Full Episode: Republicans revive health care reform and Congress compromises on government spending

ROBERT COSTA: A breakthrough on health care, House Republicans resuscitate a plan to repeal and replace Obamacare. I’m Robert Costa. We’ll explain how the proposed legislation could change lives and policy in America, tonight on Washington Week.

PRESIDENT DONALD TRUMP: (From video.) This is a repeal and a replace of Obamacare. Make no mistake about it. (Applause.) Make no mistake.

MR. COSTA: President Trump scores his first significant legislative win, and moves one step closer to dismantling the Affordable Care Act.

PRESIDENT TRUMP: (From video.) Most importantly, yes, premiums will be coming down. Yes, deductibles will be coming down.

MR. COSTA: Now the bill heads to the Senate, where it faces roadblocks and bipartisan skepticism over a number of key issues, including premiums, preexisting conditions, and billions of dollars in cuts to Medicare and Medicaid.

HOUSE MINORITY LEADER NANCY PELOSI (D-CA): (From video.) Some of you have said, well, they’ll fix it in the Senate. But you have every provision of this bill tattooed on your forehead. You will glow in the dark on this one.

MR. COSTA: But the president remains confident he’s got momentum.

PRESIDENT TRUMP: (From video.) We’re going to get this finished. And then we’re going – as you know, we put our tax plan in – pure tax reform. So we’re going to get that done next. And this really helps.

MR. COSTA: We take the pulse of health care across America, with Peter Baker of The New York Times, Molly Ball of The Atlantic, Ed O’Keefe of The Washington Post, and Erica Werner of the Associated Press.

ANNOUNCER: Celebrating 50 years, this is Washington Week. Once again, live from Washington, moderator Robert Costa.

MR. COSTA: Good evening. President Trump has declared Obamacare dead after House Republicans passed a health care bill by a narrow vote – 217 to 213. Republicans rushed the vote just 17 hours after the bill was finalized and before the Congressional Budget Office could score the plan to estimate the cost and determine how many people it would affect. Here are a few of the prominent changes contained in the House bill.

First, repeal the federal mandate that requires everyone to have health insurance or pay a penalty. Eliminate government subsidies to help people pay for coverage. Roll back the expansion of Medicaid by the year 2020. Companies with a staff of 50 or more would not be required to provide health insurance. But one key feature of the Affordable Care Act would remain in place, young people could stay on their parents’ insurance plans up to age 26. But of course, a longer and possibly more consequential battle lies ahead in the Senate, where the bill faces bipartisan pushback.

SENATOR BERNIE SANDERS (I-VT): (From video.) Mr. President, I’m sorry to disappoint you. This bill in its current form is not getting through the Senate. No way. No way.

SENATOR BILL CASSIDY (R-LA): (From video.) The Senate will write its own bill. I don’t think that the House bill necessarily predicts what is in the Senate bill.

MR. COSTA: Peter, there was this moment of celebration in the Rose Garden, but at what cost to the Republican Party did this victory come, and what does it mean for President Trump only having a victory so far in the House, and yet celebrating?

PETER BAKER: Yeah, it was quite a scene, right? You had the president of the United States and the dozens of members of his party there on the lawn, very boisterous, very happy, very jubilant about something that hasn’t happened yet. It’s one thing for the House to pass. That doesn’t make it a law. There was no signing today or yesterday of anything that actually will change the law. So when he says that Obamacare is dead, Mark Twain would have something to say about that – reports of its death are premature.

The Senate is going to take a different look at it. And as you say, there’s a whole – there is a potential cost here. You know, there was a reason why Democrats, you know, sang, you know, nah, nah, nah, nah at the Republicans. Having said that, the Democrats have gotten this wrong before. They said the same thing when the Republicans shut down the government. They said, well, gosh, you guys will pay a price. They didn’t. They swept the next midterm elections. So it’s too early to say.

MR. COSTA: Molly, what does your reporting tell you about the public reaction to this House vote. All these lawmakers are now heading home for a recess. Some of them will have town hall meetings.

MOLLY BALL: That’s right. I mean, I think that’s really how Republicans are going to get their finger on the pulse, if you will, of how this healthcare bill is going over. We’ve seen mixed signals in the past few weeks, I feel like, about how much of the resistance to Trump was falling away, eroding. Democrats are now saying that they have seen a surge of enthusiasm, donations, and participation not just from their base voters, but from a wide swath of voters who have been activated and galvanized by what the Republicans have done on health care.

