tv Washington Journal Tricia Neuman CSPAN November 20, 2021 11:04am-11:54am EST
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>> "washington journal" continues. host: we are back with tricia neuman who is the senior vice president and executive director at the kaiser family foundation. she is here this morning with us to discuss the future of medicare and rising medicare premiums. good morning. guest: good morning. host: for our viewers, some of whom might not know, can you give us an explanation of what the medicare program is and how it is funded? guest: medicare is a very popular program mostly for people 65 and older, but also
for younger people with disabilities. there are 62 million people who rely on the medicare program for health insurance coverage. medicare provides basic health benefits, inpatient hospital, physician, prescription drugs, preventive services and it is funded in a combination of ways. it is funded by payroll taxes, all of us working people pay and employers pay throughout our working lives so that medicare is there for us when we retire. it is also funded by premiums that people on medicare pay and it is funded by general revenue. that is taxpayer dollars that go for lots of different programs funded by the federal government , all of the departments, and also medicare. one of the things i should point out is medicare is different from medicaid and sometimes people get the two confused because it is not a subject
program. people are eligible without regard to their income and people are also eligible without regard to their health conditions. anybody with any pre-existing condition can qualify if they meet other eligibility criteria. host: we hear a lot especially now about the different parts of medicare. medicare part a, b, c, d. can you explain to our against a little bit about all of these different parts of medicare and how it affects the people who are on medicare? let's start with part a. guest: i am sorry it is a little more complicated than it needs to be. but it is. part a is the part of the program that pays for inpatient services like hospital services, skilled nursing facility services. it is mostly the inpatient part of the program and it is funded primarily by the payroll taxes that i mentioned before. that is part a. when people go on medicare, it
is automatic. ready for part b? guest: tell us the difference between part a and part b because part b also deals with insurance. guest: part b is also part of medicare. every part is part of medicare, but part b pays for physician first -- services, outpatient services, preventive care, things that do not have during the hospital stay or during skilled nursing facilities. that is the outpatient side. it also pays for drugs that are administered by doctors and that is important because that has become a growing part of healthcare spending for medicare. that is part b. part b is funded by premiums and general revenue. host: let's move to part c. what is part c? guest: part c is the part of the
program that covers these benefits i was just talking about, but does it through private insurance companies. these are medicare, hmos, and ppos that are offered by insurance companies and the way that works is companies get a fixed amount of money from medicare for every person that they enroll and they commit to provide all medicare benefits and they often provide additional benefits. this is called the medicare advantage program. people across the country have a choice of lots of these programs. it is an alternative to what people might think of as regular medicare or original medicare or traditional medicare, which is you just go on medicare and you do not sign up for private plans for your radical -- regular benefits. host: this is the part that we are seeing commercials about. medicare part d, the drug coverage. tell us what that is about.
guest: people are seeing a lot of ads because it is an enrollment period. part the is the way people in traditional medicare get their drug benefits. the way it works in medicare is the drug benefit is only administered through private plans. people who are in traditional medicare can sign up for just the drug plan to complement their regular medicare benefits. people could also get their drug benefits through what is called the medicare advantage plan. part d is the part of the program that delivers the outpatient prescription drug benefit, the drug that you get when you go to a pharmacy. part d is paid for by premiums and general revenue. people are paying for their part
d benefit through their premium and taxpayers are paying for part of the program. host: who determines the cost? who sets the prices? guest: the secretary of hhs ultimately puts out there premiums and deductibles each year. the secretary is relying on actuaries that work for the centers for medicare and medicaid services to follow a formula and make some decisions about what premiums should be took cover the beneficiary portion of medicare spending. host: do people have a choice of whether to use these medicare, all of these different parts, or are there options or is this an opt in plan where you can use it if you want to, but you don't have to? guest: they are not many alternatives. virtually everybody 65 and older
goes on medicare. part a is an entitlement if people work for 10 years and reach 65. they are automatically entitled to part a. there is no premium. people kind of do that. part b, many people choose to delay part b if they are working and get coverage from an employer plan. so there is some sort of choice in part b and part c. people can say, i get these benefits through my employer. i am still working. i am drawing social security. i'm going to delay medicare and that is a decision many people make. other than people who have employer-sponsored coverage, you are working longer, most people who are eligible for medicare take it because there is really no other option and people get sicker as they get older and they are much more concerned about healthcare costs as a result so once the financial protection, there is peace of
mind that comes with medicare. host: now that we have the basics out of the way, let me remind our viewers that they can take part in this conversation about the future of medicare and rising prices. we will open up our regular lines. that means that democrats, your line is going to be (202) 748-8000. republicans, you can call at (202) 748-8001. independents, your line is (202) 748-8002. we are going to open up a special line for medicare recipients. we want you to call with your questions, thoughts, concerns about the future of medicare. medicare recipients, your line is going to be (202) 748-8003. keep in mind, we are always reading on social media and on twitter at c-spanwj, on facebook, and you can text us at (202) 748-8003.
