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Lisa Murkowski, a crucial Senate swing vote, is very frustrated with AHCA

Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

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I took a walk today with Sen. Lisa Murkowski of Alaska. She's one of the crucial Republican swing votes on health care.

Murkowski told me what she wants out of health care reform. Her state expanded Medicaid under Obamacare and has some of the highest health care costs in the country. Alaska has a lot of stake.

My colleagues and I have done a few interviews with senators about this question: What do they want the GOP health care bill to achieve?

We'll round them up soon. Think of this as a preview. Stay tuned.

Dylan Scott

What do you want this health care plan to achieve?

Sen. Lisa Murkowski

I want greater access and lower costs. So far, I'm not seeing that happen.

Dylan Scott

How confident are you that the plan under discussion would do that, compared to Obamacare?

Lisa Murkowski

This is the big issue as I'm talking to folks back home. I continue to hear stories of great frustration. Increasing premium costs. Increasing share of deductibles. Decreasing access. They know what they don't like.

They know what they do like. They do like the fact that they have gotten coverage for preexisting conditions. They do like the fact that they're able to keep their kids on [their insurance]. There's some positives and then some bad things.

When you ask Alaskans about their stories and what they want, they need increased affordability. Because we are slammed in every category, with premiums and the cost of care. Everything. They wanted decreased costs, increased access.

Dylan Scott

Are you seeing provisions in the plan that's being discussed that would achieve that?

Lisa Murkowski

The plan the House laid down does not help Alaska. It does not help decrease their costs, and it does not help increase their access.

So the question is whether or not what is being built on the Senate side is going to better reflect that. My hope is that it will.

I can't show to my constituents back home anything concrete because we don't have anything. We've been talking about ideas. But for instance, if you are going to eliminate Medicaid expansion or even if you're going to wind down Medicaid expansion, that's not increasing access.

I think the requirements that I'm looking for and my constituents are asking for are pretty basic. My task is going to be to make sure that those basic asks are met.

Dylan Scott

Do you have any specific metrics in mind? How do you evaluate whether a plan is going to lower costs or increase access?

Lisa Murkowski

It was pretty easy for the state to run the numbers under the House-passed bill.

As the president was quick to point out the other day, the situation in Alaska is that we've seen a 203 percent increase in premiums. That speaks to the imperative of why you need to repeal and replace the [Affordable Care Act].

But what needs to be shared is that if the House-passed bill were actually going to play, the increase to Alaskans, for a 50-year-old male earning $50,000 a year, he would see his premiums hike by 500 percent. So it's all a matter of scale.

I don't know what it is that will actually come forward. This has been part of my frustration. What's the Senate bill going to look like? I don't know.

I've got people calling my office, I've got people coming online to protest. They're saying, "Don't vote for this!" Well, what is this? We don't know what this is yet.

Dylan Scott

I know some senators have tried to say you're starting from scratch and building your own plan. But it seems like in a lot of important ways, the Senate is really just tinkering with and trying to rework the House plan.

Lisa Murkowski

But again, I don't know that. Because none of us have actually seen language.

Is it the framework of the House-passed bill and then we're filling in our own details? I don't know. We just don't know.

My constituents expect me to know, and if we had utilized the process that goes through a committee, I would be able to answer not only your questions but my constituents' questions.

Dylan Scott

Why didn't we go through a normal process?

Lisa Murkowski

I think there was a sense of urgency that we have to get this behind us. Committee process is quite deliberative. Deliberative by necessity or by definition, I think, and deliberation takes time.

Dylan Scott

I feel like you have to be a little nervous about this process. It's such an easy political attack, deals being made behind closed doors.

Lisa Murkowski

We're setting ourselves up for the same criticism we waged against our colleagues on the other side.

This interview was lightly edited for clarity and length.

Chart of the Day

Trends in teenage smoking. We got new data today from the CDC on trends in teen smoking. The gist is that teens are smoking less in general than they did even five years ago — and even a new taste for e-cigarettes fell off a bit this year. Read more from the CDC.

Kliff’s Notes

Your daily top health care reads, with research help from Caitlin Davis

  • "The GOP Repeal Plan Sucks. But Is It Better Than Nothing?": “It’s possible, of course, that AHCA negotiations will begin with moderate proposals and transform into something free-market oriented. With widespread opposition from conservative groups — Heritage Action, FreedomWorks, etc. — the American Health Care Act looks like a non-starter. Then again, who are we kidding? The truth is that conservatives probably find themselves in the same situation frustrated liberals did in 2009.” —David Harsanyi, the Federalist
  • "Health-Care Companies See Big Risks in Plan to Replace Obamacare": “‘Right now, we have a market that is incredibly unstable and is really on fire,’ said Tom Policelli, chief executive of Minuteman Health, which offers marketplace plans in Massachusetts and New Hampshire. ‘This bill does not put out the fire.’” —Anna Wilde Mathews and Melanie Evans, Wall Street Journal
  • "The debate over the Affordable Care Act is really a debate over wealth redistribution": "Overall, it would be ‘a big transfer. This is a massive tax cut for unpopular industries and wealthy individuals,’ said Andy Slavitt, who was acting administrator of the Centers for Medicare and Medicaid Services during the final years of the Obama administration. ‘It is about cutting care for lower-income people, seniors, people with disabilities and kids to pay for the tax cut.’” —Karen Tumulty, Washington Post

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