Watch our life we can coverage of the Miami Book Fair this weekend on cspan2s booktv. Next, to Foreign Policy advisers for democrats and republicans debate healthcare policy including benefits, challenges of the current law, the gop attempts to repeal and replace it. Good morning. And hope you enjoyed the dinner last night and are bright eyed and bushy tailed this morning. Do we have a couple of panelists in the wings here somewhere by chance . Rumor had it i did. I see them, and theres a hand waiting. Very good. Chris, lanhee, good to see you. I was afraid i was going to to do you look weak or a monologue for an hour. That wouldve been something. Weve got repeal and replace ine wind, very polarized congress, polarized nation. All of this is impacting us a lot, so we thought it would make sense to go ahead and invite a couple of representatives one from the left, one from the right. So in terms of format, let me go ahead and provide introductions to these gentlemen that are probably pretty well known to you. And then well allow each of you to make a statement, maybe three, four minutes to provide your perspective on where we are in health care politically particularly, and then well go ahead and talk. So Chris Jennings here immediately to my left has been a guest a couple of times, i believe, and he has made his marks in big ways in this city working for both the Obama Administration in the architecture and the drafting of the Affordable Care act, and then prior to that with the clinton administration. So highly regarded, well known and very much a d as in democrat. So you get to represent that pole here in our polarized world. And lanhee chen, a lawyer from fox, the a fellow with the Hoover Foundation and then really mostly what lanhee is now maybe the number one lead aring voice on the right in terms of leading voice on the right in terms of health care reform. He was an adviser to the rubio campaign. You see his writings everywhere, he and i were on a panel the other night, and hes a good speaker. So with that, why dont i join you. And since youre immediately to my left, chris, ill let you go first. Okay if youd regale us with your thoughts, thatd be great. Okay, ill be happy to regale. I do feel i should go last since were in the minority right now. We have a little bit of energy now, but its and thanks to the republicans, which we appreciate. [laughter] just a little gift. Holidaysing. Were giving you guys a holidays coming. We only do well when republicans do poorly. Its not because were good at all [laughter] and their occasional division and dysfunction only does one good thing for democrats, which is to camouflage ours. And we have for which theres much. And i think today youre seeing and i thinkalmost an extraordinarily unique time in the health care debate. We just had this election. You can talk about the poles and what the polls and what were asked, etc. , but it is pretty significant that there was no other issue that polled as high amongst voters interest as did health care by 20 some points in virginia. Yeah. And theres crosscuts on in thats probably necessary to look at like economic security, etc. But the point is health care really dominated the domestic policy discussion this year and the political one. And, obviously, that was done as a consequence and was a result of a almost yearlong debate and an attempt to repeal and replace which, of course, from our perspective were pleased failed. At least today. But in the midst of that, you have a big debate all the way from repeal to replace all the way to singlepayer. The democrats base are really moving into that direction. Theres a frustration on both sides about our Health Care Delivery system. I think there is an excessive amount of discourse and attention focused on the exchanges. It represents 8 of the marketplace. Most people get their health care through their employerbased, medicare and medicaid, and yet probably 93 of the Media Coverage is on the exchanges and nongroup individual marketplace. So i think that filters through, i think, misperceptions of what our Health Care System is and what the challenges are. I think the big issues amongst the public there, actually, are frustration with complexity and outofpocket cost, and that is a huge driver of the debate in front of us. And i think candidates who only focus on the exchange on any level are probably missing the boat on having an engaged discussion with the public and how theyre thinking about this. Notwithstanding that the debate around the Affordable Care act really has anchored the discussion for the last year or so. You look at almost everything that has been focused on, and i like the last discussion because, of course, it validated and affirmed what we all know in this rook, is that health care in this room, is that health care is local as well as national and is affected by moat, and there are huge differences and dynamics you have to deal with at every level. And that filters into the political discourse as well. Lastly, ill just stop with this and turn it over to lan hee about where were going, where weve been. But where we are today, i would say that the marketplace is not in as bad a place as some people