Play Live Radio
Next Up:
0:00 0:00
Available On Air Stations

Republican Plan To Replace The Affordable Care Act Sparks Debate


Republicans in Congress have introduced a bill to overhaul the Affordable Care Act, also known as Obamacare. In a moment, we'll hear from the head of Ohio's Hospital Association. He sees problems with the Affordable Care Act but says this proposal could be far worse.

First, NPR's health correspondent Alison Kodjak joins us with a closer look at what is in this proposal and how people in Washington are reacting to it. Hi, Alison.


SHAPIRO: So briefly give us a rundown of what's in the Republican proposal. Looks like it keeps some of the more popular aspects of Obamacare, like protecting people with pre-existing conditions. What does it change?

KODJAK: Well, so it's called the American Health Care Act - so change in the name. And the biggest change is there are no longer mandates for people to buy insurance. This bill instead tries to lure people into the insurance market using tax credit that people can get ahead of time in, you know, cash essentially and go and buy insurance on the private market. They have to use them to buy insurance. They can't buy other things.

And then the second part of that is if they keep their insurance forever, they don't lose it. And the premiums can't go out of whack. But if they let their insurance drop, then they have to pay a 30 percent penalty in order to get back into the insurance market. So it's a way to try to keep people in the plan.

SHAPIRO: So I've seen people joking today, do I use the tax credit to buy an iPhone or health insurance? You're saying you can't use the tax credit to buy an iPhone.

KODJAK: No, you can't use the tax credit to buy an iPhone. (Laughter).

SHAPIRO: OK. So the Trump administration weighed in, the secretary of Health and Human Services, Tom Price came to the White House briefing. What did they add to this?

KODJAK: Yeah, so Secretary Price made it clear that the House bill is not the end of the health care overhaul. Let's listen to what he said.


TOM PRICE: There are three phases of this plan. One is the bill that was introduced last evening in the House of Representatives, that's the start of all of this. Second are the all the regulatory modifications and changes that can be put into place. And then there's other legislation that will need to be addressed that can't be done through the reconciliation process.

KODJAK: Yeah, and so he's actually already proposed the beginnings of those regulatory changes. And then what he's saying is after they get this part of it done, they'll hope to make more changes that could potentially attract Democrats once this has already gotten into place. And when he was at the White House, there was one particularly interesting exchange when a reporter asked whether the bill would cost more than the Affordable Care Act and whether millions of people would lose their insurance. Here's what Price said in response.


PRICE: What I - what I can say is that the goal and the desire that I know of the individuals on the Hill is to make certain that this does not increase the cost to the federal government.

KODJAK: So he ignored the second part of the question. And that's notable because Republicans other than the president have been careful about not promising that as many people be covered under this plan as under the Affordable Care Act.

SHAPIRO: Although, notable exception - President Trump did say everyone will have insurance under this plan who wants it.

KODJAK: Yeah, he has said that. And there are several analyses that say that this plan will result in potentially millions of people losing their coverage.

SHAPIRO: So the bill came out yesterday evening and no surprise that Democrats objected to it. But it looks like there are also some Republican objections. What can you tell us about that?

KODJAK: Yeah. So in the House Representative, the conservative wing of the House, which is called the Freedom Caucus, has come out against it because they're not happy with this refundable tax credit that they think of as potentially another entitlement. But in addition, a lot of conservative groups, outside groups, including the Cato Institute, the Heritage Foundation, the Club for Growth - these are all Republican stalwarts - they've all publicly said they oppose this plan as it is right now.

SHAPIRO: And what does that mean for the plan's progress through Congress, then?

KODJAK: Well, it's going to be tough. Tomorrow, two House committees are going to vote on it. They're going to, you know, look at changes and vote on it. And then it's going to go to the House floor. And if they don't have all the members of the Freedom Caucus, then they could not even pass the floor...

SHAPIRO: The Freedom Caucus is a more conservative wing of the House.

KODJAK: Exactly. And then it goes to the Senate, and they can only afford to lose two Republican Senate votes because there's a slim majority for Republicans in the Senate. And so it's got a tough road to pass, and there are going to be changes between now and then.

SHAPIRO: NPR's Alison Kodjak, thanks.

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

Alison Fitzgerald Kodjak is a health policy correspondent on NPR's Science Desk.