Count Oklahoma Senator James Lankford among the optimists on the Senate GOP healthcare bill. I agree as I don’t see any alternative for a majority party that wants to remain one other than rescuing a collapsing system with the best compromise the caucus can achieve:
HH: I’m joined by United States Senator James Lankford of the great state of Oklahoma. Good morning, Senator, thank you for joining me.
JL: Good morning to you as well.
HH: Senator, I want to focus on the health care bill first and right out of the box. Do you think we get a vote on a final bill next week?
JL: That is the shot. I honestly think we do. We’re trying to see what the final text is. As you know well, the text that came out two weeks ago, there was enough disagreement on it, I would say that, on different sides of the perspective, to say we need to push this back into a rewrite. And McConnell is in the final process of getting that rewrite done with his staff. It’s at CBO, and we hope to be able to have a vote next week on it.
HH: Do you expect that the vote on which, the bill on which a vote will occur will include the Cruz amendment concerning one Obamacare-compliant plan opening the door to non-Obamacare-compliant plans on the exchanges?
JL: I would assume there’d be some version of that. There’s been a lot of different options about what that means, but basically, it creates an option that a federal plan or a state-guided plan. It’s not just a plan that comes out there on the market that no one has control over. This goes back to getting state controls. As you know, once federal control started seven years ago, prices started skyrocketing. When states had the option to be able to work with insurance companies to form plans in states, prices were much lower. So this gives an option to say if you’ve got a federally-mandated plan, that you could also have a different plan that’s a state plan as well.
HH: So what is the argument against that within the conference, Senator? There have been unnamed people saying they oppose it for a variety of reasons which I don’t understand, don’t make sense to me. What is the argument against the Cruz amendment?
JL: Well, some of the insurance companies are out there pushing against it. Quite frankly, we used to, in my state, had four insurance companies competing. Now, we have one company. There are a lot states that are like mine, that either there are large regions of the states or the entire state has no insurance market anymore, just a simple monopoly that’s there. And so some of those companies are very passionate about protecting that monopoly as well, saying we want to make sure that we don’t get other competition into the states. Obviously, that’s best for the consumer to be able to have good competition into the state, not trying to make an unfair market for anyone, either the people selling the insurance. Those are not necessarily inherently evil companies. They’re companies that are also trying to make a profit, which is the nature of business. But they’re also selling a product that we want people to be able to buy. So we’ve got to be able to have the price down. So that, a lot of the argument has been from the insurance companies themselves.
HH: I imagine they are arguing that if you allow low-cost policies, adverse selection will kick in and they will end up being the insurer of last resort. They’ll absorb all of the high risk pool people. But won’t they also get a bunch of financial assistance for the high risk pool people?
JL: That is correct. And part of this plan is the nature of what health care is. About five percent of the people in the country have 60% of the health care costs, because there are some individuals that have great sickness, chronic sickness. We’re talking Alzheimer’s, cancer, ongoing renal failure, I mean, some individuals that are precious to us as Americans, but are also very expensive. If you can subsidize them with a federal subsidy, then it brings down the cost for everyone else. The other option is you don’t do that with a federal subsidy, and everyone’s rates go up. One way or the other, they’re going to get subsidized, either through rates for individuals that their insurance shouldn’t be as high based on their health condition, or through a federal subsidy. But one way or the other, they are covered. That’s the nature of insurance.
HH: Senator Lankford, does the conference understand there is a moral imperative here? 14 out of 17 counties in Nevada have no policies. 19 counties in Ohio have no policies. Iowa is looking at a large swathe of their counties, of their state having no policies. And millions more have only one choice, which is not choice at all. It’s, you know, it’s a monopoly. Does the conference grasp that they have to act, because the house is on fire?
JL: Oh, absolutely they do. That’s been the nature of this conversation. There’s one group that’s pushing saying we’ve got to get something done, and another group that’s pushing saying what we get done must be done right, because whatever is happening in the market right now doesn’t help with just activity. It helps with the right activity. And so there is a push to say let’s get it right. There’s also acknowledgement you don’t fix this in one step. The damage that Obamacare has done to the health care, all of our policies, our insurance, the nature of the hospitals, their relationships with the doctors, all that’s dramatically changed in the last eight years, and you don’t have a single vote that starts to reset the system. So whatever happens is a first step. There’ll have to be several steps after this as well. But the first step is important that we get it right, and that we allow the states to be able to control as much as possible of the regulatory scheme. That allows greater choice and options.
HH: And now Senator, the House bill, and I believe it is part of the Senate bill, redirects significant funds away from Planned Parenthood to other health providers to women. And that is a stumbling block for some senators. How many senators, do you think, find that to be objectionable?
