Hi, welcome to VERSED Podcast powered by VIUM Capital. Where you'll be hearing from leaders all across the long-term care sector who are shaping the future of our profession. Through these discussions, it's our hope that you'll be even more well-versed as you tackle your day in seniors' housing and healthcare. I'm your host, Scott Tittle, and this is VERSED.
Scott 00:23
Hey I’d like to welcome everybody to this episode of VIUM VERSED Podcast. My friend, old friend and great Hoosier, Brian Perry, who's Vice President of Government Relations from Direct Supply. Brian, thanks for being with us.
Brian 00:32
Thanks for having me, Scott. It feels like home.
Scott 00:34
It really does. You know, as we get to talking through this discussion, I think our listeners realize just how many things we have in common: not only do we share a love of all things Hoosier whether it’s basketball and now a great new football team, the Chicago Cubs, and we're both alumns of the Indiana Health Care Association. So we've got multiple different circles of old friends, alumni, and great passions, right?
Brian 00:54
I'd say that all those interests together make us a group of two.
Scott 00:56
That's right. Yeah. The Venn diagram of two. That's right.
Well, let's just jump right into it, because, Brian, I'm really excited to have you on not only because you’ve been a great friend for so long, but you have had so many interesting roles inside the long term care sector. You bring such an amazing perspective to so many things we could talk about. But now that it's past Labor Day, and we're in an election year, the campaigns have really begun, right? And so through this VIUM VERSED series, we're now going to spend the next several months talking about the election, talk about who's going to be in control in DC and what it means for long term care and senior housing. So I'm just so honored that you're the first of our guests to kick off the next couple of months of our discussion. Kind of what the result could mean in DC, and in certain states, certainly, for our long term care industry.
So I guess I kind of want to jump right in and let's just talk about the presidential election. I know, we were texting a few weeks ago. You were at the Democrat Convention, maybe say a little bit about the Harris-Walz ticket, and then what was the feeling like on the floor and the energy there and say a little bit about where that campaign stands today?
Brian 01:51
Sure. I would say, speaking of being in very, very small groups, I was one of those people that had the pleasure of doing both the RNC and the DNC, so just sort of a hazard of the job, I suppose. I mean, look, if you watched any of the DNC on television, the energy that you seem to see through the screen was palpable in that arena. It was the United Center, the place was packed to the hilt, and, Kamala Harris has brought sort of an energy to that ticket that just was not there when it was President Biden at the top. I don't know a Democrat who's not unbelievably excited about voting. We've not yet peeled back the layers of what her specific policy proposals will be. She's done, I think as of the recording of this interview, she's done one interview on television. So there's such a long way to go. I think it's 62 days as we record this until November the 5th. And, it's going to change so many times between here and there. There's going to be a debate, there's going to be interviews, there's going to be ads. We're going to be flooded with them. So this thing's going to change a bunch. But as it stands in this moment, the Harris-Walz ticket is really bringing a lot of energy to politics that we probably have not seen really, since the sort of early 08 Obama sort of vibes that we were getting. And I think vibe is the key word here, right? I mean, she's bringing good vibes and that seems to be carrying the day on TikTok and social media, and maybe that's enough to push her over the top. We will see.
Scott 03:07
You know, I think as we look back at the last several national election cycles, it really comes down to some independent voters or undecideds and just a couple of key states. Do you think this energy, these good vibes that she's brought on with having Walz join the ticket, are they reaching out to those independent voters who's undecided? So you think that's going to achieve the goal that they've desired?
Brian 03:26
I mean, I think that was her number one, two and three priority when she was looking for a vice president. I mean, really, this is an election about three states. This is about Pennsylvania, this is about Michigan, and this is about Wisconsin. And so far at least, it seems that Governor Walz is able to talk to voters in those states. She had some very interesting choices. Governor Shapiro in Pennsylvania is a wildly popular governor. A lot of folks were surprised that she didn't go that route. Senator Kelly in Arizona, also another swing state, not one of the top tier, but it's right there. Very surprising she didn't give him more of a look from what we've heard now in hindsight. But Governor Walz has availed himself very well so far. He is yet to make sort of a public misstep that has had any sort of legs to it. Any non partial observer of politics will admit: the press will probably give Democrats maybe a little more leeway than they will a Republican. And so, Governor Walz has that on his side. But they really are bringing some energy here that we've not seen in a while. And if they can hold on to that for just 62 more days, right? I mean, they've already been a ticket now, Harris has been at the top of the ticket for over 30 days now. So in a way, she's breaking this up into a third, a third, a third. And we're now in the middle of that second, third. We'll see what she can do.
Scott 04:40
It certainly seems like you mentioned the one press event that she's held. It seemed like her challenge is how to separate herself from some of the policy positions in the Biden administration that maybe weren't so popular and also kind of break through new ground. Do you kind of agree with that, that she's trying to figure out how to become her own candidate and bring the best of what she saw from her role as vice president, but also bring some new ideas to the top of the ticket?
Brian 05:03
I mean, it's fascinating. Outside of George H.W. Bush, we've not elected a vice president to become the president in the last century plus, right? And so it is an interesting thing to play. It takes a little bit of mental gymnastics, which she's been able to navigate well, but somehow she's framing herself as the change candidate, even though she's been the vice president for the last three and a half years. But she seems to be doing okay. Nobody seems to be asking that question yet, so you can see it in her interview. That is the piece that it seems the Democratic Party is a little nervous when, Vice President Harris goes off script, which a president has no choice but to do sometimes. So we're going to see if she's able to put that together. But I'm certain that every moment that you're not seeing her at a rally or reading off a teleprompter, she's probably in some of those prep rooms really working on the delivery of her craft. And if she can do it for another two months, maybe it'll work for her.
Scott 05:53
Yeah. And we're going to get to the question in a little bit about what happens in DC. Maybe do some more gaming out if the Democrats retain the White House, what happens in Congress, what that means for our sector. But I thought to ask you before, but you're just up there. You live in Chicago, but working in Wisconsin, but also have a national footprint through Direct Supply and international, too, of course. Say a little bit about Governor Walz. What was he like in terms of his treatment towards the sector in Minnesota, do you know?
Brian 06:17
You know, so it sounds a little bit like a mixed bag. I've not talked to a lot of our Minnesota folks yet to sort of get the real insight as to what it's been like. But there have been moments where he has funded the sector in ways that other governors have not. Typically, I don't have to tell your audience, we'll see more regulation, but yet more reimbursement under Democratic governors, less regulation, but sometimes less reimbursement under Republican governors. That's not a blanket statement, but that happens sort of stereotypically from time to time.
