2020 Democratic Presidential Contender Montana Governor Steve Bullock on Health Care, Climate Change and Gun Safety

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Margaret Flinter: Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter , a show where we speak to the top thought leaders
in health innovation, health policy, care delivery and the great minds
who are shaping the health care of th e future. This week Mark and
Margaret speak with Montana Governor, Steve Bullock, contender for
the Democratic nomination in the 2020 presidential race. Governor,
Bullock talks about his history of winning elections in a largely red
state which voted for t h e current president by a 20% margin. He also
talks about the need to get corruptive influences and dark money out
of politics and his vision for how to improve healthcare and the need
to address climate change.

Lori Robertson also checks in, the Managing E ditor of FactCheck.org
looks at misstatements spoken about health policy in the public
domain, separating the fake from the facts, and we end with a bright
idea that ’ s improving health and well - being in everyday lives. If you
have comments please e - mail us at [email protected] or find us on
Facebook, Twitter, or wherever you listen to Podcast and you can also
hear us by asking Alexa to play the program Conversations on Health
Care . Now stay tuned for our interview with presi dential candidate,
Montana Governor, Steve Bullock, on Conversations on Health Care .

Mark Masselli: We ’ re speaking today with Montana Governor, Steve Bullock, who is
currently running for the 2020 Democratic presidential nomination.
Prior to his election in 2012, Governor Bullock served as Montana ’ s
Attorney General , where he launched efforts to combat Citizens
United. Previously , he ran a law firm in Montana , after having
practiced law in Washington DC. Governor Bullock also taught as an
adjunct professor at the George Washington University School of Law.
He recently completed his tenure as chair of the National Governors
Association . He earned his BA in Politics and Economics from
Claremont McKenna College and his law degree with honors from
Colu mbia Law Sch ool in New York. Governor Bullock welcome to
Conversations on Health Care .

Governor Bullock: It ’ s great to be with you both for sure.

Mark Masselli: Yeah. First of all, congratulations on your candidacy. You ’ re part of a
significant group of d e mocrats w ho are battling for the 2020
presidential nomination and you ’ re a d emocrat in Montana a s tate
that went heavily for President Trump and yet you won by a sizable
margin. Talk to our listeners about your ability to bring voters from
different backgr ounds togethe r . What makes you uniquely qualified
as a presidential candidate a nd what are some of the motivating
forces behind your decision to run?

Governor Bullock: Sure, yeah. I appreciate that I was the only actually d emocrat in the
country to get ree lected in a state in 2016, where Donald Trump won .

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He took Montana by 20 points, about 25 % to 30% of my voters voted
for Donald Trump and it ’ s more ma r ked than just winning election.

My legislature in my six years that I ’ ve been here has gone f rom a
times about two thirds republican to about 60% now. But somehow ,
we ’ ve been able to get some of that politics out of there and actually
get progressive and meaningful things done like healthcare or funding
for education, kicking dar k money out of election.

So , s ome of the unique qualifications , I bring to a big field is, if we
can ’ t win back some of the places that we lost in 2016 . We ’ re not
going to win this race. I mean, I ’ ve said to people, I assure you that if
I ’ m the nominee , I will win California, Massachus etts, Vermont , but
we have to make sure that whoever is the nominee can also win place
like a Montana or Iowa or Michigan or Wisconsin , because it does
come down to governme nt [P H] . I think far too often Washington DC
is kind of a pla ce where talking becom es a substitute for doing. I don ’ t
have the luxury of just giving big speeches, right . I ha ve to see my
constituents each and every day, and they expect me to deliver , a nd
that ’ s deliver everything from the service s they expect out of
government, they also deserve forward movement from go vernment .
I think , I do bring some things both geographically, generationally, and
being able to win the sort o f place that we need to make sure that we
can win in 202 0 if w e ’ re going to win this race.

Margaret Flinter: Wel l, Governor Bullock, you ’ ve said that you have some very good
reasons for entering somewhat late into this political fray. Certainly
earlier this year, we know you ’ re very focused on the Medicaid
expansion in your state. May be you could talk with us a bit about
what must have been a bit of an odyssey . The most important thing is
you ’ re successful . Those tens of thousands of people got coverage.
The question is, is there a playbook that comes out of this for how to
work ac ross party lines?

