STEVE INSKEEP, HOST:
Nebraska congressmen took questions from constituents this week. That's a big deal, since constituents have been flooding town hall meetings since President Trump's inauguration. And some Republicans have been avoiding the meetings. Jeff Fortenberry of Nebraska decided he should show up.
JEFF FORTENBERRY: I just felt like it was important to lean into this. I knew it would be controversial, given my positions and the mail I was receiving, and particularly about the health care bill. Yet, at the same time, I felt like it was my duty.
INSKEEP: Congressman Fortenberry defended the House Republican drive to replace the Affordable Care Act. He says he told his constituents it's true that Obamacare has helped insure a lot of people. He added that other people face too much cost. And he took questions from an oversized audience. Afterward, he took ours.
FORTENBERRY: Well, to put it nicely, it was robust. It was a lot of difficult discussion, a lot of disagreement. But, you know, I'm glad I called an audible and did one and had a crowd size that was estimated to be as large as 1,500, which is highly unusual in Nebraska. I've never seen anything like that. It shows the level of deep divide in the country philosophically and politically and frankly a very intense desire for discourse.
INSKEEP: We have a little bit of tape of that discussion. It's where you asked a couple of questions of the audience. This is from KETV Omaha. Let's listen to just a little bit of that.
(SOUNDBITE OF ARCHIVED RECORDING)
FORTENBERRY: How many of you think health care is a right?
FORTENBERRY: How many of you think health care is a responsibility?
UNIDENTIFIED WOMAN: Absolutely.
INSKEEP: Little bit different response there. Why did you ask people if they felt health care was a right or a responsibility?
FORTENBERRY: To invoke a deeper philosophical discussion about what government policy ought to be, how the balance between the government setting up the guard rail so that our system both insurance and broader health care system can properly function for the protection of vulnerable persons. And yet at the same time, what is the individual's responsibility for their own well-being and the cost to the system themselves?
INSKEEP: Were you on your way to saying that if you're in this audience and you're going to end up under this change to the health care law paying more in insurance premiums, which undoubtedly will be the case for at least some people, that, well, that's your responsibility and pay up? Is that where you were going with that?
FORTENBERRY: No. What I did in the beginning of the town meeting was I put up two constituent letters that I think are representative of what's happening in our system. One was from a farmer who told me that his health care cost him $24,000 a year in premiums. He has a $20,000 deductible. He has property taxes of about $50,000 and state income taxes of about 19. He went on to say corn is $3.09, this does not work, a very straightforward Nebraska-style letter.
Another woman named Catherine (ph) sent me a letter. And she said, I have a preexisting condition. Before the Affordable Care Act, I could not get affordable coverage. It has been a godsend for me. And I asked the audience, who's right here? Is Scott (ph) right or Catherine right? And I concluded by saying they're both right. We have to have a system that's fair and works for everyone. What we are currently doing is not sustainable. It does help some people but it hurts many others.
INSKEEP: Well, let's go through a few details of this plan. The subsidies have changed. Why is it a good idea in your view to base the subsidy on someone's age rather than their income? Because changing it from income means there will be some people who have a lot harder time affording the health care.
FORTENBERRY: It's a fair point to debate. The intention here, as it's being unpacked as we speak, is to frankly try to move more younger people into the health care market. So that as your age goes up, yes, there will be increased prices for health care but at the same time an increased level of subsidy to you. So that potentially as the age ratio is widened, more younger people will be attracted into the system who need to be in the system because their prices will fall.
INSKEEP: OK. That makes sense, although young people get a relatively low subsidy. And lower income people who are older are likely to get a very low subsidy relative to their expenses. I don't quite understand that part.
FORTENBERRY: Well, I frankly - it's an important point to continue to unpack and try to debate as to whether or not this formula is the right one or needs some type of adjustment. One of the things that's also not being unpacked here is the idea of moving some federal monies to the states for innovation. If we can improve health care outcomes while lowering costs, that also shifts into lowering costs for the overall health insurance market. And it's being overlooked in this entire debate.
INSKEEP: Totally understand the point about trying to get the market to work a little better so that prices don't keep going up and up. But just to round out that point about the subsidies, when you say it's worth unpacking, are you saying maybe the current subsidy formula doesn't make sense and it would have to be changed before you'd be totally onboard with it?
FORTENBERRY: Were in the beginning of this process. It's just come out of House subcommittees - or committees, rather. And it is the beginning of the fuller debate before the full House of Representatives. Then it has a Senate process. It is a reasoned point to be raising as to whether or not this formula is precisely tuned.
INSKEEP: Another thing I want to ask about without getting too far into the weeds, but of course a lot of money is being taken out of Medicaid, hundreds of billions of dollars under the House plan. Why is that important to do?
FORTENBERRY: Well, again, one of the core premises here is when you have a national - in effect, a national health insurance program or all of the debate coming out of Washington, you're getting one-size-fits-all. That's one of the reasons that I think this innovation-type grant that - as it's being proposed, subsidy to the states - should help jumpstart some innovative ideas that provide medical homes for the sickest and should help decrease pressure on the Medicaid system.
INSKEEP: You're emphasizing another part of this which is a pile of money going to the states so that they can figure out better ways to deal with care.
INSKEEP: But you're also just taking money out of Medicaid. There's less money for Medicaid in a few years. Is that going to work?
FORTENBERRY: Well, again, what we've got now is ever-escalating health care costs in a system that is currently unsustainable.
INSKEEP: But does taking money out of Medicaid in future years make it even less sustainable? I mean, you move forward the date by which the Medicaid trust fund would be bankrupt, don't you?
FORTENBERRY: But the point is to get underneath better the drivers of health care cost and to move it out of a more Washington-based model to a more state-based model. I don't want to see anyone left behind. The president has said that. That is not American values. It's not my values. I do not want to see that happen.
INSKEEP: What, if anything, would you say to some of your Republican colleagues in the Senate who are saying for a variety of reasons they don't think they can get behind this bill, they'd like to slow down a little bit?
FORTENBERRY: It is discomforting that this is so rushed. I'll be honest with you. It would be better to have more time to unpack some of the thoughtful questions and challenges that you're raising, as well as others. I would prefer to have that time. But we are where we are. And the House has acted. And this is just a start.
INSKEEP: Well, Congressman Fortenberry, thanks very much.
FORTENBERRY: All right. Thank you.
INSKEEP: Republican Jeff Fortenberry held a packed town hall meeting in Nebraska this week, which he said he wouldn't call fun but did call necessary.
[POST-BROADCAST CORRECTION: We incorrectly refer to a Medicaid trust fund. There is no such fund, although there is a Medicare trust fund.] Transcript provided by NPR, Copyright NPR.