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Speaker Paul Ryan On The Status Of The AHCA

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Speaker Paul Ryan joined me this morning:




HH: So pleased to welcome now Speaker of the House of Representatives Paul Ryan. Speaker Ryan, welcome back, always a pleasure to talk to you.

PR: Hey, good morning, Hugh, how are you doing?

HH: I’m great, but did you really give the leader of Ireland Packers gear this week?

PR: Of course, I did. Why wouldn’t I?

HH: Because he should have Browns gear. If you’re going to go back to Ireland, that’s where the Irish live. They live in Northeastern Ohio.

PR: Only for a Browns fan that makes a lot of sense.

HH: Send him our best. Send him our great…

PR: Give him a green Green Bay Packer hat with a clover leaf on it.

HH: No, that was terrible. It was terrible. Anyway, I had the other Ryan on earlier today. Tim Ryan is my pal from Warren, Ohio.

PR: Yeah, I get his mail sometimes.

HH: And he’s a good guy, but he doesn’t admit the basic thing I want to begin with. Obamacare has collapsed. He pointed out to me 55 people in Trumbull County died of opioid in the first year, in the first month of this year, and the health care system is not working. Do Democrats not get this?

PR: Yeah, I think they just have this ideological quest for basically a government-run health care, single payer health care. They see Obamacare as a means to that end. They wanted to get it all in the full swoop, and they’ve always believed that the system will probably collapse the insurance companies. They would be in power when that happens, and then they’d have what we call the public option, where they just put in place a government program to give cradle to grave health care. And voila, you’ve got government-run health care. And I think they want to hold onto that dream, and I think that that’s kind of why they’re in denial, that this stage of their march toward government-run health care is collapsing. The insurers are leaving the market. The premiums are skyrocketing, and no one’s using it. I mean, it’s, a lot of folks just don’t, can’t afford it, or you have the pull outs where they don’t even get a choice anymore.

HH: And on the other side, we have like my friend, Lindsey Graham, your friend, came on the show last week and said maybe collapse and repeal is better. I think that’s inhumane. We can’t let Americans…

PR: Yeah, I think it’s wrong from a moral standpoint.

HH: Yeah.

PR: I think what most people will say is you Republicans are in power. You’ve got to do something about this. I think if people, if we just did nothing and then what the insurers are telling us is doing nothing, you’re going to have about a 40 or so percent increase on average this coming year in 2018. People will get those notices this fall in, say, November, they’ll have fewer choices, they’ll have more pull outs, maybe no insurers in certain areas. That’s already the case in Tennessee, and then massive premium increases, and they’ll say you guys are in power. Why did you let this happen? And I just don’t think that’s the right course for lots of reasons, and that’s why we’re moving this bill. Look, it’s good policy. I feel good where we are. We are in a four committee stage process, and we’re coming to the 4th quarter of the House game, meaning we go through Ways and Means, Commerce, Budget Committee and now the Rules Committee. So what you have is the scurrying of negotiations and those kinds of things knowing that we’re going to the last committee this week before it goes to the floor. This is sort of the tempest of the legislative process. We’re listening to our members making sure we put things together. We have kind of a critical test. Does it score, meaning does it fit fiscally, number one? Number two, does it make the bill liable for a filibuster? We had to follow these bizarre Senate rules, and we don’t want to put something in this bill that makes it simple for Chuck Schumer to filibuster it, and they don’t even get to vote on it in the Senate. And then number three, does it add votes, or are you taking away votes?

HH: Now on the House game, I think you’re going to go into overtime, and I hope you’re the Packers and not the Browns. I don’t want to fumble.

PR: That’s right.

HH: And so here’s the key on the overtime. Are you going to make some more changes from the manager’s amendment to bring in more votes? And if so, what area will those changes come in?

PR: Well, those are the kinds of conversations that are ongoing. So I won’t get into ongoing conversations. What’s important is that we get all the best ideas we can possibly get, and get them going. But we can’t move things that are fatal to the bill being even considered in the Senate. That’s pretty important. And a lot of people just don’t know, I’m saying, in America, you know, people say why aren’t you doing, you know, medical liability reform? Or why aren’t you doing across state lines? We love those things. Those are part of our phase three effort. But we know without a shadow of a doubt if we put that in this bill, the bill is killed in the Senate.

