1 00:00:00,120 --> 00:00:03,640 Speaker 1: President Trump has promised to repeal and replace Obamacare with 2 00:00:03,880 --> 00:00:07,600 Speaker 1: something great. Speaker Paul Ryan has proposed what he calls 3 00:00:07,800 --> 00:00:10,799 Speaker 1: a better way, and now the Speaker has unveiled the 4 00:00:10,840 --> 00:00:14,800 Speaker 1: American Healthcare Act, which purports to replace the Affordable Care 5 00:00:14,840 --> 00:00:18,640 Speaker 1: Act and acted under President Obama. Speaker Ryan has been 6 00:00:18,640 --> 00:00:21,320 Speaker 1: out selling the bill, explaining why it's a better alternative 7 00:00:21,400 --> 00:00:26,040 Speaker 1: to Obamacare. The fatal conceit of Obamacare is that we're 8 00:00:26,079 --> 00:00:28,720 Speaker 1: just gonna make everybody by our health insurance at the 9 00:00:28,720 --> 00:00:31,560 Speaker 1: federal government level. Young and healthy people are gonna go 10 00:00:31,600 --> 00:00:34,000 Speaker 1: into the market and pay for the older secret people. 11 00:00:34,640 --> 00:00:36,800 Speaker 1: So the young healthy person is going to be made 12 00:00:36,880 --> 00:00:39,400 Speaker 1: by healthcare, and they're gonna pay for the person you 13 00:00:39,400 --> 00:00:41,599 Speaker 1: know who gets breast cancer in her forties or who 14 00:00:41,640 --> 00:00:45,720 Speaker 1: gets heart disease in his fifties. Despite the Speaker's efforts, 15 00:00:45,760 --> 00:00:49,760 Speaker 1: Democrats perhaps predictably don't support the bill, but less predictably 16 00:00:50,240 --> 00:00:54,200 Speaker 1: less predictably, neither do many Republicans. Nevertheless, the House Ways 17 00:00:54,240 --> 00:00:56,720 Speaker 1: and Means and Energy and Commerce committees have already marked 18 00:00:56,760 --> 00:00:58,400 Speaker 1: up the bill and reported it out to the full 19 00:00:58,400 --> 00:01:01,320 Speaker 1: House for consideration. With us today to talk about the 20 00:01:01,360 --> 00:01:04,440 Speaker 1: proposed new healthcare law is Harry Nelson, a partner at 21 00:01:04,440 --> 00:01:06,560 Speaker 1: Nelson Hardeman and co author of a new book on 22 00:01:06,640 --> 00:01:10,040 Speaker 1: healthcare law and policy called From Obamacare to Trump Care, 23 00:01:10,240 --> 00:01:14,280 Speaker 1: Why You Should Care. Harry, you've written this book. Great 24 00:01:14,280 --> 00:01:16,120 Speaker 1: to be with you. It's good to have you here. Thanks. 25 00:01:16,160 --> 00:01:18,160 Speaker 1: How are You've written a book looking at the history 26 00:01:18,240 --> 00:01:21,800 Speaker 1: of the healthcare debate in the country and examining different 27 00:01:21,840 --> 00:01:25,080 Speaker 1: approaches to the healthcare system favored by Democrats and Republicans. 28 00:01:25,520 --> 00:01:28,039 Speaker 1: And now we have this new Republican healthcare bill that 29 00:01:28,120 --> 00:01:33,080 Speaker 1: purports to be, uh, you know, replacement for Obamacare. Are 30 00:01:33,120 --> 00:01:37,039 Speaker 1: you surprised by what's in this bill? Well, the good 31 00:01:37,040 --> 00:01:39,400 Speaker 1: news for us have you written the book, was that 32 00:01:39,480 --> 00:01:43,160 Speaker 1: the GOP plan unveiled earlier this week was not a 33 00:01:43,200 --> 00:01:47,000 Speaker 1: surprise at all. It aligned very closely to what Speaker 34 00:01:47,080 --> 00:01:52,080 Speaker 1: Ryan had introduced last summer. And uh, there until now, 35 00:01:52,280 --> 00:01:55,000 Speaker 1: there's really not been a surprise about what repealing replace 36 00:01:55,080 --> 00:01:57,880 Speaker 1: looked