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The Steps Ahead For The Senate On Health Care


President Trump took an opportunity yesterday to repeat a simple promise.


PRESIDENT DONALD TRUMP: We're going to give you great health care.

INSKEEP: The promise has been straightforward to make. The problem is keeping it. The president himself said shortly after taking office, nobody knew, nobody knew health care could seems so complicated. Now the United States Senate is confronting that reality. Lawmakers voted yesterday to begin debate on repealing and replacing the Affordable Care Act with something or with nothing, no clear idea what the plan is. Senator John McCain's vote was crucial. He returned from surgery and a cancer diagnosis to cast that vote in favor of starting debate. And then, as other senators listened, he said they're not doing it right.


JOHN MCCAIN: Why don't we try the old way of legislating in the Senate, the way our rules and customs encourage us to act? If this process ends in failure, which seems likely, then let's return to regular order.

INSKEEP: Senators then suffered an initial failure. A replacement plan was blocked last night. Noam Levey is national health care reporter for the LA Times. And he's on the line. Good morning.

NOAM LEVEY: Good morning.

INSKEEP: So the basics first, what actually did the senators commit to with the vote to begin debate?

LEVEY: So what they're technically doing is bringing up the repeal and replace bill that passed the House of Representatives in May. But in practical terms, what this means is that the Senate has begun debating potential replacements for that replacement.

INSKEEP: Oh, because nobody believes that that measure from the House would pass the Senate in that form.

LEVEY: That's correct.

INSKEEP: And then they put this other proposal on the table last night. What proposal was it that they killed?

LEVEY: Well, Senator - Senate Majority Leader Mitch McConnell had come up with his preferred repeal and replace bill, which had been slightly modified over the last couple of weeks in the course of negotiations with conservative Republican senators, like Ted Cruz, more centrist Republican senators like Rob Portman, who are concerned about Medicaid. That was viewed as one possible option for Republicans. But that - it didn't even come close.

INSKEEP: And now we have another vote coming up, most likely today, on just straight repeal - just repeal the Affordable Care Act. What's the effect on the public if that were to pass?

LEVEY: Well, the Congressional Budget Office, the nonpartisan scorekeeper for Congress, has calculated that would lead to 32 million fewer Americans with health insurance over the next decade, pretty dramatic.

INSKEEP: Which maybe explains why people don't expect that to pass either.

LEVEY: That's - that approach has always been the favorite of the most conservative wing of the Republican Party. But it has very little support with the public, certainly not with Democrats. And even many centrist Republican senators have said they won't back that either.

INSKEEP: So Senator McCain pointed out, this is a strange way to do a bill, actually. It's not the way they would normally have done it in the past. What have you thought about, as a reporter, as you've watched this story unfold?

LEVEY: Well, I've been covering Washington for almost a dozen years, which is short by the...

INSKEEP: By McCain's standards, but OK.

LEVEY: I've never seen anything like this. The normal committee process, which Senator McCain alluded to in his remarks, would send a piece of legislation, especially one as complex as this one, through a series of committee hearings in which experts would weigh in, the law - the legislative language would be submitted for analysis by the Congressional Budget Office and others so that lawmakers would have an idea of not only what was in the legislation but what the potential impact could be.

One of the remarkable things about the process we're in right now is that not only are the two plans that you and I discussed unlikely to go forward; we don't know what will go forward. That means that lawmakers, over the next day or two, will likely be asked to vote on something, anything that repeals part or all or none of the Affordable Care Act without a clear idea of how many people may be impacted by that, how many people would gain or lose health insurance, how - what would happen to insurance protections that people currently rely on. All that is a question mark.

INSKEEP: You know, when John McCain talked about regular order, some people have pointed out he was talking about this process, this technical process, but also talking about a frame of mind - wasn't he? - the idea that senators would deliberate, that they would think about things, that they would listen to one another, that if you do things under the normal rules, you'd also get input from the minority party. They might actually amend it in some way that makes it feel less bad to them, right?

LEVEY: I think that is the hope. And that's a sentiment that's been expressed, I think, with increasing urgency in Washington over the last six months. And that, in part, reflects, I think, the president. But I think it also reflects this headlong rush that Republicans have been in to repeal the Affordable Care Act. And that's been, obviously, an extremely partisan an issue for seven years. But I think there is a hope, at least on the public side, that this process would have been more constructive.

INSKEEP: Wouldn't - isn't this something that Republicans - very, very briefly - Republicans decried this way of approaching things?

LEVEY: They certainly did. It was a talking point they went to time and again for the last seven years.

INSKEEP: OK, Noam Levey of the Los Angeles Times, thanks very much.

LEVEY: My pleasure. Transcript provided by NPR, Copyright NPR.