>> c-span, where history unfolds daily. in 1979 c-span was created as a public service by america's cable television companies and is brought to you today by the cable or satellite provider. now more on this weeks senate action on the health care law replacement bill from today's washington journal. this is about an hour. >> "washington journal," continues. host: this week in the u.s. senate debate on the gop health care law or placement plan released this week by senate republicans, we're joined this guests, samur berger, a senior policy advisor for the center for american jacobs, whod chris is joining us from the texas public policy foundation, a senior culture analyst with them. sam berger, the news is coming

billrom the 142 page released by senator mcconnell on thursday is that 10 years down the road, a lot more people won't have a particular medicaid coverage. given the track of where we are with you affordable care act, how much worse off will people senate plan passes than where we would be 10 years from now on obamacare? guest: thanks for having me on the program. where we are now as we should look through this bill, remember, it's a bill that went through an incredibly secretive process in which a few republican senators were working on it and didn't take any public input from doctors, hospitals, patient groups. now we're looking at it, it seems like a bill really misses the mark on two key things when people think about what they are trying to do in health care systems. the things they would like to improve on, whether they're are

democrats, republicans, or independents. increasingst, access, making sure more people have coverage. it still fails on both of those accounts. on the coverage point, millions and millions of people are going to have less coverage in 10 years and would under the aca. even for those that will keep their coverage, they pay more for less. you will see folks in the individual market to their deductible skyrocket and net premiums increase because they are getting less coverage. there will be designate test of getting cuts to medicaid, employer plans for you to return to a lifetime limits, meaning when you need your coverage the most, it won't be there for you. , the program shortens medicare's life by two years because it takes about $100 billion out, all of this to give about $650 billion in tax cuts to folks in the upper income tax bracket -- insurance

companies and drug companies. it seems like most americans are going to be far worse off. if you are a ceo of an insurance company or a wealthy american who has health care coverage, you will see a tax break. host: let's start on the two things, coverage and cost. what are you seeing when you look at the bill? right that theis bill will not lower premiums and that's what the american people need most, lower premiums and reduce the cost of care. barack obama was right in 2008 when he said the problem with health insurance isn't that people don't want it, it's that people can't afford it. the dualism make premiums more it leaves theause entire regulatory structure of obamacare in place, and that much of the elements that is raised premiums. doubled, more than doubled in the individual market over the past four years. by leaving that architecture in

place, you're really not one to drive down premiums and make health insurance more affordable for people. suggest,t would you what would your organization suggest to remedy that? guest: we don't think this is a full repeal of obamacare at all. we would suggest a full repeal, including all the regulatory mandates that are in place. it states want to go back and the regulatory structure of obamacare, they can do that on the state level. some states did that prior to obamacare, but we think the point of federalism is to let states decide in within the states will decide for the lower premiums that would come by dismantling the revelatory structure at the federal level and then having sensible regulations at the state level. host: we welcome your comments and calls on conversation about the health-care measure, coming up for debate this week in the u.s. senate. we've broken down the phone lines a little differently for this hour.

for those of you with employer insurance, call (202) 748-8000, private insurance, call (202) 748-8001, uninsured, call (202) 748-8002, and all others, (202) 748-8003. picking up on what chris said about giving more responsibility or authority to states under the proposed house and senate plan, what's wrong with that? guest: there's recently passed the affordable care act and folks probably still rumor with the world was like before then. we talk about lower premiums, there are two issues. we're talking about an entirely different product. we are talking about plans that don't provide near the number of benefits, in some cases, carving up benefits for people suffering from cancer who knew that treatment. it is one of like saying we moved from a bicycle to a car. things are more expensive and there's a good reason for that.

the other problem is we're dealing with a different market. insurers weren't competing to offer the best products, they were impeding to get the best customers. they were trying to get healthy folks and if you were sick or got sick, they either didn't cover you were cut out the most expensive parts of your coverage. youaffordable care act said can't do that anymore. if someone wants coverage, you have to give it to them. you have to make sure that people have coverage that works for them. we need to keep building of the progress we've seen with the affordable care act. it is true we saw premiums go up a little bit last year, and we all think we could do better in that space. we were starting to get to a point where insurers were figuring out how must they needed to charge in order to make a profit. unfortunately, over the last few months, we've seen the trump administration actively working to sabotage the market. don't take it for me, he said that. he said it would try to threaten insurers to not pay them in order to get the democrats the table on this repeal bill.

