WEBVTT 1 00:00:00.240 --> 00:00:00.560 Hi 2 00:00:05.280 --> 00:00:08.840 everyone. Welcome back to the Hot Dish, comfort food for middle 3 00:00:08.840 --> 00:00:12.520 America. I'm Heidi Heitkamp. And I'm Joel Heitkamp. We're 4 00:00:12.520 --> 00:00:16.119 excited to be back today. And we're talking about healthcare. 5 00:00:16.119 --> 00:00:19.880 That's right, healthcare in rural communities. And we're excited to 6 00:00:19.880 --> 00:00:23.640 introduce our guests today. We're joined by Michelle Rathman and 7 00:00:23.640 --> 00:00:26.720 Jeanne Lambrew. Now, Michelle is the founder of Impact 8 00:00:26.880 --> 00:00:30.080 Communications. She's the leader in healthcare strategies and 9 00:00:30.080 --> 00:00:33.870 communications, specializing in critical access and 10 00:00:33.870 --> 00:00:37.310 rural health systems, and the host of Rural 11 00:00:37.390 --> 00:00:41.150 Impact podcast. So check that out. Jeanne Lambrew is 12 00:00:41.150 --> 00:00:44.790 the director of health care reform and a senior fellow 13 00:00:44.790 --> 00:00:47.950 at the Century Foundation. From 2019 14 00:00:48.350 --> 00:00:52.110 to 2024, she served as 15 00:00:52.110 --> 00:00:55.670 the Commissioner of the Maine Department of Health and Human Services. 16 00:00:55.670 --> 00:00:59.150 So welcome to both of you to the Hot Dish. I 17 00:01:00.150 --> 00:01:03.470 just want to bring up a couple of things. Obviously we're going to talk about 18 00:01:03.470 --> 00:01:07.110 rural health care, but to me, the beauty of the conversation 19 00:01:07.110 --> 00:01:10.830 we're about to have is it doesn't matter. It doesn't matter if you're in 20 00:01:10.830 --> 00:01:14.590 Maine. It doesn't matter if in your Missouri or North Dakota or 21 00:01:14.590 --> 00:01:18.310 sitting in a hotel somewhere. Heidi, in the truth of the matter 22 00:01:18.310 --> 00:01:22.110 is it affects all of us. So Jeanne, I got to 23 00:01:22.110 --> 00:01:25.590 ask you this. You know, what are the Democrats fighting for in this 24 00:01:25.590 --> 00:01:29.350 shutdown with respect to health care? Yeah. So while 25 00:01:29.350 --> 00:01:33.150 it may seem complicated with what is a continuing 26 00:01:33.150 --> 00:01:36.990 resolution and what's going on in D.C. the reality 27 00:01:36.990 --> 00:01:40.390 for people, especially rural Americans, is pretty simple. 28 00:01:40.870 --> 00:01:43.990 The health insurance marketplaces, which serve people 29 00:01:44.470 --> 00:01:47.750 who don't get access to employer based coverage, 30 00:01:48.790 --> 00:01:52.590 has 24 million people. Now, there were premium 31 00:01:52.590 --> 00:01:56.200 tax credits for this private insurance that were 32 00:01:56.200 --> 00:01:59.720 improved five, four or five years ago. They're going to end in 33 00:01:59.720 --> 00:02:03.240 December. And we know now that 34 00:02:03.800 --> 00:02:07.480 people in this marketplace are disproportionately farmers. 35 00:02:08.360 --> 00:02:11.560 Half are small business owners, small business workers or 36 00:02:11.560 --> 00:02:14.680 entrepreneurs. And rural people 37 00:02:15.080 --> 00:02:18.880 really rely on it. I did a study in August that found 38 00:02:18.880 --> 00:02:22.320 that the increases in premiums, if converse is an 39 00:02:22.320 --> 00:02:26.010 aptitude, continue. The current policy would be 40 00:02:26.170 --> 00:02:29.570 28% higher than in urban areas. Just to be 41 00:02:29.570 --> 00:02:33.210 concrete, people in rural America rely more on 42 00:02:33.210 --> 00:02:36.730 health insurance marketplaces on these premium tax credits 43 00:02:36.890 --> 00:02:40.650 and their loss would disproportionately affect rural Americans. 44 00:02:40.650 --> 00:02:44.450 And just to give an example, here in Maine there's a 45 00:02:44.450 --> 00:02:48.090 place called Caribou, which is on the kind of north 46 00:02:48.580 --> 00:02:52.260 northeast border of the state. For a couple age 47 00:02:52.260 --> 00:02:55.860 60 in Caribou, whose income is $85,000, 48 00:02:55.940 --> 00:02:59.500 not a lot of money, they would face a premium increase 49 00:02:59.500 --> 00:03:03.220 of over $30,000 to just stay insured next 50 00:03:03.220 --> 00:03:06.820 year if Congress doesn't act. So I think it's a very 51 00:03:06.820 --> 00:03:10.340 important issue for people's pocketbooks. It's an important people, 52 00:03:10.580 --> 00:03:14.220 important issue for rural people. And I'm sure, as 53 00:03:14.220 --> 00:03:17.380 Michelle can talk about, it's an important issue for rural hospitals. 54 00:03:17.890 --> 00:03:21.490 Yeah, Heidi, I wanna go to you on this one, though. You represented 55 00:03:21.570 --> 00:03:25.290 the very people that Gene talked about. I mean, these people were knocking on 56 00:03:25.290 --> 00:03:29.130 your United States Senate door saying, hey, I need some help. Do you 57 00:03:29.130 --> 00:03:32.810 think they get it? Do you think those people that you worked for, the 58 00:03:32.810 --> 00:03:36.530 farmers, the ranchers, the independent small businesses, do you 59 00:03:36.530 --> 00:03:40.250 think they get what Jeanne just said? You know, I don't 60 00:03:40.250 --> 00:03:44.010 think they would have but for the shutdown. And everybody's like, what 61 00:03:44.010 --> 00:03:47.760 are they fighting about? And now all of a sudden they, they are kind of 62 00:03:47.760 --> 00:03:51.400 anticipating what that November 1st rollout of these 63 00:03:51.400 --> 00:03:54.840 premiums costs will be. I talked to 64 00:03:54.920 --> 00:03:58.560 a guy who sells insurance who said that he has a 65 00:03:58.560 --> 00:04:01.880 family, that it will go from $100. They're 66 00:04:01.880 --> 00:04:05.640 ranchers, farmers, experiencing some really tough times 67 00:04:05.640 --> 00:04:09.200 right now. And it will go from $100 premium to 68 00:04:09.200 --> 00:04:12.280 $1,200 a month for his family. And so 69 00:04:12.760 --> 00:04:16.439 they're going to get it when they see those premium costs. And, and I 70 00:04:16.439 --> 00:04:19.839 think that the people who aren't getting it right now, 71 00:04:19.839 --> 00:04:23.279 Joel, are Republicans in Congress who should be making a deal. 72 00:04:24.079 --> 00:04:27.759 So, Michelle, the administrators, the very people that run these. My wife 73 00:04:27.759 --> 00:04:31.039 was a longtime administrator in long term care. 74 00:04:32.559 --> 00:04:36.399 Are they willing to admit it? And when I say that, Michelle, because 75 00:04:36.799 --> 00:04:40.559 something tells me that you're going to tell me how much it's 76 00:04:40.559 --> 00:04:44.159 going to affect those facilities. But are they willing to stick their neck out 77 00:04:44.660 --> 00:04:48.260 and tell people. That is a great question. I 78 00:04:48.260 --> 00:04:52.100 just came from a National Rural Health Association Critical 79 00:04:52.100 --> 00:04:55.780 Access Hospital Rural Health Clinic conference in Kansas City, and the mood was very 80 00:04:55.780 --> 00:04:58.980 somber, let me tell you. I mean, before the shutdown, 81 00:04:59.300 --> 00:05:02.940 rural hospitals and rural health organizations were really 82 00:05:02.940 --> 00:05:06.260 feeling the pain of losing grants, for example. 83 00:05:06.900 --> 00:05:10.700 So are they getting it? Yes. Are they having the conversations? They 84 00:05:10.700 --> 00:05:14.130 are. And one of the things that we are really, you know, in my day 85 00:05:14.130 --> 00:05:17.810 job, aside from podcasting I talk to healthcare CEOs all the 86 00:05:17.810 --> 00:05:21.090 time, say you've gotta build your bench. And that means really going out there and 87 00:05:21.090 --> 00:05:24.890 talking to your community leaders and giving it to them straight, not 88 00:05:24.890 --> 00:05:28.370 about the politics, but about the policy and helping them understand 89 00:05:28.530 --> 00:05:32.210 what this means for families. So we talk about the shutdown and the impact. 90 00:05:33.650 --> 00:05:37.450 It's a cascading effect, as we know, because it's impacting our 91 00:05:37.450 --> 00:05:41.210 food security and sustainability systems. It's impacting, you 92 00:05:41.210 --> 00:05:44.970 know, so many of our rural communities rely on USDA field offices, for 93 00:05:44.970 --> 00:05:48.790 example, and they're no longer able to get that assistance because the staff has 94 00:05:48.790 --> 00:05:52.550 been cut so dramatically. So it's not just one thing. 