Full Episode: Will Republicans be able to dismantle the Affordable Care Act?

Sep. 22, 2017 AT 9:26 p.m. EDT

Senate Republicans revived their efforts to repeal and replace the Affordable Care Act after three failed attempts earlier this year. But Sen. John McCain caused a blow to the Graham-Cassidy plan on Friday when he said he wouldn’t support the proposal. The panelists also discussed President Trump’s debut trip to the United Nations General Assembly.

Get Washington Week in your inbox


Notice: Transcripts are machine and human generated and lightly edited for accuracy. They may contain errors.

ROBERT COSTA: It’s not over. Republicans take another shot at dismantling the Affordable Care Act, but the clock is ticking. I’m Robert Costa. We look at the sudden push on Capitol Hill, plus escalating tensions between the U.S. and North Korea, tonight on Washington Week .

SENATOR LINDSEY GRAHAM (R-SC): (From video.) Here’s the test for Republicans: Could we work as hard to repeal Obamacare as they did to pass it?

MR. COSTA: Senate Republicans revive efforts to overhaul the Affordable Care Act. But as the clock ticks down, can they get 50 Republican votes?

SENATOR SUSAN COLLINS (R-ME): (From video.) There are many concerns that I have about the Graham-Cassidy proposal.

SENATOR RAND PAUL (R-KY): (From video.) I promised repeal. I didn’t promise I would sort of keep most of it.

MR. COSTA: Democrats remain united in opposition.

SENATE MINORITY LEADER CHARLES SCHUMER (D-NY): (From video.) Are we not going to rest till this horrible bill, worse than the last one, is dead? (Cheers.)

MR. COSTA: Plus, President Trump takes the world stage.

PRESIDENT DONALD TRUMP: (From video.) “Rocket man” is on a suicide mission for himself and for his regime.

MR. COSTA: And he follows up his debut at the United Nations with new sanctions on North Korea.

PRESIDENT TRUMP: (From video.) The order enhances the Treasury Department’s authorities to target any individual or entity that conducts significant trade in goods, services, or technology with North Korea.

MR. COSTA: Will the tough talk spark conflict? And what is the Trump doctrine? We’ll get answers from Philip Rucker of The Washington Post , Shawna Thomas of VICE News, Julie Pace of the Associated Press, and Peter Baker of The New York Times .

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

MR. COSTA: Good evening. Republicans right now are scrambling to get the 50 votes they need in the Senate to upend the Affordable Care Act. Senator Lindsey Graham of South Carolina and Bill Cassidy of Louisiana drafted the latest GOP legislation. The bill would eliminate insurance subsidies and employer mandates. It would significantly change the expansion of Medicaid, converting those health care funds into block grants that states would receive as a lump sum. And coverage for preexisting conditions would not be federally protected. That’s because each state could opt out of that insurance rule. A bipartisan group of 10 governors are opposed to the measure, and even reliably Republican Senator Chuck Grassley of Iowa has admitted the bill has flaws. But he said that Republicans campaigned on the issue and feel pressure from their base to act. Shawna, when you look at this piece of legislation, it says the GOP will let the states decide how to use federal money. But why is that so complicated, and what’s at the heart of this debate?

SHAWNA THOMAS: Well, it’s so complicated because even though they’re saying we’re going to create a formula and give all the states this money, in the end for a lot of states that means a lot less money is going to them. And overall, the cuts are fairly large. So Avalere Health – because we don’t have a Congressional Budget Office score – has said it’s a 215 billion (dollar) cut in health care funding between 2020 and 2026. In 2027, they say that it goes up to 489 billion (dollars). So at the heart of it, it is a program to make the size of government smaller, which is a very conservative thing. But when you start looking at what does that mean for each individual state, these states start to say things like, wait a second, if you’re going to give me a billion less over 10 years, how am I going to fund these health care programs that I already have? And the states will have to grapple with what makes the best health care for them if this thing goes through.

