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Medicaid And Discomfort · Politix

• 0:00
  I don't know why these Great Plains Republicans are more open
• 0:02
  to expansion than the
• 0:03
  SPEAKER_00: Southern ones.
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  SPEAKER_00: My suspicion is that it's about being racist.
• 0:09
  SPEAKER_00: Yeah.
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  SPEAKER_00: I'm happy to solve the mystery for you.
• 0:19
  Hey,
• 0:19
  everyone,
• 0:19
  you're listening to a free preview of the Politics Podcast.
• 0:22
  SPEAKER_01: This week,
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  Republican efforts to gut Medicaid are starting to come into
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  focus and to attract
• 0:28
  SPEAKER_01: real public attention.
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  So we're going to kick things off with a look at what
• 0:33
  Republicans hope to pull off,
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  SPEAKER_01: how they're trying to conceal their true intentions,
• 0:39
  SPEAKER_01: the messy intra-GOP politics of all this,
• 0:42
  SPEAKER_01: and the state of the opposition.
• 0:45
  Then Medicaid was actually at the center of an Obama-era legal
• 0:49
  controversy about
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  whether the federal government could use money or the threat of
• 0:54
  spending cuts to
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  SPEAKER_01: coerce states into adopting policies they might otherwise not agree with.
• 1:00
  SPEAKER_01: So now that Trump's all coercion all the time,
• 1:04
  we'll look at how Democrats and various other entities are
• 1:08
  responding to Trump's
• 1:09
  coercive threats and whether playing along with him makes any
• 1:12
  sense in light of
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  SPEAKER_01: what the law is.
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  SPEAKER_01: We'll get to all of those questions and more in this episode.
• 1:18
  SPEAKER_01: If you want to hear the whole conversation,
• 1:19
  SPEAKER_01: you can upgrade your subscription to paid at politics.fm.
• 1:22
  SPEAKER_00: Hey, everyone.
• 1:29
  SPEAKER_00: Welcome to the Politics Podcast.
• 1:30
  SPEAKER_00: I'm Brian Boyler.
• 1:31
  SPEAKER_00: I'm Matthew Iglesias.
• 1:32
  SPEAKER_00: I'm back.
• 1:34
  SPEAKER_00: Back.
• 1:34
  SPEAKER_00: Last week.
• 1:36
  SPEAKER_00: Yeah, fascinating conversation with a very distinguished guest.
• 1:40
  SPEAKER_00: I gotta say, you sounded like shit, Brian.
• 1:42
  SPEAKER_01: Yeah, yeah, yeah.
• 1:43
  SPEAKER_01: What's going on?
• 1:44
  SPEAKER_01: So yeah,
• 1:44
  a quick apology to listeners about the audio quality on my half
• 1:50
  of last week's
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  SPEAKER_01: conversation with Paul Krugman.
• 1:54
  Our recording platform flipped me back from like an external
• 1:58
  mic to the built-in
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  SPEAKER_01: one on this monitor.
• 2:02
  SPEAKER_01: So I sounded normal during the conversation itself, but the file...
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  had all this echo because I was talking at a screen instead of
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  into a dedicated mic.
• 2:12
  SPEAKER_01: Anyway,
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  I just need to accept that my years of enjoying facility with
• 2:16
  technology are over
• 2:17
  SPEAKER_01: and I'm on the downslope to embarrassing tech grandpa status.
• 2:21
  SPEAKER_00: Sleepy Brian.
• 2:23
  SPEAKER_00: Got to check the settings.
• 2:25
  SPEAKER_00: It's a bummer.
• 2:27
  SPEAKER_00: Yeah, but I mean, it was a great conversation.
• 2:29
  SPEAKER_00: It was fascinating.
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  SPEAKER_00: I mean, I was just joking before.
• 2:30
  SPEAKER_00: It's very funny.
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  SPEAKER_00: Krugman was hired to be a New York Times columnist
• 2:38
  SPEAKER_00: during the 2000 presidential campaign, basically.
• 2:40
  At a time when trade was a top-tier political issue,
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  there were these big WTO protests,
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  etc.
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  But then really soon after he took over,
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  9-11 happened and 90 million things happened.
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  SPEAKER_00: And then he left right before Trump put...
• 2:57
  SPEAKER_00: trade right back at the center of everything again.
• 3:00
  SPEAKER_00: I mean, he's a smart guy.
• 3:01
  SPEAKER_00: He has a lot to say about a lot of things,
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  SPEAKER_00: but this is his time,
• 3:05
  SPEAKER_00: and they just totally missed it.
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  SPEAKER_00: I don't know.
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  SPEAKER_00: It's more benefit to us and the larger subset community.
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  I think they weren't anticipating him becoming the voice of
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  moral clarity during
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  SPEAKER_01: the George W.
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  SPEAKER_01: Bush years about
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  the war in Iraq and Bush economic policy and competence and
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  things like that.
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  SPEAKER_01: So there was a,
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  SPEAKER_01: there was a hidden upside for everybody,
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  SPEAKER_01: but yeah,
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  SPEAKER_01: the,
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  the reason they hired him and then the timing of his departure
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  are just like,
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  SPEAKER_01: you never got what you were buying from him out of him.
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  SPEAKER_00: Yeah.
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  SPEAKER_00: I mean,
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  SPEAKER_00: just like this specific,
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  SPEAKER_00: like,
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  SPEAKER_00: you know,
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  SPEAKER_00: analytic half detail of helping people understand these issues better,
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  SPEAKER_00: you know,
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  SPEAKER_00: cause even now,
• 3:46
  SPEAKER_00: right.
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  SPEAKER_00: I mean, well, well, well pivot, but it's like,
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  The discourse is on the level of you're going to make baby toys
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  more expensive.
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  And then Trump's like,
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  maybe people don't need toys at Christmas,
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  which is really stupid.
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  SPEAKER_00: But there is more to trade than that two-sided equation.
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  SPEAKER_00: So I don't know.
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  SPEAKER_00: Is there that much more to health care?
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  All Krugman business aside,
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  actually Krugman would be really good on this topic.
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  Maybe we should have just had him become a regular third host
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  or something like that.
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  SPEAKER_01: But we are looking at Republican,
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  SPEAKER_01: we're watching Republicans week in,
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  SPEAKER_01: week out,
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  SPEAKER_01: kind of make progress towards telling us what they're going to do.
• 4:26
  SPEAKER_01: do with their one big bill that they're going to try to pass.
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  SPEAKER_01: We know about the tax cuts.
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  SPEAKER_01: They want to extend all the Trump tax cuts from 2017.
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  SPEAKER_01: But that is really bad for the federal budget,
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  particularly when we're still dealing with the embers of
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  inflation and maybe
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  SPEAKER_01: renewed inflation from tariffs.
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  So they want to also do some cutting and they're going to go
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  for Medicaid.
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  SPEAKER_01: And they've recently started talking about
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  SPEAKER_01: what aspects of federal Medicaid spending they are going to cut.
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  And they're doing it in this sort of like the dry technical
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  language of wonks that
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  obscures that really it's just like multiple ways to excise
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  probably what will end
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  SPEAKER_01: up being millions of people from their health insurance.
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  SPEAKER_01: So what are the terms?
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  SPEAKER_00: Yeah, so, I mean, it's a little bit complex because there's two things.
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  SPEAKER_00: Because, like, first, they are trying to hide the ball.
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  SPEAKER_00: But second, they are genuinely debating, like, what the ball will be.
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  SPEAKER_00: So there's a...
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  A tactical advantage in not making up your mind about what
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  you're proposing because
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  SPEAKER_00: it's like a little bit harder.
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  SPEAKER_00: So the one thing that seems broadly agreed upon is that they will do work
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  SPEAKER_00: requirements on Medicaid.
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  That seems like something that pretty much everybody in the
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  caucus is OK with.
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  SPEAKER_00: It's important to sort of understand work requirements will score by the
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  SPEAKER_00: Congressional Budget Office as saving money.
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  SPEAKER_00: I believe that work requirements will save money.
