← Bulwark Takes
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- [00:00]
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- [00:59]
Jonathan Cohn
Building today@base44.com hey, everyone, it's Jonathan Cohn here at the Bulwarks. So much health care news to talk about. Right now we have everything going on with vaccination and Robert F. Kennedy Jr. Running American Public health policy. We have a big debate about Obamacare, possibility that more than 20 million Americans could see their insurance premium premium spike, and a debate that could land us in a government shutdown. Our guest today is smack in the middle of these debates. It is Tammy Baldwin, the Democratic senator from Wisconsin, a member of the Senate Health, Education, labor and Pensions Committee, which is a fulcrum for all of this. Senator, thanks for making time with us today.
- [01:41]
Senator Tammy Baldwin
Oh, thanks for having me on such pressing issues.
- [01:45]
Jonathan Cohn
It is, it is. And we're going to get into all that. We're going to get into RFK and vaccines, and we're definitely going to get into Obamacare and the subsidies and where the Democrats stand. But before we do all that, I always like people to start these conversations with a sense of why healthcare matters. And I know you have a personal story here from your childhood. Tell us a little bit about that story and why that sort of put you where you are on this debate over what government should be doing to help people get healthcare.
- [02:13]
Senator Tammy Baldwin
Yeah, so I was actually raised by my grandparents and my grandparents had health insurance. But when I was nine, I got a very serious childhood illness that put me in the hospital for three months. It was similar to spinal meningitis. That wasn't the exact diagnosis but they realized at my time of need that their family health insurance didn't cover grandchildren and I wasn't considered a legal dependent. And so number one, in our time of need, the insurance company says, nope, we don't cover her because you had a pre exist.
- [02:56]
Jonathan Cohn
Oh, right. Yeah. Okay, keep going.
- [02:58]
Senator Tammy Baldwin
Yeah. So when I was sick, when I was in the hospital, my grandparents ended up, you know, needing to pay all those bills out of pocket. But then they tried to fix the situation as quickly as they could. Let's find her health insurance. Okay, Our plan doesn't cover her. Let's get her an individual plan. Well, back then there was no obligation on the part of health insurance companies to cover somebody who had what they call a pre existing health condition. And regularly they didn't. And so people who had cancer or had diabetes or had any sort of pre existing condition, even something they'd fully recovered from, like my own situation, they you just couldn't get insurance. And so I didn't have health insurance until it was actually offered through an employer when I was an adult. And I just grew up feeling like this was wrong, that this was a system that was totally broken. Of course, as I grew up, I saw other people who suffered under the system we had. And I grew up wanting to play some role in fixing it. And so that's what led me to run for office first local office where there was a couple of issues I tackled locally. And then I was elected to the House of Representatives first before the Senate at the time when we were writing the Affordable Care Act, Obamacare. And I actually was responsible for the provision in the House that allows young people to stay on their parents health insurance till they turn 26. Because I knew from my time in local office that the most uninsured age range is from 18 to 25. You might graduate from high school, you're legally independent, but your first job isn't likely to be one that offers health care. And so and, or you might be in school, you might be in school part time and just unable to piece together health insurance. So I was proud to get that, but also to pass this bill that outlawed this discrimination against people because they had some sort of pre existing health condition. And millions more were eligible for coverage that weren't prior to the passage of the Affordable Care Act. And then, you know, we built on the success of the Affordable Care act most recently with these premium tax credits that help people afford the monthly premiums. And that's what's at stake and at risk right now as we look at their impending expiration at the end of the year.
- [06:06]
Jonathan Cohn
Yeah, yeah. First of all, I'm glad you mentioned all that. You know, it wasn't that long ago. I remember covering it when you guys passed that law. And there's a lot of people out there I think don't remember there was a time when an insurance company could deny you coverage for pre existing condition or you couldn't just get on your parents plan when you turned, you know, up through 26. It's amazing how quickly people have forgotten that. But so let's talk about you just teed up the big debate right now. And just to give the background to our viewers, in 2021, right when you were in the Senate, Joe Biden's president, Democrats added money to the Affordable Care act and basically said, look, we're going to make extra financial assistance available to people so that insurance will become cheaper. You can either pocket the savings, you can buy a more generous policy. That money runs out at the end of this year. So the debate is, do you keep it going? You've been talking to your constituents, do you? I know because I cover this, you write it, you know, you talk about this. If nothing happens, insurance premiums are going to jump a lot for some people. Are people aware of this? Do they know about this when you're out in town halls? Or is this dawning on people yet that they could be facing these big premium hikes?
