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The Lead with Jake Tapper

Interview With Louisiana Senator Bill Cassidy; 22 Million to Lose Health Care Coverage Under Republican Plan. Aired 4:30-5p ET

Aired June 26, 2017 - 16:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

[16:30:02]

PHIL MATTINGLY, CNN CORRESPONDENT: In terms of using money, using financing, possibly for Medicaid, possibly other issues, to try and get senators back into the fold, some wary senators.

Also want to talk about premiums. Look, when you talk to conservative members here in the U.S. Senate, the thing that they care about more than anything else is premiums. How will cutting back about the Obamacare regulations affect premiums?

While premiums will go up in 2018, 2019, when you dig in a little bit further, in 2020, premiums would drop by an average of 30 percent for individual plans. By 2026, 20 percent for individual plans.

So, while the top-line number coverage is certainly something Democrats are going to seize on, Republicans are not going to appreciate, on the premiums, that is some news that I think Republican conservatives will be really interested in, no question about it.

There is a lot to take away from these numbers. Top line, difficult number, but when you dig deep into the policy right now both on the budget savings and on the premiums, you could see some positive news that you're certainly going to hear Republicans talk about going forward.

Jim, I think one of the interesting elements here obviously is we talk about politics, we talk about kind of the dynamics, the inside baseball, what actually matters here on the policy?

And you look at these coverage numbers and you talk about what is actually in the bill, compared to the Affordable Care Act, the Affordable Care Act expanded Medicaid for 32 states and the District of Columbia. That covered 10 million people on its own. This will phase that out starting in 2021. So, that would disappear over time.

You also have abortion funding. Planned Parenthood would be defunded for a year. That is a major issue for certain senators. Obviously, Democrats very upset about that issue as well.

One of the interesting elements here, as you try and figure out how they would kind of shift over the Medicaid expansion population would be the tax credit, how the tax credit is structured in this bill itself. It's very different from the House provision. Actually, it's very similar structured to what they had in the

Affordable Care Act, though lowered in terms of eligibility, based on the current poverty rate.

And the idea, according to Republican senators, is, as you kind of close out the Medicaid expansion population, that tax credit would be in place to help pick up that coverage area.

This CBO report seems to imply that, at least according to CBO standards, they don't believe that would happen at the rate that Republicans hope it will. That will be a point of contention going forward.

But that's how -- when you try and take apart what the policy is, how it relates to these numbers and then politically what that means going forward, kind of this all wraps together. We are going to have to get some reaction from senators to see where they stand on this, but a lot to take out of this kind of in every side of the spectrum, Jim.

JIM SCIUTTO, CNN ANCHOR: Phil Mattingly, thanks very much.

Joining me now to talk about the GOP bill is GOP Senator Bill Cassidy. He's a Republican of Louisiana.

It's also worth noting he is a doctor who has provided free health care to the uninsured in his work.

Senator, thanks very much for being here and fantastic timing.

(CROSSTALK)

SCIUTTO: First of all, and I realize you're reading this as we are, but we do know those headline numbers; 22 million will lose their insurance by the year 2026 with savings of $321 billion overall from the federal deficit.

Your response to this score?

SEN. BILL CASSIDY (R), LOUISIANA: I don't quite understand it.

For example, premiums are predicted to go up next year, even though we're throwing an additional $15 billion at it. I think I'm told that's because they anticipate the risk pool getting bad. The risk pool is already terrible. So, I'm not quite sure I understand that.

Secondly, as regards the uninsured by 2026, one thing that has been in the Susan Collins-Bill Cassidy bill, the Patient Freedom Act, is automatic enrollment. And I don't think they modeled automatic enrollment.

If you automatically enroll people, you are going to have more folks in the pool than if you have a mandate. That has not been. I would like to see that modeled as well.

SCIUTTO: Let me ask you this. After the CBO judged that the House version of the would leave some 22 million out of -- actually 23 million people, you called that bill unsupportable. You said you wouldn't support it.

So, after seeing virtually the same projection here, will you refuse to support the Senate version as well?

