Trascrizione completa di Single Payer Radio | Rep Joshua Watkins on the Medicaid Cuts | 10-30-2026

break up the 67 00:04:28.949 --> 00:04:34.810 district into three different parts. The eastern part, around Germantown, Schnitzelburg, St. Joseph, 68 00:04:35.290 --> 00:04:40.560 Mayweather neighborhood, Fort Hill. Parkway Village. And then I go 69 00:04:40.600 --> 00:04:43.019 through the central part, which is where the University of 70 00:04:43.100 --> 00:04:45.060 Louisville is. So I have a large portion of that 71 00:04:45.459 --> 00:04:50.040 around Old Louisville and Limerick neighborhoods. And then I have 72 00:04:51.439 --> 00:04:54.329 the western part of the district, as we say, with 73 00:04:54.370 --> 00:04:56.449 the West End, as we know it as the West End, 74 00:04:56.850 --> 00:05:01.389 which is California, Parkland, Chickasaw, Shawnee, and a portion of 75 00:05:01.449 --> 00:05:07.550 the Russell neighborhood as well. So 45,000 people represent, completing 76 00:05:07.589 --> 00:05:11.069 my first term in the Kentucky General Assembly in the 77 00:05:11.189 --> 00:05:16.259 House of Representatives, where I have also recently concluded my 78 00:05:16.339 --> 00:05:19.899 very first year as the whip, as you said. So 79 00:05:20.240 --> 00:05:25.500 my background is in public administration, community development, and government performance. 80 00:05:25.519 --> 00:05:29.120 Spent about almost 11 years in city government and global 81 00:05:29.170 --> 00:05:34.329 metro government in varying roles under two mayoral administrations. the 82 00:05:34.370 --> 00:05:37.470 current mayor, and then the former as well. But I 83 00:05:37.569 --> 00:05:43.209 had a real estate development background prior to entering into government. 84 00:05:43.959 --> 00:05:47.879 I do have an MBA that's a concentration in public administration. 85 00:05:47.899 --> 00:05:50.980 I'm also a certified project management professional. 86 00:05:51.319 --> 00:05:53.620 And all of the nerdy things that come with that, 87 00:05:53.639 --> 00:05:57.459 I would just like to add and conclude that in Frankfurt, 88 00:05:57.480 --> 00:06:01.079 I would say my work has been focused around This 89 00:06:01.160 --> 00:06:05.319 affordability crisis and that obviously goes to initially one of 90 00:06:05.339 --> 00:06:06.540 my strong suits is housing. 91 00:06:07.180 --> 00:06:08.850 I have a very strong housing background. 92 00:06:09.290 --> 00:06:13.449 Health care access is a close number to public safety, 93 00:06:13.930 --> 00:06:17.850 economic opportunity, and generally just making sure that government does 94 00:06:17.910 --> 00:06:19.290 what it says it's going to do. 95 00:06:19.750 --> 00:06:21.930 I believe that government should work. 96 00:06:21.850 --> 00:06:25.269 For the people because it is of and for the 97 00:06:25.310 --> 00:06:29.410 people and that government has a responsibility to empower its citizens. 98 00:06:30.009 --> 00:06:32.769 to be able to take care of themselves, the people 99 00:06:32.810 --> 00:06:35.709 they love, and the things they care about. And I 100 00:06:35.750 --> 00:06:38.079 just try to always keep the people first in everything 101 00:06:38.100 --> 00:06:41.389 that I do. That's what my approach to public service is. 102 00:06:41.399 --> 00:06:42.519 So thanks again for having me. 103 00:06:43.100 --> 00:06:46.519 Well, and thank you for that introduction. Jane, do you 104 00:06:46.560 --> 00:06:48.259 want to begin the conversation? 105 00:06:49.060 --> 00:06:52.149 Yeah, I'd like to make another comment about references. 106 00:06:52.329 --> 00:06:54.750 One of the best references for some of this stuff, 107 00:06:54.769 --> 00:06:59.910 particularly on health care, is the Kaiser Permanente Foundation and 108 00:07:00.410 --> 00:07:05.149 they're an independent, not-for-profit organization that does a lot of 109 00:07:05.189 --> 00:07:08.800 research into health care in America. 110 00:07:09.540 --> 00:07:11.420 And one of the interesting things. 111 00:07:12.339 --> 00:07:16.259 About Medicaid, which we're going to talk about, is the 112 00:07:16.339 --> 00:07:20.839 work requirement, and they have a lot of data on that, 113 00:07:21.620 --> 00:07:27.170 which shows that only about 8% of people who are 114 00:07:27.230 --> 00:07:31.149 on Medicaid are not working that probably could work. And 115 00:07:31.230 --> 00:07:39.220 it's very interesting that the one state that actually tried 116 00:07:39.279 --> 00:07:43.500 this in the past and were successful in getting it going, 117 00:07:44.319 --> 00:07:47.540 they found out the administrative cost of doing this was 118 00:07:48.779 --> 00:07:52.399 more than the money they lost of people being on 119 00:07:52.439 --> 00:07:57.129 Medicaid who shouldn't have been there. Well, Representative Watkins and 120 00:07:57.149 --> 00:08:00.269 I met for the first time, I think it was 121 00:08:00.370 --> 00:08:05.069 in May, and we had a symposium at Council University. 122 00:08:05.209 --> 00:08:09.129 I attended, and he was one of the speakers, and 123 00:08:09.509 --> 00:08:12.120 so I asked him if he'd be interested in talking 124 00:08:12.180 --> 00:08:15.959 about some of the health care problems in Kentucky, and 125 00:08:16.040 --> 00:08:20.560 he was excited to accept that invitation, and we were 126 00:08:20.639 --> 00:08:22.759 proud to have him in Campbellsville, and I hope he 127 00:08:22.800 --> 00:08:26.709 can come back sometime. The first question I have is, 128 00:08:27.509 --> 00:08:30.399 in a big, beautiful bill, there's going to be a 129 00:08:30.620 --> 00:08:37.200 rather significant Medicaid cut across the country. And I'd like 130 00:08:37.220 --> 00:08:41.639 to ask, what is that going to do to Kentucky? 131 00:08:42.279 --> 00:08:46.269 Well, thank you for the question, Dr. Shadley. And to 132 00:08:47.289 --> 00:08:51.259 answer just directly, I'm very concerned. 133 00:08:50.879 --> 00:08:52.820 And worried about what it's going to do to Kentucky. 134 00:08:52.840 --> 00:08:54.320 But I

want to set the stage here, and you 135 00:08:54.340 --> 00:08:57.320 all know this well as maybe your listeners. Somebody may not, 136 00:08:57.360 --> 00:09:00.960 but Medicaid covers about one in three Kentuckians. So it's 137 00:09:01.019 --> 00:09:04.009 a major source of the obviously health care benefit, but 138 00:09:04.049 --> 00:09:08.169 also revenue for hospitals and nursing homes, doctors and other providers. 139 00:09:08.669 --> 00:09:11.570 And over the next 10 years, based on this cut, 140 00:09:11.730 --> 00:09:13.610 you call it the big, beautiful bill. I like to 141 00:09:13.649 --> 00:09:17.049 say H.R.1 because I don't think there's anything beautiful about it, 142 00:09:17.539 --> 00:09:22.419 in my opinion. But that's roughly going to cut our 143 00:09:22.460 --> 00:09:27.019 spending about $ 900 billion over the next decade. And so 144 00:09:27.610 --> 00:09:29.629 what does that mean? And what does that mean for 145 00:09:29.669 --> 00:09:32.309 people in Kentucky? Well, when people in Kentucky lose coverage, 146 00:09:32.769 --> 00:09:35.149 they don't stop getting sick. 147 00:09:35.629 --> 00:09:38.990 What do they do? They delay treatments. The conditions get worse. 148 00:09:39.659 --> 00:09:41.899 And then the hospitals are left providing those care for 149 00:09:41.919 --> 00:09:45.090 patients they can't afford. So we're probably expecting to see 150 00:09:45.159 --> 00:09:48.909 some rural hospitals at the minimum cut services. 151 00:09:49.570 --> 00:09:51.309 That means some may close. 152 00:09:51.710 --> 00:09:55.450 There's some expectations that some rural hospitals may close based 153 00:09:55.529 --> 00:09:57.250 on some research and estimates. 154 00:09:57.029 --> 00:10:00.980 Out there nationally. And closures mean. the loss of jobs. 155 00:10:01.039 --> 00:10:04.059 And also for those folks that are getting care, it 156 00:10:04.080 --> 00:10:06.039 means you have to drive longer for the care that 157 00:10:06.059 --> 00:10:08.399 you're going to get. And that's a damage to the 158 00:10:08.460 --> 00:10:11.110 local economy as well. We know this is going to 159 00:10:11.129 --> 00:10:13.090 start in 2027. I'm pretty sure we're going to talk 160 00:10:13.110 --> 00:10:14.559 a little bit more about it. 161 00:10:14.970 --> 00:10:15.809 But the last thing I'll. 162 00:10:15.690 --> 00:10:19.120 Say, if you would allow me, We just wrapped up, 163 00:10:19.519 --> 00:10:22.409 the House Democratic Caucus wrapped up a Medicaid listening tour. 164 00:10:22.909 --> 00:10:26.029 Paul, I saw Paul in Prestonsburg and in Lexington. 165 00:10:26.429 --> 00:10:29.149 And we got to hear directly from families who are 166 00:10:29.490 --> 00:10:32.919 on Medicaid about what this means for them, particularly those 167 00:10:32.960 --> 00:10:35.600 who are in the waiver programs. And some of these 168 00:10:35.679 --> 00:10:39.059 folks were saying, you know, if we get any more cuts, 169 00:10:39.639 --> 00:10:41.539