Governor Bullock: Thanks, Margaret. I think that there aren ’ t . Actually, yeah, I signed my
last bill on Monday , a nd I announced on the Tuesday thereafter. On
the one hand, yeah, you could go back , Bill Clinton didn ’ t even get in
until Octobe r the year before . We actually fi rst got Medicaid
expansion passed in 2015 , a nd we we re going to reauthorize by ballot
initiative in 2018 , but tobacco companies actually spent $26 million
killing that reauthorization.

So , two months after that is wh en our legislature started, I had to
mak e sure to get that through b ecause there are 100,000 Montan an s.
The vast majority of whom are working they rely on that healthcare . I
think the model even when we got through 2015, a time where
Obamacare or the Aff ordable Care Act , wasn ’ t quite viewed as
f avorably, as it was, is even today . How we got through is by doing a
number of things, one of which is not making it all about the ballot

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[PH] of the State House , b ut by going to rural communities. I ’ ll never
forget, I was in this one in this [inaudible 00 :05:57 ] Montana, where
population i s 1 , 700 whe r e during a town meeting, when the hospital
administrator said, you know, “ 43% of the people walk through those
hospital doors don ’ t have health insurance ” or the cou nty
commissioner noted that he had been born at that hospital and they
lost that hospital, they lose that town.

So instead of making it about any sort of politics, about the
importance of healthcare, in 2019, also did a big study and figured out
that 57% of the businesses in the state have one or mo re employees
on Medicaid. So , it ’ s not just a program for , you know, those that
aren ’ t that wealthy or not working , it ’ s also taking care of employers
that unfortunately are unable or unwi lling to pay their employees
enough to have quality healthcare . What we ’ ve seen in Montana with
100,000, folks covered , 30,000 more have gotten mental health treat ,
10,000 substance use disorder . We ’ ve actually put on , made a state
website which shows county - by - county, the sort of preventative
treatments people are getting locked away b ecause we know that ,
you know, one way or another right, we ’ re all going to take care of
folks who don ’ t have health care.

Mark Masselli: Well, let ’ s pull the thread a little on the healthcare conversation.
Certainly, we hear a number of candi dates calling for Medicare For
All , and there are others they have more sort of a moderate but
progressive approach, opting to strengthen the Affordable Care Act.
I ’ m wondering how you would describe your plan ?

Governor Bullock: I think that we all hopeful ly agree that healthcare should be
affordable and accessible for all. By the Affordable Care Act, which I
think was actually the greatest advance in hea lthcare since Medicaid,
Medicare w ere first pass , and Medicare as an example , you know,
we ’ ve been conti nu ally building on to along the way . We still have
about 25 million folks that aren ’ t covered. Now, if we could expand
Medicaid in the rest of these states that would c over about half , but
what I would do is actually build on t he Affordable Care Act, let ’ s not
start all, what I would do is a public option, first of all, an option
where individuals could actually buy health insurance from the
government instead of just the pr ivate mark et . Second which it is just
a shame , w ell, it ’ s actually embarrassing that like Costco could
negotiate for prescription drug price , but it ’ s still legal at the federal
level . It clearly shows the corrupting influence of money in the
syste m . I think we get [ inaudible 00:08:33] medical billing and out of
network charges with legis lation at the federal level.

I don ’ t think that the best policy or the best political solution, if we
actually want to win this election is to tell about 180 million people
that have employer sponsored health care that we ’ re going to take all

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that away, an d that there will be no more a private market in this. I
don ’ t think that ’ s the best policy, because once people dig in to what
that might look like, you kno w, often the great majority folks say ,
“ that ’ s not the direction that I want to go. ” We have made g reat
strides . We still have a lot further to go , b ut I don ’ t think just tear it all
down and starting all over, at least from my perspective, the best w ay
to go.

Margaret Flinter : Well, Governor, you ’ ve had, I think, the incredible opportunity and
given th e incredible service as Chair of the National Governors
Association, and I would imagine a chance to, you know, work
shoulder - to - shoulder with other lea ders about some of the unique
challenges that are faced by the rural states and our country,
particularl y around delivering healthcare in rural regions . Share with
our listeners, the solutions that you ’ ve advocated for around
improving healthcare access in the rural states , a nd what would you
continue to advocate for as president? Are there some bold new
ini tiatives that you think rural America needs relative to healthcare?

