President Donald Trump recently said he’s willing to let the Affordable Care Act fail.
He could start that process soon by following through on earlier threats to eliminate $7 billion in subsidies to the nation’s insurance companies, a move Democratic Gov. John Hickenlooper said Monday would be “disastrous” for Colorado.
“We know that many of the insurance companies are struggling within the private markets,” Hickenlooper said, adding, “we need to do everything we can to support them and not put them in the role of having to raise their prices, raise their premiums, basically in the end (they) would likely deny coverage for thousands of people.”
A top Trump aide said over the weekend that Trump will decide by the end of the week whether to cut off Obamacare subsidies — known as cost-sharing reduction payments — to insurance companies that provide discounted coverage to the poor.
As Congress debated plans to replace and/or repeal Obamacare, Hickenlooper helped write letters, signed by governors from both parties, that opposed the Republican bills and sought bipartisan negotiations on fixes to Obamacare. Colorado's governor hasn't been shy on the issue, making an appearance in Washington D.C. with Ohio Republican Gov. John Kasich, appearing on Bloomberg business television and speaking to NPR's Morning Edition following the collapse of the plans in the Senate to repeal the ACA.
The governor was “discouraged” that Colorado Republican Sen. Cory Gardner supported all of the GOP's efforts to kill the current health care law, but said public opinion is overwhelmingly against those efforts.
In a wide-ranging interview, Hickenlooper spoke on signals he’s getting from Washington on marijuana, and promised his “blessing,” but not his endorsement, of Lt. Gov. Donna Lynne, who is expected to file paperwork Tuesday for a possible gubernatorial run.
Interview Highlights With Gov. John Hickenlooper
On A Plan That Could Raise Premiums Statewide To Share The Tab For High-Cost Patients:
“What you’re talking about is a relatively small number of people, and I don’t know what the number is in Colorado, let’s call it 10 people, that cost, on an annual basis, $4-, $5-, $6 million a year. If a couple of those, two or three of those people are concentrated with one insurance provider they can upset the whole applecart … If the entire population of Colorado, everyone who’s insured, paid just a little teeny bit, there’s such a small number of these high-cost individuals that you could actually take care of it.”
On Republican Sen. Cory Gardner's Votes For Repeal And Replace:
“Obviously I’m very disappointed that we couldn’t persuade Sen. Gardner to really hold out for a better solution … That being said, roughly 17 percent of the American people, the last time I saw a poll on a nationwide basis, support what the House bill and to a large extent the Senate bill proposed — that kind of a rollback on people that would have coverage. The challenge I think is more political than the will of the people.”
AG Jeff Sessions Thinks Violent Crime And Marijuana Are Linked. Hickenlooper Says Not Here:
“The data sets I’ve seen, when you begin to normalize and look at states that have similar populations but didn’t legalize recreational marijuana and you compare them to the criminal activity we’ve seen here, I don’t think there is a direct link, or if there is it’s very, very small.”
On "Blessing," But Not Endorsing, A Possible Run For Governor By Lt. Gov. Donna Lynn:
“You know when people have asked me all the way along the line am I endorsing someone I’ve said the same thing to everyone — it’s not my intention to endorse someone. Someone like Donna Lynne, who is so talented, when she enters that makes that commitment all the much harder. But that being said, this is probably the most talented group of people running for governor that anyone’s seen in a long time. It’s going to be fascinating.”
Read The Transcript:
Ryan Warner: This is Colorado Matters from CPR News. I'm Ryan Warner. It's another pivotal week for healthcare in this country. With failures to pass legislation in Congress, President Trump has suggested letting Obamacare "implode." He could hasten that by stopping payments to insurance companies, payments that make coverage less expensive for the poor. Without the money, insurers might raise premiums or leave the market entirely. I asked Colorado's Democratic Gov. John Hickenlooper, in our regular conversation what it would mean for the state.
Gov. John Hickenlooper: That's a disastrous choice because it would force insurance companies and individuals into all kinds of difficult choices. We know that many of the insurance companies are struggling within the private markets just because of the uncertainty, the costs.
RW: There are 14 counties in Colorado that only have one insurer.
JH: Exactly. With that limited number of insurance companies, we need to do everything we can to support them and not put them in the role of having to raise their prices, raise their premiums. Basically in the end, would likely deny coverage for thousands of people.