I'm not going to be able to take care of 170 00:10:41.639 --> 00:10:42.450 my family. 171 00:10:43.210 --> 00:10:44.009 Or my loved one. 172 00:10:44.269 --> 00:10:47.850 And so that's going to mean more people getting sicker, 173 00:10:48.470 --> 00:10:53.649 us paying for more health care expenditures, and then downstream economically, 174 00:10:53.840 --> 00:10:55.419 it could mean the loss of jobs for a lot 175 00:10:55.440 --> 00:10:56.279 of different people too. 176 00:10:57.240 --> 00:11:02.440 Representative Watkins, we've done a couple of programs with a 177 00:11:02.480 --> 00:11:08.830 physician from UofL Hospital who spent much of her career 178 00:11:08.990 --> 00:11:14.659 taking care of underserved populations and folks on Medicaid, and 179 00:11:15.039 --> 00:11:19.740 a Medicaid recipient named Amber. And one of the things 180 00:11:19.779 --> 00:11:23.200 that I learned from her, which I was really surprised at, 181 00:11:24.240 --> 00:11:32.320 is many of our large corporations, Kroger, Walmart, have people 182 00:11:32.379 --> 00:11:39.059 working in some sort of category that doesn't Indicate that 183 00:11:39.080 --> 00:11:42.320 they're a full time employee and they don't get access 184 00:11:42.379 --> 00:11:48.230 to health care supported by those corporations. So my question is, 185 00:11:48.409 --> 00:11:51.809 are you aware of all this? And what are you? 186 00:11:52.049 --> 00:11:56.090 Is this just something that something I was totally unaware of? 187 00:11:58.539 --> 00:12:02.019 Unaware of folks who have sort of mixed job status 188 00:12:02.039 --> 00:12:05.120 where they don't necessarily work full-time, but kind of come 189 00:12:05.139 --> 00:12:05.799 in the middle. 190 00:12:05.940 --> 00:12:10.740 Well, yes, they're put in a category that doesn't allow 191 00:12:10.799 --> 00:12:17.330 them access to health care coverage by these big corporations 192 00:12:17.950 --> 00:12:20.210 who are making billions of dollars. 193 00:12:21.009 --> 00:12:24.330 Oh, sure. I've definitely heard of that before. Yes, okay. 194 00:12:25.169 --> 00:12:27.769 You think of the full-time work week as probably 40 hours, 195 00:12:27.789 --> 00:12:30.789 which is customary. There are those who are just right 196 00:12:30.830 --> 00:12:31.710 below that, around 32. 197 00:12:31.710 --> 00:12:37.220 And you think of folks who have mixed schedules, particularly 198 00:12:37.240 --> 00:12:40.139 in the service industries. This definitely. 199 00:12:41.320 --> 00:12:46.509 And retail is really expressed in retail industry. You're going 200 00:12:46.529 --> 00:12:47.350 to see that a lot. 201 00:12:48.549 --> 00:12:49.230 But I also. 202 00:12:50.100 --> 00:12:55.240 think is really interesting is I shadowed a doctor recently 203 00:12:55.299 --> 00:12:56.580 in this program. 204 00:12:56.120 --> 00:12:56.509 That I'm in. 205 00:12:56.519 --> 00:12:59.929 It's called the White Coat Program. It is open to 206 00:13:00.070 --> 00:13:04.690 civic leaders and whatnot. It's based in Louisville. It was 207 00:13:05.429 --> 00:13:11.909 the single most eye-opening experience I have ever witnessed from 208 00:13:11.929 --> 00:13:14.919 the perspective of a provider. And this was in a 209 00:13:15.000 --> 00:13:18.120 pain management clinic. I'm preaching to the choir with you all. 210 00:13:18.279 --> 00:13:21.080 But here's one scenario as I was talking to their 211 00:13:21.200 --> 00:13:23.610 office manager around the books. 212 00:13:24.039 --> 00:13:24.730 You know, because you. 213 00:13:24.620 --> 00:13:27.769 Think about a sole proprietor who is a, you know, 214 00:13:27.950 --> 00:13:30.769 entrepreneur in this case. And what they said to me 215 00:13:31.129 --> 00:13:35.289 on about the Medicaid cuts is that the reimbursement rates, 216 00:13:35.850 --> 00:13:39.129 once those reimbursement rates continue to drop and in some 217 00:13:39.169 --> 00:13:42.610 cases become non-existent, for them to keep their doors open. 218 00:13:43.149 --> 00:13:47.159 they would have to see more clients that have private 219 00:13:47.200 --> 00:13:50.460 health insurance versus those on Medicaid. Or if they're going 220 00:13:50.480 --> 00:13:52.919 to do that on Medicaid, they would have to see 221 00:13:53.200 --> 00:13:56.799 a volume much higher. And so I said, well, what 222 00:13:56.840 --> 00:14:00.940 happens to the folks that, you know, as you are 223 00:14:01.039 --> 00:14:04.250 getting people on Medicaid who really need your service? And 224 00:14:04.279 --> 00:14:07.669 he said, well, I mean, it doesn't make sense for 225 00:14:07.710 --> 00:14:09.629 us financially to do it. It's harder for us to 226 00:14:09.649 --> 00:14:12.240 do it. So a lot of clinics will just stop 227 00:14:12.460 --> 00:14:15.580 doing it. And think about if you're the only provider 228 00:14:15.659 --> 00:14:18.519 in your area and it's too expensive for you to 229 00:14:18.580 --> 00:14:21.460 carry those costs because you eat those costs if you're 230 00:14:21.539 --> 00:14:25.240 a provider. That means you stop providing that service altogether 231 00:14:25.340 --> 00:14:29.000 and then those services disappear from your area. And I 232 00:14:29.100 --> 00:14:31.620 never saw the math on it until I walked through. 233 00:14:32.259 --> 00:14:32.980 I was terrified. 234 00:14:33.860 --> 00:14:38.950 So from a legislative standpoint, are the legislators at all 235 00:14:39.769 --> 00:14:44.370 interested in addressing this issue for Walmart and Kroger's and 236 00:14:45.029 --> 00:14:51.360 whatever other corporations have hired people and put them in 237 00:14:51.389 --> 00:14:57.320 a category where they're not, they don't have access to 238 00:14:57.360 --> 00:15:01.580 the healthcare insurance that comes with working for that company. 239 00:15:02.159 --> 00:15:07.399 So we're getting into sort of labor laws and what 240 00:15:09.059 --> 00:15:13.600 what our legislative remedies are. I

think that there are 241 00:15:13.620 --> 00:15:17.100 a lot of legislators, I would hope, that would like 242 00:15:17.120 --> 00:15:22.029 for their constituents to be paid a living wage. My caucus, 243 00:15:22.070 --> 00:15:25.730 particularly in something that I have supported, is the increase 244 00:15:25.970 --> 00:15:27.230 of the minimum wage, which. 245 00:15:27.149 --> 00:15:29.389 Is still $ 7. 25 in Kentucky. 246 00:15:30.129 --> 00:15:33.149 But in terms of the benefit packages that go along 247 00:15:33.769 --> 00:15:37.090 with employment. I think that's why it's important for everyday 248 00:15:37.149 --> 00:15:39.929 citizens who own the means of their labor to be 249 00:15:39.970 --> 00:15:40.690 able to organize. 250 00:15:41.230 --> 00:15:42.470 And so one of the things that. 251 00:15:42.389 --> 00:15:46.549 We see in Kentucky, which is a direct response to 252 00:15:46.600 --> 00:15:50.860 what they're saying, is the right to work statute. And 253 00:15:51.440 --> 00:15:55.159 once you repeal that, then you have the ability to 254 00:15:55.240 --> 00:15:59.919 organize and to fight for fair wages and the benefits 255 00:15:59.960 --> 00:16:01.710 that come with that. But when you do not have 256 00:16:01.759 --> 00:16:04.379 that and you work at a Walmart, when you work 257 00:16:04.419 --> 00:16:07.090 at other large multinational. 258 00:16:06.409 --> 00:16:08.629 Corporations, then you lose that ability. 259 00:16:09.210 --> 00:16:11.789 I have been very interested in repealing rights of work 260 00:16:12.169 --> 00:16:14.169 because I do believe that people who own the means 261 00:16:14.210 --> 00:16:17.809 of their labor should be able to negotiate with those 262 00:16:17.850 --> 00:16:20.809 who own the means of production, in most cases, those 263 00:16:21.110 --> 00:16:24.549 multinational corporations, for what is fair, what is right for 264 00:16:24.669 --> 00:16:25.509 them and their families. 265 00:16:26.970 --> 00:16:31.370 So you just expressed a view that in today's times, 266 00:16:32.250 --> 00:16:39.980 would earn you the title of communist or socialist. And 267 00:16:40.480 --> 00:16:42.720 that is so ridiculous. It just irks me. 268 00:16:42.779 --> 00:16:43.759 I hear it so often. 269 00:16:44.279 --> 00:16:47.940 Well, I think that's interesting because I don't consider myself, well, 270 00:16:47.960 --> 00:16:49.480 I know I'm not a communist and I know I'm 271 00:16:49.519 --> 00:16:52.909 not a socialist, but I understand about the ideology. But 272 00:16:52.970 --> 00:16:56.929 it's very simple to me that if you are going 273 00:16:56.970 --> 00:17:01.769 to work and you, because of your output in production, 274 00:17:02.549 --> 00:17:06.450 are helping to make money. You should get a share. 275 00:17:07.230 --> 00:17:09.740 And what that is, no one wants to do anything 276 00:17:09.799 --> 00:17:14.440 in this world for free. And so I believe that 277 00:17:15.099 --> 00:17:18.380 when I work,