but we are seeing now is a large increase in premiums mostly driven by the sabotage. host: chris jacobs, your thoughts on the people on the lower end of coverage, sick some coveredere under obamacare. what is their fate of the republican measure and limit the of medicaid with states being given more authority or flexibility over their medicaid programs? guest: on the affordability point, we've seen the people cap afford coverage under obamacare. -- can't afford coverage under obamacare. people are opting out by paying the tax penalty are getting an exemption and purchase coverage on the exchanges. barack obama didn't say you will pay more but you will get better coverage when he was campaigning, he said he would cut premiums by $2500 for family. that hasn't happened. when you go back to making coverage more affordable. -- otherdicaid

medicare side of things, flexibility has proven to reduce care, by by cutting improving care. relying on flexibility under a waiver program approved under the last days of the bush of administration back in 2009. they reduced per beneficiary spending year on year on average for four straight years and it wasn't by cutting care, it was by offering better care to seniors. offering seniors home-based care instead of spending their time in a nursing home. that provide better care to seniors. host: does rhode island get to continue the program under proposed legislation? guest: the idea is to let other states embrace that kind of rhode island model without washingtonlways been and go down bended knee to get permission to make their programs more flexible and affordable. host: chris jacobs with the

texas public policy foundation and sam berger with the center for american progress. lots of people interested. conway, new hampshire and valerie lazzaro private insurance. chris jacobs, you're right on the mark. the other gentleman was right, it is being sabotaged by can techie, your state -- kentucky, your state and all the red states. pennsylvania and new jersey, i'm not sure where you're getting off about your portable health care not working. and doctors are starting to it. the insurance did not increase that much and have somebody with cancer that needs it, like my husband did, so you can go back to work, not in a nursing home just collecting money and having the state have to pay for him, some people needed when they lose their jobs and some people even when they're going back to work. those who are unhealthy do return to work and most of them

recover. chris jacobs, you are appalling man. for valerie,y much from,, new hampshire. goodbye. valerie's point, i am on obamacare myself. my plan got canceled last year. the insurance company decided they weren't going to offer it anymore. the alternative plan i was given was a 20% premium increase and a 25% increase in my deductible. i don't think that is sustainable long-term, year-over-year. to the trump administration sabotaging that, a column in the wall street -- the primeweek genesis of that charge involves cost-sharing reduction payments. law, the obama administration made those payments to insurers. but a federal district court judge last year ruled those payments were unconstitutional. because there is no appropriation in the law to

allow the obama administration -- to disperse those funds to insurers. the trump administration is not sabotaging the law, they are trying to obey the constitution. i think that is more important than adhering to anyone law, regardless of how big or small it is. it's fidelity to the constitution. own: on chris's point, his insurance under obamacare, what would have to happen if obamacare the state in effect, what was the solution to the rising premium costs? west: i think there are ways can build on and improve your affordable care act, but we need to be focusing on bringing premiums down and deductibles down. we don't do that by making $1 trillion out of the system in order to give tax breaks to high income folks at insurance companies and drug manufacturers. it's a very odd solution. it seems a little strange to say we look -- we made a lot of

progress, let's tear it all down to go back to a world that nobody likes. there was a reason there was widespread desire on both sides of the aisle to stick to the health care system -- to fix the health care system. when you to be building a looking for bipartisan solutions. i hope republicans will take a second look at the effects of this bill now they finally got a chance to see it and think about the cost it will have for their constituents and millions of people around the country. and then put it aside and reach focusross the aisle and on bipartisan ideas. there are some good ideas of folks could use, but we need to put aside this notion that we fill a talking point or promise that we never really explained and so we are going to repeal something and kick millions and millions of people off coverage, and cause millions more to have substandard coverage they are paying more for. it's not a very good solution. host: from washington state, we hear from mark. go ahead. caller: i just wanted to point

