{"id":2165391,"date":"2026-03-05T14:00:00","date_gmt":"2026-03-05T19:00:00","guid":{"rendered":"https:\/\/kffhealthnews.org\/?p=2165391&#038;post_type=podcast&#038;preview_id=2165391"},"modified":"2026-03-05T13:45:05","modified_gmt":"2026-03-05T18:45:05","slug":"what-the-health-436-julie-rovner-40th-anniversary-chip-kahn-chris-jennings-march-5-2026","status":"publish","type":"podcast","link":"https:\/\/kffhealthnews.org\/news\/podcast\/what-the-health-436-julie-rovner-40th-anniversary-chip-kahn-chris-jennings-march-5-2026\/","title":{"rendered":"What the Health? From KFF Health News: 40 Years of Health Policy"},"content":{"rendered":"\n<div class=\"wp-block-group is-layout-flow wp-block-group-is-layout-flow\"><div class=\"block--iframe\">\n\t<iframe\n\t\tallow=\"fullscreen\"\n\t\tframeborder=\"0\"\n\t\theight=\"188\"\n\t\tsrc=\"https:\/\/play.prx.org\/e?ge=prx_14448_9ddf2582-0f57-411d-9da3-dbc492ea56aa&#038;uf=https%3A%2F%2Fwhatthehealth.feeds.wamu.org\"\n\t\twidth=\"100%\"\n\t><\/iframe>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-people block--people\">\n\t\t<h3 class=\"people-title\">\n\t\tThe Host\t<\/h3>\n\t\t<div class=\"people-card-container single\">\n\t\n\n<div class=\"wp-block-people-card block--people-card\">\n\t\t\t\t<div class=\"author-image-container\">\n\t\t\t<img srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg 1100w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=150,150 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=500,500 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=768,768 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=480,480 480w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=100,100 100w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=120,120 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=170,170 170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=300,300 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=315,315 315w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2024\/07\/Rovner-Julie2021_1100sq.jpg?resize=630,630 630w\" sizes=\"(max-width: 767px) 100vw, 500px\" \/>\n\t\t<\/div>\n\t\t<div class=\"author-meta-container\">\n\t<div class=\"author-name\">Julie Rovner<\/div>\n\t<div class=\"author-affiliation\">KFF Health News<\/div>\n\t\t\t<div class=\"author-x\">\n\t\t\t<a class=\"icon-x author-link\" href=\"https:\/\/twitter.com\/jrovner\" title=\"@jrovner\">\n\t\t\t\t@jrovner\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<div class=\"author-bluesky\">\n\t\t\t<a class=\"icon-bluesky author-link\" href=\"https:\/\/bsky.app\/profile\/julierovner.bsky.social\" title=\"@julierovner.bsky.social\">\n\t\t\t\t@julierovner.bsky.social\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t\t<div class=\"author-stories-link\">\n\t\t\t<a class=\"author-link\" href=\"https:\/\/kffhealthnews.org\/news\/author\/julie-rovner\/\"> \n\t\t\t\tRead Julie&#039;s stories.\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t<div class=\"author-bio\">\n\t\t\tJulie Rovner is chief Washington correspondent and host of KFF Health News\u2019 weekly health policy news podcast, &quot;What the Health?&quot; A noted expert on health policy issues, Julie is the author of the critically praised reference book &quot;Health Care Politics and Policy A to Z,&quot; now in its third edition.\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\t<\/div>\n<\/div>\n\n\n\n<p>This month marks host Julie Rovner\u2019s 40th anniversary reporting on health policy in Washington. Over that time, she\u2019s covered a vast range of topics, from the response to the AIDS epidemic, to Medicare and Medicaid changes, to the fight over the \u201cPatients\u2019 Bill of Rights\u201d \u2014 and a half-dozen major reform fights, including the introduction of the Affordable Care Act and the efforts to repeal it.<\/p>\n\n\n\n<p>In honor of the occasion, Rovner invited two of her longtime sources to chat about what has \u2014 and has not \u2014 changed in health policy over the past four decades.<\/p>\n\n\n<div\n\tclass=\"wp-block block--newsletter  \"\n\tdata-type=\"kaiser-health-news\/newsletter\"\n\tdata-align=\"center\"\n\tstyle=\"\"\n>\n\t<h4 class=\"newsletter__title\">\n\t\t<a href=\"\/email\/\">\n\t\t\tEmail Sign-Up\t\t<\/a>\n\t<\/h4>\n\t<p class=\"newsletter__description\">\n\t\tSubscribe to KFF Health News&#039; free Morning Briefing.\t<\/p>\n\t\n<form\n\taction=\"\/email-signup\/\"\n\tclass=\"kaiser-hubspot-mini-signup-form\"\n\tmethod=\"post\"\n>\n\t<input type=\"hidden\" id=\"kaiser_hubspot_nonce\" name=\"kaiser_hubspot_nonce\" value=\"87a489a56a\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/podcast\/2165391\" \/>\t\t\t\t<label\n\t\tclass=\"kaiser-hubspot-mini-signup-form__label--email\"\n\t\tfor=\"kaiser-hubspot-mini-signup-form-email\"\n\t>\n\t\t<span class=\"screen-reader-text\">\n\t\t\tYour Email Address\t\t<\/span>\n\t\t<input\n\t\t\tautocomplete=\"email\"\n\t\t\tclass=\"kaiser-hubspot-mini-signup-form__input--email\"\n\t\t\tid=\"kaiser-hubspot-mini-signup-form-email\"\n\t\t\tname=\"kaiser_hubspot_email\"\n\t\t\ttype=\"email\"\n\t\t\t\t\t\t\tplaceholder=\"Your email address\"\n\t\t\t\t\t\/>\n\t<\/label>\n\t<button class=\"kaiser-hubspot-mini-signup-form__submit\">\n\t\tSign Up\t<\/button>\n<\/form>\n<\/div>\n\n\n\n<section class=\"block--expandable has-label\"\n\t\t\tid=\"podcast-expandable\"\n\t>\n\t\t\t<input type=\"checkbox\" name=\"expandable-radio\" id=\"strong-transcript-40-years-of-health-policy-strong\">\n\t\t<label class=\"expandable__title-label\" for=\"strong-transcript-40-years-of-health-policy-strong\">\n\t\t\t\t\t\t\t<span\n\t\t\t\t\tclass=\"expandable__label  \"\n\t\t\t\t\tstyle=\"background-color: #cb1919;\"\n\t\t\t\t>\n\t\t\t\t\tClick to open the transcript\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span\n\t\t\t\t\tclass=\"expandable__title\"\n\t\t\t\t\tstyle=\"font-size: 36px;\"\n\t\t\t\t>\n\t\t\t\t\t\t<strong>Transcript: 40 Years of Health Policy<\/strong>\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\t\t<div class=\"expandable__content--container\">\n\t\t<div class=\"expandable__content\">\n\t\t\t\n\n<p><strong><em>[Editor\u2019s note:<\/em><\/strong><em>&nbsp;This transcript was generated using both transcription software and a human\u2019s light touch. It has been edited for style and clarity.]<\/em>&nbsp;<\/p>\n\n\n\n<p><strong>Julie Rovner:<\/strong>&nbsp;Hello from KFF Health News and WAMU Public Radio in Washington, D.C.&nbsp;Welcome to&nbsp;<em>What the Health?<\/em>&nbsp;I\u2019m&nbsp;Julie Rovner, chief Washington correspondent for KFF Health News.&nbsp;Usually&nbsp;we\u2019re&nbsp;joined by some of the best reporters covering Washington, but today&nbsp;we\u2019re&nbsp;bringing you something special. I hope you enjoy it.&nbsp;We\u2019re&nbsp;taping this episode on Friday, Feb. 27, at 4 p.m. As always, news happens&nbsp;fast, and things might have changed by the time you hear this.&nbsp;So here we go.&nbsp;<\/p>\n\n\n\n<p>I have two special guests today, who I will introduce in a moment. But first&nbsp;I\u2019m&nbsp;going to explain why I chose them. I started reporting on health policy in 1986, covering health and welfare on Capitol Hill and at the Department of Health and Human Services for what was then the Congressional Quarterly&nbsp;\u201cWeekly Report.\u201d&nbsp;This month marks my 40th anniversary on the health beat, and as anniversaries so often do, it got me thinking about everything I\u2019ve seen and covered, including a half a dozen major health reform fights, a dozen budget reconciliation bills, years-long fights over everything from the Patients\u2019&nbsp;Bill of Rights and human cloning to bioterrorism and a pandemic. It also got me thinking about where I thought the U.S. health system would be four decades after I began, and where it&nbsp;actually is. And I thought it might be fun to reminisce with a couple of people who not only were there when I started, but who also taught me a lot of what I know.&nbsp;So&nbsp;without further ado, let me introduce my guests.