95 00:05:52.550 --> 00:05:56.110 It's so many things that are happening. And Heidi, to your point, 96 00:05:56.510 --> 00:06:00.150 I mean, a lot of people right now, if the pain isn't 97 00:06:00.150 --> 00:06:03.790 knocking on their front door, it could be hard to imagine what that 98 00:06:03.790 --> 00:06:07.510 looks like. But I'm telling you, it's at people's doorsteps. And I 99 00:06:07.510 --> 00:06:10.750 think that shows like yours and the work that 100 00:06:11.420 --> 00:06:15.260 organizations like the ones that we'll talk about today are doing is so important 101 00:06:15.980 --> 00:06:19.780 again, to keep the conversation above the politics and really focus on 102 00:06:19.780 --> 00:06:23.580 the policy and give people facts because they're not going to 103 00:06:23.580 --> 00:06:27.100 get facts by going to federal websites right now. They're dark 104 00:06:27.660 --> 00:06:31.420 and very propaganda like. And so, yeah, I think the cascading 105 00:06:31.420 --> 00:06:35.260 effects come January 1, people are going to be in a, in a real, 106 00:06:35.340 --> 00:06:39.090 unfortunately, world of hurt. Yeah. Joel, can I ask Michelle 107 00:06:39.090 --> 00:06:42.930 a question really quickly? Because those of us who live in rural America 108 00:06:42.930 --> 00:06:46.450 know the largest employer beyond, you know, small business 109 00:06:46.690 --> 00:06:50.490 and agriculture is usually a healthcare facility. Do 110 00:06:50.490 --> 00:06:53.090 healthcare workers in rural America get it? 111 00:06:54.450 --> 00:06:57.570 I would say it depends on who you ask. Again, 112 00:06:58.290 --> 00:07:01.930 one of the things I think is really important is to 113 00:07:01.930 --> 00:07:05.510 convey the fact that misinformation, disinformation and 114 00:07:05.510 --> 00:07:09.230 health news deserts, I should say, are quite predominant 115 00:07:09.230 --> 00:07:12.990 right now. And so when you live in a rural space where 116 00:07:12.990 --> 00:07:16.470 there's very little outside information coming in, it's 117 00:07:16.470 --> 00:07:19.749 difficult to know. And you go online and you're reading whatever your 118 00:07:19.749 --> 00:07:23.430 algorithm wants to feed you and we consume that information. 119 00:07:24.310 --> 00:07:28.150 So right now, I would say for many of those who work within 120 00:07:28.150 --> 00:07:31.870 a rural hospital and a health clinic, leadership understands. 121 00:07:32.190 --> 00:07:35.990 I'll tell you, the CFOs understand, they're crunching those numbers. And you know 122 00:07:35.990 --> 00:07:39.710 who else understands are the billers, the coders, the people in the financial offices. 123 00:07:40.030 --> 00:07:43.870 Rural hospitals are having to hire, with very little 124 00:07:43.870 --> 00:07:47.430 budget, people to sit and answer the phone and answer 125 00:07:47.430 --> 00:07:50.830 questions about how to navigate what's going to happen with 126 00:07:51.070 --> 00:07:54.790 Medicaid, what's going to happen with the Medicare Advantage is another. 127 00:07:54.790 --> 00:07:58.510 I had an hour long conversation with a CFO yesterday about Medicare Advantage 128 00:07:58.510 --> 00:08:02.030 and how it's crushing rural hospitals right now in the state of Washington. 129 00:08:02.970 --> 00:08:06.770 So, you know, those who are in dietary services, who are working, you 130 00:08:06.770 --> 00:08:10.250 know, on intake and so forth, they may not understand it, but the physicians 131 00:08:10.250 --> 00:08:14.090 understand it. And the leaders understand it. And I say, don't let this 132 00:08:14.090 --> 00:08:17.610 be something that you carry on your own. Make sure that you are 133 00:08:17.610 --> 00:08:21.290 conveying that to your teams, not to scare them, but to make 134 00:08:21.290 --> 00:08:25.010 them aware of it and help them get on board with advocating 135 00:08:25.010 --> 00:08:28.850 for policy that stops harming rural hospitals. Because we've had 136 00:08:28.850 --> 00:08:32.570 enough closures. But there's a lot more coming. And I tell people all the 137 00:08:32.570 --> 00:08:35.520 time I, I want to be wrong. I don't think I am. 138 00:08:39.120 --> 00:08:42.840 First of all, not just the local hospitals, not 139 00:08:42.840 --> 00:08:46.280 just rural hospitals, but the American Hospital association said as 140 00:08:46.280 --> 00:08:49.800 follows, there will also be an impact on the entire 141 00:08:49.800 --> 00:08:53.640 community, even those with coverage, because of an influx of 142 00:08:53.640 --> 00:08:57.280 uninsured patients into emergency departments, causing 143 00:08:57.280 --> 00:09:00.650 longer waits, stress on the whole health care system, 144 00:09:01.130 --> 00:09:04.330 and the inability of getting care that they need. So that's 145 00:09:04.410 --> 00:09:08.130 factoid 1 and 2 is an analysis came out 146 00:09:08.130 --> 00:09:10.970 that said that the United states could lose 147 00:09:11.050 --> 00:09:14.090 339,000 jobs as a result 148 00:09:14.569 --> 00:09:18.410 of the lack of extending these premium tax credits, which for 149 00:09:18.410 --> 00:09:21.850 states and local governments could reduce their revenue by 150 00:09:21.850 --> 00:09:25.690 $2.5 billion. That is concrete, that's real. 151 00:09:26.100 --> 00:09:29.300 It's on the horizon. But what we just described everyone 152 00:09:30.020 --> 00:09:33.780 really means, if you have this groundswell, if you have people actually 153 00:09:34.980 --> 00:09:38.820 contacting their, their congress members, you know, they 154 00:09:38.820 --> 00:09:42.580 have to admit they voted wrong. I mean, they did. I mean, you look 155 00:09:42.580 --> 00:09:45.420 at that vote in the rural area. I don't care what state you're from. I 156 00:09:45.420 --> 00:09:49.260 mean, Heidi, that's the hardest thing in the world today. Way 157 00:09:49.260 --> 00:09:53.030 harder than what it was 20 years ago. It just seems to 158 00:09:53.030 --> 00:09:56.630 me that the society we live in now, people aren't willing to 159 00:09:56.630 --> 00:10:00.190 admit they voted wrong. Well, you know, 160 00:10:00.190 --> 00:10:03.470 Joel, the interesting thing about this is it's accumulative. 161 00:10:03.870 --> 00:10:05.950 You know, we've seen what's happened with 162 00:10:07.230 --> 00:10:10.990 soybeans and rice not being able to be sold. You 163 00:10:10.990 --> 00:10:14.750 know how the trade disruption has affected rural America. 164 00:10:14.910 --> 00:10:18.760 You take a look at where we are right now with giving money to 165 00:10:18.760 --> 00:10:22.120 Argentina and introducing Argentinian beef 166 00:10:22.360 --> 00:10:25.640 to shore up Argentina. You know, so 167 00:10:26.360 --> 00:10:29.880 you tell me, you talk to farmers and you talk to rural people every day. 168 00:10:30.200 --> 00:10:33.480 Is the attitude changing? Is there a willingness not to 169 00:10:33.879 --> 00:10:37.480 go to the local pub or coffee shop and say, gal, I wish I 170 00:10:37.480 --> 00:10:41.320 hadn't voted for them. But are they rethinking? And I think you've got a 171 00:10:41.320 --> 00:10:45.120 better finger on that pulse. No. The answer is yes. When you get one 172 00:10:45.120 --> 00:10:48.730 on one and you don't get in public, but if there's two, the 173 00:10:48.730 --> 00:10:51.970 answer is no. The answer is really no. And 174 00:10:52.530 --> 00:10:55.650 they just first off. They're mad if you bring it up, you know, 175 00:10:56.050 --> 00:10:59.810 because that, that is just an admission that you're going to end up talking 176 00:10:59.810 --> 00:11:03.250 about it. But the answer right now is still 177 00:11:03.490 --> 00:11:06.930 no, whether it's whether it's Argentinian beef, whether it is 178 00:11:07.250 --> 00:11:10.850 soybeans, whether now they're going to lose their real hospitals. And 179 00:11:11.340 --> 00:11:14.980 Michelle, I want to throw this at you because the biggest challenge we 180 00:11:14.980 --> 00:11:18.740 had in the area where I live, in the district that I used 181 00:11:18.740 --> 00:11:22.420 to represent in the state senate, there's two rural hospitals, but 182 00:11:22.420 --> 00:11:25.820 almost every one of the towns above 1000 183 00:11:26.060 --> 00:11:29.820 people have a nursing home. They do. They 184 00:11:29.820 --> 00:11:33.340 can't find workers. That was the biggest challenge they had 185 00:11:33.420 --> 00:11:37.260 before this. They couldn't find workers. This isn't going 186 00:11:37.260 --> 00:11:40.950 to help that. Michelle, what's your take on that? Well, you are exactly 187 00:11:40.950 --> 00:11:44.670 right. Across the board in particular, if you take a look at and we'll go 188 00:11:44.670 --> 00:11:48.390 kind of veer into another subject, which is immigration policy and how 189 00:11:48.470 --> 00:11:52.310 severely impacted rural communities are not just in agriculture 190 00:11:52.310 --> 00:11:56.110 space, but also in healthcare, long term care, daycare and so forth. 