Hi
everyone. Welcome back to the Hot Dish, comfort food for middle
America. I'm Heidi Heitkamp. And I'm Joel Heitkamp. We're
excited to be back today. And we're talking about healthcare.
That's right, healthcare in rural communities. And we're excited to
introduce our guests today. We're joined by Michelle Rathman and
Jeanne Lambrew. Now, Michelle is the founder of Impact
Communications. She's the leader in healthcare strategies and
communications, specializing in critical access and
rural health systems, and the host of Rural
Impact podcast. So check that out. Jeanne Lambrew is
the director of health care reform and a senior fellow
at the Century Foundation. From 2019
to 2024, she served as
the Commissioner of the Maine Department of Health and Human Services.
So welcome to both of you to the Hot Dish. I
just want to bring up a couple of things. Obviously we're going to talk about
rural health care, but to me, the beauty of the conversation
we're about to have is it doesn't matter. It doesn't matter if you're in
Maine. It doesn't matter if in your Missouri or North Dakota or
sitting in a hotel somewhere. Heidi, in the truth of the matter
is it affects all of us. So Jeanne, I got to
ask you this. You know, what are the Democrats fighting for in this
shutdown with respect to health care? Yeah. So while
it may seem complicated with what is a continuing
resolution and what's going on in D.C. the reality
for people, especially rural Americans, is pretty simple.
The health insurance marketplaces, which serve people
who don't get access to employer based coverage,
has 24 million people. Now, there were premium
tax credits for this private insurance that were
improved five, four or five years ago. They're going to end in
December. And we know now that
people in this marketplace are disproportionately farmers.
Half are small business owners, small business workers or
entrepreneurs. And rural people
really rely on it. I did a study in August that found
that the increases in premiums, if converse is an
aptitude, continue. The current policy would be
28% higher than in urban areas. Just to be
concrete, people in rural America rely more on
health insurance marketplaces on these premium tax credits
and their loss would disproportionately affect rural Americans.
And just to give an example, here in Maine there's a
place called Caribou, which is on the kind of north
northeast border of the state. For a couple age
60 in Caribou, whose income is $85,000,
not a lot of money, they would face a premium increase
of over $30,000 to just stay insured next
year if Congress doesn't act. So I think it's a very
important issue for people's pocketbooks. It's an important people,
important issue for rural people. And I'm sure, as
Michelle can talk about, it's an important issue for rural hospitals.
Yeah, Heidi, I wanna go to you on this one, though. You represented
the very people that Gene talked about. I mean, these people were knocking on
your United States Senate door saying, hey, I need some help. Do you
think they get it? Do you think those people that you worked for, the
farmers, the ranchers, the independent small businesses, do you
think they get what Jeanne just said? You know, I don't
think they would have but for the shutdown. And everybody's like, what
are they fighting about? And now all of a sudden they, they are kind of
anticipating what that November 1st rollout of these
premiums costs will be. I talked to
a guy who sells insurance who said that he has a
family, that it will go from $100. They're
ranchers, farmers, experiencing some really tough times
right now. And it will go from $100 premium to
$1,200 a month for his family. And so
they're going to get it when they see those premium costs. And, and I
think that the people who aren't getting it right now,
Joel, are Republicans in Congress who should be making a deal.
So, Michelle, the administrators, the very people that run these. My wife
was a longtime administrator in long term care.
Are they willing to admit it? And when I say that, Michelle, because
something tells me that you're going to tell me how much it's
going to affect those facilities. But are they willing to stick their neck out
and tell people. That is a great question. I
just came from a National Rural Health Association Critical
Access Hospital Rural Health Clinic conference in Kansas City, and the mood was very
somber, let me tell you. I mean, before the shutdown,
rural hospitals and rural health organizations were really
feeling the pain of losing grants, for example.
So are they getting it? Yes. Are they having the conversations? They
are. And one of the things that we are really, you know, in my day
job, aside from podcasting I talk to healthcare CEOs all the
time, say you've gotta build your bench. And that means really going out there and
talking to your community leaders and giving it to them straight, not
about the politics, but about the policy and helping them understand
what this means for families. So we talk about the shutdown and the impact.
It's a cascading effect, as we know, because it's impacting our
food security and sustainability systems. It's impacting, you
know, so many of our rural communities rely on USDA field offices, for
example, and they're no longer able to get that assistance because the staff has
been cut so dramatically. So it's not just one thing.
