DiscoverVox's The WeedsKentucky, the Rust Belt, and the Big Picture on Trade

Kentucky, the Rust Belt, and the Big Picture on Trade

Update: 2016-12-21


Sarah, Ezra, and Matt talk about what Obamacare-using Trump voters are hoping for, which regions really need help, and a massive overview of the evidence on globalization and inequality.

Following script is auto-generated by Speech to Text Technology:

the following podcast contains explicit language the Colonels real invention isn't a secret plan spices it's the pressure frying pan to the hello welcome to another race of the weeds boxes policy podcast intently Network met to play CS at work that that the full team back in studio home Ezra Klein Sarah Claire finally back to back to the fried chicken vacation Sera Sera is a vegetarian she apparently did not eat any of CNN's now K of C Z nor take a vacation for the mom was working I mean I did take a half an hour out of my day to visit the Kentucky Fried Chicken I heard you guys talking about this at work some on from that his work I am how I am bitter about this because I once wrote an article for slate about the arches of KFC and I asked my editor if I could go to Kentucky to go to this to museum and I was told no that they would not pay for that I had just read several books about KFC I think my editor made the right decision action Halo not much there I also enjoy a precise wording of that story I really want to go to museums to go to anyway stupid museum nobody wants to go I want to go it's like have some doesn't want the Chinese so but there was a reason Sarah was there yes it is one of the things we're going to talk about on this podcast in addition to a huge new paper on trade and globalization and inequality that is summing up a lot of other papers over the years and also its majesty I and also a quick dive into why this emerging idea that we need a lot more play space policy as a reaction to the election is probably going to get US policy oriented at the wrong places so stay tuned for that bit of economic geography but you were in Kentucky Kentucky I was in Kentucky because I wanted to go somewhere that had a lot of people sign up for Obamacare and voted really heavily for Trump and it turns out Kentucky fits that definition quite well because I eat in the wake of the election which I and everyone else thought would go quite differently I started wondering about people who have gained insurance under the Affordable Care Act A N voted for Trump and how they made those decisions and so I found this area of southeastern Kentucky that when it's about eighty percent for Trump had a huge increase in coverage under Obamacare the biggest increase in the country how big was that in years so twenty five percent uninsured to ten percent uninsured sorry that you're talking with the the just the kind of why Kentucky yep having this particular thing I did so it's like Kentucky is bold had a lot of poor people who lacked insurance yes had a Democratic governor are who expanded Medicaid but is also like a super right wing state National Park yes so is one of the things I really dig Kentucky is the only states in the south that expanded Medicaid under the Affordable Care Act on the expansion started only state in the south that launched its own marketplace and you have you talked to Steve that she or the former governor of Kentucky before going there and he like knew everyone in a state really hated Obamacare are and he said You know what here's the thing I'm going to do I'm going to launch Obamacare without calling it Obamacare I'm going to like Clinton people into getting health insurance and it fucking works like these and a half million people for health coverage and then well it works in Denmark because I'm the Democrats did not win the governorship it was actually one by this guy Matt Donovan who campaigned on dismantling Medicaid expansion dismantling Medicaid and then the state was one again by Donald Trump who campaigned on repealing Obamacare siren went to Kentucky with this question about why does this state keep voting for people who very clearly promise to take away their health and think I know one other fascinating complexity of this is backed up your peace Kentucky is the dis proof of the political theory behind Obamacare the theory that if you just pass a law he does implement the law if you just get people receiving benefits from the law the law will become popular in Kentucky is a place where the lot did go into effect for a lot of people did receive benefits where by all accounts you'll actually enjoy the insurance they get from Obamacare can act as a marketplace work pretty well Medicaid expansion work pretty well but it did not become popular it cannot become sacrosanct and this is the context because it's really interesting what you found when you talk to the folks there yet so I went in with an expectation from some of the reporting I've done before that the story I would find is that people just didn't understand I am that their health insurance was part of Obamacare and it's like in retrospect a good bit of a like a patronizing expectation of these people if only if only they understood how health insurance work but it also really lined up with what people are saying that this was Governor Bush years expectation to call the kinetic all they can act you know Medicaid either it's very hard to find any mention of Obamacare when you sign up for one of the programs in Kentucky like you're going to connect marketplace or you're signing up for Medicaid that's run by some private third party company when I talk to Governor Beshear and I talked to him in Rome encounters in Kentucky they would say people would ask them like is this Obamacare that's a no no this is a Kentucky based marketplace and they even care like they were totally fine con people into health insurance they think like it operated under his political theory you're discussing as are that at some point there because moment for the