191 00:11:56.110 --> 00:11:59.270 And so to your point, I mean, there's the financial 192 00:11:59.590 --> 00:12:03.230 impact of just the low reimbursements and then of course 193 00:12:03.230 --> 00:12:06.910 there's the workforce. So how do we age in place? You know, we 194 00:12:06.910 --> 00:12:10.570 talk so a good game about aging in place and making sure that 195 00:12:10.570 --> 00:12:13.050 rural communities have these resources. Yet every policy, 196 00:12:14.330 --> 00:12:18.050 whether it's regulatory policy, whether it's the reimbursement, whether 197 00:12:18.050 --> 00:12:21.490 it's workforce and now the visa 198 00:12:21.490 --> 00:12:25.050 programs that want someone to pony up whatever the 199 00:12:25.050 --> 00:12:28.650 ridiculous number is. And so, Joel, you're right. I mean, we are going to see 200 00:12:30.170 --> 00:12:33.690 already struggling areas to find ways to care for 201 00:12:35.210 --> 00:12:38.890 children and our aging population. And we're all getting there, you know, 202 00:12:39.050 --> 00:12:42.690 at some point in time. And I think it's interesting because that's an issue 203 00:12:42.690 --> 00:12:46.250 that rural communities can actually wrap their brains around more. 204 00:12:46.330 --> 00:12:50.170 Because, you know, when you talk about the elimination of 205 00:12:50.410 --> 00:12:53.890 long term care or skilled care, that's where people start to get 206 00:12:53.890 --> 00:12:57.690 angry because it's something that they really cherish. And because we 207 00:12:57.690 --> 00:13:01.490 have an aging population in rural America, more so than then, you know, we're not 208 00:13:01.490 --> 00:13:05.210 growing, we're not having more births. Of course we can't because we don't have 209 00:13:05.210 --> 00:13:08.970 any. We have OB deserts all over this country as well. So I 210 00:13:08.970 --> 00:13:12.690 think, you know, those are the kinds of things without being, you know, a lightning 211 00:13:12.690 --> 00:13:16.290 rod talking about immigration. Just the reality is that our rural 212 00:13:16.290 --> 00:13:20.090 health workforce in many areas and urban are largely made 213 00:13:20.090 --> 00:13:23.850 up of immigrant populations. So I'm going to throw this at you, Jeanne. And then, 214 00:13:23.850 --> 00:13:27.490 Heidi, I want you to follow up, if you would, because you lived the 215 00:13:27.490 --> 00:13:31.170 very life I'm about to bring up. But Jeanne, somebody calls into my talk 216 00:13:31.170 --> 00:13:34.670 show, let's do a scenario, and they say that I've completely 217 00:13:34.670 --> 00:13:38.190 misread the Big Beautiful Bill and that actually 218 00:13:38.190 --> 00:13:41.950 there's more protections in there for rural hospitals, 219 00:13:42.110 --> 00:13:45.750 for rural nursing care, and that what I 220 00:13:45.750 --> 00:13:49.390 don't realize is that 50 some billion 221 00:13:49.470 --> 00:13:52.830 dollars really protects them. How would you answer that? 222 00:13:53.870 --> 00:13:57.550 Yeah, so I will just do first the numbers, 223 00:13:57.550 --> 00:14:01.200 then the policy. So the One Big 224 00:14:01.200 --> 00:14:04.880 Beautiful Bill, formerly known as, because it's no longer allowed to be called that 225 00:14:04.880 --> 00:14:08.560 because of a Senate procedure. HR1 226 00:14:09.440 --> 00:14:13.120 included $50 billion over five years beginning next year for 227 00:14:13.520 --> 00:14:17.200 rural health transformation. It also reduced 228 00:14:17.440 --> 00:14:21.240 federal health spending by $1 trillion over the next 229 00:14:21.240 --> 00:14:24.400 decade. It's not even close. Map all 230 00:14:25.140 --> 00:14:28.780 keep going, which is what we've seen already from this administration 231 00:14:28.780 --> 00:14:31.580 is half of the $50 billion is 232 00:14:32.500 --> 00:14:36.300 prorated. So states like New Jersey and New York get as much 233 00:14:36.300 --> 00:14:39.940 as rural states like North Dakota, South Dakota May 2. 234 00:14:40.820 --> 00:14:44.180 The remaining half, half may be done formulaically, 235 00:14:44.180 --> 00:14:47.940 but the rest is going to be done at the discretion of this 236 00:14:47.940 --> 00:14:51.140 Administration. And they've said in the application, if 237 00:14:51.840 --> 00:14:55.600 you do what we want you to do, we'll give you money. If you 238 00:14:56.000 --> 00:14:59.640 stop limiting substandard 239 00:14:59.640 --> 00:15:03.280 plans, if you get rid of certificate of need laws 240 00:15:03.280 --> 00:15:06.960 that aim to control kind of unnecessary utilization, they 241 00:15:07.040 --> 00:15:10.720 put in a set of policies that they want states to 242 00:15:10.720 --> 00:15:14.320 adopt and said if you don't, you don't get that money. So I think 243 00:15:14.320 --> 00:15:17.920 it's going to be a real challenge for states. There's only 15 days 244 00:15:18.550 --> 00:15:22.350 from today before the application is due. You know, there's a 245 00:15:22.350 --> 00:15:25.630 lot of uses that could be in there, but we're already seeing the tensions. There's 246 00:15:25.630 --> 00:15:29.470 a tension between coordinate with other, you know, 247 00:15:29.470 --> 00:15:32.870 rural hospitals, with urban hospitals versus consolidate. 248 00:15:33.510 --> 00:15:37.110 Use it for things that are needed now like uncompensated 249 00:15:37.110 --> 00:15:40.830 care, struggling hospitals versus rural healthcare 250 00:15:40.830 --> 00:15:44.430 transformation beyond the five years. And then I think we've also 251 00:15:44.430 --> 00:15:47.910 seen a real tension between technological 252 00:15:47.910 --> 00:15:51.470 improvements. There's a real emphasis in the application 253 00:15:51.950 --> 00:15:55.510 for tech innovation, startups versus 254 00:15:55.510 --> 00:15:59.350 workforce. The people that we're just talking about. And I will just say going back 255 00:15:59.350 --> 00:16:02.630 to the immigration issue, we see it here in Maine at both the bottom end 256 00:16:02.630 --> 00:16:05.950 and the top end. That $100,000 fee 257 00:16:06.270 --> 00:16:09.910 for an H1B visa is going to hit our hospitals the 258 00:16:09.910 --> 00:16:13.640 hardest. The second largest user of those visas is 259 00:16:13.640 --> 00:16:17.400 Northern Light Health in northern Maine, where they basically 260 00:16:17.560 --> 00:16:21.280 struggle to get doctors. And I had to sign every 261 00:16:21.280 --> 00:16:24.760 single request for those visas when I was secretary, 262 00:16:24.760 --> 00:16:28.120 Commissioner of Health and Human Services. Everyone was 263 00:16:28.120 --> 00:16:31.640 urgent. That's going to be challenging. And then go to the lower end. 264 00:16:32.600 --> 00:16:36.120 We are proud to have legal immigrants coming to Maine as we have a 265 00:16:36.120 --> 00:16:39.930 declining workforce. We are the oldest state in the nation. Most percentage of people 266 00:16:39.930 --> 00:16:43.530 above age 65. We welcome legal immigrants. 267 00:16:44.090 --> 00:16:47.810 They come into our healthcare workforce at those entry level jobs that other 268 00:16:47.810 --> 00:16:51.410 Maine people don't want to take. They're the custodians, the people 269 00:16:51.410 --> 00:16:55.170 who do food service. They're the ones who, for women who 270 00:16:55.170 --> 00:16:58.890 are new Mainers, they can go into the caregiving professions as CNAs 271 00:16:59.050 --> 00:17:02.570 and work their ways up. That push 272 00:17:02.730 --> 00:17:06.530 from the top and the bottom for our healthcare workforce as 273 00:17:06.530 --> 00:17:09.630 a result of the changes that have happened are significant. 274 00:17:10.110 --> 00:17:13.950 But I'll just go back to your question. A $50 billion drop in the 275 00:17:13.950 --> 00:17:16.910 bucket for five years can't help 276 00:17:17.390 --> 00:17:20.350 rural America with a $1 trillion 277 00:17:20.790 --> 00:17:24.270 nationwide 10 year funding cut. Well, 278 00:17:24.910 --> 00:17:28.270 if I can just interject here, it's a typical, 279 00:17:28.510 --> 00:17:32.270 you know, you look at, oh, farmers are going to get a bailout, they're going 280 00:17:32.270 --> 00:17:35.900 to get help and we're going to tell you, you got $50 million. 281 00:17:35.900 --> 00:17:39.580 None of that deals with the core competencies and 282 00:17:39.580 --> 00:17:43.260 the core problems that we have. And shame on them. I mean, 283 00:17:43.260 --> 00:17:46.660 one of the challenges that we have here is we pay too much for healthcare. 