ROBERT SIEGEL, HOST:
Donald Trump said this yesterday about repealing and replacing Obamacare. As soon as his nominee for Secretary of Health and Human Services is confirmed, he said his administration will submit a plan to replace the law. He said it will be repeal and replace. It'll be done, in Trump's words, essentially simultaneously.
Republican Congressman Steve King of Iowa isn't waiting. King is a staunch conservative, and as soon as Congress convened, he proposed a repeal bill. I asked him why.
STEVE KING: It's my opinion that if we repealed Obamacare and did nothing, we're still far better off. Almost everybody I know would be happier if Obamacare had never been passed and we hadn't made any changes in health care.
But what we've missed is the last seven years or so of an opportunity to make the prudent changes so that our system, our health insurance and our health care delivery system could have been improved during that period of time.
SIEGEL: Donald Trump's adviser Kellyanne Conway recently told an interviewer, we don't want anyone who currently has insurance to not have insurance. Would that be for you the test of a new law or the test of what happens after Obamacare is repealed - no one who's gotten health insurance through Obamacare losing it under its repeal and replacement?
KING: I think that's a fine and shining ideal, but it wouldn't be my standard. We have about 20 million people that they say would be pushed off of Obamacare if we just repealed it and did nothing. I look at the numbers on the 20 million. It's about 10.8 million that were pushed onto Medicaid, and so I don't really look at Medicaid as a health insurance policy that you own.
I would argue there is no constitutional - you have no right to a health insurance policy. Whatever our hearts tell us, we can provide those things, but there's not a right to them. The roughly 9.2 million people that are insured under Obamacare that would presumably lose their insurance if it were repealed - they're living under a subsidized premium, and that subsidized premium is paid for almost a hundred percent by the taxpayers.
So we can do some things like a full deductibility of everybody's health insurance premium. That picks up some of them in that 9.2 million group. Under Obamacare, they always envisioned that 4 percent of the population would be uninsured even if it were fully implemented. So I wouldn't want to be bogged down on that, but I would want to do the best thing we can for the maximum number of American people.
SIEGEL: But you mentioned the approximately 10 million who are covered by the expansion of Medicaid, I guess around 90,000 of them in your state of Iowa. Should they just be considered out of luck? That is, would you simply repeal the Medicaid expansion outright?
KING: No, I would block grant Medicaid to the states and let each state make their decisions on that. The best decisions are made as close to the people as possible. That's why we have a federalist system.
SIEGEL: Should insurance companies be required to offer insurance to people regardless of a prior condition? Should that provision of Obamacare survive, whatever the Congress does?
KING: When I was in state government, I managed the high-risk pool. We used state tax dollars to buy down expensive premiums so we could provide guaranteed issue to those who had preexisting conditions. I think that's a far better solution. It keeps the federal government out of the insurance business and the regulation of the insurance business.
If we guarantee people that we will - that there will be a policy issued to them regardless of them not taking the responsibility to buy insurance before they were sick, that's the equivalent of waiting for your house is on fire and then buying property and casualty insurance. And that defeats the insurance concept of it, and it defeats the personal responsibility requirements necessary to have an efficient health care system.
SIEGEL: Do you sense that there's a majority in the House, that the overwhelming majority of the Republican caucus is with you on what should replace Obamacare? Or are there still arguments to be had and debates to be had about what happens after Obamacare?
KING: Let me go out on a limb here, Robert. I think most of the Republicans agree with me, but there's probably a majority of them that don't have the political will because they're afraid of the criticism that will come. And as I listen to their dialogue, they're afraid of the criticism.
They're - when I say let's repeal Obamacare and be done with that, and let's march down through these changes one at a time, not one big bill but one at a time - and I don't want to have a Republican bill that we have to pass to find out what's in it. I think at this point, they need to have more will. But I think if you take them down to where their heart of hearts is and their logical brain is, the majority of them will agree with me.
SIEGEL: Congressman Steve King of Iowa, thanks for talking with us about your thoughts on repealing and replacing Obamacare.
KING: Thank you, Robert. I appreciate it.
(SOUNDBITE OF TOPS SONG, "SUPERSTITION FUTURE") Transcript provided by NPR, Copyright NPR.