He's been good at funding the sector. It sounds like in his term as governor. Regulations, I think, have given some folks a little bit of pause up there. So he's sort of been in the mold of a Democratic governor. He's got the sort of Midwestern folksy-ness. I mean, I guess you and I maybe have a little bit of that with our Hoosier roots, so we know it when we see it. But at the same time, he can be quite progressive in his policies. You'll see some of his policies that align more with those governors that you'll find on the coasts, like New York and California. From our perspective, I think that his view of long term care, senior care will probably look very similar to the vice president's, which may indeed look very similar to President Biden's, which is sort of union heavy, union first. I say all the time it's become a motto: Unions are writing healthcare policy in America right now. And you can say it's a good thing, or you can say it's a bad thing, but I'll tell you, it's a true thing. I think we'll probably see a lot more of that. I don't see that changing. We may have some openings in a Harris administration potentially on things like foreign-born workers, right? Probably more so than in a Trump administration. So that provides one opportunity that we can really be looking at.
But I think that in a way, Harris, whether she's framing herself as the change candidate or not, really is looking at running a second Biden term. And, if that's the way she governs, I think that we as a sector have sort of seen what the last three and a half years have brought the good, the bad and otherwise.
Scott 08:06
You know, it just donned on me as you were talking in one of my prior roles when I was working at the National Center for Assisted Living, I think Minnesota still is the most recent state to really put forth a pretty comprehensive assisted living licensure and regulation program statewide. And so, I don't know how that may carry through to a Harris-Walz administration or not, but it just sort of donned on me that
that's striking that he was governor under that watch. And I think that was actually kind of welcomed by much of the sector up there. But still, I think it's really important to note.
Let's flip over to the Republican side. Say a little about where Trump and JD Vance are today. They kind of this sort of divide and conquer approach and kind of hitting as many of their real strong, supportive states as possible. But say a little bit about that campaign? And again, you mentioned you went to that convention. That was the convention, of course, happened before President Biden stepped down. But say a little bit about the energy on the floor there and what you heard and kind of everything you've seen since.
Brian 08:58
I mean, it feels like it was six months ago, right? It's incredible. So the RNC was happening in downtown Milwaukee about 900 yards from Direct Supplies Innovation and Technology Center. So we were, proverbially we could see it from our house, right? And it's so bizarre to think back just those few weeks to the mood that was in Milwaukee. Republicans were talking about not just President Trump just stomping President Biden in an election, they were looking at polls that were showing them up 15, 20 points. They were talking about sweeping both the House and the Senate. It was going to have coattails that would bring with it governors and state legislatures. And there was absolute strategy being put behind what the sector would look like in those realms. And then just, gosh, the following Sunday was when President Biden stepped down and the whole wave has just moved that direction.
So again, it's a roller coaster and there's 62 days of roller coaster left. But when you look back at the RNC, very, very different feel and vibe. I hate to keep using that word, but that's the word of the year it seems from the Republicans. I don't know if you talked to a Republican strategist at this moment that they would admit whether or not the vice presidential pick of President Trump has gone as well as they had hoped. I don't know that it has. Senator Vance may bring some very interesting things to the ticket through a debate that he will have with Governor Walz coming up and into November, certainly he’s from a very important state in Ohio. We saw that as a swing state just 20 years ago. I don't know that it is today. The mood in Milwaukee was just so different than what it would be in the Republican circles today. I think that, that was coming on the heels of an assassination attempt, which we've all frankly, forgotten even happened, right? How bizarre is that? Such is the news cycle these days. And I think that as the Republicans are really gearing up for that, and I think you sort of, referred to it as a divide and conquer kind of mindset. I think the Republicans are running a strategy that says, we've got to turn out our base as strong as we can. And if every single member of our base turns out we win, right? And I think Democrats instead are saying we fired up the base now because we have a new candidate, we've got to go find a way to win those independent voters. And if we can put both of those together, and if it doesn't rain in those three battleground states, then we win. So it's a fascinating play to see the different strategies playing out, but I think you'll start to see it in ads. Will the Democratic Party continue to be the party of joy as they were framing themselves in their convention? Will Republicans begin to reach out and find some of those voters on issues that may reach across into those independents and those leaning Democrats? That's really where this election is going to be won on the fifth. So we'll find out.
Scott 11:34
You mentioned a little bit about what we might be able to expect from a Harris-Walz ticket or at least the administration. We already have an experience with certainly a Trump administration with a different vice president, but say a little about President Trump's administration meant for the long-term care sector. And can we expect to see some of the same, do you think?
Brian 11:50
I think that's right. Someone that you and I both know well was CMS administrator under the Trump administration, Seema Verma. And one of her big pushes at CMS was patients over paperwork. And she really sort of put her money where her mouth was. So I think that when you just want to look at it from a 30,000ft level, are we going to have the regulatory challenges under a Trump, the second Trump administration that we've had under the last three and a half years? Absolutely not. I don't think that there's any question that we will see that type of sort of unfunded regulation. I think some of the heat will be turned down a little bit on, you mentioned assisted living regulation. Certainly, we've seen in the last six, eight months sort of a, maybe a tiptoe toward that direction on the assisted living side from some of the more progressive members of the Senate. And that would certainly be backed by this administration. I don't think you'll see that in a Trump administration. It's also important to remember, though, that it was the last Trump administration that, but for a John McCain thumbs down on the Senate floor where he basically got off his deathbed to save Medicaid. Medicaid would have blown itself apart, right? That would have been converted to a block grant system, which I don't think we as a sector truly, truly unpacked what that could have meant for us. So, with the good comes the bad. In every election I put together a two column sheet: who wins the election, the D or the R, and then what are the good and what are the bad? And, in this case, I think under a Trump administration, you're going to see some sort of chipping away at Medicaid and some of the social safety net. But you will certainly not have the pressures that you have on the regulatory side today.
Scott 13:19
Yeah, that's really helpful. And maybe let's talk about a really important pinpoint topic, because I think it shows the really different approaches to this key topic in both potential administrations, which is, the sniff minimum staffing ratio, right? I mean, the day that the Biden administration formally announced the final rule, he dispatched Vice President Harris to Milwaukee, right? Or somewhere in Wisconsin to announce the enactment of the other formal rule. And then I'm thinking there was all hope and intention that if President Trump wins the election, that that rule may be pulled back entirely. So you may even see that kind of disparity in the approaches to what the role of big government and how to address the labor shortage in long term care, how different the approaches could be depending on who wins the election. Is that right?
Brian 13:59
That's exactly right. And then there are also those sort of secondary issues where we've all been focused on this minimum staffing thing for what seems like the last three decades, right? It's been the last year and a half. You know when you look at things like tariffs, tariffs mean a lot to direct supply our customers and our suppliers. And you've got Trump talking about a 10% across the board tariff. Whereas the Biden administration, it doesn't seem to get the press that it should, has been using tariffs as a way of rewarding the American manufacturer. And whether that's good or that's bad, that is driving up the cost of medical supplies for providers. Because guess what? Our reimbursement system doesn't keep up when a medical mattress goes up 400% because it was made in Kosovo, for instance. So some of those, sort of secondary and tertiary issues, I think are really important that we keep an eye on. But also then as you look at the foreign-born worker issue that we mentioned before, right? We're always having to talk to folks in the Trump administration to say, when we talk about foreign-born workers coming into this country to deliver health care, we're not talking about drug kingpins jumping the wall to deliver meds in a nursing home, right? What we're talking about are folks from the Philippines and Haiti and other countries coming in and filling this gigantic gap that we have in the healthcare workforce. And so finding ways to talk about those issues are going to be really important under either administration, but particularly post-election, we've got to figure out a way to make this work.
