May 23, 2025 • 32 mins
The fight for America's health and wellbeing takes center stage as we tackle the most alarming proposals coming from Washington. Attorneys General Dana Nessel and Kris Mayes break down their ongoing legal battles against unconstitutional actions by the Trump administration – revealing why they've each filed over 15 lawsuits (and won most of them).
Our candid conversation explores the real-world consequences of federal budget cuts already taking effect across America. From overflowing toilets at the Grand Canyon to park facility closures at Sleeping Bear Dunes, national treasures are deteriorating before our eyes. Meanwhile, vital nonprofit organizations that feed vulnerable populations face extinction as funding disappears.
The heart of our episode features Georgetown University's Joan Alker, who delivers a masterclass on Medicaid's essential role in American healthcare. As Republicans propose slashing at least $625 billion from Medicaid – the largest cuts in history – Alker explains who stands to lose the most. Did you know Medicaid covers 40% of all births nationally and nearly half of all births in rural communities? Or that it's the primary funder of long-term care for seniors and covers almost half of all children?
We examine how these proposed cuts would devastate rural healthcare systems already struggling with provider shortages and hospital closures. Alker also dissects the problematic "work requirements" some states have tried implementing – revealing shocking statistics about how they've increased bureaucracy while causing thousands to lose coverage.
What makes this episode particularly powerful is the bipartisan concern emerging around these issues. As Nessel notes, people across the political spectrum are showing up at town halls worried about these changes. The message becomes clear: speaking up works, whether through contacting representatives, writing op-eds, or joining local meetings.
Join us for this urgent conversation about protecting the programs that make America healthy. The time to make your voice heard is now.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Attorney General Kris M (00:05):
Welcome back to another episode of
pantsuits and lawsuits, yourone-stop shop to find out what
you need to know about the mostpressing legal topics impacting
America today, and it's great tobe back with you, Dana.
Attorney General Dana Ness (00:23):
It's great to be back with you, Kris
.
You know it's hard to keeptrack because I know every time
we get together we talk aboutsome of the latest and greatest
lawsuits that have been filed bythe Democratic AGs against the
Trump administration.
But it's like when we say thatwe'll sue Donald Trump and his
(00:44):
administration every day if wehave to I don't think everyone
knew that we were being soliteral about that, but it's
turned out to be a lot oflitigation.
But I think we should be reallyclear about it.
It's because there's so manyillegal actions by the
administration that allows us tofile these lawsuits Even
oftentimes, of course, forthings that he could do legally
(01:07):
if he chose to.
He just doesn't want to.
Attorney General Kris Maye (01:09):
Well , I think that's really the
point, and I get that question alot too, which is you know,
Kris, how many times are yougoing to sue Donald Trump?
And my answer always is I'llstop suing Donald Trump and Elon
Musk and Doge when they stopdoing unconstitutional things,
and Elon Musk and Doge when theystopped doing unconstitutional
things.
And they could try I'm not surethey would succeed with many of
(01:33):
the things they're doing, butthey could try to do them the
constitutional way by going toCongress, and I think obviously
one of the reasons that we'rehaving so much success with
these lawsuits I think we'reboth up in the 18 lawsuit range.
In almost all of those, we'veachieved a temporary restraining
order or a preliminaryinjunction, which is a lot of
winning.
That's going on.
Attorney General Dana Ness (01:54):
Yeah , and I think what's interesting
too is we are seeing in a lotof cases where you have an
action or a proposed action thatthe administration is going to
take and when they get enoughpushback, sometimes they just
drop it altogether.
And it's really an importantand valuable lesson.
Whether I'm having town halls,which I know you're doing, many
of those-
Attorney General Kris Mayes (02:14):
I see you out there on social
media.
Attorney General Dana Nessel (02:16):
We are, but we're also doing now
smaller meetings with specificstakeholders.
So let me just tell you, I wentup to Traverse City this last
weekend and on Saturday andSunday.
First of all, we worked with acoalition of folks representing
libraries and museums.
And obviously we know what'shappened there.
We talked to a bunch of peoplewho are, I should say were
(02:39):
employed with AmeriCorps, talkedabout their work, and we also
went to, you know, sleeping BearDunes, the national park that I
always talk about, and wetalked to- I couldn't get
anybody who works there now, butI got the former director of
the park to sort of walk throughwith me what was happening at
the park as a result of fundingcuts and the.
(03:03):
You know, the one thing that Iwas hearing over and over again
is that people were afraid tosay anything because they
thought it would only make thesituation worse.
Attorney General Kris Maye (03:11):
Yeah , right
Attorney General Dana Nessel (03:12):
, but what I think we've both seen
is that actually speaking upcan cause the administration to
change their mind, and sometimesit's because they lose in court
and then they don't want toproceed because they don't see a
pathway for them legally.
But many times as well, theadministration just gets so much
opposition, including fromother Republicans, that they see
(03:36):
it's not viable politicallyanymore.
Attorney General Kris Maye (03:38):
Yeah , I mean, I mean that's a really
good point and it is why I meanit's our job to stand up for
the people of our states, tostand up for the Constitution
but also, you know, the rule oflaw.
But I'm hearing the same thingsthat you're hearing.
We have done, I think, 11, I'vedone 11 total town halls, most
(04:01):
of them in Arizona, a couple inother states.
But up in Flagstaff, where wehad 250 people turn out, we had
a few workers from the GrandCanyon National Park turn out
and talk about like one woman,one ranger spoke about the fact
that they have laid off so manypeople that in the campground,
(04:22):
one of the campgrounds, thetoilets are literally
overflowing with crap which is apublic health issue.
Attorney General Dana Nes (04:31):
Right , it is a public health issue.
And actually, when I spoke tothe park rangers at Sleeping
Bear Dunes, they said that therewere going to be a number of
their facilities they were goingto have to close down
altogether because they justsimply didn't have the summer
workers to maintain them.
So they were going to closethem.
Which means, you know, now, fora lot of people that want to be
able to enjoy that park butalso maybe don't want to have to
(04:53):
dig a little ditch forthemselves, you know they're
just not going to go, ratherthan have that kind of
experience.
And the problem is, you know,as this former director relate
to me, is that you know, word ofmouth travels fast and if
people are like I went to thatnational park, it was a complete
mess the the trails were notproperly cut and the restrooms
(05:17):
were unusable.
You're not going to go.
Attorney General Kris Mayes (05:19):
No, or it took.
It took me four hours to getinto the Grand Canyon National
Park because they didn't haveenough people at the entrance to
let people in or they couldn't.
No, you're not going to go.
And then not only does thatdisrupt the experience of the
people who want to go to ournational parks, which belong to
the people of America, but italso affects the economies
(05:42):
around the parks.
