Medicare and medicaid. Some of you have said, well, theyll fix it in the senate but you have every provision of this bill tattooed on your forehead. You will glow in the dark on this one. Robert but the president is confident he has momentum. President trump were going to get this finished and then were going as you know, we put our tax plan in. Pure tax reform. So were going to get that done next and this really helps. Robert we take the pulse of healthcare across america with peter baker of the new york times, molly ball of the atlantic, ed okeefe of the washington post, and erica warner of the associated press. Celebrating 50 years, this is Washington Week. Funding is provided by their leadership is instinct ive. They understand the challenges of today. And research the technologies of tomorrow. Some call them veterans. We call them part of our team. Additional funding is provided by newmans own foundation, donating all profits from newmans own Food Products to charity and nourishing the common good. Koo and patricia yeun. The corporation for public broadcasting, and by contributions to your pbs station from viewers like you. Thank you. Once again, live from washington, moderator, robert costa. Robert good evening. President trump has declared obamacare dead after House Republicans passed a healthcare bill by a narrow vote, 217213. Republicans rushed the vote, just 17 hours after the bill was finalized, and before the Congressional Budget Office could score the plan to estimate the cost and determine how many people it would affect. Here are a few of the prominent changes contained in the house bill. First, repeal the federal mandate that requires everyone to have Health Insurance or pay a penalty. Eliminate government subsidies to help people pay for coverage. Roll back the expansion of medicaid by 2020. Companies with a staff of 50 or more would not be required to provide Health Insurance but one key feature of the Affordable Care act would remain in place. Young people could stay on their parents insurance plans up to age 26, but, of course, a longer and possibly more consequential battle lies ahead in the senate where the bill faces bipartisan pushback. Mr. President , im sorry to disappoint you. This bill, in its current form, is not getting through the senate. No way, no way. The senate will write its own bill. I dont think that the house bill necessarily predicts what is in the senate bill. Robert peter, there was a moment of celebration in the rose garden but at what cost to the Republican Party did this victory come . And what does it mean for President Trump, only having a victory so far in the house and yet celebrating . Peter it was quite a scene, right . You had the president of the United States and dozens of members of his party there on the lawn very boisterous, very happy, very jubilant about something that hasnt happened yet. Its one thing for the house to pass. That doesnt make it a law. There was no signing today or yesterday of anything that actually will change the law so when he says that obamacare is dead, mark twain would have something to say about that, reports of the death are premature. The senate will take another look at it and there is a potential cost here. There was a reason why democrats sang nana nana at the republicans. Having said that, the democrats have gotten it wrong before. They said the same thing when republicans shut down the government, that they would pay a price but they swept the next midterm election. Its too early to say. Robert molly, what does your reporting tell you about the public reaction to the vote, all the lawmakers heading home for recess and some facing town hall meetings. Molly thats how republicans will get their finger on the pulse of how this healthcare bill is going over. Weve seen mixed signals in the past few weeks about how much of the resistance to trump was falling away, eroding. Democrats are now saying that they have seen a surge of enthusiasm, donations and participation, not just from their base voters but from a wide swath of voters who have been activated and galvanized by what the republicans have done on healthcare. But the way republicans will know whether thats true or not is that same internal sense that any politician has, when they go home to their district and go to a town hall, sure, there will be people who are mad at you but are they people that you know, are they people youve seen before . Are they the same five protestors you saw two years ago . And how many people are there, and what are they talking about . Are they people that worry you on a political basis . The republicans are going home for a week, testing the waters and political winds, seeing how bad is it going to be for us and one thing you dont hear anybody saying is oh, no, this will be a net plus. Even the republicans who voted for the bill, really dont hear them saying more people will vote for us because we passed this bill. Robert i spoke to tom tom macar and he and other centrists in the g. O. P. Seem the most skittish about the vote. Ed it was a good indication of why they should be. One report moved about races that were solidly republican, leaning closer into the democratic side. A few moved into the tossup category in california and colorado and others that were very republican are now lean republican, or probably republican. Guys like Mike Kauffman in denver and steve knight in los angeles to the north. Mario diaz in miami and mimi walter, another one in california that democrats are convinced they can knock off last year to continue what was starting last year. Its telling that people like Mario Diaz Ballard who represents part of miami told reporters this week, i dont like