of it? as we know consumers today tend to correlate high cost with high-quality even though there is very little evidence that relationship holds. make more of this knowledge more transparent to consumers so you understand more fully but the cost is of care and what the value is being purchased. and he is state action and antitrust powers to promote an official consolidation in the health care system but also to be mindful of things that can drive up cost for the six rickman issue is to reform health care regulations to system efficiency in are

so what i see is more, over time, more alignment that instead of medicaid being a program, and exchange coverage being a system and private health insurance through your job of being here and medicaid being there, over time we are seeing a lot more blending of these. and to me, that creates opportunities partly on a message side that we get away from this stigma or these black and white decisions, but also for the health care system is going i think it creates opportunities for purchasers and payers to have more leverage. so i think the long-term path here is a positive one. i think the private option, which is where you asked the question, helps clear the way to breaking down some of these barriers. don't get me wrong. i do have concerns about the erosion of patient protections, if we move too far from the core medicaid model of the base medicare program, particularly -- i used to run medicaid agency in colorado so i'm very attuned to the importance of those protections, but i think the fight over public-private is one that will fade, and what will be more important is whether the peop

in the states that are extending the medicaid programs.nsurance before are going to get coverage. >> 41% of the visitors to health care.gov were between the ages of 19 and 34 and 77% of them described themselves as being in good health. why haven't they signed up? your thoughts. >> i think they haven't signed up because they're doing what i think a lot of people would do. they don't have to sign up until there's an absolute deadline. >> so this is human nature as much as its anything else. >> of course it is. my kids have been waiting for the last minute. they want to make sure they're getting the best deal and they also more than likely are going to need some pressure, some encouragement, from mom and dad to get coverage. that'll come too. >> what is this going to look like, you think, in the middle of march? two months from now. >> the percentages are going to be much more in line with what the administration expected. we're in this for the long haul. the people who drafted the affordable care act expect that there will be more people wh

controlled head start, work study programs, the food stamp program, the job corp, the medicare and medicaid programs. it was successful at the start, poverty fell to 11% by 1973. president richard nixon took the reins and broadened the food stamp program and added an automatic cost of living increase to social security. poor people were being helped, but challenges remained. incomes were dropping and increase in single income families kept the poverty rate very high. the income gap was widening and by the late 80s the mindset changed. >> my friends, some years ago the federal government declared war on poverty, and poverty won. >> reporter: president ronald reagan's notion that government is the problem took hold as legislators sought to weaken the social safety net. the question of how to effectively help the poor remains the enduring debate of our time. today the poverty rate is at 15% with 46 million americans living below the poverty line. from 1992 to 2012 american incomes declined in every single education category except among college graduates. the great recession in 2008 saw the most dramat

. >>> for years, california's medicaid program, rob reynolds reports a shortage of doctors threatensto make the search even harder. >> jennifer hon has always wanted to be a doctor. first year medical student with a strong desire to serve. >> ultimately one of my major goals going into medicine was hopefully to work with more underserved communities. >> in the california system of for profit health care students like ha hon to get big loans. >> looking at debt for 40,000 to 50,000 per year, over four years, so close to $200,000 a year. >> university of california add riverside is an area of the state facing a severe shortage of doctors. >> because it's the fastest growing area of the state and because 40% of the doctors in this area look like me, 55 years of age or older we will have a 5,000 physician deficit no matter what anyone does. >> the they earn far less than specialists like cardiologists or orthopedic surgeons. many doctors choose lucrative specialties in order to pay off debt. so u.c. riverside is trying a bold experiment, certain students who choose primary care and agree

us today with to a lot of experience for both the medicaid program and also clearly working with the edicaid expansion a great deal. among her many professional accomplishments, it is nice to know she is a registered nurse. it also provides a direct care experience i think is very useful in dealing with the issues she has to on a day-to- day basis. we have the executive director and founder of the texas organizing project. the texas organizing project, which was founded in 2009, brings together communities to address critical problems facing low income communities of color in texas. founding, texas organizing has grown into an organization at a base of over 30,000 members and supporters. they have had been a legislative successes and are the leader -- leading voter turnout organization in the state. she works on moving texas to take out the medicaid expansion. our final panelist is the executive director of the national academy for state health policy which most of you nashp.s it provides a forum for work across branches of state government on critical health care issues. that include

