The Governor with the Secret Formula on COVID, with Governor Andy Beshear

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Andy talks to Kentucky Governor Andy Beshear, a Democrat governing in a largely red state with its share of income and health challenges. Beshear lays out his simple leadership formula: kindness. They talk about how the country could be unified in a COVID-19 response and the impact of Breonna Taylor’s death in Louisville. Plus, they reflect on the life and legacy of Supreme Court Justice Ruth Bader Ginsburg.

Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.

Follow Governor Beshear on Twitter and Instagram @GovAndyBeshear.

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[00:41] Reporter: And when the time comes, what would you like to be remembered for? 


[00:45] Ruth Bader Ginsburg: Someone who used whatever talents she had to do her work to the very best of her ability and to help repair tears in her society. To do something, as my colleague David Souter would say, outside myself.


[01:07] Andy Slavitt: Welcome to In the Bubble. This is Andy Slavitt. Pleased to have Lana joining me today. The voice you just heard was that of Ruth Bader Ginsburg, the notorious RBG, who we lost last week after a valiant battle, several valiant battles with cancer. It’s going to be hard to really encapsulate all the things that she meant to so many people and the people she impacted over the course of her career. And I think the nation is really going to mourn the loss of kind of one of our great, stalwart people. And it’s been, you know, that kind of year. John Lewis, one of our heroes, died earlier this year. Ruth Bader Ginsburg was recently. Rather than being just simply down about all of that, my sense is that if you hear it the right way, this is a call to the next generation. This is a call to the next Ruth Bader Ginsburg, to the next John Lewis, that it’s time to have a real impact and time to have a real opportunity. 


[02:13] Andy Slavitt: I would say that we stand on the shoulders of giants, but I don’t think Ruth Bader Ginsburg was much of a giant. She was what she was small woman. Talk about the connection to the Supreme Court and healthcare for just a bit. The Supreme Court is about to hear a case that they’re scheduled to hear November 10th on the Affordable Care Act. Its technical name for the case is Texas vs. California. I want to talk about that with our guest, Andy Beshear, the governor of Kentucky, shortly. He is the sixty-third governor of Kentucky. His father, Steve, was the sixty-first governor of Kentucky. We’re going to talk a little bit, not only about the legacy of Ruth Bader Ginsburg, but also what the Affordable Care Act means and what can happen. But I think to tie this pandemic into this conversation is really important in some respects. COVID-19 is the ultimate pre-existing condition. It affects, as we know now, at the very least, our limbs, our internal organs, like our kidneys, our heart, our brain, our lungs, it affects our immune system, causes blood clots. So if someone has had COVID-19, which at some point could get up to 20, 30, 40, 50 percent of the population, that becomes a whole list of things that insurance companies just don’t have to cover. And that is a very different kind of scenario in a very different situation. And for those who remember what the world was like before the Affordable Care Act, people did want to disclose their illnesses. So imagine a public health emergency where you need to do testing and contact tracing, where people are just reluctant to talk about their illnesses, reluctant to admit that they have COVID-19, for fear that it’ll make them uninsurable. That’s what losing the ACA would be about. So I’ve written a number of things on Twitter about this. We’re going to do a show about this next week. But an important thing to know is that unless we have a full sweep, a Democratic president and Senate and House, that’s really the only way to assure that the ACA is still with us next year. So I think that brings us to the importance of voting, and voting in the presidential and supporting Senate candidates becomes even more important. 


[04:27] Lana Slavitt: It’s also really important to support the legislative races in the various states, especially if the Supreme Court is at risk, because so often in the past, we’ve actually had different rights in different states. And so you want to make sure that as many of these states as possible support the freedoms that we care about. Just in general, before abortion became, you know, abortion rights for the law of the land, it varied by state. There were some states that allowed gay marriage and others did not. And if you can’t count on the Supreme Court to actually be the arbiter of equal justice across all states, then it’s really important to make sure that you have strong state legislatures and strong governors who are willing to protect those rights. 


[05:09] Andy Slavitt: So voting is more important than ever, both at the federal and the state level. Speaking of strong governors, we have a really wonderful guest on the program today, Andy Beshear. The state he’s governor of is a very challenging state, both politically and from a health and economic standpoint. So I think you’re really going to be impressed with what he’s doing and how he’s doing it. 


[05:41] Andy Beshear: When they say, Andy, how are we supposed to respond? 


[05:53] Andy Slavitt: I’m I’m going to call you governor 


[05:57] Andy Beshear: And I’ll call you professor. 