hides of the trip the well or the political theory could on the other way Republicans could have said could have decided to embrace the car right and said Oh man fuck Obamacare and then when Democrats were like Well that's going to take away your health insurers and I never know connect is fine wait I mean yeah I get expansion is made when I think the few that like Barack Obama would become popular in Kentucky because of this was always a bank shot but he didn't like the benefits themselves would somehow become untouchable like I really like I thought that light right up until the day after that Devin was sacked I do on a note of it proved a little bit more true than I think the map of a campaign would guess this was expectation going into Kentucky that I know these people who don't understand the benefits are part of Obamacare and that this weird Kentucky y con people into insurance think it actually backfired turns out I did not find that at all I talk to one guy who fit into this category who am I was on Medicaid expansion when asked about Obamacare was he said it was Obama taking people's money to take five million dollars occasions the Bahamas so it was a terrible law it really is the vomit that I don't support the town even higher than five million dollars on occasion but anyways this is the cause hey this is the only person that you kind of fat this idea I had going in and I'm mostly by Matt were quite different they really understood what Obamacare was they understood their benefits were part of Obamacare ends everyone in that voting for Trump and they said they did so for the really two reasons one they just didn't expect Trump to follow through on appeal like this idea I kind of goes back some of the rating you know Matt has done and taking on was not taking Trump later literally to him says in not taking them literally took another series yes I and that people really did have serious issues with affordability that they're quite frustrated with that kind of lead them to think there needs to be a change Trump is the change candidates and they were struggling before the insurance and the person really blew my mind on this trip was this woman Kathy aim at two was the Obamacare enrollment worker who was shadowing I kind of went in thinking if you signed up for Obamacare you probably voted for Clinton and Kathy who had signed up literally more people for Obamacare than she can count supported Trump which like when she told me thus give you guys going to see my face is his leg was and she really liked fit these two categories A is just talking about that she did not believe trumpeter Bill Obamacare is usually understood process she kept saying well you know he can do universe unilaterally S to get Congress onboard it's not just him and she you know is seen as she's been rolling when Obamacare for three years she's in premiums go up deductibles go up shares his frustration with the costs that people are paying and she took those two things together and she decided to end she voted for Obama the last two elections every decor for your interview with her yes because I think it's really fascinating so Sarah wrote this amazing story about this article but also put up to transcripts of the interviews from his article both of which are fascinating but hears it from her interview with Kathy all are Sarah asked to hear from talking about repealing Obamacare the campaigning and Kathy Ellis said he was going to get rid of it but I found out with Trump he says a lot of stuff laughs I just think all politicians promise you everything and then we'll see it's like when you get married honey I won't do this Oh honey I won't do that so this really goes to this idea in a pretty profound way and you hear her talk about it as the interview goes on that she doesn't believe he'll repeal Obamacare because it does hurt a lot of people heard a lot of people who voted for him why would he say we say to get elected but you can it be something crazy like that yet and this is a pervasive with like there's another woman while some have a transcript of my interview Debbie Mills who was on fifty three E signing up for coverage for her husband Tom they could afford coverage on their own for the CAA has in three SEC needs a liver transplant and they actually weren't really upset about the premiums they're getting such a large subsidy that they found a quite affordable and you I talked to Debbie about and she voted for Trump and where talked about a vote for Trump she is at the same thing like love the health insurance don't take away people's health insurance and why would you take away anyone's help and she more than Kathy in the course or interview seem to be like getting at they seem to be and was a hard interview to conduct just because she switched from me asking her questions to her asking me questions about like oh is my interns going to change and like me kind of walking after like what I know about all these things to these and any body of America has a strong incentive to like look into the details of what are people's policy positions on insurance coverage for low income people on the individual market with serious pre existing health problems like this family really fits the bill yes right and they evidently did not do any looking into this or believe what they found the I think it's more of because there are people I mean they watched the debates they heard you know there's a part of the interview I did with W I said Are you surprised to hear Republicans talking so much about repeal and she said no an Aster well what Will did you think they would appeal it when you voted and she said No I didn't I didn't think so I think she's still like when we started the interview I'll still saw that his campaign likely at Lakeside is not a real change I mean it is to be to it to be generous to the Republicans that they do have replacement plans that may or may not that I think they will likely be worse for someone and every situation but