like, at least from the standpoint of the administration 37 00:01:58,040 --> 00:02:01,440 Speaker 1: and Speaker Ryan look us a little bit about the 38 00:02:01,520 --> 00:02:07,520 Speaker 1: important points of the law from an unbiased point of view. Absolutely, 39 00:02:07,520 --> 00:02:09,520 Speaker 1: And I should say our goal in writing this book 40 00:02:09,639 --> 00:02:11,919 Speaker 1: was to really try and be straight down the middle 41 00:02:12,280 --> 00:02:14,280 Speaker 1: and be hard headed at looking at what worked and 42 00:02:14,280 --> 00:02:17,320 Speaker 1: didn't work under the Affordable character and what's promising and 43 00:02:17,400 --> 00:02:22,440 Speaker 1: what's UH difficult about the Republican plan. So the big 44 00:02:22,480 --> 00:02:26,639 Speaker 1: the big elements of the Republican plan are repealing the 45 00:02:27,320 --> 00:02:31,440 Speaker 1: tax credits that the Affordable Care Act provided to UH 46 00:02:31,480 --> 00:02:35,840 Speaker 1: to subsidize health insurance in order to have uninsured people 47 00:02:36,000 --> 00:02:39,320 Speaker 1: buy insurance on health plans. UH. The other the other 48 00:02:39,360 --> 00:02:41,560 Speaker 1: big part of the repeal is getting rid of not 49 00:02:41,600 --> 00:02:44,799 Speaker 1: only of the individual mandate to buy insurance for the uninsured, 50 00:02:44,840 --> 00:02:47,679 Speaker 1: but also the employer mandate for companies over fifty to 51 00:02:47,720 --> 00:02:50,839 Speaker 1: be required to provide insurance. And then the third sort 52 00:02:50,880 --> 00:02:54,560 Speaker 1: of major change that the that the Republican plan has 53 00:02:54,720 --> 00:02:59,360 Speaker 1: is to beginning in rolled back the Medicaid expansion, which 54 00:02:59,400 --> 00:03:02,280 Speaker 1: added depending on how you count somewhere between twelve and 55 00:03:02,320 --> 00:03:06,639 Speaker 1: twenty million Americans to medicaid in thirty two states that 56 00:03:06,680 --> 00:03:09,280 Speaker 1: accepted federal money, and that was for the poorest Americans. 57 00:03:09,320 --> 00:03:11,280 Speaker 1: So those are sort of the three top level changes. 58 00:03:11,280 --> 00:03:13,880 Speaker 1: There's many other small details, but those are the ones 59 00:03:13,960 --> 00:03:16,720 Speaker 1: that we would encourage people to be paying attention to 60 00:03:17,560 --> 00:03:21,200 Speaker 1: during the course of the debate over the affordable character. 61 00:03:21,200 --> 00:03:24,040 Speaker 1: Over the last several years, the Republicans have said that, 62 00:03:24,080 --> 00:03:27,880 Speaker 1: you know, deductibles are too high, um, and it's the 63 00:03:28,240 --> 00:03:32,000 Speaker 1: marketplaces don't work, the exchanges don't work. Do the changes 64 00:03:32,040 --> 00:03:37,280 Speaker 1: in this bill, you know, promote solutions to the problems 65 00:03:37,320 --> 00:03:41,360 Speaker 1: they've pointed out? Well, it depends who you talk to. 66 00:03:41,800 --> 00:03:46,280 Speaker 1: The Republicans were in our estimation were right. The exchanges 67 00:03:46,320 --> 00:03:50,120 Speaker 1: were broken uh and and deductibles were going up certainly 68 00:03:50,160 --> 00:03:53,640 Speaker 1: in many markets. UM. Whether the whether the Republican initiatives 69 00:03:53,640 --> 00:03:56,160 Speaker 1: are actually going to change that remains to be seen. 70 00:03:56,600 --> 00:04:00,400 Speaker 1: The we think that there will be a progress us 71 00:04:00,440 --> 00:04:02,480 Speaker 1: on the good news is there. We think that there 72 00:04:02,480 --> 00:04:06,960 Speaker 1: will be progress on lowering prices that healthcare providers, hospitals, 73 00:04:06,960 --> 00:04:10,360 Speaker 1: and doctors are charging as more of the responsibility is 74 00:04:10,400 --> 00:04:13,360 Speaker 1: shifted by this plan to people paying out of pocket. 