HH: Well now, I actually wrote a piece for the Post on how you use the tax code…

PR: I saw that. I saw pieces of it.

HH: Why not use the tax code to penalize policies that come from states with, for example, high med mal pain and suffering damages? Why not use the tax code to penalize states that overload essential benefits? Why not use the tax code to penalize companies that don’t offer policies in multiple states?

PR: A lot of conservatives would oppose that on federalism grounds. So we’ve been working on this for over, you know, we’ve been working on this for seven years, but in earnest over a year and a half. And so when it comes to the liability reform issues, we have a lot of conservatives who have federalism issues on having the federal government mandate state tort laws. So you actually have a conservative problem there with that kind of idea.

HH: Oh, that’s interesting. But if the Senate passed those kind of things and it got through the parliamentarian, would the House accept those kinds of changes?

PR: Oh yeah. So look, our whole thing is we don’t want to load up our bill in such a way that it doesn’t even get considered in the Senate and it’s killed in the Senate, and then we lost our one chance with this one tool we have, reconciliation. It doesn’t last long. But if the Senate can add things to the bill, then we’re all for that. Here’s the way it works, and I know this is kind of inside baseball. If we add provision to the bill that make it, they call it fatal, which takes it out of the reconciliation realm, then the bill won’t even be considered, won’t even be brought up. But the Senate can test that rule with individual amendments, with individual policies.

HH: I did not know that.

PR: They can test that…

HH: I did not know that.

PR: But then that is not fatal.

HH: So you…

PR: Just the provision is struck, but not the whole bill is struck.

HH: Oh.

PR: So if we load the bill up with things we like, the bill itself is dead. They in the Senate can add the things we like and if it doesn’t, if it rules out of order, just that provision goes away. It doesn’t kill the whole bill.

HH: Okay, I’m not ashamed to say I did not know that. That’s a hell of an argument for pushing forward to see what can be done.

PR: And that’s the key thing here. Yeah. That’s right. That’s right. And we want to beta test these ideas in the Senate. We want that. We want our senators running amendments on the things we like to see if they can get past what we call the Byrd rule, this reconciliation rule. But the last thing we want to do is load our bill up and they don’t even get a chance to do that.

HH: Would you personally support taxing state policies where the pain and suffering…

PR: I haven’t even, you just asked me this for the first time. They briefed me about your idea about ten, maybe eleven minutes ago, so I’m not going to talk off the top of my head.

HH: Then never mind. Let’s go to stuff you do know about. Will you wait for a new CBO score? And will you adhere to the three day rule before you actually have a vote on the final text?

PR: Well, we already have, we’re getting our CBO score, so yeah, we can’t go to the floor. By the way, we can’t pass it over to the Senate without a CBO score. That also is what we call violations of the Byrd Rule, so we have to have a CBO score in order to proceed and send it over to the Senate. If you don’t send to the Senate, if you send it to the Senate without a CBO score, you can’t bring it up with reconciliation. So that’s kind of a non-starter anyway. What we hope to happen is we want the Senate to try some innovative things that we want to get in the bill, but we could jeopardize the entire bill. Let me just step back for a second. And the reason I feel good where we are is number one, this is good policy. We are repealing Obamacare and replacing it with good Republican tax policy. And number two, Tom Price is working really heard in getting us the kind of regulatory relief. He’s doing what Kathleen Sebelius and Sylvia Burwell did in reverse, which will dramatically deregulate the health insurance marketplace, let the states go back to being in charge of regulating their marketplaces. And that will dramatically lower premiums far below what even the CBO says, and the CBO says the reforms in this bill alone will lower premiums when those reforms kick in.

HH: But will you…

PR: Let me just…

HH: Go ahead.