[05:58] Andy Slavitt: You call me whatever you want. I really appreciate you joining with all that’s going on. I thought maybe a appropriate way for us to start was maybe to talk a little bit about Ruth Bader Ginsburg, given that this is going to be put up on Wednesday. I think we are all reeling from this. You were the attorney general before you were the governor. Can you help us process the loss of Justice Ginsburg? Any reflections you have? 


[06:23] Andy Beshear: Well, Justice Ginsburg was an absolute titan in the legal community. And I think for our nation as a whole, she led not only with a superior intellect and wit, but also true compassion. And to lose someone that contributed in so many ways, from legal prowess, the way she wrote her opinions, to also some of the causes that she championed. The example that she is set not just for women, but for men, and not just for lawyers, but for Americans. A very special person who gave countless years of service. We’re gonna truly miss her. And I hope that her legacy doesn’t just get caught up in everything that’s going on afterwards. It’s important when we lose somebody like this that we take a little time to talk about the amazing additions that they brought to the world. And also, remember, she’s got a family, too. And we’re all just human beings. And there are people that are truly missing her.


[07:34] Andy Slavitt: That’s a great point. And I think she’s going to lie in state, in the capital, I believe this week, which is an incredibly well-deserved honor, especially if you think about what she pioneered early in her career as a young lawyer and how far that woman came in, just what it tells people it’s possible to do, whether it’s young girls, whether it’s anybody who feels like they’re facing a set of insurmountable challenges.


[07:58] Andy Beshear: I remember when as a college senior, I think, I met Sandra Day O’Connor. And listening to her life story, we see a lot of the same in Ruth Bader Ginsburg and others in that there’s a big world out there that you can make an impact in. And every time somebody like Justice Ginsburg achieves what she’d achieved while also not losing her humanity shows you that the most important muscles that we have are our hearts. And certainly the most important gift we have been given by God is our ability to think and to reason. And I think she showed people that being powerful isn’t about being physically big. It’s about being strong in so many different ways. And she’s really special and has provided such a special example for so many people. And I think people found strength in her, no matter what they’re dealing with. I mean, she took on cancer how many times? And won? Just a real powerful special individual. And I want to say to her family, we are so sorry as a nation for this loss, but I know you are very sorry as a family for this loss, and we’re thinking about you, too.


[09:13] Andy Slavitt: That so often gets lost, the personal grief. Maybe we’ll come back to talk a little bit about the impact of that loss politically. But I agree with you that my objective was just to reflect on her. And I appreciate you helping us to do that. Let’s talk about Kentucky. There’s no easy wins here. These are a series of tough decisions. So maybe just start with how y’all are doing. How is Kentucky holding up these days? What are you feeling?


[09:43] Andy Beshear: Well, Kentucky is doing better than most, certainly when we saw what we saw in March and April when there was a potential for a very dangerous escalation that could overrun our healthcare system. Kentuckians came together in a very special way, and we at that time crushed the curve. We made sure that we protected other Kentuckians. And we proved the initial models wrong. But this virus isn’t going away, doesn’t care if we get tired. And what we have seen is that there have been different times along the way that we’ve seen escalations and we’ve had to respond in kind. And where we are today is more cases than I’d ever like to see. For just the second day in our experience, on Saturday, we had over a thousand cases. I don’t want to see that again. We’ve lost over a thousand Kentuckians and we’ll lose more people to COVID than we lost either in the Vietnam War or the Korean War. And so the way that I view this is we are at war. It’s just with a very different opponent. And our civic duty, our patriotic duty as Americans is to do what it takes to protect one another. But this virus is so different in that it tests our humanity and it tests our resolve. It tests our humanity in that for most people, if you don’t wear a mask, you’re probably not going to feel the harm. But somebody that you’ve never met, their body might not be able to take it. And so it truly tests, are we willing to be our brother and sister’s keeper or are we willing to love our neighbor as ourselves if it causes us some discomfort? Are we willing to change our lives, change our economy for a short period of time if it means more of our friends and neighbors are going to be here with us afterwards? In Kentucky, I think we’ve passed this test better than most. We have seen states to our south go through devastating increases, whether it’s Florida, Alabama, South Carolina, Arizona and Texas. And we all know that when you have huge case increases, the deaths follow. And we don’t want to see that in Kentucky. We’re kind of right on that line and we’ve had to push back and push back. And while we have lost more people than I would have ever, ever anticipated, and a challenge while I was governor, I know it could be much worse in Kentucky. And you know this is unfortunately, one of the more unhealthy states out there. We’re number one, two or three in diabetes, heart disease and lung cancer, those conditions that COVID comes for. But based on taking decisive action early, making sure we’re protecting the most vulnerable and a different Governor Beshear’s decision to expand Medicaid many years ago and get more people in our healthcare system seeing a doctor, getting those conditions better controlled and having a doctor they can go to, our loss per capita is much lower than most other states out there. But we still have a long way to go. There’s a lot of fatigue out there. And so while I know we won a lot of early battles, we’ve got a lot in front of us. My job’s to worry about it every day and to keep fighting.


