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Senate Republicans Have Their Work Cut Out For Them With Health Bill


So Senate Republicans, it would appear, have their work cut out for them this week.


Indeed. Ever since they unveiled their plan last week to replace the Affordable Care Act, or Obamacare, there's been steady resistance - but not just from Democrats, from members of their own party as well. Two different Republican factions in the Senate say they will not back the current bill. And either faction alone could sink this thing.

GREENE: And meanwhile, senators could have a bit more information to help their decision making. Beginning today, the Congressional Budget Office is expected to give its assessment of the bill's impact. This is the nonpartisan government agency that's meant to be above the partisan fray in this debate. And let's talk about this with NPR congressional correspondent Susan Davis and NPR health policy correspondent Alison Kodjak, both in our studios. Good morning to you both.

SUSAN DAVIS, BYLINE: Good morning, David.


GREENE: Sue, let me start with you. Is - am I oversimplifying to say you've got some Republicans to the left, some Republicans to the right, both with some hesitation about this bill and creating a problem for the Republican leadership?

DAVIS: Yeah, that's about - I mean, you know, you have to remember that they have a pretty narrow margin. There's 52 Republican senators. And under the way that they're doing this bill, they can pass it with - they can't lose any more than two votes, right?

GREENE: Right.

DAVIS: So that's a pretty narrow margin of error.

GREENE: They need no - they need no Democrats. They just can't lose many Republicans.

DAVIS: Exactly, and so on the one hand of this equation, you have a group of conservatives, people like Ted Cruz of Texas, Rand Paul of Kentucky, who are saying this bill just doesn't do enough. It doesn't go far enough to make good on our campaign promise to repeal and replace the Affordable Care Act.

On the other end of the equation, you have more centrist, more moderate senators, like Susan Collins of Maine, Lisa Murkowski of Alaska, saying, whoa, whoa, whoa, maybe in some ways this bill might do too much, particularly when it comes to the Medicaid program.

And they might want to be able to have some flexibility in this debate to make sure that their states are protected. And the man in the middle of all of this is Senate Majority Leader Mitch McConnell, who is the one that has to navigate this path and try and pass a bill.

GREENE: Well, how do you do that if you're Mitch McConnell? How do you make Rand Paul happy without making Susan Collins less happy or vice versa? Is - are there any options?

DAVIS: You know, we have a block of about six to eight senators right now saying they're not ready to support this bill. But you'll notice, they haven't said they're going to vote against it. If they bring up this bill...

GREENE: This is like an invitation to negotiate.

DAVIS: Yes, if...

GREENE: Come to me.

DAVIS: If they bring the bill up this week, they're going to have an opportunity to go through a very long amendment process. And in some ways, senators are holding their fire and do use those votes as negotiating tactics. What can I get in this bill that can get me to yes? It seems like it's going to be very difficult. But, you know, don't underestimate the political will of Republicans who want to be able to say that they passed this bill and go home and campaign on that.

GREENE: Well, Alison Kodjak, let's dig into the substance of this bill a little bit. One of the senators Sue mentioned, Republican Rand Paul of Kentucky, saying he can't currently support this. And he talked about that a little bit on ABC's "This Week," and talking about what might need to change and what he's concerned about.


RAND PAUL: It's a false sort of over promising to say, oh, yeah, insurance premiums are going to go down. But we're keeping 10 of the 12 mandates that cause the prices to go up. It's a - it's a foolish notion to promise something you can't provide.

GREENE: So Rand Paul - it sounds like he is saying there, sure, insurance premiums are going to go down. But this thing, in his mind, still looks like Obamacare, and to say otherwise is a false promise. Does he have a point?

KODJAK: Yeah, he has a good point. Like he said, many of the Affordable Care Act mandates remain. And so that's something that someone like Rand Paul has trouble voting for. But in addition, one of the big complaints about the Affordable Care Act was the rising costs and the high out-of-pocket costs, the deductibles and co-payments. And this bill sort of bakes those in.

Insurance premiums may be lower for some people, like - likely the younger, healthier people. But they may go up for older people or people who are sicker. And in addition, the way the bill is written, the policies that people will buy are going to pay less of a share of their health care costs. So you're getting less for less money or less for more money.

GREENE: Well, we're going to learn more specifics about those very things, potentially, when the Congressional Budget Office comes out with this score and its analysis of this bill. We're expecting that today. How important is that? How much is riding on that?

KODJAK: Well, it's unclear how much is riding on it in terms of Senate votes because the Republicans have been sending parts of the bill back and forth between - to this Congressional Budget Office in order to make sure that it falls within the ranges they can deal with.

However, what is important is how it's going to play out throughout this week, when they are debating the bill publicly. If it has 20 or 23 million people, as the House bills did, losing insurance or fewer people having insurance over the next several years, that's going to be hard for them to justify.

GREENE: Sue Davis, President Trump got involved to an extent when this was happening on the House side. What are you seeing from the president so far? And should we expect him to start digging in more this week?

DAVIS: The White House has really deferred to Mitch McConnell to sort of put this bill together, both on the policy and the politics. But I don't think we can underestimate how much the White House really wants this bill. The White House was pivotal in reviving the House bill after it initially failed earlier this year and getting a vote and getting that bill passed. President Trump wants to sign this bill.

And the - and the political reality we have, even though the policies in this bill are very controversial, is remember that every single Republican serving in Congress today ran on a promise to do this, that the White House believes that Trump won election in part on this campaign promise. So the political pressure on Republicans from their base, from their grass roots to deliver on this is tremendous, even if you look at the polling numbers that say, hey, this bill isn't that popular nationally.

GREENE: And Alison Kodjak, before I let you both go, what exactly is going to happen in the days to come?

KODJAK: Well, I don't think anyone knows exactly what's going to happen. But I think we're going to see...

GREENE: I put you on the spot, sorry.

KODJAK: It's OK. There's going to be a lot of horse-trading. How can Mitch McConnell win over Lisa Murkowski and perhaps Ted Cruz? So, you know, there's going to be a lot of dealmaking on the floor, perhaps little nuggets for specific states. Or a big concern is how you deal with these lower-income people who might have their Medicaid cut. So pots of money may be created to - for specific constituencies. And we'll see how that trading goes this week.

GREENE: Trying to win over these senators on the fence. NPR's Alison Kodjak and Susan Davis. Thank you both so much.

DAVIS: Have a great day.

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

Susan Davis is a congressional correspondent for NPR and a co-host of the NPR Politics Podcast. She has covered Congress, elections, and national politics since 2002 for publications including USA TODAY, The Wall Street Journal, National Journal and Roll Call. She appears regularly on television and radio outlets to discuss congressional and national politics, and she is a contributor on PBS's Washington Week with Robert Costa. She is a graduate of American University in Washington, D.C., and a Philadelphia native.
Alison Fitzgerald Kodjak is a health policy correspondent on NPR's Science Desk.