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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning, everyone. First up on the show today, a Health & Climate Tuesdays two-parter on how the Republican spending bill is seeking to cut Medicaid and green energy projects. As some of you know, a few years ago, this show started featuring a Climate Story of the Week, mostly on Tuesdays, because the climate doesn't change at the pace of the news cycle, right? We wanted to make sure climate change didn't always get shoved aside in favor of things that were more in the headlines of the moment.

This year, with RFK Jr. pushing so much change on health policy into the pipeline, and now this budget, we've expanded the commitment to a Health & Climate Tuesdays section of the show so neither get buried in the avalanche of other Trump administration headlines. We'll begin with the future of Medicaid debate coming to a head. On Sunday night, House Republicans released a proposal to cut federal spending on Medicaid and the so-called Obamacare expansion of it.

One in five Americans are on Medicaid nationwide. Listen to these stats. Approximately 40% of all children, according to the American Hospital Association. They cite the incredible stat of nearly half of the births in rural parts of the country, as well as many low-income elderly and disabled individuals. That's how central Medicaid is as a starting point to this conversation, to the goal of every American having health insurance.

Back with us now is the local member of Congress who is most at the center of the Medicaid funding debate. It's New Jersey Congressman Frank Pallone. He is the ranking Democrat on the House Energy and Commerce Committee, where all this gets hashed out before it goes to the full House floor. They have jurisdiction over Medicaid and other healthcare laws, also climate and other environmental laws and fossil fuel industry laws too. It's the Energy and Commerce Committee. Congressman, thanks for joining us periodically this year, as you have with your committee being so central to what's happening. Welcome back to WNYC.

Congressman Frank Pallone: Thank you, Brian. Thanks a lot.

Brian Lehrer: Medicaid. I read that according to the nonpartisan Congressional Budget Office, this proposal, as written, would cause an estimated 8.6 million Americans to lose their health insurance. Some other estimates are even higher. Do you have a breakdown? We'll go through some of these categories, but a basic breakdown of why the number is so big or which Americans would be most at risk of becoming uninsured based on what criteria?

Congressman Pallone: Well, what really this is all about, Brian, is I call it red tape or paperwork. In other words, they call it work requirements. It's really not that. Over 90% of the people that are on Medicaid now do, in fact, work. The people that don't work, from every indication, are people that can't because they're disabled, because they're caring for a loved one or whatever.

There was an example in Georgia, which is the only state now, I think, that still has this type of red tape. In Georgia, there were maybe 300,000 approximately people that were eligible for Medicaid that lost it or didn't get it because of the red tape requirements. Of that 300,000 that were eligible, because I know the Republicans like to say "eligible," only, I think, 4,000, like 1%, some ridiculous amount, actually were able to navigate all these red tape requirements.

Essentially, what they've done here is to say that you're not going to be eligible because of the red tape. Now, if you manage to get through all that and prove that you're an exception because you're disabled or file the red tape thing every month, then you might be part of that 1% or 2% that navigate this. Most people could not. Then they say that if you don't meet those red tape requirements, as I call them, then you are not eligible for the ACA unless you pay the full price, right? The reason for that, Brian, is because they're trying to save about $350 billion to pay for this big-- I don't know what he calls it, big magic bill the President calls--

Brian Lehrer: Big beautiful bill.

Congressman Pallone: Big beautiful bill. This is about $350 billion of that just for the Medicaid alone. If those people, because they were not eligible for Medicaid, then went and tried to get a subsidized ACA policy on the marketplace, all those savings would disappear. The CBO said those people would naturally move over to the ACA for a very small subsidy that they have to pay, and then you lose the savings. They specifically said that if you don't meet the requirements and file the paperwork, then you're not eligible for an ACA policy that's subsidized. This is it. This is how you get to the--

Brian Lehrer: If that description is accurate, then maybe it is a magic bill creating the illusion of savings as opposed to actual savings, but let me ask you about the work requirement.

Congressman Pallone: Yes.

Brian Lehrer: As I'm reading details of it, it would require adults ages 19 to 64 to show that they are working, doing community service as an alternative to that, or participating in an educational program for at least 80 hours a month. You're pushing back on this as about red tape, but many people might consider that a fair social contract. If you're getting my tax money, people might say, to pay for your health care, and you're able-bodied and free of other crushing burdens, you should be working or out looking for work or getting trained to do work to get you off the public's dime. Do you or does your party disagree with that being a reasonable social contract?

