0:00

You know, ours is a state rich in

0:02

compassion. And time and

0:04

time again, over the past

0:06

200 years, our people have

0:08

risen to stand shoulder to

0:10

shoulder to demand that better

0:13

world, to demand that this

0:15

freedom, which is rightfully ours,

0:17

is returned to us. The

0:19

danger is imminent. And for

0:21

many of us, it is

0:23

already present. And I tell

0:26

you that through this solidarity,

0:28

and only through this solidarity,

0:30

a better world is possible.

0:33

Hey everybody, it's Josh back

0:35

with you for another interview.

0:37

This week I sat down with Tim

0:40

Faust who is a health care activist.

0:42

He's been advocating for the preservation and

0:44

expansion of federal and state health care

0:46

programs in the United States for years.

0:48

And recently he began touring the state

0:51

of Wisconsin talking with local groups about

0:53

what they can do to fight to

0:55

preserve access to Medicaid benefits in their

0:57

communities. So we talked about how and

0:59

why the federal government has been slashing

1:02

access to Medicaid, what effects these cuts

1:04

may have, and what people, including you,

1:06

including you. can do to fight back.

1:08

I hope you enjoy. This week I

1:10

wanted to talk with somebody about the

1:13

importance and value of rhetoric, the way

1:15

that you can Use speech to get

1:17

people to better understand what is going

1:20

on, and also listen to help understand

1:22

how people are thinking about something. And

1:24

so this week I wanted to get

1:27

somebody on the show who is very

1:29

good at both of those things. And

1:31

so I'm happy today to be talking

1:34

with a friend of mine. We've known

1:36

each other for quite a while now,

1:38

and he's been involved for quite a

1:40

while in advocacy. for health and health

1:42

care policy. He is the health care

1:44

director at Citizen Action of Wisconsin, and

1:46

his job is basically going around and

1:48

talking to people about health care. Welcome,

1:50

Tim Faust. Good to see you, man.

1:52

Good to see you, too. So just

1:54

to get started, I'd love to hear

1:56

a little bit about what you have

1:58

been up too late. because you've been

2:01

traveling around Wisconsin a lot in talking

2:03

with people about health care, specifically Medicaid,

2:05

right? Yep, Medicaid cuts have been, well

2:07

we can talk about how, it's not

2:09

literally in the budget, but Medicaid

2:11

cuts are coming down the tube, and

2:14

that affects one-fifth of Wisconsinites as well

2:16

as one-fifth of Americans directly, you know,

2:18

who are drug Medicaid beneficiaries, as well

2:20

as it's a major economic driver across

2:22

the country, especially in rural areas, and

2:25

I want to get out there and

2:27

talk to people about what's going on.

2:29

I did this something similar for Medicare for All

2:31

from 2017 to 2020, which was great. I

2:33

got to talk to a lot of different

2:35

kinds of people about what health care looks

2:37

like in their part of the country, because

2:40

health care varies so much from place to

2:42

place. And getting out to get to do

2:44

that in a place where I live, partially

2:46

for work and partially extracurricular,

2:48

I think was both important and

2:50

useful to me and to other people. So I

2:53

want to talk in a little bit about

2:55

the way that you have been delivering these

2:57

talks and the message that you are getting

2:59

out there. But before I get there, I

3:02

just want to hear a bit about what

3:04

you've been hearing from people on the ground.

3:06

How are they responding to the federal government

3:08

and its priorities? You've got a couple different

3:11

avenues of response. One is straight up denial.