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  SPEAKER_00: The reason that work requirements save money,
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  SPEAKER_00: if you think about it,
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  is that work requirements do not induce people to work more
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  because if they did,
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  SPEAKER_00: nobody would lose their benefits and there would be no savings.
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  SPEAKER_00: Because if you think about it, right,
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  Nobody is sitting at home figuring it's fine to not have a job
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  because at least if
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  SPEAKER_00: I get sick,
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  SPEAKER_00: I can go see the doctor.
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  SPEAKER_00: It's not fun to go see the doctor.
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  SPEAKER_00: You're not lounging around on it.
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  But a certain number of people are going to fail to find work
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  in any given span of time.
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  And a certain number of people are going to flunk the
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  verification process.
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  SPEAKER_00: You know,
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  SPEAKER_00: if you've ever done with like,
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  I recently had to re-enroll my son at the same public school
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  he's been attending
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  SPEAKER_00: for the past six years.
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  The school is across the street from my house,
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  but I have to prove that I live in my house.
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  SPEAKER_00: And so I sent forward a bunch of paperwork to demonstrate this,
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  SPEAKER_00: and I heard back from a school administrator that I had done it wrong.
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  SPEAKER_00: I said that my birthday was May 18th, 2025, which of course it isn't.
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  SPEAKER_00: You're not even born yet.
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  SPEAKER_00: I sent in a water bill from the wrong year, you know, and whatever.
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  And since this is like a friendly guy who wants me to re-enroll
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  in school,
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  SPEAKER_00: he just like called me on the phone and I did it right.
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  If you have a state government that wants to disenroll people
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  from Medicaid,
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  they can be very unforgiving about paperwork errors on your
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  work requirement form.
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  SPEAKER_00: Disenroll you.
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  SPEAKER_00: So that's like the one thing that's in the bank.
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  SPEAKER_00: Well, and can we- Yeah.
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  Let's talk about why,
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  you know,
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  because that will probably poll pretty well.
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  SPEAKER_01: Uh-huh, yeah.
• 7:40
  SPEAKER_01: Yeah.
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  SPEAKER_01: But it's still bad policy, I think.
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  SPEAKER_01: It's not great.
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  SPEAKER_01: And I don't think it's totally obvious why,
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  SPEAKER_01: just apart from the fact that you're creating this bureaucratic hurdle.
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  I think,
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  you know,
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  the way Mike Johnson,
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  the Speaker of the House,
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  will talk about it.
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  So there's all these people on Medicaid who are able-bodied,
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  young,
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  healthy men.
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  SPEAKER_02: Yeah.
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  SPEAKER_01: And we need them to be working and not just on the day.
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  SPEAKER_02: Right.
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  SPEAKER_01: And-
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  SPEAKER_01: If you think about what that would imply if it were true,
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  SPEAKER_01: it would be a bunch of people who have insurance,
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  SPEAKER_01: but they're young and healthy,
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  SPEAKER_01: so they're not really using their insurance.
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  SPEAKER_01: They're not contributing to healthcare spending in a global sense.
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  SPEAKER_01: They're just not economically productive.
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  When you are somebody who needs Medicaid and so have to jump
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  through the hoops,
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  SPEAKER_01: you're more likely to be somebody who is disabled or chronically ill.
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  And so the people who are going to end up succumbing to this in
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  a way that harms
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  SPEAKER_01: them are not the people that Mike Johnson would have you believe.
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  SPEAKER_01: It's a much more vulnerable subset of the Medicaid population.
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  SPEAKER_00: Yeah.
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  SPEAKER_00: I mean, again, there's just a kind of basic paradox, right?
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  SPEAKER_00: I mean-
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  What Mike Johnson would like you to believe is that there's a
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  large quantity of
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  SPEAKER_00: able-bodied people who are not working,
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  SPEAKER_00: and they're not working because they're on Medicaid.
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  SPEAKER_00: Yeah.
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  SPEAKER_00: And that putting a work requirement on the Medicaid is going to generate
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  SPEAKER_00: economically productive labor,
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  SPEAKER_00: right?
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  SPEAKER_00: So for example, like after Trump increases taxes on socks,
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  SPEAKER_00: theoretically, somebody is going to open a sock factory.
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  SPEAKER_00: And so it's not just that we're all going to be paying more for socks,
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  SPEAKER_00: but somebody has to do the sock work,
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  SPEAKER_00: right?
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  And so if everybody quits their job at Chipotle to go work in
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  the sock factory,
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  SPEAKER_00: now not only are socks more expensive,
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  SPEAKER_00: but I also can't buy a burrito.
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  SPEAKER_00: That's bad.
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  Versus if there is some huge pool of able-bodied people and we
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  can cut them off
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  from their Medicaid benefits and force them to go work in the
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  sock factory,
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  SPEAKER_00: then maybe that's good.
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  SPEAKER_00: But so again,
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  research has been well studied because Trump didn't force
• 10:01
  states to do work requirements,
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  SPEAKER_00: but he allowed them to.
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  SPEAKER_00: So Arkansas and several other states did this during his first term.
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  SPEAKER_00: As we've got a good study,
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  some especially good studies out of Arkansas because there's
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  good state border effects,
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  SPEAKER_00: does not induce additional work.
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  SPEAKER_00: So some people lose their insurance.
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  SPEAKER_00: But if an able-bodied young person loses their Medicaid insurance,
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  SPEAKER_00: the government doesn't really save any money because,
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  SPEAKER_00: as you're saying,
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  SPEAKER_00: they're not going to the doctor.
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  Right.
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  SPEAKER_00: So the savings,
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  SPEAKER_00: which are not large,
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  SPEAKER_00: but there are savings,
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  they come almost by definition from cutting off people who in
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  fact have reasonably
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  SPEAKER_00: serious medical conditions,
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  but for one reason or another are not qualifying through this
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  kind of process.
• 10:48
  SPEAKER_00: Yeah.
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  SPEAKER_00: Say a pregnant woman,
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  SPEAKER_00: something like that,
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  or people with disability who are having trouble navigating the
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  DI system,
• 11:00
  SPEAKER_00: other kinds of things like that.
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  SPEAKER_00: So that's one chunk.
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  SPEAKER_00: That's the part that high confidence they're going to do.
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  The other thing that keeps getting kicked around by the
• 11:10
  congressional journalists,
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  SPEAKER_00: because there's no paper from Republicans here,
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  SPEAKER_00: is FMAP changes.
• 11:18
  SPEAKER_00: So FMAP changes is very wonky.
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  SPEAKER_01: It's federal medical assistance percentage is what it stands for.
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  SPEAKER_00: Yes.
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  So the way that Medicaid works is that the federal government
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  says there is going
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  to be money that is going to be available to states to provide
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  Medicaid coverage to
• 11:41
  SPEAKER_00: various people.
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  SPEAKER_00: And then there are rules, right?
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  SPEAKER_00: If you want to get Medicaid money from the federal government,
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  SPEAKER_00: you have to meet certain floor coverage standards,
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  SPEAKER_00: or else it's like,
• 11:53
  SPEAKER_00: that's not really Medicaid,
• 11:54
  SPEAKER_00: you can't get the money.
• 11:56
  SPEAKER_00: And the people have to meet certain eligibility criteria, right?
• 11:59
  SPEAKER_00: So a state can't create Medicaid for dogs.
• 12:04
  SPEAKER_00: And then get federal matching money for it, right?
• 12:07
  SPEAKER_00: You have to qualify.
• 12:10
  But how much money do you get from the federal government is
• 12:13
  determined by the
• 12:14
  SPEAKER_00: federal medical assistance percentage.
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  SPEAKER_00: The federal medical assistance percentage varies in two ways.
• 12:21
  So there's base Medicare as it existed before Medicaid as it
• 12:26
  existed before the
• 12:27
  SPEAKER_00: Affordable Care Act.
• 12:28
  SPEAKER_00: So your base FMAP is determined essentially by your state's income.