Governor Bullock: You bet, Margaret, and we have about 20% of the rural hospita ls right
now at risk and closing in this country. If you live in a rural hospital,
that town i s gone . The via bility of that community is a t so much
greater risk. I think , we have to do everything from ensuring there are
ways that we have providers there t o ensur ing the way that there ’ s
financial viability . I mean a state like mine in Montana, we actually
have two residency programs, one is the primary care residency. W e
just started the one in psychiatry as well b ecause we know if an
indivi dual does a residency program in a community or region or in an
area they are so much more apt to stay.

We ’ ve done both psychi atry and some other things through a
program called Project ECHO, where it ’ s essentially building case
teams and doing work onlin e, to start bridge s ome of these rural gaps
or the large ly geogra p hic gaps, especially in areas where it ’ s often
mental health providers that are that much more challeng ing . I think
we also have to look at reimbursement rates for rural communities,
because at tim es they should be higher than their urban areas, just
because you can ’ t lose that connection in rural areas or really do es
got out places . We ’ ve done loan forgiveness programs, when it comes
to rural areas , and the biggest and I think most important is th e
viability of Medicaid program . Making sure that you have Medicaid
expansion because where if you have so many folks who don ’ t have
coverage and you don ’ t have a reimbursement rate through Medicaid
expansion , it ’ s that much harder for those smaller communiti es and
those rural hospitals to stay open .

I thi nk those are just kind of the base level and even in some ways
transce nds beyond just healthcare to make sure that you ’ re doing

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everything from solid internet connectivity to creating job
op portunities with either community foundations or smaller two year
or four year college s, because nobody should have to leave the place
e ither they are raised or that place they love for sure.

Mark Masselli: Well, we ’ re speaking today w ith Montana Governor Steve Bullock ,
contender for the d emocratic nomination and the 2020 presidential
campaign . Prior to his term a s governor, he served as M ontana ’ s
Attorney General and was instrumental in the Citizens United case.
Governor, I think it ’ s fair to say you ’ ve had a clarion voice on this
about sort of ironclad grip that big money has on lawmakers. You
point specifically to the National Rifle Asso ciation, which just a few
weeks ago was seem ed to manage t o influence the President to back
away from his pledge to promote universal background checks for gun
buyers, after devastating back - to - back mass shootings . Your pro
Second Amendment and you say , we must address the nation ’ s gun
violence epidemic as a public health issue. I ’ m wonder ing if you could
just talk to our listeners a little bit about where you come from on this
issue.

Governor Bullock: Yeah, and you bet Mark , and where you start out was sor t of the
corrupting influence of money in our system , that really has been the
fight of not only my ten years in public ops , but I think it ’ s a challenge
of our time . You go anywhere from gun safety to climate to why can ’ t
we negotiate prescription drug pr ices . So much of it is , I think,
because in this post Citizens United world, Washington DC ’ s influen ce
and in too many states are b asically, it ’ s written by the donor. So , we
have to address that if we ’ re going to address anything else. As you
know, yeah, I am a gun owner, I hunt 40% of households in this
country, there ’ s a fire arm, but I ’ m also a father . I ’ m also someone
that ’ s tired of lowering flags as a governor , tired of my children having
to learn active shooter drills. If we could ever look at it as a public
health issue, not as a political issue, we could make substantial
progress. When I was gro wing up, The National Rifle Association of
gun safety was hunting , it was a shooting organization. Now it ’ s more
in the political organization, use [ inaudib le 00:14:22] like, I ’ ll give you
30 million reasons why Donald Trump is doing exa ctly what he ’ s
doing. That ’ s $30 million that they spent on his election.

I remember back right after the [ inaudible 00:14:34] all the nation ’ s
governors were in the White Hou se for National Governors
Association. At that time, President Trump had said , “ We should let
the universal background checks. ” Within a week , he reversed , after
he spoke the NRA . I have lowered the flag seven times since then. He
did the same thing right after El Paso in Dade.

