On Thursday, by a vote of 218 to 214, the U.S. House of Representatives passed a massive tax and spending bill which all but two GOP lawmakers voted in favor of. Democrats remained united against it. On Tuesday, the U.S. Senate passed their version of the bill after a tie-breaking vote from Vice President JD Vance. The bill passed by the Senate is expected to add $3.3 trillion to the federal deficit, according to the Congressional Budget Office, while making steep cuts to Medicaid benefits to help pay for trillions of dollars in tax cuts.
In Oregon, roughly 1 in 3 residents get their insurance through Medicaid. According to Oregon Health Authority’s Medicaid director Emma Sandoe, an estimated 100,000 to 200,000 Oregonians could lose their Medicaid benefits under the bill. On Wednesday, Gov. Tina Kotek and former Gov. John Kitzhaber, the architect of Oregon’s state Medicaid program, urged U.S. Rep. Cliff Bentz of Oregon’s 2nd Congressional District to vote against the bill. Bentz is the sole Republican member of Oregon’s Congressional delegation and roughly 40% of the residents in his district are enrolled in the Oregon Health Plan.
Democratic U.S. Rep. Maxine Dexter of Oregon’s 3rd Congressional District is a pulmonary and critical care physician by training who testified against the bill on Capitol Hill and introduced amendments to it which were blocked by Republicans. She joins us to talk about the impacts of the Medicaid cuts for Oregonians and the new work and recertification requirements for Medicaid enrollees. “Think Out Loud” also made multiple attempts to request Rep. Bentz to participate in this conversation.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. The U.S. House of Representatives passed the president’s massive policy and tax cut bill about a half hour ago. Earlier this morning, when House Minority Speaker Hakeem Jeffries was in the eighth hour of his marathon speech railing against the bill, we got Maxine Dexter on the line. She is a physician who represents Oregon’s 3rd Congressional District.
I started by asking what the last 24 hours had been like.
Maxine Dexter: What it’s been like is an excruciating effort and solidarity to try to break this Republican betrayal from happening. It has felt incredibly empowering to a certain degree, with all of our members standing together and being in the chamber with our leader. But the fact of the matter is that they’re almost certainly going to pass this bill. So we’re holding on to hope and really pushing with everything we have, but not overly hopeful, quite frankly, that we can do this.
What I just cannot express enough is, as Hakeem has spoken longer, the hope has built, people are emailing and calling, and stories are flooding into the Leader’s office. We just have to hold on to the chance that some four Republicans will find their courage and vote against this travesty of a bill.
Miller: Oregon Senator Jeff Merkley told OPB on Tuesday, soon after the Senate vote, that it had been the most chaotic legislative process he had ever seen. Obviously, he was a lawmaker at the state level before he became a U.S. senator. He’s also been a lawmaker longer than you have, but can you put this in perspective from your own experience?
Dexter: Yeah, it’s dramatically different. It’s almost disorienting how different it is from the process that I was accustomed to in the Oregon House. We had an idea of what we wanted to pass, and worked towards policy and in a bipartisan way, as much as you can when you clearly have an agenda. But there were always conversations across the aisle and trying to bring people along. That simply is not what’s happening here. In fact, not only are the Democrats completely boxed out, but marginalized and really dismissed for the concerns that we’ve had.
The reality is that there’s two very different beliefs and framing for what is happening in this bill, and it’s really hard to rationalize some of the things that they’re saying with what we’re reading. It’s just chaotic also, because frankly, most of them hadn’t read the bill and didn’t know what was in it. That happened the first time around in the House and it’s happening again this time.
Miller: Have House Republicans made any substantive changes to the Senate passed bill? I mean, I still don’t feel like I have a clear understanding of how different the bill is likely to pass – and again we say we’re talking at 9:20 a.m. Pacific time – if it is different in any way from the Senate passed bill?
