The NPR Politics Podcast - CBO Scores GOP Health Care Bill/Listener Mail

Episode Date: March 14, 2017

This episode: host/White House correspondent Tamara Keith, political reporter Danielle Kurtzleben and congressional correspondent Susan Davis. More coverage at nprpolitics.org. Email the show at [e-mail]. Find and support your local public radio station at npr.org/stations.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

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and the NPR One app and on your local public radio station. Okay, here's the show. Hey there, it's the NPR Politics Podcast, here to discuss the Congressional Budget Office report on the GOP's health care bill and to answer a few of your questions. I'm Tamara Keith, I cover the White House. I'm Danielle Kurtzleben, political reporter. And I'm Susan Davis, and I cover Congress. Happy snow day, y'all. Happy snow day. Yes. Although there's no snow days in the news. Yeah. This is true. This is why we have to put on our snow pants and our snow boots. And yak tracks in your case, Tam. And track all the way in. It is also Pi Day, nerds. How far out can you go? 3.1415926535. Ooh. I'm going to decline to comment on that.

I have no comment for the situation. I hope I got that right because we're going to get all sorts of emails if I got that wrong, man. But speaking of nerds, the nonpartisan nerds at the CBO, the Congressional Budget Office, released their report on the American Health Care Act yesterday. This is what's known as a score. And the American Health Care Act yesterday. This is what's known as a score. And the American Health Care Act is the Republican bill to repeal and replace the Affordable Care Act, a.k.a. Obamacare. And here are their projections. It would mean, according to this report, 14 million fewer people would have health insurance by 2018. That number goes up to 24 million fewer people with coverage by 2026. The bill also reduces the federal deficit by $337 billion

over the next 10 years. All of this compared to current law. So what do we take away from these numbers and why such a dramatic drop in coverage so fast? Right. So the first phase of the increase in uninsured people would come next year, 2018. You'd have 14 million more people who are not insured. Now, that is a really big jump. Right now, the CBO said in 2016, there are about 26 million people who are not insured. So that's more than 50 percent. Now, that would come from two big things. I mean, it would come from the individual mandate being repealed. That's the thing that says you have to buy insurance or you have to pay a tax penalty on your taxes. Right. So some of those people would just choose not to have insurance. Aside from that, you have other people forego insurance because premiums are supposed to go up in a big way next year, at least for a lot of Americans.

So that would send a lot of people away from the health insurance market. This new Republican bill changes the way the government helps people on the individual market pay for health insurance. Under Obamacare, there were subsidies. What's the system for the new bill? And what does the Congressional Budget Office say about that, Sue? Okay. So what the Republican replacement offer is, is that they get rid of the existing tax subsidies and penalties in Obamacare and essentially create a new system of refundable tax credits. And that means that they would be determined by a set dollar figure ranging between two thousand dollars for people in their 20s to $4,000 to people in their early 60s. That's before they become eligible for Medicare. And it's scalable, and it's only up to a certain amount of income. So what it does is it kind of changes who pays more, right? And that's part of what the complicating factors of this bill is that under Obamacare, younger people, younger,

healthier people tended to pay more than older, sicker people. And under this new system, older, sicker people are going to pay more for health care, and younger, healthier people tended to pay more than older, sicker people. And under this new system, older, sicker people are going to pay more for health care and younger, healthier people are going to pay less. And richer people will pay less than they would people making up to something like $75,000 a year. So the Affordable Care Act said that older Americans couldn't pay more than three times the amount of younger Americans. And what this bill does is says that older Americans can pay up to five times as much as younger Americans. And Republicans would argue that this makes it more fair because older people use more health care. And if you're taking more from the system, you should be putting more into it. Right. And so the thing is that the premium supports those

tax credits don't go up from three to five times. So what is going to end up happening is that older Americans are going to end up spending a fair bit more than they would under Obamacare. And the CBO scored this out for lower and higher income Americans, and especially for lower income older adults, this could be a really big jump in what they are paying for health care in the individual market. And what makes that so provocative is that those voters tended to vote overwhelmingly for Donald Trump in last year's election. And remember that Donald Trump, in the course of this campaign, although his positions on these issues changed at certain times,

