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>> I'm Frederica Freyberg.
Tonight on "Here and Now," in our first look segment,
we examine the policy and politics
of the U.S. Senate health care bill.
Senator Ron Johnson is here.
After that a closer look at a man who visits the Wisconsin
juvenile corrections facility every week,
trying to impart a positive message.
Later, the latest approval ratings in Wisconsin
for President Trump and Governor Walker.
It's "Here and Now" for June 30.
>> Funding for "Here and Now" is provided, in part,
by Friends of Wisconsin Public Television.
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>> Wisconsin Republican Senator Ron Johnson put the brakes
on a vote this week on his chamber's version
of the Obamacare repeal and replace bill.
He said it was because he needed more time to study it.
The ardent opponent of the Affordable Care Act also has
said he doesn't think the Senate bill goes far enough.
Senator Ron Johnson joins us tonight.
Thanks very much for being here.
>> Hello Frederica. How are you doing? >> Good.
I wanted to ask you right out of the chutes your position
on repealing the ACA now and replacing it sometime later.
>> Let me first explain.
I don't think I've ever said it doesn't go far enough.
It doesn't fix the problem.
I certainly thought a week after a discussion draft was presented
to the public and also to CBO, it was way too soon
to really take a vote on it.
So I wanted the extra time.
We had intense discussions.
I think there will be improvements made to the bill.
Nothing will be perfect, but the architecture of Obamacare
particularly in the individual markets just has failed.
Premiums on a national average have increased 105%.
They've doubled.
Some places tripled as well.
We've got to fix the problem.
>> As to this question about your position on repealing the
ACA and then replacing it later.
>> Well, I'd rather do it at the same time.
Now, I think what's abundantly clear,
we don't have the votes for total repeal.
I would like to do that because I think it's a whole lot easier
to replace with something that would actually work.
But for quite some time, after the election,
it was pretty obvious that we probably didn't have the votes
for full repeal.
So that's one of the reasons I started talking about let's
focus on repairing the damage done and that's primarily in the
individual markets.
And then it'd be nice if we could work in a bipartisan
fashion, transition to a system that actually works.
From my standpoint, having participated in a free market
system, is bring in more consumer-driven free market
competition to restrain prices, improve quality and customer
service.
>> So altogether what's it going to take for you to vote yes
on a Senate health bill?
>> First of all, I never said I was no on any bill.
>> Right.
>> I just said no. We can't vote on it this week.
It has to be an improvement.
I guess that's my manufacturing background.
I do not expect perfection.
This is such a mess.
It is so complex.
We're not going to come close to perfection.
But I will evaluate anything I am going to have to vote on
in the end.
Is it going to put us in a better place tomorrow
than we are today?
I have to admit that's a pretty low bar.
But I think going in so many of us have said
we don't want to pull the rug out from anyone.
I don't think we are.
I want to make sure we're focusing on premiums.
The gross price of premiums, because if we can bring those
down, recognizing what caused premiums to artificially
increase, we can solve so many problems.
That's really been my primary focus.
>> A lot of people are focusing on Medicaid.
Do you think the measure should reduce available federal funding
for Medicaid by more than 25% in out years?
>> First of all, what we're focusing on is eliminating
the additional expansion of Medicaid expansion,
which Wisconsin is not participating in.
>> Right.
>> In 2008, we spent about $200 billion on Medicaid.
Last year, nine years later, we spent $400 billion.
So it's not exactly like Medicaid has been starved.
What I'd like to do is devolve the management of core Medicaid
back to the states.
I think like Wisconsin, we do a far better job.
What we're trying to do is stop the Medicaid expansion which is
going to threaten the stability of core Medicaid.
When everybody is talking about how much we're cutting Medicaid,
what we are doing is we are putting Medicaid expansion on a
glide path so we can focus on core Medicaid so people with
disabilities, young, elderly, those core beneficiaries of
Medicaid, that those populations are protected.
>> A lot of people want to know how do you protect states like
Wisconsin from being hurt because they did reject
the Medicaid expansion?
>> Well, that's one of the things I've been fighting for,
is there's a disparity.
There's always been a disparity.
Some states get more federal funding than Wisconsin.
And what's really unfair about it is responsible states,
states that have high-quality health care at a relatively
affordable cost, we get penalized in the doling out of
federal funds.