A public health issue will look at it a nd saying th ere are steps that we
can take, like universal background checks, vast majority of NRA

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members and republicans think that would be a good idea. A public
health issue would say safe s torage , would say red flag laws, the
ability to remove a gun where , you know, there ’ s concerns that have
been raised , and look, even the state of Indiana past red flag -- they ’ re
not the crazy liberal country [PH] . I ’ m confident when I can ge t some
backgro und, but I don ’ t think we should even wait till then, I mean
gun owners need to be c alling on folks as well in DC to make some
meaningful change b ecause I think we ’ re all just tired and worried
about both our kids and safety of our communities.

Margaret Fl inter: Well, Governor, I think one of the areas where you ’ ve really led is
making this connection between some of these major social problems
that are facing us and recognizing that they have a huge tie to public
health a nd two areas that you ’ ve really le d on w ere the areas of
protecting the environment and also the repro ductive health rights of
women. Tell us what are the some of the policies that you are really
advocating for it?

Governor Bullock: Here I am out in the West is an example , a nd fire seasons are 78 days
long than the y we re 40 years ago. I mean, we need to take immediate
and durable action when it comes to climate , a nd I certainly rejoin the
Paris Accords , I would turn around and say , “ It was great two weeks
ago when even the auto industry said they didn ’ t want to roll back
these fuel efficiency standards .” Right . The scientists say , “ As a world,
we have to be essentially carbon neutral net zero by 205 0 .” [inaudible
00:16:47 ] I mean, one of which is the federal government has to be
partner s and has to be investing money both in research and
development.

Another thin g that we don ’ t always talk about is, you know, even 1st
George Bush, when he was president, he said , “ Will address the
Greenhouse effect with the White House effect”, I mean, here was a
republican presiden t saying we have to address climate change. Now
republican s wanting to acknowledge the climate change is real and
human cost. We have to break those links because we can ’ t wait
another 30 years.

When it comes to the second issue that you raised , Margaret , we ’ ve
be en over 4 5 years with Roe v. Wade as the law of the land. My whole
time in public office, I ’ ve protected the woman ’ s right to make her
own healthcare decisions. That ’ s the decision a woman should make
in consultation with her doctor. She so choose to serve family and her
faith , but it shouldn ’ t be the decision that I make , a nd we need to
figure out when it comes to reproductive health , when it comes to
healthcare overall. We stop playing the politics and say, let ’ s
empower the women.

Mark Masselli: Governor, you know, I wanted to get back to an earlier point on the
politics, you ’ re not on the next debate. We ’ re months and months

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away before the first vote is cast in Iowa a nd then we ’ ve got all the
rest of states to deal with it a nd sort of , yo u know, what, how are you
addressing this issue? How are you making an effort to reach out or
pas s the nationally televised debates? Where do you think you go
from here?

Governor Bullock: You know, like on the one hand, I think that maybe th e DNC ’ s rules of
getting 130,000 donors was well intentioned, but what it really has
done has made campaigns spend all of their time and a lot of money
on like Facebook and Google, instead of actually spending that money
connecting with voters. Hopefully , I ’ ll be on th e following debate
stage , a nd if folks go to see Bullock .com, you know, that counts . I
think another thing that you point out, Mark , we ’ re still over 150 days
from any voter expressing preference, you know, it says early states
that take a bi g field and bring it down to a smaller size and then as
you go throughout the primary the voters can really take a look at. I
mean, John Kerry was at 4% 31 days out from the Iowa caucuses, and
it ’ s the caucus goers that make those decisions.

I a m in the , I don ’ t know 15 or 16 weeks , I ’ ve been in this to Iowa on
10 separate trip s . I have been in New Hampshire a number of times ,
continue to make sure that voters know they ’ re the ones who are
go ing to make these decisions. I trust vo ters decision s in that .

Marg aret Flinter: We have been speaking today with Montana Governor , Steve Bullock
contender for the d emocratic nomination and the 2020 presidential
campaign. You can learn more about his work by going to
Steve Bullock.com or follow t hem on Twitter or Facebook
@ Governor Bullock. Governor , t hank you for your dedication to public
service for your commitment to the American experience and for
joining us today on Conversations on Health Care .

