Think Tank

Repeal & Replace Watch

Podcast: What The Health? Senate Bill Sparks Fireworks Before The Fourth

From left, Julie Rovner of Kaiser Health News, Margot Sanger-Katz of The New York Times, Joanne Kenen of Politico and Paige Winfield Cunningham of The Washington Post team up for the inaugural episode of the “What the Health?” podcast. (Katherine Gilyard/California Healthline)

It was another cliffhanger week in Washington, D.C., as Senate Majority Leader Mitch McConnell tried — and failed, for now — to marshal the votes to approve his chamber’s controversial health bill.

Not helping matters, from GOP leaders’ standpoint, was the release Monday of a Congressional Budget Office report with a dismal forecast: 22 million fewer people would have insurance within the next 10 years under the Senate legislation than under existing law. That was just 1 million less than predicted under the House bill passed last month. Polls showed both bills have little public support.

Meanwhile, California health officials released an analysis projecting the state could take a $114.6 billion hit in federal Medicaid funding under the Senate bill, which would force it to rebuild the program, the largest in the nation, on a much smaller scale.

Congress members now are headed back to their districts for the Fourth of July recess. McConnell and the GOP leadership may use the time to regroup, fashioning deals with wavering Republican lawmakers with the help of some $200 billion in projected savings under the Senate bill (as compared to the House version). Legislators could get an earful from dissatisfied constituents, worried about losing coverage or angry about unkept promises to repeal the Affordable Care Act.

What will happen next? No one has the answers. But Kaiser Health News, in its inaugural “What the Health?” podcast, convened a group of experienced Washington, D.C., health reporters to discuss the possibilities. (KHN produces California Healthline.) The discussion included KHN’s Julie Rovner, Joanne Kenen of Politico, Margot Sanger-Katz of The New York Times and Paige Winfield Cunningham of The Washington Post. The transcript below contains highlights only and has been edited for clarity. 

Julie Rovner: Why was it so important to get [this bill] done before the Fourth of July?

Margot Sanger-Katz: I just think speed was really to their benefit in this process for a number of reasons. … I think there was a feeling among leadership that if all these [senators go home over the Fourth of July] and they see angry, sick people holding up signs, they’re going to be less enthusiastic about voting for the bill. I also just think … they don’t all really agree on a lot of really basic stuff about what they want the health care system to look like. And so I think there was a feeling that if everyone had a lot of time to negotiate and go over every detail and everyone got to present their special idea about what they want to do about health care that they were never all going to get on the same page. So the gamble was let’s write something. Let’s bring it out. Let’s have a vote right away. And that that’s sort of the best chance to passage.

Joanne Kenen: This was supposed to be easy. Remember this was supposed to be “Day One.” This was supposed to happen on Jan. 20 or maybe the following Monday. This was not supposed to be crashing up with no resolution by the July Fourth weekend. It has been harder than they anticipated. It has been more unpredictable than they anticipated. And the more time goes by, the more it gets picked apart.

Julie Rovner: You know they’ve been saying for seven years — ever since the Affordable Care Act passed — that we want to repeal and replace Obamacare. … Why didn’t they have something ready?

Paige Winfield Cunningham: Because they spent all of their time voting to repeal Obamacare and didn’t actually write legislation. You know you saw an effort in this direction by House Speaker Paul Ryan last year with the plan that they released but that was really just a framework and it’s very different to roll out a plan versus get everybody on board with it. … A lot of us wrote earlier this year about the difficulty of doing this through the budget reconciliation process, and there are certain things that can’t go into a repeal bill. But it’s been interesting to see that actually hasn’t been the biggest holdup over the last few weeks. They can’t even agree on the things that can go in the bill under the budget reconciliation process.

Margot Sanger-Katz: There’s plenty of low-hanging fruit to criticize about the health care system, but trying to come up with something better is actually pretty hard. And the last seven years have not really been an exercise in trying to constructively work together to reach consensus about what that is. … It’s very hard to make a change that makes one part of the health care system better without making another part a little worse, that helps one group of people without disadvantaging another one. [Republicans] have had the benefit of being able to point to all the people who were disadvantaged by Obamacare and to say, “Isn’t this horrible? We’re going to fix it.” … Part of the reason why the CBO report really seemed to torpedo this particular effort is really clear that their bill also has winners and losers.

Joanne Kenen: As soon as this thing fell apart this week, we found out a lot of people had quietly been not liking this bill.

Margot Sanger-Katz: I wonder a little bit about congressional leadership. It is kind of amazing to me watching this process to think that … almost all of the [Democratic] senators and … a large majority of the Democrats in the House voted for the Affordable Care Act, which did have some really serious trade-offs and did probably have some features that you know people had to hold their nose to vote for.

Julie Rovner: One big difference between 2009 and now [is] there were a lot of members of Congress who’d been here for a very long time. They had been through the ups and downs of working on health legislation. People like Henry Waxman and John Dingell, who had been fighting for national health insurance since he came to Congress in the 1950s. … They lived through the Clinton health care plan … and then they’d lived through the Balanced Budget Act, which was the one time that Democrats and Republicans came together and did a lot in terms of health care. That’s when they created the CHIP [Children’s Health Insurance] program. So they had seen what had worked and what hadn’t. And I think it was really the leadership of those longtime Democrats who had been here and been through the wars. George Miller from California was active in doing this. Nancy Pelosi obviously had been here.

Paige Winfield Cunningham: I think it’s really striking that they haven’t managed to get anybody in the health care industry on board with this. I mean, if you look back in 2010 — I wasn’t around then — but there was buy-in, as I understand it, pretty broadly across the board. You’ve seen virtually all of the doctors and hospitals come out against this bill, and the insurers are basically staying neutral on it for the most part.

Margot Sanger-Katz: This … has led to one of the funniest parts of this debate, which is that you see Democrats all the time standing up and saying, “Isn’t it horrible how none of the lobbyists endorsed this bill.” … It is a really funny, ironic thing that you have Democrats who are so often railing against the power of big money … crowing about how the hospital lobby, the health insurance lobby are not endorsing us.

Julie Rovner: One of the lessons — probably the most important lesson — that people who are putting the Affordable Care Act together learned from the failed Clinton [administration] effort is that you can’t overcome the opposition of the insurance industry and the drug industry. … [Even before Barack Obama had won the Democratic nomination], there were these meetings going on with industry groups trying to [get] buy-in. So by the time he was inaugurated, there was already a framework of what this bill would look like that [former Senate Finance Committee Chairman] Max Baucus would put out.

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This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.