Here & Now

Here & Now for June 30, 2017

Frederica Freyberg:

I’m Frederica Freyberg. Tonight on “Here and Now,” in our first look segment, we examine the policy and politics of the U.S. Senate health care bill. Senator Ron Johnson is here. After that a closer look at a man who visits the Wisconsin juvenile corrections facility every week, trying to impart a positive message. Later, the latest approval ratings in Wisconsin for President Trump and Governor Walker. It’s “Here and Now” for June 30.

Announcer:

Funding for “Here and Now” is provided, in part, by Friends of Wisconsin Public Television.

Frederica Freyberg:

Wisconsin Republican Senator Ron Johnson put the brakes on a vote this week on his chamber’s version of the Obamacare repeal and replace bill. He said it was because he needed more time to study it. The ardent opponent of the Affordable Care Act also has said he doesn’t think the Senate bill goes far enough. Senator Ron Johnson joins us tonight. Thanks for being here.

Ron Johnson:

Hello Frederica. How are you doing?

Frederica Freyberg:

Good. I wanted to ask you right out of the chutes your position on repealing the ACA now and replacing it sometime later.

Ron Johnson:

Let me first explain. I don’t think I've ever said it doesn’t go far enough. It doesn’t fix the problem. I certainly thought a week after a discussion draft was presented to the public and also to CBO, it was way too soon to really take a vote on it. So I wanted the extra time. We had intense discussions. I think there will be improvements made to the bill. Nothing will be perfect, but the architecture of Obamacare particularly in the individual markets just has failed. Premiums on a national average have increased 105%. They’ve doubled. Some places tripled as well. We’ve got to fix the problem.

Frederica Freyberg:

As to this question about your position on repealing the ACA and then replacing it later.

Ron Johnson:

Well, I'd rather do it at the same time. Now, I think what’s abundantly clear, we don’t have the votes for total repeal. I would like to do that because I think it’s a whole lot easier to replace with something that would actually work. But for quite some time, after the election, it was pretty obvious that we probably didn’t have the votes for full repeal. So that’s one of the reasons I started talking about let’s focus on repairing the damage done and that’s primarily in the individual markets. And then it’d be nice if we could work in a bipartisan fashion, transition to a system that actually works. From my standpoint, having participated in a free market system, is bring in more consumer-driven free market competition to restrain prices, improve quality and customer service.

Frederica Freyberg:

So altogether what’s it going to take for you to vote yes on a Senate health bill?

Ron Johnson:

First of all, I never said I was no on any bill.

Frederica Freyberg:

Right.

Ron Johnson:

I just said no. We can’t vote on it this week. It has to be an improvement. I guess that’s my manufacturing background. I do not expect perfection. This is such a mess. It is so complex. We’re not going to come close to perfection. But I will evaluate anything I am going to have to vote on in the end. Is it going to put us in a better place tomorrow than we are today? I have to admit. That’s a pretty low bar. But I think going in so many of us have said we don’t want to pull the rug out from anyone. I don’t think we are. I want to make sure we’re focusing on premiums. The gross price of premiums, because if we can bring those down, recognizing what caused premiums to artificially increase, we can solve so many problems. That’s really been my primary focus.

Frederica Freyberg:

A lot of people are focusing on Medicaid. Do you think the measure should reduce available federal funding for Medicaid by more than 25% in out years?

Ron Johnson:

First of all, what we’re focusing on is eliminating the additional expansion of Medicaid expansion, which Wisconsin is not participating in.

Frederica Freyberg:

Right.

Ron Johnson:

In 2008, we spent about $200 billion on Medicaid. Last year, nine years later, we spent $400 billion. So it’s not exactly like Medicaid has been starved. What I’d like to do is devolve the management of core Medicaid back to the states. I think like Wisconsin, we do a far better job. What we’re trying to do is stop the Medicaid expansion which is going to threaten the stability of core Medicaid. When everybody is talking about how much we’re cutting Medicaid, what we are doing is we are putting Medicaid expansion on a glide path so we can focus on core Medicaid so people with disabilities, young, elderly, those core beneficiaries of Medicaid, that those populations are protected.

Frederica Freyberg:

A lot of people want to know how do you protect states like Wisconsin from being hurt because they did reject the Medicaid expansion?

Ron Johnson:

Well, that’s one of the things I've been fighting for, is there’s a disparity. There’s always been a disparity. Some states get more federal funding than Wisconsin. And what’s really unfair about it is responsible states, states that have high-quality health care at a relatively affordable cost, we get penalized in the doling out of federal funds. One of the reasons I think devolving the administration of Medicaid back down to states would be in the end, fair. But I don’t want to lock into a system right now that is unfair. It’s not going to be completely fair, but that’s one of the things I'm really fighting for.

