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Can Biden Expand Obamacare Without A Majority In The Senate?


President-elect Joe Biden is moving forward. And part of that means explaining how he wants to improve the Affordable Care Act. Here's what he said in a speech yesterday.


JOE BIDEN: Beginning on January 20, the Vice President-elect Harris and I, we're going to do everything in our power to ease the burden of health care on you and your families. I promise you that.

MARTIN: But before Joe Biden can try to do that, the Supreme Court has to decide if the Affordable Care Act is even going to survive. Yesterday, during oral arguments, Chief Justice John Roberts and Justice Brett Kavanaugh seemed to indicate that they would vote to preserve most of the law. But the court has yet to give its final decision. Joining us now is Kathleen Sebelius. She was the governor of Kansas from 2003 to 2009. She also served as the secretary of Health and Human Services under President Obama. And she was instrumental in the implementation of the ACA in its early days. Secretary Sebelius, thank you so much for joining us.

KATHLEEN SEBELIUS: Great to be with you, Rachel.

MARTIN: So I guess, first off, I would ask you about that remark that the vice president just made. I don't have to tell you that President Obama had a heck of a time getting the Affordable Care Act through. How can President-elect Biden expect to expand the ACA without a majority in the Senate?

SEBELIUS: Well, I think, Rachel, the ACA, in many ways, was on the ballot in 2020. And one of the reasons that Vice President Biden will be sworn in as the next president of the United States is that people voted for health care. People made it clear over the last 10 years that the ACA has been the law of the land, that they don't want to lose their health coverage. They don't want to lose their insurance. And, in fact, Americans now, unlike the time when President Obama was trying to pass the law, widely believe that preexisting condition should be protected and that all Americans deserve health care. That's a huge step forward.

MARTIN: At this point, do you think expanding the ACA will mean pushing for a public option?

SEBELIUS: Well, it's certainly something that I think President Biden will propose. He said all during the campaign that that was his plan. It is something that we tried to put in the law 10 years ago. There were not enough Democratic votes even though there were 60 Democrats in the Senate. I think, 10 years later, there's very little question that having a public option as a competitor to the private health plans offered in the marketplace would actually give people a lower-cost choice.

MARTIN: I mean, we'll see what happens in the Georgia runoffs - right? - in terms of control of the Senate. But when it comes to Republicans who viewed the public option, as some people called it, a threat to the current health care system, do you think any of those minds have been changed?

SEBELIUS: Well, I would hope that people have paid attention in the last 10 years. The public option is a choice that people would have between privately offered health plan in the private market and a more government-like plan, which can dramatically lower administrative costs. You know, Rachel, we have exactly that same setup in Medicare. And what we know is Medicare right now can deliver benefit packages at a two to 3% administrative cost. Most private insurance companies are in the 15 to 20% level. So you get exactly the same benefits, you're just not paying huge administrative costs. And the dollars can be spent on health care and improving people's health.

MARTIN: I want to ask you about the case before the Supreme Court. I mean, this case has Democrats, liberals worried that the conservative court would strike down the ACA. But even the conservative justices suggested that the case itself isn't strong. What's your response to that? And are you confident the ACA, as a result of what the justices are intimating right now, will remain the law of the land?

SEBELIUS: Well, I certainly hope they will follow what seems to be the pretty universal sentiment among lawyers who have looked at this case, that it's a very weak case. I hope the Supreme Court doesn't try to legislate from the bench. Congress actually left the law in place as they got rid of the individual mandate. So the law has been in operation for 2 1/2 years since the mandate was gone. The argument that somehow the law can't stand without the mandate has been proven to be false for the last 2 1/2 years.

MARTIN: I want to pivot, if I could, and ask you about the state of the pandemic. I mean, you understand the perspective of the federal government as the former secretary of Health and Human Services. You were also a governor. What do you think needs to happen to make sure that, moving forward, there is a more coordinated response between states and the federal government, which has been so lacking for the past nine months?

SEBELIUS: So I think Joe Biden is doing exactly what governors would expect him to do, starting with clear, scientifically driven communication, a very clear idea that the federal government will gather and distribute protective equipment needed by the states, a very transparent process for mobilizing a national vaccination campaign, an equitable look at how the distribution system will go. Then a governor can respond to that plan. But right now, they are really on their own. And I think they will welcome a framework that has been traditionally how we operate in a disaster. The state does whatever they can, but then calls the federal government for help that they can't possibly provide within their own state.

MARTIN: Kathleen Sebelius, former governor of Kansas. And she also served as the secretary of Health and Human Services from 2009 to 2014 under President Obama. Thank you so much for talking with us. We so appreciate it.

SEBELIUS: Thanks very much for having me. Transcript provided by NPR, Copyright NPR.

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