Episode 17: Trumpcare, Senate Edition

Plus: a tale of two Nevadans, what Trumpcare means for veterans, and why Kansas should be the nation’s last experiment with trickle-down economics. Subscribe to Off-Kilter on iTunes.

The mainstream media was all but silent on healthcare — until Thursday, when the Senate unveiled its own repeal legislation, crafted in secrecy. To unpack what’s in the bill, Rebecca and Jeremy are joined by Ryan Collins of the Center for American Progress for this week’s In Case You Missed It. Next, with all eyes on Nevada Senator Dean Heller and other moderate Republicans, Nevada has made moves in the opposite direction. Rebecca speaks with State Majority Leader Aaron Ford about how Nevada almost became the first state to offer Medicaid for all. Next, Wonkblog’s Max Ehrenfreund shares the nitty-gritty on Kansas’s failed experiment with trickle-down economics — and how the state should be the canary in a coal mine for Republicans in Washington. And finally, CAP’s Larry Korb breaks down what the GOP health plan means for veterans, a group President Trump vowed to protect.

This week’s guests:

  • Ryan Collins, Center for American Progress
  • Nevada Senator Aaron Ford
  • Max Ehrenfreund, Wonkblog
  • Larry Korb, Center for American Progress

For more on this week’s topics:

This program aired on June 23, 2017.

Transcript:

REBECCA VALLAS (HOST): Welcome to Off-Kilter, powered by the Center for American Progress Action Fund. I’m your host, Rebecca Vallas. A big week, we’ve just seen the senate health care bill that Republicans are pushing to repeal the Affordable Care Act and replace it with something that is no longer just secret and behind closed doors in smoke filled rooms. We’re talking lots of healthcare this week. Veterans, how they’ll be impact, plus the Nevada legislature’s attempt to create a Medicaid buy-in; what that means, why it was stopped, what else is going on in that state that provides a heck of a contrast with what’s going on in Washington. What’s the matter with Kansas 2017 edition. But first let’s find out because I know i want to know and I’m feeling like a drumroll is the right thing to do, what’s in the Senate bill? Ryan Collins is joining us again. He’s from CAP’s government affairs office, a gentleman and a scholar and the Slevs is here too.

JEREMY SLEVIN: I’m here too.

VALLAS: And I have to say this Slevs, I’ve been told by multiple listeners that I need to embrace what Keith Ellison calls you which is the Slevinator.

SLEVIN: We need a rebranding!

VALLAS: I think it’s time for the rebirth of the Slevinator.

SLEVIN: It’s time to Slevin-ate.

VALLAS: It’s time to Slevin-ate. So that being said, Ryan, I know I don’t want to wait for any you know, more seconds to know what’s in the Senate bill, what’s in the Senate bill?

RYAN COLLINS: So it just dropped this morning. In essence, there is kind of three big parts you have to look into it. One is it repeals all of the Obamacare tax rates, so ultimately those with the wealthiest among us would be receiving huge tax breaks from this bill. It’s probably the primary reason they continue to push this.

VALLAS: Not probably.

COLLINS: Yeah.

VALLAS: I mean it just is, let’s call a spade a spade here.

COLLINS: And so then additionally, it would ultimately do a per-capita cap for the Medicaid program while also rolling back the expansion starting in 2020.

VALLAS: Pausing you there —

SLEVIN: When you say per-capita cap —

VALLAS: Yeah, we should translate this.

SLEVIN: You mean massive dismantling the program.

VALLAS: Ending Medicaid as we know it is really what per-capita cap means.

COLLINS: Exactly. They’re block granting and ending the entitlement that is Medicaid.

VALLAS: So instead of Medicaid being a promise to people who are eligible, now it’s, well let’s hope mom that we’re going to get health care this year is kind of what we’re talking about.

COLLINS: Exactly. As you know, this ultimately affects seniors, children, the disability community far more than anybody else but yes. So there are going to be huge cuts within the Medicaid program, a rollback of the expansion which is what states ultimately used to expand Medicaid to help cover folks who couldn’t afford health insurance.

VALLAS: Who maybe weren’t officially poor according to the federal government but who were teetering on the edge of poverty.

COLLINS: Exactly.

SLEVIN: These Medicaid cuts are even steeper than the House long term, am I right?

COLLINS: They are steeper than the House.

VALLAS: So all these months we’ve been expecting, oh we’re going to get something that’s crazy from the House and then we’ll get something that’s a little more moderate from the Senate but that’s not actually what we’re seeing based on what you’ve said.

COLLINS: That is not the case. As Trump called the House bill mean this is mean plus.

VALLAS: Mean plus!

COLLINS: So those are two things, the other thing to look for is they ultimately rolled back the subsidies for the ACA for folks who; it currently is at 400% of the poverty line, they roll that back to 350%. So folks who are in that kind of; it expands the coverage gap even further. Seniors are going to see their premiums explode by thousands of dollars per year. Particularly for those; I mean the median income in America is $55,000 so this would hit all of those.

VALLAS: So Republicans who are not even, I mean middle class is probably a little generous for the income ranges we’re talking about but many folks who are living paycheck to paycheck who aren’t poor but are living on the edge are now actually going to see themselves thrown into an even wider coverage gap where they aren’t going to get help anymore from the subsidies that the Affordable Care Act put in place.

COLLINS: Exactly. So that’s obviously a big concern for a whole lot of folks. The other three big things I’ll also point out is it does allow states to waive essential health benefits so this would greatly weaken protections for pre-existing conditions. Additionally, there is a moratorium on funding for Planned Parenthood involved in this. And lastly there are severe restrictions for any abortion services, what’s commonly known as the Hyde amendment, its language is throughout which is something we have heard maybe was going to be removed but in the end wasn’t.

SLEVIN: So this is, I mean this breaks their promise that people with pre-existing conditions will be covered. I heard that buried in there somewhere but that’s —

COLLINS: Yes.