&nbsp;Chip Kahn&nbsp;just stepped down as president and CEO of the Federation of American Hospitals after 25 years in that post. Chip previously worked in both the House and the Senate for the major health committees&nbsp;and also&nbsp;headed&nbsp;the Health Insurance Association of America, the industry group now known as AHIP.&nbsp;I\u2019m&nbsp;pleased to announce that Chip is not actually retiring&nbsp;\u2014&nbsp;that,&nbsp;among other activities,&nbsp;he\u2019s&nbsp;going to be a colleague of mine here at KFF as a senior fellow. Chip will also host a podcast starting later this spring on the business of health care. Chip, thanks for being here, and&nbsp;welcome.&nbsp;<\/p>\n\n\n\n<p><strong>Chip Kahn:<\/strong>&nbsp;Really happy to be here and celebrate with you.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Joining Chip is Chris Jennings, who not only worked in the Senate for a decade, but also worked in the White House as a senior health staffer for Presidents [Bill] Clinton and [Barack] Obama and&nbsp;advised&nbsp;President [Joe] Biden as well. Today, Chris is president of the health care consulting firm Jennings Policy Strategies. Chris, welcome and thanks for playing along.&nbsp;<\/p>\n\n\n\n<p><strong>Chris Jennings:<\/strong>&nbsp;Julie,&nbsp;it\u2019s&nbsp;been great to age together.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;So&nbsp;let\u2019s&nbsp;start with a little bit of a tour of each of your careers. Chip, you go first.&nbsp;How did you first get started in shaping health policy, and what was your trajectory to today?&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:&nbsp;<\/strong>It was a scary long time ago.&nbsp;I guess I got started in politics in 1968,&nbsp;actually, when I met Newt Gingrich in New Orleans and then managed his two congressional campaigns.&nbsp;But then I went to graduate school in public&nbsp;health, and finally broke into the&nbsp;Hill in 1983 and worked for a year for Dan Quayle, and then worked in the Senate, worked in the&nbsp;House, went out and worked for the health insurers, came back and worked in the&nbsp;House again during the&nbsp;\u201990s&nbsp;\u2014&nbsp;many, many years of health policy.&nbsp;And then, as you said, for almost 25 years, worked at the Federation of American&nbsp;Hospitals,&nbsp;representing&nbsp;20% of the hospital industry and all the health policy battles.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>And behind your head it says&nbsp;\u201cAEI,\u201d&nbsp;so in your not-retirement,&nbsp;you\u2019re&nbsp;going to be here at&nbsp;KFF, and&nbsp;you\u2019re&nbsp;also going to be at AEI&nbsp;[American Enterprise Institute]. What else are you planning&nbsp;on doing?&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:&nbsp;<\/strong>Well, other than being a think tanker&nbsp;\u2026&nbsp;and a podcaster,&nbsp;I\u2019m looking at a number of areas where I\u2019d like to do some writing on the health policy issues that I\u2019ve been involved with over the years, and maybe try to impact their future by some of the things I have to say.&nbsp;That\u2019s&nbsp;my,&nbsp;will be primary, although&nbsp;I\u2019m&nbsp;also working with the&nbsp;dean of the School of Public Health at Tulane on developing a&nbsp;health&nbsp;policy&nbsp;center there.&nbsp;And I do photography, street photography, and I\u2019ve got a project there too.&nbsp;So&nbsp;I\u2019m&nbsp;not retiring.&nbsp;I\u2019m&nbsp;just moving on.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>You are busier than I am, and I thought I was busy. Chris, how did you come to health policy?&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:&nbsp;<\/strong>Well, I know&nbsp;you\u2019re&nbsp;a Michigan&nbsp;gal, Julie, but&nbsp;I\u2019m&nbsp;from Ohio.&nbsp;And I came,&nbsp;actually,&nbsp;the same year that&nbsp;Chip came in, in 1983.&nbsp;John Glenn hired me as&nbsp;a very, very young&nbsp;assistant. I&nbsp;don\u2019t&nbsp;think I got to know you until&nbsp;\u2026&nbsp;1986,&nbsp;shortly behind.&nbsp;But I remember in&nbsp;\u201986 I was hired by the chairman of the&nbsp;Aging&nbsp;Committee, the then-chairman of the agency committee&nbsp;[Special Committee on Aging], John Melcher, and he held the first hearing in a blizzard on the Medicare Catastrophic&nbsp;[Protection]&nbsp;illness coverage&nbsp;Act, and I worked through&nbsp;\u2026&nbsp;that was&nbsp;\u201988-\u201989,&nbsp;we repealed the policy, as you will recall.&nbsp;By that time, you may have moved on to the National Journal. I&nbsp;can\u2019t&nbsp;even remember when you were there and in NPR, but I followed you as you followed me. And I worked on another&nbsp;chairman, David Pryor, on the&nbsp;Pepper&nbsp;Commission, where I got to know&nbsp;Chip&nbsp;\u2014&nbsp;love, hate, mostly respect Chip&nbsp;\u2014&nbsp;on the&nbsp;Pepper Commission, which both succeeded and&nbsp;immediately&nbsp;failed.&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;And&nbsp;we\u2019ll&nbsp;get to that.&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:<\/strong>&nbsp;And it set the stage, really, and&nbsp;that\u2019s&nbsp;where&nbsp;I think people&nbsp;started to know me on the&nbsp;Aging&nbsp;Committee, on the Finance Committee, on the&nbsp;Pepper&nbsp;Commission. And then,&nbsp;I\u2019d&nbsp;go on and on. But,&nbsp;of course, I was eventually tapped to help Hillary Clinton do the Health Security Act, where we spectacularly failed, but learned our lessons, and we moved on. And I was there for all eight years of the Clinton administration, set up my own consulting firm, went back into the White House, as you said, and have been proud to be involved with some, you know, both extraordinary successes and failures, but progress that I think sometimes people don\u2019t acknowledge in this debate. So hopefully we get to talk about that as well.&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:&nbsp;<\/strong>You know, Julie, one thing I think you can say about both of us is that there&nbsp;hasn\u2019t&nbsp;been anything congressionally in delivery or financing,&nbsp;over your entire 40 years,&nbsp;that Chris and I were not&nbsp;involved in&nbsp;in one way or another.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>That was why I decided I wanted&nbsp;you guys.&nbsp;I well&nbsp;know that&nbsp;you\u2019ve&nbsp;had your fingers in everything this entire time. Well,&nbsp;let\u2019s&nbsp;go back to the spring of 1986,&nbsp;when I first started covering health care on Capitol Hill.&nbsp;Congress was just finishing the COBRA [Continuation of Health&nbsp;Coverage]&nbsp;budget reconciliation bill,&nbsp;for which the health care continuation provisions that everybody knows are named, even though that was just one of&nbsp;literally hundreds&nbsp;of provisions,&nbsp;of different health care provisions in that bill.&nbsp;And from the&nbsp;\u201cSome&nbsp;Things&nbsp;Never&nbsp;Change\u201d&nbsp;file, that bill was&nbsp;very late. It had been kicking around since the middle of the year before one of the first big feature stories I wrote that spring was about how the U.S.&nbsp;had no real program to pay for&nbsp;long-term&nbsp;care for the elderly, something that is still true today. What were&nbsp;you guys&nbsp;focused on in 1986?&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:&nbsp;<\/strong>I think in 1986,&nbsp;as you said, every year during the&nbsp;\u201980s and into the early&nbsp;\u201990s,&nbsp;almost like&nbsp;clockwork, there was a budget bill, although some of those budget bills, like COBRA, lapped over.&nbsp;And I could, I could recite, until about 1990,&nbsp;I think, all the key provisions of every one of those bills.&nbsp;So&nbsp;whether it was Medicare in terms of payment modifications and payment improvements,&nbsp;or payment reforms, or whether it was Medicaid in terms of incrementalism, in terms of expanding to different populations. You know, we&nbsp;sort of saw&nbsp;it all.