3:13

Republicans don't want to go on record yet

3:15

and say I'm voting to cut Medicaid because

3:17

they'll get yelled out and they're currently

3:20

getting yelled at a lot and

3:22

generally they don't like it. The

3:24

budget resolution that was passed in

3:26

February doesn't explicitly call for Medicaid

3:28

cuts, but it does set a

3:30

cut size for the Energy and

3:32

Commerce Committee, which oversees Medicaid, which

3:34

is impossible to attain without at

3:36

least $600 billion in Medicaid cuts,

3:39

assuming they cut literally every other

3:41

program that committee oversees. So we're

3:43

looking at, you know, in the

3:45

neighborhood of $600 billion to $880

3:47

billion worth of Medicaid cuts over

3:49

a period of 10 years. which is a 10%

3:51

cut to the Medicaid program. And so you've got

3:53

a bunch of folks who are saying, no, they're

3:55

not going to cut Medicaid, they're not going to

3:58

cut Medicaid, they're not going to get delusional. Right

4:00

wing stuff and you know there's a there's

4:02

a certain firewall there some people it's

4:04

really hard to reach and I'm not

4:06

saying I'm the conservative whisper you know

4:09

by no means but it's important to

4:11

explain what's on the table so people

4:13

can talk about it with their neighbors

4:16

more articulately so I'm hearing people kind

4:18

of be uncertain about what's going on

4:20

which is totally reasonable a lot of

4:22

things are abstracted and kind of put

4:24

into the nerd domain but also a

4:26

lot of folks are Scared, obviously, you

4:29

know, we're living through the decline

4:31

of empire, at least for now,

4:33

and things are just kind of getting

4:35

shittier over time, and it's probably going

4:37

to be the case for the rest

4:39

of our lives, but this is a

4:42

way that's like very concrete,

4:44

very material and hugely

4:46

impactful to a large number of

4:48

people. This is a, not universal,

4:50

but extremely broad issue. So

4:52

you mentioned the first reaction is

4:55

yeah, just... straight denial. This

4:57

isn't happening, you know, fingers my ears

4:59

if I ignore it, it's going to

5:01

go away. But I'm assuming too that

5:03

there are a lot of people who

5:05

are seeing the thing for what it

5:07

is and they're being compelled to some

5:09

sort of action, right? Yeah, and they're

5:11

the ones that come out to my

5:13

talks usually, with some exceptions. They want

5:15

to know what's going on and they want

5:17

to know what they can do. My job is

5:19

to go out there and explain, you

5:21

know, you know, with like a 30-minute

5:23

presentation, here's the broader you know structure

5:25

of class war and into which this this

5:28

this cut is happening and then here's what

5:30

you can do to get involved and we

5:32

always host people who are directly affected so

5:34

they can share their stories that's really important

5:37

to hear from your neighbors as well as

5:39

in organizing ask for further calls to

5:41

action. I would love to hear if

5:43

there's any of those stories specifically that

5:45

you've been hearing so far that have

5:47

stuck with you, what those have been,

5:50

what they sound like. I know you've gotten

5:52

many of these over the years, but

5:54

if you could just throw me one

5:56

that could give our listeners a sense

5:58

of what this practically means. on the

6:00

ground concretely four people. I'm actually going

6:02

to give you three if that's okay.

6:05

Cool, go for it. So the first

6:07

one is my own Medicaid story, which

6:09

took place about 15 years ago, right?

6:11

I'm one of the guys that got

6:14

swine flu back in 2009, and

6:16

that was before Medicaid was expanded

6:18

in California where I was living.

6:20

So I was laid up at

6:22

home, I couldn't go to work, I

6:24

think I made $12,000, $800 that year,

6:26

working three jobs, working three jobs.

6:29

I went to a clinic and there's not a

6:31

ton you can do for swine flu, kind of

6:33

like COVID. They give you a couple of things

6:35

to tie you by, but that costs $500. So

6:37

between $500 and medical costs and the

6:40

stuff I wasn't able to pay for, the

6:42

rent that was racking up, went into

6:44

really significant credit card debt because

6:46

I wasn't able to pay my student loans

6:48

for a few months. And that

6:50

credit card debt bankrupted me more or

6:52

less. I wasn't able to get an

6:54

apartment under my own name for like

6:56

eight years following eight years following. And

6:58

I was one of the easy

7:01

ones, you know, that was a,

7:03

I'm able-bodied, I'm generally healthy, and

7:05

I did have a job to

7:07

return to. So that's, you know,

7:09

that's the least damage that was

7:11

possible, and it's still totally fucked

7:13

me up for a very long

7:15

time. And it got me pretty gun

7:17

shy. You know, after that experience,

7:19

I thought, well, okay, I guess

7:21

I just don't go to get

7:23

health care. And a couple years later,

7:25

I woke up... and I had like a

7:28

fever of like a hundred and three point

7:30

four something like that something ridiculously high I

7:32

was straight up delirious and my friend yanks

7:34

me out of bed and drives me to the

7:37

hospital they take my temperature and they whisk me

7:39

off into the you know the emergency room

7:41

or whatever pump me full of fluids and

7:43

chemicals all the good stuff and I'm I stay

7:45

there overnight turns out I had double pneumonia

7:47

you can have two pneumonia at once and

7:49

I had two of them and boy were

7:52

they robust and I was It was life-threatening,

7:54

but it was really close to fucking my

7:56

life like permanently. And when I had out,

7:58

they gave me a bill for $4,000. And

8:00

I break down crying in the hospital,

8:02

you know, again, you know, it's making

8:04

a little bit more money at that

8:06

point in time, but that would have

8:09

like totally ruined my life. I would

8:11

have had to like move, I don't

8:13

know, I guess, like, in with friends

8:15

or my grandparents or whatever, like, I

8:17

don't know, like, in with friends or

8:20

my grandparents or whatever, like, I don't

8:22

know what I would have done, but

8:24

it would have been totally life ruining.

8:26

Medicaid enrollment can be a pretty long

8:28

and arduous process, which I can talk

8:31

about, but this person was able to

8:33

help me get run rolled over the

8:35

course of like a day. And that

8:37

$4,000 bill dropped to zero. And I

8:39

mean, that saved my life, that saved

8:42

my life, and that saved my life

8:44

in some really real ways, right? I

8:46

was able to have the life that

8:48

I that I deserve, was able to

8:50

have dignity in my life and do

8:53

work and do important things that are

8:55

important to me, 30% of my annual

8:57

income in debt. You have a recording

8:59

of, that you sent me, of the

9:01

talk that you gave a couple days

9:04

ago, and that story right there, that's

9:06

the one that you use to get

9:08

people in, because everybody has a story

9:10

like that. If they haven't experienced it

9:12

for themselves personally, they know somebody who

9:15

has. Yeah, absolutely. And it's really important

9:17

talk about that, you know? Especially in

9:19

the rural areas that I visited, there

9:21

are still a stigma around receiving benefits.

