The NPR Politics Podcast - The GOP and Health Care: What's Next?

Episode Date: July 18, 2017

The Senate Republican bill to repeal and replace key elements of the Affordable Care Act — in its current form — is dead. This episode: host/congressional reporter Scott Detrow, political reporter Danielle Kurtzleben, and political editor Domenico Montanaro. 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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All right, here's the show. It's the NPR Politics Podcast, here to talk about the death of a Republican bill repealing and replacing key parts of the Affordable Care Act, at least the death of the bill in its current form. I'm Scott Detrow. I cover Congress for NPR. I'm Danielle Kurtzleben, political reporter. And I'm Domenico Montanaro, political editor.

All right, and we're here again. How many times have we done the death of health care, the resurrection of health care, the death of health care? The zombie health care bill. Yeah, but here we are. This was a big moment. It's like we were talking about By Our Desks today. I kept thinking of that scene at the end of one of the Austin Powers movies

where Mike Myers yells at one of the villains, why won't you die? Like, which is not how I feel about the health care bill. But I but really, it's more about how like this thing, it just keeps coming back. But this is the second draft of the Republican Senate bill, the Republican House bill on their second try. They got it through this try. They did not. This is a major blow to all did not. This is a major blow to all Republicans involved. It's a major blow to President Trump. His approval rating is lower than any recent president in this same time period. And this makes it a very difficult thing for his agenda going forward. Mitch McConnell, for all of the stuff that he's supposed to be

so great at, all of his machinations and maneuverings, it doesn't look like conservatives are scared of him or President Trump. And you talk about his approval rating being pretty low. I mean, one thing you do have to wonder is, you know, President And if your party has been promising to for the better part of a decade, could this be a thing that at some point pulls President Trump's approval rating down even further? All right. Why don't we pause for a second and walk through what exactly happened over the last day or so? The first half of the podcast, we'll talk about what just happened. And the second half, we'll talk about what comes next. A couple of different choices Republicans have to make. So just to recap, last night, just before 9 o'clock, you have Republicans Mike Lee of Utah, Jerry Moran of Kansas, putting out statements at the exact same time saying, nope, they could not vote for the current Republican bill.

Collusion? I mean, it's interesting they did it at the exact same time. I can't get in their heads, but you got to assume no one wanted to be the one person that tanked this bill. So can you recap what the reasons they said was for not voting for this? Yeah. So, I mean, they both listed a few reasons, but you saw some congruities in between the two of their statements. Mike Lee, for example, said, you know, it doesn't repeal all of the Obamacare taxes. He said this in a statement. It doesn't lower premiums enough. It doesn't create enough free space from Obamacare taxes. He said this in a statement. It doesn't lower premiums enough.

It doesn't create enough free space from Obamacare regulations. Likewise, Moran, he first of all criticized the closed door process, as he called it. But he also said, you know, it fails to repeal the Affordable Care Act. Both of them had this similarity in that they said, you know, this just didn't go far enough. Yeah. And these two defections were really important because Republicans have 52 votes in the Senate, which makes it really tough and a very narrow window when you have people like Susan Collins, the moderate Republican from Maine, who said she was not on board with it. And Rand Paul, the ideological libertarian from Kentucky, who said that they would not vote in favor of

this bill. So everyone was waiting to see who that next person would be, if there would be a next person, because they could pass it at 50-50 with Mike Pence, the vice president, coming in to break that tie. But with John McCain out, the senator from Arizona, after having a pretty serious surgery to remove a blood clot in his head, this bill had already been delayed, and it looked like Moran and Lee got together to

say, you know what, let's just kill this once and for all right here. So they made those statements last night right after a dinner had broken up at the White House. President Trump had had a lot of Senate Republicans, clearly not those two, over for dinner. They were all yes votes. Yeah. Okay. This was not like a dinner to sway people. These were all yes votes. Yeah. OK. This was not like a dinner to sway people. These were all yes votes. Can we just reflect on the kind of whiplash that we have here on health care? I certainly do. I mean, as of yesterday, like you said, Domenico, we were thinking, you know, Senator McCain, he's going to have the surgery. We're going to have to wait to figure out what happens. The very fact that we just keep kind of being slingshotted back and forth on this bill. I mean, you can be sitting at home at 10 p.m. in your pajamas and something new happens.