Attorney General Dana Nesse (05:51):
And you're also talking about the
massive defunding of all ournonprofits, right, because
nonprofits?
Usually they're sustained fromfederal grants, state money and
then, of course, whatevercontributions people have.
Well, if people aren't makingany money, those donors are
(06:13):
going to close their pocketbooks.
They're not going to becontributing the state.
You know, in Michigan, 42% ofour budget, of our state budget,
comes from the federalgovernment.
So now they're not going tohave the money to provide grants
to these nonprofits, andnonprofits provide so many
services to people that I don'tthink people fully understand or
grasp.
And even talking to thoseAmeriCorps workers, you know
(06:34):
many of them are involved in alot of these food sustainability
programs, right, yeah, they'rethe ones that are feeding people
in impoverished areas andgrowing the food and
distributing the food for themthe food banks, the food
pantries and also Meals onWheels.
We are literally talking aboutstarving people to death.
It is that significant.
(06:55):
Here we are in one of thewealthiest countries in the
world and we're going to have asignificant number of people who
literally won't be able to havefood to eat because of these
cuts made for literallyabsolutely no reason at all.
Attorney General Kris Maye (07:11):
It's insane.
That doesn't even speak to thedisruptions to Social Security
that we have been seeing,although, as you pointed out, it
looks like the Trumpadministration may have backed
off a couple of the things thatthey were doing to disrupt
Social Security.
We'll see what that looks like.
And then we have Medicaid,which is what we're talking
(07:34):
about on this episode.
I mean, it feels like theperfect storm in all the worst
ways, when you put together thecuts to the federal agencies,
the cuts to grants to nonprofits, the cuts, the problems with
Social Security, profits, thecuts, the problems with Social
(07:58):
Security, and then you layer ontop of that the proposed cuts to
Medicaid, which are enormous, Ithink, nationally.
The latest proposal thatCongress, the Republicans in
Congress and Trump are lookingat would gut Medicaid by upwards
of $715 billion in order toprovide a $4 trillion tax break
(08:20):
for the wealthiest Americans,and I think it's important to
note also that it would balloonthe deficit and our debt.
Attorney General Dana Nesse (08:30):
And in Michigan.
I mean, we're talking aboutbetween 700 to 750,000
Michiganders who are going tolose their health insurance
should this big beautiful billbe passed.
And just as the time of thistaping, you know, there's the
president trying to strong armthe members of his own party who
, I think, see the writing onthe wall, the wall and they just
(08:55):
absolutely know like they'renot going to be back again after
the 2026 election, in the eventthat they go through with this,
because it's going to impact somany of their constituents.
And even talking about it froman economic perspective, people
who aren't healthy can't work.
Yeah.
Attorney General Kris Mayes (09:11):
I mean, I don't know how this
makes America healthy again.
Dana Like this is not Maha.
This does not make Americahealthy again to strip people of
their health insurance.
Attorney General Dana Nessel (09:22):
I just think it's important that
we make this point to everybody.
You know who is listening tothis or sharing it, but the only
thing that actually works isspeaking out.
And you know you again.
If you're somebody who supportedthis president, it doesn't
matter.
If you see what's happening nowand you see that it's hurting
yourself and your family and themembers of your community, it
(09:46):
is more important than ever tosay this is bad for people in my
state, this is bad for peoplein my community, for all of
these many different reasons,and to keep it up to call your
congressional representative, tocall your US senators, to call
your state electeds, to calleverybody that you can to do,
whether you're doing op-eds inthe local paper, whether you're
(10:07):
filming a video on Instagram andcirculating it amongst all the
people that you know, whetheryou're going to local city
council or county commissionmeetings and you get your three
minutes and you wait through themeeting and your three minutes
is talking about hey, I wanteveryone to understand how bad
this is for this town.
It's important to make yourvoice heard because it is
(10:30):
actually making a difference and, yes, our lawsuits make a
difference.
But this is an all hands ondeck situation, right where we
have to try everything.
We have to try, you know,talking to our representatives
and congressionals.
We have to, you know, filethese lawsuits and we have to be
really loud and talk about howwe want to preserve all the
(10:50):
things that make America greatfor us, and that includes, of
course, us having healthinsurance, which everybody
deserves.
Attorney General Kris Ma (10:57):
People are coming to our town halls
who are not, who are, who areRepublicans, independents and
Democrats, and I think that is agood thing.
I think that's frankly abeautiful thing, and I'm going
to keep doing my town halls andmeetings as long as people will
come in and listen to me.
Attorney General Dan (11:15):
Absolutely .
These conversations matter.
Attorney General Kris Maye (11:24):
They do Well.
Hello everybody.
We are talking today to JoanAlker, who is the executive
director and co-founder of theCenter for Children and Families
and a research professor at theGeorgetown University McCourt
School of Public Policy.
(11:45):
Joan is a nationally recognizedexpert on Medicaid and the
Children's Health InsuranceProgram, CHIP, and she's going
to give us some insights intohow these proposed Medicaid cuts
would affect the health carelandscape nationwide, especially
for children and in small townsand rural communities.
(12:10):
So welcome, Joan.
Thank you so much for joiningme.
Dana couldn't be with us forthis interview, but she sends
her regards and thank you forbeing with us and for being
willing to talk to us about thisincredibly important topic.
So I guess what I would love tostart with is, as we know,
(12:31):
oftentimes when we're talkingabout Medicaid the conversations
get sort of bogged down instatistics.
It can sort of start to feelvery wonky very quickly, but
health care and insurance are,in all honesty, really deeply
personal topics, incrediblyimportant to all of us, and it's
so taboo sometimes that folksdon't often discuss the reality
(12:54):
of Medicaid with their friendsand neighbors.
Even so, help us set the recordstraight how do Americans
qualify for Medicaid and whodoes Medicaid serve today?
Joan Alker (13:11):
Sure Well, thanks so much for having me.
It's a pleasure to be here andyou know I often say Medicaid is
the backbone of the UnitedStates health care system.
It's performing many, manydifferent functions and it's
actually doing things that otherparts of our health care system
aren't doing.
So I'll talk first with how doesMedicaid serve seniors and, of
(13:35):
course, Medicaid not to beconfused with Medicare, which is
the primary health care programfor seniors and people with
disabilities in some instances,but Medicare does not cover long
term care.
So that is a very, veryimportant function that Medicaid
is playing in essentiallymaking Medicare work for seniors
(13:58):
in our country and families andolder adults who need long term
care.
Both Medicaid is paying for themajority of folks in nursing
homes.
Medicaid is also supportinghome and community based care
for seniors and people withdisabilities and it's also
paying the cost sharing for the20% of the poorest seniors on
(14:19):
Medicare, because thosedeductibles and co-pays can get
pretty high if you're on a fixedincome and it's low.
