medicaid -- medicaid -- allowed him to avoid that vicious cycle. like millions of americans he went to school and worked hard to get a good job and make a decent living. but despite being employed as a professional without medicaid to help his mom, he would have had to impoverish his own family, his two children to care for his aging mom. this would have put his children's future at risk. medicaid offered this individual some help, and obviously his mother some help, in providing for his family and offering a way to have his mother get the care that she needed. this is not atypical. this is reality for so many families. one quick statistic and then i'll move to children and i'll wrap up. in pennsylvania seniors accounted for just 10% of medicaid enrollees but over 22% of spending in 2011. the national numbers aren't much different than that. the number of enrollees might be around 10% or in that lower range but the spending, because the kind of care that they received, is of a higher -- of a higher cost. let me talk just for a couple of minutes abo

in the 1970s, medicare and medicaid costs mounted. as the burdens on state governments increasedthe progms rainto criticism from state governors like ronald reagan. medical, our medicaid program in california, is increasing by 50% aear. in i first 16 months it was budgete fo$7 million. t $876 million were spent. this program went $130illion in debt in that limited time. that debt must be paid out of ts year's budget. we're in trouble in this phase of welfare. in california alone, hastily drawn legislation in this field can bankrupt our ste unless we ha revisions. the costs of medicare and medicai coinued toise atn alarmingate. asesul gislators havehiedwayfromrodi t nationalalth iuranceysm caedor by esidentruman evenug rge numbers ofmeca hanadequate accesstoeah care weskedconomistichardill abouthe economicationa fogornmentubsidizeal care. the fundamental argument for government subsidized health care r the elderly and the poor is that a market economy doesn't distribute income in the way most people consider desirable. a market economy

you're not getting medicaid rates. my point is to be careful what you ask for because the reality is over time medicaid is increased as a percentage of almost every state our state's budget and the way states respond is reduce rates and before hospitals could cost shift to the private sector when medicaid wasn't paying their full share. so the hospitals need to be very careful, this crowding out because in medicaid expansion under obamacare there are no anticrowdout provisions, no ability to say we're targeting this to people previously uninsured. so hospitals may end up -- i said that part of what obamacare does is turn insurance companies into public utilities. hospitals could very much end up being very dependent on government rates and end up being underpaid for the care they're delivering and then you'll see a degree racing in quality and access. i they don't think that's going to happen, lament at what happens with physicians in the scr. i now they have this so-called fix. secondly insurance companies are not goi

and so when americans on medicaid get sick and can't find a doctor, who will treat the medicaid patients? where do they end up? of course, in the emergency room. here's how one kentucky newspaper described it last year. that's just the opposite of what many people expected under obamacare, particularly because one of the goals of health reform was to reduce pressure on emergency rooms by expanding medicaid and giving poor people better access to primary care. instead, mr. president what's happening, many hospitals in kentucky and across the nation are seeing a surge of those newly insured medicaid patients walking right into the emergency rooms. one kentucky doctor described it as a perfect storm a perfect storm. we've given people an a.t.m. card he said, in a town with no a.t.m.'s. given obamacare's most famous broken promise about americans being able to keep the health plans they liked it's easy to see how a person who had access to good insurance and quality care before obamacare would find himself or herself forced into medicaid and into the emergency room today. a recent report fou

it the largest population we have enrolled over hocking thousand individuals. >> for medicaid. >> ac a is the law of the land you have the medicaid and insurance expansion and covered california is an component of that. >> accident framework to become. >> within the next couple of months we're no negotiations now for the first negotiation had to tend end because of the enrollment time and started up to have a completion of the negotiations. >> great 3 parts to the ac a the medicaid and cover california all and, of course our own healthy san francisco to note that many communities around the country and the biggest health systems and los angeles is work the past leadership to begin another healthy la so to speak but we have almost 18 thousand people in the healthy san francisco for those who don't qualify for the ac a and left that open for the individuals in san francisco to be able to afford the covered california. >> in colonel 4 million people enrolled a 50 percent reduction in california and in san francisco we did an enforcement effort with human services agency doing enrollment

