Sen. Cassidy Has a Plan to Lower Healthcare Costs. Can It Work?

WALTER ISAACSON: Thank you, Christiane. And Senator Bill Cassidy, welcome back to the show.

 

SEN. BILL CASSIDY: Hey, very nice to be with you. Thank you for having me. Walter.

 

ISAACSON: You know, before you were a senator, before you got into public life, you were a doctor. And one of the things you did as a doctor is you had a career in public hospitals where you were serving patients who were uninsured and were poor. Tell me what drew you to that.

 

CASSIDY: Yeah, so I did my residency and fellowship at Los Angeles County Hospital. I think at the time, the largest hospital in the United States. And, I really enjoyed the patient population. I enjoyed teaching, and I also enjoyed being involved with the research thing. So I came back to Louisiana with my wife. She was at the time a trauma — practicing trauma surgery. We both started with LSU. And I worked in the public hospital in Baton Rouge — again, taking care of the uninsured and the poorly insured, teaching medical students and doing clinical research. Incredibly rewarding career, which I’m very thankful for the state of Louisiana for giving me the opportunity to do.

 

ISAACSON: And when you talk about the uninsured, you know, we’re having this big issue now. How does that inform the fact that you want to make sure that there are extensions of some sort for healthcare benefits that we’re facing that vote on soon?

 

CASSIDY: So my life has been dedicated to making sure that all Americans have access to adequate healthcare. Now, by the way, that sometimes puts me at odds with people who think just because you make insurance cheaper, it actually works for the patient. My experience as a physician is that if somebody has a $6,000 deductible, it can be as if they do not have insurance at all. The premium may be cheaper if they get in a car wreck, they’re protected from financial ruin. But they don’t have $5,000 in their account to pay for healthcare. So my whole approach to healthcare has been very much informed by those patients whom I saw a long ago and who would tell me, Doc, I can’t afford that. I got a deductible, my insurance won’t cover it. How do we make it work for them? That’s a critical question.

 

ISAACSON: And so tell me what your plan — that you’re trying to get both Democrats and Republicans as a compromise plan — how that would put money to help people pay their deductibles. And a lot of people, including the Kaiser Family Foundation, say it could actually hurt poor people.

 

CASSIDY: Yeah, so Kaiser Family Foundation is not familiar with the details of my plan — I just know that from their comments. And let’s put this in context. We’re speaking about the patients or the people — our fellow Americans — who are on the Obamacare exchanges. And it’s about 6% of the population. There has been a rapid increase in the cost of healthcare — and of healthcare premiums, health insurance premiums — rapid increase. So the original Obamacare had an advanced premium tax credit, which helped everybody below 400% of federal poverty. Costs were exploding so much, under the Biden administration, they added something called the enhanced premium tax credit, benefiting those over 400% of federal poverty. So that’s the context. And I’m sorry for the technical detail. By the way, Kaiser Family Foundation thought I was speaking of both the advanced premium, the baseline premium, tax credits and the enhanced. I am not, I’m only speaking about the enhanced premium tax credits.

What if we did this? Instead of giving that money, 100% of it, to insurance companies — who take 20% of whatever we give them as overhead in profit — 20% of the $26 billion we would spend next year given to insurance companies. 20% of that is used for overhead and profit. What instead if we said, Okay, we’re gonna take that same money. We’re gonna make sure that no one spends more than — pick a number, eight and a half, nine point half percent of their income — on health insurance premiums. That only affects a certain — older people, basically, fifties and their sixties, it only affects them – but we’re gonna instead give a hundred percent of that money to the patient in the form of a health savings account. The patient would then choose a lower bronze premium as a cheaper policy. So they’re spending less on premiums than they would under the typical Obamacare policy. But they’re also getting money into a health savings account for first dollar coverage of their deductible. Their deductible on net could be lower than the policy they’re currently getting. And not only that, they have first dollar coverage. 

What does that mean? Practically, my daughter sprained her ankle. I bring her to an urgent care center. Instead of a $5,000 deductible, and I have to spend $5,000 before my insurance pays, they have $2,000 in their health savings account and they pay for the visit out of that $2,000, not out of their pocket. That’s a sweet spot. Cheaper premiums, lower deductibles and first dollar coverage. That’s the plan I am proposing, Walter.

 

ISAACSON: And it takes all of the money that was in the enhanced benefits in Obamacare. And so it just transfers it this way so that they’re in health savings accounts, right?

