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Two views on the pros and cons of the GOP health care bill

March 13, 2017 at 6:40 PM EDT
The Congressional Budget Office predicts that more people than who got health care under Obamacare will lose coverage under the repeal bill proposed by Republicans. But the bill also shows cuts in federal spending and a smaller deficit. John Yang gets reaction to the proposed law from Dr. Ezekiel Emanuel of the University of Pennsylvania and Lanhee Chen of the Hoover Institution.
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JUDY WOODRUFF: Now reaction to the analysis of the Republican health care bill by the budget office of Congress.

As we report a few moments ago, it is forecasting that 24 million fewer people would be insured after a decade and it would reduce the deficit by more $300 billion over 10 years.

Our John Yang gets some analysis now.

JOHN YANG: And, for that, we turn to two experts who watch this all closely, Zeke Emanuel, who is one of the original architects of the Affordable Care Act, or Obamacare. He’s chair of the University of Pennsylvania’s Department of Medical Ethics and Health Policy. And Lanhee Chen, a fellow at the Hoover Institution, who advised both Mitt Romney and Marco Rubio in their presidential campaigns.

Gentlemen, welcome to you both.

Dr. Emanuel, let me start with you.

The big headline number out of this, 24 million fewer with health insurance after a period after this. That is more than who were added to the rolls by Obamacare. What’s your reaction?

DR. EZEKIEL EMANUEL, Former White House Special Adviser: Well, by 2026, one in five Americans are going to lack health insurance if this plan goes through, according to the CBO.

And lest Americans think, oh, this is only people on Medicaid or people who got Obamacare, the CBO estimates seven million people who have employer insurance today will lose coverage. So, if you’re getting coverage through your employer, it’s not guaranteed under this plan.

And the big, positive news for the Republicans sounds puny in comparison. All those people losing coverage, and the deficit goes down $34 billion per year. This sounds like no home run at all for them, and a real albatross.

One out of five Americans, no health insurance, maybe that’s acceptable in some places like Texas, but I don’t think across the country, it’s something we’re going to find very tolerable.

They also point out that the extensive coverage under this plan, what your insurance actually covers, is going to go down, so people are going to be responsible for more out of their own pocket. They are going to have skinnier health insurance, more deductibles. And, again, that is something that has proven unpopular.

Why the Republicans want to encourage that is beyond my comprehension. I think this points out it’s a loser bill. We need to go back to the drawing board and try to get a bipartisan bill. I think there is a compromise, but only when the Republicans give up on this kind of approach.

JOHN YANG: Lanhee Chen, an albatross, a loser bill, what do you say?

LANHEE CHEN, Former Policy Director, Mitt Romney Campaign: Well, that’s certainly one perspective.

I would argue that, in fact, this bill is a very good start. I think, clearly, it’s not perfect. There are improvements that need to be made in the bill.

But let’s just start with a couple of things. First of all, obviously, the Congressional Budget Office estimates do reveal that in fact the bill is going to cut the deficit, it’s going to cut spending over the next 10 years and provide almost $1 trillion in tax relief over the years — over the next 10 years.

So I think those are points you are going to hear supporters of the law point to. Clearly, on the coverage numbers, the 24 million number is a big number. I think they have got some work to do there.

The challenge is that, without an individual mandate, without a massive and costly expansion to Medicaid, you’re not going to see the same kind of coverage numbers that you saw out of the Affordable Care Act. I think Republicans need to be willing to accept that at least as presently constituted, their plan is not going to get to the same levels.

Now, the question becomes, are people going to have more choices? Are premiums going down? And indeed the CBO report finds that beginning in 2020, premiums are going to go down and consumers are going to have more choices.

The reason why consumers might want to buy skinny down plans is because they don’t want to pay for all of the excessive benefits that are mandated and required by the Affordable Care Act. So, in fact, it’s a quite reasonable response to what we have seen from the over-regulation created by the ACA over the last 10 years.

Now, in the employer marketplace, let me just make one point. The CBO when they estimated the Affordable Care Act, or Obamacare, upon passage also noted that many millions of Americans would lose their coverage in the employer marketplace. It’s not unusual to see shifting between marketplaces as it’s created by a large-scale reform such as the ACA or the current bill that Republicans are considering.

JOHN YANG: Lanhee Chen …

EZEKIEL EMANUEL: Let’s just be clear; $600 billion or so of this change is going to be tax cuts to the wealthiest 2 or 3 percent of Americans, the insurance companies, the drug companies.

We’re going to see Americans get less insurance. Lanhee Chen said that.