out that all the subsidies for the aca actually still come out of our pocket. the cost is just being shared across the entire economy. it's a drag on our economy and what we need to address is the runaway profits of the insurance companies and the pharmaceutical companies. we need socialized medicine, we don't need to waste one third of our health care dollars for pure insurance. not one band-aid. the pharmaceutical companies are running amok in this country, charging $600 for an epipen. how is it that foreign countries can give adequate health care at about 1/10 the price? this is just legalize coercion. host: chris jacobs, you want to take a quick stab at that? guest: insurance profits have doubled in 2015 compared to 2008 and whether that's commentary on

obamacare, i will leave to other folks. of drugon the issue pricing in particular, we need to do more to get generic drugs into the market faster, to bring down the pricing and have more competition. with respect to socialized , wecine and single-payer spend a greater percentage of gdp on health care. we do ultimately, that percentage is jobs and i think an ourd to spend -- we economy off of that in terms of spending more gdp. the we do that is not her socialized medicine plan that would ultimately result in higher government spending. host: michael in los angeles who gets his insurers through his employer. go ahead. caller: the trump administration

from day one sabotaged the individual mandate. the individual mandate would work if there was sufficient penalties for individuals who would not take out insurance. and when the number of persons covered nationwide would be so universal that is problems that outside this morning would not occur. those whoo penalize do not take out the individual mandate. uncovered by an employer mandate in hawaii, where i used to work. i was supposed to be the model for obamacare. because it works in hawaii. with no problem. if you do not enforce the individual mandates, there's no point to the maintenance of a skeleton of obamacare. host: sam berger on the

enforcement of the individual mandate. under the senate plan would be going away. how effective was it? this was money that those who didn't get insurance under the fine orhad to pay a attacks at the end of the year. how did that work? was somewhat effective in their questions on how you can improve the interval mandate. we found the trump administration is an argument against enforcing it at all, causing premiums to skyrocket, go back to an earlier point of uncertainty. --ertainty in the present under president obama. only happens in our politics, republicans are dammed by donald trump's own words. saying a lot cut the subsidies off, i want to hurt insurers in order to sabotage the market and force democrats to come to the table and negotiate. it is sort of like if you have a landlord with tenants and the

first one says i'm going to take care of this place in the second it is i'm going to burn this place down and they are very confused about how the landlord is so worried during the second year that there lose their apartment. it is all that we are in a world in which the president is very upfront, much more upfront about other members about what he is doing and why. paid attention to the cost it has for americans in the increase in premiums, driving insurers on the market. breaking this market is going to hurt millions of people and it's unconscionable. host: do you think the president has articulated well what he would like to see in a final health care plan? guest: i will leave it to republican senator to figure out what is terrific. how they put more heart in it and make it not mean. i don't think the president is particularly interested in the bill and its effect on millions of americans.

he's interested in getting a quote unquote political win. it's not clear that he knows what's in the bill, but it's not clear that he cares. host: chris jacobs. guest: the most important thing the president should cost is lower cost. talk about is lower cost. with the metric the american people are most worried about. it's the metric when barack obama talked about in 2008. the wall -- the law has failed to deliver. host: in litchfield, michigan. good morning, ray, who also gets private insurance. caller: it's litchfield, new hampshire. throughur policy minutemen held in new hampshire and they do business in new hampshire and massachusetts. year, premiums went up 24% and this year, they were talking about raising the premiums 30%.

