Here & Now

First Look: Thompson On How To Change Obamacare

Frederica Freyberg:

A first look tonight at the future of health care with former Governor Tommy Thompson. Thompson served as U.S. Secretary of Health and Human Services under George W. Bush and has been advising the current administration as it works to repeal, replace or repair the Affordable Care Act. Our interview took place earlier this week.

Frederica Freyberg:

Governor Thompson, thank you very much for being here.

Tommy Thompson:

It's an honor for me to be here. I’m so glad to see you again and be on a program moderated by you. Thank you and I wish you the best.

Frederica Freyberg:

Thank you. You served as an agency secretary in Washington and were in politics for a very long time. We wanted to ask you right of the chutes what you make of President Trump’s first two weeks in office?

Tommy Thompson:

I think they’ve been good. I means he’s had some stumbles, but the truth of the matter is he’s doing exactly what he said. You may disagree with what he’s doing, but the truth of the matter is he hasn’t deviated from what he told the American public that elected him what he was going to do. I happen to like people that kept their word and do things. I don’t agree with everything he’s done so far, but you know the fact that he’s done them and continues to do them, I give him credit. I give him high marks for his willingness and his intestinal fortitude to stick it out and do what he said.

Frederica Freyberg:

On some policy matters, you are on record as saying that you would like to repeal the Affordable Care Act or Obamacare?

Tommy Thompson:

Well, that’s a little bit over-broad statement, Frederica. What I want to do is I want to fix the health care system and make it more accessible to everybody, but also make it affordable and make more — willing to be more competitive and allow individuals to have more opportunities.

Frederica Freyberg:

Okay. So —

Tommy Thompson:

So you have to amend the Obamacare. Obamacare is the only major social policy that only had Democrat votes and as a result of that, there’s been a lot of problems because it was just one party that passed it.

Frederica Freyberg:

So are you saying that you would like to fix Obamacare?

Tommy Thompson:

Yes.

Frederica Freyberg:

And not ditch it.

Tommy Thompson:

I don’t think you can ditch it. You know, people say you’re going to do it. But everybody that says they're going to ditch says but there are a few parts I like.

Frederica Freyberg:

Right.

Tommy Thompson:

Such as allowing individual children to be with their parents on their parents’ insurance til 26. Make sure somebody is not cut off from insurance after they hit so many expenditures. Two provisions of Obamacare that everybody seems to like. So that part is going to stay. So what I'm talking about, Frederica, is you have an opportunity now with Republicans in control of the executive branch, the congressional branch, you have a chance to fix it and make it better and that’s what I want to see happen.

Frederica Freyberg:

You’d like to see that happen, but that doesn’t seem to be the course that is taking shape in Washington right now because they are moving ahead on some of these resolutions to basically replace Obamacare, repeal it and then they want to replace it, but they don’t really have anything bona fide in place yet. I mean, right? That’s what’s happening.

Tommy Thompson:

No, Frederica. It’s not. That’s what everybody thought was going to happen. But things have changed in the last week. They’re not talking about that right now. They’re talking about, yes, repealing and repairing Obamacare and making it better. They’re not talking about completely — the resolution you’re talking about was an executive order by the president giving — but in order to change it, you have to do it in the congressional body.

Frederica Freyberg:

Right.

Tommy Thompson:

And there’s lots of problems with that. And I've been pointing them out to the leadership in the executive branch, as Tom Price, and so on. You just can’t do that. You have to be — you have to be able to get the votes to do it. And so far they don’t have the votes for a particular plan. So what you’re saying, partially correct, but not totally correct. What I'm saying is let’s take a look at it. Let’s find where we’ve got the votes, but let’s improve and make better health care in America and that’s what we can do and that’s what America wants.

Frederica Freyberg:

And are the people you’re talking to in Washington listening?

Tommy Thompson:

Sure. Absolutely. Right now I'll give you three examples which they can’t seem to come to grips with. That’s why, what you said, they’re going to just repeal it and get rid of it. Number one, if you take away all the taxes you don’t have any money left over to rebuild it. I pointed that out. I said, “Do you think the Republicans are going to then, once they’ve taken away a trillion dollars in taxes, turn around and vote for it? I don’t think so. And I don’t think anybody does. Therefore, you better go slow on the tax repeals at this point in time until you know how much money you’re going to have to spend to repair it or rebuild it or replace it. Second thing is the baseline. The baseline, you know, that — on Medicaid, some states took an expanded match. Wisconsin didn’t. Now, how do you — how do you — how do you bring equity to that system?

Frederica Freyberg:

Good question.

Tommy Thompson:

How do you bring equity? Is Wisconsin going to get penalized because they didn’t take the federal money? I don’t think so, not with Speaker Ryan there. And the states like Republican states that put Trump in office, Pennsylvania, Ohio and Florida, are they going to want to take less now? No. So that’s a huge problem. And they haven’t been able to come to grips. How are they going to do it? These two — the taxes, how much taxes they repeal, and how they develop an equitable system on the baseline are two problems they have not been able to come to grips with because you have Republicans on both sides. The third thing is what is going to go into that? Are you going to be able to cross state lines and buy insurance? What about insurance exchanges? I talked to Speaker Ryan about that. Speaker Ryan is actually the godfather of insurance exchanges. People don’t realize that but he was one of the founders of insurance exchanges. But he wants unlimited exchanges so that whatever insurance company is going to put out there gets on the exchange, not a gold, platinum or bronze or silver. Whatever Frederica wants to buy, we’ll put it on there. And then the fourth thing is who regulates across state lines? Is it the state where the insurance company is or the state where you sell the insurance? These are problems that have to be developed. So moving fast is what everybody said they were going to do.

Frederica Freyberg:

Right.

Tommy Thompson:

But the problem is they haven’t thought through how they solve these big problems.

