Here & Now

Sen. Johnson: New Healthcare Plan Needs to Fix ACA Problems

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 unfair???

, 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.