Washington Wednesday: Healthcare

MEGAN BASHAM, HOST: It’s Wednesday, the 25th of July, 2018.

Glad to have you along for today’s edition of The World and Everything in It. Good morning, I’m Megan Basham.

NICK EICHER, HOST: And I’m Nick Eicher. First up on The World and Everything in It: Washington Wednesday.

Obamacare’s almost a decade old.

Next year marks the 10th anniversary of the U-S House passing what’s officially known as the Patient Protection and Affordable Care Act.

The Senate would pass it a few months later.

And then with the signature of President Barack Obama, it became law.

OBAMA: Today, after almost a century of trying … health insurance reform becomes law in the United State of America. [applause]

That was early 2010.

Numerous legal twists and turns followed — Is it even constitutional? What about conscience protections? Courts needed to work out those questions.

About the only thing that hasn’t been up in the air has been Republican rhetorical opposition to it. GOP politicians at virtually all levels have campaigned relentlessly on repealing it.

In Washington, the House has voted to repeal or amend the law more than 50 times. But those efforts have never gone far in the Senate — where a determined minority can prevent a bare majority from bringing a bill to the floor. Effectively, it takes 60 votes and Republicans don’t have those.

Last year, with President Trump vowing to sign legislation, Republicans in the Senate tried to repeal and replace key chunks of Obamacare using a budget tool known as reconciliation. That approach required only a simple majority vote.

The effort came to a head last September.

NEWSCAST: Senator John McCain, just days removed from his cancer diagnosis, stunning the chamber, turning a thumbs down on the repeal bill… Seven years of repeal efforts have now essentially gone up in smoke …

Majority Leader Mitch McConnell was stunned.

MCCONNELL: I and many of my colleagues did as we promised and voted to repeal this failed law. We told our constituents we would vote that way, and when the moment came … most of us did.

With that, most Republicans moved on to tax reform and other issues.

But healthcare problems haven’t gone away for most Americans. Last month an NBC-Wall Street Journal poll found 22 percent of registered voters say healthcare is their number one concern going into the midterm elections. That tops even the economy.

In part because of those poll numbers, one of the key senators involved in the repeal and replace effort has quietly continued to work on smaller solutions.

Republican Senator Bill Cassidy of Louisiana is one of three physicians in the U.S. Senate. He’s also an evangelical Christian. Last week he sat down with WORLD Radio’s J.C. Derrick to talk about bipartisan efforts to make some kind of healthcare progress.

J.C. DERRICK, MANAGING EDITOR: Well, Senator, I’d like to start with the most recent news in terms of healthcare last week. The administration announced it would stop payments to insurers, the risk adjustment payments, which total about $10 billion. So that’s billion with a B. So, a big number there. Can you briefly explain what’s going on there to the average person with those payments and why the administration stopped them?

BILL CASSIDY, SENATOR: Yeah, certainly. Let me first give you the prism by which I look at this. We have to lower the cost of healthcare and health insurance for families who are struggling. Okay? Let’s take that as given. These reinsurance payments, if one company ended up only insuring people who were perfectly healthy and a second company ended up insuring people who were all sick, there’d be some sort of transfer of dollars from the people with all the healthy folks to those with all the sick. Now the judge said that the way this was being done was not acceptable. And the administration states they feel bound by that judgment. That creates some uncertainty—that uncertainty has a potential to raise health insurance premium rates. So, I’m sorry about the judge’s judgment. I hope it gets worked out so that certainty can be reestablished. Ideally so that those premiums can come down for those families who need lower premiums.

DERRICK: So, the critics of the administration would point to the fact that that the president and Republicans in general, obviously, don’t like the Affordable Care Act. And so there’s some suspicion that these payments will be just stopped altogether. But what I hear you saying is that, no, the administration is trying to figure out a way to make this work. Is that correct?

CASSIDY: They say they are. But let’s point out that premiums have gone crazy under Obamacare. Before President Trump was elected, premiums have risen in some cases, 100 percent a year, 100 percent a year. The individual mandate was in place until this year. And premiums have skyrocketed. There is a family in Louisiana where the father is 60 years old, might pay as much as $40,000 in after-tax dollars for their premiums and have a net $10,000 deductible and copay. That’s Obamacare. Now folks are saying, well, people in this administration don’t like Obamacare. When you’re paying $40,000 a year, there’s a lot not to like. I think Obamacare does need to be changed for those families that can’t afford it right now.

