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Can An Obamacare Architect Find Common Ground With Trump?


Today, President Trump lobbies lawmakers to support a Republican replacement for the Affordable Care Act. The replacement has drawn broad criticism for costing older voters much more and providing low-income voters with less. As Republicans try to tweak that legislation, the president met, once again, with Zeke Emanuel, an architect of the original Obamacare. And he's on the line. Welcome back to the program.

EZEKIEL EMANUEL: It's nice to be here, Steve.

INSKEEP: So how different is the Republican approach as it changes over the last couple days?

EMANUEL: Well, one approach is allowing states to block grant Medicaid. And that's actually going to be worse for poor people in states because that's not as flexible as the per capita cap because it doesn't change with the number of people. That's a...

INSKEEP: I want to just explain this for people. You're saying that each state will get a set amount of money. And if, say, there's a recession and the number of people who need Medicaid goes up, the state doesn't get any more money. That's what this would be. Is that right?

EMANUEL: Steve, you're a health policy expert.

INSKEEP: (Laughter).

EMANUEL: Yes, that's exactly what it means.

INSKEEP: Is that all it takes? It's good to know.

EMANUEL: That's all it takes. And the problem is that a lot of - this is a sop to the Freedom Caucus. And a lot of states are actually going to be harmed by that because it's going to mean they're going to have to pay more out of their budget. Or hospitals in their state, doctors in their state, are going to not get money to take care of the poor when they get sick.

INSKEEP: Sop to the Freedom Caucus - those are very conservative lawmakers in the House who are concerned about the government spending too much on health insurance. And this limits the government's liability. That's the way that they would put it.

EMANUEL: Oh, actually what they want to do is just take down Medicaid as an entitlement...

INSKEEP: But given...

EMANUEL: This is not about health insurance.


EMANUEL: This is about eliminating an entitlement and claiming victory for eliminating the entitlement.

INSKEEP: Principle is the way, I suppose, that they would put it. Now, what about older people who were getting health care through the exchanges? Their subsidies change. It's based on your age rather than your income. And there's a lot of older people who might be lower income...


INSKEEP: ...Or would pay thousands more. Have they fixed that?

EMANUEL: So they're - they're creating a $75 billion slush fund for the Senate to figure out how to give more money to older people. They're not actually going to increase - or we don't think they're going to increase the tax credits. But they're going to come up with some other way to scratch their left ear with their right arm in a very complicated manner.

This - you know, it was interesting. Two things I would note - the Republicans accused the Democrats of ramming through the Affordable Care Act even though we negotiated with Republicans for months. Talk about rammed through, we're not even a hundred days into the administration, and they're ramming this through the House. They've never talked to one Democrat as far as we can see.

And then, they criticize the Democrat for so-called sweetheart deals, the cornhusker deal, which never appeared in the final bill. They are creating every kind of sweetheart deal they can to try to get this thing to get the 216 votes, a little hypocrisy.

INSKEEP: There's reportedly a deal for some New York lawmakers, for example. They haven't spoken to very many or perhaps any Democrats...

EMANUEL: Right, I mean, it's interesting...

INSKEEP: But wait, wait, wait - they have spoken with you. You've been meeting with the president. And is this deal getting any closer to the existing law, any closer to Obamacare, as it changes and evolves?

EMANUEL: Well, with these latest deals, it's not getting closer to the Affordable Care Act, I don't think. You know, these are tweaks to make - to sweeten it. What is going to happen in the Senate, where presumably this bill is going to get a very substantial overhaul, and then you're going to have the House voting for one thing, and the Senate completely changing because they don't have the votes in the Senate.

Senator Collins and others have made it quite clear they're not voting for this bill. So they'd need substantial changes to get to their 50 votes. So, you know, it's a funny thing that the House is going to vote for something that isn't going to be the real bill. And it does seem a little bit like a bait-and-switch here.

INSKEEP: In a few seconds, Zeke Emanuel, is this legislation getting it all closer to something that you would approve of?

EMANUEL: No. I have said to people very much that I think that there is a bipartisan bill to be had here. There is a bill that could be constructed around auto enrollment for coverage, around drug and cost-control measures. I think that's - as I've said in public, I think there's a bipartisan bill that can begin in certain ways. But this is not that bill at all.

INSKEEP: OK, Zeke Emanuel, thanks very much as always.

EMANUEL: Thank you. Transcript provided by NPR, Copyright NPR.