that said, oregon's medicaid program looks similar to programs in other states in many ways. it covers the same types of services including not just the emergency department but doctors office visits, prescription drugs, hospitalizations. it has no copays foreign rollees. the population in oregon looks similar to that of the u.s. with one important exception there are fewer minority res didn'ts in oregon than in many other states so oregon might not be very representative of racial or ethnic differences that would you expect to see elsewhere. >> were there any subgroups in the democrats tha that-- demographics that were using the emergency room more often, perhaps the elderly or one gender over the other? >> sure. we studied people who were 19 to 64. that's the group that was eligible for this program. where older people would already be eligible for medicare. and we saw increases in lots of different types it of utilization. we saw people going to the emergency kept more, for example, for conditions that might most readily be treatable in other settings in primary care setti

medicaid. last week steve fisher spoke about his states expansion of the program. kentucky is the only red state with its own health care exchange and expansion of medicaid. he was speaking at an event hosted by families u.s.a. here in washington. >> thank you. thank you all very much. ron, thanks for the kind introduction. referring to me as an evange3 introduction. referring to me as an evangelist has some credibility to it, because my dad was a baptist preacher. and so right toward the end of my talk today, if you don't want to answer the altar call, you better leave early. [laughter] i also brought my audience with me because i think we've got a table of kentuckians right down here in front. [applause] i appreciate the opportunity to come here to talk to you about a subject that we are not all only interested in, but very for but about and our feelings of what ought to be done in this country. you know, people who don't know kentucky might consider the commonwealth an odd choice to be leading the nation in implementing federal health care reform. after all, my s

. >>> for years, california's medicaid program has struggled to find doctors that accept low income patients. a shortage of doctors threatens to make the search even harder >> reporter: jennifer hawn has always wanted to be a doctor. the daughter of immigrants, she's a first year medical it student with a strong desire to serve. >> ultimately, one of my major goals going into medicine was to hopefully work with underserved communities. >> but in the american system of for profit healthcare, medical tuition is extremely expensive and requires students like hawn to get big loans. >> we're acquiring a lot of debt, 40,000, $50,000 per year over four years, so close to $200,000 or more. >> reporter: hawn's studies atort university of california of riverside is in a state that is facing a severe shortage of doctors. dean of the medical school. >> because it's the fastest growing area of the state and because 40% of the doctors in this area look like me, they're 55 years of age or older, we'll have a 5,000 physician deficit in five years. >> it's particularly severe for family doctors and pediatric

. >> but, michael, going into e.r.s where the medicaid program reimburses the hospital as opposed toospitals going bankrupt because governors are leaving people uninsured. they're still going to the e. r, just aren't getting reimbursed. >> it's going to be a great year for debates like this. >> thank you as always. >>> coming up, weeds, smoke signals, rocky mountain high. the jokes over colorado legalizing marijuana are easy. but there are legitimate questions. is this is a smart thing to do? does it promote the behavior society should discourage? is smoking pot no better or worse than drinking? we're going to debate that. >>> plus american children continue to fall farther and farther behind other countries in science and math. here's one symptom. 33% of americans don't believe in evolution including 48% of republicans. much of the world shakes its head over that one. >>> and guess which big city mayor just filed for re-election calling himself the best mayor this city has ever had. that would be rob ford of toronto. one of many politicians who might want to rethink running for offi

the problem is, medicaid itself is a fundamentally broken program that's failing our neediest citizens. the problems with medicaid are a stark reminder that access to coverage does not mean the same thing -- excuse me, access to coverage is different from having access to care. and this is what i mean by that: in texas only about a third of doctors will see a new medicaid patient. you might ask, well, that doesn't make much sense. well, it does if you consider the fact that medicaid, this government program, pays doctors about 50 cents on the dollar of what a private insurance coverage would pay. and because it's -- it reimburses at such a low rate, some physicians have said, i can't continue to add new patients to my practice and be compensatincompensated 50 centse dlamplet that's what i mean there is a difference between access to coverage and access to care. so, medicaid is sorely in need of reform. all across the country medicaid patients have been forced to endure the humiliating experience of walking in a a doctor's office and then getting turned away because the office doesn't a

