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The viral video of Mike Pence being grilled by an ER doctor about Medicaid cuts, explained

Pence struggled to justify a new policy in an exchange that captured something profound about the health care debate.

Mike Pence. Video screencap

Dr. Rob Davidson was grabbing a bite at the Drake Diner in Des Moines, Iowa, on Thursday when Vice President Mike Pence just happened to stroll in. The polite but determined exchange that ensued became a viral video — and captured something profound about the state of the health care policy debate in President Trump’s America.

Davidson works as an emergency room doctor in western Michigan and is the executive director of the Committee to Protect Medicare. He told Vox he was in Iowa for a press conference related to his work for the committee. So as Pence glad-handed around the diner, Davidson took the opportunity to press him on a new plan the Trump administration rolled out earlier that same day that would allow states to use waivers and block grants to cut federal Medicaid funding.

When Pence walked up to his table, Davidson introduced himself and said, “I’m an emergency doctor. I’m worried about the plans [Trump] talked about last week to maybe cut Medicare, and then the rollout today of cutting Medicaid. I work in one of the poorest counties in Michigan and my patients depend on expanded Medicaid, so how is that going to affect my patients?”

Pence, however, didn’t seem to be familiar with the plan his administration had announced.

“Uh ... I hadn’t heard about cuts,” he said, prompting Davidson to explain the block grant proposal to him.

“Cutting Medicaid — yeah,” Davidson said. “The head of CMS [the Centers for Medicare and Medicaid Services] announced the plan to let states file for waivers so they could get block grants, so that would essentially cut the amount of money going to states. So that would cut federal Medicaid funding. Is that a good idea?”

As Vox’s Dylan Scott explained, enacting block grants, a long-held goal of ideological conservatives, “would fundamentally change how the program is financed” and ultimately result in funding cuts and less coverage:

Medicaid would no longer pay whatever is necessary to provide medical care to the people in or near poverty who qualify for its benefits. Instead, spending would be limited in states that got a waiver from the federal government, and they could impose cuts on benefits.

Instead of addressing the question, Pence deflected by bringing up the Medicaid expansion that happened in Indiana while he was governor. But Davidson pressed him to actually address his question.

“Right — but now they’re talking about scaling back the Medicaid expansion that we got with the Affordable Care Act. 680,000 Michiganders, 600,000 in Iowa — a lot of people got health care,” Davidson said. “I’m just talking about the president and your administration right now.”

But Pence still seemed to be confused.

“I think you’re oversimplifying things,” he said.

“Well, I think it comes down to that for the people I take care of all the time,” responded Davidson. “People I see in the emergency department that can’t get primary care doctors, [but] once they got Medicaid they could get primary care doctors. They stay out of the ER, they actually work more, they actually contributed to our community more.”

“Now, if you tell those people, ‘Sorry, you don’t get your health care’ — that’s going to be a real negative in their lives,” Davidson continued.

The conversation extended into a second video. Pence continued to deflect by touting his health care record in Indiana, and Davidson kept pressing him to address what the Trump administration is doing right now.

“I think if the Trump administration wanted to expand Medicaid, that’d be great. But the problem is they’re contracting Medicaid,” Davidson said, alluding to the contradiction involved in Pence bragging about expanding Medicaid while he was governor of Indiana while being part of a presidential administration that’s actively working to cut it.

The interaction ended with Pence telling Davidson, “I respectfully disagree” — even though Davidson’s observations about the Trump administration’s new plan were not a matter of opinion.

Davidson told Vox that block-granting Medicaid has been part of mainstream Republican thinking about health care for decades, so he doesn’t buy that Pence was as ignorant about his administration’s new plan as he seemed to be. (The White House didn’t immediately respond to a request for comment.)

“I think he was not expecting to be pressed on that, and didn’t have his talking points prepared, so he retreated back to his safe space,” Davidson said. “I believe he understands exactly what his administration is doing.”

The interaction encapsulated a dynamic at the core of the current debate about health care policy: Republican plans involve unpopular spending and coverage cuts, so they dress them up with nice-sounding jargon like “consumer-directed.”

“‘Innovation,’ ‘flexibility’ — that’s all code for cutting spending and putting more in the laps of people who can’t afford it,” Davidson said. “This would further reduce that funding.”

Asked what he hopes people take away from the video — which has been shared more than 20,000 times on Twitter and has nearly 1.5 million views as this is published — Davidson said he hopes it raises awareness about his work with the Committee to Protect Medicare and encourages doctors to feel comfortable in the policy space.

“We all have the ability to stand up to any level of folks who are coming along and proposing policies that hurt our patients,” Davidson said. “I think it’s time now for doctors to step out of the exam room and get out into the public space and advocate in a bigger way, and I hope that health care providers who see this want to join with us or in some way on their own become advocates for health care.”

“Patients have a hard enough time scrounging to get coverage,” Davidson added. “If we won’t stand up for them, I’m not sure who will.”

The news moves fast. To stay updated, follow Aaron Rupar on Twitter, and read more of Vox’s policy and politics coverage.