the state director of medicaid in our state says if we increase medicaid coverage to 150% of the federal poverty level that costs the state of tennessee $572 million. if the federal government pays for that, the bill for the federal government for that increase is $1.6 billion just for the tennesseans covered. if we also increase the pay for medicaid providers to 110% of what medicare pays physicians, that would add another $600 million in tennessee, because tennessee medicaid pays physicians 70% of what medicare pays physicians, and medicare pays physicians 80% of what private pay pays physicians. so the increase costs just for tennessee of the medicaid expansion in the kennedy bill is $1.2 billion, according to our state medicaid directors. if the federal government has to pay the whole thing, it's $3.5 billion. then they're talking in the finance committee about shifting those costs back after five years to the state. so here comes a $1.2 billion bill to whomever is governor of tennessee in 2015. last time, just to put this in perspective, they tried to pass an income tax in tennessee

that's the medicaid program. the second thing, a senator who goes home to serve as governor for eight years would find is that increasing coverage in this way will require much higher state taxes at a time when most every state is making a massive cut in services and a few states are nearly bankrupt. for example, in my state of tennessee, if the kennedy bill were to pass, which would increase medicaid expansion by 150% and increase reimbursement rates to 110% of medicare, it would require, based on our estimates, a new state income tax of about 10% to pay for the increased costs just for our state as well as perhaps add another $500 billion or so to the federal debt. and finally, madam president, if we were to base new coverage for the 58 million people now in medicaid and others who need insurance upon this government-run medicaid program, these americans whose -- who are the people we're talking about in this debate, who are the ones we hope will have more of the same kind of health care that the rest of us hav

as somebody who deals with medicaid every day and every governor has to deal with medicaid very often because it is such a difficult issue, it's become such an expensive program, for many states, up to 20% of their state budget, and my state, almost 15% of our state budget, and the savings are not easy to come by. my state legislature has not achieved a budget yet and the two outstanding issues are both medicaid issues. so we governors understand that fooling around with medicaid is a touchy subject. but when you see what is being proposed, my people tell me in mississippi, my medicaid people, that the house bill would result in adding 300,000 mississippians to the medicaid roles that essentially is a 50% increase in the medicaid roles. we haven't got $50 million more to put into medicaid which is what a 50% increase you would wo -- would cost us. we also don't have any idea how you're going nike the savings to reduce the cost of the program where we could add 300,000 people and it not cost anything. we're very concerned about it. i think a lot of governors, democrats as well as repub

in overall market improvement in medicare and medicaid. a one to ask questions about that. the draft proposes that you fill in the doughnut hole and the prescription drug benefits to eliminate cost sharing and to expand the eligibility and medicare subsidies for low- income enrollees. how do you view the combination of these medicare savings proposals and the benefit enhancements as an improvement in the medicare program? >> i think that there is no question right now. there are areas where we are spending money that do not result in higher quality care or better results for patients. i think what this discussion draft its foreword is a way enhance the current program and put dollars into areas where we think there will be much better results for patients. hospital read missions is a category that is targeted toward this. one out of every five patients leaving the hospital today is readmitted with in a series of weeks. that is not good for the patient and will cost a lot of money for the system. coordinating post-release care, actually in

well, medicaid has even more problems. medicaid provides coverage but it does a poor job of providing access. in one way, this is really a ruse being perpetrated on the american people under medicare and medicaid. we say, yes, you have coverage, but if you can't find a doctor or health care provider that will provide you access at that price then their coverage doesn't do you any good. according to a recent "wall street journal" article, medicaid's low reimbursement rates which are lower than medicare have resulted in 40% of physicians restricting access to patients in the program. so it's no wonder as the journal of health affairs said last month that physicians typically have been less willing to take on new medicaid patients than patients covered by other types of health insurance. medicaid reimbursement rates, as i said, are lower than medicare. more than 25% lower than medicare. one group that has a significant presence in my state illustrates the problem with 1,300 physicians and 500 advance practice nurses specializ

of medicaid. and when the stimulus funding goes away after two years, which was sent to the states to help pay for medicaid costs, that's another $600 million. we throw so many dollars around up here that it's hard to say what's important. just to give you one idea of what would happen if a senator went home to be tkpwofrp and had to manage a medicaid -- went home to be governor and were faced with a $1.2 billion, $1.5 billion, $1.8 billion new state cost about 2015, where would he get that money, or she? the 10% income tax state would raise about $1.2 billion. the cost we're talking about adding to states are astronomical. most states who are having a difficult time even balancing their budgets this year, some nearly bankrupt -- think of california -- and add to that huge new medicaid costs as well as a federal addition to the debt of $2 trillion or $3 trillion is an unimaginable prospect and totally inconsistent with what president obama has said, who said very sternly to congress two or three w

the cost of medicaid going up.