let's get to the most recent news. earlier this month, the government announced the standard medicare part b premium will be increasing $21 a month to $170.10 from the current $148.50. what caused this jump and how are they justifying it? guest: that really is a jump as we think about premium increases over the years. the actuaries in the government are thinking about how to pay for future services and there is a lot of uncertainty. there are two things in particular that they are particularly uncertain about and want to be sure there is sufficient funds available to pay for services, if need be. that is costs associated with the pandemic. there is still uncertainty about what the cost will be next year.
and then there is uncertainty about a new drug, which is an alzheimer's drug that was approved by the fda, but medicare has not made a decision about whether or not it will be covered and so the actuaries have said we need a contingency fund in case medicare does decide to cover this drug because it is really pricey. it is $56,000 per person. people who have varying stages of dementia take this drug, it would be covered under part of the program or the costs are shared by the medicare program and people on the program through their premium. what the actuaries have said is we need to be sure there is sufficient money coming in in order to cover those costs. i will say that the government
has not decided whether medicare will pay for this and we will not know until january and there is a possibility the government will say we are not going to cover it. the v.a. has made that decision. but there is also a possibility that it will be covered. medicare has a track record of covering virtually every drug covered by the fda. this is sort of a cautious move on behalf of the actuaries that has resulted in a big jump in premiums. host: does this mean that if the federal government decides not to cover this one drug that the premiums will go back down or is this a permanent increase? guest: that is a great question. it would not go automatically down in 2022. that would take a major policy decision to make an adjustment during the year because they normally, virtually always have set the premiums in the year before and those premiums are
locked in for the following year. i suppose there could be an act of congress or there could be some kind of decision to adjust premiums, but i do not know that that has happened before. i think there is a possibility that in the following year, 2023, premiums could be lower, substantially lower than they would be if medicare decides not to cover the drug. host: have medicare premiums ever gone down or are they consistently going up? guest: they pretty much go up every year. it is only a question of how much. some years, they have held constant. some years, they have gone up a tiny bit. this is a relatively big jump. i will say that the very lowest income people on medicare who also qualify for medicaid and the medicare savings program
have their premiums paid for by medicaid. they will not feel this acutely. but it is the middle income people who may notice this quite a bit and for them what this really means is a reduction in their social security cost-of-living because the premium is deducted from the social security check. rather than have their social security check go up as much as it might have gone up, the amount will be reduced by the additional $21.60 you mentioned earlier. "washington journal." you jump -- host: you jump ahead to what was going to be my next question. does the increase that they are planning affect all medicare recipients? do higher income recipients pay even more or how does that work? guest: yes, they do. there is what is called an income related premium for higher income seniors. it is for people with incomes
above the $85,000 and it scales on up so that at the highest level, people are pay more than $500 per month for their premium. this will affect people at all income levels, but relatively speaking and relative to their monthly income, it's biggest impact will be on lower income people who do not get extra health from medicaid or the medicare savings program. host: let's let some of our viewers take part in this conversation about medicare and its future. let's start with frank who is a medicare recipient out of pensacola, florida. good morning. guest: yes, can you hear me? host: go ahead. guest: i am looking at all of the programs today and i was talking to a medicare company and they informed me that you
cannot use the advantage program if you are using the v.a. system. they said you have to stick to a supplement program and i talked to united yesterday and i was told, that is not correct. i could use my v.a. program and still use the advantage program. so i am very confused about what i will be able to do. i do not want to go back out of the v.a. because it has saved me quite a bit in my medical and it is a lot easier and simpler. i would like to know if i'm able to use the advantage program with my medicare program and my v.a. at the same time. guest: frank, i believe that you
are but i would like to recommend that you contact the state health insurance program, which is set up to provide one on one canceling -- counseling for people who are dealing with conflict issues related to their medicare choices. they are available in each state and i think you should call them and get information from them directly because you are hearing different things from different companies. i believe that you can use the v.a. services and also be on medicare advantage plan. situations may vary. that would be my best advice. host: we are hearing a lot of debate on our social media channel on whether you call medicare an earned benefit or welfare. which category would you put medicare under? guest: no question, i call it an earned benefit. host: why? guest: because i have been