rates for different kinds of services, i would think about a measure of medicaid effectiveness based on how much kids on the program are in school or preschool. that would nicely tie together the importance of medicaid for children's health and preventing complications and really getting to the goal of what this should be about, which is spending state dollars in a way that most effectively improves the health of the population. i do think the convening is really critical. it strikes me that it is really important that we build the constituency that is outside health care also. and really thinking about the public health care measures. some states like colorado have talked about the health of the community. that is a potential big winner as we are able to contain health-care costs to put it into health. >> we have two folks left to comment. oath of them have been governor. >> let's play governor again. governor brown in california. the governor of oregon -- oregon and governor branstad in iowa. they are all doing well in iowa earth -- they are all doing well right now. you are looking at all of the issues coming yo

and half of it is through the medicaid program. ay, particularly on the left, well, at least the medicaid portion is succeeding because those people are enrolling, as p i argue in the book you mentioned, that is not success for those people. studies show people on medicaid fare no better than people with no health insurance at all when it comes to health care outcomes. lou: say that again. medicaid is effectively not working. >>ly studies show people on medicaid don't fare better in things like mortality, heart disease, diabetes, anything like that relative to no insurance at all. people say we have to expand medicaid, because it will save lives of all these people. studies show that is not the case. . lou: the problem, medicaid is a mess now obamacare is a mess. we don't know where we're lou: medicaid is a mess. obama kays is a mess. at some point when we know people, a will be insured and whether b, sufficient numbers of young people 18 to 35 are being secured that the foundation of obama care itself, young paying for older? >> i

you're raising the important point that our study focuson oregon's medicaid program as it existed from 2008 to 2010. that's the period we studied. and during that period we saw the increase in utilization of emergency departments and other care. ever since then, oregon has had a different effect on utilization and time will tell. our study can't speak to the change in the program that was recently enacted. >> are the kinds of changes that oregon has made, the kinds of changes that are going to have to be made in other states in order for there to be more efficient use of hearing resources? we know those resources are scarce and we know there's going to be a big demand on them. >> i think oregon is in some way a leader in the industry and i admire oregon's health care quite a bit. one thing that's going to have to change, one is on the doctor side and the other is on the side of patients. the reality is the medical profession in the hospitals need to create more primariary care primary care practices, so they don't have to go to an emergency room. so that's a responsibility on the docto

he's not going talk about the millions of people who got pushed in to the medicaid program, which is t a good program. he's not going to talk about the fact that if you have medicaid you're going end up in the emergency room because you can't an appointment with the doctor. gerri: what you talk about all the time. you can't keep your doctor or health care plan. according to a report last week, people who are on obamacare now are people who already had coverage. the miss fire on this program is monumental. where can he possibly say something is working correctly? well, again, you just leave things out and you have a story. and, you know, i think what he is going to really say is that things are looking up. you can't claim complete victory, but he can make a big statement that says that millions of people in the future will get benefits. gerri: well, in the meantime, joe -- >> the problem it's expensive. >> one of six americans are struggling to pay the health care bill. those numbers aren't good. senators who have a three brand new plan other than hatch, tom coburn, richard burr. they'

to be totally honest not all of these are new to the medicaid program because some qualified before passage but 6 million people. but how many would not have been recovered? we cannot do that at this point. but they all have peace of mind that comes with high-quality insurance. and some states have not taken that opportunity to expand even though the federal payment plan is one manager%. the states of have not acted just 5 million more would have access to affordable coverage. as surprising as it may seem after the republicans and the congress voted to repeal the law 40 times, they still have not given up on the message. after disastrous effort to shut down the federal government, they didn't get the message. i am confident they will might get the message i am about to deliver to them. [laughter] but here is the message. we will not go back. we will not go back. america has turned to the page. we will not go back to days of the affordable care act when pre-existing conditions were a barrier to coverage. we will not go back to the table and mental health was not covered. we will not go back