Let's take a listen to what Trump had to say today about this. Seven years I've been hearing repeal and replace from Congress, and I've been hearing it loud and strong. And then when we finally get a chance to repeal and replace, they don't take advantage of it. So that's disappointing. I've been saying that, Mike. I think you'll agree for a long time, let Obamacare fail, it'll be a lot easier. And I think we're probably in that position where we'll just let Obamacare fail. We're not going to own it. I'm not going to own it. I can tell you the Republicans are not going to own it. First of all, I mean, that's not really up to him, right? You can't just decide,

I'm not going to own this. Well, you know, and it was really up to him, right? You can't just decide, I'm not going to own this. Well, you know, and it was really interesting. He cast a real wide net of blame without taking any responsibility himself. Oh, yeah. Being the leader of the party. And he said, for seven years, I've been hearing repeal and replace from Congress. And we finally get a chance. Now, listen to this change of pronoun here. When we finally get a chance, they don't do it.

They. They, as in his own party? As in congressional Republicans. Right. Well, and likewise, this morning, he kind of wagged his fingers at a few of those Republicans in a tweet. He said, we were let down by all of the Democrats and a few Republicans. Most Republicans were loyal, terrific, and worked really hard. We will return. So like as hands off as Trump was when this went through the House, in the end, he did get involved meeting with different groups of

House Republicans. He seemed completely, yeah, you know, took them. He seemed completely hands off with the Senate. He had senators over a couple times. But in terms of what exactly he wanted in the bill, he didn't really seem to care at all other than just having a piece of paper to sign at the end. I mean, is this kind of a, this is what happens when the White House doesn't engage at all? Well, maybe. But the thing is, he outsourced a lot of the responsibility to Mitch McConnell. McConnell is supposed to be this, you know, great leader who could shepherd all of these folks together. But really, you know, I think there are some questions that have to be asked of Mitch McConnell and his leadership abilities and the status that he has as this, you know, knower of the rules who can really get so many things done, because he wasn't able to

marshal this together. And he's frankly never had to do the job to govern as a majority leader. He has made his reputation as somebody who could stop an agenda when it came to Barack Obama and the Democrats. But this transition away from Republicans to be the image of the party of no, they're having a lot of difficulty with doing post-Obama. Now, President Trump certainly didn't look like he put a whole lot of skin in the game, which I guess gives him some plausible deniability for responsibility. But that is not much in leadership, something that President Trump, when he was Donald Trump in 2013, had tweeted about leadership saying that, you know, if something doesn't get done, it's also your responsibility.

Right. Well, I mean, I would also add, by the way, that in terms of Donald Trump having a hand or not in policies, I mean, so what has he been doing amid all of this? Well, he's been having these kind of theme weeks at the White House. There was infrastructure week, not terribly long ago. This week was made in America week. But also there is a certain kind of consistency here, I would say, much in the same way that Donald Trump didn't seem to give Senate Republicans, you know, any super specific, hey, do this, this and this in your bill instructions. Likewise, a lot of these weeks that he has, a lot of these things where he's like, here is my policy du jour. He does not get specific. This is just one of his things is broad strokes, not real policies. You'll remember his tax reform policy that he came out with was bullet points on a sheet of paper. I mean, this is just kind of how he does.

Well, maybe, but President Trump wanted a political win. He wants political wins rather than diving deeply into the policy. And one of the problems with that kind of approach as a president is that it makes it very difficult for you, the number one salesman of your own agenda, to go out there and actually make the sale. Rather than saying, oh, Democrats are obstructionists, he wasn't able to go out and sell each of the pieces that Americans found to be odious. Barack Obama, for all of the problems that the health care bill wound up having and the stops and starts. He was the best spokesman for that policy. And he actually went out and campaigned for it. Went out and campaigned for it, knew the details, went into the depths. Frankly, there's a lot that this