I think ran pretty consistently on the commitment not to change entitlements and not to raise costs on older Americans. And one thing he did promise, both in tweets and in verbal words, was not to touch your Medicaid. Right. What does this bill do to Medicaid? So in some ways, what they do to Medicaid is really the most transformational thing in this law, in that it fulfills a very long running Republican goal to sort of reshape how we think of our entitlement programs. It is the most ambitious conservative overhaul of an entitlement program in at least a generation. And what it would do is it essentially takes away the guaranteed federal match. Medicaid is essentially

a federal state partnership that the state ponies up a certain amount of money and whatever the remaining cost is, the federal government has a guarantee. They cover those costs. Under the new system, the federal government would essentially set a They cover those costs. Under the new system, the federal government would essentially set a formula that says, OK, the state comes to this yard line, but the federal government's only going to come to a certain point. And the burden will now be on the states to come up with the difference. And their argument for why this is a better system is that it will force states to be more efficient with their spending and they will give the states more flexibility on what they can do with those federal dollars. Danielle. Right. And to extend what I was talking about earlier, the first jump in people being uninsured, that comes from getting rid of

the individual mandate. The second big jump reaching out through 2026 comes in part, in large part, because of the rollback of spending on Medicaid and the rollback of the Medicaid expansion under Obamacare. Because under Obamacare, the number of people eligible for Medicaid expanded greatly because it went up to a higher income level. I mean, still a very low income level, but higher than it had been before. Right. Absolutely. And you had 31 states as of 2016 plus D.C. say, yes, we want to do that Medicaid expansion. OK, so now you roll that back and now you have a bunch more people who won't have health care. So in in this congressional budget office report, it outlines how much these nerds think will be cut from Medicaid. What is that number? So when we go back, when we talked about the deficit reduction, that $337 billion, essentially all the savings they get in this bill is from those cuts to Medicaid. And they estimate that it'll be about $880 billion less coming from the federal government

to the states over a 10-year budget window. And 10 years is the budget timeframe that the Congressional Budget Office always sort of forecasts out. That's a pretty standard time period. Okay, so let's get to the politics. The Democratic reaction, I think, is what you would expect it to be. Here's just a little audio from Chuck Schumer, the minority leader in the Senate. If you go to states where some of our senators are running for reelection, but have been won by Donald Trump, ACA all of a sudden has become popular. And that's because people realize by losing it, they're going to be in real trouble. And he has a point. You know, the Affordable Care Act, since it was enacted, has never had favorability ratings that went over 50 percent. Until now. And the first time it crossed that threshold was in January.

Right. When Republicans won the White House and won Congress and the issue became more to the front end of people's minds. I also think there's been a lot of confusion about this law, as those same polls show that a lot of people think that the Affordable Care Act and Obamacare are two different things. And when people are realizing that their health care is, in fact, the same thing, you know, common sense that people tune in much more to politics of things or policy when it's something that's going to be taken from them versus something that's going to be given to them. Well, and these numbers from the Congressional Budget Office, this just basically makes the point that Democrats have been trying to make about the bill. Right. Except if you are in the Trump White House, you have been beating up on the Congressional Budget Office for a week now.

