Face the Nation Transcript March 12, 2017: Ryan, Paul, Sanders
JOHN DICKERSON, CBS HOST: Today on FACE THE NATION: House Speaker Paul Ryan leads the charge to repeal Obamacare, but faces a revolt from within his own party.
We will go one-on-one with the speaker in an interview you will see only on FACE THE NATION.
Republicans launch the long-promised push to dismantle the Affordable Care Act, but were hammered right out of the gate by critics from the right, the left and the center.
(BEGIN VIDEO CLIP)
REP. PAUL RYAN (R-WI), SPEAKER OF THE HOUSE: You are a governing party getting a consensus among your wide, big-tent party. Everybody doesn’t get what they want.
But we are getting much better policy here.
(END VIDEO CLIP)
DICKERSON: But it is the impact of the policy that has Americans worried and gives critics ammunition.
(BEGIN VIDEO CLIP)
DICKERSON: How many people are going to lose coverage under this new...
RYAN: I can’t answer that question.
(END VIDEO CLIP)
DICKERSON: Another unanswered question in Washington, what evidence did the president have for his bombshell charge that President Obama had wiretapped Trump Tower during the campaign?
(BEGIN VIDEO CLIP)
DICKERSON: You are the member of the Gang -- the so-called Gang of 8, the top leaders who get this information. Have you seen anything to suggest there are wiretaps?
RYAN: No.
(END VIDEO CLIP)
DICKERSON: We will also talk this morning to two of the most vocal critics of the health care replacement bill in the Senate, one from either side of the aisle, Republican Rand Paul of Kentucky and Democrat Bernie Sanders of the Vermont.
And we will have plenty of political analysis of all the week’s news. It is coming right up on FACE THE NATION.
Good morning, and welcome to FACE THE NATION. I’m John Dickerson.
For the most part this past week, President Trump has been working behind the scenes to fulfill one of his biggest campaign promises, repealing and replacing Obamacare.
That left the public spotlight to House Speaker Paul Ryan, who went as far as rolling up his sleeves and making his case with charts and graphs.
We sat down with the speaker yesterday, and he told us he was excited about the reaction to the bill.
(BEGIN VIDEOTAPE)
DICKERSON: You have conservative governors, you have conservative members of the House, you have AARP, the American Medical Association, American Hospital Association, the health insurance lobby all coming out against this.
You are pleased with the reaction. The reaction has been awful.
RYAN: I wouldn’t say the reaction has been awful.
I think the reaction is, everybody wants to compare this to Obamacare, as if they can keep these guarantees going, as if we are going to have Obamacare plans, and we are just going to finance it a different way.
This is repealing and replacing Obamacare. So, this first part is very, very important. It repeals the entire fiscal pieces of the law and replaces it with a patient-centered system.
And the point is, a lot of people who you just mentioned, I think they would like to see us continue to make Americans buy what we say they should buy. We don’t agree with that.
DICKERSON: But these are critics of yours coming from the conservative side.
RYAN: Look, when you are a governing party getting consensus among your wide, big-tent party, not -- everybody doesn’t get what they want, but we are getting much better policy here.
Let me put it this way. Obamacare is collapsing. If we just did nothing, washed our hands of the situation, we would see a further collapse of the health insurance markets. So we feel an obligation to step in front of that collapse and replace this law with one that works, that has more freedom.
Some people would like it to be done a little bit differently. And the point here, though, is, we have an obligation. We made a promise to the people who elected us we would repeal and replace this law. And we basically said, this is what we would replace it with. And now we are keeping our word.
DICKERSON: There have been so many people picking at different pieces who have issues about it, on your side, on the other side.
Tom Cotton, senator from Arkansas, Lindsey Graham, senator from South Carolina, have both said, let’s slow down. Why go so fast?
RYAN: That is actually really puzzling to me. Why go so fast?
Let me see. We ran for repeal and replace in 2010. We ran on repeal and replace in 2012, in 2014, in 2016. Oh, by the way, we spent six months last year developing a replacement plan. We ran on that replacement plan.
DICKERSON: But these senators know that. They’re not unfamiliar.
RYAN: This has been a long and deliberative process.
Suggesting that this is moving fast, going through four committees, going through regular order, saying we are going to do this for seven years, and now come to the point where we are actually on the cusp of keeping our word, I hardly think that that is rushing things.
The point I would say is, this is historic. This is historic. And it’s significant. And if we don’t act, the system is going to collapse. And the beautiful thing about this plan that we’re proposing, it is more freedom, it is more choices, it is more markets, it’s lower prices, which gets us better access.
DICKERSON: Let me -- but you said you ran on this. But that’s like saying, some day, we are going to buy a car. Now we are talking about the actual car. You’re talking about the actual legislation.
RYAN: Not only did we say, someday, we’re going to buy a car. We said, this is what the car is going to look like.
DICKERSON: But you -- but all these analyses that are coming out now are based on actual legislation. Those were not coming out while you were campaigning on it. There’s actual details that are at issue here on everything from tax credits to the individual mandate.
(CROSSTALK)
RYAN: Right.
DICKERSON: All of that stuff is being debated afresh now, in a way that...
(CROSSTALK)
RYAN: We want this kind of debate. This is a good debate to have.
DICKERSON: If you pass a bill out of the House and it can’t get 51 votes in the Senate, will you have accomplished something?
RYAN: Well, I believe we can get 51 votes out of the Senate.
Look, this is what the legislative process looks like, when you are going through a deliberative legislative process, not ramming and jamming things, but going through all the committees, going through the entire process.
People are going to try and negotiate. People are going to say, I wish we could do this, let’s do that. That’s how legislation works. Negotiations and compromises occur when you are writing law. And what we are seeing and hearing is just that.
DICKERSON: The president is one of the -- he is our first marketer president.
How helpful has he been in this, applying the marketer skill to selling this? There’s no...