9:23

I know that, you know, maybe among

9:26

our milieu, it's there's not a stigma,

9:28

you know, on being on Medicaid, being

9:30

on a welfare, being on a, you

9:32

know, workers comp or whatever, like, there's

9:34

no problem with that. I have no

9:37

problem with that. That's like one of

9:39

the core tenets of a state. But

9:41

a lot of folks have a... I

9:43

feel embarrassed by it. Well, particularly if

9:46

you if your sense of identity is

9:48

tied into the Protestant work ethic or

9:50

whatever. Yeah. Yeah. And so getting folks

9:52

to come forward and say, listen, here's

9:54

all this thing shapes my life is

9:57

really important. You know, we can talk

9:59

about storytelling. It can feel very small

10:01

in a vacuum. And it is very

10:03

small in a vacuum. But these things

10:05

do have. aggregate effects. I swear to

10:08

you, they really do. I mean, I

10:10

was in Wild Rose, population 680 or

10:12

whatever, and a couple of Trump guys

10:14

came out, and they had to watch

10:16

their literal next-door neighbors say, listen, I've

10:19

got $15,000 a year in drug costs,

10:21

without Medicaid, I would die. And having

10:23

to peer their neighbors say that, I

10:25

think is the kind of thing that

10:27

makes a difference. And we see that

10:30

and how people turn out. So that's

10:32

a typical one, right. There's also, you

10:34

know, Medicaid's one of the largest payers

10:36

for disability care in the US. In

10:38

Wisconsin, at least one in three people's

10:41

disabilities are on Medicaid. And a lot

10:43

of that money goes into long-term care,

10:45

either home health or nursing home care.

10:47

And I've got a friend Steve, whose

10:49

story he lets me use all the

10:52

time. Steve is a guy from East

10:54

Rutherford, New Jersey. He's a substitute teacher.

10:56

He's an actor. He's an actor. You

10:58

know, the guy weighs 90 pounds, sopping,

11:00

what? I'm looking back to my bookshelf,

11:03

by the way, because don't you talk

11:05

about Steve in your book Health Justice

11:07

now, also? Yeah. Steve is a friend

11:09

who's relationship. I value it a lot,

11:11

but also he's got a great Medicaid

11:14

story, and it's really illustrative, what's going

11:16

on. Steve, you know, needs help to,

11:18

like, do his daily tasks, clean himself,

11:20

things like that. So he gets a

11:22

lot of money, which doesn't go to

11:25

him. It goes to pay in-home health

11:27

care providers who come to Steve's house

11:29

and help take care of the things

11:31

he needs. And so he hires people

11:33

that he knows. They take care of

11:36

him. And Steve can have a normal

11:38

life. Steve can go to work. Steve

11:40

can act. Steve can go to work.

11:42

Steve can act. Steve can go to

11:44

work. Steve can act. And granted, there

11:47

are problems with Medicaid. If anything, it's

11:49

not generous enough. But without Medicaid, Steve

11:51

would be in his own terms, warehouseed

11:53

in a nursing home, which is just

11:55

a place to go die. And my

11:58

life is made richer for Steve having

12:00

met. Medicaid. His family is made richer.

12:02

Like, you know, he does things that

12:04

the rest of us benefit from. He's

12:06

a teacher, you know, acting in a

12:09

cool show that won a lot of

12:11

awards. Like, Steve is a worthwhile person

12:13

who deserves a worthwhile life. And because

12:15

of Medicaid, he can do that. That's

12:17

a second kind of story. Disability and

12:20

long-term care. That's a pretty common one.

12:22

And then I heard one from a

12:24

person trying to keep the story fairly

12:26

anonymous that I'd never heard before. And

12:28

it was about a man in rural

12:31

Wisconsin. whose kid had been abused. I

12:33

don't know the details and frankly doesn't

12:35

matter, but the kid had undergone some

12:37

severe trauma and acted out age like

12:39

four or whatever. You know, got kicked

12:42

out of school at age six, was

12:44

getting arrested, had a ton of developmental

12:46

and psychological problems. And you know, he

12:48

was no longer allowed to go to

12:50

school. So the dad dropped out and

12:53

became a full-time teacher, full-time caregiver for

12:55

this kid. And Wisconsin's... Katie Beckett program,

12:57

which is our kids Medicaid program, covered

12:59

all the therapy costs, all the rehab

13:01

costs, like a combination of this dad

13:04

being on Medicaid and the expanded Medicaid

13:06

for children, like is keeping this kid,

13:08

is keeping this family afloat. He's bobbing,

13:10

he's bobbing around, you know, he's having,

13:12

I'm sure, you know, those scars last

13:15

for forever, but he's having a relatively

13:17

normal life and the dads able to

13:19

go out there and do the things

13:21

that he wants to do and he

13:23

needs to do, but it, but it's

13:26

Medicaid keeping that entire family structure together.

13:28

You know, we don't even Medicaid is

13:30

an umbrella term for a lot of

13:32

individual programs. Also Medicaid is known by

13:35

different names in different states. I like

13:37

that story a lot because it shows

13:39

just a family situation I'd never imagined

13:41

and how this health care infrastructure keeps

13:43

that family together and keeps the community

13:46

together. And that really moved me hearing

13:48

that story. But you know, there's folks

13:50

all over the spectrum, people who... wake

13:52

up and have spinal injuries that use

13:54

Medicaid for the rest of their life.

13:57

People that fell in hard times, you

13:59

know, I talked to a guy who

14:01

had back pain and... work at his

14:03

construction job and Medicaid's the reason why

14:05

he was able to get the care

14:08

he needed so we can go back

14:10

at it and work again without Medicaid

14:12

what happens. You just fall over and

14:14

die. The purpose of Medicaid is to

14:16

spend money to prevent long-term catastrophe and

14:19

I really appreciated getting to hear about

14:21

it from people across the state. But

14:23

those are the kinds of stories I

14:25

hear. I really, I like hearing them.