[16:11] Andy Slavitt: When you think about the impact of this virus on people, obviously for some people it’s physical, it’s a loss of life. For some people, it’s mental and emotional at some people’s estrangement from their family. For some people, it’s the loss of a business they’ve built for many years. And so because everybody does see it differently and you live in a state with very diverse, not just political views, but also just the content, urban, rural, race, et cetera. What you’re talking about is an old-fashioned notion of asking people to sacrifice for one another to look out for one another. Can we do that? Are we able to do that? 


[16:49] Andy Beshear: Well, we can and we have and I think that we will. What we have to make sure is that people can get real information and real facts. And one of the toughest challenges out there is pushing back against misinformation, or I think we’ve entered a period of rationalization where Person X really wants to do something, but the facts say they shouldn’t do it. And so they start arguing with the facts or trying to recalculate the number of cases. But what we won’t ever get to is perfection. And I think we get and I get really focused on those not following the rules and doing what’s right and we lose focus of the vast majority of people doing what’s right every single day, not getting tired and putting in the work. I do think that we still care about each other. I think that if this wasn’t an election year, in many instances, we’d see even better results. But you’re right, how much we care about each other isn’t an urban or rural value and shouldn’t be a Democrat or a Republican value. It’s just supposed to be a personal value that we all share. And so I think as governor, my job is to keep providing the information day in and day out to knock down the misperceptions or misinformation. But then also to try to make sure I’m leading with compassion and caring. Recognizing the lost. Recognizing the anxiety we all feel, because that’s also part of it. You know, sometimes when people choose I’m no longer going to wear my mask, I might go out and do everything I want, it’s because that anxiety has been eating away on them, and maybe for even a short period of time they want to ignore it. This is a mean, difficult virus that impacts every single part of our society and who we are. It impacts our emotions. It impacts our family life. It impacts our economy. But it’s here and we’ve got to beat it. And so we want to listen to each other and help each other. But then we got to buckle down and do what we’ve got to do to win, because at the end of the day, it’s people’s lives that depend on it. It’s people’s long-term health that depends on it. And whether it’s our economy or whether it’s getting kids back to school, it all depends on how we manage this virus. Our success in the short and in the medium term is all based on how we deal with this virus. You can’t separate the economy and the virus there. They’re connected. Do better against the virus, then we’ll do better with the economy. 

[19:28] Andy Slavitt: Right. You know, you said something really important, which is that there’s not a Democratic response or Republican response to this virus. And I’ve tried to make the point that if Mitt Romney were president, he would probably managing the virus very similar to the way Joe Biden would manage the virus. With competence, with compassion. And we wouldn’t see much difference between the parties. And the fact that some would politicize it makes your job tougher. One of the things that you have done in my observation is if you’ve managed it with principle. You said here’s what’s important, you’ve called on people’s better natures. But you’ve also said, I understand that not all of you voted for me and I’m not just going to speak to the people that voted for me because we all have to be in this together. I think one of the critical questions is how to appeal to Trump supporters who are suspicious of the message because perhaps they think it’s an attack on the president. They may think it’s overblown. And, of course, that just piles on top of what you’ve already said, which is that people are tired. All of us want this to be over. All of us occasionally look out the window and say, come on, let’s just forget this whole thing. But yet you do it. And part of the reason I’m asking you the question is because were Joe Biden to win for president, I’d imagine that would be one of the toughest challenges and most important challenges he would face. And so as you’ve governed in a very purple state, what have you learned about that? 


