ACA Repeal "Strong Opposition" Letter

Must-Read: gave eight Republican senators as much rope as they wanted...

Nobody wanted to say: "this Reconciliation Bill is imperfect, but it keeps the ball rolling, and after Trump signs it the real bipartisan bargaining will commence..."

Nobody wanted to say: "I will be primaried and may lose if I cannot say: 'We in the senate did our job and passed ObamaCare repeal and I was there pushing when it happened..."

And it appears that nobody had given any thought to how they were going to answer substance questions from reporters. Which, I suppose, tells us a lot about how often anybody other than tries to get senators to answer substance questions:

Tara Golshan, Dylan Scott, and Jeff Stein: We asked 8 Senate Republicans to explain what their health bill is trying to do: "Vox asked GOP senators to explain their hopes for it. Who will benefit from the legislation? What problems is this bill trying to solve?..

...“All of them,” Sen. John McCain said in an interview, not an uncharacteristic response of his Republican Senate colleagues. Over the course of the past week, Vox asked eight different Republican senators to explain the affirmative case for the bill. They rarely answered directly, at least not on the bill’s policy merits. Sometimes, a senator could identify a desired outcome, like “lowering premiums” or “stabilizing marketplaces.” But they rarely could explain the mechanism through which they planned on achieving that outcome.

How will Republicans lower premiums? “It’s working together and coming up with a bill that does do that,” Sen. John Boozman of Arkansas said. What tool will bring stability to Obamacare’s volatile exchanges? “By bringing certainty to the insurance market,” Sen. Chuck Grassley of Iowa said. What new policy will lead tax cuts to lower premiums? “It’s teetering because the exchanges are failing,” Sen. Roger Wicker of Mississippi explained. Read for yourself. Here are the transcripts of our eight interviews with Republican senators.

McCain on the problems this bill is trying to solve: “They’re trying to get to 51 votes”

Tara Golshan, Vox: Generally, what are the big problems this bill is trying to solve?

John McCain: Almost all of them. They’re trying to get to 51 votes.

Tara Golshan: Policy-wise. What are the problems in the American health care system this is trying to solve — and is the bill doing that right now?

John McCain: Well, it's whether you have full repeal, whether you have partial repeal, whether you have the basis of it. It's spread all over.

Tara Golshan: But based on the specifics of the bill you have heard so far, is it solving the problems in the health care system?

John McCain: What I hear is that we have not reached consensus. That’s what everybody knows.

Tara Golshan: Right, but outside of getting the votes. From what you hear of the actual legislation being written is it solving the problems you see —

John McCain: It's not being written. Because there's no consensus.

Tara Golshan: But generally speaking, what are the big problems it is trying to solve?

John McCain: You name it. Everything from the Repeal caucus, which as you know they have made their views very clear — Rand Paul, etc. And then there are the others on the other side of the spectrum that just want to make minor changes to the present system. There’s not consensus.

Sen. Chuck Grassley says AHCA will bring certainty to the market because insurers will “know what the government policy is”

Jeff Stein, Vox: I want to ask a very broad question: What do you think this health care bill will accomplish that will improve America? What's the positive case for this bill?

Chuck Grassley: Well, I can tell you what it's going to do for Iowa. We are one of those states that in a couple of weeks if [the insurer] Medica pulls out we'll have 94 of our 95 counties won't have any insurance even for people who have the subsidies. That's what we have to concentrate on now.

Jeff Stein: How do you think the bill will fix that problem?

Chuck Grassley: Well, by bringing certainty to the insurance market. They don't have that certainty now.

Jeff Stein: By bringing certainty to the insurance market. What certainty?

Chuck Grassley: What?

Jeff Stein: What do you mean by certainty?

Chuck Grassley: Well, they can't even file. They have to check the rates real high if they don't know what the government policy is. And so the certainty is that passing a bill gives the health insurance companies certainty.

Jeff Stein: Wouldn't not passing a bill also do that?

Chuck Grassley: No, it. Well, yeah — it gives them certainty that you'll have a lot higher rates than if you pass the bill.

Jeff Stein: So you're saying [the bill] will lower the rates?

Chuck Grassley: Um, if you're talking about lowering the rates from now down, no. The rates could be way up here. [Points to sky] And if they — if we get a bill passed, it maybe wouldn't go up or would go up a heck of a lot less than they would without a bill.

Jeff Stein: By "rates," are you talking about premiums?

Chuck Grassley: Yeah, premiums. … I'm sorry I have to go.

Sen. John Boozman on the mechanisms to bring down premiums: “It’s working together and coming up with a bill that does do that”

Jeff Stein: What do you think this health care bill will accomplish? How will it help people in America with their health insurance?

John Boozman: Well, right now when I go back to Arkansas — we’ve got so many people in Arkansas, premiums have gone up 128 percent in the past four years. We have all kinds of people in a situation where if they’re fortunate enough to afford the premium, they’ve got $5 to $10,000 deductibles. And so hopefully we’ll deal with some of those problems

Jeff Stein: How does this bill do that?