RYAN: He’s been tremendously helpful actually. He has been very helpful. He has been extremely engaged with various members of Congress. I talk to him constantly on this.
DICKERSON: Has he given you advice on how to sell this?
RYAN: Sure. Sure. And he’s -- we talk. It is a very good collaboration.
Everybody has been working on the same page, not rival plans, working together. So I am actually really excited that we have a president fully engaged and fully committed to keeping his promise, the same promise we made to the people that elected us and getting this done.
DICKERSON: You say keeping his promise. He has promised a lot for this legislation.
He said everybody will be covered. He said costs will go down, you will be able to pick your doctor. Even in company insurance plans, you can’t pick your doctor. There are limits on that.
He said that you will be able to pick whatever plan you want. He is overpromising. You can’t do all that.
RYAN: Look, here is our point.
DICKERSON: But you agree he is overpromising?
RYAN: Well, I can’t speak to all of those. I don’t know exactly all that all that he said.
He had said we will repeal and replace Obamacare with a better system, one that gives people better access to more affordable choices. And you pick what you want. We are not going to have -- read his speech that he gave to Congress just a few weeks ago.
That speech perfectly encapsulized what we are achieving here. And I think people are missing the historic nature of this. We are taking one entitlement that is going bankrupt, Medicaid, where more and more low-income people don’t even get access to a doctor, and we’re giving it back to the states, so that they can experiment and innovate and make it work better for low-income citizens.
And we are taking another entitlement, Obamacare, which is crashing and blowing up our fiscal problem, and repealing it, and replacing it with good tax policy that equalizes the tax treatment of health care and gives people more choice and more freedom. That means lower costs across the board, so you can improve access.
DICKERSON: I want to get to that, some of that in a minute.
The president has said there will be a bloodbath in 2018 if this isn’t passed through the House and Senate. Do you agree?
RYAN: I do believe that if we don’t keep our word to the people who sent us here, yes.
Look, the most important thing for a person like myself, who runs for office and tells the people we are asking to hire us, this is what I will do if I get elected. And then, if you don’t do that, you are breaking your word.
DICKERSON: You said you are working hand in glove with the president on selling this new health care plan.
But over the weekend, before you were going to launch this sales campaign, the president sends out four tweets about his predecessor wiretapping him. Did that help or hurt...
(CROSSTALK)
RYAN: Yes, that wasn’t really part of the health care marketing campaign.
(LAUGHTER)
DICKERSON: Yes.
How much off-course did that take you?
RYAN: Like I said, this is going to be an unconventional presidency. And I think he was just upset about -- I’m not really sure.
DICKERSON: But there’s unconventional, and then there is really off into new territory.
RYAN: Look, this is part of what the Intelligence Committee is investigating.
Both the House Intelligence Committee and the Senate Intelligence Committee are going through all of this. That is the proper place for this. And, by the way, we have been presented with no evidence that anybody, any American was in collusion with the Russians on meddling with our election.
We know the Russians meddled with our election. We said so before the election.
DICKERSON: Here’s a question I have for you, though.
You and I have talked about the importance of public figures making a case -- you are doing it right now with health care -- to the public based on a set of facts. You make your argument about your facts. The other person makes their argument. And the people make a decision.
How can that happen in a situation where you have a president who is saying things that -- where you have got the director of the FBI, you have got the former DNI...
RYAN: Well, there has been a lot of reporting about this.
There has been a lot of reporting about -- remember, there was an investigation by the Intelligence Committee.
DICKERSON: But not that Barack Obama wiretapped Donald Trump.
RYAN: Well, that’s what the Intelligence Committee is going to investigate. That’s what the intelligence -- there has been a lot of reporting about this all over the place.
So, the key is, get to the bottom of it. Make sure the Intelligence Committee investigates these things. And I think when we get through all of this investigation, I think we will discover that they didn’t do those things, but Russia did try to meddle with our elections.
DICKERSON: But this is a serious charge. The president is saying his predecessor put illegal wiretaps on him. That is not the basket of charges and things that have been discussed in the papers before. That is a new thing
And I wonder if you feel the way Senator Sasse does, the way Senator Graham does, which is, when a president makes this kind of a bombshell charge, that you can’t just wait for the committees to kind of get to the work. This isn’t the kind of thing you want to just linger out there.
Do you -- what do you feel about that?
RYAN: Well, that is outside of my control what is tweeted or what isn’t tweeted.
We are focused on health care. The president is focused on health care. I think he is frustrated with this whole thing about Russia. I think he is frustrated with selective leaks coming from parts of government that malign his campaign. The reason why we think the Intelligence Committees are the ones who should do this is, the last thing we want to do is compromise the sources and methods of our intelligence gathering, so that we get to the bottom of all of this.
But, yes, there has been a lot of selective leaking, I think, in many ways meant to malign the presidency, meant to get him off to a bad start. And he is expressing that frustration.
DICKERSON: You are the member of the Gang -- the so-called Gang of 8, the top leaders who get this information. Have you seen anything to suggest there are wiretaps?
RYAN: No.
DICKERSON: Could you clear up this question of wiretaps?
RYAN: Well, again, let’s -- I don’t want to get ahead of the Intelligence Committees. I don’t want to get ahead of the Intelligence Committees and their thorough investigation.
(END VIDEOTAPE)
DICKERSON: And we may get some answers soon, as the House Intelligence Committee has asked the Justice Department to turn over any specific evidence they have related to any possible wiretaps at Trump Tower by Monday.
And we will have more questions and get some more answers from Speaker Ryan later in our broadcast.
Right now, we turn to the critics of the new plan.
Yesterday, Vice President Pence traveled to Kentucky, perhaps to put a little pressure on one of the bill’s most vocal opponents, Republican Senator Rand Paul, who is with us now.
Welcome, Senator.
What is wrong with this bill?
SEN. RAND PAUL (R), KENTUCKY: I think it is basically Obamacare- lite. Keeps the subsidies, keeps the taxes for a year, then keeps the Cadillac tax forever, the tax on good insurance.