It's so many things that are happening. And Heidi, to your point,
I mean, a lot of people right now, if the pain isn't
knocking on their front door, it could be hard to imagine what that
looks like. But I'm telling you, it's at people's doorsteps. And I
think that shows like yours and the work that
organizations like the ones that we'll talk about today are doing is so important
again, to keep the conversation above the politics and really focus on
the policy and give people facts because they're not going to
get facts by going to federal websites right now. They're dark
and very propaganda like. And so, yeah, I think the cascading
effects come January 1, people are going to be in a, in a real,
unfortunately, world of hurt. Yeah. Joel, can I ask Michelle
a question really quickly? Because those of us who live in rural America
know the largest employer beyond, you know, small business
and agriculture is usually a healthcare facility. Do
healthcare workers in rural America get it?
I would say it depends on who you ask. Again,
one of the things I think is really important is to
convey the fact that misinformation, disinformation and
health news deserts, I should say, are quite predominant
right now. And so when you live in a rural space where
there's very little outside information coming in, it's
difficult to know. And you go online and you're reading whatever your
algorithm wants to feed you and we consume that information.
So right now, I would say for many of those who work within
a rural hospital and a health clinic, leadership understands.
I'll tell you, the CFOs understand, they're crunching those numbers. And you know
who else understands are the billers, the coders, the people in the financial offices.
Rural hospitals are having to hire, with very little
budget, people to sit and answer the phone and answer
questions about how to navigate what's going to happen with
Medicaid, what's going to happen with the Medicare Advantage is another.
I had an hour long conversation with a CFO yesterday about Medicare Advantage
and how it's crushing rural hospitals right now in the state of Washington.
So, you know, those who are in dietary services, who are working, you
know, on intake and so forth, they may not understand it, but the physicians
understand it. And the leaders understand it. And I say, don't let this
be something that you carry on your own. Make sure that you are
conveying that to your teams, not to scare them, but to make
them aware of it and help them get on board with advocating
for policy that stops harming rural hospitals. Because we've had
enough closures. But there's a lot more coming. And I tell people all the
time I, I want to be wrong. I don't think I am.
First of all, not just the local hospitals, not
just rural hospitals, but the American Hospital association said as
follows, there will also be an impact on the entire
community, even those with coverage, because of an influx of
uninsured patients into emergency departments, causing
longer waits, stress on the whole health care system,
and the inability of getting care that they need. So that's
factoid 1 and 2 is an analysis came out
that said that the United states could lose
339,000 jobs as a result
of the lack of extending these premium tax credits, which for
states and local governments could reduce their revenue by
$2.5 billion. That is concrete, that's real.
It's on the horizon. But what we just described everyone
really means, if you have this groundswell, if you have people actually
contacting their, their congress members, you know, they
have to admit they voted wrong. I mean, they did. I mean, you look
at that vote in the rural area. I don't care what state you're from. I
mean, Heidi, that's the hardest thing in the world today. Way
harder than what it was 20 years ago. It just seems to
me that the society we live in now, people aren't willing to
admit they voted wrong. Well, you know,
Joel, the interesting thing about this is it's accumulative.
You know, we've seen what's happened with
soybeans and rice not being able to be sold. You
know how the trade disruption has affected rural America.
You take a look at where we are right now with giving money to
Argentina and introducing Argentinian beef
to shore up Argentina. You know, so
you tell me, you talk to farmers and you talk to rural people every day.
Is the attitude changing? Is there a willingness not to
go to the local pub or coffee shop and say, gal, I wish I
hadn't voted for them. But are they rethinking? And I think you've got a
better finger on that pulse. No. The answer is yes. When you get one
on one and you don't get in public, but if there's two, the
answer is no. The answer is really no. And
they just first off. They're mad if you bring it up, you know,
because that, that is just an admission that you're going to end up talking
about it. But the answer right now is still
no, whether it's whether it's Argentinian beef, whether it is
soybeans, whether now they're going to lose their real hospitals. And
Michelle, I want to throw this at you because the biggest challenge we
had in the area where I live, in the district that I used
to represent in the state senate, there's two rural hospitals, but
almost every one of the towns above 1000
people have a nursing home. They do. They
can't find workers. That was the biggest challenge they had
before this. They couldn't find workers. This isn't going
to help that. Michelle, what's your take on that? Well, you are exactly
right. Across the board in particular, if you take a look at and we'll go
kind of veer into another subject, which is immigration policy and how
severely impacted rural communities are not just in agriculture
space, but also in healthcare, long term care, daycare and so forth.
