Matt and Sarah sit down with Dylan Scott to talk through all the nitty gritty details of the Senate's latest health care plan.
Ezra debates the Senate health care bill with Avik Roy
Dylan Scott's reporting leading up to this latest iteration of the bill
McConnell talking to moderates about tax cuts
How the Trump administration saved Obamacare in Alaska
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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
This episode, responsive by square space, he's Africa weeds a check out for ten percent off you first purchase of webs
and domain hello welcome turnover hello,
hello, hello, welcome to another episode of the reeds on the box media pike network, I'm Matthew Places- and I have with me today s hair, cliff and also Dylan Scott other amazing healthcare reporter, because there is
brand new health care bill, it is,
in some ways more different and in some ways less different from the last hope, your bill than than I would have expected personally, and they were well tell us all about it, but also on the off
is it your Board of Healthcare pie casts the box media.
cause network does feature many other pied casts the lead
sort of a broadly to combat terrorism and the war against ISIS, because he's
Efficiency, amazing, intriguing
gala impression as reclined got some interesting. As I mentioned, the lash sometimes even get felt care
I actually really enjoyed as rose interview with Eddie. Is it who had a whole Larry s recap on the causes of world war? One, I think our listeners, wouldn't you
and if you are ready just to get out of politics and policy all together
Todd Vanderwiller Spot guest. I think your interesting has Arrow Morris this week, untrue crime and the art of documentary. It is a fantastic break
risk schools and health insurance and all those things we talk about here, but I love health insurance
love risk if you love health in ways that clear that you're gonna. Now I think you will have this he's. They think you condemn
with something that doesn't look like old, enter into the bad
choose significant changes. First of all, I did is health both still, if you compare it to the fort
acted still, basically, the same deal like good for healthy, richer people-
bad for poor, sick people. They got still the universe. We're talking about but kind of two
changes that I think are most significant.
one is as amendment offered by Senator TED crews and Senator Michael D,
Essentially, let's these no rules, health insurance plans back into the market, so under the Senate benefit passed today, you could have plans that deny coverage to sick
people that cover very few benefits,
I think this is like the I don't like. The pizza
ever plan. You talked about before the pot get as a guideline. That's like our health insurance policies. We offer you pizza and may be safe to beg, laid against,
but you really would have these very skimpy bourbon.
its plans, and this could really
the potential to wreak some havoc on the insurance market, we talked about the crews amendment
Wednesdays episode of the weeds indefinitely. All of that is very relevant to the Senate Bell and then
The thing going on here is they're, taking out some of these taxes on higher earning Americans, I'm too taxes in particular got remove. That adds a significant amount. I think it's about two hundred and thirty billion of deficit reduction to
of your bill, some of that gets spent with other programmes. Some of that seems to be in the pocket of Santa Claus Mitch Mcconnell, who can hand out present
to the senator is he is trying to win over by
You're, damn policing changes. I think the insurance market. This one sets up. I'm carry still on your thoughts, is way
worse unless functional. You know, then the affordable care
after even the version imagined under the sun it, but I think we would end up being
pretty similar insurance market that existed before the affordable care act with this kind of not
farewell. Funded high risk fool for literally anyone with any health condition. So you know, I think this ranges from cancer diabetes. You knew acute problems to chronic care that you really.
With a pretty too
function on Sharon's market. As far as I see it, yeah, I think one way to think about it is this turns Obama care into a high risk poor. So the crews amendment for those who don't know is basically, if a
Health plan sold and insurance plan that,
eyes with a Cares regulations than they also be allowed to sell plans that don't comply with those regulations, and
It see how that would segment the market, the sick people organ
by the more robust
Obamacare coverage and healthier people are gonna, buy the skin Pierre Non Obamacare coverage and that's gonna drive up the costs in the Obama CARE markets and, as you pointed out
the bill does provide some funding to to help account for those costs, though it's not at all clear whether that's going to be enough, so yeah
thank you know this is sort of a backdoor way. Republicans have talked a lot over the last few months about how high risk pools are a better way to cover sicker people rather than having healthy people.
higher premiums to subsidize the sick and the seems like a backdoor way that tunnel bomber care into that high risk, pull that they ve always wanted sufficient weird thing about how the economics of this would work, because
like in the old pre Obamacare individual market, there are subsidies available to go by these plans. So it's not inconceivable that someone would
surely by this, is kind of like market for lemons right, but you might actually by eleven, because you can get attacks credit to help. You afford the premium
but the plan is gonna have a high deductible. So if you're actually poor,
and you're not going to be able to afford to pay the deductible
The tax credits don't really help you all right.
the one thing that, even here, if you're but both rich and sick.
