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SANJAY GUPTA MD

Questions about Obamacare; Obamacare: Just the Facts; Shutdown Interrupts Medical Treatment

Aired October 6, 2013 - 07:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


DR. SANJAY GUPTA, CNN HOST: Welcome to a very special edition of SGMD.

The country is still in a hug of war over the government shutdown and about Obamacare. And despite it all, sign-ups for new insurance did go into effect this week. Love it or hate it, this is a big deal. I mean, not since the creation of Medicare and Medicaid nearly 50 years ago has the country expanded its safety net to so many people or at so much cost. It's a historic moment.

So, we decided to spend the week traveling the country on the CNN Express, from Atlanta, to Greenville, Lexington, right here in Baltimore, to try and get a glimpse of how the Affordable Care Act is going to impact you and it does impact everybody. I do have to say that I quickly realized that for most people, some of the details have really gotten lost in all this.

In fact, take a listen to a little bit that Jimmy Kimmel pulled earlier this week.

(BEGIN VIDEO CLIPS)

QUESTIONER: We're talking about health care today, which plan do you support, Obamacare or the Affordable Care Act?

UNIDENTIFIED FEMALE: The Affordable Care Act.

QUESTIONER: So, the Affordable Care Act is more affordable than Obamacare?

UNIDENTIFIED MALE: Just the name says it all.

QUESTIONER: Right.

So, you disagree with Obamacare?

UNIDENTIFIED MALE: Yes, I do.

QUESTIONER: Do you think insurance companies should be able to preclude people with pre-existing conditions?

UNIDENTIFIED MALE: No.

QUESTIONER: Do you agree that young people should be able to stay on their parents' plans until they are 26?

UNIDENTIFIED MALE: They should be able to, yes.

QUESTIONER: Do you agree that companies with more than 50 or more employees should provide healthcare?

UNIDENTIFIED MALE: I do.

QUESTIONER: Do you know that Obamacare and the Affordable Care Act are the same thing?

UNIDENTIFIED FEMALE: No, they're not. Thanks, you made me look stupid.

(END VIDEO CLIPS)

GUPTA: A lot of people seemingly don't even try and hide this. In fact, a recent poll found more than two-thirds of Americans admit they don't know the basics about this. I personally had the opportunity to hear from hundreds of people as I traveled around the country this week.

(BEGIN VIDEOTAPE)

UNIDENTIFIED MALE: We hear a lot of rhetoric about how much the Affordable Care Act will hurt the economy, but I wanted to know, do you have any idea of how much based on the preventive care portion of this act, how much of a return on investment that could bring to the economy?

GUPTA: A lot of people have tried to answer that very question, trying to figure out over the long run could it actually save our health care system money, and there's an institution known as CBO or Congressional Budget Office that says basically over 10 years, these are projections, that it could save money, while the costs may be higher initially, this is, in part, part of what this whole idea of bending the cost curve down.

UNIDENTIFIED MALE: Yes, sir.

GUPTA: And basically says if we are a healthier America because more people are getting preventive care and not getting sick in the first place, that could save us money. And not everyone agrees with that.

UNIDENTIFIED FEMALE: I wanted to know if a person's age was going to impact the premiums, whether it's going to be higher for older people or lower, or just how that was going to work out.

GUPTA: I think the best way to sort of explain that is that you can't be discriminated against based on pre-existing conditions. You've heard that, right?

UNIDENTIFIED FEMALE: Right, right.

GUPTA: Diabetes, heart disease, cancer, they don't even ask you about those things when you are filling out this three-page application. They will ask your gender, female, male. They will ask your age. And the simplest way of putting it, this sort of develops a community rating.

So, what they want to do, Jeanie (ph), is ultimately you pay the same price as another person living in your community that's of your gender and your age. It doesn't matter what pre-existing conditions you have, but it's your gender and your age that sort of ultimately reflect the premium.

UNIDENTIFIED MALE: I currently do have insurance through my employer but I just found out this Monday that I'm getting laid off and I was hoping I could talk to you about what the next steps forward are with the Affordable Healthcare Act, what's available for me and what the next options are.

GUPTA: By January of 2014, you're going to -- required to have health care insurance or you pay a penalty. Now, if you have money to be able to pay for it, you can buy it. If you don't, then you can get the subsidies. You may fall into a position where if you have a job, again, before that happens, you may get insurance through your employer again. That's probably the best option, still.

People who have insurance through their employer, their lives probably don't need to change a lot as a result of what's happening. If you're still unable to have a job or get insurance from your employer, you need to go to healthcare.gov, look at the marketplace of options and see what's the best option for you.

Do you have health care insurance?

UNIDENTIFIED MALE: I have dental. I have dental. I don't have health care insurance. So --

GUPTA: Were you on your parents' plan prior?