Keeps the individual mandate, interestingly. You know, Republicans have complained for years, saying we didn’t like the government was going to make you pay a penalty. Well, now instead of paying the penalty to the government, you pay the penalty to the insurance industry.
There’s also bailouts for the insurance industries. The one primary thing that is wrong with Obamacare that is most visible to everybody is that premiums are rising through the roof, soaring in the individual market. That will happen under the Ryan plan as well, because they do nothing to fix the fundamental problem.
DICKERSON: What Paul Ryan would say is, you are missing the forest for the trees, which is to say you are missing that this is changing Medicaid fundamentally, making it a block grant that goes back to the states, that it’s getting rid of the Obamacare entitlement, that it’s getting health savings accounts, which Republicans have long asked for.
PAUL: Let’s start just with the Medicaid expansion.
It may be fundamentally changing it or it may not. Built into Medicaid, they are going to block-grant it, but not with a fixed amount of money. It’s going to go up at about 5 percent a year. It goes up at CPI, an indicator of inflation in the medical community, which is going up at about 4 percent, plus 1.
So it is going to go up at about 5 percent a year. The question, is that a lot slower than what Medicaid is going up now? Is it quicker? I think it is still building in the growth of an entitlement program that really isn’t paid for.
So, for example, under Obamacare, I think it was dishonest accounting. They said the federal government will pay for Medicaid, 100 percent of it. But we have no money. We borrow a million dollars a minute and have a $20 trillion debt, so it is dishonest.
It sounds good. Give somebody stuff for free. Give them free health care. But it is not really free. We are borrowing it from China, which really threatens our country from within.
DICKERSON: You said it retains the individual mandate.
The argument is that if you don’t have something to get healthy people into the insurance market, that it ends up just being sicker and older people, and that’s why premiums go up.
PAUL: Well, exactly right.
The fundamental premise of Obamacare was, we have to have healthy people buy it, so we’re going to give them a mandate. So, here is the interesting thing that left and right, people who are really looking at this, agree on. It’s going to get worse.
The individual market will get worse when you get rid of the individual mandate and make it an insurance mandate, which is a slightly lesser penalty. And so more and more sick people will be in the pool. And let’s say you have lost your job and you have lost your insurance.
Do you have any incentive to get back in and pay the penalty? No, the penalty will look at -- people are writing now that it’s a disincentive to buy insurance. Why don’t you wait until you are sick? So, really, you can’t have an insurance model where people wait until they are sick to get insurance.
It doesn’t work. And here is the problem with Ryan’s plan. He keeps that fundamental aspect of Obamacare. He doesn’t change it.
DICKERSON: You say that Speaker Ryan is pulling the wool over the eyes of the president. Really, pulling the wool?
PAUL: I think there is a separation between the two.
I have talked to the president, I think, three times on Obamacare. And I hear from him that he is willing to negotiate. You know what I hear from Paul Ryan? It is a binary choice, young man.
And -- but what does a binary choice mean? His way or the highway. There are two choices, according to him.
DICKERSON: Well, I think his argument would be, the binary choice, you do this now through reconciliation, a Senate process that is kind of a pain, and then you have a second piece of legislation that does the rest.
PAUL: Well, what we are hearing is a binary choice is, it is the Ryan plan or the status quo.
And what he has rammed through his committee is his, without any amendments. And that’s a question. If we get what we have got from Ryan, Obamacare-lite, he will not have the votes. And we have to get to that point before true negotiations begin.
Right now, I think there is a charm offensive going on. Everybody is being nice to everybody, because they want us to vote for this. But we are not going to vote for it.
DICKERSON: You talked to the -- I’m going to get to the Senate in a second. But you said you spoke with the president. Where do you think he is willing to negotiate on these issues that you have highlighted?
PAUL: I don’t think the president is rigid in support of the House bill. I think he is open to seeing how we can get consensus.
And what I have told the president is what I am telling everybody. We are united on repeal, not so much on replacement. We do not agree with the fundamental three or four things that Ryan has, subsidies, taxes, mandates, and insurance bailout.
That is Obamacare. We don’t want that. If you take that off, what do you have? You have got repeal. Now, what do you do help people...
DICKERSON: Can you do just repeal by itself?
PAUL: Well, no, I would do replacement in a separate bill, because what I would do through replacement is, there are two things you have to do to fix the individual market.
You have to tell people that they can buy any kind of insurance they want. So, you get rid of the mandates on what goes into insurance. But you also have to allow for people to join a buying group. If people join a health care association or a co-op, that...
DICKERSON: Right. That’s part of Ryan’s plan, though.
PAUL: That drives down -- it is not in the Obamacare-lite proposal.
DICKERSON: It’s in the second set of legislation.
PAUL: He’s talking about it -- but the reason they have to be discussed at the same time is, CBO is going to come out and say a lot of people are not covered.
DICKERSON: Right.
PAUL: so how are we going to cover them?
I would cover them with something much better than Obamacare. And that would be joining a co-op to drive down prices, but also to get guaranteed issue, where you won’t be dropped.
DICKERSON: Let me ask you a question.
You have said that there is a room perhaps for negotiation with the president. But Mike Pence was in your state. And he said, “For us to seize this opportunity to repeal and replace Obamacare once and for all, we need every Republican in Congress.”
That sounds like he is talking to you.
PAUL: I think that is the pre-negotiation. We are still in the pre-negotiation period.
The real negotiation period comes -- and I promise this is the way it’s going to work. We will get Obamacare-lite, Ryan’s plan, unless there’s enough conservatives in the House to say no. If there’s enough to say no, when they start voting on the rules of debate, if they bring down the rule, if they stop him in the tracks, then a true negotiation begins.
No negotiation right now counts, until they determine to have enough votes to stop Obamacare-lite.
