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Republicans Still Divided Over Health Care Bill


You're going to hear a lot of this kind of wordplay today. The Republican health care plan is on life support. It could be on its last breath, all that stuff. But it really is an important moment for the promise by Republicans to repeal and replace the Affordable Care Act, or Obamacare.

President Trump and House Republican leaders have spent most of this week trying to cajole and strong arm their members to support the bill - to little gain. Yesterday, representatives of various factions of the Republican caucus remained opposed to the proposed bill.

So joining me now in the studio is NPR health policy correspondent Alison Kodjak to talk about what is actually in this bill because, Alison, it has changed an awful lot over the course of the past week. Right?


MARTIN: Where do we stand now?

KODJAK: Well - so the basic framework remains the same. It's the bill that basically gets rid of the individual mandate so people don't have to own health insurance. It replaces the Obamacare combo of income-based subsidies and tax credits with a single, fixed tax credit based on your age.

But there are big changes to Medicaid, and that's one of the sticking points. It really reduces spending on Medicaid over the long term that will essentially amount to less money for health care and fewer people getting coverage. And then finally, last night, the change that will be coming today in an actual legislative language is that they eliminated the list of benefits that under Obamacare are required to be covered if a policy is going to get federal help to buy it.

MARTIN: So let's talk more about what those essential benefits are. So this is something that became federally mandated under the Affordable Care Act. It's just, like, a baseline of things that all insurance companies have to provide?

KODJAK: It is. It's a floor. And it's a pretty high floor. I mean, it - there's a list of 10 things, you know, areas of coverage in the language. They range from hospitalization and doctors' visits, your obvious, to maternity care, mental health care - any number of things and then...

MARTIN: Some prescription drugs...

KODJAK: Prescription drugs, yeah. And then under that, the regulations by the Department of Health and Human Services sort of lists very specifically what has to be covered.

Conservatives - they don't like this because they call it Washington dictating what you have to buy. And...

MARTIN: So they want this to go back to the states. States can decide what kind of baseline they want.

KODJAK: Right. And that's what they changed last night. They got rid of it out of the federal bill. They want it to go back to the states. And, you know...

MARTIN: This was supposed to satisfy conservatives in the House who say that this bill isn't actually a full repeal of Obamacare and it still doesn't do enough to lower premiums.

KODJAK: Exactly. And we'll see. I mean, some of those members, the most conservative, probably have come toward the bill. The problem is once you do that, you get rid of a lot of protections for people and the insurance. And so some of the more moderate Republicans may be falling off on the other end.

MARTIN: Especially on the Senate side, if it gets that far. So...

KODJAK: Right.

MARTIN: Let's talk - we've talked an awful lot about where the dividing lines are in Washington on this bill. But what's the conversation like outside of Congress, outside of Washington? Lobbying groups, doctors - what kind of support does this bill have?

KODJAK: Yeah, that's - I think that's one of the big problems. There's not a lot of support outside of Washington for this bill, at least among the organized groups. And that - you know, the American Medical Association has come out again against it, the American Hospital Association, any number of patients groups - the Lung Association, the American Cancer Society are against it.

And a lot of governors don't like it either. People - it's hard for people to come out for a bill where people are going to lose insurance coverage.

MARTIN: Which the CBO has again indicated that more than 20 million Americans additionally will lose coverage under this plan.

KODJAK: Right. And they repeated that last night.

MARTIN: NPR health policy correspondent Alison Kodjak - thanks so much, Alison.

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

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