DAVID GREENE, HOST:
And let's talk about an issue that is before Congress right now. The Senate looks like they will vote next week on the latest Republican effort to repeal the Affordable Care Act. It's a bill known as Graham-Cassidy, named for its sponsors. Its chances of passing - just not clear. Some moderate GOP senators need convincing, and a number of moderate Republican governors have signed a letter urging Majority Leader Mitch McConnell to get rid of this new bill. Massachusetts Republican Governor Charlie Baker is one of them and joins us on the line.
Good morning, Governor. Governor, you there?
Looks like we don't have a Republican Governor Charlie Baker. We will try as best we can to get him on the line. We're going to be talking with him about bill Graham-Cassidy and - Governor, you there? All right, well, let's just explain the bill a little bit. One of the big issues that has come up as this bill has been debated is the issue of pre-existing conditions, which is something that President Trump tweeted about last night. He said he would not sign this bill if it does not include pre-existing conditions.
And I believe we have Governor Baker on the line now. Governor, you there?
CHARLIE BAKER: I am.
GREENE: Fantastic. Well, welcome to the program. We appreciate it.
BAKER: Thank you.
GREENE: I guess it's - I suppose it's worth pointing out a few things on your resume. You were Health and Human Services secretary from Massachusetts in the '90s. You were the CEO of a health care provider for 10 years, so you've been dealing with this issue for some time. What's your big concern with this piece of legislation?
BAKER: Well, I guess I'd say three things. The first is, it - one of the things it does is it establishes this notion that health care costs be the same across all 50 states, and it goes to kind of a national average for determining how this block grant proposal works. Now, even the Medicare program, which is a national reimbursement program for people who are elderly and disabled, makes adjustments in what it pays providers for services that they render based on the wage rates in their county.
And I don't see how you can say that health care, which - 75 percent of the cost of health care is typically wages - how you can say there's one cost of health care for service delivered for the entire country and make that work. And any high-wage state, of which Massachusetts is one, gets absolutely slammed under a proposal like that, unfairly.
GREENE: Well, let me just help our listeners understand exactly what you're talking about. You're talking about the block grant because one of the key parts of this bill would be flexibility to the states, taking a lot of the money on Obamacare programs and giving them to states, which in theory, sounds like flexibility that you have asked for. But you're making the argument that the funding model would really hurt a state like Massachusetts because it assumes - the bill, you're saying, gives - doles out money to the states equally.
Governor, you still with us? OK, it looks like we've lost governor of Massachusetts, Mary Louise. We had him very briefly.
MARY LOUISE KELLY, HOST:
We had him very briefly. And he was just gearing up, and I was actually really (laughter) waiting to see what you were going to ask him next. It was an interesting conversation.
GREENE: He's back, I hear. Governor, you there?
BAKER: Yeah, I don't know what's going on on this. But yes, I'm back.
GREENE: That's OK. Well, let me just ask you one broad question. I mean, it's - it sounds like you are open to this bill in theory - the idea of taking money out of Obamacare, giving it to states to have the flexibility to build their own models. You're just not happy that a state like yours under this model would not get as much money as it has in the past.
BAKER: No, there's more to it than that. I mean, there are block grants that states get from the federal government for all kinds of things, you know? And they come with rules, with standards and guidelines, as they should because they're federal money that states are using to pay for services that they're rendering in their states. We get block grants for substance use services. We get block grants for mental health services, child welfare service. A lot of the transportation money looks like block grants.
The whole notion of a block grant is not something that's foreign to federal-state relation. But when you get into something the size and magnitude of this, that's just a completely different game. And that's something that people should keep in mind because there are very important elements of just sort of how the health care system works generally that need to be dealt with on a state, local basis. And I'm one of these people who thinks the Medicaid program, which is a shared state, local - excuse me, state, federal program - has worked pretty well for 50 years.
GREENE: All right, forgive me. We're out of time, and I'm sorry the line was so bad.
BAKER: Me too.
GREENE: We'll have to try and correct that later on. It's Republican Governor Charlie Baker of Massachusetts, one of the moderate Republican governors who has asked Senate Majority Leader Mitch McConnell to scrap this new Republican health care proposal. Transcript provided by NPR, Copyright NPR.