You now get a government subsidy to buy your hide. It equable insurance plan is that right, yeah, I think that's
decent wage think about it. Although EU its external risky market for you, if you're wrong,
and sick, because the premiums might keep going up and up until you're right
you know, you're not getting the subsidy to subsidies, count that's right, you're. Naturally, fifty percent of poverty, so
actually, no, no, I take better. Who is it? Who is the customer for this? Guy simmer for this line in someone's, like forty
thousand dollars and is sick. So getting the subsidy but out, even though
in a great place, could be Silva six thousand dollar deductible, which, when you're earning forty thousand dollars and like you, presumably after, like paper
to mortgage, unlike all these other things, went peacefully.
Is that I don't I don't know,
Hu, the winner, as I mean you at a piece yesterday, met that the seems to it takes out. Some of the winds were like the ultra wealthy, but doesn't really seem to like fun all that bad.
Into the cuts of health insurance, will it
The strange thing about the revisions that they made as there was a lot of talk about wealth. We keep some of these Obamacare taxes than we can increase the financial assistance available to people, because the Senate,
scales it back from one Obama. Careful
I'd, send point basically pegs it to a higher deductible plan
but the revised builders, and actually do that. It is provides more funding that goes to health insurance companies to have lower costs, but it still seems like the basic structure is going to be higher deductible higher coffee and I wanna watch you, though the presence in this cause- that's like the first bill, came out.
if you look at how these problems
but we did have what we don't have other groups who we ve interviewed. I'm aside who's been on an average plan, and you know he was making a strong conservative case against Medicaid. That medicate is like garbage and that this is going
better because, like even this, like crappy high deductible plan is, can we better, but even he allowed that, like really too
ex that you had to provide more financial assistance to low income people so that they can use the Mikado so here
He was making the case for the Mcconnell CARE vision
the insurance market, but he
conceding that there wasn't quite enough money in it till I get poor people into those points,
and then I was sitting off here, being MR cynical being like what's that
coincidence, they don't have the money like they want, is giant tax cuts, four billion airs, and then I read in in your reporting Dylan that it was like this talk of like just take
out some of the giant tax cuts for billionaires and then they good, then they could find health care, and I thought what that's weird:
That doesn't seem like saying they would do, but what they actually was they took
so they're, so big tax cuts, but but-
giving less, and particularly that is a lot less regressive, but they didn't take that money.
Put it in TAT, more health insurance for people,
and when you look at it it does spend a little bit more money, but the
money. It spends is actually so small that even the old bill had like enough budgetary had room too
do that? What what what is it is opiate funding, yet as forty five billion dollars for a private funding yeah, so they didn't
they didn't need to remove the tax cuts to free up the others, also additional seventy billion. This sum patient civilization fund, but I think one things secularized sounds a little can be using.
and it seems like it might Be- doubled counted in some ways that I don't feel fully prepared to talk about right now. But essentially it is
fund that goes to health insurance companies, like dawn, was mentioning to offset the costs of people
really expensive. So maybe this could actually help like. Maybe health insurance company could decide that
oh I'm going to use this made a lower deductibles. But
it's not a sure, shot that the way the affordable care act, as it says, like ok
no fewer than ten thousand dollars you you get the subsidy and premiums you that the subsidy on your deductible and it's very targeted and
you're. How the money is being spent? This one is like this fund,
It states people money from, but there's no formula for how the money goes out, like you
see you do in some of the gas said it could be used to like rewards states, they're doing things
central government links are, you know, punish state through doing things tat. They don't like it.
of like a big unknown. I think like what is that
and eighty billion at this point with the new money aid that goes
being unknown pile of money that our no done? What do you think about about this fund?
I mean it it's. It seems like a more convoluted way to try to do the same things that the affordable care act already does in terms of luring out of pocket costs and and covering high risk patients. So yeah, I think it's all it's kind of being done in the name of
flexibility is a lot of money. Is funding the state programmes that they can decide how to try to lower costs for people, and I mean the other thing. I guess I just keep in mind. As you know, most of the healthcare industry is opposed to this bill as far as we can tell, but the one thing we know is that
health insurers have often been in the room with sent a republican leadership hoping to craft this, and so this is a lot of money, that's being, but they don't like this guy that NATO is not the crews and men and right exactly when the other thing
just occurred to me Matt, you know in terms of what are they doing with these taxes that there now
keeping as they didn't touch the medicate stuff like this is still a huge medication cut, even though in other a half dozen republican senators who seem
genuinely perturbed by
cuts, thematic area of ending the generous fellow funding from etiquette expansion and placing of spending cap on medicate for the first time, and yet, even with all these?
