00:00Is the administration willing to consider changes to the provider tax, particularly the concerns that are being raised by people like Senator Josh Hawley who believe that what's in the Senate will lead to the closure of rural hospitals?
00:18We do not believe that addressing the provider tax effort is going to influence the ability of hospitals to stay viable.
00:25In fact, the provider tax and the state-directed payments are often used to pay institutions that have the best connections to the government of the state, not necessarily the hospitals that need the help the most.
00:37It is important that we clean up this system. These programs have grown dramatically.
00:41The provider tax now, which has dramatically increased once it became apparent that you could game the system, is now becoming a dominant part of financing our states.
00:50It's not where the money should be going. The money should be spent wisely in a very transparent way. There are better ways of addressing these needs.
00:56And the state-directed payments are another part of that equation that likewise complicate issues unnecessarily.
01:01People who need the money to get the best care possible because they're offering quality should be rewarded in ways that CMS and the federal government can do that more effectively for the American people.
01:12So you won't change that language? You won't change that language in the bill?
01:14Well, the details of the language are up to the leadership, but the specifics, the framework of addressing the legalized money laundering with state-directed payments and provider taxes must be in this bill. It should be in this bill. And I believe it will be in the bill.
01:28Dr. Ross, what do you say about the analysis from the Congressional Budget Office and other nonpartisan observers that more than 10 million people will go without health coverage under the House passed version of the bill?
01:46We actually did effectively an experiment over the last two years where we began to reverse some of the rules under the Biden administration around Medicaid and that unraveling of that system had 15 million Americans leave Medicaid.
02:06So when you're trying to analyze what happens to people leaving Medicaid, it's not an economic analysis as much as it's behavioral analysis. What will someone do? What will an American do if they're given the option of trying to get a job or an education or volunteering in their community, having some engagement or losing their Medicaid insurance coverage?
02:25I have more confidence in the American people than is being given to them by some of these analyzing organizations.
02:31But more importantly, we know from what happened in the last two years that of the 15 million people who disenrolled from Medicaid, the incidence of unemployment went up about 10 percent.
02:42So it wasn't 50 percent. Most Americans thoughtfully, wisely reengage life, go back to work, find other solutions, got onto the exchanges or commercial insurance, but they did not end up without insurance.
02:54And that's why I believe that's what will happen in this case as well.
02:57I have the confidence that the American people will make that decision wisely.
