Where does Congress go next on health care?

Now that Republicans have withdrawn a health care bill to repeal and replace the Affordable Care Act, what comes next? Judy Woodruff gets two perspectives on the aftermath and next steps from Rep. Tim Ryan, D-Ohio, and Lanhee Chen of The Hoover Institution.

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    Now the aftermath of today's failure by Republicans to move ahead with repealing and replacing the Affordable Care Act.

    We talk with prominent figures in both political parties about what it means and what is next.

    I spoke a short while ago with eight-term Democratic Representative Tim Ryan of Ohio.

    Congressman Ryan, welcome.

    What do you make of all this?

  • REP. TIM RYAN, D-Ohio:

    Well, it's been a very interesting day, Judy, you know, a lot going on here on the Hill.

    But, clearly, the Republicans didn't have the cohesiveness, the plan that was going to move this piece of legislation forward. And I think the plan really, in so many ways, was disastrous. It was knocking 24 million people off of their health care. That became something that a lot of members weren't willing to go home and defend.

    The repealing out of the stance abuse coverage, the mental health coverage, for people who have to go back to districts and states that are seeing one of the greatest heroin and drug epidemics in the history of our country happen right before their very eyes, that becomes very tough to vote for when it hits the ground back in places like Ohio or other states that are having these huge substance abuse epidemics happening.


    Well, Speaker Ryan is saying — he just said to the press a few minutes ago that the real disaster is Obamacare, the current Affordable Care Act, that he says it's something that's collapsing of its on weight, premiums are going up. He said a third of the counties in the country have only one plan to choose from.


    Well, there are some issues with the Affordable Care Act.

    We made great strides. We covered 20 million people. We are bending the cost curve in the long term. Many people have the kind of coverage that I just talked about, mental health, substance abuse, preventative care, prenatal care, all the things that save you money in the long run. That is in the Affordable Care Act.

    So, let's sit down and try to fix the things that we need to fix. Part of the problem is, the Republicans gutted payments to the insurance companies that would have allowed them to participate in some of these riskier areas. We needed to get coverage in these areas, but you needed to help the insurance companies, so they wouldn't lose money.

    The Republican Party gutted that part of the budget, those insurance transfer payments. So, that's when the insurance companies started to leave. And so they're saying it's not working in certain areas. Well, because they cut the funding to some of those areas.

    Let's sit down, Judy, and fix the problems. There are problems there. I'm not ashamed to admit it. We passed a great piece of legislation that had some flaws. Let's sit down and fix them, Democrats and Republicans, and make this thing work.


    Well, is your party prepared to do that, and do you think the Republicans are prepared to do that?


    Well, I don't speak on behalf of my entire party, but I know I'm willing to sit down and say, look, we have made some great strides.

    There are some issues. Let's sit down and fix them. I have raised my hand to say, I'm all in to try to make sure that health care is more affordable for more people, that it's more accessible. We should have universal coverage and that should be affordable for everybody.

    Here's the thing, Judy. And I hope Republicans would be willing to sit down and do it. They have been complaining about Obamacare for seven years. They get into power, and their first legislative initiative, they can't even pass something that is an attempt to fix it, but that was because it was making it worse, I think, was why it didn't pass.

    But here's the thing. We're the United States of America. We're the wealthiest country in the world. And yet we're 37th in health care delivery. We spend 2.5 times what other developed countries spend on health care. Clearly, we're not doing everything right. We need to move more of that money into prevention.

    We need to make sure that our citizens are healthier. We got to have a big national conversation about our food system. This is how we're going to solve the problem in the long run.


    So, when President Trump says this was due to — that this is really the Democrats' fault, what's your answer?



    Well, we're not even in the majority in the House of Representatives. I mean, how could it possibly be our fault?

    He has complete control of the House of Representatives. They're all Republicans. And he couldn't even get the Republicans to pass it.

    And it's typical Donald Trump. He's going to find somebody to blame, and so he's going to blame the Democrats. I assume he's going to blame President Obama and maybe even Hillary Clinton for this problem.

    They need to take responsibility. They need to put a plan forward that their members can vote on and that actually solve problems. The problem right now with the Republican Party, Judy, is they're living by bumper sticker slogans.