But, you know, the way Republicans will know whether that’s true or not is that same internal sense that any politician has, when the go home to their district and they go to a town hall. Sure, there are going to be people who are mad at you. But who are those people? Are they people that you know? Are they people that you’ve seen before? Are they the same five protestors that you saw two years ago? Or – and how many of those people are there? And what are they talking about? And are they people that worry you on a political basis?

So I think the Republicans are going home for a week. They’re going to be testing those waters, testing those political winds, seeing how bad is this going to be for us. And the one thing you don’t hear anybody saying is, oh, no, this is going to be a net plus. Even the Republicans who voted for this bill, you really don’t hear them saying more people are going to vote for us because we passed this bill.

MR. COSTA: Ed, I spoke to Tom MacArthur, a congressman from New Jersey, a moderate. And he and other of the centrists within the House GOP seem perhaps the most skittish about this vote.

ED O’KEEFE: Yeah. And it was a good indication of why they should be today, when the nonpartisan Cook Political Report moved about 20 Republican races that had either been solidly Republican or that lean Republican a little closer to the Democratic side. None of them sort of seen now as Democratic pickups, but a few moved into the tossup category, in California and Colorado, and others that were very Republican are now sort of more lean Republican or probably Republican. That’s guys like Mike Coffman in the suburbs of Denver, Steve Knight in the suburbs of Los Angeles to the north, Mario Diaz-Balart in Miami, and, you know, Mimi Walter(s), another one in California that Democrats are convinced they can knock off next year, to continue what was starting last year when Hillary Clinton won a lot of these Republican districts.

It’s telling that people like Mario Diaz-Balart, who represents part of Miami, told reporters this week: I don’t like this, but I voted for it because there was an understanding that to not vote for this would cause such an existential crisis for the Republican Party you would have – probably be sitting here tonight talking about who the next speaker is and what a great guy Paul Ryan was for the 18 months he ran the place. (Laughter.) And instead, you know, they live to fight through another week or two. But that recess, plus whenever that CBO score comes back that suggests how many millions of people could be affected by this and how many billions of dollars that could be moved around in the federal coffers, I think it’s going to cause them great heartburn in the next few weeks as they really sort of think about this.

MR. COSTA: Erica, following up on Ed’s point, this seemed to be driven a lot by politics, the culmination of these seven years of fights on the Republican side against the Affordable Care Act. And there seemed to be this rush to vote because of that.

ERICA WERNER: Right. Well, as you know, Republicans have been promising ceaselessly, over and over again for seven years, ever since Obamacare passed, that they would repeal and replace it. That’s how they won control of the House, the Senate, and the White House, in part. So it’s been their number-one priority. They had to do it. Failure was not an option, as many of them said. Well, failure became an option in March when the bill collapsed on the first go-round. And many of us thought that it would never be revived. But Trump really wanted it. House Republicans really wanted it. And they kept at it and managed to bring it back from the dead.

Now, part of the reason that many of them were motivated to do that, I’ve heard from Republicans on the Hill, is because their base was really pushing them. Internal polling was showing that enthusiasm was dropping from base voters. And they had to do something to get back that enthusiasm from the base, even though liberals aren’t going to like it. But they need base enthusiasm to match and counteract that liberal enthusiasm if they’re going to survive in 2018.

MS. BALL: I think – I think that’s a really good point about the base, though, because for so many years we’ve seen the biggest threat to, especially House Republicans, come from the base. And it’s surprising that – it’s interesting, as Ed was saying, the members who are under threat now are those ones in the middle, the ones who have something to fear from Democrats. It’s not the Freedom Caucus guys. It’s not the guys on the right, who swore up and down for all these years that nothing short of full repeal would suffice, that we must get rid of every single bit of Obamacare, root and branch. Any attempt to fix it or make it better was unacceptable. Full repeal. This is not a full repeal of Obamacare. And this is not, by a lot of conservative standards, a very conservative bill. And yet, it is apparently good enough for the entire right-wing Republican base.

MR. COSTA: It seems, Peter, almost that the president’s riding this Republican horse that’s carrying him along this path because, as you said, the base is pushing for this. But the president actually seemed to step back in the negotiations the second time around – wasn’t as involved, didn’t use the bully pulpit.