And so to your point, I mean, there's the financial
impact of just the low reimbursements and then of course
there's the workforce. So how do we age in place? You know, we
talk so a good game about aging in place and making sure that
rural communities have these resources. Yet every policy,
whether it's regulatory policy, whether it's the reimbursement, whether
it's workforce and now the visa
programs that want someone to pony up whatever the
ridiculous number is. And so, Joel, you're right. I mean, we are going to see
already struggling areas to find ways to care for
children and our aging population. And we're all getting there, you know,
at some point in time. And I think it's interesting because that's an issue
that rural communities can actually wrap their brains around more.
Because, you know, when you talk about the elimination of
long term care or skilled care, that's where people start to get
angry because it's something that they really cherish. And because we
have an aging population in rural America, more so than then, you know, we're not
growing, we're not having more births. Of course we can't because we don't have
any. We have OB deserts all over this country as well. So I
think, you know, those are the kinds of things without being, you know, a lightning
rod talking about immigration. Just the reality is that our rural
health workforce in many areas and urban are largely made
up of immigrant populations. So I'm going to throw this at you, Jeanne. And then,
Heidi, I want you to follow up, if you would, because you lived the
very life I'm about to bring up. But Jeanne, somebody calls into my talk
show, let's do a scenario, and they say that I've completely
misread the Big Beautiful Bill and that actually
there's more protections in there for rural hospitals,
for rural nursing care, and that what I
don't realize is that 50 some billion
dollars really protects them. How would you answer that?
Yeah, so I will just do first the numbers,
then the policy. So the One Big
Beautiful Bill, formerly known as, because it's no longer allowed to be called that
because of a Senate procedure. HR1
included $50 billion over five years beginning next year for
rural health transformation. It also reduced
federal health spending by $1 trillion over the next
decade. It's not even close. Map all
keep going, which is what we've seen already from this administration
is half of the $50 billion is
prorated. So states like New Jersey and New York get as much
as rural states like North Dakota, South Dakota May 2.
The remaining half, half may be done formulaically,
but the rest is going to be done at the discretion of this
Administration. And they've said in the application, if
you do what we want you to do, we'll give you money. If you
stop limiting substandard
plans, if you get rid of certificate of need laws
that aim to control kind of unnecessary utilization, they
put in a set of policies that they want states to
adopt and said if you don't, you don't get that money. So I think
it's going to be a real challenge for states. There's only 15 days
from today before the application is due. You know, there's a
lot of uses that could be in there, but we're already seeing the tensions. There's
a tension between coordinate with other, you know,
rural hospitals, with urban hospitals versus consolidate.
Use it for things that are needed now like uncompensated
care, struggling hospitals versus rural healthcare
transformation beyond the five years. And then I think we've also
seen a real tension between technological
improvements. There's a real emphasis in the application
for tech innovation, startups versus
workforce. The people that we're just talking about. And I will just say going back
to the immigration issue, we see it here in Maine at both the bottom end
and the top end. That $100,000 fee
for an H1B visa is going to hit our hospitals the
hardest. The second largest user of those visas is
Northern Light Health in northern Maine, where they basically
struggle to get doctors. And I had to sign every
single request for those visas when I was secretary,
Commissioner of Health and Human Services. Everyone was
urgent. That's going to be challenging. And then go to the lower end.
We are proud to have legal immigrants coming to Maine as we have a
declining workforce. We are the oldest state in the nation. Most percentage of people
above age 65. We welcome legal immigrants.
They come into our healthcare workforce at those entry level jobs that other
Maine people don't want to take. They're the custodians, the people
who do food service. They're the ones who, for women who
are new Mainers, they can go into the caregiving professions as CNAs
and work their ways up. That push
from the top and the bottom for our healthcare workforce as
a result of the changes that have happened are significant.
But I'll just go back to your question. A $50 billion drop in the
bucket for five years can't help
rural America with a $1 trillion
nationwide 10 year funding cut. Well,
if I can just interject here, it's a typical,
you know, you look at, oh, farmers are going to get a bailout, they're going
to get help and we're going to tell you, you got $50 million.
None of that deals with the core competencies and
the core problems that we have. And shame on them. I mean,
one of the challenges that we have here is we pay too much for healthcare.