tens of billions of dollars that they now have by keeping the tax cuts or the taxes on the wealthy. So everyone has- and I want to discuss it. What are you guys are now that we ve seen like the high? They think there was kind of a liberal narrative that, like oh, this is just to do to exploit its like. This is a builder great tax cuts in the wealthy and have taken some those out and
Is that how you guys think about like white? What is the goal of this bill
uniting sort of see it from TED Cruises. Point of view, like the goal of this bill, is to deregulate the helping
Parents industry both care,
Out of your way, doesn't like me,
But what is this? What events relate this bill is trying to do it
I need to say it because, like on its face, if you look at the impact of this bill, it looks like someone is really concerned about
federal budget deficit rain. I dont believe that that's what's going on here, but that's what it seems to me that if you took
face value. Some two thousand
eleven vintage tea party rhetoric that, like debt and deficits, are killing America that a bill that
cuts, taxes some but then cut?
spending now about twice as much as it cuts taxes legacy it's a,
really earnest honest
to guide conservative small government effort at deficit reduction partake.
early, because as big as the deficit reduction in the first ten years is that it,
action in the second ten years, is gigantic, because the the Medicaid cuts are becoming
cataclysmic law. Only five percent cut to medicate intuitions a decade, and I would say two weeks ago I would have said why is there this cataclysmic Medicaid cut, pushed way out into the future?
Is it the reason is because, under the bird we're all that kind of long term, Medicare cut gives you
licence to enact a gigantic tax cuts, but now
like a medium sized tax cuts? So I dont
I wonder if we should start to think about us about it as almost privatizing, medicate or maybe privatizing the medicate population, so the bill you know, ends medicate expansion, effectively. Paces of spending cap on medicated
and then it also adjust. This doesn't go in the town of attention, but it adjusts the eligibility for the tax subsidies for private insurance so that anybody can cloth.
form right now. If you make below the poverty line, you actually can qualify for the tax subsidies because of a kink in Obama, care and the Supreme Court and Yadda yadda yadda, and I thought it was interesting. I was just listening to John Hove in a senator from North Dakota Talk about the bill yesterday and he seemed a sort of be no cause. He's been preoccupied with Medicaid
did, he seem pretty positive and he, as he was kind of justifying what this bill does. He was like well the people in that population
yeah they're gonna get tax credits and maybe some of the for private insurance, and maybe some of the Medicaid money can be funneled to them. To pit help pay for private insurance like and to Europe
earlier about how, over others of very obviously an overarching conservative problem
with medicated as it currently exists, and I wonder if you
It has really been presented that way, but I wonder if that's part of the long,
kind of philosophical
this has been like a long term goal of the Republican Party that I think that's a good point about this
contacts of making medicate much smaller, of privatizing medicated some sort of way
transitioning at two. You know almost doing something that, like Harkin's
to welfare of arm in the ninety nine days of changing the way that the programme works. But
of yours to draw like a lot of wrong lessons from the affordable care act like one. I think pretty clear lesson to me is that these private, more
place clans, like they just haven't like work that great and it's really are
for me, to see, ensures wanting to
now it particularly if you keep this cruise amendment, like insurance companies wanting to compete in this, like zany landscape, where you have like
Britain, the no rules, plans and the tonnes of rules plans, and they don't feel like they can price and like everyone,
talk to the insurance industry. Lake units
some folks, who said that crews amendment is drafted was even worse than they expected that they don't. They had come out this group
come out opposing at bay they'd turn
even worse than what they had expected from at that.
it's hard to see. You knew how
but who are currently etiquette? Expansion like come out and an ok way in this kind of world, even if they do have like those those subsidies that Eco senator ovens talking about will, because I mean this goes back to the the deductibles or too high for the medics,
popular uneasy. Scipio did this in their previous analysis,
Nothing in this new bill that I can see would change that, but they were you know. So if you are eligible
four Medicaid right now, you're making twelve thousand
seventeen thousand or a single for fifteen thousand. So even if you get
a really good tax or even just for free. Ok, we will sign you up for free, but for a plan with a five thousand our deductible. Well, the plans, never getting
can you know I, unless you year hit with some seven?
close and even then it's like not providing the financial protection, because I right you're not likely you could say, oh what these its protecting from bankruptcy. But if you're earning fifteen thousand dollars a year and it doesnt thousand dollar event could like send you to bankruptcy varies,
and he doesn't do the thing that Medicaid does the even in the studies that there
Frankie right wingers like two point two like say that, like
Betty cave. Let poor people like go see the doctor. They got their cancer, diagnose, they got their blood pressure taken, you know like,
like routine stuff, you can't do that on a five thousand deductible plan
when you're living below the poverty line. I guess it's true that eventual
de the spell allows states and almost forces states to apply for their medicate bunny to become a block grand in the book.
It's more in the distant future, but that, but the cuts are get so severe that I think you would have to do that.
Then you could say I guess in your background application will, instead of giving any body Medicaid I'm gonna help.