SLEVINS: That’s kind of a big deal.

COLLINS: It totally breaks their promise. Very similar to what the house bill did. This is as close to as you can be breaking that promise.

VALLAS: And remind us how, I mean it’s a large share of Americans who have pre-existing conditions.

COLLINS: The Center for American Progress estimated that there’s about 300 million Americans. No, 100 million Americans.

VALLAS: So basically like almost a third of the country.

COLLINS: Exactly.

VALLAS: Right, has some kind of pre-existing condition.

SLEVIN: It’s like 48% of people —

COLLINS: Exactly.

SLEVIN: Working age people have a pre-existing condition.

VALLAS: That’s right. You know, a third is low, so it’s like almost half. Almost half of the country has some kind of pre-existing condition, because in some cases this is like we had a woman who wrote for Talk Poverty a while back, right, her husband had been denied health care coverage on the private market because when he was a teenager he had acne and he had taken an acne medication and that was considering a pre-existing condition, just to drive the point home, how many people are going to fall into that category.

COLLINS: Exactly and ultimately what this bill will probably end up doing will allow insurance companies to dictate what they’ll ultimately cover. So what they consider a pre-existing condition moving forward.

SLEVIN: And they can charge whatever they want, right?

COLLINS: Whatever they want. The other big thing in here and this is why AARP has been so opposed to this bill is it does reinstitute the age tax, instead of going from a 1 to 3 rage ating, age rating excuse me.

VALLAS: I’m feeling some rage! I don’t know about you Ryan, I’m feeling rage.

SLEVIN: Freudian slip.

COLLINS: Exactly so, that’s kind of the overview, again, it’s about 145 pages long, people are just getting into the details of it but that’s what I know.

VALLAS: I want to hone in one of the things that you; home in, home in not hone. For everyone listening, I said that incorrectly, sorry, it’s one of my own pet peeves.

SLEVIN: I never knew that!

VALLAS: Yeah, well now you know, now you know, with a little rainbow going —

SLEVIN: It’s a homing device.

VALLAS: Yes, home in. Homing in on something that you said, Ryan, that I don’t want to gloss over, essential health benefits. So there’s a lot of folks out there who might be saying, “You know what, I don’t get Medicaid and I don’t get my health care on the exchanges therefore why is this debate relevant to me?” But several parts of what you just said implicate anyone who has health insurance or who wants health insurance from any source including private healthcare companies not on the exchanges or not getting help from subsidies. And one of the main reasons for that is by ending these essential health benefits which basically that was the Affordable Care Act saying you know what, health insurance providers, you have to provide everybody at a minimum these certain core benefits, one of which is mental health care coverage. There needs to be parity between physical health coverage and mental health coverage. And every plan offered needs to meet those criteria and have those basic benefits. This throws that in the toilet.

COLLINS: Yep, absolutely. I mean CBO ultimately looked at the house bill and let’s make no mistake that this is the house bill, if not worse. That about a sixth of the country wouldn’t be able to afford health care due to the waivers of essential health benefits. Because again, states would potentially waive these things, your employer could base its health care coverage within that state. And so even if you’re in a state that ultimately does protect against these types of things, save for California, your employer might end up buying its insurance in Texas and you might get screwed.

VALLAS: So what are the politics here? What are we hearing? Can they actually pass this bill?

COLLINS: So it’s a big question mark I think. This is going to be the first round in what will be a very interesting week heading up to this. McConnell has still said he plans on having a vote in the Senate, on the Senate floor by the end of next week. My guess would be you start seeing the process start Wednesday morning, Tuesday evening as it then boils over into Thursday with probably a vote late Friday.

VALLAS: So we’re talking about next week being the week of, the last week in June, which is right before the July 4th recess.

SLEVIN: I’d just add some green shoots so we’re heard this morning —

VALLAS: Green shoots!

SLEVIN: Spoiler, it’s Thursday. Everything, green shoots, they’re like, right [LAUGHTER] Plants growing? Good news?

VALLAS: It was just so weird coming from you. I don’t know it was a weird thing.

[LAUGHTER]

SLEVIN: I know, I’m like a weird dad.

[LAUGHTER]

VALLAS: You kind of are, you’re like a weird dad. This is what happened to you now that you have a cat.

SLEVIN: It’s true I’ve officially become —

VALLAS: Become very paternal.

SLEVIN: I’m a weird cat father. Anyway, on a more serious note, we now know that at least three Republican senators, and to be clear they can only afford to lose two. If they lose three —

COLLINS: It’s over.

SLEVIN: They lose. And we now know that three Republican senators are planning on coming out against this version of the bill.

VALLAS: This is what news reports as of Thursday morning are saying.

SLEVIN: And just, I just saw, Nevada Senator Heller, who’s up for election in 2018, just said, “At first glance I have serious concerns about the bill’s impact on the Nevadans who depend on Medicaid.”

VALLAS: And later in this episode we’ll actually be hearing from an important leader in Nevada’s state senate who has some thoughts about that as well.

SLEVIN: So if these three senators stay where they are and vote against this, unless McConnell can buy them off or make concessions, this bill is going down.

COLLINS: So that, I mean that’s the hope again, the margins on this are incredibly thin. It’s very similar to ultimately how the House kind of boxed themselves in. You’re going to have conservative senators like Texas Senator Ted Cruz, Rand Paul from Kentucky —

SLEVIN: He’s conservative?

COLLINS: Coming out, and as I mentioned Planned Parenthood provisions are in there, Hyde amendment provisions are in there. There’s some pretty good arguments to potentially removing these from the bill and so you might see a backlash from conservatives if they make this any better for moderates but at the same time you might see if they try to make this more conservative, you’ll get push back from the Collins’s, the Heller’s.

VALLAS: So McConnell’s in a squeeze, right.

COLLINS: He’s in a squeeze.

