[00:00:00] Welcome to the Health Policy Podcast. I'm happy to welcome Ryan Ellis, the President of the Center for a Free Economy as our guest for this episode. Uh, Ryan, welcome to the show. Would you mind telling us just a little bit about who you are and what you do? Uh, so I'm the president of a conservative 5 0 1 C four called the Center for a Free Economy, and we do work every single business day, uh, on issues related to federal tax issues, federal spending issues, federal regulatory issues. Things that are of interest to the American people. I've, I've spent a long, long time, uh, working in politics on the policy side, uh, the policy advocacy side is what I like to call it, um, on those issues especially, uh, taxes, healthcare, federal spending, budget, all that fun stuff. Boy, healthcare and, and government seem to be, uh, pretty tightly enmeshed with one another here lately. Um, let's, let's talk about what is at the top of your priority list in terms of what you're working with at the Center for a Free Economy regarding [00:01:00] healthcare. These days, a lot of it, uh, and this has been true for the last two to three months, has been a question of whether we're going to extend the COVID era, Obamacare super subsidies. So Obamacare is a very heavily subsidized program for individuals to buy health insurance. It's been a heavily subsidized program ever since it began. Uh, during COVID, there were additional subsidies. Put on top of the legacy permanent Obamacare subsidies. Understandably, maybe because people were in COVID, they were working from home, maybe they had an employment disruption and it was intended as a patch to get people for a few years past, uh, COVID. Well, that's obviously expired. We're back onto a normal footing. And so as a result, those extra. Uh, COVID era. Obamacare subsidies, um, have, uh, have expired. They expired at the end of last year. Uh, the Democrats would like to extend them, uh, ideally make them permanent. That's a very expensive proposition. Um, it would be hundreds of billions of dollars in additions to the national debt. Um, it doesn't have much of an impact because we already [00:02:00] have a heavily subsidized Obamacare system for those who need it. Obamacare is really intended for those who are, let's say, exiting Medicaid, which is health insurance for the poor. Maybe don't have employer provided coverage and don't have a high enough income to pay for it themselves. That's really what Obamacare is there for. And uh, while Obamacare did a lot of damage to the healthcare system, the subsidy part of it was probably pretty well thought out because that's where a lot of the subsidy was needed. That's where a lot of the subsidy is. These COVID era supplements were going to people making 6, 7, 8, 9 times, uh, the federal poverty level. Um, people who frankly didn't need the subsidies in order to help pay for it, there was a lot of enrollment of people who didn't even know they were enrolled. They were just simply enrolled, getting a subsidy, never going to the doctor. And whoever enrolled them was getting a commission and whoever their insurance company was was getting a windfall. So getting that completely put away and done is important. Yes, in itself. But it's also important because we have all sorts of [00:03:00] spending cuts, reforms that we did. Back in July as part of the one big beautiful bill act that Congress needs to see through. It needs to, and not, not, um, take these reforms off the table at the last minute when things get a little bit politically uncomfortable. So it's very important that we see this through and that on the other side of this, we can prevent, we can provide a little bit more. Of, um, of a positive vision for what healthcare should look like to the American people. Okay. I wanna make sure that I'm understanding, um, what, what you have said here. Um, are you saying that the, the Obamacare subsidies, particularly those enacted during COVID, uh, should be, should, should remain albeit to perhaps, uh, maybe with some revision rather than just being outright discarded. Am I hearing? No, no. Quite the opposite. They, they have, they expired at the end of the year. They should remain expired. Gotcha. We, we don't, we don't need them. There's already a legacy Obamacare subsidy that's permanent and part of the law that has always been part of Obamacare. Um, that's, that's there and that's, that's doing the job that it's always done. And, uh, it doesn't [00:04:00] need this sup the supplement. It doesn't need this extra COVID supplement. Uh, there's lots of things I would do in order to reform Obamacare. Um, you know, but that, you know, certainly one of the things that we would not wanna do is put additional subsidies onto a system that's fundamentally broken. And, and this is one of the questions I have about Obamacare. I mean, originally it was passed as the a CA, the Affordable Care Act. Um, it seems to me that, uh, the costs, uh, despite the, you know, the intentions of, of that, uh, that particular legislation. It's, it has, we've still seen costs. Absolutely. Go up. Uh, so I guess my question is, Ryan, did, did Obamacare deliver on making healthcare affordable or was that a good intention that wasn't quite realized? I, I don't think it was ever going to deliver on making healthcare affordable, because if you look at Title one of Obamacare, if you actually read that law, it's two laws. But if you read title one of the Affordable Care Act, what it does is it places all sorts of design restrictions on how insurance policies are to be written. [00:05:00] There's all sorts of arcane things that insurance people understand and almost no one else does. Myself included things like the medical loss ratio that the president mentioned yesterday. Things like, um, community rating, uh, things, uh, things like actuarial value bans as to how plans can be offered. All. And then there's a lot of, uh, there's a lot of, uh, benefit mandates that every insurance plan has to cover X, Y, and z even if you don't need coverage for it. All those things conspire to make health insurance much more expensive. Than it needs to be. It wasn't as if a health insurance was cheap before Obamacare by any means, but there was a lot more design flexibility so you insurance