I'm gonna use Medicaid money to create pre funded each essays for people, but that's very hypothetical
There is a precedent for the right, so, like Arkansas has expanded Medicaid, but use that money for people to buy private insurance on their exchange rate. They use their medical expansion money for people, yet private coverage so yeah
different private compromise like ground because they ve all this Medicaid money. The deductible
basically non existent like the public, they had to put these
guard rails around the traditional private coverage because they are dealing with this low income? Putting so is more like what I think Senate Democrats
initially wanted. Yes, the whole thing to be
and then they wound up concluding that it would actually be cheaper.
to do a lot of medical aid, but the abundant restriction is supportive of like Arkansas, and it takes a bit some background arson sized ages ago and twenty fourteen Arkansas kind of, like others, innovative idea of using its
Kate money to buy private coverage in the marketplace that helped. You knew that kind of in the marketplace. Look at more robust,
but in order to do at the administration acquired like these, people have to
like a similar experience to medicated. They can have this big deductible. They can't have these big premiums,
to give them or non emergency transport to their doktor appointment, to give to make it look like Medicaid to them, and I don't think
That is exactly what what
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several domesticated that in the out years, right back
Firstly, in the make expansion and then they cat Medicaid spending, which is what the house built right, which is basically say you have- is a form of five categories of people.
It's for running fire soon for categories of people, it's our kids, disabled, elderly, pregnant women, ethics, us, why not pregnant women
Answer then, for each kind of person. There's like a cap, you got you know whatever thousand dollars for a kid,
and then that is set to grow in the house bill at the rate of medical services, inflation with
You know, ok, that is those problems with it, but I can make the case for that right.
What what conservatives would the house
is saying, is like luck
we shouldn't just have a totally open, ended commitment to Medicaid spending.
We should have a real.
Annabelle fish were strained to on it, and states are gonna have to make this work.
You really do matter showed to peace, about who's. Gonna lose out in that framework
it's a cut? I mean it's a meaningful cut, but it's a cup with some. I could. I could explain to you. What is for
in the Senate bill. The per capita caps grow at that
overall rate of price inflation, which is quite a bit lower right and
no you crazy situation. Word saying: ok like treat these people, but you don't have enough money to treat
yeah well, and that that cut or the deeper cut starts and twenty twenty five. I think, which is why, if you look at the longer budget window, the cuts become that much more
severe and that's. What's that's one of the things in this is maybe getting more to political speculation, but that's one of the things that's perplexed
about this is because you know, there's a half dozen senators who have been really hung up on this lower growth rate for the spending caps in the later years, and
really it what it costs that much money, at least in the ten year,
a window that were using to evaluate this bill to just bumping up toward the House bill had to her to our growth rate, that's linked to medical expenses and yet Mcconnell
decided, not believing crazier. He has told this matter, as I think actually supported this
have to worry about these far range medicated cuts, because they'll never take a fact taken. Some point, though, intervene
in the wood and more money like oh, we can actually with those deep cuts take effect, but you presume, if, like your goal, was not to have the deep cuts. You just change your bill, but I want to talk about the
forthcoming, Scipio report and links and expectations there, because
going to come out Monday, two days from now and will not have a podcast on Monday. As far as I know, but I think one thing
interesting is how this cruise amendment
had scored and like how that is in clear
it seems like the crews moment, might not even be score too, might be scored separately by each US and when you think through like one of the reasons they might, I want that to him
Ben is thinking back.
To the ceo
post from December, that kind of stuck in my mind is severe like us have a way of,
we are doing in there
issued this kind of like out of nowhere blog posts last December, where they basically said like we
are you guys, are gonna work on Obamacare appeal and like war or not
a score like anything.
Health insurance? If we are going to count someone is covered, it has to do that
is provide financial protection against high medical costs, and it seems like these plans that might be offered
the crews. Amendment may not in fact, do that
This is one the reasons the crews amendments really hard Presidio to score. They ve never said that cares what counts as financial protection. They just said like it has to offer this thing
or financial protection, but I dont know if these plans
like offered in the crews, amendment meets that arms metrics. You could
see like a lot, and then you can really see this Scipio report.
can warlike had a fever.
receive studio, saying all that stuff, not helping
France and then Republican, saying we're like look at this bias. Scipio like we're getting all these people covered, and they won't even count at it seems like
could be a relatively contentious report that we get on Monday. Dear into your point, for totally different reasons, I was asking some budget experts last night what they were expecting from the sea, biased Gore and usually they, it seems,
They have a pretty good handle on what to expect, but yesterday they seemed totally perplexed about how the crews amendment is gonna shake out, and so yeah seems like a
x factor show how many people had do. I won't budge on the spot, but like in the
pre Obamacare individual insurance market, like those plans or pre crappy.
but they must. I warrant covering very many people write. It wasn't like a soup
Popular with small, I want to say, is around like tend to eleven million people in the individual market. Piazza it certainly ground it hasn't grown as quickly as the drafters at affordable care acts would have liked, but
plans that have been the way you measure. The generosity of a plan is actual aerial value. That per cent of benefits covers reaction for em. You don't ever
beneficiary and you would like forty.
fifty percent av plans, meaning like for the average person you're buying this plan, your pain premiums, and it covers forty percent year medical.
