1 00:00:00,120 --> 00:00:02,840 Speaker 1: Many thought the Republican attempted to repeal and replace the 2 00:00:02,840 --> 00:00:06,800 Speaker 1: Affordable Care Act, better known as Obamacare, was dead, but today, 3 00:00:06,840 --> 00:00:09,480 Speaker 1: in fact, within the next hour, the House of Representatives 4 00:00:09,520 --> 00:00:11,879 Speaker 1: is expected to vote on a Republican healthcare bill that 5 00:00:11,880 --> 00:00:15,560 Speaker 1: would dramatically change the American health insurance landscape. The bill 6 00:00:15,600 --> 00:00:18,160 Speaker 1: has not yet received a score from the Congressional Budget Office, 7 00:00:18,160 --> 00:00:20,520 Speaker 1: and changes to the bill appear to be happening up 8 00:00:20,520 --> 00:00:22,880 Speaker 1: to the last minute. It appears clear, however, that the 9 00:00:22,880 --> 00:00:26,040 Speaker 1: bill would have enormous ramifications for how healthcare works across 10 00:00:26,079 --> 00:00:29,600 Speaker 1: the country, including who gets insurance coverage, what people pay 11 00:00:29,640 --> 00:00:33,000 Speaker 1: for it, and what is covered under insurance plans. With 12 00:00:33,080 --> 00:00:36,120 Speaker 1: us to talk about the Republican bill are Anna Edney, 13 00:00:36,360 --> 00:00:39,400 Speaker 1: who is Bloomberg News Healthcare reporter, and Bloomberg First World 14 00:00:39,440 --> 00:00:42,279 Speaker 1: reporter Greg Sullivan. We're glad to have both of you 15 00:00:42,520 --> 00:00:46,800 Speaker 1: here today. Anna, this bill will affect something like one 16 00:00:46,960 --> 00:00:51,240 Speaker 1: sixth of the American economy, the American healthcare system. It's 17 00:00:51,240 --> 00:00:53,840 Speaker 1: got a lot in it. Um. You know, people have 18 00:00:53,920 --> 00:00:56,120 Speaker 1: focused on kind of some of the amendments at the 19 00:00:56,200 --> 00:00:58,960 Speaker 1: last minute about pre existing conditions and high risk pools 20 00:00:59,000 --> 00:01:01,720 Speaker 1: and things. But can you summarize for us kind of 21 00:01:01,760 --> 00:01:06,160 Speaker 1: what the major provisions of this bill are sure so 22 00:01:06,520 --> 00:01:09,319 Speaker 1: and when it was introduced back in the beginning of March, 23 00:01:09,400 --> 00:01:14,200 Speaker 1: the main focus was to undo an Obamacare mandate that 24 00:01:14,280 --> 00:01:18,520 Speaker 1: everyone has to purchase insurance and the employers have to 25 00:01:18,720 --> 00:01:23,800 Speaker 1: provide that insurance UM, so that would be eliminated in 26 00:01:23,840 --> 00:01:28,400 Speaker 1: this legislation, as well as some tax um taxes on 27 00:01:28,560 --> 00:01:33,160 Speaker 1: health insurance companies, drugmakers, and the wealthy UM those were 28 00:01:33,280 --> 00:01:36,479 Speaker 1: used to fund Obamacare, so those would be eliminated as well. 29 00:01:36,840 --> 00:01:40,240 Speaker 1: There's also a big piece of this is getting rid 30 00:01:40,280 --> 00:01:43,720 Speaker 1: of an expansion of Medicaid UM that the Affordable Care 31 00:01:43,760 --> 00:01:47,120 Speaker 1: Act allowed for, so some some states opted into that, 32 00:01:47,240 --> 00:01:52,040 Speaker 1: and it would wind that down in so UM at least. 