All right, which part of the essential benefits that the government is so-called mandating don’t you want? Hospital care? Emergency room care? Drug care? Doctor care? Preventative services?

LANHEE CHEN: Zeke, I would like for Americans to be able to choose the benefits they want. I don’t believe that it makes sense for Washington to mandate the same plans broadly across the board.

(CROSSTALK)

EZEKIEL EMANUEL: Lanhee, what you’re doing is not giving them choice.

What you’re doing is saying, we’re taking away the money and we’re going to let you choose with no money. Health care is extremely expensive. It’s $10,000 on average per American. Americans don’t have that kind of money.

LANHEE CHEN: It is, and the Affordable Care Act has made it less affordable.

EZEKIEL EMANUEL: And they need subsidies.

And we — no, the Affordable Care Act didn’t make it less affordable. It made it more affordable.

LANHEE CHEN: Twenty-five percent increase in premiums silver plan year over year from 2016 to 2017 sounds less affordable to me, Zeke.

EZEKIEL EMANUEL: In fact, the silver plan is low than the CBO predicted in 2010. It’s actually been — we have been able to control health care costs and that has gone on.

You tell me the one service on the essential benefits you’re going to get rid of that is going to be better for people. No Republican can say …

(CROSSTALK)

EZEKIEL EMANUEL: That’s the one they want to throw out.

LANHEE CHEN: I’m not in the business of telling people what benefits they should and shouldn’t have.

Look, the bottom line here is this.

EZEKIEL EMANUEL: Lanhee, just tell me what benefit you don’t want.

LANHEE CHEN: What this plan will do is, it will allow people to choose the plans — there are things that I would choose. They are not going to be the same as the things someone else would choose, Zeke. That’s the point here, that this is not a decision Washington should be making.

And that’s the point that supporters of the law have been making. But, look, at the end of the day the AHCA actually, as you know, leaves the essential health care benefits in place for now, because they can’t be removed through reconciliation.

You know that better than anybody else.

(CROSSTALK)

JOHN YANG: You talked about premiums would be going down.

But the CBO found that there is going to be a difference by age. By 2026, premiums for a 21-year-old would be 20 to 25 percent lower, for a 40-year-old, 10 percent lower. But, for a 64-year-old, one year before Medicare, 20 percent to 25 percent higher.

LANHEE CHEN: Well, yes, the notion of insurance again is about …

(CROSSTALK)

EZEKIEL EMANUEL: People who are sick and who need it are going to be …

(CROSSTALK)

JOHN YANG: Hold on. Hold on. Let him answer. Let’s let Lanhee Chen answer that.

LANHEE CHEN: Yes.

The point is that any time you create an insurance marketplace, you are going to have people coming in and out of it. You’re going to have people of different ages.

And it is the case that there is going to be variation across age categories. Look, the Affordable Care Act increased premiums significantly for younger people. It did bring the premiums down for older people because of the way the law was structured.

So, there are always going to be winners and losers in these situations. We have got to take look at exactly what happens. But, remember, what the AHCA, What The Republican proposal does is to create an additional subsidy to help people who are older.

Now, arguably, you could tweak That subsidy to give them even more support. That may be a change want to look at. But the notion that there will be differences in costs of premiums across age is not surprising any time you have a large health reform.

JOHN YANG: Thirty seconds, Dr. Emanuel. You want to respond?

(CROSSTALK)

EZEKIEL EMANUEL: Wait a second.

And you take the subsidies way down, so you give people less money to buy insurance. This is a double whammy, which is, we’re going to allow the premiums to go up, and, by the way, the amount of coverage is going to go down, because the essential benefits are going down.

So — and we should also mention that by 2022 …

(CROSSTALK)

LANHEE CHEN: The essential benefits aren’t touched by the law, Zeke. You know that.

EZEKIEL EMANUEL: They’re actually going to send the premiums up for all people 15 to 20 percent.

So, yes, by 2026, a decade from now, premiums for the younger will come down, but, before that, they are going to actually go up. So this is hardly a very good thing if you’re going to say we’re going to make it cover everyone and we’re going to make it cheaper. It’s not going to be cheaper.

JOHN YANG: Time, gentlemen. Time. I’m sorry. We are going to have to leave it there.

EZEKIEL EMANUEL: Yes. Thank you.

JOHN YANG: Dr. Emanuel, Lanhee Chen, thanks for joining us.

EZEKIEL EMANUEL: Thank you.

JUDY WOODRUFF: And that’s a debate thanks to hear. Thanks to both of them.

And we want to hear what people think on all sides of the health care debate. If you’re concerned about health care reform, you can go online, find a brief questionnaire and share your experience.

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