the medicaid system continues to grow. as our economy has improved, our share of the medicaid costs goes up, which it has. the federal share goes down. and the k12 spending, it has gone up. that is the problem to we have got revenue but it is not enough to cover the big spend growth. >> our book tv focuses on non- fiction books. we are interviewing local nonfiction authors. other any books or authors that have had an impact on you? governor brownback: a lot have time reading one now that i have reread several times. a guy by the name of watchmen, a chinese writer that wrote a series of books. the one i'm reading now is the normal christian life. it is a beautiful one. i'm just starting carl sandburg's look, when he boiled all of his other books down on lincoln. lincoln is a revered figure across the country. we came into the union at the same time lincoln is coming up and the kansans at that time were passionate for lincoln. he said once, famously, look, if i were a young man now, i think i would go to kansas. we came in w

that's medicaid. you know the difference between medicaid and obamacare. and with medicaid we've cut our growth rate from 9% this budget it will be about 4% 4.5%. and we're treating a lot of people. nobody ever said -- i've never said i was against the medicaid program. i would like it to be block-granted to me is i can be more helpful in helping those who are poor and live in poverty. but i also want to hold them accountable to get them work and get out of that situation. but we have programs in ohio to deliver value-based medicine where we are incentivizing physicians insurance companies to be in a position of where we deliver better health care at lower prices. that's where i think we have to go. and i think obamacare's disrupted too much. >> you have said that the republican -- >> how's that? >> well that's clearly what you're going to say when all your opponents take you on on the stage -- >> oh jake, i don't worry about that. the deal is with me if you play golf you play your game and don't worry about anybody else. i've been okay in being able to st

let's expand medicaid. it would have been a much more honest way to do this. the way it was brought about was negligent, sloppy, a lot of people have less to lease, deductibles of increased. it helps some people and hurt other people. for those on medicaid has generally helped but if that was the goal, if that was a great grand plan to get more people covered the president should have said let's expand medicaid let's do it. he didn't do that. is happening incrementally. with regard to medicaid there are problems in that program as well and i like governors having more waiver authority to implement the program. >> thank you for the question. a lot of governors in this race. >> governors are good. >> next question from laura flanagan. >> since improving the employment picture is dependent on new housing starts did you have a plan that was significantly improve the conditions for new housing starts? >> please read my first book, the chapter about mortgages. >> you know how this started. do you care to give me

medicaid volume of about 10%. we are a taxing entity. we are able to appropriate tax funds from our district, which is about $900,000, what's interesting with that number, in our fiscal year ending in 2014, we ended up having to write off nearly $800,000 to medicare bad debt. so that essentially washes itself out. when it comes to the cost base, you're absolutely right. our reimbursement of 101% does not equate to our total cost of providing the health care within our facility. i would not -- knowing that number off the top of my head exactly, but i would say it's probably around the 75 to 80% margin, which covers our costs. so we have to look towards our local tax base to make up that difference or otherwise start looking at reduction of services which we do not want to do. >> it used to be that hospitals would tell me that that mix, that 70% some medicare medicaid, you suppose you do everything you can to cost shift those to those who have private insurance. but are those opportunities available now as -- is it better to have a medicar

does that mean is this a better deal than if it was medicaid or medicare? >> we look forward to the blue cross blue shield they can come into our facility. >> the percentage of those who come in the door is a small percentage? >> a very small percentage yes sir. sir. >> you mention uninsured and having to write off cause. i'm not trying to portray this in any partisan or the way this issue is look around here too often but under a affordable care act, a theory this would be more people injured. has not proven to be true in light of what you just said about hoping that the private insurance covered patient walks in the door? >> we have seen a small increase of those individuals that are once uninsured. we found them to be enrolled in medicaid in our state based nco program that we have. we have seen a small increase in the marketplace of those that once did not have insurance but otherwise founded on the marketplace. but when you look at the overall, that is a very small percentage of those individuals. they still find themselves uninsured. >> some hospital

medicaid volume of about 10%. we are a taxing entity. we are able to appropriate tax funds from our district which is about $900,000. what's interesting with that number in our fiscal year ending in 2014, we ended up having to write off nearly $800,000 to medicare bad debt. so that essentially washes itself out. when it comes to the cost base, you're absolutely right. our reimbursement of 101% does not equate to our total costs of providing that health care within our facility. i would not -- knowing that number off the top of my head exactly, but i would say it's probably around the 75 to 80% margin, which covers our costs. so we have to look towards our local tax base to make up that difference. or otherwise start looking at reduction of services, which we do not want to do. >> it used to be that hospitals would tell me that that mix, that 70 some percent medicare/medicaid, i suppose you do everything you can to cost shift that to those who have private insurance. but are those opportunities as available now as -- is it better to have