DICKERSON: Let me ask you a question on wiretapping, because I know that is an issue you care a lot about.
There are your colleagues -- Lindsey Graham and Senator Sasse have said this claim the president made about being wiretapped as a candidate by President Obama, they say this is too incendiary to wait for the committees to adjudicate it, that the president should bring forward whatever evidence he has.
Does that bother you, matter to you?
PAUL: Well, I think the first thing to realize is that I think everybody has been getting the story wrong. I doubt that Trump was a target directly of any kind of eavesdropping, but I am not saying it didn’t happen. I think there’s a very good chance it does. I don’t have any special information.
But the way it works is, the FISA court, through Section 702, wiretaps foreigners and then listens to Americans. It is a backdoor search of Americans. And because they have so much data, they can tap -- type Donald Trump into their vast resources of people they are tapping overseas, and they get all of his phone calls.
And so they did this to President Obama. They -- 1,227 times eavesdrops on President Obama’s phone calls. Then they mask him. But here is the problem. And General Hayden said this the other day. He said even low-level employees can unmask the caller. That is probably what happened to Flynn.
They are not targeting Americans. They are targeting foreigners. But they are doing it purposefully to get to Americans.
DICKERSON: OK.
So, your point is, the president would have been caught in a net -- or -- excuse me -- candidate Trump caught in a net, but not targeted directly.
PAUL: Or his associates.
But it is very dangerous, because they are revealing that now to the public.
(CROSSTALK)
DICKERSON: All right, thank you, Senator. We ran out of time.
Next up, a senator with a different take on why the Republican effort to overturn Obamacare won’t work.
We will be back in a minute with Bernie Sanders .
(COMMERCIAL BREAK)
DICKERSON: We are joined by Vermont Senator Bernie Sanders, who is in Burlington this morning.
Senator Sanders, House Speaker Paul Ryan thinks that his legislation can get 51 votes in the Senate. What do you think?
SEN. BERNIE SANDERS (I), VERMONT: Well, I sure hope not, John. It is an absolute disaster. It is a disgrace.
And, by the way, this really has nothing to do with health care. What this has everything to do with is a massive shift of wealth from working people and middle-income people to the very richest people in this country.
It is a $275 billion tax break for the top 2 percent. Millionaires will get about $50,000 a year in tax breaks, while at the same time, some five to 10 million people are going to lose their health insurance, premiums are going to soar.
The AARP says that if you’re 64 years of age, and you’re making about $25,000 a year, you are going to pay up to $7,000 more for your health insurance. They are going to defund Planned Parenthood. Deny over two million women the right to choose the health care that they need.
They’re going to decimate Medicaid, which is why the American Medical Association, the AMA, and the American Hospital Association oppose it, in addition to the AARP.
This is a disgrace. And, by the way, they are so cowardly that they want to go forward before the CBO even gives an estimate as to what it will cost and how many people will lose their insurance.
DICKERSON: Well, a lot of charges there.
The speaker says the CBO will be giving, the accountants in Congress will be giving their score on Monday, so it will be able to be a part of the debate.
But let me ask you this question about how many people will lose coverage. What Speaker Ryan says is, it is an unfair comparison, because the people who have coverage now have coverage in a rickety system that is getting worse, premiums are going up, insurance companies are dropping out of the system, so it is unfair to compare the people who have it now, because the system is falling apart.
SANDERS: Oh, really? Well, five to 10 million people are going to have no health insurance at all.
Nobody has ever suggested that the Affordable Care Act, Obamacare, was perfect, but it did put 20 million people into the ranks of the insured. In my view, and what the American people want is an improvement on Obamacare, not the decimation of Obamacare, and throwing so many people off of health insurance and raising premiums substantially.
It is very hard for Ryan or anybody else not to deny that what they are bringing forth is far, far, far worse than Obamacare, and that its primary purpose is massive tax breaks for the very wealthiest people in this country.
DICKERSON: There has been a lot of criticism from some senators about what the House is putting together.
I wonder if you see an opportunity to use the opposition against the House bill to do something that is closer to what you want.
SANDERS: Well, John, that is a very fair question.
But, as I understand it, this bill is so outrageous that not only have the Republicans moved forward in the House without the CBO score; they want to move forward in the Senate without any hearings whatsoever, if you realize this bill is going to impact tens and tens of millions of people, and to the best of my knowledge, they want to bring it right to the floor of the Senate.
I am a member of the Health Education Committee. When Obamacare was being debated, we had hearing after hearing, meeting after meeting. It never ended. And these guys want to take a bill so significant to so many people and just shove it through because they don’t have the guts to hold hearings. They don’t want the American people to know what is going on.
DICKERSON: They say that there will be a multistep process here, this is one step, and then there will be future legislation, so the -- what you might want would be in that future legislation, which would also have a 60-vote threshold.
This one has only a 50-vote threshold because of the way it is going through.
SANDERS: Well, they can say what they want, John, but it is impossible for any serious legislator to defend a process by which a bill is coming through the Senate without one hearing before the vote takes place.
And I think it’s clear to everybody. They want to move as quickly as they can. They are embarrassed about the product. And let’s not forget that President Trump, who now, I guess, today at least supports it -- we don’t know what he will say tomorrow -- but Trump was the guy who said to the American people when he ran for president, oh, don’t worry, we have got a terrific idea. We are going to provide health care to all people.
Well, this is far from it. This is throwing five to 10 million people off of the health insurance they currently have.
DICKERSON: All right, Senator Sanders, we’re going to have to leave it there. Thanks so much for being with us.
SANDERS: Thank you.
DICKERSON: And we will be back in a moment.
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DICKERSON: Welcome back to FACE THE NATION. I’m John Dickerson.
Among the biggest criticisms of the debate so far on health care is that it has happened without an official accounting from the Congressional Budget Office, or CBO. Among the big questions that remain unanswered about the Republican health care bill are how much will it cost and how many people might lose coverage if enacted in its current form? We ask Speaker Ryan why the House has started work on the bill without this information.