friday, they announced they were going out of business, january 1, they're not going to write anymore policy so my wife and i have to find another policy. the only other choices anthem. plan that isnze -- $900dollars a month a month with a $50 deductible per person with a maximum out-of-pocket of $6,300 per person and -- host: what have you been paying under the minutemen plan? that's whatller: we're paying, almost $900 a month with those deductibles and anthem, it was $1200 a month, everyone at a silver plan, it was $1400 a month or a $3500 deductible per person. now the only choice is going to be anthem, so guess my question

is with everybody talking about the costsre high, are. what it costs to go to a hospital or pharmaceuticals. can sayur guests specifically what they would do, and be specific on what you would do to lower the cost of a doctor's visit, a hospital visit, pharmaceuticals. pharmaceuticals are ripping off everybody and their prices are too high, but how about the regular doctor's visit or hospital visit. how could you reduce the cost of those? host: we will start with chris jacobs. guest: i don't know if the caller is there, i think minutemen health was actually a co-op, which is going out of business. the insurance cooperatives were created under obamacare for several billion dollars of spending. most of them ultimately went under for some of the financial

problems that ray was talking about. when it comes to premiums and specifically, the premiums -- he said $900 a month. because of thes regulatory mandates created by the law. sam was talking about the individual meeting. more people opted out or at its engines from the individual mandate and actually pay the tax under the obama administration. that's how the trump administration 7000 the law, that the obama administration that more people were getting exemptions for the mandate then were paying the mandate. that's the problem. the mandates have raised the premiums so high that only very sick people are in the marketplace, and that's was raising the premiums. to the specific point in terms of lowering the cost of health care, i think there are other things that the states can do -- texan public policy, we believe

in federalism. states can reform herself with practice and certificate of need laws. strep come down with throat, human money to go to the doctor or the emergency room and pay hundreds of thousands of dollars. you can go to a minute clinic in get seen by a nurse practitioner and cheaply and get the care you need and reserve the trip to the doctor's office with specialist costlye -- for more ailments. host: the caller from you after asked for specificity for lowering -- guest: i want to talk about this notion for exemptions from the individual mandate. court,k at the supreme they basically said states would have the option and a number of public and governors chose not to expand, not for policy reasons, but as a stake in the eye to the administration and that left a bunch of oaks out in the cold -- a bunch of folks out

in the cold. now the question is what you do with them? it seems unfair to make them pay the penalty because the governor is having a political fight with washington. i think that number is skewed. in terms of what we can do concretely, we are talking about a high deductible bronze plan. what the republican bill would be doing is moving everyone in that direction. everyone would be moving and they would see their premiums double by $2000. some folks would see their premiums go up $6,000. i think there is work we can do, and such as lowering the cost of care, it's also the health of the market in bringing more people in. there are a lot of ways you can do that. we've seen some of them, where you try to change the medical practices from paying for a test to paying for patients. some of these are starting to

take effect and we've seen much slower growth in health care costs over the last few years than the previous few decades. we've been making progress and we can do more. it doesn't seem to make much sense to parroting back to a system we all know is terrible and we all think isn't sustainable. we don't need to go back, we need to go forward, missing words working. in some states, it's working quite well. figure out what we can do a better job in rural areas. we are not rooted you have by stripping health care for millions of people -- we are not going to do that by stripping health care for millions of people. host: "new york times," with a look on how the plan would change. it raised the eligibility cutoff to 138% of the poverty level in any state that chose to expand the program, around $16,000 for a single person.

federal government pays at least 90% of the cost for eligible beneficiaries. host: consider from bill in winnsboro, pennsylvania. good morning. you are on was hamburger and chris jacobs. -- with sam berger and chris jacobs. caller: most of the opposition you hear from obamacare is from the republican leadership, and they use the same old phrases over and over again. they say obamacare is in a death spiral, they say the new plan is going to be patient centered, but don't explain what that means or how it's going to be done.

plan is going to be a disaster for older people. young people. -- not young people, poor people , and people with special needs. that's my comments. texaslet's go to plano, and hear from matt, and gets private insurance. caller: good morning. thank you for the c-span radio app. i appreciate it. i want to make two quick points. jacobs, ill, chris had a chance to read your analysis. it was quite good. you should rightfully point out this bill may not even passed the senate rules because part of the bill may be considered reconciliation, parts of it may not be. i at least give the obama administration credit for going the whole distance and doing the full overhaul. now they are trying to do a repeal when it's not a repeal.

