Thank you. Let me introduce sarah kliff, senior policy correspondent for vox Seung Min Kim and with politico. We will talk a lot about our bill. Would you tell our audience the most important things you need to know. To give further context, as a physician my practice for 30 years with the help those that were uninsured and underinsured. The Public Hospital was decrepit. In that i found if a patient has the power that the whole system lines up to serve her. Our bill we intend to give her the power. Because women make 95 of Health Care Decisions in our society. And we return power back to the we give her the power states. How do we do that . We give states the option of going with a better choice. Doing nothing, or stay with obamacare. But that is federalism. We allowed the money to follow the patient. If they go with the better choice, the patient would receive a tax credit that she they could on be used for Health Insurance for health care. If she does nothing, she will have a Health Savings account prefunded. And a highbenefit deductible health plan. But she can manage it to make it work better for her and her family. The goal being to enable her to become the activated patient who we have learned from empirical evidence will have Better Health outcomes and a lower cost. That is our goal. We will turn to sarah for perspective. One of the big differences between the better way plan and obamacare is the tax credit is the same for everyone. If i am buying insurance on my own, bill gates, senator cassidy that is not true. Walk me through how this is different and similar. Senator cassidy the way ours works is we give states the option. We think states should have the option. Lets imagine one set of options. The tax credit would go to the patient. She would have the policy i previously described. Those who would qualify would be those who do not receive an income tax benefit from employer sponsored insurance. Upper income folks almost always have employersponsored insurance. We would begin to phase it out at the top level. Even if bill gates is in the individual market, he gets nothing. On the other hand it phases out lately so middle income families who have this cliff under obamacare, 400 of federal Poverty Level gets nothing. Our slightly phases out. There is some support for those middle income with three kids. We empower the patient. Obamacare tells the patient what she has to buy. So many women told me stories. One woman was 58 and her husband 59, she does not by obstetrical benefits. Unless my name is sarah and he is abraham, we dont need those benefits. You chuckle but you get the point. We want her to combine if she on her familys credit so they can buy a richer family policy. They can define it as the employer contribution to the employees sponsored plan. If they decide to stay with their Health Care Savings account one person has cash , exposure outofpocket, other members of the family can contribute their Health Savings account cash to help meet that family members expense. We give her the power. If you can give for the power, Health Outcomes are better. One of the interesting features about your plan is it leaves obamacare as an option. The politics of that are interesting. How do you persuade members of your party who have held for years that nothing but completely repealing obamacare is unacceptable and your plan is a good one to join . Senator cassidy but thats lets talk about principles. Susan collins says ours is the most republican of plans because republicans have always believed in federalism. If california in new york love obamacare, i think it is a mistake. I think ultimately you go with our way. On the other hand, a republican principle is that our Nations Capital should not be telling state capitals what to do unless it is something pertaining to war or Something Like that. If sacramento and albany want to keep obamacare, and we mean a unlike president obama who did not, this is our way of fulfilling that principle. If sacramento, albany, washington state, if they want to say, god bless you. It is not for us to say otherwise. Those days were obamacare is not working like louisiana were the individual market is going crazy, you can choose a better way. A better choice. I want to followup up on that idea of keeping your Health Insurance plan. I know one of the big frustrations with the Affordable Care act are the essential health benefits. The idea that you cover a wide array of benefits, including Mental Health services, and that drives up the premium. On the flipside of that, before the Affordable Care act there were a lot of pregnant women who could not get their Pregnancy Services covered. For they found those were very expensive. They were shouldering the burden and set of spreading it out among a larger pool. I am curious how you see your plan. How does that serve people like pregnant women who need Mental Health services, people with a High Health Care burden . Where will they be left under the better way approach . Senator cassidy the better ways paul ryan. A couple of things. Among the essential health benefit, one of those is Mental Health. Specifically for serious Mental Health issues. That is the one time where someone may be incapable of making an informed decision. Number one. Number lets speak about women two, in general. I will speak about what is in my bill and what we hope to also a accomplished going forward. Turns out women in their 20s cost more to care for then men. They have children. You just mentioned live. One thing i would like to do is to give women in their 20s a greater credit. For example we have seen stats that women in their 20s cost 1. 64 times that of a man. As a physician, i think they should get 1. 