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The Possibilities For Compromise On The Republican Health Care Plan


Republican leaders in Congress say they are determined to pass their proposed replacement for Obamacare. They say they remain determined despite intense criticism from the left and right since their bill was introduced. But that does not mean the bill is in its final form. President Trump has invited negotiation, as did his top health official, Tom Price.


TOM PRICE: This is a work in progress. And we'll work with the House and the Senate in this process. As you know, it's a legislative process that occurs.

INSKEEP: A process that Zeke Emanuel knows well. He was deeply involved in crafting Obamacare years ago for President Obama. Now he's been consulted by both the new White House and people in Congress as they consider how to change the law. He's not a fan of the legislation as it stands.

ZEKE EMANUEL: The Democrat subsidies vary by state depending upon how expensive insurance is in a state. The Republicans' don't. So for example, very high-cost states like North Carolina or West Virginia or Alaska - you know, the difference in premium between Alaska and Hawaii is threefold. And that's not reflected in the Republican proposal. That's the same tax credit across the country.

You have to take account of things people don't control like, what are the expenses in their local health care marketplace? The Democrats did that in the Affordable Care Act. The Republicans somehow are choosing to ignore it. And ironically, it's going to hurt their very base - people in West Virginia, North Carolina, Alaska. That just seems like bad policy and bad politics.

INSKEEP: Is this something that is negotiable? You go in, you talk this through and you end up raising the subsidy. It goes to something higher, something closer to what it was under the Affordable Care Act.

EMANUEL: Well, I think Secretary Price seemed to say it is negotiable. We haven't had a lot of negotiation in the - during the Obama administration. I would hope that we can actually come to a better place. I am one of these people who really desperately hopes that, you know, we put the country above partisan politics. But the Republicans are going to have to recognize, I think, here that the responsibility is on them.

INSKEEP: What do you mean by the responsibility is on the Republicans - they need to reach out first?

EMANUEL: Yes, I think - I think they do need to reach out first. I think we have legislation that is going pretty well - 22 million people covered, health costs moderated over time, quality improving. The idea that it's falling apart - the Affordable Care Act is falling apart is a misnomer.

INSKEEP: You do have insurance companies pulling out of some marketplaces and fewer and fewer choices in many places. That's true, isn't it?

EMANUEL: That's absolutely true. And the reason you have that - let's be very clear - the reason you have that is that the Republicans changed the rules halfway through the game. They took away the reinsurance money. They took away the risk corridors. And that was part of the game that allowed insurance companies to come in.

INSKEEP: So when you met with President Trump about this, what was the conversation like, to the extent you're comfortable sharing?

EMANUEL: Well, that's for the president to talk about it. I'll say one thing that I think, you know, drug prices is something where I think there's bipartisan agreement. And I think the president has said very clearly he thinks drug prices are too high. And I think that's a nidus, a bipartisan agreement we could all move forward on. That's just one example.

INSKEEP: In an earlier interview on this program, you indicated that there ought to be grounds for compromise simply because Republicans hated it that one party passed the last big health reform and that it ought to be both parties. Do you sense that both parties still agree that it ought to be bipartisan?

EMANUEL: Well, (laughter) I think - what I am afraid of is that each side could dig in their heels. I think, you know, the Republicans may have a situation where if it's not our proposal, if it's not our reforms on these things, we're not going to compromise. That is a very bad place to be.

And I think, you know, there is a faction of the Republican party, the Freedom Caucus, which doesn't really want any replacement. But once you move off that group, there are many Republicans who recognize Medicaid expansion has been good for their states. They do want to get an exchange for individuals, especially older individuals who have been left out or might have pre-existing conditions. And the exchanges can work. And I think the Democrats want to see - you know, look, we still have 10 percent of people uninsured in this country. Democrats would like to solve that problem. And I think everyone wants to solve the affordability problem.

INSKEEP: Zeke Emanuel, thanks very much.

EMANUEL: Thank you.

INSKEEP: He's chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania and one of the architects of Obamacare. Transcript provided by NPR, Copyright NPR.