Dexter: Yeah, so what budget reconciliation is a process that allows for a simple majority in the Senate to get the bill across the finish line. And what it requires is that the exact same bill passes both chambers. The Senate gets the last say, and that’s to overcome the filibuster. So if we change this bill … which it has not been changed at all. This is exactly the same bill right now in the House that the Senate sent to us.
Now, let me just clarify that it is a much worse bill. We were hoping it would get better in the Senate. It actually got worse and they sent it back to us. So far, there’s been no amendments accepted. We put over 500 amendments forward the night before last and none of them were accepted. So if this bill passes today, it is exactly the same bill and it will not have to go back to the Senate before it can be signed.
Miller: Do you have a sense for what seems to have changed the minds of two sets of your Republican colleagues – the moderate ones who’ve been saying for a while now that the Senate’s Medicaid cuts were too draconian, and then the self-proclaimed deficit hawks who, just yesterday, were saying that adding more than $3 trillion to the national debt was going to mean a definite no vote for them? What changed?
Dexter: Well, nothing changed in the bill. The only thing that changed was their resolve. They said that they had principles, and they have compromised those principles. We know that there were many conversations at the White House and between the Speaker. I certainly don’t have firsthand knowledge, but the reports are that there’s deals being made, and backroom deals, and arms being twisted. I think that that’s probably what happened, because one of the members literally voted no on the rule, which is the last step before this bill’s final passage, then ran off the floor and couldn’t be found again to get him to change his vote back.
So they know that they’re going to be pressured and part of that is a play. This happened with Senator Murkowski, that she was going to be a “no.” Then she was able to get things for the state of Alaska and then she became a “yes.” So I think part of this is people trying to get some sort of accomplishment for their constituents or themselves and that’s deeply unfortunate that this is the state of American politics right now.
Miller: One difference there is that for, in Senator Murkowski’s case, what she asked for was put into the Senate bill. And it seems like what you’re saying now is there are no changes to the bill, so instead, it’s theoretically a promise of executive action that members of Congress are now able to say that they got from the President in return for their “yes” vote.
I want to turn to the bill itself. What impact will new eligibility and work requirements have on Oregonians who get their health insurance through Medicaid, through the Oregon Health Plan?
Dexter: In Oregon, we’re looking at a loss of at least $20 billion over 10 years because of cuts to Medicaid and the projection is that approximately 198,000 Oregonians will lose their health care coverage. The vast majority of those, almost three-quarters, due to Medicaid cuts and 54,000, about a quarter, due to the Affordable Care Act cuts.
There’s also the risk of hospitals being closed. The provider tax changes are going to have a deep impact on that, as well as the loss of Medicaid coverage. That doesn’t include the fact that $500 billion in Medicare cuts are going to be automatically triggered because of the budget impacts of this bill.
Miller: How do you think about that? I mean, you just put out a lot of numbers. But to me, the most urgent one is not about the money itself, but about the number of Oregonians who will lose access to their current health insurance – close to 200,000 according to the numbers you were just talking about.
Dexter: Yeah.
Miller: How do you think about those Oregonians?
Dexter: Dave, I took care of the sickest people in our communities for almost 20 years. And almost assuredly the lack of access to health care played a role in almost all of the sickest patients that we would see, whether it was an inability to afford their prescription drugs or inability to get in to see a surgeon before something became an emergency. The vast majority of people who come in in distress, it’s because they have delayed care or haven’t had access to the care they need.
So what this means is that Oregonians, regardless of your health insurance, this has nothing to do with the people who are on Medicaid who won’t … everyone is going to have an impact. Emergency room times, waiting times are going to go up. Hospitals probably are going to close. There’s a projection that one quarter of all nursing homes will close, which slows down discharges from hospitals, which delays people getting in. It’s a cascade of events that will impact each and every one of us.
The fear of what’s going to happen and the preparation for what’s going to happen is going to cause preemptive changes to the health care system, because we know part of the reason so many people are going to lose their coverage is because they’re going to have all these red tape tasks that they have to do. One person said it’s like having to file your taxes every six months just to keep your health care insurance to prove that you’re working.