64 times the credit. Women are the future of our society. They bear our children. We need to protect them. Second, the Health Savings account law, you can have an hsa in which Maternity Services are typically not subject to a technically not subject to a deductible, meaning the woman is not exposed to outofpocket exposure. We would strengthen that. Making sure that throughout the course of her pregnancy she would have the option to buy a policy in which she would not have a deductible or copay. The third way we do it is we mandate Price Transparency. If there is a woman out there, and many women are like this, shes going to cost shop will know the soup to nuts co sts of her delivery before she goes in. That allows her to purchase the service, the provider, the hospital that gives her the best value. There is a lot of women that would do that if given that information. We will mandate the Price Transparency for her to get the better cost do you mandate. That some insurers cover maternity . The bigger question is do Insurance Companies want to cover this experience that is quite expensive . Senator cassidy if she keeps the standard policy and imagine she and her husband have hsas with a High Deductible Health plan. It may be that she moves into the High Deductible Health plan portion. Lets imagine between them they have the cash value for 4000 of Health Savings account they would apply to it and a High Deductible Health plan picks up everything after 6,000. There might be the 2000 exposure. Other family members can chip in from their Health Savings account to cover that exposure. That is another option. We have four or five options for how a family may choose to address that. Speaker ryan laid out an ambitious policy agenda, one of those things was repealing and replacing obamacare by april. Is that realistic . Senator cassidy i dont think so. Let me start over. When we say repealing the place, repeal and replace everyone , assumes there will be a let there be light moment. At one point in time every thing goes away. I think if you listen carefully and i think this is a better to what paul ryan says interpretation, he says it , should be done concomitantly. There should be a transition period. We will not hold the rug out from under these people. He is not speaking at one point in time there is a great divide. What i pointed out is that we would do the first reconciliation and repeal of obamacare and set the stage for replace. Republicans have always said that we should, that we want to keep the provision that someone can stay on her parents policy until age 26. Dont repeal that. Because you dont repeal that, it is inherently part of your replace. By the way, that was originally a republican proposal. One of the few incorporated into the aca. We will keep that. So so we will keep that. We will speak a process you are familiar with. If it is a true repeal and replace we need Democrats Join with us, that would be a 60 vote threshold in the senate, which means we will need at least eight democrats to vote with us. That would be another portion. The second reconciliation bill in the fall will be conference conference of tax reform that may be completed at that point. Let me mention a time when i would prefer. That this year, 2017, Congress Passes legislation that gives states the authority to choose in between our better choice 2018 option or to stay with obamacare. In 2019, they would implement their choice. In 2020, it is all done. Is that simultaneously replacing . Absolutely. That avoids the disruption. I am a doc. I keep on thinking of the woman who did not go to college, works hard, a little bit vulnerable economically. She voted for donald trump becuase she cannot stand for her 6,000 deductible on obamacare. And she has Breast Cancer. We need to take care of her. She should be the prism through which we will have the system. The only thing she should notice as she goes toward physical healing is that her coverage gets better. If we keep her as a prism knowing that if the worstcase scenario this drags out, thats her coverage is not dropped off after two years or three years from the deductible is no longer 6,000, her coverage can help support her. We have done our job and that is my goal. Lets return to the economics of your legislation. You mentioned you propose to keep the 26yearold purchase option. You also want to keep the preexisting conditions mandate. Senator cassidy as President Trump says he wishes to. But as i understand your dropping the individual mandate and the employer mandate. How does the economics work . Senator cassidy americans hate the federal government telling them what to do. They ate it. They hate it. The individual mandate is one of the least popular things about obamacare. The employer mandate right behind it. So out of the gate, that should , be repealed. Get rid of the individual mandate and employer mandate. Legacy of new hampshire, live free. We get rid of that. But the way we accomplish the the law of big numbers how do we keep the people in to make it sound . We give states the option to say everyone who is eligible for these tax credits is enrolled unless they choose not to be. Think of when i turn 65. I will be on medicare, not a mandate. I can call them up and tell them i dont want to be on medicare. But otherwise i am on medicare. We do the same thing. We say that we give the states the option to say you are enrolled unless you choose not to be. The credit the person receives would be sufficient for the premium. It is not like it is out of their pockets. First i will say this reaches to two folks we need to reach. And posted on the responsibility of their life. The first is the person living underneath the bridge who will never go to the Public Library and log on to healthcare. Gov and sign up for an obamacare policy. He just wont. He does not have his life together. We provide him coverage. The other person who is quite irresponsible is a 28yearold man who does not think about Health Insurance and has a loan to pay and a car note and is trying to buy new clothes for his new job. He will not take his outrageous rates that obamacare demand he spent spend for coverage he thinks he will never use. I have breakfast with a 20yearold hundred newer it is not have Health Insurance because for him to buy it is too expensive and he cannot maintain his business. You restore the love big numbers. By doing so, one person gets sick, that cost of that illness is spread over the many and not concentrated among the few. Health Insurance Companies say just by that provision they will lower premiums by 20 . That is huge. We are at the nine minute mark left to go. I was at your press conference where you announce this bill