MR. COSTA: And governors are big stakeholders here, Phil, and they seem to not want the disruption for their insurance markets or the way they spend health care money.

PHILIP RUCKER: That’s right, and you know, a number of states expanded Medicaid programs in their states under the Affordable Care Act, and those are the states in particular that would likely see less money coming in for their programs, which could result in big cuts to Medicaid. And it’s one of the reasons that you see Republicans like Ohio Governor John Kasich so strongly opposed to this bill, because it would disrupt a system that they’ve spent really years trying to build in their states after the Affordable Care Act. Health care is complicated, and these governors have had to navigate a lot of different rules and regulations to create a system that the industry can get used to, and this is just more disruption potentially.

MR. COSTA: And we saw, as Shawna mentioned, we don’t have a Congressional Budget Office score yet. We don’t know how much this Republican bill would cost, Julie. But we had big news today: not only because we don’t have a CBO score and the process has been somewhat rushed, but Senator John McCain, veteran Republican from Arizona, said he is once again opposed to the Republican bill, major news for this bill’s fate.

JULIE PACE: It essentially puts this bill on death’s door. I mean, you can really only afford to lose three of these – or two of these Republican lawmakers. Three would be a bridge too far. Rand Paul is already a no. McCain now says he’s a no. All the attention is going to be focused on Susan Collins from Maine and Lisa Murkowski from Alaska. And the problem for the White House and for Republican leadership is these are two senators that can’t be swayed in the ways that you would usually try to get a senator to change course. Murkowski had to run in a write – in a – she had to do a write-in to get – to get in her seat, and McConnell didn’t back her in that race. She owes these leadership members nothing. And Collins is the traditional moderate Republican. This is the role that she plays. It’s really hard to see, especially with cover from John McCain, that either of these women will change course now.

MS. THOMAS: And with Senator Collins you have the issue that everyone kind of thinks she’s going to run for governor of Maine, and it’s hard to run for governor of Maine if you also have to go to your citizens and say, well, I voted for something that took a billion dollars away from your state when it comes to something like health care, which is so personal to people.

PETER BAKER: That’s sort of the genius or the deviousness of the Obama plan, right? They understood from the beginning if you get these states hooked on money for health programs, they’re going to want to keep it. They’re going to – you know, once government programs are started, it’s awfully hard to undo them. And so, in effect, they created a constituency for a law that might, in fact, be controversial, but has a lot of people who are currently stakeholders in it.

MR. COSTA: And we saw, Peter, that President Obama spoke out this week about the health care legislation, and Democrats seem to be mounting their own effort.

MR. BAKER: Yeah, that’s right. Listen, nothing is closer to his heart, I think, as a legacy item than this health care bill. From his point of view, it was one of the major accomplishments. He did what presidents had sought to do for decades. But, you know, the problem is for Democrats, you know, is let’s say this goes down, as people now think it might. What do they do next? Is there a way to fix what everybody agrees are flaws in the law, which require a bipartisan effort? And what’s interesting is a test for President Trump and his newfound fondness for “Chuck and Nancy” is, is he going to do that?

MR. COSTA: Yeah, but that brings up this key point. The way, Julie, this health care debate is evolving is that you have Republicans pushing block grants in states and Democrats are pushing at some level for single-payer health care, led by Senator Sanders, independent but aligned with the Democrats, from Vermont. Is this the way the health care debate’s now moving in the United States?

MS. PACE: Well, it’s these two parties moving in these opposite directions right now. I think that the single-payer debate among the Democrats right now is a fascinating aspect of this story, led by Bernie Sanders, who is continuing to play a disrupter for Democrats, pushing a lot of people to the left. In principle, a lot of Democrats do support the idea of a single payer. In practicality, that’s a lot different, but Sanders is trying to push them in that direction. I do think that this Patty Murray-Lamar Alexander bipartisan discussion that was going on before Graham-Cassidy got pushed to the forefront is something to keep an eye on because, as Peter said, you won’t find any senator of either – any lawmaker of any party that would say that Obamacare as it exists now is working. It has to be fixed. It’s unsustainable in its current form.