VALLAS: Because it’s similar to what we saw in the House and what Paul Ryan had to do to actually manage to get the votes in the House to pass this. And he did it with the narrowest of margins, if he lost even a couple more votes it wouldn’t have passed last month. But what we’re watching here if I’m understanding you correctly is McConnell, being squeezed between the rock and hard place that represent his moderate wing and his conservative, his super right wing wing; right wing wing [LAUGHTER] Is apparently the thing that I’m going to say now. And if he tries to please the “mods” he’s going to end up potentially losing the right wingers, but if he tries to please the right wingers, he’s at risk of losing the mods. Jeremy is raising his hand, which I think means he wants to say something.

[LAUGHTER]

SLEVIN: Well my question is what more does Ted Cruz want? This seems like Ted Cruz’s daydream.

VALLAS: Similar to how this is like Paul Ryan’s keg party dream.

SLEVIN: Yeah, which he actually said.

VALLAS: Which he actually said.

SLEVIN: He’s been dreaming about this since kegger days.

COLLINS: So as I understand it obviously he’s actually been playing a much more moderate role this time around than he has previously. I think again, the Planned Parenthood stuff, access to reproductive rights, I think is kind of a sticking point for him.

VALLAS: Meaning that no one should have it.

[LAUGHTER]

COLLINS: Exactly, he doesn’t want anybody to have access.

VALLAS: We were both like let’s be clear here.

COLLINS: The other thing is though I think he’s going to have a tighter election race in 2018 than most anticipated and this could be the reason that you’re starting to see him kind of moderate his tone a little bit being one of the, there’s numerous news articles out there saying he was kind of trying to compromise here. He’s already talking to folks over in the House Freedom Caucus so that if and when this passes the Senate, that they’re on board. So it’s really actually unclear what he wants.

SLEVIN: So does he want it, it’s unclear whether, he may want less Medicaid cuts?

COLLINS: So the good thing from his perspective is Texas never expanded Medicaid so he ultimately —

SLEVIN: Right, not for you know, a million Texans.

COLLINS: Exactly. So he doesn’t have the same pressures that Heller in Nevada, Capito in West Virginia have.

VALLAS: Because those were expansion states.

COLLINS: Exactly, those are expansion states. And so he has less concerns about the Medicaid program and if you look at anything that he said over the course of his career, those types of entitlements have never been, he’s never been a big fan of those, so. I think deeper Medicaid cuts are probably something he’d push for. I think if he ends up coming out against this bill it will be because of conservative reasons.

VALLAS: So what are the next steps, what do we watch for in the coming days, the coming weeks. You said we’re expecting if you trust leader McConnell and take him at his word that he’s trying to take this to a vote before the July 4th recess. But what’s the process that this goes through, like let’s pretend for a secord the Senate actually is able to narrowly pass this bill, what happens next? That isn’t law automatically.

COLLINS: So yes. So as I said, we’ll probably see the bill reach the floor of the senate Tuesday evening, Wednesday morning. They’ll debate for 20 hours, then they’ll go into vote-o-rama which I know we’ve talked about on the show before. They’ll have a handful of amendments and they’ll end up voting on whatever the final package might look like. And again, I think Jeremy kind of caveated pretty well that right now there are three senators that are potentially voting against this thing but they can sweeten the pot to get those guys on board so you will probably see a lot of backroom negotiating happening between now and that vote to cajole all those members over. Once it passes the senate, if it passes the senate —

VALLAS: Knocking on all of the wood in the radio studio.

COLLINS: It would then have to go back to the house and we’ve been hearing numerous reports that they don’t plan on doing a conference which would mean both the house and senate create conferees and they would talk about this again.

VALLAS: They don’t want to do that.

SLEVIN: Meaning they’re not, like basically the senate bill is it, is that what you’re saying?

COLLINS: This is, I mean this is what we’ve been telling everybody. Whatever the senate passes will be what they end up signing into law.

VALLAS: So there’s a step there that we should explain. And I feel like we should cue Schoolhouse Rock, as a bill becomes a law. [LAUGHTER] I don’t know what that voice was but apparently it was my —

SLEVIN: I think that was the bill, that was the voice of the bill. Yeah, yeah.

VALLAS: Being like “I’m just a bill sitting here on Capitol Hill.”

COLLINS: That’s baritone.

[LAUGHTER]

VALLAS: It was actually, it was an alto. I was a mezzo, I was a classically trained mezzo. That’s a thing and that was me. So Eliza, who is quietly producing the show also was pointing at herself which tells me she was also an alto. I knew I liked you for other reasons than your brilliance.

SLEVIN: I also was an alto.

VALLAS: No comment. So once the senate, if it were to pass the bill and the bill were to go to house, the house would be voting on the senate bill, that’s what you’re saying. And if they were able to pass it then it would go to the president, it has to be signed.

COLLINS: Then it goes right to the presidency.

SLEVIN: Which to get back to something we talked about last week, this is why it’s so shocking that we haven’t seen the kind of coverage that we did in the house on this senate bill because this is —

VALLAS: This is the bill.

SLEVIN: This is what is going to be the law of the land if the senate passes this. If these three senators, or three or more senators don’t remain no’s, this is it. This is the end of Medicaid as we know it and is the end of health insurance for millions of people.

VALLAS: And we think the house would pass this is what I’m hearing you say.

COLLINS: Every indication that we’ve been hearing is that. Again you never know what the Freedom Caucus and the conservative members of the house are going to do but I have to, I’d have to bet that you are the single vote between this becoming, going to the president’s desk to be signed and I just don’t see conservative members bucking their party to make this more conservative when they fully know that a repeal [INAUDIBLE] happening.

SLEVIN: Especially if you get Ted Cruz and Mike Lee, two arch-conservatives, on board.

VALLAS: Which gives it a heck of a lot of cover. So in the last minute that we have, Jeremy sorry no, you don’t get to say anything. I mean you might.

SLEVIN: I’m done anyway.