284 00:17:46.660 --> 00:17:50.460 And we've got to figure that out. We've got to figure out how we 285 00:17:50.460 --> 00:17:54.180 can provide more equality in healthcare. But Joel, 286 00:17:54.260 --> 00:17:58.020 the Congress, if the Congress were functioning and if this administration 287 00:17:58.020 --> 00:18:01.840 was functioning correctly, they would be having a very serious 288 00:18:01.840 --> 00:18:05.400 conversation about healthcare writ large 289 00:18:05.400 --> 00:18:09.040 and how they can guarantee healthcare going forward. 290 00:18:09.880 --> 00:18:13.720 You know, if I'll just say, I am an unapologetic 291 00:18:13.880 --> 00:18:17.680 skeptic about the Rural Health Transformation Fund because if it was meant to 292 00:18:17.680 --> 00:18:21.000 really transform, let's be honest, it would not have been thrown 293 00:18:21.400 --> 00:18:24.840 in at the very last minute. And so Joel asked the question about our people, 294 00:18:25.160 --> 00:18:28.960 you know, our elected officials, you know, feeling like they can say that 295 00:18:28.960 --> 00:18:32.680 they made a mistake. I think the Rural Health Transformation Fund is the, is the 296 00:18:32.680 --> 00:18:35.400 make good, if you will, kind of like, "sorry you had a bad meal, here's 297 00:18:35.400 --> 00:18:39.160 a gift certificate, come back and see us again sometime." At the end of 298 00:18:39.160 --> 00:18:43.000 the day. To, to Gene's point, this is at the 299 00:18:43.000 --> 00:18:46.680 discretion of the Department of Health and Human Services and it's 300 00:18:46.680 --> 00:18:50.480 approved applications. So I will just say if you 301 00:18:50.480 --> 00:18:54.300 hear someone call it a rural hospital fund, please correct them. It is 302 00:18:54.300 --> 00:18:58.060 not I again would like to be proven wrong. I see 303 00:18:58.060 --> 00:19:01.740 very little money coming in for the rural hospitals. I think 304 00:19:01.740 --> 00:19:05.420 technology companies are going to be the winners. I think it's going to be that 305 00:19:05.420 --> 00:19:09.180 second disbursement will be a pay to play and again, 306 00:19:09.180 --> 00:19:12.740 a history. As a teacher, we had something back in the Bush era where it 307 00:19:12.740 --> 00:19:16.220 was kind of the same kind of thing. But 308 00:19:16.380 --> 00:19:19.860 I'm very much a skeptic about what this will do, especially in light of the 309 00:19:19.860 --> 00:19:23.710 fact that we've cut Medicaid, we've got Medicare Advantage plans, which 310 00:19:23.710 --> 00:19:27.430 is the big push of this administration. And now we're talking about cuts to SNAP 311 00:19:27.430 --> 00:19:29.910 and all these other things that are supposed to be a part of making us 312 00:19:29.910 --> 00:19:33.510 healthier. So I just don't see - a drop in a bucket would be kind 313 00:19:33.830 --> 00:19:35.870 of a nice way to say it. I think it's less than that. 314 00:19:38.710 --> 00:19:42.550 One thing that I'm going to say is that this is a president who 315 00:19:42.550 --> 00:19:45.990 got elected with a huge 316 00:19:46.740 --> 00:19:50.420 kind of margin of working class people with the idea that he was going to 317 00:19:50.420 --> 00:19:54.060 make life easier for working class people. And everything that we're 318 00:19:54.060 --> 00:19:57.540 talking about is going to make life harder, especially for working 319 00:19:57.540 --> 00:20:01.380 class Americans in rural America. You know, and I think, 320 00:20:01.380 --> 00:20:04.660 you know, to Joel's point, and he keeps bringing this up, 321 00:20:05.060 --> 00:20:07.620 when does that come home to roost politically? 322 00:20:09.220 --> 00:20:12.940 You know, I might just jump in because I've been trying to put the 323 00:20:13.020 --> 00:20:15.980 numbers in context in the real world setting of 324 00:20:16.300 --> 00:20:20.060 families lives. So just take the premium tax credits 325 00:20:20.060 --> 00:20:23.500 for the Affordable Care Act. For a family of four 326 00:20:24.540 --> 00:20:28.300 not earning a ton of money, earning like, you know, $90,000 327 00:20:28.300 --> 00:20:32.020 a year for a family of four, the increase that 328 00:20:32.020 --> 00:20:35.740 they'll have to pay to get healthcare will more than wipe out 329 00:20:35.980 --> 00:20:39.740 any wage increase that they get next year because 330 00:20:40.250 --> 00:20:44.010 the premium increases are so much higher than general inflation, 331 00:20:44.090 --> 00:20:47.450 wage inflation, etc. They'll be 20 332 00:20:47.610 --> 00:20:51.450 times higher than the increases in rent and food. It's 333 00:20:51.450 --> 00:20:55.290 just like enormously big compared to a family's household budget. 334 00:20:55.370 --> 00:20:58.530 And when you look at an older couple, like I'm looking at the 60 year 335 00:20:58.530 --> 00:21:02.250 old couple here in Caribou, Maine, who will be paying a lot more for 336 00:21:02.250 --> 00:21:05.980 health care, they're sixty years old, they need to pay that 337 00:21:05.980 --> 00:21:09.700 kind of high premium for five years before they finally get 338 00:21:09.700 --> 00:21:13.500 Medicare eligibility. That will wipe out most of their retirement 339 00:21:13.500 --> 00:21:16.900 savings. I think we can't underestimate 340 00:21:17.460 --> 00:21:20.900 the hard hit that will be coming to 341 00:21:21.779 --> 00:21:25.380 most Americans. Middle income Americans, low income Americans. 342 00:21:25.380 --> 00:21:29.220 When Congressional Budget Office said this, some are very crystal clear. 343 00:21:29.780 --> 00:21:33.540 The top 10% of Americans will get a 344 00:21:33.620 --> 00:21:37.140 $13,000 tax break as a result of what happened this summer. 345 00:21:37.300 --> 00:21:40.780 Whereas the bottom 10% of Americans will 346 00:21:40.780 --> 00:21:44.500 lose $3,200, which may 347 00:21:44.500 --> 00:21:47.860 be smaller than that big amount, but it's a bigger percent of their 348 00:21:47.860 --> 00:21:51.380 resources. Let me, let me ask Michelle this, 349 00:21:51.860 --> 00:21:55.660 is this a back end way of getting rid of the Affordable Care 350 00:21:55.660 --> 00:21:59.420 Act? I mean, is that, is this, hey, this 351 00:21:59.420 --> 00:22:03.220 is something that's gonna be there a long time. It worked. It's like Social 352 00:22:03.220 --> 00:22:06.940 Security. It's like Medicare. It's like Medicare. It's like the silver, right? 353 00:22:07.100 --> 00:22:10.860 This is something we don't want the Democrats years from now to be 354 00:22:10.860 --> 00:22:14.540 able to declare victory on or. And I 355 00:22:14.540 --> 00:22:18.340 never forget this, Heidi, it's your good, good friend John 356 00:22:18.340 --> 00:22:21.980 McCain that stopped this by one vote. He walked to 357 00:22:21.980 --> 00:22:25.710 the well of the Senate, walked to the front and said, no, we're not going 358 00:22:25.710 --> 00:22:29.470 to kill the Affordable Care Act today. So, Michelle, I'm throwing that on your 359 00:22:29.470 --> 00:22:33.230 lap. Is this just a sneaky little way of killing the 360 00:22:33.230 --> 00:22:37.070 Affordable Care Act? Well, I don't actually think it's sneaky. I think it's 361 00:22:37.070 --> 00:22:40.470 quite transparent what they're doing. I mean, if you take a look at the totality 362 00:22:40.470 --> 00:22:43.910 of all the different policies that are coming down, I don't think it's a secret. 363 00:22:44.870 --> 00:22:48.230 And you know, when you think about the fact that, you know, 364 00:22:48.310 --> 00:22:52.150 nearly half of all births in rural America, 1/5, 365 00:22:52.470 --> 00:22:55.790 are covered by -- half are covered by Medicaid. And 366 00:22:56.110 --> 00:22:59.950 so when you think about that, so when you see the very deliberate actions 367 00:22:59.950 --> 00:23:03.150 of saying we are going to cut millions 368 00:23:03.390 --> 00:23:07.110 of people, 66 million people live in rural America, approximately depending 369 00:23:07.110 --> 00:23:10.870 on the rural definition these days. When you think about how many 370 00:23:10.870 --> 00:23:13.870 millions of people will lose their Medicaid coverage. And 371 00:23:14.590 --> 00:23:18.270 now let's throw in the work requirements. So again, it's 372 00:23:18.270 --> 00:23:21.650 another hurdle. It's like, I don't know, I think about the 373 00:23:21.650 --> 00:23:25.210 obstacle courses that you see and people have to jump through fire hoops 374 00:23:25.210 --> 00:23:29.010 and, you know, and stay underwater and, you know, be put in a vat 375 00:23:29.010 --> 00:23:31.930 of snakes or what have you. It just feels that way to me 376 00:23:33.210 --> 00:23:36.810 because we've got layers of complexity. So 377 00:23:36.810 --> 00:23:40.610 cuts to Medicaid