PR: We have good reforms, number two, we’ve got a promise to keep. We promised the American people we would repeal and replace this law. We have to do it for real, not for fake, for real, and that means the only way to do this is through reconciliation. We don’t have 60 senators. We have 52. Remember, the Democrats put this in law with 60 votes. We’re going to get rid of it with 50 votes, and that makes it harder to do, but a real promise kept is one where we actually use the only process we have to actually repeal this law. And so I believe at the end of the day, remember, you’re going to say I’m going to keep my promise to the people I, who voted for me and who sent me into office. And number three, we have a very engaged president. I am so pleased and impressed with Donald Trump and Mike Pence, who are really leaning into this thing, working hard, talking to members, brokering things, getting it done, leaning into it. So we have an engaged president. We have a prominent promise to keep, and we have good policy. Those three combinations are very, very good combinations.

HH: Now I would, if I were a member of the House, and I’ve said this, I would vote for your bill as it currently exists, but I would also want it posted for the three day rule, because I want to keep that promise to the American people.

PR: It’s been posted since Monday.

HH: But after the changes are made. If there are final changes made, will you post it again for the three day rule?

PR: Well, I can’t speak to that, because I don’t know that we’re going to have changes in the House that are made, simply because of the fact that we don’t want to make changes that would blow up the bill from the perspective of making it Byrdable.

HH: I get that. I get that.

PR: Making it un-reconcilable.

HH: But if changes are made, I’m just saying it will be a nightmare…

PR: I’ll cross those bridges when I get to them, but I don’t know that we’re going to make changes. The question is can we make changes in the Senate bill, and that’s what we’re looking at.

HH: And I’m hoping for that. But if you, this is just my advice to you. If changes are made, post it for three days and wait. What is the timeline after a successful House vote, Mr. Speaker?

PR: So we pass the bill, it goes to the Senate, and then the Senate has a, because of reconciliation, it limits debate so that they can’t endlessly drag it on forever, and they’ll take a week working on this. And they’ll take all of next week working on this bill, testing amendments, seeing what they can get into it past the Byrd Rule, and then next week, the Senate takes over and they basically start the process over that we did. So we are making changes, amendments, we go through four committees. They won’t go through four committees. They don’t, it doesn’t work like that over there. They’ll spend a week on the floor, and they call it voterama. They’ll have all these different amendment votes that they’ll take and try to pass to amend the bill. And so they’ll have a chance to rewrite the bill over there in the Senate, and our goal is to make it even better over there with our friends and allies in the Senate. Then they’ll send us the bill after that. And then they go on to Gorsuch. So we’ve got a pretty packed schedule between the two of us.

HH: But do you expect, yeah, assuming that they get you the bill back for the week of April the 3rd, do you expect a vote the week of April the 3rd on the final?

PR: Absolutely. Absolutely. Absolutely.

HH: So we will be done by Easter?

PR: Yes.

HH: We will repeal and replace Obamacare by Easter?

PR: Yeah, that has always been our plan. That was, the President asked us to put this on his desk before Easter, and we’re going to keep the commitment to him.

HH: You see, that would be huge, and I can’t stress to Republicans enough they’ve got to ask their members to support the Speaker on this, because it’s a disaster for Americans if they don’t get health care. It’s a disaster for the Republican Party if they don’t deliver. But now let me talk to you about the three phases, and let’s be blunt. I want to play for you some tape of your friend, Tom Cotton, and your friend, Ted Cruz, talking about phase three.

Tom Cotton: Hugh, there is no three phase process. There is no three step plan. That is just political talk. It’s just politicians engaging in spin.

Ted Cruz: I’ve called bucket three the sucker’s bucket.

HH: Okay, so Speaker Ryan, these are your friends.

PR: Yes, they are. And with friends like that, who needs, you know, you know the rest of the sentence.

HH: I know.