So at the other end of thespectrum of life, Medicaid is
the most important public payerfor births and paying for over
40% of births nationally and inrural communities, paying for
(14:40):
almost half of all births.
Attorney General Kris Mayes (14:43):
Wow , that's a statistic.
Joan Alker (14:46):
Yeah, and then Medicaid is doing lots of things
in between.
So Medicaid and its sisterprogram, CHIP, is covering
almost half of children in theUnited States, so it goes beyond
low income to moderate incomefamilies because there's higher
eligibility for children.
And then, of course, medicaidis covering lots of people with
(15:07):
disabilities and lots of lowwage working adults and parents
Attorney General Kris Mayes (15:14):
Wow , you know, it's just a really
important point.
I think that you make that somany Americans rely on that.
Toward the end of our lives,and especially as we live longer
or we experience illnesses likeAlzheimer's, this becomes all
(15:34):
the more important that we havethis safety net.
Joan Alker (15:37):
Yeah, absolutely, and of course we have an aging
population in this country, andso the need for long-term care
is going to grow.
Attorney General Kris Mayes (15:50):
And I guess in Michigan the
statistic is that more than 2.6million Michiganders are on
Medicaid.
Over 200,000 Medicaid-enrolledproviders are in Michigan, and
that includes 1 million children.
And I think we have someArizona statistics here too:
(16:18):
nearly 2.2 million Arizonans areenrolled in Medicaid, which is
what we call ACCESS or kidscare, which is our CHIP program,
with 93000 Medicaid enrolledproviders.
So I guess would it be fair tosay that's not unusual for
states and other states wouldhave a similar story to tell.
Joan Alker (16:37):
Yeah, they would certainly.
On the children's side of theequation, because, I mentioned,
medicaid is covering between 40and 50 percent of children
nationwide.
That does vary by state, butit's incredibly important
program along with CHIP for kidsand, of course, if states have
picked up the Affordable CareAct, medicaid expansion for
adults, which both Arizona andMichigan have.
(16:58):
It's a more important source ofcoverage for parents and
low-wage working adults.
Attorney General Kris Ma (17:05):
That's a great point.
So we keep hearing about howthese cuts would have an
outsized impact on ruralcommunities, and I think you've
sort of spoken a little bit tothis already.
But why is that?
And then why should Americanswho don't live in a small town
care about health carecapabilities and other less
(17:26):
populated parts of the country?
Joan Alker (17:29):
Yeah.
So this is a project we've beenworking on for about 10 years
now, looking at Medicaid's rolein rural communities and small
towns, and you know we'vealready talked about Medicaid is
incredibly important foreverywhere, Every.
There's no part of the country.
There's not many familiesaround that are very far removed
(17:51):
from Medicaid for one reason oranother But as important as
Medicaid is for our health caresystem more generally, it's even
more important for rural areasand small towns and I think
folks you know maybe think, oh,you know, this is more like
people in cities who rely onMedicaid.
Well, that's actually not true.
(18:11):
There's a higher rate ofMedicaid being your health
insurer if you live in a ruralcommunity, small towns, if you
are a child or if you're anon-elderly adult, and so we've
been looking at this data forsome time and it's interesting
because the ACA Medicaidexpansion, which is very much
under attack right now inCongress, has been really
(18:32):
important for rural communitiesunder attack right now in
Congress has been reallyimportant for rural communities
and you do see these highershares, both in terms of
children we talked about birthsup front, higher percent of
births covered in rural areasand the reality is that rural
areas and small towns arealready struggling with access
to health care.
Right, I mean they.
There have been rural hospitalshave been closing.
(18:54):
We have a new report coming outin a couple of days looking
specifically women ofchildbearing age in rural
communities, and that iscritical because rural
communities have lost labor anddelivery units.
They've lost obstetric servicescapacities in those rural
hospitals.
So if there's nowhere to have ababy safely, it's really hard
(19:16):
for a community to grow andthrive.
Attorney General Kris Mayes (19:18):
Can you speak more to the provider
shortage in rural America, likewhat is going on with that,
because that is definitelysomething, like I said, that
we've seen here in Arizona.
Joan Alker (19:30):
Many, many communities have been facing
these provider shortages, andthat's a huge problem that needs
to be addressed.
This is exactly why we worry somuch about these Medicaid cuts
and their impact on ruralcommunities, because not only do
they have these providershortages already, they also
(19:51):
have, and one of the reasons whyrural communities do rely on
Medicaid more is because theytend to have lower income.
Right, they're just not doingas well and they have more
people who are aging, they havemore people with disabilities,
so they have a profile of folkswho really are going to have to
rely on Medicaid.
So there are ways to look atthings like telehealth.
(20:15):
You know other ways to try torely on Medicaid, so there are
ways to look at things liketelehealth.
You know other ways to try toaddress some of these provider
shortages, but that's not goingto help when you have a heart
attack or you want to have ababy.
Attorney General Kris Maye (20:39):
Well , let me back up a little bit
and go to some of theseproposals for Medicaid cuts.
As you're looking at this, whatin your mind is the worst case
scenario and what would it meanto our states if Congress were
actually to do it?
Joan Alker (20:57):
Well, a timely question, because Congress is
literally working on this rightnow, as we're taping this, and
the Congressional Budget Office,which is the nonpartisan kind
of scorekeeper, just releasedsome information and I have to
say it's actually incomplete.
It doesn't cover all of thecuts in the bill.
(21:18):
The Republicans are moving cutsin the in the bill the
republicans are moving, but soit would be at least 625 billion
dollars of cuts over the10-year period in medicaid, and
it's, it's more than that.
We don't have a complete numberyet
Attorney General Kris Mayes (21:29):
wow
Joan Alker (21:30):
yeah,
Attorney General Kris Maye (21:31):
$610 billion , with a b?
Joan Alker (21:34):
$625 billion correct
Attorney General Kris Mayes (21:37):
wow , and and what is that?
What does that look like?
What does that mean?
Joan Alker (21:44):
Yeah.
So you know I'll say I've beenworking on Medicaid for a couple
of decades now.
This is definitely by far thelargest cut and attack on
Medicaid that I've ever seen.
There are ways that Congress isgoing about this.
As you can imagine, it's verycomplicated.
Medicaid policy is verycomplicated and there's been an
(22:07):
interesting dynamic within theRepublican Party because the
Republicans are very nervousabout this.
Ok, we should be.
We've had the president's ownpollster, Tony Fabrizio, come
out and say don't cut Medicaid.
You know and have some pollingdata to indicate that voters of
all political stripes do notwant Congress to cut Medicaid.
(22:30):
It's like literally the lastthing they want, but yet
Congress is moving ahead to cutMedicaid.