Congressman Pallone: Yes, of course, it's reasonable, but that's already the reality. In other words, the reality is that these people are already working, right? The reason they're on Medicaid is because their income is so low and they don't get health insurance on the job. Remember, over 60% of the people still get health insurance on the job. There's millions and millions of people that work that don't get health insurance, particularly if they're low-income, right?

The bottom line is these people are working. What we found in Georgia, which is the only example really, is that, essentially, what they're doing is making them fill out papers and then saying, "Okay. Well, if you think you should be excepted," E-X, excepted, "then you have to fill out a form saying that you don't have to meet the work requirements either because you're already working or because you're disabled, you're caring for somebody." What we found in Georgia is that that just never happens. In other words, the way this is set up, you either don't meet the work requirements because you don't fill out the papers, or you apply for an exception, you don't get the exception because you don't qualify. Therefore, like I said, less than 1% or 2% of the people that were eligible.

Brian Lehrer: An attempt to set up barriers. All right, let's keep going down the provisions. Here's a culture war provision as it looks to me. The Republican proposal seeks to bar Medicaid from paying for services of any kind at nonprofits that are primarily engaged in reproductive health or provide abortions. Now, to be clear, federal funds are already currently not about to be allowed to be used for abortions. That's the famous old Hyde Amendment. This puts nonprofits like Planned Parenthood squarely in the crosshairs in a different way. Can you explain it?

Congressman Pallone: Well, we asked the question during that 3:00 AM markup, who would qualify for this other than Planned Parenthood? The answer was pretty clear. Only Planned Parenthood. I don't want to give the other nonprofits the impression that they're going to qualify for it. It's Planned Parenthood. What that means is even though a Planned Parenthood clinic doesn't provide any abortions, or because the national organization allows some of them to have abortions, you don't qualify and you can't get Medicaid.

Of course, most of them were closed because as with any hospital or any community health center or any clinic, if you can't take Medicaid patients, which are the majority of your patients, overwhelmingly, then you can't stay open. That's the bottom line. I know you're talking about Planned Parenthood. They just won't be able to operate. You'll have a lot of hospitals and other institutions that primarily take Medicaid patients that will close as well, because if they don't get third-party reimbursement, then they can't operate.

Brian Lehrer: Another provision of the bill, states currently are allowed to use what are called "provider taxes" that allow them to pay for a portion of their Medicaid spending. Those are on the chopping block in this bill, I see. Opponents of provider taxes say they inflate the amount the federal government matches state spending. Can you explain what those provider taxes are? This may sound obscure to some people, but tell us why you think this is important and how they work.

Congressman Pallone: Well, because Medicaid is a state-federal partnership, right? Depending upon the state and how poor the state is, some states, 50% of it is paid for by the federal government. Some states, the poorer states, 70% of it may be paid for by the federal government. They still have to raise the other match, if you will, in order to get the Medicaid funding from the federal government. A lot of them do that by using provider taxes, which means that they basically tax the hospitals or the doctors who provide services.

The problem with this is that if you limit the ability to do that, then you're also going to have people that, or maybe not people that don't get Medicaid, but level of services that states provide for Medicaid will go down because they won't have the money to meet the federal match. They'll have to pay for a lot of this on their own. Let's use an example with nursing homes, right? Most nursing home care is paid for through Medicaid. Well, if that's not generous, then the quality of nursing home care goes down.

In this bill, they actually get rid of the nurse staffing ratio in order to save $7 billion or $8 billion. If the states can't get the federal match because they can't raise money to pay for the match, then they either throw more people off Medicaid or they provide less services. Perfect example would be nursing homes because I'm old enough to remember when nursing homes were terrible places because they had no safety or health requirements. One of the things they do in this bill is get rid of the nurse staffing ratio. That's going to also lessen the quality of care.

Brian Lehrer: Well, from what I'm reading, the bill would require states to provide greater oversight over Medicaid recipients and Medicaid providers. It would increase checks on eligibility for recipients. They say that's a hedge against fraud. Providers would be checked once a month, I think also for honest billing. Is that part less objectionable? They often say waste, fraud, and abuse like in DOGE to cover up ideological attacks. Maybe this part is actually waste, fraud, and abuse, but is it to you?