    But now they're not in the minority. They're in the majority now. The dog has actually caught the car, and they got to figure out how to govern the country.


    Representative Tim Ryan, we thank you for talking with us.


    Thanks for having me.


    Next, for an opposing perspective, I am joined by Lanhee Chen. He is a fellow at the Hoover Institution who advised Mitt Romney and Marco Rubio in their presidential campaigns.

    Lanhee Chen, welcome back to the program.

    What's your reaction to what happened today?

  • LANHEE CHEN, The Hoover Institution:

    Well, thank you, Judy.

    I think this is clearly a self-inflected wound for Republicans. They had the opportunity to move ahead on really the only train out of town, if you will, to repeal the Affordable Care Act and replace it with some other reforms. And they didn't do so.

    And I think it is real disappointment for those who have been seeking to do this for some time. And we will have to see what happens next, but it appears as though health care is off the table for some period of time.


    And I want to ask you about that, but what about the president? The president's comment is that this is all due to the Democrats, not Republicans.


    Well, Democrats certainly weren't helpful. They didn't participate in the process, obviously.

    But, from the Republican perspective, there were a lot of people here that appeared to say they wanted a perfect piece of legislation. And it seems to me that they allowed the perfect to be the enemy of the good in this case, that there were a lot of things about this legislation that would have moved the ball forward, for example, on reform of Medicaid, which is a huge entitlement program.

    If they had actually voted for the bill, they would have been moving forward that effort. Instead, it seems to me, there are some Republicans that stood in the way. And, as I said, I really see this as a self-inflicted wound more than anything else.


    So, what do you think should happen next? I mean, the president is saying — we heard this from what he told to — told Robert Costa with The Washington Post. He said, I'm moving on to tax reform.


    It's going to be a challenge. As Speaker Ryan said today, not being able to get this done, I think, does make tax reform harder.

    I think it is probably wise to move on to a different subject for some period of time. It is clear that there are divisions within the Republican Party, Judy, about how to handle health care and health care reform going forward.

    I do think this notion that Obamacare is going to collapse in one, large giant flame is probably simply inaccurate. I think it's the case that, in many markets, you are going to see significant issues, but the Medicaid expansion will continue. And Obamacare will, by and large, continue as well.

    So, I think we need to take a step back, take stock of what's going to happen, and hopefully return to this issue at some point in the future.


    Well, it's interesting you should say that, because I'm looking at what the president said when he talked to the press a short time ago.

    He said what you just said. He predicted that it will collapse. And he said, at that point, Democrats are going to come crawling back, in so many words, looking for a way to work with Republicans.

    But you're saying that your view of this whole thing is different.



    I mean, I think, more than anything, Judy, I would call this kind of a slow-motion train wreck more than a significant sort of single implosion or single situation where the bill completely — where Obamacare completely goes down in flames.

    I think it's the case there are some markets where there's significant difficulty. There will be additional markets where there will be even more difficulty as we get toward the end of 2017 into 2018. But something like the Medicaid expansion, that will continue, and that will continue to place pressure on the federal budget, as well as on state budgets.


    So, if you're saying it's not a good idea for Republicans to come back to this issue right now, what happens to it? Where do you see this going?


    Well, I do think, as I said, in certain markets, you are going to see, particularly on the individual market side and Obamacare exchanges, you are going to see continuing declines if insurer participation.

    I do think premiums continue to go up in some markets. And I think there will need to be efforts made to look at how to repair the individual market and to shore up that part of this.

    But if we want to go toward larger system change, toward entitlement reform, et cetera, that's going to have to be a completely different discussion. And it is going to be something that Republicans have to get on the same page on first before that ball gets moved forward.


    And how long does it take until you see Republicans getting there?


    Well, I thought — I had hoped they would have been able to get there hopefully over the last few weeks, but that obviously didn't happen.

    I think it's something where they're going to have to revisit this issue after dealing more seriously with whether it's tax reform or infrastructure spending or some other issue to be able to demonstrate that they can govern and then hopefully come back to this issue as time goes on.


    Lanhee Chen, we thank you very much.


    Thank you.

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