Pennsylvania Senator Pat Toomey joined me this AM to talk health care:
HH: Senator Pat Toomey joins me now. Good morning, Senator, thank you for joining me. I was just reading the Paul Kane article that discusses the differences between you and Rob Portman. Is it fairly accurate?
PT: Well, I would say the, my only dispute is that Rob Portman and I get along very well, and I don’t think that comes across in the article.
HH: Yeah, that’s what I was going to, I agree, I know that to be true. Senator, before we get to the details of where we are in the negotiations, last hour, I had a caller, Terry from Tennessee, call in. He’s a business owner. I’d like to hear you, have you hear what he had to say. This is Terry from Tennessee.
TT: I own a small business. We employ about 25 people, most of whom are women, half of whom are single mothers. And Hugh, we have two choices. That’s it. Two plans to choose from. The Blue Cross plan will go up another 16.10%, and the Humana plan, are you sitting down, 29.38%.
TT: Hugh, this is the second highest business expense next to payroll, and we made a conscious decision…
HH: You’re not going to be able to keep giving health care, right?
TT: You’ll have to excuse me…
HH: You just dropped off. Did you hit a mute button?
TT: It just, it breaks my heart, because we made a conscious decision, and we just can’t do it anymore.
HH: Senator Toomey, this is going on across the country. I know we’re focused on Medicaid and opioids, but the basic health care system of the country is falling apart.
PT: That is exactly right, Hugh. Certainly, the small business market, the individual market, Obamacare has ruined it. And we’ve got to restore a normal market. We’ve got to give people choices. We’ve got to put consumers back in control of their own health care decisions rather than having all this power centralized in Washington. And you know, this legislation we’re working on, I will guarantee you it’s not perfect, and it is not complete, but it’s a big step in that direction. And that’s why I’m hoping we can get it done.
HH: Well, that brings me to the $64,000 dollar question, to use a reference that most millennials won’t get. Is it going to get there? Are we going to get a bill that has 50 or 52 votes, which I would prefer every Republican to support it, and I’d love Joe Manchin and some reasonable Democrats. But first, we’ve got to get to 50. Have we got 50 people to agree on something, yet?
PT: We’re not there, yet, but we’re not giving up. I think it’s way too important to give up. I’ve been very actively involved in this, Hugh. This bill has many features that I’m not enthusiastic about. It’s lacking things I would like to see. As I say, it is not perfect, but I’m ready to support it, because it is that step that we have to begin the process with.
HH: Now early, and I’ve been pretty hard on your colleague, Dean Heller, this week, because he came out against, he put a torpedo mid-ships before the negotiations began. Have you see him trying to climb back on board, because yesterday, Nevada announced they’re going to have no plans in 14 out of 17 counties, zero choices.
PT: Wow. Wow, well, look, I have seen Dean. He’s been attending the discussion meetings that we’ve had, our discussion lunches. He joined Republican senators at the White House in a meeting with the President. I think Dean would like to get to yes. I will, I will tell you candidly I think he’s further away from yes than many of my colleagues, than most of the Republican conference, but I don’t think it’s impossible. And I hope, I still hope we’ll have Dean on board in the end.
HH: So where, you know, one of my, I’ll give you my pet solution, which is bloc grant of endowment funds, the interest income of which can treat opioid and rural health care issues, because I’ve done that in Orange County, California for 18 years. I served on a board that got cigarette tax money. We know how to take care of people in Orange County better than Washington, D.C. does. I was just up in Scranton and Wilkes-Barre for the 94.3 Talker/Bold Gold thing. I talked to people up there. They know what to do in their communities, Senator Toomey. We’ve got to get this out of D.C.
PT: Well, this is the great conceit and the fatal conceit of Obamacare, is that Washington should dictate health care policy for the whole country, and that’s exactly what it does. Let’s not pretend anything else. It is a centralization of power and authority in Washington that controls Medicaid, Medicare, and now this legislation has nothing to do with Medicare, but my point is just that concentration of power and authority eliminates decision making that is, could be done better locally, better at the state level. And by the way, as we all know, state governments are much more responsive to people, and they’re more flexible, they’re more accountable, because they’re closer to people. So of course, it makes perfect sense that there will be better solutions. The other point I would make is look, health care problems and challenges are very, very different as you go across the country. In the Appalachian states and in New England, the opioid crisis is a huge, huge crisis, one of the biggest health care and public health crises we’ve ever seen. But there are some states where methamphetamines are a much more serious problem than opioids.
HH: And there are states such as California where Medical dental, there are no dentists that will take it. It doesn’t, it’s not really insurance. It’s a piece of paper that won’t get a poor kid in to see a dentist, no matter how bad the abscess off their tooth is.
