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back to our discussion on health care policy. we are joined by the senior vice president for inclusive growth at the center for american progress action fund and michael cannon's director of health policy studies at the cato institute. welcome to both of you. i want to start -- it's a 14th anniversary of the affordable care act and i want to show a poll thatkfs did asking how favorable or unfavorable an opinion of the aca, also known as obamacare is. this shows the trend with this dark blue line being favorable, up to 51% now with unfavorable at 40%. it looks like it's the biggest, the highest it's been since it was signed into law. what you think of that and why do you think that is? guest: it's the highest it's been since it was passed in 14

years. it's a surprise because we have more people that are benefiting from the affordable care act. 45 million people are now covered whether it's buying coverage on their own for the health insurance marketplaces, coverage through the affordable care act, medicaid and childless adults or getting basic health plan coverage, people also are benefiting from better protection. if you have a chronic condition like diabetes or asthma or you are pregnant or you're going through some sort of surgery or cancer treatment, you can't be discriminated against by health insurance plans the way you could before the aca. host: there has been some sparring politically about the aca and the future of it. i want to show a biden campaign add. it's very quick, about health policy specifically. [video clip] >> obamacare is a disaster. what would like to do is totally

cancel it. obamacare is a catastrophe. {beeps] host: it was not rick very radio from the of the end but essentially saying that trump wants to take away coverage for pre-existing conditions. 45 million americans could lose their health insurance. this is what he said on truth social. he said i'm not running to terminate the aca. joe biden disinformation and misinformation all the time. i want to make our military grade and strengthen our

military make the aca or obamacare as it is known much better, stronger and far less expensive. in other words, make the aca much, much, much better for far less money to our great american citizens. michael, your reaction to that? guest: it's hard to know what president trump things from one day to the next but certainly, he is not running on health care. i don't think he did last time. i don't think he took the repeal effort seriously and that's too bad because research by president biden's economic advisor at the council of economic advisors shows that obamacare's central provision, the pre--- the suppose a protection for people with pre-existing conditions are actually making coverage worse for people with conditions like multiple sclerosis because they penalize insurers unless they make the coverage worse.

those provisions that are supposed to protect the sick are actually harming the sick. if you ask respondents about those effects of those provisions of obamacare, even democrats turn against obamacare. the kaiser family foundation poll, single pairs are asked about the cost -- single payers are asked about the cost. . if they looked at it, they would find that not only do republicans and independents turn against obamacare but even democrats. host: explained that, what do you mean the coverage would get worse? guest: whatever one calls obamacare's protections for people with pre-existing conditions is the government telling insurance companies you cannot charge sick people higher premiums which imposes what we call a branding -- a binding place -- price ceiling. when you have a binding price ceiling like that, the quality

of the product gets worse. if you said you can only charge five cents for an apple, then if an apple costs $.60 to produce, you will not get a 60 sent apple anymore. you will get apples with worms and holes in them and that's what's happening with health insurance under obamacare. host: we've seen that over the last 14 years? guest: president biden's economic advisor has studied this showing that as a result of these provisions, coverage is getting worse for people with multiple sclerosis and lots of other expensive conditions. the debate has not focused on that. when republicans attacked his law, they don't bring up that part which gets back to president trump inattention and the inattention of republicans in congress. host: has the aca made health care worse? guest: it has made health care so much better. we are so far from a perfect system on whether you have marketplace coverage or other

coverage, there are things we can still do to make sure people have access to the providers they need and the medicines they need, have adequate insurance networks. let's go back to pre--2010. people with multiple sclerosis are cancer might've gotten denied coverage altogether. they might've gotten charge more because insurance plans were allowed to discriminate and say we will cover you but not cover your cancer or i will charge you more because you previously had a c-section or you are a female. the aca outlawed that. it's a wildly popular provision of the aca where the majority people in the u.s. thinks insurance companies should not be able to be prejudiced based on pre-existing conditions. host: the provisions are set to expire at the end of 2025. explain with these premium subsidies are and what would happen if they were to and at the end of 2025? guest: from the beginning, the