Last year on the first sixty and I dont know like how they do
like a bit of like philosophic argument like what counts is health insurance. Where do you draw the line that I think people would have varying opinions?
but yet you have some real you're, too small, a market with plans that were not nearly as robust as the ones you have now to what I said
Small wish, but may be big tweak. That's in this group amendment is it
you could. You is
each has a mighty to pay premiums on the individual market which may,
makes this whole thing more. I don't have it
people. This would apply doubling if you were
genuinely pang at a high income tax rate but for some reason didn't have health insurance, which
I am a little unclear, unlike who this is, but it would be a lot
financial assistance to like a hypothetical like wealthy, yet somehow unemployed person.
HU, I don't I haven't. I really dont know who this is but like that that seems like rain. I guess
someone in a start up, maybe who, like doesnt, have like a health insurance plan,
in Silicon Valley. I don't know I'm trying to figure out what is known as you start to really benefit I dont now, but is it like upper middle class
You know, I mean it, you get there, some benefit all the way down. But how do you know how much whenever you get from age essay I was. It depends on what you are your tax back it s right. So if you make over four hundred fifty thousand dollars a year, you're paying marginal tax rate of a forty percent or more
depending on what say you live in so being able to use agent, say money if you're like a new Yorker California, Andrew Soup Ridge is like fifty percent off the on your insurance premiums.
It's a great deal. But again I'm I'm sceptical that there are like a lot of people
earning seven hundred grand living in
city but for some reason there can't get employer sponsored health insurance.
Think in your head, you like, well, maybe it's movie star is right, but
but they have this screen actors guilty of this a long time ago, and so they have
A union plans armor its
Sars is Taylor. Swift, as I have to tell you, I don't know if the musicians have have some kind of some kind of guilt for this. But it's it's a week,
think women have seen some liberal economists expressed concern.
this is gonna, be like it really big, expand,
of agencies, as as it serves
tax evasion and tax avoidance vehicle for fry income people, one of the other things going on, as I think they're, also lifting how much you can contribute to age is worthy of two things going on. Both you can spend reaches a on more things and you can contribute more money to its way and today
the kind of thing we're like in some hypothetical
Conservative science fiction universe, where you eliminate the employer sponsored
tax deduction. These new, much bigger age essays become a really big deal and it becomes that this,
broad upper middle class. Professional laws would be sheltering
tat sheltering money in ages is
then, using that money to pay for premiums for high deductible insurance plans and may the out of pocket costs. And then I don't know what has happened to poor people right but like the predicated that doesn't apply it like most people, most like
for income people dislike, have jobs right, cause obvious. It is your bike ideologically it's about equalising the tax treatment of health insurance right right
and I wonder if this is part of more of a long term play
like there was originally in the House Bill way back when there would have been some changes to the tax treatment of employer based insurance, and they ended up getting rid of that because its german,
ethically unpopular politically. But I know like when I sat down with the folks at heritage
shortly after the action they were like you're getting rich
the tax exclusion for employer based insurances, like our number one goal for health reform, and I wonder if they still have that that in the back of their mind and so giving some wins on H. Essays now helps for that country.
On like lay the groundwork, for something like other seems like weird. Yours is going in the other direction like, instead of and it's like, almost making it
I would actually you'll handling the playing field over. There sat right exactly easy you're trying to like you have like the employers lantern at a very high level in your point, other people up like a little closer to that right, but I do think again, like I don't know, like Don T, you know you're working like at a fast food restaurants,
and maybe you're already and trying to think. Through this situation, like someone whose working I have asked,
round there already they're getting attacks credit. They are already paying their premiums, like maybe they're, helpful,
all the others. I dont think that, because he's ready, you know
patients. Savings accounts at five. Twenty nine accounts for one cake, you just you have to be pretty rich to be like running up against
you're tax law ability to live
stash money in these different kinds of accounts. Like the reason people don't aren't Maxine
his accounts, is like they don't have that much money
There is one of the many I'm like rent and gas, and suchlike
I recommend you to imagine an american whose, like
sing out his our contributions. Maxim out, outdoes five. Twenty nine
tribulations Maxie at the eggs.
sting small, H, essays and then like just like.
