STEVE INSKEEP, HOST:
Let's pose questions about a replacement for the Affordable Care Act. House Republicans released a plan this week. And Georgia Congressman Buddy Carter says it has a virtue - simplicity. You just buy health insurance, save the receipt and get back some of the cost through a tax credit.
BUDDY CARTER: We've achieved that through the tax credits, through - instead of penalizing people and taxing them for not having insurance, we're going to give them credit for having insurance. And we're going to make sure that they are rewarded for that.
INSKEEP: The plan has drawn intense criticism from the left and right. For starters, the tax credits of $2,000 to $4,000 per year are not enough for many people to afford insurance. For another, the plan rolls back Medicaid coverage for the poor in a way that some see as cruel and others see as too timid. Carter backs the plan, saying a free insurance market will better serve customers in the end.
So let's address some of the questions that are coming at this plan from the left and the right. First, will the 20 million or so people who've have gained insurance over the last few years under Obamacare, the Affordable Care Act, be able to keep their insurance?
CARTER: What we have said from the get-go is that we are not going to pull the rug out from underneath people. We want to have a stable transition period. We made it clear that three things were essential.
First of all, that people with preexisting conditions would be able to keep their insurance. Secondly, the parents would be able to keep their children up to the age of 26 on their insurance. And thirdly, that we would empower patients and give them the ability to make health care decisions along with their health care professionals.
INSKEEP: But you said stable transition. I read that to mean you are acknowledging some people, maybe millions of people who have insurance now will lose that plan, end up with a worse plan or a different plan or be paying more for the same plan.
CARTER: Listen. If you look at the state of our health care system right now and the way that the insurance market is, I mean, let's face it. Premiums are rising by 25 percent on the average. Seven states have an increase in premiums over 50 percent. Obamacare is imploding. We have got to do something. It's got to be market-based.
INSKEEP: I understand what you're saying. But you understand the question that I've put on the table here. The number of people, percentage of people insured has gone up in recent years. And studies of plans like the one the House Republicans put out indicate that's going to go down. That's correct, isn't it?
CARTER: I don't think that is correct. In fact, what our plan does is to make sure that the market forces will cover as many people as it possibly can. If we can create a health care market that is more competitive, that is more accessible, that people will be able to get insurance.
INSKEEP: A couple of other things. There's a mandate right now under Obamacare to buy some kind of health insurance or pay a tax penalty. That is removed under this bill. But something else is put in, congressman, and that is a penalty if you go off of insurance and stay away from the insurance market for a while and then try to come back. You pay a 30 percent penalty. Isn't that about the same thing as a mandate?
CARTER: I would not say so at all. Because what I would say is that these are people who have been gaming the system. I mean, essentially they have stopped paying knowing that they're not going to need it. And then all of a sudden when they need it, they go and pay. That's not going to work. That's not the way the system works at all.
INSKEEP: That's what the authors of the Affordable Care Act said when they wrote the mandate into law. And it sounds like you're trying a different way to do the same thing.
CARTER: No. I wouldn't say that at all. I would disagree with that. I would say again that it's not a system where, oh, I'm sick this month, so I'm going to pay. I wasn't sick last month, so I'm not going to pay.
INSKEEP: So let me ask you now to speak to more conservative lawmakers who are concerned about this House plan. And I'm sure you've heard a lot from them. One of the things they're saying is that they don't really want to replace the Affordable Care Act with what they see as another entitlement. They'd rather just repeal it. Let's listen to your colleague Dave Brat.
DAVE BRAT: The last thing we need to do is replicate a system that doesn't work, right? It's going to create a new entitlement program. The expansion of Medicaid is not clear but goes off for about eight more years. And it basically keeps too many of the bad uses. And it will collapse.
INSKEEP: Are you eliminating one entitlement for health insurance and just replacing it with another?
CARTER: No, not at all. I would have to respectfully disagree with Congressman Brat. I have no intention whatsoever of replacing a bad law with another bad law. And I would also say that as far as Medicaid expansion goes, in our plan we do address that. And we do phase it out over a shorter period of time than five or eight years. We tried to make it as fair to the non-expansion states over the next few years as we can. The modernization of Medicaid is a big part of our plan.
Medicaid was intended to be a safety net. Instead, you know, we've called this Obamacare. It should have been called Obamacaid. If you look at the 20 million people who have gained insurance as a result of Obamacare, 14.5 million of those have come through Medicaid expansion. So what we've done is we've taken able-bodied adults and put them on a safety net program. That's not where they're supposed to be. That's not what Medicaid was intended to be.
INSKEEP: One final thing. One of the great criticisms of the Affordable Care Act was that it was passed without any Republican votes. Just one party was invested in it. The other party was totally against it. And some Republicans have said this time around it needs to be bipartisan. Would you go so far as to say that there must be some Democratic support for this or you really shouldn't do it?
CARTER: Well, we should do what we can without the Democratic support. But I think that we will reach a point, and I'm very confident we will reach a point where those Democrats who truly understand and who truly put the American citizens before their own partisan politics will come around and will vote in favor of rescuing our health care system. They understand how important it is.
INSKEEP: Republican Representative Buddy Carter of Georgia. Thanks very much.
CARTER: Thank you, sir. Transcript provided by NPR, Copyright NPR.