 

CASSIDY: Yeah, basically. There’s some other things you can do with it. One thought I’ve had is what if we set up a reinsurance fund for maternity? What can sometimes happen if a young couple has a health savings account with a couple thousand dollars and a deductible, a net deductible, $5,000. And the woman has a problem pregnancy. They use all their HSA, they blow through their deductible and they end up being so expensive, it can increase the rates for everybody. If we did a reinsurance for that. It’s pro-family. It’s pro mama. It’s pro everybody. Because not only is she cared for financially as well as physically, but it also keeps premiums down for everybody. So you may take a portion and set up a program like that.

 

ISAACSON: It seems if it spends about as much money, you would have trouble getting your fellow Republicans on board. Are they in the Senate — and with your colleague from Louisiana, Mike Johnson, in the House — supportive of this continued spending?

 

CASSIDY: Two things. First, you could actually save some money. <Laugh> Did I mention, instead of giving 100% to insurance companies who take 20% for profit and overhead, you would take a hundred percent and put over here? But you’re still saving 20%. There’s still opportunity to make it less expensive for the taxpayer, number one. Number two, this fits exactly where President Trump is. Exactly where. He has said — I’m like quoting — Don’t give money to the money-sucking, blood-sucking insurance companies. Give it to the patient. Mike Johnson, I think, would be sensitive to what the president was interested in. If we can come up with a policy that works for Republicans, works for Democrats, President Trump embraces, I think we get a vote in the House of Representatives.

 

ISAACSON: Have you talked to the White House on this?

 

CASSIDY: Yes. We have spoken to the White House. I sent them some of my ideas. They’ve incorporated some of them, not all of them. But I can continue to speak with Republicans and Democrats in both the Senate and the House.

 

How many Democrats have you spoken to and how many do you think might come along with you on this? If there’s a force — if, if there’s a vote?

 

CASSIDY: Probably four or five. I lose a little bit of track. Have got meetings set up. And of course I’m speaking today we’re recording this, but later today I will be speaking to all of my Republican senators. I’ll be speaking later this week to some Democratic and Republican House members. You continue to work it — which is, by the way — thank you for having me on ’cause I need the American people to know this is not a Republican plan. It’s not a Democratic plan. It’s an American plan. It gives profit, it gives power to the patient, not profit to the insurance company.

 

ISAACSON: If this doesn’t come to pass, there’s gonna be an up or down vote that Senator John Thune said he would have in the Senate on extending the Obamacare and Biden enhanced subsidies. If your plan doesn’t go through, would you vote for that?

 

CASSIDY: No. Why? It still leaves the patient with a $6,000 deductible. It is more about profit for the insurance company than is about, than is about power to the patient. The ability to give the patient the ability to afford the healthcare that they need as opposed to if I get in a car wreck — that’s important. But what about your daughter’s sprained ankle? And so I’m working so that we don’t have an up and down vote on a Democratic plan and an up and down vote on a Republican plan and both fail. Rather that we have an American plan that we can all vote for and pass and turn into law. 

By the way, you probably won’t — you rarely lose money betting against the ability of Congress to get something done. But this is so important. I’m hoping that people can put aside their kind of, I’m not gonna work with President Trump because it’s President Trump or whatever. And say, Wait a second, this fits the need. It balances lower premiums, first dollar coverage, lower deductibles. This is the way we should go irrespective of who actually is proposing the plan.

 

ISAACSON: What would happen to our state in Louisiana- — people there — if none of this passes and the extension doesn’t pass?

 

CASSIDY: Yeah, so there’s gonna be a subset of people in Louisiana, but across the nation, who don’t do as well. And that’s why I’m so committed to actually making it work. By the way, I’ll point out once more, my experience practicing in Louisiana — but I could say in California ’cause I did long ago — is that when you give somebody who has a deductible of $6,000, that policy doesn’t really work for them. Most people don’t have $6,000 in their back pocket to pay for that deductible. So if we can give ’em a policy which lowers the premium, lowers then that deductible, and gives them first dollar coverage to pay for that sprained ankle that their child has — that does work for them. And I say again, that is an American plan, giving power to the patient, not profit to the insurance company.

 

ISAACSON: When you were here in Louisiana and practicing, you ended up developing a public-private partnership to vaccinate, I think it was 36,000 Baton Rouge area children against Hepatitis B, no cost to the parents and all. I think the CDC advisory committee, the Vaccine Advisory Committee, is expected to vote on whether to undo all of that. What would you do if that happens? And how can you make sure that Secretary Robert F. Kennedy Jr doesn’t push that through?