MR. COSTA: Yep, people don’t want to uproot it. It seems the disruption factor is keeping a lot of people opposed to this legislation.

MS. PACE: And a lot of that’s coming from these governors, who are the ones that are actually on the ground having to implement this.

MS. THOMAS: Well, and also uprooting it. It goes back to who do you tell in your state who – especially if you’re in a state that expanded Medicaid, like Ohio, like you mentioned, OK, we are going to change these rules so that all of a sudden you are not allowed to have Medicaid anymore? Who are you going to tell that to practically, especially if you’re a governor or someone on the local level?

MR. COSTA: And what about preexisting conditions?

MS. THOMAS: The preexisting conditions fight that Jimmy Kimmel has brought to the forefront of America is interesting because the bill can’t get rid of the idea that preexisting conditions need to be covered by insurance companies, that an insurance company cannot deny you if you have a preexisting condition. And they can’t change that in this bill. But what they have done is said, hey, states, we’re giving you a lot of latitude. If you write a program and you assure us that people will have adequate and affordable coverage, and even if they have preexisting conditions they will have adequate and affordable coverage, then you can create some room for yourself, basically. And no one knows really what that is going to mean from a state by state by state basis. And because there is that uncertainty, it leads to sort of the fight we’ve seen on late night TV lately.

MR. COSTA: That cultural effect matters.

MR. RUCKER: It does matter. And a big obstacle for Senate Republicans on this bill is the popularity of their effort. There’s a new poll out tonight for The Washington Post and ABC News that finds that 56 percent of Americans think Obamacare is better and only 33 percent think the Senate GOP bill is better. And actually, if you look at the Republicans – only Republicans in that poll, a full quarter of them do not like this Senate bill. So the senators are having a really hard time galvanizing support for this measure out in the country even though they campaigned on repealing Obamacare, even though repealing it has been a galvanizing force in their base. The specifics of this bill are not popular.

MR. BAKER: It may become the best thing for Obamacare because it was very unpopular when it was just President Obama, but now that people are faced with the choice of maybe losing it –

MS. PACE: And one of the downfalls of not going through what John McCain is talking about, regular order where you have hearings and you have a public debate on the merits of it, is that there really hasn’t been a chance for Republicans to even sell the public on this. Most Americans probably don’t know the details of it. What they are hearing is coming from news reports, coming from Jimmy Kimmel. But when you do the process in this way, where you try to rush legislation through that’s really complicated, you lose that ability to actually bolster the popularity of what you’re trying to do.

MR. COSTA: And I really wonder, does the Trump voter actually want this legislation? We always talk about the conservative base prompting Republicans in Congress to move quickly, Peter. But are we sure that the Trump voter, who’s sometimes a little more independent and populous, wants this bill?

MR. BAKER: Well, I think once they saw the effect of it they might not want it. I mean, I think a lot of people want it in theory, right? They think Obamacare was terrible. It was either government run amok of their premiums were going up, or what have you. The businesses were required to provide things they couldn’t afford. But if they saw the alternative as being better, you know, that’s the real test. And I think one of the things we’ve learned now in these last 10 years of health care debates is there is no model system that everybody is going to love. In fact, each one is going to drive somebody crazy and become unpopular for one reason or another.

MR. COSTA: So if this bill falls apart, and the Graham-Cassidy bill is put on the shelf, Shawna, we saw Senator McCain’s statement tonight. He was talking about bipartisan efforts maybe being on the horizon. You see Senator Alexander of Tennessee, Lamar Alexander, Senator Patty Murray of Washington are working on their own proposal. Could that actually happen?