on monday. You talked about how you thought it would appeal to democrats in california and new york. They would like to keep obamacare, which i think they do. So far the reaction is been quite negative. All of the Democratic Senators i talked to did not like the idea of getting states the option to doubt or do nothing at all. Im curious if you would talk about any conversations you have had with Democratic Senators and whether you expect the town to change or do you feel it you are running into a bit of a wall with them . Senator cassidy several things. Ive spoken to five or six or seven different Democratic Senators at length. I have other appointment set up. We are actively reaching out. This is not a republican plan. It is not a democratic plan. I want to be about that woman, economically vulnerable with Breast Cancer who cannot afford her 6,000 obamacare deductible. It should be an american plan. Chuck schumer criticized it saying things that were not true before he read the bill. I know it was before he read the bill because we had not yet introduced it. So i think he has a partisan, as , the minority leader is trying to crack the whip. Telling his senators that you listen to me even if this is an attractive bill. That is what is the worst thing about washington, d. C. I am first a physician and after that i am a partisan politician. This is about patients. If they have a better idea about how we can improve this bill, we are open. Totally open. The fact that before someone reads it he is telling his membership not to endorse is what is wrong with this debate. I would just say, mr. Schumer, we looked it up. Individual marketplace rates are going up 16. 6 in new york. If you are ok with that, and new york wants to keep it, keep it. Why should you force one of your Democratic Senators in a state where premiums are increasing by 40 per year, force her or force him to ahere to a policy that benefits new york, but not their state . Hopefully the senators will see it as i. It is about that woman with Breast Cancer, not about partisan politics. Can you disclose which democratic seniors senators you are talking about . Senator cassidy i cannot. I wanted to shift to some other big news we have coming up next week with the Supreme Court nomination we expect from donald trump. Senate democrats, including minority leader Chuck Schumer have already said we will block someone who is not mainstream. Schumer has gone on to say he does not expect mainstream nominees from this president. Should republicans be prepared to use the Nuclear Option to change the rules so Supreme Court nominees will only need 51 votes . Senator cassidy i will echo Mitch Mcconnell, whoever the president nominates, assuming they are reasonable, they will get approved. Period. It sounds like you are open to going nuclear. Senator cassidy i am open to doing what we need to do. I have Great Respect for the institution. I think there is such advantage for having to build bridges. Obamacare past on strictly partisan lines. It never built a bridge and that is why it has never been fully accepted and is not being rejected. That is why i am trying to build a bridge and Susan Collins and others are trying to build a bridge. The Supreme Court is an opportunity for us to build a bridge. But if someone before someone is nominating declaring just as he did before reading my bill that he is going to reject it and totally recognizes as partisan politics, that can change. I hope as with our bill as with the Supreme Court nominee the merits of him or her will be considered as the character and not the label of the party. Four minutes left. I want to ask you about some news that broke on obamacare earlier this week. On thursday, politico rolled a reported a story that the Trump Administration what stopped advertisements on obamacare. The last day of open enrollment is january 31. Former Obama AdministrationOfficials Say that this moment is important to get those young people who have been too distracted or dont care as much about coverage to sign up. I was hoping youd comment on the Trump Administrations decision to halt these ads that were prepaid by the administration. They are not getting any money back from this decision. Senator cassidy i was not even aware of that. I had not even thought about that. I have not thought about it. I would rather not render an opinion on something i have not even contemplated. Not to duck, but i have not thought about it. Can you talk a little bit about relationships in washington. One of those important relationships in d. C. Will be a relationship between President Trump and majority leader Mitch Mcconnell. We are only a few days into the new administration, but how do you see that elation relationship going so far . These are men with very different relationships and tactics. How do you see them influencing each other as 2017 continues . Senator cassidy i think this could be one of the great partnerships and political history. Mitch mcconnell did his phd thesis, i think he is a phd, on henry clay. Which meant he also studied Andrew Jackson. Contemporaries, they butted heads. He spoke about a picture of donald trump and behind his head was Andrew Jackson. And how for the 40 years before Andrew Jackson, every candidate for president was establishment. And jackson came in and turned it over. He compared that approach to what trump is done. We have gone through a series of establishment candidates and also what is coming in just like jackson and turning things over, refreshing if you will. If anyone is going to have a Historical Perspective on the donald trump presidency, it is going to be Mitch Mcconnell. Mitch mcconnell always has his eye on history. In service of our country. I think it can be great. Is there a potential for friction with Mitch Mcconnell being establishment . Senator cassidy of course there is. My wife and i have friction. I have been happily married for quite some time. In any adult relationship, the there is friction. On the other hand, what is important is not donald trump or Mitch Mcconnell, it is our country. I think they will both focus on our country. As long as we keep our country, trump said he is about the person who has been forgotten. I