You've been saying, you know, their numbers were wrong on Obamacare. And the CBO did overshoot by a fair shot the number of people who would be in the Obamacare exchanges. That is true. However, in a lot of other ways, it does have a pretty good track record. Now, the White House yesterday did something very interesting, and they carried on a pattern that they've had before, which is they took the numbers they liked and said, these are real. And they took the numbers they didn't like and said, ah, CBO got it wrong. Mick Mulvaney, the Office of Management and Budget Director yesterday said, the place where the CBO might have gotten this right is in saying that 10 years out, premiums are going to be

lowered. They might have gotten that right. The rest, we don't like it. Yeah. And Tom Price, who is the head of the Department of Health and Human Services, almost immediately after this report came out, came out to the microphones just outside of the West Wing. We believe that the plan that we're putting in place is going to insure more individuals than currently are insured. So we think that CBO simply has it wrong. Although, interestingly, correct me if I'm wrong, Sue, what I've seen from Paul Ryan thus far, he seems to be taking the numbers at face value and saying, all right, here are the numbers. Here's what's good in them. And he's the Speaker of the House.

And putting some sunshine on the numbers. I think he came out and said, I'm excited about it. I'm excited about this analysis. And yeah, I think they sort of overestimate the uninsured number, just like they overestimated who would be insured by Obamacare. But I do believe that if we're not going to force people to buy something they don't want to buy, they won't buy it. And that is what they've been campaigning on this whole time. And Paul Ryan's argument, Tom Price's argument, is that it is simply not the federal government's job to make you buy in health insurance. It is their job to create a marketplace that makes individuals want to buy it or choose to buy it. But that the concept of an individual mandate is just something Republicans don't support. Do you think that Tom Price, like the messaging coming from the White House and the approach to this report and the approach to the effects, possible effects of the legislation coming from the White House is exactly the same as the approach coming from Paul Ryan, the House speaker up on the Hill?

You know, there's nothing to suggest that the White House and the speaker's office aren't on the same page about what they want this bill to do. What they don't seem to be on the same page about is how do you sell it? And they're not arguing about the details of the bill, but the message and how do you, you know, litigate what the CBO says and how do you sell it to the public and and how do you sell it to your colleagues? They don't seem to have a very coherent message there. And the divisions in the Republican Party are pretty clear on this. And we saw this in reactions yesterday to the bill. You have conservatives who continue to be opposed to this. If you were opposed to this bill before, there's nothing in the CBO report that a conservative like Rand Paul of Kentucky or Ted Cruz of Texas is going to read and get them on board. If anything, you're going to solidify their opposition. And then you have moderates like Susan Collins of Maine, who put out a statement saying they were very skeptical of what they're trying to do to Medicaid and that every and the message coming from the Senate was, let's slow this whole thing down. It just doesn't

seem like they have the kind of unity they need at this stage to pass this bill. How do they sell it? And who are they selling it to? Because you have several people in the Senate, right, who are already coming out in big opposition to this. And this is where presidential leadership is everything. This is where President Trump needs to not only make the public case for why this is a better deal for the American people, but he has to convince his colleagues in the Republican Party that they should vote with him on this. And he has engaged. I don't think he's fully, fully throttled in on this argument yet. Next week, he's going to go to Kentucky and have a political rally there, which is an interesting choice because Rand Paul, the junior senator from

Kentucky there, is very opposed to this bill. It's hard to see him becoming a yes at the end of the day. And Kentucky is a state where the Affordable Care Act has actually worked out pretty well. But it's a state full of Trump voters. So here is this tricky and this tricky reality Republicans are facing is that, you know, a lot of voters say, oh, you got to get rid of this Obamacare. And then when they realize it's their health insurance, everybody says, oh, well, wait a minute. Maybe we got to slow this down. But then how do they explain, oh, well, I didn't vote to repeal Obamacare. I did. You know, I've been talking about this promise for seven years and now I'm not going to keep it. And this is precisely the speaker's argument. And they're not only policy wise, they believe

this is a better deal. But politically, they say that it is much riskier for Republicans to do nothing on something they've campaigned on for the better part of the last decade and do nothing when they hold all the levers of power than to pass something that maybe it's going to take a little bit longer to convince the public that it has some merit. Right. Except they're kind of caught between a rock and a hard place because, you know, next year, 2018, first of all, you're gonna have this big spike in uninsured people. Also a thing we haven't touched on yet. Premiums. Yeah. Further in the future, they'd go down. Next year, they would go way up. And also next year in November, something happens.