75 00:04:13,800 --> 00:04:16,240 Speaker 1: But the bad news is that the insurance companies are 76 00:04:16,279 --> 00:04:18,960 Speaker 1: going to be covering a lot less and it's not 77 00:04:19,000 --> 00:04:20,839 Speaker 1: clear who's going to flit the bill for some of 78 00:04:20,880 --> 00:04:24,039 Speaker 1: the expensive care, particularly end of life care and chronic care. 79 00:04:24,360 --> 00:04:26,560 Speaker 1: So we think there will be some progress, but the 80 00:04:26,839 --> 00:04:29,760 Speaker 1: system is going to be uh still remain broken. In 81 00:04:30,120 --> 00:04:33,600 Speaker 1: other ways. A lot of groups have come out against 82 00:04:33,640 --> 00:04:39,200 Speaker 1: the bill, including a RP, which campaigns for older Americans. 83 00:04:39,640 --> 00:04:44,320 Speaker 1: How how serious is this for older Americans if this 84 00:04:44,440 --> 00:04:49,320 Speaker 1: bill goes through. Well, older Americans are over the age 85 00:04:49,360 --> 00:04:53,400 Speaker 1: of st are covered under Medicare for the majority of 86 00:04:53,440 --> 00:04:56,440 Speaker 1: their services. The seniors who are the most affected by 87 00:04:56,480 --> 00:05:00,400 Speaker 1: this are our seniors who are living at or near 88 00:05:00,400 --> 00:05:03,520 Speaker 1: the poverty line who also qualify for Medicaid what we 89 00:05:03,560 --> 00:05:07,000 Speaker 1: call the dual eligibles or METI medi population UH and 90 00:05:07,000 --> 00:05:11,279 Speaker 1: and the Republican plan is significantly rolling back UH funding 91 00:05:11,360 --> 00:05:15,080 Speaker 1: for for poorer older Americans UM and I think that 92 00:05:15,080 --> 00:05:17,600 Speaker 1: that's a big source of the UH the A r 93 00:05:17,680 --> 00:05:20,080 Speaker 1: P S position. The other issue is that even though 94 00:05:20,440 --> 00:05:24,640 Speaker 1: the GOP plan does not actually limit Medicare spending UH, 95 00:05:24,680 --> 00:05:28,159 Speaker 1: it does cut significant taxes that fund Medicare, things like 96 00:05:28,240 --> 00:05:31,840 Speaker 1: the prescription drug tax and the medical device tax. And 97 00:05:31,880 --> 00:05:34,440 Speaker 1: I think the longer term fear is that the Republican 98 00:05:34,920 --> 00:05:38,240 Speaker 1: the next stage of the Republican agenda will be tougher 99 00:05:38,240 --> 00:05:40,760 Speaker 1: cuts into Medicare that will affect all seniors, not just 100 00:05:40,839 --> 00:05:44,320 Speaker 1: poor seniors. Well, in about thirty seconds, there's also the 101 00:05:44,320 --> 00:05:47,560 Speaker 1: the individual mandate you mentioned is gone, isn't there a 102 00:05:47,600 --> 00:05:51,719 Speaker 1: provision about penalties for people who don't go without health 103 00:05:51,720 --> 00:05:55,359 Speaker 1: insurance for some period of time. Yeah. So, so basically, 104 00:05:55,360 --> 00:05:58,680 Speaker 1: what the Republican plan is doing is shifting the the 105 00:05:58,680 --> 00:06:02,680 Speaker 1: the agent, the entity with power to penalize people from government, 106 00:06:03,160 --> 00:06:06,800 Speaker 1: which Republicans don't like, to insurance companies and so the government. 