MS. THOMAS: Well, I think what we know – and it goes back to kind of what Julie said – is that a lot of people – none of these people really totally like Obamacare in its current form. And there is Republican and Democratic agreement that if we don’t figure out a way to shore up the insurance markets, if we don’t figure out a way to stabilize them, if we don’t give the insurance companies some kind of idea that this is – the payments to them from the federal government are going to continue, they will keep pulling out. And so while that could be a way to sort of destroy Obamacare, which is something Republicans might want, if that makes it harder for people to get health insurance, I think you’re going to see people try to come together around this, which is what Alexander and Murray were doing.

MR. COSTA: Phil, the president’s in Alabama as we speak participating in a primary runoff. You have Senator Rand Paul of Kentucky firmly opposed to this legislation. Does the White House feel any pressure to move on health care?

MR. RUCKER: They’d like to move. They saw an opportunity this week. I think there was some momentum building behind this bill. And it’s the reason you saw Vice President Pence leave the United Nations midday Tuesday to come to Capitol Hill and try and twist some arms in the Senate. Look, the president has not been at the forefront of this Graham-Cassidy effort, but he’s trying push it along. He sees a chance for a win. And I think McCain dashed it tonight, probably.

MR. COSTA: And it’s not just the president who has some political capital on the line here. Senate Majority Leader Mitch McConnell. He’s pushing in this Alabama primary as well, but he also is trying to show the White House or the Republican voter, Julie, that he can get something done.

MS. PACE: Absolutely. And again, on this promise that has been so central for Republicans for seven years now. And there is still this open question, even with McCain taking this position today, if McConnell will put a bill on the floor.

MR. COSTA: Will he?

MS. PACE: I don’t know the answer to that. I think that’s a really fascinating question. You could argue that he might want to put it on the floor and let it fail, have two failed votes, and go turn to his members and say: We have to move on. It’s time to put this behind us. Whether that works or not with their voters, I think, is also an open question.

MS. THOMAS: You could argue, is it worth the embarrassment to have another failed vote in the middle of the night, yeah.

MS. PACE: Is it worth the embarrassment, absolutely.

MR. BAKER: Well, and once again, you’ve got a White House that had thought it was beginning to kind of get a little bit of traction, right, that things had started to settle down a little bit. That the president had done pretty well at managing the hurricanes, that he had done pretty well at the U.N. Obviously not everybody agreed with that. But they had a plan. And the plan was for the fall to be about tax reform. Now, suddenly, you’ve got this overshadowing it, another loss if it goes down. And, by the way, immigration looming in the background ready to come up at any moment. So instead of being able to focus on what they thought was going to be their one priority, they keep getting pulled in different directions.

MR. COSTA: But, Peter and Phil, I’m not so sure if they do move on from health care to tax reform that’s going to be any easier. These dynamics still exist on that issue.

MR. RUCKER: Tax reform is tough. And the president wants to try to put a little more meat on the bone, if you will, next week, reveal something more of a plan. Right now, we must basically have some principles and a list of bullet points. But tax reform’s going to be tough. They’re trying to get some democratic support. That’s going to be hard. It’s complicated. There are a lot of different constituency groups – millions – tens of millions of dollars at stake here for industries that are lobbying hard.

MR. BAKER: It’s in some ways much harder than health care.


MS. PACE: It is much harder than health care. And I think that if you talk to Republicans who are working on 2018 races, the prospect of going into the midterms without health care, without taxes, they know that map looks really good but that just is ugly for them. And they’re pretty honest about that behind the scenes.

MR. COSTA: So as all this brews on Capitol Hill, we have to, again, turn to the other big issue of the week. The president was at the United Nations. And tensions between the United States and North Korea continued to rise after President Trump announced new economic sanctions designed to choke off that country’s trade with the outside world. The move comes days after President Trump threatened North Korea in his first address to the U.N., where he mocked North Korea’s Kim Jong-un. He called him “rocket man.”