[20:54] Andy Beshear: Well, I think that even though I was inaugurated just this last December — and that’s hard to believe sometimes because the last six months certainly have felt like a lot longer. I’ve realized while there’s a lot I want to do for this state, while I fully intend to serve a full two terms, provided that the people of Kentucky want and allow that, and I want to move this state forward on education and the economy, on providing affordable access to healthcare for everybody, managing this virus and responding to it is probably the most important thing I will ever do in state government. Probably the most important thing I will ever do in my life. And treating it that way. Making sure that I am humble in what we don’t know about this virus. Making sure that it is not about me, about the people of Kentucky. That’s been absolutely critical. And being vulnerable, admitting to people that we don’t know everything. And sure, I’m likely to make mistakes because of what we don’t know, but I’m always going to be honest and upfront about the risks and where the science is and when it changes. And I think that that’s just so important because we talk about Trump voters or Biden voters, they all start out as Kentuckians and they may support one candidate or the other. But that doesn’t mean that large parts of them don’t understand where we are on the virus and aren’t aren’t doing their part. I think what we’re dealing with right now is a small minority that’s realized how to use social media effectively to convince the media and the country that they are a louder voice, that they’re 50 percent when they’re not. For me, it’s about not spending too much time on that, but talking to everybody else who wants to do the right thing, who is pushing to do the right thing, because the right thing isn’t easy in all this because you can’t see it. So I had somebody the other day in one of our counties that’s been hit the hardest say, well, I know it’s out there, they say it’s out there, but I don’t see it. That’s a challenge. You can’t see this because somebody should be quarantined if they know they have it or they’ve been around it or they’re in the hospital. And if you’re not in either of those, you’re not going to either of those places. And so even though it is in our communities, it’s not actually very visible. And that that’s a real challenge, too, for people. 

[23:27] Andy Slavitt: Our brains don’t really work that way. I really agree with what you said about how the media needs enough of a controversy to say — in fact, I understand that there’s a lawsuit in Kentucky suing you for requiring masks. One of my favorite signs was “Andy Beshear is drunk with power.” Now, I have to ask you a question. If you were to get drunk with power, would that be the first thing you do? Would you say everybody wears masks? 


[23:52] Andy Beshear: You know, I’m laughing because some critics say I’m drunk with power. I’m a tyrant. I can’t even leave my house, for the most part, that I’m living by the same rules that everybody else is there, set out by the public health officials and our scientists. And no governor, none of them Democrats or Republicans, want to be taking the steps that we’re taking. We just have to deal with this virus. Every decision that I make is between a bad option and a bad option. Every single decision that I have to make is going to bring pain to somebody. And every decision I make on some level is going to be politically unpopular. Most of them couldn’t even conceive of making it in a normal environment so early on. I said if this is the most important thing that I’m ever going to do, I’m going to do it right to make sure that I can look in a mirror the rest of my life and know that I didn’t gamble with the lives of Kentuckians, our kids, that I made the best decisions I could for our economy and the education of our children. And I’m going to go ahead and make what I think is the right decision, whether it’s politically popular or not. And I think that the people of Kentucky have appreciated that. I think that they’ve also appreciated that I try not to attack any administration or individual, because right now, I mean, we’re just making the best decisions we can. 


[25:15] Andy Slavitt: Nobody ran for governor thinking this was going to happen. And, you know, the truth is, if you look around the country, some of them, had they known, wouldn’t or shouldn’t. But you know what? I look at what you’ve done and I know some of the advisers you brought around. Not just your father, who tells me he tries to stay out of your way, only answer questions when asked. 


[25:35] Andy Beshear: I don’t think that’s true. But, you know, my dad was a two-term governor who expanded health care here in Kentucky. Wonderful man, wonderful governor. And I’m lucky to have his advice. 


[25:45] Andy Slavitt: Absolutely. And I can vouch for that. But you have a series of tough decisions to make right now as you look towards an uncertain future, as you say, cases are ticking up a little bit. Schools, you’ve got University of Kentucky, you’ve got several variables around how this fall goes, as do other governors right now around the country, some of whom are just beginning to experience some of the pain, some of whom think they’re past it but are coming into a different season. What do you think are the two or three most important messages right now, and most important action for the state, as you think about both the schools and other other things that you’re facing right now? 


[26:23] Andy Beshear: I think the number one thing that we’ve got to do as a commonwealth and as a country is to wear masks in every interaction that we’re in, whether it is school or our place of employment. I believe it is, first of all, the easiest, even if it’s uncomfortable and second, one of the most effective things that we can do, regardless of what situation we’re in, to reduce the spread. And it really shouldn’t be that hard, if you think about what we have asked of our nation at different times. My granddad, that’s my mom’s dad, followed Patton’s army into Europe as part of a medical team. He was asked to leave his family not knowing exactly for how long and go overseas in World War II. We’re asked to wear a mask and keep social distance. So I think that we just simply have to buckle down, know that it’s our patriotic duty and then do it. But I think the second piece we’ve got to do is to be fluid and flexible, knowing that we don’t know everything about this virus. Some people thought that the summer would slow it down. It seems to have been just the opposite. I think we also aren’t sure exactly how it’s going to act or react as we enter the fall and flu season. And we don’t yet know exactly how effective any vaccine is going to be, what time it’s going to get here, how long it’s going to take to manufacture, and then how we’re going to effectively deploy it. Though, as a state, we’re certainly working on that piece. So, you know, if we view this as a war, which it is, you know, we’re losing 200,000 people, I think, as of today or have lost, then we’ve got to know that we’ve got to be strong. We’ve got to continue to do what it takes. And we’ve got to be fluid and flexible as more challenges come at us. But here’s the good news: we know it’s going to end. You know, when my granddad deployed for World War II, they didn’t know when it would end or even if they would win. We know that this will end and we know that we as a country will survive, and that ought to give us the extra confidence to do what’s necessary. 