There's kinda something in herefor everyone to get hurt in
terms of states, there's avariety of proposals.
Quite a few of the proposalsare kind of a direct attack on
people who are getting coveragethrough the ACA Medicaid
Expansion, like the workrequirement, which we can talk
about.
But there are also proposals inhere, them some of them they
haven't t of e t Quite 'teven estimated the the cuts yet
that are really complicatedabout changing the way states
(23:06):
raise their share.
So states this is a federalstate matching program, so
states put up their money andthey draw down the federal money
.
So some of the proposals thatthey're considering limit the
ways that states can raise theirshare and so those kind of
proposals are going to hit allstates really red states, blue
(23:30):
states, even if you've doneMedicaid expansion under the ACA
or not.
So there are lots of things inhere.
Obviously the impact will varystate by state, but all states I
would say
Attorney General Kris Mayes (23:44):
Wow , that's just stunning.
Hard to believe, but it seemslike they are at least trying to
head down that path.
It's it's catastrophic.
So could you talk about thatwork?
Proposed work requirement.
So these are the proposed workrequirements for Medicaid
beneficiaries.
Have measures like that beenattempted in the past?
(24:07):
How did that play out?
And then, what are some of theunintended consequences of
forcing sick people into theworkforce?
Joan Alker (24:17):
Yeah.
So this has been a big topic ofdiscussion, I'd say, since
President Trump's first term inoffice, and at that time we had
some states that that triedthese out.
Ok, this was a voluntaryagreement between states and the
federal government to try thisconcept, and the proponents of
(24:38):
work requirements say that thereason to do them is because
they want people to work, andthey, you know they want people
to work.
Okay, I mean, that's a fairgoal.
I think that's a fair goal forgovernment, right, it sounds
good.
It's not.
You know, government might wantto try to support work, but
unfortunately this policy has itexactly backwards.
(25:01):
If you want to support work and, by the way, most of these
adults who can work are alreadyworking but if you want to
(25:23):
support more of these folksworking, then you've got to
address their barriers to work,like child care, affordable
child care, the lack of jobs ortransportation, particularly in
rural communities.
But, most importantly, helpingpeople be more healthy is going
to help them work.
So taking away their access tohealth care has it backwards, in
my view, because people areless likely to be able to work
if they're not able to addresstheir chronic conditions that
are preventing them fromentering the workforce.
Attorney General Kris Maye (25:45):
Yeah , so how?
I mean, how would the workrequirements actually work?
I mean, what would?
What would that look like?
Joan Alker (25:52):
Yeah, and I'll tell you, we've had.
We've seen these in two statesArkansas, which enacted this on
the first Trump term, andGeorgia has has one in place
right now.
And, unfortunately, as apractical matter, what happens
is that states have to set upvery complicated bureaucratic
(26:13):
red tape systems to kind ofdelve into every aspect of your
life, right, so you have toreport work hours, but then
there's all these exemptions.
So if you have, you'remedically frail or you're doing
this out of the other thing, youcan get an exemption.
So you have to prove that tothe government.
And so what has happened inpractice is that folks in
(26:35):
particularly in Arkansas, wherewe saw this rollout very quickly
, thousands of people lost theirhealth insurance because they
didn't know they were supposedto do this.
The website bizarrely went downat night when people who were
working could actually entertheir hours.
The website didn't work as amatter of choice.
(26:56):
So there's just been all thesered tape barriers and the
practical effect has been thatpeople lose coverage.
And what's really shockingbecause I've been saying for a
long time that this policy has abackwards, it's not going to
work, it just doesn't workexpand coverage ironically it's
(27:23):
called pathways to coverage, butin fact, only a few thousand
people have made it down thepathway and in the first year,
90 of the money went tocorporate consultants to fund
the construction of all this redtape.
Attorney General Kris Mayes (27:34):
Wow
Joan Alker (27:36):
so it's fiscally.
Oh, it's been shocking to me.
I always figured there'd behigh administrative costs, but
what's happened in Georgia isreally quite shocking the use of
taxpayer dollars there and, infact, the House bill this, this
is really a fun fact.
So this is their kind ofmarquee policy, right?
(27:56):
This is the one thing all theRepublicans in the caucus can
agree on.
Well, first of all, it has thelatest implementation date
January 1st 2029, after the nextpresidential election.
So they know this isn't goingto work because they've pushed
(28:21):
it back to presumably when Trumpis going to be out of office.
Because they know that it isgoing to require so many costly
IT consultants and all folks toset up the red tape.
Attorney General Kris May (28:36):
We've sort of touched on this a
little bit.
I wonder if you could speak tothe idea that health care really
is one of the largestindustries driving our economy
right now.
You certainly can see that in alot of different ways.
How would a significant, abruptloss of funding affect
(29:04):
stability or profits across thewhole health care industry?
And I would just say I've got acouple of statistics here.
For instance, michigan'shealthcare industry is the
largest industry in that statewith a total economic impact of
$77 billion a year.
And then here in Arizonahealthcare is also the largest
employment sector in Arizona,employing over 400,000 people
(29:26):
directly.
240,000 new jobs have beencreated in Arizona in the health
care sector since the year 2000.
So obviously it's important.
What would these cuts mean inthat respect?
Joan Alker (29:40):
Yeah, I mean, as we've talked about, there are
economic effects of cuttingMedicaid associated job loss.
I think the kinds of providerswho could be particularly hard
hit by some of these proposalsCongress is considering include
long-term care facilities.
We talked about Medicaid beingthe largest payer for long term
(30:01):
care facilities.
Hospitals, particularly ruralhospitals, are very upset about
these proposals and what couldhappen to them.
And then you know the flip sideis, like I said before, these
are not doing anything toaddress the provider shortages
we have.
And I'll flag another areabehavioral health.
We haven't talked aboutbehavioral health, but we have a
(30:23):
huge behavioral health crisisin this country.
Medicaid is the largest payerfor behavioral health and
substance use disorder treatment, so that's another piece of the
puzzle that I'd really worryabout.
Of course, we need moreproviders there across payers,
right?
There's a shortage for anybody,regardless of what kind of
(30:45):
insurance you have.
Attorney General Kris Mayes (30:47):
And what time frame do you
anticipate this being addressedby Congress?
Joan Alker (30:51):
Yeah, well, they're moving on it now in the House.
They're trying to get the billto the floor soon, but in
general I think they're going tohave to be done by August,
because they're trying to putthe debt ceiling limit on this
bill and we've just heard fromthe Treasury Secretary they're
going to hit the debt ceilinglimit in August.
So I think you know right now.
The rest of May, june and Julyare really the time when
(31:15):
Congress is going to be dealingwith this.
Attorney General Kris Mayes (31:18):
All right.
