An undated image provided by the campaign for U.S. Rep. Cliff Bentz.
Courtesy of Cliff Bentz
U.S. Rep. Cliff Bentz, R-Ore., joined OPB’s “Think Out Loud” on Wednesday to discuss the nation’s spending on Medicaid programs, his recent town halls in Oregon and his views on the balance between the branches of federal government.
This transcript has been lightly edited for clarity and concision. A briefer version of this story focused on the conversation’s highlights is available here.
Dave Miller: Under the blueprint that you voted for yesterday, the House Energy and Commerce Committee has to make $880 billion of cuts over the next 10 years, and I should say that you are on that committee. I’m right about that, right? You’re on that committee?
Rep. Cliff Bentz: I am, yes. So it is the Energy and Commerce Committee, but it’s the Subcommittee on Health Care will be doing most of the analysis
Miller: How do you propose to make those cuts?
Bentz: First of all, we’ve been looking at all kinds of different reductions across the board in the Energy and Commerce Committee, so the health care space is not the only space. I’m also on the energy space, so we will be looking there too. So the starting point is a much broader scope of activities and agencies than just health care, but health care will be one of the focal points.
The types of things we’ve been looking at include the possibility of a work requirement for those who are able to work. Currently there isn’t one, and so the idea is if you’re able to work and for whatever reason you’re not working, that if you want to be eligible for Medicaid, you’ll have to work or at least be making an effort to get a job.
There’ll be all the usual protections, if that’s the angle that we choose to use. You should also know that I’ve reached out to people very, very experienced in this space in Oregon and put together a little team of people to help advise me on the types of impact any of the proposals that we’ll be discussing over the next month and a half might have on Oregon.
Miller: Let’s start with that first idea that you mentioned, the possibility of a work requirement. NPR has reported that most enrollees already work or go to school, or service caregivers or have a disability. The critique I’ve read is that that might add red tape but not significantly reduce the cost of the program. Have you heard otherwise?
Bentz: I have, and the indication is that there would be a substantial positive impact of a work requirement. But again, Dave, we’re looking at all of these things. So this’ll be one of many different things reviewed to see how to make the system still deliver the type of benefits that people need while at the same time doing it better, and in a way that saves money.
Miller: How do you get rid of almost a trillion dollars of spending? And I should say, I take your point, you said you’re not just looking at health care here, but you can look at the graphs of the money that the Energy and Commerce Committee has control of in terms of programs, and it seems impossible to get that level of savings unless you’re going to make serious cuts to health care itself — to Medicaid or Medicare. And if Medicare is going to be held harmless, we are really talking here about Medicaid. So how do you make those levels of cuts, tens of billions of dollars a year for 10 years, without impacting the services themselves?
Bentz: Yeah, so let’s talk about it in the real numbers first. The number is $880 billion over 10 years or $88 billion a year. And so one thing that people forget is that we have jurisdiction over spectrum, and so the amount that we, the federal government, can sell spectrum for will be one of those items that will offset that target number.
Miller: When you say spectrum, do you mean telecommunications spectrum?
Bentz: Yeah, I do mean, yeah. It’s auctioned off now. In the past, there had been a lottery system, but now it’s auctioned off and the numbers that I have heard are between $50 billion and up to $80 billion. And so there are going to be things we’re looking at that raise money as opposed to reduce spending. And so I’ll just say, wait until you see what the proposals are before people start making assumptions.
I’ll just say that I’ve got to listen to all kinds of what I’ll call “Meda-scare” — Medicaid scare remarks — over the past couple of weeks. And it’s annoying because I’m pretty sure that most Democrats agree if we can do something for less money, we should do so, and they’re not married to the exact form of service delivery.
They need to focus on the fact that we’re spending $2 trillion more a year than we have coming in the door. They need to focus on the fact that even if you were to raise taxes on the wealthy, you wouldn’t raise anything close to $2 trillion. So come on. And that’s every year, Dave, so I would just say to the Democrats on your show: What in the world are you doing to at least admit that we have a spending problem?
Miller: Do you think that they would be more willing to consider the kinds of cuts you’re talking about if they could see the cuts that you’re talking about?
Bentz: They’re going to get a chance to participate in the discussions. And you keep saying cuts, I think the better word would be savings, and no one’s going to object to savings. So they’re going to have a chance, they’re on the committee. There’s, I think, 24 or 26 members of the Democrat party on the Energy and Commerce Committee. They’re going to be involved in all these discussions. So what they’re doing now is trying to scare people and it’s reprehensible because they should be saying to folks: We’re spending $2 trillion a year more than we have coming in and we need to do something about it. And the Energy and Commerce Committee — known for its bipartisan nature — will be working in that direction.