Has this money burning hall in their accountants pocket, and so this is a I dont like the not doing the tax cuts in the not using the money for anything,
like it does its feels like
a move in chess game, that's supposed to say,
something else out, but like Y yeah and alone, it seems
far fetched, that wherever gonna get to their endgame spun,
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So should we talk a lot about the vote, so he s an essay like what what's next week, look like telling your are our man on the hell soul, end of all
that's the way I see it we need yet we need. We need senator sand of all to make his position be then
and actually for Governance Association is very close by wondering at the Democrats could like pay for him to fly down to DC and obtain Heller's ear. It would deceive us like this bill. That's CBS
they are no longer the governors that I'm guessing CBS
and they even weight and make us less medical's mending. But that's engineers are there anyway, sorry. So what happens next week so right now
looking leaders are saying that they are going to hold the vote to start a debate on the bill on Tuesday, and so
it's really just a procedure, although it's not of, though on final,
acid, but I think everybody is treating it as the money, the crew
shall vote because, once you start debate on the bill which then,
Shelly allows you to get to a final vote on the bill and how many votes do need to open debates. You need fifty votes, but plus one. If vice president pens has to come down and break a fifty fifty tie, and so right now after the revised bill was released yesterday there are fifty two centre, Republicans and Susan columns of main and ran. Paul of Kentucky have already said that they would oppose that
see, drove out to start debate and so
Mitch. Mcconnell is already working with no room for air. There right now are
essentially fifty votes to start a debate on that
and so that's why we have our eyes on these senator
like Dean, Heller of Nevada, we LISA Caskey of Alaska, showing more Capital West Virginia, who have been pretty apprehension
about the Senate bill thus far, but have not yet said whether they would under the revised bill, whether they would vote to start debate or- and this is a group whose, like yours,
like their concerns, were not met in this new draft,
da, like the draft really felt lake it addressed. It pulled the bill very far. Right word an outlook. What's your juvy like they get like special
handouts at this point, or how do you read like Kazoo, because you said they have all these medikit concerns that are its answered aware and this bell right like how did they get on board or do they get aboard? Yes? So I will note that this group,
England, I don't think I mentioned, Rob Portman of Ohio but he's another one. They met with Mcconnell for about two hours. Yesterday afternoon, after the revised bill came out, you were there. I was there. I decide to highlight exile out a shave after that anyway, so
Nobody really said much coming out of it, but I would know
guess two things: one is the bill, as the folks at Bloomberg. Already flagged includes
a funding stream that effectively, it doesn't say this, but its effectively for Alaska and therefore early summer Caskey.
and the quota kick the higher back. Ok off, I saw at Genoa Jackpot, which I thought was pretty good,
And so we won't know exactly how much until the new CEO score comes out, but Mcconnell is gonna have some sum of money. I got like a very rough estimate that it could be like a hundred billion dollars that he can add to the bill whilst still meeting the budget rules that he must under the Senate process and so that it becomes a question of
Yeah I've seen some lobbyists. Thank you know. Maybe he'll still increase the growth rate to the to match. Medical's fixed spend the chairs do not satisfy some of these senators or maybe we'll start to see more targeted provisions. That means are directed to Nevada are directed to Ohio and West Virginia, but I think it's hard to know. You know, that's probably those conversations that price
yesterday. I mean one thing to be said about this: is that if we had,
seeing the passage of the bill in the house? I think we will.
Be saying this is like a non starter
read that you have a half dozen senators whose
stated objections to the first bill are not addressed here at all. The bill did some other things would seem like they make it worse. From the perspective that stated objections, and so it can't pass,
substantive change, but we saw this movie in has representatives
where you had some defectors from the right, and you had some two fingers on the left
change the bill to answer the concerns on the right and then
Most of the moderate just got on board for no reason before I mean
There is more, maybe they had reasons, but it really was the the bill.
Did not change to answer their substantive concerns. It's more like
one is the bill wasn't going to pass. They were
to raise moderate sounding objections to it, but once the Freedom caucus was no longer blocking the bill.
how's Republicans from California in particular, didn't want about the bill either
and so in the Senate. You see something a little bit like that's right. I mean I M like normal world. If you have a bit
and they have shown more capital saying I can't
This bell, because medicate cuts extra money for
Aids is not good enough. It's about the Medicaid cuts and the new
of comes out with some extra money.
opiates, but it keeps the medicate guts.
capital would say right away as I
at last week. You know, and then we do not like knowledge. This is doom dried, but that, like something else, has to happen, but instead
All this we were foot from like no two undecided in a mist
Yes way that I think is making the progressive advocates very queasy
that you know this is, can be a little better hand, waving and Sworder legislative magic, but
we just all based on what happened in the house, and I do think this is
the second, is a little bit different from the house. Just in this
All of these centres are even most of them by any means, but that, like
Collins, loosened Rakowski, Rob Portman, certainly, all like are much more, but it did much bigger politically in their state. Then, like the Republican Party per se like well Poorman, ran, I think, ten points ahead of Donald Trump and Ohio, at least in my house.
Beat the Republican Party nominee to win her election. Was you to write and valor anyone? This debt, which is his criticisms, were actually Ozma, colonel, absolutely nothing right. So why don't you say that they want to back down but that they have the means to not
mostly senators who we are representing statewide office in states that that quite successful medicate exam
chance that they really have like a lot on the line here.