Well, it is crunch time forMedicaid dealing with this, all
right.
Well, it is crunch time forMedicaid, and we appreciate you,
joan, for helping guide usthrough this incredibly
important topic that will impactour country for years and
decades to come.
So, joan Alker from GeorgetownUniversity, thank you so much
for joining us.
We really appreciate it.
Joan Alker (31:37):
Thanks so much for having me.
Attorney General Dana Ness (31:44):
Well , that's all we have time for
today.
Attorney General Kris Ma (31:46):
Thanks for joining us on Pantsuits and
Lawsuits.
For more information, you cancheck out our websites or follow
us on social media.
Attorney General Dana Nesse (31:56):
Yep , and we'll be back in just
another few weeks with someinsightful discussions shining a
light on the legal issuesaffecting everyday Americans
like us.
Attorney General Kris May (32:08):
Until next time.
Welcome back to another episode of
pantsuits and lawsuits, yourone-stop shop to find out what
you need to know about the mostpressing legal topics impacting
America today, and it's great tobe back with you, Dana.
Attorney General Dana Ness (00:23):
It's great to be back with you, Kris
.
You know it's hard to keeptrack because I know every time
we get together we talk aboutsome of the latest and greatest
lawsuits that have been filed bythe Democratic AGs against the
Trump administration.
But it's like when we say thatwe'll sue Donald Trump and his
(00:44):
administration every day if wehave to I don't think everyone
knew that we were being soliteral about that, but it's
turned out to be a lot oflitigation.
But I think we should be reallyclear about it.
It's because there's so manyillegal actions by the
administration that allows us tofile these lawsuits Even
oftentimes, of course, forthings that he could do legally
(01:07):
if he chose to.
He just doesn't want to.
Attorney General Kris Maye (01:09):
Well , I think that's really the
point, and I get that question alot too, which is you know,
Kris, how many times are yougoing to sue Donald Trump?
And my answer always is I'llstop suing Donald Trump and Elon
Musk and Doge when they stopdoing unconstitutional things,
and Elon Musk and Doge when theystopped doing unconstitutional
things.
And they could try I'm not surethey would succeed with many of
(01:33):
the things they're doing, butthey could try to do them the
constitutional way by going toCongress, and I think obviously
one of the reasons that we'rehaving so much success with
these lawsuits I think we'reboth up in the 18 lawsuit range.
In almost all of those, we'veachieved a temporary restraining
order or a preliminaryinjunction, which is a lot of
winning.
That's going on.
Attorney General Dana Ness (01:54):
Yeah , and I think what's interesting
too is we are seeing in a lotof cases where you have an
action or a proposed action thatthe administration is going to
take and when they get enoughpushback, sometimes they just
drop it altogether.
And it's really an importantand valuable lesson.
Whether I'm having town halls,which I know you're doing, many
of those-
Attorney General Kris Mayes (02:14):
I see you out there on social
media.
Attorney General Dana Nessel (02:16):
We are, but we're also doing now
smaller meetings with specificstakeholders.
So let me just tell you, I wentup to Traverse City this last
weekend and on Saturday andSunday.
First of all, we worked with acoalition of folks representing
libraries and museums.
And obviously we know what'shappened there.
We talked to a bunch of peoplewho are, I should say were
(02:39):
employed with AmeriCorps, talkedabout their work, and we also
went to, you know, sleeping BearDunes, the national park that I
always talk about, and wetalked to- I couldn't get
anybody who works there now, butI got the former director of
the park to sort of walk throughwith me what was happening at
the park as a result of fundingcuts and the.
(03:03):
You know, the one thing that Iwas hearing over and over again
is that people were afraid tosay anything because they
thought it would only make thesituation worse.
Attorney General Kris Maye (03:11):
Yeah , right
Attorney General Dana Nessel (03:12):
, but what I think we've both seen
is that actually speaking upcan cause the administration to
change their mind, and sometimesit's because they lose in court
and then they don't want toproceed because they don't see a
pathway for them legally.
But many times as well, theadministration just gets so much
opposition, including fromother Republicans, that they see
(03:36):
it's not viable politicallyanymore.
Attorney General Kris Maye (03:38):
Yeah , I mean, I mean that's a really
good point and it is why I meanit's our job to stand up for
the people of our states, tostand up for the Constitution
but also, you know, the rule oflaw.
But I'm hearing the same thingsthat you're hearing.
We have done, I think, 11, I'vedone 11 total town halls, most
(04:01):
of them in Arizona, a couple inother states.
But up in Flagstaff, where wehad 250 people turn out, we had
a few workers from the GrandCanyon National Park turn out
and talk about like one woman,one ranger spoke about the fact
that they have laid off so manypeople that in the campground,
(04:22):
one of the campgrounds, thetoilets are literally
overflowing with crap which is apublic health issue.
Attorney General Dana Nes (04:31):
Right , it is a public health issue.
And actually, when I spoke tothe park rangers at Sleeping
Bear Dunes, they said that therewere going to be a number of
their facilities they were goingto have to close down
altogether because they justsimply didn't have the summer
workers to maintain them.
So they were going to closethem.
Which means, you know, now, fora lot of people that want to be
able to enjoy that park butalso maybe don't want to have to
(04:53):
dig a little ditch forthemselves, you know they're
just not going to go, ratherthan have that kind of
experience.
And the problem is, you know,as this former director relate
to me, is that you know, word ofmouth travels fast and if
people are like I went to thatnational park, it was a complete
mess the the trails were notproperly cut and the restrooms
(05:17):
were unusable.
You're not going to go.
Attorney General Kris Mayes (05:19):
No, or it took.
It took me four hours to getinto the Grand Canyon National
Park because they didn't haveenough people at the entrance to
let people in or they couldn't.
No, you're not going to go.
And then not only does thatdisrupt the experience of the
people who want to go to ournational parks, which belong to
the people of America, but italso affects the economies
(05:42):
around the parks.
Attorney General Dana Nesse (05:51):
And you're also talking about the
massive defunding of all ournonprofits, right, because
nonprofits?
Usually they're sustained fromfederal grants, state money and
then, of course, whatevercontributions people have.
Well, if people aren't makingany money, those donors are
(06:13):
going to close their pocketbooks.
They're not going to becontributing the state.
You know, in Michigan, 42% ofour budget, of our state budget,
comes from the federalgovernment.
So now they're not going tohave the money to provide grants
to these nonprofits, andnonprofits provide so many
services to people that I don'tthink people fully understand or
grasp.
And even talking to thoseAmeriCorps workers, you know
(06:34):
many of them are involved in alot of these food sustainability
programs, right, yeah, they'rethe ones that are feeding people
in impoverished areas andgrowing the food and
distributing the food for themthe food banks, the food
pantries and also Meals onWheels.