107 00:06:06,880 --> 00:06:10,560 Speaker 1: So the Republican plan does allow insurance companies to penalize 108 00:06:10,760 --> 00:06:14,920 Speaker 1: for anybody who doesn't uh continuously maintain coverage by applying 109 00:06:15,000 --> 00:06:17,600 Speaker 1: a one year penalty. That basically where that where the 110 00:06:17,640 --> 00:06:21,360 Speaker 1: person who basically allowed insurance to laps will pay an 111 00:06:21,400 --> 00:06:25,839 Speaker 1: additional searcharge for having let their insurance laps. We've been 112 00:06:25,880 --> 00:06:30,080 Speaker 1: speaking about Republican plans to repeal and replace Obamacare. In 113 00:06:30,120 --> 00:06:32,719 Speaker 1: the United States, healthcare makes up about eighteen percent of 114 00:06:32,800 --> 00:06:35,479 Speaker 1: g d P, and Speaker Paul Ryant has unveiled the 115 00:06:35,480 --> 00:06:39,520 Speaker 1: Republican bill to change America's health insurance system. He's been 116 00:06:39,560 --> 00:06:41,880 Speaker 1: selling the new act as a change from Obamacare, which 117 00:06:41,880 --> 00:06:45,440 Speaker 1: he says was fatally flawed. The whole idea of Obamacare, 118 00:06:45,960 --> 00:06:48,200 Speaker 1: the people who are healthy pay for the people who 119 00:06:48,240 --> 00:06:50,680 Speaker 1: are sick. It's not working, and that's why it's in 120 00:06:50,680 --> 00:06:53,880 Speaker 1: a death spiral. Ryan's bill has come under attack from 121 00:06:53,920 --> 00:06:56,400 Speaker 1: some who are concerned it rolls back too much of Obamacare, 122 00:06:56,520 --> 00:06:59,159 Speaker 1: such as the Medicaid expansion, and others who believe it 123 00:06:59,160 --> 00:07:03,040 Speaker 1: doesn't go far and often eliminating Obamacare. We've been talking 124 00:07:03,040 --> 00:07:05,599 Speaker 1: with Harry Nelson, a partner at Nelson Hardeman. He's the 125 00:07:05,680 --> 00:07:09,080 Speaker 1: author of From Obamacare to trump Care, Why You Should Care, 126 00:07:09,120 --> 00:07:14,280 Speaker 1: which takes a look at American healthcare law and policy. Harry, 127 00:07:14,520 --> 00:07:17,400 Speaker 1: in your book, you talk about different approaches that Democrats 128 00:07:17,400 --> 00:07:21,080 Speaker 1: and Republicans tend to favor. With the Democrats, the way 129 00:07:21,120 --> 00:07:22,400 Speaker 1: you seem to put it in the book is the 130 00:07:22,400 --> 00:07:26,440 Speaker 1: democrats favorite insurance approach, whereas Republicans don't really look at 131 00:07:26,480 --> 00:07:31,360 Speaker 1: this in an insurance lens. What do you mean by that? So, 132 00:07:31,640 --> 00:07:33,600 Speaker 1: what we mean by that is that for Republicans, the 133 00:07:34,000 --> 00:07:38,120 Speaker 1: real issue here is about spending, and about and and 134 00:07:38,120 --> 00:07:41,240 Speaker 1: and really an issue of tax relief. Republicans are looking 135 00:07:41,280 --> 00:07:45,440 Speaker 1: for the market to fix healthcare, essentially to bring prices 136 00:07:45,440 --> 00:07:48,640 Speaker 1: into alignment and to get get people the health care 137 00:07:48,640 --> 00:07:51,120 Speaker 1: they need and bring costs down. There. For the Republicans, 138 00:07:51,120 --> 00:07:54,000 Speaker 1: this is a cost issue. For the Democrats, this is 139 00:07:54,080 --> 00:07:59,160 Speaker 1: a a justice and really a compassion issue. You hear 140 00:07:59,240 --> 00:08:02,480 Speaker 1: Paul Ryan saying, you know what would have what's happening 141 00:08:02,520 --> 00:08:05,600 Speaker 1: now is that the young are paying for problems that 142 00:08:05,760 --> 00:08:09,360 Speaker 1: people and that are older women with breast cancer have 143 00:08:09,640 --> 00:08:13,160 Speaker 1: and the poor are