• 12:35
  SPEAKER_00: Poorer states get a more generous FMAP than rich ones,
• 12:39
  SPEAKER_00: which is supposed to encourage states with needs,
• 12:44
  SPEAKER_00: you know,
• 12:45
  SPEAKER_00: to pony up the cash.
• 12:47
  SPEAKER_00: Then you have the ACA expansion.
• 12:50
  SPEAKER_00: So the ACA expansion had sort of two elements to it.
• 12:54
  SPEAKER_00: One was if you extend coverage to the expansion population,
• 12:58
  SPEAKER_00: you get this incredibly generous FMAP.
• 13:01
  So the federal government picks up the whole tab for some
• 13:04
  number of years,
• 13:05
  SPEAKER_00: and then it drops to 90%,
• 13:08
  SPEAKER_00: which is much higher than even the poorest states,
• 13:11
  SPEAKER_00: FMAPs.
• 13:12
  SPEAKER_00: And then in the original law,
• 13:14
  SPEAKER_00: which we will discuss later,
• 13:16
  it also said you were going to lose your existing money unless
• 13:21
  you expanded Medicaid.
• 13:22
  SPEAKER_00: The Supreme Court said you couldn't do that.
• 13:24
  SPEAKER_00: So we have a mix of expansion and non-expansion states.
• 13:28
  The non-expansion states are almost all in the Deep South,
• 13:31
  except for,
• 13:31
  I believe,
• 13:32
  Wisconsin.
• 13:33
  SPEAKER_00: And maybe a couple of the empty plain states.
• 13:36
  SPEAKER_00: I mean...
• 13:37
  SPEAKER_01: Maybe I missed it, but Texas and Florida still haven't expanded.
• 13:41
  SPEAKER_00: Yes, sure.
• 13:42
  SPEAKER_00: That's, I guess, the shallow south.
• 13:45
  SPEAKER_00: I should actually just look it up.
• 13:47
  SPEAKER_00: So the non-expansion states are...
• 13:52
  SPEAKER_00: So Texas,
• 13:53
  SPEAKER_00: Florida,
• 13:54
  SPEAKER_00: Mississippi,
• 13:54
  SPEAKER_00: Alabama,
• 13:55
  SPEAKER_00: Georgia,
• 13:55
  SPEAKER_00: South Carolina,
• 13:56
  SPEAKER_00: North Carolina,
• 13:57
  SPEAKER_00: Tennessee...
• 13:59
  SPEAKER_00: No, sorry, that's old.
• 14:02
  SPEAKER_00: It's the southern states.
• 14:04
  SPEAKER_00: We prepped so hard here.
• 14:06
  SPEAKER_00: I'm sorry, I'm sorry.
• 14:07
  SPEAKER_00: I just got it wrong.
• 14:08
  SPEAKER_00: Okay,
• 14:09
  SPEAKER_00: it is Texas,
• 14:10
  SPEAKER_00: Florida,
• 14:10
  SPEAKER_00: Georgia,
• 14:11
  SPEAKER_00: Alabama,
• 14:11
  SPEAKER_00: Mississippi,
• 14:12
  SPEAKER_00: Tennessee,
• 14:13
  SPEAKER_00: South Carolina,
• 14:14
  SPEAKER_00: Wisconsin,
• 14:15
  SPEAKER_00: and Wyoming.
• 14:17
  SPEAKER_00: So it's like red states in the south,
• 14:20
  SPEAKER_00: plus Wyoming in the north,
• 14:22
  SPEAKER_00: plus Wisconsin,
• 14:23
  SPEAKER_00: where the state legislators are like real...
• 14:26
  SPEAKER_00: Ornery bitches.
• 14:28
  SPEAKER_00: And we're working on it.
• 14:31
  SPEAKER_00: And so what you see is that Medicaid expansion is pretty sticky, right?
• 14:36
  SPEAKER_00: So Louisiana had a Democratic governor in the past.
• 14:41
  SPEAKER_00: They expanded Medicaid, and now there's a Republican governor.
• 14:44
  SPEAKER_00: He hasn't rolled it back.
• 14:46
  SPEAKER_00: West Virginia had a Democratic governor in the past.
• 14:48
  SPEAKER_00: They expanded Medicaid.
• 14:50
  SPEAKER_00: It hasn't been reversed.
• 14:51
  SPEAKER_00: Kentucky and North Carolina both have –
• 14:54
  SPEAKER_00: Democratic governors currently.
• 14:57
  I don't know why these Great Plains Republicans are more open
• 15:00
  to expansion than the
• 15:00
  SPEAKER_00: Southern ones.
• 15:01
  SPEAKER_00: My suspicion is that this is about being racist.
• 15:06
  SPEAKER_00: I'm happy to solve the mystery for you.
• 15:10
  SPEAKER_00: I'm trying to be a little more chill with that kind of allegation.
• 15:14
  SPEAKER_00: Wyoming, I don't know, they're psychos.
• 15:16
  SPEAKER_00: Wisconsin, they just fight about this all the time.
• 15:17
  SPEAKER_00: Anyway, this becomes important.
• 15:21
  SPEAKER_00: So FMAP changes.
• 15:24
  There are two changes that were in the House Energy and
• 15:29
  Commerce Committee
• 15:30
  published a quote unquote menu of potential budget cuts like
• 15:34
  months and months and
• 15:35
  SPEAKER_00: months ago.
• 15:37
  SPEAKER_00: And so they were this was like the real right wingers were like,
• 15:40
  SPEAKER_00: here's like 90 million ways we would like to cut spending.
• 15:43
  SPEAKER_00: Most of the ways involve Medicaid.
• 15:46
  Most of the ways that they proposed have already gotten sort of
• 15:48
  ruled out in the process.
• 15:51
  SPEAKER_00: But two that are remaining relate to FMAP.
• 15:56
  And so one of them is that base FMAP is a function of your
• 16:00
  state's income,
• 16:02
  SPEAKER_00: but your FMAP cannot go below 50%.
• 16:06
  SPEAKER_00: Right.
• 16:07
  SPEAKER_00: So there are various states, notably, I think, California.
• 16:11
  SPEAKER_01: California is at 50, I believe.
• 16:14
  SPEAKER_00: Yeah.
• 16:15
  So there's a bunch that are like,
• 16:16
  that in some sense,
• 16:17
  quote unquote,
• 16:18
  should be below 50.
• 16:20
  SPEAKER_02: Yeah.
• 16:21
  SPEAKER_00: Based on their income, but there's a floor.
• 16:24
  SPEAKER_00: And these are blue states.
• 16:25
  SPEAKER_00: The higher income states are all blue, right?
• 16:28
  SPEAKER_00: So Maryland, I think, is the richest state.
• 16:32
  SPEAKER_00: And if you didn't do this,
• 16:34
  SPEAKER_00: right,
• 16:34
  SPEAKER_00: if you just said FMAP will be a pure function of state per capita income,
• 16:39
  SPEAKER_00: then the FMAP in Maryland,
• 16:41
  SPEAKER_00: New York,
• 16:42
  SPEAKER_00: New Jersey,
• 16:43
  SPEAKER_00: California,
• 16:44
  SPEAKER_00: some other high income states would go down.
• 16:47
  SPEAKER_00: Right.
• 16:48
  SPEAKER_00: So if you're looking at a Senate map,
• 16:51
  SPEAKER_00: that's like an easy yes for Republicans,
• 16:54
  because they're basically I think there are literally no
• 16:57
  Republican senators who
• 16:58
  SPEAKER_00: represent states that would have their F-map cut under that process.
• 17:04
  SPEAKER_00: Now, if you look at the House, it's the opposite, right?
• 17:06
  Like the most vulnerable House Republicans are essentially all
• 17:14
  from the suburbs of
• 17:15
  SPEAKER_00: New York City.
• 17:17
  SPEAKER_00: And I don't understand the geography of California,
• 17:20
  SPEAKER_00: but different parts of California,
• 17:23
  SPEAKER_00: except for Don Bacon in Nebraska.
• 17:26
  SPEAKER_00: So that's like a really hard vote for House Republicans.
