senate republicans can only afford to lose two votes from their party in order to get the measure to a tie-breaking vote by the vice president. it can come up as early as next week after it is scored by the congressional budget office and debated by the full senate. coming up on c-span come we take a closer look at health care law bolton.x that's followed by president trump signing a bill today at the v.a. to be fired for misconduct. later, george w. bush and laura bush discussed ways to help veterans tradition back to civilian life. ""washington journal continues. with alexre back bolton to talk about the senate health care legislation and how it compared to the other version -- the senate republican version and the house version as well as what this means for the affordable care act. thanks for being here. i want to begin with what happens next. our viewers know mitch mcconnell

needs 50 of his 52 republicans -- four have already sent know as of right now. what is it mean for next week? walk us through what we are going to see. guest: the first thing is we are score, andt a cbo analysis from the congressional budget office that will estimate how many people are going to lose their insurance because of these changes, how deep the cuts to medicaid are going to be, and those things -- and also what the impact on the budget is going to be in terms of -- reduce the deficit. that will determine a lot how people vote. several of the especially moderate -- moderates worried about medicaid cuts, they are worried about that congressional budget office score before they make their decision. already mcconnell is in the hole. four conservatives say they cannot support the bill as drafted. they are willing to negotiate, but moderates are waiting for

the cbo score coming out early next week and then mcconnell i think is going to move ahead and scheduled to vote whether the -- whether he has the votes or not and roll the dice and hope he can change people's mines on the floor during the debate by allowing them to have amendments. i would expect a vote to pass on thursday. host: you do expected to pass? guest: i expect a vote to pass, i don't know if anybody knows if it is going to pass. i don't think mcconnell himself knows. host: does this influence those republicans? an argument made by the wall street journal this morning editorial where they talk about the four senators we had on the screen and i say that they oppose the draft in its current form enough to kill it. --y weeks of talks have been has been to produce a bill that can get 50 votes. perhaps they are trying to coax one or two policy changes during debate, but a final know really

would be a vote to live with obamacare and they go on to write the senate bill is imperfect, but it includes many conservative policy victories that have long been republican owls. it is not too much to say this is a defining moment. if republicans fail, the next step -- stop is single-payer. host: that is over the -- guest: that is over the top, i would say. i'll think republicans agree with that and here is why. there is consensus that obamacare is not sustainable and is going to implode. there are all sorts of problems with the bill. insurers fleeing market and the medicaid program expansion is not sustainable. i think some republicans take the view that if we don't repeal it now, we will have to do -- deal with this sooner or later. i think the question of whether this is the best piece of

legislation and a question if support is there. the house bill has terrible public ratings. 16%. the cbo score, the impact of the senate bill is about the same as the house bill. i think it is fair to expect public ratings to be just as low. there lastre this is chance, so they will have another -- i don't feel they are going to have another bite of the apple if this bill does not pass. host: how will respondents judge the current health law? idea.id it was a good 48% said it was a bad idea. compare that to the current law, 41% say a good idea, 38% saying it's a bad idea. guest: those are terrible numbers. why people are really worried about voting for

this bill. not only is this bad in the short term politically because the legislation is unpopular right now being highlighted by the press, but the other major -- randare the guys paul, once you vote for this legislation then it is a republican problem going forward and republicans saw what an output raw's for the democrats .fter they passed in 2010 it hurt them in the 2014 midterm election and 2016. this has been a terrible issue for democrats. i am not sure they want to take ownership of a health care system that is in disarray. that is why people like lindsey graham who will reluctantly vote for the bill says i prefer we do this on a bipartisan basis. host: what are your questions about this health care legislation? alex bolton is here to answer them for you of "of the hill" newspaper. republicans, 202-748-8001.

