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Senate Republicans Prepare To Release Details Of Their Health Care Plan


Today Senate Republicans promised to show their work. They've been secretly drafting a replacement for the Affordable Care Act. They are revising a bill that passed the House, a bill that President Trump has referred to in different ways. On one day, the president celebrated that measure in the Rose Garden. On another day, he called the bill mean. The measure was criticized for cutting back so much on health subsidies that tens of millions of Americans would go off health insurance. Last night in Iowa, the president suggested the Senate version of this bill should be different.


PRESIDENT DONALD TRUMP: And I think - and I hope - can't guarantee anything - but I hope we're going to surprise you with a really good plan. You know, I've been talking about a plan with heart. I said, add some money to it.

INSKEEP: Well, that raises a question for NPR's Alison Kodjak, who covers this story. Alison, is the Senate plan going to have more money and more heart?

ALISON KODJAK, BYLINE: Really going to track the House bill very closely - and that's because they are using this complicated legislative maneuver to pass this bill without any Democratic support. And that's tied to the budget. They have - they can't increase the deficit any more than the House did. And so the Senate doesn't have a lot of wiggle room.

INSKEEP: OK. So there may be some changes. We haven't seen the bill, but the math suggests not grand changes. And that makes us think at this moment, before we have the Senate bill, about the House plan, which, for example, says - this was a major criticism - if you're in your 50s, if you're not making very much money, you lose thousands of dollars in health care subsidies that you had previously. Can the Senate change that very easily?

KODJAK: They can change that in that they can shift around where the subsidies are. They're not adding tons of money to the bill. But they have promised to at least increase subsidies for the older population so that the blow isn't quite as big as it would have been in the House bill. And so what we're hearing is that, rather than giving subsidies to everybody, which was the original plan in the House bill - even wealthy - that they may tie these subsidies more to income and then make them more generous for people who are older...


KODJAK: ...Which could cut the blow to some degree.

INSKEEP: Let me ask about Medicaid. That's a huge part of this. Obamacare allowed states to expand Medicaid. Many eventually have done so. Republicans proposed to reshape the program in various ways and take hundreds of billions of dollars out. Are all Republicans entirely comfortable with that?

KODJAK: Yeah, no, they are not. And that is a big sticking point here. There are several Republicans in states that expanded Medicaid, and they're very concerned about throwing that vulnerable, low-income population off the system. Most of these people who got Medicaid expansion are the working poor. They're people who work. They sometimes work two jobs. They just don't make enough money to pay for health care premiums. But without health insurance, that makes them all that much more vulnerable. So you have senators like Susan Collins of Maine, Shelley Moore Capito in West Virginia, who are very worried about their low-income populations losing access to health insurance.

INSKEEP: Well, let me do a fact check here, before I let you go, of something that Democrats have said about Medicaid and they're surely going to keep saying. Democrats have said that what Republicans are doing here is taking people off Medicaid - including, as you said, working people - taking them off Medicaid, in order to cut taxes for the wealthy. Is that true?

KODJAK: It's true to some degree in that, yes, there are tax cuts go to the wealthy in that - there are tax cuts that are specifically for health care executives. There are tax cuts for wealthy people. There was a sub (ph) - an extra tax to help people pay for health care. And there's a lot of tax cuts for corporations. And those go, you know, eventually, to shareholders. So yes, the - not the low-income, working people who are going to get those tax cuts. But they are going to lose some of their support in health care.

INSKEEP: OK, so the broad strokes there from NPR's Alison Kodjak. And we'll learn the details of the Senate plan - we're told anyway - sometime today.

Alison, thanks very much.

KODJAK: Thank you, Steve. Transcript provided by NPR, Copyright NPR.

Alison Fitzgerald Kodjak is a health policy correspondent on NPR's Science Desk.