Week In Politics: Republicans Unveil Health Care Plan

NPR'S Robert Siegel speaks with Matthew Yglesias of Vox and Eliana Johnson of Politico, about the Republican plan to repeal and replace the Affordable Care Act and President Trump's revised executive order on immigration.

ROBERT SIEGEL, HOST:

This week the Trump administration and Republicans in Congress did get to work on their biggest campaign promise to repeal and replace Obamacare, and that's where we'll start our Friday politics discussion. And starting this week, our Friday regulars E.J. Dionne and David Brooks will be on roughly every other Friday, alternating with a variety of voices. Today - Matthew Yglesias, co-founder of Vox, and Eliana Johnson, national political reporter for Politico. Welcome to both of you.

MATTHEW YGLESIAS: Thank you.

SIEGEL: And first, replacing health care - replacing and repealing Obamacare. Eliana, we've heard Republicans promise an end to Obamacare for about seven years. From what you've seen of the bill that House Republicans have proposed, first of all, do you think that it would greatly change the ambitions of the federal government or just the methods by which it pursues those?

ELIANA JOHNSON: You know, the surprising thing about this bill is its unveiling was this huge moment for Republicans, probably, the most important day of the Trump presidency so far. And the unveiling of the bill revealed something that really had no friends. Conservative critics say precisely what you suggested that it wasn't ambitious enough in rolling back Obamacare. It takes a side in the conservative debate over replacing Obamacare - replacing the Obamacare subsidies with tax credits, which is why many people are calling it Obamacare 2.0 or Obamacare lite.

And it displeases Republican moderates by reforming Medicaid and replacing it with block grants in 2020 and thereafter and really ties itself in knots thinking about what the Senate will have to do to conform with its own procedures. So the result is criticisms from both sides of the Republican Party and from conservative wonks, who in the past really had been Paul Ryan's best allies, and, really, a great deal of surprise, I think, from all sides of the Republican Party on this.

SIEGEL: And, Matt, no applause at all from the Democrats for this plan.

YGLESIAS: No, none at all and no real effort to build a process. I mean, there's a number of Democratic senators representing states that Donald Trump won who potentially you could try to win over, but there's been no olive branch to them.

And I'm struck by how different this plan is from what Donald Trump said he was going to do. As recently as January, he was saying his replacement was going to cover everybody, that it was going to lower deductibles, that it was going to lower premiums.

This strategy, while a lot less conservative than some of the previous plans coming from congressional Republicans - it still doesn't do any of those things. It will cover fewer people. It will lead to higher deductibles. It will probably lead to higher premiums.

SIEGEL: Does it have a chance, Eliana, I mean, to pass the Senate and get signed into law?

JOHNSON: I think the thing to watch for is how aggressive is Donald Trump in campaigning for this bill. I think we've seen him really do a soft sell. He seems to have one foot in and one foot out right now. We heard initially he was going to go to Kentucky, the home of Rand Paul, who has been one of the most vocal critics of it, and Senate Majority Leader Mitch McConnell and heard later that, actually, it was Vice President Mike Pence who was going to go.

It's unclear to me right now how forceful he's going to be in campaigning for this. And I think that will matter a lot because he won these states at the most conservative lawmakers in Congress won, and that could matter a lot.

SIEGEL: Onto another matter, Matt. One thing the new administrations do is they fill hundreds of jobs in the executive branch of government, including some very big jobs like deputy secretaries and undersecretaries and assistants. Where are these people?

YGLESIAS: Yeah. There's been a sort of strikingly slow rollout of some of these positions, particularly ones in the national security space. We have in the Defense Department most of the sub-Cabinet roles are currently being filled with career civil servants. The deputy secretary is the holdover from the Obama administration.

At the State Department, there's essentially nobody. Secretary Tillerson doesn't even have a sort of a full-time spokesman in place. They're using a career foreign service officer. He's very qualified, but that's a traditionally political role.

SIEGEL: He just gave his first briefing this week.

YGLESIAS: Yes, he did. And he's done a couple of briefings this week. And the State Department in a number of ways seems to be a little bit out of the loop. It seemed that they didn't know that Mexico's foreign minister was in town, and they don't really seem to have that whole shop up and running.

SIEGEL: Does it mean, Eliana, that if the agencies aren't staffed up to proper levels, that, say, State and Defense's counterpart at the White House, the National Security Adviser, becomes that much more influential?

JOHNSON: You know, it's - I think it's unclear to conservatives and Republicans, who were really cheered by most of Donald Trump's cabinet nominations, how much influence they're actually going to have. He really pleased conservatives and unified the party, I think, by appointing strong Cabinet nominees like Secretary of Defense James Mattis. When he - his national security adviser - his first national security adviser, Michael Flynn, didn't last very long, his replacement H.R. McMaster - Politico reported - before his big speech to Congress, urged him not to use the phrase radical Islamic terror...

SIEGEL: Urged Trump not to use.

JOHNSON: Urged the president not to use that phrase. He went ahead and did it anyway. I think it remains unclear how much he's actually listening to anybody outside his closest circle of advisors that include Chief Strategist Steve Bannon, son-in-law Jared Kushner and Chief of Staff Reince Priebus.

SIEGEL: What do you think about that, Matt? It's not a contest between senior advisers and the cabinet agencies but senior advisers and really senior advisers.

YGLESIAS: I mean, they appear to not have a very traditionally structured policy-making process. There's a handful of people who are very close to Donald Trump. They clearly have a lot of sway. What's happening in the agencies is much murkier. There've been a lot of reports from out of the Treasury Department that Secretary Steve Mnunchin is having difficulty getting some people cleared by the White House because of old social media posts. But in other agencies, people who were critical of Trump have been waived through. And I think there's a lot of confusion.

JOHNSON: U.N. ambassador Nikki Haley is one of those previous critics, so Trump does seem to waive these things on a whim, really, when he feels it suits his interests.

SIEGEL: This week, Donald Trump signed a new version of his travel ban. This time he signed it off camera - no big photo op. Was there a meaningful learning experience, do you think, from the first travel ban that was reflected in the second one? Matt, start with you.

YGLESIAS: I mean, this time it looks like he has tried to come up with something that will stick legally and that will minimize public blowback. The first version of this was exactly the opposite. I mean, it took effect immediately. It was designed to make as big a splash as possible, and I think they feel a little stung by some of the reaction to it.

JOHNSON: You know, for an administration that has a really ambitious legislative agenda, I think the relative quiet surrounding this revised executive order really throws in to stark relief just how important it is for the Trump administration to slow things down and get them right on some of these things because there's a real risk that on these big ticket items - there's a real risk that they could undermine themselves on the things that they care most about.

Really interesting to see conservative senators - Arkansas' Tom Cotton chief among them - warning that they need to do this on health care right now. He said, slow things down. You're moving too fast - warning them that they could fall into some of the same patterns of errors that they did on this travel executive order.

SIEGEL: But on the travel executive order, there are state attorney generals out there who say the second one has the very same constitutional problems as the first one.

YGLESIAS: Well, exactly. And I think if this second one had been the only one that they would be in much better shape with it. But because it's sort of a successor to an earlier order, some of the attorneys general are still out there with legal arguments saying, you can't escape the restraining orders. And I think that speaks to Senator Cotton's point that it's better to get it right than to sort of get things done quickly.

SIEGEL: Matt Yglesias of Vox and Eliana Johnson of Politico, thank you very much for talking with us today.

JOHNSON: Thank you.

YGLESIAS: Thank you.

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