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Week In Politics: House Passes American Health Care Act


And we're going to stick with health care for our Friday politics conversation, this week with E.J. Dionne of The Washington Post and The Brookings Institution and, sitting in for David Brooks, Ramesh Ponnuru of the National Review and Bloomberg View. Good to see you both.

E J DIONNE, BYLINE: Good to be with you.


SIEGEL: Yesterday witnessed some sharply contrasting scenes. House Democratic Leader Nancy Pelosi told her Republican colleagues they were about to approve a bill so bad they will pay for it at the polls.


NANCY PELOSI: Some of you have said, well, they'll fix it in the Senate. But you have every provision of this bill tattooed on your forehead. You will glow in the dark on this one. You will glow in the dark.

SIEGEL: But House Republicans voted and were bussed en masse to the White House where the president had unstinting praise for the health care bill they had just passed. Let's hear some more of what he had to say. It is, he told them, a real repeal and replacement of Obamacare.


PRESIDENT DONALD TRUMP: And I think most importantly, yes, premiums will be coming down. Yes, deductibles will be coming down. But very importantly, it's a great plan. And ultimately, that's what it's all about.

SIEGEL: First, E.J., can the White House and the Republican House leaders claim a genuine win for mustering a majority for an amended version of a bill that they had to pull back in March for lack of votes?

DIONNE: Well, if there's ever a definition of pyrrhic victory, a victory that becomes a catastrophe for you, I think this is it. And forgive me because guaranteeing every American health care is - health insurance is one of my hot-button issues. And I was really struck when Paul Ryan said, this is who we are. This will define us. Yes, it will define them cutting 880 billion from Medicaid to support a $596 billion tax cut mostly for the wealthy, threatening the health insurance of 24 million people.

And I think the Republicans have just a series of problems based on what they said in the past. Paul Ryan said over and over again during the Obamacare fight - and that was debated for a year - that it wasn't subjected to sufficient scrutiny. This didn't even get a score from the Congressional Budget Office. And you hear in President Trump these promises that are utterly unkeepable - premiums will be going down. No, they won't be going down. And he acts as if we've passed a Bernie Sanders single-payer bill when we are in fact cutting the number of people who will have health insurance. I think this will be a big problem for them.

SIEGEL: Let me ask Ramesh. Ramesh, can the Republicans claim to have answered the question, if not the Affordable Care Act, what? Or did the House just punt it to the Senate and say, you go figure out what we stand for in the way of health care reform?

PONNURU: There was a lot of discussion in March when an earlier version of this bill failed in the House, didn't even get brought up for a vote, about the political implications of it. And the fact is it didn't have any political implications. The question really depends on what the ultimate outcome is here. And I think that's the case here as well. I think that probably the House Republicans who voted for this bill, if they are to have the best possible political outcome - which is really the least worst political outcome - it will involve Senate passage of a bill that is a little bit more moderate than this one, that attends to some of the concerns about the coverage numbers and people with pre-existing conditions more than this one. If they get that I think it is a big victory.

SIEGEL: And if they get that, you think it would go back to the House and win the support of the Freedom Caucus Republicans?

PONNURU: I think in the end if you've got an outcome where you can plausibly say that you are undoing a lot of Obamacare, you are moving towards a less regulation and spending-heavy health care system, you will get the Freedom Caucus and maybe lose a couple of them, but pick up some of the moderate Republicans.

SIEGEL: I want to hear your - E.J., your opinion first of a scene yesterday. The Democrats actually sang derisively to their Republican colleagues. They sang that unforgettable lyric, na (ph) na na na, na na na na, hey, hey, hey, goodbye, meaning you're going to lose. What do you think? What Ramesh says is what people will know about come the next election is the final outcome of this process, not the Republican bill. Were people really taking their careers in their hands yesterday?

DIONNE: I think they were. And - because there are certain issues where people, I think, are very sensitive. It's when the government is taking away something or threatening to take away something that you already have. And that a lot of the people Obamacare has helped ironically are moderate to low-income white Americans in states like West Virginia, Kentucky, Louisiana, Arkansas, who are part of the Republican base. So I think that they pay a price for this vote even if there is a better outcome at the end.

And I'm not sure - I'm not as sanguine as Ramesh is about their getting to that better outcome because in order to get the Freedom Caucus votes you're still going to have to throw an awful lot of people off health insurance. And they're not going to get any Democratic votes for that kind of solution.

PONNURU: Well, you know, one of the things that is worth looking at here is the composition of this change in the insurance rolls because the Congressional Budget Office says that there'll be an initial impact where there is a decline in 14 - of 14 million in the number of people who have insurance. But it also says that the bulk of that is because you're no longer going to be levying fines on people for not having insurance. Are those people who are going to leave the insurance rolls not because insurance has been stripped from them but because they have voluntarily chosen to drop insurance - are they really going to hold that against the Republicans?

SIEGEL: You're saying they don't - that you think they may not consider that loss of an entitlement if they didn't want it in the first place.

PONNURU: I mean, based on the Congressional Budget Office analysis, the idea is that they are better off from their own perspective.

DIONNE: But I don't think that works in the end because when you're cutting $880 billion for Medicaid, a program that serves about 74 million Americans, you are going to be throwing a lot of people off health insurance who want health insurance. And some of those that the CBO refers to, now that they're on insurance, will not feel like, oh, gee, I'm liberated not to have health insurance.

SIEGEL: Ramesh?

PONNURU: I think that both of these effects are going to happen. And I think what the Senate Republicans should be doing is focusing on the issue of the people who can't afford insurance, enabling them to get insurance. But the total number, which includes the people who are just going to voluntarily drop insurance, that's not something that they should be as obsessed about.

SIEGEL: I have just one last question, E.J., for you, very short answer. Do you think that the Democrats will be considerably more involved in the process in the Senate than they were in the House? Will they take part in changing what comes to them from the House?

DIONNE: I think the answer is no unless the Senate says we want to fix Obamacare, we don't want to repeal it. And I don't see the Republicans doing that.

SIEGEL: E.J. Dionne of The Washington Post, Ramesh Ponnuru of the National Review and Bloomberg View. Thanks to both of you.

DIONNE: Thank you.

PONNURU: Thanks.

(SOUNDBITE OF ATMOSPHERE SONG, "THE BEST DAY") Transcript provided by NPR, Copyright NPR.