- [07:11]
Senator Tammy Baldwin
Yeah, awareness is growing about that. I know that while we were debating President Trump's signature tax legislation, there's a lot of focus on how that measure was going to decimate people's access to health care and policy. Part of it was, of course, the massive cuts to Medicaid, which will throw about 10 million people off their health care. And then part of it was just the failure to extend these tax credits for the Affordable Care act marketplace. In that measure, which was a tax measure, it was the appropriate and perfect place to extend this tax provision. But the failure to do that, people were also realizing that about 4 million Americans will lose their health care, see it terminated because of that failure of that bill. And so people were hearing that this debate was happening and learning more about it, but pretty soon a lot more are going to know about it because at a certain point, your insurers have to tell you what your premiums are going to be next year. And so there's going to be a lot more awareness. And I can tell you, I'm hearing from a lot of constituents, especially folks who may be a small business owner and Use the marketplace for themselves and their employees or self employed individuals where your employment doesn't have benefits that come with it. As an entrepreneur, you're the one who has to make sure that there is a health care benefit.
- [09:00]
Jonathan Cohn
So when I talk to the conservatives who oppose this, I mean, so you know, there's, there are, you know, you read the conservatives are like, we shouldn't do this. And some Republicans, not all have come out and said we shouldn't do this. And the argument I hear most frequently is, look, when you guys extended the subsidies, it was 20, 21. It was, it was, it was initially, you know, sort of presented at least, you know, as a pandemic measure. Right? This is an emergency. We need to get everybody healthcare. We should, you know, if we have to, we, we should do whatever we do to get people health insurance. That was, you know, five years ago. We don't have the emergency anymore. This is expensive. It's, it's about 30 to 40 billion dollars a year for every year you want to keep it going. And we just, it's not, you know, that is not an expenditure worth doing. Now it was one thing during an emergency maybe, but we're not in that emergency. And there are better uses of that money than throwing it at health insurance subsidies. What is your answer to that?
- [09:51]
Senator Tammy Baldwin
Well, first of all, when we increased or passed these premium tax credits, we saw an incredible stabilization in the healthcare market and we saw a dramatic increase in the number of people who became insured. And that something that is a benefit to everyone because when you have a more stable health insurance market, everyone is advantaged. So that's number one. We just dramatically increased the number of Americans who had health insurance coverage. And that's something we want to keep up because we know that the degree to which, between the Medicaid measures and the Affordable Care act failure to extend the tax credit so far, that about 15 million people are predicted to lose their health care in the coming years. That's gonna incredibly destabilize health markets for everyone. So not only does it benefit the people who are enrolled and of course then seek preventative care and are more likely to stay healthier, but it helps everybody by way of just having a more stable health care system.
- [11:17]
Jonathan Cohn
So there's a strategic question here I want to get into, which is not usually my favorite topic, but at this point I think it's, it's, it's sort of the, the one that's on everyone's mind. So you have, the government runs out of money. I have a look at what day is today? I mean, like two, two and a half weeks, three weeks. And Democrat leadership has certainly said we want to, any, any, if you want our support in a, in a government funding deal, you have to address health care. And unless they want to change the filibuster rules, they can't pass a budget without, they can't pass a spending bill without some Democratic votes. But there's a divide even among Democrats about what to ask for. So I mean, there, there's some, and you know, House, Senate, you know, there's some who say, look, just, you know, are sort of suggested there's a bill out there to just do a temporary extension, like one or two years. On the other side, there's people saying not only should you demand a permanent extension and you know, maybe undo some of the Medicaid cuts, but you should be asking for other things too. I mean, you know, you know, you should be asking for some kind of guarantees that the administration's going to drop, stop, you know, passing, you know, trying to rescind money and basically not spend money that Congress has authorized.
- [12:22]
Senator Tammy Baldwin
Right?
- [12:22]
Jonathan Cohn
Where are you in terms of what the Democrats. What is the what what, what should be the opening? Ask here. Walking into these negotiations, picture the app.
- [12:32]
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- [12:59]
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- [13:32]
Senator Tammy Baldwin
So I want to add just a little bit more context to what we're seeing right now because just very recently we have seen now a completely partisan proposal be put forward in the House of Representatives. And in fact, you heard this week Trump sort of egging on the House and Senate Republicans saying, don't even talk to the Democrats. I don't care what their views are, just put forward a partisan plan. And so our response is frankly very similar to what you just outlined. Let's repair the incredible damage that Republicans have done to the health care system, be it by extending permanently the Affordable Care act tax credits, but also restoring the cuts to the Medicaid program and the cuts to the life saving research done at nih. And let's put in enforcement provisions that make sure that the President isn't going to just say, well, very good, but I'm not going to spend that money. Right. So get rid of his recession rescissions, power and impoundment that he's been partaking in. So, yes, I think you should expect that that is our response to the partisan Republican written resolution that was offered earlier this week. And that will be, you know, that's where we will start our negotiations, assuming they talk to us at all. I mean, it was just stunning this week to hear the President say that he doesn't even want Republicans in Congress to bother talking to Democrats. He may have forgotten that it takes more than a majority to, to pass a budget bill in the United States Senate.