Republican Congress and this Trump White House could learn from the way that the Obamacare sale went. It didn't go perfectly, but there are a lot of things they could have looked at and improved on instead of just thinking, that's how Obama did it. It must be wrong. Speaking of the salesmanship, and I guess we'll talk about this more when we're looking forward, but for all of that salesmanship that Obama did, and it was enough to get the bill passed, which as we know, who knew it was so hard? It's hard. When all that salesmanship was actively happening, the policy, the bill, the law was not that popular. And then Obama goes away and it's suddenly very popular. And I've reported on this. There's a thing called relative deprivation, which is a fancy way of saying, like, you know, give me something and then try to take it away. And, you know, I now have ownership of it. You know, I'm going to be more upset once you take it away than beforehand when I didn't have it to begin with. Even if you didn't seem to want it? Right. Yeah. And, you know, like we've seen,

public opinion has bounced in a pretty significant way for Obamacare. Now a modest majority, but a majority of Americans now approve of Obamacare, which was not the case while President Obama was in office. But, you know, if you poll people on the individual things that are in Obamacare, a lot of them, people really like them. People like coverage of pre-existing conditions. People like having their 26-year-old or their up to 26-year-old being able to stay on their insurance. They don't love the individual mandate, but the rest of it they do seem to like. You know, there's a political cliche for this also. The enemy of my enemy is my friend.

Sure. Right. And a big piece of where Obamacare was down in public opinion was among liberals who thought that the law should have done more. As soon as Donald Trump got into office, all of them got on board with the Affordable Care Act because, hey, at least that was more progressive and better in their view than whatever could come from a Republican Congress. And the exact opposite with Republicans. Absolutely. Right. And the problem that Republicans seem to have run into here is that

I don't like Obamacare is not an organizing principle, is not an organizing theory that drives a coherent health care policy. Health care, as you may have heard, is really complicated. And just saying, not Obamacare, let's do some other stuff that doesn't even fully repeal Obamacare, but call it a repeal and then say it's a repeal and replace. That clearly was not enough to drive this policy. And like Domenico was saying, it wasn't enough to sell it because how do you sell that in a positive manner? They mainly sold it in a negative manner. It's not Obamacare. Yeah. And the other policy problem that Republicans have, frankly, is there's really only two big ways to overhaul health care. There's one, you either have this big government funded single

payer system, which a lot of liberals and progressive want something akin to what's done in Canada or the United Kingdom, or a hybrid market based system, which is what the Affordable Care Act is, and which was designed originally by conservatives at the Heritage Foundation as an alternative to HillaryCare. So if you're Republicans and you're trying to get rid of this thing you don't like in Obamacare and try to craft an alternative to it that's built around market-based principles, how do you change it all that much than what's already out there? All right. Well, Danielle, you said before that not Obamacare is not an organizing principle.

That being said, it seems like they're going to give that a try again now. We're going to take a quick break and come back and talk about repealing it without replacing it, which seems to be the new plan, or maybe not. All right, we're back. The question is, what happens next? In the wake of the surprise announcement from Lee and Moran, Republican leaders were quick to move forward. Here's Mitch McConnell on the Senate floor this morning. In the coming days, the Senate will take up and vote on a repeal of Obamacare combined with a stable two-year transition period as we

work toward patient-centered health care. A majority of the Senate voted to pass the same repeal legislation back in 2015. President Obama vetoed it then. President Trump will sign it now. And President Trump was tweeting the exact same thing. Let's just repeal it. There's a couple problems with that. First of all, the fact that McConnell and Trump and many other Republicans, when this was initially thought about back in January, decided, no, that would be a pretty strategically bad idea. Here's what's really a problem for Republicans.