Scott 15:17
So let me just ask you just put you on the spot a little bit: so I know, and you kind of watch the polling pretty closely. If the election were held today, what do you think happens?
Brian 15:24
Well, if I had a dollar for every time I get asked that question and if I had also another dollar for every time I punted, as I always joke, we would be coming to the end of a second administration for President Hillary Clinton, who followed President Mitt Romney. I’m really bad at the prediction game. I don't know if it's the Chicago Cubs fan in me or what. But what I do say is this: we have to look at the field. We have to follow these polls and figure out how best to help navigate senior care providers through whoever wins the election. That's why we don't play politics. Yes, we have political action committees. We have a very robust one, at Direct Supply that we use in support of our customer base. We work closely with associations like AHCA/NCAL, Argentum, LeadingAge and others to really try to elect those who support senior care. And sometimes those are Republicans and sometimes those are Democrats. But we have to be sure that come day one, we're prepared and ready. So we're working right now with those who we think could be HHS secretary in a Trump administration or in a Harris administration, and really trying to educate them today, now, early on what senior care is versus what it is claimed to be on the front page of the Washington Post or The New York Times and really show them the actual things that are happening from people who are actually delivering care, instead of those sort of spreadsheet warriors that often create public policy in some cubicle in Baltimore, for instance.
Scott 16:47
Brian, I think as our listeners can tell by now, I'm so glad we had you on today because you were doing so much on behalf of the sector through Direct Supply and to support all the trade associations, too and thinking ahead already as to who could be in those certain leadership positions. So I'm really glad to hear that you're already anticipating doing some of that heavy lifting.
Hey, let's switch over to Congress and Capitol Hill, because there's a lot of talk in the press and among political circles about what happens with the general election. But, gosh, there's some really fascinating things happening on the House and Senate side. And that could obviously impact, will impact what happens to long term care and senior living going forward, too.
So just jump right in the Senate. We've got kind of two legendary senators who have retired in Mitch McConnell and Joe Manchin, and those two have been critically important for our industry over the many years, right as supporters. Say a little about what's happening in the Senate right now, what their retirements mean, and then what you think may could happen going forward after November with respect to who's running the Senate?
Brian 17:39
Sure. Just from a horse race standpoint, I want to say one thing, but those two in particular really bring up a policy piece to me that I think is wildly important. So, on that horse race side, Senator Manchin stepping down absolutely delivers a seat from Democrats to Republicans. There's one prediction I will make: Governor Jim Justice will win the United States Senate seat in West Virginia, and if he does not, I will eat my hat. So we'll come back and discuss that on the 6th of November. But what that does is it makes the Senate 50/50 probably at best for Democrats, right? So President Harris becomes President Harris, then you've got vice president Walz breaking a tie. Democrats still hold the Senate. But there is so much math that is against Democrats this election cycle. You've got an open seat in Michigan that is currently a toss up. Right now, the Democrat is up four points as of the last poll that I saw. But you've got a state like Montana, which President Trump won by 25 plus points in 2020. And you've got a Democratic senator that's running into sort of that headwind. Now, if there's a human being on the planet who can overcome those odds in the state of Montana, it is Jon Tester. He has been an unbelievably good senator for the long term care sector. You will find him standing up to his own party, to his own president, to the big money interests in his party in support of senior care. So he's a really, really marquee race to watch on the fifth. If he can hold onto his seat, then Democrats have a shot at this. But I think that if you were going to Vegas today, you would probably lay down a bet that Republicans squeak out the win in the Senate, which would give us a new Senate majority leader. And as you mentioned, Senator McConnell stepping down from that position. So, that's sort of a horse race. You've got Senator Thune in there. You've got Senator Cornyn from Texas that's in there. I think most of the smart money right now is on Senator Thune. But look, if President Trump wins the race and puts his thumb on the scale, really, truly anything could happen within that caucus for that position.
The Senate is to me, the most important thing to watch. I'll be watching that Montana race probably more than I'm watching the presidential race, just because I think that it is just more important for our customers as we look at, sort of the next few years of electoral politics.
Scott 19;47
Yeah, and one more point on Senator Tester, I know he's been incredibly helpful on the minimum staffing ratio regulation as well. So kind of leading the talking points for the industry inside those chambers. Just something our listeners should know about.
How about the House? Because it seems like the house has just been all over the place the last many election cycles. Kind of say a little about, we've had multiple retirements on the Republican side, we've got leadership changing hands seems like every nine months or so. Where does the House stand today and where do you think it goes?
Brian 20:15
Sure. I don't think that anybody, myself included again, the predictions are terrible. I didn't predict speaker Mike Johnson lasting more than six weeks in the job just based on not himself, but just based on how bananas the House has been of late from a managerial standpoint. But he's done a pretty good job holding everything together. I just think, again, if you look at just the raw math, the seats that are up, the way that some interstate political changes have happened, Democrats really do seem to be in the driver's seat here. Even regardless of whether Trump or Harris wins this race, I think. Which would give us a new Speaker of the House in Hakeem Jeffries from Brooklyn. He's someone who, we've had a lot of conversations with, again, as we're planning for what the future could look like. I've also had a lot of conversations with Speaker Johnson. I do think one of those two people are likely leading the House. You could always have somebody pop up out of nowhere and get some momentum behind them. But again, if you're going to Vegas and you're laying a bet, I think that the House, switching hands to Democrats is not a terrible bet in this moment with 60 some days to go. And, with that, we'll see a lot of different changes on policy. You've got all new chairmen, for instance, right? So Ways and Means would switch, in that scenario from Jason Smith, a really, really good friend of the sector, most likely back to, Ways and Means Chairman Richie Neil. He's been chairman in the past. So we have a little bit of a track record for what he looks like, I think, Scott, for a lot of your investment-minded clients and those that are putting capital into this space, I think someone like Richie Neil is someone that you're going to see a lot from. He is not a fan of things like private equity. He's not a fan of things like real estate investment trusts. And so the tenor and tone of Ways and Means could really change for the sector. And that's something that we're keeping a really close eye on over here.
Scott 22:00
Yeah, and I think as you start mentioning certain individuals and what that could mean for certain leadership positions, the Democrats take over the Senate in particular, and you have Elizabeth Warren then kind of giving talking points to leadership where there could be some really interesting, not in a good way, focus on the sector. You mentioned on private equity and public owned nursing homes, assisted living facilities. So there could be a lot more focus and attention there.