contributed to it all of my life. every working person who has paid payroll taxes has contributed to it all of their working life. it is just like social security in that regard. it is based on my -- my contributions are based on my earnings. that is a very fair definition. host: let's go back to our phone lines and talk to kirk who is calling from morganton, north carolina on the democratic line. good morning. guest: good morning. this supplement stuff, i had humana and then i got older and i started taking care of myself. i do not really need any more drugs from big pharma. i sat down with my pharmacist i have been using for the last 30 years. he told me if you do not get a plan when you do need to get some more drugs in your older years, you will be paying more
for the years you did not use them. can i understand that? guest: absolutely. the pharmacist is right. the idea is that everybody has been can tripping to the system, not just people who are needing expensive medications. the way that the program works is if you delay part b enrollment, the drug plan part of the program, then you will pay a penalty for every year you delay when you do sign up for a drug plan. if you are a person who really does not take expensive drugs, you still have time now during the open enrollment period to choose a relatively expensive plan with very low premiums. but it is probably a good idea to do that because if you do not and you wait 10 years, you could pay a hefty premium penalty for your drug plans for the rest of your life.
the pharmacist is trying to protect you from a premium penalty and there are plans out there that have relatively low costs. it is probably a good idea to look at those plans now before the open aroma period ends december 7 just to save yourself the financial burden if you should start to need an expensive drug in the future. host: we have another question from our social media followers who want to know about whether they should get into medicare now. the question goes, "i turned 65 last month, went online phoned medicare and was told i did not have to sign up because i am still employed and ensured. do i need to sign up for a now or not?" guest: you do not need to sign up for medicare. what you might want to do is contact medicare or the social security office to be clear that they know that you have employer-based coverage and to
delay enrollment in part b and c because there is no reason to pay the premium if you have coverage from an employer plan. no, you do not need to sign up now until you are ready to leave your employment-based coverage and you should to make sure you have continuous coverage and you do not pay penalty for late enrollment. host: right now, lawmakers will start debating in the senate the biden build back better plan. included in that plan is an agreement that would empower medicare to negotiate the price of some drugs. how significant with this development be if it passes the senate? guest: there are a lot of things in the build back better legislation that would make a difference for people on medicare. this particular provision is one that is very popular. we did some polling and we found
that democrats, republicans, and independents all agree with the idea of allowing the government to use its purchasing power to leverage lower prices for people on medicare. congress has been working on this now for some time. the house of representatives had a bill a couple of years ago that would have included more prescription drugs that are -- than are in the build back better legislation. the build back better legislation is moving through, would be a precedent change. it would move the process forward, allow the secretary to negotiate prices for the most expensive drugs under part b, the physician administered part of the program for physician-administered cancer drugs and part d where there are other expensive drugs. it starts gradually. it starts with just 10 drugs in 2025.
it would be a big deal for those drugs and it would help provide peace of mind to people who are taking various kinds of drugs and the same time, it is structured in a way to give the good -- drug companies an opportunity to be on the market for a while, capture some of their investments before the government is even able to start negotiating with them. host: i want to put a few of these other provisions of the democrats medicare drug polling here on screen and have you talk a little bit more about each one of these provisions. understand that these provisions are not final. the bill is going to the senate and there will be some changes. so far like we just talked about, it would allow medicare parts b and d to negotiate prices directly with drug manufacturers on certain drugs. it would tap out-of-pocket prescription seniors -- prescription spending for
seniors and $2000 a year. understand in the latest proposal, those price negotiations are going to apply to fewer drugs, require smaller discounts, and shield some new drugs from the negotiation. first of all, do you see these provisions surviving the senate and going to the conference committee? tell us what do you think the final proposal will look like. i know we do not know because the senate can do anything, but tell us what you think about the provisions and whether they will provide. guest: ok. you are asking me to predict what the senate will do and i am not so sure i am not so sure i'm the best person to do that. but i will tell you that some of these provisions are quite popular and have bipartisan support in the senate. in particular, the limit on out-of-pocket spending, the $2000 cap is not really a -- that is a big deal for people on
medicare. if you think about it, i know somebody who is taking a drug that is $12,000 a year for her even with part d. that is a huge amount of money from somebody who has insurance, but still has to pay for a very important drug. this provision, if the senate adopts it, will say no matter who you are in medicare part d, the most you will pay is $2000 for just -- for this drug or any type of drug. that is a game changer for people on medicare who rely on drugs that are very pricey. i think there is bipartisan support for that. it was a bill in the senate. it also had a cap on par be spending. if the bigger bill goes through, i think that has a good shot of making it to the finish line.