I go to work every day before 278 00:17:18.420 --> 00:17:20.839 I was elected. I mean, I go to work every 279 00:17:20.859 --> 00:17:23.380 day and I have what I'm supposed to do. And 280 00:17:23.660 --> 00:17:26.880 whatever that pay period is, I expect as an exchange 281 00:17:26.920 --> 00:17:29.789 for my labor, I expect to be compensated for it. 282 00:17:30.269 --> 00:17:34.349 And that to me is what it what it boils 283 00:17:34.430 --> 00:17:34.970 down to. 284 00:17:35.109 --> 00:17:37.529 And then a company is supposed to give me that 285 00:17:37.569 --> 00:17:41.519 sort of compensation package or what they're offering in exchange 286 00:17:41.579 --> 00:17:42.299 for my labor. 287 00:17:42.559 --> 00:17:44.420 And that's going to come in the form of a wage. 288 00:17:44.759 --> 00:17:46.579 And that's going to come in the form of. 289 00:17:46.660 --> 00:17:50.460 A benefits package, which in that case is a replacement 290 00:17:50.559 --> 00:17:55.990 for direct wage. So if multinational corporations do not want 291 00:17:56.009 --> 00:17:59.859 to provide things like health care and for all the 292 00:17:59.880 --> 00:18:03.309 things we need, dental, vision, going to the doctor, then 293 00:18:03.329 --> 00:18:06.609 the wage goes up. And so that's pretty much that's 294 00:18:06.690 --> 00:18:09.049 the exchange of what's supposed to be the free market. 295 00:18:09.569 --> 00:18:14.589 And to me, the marketplace of labor and production is 296 00:18:14.829 --> 00:18:16.829 very much within the system that we have. 297 00:18:16.970 --> 00:18:20.500 I just feel like the everyday person is not getting 298 00:18:20.680 --> 00:18:21.279 a good deal. 299 00:18:21.880 --> 00:18:23.880 And when you're not getting a good deal, I think 300 00:18:23.980 --> 00:18:25.940 everybody wants the ability to negotiate. 301 00:18:26.500 --> 00:18:29.859 Well, the middle class and the lower classes in this 302 00:18:29.960 --> 00:18:35.779 country haven't moved forward and increased in their access to 303 00:18:35.880 --> 00:18:40.619 health care and jobs and salaries for 30 years. 304 00:18:42.769 --> 00:18:43.250 Exactly. 305 00:18:43.269 --> 00:18:46.640 So I think. I think when we have these conversations 306 00:18:46.740 --> 00:18:51.140 about these buzzwords around communism and socialism, what I'm hearing 307 00:18:51.200 --> 00:18:54.000 on the street in my district and when I travel 308 00:18:54.019 --> 00:18:58.000 to Prestonburg or as they say from Pikeville to Paducah, 309 00:18:58.059 --> 00:19:02.039 I've been to mostly all of the corners, the regions 310 00:19:02.599 --> 00:19:06.519 of Kentucky within this last interim session. When I'm talking 311 00:19:06.539 --> 00:19:08.839 to everyday people at the coffee shop or at the 312 00:19:08.880 --> 00:19:12.140 gas station, we're knocking doors as I've knocked for other 313 00:19:12.220 --> 00:19:17.329 candidates and such this cycle. People aren't talking about socialism 314 00:19:17.529 --> 00:19:22.190 and communism or even capitalism as a word. They're thinking about, 315 00:19:22.430 --> 00:19:23.890 am I going to be able to put food on 316 00:19:23.910 --> 00:19:27.130 the table? Am I going to be able to get 317 00:19:27.210 --> 00:19:30.170 what I need, take care of my family? If I'm 318 00:19:30.190 --> 00:19:31.910 going to be able to put something back for a 319 00:19:31.970 --> 00:19:34.839 rainy day. Well, if I've worked really hard for a. 320 00:19:34.839 --> 00:19:36.759 Long period of time, am I going to be able 321 00:19:36.779 --> 00:19:38.200 to retire with some dignity? 322 00:19:38.680 --> 00:19:41.809 And that to me is a human condition. And I 323 00:19:41.829 --> 00:19:44.670 think we cheapen the argument when we throw out these 324 00:19:44.809 --> 00:19:48.230 labels of, you know, are you a capitalist or a 325 00:19:48.309 --> 00:19:51.140 socialist or a communist? To me, are you for the people? 326 00:19:51.200 --> 00:19:54.500 And are you defending the rights of what the people 327 00:19:54.559 --> 00:19:59.019 need to be successful in the Commonwealth within writ large 328 00:19:59.079 --> 00:19:59.519 the country? 329 00:19:59.859 --> 00:20:02.960 Yeah, I absolutely agree with you. We are the only 330 00:20:03.059 --> 00:20:08.230 first world country that does not have some kind of government-run, 331 00:20:08.490 --> 00:20:14.470 not-for-profit healthcare system that provides access to healthcare for all 332 00:20:14.509 --> 00:20:23.720 of the citizens. Australia, New Zealand, Canada, Japan, the European Union, 333 00:20:23.740 --> 00:20:31.380 the Scandinavian countries, and even some South American countries Now, 334 00:20:31.579 --> 00:20:38.279 in your interaction with the people that you represent, is 335 00:20:38.319 --> 00:20:43.500 there an understanding about that? I get the impression that 336 00:20:44.519 --> 00:20:47.279 a lot of the people living in this country really 337 00:20:47.400 --> 00:20:52.789 don't understand how bad our health care system is compared 338 00:20:52.849 --> 00:20:54.809 to most of the rest of the world. 339 00:20:55.369 --> 00:21:00.289 Yeah, I think you're spot on there. Most people... are not. 340 00:21:00.210 --> 00:21:04.509 Paying attention to the fine print and the details that 341 00:21:05.150 --> 00:21:06.599 we all may talk about. 342 00:21:07.680 --> 00:21:09.710 But it's not because they don't care about it. 343 00:21:10.160 --> 00:21:13.200 Because they don't have the capacity to do all of 344 00:21:13.259 --> 00:21:15.940 these things at once. I mean, people are working two 345 00:21:15.980 --> 00:21:17.779 or three jobs just to make ends meet. 346 00:21:18.759 --> 00:21:19.640 It's an old saying. 347 00:21:19.680 --> 00:21:23.369 I was raised around a lot of seniors and elders, 348 00:21:23.410 --> 00:21:27.630 so I have a lot of sort of old euphemisms 349 00:21:27.690 --> 00:21:33.059 to explain myself, so excuse that in advance, but

Back 350 00:21:33.079 --> 00:21:35.180 when I was coming up, they would say you had 351 00:21:35.220 --> 00:21:37.059 more month than money or you try to make a 352 00:21:37.099 --> 00:21:39.920 dollar out of 15 cents. And a lot of people 353 00:21:40.029 --> 00:21:42.309 are trying to do that. So they simply don't have 354 00:21:42.329 --> 00:21:45.430 the capacity to talk about the health care system and 355 00:21:45.529 --> 00:21:50.559 understand the minutia of insurance and reimbursement rates and prescription 356 00:21:50.579 --> 00:21:52.119 drug prices and negotiations. 357 00:21:52.180 --> 00:21:52.380 I mean. 358 00:21:53.430 --> 00:21:55.809 I'm a legislator, and some of that stuff is confusing 359 00:21:55.829 --> 00:21:59.930 to me, too. We are the only developed, first world 360 00:21:59.950 --> 00:22:03.940 developed country in the world that does not have a 361 00:22:04.200 --> 00:22:07.700 health care system that works for the public good. And 362 00:22:07.759 --> 00:22:10.799 it's largely because our health care system is profit driven. 363 00:22:11.809 --> 00:22:14.930 And we've gotten to the point to where I think 364 00:22:14.970 --> 00:22:17.950 the rub, maybe the initial question you were asking me 365 00:22:18.009 --> 00:22:20.910 about is how, you know, me as a Democrat and 366 00:22:20.990 --> 00:22:23.609 my colleagues across the aisle, how we think about it. Well, 367 00:22:23.650 --> 00:22:27.190 here's the true problem. We don't have a messaging problem. 368 00:22:27.210 --> 00:22:30.380 We have a math problem. Health care is just too 369 00:22:30.440 --> 00:22:33.680 expensive in the United States. That's really what it is. 370 00:22:34.500 --> 00:22:38.559 The difference between my colleagues and I is just we 371 00:22:38.599 --> 00:22:42.880 have different ways of addressing the cost of health care. 372 00:22:43.559 --> 00:22:48.069 And my proposition to anybody listening, my pitch, if you will, 373 00:22:48.309 --> 00:22:52.150 is which way of addressing the cost of health care 374 00:22:52.829 --> 00:22:55.289 is going to ultimately work for you and your family. 375 00:22:55.690 --> 00:22:56.930 Take out the ideology. 376 00:22:57.410 --> 00:23:00.390 Because sometimes when you hear that somebody's a Republican or 377 00:23:00.450 --> 00:23:04.089 somebody's a Democrat or anywhere on the spectrum, some. 378 00:23:03.990 --> 00:23:06.150 People tend to cover their ears. And I think that's 379 00:23:06.190 --> 00:23:07.289 the wrong approach. 380 00:23:07.930 --> 00:23:11.940 I would like to offer which way is going to, 381 00:23:12.279 --> 00:23:17.099 are these drastic cuts? Is that, they're trying to, the 382 00:23:17.319 --> 00:23:20.460 Republicans are trying to adjust the cost because healthcare costs 383 00:23:20.519 --> 00:23:24.329 are the single largest expense for us in the commonwealth. 384 00:23:25.109 --> 00:23:28.220 But for us, we want to look at the government 385 00:23:28.259 --> 00:23:32.140 getting involved because the marketplace is not working for working 386 00:23:32.200 --> 00:23:36.220 families and those who are poor. So other countries are 387 00:23:36.240 --> 00:23:40.269 figuring this out, and they are having better outcomes for 388 00:23:40.829 --> 00:23:42.289 their constituencies. 389 00:23:42.329 --> 00:23:43.549 And I want to see the same thing. 390 00:23:44.609 --> 00:23:47.819 I think one of the issues we can bring up 391 00:23:47.950 --> 00:23:51.279 if they accuse us of being a socialist is that 392 00:23:54.079 --> 00:24:02.019 throughout Western civilization, The professions, which were included, the ministry, lawyers, 393 00:24:02.160 --> 00:24:07.559 and doctors were people with higher educations, but they were 394 00:24:07.640 --> 00:24:13.420 expected to provide care regardless of the patient's or person's 395 00:24:13.480 --> 00:24:17.660 ability to pay. And that's always been our tradition. But 396 00:24:21.039 --> 00:24:24.619 we've gotten off track. The other thing is that we 397 00:24:24.680 --> 00:24:30.440 can provide... health care for everyone, and it doesn't have 398 00:24:30.480 --> 00:24:34.230 to be so-called socialized medicine like it is in England 399 00:24:34.289 --> 00:24:34.910 and Canada. 400 00:24:35.349 --> 00:24:36.269 We could just go. 401 00:24:36.150 --> 00:24:43.049 To a nonprofit system with a highly regulated system, regulation 402 00:24:43.089 --> 00:24:45.990 by the government like they have in Switzerland, Germany, and 403 00:24:47.799 --> 00:24:53.480 some other countries that could provide care and drastically reduce 404 00:24:53.519 --> 00:24:56.990 the cost. I'd like to point out one other thing. 405 00:24:58.549 --> 00:25:02.069 It's not just big corporations that hire people that have 406 00:25:02.109 --> 00:25:03.210 to be on Medicaid. 407 00:25:03.289 --> 00:25:06.660 For example, our assisted living in. 408 00:25:07.680 --> 00:25:13.420 Camelsville, almost everyone who works there, the administrator told me, 409 00:25:13.500 --> 00:25:18.369 was on Medicaid. And then also some of the hospitals 410 00:25:18.930 --> 00:25:22.150 have people who are working low wages who. 411 00:25:22.109 --> 00:25:26.680 Are also on Medicaid. Let me ask you another question. 412 00:25:26.740 --> 00:25:31.960 Does the state of Kentucky have the ability to try 413 00:25:31.980 --> 00:25:37.589 to correct some of these problems that were getting handed 414 00:25:37.650 --> 00:25:41.150 down by the federal government, or is there too much 415 00:25:41.230 --> 00:25:45.289 money involved for a small state like Kentucky to deal with? 416 00:25:45.769 --> 00:25:47.549 Do you have any specific? 417 00:25:48.109 --> 00:25:51.339 Well, the total amount of money we get from Medicaid 418 00:25:52.150 --> 00:25:55.470 Is there any way we could, do we have enough 419 00:25:55.549 --> 00:26:01.920 reserve to try to stimulate or try to help out 420 00:26:02.180 --> 00:26:03.200 some of the Medicaid? 421

