Andy Kim Reveals the Terrifying Family Crisis That Drove Him Into Politics

Hey everybody. Welcome back to Bullwork Takes. So I'm Jonathan Cone. I write the breakdown newsletter where I write about healthcare and boy, healthcare is a big issue now. You can tell by looking at the polls or ask a friend, a family member, a neighbor. I promise you, you will find somebody who is struggling with the cost of their premiums or out of pocket cost or maybe they need a medical treatment. They can't get it because an insurance company is saying no. Now Republicans, they have spent the last year cutting Medicaid, letting extra money for the Affordable Care Act laps of insurance costs have gone up. Democrats are unified that if they get power, Congress and maybe someday the White House, if that's what it takes, they are going to restore those cuts. But what comes after that? You know, Democrats have been the party of universal coverage since Harry Truman's day, but there's lots of disagreement over what a system should look like in the end and how you get there. Our guest today is Senator Andy Kim from the great state of New Jersey, home of Bruce Springsteen. I have his poster here on the wall and also host home to some interesting ideas, including a new idea for healthcare that Senator Kim has put on the table. We're going to talk about this idea why healthcare is so important to the American people and why healthcare is so important to him personally. Senator Kim, hey, thanks for making time for us. Yeah, thanks for having me on. So I want to talk about your origins, right? I just refer to it. You know, when you first ran for Congress in 2018, healthcare was a big part of that story. Tell us, what were you seeing and why did that make you want to run for Congress? Yeah, absolutely. Well, you know, in 2017, not only did Trump just get into the White House, but my wife and I were expecting our second baby that year. And I remember we were getting up close to the due date and when we went in for an ultrasound, the doctors came in and talked to us and they said, you know, there's a problem, which is the last thing you want to hear when you're there for an ultrasound. And they said that they just took the measurements and that our baby to be was dramatically underweight, at least in terms of size, and said that this could be potentially a growth problem. And we had to really prepare ourselves. They said that, you know, the baby might not make it. And if the baby made it, there could be some growth challenges for the rest of his life. And I was devastating to get this news. And while I'm there taking, you know, my wife to the hospital, constantly for different therapies and see what we can do to get the weight up, you know, I was watching the TV and I was watching the news. My own congressman from New Jersey, leading the charge on trying to gut pre-existing condition protections as part of the Republican effort to gut the Affordable Care Act. And, you know, the fact that he was leading that charge, just like it was a reason why I decided to step up to run for Congress. You know, thankfully my baby was born. We've been able to manage his health challenges and now he's an all-star on his soccer team. And I'm really proud of that. But ever since then, it really just stuck with me, just like the concerns about health care for everybody. But in particular, when it comes to kids, when it comes to those who are most vulnerable, those who can't look out for themselves, those that we as adults have a responsibility for. And, and channeling a lot of my concerns and anxieties as a father of young kids in the US Senate. They're not very many of us, parents of young kids in the US Senate, trying to really make sure we're standing up for their health care. Yeah. Yeah. Well, I want to get into your proposal in a second, because, you know, I love to get deep in the weeds on this stuff. But before we do that, I'm going to take a step back. Imagine I made you king for a day. You could snap your fingers. You could create any health care system you want. You don't have to worry about the political challenges. You don't have to worry about the disruptions to one six of the American economy. This is your ideal health system and it's in place. What does it look like? You know, thanks for asking that. Well, if there was any issue that I could take on as king for the day, it would be health care. And within health care, yes, I would absolutely be a universal system. It'd be probably closer to what we'd see as a single payer system that we have in other countries. Something that I think would, again, just make sure that there's this understanding across the board that health care is a right. And I think that that's just the message I think the American people are really starting to internalize now is a sense that everybody deserves health care. Everybody deserves to be able to go see the doctor if they're sick and not have that break the bank. And so, you know, as I've tried to think through, you know, I've studied a lot of different health care systems. I know you have as well around the world. You know, there are different ways that one can get to universal care. You know, not every single one of them is the same kind of structure. So, you know, I've been kind of thinking through what makes sense, you know, I've been intrigued by some of the different systems, whether Switzerland or others, where they do have some choice available within it. And, you know, I've been thinking about that. But, you know, when you look at what's the scale for a country this big, you know, 340 million people, you know, I've been trying to think through. 