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House Set To Vote On Republican Health Care Bill


What a day to be in Washington, a good morning to recall a story about former House Speaker John Boehner. He said recently that when Republicans vowed to move quickly on replacing the Affordable Care Act, he started laughing. Republicans, he said, had never ever one time agreed on what a health care proposal should look like.

Today, we find out who gets the last laugh because despite Republican opposition, House leaders plan to hold a vote on a replacement plan. Ohio's Jim Jordan is among the Republicans who've been leaning against it.


JIM JORDAN: We actually think this is the wrong piece of legislation. Ask yourself a couple fundamental questions. Does it repeal Obamacare? No, it doesn't. Does it unite Republicans? No, it doesn't. Every major conservative group's against it. You've got senators opposed to it, House members opposed to it. It doesn't unite Republicans and doesn't, most importantly, lower premiums.

INSKEEP: So those are some of the questions on the table for Jordan. Other Republicans are arguing they must go with this legislation. NPR health policy correspondent Alison Kodjak is in our studios. Hi, Alison.


INSKEEP: How is the legislation changing as Republican leaders try to get it through?

KODJAK: Yeah. The leadership has been working all week to make changes to get people like Jim Jordan to say yes, I'll vote for this. Earlier this week, they made some major changes to the Medicaid proposals in the bill.

One of those is to allow state governors to turn Medicaid into a single block grant, which means the federal government just gives them a fixed amount of money every year. That would only go up with inflation but wouldn't go up as peoples' health care needs grow or as more people qualify for Medicaid.

INSKEEP: Meaning like if there's a recession or something, people are not assured of the same quality of Medicaid care if there are more people in Medicaid?

KODJAK: Exactly. Exactly. They'd have to make some choices.

INSKEEP: There was something about essential health benefits discussed last night. What's that about?

KODJAK: So in the Affordable Care Act or Obamacare, there are a list of 10 essential health benefits. They're sort of broad categories that include maternal and child care, that include mental health care and other things. And then they're very well detailed in regulation. This is one of the things that conservative Republicans really hate about the Affordable Care Act 'cause they say that requiring insurance companies to cover these things makes premiums higher, which it does because the insurance is better.

INSKEEP: Every policy has to cover every one of these essential health benefits. OK.

KODJAK: Exactly. And before the Affordable Care Act, there was this problem of people not knowing what they got covered. So last night into the night, they were really working hard to figure out if there's a way to remove essential health benefits from the bill or repeal them in the bill.

INSKEEP: The idea being that there would be plans offered that are far less comprehensive and therefore cheaper. And you could say that people's health care costs have gone down. Is that it?

KODJAK: Exactly, and that more people would have insurance by buying it on their own.

INSKEEP: OK. So they're changing this bill on the fly. Here comes the vote supposedly today. Do they have enough votes to pass it?

KODJAK: Not as of midnight last night. There were about 30 Republicans who had said they were against this bill as it is. And they only can afford to lose 21 or 22. There's some report that one Democrat's going to be gone today. And so they really have to do some work to get enough support. And yesterday, it was going the wrong way. There was 21 people against early in the day. And by the end of the day, it was closer to 30.

INSKEEP: Although the Republican argument for voting for this bill, the political argument is pretty strong. You've been saying for years you want to repeal and replace Obamacare. Here's a replacement. It's on the table. Are you really going to vote it down? Is that what leaders are going with?

KODJAK: That's kind of what they're going with. It's exactly what John Boehner said. Republicans have been promising to repeal the bill but have never said what they want to replace it with.

INSKEEP: Based on what you're following, are there Republicans willing to see this fail?

KODJAK: There is some talk that some - that Republicans are willing to see this fail rather than vote for a bill that is less than a full repeal of Obamacare. Those conservative Republicans who have been promising for years that they want to repeal say they'd rather not vote at all.

INSKEEP: OK. Alison, thanks very much.

KODJAK: Thanks, Steve.

INSKEEP: That's NPR's Alison Kodjak this morning. Transcript provided by NPR, Copyright NPR.

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