think. We, the irony of the withdrawal of the costsharing reduction payments means that more money is going into the system to subsidize premiums at higher levels, and now people are being able to buy gold plans and bronze plans for much less than they otherwise would have if theyre subsidized. The population who has been and continues to be screwed are those people over 400 of poverty who are exposed to very, very high premiums and very poor benefits. And thats something that i think is unsustainable over a period of time, that has to be addressed. But nonetheless, i would predict to you that the markets today and the insurers participating are going to have an actually pretty good year in terms of their revenue intake. That doesnt mean its perfect. Health cares always here for those of us to reform, and thats why we all have jobs. [laughter] so with that, ill stop. Very good. Thank you, chris. Lanhee. Well, thanks for having me. Sure. Funny, i guess the title of this panel is the saga continues, but rather than sort of another star wars movie, it seems to me weve been through groundhog day a little more than star wars. [laughter] you know, look, i think that theres a couple of observations i would make about where we are right now. The first observation is that, obviously, we went through a very tumultuous period of time where republicans were kind of coming at this problem from a lot of Different Directions with the same outcome which, i think, predicts that theyre going to do the same thing again next year. And i think that were likely to see a similar effort next year on repeal and replacement of the aca in part because theres a policy imperative, in part because theres a political imperative, and ill start with the latter first. If you look at Public Opinion polling of Republican Voters in particular, what you will find is that a majority of them and i literally mean a majority still believe that the top agenda item for congress to deal with is repeal and replacement of the aca. And so that remains a, if you think about the echo chamber that republican members of congress are getting when they go back to their home districts, what they continue to hear is that the aca is a problem and that something has to be done about it. And so that suggests that even though they went through a lot of difficulty, a lot of political difficulty, a lot of policy difficulty in dealing with the aca over the last several months, they still feel a strong motivation and desire and need to do something about this. And so i think 2018, you know, were in a tax reform debate right now. That debate will wrap up in december or july depending on who you ask. But regardless are, i do think it wraps up at some point before we get too far into 2018. And then i do think that we do come back to another round of discussions on the future of the aca. So i think that is nearly ineffable. Inevitable. There is a policy issue here as well though which is that there are concerns about where things are going. And certainly a lot of that concern is in the aca marketplaces which chris rightly points out is not, its not a huge number of people were talking about. But some of the cases that were hearing about do make for good media fodder. And i think youre seeing, for example, stories about rapidly escalating premiums, declining choices, and these are real problems in some states. Also the quality or the nature of peoples plans are changing, so you have higher and higher deductibles, less access to physicians. Those are problems that congress will need to deal with. Now, ideally they would deal with it in a bipartisan manner. But, you know, the energy for bipartisanship, thats not really where the energy is right now. And our political system doesnt seem to be rewarding that. So thats sort of the first observation i would make. The second is that were in a very interesting time with respect to the discussion around health care on the progressive left. And maybe we can hear a little bit more from chris about where he thinks this is. But in my view, it is super interesting how quickly we have gone now to a discussion around governmentrun singlepayer alternatives, medicare for all, whatever you want to call it. And, by the way, the reason why different people call it Different Things is because Different Things happen to register Different Levels of popularity with the american public. Medicare for all, surprisingly not, does better than single payer. The reason you hear people talk about it as medicare for all now is because that seems to be the way to talk about it so that you dont scare people into thinking that were turning into some european country. But its interesting how quickly now the discussion on the left has migratedded there. And i would suggest that because the next election is never that far away, the reason why people are my grating there is migrating there is because there is a sense that when we get to 2020 ahead of the next president ial election, someone in order to be successful as a democratic candidate for president needs to have been there, needs to have been there earlier and more vociferously than other people. And i think thats part of why youre seeing the dynamic