STEVE INSKEEP, HOST:
Let's talk about President Trump and the health insurance repeal and plan for a placement with Hugh Hewitt, radio host and author. Among many other things, he was a questioner in a Republican presidential debate who famously asked then-candidate Donald Trump about the nuclear triad.
In an extended answer, Mr. Trump never showed that he knew the phrase nuclear triad means sea, air and land-based nuclear missiles. This is the end of the exchange.
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PRESIDENT DONALD TRUMP: In my opinion, that is the single biggest problem that our country faces.
HUGH HEWITT: Of the three legs of the triad, though, do you have a priority? - because I want to go to Senator Rubio after that and ask him.
TRUMP: I think - to me, nuclear is just - the power, the devastation is very important to me.
INSKEEP: One of the debates where Hugh Hewitt was asking questions. Despite his doubts, Mr. Hewitt finally said he voted for Trump. And he joins us now from Orange County, Calif.
Welcome to the program, sir.
HEWITT: Good morning, Steve. Good to be with you. I did indeed. I was a reluctant Trump voter, but I came around to that based primarily on defense and the Supreme Court. And he's done pretty well thus far on those.
INSKEEP: Do you think the president better knows what the nuclear triad is now?
HEWITT: Yes. In fact, the new budget calls for the Colombia-class to start rolling off in four years, which is good. That's the Ohio-class replacement submarine. So I think - as he promised me in a radio interview - not a debate - he would be smarter than the generals on Day 1. I'm not sure that he's there, but he's working on it.
INSKEEP: Now let's talk about the proposed replacement for Obamacare. What is making it so hard, do you think, for Republicans to agree on what that replacement should look like?
HEWITT: Some Republicans, primarily in the Freedom Caucus, wanted a straight repeal - just dump it and then repeal all 2,000 pages of it and then come back and work on a 60-vote replacement that would have had some additional ideal language in it.
But that was not considered politically viable following the receipt of a letter from four Republican senators saying we will not support a repeal of Medicaid expansion without some sort of transition. So the House is doing the art of the possible. And I am of the opinion that perfect must not be the enemy of the good.
INSKEEP: Art of the possible - you're reminding us when you say 60 votes, if you get Democratic cooperation, you might be able to get to 60 votes in the Senate. But if you're just doing it with Republicans, you're never going to do that. And not all Republicans are necessarily on board with Speaker Paul Ryan's plan.
HEWITT: That's correct. In fact, I think you can fairly count on Susan Collins and Rand Paul opposing the plan, so they can't lose anymore.
INSKEEP: And it could be that there will be a third that they could lose. It's not guaranteed to pass at all.
Now, I want to ask about the scale of this plan. Is there any doubt in your mind about the numerous studies that appear to have shown that if the Republican plan, as now drafted, becomes law, fewer people - millions of fewer people, perhaps - will be insured than have been insured under Obamacare.
HEWITT: No, I think it will be about 15 million. But the question is - what is that insurance worth? I have spent 18 years here in Orange County on a commission that makes sure that children are healthy and ready to learn by the age of 15, Rob Reiner's commission - by the age of 5 - Rob Reiner's Prop 10 commission.
And in fact, medical insurance for the poor is often the piece of paper that cannot be converted into actual care because Medicaid reimbursement, especially in California, is so low. Pediatric dentistry, for example, Steve, is almost unknown unless provided by a Medicaid provider that we set up in Orange County. So...
INSKEEP: You're reminding people that Medicaid doesn't - it sets the reimbursement rates. It's not very high. Doctors don't have to take Medicaid. And you're telling me a lot of people just don't.
HEWITT: They don't. And in Orange County, we had a crisis in pediatric dentistry, in pediatric care, neurology especially, especially with children on the spectrum. And we realized - I realized from that experience, repealing medical insurance does not often change the medical care envelope for a poor person at all. What does is the provision of services, often in the old public health model.
So I'm hoping Medicaid devolution, which is the centerpiece of this bill and I think the most important thing for conservatives to focus on, will increase the delivery of medical care to people at or below the poverty line.
INSKEEP: But help me out here - money is going to be taken out of Medicaid. In fact, the financial trouble of the program is going to get a little bit closer. How is it going to raise reimbursement for doctors so that more doctors are taking Medicaid?
HEWITT: I don't know that it will raise reimbursement. I think it will increase delivery of services. If money is block-granted to places like Orange County or California generally, they will go in a different direction, as we have in a program here called CalOptima, which focuses on the delivery of a larger reimbursement for more primary care and then on the the grace of the community for bigger services that, for example, Children's Hospital Orange County, have to deliver.
When you devolve, you allow the good elements in a community to band together to deliver actual health care as opposed to paper. I think Tom Price was right when he said - the secretary of HHS - yesterday, no one will be worse off from a medical care standpoint after this passes.
INSKEEP: Wait a minute. You acknowledged early in this interview that you would agree that perhaps as many as 15 million people are going to lose insurance if the House plan were to become law - compared to Obamacare, 15 million people. And I think you're telling me, essentially, you don't care - not that you don't care about the people but that you don't think it's going to matter very much (unintelligible).
HEWITT: That's essentially what I'm telling you - is that what those people will get up is a replacement at the state level, which will be different from the Medicaid they presently have, for example CalOptima in Orange County, that is funded with Medicaid dollars. But it will be a replacement of actual care as opposed to the piece of paper that they have received via expansion.
Some people will lose. There is no doubt about it. And those people who stand up at the public meetings with Republicans and complain that their lives were saved by Obamacare, they're not making up - those are not false stories. But net-net, more people will have better care at the end of the day. So the 15 million who go off will be replaced by 15 million - or more, I think significantly more - who have insurance that they can actually use in the public health system.
INSKEEP: If every single one of the 50 states does something better than the current Medicaid arrangement.
HEWITT: No, it just has to be net-net. I think if we look at the country at a whole, there will be some losers. There will be some states that do not transition well because state governments often fail. But there will be far more winners than losers, and the net-net effect for health care in America will be better and improving as opposed to bad and declining, where everyone will have paper coverage and no one will get care.
INSKEEP: Just got a few seconds left. But I want to ask about the Obamacare subsidies for people outside of Medicare. As you know, the current Obamacare subsidies are based on your income. The poorer you are, the more you might get. Now they're going to be based on age, which means you might be a little bit older and need some help - you're not going to get very much. You might be quite well off, and you nevertheless get a subsidy.
In a few seconds, why does that make sense?
HEWITT: The speaker explains that the tax credit elevation, the tax credit scaling-up goes with age because premiums increase with age. It makes sense in the details. It does not make sense in the quick response to it. But I had the speaker on last week on my radio show. It's been thought through to the very nth degree. Avik Roy and a few others disagree with it - may get tweaked in the Senate. But in fact, as you get older your health care gets more expensive.
INSKEEP: Well, we've invited the speaker to come back on the program here and talk about it. Hope we get a chance to do that. Hugh Hewitt, it's been a pleasure talking with you. Really appreciate it.
HEWITT: Thank you, Steve.
INSKEEP: Hugh Hewitt is author of "The Fourth Way: The Conservative Playbook For A Lasting GOP Majority."
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