And we've got to figure that out. We've got to figure out how we
can provide more equality in healthcare. But Joel,
the Congress, if the Congress were functioning and if this administration
was functioning correctly, they would be having a very serious
conversation about healthcare writ large
and how they can guarantee healthcare going forward.
You know, if I'll just say, I am an unapologetic
skeptic about the Rural Health Transformation Fund because if it was meant to
really transform, let's be honest, it would not have been thrown
in at the very last minute. And so Joel asked the question about our people,
you know, our elected officials, you know, feeling like they can say that
they made a mistake. I think the Rural Health Transformation Fund is the, is the
make good, if you will, kind of like, "sorry you had a bad meal, here's
a gift certificate, come back and see us again sometime." At the end of
the day. To, to Gene's point, this is at the
discretion of the Department of Health and Human Services and it's
approved applications. So I will just say if you
hear someone call it a rural hospital fund, please correct them. It is
not I again would like to be proven wrong. I see
very little money coming in for the rural hospitals. I think
technology companies are going to be the winners. I think it's going to be that
second disbursement will be a pay to play and again,
a history. As a teacher, we had something back in the Bush era where it
was kind of the same kind of thing. But
I'm very much a skeptic about what this will do, especially in light of the
fact that we've cut Medicaid, we've got Medicare Advantage plans, which
is the big push of this administration. And now we're talking about cuts to SNAP
and all these other things that are supposed to be a part of making us
healthier. So I just don't see - a drop in a bucket would be kind
of a nice way to say it. I think it's less than that.
One thing that I'm going to say is that this is a president who
got elected with a huge
kind of margin of working class people with the idea that he was going to
make life easier for working class people. And everything that we're
talking about is going to make life harder, especially for working
class Americans in rural America. You know, and I think,
you know, to Joel's point, and he keeps bringing this up,
when does that come home to roost politically?
You know, I might just jump in because I've been trying to put the
numbers in context in the real world setting of
families lives. So just take the premium tax credits
for the Affordable Care Act. For a family of four
not earning a ton of money, earning like, you know, $90,000
a year for a family of four, the increase that
they'll have to pay to get healthcare will more than wipe out
any wage increase that they get next year because
the premium increases are so much higher than general inflation,
wage inflation, etc. They'll be 20
times higher than the increases in rent and food. It's
just like enormously big compared to a family's household budget.
And when you look at an older couple, like I'm looking at the 60 year
old couple here in Caribou, Maine, who will be paying a lot more for
health care, they're sixty years old, they need to pay that
kind of high premium for five years before they finally get
Medicare eligibility. That will wipe out most of their retirement
savings. I think we can't underestimate
the hard hit that will be coming to
most Americans. Middle income Americans, low income Americans.
When Congressional Budget Office said this, some are very crystal clear.
The top 10% of Americans will get a
$13,000 tax break as a result of what happened this summer.
Whereas the bottom 10% of Americans will
lose $3,200, which may
be smaller than that big amount, but it's a bigger percent of their
resources. Let me, let me ask Michelle this,
is this a back end way of getting rid of the Affordable Care
Act? I mean, is that, is this, hey, this
is something that's gonna be there a long time. It worked. It's like Social
Security. It's like Medicare. It's like Medicare. It's like the silver, right?
This is something we don't want the Democrats years from now to be
able to declare victory on or. And I
never forget this, Heidi, it's your good, good friend John
McCain that stopped this by one vote. He walked to
the well of the Senate, walked to the front and said, no, we're not going
to kill the Affordable Care Act today. So, Michelle, I'm throwing that on your
lap. Is this just a sneaky little way of killing the
Affordable Care Act? Well, I don't actually think it's sneaky. I think it's
quite transparent what they're doing. I mean, if you take a look at the totality
of all the different policies that are coming down, I don't think it's a secret.
And you know, when you think about the fact that, you know,
nearly half of all births in rural America, 1/5,
are covered by -- half are covered by Medicaid. And
so when you think about that, so when you see the very deliberate actions
of saying we are going to cut millions
of people, 66 million people live in rural America, approximately depending
on the rural definition these days. When you think about how many
millions of people will lose their Medicaid coverage. And
now let's throw in the work requirements. So again, it's
another hurdle. It's like, I don't know, I think about the
obstacle courses that you see and people have to jump through fire hoops
and, you know, and stay underwater and, you know, be put in a vat
of snakes or what have you. It just feels that way to me
because we've got layers of complexity. So
cuts to Medicaid work requirements, cuts to SNAP, new work requirements for
that, closing rural hospitals, you know, the
assault on providers, being able to make a living wage, as another
example, loan repayment, medical training. What
more can we take? What more pressure can rural Americans
shoulder? And I think sooner than later, I hope
this is the case that there's a revelation that these policies
are killing - not just making people sick, but they are going to kill rural
Americans as a result, when we have no more access to health care in
large swaths of our country. That should wake people up, I hope.