14:27

You know, when I watched the video

14:30

that you sent me of that town

14:32

hall that you were part of, it

14:34

wasn't just you. That was the thing

14:36

that I know. There were other speakers

14:38

who came up and everybody had their

14:41

story. This is so, so, so common.

14:43

the way that these stories touch people

14:45

and the way that once people start

14:47

telling their stories, all of a sudden

14:49

they feel less alone, I feel like

14:52

they feel empowered to be able to

14:54

not just connect with each other, but

14:56

advocate for each other. And I'm wondering

14:58

how you see things shift, sort of

15:00

from the beginning of one of these

15:03

sessions to the end. What is it

15:05

that brings people together, makes them feel

15:07

more connected, compels them to action? Well,

15:09

when you have a clear articulation of

15:11

what Medicaid does for somebody or what

15:14

it does for your community, I think

15:16

it's easy to rally around that, right?

15:18

And the point of telling stories isn't

15:20

just to tell stories, right? Like, great,

15:22

we heard a story, let's go home,

15:25

let's applaud whatever. That doesn't do anything

15:27

for anybody. Stories are a tool. Elected

15:29

officials live in a bubble. Part of

15:31

it is self-created, part of the job.

15:33

and it's very easy to not experience

15:36

or not understand the consequences of their

15:38

actions. And granted, there's a lot of

15:40

other forces at play. Don't get me

15:42

wrong. You know, the way that capital

15:44

controls the government is not ignoreable. I

15:47

think it's the fundamental part of this

15:49

entire relationship. But you still got to

15:51

put these stories onto the tip of

15:53

the spear and drive it into that

15:55

bubble. You got to puncture it. You

15:58

got to penetrate it. And so a

16:00

movement that puts these people at the

16:02

front of the line and brings them

16:04

to the off, like one of the

16:06

things we're considering doing is taking over

16:09

one of our elected offices for multiple

16:11

days. Just having a nonstop cavalcade of

16:13

people telling their stories over and over

16:15

and over again to the elected or

16:17

to staff Continually and then you know

16:20

you video it you film it you

16:22

put it out there that does a

16:24

couple of things One is in the

16:26

unlikely event the elected has a change

16:28

of heart. That's the way you do

16:31

it. Two is it demonstrates pent-up demand

16:33

it demonstrates the threat of There are

16:35

consequences to your vote both in the

16:37

literal human sense and also in the

16:39

electoral sense and lastly you build a

16:42

movement around it right I hate casting

16:44

all my hopes to electoral politics for

16:46

a lot of reasons. But it is

16:48

important to build that kind of force.

16:50

It isn't important to build that kind

16:53

of power. And building it around people

16:55

like this, bringing them to the front

16:57

of the line, sharing those stories, building

16:59

a coalition, this is a core part

17:01

of it. It's a thing that keeps

17:04

people motivated and keeps them coming back.

17:06

And so... integrating that fully into the

17:08

force I think is important and you

17:10

know it's that it's not gonna it's

17:12

there's so much more to building power

17:15

than just these kinds of things but

17:17

they are a critical part you got

17:19

to do them that that's something that

17:21

is interesting to me as somebody who

17:23

has a background in storytelling right and

17:26

this is something that we have in

17:28

common you did a lot of like

17:30

backyard wrestling stuff for a really long

17:32

time and so it was about putting

17:35

on a show capturing narratives and engaging

17:37

people but there is a distance of

17:39

course between simply being able to engage

17:41

people and taking that engagement and using

17:43

it to compel people to meaningful action

17:46

and this is something that I've noticed

17:48

a lot in I don't know call

17:50

it the the liberal bubble of theater

17:52

right where it's like oh if we

17:54

just all stand up and we say

17:57

that's enough, then surely this will stop

17:59

it. And so I'm so interested in

18:01

the way that you bridge that gap.

18:03

And I think you are doing it

18:05

in a meaningful way. I think that,

18:08

you know, getting people to tell their

18:10

stories is one thing, but then finding

18:12

the connective piece to have that story

18:14

be something that reaches other people, that

18:16

compels them to do something. You know,

18:19

how do you make that link? The

18:21

purely operational nuts and bolts part of

18:23

it. You know, we have a series

18:25

of forms floating around these town halls.

18:27

When people feel compelled by the story,

18:30

they can sign up. We bring them

18:32

into a team that's entirely member directed

18:34

and they plan the things they want

18:36

to do. You know, my job and

18:38

the jobs and my co-workers is to

18:41

keep them engaged and help build out

18:43

things, help build out options to education,

18:45

etc. But it's up to these people

18:47

who come to these town halls and

18:49

feel affected and want to move to

18:52

act to build out these teams and...

18:54

do things that contribute to this broader

18:56

building out of power, right? So I

18:58

talked about taking over the elected offices,

19:00

that's the kind of thing they can

19:03

do, kind of build this momentum, bring

19:05

more folks in. The stories are an

19:07

activation tool, as well as a thing

19:09

you bring to the front of the

19:11

line. People hear these stories and say,

19:14

fuck it, I want to get involved.

19:16

Whether they have a story or not.