companies could innovate, they could offer different products to different types of people. Obamacare made a lot of those products either illegal or functionally illegal. The Trump administration has tried to introduce some more flexibility into the type of products that could be offered. Things like short-term renewable plans or um, health reimbursement arrangements at work, what are called IRAs. Health Sharing ministries [00:06:00] is another one that people have found popular. There's lots of different models for how you can build that mousetrap on, on insurance, but uh, you know, there was kind of a model T you can have any call you want as long as it's black kind of sense of, of the Affordable Care Act. Um, and as a result it's, it's caused insurance premiums to go up and up and up every year because there's simply no cost constraint in the system and there can't be because of the plan design mandates. Is competition something that's needed to help, uh, address that, that, uh, you know, one size fits all problem that, that you just described. Yes. And, but that competition's impossible without deregulation. If, if the only thing you could buy is McDonald's hamburgers, then it doesn't matter how many McDonald's you have that are competing with each other, they're all gonna look like McDonald's hamburgers, right? It's only when you deregulate and you can say, well, that can be a McDonald's, that can be a Burger King, and that can be a Wendy's and that can be a five guys that you start to actually get some competition because then they're all gonna innovate and come up with a different way to build that burger for you and try to [00:07:00] sell you. On their burger versus the guy across the streets burger, until you have the deregulation that says everything has to be a McDonald's hamburger. Unless, until you can get rid of that in the Affordable Care Act, there's very little chance of the competition that we need to have happening happening. Ryan, maybe you could shed some light on this for me. Um, the, the Democrats fought so hard to keep those, uh, those subsidies in, uh, before the end of the year, before they expired and, and. I don't quite understand what was in it for them. I mean, I try to ask CU Bono, you know, whenever there's, there's some kind of intrigue, who's gonna benefit from this? What, what did they stand to gain if they were able to compel the Republicans to keep those subsidies? Well, there's a couple theories of the case as to as to why uh, none of them are particularly favorable or charitable toward the Democrats, but I'll, I'll share what the prevailing wisdom is. One is that the big insurance industry, along with big hospital industry and a lot of the large insurance providers and the, and the people, the insurance providers. Pay the insurance companies, pay [00:08:00] hospitals especially, uh, have really gotten into bed with the Democrats in a political way. And there's an iron triangle effect happening here where you have the party of government, which is the Democrats conspiring with the recipients of government spending, which in this case is big insurance and big hospitals conspiring together to get more of the loot from the American taxpayers. If you have that on the Republican side with defense contractors, for example. So this isn't like, this is, this is a, a, an issue that only affects one side or the other. So think of it like, well, why would defense contractors be so cozy with the Republicans? Probably for the same reason the big insurance and big hospitals is being cozy for the Democrats. They want the money. I. Ideologically where the Democrats would like to go is they would like to have the government pay for all health insurance as a human right. That's an ideological position on their part. They would like single payer health insurance, socialized medicine, where the government is the ultimate payer for all healthcare, and that you simply get it from the government. In the same way that you, you know, if for instance, your, your mail that you get is entirely a government monopoly, [00:09:00] they would want it to be like the post service, postal service or your driver's license. That's entirely a government monopoly. Or in a lot of places where people live, they might have one electric company, they. Or one gas company, um, in order to get, that's a government monopoly, that that's the way they would like to do it. Have a single payer providing everything and you need a lot of subsidization for that. And, uh, that that's the way the Democrats would like to move anyway. So more subsidization is always a good thing. They want the government to pay for it anyway. I gotta thank you. That's, that is one of the best, most concise explanations I've heard. I feel like I, I actually understand this issue better than, than I have, um, you know, as, as much as it's been discussed over the last few years. Let's shift gears for a moment. Um. The, the fraud that is coming out in Minnesota right now, particularly, um, you know, we're hearing about, you know, daycare centers and, and, and, uh, basically a lot of, uh, big time fraud on the part of, um, Somali controlled, uh, businesses as well as, uh, people who are on, uh, or people who are recipients of, of, uh, government, uh, [00:10:00] healthcare. How, how does this, uh. How does this play into the work that, that you're doing? Or what, what problems does it shed light on the, the, the Center for a Free Economy, you know, has some solutions to proffer? Well, the entire apparatus of helping people that we have in this country is, is a model that is in deep need of reform. Um, so what you're seeing up in Minnesota, things involving snap, which is food stamps, things involving daycare centers. Some, some healthcare is involved in here as well. Um, but if you take a look back at the one big beautiful Bill act, which was the bill that, that the law that Congress passed last, uh, late June, early July, it put in place finally some basic common sense, uh, welfare reform restrictions that we have been crying out for a long time. Basic work requirements within snap basic illegal immigrant screening requirements within snap. Um, similar requirements within Obamacare, similar requirements within Medicaid. There were some reforms around