this but i voted for it because there was an understanding that to not vote for this would cause such an existential crisis for the Republican Party, you would probably be sitting here tonight talking about who the next speaker is and what a great guy paul ryan was for the 18 months he ran the place and instead, they live to fight through another week or two. But that recess, plus whenever that c. B. O. Score comes back that suggests how many millions of people could be affected by this and how many billions of dollars that could be moved around in the federal coffers, i think it will cause great heartburn in the next few weeks. Robert following up on eds point, it seems to be driven a lot by politics, the culmination of seven years of fights on the republican side against the Affordable Care act and a rush to vote because of that. Erica republicans have been promising ceaselessly, over and over again, for seven years, ever since obamacare passed, that they would repeal and replace. Thats how they won control of the house, the senate and the white house, in part. So its been their number one priority. They had to do it. Failure was not an option, as many of them said. Well, failure became an option in march when the bill collapsed on the first goround and many of us thought it would never be revived but trump really wanted it. House republicans really wanted it and kept at it and managed to bring it back from the dead. Now, part of the reason that many of them were motivated to do that, ive heard from republicans on the hill, is because their base was really pushing them. Internal polling was showing that enthusiasm was dropping from base voters and they had to do something to get back that enthusiasm from the base, even though liberals arent going to like it but they need the base enthusiasm to match and counteract the liberal enthusiasm to survive in 2018. Molly thats a really good point about the base. For so many years weve seen the biggest threat to republicans come from the base and its surprising that its interesting, as ed was saying, the members under threat now are the ones in the middle, the ones who have something to fear from democrats. Its not the Freedom Caucus guys or the guys on the right who swore up and down for years that nothing short of full repeal would suffice, that we must get rid of every single bit of obamacare, root and branch, any attempt to fix it was unacceptable, full repeal. This is not a full repeal of obamacare and this is not by a lot of conservative standards a very conservative bill and yet it is apparently good enough for the right wing republican base. Robert it seems almost the president is riding this republican horse thats carrying him along this path because as you said, the base is pushing for this but the president seemed to step back in the negotiations the second time around. Wasnt as involved. Didnt use the bully pulpit. Peter no, he didnt. He let the process play itself out. Hes not a detail guy and its not his thing to say, lets have this provision or that provision and at times seemed confused about provisions in the second bill regarding preexisting conditions. That wasnt his strength but he was what he did do was provide the energy to say we cannot stop, we will make this happen no matter what. Theres something to be said for that. There is something to be said for a president who provides energy and leadership and determination and leaves the details to others. Were not anywhere near the end of the process and he seemed to be celebrating at a point when we dont have a result. Ed nobody thought he would win the republican primary. He did. Nobody expected him to win the presidency. Nobody thought the house would do what it did this week, it did so, yes, trumps theory of the case is if we focus on winning instead of our differences, we can get things through even with the divisions and that happened. Robert its so complicated for the Republican Party because they were celebrating this week as a political moment but the details of the legislation, which could be changed in the senate, matter. One of the reasons the original plan failed to get a vote in march was the issue of coverage for people with preexisting conditions and it remains one of the biggest flash points in the healthcare debate. Under the Affordable Care act, insurers could not refuse coverage to people with a medical condition like diabetes, Heart Disease or cancer and could not charge these policy holders a higher premium. In the house passed plan, in states that apply for a waiver, insurers could charge higher premiums for people with preexisting conditions. The plan would also add 8 billion to an existing 130 billion highrisk fund. Many experts say the new funding falls far short of the money needed to provide coverage. When you look at the details of this, the president celebrating. But how does it affect his base, molly . Molly we dont know yet, in part because they rushed it through without a c. B. O. Score. And there is some debate going on about the degree to which that preexisting coverage loophole, you could call it, will or will not be put into practice, if this bill becomes law, which it will not because the senate has said they have no intention of passing the house bill. However, thats a big deal and that is why they lost republican votes and never even tried to get any democratic votes for this bill. And that is going to be the thing that the democrats try to hang around republicans necks, that all of these people want Health Insurance and now cant get it because of something that the republicans did. And its very likely that will be the case. Robert erica, i see you walking through the capitol all week and you