&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:&nbsp;<\/strong>There were notable reforms. In fact,&nbsp;it\u2019s&nbsp;important to remember back&nbsp;then,&nbsp;health care really was the domain of the Congress.&nbsp;Presidents, barely, you know, they were for technical&nbsp;assistance, they provided information. But the big players in health&nbsp;care in the&nbsp;\u201980s were&nbsp;\u2014&nbsp;and&nbsp;it\u2019s&nbsp;a very impressive group of people, both members and staff. And I&nbsp;don\u2019t&nbsp;want to sound like an old person, but those were days when you&nbsp;actually did&nbsp;get bipartisan policies done. They&nbsp;weren\u2019t&nbsp;easily done, but they were done, and I think&nbsp;it\u2019s&nbsp;important to recognize that.&nbsp;I go&nbsp;\u2014&nbsp;you\u2019re&nbsp;saying&nbsp;\u201986,&nbsp;so I\u2019m going to stick with&nbsp;\u201986.&nbsp;But&nbsp;\u201986 was a&nbsp;big year&nbsp;\u2026&nbsp;I think that&nbsp;was also&nbsp;\u2014&nbsp;when did we do COBRA?&nbsp;\u201985-\u201986 we were implementing&nbsp;COBRA.&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:<\/strong>&nbsp;It was done in&nbsp;\u201986.&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:<\/strong>&nbsp;Yeah,&nbsp;\u201986.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;It was in&nbsp;COBRA.&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:<\/strong>&nbsp;Yeah,&nbsp;yeah. So, you know, that is, again, a policy that a number of people actually do&nbsp;utilize&nbsp;and it\u2019s very, very important.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;And EMTALA was in that bill.&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:&nbsp;<\/strong>EMTALA was in that bill, yes.&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:<\/strong>&nbsp;But besides these bills, and you brought it up,&nbsp;Medicaid&nbsp;Catastrophic, which was started a little bit after that,&nbsp;actually was&nbsp;a Reagan&nbsp;administration initiative. Dr&nbsp;[Otis]&nbsp;Bowen, the&nbsp;secretary of HHS&nbsp;[Department of Health and Human Services],&nbsp;was the major proponent. Then it became,&nbsp;obviously,&nbsp;very congressional. And so&nbsp;the&nbsp;major piece of health legislation that was just a health bill that&nbsp;wasn\u2019t&nbsp;connected to one of these big budget bills, these&nbsp;big reconciliations, it passed, and it passed overwhelmingly in both chambers. After a lot of work, we could talk about that, if you want. And then within a year, you know, it was repealed. And one of the weird experiences of my&nbsp;life,&nbsp;was that, on the one hand, Bill&nbsp;Gradison&nbsp;in the&nbsp;House was one of the original framers of that legislation.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;Your boss at the time.&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:<\/strong>&nbsp;One of my bosses at the time. But&nbsp;the day before repeal was considered in the&nbsp;House, I had to&nbsp;write for&nbsp;Bill&nbsp;Gradison&nbsp;a draft of a statement for him.&nbsp;And I, but I also worked for Bill Archer, who was one of the authors&nbsp;of the&nbsp;Archer-Donnelly amendment, which would repeal Medicare&nbsp;Catastrophic.&nbsp;So&nbsp;I also had to write a draft of a statement for him.&nbsp;Actually, let&nbsp;me say,&nbsp;I&nbsp;didn\u2019t&nbsp;write&nbsp;them&nbsp;on the same day because I&nbsp;couldn\u2019t&nbsp;bring myself&nbsp;to.&nbsp;But I was really sort of&nbsp;\u2014&nbsp;I got to be careful here&nbsp;\u2014&nbsp;\u201cschizophrenic\u201d&nbsp;on the issue, because I worked both on the legislation and then on its repeal.&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:&nbsp;<\/strong>Julie,&nbsp;also, I just have to say there\u2019s another irony that I think no one knows really about, but the lead sponsor of the repeal was John McCain.&nbsp;John McCain,&nbsp;who raised all the&nbsp;issue&nbsp;of the&nbsp;so-called surtax,&nbsp;OK?&nbsp;Do you remember this?&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>I do. I&nbsp;wrote&nbsp;a big story about John McCain.&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:&nbsp;<\/strong>People think&nbsp;John McCain is Mr. Savior of the Affordable Care Act, but he also repealed the most significant,&nbsp;at the time, bipartisan, bicameral health care reform bill&nbsp;that actually,&nbsp;we&nbsp;should also say,&nbsp;did include an incremental Medicare prescription drug benefit.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;John McCain was&nbsp;very sorry.&nbsp;He actually felt bad that he ended up&nbsp;\u2026&nbsp;he tried to undo the repeal that he led.&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:&nbsp;<\/strong>And also,&nbsp;there was a secret weapon in there, which&nbsp;actually was&nbsp;very expensive, which was a&nbsp;Bill&nbsp;Gradison&nbsp;initiative, which was to change the skilled nursing facility benefit so that Medicare would&nbsp;basically cover&nbsp;six months without three days prior hospitalization.&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:<\/strong>&nbsp;Yeah.&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:<\/strong>&nbsp;And that was something that CBO&nbsp;said,&nbsp;the&nbsp;Congressional Budget Office said would just cost a few 100 million dollars. It was&nbsp;actually costing&nbsp;billions almost&nbsp;immediately, because all the states&nbsp;immediately&nbsp;changed those dual-eligible patients, dual eligible for Medicare and Medicaid, and made them Medicare patients because of the six months.&nbsp;So&nbsp;there was even a long-term care&nbsp;provision in&nbsp;there, despite the fact that some felt that Medicare&nbsp;Catastrophic didn\u2019t touch long-term care.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Well, while&nbsp;we\u2019re&nbsp;on the subject of the&nbsp;poor,&nbsp;be-knighted,&nbsp;repealed Medicare&nbsp;Catastrophic bill, which we all experienced,&nbsp;that led to the Clinton health reform bill.&nbsp;Chris, you were instrumental in that.&nbsp;What had you learned from the passage and repeal of catastrophic that you tried to put into place when you were working on the Clinton plan?&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:<\/strong>&nbsp;Sure.&nbsp;Well, first, Julie, I think we learned from all of our mistakes, and you learn more from your mistakes&nbsp;than&nbsp;you learn from your successes.&nbsp;And sometimes you&nbsp;mislearn&nbsp;your successes in major ways.&nbsp;But I do want to say the one thing that we did not repeal in the Medicare&nbsp;Catastrophic&nbsp;[Protection]&nbsp;coverage&nbsp;Act was the&nbsp;Pepper&nbsp;Commission. And the&nbsp;Pepper&nbsp;Commission was the first attempt to do the comprehensive reform proposal, and it was reported out, but in a really humorous, terrible scene, which I won\u2019t bore people with,&nbsp;but&nbsp;\u2014&nbsp;Chip was there,&nbsp;and I was there, and it was painful, and that people actually almost came to blows over that policy. Physical, physical blows&nbsp;between&nbsp;my boss, David Pryor,&nbsp;and Pete Stark, of all people. So&nbsp;that\u2019s&nbsp;another story. But yes, after that, there was a[n]&nbsp;election in Pennsylvania&nbsp;\u2014&nbsp;and this is&nbsp;sort of interesting&nbsp;historical context&nbsp;\u2014 it was&nbsp;a special election by&nbsp;[Sen.]&nbsp;Harris Wofford, who won, and it was all about health reform. And his political advisers, interesting,&nbsp;was James Carville and Paul Begala, and health&nbsp;care suddenly became,&nbsp;comprehensive&nbsp;health care reform became, oh, this is a big issue. And every candidate who was running at that time&nbsp;\u2014&nbsp;really,&nbsp;people who&nbsp;\u2026&nbsp;no one even knew the people running, because no one wanted to run against George W.&nbsp;Bush&nbsp;\u2014&nbsp;but Bill Clinton was running against it, and he, he ended up winning, as you know, and then he chose&nbsp;\u2026&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;It was George H.W.&nbsp;Bush.&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:<\/strong>&nbsp;George H. \u2026&nbsp;George H.