CASSIDY: Well, I have to read it first.

I'm looking at a headline. But the reason I find it curious, whereas for a 62-year-old man making $20,000 a bill, under the House bill, he would have paid $13,000 a year for his insurance, totally unaffordable. Under the Senate bill, he would pay $800 a year, $13,000 to $800.

Now, clearly, that is a more affordable policy. So why do the coverage numbers not move that much?

(CROSSTALK)

SCIUTTO: Are you saying you just don't accept the CBO scoring of how many people would lose their health insurance under this?

CASSIDY: I'm just saying I have to understand it.

I can't comment on something before I understand it. And when you said perfect timing, not quite, because as I walking up, it came out the CBO score had been released. I have not read it yet.

SCIUTTO: Fair enough. We do want to give you more time to do that.

But I do want to get to what the defense of this bill has been so far. To address the high health care costs, this bill does make cuts to Medicaid, allocating less money to Medicaid.

Yet, over the weekend, Kellyanne Conway, of course, spokesperson, surrogate for the White House, made a remarkable claim that there aren't any Medicaid cuts in this bill.

Is the GOP misleading Americans about what's actually in this bill?

[16:35:03]

CASSIDY: Well, Kellyanne Conway is not the GOP. I can speak for myself.

SCIUTTO: She's a very close spokesperson for the president and speaks for the president.

CASSIDY: I just can't address that.

I can address what you raised. Just there's three aspects to spending less on Medicaid. One is that people would move off of Medicaid onto private insurance. That's actually a good thing.

If you can preserve the private insurance market, that's a good thing. Secondly, there is a cut in the rate of inflation. That does not actually occur until 2025. And so the spinach, if you will, is postponed, giving an opportunity to see how this plays. And the third way is that the Medicaid expansion begins to -- the amount of money the federal government puts toward that begins to decrease.

But my point all along is that states cannot afford the money they are already obligated to put up. In California, it would be $2.2 billion a year by 2020 for the Medicaid expansion, my state, much smaller, $310 million, both numbers very hard to cover.

Now, by the way, I have not committed to voting for this bill, but I do think it needs to be addressed fairly.

SCIUTTO: From what you can see here -- and, listen, I want to give you more time, but your experience is material to this.

You're a physician. You served in a hospital helping a community clinic, rather, helping people who have trouble affording health care, getting health care.

When you look at this bill, if one of them came up to you and said, is this bill going to make it more or less likely for me to get health insurance, what's your answer to that?

CASSIDY: It makes you more likely to get private health insurance, because right now...

SCIUTTO: Affordable private health insurance? Because it's clearly taking money away from the Medicaid system, which is how millions of Americans are able to pay for their health care.

CASSIDY: So, if you recall, I said that the 62-year-old making $20,000 a year, $20,000, which, granted, would not be Medicaid- eligible, but it's in the ballpark, his premium would be $800 a year.

And so you're right. There might be somebody who is on if things are totally free, as opposed to someone who has to pay 1 percent or 2 percent of his income. That said, it also has to be sustainable.

And that's one thing I have learned working in a public hospital system for the uninsured. You can have the best plan in the world. If it is not sustainable for the taxpayer, that plan will not continue. And so we have this tension. How do we make sure things are affordable both for the taxpayer, but also for the patient? That's why I need to report the report.

And I don't mean to defer. I just have not read the report there.

SCIUTTO: I understand.

And you're describing the actual tension right there. At the end of the day, yes, bills like this, or actually, rather, Obamacare did insure more people, but essentially the Republican argument is that the price, the cost is too high, is it not?

Are you saying, in effect, that Republicans are willing to insure fewer people to save money at the end of the day, saying that we can't, as a country, afford Obamacare or ACA, whatever you want to call it, as it stands? Is that the essential argument?

CASSIDY: I'm not saying that at all, because when I spoke of automatic enrollment, if you have automatic enrollment, as we do on Medicare, where, when you turn 65, you're automatically on Medicare, unless you call and say you don't wish to be, we have like 99 percent of those 65 and above on Medicare.