(BEGIN VIDEOTAPE)
RYAN: The score, we believe, will come out probably Monday or Tuesday, well before we go to the floor. Well before we go to the floor we’ll have the score. 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 we can -- you can compete with on paper a government mandate with coverage.
What we are trying to achieve here is bringing down the cost of care, bringing down the cost of insurance, not through government mandates and monopolies, but by having more choice and competition. And by lowering the cost of health care, you improve the access to health care. And by having the things that we’re talking about, tax credits, risk pools, health savings accounts, you dramatically increase the access to health care, but we’re not going to make an American do what they don’t want to do. You get it if you want it. That’s freedom.
DICKERSON: How many people are going to lose coverage under this new --
RYAN: I can’t answer that question. It’s up to people. Here -- here’s the premise of your question. Are you going to stop mandating people buy health insurance? People are going to do what they want to do with their lives because we believe in individual freedom in this country. So the question is, are we providing a system where people have access to health insurance if they choose to do so? And the answer is yes. But are we going to have some nice looking spreadsheet that says we, the government of the American -- of the United States are going to make people buy something and, therefore, they’re all going to buy it? No. That’s the fatal conceit of Obamacare in the first place.
So it’s not our job to make people do something that they don’t want to do. It is our job to have a system where people can get universal access to affordable coverage if they choose to do so or not. That’s what we’re going to be accomplishing.
DICKERSON: But there have been promises made from -- and President Trump ran on this and you have talked about how promises you make in your campaign set the table for things you are going to do. He has promised everyone will be covered. Cathy McMorris Rodgers has said, quote, no one who has coverage because of Obamacare today will lose that coverage.
RYAN: Yes, so that’s talking about the transition. I can’t speak what Cathy -- with respect to Cathy. We don’t want to pull the rug out from under people. We -- here’s what I’m concerned that some people in America are thinking, the day we pass this bill, the day after, everybody loses their coverage. That’s just not the case. There’s going to be --
DICKERSON: But they’re also concerned they might lose it in two months.
RYAN: They won’t in two months either, or two months later. So the point we’re trying to make there is, there will be a smooth transition, a stable transition, so that people who are covered today don’t have the rug pulled out from under them. But let’s remember where we are when I started this conversation, the system is collapsing. One hundred and sixteen percent increase in premiums in Arizona alone. Five states, one plan, over 1,000 counties, one plan, Humana --
DICKERSON: Will premiums now go up now? Because there are lots of people who are saying that premiums will go up in -- under this plan.
RYAN: Premiums -- if we do nothing, premiums will go far, far, far higher than they would otherwise go up.
DICKERSON: But they’re going to go up?
RYAN: I -- I think they’ll go down once this system coms into place. So that point would --
DICKERSON: And when’s that going to happen?
RYAN: Look at the bill. In two years -- that’s the point, there’s a transition -- it takes a little while to get the states back in the game to regulate health insurance. It takes a little while for risk pools to be set up in the states to cover people with preexisting conditions. It takes a little while for tax credits to be deployed so the guy waiting tables getting $12 an hour can get health insurance. It takes some time to do that.
And in the meantime, there will be a stable transition so people don’t -- don’t have the rug pulled out from under them. That’s what we’re talking about when we say a stable transition from the system that is creaky and collapsing to one that is better and more endurable.
DICKERSON: Why not use just plain terms, though? Rugs pulled out from under them is -- why not just say, if you have Obamacare and you’re being covered, you’ll be still covered.
RYAN: Because private insurance companies and non-profit insurance companies are pulling out of markets left and right. The government doesn’t control the decision Humana made, which is, I’m pulling out of this market and therefore Tennessee and counties in Tennessee don’t have health insurance. That’s not a promise a politician can keep because it’s outside of that person’s control.
DICKERSON: But that’s the old promise. There is a new bill with new promise and the president has said, everyone is going to be covered.
RYAN: The point I’m trying to make is, Obamacare is crashing and collapsing --
DICKERSON: No, I get that.
RYAN: No, but -- but you can’t say and the next -- what the actuaries and the insurers are telling me, you guys do nothing, there’s going to be even bigger premium increases next year and even more pullouts. So we can’t --
DICKERSON: I guess the question for --
RYAN: We can’t promise that that’s not going to happen.
DICKERSON: I -- for --
RYAN: But what we can promise is, we’re going to replace it with a better system so we have more insurers, more choices, more competition, prices go down and we give people the ability to go access affordable coverage.
DICKERSON: If I’m getting coverage through the individual market now, though, I’m nervous. There’s a lot of changes that you’re talking -- you’re -- you’re saying it’s all going to work out wonderfully, but essentially this is -- it’s a theory about how markets will work and the competition will -- it’s a theory you believe in passionately.
RYAN: It’s not a theory that I just believe in passionately. It’s a theory that, when tested, has worked very, very well. And, by the way --
DICKERSON: In what -- in what instance with health care? This is an -- this is the first time this is being done.
RYAN: When you increase -- when you increase choice and you increase competition, you bring more players to the marketplace who complete against each other for our business. What we’ve never had in the individual market is equal tax treatment so that a person who doesn’t get health care from their job but is out there working gets a tax benefit to go buy health insurance. That’s what health savings accounts and tax credits are.
Risk pools work very, very well. We had them in Wisconsin. It was a -- the -- I think the best way of getting people with pre-existing conditions affordable coverage. Obamacare destroyed that system. Obamacare federalized the entire system and blew up the American health care system. So it’s going to take us more than a few months to stop that damage and replace it with a better system.
DICKERSON: Let me ask you a question about the -- the -- the tax credits in the bill. You’ve gotten a lot of criticism from conservatives who the -- Freedom Works has called this an individual mandate by another name, an individual mandate, that part of Obamacare they don’t like. The Republican Study Group said that this credit is, in principle, Obamacare. So why are they wrong?