00:26:03.460 --> 00:26:08.259 Joshua, you might tell the story about the lockbox that 422 00:26:08.299 --> 00:26:08.799 you guys have. 423 00:26:08.880 --> 00:26:09.240 Oh, yeah. 424 00:26:09.960 --> 00:26:14.849 Well, so I guess to answer, that's a complex question, 425 00:26:15.130 --> 00:26:19.549 but we do have, does the state of Kentucky have money? 426 00:26:20.599 --> 00:26:25.180 To fully fund Medicaid? In my opinion, yes. 427 00:26:25.799 --> 00:26:30.440 Just looking at the budget and the numbers, again, the 428 00:26:30.509 --> 00:26:34.769 question is going to come largely, federally, the cost of 429 00:26:34.869 --> 00:26:38.430 health care is what we're going to always come back to. 430 00:26:40.349 --> 00:26:45.849 With the passage of H.R. 1, federally, This past session, 431 00:26:46.369 --> 00:26:51.210 the General Assembly, largely on all actually all on party lines, 432 00:26:51.690 --> 00:26:56.710 passed House Bill 2, which goes further in terms of 433 00:26:56.730 --> 00:27:01.049 the changes to Medicaid at the state level. And depending 434 00:27:01.109 --> 00:27:04.869 upon wherever you fall on the political spectrum, you may 435 00:27:04.950 --> 00:27:06.349 or may not agree or disagree. 436 00:27:06.630 --> 00:27:10.670 But the facts remain that Hospital 2 did make some 437 00:27:10.710 --> 00:27:17.599 statewide changes to Medicaid. One of those things also was 438 00:27:17.880 --> 00:27:20.579 on the work requirements, and I think you talked about 439 00:27:21.200 --> 00:27:25.940 a little bit more. And we were already facing. 440 00:27:26.799 --> 00:27:31.140 a Medicaid funding shortfall in the 2026 budget process, even 441 00:27:31.180 --> 00:27:38.410 before the federal changes came in. The governor used about $ 255. 442 00:27:36.329 --> 00:27:39.809 Million in surplus funds. So money, I'd. 443 00:27:39.710 --> 00:27:42.079 Like to refer to the surplus as like a piggy bank. 444 00:27:42.670 --> 00:27:44.079 Or a safe deposit box. 445 00:27:44.140 --> 00:27:47.059 We call it the Budget Reserve Trust Fund. We have 446 00:27:47.079 --> 00:27:50.400 a few billion dollars in there to prevent an immediate 447 00:27:50.400 --> 00:27:55.200 4% cut in provider reimbursements. But then the General Assembly 448 00:27:55.250 --> 00:28:00.470 did something else, which I agree with the logic behind this. 449 00:28:01.130 --> 00:28:03.970 It was to create what's called a Medicaid lockbox. So 450 00:28:04.009 --> 00:28:08.069 it set aside $ 290 million dollars for Medicaid and put 451 00:28:08.109 --> 00:28:11.430 it inside of a lockbox that you can only open 452 00:28:11.470 --> 00:28:12.450 that box. 453 00:28:12.519 --> 00:28:14.279 With legislative approval. 454 00:28:15.039 --> 00:28:18.559 And the logic behind that was, if there is shortfall, 455 00:28:18.660 --> 00:28:21.680 which we believe that there will be, that we would 456 00:28:21.740 --> 00:28:24.019 be able to go and pull out money to cover 457 00:28:24.059 --> 00:28:24.720 that gap. 458 00:28:25.069 --> 00:28:27.950 But we had to prove that there was actual gap 459 00:28:28.009 --> 00:28:28.829 in such to spend. 460 00:28:29.509 --> 00:28:32.230 Now, I believe and my colleagues believe that we. 461 00:28:32.190 --> 00:28:34.670 Should open that $ 290 million lockbox to. 462 00:28:34.589 --> 00:28:38.559 Address those immediate needs. But the problem is, my friends, 463 00:28:38.599 --> 00:28:41.819 is that that's one-time money. So we would also need 464 00:28:41.839 --> 00:28:45.900 to identify additional funding for the next fiscal year when 465 00:28:45.940 --> 00:28:49.299 the shortfall could become much more serious. And then we 466 00:28:49.339 --> 00:28:53.630 also have to account for the new financial and administrative costs. 467 00:28:53.589 --> 00:28:57.539 For implementing the new federal requirements. So there are. 468 00:28:58.809 --> 00:29:01.789 I think what I'm also thinking about is the risks 469 00:29:02.630 --> 00:29:05.670 that happen if we wait. If we don't address that 470 00:29:05.730 --> 00:29:09.569 funding problem, obviously what that means to everyday people. So 471 00:29:09.990 --> 00:29:13.650 opening the lockbox at $ 290 million, which is something that 472 00:29:13.670 --> 00:29:16.700 we're going to push forward in this one-to-seven session, will 473 00:29:16.839 --> 00:29:19.740 help meet those immediate needs, but we also need to 474 00:29:19.779 --> 00:29:22.299 develop more sustainable funding for the next fiscal year. 475 00:29:23.460 --> 00:29:25.920 Representative Watkins, do you. 476 00:29:27.519 --> 00:29:31.500 Well, let me ask this in a different way. I'm 477 00:29:31.539 --> 00:29:34.029 sort of curious to know what is in the heads 478 00:29:35.210 --> 00:29:41.380 of the Republican legislatures coming forward. rural parts of the 479 00:29:41.450 --> 00:29:48.819 state that with these issues, these Medicaid issues out there 480 00:29:49.220 --> 00:29:51.339 as a result of, and I agree with you, I 481 00:29:51.400 --> 00:29:54.210 wouldn't call it the big beautiful bill, but I If 482 00:29:54.309 --> 00:29:57.049 I used the four-letter words I would describe it, Paul 483 00:29:57.089 --> 00:29:59.789 will get me in trouble. So I'm just not going 484 00:29:59.829 --> 00:30:04.220 to do that. But what, I mean, can you give 485 00:30:04.259 --> 00:30:10.640 me an idea of what the average representative from a 486 00:30:10.640 --> 00:30:16.920 rural area in Kentucky where some of these issues, the 487 00:30:17.019 --> 00:30:19.920 impact on health care is going to be really significant, 488 00:30:21.359 --> 00:30:22.380 where are they with this? 489 00:30:23.029 --> 00:30:25.710 Again, so all of the legislators that I've talked to, 490 00:30:25.869 --> 00:30:28.710 I've talked to a lot on the House side and 491 00:30:28.829 --> 00:30:31.990 even some on the Senate side that come from rural areas, 492 00:30:32.670 --> 00:30:37.319 they are concerned about the