We are literally talking aboutstarving people to death.
It is that significant.
(06:55):
Here we are in one of thewealthiest countries in the
world and we're going to have asignificant number of people who
literally won't be able to havefood to eat because of these
cuts made for literallyabsolutely no reason at all.
Attorney General Kris Maye (07:11):
It's insane.
That doesn't even speak to thedisruptions to Social Security
that we have been seeing,although, as you pointed out, it
looks like the Trumpadministration may have backed
off a couple of the things thatthey were doing to disrupt
Social Security.
We'll see what that looks like.
And then we have Medicaid,which is what we're talking
(07:34):
about on this episode.
I mean, it feels like theperfect storm in all the worst
ways, when you put together thecuts to the federal agencies,
the cuts to grants to nonprofits, the cuts, the problems with
Social Security, profits, thecuts, the problems with Social
(07:58):
Security, and then you layer ontop of that the proposed cuts to
Medicaid, which are enormous, Ithink, nationally.
The latest proposal thatCongress, the Republicans in
Congress and Trump are lookingat would gut Medicaid by upwards
of $715 billion in order toprovide a $4 trillion tax break
(08:20):
for the wealthiest Americans,and I think it's important to
note also that it would balloonthe deficit and our debt.
Attorney General Dana Nesse (08:30):
And in Michigan.
I mean, we're talking aboutbetween 700 to 750,000
Michiganders who are going tolose their health insurance
should this big beautiful billbe passed.
And just as the time of thistaping, you know, there's the
president trying to strong armthe members of his own party who
, I think, see the writing onthe wall, the wall and they just
(08:55):
absolutely know like they'renot going to be back again after
the 2026 election, in the eventthat they go through with this,
because it's going to impact somany of their constituents.
And even talking about it froman economic perspective, people
who aren't healthy can't work.
Yeah.
Attorney General Kris Mayes (09:11):
I mean, I don't know how this
makes America healthy again.
Dana Like this is not Maha.
This does not make Americahealthy again to strip people of
their health insurance.
Attorney General Dana Nessel (09:22):
I just think it's important that
we make this point to everybody.
You know who is listening tothis or sharing it, but the only
thing that actually works isspeaking out.
And you know you again.
If you're somebody who supportedthis president, it doesn't
matter.
If you see what's happening nowand you see that it's hurting
yourself and your family and themembers of your community, it
(09:46):
is more important than ever tosay this is bad for people in my
state, this is bad for peoplein my community, for all of
these many different reasons,and to keep it up to call your
congressional representative, tocall your US senators, to call
your state electeds, to calleverybody that you can to do,
whether you're doing op-eds inthe local paper, whether you're
(10:07):
filming a video on Instagram andcirculating it amongst all the
people that you know, whetheryou're going to local city
council or county commissionmeetings and you get your three
minutes and you wait through themeeting and your three minutes
is talking about hey, I wanteveryone to understand how bad
this is for this town.
It's important to make yourvoice heard because it is
(10:30):
actually making a difference and, yes, our lawsuits make a
difference.
But this is an all hands ondeck situation, right where we
have to try everything.
We have to try, you know,talking to our representatives
and congressionals.
We have to, you know, filethese lawsuits and we have to be
really loud and talk about howwe want to preserve all the
(10:50):
things that make America greatfor us, and that includes, of
course, us having healthinsurance, which everybody
deserves.
Attorney General Kris Ma (10:57):
People are coming to our town halls
who are not, who are, who areRepublicans, independents and
Democrats, and I think that is agood thing.
I think that's frankly abeautiful thing, and I'm going
to keep doing my town halls andmeetings as long as people will
come in and listen to me.
Attorney General Dan (11:15):
Absolutely .
These conversations matter.
Attorney General Kris Maye (11:24):
They do Well.
Hello everybody.
We are talking today to JoanAlker, who is the executive
director and co-founder of theCenter for Children and Families
and a research professor at theGeorgetown University McCourt
School of Public Policy.
(11:45):
Joan is a nationally recognizedexpert on Medicaid and the
Children's Health InsuranceProgram, CHIP, and she's going
to give us some insights intohow these proposed Medicaid cuts
would affect the health carelandscape nationwide, especially
for children and in small townsand rural communities.
(12:10):
So welcome, Joan.
Thank you so much for joiningme.
Dana couldn't be with us forthis interview, but she sends
her regards and thank you forbeing with us and for being
willing to talk to us about thisincredibly important topic.
So I guess what I would love tostart with is, as we know,
(12:31):
oftentimes when we're talkingabout Medicaid the conversations
get sort of bogged down instatistics.
It can sort of start to feelvery wonky very quickly, but
health care and insurance are,in all honesty, really deeply
personal topics, incrediblyimportant to all of us, and it's
so taboo sometimes that folksdon't often discuss the reality
(12:54):
of Medicaid with their friendsand neighbors.
Even so, help us set the recordstraight how do Americans
qualify for Medicaid and whodoes Medicaid serve today?
Joan Alker (13:11):
Sure Well, thanks so much for having me.
It's a pleasure to be here andyou know I often say Medicaid is
the backbone of the UnitedStates health care system.
It's performing many, manydifferent functions and it's
actually doing things that otherparts of our health care system
aren't doing.
So I'll talk first with how doesMedicaid serve seniors and, of
(13:35):
course, Medicaid not to beconfused with Medicare, which is
the primary health care programfor seniors and people with
disabilities in some instances,but Medicare does not cover long
term care.
So that is a very, veryimportant function that Medicaid
is playing in essentiallymaking Medicare work for seniors
(13:58):
in our country and families andolder adults who need long term
care.
Both Medicaid is paying for themajority of folks in nursing
homes.
Medicaid is also supportinghome and community based care
for seniors and people withdisabilities and it's also
paying the cost sharing for the20% of the poorest seniors on
(14:19):
Medicare, because thosedeductibles and co-pays can get
pretty high if you're on a fixedincome and it's low.
So at the other end of thespectrum of life, Medicaid is
the most important public payerfor births and paying for over
40% of births nationally and inrural communities, paying for
(14:40):
almost half of all births.
Attorney General Kris Mayes (14:43):
Wow , that's a statistic.
Joan Alker (14:46):
Yeah, and then Medicaid is doing lots of things
in between.
So Medicaid and its sisterprogram, CHIP, is covering
almost half of children in theUnited States, so it goes beyond
low income to moderate incomefamilies because there's higher
eligibility for children.
And then, of course, medicaidis covering lots of people with
(15:07):
disabilities and lots of lowwage working adults and parents
Attorney General Kris Mayes (15:14):
Wow , you know, it's just a really
important point.
I think that you make that somany Americans rely on that.