Midterms. Oh, yeah. People are running for election again. Right. And so then I honestly, I don't follow the politics of this quite as closely as you do, Sue. But I mean, that strikes me as being a really tough thing to run on, even if you are keeping the promise that you made. Though the promise also was your health insurance is going to get cheaper. Yeah. And I don't believe as as we're taping this, this may change, but I don't believe the president himself has weighed in on the CBO report.

And that was an open question, because one thing we know about Trump is he's a very good salesman. Right. But he gets that people like simple concepts that in order to sell something, it needs you need to be able to make it easily understood. And this is the kind of thing where, you know, when he was quoted, I believe it was last month or earlier this month saying this stuff's really complicated. Health care is really complicated. And it is. And I don't think if his people can't give him clear answers about how he can go sell this, he might have some problems with this legislation. There's one way that the president has been trying to sell this. Yesterday, he had this listening session with so-called victims of Obamacare. They were describing them as victims of Obamacare. And the thing that the president keeps saying is the Affordable Care Act, Obamacare is in a death spiral. It's imploding. And there's one line in this

Congressional Budget Office report that really stood out to me right away. And it says, in the CBO's assessment, the non-group market, so that's people buying individual market insurance, that's who's covered by this, would probably be stable in most areas under either current law or the legislation. Yeah, No death spiral. Now, CBO, they also have limits on what they can best guesstimate, right? And they use statistical modeling to make these guesses. So they can't preempt future events. And what Republicans are saying with death spiral is that if nothing is done, more people are going to opt out of this system. But that's their political guesswork. Right.

The statistical guesswork shows a different story. All right. What is next in this process? Next in this process this week, the House Budget Committee is going to finalize the legislation, the final, final bill. And according to the Speaker's office, the plan as of right now is to have a vote in the House next week on this. And of course, after that, the Senate still has to pass the bill, which according to the time frame that they have right now, they want to take place before the Easter recess. And this week, we are expecting potentially Tom Price, the Health and Human Services Secretary, to come out and say what sorts of administrative changes he would make if this bill gets passed. So there's this

is like a multi-phase thing, right, Danielle? Right. Yes. And this is what Republicans are stressing right now, that they also said, you know, the CBO is only scoring part one of our grand plan. Part two is going to be, you know, regulatory changes, which, by the way, the Trump administration can do without Congress. Then part three, there's another bill that will be passed. That would allow you to buy insurance across state lines or do tort reform or any number of other things that they've talked about before. But there's reason to be deeply skeptical about this strategy and that the bills that Republicans are talking about are all subject to a Democratic filibuster in the Senate. And, you know, we can't predict the future, but it's a pretty good bet

that Democrats aren't going to make it easy for Republicans to get their agenda through. And they would need Democrats. And they would need Democrats to do it. All right. Let's take a quick break. And when we come back, we'll answer a few of your questions from our listener mailbag. Support for this podcast and the following message come from 1-800-DENTIST. If you've had dental work done, you know it's important for your dentist to have the latest technology. Dentists with CEREC, that's C-E-R-E-C, can create high-quality crowns in just one appointment,

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you can write us with your questions and comments at nprpolitics at npr.org. You can also record and send us buzzed voice memos after your Tinder dates. Shout out to Lizzie from Philadelphia. We will not play that one on the podcast because it could encumber your future run for public office. But let's just say it was amazing. It's a shame we're not playing it. That was that made my week last week. All right. Let's move on to the first question. Our first question of the day is from Kristen in Boise, Idaho. She emails this week to ask, could you discuss whether women's health provisions are being repealed, particularly the requirement that insurance fully covers

contraceptives and breast pumps, and that employers are required to provide a space for new moms that isn't a bathroom stall for pumping? Thank you so much. Thanks, Kristen. Danielle. Yes. Okay. So I wrote about this last week. In short, Kristen, that stuff doesn't change. Because this was a reconciliation bill, it dealt in fiscal matters. So they didn't really get into the nitty gritty of exactly what is covered and what is not in your plans. So, for example, the no co-pay for contraception, the paying for breast pumps and all of that, that will stick around.

