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Trump Faces High Stakes Over Senate Republican Health Care Bill


The Supreme Court's announcement that it would take up the travel ban is one thing that makes this a big week for President Trump - another, Senate Republicans' effort to pass a replacement to the Affordable Care Act or Obamacare by July Fourth. NPR national political correspondent Mara Liasson joins us from the White House to talk about that. Hi, Mara.


SHAPIRO: Let's start out with the score that came out just this afternoon from the nonpartisan Congressional Budget Office which says 22 million more people would be uninsured over the next decade under the Senate legislation. Tell us more about what the CBO says.

LIASSON: Well, the CBO - so that means it's almost identical to the CBO score for the House bill, which had said that 23 million more people would be uninsured. It also says that older, poorer people would have higher out-of-pocket spending on health care. And in some cases, people who get their coverage through their employer might get less coverage because there were - there will be annual and lifetime limits on covered benefits in some cases. However, the CBO did have a little bit of good news for the Republicans. There's more deficit reduction in the bill than there was in the House bill. And if that's your goal, that's a good thing.

SHAPIRO: At the same time, President Trump has been tweeting that Obamacare is failing. He says it's dead. Is that an effective way to sell this?

LIASSON: That certainly is the way they're selling it. They've been having administration officials go all over the country and meet with people they call Obamacare victims. However, as he is saying this, Obamacare keeps on getting more and more popular. In the polls it's now up to 51 percent. And the House bill - and now we will wait for polling on the Senate bill - is getting less and less popular. The thing that the bill does - it does two different things.

It changes the individual market, raises premiums and deductibles for people in the individual market, particularly, as I said, older, sicker, lower income people. But it also transforms Medicaid. It changes it from an entitlement into a block grant. That is a generational achievement for conservatives if they can get this passed because they've been wanting to do this for a very long time.

SHAPIRO: Now, the Republican Senate leadership has kept saying they want to have a vote this week. How likely is it that they will actually get a bill passed this week before leaving for the July 4 recess?

LIASSON: Well, that's the big question. Republicans are confident. Even though this bill is unpopular, Republicans feel they have to do this because they've promised to do this for seven years and their base expects them to do it. They feel safe, in some cases, voting for something that is unpopular because there are so few contested Republican seats and they need their base in a midterm. There right now is a handful of senators who have expressed reservations. Mitch McConnell can only afford to lose two senators.

But because the CBO score showed that he has some room to play with in the deficit, because that deficit number was lower than the House bill, he's got some money that he can offer some of those doubting senators to make it more - to make them more likely to cast a yes vote - more money for opioid addiction, for instance.

SHAPIRO: Now, the holdouts range from people on the far right to people who are closer to the center. There seems to be a risk that in trying to appease one he will alienate more of the other. Do you think there's a way for him to thread the needle here?

LIASSON: Well, he certainly thinks so. And that's what they did in the House. They satisfied the conservatives and they didn't get too many moderates to drop off. But that's the big question. One of the people who have come out in opposition to this bill is Nevada Senator Dean Heller. He is the only Republican in a state that Clinton won who's up for re-election next year. And he is considered a pretty hard no vote because he walked out on a limb and if he walks back he'll look weak.

And right now a pro-Trump super PAC is threatening him with a million-dollar ad buy against him, which is quite extraordinary. He's also facing ads from the other side, from supporters of Obamacare in Nevada who don't want him to vote to repeal it. So he's really stuck in the middle. He's a pretty good example of the conflicting pressures on Republican senators.

SHAPIRO: NPR's Mara Liasson joining us from the White House. Thank you, Mara.

LIASSON: Thank you.

(SOUNDBITE OF DEBO BAND'S "AND LAY") Transcript provided by NPR, Copyright NPR.

Mara Liasson is a national political correspondent for NPR. Her reports can be heard regularly on NPR's award-winning newsmagazine programs Morning Edition and All Things Considered. Liasson provides extensive coverage of politics and policy from Washington, DC — focusing on the White House and Congress — and also reports on political trends beyond the Beltway.