changes and what it means 493 00:30:37.380 --> 00:30:39.059 to their communities too. 494 00:30:39.420 --> 00:30:40.660 At least that's what they tell me. 495 00:30:42.180 --> 00:30:48.640 They are very aware of some of the provider challenges 496 00:30:49.380 --> 00:30:54.359 with a lot of the medical professionals that are leaving areas, 497 00:30:54.519 --> 00:30:58.329 particularly out East and even Western Kentucky too. 498 00:30:59.029 --> 00:31:02.569 And so they've expressed the need and you can see 499 00:31:02.589 --> 00:31:04.589 it through their floor. 500 00:31:04.369 --> 00:31:10.480 Testimonies and such and comments during committees that they are saying, well, hey, 501 00:31:10.519 --> 00:31:14.440 wait a minute, my community. 502 00:31:14.019 --> 00:31:15.299 Does depend on Medicaid. 503 00:31:15.819 --> 00:31:18.259 So that's what I've heard directly and I've even heard 504 00:31:18.380 --> 00:31:23.440 publicly Again, we come back to the fundamental question. 505 00:31:23.859 --> 00:31:27.440 Which is healthcare in the United States is too expensive. 506 00:31:28.339 --> 00:31:28.920 It just is. 507 00:31:29.940 --> 00:31:33.819 And what we believe are our options to deal with it. 508 00:31:34.289 --> 00:31:38.490 And so I oftentimes ask, and I wanna just stick 509 00:31:38.529 --> 00:31:42.579 on that question moving forward when we go in 27, 510 00:31:42.579 --> 00:31:45.839 back to Frankfort, what do they feel are the tools 511 00:31:45.940 --> 00:31:50.259 necessary to do so? Because cutting spending, looking at the 512 00:31:50.460 --> 00:31:54.640 fiscal health of the state, I understand that. Everybody understands 513 00:31:54.700 --> 00:31:57.089 that in their household that sometimes you gotta cut back 514 00:31:57.430 --> 00:31:59.650 or tighten the belt when money. 515 00:31:59.490 --> 00:32:02.970 Is getting low. But what's hard for me to wrap 516 00:32:02.990 --> 00:32:07.690 my mind around is money that we would spend elsewhere 517 00:32:08.650 --> 00:32:12.470 or approaches that we would do like cutting the state 518 00:32:12.589 --> 00:32:17.410 income tax. Like those two things, like a half a 519 00:32:17.450 --> 00:32:21.650 percent cut in the state income taxes is equivalent to 520 00:32:21.690 --> 00:32:23.329 something like $ 700 million. 521 00:32:23.690 --> 00:32:27.630 And so I just find it difficult to reconcile the two. 522 00:32:28.440 --> 00:32:32.680 That if we have needs of people who, these are 523 00:32:32.720 --> 00:32:35.319 not people who are gaming the system. These are not, 524 00:32:35.880 --> 00:32:38.799 you know, folks that are in their parents' basement playing 525 00:32:38.880 --> 00:32:39.619 video games. 526 00:32:40.269 --> 00:32:44.230 You know, these are real people that are out there working. 527 00:32:44.529 --> 00:32:50.549 These are our seniors. These are our young families. These 528 00:32:50.609 --> 00:32:53.910 are folks that are disabled. 529 00:32:53.150 --> 00:32:56.509

And those who care for them. We don't have enough 530 00:32:56.569 --> 00:32:57.289 money to do that. 531 00:32:57.990 --> 00:33:01.250 Then why are we continuing cutting our revenue when we 532 00:33:01.269 --> 00:33:02.539 can take that money to do it? 533 00:33:02.809 --> 00:33:06.450 So that's my question to my Republican colleagues. 534 00:33:07.230 --> 00:33:09.059 And I think that should be a question that I 535 00:33:09.099 --> 00:33:11.579 know that they're being asked every time they go back 536 00:33:11.599 --> 00:33:11.970 to the district. 537 00:33:12.460 --> 00:33:15.059 Well, what kind of answers do they give? Because I 538 00:33:15.759 --> 00:33:20.660 keep seeing people on television talking about decreasing the state 539 00:33:20.839 --> 00:33:26.569 income tax to the extent that there wouldn't be any. And, 540 00:33:28.390 --> 00:33:34.819 you know, the impact of that on infrastructure and just 541 00:33:34.839 --> 00:33:41.400 the fundamental needs of a population of citizens is just incredible. 542 00:33:42.319 --> 00:33:43.539 Yeah, I totally agree. 543 00:33:43.960 --> 00:33:47.910 Some of the things that I get in response when 544 00:33:47.990 --> 00:33:51.890 I say that to them, it comes back to the 545 00:33:51.970 --> 00:33:53.130 biggest expense that we. 546 00:33:53.069 --> 00:33:55.990 Have in the Commonwealth is healthcare spending. 547 00:33:56.390 --> 00:34:01.069 So they think about the whole picture and the state 548 00:34:01.569 --> 00:34:04.910 of the Commonwealth, the financial state of the Commonwealth. 549 00:34:05.170 --> 00:34:06.329 And I understand that. 550 00:34:06.670 --> 00:34:09.039 A lot of them point back to me saying, well, 551 00:34:09.059 --> 00:34:11.500 when we were not in the majority, we didn't even 552 00:34:11.579 --> 00:34:15.559 have any savings. And so after 10 years of being 553 00:34:15.860 --> 00:34:18.300 in the majority, we have this savings for a rainy day. 554 00:34:18.380 --> 00:34:21.599 And they'll point back to the budget reserve trust fund. 555 00:34:21.840 --> 00:34:24.420 And I'll say, okay, well, if it's a rainy day, 556 00:34:25.460 --> 00:34:28.550 meaning we have a crisis or an issue or an emergency, 557 00:34:29.309 --> 00:34:31.070 then we need to be able to pull from that 558 00:34:31.130 --> 00:34:35.090 money to address it. But then they'll come back and say, well, yeah, sure, 559 00:34:35.570 --> 00:34:37.909 but the costs are too expensive. 560 00:34:38.010 --> 00:34:39.309 It almost sounds like. 561 00:34:41.099 --> 00:34:45.599 It's thinking federally about how we address health care. And 562 00:34:45.679 --> 00:34:48.960 I think that's really what I find the benefit of 563 00:34:49.039 --> 00:34:51.860 this program and what you all talk about, which are 564 00:34:51.920 --> 00:34:55.139 what our options are. We talk about a single payer system, 565 00:34:55.179 --> 00:34:58.139 but why is that attractive? It's because the current system 566 00:34:58.159 -->

00:35:01.099 that we have is just entirely too expensive. So I 567 00:35:01.420 --> 00:35:05.579 also want to challenge my colleagues to, as we look 568 00:35:05.619 --> 00:35:08.500 at the numbers, to understand that our colleagues in the 569 00:35:08.539 --> 00:35:11.260 majority do have the power. 570 00:35:11.960 --> 00:35:13.059 They're in the majority for now. 571 00:35:14.039 --> 00:35:17.159 They do have the power to address issues some of 572 00:35:17.179 --> 00:35:18.699 the immediate needs that we have, and. 573 00:35:18.679 --> 00:35:19.519 I know they want to. 574 00:35:20.460 --> 00:35:22.179 And I think that we need to do that, and 575 00:35:22.219 --> 00:35:25.480 our budgets should reflect that as well. But I don't 576 00:35:25.500 --> 00:35:27.559 think you can do both. I don't think that you 577 00:35:27.599 --> 00:35:31.280 can adjust our urgent and immediate health care needs and 578 00:35:31.340 --> 00:35:34.690 continue to go down to zero in our state income tax. 579 00:35:35.530 --> 00:35:39.409 You know, there are a number of issues and situations 580 00:35:39.730 --> 00:35:43.650 in the health care system And maybe Jean would make 581 00:35:43.690 --> 00:35:46.030 a comment about this, but one of the things we've 582 00:35:46.090 --> 00:35:51.550 talked about on previous programs has been the impact of 583 00:35:51.690 --> 00:35:58.469 private equity companies buying up various health care systems, everything 584 00:35:58.510 --> 00:36:06.269 from hospitals to surgical care centers to nursing homes. And Jean, 585 00:36:06.309 --> 00:36:09.860 if I'm correct on a previous program, you let us 586 00:36:09.949 --> 00:36:14.599 know that Almost all the nursing homes around where you 587 00:36:14.659 --> 00:36:19.440 live are owned by private equity companies. The goal of 588 00:36:19.500 --> 00:36:22.400 a private equity company is not health care. It's to 589 00:36:22.440 --> 00:36:27.480 make a profit from whatever health care activities are going 590 00:36:27.619 --> 00:36:28.000 on there. 591 00:36:29.139 --> 00:36:33.760 Yes, I think all the nursing homes in my county 592 00:36:33.800 --> 00:36:39.539 and surrounding counties are now owned by private equity companies. And, 593 00:36:39.559 --> 00:36:42.280 of course, they're out of town. They're being managed by 594 00:36:42.380 --> 00:36:46.559 people who don't know the community. I know of one 595 00:36:46.599 --> 00:36:51.039 nursing home where they brought in new doctors and nurse 596 00:36:51.099 --> 00:36:55.800 practitioners who don't know the patients. We had had previous 597 00:36:56.280 --> 00:37:00.260 physicians and nurse practitioners who knew almost all the patients 598 00:37:00.340 --> 00:37:05.929 very well and had a very good relationship with the patients. 599 00:37:07.210 --> 00:37:11.130 So it's more than... not just money, it's the way 600 00:37:11.170 --> 00:37:14.610 they operate them. It's like we've. 601 00:37:14.449 --> 00:37:21.769 Got people

