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Health Care Debate Opens A Wound Between House And Senate GOP


The U.S. Congress has gone home. And Republicans, who control both houses and the White House for that matter, campaigned on the pledge to replace the Affordable Care Act, have left the Capitol without doing so. A gap has opened among Republicans in the Senate and the House and perhaps even the White House. Mark Hemingway, a senior writer for The Weekly Standard, is in our studios. Mark, thanks so much for being with us.

MARK HEMINGWAY: Very glad to be here.

SIMON: Help us understand where these divisions are.

HEMINGWAY: Well, there's really two different ways of thinking about the same division. One is the simple sort of conservatives versus moderates divide in the Senate, which defines a lot of issues. But the other thing is what maps neatly onto that ideological divide is who represents states where they did the Medicaid expansion in Obamacare and who represents more conservative states where the Republican governors didn't go along with that.

SIMON: I wonder about the public opinion polls because they show this week, once again, that the Republican alternative being proposed is popular with less than 20 percent of the American people. Shouldn't that concern Republicans in the House and Senate?

HEMINGWAY: I think it absolutely does concern them. I think the question is how much they actually do not like the specifics of the bill or how much they're responding to the fact that this has been a bit of a goat rodeo trying to, you know, organize a piece of legislation to replace it. And there's no confidence in the decision-making process and the obvious acrimony that's gone on as a result of the tensions over putting the bill together.

SIMON: Yeah. Mitch McConnell suggests that if he can't get an agreement among his own Republicans, he's going to have to turn to the Democrats. Isn't that democracy? I mean, isn't that good for the system?

HEMINGWAY: Yes. I think that would be. But on the other hand, when you look at what happened with Obamacare, it kind of set a big norm. It was, like, the first time we ever saw a major piece of legislation quite that, you know, impactful on, like, one-sixth of the economy where only one party authored it. So now that's kind of the way things are going forward.

So I think that would be great if everybody could come to the table and do that. But on the other hand, I have a hard time seeing the Democrats in the opposition necessarily coming to the table in a way that Republicans, even the more moderate ones, would be amenable to.

SIMON: Yeah. But I mean, can't we turn that around for the Republicans, though, too? I mean, shouldn't they also address the anxieties of tens of millions of Americans about the Congressional Budget Office estimation that 22 million Americans might be not covered by health care?

HEMINGWAY: Well, that's exactly what the tension in the - over the split in the party between conservatives and moderates is about. It's about the Medicaid expansion and about, you know, dramatically affecting the number of, you know, Americans who are going to lose health insurance or going to have their Medicaid benefits possibly scaled back.

You know, obviously, the people that represent more moderate, purple states don't want to, you know, suffer the political consequences there, whereas, you know, if you're a senator from say, you know, Texas or Utah, where the senators there are leading this sort of opposition against that, you don't have nearly as much concern from your constituents over that that because you didn't do the Medicaid expansion.

SIMON: Yeah. You mentioned they don't want to suffer the political cost. But, I mean, we could also be talking about a lot of Americans who aren't covered by health care. It's not just a political matter.

HEMINGWAY: Yes, (laughter) it is. But, you know, any major piece of, you know, redistributive legislation is going to have, you know, dramatic effects one way or the other. And a huge bulk of the people that are going to lose health insurance - it's simply a function of the fact that there is no longer a mandate requiring them to buy it. So they're choosing to do that. So, politically, it's not quite as consequential.

SIMON: Mark Hemingway, senior writer for The Weekly Standard, thanks so much for joining us.

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