Can I just add just a point there, which is I think significant
because a lot of people in America say they should work if they can
work and they should be getting assistance. But I
love all these Senators who say, well, when they get a job they'll be covered
on their workplace. What a joke. They haven't looked at
what the workplace actually covers and with premiums going up,
it's going to get worse. So we've just, we've talked about
Medicaid, we've talked about the subsidization on
Obamacare, we haven't talked about the dramatic increase,
13% nationwide of increase in premiums.
Employers are going to ratchet back what they're going to cover and that's going to
leave even more people with higher co pays and higher healthcare
burdens. But when you look at it, I can
tell you as somebody who has spent a lot of time working with people,
they are exhausted at the end of the day. And it's
not just the work requirements. In fact, it's not nearly as
onerous as the paperwork requirements. And you
take a look at kind of going forward, what, what's going
to affect people coming off Medicaid. It's not going to be
that they're not working and that they don't qualify. It's that they are going to
be taken off Medicaid because they haven't filed the paperwork.
Heidi, we just, I'm sorry, we just did an episode on this with the
folks from KFF and we talked about the question was are states ready
to implement Medicaid work requirements? And the answer is a big fat
no. You know, we take a look at the, the employers in rural
America, the, the Walmarts, you know, employers don't,
in rural America are not the same as, you know, going into a big
metropolitan area where they've got thousands of lives they can cover to
offset some of those costs. So we've got a lot of gig workers, we got
a lot of independent contractors. They're working,
they barely qualify, but they are deserving of healthcare. And now these
work requirements truly is just putting a padlock on
healthcare for them as a result. So Heidi, would you trust them? Because really
what we're talking about here, John Thune is getting in front of every
camera he can saying, look, you know, vote for the Clean CR
in November. We're going to fix this regardless of the fact that
signup begins November 1st, I mean, we all know
that. So the point is,
if you were back in one of those chairs, would you trust them?
The answer is no. And I'll tell you why. Because the last time
they cut a deal when Schumer basically said, we're going to give you enough
votes to keep government open this spring, and he
did. And the Democrats said, we don't want to shut down government, we want to
have a conversation. What's the first thing the Republicans did?
They passed rescissions with a 50 vote majority.
And so they took that, that deal, which
was to fund government, to continue to
fund it at a certain level, and they unwound
those things they didn't like. And so you can cut this
deal tomorrow and they'll undo it with rescissions. And
that's where John Thune made the mistake. I think he violated and
breached a trust. And people feel pretty burned by that whole process.
So I'm going to throw another scenario to every one of you and then you
can go ahead. We talked about employees in the healthcare industry.
We talked about immigrants in the healthcare industry. Jeanne, you did a great
job of explaining that. I'm going to throw this one, I guess, to you first,
Michelle. It's the competitive nature of the
employee because there is only so many employees to go around
in the rural area. I know guys who want to work on a
farm. They don't have a farm. They're going to work there as a laborer, but
that's what they want to do. If the exchange goes away, that
farmer isn't going to be able to provide them health care. But you know what,
where they're manufacturing skid steers, they can.
And so they're already wanting the employee. But I'm
wondering if you're seeing that, you know, from your angle. Well,
I think there's a lot of size to this. I think about the fact that,
you know, we are, we, we. There's a lot of conversation about kind of
bringing back manufacturing, for example, in rural America.
There is no manufacturing organization that I know of that wants to go into
a community that does not have health care, that does not have
quality health care, but does not have any health care, does not have any of
those services, daycare, long term care and so
forth. So I think we are going to be seeing, you know, a pretty
significant battle between, you know, where, where, where
will people be able to go to even find jobs if there's no health care
in a community? So that's a pretty significant blow to
any community. Economic development is essential for rural
America to thrive. And when we don't have health care
on top of food insecurity, on top of
defunding education, I'm all about connecting dots. And I think
it's just imperative that we take a look at this not just as a single
issue, but remind those who are supposed to represent us
that we're more than a single issue voter.