One of the reasons I think devolving the administration of
Medicaid back down to states would be in the end, fair.
But I don't want to lock into a system right now that is unfair.
It's not going to be completely fair,
but that's one of the things I'm really fighting for.
>> Do you think any bill should include protections
for pre-existing conditions? >> Absolutely.
But the architecture of Obamacare puts those
protections, the burden, the cost burden of that,
on a very small slice of the American public.
That's why premiums have doubled,
in some cases tripled on the individual market.
What we need to do is separate that population out.
Those with high-cost and pre-existing conditions
and we need to subsidize those.
We can do that, keep premiums at a reasonable level,
an affordable level without penalizing the people
Bill Clinton talked about.
Those folks out there busting it, working 60 hours a week.
They make enough money
they don't qualify for any government assistance.
They've literally been priced out of the insurance market,
which is why I'll come back to, I want to focus on bringing down
the gross price of premiums.
It solves so many problems. But no.
I think our country has decided we want to protect people with
pre-existing conditions.
We can do it in a manner that doesn't collapse these
individual markets and doesn't unfairly put the cost burden on
a very small slice of the American population.
>> How do you do it?
>> Through things like, for example,
Maine passed guaranteed issue.
That's what this insurance policy is called to protect
people with pre-existing conditions, guaranteed issue.
You guarantee that anybody can buy insurance at just about any
point in time.
That collapses insurance markets.
The analogy literally is, who would buy auto insurance,
collision insurance, if you didn't have to buy until after
you crashed your car?
That would crash the insurance market?
The same thing happens in health care.
When Maine passed guaranteed issue,
their premiums skyrocketed.
So without even repealing guarantee issue,
they supplanted it with something called
an invisible high-risk pool.
A little bit different operation
than what Wisconsin's high-risk pool.
Wisconsin's high-risk pool isn't perfect,
but it worked pretty well.
So we should take a look at those best practices example.
That's the path toward guaranteeing people coverage
with pre-existing conditions without collapsing markets and
without causing premiums to skyrocket.
>> You've said this week that you could support maintaining
some of the tax increases in Obamacare? Which ones?
>> Well, first of all, again, we're not repealing Obamacare.
We're keeping an awful lot of the architecture and certainly a
lot of the benefits.
Again, 20 million Americans got health care.
We don't want to take that away from them.
So when you're going to be basically carrying on about $443
billion of Obamacare subsidies forward,
that's in the current Senate bill.
I think we ought to maintain whatever revenue flow
to fund those benefits.
I'm very concerned about the fact we're $20 trillion in debt.
Over the next 30 years, according to CBO and we've
turned these into dollars, $129 trillion of additional deficits.
I'm concerned about that.
So if we're going to offer government programs,
we ought to be able to pay for it.
The first one under discussion is the investment tax.
That has nothing to do with premiums,
has nothing to do with cost of health care.
That would probably be the first one not to repeal
or basically to retain.
>> We need it leave it there. Senator Ron Johnson, thanks very much.
>> Thank you.
>> For her part, Wisconsin Democratic U.S. Senator
Tammy Baldwin had this to say about the Senate plan.
The people of Wisconsin did not send me to Washington to take
people's health care away.
We should be working together to make things better, not worse.
And the CBO makes clear that the Senate repeal plan will leave
millions of families behind.
Health care systems and physician groups in Wisconsin
have been vocal about their concerns over possible negative
impact of the Senate health care bill.
Concerns for both providers and for patients.
For more perspective on the Senate health care bill we turn
to Bobby Peterson, executive director of ABC for Health,
a public interest law firm that helps connect Wisconsin families
to health care coverage plans.
Thanks for being here. >> Great to be here.
>> Right now, out of Washington there is this discussion of just
repealing the ACA and not replacing it.
What's your reaction to that?
>> Short-term, maybe it's a win,
but it's a loss for the people, I think.
We don't get to a situation where we actually
make things better.
Just repealing the Affordable Care Act doesn't get us
to the right place.
>> On the Senate bill, there are many constituencies,
as you know, sounding the alarm over the proposed reduction
in Medicaid funding.
Who in your mind would this hit the hardest?
>> Well, there's 1.2 million people in Wisconsin
on some form of Medicaid.
It affects a lot of people.
A lot of family, friends and relatives.
So seniors in long-term care, children with disabilities,
young children that need health care coverage,
low-income adults, people with disabilities.