Let's step back a little bit, Brian, because I think you kind of mentioned a little bit, but as we think about what could happen collectively, both in the White House and in Capitol Hill, if there's a complete win on the Democrats side, both in the white House and the Senate and the House, what do you think is on the table, then?
Brian 22:37
Well, that brings me to the point that I wanted to make on Manchin and McConnell. If there's a complete sweep by the D's or a complete sweep by the R's, something that I haven't seen a lot of talk about, but I think is absolutely an issue, is the idea of overturning the filibuster. And I say that because there have been two individuals in the past who have stood up to their own party when their own party wanted to overturn the filibuster, and they themselves blocked it. And it happens to be Senator Mitch McConnell on the Republican side and Senator Joe Manchin on the Democratic side. And they're not going to be there now to stop that. So the first time somebody tries to ram something through and the minority raises a hand, somebody is going to be able to say, maybe now's the time to overturn the filibuster, and they'll probably have the votes to do it. So under either scenario of a sweep, I keep an eye on that. If it's Democrats sweeping and you have any sort of a capital interest in senior care, including a provider who wants to do renovations, who wants to expand, who wants to build a new building. I think you've really got to look at what that will mean for you, because they're going to come in hard and heavy in private equity, real estate, investment trusts and all of the “big money interests”, because apparently these are the only folks spending money in politics, right? You and I know the difference. Your listeners know the difference. But I think it's really, really important to see what they do there. Senate finance has laid the groundwork to go after those sectors. And using, as I always say, folks like assisted living providers as the rope in the tug of war between Wall Street and Main Street, right? That's a vote winner for them and they know it. So I think it's really important to keep an eye on how that would play out in all D mindset. To imagine a President Harris not signing a bill that was passed to go after some of those entities, be it as little as, say, transparency on the low end to an all out ban of capital, which we've seen from certain states, I think Harris signs either one of those efforts. So it'll be really, really interesting if the D sweep, what it will mean for our listeners.
Scott 24:32
Yeah, let's go the other way, too. And if there's a full sweep of the Trump administration and then also Republicans keeping the House and Senate, what does that mean? And, both pro and con for the industry.
Brian 24:41
Sure. So again, with a potential of no filibuster to stop some of the worser intentions of a swept government, you'll certainly see something strengthened up at the border. Will that impact how our providers can import the workforce that they need from overseas? It might. So that's something that I would really keep an eye on. I think you've got to keep an eye on things like Medicare and Medicaid. As we talked about. Again, it was Senator McCain throwing a thumbs down that blocked that last time on Medicaid block grants. Senator McCain's not here right now, and there's no filibuster to block it in this scenario. So I think those are the things you really have to watch is what that would mean for Medicaid providers, certainly in states and cities in which that's a really, really big component of the reimbursement system.
Scott 25:24
Yeah. Let me just drill down a little bit, too, because I remember those days all too well in that dramatic vote. I think if I remember, then Paul Ryan kind of led that charge. He was the Speaker, right? If that proposal had gotten through and that was to reverse Obamacare, right? And then Paul Ryan kind of slipped in his Medicaid reform puzzle into that Obamacare repeal bill. And I think I remember the talking points, if that had gone through, that would have meant about a 20% cut across the board for Medicaid providers over ten years. That would have been incredibly significant. So I think as we again, look at big picture here, if the Democrats sweep, we could see more focus on kind of investment and ownership and capital, and also heavier role of federal and maybe state governments in our sector. If it's a complete Republican win, could be some entitlement reform that could be pretty significant, not a good way for industry. So I always say, Republicans don't like gridlock in DC, but for healthcare advocates, boy we sure like checks and balances don't we? Because there's always someone to negotiate with. But again, I think that's good policy as result with good negotiation. So I think we’ll be watching all that really closely.
Well Brian, this has been awesome and I'm so glad to have you on, especially on the heels of the Democrat Convention. Let me just ask you a couple more personal questions. Again we’re both big IU fans. IU maybe a football school again this year. We got a new coach and all kinds of transfers. Let's just say about the basketball team, I mean, we've had five banners, been holding five for a long time. Could we see a sixth banner sometime soon?
Brian 26:41
I'd like to think so. I think Coach Woodson certainly did the absolute best he could with the transfer portal. So, if there's a fan base in all of sports that deserves it, it's certainly IU basketball fans. I'm 100% biased when I say that. But if you've never seen a game in Bloomington, Indiana, then go change your life and do it this season.
Scott 26:58
At VIUM Capital, headquartered in Columbus, Ohio I work with a lot of great Ohio State Buckeye fans, and so we have a lot of fun in the office. But I remember the old days of Jimmy Jackson and Calbert Cheaney basketball days. So those were awesome.
Hey, I always ask our listeners, it's kind of one last question: what's on your nightstand? Is there a book that you're reading right now you want to recommend to our viewers or maybe a book that has inspired you over your career you want to hand that you hand off to people?Say a little about that.
Brian 27:22
Well to the chagrin of my wife, I usually have about 5 or 6 books sort of rocking the nightstand, which always gets in the way of the alarm clock and everything else when I'm trying to snooze in the morning. But, honestly, right now I'm doing everything from business books to things that are informing sort of my policy development, right? So, I'm currently reading The AI Revolution in Medicine, which is a GPT four focus thing. Direct Supply does a lot in the AI space to bring efficiencies into healthcare. I figure I better learn how to talk about this. I'm talking to folks on Capitol Hill who don't know how to spell healthcare because they're so focused on AI. So that's been a really, really big thing for me to learn. It's a bit like a textbook.
Radical Candor is a business book that I'm about to finish off that is highly recommended for those that are in a management position in business. But the one that I have to say has probably changed my life from a political standpoint is a four volume, God willing, hope to be fifth volume about Lyndon Johnson by Robert Caro, The Years of Lyndon Johnson. He has been writing about Lyndon Johnson since the early 1980s and is working on finishing off this book. It is, yes, a biography, but it is really, truly a book about the obtaining of and use of political power. It is absolutely unbelievable. If you read one of the four, please read Master of the Senate about Lyndon Johnson's ability to grab power, become the Senate Majority Leader, and probably the most effective Senate Majority leader that we've ever seen in the history of the country. It's not as well known as his presidential years, but Robert Caro is a master and has probably put together the best set of biographies that I've ever read in my life. So go grab those. You'll need a truck to haul them out of your Barnes and Noble. Trust me, they are very, very thick, but they are very, very worth it.
Scott 29:02
Brian, thanks so much. I think again, for our listeners, we can't thank you enough for your time and for all the work you do at Direct Supply. You guys are great partners here at VIUM Capital with us. And we’re so thankful for all the work you're doing to help support all the trade associations and all the right people that hopefully will take over in many levels of leadership to help support the sector grow in the future. So, Brian, thanks for all you're doing and thanks for being on. Really appreciate it.