Frederica Freyberg:

Do you think any bill should include protections for pre-existing conditions?

Ron Johnson:

Absolutely. But the architecture of Obamacare puts those protections, the burden, the cost burden of that, on a very small slice of the American public. That’s why premiums have doubled, in some cases tripled on the individual market. What we need to do is separate that population out. Those with high-cost and pre-existing conditions and we need to subsidize those. We can do that, keep premiums at a reasonable level and affordable level without penalizing the people Bill Clinton talked about. Those folks out there busting it, working 60 hours a week. They make enough money they don’t qualify for any government assistance. They’ve literally been priced out of the insurance market, which is why I’ll come back to, I want to focus on bringing down the gross price of premiums. It solves so many problems. But no. I think our country has decided we want to protect people with pre-existing conditions. We can do it in a manner that doesn’t collapse these individual markets and doesn’t unfairly put the cost burden on a very small slice of the American population.

Frederica Freyberg:

How do you do it?

Ron Johnson:

Through things like, for example Maine passed guaranteed issue. That’s what this insurance policy is called to protect people with pre-existing conditions, guaranteed issue. You guarantee that anybody can buy insurance at just about any point in time. That collapses insurance markets. The analogy literally is, who would buy auto insurance, collision insurance, if you didn’t have to buy until after you crashed your car? That would crash the insurance market? The same thing happens in health care. When Maine passed guaranteed issue, their premiums skyrocketed. So without even repealing guarantee issue, they supplanted it with something called an invisible high-risk pool. A little bit different operation than what Wisconsin’s high-risk pool. Wisconsin’s high-risk pool isn’t perfect, but it worked pretty well. So we should take a look at those best practices example. That’s the path toward guaranteeing people coverage with pre-existing conditions without collapsing markets and without causing premiums to skyrocket.

Frederica Freyberg:

You've said this week that you could support maintaining some of the tax increases in Obamacare? Which ones?

Ron Johnson:

Well, first of all, again, we’re not repealing Obamacare. We’re keeping an awful lot of the architecture and certainly a lot of the benefits. Again, 20 million Americans got health care. We don’t want to take that away from them. So when you’re going to be basically carrying on about $443 billion of Obamacare subsidies forward, that’s in the current Senate bill. I think we ought to maintain whatever revenue flow to fund those benefits. I’m very concerned about the fact we’re $20 trillion in debt. Over the next 30 years, according to CBO and we’ve turned these into dollars, $129 trillion of additional deficits. I’m concerned about that. So if we’re going to offer government programs, we ought to be able to pay for it. The first one under discussion is the investment tax. That has nothing to do with premiums, has nothing to do with cost of health care. That would probably be the first one not to repeal or basically to retain.

Frederica Freyberg:

We need it leave it there. Senator Ron Johnson, thanks very much.

Ron Johnson:

Thank you.

Frederica Freyberg:

For her part, Wisconsin Democratic U.S. Senator Tammy Baldwin had this to say about the Senate plan. The people of Wisconsin did not send me to Washington to take people’s health care away. We should be working together to make things better, not worse. And the CBO makes clear that the Senate repeal plan will leave millions of families behind. Health care systems and physician groups in Wisconsin have been vocal about their concerns over possible negative impact of the Senate health care bill. Concerns for both providers and for patients. For more perspective on the Senate health care bill we turn to Bobby Peterson, executive director of ABC for Health, a public interest law firm that helps connect Wisconsin families to health care coverage plans. Thanks for being here.

Bobby Peterson:

Great to be here.

Frederica Freyberg:

Right now, out of Washington there is this discussion of just repealing the ACA and not replacing it. What’s your reaction to that?

Bobby Peterson:

Short-term, maybe it’s a win, but it’s a loss for the people, I think. We don’t get to a situation where we actually make things better. Just repealing the Affordable Care Act doesn’t get us to the right place.

Frederica Freyberg:

On the Senate bill, there are many constituencies, as you know, sounding the alarm over the proposed reduction in Medicaid funding. Who in your mind would this hit the hardest?

Bobby Peterson:

Well, there’s 1.2 million people in Wisconsin on some form of Medicaid. It affects a lot of people. A lot of family, friends and relatives. So seniors in long-term care, children with disabilities, young children that need health care coverage, low-income adults, people with disabilities. So it has a broad impact. And I think that’s why there’s been such vocal opposition. These Medicaid changes are significant and alarming for a lot of folks.