• 17:31
  SPEAKER_00: You know,
• 17:31
  because it's like their frontline members will be just fucking
• 17:34
  over their own
• 17:35
  SPEAKER_00: constituents for really no good reason.
• 17:39
  The other FMAP change that they've considered is to essentially
• 17:43
  repeal the ACA
• 17:45
  SPEAKER_00: expansion and say that instead of this 90% FMAP,
• 17:49
  SPEAKER_00: we're going to go back to the regular FMAP,
• 17:52
  SPEAKER_00: which would be a huge,
• 17:54
  SPEAKER_00: huge,
• 17:54
  SPEAKER_00: huge cut.
• 17:56
  SPEAKER_00: So for House Republicans,
• 17:59
  that one's maybe a little bit easier in some ways because their
• 18:03
  frontline members
• 18:04
  SPEAKER_00: aren't as on the line as much.
• 18:06
  But there are these – a bunch of low-income states that have
• 18:13
  expanded Medicaid,
• 18:14
  right?
• 18:14
  SPEAKER_00: West Virginia, Kentucky, Arkansas, Louisiana, Missouri –
• 18:19
  Those are all states where the ACA Medicaid expansion is just a
• 18:24
  huge financial
• 18:25
  SPEAKER_00: windfall to those states.
• 18:28
  Incredible number of people got coverage through the ACA
• 18:33
  expansion because they
• 18:34
  SPEAKER_00: have a large low-income population.
• 18:36
  SPEAKER_00: The 90% match is extremely generous.
• 18:39
  And so it's not only like providing healthcare for low-income
• 18:43
  people in these states,
• 18:44
  SPEAKER_00: but it's like propping up their whole hospital system.
• 18:47
  SPEAKER_01: Right, right.
• 18:50
  The nature of the politics of this is not just like Republicans
• 18:56
  seem austere and
• 18:56
  cruel and they don't care about the health and well-being of
• 18:59
  poor people or
• 19:00
  SPEAKER_01: disabled people.
• 19:01
  SPEAKER_01: It's also that like
• 19:04
  big moneyed interests in their states are going to be opposed
• 19:08
  to this because it's
• 19:10
  SPEAKER_01: going to just pull a ton of money out of the state.
• 19:12
  SPEAKER_01: And so mostly it's money that hospitals and doctors and so on care about,
• 19:17
  but those are not poor people and they are much more likely to
• 19:22
  be Republican voters.
• 19:25
  And so what,
• 19:27
  like,
• 19:27
  I feel like the ideas that Republicans are dancing around are
• 19:32
  like vintage,
• 19:34
  Republican ideas in some sense that might have made sense for
• 19:38
  the Romney era coalition.
• 19:40
  But as the Republican voting base has gotten poorer and the
• 19:48
  Republican kowtowing to
• 19:50
  SPEAKER_01: big money instincts have not gone away.
• 19:53
  This is like a,
• 19:53
  this is like poisonous for if you're Mike Lawler or Brian
• 19:58
  Fitzpatrick or
• 20:00
  SPEAKER_01: in Pennsylvania or David Valadeo in California, right?
• 20:03
  SPEAKER_01: Like it doesn't matter what state you're from almost.
• 20:07
  You're talking about things that are going to affect your
• 20:09
  politics on the populism
• 20:11
  SPEAKER_01: side and on the money side.
• 20:13
  SPEAKER_00: Yeah.
• 20:14
  SPEAKER_00: Medicaid has also just become a lot more popular over time.
• 20:20
  SPEAKER_00: I mean, you know, because Trump won the election,
• 20:24
  There's been a lot of coverage of opinion trends that are sort
• 20:29
  of MAGA friendly and
• 20:31
  SPEAKER_00: a lot of vibe shift takes and stuff happened during the lame duck period.
• 20:35
  But two noteworthy things have happened in American public
• 20:39
  opinion over the past decade as well.
• 20:42
  SPEAKER_00: One of them is that public opinion has become much more pro-choice.
• 20:46
  And this has been reflected in like Donald Trump has adopted a
• 20:50
  position on abortion,
• 20:52
  on federal abortion restrictions that is to the left of where
• 20:56
  Obama era moderate
• 20:58
  SPEAKER_00: Democrats were.
• 21:00
  You know,
• 21:00
  even as Republicans in the states are banning abortions,
• 21:03
  et cetera,
• 21:04
  et cetera.
• 21:04
  SPEAKER_00: But like Trump made a real adjustment there.
• 21:07
  SPEAKER_00: Then Medicaid has also become dramatically more popular.
• 21:10
  SPEAKER_00: Like Medicaid was expanded.
• 21:13
  SPEAKER_00: Many more people are on Medicaid than used to be.
• 21:16
  SPEAKER_00: There's cycling.
• 21:17
  So there's like a good number of people who were on Medicaid in
• 21:20
  the past but are doing better.
• 21:22
  SPEAKER_00: Yeah.
• 21:24
  The political coalitions have changed so that there are more
• 21:27
  upscale Democrats who
• 21:29
  SPEAKER_00: don't necessarily benefit personally from Medicaid,
• 21:32
  SPEAKER_00: but are like acculturated to the idea that it is good.
• 21:36
  SPEAKER_00: And there are more downscale Republicans.
• 21:38
  So if you looked at like Obama era politics,
• 21:41
  almost everybody getting Medicaid was a Democrat.
• 21:45
  SPEAKER_00: That's not true now.
• 21:47
  SPEAKER_00: So it's just like become a much more sort of popular thing.
• 21:51
  There's also been,
• 21:52
  you know,
• 21:53
  economic just changes to the economics of hospitals.
• 21:56
  It has become harder to operate rural hospital systems over
• 22:03
  time because there is a
• 22:04
  SPEAKER_00: scarcity of personnel.
• 22:06
  SPEAKER_00: And a tendency to just sort of migrate to the biggest cities.
• 22:10
  SPEAKER_00: So there's more,
• 22:11
  SPEAKER_00: I think,
• 22:12
  understanding in rural communities of the kind of systematic
• 22:17
  dependencies and
• 22:18
  SPEAKER_00: benefits on Medicaid.
• 22:20
  SPEAKER_00: But the expansion population, right?
• 22:22
  SPEAKER_00: This is a big divide inside the GOP caucus.
• 22:26
  SPEAKER_00: Because if you are, I don't know, say you're John Cornyn, right?
• 22:31
  SPEAKER_00: Who's like a pretty normal Republican.
• 22:36
  The Medicaid expansion dollars here is like a large federal
• 22:40
  funding commitment of
• 22:42
  SPEAKER_00: which zero dollars go to Texas.
• 22:45
  SPEAKER_00: Right.
• 22:45
  SPEAKER_00: So like he's like jazzed up to cut something like that.
• 22:49
  SPEAKER_00: Right.
• 22:50
  I mean,
• 22:50
  you're looking for spending cuts that don't hurt your constituents.
• 22:54
  And if you are a Republican from if you're Ron Johnson,
• 22:57
  if you're John Cornyn.
• 22:58
  SPEAKER_00: If you're Phil Scott, you're like, this is great.
• 23:01
  But it's exactly the reverse if you're Josh Hawley or I don't
• 23:06
  know the names of the
• 23:07
  SPEAKER_00: Arkansas guys.
• 23:09
  SPEAKER_00: But this is like terrible for those expansion states.
• 23:13
  You mentioned Ron Johnson and you would expect him given his
• 23:17
  ideological extremism
• 23:20
  SPEAKER_01: and his closeness to Trump.
• 23:23
  Well,
• 23:23
  he's also like the only vulnerable Republican senator,
• 23:26
  I guess,
• 23:26
  at this point.
• 23:28
  SPEAKER_01: Also, the fact that Wisconsin doesn't have the expansion yet.
• 23:31
  SPEAKER_01: Right.
• 23:33
  SPEAKER_01: He's not up until 2028.
• 23:35
  SPEAKER_01: And so you'd expect him to be on board.
