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Republicans Divided Over Health Care Bill After Critical CBO Report


A budget analysis showing that millions of Americans would be uninsured under the Republican's proposed health care plan is giving some GOP lawmakers pause. The Trump administration and House Speaker Paul Ryan want fast passage of their bill before Congress adjourns for Easter, but many Senate Republicans remain skeptical. NPR congressional correspondent Susan Davis has more on what changes Republicans say they need to see first.

SUSAN DAVIS, BYLINE: Republican Senator John Boozman is from Arkansas, a state that has seen their uninsured rate cut in half since the Affordable Care Act was enacted. So he doesn't sound as eager as many of his Republican colleagues to act fast to repeal and replace key parts of the law.

JOHN BOOZMAN: We don't need to do something. We need to do the right thing. And so that's however long it takes.

DAVIS: Right now that something is the American Health Care Act, a House bill that the nonpartisan Congressional Budget Office said on Monday would see 24 million Americans uninsured over the next decade compared to if the current health care system just stayed in place. It also reduces federal spending on Medicaid by $880 billion in that same period of time, and it could hit one group of Americans particularly hard.

ROY BLUNT: Well, I think older lower-income people are the most at jeopardy in any plan.

DAVIS: That's Missouri Republican Roy Blunt. He says Republicans will have to make changes to the bill to get it through Congress. One proposed change already circulating is to increase the amount of refundable tax credits to older lower-income Americans. Louisiana Republican Senator Bill Cassidy, who's a doctor, says it's a necessary change.

BILL CASSIDY: It should be - right? - because otherwise, folks who - I think the CBO reports folks over 60 earning $20,000 a year would have a hard time affording insurance, and that's not good.

DAVIS: Cassidy says he will try to change the bill in the Senate if the House doesn't get there first, but they might need to do more than that. Another prominent critic, Senator Ted Cruz, says the bill doesn't address his top concern.

TED CRUZ: When I'm home in Texas, the most common concern I hear about Texans about Obamacare is that it's driven premiums through the roof. People can't afford health care anymore.

DAVIS: The CBO report does forecasts lower premiums over the next decade. Cruz says it's not enough.

CRUZ: They go down compared to the prediction of how much they would rise under Obamacare. Under the CBO report, they don't ever go down.

DAVIS: Right now, the one thing Senate Republicans do agree on is that the health insurance plan doesn't have the votes it needs to pass Congress even as party leaders continue to lobby for the bill. The White House indicated today that it's working on possible changes before the bill hits the House floor. Conservatives in the House are pushing House Speaker Paul Ryan for a more aggressive rollback of Obama's health care law. Here's Spokesman Sean Spicer.


SEAN SPICER: This has never been a take-it or leave-it. And I've said it from this podium. The president's talked about it, as you mentioned just a second ago.

DAVIS: Senate Majority Leader Mitch McConnell says senators will have their chance to change the bill through amendments on the Senate floor. After a closed-door meeting today between Senate Republicans and Health and Human Services Secretary Tom Price, McConnell focused on the bill's selling points.

MITCH MCCONNELL: Lower taxes, lower deficits and the most significant entitlement reform in history.

DAVIS: And McConnell's allies, like Wyoming Senator John Barrasso, continue to press the case for scrapping the government mandate that individuals buy health insurance.

JOHN BARRASSO: We are a party of choice, of freedom to make those choice, of choosing between options. The Democrats have been a party of mandates. And as a doctor, I will tell you patients prefer options and choices over mandates.

DAVIS: What's holding Republicans together is a widespread view that doing nothing on Obamacare could be politically disastrous. Here's Cruz again.

CRUZ: For six years, we have campaigned promising the voters, if you elect us, we will repeal the disaster that is Obamacare that is hurting millions of Americans. We need to honor that commitment.

DAVIS: The House still plans to take up the bill next week. If they can pass it, the Senate will take it up the week after that and have their chance to change it. Susan Davis, NPR News, the Capitol. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Susan Davis is a congressional correspondent for NPR and a co-host of the NPR Politics Podcast. She has covered Congress, elections, and national politics since 2002 for publications including USA TODAY, The Wall Street Journal, National Journal and Roll Call. She appears regularly on television and radio outlets to discuss congressional and national politics, and she is a contributor on PBS's Washington Week with Robert Costa. She is a graduate of American University in Washington, D.C., and a Philadelphia native.