PR: I totally and fundamentally disagree. And first of all, why would we want to let Democrats off the hook with that kind of rhetoric, because all that does is it takes pressure off Democrats. Phase three are popular things that, like let’s just take association health plans. We just passed it here, or we’re just in the middle of passing it. And association health plans says let a farmer buy his insurance through the National Farm Bureau Plan. Let a restauranteur buy her insurance through a national association of restaurant plan. It’s interstate shopping for small businesses. It’s extremely popular, and Donald Trump is chomping at the bit to crisscross those ten states he won big where Democrats are up for reelection in 2018 and hammer them on this. Plus, there are things that Democrats want and need that will vote for, like the children’s health insurance law, which expires at the end of the fiscal year that we will combine in these bills to make them, to pass them. So I really, really believe we have a very good phase three plan. I’m not saying everything we want in phase three will go into law, but I think a lot of these things will go into law, because you have an extremely engaged president. These are popular provisions, popular provisions that the restaurant association, that entrepreneurs, small businesses, people want. And it’s going to be really, really, really hard for these Democrats in these red states who are up in 2018 to oppose those things. And why we would want to let them off the hook or take pressure off of them at this stage is beyond me. I don’t think that that’s important. But I think, I don’t think that that’s valuable. But I also think you take a step back and look at phase one and phase two. Phase one is the bill we’re talking about. Phase two is the incredible discretion in de-regulatory authority that Tom Price has that dramatically lowers the price of premiums. The insurers are already telling us just what they’ve already seen will lower premiums. The question is can we lower them even more with better things like phase three, and the answer is, I believe, yes.

HH: Okay, now I want to move…

PR: But to say that we’re not going to do something before we even try, to say to Democrats, we’re going to give you a pass and not put pressure on you, I think, is just a big mistake to make.

HH: Now I want to move to President Trump and what he had to say to the caucus yesterday. There are various reports. Did he in fact, has he in fact said I will campaign against Republicans who oppose the House AHCA?

PR: He was joking around with people. You know how Donald Trump is. And he just, he risked such a thing, and I think he was just joking around with people.

HH: Yes, I do.

PR: He was basically saying how important this was not just to his presidency, but to our party and to our country. The health care law is collapsing. It’s, if we don’t replace it with patient-centered, Republican-based conservative reforms, it will just increase the hue and cry for socialized medicine. And it will be a fundamental broken promise. There is no more prominent promise any Republican has made over the last seven years than this one And if we have this chance to actually, we’ve had a lot of votes repealing this thing. All along, we knew it wasn’t going to go anywhere, because either Barack Obama was president, or the Senate filibustered it. This one’s for real. This is the one real chance and opportunity we have to actually repeal and replace the law. And by the way, we have to pass a bill that can pass.

HH: Yeah, your predecessor…

PR: We have Republicans in New Jersey and Arizona and California and Texas and Alabama and Minnesota. You’ve got to have a bill that you can get buy in from a big tent, wide caucus party, the Republican Party, that can actually pass, which is what we’re putting together. No one gets everything they want, but we’re getting, there are so many good things in here that every Republican, moderate, liberal, conservative Republican, not that we have liberal Republicans, but everyone should be proud to support, and that’s really important here. And that’s basically what the President laid out here.

HH: Last question, I want to stress this. Your predecessor, Speaker Boehner, when he was majority leader, sat in this California studio and told me in 2006 there was no way the Republicans could lose the House. We lost the House in 2006 after he assured me in person, and then he went off and played golf at Shady Canyon. And I remember to this day, because we were over-confident about redistricting and about that.

PR: Right.

HH: What do you think is the partisan danger if Republicans don’t deliver? We have one minute, Speaker.

PR: We made a promise. We’ve got to keep our promise. Everybody knows that this is the one for real opportunity. We’ve had what I would call sort of faulty, fake opportunities to repeal this law, because we knew Obama was going to kill it or it would be filibustered. This is the one chance we have to actually repeal Obamacare and replace it with the stuff we believe in. The President is all in. We all made this promise, and that’s why I’m confident people will realize I’m not going to go home and face voters reneging on my word.

HH: Speaker Paul Ryan, great to talk to you. Next time, give them Browns gear and come back early and often. Thank you, Speaker.

PR: Good luck with that. See you, Hugh.

HH: Yeah, someday, I’m going to get someone to give somebody the Cleveland Browns gear, and they’ll tell the world about it.

End of interview.


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