Is right now. This is the closest we will ever get to repealing and replacing obamacare. Republicans racing the political clock to push through a Health Care Replacement bill have a message. Republicans unified. We are unified. We are really excited about the unified vote. But the fight over health care is exposing divisions within the Republican Party. Between small government conservatives, swing state moderates and a president who ran as a populist and is governing as a nationalist. This week, two key house committees approved a plan to overhaul the Affordable Care act, but not before conservatives rushed out to pan the bill both in the house this is just obamacare with a different label. It appears to be the largest Welfare Program ever proposed by republicans in the history of our country. And in the senate. The bill as written is not going to pass the senate. Simply would not pass the tax credits are a government giftaway and they want obamacares expansion phased out quickly and then there are republican moderates meaning fierce opposition at town hall. They are pushing back on the plan to phase out the Medicaid Expansion by 2020 and to cap federal funding by medicaid enrollees. In ohio we have the expanded medicare. Pulling the rug out from the vulnerable populations is not really the direction we want to go. During the campaign the president was open to further expanding medicaid. We will get will you expand medicaid. You can through it through medicaid. You can do it through some other way, but i am very this has to do with humanity. This has to do with having a heart. And in january, mr. Trump promised insurance for everybody, telling it the washington post, there was a philosophy in some circles that if you cant pay for it you dont get it. Thats not going to happen with us. Conservatives want obamacare completely and they call the current House Republican care obamacarelite. Will the president use his own Political Capital to insist that the president put aside ideological differences and support the bill . On the campaign trail mr. Trump well call it donald care. Schmoozing lawmakers and so far not twisting arms. It was Vice President mike pence in kentucky on saturday selling health care, not the president. For us to seize this opportunity to repeal and replace obamacare once and for all, we need every republican in congress and were counting on kentucky. Yesterday afternoon i spoke with the secretary of health and Human Services tom price whose job it will be to implement the obamacare replacement. I started by asking him whether the republican plan which leaves much of the obamacare architecture in place is an acknowledgement that the Health Care System cant be run by the free market alone . No, not at all. Obviously, this is a transition that were going through, b appreciate that the market as it is right now is failing. Obamacare, the aca, has failed. You have premiums going up, you have deductibles where people have an insurance card, but they dont have any coverage. We have a third of the counties that only have one insurer offering coverage. Five states offering only one insurance and that is not responsible to the individuals selecting the coverage. We need to fix this and move in a direction that puts patients, and doctors in charge not washington d. C. I know you say obamacare is failing, if you have a system that premiums go up and enrollment went up, too, thats not the definition of a failing system. Well, in fact, the number of individuals who actually got coverage through the exchange who didnt have coverage before werentelicible for medicaid before is relatively small so it turned things upside down 5 million individuals and the premiums didnt go down as the previous president promised. They lost the coverage they have, and the lost the ability to see the providers they wanted to see. We need to move in the direction that respects the principles of access ability for all, quality and choices for patients making certain that we, again, have the patientcentered system. Lets go to the affordability aspect. First of all, can you say for certain that once this bill is passed, nobody, nobody will be worse off financially when it comes to paying for health care . Ill tell you right now there are a lot of people that are worse off right now paying for health care and they arent getting the care that they need. The premiums are up and deductibles are up. If youre an individual making 50,000 60,000 and your deductible is 8,000, 12,000, you may not have coverage, and i hear from former colleagues all of the time about patients who come into their office and they recommend something t because the deductible is so high. I noticed you ducked the aspect of whether you can guarantee that nobody will be worse off financially . I firmly believe that nobody will be worse off financially in the process that were going through understanding that theyll have choices that they can select the kind of coverage that they want for themselves and for their family, not the Government Forces them to buy. So theres costs that needs to come down and we believe were going to be able to do that through the system. Theres coverage that will go up. Remember, chuck, there are 20 million folks right now in this nation who said to the federal government, ill pay a penalty or take a waiver. Im not each going to get coverage in the system that we currently have. That may be a system that works for government or insurance, but it doesnt work for people. We need one that works for people. You think it will work for the 20 million. You believe that . We believe i believe and the president believes firmly that if you create a system thats and provide the financial feasibility that we have a great opportunity to increase coverage over where we are right noi as opposed to where