so this affects everybody. >> one of the things, neera, that i learned from steven brill and his piecet "time" magazine is the affordable care act, because of the focus on who pays, is going to leave unaddressed many of the issues that he's describing. can you respond to that issue? >> well, look, i think that there are solutions in the affordable care act and that they should be strengthened. one of the challenging is we don't have enough competition. there's not competitive bidding. one of the things is that people can charge exorbitant prices, and there's no competition to get a lower price. it's something that this really amazing article points out, and i think that is -- there are a number of steps -- it doesn't matter who is paying for things and how they're paid for. some of the ideas around bundling and ensuring that we're paying for episodes of care will help illustrate why -- it will help create incentives to lower the cost of every individual item, every particular service. so there are steps within the affordable care act that get at why prices are so high. we should take a

. >> well, i think the fair thing with all due respect to neera and her work, the fair thing is to say the reason obama care passed was it didn't do anything to cut into the profits of the drug companies, of the hospitals, the exorbitant profits that your local knob profit hospital makes even though we ni it's a nonprofit. the affordable care act did nothing to cut the profits of everybody involved. in fact, if anything, it's going to add to the profits because it's going to put more people into health care which is a good thing. they're going to have insurance, but the taxpayers are going to subsidize that. >> what i learned from you is nonprofit really means opportunity to expand. >> nonprofit means you don't pay taxes, and you don't have to give the money to shareholders. instead, you can distribute it to the nondoctor executives at the hospital in millions of dollars in salaries and bonuses. >> another -- you said another cost driver is nonprofit hospitals, they're making big profits and the article points this hout. quote, in hundreds of small and midsized cities across the countr

my name is neera tanden and i'm the president of the center for american progress.thank you for joining us this morning for this important discussion of how health reform is addressing the needs of gay and transgender communities and people living with hiv. reforming america's health care system is a massive undertaking. one of the president's advisers on health reform, i know that as we gear up for health care reform it will touch the lives of every american. that effort means it will touch the lives of the lesbian, gay and transgender community as welcome as those people living with hiv. the united states currently has 9 million -- 19 people living with hiv. hiv epidemic continues to raise and marginalize. like the uss russell, this topic is diverse. gay and transgender people live in all corners of our country and they come from families of all varieties. regardless of the diversity of who they are, where they live, what their families look like, discrimination and marginalization remain common expenses for people with hiv and gay and transgender americans. despi

as neera said we're talking about the promise of reform how obamacare effects us. we agree that joe biden that health care is a big deal. who are lgbt people? research shows that there are about 8 million americans about 3.5% of the population who identify as lesbian, gay, bisexual and transgender. about 700,000 according to the same research identify as transgender. that means that at least 9 million americans identify as lesbian, gay, by -- bisexual or transgender. we know that many have engaged in same-sex behavior. and more than 25 million who are more than 11% of the population acknowledge same-sex attraction. some of the social determinant how healthy lgbt people are able to be, unfortunately predispose us to disparity in health status and health care access. some of the particular concerns that lgbt populations experience include a lack of data, a lack ever official data about what it's like to be an lgbt person in the u.s. today. allowing too many people in positions of power making decisions about our lives to believe if there's no data, there's no problem

it's one of the issues that the center for american progress has been under the leadership of ny neera. >> i want to start off by asking you, the universal pre-k paul ryan announced he is going to introduce his new budget. it looks like the old budget. he said the centerpiece of it is appealing obama care. really? >> yeah. what's fascinating is that in order to meet these targets that are incredibly unrealistically of slashing federal government he is coming forward with plan that is dead on rifle -- dead on arrival because that's never going to happen. when you have fox news challenging him on it that is another going to happen. you know it's not realistic. it seems there is little point to the whole process. right? they are coming up with a budget that's never going to get passed. it's an ideological document. i think the thing it demonstrates is they haven't changed. they got swamped in many ways and the house republicans feel like doing the same thing over and over again is the best course. >> nine republican governors now who have signed on to obama care for the expansion of medic