RW: If you call that disastrous, what are you doing to plan for that?
JH: We're trying to look at how else within the system you can find the resources to make up that subsidy.
RW: They were $7 billion nationally ...
RW: ... last year.
JH: In a state like Colorado, where we have TABOR, there is no, at the scale we would need, there is no immediate opportunity where you could automatically make up those costs.
RW: It's possible the president is just driving a hard bargain here to motivate Congress, but if the president's idea is to just let Obamacare fail and then I suppose start from scratch, might that be an avenue in what appears to be intractable?
JH: Again, I hope that the White House doesn't choose this path. That said, if they begin to pull away the federal commitments to the Affordable Care Act without providing any replacement or any way to help states deal with the obvious outcomes, you really are snatching healthcare away from people. They'll go back to having their only source of healthcare at an emergency room when they're in an emergent care situation. That's not where we want to go. That's pulling us backwards. We all agree how important it is to control costs. We are 1000 percent focused on how can we provide incentives and the appropriate motivation so people take better care of themselves, trying to find ways to help the insurance companies deal with high cost pools and some of the consequences of the Affordable Care Act, but the way to improve the system is not dramatically to reduce the federal participation in the program. Not constructive.
RW: You say you're 100 percent focused on-
JH: No, I think I said 1000 percent.
RW: 1000 percent focused on reducing costs, and yet on the individual market, people in Colorado are looking at a 27 percent increase on average.
JH: That's because, we haven't done, in the individual market, the state can't help reduce costs there unless we can do certain things like high cost pools or reinsurance programs that allow us to address these issues of a concentration of people with serious medical conditions. A lot of these private insurance programs, they end up with the most unhealthy segments of the population.
RW: So what would you propose then because I want to say you've been very active nationally on this issue, as active, I think, as on any issue I can recall in your tenure. What would you suggest for those pools of particularly ill people?
JH: Right, and there are different states working on different responses to this situation. Some are looking at what are the illnesses that people have, such as hemophilia, that become very high cost. So do we find a way to raise money? It could be through reinsurance, which is basically charging a little more insurance from everybody and using that to subsidize those people that go to an insurer and are incredibly expensive.
RW: If some people pay more to defray the costs of those who use a lot of healthcare, doesn't that mean that rates are headed in the wrong direction?
JH: This would be all rates. There would be some very small increase in what everyone would pay. What you're talking about is a relatively small number of people. I don't know what the number is in Colorado. Let's call it 10 people that cost on an annual basis, $4-5-6 million a year. If a couple of those, two or three of those people are concentrated with one insurance provider, they can upset the whole apple cart because again, some of these regions have such a low number of people that are actually in the private market, it dramatically raises the cost for everyone else. Now, if the entire population of Colorado, everyone who's insured, paid just a little teeny bit, there's such a small number of these high cost individuals that you could actually take care of it.
RW: There was a reinsurance program in the earliest days of Obamacare, and that sunsetted. Are you saying that you'd like to see the federal government bring that back up? What's the likelihood of that?
JH: I'm not sure whether that's the right solution. I think that people were worried six years ago, or seven years ago, that this could be an outcome, that we would end up with a concentration of people that had chronic medical conditions, that they would end up in the private market or on exchanges.
RW: Because younger, healthy people aren't necessarily buying insurance.
JH: Right, and the efforts to make sure that everyone bought insurance, the so-called mandate, a lot of people really rebelled against that and wouldn't participate. These reasons all come together to create a situation where we probably have to revisit. Whether it's a high cost pool or a program of reinsurance, you're trying to get to the same place.
RW: Here in the state or federally?
JH: Federally is the main way to do it. Ultimately, if we were to do it within the state, it would be a much longer and more complicated process, but I'm not saying we couldn't do it. I mean it's something that we would obviously look at, but in the meantime, that's why for the White House to say that they're arbitrarily going to suddenly stop providing these subsidies for insurance companies doesn't seem constructive. It really seems very, very harmful. We need to make sure that if that happens, at least it happens over a long period of time so we can begin to design a state response.
RW: Here you are with these ideas, reinsurance among them. Is anyone listening in Washington to that? I want to point out that Colorado's Republican Senator, Cory Gardner, voted with the Republicans in every iteration of repeal and/or replace. I know you've been in touch with him and so far at least apparently have failed to sway him, or he you for that matter.