UNIDENTIFIED MALE: Yes.

GUPTA: Are you familiar with what this means for you particularly as a 23-year-old?

UNIDENTIFIED MALE: I'm not. I'm not.

GUPTA: So, I think there's good news here for you which is that you can now stay on your parents' plan up until age 26. So you get three more years of health care coverage that is not something you have to go out and buy. This is part of your parents' plan under which you will now be covered. Have you had heard that before?

UNIDENTIFIED MALE: I had not. And that's -- you're the bearer of good news.

(END VIDEOTAPE)

GUPTA: After South Carolina, my next stop, Kentucky. Now, its leaders and Congress and Senate are Republicans. They are fiercely opposed to this law. But not the governor. He's a Democrat. He's for it. In fact, his state is the only Southern state setting up its own marketplace and extending Medicaid to more low-income families.

(BEGIN VIDEO CLIP)

GOV. STEVE BESHEAR (D), KENTUCKY: We've got 640,000 uninsured Kentuckians in our state. And we now have the opportunity for the first time in history to provide health insurance, affordable health insurance, for every single Kentuckian and that's going to be a transformative period for us.

Look, we have some of the worst health statistics in the country. We don't rank well at all. And those rankings aren't just this year and last year. We've ranked like that ever since they've kept rankings, and we've made some small, incremental changes to try to improve things, but we've never had that -- that major transformative time of event that can make a huge sea change in Kentucky.

(END VIDEO CLIP)

GUPTA: I do want to tell you that we did reach out to Senator Paul, Senator McConnell, and to the Republican congressmen who represent Lexington -- all of them declined to speak about it this week.

I did get to visit with Matt Bevin, who runs a small business, and he's also running for Mitch McConnell's seat.

(BEGIN VIDEO CLIP)

MATT BEVIN, SMALL BUSINESS OWNER: This is a regressive tax on the poor. Those subsidies for three years are going to cover Kentuckians three years and it's being paid for by other taxpayers including those from Kentucky. When the subsidies are gone, then it becomes increased -- increase in tax. It's a regressive tax on the working poor. That's the primary reason I'm opposed to this.

(END VIDEO CLIP)

GUPTA: Now, the rollout has been a little bumpy. It's no secret. As traffic on the sign-up sites has been heavier than expected, that's what we're seeing. In fact, the White House said that 4.7 million people went to healthcare.gov in just the first 24 hours.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): Eight a.m. Eastern, the doors fling open on the new marketplace where millions of Americans should be able to sign up for health insurance. But within minutes, thud! The site started going down, overwhelmed they say by heavy traffic.

New York state, internal service error. Washington state, the same thing.

The federal Web site is handling signup for 36 states, including Pennsylvania. That's where 25-year-old Lauren Hartley tried to sign up.

LAUREN HARTLEY, LAW STUDENT: And then on the third page, it asks for security questions, but the page just wasn't populated. There's some sort of technical glitch and it wasn't working.

GUPTA: By midday, both the president and his critics were weighing in.

BARACK OBAMA, PRESIDENT OF THE UNITED STATES: Like every new law, every new product rollout, there are going to be glitches in the signup process along the way that we will fix. I've been saying this from the start. And we're going to be speeding things up in the next few hours to handle all this demand that exceeds anything that we had expected.

SEN. ROY BLUNT (R), MISSOURI: In a system that's full of glitches, I think that's the word most frequently being used today, glitches means it's not working.

(END VIDEOTAPE)

GUPTA: Now, we did check back in with Lauren. She hasn't logged back on yet. She's not worried about this because she says she has time, and she does. I mean, look, the enrollment period is six months long. So, if you want your new health insurance to go into place on January 1st, you do need to sign up by December 15th, but the enrollment period goes until the end of March.

Now, the glitches and the backlog, they did seem to get better as the week went on. In fact, we decided to stop by one of the government- sponsored call centers in Baltimore, Maryland, where they were fielding calls from consumers.

(BEGIN VIDEO CLIP)

GUPTA: You know, I hear from a lot of people talking, they're just frightened of doing this. I think people signing up for anything makes them nervous. You are here to shepherd them through, what advice would you give people?

MARIA RILES, CALL CENTER REPRESENTATIVE: Give us a call. We have navigators, we have local health departments, we have department of social services and insurance brokers out there. There's a lot of avenues to get help.

(END VIDEO CLIP)

GUPTA: So, are you still confused by all this? A lot of people are, Obamacare, just the facts. We're going to have it for you, coming right up.

(COMMERCIAL BREAK)

GUPTA: You know, millions of Americans are now for the first time able to purchase insurance with no questions asked.

So, we asked CNN's Tom Foreman to take a closer look at how this new marketplace works and what your insurance plans may look like as well.

