STEVE INSKEEP, HOST:
The Republican bid to repeal and replace the Affordable Care Act is delayed, not dead.
RACHEL MARTIN, HOST:
Senate Majority Leader Mitch McConnell put off a vote this week. He was well short of the 50 votes required to pass the legislation. Now he's going to try to tweak the bill to gain senator support.
INSKEEP: Senators will also be hearing from health care providers and interest groups. And, oh, do they have a lot to say. The AARP, which represents people over 50, doesn't want the bill tweaked. The group's legislative policy director David Certner says it should be scrapped.
DAVID CERTNER: We think this bill is so flawed, it would be very difficult to fix it. You have to change dramatically what they have done to the Medicaid program. You have to change dramatically the premium structure, which falls very heavily on older people and puts those with preexisting conditions at risk. This bill actually cuts funding for Medicare, by the way, because it cuts back on a tax right now that goes to fund the Medicare program. You know, we think all these things are a mistake.
So we, of course, have been urging that they start from scratch. However, we know over the next week or two or three, the Republicans in the Senate will be trying to come together to get to their 50 votes that they need to pass this bill. And they have some money within the confines of this bill to try to basically make side deals with people to get them to come onboard and support this bill.
INSKEEP: What if Senator McConnell were to call you up and say, glad to hear your input. You represent older Americans. Is there anything you could imagine that would satisfy your concerns that would remotely be appealing to conservative lawmakers?
CERTNER: At this point, no. I think it's difficult to say yes to that question because I think part of the problem is the fundamentals of this bill are that it's a large cut in benefits, in health benefits, particularly for lower income and older people, in order to pay for tax cuts for, you know, prescription drug, insurance industry, other special interests - high income people.
And that is just an untenable way to do a health care bill. This is really more of a tax bill, a tax cut bill that has to be paid for because they want to offset it by huge cuts to health benefits. And if that's your premise, it's very difficult to do a bill that makes sense for health care.
INSKEEP: If you were starting over, what would you write?
CERTNER: I would try to do a bill that basically tries to deal with some of the problems that we have in the marketplace right now. We want to have more competition in the marketplace. We want to have more people in the marketplace. So that may mean, for example, putting in additional incentives to get younger people to join plans and to get insurance companies into the marketplace.
That may mean, for example, providing some additional certainty. One of the issues is that there's a lot of uncertainty because there are cost-sharing subsidies that the administration has been threatening to cut off. So insurers don't know what they're getting. So if you make some of those changes, I think we could help stabilize the market.
INSKEEP: Every time health care has been debated over the last many years, someone at some point will say, well, this is a complicated mess - time to go for single-payer national health insurance. Should we do that?
CERTNER: Well, we have single-payer in parts in this country.
INSKEEP: Senior citizens.
CERTNER: For example, the Medicare program, VA system. So we do have single-payer systems that do work in part for at least a segment of the population. We have not tried that for the whole population. You know, most people today still get their insurance and are fairly happy with their insurance through their employer. But the debate is starting to trend more in that direction because of all the problems that we're seeing in the private marketplace. People have wanted in this country, both on the right and the left, really to stick with the private marketplace as the driver of health insurance change and innovation in this country.
But you are beginning, I think, to see a lot more people talking about the advantages of a single-payer system, how we could potentially save money by cutting out some of the for-profit middlemen that take money out of the system and don't basically add to health care. But we do have a health care cost problem in this country, and I think we're going to be wrestling with that for many years, regardless of what happens with this bill.
INSKEEP: David Certner thanks very much.
CERTNER: Thank you.
INSKEEP: He's legislative policy director for AARP. Transcript provided by NPR, Copyright NPR.