Brian 29:21
Thanks, Scott.
Scott: 29:22
This is VERSED.
Scott 00:23
Hey I’d like to welcome everybody to this episode of VIUM VERSED Podcast. My friend, old friend and great Hoosier, Brian Perry, who's Vice President of Government Relations from Direct Supply. Brian, thanks for being with us.
Brian 00:32
Thanks for having me, Scott. It feels like home.
Scott 00:34
It really does. You know, as we get to talking through this discussion, I think our listeners realize just how many things we have in common: not only do we share a love of all things Hoosier whether it’s basketball and now a great new football team, the Chicago Cubs, and we're both alumns of the Indiana Health Care Association. So we've got multiple different circles of old friends, alumni, and great passions, right?
Brian 00:54
I'd say that all those interests together make us a group of two.
Scott 00:56
That's right. Yeah. The Venn diagram of two. That's right.
Well, let's just jump right into it, because, Brian, I'm really excited to have you on not only because you’ve been a great friend for so long, but you have had so many interesting roles inside the long term care sector. You bring such an amazing perspective to so many things we could talk about. But now that it's past Labor Day, and we're in an election year, the campaigns have really begun, right? And so through this VIUM VERSED series, we're now going to spend the next several months talking about the election, talk about who's going to be in control in DC and what it means for long term care and senior housing. So I'm just so honored that you're the first of our guests to kick off the next couple of months of our discussion. Kind of what the result could mean in DC, and in certain states, certainly, for our long term care industry.
So I guess I kind of want to jump right in and let's just talk about the presidential election. I know, we were texting a few weeks ago. You were at the Democrat Convention, maybe say a little bit about the Harris-Walz ticket, and then what was the feeling like on the floor and the energy there and say a little bit about where that campaign stands today?
Brian 01:51
Sure. I would say, speaking of being in very, very small groups, I was one of those people that had the pleasure of doing both the RNC and the DNC, so just sort of a hazard of the job, I suppose. I mean, look, if you watched any of the DNC on television, the energy that you seem to see through the screen was palpable in that arena. It was the United Center, the place was packed to the hilt, and, Kamala Harris has brought sort of an energy to that ticket that just was not there when it was President Biden at the top. I don't know a Democrat who's not unbelievably excited about voting. We've not yet peeled back the layers of what her specific policy proposals will be. She's done, I think as of the recording of this interview, she's done one interview on television. So there's such a long way to go. I think it's 62 days as we record this until November the 5th. And, it's going to change so many times between here and there. There's going to be a debate, there's going to be interviews, there's going to be ads. We're going to be flooded with them. So this thing's going to change a bunch. But as it stands in this moment, the Harris-Walz ticket is really bringing a lot of energy to politics that we probably have not seen really, since the sort of early 08 Obama sort of vibes that we were getting. And I think vibe is the key word here, right? I mean, she's bringing good vibes and that seems to be carrying the day on TikTok and social media, and maybe that's enough to push her over the top. We will see.
Scott 03:07
You know, I think as we look back at the last several national election cycles, it really comes down to some independent voters or undecideds and just a couple of key states. Do you think this energy, these good vibes that she's brought on with having Walz join the ticket, are they reaching out to those independent voters who's undecided? So you think that's going to achieve the goal that they've desired?
Brian 03:26
I mean, I think that was her number one, two and three priority when she was looking for a vice president. I mean, really, this is an election about three states. This is about Pennsylvania, this is about Michigan, and this is about Wisconsin. And so far at least, it seems that Governor Walz is able to talk to voters in those states. She had some very interesting choices. Governor Shapiro in Pennsylvania is a wildly popular governor. A lot of folks were surprised that she didn't go that route. Senator Kelly in Arizona, also another swing state, not one of the top tier, but it's right there. Very surprising she didn't give him more of a look from what we've heard now in hindsight. But Governor Walz has availed himself very well so far. He is yet to make sort of a public misstep that has had any sort of legs to it. Any non partial observer of politics will admit: the press will probably give Democrats maybe a little more leeway than they will a Republican. And so, Governor Walz has that on his side. But they really are bringing some energy here that we've not seen in a while. And if they can hold on to that for just 62 more days, right? I mean, they've already been a ticket now, Harris has been at the top of the ticket for over 30 days now. So in a way, she's breaking this up into a third, a third, a third. And we're now in the middle of that second, third. We'll see what she can do.
Scott 04:40
It certainly seems like you mentioned the one press event that she's held. It seemed like her challenge is how to separate herself from some of the policy positions in the Biden administration that maybe weren't so popular and also kind of break through new ground. Do you kind of agree with that, that she's trying to figure out how to become her own candidate and bring the best of what she saw from her role as vice president, but also bring some new ideas to the top of the ticket?
Brian 05:03
I mean, it's fascinating. Outside of George H.W. Bush, we've not elected a vice president to become the president in the last century plus, right? And so it is an interesting thing to play. It takes a little bit of mental gymnastics, which she's been able to navigate well, but somehow she's framing herself as the change candidate, even though she's been the vice president for the last three and a half years. But she seems to be doing okay. Nobody seems to be asking that question yet, so you can see it in her interview. That is the piece that it seems the Democratic Party is a little nervous when, Vice President Harris goes off script, which a president has no choice but to do sometimes. So we're going to see if she's able to put that together. But I'm certain that every moment that you're not seeing her at a rally or reading off a teleprompter, she's probably in some of those prep rooms really working on the delivery of her craft. And if she can do it for another two months, maybe it'll work for her.
Scott 05:53
Yeah. And we're going to get to the question in a little bit about what happens in DC. Maybe do some more gaming out if the Democrats retain the White House, what happens in Congress, what that means for our sector. But I thought to ask you before, but you're just up there. You live in Chicago, but working in Wisconsin, but also have a national footprint through Direct Supply and international, too, of course. Say a little bit about Governor Walz. What was he like in terms of his treatment towards the sector in Minnesota, do you know?
Brian 06:17
You know, so it sounds a little bit like a mixed bag. I've not talked to a lot of our Minnesota folks yet to sort of get the real insight as to what it's been like. But there have been moments where he has funded the sector in ways that other governors have not. Typically, I don't have to tell your audience, we'll see more regulation, but yet more reimbursement under Democratic governors, less regulation, but sometimes less reimbursement under Republican governors. That's not a blanket statement, but that happens sort of stereotypically from time to time.