The vast majority of people that they are going to drop off of these Medicaid roles is because they’re working, they’re raising children, and they won’t have the time to just do all the paperwork and keep up with the requirements. Most of the vast majority of them already qualify and would still qualify.
Miller: You mentioned this briefly, but I want to just turn to it again because it’s one of the significant changes from the Senate passed bill that was sent back to you, which is they added back major changes to the provider tax. This gets sort of complicated and it’s a weird kind of kickback scheme, but it’s also a significant way that hospitals have been able to get federal money to operate in this country and in Oregon for a while now.
The Oregon Health Authority has said that this change to the provider tax could lead to a loss of close to $12 billion in revenue over 10 years. What impact do you think this is going to have specifically on Oregon’s rural hospitals?
Dexter: Yes, so the projections … Oregon has used the provider tax as a way to increase reimbursement in our state. And this is a common thing in lower income states. This is not the truth for Oregon, but it has been something that we have adopted. We have one of the highest provider tax rates in the country, so it will impact Oregon disproportionately to other states because it’s rolling it back. We’re currently at the point where it wouldn’t have had to be rolled back if the House bill hadn’t changed. It wouldn’t have allowed us to go up, but it wouldn’t have rolled us back. Now it’s going to roll us back over time.
So what that does is hospitals that are barely making ends meet, that 3% that they were getting in reimbursement back from the federal government will disappear. It’s almost 3%. It’s 5.5% divided by, they get a 50% reimbursement once they pay the tax, and they get 50% back. So that percentage is going to go down significantly. That was the buffer that they needed to maintain the liquidity that they needed, the margin that they needed to stay open. So with this, rural hospitals that are already dependent on Medicaid patients will lose those patients and the provider tax. The double whammy of that is going to lead to hospital closures. And two that are expected to or are at risk for closure are in Cliff Bentz’s district.
Miller: We have reached out a number of times to him, as have members of our newsroom, to get him on, to have an interview about this. We have not heard back. Have you yourself had a conversation with the only Republican member of Oregon’s congressional delegation about this momentous vote?
Dexter: Yeah, I actually spoke with him yesterday. I will just say from the get-go, he’s always taken my calls, always is very collaborative and he is a lawmaker who is accustomed to working across the aisle. And the reality is that he voted right away for this bill, there was no delay for Cliff. So I think he is having conversations, he’s trying to understand the problem. He wants to do something to help. But at the end of the day, he was in a position where he was going to vote “yes.”
Miller: This is an enormous bill. We have focused almost exclusively on the health care side of this because it is momentous in and of itself, but it’s just one piece of a sprawling bill. What are some of the other provisions that you are thinking about the most today in the hours before its likely passage?
Dexter: One of the most, quite frankly, destructive things is that we have made a policy choice to allow hunger to be an outcome for giving tax breaks to billionaires. And Oregon itself is facing an $850 million extra cost per biennium, due to the food assistance program cuts, so that is going to put at least 62,000 Oregonians at risk for being hungry. That’s a policy choice. That could go to the state to backfill, but the governor’s been very clear that they simply don’t have the budget to be able to do that.
So the federal government is putting Oregon in the extraordinarily problematic and, frankly, immoral position of deciding whether or not they’re going to let people go hungry or cut something else that’s already been, as you know, in a very difficult cycle for the legislature. There’s no money around to fill the gap. And letting children go hungry is not just going to happen because of the SNAP cuts, but because of the Title I rollbacks that they are doing. So kids who are now eligible for free and reduced lunch at Title I schools, those schools are going to get clawed back significantly with this bill. So they won’t have free lunch or breakfast at school, and then they’ll go home and be hungry there as well.
Miller: Maxine Dexter, thanks very much.
Dexter: Thank you so much, Dave. I really appreciate your coverage.
Miller: That’s Democrat Maxine Dexter, who represents Oregon’s 3rd Congressional District. We talked earlier this morning, just a few hours before the House did pass President Trump’s massive policy and tax cut bill.
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