19:18

It's very easy to chalk things up

19:20

to alienation by and I think that's

19:22

largely correct. how we live within the,

19:25

you know, even within the neighborhood that

19:27

we exist in. This is a one

19:29

of the rare things that kind of

19:31

reassembles us into understanding ourselves as being

19:33

part of a cohesive whole to an

19:36

extent. And it's only moments like that

19:38

you can get people to sign the

19:40

data line and bring them to a

19:42

meeting and bring them to do something.

19:44

And you know, a good organizer, which

19:47

I'm not saying I am, I'm a

19:49

health care guy, but a good organizer

19:51

can tie those things together into a

19:53

variety of things together into a variety

19:55

of causes. state election for Supreme Court,

19:58

which happens on Tuesday, which I don't

20:00

feel amazing about. We had a big

20:02

one two years ago. Democrats won. It

20:04

got us new voting maps, which have

20:06

changed the entire composition of the legislature.

20:09

We've got another one of those coming

20:11

up, as well as a case about

20:13

Act 12, which is the Scott Walker

20:15

bill that destroyed public sector unions. And

20:17

so this election will determine the shape

20:20

of the state for years to come.

20:22

And so a lot of people mutable

20:24

population. but it's part of putting people

20:26

into like a broader coalition. You know,

20:28

if you share this worldview, if you

20:31

feel if you feel affected by these

20:33

things, you know, here's all these options

20:35

available to you to go out and

20:37

do something with it. And people do.

20:39

to that, people do respond. And it's

20:42

the job of my co-workers to help

20:44

kind of put together those ties to

20:46

bring people in for multiple causes and

20:48

keep them there for the long term.

20:50

So I wanted to pull it back

20:53

now to Medicaid and specifically the federal

20:55

campaign against Medicaid funding. You had mentioned

20:57

coming down the pike, 600 to $880

20:59

billion worth of cuts. And this is

21:01

all part of the broader plan to

21:04

make America healthy again, I guess. I'm

21:06

wondering if you could speak a bit

21:08

more to what that plan is, how

21:10

it's being executed, and why it's being

21:12

executed in the way that it is.

21:15

I mean, I wish I had a

21:17

more like complex answer, but it's class

21:19

warfare that's being... built by picking on

21:21

people who are most vulnerable and therefore

21:24

whom they calculate have least of a

21:26

chance of fighting back. The budget calls

21:28

for a 4.5 trillion dollar tax cut,

21:30

half of which is funded by cutting

21:32

back government programs, half of that comes

21:35

from cutting Medicaid or other adjacent Medicaid

21:37

programs. They are making the gamble that

21:39

people on Medicaid are too diffuse and

21:41

too powerless to force. a vote otherwise,

21:43

which is the same gamble they made

21:46

with the ACA in 2018 and it

21:48

didn't work. So, you know, that's my

21:50

silver lining is that we were able

21:52

to stop these, the ACA cuts seven

21:54

years ago, and that model might work

21:57

a gun for Medicaid. Realistically, you know,

21:59

I anticipate there might be a cut

22:01

of some sort, right? They do have

22:03

unilateral power. So I think we're fighting

22:05

for a 10% cut versus a 1%

22:08

cut. Both of those are catastrophic catastrophic.

22:10

in the lives of millions of people

22:12

about whether to stay on these programs.

22:14

And so the shape of the cuts

22:16

are still to be determined. There's a

22:19

lot of ways they can work it

22:21

through, a lot of accounting tricks, a

22:23

lot of implementation, a lot of architecture,

22:25

but at the end of the day,

22:27

any cut to Medicaid kicks people off.

22:30

the program and closes facilities that depend

22:32

upon Medicaid payments. Half of rural hospitals

22:34

in the U.S. are more or less

22:36

underwater, and Medicaid is the only thing

22:38

keeping them afloat. We already see like

22:41

a wave of rural hospital closures and

22:43

closures of hospitals and clinics in low-income

22:45

areas. You know, people in rural areas

22:47

and people in poor neighborhoods have a

22:49

lot more in common than they might

22:52

suspect. But it's the same force as

22:54

acting in both. Either places with low

22:56

volume of care or low-income patients. Overly

22:58

index on Medicaid to keep themselves afloat.

23:00

Just for people who might not be

23:03

entirely familiar with how Medicaid actually works,

23:05

this is a series of federal grants

23:07

that are made to the state level,

23:09

and it's generally up to the state

23:11

in terms of how they administer those

23:14

funds, right? So at the end of

23:16

the day, these cuts are going to

23:18

be administered differently in different states, correct?

23:20

To an extent. That's a good thing

23:22

to bring up. So let's contrast it

23:25

with Medicare. Medicare is an entirely federally

23:27

funded, federally run program. Everything that happens

23:29

in Medicare happens in Washington, D.C. and

23:31

they take care of everything. Medicaid is

23:33

jointly funded by the federal government and

23:36

the state government and as administered by

23:38

the state. So in different states, the

23:40

federal government pitches in a different amount.

23:42

In Wisconsin, it's 60-40, 60% federal of

23:44

40% state. In other places, it's, you

23:47

know, 70, 30, 55, 45, etc. I

23:49

think nationwide it's like 6921, that's the

23:51

breakdown. So the federal government is targeting

23:53

that 60% or nationally 69% that's the

23:55

money that's going to get cut here.