of expanding the medicaid program and then finally on the medicaid program just because you have a card doesn't mean you get the care. there's got to be a primary care dr., there's got to be somebody there to take care of you and 40 percent of doctors nationally don't provide an will serve us to medicaid patients because of the low reimbursement rates so it is hard for me to imagine why would you even consider expanding health care that we all want to do through such a failed government program whether so many other better alternatives. on on just one other aspect the employer mandate. of this is not a time to be putting a tax on employers in america. in the middle of a recession when we have 9 percent unemployment and automobile businesses are having a difficult time and are spotlighting defective worldwide competition we give you an example. tennessee is in idle state and a third of our jobs are on jobs. every one of those suppliers is sitting there watching costs. and just a little bit to the cost of making it part to a car in tennessee and it increases the want the chance that that

the people committing the fraud is not medicare and medicaid. it is private corporate interests. >> trying to quantify this is not easy, but just to briefly share with my colleagues is how much fraud is out there. 1990s, the fbi estimated 10% of all health spending was lost to fraud and abuse. that is an fbi conclusion. the national health care anti-fraud association estimates that 3% of all health standings is lost to fraud. whether it's 8% or 10%, it's a significant amount. some suggest fraud and abuse is only a problem in the public sector. senators sar bain -- senator sanders, i think, answered that clearly. how well these programs are managed is very important. i authentic your analogy to use the suggestion where fraud and abuse is occurring is misplaced. department of labor is a key enforcement agent. as of may 2009, a month ago, they initiated 768 and 207 criminal investigations obtaining monetary penalties of more than $205 million. they currently have 73 civil and 60 criminal investigations that are ongoing. criminal activities often or

typical estimates of the medicare and medicaid fraud are around $60 billion. now, i want to just touch on because we have not gotten into this, to make a simple point, we have uniquely in the industrialized world a health care non-system which is dominated by private corporate interests. i want to touch on a few of the aspects of that. when you talk about health care costs in america, you are always talking about the cost of medicine, and prescription drugs are expensive in america where we pay by far the highest prices in the world for prescription drugs. let's talk about some of the major pharmaceutical companies and the role they play in making our health care system by far the most expensive in the world. start out with the largest, pfizer, and some of you may know this, but just this year a jury found that pfizer owed the state of wisconsin $9 million for violating their medicaid law more than 4 million times. that i face potential fines of $431 million and $4 billion. and also 2004, a division of pfizer plead guilty to felonies and agreed to pay $430 mil

program and watching every other governor struggle with the medicaid program. in 1980, shortly after i was elected or maybe it was '81, i came to visit president reagan and i suggested to him that the federal government take over the entire medicaid program and let states take kindergarten through the twelfth grade, all funding, just a grand swap. my reasoning was that i thought the program was inefficiently run because we had the federal government paying for 60% of it and writing the rules and then the states paying for 40% of it, a little less in tennessee's case, and having to live under the rules. so we had a case of people in washington saying this sounds like a good idea and putting it into law, then all of a sudden when governor dodd or governor alexander, governor mccain or govern enzi in their home states try to implement it and they find out they have to pay extra state money for it and that has to come out of the money for the universities or whatever place. without getting into a long discussion of it, this was the principal contributor over the la

and medicare fraud and and we know from state experiments which do with medicaid because that is the one i have to pay a portion of and there are extension in there are huge opportunities there. even suggest a doctor from the squad was should be a demonstration program or there would be health care professionals that would conduct random visits to health care practices and attempt to purchase pharmaceutical medical equipment participated in visits and inspector general two follow-up on notable findings in refer individuals to appropriate federal authorities. and, of course, help the courts come up again the state health courts, state medical liability situation senator gregg has much more technical amendments he would offer but would ask you to look at because the kennedy bill would open up the current preemption of state fraud laws under erisa and allows the plans to be subject to 50 different state laws on fraud. and his amendment was strike that provision and maintain the current law. that is one of those things where we would be make it extremely difficult for employers to comply

senior adviser for health care fraud established under this bill will focus also on fraud in medicare, medicaid and schip. my second amendment requires the senior adviser for health care fraud created under title five of this bill to report to congress on federal efforts regarding the detection and prevention of health care waste, fraud, and abuse. my third amendment requires school based health centers and those employed under or under contract to follow state law requiring the reporting of child abuse, child molestation, sexual abuse, rape and incest. funding authorized in title iii is discontinued and the provider of services fails to report this information in accordance with state law. n deferment program, also known as the 220 rule. this rule was eliminated in the college cost reduction and access act and has had a negative effect on the ability of medical residents to repay their student loans. we're going to increase the pot, we better increase the providers. my fifth amendment requires school based health center program to provide age appropriate care to children. my sixth amendment re