the line is going right now where people are losing coverage and well have fewer individuals covered than we do currently. Lets go to the financial feasibility here. In fayette county, west virginia, Kaiser Family foundation estimates the 4,000 tax credit that a 60yearold making 30,000 a year will get under the American Healthcare act is almost 8,000 less than they would get under obamacare. This is a county, by the way, that voted overwhelmingly for President Trump. The point is this, you say that this will make it more affordable and access to coverage, under this plan in this county in this state, less money and more expensive for these folks. Thats looking at it in a silo. If you look at it in the way that the market will allow them for individuals to have choices, who knows what that wants. I know the federal government doesnt know what the 60yearold wants. I know that he or she knows what he or she wants and theyll provide decreasing costs and choices for folks you make it so the system can be responsive to that individual. Thats the way you drive down costs. Why not means test the tax credits . Why do it by age where you may essentially have it where youre incentivizing folks not to buy Health Insurance until they actually need it . Its a great question. In fact, ive been working on this for so long ive gone through the phase where ive had it completely related to income and became convinced by the folks who do this on a daytoday basis, day in and day out basis, that the most predictive element of an individuals life in terms of what Health Coverage will cost is not income and it makes sense, its age. As your age increases your Health Care Costs increase and the cost of the coverage increases. So theyve pegged it to age. Theres an opportunity topu thats not the most thats not the correlation factor to what it actually costs. Age is the thing that correlates best to what Health Coverage costs. Age is also and this is a part of obamacare that didnt work which was to try to get as many young people on the system. They needed 40 of folks under 35 in the system to keep premiums down. It hasnt gotten to that. How do you do it . How does it do it here . Because this system seems to essentially say to folks under 35, dont worry about it. If you dont want to get health care were not going to make you do it and that only increases premiums for older folk, does it not . No. What we say to that 30, 35yearold individual, you know that you need Health Coverage. What well do is provide a system that allows you an array of choices so that you can respond and choose the Coverage Plan that works best for you and your family and not be dictated to by the federal government and have to purchase something that you most likely do not need. We information we do wanot have ye and there is voting on in congress. The estimate of this bill and how many would be covered and the second is whats to hit to the deficit . On the coverage issue, we dont know the financial issue yet, on the coverage issue a couple of estimates out there. One as high as 15 million fewer people covered according to one estimate by brookings that thats what they believe the Congressional Budget Office will show when theyre able to come out with an estimate. 15 million. Is that an acceptable number to you . Is that what it really is . Do you go back and say we have to tweak this . Ill tell you the plan that we leave out here will not leave that number of individuals covered. I believe well have more individuals covered and well have folks evaluating this and modeling this is aing yes, indeed, this plan will cover more individuals than are currently covered. Remembering right now that the trend line is down on the number of individuals being covered. Its not increasing, and the cbo ago when this started they estimated that over 20 Million People would have coverage at the end of the tenyear window. In fact, its about half of that right now. So cbo has been very adept in not providing appropriate coverage statistics. All right. This plan has some Medicaid Expansion in it to form, although you cap it in certain respects. This plan has tax credits, another name for a subsidy. Its made some on the right say, you know what . This is obamacarelite. Youre essentially accepting the architecture, but just trying to remodel the building. What say you . No. Absolutely not. In fact, this is a little puzzling because independents and conservatives for decades have said havent we equalize the tax treatment of the purchase of Health Care Coverage for folks who get it through their employer and folks who arent able to get it th the tax credits do. We dont dictate to people what they must buy. What we say is here is an opportunity for you to get a tax credit that the 175 million individuals getting their coverage from their employer those folks have a tax credit and its the moms and the pops should those folks have a tax credit or should people like you and may have to pay taxes on their Health Insurance benefits . On. If part of our society have a tax benefit for a tax coverage, then im of the belief and the president is of the belief that it needs to be fair for everybody. We thats why you have to have a tax credit. Thats why you want to have a tax credit, but youre not going to of get the revenue from upper income folks who get generous tax benefits from their company . Thats another system thats been in place, as i say, 175 million folks are getting their coverage through their employer right now and thats a debate that we ought to have, but the malm orit of the American People support individuals getting it from their employer and not getting from their employer and theyre in the Small Group Markets which has been literally destroyed by the aca and it will reinvigorate the Insurance Market and it will drive down costs