all of the states that have extended the medicaid program. >> bruce: more than more than 6 million people have been eligible for medicaid. many of the states did not expand medicaid and that made a huge gap for people who made too much or too little and didn't make medicaid or the affordable care act. beyond this, the question is who is signing up in this, the young healthy americans are going to be crucial to this. and we have a graphic to kind of demonstrate who has signed up already. as i said the young people are going to be crucial for the stabilization. if you look at the numbers only 25% of the people who signed up are actually between that age bract of 18 to 24. ideally what is needed is 40% of these young invincibles to make this plan staiblgz, they would off -- stabilize, because the fear would insurance companies would increase these premiums. >> the president made a reference, he suggested you go and call your mother and help her enroll and she would appreciate you calling her. but he specifically refers to the young people that the president needs to get enrolled. >> he was v

sort of makes clear that it's not as much of the rich -- rush to the exchanges and expanded medicaid programe seeing similar games with numbers in medicaid as well, we the administration touting four million signup up in, the actual number is probably 200,000. so, -- >> wait, wait, wait. how do we get from four million, their figure to the 200,000, your fig. >> sure. this is actually and calculations that sean trend at real clear politics did. impressive. he said, well, you have to only look at the states where medicaid is actually being expanded. so you go from about four million down to 1.9 million, and when you look at the scale of the expansion, we're really only talking about 200,000 people give or take. >> monica, long before these numbers were out you said this is going to be very tough for them to make the math and make up for what will be people losing their insurance. now to compound it these signing up are actually mostly those who had coverage being forced to switch to this coverage. so we're down millions of people. >> exactly right. remember when the whole obamacare policy was

the purchasing power of state health care programs including medicaid, to some extent local employees and individuals in state exchanges. in some states local employees and individuals enrolling in state exchanges. state laws and authorities that govern insurance, provider rates and medical malpractice. affecting market competition, consumer choice, antitrust and cost and quality transparency. the authority to invest in initiatives that involve population health, programs that help lifestyle choices and personal responsibilities. the power of governors to engage stakeholders in process for change. under the first category of spending, programs administered the numbervernments, of individuals eligible for health care coverage through state administered programs will million over the next few years, far larger than the 53 million enrolled in medicare. 70 milliones patients likely to be enrolled, and includes 3 million state employees. its potential of 11 million local employees and those who can't be part of state programs. it includes another 6 million who will be purchasing health car

to be fair, totally honest and not all of these folks are new to the medicaid program because some alreadyqualified for the passage of the act. 6 million people, i asked them to disaggregate to remedy would not have been covered. we don't have the ability to do that at this point. they all have peace of mind that comes with a quality health insurance. and as you well know, some states have not taken that opportunity to expand medicaid and the the dca. as i said before, and the states had not acted would just like to know, 5 million more have access to affordable coverage. as surprising as it may seem, they voted to repeal the law 40 times, they still have not given up on the message. after disastrous effort of shutting down the federal government they did not get the message. i am confident they're not going to get the message of to deliver to them. here's the message, we will not go back. we will not go back. america has turned a page. we will not go back to the days before the avoidable care act. pre-existing conditions or a barrier to coverage. we will not go back to that day when women

that was run in the state of oregon, where in 2008 the state had the opportunity to scabbed its medicaid programut had 90 million applicantses for 10 million slots. so they put them 'in a lottery. and they conducted a series of studies to see what happened to people who got met cared verse people who didn't and there's been a number of studies that came out. that found the people who got medicaid, their health care costs went up but their health didn't improve, and the latest study showed a 40% increase in the use of emergency room among people who got medicaid versus those who didn't. >> is that counterintuitive? you have insurance, you can see a doctor, but now we're seeing that people actually got insurance using the emergency room as a 40% faster clip than those who didn't have insurance. is there something counterintuitive about that. >> what happened with medicaid is reimbursement rates -- medicaid is broad but reimbursement rates are so low that providers don't take medicaid. so patients on medicaid can't find primary care providers so they end up in the emergency room. so it's not surpri