medicaid had an estimated improper payment rate of 10.5% or $18.6 billion for the federal share of medicaid expenditures. the highest rate of any federal program. and it is my belief that in the second half of the legislation that we are going to consider we are actually going to consider and i expansion of the medicaid program. and that it will probably be presented at the federal government is going to pick up 100% of the expansion cost for a period of four years and the states will be partners again. i think i know why we are not seeing the legislation will in advance because the state's, the governor's regardless whether they are republican or democrat would be opposed because its medicaid that's not the bogeyman in the state budget right now. they've got to get control but we do nothing in this bill to address the problems that exist in medicaid and at the top of the list. it is $18.6 billion worth of improper payments. we have all been quick to come to a floor and point out of the administrative cost is of private insurance and where it is in medicare and medicaid. three, four per cen

provided by the medicaid plan. there is a restrictive formulary, and that is not what we want. clearly if this program, though -- and i would be willing to accept, after a three-year trial period in which it was not working, i would want to go back and look at other possibilities, even including having the government come in and negotiate prices. but if the free marketplace is working, why not let that merkel continue? why come in and -- why not let that merkel continue? why come in and mess it up. i think it would be wrong in this new health care reform to say that we are going to have the federal government default insurance program. what they will do eventually is cut reimbursement to our providers who are already cut to the bone on medicare, medicaid programs. at lot of the democrats, very powerful democrats in the house where i serve, what this government to fall plan to look like medicare. goodness gracious, that is the last thing that i would want to see any health-care plan look like, medicare. we have lots

spending on medicaid has grown by 13% and in north carolina medicaid spending has increased 15%. at the county level in north carolina, medicaid spending has far outpaced inflation and population increasing more than 63% over the past five years. among 48 counties, they spend more of their local share on medicaid than they spend on public school construction. medicaid spending in my state, north carolina, is almost $10 billion and crippling many of the local communities. i don't think we can afford to wait another year to pass reform that's going to bring fairness and stability back into this health care system. i think the fundamental promise of this effort to the american people has been and should continue to be that if you've got health insurance now, you're happy with it, you can keep it. not that you can keep it until you have to change jobs or you can keep it until it's not affordable, but that you can keep it, period. middle class families have enough to worry about. if they have themselves and their children, if they're in a plan that works for them, they shouldn't have

or medicare and medicaid to the private sector? the biggest shift coming from medicare and medicaid to the private sector burma bubo were reimbursement levels the cost is shifted to the private sector than congress comes in complaints about the cost of the private sector. yet they are responsible for its. we'll there be lower administrative costs in the public option? no. we have the actuarial firm to a study of two years ago medicare head and administrative costs when they talk about the 2% administrative costs that is simply what a cost to pay the bills. the rent on the building, salaries, management , insurance, all of that comes under other parts of the federal budget. that is what the study did go up during it in the of budget even the prod the office of inspector general comes under a different budget and the medicare administrative costs. those are actually very high they may not be quite as high as the private sector but very high and they will be higher in the public plan. then there's the startup cost of yugo start an ins

medicaid knows they have access to medicaid and gets on the medicaid system. many of the uninsured today actually qualify for existing programs. 10 million of the uninsured today -- among other things, employees should have the opt out aggressively as opposed to aggressively having to opt in. there are things like that that can make a big difference in the system in a hurry. on the ground work that the government will never compete fairly, look at what is happening in the auto industry. the government run general motors with gmac financing cars close to zero. before credit is quite a bit above zero. -- the ford credit is quite above thzero. the government will not compete fairly. we think there's a marketplace we can help create. our members are going to come up and talk about that. they're going to come and talk about elements of the plan that will be working with folks to draft. while we are almost always last in line with the resources available to congress these days, we're going to be working hard now to bring these concepts and the legislative language i

knows they have access to medicaid and gets on the medicaid system or the schip system. many of the uninsured today qualify for existing members. 10 million have insurance available to them at work and so among other things we think employees should have to opt out aggressively of choosing their insurance at work as opposed to aggressively having to opt in. there are things like that that can make a big difference can in a hurry. on that groundwork that government will never compete fairly look at the auto industry. the government rush run general motors with gmac financing for a car is close to zero. ford motor credit it is quite a bit above zero. for those that say this is just another competitor in the field and won't make any difference, it just makes competition bigger, that is not -- there is no fact ever that bears that out. the government will not compete fairly. we believe there is a big marketplace beyond today's marketplace that we can help create and our members are going to talk about that. mr. camp, mr. barton, mr. mckeon and jenny brown-waite and we will t

