tv Washington Journal Yasmeen Abutaleb Discusses Health Care Reform CSPAN August 19, 2017 8:00am-8:40am EDT
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listen live on the free c-span radio app. continues.on journal host: welcome back. yasmeen abutaleb is with us, a reuters health care reporter. we're talking about some of the administration's decisions with cost-sharing reductions. guest: thank you for having me. host: explain the these actually are. americansut 6 million get the cost sharing reduction and they help lower out-of-pocket medical expenses for low income americans. 100%ally people between and 250% for the federal poverty level and they are buying insurance on the obamacare markets. insurers -- the payments are made directly to the insurers but they can subsidize a greater portion of people's health care costs.
people from premium increases and high deductibles and co-pays and that sort of thing. the administration has been paying these on a month by month basis? guest: this started under the obama administration. the house of representatives sued the obama administration saying these payments needed an appropriation from congress. the administration cannot make it unilaterally. the district of columbia court ruled in favor of the they didns, saying need an appropriation from congress. the obama administration killed a lawsuit and is shifted to the trump administration. they asked the hold off on their decision while they tried to repeal and replace the law. now the trump administration is making a decision month-to-month whether to pay these are not. host: the president has said he plans to let obamacare fail and the democrats fix it. i have a trump:
hearings about repeal and replace. obamacare is a total disaster. some states have over 200% increase. 200% increase in their premiums. the deductibles are through the roof. it's an absolute disaster. agree let will also obamacare fail and everyone will have to come together and fix it and come up with a new plan, a plan good for the people at much lower premiums, much lower costs, and much better protection. i have been saying that for a long time. let obamacare fail. it will be a lot easier. i think we are probably in a decision where we have -- position where we have to let obamacare fail. republicans are not going to own it. let obamacare feel and the democrats will come to us and say, how do we fix it? or how do we come up with a new plan? host: there is a disconnect
between what the president says about the affordable care act and what he actually does. he says let it fail, but then they pay the csr's to keep the markets from going to a death spiral. the way the president talks about the markets, does that have an effect on what insurers might do? andt: it definitely does, several have raised premiums more than the other rise would have because of uncertainty around with going to happen to the law, whether it will be a repeal and replace eventually, whether the president will make these payments. insurers have said they need certainty on these payments. if they knew they would not raise their premiums as much. one said they would be a 9% 'screase if they knew the csr are going to be paid, they would have to raise them 20% because they are not sure. right now you have a lot that are unsure of whether they would get these payments which are
estimated at about $7 billion in 2017. just the president's word he will let the law explode and not own it is causing a lot of uncertainty in the markets. host: we're talking with yasmeen abutaleb about the state of health care and taking your calls. the line for republicans, (202) 748-8001. democrats, (202) 748-8000. independents, (202) 748-8002. grass -- graphic here from cms that shows the country. then it shows the state of the insurer participation. all of this yellow, for all the states and counties that had just one insurance carrier. the dark green is whether have three carriers. there is far less dark green and yellow. is there anything to suggest this could improve absent of anything congress or the president might do? provided the president some certainty over whether the
payments are going to be made. if congress made this a permanent appropriation, which there are a lot of democrats and some republicans who have expressed interest in doing so. that could provide certainty. 2018 looks a little bit chaotic. it is hard to set rates when you're not sure what happening month-to-month. a little bit of reassurance from the administration that they are going to uphold the law as long as congress has not passed something would calm the markets a little bit. host: who qualifies for these cost-sharing reductions? guest: americans between one and 2% and 250% of the federal poverty level, about 6 million people. they are buying insurance on the individual markets. i don't qualify for medicaid and they don't get employer-sponsored insurance. host: there is a bill from patty murray that would in effect pay for these csr's for a two-year basis? guest: when congress comes back
in the fault but will start bipartisan health care hearings, which are a big deal because the health care debate under this administration has so far been very partisan. in the senate he did not have any hearings over the bill. when they come back in september, patty murray and the mark alexander, the republican on the health education and labor committee will start holding committees on the bill that would in theory sure of the markets and provide certainty. host: carl from montana, good morning. caller: good morning. george h.w. bush pass the law where a bunch of people get health care for free. there was 1300 voices throughout united states places throughout the united states. i was wondering when you tell me about that bill. i heard it from the doctor. unfortunately i don't
know a lot about that bill. you have obviously got medicare and medicaid, the two biggest government provided forms of insurance. there is a lot of concern in congress over medicaid and the expansion of medicaid under obamacare. a lot of republicans have said too many people who should be in the employer market or the individual market are relying on the medicaid expansion. there is some concern about the. host: the cbo put out an estimate about the effects of what would happen if the administration did not pay for csr's. guest: the cbo under the request from house democrats looked about what happened if president trump falters on this best follows through on this threat. -- president trump follows through on this threat. there would be a rise in 2018, 25% by 2025. the interesting thing the cbo found was the market would be fairly resilient to this. they would be some chaos for
2018 and 32020, but they -- and through 2020, but most counties of the insured by 2020 because they would adjust to the new policies and not having these csr's. they would raise premiums accordingly. eventually mostly participate because he understood how the markets work and most people could buy insurance. host: larry from seattle, republican. caller: good morning. this is the first time i have watched your show and i'm actually pretty happy about the bipartisanship. what i want to talk about is the health insurance. i am very disappointed in donald trump paying these insurance on going witheep obamacare because the truth is only 6 million people are holding up 320 million americans .