MR. BAKER: Yeah, no he didn’t. In fact, he let the process play itself out a little bit. Look, he’s not a detail guy. It’s not really his thing to sit there and say let’s have this provision or that provision. He even at times seemed somewhat confused about the provisions that were in the second bill, whether or not preexisting conditions would still be covered or not. So that wasn’t his strength. But, you know, he was willing – what he did do, as Erica said, is sort of provide the propulsive energy to say we cannot stop, we will make this happen no matter what. There’s something to be said for that, right? There is something to be said for a president who provides energy and leadership and determination, and lets the details to others. We’re not anywhere near the end of the process, though, and he seemed to be celebrating at a point where we don’t have an actual result.

MR. O’KEEFE: And let’s give him some credit. Nobody thought he’d win the Republican primary. He did. Nobody thought he’d win the presidency. He did. Nobody thought the House would do what it did this week. It did. Official Washington may want to stop betting against him.

MS. BALL: And the rap on Republicans for so long has been that they can’t get anything done because they are too hung up on their disagreements on issues. And so, yes, that’s a – Trump’s theory of the case is, if we focus on winning instead of our differences, we can get things through even with all the divisions. And that happened.

MR. COSTA: It’s still complicated for the Republican Party because they were celebrating this week as a political moment, but the details of this legislation – which, of course, could be changed in the Senate – matter. And one of the reasons the original plan failed to even get a vote in March was the issue of coverage for people with preexisting conditions, and it remains one of the biggest flashpoints in the health care debate. Under the Affordable Care Act, insurers could not refuse coverage to people with a medical condition like diabetes, heart disease or cancer, and could not charge these policyholders a higher premium. In the House-passed plan, in the states that apply for a waiver, insurers could charge higher premiums for people with preexisting conditions. The plan would also add $8 billion to an existing $130 billion high-risk fund. Many experts, let’s remember, say the new funding falls far short of the money needed to provide coverage. So when you look at the details of this, the president’s celebrating, but how does it affect his base, Molly?

MS. BALL: Well, we don’t know yet, in part because they rushed it through without a CBO score. And there actually is some debate going on about the degree to which that preexisting coverage loophole, you could call it, will or will not be put into practice if this bill does become law, which it will not because the Senate has already said they have no intention of passing the House bill. However, you know, that’s a big deal, and that is why they lost Republican votes and, you know, never even tried to get any Democratic votes for this bill. And that is going to be the thing that Democrats try to hang around Republicans’ necks, that all of these people want health insurance and now can’t get it because of something that the Republicans did, and it’s very likely that that will be the case.

MR. COSTA: Erica, I see you walking through the Capitol all week and you follow the policy closely. What was the Republican thinking behind trying to give this waiver for preexisting conditions? And does it mean, if you’re in a state like Wisconsin with Governor Walker, who’s already talking about maybe having a waiver and not having these preexisting condition rules? What does it mean for people out it the country, based on all of your coverage, to have this Republican plan, if it actually became law?

MS. WERNER: Well, it’s not clear how many states would take this waiver. And, in fact, GOP leaders think that few, in all likelihood, would. We’ve heard from Walker today that he’s interested in doing so. I must say that that addition to the bill, the waiver that states can take to allow insurers to get out of the preexisting coverage requirements, that was the deal that brought the Freedom Caucus onboard, which then pushed moderates away. They were then brought back onboard with this $8 billion addition to the fund that you mentioned. In both cases, these deals really were fig leaves. Neither of them does a lot, OK? The waiver may be taken by few, if any states; $8 billion is a pittance for high-risk pools, which have had a very mixed track record. So in both cases, in my view and a lot of Republicans’ on the Hill, this all came after the initial failure, which was very humiliating for Republicans on the Hill and off. And these different groups were finding a way to get to yes. Amazingly, they did so, but the policy implications may not be huge of the changes that got them there.

MR. COSTA: And there are huge challenges, Ed, in the Senate. Senator Portman of Ohio, from a swing state, he’s already expressing real concern about the phasing out of Medicaid expansion.

MR. O’KEEFE: He’s not the only one. Shelley Moore Capito of West Virginia, which has really become a reliably Republican state in recent years, because that state has seen its Medicaid program grow. Tom Cotton, who many see as a rising star in the party and a pretty loyal conservative foot soldier on just about everything else, has said – he told our colleague Sean Sullivan in a story in tomorrow’s Washington Post that he has to be concerned about this because there are tens of thousands of people in Arkansas who have now received Medicaid, and he realizes that his state has no other way to pay for these things. So you’re going to see by geography and ideology a really different debate take place in the Senate among some Republican senators you might not think would be concerned about this law because they understand that back home, you know, the politics of health care are a very dangerous thing for them.