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Get 15% off your first order plus free shipping at bullenbranch.com/bullworktakes with code bullworktakes. That's bull and branch B-O-L-L-A-N-D branch.com/bullworktakes with code bullworktakes to unlock 15% off exclusion supply. I played this game. I don't know if this other was a feature in the New York Times a couple years ago. They're like, what is your favorite healthcare system? I've always been a little partial thinking about what would work in the United States or the French system, which is kind of single pay or ish, but it's also there's some see get supplemental private insurance anyway. There's a good tier system. I've thought about that as well and I can't remember if Netherlands is somewhat similar to that, but yeah, there are these different systems there where you have a baseline of care and then supplemental beyond that. That's something I've also kind of thought through. Well, of course, we don't live in that kind of world where you can just snap your fingers. You're one of a hundred members of the United States Senate, possibly needing 60 or 50 to pass anything depending on the filibuster. You got the house, neither presidency, you know, at best, you know, we're talking about Democrats getting both houses of Congress after the midterms that you're still at least two years away from the midterms. You have been thinking about a step, a first step to take or an important, but I don't want to minimize that very important first step. Describe for me your proposal. You call it Medicids. It kind of gives a way that we're the focus, but tell me what your proposal is. Yeah, well, Medicids and the fact that it comes right across to you just from that's name is part of the reason I did it. So the idea of having guaranteed health care for every child in this country that every child born would be automatically enrolled into Medicids, which would be a version of Medicaid, and that you would have that guaranteed coverage until year 26. Now, parents can opt out if they want, but this is something where I'm trying to close that gap of the 4.4 million kids in this country that don't have health insurance. Over 23 million kids are under insured, which means their coverage isn't meeting their needs. That's absolutely an abomination, in my opinion, that we in the richest, most powerful country in the world cannot guarantee care for children here. So that's really the premise. I mean, you heard where I kind of started off my journey in politics with concerns about my kids. I'm not concerned about not just my kids, but every child in this country as should all of us as adults be focused on every single child here. And so the idea is that we would have this guaranteed care, and not just guaranteed on the health care side traditionally, but also on universal mental health and vision and dental and hearing, so incredibly important. And the reason why we chose to build off of Medicaid is for two reasons. One is that Medicaid is designed for kids through the EPSDT, the early periodic screenings, and the diagnostics and the treatment. This is something that is specific for kids, and in my opinion, isn't just about closing the gap, but raising the bar for all children to have health insurance designed for them. But number two is I wanted to design something that was implementable. This is not a messaging bill. This is something that I designed to be able to be passed through reconciliation process, understanding the political realities that we have in our time right now. So to be able to design something that could actually move forward this goal towards universal care in a massive way. And I think that this would fundamentally reshape the landscape for universal care, especially if you give that guaranteed care at the front end of one's life rather than the end. And it's something that, you know, you're really going to have this type of care and then all of a sudden when you're 27 years old want to give it up, I think it's going to be something that will absolutely put us on that path. for the universal care in this country. - Yeah, well, you mentioned why you did Medicaid and part of that reason, if I understand what you're saying, is that Medicaid, the benefit package is really, it's very comprehensive and actually very much designed for kids with early testing for lead, which is the early screening you were mentioned, not just lead, a bunch of other conditions also. And that all makes sense, but you're a healthcare, you're a wonk, love wonks. And you know that traditionally one of the problems with Medicaid is that yes, it covers everything, but it reimburses really low. It pays us for doctors and hospitals traditionally, not always, but traditionally it's been the low payer. And because of that, it can be hard to go find a specialist who will take Medicaid. Are you, is that a concern? Are you worried that you're gonna overload the system? Do you have as part of your plan address that? - Yeah, absolutely. Yeah, we do need to address Medicaid reimbursement and just workforce writ large. We unfortunately as a country don't have the pediatric workforce that we would need to be able to cover every child. When we talk through the mental health challenges that we face, especially children, we do not have, you know, pediatric mental health professionals to the level that is needed to guess. You know, this is part of the challenge of just transition, right, like I'm all for healthcare is right, and we should have it in a universal way. But what's preventing us from getting that isn't just the system of payer. It's also just about, it's also about the workforce side of this that we need to be building towards to make sure that we are creating something that actually can be implemented. Because if you don't have the workforce, that's when you start to have, you know, shortages. That's when you start to have longer weights for medical care, which would reduce confidence from the public in the system. So it's so important that we, it's not just designing the structure, but to actually have the implementation necessary. So yes, we've, we've readily agreed that, you know, Medicaid reimbursement is going to be part of that, not just for kids, but writ large. And that's why, you know, that's something that we need to have as a broader conversation about Medicaid writ large. But I very much recognize that being an important part of us trying to implement Medicaid. - Now, if you're talking about raising the Medicaid reimbursement rate, covering potentially millions of new kids, that's, that's you're getting to real money in Washington. Have you, do you have a sense what this is going to cost ballpark, you know, per year or per 10 years? What's your guess? - Yeah, we haven't, I mean, what are the point gap where we are getting a CBO score? You know, the hope is that this could be part of a broader healthcare package that the Democrats put forward in a new Congress. And hopefully under a future president to actually get implemented. But a couple of things that I'll tell you here, one is that, I think you already know this, that, you know, that kids are relatively much cheaper to cover than grownups, especially seniors. I mean, when we look at Medicaid right now, you know, children are over 50% of the population on Medicaid, but they are less than 18, 90% of the total cost