23:58

But yeah, they'll say, okay, Wisconsin, typically

24:00

we give you $6.6 billion. This year

24:02

we're giving you $5.6 billion. A 10%

24:04

Medicaid cut shakes out to $1 billion

24:06

fewer from the federal government to the

24:09

state of Wisconsin. And in every single

24:11

state Medicaid funding from the federal government

24:13

is the largest pool of... federal money

24:15

that they get. This is a massive

24:17

part of every state budget because health

24:20

care is expensive. There's a lot of,

24:22

that's why I think we didn't Medicare

24:24

for all. But this is like a

24:26

massive chunk of federal money that states

24:28

use. And so in Wisconsin at least,

24:31

just because I have those stats on

24:33

top of my mind, the state's use.

24:35

And so in Wisconsin at least, just

24:37

because I have those stats on top

24:39

of my mind, the state government would

24:42

need to spend an additional $1 billion.

24:44

In New York, the projected cuts would

24:46

pull $10 billion from the state budget.

24:48

These are massive cuts, even on a

24:50

small level, because of that funding program.

24:53

And so the federal government can say,

24:55

okay, we're going to cut back that

24:57

funding by doing A, B, or C.

24:59

And then the state implements it, or

25:01

the state has to kind of maneuver

25:04

around the avenues set there. A lot

25:06

of this is frustratingly ambiguous because things

25:08

haven't been determined yet. They kind of

25:10

like the dog caught the car and

25:13

said... $880 billion, which is important that

25:15

is over a 10-year period, which is

25:17

how much Medicaid spends per year, $880

25:19

billion. And now they've got to figure

25:21

out how to do that math. And

25:24

I don't think they figure that out

25:26

yet, because it's politically, they're learning that

25:28

it is politically very dangerous to cut

25:30

Medicaid. Is there any particular reason that

25:32

they've gone with 10% or is it

25:35

just, we need to do some austerity,

25:37

so here's a number? Medicaid spends $180

25:39

billion a year, so cut it by

25:41

10% over a 10-year period. It's just

25:43

nice math. Cool. So in terms then

25:46

of the immediate... impacts. We've talked a

25:48

little bit about what that could look

25:50

like. Rolling back, particularly provision of care

25:52

in rural areas, some of these specialized

25:54

programs that deal with specialized populations. What

25:57

are other things that could happen as

25:59

a result of these cuts? Sure, so

26:01

I mean they could open up the

26:03

ability for the state to restrict who's

26:05

on Medicaid. Medicaid eligibility requirements were greatly

26:08

expanded under the Affordable Care Act in

26:10

40 states. In 40 states, if you

26:12

have under 138% of the federal poverty

26:14

line as your household income, you are

26:16

eligible for Medicaid full stop. And then

26:19

there's like bonus programs in top of

26:21

that for disability, children, etc. Is that

26:23

just in Wisconsin or is that everywhere?

26:25

That's in all states. In Wisconsin, we

26:27

don't have expansion. Wisconsin, we cap out

26:30

at 100%. Got it. And we're the

26:32

most generous non-expansion non-expansionion state. Medicaid was

26:34

rolled out as part of, assistance for

26:36

families with dependent children, AFDC, which turned

26:38

into TANF under the Clinton era, but

26:41

it was an extension of state welfare

26:43

programs, which is why this whole thing

26:45

is run by the states, and for

26:47

a long time states could determine who

26:49

was eligible and who was not. There

26:52

are two consequences for cutting Medicaid that

26:54

are non-negotiable, completely like what's going to

26:56

happen, totally predictable, and non-avoidable. People will

26:58

lose their health insurance, and facilities which

27:00

depend upon Medicaid to... break even will

27:03

close. Now the particular manner by which

27:05

it's determined who loses their health insurance

27:07

and which facilities close is largely up

27:09

to the conversations that are that are

27:11

happening now and then the resulting conversations

27:14

that states have. We don't necessarily know

27:16

the criteria, how that's how it's going

27:18

to shake out. One thing that's passed

27:20

around a lot is work requirements, a

27:22

model that has been shown to be

27:25

insanely ineffective and not cost efficient. and

27:27

penalizes people not who aren't working, but

27:29

who can't handle filling out forms every

27:31

month because they're pretty Byzantine and there's

27:33

no, it's really hard to submit those

27:36

documents. It's estimated that work requirements would

27:38

kick I think 5 million people off

27:40

Medicaid, which is a lot. There is

27:42

no way to finagle a cut that

27:44

doesn't result in a similar number of

27:47

people losing their health insurance. That's the

27:49

bricks. And so the choice Congress is

27:51

forcing states to make is either... raise

27:53

taxes, spend money they can afford to

27:55

match or cut their Medicaid program. That's

27:58

it. There's no other option. There's no

28:00

work around. There's no hack. And what

28:02

What that looks like is a thing

28:04

we will discover together over the course

28:06

of the next few months. When I

28:09

hear that, and I'm sure when you

28:11

hear that as well, the immediate

28:14

impulse in my gut is, oh

28:16

no, and I'm afraid, and

28:18

there's something I think

28:20

overwhelmingly disabling

28:23

about the fear sometimes, if

28:25

you let it... really sit there.