democrats, 202-748-8000 and butpendents, 202-748-8002 talk about the major differences and begin with medicaid. what do senate republicans want to do versus republic -- democrat? guest: they are going to delay reducing the match for extended medicaid enrollment under obamacare. it is little bit more generous than the house built in 2020 bill inp that -- house 2020 would cap that. startnate bill would not a phase that out or reduce the federal match until 2021 and it would phase it out over three years to 2024. that is where it is a little more generous. but the senate will will -- bill that ispt a new metric less generous than the house of

bill. to house bill index is it medical inflation, which is higher than regular inflation and the senate bill would index it to the regular consumer price index. that means in the out years, major cuts, maybe hundreds of millions of dollars of cuts great to analysis i have seen in the out years after 2025. what republicans say is ok, people who support the bill, they say this does not go into effect until 2025 so we have some time to change this and we can assess what the impact will be as we are phasing out the expanded enrollment, putting these new subsidies into place. we can change it in the future and by the way, there have been other cuts like sustainable doc fix,te -- the medicare payments of doctors passed in the 90's and that congress kept kicking that can down the road. those medicare costs -- those

medicare payment doctors are supposed to be cut in the 90's never were. they were postponed and finally there was a permanent fix in the last congress where they wiped it out altogether. i think some republicans are saying yes, these medicaid cuts are going to be a little bit steeper than the house bill after 20-25, but that doesn't mean it will take place. host: good morning, democrat. caller: good morning. i am calling to ask what the actual name of the legislation will be is. my understanding is it is a tax bill, not a health care bill. guest: the senate bill is the better care reconciliation act. bcra is the acronym. the house bill is the american health care act. it is not titled a tax bill. host: i think maybe her point

was, and this is a point liberals are making is that this is a tax cut, essentially. what are they getting at when they say that? guest: this bill will cut something like -- this will reduce revenues on the order of $900 billion over the next decade. and pretty much all the obamacare taxes are eliminated except for the so-called cadillac tax on expensive plans that does not kick in until 20-26. the tax on prescription drugs is gone. couples whox on make more than $200,000. guest: if there is a capital gains tax cut, 3.8 capital gains tax cut for investment income for people --

individuals who earn over $200,000, couples who earn over $200,000 reduce that rate from -- to 20% and also for high earning individuals over $200,000, couples over $250,000 that would reduce the payroll tax. obamacare added a payroll tax increase for those high earners that intended to shore up medicare. those are the taxes on wealthy people they go out the window with this legislation in the house and the senate and that is what democrats are really focusing on when they say this is a tax cut for the wealthy to basically cut benefits for people who are lower income and older and in rural areas. host: let's hear from a democrat in virginia. i want to ask you a couple of things. nobody seems to talk about one of the big reasons why is that

the republicans undermined payments that were going to be made to these insurance payments for a period of time. people like me who have had cancer before and i am going to cost the insurance company a lot more money. when insurance companies got into the aca, they were made promises they were going to be funded certain amounts of money republicansr us and diligently, as soon as they got control, they worked to eliminate those payments going out. what that causes is instability andhe insurance companies they can't make commitments because they don't know whether or not they're going to make their subsidies and they want to make a profit and i think it is horrific that people make a profit off of our health care and our life and death choices, but that is how it is in america right now. that is one of the reasons and no one seems to highlight that

the republicans have created this situation so that they can actually get is failing. republicans made it fail. the second thing i want to talk about is i have been employed since i was 14 years old. i have worked every single year of my life and supported my self every year of my life. i have had cancer three times. the first time was 10 years ago and i was able to survive that. between that time and the next cancer i was unemployed for a short period of time and that was six months due to recovering from cancer and having to move to find a job. that may be have a pre-existing condition and i was no longer insurable so i was very anxious for aca to pass. two years ago i got cancer again and because of the aca, it was covered. i didn't have nightmares and anxiety that i was then a die because we didn't have medical