they are try to do half the job. no wonder that senator cruz and rand paul other paul and other conservatives do not like this bill. -- ither question i have think i read in the bill that up touse version left it the states to determine what health benefits will be cut. i believe in the senate version, after 2019, the medicaid expansion is gone. so, i do not know why you would not want to include mental health benefits and medicaid. i think a lot of people count on that, and i thought republicans and conservatives cared about funding mental health for the poor. i think that would be something you would want to keep should -- want to keep. host: let's start with chris jacobs. guest: obamacare past the initial bill with votes on

christmas eve in the senate. scott brown was from sea to be promisingican -- was to be the republican to block the passage of obamacare. what the house did was passed the senate bill and then a reconciliation bill fixing the original bill. -- pasmacare past with sed with 60 votes and overcame a republican filibuster. bill a reconciliation fixed portions of obamacare. obviously, there are not 60 republican votes in the senate, so they are limited in terms of what they can and cannot do under the budget process known as reconciliation in the senate. that said, i think the bill could go further to repeal the architecture of the law and

regulatory mandates under the law under the senate procedure. guest: to pick up on his comments, the essential health benefits as to when needed in the house version would go away in the senate version. guest: i want to pick up on one thing chris mentioned. i think you mentioned that republicans do not have the votes to move forward or get rid of a filibuster. they have not tried to get the votes. the have not talked to any democrats. they have not made any effort to have public hearings to explain to the american people why this bill will improve their lives. with doctors,t the american cancer society or the american heart association. passt is a little hard to this through reconciliation when they have not even try. to the essential health benefits, there is a claim that republicans are making that they are protecting pre-existing conditions, but it is not really true. the issue around this is being

able to weigh the essential health effects. basically, whether or not they have to improve maternity coverage, mental health coverage, prescription drug coverage, the bill allows states to waive that requirement which will drive up costs for folks with various conditions. if you need maternity coverage, it will cost an extra $17,000. certain forms of cancer, you could be talking anywhere between $30,000 to $70,000 increase to see the care that you actually need. when we talk about getting rid of these regulations, that is not what people are concerned about. they love the fact they cannot be discriminated against. they love the fact that their coverage will be there when they need it. the love that a 26-year-old can stay on their parents plan. what people are concerned about are the premiums and deductibles. the are things we can do about

that, but we do not need to throw the baby out with the bathwater. we need to fix and build on a system that is working quite well. i think there are real things we can do to improve it, that we need to work on this on a bipartisan basis. we are not going to get there that youcretive bill are trying to pass without getting the american people involved. host: we are hearing from robert now in maryland. caller: good morning. how are you doing? host: good. caller: these parasitic corporate cultures want to solidify their hold on the american citizens. what do we do? we can send out the lobbyist from k street the capitol hill with our proposals. let's get this or that deregulated so that we can just

have a grip on the american citizens and make point for century slaves out of the. -- out of them. thing i do like about some of the other countries around the world, they would not allow these kinds of people to take control over the health care of their people. they put them in jail in cuba. they are healthier than we are. we are 21st century slaves in america paying dues to these people, and our politicians are sold out because they can get a little bit of grant money in their pockets. when you do get control over these people and stop letting them run shop over our country. cubansnese people and

would put them in jail. it would not let this happen. elimination of the taxes under the affordable care act, who benefits most from those? i would not say this is a good bill because it cuts taxes, i would want to repeal all of obama care. if this was about tax cut, then i think this bill might make sense. but the important thing is to repeal all of obamacare, and this bill will not do that. about last caller's point , the bill has $65 billion over the next four years between now and 2021 in subsidies to the insurance companies. that may lower premiums in the short term, but insurance companies like that because they had been begging for more funds

which arelity funds" really bail outs to the insurance companies. what happens when you have now created this permanent entitlement to the insurance companies 42022 and beyond -- compaines for 2022 and beyond? that is not fixing the market. host: what does it taste -- take these days to get an insurance company to stay in the business and ensuring people at an affordable rate? guest: i want to take a moment to know something chris said. he said he wants to repeal every part of the affordable care act. this is an enormous bill with lots of provisions that affect all different sectors of our health care. i'm a little surprised that there is not a single part he would like to keep. it sounds like the problem is " andthat it is "obamacare,