because youll have competition and transparency in the system. You accept this bill. You own this bill. President trump accepts this bill and owns this bill. Fair . We strongly support this plan. The bill and the regulatory opportunity to modify the system in a way that works for patients and the other piece of legislation that is required that cant go through on the first part. My thanks to hhs secretary tom price who i spoke to yesterday. Last month President Trump said nobody knew health care could be so complicated. One person did, kathleen sebelius, who was secretary of health and Human Services and is a strong advocate for oba nice to see you. Nice to see you. Let me start with a question about the republican plan and whether you accept the idea that this is obamacarelite. Do you believe theyve kept the architecture of obamacare . We were pretty clear in the Obama Administration what the point was, insure everybody. We know we had to fix insurance rules. People who were buying insurance on their own needed some financial help in the marketplace because they didnt have an employer contribution. You could keep kids on their parents plan and make medicaid equal across the country, whether you lived in georgia or california you qualified as a lowincome adult at the same level. Im not sure what the goal is here. So they have kept some pieces. The preexisting condition, they have kept some subsidies in sort of the folks i understand that, but if there were the plan in place and you and president obama were back in office in four years and you could reimplement obamacare, could this architect thaur the republicans are put pg together be used to reimplement obamacare . I dont think so because this does serious damage to the whole marketplace theory and companies will flee given the uncertainty and the likelihood, this quickly becomes a highrisk pool. They make the argument, by the way, that companies are fleeing now because they feel as if its too expensive to try to insure everybody and we do have this issue in rural america. Its truly the Rural Counties that have been hit the hardest on the obamacare when it comes to the word choice. I think thats true, chuck. Theres no question this is a young and fragile market. Its been made that way sort of intentionally by congress who blocked the risk sharing. I was interested in the piece in this bill that has a state stabilioo you really do need to get a stable market. This also was a monopolistic market for decades before the Affordable Care act. So the notion that somehow it blossoms overnight. There are new insurers in. I was in florida last week. Pat garrity who is the head of the Bluecross Blueshield of florida. Florida has not been a welcoming state to this law. Right. Pat garrity ended up 2016 open enrollment with 1 million members in the florida marketplace and the company in the black. He said, of course, this works. We can make it work and go forward. I want to play something that former president bill clinton said on the campaign trail and get your reaction. Take a listen. People are getting killed in this deal are Small Business people and individuals who make just a little too much to get into these subsidies. So you have this crazy system where all of a sudden 25 million more people have health care and then the people busting it at sometimes 60 hours a week wind up with their premiums doubled and their coverage cut in half. Its the craziest thing in the world. Obviously, republicans took those comments and had a field day with them. You bet. Did he have a point . He did have a point. There was a bill with 400 of poverty and you no longer have a subsidy in the marketplace and about 85 of the folks have a subsidy and any talk about premium increases, that isnt what consumers are paying because their subsidies rise where the premiums rise. Again, this is fixable. You could have a much more graduated subsidy system. You could have a higher income point that could easily be done to stabilize the marketplace, but that wasnt what the Republican Congress wanted to do. They wanted to actually dismantle this bill from the outset. One of the pledgees that secretary price made to me in that interview was there will be more people covered proclamation . What i know right now and this is a real fact is that we are at the lowest point of uninsured americans that has ever been recorded. Under 10 of americans lack coverage. Thats still too many, but thats where we are. There is no estimate in looking at this bill that with less money going to subsidies, with Older Americans being able to be charged five times what younger americans are being charged, and with no variation based on income that more people will have coverage. Theres everest nation that anywhere from 2 million to 15 Million People will lose coverage in this bill and there are going after Medicaid Expansion which is a lot of lower income, working adults who will also lose that coverage. What do you say to conservatives who worry that the Medicaid Expansion thats in obamacare will only make that people will never get off medicaid. What do you say to that criticism . Thats a good point, and i think they have gone and doubled down on medicaid. Republicans for a while in the congress have been really fundamentally opposed to the 50yearold partnership about medicaid. A Health Safety net. They not only in this bill go after the expanded population which is actually much cheaper to insure in medicaid than it is in the private market and lower premiums and lower out of market costs and they have gone after the traditional medicaid program, disabled individuals, poor kids, pregnant moms, have the bursts in the country, the largest payer for nursing home care and theyll cap what the feds pay. Those populations dont go away. I used to run a medicaid program. We ha