affordable care act made marketplace coverage for people who buy insurance on their own more affordable by guaranteeing that coverage would cost no more than a certain percentage of their income. that's on a sliding scale. if you are someone who is just above the cutoff for medicaid eligibility, you can get a plan that doesn't cost your family that much. the obligation for the family gets higher as income gets higher. what the enhanced subsidies that were first passed as part of the american rescue plan act and extended through the inflation reduction act do is they give more financial help to families on the lower scale and eliminate the subsidy cliff at the higher end which meant there were some middle-class families that suddenly got over an income cut off and lost their subsidies. it's a better tax design but also made financial help available to more families. host: we are at the point where

four out of five marketplace consumers could have found some sort of coverage on the marketplace for $10 or less. host:host: michael, your opinion. guest: these are premium subsidies that hide the cost of obamacare plants. they don't reduce the cost, they hide the premium by shifting the net burden to taxpayers rather than the enrollee. that doesn't reduce the cost of health insurance subsidies. it increases the cost of things. yet, even with all of those subsidies, obamacare plans, as a result of the subsidies, obamacare plans are becoming more extensive overtime. the pre-existing conditions provision we been discussing caused some people to double or triple their premiums since congress passed the law. it has become so expensive under obamacare that the average silver plan premium for single adults is about 13% for 40 years

old. it's a significant chunk of income. and it's growing faster than household income. premiums have risen so rapidly that congress is now subsidizing people making $200,000 per year to help them afford this supposedly informal coverage. those folks are receiving subsidies of $12,000 per year to afford this supposedly affordable coverage. the enhanced subsidies run all the way up the income scale to people making $600,000 per year. if congress had to subsidize people making six of the thousand dollars per year, this coverage is not affordable host: i will invite our viewers to call in and ask a question of our guests. the lies this time or buy insurance. if you have private insurance, call us on (202) 748-8000. if you are insured through the aca or obamacare, that number is (202) 748-8001.

if you are on medicare, you can call is on (202) 748-8002. everybody else can call on (202) 748-8003. you can also use that line for texting us. remind viewers of the trump administration, what that administration did while in office to rollback the aca. guest: very little. the administration gave people options so they wouldn't have to enroll in the aca if they didn't want to. one of those options was an option that congress created back in 1996. there is a market for health insurance in the united states that is not subject to any federal regulation because congress avoided that. we call that short-term insurance. what the trump administration did is rollback and obama era rule or regulation that said those plans cannot last more than three months. they always less 12 months.

the obama administration limited them to three months which had the effect of throwing people out of their health insurance plan after they got sick and leaving them without insurance for up to 12 months. the trump administration added consumer protection to those plans and allow people to keep them for 12 months or 36 months so they can at least get to the next obamacare enrollment period. the congressional budget office says it offers comprehensive coverage, lower deductibles then obamacare plans. for 9-10 months of the year, they are more comprehensive than every obamacare plan because you cannot buy in obama plan for 10 months of the year. the trump administration, by rolling back or eliminating the obama your role that talks people out of health insurance, the trump administration made health insurance more affordable for people. unfortunately, the biden

administration is no basically reinstated their obama rule yesterday. they announced they would be throwing people out of their short-term plans after four months which means that by a short-term plan, you get sick in the by ministration will terminate that plan within four months and leave you without insurance for up to 12 months. host: here is the new york times article from yesterday about that -- host: your comment on that? guest: these plans that michael is talking about, the short term duration plans are junk insurance. they are not aca coverage and they can discriminate against people for pre-existing conditions. they don't have to offer basic services like prescription drugs or maternity care, mental health care. these are really meant as a

bridge for people between types of coverage. if it's short-term coverage, it should be short-term which is what the biden administration has allowed. if you need a bridge between different coverage, you can get it but otherwise, it should be -- it should not be a permanent type of coverage. the marketplaces provide special enrollment periods. if you lost a job or lost their medicaid coverage removed from state to state, you have time outside the usual open enrollment window to enroll in coverage or shopper coverage. there is a year round marketplace option for people who experience those life transitions. host: michael? guest: what distinguishes the short-term market as you can buy as much coverage as you want or as little coverage as you want. what we are seeing is people who get the coverage they want and not having to buy coverage they don't want or the government wants to compel them to buy. that's why obamacare, it gives people the option to choose