from out of town whose thought process is 602 00:37:21.829 --> 00:37:26.969 mainly how much money we can make and not how 603 00:37:27.030 --> 00:37:33.480 much care or empathy we can give to these patients. 604 00:37:34.400 --> 00:37:37.019 I mean, just think about yourself if you had a 605 00:37:37.099 --> 00:37:41.119 loved one in a nursing home Why should 15% of 606 00:37:41.239 --> 00:37:47.980 the amount of money you pay go to private equity 607 00:37:48.119 --> 00:37:49.159 or stockholders? 608 00:37:49.199 --> 00:37:52.579 This is, to me, seems insane. 609 00:37:53.219 --> 00:38:02.949 But America has become obsessed with profits and health care. 610 00:38:03.849 --> 00:38:09.610 Representative Watkins, do you know, or I guess ask the question, 611 00:38:10.409 --> 00:38:13.800 are the members of the House of Representatives aware of 612 00:38:13.840 --> 00:38:17.420 these issues? Do they have any thoughts about it, or 613 00:38:17.440 --> 00:38:19.639 is it just a non-issue there? 614 00:38:20.460 --> 00:38:21.219 Some of us do. 615 00:38:21.679 --> 00:38:25.139 I would imagine that a lot of us are looking 616 00:38:25.289 --> 00:38:31.610 at the presence of private equity companies owning many different assets. 617 00:38:32.519 --> 00:38:37.940 Many different businesses from hospitals to hospital systems, physician practices, 618 00:38:37.960 --> 00:38:39.239 and especially housing. 619 00:38:39.630 --> 00:38:41.369 We definitely see this in the housing market. 620 00:38:41.989 --> 00:38:45.010 There was legislation that was introduced by one of my 621 00:38:45.070 --> 00:38:49.639 colleagues to ban private equity and large-scale companies from just 622 00:38:49.699 --> 00:38:53.940 swooping in and buying up. all of the available rental 623 00:38:53.980 --> 00:38:56.940 housing on the market. And so it's no different than 624 00:38:57.000 --> 00:39:01.639 hospitals and hospital systems. I've seen a growing number. I've 625 00:39:01.659 --> 00:39:05.369 seen actually more scrutiny, I would say nationally, of private 626 00:39:05.429 --> 00:39:11.369 equity owning in other industries, because typically, like you mentioned, 627 00:39:11.449 --> 00:39:14.769 when they jump in into an industry, it's all about efficiency. 628 00:39:15.389 --> 00:39:20.820 And so those cuts are To generate profits typically mean. 629 00:39:20.579 --> 00:39:22.559 A reduction in quality and service. 630 00:39:23.179 --> 00:39:25.679 And in health care, this is not like a restaurant, 631 00:39:25.829 --> 00:39:28.260 for example, but in healthcare, those consequences when you do 632 00:39:28.280 --> 00:39:32.900 those cuts can be very, very serious. If a restaurant 633 00:39:32.960 --> 00:39:37.559 cuts corners, you know, customers, your favorite restaurant stops to 634 00:39:37.579 --> 00:39:40.340 change its recipes or cuts corners, you can go somewhere else. 635 00:39:40.840 --> 00:39:43.420 But if a nursing home reduces staffing. 636 00:39:43.039 --> 00:39:47.070 Or a hospital cuts services, patients don't really have that 637 00:39:47.110 --> 00:39:51.260 many alternatives based on what's in the market. So And 638 00:39:51.280 --> 00:39:55.019 then I've also seen, as recently as like a month ago, 639 00:39:55.039 --> 00:40:01.289 some articles talking about patient safety problems because of private equity. 640 00:40:01.030 --> 00:40:02.369 Acquisition in hospitals. 641 00:40:03.010 --> 00:40:05.190 And again, we're going to keep coming back to the 642 00:40:05.210 --> 00:40:09.909 cost of health care because everything is just increasing. because 643 00:40:09.949 --> 00:40:13.989 hospitals and medical practice, they do have to be financially sustainable, 644 00:40:14.489 --> 00:40:18.610 but we should be asking whether or not staffing is adequate, 645 00:40:19.000 --> 00:40:21.920 whether or not patients are receiving the quality of care 646 00:40:21.940 --> 00:40:25.860 that they need, and how does a financial decision affect 647 00:40:25.900 --> 00:40:27.840 the services available to those communities? 648 00:40:28.380 --> 00:40:31.519 We should be asking those questions more so than, are 649 00:40:31.559 --> 00:40:32.280 you making money? 650 00:40:34.389 --> 00:40:40.130 Yes, every study that's been done on the access of 651 00:40:41.690 --> 00:40:47.090 nursing homes by private equity companies has indicated that the 652 00:40:47.179 --> 00:40:52.480 quality of care goes down. And because of some of 653 00:40:52.519 --> 00:40:58.099 the things you've mentioned, they reduce the staff, they have 654 00:40:58.199 --> 00:41:03.079 fewer physicians there. I mean, there's a whole set of 655 00:41:03.800 --> 00:41:09.320 situations that have to do with saving money that is 656 00:41:09.739 --> 00:41:15.360 generally needed to provide decent care for the individuals that 657 00:41:15.400 --> 00:41:16.519 are in the nursing homes. 658 00:41:17.440 --> 00:41:21.480 You know, nationwide, that number Gene said down in his area, 659 00:41:21.519 --> 00:41:25.519 it's all of the nursing homes. But nationwide, it's over 660 00:41:25.519 --> 00:41:28.480 70 percent of all the nursing homes are owned by 661 00:41:28.559 --> 00:41:29.539 private equity now. 662 00:41:29.639 --> 00:41:30.960 Yes, that's correct. 663 00:41:31.380 --> 00:41:34.199 Well, and it's going to get worse as we look 664 00:41:34.280 --> 00:41:37.380 at You know, we hear this in the policy lens. 665 00:41:37.619 --> 00:41:39.539 I know private equity knows this as well. 666 00:41:40.000 --> 00:41:43.440 When we look at the silver tsunami, what it's called, 667 00:41:43.460 --> 00:41:46.099 I know you all know about it too, with the 668 00:41:46.119 --> 00:41:48.860 baby boomer generation, the largest generation. 669 00:41:49.699 --> 00:41:52.199 In America at the time, I think before. 670 00:41:52.559 --> 00:41:56.579 Millennials, millennials, which I'm a millennial, I think we surpassed 671 00:41:56.940 --> 00:42:00.000 the baby

boomer generation, but that's my parents' generation. 672 00:42:00.199 --> 00:42:02.139 My parents are 69 and 71, respectively. 673 00:42:04.949 --> 00:42:09.079 So they're retiring, going off the scene in terms of 674 00:42:09.099 --> 00:42:12.260 the workforce and then changing needs relating to health care 675 00:42:12.280 --> 00:42:13.539 and housing and food. 676 00:42:13.239 --> 00:42:14.159 Stability and such. 677 00:42:14.219 --> 00:42:18.570 And so the need for multiple forms of care, whether 678 00:42:18.590 --> 00:42:22.789 it be in-home care, assisted living facilities, et cetera, that's 679 00:42:22.929 --> 00:42:27.110 only going to continue to grow and actually explode in 680 00:42:27.130 --> 00:42:30.630 the next decade. And so I know that private equity 681 00:42:30.670 --> 00:42:33.519 looks at that population as like, OK, that's an ability 682 00:42:33.559 --> 00:42:37.820 to turn a profit. But I think for us, especially 683 00:42:37.840 --> 00:42:40.989 as legislators, and then there's everyone. My dad always says, 684 00:42:41.010 --> 00:42:42.710 you're gonna get old one day if you keep moving. 685 00:42:43.409 --> 00:42:48.329 So you wanna make sure there are things that we 686 00:42:48.369 --> 00:42:51.409 need to care about. And as a millennial, I also 687 00:42:51.429 --> 00:42:53.929 think about, well, what is the healthcare system gonna look 688 00:42:53.949 --> 00:42:57.150 like when I'm 65? And how, I mean, if we 689 00:42:57.190 --> 00:43:00.389 can barely afford to do things now, can you imagine 690 00:43:00.429 --> 00:43:01.050 in the next 20, 25 years? 691 00:43:02.570 --> 00:43:05.730 I I'm glad you do think about that, Joshua, because 692 00:43:06.250 --> 00:43:08.369 I think a lot, a lot of young people now 693 00:43:08.630 --> 00:43:11.610 are already convinced it's not going to be there. And 694 00:43:11.650 --> 00:43:13.230 I don't know what they think is going to happen 695 00:43:13.250 --> 00:43:17.730 to them, but it's time they need, they get involved. 696 00:43:18.130 --> 00:43:18.590 I'll tell you. 697 00:43:18.610 --> 00:43:19.849 Yeah. 698 00:43:20.409 --> 00:43:23.010 Well, that's why I'm sorry. That's why I think this 699 00:43:23.070 --> 00:43:27.780 question is so important at a larger scale, Paul and Paul, 700 00:43:27.880 --> 00:43:32.030 actually my interactions with you, over the last month or 701 00:43:32.070 --> 00:43:35.630 so have really clarified my focus. 702 00:43:35.469 --> 00:43:38.969 In this space. Because oftentimes, when we're up there, we're 703 00:43:38.989 --> 00:43:42.530 a part-time legislator. I'm a part-time legislator. 704 00:43:42.570 --> 00:43:46.170 We are a part-time legislature as a governing body, meaning 705 00:43:46.289 --> 00:43:52.019 we don't have year-round session. We meet alternative years for 706 00:43:52.039 --> 00:43:55.099 a portion of the calendar year. On the even years, 707 00:43:55.820 --> 00:43:58.639 we meet until April. On the odd years, we meet