there is there is a plan to do some kind of plays and that's the hard part to navigate with someone like that but there's another fascinating piece of context here partly for why people specifically in Kentucky might think that Republican politicians who run a campaign on repealing Obamacare like so mad that it ran in Kentucky on a campaign of appealing not to like getting rid of the CAC marketplace getting rid of Medicaid overhauling that made overhauling Medicaid this is like a very restrictive in a so far he has to some degree backed off of some stuff to some degree not been able to do and he did any dismantled can act but the statewide over the market price and he I mean he is likely that thing that has stood in his way of overhauling is the Obama administration he's likely going to deliberate this is what I mean have to get ON button for it so I did not this did not come up with as it once and no one said Well he's not going to kill Obamacare because look at look at what Governor Bev and Ed he made these promises and he did anything so I mean is this is a small sample but that I understand that like line of thinking soon I think one thing that we need to consider in this discussion because there are two ways of looking at what you were told here and these are two ways we've discussed on the show before one is to say that these voters have to the extent that they were Obamacare but maybe that maybe other things with us more important to them and so they wiped out the cognitive dissonance on the Obamacare issue by not taking some particular serious but there's one way of looking at it which is that these voters who made a grievous mistake they thought Republicans would not do this about trumpet not do this and they will and He will other ways to say maybe they're right maybe when Debbie Goh student says but he wouldn't do that that would hurt a lot of people that at some point Tom Price or somebody in Tom Price's office or the Congressional Budget Office is going to go to the chump administration more people or the folks in Congress and say here to be the consequences of the plan and Steve and then who does not I think care all that much about the stuff that does care about getting reelected and all the things that you strategists cares about again simple we can't do that like that's not a good idea or Double trouble decide that's not a good idea so I just want to raise the possibility I lean more in some ways towards the former interpretation but it could be and this is something that I take seriously the voters approve right that what we're seeing here is not it's not voters being wrong about the incentives but voters representing showing what trumps real incentives are going to be because of a lot of people makes a lot of people Kentucky suffer presume it's not going to make and lose Kentucky in twenty twenty but it could make him lose other places that are closer I do think like Mitch McConnell's tireless effort over a period of years to block a bill was like only purpose is to help Kentucky coworkers like cast some doubt into this question I mean I think like Kentucky Republican Party politicians have demonstrated a profound desire to inflict pain on residents of Kentucky and the voters there don't really care and like a in the Downs is like classic point about voter ignorance is that like you can say that Kathy made a grievous mistake but would really have been like a profound mistake for Kathy would have been to spend a lot of time getting in touch with like leading experts reading all the best stuff forming the opinion that actually what she needed to do is like break with friends and family and community embrace Hillary Clinton vote for somebody who like nobody who she knew liked it she didn't particularly feel an emotional connection with to save for Obamacare because that would not have made any difference right right like having arguments with your friends and family all that voted for Obama to actually feel a way yes I mean in general if you have a real incentive in your life you meet a real difference in your life whether you get along with your friends and family and coworkers getting into like bitter vicious arguments about politics will make your life worse changing your vote particularly in this non swing state like Kentucky is not going to change who becomes president and so like there is no good reason for a person to try to become an informed voter who votes based on issues rather than being an identity politics voter who goes along with whatever people like me doing in the world needs you can use the Like verbiage of like irrationality but like what ignorant people are behaving irrationally ignorant way and when they vote the same way that people who are like them are voting and when they then choose to believe that I mean one thing we often see right that's a classic result is that it is a completely abstract issue that clearly has no impact on your life like should the president make phone calls to Taiwan you will just take which politicians you like and agree with whatever it is they're saying when it affects you directly like this Obamacare thing like that's harder to give you your husband getting a liver transplant it's like hard to say Trump is right he should lose his insurance so you make this other movie which is like well we all know politicians sometimes say things that don't happen so maybe this is one of those things and like all of that that like reasoning to the conclusion that the people who you are most likely to talk about politics with our voting for the right person like that's the rational response like being some jerk was like telling everyone they're wrong actually Obama is really good like that would be terribly irrational it's not going to change the election is going to make your life that I want to go back she said your question about like will these people be proven right this is something I thought about it I think if we're in a scenario Republicans