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Words You'll Hear: The Better Care Reconciliation Act


With Congress back in Washington this week, we wanted to take a look at a Word You'll Hear. And in this case, the word is actually letters - BCRA. That's the acronym for the Better Care Reconciliation Act. It's the proposed Senate bill to repeal and replace the Affordable Care Act. So far, this GOP draft is very unpopular, with just 17 percent of Americans supporting it according to an NPR "PBS NewsHour" Marist Poll. With so many people unhappy with this proposal, we were curious what they do want to change about the Affordable Care Act. NPR political reporter Danielle Kurtzleben has been looking into that. Hi, Danielle.


SINGH: So we know Republicans are working on different options for how to approach their repeal and replacement of the Affordable Care Act. What are some of the ways the system could change?

KURTZLEBEN: So Obamacare, of course, expanded Medicaid. What the Senate bill would do would be to rollback that Medicaid expansion. Plus, it would cap Medicaid spending further. Aside from that, it would provide less generous subsidies for people to buy insurance on those individual markets. And it would get rid of a lot of the taxes that Obamacare imposed to help pay for itself.

SINGH: What did you see when you looked more closely into what people might actually want to see in health care reform?

KURTZLEBEN: You know, it's hard to say. For example, right now, a majority of Americans - about 60 percent according to the Pew Research Center - say it's the government's responsibility to make sure people have health care. OK, so that's cut and dried, 60 percent. And that was true before Obama took office, as well. But while Obama was in office, there was no clear majority on either side of that. So clearly people's opinions on this can vacillate one way or the other pretty quickly depending on what's going on.

Likewise, a growing share of Americans - right now it's 53 percent - they say that they want single-payer health care. Once again, that sounds cut and dried. But what the Kaiser Family Foundation found out is if you present people with an argument for or an argument against, you can swing public opinion in a massive way on single-payer. So it's not really clear how much people do like that idea.

SINGH: So it can depend a lot on how this is actually framed.

KURTZLEBEN: Right. Absolutely. And one way to think of this is, you know, you can say, yeah, Americans are just squishy on this, but if you really think about it, health care is just a very personal, really kind of scary issue for people. It could be a life-or-death issue for many of us at some point. So the idea of massively overhauling, it you can understand how that would make people feel in conflicting ways about it.

SINGH: What about this current system? We've seen figures that indicate Obamacare is getting consistently more popular, right? So what does this mean? Are people generally satisfied to keep things the way they are?

KURTZLEBEN: Sort of. I mean, Gallup did find in late 2016 - I mean, even before the election - that around two-thirds of Americans say they're satisfied with the health care system. And Gallup also found that right now, for the first time this year, Obamacare had majority approval. But certain parts of Obamacare are very popular in certain parts, namely the individual mandates are not popular at all.

The individual mandates, that provision that says you have to have insurance or pay a penalty, that's the only one that a majority of Americans didn't approve of. Only 30 percent of people like that. The irony, of course, is that you need the individual mandate to make the rest of Obamacare work.

SINGH: What might congressional leaders keep in mind then if they're looking to please as many Americans as possible, if not all Americans?

KURTZLEBEN: Right. Well, I mean, of course, you can't please all Americans. You know what? You might not even be able to please everyone in your own party fully. It's a very unforgiving topic to try to create legislation on just because it is such a complicated topic. This is not repealing or imposing a tax. This is making a whole massive system for a whole bunch of Americans work correctly.

SINGH: That's NPR's Danielle Kurtzleben. Thanks, Danielle.

KURTZLEBEN: Thank you. Transcript provided by NPR, Copyright NPR.

Danielle Kurtzleben is a political correspondent assigned to NPR's Washington Desk. She appears on NPR shows, writes for the web, and is a regular on The NPR Politics Podcast. She is covering the 2020 presidential election, with particular focuses on on economic policy and gender politics.