708 00:43:58.760 --> 00:44:02.269 until March. but that there's a whole chunk of the 709 00:44:02.309 --> 00:44:04.389 rest of the year that we are not in session, 710 00:44:04.829 --> 00:44:07.530 meaning we don't pass laws and things aren't changing in 711 00:44:07.550 --> 00:44:11.130 that regard. And so once I started talking to you, 712 00:44:11.230 --> 00:44:15.690 particularly about, you know, Medicaid expansion, Medicare, single payer systems, 713 00:44:15.750 --> 00:44:20.750 et cetera, it started, it made me get down to 714 00:44:20.929 --> 00:44:24.510 why are we not agreeing about this? You know, it 715 00:44:24.550 --> 00:44:27.269 just seems like it should be so common sense, but again, 716 00:44:28.170 --> 00:44:29.530 The question that I come back. 717 00:44:29.369 --> 00:44:30.989 To, and I'm going to sound like a broken record, 718 00:44:31.030 --> 00:44:33.230 you all may not ever have me on this program. 719 00:44:32.969 --> 00:44:37.210 Again, but it is, are we actually making health care 720 00:44:37.289 --> 00:44:40.760 less expensive, or are we just changing who gets stuck 721 00:44:40.780 --> 00:44:41.340 with the bill? 722 00:44:42.059 --> 00:44:45.960 Here's one key takeaway that's very important, and I haven't 723 00:44:45.980 --> 00:44:49.019 brought this up yet, but I will now, is that 724 00:44:49.079 --> 00:44:53.719 we usually recognize we have 32 developed countries in the 725 00:44:53.760 --> 00:44:56.800 world that we measure against. And, of course, out of 726 00:44:56.820 --> 00:45:01.579 the 32, only one cannot provide a single-payer system or 727 00:45:01.659 --> 00:45:04.260 universal health care for its citizens. And we know which 728 00:45:04.340 --> 00:45:07.360 one that is, obviously. And then we hear the thing 729 00:45:07.429 --> 00:45:11.389 that health care is too expensive. But if you take 730 00:45:11.429 --> 00:45:15.150 that one country, we spend twice as much as the 731 00:45:15.349 --> 00:45:21.429 average of the other 31 countries per capita on health care. 732 00:45:21.530 --> 00:45:23.010 We're already spending that money. 733 00:45:23.820 --> 00:45:27.369 Well, we're not spending it on healthcare. That's the problem. 734 00:45:28.050 --> 00:45:33.610 The money that is being spent is being siphoned off 735 00:45:34.150 --> 00:45:41.429 for profit, for political contributions by investors. So it's not 736 00:45:41.780 --> 00:45:47.280 that we're paying for healthcare. We're paying into a healthcare 737 00:45:47.539 --> 00:45:54.579 industry that is driven by making profit from healthcare activities. 738 00:45:54.659 --> 00:45:55.059 Exactly. 739 00:45:55.099 --> 00:45:57.480 Mike, jump right in on that, uh, bringing up that 740 00:45:57.639 --> 00:45:58.800 big elephant in the room. 741 00:46:00.639 --> 00:46:04.510 Well, it's approximately a third of all of, uh, I 742 00:46:04.570 --> 00:46:09.210 think it's $ 5. 5 trillion we're going to spend this year 743 00:46:09.309 --> 00:46:12.769 on healthcare. About a third of that is wasted. Uh, 744 00:46:12.829 --> 00:46:16.190 for example, uh, we're the only country in the world 745 00:46:16.230 --> 00:46:21.760 that allows doctors and hospitals and pharmaceuticals to advertise, uh, 746 00:46:23.590 --> 00:46:32.170 Our profit is huge, at least 15%. And pharmacy benefit 747 00:46:32.210 --> 00:46:40.250 managers and the huge administrative cost, these are all unnecessary 748 00:46:41.110 --> 00:46:44.849 costs that we could eliminate if we would just go 749 00:46:44.949 --> 00:46:49.110 to some type of not-for-profit system. 750 00:46:50.869 --> 00:46:52.070 Joshua.... 751 00:46:52.679 --> 00:46:57.460 Has pharmacy benefit managers been discussed in the legislature, to 752 00:46:57.500 --> 00:46:58.119 your knowledge? 753 00:46:58.139 --> 00:47:02.440 Yeah, broadly, I would say. 754 00:47:02.960 --> 00:47:04.219 Okay. 755 00:47:04.449 --> 00:47:09.769 Mainly in the conversation of, well, of course, with Medicaid. 756 00:47:09.849 --> 00:47:11.909 But I want to say my. 757 00:47:13.550 --> 00:47:20.699 Very first session, there was this really large discussion relating 758 00:47:20.820 --> 00:47:25.960 to There's a program that's going to come to me. 759 00:47:26.960 --> 00:47:27.940 I think it's 340B. 760 00:47:28.440 --> 00:47:28.900 Yeah, sure. 761 00:47:29.420 --> 00:47:30.260 Yeah, the. 762 00:47:33.030 --> 00:47:33.230 340B. 763 00:47:33.650 --> 00:47:37.889 Imagine somebody having their first session and everything moves. You 764 00:47:37.909 --> 00:47:41.090 all know Frankfurt. Frankfurt moves at a million miles a 765 00:47:41.110 --> 00:47:43.260 minute when you're in session. 766 00:47:43.699 --> 00:47:44.019 But then. 767 00:47:44.519 --> 00:47:47.059 It's like the fastest and slowest place on earth at 768 00:47:47.099 --> 00:47:50.480 the exact same time. You're talking about everything and every time, 769 00:47:50.539 --> 00:47:53.420 but it takes you 25 years to get one thing done. 770 00:47:53.460 --> 00:47:56.079 I mean, it's such a paradox. 771 00:47:56.590 --> 00:48:01.690 But 340B, as a freshman legislator, that was one of 772 00:48:01.710 --> 00:48:05.079 the most complicated things. items to try to wrap my 773 00:48:05.139 --> 00:48:09.820 head around in the last three days of session around changes. 774 00:48:09.480 --> 00:48:10.380 To that program. 775 00:48:10.519 --> 00:48:13.260 And the pharmacies and hospitals were arguing over it. I mean, 776 00:48:13.280 --> 00:48:16.190 it was just, it was a nightmare. But so I 777 00:48:16.230 --> 00:48:19.409 would say I've seen it in that context with that 778 00:48:19.449 --> 00:48:21.929 specific program and then broadly with Medicaid overall. 779 00:48:22.550 --> 00:48:23.750 It's very interesting. 780 00:48:24.469 --> 00:48:27.849 As we speak, I found an article yesterday where the 781 00:48:27.869 --> 00:48:35.059 University of Kentucky is suing CVS over 340B, CVS was 782 00:48:35.099 --> 00:48:39.159 apparently

managing that, and the University of Kentucky thinks they 783 00:48:39.179 --> 00:48:47.070 were mismanaging it, and money was not properly allocated. So 784 00:48:48.530 --> 00:48:57.170 both CVS and 340B is extremely complicated. Sometimes I wonder 785 00:48:57.230 --> 00:48:59.699 if they don't make it complicated so the rest of 786 00:48:59.780 --> 00:49:00.820 us can't understand it. 787 00:49:01.880 --> 00:49:05.219 Yeah, I think, so the session right before I got there, 788 00:49:05.280 --> 00:49:08.559 which was in 2024, that was what, Senate Bill 188 789 00:49:08.559 --> 00:49:16.010 that did, that established the additional pharmacy benefit managers oversight, 790 00:49:16.250 --> 00:49:19.670 like the network requirements and reporting and protection for pharmacies. 791 00:49:20.219 --> 00:49:23.159 But I want to say The Department of Insurance, we 792 00:49:23.360 --> 00:49:27.449 know DOI, said that those provisions generally do not apply 793 00:49:27.469 --> 00:49:30.750 to Medicaid or Medicaid Part D claims, which. 794 00:49:32.289 --> 00:49:33.429 I don't want to assume. 795 00:49:33.170 --> 00:49:36.989 That everybody even understands what a pharmacy benefit manager is 796 00:49:37.710 --> 00:49:41.019 or a PBM is that may be listening. But essentially, 797 00:49:41.039 --> 00:49:44.480 they're like the intermediary or the middle person between the 798 00:49:44.519 --> 00:49:48.280 health insurance or the drug manufacturers and the pharmacies. They're 799 00:49:48.300 --> 00:49:52.920 supposed to negotiate drug prices and rebates. amongst a whole 800 00:49:53.949 --> 00:49:59.030 host of other things, process prescription claims and establish reimbursement 801 00:49:59.090 --> 00:50:03.329 arrangements for pharmacies. And in theory, they use their purchasing 802 00:50:03.369 --> 00:50:07.409 power to negotiate lower prices. And I think the concern 803 00:50:07.449 --> 00:50:10.449 that you're raising and probably others are sharing is whether 804 00:50:10.469 --> 00:50:16.070 or not those negotiated savings actually reach patients, employers, and taxpayers. 805 00:50:16.820 --> 00:50:20.079 That's a good point. It's actually the big health care companies, 806 00:50:20.159 --> 00:50:24.599 UnitedHealthcare and CVS, and I'm sure there are others, they're 807 00:50:24.659 --> 00:50:30.289 vertically integrated. They actually own their own management systems. 808 00:50:30.909 --> 00:50:32.030 And why is that an issue? 809 00:50:32.349 --> 00:50:34.230 Because it brings up the question of whether or not 810 00:50:34.269 --> 00:50:38.429 there's a conflict there between when they determine which pharmacies 811 00:50:38.469 --> 00:50:43.280 participate and how much they're paid. When one company owns 812 00:50:43.599 --> 00:50:47.639 everything up and down the vertical stack, then you will 813 00:50:47.719 --> 00:50:49.820 always have those questions of whether or not there's a 814 00:50:49.860 --> 00:50:53.579 conflict there between those different interrelated parts. 815 00:50:54.260 --> 00:51:02.309 CVS also owns a health insurance company. I think it's Adenham. 816 00:51:03.210 --> 00:51:06.269 And then they also own some doctors. And I think 817 00:51:06.409 --> 00:51:10.130 that in some places they have their doctors and nurse 818 00:51:10.170 --> 00:51:16.210 practitioners in the pharmacy and the drugstore. So You know, 819 00:51:16.230 --> 00:51:20.070 if you go to see a doctor in the drugstore 820 00:51:20.170 --> 00:51:24.079 and they write you a prescription, it's pretty convenient just 821 00:51:24.119 --> 00:51:25.760 to get a feel there at CVS. 822 00:51:26.380 --> 00:51:26.719 Yeah. 823 00:51:27.159 --> 00:51:29.739 There are a couple of other things that I've heard 824 00:51:29.860 --> 00:51:35.809 some interesting scrutiny around, aside from the vertical integration that 825 00:51:35.829 --> 00:51:40.590 you were talking about, whether a pharmacy company owns, you know, 826 00:51:41.230 --> 00:51:42.130 other operations. 827 00:51:42.329 --> 00:51:44.130 It's the rebate arrangements. 828 00:51:45.000 --> 00:51:47.280 I think that's really interesting as I'm starting to learn 829 00:51:47.710 --> 00:51:52.690 more about like a PBM. That's what I'm going to 830 00:51:52.730 --> 00:51:56.929 call the benefit managers for those listening. But the PBM, 831 00:51:57.380 --> 00:52:00.880 they may get a rebate that can or is supposed 832 00:52:00.900 --> 00:52:06.139 to create some incentive to favor drugs with drugs. larger 833 00:52:06.159 --> 00:52:10.039 rebates rather than lower the actual net cost of the drug. 834 00:52:10.559 --> 00:52:14.880 That's really interesting. And then the pricing, the spread pricing, 835 00:52:14.940 --> 00:52:17.659 I think, is another one, which is whether or not, 836 00:52:18.380 --> 00:52:23.300 you know, PBM charges an insurer or Medicaid plan more 837 00:52:23.429 --> 00:52:28.670 for a prescription than it reimburses the actual dispensing pharmacy. 838 00:52:28.989 --> 00:52:31.250 And then they retain that difference. But that's profit. 839 00:52:33.329 --> 00:52:37.210 These are all examples of the dysfunctional health care system. 840 00:52:38.269 --> 00:52:42.849 Representative Watkins, let me ask you a little different political question. 841 00:52:42.949 --> 00:52:47.409 I'm curious to know your thoughts about this. As you know, 842 00:52:47.429 --> 00:52:54.389 this program is sponsored by Kentuckians for Single Payer, promoting 843 00:52:54.449 --> 00:53:00.960 Medicare for All. Can you give us a sense of the... 844 00:53:02.679 --> 00:53:10.949 The consideration of that by your fellow politicians, both on 845 00:53:11.030 --> 00:53:16.949 the Democrat and Republican side, I just look down the 846 00:53:17.010 --> 00:53:21.980 road and with the political climate we live in today, 847 00:53:22.000 --> 00:53:25.920 I don't see a whole lot of change going in 848 00:53:25.980 --> 00:53:29.889 that direction. I'd be curious