• 23:38
  But he is,
• 23:40
  in theory,
• 23:40
  a vulnerable Republican three and a half years from now.
• 23:43
  SPEAKER_01: And so-
• 23:45
  the latest that he said is that like,
• 23:47
  I'm not going to support this reconciliation bill.
• 23:49
  SPEAKER_01: Cause so he's,
• 23:50
  SPEAKER_01: he's saying,
• 23:50
  I'm not going to support it because the cuts aren't nearly
• 23:52
  extreme enough,
• 23:54
  SPEAKER_01: but,
• 23:54
  SPEAKER_01: but that's his way of saying,
• 23:56
  SPEAKER_01: I want to,
• 23:56
  SPEAKER_01: I think that it's his way of saying,
• 23:58
  SPEAKER_01: I want to kill this unpopular right-wing bill because,
• 24:02
  SPEAKER_01: but pretend I'm doing it because it's not right wing enough.
• 24:04
  SPEAKER_00: Yeah, yeah, yeah, yeah.
• 24:06
  SPEAKER_00: But this is like,
• 24:07
  SPEAKER_00: Jared Golden did this on the Build Back Better where he like voted no,
• 24:13
  but he like said the reason he voted no was like it didn't tax
• 24:16
  rich people enough.
• 24:17
  SPEAKER_00: But then it's, sometimes people pull that kind of move off.
• 24:22
  SPEAKER_01: I don't want to give Republicans any ideas here,
• 24:26
  and I don't think I was fully aware of how much more popular
• 24:29
  Medicaid had become
• 24:31
  since the expansion took effect until we started planning for
• 24:34
  this episode.
• 24:35
  But one thing I've just noticed in being an American in the
• 24:39
  year 2024,
• 24:39
  2025 –
• 24:42
  SPEAKER_01: is that the things that Obamacare does that are overt are popular.
• 24:48
  And they're – like a red flag should go up if you're a
• 24:52
  Republican and your
• 24:53
  SPEAKER_01: leadership says we want to cut this.
• 24:54
  So that's like the Medicaid expansion and it's like stay on
• 24:59
  your parents' health
• 24:59
  SPEAKER_01: insurance until you're 26.
• 25:01
  SPEAKER_01: And it's the subsidies that help you pay for insurance on the exchanges.
• 25:07
  SPEAKER_01: But –
• 25:08
  SPEAKER_01: Not like the guts,
• 25:11
  SPEAKER_01: the coverage guarantee,
• 25:13
  the guaranteed issue community rating that make it so that
• 25:16
  people who have
• 25:17
  SPEAKER_01: preexisting conditions can get insurance.
• 25:20
  My sense is that there are a lot of younger voters who do not
• 25:26
  realize that just
• 25:28
  SPEAKER_01: like 10 or 15 years ago –
• 25:31
  people who didn't get health insurance through their jobs or
• 25:33
  Medicaid or VA or Medicare,
• 25:37
  SPEAKER_01: they just either had to be super healthy or they were completely fucked.
• 25:40
  SPEAKER_01: Yeah.
• 25:41
  And so they don't – they take for granted that that's just how
• 25:46
  it's been in the
• 25:47
  SPEAKER_01: United States or that that's some like –
• 25:50
  SPEAKER_01: unchangeable aspect of our health insurance system.
• 25:55
  SPEAKER_01: And obviously, if Republicans did change it, it would become unpopular.
• 25:58
  SPEAKER_01: But I don't think that there's the same sort of like,
• 26:01
  SPEAKER_01: oh,
• 26:03
  I am benefiting from that in a silent way that I don't think
• 26:07
  about most of the time,
• 26:08
  SPEAKER_01: but I'm going to be really protective of it.
• 26:09
  SPEAKER_01: I think that there's a lot of people who just don't
• 26:13
  It doesn't register for them that that's a benefit because it's
• 26:18
  sort of hidden.
• 26:19
  SPEAKER_01: It's in the architecture of the marketplace.
• 26:23
  SPEAKER_01: It's not a benefit in the way that Medicaid is.
• 26:27
  SPEAKER_01: Does that make sense?
• 26:28
  SPEAKER_00: I know,
• 26:28
  SPEAKER_00: but I mean,
• 26:29
  SPEAKER_00: so their view though,
• 26:30
  SPEAKER_00: I mean,
• 26:30
  SPEAKER_00: it's clear,
• 26:31
  SPEAKER_00: like Republicans' view is that ACA repeal was a catastrophe.
• 26:35
  SPEAKER_00: And so they are not going to repeal the ACA.
• 26:38
  SPEAKER_00: Instead, they're going to make changes to Medicaid.
• 26:42
  And so like the big one that they want that we've been
• 26:44
  discussing is at least like
• 26:46
  House Republican leadership wants to repeal the Obamacare
• 26:51
  Medicaid expansion.
• 26:53
  SPEAKER_00: But they want to say...
• 26:55
  SPEAKER_01: Changes to FMAP.
• 26:56
  SPEAKER_00: Right.
• 26:57
  SPEAKER_00: They don't want to say those words.
• 26:59
  SPEAKER_00: You know,
• 26:59
  SPEAKER_00: so I think the risk in terms of what you're talking about,
• 27:02
  SPEAKER_00: it's true that I think most people under 30 or possibly even under 40,
• 27:08
  SPEAKER_00: like don't know about this stuff.
• 27:12
  SPEAKER_00: On the other hand, they ran into this kind of Jimmy Fallon buzzsaw thing.
• 27:18
  SPEAKER_00: The last time they tried that,
• 27:21
  like literally like a popular television host just started
• 27:25
  talking about Republican
• 27:26
  SPEAKER_00: Party health care cuts on national television because...
• 27:32
  SPEAKER_00: There's like a blind spot among people who are like too young,
• 27:35
  but like information about how pre-ACA insurance worked is like
• 27:41
  very widespread
• 27:42
  SPEAKER_00: among older people,
• 27:44
  SPEAKER_00: right?
• 27:45
  SPEAKER_00: Like it's like universal actually,
• 27:48
  SPEAKER_00: regardless of,
• 27:48
  SPEAKER_00: I don't want to say universal,
• 27:50
  SPEAKER_00: but it's cross cutting across the population,
• 27:52
  SPEAKER_00: right?
• 27:52
  Like non-poor people have personal experience with this and can
• 27:57
  just like tell you about it.
• 27:59
  SPEAKER_00: Yeah.
• 28:01
  SPEAKER_00: So the non-expansion FMAP change, right?
• 28:10
  SPEAKER_00: That's a tough one.
• 28:12
  It's a tough one politically to discuss because it does sound
• 28:18
  very technocratic.
• 28:21
  SPEAKER_00: And because it will let them say,
• 28:24
  SPEAKER_00: like we are not saying that anybody needs to lose benefits,
• 28:29
  SPEAKER_00: right?
• 28:30
  SPEAKER_00: We are just like rationalizing the federal matching system.
• 28:34
  California and New Jersey and Maryland are like getting more
• 28:38
  money than they deserve.
• 28:40
  SPEAKER_00: And we just wanna make the formula work in a fair way.
• 28:43
  SPEAKER_00: Now, that's not like a no-brainer.
• 28:44
  SPEAKER_00: You're still cutting Medicaid.
• 28:47
  But it is dependent on other actors in the system than speaking up,
• 28:53
  right?
• 28:53
  SPEAKER_00: So,
• 28:53
  SPEAKER_00: like,
• 28:53
  SPEAKER_00: I was checking out the American Hospital Association website,
• 28:57
  SPEAKER_00: you know,
• 28:58
  SPEAKER_00: to,
• 28:58
  SPEAKER_00: like,
• 28:58
  SPEAKER_00: see what's cooking.
• 29:00
  SPEAKER_00: And they do have,
• 29:01
  SPEAKER_00: like,
• 29:01
  the lead thing in their carousel is urge your members of
• 29:04
  Congress to protect
• 29:05
  SPEAKER_00: Medicaid and other crucial programs,
• 29:07
  SPEAKER_00: right?