Miller: Let’s move on, past the talk about Democrats and Republicans, and just talk about constituents. Thirty-six percent of your constituents in Umatilla County get their health insurance through the Oregon Health Plan. In Klamath County it’s 43%, in Josephine it’s 44%, Malheur is 47%. Your home county, Jefferson, 50%. More than half of Oregon children are insured through Medicaid in Oregon, the Oregon Health Plan. What do you have to say directly to your constituents who right now might be worried about losing access to health care for themselves or for their children?
Bentz: Well, the first thing I would do is say to them: Who in the world is scaring them? Who in the world is taking the position that all of this is going to be reduced? Who’s doing that? It’s certainly not me.
What I’ve been trying to do is say, let’s look at this program because as we are currently proceeding down this path, it’s not sustainable. We cannot continue to do all of these things when we’re spending $2 trillion a year, 30 cents of each dollar, more than we’ve got. And so the first thing that everybody, I think they all do understand, is that if we don’t take care of business and do this thing better across the board, we’re not going to have the wherewithal to borrow the money necessary to make this work.
Dave, we have to borrow every year. A huge amount, $2 trillion because that’s the amount that exceeds that which we’re bringing through the door in the form of revenue. And so why will people continue to loan us that money if we can’t exhibit an ability to control our spending? I think those, it’s actually 40% across my district. Those are smart people and they know that this program will only last if we can do things better than we’re doing them now.
Miller: What about the argument that, given the cost issues you’re talking about, now is not a great time to extend a tax cut that would cost the federal government $4.5 trillion?
Bentz: I’m not sure there’s any good time to raise taxes by $4.5 trillion, because what you’re suggesting is the proper alternative. You may not be suggesting that. But the alternative is to let those tax cuts expire and then see the greatest tax hike in the United States' history.
So the challenge is how do we not allow that to happen and have the negative economic consequences occur? This is an important matter, particularly for… every person listening should understand that. They will see, if they’re paying income tax, a substantial tax hike if this Trump tax cut bill passed back in 2017 is not extended.
In other words, the current situation will change dramatically if those tax laws are not extended for everybody. Small business in particular, because they currently — the past two entities — currently get a 20% discount that would go away and they would get to pay taxes on that 20% of income currently taken off the top under the Trump tax cuts of 2017. But there’s many things that would happen that are inside the reasons for extending that set of tax policies.
Miller: I want to go back to my earlier question when I had said: What would you say to people who are worried about losing access to health care through the Oregon health plan? Your first response is ‘who is scaring them?’ ‘Who was behind that messaging?’
Can you tell us now that you will not vote for a final bill that would lead to Oregonians being kicked off of the Oregon Health Plan?
Bentz: So, you might want to qualify your question and say… if Oregonians are kicked off the plan, it’s because they don’t deserve to be on it. And so they don’t, when I say deserve, for whatever reason, they are fraudulently participating or they’re participating for reasons that have nothing to do with the original goals of the program.
Miller: That last part is an important one because those–
Bentz: No, no, no, Dave, no Oregonian is going to object to our doing a better job in delivering Medicaid services. Nobody.
Miller: Wait wait, let me sharpen the question here. The way you phrase that, it seems like you left open the possibility that people who are now eligible for Medicaid, because of the Medicaid expansion made it possible under the Affordable Care Act–
Bentz: Stop, stop.
Miller: Let me finish my question.
Bentz: Well you’re already including, in your question, assumptions. Don’t do that.
Miller: I’m not sure what exactly you mean by that, I’m–
Bentz: You just said, your statement says that I’m targeting those who are included in the expansion. I did not say that.
Miller: No, you said people who don’t deserve to get–
Bentz: Don’t do that. Don’t do that to me Dave, or we’ll have to discontinue our conversation.
Miller: Okay, let’s both take a breath. I’m just trying to understand your position here. So let me put it to–
Bentz: Then ask your question without putting assumed facts in it.
Miller: Do you support a change to Medicaid that would essentially get rid of money for the Medicaid expansion — meaning that more people in Oregon but around the country, tens of millions of people in red states and blue states now are eligible for Medicaid because of this expansion. Would you support changing that to essentially get rid of the expansion?
Bentz: I think that’s unlikely in two respects. One, I don’t think that’ll be something that we’ll be doing, but I think it more unlikely that I would support it. But I’ll just tell you that the area that you are asking about is a complex area, and the one that requires far more precision in the discussion that you and I are currently engaging in.