 

CASSIDY: So the real vote will be not on adolescent immunization, but on whether to recommend a birth dose of Hepatitis B. Now, I’m strongly in favor of that. It’s not a mandate. But it is a recommendation to the mother that the child be vaccinated upon birth. Now folks say why? ‘Cause the common criticism is that it’s sexually transmitted. And so why would you give a vaccine to a child for a sexually transmitted disease? Why? Because when the child passes through the birth canal, that child is exposed to the same secretions as if it were intercourse. And if the mother turns out to be Hepatitis B positive, that child, if infected through those secretions, has a 95% chance of becoming chronically or permanently infected with Hepatitis B. Instead, if you give that child a birth dose of Hepatitis B vaccine, not a mandate, a recommendation, then that child has a 95% chance of not becoming chronically Hepatitis B infected.

By the way, since this policy has begun, the number of children who’ve acquired Hepatitis B at either birth or shortly after birth has decreased from $20,000 — 20,000 a year to 200 a year. So how remarkable. All because of a recommendation. And folks say, wait a second we should know what the mother’s Hepatitis B status is. If you do, that’s fine. But turns out sometimes it is just missed. The regular OB is not there. The mama is out of town and goes to a different hospital who doesn’t have access to the records. Or she just shows up and has not had prenatal care. That happens in a country as big as ours. This is a way to, as much as possible, make sure that when that child is born, that that child, if exposed to Hepatitis B, is not chronically infected.

 

ISAACSON: When you voted to confirm Robert F. Kennedy Jr. — rather reluctantly, I think, you were tentative there — you extracted a few promises, including the fact that they would keep a recommendation on the CDC website saying that vaccines do not cause autism. 

 

(ViDEO CLIP)

 

ISAACSON: Well, he’s backtracked on that. What do you think of that and how can you hold him accountable?

 

CASSIDY: As a physician, of course, I know this is wrong. That there has been lots of information out there to show that this is not the case. If you’re suing drug companies, I can see why you want this out there. But if you’re trying to reassure a mother whose child has autism and now may blame herself because her child was vaccinated and you’re blaming yourself, why put that guilt trip on a mom when that has nothing to do with it? By the way, it also distracts attention from going after real causes, which appears to be a complex mixture of a child’s genetic predisposition, the age of the parents, environmental stressors — all that as a kind of complex mixture. That’s where we should be focused on. To distract on the falsity, the falsehood, that immunizations have a role or even to imply is a terrible injustice. 

That said, the only parents I know who read CDC websites on immunizations are probably pediatricians who happen to also be moms. So it’s not commonly read. I strongly encourage mamas and daddies to talk to the child’s pediatrician — to have somebody who’s learned, who’s gone to medical school, reviewed the information — to actually review it with you. So that you can be reassured that the benefits of preventing diseases by having your child vaccinated are fanta — are incredible. And the risk of autism is absolutely nothing.

 

ISAACSON: Well wait, if it’s on the CDC website, that does have an impact, doesn’t it?

 

CASSIDY: I’m not denying that. I’m not denying that <crosstalk>

 

ISAACSON: And didn’t you make sure that they weren’t gonna do that? Have you talked to Secretary Kennedy? 

 

CASSIDY: We have spoken — 

 

ISAACSON: <crosstalk> gone back on that promise?

 

CASSIDY: We’ve spoken in a very strenuous conversation. I’ll leave it at that. And now, now they’re telling me I have to go to my next function. And I don’t mean, but I just have to go. Yeah.

 

ISAACSON: All right. Let me ask you one more general question, which you may wanna answer. You’ve been able to reach across the aisle — Senator Bernie Sanders at one point, Senator Tim Kane at another — about things including on vaccines. Do you think it’s possible to restore that ability to work across aisles on, especially on the healthcare coverage issue?

 

CASSIDY: Yes. I wouldn’t work at this if I didn’t think it was possible, because this will not pass unless it has both Republicans and Democrats voting for it. And when I ask people, put aside your prejudice, don’t be a Democrat. Don’t be a Republican. Be first an American. Think about that couple — who cares what their political party is who is actually struggling to make their ends meet? And they need to have that health insurance. They need to have that healthcare. They don’t, they can’t handle a $6,000 deductible. If we can do better for that family with the same amount of money or less, why don’t we do it? And I say that probably more as a doctor, certainly more as an American than anything else. And that’s, I think, the approach that we should all take: Americans first.

 

ISAACSON: Senator Bill Cassidy, thank you so much for joining us.

CASSIDY: Thank you, Walter.