PT: That’s it, and you just pointed out there are, increasingly, there are counties in America, and soon, entire states, where there are no options, because this market has failed so badly. So there’s an urgency to get this done, and I think a big, big part of it has to be to, you know, to devolve authority, power, decision making away from Washington, and to the states and individuals.
HH: Now there are two issues that seem to divide Republicans. One is the 3.8% wealth tax. Now I don’t like that tax. I think it’s destructive of jobs and growth and the ability of people to afford regular health care. But if that’s a sticking point, why not, you know, compromise? We’ll keep 1.9% of it and get rid of 1.9% of it. What is the state of play on the 3.8% repeal?
PT: So this has been a subject of discussion, but it’s not clear to me that it is actually preventing us from getting to 50. My own view is I can tell you unequivocally I’ve spent the last seven years promising Pennsylvanians that I’m going to do everything I can to repeal Obamacare. I didn’t put caveats that say oh, but when President Obama socked it to productive people with a tax on their investment income, I’ll keep that. I didn’t do that, because I don’t think that’s the right policy. So I’m in favor of repealing all of it. And I think a majority of the conference is. But it is still a matter that’s under discussion. As I said, I don’t think that’s as controversial as some of the other items.
HH: Well, where is the divide, Senator, because to me, the house is on fire.
HH: I read every day health care disaster, I get callers like Terry in Tennessee. I actually talk to people about this. And the Senate, we’ve asked for years for the House, the Senate and the presidency to be in Republican hands. It’s down to your 52 people to send a bill back to the House and then to the President. It’s on your guys.
PT: You’re absolutely right. You’re absolutely right. And that’s why we’ve been meeting several times a day every single day to try to get there. I’ll tell you one of the areas that is, that has proven to be extremely contentious, and this is written about in the Washington Post article you alluded to. But it is how we treat Medicaid. And we have to deal with it. It is part of Obamacare. You know Medicaid is the government-run health care system for very low income Americans. And Obamacare created a new category of eligibility, a category of Americans who were never eligible before. And that is working-age able-bodied adults with no dependents. So for the first time, this category of people, if their income is below 138% of the poverty line, they can get Medicaid. Well, you know, we’re going to continue to allow these people to be eligible. That’s a big concession to Obamacare conservatives we’re making. This category of eligibility will remain in perpetuity under the bill. But what’s controversial is the vast majority of Republicans in the House and the Senate believe that the federal contribution towards covering this category of folks should go from the 90% that Obamacare has established down to the ordinary share, which on average is 57% across the country, with the states picking up the balance. So it’s a matter of restoring, or placing on this category of beneficiaries, it doesn’t affect the beneficiaries. It’s a relationship between the state and the federal government. Should the states bear their fair share of this cost? I would argue because of the fiscal train wreck of the federal budget, we need to also create an incentive for states to actually care about the cost and the administration of this program. We’ve got to do this. This is one of the most controversial features. Governors are screaming. Governors are, of course, I’m shocked, governors want free money from someone else.
PT: And we’ve got to do what’s right for federal taxpayers, for our country, and that means transitioning to the point where the states are paying their fair share. How we get there and how we limit the growth of this program over time has proven to be very, very contentious and very difficult for our conference.
HH: Well, Senator, my view is, back when I was in the government in the 80s, we had to transition the federal government from a guaranteed benefit to a guaranteed contribution program. We took 30 years to do it. I don’t care how long the runway is. But we’ve got to do it right now. This is a, and my last question to you, does everyone understand this is a make or break moment? The house is on fire, we will lose the House, we could lose the Senate. It will destroy, more importantly, people like Terry in Tennessee and his health care for his employees. Does everyone in the caucus get this is a make or break moment?
PT: Many of us are making that point every single day. This is a make or break moment. We have to follow through on a promise that we made. We have to save the country from a disastrous system, first and foremost. And politically, Hugh, we’ve got to demonstrate that we can govern. We have the entire elected government. We’ve got to prove that we’re competent to manage it, and to fulfill the promise we’ve made. So I couldn’t agree more.
HH: Well, I think a lot of people are praying for your success. Good luck today, Senator Toomey. You’ll send a bill over to get it scored at CBO by the end of the day, right, even if it’s only in the outlines?
PT: Well, it could be that there are a number of pieces going over to CBO. I can’t say that there’s a complete agreement that gets 50 votes on any one configuration, so we’re probably going to send several configurations over so that we still have a few pieces to move, and some dials to turn, but we’ll have the information back from CBO about what it all costs, and that will help us make a better informed decision.
HH: And should the August recess be cancelled if you guys aren’t done, yet?
PT: If we can’t, look, we have to stay until it’s done.
HH: Thank you, Senator Toomey, for joining me. Very, very important conversation.
PT: Thanks, Hugh. Thanks for having me.
End of interview.