Senate Republicans Up Against Sept. 30 Deadline For Last Effort To Replace Obamacare

Sep 20, 2017
Copyright 2017 NPR. To see more, visit http://www.npr.org/.

ARI SHAPIRO, HOST:

Senate Republicans may vote next week again on repealing the Affordable Care Act, or Obamacare. This latest bill is sponsored by senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. Republicans are up against a deadline of September 30. The rules say any bill that comes after that will need the support of more than 51 senators, which would mean Democratic support.

Joining us now to talk about what this latest Republican health care bill would do is NPR health policy correspondent Alison Kodjak. Hi, Alison.

ALISON KODJAK, BYLINE: Hi, Ari.

SHAPIRO: How does this bill compare to the other three that we've seen this year from Republicans?

KODJAK: Well, this one most people will say is the most radical bill in that it makes the most drastic changes. It dismantles the major parts of the Affordable Care Act, including the subsidies that help people buy insurance, the expansion of Medicaid, the individual mandate that requires people to buy insurance and even gets rid of the health care exchange. And then it takes all the money from those programs and rolls it all up and turns it over to the states so that they can set up their own health care programs.

And then the states can use the money for any number of things. They can help people buy insurance. They could set up what's called a high-risk pool to cover the people who are the sickest and most expensive. Or they could just expand access to Medicaid. But it doesn't really require them to do anything specific.

SHAPIRO: Now, one big question is, would more or fewer people be covered under this plan? This was the bill's sponsor, Senator Cassidy, on CNN this morning.

(SOUNDBITE OF ARCHIVED RECORDING)

BILL CASSIDY: There are more people who will be covered through this bill than under the status quo.

SHAPIRO: More people - is he right?

KODJAK: It's really unclear. Right now most private experts say that fewer people would end up covered under this. But we don't have an official analysis from the Congressional Budget Office, and we won't before they vote on this bill if they do so next week.

SHAPIRO: There were two big things that worried people in the last vote. One was people with Medicaid - what would happen to them? And the other was people with pre-existing conditions. Let's take Medicaid first. What would this bill do for people who get coverage under Medicaid?

KODJAK: Yeah, and that's a big deal because Medicaid covers about 70 million people. Under the expansion, about 10 million people got insurance, and that's going to be rolled back. But the basic Medicaid program will change as well.

It's similar to earlier versions where right now Medicaid pays for whatever health care that people in the program need. There's no limit. And Republicans see that as a huge problem because it's a growing part of the federal budget. But this bill caps Medicaid spending a specific amount per person in the program and then it grows it more slowly. Most people say that over time, the program's going to shrink by about 25 percent.

SHAPIRO: And as to pre-existing conditions, let's listen to what Senator Cassidy said on CNN about coverage for people with ongoing health problems.

(SOUNDBITE OF ARCHIVED RECORDING)

CASSIDY: The protection is absolutely the same. There's a specific provision that says that if a state applies for a waiver, it must ensure that those with pre-existing conditions have affordable and adequate coverage.

SHAPIRO: Affordable and adequate seem like important words there. Is this a guarantee for people with pre-existing conditions?

KODJAK: It's not exactly a guarantee. And the issue is that this bill allows states to get those waivers. And that would get them out of the rules imposed by Obamacare. Those rules define what has to be included in a health insurance policy, things like mental health care, prescription drug coverage, hospitalization coverage.

Under this bill, states can get out of those requirements. So an insurance policy in a certain state doesn't have to necessarily have, say, prescription drug coverage. So if you're a person with diabetes or arthritis and you buy insurance in that state, you might be able to get coverage, but it won't necessarily pay for all the care you need.

SHAPIRO: NPR's Alison Kodjak. Thanks a lot.

KODJAK: Thanks, Ari. Transcript provided by NPR, Copyright NPR.