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Lawmakers debate whether GOP health bill solves its pre-existing condition problem

May 3, 2017 at 6:45 PM EDT
The revised Republican plan to replace Obamacare gained key endorsements from two moderate Republican holdouts, who were convinced that a new amendment would help cover people with pre-existing conditions. Will the plan garner enough support? Judy Woodruff gets reaction from Rep. Mark Sanford, R-S.C., and Rep. Kathy Castor, D-Fla.
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JUDY WOODRUFF: After fits, starts and failure, Republicans in Congress are aiming for a new amendment to win over enough votes to repeal and replace the Affordable Care Act.

We get two takes now on this latest legislative back-and-forth from both sides of the aisle.

We start with Representative Mark Sanford, Republican from South Carolina.

Congressman Sanford, thank you very much for joining us.

So, you opposed the first version of Obamacare replacement back in March. I believe your argument was that it left too much of the original Obamacare in place. You apparently have come around now to this new version. Why?

REP. MARK SANFORD, R-S.C.: It, in essence, split things. It left open the possibility of federalism, which is to say, we have historically had a patchwork of different states and different remedies.

Our founding fathers were so intent on this idea of letting states try different things that they built it in, though we had a population of about four million people when our country started. So, I think what it does is, it allows Vermont to go to a single-payer system if Vermont wants to do so, and South Carolina can go to a more market-based system, if it chose to do so.

JUDY WOODRUFF: Well, you know, I’m sure, that today Congressman Fred Upton and others worked on an amendment, a proposal to further change this new version that would add more money to cover those people with so-called preexisting conditions.

Are you confident, from what you know, though, that this is going to guarantee everybody with preexisting conditions coverage?

REP. MARK SANFORD: Built into the base bill is this issue of guarantee issue, so that you cannot be denied based on a preexisting condition.

The question all along has been, if a state opted out and they chose to, again, make alterations on that front, which this bill does allow, what happens to them? And that’s why it’s been important that this issue of a risk pool, as Maine has done, was built into the bill. There is about $130 billion built into the bill to that very effect.

And what has been talked about here in the 11th hour is an additional $8 billion based on Fred Upton and a couple of other folks’ insistence, that a little bit more money be built in as a cushion on this front. But you’re talking over $100 billion being built into the high-risk pool to cover somebody in the event that a state opted out of this issue of not preexisting condition, but the idea of somebody being able to be charged more based on a preexisting condition.

JUDY WOODRUFF: I know this can get really complicated, and I’m going to try to keep my question as basic as possible.

Congressman, I’m sure you know the American Medical Association has come out today saying they are still opposed. They are worried that millions of people are going to be left out with preexisting conditions. The AARP, retired persons association, says they’re still opposed. And the American Cancer Society says they have taken a look at this, and they say every bit of history for anything that looks anything like this high-risk pool arrangement that Congressman Upton has included is going to be unaffordable, is still going to leave too many people out.

So, they can’t support it either.

REP. MARK SANFORD: Well, one, I would expect them to say that as advocates. And that is what they’re supposed to do.

I think that what we’re trying to include is that vast unspoken group out there that maybe hadn’t gotten the degree of media coverage, small business people across the state of South Carolina or other states in this country that have been really struggling with the limitation of coverage and the increase in premiums.

In South Carolina last year, premiums went up by about 30 percent. And so what we’re trying to do is to let insurance be insurance for the preponderance of folks that are in the individual marketplace that have seen their premiums rise dramatically, while, at the same time, covering folks that indeed have a preexisting condition or have been — seen the consequence of a horrendous accident.

And I think that that’s what this bill does. It tries to cover both. It does so imperfectly, as any bill would, but I think it’s the best that we are going to be able to see out of this House at this particular moment in time.

JUDY WOODRUFF: You are saying it does so imperfectly. The doubters out there are saying it still leaves too many people with preexisting conditions who can’t afford coverage uncovered and people — people who would then be in a vulnerable position not able to access health care.

REP. MARK SANFORD: What I would say to that is, that was not the experience of what we saw in Maine. And I would ask people to look at the risk pool that took place in Maine and the degree of coverage that it afforded people indeed with preexisting conditions, while simultaneously bringing down the rate of premium for, again, those small business folks that don’t have, again, the kind of health challenges that we see there in the risk pool in Maine, or, frankly, other states.

JUDY WOODRUFF: Congressman, is it the government’s responsibility to make sure everybody has health care coverage?

REP. MARK SANFORD: I think that that’s a debate that will be ongoing.