youre seeing. That having been said, it is remarkable to me that we havent had a more earnest debate about singlepayer systems in the united states. And so i do think were going the see that debate. Now, whether it is substantive, thoughtful, that i am skeptical of. But i do think were going to see that discussion, and i think were going to see it pretty significantly as we move through 2018, into 2019 and approaching the 2020 election. Last point i will make is i think republicans, where they have settled in terms of what they want to do about the aca is i think more and more republicans are agreed that the way forward is in emphasizing themes of federalism. And you saw this in the last iteration of the republican repeal and replace effort in the proposal introduced by senators graham and cassidy. And their proposal really focused on giving states greater freedom and flexibility in the form of a block grant and the loosening of a lot of the acas regulatory strictures. That effort, i think, was probably too far, too fast for a lot of people. But i think signals where republicans are going to be most comfortable. If theres anything the aca debate in the summer and fall exposed, its that republicans actually dont agree on a whole lot when it comes to Health Care Policy. I think thats a fine thing. I think its a healthy thing to have disagreement even within one side of the political spectrum to think about really future of Health Care Policy in a more thoughtful way. But i think it did expose some of those fissures within the conservative movement on Health Care Policy. That having been said, if you were to poll a hundred republicans in congress, the one theme that i would argue would get the most support is sort of federalism, devolution, greater responsibility for states. And so whether the foundation is the grahamcassidy legislation or the loosening of some of the requirements around what are known as section 1332 waivers which is a provision in the Affordable Care act that allows states greater flexibility to design their own Health Care Systems so long as those systems comply with certain requirements and certain benchmarks that the aca establishes whether its, you know, sort of broader or more narrow, i do think were going to see some effort on the right to my grate the discussion migrate the discussion toward the value of federalism and the importance of federalism in Health Care Policy. So thats how i see the environment right now. I think it is a very interesting time because health care is never that far away from the center of the discussion. Even though were talking about tax reform today, theres a question of will republicans put into their tax package repeal of the individual mandate, which i think, you know, as an idea has a lot of problems to it, you know, not least of it is when you mix health care and tax debates, you know, bad things tend to happen. That having been said, i think it is an interesting time. We are going to see a lot of discussion around health care, and im eager to hear, chris and don, your thoughts about where were headed. So ill ask you a question, lanhee. The republicans made a promise to repeal and replace. Weve seen their efforts to uphold that promise, house bill, ahca, skinny repeal, grahamcassidy, all of them and i want to break it down here now, because there was a lot to the Affordable Care act. I mean, there was exchange, there was expansion, delivery reform, is theres a lot more, and i think we need to parse it out a little bit. I want to focus, first, really on medicaid. So all of those republican attempts included provisions that would have had the effect of rolling back the expansion. Uhhuh. Why . Why . Whats the republican think behind that . So i think there are a couple of reasons why. Let me just say, first of all, i think that the notion of putting medicaid on some coupe of fixed some kind of fixed federal allocation is something thats been around in conservative circles for a long time. And i think that is partly motivated by two things. One is a sincere sense that the federal obligation, the federal fiscal obligation for medicaid is growing at an unsustainable rate. Relatedly, i think there is a sense that the program has somehow gotten too big. And that in part has to do with the expansion of the aca through expansion of medicaid through the aca being sort of relatively broad in its scope. So whether its the fiscal issue, whether its just the notion that a Government Programs getting too big, i think those are the, those are the pure policy motivations. Now, the other side of it is theres an argument that if republicans wanted to undermine the aca, that the core of what the aca did, in my mind, really is the Medicaid Expansion. I think to understand the aca, you really have to understand the role that Medicaid Expansion played in it. And whether you think its a good idea or not, i think we can all agree that Medicaid Expansion explains a significant amount of the coverage increases in the aca. Sure. And so the other part of this is the politics of it which is if you wanted to really strike a blow at the aca, getting at the Medicaid Expansion would be a big part of that. So you can make the