VALLAS: Not until I say the next thing which is to take us out, I would, we would be remiss if we didn’t close on a note of what can we do because we’re not just going to passively sit by and hope and cross our fingers and think a lot about how we really don’t want this to happen. There are millions of Americans, actually the Washington Post, I think it was just did a feature recently with a map showing state by state; in no state in this country is what the senate is trying to make law actually popular. It’s deeply unpopular.

COLLINS: Deeply unpopular.

VALLAS: People don’t want this, this is why members of congress are hiding in the bushes Spicer style instead of doing town halls in their districts.

SLEVIN: Hiding in closed door rooms.

VALLAS: Hiding in rooms.

SLEVIN: They’ve got better hiding practices than Sean Spicer, that’s their own advantage

[LAUGHTER]

VALLAS: The bar is low. What in the last 20 seconds or so Ryan, how can people get involved in stopping this thing?

COLLINS: Absolutely. It takes calling your senator, emailing your senator, showing up at the district offices over the course of this weekend. I mean this is really the last chance you’re going to get. If you’re in and around the DC area there’s going to be numerous rallies and protests.

VALLAS: As we’re taping there’s actually a die-in happening at Leader McConnell’s office, staged by ADAPT, thank you ADAPT.

SLEVIN: And trumpcaretoolkit.org

COLLINS: I was just going to say trumpcaretoolkit.org, this can be your one stop shop to pinging all those Senators that are going to be the key vote on this. And so it really means that we need to raise the decibel level to an absolutely screaming pitch.

VALLAS: Trumpcaretoolkit.org, if you haven’t done it go there now. If you have done it, go there again. And if you haven’t been calling your members or tweeting at them or whatever it is that you do every single day then do it now. Ryan Collins, a gentleman, a scholar, a government affairs guru at the Center for American Progress who is tirelessly fighting to stop this health care bill from becoming law so that people still get to see doctors and have the services and the coverage that they need in this country. The Slevinator, also a pleasure every time he’s here and that’s all I’ll say there. [LAUGHTER] Don’t go away, with all eyes on senate moderates like Dean Heller from Nevada, the state of Nevada quietly took a major step forward to create a public option for residents who need health insurance. That and more next on Off Kilter.

[MUSIC]

VALLAS: You’re listening to Off-Kilter, I’m Rebecca Vallas. While senate Republicans continue to seek to dismantle the nation’s health insurance system, including ending Medicaid as we know it, the Nevada legislature quietly took a major step in the exact opposite direction, passing a bill that would massively expand health coverage in the state by giving the state’s 2.8 million resident access to a public health insurance option. Whenever a public option gets discussed, people are usually talking about Medicare and so called Medicare for all proposals to open up the program which is currently restricted to seniors to all Americans under age 65. But Nevada’s proposal would allow people to buy into Medicaid, making Nevada the first state to open its Medicaid program to everyone, regardless of income or health status. Nevada’s bill for a so called Medicaid buy in would also any state resident who lacks health coverage to buy in to the state Medicaid program. People who qualify for tax credits under the Affordable Care Act would be able to use those credits to buy Medicaid coverage. And people who don’t qualify for subsidies under the ACA would be allowed to use their own money to buy in. The plan would be sold on Nevada’s health insurance marketplace, making it a true public option to compete against the private health insurance plans also selling there.

Many have called the proposal Sprinkle-care in homage to its sponsor Nevada assembly member Michael Sprinkle. While governor Brian Sandoval recently vetoed the bill, as Vox’s Sarah Kliff notes in an article describing the legislation, the Nevada legislature’s passage of this type of proposal marks a particularly important milestone and one worth watching given the implications for the future of the health care debate beyond the ACA. This is because states have a large role in running Medicaid, so they can move these proposals forward with less involvement and possibly no involvement by the federal government. So while public options proposals based on Medicare have always failed at the federal level, we could see blue states like Maryland or Connecticut or maybe even purple states like Nevada bypassing Washington and moving forward public option policies using Medicaid on their own. I spoke with Senate majority leader Aaron Ford who partnered with assembly member Sprinkle in championing the bill to hear the story behind the legislation and what else is going on Nevada in deep contrast with Washington. Let’s take a listen.

VALLAS: So tell us a little bit about the story behind the bill, how did it come about in a state that a lot of folks tend to think of as red, and as you mentioned at a time when Republicans are actually trying to do the very opposite here in Washington when it comes to eviscerating Medicaid as we know it.

SENATOR AARON FORD: Well I think frankly, let me step back and say I think we have dispelled with this false notion that Nevada is a red state by virtue of the fact that we were as we like to say, the blue star if you will during the November election of last year. Every office that had a race went Democratic from our U.S. senate seat to our congressional seats to both houses of the legislature and we are looking to again make that stride going forward in 2018. Now I would consider us a red state, it may be purple by some people’s, in some people’s mind. But generally speaking as I’ve indicated what we saw with the electorate in our state was that people were concerned about some of the rhetoric coming out of Washington D.C. and the candidate that ultimately won the presidential election. And so this conversation is one that popped up immediately, and it wasn’t just about Medicaid, it was also about enshrining what’s in our state, protection for reproductive health for women, for preventative health for all folks, for being able to allow people to stay on their parents’ insurance up to age 26, and for ensuring that pre existing conditions were not barriers to being able to get insurance and again. That’s part of our Nevada blueprint. We have run on a platform that looks to help our working Nevadans and Medicaid for all was one of those types of bills that we felt could help do that.

Most of America wants the same thing that we are doing here and what we’ve attempted to do here in Nevada. No one wants to be able to lose their health insurance coverage at this junction. No one wants to envision a day where Medicaid no longer exists and so what we’ve done is attempted to abide by the wishes of those who sent us to Carson City and we think that frankly at the national level congress should be doing the same.