RYAN: I think they’re wrong because this has been longstanding conservative reform for decades. Heritage Foundation --
DICKERSON: But the individual mandate -- the individual mandate came out of the -- that came out of --
RYAN: No, not the -- nobody -- nobody -- this doesn’t have an individual mandate.
DICKERSON: No, no, but the individual mandate came out of Heritage. So to say that it’s longstanding principle is --
RYAN: Oh, oh, I see. OK, well -- well, but it -- tax credits. So, look, here’s what we’re -- we’ve always said as conservatives, which is, we should equalize the tax treatment of health care. Everybody who gets healthcare from their job has a tax benefit (ph) for that health care plan. But if you don’t get health care from your job, there’s no tax benefit. So the only way to make sure that that working core person, that working low and middle income person can actually get something off of their taxes is through a tax credit.
We think equalizing the tax treatment of health care, giving people more freedom in the individual market is the best way to replace Obamacare with a patient centered system. And so it’s been longstanding conservative reforms that we do this. Is it frustrating that some conservatives are now changing their tune and mischaracterizing these things? Of course it is. But that’s how the legislative process works.
DICKERSON: In Medicaid you’ve got conservatives saying that you’re phase out of the expansion is happening too slowly. 2020, the target date, is too slow. Then you’ve got Republicans in the Senate saying, it’s happening too fast, the poor and the mentally ill will be hurt.
RYAN: So we’re probably right in the -- in the sweet spot. I think what’s happening here --
DICKERSON: Is it going to stick? Is it not going to move or change?
RYAN: Yes, so this is a carefully balanced consensus among all of our Republicans in consultation with our governors about how to have a smooth transition as we get Medicaid back to the states. The concern about ending the Medicaid -- changing Medicaid too soon is there will be a gap in coverage before the tax credits kick in. And so that’s the concern about doing this too soon.
Here’s what I would say -- this is what I mean when I say, people are losing the forest through the trees. We are sending Medicaid through a per capita block grant to the state and capping its growth rate. This is the most historic entitlement reform we have ever had. This is bigger entitlement reform than welfare reform in 1996. So if the transition takes three years or two years, that’s missing the forest through the trees. So that’s the point I keep trying to make, which is, look at the totality of this, look at the historic achievement this is and -- and this, I think, this at the end of the day, is going to win this argument among people on my side of the aisle.
DICKERSON: All right, Mr. Speaker, thanks so much with being with us.
RYAN: You bet. Thank you, John.
(END VIDEOTAPE)
DICKERSON: We’ll be right back with our political panel. Don’t go away.
(COMMERCIAL BREAK)
DICKERSON: And we’re back with our political panel.
Avik Roy is the president of the Foundation for Research on Equal Opportunity, and a former policy advisor to the Republican presidential candidates Mitt Romney and Marco Rubio. Ezra Klein is the editor in chief at vox.com, and we welcome Indira Lakshmanan of “The Boston Globe.” Indira has also been named the Newmark Chair of Journalism Ethics at The Poynter Institution. And chief White House correspondent for “The New York Times,” Peter Baker, is also with us today.
Peter Baker, I’m going to start with you.
Give me your assessment of where things stand here after the first week of the rollout of the alternative to the Affordable Care Act.
PETER BAKER, “THE NEW YORK TIMES”: Well, as you -- you have very aptly demonstrated on your program today, we’ve got the left and the right with very different critiques of this plan and you’ve got a president who isn’t quite sure which way forward. He’s -- he’s subcontracting, in effect, the policy to Paul Ryan, which is, as you demonstrated very aptly, very wonky and very smart, you know, subject on this -- or master of the subject. But President Trump is not. And I think the question is, what investment is he going to put into passing this bill. He doesn’t really care, I think, about some of the specific details. What he wants is a winner. That’s -- he’s always been of this philosophy, you have to have a win. He has to have something that he can call repeal and replace. Whether this is going to be it, it’s not -- it’s unclear. Rand Paul says that -- to you that President Trump is open for negotiations. Sean Spicer said on Friday he’s not. And so we’re waiting to hear from the president.
DICKERSON: That’s right. Avik, what do you make of the legislation put forward by Paul Ryan? Is it the best he could get?
AVIK ROY, FOUNDATION FOR RESEARCH ON EQUAL OPPORTUNITY: Well, I think he’s tried to split the difference between the people who -- the more pragmatic Republicans who want to make sure that their replacement is competitive with the ACA on covering the uninsured.
DICKERSON: Right.
ROY: And the people like Rand Paul who say that anything that attempts to provide financial assistance to the uninsured is Obamacare-lite. And I thought your interview with him today was really interesting because Rand Paul, in 2012, introduced a bill to provide private coverage to seniors as an alternative to Medicare that would be heavily subsidized with richer benefits than Medicare, it would protect people against pre-existing conditions, require insurers to charge the same prices to the healthy and the sick and cap out-of- pocket costs and lifetime limits, all the things that are theoretically unique to Obamacare. So he’s for Obamacare-lite when it comes to seniors, not when it comes to the uninsured.
And I think this is operationally the challenge Republicans have. They say that they are for limited government and against subsidies to provide health insurance. The federal government’s involvement. But what they’re operationally against is assistance for the uninsured and the low-income populations. For Republican voters, the older, the employed, they’re totally in favor of and comfortable with subsidizing coverage.
DICKERSON: Ezra, how do you see the winners and losers of this plan?
EZRA KLEIN, VOX.COM: This is a bad bill. This is a bad bill and that is why it has received a very bad reception. And -- and I’m sorry I can’t be more positive about it than that. You have a $6 billion tax cut, you have a sharp lowering of subsidies for people and you have the betrayal of promise after promise made by Donald Trump and made by Paul Ryan and Mitch McConnell. Donald Trump promised during the campaign no cuts to Medicaid. This is a sharp, sharp cut over time to Medicaid.