onerance and approximately year -- in november last year i got cancer again and i am currently on an aca plan. that is what helped me throughout that cancer session and now i am on an aca plan for this cancer session. i have stage 4. congratulations for that, i want to congratulate science and the medical industry for that. i know i have to be on some level of chemo the rest of my life. my cancer will double every four weeks. i have been working through stage 4 cancer for a month and a half. i have been taking -- putting practically every penny into it. i currently have $50 a month in money to feed myself, which is fantastic, note the sarcasm. here we go with republicans taking this away and as of december, me and all the people i talked to every single week when i go in for my chemo

treatments in my daily shot, we are all in the same boat. as of december, we no longer will be able to afford medical insurance if this horrible plan goes through. people like me who have spent our savings this year keeping ourselves to pay the premiums in the co-pays on the shots and the andor visits and surgeries things to save our lives, that is what it is for. we are paying. i am paying practically every penny i have. the cadillac plan, premium is great. it is a little less than $500 a month, which i expect for someone like me. i am complaining that at the end of this year i have to pay 42,000 -- $142,000 just to be able to get insurance, not counting the tens of thousands of dollars i may have to pay in premiums and deductibles and doctor visits just to keep

myself alive and i am a contributing member to society. cancerd through stage 4 and i was off a month and a half and that was it. a month and a half total in the past year. host: heather, thank you for your story and sharing that. alex bolton. what do you know about people who did not have insurance but now have it through the affordable care act? what happens. you know exactly what is going to happen with people who were able to get it through the aca? guest: people will still get tax insurance, but one of the things the senate bill does is it lowers the level at which people are eligible for -- from 400%om the at the federal poverty line, to 350%. the senateolder, bill -- the subsidies are adjusted for people who are

older and poorer and live in geographic areas where costs are higher. --is not going to be especially if you are older, it will not be as generous as the affordable care act, which basically says they charge older people three times as much as younger people. the senate bill, let's charge five times -- older people five times as much. the other thing the legislation does is it doubles the amount of money you can put into health so that you can stash money to buy insurance. if you are already sick, you already spend money on insurance you only have so much money because you life are paying so much already. of the story we just heard is -- those are the very tough circumstances that obamacare was supposed to address.

it was supposed to help people because their insurance they didn't have an employer-provided plan and then they are trying to buy insurance on the individual market and i have pre-existing conditions he cut they have a history of ander and it is expensive ruins them financially. that is why the bill was passed in the first place, to address those problems. thebottom line here with health care legislation being pushed by republicans is the house bill, according to the congressional budget office, would reduce federal health care spending by $1 trillion over the next 10 years. $1.1 trillion. i looked at the cbo score yesterday. there is a lot less federal assistance going out to help people buy health insurance. that is going to hit people who have existing conditions and recurring bouts of cancer. those are the people who are really going to be in trouble. house bill also sets up a $130

billion fund for states to fill up high risk pools and the senate bill has money for a patient stability fund to reimburse insurance companies that take big losses. the senior member of the house pushed for $8 billion in federal funding to help people who are sicker. maybe then the question is do these additional funds help sicker people? can she be put in a future high risk full with other sick people that insurers are willing to cover? i think there is a lot of skepticism amongst policy experts whether that is really going to work. the criticism is it is just not nearly enough money to cover high-risk individuals. we will find out. that is cold comfort to someone who has cancer. host: let's go to alan in new

york, independent. good morning. what are your thoughts on the health care debate? caller: i have a few questions. number one, why can't we have single-payer health care? 2, if this plan by the republicans in the senate passes and let's say it becomes law, you are going to have the same problem we had 10 years ago with all these people going to the emergency room and not paying in the hospitals are about to get in deep trouble. i am telling you. it's not going to work and senate thing is, these and the house of representatives, they are too political and we need to get rid of that. host: let's take single-payer. that is the wall street journal's prediction if they do