work requirements, cuts to SNAP, new work requirements for 378 00:23:40.610 --> 00:23:44.050 that, closing rural hospitals, you know, the 379 00:23:44.050 --> 00:23:47.650 assault on providers, being able to make a living wage, as another 380 00:23:47.650 --> 00:23:51.440 example, loan repayment, medical training. What 381 00:23:51.440 --> 00:23:55.160 more can we take? What more pressure can rural Americans 382 00:23:55.160 --> 00:23:58.920 shoulder? And I think sooner than later, I hope 383 00:23:58.920 --> 00:24:02.080 this is the case that there's a revelation that these policies 384 00:24:02.640 --> 00:24:06.480 are killing - not just making people sick, but they are going to kill rural 385 00:24:06.560 --> 00:24:10.160 Americans as a result, when we have no more access to health care in 386 00:24:10.400 --> 00:24:14.120 large swaths of our country. That should wake people up, I hope. 387 00:24:15.490 --> 00:24:19.170 Can I just add just a point there, which is I think significant 388 00:24:19.490 --> 00:24:23.250 because a lot of people in America say they should work if they can 389 00:24:23.250 --> 00:24:26.850 work and they should be getting assistance. But I 390 00:24:26.850 --> 00:24:30.690 love all these Senators who say, well, when they get a job they'll be covered 391 00:24:30.770 --> 00:24:34.490 on their workplace. What a joke. They haven't looked at 392 00:24:34.490 --> 00:24:38.050 what the workplace actually covers and with premiums going up, 393 00:24:38.050 --> 00:24:41.170 it's going to get worse. So we've just, we've talked about 394 00:24:41.250 --> 00:24:44.330 Medicaid, we've talked about the subsidization on 395 00:24:44.330 --> 00:24:47.170 Obamacare, we haven't talked about the dramatic increase, 396 00:24:47.630 --> 00:24:51.070 13% nationwide of increase in premiums. 397 00:24:51.950 --> 00:24:55.150 Employers are going to ratchet back what they're going to cover and that's going to 398 00:24:55.150 --> 00:24:58.990 leave even more people with higher co pays and higher healthcare 399 00:24:59.390 --> 00:25:03.189 burdens. But when you look at it, I can 400 00:25:03.189 --> 00:25:06.790 tell you as somebody who has spent a lot of time working with people, 401 00:25:06.790 --> 00:25:10.190 they are exhausted at the end of the day. And it's 402 00:25:10.350 --> 00:25:13.910 not just the work requirements. In fact, it's not nearly as 403 00:25:13.910 --> 00:25:17.600 onerous as the paperwork requirements. And you 404 00:25:17.600 --> 00:25:21.280 take a look at kind of going forward, what, what's going 405 00:25:21.280 --> 00:25:25.080 to affect people coming off Medicaid. It's not going to be 406 00:25:25.080 --> 00:25:28.600 that they're not working and that they don't qualify. It's that they are going to 407 00:25:28.600 --> 00:25:32.320 be taken off Medicaid because they haven't filed the paperwork. 408 00:25:32.880 --> 00:25:36.440 Heidi, we just, I'm sorry, we just did an episode on this with the 409 00:25:36.440 --> 00:25:40.200 folks from KFF and we talked about the question was are states ready 410 00:25:40.200 --> 00:25:43.710 to implement Medicaid work requirements? And the answer is a big fat 411 00:25:43.710 --> 00:25:47.110 no. You know, we take a look at the, the employers in rural 412 00:25:47.110 --> 00:25:50.910 America, the, the Walmarts, you know, employers don't, 413 00:25:50.910 --> 00:25:54.110 in rural America are not the same as, you know, going into a big 414 00:25:54.110 --> 00:25:57.790 metropolitan area where they've got thousands of lives they can cover to 415 00:25:57.790 --> 00:26:00.670 offset some of those costs. So we've got a lot of gig workers, we got 416 00:26:00.670 --> 00:26:03.270 a lot of independent contractors. They're working, 417 00:26:04.150 --> 00:26:07.950 they barely qualify, but they are deserving of healthcare. And now these 418 00:26:07.950 --> 00:26:11.310 work requirements truly is just putting a padlock on 419 00:26:11.310 --> 00:26:15.030 healthcare for them as a result. So Heidi, would you trust them? Because really 420 00:26:15.030 --> 00:26:18.590 what we're talking about here, John Thune is getting in front of every 421 00:26:18.670 --> 00:26:22.030 camera he can saying, look, you know, vote for the Clean CR 422 00:26:22.990 --> 00:26:26.830 in November. We're going to fix this regardless of the fact that 423 00:26:26.830 --> 00:26:30.510 signup begins November 1st, I mean, we all know 424 00:26:30.510 --> 00:26:33.390 that. So the point is, 425 00:26:34.190 --> 00:26:37.480 if you were back in one of those chairs, would you trust them? 426 00:26:38.360 --> 00:26:42.160 The answer is no. And I'll tell you why. Because the last time 427 00:26:42.160 --> 00:26:45.840 they cut a deal when Schumer basically said, we're going to give you enough 428 00:26:45.840 --> 00:26:49.640 votes to keep government open this spring, and he 429 00:26:49.640 --> 00:26:53.240 did. And the Democrats said, we don't want to shut down government, we want to 430 00:26:53.240 --> 00:26:57.080 have a conversation. What's the first thing the Republicans did? 431 00:26:57.320 --> 00:27:01.040 They passed rescissions with a 50 vote majority. 432 00:27:01.040 --> 00:27:04.590 And so they took that, that deal, which 433 00:27:04.590 --> 00:27:07.670 was to fund government, to continue to 434 00:27:08.550 --> 00:27:11.990 fund it at a certain level, and they unwound 435 00:27:12.390 --> 00:27:16.150 those things they didn't like. And so you can cut this 436 00:27:16.150 --> 00:27:19.750 deal tomorrow and they'll undo it with rescissions. And 437 00:27:19.750 --> 00:27:23.430 that's where John Thune made the mistake. I think he violated and 438 00:27:23.430 --> 00:27:27.270 breached a trust. And people feel pretty burned by that whole process. 439 00:27:27.510 --> 00:27:30.750 So I'm going to throw another scenario to every one of you and then you 440 00:27:30.750 --> 00:27:34.320 can go ahead. We talked about employees in the healthcare industry. 441 00:27:34.400 --> 00:27:38.240 We talked about immigrants in the healthcare industry. Jeanne, you did a great 442 00:27:38.240 --> 00:27:41.520 job of explaining that. I'm going to throw this one, I guess, to you first, 443 00:27:42.240 --> 00:27:45.440 Michelle. It's the competitive nature of the 444 00:27:45.440 --> 00:27:48.800 employee because there is only so many employees to go around 445 00:27:49.040 --> 00:27:52.760 in the rural area. I know guys who want to work on a 446 00:27:52.760 --> 00:27:56.280 farm. They don't have a farm. They're going to work there as a laborer, but 447 00:27:56.280 --> 00:27:59.840 that's what they want to do. If the exchange goes away, that 448 00:27:59.840 --> 00:28:03.320 farmer isn't going to be able to provide them health care. But you know what, 449 00:28:03.560 --> 00:28:06.760 where they're manufacturing skid steers, they can. 450 00:28:07.320 --> 00:28:11.120 And so they're already wanting the employee. But I'm 451 00:28:11.120 --> 00:28:14.960 wondering if you're seeing that, you know, from your angle. Well, 452 00:28:14.960 --> 00:28:18.640 I think there's a lot of size to this. I think about the fact that, 453 00:28:18.640 --> 00:28:22.360 you know, we are, we, we. There's a lot of conversation about kind of 454 00:28:22.360 --> 00:28:25.960 bringing back manufacturing, for example, in rural America. 455 00:28:26.410 --> 00:28:30.170 There is no manufacturing organization that I know of that wants to go into 456 00:28:30.170 --> 00:28:33.290 a community that does not have health care, that does not have 457 00:28:33.610 --> 00:28:37.050 quality health care, but does not have any health care, does not have any of 458 00:28:37.050 --> 00:28:40.850 those services, daycare, long term care and so 459 00:28:40.850 --> 00:28:44.690 forth. So I think we are going to be seeing, you know, a pretty 460 00:28:44.690 --> 00:28:48.330 significant battle between, you know, where, where, where 461 00:28:48.330 --> 00:28:51.850 will people be able to go to even find jobs if there's no health care 462 00:28:51.850 --> 00:28:55.550 in a community? So that's a pretty significant blow to 463 00:28:55.550 --> 00:28:58.870 any community. Economic development is essential for rural 464 00:28:59.030 --> 00:29:02.870 America to thrive. And when we don't have health care 465 00:29:03.110 --> 00:29:06.070 on top of food insecurity, on top of 466 00:29:06.470 --> 00:29:10.190 defunding education, I'm all about connecting dots. And I think 467 00:29:10.190 --> 00:29:13.390 it's just imperative that we take a look at this not just as a single 468 00:29:13.390 --> 00:29:17.190 issue, but remind those who are supposed to represent us 469 00:29:17.350 --> 00:29:19.990 that we're more than a single issue voter. 