i have not had health insurance since obamacare took place. they took my health care away. i can't afford to pay for it. i'm a construction worker. know, issues that most americans have but cannot go to a doctor. it is said because i don't qualify for medicaid. i can't pay for health insurance. there are millions and millions of people in my category they cannot afford this. because i heare so many people talk about why they voted for trump. i support him one of 2% still, -- 100% still, but i'm disappointed in how this whole health. she was going. -- whole health care issue is going. guest: the bill that went through congress of the approval ratings. a lot of people want to see bipartisanship.
a large number of americans want to see congress work on a bipartisan basis to repair the law. i don't know what your particular situation is, but under obamacare, because medicaid was initially supposed to be expanded in every state and then the supreme court ruled states to decide whether they want to take the expansion, you had several people who maybe would have qualified for medicaid expansion in certain states and then ended up not getting it as their income level was too high for traditional medicaid, but they also do not qualify for tax credits or subsidies in the individual market. obviously you have people unhappy with premium raises and that sort of thing and the -- in the individual market. there is disappointment on both sides of how the debate has gone. a lot of people are stuck with high premiums or maybe not able to afford insurance, and it's still unclear what shape the debate will take. host: a story from the help. m caucus once use a
discharge position -- petition typically used to go around the leadership to bring a measure to the floor for a vote. do you think we are heading for another round of this health care debate on the hill? guest: it is hard to tell right now. it depends on how much support is among republicans when they get back from the august recess. a lot of them are not holding town halls for whatever reason. i think it is because they don't want to face constituents on this health care vote. the freedom caucus is garnering a good bit of support to vote on what they call a straight repeal bill. or thesimilar version exact version of a voted on in 2015 that would repeal obamacare, the taxes, the regulations, not have immediate replacement. the same thing that passed the house was maybe not conservative enough. there is a desire among many of the more conservative members of the house to take this vote and
be on record. it seems unlikely that paul ryan and mitch mcconnell would take up a vote if they do not have or know they had the votes because of how chaotic the process got over the past several months and how difficult it has been for many, especially the more moderate members to answer constituents. mcconnell thought he had the vote until john mccain had other ideas. let's go back to twitter. "allow all 50 states to expand medicaid and see of the aca does not blue like a rose. 23 million people losing coverage is not better." another tweet. guidelines arey 50 years out of date and are a joke. start with realistic numbers before deciding who qualifies for subsidies." all 50 states actually can expand medicaid now if they want to. the supreme court ruled it is not -- they did not have to.