MR. BAKER: We’re really testing an interesting historical lesson here, which is that once enacted, an entitlement program doesn’t go away, right?

MR. O’KEEFE: Right.

MR. BAKER: That once you’ve given the public government benefits of some sort, of course no politician would ever want to take it away, even if philosophically they think the government shouldn’t be in the business of doing that. This is the first time I can think of in a long time where they’re actually going to try doing it, or at least they want to try doing it, and the reaction to that will tell us a lot, and tell us a lot about views of government and the size of government and the reach of government. People who might actually suffer themselves might still support it because they just think it’s wrong for government to be involved.

MR. COSTA: Let’s recall it’s not just getting rid of a federal spending program, but the president back in January promised, Molly, insurance for everybody. And this bill has not yet been scored in its revised version by the CBO, the Congressional Budget Office, but in the original incarnation of the bill more than 20 million people in a decade would be set to lose their insurance. And so this is a president who has this populist instinct of insurance for everybody, but what’s the reality of the legislation?

MS. BALL: Well, it falls very far short. There is no question that no matter what the Congressional Budget Office ends up determining about this bill, there is no way it will fulfill the Trump promise to cover everybody with health care that is better and less expensive, and is available to all Americans. That’s just not what this bill is even designed to do. At its very, very best, it could provide access to health care through the private market to more people because the private market is eventually functioning better, with fewer restraints.

So I think that’s an issue, right? You have a president who many times made these promises that his own Congress had no intention of keeping. And you can say that a compromise was made, but you know, I’ve heard from many of my Republican sources today that they worry that that moment in the Rose Garden with Trump celebrating Obamacare being dead is the equivalent of the George W. Bush “Mission Accomplished” banner, celebrating a victory prematurely that voters then held the whole party accountable for.

MR. O’KEEFE: I had one liberal activist say to me today all that was missing is a “Mission Accomplished” banner. I think one of the things to keep an ear out for more than anything is you heard Kevin McCarthy this week say that nobody will lose their Medicaid coverage who has it now, essentially – the reason being, of course, that these changes don’t happen until 2020. So there you set people who are in their late 40s and 50s – which, let’s be frank, are a lot of voters – who were planning to have Medicaid in the next few years, they’re the ones that are now going to have to scramble. Well, who has been most affected by the economic downturn in recent years? Middle-aged guys, right, who are probably thinking that they were going to have this benefit for them. Who do these guys vote for? Usually they vote for Republicans. It could be a huge problem for the party, especially next year, not only at the federal level but down to the state, where –

MS. BALL: Well, but the people on Medicaid are poor people, and those people mostly vote for Democrats already.

MS. WERNER: Well, it’s also worth noting, though, that by the time the 2018 midterms roll around, under the best-case scenario, none of this will have become law. I mean, even if this bill were to pass – which it won’t, because of the Senate, et cetera. So the existing problems with the health care system that Republicans are constantly complaining about and blaming on Obama will still be in place. So what are Republicans up for reelection going to do at that point? Do they still blame Obama for the problems in the health care system that they also simultaneously claim that they have tried to fix? I mean, I’m not sure that that’s a winning midterm message.

MR. COSTA: And it’s so hard to read the political fallout and complications. I was looking at some comments by congressmen this week. Congressman Curbelo, a moderate Republican from Florida, said for sure Florida probably wouldn’t take a waiver. Congressman Barton of Texas, a conservative, said Texas would certainly take a waiver. So if you’re calculating all this policywise or politically, you don’t even know how the states are going to respond if this bill ever becomes law.

And I’d just like to say, if you have a health care story you’d like to share, send us an email. The address is on the screen.

Health care was not the only issue this week, of course. President Trump signed a $1.1 trillion spending bill today that will keep federal agencies funded through September. Congress passed the budget earlier this week after intense negotiation between Democratic and Republican lawmakers, and to no one’s surprise, both sides claimed victory. While Republicans pointed to the additional funding they included for border security and the military, Democrats blocked the GOP efforts to secure funding for the president’s famous promise, his border wall with Mexico. Peter, because the president did not get the border wall in this round of funding for the government, does that mean we’re going to have a shutdown in September when it expires?

MR. BAKER: Well, he said so, almost, in a tweet that came out afterwards. He said, well, we have to either change the rules or we need a good government shutdown in September. Now, that’s a negotiating position, presumably. He made a calculated decision this time, he was not going to go anywhere near the cliff the Republicans have gone to several times in the last few years of possibly risking the government shutting down. It’s a rational decision that that chaos would have been worse than not winning on certain budget items – people won’t remember that, and this is only a temporary, you know, relatively short-term bill. He can come back and fight another day. But come the fall, if he doesn’t get some of his bigger priorities in, that’s a different situation, and it will be a test for him because at that point you’ve lost the first really two years of your presidency if you can’t start to get some of that funding in.

