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What You Should Know About The Senate Health Care Bill


Now for an update on the latest Republican effort to repeal and replace the Affordable Care Act. Earlier this week, Senate Majority Leader Mitch McConnell announced that the Senate would not be able to vote on a bill before the July Fourth recess, which means Republicans are still fighting for votes among their own members to pass it since Democrats have made clear that none of them will. On Friday, Republicans began talking about making some big changes.

We wanted to know what those could be, so we called Julie Rovner once again from Kaiser Health News to tell us what she knows. Julie, thanks so much for joining us once again.

JULIE ROVNER: Always a pleasure.

MARTIN: So if you could just set the table for us for people who may not have been following this, what were the objections of the holdouts, the senators who made it clear that they would not vote for the bill that the leadership put forward?

ROVNER: On Monday, the Congressional Budget Office came out with its estimate of the bill. And it found that it would leave 22 million more people without health insurance at the end of 10 years. And I think there were some moderates who were unhappy about some of the cuts in the bill, and that kind of sent them fleeing. At the same time, you have a lot of conservatives who didn't like the bill from the beginning. They think it didn't repeal enough of the Affordable Care Act.

So by the time Senator McConnell was thinking he might be able to go to the floor, he was at least nine votes short. So what he said was OK, let's sort of go back behind closed doors and see if we can work some of this out, get something to the Congressional Budget Office to re-score while everybody's home on break and vote when we come back. But they left Friday without any obvious progress.

MARTIN: Tell us a bit more, if you would, about the proposals that they seem to be considering.

ROVNER: One of the problems that the moderates were having is the cuts to the Medicaid program for people with low incomes. There are two kinds of cuts to Medicaid. They are a phase-out of the expansion that was in the Affordable Care Act for people who have slightly more money - they're still poor but slightly more money. Then there is a very deep cut to the base Medicaid program that serves 73 million people.

One of the specific things that the moderates were unhappy about is that about 30 percent of all opioid treatment goes through the Medicaid program. So they were worried that people would be cut off, couldn't be treated for their substance abuse problems. And so Senator McConnell was looking at putting some more money back for that, but even then, some of the moderates, particularly Shelley Moore Capito of West Virginia, said she still wasn't very happy.

MARTIN: One of the things you were telling us earlier is that this is a very difficult thing to thread the needle because all the things that bring the moderates on board are exactly the kinds of things that the conservatives don't want and vice versa. So is there any effort being made to bring more of the conservatives onboard?

ROVNER: What the conservatives really want is to repeal the insurance regulations part of the Affordable Care Act. Which the problem with that is that they're doing it through a special budget process that lets them pass a bill with only 50 votes, but you're not allowed to do things in that bill that aren't directly impacting the federal budget. And most people assume that those are things that you can't do in this kind of budget bill. So it's very difficult to give the conservatives what they want because otherwise if they did, they would need Democratic votes, which they're not going to get.

MARTIN: Well, you know, to that end, is there any indication that Republicans will try to reach out to get Democratic support? I mean, Democrats have been very vocal about the fact that they were kept out of the process. So is there any strategy that includes them?

ROVNER: Well, interestingly, we started to hear sort of Tuesday, Wednesday from Republicans who are actually using what I call the R word which is repair rather than repeal and replace. Those are things that the Democrats would be happy to participate in. And there was a lot of suggestions by a few Republicans that, you know, maybe we should sit down with some of the Democrats. We could find some things that we agree on.

What Democrats have said is that they're not going to sit down, though, until the Republicans take the repeal off the table and take the big Medicaid cuts off the table. Of course, it's those big Medicaid cuts that is keeping some of those conservatives on board, so it really is a very difficult needle for the Senate majority leader to thread.

MARTIN: That's Julie Rovner. She's the chief Washington correspondent for Kaiser Health News, has been covering health policy for quite some time. Julie Rovner, thank you so much for joining us.

ROVNER: Anytime. Transcript provided by NPR, Copyright NPR.

Michel Martin is the weekend host of All Things Considered, where she draws on her deep reporting and interviewing experience to dig in to the week's news. Outside the studio, she has also hosted "Michel Martin: Going There," an ambitious live event series in collaboration with Member Stations.