I think that — you know, I guess part and parcel to any open and free society is this debate between freedom on one side and security on the other. And I think that there is a vital tension between those two. So even if this bill makes its way to the Senate and passes there, even if it comes back and is signed by the president, based on the conference report that got signed off on in this House, even that happens, this is a debate that is going to be ongoing, because I think that that tension between security and freedom is one that fits in this debate, as it does in so many others here on Capitol Hill.

JUDY WOODRUFF: Congressman Mark Sanford, we thank you very much.

REP. MARK SANFORD: My pleasure. Thank you.

JUDY WOODRUFF: And now, for a Democrat’s perspective, we are joined by Representative Kathy Castor of Florida.

Congresswoman Castor, I think you were able to hear what Congressman Sanford is saying.

Do you believe that what the Republicans appear to be coming together on does now cover enough Americans?

REP. KATHY CASTOR, D-Fla.: No.

And the next 24 hours are going to be very important for families all across the country that are concerned about their health coverage, because what we know about the Republican bill is that it will rip coverage away from millions of Americans, raise costs, impose a huge age tax on our neighbors who are 50, 55, and older, and not yet in Medicare.

And then it weakens the life of the Medicare trust fund, just at a time we have more baby boomers retiring and going into Medicare. But here’s the kicker for the vote that could come up in the next 24 hours, is the bill has gotten even worse.

To round up the votes of the Tea Party Caucus, Speaker Ryan and the White House agreed to go to the heart of the Affordable Care Act, which was a guarantee that no American could be discriminated against because they have a preexisting condition, like cancer or diabetes.

JUDY WOODRUFF: Right.

REP. KATHY CASTOR: So, apparently, this is going to be a close vote tomorrow. The phones are ringing off the hook all across the Capitol, because families understand what is at risk, higher costs and a fundamental return to the bad old days where insurance companies could charge you anything.

And if you had a preexisting condition, it was very difficult to get coverage.

JUDY WOODRUFF: Well, let me ask you about what Congressman Sanford just said. He said there are examples — he kept citing the state of Maine — where they have created these so-called high-risk pools that allow money to be put into one pool that people who can’t afford coverage, who have preexisting conditions would be able to access that and get coverage.

REP. KATHY CASTOR: Well, it’s very inefficient and very costly.

And this so-called Upton amendment that has been floated today to provide $8 billion to states that go that direction is — would be wholly inadequate. And, in fact, in my home state of Florida, we have tried high-risk pools in the past, and the state never stepped up to their responsibility to fund them.

The feds here, I would be very skeptical that, under a Republican Congress and this White House, they would say, yes, it’s important to provide billions of dollars for that.

At the same time, remember, under this bill, they decimate Medicaid services. Those are the services for our neighbors suffering from Alzheimer’s that need nursing care, and children, and the disabled. So it’s very difficult to see how this is going anywhere.

In fact, you mentioned the opposition from the AMA and the AARP. When you have America’s doctors, America’s nurses, AARP, the American Cancer Society opposed to it, I’m surprised it’s even close right now.

JUDY WOODRUFF: Right. At the same time, Congresswoman, you know elections have consequences. Republicans control the House. They control the Senate. They obviously control the White House now.

What the Republicans are looking at putting before the House for a vote now has made accommodations toward the Democrats. It does preserve some of Obamacare, unlike what the most conservative members of the House want.

Doesn’t there have to be some sort of compromise? And are Democrats not willing to move at all on your own, as Republicans have been willing to do?

REP. KATHY CASTOR: No, the Republican bill goes to the heart of the Affordable Care Act repeal now.

They could make that argument before, before they were talking about gutting the protection for preexisting conditions and essential health benefits.

I mean, what good is an insurance policy if you buy it and you can’t go to the emergency room and be covered? But, yes, Democrats, we’re willing to work on the high cost of pharmaceuticals. I would really like to get to the heart of the matter of how we encourage greater competition in areas of the country that do not have competition.

There are a lot of great ideas, and, hopefully, this will — this new repeal effort will fail tomorrow, and we can get down to brass tacks, to improving what works and fixing what doesn’t.

JUDY WOODRUFF: But you’re prepared with the idea that it may pass, that the Republicans may now have enough votes among themselves to get this through the House?

REP. KATHY CASTOR: Boy, they’re really trying to ram it through. The White House and Speaker Ryan have really been twisting arms. That’s what I’m hearing from my colleagues here in the Capitol.

But we have the American people on our side, in addition to America’s doctors, nurses, so many advocates. But this next 24 hours will be critical. And there’s no other issue that touches every American family, every small business owner. So, this is critical. And time is of the essence.

JUDY WOODRUFF: You’re absolutely right about it touching everybody.

Congresswoman Kathy Castor, thank you very much.

REP. KATHY CASTOR: Thank you.

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