liken that to the woman i refer to with Breast Cancer. As long as we focus on her, our country will go forward. Since you are so bullish on the new administration, just a question about the new president s focus. Voter fraud. Do you agree with it . Senator cassidy that is one of those things where, obviously, i once read about henry clay and Andrew Jackson. Whatever they ran, 1834 in like that, Andrew Jackson got three times as many votes in Plaquemines Parish as people who lived in Plaquemines Parish. We have to make sure there is integrity of the polls. Of course we do. By the way, Plaquemines Parish is much better now. My point being that there is something to show that indeed you are this person. That can be a drivers license. They can be a utility bill. It can be anything with your name on it and the address. It is low threshold. It presents the sort of thing that happened Andrew Jackson and henry clay race. I think that is important. Ive been thinking about health care and not this sort of thing. I just dont Pay Attention to that. No offense. You have to think about that, but that is the degree to which i have thought of it. I will give you 30 seconds if either has a final question. Going back to your health care plan. What has been the feedback from leader mcconnell and the prospective chairman about it . Senator cassidy it is more of a kind of general conversation, not so much with leader mcconnell as with others. They feel we are moving i think. Theyre becoming better aware of the issues and folks will have that understanding. The medicaid expansion, we have had republican governors come with a very good presentation. They would like to see it continued. They need freedom from restrictive d. C. Regulations and continued income stream. That is important for us to hear. It has been a good conversation. One small followup question. Have you had any interaction with President Trump or the white house about your Health Care Bill or the proposal they said they are working on . Senator cassidy tom price and i had breakfast once weekly for two or three years when we were in the house together. If you look at his bill and our bill, there are differences. In some parts it is plagiarized. I think he copied me. We will let that go. The point being is his awareness of what we are trying to do and , i just asked my staff today if they would make an important because i would like to give him the courtesy of what we are talking about. Senator cassidy that is it , for our time. Thank you for coming. As this debate over health care continues, please come back. Senator cassidy thank you. Thank you for being with us. This week our guest was senator bill cassidy of louisiana, a physician who has been involved in the Affordable Care act debate, says he has a plan for changing it that he is advancing in the senate. Our two reporters are sarah kliff and Seung Min Kim. What are the prospects for his legislation . Based on what you are both hearing. I think right now does not looking especially bright. Senator cassidy has framed this as a compromise bill. But democrats have been critical. I dont think they like the idea of any state repealing obamacare. Even if they get to keep it in their own state. Senator cassidy says he has been talking to Democratic Senators. It is possible we might see some shifts as democrats think about what their strategy looks like. I would not expect Serious Movement on this in the next few months. I think it will take a lot of work for democrats to sign onto a bill that lets some states get rid of obamacare. Democrats dont want to get rid of obamacare. Republicans have been operating under this pull it out by the roots. Bears, aike the three little bit of each and does that make it possibly enough . You may make a lot of people happier or you may make nobody happy, which is the problem. It is important to hear what leader mcconnell wants to say, orrin hatch, lamar alexander. They will be driving the train as far as obamacare appeal. Repeal and replace it looks like. Even if democrats are resistant now, i think it republicans have a successful repeal vote and donald trump signs that into law i think that creates a , different political environment for democrats such as joe odonnell and indiana, bill mansion and West Virginia because now you have to do something. That is what a lot of republicans are banking on. That pressure will create the political will for moderate democrats to come on board. They may not say yes now but who knows in several months. There has been so much news over the past seven days. It is amazing to think we are only going into the second week of the Trump Administration. One that we know will be a Supreme Court announcement. What happens to this town given the fractured politics . I think it will be quite busy. I think some will be covering it more than i will, but i think it will be very not a lot of working together. Focus. On the policy does every thing else stop . They cant turn issues Like Health Care . I think progress will still be being made. A lot of ideas are being put out there. Senator cassidy and senator collins and then two days later, rand paul from kentucky, he introduced his own replacement plan. What youre seeing now is republicans just as surprised as many of us were that donald trump won the presidency and they are trying to play catchup , make sure they have a good array of ideas. What you will see happening, regardless of what else is a lot of capitol hill staff and a few key senators really drafting out ideas, which is how obamacare started, where you have a number of competing bills that duke it out a little bit and end up in some kind of final form. Democrats are unhappy with the way the Supreme Court pick handled. How does this one play out . The feelings are very raw in terms of mayor garland, Merrick Garland was treated. Democratic senators are not trying to say we will do payback yet, but there is this sense that look, that is always going to be in the back of their minds. We dont know who the nominee is and that is why schumer and everyone else are saying let us look at whether they are qualified. You will have a lot of pressure from the outside these progressive groups, saying look at