VALLAS: So you mentioned before we actually started rolling tape that you have sent a letter along with the Speaker of the House in Nevada to Senator Heller. He is a senator here in Washington representing the state of Nevada and he is one of the handful of folks who are considered to be moderate Republicans in the senate as the senate continues to debate the health care bill, or I shouldn’t really say debate since they’re not doing it out in the public but as the senate continues to move forward its health care bill to repeal the Affordable Care Act and replace it with something that now we’re only just starting to see the details of. He is one of the folks looked to as a potential swing vote, a potential vote to oppose the legislation and to break with his party. What is it that you sent in a letter to him and what would you like him to hear?

FORD: Well Speaker Frierson and I, the speaker of the assembly here in Nevada have actually sent U.S. Senator Dean Heller three letters. We received no response to any of them. And I’ll quote from the most recent letter that we sent on June 20th and we say, and I quote, “We’ve attempted to express our concerns to you on several occasions. Despite the promises of a detailed reply in the last seven months neither your office nor the Trump administration have provided any satisfactory answers to either of our concerns.” So that’s a quote from the letter and we raised specific questions in this third letter that we sent on June 20th. For example, how many people in Nevada will lose health insurance coverage under Trumpcare? How many, how would the bill impact Nevada’s Medicaid budget? We’re interested in understanding what the cost to our state would be to maintain our current level of coverage and current Medicaid benefits. We’ve asked him specifically how many of thousands of individuals in Nevada who require care will continue to have access to substance abuse disorder and mental health services, maternity care and other critical services. We’ve asked several other questions as well. Again we’ve asked him questions comparable like this three times, three times already and we’ve not received any satisfactory responses.

VALLAS: He is actually ignoring every time you reach out as the leadership in his state, he has yet to reply to you as you’re asking questions, very reasonable questions about legislation that he is far is supporting.

FORD: He has not and what’s interesting about it is that he made a show of the fact that we sent him a letter and he had received it. I remember when he was interviewing, or questioning Mr. Price who was then interviewing to become HHS secretary. He said on the record that he had received letters for us that were, that had good questions and that he would submit them directly to Mr. Price. We never got any responses from Mr. Price or from Dean Heller. It was all for show. We are concerned about how the bill there is going to protect those in Nevada for example with pre-existing conditions from spikes in premium costs or other out of pocket cost increases and based on the status of their health the types of services they need. And we asked them those questions point blank, haven’t received answers and so I think your initial assessment that he’s ignored us is an accurate one.

VALLAS: Has he also been hearing from constituents in ways that he’s ignored? Whether they are holding town halls or otherwise trying to raise their voices in ways that you believe he’s not representing.

FORD: Hearing from constituents, I think that’s an understatement and in fact I received several emails from some of constituents, our mutual constituents who reached out to him and have not received returned phone calls, have not received letters in response and who simply are cast by the side as Senator Heller and other republicans hide behind the closed door of negotiations and then present us a bill that is worse than any Trumpcare bill that we could have imagined.

VALLAS: So you mentioned earlier that the Medicaid buy in proposal was just one part of a larger progressive agenda that you and others in the senate as well as in the state assembly have been seeking to push forward. I would love to hear a little bit more about what you guys have been advancing, given that it feels, again, so directly in contrast with what we’re watching happen here in Washington.

FORD: Well I’m happy to discuss that. As I indicated, the legislative democrats platform, if you will, was memorialized in the Nevada blueprint, there’s a website, nevadablueprint.com that details umbrella items with bullet points that were actually accompanied and associated with bills that we sponsored and got passed and so criminal justice reform is an example of some of the progressive and sometimes not so progressive but common sense based items. We want to be certain that public safety was addressed so we had law enforcement bills, we had a rape kit backlog bill, we had elder abuse bills, we had juvenile justice bills, and we had other forms of bills that would help to reintegrate ex-offenders, those who paid their debt to society back into society. I had a bill that dealt with consumer protection, a fiduciary duty bill that will require investment bankers and broker dealers to comply with the fiduciary duty standard and look out for their clients best interests as opposed to their commissions when it came to decision making. We had one big bill that I think has made headlines internationally and that’s dealing with the price of diabetes medication and my colleague Senator Cancela and I worked with the rest of our colleagues to ensure that we could come up with a bill that the governor initially vetoed but we were able to work it with some other republican senators and we got it signed. We worked on women’s legislation dealing with birth control, codifying the ACA protections for women into Nevada law. Dealing with family planning and pregnancy accommodation, we even ratified the equal rights amendment finally. We offered and we attempted to get paid sick leave for all of our constituents here in our state and the governor vetoed that one. We worked on minimum wage that people could take care of themselves and their families and unfortunately the governor vetoed that. But we could 608 bills signed and most of which were good for hard working Nevadans from a Nevada blueprint perspective. All of which, however were good for everyday Nevadans who were looking to their government to make good decisions for them.

VALLAS: I’ve been speaking with Nevada Senator Aaron Ford. He serves as majority leader of the state senate. Senator thank you so much for taking the time to speak with us for Off Kilter, and I just really want to commend you for the amazing progressive momentum that you’ve been championing and seeking to push forward in the state. Obviously met with obstacles when your governor is not willing to sign into law the very proposals and policies that Nevadans are asking for but you are to be commended for what you’re doing.

FORD: Well I certainly appreciate the opportunity to speak with you, and you have a good day.

VALLAS: You as well.

[MUSIC]

VALLAS: You’re listening to Off Kilter, I’m Rebecca Vallas. In 2012 Governor Sam Brownback began what he dubbed a quote real live experiment with Kansas’s economy. He cut income taxes for the wealthiest Kansans and for some businesses and corporations. And today the state is reeling. Infrastructure spending has been halted, the state’s Supreme Court ruled that schools aren’t being equitably funded, and programs like Medicaid and Temporary Assistance for Needy Families have faced significant cutbacks. Earlier this month in a rebuke to Governor Brownback the Kansas legislature voted to rollback some of these tax cuts to help close the state’s widening deficit. But with Donald Trump and Republicans in congress on a mission to slash programs that help families afford the basics all to pay for tax cuts for millionaires in many ways, Kansas looks like a canary in a coal mine. I’m joined by Max Ehrenfreund, a reporter at WonkBlog, who has been digging into this in a series of reporters over the past month. Max, thanks so much for coming back on the show.

