RACHEL MARTIN, HOST:
After seven years of railing against Obamacare, the Affordable Care Act, Republicans are faced with their first real chance to repeal and replace that law. President Trump says it's now or never. House Republicans were supposed to vote yesterday on the bill. But just hours before the vote was going to happen, the support just wasn't there. So the vote was delayed until today. Conservative Republicans, including some members of the House Freedom Caucus have said the bill just isn't a full repeal of Obamacare and wouldn't drive down premiums enough. Representative David Schweikert is a Republican from Arizona. And he's in kind of a unique position. He supports the health care bill and is a member of the House Freedom Caucus. He joins us in our studios. Welcome back to the program.
DAVID SCHWEIKERT: It's always a joy to be here.
MARTIN: So how were you able to get behind this plan when so many of your colleagues have not been?
SCHWEIKERT: Well, and you'll find, actually, from even the most moderate of our conference to the most conservative to the most libertarian, big concern right now is are we doing enough? Are we moving enough things in the legislation for that individual market. Remember, there's often this misunderstanding. We're talking substantially about the individual purchasing market. So in a congressional district like mine, in the Scottsdale, Phoenix area, it's about 2 percent of my population that actually buy their health care directly. So...
MARTIN: Everyone else is getting employee-based...
SCHWEIKERT: Yeah. And I've - we've all had this experience where someone comes up to you and says, how can you be taking my health care away? And then they explain they work for the local school district. They're fine. This isn't about their health care. The vast majority of our population receives their health care from their employer or then Medicare, Medicaid. But it's still an important - because it's part of the cost driver for everyone else.
MARTIN: And you mentioned Medicaid. That's a big issue right now. There are Republican governors who have said any suggestion that we're going to roll back the Medicaid program is going to be a problem.
SCHWEIKERT: So in the situation I'm seeing, and what is going to be fascinating in the vote in just a few hours, is I believe you'll see a number of folks in the very moderate side who may be a no, some of the more libertarian side that are a no. Yet, the common theme is, we're not doing enough to lower premiums. So that's why I'm one of those who's sort of optimistic that if we fail - I'm hoping we don't because I'm a yes vote on it - at least we need to turn around and say, OK, there's a common theme. What else are we - can we do that's about maximizing premium efficiency?
MARTIN: So let me ask you about the conversations you've been having because the big issue for the House Freedom Caucus has been, this isn't a full repeal. This is still Obamacare light, and we're not getting rid of enough of the initial law to really reduce premiums. So how are you making the case to your colleagues that this is the best deal you're going to get?
SCHWEIKERT: Well, look, you've heard the argument. It's we're not doing enough to deal with the cost drivers. In a state like mine, I have counties that had 116 percent increase. And all of Arizona, you have only a single choice now. So I make the argument, we don't have a choice. We have to do the reforms here because states, like Arizona, is in real trouble. Now, how do you turn to your brothers and sisters and also say, oh, by the way, you don't get to use a normal legislative process. We have to do through this sort of strangled mechanism that's given us at the Senate - because we have to do reconciliation...
MARTIN: There's a window with reconciliation that happens down the line.
SCHWEIKERT: And then we have to do some - see what can happen on the regulatory side. And then we - so this is the nature when you're doing something that's so polarized that it...
MARTIN: But why is it so polarized? Seven years Republicans have had to come up with a plan that they could unite behind. Why is it at this point?
SCHWEIKERT: Well, I think, actually, if you even go to the original drafting of Obamacare, it was Republicans versus Democrats. And now it's Republicans versus Democrats. And now you also have the regional variances, a congressional district like mine that has very few people in the participation to others that have lots that are receiving subsidies or within some of the Medicaid populations. Somewhere here there's an elegant solution. But how do you also now deal with the mechanisms you're given at the Senate, where you have to do reconciliation so you can do the 51 vote mechanics, which limits the types of language you can put in the legislation?
MARTIN: Let me ask you about - the CBO numbers came out saying that even with the revisions, this bill is still going to mean 24 million more Americans are going to lose health insurance through this bill.
SCHWEIKERT: Well, be...
MARTIN: A Quinnipiac poll said that 17 percent of Americans say they approve of this bill; 56 percent say they disapprove.
SCHWEIKERT: Well, can we back up on one number? That isn't actually what CBO said. CBO said the majority of that 24 million number are individuals who chose not to purchase health care. And that becomes a really interesting sort of societal ethical question of, does an American have the right to not purchase health care?
MARTIN: But then they go to an emergency room. And then we all bear the brunt of that cost.
SCHWEIKERT: Yeah, and it's - that sort of societal transfer is uncomfortable. I think you're actually crazy not to at least purchase some sort of product. But what we've also done is - you know, how do you actually design enough optionality so there all - there's types of products that deal with every portion of the population - the person that wants catastrophic...
MARTIN: Yeah.
SCHWEIKERT: ...The person who just wants, actually, a health delivery contract, not actual traditional insurance?
MARTIN: So now, in the remaining seconds, I have to ask you if you think you have changed minds between last night and today. And do you have the votes to move this forward?
SCHWEIKERT: Yeah. The one prediction I'll beg of you to look for is look how many members from the moderate side to the conservative side vote yes and vote no. I think you'll actually find there may be a barbell here. I'm pathologically optimistic, but we'll know in a few hours.
MARTIN: Representative Dave Schweikert of Arizona, Republican. Thank you so much. Transcript provided by NPR, Copyright NPR.