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Details Of Bipartisan Health Insurance Plan Come Into Focus


We have a clearer picture this morning of what a bipartisan health insurance compromise looks like. Text of legislation obtained by NPR News offers ways to fix the Affordable Care Act that some Republicans and Democrats favor. Whether it ever becomes law is a different question. President Trump said this week that he liked the approach and also that he did not like it. And Press secretary Sarah Huckabee Sanders said this.


SARAH HUCKABEE SANDERS: This president certainly supports Republicans and Democrats coming to work together, but it's not a full approach. And we need something to go a little bit further to get on board.

INSKEEP: NPR's Alison Kodjak covers health care policy. She obtained the legislation. She's with us now.

Hi, Alison.


INSKEEP: OK, so you got this text. What's it say?

KODJAK: Well, it has a few elements in it that, you know, should be able to appeal to both Republicans and Democrats, as you mentioned. The biggest thing is that it restores these subsidies to insurance companies.

INSKEEP: Oh, the things that President Trump canceled the other day.

KODJAK: Yeah, he canceled them last week. And these subsidies basically pay insurance companies back for discounts that they give to low-income customers on their deductibles and copayments. So, you know, if you have a policy that had a $500 deductible, somebody with a lower income than you would get a policy - the same policy but maybe with a $100 deductible. And this money goes to pay that back.


KODJAK: And insurance companies think this is important because they counted on it, and without it, premiums go up, so...

INSKEEP: Premiums for everybody. Go on.

KODJAK: For everybody. And so, you know, both Democrats and Republicans should like this. The - it also has something called 1332 waivers, which is a technical term, but it basically allows states to change the law with the approval of the federal government so that they can sort of cater their health care system to the people in their state, to what they need.

And that's really appealing to Republicans, especially, who say they want states to have more control. They want it back at the local level. And then the third thing is, it allows more people to get what are called catastrophic health plans, these health policies that cost less, offer a little bit less coverage and appeal to healthier people. They think this might bring more people back into the insurance pool.

INSKEEP: I'm beginning to get a sense of the compromise here. Democrats want to restore these subsidies along with a lot of Republican governors and others, we should mention. But there are things that, if you're a conservative, you're going to like in there.

KODJAK: You - exactly.

INSKEEP: ...State flexibility, for example.

KODJAK: Exactly, exactly.

INSKEEP: OK, so the president has said that he doesn't want to sign onto anything that's a bailout for insurance companies, which is the way he's characterized these subsidies. Does this bill address that?

KODJAK: It does. So most people would say these are not a bailout. As I just explained, they're sort of more a reimbursement to insurance companies for things they have to do.

INSKEEP: There's a mandate that they get paid to take care - yeah.

KODJAK: Yeah, its's in the law. But what this bill does is essentially ensure that if the insurance companies get these subsidies back, they have to actually benefit consumers or they have to pay back the federal government. There's, like, more than a page of text in the bill with a whole bunch of paragraphs making sure that they don't get extra money that they don't deserve.

INSKEEP: And I appreciated hearing just last night on All Things Considered, you were pointing out that insurance companies already have this requirement that the vast majority of any income they get has to go back to patients, customers, people being insured.

KODJAK: Exactly. And it's - that's one of the things that is interesting is, the Affordable Care Act actually does limit how much money insurance companies can make off this law. If they spend less than 80 percent of their money on health care, they have to send a check back to their customers.

INSKEEP: OK, so just let's ask about the politics here. The president is in, or out, or in or out, it's hard to say. Senators - some of them are on board with this. House of Representatives - mixed signals, it seems. Paul Ryan, the speaker of the House, wasn't jumping all over this.

KODJAK: He was not jumping all over it. But what's interesting is, Congressman Mark Meadows, the head of the Freedom Caucus, which is the really conservative wing - he's sort of expressed some tepid support that he might go with this. And he controls a lot of votes, so that could actually bring the House around.

INSKEEP: Tepid support - a breakthrough.

KODJAK: (Laughter).

INSKEEP: Alison, thank you very much.

KODJAK: Thanks, Steve.

INSKEEP: That's NPR's Alison Kodjak. Transcript provided by NPR, Copyright NPR.

Alison Fitzgerald Kodjak is a health policy correspondent on NPR's Science Desk.
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