to know what your thoughts are, 849 00:53:30.929 --> 00:53:36.090 what your political colleagues think and feel about this, and 850 00:53:36.159 --> 00:53:41.869 if you have any sense of what the constituents that 851 00:53:41.909 --> 00:53:46.489 you represent have some thoughts or feelings or even an 852 00:53:46.670 --> 00:53:50.079 awareness of the prospect of Medicare for All? 853 00:53:50.539 --> 00:53:53.460 Yeah, so that's a really great question, and I hope 854 00:53:53.480 --> 00:53:57.340 you would allow me to answer it in a few ways. One, 855 00:53:57.980 --> 00:54:02.559 what I think the general sense of my district is, 856 00:54:02.980 --> 00:54:07.989 secondly being the overall general assembly, then my own individual take. 857 00:54:08.010 --> 00:54:08.630 I think. 858 00:54:10.030 --> 00:54:12.369 Going back to something that we said earlier, a lot 859 00:54:12.389 --> 00:54:16.460 of people don't get into the weeds, as we call it, 860 00:54:16.659 --> 00:54:21.280 around the different health care options. So if you were 861 00:54:21.300 --> 00:54:25.739 to ask a On a random day like today, you 862 00:54:25.780 --> 00:54:28.860 just walk into the 42nd House District and you were 863 00:54:28.880 --> 00:54:31.480 to find the first person you met and say, do 864 00:54:31.519 --> 00:54:35.039 you know about Medicaid for All? I would imagine that 865 00:54:35.440 --> 00:54:39.300 a lot of people would say, well, what is that? 866 00:54:39.320 --> 00:54:41.889 A lot of people don't even know what it is. 867 00:54:42.150 --> 00:54:44.469 I think that's one of the things that makes the 868 00:54:44.550 --> 00:54:49.869 conversation about healthcare costs and spending so difficult. It's just 869 00:54:50.289 --> 00:54:55.300 there's not a broad knowledge of any alternative to the 870 00:54:55.340 --> 00:55:00.340 parent system. In terms of the General Assembly, I think 871 00:55:00.400 --> 00:55:05.260 you would find, possibly along party line, more of an 872 00:55:05.320 --> 00:55:12.449 appetite to discuss single-payer systems on the Democratic side. But, 873 00:55:13.170 --> 00:55:14.949 and there are plenty of members that have been in 874 00:55:14.989 --> 00:55:17.809 the General Assembly a lot longer than me, I believe 875 00:55:17.849 --> 00:55:20.969 that the General Assembly has a higher degree of understanding 876 00:55:21.730 --> 00:55:25.030 of things like Medicaid for all than obviously the average person, 877 00:55:25.090 --> 00:55:28.309 because that's what we're seeing every day. And I would 878 00:55:28.349 --> 00:55:30.869 imagine that there are people on the Republican side of 879 00:55:30.909 --> 00:55:33.989 the aisle that know just as much, if not more, 880 00:55:34.130 --> 00:55:35.150 than members on my. 881 00:55:35.010 --> 00:55:37.570 Side about the program and what it could be. 882 00:55:38.409 --> 00:55:40.530 I would venture to say that I find a lot 883 00:55:40.550 --> 00:55:44.949 of my colleagues across the aisle to be highly intelligent 884 00:55:45.550 --> 00:55:47.809 about a lot of these issues, simply because they've been 885 00:55:47.849 --> 00:55:52.579 around for so long. And some actually have the backgrounds 886 00:55:53.239 --> 00:55:56.360 that relate, but some just have been around so long 887 00:55:56.400 --> 00:55:59.280 in the General Assembly, they just have learned from session 888 00:55:59.300 --> 00:56:02.920 to session the pros and. 889 00:56:02.860 --> 00:56:08.929 Cons and the different arguments. Individually, I am very. 890 00:56:09.820 --> 00:56:13.780 very aware of the appeal of universal health care because 891 00:56:13.820 --> 00:56:17.139 I think it's straightforward. And for me, as somebody who 892 00:56:17.179 --> 00:56:18.570 likes to make sure I have a pulse of what 893 00:56:18.610 --> 00:56:21.670 people are saying, people want to know if they can 894 00:56:21.710 --> 00:56:24.869 get medical treatment when they need it without worrying about 895 00:56:24.949 --> 00:56:28.510 financial ruin. And as I get older, that's something that 896 00:56:28.530 --> 00:56:33.730 I think about too. So the advantages are out there. 897 00:56:34.969 --> 00:56:40.659 because it simplifies administration and the cost of it, consistent coverage, 898 00:56:41.019 --> 00:56:45.300 greater leverage. I mean, I'm seeing coverage variances in my 899 00:56:45.539 --> 00:56:50.489 own health care choices, which, you know, they concern me. 900 00:56:50.630 --> 00:56:56.329 So I think for me, as someone who has sponsored 901 00:56:57.190 --> 00:57:00.889 bills on Medicaid and supported things. I actually sponsored legislation 902 00:57:00.949 --> 00:57:04.989 to extend postpartum Medicaid coverage. I presented that to the 903 00:57:05.030 --> 00:57:08.230 Medicaid Oversight and Accountability Board. I wanted to expand that 904 00:57:08.590 --> 00:57:11.909 from 12 to 24 months. Universal health care is very. 905 00:57:11.730 --> 00:57:12.670 Attractive to me. 906 00:57:12.769 --> 00:57:16.369 Representative Watkins, I don't want to interrupt you. We're down 907 00:57:16.409 --> 00:57:19.690 to our last two minutes. So first of all, I'd 908 00:57:19.730 --> 00:57:22.070 like to thank you for coming on. I think this 909 00:57:22.110 --> 00:57:26.570 has been a really interesting and informative discussion. And I'd 910 00:57:26.630 --> 00:57:29.489 like to give you an opportunity to make whatever few 911 00:57:29.570 --> 00:57:33.860 comments you'd like to make in the last few minutes 912 00:57:33.889 --> 00:57:36.460 we've got left for the end of the program. 913 00:57:36.960 --> 00:57:39.440 Well, just to talk about a little bit of my 914 00:57:39.579 --> 00:57:42.659 own work, I talked about expanding both part of Medicaid 915 00:57:42.699 --> 00:57:47.170 coverage of also supported budget amendments to address Medicaid funding 916 00:57:47.230 --> 00:57:53.429 shortages and to provide additional assistance to rural hospitals. But 917 00:57:54.869 --> 00:57:58.699 I would be very interested in a national conversation about 918 00:57:59.519 --> 00:58:03.539 a national overhaul of our healthcare system. But I won't 919 00:58:03.579 --> 00:58:06.760 hold my breath for Congress to do something like that. 920 00:58:06.840 --> 00:58:11.570 So hopefully good showing in the midterms will force that conversation. 921 00:58:11.909 --> 00:58:14.829 But I will just say, finally, we don't have to 922 00:58:14.949 --> 00:58:18.489 wait for that national overhaul in Kentucky. We can do 923 00:58:18.550 --> 00:58:23.230 things like addressing Medicaid, medical debt, mental health care, strengthening 924 00:58:23.289 --> 00:58:26.949 our rural hospitals simply by what we choose to pay for. 925 00:58:27.510 --> 00:58:30.690 We've learned that over our Medicaid listening tour. And I 926 00:58:30.710 --> 00:58:34.050 think those experiences that we've heard there and things even 927 00:58:34.070 --> 00:58:36.610 discussed here should be applied in. 928 00:58:36.570 --> 00:58:37.349 The General Assembly. 929 00:58:37.469 --> 00:58:41.480 And it's something that coming January of 2027, as we 930 00:58:41.500 --> 00:58:45.760 look about funding those Medicaid shortages, me and my colleagues 931 00:58:45.780 --> 00:58:46.739 are going to be pushing for. 932 00:58:47.059 --> 00:58:49.980 Well, thank you again. And this was a great program, Paul. 933 00:58:51.159 --> 00:58:53.880 I just want to thank our listeners today for joining us. 934 00:58:54.420 --> 00:58:56.679 And I hope you enjoyed the program. See you again 935 00:58:56.739 --> 00:58:58.800 next time. Have a wonderful rest of your day.