there are people on medicaid and we got rebates will be paid medicaid costs for drugs because of the medicaid law said that the government will get the best price. well, under the republican plan a shift of the people who were on medicaid and medicare on to medicare so the same people who get the same drugs but the taxpayers paid more money for those drugs. it was a windfall of billions of dollars. we would like the drug companies to give us that money back and stop doing that kind of thing in the future, that is what we have in our draft. >> who defines what health care is? affordable and good quality is great. >> for health care services the physician will be the one in charge and people can choose their doctor and decide when needs to be done. we are trying to improve the delivery system so is like the start indicated in other evaluations that have shown and that we have a variation from one part of the country to another. in fact, there was an article in the new yorker that show that even within texas there was a huge disparity of health care costs for similar populations. we wan

of medicaid by the states. what your grade when you were the commissioner and governor with regard to that? >> by -- who's grading me? >> i don't know what you're talking about. i mean, i guess the people of kansas thought i got a pretty good grade because i got re-elected as the insurance missioner and governor. >> you got a d. if you got a d and you're happy about that and you're glib about that -- >> i don't know what you're talking about. >> i'm not yielding. the question i have here is, if we're going to say to our states that we're going to the federal government will pick up an additional cost on medicaid how -- aren't we sending a signal under the state's that if the federal government is picking up additional costs that they don't have to be as concerned and cost conscious? is that -- should i worry about that? >> well i would say that the bulk of the medicaid beneficiaries will still have a very significant state share and i don't know any governor in the country whose not concerned about the cost of

there's rampant fraud and abuse in medicare and medicaid. whatever the government-run program starts -- however it starts out, it is eventually going to look like medicare and medicaid at some point in time. there will be price controls. one aspect of the legislation, one piece of legislation sfatted that it would be medicare plus 10% for the government-run public option. so they would give doctors and hospitals a little bit more than medicare. maybe. maybe. you may have noticed that congressman wrangle has suggested that he would like to pay for this in part with $400 billion in cuts to medicare and medicaid. the president has suggested a little bit lower number than that, but he included in that $110 billion cut cuts in what they're calling productivity adjustments to doctors and hospitals. $110 billion in cuts to doctors and hospitals. i'm still waiting to see the headline to say, is this going to hurt seniors? has anybody seen that headline? has anybody seen the press release from aarp saying this will hurt seniors? or is this political?

they would pay themselves a portion to medicaid. seniors would pay a portion to medicare and medicaid as a supplement. host: front page of the times, ahmadinejad defiant as protests raid -- rage. here are supporters of a madonna shot. -- supporters of ahmadinejad. caller: i am extremely disappointed in some of the ideas illustrated by the middle of the road democrats. they are anxious to snatch defeat from the jury -- from victory. host: what kind of changes would you like to see? caller: i like the public auction and single payer. this is based on inaccuracies. i don't know how they can not consider that. host: do you have familiarity with the canadian system? caller: my wife is from canada. if you don't think we have rationing now, i have some horrendous experiences with my government. i am a government employee. dr. screaming on the phone screaming to these gatekeeper's trying to get health care. i don't understand why this is tied to your employment. it doesn't make any sense. it is a time to take a look at the whole thing. host

patients are medicaid or medicare they can no longer make a living. you know how these costs are picked up? the hospitals and dockets who take medicare and medicaid have to charge private insurers more money every year because every year the government pays doctors less. that's why fewer and fewer of our best and brightest students are going to medical school and that we're headed for a real position shortage in this country not because of private health insurance, but because of the government plans. we've got about 16% who have no coverage in our country today. those are the ones that we say we're concerned with right now. the government requires hospitals to provide them service whether they have any insurance or money anyway. and where do these costs go? they're transferred to those who have private insurance. so every year the inept government is transferring huge amounts of cost over to those employers and those individuals who are buying private health insurance and now my colleagues are trying to say this is what's failing us. we need to expan

and we all dealt with medicaid. medicaid is a program where the federal government pays about two-thirds of t the states pay about a third of it and the states run it. well, when we got into this business of expanding medicaid under this legislation to 150% of poverty, which is a 50% increase in eligibility, i thought back to my days in the legislature about how much money that really was that my state then was going to have to come up with under the one-third match. madam president, in georgia in 1968, the first year that we had medicaid, the state's share of medicaid for the year was $7.791 million. in 2008, the state's share was $2.468 billion. which would go up by peds 1 billion if we raise the -- which would go up by $1 billion if we raise the eligibility by 50%. that's only putting off the inevitable for the states which will be a percent of their budget they cannot afford. medicaid in georgia in 40 years has gone from 1% of our budget to 12% of our budget, with this proposal it would go to 18%. and we must re