(BEGIN VIDEOTAPE)

TOM FOREMAN, CNN CORRESPONDENT: Hey, Sanjay, despite all these monumental changes to health care, most of us who have insurance -- and that is most of us -- probably won't see much change. Maybe some modifications but this is really about the 48 million people who do not have insurance, about half of whom are now expected to buy it through these health care marketplaces, and about 7 million by the end of the year, I can point out, to give you an idea how fast it will be moving along.

So, how will these marketplaces operate? Imagine a store where you can go in and buy one of four different types of health plans. Bronze, silver, gold, or platinum.

Here's the difference between them.

If you buy at the lowest level, the bronze level, for example, your premium each month will be fairly low, but if you go to the doctor, your co-pay, your deductible, and your other fees will be higher.

Platinum, just the opposite. You will pay a higher monthly premium, but at the doctor's office all of your fees will be lower. This will not be exactly the same state to state to state because there will be local companies involved, and that could make a difference.

But this part should be the same no matter where you go in the country. You will not have higher premiums if you get sick. You should not be denied coverage if you're already sick, and you will not pay fees for preventive care. You get a mammogram, your kids get vaccinations, you get a general physical. You won't pay any extra for any of that under this plan.

Still, there's a lot of money involved in all of this, and the government wants to help people who may have trouble paying for it, because a lot of people who don't have insurance don't necessarily have a lot of cash for it.

So, if you make $40,000 or less an as individual, if you make $94,000 a year or less as a family of four, they're going to give you a refund to help pay for this.

Nonetheless, no matter how you get there, everyone is going to be involved. It doesn't even matter if you live in one of the dozens of states that have said they want nothing to do with Obamacare. You're still going to be part of this program. The federal government will administer the marketplace in your state instead of the state. That's simply how it's going to work.

But you will have to get involved, because if you don't pick a plan, if you don't get involved, you're going to be fined by the federal government. That's how this is going to work. So, if you're uninsured in this country, the time is upon you now. You are going to have to make a decision no matter where you live coast to coast -- Sanjay. (END VIDEOTAPE)

GUPTA: Thanks, Tom.

And I'll tell you that some of this is enough to make you sick as well. There are criminals out there who are taking advantage of all this confusion around the law to rip off unwitting consumers.

Zain Asher joins me now from New York with the top Obamacare cons.

I can't believe, Zain, I'm putting those two words together in the same sentence.

ZAIN ASHER, CNN CORRESPONDENT: I know.

GUPTA: What should people be looking out for?

ASHER: Hi, Sanjay.

Well, the Affordable Care Act really does represent the opportunity of the decade for scam artists and there are a number of scams we do want to warn viewers about.

Number one: fake health insurance sites. Now, these are the sites that might look like state exchange sites, that might have the appearance of them, but they are fake. You type in a state exchange Web site into your browser, for example, and you misspell it by one letter and you are redirected to a fake site. So, it's important that people be vigilant.

Most but not all of the legit sites do end in dot-gov. California's site, for example, does end in dot-com. But most do end in dot-gov.

Another thing we do want to tell people about is people impersonating navigators. So, if the people that don't know navigators are certified professionals who can help you shop for health insurance. But an impersonator might say, hey, Sanjay, you know, pay us $100 or $200, and we'll help you sign up. Watch out for anybody asking you for money.

Sadly, another thing that does breaks my heart is that seniors often do become targets with these kind of things. Someone might tell you they'll lose coverage if they don't get a new Medicare card and then they will begin to press for your Social Security number.

Bottom line is you do not need a new Medicare card with Obamacare and it's important that people know that and tell their parents the same thing.

Lastly, I do want to say, watch out for companies offering a cheaper alternative to insurance. Now, these so-called medical discount plans are bogus. They falsely claim to exempt you from minimum insurance coverage requirements.

Bottom line: if you're unsure, stick with the federal and state exchanges -- Sanjay. GUPTA: So, is there anything you can do if you think you've come across one of these bogus scams?

ASHER: Yes, absolutely, there are a number of things you can do. You can file a complaint with your state attorney general or your local consumer protection agency. But, you know, listen, under normal circumstances -- under normal circumstances -- you would be actually file a complaint with the FTC, but because of the government shutdown, unfortunately they are not taking complaints at the moment -- Sanjay.

GUPTA: And the ironies just remain breathtaking, I think, Zain.

ASHER: I know, I know.

GUPTA: Thank you so much for joining us. Very important information there.

And coming up, perhaps the saddest part of this whole thing, this whole government shutdown: blocking kids with cancer from taking part in clinical trials. We'll be right back.

(COMMERCIAL BREAK)

GUPTA: The cascading effects if you will of the government shutdown could be felt all across the country, even maybe putting some lives at risk. Two hundred people, 30 of them who are children, unable to start clinical trials for the crucial medical treatment that they need at the National Institutes of Health.