Toward the end of our lives,and especially as we live longer
or we experience illnesses likeAlzheimer's, this becomes all
(15:34):
the more important that we havethis safety net.
Joan Alker (15:37):
Yeah, absolutely, and of course we have an aging
population in this country, andso the need for long-term care
is going to grow.
Attorney General Kris Mayes (15:50):
And I guess in Michigan the
statistic is that more than 2.6million Michiganders are on
Medicaid.
Over 200,000 Medicaid-enrolledproviders are in Michigan, and
that includes 1 million children.
And I think we have someArizona statistics here too:
(16:18):
nearly 2.2 million Arizonans areenrolled in Medicaid, which is
what we call ACCESS or kidscare, which is our CHIP program,
with 93000 Medicaid enrolledproviders.
So I guess would it be fair tosay that's not unusual for
states and other states wouldhave a similar story to tell.
Joan Alker (16:37):
Yeah, they would certainly.
On the children's side of theequation, because, I mentioned,
medicaid is covering between 40and 50 percent of children
nationwide.
That does vary by state, butit's incredibly important
program along with CHIP for kidsand, of course, if states have
picked up the Affordable CareAct, medicaid expansion for
adults, which both Arizona andMichigan have.
(16:58):
It's a more important source ofcoverage for parents and
low-wage working adults.
Attorney General Kris Ma (17:05):
That's a great point.
So we keep hearing about howthese cuts would have an
outsized impact on ruralcommunities, and I think you've
sort of spoken a little bit tothis already.
But why is that?
And then why should Americanswho don't live in a small town
care about health carecapabilities and other less
(17:26):
populated parts of the country?
Joan Alker (17:29):
Yeah.
So this is a project we've beenworking on for about 10 years
now, looking at Medicaid's rolein rural communities and small
towns, and you know we'vealready talked about Medicaid is
incredibly important foreverywhere, Every.
There's no part of the country.
There's not many familiesaround that are very far removed
(17:51):
from Medicaid for one reason oranother But as important as
Medicaid is for our health caresystem more generally, it's even
more important for rural areasand small towns and I think
folks you know maybe think, oh,you know, this is more like
people in cities who rely onMedicaid.
Well, that's actually not true.
(18:11):
There's a higher rate ofMedicaid being your health
insurer if you live in a ruralcommunity, small towns, if you
are a child or if you're anon-elderly adult, and so we've
been looking at this data forsome time and it's interesting
because the ACA Medicaidexpansion, which is very much
under attack right now inCongress, has been really
(18:32):
important for rural communitiesunder attack right now in
Congress has been reallyimportant for rural communities
and you do see these highershares, both in terms of
children we talked about birthsup front, higher percent of
births covered in rural areasand the reality is that rural
areas and small towns arealready struggling with access
to health care.
Right, I mean they.
There have been rural hospitalshave been closing.
(18:54):
We have a new report coming outin a couple of days looking
specifically women ofchildbearing age in rural
communities, and that iscritical because rural
communities have lost labor anddelivery units.
They've lost obstetric servicescapacities in those rural
hospitals.
So if there's nowhere to have ababy safely, it's really hard
(19:16):
for a community to grow andthrive.
Attorney General Kris Mayes (19:18):
Can you speak more to the provider
shortage in rural America, likewhat is going on with that,
because that is definitelysomething, like I said, that
we've seen here in Arizona.
Joan Alker (19:30):
Many, many communities have been facing
these provider shortages, andthat's a huge problem that needs
to be addressed.
This is exactly why we worry somuch about these Medicaid cuts
and their impact on ruralcommunities, because not only do
they have these providershortages already, they also
(19:51):
have, and one of the reasons whyrural communities do rely on
Medicaid more is because theytend to have lower income.
Right, they're just not doingas well and they have more
people who are aging, they havemore people with disabilities,
so they have a profile of folkswho really are going to have to
rely on Medicaid.
So there are ways to look atthings like telehealth.
(20:15):
You know other ways to try torely on Medicaid, so there are
ways to look at things liketelehealth.
You know other ways to try toaddress some of these provider
shortages, but that's not goingto help when you have a heart
attack or you want to have ababy.
Attorney General Kris Maye (20:39):
Well , let me back up a little bit
and go to some of theseproposals for Medicaid cuts.
As you're looking at this, whatin your mind is the worst case
scenario and what would it meanto our states if Congress were
actually to do it?
Joan Alker (20:57):
Well, a timely question, because Congress is
literally working on this rightnow, as we're taping this, and
the Congressional Budget Office,which is the nonpartisan kind
of scorekeeper, just releasedsome information and I have to
say it's actually incomplete.
It doesn't cover all of thecuts in the bill.
(21:18):
The Republicans are moving cutsin the in the bill the
republicans are moving, but soit would be at least 625 billion
dollars of cuts over the10-year period in medicaid, and
it's, it's more than that.
We don't have a complete numberyet
Attorney General Kris Mayes (21:29):
wow
Joan Alker (21:30):
yeah,
Attorney General Kris Maye (21:31):
$610 billion , with a b?
Joan Alker (21:34):
$625 billion correct
Attorney General Kris Mayes (21:37):
wow , and and what is that?
What does that look like?
What does that mean?
Joan Alker (21:44):
Yeah.
So you know I'll say I've beenworking on Medicaid for a couple
of decades now.
This is definitely by far thelargest cut and attack on
Medicaid that I've ever seen.
There are ways that Congress isgoing about this.
As you can imagine, it's verycomplicated.
Medicaid policy is verycomplicated and there's been an
(22:07):
interesting dynamic within theRepublican Party because the
Republicans are very nervousabout this.
Ok, we should be.
We've had the president's ownpollster, Tony Fabrizio, come
out and say don't cut Medicaid.
You know and have some pollingdata to indicate that voters of
all political stripes do notwant Congress to cut Medicaid.
(22:30):
It's like literally the lastthing they want, but yet
Congress is moving ahead to cutMedicaid.
There's kinda something in herefor everyone to get hurt in
terms of states, there's avariety of proposals.
Quite a few of the proposalsare kind of a direct attack on
people who are getting coveragethrough the ACA Medicaid
Expansion, like the workrequirement, which we can talk
about.
But there are also proposals inhere, them some of them they
haven't t of e t Quite 'teven estimated the the cuts yet
that are really complicatedabout changing the way states
(23:06):
raise their share.
So states this is a federalstate matching program, so
states put up their money andthey draw down the federal money
.
So some of the proposals thatthey're considering limit the
ways that states can raise theirshare and so those kind of
proposals are going to hit allstates really red states, blue
(23:30):
states, even if you've doneMedicaid expansion under the ACA
or not.
So there are lots of things inhere.
Obviously the impact will varystate by state, but all states I
would say
Attorney General Kris Mayes (23:44):
Wow , that's just stunning.