think about medicaid for a moment. we have all of these people on medicaid. yet 40% of the physicians in this country -- the cost to them is greater than the reimbursement for it. so we've promised all of these people health care. but what we've really done is say you can only have 60% of the physicians out there. you can't have the 40%. it's much higher with some specialists that won't take medicaid. under this plan we would take medicaid, make it a defined contribution, plus add the $5,700. so we have every medicaid patient at a level of contribution that's above what the average cost of health insurance policy is today. they got an insurance policy. they no longer has a stam temperature on their forehead that says you're a medicaid patient. so what we are doing is giving them an equal basis as everybody else in the country. so we give everybody the same access to the same quality and the same choice. and while we do that, we save the states $900 billion. host: first call is from austin, texas. democrats line. go ahead. caller: thank you. i'd like to ask th

to medicaid knows they have access to medicaid and gets on the medicaid system or the schip system, many of the uninsured today actually qualify for existing programs. 10 million of the uninsured today have insurance available to them at work and so among other things we think employees should have to opt out aggressively of choosing their insurance at work as opposed to aggressively having to opt in. there are things like that that can make a big difference in the system in a hurry and on that groundwork that government will never compete fairly, i mean, look what's happening right now in the auto industry. the government-run, general motors with gmac, financing for cars is close to 0%. ford motor credit the quite a bit above 0%. for those say this is another competitor in the field and it won't make any difference, it just makes competition bigger, that's not -- there's no fact ever that bears that out. the government will not compete fairly. we believe there's a big marketplace beyond today's marketplace that we can help create and our members are going to come up and talk about

just in medicare, medicaid and social security. this bill is suggesting that we add another $2 trillion to that. in my opinion, that is totally irresponsible. the debt we are putting into this country and on to the children's back is going to bankrupt our nation, bankrupt our children and make our nation a pauper. we know that. the president knows that. he has even said it is unsustainable and for us to suggest or bring forward language that would aggravate that problem by $2 trillion is absolutely fiscally irresponsible. now i have listened to the president this week, as he has been aggressive in promoting health care. he says he has three standards. the first standard is that everybody in america should have access to adequate insurance. second standard is that we should bend the outyear cost curve so that we can afford health care in this country, and the third standard is that nobody should lose their plan if they like their plan. i think that everybody agrees with those standards as purposes. i certainly agree with them, and i

medicaid is for the uninsured and poor in this country and medicare is for citizens over 65. this was a medicaid waiver to form a managed care plan called tenncare and it was a rich blended care that provided a lot of care for not much money. what we found is that 45% of the people who got on tenncare who had private health insurance, dropped it. i asked the providers, what percent of your cost does tenn care pay? i went to our hospitals, 60% and medicare pays 90%. as you pointed out and the uninsured pays somewhere in between. what you pointed out clearly, what happens is that cost has shifted and more costs -- so your private health insurance goes up, not because what you do but what the government has done, and that is not pay the freight. if we get a public plan that will offer a lot of benefits, it won't pay the cost of services, once again causing a shift to the private health insurer. over time, i'm afraid you will end up with a single-payer system and that's not what the american people want. and that's something that will be discussed in great detail in the future. m

medicaid knows they have access to medicaid and gets on the system or the s-chip system. many qualified today for the existing programs. 10 million have insurance available to them through work. among other things, we think employees should have to opt out aggressively to in choosing their insurance at work as opposed to aggressively having to opt in. there are things like that that will make a big difference in the system. on the ground work the government will never compete fairly, look at what is happening right now in the auto industry. the government run general motors with the gmac financing cars close to zero. ford motor credit is far more above a zero. some say it makes competition vigorous. there is no fact that for the bears that out. the government will not compete fairly. we believe there is a big marketplace beyond today's marketplace that we can help create. our members will come up and talk about that. many will talk about elements of the plan we will be working with an drafting people on and hopefully -- we are almost always last in line with the resources

the medicaid patients because they can afford to do it. who is paying for that is private insurance. the estimates came out a few weeks ago and whether they are entirely right or not i don't know but in the range of everybody paying $1,000 to support public programs to have private insurance. so i think this kind of transfer of the private sector dollars in health insurance to support the public programs like medicare and medicaid are not going to be able to happen if you lose the private system. i think the bigger question is, is that quite fair? is that quite a appropriate? why might make that transparent and in fact why should medicare or medicaid under pay for care of a patient's, and that is the discussion we really have not had as a matter of fact. and medicaid in particular has been bankrupting states left and right, so i think that before we say the answer is a single-payer government system the public has to be in on the dialogue of exactly what has been that good things and the bad things about the two biggest public programs, bu

