美国国家公共电台 NPR Here Is What's In The House-Approved Health Care Bill（在线收听）

ROBERT SIEGEL, HOST:

President Trump and congressional Republicans celebrated in the White House Rose Garden today after the House narrowly passed health care legislation to replace the Affordable Care Act.

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PRESIDENT DONALD TRUMP: This is a great plan. I actually think it will get even better. And this is - make no mistake. This is a repeal and a replace of Obamacare. Make no mistake about it.

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SIEGEL: That bill now goes to the Senate. And here to explain what is in the bill and how it's likely to change is NPR's health policy correspondent Alison Kodjak. Hiya.

ALISON KODJAK, BYLINE: Hi, Robert.

SIEGEL: House Republicans did today what they failed to do back in March when House Speaker Ryan had to pull the bill for lack of votes. What changed the bill so much to make the difference?

KODJAK: Well, the original bill - the conservative wing of the House Republicans which are known as the Freedom Caucus really thought it kept way too much of Obamacare in place, and so they didn't like it. And then the more moderate side was worried about preexisting condition protections and other regulations that are in Obamacare being protected. And so they couldn't get the votes together at that point.

So what they did in the meantime is basically create a compromise where state governors can apply for waivers to get out of those Obamacare regulations, those protections for consumers, which pleases the Freedom Caucus because it gives people more freedom to buy different kinds of insurance. But it also technically in the federal regulation keeps all those protections for people with preexisting conditions.

SIEGEL: Well, the Congressional Budget Office said that the earlier version of the bill would have cost less than Obamacare, but it would cover 24 million fewer Americans. Why don't we have a clear idea of what impact this version of the bill would have?

KODJAK: Well, in part because we haven't heard yet from the Congressional Budget Office. There have been a number of amendments to the original bill, as I mentioned before. Since then, they have allowed these waivers, and there's no saying how many states really will accept them. Although, you know, you could do a poll and figure out how many governors are interested. And they've created a variety of funds to help people with preexisting conditions if they are left out of some of these insurance plans to help them get coverage. And they have offered other changes in the bill that the CBO hasn't scored yet. So there's no - there's some sense among experts that this is going to cost more because they put...

SIEGEL: Yeah.

KODJAK: ...More money in the bill, but - and may - in those states that go for waivers, have fewer people covered even.

SIEGEL: And the CBO is the official scorer in these matters for...

KODJAK: It's the official scorer.

SIEGEL: ...If it becomes - if this bill were to become law as it is, who would be the big winners and who the big losers by its passage?

KODJAK: Well, the big winners would be younger, healthier people who would probably see their insurance premiums go down because they wouldn't be subsidizing people who are older and sicker. And those are exactly the people who might lose - are the older, sicker people who would see their subsidies really go down so that they would have to pay much more for insurance and people on Medicaid. There's Medicaid expansion in the - in Obamacare, and that's being rolled back in this plan.

SIEGEL: The bill now goes to the Senate where Republicans have a much slimmer lead - 52 of the hundred seats. Do they need, in this case, just 51 to win in the Senate, by the way?

KODJAK: They need just 51.

SIEGEL: Not 60.

KODJAK: No.

SIEGEL: What's likely to change in the bill over there?

KODJAK: Well, there are a lot of senators who are already saying they're very worried about that Medicaid rollback, the Medicaid expansion rollback, so that's one thing that's going to be on the list of things that may change. And then there might be some more protection for people with preexisting conditions in these state waivers because there are a lot of members of the Senate who say they are worried about people losing coverage.

SIEGEL: After which, if all that happens, it has to go back and be approved by the House again. So...

KODJAK: Exactly.

SIEGEL: OK. NPR health policy correspondent Allison Kojak, Thanks.

KODJAK: Thanks, Robert.

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