He's been good at funding the sector. It sounds like in his term as governor. Regulations, I think, have given some folks a little bit of pause up there. So he's sort of been in the mold of a Democratic governor. He's got the sort of Midwestern folksy-ness. I mean, I guess you and I maybe have a little bit of that with our Hoosier roots, so we know it when we see it. But at the same time, he can be quite progressive in his policies. You'll see some of his policies that align more with those governors that you'll find on the coasts, like New York and California. From our perspective, I think that his view of long term care, senior care will probably look very similar to the vice president's, which may indeed look very similar to President Biden's, which is sort of union heavy, union first. I say all the time it's become a motto: Unions are writing healthcare policy in America right now. And you can say it's a good thing, or you can say it's a bad thing, but I'll tell you, it's a true thing. I think we'll probably see a lot more of that. I don't see that changing. We may have some openings in a Harris administration potentially on things like foreign-born workers, right? Probably more so than in a Trump administration. So that provides one opportunity that we can really be looking at.
But I think that in a way, Harris, whether she's framing herself as the change candidate or not, really is looking at running a second Biden term. And, if that's the way she governs, I think that we as a sector have sort of seen what the last three and a half years have brought the good, the bad and otherwise.
Scott 08:06
You know, it just donned on me as you were talking in one of my prior roles when I was working at the National Center for Assisted Living, I think Minnesota still is the most recent state to really put forth a pretty comprehensive assisted living licensure and regulation program statewide. And so, I don't know how that may carry through to a Harris-Walz administration or not, but it just sort of donned on me that
that's striking that he was governor under that watch. And I think that was actually kind of welcomed by much of the sector up there. But still, I think it's really important to note.
Let's flip over to the Republican side. Say a little about where Trump and JD Vance are today. They kind of this sort of divide and conquer approach and kind of hitting as many of their real strong, supportive states as possible. But say a little bit about that campaign? And again, you mentioned you went to that convention. That was the convention, of course, happened before President Biden stepped down. But say a little bit about the energy on the floor there and what you heard and kind of everything you've seen since.
Brian 08:58
I mean, it feels like it was six months ago, right? It's incredible. So the RNC was happening in downtown Milwaukee about 900 yards from Direct Supplies Innovation and Technology Center. So we were, proverbially we could see it from our house, right? And it's so bizarre to think back just those few weeks to the mood that was in Milwaukee. Republicans were talking about not just President Trump just stomping President Biden in an election, they were looking at polls that were showing them up 15, 20 points. They were talking about sweeping both the House and the Senate. It was going to have coattails that would bring with it governors and state legislatures. And there was absolute strategy being put behind what the sector would look like in those realms. And then just, gosh, the following Sunday was when President Biden stepped down and the whole wave has just moved that direction.
So again, it's a roller coaster and there's 62 days of roller coaster left. But when you look back at the RNC, very, very different feel and vibe. I hate to keep using that word, but that's the word of the year it seems from the Republicans. I don't know if you talked to a Republican strategist at this moment that they would admit whether or not the vice presidential pick of President Trump has gone as well as they had hoped. I don't know that it has. Senator Vance may bring some very interesting things to the ticket through a debate that he will have with Governor Walz coming up and into November, certainly he’s from a very important state in Ohio. We saw that as a swing state just 20 years ago. I don't know that it is today. The mood in Milwaukee was just so different than what it would be in the Republican circles today. I think that, that was coming on the heels of an assassination attempt, which we've all frankly, forgotten even happened, right? How bizarre is that? Such is the news cycle these days. And I think that as the Republicans are really gearing up for that, and I think you sort of, referred to it as a divide and conquer kind of mindset. I think the Republicans are running a strategy that says, we've got to turn out our base as strong as we can. And if every single member of our base turns out we win, right? And I think Democrats instead are saying we fired up the base now because we have a new candidate, we've got to go find a way to win those independent voters. And if we can put both of those together, and if it doesn't rain in those three battleground states, then we win. So it's a fascinating play to see the different strategies playing out, but I think you'll start to see it in ads. Will the Democratic Party continue to be the party of joy as they were framing themselves in their convention? Will Republicans begin to reach out and find some of those voters on issues that may reach across into those independents and those leaning Democrats? That's really where this election is going to be won on the fifth. So we'll find out.
Scott 11:34
You mentioned a little bit about what we might be able to expect from a Harris-Walz ticket or at least the administration. We already have an experience with certainly a Trump administration with a different vice president, but say a little about President Trump's administration meant for the long-term care sector. And can we expect to see some of the same, do you think?
Brian 11:50
I think that's right. Someone that you and I both know well was CMS administrator under the Trump administration, Seema Verma. And one of her big pushes at CMS was patients over paperwork. And she really sort of put her money where her mouth was. So I think that when you just want to look at it from a 30,000ft level, are we going to have the regulatory challenges under a Trump, the second Trump administration that we've had under the last three and a half years? Absolutely not. I don't think that there's any question that we will see that type of sort of unfunded regulation. I think some of the heat will be turned down a little bit on, you mentioned assisted living regulation. Certainly, we've seen in the last six, eight months sort of a, maybe a tiptoe toward that direction on the assisted living side from some of the more progressive members of the Senate. And that would certainly be backed by this administration. I don't think you'll see that in a Trump administration. It's also important to remember, though, that it was the last Trump administration that, but for a John McCain thumbs down on the Senate floor where he basically got off his deathbed to save Medicaid. Medicaid would have blown itself apart, right? That would have been converted to a block grant system, which I don't think we as a sector truly, truly unpacked what that could have meant for us. So, with the good comes the bad. In every election I put together a two column sheet: who wins the election, the D or the R, and then what are the good and what are the bad? And, in this case, I think under a Trump administration, you're going to see some sort of chipping away at Medicaid and some of the social safety net. But you will certainly not have the pressures that you have on the regulatory side today.
Scott 13:19
Yeah, that's really helpful. And maybe let's talk about a really important pinpoint topic, because I think it shows the really different approaches to this key topic in both potential administrations, which is, the sniff minimum staffing ratio, right? I mean, the day that the Biden administration formally announced the final rule, he dispatched Vice President Harris to Milwaukee, right? Or somewhere in Wisconsin to announce the enactment of the other formal rule. And then I'm thinking there was all hope and intention that if President Trump wins the election, that that rule may be pulled back entirely. So you may even see that kind of disparity in the approaches to what the role of big government and how to address the labor shortage in long term care, how different the approaches could be depending on who wins the election. Is that right?
Brian 13:59
That's exactly right. And then there are also those sort of secondary issues where we've all been focused on this minimum staffing thing for what seems like the last three decades, right? It's been the last year and a half. You know when you look at things like tariffs, tariffs mean a lot to direct supply our customers and our suppliers. And you've got Trump talking about a 10% across the board tariff. Whereas the Biden administration, it doesn't seem to get the press that it should, has been using tariffs as a way of rewarding the American manufacturer. And whether that's good or that's bad, that is driving up the cost of medical supplies for providers. Because guess what? Our reimbursement system doesn't keep up when a medical mattress goes up 400% because it was made in Kosovo, for instance. So some of those, sort of secondary and tertiary issues, I think are really important that we keep an eye on. But also then as you look at the foreign-born worker issue that we mentioned before, right? We're always having to talk to folks in the Trump administration to say, when we talk about foreign-born workers coming into this country to deliver health care, we're not talking about drug kingpins jumping the wall to deliver meds in a nursing home, right? What we're talking about are folks from the Philippines and Haiti and other countries coming in and filling this gigantic gap that we have in the healthcare workforce. And so finding ways to talk about those issues are going to be really important under either administration, but particularly post-election, we've got to figure out a way to make this work.
