Senate GOP plan to delay Medicaid cuts ‘doesn’t make it less awful,’ says former HHS secretary

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• HARI SREENIVASAN:

  There have been many responses to the Senate plan today, including from former President Obama.

  He said — quote — "Simply put, if there's a chance you might get sick, get old, or start a family, this bill will do you harm. And small tweaks over the course of the next couple weeks cannot change the fundamental meanness at the core of this legislation."

  And now to Judy Woodruff in Aspen, Colorado, who spoke today with a key figure in the Obama administration about the Republicans' plan to undo much of the Affordable Care Act.

• JUDY WOODRUFF:

  Now we get reaction to the Senate plan from a woman instrumental in creating the Affordable Care Act.

  I sat down today with the former Secretary of Health and Human Services Kathleen Sebelius. And I began by asking her overall assessment of the proposal.

  KATHLEEN SEBELIUS, Former U.S. Health and Human Services Secretary: I think it follows the unfortunate framework of the House bill.

  People will lose coverage. We don't know how many until the CBO actually scores the bill sometime next week, but no doubt there will be people priced out of the marketplace.

  We know that individual costs will go up, which seems really contrary to what people are telling me they want. They want to pay less out of pocket. They'd like to pay less for their premiums. But nothing in this bill does that.

  It changes the Medicaid programs for every state in the country. And, Judy, as you know, I'm a former governor. I ran a Medicaid program. Medicaid has been a 52-year-old partnership for state and federal governments to take care of the most needy Americans, and then was expanded in the Affordable Care Act to cover low-income working adults.

  And there's a huge slash in that program, again proposed by the Senate. It cuts Planned Parenthood funding, which gives services and support to millions of women across the country. So, it continues the path that the House took.

• JUDY WOODRUFF:

  Let me pick up on the Medicaid point. It is true that the House bill did make deep cuts, changes in Medicaid.

• KATHLEEN SEBELIUS:

  Right.

• JUDY WOODRUFF:

  What Republican senators say they are doing is phasing this in, that they stretched it out over a longer number of — longer period of years. It delays the effectual date of these changes in Medicaid.

  So isn't this something of an improvement, makes it more acceptable?

• KATHLEEN SEBELIUS:

  Well, delaying the awful doesn't make it less awful.

  So I think having a few more years of grace period is probably a good thing, but they make — actually, in the Senate bill, as I have read the draft, they make deeper cuts in the underlying Medicaid program than the House even suggested. And that really affects every state budget in the country.

  Every governor receives from the federal government the largest amount of federal funds through the Medicaid program. It takes care of disabled children and adults, takes care of a lot of poor seniors in nursing homes.

  It pays for half of the births in the country and about 40 percent of children's health insurance. That's the underlying program. You can't cut that program without really harming services to the most vulnerable Americans and really blowing up state budgets across the country. It takes longer, but it still happens.

• JUDY WOODRUFF:

  But I think what Republicans are arguing is that Medicaid, as it's presently structured, is unsustainable. It costs too much for the federal government, costs too much for the states. And they say they're taking steps to make sure that it's there in the longer run.

  They also say they're creating this fund with tens of billions of dollars to take care of some coverage gaps that have been created by these changes.

• KATHLEEN SEBELIUS:

  Well, again, I think it's important to understand these populations don't disappear.

  So the federal government has decided they will stop paying for vulnerable people across America, for poor seniors in nursing homes, for poor pregnant women and children, for disabled children and adults.

  They are capping the amount of federal money that goes. That doesn't change the population. So all it does is shift costs to state budgets — and a lot of states do not have the extra money — to local budgets, or to make sure that people don't have services.

  Every pot of money that is talked about to cover the gap in services is well under what is being paid for right now. So we're here talking about opioid treatment and the crisis that we have across America. There is about $5.5 billion this year being spent on mental health services and opioids. Nowhere near that amount is being proposed as even a multi-year funding plan.

  If they take away Planned Parenthood coverage from pregnant women and children, they then have a huge gap in services. So, I don't think they're being very honest about who gets affected and what happens to those folks if the money is cut at the federal level.

• JUDY WOODRUFF:

  Let's go back to the basic complaint the Republicans have had.

• KATHLEEN SEBELIUS:

  Sure.

• JUDY WOODRUFF:

  And that this is, their complaint, and even Democrats acknowledge problems — and some serious problems — with the Affordable Care Act — the cost of premiums going up, the fact that many insurers have pulled out of the exchanges. What is it now, dozens of counties around the country that only have one insurer?

  These are fundamental problems that had to be addressed one way or another, aren't they?

• KATHLEEN SEBELIUS:

  You're absolutely right.

  The coverage issues — getting more insurers to offer coverage across the country, needed to be solved. And there are solutions for that with the re-insurance pools that have been proposed. People want to pay less. And less means not only premiums, because about 85 percent of the people get help with their premium coverage. But they want the pay less out of pocket.

  Again, none of this bill does that. In fact, it would shift more cost on to individuals. So, fixing the Affordable Care Act is important. The Trump administration, I would suggest, has done nothing but sabotage the act since they came to office, refusing to enforce the mandate, refusing to tell insurers they will pay the subsidies, which has caused dropouts, and not clarifying what the rules are.

  So, companies are indeed charging higher rates.

• JUDY WOODRUFF:

  At the same time, President Trump himself has said he believes all people should be covered by health insurance. He said again this week, 'I want to see health coverage that has heart.'

• KATHLEEN SEBELIUS:

  Which would be great, but that isn't what is proposed in either the House bill or the Senate bill. And both, President Trump has declared as great bills.

  Well, I haven't — I apologize. I haven't seen what he said about the Senate bill. He applauded the House for their 'terrific' bill, which took coverage away from 23 million Americans. We don't know how bad the Senate bill is going to be. But I can guarantee you millions of people will lose coverage and pay higher costs.

• JUDY WOODRUFF:

  He also called it 'mean.'

• KATHLEEN SEBELIUS:

  The House bill. The House bill.

• JUDY WOODRUFF:

  The House bill.

  Whatever happens here, it looks as if this is the beginning of the end of Obamacare. I mean, this bill — right now, there is some Senate opposition, but they are working to try to get something passed through Congress. It's a huge priority for Republicans.

  Is this the beginning of the end for Obamacare?

• KATHLEEN SEBELIUS:

  It's hard to tell.

  I think we have a different conversation now in America, which is a good thing — that people now say insurance companies shouldn't ever again be allowed to discriminate against individuals with preexisting health conditions.

  That conversation wasn't even had five years ago. There is some recognition that health care for all is a positive step forward and shouldn't be just available depending on where you work or where you live. That's a good thing.

  But what we're actually doing in the future, I think, is really important. Who loses and who gains? And both the House bill and the Senate bill fall most heavily on the sickest, oldest, and lowest-income Americans and shift those dollars not into the federal treasury, but to tax breaks for the richest.

• JUDY WOODRUFF:

  Kathleen Sebelius, former Secretary of Health and Human Services, thank you very much.

• KATHLEEN SEBELIUS:

  Good to be with you.