33 00:01:52,120 --> 00:01:55,720 Speaker 1: You know, a few weeks ago, the Congressional Budget Office 34 00:01:55,760 --> 00:01:58,960 Speaker 1: said that that would mean fourteen million fewer people would 35 00:01:59,000 --> 00:02:03,440 Speaker 1: be enrolling in the program. So those were some of 36 00:02:03,440 --> 00:02:06,800 Speaker 1: the main focuses of of this legislation. It also would 37 00:02:06,880 --> 00:02:10,120 Speaker 1: replace some of the tax h the subsidies that people 38 00:02:10,200 --> 00:02:14,720 Speaker 1: receive now under Obamacare to afford their premiums um with 39 00:02:14,840 --> 00:02:17,360 Speaker 1: some things that are less focused on income. The tax 40 00:02:17,400 --> 00:02:20,760 Speaker 1: credits instead would be focused more on age, Greg Sullivan, 41 00:02:20,760 --> 00:02:24,320 Speaker 1: You've been following the numbers here very closely in terms 42 00:02:24,320 --> 00:02:27,480 Speaker 1: of whether Republicans actually have the votes to pass this. 43 00:02:27,680 --> 00:02:30,919 Speaker 1: They need to sixteen. What's what's our best sense of 44 00:02:30,919 --> 00:02:32,880 Speaker 1: of how close they are? Well, it's going to be 45 00:02:33,000 --> 00:02:36,239 Speaker 1: very close. There's still some uncertainty as to whether leaders 46 00:02:36,280 --> 00:02:39,280 Speaker 1: have the votes. They've been expressing confidence that they will 47 00:02:39,320 --> 00:02:41,400 Speaker 1: get there, that they will pass the measure. House majority 48 00:02:41,480 --> 00:02:45,160 Speaker 1: leader Kevin McCarthy said explicitly, we have the votes. However, 49 00:02:45,400 --> 00:02:48,320 Speaker 1: dozens of lawmakers have not commented how they will vote 50 00:02:48,360 --> 00:02:50,239 Speaker 1: or have said that they are undecided, and at least 51 00:02:50,240 --> 00:02:52,760 Speaker 1: fourteen have told Bloomberg that they will vote no on 52 00:02:52,840 --> 00:02:55,920 Speaker 1: the measure. This means, given that they can only lose 53 00:02:56,000 --> 00:02:58,520 Speaker 1: about twenty two if everyone shows up to vote, it 54 00:02:58,560 --> 00:03:01,119 Speaker 1: means they're only a few away from potentially not having 55 00:03:01,160 --> 00:03:04,320 Speaker 1: the votes. So and people thought that, in fact, they 56 00:03:04,320 --> 00:03:06,880 Speaker 1: weren't going to have the votes until pretty much yesterday 57 00:03:07,000 --> 00:03:10,840 Speaker 1: when when their leadership said that they did. What is it? 58 00:03:10,880 --> 00:03:13,399 Speaker 1: That's what you know? The A lot of the talk 59 00:03:13,440 --> 00:03:15,919 Speaker 1: has been about how whether or not the bill actually 60 00:03:15,919 --> 00:03:18,760 Speaker 1: protects people with pre existing conditions. So can you sketch 61 00:03:18,760 --> 00:03:21,320 Speaker 1: out for a bit of detail about what they've changed 62 00:03:21,360 --> 00:03:26,480 Speaker 1: in the bill that would address that issue. Sure, So, um, 63 00:03:26,520 --> 00:03:30,240 Speaker 1: you know, first of all, there is an amendment that 64 00:03:30,840 --> 00:03:36,200 Speaker 1: allowed states to apply for waivers that would let insurance 65 00:03:36,240 --> 00:03:39,640 Speaker 1: companies charge people with pre existing conditions more, and that's 66 00:03:39,680 --> 00:03:42,800 Speaker 1: if they had a gap in coverage in the previous year. 67 00:03:43,400 --> 00:03:46,680 Speaker 1: And that was able to help bring um, some of 68 00:03:46,720 --> 00:03:50,480 Speaker 1: the conservative members on board who were really concerned about 69 00:03:50,520 --> 00:03:53,640 Speaker 1: bringing the cost of insurance down. But of course that 70 00:03:53,720 --> 00:03:56,600 Speaker 1: made some moderates uncomfortable. They weren't sure that there was 71 00:03:57,000 --> 00:04:01,280 Speaker 1: going to be enough protection for people with pre existing conditions. 