JL: You know what? I do not know, yet, on that, how many find that objectionable. I would say the vast majority of our conference does not find that objectionable. Planned Parenthood’s the single largest provider of abortion in the country. It is their main economic stream, is both referring for abortion and providing abortion. But we absolutely do want to take care of women’s health issues. In my state, there are five Planned Parenthood clinics, but there are almost 90 federally-qualified health centers. What we have done in this plan is we have allowed those 90 facilities to be able to receive additional dollars, but we’ve pulled the dollars back from Planned Parenthood and organizations like them and have said that that is not the reason that we’re providing funding. It is a basic philosophical belief that when you’re taking life, that’s not health care. Protecting life is health care.
HH: If the cost of passing the bill is to remove that redirection, would you support that redirection?
JL: I think we can work it out. I do. I just think that we can work it out to be able to make sure that we protect life on all levels.
HH: But if, again, I’m kind of pressing on this. It’s my understanding there are two or three members of the conference who will not go for this bill if it redirects money from Planned Parenthood. And I talked to my evangelical and conservative Catholic friends, and they’re very adamant about it as well. But if that’s the cost of passing the bill in order to get moving forward on the repeal, Medicaid can address this, the states can regulate this, would you accept that as a cost of moving the bill forward, you, James Lankford?
JL: You know what? I don’t think I would, actually, because again, we’re going back to the basic theme that health care protects life on it. If the focus of it is becoming taking life, that’s philosophically a different direction for us. I want to do whatever we can to be able to protect life. That is both protecting the life of the woman if she’s in a high risk pregnancy, to be able to make sure that she can have those options to be able to protect her. All those things are still included in it, the basic Hyde protections. But that’s a basic philosophical belief, and I don’t think that’s going to be the major stumbling block.
HH: What is going to be the major stumbling block?
JL: Right now, it’s the process of how you actually get states their control. How much control do states get? What does that look like? What does Medicaid look like in the days ahead? Medicaid is an entitlement program that was traditionally for those that are in greatest need, those that have disability, those that are the elderly that cannot take care of themselves, and Medicaid was expanded dramatically under Obamacare to healthy working adults. So we want to be able to say okay, let’s get back to Medicaid, to what Medicaid was intended to be – for women with children, for those children, for the disabled, and for the elderly. And for healthy working adults, for them to be able to actually engage in work and to be a part of that. So that’s a part of that. It shouldn’t be that difficult. But trying to deal with the amounts, how do you stabilize this program, and how you make sure it’s actually working for the people it’s designed for has proved to be contentious.
HH: There is an argument over the inflation measure to use on the basic Medicaid bloc grant. Do you think that will get resolved? Because, and I don’t want to get into the acronyms, but there are two or three different ways that you can increase the spending.
HH: That does not seem to be other than a split the difference issue. That’s one of those ones that you ought, you know, that’s, that isn’t even hard.
JL: Right, and I would fully agree with that. That is a split the difference type issue, and I think that’s one that will get worked out. Again, I’d love to be able to tell you what the exact text is. We’ve not seen the next version of the text. McConnell’s staff has worked up the next version, and he’s taken in all the arguments that we have made. We’ve all pushed in different directions to say let’s find a way to be able to resolve this. We’ve, many of us, myself included, have brought up here’s some compromises that could be made among different Republicans to try to get this thing done. And now we’re waiting to be able to see what that text is and what the score will come back from CBO.
HH: Is the 3.8% tax on interest income from high-earning Americans a stumbling block? Or is that something that again is subject to compromise?
JL: Yeah, I think that’s subject to compromise as well. We will do tax reform in the fall, and a lot of those tax issues we can resolve at other times in other places. That should not be a stumbling block in the health care debate.
HH: So wrapping up, Senator, are you an optimist like Marc Short, the President’s head of legislative affairs, said we’re going to get a bill next week? I’ve always believed that this is doable. Are you an optimist about getting this done?
JL: I am an optimist. And I hear some of my colleagues say there’s no way, I don’t think there’s any way to get this done. I think they’re posturing to be able to get the best possible deal that we can, which I fully agree with. But at the same time, I’m also an optimist to say we can get this done. We’re not that far away. And everyone in the conference is all saying the same thing. I want to get this done. No one is backing up and saying no way, I’m not going to do anything.
HH: Not Rand Paul? Not Susan Collins?
JL: No, that’s correct. Even Rand Paul and Susan Collins are saying here’s the way to be able to get me. Here’s the things that I want to be able to do. So everyone is leaning in and saying I want to be able to get this resolved. This is a big issue. In my state, rates went up last year 76% in one year.
JL: And we’re down to one insurance carrier. Everyone complains about the high cost of college tuition. That’s gone up 76% in 15 years. It’s gone up in health care 76% in one year. And so it’s a big issue for us, and I think a lot of people need to understand this is important to get it done, but get it done right.
HH: Senator James Lankford, thanks for joining us, spreading some information on that, an optimist along with me. Good luck in these closing days.
End of interview.