Now, the question is, what happens next, right? Right. Because as we just talked about, the Health and Human Services Secretary can do a lot of stuff administratively, and they intend to, and this likely would be part of that. Right. So it hasn't changed yet, probably will change in the months to come. At least that is what is pretty heavily expected now. A few other things that do change and that don't change under the bill as introduced right now. First of all, no gender rating. In the past, before Obamacare, health insurers could charge women a bunch more, and they did, because women tend to use more health care than men do. For example, because, you know, women tend to have babies and that sort of thing. So Obamacare got rid of that. And this does not appear at all likely to bring gender rating back.

This is one of the big selling points on the Republicans' website. We're going to keep coverage equal and payment equal for men and women. But one big thing that this does get rid of is funding for Planned Parenthood. This bill was written very specifically to make sure that federal funding does not go to Planned Parenthood in the form of Medicaid reimbursements. And the overwhelming majority of what Planned Parenthood provides is contraception and STD and STI testing, that sort of thing. So the CBO actually scored this out. And what they found is that 15 percent of people who currently rely on Planned Parenthood for that sort of thing in low health coverage areas, low income people, they're going to lose access. So that's another big thing. One other thing, by the way, of course, Medicaid. A lot of funding is going to be cut for Medicaid. So you have women

in general who are on Medicaid who will lose coverage as well. Fun fact about Medicaid that I learned in all of this. Half of all births in the United States are paid for by Medicaid. Right. Yes, that's true. Next up, here's a recorded message from Blake from Boston. Let's hear it. Hey there, NPR politics team. My question had to do with the congressional redistricting that is supposed to occur in 2020. My understanding is that this occurs as a result of the census, but I don't have a great sense for, you know, how these congressional districts get redone and how this could potentially affect future elections.

Could you guys comment on sort of when this process occurs and, you know, who decides how the districts get redrawn? Thanks so much for everything you guys do and really love the podcast. Thanks so much. Thanks, Blake. Sue? This question was made for me, Blake. Thank you. So every 10 years, the United States government conducts the census, and it accounts for every man, woman, and child in the country. And then they take this information and they do what is called reapportionment, which is when they redraw the congressional district lines in the entire country based on population shifts.

And every congressional district, and there's a static number, there's only ever 435 congressional districts, have to have roughly the same amount of people in them. Equal representation under the law is part of that. And so they take this data and they redesign the map. And so some states in this process lose a congressional district. Some states gain congressional districts. Over the course of the past, you know, 20 or 30 years, the population shifts in the country have sort of left New England and moved west. So we've seen things like New York, Pennsylvania, Ohio, they tend to lose population. And the Mountain West states like Colorado, Arizona, California is where people are moving. So it also kind of tells the story of American migration and power in Congress. You know, Texas is a lot more powerful today than it was 60 years ago because of those population shifts. So then once they decide how many districts they get, they turn the process over to the states and every state is allowed to decide how to draw its own lines. And every state does it totally differently. And many of these end up in court. Right. And are even currently at this very moment in court in some states. So some states do it by independent commission.

Some states do it by special commission. That's a little bit more politically appointed. Some states do it by their legislatures and approved by governors. And that's where partisan redistricting comes into play. And those more often tend to be the ones that are challenged in court. So, yes, the process only really is supposed to happen every 10 years. But we've seen districts redrawn within those time frames based on court challenges. OK, moving on. Here's a question from Brendan in Portland, Oregon. I have a question regarding Mr. Trump's allegation of wiretapping by the Obama administration. The denials of such wiretaps have focused on FISA warrants.