DERRICK: Well, and the word you just used there I think is important: “changed.” Because Democrats have acknowledged there’s issues with the law but say repeal and replace is a nonstarter. They only want to make changes to the law. So, is it fair to say, at least for the time being—I won’t call it that repeal and replace is dead, but is it on indefinite hold? Is that fair?

CASSIDY: You can’t– until you have the votes, you can’t go forward. And right now we don’t have the votes.

DERRICK: Well, let’s talk about the white paper that you’ve recently put out—taking bite sized chunks out of this healthcare issue. Can you talk about what you’re trying to do with that white paper?

CASSIDY: Well, everything we have in there is about giving power to the patient. One example, the power of knowledge. In this case, price transparency. Wouldn’t it be great if you knew the price of something before you had it done, as opposed to getting the bill six weeks later and being shocked by how much it cost? One example, there are some urgent care centers which will actually publish their prices. You have an earache? That’s going to cost you 50 bucks. You need stitches? It’s going to cost you 150 bucks. There’s others that under law can serve as an extension of a hospital’s emergency room, even if the emergency room is 30 miles away. And they can charge you what the hospital does. So instead of $50 for an earache, it’s $550. Instead of $150 for getting something sewed up, it might be $750. You should know that. We should have the power of price.

DERRICK: It seems like that would be something that Democrats could get onboard with.

CASSIDY: On that is bipartisan, we think.

DERRICK: Okay.

CASSIDY: We do have folks both in both parties, in both houses of Congress who have sent letters or otherwise working on price transparency. Price transparency should be bipartisan. Give the patient the power, in this case the power of knowing the price.

DERRICK: And as I understand it, you’re part of a working group that’s working on that issue specifically.

CASSIDY: Yes, there’s about six of us total, but there’s more who are interested. If I’m in a town hall meeting, and I say, ‘Well, wouldn’t it be great if your pharmacist could tell you it’s cheaper to pay cash than to pay your insurance company’s deductible? Shouldn’t the pharmacist be able to tell you that?’ Everybody says yes. Turns out, in many cases that pharmacist is banned from telling the patient that it’s cheaper to pay cash than the deductible because they have a contract that forbids them from doing so. The patient should have the power.

DERRICK: And that’s something that could draw a bipartisan support. What are some of the other ideas that are in discussion right now that could potentially be bipartisan efforts?

CASSIDY: Well, there are some generic medications that there’s only one provider in the United States. And so that provider says, ‘Huh, I’m the only one providing this medicine. I’m going to charge whatever I want.’ And so a medicine, which might be 50 years old, at one point cost $1.50 a pill, now will go for $13.50 a pill, in some cases $750 a pill. We need to change that. We need to allow companies to import from other companies because probably the same factory in India made the same pill that’s going to Germany as is going to the United States. So, if you will, allow importation of medication.

DERRICK: And right now that’s prohibited.

CASSIDY: Right now it’s prohibited. That works for the drug company, doesn’t work for the patient.

DERRICK: Okay, so ideas are one thing, bipartisan support is one thing, politics is another thing. We’re in the middle of an election year. Do you see any of these types of proposals having a legitimate chance of becoming law in the next, say, six months before the end of the year?

CASSIDY: Well, good policy is good politics and if you’ve got some really good policy, people are going to have to defend why they’re not voting for it. So we’re going to bring up some of this stuff. I’ll introduce the bill and hopefully I’ll have others introducing with me, and then we’ll see who votes against it. And we will work it. Ideally, people listening to this program will call their congresswoman, congressman, or senator and say, listen, please support that, sir, or please support that, ma’am. Because we need the American people to weigh in that this is important. Since health care costs are really important to many Americans, I think they can make a big difference.

DERRICK: Senator Bill Cassidy. Thank you so much.

CASSIDY: Thank you, J.C.

(AP Photo/Alex Brandon) Sen. Bill Cassidy, R-La., center, listens as Sen. Lindsey Graham, R-S.C., left, speaks on Capitol Hill, Tuesday, Sept. 19, 2017 in Washington. 

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