• 29:08
  SPEAKER_00: Like, the American Hospital Association is not...
• 29:12
  SPEAKER_00: They can't be snowed with wonky rhetoric.
• 29:15
  SPEAKER_00: They're very familiar with how the payment matching system works.
• 29:19
  SPEAKER_00: That being said,
• 29:20
  SPEAKER_00: like if you look at like their press releases,
• 29:23
  SPEAKER_00: like they don't have a release front and center,
• 29:27
  SPEAKER_00: like blasting Republicans for this.
• 29:29
  They don't have that I see like a highly visible like fact
• 29:34
  sheet aimed at motivating people.
• 29:37
  I mean,
• 29:38
  when I click on the take action now button,
• 29:40
  it takes me to like a members only zone.
• 29:43
  SPEAKER_00: You know?
• 29:43
  SPEAKER_00: And so, like, we just, like, we know how lobbying works, right?
• 29:47
  SPEAKER_00: And this is,
• 29:48
  SPEAKER_00: like,
• 29:48
  SPEAKER_00: at a pretty,
• 29:50
  SPEAKER_00: like,
• 29:50
  SPEAKER_00: low boil of lobbying intensity right now for something that,
• 29:56
  SPEAKER_00: like,
• 29:56
  SPEAKER_00: could happen next week.
• 29:59
  SPEAKER_00: You know?
• 29:59
  SPEAKER_00: Like, House Republicans may write this down, pencil to paper,
• 30:05
  SPEAKER_00: try to get this done fast, right?
• 30:07
  SPEAKER_00: Now,
• 30:07
  SPEAKER_00: they keep saying,
• 30:08
  SPEAKER_00: like,
• 30:09
  SPEAKER_00: the whole thing,
• 30:09
  we're hoping to have it done by Memorial Day or maybe by
• 30:12
  Independence Day.
• 30:13
  SPEAKER_00: There's a lot of, like, known unknowns to kind of work out.
• 30:17
  SPEAKER_01: Yeah, another thing Ron Johnson said is that's all a pipe dream.
• 30:19
  SPEAKER_01: We'll be lucky to get this done by the end of the year.
• 30:21
  SPEAKER_00: But that's, like, House-Senate disagreements, stuff like that.
• 30:23
  Just,
• 30:24
  like,
• 30:24
  we know that,
• 30:25
  like,
• 30:26
  the House,
• 30:27
  like,
• 30:27
  blitzkrieg stuff sometimes.
• 30:29
  SPEAKER_00: Yeah.
• 30:30
  SPEAKER_00: And right now,
• 30:31
  House Republicans seem to be putting stuff in the bill that is
• 30:36
  probably not
• 30:37
  SPEAKER_00: birdable and like probably won't pass the Senate.
• 30:41
  But just like in order to kind of ramp up pressure on members
• 30:46
  to vote for,
• 30:47
  SPEAKER_00: but it's still like Medicaid cuts,
• 30:49
  SPEAKER_00: DKs.
• 30:49
  SPEAKER_00: Anyway, there's all of which to say like my big concern right now is that
• 30:56
  SPEAKER_00: Actors in American society,
• 30:58
  SPEAKER_00: which includes the Democratic Party,
• 31:00
  SPEAKER_00: but more includes America's medical doctors,
• 31:06
  SPEAKER_00: America's hospital systems,
• 31:08
  SPEAKER_00: America's nurses,
• 31:09
  SPEAKER_00: America's people who decide which article goes on the front page,
• 31:15
  SPEAKER_00: are not adequately...
• 31:21
  Just raising the salience of this topic such that people know
• 31:28
  what's happening.
• 31:30
  SPEAKER_00: This is one of the big differences between now and eight years ago,
• 31:34
  SPEAKER_00: is that we did flip at a certain point.
• 31:37
  SPEAKER_00: To like,
• 31:37
  SPEAKER_00: OK,
• 31:38
  we like we all talked about firing Comey and like tweets and
• 31:43
  like 90 billion other things.
• 31:44
  SPEAKER_00: But like,
• 31:45
  SPEAKER_00: oh,
• 31:45
  SPEAKER_00: shit,
• 31:46
  now there's a bill going through Congress and it's going to
• 31:49
  impact people's health care.
• 31:50
  SPEAKER_00: And like we haven't had that turn, even as the bill keeps moving forward.
• 31:56
  SPEAKER_01: I actually feel like it's not so different because
• 32:01
  The Republican effort to repeal the Affordable Care Act did
• 32:07
  happen basically
• 32:08
  SPEAKER_01: coincident with the Russia scandal and the firing of COVID.
• 32:10
  SPEAKER_02: Yeah, yeah.
• 32:11
  SPEAKER_01: Appointment of special prosecutor.
• 32:15
  SPEAKER_01: And what really triggered – like there was a real big burst.
• 32:19
  SPEAKER_01: Like it was a slow boil all along.
• 32:21
  But then when Republicans started actually issuing bill text
• 32:25
  and you could be like,
• 32:26
  SPEAKER_01: this is going to kick 20 to 30 million people off their plans –
• 32:30
  SPEAKER_01: The politics got real.
• 32:31
  SPEAKER_01: And the period where it was like the front and center issue,
• 32:36
  SPEAKER_01: like had eclipsed the Russia scandal stuff,
• 32:39
  SPEAKER_01: it was not that long.
• 32:40
  SPEAKER_01: Yeah, yeah, yeah.
• 32:41
  SPEAKER_01: And by contrast,
• 32:43
  SPEAKER_01: I mean,
• 32:43
  SPEAKER_01: I realize it's only front and center in newspapers,
• 32:47
  SPEAKER_01: in certain communities,
• 32:48
  SPEAKER_01: and in national discourse in a factional sense.
• 32:51
  SPEAKER_01: But like Bernie Sanders and AOC,
• 32:54
  they call their tour the Fighting Oligarchy Tour or the Fight
• 32:57
  Oligarchy Tour.
• 32:58
  But the main theme of it when you watch the speeches is hands
• 33:01
  off Medicaid.
• 33:02
  SPEAKER_01: Yes.
• 33:03
  SPEAKER_01: And these have been big, well-attended events.
• 33:05
  SPEAKER_01: So they're doing their thing.
• 33:08
  SPEAKER_01: Um,
• 33:09
  SPEAKER_01: I agree with you that it's a little weird that the,
• 33:11
  SPEAKER_01: that there's this difference between the hospitals and the doctors,
• 33:14
  SPEAKER_01: and maybe it'll be closed in the coming days.
• 33:16
  But one thing I think Democrats can do and Democrats in general
• 33:20
  are just like,
• 33:20
  SPEAKER_01: this is the one issue that they feel they know how to fight on.
• 33:23
  SPEAKER_01: Like the leadership isn't scared of making,
• 33:25
  SPEAKER_01: uh,
• 33:26
  SPEAKER_01: making the progressives and the moderates say the same thing.
• 33:29
  SPEAKER_01: Hakeem Jeffries had a good tweet about how,
• 33:32
  SPEAKER_01: when Republicans say that they don't have,
• 33:34
  SPEAKER_01: don't intend to cut Medicaid,
• 33:35
  SPEAKER_01: they're lying.
• 33:35
  SPEAKER_00: I know Democrats are very eager to discuss this.
• 33:38
  SPEAKER_00: The question is like,
• 33:39
  can Democrats get the other like relevant actors in American
• 33:44
  society to talk about?
• 33:46
  SPEAKER_01: So I think that like,
• 33:48
  One thing that they can do – one thing I think that they should
• 33:51
  do just in general,
• 33:52
  like when we had this conversation probably when there was
• 33:56
  questions about like
• 33:57
  SPEAKER_01: should Democrats vote for various Trump nominees and stuff like that,
• 34:02
  SPEAKER_01: is not just to oppose,
• 34:04
  SPEAKER_01: not just to warn the country that this would be bad if it passed,
• 34:07
  SPEAKER_01: but to warn Republicans like –
• 34:10
  SPEAKER_01: You're going to be doing harm to people,
• 34:12
  SPEAKER_01: but you're also going to be signing your own political death warrant.