[28:34] Andy Slavitt: That’s a great point about giving people the light at the end of the tunnel. It’s so important. But without snowing them, as I think they’re getting from the federal level sometimes. But really giving them the absolutely correct perspective that we’ll absolutely beat this virus. The only question is, what’s the costs going to be at the end of this all? I think there’s two questions that we’ll have to answer to history. One is, how many people did we lose? And secondly, did we do things we were proud of that helped others along the way? That’s it. Everything else is just noise. 


[29:06] Andy Beshear: And this is the challenge of our generation that we will write history about. This will be the greatness or the kindness of our generation. We talk about the greatest generation. We are facing our challenge right now. And for us, it’s a different set of skills. Do we have what it takes to continue doing the right things? Can we be kind and compassionate to each other during it, understanding the anxiety and the difficulties there? Can we sacrifice small things and sometimes bigger things? We worry about our kids falling behind in certain forms of educational instruction, but are we willing to make personal sacrifices to save the lives of those around us? We’ve seen some really callous examples of suggesting just because people are older, that the loss of life isn’t tragic, and the loss of eight to 10 years with a family isn’t important. It is. But then we’ve also seen the vast majority of people some really incredible things here in Kentucky. We light our homes up green every night and institutions all across Kentucky to honor those we’ve lost. Green’s the color of compassion and renewal, knowing a better day is coming. And every time I get a little bit down, I take a drive at night or early in the morning when it’s still dark and you see those green lights across every highway off the interstates and in every neighborhood. And that just tells you that there are people out there doing the right thing, even if they’re not on Facebook all day long talking about it. 


[30:43] Andy Slavitt: I love that. I love that image. And I think other states need to consider that. 


[33:24] Andy Slavitt: I listen to you and I hear it is possible to govern through this with patience, with humanity, with compassion, with competence. So it forces me to want to ask the question on the national level, which is are we governable with a federalist system? With so many of the forces that you have there in Kentucky, the social media, etc., that exist on an even broader basis with all the cultural patterns and differences throughout the country. And if Joe Biden were to win and take an approach similar to the approach you’re taking Kentucky, can we do it? 


[34:01] Andy Beshear: So, yes, I believe that we are governable and can come together as a country, but we have to know it won’t be perfect. I mean, I think that our success in this is a pretty simple equation. It is the best rules and practices times the number of people that are willing to follow them equals our best result. And we’ve got to understand that we’ve got to get the people up, and so sometimes we can’t get perfection in the practices. We’ve got to find that sweet spot and understand that that can change as people may get a little bit tired. And what we see are different moments, like the beginning of summer or the traditional beginning of school, that are more deeply rooted than maybe I had previously thought about our behavior. So if we can have that national strategy with what those should be, and we should clearly communicate them and the expectations, get the vast majority of people following them, have federal and state governments and local governments on the same page, have examples of leaders of each following those rules, then I absolutely think that it’s doable. Now, a couple of things that I think that the federal government could help with that we’ve been able to have great success here in Kentucky. The first is testing. Now, originally, we were concerned that we would never have enough tests in the midst of this. And admittedly, it’s a brand new virus, I know it’s connected to others and a test didn’t exist. And so it’s a real challenge that I don’t Monday-morning quarterback, getting it up and going, even though there was that original problem with the first series of tests. But here in Kentucky, we’re now over a million tests since March 6. We’ve only got about four million people. And right now, our testing is actually increasing in ways to where even though we had a thousand positive cases on Saturday, our positivity rate that we calculate in this state is below four percent. And hopefully we can hold it there. But what we’ve got to have significant testing and it needs to be nationwide. Some states like us, I think, are succeeding. I worry about others because no matter where you live, you deserve to have access to testing and it needs to be accurate testing as well. Second one is PPE, I’m not sure I can describe for your listeners how it felt early on when we were seeing predictions, you know, here in Kentucky. One was 80,000 people that we were going to lose. And I’ve been governor for months and I’ve got a projection that we were going to lose 80,000 Kentuckians and we would spend an all day long, me included, on the phone trying to buy necessary PPE, not just the N95 masks. And every single rabbit hole that we ran down, you couldn’t get any. 


[37:06] Andy Slavitt: Did you know how short you were? How much did you think you needed? 