MAX EHRENFREUND: Thanks for having me.

VALLAS: So I feel like I can’t start this segment in any other way than to ask what’s the matter with Kansas?

EHRENFREUND: That’s a good question and it’s an interesting question. Liberals and democrats have always wondered why people in red states seem to vote against their economic interests, that is they seem to support republicans whose policies will not benefit them economically and in the case of Kansas have actually resulted in them being worse off, not just in the sense that they have lost out on basic public services like health care and education but in fact are paying more in taxes than they were before. And I think it’s an interesting point and one worth emphasizing. Governor Brownback was elected in part because he promised to cut taxes and in fact he did cut taxes for many in Kansas but those tended to be wealthier and he raised taxes, or to make up some of the difference, especially on the lower middle class and the poor.

VALLAS: So tell the story of how we got to a place where Kansas is seeing a three hundred million dollar deficit because of really a quote, real live experiment in Brownback’s words with trickle down economics.

EHRENFREUND: Brownback was elected back in 2010 and by 2011 and 2012 he had won support in the Kansas state legislature for some very ambitious changes to the tax system. In particular he brought down the tax rate on marginal income for wealth Kansans and he simplified the structure of the marginal income tax, eliminating one of the tax brackets so the result was basically that wealthiest taxpayers were paying the same amount or the same rate on every additional dollar of income as the middle class. He also set up a system that, his goal was to, his goal with this new system was to foster entrepreneurship and to help small business. Unfortunately most analysts agree that the result was simply that many ordinary Kansans just claimed to be small businesses in order to take advantage of this tax break without actually starting anything new.

VALLAS: So it’s not just corporations that are people too, it’s small businesses now as well.

EHRENFREUND: That’s right, small businesses are people too, yeah. So Brownback believed it seems that these measures would do a great deal to stimulate Kansas’s economy and bring in more jobs, business, hiring, investment, it could encourage people to go back to work and so on; and because of all that there would be more income in the state for the state to tax and so even if the rates were lower and even if there were a few breaks for small businesses and what have you, the state wouldn’t run out of money because the overall tax base would expand, there’d be more to go around. That didn’t happen. Instead revenues to the state government declined steadily, after the tax cuts went into effect in 2013, and especially in 2014, Brownback was forced to increase taxes on the middle class and the poor. As I said earlier, he did not want to undo the breaks that he’d given to the wealthier taxpayers in the state. Instead he raised the sales tax which is a tax that disproportionately paid by people who spend more of their income on you know, everyday goods and services, ordinary items off the shelf, and those people tend to be less well off. So the result of that was that the rich were paying less, the poor were paying more and the state was still very short on cash. This past year, Brownback’s allies in the legislature were in many cases, voted out by Republican and Democratic voters in Kansas. And when the legislature reconvened this year they said enough is enough. And they voted to undo many of the tax cuts Brownback had passed five years ago.

VALLAS: So a lot of what you described as far as the case that gets made for so called trickle down economics or for tax cuts for the wealthy and at times for corporations, all in the name of supposed economic growth to follow, sounds very similar to a lot of what we’re hearing right now in Washington. Paul Ryan actually just gave a speech with many of these themes.

EHRENFREUND: That’s right. Yesterday here in Washington the Speaker of the House laid out his goals for tax reform under President Trump and the proposal from President Trump is very similar to the one that Brownback enacted in Kansas. In particular, both proposals share the same break for small businesses. It’s not quite as obvious in Trump’s plan but the structure is essentially the same. If you have income from a small business you’re able to pay taxes at a lower rate than you would if you had income from some other source like a salary or a wage or what have you. And so that kind of similarity has a lot of people concerned and I think it also has a lot of Republicans concerned as well because there are many Republicans not just in Kansas but elsewhere in the country who are worried about you know, what the effects would be on public programs and on the federal deficit and the national debt if this kind of package were to be approved at the national level.

VALLAS: So you and I were actually talking before we started taping about how that’s not the only connection that Paul Ryan has to Governor Brownback.

EHRENFREUND: That’s right. Paul Ryan used to work for Governor Brownback when Brownback was a senator here in Washington representing Kansas, now he’s the governor. And besides that Brownback relied on many of the same people when he was putting together his tax cuts five years ago that have advised Trump and the republicans in the years since then. That’s of course the journalist Stephen Moore, a noted advocate of reduced taxes, as well as economist Arthur Laffer who many people know because he famously argued that tax cuts could in some circumstances pay for themselves. And he continues to make that case to Republicans and he remains very influential both with state figures such as Brownback as well as Republicans who now have a chance to implement some of those ideas and test them out nationwide.

VALLAS: So I don’t want to waste any more time before we get to a discussion about the human consequences of these kinds of policy decisions. I haven’t mentioned it yet but also important to note as part of Brownback’s agenda over the past few years, it hasn’t just been this tax cuts to the wealthy and corporations and raising taxes on lew well to do people and cuts to vital programs to pay for all of it. It was also part of his agenda to veto expanding Medicaid for his state’s residents and reporting that you did with a colleague Ana Swanson, also at Wonk Blog, on the ground in Kansas really puts a human face on the toll that this whole combination of decisions has taken. I was particularly struck in reading over the weekend when the story posted, a description of a 13 year old girl who lost part of her jaw when her parents couldn’t pay to finish a dental operation and then the packing pellets that a dentist has put in her tooth rotted. There are stories like this across the board. I’d love for you to talk a little bit about what this has meant in human terms as well.

