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Brian Lehrer: Brian Lehrer on WNYC. Now we conclude this year's 30 Issues in 30 Days election series. We've done stretches on abortion rights, crime, immigration, education, the climate, 10 of the 30 parts on democracy in peril, and different aspects and we've been wrapping it up with your money week, including, which is the party of the working class on Monday, affordable housing on Tuesday, fighting poverty on Wednesday, is there a Democratic and Republican approach to inflation yesterday.

We ended all today with the question, is there a Democratic and Republican approach in 2022, to affordable healthcare, a bedrock pocketbook issue for many Americans, although less on the political front burner this year for many candidates, I think. With us now, Julie Rovner, chief Washington correspondent for Kaiser Health News and host of the What the Health podcast, you may remember, Julie used to cover health for NPR. Julie, thanks for coming on the show again. Welcome back to WNYC.

Julie Rovner: Thanks for having me. Always great to be here.

Brian Lehrer: Before we get into the politics and competing approaches, how do you see the state of the insurance premium market and out-of-pocket co-pays and deductibles and other expenses compared to four years ago or eight years ago? Is health care inflation a burden, like the gasoline and food inflation, the candidates seem to be talking about much more for insured people as well as those who are uninsured.

Julie Rovner: I think the best way to think about it is that it's going to be a burden but it isn't yet. Healthcare premiums lag, often by more than a year because they get finalized before things happen. The healthcare premiums that we're seeing now for next year, are probably not as high as they will be next year for the year after. That said, the health inflation is still pretty healthy.

We now see that the average employer-provided premium for a family is over $22,000. For an individual, it's almost $8,000. Family premiums are up 20% over the last five years and 43% over the last 10 also up our average deductible, people are paying more, but for the first time, in recent memory, in fact, to type in covering it. The cost of health care for the moment is going up more slowly than people's wages. They're able to keep up with those increases. That's not been the case traditionally.

Brian Lehrer: Right because for these decades, when we have generally said we have low inflation, we have had high health care inflation, which is why it's been such a front-burner issue in a whole bunch of election cycles in a row, and what's the rough percentage of uninsured Americans these days? Do you happen to know?

Julie Rovner: I do happen to know it's down. It's at a historic low. Depending on what survey you look at, it's between 8% and 9%. When I started covering health care, it was closer to 14%. Many more people have health insurance for a variety of reasons. One of the big reasons right now is that during the entire time of the pandemic, we've been under something the federal government calls a public health emergency and everybody who qualified for Medicaid has been left on the Medicaid program, when the public health emergency and probably early next year, states will have to basically reevaluate everybody, and we're expecting many people to no longer turn out to be eligible but that's one of the reasons that the number of people with insurance is up high is that there are a lot of people on Medicaid.

There's also a lot more people buying insurance through the Affordable Care Act because the Democrats had increased subsidies, which resulted in lower premium and including helping some people who had been sort of at the top of the income scale and hadn't been eligible for any subsidies but still couldn't afford the premiums. Now many of them can we're seeing historically high enrollment in the Affordable Care Act plans too.

Brian Lehrer: I'll take that in part as Obamacare worked, and Dems ran in the past on the Affordable Care Act, AKA Obamacare, then Medicaid expansion within Obamacare to cover more working-class income, let's say families, Republicans, how quickly we forget, ran on repeal and replace, as recently as 2016 and market solutions to universal coverage. Are either of these in play this year or has Republican America now embraced Obamacare, and that's a dead issue?

Julie Rovner: I wouldn't go that far, but Republicans certainly have moved on to other things. I think they've decided that for a long time they had repeal and replace without admitting that they had no replacement, and we saw rather publicly in 2017 when Republicans could not agree on a replacement and ended up not doing anything, and then got hammered for it on the campaign trail in 2018. We see a few Republicans here and there, Kari Lake in Arizona, most notably, who's running for governor, not running for federal office, suggesting that repeal of Obamacare, but mostly, we are not seeing it, they've moved on to talking about things like controlling Social Security and Medicare and Medicaid.