28:27

And this is the thing that

28:29

I come back to time and

28:32

time and time again, as we

28:34

are facing down the various tendrils

28:36

of fascism and the mundanity of

28:38

the way that austerity just sort

28:41

of ruins our collective society. And

28:43

so when you find yourself in

28:45

those moments, I wonder what is

28:47

it that you do to keep

28:50

yourself from freaking out? That's a

28:52

great question. I'm trying to figure that out

28:54

myself. Yeah. I mean I won't lie. I

28:56

feel like shit basically all the time. Yeah. However,

28:58

you know, you can do a couple of things

29:00

with feeling like shit. You can stay in bed

29:02

and roll around or you can get out there

29:04

and try to like help build the thing

29:07

that pushes back. Right. We are living in

29:09

a declining empire. I think it's more or

29:11

less irrefutable at this point. The tagline of

29:13

our show. Case studies in the pop culture

29:15

of a pop culture of a dying empire.

29:17

I don't know, you got to. This

29:20

is life or death for a lot

29:22

of people, but it's coming for us

29:24

next. We're all temporarily healthy, we're all

29:26

temporarily able-bodied. At some point, a car

29:28

accident, a pregnancy, a rabid raccoon, focks

29:30

up your health care, fucks up your

29:32

life. So fighting for Medicaid now is

29:34

a way of fighting for yourself later.

29:36

interest in the work here, not just

29:38

in people that you love and people

29:40

that you care about, which is self-interest,

29:42

but also it can happen any of

29:44

us. You know, we're all so much

29:46

closer to being homeless or being disabled

29:48

or getting very sick than any of us

29:50

realize. And the mechanisms by which we

29:53

are insulated from that, the bowl works

29:55

against total devastation, are programs like Medicaid.

29:57

So you got to fight to keep

29:59

them going. So the thing that gets me

30:01

through feeling like shit is getting out there

30:03

and talking to people. It's much better

30:05

to feel like shit collectively than

30:07

individually. I think that's really what it

30:09

comes down to, right? Like it's much better,

30:12

if you feel scared and mad and angry

30:14

and alone, it's way better to do that

30:16

with people near you than sitting in your

30:18

little apartment or whatever and just freaking out.

30:20

That leads to a lot of... insanely

30:22

unhealthy behaviors to which I think

30:24

we all are suspect probably participated in

30:27

during during COVID lockdowns. I got a

30:29

friend Phil who responds got to

30:31

whenever I talk about this and I

30:33

just hear Phil's voice in my head, got

30:36

to get out there, got to do this.

30:38

It's not fun, it's not easy, it's rewarding,

30:40

but it's necessary. You know, if we have

30:42

any chance of resuscating anything that they're

30:44

cutting right now, of building back any kind

30:47

of America that's more beautiful than the moment

30:49

we have today. It's shit like this you

30:51

gotta do to get out there. And it

30:53

is rewarding. Talking to people is fun. Making

30:55

friends is fun. Like there are nice parts

30:57

to it. It's possible to enjoy these kinds of

30:59

activities and these kinds of actions and this kind

31:01

of work. Even though it's in the context

31:03

of something terrible. You know, don't get me

31:05

wrong. It's not drudgery. It is like pleasant

31:07

and nice to do. Even if you step back

31:10

and wake up in the morning and

31:12

go, fuck, this shit's falling apart. Well,

31:14

that's kind of what I wanted to

31:16

bring it back to here is, again,

31:18

you have been out on the road

31:20

doing these talks. And since you started

31:22

doing that, how many have you done

31:24

at this point? Six in Wisconsin, and

31:26

I'm trying to roll out more across

31:28

the Midwest over the next month or

31:30

so. Can you just give me a

31:33

sense of the feeling in these rooms?

31:35

Because I have watched, again that video

31:37

that you sent along, I've gotten a

31:39

sense of it, but just for

31:41

our listeners, I was hoping that

31:43

you could give them a sense

31:45

of what it feels like, and...

31:47

how activated people actually are. Because

31:49

the reality of the situation is

31:51

that there are a lot of

31:53

people who are just pending activation,

31:55

and once they feel it, oh

31:57

boy, do they feel it. First

31:59

off. like any kind of performance, it

32:01

really varies from room to room and varies

32:03

from town to town. At its best case,

32:06

yeah, you get people who come and afraid

32:08

and angry, you want to educate them about

32:10

why they should be afraid and angry, and

32:12

then give them a vision of a better

32:14

world that they can participate in if they

32:17

act now, right? That's the foundation of any

32:19

core political speech. And people are hungry for

32:21

any kind of chance to experience or understand

32:23

or visualize that better, more beautiful, gentler world.

32:26

and offering it to them is part of

32:28

my job. And then turning that into, okay,

32:30

let's get out there and let's work. You

32:32

know, we're getting 20, 40, 60 people at

32:34

a time who say they want to get

32:37

involved in building what comes next. It's pretty

32:39

substantial turnout in some areas. In other areas,

32:41

it's just a lot more fear, you know,

32:43

it's a smaller room, smaller town. People know

32:45

that their hospitals, the ones going to close,

32:48

and so it's a mix. But this all

32:50

really comes down to the quality of the

32:52

organization that's putting on the event. Do they

32:54

have the ability to capture whether it's three

32:57

people or 30? And build into something new.