not repeal and replace the affordable care act we are one step closer to single-payer. guest: my response to that is the reason we don't have single-payer is because there is not clinical support for single-payer. 2009 -- not political support for single-payer. 2009 was not that long ago. president obama was in the white house and they try to pass a baby version of single-payer aere you basically create government operated insurance company to compete with the private sector. there were not enough democrats to support that. there just isn't enough political support for that yet. one of the major policy objections is the runaway expense -- it would be too expensive and the country cannot afford it. there hasn't been a whole lot of serious discussion about single-payer even amongst the democrats. yes, it was discussed during the campaign, but on capitol hill,

no one is discussing it seriously. i guess maybe there are people in the house that offers single-payer bills, but in terms of what senate democrats have proposed in their outlines, it is focused on working with obamacare and finding ways to sure up obamacare and single-payer is not being pushed all that seriously. the other point i wanted to make is in response to your prediction that hospitals will bear the brunt of this, i think that is absolutely right. the strong statements we heard --terday came from possible hospital groups. they really trashed this bill and a lot of them came out with strong statements. i think they are anticipating that they are going to see their reimbursements go down because there is a big cut in federal health care spending. people are still going to get sick and still show up to emergency rooms and hospitals will have to bear the cost. host: larry in michigan, republican. comments willk my

probably be more along the independent line because first, i've got to say, i have not read anywhere in the constitution or the bill of rights that we owe a health care system to the people. we existed without one for quite some time. with that being said, i recently outan emergency room visit of pocket -- out of whatever you call it for my health care. i just got a doctor bill and he spent 10 minutes with me and his cost is $17,000. that is insane. somebody needs to put constraints and controls for that kind of craziness. host: let's pick up that issue of health the cost care because originally when i was part of the discussion for the affordable care act, where is that discussion now? what is the state of that? the this legislation by

house or senate republicans do anything to lower the cost of health care? have: that is what you mike lee of utah and ted cruz of wisconsin coming out against this bill because it does not do .nough to lower premiums what they are proposing is they want to create a competitive national healthcare marketplace so that there is more consumer choice and through competition it will lower cost. that is something that i think might work in theory, whether it works in actuality, who knows. there are a lot of objections raised to say that health care -- they aren't like cell phones, it is very tough to achieve pure competition in the marketplace because it is such a complex -- ate and you do develop least as far as insurance goes, you develop these regional monopolies.

insurance companies decide what areas of the country they want to cover and the kind of have dominance in those areas. how do you achieve competition? what ted cruz is talking about is allowing insurance companies to sell plans across state lines . at the senate republican lunch he handed out little cards entitled path to yes to explain what it would take to get him to vote for this legislation and he talked about letting companies sell across state lines. even within the republican conference there is skepticism about whether or not that is a workable plan and the senator of south dakota, he worked in the insurance industry beginning in 1978 and he is an interesting guy to talk to. he is a guy who sold insurance. he knows it from a business perspective and he said it just does not work because the idea that you can buy a cheap plan from south dakota if you are

someone living in new york city is fantasy, is what he says because the south dakota insurer , there are benefits in south dakota that don't exist in new york. for example, south dakota is a whole lot cheaper and there are a range of things. again, going back to the strategy in this bill, achieve market competition and one of those things is increase the amount people can contribute to health savings account so that it is not the insurer, but the individual paying the money and can exercise more discretion as to what they are going to pay for and not going to pay for. host: portland, oregon, calvin is watching us there. independent. caller: i want to thank you as a host of c-span for these numerous topics. youink in many respects allow the nation to decipher intellectual dishonesty within

the system so i want to thank you for your show. i would like to thank the host as well for his responses. i am a doctorate candidate and i just wanted to say that i believe what is critical in this narrative is to have the governors across the nation have a conversation and identify a strategic plan of concerns and take that plan and give it to both the house and the senate because james madison said it best. .we are a republic of factions unless we can be governed by justice can we live throughout the ages." i think that is a reflection of where we are with health care. we've got to give the folks who are closest to the issue giving their position and having unified plans from both the republicans and democrats. governors giving it to the house and the senate. the final piece in this context