Brian Lehrer: Listeners, we can take a few phone calls here. Do you trust one party more than the other on affordable health care? Is there a Democratic and Republican approach to affordable health care that you can even identify? If you opposed Obamacare in the past? Is that a dead issue for you? Is health care a source of inflation for you, if your top issues include inflation this year, or not so much compared to energy and food, and you're not worrying about it that much?

212-433-WNYC, 212-433-9692, or tweet @BrianLehrer for Julie Rovner, chief Washington correspondent for Kaiser Health News, Issue 30 in our 30 Issues in 30 Days election series affordable health care. Bringing it up to the present now that we've done a little historical context, some of the proudest accomplishment for Democrats, as they would describe it, in their Inflation Reduction Act, have to do with healthcare. Can you say the top-line items there?

Julie Rovner: Yes, that's absolutely true. For the first time, in anyone's memory, the Democrats managed to defeat the very powerful prescription drug industry and institute some of the first minor curbs on prescription drug costs. Those have not taken effect yet. I think that's part of the difficulty with Democrats telling the story is that's something that's going to happen in the future, there's also going to be a $2,000 out-of-pocket cap for Medicare beneficiaries on how much they have to pay for prescription drugs.

That is a big deal, it will affect several million people who now have to pay considerably more than that and they're going to cap the price of insulin at $35 a month for Medicare beneficiaries. They had wanted to cap it for everyone, but Republicans managed to get that taken out of the bill using a technicality.

Democrats have a pretty good story to tell on health care. Also, last year, they curbed surprise bills. That was a bipartisan issue but again, we're not. These are things that have happened and people aren't much worried about them. There's not as much talk about them.

Brian Lehrer: Remind our listeners more about that insulin debate. I think it flew a little bit below the radar, with other big things going on at the time but correct me if I'm wrong, the Democrats wanted a price cap on insulin for people with diabetes. Of course, for every American, they got it for Medicare but they didn't get it for everyone else on insulin because the price cap for them was subject to the Filibuster and Republicans wouldn't go along in any numbers. Do I have that right?

Julie Rovner: Yes, you do. I mean, it has to do with the vagaries of the budget reconciliation process. It wasn't technically the Filibuster to waive the Budget Act, they needed 60 votes, and they only got 57. the Republicans basically raised a point of order that in this budget bill, they were not allowed to extend this to non-Medicare patients and with 60 votes, they could have waived that and left it in and they didn't get the 60 votes they needed.

Brian Lehrer: For you as not only health care reporter but a political reporter based in Washington for Kaiser Health News. Why aren't the Democrats shaking the trees, raising flags and knocking cowbells and everything else and saying, we got people on Medicare, a cap on their insulin, which was going up big time because we had the power in Congress when we didn't have enough votes to get it for everybody else. The Republicans blocked it. They want the pharmaceutical companies to be able to keep gouging you for insulin, there are many Americans with diabetes, or who know people, loved ones, with diabetes, that could have been a big issue, but apparently it isn't.

Julie Rovner: Yes, I know. It's been a very odd campaign year. Obviously, abortion has been an overriding issue on the healthcare side and I am seeing candidates talk about drug prices and some of the things that they've done and some of the things that the Republicans would like to do. The first order of business for Republicans is to repeal that Inflation Reduction Act, which has those historic, limits on drug prices for the first time, and yet, that's not been a big issue either. I don't know, actually on our podcast we talked yesterday about why the Democrats have not made Republican vows to trim social security and Medicare and Medicaid a bigger issue because, traditionally, in the midterms, seniors vote more than everybody else.

Brian Lehrer: Right. Well, let's go to that one because I think that issue is in play on the campaign trail at least in recent days the security of Medicare, Florida Republican Senator Rick Scott for people who don't know the background here has proposed that Congress would have to reauthorize the program with a vote every five years. Presently, it's a permanent program and it doesn't need to be reauthorized periodically.

I guess they could take some extraordinary parliamentary steps to add Medicare but what he is saying is don't make it extraordinary. Make Congress go back and reauthorize Medicare and social security every five years. President Biden has seized on that in recent campaign appearances by him like here.