John Boozman: Well it makes it such that it’s more affordable. So that’s really what we’re working through now. We don’t have a bill yet; we’re working hard to come to an agreement so we can solve some of those problems.

Jeff Stein: Why will this bill reduce premiums? How will it lead to the outcome you’re describing?

John Boozman: Well, again, like I said, that’s what we’re working through here. I’m not going to negotiate the bill now. We’re in a situation where that is the outcome. I know that the course we’re going down is simply not sustainable. The other problem we’ve got is that premiums were held down through the election; the premiums, in my state, the increase will be at least 20 to 25 percent. That’s what the insurance commissioners are telling me. I think we’re on an unsustainable course.

Jeff Stein: But I’m curious why you believe this bill will fix that problem? What’s the mechanismfor fixing it?

John Boozman: It’s working together and coming up with a bill that does do that. Because we’re in a situation with Obamacare that, again, we don’t have a sustainable product.

Jeff Stein: Why is cutting Medicaid necessary?

John Boozman: I’m not going to argue with you. Who do you represent?

Jeff Stein: Vox-dot-com. It’s a website. I’m just trying to understand how the bill works. That’s it.

John Boozman: Well, we don’t have a bill. That’s what we’re working on. The reason we’re working really hard to come up with a bill is to solve some of the problems of Obamacare. Because of the problems I outlined we have a lot of people in a situation with increased premiums, increased deductibles. If you’re an Arkansan you have a $5,000 deductible, you really don’t have insurance. You have catastrophic insurance and after that it’s not such that you don’t have everything paid for — it’s probably an 80-20 match after that. So these are real problems that affect real people. We’re trying to come up with a solution that makes things more affordable. We come up with a bill, and then Health and Human Services — [Secretary of Health and Human Services] Dr. [Tom] Price is working hard — the bill that was written, Obamacare, the way it was written, they have a lot of flexibility. We’re looking for ways to put more flexibility in the system. We have a bunch of counties next year that simply won’t only not have limited competition; they’re going to be in a situation where … there…

Jeff Stein: I know the bill isn’t done, but what do you think in the general Republican overhaul — what do you think Obamacare is doing right now that isn’t allowing these problems to be taken care of? What is your hope for what the Republican bill will do to change the problem you’re identifying?

John Boozman: I think Obamacare, the problem with it is there is nothing in it to drive down and contain costs. That was the problem we had going into health care when we were trying to fix it, was affordability.

Jeff Stein: So you think this will drive down costs. How?

John Boozman: Again, that’s what we’re trying to work through. Identifying the solutions that will work.

Sen. Roger Wicker of Mississippi: AHCA “will encourage more freedom”:

Jeff Stein: What do you think this health care bill would solve?

Roger Wicker: What do I think of the health care bill in general?

Jeff Stein: What problems do you think it would take care of in America.

Roger Wicker: Oh, goodness. Well. It will, well, encourage more freedom by eliminating mandates at the individual level and the employer. It will cut taxes. It will moderate prices for premiums and inject some competition that is sadly lacking. And it will save money. It will rescue a system that is teetering on the brink.

Jeff Stein: How will it rescue a system teetering on the brink? Because you think the tax cuts will allow for premiums to come down? How?

Roger Wicker: It’s teetering because the exchanges are failing. They’re not acting as they were intended. And, as a result, insurers are dropping out. There are counties with no option.

Jeff Stein: I want to understand why you think the bill will help the marketplaces.

Roger Wicker: For the reasons I’m giving you. A very comprehensive answer, I think.

Sen. Lisa Murkowski of Alaska is frustrated. “I want greater access and lower costs. So far, I'm not seeing that happen.”

Dylan Scott, Vox: What do you want this health care plan to achieve?

Lisa Murkowski: I want greater access and lower costs. So far, I'm not seeing that happen.

Dylan Scott: How confident are you that the plan under discussion would do that, compared to Obamacare?

Lisa Murkowski: This is the big issue as I'm talking to folks back home. I continue to hear stories of great frustration. Increasing premium costs. Increasing share of deductibles. Decreasing access. They know what they don't like. They know what they do like. They do like the fact that they have gotten coverage for preexisting conditions. They do like the fact that they're able to keep their kids on [their insurance]. There's some positives and then some bad things. When you ask Alaskans about their stories and what they want, they need increased affordability. Because we are slammed in every category, with premiums and the cost of care. Everything. They wanted decreased costs, increased access.

Dylan Scott: Are you seeing provisions in the plan that's being discussed that would achieve that?

Lisa Murkowski: The plan the House laid down does not help Alaska. It does not help decrease their costs, and it does not help increase their access. So the question is whether or not what is being built on the Senate side is going to better reflect that. My hope is that it will. I can't show to my constituents back home anything concrete because we don't have anything. We've been talking about ideas. But for instance, if you are going to eliminate Medicaid expansion or even if you're going to wind down Medicaid expansion, that's not increasing access. I think the requirements that I'm looking for and my constituents are asking for are pretty basic. My task is going to be to make sure that those basic asks are met.