is i think what is critical to the dialogue of health care is that when obama got the health care past, he did not have a super majority. therefore, he had to give it over to the insurance companies to draft the plan as a compromise to getting the republicans to pass it. that was where the problems came in terms of not having things that were consistent with what his narrative stated. i am going to stop it. i think this is a critical show and i hope this show continues at a different time. host: thank you, calvin, for your comments. caller: good morning. thank you for c-span. the reason i am calling is we have blue cross blue shield and we my husband's job are paying $800 a month with a 750 dollars deductible for each person and we are a three-person family. the reason i am calling his we need help with the prices.

we have gone from $82 to $196 we pay a week in insurance. we would from $300 in dollar the to $750 dockable. .- deductible entry-level jobs, they are not even giving you full time work. they are only giving you part-time because of insurance. obamacare has to go. host: alex bolton, what do you make of those comments? guest: is something she is buying insurance on the individual market and premiums are soaring. i don't know exactly where she is living and how many insurers are offering plans on the obamacare exchange. one of the criticisms of obamacare and the reasons republicans say it is imploding is because i think in 30% of the counties of the united states or something like that there is only one insurer and insurers

are pulling out. the lack of composition -- competition means premiums are going up. the problem is you have a lot of sick people on the exchanges. healthier people are not signing up in the numbers anticipated and that is sending up premiums. the reimbursements to insurance companies that were supposed to happen under obamacare to keep costs under control have been curtailed. there was an amendment a few years ago to a spending bill the riskntially capped corridor adjustment program. essentially what obamacare envisioned to reimburse companies -- insurance companies that incurred high cost to keep the cost from being passed on to the insurer -- to the consumer. as the caller pointed out, that by a republican amendment. one of the biggest mistakes the democrats made. harry reid who wrote the bill,

he is the father of this legislation, but he made a mistake agreeing to limit those risk corridor payments and that hurt and disrupted the marketplace. and thatare going up is the strongest republican argument for why this law needs to go. really, they are not repealing it, they are amending it substantially. in albuquerque, new mexico. independent. caller: good morning. want to hear about the .olitical garbage medicare for everybody. everybody puts into it, you pay your co-pays, ok? stop with all this stuff. get together and do something for the people and not for yourself. you have people in washington

that make 6 figures a year and don't work. they work less than a hundred days a year. that is sad. we are getting ripped off. robert in terry, mississippi on the line for republicans. go ahead. caller: yes. this might be a little off-topic, but there were 3 of us kids and none of us went to the doctor, none. onund here, people that are went to the doctor three or six times a week. most of these people are just getting their kids on some kind of disability. i don't understand it.

$300 billion, that doesn't mean nothing to washington. it's just ridiculous. they are just all trying to get -- host: alex bolton, what are your talks? two callers talking about washington distrust of whatever they might do. guest: i think to say -- i didn't go to the doctor as a kid. if you are still around, you are lucky you were not that as a kid. a lot of these -- medicaid covers more kids. i think there is a consensus that everyone deserves some basic or minimum level of medical care, especially if you are a child or disabled, that you cannot just be allowed to that is whytreet so medicaid has a lot of support in

congress and that is why many republicans who are certainly critics of obamacare, they like the fact that it expanded medicaid and it remains an issue right now. yesterday you had rob portman of ohio saying he is concerned about what the medicaid cuts meant to constituents in his state. in ohio and other states, the -- prescription epidemic is a big problem and medicaid covers a lot of those people. heller of nevada said he has syria's concerns about what this bill means for veterans on concerns-- serious about what this bill means for medic and -- veterans on medicaid. for even the fiercest radix of obamacare, medicaid was viewed as a very important thing. they also acknowledge it is not necessarily sustainable or pat