are talking about doing repeal and replace it the same time and were on the second long timeline that would seem plausible to me the reason I feel like it's less plausible it seems very clear like repeal mechanics are going to start the first week of January and like we are going to move towards repeal quite quickly before there is really time for that campaign of like look at the consequence as to builds and then like we have appeal we have the marketplace is starting to collapse again ends up being this like slow motion train wreck that that seems harder to like put it back once when he started with that first repeal vote oh and I actually grew this I think a lot depends on how they structure their repeal effort if they're still trying to do this two year yet so they're saying right now that's what they're saying um but the mechanics of it are very I do on at the mechanics go both ways the mechanics of how these things will go through the committees the mechanics of what is going to be scored by CBO I mean all that stuff actually for some time on consequences now as you say life is going to be this period were possibly going to accidently claps the marketplace is an interim measure but if I am not sure that goes in the direction of making people more likely so much is being a taste of the pain you might inflict upon yourself if you add all the way one other thing I found the Kentucky are pouring I think was it helpful to understand why people are voting the way that they were voting was just a lot of resentment towards welfare programs in a lot of resentment when the choir and I'm this is really one of the unexpected ways and I found Medicaid expansion playing out where I talked and you know Kathy was part of this group I've talked a lot of people who saw people using Medicaid who saw these people who I am because right now the marketplace plans can be quite expensive even if you're low and calm like pretty high I was again someday things from Commonwealth Fund that the average deductible for a mid level plan this year's thirty five hundred dollars low income people are getting some subsidies to help it that maybe I'm a little bit less onerous but is really high cost sharing in these marketplace plans and her Don't number of people saying I work and I have to peel those made by the doctor I can afford to go to the doctors my deductible so high and look at these people on Medicaid that they can go to the E R for a headache and they don't deserve that like I work and I deserve this help and these other people don't deserve his help and I'm here even Kathy talked a little bit about this where she was saying she I'm she gets frustrated at people who are on Medicaid and don't work and she feels like there's some lazy people who are using at the end would be penalized for for working and I think there are his eyes actually in Colorado last week when I wasn't on the weeds and I was I'm talking to us is going to Sonic such a time treatment story but I was talking to my shuttle driver who had got in a twelve cent raise I think he's earning eight forty four an hour now and bumped him off of Medicaid and to exchange coverage and I was in a can afford he says he can afford discovered James decided to drop the end like is really frustrated that he got this like tiny rays and then now he doesn't have noticed on his her look again at trivia he goes for it but I think that was quite potent and the backlash to Medicare expansion was something I had not expected to see but also really seem to factor into people's decision to support from Democrats who really wanted the election to be about the resentment they want elections to be about than resentment of the ninety nine percent versus one percent and something Trump understood in a sort of profound ways it is a very powerful resentment from like the forty third percentile of income distribution again seventeen or thirty second against the fourteenth and you know they're a lot of things you can take from this rate I think one version of this is that it's an argument for universalism and programs but universe lies in programs makes him much more expensive and so you then have the upfront cost of trying to convince people that their taxes should go up by quite a bit when you look at say the Bernie Sanders a single payer plan that had a lot of middle class and upper middle class tax increases in it which maybe is a great trade off it just all these things have something that makes them harder but this is a real issue you know and it has I want to note your reporting was not able to answer how racial eyes this is a lot of very white yeah but that's what a lot of racial issues within the sort of working cos recess before kind of language that you hear oftentimes that is standing in for another argument that is less socially acceptable have but but this stuff is powerful but I think there's a real program design issue here I mean there's there's one thing about like means testing of programs fine if you look like classic Obamacare with the sliding scale subsidy right that's a means tested rather than a universal program there are some downsides to that in particular there's a certain like saw two fee structure is like a couple of end points where income going up slightly actually hurts you financially which is like not great and they probably should have thought harder about continuous functions and the existence of graphing calculators not affected means tested programs can breed this kind of this kind of resent men to you know people or above forty percent of the poverty line aren't getting any help but the upside is that it's not as expensive to raise taxes much and within that sort of like war or sliding scale Obamacare the fact of the matter still is is that people at two hundred percent of the poverty line are better off than people a hundred fifty percent of the poverty line you can have whatever resentments he wants but like you are definitely better off the Medicaid expansion