study out of columbia university looked at the legacy of the war on poverty programs and concluded that thanks to things like medicaid and food stamps americans today are better off than they would have been without such programs according to the study without taxes and other government programs poverty would have been roughly flat between one nine hundred sixty seven and two thousand and eleven at twenty seven to twenty nine percent while with government benefits poverty has fallen from twenty six percent to sixteen percent that's right the war on poverty reduced poverty by ten percentage points these programs so now fifty years old work they just work it's common sense if you give a family that can afford food some assistance and they can go out and buy food which helps that grocery stores sell more products which creates demand for the farmer food producer and soon new people have to be hired and one of those new people hired might just be in that original family that you gave a little assistance to to buy some food that's why for one dollar the government invests in food stamps it creates about a dollar seventy t

programs is going to approach 80 million over the next several years. that is far larger than the 53 million enrolled in medicare. this includes medicaid patients which will likely have 70 million enrolled in the next few years but it also includes 3 million state employees. it's a potential of 11 million local employees that can be part of state programs. that includes another 6 million who will be purchasing health care through state exchanges so if you add up all those totals if the huge purchasing power at the state level which could be used to transform the delivery system from fee-for-service toward one that provides high-quality, low-cost care. under the second category i mentioned, state laws and regulations that affect insurance. at all states regulate health insurance including a review of solvency, review of rate increases, contractual rules between plans and providers. while the fuse dates make rigorous review of rate increases and at times deny increases, most and not have the resources to perform a serious analysis. that said under state laws they have vast authority to do it. also, all scope of practice laws regarding wh

since october 1st enrolled either through the exchange for private insurance or through the medicaid program and another 3 million people as you know, neil, who are you young adults under the age of 26 who now get to stay on their parents' insurance policy. >> you're conflating a lot of data. >> these are people who wouldn't have insurance. >> 6 million lost their insurance. they may transition to something else. but a lot who are finding out is that they will pay more and they are going to have to because of the affordable care act cover a lot of policies and conditions that don't even affect them. and for which some are too old, pre-natal care, someone who is past 50 years old. >> remember, no one is losing insurance because of the affordable care act and the insurance company may have decided -- >> but they are, congressman. >> you can still qualify to get insurance through the affordable care act. >> i know that. your company is saying the conditions of the affordable care act and they are generous conditions. it means they can no longer afford that coverage for their workers. they are l

of the war on poverty programs and concluded that thanks to things like the war on poverty is medicaid program the war on poverty food stamps programs these are things that were invented by lyndon johnson and the war on poverty americans they are better off than they would have been without such programs according to the study without taxes and other government programs poverty would have been roughly flat between sixty seven and two thousand and twenty seven to twenty nine percent with government benefits poverty has fallen from twenty six to sixteen percent so the war on poverty reduce poverty by ten percentage points but when you look at the graph it reduce poverty by ten percentage points mostly in the first ten years and then you know along came well along came ronald reagan said enough of that and then along came bill clinton said we're going to end welfare as we know it and we've seen nothing added to any of these programs we've seen everything incrementally taken away and medicare used to be fully paid program now you got to spend hundreds of dollars a month on medicare there's always

to be honest, not all of these folks are new to the medicaid program because some identified before thepassage of the act. asked them to disaggregate how many would not have been covered but we don't have the ability to do that. they all have the peace of mind that comes with high-quality health insurance. states have some not taken the opportunity to expand medicaid even though the federal payment at the front end is 100% will stop the states that haven't acted, 5 million more would have access to affordable coverage. as surprising as that would they still haven't given up on the message. the disastrous effort of cutting down -- of shutting down the federal government, they didn't get the message. confident they are not going to get the message i'm about to deliver to you. but here is the message -- we will not go back. we will not go back. america has turned the page. we will not go back to the days when mental health was not covered or when women could pay the same for a man with the same coverage. dayill not go back to the when patients lied in a hospital bed fighting for their live