paying for this. They keep they 144 00:08:13,240 --> 00:08:15,480 Speaker 1: equate this, the young are paying for the old. But 145 00:08:15,560 --> 00:08:19,239 Speaker 1: the young eventually will become the old and then people 146 00:08:19,240 --> 00:08:22,679 Speaker 1: will be paying for them. So what are they trying 147 00:08:22,720 --> 00:08:25,640 Speaker 1: to do here? They're trying to set the young against 148 00:08:25,640 --> 00:08:27,840 Speaker 1: the old. It just it just seems like that's that's 149 00:08:27,880 --> 00:08:30,280 Speaker 1: the way it works. So yeah, I think you hit 150 00:08:30,320 --> 00:08:32,960 Speaker 1: the nail on the head right the Democratic view of 151 00:08:32,960 --> 00:08:35,040 Speaker 1: how we fix health careers. But really by making health 152 00:08:35,040 --> 00:08:37,960 Speaker 1: care like social security, we all pay in when we're young. 153 00:08:38,480 --> 00:08:41,240 Speaker 1: Uh and because we went once you the study show 154 00:08:41,280 --> 00:08:43,880 Speaker 1: that somewhere in your fifties or early sixties, for for 155 00:08:43,920 --> 00:08:46,320 Speaker 1: a significant chunk of the population, you start hitting real 156 00:08:46,320 --> 00:08:48,920 Speaker 1: health issues, even though you most of us are healthy 157 00:08:49,120 --> 00:08:52,760 Speaker 1: throughout our twenties forties. Uh and and and that's so 158 00:08:52,760 --> 00:08:54,439 Speaker 1: that you have this this this change that we all 159 00:08:54,440 --> 00:08:57,319 Speaker 1: go through. Um the problem. You know, the Republicans hit 160 00:08:57,360 --> 00:09:00,720 Speaker 1: on a really winning issue beginning in twenty ten when 161 00:09:00,960 --> 00:09:04,560 Speaker 1: Scott Brown won ted Kennedy's seat in the Massachusetts Senate 162 00:09:04,640 --> 00:09:07,199 Speaker 1: rate by by talking about personal freedom and the right 163 00:09:07,240 --> 00:09:09,719 Speaker 1: of people not to be forced to buy insurance. So 164 00:09:09,800 --> 00:09:12,120 Speaker 1: the good news for the Republican was that they hit 165 00:09:12,160 --> 00:09:14,959 Speaker 1: on a winning issue by complaining that young people were 166 00:09:14,960 --> 00:09:17,400 Speaker 1: being forced to buy healthcare. The problem and the challenge 167 00:09:17,400 --> 00:09:19,840 Speaker 1: for the Republicans is that without those young people coming 168 00:09:19,840 --> 00:09:23,679 Speaker 1: into the system, it's very hard to stabilize the very 169 00:09:23,720 --> 00:09:27,079 Speaker 1: expensive costs that come with all of these age related conditions, 170 00:09:27,080 --> 00:09:31,480 Speaker 1: whether it's end of life care or chronic conditions like diabetes. Well, 171 00:09:31,520 --> 00:09:34,160 Speaker 1: on the other end, Harry, you know, from the right, 172 00:09:34,520 --> 00:09:38,640 Speaker 1: Ryan's bill is getting attacked as being Obamacare light by 173 00:09:38,640 --> 00:09:43,480 Speaker 1: some more conservative Republicans. Is that a fair assessment of it? Well, so, yeah, 174 00:09:43,559 --> 00:09:46,080 Speaker 1: I think there there is legitimate issue. From my in 175 00:09:46,120 --> 00:09:48,079 Speaker 1: my perspective, the best analogy I can use is it's 176 00:09:48,080 --> 00:09:51,240 Speaker 1: sort of like the difference between a parent who wants 177 00:09:51,280 --> 00:09:53,040 Speaker 1: to teach their kid to ride a bike by putting 178 00:09:53,080 --> 00:09:56,120 Speaker 1: on training wheels and and running alongside holding the kid 179 00:09:56,120 --> 00:09:58,440 Speaker 1: on the back, versus somebody who