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Health Care Policy Expert On GOP Bill: Will Allow Equality And Better Decision-Making Among States


Although Senator John McCain's announcement that he cannot support the Graham-Cassidy health care bill is bad news for the measure's supporters, the fight for its passage is still going on. So we want to take a closer look at what supporters say the bill has to offer. Lanhee Chen is a research fellow at Stanford's Hoover Institution with a deep interest in health policy. He served in the George W. Bush administration in the Department of Health and Human Services, and he's head key advisory roles in two GOP presidential campaigns. And he is with us now. Mr. Chen, thank you so much for speaking with us.

LANHEE CHEN: Thank you for having me.

MARTIN: You know, it has to be said, it's hard to separate the politics from the policy. For example, you had Senator Charles Grassley say openly to reporters that he could cite 10 reasons to vote against this bill, but the main reason to vote for it is that Republicans campaigned on it. But I'm going to ask you to focus on the substance of the policy. I don't know if we have time for 10 reasons, but what are your key reasons why you support this bill?

CHEN: Well, I appreciate that. I think the biggest advantage of the bill is that it does restore to states the authority to come up with reform plans that suit their citizens best. The reality is that states are in the best position because they're closest to their residents, closest to their citizenry to make determinations about what their needs are.

And the other point I'll just make, one of the issues raised by the Affordable Care Act's expansion of the Medicaid program is that it created significant inequities in how much the federal government sends to states across America. So some states are receiving far more per capita, and that is something that Graham-Cassidy tries to fix by equalizing the amount that goes to states per resident.

MARTIN: You talked about the inequalities in the amount each state is spending on Medicaid, but isn't that because those states chose through their political processes to make those decisions? So why is this better, from a federal standpoint, to undo state decision-making and you're forcing equality on states that chose to make other decisions?

CHEN: Because different states, even if they made the decision to expand Medicaid, have different levels of federal funding. So you can take two states like Massachusetts and Pennsylvania as perfect examples of states where even though they made the same decision, they're getting sent differential amounts of money. And part of the reason why is because of various decisions made at the state level that drive up the amount of spending, therefore the amount of federal spending correspondingly increases as well.

And so one of the ideas here is to try to level the playing field to allow states to do different things but to create some equality in the per capita amount that states get. And I tend to think that that will allow for better decision-making going forward.

MARTIN: Why is this bill in the best interests of just your ordinary citizen who needs care, whether it's a catastrophic incident or is sort of the normal course of life like having a baby? Why is this in their best interest?

CHEN: I think one of the challenges created by the Affordable Care Act is that it did put in place a system that is unsustainable, whether it's fiscally unsustainable or unsustainable because it's creating regulatory issues that are raising premiums to a significant percentage where you've got insurance that's affordable in many places. And so what I think Graham-Cassidy fundamentally does is, one, is it addresses those issues of affordability of health insurance by creating potentially a more competitive landscape in many states.

And secondly, it addresses the long run health of programs like Medicaid which under the current system simply cannot exist as they currently are. And so I think that what Graham-Cassidy tries to do is to create a health-care system that is more sustainable in the long run.

MARTIN: That was Lanhee Chen. He is a research fellow at Stanford's Hoover Institution. He's had key policy roles in two GOP presidential campaigns and also served at the Department of Health and Human Services in the Bush administration. He was kind enough to join us from his home office in California. Mr. Chen, thank you so much for speaking with us.

CHEN: Thank you.

(SOUNDBITE OF EMANCIPATOR'S "GOODNESS") Transcript provided by NPR, Copyright NPR.