say I don't believe in part because they changed around how big the Medicaid expansion was relatively late in the process I don't think that the authors of the Bell spent a lot of time considering whether being on Medicaid would actually be better for you then being on these exchange plans why he clearly in their in their minds Medicaid was supposed to be inferior to these plans write about Medicare cave was actually like better the bill would have been even more Medicaid expansion right I mean it would necessarily been like Bernie Sanders single payer like they fought with this exchange architecture that they were creating like a superior system that people want one you actually if you look at surveys of marketplace or Medicaid enrollees Medicaid enrollees are happier with the correct and I think it speaks to some as issues people in Kentucky were bringing up like the cost sharing is way lower there's no deductibles I'm your network is probably more restricted by the marketplace networks are pretty restricted till I actually heard from great now I run this group of Obamacare enrollees for Vox and myself the more encounters social media managers and lace Book of Peace but there is nothing area out with this Facebook group of people use Obamacare programs and one guy posted a story his I'm kind of work it does but he actually asked his manager to reduce his hours so he could stay on medication and not go to marketplace coverage because he values the cheap coverage more than he would value earning usually it's me that's just like genuinely like an error that if you could roll back to two thousand and seven when Max Baucus is starting to hearings about the As Ted Kennedy's thinking about like what's his more liberal vision going to be if everybody knew OK this like exchange thing that we've picked up from like maybe Mitt Romney or maybe an old New America Foundation paper whatever people are actually going up for Medicaid like why Bob well and all the work of creating this you could create some kind of a Medicaid Buy In System item even if he was just about the money you could have done something else like that goal of the exchanges was to create like a good solution altho are two things that I think are getting a little under played so far the Medicaid is always cheaper actually one of the tension when the bell was that if you just ratcheted up Medicaid you actually the bill less expensive because Medicaid insurance is cheaper per unit basis than than private insurance and one of the things was happening at that point there were a bunch of efforts to prove to people like Max Baucus this wasn't just a single parent a sky spell that oftentimes it's always the better example this Medicare Medicare is a much less Freedom Program in American politics people really like it members of Congress really like it there's not this I think often the little that bullshit the argument about whether or not Medicare insurance actually helps you and what you got there WAS there is a move late in the game to create a Medicare buy in for people who are done age fifty five so again here you're just letting people make a choice or not even making them beyond its not any single payer program and that was killed by every Republican and Joe Lieberman and so does one of the things that went on here in a way that I do think negatively influence program design was you had this one of the Sally and articulated been ever thus fully binding arguments was coming from the conservative Democrats was that this couldn't just be like the road to single parent had they really had to be setting up some kind of private insurance based choice architecture even when that was worse even when it was obvious what people can get out of that was a works program I think from from the liberal point of view right at me just like a decision was made to like go for this right and if everyone had just known in advance what good have been X years into it people are going to be saying Oh man I wish I was on Medicaid yet progressives would have just set their aspirations different from any one of the rest think as I think you lose a few conservative Democrats and I think you also like you look at Massachusetts At that point is though that six teams reworking of Massachusetts is a much more affluent population which might explain some of the difference as UA the one thing they don't expect given the Massachusetts experience that the marketplace and struggle to attract carriers that premiums go up because the marketplace became more concentrated so I think they saw messages of the book that seems to be working unlike the people on the private coverage in Massachusetts seem to be un alright Natick Massachusetts In even subsidizes much I think the only one up to three hundred F and the poverty line not far and we understand and agree like knowing what we know now but I also totally understand how at the time that seems like an OK decision please it is ironic because there was a lot of influence on legislation from from Max Baucus from from Tom Daschle who was out of the Senate from Ben Nelson from from Democrats who represent a very whirl type constituencies and it looks like in retrospect they really under played Miss understood actually how much regional sort of differences would matter here that in much more urbanized areas like Massachusetts this competition structure like works a lot more effectively than it does in some of like the kinds of places that they were from and like I think it would actually have not occurred to me to like strongly second guess Max Baucus about like what can work in the state of Montana that like seems like something he would know a lot about it but it turns out that in low population density area inns is very difficult to get like robust competition between insurance networks there's been this discussion pretty since the less
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Kentucky, the Rust Belt, and the Big Picture on Trade