[37:09] Andy Beshear: Oh, we were worried about running out at the end of every week through every one of our systems early on. And as you know, different practices changed about reusing or OKing different types. But I will tell you that every day we worried about failing our heroes walking into the E.R. And I had to look at a camera every day, because I was doing a press conference every day, and say, I can’t tell you that we’ll have enough, but we are fighting as hard as we can to get it. But please respect those people walking into the ER without appropriate PPE. Now, I just went over to our warehouse. We have a 120-day supply of everything that we need in case we have another spike. Each of our hospital systems has an additional 14-day supply. That’s been something that has required really hard work. But ensuring that that’s available all around the country would be helpful. 


[38:11] Andy Slavitt: Are you talking to other governors to see if they run short? Is there good coordination? 


[38:16] Andy Beshear: I talk with a group of governors on a regular occasion. And, you know, while we talk about partisanship, Mike DeWine, Republican Governor Eric Holcomb and I talk once a week. Sometimes we commiserate, sometimes we strategize. But all of us trying to do the same thing. Sometimes things are more possible in one state than another, but really exchanging ideas. And we developed a system of trust to where we can talk about things we’re considering to do as well. It’s been really helpful. Those are two good people. Just because we have different ideological opinions on a couple of views doesn’t mean we haven’t worked really together in the midst of this really well together. 


[39:01] Andy Slavitt: It’s, I think, really encouraging for Americans to see those moments, like when Kate Brown sent folks from Oregon over to New York and vice-versa. And we started to feel like a country in those moments. Those are too few and far between. I spent time trying to figure out where surpluses were during those days because there were a lot of people running short and there were a lot of people stuffing their closets. And then there were a lot of people out profiteering. If you were attorney general, you would have a field day with all of these profiteers out there. I mean, the idea of your nurses and doctors, technicians, not having materials, we would have gone after each and every one of these. 


[39:40] Andy Beshear: But I’ll tell you what got us through the most difficult times. It was Kentuckians going to their place of business, may have been construction, may have been a veterinarians, taking everything they had and putting it in a car and driving it to one of our Kentucky state police posts. And then we would bring it to our warehouse and immediately send it out. We got through the toughest times because Kentuckians looked at what they had in their garage, their business and gave and gave as much as they could, gave until past the time when it hurt. That was another amazing show of humanity we needed it the most. 


[40:19] Andy Slavitt: Well, you know, that reminds me of something you said earlier, which is that it’s easier if we’re asking something of people in many respects, if we’re saying sacrifice, we’re saying you can contribute, you can save lives, there’s a tangible way to help people. Don’t flip to that mindset that we talked about earlier quite as much. Now, this is just kind of stringing on and there’s nothing for me to do it, they get a lot of anxiety and I’m going to run the other direction. 


[40:46] Andy Beshear: I do think that we’ve learned here that when you really need people to do something, but that something is sometimes to do nothing, it is more emotionally challenging than if we’d ask people to head into the factories like we like we did during World War II. What we’re asking of people really here is so little compared to what we’ve had to in the past. But emotionally and in terms of anxiety, it may be even more difficult. This virus is mean and how it attacks our human psyche and our emotions. But we’re strong and we just have to be committed. 


[41:23] Andy Slavitt: If the ACA were to go away — Steve Beshear, who probably gets credit, deservedly so, for the best implementation of expanding health care coverage in the country. There’s just a dramatic chart which shows the difference between what was done in Kentucky and what was done in Tennessee — to take nothing away from Tennessee, but Tennessee didn’t expand Medicaid. Kentucky really jumped into the exchange. And it was something like a 22 percent uninsured rate that went down to eight. I don’t know if those are the exact numbers, but it was something similar to that. And I think it’s transformed the lives of a lot of people in Kentucky. They were headed backwards under Governor Bevin. That may have been one of the things that was part of the election that you ran on. And now back in a good place, but that’s all in jeopardy with the California versus Texas case that’s coming up. So what would you do in the state if that law went away?


