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The way Rep. Jim Jordan sees it, House Speaker Paul Ryan can tinker with the American Health Care Act all he wants — he’s still not really repealing Obamacare.
Ryan could accelerate the repeal of some of Obamacare’s taxes, or speed the end of its Medicaid expansion, or tweak the subsidies in the bill’s tax credits. None of that will win over Jordan, an Ohio Republican who is former chair of the arch-conservative House Freedom Caucus.
“It's not going at the fundamental issue. The fundamental issue is that you repeal Obamacare. That's not doing it,” Jordan said in an interview Monday night. “That's saying, ‘We'll repeal it; but we'll keep Medicaid expansion; we'll repeal it, but keep its taxes; we’ll repeal it, but add this new entitlement for people who don't have a tax liability.’"
Few members of Congress, if any, have more vocally or forcefully made the conservative case against Ryan’s bill than Jordan has. His position is vital to understanding why AHCA appears to be in danger. The Freedom Caucus’s current chair, Rep. Mark Meadows (R-SC), vowed Monday night that his members had the votes to sink Ryan’s bill when it comes up on the floor this Thursday.
What those members would prefer is the position Jordan has been pressing to President Donald Trump and Ryan’s team for months: Scrap Obamacare altogether.
In attacking Ryan’s bill, Jordan echoed some of the Democratic Party’s main objections to it — that it is being sped through the House with almost no input from members, that it ignored objections from the medical community, and that it suggests the GOP’s years-long cry to repeal Obamacare was merely hollow campaign rhetoric.
He breaks his opposition into four main parts — that it doesn’t really repeal Obamacare; that it won’t lower premiums; that it divides Republicans; and that the “three-pronged” solution advanced by Speaker Ryan will be torn up by the courts.
Here is a transcript of Vox’s interview with Jordan, edited for length and clarity.
Jeff Stein
We’re about to get the new draft of Paul Ryan’s AHCA, and I wanted to ask — how far are you from supporting this bill?
Jim Jordan
There are four big problems with this bill — four big questions you’ve got to ask.
Does the speaker’s bill repeal Obamacare? No, it doesn’t. It keeps a lot of the taxes; keeps the Medicaid expansion, and actually expand it; they get rid of the mandate, but bring in this other penalty which is just basically the mandate penalty. This is Obamacare in a different format.
Second question: Will it lower premiums? No, it won't. We understand that. Until you get after the insurance regulations — the mandated benefits, the guaranteed issue, all these things — until you go up to those, you’re not going to lower premiums.
Does it unite Republicans? No. Every major conservative organization in the country is opposed to it. Five Republican senators are against it. A bunch of Republicans in the House are against it. So it doesn't unite Republicans.
The last question is: Will phase two and phase three [of Republicans’ “three-pronged” plan] ever happen? And the answer to that is clearly, “No.” Phase two [which calls on President Trump’s administration to unilaterally repeal Obamacare’s regulations] is going to be tied up in court. President Trump reissues his executive travel order — even though everyone knows it's consistent with the law and national security interests — and it gets tied up in court right away.
So we just think Secretary [Tom] Price will somehow change the regulations on Obamacare and then have it not get tied up in court? Of course it will. Anyone can see that.
And for phase three [which imagines Congress passing bipartisan health bills to compensate for AHCA’s shortcomings], if we got 60 votes for some things — let's do them now. Why wait months to do them?
Jeff Stein
I wanted to take a step back and look at your overall philosophy and policy perspective on health care.
If you look at the charts the federal government has put out, the uninsured rate was basically around 15 percent for about 30 years before 2009. And now it's below 9 percent.
Do you think that drop was not caused by Obamacare? Or do you think it was, and that's just a meaningless statistic?
Jim Jordan
I think what has to happen is we have to bring back affordable insurance. Look, you’re going to say the percentage went from 15 to 9 because of Obamacare, and I would argue, “Did that 6 percent who got insurance — did they really have something where they could afford the deductible?" I think there's a whole host of questions there.
What I want to see is not people having to sign up for Obamacare, or having to go into Medicaid. I want to see affordable insurance be offered so families who get their insurance via the government can get it in the private sector — and get a policy that actually fits their needs.
I don't get into all the — my focus is on bringing back affordable insurance and defining success as, "People can choose the plans that fit their needs," not, "Signing people up for government-sponsored health care."
Jeff Stein
I think that distinction makes some sense, but why do you think that didn't happen in the pre-Obamacare markets? Why was 15 percent of the country — millions and millions of people — still without insurance before Obamacare? If your answer is "the government," then wouldn't you want to go far beyond repealing Obamacare?
Jim Jordan
Well, I'm not saying it was perfect before Obamacare. I'm just saying, we've had three major elections on this issue, and the voters spoke pretty darn clearly. 2010, 2014, 2016 — they said, "we want Obamacare gone." They want affordable premiums and affordable deductibles, particularly if they were in the individual market. They don't have it now.