Dylan Scott: Do you have any specific metrics in mind? How do you evaluate whether a plan is going to lower costs or increase access?

Lisa Murkowski: It was pretty easy for the state to run the numbers under the House-passed bill. As the president was quick to point out the other day, the situation in Alaska is that we've seen a 203 percent increase in premiums. That speaks to the imperative of why you need to repeal and replace the [Affordable Care Act]. But what needs to be shared is that if the House-passed bill were actually going to play, the increase to Alaskans, for a 50-year-old male earning $50,000 a year, he would see his premiums hike by 500 percent. So it's all a matter of scale. I don't know what it is that will actually come forward. This has been part of my frustration. What's the Senate bill going to look like? I don't know. I've got people calling my office, I've got people coming online to protest. They're saying, "Don't vote for this!" Well, what is this? We don't know what this is yet.

Dylan Scott: I know some senators have tried to say you're starting from scratch and building your own plan. But it seems like in a lot of important ways, the Senate is really just tinkering with and trying to rework the House plan.

Lisa Murkowski: But again, I don't know that. Because none of us have actually seen language. Is it the framework of the House-passed bill and then we're filling in our own details? I don't know. We just don't know. My constituents expect me to know, and if we had utilized the process that goes through a committee, I would be able to answer not only your questions but my constituents' questions.

Sen. Ted Cruz of Texas says “the most important objective” is to lower premiums:

Dylan Scott: Stepping back, what is the most important thing for this bill to achieve? How is it going to make things better?

Ted Cruz: The most important objective in repealing Obamacare is to lower health insurance premiums. The biggest reason so many millions of people are frustrated and angry with Obamacare is that it’s caused premiums to skyrocket, making health insurance unaffordable. That is a problem the federal government caused and we need to fix that.

Dylan Scott: Do you think you can lower premiums for everyone, though? Because obviously there are some policies that could lower premiums for some people but might not for others.

Ted Cruz: Under Obamacare, the average family’s premiums have increased over $5,000 a year. Every week, when I go back to Texas, I hear from Texans who say, ‘I can’t afford health insurance for my family.’ That is an enormous problem and it is the direct legacy of the failed policy of Obamacare.

Dylan Scott: So the idea is that it needs to average out to a premium decrease, even if some people might see higher premiums?

Ted Cruz: We should work toward giving consumers more choices, more options, more competition, and as a result lower prices that are more affordable.

Sen. Shelley Moore Capito of West Virginia says “people are hurting here.” Will GOP bill help? “That’s the goal.”

Dylan Scott: What do you want this bill to achieve and how do you think it’s going to improve health care in America?

Shelley Moore Capito: First of all, we’ve got to stabilize the market of the places that have no coverage for the individual market, whose premiums are skyrocketing, whose deductibles are through the roof. This is a real phenomenon. Somehow we’ve lost sight of the fact that people are hurting here and if we don’t act relatively quickly, the whole system could collapse.

Dylan Scott: So how do you evaluate, what metrics do you use to evaluate whether it achieves that or not?

Shelley Moore Capito: It’s simple. It’s the affordability, protect people with preexisting conditions, protect people with Medicaid. Try to figure out the differences between the Medicaid expansion states and the ones that didn’t expand Medicaid. These are the same principles we’ve been talking about because they’re better principles than what the ACA is giving us.

Dylan Scott: Are you confident that the Republican bill would do that in a way Obamacare has not?

Shelley Moore Capito: That’s the goal.

Dylan Scott: Right. But do you feel confident that it actually will?

Shelley Moore Capito: Unless I’m confident we can do that, I don’t know how we can move forward in good conscience.

Sen. Rob Portman of Ohio: “I’m not suggesting premiums will go down, but they won’t go up as much”

Dylan Scott: To step back a bit on this debate, what fundamental goal do you want this legislation to achieve? How is it going to improve health care?

Rob Portman: We’ve got to fix a real problem, which is that the Affordable Care Act has not worked in a couple really fundamental respects. One is you do have insurers who simply cannot operate in this market, so they’re pulling out and they’ve been losing money for some time and cost-shifting onto the employer-based plans and other private plans. So it’s already been a problem. Now they’re at the point where they feel as though they can’t make enough money to stay out of bankruptcy, so they’re leaving. My state just got hit with 20 of those counties, but other states have been dealing with this. So that’s obviously one of the big issues and that’s because this thing is not structured properly. The second, and a more fundamental one, for everybody I represent, it’s the cost of health care. Premiums and copays and deductibles have skyrocketed compared to what was promised.

Dylan Scott: You guys have gone beyond stabilizing the market, into overhauling Medicaid, reworking the financial assistance. How confident are you that this plan will really achieve those goals?

Rob Portman: I think we can help stabilize the market and have some impact on the cost increases. I’m not suggesting premiums will go down, but they won’t go up as much. On Medicaid, you’re right, that’s a whole different issue. There was expansion in the ACA, but the Medicaid system itself continued as before. That’s a separate issue, which is where I’m focused, to make sure we aren’t pulling the rug out from under people.