Scott 15:17
So let me just ask you just put you on the spot a little bit: so I know, and you kind of watch the polling pretty closely. If the election were held today, what do you think happens?
Brian 15:24
Well, if I had a dollar for every time I get asked that question and if I had also another dollar for every time I punted, as I always joke, we would be coming to the end of a second administration for President Hillary Clinton, who followed President Mitt Romney. I’m really bad at the prediction game. I don't know if it's the Chicago Cubs fan in me or what. But what I do say is this: we have to look at the field. We have to follow these polls and figure out how best to help navigate senior care providers through whoever wins the election. That's why we don't play politics. Yes, we have political action committees. We have a very robust one, at Direct Supply that we use in support of our customer base. We work closely with associations like AHCA/NCAL, Argentum, LeadingAge and others to really try to elect those who support senior care. And sometimes those are Republicans and sometimes those are Democrats. But we have to be sure that come day one, we're prepared and ready. So we're working right now with those who we think could be HHS secretary in a Trump administration or in a Harris administration, and really trying to educate them today, now, early on what senior care is versus what it is claimed to be on the front page of the Washington Post or The New York Times and really show them the actual things that are happening from people who are actually delivering care, instead of those sort of spreadsheet warriors that often create public policy in some cubicle in Baltimore, for instance.
Scott 16:47
Brian, I think as our listeners can tell by now, I'm so glad we had you on today because you were doing so much on behalf of the sector through Direct Supply and to support all the trade associations, too and thinking ahead already as to who could be in those certain leadership positions. So I'm really glad to hear that you're already anticipating doing some of that heavy lifting.
Hey, let's switch over to Congress and Capitol Hill, because there's a lot of talk in the press and among political circles about what happens with the general election. But, gosh, there's some really fascinating things happening on the House and Senate side. And that could obviously impact, will impact what happens to long term care and senior living going forward, too.
So just jump right in the Senate. We've got kind of two legendary senators who have retired in Mitch McConnell and Joe Manchin, and those two have been critically important for our industry over the many years, right as supporters. Say a little about what's happening in the Senate right now, what their retirements mean, and then what you think may could happen going forward after November with respect to who's running the Senate?
Brian 17:39
Sure. Just from a horse race standpoint, I want to say one thing, but those two in particular really bring up a policy piece to me that I think is wildly important. So, on that horse race side, Senator Manchin stepping down absolutely delivers a seat from Democrats to Republicans. There's one prediction I will make: Governor Jim Justice will win the United States Senate seat in West Virginia, and if he does not, I will eat my hat. So we'll come back and discuss that on the 6th of November. But what that does is it makes the Senate 50/50 probably at best for Democrats, right? So President Harris becomes President Harris, then you've got vice president Walz breaking a tie. Democrats still hold the Senate. But there is so much math that is against Democrats this election cycle. You've got an open seat in Michigan that is currently a toss up. Right now, the Democrat is up four points as of the last poll that I saw. But you've got a state like Montana, which President Trump won by 25 plus points in 2020. And you've got a Democratic senator that's running into sort of that headwind. Now, if there's a human being on the planet who can overcome those odds in the state of Montana, it is Jon Tester. He has been an unbelievably good senator for the long term care sector. You will find him standing up to his own party, to his own president, to the big money interests in his party in support of senior care. So he's a really, really marquee race to watch on the fifth. If he can hold onto his seat, then Democrats have a shot at this. But I think that if you were going to Vegas today, you would probably lay down a bet that Republicans squeak out the win in the Senate, which would give us a new Senate majority leader. And as you mentioned, Senator McConnell stepping down from that position. So, that's sort of a horse race. You've got Senator Thune in there. You've got Senator Cornyn from Texas that's in there. I think most of the smart money right now is on Senator Thune. But look, if President Trump wins the race and puts his thumb on the scale, really, truly anything could happen within that caucus for that position.
The Senate is to me, the most important thing to watch. I'll be watching that Montana race probably more than I'm watching the presidential race, just because I think that it is just more important for our customers as we look at, sort of the next few years of electoral politics.
Scott 19;47
Yeah, and one more point on Senator Tester, I know he's been incredibly helpful on the minimum staffing ratio regulation as well. So kind of leading the talking points for the industry inside those chambers. Just something our listeners should know about.
How about the House? Because it seems like the house has just been all over the place the last many election cycles. Kind of say a little about, we've had multiple retirements on the Republican side, we've got leadership changing hands seems like every nine months or so. Where does the House stand today and where do you think it goes?
Brian 20:15
Sure. I don't think that anybody, myself included again, the predictions are terrible. I didn't predict speaker Mike Johnson lasting more than six weeks in the job just based on not himself, but just based on how bananas the House has been of late from a managerial standpoint. But he's done a pretty good job holding everything together. I just think, again, if you look at just the raw math, the seats that are up, the way that some interstate political changes have happened, Democrats really do seem to be in the driver's seat here. Even regardless of whether Trump or Harris wins this race, I think. Which would give us a new Speaker of the House in Hakeem Jeffries from Brooklyn. He's someone who, we've had a lot of conversations with, again, as we're planning for what the future could look like. I've also had a lot of conversations with Speaker Johnson. I do think one of those two people are likely leading the House. You could always have somebody pop up out of nowhere and get some momentum behind them. But again, if you're going to Vegas and you're laying a bet, I think that the House, switching hands to Democrats is not a terrible bet in this moment with 60 some days to go. And, with that, we'll see a lot of different changes on policy. You've got all new chairmen, for instance, right? So Ways and Means would switch, in that scenario from Jason Smith, a really, really good friend of the sector, most likely back to, Ways and Means Chairman Richie Neil. He's been chairman in the past. So we have a little bit of a track record for what he looks like, I think, Scott, for a lot of your investment-minded clients and those that are putting capital into this space, I think someone like Richie Neil is someone that you're going to see a lot from. He is not a fan of things like private equity. He's not a fan of things like real estate investment trusts. And so the tenor and tone of Ways and Means could really change for the sector. And that's something that we're keeping a really close eye on over here.
Scott 22:00
Yeah, and I think as you start mentioning certain individuals and what that could mean for certain leadership positions, the Democrats take over the Senate in particular, and you have Elizabeth Warren then kind of giving talking points to leadership where there could be some really interesting, not in a good way, focus on the sector. You mentioned on private equity and public owned nursing homes, assisted living facilities. So there could be a lot more focus and attention there.