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President Biden: They're coming after Social Security and Medicare in a big way, folks here in Florida you need to know this. I mean this sincerely. You need to know this. You need to know why because of your own senator, Senator Rick Scott. I have the brochure [unintelligible 00:11:23].

[end of audio playback]

Brian Lehrer: The president continued in that campaign appearance in Florida with so many retirees.

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President Biden: Every five years, the Congress have to vote to reauthorize social security, reauthorize, [unintelligible 00:11:39] goes away, would have to vote to reauthorize Medicare, reauthorize veterans benefits, and I go down the list.

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Brian Lehrer: Senator Scott was asked about the every five-year approach to vote on the continued existence of Medicare on Morning Edition just today with Steve Inskeep and Scott said this

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Senator Rick Scott: There's not one Republican that I know, that has any interest in reducing any Medicare or social security benefits. We've got to figure out how to preserve those programs. The Democrat radical spending is putting those programs at risk.

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Brian Lehrer: Decode both sides of that for us. Julie, could you? Katie was our last segment.

Julie Rovner: That's okay.

Brian Lehrer: Still thinking about our last segment. Anyway, sorry, Julie, go ahead.

Julie Rovner: That's all right. President Biden, yes, is now raising this issue but this week, this is the last week before election day. Millions of people have already voted. Lots of people have voted early including me. You have to wonder why they waited so long to get to this for, one, I did hear Rick Scott this morning and of course, it's important to say that Rick Scott is not speaking technically for the entire Republican Party in the Senate, but there is a house Republican document and it talks about repealing the Inflation reduction Act.

Which as I just pointed out would immediately cut benefits for Medicare. Not true what Rick Scott is saying that there's not a single Republican. Part of it depends on how you define cutting benefits for Medicare and this is an age old debate. If you cut payments to providers, that tends to save money for beneficiaries because it lowers their premiums. Technically, it's a cut because you're not you're paying less for Medicare, but it's a cut that helps the patients.

If you cut benefits or if you raise the age of eligibility which is something republicans are also talking about, that would be fewer benefits for people. We use this generic cut Medicare when it would be more precise to say give more benefits to beneficiaries or take benefits away from beneficiaries. To not talk about the entire program but to talk talk about its impact on patients.

Brian Lehrer: What's Rick Scott actually getting at when he says instead of letting Medicare continue permanently which is its current status may Congress have to reauthorize its existence every five years?

Julie Rovner: Well this is part of Rick Scott's and this goes back to very traditional Republicans on healthcare. The deficit is too large and healthcare is a big piece of that. We spend too much federal and state just pub too much public money in general on healthcare, and we should spend less, and perhaps we should if we reexamine these programs every five years we could find ways to perhaps more privatize the program which is already happening to a large extent on its own helped by Republicans back in 2003.

If they had to look at the program as a whole every five years, they might make different decisions rather than the way it works now which is the programs continue as they are until and unless Congress changes them. Congress does alter both Medicare less so social security but Medicare and Medicaid really every year or two they do something to the programs.

Brian Lehrer: A few more minutes in our 30 Issues and 30 Days concluding segment. Issue 30, affordable healthcare as an issue between Democrats and Republicans this year with Julie Rovner who is the Washington Bureau chief for Kaiser Health News, and let's take a phone call. Here is Louisa in Chesterfield Virginia, who I think among other things wants to talk back to the women of color who were calling in our previous segment saying they may or may not turn out to vote, because Democrats take them for granted even though they don't like Republicans. Louisa you are on WNYC. Hello.

Louisa: Hello, Brian, and thank you for these wonderful conversations. I am a retired New York City public school teacher from Brooklyn living for the last few years in Chesterfield Virginia, but I stay in touch with what's happening in New York, thanks to your program. I have to say I am horrified to hear people of color two women one from Brooklyn saying that they're even considering staying home. All we have to do is remember what happened with Hillary Clinton and people claiming that she was the imperfect candidate, and they had all these reasons why and suddenly we got stuck with this insanity that we're now looking to face forever, that could doom the democracy forever.