So I'm not saying it was perfect before. It could have been driven by all the government involvement we have in health care, even pre-Obamacare.
Jeff Stein
So you think that the rates of the uninsured were so high before Obamacare because government was too involved?
Jim Jordan
It could be. What I know is the situation we're in now. And I think Obamacare has been a disaster for most Americans. The premise that we're going to put all these regulations on insurance, put all these costs on it, mandate that you get it, and if you don't you get penalized — that was Obamacare to me. That was not a formula for success.
Jeff Stein
Are there specific examples of market-based solutions you can think of, either in America or internationally, of the kind you'd like to see?
Jim Jordan
I think the answer is: Allow a market to develop. Don't mandate coverage for everything. So people can say, "If you want a plan that covers everything, fine, you can pick that plan." But it's going to cost more — either way, you allow the market to work more.
Right now, when you have all these mandated coverages, you're limiting the market. What we want to get to is where you can have the next Uber come into the health insurance market. I don't know if that's possible under Obamacare, because it's so restrictive and so many essential coverages have to be in every plan.
Jeff Stein
You're still talking a hypothetical. Is there a state or a country with the kind of health care system you're talking about that we should be trying to emulate here?
Jim Jordan
I've not seen that. As I said from the outset, the bill from the speaker is not consistent with what we told voters. It's just not. And that's my biggest concern with the legislation.
Jeff Stein
The reason I bring this up is because if there were another country that you could point to and say, "The free market exists here in a way that people have a chance at affordable health care” of the kind you're talking about, I think that would assuage a lot of people's concerns. Especially after the CBO says Ryan’s bill will cost 24 million people their health insurance.
Jim Jordan
The point is we don't have a free market. I think Americans have forgotten what a free market looks like in health care. And most countries have gone in the other direction, as you well know. A more government/socialized type of approach.
I do know that every other industry, every other area where you have markets, when you can shop for price and shop for value, prices come down over time. That's what we'd like to see more of in health care.
Jeff Stein
Do you recognize the position Ryan is in with moderates in the Senate appearing to have little willingness to support a more conservative direction? Is that a reality that he faces, or do you think he's misreading his own caucus?
Jim Jordan
But, Jeff, we all voted for [clean repeal of Obamacare]. We voted for it a year ago; we can't vote for it now? That's what drives voters crazy. "You voted for it during the campaign, and you can't vote for it now? Now that it actually counts you can't do it?"
Come on. I know what we’re [the Freedom Caucus] for: We're for what we voted for before — plus a separate replacement legislation I'm for passing right now. If we can get to 60 votes, let's pass our replacement bill, too.
That'd be a great package. Could you imagine if we actually did that on Thursday? Pass the clean repeal — the same thing we put on President Obama's desk — and we did it Thursday. Oh. My. Goodness. Finally, you'd get the American people going, "Those guys are doing exactly what they said."
That'd be great. That's what I'm for.
Jeff Stein
There's a funny way in these conversations where the objection raised by the House conservatives sits in the same space in the Venn diagram with what Democrats are saying about Republicans’ bill — that, "Didn't you stand for this before it became politically expedient?" And I think they’re coming together in an interesting way.
Jim Jordan
Yeah! It's funny how it works out. Our plan is exactly what we told the American people. So let's do that.
Jeff Stein
There's been some talk tonight that Ryan is going to change the tax credits, but also speed up the Medicaid expansion phase-out. If they increase the tax credits at all [Ryan’s revised bill did add an $85 million new fund that will be used for the tax credits], I assume that's going to be a sticking point for you guys?
Jim Jordan
Yes, because it's not going at the fundamental issue. The fundamental issue is that you repeal Obamacare. That's not doing it. That's saying, "We'll repeal it; but we'll keep Medicaid expansion; we'll repeal it, but keep taxes; repeal it, but add this new entitlement for people who don't have a tax liability, and yet they'll still get a credit."
Jeff Stein
And you told this to the president?
Jim Jordan
Yes. We told him that the key is: "Repeal it. Repeal it all." And, "Add in the insurance regs we know are driving up the cost." Put that in there, and don't let a parliamentarian tell you that you can't put it in the bill.
Jeff Stein
There's been a lot of talk about the lack of an open process and a lack of transparency around this bill, and now they're going to rush it through Thursday without much input. What do you think of that?
Jim Jordan
It was rolled out two weeks ago. There were no hearings; they went straight to mark-up. They didn't even have any witnesses come and testify, which I think is a problem.
Every major conservative group in the country is opposed to it. So many of the people in the hospitals, and doctors, are opposed to it. Sometimes that happens when you don't have actual hearings and a real mark-up. There were no amendments to be offered in any of the committees.
And here we are, supposed to vote on it in three days. And we were told three days ago that it was a binary choice, "Take it or leave it." I don't think that's how it's supposed to operate.
