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To Save ACA, Obama Strategizes With Hill Dems


President Obama has been up on Capitol Hill this morning strategizing with Democrats about ways to save the Affordable Care Act, a major part of his presidential legacy. Vice President-elect Mike Pence has been in meetings with Republican lawmakers. He spoke a short while ago and made it clear why Republicans are determined to dismantle the president's signature program.


MIKE PENCE: The first order of business is to repeal and replace Obamacare. And that was our message today, and it'll be our message on Capitol Hill. And it needs to be done, not just as a promise kept but because, in the course of this election, the American people had a choice. And what appeared to many as against all odds, oftentimes with overwhelming opposition, our president-elect took his case to the American people to repeal and replace Obamacare. And the American people voted decisively for a better future for health care in this country.

MARTIN: NPR's congressional correspondent Ailsa Chang joins us now from the Capitol.

Hi, Ailsa.


MARTIN: Let's start with President Obama. What are you hearing from Democratic leaders about how that meeting went?

CHANG: Well, the big line from Senate Democratic leader Chuck Schumer was that Republicans are like dogs who just caught a bus. They don't know what to do now. They're basically going to take health care away from 20 million people - according to Democrats - but they have no plan for what to do after that. Here's what Schumer said.


CHUCK SCHUMER: For five years now, they have had nothing to put in its place. It's all starts with the ACA. As we all know, the ACA is a delicate balance. President-elect Trump even expressed support for the three most popular parts of the law - pre-existing conditions, allowing young people to stay on their parents' insurance until age 26, equal treatment for women. But Republicans will soon learn that you can't keep the good parts of the ACA and remove the rest of the law and still have it work.

CHANG: So basically, what he's saying is repeal will cause disastrous consequences. It'll make premiums skyrocket. It'll put insurance companies back in charge. It would cause rural hospitals to get hit hard. Schumer says Republicans are stuck. They have been making these extreme promises. You know, it's easy to rail against the health care law as a campaign mantra. But they're paralyzed now with the hard part, the replacement plan.

MARTIN: OK. So we'll talk about that in a second. But what do we know, at this point, about how Trump and Republicans are going to go just about getting the repealing part done?

CHANG: Well, Donald Trump had an interesting tweet this morning. He seems to be warning Republicans that they shouldn't be too disruptive to - with this repeal to families. He tweeted, Republicans must be careful in that the Dems own the failed Obamacare disaster with its poor coverage and massive premium increases. Basically, he's reminding Republicans that they can just as easily be accused of what Democrats were accused of after the rollout of the health care law, when people saw their premiums go up or they couldn't keep their old plans.

And House Speaker Paul Ryan said the goal was not to pull the rug out from underneath families. Vice President-elect Mike Pence said the same thing this morning after meeting with House Republicans. But Republicans are already paving the way to repeal the law. They've introduced legislation in the Senate to get the process started. The challenge is - do they want to repeal and replace the law simultaneously? Or do they repeal first, delay the effective date of that repeal and then replace later? And there's still no consensus among Republicans on just what they're going to do exactly.

MARTIN: Plus, there are concerns in this whole process that people would go without health insurance. Is that what's complicating the whole replacement issue?

CHANG: Absolutely. And figuring out what the replacement plan will look like is incredibly complicated. I mean, Trump has already said he wants to keep parts of the health care law, like not excluding people who have pre-existing existing conditions or allowing young people to stay on their parents' plans until they're 26 years old.

But if Republicans get rid of the individual mandate, which is probably the most objectionable aspect of the law to the GOP, what happens if not enough young, healthy people pay into the pool, and then you don't have enough money to cover the cost of very sick patients? It's extremely complicated, and Republicans don't have a solution yet to that problem.

MARTIN: So what kind of leverage do the Democrats have?

CHANG: Well, they don't have a lot of leverage right now. Republicans have enough votes, through a procedural shortcut called budget reconciliation, to repeal large parts of the law. But what Democrats are trying to do now is wage a robust messaging campaign. They're reminding the public that more than 20 million people could lose their health care coverage, including swaths of people in states with Republican senators where Medicaid was expanded under Obamacare, states like West Virginia.

In the meantime, Senate Democrats will try to get Republicans on the record on various aspects of the health care law. The chamber is considering a budget resolution which will serve as the vehicle for the repeal. And senators will be able to introduce all kinds of amendments to that vehicle in what's called a vote-a-rama next week. They're going to try to get Republicans to vote on provisions like an individual mandate...


CHANG: ...Or Medicaid expansion...

MARTIN: We'll have to leave it there. NPR's Ailsa Chang.

Thanks, Ailsa.

CHANG: You're welcome. Transcript provided by NPR, Copyright NPR.

Rachel Martin is a host of Morning Edition, as well as NPR's morning news podcast Up First.
Ailsa Chang is an award-winning journalist who hosts All Things Considered along with Ari Shapiro, Audie Cornish, and Mary Louise Kelly. She landed in public radio after practicing law for a few years.
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