>> my system is about 65% medicare/medicaid. >> how much uninsured? >> about 7% at this point. >> so you have medicare and medicaid, and rest has some -- rest of your patients have some kind of coverage? >> some sort of commercial coverage, correct. >> on rack audits did you mention mr. walters you had 500 claims currently? >> that is still setting at the alj level and the backlog at the hearings center for the alj. so we've had about 1,000 denials overall over the past four or five years and we've appealed 85% of the denials. of those that have been heard we've been successful about 90% of the time in overturning the denial but the vast majority of appeals are still setting at the level and probably will be for another couple of years. >> cms suspended rack audits because there is no processor continuing to have audits? >> they are reworking the contracts for the racks so they have essentially suspended activity while they are renewing the contracts. nef said they are going to make some changes but it appears that may not go far enough in trying to c

you're going to have a medicaid car you're going to have to go to a medicaid hospital that takes a lot of medicaid and if you need a cardiologist you need four or five weeks orthopedic surgeon you wait four or five weeks that is the norm. that is what obamacare is all about. >> with the underlying problem the cost of medical treatment. for example, recently i had some blood test done, 14 00 for ordinary blood test? >> that was well written talking about how defendant it is to figure outs a medical bill. we don't put millionth bill together. right these with coders, billers with multiple codes. you have one code walk to the corner another code. incredible charges at the end of the day doesn't matter because your insurance company is going to reimburse a doctor a prefix amount same thing for the hospital. in may that is a different problem that we have to fix. but when you look at medicaid recipients now aa days, many of them are sicker because these are people that couldn't get private insurance before. so you have diabetics, you know people with heart conditions, people that really nee

. >> medicaid paid him per toonl. so can i cap it twice and then pull it and then obtain benefits for all three? absolutely. >> and dr. schneider has made a ford un from medicaid. state reports show he had received $4 million in reimbursements in the last five years. now the florida attorney general has launched a medicaid fraud investigation and the claims stretch back decades. a 1995 malpractice suit was settled out of court saying he placed 16 crowns in the mouth of a 3-year-old. the boy's family was paid $7,500. a said suit was filed that year but the documents have been destroyed and the outcome is unclear. >> someone performing procedures that children don't need and pulling teeth that he knows should still be in the child's mouth, in some cases, we even have where many procedures were done except for what they came in. >> this attorney represents dominic and dozens more of the doctor's former patients and this month he filed a potential class-action lawsuit on behalf of these children claiming patterns of abuse

the medicaid system continues to grow, and as our economy has improved, our share of the medicaid cost goes up, which it has. the federal share goes down. so that has gone up. and then k-12 spending, which is over half of our general fund budget, has gone up. so that is the problem. we have got revenue, but it is not enough to cover these big spend growths. >> at c-span, kind of turning the page, our book tv focuses on nonfiction books, and we are here in topeka focusing on nonfiction authors also are there any nonfiction books or authors who have had an impact on you? sam brownback: a lot, i'm reading one now that i have reread several times. a guy by the name of watchmen knee. he was a chinese writer that wrote a series of books, the one i am reading is called the " normal christian life." he ended the last 20 years of his life in prison in china. for his faith. it is a beautiful one. i'm just starting coral sandberg's book,

medicaid. we know that medicaid reimburses hospitals for less than it cost to treat patients. so despite ways to decrease visits to the emergency room the vast majority now say they've actually experienced a surge in patients. visiting the er since obama care came into effect, in fact the recent survey reported that er doctors have seen an increase since the start of last year. one physician from lexington in said he has seen a huge backlog in the er because the volume has increased. the er volume roles by almost a fifth which is nearly double what they saw in the same period last year. for a lot of reasons these volume in the er is driven as a result of adding new people. it has largely been borne by the medicaid program. as i said previously though, increasing coverage doesn't increase the quality of care. kentucky are ready faced a shortage of physicians and now they're more than 300000 enrollees in a broken system. that is 300,000 new people to an already broken system. so when americans on medicaid get sick and can't find a dr. who will take the medicaid patients? where t