&nbsp;was so popular that the&nbsp;primary Democratic candidates&nbsp;didn\u2019t&nbsp;want to run against him.&nbsp;So&nbsp;people just said,&nbsp;I\u2019ll&nbsp;just try.&nbsp;And,&nbsp;long story short, Bill Clinton wins.&nbsp;And he&nbsp;designates&nbsp;Hillary Clinton.&nbsp;And Hillary Clinton,&nbsp;because I had done some work for their campaign and helped in the transition,&nbsp;I was asked to become the congressional liaison. So now, what did I learn from that? Well,&nbsp;there\u2019s&nbsp;so many things to learn, and we applied them&nbsp;almost all&nbsp;to the Affordable Care Act. And of course,&nbsp;we\u2019re&nbsp;going to have to give&nbsp;Chip his&nbsp;\u2014&nbsp;you know,&nbsp;Chip\u2019s&nbsp;the star of&nbsp;\u201cHarry and Louise,\u201d&nbsp;and proudly contributed&nbsp;to \u2026&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;We\u2019ll&nbsp;get to that.&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:<\/strong>&nbsp;\u2026&nbsp;the demise. But I will say, even if we had perfectly executed the Health Security Act policy,&nbsp;because of the time and the delay of it and how in the environment in which it was in, it probably would have been very, very difficult to&nbsp;pass and enact at that time.&nbsp;We can talk about that.&nbsp;But one thing we learned is&nbsp;it\u2019s&nbsp;really important&nbsp;for presidential candidates to have a vision and a way to finance their vision, but not to micromanage exactly the specific policies you need to get congressional investment in those policies. And if you impose details, the details will get,&nbsp;will be picked apart before you get the momentum to pass legislation. And you&nbsp;won\u2019t&nbsp;have time to get both members of Congress and stakeholders,&nbsp;who inevitably you&nbsp;can\u2019t&nbsp;pick, you&nbsp;can\u2019t&nbsp;have everyone be your enemy if&nbsp;you\u2019re&nbsp;going to pass health care reform, and we succeeded in getting most everyone against us. That&nbsp;wasn\u2019t&nbsp;completely my fault, but sure,&nbsp;I\u2019ll&nbsp;take whatever responsibility there is.&nbsp;But those are two big reasons. You know me, Julie. I could go on forever, but&nbsp;I\u2019m&nbsp;going to stop with that and let&nbsp;Chip take his victory lap or whatever.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yeah, because&nbsp;Chip,&nbsp;at that point, you were with the health insurers,&nbsp;who were not thrilled with the Clinton plan.&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:&nbsp;<\/strong>Well, let me say this. I always have to say this when I talk about the Health Insurance Association of America. Bill&nbsp;Gradison&nbsp;went over there in early&nbsp;\u201993,&nbsp;and he took me with him. I was his executive vice president at that point.&nbsp;And the health insurers that we&nbsp;represented&nbsp;were for some kind of universal coverage structure. They&nbsp;weren\u2019t&nbsp;for the model that was developed by the Clinton administration that they took to Congress. But&nbsp;I think Chris&nbsp;made&nbsp;a very important&nbsp;point: All the noise from the campaign around&nbsp;\u201cClinton&nbsp;Care,\u201d&nbsp;pro and con, there were a lot of things going on. First, a new administration only gets so many bites at the apple, even if&nbsp;they\u2019ve&nbsp;got big majorities in Congress.&nbsp;And they chose to do their big budget bill and a gun bill, which were&nbsp;very difficult&nbsp;votes for many members of Congress, before starting,&nbsp;in September,&nbsp;on the&nbsp;Hill with the presidential speech to lead into health reform.&nbsp;So&nbsp;I think they&nbsp;went in with a clock that was against them,&nbsp;in terms of how much a new administration has.&nbsp;Second,&nbsp;I don\u2019t think everybody completely understood it at the time, but we had congressional control by the Democrats of the&nbsp;House for 40 years, and in some ways, they were a bit bankrupt, and there were a lot of issues around, you know, their unity.&nbsp;And we&nbsp;didn\u2019t&nbsp;know it until the election in&nbsp;\u201994&nbsp;\u2014&nbsp;and Clinton&nbsp;Care had had some effect&nbsp;on that election&nbsp;\u2014&nbsp;but we were about to see the Republican&nbsp;revolution taking place.&nbsp;But the soundings of that and the effects of that played out in Clinton&nbsp;Care.&nbsp;But,&nbsp;all that being said, if&nbsp;you believe that campaigns make a difference in policy process and elections, there were campaigns that said Clinton&nbsp;Care, as proposed, needs to change.&nbsp;And&nbsp;the Health Insurance Association of America did the Harry and Louise campaign, which&nbsp;I&nbsp;managed. And&nbsp;actually&nbsp;there was one point&nbsp;\u2026&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>I would say,&nbsp;for those who&nbsp;don\u2019t&nbsp;remember,&nbsp;Harry and Louise were a couple of actors. Those were their names, actually, Harry&nbsp;and Louise, who sat around their kitchen table wondering how they were going to pay for their health insurance if the Clinton plan passed.&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:<\/strong>&nbsp;And that concept came from over the summer, leading into that August, before the Clinton&nbsp;Care process began in Congress.&nbsp;Bill&nbsp;Gradison&nbsp;had been going around giving speeches,&nbsp;saying that health reform was going to be decided around the kitchen tables of America.&nbsp;So&nbsp;I told our advertising firm,&nbsp;First Tuesday&nbsp;[Strategies],&nbsp;go&nbsp;test that. And&nbsp;that\u2019s&nbsp;how it all got started. And they&nbsp;came up with&nbsp;the concept, and we spent a lot of time on scripts.&nbsp;And our whole point was not to defeat but to raise questions and actually just get a seat at the table.&nbsp;Well, I could give anecdotes about why we&nbsp;didn\u2019t&nbsp;get a seat at the table, and thus we began a campaign that was one of the components of the opposition to health reform that really defeated Clinton&nbsp;Care.&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:<\/strong>&nbsp;And Julie,&nbsp;I\u2019ll&nbsp;just say I think&nbsp;it\u2019s&nbsp;important to note that we also played into it by complaining so much about&nbsp;[how] it&nbsp;got&nbsp;lot&nbsp;of free&nbsp;airtime,&nbsp;too.&nbsp;So&nbsp;then the media covered it even more than the other one. And&nbsp;so&nbsp;it was the amount of money they paid for those ads versus the&nbsp;amount&nbsp;of&nbsp;ads&nbsp;people who see that ads was an extraordinary ROI&nbsp;[return on investment]&nbsp;for Chip&nbsp;Kahn&nbsp;and Bill&nbsp;Gradison.&nbsp;But&nbsp;I do feel it\u2019s important to note that a lot of the predicate for rationale behind and policy underpinning the Affordable Care Act, you\u2019ll find a lot in the seeds of the Health Security Act, and then you\u2019ll see them again&nbsp;in the debate between Barack Obama and Hillary Clinton.&nbsp;And in many ways, Hillary Clinton\u2019s policy is more like what&nbsp;ultimately was&nbsp;passed and enacted in 2008 and 2009.&nbsp;So&nbsp;it\u2019s&nbsp;a very interesting&nbsp;circle of the process. And the other thing that I think people don\u2019t understand, is, right after that we had another health care debate, which was the&nbsp;\u201cContract&nbsp;With America\u201d&nbsp;and, or on America, as we used to call it, and, and that was a huge Medicare-Medicaid fight, which didn\u2019t, which also failed. But I think you almost had to&nbsp;have&nbsp;these two&nbsp;attempts to have an attempt&nbsp;to make some progress. That led to things like the Children\u2019s Health Insurance Program and beyond,&nbsp;so all of which&nbsp;\u2014&nbsp;and by the way, HIPAA,&nbsp;insurance reforms beyond that&nbsp;\u2014&nbsp;which began to lay the predicate for it. Yes.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>All right.&nbsp;Well,&nbsp;we\u2019re&nbsp;going to take a quick break. We will be right back.&nbsp;<\/p>\n\n\n\n<p>OK,&nbsp;we\u2019re&nbsp;back.