I would just add that when we look at the
Affordable Care act here remain, we have some farmers, but we have a lot of
fishermen. These are like literally self employed small
business employees who had no choice. They have tough
jobs with lots of demands on their health
and their only choice is going to the health insurance
marketplace. We created our own here in Maine called coverme.gov
so one of the things that we did in designing, and
I thank Senator Heitkamp for this as well, is design
private insurance with a premium tax credit, not an
entitlement program, a premium tax credit that's set by
competition in local areas. So if in rural
areas it's extra expensive to provide health care,
the premium tax credit adjusts. That doesn't happen with other
programs, doesn't happen with employer-based coverage. So it's an especially
important, important support for small businesses,
agriculture, aquaculture, fishing industries,
all those startup companies and rural areas that are the
engine and the heart of our economy. And I just feel
badly that it does feel targeted. Going back to the
question, did the One Big Beautiful Bill go after Obamacare?
Just look at the numbers. KFF put out a study that said more than
half of the Medicaid cuts will come
from states that took the Affordable Care Act Medicaid expansion.
And when you fast forward to that last year, when everything is
fully in effect, 46% of the
funding for the Affordable Care act marketplaces will be gone.
I mean, it's a very dramatic change that's on the
horizon that I think is potentially politically
targeted. I am so proud of Senator McCain and
Senator Collins here in Maine voted against that bill. She voted against HR1.
I'm hoping she votes for the extension of
the premium tax credits. So, Heidi, did the Republican governors get
it? Oh, I think they get it. And you think about
Sarah Huckabee, she -- or Sanders, I guess is what she wants
to be known as in Arkansas. They were one of the first states that adopted
a work program for Medicaid. And because there's
a lot of flexibility in the Medicaid program for governors to fashion
it the way they want to fashion failed miserably
she didn't know how to administer it. And, you know, there's
a lesson there. But they are, that they are so
captive to the kind of MAGA movement and
so terrified by any kind of criticism. I mean, you know who
gets it? John Thune gets it. I mean, this is going to have a dramatic
effect on his rural hospitals in South Dakota. You know that,
Joel, and I know that. And I think he, he's,
he's playing what he thinks is the long game, which is, I'm not going
to be held captive to this, and I'm going to do this and I'm going
to do that. But I don't think he's calling the shots. I think
the president is calling the shots. Now, in the good news category there, I
think President Trump has done enough damage to
rural America. He might want to repair that damage and might want to sit down
and negotiate, but he, he hasn't demonstrated a willingness to be engaged
in this at all. And I think that the pressure
point, and I've said this all along, is gonna come November 1st,
when people actually see these and there becomes a
groundswell, and there will be of people calling
their congressional members, people calling their senators, saying,
what the hell? I've had really affordable health insurance
now for three years, and you're taking that away. What is
happening? And, you know, I think that they would
love to get this resolved before those premiums come out. Well, we
laid out the problems. Now it's time for a prediction.
Joel, can I just. I mean, we've talked about KFF
quite a bit here. That's the former Kaiser Family Foundation. They
now just go by the initials. But for our listeners who are really
curious about this, if you want the most reliable
healthcare source of information, go out
on their website and read what they publish because it is
grade A+ analysis. I want
to know how this ends. You know, it's going to end one way or
another. And so we all know how it needs to end.
We've pointed that out. But let's do a little predictions
to close out this conversation. Michelle, what's going to happen? Well,
I think we are going to be - it's kind of like the aftermath, I'm
a Midwestern girl, of a tornado, and we're going to have to
look around and pick up the pieces and figure out how to rebuild our lives.
And I think about our food supply, I think about our nutrition assistance
programs, all those programs that are now at jeopardy. And
we take away people's healthcare and you take away their food.
I think that might be the straw that breaks the
camel's back. I do believe it's going to take us decades to build
back what was lost, including the data, very important
data. I mean, all of us rely on sound data for making
decisions. And so what's going to have to happen is there has to
be a major shift and some
significant repairing of the disinformation
damage that has been done. So I'll say we have a lot of work
ahead of us and none of us should shy away from it because what's
our all our alternative to that? We had to keep
having courageous conversations and try our
hardest to stay above the name calling and all of
that stuff and just be straight up with people about the realities and the
facts of the situation. And I tell people this. Build your bench.