Frederica Freyberg:

Do you have an answer to the Medicaid problem?

Tommy Thompson:

I think I do.

Frederica Freyberg:

What is it?

Tommy Thompson:

Well, I think what you have to do is you have to make sure there’s equity. And I think the only way you’re going to have equity is to bring everybody up to the same baseline. Because Ohio and Pennsylvania and California, Florida and Michigan are not going to take less.

Frederica Freyberg:

Right.

Tommy Thompson:

And Wisconsin will get crucified if they take less. We’ll be penalized forever. So I think the only equitable system is you got to adjust where the baseline is for the highest and freeze it at that and put an inflationary index in. If you do that, then you treat equity. But that costs money. And therefore go back to my taxes.

Frederica Freyberg:

Right.

Tommy Thompson:

If you take care of all the taxes, there’s no way to backfill that. That’s why this thing is not going to move as rapidly as you indicated in your question. It’s got to have these answers solved in order to make it happen.

Frederica Freyberg:

Now, one thing that you’re quoted as saying is that just like people are required to have car insurance, they should be required to have health insurance. Still think that?

Tommy Thompson:

No. I didn’t — I said take into consideration. That statement was one that I just had at the noon luncheon. And that is not what I basically said. I said this is an example where there’s mandatory insurance. We have car insurance, so you could make the argument that you should have health insurance. But you got to be able to get people in the system. Because if you don’t have everybody buying health insurance, then the healthy are going to stay away and sick people are going to go in there, which will drive up the cost and nobody will want to sell it and nobody will want to be able to pay for it or will be able to pay for it. So you got to have a broad parameter. And that means in order to get people in there, I'm not big on mandates. I’m big on trying to make sure that the health care system is so affordable and accessible, that, Frederica, this is what you want in a policy for you and your family, your husband, your family. This is what I want. I may not need as much as you do. So I want to be able to do that. But I want to be able to go into the system and do that and not have the government tell me what I have to have but what I think I should have.

Frederica Freyberg:

How do you get at that affordability?

Tommy Thompson:

That's the problem? You can do it, I think, by allowing for a lot of information. You’re going to have to have insurance companies. You’re going to have the states and the federal government really be able to talk to you and explain to you what health insurance is all about and be able to try and give you a tutorial on what, Frederica, at your age level, your marriage status, children you have, what you need. And that’s going to be an educational thing. It may not be a gold, silver platinum. It may be a thing called a copper program, which we don’t have.

Frederica Freyberg:

Do you think the insurance agencies, though, are really going to want to tailor each kind of health insurance plan to the individual?

Tommy Thompson:

No. But the insurance exchanges can. You can set up on the insurance exchanges, Frederica, all of the things that are out there that company A is selling and be able to buy into that thing and you’re going to be able to pick and choose. It’s not there yet, but it certainly is conceivable and could be easily done. So insurance companies could have it. And have a — just like anything. You go into a grocery store.

Frederica Freyberg:

Ala carte.

Tommy Thompson:

Ala carte. You buy what you need and you put it on the insurance program and this is what I need for myself and my family and that’s how you do it.

Frederica Freyberg:

Now, you very much espouse prevention; is that right?

Tommy Thompson:

I'm big on that. I really sincerely believe, you know, that the problem we are in our society is 133 people over the age of 65 have got one or two or three chronic illnesses. 75% of the cost of health care is because of chronic illnesses. And that’s because of individual decisions. We still have too many people smoke. We too many individuals that are overweight. We have too many individuals that are not exercising. And we have too many people, you know, that don’t know about nutrition, so on and so forth. All of these things, exercise, eating properly, getting the proper amount of sleep, can do a tremendous amount to make you healthy. And that’s what I'm trying to say. Let’s build — let’s build a healthier society, which will hold down costs, make you healthier and put prevention front and center. 91% of health insurance dollars and health care costs go to fix you. Only 9% of the money goes to keep you well in the first place. Isn’t there something wrong with that scenario?

Frederica Freyberg:

Now, the ACA had built in a lot of preventive services that ended up under that law being free. What do you think of that?

Tommy Thompson:

Well, the problem is somebody’s got to pay. We’ve got to come to the realization in society there’s nothing free. Somebody pays for it.

Frederica Freyberg:

So do you think that ought to be in any of the array of the ala carte plans?

Tommy Thompson:

Absolutely. I think anything dealing with wellness and health and prevention has got to be in that array or you’re not doing your job. As I said, 91-92% goes to get you well in the first place after you get sick. I want a bigger share of that money to keep Frederica and Tommy Thompson and all the people who work around here healthier at the beginning. And we can do that.

Frederica Freyberg:

I want to switch gears to FoodShare and a plan that our Governor Walker wants to institute requiring able-bodied parents who are on FoodShare to either train or work 80 hours a month. Now, a critic of this that we had on our program last week said that if you dock parents of FoodShare, that food is literally going to come out of the mouths of their children. What do you say to that?

Tommy Thompson:

Well, they said the same thing about me when I put in W-2 and so on and so forth. I sat down with welfare mothers, and I had a tremendous exchange with them. And I said, “Why don’t you work?” If I work, I don’t get child care. If I work, I don’t get health insurance. I said, “What if I give you child care and health insurance?” Yeah, but I don’t have any training. So I said, “Give them training.” And then they said, “How am I going to get there?” I said, “I'll set up transportation for you.” I did this. And so I don’t want to be punitive and I don’t think Governor Walker does. What he wants to do is get people to work. And there’s nothing wrong with that. And I think if you do it right, roll it out and get buy-in from people that are doing it. You know, people want the same thing. They want a good home. They want a good education for their children. They want safe streets. You know, it’s not rocket science. It’s right there. So let’s do that. Let’s make it easier.