&nbsp;In the 1990s, after the death of the Clinton health reform plan, there was this huge sort of flow of big, important health bills:&nbsp;the Children\u2019s Health Insurance Program;&nbsp;like you say, HIPAA, the Health Insurance Portability and Accountability Act, which was a whole lot more than just the confidentiality provisions. In fact, my favorite piece of trivia is that there were no medical&nbsp;records&nbsp;confidentiality provisions because it was a requirement for Congress to write them, which they never bothered to do.&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:<\/strong>&nbsp;If you&nbsp;want an anecdote on that,&nbsp;I\u2019ll&nbsp;give you an anecdote.&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;OK.&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:<\/strong>&nbsp;That\u2019s there&nbsp;because of me.&nbsp;But I can only take credit for a few things:&nbsp;diabetic shoes and HIPAA confidentiality.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>I do remember diabetic shoes, but I will not make you explain that.&nbsp;But do explain how the confidentiality&nbsp;\u2026&nbsp;because HIPAA was&nbsp;actually about&nbsp;being able to change jobs without losing your health insurance&nbsp;\u2014&nbsp;it was&nbsp;literally about&nbsp;portability of health insurance, and the confidentiality stuff got tacked on at the last minute.&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:&nbsp;<\/strong>No, no, no. It&nbsp;didn\u2019t. It&nbsp;didn\u2019t. No, the point of HIPAA&nbsp;\u2014 and,&nbsp;frankly, I&nbsp;wasn\u2019t&nbsp;the author of this;&nbsp;I&nbsp;sort of stole&nbsp;this idea&nbsp;\u2014&nbsp;but HIPAA was either the seven-point plan or the nine-point plan. And the idea of the way we structured HIPAA in the&nbsp;House was to take four or five different things&nbsp;\u2014&nbsp;and it was, it&nbsp;was much more than just insurance reform&nbsp;\u2014and build out aspects of health reform,&nbsp;sort of small-ball&nbsp;health reform. And&nbsp;the confidentiality&nbsp;was one part of it. And we thought at the time that there was an&nbsp;administrative&nbsp;simplification portion of the bill, which came from a congressman from Ohio that, frankly, as a staffer, I was the one in the&nbsp;House that put that in the bill, and I and our expectation was that Congress would come back and do confidentiality, but we needed to require it, to set a framework for it. And there was one day when the bill was&nbsp;in&nbsp;conference, when Dean Rosen, who was working for Ms. [Sen.&nbsp;Nancy]&nbsp;Kassebaum&nbsp;\u2026&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:<\/strong>&nbsp;Yeah, it was&nbsp;Kassebaum.&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:<\/strong>&nbsp;\u2026&nbsp;called me and said,&nbsp;<em>Do&nbsp;we really have to leave those lines in the bill?<\/em>&nbsp;And I said,&nbsp;<em>Boy, it\u2019s really, really important<\/em>.&nbsp;<em>And the&nbsp;congressman&nbsp;from Ohio feels strongly about it, and Mr.&nbsp;[Rep. Bill]&nbsp;Thomas feels strongly about it<\/em>.&nbsp;And so&nbsp;that\u2019s&nbsp;why we got HIPAA, and&nbsp;then, then&nbsp;they&nbsp;couldn\u2019t&nbsp;legislate on&nbsp;it because it was too sensitive, but we put language in,&nbsp;and HHS wrote the rules.&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:&nbsp;<\/strong>I think it\u2019s really important to note that in the olden days, when we started this, Congress actually gave much more explicit guidance to the executive branch as to how they&nbsp;implemented.&nbsp;HIPAA was a good example as a bridge to where we are today, which&nbsp;was&nbsp;<em>we will do something<\/em>. This is what we were saying in HIPAA.&nbsp;<em>But if we&nbsp;fail to&nbsp;do so, we authorize you, executive branch, to implement the provisions of HIPAA<\/em>, which is what&nbsp;ultimately the&nbsp;Clinton administration had to do.&nbsp;And&nbsp;a lot of&nbsp;that is because the Congress&nbsp;couldn\u2019t&nbsp;agree on the details, as they often&nbsp;can\u2019t, but they still want to be associated with the underlying policy. But anyway,&nbsp;it\u2019s&nbsp;just another lesson of the life that we were at and where we are now.&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:<\/strong>&nbsp;And when you say,&nbsp;wouldn\u2019t&nbsp;agree on the&nbsp;details,&nbsp;the trouble is that the poison pills, those cultural issues,&nbsp;frequently&nbsp;come into issues here. I mean abortion and other issues,&nbsp;which are extremely&nbsp;important issues, but&nbsp;they\u2019re&nbsp;cultural issues, and people are not&nbsp;generally willing&nbsp;to compromise on those. And those are the issues that ended up holding up things like confidentiality, which Congress should have acted on.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;Yeah, I want to get to the Affordable Care Act, but before I do,&nbsp;Chip,&nbsp;I want to talk about the strange bedfellows. Because I want&nbsp;\u2026&nbsp;you were talking about in the context of the Clinton reform, that the stakeholders&nbsp;weren\u2019t&nbsp;really against it. They were only against parts of it.&nbsp;I think I&nbsp;wrote in a monograph on this that everybody wanted to cut off just one finger, but,&nbsp;in&nbsp;the end, the patient bled to death. You wanted to prevent that from happening when there was the next round that became the Affordable Care Act, and you got together with Ron&nbsp;Pollack, who was, you know, a very liberal, also outside group. And&nbsp;you guys&nbsp;tried to put together a framework, right?&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:&nbsp;<\/strong>Well, when I&nbsp;went to&nbsp;back to the&nbsp;Health Insurance Association of America in 1998,&nbsp;Ronnie Pollack and I got together and wanted to see what we could do. I mean, in a sense, we both really agreed that we needed various kinds of coverage expansions. We started&nbsp;incremental. And as part of that, the Rob[ert]&nbsp;Wood Johnson Foundation came in with a major initiative&nbsp;to fund us and to fund the conversations we began, and to fund other groups coming in and joining us in a big coalition. And,&nbsp;frankly, we were very close&nbsp;on&nbsp;some subsidization. We had&nbsp;a&nbsp;Republican and Democratic senator right before 9\/11 and then 9\/11 happened, and it just&nbsp;\u2026&nbsp;killed us. And&nbsp;\u2026&nbsp;we got put on the back burner. And&nbsp;so&nbsp;then we went through many years of Ronnie and I doing a lot of different efforts with many other stakeholders&nbsp;\u2014&nbsp;around either doing small-ball expansions or pushing for the ultimate&nbsp;\u2014&nbsp;and that, ultimately, I&nbsp;think, at least helped fuel what happened in&nbsp;\u201909. I mean, a lot of things led to&nbsp;\u201909,&nbsp;but at least, I think,&nbsp;our effort laid a base of commonality across stakeholders that made&nbsp;\u201909&nbsp;very different from&nbsp;\u201993.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;Chris, you said that, you know, one of the things that you learned from the failed Clinton&nbsp;health&nbsp;reform is it&nbsp;\u2026&nbsp;you\u2019ve&nbsp;got to have at least some of the stakeholders inside the tent, right?&nbsp;\u2026 That&nbsp;seemed to me one of the&nbsp;big changes&nbsp;between 1993 and 2009.&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:&nbsp;<\/strong>Yes, I mean, like every story that sounds black-and-white, there\u2019s&nbsp;grays&nbsp;in those.&nbsp;But yes, for sure, and I do agree that the larger insurers knew the market&nbsp;couldn\u2019t&nbsp;\u2014&nbsp;at least the individual, non-group market had to be reformed so that they&nbsp;didn\u2019t&nbsp;\u2026&nbsp;they&#8217;d&nbsp;make their money on avoiding sick people. They needed to have a pool of people that they could insure, and it&nbsp;wasn\u2019t&nbsp;an irrational, expensive, immoral health care system.&nbsp;So&nbsp;I felt, and to&nbsp;Chip\u2019s credit a lot,&nbsp;and others, they wanted to have.&nbsp;\u2026&nbsp;And actually, the other argument that happened in 2008 and&nbsp;\u201909,&nbsp;there\u2019s a lot of different things that came together.