political argument when you go home, hey, look, ive done something about the aca because ive done something about the Medicaid Expansion. But what the debate exposed is that there are actually a number of republicans who like the Medicaid Expansion people like Susan Collins fundamentally uncomfortable with rolling it back. And, you know, i dont think people realized that before we had this debate. I think there was a sense that republicans monolithically wanted to roll back the Medicaid Expansion. As it turns out, the coalition is more limited than we thought. Yeah, but all of the attempts included that rollback. Yeah. Introducing the cost of increases that were slated at a different index on the block grants, you get to the rollback. And that was a feature across all of the efforts. So i hear you say, you know, there was philosophical opposition to that, but inherent in what im hearing also is somehow the notion that it cant be afforded. Right. Is that true . Well, look i mean, arent those costs borne by somebody somewhere somehow whether its Community Clinics or Emergency Rooms across the country . Yeah. I mean, i think its fair to say that nothing is free, so it is the case that, you know, we have to look system wide and figure out if those costs are not absorbed by medicaid, where are those costs absorbed . I think its a perfectly fair point. But there is also this other issue which is what would be the most effective way to cover that population. Now, you know, in some states medicaid is very effective, as it turns out, right . A very low cost basis in some states. In other states, less so. So i think that variation across states gives people who argue that medicaid is not an efficient form of coverage something to shoot at, something to say, aha, look, i have an example. But, look, when youve seen one Medicaid Program, youve seen one Medicaid Program, right . Theres actually a lot of variation. And so, look, i think that there is an argument to be made that medicaid is consuming a i mean, its not an argument, its just the truth. Medicaid is consuming a greater and greater percentage of the federal budget. The question is, is that a useful expansion of federal spending or not . I think most progressives would argue it is, and some conservatives would argue that it isnt because there are better and more effective ways to get at that population. Chris, is that double talk . [laughter] i mean, i, i feel sorry for lanhee. [laughter] you and me both. I feel sorry for myself some days. [laughter] no, i mean, i feel like i, im double teaming. But i will just say a few things. One, i think the medicaid debate exposed a couple important points. One is, yes, theres some republicans in the senate who are liking it, but also the stakeholders, the providers, the health plans, theyve now become, oh, this isnt as bad as i thought it was going to be. Theres actually a specific funding stream that i i had to take care of these populations indirectly through different types of crosssubsidization, now im going to get payment for it. And guess what else . There was a lot of republican golfs who expanded medicaid governors who expanded medicaid in the intervening time. If you ask most people in washington who was the most effective opponent of the repealreplace, it would be republican governors. They had more of an impact on this debate than probably anyone else. Notwithstanding everything else. The second issue on medicaid is, of course, you know, when you look at mediaover to coverage and the Media Coverage and the legitimate policy problems raised postenactment, its largely been focused around the nongroup individual market, the exchanges. The Medicaid Expansion, for as large as it was, has been expanded in a significant way with very little negative reaction. And so working very quickly to repeal and replace that particular policy rather than focusing particularly on the exchanges, i think, was a political mistake. In the end, and i think as a consequence medicaid has actually become stronger than it ever has been in terms of political ethos of washington. Theres going to be nervousness about this. Thirdly, there is, you know, theres math here, right . Republicans needed offsets to do some of the policies that they wanted to have. So i would argue what they probably did wrong i mean, i think theres a number of things im pleased they strategically made some errors, but one i thought was to go not just to repeal the expansion, but then to cap growth of the Medicaid Program. It was like a onetwo punch in the Medicaid Program. So that brought in a lot of different people into the arguments. So for all these reasons, i think it was a huge mistake but notwithstanding that fact, they need to have the offsets Going Forward. Lastly, i did want to say we often hear medicaid costs and growth are out of control, but, of course, on a per capita expending level as opposed to an aggregate, on a per capita were growing at very low levels in the Medicaid Program. And, in fact, its probably the cheapest way. Indeed, the reason why the democrats expanded to 138 rather than 100 in the Medicaid Program is that cbo scored it as less of a cost because you could secure the coverage at