toomey who helped write this bill, he put out kind of a fact sheet yesterday or argument sheet defending the bill and said medicaid is not sustainable. maybe one of the arguments -- i think one of the arguments that can be made for reforming medicaid and reducing payments is we need to keep it around for the long-term. i think both sides agree medicaid is important. host: davenport, iowa, jack, a democrat area good morning. caller: good morning. i went to the annual work for hathaway meeting and warren buffett said the u.s. is spending 17% of its gdp compared to the european and canadian care.ng of 11% on health that has a greater impact on our corporations than any tax reforms for corporate income taxes. does anything in this proposal

address the overspending and health care overall system itself? in other words, lowering 17% to 11% like the rest of the civilized world. host: alex bolton. guest: i don't think so. discussedat has been much. passed incare was 2009, there was a lot of talk about ending the cost curve and that is what the president talked about. they talked about reducing how much we spend on health care. one of the big things they come up with -- came up with was the cadillac tax, a tax on expensive plans and i was supposed to bend the cost curve because it provided disincentive for insurers spending tons of money on these goldplated plans. interestingly, that is the one obamacare tax they kept in

place. i think republicans bought into that theory. it doesn't get implemented until 2026, so it doesn't happen until a ways down the road pretty they have embraced that idea we are planned.tax cadillac we haven't had a chance to see if it works or not because it keeps being postponed. democrats don't like it because unions in particular, their members tend to have generous plans and so democrats have postponed this and try to eliminate even though it was in vision, senator harry reid who was the senate majority leader for years, he wanted to get rid of the cadillac tax. it has been postponed. that is the major cost perform alsois still in there and the idea that with health savings accounts, if you contribute more to it, you can exercise more consumer discretion in terms of buying plans and through natural competition in the marketplace

you will lower cost. on the other hand, rand paul who is a no and i don't think will flip to the yes, he seems the most staunch no. for bill is obamacare lite him and subsidies in the republican bill are just as costly and just as big when you total them all up as a obamacare would be. his argument is spending taxpayer money on insurance plans, private insurance companies is contribute into medical inflation. that it is causing cost to go up. whether this bill will really reduce the cost curve, it will keep one of the main obamacare reforms. idle think people are expecting the search in premiums that much -- i don't think people are expecting a surge in premiums that much. president barack obama issuing a statement on facebook

yesterday saying "i recognize repealing and replacing the affordable has become a core tenet. still i help our senators step back and measure what is really at stake and consider the rationale for health care or any other issue must be something more than simply undoing something that democrats did. " brian in virginia, democrat. caller: insurance is a complex problem. health insurance and everything. one of the big things that needs to be reformed is tort. doctors pay an exorbitant amount of liability insurance because somebody can have a hangnail and the guy messes up and he bleeds a little bit and he sues him and gets $8 million or something. we have all heard the mcdonald's coffee story, which is not health insurance, but the cost of health insurance -- the fees the doctors charge are

exorbitant and one of the reasons is because their liability insurance is through the roof. the affordable care act nor the republican act do anything to lower the cost of the medical bills. host: let's take that because the house is about to gavel in early this morning so i want alex bolton to talk about the debate that also happened when lawmakers were considering the affordable care act. guest: that is a good point. another thing republican policymakers point out is because of the medical liability, because of the lawsuits doctors face, that there is a tendency to to call fored -- the cat scan right away or the of right away or the battery tests right away which adds to the cost of health care, what they want to protect themselves from liability. they don't want to be held accountable in court and ask why did you not prescribed all these tests to figure out what is

happening, you could've saved my client's health. so the port situation -- tort situation does lead to the "-- over prescription of health care. this bill is passing in the senate under a process known as reconciliation. that is what is allowing republicans to pass with a simple majority. it has to have budgetary impact. could some of the provisions in the senate bill next week be ruled out of order because of the reconciliation consignments? guest: that is absolutely right. this bill has now been drafted and it has to go before the senate parliamentarian and she will make the decision what will stay in and what will go out and we do not know how she is going to rule. that is a potential monkeywrench in the process. guest: alex bolton announcer: