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Can Republicans In The Senate Get Their Health Bill Passed?


We're going to bring another voice into the conversation now - NPR health policy correspondent Alison Kodjak.

Alison, what did you hear in that interview just now?

ALISON KODJAK, BYLINE: You know, what I thought was most interesting about the interview was how much he focused on the effects on low-income people. I mean, he says that this bill would result in millions of, specifically, low-income people losing their insurance. And then he, in addition, mentioned the effects on the institutions that serve those low-income people. What he's talking about are hospitals.

Before the Affordable Care Act, the hospitals that serve low-income people either in cities - but specifically rural hospitals treated people when they came through the door and often weren't paid for, if they weren't insured. When Medicaid was expanded and when many of these lower-income working families were able to get insurance under the Affordable Care Act, that changed. Hospitals then were paid for the care they gave. And a lot of rural hospital executives now really worry about losing that income. They're at risk of closing.

MARTIN: He also referenced the fact that the individual mandate in this new bill is gone, and there's nothing to replace it.

KODJAK: Yeah, and that's a real concern among insurance executives because the individual mandate requires that people buy insurance, whether they're healthy or sick. Under this bill, there's nothing to replace that. There's no incentive for the healthier, younger people who don't necessarily think insurance is worth it to buy insurance.

Now, one of the points he made was that the mandate isn't working. Only 10 million people are buying insurance on the Obamacare exchanges. And it should be about 25 million. But he also sort of expressed this idea that, without anything to replace it, that could get worse.

MARTIN: And so this is something that he and other industry experts are just assuming - oh, it's just going to get fixed later.

KODJAK: Yeah, and he actually said that - like, this week, they'll have to fix it. I've talked to several insurance company executives who also say the way it's written now - not so good. But they think it will be fixed over time.

MARTIN: And we're looking now at a day when the Congressional Budget Office is expected to give its score. This is important. This is significant. What comes down out of this?

KODJAK: Well, what comes down is, one, that number. How many people will have insurance or will not have insurance as a result of the bill? And two, the effect on the budget.

And one thing that Mr. Mendelson didn't mention and that I thought was really - it's a glaring thing that's going to show up today. The thing that causes those low-income people to lose their insurance - the other side of that equation is tax cuts. This bill contains a lot of tax cuts for corporations, wealthy people. And in order to pay for those tax cuts, they have to cut the spending on Medicaid. And so that's where this is going to show up in the budget, as well - how much they're cutting federal spending on this program for health care for the poor.

MARTIN: Alison Kodjak, she covers health care policy for us. Thanks so much, Alison.

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

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