32:59

And we're trying to figure that out. This

33:01

is a, we're trying to rebuild a lot

33:03

of infrastructure that has been malnourished or fallen

33:05

apart over the past five years and the

33:08

past 30 years. It's a working process. And

33:10

I'll keep it in the road. I'll keep

33:12

talking to folks. We've got four state reps

33:14

who are pounding the pavement every corner of

33:16

the state well beyond their own districts, not

33:19

as elected officials, just as people who have

33:21

connections to organizing. And you need to, that's

33:23

what you got to do. You got to

33:25

get out there, you got to get out

33:28

there, you got to do that. You got

33:30

to get out there, you got to do

33:32

that. You got to get out there, you

33:34

got to do that. You got to get

33:36

out there, you got to do that. You

33:39

got to get out there, you got to

33:41

do that, you got to get out there,

33:43

you got to do, you got to get

33:45

out there, you got to do, you got

33:47

to do, you got to get out there,

33:50

you got to do, you got to get

33:52

out there, you got to do, you got

33:54

to do, you got to do, you got

33:56

to do, you got to get out there,

33:59

you got to do, you got to do,

34:01

you got to do, you got to do,

34:03

you got to get out there, you Well

34:05

to that point if there are folks who

34:07

are looking to get involved specifically with this

34:10

fight and I just wanted to throw out

34:12

as well, there's a lot of fights out

34:14

there and whatever it is that you, the

34:16

listener, feel the most drawn to, go out

34:19

there and make that your fight. If Medicaid

34:21

and fighting for Medicaid and this sort of

34:23

baseline of medical backstop in the United States

34:25

is something that you want to fight for,

34:27

what should our listeners do to get involved?

34:30

Find the organization in your area that is

34:32

leading the fight. Not just with protests, other

34:34

protests are very important, but who is doing

34:36

durable work, movement work, find that organization. If

34:38

there is not one, then get five friends

34:41

and build something yourself. Doesn't need to have

34:43

formal bylaws or rules or whatever. Just got

34:45

people who are willing to, for example, carpool

34:47

to your elected's office and yell at them

34:50

and get it on video and get more

34:52

folks in. Which by the way. Yelling at

34:54

elected officials feels good as hell. I just

34:56

wanted to throw that out there. It's a

34:58

healthy way to yell. It's a very good

35:01

thing to do. Getting into their office, making

35:03

the appointment, having the meeting, having the meeting,

35:05

can be a little tricky, having the meeting,

35:07

can be a little tricky to coordinate, having

35:09

the meeting, can be a little tricky to

35:12

coordinate, but it's worthwhile, but it's worthwhile, and

35:14

if it's a little tricky, to coordinate, having

35:16

the meeting, it can be a little tricky

35:18

to coordinate, can be a little tricky, and

35:21

go do these things, You know, throw these

35:23

meetings, talk to your neighbors, hand out flyers,

35:25

if you need a flyer, email me, I

35:27

will give you a model flyer about Medicaid

35:29

cuts you can use. You can put my

35:32

email in the show notes or whatever. I

35:34

will. You gotta get people together to do

35:36

the work. You know, there's no other way

35:38

around it. We've tried other models, they don't

35:40

work, this is it. So, you know, the

35:43

thing you can do, find these works, get

35:45

involved if they don't exist, do something your

35:47

own, do something your own. Go tell stories,

35:49

go tell stories, go tell stories, kind of

35:52

stories, kind of the front of the front

35:54

of the front of the front of the

35:56

front of the front of the line, And

35:58

like you said, what you said is absolutely

36:00

correct. You got to pick your issue. Mine

36:03

have. to be about a kid right now

36:05

because it's the thing I know the most

36:07

about. It's very easy to be totally bamboozled

36:09

and stupefied by the one of things happening

36:11

in the world. So you got to put

36:14

on blinders if you want to function. And

36:16

I, that's, these are the things that I've,

36:18

that I've put together for myself. Well, we

36:20

will put in the show notes some links

36:23

to organizations that you can potentially get involved

36:25

with that are connected to Medicaid and preserving

36:27

Medicaid, as well as, yeah, Tim will put

36:29

your contact info in there as well if

36:31

people want to get a hold of you

36:34

about anything. Beyond that, is there anything else

36:36

that you wanted to point up or plug

36:38

or whatever for people who are interested in

36:40

getting involved? Well, I mean, if you would

36:43

have learned, like, education is a part of

36:45

this, right? Like, what are the reasons that

36:47

my traveling around is actually worth anything is

36:49

because Medicaid and Medicaid policy and health care

36:51

policy are often abstracted. If you want reliable,

36:54

digestible news about health care things, I recommend

36:56

stat news, as TAT. I think they are

36:58

far and away the best health policy news

37:00

service out there. They've got funding, they've got

37:02

great reporters, and they cover this shit, like

37:05

in... rapidly and with great contextual information. If

37:07

you want data, there's a lot of sources.

37:09

The gold standard one is usually KFF, formerly

37:11

known as the Kaiser Family Foundation. They put

37:14

out a lot of papers that are interesting

37:16

and are pretty easily digestible. If you just

37:18

want to follow what's going on, that's the

37:20

place to do it. That kind of education

37:22

is important for being able to talk more

37:25

capable of what's happening, which I think is

37:27

an important part of being able to fight

37:29

it. Well, check those links out and Tim's

37:31

thank you so much for your time coming

37:33

on here today I look forward as well

37:36

to seeing what it is that you and

37:38

all of the people who you're working with

37:40

are able to Cook up and get people

37:42

all hot and bothered about in the coming

37:45

months It's got to keep on trucking, you

37:47

know, you got to and for you the

37:49

listener. Thank you so much for taking some

37:51

time with us today. We'll be back on

37:53

Wednesday for the regular episode until Until

37:56

then, I'm the worst

37:58

of all possible possible

38:00

see you next time. time.