snider has made a fortune from medicaid. state records show she has received nearly 4 million dollars in last the last five years. now the florida attorney gen's office has launched a criminal medicaid fraud and the claims stretch back decades. a 1995 malpractice suit was file out of court. it says he unnecessarily placed 16 crowns in the mouth of a 3-year-old. the boy's family was paid $7,500 as part of a cement agreement. and another one filed wut the documents destroyed and outcome unclear. >> somebody who is performing procedures that children don't need and pulling teeth that he knows should still be in the child's mouth, in some cases we have where many procedures were done except what they came in for. >> reporter: he represents dozen more of dr. snider's former patience. and he filed a class action lawsuit on behalf of these children claiming patterns of abuse, an accusation that cnn discovered has been made before. according to this 2013 police report the mother of a 5-year-old patient was allowed to sit with her ch

state medicaid agencies have taken action to attack that epidemic. efforts include expanding medicine dade to include behavioral health service for those addicted to drugs and pharmacy management review programs. cms does not determine what services are provided if each medicaid program to prevent and treat abuse, we are encouraged by the increasing efforts by states effected strategies tore designing benefits for the population. we launched the accelerator program, iap, toprovide states with tech nal assistance and t% other support to address this important issue. cms in coordination with cdc, and nih, issued informational bulletin on medication assisted treatment for substance abuse disorder in the medicaid program. it outlined that medication and behavrju(s herapies is the most effective combination of treatment. we issued a similar bulletin "t#ocused on these services in the pediatric and youth population. cms is dedicated to providing the best care to beneficiaries with opioid addiction. working with part d sponsors and state medicare programs t

the medicaid system continues to grow. as our economy has improved, our share of the medicaid costs goes up, which it has. the federal share goes down. and the k12 spending, it has gone up. that is the problem to we have got revenue but it is not enough to cover the big spend growth. >> our book tv focuses on non- fiction books. we are interviewing local nonfiction authors. other any books or authors that have had an impact on you? governor brownback:

are financed by medicaid, and they're cutting medicaid by $1.3 trillion. they'll fight for your right to be born but boy don't count on you getting any help if you wind up in a maternity ward. at a time when more than 50 million senior citizens and disabled americans are in the medicare program and baby boomers continue to age in, they propose cutting the program by $430 billion and placing the burden on the backs of seniors and privatizing that program through vouchers. they're going to end medicare. senior citizens, you're under new management here, and they're ending medicare as we know that. as we know that great program. so after years of being the most successful program, and if you ask people on medicare if they like it, they not only like it they love it, they're ending it. and as senator sanders points out eloquently, i thought they're saying to a sick person you know, people are living longer thank god. and so let's say a person is 85 90 years old. having a hard time functioning then getting a desperate cancer on top of it. here's money. go out a

state medicaid agencies have taken action to attack that epidemic. efforts include expanding medicine dade to include behavioral health service for those addicted to drugs and pharmacy management review programs. cms are encouraged by states effected strategies tore designing benefits for the population. we launched the accelerator program to provide states with technical assistance and other support to address this important issue. cms in coordination with cdc and nih, issued informational bulletin on medication assisted treatment for substance abuse disorder in the medicaid program. it outlined that medication and behavioral therapies is the most effective combination of treatment. issued a similar bulletin focused on these services in pediatric and youth population. cms is dedicated to providing the best care to beneficiaries with opioid addiction. working with state medicare programs to have safeguards to prevent the abuse and treat them effectively. we have made progress but there's more work to be done. they're taking mumt am interventions to r

had to start and about 70 million people are on medicaid, 60 million on medicare a two thirds of all of the nursing home care in the country are paid for by those bills and of course the 64 act against the discrimination and employment and public accommodation, the voting rights act which is controversial even to this day. people forget immigration reform. we have something called the national origins corker act, and then in the british isles and northern europe at the time that he become you become president 85% of the immigrants were from the british isles and northern europe. this past year 15% of immigrants were from those places. people don't think of lbj as the man of the yards and those of you familiar with washington for decades and congress just wouldn't do it, and lyndon johnson said let's name it the john f. kennedy center. he passed out in a week before he gave the first state of the union message because he knew he could get its done that way. the national endowment for the arts and humanities spawned thousands of companies and orchestras and the freedom of information a