EHRENFREUND: Yes, absolutely, I think that it’s worth noting to start that reducing funding for Medicaid is crucial to the Republican plan on health care and that’s being debated right now in congress. The Affordable Care Act also known as Obamacare expanded Medicaid to include more people and to provide health insurance to more people who are poor, and some who are not poor, or not quite poor as well but who are living on the edge of poverty. The republican plan would reduce that funding and it would also in addition change the structure of the Medicaid program to give states what Republicans say would be more flexibility in terms of how they design their plans and how they design the kinds of policies that are available under Medicaid but would also limit overall funding very strictly to a set amount. And —

VALLAS: Something often called a per-capita cap.

EHRENFREUND: That’s exactly right, yeah, a per-capita cap. It also seems that some states might be able to select what’s known as a block grant, which is even more of a strict limit because it doesn’t vary with the number of people.

VALLAS: But both of those being code for huge huge cuts and lots of people losing access to coverage and services.

EHRENFREUND: Yeah, that’s exactly right. In the current system there’s something of a cruel irony because we at the Post have interviewed people who, they are to poor to get help from the federal government receiving health insurance. And the problem for them is that Republican governors and states like Kansas such as Brownback have refused to expand Medicaid under Obamacare and so they are unable to receive any help through Medicaid and they’re also too poor to qualify for subsidies that are available through Obamacare to buy private insurance.

VALLAS: So they fall into sort of coverage gap.

EHRENFREUND: Yes that’s right. When Obamacare was designed Democrats thought that Medicaid would be expanded to cover the poor and then people who were a little bit better off could get subsidies to buy private insurance and so those subsidies aren’t available to the poor because they’re supposed to buy Medicaid. You know, this is really frustrating to people I think and it’s confusing because it’s just very counterintuitive. I mean how could you be too poor to get help buying health insurance? And yet that’s the reality for many people. You know, we talked with one grandmother who she had taken her grandkids out of a dangerous home situation and when she did so she became legally poorer than she was before because she was living on her own, then she had a household of three. And if you have three people on the same income you’re worse off in the eyes of the law than you are if you have one person at that level of income and so she became poorer and because she was poorer she could no longer receive subsidies through Obamacare to buy private insurance so she’s going without coverage.

VALLAS: So a lot of ways that the aftermath of these decisions by Governor Brownback in Kansas mirror the very conversation happening on the national stage in Washington right now both on the tax side of things and the implications for cuts to programs that help families afford to pay for those tax cuts as well as the health debate. Where do things stand now in Kansas after that rebuke by the legislature to the governor and where do things go from here?

EHRENFREUND: Well the legislature has enacted over Brownback’s veto a bill that will raise taxes by about $600 million a year. Now a lot of that money is going to go the Kansas’s public schools, as you mentioned earlier there was a court order stating that the public schools level of funding is too low, so low in fact that it violates Kansas’s constitution and students right to an adequate education. Now the big question is how will Kansas’s economy respond and how will Kansas respond politically to a substantial tax increase, it’s really a tax increase across the board. It’s a tax increase for the poor, for the middle class and for the rich. And so you know, increasing taxes can always have uncertain effects on the economy and there could also be resistance, certainly we’ve talked with a number of conservative activists who are very upset that they’ve lost this battle and they’re planning to retaliate against those moderate Republicans who supported the increase in taxes. I mean it’s worth saying that a majority of Republicans in the legislature voted together with Democrats to override the veto of Brownback who is a member of their own party.

VALLAS: In the last minute that I have with you do you feel that based on the conversations you’ve had with conservatives, whether in the state or in Washington throughout your reporting, are they paying attention and realizing this real live experiment in Kansas actually portends pretty scary things if moved forward on the national stage?

EHRENFREUND: That’s a very good question. I think there are some conservatives who certainly are paying attention and you know, many of the conservative economists I’ve talked to have said that yes, it’s unreasonable to expect tax cuts to pay for themselves. We’ve known this for a long time. Art Laffer is wrong or if he is right, it’s only in very limited and special circumstances. And so there are a number of conservative experts and I think moderate Republican policymakers who are very concerned about what’s happening in Kansas and you see around the country, Republicans pointing to Kansas as an example of what not to do in their speeches and so on and so forth. But the problem is you know it’s just not clear how much influence those Republicans have in the Trump administration or in Speaker Ryan’s office. We just don’t really know to what degree Washington DC Republicans are paying attention.

VALLAS: Particularly when the facts are so inconvenient. Max Ehrenfreund is a reporter for Wonkblog. He’s been digging into what’s the matter with Kansas in it’s 2017 iteration in a series of reports over the last several weeks for the Washington Post. And thanks again Max for joining the show. Always glad to have you here.

EHRENFREUND: Thank you.

[MUSIC]

VALLAS: You’re listening to Off Kilter, I’m Rebecca Vallas. On the campaign trail, President Trump pledged to quote take care of the veterans who have served this country so bravely, close quote. He also pledged to repeal the Affordable Care Act. to find out how this repeal would affect veterans I’m joined by Larry Korb. He’s a senior fellow at the Center for American Progress and former assistant secretary for defense under President Reagan. Larry thanks so much for joining the show.

LARRY KORB: Nice to be with you thanks for having me.

VALLAS: Well so just to kind of connect these threads, there’s a lot of promises that conservatives like to throw around about how important veterans are and how we need to honor our veterans and our troops, and that’s certainly something that President Trump made campaign statements sort of in keeping with as tradition. But simultaneously he has full throatedly and so have his colleagues in congress with very few exceptions, supported moving forward, repeal of the Affordable Care Act and quote, unquote, replacement with something that’s going to risk loss of coverage to possibly more than 20 million Americans. Hard to know without seeing the senate bill right now. What will this mean for veterans?