31 states and d.c. did decide to expand medicaid. if we see the debate moved to the back burner or congress has said definitively we will not repeal the law, just repair it, others might take of the medicaid. as it stands anyone can take the expansion of they want to. there is a desire among people to see the law work, to see congress and the trump administration uphold it. at the same time he have republicans worried about answering the constituents who are promised for seven years to repeal and replace this law and they don't be seen as giving up after only a few months. host: east berkshire, vermont where we have timothy on the line, the democrat. caller: good morning, folks. i guess it is my understanding it put a wrench in obamacare, a wrench in the works of the will, which dissuaded vendors in
to be in that state. 2015 was in it? in the middle of the night and some on the this bill, did marco up was called the risk for door benefits -- risk somedor benefits were companies would be put in a high risk pool if they were too sick? marco rubio took that stuff out. if set of matching dollar for dollar, no, we will give you $.18 on the dollar. that put a huge range in this inle situation -- wrench this whole situation and nobody ever talks about it. guest: there is some concern among insurers and even before this repeal and replace debate
started, in earnest you saw some pulling out or waffling on whether they would participate because in the individual market you ditzy much it -- you did see much bigger pools and affected. under obamacare with the individual mandate which required people to buy insurance or else pay a fine, the hope is you would attract enough healthy people to the market to offset the high costs of sicker people. that did not happen in a lot of states. you see insurers saying the pool is bigger than effective but the costs are too high for them to participate in the profitable. it is a concern among them in part of the stabilization effort , to provide more money to the markets to help them work better and help cover the costs of some of the sicker people. host: new orleans, susan on the line for independents. good morning. caller: thank you for c-span.
i really enjoy the conversations every morning. i think the insurance companies are playing a game of chicken with the people of the united states. they are pulling out of states and they are just holding back just to see where this all goes. i truly believe that is why they are doing that, to see how far they can push the american people to settle this. it has gotten so out of hand with the insurance companies. thank you. guest: there is definitely a lot of people who are unhappy with the way the insurers have behaved, people who feel they are not being taking care of the not given certainty over whether they will be a will to purchase insurance next year, for having insurance carriers they will be a will to choose from next year. there are people who believe these cost-sharing reductions, including president trump and republicans, believe they are a bailout for insurance companies and they should not have to pay for the cost of some of these
sick or patients. that sicke -- sicker patients. "if insurance companies cannot offer products at a price that is affordable to all, government subsidies to prop them up is not the answer." we talked earlier about the planned by the freedom caucus to force a straight repeal. bernie sanders is doing something else. he told a group of seniors the solution to the health care crisis is make medicare available to all. a proposal he plans to introduce shortly after congress reconvenes in september. bernie sanders has been talking a lot about single-payer. a fine with those proposals are. guest: there is a growing interest among democrats in seriously looking at a single-payer option, something bernie sanders talked about on the campaign trail. in theory even make insurance accessible to everyone. duringthe senate debate the 20 hours of debate, a republican did force democrats
to take a vote on a single-payer option. host: what happened? guest: a lot of democrats basically did not cast a vote. they forced them to take a difficult vote in the middle of all this and he got lost. they voted on several bills and it got lost in the mess. there is a growing interest, especially among the more progressive side of the democratic party to see if single-payer options. the biggest question is how it is going to be paid for. it is very expensive. that is creating more partisanship pcn congress. some of the democrats are moving further left and republicans are moving further right. florida, petersburg, stephen on the line for democrats. caller: good morning. thanks for taking my call. with theholeheartedly public option. what is interesting to me is the
poor marketing from the democrats with regard to obamacare. for me and my family it works great. yes, we get a subsidy. we pay about $280 a month for the three of us. we are on an hmo plan, great system, physicians, but nobody talks about that. obamacare may not be perfect, but it is certainly a start. i think the republicans do everything in their power not the legs -- knock the legs out from under the chairs of this obamacare because they don't want to see it -- they don't want a single-payer system. they sabotage it. i hope one day that all of the , who is and congress paying for their health care? we are covering their health