Frederica Freyberg:

Now is Wisconsin hurt more than states that expanded Medicaid because it would be capped to what was spent in 2016?

Bobby Peterson:

Sadly, yes. I think that’s one of the bad outcomes of the bill because Wisconsin is penalized. A lot of us thought Wisconsin should expand Medicaid and we’ve lost a lot of money. We’ve left a lot of federal money on the table that we could be using, replacing GPR funds. We could fix a lot of roads and improve K-12 education with those funds. But it’s going to be a significant amount. Missouri Hospital Association came out with a report that said over the next, till 2026 it’s over $30 billion that Wisconsin loses out on.

Frederica Freyberg:

And yet here we sit and having perhaps the governor was right when he said, “Well, I don’t want to expand Medicaid because I'm afraid the feds won’t be good for that money” and kind of here we are.

Bobby Peterson:

Right. But you always — the feds — we take $12 billion a year in federal money. So what category of federal money are we going to say they’re good for and they’re not good for? So that argument didn’t carry a lot of weight with me because we’re heavily dependent on federal money in the state of Wisconsin for a variety of things, our roads, our education system. So it was a bad decision and I think most people agree with that.

Frederica Freyberg:

What are you hearing from clients that you help with health care coverage about all of this?

Bobby Peterson:

Well, the volatility, the dynamic of what’s going to happen. Am I going to lose pre-existing condition coverages that I've had. Are we going to go back to high-risk pools where I feel like I’m in health care segregation? Those are some real concerns people have. Are they going to cap Medicaid? Is it going to lead to health care rationing? Which you have a sum sufficient of money, and it ends, that could be an outcome.

Frederica Freyberg:

Do you feel as though the policymakers in Washington are hearing all of these concerns?

Bobby Peterson:

I think they will over the break. I think they need to get out of Washington to get back and talk to their constituents and realize I think for a long time Medicaid has just been considered a welfare program for poor people, but it has a much broader impact. It has expanded its spread at some point. It’s a fundamental core of our society and cares for a lot of people.

Frederica Freyberg:

Isn’t that one of the issues, though, that it’s just expanded so much and it’s so expensive?

Bobby Peterson:

Well, it’s expensive, but in some ways it can be more efficient than some of the other programs out there. It depends on how it’s operated. But Wisconsin runs a very efficient Medicaid program in many respects. We have public/private partnerships with Badgercare that extend coverage through managed care organizations, that provide Badgercare plus commercial coverage. I think there’s some innovations in Wisconsin that are worth looking at that make the program run more efficiently.

Frederica Freyberg:

So let’s take a look at a potential Medicaid recipient. You choose whom that might be. What are they looking at? I mean, they’re not looking at immediately losing their coverage.

Bobby Peterson:

No. And I think it’s time to speak up and say how important your coverage is. But I think the people we represent. And we’ve been representing people on Medicaid for the last 23 years. Navigating systems, difficult coverage situations, people with pre-existing conditions, the fear is that they’re going to lose important coverage or services that they have that have helped them stay in their community, stay in their home, work, transition into jobs. So those are things that people are very concerned about that we’re hearing from.

Frederica Freyberg:

Now, framers of repeal and replace talk about Wisconsin going back to its high-risk kind of insurance plans and you mentioned that it was called HIRSP. What’s your reaction to putting people with pre-existing conditions into that high-risk plan?

Bobby Peterson:

Yeah. It’s going backwards. In Wisconsin we like to move forward. This is not the right direction. We’re segregating people with pre-existing conditions. It’s difficult to manage in some ways because self-funded plans don’t have to pay into the pool. It’s a small group of insurance companies, as it was set up previously, that help support the pool. And premiums were very high for people. You had a six-month waiting period to get into it, so people end up dying before they become eligible for coverage. It’s an anachronism of the past. I think most people have moved on from that to say we’re going to find a better way to cover people with pre-existing conditions than to segregate them.

Frederica Freyberg:

We need to leave it there. Bobby Peterson, thanks very much.

Bobby Peterson:

Thank you.

Frederica Freyberg:

In tonight’s closer look, a federal judge in Madison has ordered changes in use of solitary confinement and pepper spray at Wisconsin’s juvenile prison. The ruling came last week as the result of one of the lawsuits filed on behalf of inmates at Lincoln Hills and Copper Lakes School. Even as a federal investigation into the operation of the institution continues, one Madison man takes his skills both professional and personal on the road each week, traveling more than five hours round trip to the institution in northern Wisconsin.