PRESIDENT TRUMP: (From video.) The United States has great strength and patience, but if it is forced to defend itself or its allies we will have no choice but to totally destroy North Korea.

MR. COSTA: Kim Jong-un fired back in a personal statement, very personal, calling Mr. Trump, “mentally deranged.” North Korean officials are warning that they may test a hydrogen bomb in the Pacific Ocean. The president responded via Twitter writing, “Kim Jong-un of North Korea, who is obviously a madman who doesn’t mind starving or killing his people, will be tested like never before!” The president also took aim at Iran, which he called a “corrupt dictatorship,” and called Iran’s nuclear deal an embarrassment. The president seems to be trying to provoke these nuclear nations. And that, of course, could have global consequences.

Peter, you were in New York watching this all unfold. When you were watching the president’s speech, what as the mood in that room as the world watched?

MR. BAKER: Yeah, it was interesting. It’s a tough audience for any president, because it’s – everybody’s got different languages and different cultures and you’re listening. And so I think other presidents have discovered you can’t make jokes, you can’t, like, interact with the audience, which is where President Trump is at his most comfortable, where he probably is tonight in Alabama. So it’s – you know, George Bush once said it’s like speaking to a wax museum. Nobody moves. (Laughter.) And that’s what President Trump saw. It was stony silence for the most part, a little smattering of applause here and there. When he used the words “rocket man” there was kind of a buzz that went through the room. When he said that the world, by the way, was going to hell, kind of a buzz going through the room.

But they don’t know what to make of the guy, right? This is not a typical American president. American presidents don’t get up there and say, we’re going to destroy another country, even if it’s, you know, provoked. And so they’re used to a diplomatic, polished kind of presentation. And that’s how the way President Trump rolls.

MR. COSTA: But beyond the presentation, Peter, what was the message? Was it America first? Was it isolationist?

MR. BAKER: It is America first. It’s not isolationist, but he used a different word this time. He used the word “sovereign,” or “sovereignty.” He used it 21 times in this speech. And by that, it’s a favorite term on the right that hates the U.N., you know? Why should we be part of this global body? We are our own sovereign nation. The U.N. should butt out and not tell us what to do. The problem is that on the one hand he’s defending American sovereignty, really, while telling other countries what to do. He’s attacking Venezuela for its repression of its own people. He’s attacking, you know, not just North Korea, which you could argue is a threat to other countries, but countries that are internally violating human rights. Well, they would say sovereignty applies to them too; butt out, United States.

MS. PACE: And also pushing China to act tougher on North Korea, even though they don’t always feel like it’s in their own sovereign interest.

MR. BAKER: Exactly, exactly.

MR. COSTA: And we’ve seen some developments, Julie, this week. Chinese banks are now saying they’re going to screw the lid a little bit tighter when it comes to giving money to North Korea and trade with North Korea. Is that progress? Is North Korea actually becoming more isolated?

MS. PACE: You know, it’s sometimes hard to know with the Chinese banks because they’re a bit insular, which is probably an understatement. I don’t think we know the full extent of what China is doing here. Rhetorically, though, the White House jumped on this. You had the president talking about this at the U.N. China continues to be the key for the administration in terms of getting progress on North Korea. Everything else that we’ve seen so far has really had no practical effect. The momentum is all in one direction, with North Korea continuing to move forward with testing, continuing to take provocative actions. They show no sign of being cowed by Trump’s rhetoric. They actually like to return the fire with the – with the rhetoric. So China remains a puzzle for this administration. The can’t quite figure out how to get them to move as quickly as they want them to, but that’s because China doesn’t move quickly. I mean, there’s this fundamental sort of lack of understanding, I think, sometimes in this administration about the way that China approaches these issues and the speed at which they’re willing to move.

MR. COSTA: Phil, when you think about the very personal way these two leaders are going at each other, it’s typical President Trump. You’ve covered him for a long time. But it has real implications for foreign policy.