medicaid programs cover it. but medicare fee service stand as loan in the failure to cover the services, equipment and supplies needed for home infusion therapy. so my bill which is the medicare home infusion therapy coverage act, i've introduced with 92 members of congress. i've introduced it with my republican colleague, tim murphy and 20 members of the energy and committee are sponsored. can i have your commitment that your staff will work with me >> we will certainly look forward to working with you and seeing what can be done in this area. >> thank you. i'm turning back my time. i want it duly noted, mr. chairman. >> it is duly noted. >> thank you so much. madam secretary, thank you very much for taking your time to be here. i understand you have to go to the white house for a taping and i would hope -- >> with the attorney general. >> i am sorry. then i was misinformed but i would certainly hope that you will be able to return and answer the questions that those on the committee have about the health care

we call it medicaid. it is a terrible example. the government accounting office says we literally waste 10% of every dollar -- of all the dollars that we give to it. that's $32 billion a year. it's filled with lawsuits, bureaucracies, inefficiencies, it is a tremendous expense to states. it is ruining higher education because governors and legislatures a putting every available dollar into medicaid and have nothing left for the community college. the worst is, it doesn't provide service. it's like giving you a metro pass and there's no subway because 40% of the doctors won't serve medicaid patients, low-income americans, because of the low reimbursement rates. so what do would have with our great government program called medicaid? twice as many medicaid patients going to the emergency room to get their care as do uninsured americans going to the emergency room. that's what we have with that government program. yet the kennedy bill, which we're considering in the senate "help" committee -- that's the only bill we're considering, e

first was the 87 billion in medicaid. it's not that the federal money was flexible but it allowed states to take the previous match they were going to do 6.5% or so and use that to potholes and other places and the second piece was a stabilization which was 48 billion that went to education. and because education totals about 30% of the average budget there was a lot of flexibility there as well. the remaining 110, 111 billion was specific in terms of categories, flexibility to move that money around. and of course be provided flexibility because as economists often say because the balanced budget requirements states actually do the cyclical activity of cutting the budgets and raising taxes makes the downturn deeper and longer. and i think that when i look at the recovery package on think it was positive from a number of standpoints both for the states as well as kaput economy. first the 135 billion was a high percentage of the total that came to the states that this flexible, which was a plus. second, the money came in t

and what is allows states to do particularly in the medicaid because it is also the medicaid money retroactive to october as i remember 2008 and is over 27 months the number that has out states to take their money because the fed was picking up an extra 6% share and to spread it around and factual find places where that money was even used to protect education. from a macro economic standpoint it was very positive because we have shortfalls of 200 billion going into the downturn before the recovery package and that would have had a larger negative impact, so the medicaid money in the education money really you can see it as soon as it was the bill was going to go through. and number of states have are the announced cuts were able to put them on hold. the problem is that we always figured it would be nice to get 30 to 50 percent of the shortfall and a particular time and that is what it pinned down to me, but the economy deteriorated so much more after that that there is just not enough flexible money. so i think it was a very very good policy, it was a fair amount of flexible money and it was

and what it has allowed states to do, particularly the medicaid, because it's also medicaid money was retroactive to october as a remember, 2008. and it's over a 27 month period. but that's allowed states really to take back their money because the feds are picking up over a 6% share. and to spread it around in fact you will find places where that money was even used to protect education. from a macro economic standpoint it was very positive because we had shortfalls of 200 billion going into -- or before the recovery package, and i would've had a larger negative impact so that medicaid money and the education money, really you could see it as soon as it appeared that that bill was going to go through. a number of states had already announced that. were able to put them on hold. the problem is that we always figured it would be nice to get 30 to 50% of the shortfall. and in the particular time, that's what it and out to be, but the economy deteriorated so much more after that that there's just not enough flexible money. so i think it was a very, very good policy. it was a fair amount

medicare and medicaid is driving costs and yet we are going to increase medicaid to 133% of federal poverty level. i have an article here from a group that points out that when you have increased medicare and medicaid, for the private insurance companies, it drives the cost of. it is a hydraulic effect. he pushed down here and it pushes up here. one question i have is, how are we going to control medicaid we are increasing the reimbursement levels and we are increasing the eligibility? that is just across purposing. secondly, next tuesday morning, i'm going to be tree lots and medicaid patients in a public hospital in louisiana. i've done for 20 years. i do not think a single one of them would say it is a patient center. i frankly did not see much over the weekend that said patients center. we are using that rhetoric. as a guy that has been spending 20 years addressing it, i've not seen it. even the advocates admit that there are a lot of obstacles to be instituted. bundling is an improvement. i wonder how we are going to save money by using the state power to drive down the provider reimbu