So it has a broad impact.
And I think that's why there's been such vocal opposition.
These Medicaid changes are significant and alarming
for a lot of folks.
>> Now is Wisconsin hurt more than states that expanded
Medicaid because it would be capped to what was spent
in 2016? >> Sadly, yes.
I think that's one of the bad outcomes of the bill because
Wisconsin is penalized.
A lot of us thought Wisconsin should expand Medicaid
and we've lost a lot of money.
We've left a lot of federal money on the table that we could
be using, replacing GPR funds.
We could fix a lot of roads and improve K-12 education
with those funds.
But it's going to be a significant amount.
Missouri Hospital Association came out with a report that said
over the next, till 2026 it's over $30 billion
that Wisconsin loses out on.
>> And yet here we sit and having perhaps the governor was
right when he said, "Well, I don't want to expand Medicaid
because I'm afraid the feds won't be good for that money"
and kind of here we are.
>> Right.
But you always -- the feds -- we take $12 billion a year in
federal money.
So what category of federal money are we going to say
they're good for and they're not good for?
So that argument didn't carry a lot of weight with me because
we're heavily dependent on federal money in the state of
Wisconsin for a variety of things, our roads,
our education system.
So it was a bad decision and I think most people agree with
that.
>> What are you hearing from clients that you help with
health care coverage about all of this?
>> Well, the volatility, the dynamic of what's going to
happen.
Am I going to lose pre-existing condition coverages that I've
had.
Are we going to go back to high-risk pools where I feel
like I'm in health care segregation?
Those are some real concerns people have.
Are they going to cap Medicaid?
Is it going to lead to health care rationing?
Which you have a sum sufficient of money, and it ends,
that could be an outcome.
>> Do you feel as though the policymakers in Washington are
hearing all of these concerns?
>> I think they will over the break.
I think they need to get out of Washington to get back and
talk to their constituents and realize I think for a long time
Medicaid has just been considered a welfare program
for poor people, but it has a much broader impact.
It has expanded its spread at some point.
It's a fundamental core of our society
and cares for a lot of people.
>> Isn't that one of the issues, though,
that it's just expanded so much and it's so expensive?
>> Well, it's expensive, but in some ways it can be more
efficient than some of the other programs out there.
It depends on how it's operated.
But Wisconsin runs a very efficient Medicaid program in
many respects.
We have public/private partnerships with Badgercare
that extend coverage through managed care organizations,
that provide Badgercare plus commercial coverage.
I think there's some innovations in Wisconsin that are worth
looking at that make the program run more efficiently.
>> So let's take a look at a potential Medicaid recipient.
You choose whom that might be. What are they looking at?
I mean, they're not looking at
immediately losing their coverage.
>> No, and I think it's time to speak up
and say how important your coverage is.
But I think the people we represent.
And we've been representing people on Medicaid for the last
23 years.
Navigating systems, difficult coverage situations,
people with pre-existing conditions,
the fear is that they're going to lose important coverage or
services that they have that have helped them stay in their
community, stay in their home, work, transition into jobs.
So those are things that people are very concerned about that
we're hearing from.
>> Now, framers of repeal and replace talk about Wisconsin
going back to its high-risk kind of insurance plans
and you mentioned that it was called HIRSP.
What's your reaction to putting people with pre-existing
conditions into that high-risk plan?
>> Yeah.
It's going backwards.
In Wisconsin we like to move forward.
This is not the right direction.
We're segregating people with pre-existing conditions.
It's difficult to manage in some ways because self-funded plans
don't have to pay into the pool.
It's a small group of insurance companies,
as it was set up previously, that help support the pool.
And premiums were very high for people.
You had a six-month waiting period to get into it,
so people end up dying before they become eligible for
coverage.
It's an anachronism of the past.
I think most people have moved on from that to say we're going
to find a better way to cover people with pre-existing
conditions than to segregate them.
>> We need to leave it there.
Bobby Peterson, thanks very much.
>> Thank you.
>> In tonight's closer look, a federal judge in Madison has
ordered changes in use of solitary confinement and pepper
spray at Wisconsin's juvenile prison.
The ruling came last week as the result of one of the lawsuits
filed on behalf of inmates at Lincoln Hills
and Copper Lakes School.