not necessarily the changes that are happening. i think that is what is affecting the whole republican party. the fact itused on is "obamacare," and not how we can necessarily improve our health care. we are seeing insurers starting to fill out -- starting to figure out the market. they have moved from a world where they were trying to get only the healthy customers to not trying to offer the best products. they are starting to figure it out. they are seeing revenues going up. 2018 will be at good year where you see low, single-digit -- excuse me, high single digits and low teens, but, instead, the sabotage that the president has said he is engaging in, we have seen rates that are much, much higher. because of what we are seeing

from the trump administration, these rates could be in the high 30's. seeing of what they are from the trump administration, they are in the mid-20's. this is having a real affect. even if the bill fails and people realize it is stripping health-care coverage from millions of americans in order , those premiumks increases are still going to be there. what we need are folks able to --ure out what the trump is with the trump administration is doing so that premiums can go back down and people can afford coverage. let's hear from bill who gets his health insurance from his company. caller: thank you for your time, and good day. weekset saw this bill before, so i am suspect about it already. this is just a redistribution of our wealth. we all know that medicare is a

welfare program. $.25 out of every state dollar is spent on medicaid. this is an expansion of medicaid. let's be honest, gentlemen, and especially you sam this pushes more people into medicaid and onto welfare. this is reduced to be should of wealth just like obamacare. i'm not being full by this head fake. we have cautionary subsidies like chris just explained. they are bailouts to the insurance companies. this is just redistribution of our wealth. i fear for the future generations of this country. i never hear the words "free market capitalism." i am sad to not hear. i am not full by this. it is just an extension of welfare, and i want government out of the way. guest: i think, for the caller's

at least, if you are concerned about the medicaid is going-- this bill to hurt them. 14 million people are likely going to lose their medicaid coverage. to give you a sense of who this is, these are lower income folks may be working two jobs to keep a roof over their heads. medicaid is not a welfare program. it is a health care program. it is a program that millions of americans support. i think we all understand we have to be in this together. it means something that we are a community. part of that means we need to look out for each other. medicaid is one of the ways we do that. it is an incredibly important program to many people. the idea that we would just cut it and kick these people off coverage is really unconscionable. host: we spoke about the rhode island experience with medicaid.

based on what the caller said and what sam said, what does the future look like if it is handled by many states across the country? average think the state spending on medicare has been tripled over the past three decades. if you spend more on medicaid, is less to spend on schools, transportation, or law enforcement. states are having to make these tough choices. states are having billions of dollars in added, unexpected costs, because they accepted the obamacare medicaid expansion. that is what the caller is pointing out. it is causing debt. a safety net that is potentially too large for us to afford. we need to take some steps to prevent back. prune it back.

host: you mentioned states have other priorities that come up. where then to those people go who may have been eligible for medicaid in the past? guest: one thing that was not pointed out -- we have not seen the estimate from the cbo on the senate billion. people on medicaid would just drop off because the and eventual mandate is repealed. that -- the individual mandate is repealed. that would mean that medicaid is being provided to lower income individuals. because they would no longer be forced to buy or obtain coverage, people would just walk away from the program. host: here's some perspective on medicaid from the new york times. or, rather,kend, -- in today's new york times, they write that spiraling health care costs has left americans -- has left americans in nursing homes dependent on medicaid.

three the primary care on health of americans on care in nursing homes. it faces long-term financial challenges. it is inspected to grow at 6% a year on average. according to the -- guest: i think it was sort of interesting that he was talking about the strange that medicaid was putting on state budgets, but this will is taking money out of medicaid. it will cut even more in the second decade. if your concern is that the whyes are under stress, then would we take money from them and give them to the wealthiest people in america? this is really the problem we keep coming back to. folks can point out concerns that they have, and i might not

agree with them, but it is hard to describe any positive thing coming out of this senate bill other than it gets rid of "obamacare." but this bill is just going to exacerbate the problems people have both sides of the aisle. i hope people take some time to look at the bill and realize it is not going to help you to matter what side of the spectrum you are on. host: we have posted the bill on our website, www.c-span.org. you can find a link at the top of the page. next, we hear from susan. caller: good morning. thank you for taking my call. when obamacare was passed, the model question was answered here which is "should we guarantee medical treatment to everyone who needs it?" and question was answered, now that question is back on the table. it is ludicrous that the wealthiest country on earth would now go backwards.