much of our mental health care system is the medicaid program. much of the problems that populations afflicted with mental illness have our lower income people. and this is a really important point about the health care debate. we have to talk about when we're talking about delivery changes and reforms, and when people are discussing, you know, in washington all people will talk about is the prevention of and care for the chronically ill. who is the mentally ill? who are the people we can prevent the mental ill? that is your issue. you should own it. you should own the issue. and i suspect you will. you just need to make sure that -- by the way, you should say don't act as though mental illness is an issue that's independent of or somehow out of this broader debate. it is fully integrated and must be addressed as such. and as you do that, you will find -- so you are saying you're right, senator so-and-so. you're right congressman so-and-so. this is the biggest issue, chronic illness. and if you want to do chronic illness right, if you want to do

and what it's allowed states to do particularly under medicaid, because it is also the medicaid money was retroactive to november 2008 and it's over 27 month period but that has allowed the states to take back their money because the feds were picking up an extra 6% share and to spread it around you find places where that money plus used to protect education and from a macroeconomic standpoint it was very positive because we have shortfalls of 200 billion going in before the recovery package and that would have had a larger negative impact so that medicaid money and education money you could see as soon as it appeared that bill was going to go through. and number of states had already announced cuts were able to put them on hold. the problem is that we always figured it would be nice to get 30-50% of the shortfall in that particular time that is what it panned out to be. but the economy deteriorated so much more after that that there is just not enough taxable money. so i -- i think it was a very, very good policy. it was a fair amount of flexible money and highly targeted. basically

. -- of a medicaid expansion. perhaps some tax credit that will help people for their coverage. they are looking at what the cost of the bill is. they want to get it under a trillion dollars. also in the senate, the health committee has started their mark up of their bill. it is very contentious. it has republicans offering tons of amendments to the bill. chris dodd has been handling things. he is trying to get consensus on that panel, but that could go till the end of the week. in the house, republicans have come up with that the outline of a product that would look at private sector solutions. they don't want an employer mandate plan. they might want to increase the use of health savings account, they want people to be able to purchase health insurance across state lines. today, house republicans are expected to reveal their bill. individual that mandate, medicaid expansion, a robust role for government. >> one of the cornerstones is, even if you get consensus on it, is how you pay for it. the new york times tal

in tennessee, about 14, 15 years ago, we had medicaid. we got a waiver to try a managed care system back in the 1980's and 1990's. managed care is how we were going to control the escalating costs. it was a wonderful idea to provide coverage to as low a cost as we could. we put a plan together, as we're doing right here in this congress. we are going to put -- the most astounding thing i ever heard of, in less than 60 days, we're going to vote on a health care plan that affects every american citizen, 300 million of us. and your health care choices are very personal choices. they're between you, your physician and your family. so the plan was a managed care plan and it was a very roots plan. it provided care for not much money, and for some people, no money. and what happened was -- and people made very logical choices. about 45% of the people ended up on tenncare and had private health insurance and dropped it. why did they do that? this tenncare provided more coverage and people made a conscious decision. the problem with the plan is it

about two-thirds of our suggested savings from medicare and medicaid. one-third coming from new tax revenues. he had a suggestion which is limiting the atomized reduction on high-income earners. -- limiting the atomizeitemized deduction on high-income earners. >> should we pass the tax cuts first and then get around to health care? >> i think we should do extensive health care reform. we need to do it for health care and make sure that it does not increase the deficit in the crucial putin your budget window -- crucial 10-year budget window. >> thank you. >> thank you for being here today. i agree with the economic arguments. we got a medicaid waiver in tennessee to a form a managed health-care plan to cover most of the people in the state of tennessee. what happened was it was a very rich plan offering a lot of benefits. small businesses and others may be perfectly logical decision to drop private health insurance and go into the government run plan. 45% of the people who are in the plan had a private health insurance but dropped it for the government a

even though she wasn't available for the medicaid program in connecticut. so the point is we don't leave anybody out. it doesn't mean you get everything for free and it's zero -- you know, first dollar coverage. it means that there is a way to help people to make sure that they're not going to go broke that they are still going to have access. there is a means to do that that's fair to every american, that we treat every american family the same. host: there will be a hearing july 13. what does that mean? guest: it means a lot of hard work. i wish they would have delayed it. we have a commitment to get that nomination through before justice souter retires. there's 4,000 cases. and for me to do a good job and to make an appropriate -- i've got stay. i'm spending an hour a day on it right now. i'm sorry that we've got the conflict over time. actually, i heard the debate on the floor last night. it sound like a bunch of children argue between the republicans and democrats on it. fact is, it's not about time, it's about making a really good, informed decision.