Governor Bullock: Thank you.

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Mark Ma sselli: At Conversations on He alth Care we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy. Lori Robertson is an award winning journalist and managing
editor of FactCheck.org, a nonpartisan, nonprofi t consumer advocate
for voters that aim to reduce the level of deception in U.S. politics.
Lori, what have you got for us this week?

Lori Robertson: The Affordable Care Act open enrollment period for most states is
coming up running from November 1 st to De cember 15 th . Let ’ s take a
look at how coverage of the uninsured has changed since the ACA was
enacted in 2010. The National Health Interview surveys most recent
report shows that in 2010 , 16% of the population or 48.6 million

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people were uninsured at the t ime they were interviewed, tha t figure
dropped by 20 million to 28.6 million uninsured people in 2016.

Since then, under President Trump the figure has crept up rising by
1.8 million people to an estimated 30.4 million uninsured or much
greater recent rise was reported by a Gallup surv ey. Gallup put the
rise in uninsured adults at about 7 million compared with the last half
of 2016.

Democratic presidential candidate Bernie Sanders has used a much
higher figure that includes the under insured. He said in the last
presidential debate that there were 87 million uninsured or under
insured in the country now. A Commonwealth Fund study supports
that figure. The study found , “ Of the 194 million US adults ages 19 to
64 in 2018, an estimated 87 million were inadequat ely insured. The 87
million fi gure includes 24 million uninsured in 2018 , 43.8 million who
were under insured. The under insured measure includes people
whose out of pocket costs were 10% or more of household income
over 12 months. ” That ’ s my fa c t check for this week. I ’ m Lori
Robertso n, Managing Editor of FactCheck.org.

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Margaret Flinter: FactCheck.org is committed to factual accuracy from the country ’ s
major political players and is a project of the Annenberg Public Policy
Center at the Universi ty of Pennsylvania. If you have a fact that you ’ d
like checked, e - mail us at www.chcradio.com , we ’ ll have
FactCheck.org ’ s Lori Robertson check it out for you here on
Conversations on Health Care.

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Margaret Fl inter: Each week Conversations hi ghlights a bright idea about how to make
wellness a part of our communities and everyday lives. Vaccinations
are considered one of the great public health achievements of the
20th century, reducing fatalities for most commo n and fatal diseases
by up to 99% , but in the 21st century, some of those numbers just
start ed stacking up. As recently as 2009, only 45% of the nation ’ s
preschool aged children had received all of their recommended
vaccinations and boosters. Researchers at the Children ’ s Outcome
Research Program at Children ’ s Hospital in Colorado decided to take
an in depth look at the problem. Dr . Allison Kemp e heads up the
Children ’ s Outcome Research Program and she conducted a study on
what would help to generate better compliance with required
vaccina tions. She found that when parents receive timely reminders
from their state and local health departments, parents were much
more likely to get the vaccinations and boosters for their children that
t hey needed.

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Dr Allison: Our study didn ’ t take away from t he primary care providers, but it
helped them to do the reminder recall for their practices centrally
using a state registry .

Margaret Flinter: The research shows that one reminder message can be gen erated for
an entire population. It takes the onus and th e burden off of the
primary care and pediatric practices .

Dr Allison: In the counties where this was done centrally , a bout 19% of children
who are not up to date became up to date versus about 13% in th e
“ practice space , recall state .”

Margaret Flinter: Th e study also suggested as a cost savings as fewer children fall ill .

Dr Allison: I can tell you that there have been some studies in recent years
showing outbreaks related to lack of immunization partic ularly
pertussis , measles, even H . Influenza , and you know, you have one
case of Hemophilus meningitis can cost tens of thousands of dollars .

Margaret Flinter: A State Health Department driven vaccination program that assists
private practices and vaccine compliance for their patient population,
improving vac cination rates of young and vulnerable children. Now
that ’ s a bright idea.

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Mark Masselli: You ’ ve been listening to Conversations on Health Care. I ’ m Mark
Masselli.

Margaret Flinter: I ’ m Margare t Flinter.

Mark Masselli: Peace and health.

Margaret Fl inter: Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or wherever
you listen to podcasts. If you have comments, please e - mail us at
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Health Center.

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