RW: What does this tell us about, I guess, one, your working relationship with Senator Gardner, but in general, with Washington?
JH: Well obviously, I'm very disappointed that we couldn't persuade Senator Gardner to really hold out for a better solution. That's what it is. He's a US Senator. He makes his own decisions. That being said, roughly 17 percent of the American people, the last time I saw a poll on a nationwide basis, support what the House bill and to a large extent the Senate bill, proposed, that kind of a rollback on people that would have coverage. The challenge, I think, is more political than the will of the people. I think the will of the people are pretty clear that they don't want us to roll back coverage. They do want us to control costs and improve the system. The reason I'm involved in this on a bipartisan basis was I discovered a bunch of Republican governors that felt just exactly the way I did. I got talking with Gov. John Kasich of Ohio who has, he has spent a lot of time working on healthcare.
RW: I guess what I'm asking is what good is this work doing? You've found some likeminded Republican governors. So what?
JH: I think what we proposed in letters to Mitch McConnell, in op-eds in the Washington Post, press conference at the National Press Club, where John Kasich and I, and then at one point we've had as many as eleven governors signing these various letters, is saying this should be a bipartisan solution. It should be done with full transparency. We shouldn't be making these difficult decisions and serious compromises in the darkness of a back room.
RW: But do you see any evidence that they're being swayed?
JH: Yeah, they didn't pass it, did they?
RW: Do you take some credit for John McCain's vote?
JH: I don't know. I do know that he was aware of the letter, and he certainly made a rather impassioned statement that we should have a bipartisan solution that wasn't made in a back room. That was something that was in our letter. That being said, John McCain doesn't need to take direction from governors or anyone. He obviously stood up in a way that few other senators have. The Senate should be the conscience of this country. For a while there, it looked like maybe it wasn't going to be. It looked like it was going to be held hostage by partisan politics.
RW: Let me say that Politico is reporting as we record this that there is a group of 40 Representatives in the US House working on what they're calling a "stabilization bill," a bipartisan effort in that other chamber. I want to talk about Medicaid in the Affordable Care Act, because that's been a huge part of this debate. Simply that Republicans feel Medicaid has expanded too much. They want to give states more control over how to implement it. In Colorado, one in four Coloradans is on Medicaid. And I'd like you to square for me, governor, Colorado's relatively successful economy and low unemployment rate, and its Medicaid rolls. Help people understand how those two things are true.
JH: So a lot of those people, when you look at the overall Medicaid rolls, a large number of the people that were added were children. You've got elderly, you've got people with disabilities. What you're seeing is a lot of people who are working, and they can't afford healthcare. And look at what the cost of private healthcare is, and imagine that you're making $10 an hour. So $10 an hour is roughly $20,000 a year. How many healthcare plans, if you've got a couple kids, can you go to for less than $1,000 a month? Not too many, right? Without a subsidy, you're gonna be out of luck. And even with a huge subsidy, you have a hard time. So all of a sudden, you're asking people to pay 60 percent of their net income to healthcare? It's hard to buy food, to pay rent.
RW: What I heard, for instance, from Senator Gardner is, yeah. That speaks to the underlying problem of the economy. Not to the need to expand Medicaid rolls. It's a deeper issue.
JH: Well certainly there is a level of the economy where employers are doing more work with robots. There is an increasing priority placed on technical backgrounds, and a lot of the newer jobs are jobs that were in the hospitality industry, or in various other industries. You know, agricultural industry, where they have not been able to give the raises that other industries have been able to do. That doesn't mean those people don't deserve the opportunity to live, right? That doesn't mean they shouldn't have healthcare.
RW: I want to say that Colorado's Democratic Senator, Michael Bennet has suggested, essentially a public option, and that is letting people who can't afford coverage buy-in to Medicaid at a lower cost, but defraying some of those expenses. What do you think about a public option?
JH: There are all kinds of variations on a public option. One thing we've talked about here is, should there be a sliding scale? Medicaid would include those people who are really making so little, or have sufficient disabilities that they need full compensation, that they can't pay anything towards Medicaid, but then maybe there should be a sliding scale as people earn more and more money, they pay more and more, a larger and larger percentage of their healthcare cost. I think the bottom line is, you're never gonna get your economy going full tilt if people aren't healthy.