care. they should all be on the aca. thank you. allt: under obamacare members of congress do have to purchase insurance on the d.c. obamacare individual exchange. the point you raise is a good one. you will hear a lot of people who helped create and implement obamacare say they did not advertise well. they basically had president obama going around the country advocating for the law and what they needed was doctors advocating for it. you will hear a lot of proponents say they did not sell it well when it passed. not beingibuted to it as successful as it may be could have. you are faced with the problem now of trying to get people to sign up for insurance next year on healthcare.gov, the website created under the law. the trump administration pulled many hats for it. there is concern if it will be
harder for people to sign up next year. they shortened the enrollment period. there is more concerned some of the advertising is being told back in will be harder for people to see how and where they can sign-up for insurance. host: yaya from chicago. caller: good morning. i don't think people are aware that health insurance products are very expensive and always have been. the cheapest rate he will find in this country is about $500 a month per person. that is unsubsidized. we all know most americans don't even have $500 saved. that is why health insurance is fromdered "a benefit" employers because it is a goodie. it's an expensive goodie you can get free or subsidized by an employer. ithink a lot of these people
hear complaining about the cost and repeal, from what i understand they want repealed because they are under the impression it will bring the cost down. that's a disservice by the republican party because that will not bring the cost down. the gopo mention that sued and won to drop the csr money. all the have to do is drop the appeal and he can let the gop think ahead and blame them for driving costs up. why is that not happening? somebody has made the white house aware, please don't because the gop will suffer for this. now they are scrambling to find an option. i think it is really disgraceful the republican party continues to politicize health care. they are completely dishonest when presenting their repeal. repeal will not drive costs down, especially when the chief policy is $500 per person -- the
cheapest policy is $500 per person. it has to be subsidized. it is too extensive for americans to afford out-of-pocket. guest: you are absolutely right. president trump could drop the appeal and stop making the payments if he wanted to. as much talk as there is that he is not going to own obamacare, the democrats are going to own it, polls show republicans have unified control of government. they have the house, the senate and the white house. even though obamacare is not the love they passed, they are responsible for repealing it and replacing it with something else for upholding the current law. as much may please people the implode,ill let it ultimately you would see a rise in premiums for 2018. you have midterm elections next year. the republican majority could be at risk. there is a concern that if he
really did but the law and float and did not make these payments, the republicans will be held responsible and approval ratings could sink. the obamacare repeal and replace debate does not solve all the problems with the cost of health care, the cost of drugs you raised. there is talk in congress of taking up things like prescription drug pricing. the repeal and replace debate is not the only place they can resolve issues over how expensive health care is an at least hold hearings on many ways to lower costs for people. that is one of the top concerns in the country. host: "obamacare was designed to fail to force single-payer." is that true? guest: i don't think that's true. the most was basically progressive health-care system democrats have put in place and time. you probably have a lot of democrats who would like to see something more progressive, but given the constraints they were working with this is the best
they could do. single-payer was not a widespread debate back in 2010. it has more momentum now. i don't think letting the law failed for single-payer. you have to find other ways to fix it or replace it with something else. right now republicans controlled congress so with highly unlikely he will see it replaced with single-payer. host: north carolina only have marlene on the line, independent. caller: good morning. i listen to this. i have a family member that was the head of a hospital. he quit because what happened was you don't have a health care system in this country anymore. you have an insurance system. i moved to north carolina from new jersey. before i left, a corporation from california bought up almost every hospital in northern new jersey. why did a corporation by? they raised the prices and make
a profit. we cannot have -- i'm standing i gotith time magazine about six or seven months ago. it talks about why the doctors only take cash. there is an article about a man in montana who needed a knee replacement. he got a price for $62,000 for it. he shopped around. he found the clinic that only takes cash in oklahoma. he paid $16,000. the problem is the insurance company is for profit. we are paying millions of dollars to people that don't have anything to do with health care. and when i was, young there was a hospital in dover, new jersey. they had fundraisers. they built the hospital and that is how it was built.