. >> i don't support obamacare and i want to repeal it but i did expand medicaid because i was able to bring ohio back home to treat the mentally ill and the drug addicted and help the working poor get health care and because you oppose obamacare doesn't mean when you have an opportunity to bring the $14 billion of ohio money back to ohio, that's not obamacare, that's medicaid. >> i think the words expand medicaid will cause republican voters at least some of them to say, i am not so sure about you? >> i had been on the trail with john kasich and he gets asked about this because republican voters are skeptical of expanding any program. and john kasich is not alone in being the republican governors that accepted money and there was an influx of federal funds and i think he will have to better explain why he did it and i don't think it's the last time he will get this question. if you are a republican voter skeptical of the president's health care law and you see a guy running for president that took that money, it's going to be a problem. >> and the reason john kasich did that is a good

they would otherwise be medicaid recipients? >> yes. and that's why our governor is -- feels so strongly about this. and we are blessed to have rick scott as our governor in florida and i am representing the governor right now and we are suing over, this saying basically if you don't accept the medicaid expansion we're going to pull or we can pull your low income pool. >> let me ask you quickly. >> these are the poorest of poor families, greta. that's what is so sad. this is over a 2 billion-dollar program that they are threatening to take away from floridians, our tax dollars if we don't expand medicine cadz that is not a job for the president. >> follow what the court says. i want to get to another court issue. there was some charity frauds in florida there has been a recent settlement for agreement. >> yes. absolutely. this is a great warning for consumers. we have great cancer programs out there. but there are three. it's called cancer fund of america. children's cancer fund. and breast cancer society. this is a national settlement

statutorily, medicaid programs have the ability to set their preferred drug list. however, we have taken a couple of actions to try to address this issue. one, working with samhsa and others on the panel, put an informational bulletin to medicaid programs talking about this issue and complete array of pain both on the medication side, risks of methadone and the other options and importantly as others have said, the importance of behavioral treatment and medication treatment. i also call out that our medicaid innovation accelerator program, the first area we are working on is substance abuse disorders. we have over 30 states involved and they're taking a comprehensive approach to the medicaid program to appropriate substance abuse treatment, including appropriate use of medications and other therapies. >> appreciate it. mr. chairman, i yield back. >> a followup. >> one of the questions or statistics i was giving in talking about perspective is the model or the situation that they're facing in europe. the average is 21 per million. i was just looking. that's the aver

. >>> a florida collected millions in medicaid payments for procedures some patients didn't need or want. he is still licensed in jacksonville. it started in december when a mother took her 6-year-old daughter to dr. snyder to have one soothe pulled. the doctor ended up pulling 7 teeth. attorneys representing multiple families filed a class action lawsuit against dr. snyder. >> somebody who is performing procedures that children don't need pulling teeth that he knows should be in the child's mouth in some cases we have where money procedures were done except where what they came in for. >> a criminal medicaid fraud investigation was launched. the doctor said these allegations are not correct and that's it. >>> dramatic footage of a young baby pulled from the rubble of syria after a massive 616 hour rescue. >>> flavor flav is no stranger to problems, police arrested him in los vegas for a lot of things. we'll break it down when "action news" comes right back. (female announcer) you could win $1,000 a day for life... (husband) hon! it's grover cleveland! (female announcer) ...when you play

president clinton reformed medicaid reform. which helped send a positive message. you know five years and you're out, you have to find a job. we're not rehabilitating anybody. the thing that -- the culture of america is we don't seem to want to hold you responsible or accountable. you know we give you something. if it does not work, we give you twice as much. it's not like -- why don't you go to the doctor's visits. when i was governor i asked for a medicaid waiver because i couldn't keep up the cost. i had a lot of people who needed help. i told the federal government, do not make me take care of the healthy poor person the way i think i have a moral responsibility to take care of a sick poor person. that sick poor person has very little options. the healthy person, if i get them back in the work stream, they can get off their -- get on their feet and do something. i called it mountain choices rewards. i rewarded you. you know, pain and suffering for dental and for eye care, and i said, if you went to the doctor's visit and not the emergency room, if you joined th