there are a little over 200 countries in the world, and about 40 of them are developed, industrialized and have made the choice to cover all of their citizens. i would recommend a book written in 2009 and updated again in 2010 which is a longitudinal analysis of all the health care plans across the world by the countries that choose to provide health insurance to all citizens whether they are employed, underemployed, young, disabled, old, and they get it done. as obamacare had bumps along the road? yes, of course. however, it did answer that moral question.

if all of these republicans are not talking about this -- if they are characterizing this as entitlement reform disguised as a health care bill. guest: certainly, we want to make health care and health insurance more affordable to americans, but i think the answer to that is not mandating a specific package of insurance benefits, canceling millions of policies which is what happened in 2014 and then taxing theicans if they do not buy more expensive package of benefits. see: what would you like to in terms of language in the senate bill about planned parenthood funding? sam? guest: i think this gratuitous attack on planned parenthood is really a giveaway to certain elements of the conservative party. makes aparenthood

difference in millions of people's lives by providing a wide range of services. i do not think there is any policy rationale here. it is really just a matter of try to get the folks on the religious right to support a bill that is otherwise probably difficult for them given that it is stripping millions of people of their coverage and decimating medicaid in order to give tax breaks to the wealthy and insurance companies. it is bad policy. it really should not be in there. i do not think it is intended as a policy proposal at all. are tens of thousands of committee health centers across the country which would receive an increase in payments under the bill, so we do not need to subsidize the nation's largest abortion providers. guest: we talk about subsidies, we should not reimburse them too

important health care that they provide to noise of people. sort of an idea that planned parenthood is the only place we are going to ask to provide care and not get paid. it does not make much sense. people support and depend on because of the support it has made in their lives. this notion that we would just pick up the slack is just not true. we're not going to be able to. particularly in rural and other underserved areas where planned parenthood is one of few providers. i do not think it makes much sense that planned parenthood should not be paid for the work that they do what it is good work that they do helping people get health care. host: looking at the senate efforts to repeal and reform health care as announced by mitch mcconnell earlier this week. it was released by mitch mcconnell and republicans earlier this week. sam berger is with us along with

chris jacobs. we continue with your calls. donna in st. louis. good morning. caller: good morning. is moreings, first, it expensive for taxpayers to pay for going to people to get primary care from the emergency room. that is a lot more expensive. secondly, the republicans want to take a trillion dollars out of medicaid and obamacare subsidies to give the rich tax cuts. when i asked landis to my nephew who voted for trump, he said he liked the idea of medicare for all. that would really reduce premiums. fought republicans have ,edicare, social security medicaid, and obamacare since 1935. they could care less about people's insurance.

peoplehe working, poor who got obamacare, because republicans took out most of the high paid jobs in 2006 with the free trade deal with china. they could care less. jacobs, she brought up the issue of people resorting to emergency room care under this senate bill. guest: that is where i think you reform the scope of practice. create more avenues for people to avoid the emergency room and avoid having to rely on the most expensive sources of care. medicare, i about would point out that obamacare itself took half $1 trillion out of medicare to pay for obamacare. there was some double counting chikanery, for lack

of a better word, to extend the obamacare trust fund. it does not really add up in any substitute sense. medicare has its own problems and obamacare did not help them. fortunately, we should be passing a full repeal that restores some of that money in the medicare trust fund that was double counted under obamacare, but that is not what we are doing here. host: december, he wrote an article this week -- sam berger, you wrote an article this week. how did you come to the figure in the article? guest: we spent a lot of research on this. not surprisingly, researchers found that having coverage improves health and reduces mortality.