72 00:04:01,360 --> 00:04:05,320 Speaker 1: So there, you know, just yesterday came up an amendment 73 00:04:05,400 --> 00:04:09,120 Speaker 1: from Congressman Fred Upton, and that would provide eight billion 74 00:04:09,120 --> 00:04:13,960 Speaker 1: dollars over five years to try and bring some assistance 75 00:04:14,000 --> 00:04:16,360 Speaker 1: to those people with pre existing conditions, on top of 76 00:04:16,400 --> 00:04:20,400 Speaker 1: some money that is already in the bill. Greg that 77 00:04:20,480 --> 00:04:22,200 Speaker 1: eight billion is really kind of a drop in the 78 00:04:22,200 --> 00:04:25,159 Speaker 1: bucket in terms of the big picture of healthcare dollars, 79 00:04:25,160 --> 00:04:27,599 Speaker 1: and critics say that's actually not enough to make a 80 00:04:27,600 --> 00:04:29,880 Speaker 1: big difference. But does that seem to you like it 81 00:04:29,920 --> 00:04:32,800 Speaker 1: has been enough that it has a swede. Swede the 82 00:04:32,839 --> 00:04:35,960 Speaker 1: moderate members who who the leadership has been worried about 83 00:04:36,000 --> 00:04:38,800 Speaker 1: losing here. Well, it does seem to have changed the momentum. 84 00:04:39,000 --> 00:04:41,160 Speaker 1: Several members who had previously said that they were no 85 00:04:41,480 --> 00:04:43,680 Speaker 1: or undecided have in fact gone on the record saying 86 00:04:43,680 --> 00:04:45,880 Speaker 1: they will support the measure. Now, it's unclear whether it 87 00:04:45,880 --> 00:04:48,599 Speaker 1: will be enough to draw everyone needed to pass the bill, 88 00:04:48,720 --> 00:04:51,680 Speaker 1: but it certainly seems to be getting closer. Uh. And 89 00:04:52,120 --> 00:04:54,400 Speaker 1: so if we only have about a minute here, But 90 00:04:54,920 --> 00:04:57,920 Speaker 1: there are really dramatic changes to Medicaid in this bill, 91 00:04:57,960 --> 00:05:01,200 Speaker 1: aren't there for sure? Um? You know, there are changes 92 00:05:01,240 --> 00:05:04,960 Speaker 1: to how Medicaid is funded and so that has even 93 00:05:05,000 --> 00:05:09,760 Speaker 1: some insurance companies concerned. Um. And then there are changes 94 00:05:09,839 --> 00:05:13,440 Speaker 1: to the expansion. Um. It there is a wider net 95 00:05:13,480 --> 00:05:15,839 Speaker 1: that states were able to cast to bring in people 96 00:05:15,839 --> 00:05:19,359 Speaker 1: for Medicaid, and um, that could the matching money for 97 00:05:19,400 --> 00:05:21,680 Speaker 1: that that the federal government gives to states could be 98 00:05:21,680 --> 00:05:25,080 Speaker 1: going away. In the House of Representatives is about to 99 00:05:25,120 --> 00:05:28,039 Speaker 1: begin voting on the American Healthcare Act, the Republican bill 100 00:05:28,080 --> 00:05:31,360 Speaker 1: that will repeal the Affordable Care Act, popularly popularly known 101 00:05:31,360 --> 00:05:35,000 Speaker 1: as Obamacare. The Republican bill would eliminate the individual mandate 102 00:05:35,040 --> 00:05:37,960 Speaker 1: to have insurance changed the way insurance companies can handle 103 00:05:37,960 --> 00:05:41,719 Speaker 1: people with pre existing conditions, make large changes to Medicaid, 104 00:05:41,760 --> 00:05:44,560 Speaker 1: and provide a tax cut that critics say would predominantly 105 00:05:44,600 --> 00:05:47,760 Speaker 1: benefit the wealthy. With us to talk about the bill 106 00:05:48,200 --> 00:05:51,400 Speaker 1: here on Bloomberg Law are Bloomberg News healthcare reporter