medicaid is not working for patients or the doctors who would like to be able to serve them. the status quo is unsustainable and doing nothing is un defensible. we have to save these programs for the sake of beneficiaries and future generations, and our budget does just that. further, our budget prioritizes the safety and security of the american people channeling important resources to our men and women in uniform. we do so in a responsible way, in a manner consistent with current law and without allowing further across the board cuts in defense spending. there are those who criticize on how we do that and i respect their opinion, but we are faced with largely complex national security threats and we need to find a way to move forward to ensure those protecting our lives and freedom have the support and training that they need. i look forward to an open and honest debate about the vision we put forward to get our nation's fiscal house in order, to strengthen our nation's defenses and to ensure a healthier economy for all americans because that's exactly what this budget agre

the florida's office has launched a criminal medicaid fraud investigation. the doctor said the allegations are not correct and that's it. >> two years of blurnldz -- blunders made a school in indiana upset. another page of the editors include a picture of the alum, who was killed by islamic militants last year, students expected a tribute to the local hero than a cursory blurb in the off campus section. the school had no comment. >>> the decision to rent or by can be a difficult one but the numbers may help you make up your mind. hey everyone, it is 6:00 a.m., friday, may 22 here's what's happening. >> sunny mild weather returns to the accuweather forecast just in time for the holiday weekend. of. >> thieves target a montgomery county gun shop and weapons are in the wrong hand. >> we'll get you ready for at busy holiday weekend on the roads. of. >> let's start with david and matt. good morning. >> reporter: we have sun buildings over the horizon and early

>> yeah, 30% increase, most of the people on medicaid and doctors don't want to treat medicaid, it doesn't pay the same reimbursement on a good plan. that's what's driving this up. most of the people aren't in the exchange and obamacare plan they are in medicaid. states have done this increased that population that's part of the problem. but it all comes from the affordable care act, driving up the cost for policies and driving up premium costs and getting inferior care and driving up visits to the emergency room. neil: very well explained. jim jordan republican from the state of ohio. >>> i want you to meet the green beret who suddenly snapped to all of america's attention. new york state is reinventing how we do business by leading the way on tax cuts. we cut the rates on personal income taxes. we enacted the lowest corporate tax rate since 1968. we eliminated the income tax on manufacturers altogether. with startup-ny, qualified businesses that start, expand or relocate to new york state pay no taxes for 10 years. all to grow our economy and create jobs. see how new york can give your b

president clinton reformed medicaid reform, which helped send a positive message. five years and you're out, you have to find a job. we are not rehabilitating anybody. the culture of america is we don't seem to want to hold you responsible or accountable. we give you something, and if it does not work, we will give you twice as much. it's not why did it not work. why was governor, i asked for a medicaid waiver because i just could not keep up with the cost. i had a lot of people that needed help, and i told the federal government, you should not make me take care of a healthy poor person the way i think i have a moral responsibility to take care of a sick poor person. that's sick poor person has very little options. that healthy person, if i can get them back of the work stream and mainstream, they can get back on their feet and go back and do something. i did what we call mountain choices, rewards. i reward you. pain and suffering for dental and eye care -- i said if you want your doctor's visit and did not go to the emergency room, if you join healthy choice, hea

. >>> a florida dentist is accused of collecting millions in medicaid payments for procedures his patients didn't want or need. howard snyder is licensed in jacksonville but protests have been taking place outside of his office. it started in december when a mother took her daughter to have one tooth pulled. the doctor pulled 7 teeth. attorneys representing multiple families filed a potential class action suit. >> somebody is performing procedures that children don't need pulling teeth that he knows should be in the child's mouth in some cases we have where many procedures were done except for what they came in for. >> the florida attorney general's office has launched a criminal medicaid fraud investigation, dr. snyder told a report that these allegations are not correct and that's it. welcome back chopper 6hd is over camden our breaking news, a house fire, we see all smoke. the this broke out around 6:00 a.m. heavy fire showing through the second floor. firefighters had to pull a colleague out of the scene who hurt his leg inside. they have concerns about the buildings so close the one i