Find ways to have new conversations with those who you may disagree with, but
you agree on some things. We deserve healthy food, we
deserve access to healthcare, and we deserve to be
told the truth about what's really happening.
Jeanne, I'm gonna throw the same thing at you. Where do you see this ending?
I mean, we've got to shut down at some point. The government has to go
back to work. But what happens? How does this shake out in the end?
Yeah. So I am a believer in the arc of history
bending towards justice. Where it was a year ago
that we were in a situation in our health system where we had record
high coverage rates. We had implemented drug
negotiation in Medicare, we had ended medical
debt being reported in consumers report cards. We
had really made some progress. Things have
changed dramatically. And I think we've seen a small margin in
an election cause a dramatic pendulum swing. And
what our policy is probably more than what Americans want when you
listen to them and really hear what their pocket,
pocketbook concerns are. So it's going to get worse
before it gets better. But I do believe it's going to get better because of
the persistence of people, of hospital administrators,
of doctors, nurses, and many politicians, if not most
politicians who are elected to represent the people who they serve.
And I'm just hopeful that people do stand up. They
express their concerns about health care. They support the
policies that help them navigate. And not only
do we. I don't want to go back to where we were because we
were needed improvements as well. I hope that generates a new
round of health reform that truly gets the wealthiest nation in the
world to be providing a fair, affordable,
equitable, just health care system for
his residents. Heidi, you've been there. You've been in that room. When
negotiations are going on, if Congress actually came back to work
and actually decided that they wanted to be in D.C. doing
their jobs and the curtain was pulled and you were behind that
curtain negotiating out how to end this shutdown,
what do you think would happen? What do you think it would take? Where do
you see this ending? So I was there for one of the longest
shutdowns and I joined a group of people, including Senator
Collins up in Maine, to actually begin to have those
conversations about how do we reopen government. So I have
no inside information at this point, but I will tell you, the
last time we were pressured by the debt limit. Now, the Big
Beautiful Bill extended the debt limit for two years. So they don't have that
pressure. That is creating a must
got a drop dead date, you gotta get this done kind
of scenario for opening backup government and
dealing with the debt limit. But what I think is probably
happening is behind the scenes, there's a group of people who are
now convening quietly in hideaways.
They're having zoom conversations. They're doing everything
that they can. And it's going to be that group of people that is
going to fashion a compromise that will open up government.
Because when Schumer's not talking to Thune,
you don't have an end in sight. When the President is
disengaged and he's too busy, you know, I guess
wrecking the White House, that's his big
distraction today. And, you know, concerned about what's
gonna happen with the Epstein files. He's not engaged in a
negotiation. He, he likes the shutdown. Cause he thinks it gives him
a tremendous amount of power to inflict damage on
Democratic districts. So I think there's
gotta be a group of very responsible members who are now
sitting down saying, how can we resolve this? And I
think for the Democrats they're concerned about this will be
a short term fix. It will carry them through the midterms.
And people, then we're back in the soup trying to fix this again.
But at the bottom line, you need to open up government. And I think
both Jean and Michelle have talked about food security. Come
November 1, there may not be any SNAP benefits.
And that is gonna be a huge pressure point, but it also is
gonna show those new premiums. And I think the combination
of absolute, essentially needing to open up government,
along with the realization of what these premium
increases look like for families, I think will drive an
urgency. Okay, I'm going to take just a little leave on my part too.
As a former state Senator, way smaller scale. I can tell you
this, I could count. So with all due respect to Susan Collins,
Senator from Maine, I think she's pretty good at counting. And so she can
throw a vote here or there when she knows that, that they're going to
win anyway. So I'm not as big on the fan train as some people
might be. I will throw you this. I think that the leadership's going to
end up coming from the state. I think that Governors behind the scene
where these red states are, are going to be talking to through
their Governor Association, through somebody to John Thune and saying,
what the hell are you thinking? Do you realize the wet bundle that you're leaving
on our doorstep? And I look for the states to be a
big, big hand in helping resolve this, if
we are able to resolve it. So there, I took
my personal leave. Thank you. Thank you so much. Thank you
to Michelle, thank you to Jeanne. We appreciate you coming on the Hot Dish.
Thank you for having us.
You know, Heidi, I know you wanted to be queen when we were growing up.