[42:25] Andy Beshear: Well, let me first start by saying Steve Beshear’s decision to expand Medicaid was transformational for our state and allowed us to be competitive in so many ways during his tenure. And during the next governor’s. But it has saved countless thousands of lives during COVID. It’s the reason that a state that is otherwise unhealthy — and we’re gonna work on that — has lost far fewer people than most other states. It wasn’t just the right thing to do and the moral thing to do was one of the most important steps taken in the past to protect our people now. For that, I’m grateful. I’m grateful that he was governor. I’m grateful that he did it. And part of how I’m doing, trying to manage this virus, I owe thanks to my dad. Now, I was one of the attorney generals at the time that filed suit to protect the Affordable Care Act. The Affordable Care Act is so critical. And the current decision out of I think it was the 5th Circuit would eviscerate not just protections for preexisting conditions, a prohibition on discrimination against women and seniors, but it would also end expanded Medicaid in my state. That’s hundreds of thousands of people, more than 500,000 that have healthcare for the first time based on that, that are getting healthier, that give us a better shot at life. And many of which are alive that might not have been during COVID. It is unfathomable that that form of healthcare about things that we all agree on could be eliminated and we just can’t let that happen. The Affordable Care Act was so critical in making sure that even a family like mine, we seem healthy, but three out of four of us have preexisting conditions, can secure affordable health care, and there’s so much we can do to build on it. Here in Kentucky, we have really big plans that are only growing. We’re going to restart our state exchange. That’s going to save us almost $12 to $15 million a year. And we think we’re gonna be able to provide more options in it. The Affordable Care Act didn’t set up a system that’s perfect. Nobody ever thought that it would. We thought that we’d be able to make positive changes in it that Congress hadn’t been willing to look at. But it is a system that I can work with to maximize health care opportunities for Kentuckians. 


[45:04] Andy Slavitt: So what happens if there’s an unfavorable favorable ruling? What options do you have? 


[45:09] Andy Beshear: Well, here in Kentucky, we’re going to have to look at, first of all, putting that into state law. And I’ve tried to put a lot of those protections into state law, but there aren’t great options. This is one where the damage you cannot fix in the next legislative session or maybe even multiple legislative sessions. You can’t take what’s become many of the core principles in the healthcare markets that are out there, eliminate them and be able to fix it overnight. What’s going to happen is people are going to suffer and we’ll all do the best we can afterwards. But people are going to suffer. And there’s no easy answer. This loosening up, selling across state lines where people buy policies that won’t cover anything if they’re actually hurt, but you can say they’re insured or covered, that doesn’t help. I mean, healthcare’s got to be real to matter. 


[45:58] Andy Slavitt: That’s right. So one of the reasons why what you say is correct is because most people don’t realize that with the fall of the Affordable Care Act were to go away, the money that supports low-income folks and middle-income folks and subsidies would go to a giant tax cut. And once that giant tax that goes away, finding the money to bring that back. And I can’t imagine a state, whether it’s Kentucky or Massachusetts, has the wherewithal in their budget to be able to replicate that. So even if you could, by executive order, keep some of the rules perhaps in place, and I think many states can’t even do that, there’s no path. 


[46:35] Andy Beshear: That’s right. And how do you cover those on expanded Medicaid without the federal government providing their portion of it? How do we make up for seniors what they would lose on prescription drug costs and the rest? I mean, virtually every Kentuckian out there is helped by the system created by the Affordable Care Act, whether they like the name of it or who passed it or not. This is our system of healthcare and we’ve got to improve upon it. We can’t eliminate it. And the answer is we will all suffer if it’s eliminated.


[47:08] Andy Slavitt: I want to finish up in one one topic here. We have a little bit in common where we both sit today. You’re in Kentucky. I’m here with Lana in Minnesota. You had a horrible incident with Breonna Taylor. We had a murder here in our community this summer that galvanized the country. And you made, I think, a series of really bold and principled statements about what needed to be done in a way that I don’t think has been talked about or had been talked about, certainly at the time, very much in the way you did. I wonder if you could just comment on your reflection of what you thought, how you’re feeling about that in kind of what you covered there after many incidents that occurred throughout the country.


[48:01] Andy Beshear: We all witnessed people taking to the streets to express 400 years of frustration and anger and hurt over slavery and segregation and Jim Crow. And understanding that I will never truly be able to feel that frustration, but being willing to to listen and to try to hear and to acknowledge that systemic racism pervades every single part of our society. It is there. And if we can acknowledge that, then we can start to work to truly do something about it. And we see it in healthcare, you know, in Kentucky, black or African-American Kentuckians are dying at twice the rate that they make up of the population due to COVID. Now, when Martin Luther King Jr. talked about healthcare being one of the greatest inequalities, he was right. But we should have fixed it between then and now. And we did so in Kentucky. We’re working on signing everybody up for some form of healthcare, but we’re starting with those that have been ignored the most. And that’s our black and African-American communities, making sure in the middle of a pandemic that is impacting them more, that we are getting them signed up first. Finally giving priority to a group that never seems to get it. 


[49:23] Andy Slavitt: How did people react to that commitment, which was a very bold commitment? 


