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Speaker 1: After last week's defeat of three Republican Obamacare repeal proposals,

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Speaker 1: Senate Majority Mitch McConn Senate Majority Leader Mitch McConnell said

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Speaker 1: that it's time to move on from healthcare. But over

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Speaker 1: the weekend and this morning, President Trump has been tweeting

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Speaker 1: about it, and he said that Republicans look like fools

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Speaker 1: on healthcare, and he's threatened to discontinue paying subsidies to

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Speaker 1: health insurance companies that help ensure coverage for low income Americans,

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Speaker 1: as well as subsidies for coverage of congressional employees. Here

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Speaker 1: to talk with us about the future of the health

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Speaker 1: insurance debate and what happens now that the Senate has

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Speaker 1: voted down those proposals are Abby Gluck, the director of

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Speaker 1: the Solomon Center for Health Law and Policy at Yale

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Speaker 1: Law School, and Timothy Just, a professor at Washington and

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Speaker 1: Lee University School of Law. Abbey. So, the Republicans have failed,

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Speaker 1: at least so far to repeal Obamacare. Um the these

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Speaker 1: insurance companies get these subsidies from the federal government as

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Speaker 1: part of the law, and yet the President is now

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Speaker 1: saying he might threatened to He's been threatening to cut

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Speaker 1: them off. And now he's been quite explicit about it.

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Speaker 1: How is it that the president can refuse to pay

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Speaker 1: insurance subsidies that are part of a law that's still

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Speaker 1: in place. Well, there is a lawsuit underway, which is

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Speaker 1: the House challenge the legality of these subsidies, and so

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Speaker 1: what the President is essentially arguing is that, uh, you know,

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Speaker 1: the House is correct, the subsidies are illegal, so I

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Speaker 1: can use my executive authority to turn them off. His

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Speaker 1: motivation is to destabilize the insurance markets by turning off

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Speaker 1: this funding, and it's an continuing effort to try to

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Speaker 1: get the statute to fall under his own weight, as

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Speaker 1: he likes to put it, and as far timothy as

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Speaker 1: what will happen if he does this? Because the insurance

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Speaker 1: companies want reassurance about these subsidies, what will what will

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Speaker 1: we see happen if they don't get them? Well, it's

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Speaker 1: pretty hard to say. Uh. In the short term. Um,

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Speaker 1: the insurance companies do have the right under their contract

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Speaker 1: with the Federal Exchange in the states where that is covers,

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Speaker 1: to withdraw from the exchange if they don't get the payments.

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Speaker 1: But um, they would have to then give notice to

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Speaker 1: their consumers and to the state if they states if

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Speaker 1: they did that, and we're probably late enough now in

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Speaker 1: the year where it wouldn't make sense for them to

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Speaker 1: try to do that yet. For so, I think the

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Speaker 1: big question would be what happens in and I think

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Speaker 1: one of two things would happen. One is that they

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Speaker 1: will dramatically raise their premiums, probably around so that the

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Speaker 1: premiums tax credits they get from the federal government cover

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Speaker 1: the cost of the cost sharing reductions. And that's probably

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Speaker 1: what a lot of them will do. Um and and

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Speaker 1: the big losers there are going to be people over

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Speaker 1: f of poverty who who don't get premium tax credits,

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Speaker 1: who are just going to see their their premium skyrocket. Um.

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Speaker 1: The other thing is that some of them will probably

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Speaker 1: say that the federal government is totally unreliable as a

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Speaker 1: bargaining partner and we're cashing it in. Uh. And then

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Speaker 1: they're going to be problems, probably worse than what we're

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Speaker 1: seeing now of parts of the country where there aren't

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Speaker 1: any insurers available or just fewer insurers. So, as Abby said,

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Speaker 1: this is uh, you know, this is sabotage of the market,

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Speaker 1: and it's likely to have some effect, but it's probably

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Speaker 1: not likely to destroy the Affordable Care Act exchanges ABBY,

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Speaker 1: given what appears to be the importance of these payments

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Speaker 1: for stabilizing these markets. You know, some members of Congress

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Speaker 1: have evinced an interest in authorizing them by statute. Is

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Speaker 1: there any chance that's going to happen? Um, You know,

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Speaker 1: it would be a terrific outcome if there could be

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Speaker 1: by partisan group of members of Congress would come in

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Speaker 1: and just stabilize the markets. UH in the idea of

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Speaker 1: ways that really should have been done a long time ago,

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Speaker 1: which people thought would have been done had the administration

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Speaker 1: been different after the election. Um, it's not just these payments,

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Speaker 1: so they would be what would happen here would be

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Speaker 1: some members of Congress might confirm that the Affordable Character

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Speaker 1: does in fact give these UH cost sharing reduction payments.