25% of Americans said that they were in favor of repeal only in our NPR PBS NewsHour Marist poll. That's what President Trump and Mitch McConnell are talking about now. That may not sound like a lot, but only 7%, 7% wanted to have the Affordable Care Act stay in place but do less, which is what the Republican Party was trying to do. The plurality in our poll, 46% said that they wanted the Affordable Care Act to stay in place with some fixes. Right. And I mean, you know, here's another big problem. The CBO back in January did an analysis of a repeal plan, and it said that it would leave 32 million more people uninsured in a decade from now than there would be otherwise. Now, compare that to

these bills. The House bill, the AHCA initially was what, 23 million. The Senate bill was initially 22 million. I mean, so 32 million is even bigger than those already big numbers. That is a problem. And the other thing that I keep thinking about here, by the way, is the last time that Congress passed something and then said, you know, we'll do more later. We can fix it later, was sequestration. And sequestration happened. And later still hasn't come. People thought it wouldn't happen. People thought, you know, this whole scheme of all of these spending cuts that we're going to put into place, like they're just too crazy for us to actually do. And then it happened.

So, I mean, I don't know if you say, you know, repeal now or place later. I don't know if Congress members can hold themselves to that. So back to this bill, you flag some kind of policy and strategic problems. The more short-term problem is political, and that's the fact that this plan already doesn't have enough votes to pass. Several Republican senators were quick to come out and say, yeah, I'm not a vote for only repealing and doing nothing. Shelley Moore Capito put out a statement. Susan Collins said this to reporters in the hallway. I do not think that it is going to be constructive to repeal a law that at this point is so interwoven within our health care system and then hope that over the next two years we will come up with some kind of replacement. I think that would create...

So this plan, which is like Plan C, Plan D, Plan E, I don't know, it already, it's been around for like half a day and already does not have enough votes to go forward. So what do they do? Well, McConnell's argument for why to do this was because in 2015, they voted on something similar, and it got a majority support from Republicans and eventually vetoed by President Obama. Real easy to do when there are no real consequences, and you know that it's going to be vetoed by the president. Far different when you are tasked with governing and still saying no.

So here's something McConnell said this afternoon when asked about what the timeline is going forward, and it sounds like he doesn't really have an answer for it. Well, I think we'll have to see what happens. We will have demonstrated that Republicans by themselves are not prepared at this particular point to do a replacement. And that doesn't mean that problems all go away. And you'll have to look at our committee chairman and their ranking members. My suspicion is there'll be hearings about the crisis that we have, and we'll have to see what the way forward is. Committees, hearings, this idea of we're doing this before the end of summer seems to be long gone at this point. And crisis, don't forget the crisis we're doing this before the end of summer seems to be long gone at this point. And crisis. Don't forget the crisis we're in.

You know, it's funny. The Congressional Budget Office, the Kaiser Family Foundation have both said that Obamacare is not in a death spiral, that there are pockets of problems. But that, you know, the crisis that Mitch McConnell is trying to show and President Trump is trying to say it's dead, it's gone. Those aren't exactly accurate. Right. Yeah. So the Kaiser Family Foundation just last week said, you know, look, the individual market is stabilizing, as they put it. They said that insurers are regaining profitability. Now, insurers have been pulling out saying, you know, we just this is a money loser for us. Why should we do this? Well, it appears that that is turning around in many places, not all places. It is

totally true that the markets are fragile, I believe is the is turning around in many places, not all places. It is totally true that the markets are fragile, I believe is the word Kaiser used in some places. And the other thing is this. Kaiser does point out, you know, look, premiums are going up. Things are not perfect in Obamacare, but things are improving in pretty substantial ways when it comes to the outlook for insurers in these markets overall. So it really does not seem true given this data. And given recent data from the Center for Medicaid and Medicare Services, likewise, it doesn't seem at all true to say that Obamacare isn't a death spiral. So here we are, mid-July. Seems like this is going back to the drawing board.

Did the Republican Party just waste more than half a year on a totally failed effort? Well, look, Republicans had to try to do this. I mean, they are they've been promising for seven years, as Donald Trump said, to repeal. And then they said to replace Obamacare. They took some 60 votes dealing with repealing parts of or Obamacare entirely. So they had to do something. But it's amazing still that they did not come up with something, have something ready to go within that seven years time. They had plenty of people in the minority and in the majority in the House to be able to

try and come up with something. I think Republicans, frankly, are in a brand crisis. They have a Republican in the White House as president who does not agree with Republicans, establishment Republicans as a whole. And establishment Republicans are the ones who are running things in Washington. And I think Donald Trump was willing to take that so long as there was a win. He was willing to defer to Mitch McConnell as long as he felt like he was getting something out of it. Now, it's going to be really interesting to see what Trump's approach becomes. Originally, Trump had started talking about wanting to work with Democrats and Chuck Schumer. Recently, he's decided he's not doing that. But as we know, Trump can change like the wind.