And my good friend and colleague, Elizabeth Cohen, she's been following this. She joins me now from the CNN Center.

And, Elizabeth, you've been talking to the family of one very sick child it sounds like.

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: Right, Sanjay, her name is McKenna Smith. She's 12 years old and her last hope at life is an experimental drug. But, Sanjay, this week that hope began to fade.

(BEGIN VIDEOTAPE)

COHEN (voice-over): McKenna Smith spends most of her time in this wheelchair because of a rare genetic disease. Doctors say she probably won't see her 20th birthday.

MCKENNA SMITH: Sometimes I don't even feel like I want to get up because my back is aching so bad.

COHEN: The pain she feels is caused by tumors that wrap their way around her nerves and compress her organs. There's no cure but there is hope.

On Monday, McKenna and her dad, Justin, arrived here at National Institutes of Health in Bethesda, Maryland, so McKenna could start taking an experimental drug that might shrink the tumors. But with the government shutdown, including most of the NIH, the family was told there was a chance McKenna might not get the medicine.

MCKENNA SMITH: I hope it doesn't affect me or anybody else who needs this drug.

COHEN: Her father waited and worried, tweeting Wednesday morning, "Government shutdown needs to end. Now hurting sick people. Have the House come here to apologize to my young daughter and others."

JUSTIN SMITH, MCKENNA'S FATHER: I'm very angry. Now finally, we're here and our government can't get its act together.

COHEN: They thought might have to go home to Florida without getting the medicine.

But late Wednesday, a turnaround. The family was informed McKenna's treatment could go forward.

McKenna's fortunate. About 200 other new patients, including some 30 children, aren't so lucky. They won't get to join NIH studies just yet. These patients are being put on hold until the government is back in business. McKenna's dad says this just isn't right and he has a message for leaders in Washington.

JUSTIN SMITH: Get your act together. This is not a game. You're not -- you can't play politics over children's and other patients' lives.

(END VIDEOTAPE)

COHEN: Now, if this shutdown continues, that means that another 200 patients won't be able to begin their trials next week -- Sanjay.

GUPTA: That's sad. I mean, she's such an adorable girl. It's an important reminder, I mean, there's real lives behind all of this.

Also, I mean, the CDC, there's some -- it could impact them as well. They track these big impact things like flu and infectious disease outbreaks, they're being crippled by the shutdown as well. What are you are hearing that they're having to cut back?

COHEN: Right. So, most of CDC has gone on furlough, most of their employees. And, you know, as you said, we're gearing up for flu season and it's CDC who tracks and it and lets everyone know where the resources should go. Well, they can't track it because they're not there. They can't track avian flu, which is another issue.

And, Sanjay, you know that whenever there's an outbreak anywhere in the country, state health departments call the CDC for help. Well, now, they can't do that.

GUPTA: Yes. And, I know, and you get the impression was that some of these things, you know, obviously, have immediate impact and some of the things may have longer-term impact, the FDA as well, you and I report on food disease outbreaks.

What are you hearing about the food supply investigators? COHEN: Well, those investigators, many of them have been furloughed. So, the FDA has really had to curtail their produce inspection program, and they're the ones who inspect produce before it's allowed to go on to grocery store shelves. So they can't be there, you know, in full and they also can't do their laboratory kinds of work in full. So, all sorts of things, things we just don't even really think about, just can't happen.

GUPTA: You know, it's, again, such a great piece and a great reminder, I think, that there are real lives behind all of this. A lot of people are hearing the politics and the numbers, but McKenna is a great example.

Elizabeth, thank you so much.

We're going to have much more from the road as well as the CNN Express rolls on. Stick with us. We're visiting many states. We'll bring it all to you.

Stick with us.

(COMMERCIAL BREAK)

GUPTA: My crew and I spent this past week on that bus there behind me. Long road trips and maintaining good nutrition in a situation like this can sometimes be tough, but we did our best.

(BEGIN VIDEO CLIP)

GUPTA: All right. So you've seen the outside of the bus. This is what the inside looks like. People working very hard.

I want to talk about food for a second, you know, one of the things that we try and do our best on trips like this, you know, maybe getting the baked chips instead of the fried chips and we really focus on protein, lots of nuts. This is hummus, for example. Water. It gets very dry on a bus like this.

So, again, we do the best we can. We did pretty good on this trip. What might be more dangerous than the food, though, could be the way that we were forced to sleep.

(END VIDEO CLIP)

GUPTA: That's going to wrap things up for the special edition of SGMD. Stay connected with me at CNN.com/Sanjay and keep the conversation going on at Twitter @DrSanjayGupta.

It's time now, though, to get you back to the "CNN NEWSROOM" with Don Lemon.