of Medicaid. So, you know, that is one aspect of that in terms of it. Second is, and we're trying to, you know, take this into account when we think through what is this ultimately going to cost us, because I think of healthcare for children in particular, being really an investment in this country. Healthier kids mean healthier adults, which means a healthier workforce, which means more productive economy. It also means hopefully addressing a lot of the healthcare challenges that we face as a nation earlier on, trying to address some of the chronic illnesses that we face being able to take that on an earlier level. So, it's something where we, when we look at the costs of something like Medicaid kids, we're going to have to make sure we're taking into account the cost savings over time of having a healthier society, and hopefully the downward pressure that we'll have later in life, as we see so much of the healthcare problems of adults and whatnot, stemming from unaddressed issues that often can stem from their childhood teenage years into their early 20s. That is something that we're trying to get ahead of when it comes to Medicaid. So, you know, still haven't talked through and been able to explore the full cost of it, but I think overall it's something that I hope all of us can recognize is good for our society. And as I've been trying to think through, how do we actually close that gap, like fully close that gap of the uninsured children in our country, I really could think, I've spent years thinking about this, and I really couldn't think of anything else other than this automatic enrollment effort. Everything else was always gonna leave some meaningful gaps, sadly, in the millions. And I think we as a society just need to ask ourselves, is that just acceptable? Is it, is like having millions of kids without health insurance, just the unfortunate remainder of the equation of capitalism in America, or are we actually going to say no, we are a society that values children every child and wants to make sure that every child has opportunity in this country? - And are you concerned that if Medicaid is available to all children? It's, you know, it's a universal entitlement, basically, that employers who currently are the, you know, primary source of coverage for the working age population are gonna be less likely to offer family coverage. They'll say, oh, well, we don't need to offer coverage anymore 'cause the government will pick it up and you'll see it trend away from employer. This will erode, maybe not get rid of, but will erode employer insurance? Is that a concern? - No, look, I mean, employer insurance will still continue for the employers for the vast majority of the rest of the population. And, you know, as I said in insurance for children is very small compared to the overall pot of health care spending. So it's not gonna be on much of the insurer to be able to add on children as needed. And I said, Medicaid is optional. If parents don't want to have their kids on Medicaid's that they can use their own. But I will say though, that my goal wasn't just to close the gap of the 4.4 million on short and the 23 million underinsured. It is also to get kids on a coverage that is built for them. So children that are on employer-based, tacked on, like my kids are on employer-based, tacked on to what is essentially an adult coverage. And they're kinda tacked on. My employer-based coverage for my kids does not have the EPSDT. Does not have the different types of screenings and the guarantee that if there is something that pops up as a need, that they will have it covered. And so, like, I don't want my kids to be on an insurance that isn't designed for them. That isn't thinking through all the different needs of a child. I talked with a, you know, a mom not too long ago who told me that her child has hearing problems. And needed an hearing aid. Well, not too many companies make hearing aids for children. And as a result, even though she had really strong employer-based insurance, it still cost her about $6,000 out of pocket for that hearing aid. I mean, and look, I mean, you've got to worry that kids are going to lose these things, do you? Like, there's a lot of challenges on this front. So I just share that because I think a lot of people think that my plan is simply for the 4.4 million and therefore, let's look at other ways where we can address that gap, like, I'm happy to have that to be. But what I'm also trying to do is literally raise the bar. I want every single child in this country to be on insurance that is designed for them. You know, that's why I wasn't thinking about, you know, like a Medicare for kids because Medicare doesn't have the EPSDT. It doesn't have the design functions. You could always try to embed it within it, but why not use something that already has it? Why not use something that already exists? And as a result, can make this plan much more implementable. Because like, I'm trying to think through not just what is the structure of universal care that I want in this country, but how do we make that transition? You alluded to that earlier. That's going to be an enormous challenge for this country one way or another. And it's not just about time duration. It's about how do we actually make that transition and have the political and the popular support to be able to do that? We know that's always politically a very challenging question. So with medics, I was trying to put forward our strongest possible argument for guaranteed care. And to be able to do so in a way that isn't trying to create some brand new agency, department, bureaucracy, but be able to utilize the structures that we have to be able to do something unbelievably bold. And I hope people see that. The idea that we could cover every single person in this country from birth to 26, that's not incremental. That's a massive step in this step towards universal care. And as I said, could very well, in my opinion, lead to the inevitability of guaranteed care later. So that's kind of how I'm thinking about it in terms of it. Well, Senator, I could go on for literally hours on this. I'm sure you could too, but I know you have a schedule. I got some of the stuff to do too. So thanks for joining us here at the Bullwork. And viewers, if you're watching this, if you care about policy, think about subscribing to the Bullwork because we do cover healthcare a lot. Watch our videos, hit like on this video because it helps with the algorithms. And we'll see you here next time.