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President Trump says he's very supportive of the Senate's new bill to repeal and replace the Affordable Care Act or Obamacare. But the president admits tinkering with the nation's health care system is complicated. Senate Republican leaders unveiled the legislation yesterday. They want it to pass next week. They have little margin for error, as NPR's Scott Horsley reports.
SCOTT HORSLEY, BYLINE: Senate Republicans can only afford to lose two votes if they hope to pass their bill. And five Republicans are already on record in opposition to the measure in its current form. After the first four Republicans raised concerns, President Trump told "Fox & Friends" there's a narrow path to success.
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PRESIDENT DONALD TRUMP: I think we're going to get there and we have four very good people that - it's not that they're opposed. They'd like to get certain changes. And we'll see if we can take care of that.
HORSLEY: One of the holdouts is Kentucky Sen. Rand Paul. He told NBC's "Today" show, in its current form, the Senate bill could aggravate the problem of healthy people going without insurance and driving up costs for everyone else.
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RAND PAUL: If you can get insurance after you get sick, you will. And without the individual mandate, that sort of adverse selection, the death spiral, the elevated premiums - all of that that's going on gets worse under this bill.
HORSLEY: Obamacare addressed that problem by requiring Americans to have health insurance or pay a penalty. But the so-called individual mandate is one of the least popular provisions of the law. And Senate Republican leader Mitch McConnell and his colleagues are determined to get rid of it.
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MITCH MCCONNELL: We agreed on the need to free Americans from Obamacare's mandates so Americans are no longer forced to buy insurance they don't need or can't afford.
HORSLEY: But the Senate bill preserves another, more popular piece of Obamacare, the requirement that insurance companies cover everyone, even those with pre-existing conditions. Health policy expert Linda Blumberg of the Urban Institute says imposing a coverage requirement on insurance companies without a corresponding mandate for customers creates a very shaky insurance market.
LINDA BLUMBERG: What you don't want to have is a situation where you're saying, we're going to have everybody, regardless of their health problems, come in and then have all of the healthy people exit the market because then the average cost of those who remain goes up really high.
HORSLEY: As premium costs go up, even more healthy people drop out. That's the so-called death spiral. The House version of the health care bill tried to discourage healthy people from fleeing the market by allowing insurance companies to charge more for those who don't maintain continuous coverage. Former GOP Senate staffer Rodney Whitlock thinks the Senate bill will have to add something similar.
RODNEY WHITLOCK: I believe that the bill that the Senate will vote on, assuming they get to that point, will have some sort of mechanism to cause participation in it.
HORSLEY: So why isn't that already in the bill? Whitlock says McConnell may be worried that it runs afoul of procedural rules that allow Republicans to pass the health care bill with a simple majority vote.
WHITLOCK: If you are concerned that that might be the case, then, strategically, you may want to wait until the very last second to be presenting the language to the parliamentarian.
HORSLEY: Blumberg warns without a strong provision to keep healthy customers in the marketplace, insurance companies will be tempted to offer more stripped-down policies. And that could leave the individual market in worse shape than before Obamacare.
BLUMBERG: What will be available are policies that don't cover a number of benefits that people are used to getting coverage for today. They will have much higher deductibles than they're used to seeing. And I think, as you get older, the coverage will be less and less affordable.
HORSLEY: AARP is already on record against the Senate bill, citing what it calls an age tax, as well as cuts to Medicaid. The senior lobby is promising to hold all senators accountable for their votes. Scott Horsley, NPR News, the White House. Transcript provided by NPR, Copyright NPR.