470 00:29:20.390 --> 00:29:23.960 I would just add that when we look at the 471 00:29:23.960 --> 00:29:27.760 Affordable Care act here remain, we have some farmers, but we have a lot of 472 00:29:27.760 --> 00:29:31.120 fishermen. These are like literally self employed small 473 00:29:31.600 --> 00:29:35.400 business employees who had no choice. They have tough 474 00:29:35.400 --> 00:29:38.640 jobs with lots of demands on their health 475 00:29:38.960 --> 00:29:42.240 and their only choice is going to the health insurance 476 00:29:42.240 --> 00:29:45.760 marketplace. We created our own here in Maine called coverme.gov 477 00:29:46.400 --> 00:29:50.140 so one of the things that we did in designing, and 478 00:29:50.140 --> 00:29:53.780 I thank Senator Heitkamp for this as well, is design 479 00:29:55.220 --> 00:29:58.980 private insurance with a premium tax credit, not an 480 00:29:58.980 --> 00:30:02.340 entitlement program, a premium tax credit that's set by 481 00:30:02.340 --> 00:30:06.140 competition in local areas. So if in rural 482 00:30:06.140 --> 00:30:09.860 areas it's extra expensive to provide health care, 483 00:30:10.020 --> 00:30:13.620 the premium tax credit adjusts. That doesn't happen with other 484 00:30:13.620 --> 00:30:17.220 programs, doesn't happen with employer-based coverage. So it's an especially 485 00:30:17.300 --> 00:30:20.420 important, important support for small businesses, 486 00:30:20.980 --> 00:30:24.420 agriculture, aquaculture, fishing industries, 487 00:30:24.980 --> 00:30:28.460 all those startup companies and rural areas that are the 488 00:30:28.460 --> 00:30:32.020 engine and the heart of our economy. And I just feel 489 00:30:32.740 --> 00:30:36.420 badly that it does feel targeted. Going back to the 490 00:30:36.420 --> 00:30:40.260 question, did the One Big Beautiful Bill go after Obamacare? 491 00:30:40.260 --> 00:30:43.970 Just look at the numbers. KFF put out a study that said more than 492 00:30:43.970 --> 00:30:47.570 half of the Medicaid cuts will come 493 00:30:47.570 --> 00:30:51.250 from states that took the Affordable Care Act Medicaid expansion. 494 00:30:51.490 --> 00:30:55.050 And when you fast forward to that last year, when everything is 495 00:30:55.050 --> 00:30:58.530 fully in effect, 46% of the 496 00:30:58.530 --> 00:31:02.210 funding for the Affordable Care act marketplaces will be gone. 497 00:31:02.370 --> 00:31:05.690 I mean, it's a very dramatic change that's on the 498 00:31:05.690 --> 00:31:09.050 horizon that I think is potentially politically 499 00:31:09.050 --> 00:31:12.390 targeted. I am so proud of Senator McCain and 500 00:31:12.470 --> 00:31:15.710 Senator Collins here in Maine voted against that bill. She voted against HR1. 501 00:31:15.710 --> 00:31:19.350 I'm hoping she votes for the extension of 502 00:31:19.350 --> 00:31:23.070 the premium tax credits. So, Heidi, did the Republican governors get 503 00:31:23.070 --> 00:31:26.870 it? Oh, I think they get it. And you think about 504 00:31:26.870 --> 00:31:30.670 Sarah Huckabee, she -- or Sanders, I guess is what she wants 505 00:31:30.670 --> 00:31:34.230 to be known as in Arkansas. They were one of the first states that adopted 506 00:31:34.230 --> 00:31:37.790 a work program for Medicaid. And because there's 507 00:31:37.790 --> 00:31:41.550 a lot of flexibility in the Medicaid program for governors to fashion 508 00:31:41.550 --> 00:31:44.910 it the way they want to fashion failed miserably 509 00:31:44.910 --> 00:31:48.310 she didn't know how to administer it. And, you know, there's 510 00:31:48.550 --> 00:31:52.150 a lesson there. But they are, that they are so 511 00:31:52.150 --> 00:31:55.950 captive to the kind of MAGA movement and 512 00:31:55.950 --> 00:31:59.670 so terrified by any kind of criticism. I mean, you know who 513 00:31:59.670 --> 00:32:02.800 gets it? John Thune gets it. I mean, this is going to have a dramatic 514 00:32:02.800 --> 00:32:06.600 effect on his rural hospitals in South Dakota. You know that, 515 00:32:06.600 --> 00:32:10.280 Joel, and I know that. And I think he, he's, 516 00:32:10.280 --> 00:32:14.120 he's playing what he thinks is the long game, which is, I'm not going 517 00:32:14.120 --> 00:32:16.840 to be held captive to this, and I'm going to do this and I'm going 518 00:32:16.840 --> 00:32:20.560 to do that. But I don't think he's calling the shots. I think 519 00:32:20.560 --> 00:32:24.400 the president is calling the shots. Now, in the good news category there, I 520 00:32:24.400 --> 00:32:28.000 think President Trump has done enough damage to 521 00:32:28.000 --> 00:32:31.520 rural America. He might want to repair that damage and might want to sit down 522 00:32:31.520 --> 00:32:35.290 and negotiate, but he, he hasn't demonstrated a willingness to be engaged 523 00:32:35.290 --> 00:32:39.010 in this at all. And I think that the pressure 524 00:32:39.010 --> 00:32:42.610 point, and I've said this all along, is gonna come November 1st, 525 00:32:42.850 --> 00:32:46.370 when people actually see these and there becomes a 526 00:32:46.530 --> 00:32:50.130 groundswell, and there will be of people calling 527 00:32:50.130 --> 00:32:53.890 their congressional members, people calling their senators, saying, 528 00:32:53.890 --> 00:32:57.530 what the hell? I've had really affordable health insurance 529 00:32:57.530 --> 00:33:01.300 now for three years, and you're taking that away. What is 530 00:33:01.300 --> 00:33:05.100 happening? And, you know, I think that they would 531 00:33:05.100 --> 00:33:08.860 love to get this resolved before those premiums come out. Well, we 532 00:33:08.860 --> 00:33:12.180 laid out the problems. Now it's time for a prediction. 533 00:33:13.300 --> 00:33:16.900 Joel, can I just. I mean, we've talked about KFF 534 00:33:16.980 --> 00:33:20.780 quite a bit here. That's the former Kaiser Family Foundation. They 535 00:33:20.780 --> 00:33:24.260 now just go by the initials. But for our listeners who are really 536 00:33:24.260 --> 00:33:27.610 curious about this, if you want the most reliable 537 00:33:27.930 --> 00:33:31.650 healthcare source of information, go out 538 00:33:31.650 --> 00:33:35.450 on their website and read what they publish because it is 539 00:33:35.930 --> 00:33:39.730 grade A+ analysis. I want 540 00:33:39.730 --> 00:33:43.490 to know how this ends. You know, it's going to end one way or 541 00:33:43.490 --> 00:33:47.210 another. And so we all know how it needs to end. 542 00:33:47.210 --> 00:33:50.970 We've pointed that out. But let's do a little predictions 543 00:33:50.970 --> 00:33:54.790 to close out this conversation. Michelle, what's going to happen? Well, 544 00:33:54.790 --> 00:33:58.550 I think we are going to be - it's kind of like the aftermath, I'm 545 00:33:58.550 --> 00:34:02.310 a Midwestern girl, of a tornado, and we're going to have to 546 00:34:02.310 --> 00:34:05.310 look around and pick up the pieces and figure out how to rebuild our lives. 547 00:34:05.310 --> 00:34:09.110 And I think about our food supply, I think about our nutrition assistance 548 00:34:09.110 --> 00:34:12.950 programs, all those programs that are now at jeopardy. And 549 00:34:13.190 --> 00:34:16.310 we take away people's healthcare and you take away their food. 550 00:34:16.950 --> 00:34:20.430 I think that might be the straw that breaks the 551 00:34:20.430 --> 00:34:24.090 camel's back. I do believe it's going to take us decades to build 552 00:34:24.090 --> 00:34:27.730 back what was lost, including the data, very important 553 00:34:27.810 --> 00:34:31.650 data. I mean, all of us rely on sound data for making 554 00:34:31.650 --> 00:34:35.490 decisions. And so what's going to have to happen is there has to 555 00:34:35.490 --> 00:34:39.170 be a major shift and some 556 00:34:39.250 --> 00:34:43.090 significant repairing of the disinformation 557 00:34:43.090 --> 00:34:46.930 damage that has been done. So I'll say we have a lot of work 558 00:34:46.930 --> 00:34:50.770 ahead of us and none of us should shy away from it because what's 559 00:34:50.770 --> 00:34:54.450 our all our alternative to that? We had to keep 560 00:34:54.450 --> 00:34:58.130 having courageous conversations and try our 561 00:34:58.130 --> 00:35:01.930 hardest to stay above the name calling and all of 562 00:35:01.930 --> 00:35:05.770 that stuff and just be straight up with people about the realities and the 563 00:35:05.770 --> 00:35:09.250 facts of the situation. And I tell people this. Build your bench. 