&nbsp;Bipartisan&nbsp;Policy Center was there. There was interest in doing comprehensive reforms that were very consistent with what the Affordable Care Act ended up happening. But there was also this notion of all the stakeholders were&nbsp;just tired&nbsp;of fighting, and it was like,&nbsp;<em>Let\u2019s&nbsp;get something together<\/em>. There\u2019s one last point&nbsp;that I think people&nbsp;neglect to cite, and I know&nbsp;Chip would agree.&nbsp;At the time, there was a concern that a lot of the savings from health care would go to something like deficit reduction or tax&nbsp;cuts, but&nbsp;not reinvested in health care for coverage expansion. And so when,&nbsp;you know, if you\u2019re a stakeholder and you\u2019re going to contribute something to the offsets, you want to be reinvested in your system so you have paying customers, and that\u2019s why I think the hospitals and the physicians and the insurers all came together to say,&nbsp;<em>let\u2019s figure out a way that this can work<\/em>.&nbsp;So that at least helps paint the picture about how you could tie it together.&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:&nbsp;<\/strong>And one experience that I had was that I brought&nbsp;\u2014&nbsp;I was then working by&nbsp;the&nbsp;early 2000s for the hospital association,&nbsp;the&nbsp;Federation&nbsp;of&nbsp;American&nbsp;Hospitals. And at that point, you know, obviously my members were supportive of the work I was doing with Ronnie. But there came a point,&nbsp;I can remember it to this day, in October 2006 we were having a meeting, and a number of the CEOs of the systems I work for&nbsp;came to me in a meeting and said,&nbsp;<em>This&nbsp;isn\u2019t good enough<\/em>.&nbsp;<em>There are just too many patients that&nbsp;we\u2019re&nbsp;treating that&nbsp;don\u2019t&nbsp;have insurance,&nbsp;where their finances are getting in the way of the care they need, and&nbsp;we got to&nbsp;have something comprehensive<\/em>.&nbsp;So&nbsp;they moved away from,&nbsp;not that they&nbsp;didn\u2019t&nbsp;support incremental changes, but they wanted to see the big picture done, and that led the Health Insurance Association&nbsp;\u2014&nbsp;we were a small group&nbsp;\u2014&nbsp;to&nbsp;develop our own plan, the health&nbsp;care passport.&nbsp;And there were other plans out there. And the increment, the very important thing about that plan and the others and the way that&nbsp;\u201909 worked was that in the administration&nbsp;and&nbsp;in&nbsp;Congress, they wanted to build on what works in the system, and reform the individual market and lay in enough subsidization and expansion of Medicaid so that we could say everybody has the opportunity for coverage. Now we could say&nbsp;that&nbsp;was not that different from&nbsp;\u201993 and&nbsp;\u201994,&nbsp;but it was handled completely differently. And&nbsp;I think it&nbsp;was more sensitive to all the concerns of all those that were stakeholders, that were players.&nbsp;And that was the framework, but it was building on what exists with those kinds of playing with the knobs that really made the difference, that you could say everybody could have access to coverage.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>So&nbsp;as we\u2019ve kind of talked about, up to 2009 health care was pretty bipartisan. I mean, you know, there were partisan fights. There are obviously fights that&nbsp;Chip,&nbsp;you noted,&nbsp;that&nbsp;were going to be perennial, like fights over abortion.&nbsp;But,&nbsp;generally,&nbsp;big things&nbsp;that got done got done with&nbsp;Democratic and at least some Republican votes, or, you know, Republican&nbsp;\u2026&nbsp;in the case of the Medicare prescription drug bill, Republican and some Democratic votes. And yet, you know, in 2009,&nbsp;it just suddenly became partisan in a way that it still is today. I mean, what happened?&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:&nbsp;<\/strong>Well, let me say&nbsp;it\u2019s&nbsp;very, very important&nbsp;to think of the broader context and not just focus on health care for a second. A lot was changing. The Tea Party, we go on and on about how we got to where we are today, and the great divide.&nbsp;So&nbsp;there was a great political divide. There was no more getting&nbsp;\u2026&nbsp;there was much less getting to yes in Congress. And I think that health reform, in a sense, suffered from that. And the other dilemma that health reform had, I think, which was it&nbsp;was successful because of the vast&nbsp;Democratic majorities.&nbsp;They&nbsp;didn\u2019t&nbsp;need the Republicans.&nbsp;On the other hand, the fact that&nbsp;\u2014&nbsp;and the Republicans wouldn\u2019t play, so I\u2019m not saying there was a possibility there&nbsp;\u2014&nbsp;but the fact that it got done in a partisan fashion, you know, fit into a larger context that made it part of the divide. And,&nbsp;frankly, after it passed&nbsp;\u2014&nbsp;and,&nbsp;obviously, hospitals were&nbsp;very supportive&nbsp;of it&nbsp;\u2014 there&nbsp;were a lot of Republicans that would never speak to&nbsp;me again.&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:<\/strong>&nbsp;Yeah. And Julie, I think it\u2019s important to recall that even back in&nbsp;\u201993-\u201994,&nbsp;around the Health Security Act, there were Republicans who wanted to do this, but&nbsp;\u2014&nbsp;and I\u2019m sure&nbsp;Chip will yell at me about this&nbsp;\u2014&nbsp;but Speaker Gingrich was not interested in having a health&nbsp;care achievement signed into law by Bill Clinton. He made that very, very explicit.&nbsp;So&nbsp;I think different people will say,&nbsp;When&nbsp;did partisanship around health&nbsp;care really start? But I would say there was a big one. Then we had the big fight around the&nbsp;\u201cContract&nbsp;With&nbsp;America,\u201d&nbsp;and from then on, even though there were significant reforms that were bipartisan, I would call them important, but incremental, you know.&nbsp;And&nbsp;Chip\u2019s right.&nbsp;I&nbsp;don\u2019t&nbsp;think you could have gotten anything close to the Affordable Care Act on a bipartisan bill.&nbsp;Maybe&nbsp;he\u2019d&nbsp;disagree, but I just, I&nbsp;don\u2019t&nbsp;think there are some Republicans&nbsp;\u2014&nbsp;I\u2019ll&nbsp;tell,&nbsp;I can even tell you&nbsp;\u2014&nbsp;who would say,&nbsp;<em>Oh, if&nbsp;you\u2019d&nbsp;only tried or whatever<\/em>&nbsp;\u2026&nbsp;I think&nbsp;[Sen.]&nbsp;Max Baucus&nbsp;[the&nbsp;Finance Committee&nbsp;chairman]&nbsp;really wanted,&nbsp;you may recall this. He worked for a long time. He desperately wanted to have&nbsp;bipartisanship. I&nbsp;don\u2019t&nbsp;think that was going&nbsp;\u2026&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yes.&nbsp;And I sat in the hall during those meetings for weeks at a time. I remember.&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:&nbsp;<\/strong>Yeah, yes. You remember?&nbsp;I mean&nbsp;\u2026&nbsp;and to the criticism of&nbsp;a lot of the&nbsp;Democrats, what are you holding up for? So unfortunately, there are elements of health care, and&nbsp;I think a lot&nbsp;have&nbsp;to do with coverage&nbsp;\u2014&nbsp;Medicare, Medicaid, marketplace, the three M\u2019s, if you will&nbsp;\u2014&nbsp;that are&nbsp;very hard&nbsp;not to politicize. And&nbsp;unfortunately, public health has now become very politicized, too.&nbsp;So&nbsp;we\u2019re&nbsp;having a smaller&nbsp;[unintelligible] of&nbsp;elements of health care that you can see bipartisanship.&nbsp;But&nbsp;\u2026&nbsp;there are some, and I\u2019m sure we were going to talk about that, but I look back and reflect about that debate, and I don\u2019t see a possibility of where it would have worked and Barack Obama would have been able to achieve what he said he was going to achieve.&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:&nbsp;<\/strong>Well, let me say a couple of things. First, I think,&nbsp;to&nbsp;modify&nbsp;your history. I think that in the&nbsp;House&nbsp;\u2026&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:<\/strong>&nbsp;Yes.