Even as a federal investigation into the operation of the
institution continues, one Madison man takes his skills
both professional and personal on the road each week,
traveling more than five hours round trip to the institution in
northern Wisconsin.
>> As dawn breaks,
Lamar Skinner packs up for the long trip north.
Every week, Skinner takes his skills on the road to Irma.
He's been hired as a barber at the Lincoln Hills Copper Lake
School, Wisconsin's juvenile detention center.
>> There's a guy that's been working there
for about 30 years.
He's like, "Man, I'm glad you're here.
I'm glad you're here.
They just didn't understand.
You gotta have an African-American
to cut these African-American kids' hair."
>> Skinner came to take the job
after one of his regulars saw a need.
>> Who comes in?
Well, we got Everett Mitchell.
We got Reverend Larry right here, Jackson in the chair.
>> It was Dane County Judge Everett Mitchell who thought of
his own barber back in Madison.
>> Well, he just took a visit and he saw some kids that needed
some haircuts.
>> Skinner's adult clientele reads like a who's who
of community leaders.
>> We build during these times.
We joke a little bit.
That's what it's about for me.
It's always good to have an elder around.
I can pick Larry's brain all day.
>> Those elders approve of their barber's work at the youth
prison.
>> By Lamar being there as an African-American,
just his presence will encourage a lot of them.
Just by him being African-American in there
doing something positive.
>> Just like he said, I'm just living proof that you can
actually achieve something without being negative about it.
>> For his part, Skinner says 30 haircuts a day is hard work.
It's emotionally draining, too.
>> They're far away from home.
Far away from everything they know and love.
So I know it's bittersweet,
I guess is the best way to describe it.
You got young people, some of them are facing a lot of time.
And some of them are going to get a chance to go home.
>> Skinner says he tries to be a role model as a businessman,
a parent for the young people sitting in his chair inside the
facility.
>> I just try to put a little positivity in there,
shed a little light on something that they could be doing,
maybe get them to think in a different way.
It's about all I can do.
I'm pretty much there for the haircut,
but if I can insert little bits and pieces of things they can
use, I do that.
>> As Skinner plies his trade with a different clientele week
by week, haircut by haircut, he hopes he's making a difference
in some young lives.
He says there is a connection: respect.
>> When I'm there, they sweep up the hair.
They thank me.
They shake my hand.
They're polite.
You know, just regular kids.
They got in some trouble.
I didn't know I was going to like it that much until I got
into it.
Just seeing the kids smile, you know.
That's good enough for me.
>> Still, on the long road trip back to Madison and his Park
street barbershop, Skinner reflects on his own fortunes
compared to those he leaves behind the gates.
>> It can get sad, not for me, because I get to go home,
you know.
I get to go home.
So for them, I can kind of see, you know,
where they can have some days where it's frustrating and it's
not, you know, it's not the place they want to be.
>> The federal judge in Madison gave parties in the Lincoln
Hills lawsuit until July 7 to come up with a plan reducing the
use of solitary confinement and pepper spray at the juvenile
correctional facility.
A new Marquette Law School poll out this week shows what
Wisconsin thinks of Donald Trump,
health care law changes and Scott Walker and Tammy Baldwin.
We get right to it now with the director of the poll,
Charles Franklin.
Thanks for being here.
>> Thank you.
Good to be here.
>> So on President Donald Trump the first look we're going to
take, 51% of your respondents disapprove of what he's been
doing, 41% approve, 7% don't know.
Is he slipping or rising?
>> His approval is exactly the same at 41 that it was three
months ago in March.
But the disapproval has risen four points from 47% to 51% and
we still have a few more don't knows than most national polling
is showing.
We've seen that in the national data as well,
that the disapprove has moved up faster than approval has come
down, as those initial undecided have begun to make up their
mind.
>> Now, the partisan divide is as strong as ever though,
comparing who likes his work to who doesn't.
How is that expressed in your polling?
>> It's at least as strong as ever.
85% of Republicans approve of the job he's doing.
For context, that's about where Democrats were about President
Obama at relatively high levels.
So party loyalty.
But what's really jaw-dropping is on the Democratic side,
only 3% of Democrats approve and 95% disapprove.
That is worse for Democrats and Trump than it was for
Republicans and Obama, where Republicans consistently gave
Obama about a nine or ten-point approval rating.
>> Also where in Wisconsin is Donald Trump's approval rating
the highest?
