A vote could come as early as next thursday. Now, a look at the future of healthcare in the u. S. The senates work on healthcare is the topic of the next discussion. Also the longer look at what healthcare might look like in the United States. To guess joining us the senior policy correspondent and joining us for this correspondence is the White House Reporter and to both of you, thank you for joining us. I know you do not write the story but your colleagues say house that there is a plan vote on healthcare especially on the senate side street. Could you give us a sense of the white houses role and what youd like to see happen . Right in at brown now the cbo score early next week and then potentially vote on thursday. Is it was not yet aware that republicans have the votes that they need but a firmer sense at the end of the week and their confident things are heading in the right direction. And what is it being based on . Is the senate willing to take a gamble even at the votes are not there . The house was charging towards a vote in march, kind of getting reading and in a dramatic move they pulled it at the last movement. Moment. They realized it didnt have the votes didnt want to put up the bill only ton fail. It is still unknown whether we will see a similar scenario play out in the senate. Things feel very unknown because we have not seen the bill tax if we see a vote, and friday this week we may get a sense of what0 the senators have an even aat all t possible vote and all these issues been resolved is that the case as far as the major issues . S. I think theyre still looking through some key issues. Medicaid has been a challenging issue for the senators. A number of senators who represent states who represent the Medicaid Expansion and the effects it will have on the constituents. D we did look at some effects of it and it looks like theyre getting closer to the finish line. Thats a key area that im watching. One thing weve not heard a lot about is the tax credits people get on the individual market. There has not been as much information coming out about how generous those would be. If you remember last week donald trump called the hospital mean bill. Yes the senate to come up with something more generous. Well see if that fosters into the type of tax credits the senate includes and their version of the house bill. When trump make statements like that does that company get the process as far as what the legislators have to do in order to get a final bill done . It didnt make their life any easier. They had quite a push to get them across the finish line and got many of them to vote for this bill. Apparently the president did refer to some. It could make the Senate Republican easier. Itse the Senate Republican party could position itself is making a bad bill better and that would make people who want to pretrade as been more complicated. The important thing is that Senate Leadership just like house leadership at some point needs to put a bill out there in order for people to coalesce around it. In other words you cant really count the votes until theres a bill. Once you have a bill if yourr leadership trying to get across the finish line you really just want to move quickly to that point. Are two guests who are joining us to talk about thefu Senate Status of healthcare in the future status of the healthcare system, if you want test questions about this we divided the lines differently this morning. Heres where were breaking it down. If you see insurance through the Affordable Care act called if you get insurance from your employer call is the white house okay to move on from this topic regardless of what happened . Probably would like to see a win but are they okay if we dont get it . We for conflicting signalss whe about this. That was the approach the whitebi house started with over the house bill. They said they were done and walking away. What has happened is they got a sense that a win was possible and thats what brought them back to the table. Right now you dont how long theyre willing to stick with senate because you dont know ifry the first trade is going to succeed. You have to go through that same process. On the senate side were coming up with a july 4 break. Theres an august recess theres talk about shortening that. Are Senate Republicans okay with moving on if this doesnt work . Can you also had on who are the close people to watch particularly on the senate side . I think thats a great question, does mcconnell want to deliver on this when wars their lobbyists who said that Mitch Mcconnell just needs to show w them a body he just needs to put up for vote, the feels they can say they tried to do it and move on. I think these two next week will l be quite instructive and i think back to the house experience with a declared obama care was the law of the land that look like theyre about to move on and then two months later they pass the bill. Po i take everything with a grain of salt in terms of how strong the commitment is to repeal. In terms of senators to watch you have two moderate senators who are important to this deal. The senator from alaska, two women quite concerned about the medicaid cuts in the bill who are pushing for more generous medicaid funding. On the other side you have more conservatives senators like michael lee, ted cruz who are pushing for more aggressive cuts and you can maybe lose one side of that spectrum but its a difficult balancing act trying to get everyone to coalesce around the same bill. Remind us of how this will be voted upon. How many will be needed to getil the bill passed give us a sense of the blowbyblow. They just need 50 votes to move to the senate. Te there using a process called reconciliation. With a can do anything that relates to the budget and only need 50 votes. They dont need to get to the 60 votes majority. They only 52 members of the chamber and dont expect any democrats to vote for. The only need 50 votes because of the avatar the Vice President can come in with a tiebreaking vote and obviously we have a republican Vice President who supports the bill. We dont fully know how the debate lungful. Seems like therell be some timeframe in which senators can offer amendments or speeches. Last night minority leader check schumer was pressing that it would we have at least ten hours to debate this. Ar Mitch Mcconnell would not really commit to a time. To we see a direct hand byen the president or Vice President was senators visiting them or encouraging those who might still be iffy on whether they can support this . Not right now. S that this is a strategy using Insurance Market woes in a number of states to drive home the message that they have no choice but to vote for healthcare belfast to prop up the markets. Coincidentally this wednesday is one of those major deadlines for come rates and participation information to come in from a number of states. That is expected to be a turning point this week in that discussion. The white house was willing to get involved at the end to get votes across the finish line where they thought they could be helpful a passing a house bill. That could happen again depending on where they are pointed out. The senators come down in some ways all 52 senators on the