Let's step back a little bit, Brian, because I think you kind of mentioned a little bit, but as we think about what could happen collectively, both in the White House and in Capitol Hill, if there's a complete win on the Democrats side, both in the white House and the Senate and the House, what do you think is on the table, then?
Brian 22:37
Well, that brings me to the point that I wanted to make on Manchin and McConnell. If there's a complete sweep by the D's or a complete sweep by the R's, something that I haven't seen a lot of talk about, but I think is absolutely an issue, is the idea of overturning the filibuster. And I say that because there have been two individuals in the past who have stood up to their own party when their own party wanted to overturn the filibuster, and they themselves blocked it. And it happens to be Senator Mitch McConnell on the Republican side and Senator Joe Manchin on the Democratic side. And they're not going to be there now to stop that. So the first time somebody tries to ram something through and the minority raises a hand, somebody is going to be able to say, maybe now's the time to overturn the filibuster, and they'll probably have the votes to do it. So under either scenario of a sweep, I keep an eye on that. If it's Democrats sweeping and you have any sort of a capital interest in senior care, including a provider who wants to do renovations, who wants to expand, who wants to build a new building. I think you've really got to look at what that will mean for you, because they're going to come in hard and heavy in private equity, real estate, investment trusts and all of the “big money interests”, because apparently these are the only folks spending money in politics, right? You and I know the difference. Your listeners know the difference. But I think it's really, really important to see what they do there. Senate finance has laid the groundwork to go after those sectors. And using, as I always say, folks like assisted living providers as the rope in the tug of war between Wall Street and Main Street, right? That's a vote winner for them and they know it. So I think it's really important to keep an eye on how that would play out in all D mindset. To imagine a President Harris not signing a bill that was passed to go after some of those entities, be it as little as, say, transparency on the low end to an all out ban of capital, which we've seen from certain states, I think Harris signs either one of those efforts. So it'll be really, really interesting if the D sweep, what it will mean for our listeners.
Scott 24:32
Yeah, let's go the other way, too. And if there's a full sweep of the Trump administration and then also Republicans keeping the House and Senate, what does that mean? And, both pro and con for the industry.
Brian 24:41
Sure. So again, with a potential of no filibuster to stop some of the worser intentions of a swept government, you'll certainly see something strengthened up at the border. Will that impact how our providers can import the workforce that they need from overseas? It might. So that's something that I would really keep an eye on. I think you've got to keep an eye on things like Medicare and Medicaid. As we talked about. Again, it was Senator McCain throwing a thumbs down that blocked that last time on Medicaid block grants. Senator McCain's not here right now, and there's no filibuster to block it in this scenario. So I think those are the things you really have to watch is what that would mean for Medicaid providers, certainly in states and cities in which that's a really, really big component of the reimbursement system.
Scott 25:24
Yeah. Let me just drill down a little bit, too, because I remember those days all too well in that dramatic vote. I think if I remember, then Paul Ryan kind of led that charge. He was the Speaker, right? If that proposal had gotten through and that was to reverse Obamacare, right? And then Paul Ryan kind of slipped in his Medicaid reform puzzle into that Obamacare repeal bill. And I think I remember the talking points, if that had gone through, that would have meant about a 20% cut across the board for Medicaid providers over ten years. That would have been incredibly significant. So I think as we again, look at big picture here, if the Democrats sweep, we could see more focus on kind of investment and ownership and capital, and also heavier role of federal and maybe state governments in our sector. If it's a complete Republican win, could be some entitlement reform that could be pretty significant, not a good way for industry. So I always say, Republicans don't like gridlock in DC, but for healthcare advocates, boy we sure like checks and balances don't we? Because there's always someone to negotiate with. But again, I think that's good policy as result with good negotiation. So I think we’ll be watching all that really closely.
Well Brian, this has been awesome and I'm so glad to have you on, especially on the heels of the Democrat Convention. Let me just ask you a couple more personal questions. Again we’re both big IU fans. IU maybe a football school again this year. We got a new coach and all kinds of transfers. Let's just say about the basketball team, I mean, we've had five banners, been holding five for a long time. Could we see a sixth banner sometime soon?
Brian 26:41
I'd like to think so. I think Coach Woodson certainly did the absolute best he could with the transfer portal. So, if there's a fan base in all of sports that deserves it, it's certainly IU basketball fans. I'm 100% biased when I say that. But if you've never seen a game in Bloomington, Indiana, then go change your life and do it this season.
Scott 26:58
At VIUM Capital, headquartered in Columbus, Ohio I work with a lot of great Ohio State Buckeye fans, and so we have a lot of fun in the office. But I remember the old days of Jimmy Jackson and Calbert Cheaney basketball days. So those were awesome.
Hey, I always ask our listeners, it's kind of one last question: what's on your nightstand? Is there a book that you're reading right now you want to recommend to our viewers or maybe a book that has inspired you over your career you want to hand that you hand off to people?Say a little about that.
Brian 27:22
Well to the chagrin of my wife, I usually have about 5 or 6 books sort of rocking the nightstand, which always gets in the way of the alarm clock and everything else when I'm trying to snooze in the morning. But, honestly, right now I'm doing everything from business books to things that are informing sort of my policy development, right? So, I'm currently reading The AI Revolution in Medicine, which is a GPT four focus thing. Direct Supply does a lot in the AI space to bring efficiencies into healthcare. I figure I better learn how to talk about this. I'm talking to folks on Capitol Hill who don't know how to spell healthcare because they're so focused on AI. So that's been a really, really big thing for me to learn. It's a bit like a textbook.
Radical Candor is a business book that I'm about to finish off that is highly recommended for those that are in a management position in business. But the one that I have to say has probably changed my life from a political standpoint is a four volume, God willing, hope to be fifth volume about Lyndon Johnson by Robert Caro, The Years of Lyndon Johnson. He has been writing about Lyndon Johnson since the early 1980s and is working on finishing off this book. It is, yes, a biography, but it is really, truly a book about the obtaining of and use of political power. It is absolutely unbelievable. If you read one of the four, please read Master of the Senate about Lyndon Johnson's ability to grab power, become the Senate Majority Leader, and probably the most effective Senate Majority leader that we've ever seen in the history of the country. It's not as well known as his presidential years, but Robert Caro is a master and has probably put together the best set of biographies that I've ever read in my life. So go grab those. You'll need a truck to haul them out of your Barnes and Noble. Trust me, they are very, very thick, but they are very, very worth it.
Scott 29:02
Brian, thanks so much. I think again, for our listeners, we can't thank you enough for your time and for all the work you do at Direct Supply. You guys are great partners here at VIUM Capital with us. And we’re so thankful for all the work you're doing to help support all the trade associations and all the right people that hopefully will take over in many levels of leadership to help support the sector grow in the future. So, Brian, thanks for all you're doing and thanks for being on. Really appreciate it.
Brian 29:21
Thanks, Scott.
Scott: 29:22
This is VERSED.