• 34:15
  SPEAKER_01: But also,
• 34:15
  SPEAKER_01: also,
• 34:16
  it'll be for nothing because we're going to come back prepared
• 34:20
  and we are going to
• 34:21
  SPEAKER_01: reinstitute this one way or another.
• 34:23
  SPEAKER_01: And like we,
• 34:25
  SPEAKER_01: I guess,
• 34:25
  SPEAKER_01: could have a conversation about what should,
• 34:28
  what should Democrats say they're going to do if we wake up in
• 34:31
  July or August or whatever,
• 34:33
  and Republicans have pulled it off and 20 million people lose
• 34:36
  their Medicaid
• 34:36
  coverage because restoring the 90% F map is just going to be
• 34:43
  vulnerable to being
• 34:44
  SPEAKER_01: cut again.
• 34:45
  SPEAKER_01: So you could do a hundred percent forever and just spend more money.
• 34:48
  SPEAKER_01: You could do it like a public option and just kind of incorporate
• 34:52
  SPEAKER_01: the Medicaid population or the,
• 34:54
  at least the expansion population into the larger pool of
• 34:59
  people on like individual
• 35:02
  SPEAKER_01: health plans,
• 35:02
  SPEAKER_01: but they'll just be buying from the government.
• 35:04
  SPEAKER_01: But I just think that like,
• 35:06
  we're not going to take this one on the chin and then come back
• 35:10
  to power and then say,
• 35:12
  SPEAKER_01: you know,
• 35:12
  SPEAKER_01: well,
• 35:12
  we're back to 15% on insurance and we're not going to do
• 35:17
  another Obamacare.
• 35:18
  SPEAKER_01: So yeah,
• 35:20
  SPEAKER_01: life sucks and good luck to the people who lost their insurance.
• 35:23
  SPEAKER_01: Like,
• 35:24
  I think that element is missing from kind of all other
• 35:28
  opposition that you will
• 35:29
  live to regret this and we're going to be the ones that make
• 35:31
  you live to regret it.
• 35:33
  SPEAKER_01: But generally speaking,
• 35:34
  I kind of feel like they're pretty well poised and it's just a
• 35:37
  question of whether
• 35:39
  SPEAKER_01: Republicans through like,
• 35:42
  SPEAKER_01: you know,
• 35:43
  marinating and Trumpism for eight more years and living under
• 35:47
  fear of him are –
• 35:49
  SPEAKER_01: more disciplined now are like,
• 35:51
  SPEAKER_01: you know,
• 35:51
  the Republicans had huge whip operation problems under Paul
• 35:56
  Ryan and Donald Trump's
• 35:57
  SPEAKER_01: first term.
• 35:57
  SPEAKER_01: And they still obviously have real difficulties.
• 36:00
  But multiple times now,
• 36:02
  they've just basically strong armed everyone on board.
• 36:06
  SPEAKER_01: And so it's been there's been much less,
• 36:09
  SPEAKER_01: many fewer obvious failures than there were,
• 36:13
  SPEAKER_01: I think,
• 36:13
  SPEAKER_01: in in Trump's first
• 36:16
  SPEAKER_01: 100 or 150 days of term one.
• 36:16
  SPEAKER_00: Well,
• 36:17
  SPEAKER_00: I mean,
• 36:17
  SPEAKER_00: because I think the biggest difference is that in the Senate,
• 36:21
  SPEAKER_00: right,
• 36:24
  their majority is big enough that they can lose Collins and
• 36:28
  Murkowski and still
• 36:30
  SPEAKER_00: pass things.
• 36:32
  They can lose Collins,
• 36:33
  Murkowski,
• 36:33
  and Mike – or Ron Johnson and – Well,
• 36:37
  yes.
• 36:38
  SPEAKER_00: I mean, they can lose Collins and Murkowski –
• 36:42
  And they can say,
• 36:43
  I'm going to give in cycle Tom Tillis a pass in North Carolina
• 36:52
  or whatever.
• 36:53
  SPEAKER_00: Right.
• 36:53
  SPEAKER_00: They just like they have a lot of flexibility in the Senate.
• 36:56
  SPEAKER_00: And also there's really little electoral pressure on Republican senators,
• 37:01
  SPEAKER_00: you know,
• 37:02
  SPEAKER_00: because just like Dems are so like fucked vis-a-vis the Senate map.
• 37:07
  SPEAKER_00: So theoretically, the blocking point on everything should be the House.
• 37:12
  SPEAKER_00: The Republican House majority is really small.
• 37:15
  SPEAKER_00: Republicans have a bunch of vulnerable House members.
• 37:20
  SPEAKER_00: Like, Republicans are like, there's, you know...
• 37:25
  Not that many House members who are like above 50% likely to
• 37:29
  lose their seats,
• 37:30
  SPEAKER_00: but there's a ton who are above 30%,
• 37:32
  SPEAKER_00: you know,
• 37:33
  SPEAKER_00: probability of losing their seats in the midterms,
• 37:35
  who like should worry about it and should be thinking about
• 37:38
  what they're doing.
• 37:39
  SPEAKER_00: But House members are like...
• 37:43
  SPEAKER_00: Who fucking knows?
• 37:44
  SPEAKER_00: You know what I mean?
• 37:44
  They just like,
• 37:45
  they don't have the independence and stature that senators have.
• 37:51
  SPEAKER_00: And this group of House Republicans from...
• 37:57
  Bacon on,
• 37:59
  with the exception of Bacon on the left,
• 38:01
  who's like quitting,
• 38:02
  it sounds like.
• 38:04
  SPEAKER_00: And,
• 38:06
  SPEAKER_00: you know,
• 38:06
  SPEAKER_00: maybe Chip Roy on the right,
• 38:09
  SPEAKER_00: just like,
• 38:10
  SPEAKER_00: they're like nobodies,
• 38:11
  SPEAKER_00: you know,
• 38:12
  SPEAKER_00: who like have all this like whining and caveats and whatever.
• 38:16
  SPEAKER_00: But like, I,
• 38:19
  SPEAKER_00: I just like I think they really might just like move a toxic,
• 38:23
  SPEAKER_00: you know,
• 38:24
  SPEAKER_00: like a well messaged against very unpopular kind of bill.
• 38:27
  SPEAKER_00: Like,
• 38:28
  SPEAKER_00: I think they might just do it,
• 38:29
  SPEAKER_00: which,
• 38:29
  SPEAKER_00: you know,
• 38:29
  SPEAKER_00: in some ways,
• 38:30
  SPEAKER_00: like politically is like,
• 38:32
  SPEAKER_00: quote unquote,
• 38:33
  SPEAKER_00: good.
• 38:35
  SPEAKER_00: But like bad for America, I would regret it.
• 38:39
  Because what House leadership is doing right now is they're
• 38:42
  like putting unrelated
• 38:43
  SPEAKER_00: stuff in there,
• 38:44
  SPEAKER_00: right?
• 38:44
  SPEAKER_00: So they're telling people,
• 38:46
  SPEAKER_00: well,
• 38:46
  SPEAKER_00: this bill,
• 38:47
  SPEAKER_00: it's not just like tax cuts and Medicaid cuts and SNAP cuts.
• 38:52
  This like also is the money that we're going to need to do mass deportation.
• 38:56
  It's this like big deregulation bill that lots of random
• 38:59
  business owners are going
• 39:01
  SPEAKER_00: to be excited about.
• 39:03
  SPEAKER_00: And-
• 39:04
  SPEAKER_00: So I don't know.
• 39:05
  I want to ramp up the advocacy around this and engage hospitals
• 39:11
  and other providers
• 39:13
  SPEAKER_00: and get news coverage just because I don't want it to happen.
• 39:18
  SPEAKER_01: I think it's quite bad.
• 39:19
  SPEAKER_01: No, it would be very bad.
• 39:21
  I think that that is happening,
• 39:22
  so I don't think you're going to be disappointed.