If a state decided to do automatic enrollment in Medicaid for those eligible, and then the exchange population for those eligible, you would have 95 percent eligible enrolled.

And that actually would increase your -- frankly, the -- increase the amount of money you're spending, although lower on a per beneficiary basis, and it would also increase your number of insured.

So, I want to see everybody insured. I think actually the automatic enrollment feature, which we are proposing, Collins and Cassidy, is a more effective than the individual mandate.

SCIUTTO: Final question for you. And, again, I know you have to review this word for word, but just based on what you have seen so far from the CBO score, does it make you vote more or less likely to vote yes on the bill?

CASSIDY: It makes me more concerned.

I have been uncommitted. And I remain uncommitted, just deadline uncommitted. But it certainly makes me more concerned. It makes me want to explore this more.

SCIUTTO: Congressman Bill Cassidy, we appreciate you taking the time. And we know you're just looking at it, so we take that to account as well.

CASSIDY: Thank you.

SCIUTTO: Coming up, more on the breaking news, the CBO estimating 22 million fewer Americans with health insurance by 2026 under this current version of the Senate health care bill. We're going to talk more about that right after this.

(COMMERCIAL BREAK)

[16:43:33]

SCIUTTO: And welcome back.

Lots of news, and my political panel here to break it down.

Of course, these CBO numbers, reiterating them, 22 million people will not be insured or lose insurance, rather, by 2026, $321 billion saved.

David Chalian, bad news for the GOP health care bill?

DAVID CHALIAN, CNN POLITICAL DIRECTOR: I don't think going from 23 million losing insurance on the House side to 22 million on the Senate side is going to make the ads against this bill any better bill for Republicans.

It's a tough number and a bad headline. They clearly got more money to play with on the deficit reduction side, some $188 billion more in deficit reduction here. That, either, A, could be pumped into tax reform, or, as Phil Mattingly suggested to you earlier, could help bring on some senators on board with fixes to the bill if they're not all there.

I think the biggest problem for Republicans, besides just the bad headline of 22 million fewer with insurance, is that, again, the people, according to CBO in this report, most dramatically impacted are older people, lower-income, 50-to-64-year-olds with lower -- we're talking about Trump voters here.

That is what we're talking about in terms of the impact here, a disproportionate impact, as the CBO report spells it out. I think that's a political problem.

SCIUTTO: Let's take a look at where Republicans currently stand on the health care bill.

Right now, five Republican senators say they're opposed to their party's health care bill. And here they are right there. And we also just spoke with Senator Cassidy, who is uncommitted, but he said, looking at these numbers, he told me just a few minutes ago, Kirsten, that it makes him more concerned, not less concerned.

What do you think this means for that whip count?

KIRSTEN POWERS, CNN COMMENTATOR: Well, I mean, and there are also other senators who are on the fence.

SCUITTO: Right.

POWERS: You know, Senator Collins has obviously is on the fence and is looking to the numbers -

SCUITTO: And that's what Cassidy was before, now he says he's more -

POWERS: I think, honestly, I mean, the overall - the goal of the Republican health care reform has never really been about the uninsured, right? I mean, that's not - they've been explicit about that, that it's about what they call access to health care. So I don't know how much that number actually affects them. It's in line with what the House bill was. So while it may - you know, look bad and I think they may pay a price for it down the road. I don't know that it would keep them from voting. I think it's what is going to be the problem to them is what David brought up, which is that the only people are - the only people who will see their premiums go down under this are young people, and I think that's a real miscalculation on their part. If you have people - you know, 60 and older seeing their rates go up sometimes - you know, by really astronomical rates, by five times what they were already paying, I think that there will be a real political price to pay for that.

SCUITTO: Of course they say all politics is local. There's no more local issue. There's no more issue that is more tactile for voters than health care, really. When you say - people are going to notice that. They're going to notice what their premiums are; they're going to notice if they don't suddenly have insurance. How does the Republican Party make that work for them?