[49:27] Andy Beshear: Well, we saw we saw a couple of different reactions, some that saw that as listening and maybe hearing. We saw some that reacted in ways that just tell me that it’s that much more important and that there truly is systemic racism out there. Because, you know, what I said was that, you know, we’ve got COVID. It is impacting black and African-American Kentuckians at a higher rate. We’ve got to get them signed up for healthcare first. And we had some people that responded by saying, what about me? That is not right. And my response was, wait a minute. If I had said we’ve got people in eastern or western Kentucky, northern Kentucky suffering the most from COVID, and so we’re going to prioritize them and sign them up first, would you be having the same reaction? So it just shows that there is still a long way to go. But the right thing is the right thing. If COVID’s taught me anything as a leader, it’s just go ahead and do the right thing. There’s going to be detractors no matter what you do, you only have limited time in a spot like governor, and I’m only going to face, I hope, one crisis like this one. So we’ll do the right thing. And I can live with with any of the ramifications. 


[50:45] Andy Slavitt: Good. What’s your wish for the New Year? Which do you have a wish or two for the New Year?


[50:49] Andy Beshear: I wish for a safe, successful vaccination that everybody will be willing to take when it’s here. But aside from that, my wish is that everybody takes a breath. Backs away from their computer and social media. If they’re a person of faith, looks at their text — for me, it’s obviously the Bible — or that thinks about their values and how they’re supposed to be treating one another. We are not each other’s enemy in the country. We can disagree. We can sometimes, maybe even not like each other, but we are not each other’s enemy. And that’s how we’re treating each other right now, using words and phrases, approaches that dehumanize other people and other Americans. And that is just at a core level, really wrong. And so I hope in this new year that we can make a commitment to be better, more compassionate, more patient, more kind, because I think that’s opposed to being the greatest generation. That title is taken. To defeat COVID, we almost have to be the kindest generation about how we treat each other and what we’re willing to do for one another. I just know we are better than what we’re seeing and we’ve got to prove it. And we also have to expect it from others. My hope is that we can take a breath. We can realize that we all get riled up at different times. And maybe some of us have been riled up for months or even years. But we need to step back and remember who we are and get back to being the good people that we should be. 

[52:30] Andy Slavitt: I hope your wish is granted. It’s the right one, because I think from that wish will come all other good things, and it’s the thing we need. Governor, thank you so much for spending the time. It’s just fantastic to hear how you’re leading in the state. And I think it’s going to be very inspiring for other people, because you really shown what’s possible. 


[52:54] Andy Beshear: Well, Andy, I really appreciate you, appreciate all the service that you’ve provided to this country. And I appreciate you being a voice during this time, which is so important. So thanks for having me. 


[53:12] Andy Slavitt: Thanks to Governor Beshear for coming on and sharing what you’ve been able to accomplish, it is quite inspiring to know that there are leaders out here like that. I don’t know if you reacted the same way that I did. Let me just tell you what’s coming up on upcoming podcast episodes. On Monday, we have a show that is going to be dedicated to the topic of the Supreme Court, healthcare and the pandemic with Nick Bagley. Nick is a Supreme Court expert and healthcare expert. And he and I have written many pieces together. And it will be fun to have him on because we’re going to chat about what’s going to be the impact of what happens in the court on the pandemic and on the Affordable Care Act as a whole. On Wednesday, it is our West Wing episode with Pete Souza. Pete Souza was the White House photographer. And he’s also starring in a movie that’s just been released called The Way I See It. And many have asked me who the special guest is that’s on after Pete Souza. And I’m not going to tell you, but I have a feeling many of you think it’s somebody that it’s not. Anyway, it should be a fun episode. And then the following Monday, we have the former head of the USAID and president of Rockefeller Foundation, Rajiv Shah. He is one of the most experienced experts in managing pandemics and global public health and is really a principal player now in transforming the way the U.S. is handling the coronavirus response. And that’s all you’re getting for me for now. The rest will come later. Thank you so much for hanging on and have a great rest of the week. 


[55:02] Andy Slavitt: Thanks for listening to In the Bubble. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen, produce the show. Our mix is by Ivan Kuraev. My son Zach Slavitt is emeritus co-host and onsite producer. Improved by the much better Lana Slavitt, my wife. Jessica Cordova Kramer and Stephanie Wittels Wachs still rule our lives and executive produce the show. And our theme was composed by Dan Molad and Oliver Hill, and additional music by Ivan Kuraev. You can find out more about our show on social media @LemonadaMedia. And you can find me @ASlavitt on Twitter or @AndySlavitt on Instagram. If you like what you heard today, most importantly, please tell your friends to come listen. But still tell them at a distance or with a mask. And please stay safe. Share some joy and we will get through this together. #StayHome.


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