the same with several of these other proposals. i think the negotiation provision has been scaled way back, probably more than the progressives would have liked. now the congressional budget office says it would affect drugs coming to market. there was concern it would dampen innovation. they say fewer than 1% of drugs that would have come to the market will not come to the market. that argument has not been put to rest. i would say minimized by the congressional budget office's estimates that came out just this week and i think there is also concern about inflation. there was a provision like that in the senate. i think the medicare provision might change a little bit, but i think there is a fair amount of support for each provision and more. host: let's go back to our phone lines and let's talk to laverne,
a medicare recipient from tuscaloosa, alabama. good morning. guest: hello? host: go ahead. guest: i was concerned about the medicare. i think that if they cut it, it would be hard on a lot of people. i have lupus. the benefits that we have now are great. they really help me a lot with getting the medical procedure i need. i was just trying to figure out what they are going to cut. guest: i'm glad to hear you say that medicare is working so well for you. this legislation does not have cuts to medicare benefits. in fact, it has an additional medicare benefit and the cuts
are really in drug prices, the cost of drugs, and to people, that is a benefit. when medicare slows the growth in drug prices or has an out-of-pocket cap for drugs, that is a benefit enhancement for people covered by the program. i am not anticipating a reduction in benefits in this legislation. i think it could be just a win for people in the program. host: let's talk to michael who is calling from fayette, alabama on the democrat line. good morning. guest: hello. i am calling to ask, i want to say that we too many times forget that we are to help people who need help. i also want to say that i am for
one-size-fits-all. i believe that inflation, which is one question i wanted to ask, because some people think that $2000, that is still way too much, especially if you are on disability. i am wondering how would the inflation be covered if we did have a one-size-fits-all in medicare and what that cover or even lower and how would that work? guest: good question. i want to point out that with the medicare drug benefit, there are special provisions for lower income people, including people who are on disability. the medicare drug program has low income premium and
cautionary assistance for lower income people, which hopefully makes a difference. the inflation protections that we were just talking about apply only to prescription drugs for medicare and people with private insurance, which is something that often gets overlooked. the way that works is drug companies would have to pay the government, pay medicare back money if they increase their prices faster than inflation. it is a strong incentive for drug companies to keep their drug prices, price increases no more than inflation because if they raise their prices faster than inflation, they need to send a check to the government. the idea is that will dampen the growth in drug prices, which will make it easier for everyone on medicare to pay for their
prescriptions. host: biden's build back better plan which was passed overwhelmingly by democrats in the house now goes to the senate. where are republicans on the medicare portion of the build back better plan? are they talking about this or is it just -- or are they just staying silent as the bill works its waste -- works its way through? guest: that is another good question. i have not heard specific criticism from republicans. there will likely be concerned about the prescription drug provisions being scaled back. there are people who feel this is a crack in the armor and puts the government and a stronger position to to set prices or decide what drugs people take. i have seen ads about this.