Mitch McConnell -- I was sitting here on this program when he said, the problem with Obamacare is the deductibles are too high, the co-pays are too high, people are buying insurance and they can’t afford to use it. The way this bill works is you push people into insurance when they could afford it that had higher deductibles, that had higher co-pays.
They seem to have defined the problem extremely narrowly. How do we pass something, anything, that we can call repeal and replace of Obamacare. But when they actually tried to put this into law, which they have brought out a bill, they just -- it’s shoddy in its construction. They’re not waiting long enough to even figure out how to amend it. If they tried to put this into law, it would create tremendous adverse selection in these markets, skyrocketing premiums, a lot less competition in a -- in a context where we already don’t have enough competition, and tens -- and about 10 million people, depending on which estimate you want to look at, who would lose insurance. I don’t know who they think is going to be happy with that.
DICKERSON: Right, adverse election, meaning sicker picker take insurance --
ROY: Yes.
DICKERSON: Healthy stay out and you end up having the -- the risk is too high and expensive.
Sorry, you wanted to just --
ROY: Yes. No, I was going to say, one -- one big constraint that Republicans have is, because they’re insisting on doing this in a party line approach, using the Senate reconciliation process --
DICKERSON: Where you only need a majority and not the 60 votes?
ROY: Where you only -- right, exactly. The problem there is, you can address tax against spending to the reconciliation process, but you can’t really do anything about regulation. And so much of the Affordable Care Act is regulations. All the complaints that Paul Ryan made in your interview about rising premiums, those are driven by regulations. And if you can’t reform those regulations through this bill, you’re not actually solving the problems you think that Obamacare has.
DICKERSON: And that’s why he says it’s a multistage approach, but the fact is everybody’s focused on this first stage not the second and third.
Indira, what do you make, if President Trump were watching this discussion, it would sound like a lot of noise probably to him.
INDIRA LAKSHMANAN, “THE BOSTON GLOBE”: That’s right.
DICKERSON: He is a great salesman, you know --
LAKSHMANAN: But -- well, that’s exactly what I was going to say, John. I think that we really need to look at this also from a political point of view. It’s great to hear all of the details of the plan, but President Trump sold himself on the campaign trail as deal maker in chief. He said to the American people, I am going to be able to get you a better deal. I am going to be able to fix health care because I’m going to be able to negotiate better drug prices. I’m going to be able to negotiate better with the health care companies. I’m going to be able to do everything better. So this is his first big test. He’s coming into Washington. I don’t think he cares so much about the details. That’s what we talked about. He kind of subcontracted this out to Speaker Ryan and said, you know, you do it, that’s OK. We know we have to repeal and replace all in one step, so just do it. That’s fine.
Now he’s going to have to go out to Kentucky, he’s going to have to go out to Tennessee, he’s going to do the salesmanship. He’s got people coming -- he’s got members of Congress coming to his bowling alley in the White House and by all accounts he is, you know, making friends, influencing people. Even Senator Lindsey Graham, who’s no big fan of Donald Trump’s, I was amazed to hear his interview yesterday coming out of the White House saying, well, I had a pretty good time and, boy, he’s a charming guy. And at the same time, Donald Trump is putting pressure on the Republicans, saying, it’s going to be a bloodbath in 2018 if you don’t pass this.
DICKERSON: And Paul Ryan also saying that everything else can only come -- tax reform --
LAKSHMANAN: That’s right.
DICKERSON: All -- all the other things they want to pass can only happen if this happens.
Peter, is it -- is the big hurdle for Donald Trump the fact that he said everyone would be covered and we have estimates of 10 million, maybe 15 million, the CBO score, the official accounting, might be quite bad. Is that the big thing that the president will have the hardest time reconciling or --
BAKER: Yes, I do -- I think that -- as you pointed out in the interview with Speaker Ryan, he promised so many things that seem untenable if you put them together into a plan unless you’re wanting to spend lots and lots of money and do things in a different way than Paul Ryan wants to do them. And ultimately he can’t live up to some of those -- those specific expectations that he created. And they’re his voters.
What’s striking, of course, is that some of the people who are probably most affected by some of the changes we’re talking about here are less wealthy, rural, white, you know, working class Americans who love Donald Trump, who voted for him, who put him into office, and he owes them and he wants to keep them on his side. So I think that’s going to be a real tricky, you know, circle square or square circle.
DICKERSON: We will return with this geometry lesson in a moment.
We’re going to take a break here quickly and then we’ll come back to continue this conversation. Stick with us.
(COMMERCIAL BREAK)
DICKERSON: Panel.
Avik, I want to ask you a question about something Bernie Sanders said about the tax cuts that are -- or the windfall he says is going to the top one percent. Remind people why we’re talking about tax cuts and why this is a part of healthcare.
ROY: Well, it had to fund the ACA’s coverage expansion. So roughly speaking, on a back of the envelope basis, over a 10 year period, the ACA spends $2 trillion trying to cover the uninsured and it funds that through about 1.2 trillion in tax increases and about $850 billion in Medicare cuts. And what the House Republican bill does, it actually preserves the Medicare cuts in the ACA because you can’t touch Medicare through reconciliation. But they repeal nearly all of the tax hikes, and then have their own coverage expansion in this new structure that you talked about with Paul Ryan.
DICKERSON: Ezra, is one of the challenges here that there has been a bit of a success for our -- for the Affordable Care Act, Obamacare, which is that it’s created expectations that you’re going to cover pre-existing conditions, you’ll have minimum coverage requirements and then also that -- that kids till the age of 26 stay on their parent’s plan. If you keep all of those, which this does, that makes it expensive.