• 39:24
  SPEAKER_01: I do think that we should explain that –
• 39:28
  the way Republicans might try to get everyone on board in the
• 39:30
  house is by larding
• 39:31
  SPEAKER_01: the bill up with provisions that aren't budgetary.
• 39:34
  SPEAKER_01: And you refer to this as birdable.
• 39:36
  SPEAKER_01: And what that means is that when it goes to the Senate,
• 39:38
  the Senate has these persnickety rules about what a
• 39:41
  reconciliation bill requires in
• 39:43
  SPEAKER_01: order to avoid the filibuster.
• 39:45
  SPEAKER_01: And like,
• 39:45
  you can't just deregulate all of industry in a budget bill
• 39:48
  because it's not about
• 39:50
  SPEAKER_01: tax revenue or spending.
• 39:53
  SPEAKER_01: And then the, uh,
• 39:55
  The only thing that I think maybe we should prepare people to
• 40:00
  anticipate is some
• 40:02
  SPEAKER_01: funniness around phase-ins because –
• 40:06
  the same reconciliation rules that prohibit non-budgetary
• 40:10
  things also have criteria
• 40:13
  SPEAKER_01: for how,
• 40:14
  SPEAKER_01: you know,
• 40:14
  SPEAKER_01: the bill needs to be deficit neutral basically year in,
• 40:17
  SPEAKER_01: year out for 10 years.
• 40:18
  SPEAKER_01: And then in the out years,
• 40:20
  the past the 10-year budget window needs to tend to reduce the
• 40:23
  deficit further,
• 40:24
  SPEAKER_01: right?
• 40:25
  SPEAKER_01: And so since we're in this era where both parties seem to try to
• 40:31
  SPEAKER_01: cram as many objectives as they can into these filibuster-proof bills,
• 40:35
  SPEAKER_01: in order to avoid sticker shock or having to increase taxes too much,
• 40:40
  SPEAKER_01: they'll say,
• 40:40
  SPEAKER_01: this becomes law today,
• 40:43
  SPEAKER_01: but the law doesn't take effect for another couple of years or whatever.
• 40:46
  You can shrink the amount of money you appear to be spending or
• 40:48
  the amount of taxes
• 40:50
  SPEAKER_01: you appear to be cutting or whatever.
• 40:53
  SPEAKER_01: But also you can delay the pain.
• 40:55
  And so if they want to find some paper savings for their big
• 41:00
  tax cuts and they
• 41:02
  SPEAKER_01: obliterate the Medicaid expansion,
• 41:04
  but they say that Medicaid expansion doesn't take –
• 41:06
  obliteration doesn't take
• 41:07
  SPEAKER_01: effect until January 21st,
• 41:09
  SPEAKER_01: 2029,
• 41:09
  SPEAKER_01: one day into the next administration.
• 41:14
  SPEAKER_01: They can do that,
• 41:16
  and it'll make the midterms feel easier for them because what
• 41:22
  would really hurt
• 41:23
  isn't just news coverage of the fact that they passed this bill
• 41:26
  that will in the
• 41:27
  SPEAKER_01: future cause lots of people to lose their insurance.
• 41:30
  SPEAKER_01: it would be the like,
• 41:31
  SPEAKER_01: oh,
• 41:31
  there's suddenly 20 million more people without health
• 41:34
  insurance in the United
• 41:35
  SPEAKER_01: States almost overnight.
• 41:37
  And we need actual legislative text to see if they're going to
• 41:40
  try that kind of funny business.
• 41:42
  SPEAKER_01: But like,
• 41:42
  SPEAKER_01: I think that that would be a way to kind of get the,
• 41:48
  SPEAKER_01: you know,
• 41:48
  SPEAKER_01: the Mike Lawlers and the David Valadeos and whoever else to say,
• 41:53
  SPEAKER_01: okay,
• 41:53
  SPEAKER_01: we'll just like,
• 41:56
  SPEAKER_01: We'll just vote yes and deal with the political consequences.
• 41:59
  SPEAKER_00: Yeah, yeah, yeah.
• 42:00
  SPEAKER_00: Yes.
• 42:00
  SPEAKER_00: I mean, so, and, you know, we'll have to discuss this in future episodes.
• 42:05
  But,
• 42:05
  like,
• 42:05
  the other thing going on here is that full TCGA expansion is
• 42:12
  very costly.
• 42:14
  SPEAKER_00: They also want to throw in...
• 42:17
  SPEAKER_00: All these gimmicky Trump tax ideas that wonks hate,
• 42:21
  SPEAKER_00: no taxes on Social Security,
• 42:22
  SPEAKER_00: no taxes on tips,
• 42:23
  SPEAKER_00: no taxes on overtime.
• 42:24
  SPEAKER_00: The polling on that stuff is all really good, really solid.
• 42:30
  SPEAKER_00: So they do want to put that in.
• 42:32
  SPEAKER_00: Trump featured that.
• 42:33
  It wasn't discussed that much in the media,
• 42:35
  but Trump talked about that stuff a lot.
• 42:38
  in his campaign the polling on that is really good there's
• 42:42
  absolutely no way to do
• 42:44
  those three things and do full TCGA extension and avoid like
• 42:49
  all the cuts we've
• 42:50
  been talking about even if you did them all don't come close to
• 42:52
  paying for that so
• 42:53
  they're gonna do like who knows what like phase out stuff on
• 42:57
  the tax side to like
• 42:59
  SPEAKER_00: kind of sort of make the numbers work but the um
• 43:02
  economic consequences of just like wrecking the budget deficit
• 43:06
  are going to be very severe.
• 43:08
  SPEAKER_00: And, you know, that that's another episode.
• 43:11
  But it's another one of the like food for thought for Democrats
• 43:15
  in the future kind
• 43:16
  SPEAKER_00: of things,
• 43:17
  SPEAKER_00: because unfortunately,
• 43:19
  SPEAKER_00: like on the Medicare side,
• 43:20
  SPEAKER_00: if they do repeal the Medicaid expansion,
• 43:24
  that sort of just gives Democrats another bite at the apple of
• 43:27
  like what's honestly
• 43:28
  SPEAKER_00: their favorite topic.
• 43:30
  SPEAKER_00: which is like incremental health insurance expansions.
• 43:34
  SPEAKER_00: So that's fine.
• 43:35
  SPEAKER_00: And they can maybe even come up with a better idea.
• 43:39
  SPEAKER_00: Ruinous budget deficits are like not a good time
• 43:43
  SPEAKER_00: for the new party to take over,
• 43:44
  SPEAKER_00: it's like quite likely that we'd be looking at a repeat of like 1993,
• 43:49
  SPEAKER_00: kind of like bad news.
• 43:51
  SPEAKER_00: You can't do anything fun.
• 43:53
  You just need to reduce the deficit and make people's mortgages
• 43:55
  affordable again.
• 43:56
  SPEAKER_00: And that's going to be some difficult conversations, I think.
• 44:01
  SPEAKER_01: In the future episode when we discuss this,
• 44:02
  this is why I think like the Sanders AOC approach of tying this
• 44:08
  all to oligarchy is
• 44:09
  okay because the way to do both things if you inherit a wrecked
• 44:14
  economy and a bunch
• 44:15
  SPEAKER_01: of uninsured people is to punish the people who brought it all on,
• 44:18
  SPEAKER_01: aka the oligarchy,
• 44:21
  by taxing the bejesus out of them as kind of both to pay for
• 44:26
  the damage but also as
• 44:26
  like a moral punishment and give that money back to the people
• 44:29
  they took it from.
• 44:30
  Let's put a pin in that for like a week or two and then put a
• 44:34
  paywall here and then
• 44:36
  talk about what this like ancient history of the Medicaid
• 44:41
  expansion implies for
• 44:45
  SPEAKER_01: Democrats as they figure out how to push back against Trump.
• 44:48
  SPEAKER_01: If you want to hear that part of the conversation,
• 44:50
  SPEAKER_01: go to politics.fm and upgrade your subscription.