Sen. Thune: GOP health bill negotiation process is difficult but necessary

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    Here's a question. What's next in the Republican effort to repeal and replace Obamacare?

    I spoke short time ago with one of the senators who helped write the now-delayed bill, John Thune of South Dakota. He is chairman of the Republican Conference, making him the third-ranking Republican in the Senate.

    Senator Thune, thank you for joining us.

    I want to start out asking you where the negotiations stand this afternoon. The president acknowledged today that it's going to be very tough, but then he went on to say there's a big surprise coming. Do you know what he was talking about?



    Well, I'm not sure what that is, Judy, but thank you. It's nice to be with you.

    I think the state of negotiations at the moment are we're still having conversations and working through the issues that right now are, I think, keeping us from getting to a consensus, and I hope that eventually we will be able to work through those. But that's the next few days.

    And I think the goal is, as much as we can, have at least sort of a framework in place by the end of the week that we can send to the Congressional Budget Office to get scoring back, so that when we come back after the Fourth of July break next week, the following week, we can move a bill to the floor, get it up and get to work on it and open up the amendment process and hopefully eventually pass it.


    What is the bigger challenge, Senator? Is it appealing to the moderates, who believe that the cuts in Medicaid and other parts of the bill are too hard on those with lower income, or is it the more conservative members, who want a bigger repeal of Obamacare?


    It's kind of a combination.

    And it's really — you know, there are some things, Judy, in this process that you can dial back and forth. And we have been trying to turn those dials as much as we can to bring people on board. But we do have the more conservative members in our conference who have specific things that they want to see addressed in this bill. And then we have got more moderate members who, as you mentioned, are concerned about Medicaid and trying to put, you know, the final touches on that.


    Well, let me pick up on the Medicaid point, because we are hearing today from more health care experts who say these Medicaid changes would force the states to make some very tough decisions about what they're going to pay for.

    They talk about things like in-home services for the elderly, for people with disabilities. And they say those could be in very serious jeopardy.


    Well, look, I think the thing with Medicare — and a lot of this — I should say, with Medicaid — and this is going to depend — states are going to be in a position to have a lot of flexibility.

    What this basically does is allows them to choose the two base years that they would calculate current their reimbursement levels on. And there's a separate reimbursement for elderly, so for nursing home recipients, another one for the blind and disabled, another one for children, and yet another one for able-bodied adults.

    And they all have per-capita allotments based upon what the states are experiencing today in terms of Medicaid costs. And then those are inflated over the years, the next decade, increased at the rate of inflation. And so they have to figure out how to take those dollars and put them to the best use in the state.


    Well, speaking of state by state, the Center for American Progress took those CBO numbers. They broke them down by state.

    They looked at South Dakota, your home state. They determined that almost 64,000 fewer South Dakotans would be covered under the Senate plan by 2026 than if the ACA remained in effect, and that includes something like 40,000 on Medicaid, 24,000 on the individual market.

    How would you deal with that?


    Well, I don't know how they would — how they came up with that number.

    In my state of South Dakota, we weren't an expansion state. And we currently operate the Medicaid program in a fairly cost-effective and efficient way. People in the individual marketplace should have more options. The plan that we — the discussion draft that we have out there today, which is in the process, of course, of being modified, actually opens up for people who are zero percent to 100 percent of the federal poverty level, not eligible for Medicaid, would open up the opportunity for them to purchase insurance with help from the federal government.

    And in my state, that's 37,000 people. So there are 37,000 people today who don't have access to health insurance that would under the proposal that — the discussion draft at least that is out there today.


    Another subject, Senator, a lot of reporting in the last few days about President Trump's role in all this. A number of reports saying the president is not as steeped in the details as he might otherwise be, and that he doesn't have a strong view of how this should come out, that mainly his view is he just wants to see something passed.

    What is your how — would you describe the president's role?


    I think he does want a result. He clearly, in the meeting that we had about him yesterday, was trying to sort of push the process along, realizing that the Senate has a role to play and that there are differences of opinion.

    And I think he got a flavor yesterday for what we have been hearing in our meetings with Republican Senators, because some of those differences came out. But I think the president is engaged. He's, obviously, talking to individual senators about their specific concerns. He's talking to groups of senators. He had all of us down there yesterday.




    So I think he wants to get a result, Judy. And I think he wants it to be a health care plan, proposal that we can go out there and defend and that he can defend and argue for to the American people. And I don't — I still think we're going to get there.


    Last weekend, I'm sure you know, there was a pro-Trump political action committee that ran an attack ad, essentially, against Senator Dean Heller of Nevada, who was at that point expressing concerns about the health care bill.

    And the reporting is that Leader McConnell called the White House, said that this was stupid to do. Is this something that you and other Republicans have let the White House know you don't want them to do? I mean, what are you saying to the White House about this?


    I think it's been conveyed in pretty uncertain — I should say certain terms that, that's a bad idea.

    Particularly in the middle of a discussion where you're trying to get to a result on a major consequential issue like this, you don't want to have one of your own members being attacked. We need to get to 50, but that works a lot better if members are allowed to be able to discuss it with their colleagues, with their constituents, and not have the threat of a political campaign hanging out there over their head.


    And finally, just quickly, Senator Thune, any serious discussion of including Democrats in these deliberations?


    It's my preferred working style here is to have bipartisan legislation.

    I think what the Democrats have made clear is that they don't want to deal with anything that repeals and replaces Obamacare. I think they wouldn't want to do anything that gets rid of the mandates, which is a big part of our proposal, getting rid of the individual employer mandates.

    They would want to keep the taxes. And we want to do away with taxes that are driving up the costs of premiums. So, I think it would be hard to see a scenario where Democrats would be willing to come to the table in good faith and actually work with us on a solution that meets those — you know, those requirements.


    Senator John Thune, a member of the Republican leadership, thank you very much.


    Thanks, Judy.

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