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Testimony thirteen kicks off the Affordable Care Act will be front and center of the Obama administration set to implement changes to the health care system and my next guest says 2013.
Well it will be a very eventful year for the industry and here would moral want to.
Since she's senior fellow heavy Troy tell me.
OK we know it's going to be an eventful year what are some of the biggest things that we need to keep -- -- Well the first thing and the biggest thing of course is what you just suggested the Affordable Care Act and its implementation.
The Obama administration sees this -- -- key year for getting it implemented getting the state based exchanges working.
There's a problem with that though -- that most of the governor said they don't wanna participate so it's going to be hard to get these exchanges up and running -- fourteen so if they don't participate.
Does that mean that the federal government comes in and takes over.
That's exactly what it means if you don't do a state based exchange in your state than the federal government comes in and does it for you know the if you do it yourself though in your state you really don't have that much discretion because the was somewhat heavy handed it tells -- exactly what the parameters are so a lot of governor saying.
Why should I participate -- but the federal government come in.
And we'll give them the blame for it if it doesn't work.
But you could argue that doing it yourself would be the lesser of two evils that you could run it backs up.
And more cost efficient Li I mean yes to be -- yourself you have to live by these.
Tough time lines I think that from the federal side but I find it -- -- that states don't -- at least have control over their own destiny when it comes these exchanges.
Well what you just said is this theory that Butch -- the governor of Idaho is using -- -- I'd rather try do myself than have the federal government -- -- however.
The what other governors have looked instead they don't wanna participate if not the tough time -- that there worried about so much.
As they're worried about their restrictions the federal government imposes on the exchanges so it's not you get to make the exchange the way you want to do it like the Utah governor trying to do it it's.
-- to do the exchange is exactly how we tell you do it.
Talk about also the expansion of Medicaid how exactly is that going to work.
Well well -- they're talking about adding sixteen million more people to Medicaid over the next five or six years.
The problem is that Medicaid state budgets are already quite -- overall we spent over 400 billion dollars on Medicaid annually.
And it's the largest single aggregate spending item on all of states.
State budgets have you taken together about 25% of state funding.
So that the state governors are looking at Medicaid they're saying well -- -- government promises to pay more of the expansion in the first couple years.
But they don't say what's gonna happen in the subsequent years of the state governors are worried about expanding and then being left holding the back.
You and we should also mention we're about -- is facing substantial cuts in there have Medicare reimbursement.
Yeah -- of the fiscal cliff feel that they're talking about president -- will be -- few minutes and supposedly they're talking about the doc fix yeah which would sit save.
Doctors from seeing a big.
Cut in how much they get reimbursed but that also costs money everything they're looking at in this fiscal -- deal that's been announced so far is something that's -- Increase the size of the debt or deficit so.
If you're looking for ways to fix the debt and deficit problems we've got over trillion dollars annually in Medicare Medicaid spending and that's probably the biggest place to go in terms of -- cuts if you want to make changes to the debt deficit situation.
All right have a Terry -- thank you so much from the Hudson Institute thank you for joining its convenience and -- 2013 with -- -- health care about thank you.