MELISSA BLOCK, HOST:
The Senate's version of health care overhaul calls for major cuts to Medicaid, the federal program for low-income Americans. Medicaid is this country's biggest health care safety net program that covers half the births in the U.S. and two-thirds of the seniors getting long-term care in nursing homes.
Rodney Whitlock worked on health policy in the Senate for a decade as a Republican aide. He's now a consultant and lobbyist for hospitals and disability service providers. Welcome to the program.
RODNEY WHITLOCK: Thank you.
BLOCK: There are 31 states that expanded Medicaid as part of the Affordable Care Act or Obamacare. The Senate bill would cut federal financial support of that program starting in 2021. What would the immediate effect be?
WHITLOCK: Certain states will have on the books laws that say if the federal government reduces its support, then they need to cut their expansion population - that population that was covered under the Affordable Care Act. Whether or not the states will then go back, revisit those laws, whether or not they will take the time to say we need to reconsider this - we've got several years before we see the first cut in payment. It's not clear that anybody loses coverage immediately under this bill if it is passed into law.
BLOCK: In Medicaid?
WHITLOCK: In Medicaid.
BLOCK: We mentioned, Rodney, that you're a lobbyist. Your clients include hospitals and disability service providers. What are you hearing from them about this bill?
WHITLOCK: They're deeply concerned and legitimately so. They depend very heavily on the Medicaid program. Medicaid doesn't reimburse particularly well to begin with. And so anything that feels like a threat to reimbursement is a threat to their existence.
BLOCK: A lot of Democrats, including President Obama, say that this Senate bill is a massive tax cut for the richest Americans - $700 billion - paid for on the backs of the most vulnerable people - the middle class and the poor. What is the Republican Party's answer to that?
WHITLOCK: So I think folks try to separate out the two concepts in that there were a number of taxes that were put in the Affordable Care Act and that they're all being repealed - all of them at once. And so the specifics of what they did or why they did that or not as relevant as the fact that they were part of the Affordable Care Act. And then they separate out the question of the Medicaid program and say that the goal here is to try to create a more efficient Medicaid program. And that's the nature of the changes they're making.
BLOCK: Do you think they can sell that message? That seems tough to me.
WHITLOCK: I think it's an uphill battle because, on face, a lot of what you said is right. There are going to be significant tax reductions for folks. And there's going to be significant cuts to the Medicaid program. Those are both true statements. And so drawing the straight line between the two is a fairly simple process.
BLOCK: A lot of Republican members of Congress went home in the last break and got an earful from constituents who were saying don't take away my health care. I may not have thought too much about the Affordable Care Act before, but there are parts of it that I really like now. Are they going to be hearing those same voices when they go home the next time?
WHITLOCK: Absolutely. And I think one of the most difficult problems Republicans have right now - there's no one asking for this bill. Every stakeholder group in health care almost universally are varying degrees of opposed to setting themselves on fire. I mean, you may have a couple of groups that are at best neutral. But any state with Medicaid expansion - who's asking to be cut?
BLOCK: Well, who's asking for it would be the people who have said repeal Obamacare, right?
WHITLOCK: Repeal Obamacare is a slogan. Repeal Obamacare is not public policy. And that's the challenge that Republicans have run into all of 2017. They're having to make policy decisions now. And some of those policy decisions are hard. If you want to roll back the expansion of Medicaid, there is a consequence. If you want to lower the value of somebody's health care, there's going to be a consequence. And these are the decisions they're having to make.
BLOCK: That's Rodney Whitlock of ML Strategies. That's a lobbying and consulting firm. He specialized in health policy as an aide in the Senate. Thanks for being with us.
WHITLOCK: Thank you very much, mam. Transcript provided by NPR, Copyright NPR.