their own health insurance instead of empowering the government to choose it for them. on the question of junk insurance, if it is march and you go to buy health insurance and the next day you get hit by a bus, if you bought a short-term plan, the plan would cover you. if you tried to buy in obamacare plan, it would not cover your care at all. you can by obamacare in march. tell me which of these plans is junk. host: let's talk to callers now kim is in ottumwa, iowa, good morning. caller: i was thinking about the health care debate. i think mr. cannon is totally wrong. short-term is junk, it's just junk. when people are working and you put everything in the kitty to

receive services, that means premiums will go down. down. i don't understand what he's saying -- the only thing he's trying to say is that you tried to convince the lower tier that doesn't make $200,000 but don't put it in the kitty because it's hurting their subsidies. it's taking away part of your health care. you should not want dental, you should not want all the other stuff including children that are disabled. that's what i fear. that's what i hear. host: let's get a response. guest: unfortunately, neither the trump campaign or biden campaign or republicans or democrats are introducing the sorts of reforms we need on health care which is reform that makes health insurance more

affordable but health care more affordable, that drive down health care prices. all the people the caller is talking about are suffering because health care prices are excessive. the reason they are excessive is because government is trying to do everything it can to make health care free. when the government does that, what happens is there is no such thing as a free lunch. all of the subsidies the government throws at health care and all of the tax preferences the government throws at health care encourage people to enroll in more insurance and the subsidies makes people less price sensitive say don't get the price competition we see in other sectors of the economy. when prices rise, people think now prices are so high, i need more insurance. that just perpetuates the cycle and they demand more insurance or more subsidies for insurance. the short-term market is a small step in the right rector because gives people the choice to purchase less insurance than the

government is subsidizing or compelling them to purchase elsewhere. that can put downward pressure on prices but what congress really needs to do and i sympathize with the caller. i struggle with health care prices as well. but the government needs to do is less consumer control of the $4 trillion that this country devotes toward health care every year. right now, employers and the government control 83% of that directly or indirectly. let consumers control that spending. they will have greater price sensitivity and spark more competition. that will cause prices to plummet and make health care more affordable for everyone .what you once more universal health care. you need that sort of price sensitivity and competition to drive down prices because that is what makes health care more universal. host: will that drive down prices? guest: in talking about prices,

you can talk about the role of insurance.and the government has a responsibility make sure the that when people buy insurance, they get insurance. the same way if you buy a car, it better have seat and lights and breaks. if the junk plans are providing the kind of protection people expect, if you get hit by that last with your plan, the plan might come back and say we are going to cap your coverage and i can't pay your entire hospital bill. we have a responsibility to make sure there is a market functioning for comprehensive insurance. the point of insurance is to spread risk across people and over lifetimes and at least provide a floor for the benefits people need that are essential. host: let's talk to carolyn in orlando, florida, good morning. caller: good morning. host: go ahead. caller: hi, i'm a medicare recipient but prior to that, i had to use the aca program.

once somebody says obamacare, they have dug into every negative aspect of aca. aca was helpful for me when i was working in between jobs and prior to aca, you are not able to buy insurance at all. it is a good thing for americans. it's available to everybody so that makes it, you know, good for america. host: there are people that say it's too expensive. what was your experience with the cost of the aca? caller: it was comparable to private insurance. i used it prior to trump. my sister used more recently and she likes it and she had good coverage. she had good prices but she can no longer use it anymore once she retired. i am retired. i prefer it. i had better coverage.

he's looking into the negative and the junk is people who don't want to buy private insurance or have to have some insurance proof for their employer. that's where the junk insurance comes in. but aca has been good for me and my sister. host: what you think, michael? guest: i'm glad for the people the affordable help. -- does help. the people that it harms vastly outnumber them and the people it harms our women age 55-64. it's been found that obamacare increase premiums on women age 55-64 more than anyone else. reason for that is because it pools those women with men of the same age who are much

sicker. as a result, the affordable care act or obamacare discriminated against women by increasing their premium differentially. i think the real problem here and what we are all struggling with and obamacare is an attempt to fill the gaps of this problem -- for almost 100 years now, the government has been penalizing u.s. workers unless they enroll in employer-sponsored insurance. they let their employer control huge chunk of their earnings and used to purchase and enroll in and choose for the worker lousy health insurance plan. it disappears after you get sick. the government is compelling people to enroll in junk insurance and has been for 100 years, insurance that throws people out of their coverage if they get sick and leaves them to fend for themselves in a market that won't cover them because