although that certainly is important i think we need to look at the national solvent see of the medicaid program we're going to be spending twice as much as we are on it ten years from now as we are today we're going to it's going to you know eclipse a large part of the federal budget somebody ultimately has to pay for all this at the end of the day and we have a situation with obamacare where rather than driving half of people into medicaid and half of people in the private insurance as they initially said was going to happen so that ninety percent on medicaid. you could use anything you like your great point and to have somebody has to pay for all that if you're going to write it and in fact you know last year if we had a single payer healthcare system in other words if we want to skim and twenty thirty forty percent off the top so the stephen j. hensley could build a little mansion you know the c.e.o. of health care we would have actually showed a budget surplus instead of a budget deficit if we had a single payer health care system and medicaid is a single payer healthcare system it is a sin

if you look at why it has to do ,ith a lot of the tax credits the food stamp program, medicaid, medicare, all of those great societies that provide us opportunities for people. we are a long way to go because we squeeze all of these initiatives and policies. primarily the tea party republican congress creating the job opportunities of people who are living or want ,o be lifted from the poverty they had those opportunities to get job training and jobs. what are the democrats solution? need to immediately extend unemployment, taxation. when you look at the fact that 11 million people have been killed -- have been kept from the ranks of the poor just by the emergency unemployment policy and programs, this is extremely important not only for those people to not fall into the ranks of the poor, but also for our economy and the economic benefits for people to receive unemployment compensation until they are able to sign for the job. we also need to raise the fromum wage from 7000 -- seven dollars and $.10. wageing range -- a living would be $25 per hour. we need universal preschool, childcare.

jon: sign-ups for medicaid, federal insurance program for the poor has surged in many states. we want people to be healthy. is that a good thing they're signing up in droves for medicaid but not necessarily for private insurance offered under obamacare? >> medicaid has its problems as you know. it is not sustainable in its current form. meaning costs are increasings to the point it can't be paid for. some states as you know chosen not to expand medicaid. this is happening in some states and not in others because others chose not to expand medicaid. the government at the federal level agreed to step in first couple years to pay for it all but the question is what will happen down the road? states like mine, ohio, looks as medicaid our second biggest cost. who will pay for it down the road. we have a 17 troll dollars budget deficit as you referenced earlier and we have big problems at the federal level dealing with this unprecedented level of debt. that is one of my concerns about this. we need to reform the medicaid program, give more flexibility to the states and help it to wor

on october 1, she found out she finally qualified for california's new expanded medicaid program which she had never qualified for before. she wrote to me. this is what she writes to meevment "please do not give an inch on the affordable care act. this is the first time i have taken a deep breath in 20 years than.thankthank you." and i see our new presiding officer. this is a story of one of my constituents who was diagnosed with breast cancer at 27 years of age. since that diagnosis, she was so scared she'd lose her insurance because of her existing condition that she kept paying very high cobra premiums. when she finally ran out of options, she lost her insurance and she just found out she qualifies for the new expanded medicaid. and this is what she say, "please do not give an inch on the a.c.a., the affordable care act, this is the first time i've taken a deep breath in 20 years. thank you." so you know, i say to the american people -- i hope a few would hear my voice -- nothing in life is perfect. no bill is perfect. no business is perfect. no one is perfect. no individual, no pre

that somehow the millions of people that administration takes credit for signing up for medicaid, welfare program of insurance for lower-income families is boeing were yous -- bogus. people sign up for medicaid all the time. the person in the president in the state of the union is taking credit for everybody who signed up for medicaid after obamacare and that is just not right. >> yes. and attributing it to ata when there is no fact of proof. look at it. this is their warning ignore claims that 3.9 million signed up to medicaid because of obamacare and they gave the president three pinocchioos on this. and warned people not to use that number. it's the very number submersed in the 9 million number put out tonight. they continue to misstate facts on the newspapers, chris. >> to mislead people on this is remarkable. given the fact everything else he talked about in the most important thing he's done of his presidency was buried 40 minutes into the speech talking about noncontroversial already-existing things then throws in not mentioning the millions of people who got cancelled, or disruptions ahea