less of a cost because of lower reimbursement rates. So for all these reasons, i think its going to be hard and i would argue against playing off medicaid. One last point. I guess i want to just, a political dynamic that i think they made a mistake about strategically, but what happened right after the election which didnt exactly turn out the way i had hoped or expected [laughter] the, i think it was pretty much expected that we were going to have a quick repeal vote. I mean, it was a certainty. And i think what happened in the intervening period of time is suddenly the media focused on this debate in ways that they hadnt before. And in fairness to republicans who had repealed this many, many times prior to this, they never had felt that debate because no one covered it. Why . Because it was never going to happen. Now it was real. And i think the republicans werent prepared for that type of analysis and critique that, okay, now its real, and they werent prepared to produce the type of product that the media was quite hungry for. And the consequence with that was President Trump said, well, i would never repeal something without replacing it. And the moment that a lot of republicans or a number of republicans said, okay, were going to have to repeal and replace at the same time rather than repeal and delay, it did expose those divisions amongst republicans that lanhee has talked about. And they werent ready to produce a product that could sustain a republican consensus because they werent going to get democrat support for repeal on that package. Which, i think, will thwart them Going Forward too, Going Forward particularly in the aftermath of this debate. At least i hope so. So underneath this though, i mean, theres issues of affordability and so on and the trust funds and the like, but underneath it theres a more fundamental question as to right versus privilege. And i think it becomes even more graphic as we kind of fold in the singlepayer debate with Bernie Sanders and so forth. Where is the country in 2017, where are the two parties in terms of answering that very fundamental question, is health care a right or a privilege . Chris . Well, i think that what has happened and this is, i think, a change, an evolution. And in the Republican Party, maybe a revolution. Which is i think that the, for the most part now republicans are saying, well, we want to coffer everyone, but cover everyone, but were going to do it our way. As opposed to, and, you know, one of the big criticisms they cite is the Affordable Care act didnt cover everyone. Which is sweet. I like that. [laughter] but the notion, political notion that we should be covering everyone whether its a right or a privilege, we should be covering everyone and that no one should be exposed to discrimination on the basis of preexisting condition i think now has been followed into sort of the ethos of the debate. Which i think makes the alternatives to the Affordable Care act that are not single payer difficult to achieve. Yeah, i disagree with that slightly in the sense that i think it is not the case still amongst all republicans that that is a agreedupon belief. I wrote a piece in the Washington Post where i said lets all just agree that the goal of any reform ought to be to move us toward, if not accomplish, the goal of universal coverage. I cant tell you how much blowback i got from that. And not from your people, from my people. Oh, i dont expect it from your people were very supportive which may explain why my people were not. [laughter] but i think it was, it was not surprising to me you can come over to our side. [laughter] a little late for that. [laughter] but i, what was, what was surprising to me, and i shouldnt say it was surprising, but it is the case that there are, there are disagreements within the conservative movement about whether coverage is a meaningful metric or not. And weve had this debate for a long time. But its still very much, i mean, thats why republicans are having this difficult time, because if they all, if all republicans agreed that coverage was a meaningful metric and, you know, we ought to be moving toward universal coverage, the terms of the debate would be very different than they are now. So we dont even have that lexicon in common. So i think theres actually more disagreement on these fundamental terms of art than we might even think. Let me turn to the exchange now by the way, can i just say one thing . Sure. I think lanhees correct e, and i think people in the Republican Party who are saying coverage is not the best metric is actually an honest way of addressing this issue absolutely. Yeah. Because the you pretend otherwise if you pretend otherwise, you cant come up with a policy. Right. But what im suggesting is the political messaging and ethos is counter from the underlying opinion. And that creates real problems in terms of reconciling policy versus rhetoric. So i get confused hearing all of this as i was confused about the discussion regarding the exchange. And we had some of that here yesterday. So ill start with you, lanhee. Whats sort of wrong with the exchange . We heard yesterday congressman walden talk about the rising premiums in the exchange. Members