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With New Healthcare Bill, Senate GOP Give 'Repeal And Replace' Another Shot


Well, Republicans are giving it another shot. They have a new proposal to repeal and replace the Affordable Care Act. It could be voted on in the Senate as early as next week. This bill has become known as Graham CASSIDY. It comes from Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. What would it do? Well, let's ask NPR health policy reporter Alison Kodjak. Alison, good morning.

ALISON KODJAK, BYLINE: Good morning, David.

GREENE: So you've been reporting on this bill and saying it has a potential to be radical.

KODJAK: Yeah. It's probably making the biggest changes of any other proposal so far to repeal and replace the Affordable Care Act. The exchanges where people buy insurance disappear. The individual mandate that requires people to buy insurance disappears. And it gets rid of all the subsidies that help people buy insurance. And it gets rid of the expansion of Medicaid.

And what it does it takes all the money from all those programs and rolls it all up. And then it turns it over to the states to use to help provide health care for their people at the state level. But what it doesn't do is really lay out specifically what the states have to do. So they can create any number of different systems. They could help people buy insurance. They could create high-risk pools. But there aren't really a lot of rules.

GREENE: And I guess we could have seen this coming. When you take a bunch of money and you start doling it out to states, states are going to start debating how much money each of their states should or shouldn't get, which is causing quite a controversy right now, right?

KODJAK: Yeah. Well, what it does - what this bill does is it takes the amount of money that's being used right now across the country and it redistributes it. So under the Affordable Care Act, some states expanded Medicaid and some didn't. So the state that expanded Medicaid got a lot more money than others.

This bill actually redistributes that money across all states. And the end result is a lot of blue states with Democratic governors or even Republican governors but with more moderate populations that expanded Medicaid lose and red states gain.

Here's what Senator Cassidy, one of the sponsors, says about this.


BILL CASSIDY: Thirty-seven percent of the revenue from the Affordable Care Act goes to Americans in four states. Thirty-seven percent of the revenue goes to those who live within four states. That's frankly not fair.

KODJAK: Now, what he doesn't mention here is that those red states chose not to expand Medicaid. So, you know, it's not fair. But they could have done so in the past.

GREENE: They decided they didn't agree with or didn't want to be as much a part of Obamacare, which is one reason they're not getting as much money.

KODJAK: Exactly.

GREENE: Well, so we heard from one governor and - a moderate governor from the state of Massachusetts. It's Charlie Baker. And he was formerly secretary of Health and Human Services in his state. He's been in this industry for a long time. He is not so happy about his state losing money if this bill passes. And here's what he said.

CHARLIE BAKER: I don't see how you can say that health care, which 75 percent of the cost of health care is typically wages, how you can say there's one cost of health care for service delivered for the entire country and make that work. And any high-wage state of which Massachusetts is one gets absolutely slammed under a proposal like that.

GREENE: So this sort of seems unresolved - this question about whether to level the playing field or not. Could this issue hold up this bill from getting passed?

KODJAK: Well, there are several governors who are opposed to the bill. And in those states, some of the senators are really looking to their governors for guidance. So Alaska, like Charlie Baker said from Massachusetts, it's a high-wage state so health care costs a lot. Alaska - health care cost quite a lot too in part because it's scarce.

And Senator Lisa Murkowski from Alaska is considered one of the swing votes on this bill. And her governor came out against it as well. So, you know, that redistribution is playing into it to some degree, the governors' just general opinions on it as well.

GREENE: You mentioned swing vote Murkowski. And this could swing on like one vote. I mean, it looks that close in the Senate.

KODJAK: It sure does, yeah. It's up to - you know, people are looking very closely at just a few senators to determine whether or not they'll say no. And if they do, there's a good chance this will not pass.

GREENE: Couple seconds we have left - I just want to tick through a couple of other questions that have come up in these previous bills. There's the question of whether a law would cover people with preexisting conditions and also Medicaid. How would this bill handle those?

KODJAK: So as I mentioned, you know, they rolled back the expansion of Medicaid, but it even goes further. They take the Medicaid program and change it all together. Right now Medicaid pays for all the health care that its beneficiaries need. This bill will put a cap on that. And it'll grow more slowly. And a lot of estimates say that over time, it'll probably shrink the spending by about 25 percent. So there's a lot of concern there.

And in terms of preexisting conditions, it's a little complicated. The bill says people will be able to get coverage. But it could take away some of the things that have to be included in that coverage, which means - say you have a mental health condition. You have depression, but you buy an insurance plan that doesn't cover it. It's not going to help you that much.

GREENE: All right. NPR's Alison Kodjak, helpful as always in working through health policy. Thanks so much.

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

David Greene is an award-winning journalist and New York Times best-selling author. He is a host of NPR's Morning Edition, the most listened-to radio news program in the United States, and also of NPR's popular morning news podcast, Up First.
Alison Fitzgerald Kodjak is a health policy correspondent on NPR's Science Desk.