Congressman Pallone: No. Look, what happened in Georgia, and this is all part of the Georgia experiment too, if you will, is that they ended up spending more money doing this kind of checks that you just discussed, right? Red tape, whatever. They spent more money enforcing that than they did on actually providing health care to the limited number of people who are eligible.

What you're seeing here is whatever money we have on the state, we're going to force you to use that to essentially kick people off or to make sure people are not eligible. It is ideological, Brian, in the sense that you're not focusing on providing health care because you really don't think the state or the federal government should provide health care. You're focusing on trying to make sure that this terrible law that allows people to get health care is not applicable to as many people as possible.

A lot of these guys, I'm not saying every Republican, but you talk to some of them, they don't believe the federal government should be giving health care or helping people pay for the health care at all. I obviously is someone who believes that the federal government should provide health insurance, but many right-wing Republicans don't believe that we should do that at all.

Brian Lehrer: Well, do you think that this is going to get through? If it gets through in the House where you serve, is it going to get through in the Senate? I saw Senator Josh Hawley from Missouri, quite MAGA Republican, on TV the other day, saying he doesn't want any Medicaid cuts to his state that would make people lose their Medicaid health insurance other than with the work requirement. I cited that stat in the intro that, according to the American Hospital Association, nearly half of the births in rural parts of the country are paid for by Medicaid. Is this going through in the red parts of the country?

Congressman Pallone: We're going to try to do our best to make sure it doesn't go through. I think that the Senate is less likely to approve this than the House. You're pointing out the reason why it might not go through, which is it seems to affect the red states, the Republican states, even more so than the Democratic states. I think a lot of the congressmen and the senators from those red states do understand that. Right now, one of the concerns I have. Last night, they voted this bill out of the budget committee only because they made it even more harsh and cruel.

We understand that we don't have officially anything yet, but we understand that one of the ways that they got the votes last night is because they got some of the right-wingers to abstain or vote present. They only did that as opposed to voting no because they moved up the date when this red tape would apply a couple of years. That is even more harsh because it wasn't supposed to take place for another two or three years. I think they moved maybe to one year from now. It's very possible that this gets worse before it passes the House, but I do think that we're going to keep pointing all these things out. That's why I appreciate you're doing this interview.

Brian Lehrer: Congressman Frank Pallone, ranking Democrat on the House Energy and Commerce Committee. Congressman Pallone from New Jersey, before you go, our next segment with a climate and energy reporter from Politico will look specifically at green energy and other climate-related provisions in this bill. So many green energy projects being funded today are apparently also in red states that it might be harder than one might assume to cut them to the bone despite the climate change impact denial of the energy secretary and "Drill, baby, drill" and all that. Is there anything you'd like to flag from that part of what your committee covers to keep it on the public's radar or that I might ask our next guest about?

Congressman Pallone: Well, everything that they've done is to repeal sections of the Inflation Reduction Act that were designed to encourage clean energy and address climate change. Three examples. The methane reduction program. They postponed any fees or penalties, if you will, for 10 years. That means that probably those efforts to try to reduce methane gas, they'll be eliminated.

They also eliminated the greenhouse gas fund, which is trying to encourage manufacturing and others with more clean energy. The thing that really drove me crazy was that they said that if an oil and gas company or an LNG company wanted to get approval, they could pay somewhere between $1 million and $10 million fine, not "fine," fee with their application. If they did that, then they would not have to go through any environmental review.

If an oil company pays $1 million for a pipeline or somebody wants to do an LNG and they pay $10 million, depending on the circumstances, a minimum of $1 million, you don't have to bypass environmental review. Not only they're discouraging clean energy, they're encouraging the fossil fuel companies to not even abide by any environmental laws whatsoever, but there's so much more. I'm sure you'll go into it more, Brian, later.

Brian Lehrer: Well, we'll follow up on that, coming up for sure. New Jersey Congressman Frank Pallone, ranking Democrat on the House Energy and Commerce Committee. Congressman Pallone, thanks as usual.

Congressman Pallone: Thank you, Brian. Thanks a lot.

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