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Congressional Budget Office Delves Into GOP Health Plan's Cost


House Speaker Paul Ryan is preparing the way for a grim-sounding forecast. Today, the nonpartisan Congressional Budget Office is expected to give its projections for the impact of a Republican health care bill - a replacement for Obamacare. We'll get a set of answers to questions like, how much does this cost or how many people may lose coverage compared with the Affordable Care Act. The House speaker declined NPR's invitation to take questions about his party's health care proposal but did take questions from CBS.


PAUL RYAN: The one thing I'm certain will happen is CBO will say, well, gosh, not as many people will get coverage - you know why? - because this isn't a government mandate. This is not the government makes you buy what we say you should buy, and therefore the government thinks you're all going to buy it. So there's no way you can compete with, on paper, a government mandate with coverage.

INSKEEP: NPR's Mara Liasson is on the line. Good morning, Mara.


INSKEEP: What do you hear in what the speaker said there?

LIASSON: What I heard is him saying, yes, people will lose coverage, but that's not the way this should be judged. Universal coverage is not the Republican's goal. The goal is more freedom and more choice. He sounds like he's a real Reaganite conservative on that. It's possible that what people want is just better coverage at less cost, and that really clashes with Donald Trump's populist vision. And he said this many, many times. He said everyone will be covered, even if they can't pay.

INSKEEP: Yeah, he even used the phrase health insurance for everybody. But how hard is President Trump working to sell this plan?

LIASSON: I think he is going to work very hard. The White House says he is in sell mode. This is the first big test of his presidency. Can he sell this legislation? He's supposed to be a master salesman. But so far, Trump, who is a great brander, has not decided to call this Trumpcare (ph). This plan could end up helping affluent millennials, who didn't vote for Trump, and hurting lower income, older, sicker Trump voters, especially if the Congressional Budget Office estimate is even close to being accurate - 3 to 5 or 6 to 10 million people losing health care. Then what happens to Trumpcare? Is there a backlash?

INSKEEP: And let's just remember that they've not only reduced the subsidies under this plan, but also changed who gets them. It's not based on your income and whether you may need it based on your income, but based on your age and what the price might be based on your age. Tom Price, the Secretary of Health and Human Services, though, is saying don't worry about all this. He spoke with NBC. Let's listen to a little bit of that. He's betting that, ultimately, costs for health insurance under this plan will go down.


TOM PRICE: I firmly believe that nobody will be worse off financially in the process that we're going through, understanding that they'll have choices that they can select the kind of coverage that they want for themselves and for their family, not the government forces them to buy.

INSKEEP: Is this true, that people are going to be assured of better, cheaper plans so they won't need as much subsidies?

LIASSON: Well, that's certainly what Price hopes. This sounds a little bit like Barack Obama saying you can keep your plan; you can keep your doctor. Some people are going to have to pay more. Some people will get less. Price also said that success is defined as, quote, "more people covered than are covered now at an average cost that is less." That is not what Paul Ryan said. He's saying coverage numbers are not the metric that this should be judged by.

INSKEEP: Ryan is acknowledging that coverage is likely to go down. The projections are going to say coverage is going to go down.

LIASSON: That's right. They are. And, you know, you've got a big conflict between conservatives in the House, more moderate Republicans in the Senate who want changes in this bill. Also this weekend, Tom Cotton of Arkansas said to House Republicans, don't walk the plank. Don't vote for this bill just to see it die in the Senate. You will put your Republican majority in the House at risk. Please slow down. On the other hand, you had Paul Ryan warning of a bloodbath if they don't pass this bill because the base will be enraged. So this is sounding very apocalyptic for Republicans no matter what they do.

INSKEEP: Mara, thanks as always.

LIASSON: Thank you.

INSKEEP: That's NPR's Mara Liasson. Transcript provided by NPR, Copyright NPR.

Mara Liasson is a national political correspondent for NPR. Her reports can be heard regularly on NPR's award-winning newsmagazine programs Morning Edition and All Things Considered. Liasson provides extensive coverage of politics and policy from Washington, DC — focusing on the White House and Congress — and also reports on political trends beyond the Beltway.
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