in the audience observed that, hey, the premiums are rising outside the exchange as well and the rising premiums in the exchange are a justification for, you know, to opposing it and so forth. Whats your perspective on the exchange . Whats wrong with it . Why should it be curtailed or removed . Well, first of all federal and state exchanges. Yeah. I think that there are some technical questions about, for example, whether, you know, whether the you know, in some situations, for example, you have private marketplaces that are growing up that have been stunted by some of the regulatory pieces put in place by the aca. I think that those are the minority of cases. I, look, i think that the problems the exchanges are experiencing are emblematic and symptomatic of the sort of Health Insurance system more broadly. So i would not necessarily say its an exchangespecific problem. And this gets back to the question of do you think that the aca Regulatory Regime as put in place was a good thing or a bad thing. And really thats what fundamentally the debate comes down to. So when republicans talk about wanting to effectuate change on the exchanges, really what i think theyre saying is they dont like the fact that a lot of the decisions that previously have been made by states have been, quote, federalized. And thats really what this comes down to. I do think its the case that in some states youre seeing some challenges that have been created by the patient mix thats showing up on the exchanges, you know . Some insurers in some states have decided its not a particularly profitable book of business for them s and so their looking elsewhere. Regulatory uncertainty has been a problem on the exchanges, and if you look ahead to 2018, if you try to discern why premiums are rising in 2018, i think most observers would say that a good chunk of that has to do with uncertainty around payment of the costsharing reductions and what that created. So theres a lot of regulatory uncertainty thats built into it as well. But you have of to unwind that a little bit and say why is there regulatory uncertainty . Part of it is because there were elements of the law when they were written that werent written in a way that were precise or werent written in a way that anticipated these problems. So the easy answer would be, well, lets just go back and fix those. But unfortunately, a lot of thats got caught up in the discussion around repeal and replace of the aca. But i dont want to undersell that i think in some states there is a significant problem with patient mix, insurer competition, premiums going up. I do think does this justify a repeal of all the exchange . I think that and answer that in the light of the recent open enrollment where the numbers are higher than they have been in the past. I mean, i think that it ends up being a binary discussion. So in an ideal world, yes, you would just go and fix, you know, create the technical technically, you would, like, pull the levers you needed to pull to make the exchanges more attractive, for example, for insurers to participate. I have no quarrel with that. But thats not the reality of where we are. The reality of where we are is exchanges are a part of the aca. If you dont like the aca, you cant like the exchanges. I mean, thats just the politics of where im just being honest. Yeah. So while i see a series of technical corrections that could be made to really improve this, the likelihood that i mean, you look at the proposal, theres a bipartisan proposal right now on the table right. From senators alexander and murray that would make some of these changes that i think both sides would say, okay, those are reasonable things you would need to do. But its got close to zero traction now because of the environment that were in. Okay. Chris . Well, i theres just so many things about the exchange. First of all, youre right to raise that premiums have gone up in other contexts. Its not just the exchange, but also i think its appropriate to say that the nongroup individual market is the hardest place to make the marketplaces work. Yeah. You have a much more volatile population going in and out, you have people going in between medicaid and the exchanges and exchanges and employerbased. If youre an insurer, this is all preaca and postaca this is always a problem, and as a consequence, there will always be some challenges that exist there that dont in other areas. Yes. Secondly and notwithstanding that fact, if i was this is the ultimate irony, of course, is that most republicans prior to the Affordable Care act would say we need exchanges as an alternative to a big, singlepayer medicare. We need a privatebased coverage of approaches. And i would argue respectfully but, you know, id be ignored by most, some people [laughter] wrongly so, but [laughter] is that you would work to strengthen the exchanges specifically because, you know, its very hard to argue for such policies as i want medicaid to be in the private plans or medicare to be in private plans through premium support without having a viable marketplace. So i never, like, i never really understood this whole discourse, because i just felt, you know, what are you doing . Also