KRISTEN SOLTIS ANDERSON, WASHINGTON EXAMINER COLUMNIST: Right. I firmly believe the way that people are experiencing the health care system will have a far greater impact on their voting than any ad they see on television. And Republicans have done quite well in the last number especially the last two midterm elections by talking about how bad they say ObamaCare was. This has been an issue that Republicans feel has been politically beneficial to them, at least up to this point, which makes the politics so much more interesting now that Republicans kind of own it. If Republicans pass a bill and people feel like their health care has not gotten better, I believe they will punish Republicans. On the other hand, if this bill does all the great things that Republican say it will, then they'll benefit. I don't think that a CBO report will change things merely as much. As voters say those elderly voters find their premiums going up or younger voters suddenly love the GOP because their premiums have gone down.

SCUITTO: To David Chalian, as you look at those Senators, I mean, of course, you have a mix here because some wanted to go further, right, and some think it goes too far. But as you look at those five names, plus we have the others in the kind of on the fence category, who do you think is - this is most likely to move or not move? And I know this is a little bit of political tea leaf reading.

DAVID CHALIAN, CNN POLITICAL DIRECTOR: I don't think all five of those Senators are in the same category, right? Some of them believe let's say like Ted Cruz or Mike Lee might be publicly negotiating here trying to express early opposition so that then they get something to go back home with them and say, I pushed this bill to the right, I got a more conservative solution. Dean Heller I think is a different case here. I mean, here's the most politically imperiled Republican up for reelection going against the bill, now facing the potential wrath of a pro-Trump Super PAC for doing so, sort of an inter-party fight among Republicans. But he clearly looks at the politics of this, stands with his Republican Governor and says, this is going to hurt Nevadans. I can't get there in this version of the bill. I don't see anything in this report today or in the reports of how the bill may be changing slightly, that will all of a sudden allow Dean Heller to join forces with the President and help push it through.

SCUITTO: Honestly that will, of course, the other big headline today as the Supreme Court's decision on the travel ban. Something of a decision allowing parts of it to stay in place while at the same time saying that the four courts is going to take it up in the fall. We also have Jeffrey Toobin with us. He knows the issues behind this. Jeffrey Toobin, first of all, were you surprised by this ruling and what does it mean for the travel ban going forward?

JEFFREY TOOBIN, CNN SENIOR LEGAL ANALYST: Well, I was a little surprised, because the court obviously did more than just decide to review the case. They modified - they modified the stay that had been in effect, in, I think, a rather clever way. What the court said is that the blanket travel ban from the six Muslim countries, Muslim- majority countries, is not in effect anymore. But the people - but the people who have a bona fide connection to the United States, who have relatives here, who have a job offer here, who are admitted students here, they can come in. So the stay does not apply to them. So, strangers, tourists can't come in from the Muslim majority countries, the six countries, but people with a connection to the United States can come in. And that strikes me as an interesting compromise, and it is certainly a better result for the Trump administration than it's had from any of the courts of appeals so far, so certainly this is a better day for the Trump administration and the Supreme Court than they've had.

SCUITTO: Let me ask you this. Were you surprised that there was no dissent from the more liberal side of the court kind of teeing up that they're going to vote against it in the full court in the fall?

TOOBIN: Well, you know, that's an interesting question, but I actually am not that surprised. But I have been surprised as how tough the courts have been on the travel ban so far. You know, I've always thought that the Supreme Court was going to be a much more receptive audience to the Trump administration than the earlier - than the lower courts. And it is worth noting that the three of the for conservative justices, Justice Alito, Justice Thomas and Justice Gorsuch, they all said they would leave the entire travel ban in place. So they look like three certain votes in favor of the Trump administration when the court hears the merits of the case in October. So all it looks like the Trump administration needs is to find two more votes, and that's, I think, fairly likely. So I think the Trump administration is looking pretty good going forward in winning this case. So I think, by and large, it was definitely a good day for the - for the Trump administration and the Supreme Court regarding the travel ban.

[16:50:56} SCUITTO: Well, big news today on the CBO health care bill but also on the travel ban. Thanks to my panel here in Washington, Jeff Toobin in New York as well.