&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:<\/strong>&nbsp;\u2026&nbsp;Newt&nbsp;wasn\u2019t&nbsp;speaker at the&nbsp;time,&nbsp;he was&nbsp;minority&nbsp;leader.&nbsp;Clearly, there&nbsp;was nowhere to go with Clinton&nbsp;Care. I mean, the Republicans just were not going to go.&nbsp;I think you saw something quite different in the Senate.&nbsp;And there were many Republicans in the Senate, probably not a majority of the conference, but a very large minority who were willing to at least try&nbsp;\u2026&nbsp;but I think the environment completely changed over time, and by the time you got to 2009,&nbsp;2010,&nbsp;despite some&nbsp;kabuki&nbsp;theater on the part of some Republican senators,&nbsp;who I won\u2019t name, who sort of played along, they were not going to cooperate. But let me say, one of the turns in history&nbsp;that\u2019s&nbsp;important is that&nbsp;you\u2019ll&nbsp;remember the Democrats had 60 votes in the Senate until the end, when, unfortunately, Sen.&nbsp;[Ted]&nbsp;Kennedy died.&nbsp;But actually, I&nbsp;would argue that it was his death, in a sense, that&nbsp;ultimately led&nbsp;to health reform passing, because a conference report on health reform between the House and the Senate&nbsp;probably&nbsp;wouldn\u2019t&nbsp;have gotten all the Democratic senators. I&nbsp;don\u2019t&nbsp;think Sen. [Ben]&nbsp;Nelson&nbsp;[D-Neb.]&nbsp;could have done it, so you would have had a filibuster against it. But by&nbsp;[Kennedy]&nbsp;dying, the&nbsp;House was forced to take on,&nbsp;for the bulk of health reform, the Senate bill, and they passed the Senate bill. Yes, there was a reconciliation later, but it was really,&nbsp;that was the framework for health reform, and in a bizarre way, it was the contribution of his death and the&nbsp;\u2026&nbsp;House having to accept the Senate bill that led to health reform really passing, you know, by the skin of its teeth, even though there were these vast majorities of Democrats in the House and Senate.&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:&nbsp;<\/strong>Yes, I think&nbsp;that\u2019s&nbsp;a very insightful comment, and I rarely say that about&nbsp;Chip. [Kahn laughs.]&nbsp;So, no, I&nbsp;do&nbsp;all the time. It is,&nbsp;but Kennedy,&nbsp;the sacrifices Kennedy would make to become the ultimate legislator, even to go&nbsp;so&nbsp;far as&nbsp;to die. But I will say, I think&nbsp;that\u2019s&nbsp;right, because there was&nbsp;a very significant&nbsp;frustration amongst the House Democrats, and they desperately wanted to have a true conference, and that would have made it&nbsp;very hard&nbsp;in the Senate. It would&nbsp;\u2026&nbsp;have been hard to clear through reconciliation rules in the Senate.&nbsp;And there would have been lots of challenges, and,&nbsp;ultimately, this&nbsp;is why Nancy Pelosi gets most of the credit, and so too should Harry Reid. They brought it home in a way that&nbsp;probably was&nbsp;the only way to get it done. And&nbsp;subsequently, one of the problems was&nbsp;it&nbsp;probably&nbsp;wasn\u2019t&nbsp;drafted as cleanly as we would have liked it to be. You know what&nbsp;I\u2019m&nbsp;saying?&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Yes, I know what&nbsp;you\u2019re&nbsp;saying. For those who, for those of us who had to follow this&nbsp;sort of ins and outs of the not being able to make technical corrections to it for its entire history&nbsp;\u2014&nbsp;which,&nbsp;flash-forward to today, is there any chance of ever getting back to bipartisanship on health care?&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:&nbsp;<\/strong>I&nbsp;don\u2019t&nbsp;think&nbsp;on&nbsp;anything&nbsp;regarding&nbsp;delivery and financing&nbsp;that\u2019s&nbsp;major&nbsp;is there much likelihood of consensus.&nbsp;Now, if you remember, not too long ago, there were bills on, you know, FDA processes and&nbsp;the such, and they were done in&nbsp;a&nbsp;bipartisan manner. And&nbsp;maybe some&nbsp;of those things&nbsp;at&nbsp;the edges.&nbsp;I think there&nbsp;are some hospital issues and others that still could be dealt with in a bipartisan manner. But that gets back to&nbsp;context.&nbsp;You\u2019ve&nbsp;got to have the&nbsp;sun&nbsp;and the moon come together on political context that would allow some&nbsp;\u2014&nbsp;I&nbsp;won\u2019t&nbsp;call them marginal,&nbsp;but&nbsp;\u2014&nbsp;relatively&nbsp;small changes&nbsp;to be legislated. Other than that,&nbsp;we\u2019re&nbsp;in an environment right now where I just&nbsp;don\u2019t&nbsp;see compromise on anything big, because the divide that we saw coming out of&nbsp;\u201910&nbsp;is still there. And if anything,&nbsp;it\u2019s&nbsp;just deeper than ever.&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:&nbsp;<\/strong>Right, and&nbsp;\u2026&nbsp;although I&nbsp;don\u2019t think&nbsp;Chip would disagree with&nbsp;\u2026&nbsp;what I\u2019m about to say,&nbsp;is,&nbsp;there are issues that are not so much ideological in coverage:&nbsp;biomedical research, transparency, even physician payment reform, rural health,&nbsp;telemedicine, community health centers.&nbsp;I\u2019m&nbsp;just mentioning these&nbsp;out loud, because&nbsp;you\u2019ll&nbsp;see bipartisan agreements on some of those things.&nbsp;But in terms of&nbsp;real structural&nbsp;reform, and particularly when&nbsp;you\u2019re&nbsp;talking about where people get coverage and how much you subsidize it, boy, is that tough. In fact, I would even argue, and this is&nbsp;really unbelievable&nbsp;to say out&nbsp;loud,&nbsp;that cost containment in some fields, which is&nbsp;almost always&nbsp;impossible, is easier than how you spend the money. Because&nbsp;people&nbsp;don\u2019t,&nbsp;can\u2019t&nbsp;agree on the structure by which you would reallocate the savings to make health care work.&nbsp;So&nbsp;it is a frustrating time, which is why&nbsp;it\u2019s&nbsp;hard to make&nbsp;the&nbsp;argument against people who say,&nbsp;<em>then we need to have all one party or the other party to get something big done<\/em>.&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:&nbsp;<\/strong>Now, let&nbsp;me say I think there could be some surprises next year if the Democrats took over in the&nbsp;House. You know, is there some possibility that there could be a big compromise with a Trump administration in the future on drug negotiation or drug costs?&nbsp;So&nbsp;I&nbsp;don\u2019t&nbsp;want to say that&nbsp;there\u2019s&nbsp;nothing that can be done. And I agree with,&nbsp;and&nbsp;I think I&nbsp;said,&nbsp;with Chris that there are these issues around the edges that could be dealt with, and the ones he outlined are the ones that I would agree with.&nbsp;I think the one big one&nbsp;is there is some possibility around drugs. But I think, other than that, I&nbsp;don\u2019t&nbsp;see the Republicans being willing to help on Medicaid.&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:&nbsp;<\/strong>And that is a cost containment as opposed to&nbsp;kind&nbsp;of&nbsp;a coverage, you know.&nbsp;And&nbsp;it\u2019s&nbsp;sort of a&nbsp;one-off. It&nbsp;isn\u2019t, you know, big, big reform. But I agree with&nbsp;Chip that there you could see Democrats in the House push something that&nbsp;[President Donald]&nbsp;Trump would endorse, that Republicans in the Senate&nbsp;wouldn\u2019t&nbsp;like to pass but would. \u2026 They&nbsp;probably would&nbsp;want to have&nbsp;come up&nbsp;with&nbsp;an&nbsp;excuse not to.&nbsp;But that\u2019s,&nbsp;that is a target area that could happen. Although, you know,&nbsp;I\u2019m&nbsp;\u2026&nbsp;Democrats&nbsp;aren\u2019t&nbsp;catching,&nbsp;counting our chickens just yet,&nbsp;Chip.&nbsp;\u2026&nbsp;We\u2019re&nbsp;knocking on wood here.&nbsp;[knocks]&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:&nbsp;<\/strong>Yeah, let me say, if the Congress doesn\u2019t change,&nbsp;in terms of who has the majorities in both House and Senate, I don\u2019t see anything major, other than some of the things, you know, transparency and some of these other issues, getting attached to something bigger.