KLEIN: You are -- it -- it makes it expensive, but it also means you’re working within the -- the broad framework of -- of Obamacare, which they are still doing. And if you’re doing that, then you actually have to retain important parts of that framework. You can’t -- they are splitting the difference between so many different arguments that they have stopped being able to make sense of any of them in particular. So you’re -- they’re trying to take out the individual mandate, replace it with something that’s not quite an individual mandate, this 30 percent surcharge on health care when you come back into the market. And all of a sudden it may not work quite as well, but it also makes people angry and it’s not really clear what goal you’re trying to achieve.
I think -- at this point about reconciliation, which Avik has brought up, is a really important one. I was stunned, actually, to hear Paul Ryan on the program earlier today say that the ACA was jammed down the country’s throat, but this -- this is a regular order slow process. We did not see this bill until last Monday. This is the first time anybody has seen it. And I saw the stuff Ryan produced before. It was all different. This is the first time we’ve seen this piece of legislation with this constellation of ideas.
There are no serious independent analysis of it out yet. It has already passed two committees before those committees knew how it worked or what it would likely do. And without being able to go through regular order process, where there’s actually information, that there are amendments, you go back and forth, you decide if what you’re going to do is actually going to work, there’s not been time for Republicans, or really for anybody, to ask those very fundamental questions and decide, do they need to change this bill in pretty fundamental ways? The speed with which they’re trying to do there is, I think, a speed born of fear, but the speed that is going to make bad policies.
DICKERSON: And that’s why when I asked him about, you know, you can say you ran on this, but you didn’t run on the particulars that were being debated right now.
ROY: Right.
DICKERSON: Indira, one thing that strikes me is, this White House doesn’t really have a bunch of old legislative hands in it.
LAKSHMANAN: That’s right.
DICKERSON: Usually a White House has some people who have worked on The Hill who know how to figure this stuff out. So this is a -- this is a kind of operational challenge for them over there.
LAKSHMANAN: That’s right. And as a comparison, you know, the Republicans, of course, were saying that the Obama administration shoved healthcare down the throat of the American people, but, in fact, it was 15 months that there was open debate over the -- you know, the Affordable Care Act.
KLEIN: They want to do this in one month.
LAKSHMANAN: They want to do it in one month, and 15 months is a huge difference, where everybody was looking at it, debating it, talking about it. So that is a very important difference. And you -- you know, you make a point, it’s operationally different. If you don’t have the expert on, you know, the liaisons with the legislature, then you don’t really know how to do it. But we see that in so many ways. I mean it’s -- it’s sort of akin to putting in charge of cabinets, you know, putting cabinet secretaries in charge of agencies that those people want to abolish those agencies. So it’s kind of a similar thing that, you know, it’s the sort of disruptive factor in government.
ROY: You know what’s going to be interesting is, when that Congressional Budget Office score comes out for this bill, and it says something like, the bill will cover 20 million fewer people than the Affordable Care Act, does Donald Trump, does the president, who’s promised insurance for everybody, say the CBO is fake news? Does he say, Republicans, go back to work and fix this? Because there are certain things about the CBO -- the CBO really, really believes in the individual mandate, much more so than actually the insurers do. So there may be part of the CBO report that are uncharitable in perhaps a way that you could dispute, but there are aspects of the bill that are going to result in fewer people having health insurance. And it’s going to be interesting to see how the president himself reacts to that.
DICKERSON: They already started lowering the view of CBO in the -- in the White House briefing, trying to -- maybe anticipating a bad ruling.
Let me ask you a question, Peter, about another piece of news, which is the travel ban the president’s changed this week.
BAKER: Right.
DICKERSON: There wasn’t as much coverage as the first one.
BAKER: Yes.
DICKERSON: How did it change?
BAKER: Well, it did some important things differently. One, it took out Iraq, our ally in this war against ISIS. Another thing it did was it made clear and explicit that green card holders and people who have visas already are not included, and it took out a preference meant for Christian minorities in some of these Muslim countries. So those -- those things are important in -- in minimizing some of the disruption that we saw the first time around. You didn’t have people on airplanes literally blocked at the border when they got here.
Beyond that, it’s still pretty similar. Still, you know, stopping all refugees and all visitors from these six countries, Muslim majority, for a time. And you -- now back in court. You now have lawsuits already. And I think that the issue is going to be, will these courts look at this as basically a dressed-up version of the same thing, or will they see those changes as being substantive enough to give it, you know, a constitutional veneer.
LAKSHMANAN: They did reverse engineer this second travel ban in a way. I mean it’s clear from looking at it, I’ve -- I’ve spoken with many legal scholars about this, that the -- the Trump administration kind of looked at the bill, looked at what the complaints were from the judges, from the Ninth Circuit Court of Appeals, and sort of created the new travel ban kind of backwards from that. So a lot of legal scholars think that this will, you know, stand up in court, although there are a lot of problems that predate anything that’s written down, which is that Donald Trump himself said on the campaign trail back in December 2015, I want a Muslim ban, keep them all out.
DICKERSON: Right.
LAKSHMANAN: So there are so many things that he said in the public record that courts can look at, they can say, hey, this is really a Muslim ban dressed up as something else.
DICKERSON: Right.
LAKSHMANAN: And so that’s sort of irrespective on what’s on the piece of paper.
DICKERSON: Ezra, can I get a last thought from you on the job numbers we had Friday. The president took credit for the strong February. Put that in context. It has to be a relatively brief context.
KLEIN: I don’t think he deserves much credit for it just because we’re in the context of a long running labor market expansion now. But these are good job numbers. It’s a buoy to his administration. He’s not done anything yet to interrupt them and presidents can do a lot to mess up a good economy. So right now I think we should be thankful. We have a tightening labor market. We’re seeing wages go up. That is good and we should be careful to try to preserve it.
DICKERSON: All right, thanks all of you for being here.
Thanks for watching. And we’ll be back in just a moment.
(COMMERCIAL BREAK)
DICKERSON: I’ll see you tomorrow when we welcome back our friend and colleague Charlie Rose on “CBS This Morning.” Until next week, for FACE THE NATION, I’m John Dickerson.