So I would suggest that we wait to see what the proposal is, and then you and I discuss it again, as opposed to assuming anything, and you are trying to get me to commit to stuff that is inadequately on the table for this type of discussion.
Miller: OK. I do hope and I plan to talk again. The reason I brought that up is that it has been on the table and I think one of the issues here, which maybe is frustrating for everybody and probably for people listening as well, is so much is at stake but there’s not yet a ton of clarity about what the final budget is going to look like.
The reason I did bring that up, though, is because of the number of people who have gotten onto the Oregon Health Plan — and Oregon is just one example among many — as a result of this expansion. The numbers I’ve seen is something like 600,000 Oregonians, close to half of the current total, now get health care insurance because of that expansion. So it’s not a rounding error, it’s a gigantic percentage. But I take your point, we can return to that in the coming weeks or months.
Bentz: If I may, I’m working with a team of people, absolutely qualified people, in discussing these kinds of issues that know more about the Oregon Health Plan than anybody else — certainly the two of us. And I’ll be placing whatever the proposals are before them.
I just want to say that Oregon’s done some really, really good things in the Medicaid space. One of them is that Oregon, through Dr. Kitzhaber’s genius, put a cap on the Medicaid expenses with the CCO device — that coordinated care organization model. Very clever. And that the expansion is around 3.4%, or something like that, it’s not inflation. And so Oregon is ahead of the game when it comes to realizing that Oregon cannot afford an out-of-control Medicaid program. That’s why there’s a cap.
And so these are the kinds of things that lend themselves to perversion by folks that are opposed to any sort of controls on these programs. Yet Oregon has a cap, put in by Democrats, because they knew that this kind of program could not survive at the state level — just paying 10% of the total cost — if there wasn’t a control feature in place. Those are the kinds of discussions that we should be having because there is not unlimited funding for these kinds of programs
Miller: In the time we have left. I just want to turn to the bigger picture. Some of the issues that have been brought up at town halls that you took part in last week. Over the last month, the administration has effectively shut down congressionally created and funded agencies like USAID, it tried to put forward a complete freeze on federal grants and spending. A lot of this obviously is being reviewed by judges and in your town halls last week, you seemed to imply that that’s the right venue for this. I’m wondering what it would take for you–
Bentz: Where did you get, did you watch all my town halls?
Miller: I read a bunch of reporting on them in I think four different places.
Bentz: Dave, did you listen to them?
Miller: Just parts of them. I didn’t listen to the entirety of any one of them.
Bentz: I seem to imply, as a quote, that I would hope you based upon actually listening to what I said.
Miller: Yeah, well, I mean you said that this is the realm, I forget the exact wording, but it was like that judges are looking at this now and that’s appropriate. Did I miss–
Bentz: Yeah, that’s a much better way of stating the point. What I was saying is, if the executive branch oversteps its authority, then the judicial branch will say, ‘you’re out of luck.’ And then the executive branch’s job is to do what the judicial branch has called, you’ve stopped doing, that they’ve set us out of bounds. That’s how our constitutional system works.
Miller: The question that I’m wondering is, what it would take for you to say, as a member of Congress, that your control of the purse strings outlined in the first article of the Constitution is being ignored or trampled on. I take your point that under the basics of the separation of powers, it’s the judicial branch that checks the constitutionality of things. That is a check on the other two branches.
I’m just wondering about your own take as a member of the legislative branch, what it would take for you personally to say ‘we are being ignored.’ And this could be in the context of the current president or a future president who may be in a different party.
Bentz: I’ll guarantee you that we are not being ignored. I guarantee it. I would like to know more about what’s going to happen, that the executive branch is going to do, sooner than has been the case. But we are not being ignored.
And the reason is, the administration understands that an executive order won’t be permanent. They need law to back them up and they are coming to us and saying ‘hey, we’re doing this with an executive order, but we know we need Congress to back us up.’
And I’m a Republican. I support what the administration is doing, and if it turns out that it is beyond the scope of that which the court thinks is appropriate, then the court will tell us and we will follow that particular direction because we have to.
So I’ll just say that I support trying to get spending under control, and I’m happy to see the administration trying to do something about it. It’s really, really, really hard. I have an outline here of what it takes to shrink the federal workforce, it is super hard. And so the approach they’re using may be pushing the envelope. The court will call out whether or not it’s Constitutional
Miller: Cliff Bentz, thanks for your time. I look forward to talking again.
Bentz: I do too, Dave. Take care.