Protesters shot at point blank range in the middle of the street, and that's just the human rights abuse cases we can see. A closer look coming up at Venezuela where democracy is at risk today of being defeated. Please stay with us.

(COMMERCIAL BREAK)

[16:55:00] SCUITTO: We're back now with our "WORLD LEAD." You might describe Venezuela as a country falling apart in silence, or at least outside the attention of many Americans. In 85 straight days of violent clashes between protesters and security forces under the government of Nicolas Maduro, at least 75 people have lost their lives, a death toll that rises almost every day. One of the latest victims is this young man seen here, shot to death point blank by soldiers during a protest last week. Now we're hearing new details about unthinkable human rights abuses inside Venezuela's prisons. Human Rights Watch says the Venezuelan government is torturing protesters, beating them, tazing them, and in some cases forcing them to eat human feces. The Maduro government denies these allegations. I want to bring in Phil Gunson now. He's a Senior Analyst for the International Crisis Group. He's also a former journalist who has spent decades covering political unrest in Latin American, including in Venezuela. Phil, thanks for joining us today. We're hearing behind the scenes in jails about the horrific treatment of prisoners and conditions in the prison. One woman told the Washington Post that she would rather kill herself than go back to prison. You've been in Venezuela for some time. What evidence are you seeing and hearing of similar mistreatment by the government of these prisoners?

PHIL GUNSON, INTERNATIONAL CRISIS GROUP ANALYST: Well, Venezuela prisons at the best of times are hell holes. And it's not a fate I would - I would wish on anybody. I talked in the past to people who have been tortured by the national guard and by people who run the prison, and it's certainly no surprise at all that we're hearing of now large numbers of testimonies of people coming out of detention who say torture is routine. This is looking much, much more like a traditional dictatorship now than it did until recently. We're seeing demonstrators shot in the streets, we're seeing nighttime raids by secret police. (INAUDIBLE) military trials. Democracy has been suspended in Venezuela.

SCUITTO: You mentioned people getting shot in the street. The video of this just recently, a 22-year-old gunned down, shot at point blank range. How is this able to happen? Is anyone holding this government to account? Of course, the demonstrators are, but it in the international community, it seems that the government is acting with impunity now regarding the demonstrators.

GUNSON: Internationally, there are efforts, of course, to bring this to a stop but the main form has been the organization of American state and over that, the General Assembly Meeting just a few days ago in Cancun where a handful of Caribbean Nations have allied to Venezuela blocked any kind of international action. So it's proving very, very difficult to bring them to account. Of course, all these evidence of torture, ill-treatment, shooting deaths in town is accumulating and one hopes at some point the people's concerns will be brought to justice. There have been some trials - there have been some people arrested, but there's no guarantee, of course, that they're going to spend any serious time in jail.

SCUITTO: How are the demonstrators reacting? Do they still have a voice? Do they have a chance of bringing this government down?

GUNSON: It seems almost stalemated. The remarkable thing is that it's been going on now for about three months and despite the violence, despite the death, despite the efforts involved in going out in the street, day after day people are still doing that. And if anything I would say - you know, maybe the numbers are slightly smaller but the determination is greater than there ever was. I think people are more aware now the (INAUDIBLE) three months ago when this started that really this could be the last chance to save Venezuela and from an outright military dictatorship and the determination is very, very strong.

SCUITTO: Last chance to save Venezuela. Phil Gunson, thanks for giving us a view from the ground there.

GUNSON: Thank you very much.

SCUITTO: Be sure to tune in for a CNN Special Report. "THE RUSSIAN CONNECTION Inside the Attack on Democracy." I take you inside the Russian hacking investigation from the very beginning. It will all air for the first time tomorrow night at 10:00 Eastern time.

That's it for me. It's been a pleasure filling in for Jake today. You can follow me @jimsciutto on Twitter, also Jim Scuitto on Facebook. Meanwhile, I turn you over now to Wolf Blitzer he is as you'd expect to find him in "THE SITUATION ROOM."

WOLF BLITZER, CNN THE SITUATION ROOM HOST: Happening now, breaking news, millions uninsured.