this nonsense of having corporations come in, buying out things and raising the prices. i have a dear friend that has high blood pressure. her medicine for years with $50 a month. it went to $600 a month for the same medication. i want to say something to everyone listening. the government does not want to end this because when a prize goes from $500 to $600, that affects the gross domestic product of this country. moneyer to borrow more the gross domestic product goes up and our government is able to borrow more money and keep us further in debt. all this needs to be thrown out. i never thought i would say it because i'm a conservative. we need a single-payer system because the only people making money are the insurance companies and the stockholders. guest: what you raise is a
common concern among a lot of people, that even outside repeal and replace health care is still unaffordable for many people. you obviously have some drug prices, especially for drugs that maybe not a lot of companies make that rise dramatically overnight. it is something president trump talked about on the campaign trail and as he has been in office.the drug companies are getting away with murder. he is referring to the csr payments as bailouts. there is a widespread desire to see congress not only focus on obamacare repeal and replace, get rid of the law or make some fixes, but to seriously address pricing and health care. you see a lot of people who, even if they have health care, can barely afford it because of high deductibles or co-pays. you go to the hospital not knowing exact how much you will need to pay and getting surprise bills. there is a widespread desire to
see some serious efforts to bring down drug prices, bring down the price of health care. there is a concern the drug companies, the insurance companies are powerful lobbying forces in washington. people wondering what realistically can get done as long as they are there. host: a lot of people want to talk with you. let's hear from michael from macon, georgia, a democrat. caller: good morning. how are you doing this wonderful morning? host: fine, thank you. what is on your mind? caller: i'm 60 years old. i have affordable care. it saved my life. i thank god it did. life insurance all my except for one month before the affordable care started. it had gotten so high i could not afford it. that january i was able to get the affordable care. when i had insurance before, my deductible and out-of-pocket
money was so high i could go get anything done except go to a primary physician. it was really ridiculous. i had out-of-pocket expenses close to $20,000 a year. pay for my expenses on, myhumana care i was premium would be $2600 a month for me and my wife. there is not a lot of people that can pay $2600 a month. let me say one thing that is very important. listen. people that work for somebody, --y get subsidies through getting a tax break for the amount of money they are giving to the employees to help pay for their taxes. whicht was taken away, would be the fair way to do it, employees would
have to start paying their fair share of taxes. or their fair share of insurance. look, there are people that are going to die if president trump and the republicans don't do something. if they want to do something to fix it, that is great. every plan we have heard that they have come up with so far is nothing but a big tax break for the rich. guest: that is definitely something a lot of republicans when they went back to their districts or fielding calls heard as various iterations of the bill were released. --ost all the virgin versions of the obamacare repeal and replace included repealing most of the taxes created under obamacare, which includes a net income tax on high-income
earners, taxes on pharmaceutical companies and medical device manufacturers and some other businesses. and of course the cbo, when they analyzed the house bill and a couple of versions of the senate bill found in each version one than 20 million people would lose their insurance. republicans say that's because people would not have to anymore. they would repeal the individual an employer mandate. but there is broad concern if the republicans to succeed in some form of the bills we have seen so far, millions and millions of people to visit insurance. the cbo found various forms of this bill would cause premiums to rise. the only way it might be a little lower is through some of these proposals that would get rid of some of the mandates that insurance covers certain benefits. there is a concern insurance without help people pay for costs. it would cover very little. the so-called skinny or skimpy
plans, and they would not be that useful. people would still be faced with the same astronomical cost they may have now or worse. host: one more call, carol from maine. -- harold from maine. good morning. caller: i just want to mention i am 48. i remember pretty clearly when i was a young man in the early 1980's, my dad was a welder. family, we were a family of four, he had blue cross and blue shield through the outfit he worked through. there was no deductible. he had 100% coverage for the entire family. if it was possible back in the early 1980's, why in the world
is a not possible now? there are 320 million americans, 180 million working taxpayers. they gross domestic product of $20 trillion annually. we are exponentially wealthy nation. ironic that have a thing called the affordable care act and it is not really affordable. guest: that is something i think members of congress across the aisle have heard from a lot of their constituents. whether you are republican, democrat, independent, health care is unaffordable for a lot of people. there are a lot of countries that are watching our health care debate with a lot of interest, especially countries like canada. they are wondering why the u.s. is such a complicated, extensive health care system. health care costs have risen
dramatically over the past couple of decades, faster than the rate of inflation. there is a desire to see congress hold hearings on this to discuss why the health care system is the way it is. it is very complex. it does not make sense to most people. you don't always know what you are going to pay when you walk into a hospital or doctor's office. while the affordable care act tried to address that in some ways, it has obviously fallen short. we will hear a lot of democratic knowledge that. there is a desire to work within the affordable care act to try to make it better, try to address the concerns many people have better health care is unaffordable. whatever program they might be on. you have not seen that happen quite yet. you have seen a lot of focus on upholding this campaign promise. there has not yet been a lot of discussion about what to do about health care costs. host: yasmeen abutaleb covers health care for reuters. thank you for being with us this morning. guest: thank you.
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