now they have a pre-existing condition. government is not the solution to the problem of pre-existing conditions, government is because of the problem. -- is the cause of the problem. the thing that congress must do if you want to make health insurance more affordable and secure is a need to reform the tax treatment of insurance that penalizes workers unless they enroll in a very insecure form of junk insurance. host: let's talk to kansas in maine, good morning. caller: good morning. i just want to thank michael cannon, thank you so much for shedding light on the skyrocketing cost. i want to highlight how expensive it is for working families. i understand the aca might work for a single person but for working families, we were quoted in maine that it would be $1250 for a bronze plant. that's simply unaffordable, is

more than our mortgage. i just hope that we get the reform we really. desperately need host: what you think of that, the cost for families? guest: the underlying cost of marketplace coverage is comparable, in the same ballpark as employer-sponsored insurance. there are subsidies available that are on a sliding scale with more help for lower income families. it will be critical to keep it affordable as it is now that congress and year before the end of the enhanced premium tax credits which expire the end of 2020 -- 2025, renew those of middle -- some more middle-class families can of access to financial help and marketplaces. i think there is also we need to do across the board to help lower the cost of health care. we pay a lot in this country for

health that is not comparable to developed nations. in addition to the financial help for insurance, we need to look at things to lower the price of drugs which president biden has done. also extend the reforms for medicare to the commercial sector and deal with the consolidation of health care providers in this country. a lot of the hospital systems, conglomerates or insurance and hospitals and other entities as well. host: let's talk about medicaid. i will start with you, michael. this is the axios article -- what's going on with that? this is the republican study committee in the house that released a budget that released a budget the calls for converting medicaid from an open ended entitlement to block grants.

tell us how that would work, what's the difference? guest: we need to understand the federal government is so large and the debt to gdp ratio is about 100%. even if you eliminate, completely eliminate medicare and medicaid and obamacare and the chip program, you still wouldn't illuminate the federal deficit. you would come close but you wouldn't illuminate the entire thing. congress has to cut somewhere and it has to cut health care because health care's social security and health care combined are about 46% of the federal budget. you cannot balance the budget without cutting these programs. the medicaid program is probably the easiest one to cut and the easiest one to cut because even if you zero doubt federal medicaid spending right now, that doesn't mean anyone would lose any access to medical care at all. states pay for about 40% of the medicaid program and if they

want to maintain those programs at current levels, they just increase taxes and fund those programs at the same level they are now. if states are not willing to do that, that means this program is not popular at current levels in which case we should definitely be cutting it if it's not popular. the way the proposal would work is it wouldn't eliminate the federal medicaid contribution. it would reduce the growth in spending, call that a cut, and it would give that money to states more and allow them to spend it more flexibly than they can now. there are a lot of very prescriptive rules to whom you have to provide coverage and what coverage you have to provide and so forth. what the republican study committee wants to do is say for these categories of medicaid enrollees, we will give you more flex ability when it comes to how to provide health insurance for the aged or the disabled or

so forth. they should have gone farther in cutting medicaid, federal medicaid spending and they should have given states much more flexibility than they propose to do because of the federal government is going to give states money, they should give it to them as one unrestricted block grant so that if the state thinks there is a more dire need for subsidies for the disabled, then they can do that. they can spend the money there and other states can make other decisions. it still doesn't make sense to have the federal government say states need to spend this much. host: what do you think? guest: you can go back and look at what trump did when he was president and you see that he was cheering on efforts to block grant medicaid. host: what's wrong with making it a block grant? guest: that doesn't give states more flexibility, it caps what they can provide.

we know there is a lot of variation in health care cost. sometimes new drugs come online that can radically change how we treat health conditions like the hepatitis c drugs. states might experience natural disasters or gains or losses in population or economic ups and downs. when you block grant the program, it restricts the state's ability to react and provide health care. it also hampers states for making investment in care they could pay off for

caller: we could have a six month plan to treat it and we can be on their pockets longer and make more money from it. they are obligated to keep somebody in a poor condition longer. they don't compete for the consumer, they compete -- they compete for deep customer class. they've allowed too many mergers and acquisitions. they shouldn't allow any of that at all. the profit motive is dominating everything. when we talk about health care, there are profiteers in charge of writing everything. the aca does have a lot of problems and lawyers -- and they don't have the means to provide good plans on up at the profit

motive has to stop dominating absolutely if not the free market, is the private market. host: we will take that up. guest: i disagree because if he were correct, that health care providers and drug companies can keep bleeding us for money, when we have a 95% care for hepatitis c. why would a drug company develop a drug like that? the reason is they can make money by helping patients. that's all to the good and if profits were an indication of how much a doctor or hospital or drug company were meeting human needs, we would love profit and celebrate it. it would be wonderful.