followed the policy closely. What was the republican thinking behind trying to give this waiver for preexisting conditions . And does it mean if youre in a state like wisconsin, with Governor Walker who is talking about the waiver, what does it mean to have this republican plan if it became law . Erica its not clear how many states would take this waiver. And, in fact, g. O. P. Leaders think that few, in all likelihood, would. Weve heard from walker that hes interested in doing so. I must say that that addition to the bill, the waiver that states can take to allow insurers to get out of the preexisting coverage requirements, that was the deal that brought the Freedom Caucus on board which then pushed moderates away. They were then brought back on board with the 8 billion addition to the fund that you mentioned. In both cases, these deals really were fig leaves. Neither of them does a lot. The waiver may be taken by few, if any states. 8 billion is a pittance for highrisk pools which have had a very mixed track record. So in both cases, in my view and a lot of republicans on the hill, this all came after the initial failure which was very humiliating for republicans on the hill and off, and these different groups were finding a way to get to yes. Amazingly, they did so, but the policy implications may not be huge of the changes that got them there. Robert there are huge challenges in the senate. Senator portman of ohio, from a swing state, is already expressing real concern about the phasing out of medicaid expansion. Ed hes not the only one. Shelly morcapito of west virginia, that state has seen its Medicaid Program grow. Tom cotton, who many see as a rising star in the party and a pretty loyal conservative foot soldier in just about everything else, told our colleague in a story in tomorrows the washington post, that he has to be concerned about this because there are tens of thousands of people in arkansas who now receive medicaid and he realizes his state has no other way to pay for these things so youre going to see by geography and ideology, a different debate take place in the senate among some republican senators you might not think would be concerned about the law but they understand the politics of healthcare back home. Robert were testing an interesting historical lesson, that once enacted, an Entitlement Program doesnt go away. Once youve given the public government benefits, of course no politician would take it away even if they disagree philosophically. This is the first time i can think of in a long time where they want to do it and the reaction will tell us a lot about views of government and size of government and reach of government, people who might not suffer themselves might support it because they think its wrong for the government to be involved. Its not just getting rid of a federal Spending Program but the president promised insurance for everybody and this bill has not been scored by the Congressional Budget Office but in the original incarnation of the bill, more than 20 Million People in a decade would be set to lose their insurance so this is a president who has a populist instinct of insurance for everybody but whats the reality of the legislation . Molly it falls very far short. Theres no question that no matter what the Congressional Budget Office determines about the bill, theres no way it will fulfill the trump promise to cover everybody with healthcare that is better and less expensive and is available to all americans. Its just not what this bill is even designed to do. Its at its very best, it could provide access to healthcare through the private market to more people because the private market is eventually functioning better with fewer restraints. But so i think thats an issue, right . You have a president who many times made these promises that his own congress had no intention of keeping and you can but ive heard from many of my republican sources today that they worry that that moment in the rose garden with trump celebrating obamacare being dead is the equivalent of the george w. Bush Mission Accomplished banner, celebrating a victory prematurely that voters held the party accountable. I had one voter saying all it was missing was that mission you heard Kevin Macarthy saying this week that nobody will lose Medicare Coverage that has it now because the changes wont happen until 2020 so you set people who are in their late 40s and 50s who were planning to have medicaid in the next few years, theyre the ones that have to scramble. Who has been most affected by the economic downturn in recent years, middleaged guys who usually vote for republicans. It could be a huge problem for the party especially next year. Erica its also worth noting that by the time the 2018 midterms roll around, none of this will have become law. Even if the bill were to pass, which it wont. So the existing problems with the Healthcare System that republicans are constantly complaining about and blaming on obama will still be in place so what are republicans up for reelection going to do at that point . Do they still blame obama for the problems in the Healthcare System that they simultaneously claim they tried to fix . Im not sure thats a winning midterm message. Robert its so hard to read the political fallout and complications. I was reading comments from congressmen. Congressmen barton of texas said texas would take a waiver. If youre calculating all of this, you dont even know how the states will respond if the bill becomes law and id like to say if you have a healthcare story youd like to share, send us an email. The address is on the screen. Healthcare was not the only issue this week. President trump signed a 1. 