Hard to believe, but it seemslike they are at least trying to
head down that path.
It's it's catastrophic.
So could you talk about thatwork?
Proposed work requirement.
So these are the proposed workrequirements for Medicaid
beneficiaries.
Have measures like that beenattempted in the past?
(24:07):
How did that play out?
And then, what are some of theunintended consequences of
forcing sick people into theworkforce?
Joan Alker (24:17):
Yeah.
So this has been a big topic ofdiscussion, I'd say, since
President Trump's first term inoffice, and at that time we had
some states that that triedthese out.
Ok, this was a voluntaryagreement between states and the
federal government to try thisconcept, and the proponents of
(24:38):
work requirements say that thereason to do them is because
they want people to work, andthey, you know they want people
to work.
Okay, I mean, that's a fairgoal.
I think that's a fair goal forgovernment, right, it sounds
good.
It's not.
You know, government might wantto try to support work, but
unfortunately this policy has itexactly backwards.
(25:01):
If you want to support work and, by the way, most of these
adults who can work are alreadyworking but if you want to
(25:23):
support more of these folksworking, then you've got to
address their barriers to work,like child care, affordable
child care, the lack of jobs ortransportation, particularly in
rural communities.
But, most importantly, helpingpeople be more healthy is going
to help them work.
So taking away their access tohealth care has it backwards, in
my view, because people areless likely to be able to work
if they're not able to addresstheir chronic conditions that
are preventing them fromentering the workforce.
Attorney General Kris Maye (25:45):
Yeah , so how?
I mean, how would the workrequirements actually work?
I mean, what would?
What would that look like?
Joan Alker (25:52):
Yeah, and I'll tell you, we've had.
We've seen these in two statesArkansas, which enacted this on
the first Trump term, andGeorgia has has one in place
right now.
And, unfortunately, as apractical matter, what happens
is that states have to set upvery complicated bureaucratic
(26:13):
red tape systems to kind ofdelve into every aspect of your
life, right, so you have toreport work hours, but then
there's all these exemptions.
So if you have, you'remedically frail or you're doing
this out of the other thing, youcan get an exemption.
So you have to prove that tothe government.
And so what has happened inpractice is that folks in
(26:35):
particularly in Arkansas, wherewe saw this rollout very quickly
, thousands of people lost theirhealth insurance because they
didn't know they were supposedto do this.
The website bizarrely went downat night when people who were
working could actually entertheir hours.
The website didn't work as amatter of choice.
(26:56):
So there's just been all thesered tape barriers and the
practical effect has been thatpeople lose coverage.
And what's really shockingbecause I've been saying for a
long time that this policy has abackwards, it's not going to
work, it just doesn't workexpand coverage ironically it's
(27:23):
called pathways to coverage, butin fact, only a few thousand
people have made it down thepathway and in the first year,
90 of the money went tocorporate consultants to fund
the construction of all this redtape.
Attorney General Kris Mayes (27:34):
Wow
Joan Alker (27:36):
so it's fiscally.
Oh, it's been shocking to me.
I always figured there'd behigh administrative costs, but
what's happened in Georgia isreally quite shocking the use of
taxpayer dollars there and, infact, the House bill this, this
is really a fun fact.
So this is their kind ofmarquee policy, right?
(27:56):
This is the one thing all theRepublicans in the caucus can
agree on.
Well, first of all, it has thelatest implementation date
January 1st 2029, after the nextpresidential election.
So they know this isn't goingto work because they've pushed
(28:21):
it back to presumably when Trumpis going to be out of office.
Because they know that it isgoing to require so many costly
IT consultants and all folks toset up the red tape.
Attorney General Kris May (28:36):
We've sort of touched on this a
little bit.
I wonder if you could speak tothe idea that health care really
is one of the largestindustries driving our economy
right now.
You certainly can see that in alot of different ways.
How would a significant, abruptloss of funding affect
(29:04):
stability or profits across thewhole health care industry?
And I would just say I've got acouple of statistics here.
For instance, michigan'shealthcare industry is the
largest industry in that statewith a total economic impact of
$77 billion a year.
And then here in Arizonahealthcare is also the largest
employment sector in Arizona,employing over 400,000 people
(29:26):
directly.
240,000 new jobs have beencreated in Arizona in the health
care sector since the year 2000.
So obviously it's important.
What would these cuts mean inthat respect?
Joan Alker (29:40):
Yeah, I mean, as we've talked about, there are
economic effects of cuttingMedicaid associated job loss.
I think the kinds of providerswho could be particularly hard
hit by some of these proposalsCongress is considering include
long-term care facilities.
We talked about Medicaid beingthe largest payer for long term
(30:01):
care facilities.
Hospitals, particularly ruralhospitals, are very upset about
these proposals and what couldhappen to them.
And then you know the flip sideis, like I said before, these
are not doing anything toaddress the provider shortages
we have.
And I'll flag another areabehavioral health.
We haven't talked aboutbehavioral health, but we have a
(30:23):
huge behavioral health crisisin this country.
Medicaid is the largest payerfor behavioral health and
substance use disorder treatment, so that's another piece of the
puzzle that I'd really worryabout.
Of course, we need moreproviders there across payers,
right?
There's a shortage for anybody,regardless of what kind of
(30:45):
insurance you have.
Attorney General Kris Mayes (30:47):
And what time frame do you
anticipate this being addressedby Congress?
Joan Alker (30:51):
Yeah, well, they're moving on it now in the House.
They're trying to get the billto the floor soon, but in
general I think they're going tohave to be done by August,
because they're trying to putthe debt ceiling limit on this
bill and we've just heard fromthe Treasury Secretary they're
going to hit the debt ceilinglimit in August.
So I think you know right now.
The rest of May, june and Julyare really the time when
(31:15):
Congress is going to be dealingwith this.
Attorney General Kris Mayes (31:18):
All right.
Well, it is crunch time forMedicaid dealing with this, all
right.
Well, it is crunch time forMedicaid, and we appreciate you,
joan, for helping guide usthrough this incredibly
important topic that will impactour country for years and
decades to come.
So, joan Alker from GeorgetownUniversity, thank you so much
for joining us.
We really appreciate it.
Joan Alker (31:37):
Thanks so much for having me.
Attorney General Dana Ness (31:44):
Well , that's all we have time for
today.
Attorney General Kris Ma (31:46):
Thanks for joining us on Pantsuits and
Lawsuits.
For more information, you cancheck out our websites or follow
us on social media.
Attorney General Dana Nesse (31:56):
Yep , and we'll be back in just
another few weeks with someinsightful discussions shining a
light on the legal issuesaffecting everyday Americans
like us.
Attorney General Kris May (32:08):
Until next time.
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