student loans. But this entire apparatus of [00:11:00] government support for the needy, uh, is very well intentioned, but often we lose a lot of accountability as it goes down the chain. And in Minnesota, what you found is that it was outsourced and outsourced and outsourced down the chain to where you have, let's say, a local nonprofit or a local, non-government organization, which was then, which was corrupted and captive by the population that it's, that it's serving, skimming off the top, taking money. Setting up, uh, phony distribution centers for food phony distribution centers for, for daycare, um, in the billions of dollars in order to steal money from these government programs either to be used for personal enrichment or to be maybe sent back to their home country or whatever was happening here. Um, and that that's because there's no accountability. And if you saw what the Democrats were talking about for most of last year, it was, oh my God, women and children are gonna be thrown out on the streets. If we have the least amount of accountability, if we, let's say, check every six months that someone is still food stamp eligible, or if we check every year that someone is still [00:12:00] eligible for this level of Obamacare subsidy that they say that they're eligible for, by running those basic checks, which I think most people would say are just common sense. Are you in this country legally? Do you have a criminal record? Have you paid up all your child support? Um, you know, are, do you earn too much money to qualify for this benefit? Um, you know, those type of questions are common sense questions that it took moving heaven and earth to get those into the law. And now I think the Minnesota example is why those things are so badly needed. And the thing that drives people nuts is they're trying to cover it up everywhere. This is what they simply failed to cover up. This little tip of the iceberg is where they failed to cover it up. What else is going on all around the country in even more corrupt states than Minnesota, where a lot of these shenanigans are probably happening in a lot of communities. Fair enough. Um, let's talk about that one big beautiful bill act and, and tell me the, the good and the bad if there's any in there. Um, I, I've heard a lot of positive things [00:13:00] that, uh, that were accomplished by that law. Um. Are there any that stand out to you that were particularly noteworthy? Well, it's important for people. You know, you, you hear a lot about, oh, it didn't do enough. It didn't go far enough. It should have done more. We were dealing with a very, very tight Republican majority in the US House of Representatives. I think at one point they had maybe three or four votes they could spare. Uh, these type of exercises are always a hundred percent partisan, so they had to get to 218 votes in the house, which is a majority with something like 221 or so Republicans in the house and zero Democrats helping them out. So it was virtually. A unanimous vote that had to happen from the Republicans and it wasn't much better in the Senate, frankly. Um, so you, the, the fact that they got everything that they got in terms of fully funding the border, fully funding defense, doing the welfare reforms that we've talked about, making sure that trillions of dollars of scheduled tax increases were turned off, and in fact the tax relief is now made permanent. All sorts of new additional pro-growth and [00:14:00] pro-family tax relief that was put in place. There was a trillion and a half dollars of spending cuts over 10 years, not because we were cutting benefits that people needed because we were taking the waste, fraud and abuse outta the system like I've been describing here, doing basic checks on people, making sure they're in the country legally, making sure that they're not earning more income than is, uh, than than they can in order to benefit from these programs. Making sure that they're getting off their butt for at least 20 hours a week to at least work or volunteer. That's another thing that we put in with some basic work requirements. Those are very good. Uh, down payments on welfare reforms that are, are going to be needed. We're gonna need to go much, much farther than that. If the goal is to, let's say, balance the budget and pay down the national debt, we're gonna have to start taking a look at some very fundamental structural reforms to social security to Medicare. To our Medicaid system, things that we didn't really get into in the one big beautiful Bill act, frankly, because we didn't have the, the margin to do so. There wasn't the political ability to do so. Um, but there's the economic necessity of doing that over as we [00:15:00] get deeper here into the 21st century. Talk to me now about, uh, the Center for a Free Economy and, and what you are doing to move the needle in the right direction, um, to, to help address some of the, the problems that you have described for us thus far. Well, center For a Free Economy was founded, I, I should know this, I think it's 2018. I know it was just before COVID. That's what I always tell people. Uh, we were founded a little bit before COVID, uh, to focus on the bread and butter, uh, national fiscal issues. Uh, so my background is tax. I have a huge background in tax, a huge background in healthcare, uh, and also budget policy to a lesser degree. So that's, that's mostly what we focus on. Uh, we put up content every single day, uh, on our website, on Facebook, on x, on Instagram. Um, and, uh, you know, we're, we, we do, we talk about things as varied as food stamp reform to full business expensing in the tax code, uh, to what's going on in, uh, in Minnesota, um, to, uh, what we ought to be doing on social security for people who are [00:16:00] in their twenties. We talk about all those things in more, uh, I would definitely encourage people to go check out it's center free economy.org and our social handles are at CF economy. Very good. Again, we're talking with Ryan Ellis, who is President for the Center for a Free Economy. Ryan, thank you so much for joining us today on the Health Policy Podcast. Great for being here. Uh, and I hope all your listeners have a, a very, uh, uh, very fruitful and, uh, generous tax season as we approach it for them.