Anna 107 00:05:51,520 --> 00:05:55,960 Speaker 1: Edney and Bloomberg Congress reporter rit John Anna. One of 108 00:05:55,960 --> 00:06:00,240 Speaker 1: the things that is interesting about the ways US this 109 00:06:00,360 --> 00:06:02,000 Speaker 1: has worked to get the bill to the floor has 110 00:06:02,040 --> 00:06:05,640 Speaker 1: been that there is not a CBO score. Now, Um, 111 00:06:05,640 --> 00:06:07,960 Speaker 1: there was a CBO score on the previous version of 112 00:06:07,960 --> 00:06:11,160 Speaker 1: the bill that said something like million people would lose 113 00:06:11,200 --> 00:06:15,279 Speaker 1: insurance under the bill by two thousand six. Do we 114 00:06:15,320 --> 00:06:17,800 Speaker 1: have any sense of what the likely CBO score of 115 00:06:17,800 --> 00:06:19,480 Speaker 1: this is going to be when they eventually get around 116 00:06:19,480 --> 00:06:23,560 Speaker 1: to scoring the bill. We don't. Actually, it's hard to 117 00:06:23,640 --> 00:06:28,640 Speaker 1: gauge what the effect exactly could be, particularly since the 118 00:06:28,760 --> 00:06:32,960 Speaker 1: language actually, um for these amendments haven't has not been 119 00:06:33,000 --> 00:06:37,360 Speaker 1: out there all that very long. Um. You know, there 120 00:06:37,360 --> 00:06:40,240 Speaker 1: our thoughts on both sides. Republicans claim the changes they 121 00:06:40,320 --> 00:06:43,240 Speaker 1: make will bring down the cost of insurance so more 122 00:06:43,279 --> 00:06:45,560 Speaker 1: people are going to be signing up for it, and 123 00:06:45,600 --> 00:06:50,200 Speaker 1: that they're not going to lose as many um in 124 00:06:50,440 --> 00:06:53,760 Speaker 1: coverage as they as the Congressional Budget Office has said before. 125 00:06:54,360 --> 00:06:56,760 Speaker 1: And then there are those um you know on the 126 00:06:56,800 --> 00:07:01,560 Speaker 1: Democratic side who think that insurance will be unaffordable for 127 00:07:01,640 --> 00:07:04,920 Speaker 1: a lot of people, particularly those four with pre existing 128 00:07:04,960 --> 00:07:08,440 Speaker 1: conditions since some of these changes that were made in 129 00:07:08,480 --> 00:07:11,679 Speaker 1: the bill, and that that could actually increase the number 130 00:07:11,720 --> 00:07:16,000 Speaker 1: of uninsured that CBO came up with previously. You're there 131 00:07:16,040 --> 00:07:19,240 Speaker 1: on Capitol Hill. Tell us what you're hearing from Republicans. 132 00:07:19,280 --> 00:07:23,320 Speaker 1: Are they still as confident in getting this past as 133 00:07:23,360 --> 00:07:28,320 Speaker 1: they suggested earlier this morning? Well, Tom Cole said that 134 00:07:28,400 --> 00:07:31,080 Speaker 1: they went into their conference meeting this morning listening to 135 00:07:31,320 --> 00:07:33,320 Speaker 1: I have a tiger and taking care of business. So 136 00:07:33,360 --> 00:07:36,440 Speaker 1: I think that they are. They have to be confident 137 00:07:36,520 --> 00:07:38,280 Speaker 1: that they have the votes. That's what we've been hearing 138 00:07:38,280 --> 00:07:40,680 Speaker 1: for the last few weeks that well, when they have 139 00:07:40,800 --> 00:07:43,760 Speaker 1: the vote, will have the vote. And so for Speaker 140 00:07:43,840 --> 00:07:48,480 Speaker 1: Ryan Too and Majority Lay McCarthy to schedule this vote 141 00:07:48,520 --> 00:07:52,280 Speaker 1: after the embarrassment last month, they must have it. And 142 00:07:52,320 --> 00:07:54,840 Speaker 1: we've been hearing for a few days people