there is nothing in this legislation that would have the government decide what drugs plans will cover. that is not something that is being envisioned. the drug industry has been lobbying aggressively against this provision and it could be that there continues to be some resistance. i do not know that there is much resistance on the out-of-pocket cap. that is a popular bipartisan proposal. the other benefit we have not talked about, there are a few other benefits. one is that cap on insulin costs, which would help people with diabetes on medicare and i think that could be popular across the aisle and i also think there is a hearing benefit that is in the house bill and i am not sure that there would be opposition to that. i think the opposition is about the broader issues and there are concerns about the spending, the
overall spending in the legislation. but i do not know specifically that there are concerns about the insulin benefit or the caps on out-of-pocket spending for the hearing benefit, all of which would make significant improvements for people covered by the program. host: we have a question from one of our social media followers that wants to ask this about the future of medicare. "will the eligibility age ever be changed for medicare?" guest: i cannot predict the future. i do not think there is a strong move to do that at the moment. there is a long-term financing challenge facing medicare with all of his aging into the program at some point in the future. baby boomers are starting to age into the program. the medicare, hospital insurance, that is part a, it is facing a projected insolvency date of 2026.
what does that mean? that means congress will have to make some tough decisions in order to shore up the financing of the medicare trust fund. congress has done this in the past and it is almost unthinkable that congress would allow the trust fund to be insolvent, but that could involve some tough choices about raising revenues and -- the more money comes in, or cutting spending and raising the eligibility age would be one way to cut spending, but it one -- may be one of the more unpopular ways to do that. host: who have to make that decision? what that be a congressional decision? with that be a decision coming from the executive branch? guest: that would take an act of congress because the eligibility age is set in law. for the eligibility to change, for the eligibility age to change up or down, that would require an act of congress. host: let's go back to our phone
lines and talk to allen calling from scottsdale, arizona on the republican line. good morning. caller: hi. good morning. i am 73 years old. i have plan g so we have not heard about plan g. thank god for medicare because when i turned 65, i went right in and i would not be talking today if i did not have it. the other thing is i'm self-employed and i do not plan on retiring until i can book the palladium in london. so much for humor. i would like to know little bit about plan g. the other thing is regarding the democrats build back program. republicans had zero input. no committees, nothing in the house. mccarthy was on for eight hours
and 32 minutes or whatever it was, wanting to be part of the party. evidently, we are not. thank you for c-span. i am having a great time being on medicare. they have been great. just to mention really quick, three tests i have had for covid, i am still negative. three years ago, i went meet people -- i went medieval on myself. i went from 285 to 234. but i am taking some really good things vitamin-wise. b-3, zinc, and b complex. i have been around a lot of people who have have covid. two of my employees have had it. i am 100% right now.
host: before you answer, tell us what part g is. guest: thanks for raising that. many people on medicare have supplemental insurance. this helps people with medicare deductibles and coinsurance and medigap has different letters because they are different standard policies and g is one of the more popular policies out there. for people who are in regular medicare, non-medicare advantage plan, often purchase medigap because it helps with the extra cost and it also makes bill paying easier because there is coordination between medicare and medigap plans. i want to make a point about medigap now that you have raised it because when people go on medicare and they are choosing between medicare advantage and
traditional medicare, a lot of people are starting to choose medicare advantage because they offer extra benefits and low premiums. the one thing that is important to take into account is that while people always have the option of going from medicare advantage to traditional medicare and vice versa during the open enrollment period, in most cases medigap insurers are permitted to underwrite to either deny people coverage because of a pre-existing condition or charge more. it is something that people who are going on medicare should really think about because people think they have the opportunity to go back and forth and they always do, but they may not have the opportunity to purchase a medigap policy if --
once they get older and sicker and have a pre-existing condition. when they got to be over 75 or 81, one person was 90 and she wanted to switch plans and they said you cannot or we will charge you more. that is something to bear in mind. medigap is not a medicare program. medigap is offered by private insurers. that is not use any federal dollars. that is paid for by premiums that people on medicare pay, if they choose it. host: let's talk to trish who was calling from seattle, washington. trish is a medicare recipient. good morning. caller: good morning. good morning, tricia. i have a question for you. it was a point of discussion over my birthday lunch yesterday. i read the reason for the cost of the significant price