Frederica Freyberg:

As dawn breaks, Lamar Skinner packs up for the long trip north. Every week, Skinner takes his skills on the road to Irma. He’s been hired as a barber at the Lincoln Hills Copper Lake School, Wisconsin's juvenile detention center.

Lamar Skinner:

There's a guy that’s been working there for about 30 years. He’s like, “Man, I'm glad you’re here. I’m glad you’re here. They just didn’t understand. You gotta have an African-American to cut these African-American kids’ hair.”

Frederica Freyberg:

Skinner came to take the job after one of his regulars saw a need.

Lamar Skinner:

Who comes in? Well, we got Everett Mitchell. We got Reverend Larry right here, Jackson in the chair.

Frederica Freyberg:

It was Dane County Judge Everett Mitchell who thought of his own barber back in Madison.

Lamar Skinner:

Well, he just took a visit and he saw some kids that needed some haircuts.

Frederica Freyberg:

Skinner's adult clientele reads like a who’s who of community leaders.

Lamar Skinner:

We build during these times. We joke a little bit. That’s what it’s about for me. It’s always good to have an elder around. I can pick Larry's brain all day.

Frederica Freyberg:

Those elders approve of their barber’s work at the youth prison.

Larry Jackson:

By Lamar being there as an African-American, just his presence will encourage a lot of them. Just by him being African-American in there doing something positive.

Lamar Skinner:

Just like he said, I'm just living proof that you can actually achieve something without being negative about it.

Frederica Freyberg:

For his part, Skinner says 30 haircuts a day is hard work. It’s emotionally draining, too.

Lamar Skinner:

They're far away from home. Far away from everything they know and love. So I know it’s bittersweet, I guess is the best way to describe it. You got young people, some of them are facing a lot of time. And some of them are going to get a chance to go home.

Frederica Freyberg:

Skinner says he tries to be a role model as a businessman, a parent for the young people sitting in his chair inside the facility.

Lamar Skinner:

I just try to put a little positivity in there, shed a little light on something that they could be doing, maybe get them to think in a different way. It’s about all I can do. I’m pretty much there for the haircut, but if I can insert little bits and pieces of things they can use, I do that.

Frederica Freyberg:

As Skinner plies his trade with a different clientele week by week, haircut by haircut, he hopes he’s making a difference in some young lives. He says there is a connection: respect.

Lamar Skinner:

When I'm there, they sweep up the hair. They thank me. They shake my hand. They’re polite. You know, just regular kids. They got in some trouble. I didn’t know I was going to like it that much until I got into it. Just seeing the kids smile, you know. That’s good enough for me.

Frederica Freyberg:

Still, on the long road trip back to Madison and his Park street barbershop, Skinner reflects on his own fortunes compared to those he leaves behind the gates.

Lamar Skinner:

It can get sad, not for me, because I get to go home, you know. I get to go home. So for them, I can kind of see, you know, where they can have some days where it’s frustrating and it’s not, you know, it’s not the place they want to be.

Frederica Freyberg:

The federal judge in Madison gave parties in the Lincoln Hills lawsuit until July 7 to come up with a plan reducing the use of solitary confinement and pepper spray at the juvenile correctional facility. A new Marquette Law School poll out this week shows what Wisconsin thinks of Donald Trump, health care law changes and Scott Walker and Tammy Baldwin. We get right to it now with the director of the poll, Charles Franklin. Thanks for being here.

Charles Franklin:

Thank you. Good to be here.

Frederica Freyberg:

So on President Donald Trump the first look we’re going to take, 51% of your respondents disapprove of what he’s been doing, 41% approve, 7% don’t know. Is he slipping or rising?

Charles Franklin:

His approval is exactly the same at 41 that it was three months ago in March. But the disapproval has risen four points from 47% to 51% and we still have a few more don’t knows than most national polling is showing. We’ve seen that in the national data as well, that the disapprove has moved up faster than approval has come down, as those initial undecided have begun to make up their mind.

Frederica Freyberg:

Now, the partisan divide is as strong as ever though, comparing who likes his work to who doesn’t. How is that expressed in your polling?

Charles Franklin:

It's at least as strong as ever. 85% of Republicans approve of the job he’s doing. For context, that’s about where Democrats were about President Obama at relatively high levels. So party loyalty. But what’s really jaw-dropping is on the Democratic side, only 3% of Democrats approve and 95% disapprove. That is worse for Democrats and Trump than it was for Republicans and Obama, where Republicans consistently gave Obama about a nine or ten-point approval rating.