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Speaker 1: It would write that into a lot, and then likely

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Speaker 1: they would also turn back on the other set of

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Speaker 1: stabilization payments at the States turned off a couple of

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Speaker 1: years ago UH and Appropriations writer UH proposed by Marco Rubion,

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Speaker 1: which pass um. Tim. We hear all these conflicting things

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Speaker 1: about what Trump wants to do and what what position

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Speaker 1: he has and then Republican Senators Lindsay Graham of South Carolina,

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Speaker 1: Bill Cassie of Louisiana, and Dean Heller of Nevada met

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Speaker 1: with Trump on Friday on a new proposal that Graham

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Speaker 1: said Trump was optimistic about. Are we ever going to

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Speaker 1: hear about these proposals before they're actually out and ready

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Speaker 1: to be voted on? Why all the secrecy still when

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Speaker 1: it didn't work before? Well, there is a Graham Cassidy

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Speaker 1: Heller proposal out there. Uh, and it was filed as

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Speaker 1: an amendment last week. UM, and I'm quite confident the

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Speaker 1: President does not understand it. It's very complicated, Um, but

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Speaker 1: it really doesn't. It isn't that much difference from different

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Speaker 1: from all the proposals that were voted down. Uh. It's

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Speaker 1: still would get the Medicaid program. Um. And it's still

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Speaker 1: would have probably throw millions of people off of off

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Speaker 1: of coverage. We don't have a CBO report on it,

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Speaker 1: so UM. I I'm pretty pessimistic that it's that the

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Speaker 1: Senate this week is going to take up the Graham

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Speaker 1: Cassidy Heller proposal. And I think they're thinking pretty hard

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Speaker 1: now about heading back to the districts on Friday, So

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Speaker 1: I you know, I just don't see that going anywhere.

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Speaker 1: If you thought that the discussion of whether or not

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Speaker 1: the Affordable Care Act was going to survive was over,

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Speaker 1: well it's not. We've been talking with Abby Gluck, the

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Speaker 1: director of the Solomon Health Center for the Solomon Center

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Speaker 1: for Health Law and Policy at Yale Law School, and

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Speaker 1: Timothy Joseph, Professor Professor at Washington and Lee University's School

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Speaker 1: of Law, about the President's tweets and threats about getting

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Speaker 1: rid of subsidies that help insurance companies to provide insurance

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Speaker 1: to lower income Americans, as well as what possible congressional

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Speaker 1: action there is coming up. Timothy, we were talking a

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Speaker 1: bit about the the the Senator Graham and Cassidy and

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Speaker 1: Heller have been trying to come up with a proposal

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Speaker 1: and have there's some plan out there about what might

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Speaker 1: what they might be able to do as a different

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Speaker 1: kind of Obamacare repeal and replacement. Can you give us

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Speaker 1: some details on what we know about their plans so

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Speaker 1: far besides what effects would be like, what's in it? Well, um,

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Speaker 1: it's based on the Better Care Reconciliation Act, the original

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Speaker 1: version that is introduced in the Senate. So a lot

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Speaker 1: of the provisions simply repeat that, like the provisions for

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Speaker 1: defunding Planned parenthood or banning abortions or or a small

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Speaker 1: business association health plans, and as far as I can tell,

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Speaker 1: the Medicaid provisions are fairly similar to It would phase

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Speaker 1: out funding for the Medicaid expansions and impose a per

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Speaker 1: capita cap or block grant on Medicaid, which would eventually

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Speaker 1: dramatically reduce payments to the states under Medicaid and force

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Speaker 1: them to spend a lot more in state money or

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Speaker 1: or to cut eligibility. Um. The big, the big innovation

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Speaker 1: of it is that it would completely get rid of

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Speaker 1: as the pre m tax credits and cost sharing reduction

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Speaker 1: payments under the Affordable Care Act and instead just give

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Speaker 1: the states big hunks of money about a trillion dollars

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Speaker 1: over eight years um that the states and and according

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Speaker 1: to very complicated formulas as to how the money would

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Speaker 1: be allocated, But it would basically then just say to

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Speaker 1: the States, here's a bunch of money. You're going to

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Speaker 1: have to match this at some level um like three

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Speaker 1: to five percent and uh and and go figure out

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Speaker 1: what to do with it. Um, So there's probably some

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Speaker 1: states that would really like that. It would make me

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Speaker 1: very nervous abby. According to a Reuter's It's Its Opinion

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Speaker 1: poll of the country want to either keep or modify

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Speaker 1: the Affordable Care Act. That's up from in January. What,

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Speaker 1: in your opinion would be the best way to keep

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Speaker 1: the Affordable Care Act? Well, um, I think it's We've

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Speaker 1: been saying all along for the last few months, and

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Speaker 1: many times on the show, actually that the Affordable character

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Speaker 1: wasn't perfect right. There were some things that needed some adjustment.

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Speaker 1: The insurance subsidies for individuals are set a little too low.

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Speaker 1: They probably have to be adjusted the insurance markets. It

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Speaker 1: can be adjusted. But people like the affordable cacharret because

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Speaker 1: it's working very well. We're starting to see economic studies

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Speaker 1: coming out the Medicaid expansion has been very positive and

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Speaker 1: a lot of states costs so coundown people are healthier. Um.