increase was due to the new alzheimer's drug by biogen that was fiercely fought by the fda. in fact, several members quit. the east you is bucking back on that now -- the eu is bucking back on that now. that is my question. for the gentleman who just called, i do not understand why you would not get vaccinated at your age. as a nurse, you must have read the statistics of people getting covid without having been vaccinated. again, it is all about me, not about anybody else. as a nurse, i do not understand that logic, why you would want to put your family through that and put the medical folks in the line of fire. host: go ahead and respond, tricia. guest: i think you have spoken
clearly about the vaccine situation so i'm going to go back to the part b premium and tell you that you are right. the major factor is the concern about the cost of this one drug by bio-gen. the concern there from the government actuaries is that if medicare decides to cover it, then it could drive up medicare spending and if it does, then the premiums would need to cover those additional costs. as a conservative measure, the actuaries have said we need to increase the premium in the event that it is covered and doctors prescribe it. you are completely right that there has been strong resistance to -- strong opposition to the
fda decision to approve this particular drug and there was pushback in europe and the insurance companies and the v.a. it is uncertain what medicare will do. the actuaries looked at medicare's record and they typically cover drugs that have been approved by the fda. that was one major factor in the bump in premiums. host: how did the pandemic affect medicare? did the pandemic affect medicare? guest: that had to make did affect medicare. medicare stepped up in terms of offering vaccines and covering vaccines and helping hospitals by paying more for covid-related admissions. it has certainly affected people on medicare. if we think about the early stories of nursing homes, any of which were medicare
beneficiaries who were the first in line to get covid and die from covid and be hospitalized with covid. the pandemic certainly have ripple effects on people in the program who were disproportionately affected by the pandemic. at the same time, medicare stepped up to do whatever changes it could in order to support providers who were struggling with a pandemic in terms of payment policy and other decisions. host: let's go back to our phone lines and talk to dawn calling from baton rouge, louisiana. good morning. caller: good morning. good morning. i am on medicare. i am 70 years old. i am looking at the medicare advantage plans. i am currently on the ppo with
supplemental with another insurance company and i sat with my doctor, but i want to lower my drug costs. i have quite a few ailments. my drug costs are pretty high. i'm a diabetic, high blood pressure, and all of that. what i am afraid of is for the specialist for the medicare advantage plans, i would have to pay to see a specialist. you do not have to pay to see your regular primary care doctor. my drugs may not be -- it may not be advantageous for the drug prices. guest: i am glad that we are still in the open enrollment period. there is one place, there are a
couple of things you can do. one is you can go to medicare.gov. there is something called the medicare plan finder. if you are good with computers, it is a great place to go because what you can do is enter each drug that you take, the pharmacy that you like to go to, and it will list all the plans that operate in your area and the cost of those plans to you. it takes a bit of work. it is not that much fun to do. but you can start to get a feel for how much you might pay under one plan or another. it really does make a difference. people don't want to do it and i know it is hard to do. it takes time, particularly if you take a number of drugs. i also would advise you to find out if the doctors who you see
regularly are in the network of those plans, whatever plan you are choosing because there could be high costs for going out of network, which would mean you would pay more to see a specialist if they are not in your insurance company's network. the other thing you can do is go into traditional medicare by a medigap -- buy a medigap policy and a separate drug plan. but no matter what choice you make, this is a great time to go through the medicare plan finder and try to sort through all the different things that matter to you. what is important? is pharmacy important? which of your drugs are covered and at what cost? are all of your doctors in the network? this is the moment between now and december 7. i would strongly encourage you to do that because when i have been helping other people, i find it can make an enormous difference. that because there plan choices
and people have a choice on average of something like 30 medicare advantage plans in their area and the same number of drug plans, it is almost bewildering. people say it is too much, it is overwhelming. but it really can be worth it. i'm glad he raised the question because you do have time. i hope you can find a plan that will lower your cost and best meet your needs. host: we would like to thank the kaiser family foundation's tricia neuman for being with us this morning and talking us through the future of medicare and rising medicare premiums. thank you so much for being with us this morning. guest: it has been a pleasure. host: coming up, we will move to our open forum where you can call and talk about the most important political story on your mind. you see the numbers they are on screen. later, our weekly spotlight on podcast segment features hannah mccarthy and nick capodice who are the host and producers of
new hampshire public radio's civics 101 podcast. we will talk about the creation of their show and the role of civic education in america. we will be right back. ♪ >> exploring the people and events that tell the american story on american history tv. brett baird discusses his book to rescue the republic -- ulysses s grant and the crises of 1876 in which he insists grant's presidency has been underrated. then a symposium with robert caro that runs in conjunction with the new york historical societies exhibition. speakers include bob woodward and a keynote address by robert caro. watch american history tv every weekend and find a full schedule on your program guide or watch any time at c-span.org/history.
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