saying we're confident, 143 00:07:54,840 --> 00:07:57,440 Speaker 1: We're confident that spread up into vetment to add more 144 00:07:57,480 --> 00:08:01,560 Speaker 1: money to cover pre existing change that that swayed a 145 00:08:01,560 --> 00:08:04,160 Speaker 1: lot of votes. So I think that people are feeling 146 00:08:04,160 --> 00:08:07,280 Speaker 1: pretty good. Maybe a little nervous, but likely more nervous 147 00:08:07,280 --> 00:08:08,760 Speaker 1: about what's going to happen to the bill in the 148 00:08:08,800 --> 00:08:11,400 Speaker 1: Senate than what's going to happen on the floor today. Well, Arie, 149 00:08:11,440 --> 00:08:13,440 Speaker 1: why don't we talk about that? What what is likely 150 00:08:13,480 --> 00:08:15,640 Speaker 1: to happen. Let's assume for the moment it gets through 151 00:08:15,680 --> 00:08:18,440 Speaker 1: the House. What happens when it gets to the Senate, 152 00:08:20,160 --> 00:08:22,960 Speaker 1: No one really knows. I talked to one lawmaker today 153 00:08:23,000 --> 00:08:25,800 Speaker 1: who is against the bills. He said, I've heard that 154 00:08:25,880 --> 00:08:28,040 Speaker 1: the Senage talking to do anything. I've heard that the 155 00:08:28,080 --> 00:08:31,280 Speaker 1: bill is going to come back completely unrecognizable. I think 156 00:08:31,360 --> 00:08:33,360 Speaker 1: that the main problem is that this is a bill 157 00:08:33,679 --> 00:08:36,719 Speaker 1: that was heavily influenced by the Freedom Caucus, and when 158 00:08:36,720 --> 00:08:38,560 Speaker 1: it gets over to the Senate, you have a lot 159 00:08:38,600 --> 00:08:42,480 Speaker 1: of moderate like Susan Collins, even Bill Cassidy's people who 160 00:08:42,800 --> 00:08:47,000 Speaker 1: are very concerned about what's repealing the Medicaid expansion means 161 00:08:47,000 --> 00:08:50,000 Speaker 1: for their state because because they represent the whole state, 162 00:08:50,040 --> 00:08:52,160 Speaker 1: not just a district. So I think that you have 163 00:08:52,520 --> 00:08:54,840 Speaker 1: that wing, and then you also have head Cruise and 164 00:08:54,920 --> 00:08:57,719 Speaker 1: Mike Lee, who some people think we'll try and make 165 00:08:57,760 --> 00:09:00,760 Speaker 1: the bill even more conservative. So I mean, it's just 166 00:09:01,200 --> 00:09:03,120 Speaker 1: it's really hard to say what's going to happen. And 167 00:09:03,120 --> 00:09:05,960 Speaker 1: then if the bill becomes more moderate, it comes back 168 00:09:05,960 --> 00:09:07,640 Speaker 1: to the House and then you do this whole dance 169 00:09:07,679 --> 00:09:11,320 Speaker 1: over again. And as we've discussed, one of the pivotal 170 00:09:11,320 --> 00:09:14,880 Speaker 1: position provisions in this in this bill is that states 171 00:09:14,880 --> 00:09:18,040 Speaker 1: will be allowed to seek waivers of of the requirements 172 00:09:18,920 --> 00:09:21,680 Speaker 1: of federal law. Do we have any sense as to 173 00:09:21,760 --> 00:09:24,960 Speaker 1: whether a lot of states would would take advantage of 174 00:09:25,000 --> 00:09:28,840 Speaker 1: that and actually you know, uh, you know, say reduce 175 00:09:29,000 --> 00:09:32,800 Speaker 1: the requirements for for the plans that have to be 176 00:09:32,880 --> 00:09:37,080 Speaker 1: available for people. So um, a lot of lawmakers have 177 00:09:37,200 --> 00:09:39,440 Speaker 1: said that on the Republican side has said that they 178 00:09:39,520 --> 00:09:42,000 Speaker 1: don't think there will be a lot of use of 179 00:09:42,040 --> 00:09:44,880 Speaker 1: these waivers. Then that calls into question, Okay, why is 180 00:09:44,920 --> 00:09:47,560 Speaker 1: this really in the law then? Um. But at the 181 00:09:47,600 --> 00:09:52,199 Speaker 1: same time, I did reach out to a few states yesterday. Um, 182 00:09:52,360 --> 00:09:54,560 Speaker 1: some of the more conservative ones, some of the ones 183 00:09:54,640 --> 00:09:58,319 Speaker 1: where the Obamacare markets are in trouble, like Tennessee, where 184 00:09:58,520 --> 00:10:02,319 Speaker 1: you know, they're losing coverage there because there are no options. 185 00:10:02,320 --> 00:10:05,280 Speaker 1: Insurers are dropping out, and they said, we just don't 186 00:10:05,280 --> 00:10:07,160 Speaker 1: know yet. We still have to look at it. We're 187 00:10:07,240 --> 00:10:10,880 Speaker 1: glad for the flexibility if this is actually what ends 188 00:10:10,960 --> 00:10:12,880 Speaker 1: up being the end result, but we don't know if 189 00:10:12,920 --> 00:10:16,040 Speaker 1: well that's something we would apply for yet. So you 190 00:10:16,080 --> 00:10:17,840 Speaker 1: mentioned Tennessee, and that's one thing I wanted to ask 191 00:10:17,840 --> 00:10:20,080 Speaker 1: you about. There are other states also, like Iowa, where 192 00:10:20,120 --> 00:10:23,599 Speaker 1: it looks like they maybe without and ensure who's is 193 00:10:23,640 --> 00:10:27,600 Speaker 1: operating in the Obamacare marketplace? What what would happen if 194 00:10:27,679 --> 00:10:30,240 Speaker 1: this bill doesn't go go through? What I mean, we're 195 00:10:30,480 --> 00:10:34,920 Speaker 1: it's not like the Obamacare you know as as uh 196 00:10:36,280 --> 00:10:39,640 Speaker 1: uh run by the Trump administration seems to be working 197 00:10:39,760 --> 00:10:42,640 Speaker 1: very well at the moment right well, you know, and 198 00:10:42,480 --> 00:10:45,200 Speaker 1: and there really is no Plan B that we know of. 199 00:10:45,400 --> 00:10:50,040 Speaker 1: So the the idea is if Obamacare was to remain law, 200 00:10:50,240 --> 00:10:53,720 Speaker 1: you know what could happen. The Trump administration hasn't exactly 201 00:10:54,320 --> 00:10:58,280 Speaker 1: been very keen on enforcing the pieces of Obamacare that 202 00:10:58,400 --> 00:11:01,520 Speaker 1: might be needed to um to shore up the markets 203 00:11:01,520 --> 00:11:04,240 Speaker 1: and maybe bring some of those insurers back. So it 204 00:11:04,280 --> 00:11:06,760 Speaker 1: looks like the possibility could be going back to the 205 00:11:06,840 --> 00:11:10,160 Speaker 1: drawing board, but actually having Democrats at the table this time. 206 00:11:10,160 --> 00:11:12,880 Speaker 1: Which is a key piece that is missing that insurance 207 00:11:12,920 --> 00:11:16,200 Speaker 1: executives have called for bringing to the table because they 208 00:11:16,240 --> 00:11:19,400 Speaker 1: don't see this being anything that has any staying power 209 00:11:19,480 --> 00:11:23,480 Speaker 1: if there's not a bipartisan solution. Well, our thanks to 210 00:11:23,920 --> 00:11:27,480 Speaker 1: uh Anna Ednie, Bloomberg News Healthcare reporter, and also to 211 00:11:27,720 --> 00:11:30,719 Speaker 1: Ari John uh the Bloomberg Congress reporter, for talking to 212 00:11:30,800 --> 00:11:35,080 Speaker 1: us about the impending vote on the American Healthcare Act 213 00:11:35,200 --> 00:11:38,840 Speaker 1: republican alternative to Obamacare that is being debated on the 214 00:11:38,880 --> 00:11:40,720 Speaker 1: House floor as we speak.