just sort of throws 180 00:09:58,480 --> 00:10:02,000 Speaker 1: the kid into it. The Ryan plan includes hundred billion 181 00:10:02,040 --> 00:10:06,240 Speaker 1: dollars through for what's called the Patient and State Stability 182 00:10:06,240 --> 00:10:09,280 Speaker 1: Fund that's going to essentially soft cushion the blow as 183 00:10:09,280 --> 00:10:12,079 Speaker 1: we transition from all these these people, this twenty to 184 00:10:12,200 --> 00:10:15,439 Speaker 1: thirty million Americans who got care in the last seven years, 185 00:10:15,720 --> 00:10:19,480 Speaker 1: and as we transition to Republican plan. The more purest 186 00:10:20,320 --> 00:10:24,880 Speaker 1: Republican right conservatives want to see just a straight move 187 00:10:25,000 --> 00:10:27,920 Speaker 1: to a system that works. And they're less concerned about 188 00:10:27,920 --> 00:10:30,760 Speaker 1: the pain, and they certainly don't like the spending. And 189 00:10:30,760 --> 00:10:32,320 Speaker 1: the other issue they're very worried about is all that 190 00:10:32,280 --> 00:10:35,760 Speaker 1: the how the tax cuts and the UH and all 191 00:10:35,800 --> 00:10:38,440 Speaker 1: the this this new spending lineup, and they're worried about 192 00:10:38,520 --> 00:10:42,120 Speaker 1: essentially adding to the budget deficit and the national debt 193 00:10:42,480 --> 00:10:45,720 Speaker 1: rather than shrinking it. Just about thirty seconds here, there 194 00:10:45,760 --> 00:10:50,120 Speaker 1: has been talk that President Trump might just leave it 195 00:10:50,559 --> 00:10:54,880 Speaker 1: everything as it is and let Obamacare die. What result 196 00:10:54,920 --> 00:10:58,240 Speaker 1: would that have, Well, that that could be the worst 197 00:10:58,240 --> 00:11:01,440 Speaker 1: of all worlds, uh, certain for for everybody, for these 198 00:11:01,480 --> 00:11:04,640 Speaker 1: twenty thirty million Americans who either got subsidies that helped 199 00:11:04,679 --> 00:11:07,040 Speaker 1: them get insurance for the first time UH and and 200 00:11:07,080 --> 00:11:09,599 Speaker 1: had to deal with disease, and with all of the 201 00:11:09,600 --> 00:11:13,400 Speaker 1: people who got Medicaid expansion, just allowing it to die 202 00:11:13,480 --> 00:11:16,760 Speaker 1: and be defunded. It is probably the worst option. Um, 203 00:11:16,800 --> 00:11:19,840 Speaker 1: you know what, from our perspective, what the Republican plan 204 00:11:19,920 --> 00:11:22,920 Speaker 1: looks like is a way to try and uh to repair, 205 00:11:23,520 --> 00:11:26,720 Speaker 1: rather than truly to do away with the system, because 206 00:11:26,760 --> 00:11:29,760 Speaker 1: there could be a voter revolt in eighteen if if 207 00:11:29,760 --> 00:11:33,080 Speaker 1: this thing is just allowed to disappear. That's Harry Nelson, 208 00:11:33,080 --> 00:11:35,560 Speaker 1: a partner at Nelson Hardeman and the author of From 209 00:11:35,559 --> 00:11:38,600 Speaker 1: Obamacare to trump Care, Why You Should Care. Thanks for 210 00:11:38,679 --> 00:11:42,360 Speaker 1: being with us on Bloomberg Law. Coming up on Bloomberg Law, 211 00:11:42,440 --> 00:11:47,600 Speaker 1: we're going to be talking about um tweets, the president's tweets. 212 00:11:48,000 --> 00:11:52,480 Speaker 1: Does he have to archive them? Some uh, some ethics 213 00:11:52,800 --> 00:11:55,559 Speaker 1: experts think that he should, and that he's required to 214 00:11:55,640 --> 00:11:57,520 Speaker 1: by federal law. And we're going to be talking that 215 00:11:57,679 --> 00:11:59,720 Speaker 1: coming up on Bloomberg Law.