564 00:35:09.410 --> 00:35:13.170 Find ways to have new conversations with those who you may disagree with, but 565 00:35:13.170 --> 00:35:16.980 you agree on some things. We deserve healthy food, we 566 00:35:16.980 --> 00:35:20.820 deserve access to healthcare, and we deserve to be 567 00:35:20.820 --> 00:35:24.060 told the truth about what's really happening. 568 00:35:24.860 --> 00:35:28.180 Jeanne, I'm gonna throw the same thing at you. Where do you see this ending? 569 00:35:28.180 --> 00:35:30.900 I mean, we've got to shut down at some point. The government has to go 570 00:35:30.900 --> 00:35:34.620 back to work. But what happens? How does this shake out in the end? 571 00:35:35.740 --> 00:35:39.580 Yeah. So I am a believer in the arc of history 572 00:35:40.300 --> 00:35:43.980 bending towards justice. Where it was a year ago 573 00:35:44.500 --> 00:35:48.180 that we were in a situation in our health system where we had record 574 00:35:48.180 --> 00:35:52.020 high coverage rates. We had implemented drug 575 00:35:52.020 --> 00:35:55.860 negotiation in Medicare, we had ended medical 576 00:35:55.940 --> 00:35:59.740 debt being reported in consumers report cards. We 577 00:35:59.740 --> 00:36:03.140 had really made some progress. Things have 578 00:36:03.140 --> 00:36:06.940 changed dramatically. And I think we've seen a small margin in 579 00:36:06.940 --> 00:36:10.690 an election cause a dramatic pendulum swing. And 580 00:36:10.690 --> 00:36:14.450 what our policy is probably more than what Americans want when you 581 00:36:14.450 --> 00:36:17.730 listen to them and really hear what their pocket, 582 00:36:17.890 --> 00:36:21.690 pocketbook concerns are. So it's going to get worse 583 00:36:21.690 --> 00:36:24.970 before it gets better. But I do believe it's going to get better because of 584 00:36:24.970 --> 00:36:28.690 the persistence of people, of hospital administrators, 585 00:36:28.690 --> 00:36:32.370 of doctors, nurses, and many politicians, if not most 586 00:36:32.370 --> 00:36:36.090 politicians who are elected to represent the people who they serve. 587 00:36:36.090 --> 00:36:39.760 And I'm just hopeful that people do stand up. They 588 00:36:39.760 --> 00:36:43.480 express their concerns about health care. They support the 589 00:36:43.480 --> 00:36:47.320 policies that help them navigate. And not only 590 00:36:47.640 --> 00:36:51.280 do we. I don't want to go back to where we were because we 591 00:36:51.280 --> 00:36:55.120 were needed improvements as well. I hope that generates a new 592 00:36:55.120 --> 00:36:58.960 round of health reform that truly gets the wealthiest nation in the 593 00:36:58.960 --> 00:37:02.360 world to be providing a fair, affordable, 594 00:37:02.600 --> 00:37:06.210 equitable, just health care system for 595 00:37:06.210 --> 00:37:09.930 his residents. Heidi, you've been there. You've been in that room. When 596 00:37:09.930 --> 00:37:13.650 negotiations are going on, if Congress actually came back to work 597 00:37:13.890 --> 00:37:17.570 and actually decided that they wanted to be in D.C. doing 598 00:37:17.570 --> 00:37:21.290 their jobs and the curtain was pulled and you were behind that 599 00:37:21.290 --> 00:37:24.530 curtain negotiating out how to end this shutdown, 600 00:37:25.010 --> 00:37:27.890 what do you think would happen? What do you think it would take? Where do 601 00:37:27.890 --> 00:37:31.700 you see this ending? So I was there for one of the longest 602 00:37:31.700 --> 00:37:35.140 shutdowns and I joined a group of people, including Senator 603 00:37:35.140 --> 00:37:38.860 Collins up in Maine, to actually begin to have those 604 00:37:38.860 --> 00:37:42.620 conversations about how do we reopen government. So I have 605 00:37:42.620 --> 00:37:46.220 no inside information at this point, but I will tell you, the 606 00:37:46.220 --> 00:37:49.900 last time we were pressured by the debt limit. Now, the Big 607 00:37:49.900 --> 00:37:53.660 Beautiful Bill extended the debt limit for two years. So they don't have that 608 00:37:53.660 --> 00:37:57.180 pressure. That is creating a must 609 00:37:57.610 --> 00:38:01.250 got a drop dead date, you gotta get this done kind 610 00:38:01.250 --> 00:38:04.650 of scenario for opening backup government and 611 00:38:04.730 --> 00:38:08.410 dealing with the debt limit. But what I think is probably 612 00:38:08.410 --> 00:38:11.850 happening is behind the scenes, there's a group of people who are 613 00:38:12.250 --> 00:38:15.450 now convening quietly in hideaways. 614 00:38:15.850 --> 00:38:19.570 They're having zoom conversations. They're doing everything 615 00:38:19.570 --> 00:38:23.380 that they can. And it's going to be that group of people that is 616 00:38:23.380 --> 00:38:26.500 going to fashion a compromise that will open up government. 617 00:38:27.140 --> 00:38:30.100 Because when Schumer's not talking to Thune, 618 00:38:30.820 --> 00:38:33.980 you don't have an end in sight. When the President is 619 00:38:33.980 --> 00:38:37.420 disengaged and he's too busy, you know, I guess 620 00:38:37.420 --> 00:38:40.340 wrecking the White House, that's his big 621 00:38:40.660 --> 00:38:44.300 distraction today. And, you know, concerned about what's 622 00:38:44.300 --> 00:38:47.740 gonna happen with the Epstein files. He's not engaged in a 623 00:38:47.740 --> 00:38:51.470 negotiation. He, he likes the shutdown. Cause he thinks it gives him 624 00:38:51.470 --> 00:38:55.030 a tremendous amount of power to inflict damage on 625 00:38:55.030 --> 00:38:58.830 Democratic districts. So I think there's 626 00:38:58.830 --> 00:39:02.670 gotta be a group of very responsible members who are now 627 00:39:02.670 --> 00:39:06.430 sitting down saying, how can we resolve this? And I 628 00:39:06.430 --> 00:39:10.270 think for the Democrats they're concerned about this will be 629 00:39:10.270 --> 00:39:13.830 a short term fix. It will carry them through the midterms. 630 00:39:14.070 --> 00:39:17.590 And people, then we're back in the soup trying to fix this again. 631 00:39:18.260 --> 00:39:21.940 But at the bottom line, you need to open up government. And I think 632 00:39:22.500 --> 00:39:26.100 both Jean and Michelle have talked about food security. Come 633 00:39:26.100 --> 00:39:29.940 November 1, there may not be any SNAP benefits. 634 00:39:29.940 --> 00:39:33.700 And that is gonna be a huge pressure point, but it also is 635 00:39:33.700 --> 00:39:37.220 gonna show those new premiums. And I think the combination 636 00:39:37.380 --> 00:39:40.900 of absolute, essentially needing to open up government, 637 00:39:41.460 --> 00:39:44.900 along with the realization of what these premium 638 00:39:45.140 --> 00:39:48.700 increases look like for families, I think will drive an 639 00:39:48.700 --> 00:39:52.550 urgency. Okay, I'm going to take just a little leave on my part too. 640 00:39:52.550 --> 00:39:56.390 As a former state Senator, way smaller scale. I can tell you 641 00:39:56.390 --> 00:39:59.950 this, I could count. So with all due respect to Susan Collins, 642 00:40:00.110 --> 00:40:03.910 Senator from Maine, I think she's pretty good at counting. And so she can 643 00:40:03.910 --> 00:40:07.710 throw a vote here or there when she knows that, that they're going to 644 00:40:07.710 --> 00:40:11.470 win anyway. So I'm not as big on the fan train as some people 645 00:40:11.470 --> 00:40:15.230 might be. I will throw you this. I think that the leadership's going to 646 00:40:15.230 --> 00:40:18.940 end up coming from the state. I think that Governors behind the scene 647 00:40:19.260 --> 00:40:23.060 where these red states are, are going to be talking to through 648 00:40:23.060 --> 00:40:26.780 their Governor Association, through somebody to John Thune and saying, 649 00:40:26.780 --> 00:40:30.500 what the hell are you thinking? Do you realize the wet bundle that you're leaving 650 00:40:30.500 --> 00:40:34.140 on our doorstep? And I look for the states to be a 651 00:40:34.140 --> 00:40:37.740 big, big hand in helping resolve this, if 652 00:40:38.060 --> 00:40:41.740 we are able to resolve it. So there, I took 653 00:40:41.740 --> 00:40:45.480 my personal leave. Thank you. Thank you so much. Thank you 654 00:40:45.480 --> 00:40:49.120 to Michelle, thank you to Jeanne. We appreciate you coming on the Hot Dish. 655 00:40:49.520 --> 00:40:50.640 Thank you for having us. 656 00:40:55.440 --> 00:40:58.880 You know, Heidi, I know you wanted to be queen when we were growing up. 657 00:41:00.160 --> 00:41:03.160 That was always certain, you know, [Heidi: I did not!] but the, the other six 658 00:41:03.160 --> 00:41:05.080 of us that were your siblings [Heidi: I wanted to be a second baseman] that's 659 00:41:05.080 --> 00:41:08.920 why you played first. But, but