ironically, when the aca passed, we provided the states the opportunity and the resources to set up their own exchanges. Now, of course, mostly it was blue states who made that choice. In retrospect, maybe they would be, they would want to be the ones to do it. But why was the reason . One, they didnt want to buy into the Affordable Care act, obamacare, etc. But the second was they were comfortable administering the Medicaid Program. They did not want the deal with other populations over and above that, and they were going to leave it to the Insurance Commissioners to do what they wanted to do. So, you know, you have to kind of understand the conduct. So, but i for the life of me, i dont believe, i dont understand why we cant Work Together the fix this. Because these exchanges are actually functioning fairly well short of the population that i mentioned, the nonsubsidized populations that have to be addressed, and they can be addressed without blowing it up, and it should be. But is there a way to, i mean, the issue with the nonsubsidized population is precisely that theyre not subsidized, right . That seems to be the big problem. Because the takeup is actually pretty good at the lower income brackets because the subsidies are relatively generous. And so in my mind, we ought to be focusing the discussion on those folks because we are buying out some of the base when you get up to 350, 400 of federal poverty, those people are getting offers of coverage through their employers maybe. And so what i would think would be a productive approach would be to say, look, lets really focus on the costsharing reduction population, 250 of federal poverty and below, that actually need the assistance and are getting usable assistance on these exchanges. Thats the population we ought to be really focusing in on. Right. But i guess i would say, and i welcome that, for sure, but the truth is Health Care Comes down to affordable, affordability. And also it has to be affordable to a relatively decent package. It doesnt have to be cadillac, but it needs to be a relatively decent package. And i would argue that, yes, the idea you have a cliff at 400 of poverty, i mean, you talk about people in california where its just like, boom, you dont have access to subsidies, theyre mad. And they have a reason to be. Theres a cliff where theyre not getting any type of protections against these high premiums. Now, all one would have to do would be to eliminate that cap, just eliminate it. Because remember, its at, what, 9. 6 right. Or whatever it is. It automatically is income adjusted, so you fix it. And youd find some other ways to strengthen the marketplace. But i, again, this is a very fixable marketplace, and it will always be a challenge. But we should be focusing on that and getting some bipartisan interest in doing so, and i think we could build on the efforts of alexander and murray and others. Is the goal to increase coverage or, and or is it to address the fact that individuals dont get the benefits of tax exclusion that employed individuals do . What problem we addressing . Is there another way to deal with that . Well, sure. I mean, look, im a democrat. I want to cover everyone, okay . Yeah. I want to figure out some way to make it work. We havent achieved the ultimate objective, and thats why theres some of our party, understandably, are, you know, frustrated. Remember, the Affordable Care act was polling at not very great levels during the presidency, right . Not just because republicans hated it, there were some of our left who said you didnt go far enough. Sure. Okay . Now whats happened, its like, you know, health cares like relationships. You never, you never care more about them than when youre about to lose them, right . Thats what health care is. And thats what weve just seen in this debate which is, oh, my god, youre going to take this away from me . You cant do that. Yeah. Well, the don, to your point, the tax exclusion piece is, in my mind, critically important. If we werent operating within the bounds of political constraint, one could argue that, you know, why do we have a subsidy that is available to people who get offers of insurance through their employer but not available to individuals . And you could say the aca actually took a step in the right direction by imposing the cadillac tax which is designed at some level to function like altering the existing tax treatment of health care for those who get it through their employers. Most economists would argue that the sort of original sin of our Health Care System if there was one was this revenue ruling in the 1940s from the irs that made health care nontaxable to the employee as a fringe benefit as a way to circumvent wage controls. So if you were to change the treatment good afternoon. [inaudible conversations] yesterday momentum continued to build behind our plan to deliver massive tax relief and job creation for the american people. The house passed the tax cuts and jobs act, and the Senate Finance committee passed its companion tax reform bill. These were important moments as we move closer to a final vote. In recent months weve heard from american
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