Alaska as a provision in state law that, if the funding mansion medicate expansion drops, they stop participating and I think they their depart. They'll ask a department of Health and even services put out some figure like
their done in twenty twenty mitigates. The engine is over. You know, despite the polar pay,
offer whatever that helping out in the private market like this is the end of may
then it's a lot of federal money lost and then
well like Boatport men
an Heller. Have these governors, who Erlich constantly until
in talking great medicate, as in warlike, become
he's weird salesman for the affordable care act. I think it's a different.
You did not have that kind of dynamic in the house. I think I could follow the House path, but there are more
shares in this case and more fun,
ability, given like their strength at home, that that may be suggested different path. Squares banks make your next move. Make your next website make it quits where space people need to have websites in
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listen Dean Heller specifically in the crosshairs.
I mean he's the most interesting character to me, because he is he's in the most precarious,
the composition has to run for reelection next year and us
that is increasingly trending blue. You know if they are elected, democratic senator last year and voted for
Laurie Clinton over Donald Trump and he's got
an overwhelmingly popular republican governor Brian Sand of all who one I had forgotten this? He run one reelection in twenty fourteen with set
the percent of the vote, which has just how absurd and he is
Fleetly, embraced Obama care the expanded Medicaid. They created their own exchange and
stood side by side in late June and said the Senate bill isn't good enough, and if this is the building were not yellow sand of all
that he would oppose it and how are basically said, if say, and of all those that then I oppose it and there
no indication as we ve been going over and over again that that anything
changed in this bill. That addresses their substantive concerns. The flip side of
is that from the beginning
Susan Collins seems to have been given like a pass on this from republican leadership, which is a kind of reflection that she's
do what you gonna do she's been in Maine. Politics sense like before the dawn of time and main is weird, and it is what it is
is Heller has come under intense pressure. There was like talk of trumps, super pack,
adds against him. There's this story about Steve Win and whose
it shall aid ought also big casino guys in the state, like really leaning on him. The quote was
republican say tell our is gonna, be bought off, rob and sew up. I mean it
a dilemma in the sort, hyper, partisan era that people face is that if you personally are like a huge political friend,
I said you're state the waiting counts, as in me in or were John Mccain, isn't Arizona. The din bucking your party and being independent, can be great for you,
because there's this voters who were dad and like you, you just big news,
like I'm doing? What's right? For me but
however, is not like up like a famous political superstar he's in an actual tenuous situation.
Nevada, and he he needs to appeal to cross over voters, but he also needs the enthusiastic backing of republican Party donors and of Donald Trump. He can't have
he'll send sand and when he can have like donors and republican Party leadership, saying
we're through with within Heller. He wasn't there for us when we needed
m like let's let whatever Jackie Rosen take the sea gas then he's definite
do, but I'm curious. How does he? How does he ever walk back from the press conference
I dont think like using a kind of these republican donor is, but if he is totally out of sync with the rest of the staff, like a ethic when the interesting things
watching so the way this went out last time was, I think the bill came out on a Thursday on Friday
Sandoval and they are like have this press conference are basically like Sandra Bullock talks for a long time about her
Obamacare is and how they were accepted,
opponents as a few words visiting the guess. I agree and then that's really
the sound of a press conference. So I am curious eyes.
to see, if, like later today, which is Friday, if he once again like inserts himself in a high profile leg, think that shifts
It makes me think you know you're doing a hint of dislike republican super donors against him. I don't know if you can like survived the lake democratic, progressive world
its becoming increasingly strong and in Nevada,
completely you're going against them either they really high.
for me to see like how he comes out
this on either side, because I think he's become for progressive activists like this flashpoint. I d do person to focus on that day,
well, just just as conservatives well like they will go hard at hand if they see him vote for this, that the old fashioned thing for him to do would be to
mid to voting no one s and to them
give Republicans a gut check moment where
either they support the most vulnerable nominee, because party leaders support them
honourable members, and try to get them reelected, or else he switches parties right, but that the island Spectre Press
and was that gives you a spectre. Remember: wound up switching parties in that kind of circumstances. He he defected to vote for the stimulus bill
and then the republican Party leadership had been protecting spectre for four years, but he was like
Prime Tea party moment and like he was gonna, lose a primary challenge to pat to me. He switched to
Democrats. But then he wound up losing the democratic primary right,
the Democratic party leaders were not able to like seal the deal,
way that that you would want, because the flip side of this this whole thing for Heller,
so it's gonna make it tough for him. Is it it's not like if he votes no on this, that the
the Culinary Workers Union in Havana and the diseases of one or two house Democrats who are vying turning out some then I can all be like. Thank you deem hell, hurt you saved, Obamacare, they're gonna still be gunning for right, and it's like,
you know this is again a difference would like for
for Reasons Collins and we're are unbeatable by Democrats so like they can just like gain
credit, but I can also those good only the number one target, no matter what he d waiting, awesome or Kuski, as I and Peter Bull, by challenges, as she has proved. With her right hand rang, like she's seems
someone who can do like whatever the fuck she was at this point, but Heller's like very much stuff. I don't feel like a good way to come out of this.