the, the 660 00:41:08.920 --> 00:41:11.440 truth of the matter is anyone, anyone would 661 00:41:12.800 --> 00:41:16.200 have to say that the individuals that organized and wanted the 662 00:41:16.200 --> 00:41:20.000 No Kings march to do well, it did do well 663 00:41:20.000 --> 00:41:23.720 for those people trying to make a statement. Well, and, and they were 664 00:41:23.720 --> 00:41:27.360 meticulous about making sure that there wasn't violence, making sure 665 00:41:27.360 --> 00:41:31.160 that these were joyful events. There were lots of flags. You 666 00:41:31.160 --> 00:41:34.840 know, everything that they said, this is, you know, that that was terrible 667 00:41:34.840 --> 00:41:38.490 about this. The Republicans and kind of fanned that flame that 668 00:41:38.490 --> 00:41:42.130 the, the people who went out and exercised their First Amendment 669 00:41:42.130 --> 00:41:45.730 rights to assemble and, and protest, guess what? They 670 00:41:45.730 --> 00:41:49.010 proved them wrong. Well, and I would add this, the 671 00:41:49.010 --> 00:41:52.650 individuals that didn't want to see a part of the White 672 00:41:52.650 --> 00:41:56.370 House being tore down by a king, those individuals 673 00:41:56.610 --> 00:42:00.450 know the words to the Star Spangled Banner and they proved that. 674 00:42:00.770 --> 00:42:03.570 It's their country too. It's my country too. 675 00:42:04.490 --> 00:42:08.250 Well, and can we just talk a little bit about the 676 00:42:08.250 --> 00:42:11.890 President's so called presidential response 677 00:42:11.890 --> 00:42:14.810 to 7 million people, you know, 678 00:42:15.930 --> 00:42:19.650 basically tweeting out, or I don't know what they call it, xing 679 00:42:19.650 --> 00:42:23.410 out a video of him flying with a crown on 680 00:42:23.410 --> 00:42:27.090 his head, dropping brown liquid - and we 681 00:42:27.090 --> 00:42:30.860 all know what he meant by that - onto the protesters. That's where we 682 00:42:30.860 --> 00:42:34.700 are in America now. That's where we are, Joel. Well, and 683 00:42:34.700 --> 00:42:38.220 I would add to that, you know, as he's drying, flying around in that 684 00:42:38.220 --> 00:42:41.900 fighter jet Looking like he was at Burger King. That Kenny 685 00:42:41.900 --> 00:42:45.580 Loggins came out and he said, I want my song back. Nobody 686 00:42:45.580 --> 00:42:49.300 gave you the authority to use that song. That song 687 00:42:49.300 --> 00:42:53.140 from Top Gun. And I gotta. I gotta wonder if he doesn't look 688 00:42:53.140 --> 00:42:56.780 even more foolish, you know, Heid. He went around saying that he heard 689 00:42:56.780 --> 00:42:59.540 there weren't going to be a lot of people that turned out. And so what's 690 00:42:59.540 --> 00:43:03.300 their answer to that? The people that hated that march are going around 691 00:43:03.300 --> 00:43:07.060 saying, well, it's all AI or it's just fake. 692 00:43:07.060 --> 00:43:10.860 And some even going, Heidi, as far as to say, well, the crowd that went 693 00:43:10.860 --> 00:43:14.100 was paid off. Yeah, they 694 00:43:14.100 --> 00:43:17.940 cannot believe that that many 695 00:43:17.940 --> 00:43:21.420 people would come out and basically take their time, 696 00:43:21.820 --> 00:43:25.550 invest their kind of reputations in defending 697 00:43:25.550 --> 00:43:29.230 democracy. And it was a good day for democracy. I think it's a bad day 698 00:43:29.230 --> 00:43:32.950 for Donald Trump. Someone said, well, these are all people who didn't vote 699 00:43:32.950 --> 00:43:36.510 for him anyway, so what difference does it make? I said, you know what? 700 00:43:36.750 --> 00:43:40.270 There's organizers out there with clipboards who are 701 00:43:40.270 --> 00:43:44.070 saying, you as an organizer, every one of those people, 702 00:43:44.070 --> 00:43:47.070 you're going to bring 10 people to the polls. You're going to do what you 703 00:43:47.070 --> 00:43:50.510 can to turn this around in the midterms. And so it's a great 704 00:43:50.510 --> 00:43:54.170 organizing tool. Well, last thing I'm going to hit you with here, Heid, is the 705 00:43:54.170 --> 00:43:57.690 fact that everybody's saying, well, he's not a king. He's not a king. If he 706 00:43:57.690 --> 00:44:01.490 was a king, he would have stopped the march. Well, if he wasn't a king 707 00:44:01.490 --> 00:44:05.170 or didn't see himself as one, he wouldn't be taking an excavator to the 708 00:44:05.170 --> 00:44:08.770 White House. Isn't that something? He's tearing apart 709 00:44:08.770 --> 00:44:12.530 the people's House. It's not his. It's not. He 710 00:44:12.530 --> 00:44:16.250 treats it as though it's his castle. I mean, I 711 00:44:16.250 --> 00:44:19.670 had people call into my show that were literally crying, 712 00:44:19.670 --> 00:44:23.390 Heidi, with what he was doing to the White House. Well, he had started 713 00:44:23.390 --> 00:44:26.790 with the Rose Garden. I mean, he wanted to wipe out any 714 00:44:26.870 --> 00:44:30.510 legacy from Jackie Kennedy, from John Kennedy 715 00:44:30.510 --> 00:44:33.990 that's been preserved by Democrat and Republican presidents alike 716 00:44:34.470 --> 00:44:38.150 and basically paved it over so that I 717 00:44:38.150 --> 00:44:41.670 guess he can have a - What? 718 00:44:42.070 --> 00:44:45.470 So he can have, you know, some kind of fight on the Capitol 719 00:44:45.470 --> 00:44:49.230 grounds. I guess that's going to be some arena now for 720 00:44:49.230 --> 00:44:52.910 the 250th anniversary. But he's just, you know, 721 00:44:52.910 --> 00:44:56.710 what he's done to our house, the gilding, the 722 00:44:57.110 --> 00:45:00.950 gold, the kind of trashing, I mean, just 723 00:45:01.030 --> 00:45:04.790 absolute trashing of now, now 724 00:45:05.270 --> 00:45:08.870 taking down historic buildings. You know, 725 00:45:09.430 --> 00:45:13.190 it is, you just have to ask, when is enough enough? 726 00:45:14.060 --> 00:45:17.900 I mean, this is symbolic. It's not just a building. It's a symbol 727 00:45:18.140 --> 00:45:21.980 of where he thinks he is in terms of his 728 00:45:21.980 --> 00:45:25.580 power. Well, when you pardon people that went into a Capitol 729 00:45:25.660 --> 00:45:29.339 and smeared the very thing that he was joking, he was dropping on people, 730 00:45:29.339 --> 00:45:32.940 and they actually did it on the walls of the Capitol. I suppose you 731 00:45:32.940 --> 00:45:36.580 don't have much respect for the institutions and the 732 00:45:36.580 --> 00:45:40.170 buildings this nation has built, but I'm going to say 733 00:45:40.170 --> 00:45:42.410 this. He wants a ballroom. 734 00:45:43.930 --> 00:45:47.610 He must want to dance. The last time I saw him 735 00:45:47.610 --> 00:45:51.250 on video dancing, it was he and Jeffrey Epstein picking out 736 00:45:51.250 --> 00:45:54.930 which woman they wanted to be with. I mean, literally, the 737 00:45:54.930 --> 00:45:58.530 last time I saw him on video dancing, it was the video 738 00:45:58.530 --> 00:46:02.330 with him and Jeffrey Epstein. So I don't know why he wants 739 00:46:02.330 --> 00:46:06.130 to dance so bad, Heid. Yeah, well, I mean, the other thing 740 00:46:06.130 --> 00:46:09.610 is, just as an aside, one of the pardoned 741 00:46:10.260 --> 00:46:13.060 January 6th attackers 742 00:46:13.860 --> 00:46:17.540 basically has been rearrested for threatening the life of 743 00:46:17.540 --> 00:46:20.900 Hakeem Jeffries. These are not good people. He just pardoned 744 00:46:21.060 --> 00:46:24.740 George Santos, who defrauded millions of people. And 745 00:46:25.060 --> 00:46:28.740 Trump says it out loud. Oh, you know, it's all 746 00:46:28.740 --> 00:46:32.100 okay because, you know, he's a good voting Republican. 747 00:46:32.340 --> 00:46:36.190 Yeah, I guess that's what it takes to get a pardon. Yeah. Well, 748 00:46:36.510 --> 00:46:40.190 and we'll see what happens with one of the ones everybody's talking about 749 00:46:40.430 --> 00:46:44.070 soon. A really, really scary pardon come. They're all 750 00:46:44.070 --> 00:46:46.510 scary. Heidi, always good to talk to you here on the Hot Dish. 751 00:46:49.870 --> 00:46:53.710 Thanks for joining us today on the Hot Dish, brought to you by One Country 752 00:46:53.790 --> 00:46:57.230 Project, making sure the voices of all of us are. Heard in 753 00:46:57.230 --> 00:47:00.770 Washington, D.C. learn more at 754 00:47:00.770 --> 00:47:04.400 onecountryproject.org. That's one countryproject.org. We'll be back next 755 00:47:04.400 --> 00:47:07.960 week. That's right, next week. You'll see us with more Hot Dish, 756 00:47:08.040 --> 00:47:10.040 comfort food for rural America.