1 trillion spending bill today that will keep federal agencies funded through september. Congress passed the budget earlier this week after intense negotiations between democratic and republican lawmakers. To no ones surprise, both sides claimed victory. Pointing to additional funding for Border Security and the military. Democrats blocked the g. O. P. Efforts to secure funding for the president s famous promise, his border wall with mexico. Peter, because the president did not get the border wall in this round of funding for the government, does that mean well have a shutdown in september when it expires . Peter he said so almost in a tweet that came out afterwards. He said, well, we have to either change the rules or we need a Good Government shutdown in september. Now, thats a negotiating position. He made a calculated decision he was not going to go near the cliff that republicans have gone to several times in the last few years of possibly risking the government shutting down. Its a rational decision that chaos would have been worse than not winning on certain budget items. People wont remember that and this is a shortterm bill that he can fight another day. But come the fall, if he doesnt get some of his bigger priorities in, thats a different situation and it will be a test for him because at that point youve lost the first really two years of your presidency, if you cant start to get some of that funding. Robert when you look at the budget, this was a bipartisan agreement and most of the top lawmakers in capitol hill seem comfortable with it in spite of it not having some of the projects. Ed this was some of the bipartisan deal making we pine for from the past because they were essentially left alone to figure out how to get this passed. It wasnt until right after easter that the white house interjected and said, what about the border wall and republicans and democrats told Mick Mulvaney the budget director to go back to the eisenhower building and wait out an agreement. It was passed and border wall money im told was never part of the conversation, even during the transition when the appropriators worked on this. I do think we face a bit of a showdown later this year if negotiations continue and theres no sign of border money. Remember this, the calculation will be different. You always think the party in congress will be blamed. The party that runs congress is the Republican Party. And senators especially know if anyones going to be blamed for the shutdown, it will be republicans entirely because they control all the levers. Robert some people on the outside might have been singing consume kumbaya, but the president reacting and democrats reacting. Erica its worth noting that democrats were able to take a victory lap, but thats partly because of the mixed messaging coming out of the white house. Had the white house said all we want from this spending bill is a bump in defense spending and then it will be the best omnibus ever, they could have claimed victory but instead trump comes in and wants the border wall which was never going to happen, which was not feasible under any scenario so he doesnt get it and it looks like a loss for the white house and schumer can claim victory. I think the white house, a little more discipline from them, and letting the hill republicans do what they do best, without interfering, might work out a little bit better for them. Molly it was amazing to me and perhaps as peter said, im not giving him enough credit and it was strategic but for the president to threaten a shutdown when he has just made a successful bipartisan deal he could claim victory on, it seemed to be almost snatching defeat from the jaws of victory because he could have said look at this great thing we all did together. I think he was stung in part by the criticism from the conservative media because they were earnestly dismayed by this bill which didnt make all of the cuts they would have liked to have seen to agencies and programs. Very much a status quo. But it fell short of a lot of the things that conservatives felt they were promised. Trump is very sensitive to criticism, i think, from the right, and that was part of the reason he had to go out and say, dont worry, guys, well take them all the way to the brink next time and get the things we promised you. Today he signed the bill, on friday he signed the bill, no publicity whatever. This is the biggest most consequently thing he signed as legislation goes and nobody was there. He did not have, while it was a return to the bipartisan days, he did not have senator schumer and nancy pelosi and both sides of the leadership to the white house for a ceremony like the old days so while they may have moments of kumbaya, its not really erica . Erica he could have not signed the bill. Robert what a week for President Trump and erica, welcome to Washington Week. Our conversation will continue online on the Washington Week extra where well talk about former secretary Hillary Clintons interesting take on why she lost the election and why she and james comey are on the same page when it comes to russian interference. You can find that later tonight at pbs. Org washingtonweek. Im robert costa. Thanks for watching and enjoy your weekend. Funding for Washington Week is provided by boeing, newmans own foundation, donating all profits from newmans own Food Products to charity and nourishing the common good. Koo and Patricia Yuen through the yuen foundation, committed to bridging cultural differences in our communities. The corporation for public broadcasting and from contributions to your pbs station from viewers like you. Thank you. Thank you. Pedro e. 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