MR. RUCKER: It does. And you know, there are some people here in the United States, when they see Trump fire shots on Twitter or whatever, they just say don’t listen to what he’s saying, just focus on the actions. But in this case, the words are the actions, and you can’t trust that North Korea is going to not pay attention when Trump says “rocket man” and threatens to destroy their civilization, really. It’s very dangerous for the region. It’s, you know, something that has Japan and South Korea in particular, our allies there, very nervous. The president met with their leaders – the leaders of Japan and South Korea this week in New York, and I think they’re trying together to try to bring more pressure on China to pressure North Korea. But there’s no easy option. And you talk to folks in the White House, and they’re nervous about this. They’re very jittery about North Korea. And they have not identified any sort of magic bullet.

MR. COSTA: And, Shawna, Iran’s watching very closely. They strike a nuclear deal with the United States. Kim Jong-un is watching. Does he want to cut a deal with the United States? The president is not just making nuclear tough talk with North Korea, but with Iran.

MS. THOMAS: Well, and I think one of the issues that people brought up is that if Kim Jong-un is watching the way the president, President Trump, talks about Iran, he’s saying to himself, well, I saw you make a deal with a bunch of other countries and international bodies are saying they – Iran is adhering to the nuclear part of the deal, and America seems to want to still try to figure out a way to get out of that deal. Why should I make a deal with you if this is – if you’re going to go onto the world stage if I’m cooperating and still, you know, say the worst about me? There’s no good reason to make the deal, to a certain extent.

MR. COSTA: And on that point, Peter, the president said he’s made a decision on the Iran deal but he won’t reveal it. This is a totally different figure on the world stage. But on Iran and North Korea, what’s next?

MR. BAKER: Well, that’s the real question, right? I mean, you know, with Iran you could see a possible path forward if they are good at diplomacy. Now, that’s a big if. The president has until October 15 th under American law to certify whether, in fact, Iran is complying with the deal and – the other part of the phrase, it’s interesting – that it’s in America’s national interest. So he may not be able to make the argument that they are violating the deal, but he may declare on October 15 th it’s not in our national interest. Now, that doesn’t get us out of the deal, but it does say to Congress you have a 60-day clock to repass these sanctions if you want. That would get us out of the deal. And he may be using this as leverage to try to get people to come to the table. The French said this week that they would be open to negotiations – not to reopen the actual deal, but to have an addendum, a supplemental, I think, in which they deal with some of these other issues. The Iranians said no, we’re done, sorry, this is a closed issue.

MR. RUCKER: And you could see – you could see the president, President Trump, tinkering a little bit with this addendum and claiming that he renegotiated the deal, and being able to go to his base like in Alabama and say I totally redid the deal and made it beautiful and wonderful like he had campaigned on.

MS. THOMAS: And there are people and organizations sort of around the United Nations, as there’s always other groups and people who talk about these things. And one of them was a group talking about Iran which included Bill Richardson, John Bolton, Dennis Ross, and a couple of other people who it seemed were trying to help President Trump make this – make this conversation about the spirit of the deal, which is how President Trump talks about it, which is the American interest part – that if they can figure out a way to create some room and show people that Iran is not part of the spirit of the deal, then maybe he can do something.

MR. COSTA: We could talk all night. (Laughter.) We’re going to have to leave it there, unfortunately. Thanks, everybody, for being here.

Our conversation will continue on the Washington Week Extra , where we’ll tell you why President Trump is risking his own political capital in a Senate race in Alabama right now that pits him against his former White House advisor, Steve Bannon. You can find that later tonight at PBS.org/WashingtonWeek.

I’m Robert Costa. Enjoy your weekend.


Support our journalism

Washington Week Logo

© 1996 - 2024 WETA. All Rights Reserved.

PBS is a 501(c)(3) not-for-profit organization

Support our journalism


Contact: Kathy Connolly,

Vice President Major and Planned Giving

kconnolly@weta.org or 703-998-2064