that's despite the fact that our state had a very successful medicaid expansion program. we provide coverage to 535,000 additional washingtonians through expanded medicaid and the health insurance exchange enrolled another 170,000 washingtonians. these efforts need to continue. rural communities also face greater shortages of health care professionals than their urban counterparts. as the ceo, physician recruitment is a constant activity for me. i have an aging workforce and our doctors are still required in many cases to participate in call, which is not the case in urban areas. so they work very, very long hours, and they see far more complex cases in the clinic setting. programs like the national health service core and the nurse training initiatives enable many communities like mine to attract the providers that they need. these challenges our unique population, the fragmented population and work financial shortages make it very difficult for rural health care facilities to survive. we need flexibility. in washington, as senator murray pointed out, we've identified ab

medicaid is a little different. most medicaid programs, and as you know medicaid has more flexibility to decide what services they will and will not cover. most medicaid programs cover telehealth and telemedicine in some form. some of them follow the medicare restrictive rules some are more liberal on the issue. if you cover remote patient monitoring, if you cover ford, there's no uniformity. really, there's no logic to what states can and will cover. i think this could change especially if medicaid programs come under increasing fiscal pressure. private pairs, the private pair world is probably in a better spot. a number of states, and gary, correct me if i'm wrong, almost half the states now have statutes in place that require private pairs to pay for telemedicine services if those same services are covered and provided in person. basically states are forcing private pairs to cover telehealth and telemedicine. the definition of telehealth and telemedicine and what is covered varies state by state. they don't manda

it's also medicaid. we need a reconciliation bill in congress that we can get enough democrats to vote on. president bush tried, as you know, tried. he was absolutely, absolutely crushed trying to reform social security. as long as class warfare is a component of the attack on social security, it will be difficult to attract democratic votes to get real reform done. but leave ♪ real leaders lead. ronald reagan sat down with, who? tip o'neill. they did not agree on anything and they sat down together and they agreed on comprehensive tax reform that lasted until now. by the way, we need comprehensive tax reform. they sat down together. presidents lead. to achieve reform, medicare, medicaid, social security, whatever it is, you need to lead. this president does not even talk to congress or the senate. it is not his comfort zone. we need a president who will go up the street, sit down with the majority leader, minority leader and lead the country. this is the only way it will happen. as wrong at -- as long

because a lot more people are on medicaid. many expanding medicaid in a big way. giving people medicaid insurance is almost like giving them nothing. you can't find a doctor that will see medicaid patients. so where do they end up? the same place they used to end up, the emergency room. >> are you going to need hillary clinton's help? st the democratic party is led by two people the nominee her and the president. he clearly is trying to lobby house members. are you going to need her help? >> the president needs trade promotion authority to continue to get agreement with the agents on the trans pacific partnership. hillary clinton was for trade promotion authority. hillary clinton is for the trade bill with the agents. she just won't say so. and the fact is the president needs her help in order to get democrat votes to get this passed. >> you think they look at the split and think she is on the ballot, i better -- >> every democrat leader? the congress is opposed to the president's position. listen, we've got a majority here in the house and the senate, but we can'

let's get to the nub of medicaid. first of all, the last republican i can think of who expanded medicaid was ronald reagan. people tend to forget that. if other people don't want to take the money, that is up to them. i have money i can bring to a higher. it is my money. there is a money in washington. it is the money of the people who live in my state. what do we do with the money? we have 10,000 people sitting in prisons who are mentally ill. we have more people sitting in prisons in america then we have psychiatric hospitals. to me, that is immoral. that is a failure on our part. we deem institutional life the mentally ill and promised to take care of them, and we have not done it. my goal is to treat them. to get them on their feet and in a position where they can work. many people with mental illnesses can, if given medication and properly handled. in our communities, we have the ability to treat mentally ill. you know there are things that can happen with the mentally l with they get themselves in deep trouble a

the san francisco health network they're receiving care at the time did you want people on expanded medicaid and bic definition newly eligible under the affordable health care act that's a big expansion the next phase will try to move to the covered cal area to expand our outreach to the populations eligible for the programs but not eligible for medi-cal medicaid so the up fluctuation of insurance is a very good thing we have a lot infrastructure to put in place to be able to accommodate that population and make sure we're being pro-active and effective in deliver care i'm sure you're aware of we have over the past year banished or launched the san francisco health network it is historically our department had been a san francisco san francisco general a laguna honda a primary care system and pay system we're bringing those together into one umbrella networked organizations and try to network the care across the system and allows us to have better health outcomes and prospective care but a big change in infrastructure so we have the new organizational infrastructure we have the next phase ki