- [15:55]
Jonathan Cohn
That would be very unlike this president to miss the finer points of governing, although that's not a very finer point. You're in the Senate. Senate has a tradition of bipartisan. And you're, you're, you're a Midwesterner, right? I'm a Midwesterner. I mean, you must talk to some of these, you must have some friendships on the other side. I mean, what are they saying to you privately? I mean, are they, are they kind of like, yeah, we got to make a deal here, we're ready, we'll talk to you when the time has come. Or are they all like in line, you know, going on the partisan, more partisan direction?
- [16:20]
Senator Tammy Baldwin
Well, from the encouraging side of things, I do have several Republicans who I am talking to who very much want to extend these premium tax credits because they understand the devastating impact that seeing them lapse would have on people they represent in their states and the disproportionate impact it's gonna have in rural areas in particular. And so they privately, quietly talked to me about path forward on this. The problem, I think, with most of these discussions is not yet having a commitment to making these tax cuts permanent and also wanting to potentially separate this piece of the debate from the government funding debate that we're having right now. We have the most leverage we're going to have on this issue right now. And I think that now is the time to press forward. So that's what I'm trying to convince my Republican colleagues. Again, there are some Republicans who are dead set against extending these tax credits. But I do think between the support of all of the Democrats in the Senate and the number that we'd have to pick up in order to have the 60 votes necessary, that we could do it. We can do it. And I think that's why it's such a really clear and common sense demand at this moment.
- [17:59]
Jonathan Cohn
I want to switch gears to another topic I'm curious about the feeling on the other side of the aisle about, which is Robert F. Kennedy Jr. You got a big hearing coming up on Wednesday and a lot of people watching this will have probably seen that hearing by the time this airs. But you're gonna have Susan Menarez, who is the ousted CDC director in front of the HELP committee. I am just sort of curious. Are you again, what do you hear from your colleagues on the Republican side about RFK Jr. I mean, he's pushing this, this agenda that's very, you know, pushing back vaccination. Polling suggests is not, you know, most Americans do want, they believe in vaccination, but we're on the verge of maybe seeing some major changes in what's recommended and what's approved. And I'm just sort of curious and we've seen bits and pieces. Right. Senator Cassidy has certainly said some things in testimony, in hearings. What do your Republican colleagues say to you privately about what RFK Jr. Is doing?
- [18:52]
Senator Tammy Baldwin
Yeah, I mean, certainly just like we were talking, there's Republicans who fall on all sorts of different, have different positions on this and some who big fans of his, even with regard to vaccine policy. So, so let's just, let's just name that. But I am, I am carefully watching those Republicans who have asked some really tough questions of Secretary Kennedy at the Finance Committee in recent weeks, who a number of them are trained as doctors themselves and, and said I vaccinations and you know, really pressed him on issues. I think in addition to that, I, I know because Senator Cassidy said it aloud when he was about to cast his vote to confirm RFK Jr. He said, Look, I have my doubts. We've had a discussion. He's promised me this, that and the other thing. And he named about four, five things that RFK Jr. Pledged to him. And it appears to me that he's broken all of those commitments that he made. And so I've got to imagine that there's a regret, if you will, about that confirmation vote on behalf of some of my Republican colleagues who felt as though they got commitments from him. Now, that said, this hearing will be really interesting because I think we're going to hear a lot more about the backdrop to Dr. Minarez's firing and what RFK Jr. Was asking her or demanding of her, that she pre approved sight unseen certain recommendations and fire certain colleagues. And she, you know, we'll get a bigger insight into the type of things that Secretary Kennedy has been asking and demanding of employees and heads of different agencies within hhs.
- [21:09]
Jonathan Cohn
Senator, I know you need to go. I want to get one last question, a subject I know is close to your heart, which is medical research. We've all been seeing the cuts to nih and through nih, the official cuts, the unofficial cuts. Here's my question. What kind of leverage do you, the Democrats, and maybe Republicans in Congress who are not happy about those cuts, what leverage do you have to get some of that money back or to at least stop the cutting back of funding?
- [21:36]
Senator Tammy Baldwin
Number one, I sit on another committee that has something to do with this, and that's the Health and Human Services Subcommittee of Appropriations. That's the committee that funds Health and Human Services. And in our bill for next fiscal year, we have not only restored the 40% proposed cut that Trump suggested earlier this year to NIH, we've not only restored full funding, we've actually increased funding for the nih. But in our bill, we've included basically enforcement language that says that, you know, it's already the law, that they shouldn't be able to quote, unquote, impound money. But this basically says it needs to be spent on a timeline that is appropriate. And I think we'll have better guardrails, more enforceability if we're able to pass that bill into law. Especially if we pass it into law. Obviously the president signs it. He can't do that with his fingers crossed behind his back.
- [22:46]
Jonathan Cohn
Senator Baldwin, thanks again for coming by and visiting. And we'll be watching all these issues along with you.
- [22:54]
Chris Counahan
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Jonathan Cohn
Well, I was. I wanted to ask Chris what I need to do to get my gutters ready to have leaffilter installed.
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Jonathan Cohn
So I didn't need to get on this ladder.
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Jonathan Cohn
Thank goodness.
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