KORB: Well what people don’t understand, they assume that every veteran gets taken care of by the VA. And that doesn’t, most do not. And so what happens and if you take a look at the data you’ve got almost about 2 million veterans now would get Medicaid who would lose it under the proposed changes to the so-called Obamacare. And the other thing to keep in mind is that we have a saying in the military, you recruit individuals but you retain or deploy families. A lot of the families have a lot of things that occur. We talk about PTSD for those who serve but a lot of the young children and spouses you know also have it because they’re very, very, very worried about it. They’re also going to be affected by this. And they are not eligible for the VA care. I think that’s very very very very important. So yeah, you have these 20 million people out there, best we know close to 2 million are on, getting Medicaid now. A lot of them are going to be affected by this and the VA simply can’t handle it. They’d be overwhelmed by all those people coming.

VALLAS: A new analysis that CAP has just put out actually puts a number to how many of those two million or close to two million veterans who rely on Medicaid would be projected to lose coverage if this GOP health bill moves forward. And it’s almost half a million, it’s 441,000 of America’s veterans. And as you point out that doesn’t include the families.

KORB: That’s correct. They would and that’s something that they didn’t think through when they did this bill because again a lot of, they just assumed that the veterans would be taken care of by the VA, the Veteran’s Administration.

VALLAS: Two other components of the health care debate over the course of the past few months have centered around so called essential health benefits and then also the concept of pre-existing conditions. These are of course two critical pillars of the Affordable Care Act. There was the guarantee of something called essential health benefits which I hope we can get into but then also there was the elimination of discrimination against people with so called pre-existing conditions which really is many folks who don’t even realize that they could be implicated. What do the risks and potential loss of these kinds of protections mean for veterans and their families.

KORB: Again I think it’s important that to keep in mind, first of all, the good news is that because of military medical care has improved so much a lot more people are surviving that didn’t. But then when they’re discharged they have those disabilities. You also have the individuals and the families with what we call post traumatic stress syndrome, that could be considered as a pre-existing condition if you try to get insurance. So you have an awful lot of diseases. I mean just simple things like I used to fly for the Navy and my hearing was affected. I probably didn’t wear my helmet as much as I should have. But you know, theoretically if I wanted to get that, they’d say well you know you already had that because you got it when you’re in the service, when you’re in the service you have very very good medical care but when you leave you’re on your own. And again, trying to go to the VA which is already has it’s horrific backlog. You’re going to throw all these people in there, just going to make the system crash.

VALLAS: You mentioned PTSD, post traumatic stress disorder. One of the pieces of that essential health benefits package that the Affordable Care Act required providers to make sure that that was part of everyone’s plans, everyone’s coverage, is mental health benefits. And that seems like something that would also be particularly important for veterans.

KORB: Oh very very important given the nature, any war is going to be very hard on a man or woman’s mental health. But these wars are even more frustrating because it’s hard to tell who is friend and who is foe. You have people that you end up killing who are innocent civilians through no fault of your own. And so this is even worse than in previous wars, not that any war is nice but this is I think the number of people who have these mental problems is increased.

VALLAS: So I’ll just ask a question because I’m curious to know your answer and your opinion to this. How is it if Republicans, and serious question here, how is it if Republicans including Trump, including leaders in congress, claim to care so much about veterans and wrap themselves up so much in American flag as they do it, how can they at the same time be so blind to what this bill means for veterans?

KORB: Well I think there are two reasons.. Number one, nobody’s told them about it, number two as I mentioned before there assuming that all veterans go to the VA and they would be taken care of. Again given the problems that the VA has had and the sheer numbers, there is no way that the Veteran’s Administration can do that. A lot of people don’t live near a Veteran’s Administration facility, so they haven’t thought that and that’s why I think it’s so important for the work we do here at CAP to point this out and say, well you know, you said you support veterans you see what this is going to do to veterans? Maybe you want to think about what you’re doing.

VALLAS: One of the things we were actually talking about before we started rolling tape was that not just on the back end of when people are coming home, reentering their communities and seeking to get the care that they need is this health bill potentially devastating for veterans, but that there’s also our military preparedness to be thinking about. How is that implicated here?

KORB: Well I think again, it’s important, if you take a look right now, 75% of the men and women in this country cannot meet the standards to get into the military. So you’re down to about 25%. If you cut the health benefits to people, it’s going to make that even less. And the military will have a much more difficult time getting the qualified people that they need to serve the country. So this is something you need to think, if you don’t have a healthy population it’s going to be very hard to get the men and women that you need to serve the country and endure the very demanding tasks that they have to.

VALLAS: Are you seeing veterans getting engaged in this health care fight?

KORB: Unfortunately I do see some of them. A lot of the veteran’s groups have pointed out things that are in the bills, not some of these things, but some technical things, you know for example one of the things in the budget that were going to say when you’ve gone on social security you’re going to lose your disability benefits, you know, veterans. That’s been pointed out and they’ve sort of backtracked there. They’ve also instructed the Internal Revenue Service how to handle certain things. So they’ve beginning to but I do think that the work you guys have done here at CAP is going to really make it come home to them.

VALLAS: How can people get involved if they want to raise their voices about veterans, if they want to connect with veteran’s groups or if they want to let congress know what they think about this bill?

KORB: Well I think obviously they need to inform their members. The other thing is there are a lot of groups that they can work with or contribute to, the Afghan and Iraq Veterans of America, the American Legion, the Veterans of Foreign Wars, all of these groups do look out for our veterans. They can make their voice known because when they come to Capitol Hill, believe me, the members pay attention.

VALLAS: Larry Korb is a senior fellow at the Center for American Progress and he served four years on active duty as a Naval flight officer. He was also the assistant secretary of defense in the Reagan administration in the early 1980s. Larry, thanks so much for joining Off Kilter.

KORB: Thank you for having me.

VALLAS: And that does it for this week’s episode of Off-Kilter, powered by the Center for American Progress Action Fund. I’m your host, Rebecca Vallas. The show is produced each week by Eliza Schultz. Find us on Facebook and Twitter @OffKilterShow. And you can find us on the airwaves on the Progressive Voices Network and the We Act Radio network, or anytime as a podcast on iTunes. See you next week.

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