&nbsp;And then&nbsp;you\u2019ve&nbsp;got to have context, as I said, the right context to have it. But I&nbsp;don\u2019t&nbsp;see anything big unless we get split government. I think split&nbsp;government&nbsp;could lead to some interesting things in some of these areas.&nbsp;But what we think of&nbsp;as health reform writ large,&nbsp;right&nbsp;now,&nbsp;it\u2019s&nbsp;just politically charged.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>We\u2019re&nbsp;going to&nbsp;have to wrap up. But one thing that I\u2019ve been sort of thinking about a lot is that we seem to be getting to this place that we were in in 1993 again, and in 2008 again, where everybody is unhappy with the system&nbsp;\u2014&nbsp;that,&nbsp;particularly patients, even people with insurance, are unhappy with the way the system is working. Doctors are unhappy, hospitals are unhappy, insurance&nbsp;companies are unhappy.&nbsp;Is it possible that that\u2019s going to push this big divide a little bit back together, at least in an effort to do something?&nbsp;I mean, clearly&nbsp;President Trump knows that people are unhappy with the cost of drugs, if nothing else in health care. Do you think&nbsp;we\u2019re&nbsp;heading for another round of major health reform debate?&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:&nbsp;<\/strong>It feels like that,&nbsp;Julie,&nbsp;for sure,&nbsp;\u201991-\u201992-ish,&nbsp;or, you know.&nbsp;It does not feel like in any way.&nbsp;\u2026&nbsp;I think people are really frustrated with costs, really frustrated with complexity, really frustrated with how they think the system is not necessarily responsive.&nbsp;They\u2019re pretty good at kind of defining the problems, but in terms of developing a consensus around how best to do that, which is, you know, typically what people say,&nbsp;<em>I want comprehensive reform that doesn\u2019t disrupt me<\/em>, you know, which is&nbsp;a&nbsp;hard nut to crack sometimes.&nbsp;But&nbsp;\u2026&nbsp;it feels like&nbsp;we\u2019re&nbsp;seeing it. And&nbsp;you\u2019re&nbsp;going to hear a lot about talk, but I think&nbsp;you\u2019re&nbsp;\u2026&nbsp;the&nbsp;big thing&nbsp;will happen around a&nbsp;\u201927-\u201928 period, when the two open electorates for presidency come up, and&nbsp;\u2026&nbsp;this issue will be absolutely debated.&nbsp;But the big,&nbsp;big thing&nbsp;probably&nbsp;isn\u2019t&nbsp;going to happen until the next president is elected.&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:&nbsp;<\/strong>So let me say this, and&nbsp;I\u2019m&nbsp;going to give a plug to&nbsp;KFF\u2019s&nbsp;<em>Business of&nbsp;Health&nbsp;With&nbsp;Chip Kahn<\/em>, a podcast that will come sometime in April.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;Absolutely.&nbsp;<\/p>\n\n\n\n<p><strong>Jennings:<\/strong>&nbsp;He\u2019s&nbsp;shameless.&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:<\/strong>&nbsp;We\u2019re&nbsp;going to&nbsp;\u2026&nbsp;focus&nbsp;on AI&nbsp;[artificial intelligence]&nbsp;for the first three or four months. And I&nbsp;don\u2019t&nbsp;want to say&nbsp;it\u2019s&nbsp;going to change the world.&nbsp;It\u2019s&nbsp;going to change the world. I&nbsp;don\u2019t&nbsp;want to say&nbsp;it\u2019s&nbsp;going to change health care.&nbsp;It\u2019s&nbsp;going to change health care. Is it going to solve all these problems? I&nbsp;don\u2019t&nbsp;know, but I think many of these issues could be different five years from now because of the effect of AI,&nbsp;and will doctors be practicing the same way they are now?&nbsp;Will all these issues of&nbsp;thousands&nbsp;of people working with green eyeshades&nbsp;in&nbsp;hospitals to make sure the claims are done right, they go to insurance companies. With respect to those&nbsp;thousands&nbsp;of people,&nbsp;it\u2019s&nbsp;going to be&nbsp;AI.&nbsp;\u2026&nbsp;They\u2019re&nbsp;not going to have jobs anymore, and&nbsp;it\u2019s&nbsp;going to change a lot. Now, is it going to solve any of these problems, or is it going to raise risks and challenges we&nbsp;can\u2019t&nbsp;even foresee?&nbsp;I don\u2019t know, but I think we\u2019re going through, about to go through,&nbsp;an evolutionary period, and I don\u2019t know what it\u2019s going to look like on the other end.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:&nbsp;<\/strong>Well, I think&nbsp;that\u2019s&nbsp;as good a place as any to leave it. I want to thank both of you. I could&nbsp;definitely go&nbsp;on for another hour, but we&nbsp;won\u2019t.&nbsp;Chip Kahn,&nbsp;soon to be a fellow at&nbsp;KFF.&nbsp;Chris Jennings, Jennings&nbsp;Policy&nbsp;Strategies. Thank you very much.&nbsp;&nbsp;<\/p>\n\n\n\n<p><strong>Kahn:<\/strong>&nbsp;Thanks a lot.&nbsp;<\/p>\n\n\n\n<p><strong>Rovner:<\/strong>&nbsp;OK, that is this week\u2019s show.&nbsp;As always, thanks to our editor,&nbsp;Emmarie Huetteman, and our producer-engineer this week, Taylor Cook. A&nbsp;reminder:&nbsp;<em>What the&nbsp;Health?<\/em>&nbsp;is now available on WAMU platforms, the NPR app,&nbsp;and wherever you get your podcasts, as well as,&nbsp;of course,&nbsp;<a href=\"https:\/\/kffhealthnews.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">kffhealthnews.org<\/a>. As always, you can email&nbsp;us&nbsp;your comments or questions.&nbsp;We\u2019re&nbsp;at&nbsp;<a href=\"mailto:whatthehealth@kff.org\" target=\"_blank\" rel=\"noreferrer noopener\">whatthehealth@kff.org<\/a>.&nbsp;We\u2019ll&nbsp;be back in your feed next week&nbsp;with all the health news. Until then, be healthy.<\/p>\n\n\t\t<\/div>\n\t<\/div>\n<\/section>\n\n\n\n<div class=\"wp-block-credits block--credits\">\n\t\t<h3 class=\"credits-title\">\n\t\tCredits\t<\/h3>\n\t\t<div class=\"credits-card-container twowide\">\n\t\n\n<div class=\"wp-block-people-card block--people-card\">\n\t\t\t<div class=\"author-meta-container\">\n\t<div class=\"author-name\">Taylor Cook<\/div>\n\t<div class=\"author-affiliation\">Audio producer<\/div>\n\t\t\t\t\t\t<div class=\"author-bio\">\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-people-card block--people-card\">\n\t\t\t<div class=\"author-meta-container\">\n\t<div class=\"author-name\">Emmarie Huetteman <\/div>\n\t<div class=\"author-affiliation\">Editor <\/div>\n\t\t\t\t\t\t<div class=\"author-bio\">\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\t<\/div>\n<\/div>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\" \/>\n\n\n\n<p><em><a href=\"https:\/\/kffhealthnews.org\/our-podcasts\/\"><u>Click here to find all our podcasts.<\/u><\/a><\/em><\/p>\n\n\n\n<p><em>And subscribe to &#8220;What the Health? From KFF Health News&#8221; on <a href=\"https:\/\/podcasts.apple.com\/us\/podcast\/what-the-health\/id1253607372?mt=2\"><u>Apple Podcasts<\/u><\/a>, <a href=\"https:\/\/open.spotify.com\/show\/32EdsB662C3oyIrqLMmBXI?si=TQhRjzzLTgWtK3crfbOFtA\"><u>Spotify<\/u><\/a>, <a href=\"https:\/\/app.npr.org\/aggregation\/fis-1269164038\"><u>the NPR app<\/u><\/a>, <a href=\"https:\/\/www.youtube.com\/playlist?list=PL5Qew-7pSXbAucCUQnyRx6qpLglzrxzFb\" target=\"_blank\" rel=\"noopener\">YouTube<\/a>, <a href=\"https:\/\/play.pocketcasts.com\/web\/podcasts\/a379e280-3f57-0135-9028-63f4b61a9224\"><u>Pocket Casts<\/u><\/a>, or wherever you listen to podcasts.<\/em><\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This month is 40 years since host Julie Rovner, chief Washington correspondent for KFF Health News, began reporting on health policy in Washington. To mark the anniversary, Rovner is joined by two longtime sources to discuss what has \u2014 and has not \u2014 changed since 1986.<\/p>\n","protected":false},"featured_media":2103181,"template":"","meta":{"_cr_original_post":"2103176","_cr_replace_post_id":"","_cr_replacing_post_id":"","jetpack_post_was_ever_published":false,"kaiser_health_news_featured_image_caption":"","kaiser_health_news_header_theme_slug":"","kaiser_health_news_hero_image":0,"kaiser_health_news_backdrop_padding":115,"kaiser_health_news_kicker":"What the Health? 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