MR. COSTA: Ed, when you look at the budget, this was a bipartisan agreement, and most of the top lawmakers on Capitol Hill seem pretty comfortable with it in spite of it not having some of the projects.

MR. O’KEEFE: This was sort of the bipartisan deal-making that we all pined for from the past because they were essentially left alone to figure out amongst themselves how do we get this thing passed. It wasn’t until right after Easter that the White House interjected and said, what about that border wall? And Republicans and Democrats told Mick Mulvaney, the budget director, to go back to the Eisenhower Building and just wait out an agreement. It was passed, and border wall money, I’m told, was never part of the conversation, even during the transition when the appropriators began this, because they understood that the way you pass appropriations bills required bipartisan support. You needed to have enough Democrats in the House and the Senate, and they’ve said it’s amoral, it’s something they’re not interested in. But I do think we face a bit of a showdown later this year if negotiations continue and there’s no sign of border money. Remember this, though: the calculation will be different. You always think the party in Congress is the one that’s going to get blamed. Well, the party that runs Congress is the Republican Party. And senators especially know if anyone’s going to get blamed for a shutdown, it will be Republicans entirely because they control all the levers.

MR. COSTA: Erica, some people on the outside may have been singing Kumbaya about the bipartisanship, but the Democrats – Ed, you spoke with Leader Pelosi this week – Democrats are touting this as a big win, and you saw the White House react and the president react saying it’s not a big win for Democrats. So it had a partisan edge.

MS. WERNER: Well, it’s worth noting that Democrats, Schumer in particular, were really able to take a victory lap on this. But that’s partly because of the mixed messaging that came out of the White House. Had the White House, for example, said all we want from this spending bill is a bump in defense spending, and then it’ll be the best omnibus ever, then they could have claimed victory when that happened. But instead, Trump comes in and wants the border wall, which was never going to happen, which was not feasible under any scenario. So he doesn’t get it, and it looks like a loss for the White House, and Schumer can go around claiming victory. So, you know, I think that the White House, a little more discipline from them and letting the Hill Republicans do what they do best without interfering might be – might work out a little bit better for them.

MS. BALL: Yeah, I mean, it was amazing to me. And perhaps as Peter said I’m not giving him enough credit and it was strategic, but for the president to come out and threaten a shutdown when he has just made a successful bipartisan deal that he could claim victory on, it sort of seemed to be almost snatching defeat from the jaws of victory there because he could have said look at this great thing that we all did together. I think he was stung in part by the criticism from the conservative media because they were very earnestly dismayed by this bill, which didn’t make all of the cuts that they would have liked to see to agencies and programs. Very much a status quo; that’s what you get when you do a continuing resolution and not a full budget. But it fell short of a lot of the things that conservatives felt they were promised. Trump is very sensitive to criticism, I think, from the right, and that was part of the reason that he had to go out and say don’t worry, guys, we’ll take them all the way to the brink next time, we’ll get those things that we promised you.

MR. BAKER: It’s just interesting that today he signed the bill. On Friday he signed the bill, no publicity whatsoever. This is actually the biggest, most consequential thing he’s signed, as legislation goes; nobody there. And he did not have – while this was sort of a return to the bipartisan days, he did not have Senator Schumer and Nancy Pelosi and both sides of the congressional leadership to the White House for a ceremony that would be like it was in the old days. So, in fact, you’re right; while they may have moments of Kumbaya, it’s not really –

MR. COSTA: Not this time.

MS. WERNER: And if he really wanted a good shutdown, he could have not signed the bill.

MR. BAKER: Yeah, yeah. (Laughter.)

MR. COSTA: We’ll have to watch and wait and see. Thanks, everybody. What a week, again, for President Trump.

And, Erica, welcome to Washington Week.

MR. BAKER: Hear, hear.

MR. COSTA: Our conversation will continue online on the Washington Week Extra, where we’ll talk about former Secretary Hillary Clinton’s interesting take on why she lost the election, and why she and FBI Director James Comey are actually on the same page when it comes to Russian interference. You can find that later tonight at PBS.org/WashingtonWeek.

I’m Robert Costa. Thanks for watching and enjoy your weekend.