>> He's especially strong in the Green Bay and Appleton area.
That media market that contains
the Green Bay and surrounding area.
He's over 50% approval there.
The only area of the state that he's solidly over 50%.
But in the north and the west, Wausau and over to the
Mississippi River and down a bit,
he's net positive in his evaluations.
So those are areas that in most counties he did especially well
in the vote.
And I think tellingly in the Milwaukee suburbs,
he's just slightly underwater.
A little more disapproval than approval.
In those suburbs Donald Trump won the area in November,
but he did not do as well as Mitt Romney did.
It looks like those suburbs have still some reservations.
>> I want to jump ahead to the health care law and what people
think of that in your survey.
On the changing tides of the federal health care law,
your survey shows 54% want to keep it and improve it,
but 6% -- 6% want to keep it as is, 27% repeal and replace,
7% repeal and not replace.
Tell me what you make of these numbers.
>> Well, the two ends are about the same,
keep it as it is or throw the whole thing out.
But if you look in that middle, twice as many would keep and
improve as opposed to the 27% that would repeal and replace.
That really raises a question of what kind of changes to the law
are really repealing and replacing and what changes to
the law are really just incremental changes and
improvements.
Clearly the public is very concerned, though,
about dumping the law altogether.
We asked and people thought fewer people would be covered
and it would cost more for a replacement.
So people are skittish about a replacement.
>> So it makes it pretty difficult for the Republicans in
Washington who are moving ahead on this.
>> It does.
But Republicans in the state are quite in favor of either repeal
and replace or outright repeal.
So the Republican base still favors something like repeal.
>> I got to buzz right through these now with our time
constraints.
On Scott Walker, it's the perfect partisan divide.
Governor Walker comes in with an even 48% approval,
48 disapproval.
How has this changed?
>> He's been creeping up since January of 2015 when his
approval rating really crashed into the 30s and stayed there
for most of that time.
He has steadily edged up over the last year or so and this is
his best showing since the week before he was re-elected.
>> On Tammy Baldwin, your numbers show that she also gets
an even split, favorable to unfavorable.
That's a slip from your last poll.
>> It's a small slip.
It's just a couple of points on each side.
But it's-- as we see with her and, for that matter,
with Senator Johnson and Paul Ryan,
fairly even distributions of opinion that haven't trended
sharply up or down.
Unlike the governor's approval rating,
which has been trending up so steadily for the last year.
>> Finally, on the state budget with the Republican majority
at a seeming kind of impasse over it,
you surveyed respondents about their state budget spending
priorities.
37% on K-12 schools, 25% health coverage and 23% roads.
Interestingly to me, you also found that 61% would be willing
to pay higher taxes on these priority items
while 35% would not.
>> And these items are the most important out of six items that
we gave them as options.
But interestingly for those on K-12 education,
the top priority, 75% said they were willing to pay more.
When we drop down to health care it's in the 50s.
When we drop down to roads, it's actually a 48% would pay,
51% would not pay more,
even though those are people that picked roads
as their top priority.
So the same struggles the legislature and the governor are
having between paying for something but wanting it,
is also reflected in public opinion on this.
>> Interesting.
Charles Franklin, thanks very much for your work.
>> Thank you.
>> Now for an update from the state capitol.
On Wednesday, hundreds of immigrant supporters from around
the state protested in Madison over a proposed bill that would
have local law enforcement act like immigration agents.
Under the Republican measure, municipalities could face some
loss of shared revenue payments for failing to comply.
Protestors fear this will lead to immigrants being harassed and
deported as well as being too afraid to report crimes to
police.
In Washington, the House voted Thursday to crack down on
so-called sanctuary cities by withholding federal funds.
House Speaker Paul Ryan.
>> By flagrantly disregarding the rule of law,
sanctuary cities are putting lives at risk and we cannot
tolerate that.
Every day Secretary Kelly leads professionals around the country
and around the world quite frankly,
who are charged with keeping our homeland safe.
They make incredible sacrifices.
Our job here is to make sure that those professionals have
the tools that they need and resources they need to carry out
their work and to protect our communities.
>> That was Speaker Ryan on Thursday.
That is all for tonight's program.
I'm Frederica Freyberg.
Have a great weekend.
>> Funding for "Here and Now" is provided, in part,
by Friends of Wisconsin Public Television.