when the patient is only paying $.10 on the dollar, they want more and more. when the government is paying directly for 50%, the industry is able to go to members of congress and say can you reduce the price medicare is paying for me and my colleagues. they can gain the formulas and medicaid. they can use it to come up with a price they pay for drugs. they are able to make money because the government is so heavily involved in health care. they can make money even though they are not meeting patient needs. the best research we have on the medicare program from dartmouth suggests that one out of every three dollars medicare spends on health care for seniors does nothing to make seniors healthier or happier or secure.

that's a pure income transfer. it's more like plunder of the taxpayers. that's my take on the caller's concern. i also think the data highlights that congress should be cutting the medicare program pretty drastically as well. guest: we do have a problem where the price of drugs is disconnected from the value. there are drugs where it is quite expensive but cures hepatitis c but there are drugs like insulin that are decades-old where people were paying far too much to the point were sometimes they were rushing their insulin or not filling the prescription at the pharmacy because they couldn't afford what's literally a life-sustaining medication. if you go back and look at the poll numbers now for a few years

ago, that's why one of the most popular health care reforms was allowing medicare to negotiate drug prices. until president biden signed the inflation reduction act couple of years ago, medicare didn't have the authority to do that. we in america pay about two or three times more than comparable countries. for brand-name drugs but now, medicare can negotiate drugs and they are doing that with the first 10 drugs, the top 10 by medicare dollars spent which is dramatic savings for the medicare program and taxpayers and it will also lower copayments for medicare beneficiaries and the president has cap the cost of insulin through medicare. it's $45 per month. host: the caller also mentioned the ads we see for drugs. those didn't used to be allowed. what do you think of that? guest: there are countries

around the world that don't allow pharmaceutical advertising the volume of ads you see when you turn on your favorite program or football game show you how much profit there is to be made in this industry. companies spend more in advertising than they do on r&d. a lot of that is paid by us the taxpayers through national institutes, the basic science that goes into drug development is public money. there is still a lot of profit in the system and more we can do to reduce drug prices and connect them host: host: to value better. let's go to chicago and talk to justin who is on the aca. caller: shalom like him. the point is, i've worked 30 plus years in the union and i had great coverage. now i have aca. when roosevelt started social

security, it wasn't perfect. it took years to iron it out and it still not perfect today but it works quite well. if you stop fighting over china getting rid of obamacare and really dig into -- we are supposed to be the great's nation the world. we are not in a comes to health care, we are not when it comes to insurance. we have seniors that are in bad positions and not getting taken care of. we have people falling in the gaps who have worked all their life. we should have coverage and there should be nobody who doesn't have coverage in america today. it is ridiculous with the money we had over the years that we are fussing and fighting especially when there are other nations that have full coverage. all you have to do is walk in. we should be embarrassed and ashamed of ourselves that we don't cover each and every person in the united states, homeless people that are just

starting families, all of this should be covered. stop talking about costs. let's talk about the cost it creates that if they are well and healthy, how they can participate in making the united states better. host: do you think everybody should be covered? guest: i want a health sector that fills in the gaps, over time. so that fewer and fewer people fall through overtime. that's my idea of coverage. does everyone need health insurance for every item? no, because we reliant health insurance too much. it causes those gaps to widen an example that came to mind was we were talking about insulin but in the example of obamacare, it must cover all fda approved contraception. it's 100%. there will be no out-of-pocket

charge when we access these contraceptives. you would think this is wonderful. what hit has axley done is because the prices of contraceptives to skyrocket. when you pay for things through insurance, prices go up. host: shouldn't that not be allowed? that's like price gouging. guest: you can call it priors -- price gouging if you want but we know it will happen. then we should use a more reliable to forgiving those prices down which is letting consumers control the $4 trillion in the health sector and exercise price sensitivity with the purchasing pharmaceuticals directly over the counter or when they pay for their health insurance premiums. then they can put themselves in plans based on how good the plans are and their negotiations with the drug companies.