And where does he decide to go? What does he decide to do? How does he decide that his base is rallying around him or not? And what do they want? There's a lot to be written still on this. All right. So last question on this. The response you've seen from Democratic senators, liberal activist groups the last few times ever since the House bill first seemed to be dead, then came back and passed was this isn't dead yet. This could still happen. We need to keep making calls. We need to keep being active on this. So when will we know that this is like really dead, dead, dead, not coming back? This is the end of it. We are not going to take up health care bills again. Dead. I have an annoying answer to this, which is the question is what the this refers to here when you say is this dead? I mean, if you're talking about the desire to repeal

Obamacare, you know, I was thinking about this earlier. One could argue that the ability to repeal Obamacare was dead a long time ago. I mean, like I was saying earlier. Like Bruce Willis? Huh? Is this Sixth Sense? Yes. Oh, gosh. Been dead the whole time. Who's Haley Joel Osment in this analogy? Okay, no, but I mean like... I guess you if you're... Yeah, so I see dead policies. All right, no, so it's that Obamacare has become intertwined in people's lives. I mean, this bill, as various conservative lawmakers pointed out, and it's true, this bill was not a full repeal of Obamacare by any means, nor was the House version. You kept the basic infrastructure of Obamacare in place,

a.k.a. the markets. That was basically Rand Paul's argument. Yeah. I mean, you know, you can get rid of the mandates and those were, you know, big parts, too. But my point is that Americans now like a lot of Obamacare. It's a part of their lives. Getting rid of Obamacare at this point, that is entirely dead. Now, whether you say we're going to fiddle with the health care system and call it an Obamacare repeal, honestly, I don't know. But at a certain point, I wonder if, you know, Obamacare stops being the boogeyman that it is right now. I mean, or even attaching President Obama's name to something, because of course, he's not president anymore.

Dominico, any thoughts on that? On whether the bill's dead? I have other thoughts. All right. What are your other thoughts? Grab bag. Let's hear it. My grab bag of thoughts. What I'm fascinated by in this entire process is just sort of the arc of where we've come from with the Republican Party. You know, in the 1950s, they had controlled Congress briefly, and they were out of power in the House for 40 years until

the 1994 Republican Revolution with Gingrich's contract with America. And there was something that Republicans had tried to brand themselves as, the party of management, that Democrats were really the party of bloated government. Now Republicans are back in control, but they took control led by an ideological faction of the Tea Party. They made this bargain with the Tea Party and they're no longer the party that they were a decade ago. This is not the party that's looking to manage government and do government better. This is not the party that's trying to come up with a contract with America to say, here's what we believe and how we're going to actually implement a vision.

This is a party that's flexed its muscles on saying no and having a very difficult time overcoming that. And when you're defining characteristic is being against government, it's clearly hard to set big government policies. Correct. Just to add on to that, though, like, yeah, it's hard to get big things done in terms of government policies. But I mean, what they would want to do is get big things done in terms of getting rid of government policies. I mean, you would think that that is a thing that they could do. The problem is they're just too divided.

Well, so but that's an issue, right? I think that there's that faction of Republicans, the Tea Party Republicans who would want to undo a lot of the big things. But they can't agree with the majority or not even the majority. They certainly have a majority, but they can't all agree together to get enough over the finish line without Democrats to help out. And you're certainly not going to get a whole lot of Democrats who are going to say, hey, repeal this big thing that we worked on that we think helps a lot of people. All right. So the fallout from this is going to keep continuing over the next couple of days. A lot of different reaction from different Republicans on what exactly to do

next. We'll follow up on that, I'm sure, in our weekly roundup on Thursday, as well as the rest of the week's political news. I'm Scott Detrow. I cover Congress. I'm Danielle Kurtzleben, political reporter. And I'm Domenico Montanaro, political editor. Thank you for listening to the NPR Politics Podcast.