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Speaker 1: The outcomes are good, and I think that the last

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Speaker 1: few months have really shown us that people are starting

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Speaker 1: to understand what this act does and they don't want

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Speaker 1: these benefits taken away. I think our best chance at

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Speaker 1: this point is a group of bipartisan congressmen like those

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Speaker 1: that we sort of have started to hear today may

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Speaker 1: be emerging that are going to look to keep the

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Speaker 1: statute in place and just make the adjustments that we

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Speaker 1: all think are necessary. Timothy, one of the things that

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Speaker 1: a lot of people who don't like the Act have

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Speaker 1: criticized is that, you know, there are counties in the

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Speaker 1: United States where there are no insurers available for people

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Speaker 1: to by insurance under the Affordable Care Act. How widespread

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Speaker 1: a problem is that at this point, well, a lot

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Speaker 1: less widespread today than it was yesterday. There was just

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Speaker 1: an announcement at Ohio, where most of the bearer counties

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Speaker 1: were has now reached an agreement with its insurers to

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Speaker 1: cover all but one of those counties. There are still

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Speaker 1: a few counties in in um in Indiana, and in Nevada,

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Speaker 1: but a number of states now have been successful in

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Speaker 1: negotiating with their insurers to cover the bear counties. UM.

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Speaker 1: And it's a solvable problem. Again, though, if President Trump

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Speaker 1: announced that the federal government is going to cut off

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Speaker 1: the cost sharing reduction payments, we could see a lot

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Speaker 1: more bear counties very quickly. UM. So that's a risk

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Speaker 1: that he is going to have to decide whether he

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Speaker 1: wants to take and Abbie. He's come out both, you know,

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Speaker 1: different ways. He said on Sunday, don't give up Republican senators.

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Speaker 1: The world is watching repeal and replace and go to

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Speaker 1: fifty one votes. And then he said the other day,

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Speaker 1: you know, let's just watch Obamacare implode. Do you and

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Speaker 1: I hate to ask anyone what what he's thinking but

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Speaker 1: or what he might do, but do you think he

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Speaker 1: has enough nerve to just let it implode? You know?

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Speaker 1: I think that you'll be a big political mistake on

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Speaker 1: his part if he decided to do that. I think

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Speaker 1: that what he has done with these threats is that

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Speaker 1: very important to understand your answers him a question. The

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Speaker 1: Republican actions are the reason the insurance markets are destabilizing.

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Speaker 1: They're the reason that the affordable character is weak in

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Speaker 1: a lot of states because considers have been pulling out.

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Speaker 1: He is under some impression, the president, that if he

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Speaker 1: turns off these payments, somehow the Democrats and Obama are

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Speaker 1: going to be blamed for this, and I think that's

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Speaker 1: pretty naive political thinking. Um. The reason that he's doing

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Speaker 1: both of these things, tweeting about getting the Senate back

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Speaker 1: in action, and also saying I'm going to or off

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Speaker 1: these payments. That he has two levers at his disposal,

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Speaker 1: which his pen, he could turn off the payments. He

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Speaker 1: doesn't need the Senate, and he could would rather, I think,

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Speaker 1: have the Senate acts. So he's basically saying I have

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Speaker 1: two weapons, and he's trying to threaten the Senate into

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Speaker 1: doing something before he causes massive financial tasks. Thus far, Uh,

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Speaker 1: the Senate hasn't fallen victim to his threats. So we'll

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Speaker 1: see what happens. But I think it's again very naive

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Speaker 1: for him to think at this point that the republic

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Speaker 1: is going to turn their finger at the Democrats. Uh

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Speaker 1: for his heart his actions, Timothy, one of the things

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Speaker 1: that's sort of interesting here is the interplay between UM,

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Speaker 1: this long now congressional attempt to get rid of the

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Speaker 1: Affordable Care Act, which is so far not worked and

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Speaker 1: their design, and the Republican Caucuses desire to pass tax

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Speaker 1: reform or at least the tax cut, depending on what

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Speaker 1: they're able to work out. UM, and you know a

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Speaker 1: lot of people, there are some people who think they

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Speaker 1: should have gotten on taxes first. Do you think that

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Speaker 1: there's an appetite in the Congress to revisit the Affordable

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Speaker 1: Care Act at this point or do they just do

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Speaker 1: Do they, as Mitch McConnell said, really just want to

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Speaker 1: move along to something else. Well, I think there's absolutely

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Speaker 1: no appetite in the House to to walk the plank

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Speaker 1: again going first, So it'll be up to the Senate

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Speaker 1: as to whether the Senate wants to move or not.

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Speaker 1: And uh, you know, I'm I'm I'm certainly not an

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Speaker 1: expert on tax reform or or on what Mitch McConnell

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Speaker 1: is thinking, but I think he indicated pretty clearly on

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Speaker 1: Thursday that he's ready to move on to other things

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Speaker 1: and doesn't see a lot of mileage and spending a

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Speaker 1: lot more time on