For I am the only I mean them. I guess the best rationale I could think of for him to turn co and support. This bill is just a sort of
contain having a future and republican politics
you know like. Maybe he just wants to go work for the Chamber of commerce someday or something
I do know the one tricky thing I just I fallen about politics a little closer than others. They lived there for a little bit and I'd be wasted,
have. You ever saw him yeah and I do know I've seen John Ralston Report that
maybe the one logical thing would be for Dean Heller to lose next year and then run for governor something, but I think there are some pretty. The sand of all is is termed
in either twenty eighteen or twenty twenty, but I've seen reports that the
republican side of the next governors, races pretty robust already, so that might not be a winner he's in an impossible eyes why? I do not envy. I know it is cause for Harry read to me:
some calls and works it works at magic. He must be loving Serbia
I mean I'm sure he I'm sure he is, but I mean it. It's yeah I mean he's he's stuck great, but even though the way for Democrats to win this fight would be to build a bridge for Dean Heller into the Democratic Party, it seems to me
The two eldest offer him that opportunity worldly summer Caskey ends up killing at amending Heller has covered
yes, that's true. She could she could she could do I'm a favor. I enjoyed sing with with more cowskin, because there is this. What
caught cardiac cutting a kick back a cardiac, so one difference from this. Unlike the Louisiana, purchased or Orson, that is met net with this provision in
I'll ask us to Warsaw. Oh yeah, I think a very small like the moment they lose from medicate is really significant. Unalaska got something
say brought about this week that I've no eighty of this really agents Annabel boat. The Trump administration, actually took a very big step to make Obamacare work.
better in Alaska. They are sending them forty eight million dollars for this programme,
I'm off at the cost of expensive patients. They think it'll be deficit neutral because they will spend less on these tax subsidies. So in the first time in the Trump administration, take a big step,
to make Obamacare work better and you can really feel more details on boxer. If you
Dr Journeys, letterbox, carry you would have done that in your inbox on Wednesday, but these things
like small potatoes, like the money for Alaska medicate expansion and, like
Maybe it's oh. You mean, like the quota, kick back to be like something in the Medicaid
is because, like said earlier, alas, is ready to pull out of them
and expansion of the funding goes down here and she's.
pretty directly that this is not enough. Like pray,
ITALY and when I interviewed her last month,
she more or less said that, if any
bill, ended medicate expansion. She wouldn't be able to support
and she's told the state legislator
legislators as long as you want medikit expansion. I want medicate expansion, so I am a little purpose.
Plex why she hasn't just come out and said to oppose this bill, cause her entire public record over the last few months. Succeed
that she should but, but
I don't see. How be the coda kick back of the polar path can can Vienna
does it mean I edges so, do things worth Amazon, we classic state based legislative pay off the ideas to make your state better off than it
as before the bill ride so like. Maybe you don't actually love the underlying concept, but there's like
deal. That's like really good for you. So little
deal where you're less worse than other states, with which I am
my dear Sullivan standpoint, I sort of secret, so it's like your ideologically committed to the vision of this bill, but it's a disaster for Alaska. It's now like it's only
not specially catastrophic for Alaska,
bad and the sensitive like bad for all. Medicate expansion states more or less, but yeah it doesn't mean. This is across the board right. If, if cabinet port men were Cowskin Heller, that's about them
the big ones here if they meant what they said, this bill would beat yeah. I think
that's right and they could all you know- maybe we'll see a situation where they all come out together so nobody's the third vote that killed this bill or something and I,
heard over the last couple months that you know those that group is
trying to stay in pretty close contact and present sort of a united front. So maybe they just have an agreed yet on how
actually they're. Gonna oppose the bill, but otherwise it does seem like they'd have to basically walk back
thing that they ve said thus far about not being able to support a bill that cuts medicate. This deeply.
we'll see what Heaven by next by one, sees its yes but don't walk back your phantom of the weeds and other fine vocs. Media pied casts chicken worldly, as reclined show. I think you're interesting, I am looking forward to hearing eddie- is its take on the causes, work where one personally, it's pretty good. You know share share, share Europe, this with with all your friends and year joiners as in weeds Facebook Group, where you can talk to, I think about six thousand other weeds man's. It's a really good discussion will have a link to the group and description of this package, and while we will not have an episode on Monday to to match the c b o score, may I may happen there and makes a example marks on the facebook, page,
So thanks to two Dylan and Sarah for taking the time extra producer Bert,
anger term, and we will see you next week.
Transcript generated on 2021-09-13.