here, we are kind of relying on the gold standard in this build. that is, the massachusetts experience. health care reform in massachusetts, as many people was reform for the aca. folks getk at that, coverage and you have one fewer death. we do not know yet how many people will lose coverage under the senate bill. we know it will be in the tens of millions, but we do not have an exact figure. so, we used different models. moderate -- was some models where there was moderate reductions, but no matter what you do, you see a huge increase in death on an annual basis. when the caller was referencing people using the emergency room, i do not think that was because it was the only place available, but i think it was she was suggesting that people do not have coverage and so they have

to go to the emergency room. i think allowing for more doctors -- that is not the problem. it is not so much that you cannot find someone, it is that you do not have coverage you do. anna int's hear from georgia. she gets her coverage from a private insurer. go ahead. caller: i wonder if anyone stops in considers the difference prices that hospitals, doctors, and pharmaceutical companies charge if you are on medicare. if you are on medicare, the hospital will accept $300 for your hospital room. if you are a private person going in, you have to pay $3000 for it. that does not seem right. the same thing with pharmacy. in particular, a type of eye drop that is used in cataract surgery -- if you are under 65 years old, the eye drop is about

$30 a bottle. if you are over 65 years old, it is $200 a bottle for exactly the same thing. it seems to me -- i do not know how you do it in a free country, in a capital type economy, but it seems to me there needs to be some sort of regulation. a hospital room should cost what a hospital room costs. in emergency room the same thing. reimburses the hospital a small amount. host: that would seem to be an area of common agreement between the two of you when it comes to prices. even the president saying that he would like prescription drug prices down. guest: sure, and i think that is something under the radar screen that obamacare has exacerbated. we have seen hospitals consolidating a lot of industry

consolidation. health insurers are attempting to consolidate. you see hospitals buying up dr. practices -- up doctor practices. an independent doctor could charge $50, and then they get taken over by a hospital and it is now a hospital outpatient visit that costs $150. i think that is something the federal trade commission was looking at last year, whether obamacare was encouraging the consolidation that was driving up prices. guest: i would just like to say, it would be wonderful -- we are talking about -- it would be wonderful if we were talking about a bill that was tried to fix drug prices or hospital prices. that would be interesting, and i think we would have a great, substitute debate. unfortunately, we are not talking about that. we are talking about whether it

makes sense to strip coverage from millions of americans to give tax breaks to insurance companies and wealthy americans. we are sort of through the looking glass here. there are real issues with our health care system and improvements that could be made, but we cannot talk about those we say that we are not going to strip coverage from millions of people. instead, let's focus on a bipartisan racist to try and -- bipartisan basis to try and get improvements out there. we do not have to repeal every single piece of legislation in obamacare, rather than focus on the concrete things we can do to make it easier for people to get better care and cheaper care in their lives. that is where the focus should be, that we are not there today. host: let's get one more comment from adrian in virginia. caller: good morning. thank you for c-span. my question is, what did people

have before obamacare? asnow in most states, as far -- in most saying states, when you buy a car, it is mandatory for you to get insurance. or, if you get caught without insurance, you have to pay uninsured motorist fees and a fine. say -- i'mld like to sorry -- host: adrian, we will let you go there. thank you for your comments. mandates, it as was said that the individual mandate was unconstitutional under the commerce law.

the federal government cannot force people to buy something. it was ruled constitutional only by calling it a tax even though the bill itself said it was not a tax. i think, on the state level, states can and cement and mandate. we saw that -- can implement a mandate. we saw that in massachusetts. obamacare taxes people just for their very existence if you do not buy coverage. guest: i think the caller asked an excellent question. what kind of coverage give people have before the affordable care act? many people had plans that would not coverage the care they needed when they needed it. coverage because they could've been denied coverage because they were a woman or a victim of domestic abuse, pre-existing conditions. before.the world we had it is a world no one should want to go back to.

when we talk about repealing this bill, i think it is important to remember the caller's question. what was the world like back then? we really want to go back or do we want to go forward on a bipartisan basis to keep premiums and deductibles down? -- the aca gave us millions more with health care, and if we could come together with bipartisan solutions, i think we can take care of them and get more. sam berger and chris jacobs, you can find them both on