RW: As I said, you've been extraordinarily visible on this issue. This is just a sampling from the past six weeks or so. Two appearances on CNN, this appearance at the National Press Club, an op-ed in the Washington Post, and I have to ask, I know you're asked this all the time, do you want to hold national office? Now I'm not asking the question everyone asks, are you running for president, or will you? You can tell me that if you'd like. But I'm speaking in terms of desire, here. Please speak to your desire. Do you want to run for national office?
JH: I would not say that's a high priority right now. I am attracted to this specific issue because it has so much importance to Colorado, and because my past as the former chair of the National Governor's Association, I've got good relationships with a number of Republican governors. This is someplace where I saw an issue that was very important to Colorado, very important to the country, and my relationships with all these other governors, could make a difference.
RW: For a moment to a different topic, and that's marijuana. The US Attorney General has called marijuana as bad as heroin. He's interested in whether there's a link between pot and violent crime. I want to note that a federal delegation came to Colorado just a few weeks ago, met with your staff and with others. Do you see a link between violent crime and recreational marijuana in Colorado, or was your staff able to tell them with any certainty that that's just not a strong connection here?
JH: Well the data sets I've seen, when you begin to normalize and look at states that have similar populations, but didn't legalize recreational marijuana, and you compare them to the criminal activity we've seen here, I don't think there is a direct link, and if there is, it's very, very small. We, when I met with Attorney General Sessions several months ago, I guess it would be close to four months ago now, we invited him to come visit. And we really reached out and said, "We know we've got problems, and some of these we addressed in this last legislative session." You know, this is one of those situations where we have to continue to improve this system.
RW: Do you have a sense from that meeting with the delegation, and I know you weren't physically there, your staff was, do you have some sense of how the administration will proceed? Is a crackdown coming? What did you take away?
JH: We certainly didn't take away any sense that there was a crackdown coming, but ...
RW: On the other hand, where there any assurances one wasn't coming?
JH: No. I don't think so. Not that I heard, and when I met with Attorney General Sessions, he was very candid that he doesn't think legalized marijuana makes this country any better.
RW: But nothing about the more recent meeting with his delegation from the Justice Department, seems to have changed the scenario, the outlook, that you took away from your meeting with Jeff Sessions.
JH: Right. That is my understanding was there was no threat, but nor was there any reassurance that there couldn't be trouble ahead.
RW: Is any member of your staff gaming out what a crackdown would look like? A suspension of federal funds or increased law enforcement activity on a federal level in this state? Are you playing through what the consequences could be for Colorado?
JH: Well, again it's hard to imagine, there are so many states, over 60 percent of the United States population, live in a state where either medical or recreational marijuana is legal.
RW: It's hard to imagine, but that's what you've heard from the Attorney General.
JH: Yeah, I've never heard him say that he was come and crackdown. He was very explicit that he understands his highest priority is meth, cocaine, heroin, as he said, "I don't even have enough resources to really address those issues the way they need to be addressed." So he says recreational marijuana is not gonna be my highest priority. That being said, he said something close to, "I don't want to do anything that will encourage a single person to begin growing legal marijuana or to begin selling that legal marijuana."
RW: We've heard a lot of talk recently that your lieutenant governor, Donna Lynne, may be considering a run for governor next year to succeed you.
JH: She's mentioned that. The possibility.
RW: She's mentioned it to you?
JH: Uh-huh. Yeah. Several months ago.
RW: What did she say?
JH: She just said that she was, wanted to make sure I was okay with it, and that she was thinking about entering the primary as a candidate to take my place.
RW: What did you say?
JH: I said, "You have been one of the best people I've ever worked with, and certainly you have earned the right, if anyone has, if that's something you want to do, you should go and do it 100 percent."
RW: So that's your blessing. Would it come with your endorsement?
JH: You know, when people have asked me all the way along the line, am I endorsing someone, I've said the same thing to everyone, it's not my intention to endorse someone. Someone like Donna Lynne, who is so talented, when she enters, it makes that commitment all the much harder. But that being said, this is probably the most talented group of people running for governor that anyone's seen in a long time. It'll be fascinating.
RW: Governor, thank you for being with us.
JH: Always a pleasure.