It's insanity. People need to get out and vote. Let's consider, let's stop thinking about what the Democrats didn't do right, because there's a long list of what they have done, and they're too busy working to actually campaign properly. Let's consider what we're facing if Republicans take New York, if Republicans take over the state of New York, the message that will be sent worldwide is devastating for our country and that is what I need people to think about before they consider staying home. Thank you.

Brian Lehrer: Luisa you identified yourself as a Latina to our screener. I'm curious if you're having conversations with friends or family members who are also Latino Latinas, and in this year when we keep hearing there's more of a trend toward the Republican party among those voters than in the past.

Louisa: Yes. I have sent out messages, emails, and had conversations with family members because I'm a grandmother, and an aunt, and a sister, and have many friends in the teaching community obviously, in the progressive community. Yes that's a big conversation around why are Latinos tending now towards Republicans? People are saying it's, well it's the price of gas, and so people are just looking at their own very tiny little circle and living day to day, and I get it that it's a survival issue.

The bigger issue is let's look at what would happen if because we don't vote for the imperfect candidates who have imperfect campaigns. When I think about Kathy Hochul taking over the state of New York after what happened with the previous governor, it's no wonder nobody knows her. She's busy working, and so this issue of the perfect campaigning is it's just getting, it's I don't even have words to describe how frustrated I am about it.

Brian Lehrer: Thank you very much. Call us again from down there. Gretchen in Brooklyn you're on WNYC. Hi, Gretchen.

Gretchen: Hi, Brian, thank you so much. I'm just calling because I am a type one diabetic and I've lived in New York for 10 years and this election is really important to me from a healthcare perspective especially. I've always worked full time up until recently and I'm a contractor now, so I'm on Obamacare but my premiums were so high I had to actually delay signing up because I couldn't afford them.

Brian Lehrer: Julie you want to talk to Gretchen and talk about how her story is emblematic of many people or not or?

Julie Rovner: Well, yes, right now most people should be eligible for subsidies that will help them afford their coverage. I don't know if the caller has reached out, there's the Biden administration is devoting a lot of money that was this is something that the president said in his speech to helping people sign up in a way that the Trump administration did not, so there should be a lot of community resources out there. Even if you're on a plan that's expensive right now, there might be a better plan that's cheaper for you, that will cover more of the costs that you need.

Everybody who's on Affordable Care Act plans ought to go back and reexamine them this year because even if you get, even if you renew into the same plan it may no longer be the best plan for you, so it's worth it to go back and take a look during this opening. That just started on Monday, goes through January 15th, and see if there's a plan that's better. If you need help, there are ways on the internet and in your community, lots of places to get help signing up for, ACA coverage.

Brian Lehrer: Thank you, Gretchen, for your call, and I hope that's helpful to you. Maybe that actually is going to help you with your own healthcare costs. Julie, to wrap this up, and you kind of touched on a piece of it before, but COVID has been such a big thing in everybody's lives these last few years. What has COVID changed, if anything, in affordable healthcare costs or healthcare economics policies?

Julie Rovner: Not as much as I thought it would. I really thought at the beginning that it would help sort of people see how important healthcare is. In many ways, it's more important than gas prices. It's just not as immediate for many people. When it is immediate, it is a big problem and a big issue. I think it got so politicized that, basically, the two sides have retreated to their corners. We're back to sort of traditional democratic Republicans, Democrats who would like to have the government, in general, regulate more of healthcare, and Republicans who would like to have private industry do more of healthcare. We're sort of back to where were in the late 1980s and early 1990s in some ways.

Brian Lehrer: Julie Rovner, Chief Washington correspondent for Kaiser Health News and host of their what the Health Podcast, hitting that TH really hard there. You may remember Julie used to cover health for NPR before she did this. Julie, thank you so much.

Julie Rovner: Thank you, Brian.

Brian Lehrer: That concludes this year's 30 Issues and 30 Days election series

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