But if you had a FISA warrant to surveil the Russian ambassador and happened to pick up an incoming call from the Trump campaign, what kind of legal justification, if any, do you need? Thanks, Brendan. Well, you need very specific justification if you want to wiretap on an American. The only way that legally you can wiretap an American citizen is if you get a warrant based on probable cause that you would need to get approved by a judge or your American is picked up in a conversation by a foreign national that the government is surveilling for security purposes. And even then you're supposed to minimize. Yes. And we have never received any kind of public confirmation of how Michael Flynn's phone conversation was picked up. As the listener suggests, it has been widely assumed that the Russian ambassador phone lines

were tapped, as this is a pretty familiar part of spycraft, and that it was picked up in the phone. We know he had the phone conversation. It has become further clear that Michael Flynn was not the subject of the wiretap. So Reason would presume that this was picked up in a conversation with the Russian ambassador. Now, as you said, Tam, they're supposed to take steps when an American is picked up to minimize their identity, or if there is something in this call that raises a national security flag, needs to go up the food chain pretty fast. And if there's nothing in this that involves a national security question, they're supposed to dump the conversation. But the question that was raised by President Trump's tweets

is not about whether Michael Flynn was accidentally caught. It is about whether Barack Obama ordered a wiretap on candidate Trump. And he has still provided zero evidence of exactly why he seems to think that that happened. And there's been no backing up of Trump by anyone in the intelligence community or by congressional leaders, all who have said publicly that it either did not happen or there's no evidence to justify that it did. asked the Justice Department to provide any evidence that they had warrants or court orders related to the wiretapping of Trump. And thus far, they have not provided that. There was a deadline of last night and the Justice Department asked for an extension. Thank you, Brendan. On to our last question. It is from Laura. She writes, I've been keeping tabs on what Congress is up to via GovTrack.us, which lists all in order to continue aggressive growth in the nation's telecommunications and technology industries, the U.S. government should get out of the way and stay out of the way. That was a quote. Do bills like this serve any purpose or are's political favor, right? Right. But you have some more bills kind of that are in this vein that would actually do a bit more, but still not do exactly what they intend to. For example, there was recently a very short bill that came out that said, essentially, we're going to abolish the EPA.

We're getting rid of it. But my understanding is that in order to get rid of the EPA, you would need to do a lot more than pass a single bill that says one line, no more EPA. So that strikes me as a bit more in the stunt category. I guess, yes, there is absolutely an element of political stuntery. Is that a word? Did I just make up a word? I like it. Political stuntery to this. But I also think that these resolutions in some ways are maybe like the last remnant of all politics is local in that those kind of resolutions are more about policy. But I think what the listeners referring to a little bit is the like resolution that the New England Patriots are the greatest team on earth introduced by the home state senators or the home state congressman. A lot of times they recognize

their industries, their sports teams, their cities, their job markets. And so they're kind of feel good and they're easy votes. And it's something that people can do and go home and say, like, I passed a resolution in Congress that says Pittsburgh's a great city. These are bills. These are not laws. No, these are resolutions. Bills become law. Resolutions are just kind of I like the way that the listener put it. They're like feelings. It's how the Congress feels about things. And those are, I think, what we call simple resolutions. They're just kind of like a statement. There's other different kinds of resolutions that are more serious, more binding and have more legislative impact. But I think

what she's referring to, yeah, they do a lot of them. And more often in Congress than not, they pass more resolutions at the end of a Congress than they do bills. So they mean a lot to lawmakers, even if they do seem a little silly sometimes. TK Rez 72. You guys rock. And that's it for the mail today. The gentle lady votes aye. I abstain. Keep going.

All right. That's the mail for today. And as always, you can catch more of our political coverage at NPRPolitics.org and on the NPR One app. And do support the podcast by supporting your local public radio station. We'll be back in your feed with our regular weekly roundup on Thursday. I'm Tamara Keith. I cover the White House. I'm Danielle Kurtzleben, political reporter. I'm Susan Davis. I cover Congress. And thanks for listening to the NPR Politics Podcast. podcast.