That was always certain, you know, [Heidi: I did not!] but the, the other six
of us that were your siblings [Heidi: I wanted to be a second baseman] that's
why you played first. But, but the, the
truth of the matter is anyone, anyone would
have to say that the individuals that organized and wanted the
No Kings march to do well, it did do well
for those people trying to make a statement. Well, and, and they were
meticulous about making sure that there wasn't violence, making sure
that these were joyful events. There were lots of flags. You
know, everything that they said, this is, you know, that that was terrible
about this. The Republicans and kind of fanned that flame that
the, the people who went out and exercised their First Amendment
rights to assemble and, and protest, guess what? They
proved them wrong. Well, and I would add this, the
individuals that didn't want to see a part of the White
House being tore down by a king, those individuals
know the words to the Star Spangled Banner and they proved that.
It's their country too. It's my country too.
Well, and can we just talk a little bit about the
President's so called presidential response
to 7 million people, you know,
basically tweeting out, or I don't know what they call it, xing
out a video of him flying with a crown on
his head, dropping brown liquid - and we
all know what he meant by that - onto the protesters. That's where we
are in America now. That's where we are, Joel. Well, and
I would add to that, you know, as he's drying, flying around in that
fighter jet Looking like he was at Burger King. That Kenny
Loggins came out and he said, I want my song back. Nobody
gave you the authority to use that song. That song
from Top Gun. And I gotta. I gotta wonder if he doesn't look
even more foolish, you know, Heid. He went around saying that he heard
there weren't going to be a lot of people that turned out. And so what's
their answer to that? The people that hated that march are going around
saying, well, it's all AI or it's just fake.
And some even going, Heidi, as far as to say, well, the crowd that went
was paid off. Yeah, they
cannot believe that that many
people would come out and basically take their time,
invest their kind of reputations in defending
democracy. And it was a good day for democracy. I think it's a bad day
for Donald Trump. Someone said, well, these are all people who didn't vote
for him anyway, so what difference does it make? I said, you know what?
There's organizers out there with clipboards who are
saying, you as an organizer, every one of those people,
you're going to bring 10 people to the polls. You're going to do what you
can to turn this around in the midterms. And so it's a great
organizing tool. Well, last thing I'm going to hit you with here, Heid, is the
fact that everybody's saying, well, he's not a king. He's not a king. If he
was a king, he would have stopped the march. Well, if he wasn't a king
or didn't see himself as one, he wouldn't be taking an excavator to the
White House. Isn't that something? He's tearing apart
the people's House. It's not his. It's not. He
treats it as though it's his castle. I mean, I
had people call into my show that were literally crying,
Heidi, with what he was doing to the White House. Well, he had started
with the Rose Garden. I mean, he wanted to wipe out any
legacy from Jackie Kennedy, from John Kennedy
that's been preserved by Democrat and Republican presidents alike
and basically paved it over so that I
guess he can have a - What?
So he can have, you know, some kind of fight on the Capitol
grounds. I guess that's going to be some arena now for
the 250th anniversary. But he's just, you know,
what he's done to our house, the gilding, the
gold, the kind of trashing, I mean, just
absolute trashing of now, now
taking down historic buildings. You know,
it is, you just have to ask, when is enough enough?
I mean, this is symbolic. It's not just a building. It's a symbol
of where he thinks he is in terms of his
power. Well, when you pardon people that went into a Capitol
and smeared the very thing that he was joking, he was dropping on people,
and they actually did it on the walls of the Capitol. I suppose you
don't have much respect for the institutions and the
buildings this nation has built, but I'm going to say
this. He wants a ballroom.
He must want to dance. The last time I saw him
on video dancing, it was he and Jeffrey Epstein picking out
which woman they wanted to be with. I mean, literally, the
last time I saw him on video dancing, it was the video
with him and Jeffrey Epstein. So I don't know why he wants
to dance so bad, Heid. Yeah, well, I mean, the other thing
is, just as an aside, one of the pardoned
January 6th attackers
basically has been rearrested for threatening the life of
Hakeem Jeffries. These are not good people. He just pardoned
George Santos, who defrauded millions of people. And
Trump says it out loud. Oh, you know, it's all
okay because, you know, he's a good voting Republican.
Yeah, I guess that's what it takes to get a pardon. Yeah. Well,
and we'll see what happens with one of the ones everybody's talking about
soon. A really, really scary pardon come. They're all
scary. Heidi, always good to talk to you here on the Hot Dish.
Thanks for joining us today on the Hot Dish, brought to you by One Country
Project, making sure the voices of all of us are. Heard in
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