is medicare and medicaid. that is -- when you hear all these projections about all these trillions of dollars and red ink got out as far as the eye can see, almost all of that is because of the increase in medicare and medicaid costs that are going up much faster than inflation. host: what is your reaction to the president's speech yesterday? guest: there is no question that health care expenses are a big driver of federal debt and federal deficits, but i think what he said is true but it is misleading because his plans and the plans being circulated on capitol hill by his allies, do not have much in the way of cost control. it is hard to come up with an example of a country that has expanded coverage while cutting costs. he may talk a lot about cost control, but the driving force on capitol hill is to expand coverage and that will cost serious money. host: what do you envision health care reform looking like? guest: i would like to see an end to the tax penalty for buying insurance policies yourself, as oppos

pay a portion to medicare and medicaid as a supplement. >> host: thanks for the call. front page of the los angeles times -- ahmadinejad. and pitcher of supporters of president ahmadinejad as we go to maryland and this is paul honor democrats line. >> caller: good morning. a couple of comments about health care. i am extremely disappointed in some of the cowardice demonstrated by the middle of the road democrats. it you know, they are just anxious to snatch defeat from the jaws of victory, though they understand this is a once-in-a-lifetime opportunity to make some real changes. >> host: what kind of changes? cust. >> caller: i am for a single pair and a lot of the canards about the canadian system just totally based on inaccuracies, i don't know how they can not consider that. >> host: do you have some familiarity with the canadian system? >> caller: i do. my wife is from canada and all her relatives are there and, in fact, if you don't think we have rationing now, i have had some horrendous experiences with my government there and i am a government employee, in terms

well, the medicaid program in the kennedy bill that we're considering would increase medicaid by to 150% of the federal poverty level, which sounds real good until you take a look at the cost. in tennessee alone, if the state had to pay just its share of the requirement -- about one-third -- that would be $600 million. and it would be another $100 million if it has been suggested, it's required that the state reimburse physicians up to 110% of medicare. that's $1.2 billion of new costs just for the states. well, the discussion has been the federal government will take that over for a few years and then will shift that back to the states. my response is that every senator who votes for such a thing ought to be sentenced to go home and serve as governor of his or her home state for eight years and figure out how to pay for it or how to manage a program like that. in our state -- i mean, we talk about money up here, a trillion here, a trillion there. but $1.2 billion in the state of tennessee equals to what, about a 10% income tax on the people of tennessee would bring in. we don't have an

it is medicare and medicaid. when you hear all these projections about all these trillions of dollars in red ink going out as far as the eye can see, almost all of that is because of the increase in medicare and medicaid costs that are going up much much faster than inflation. it is undoubtedly true that this economic crisis has hurt our budget situation, because again, a lot less money is coming in from corporate taxes. that reduces the amount of money coming in. we have a diploma -- a lot more money out for food stamps, insurance, and all kinds of other help the people the when they get thrown out of their jobs. that has contributed to some of it. i have proposed investments in education, energy, and health information technologies. all those things i have proposed, my stimulus package, the financial system, all of that stuff accounts for 7% or 8% in terms of increases and deficit. the real problem is medicaid and medicare. that is the nightmare scenario. health care inflation is no more than ordinary inflation

and as we know for people who we know and love much of the medicaid system is mental health and much of that is medicaid and much of the problems of the populations that afflicted with mental illness is lower income people. this is a really important point* of the health-care debate. when we talk about delivery change and reform and when people are discussing in washington all people talk about is the prevention of and care for the chronically ill. right? who is a mentally ill? who were those people? that is your issue. you should own at that issue. i suspect you will you just need to make sure, by the way, you should say don't act as though mental illness is an issue independent of or somehow out of the broader debate, it is fully integrated and must we addressed as such protests you do that, you are saying that you are right senator so when so or congress man so and so, this is the biggest issue, mental illness 512 do prevention right, you must do this progress ynez you use that as a strategy as the best that you can, you are attaching your train car to the in gin. that's is what y

dent: that's medicaid and schip. mr. kirk: that's right. as we found in the state of massachusetts, when a mandate that everyone has to buy health insurance is put forward, what they have generally found is that a technical and legal solution is not adequate. they thought by putting a health insurance signup machine at the entrance of every emergency room at the state would register and collect the required number of people who hadn't yet signed up for public assistance that they were eligible for. what they found is, for a small percentage of the most difficult parktes, either because of alcohol, drug abuse, or law enforcement problems, these patients were not registering under similar names, not registering under similar addresses and were failing to report for appointments and other preventive care. meaning for that small percentage of american we need to provide an open public clinic. it's the most more -- it's the much more appropriate health delivery system. for this small percentage of americans, we have different names, different ad