Rep. Clark, Key Health Care Architects On The GOP Health Care Bill

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President Donald Trump, flanked by House Ways and Means Committee Chairman Rep. Kevin Brady, R-Texas, and House Speaker Paul Ryan of Wis., are seen in the Rose Garden of the White House in Washington. (Evan Vucci/AP)
President Donald Trump, flanked by House Ways and Means Committee Chairman Rep. Kevin Brady, R-Texas, and House Speaker Paul Ryan of Wis., are seen in the Rose Garden of the White House in Washington. (Evan Vucci/AP)

Today, the U.S. House of Representatives passed a GOP plan to repeal and replace major parts of the Affordable Care Act.

The final vote was 217-213, with 20 Republicans and all House Democrats voting against the bill.

After the vote, President Trump held a press conference in the Rose Garden with Republican lawmakers including House Speaker Paul Ryan and House Majority Leader Kevin McCarthy.


Martha Bebinger, WBUR reporter. She tweets @mbebinger.

Matt Viser, deputy Washington bureau chief for the Boston Globe. He tweets @mviser.

Jonathan Gruber, professor of economics at MIT, one of the architects of Massachusetts landmark health care reform law, and a senior adviser to President Obama on the Affordable Care Act.

Katherine Clark, congresswoman from the Massachusetts 5th District. She tweets @repkclark.

Don Berwick, pediatrician; former Medicare chief under President Obama; founding president and current senior fellow at the Institute for Healthcare Improvement. He tweets @donberwick.

Interview Highlights

On the political importance of the victory for House Speaker Paul Ryan

Matt Viser: "From the House perspective I think it is a big deal. If you look back 40 days ago, it was a huge embarrassment for them to have to pull that bill. So in the short term, it is a success ... There's a lot of caution to look at toward the future though. They don't know the CBO score — how much this bill will actually cost, how many people will lose health care as a result of this. And the Senate is a major kind of question mark at this stage."

On potential opposition to the bill in the Senate

Viser: "They've only got a two seat majority in the Senate, so [the bill] is going to face a lot more roadblocks here in the next couple of weeks. And the Senate could almost start from scratch and do something completely different than the House."

On the potential vulnerability of Republicans who voted to pass the bill

Viser: "It's almost the inverse from what happened seven years ago when Democrats passed Obamacare — you saw immediate reaction in a lot of those districts, and the midterms became an avalanche of support for Republicans ... House Republicans are about to now go into recess and they’ll be back in their districts next week. I would watch a lot of those town hall meetings and watch as pressure comes on a lot of the people who voted for this."

On the potential impacts of the bill on Massachusetts

Martha Bebinger: "There's a lot of fear about what it will do because if people lose their health insurance, they tend not to go to the doctor until they are sick and then they go to emergency room or clinics where they can get free care ... Insurers are left with typically sicker people — the healthy people drop coverage. Sicker people cost more, that means premiums go up and those costs are for all of us, not just the insurers, but everyone who buys premiums."

Jonathan Gruber: "There's nothing in this law that would increase competition. There's nothing in this law that increases choice ... The Congressional Budget Office said that low income elders will pay up to ten times more for the health insurance. That's not making them better off. And to make this round [of the proposal] pass, [Republicans] moved it further to the right, by allowing states to remove the one protection that’s most important in this law: the inability of insurers to charge a sick more than the healthy. They can say what they want about protecting those preexisting conditions, but if an insurer can charge a sick person ten times what they can charge a healthy person, there is no protection against preexisting conditions. We're back with the broken insurance market we had before."

Don Berwick: "This law takes almost a trillion dollars away from Medicaid ... We're looking at major major increases in health premiums for people age 60, 62, 63, before they get to Medicare.

"In Massachusetts, it could pull the rug out from under a lot of very terrific improvements we're making in Medicaid coverage ... We have a waiver from the federal government that I think now comes under tremendous pressure. We could end up holding the bag for a billion or two billion dollars of care that we have no other coverage for ... Millions of low income Americans are going to be hurt and millions of middle income Americans could be hurt by health care insurance premiums ...

"One thing they're doing is delaying implementation for a year or two or three for various elements, so I think they're hoping to buy some time while the public goes to sleep. And I hope the public does not go to sleep on this. We've got to stop it."

On how the Democrats plan to hold the Republicans accountable

Rep. Katherine Clark: "We are going to continue to tell the American people what is in this bill and how it turns the clock back on millions of Americans who have gained access to coverage for preexisting conditions, gotten rid of lifetime caps.

"This bill is just fraught with peril for American families. It takes away so many protections for families back home in Massachusetts — making being a woman a preexisting condition again, saying that you can deny coverage for sexual assault, domestic violence, postpartum depression, even C-sections, really cutting back on families abilities to get treatment when we are in the middle of an opioid epidemic — these are dangerous and callous practices. And the Republicans tried to really paint a picture today on the House floor that everything was going to be taken care of. But they know full well that this bill was about getting you know, $50,000 in taxes back to every millionaire in this country."

On the Republican argument that the bill shifts power back to the states

Clark: "It is great rhetoric to say this is about freedom and liberty for people to choose the health care they want, but we know that is not how the system works ... Insurance companies in the past have  put their bottom line ahead of the [vulnerable, the sick, the elderly] and that is exactly the invitation that the Republicans in the House gave to the industry again."

Berwick: "The Affordable Care Act introduced a whole lot of state level innovation — it's supported by the Affordable Care Act. There are state innovation grants that are being taken advantage of by the majority of states. We have lots of variation in implementation — Oregon, Maryland, Arkansas, Massachusetts, many states are doing very exciting things. That stops cold with this bill."

On working with Republicans on a solution

Clark: "We've always been open to that. I mean, you heard Speaker Ryan say that 'I am not working with Democrats.' I hope that will be different in the Senate. You know there are things that we can do to improve the Affordable Care Act, but the House Republicans weren't open to that. I certainly hope that they will be in the Senate. But it's really on them."

Berwick: "If we actually wanted to fix [the ACA] we know what to do. There's plenty of experience that tells us what we need to do to make exchanges more robust, to allow negotiation of drug prices by Medicare, to change and improve the incentives for young people to join increasing marketing exchanges ... but the Republicans have shown no interest in that."

Correction: An earlier version of this post incorrectly identified House Majority Leader Kevin McCarthy. We regret the error.

This segment aired on May 4, 2017.


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