Frederica Freyberg:

Also where in Wisconsin is Donald Trump’s approval rating the highest?

Charles Franklin:

He's especially strong in the Green Bay and Appleton area. That media market that contains the Green Bay and surrounding area. He’s over 50% approval there. The only area of the state that he’s solidly over 50%. But in the north and the west, Wausau and over to the Mississippi River and down a bit, he’s net positive in his evaluations. So those are areas that in most counties he did especially well in in the vote. And I think tellingly in the Milwaukee suburbs, he’s just slightly underwater. A little more disapproval than approval. In those suburbs Donald Trump won the area in November, but he did not do as well as Mitt Romney did. It looks like those suburbs have still some reservations.

Frederica Freyberg:

I want to jump ahead to the health care law and what people think of that in your survey. On the changing tides of the federal health care law, your survey shows 54% want to keep it and improve it, but 6% — 6% want to keep it as is, 27% repeal and replace, 7% repeal and not replace. Tell me what you make of these numbers.

Charles Franklin:

Well, the two ends are about the same, keep it as it is or throw the whole thing out. But if you look in that middle, twice as many would keep and improve as opposed to the 27% that would repeal and replace. That really raises a question of what kind of changes to the law are really repealing and replacing and what changes to the law are really just incremental changes and improvements. Clearly the public is very concerned, though, about dumping the law altogether. We asked and people thought fewer people would be covered and it would cost more for a replacement. So people are skittish about a replacement.

Frederica Freyberg:

So it makes it pretty difficult for the Republicans in Washington who are moving ahead on this.

Charles Franklin:

It does. But Republicans in the state are quite in favor of either repeal and replace or outright repeal. So the Republican base still favors something like repeal.

Frederica Freyberg:

I got to buzz right through these now with our time constraints. On Scott Walker, it’s the perfect partisan divide. Governor Walker comes in with an even 48% approval, 48 disapproval. How has this changed?

Charles Franklin:

He's been creeping up since January of 2015 when his approval rating really crashed into the 30s and stayed there for most of that time. He has steadily edged up over the last year or so and this is his best showing since the week before he was re-elected.

Frederica Freyberg:

On Tammy Baldwin, your numbers show that she also gets an even split, favorable to unfavorable. That’s a slip from your last poll.

Charles Franklin:

It's a small slip. It’s just a couple of points on each side. But it’s — as we see with her and, for that matter, with Senator Johnson and Paul Ryan, fairly even distributions of opinion that haven’t trended sharply up or down. Unlike the governor’s approval rating, which has been trending up so steadily for the last year.

Frederica Freyberg:

Finally, on the state budget with the Republican majority at a seeming kind of impasse over it, you surveyed respondents about their state budget spending priorities. 37% on K-12 schools, 25% health coverage and 23% roads. Interestingly to me, you also found that 61% would be willing to pay higher taxes on these priority items while 35% would not.

Charles Franklin:

And these items are the most important out of six items that we gave them as options. But interestingly for those on K-12 education, the top priority, 75% said they were willing to pay more. When we drop down to health care it’s in the 50s. When we drop down to roads, it’s actually a 48% would pay, 51% would not pay more, even though those are people that picked roads as their top priority. So the same struggles the legislature and the governor are having between paying for something but wanting it, is also reflected in public opinion on this.

Frederica Freyberg:

Interesting. Charles Franklin, thanks very much for your work.

Charles Franklin:

Thank you.

Frederica Freyberg:

Now for an update from the state capitol. On Wednesday, hundreds of immigrant supporters from around the state protested in Madison over a proposed bill that would have local law enforcement act like immigration agents. Under the Republican measure, municipalities could face some loss of shared revenue payments for failing to comply. Protestors fear this will lead to immigrants being harassed and deported as well as being too afraid to report crimes to police. In Washington, the House voted Thursday to crack down on so-called sanctuary cities by withholding federal funds. House Speaker Paul Ryan.

Paul Ryan:

By flagrantly disregarding the rule of law, sanctuary cities are putting lives at risk and we cannot tolerate that. Every day Secretary Kelly leads professionals around the country and around the world quite frankly, who are charged with keeping our homeland safe. They make incredible sacrifices. Our job here is to make sure that those professionals have the tools that they need and resources they need to carry out their work and to protect our communities.

Frederica Freyberg:

That was Speaker Ryan on Thursday. That is all for tonight’s program. I’m Frederica Freyberg. Have a great weekend.

Announcer:

Funding for “Here and Now” is provided, in part, by Friends of Wisconsin Public Television.