republican side are what you need to watch. Have will talk more about this we go on. Our first calls from william from new york. He is insured under the aca. Youre on with our guests, go ahead. a morning. The future of healthcare has to include the repeal of obama care because for selfemployed people we literally have been thrown under the bus. We used to have Health Insurance now, my family is a family of three, we have an 11000 deductible. We pay 600 per month and we go to the medicaid clinic. All the doctors do is look at their screens, we dont see doctors anymore we see nurse practitioners. Is the worst case nightmare for self and cared the true self and my wife had have a mammogram and it was 650 in advance. All we have is bills. So when you hear the democrats talking about preserving obama care the democrats are self employed people under the bus. S. We have no Health Insurance just enormous deductibles. Our coverages. Mployed medicaid but the differences because we work we pay for it. Repub whatever the republicans do for selfemployed people will be better that has existed. We pay 20000 before we have any coverage in what we do have is medicaid. Its a atrocious. Host thank you for sharing your story. Im sure this isnt the first time you hear this argument. Youll hear the president talk about victims of obama care for people talk about higher premiums, higher deductibles and t narrower networks, scene changes to Health Insurance theyve noticed since the Affordable Care act came into effect. They were benefiting the system in which Healthy People paid less and sicker people or highrisk people paid more and were not able to get insurance altogether. Under the new system it tilts in favor of those who have higher w claims. Istrat conversely you have people who feel like they have lost out and to some extent they can be right. There is a tradeoff. Americans havent decided which tradeoff though except. When ive talked with democrats when they talk about what theyd want to fix with the Affordable Care act think they would identify some problems that we need to provide more generous Financial Support andnd spend more money to make it more affordable for individuals enrolled. Thats not the approach republicans want to take. One question is how someone like william gets treated under the American Health care act. Thats a bill the Congressional Office expects because the dr. Both to rise more because its providing less generouse support. S not these are questions and frustrations i hear from obama care enrollees. Sol its not clear to me that the republican bill the past the house would solve these. Host a color from maryland. Was gone to another call jan from massachusetts online. Caller good morning. I just wanted to say that i remember the day they were doing the first passing and im told the president they had is vote and youre watching cspan all day, so im watching the form and i see paul ryan come in and say that he just had lunch with the co batna. And unlike what went on with at lunch because three or four weeks later theyre pulling out of virginia and its crazy. And obama care everybody was worried about and bills. Mitch mcconnell asked to have the program on the ohio river not be canceled and have complete funding of that. And now, i dont understand. The whole reason we get a job is to get Health Insurance to come with it, longterm shortterm disability, life insurance, this is normal since 1974. Live on a very happy that i am a military brat and i got to live on an army base in japan where i never had to worry about food, clothing, education, security. I get back to the states at the age of 12 and you people are nuts. Its been the same thing every day. Ay host okay thank you. Re guest i think the process has been challenging and interesting to watch. Theres a lot of concern and part of everybody would talk to about what is the role of the Health Insurance industry and how vulgar they is been interesting to watch that its been a little bit muted in this debate if you think back to 1994ck before ours covering healthcare i looked at that debate and it was an aggressive attempt of the healthcare to kill hillary care. You have not seen industry playing as much of a role. You might expect hospitals to really be throwing everything that happened this, but they seem a bit on the sidelines at this point which is been surprising to me as a reporter to see the. The hill reporting thing inrance, iowa that theyll stay in iowa and he could see premiums rise almost 50 . The white house look at this because it is one of Donald Trumps things during the campaign. The ultimate collapse of the current state of obama care. A number of significant rate increases came in last year that were confirmed before electionre day propelled Donald Trumps campaign and we are seeing in some states similar increases being proposed. There is a bit of a backandforth debate where democrats blame republicans for the rate increase this year. But the republicans have sabotaged it. And republicans reply that they did not create the exchange with the problems i have today. There is a bit of a political calculation. Do republicans as the last to touch Health Policy, get blamed now for just any problems that arise from the healthcare act, but any problem that any person has in the Health Policy at all. People have gripes in many has nothing to do with whats going on in washington. But its nash track natural that they will attribute them to the healthcare act. s appear to say that we saw these trends happening in the Previous Administration . The Current Administration gets exacerbated the new announcement w sourcing . I think both of those arerethe true. S. I think the obama care marketplaces were struggling a little bit. There sing carriers leave the market, they were not making money. U you saw increase in countiesea that only had one health care imagineen insurance available which is not the type of competition they imagined. Ertainly they thought there be robust and vibrant markets. That is true for a number of reasons and how this was l designed that the markets were not functioning as democrats wouldve liked. You see monopoly markets with high insurance rates. Theres also certain actions that have is ask exacerbated these. One is costsharing subsidies which is this fund to help lower copayments for lowincome obama care enrollees. The Trump Administration has been ambiguous about whether they will continue paying the subsidies. Youre seen some insurancepa Companies Say we dont know forget this money and dont want to lose our shirts. The blue cross plana northhey woul carolina which is the only carrier left in that market said they would have raise the ratestheyr a person but because they dont know about these theyre asking for 22 rate increase. It is true there were challenges Health Markets face before the Trump Administration. If you read the insurance filings you see a lot of Insurance Companies are tribute in the right hikes to the congres uncertainty the white house and congress has created. We still see ambiguity about what decision will be made ont . That . Guest yes, but they hinted at a couple of different directions. Its also a manager of subject ongoing litigation. Republicans did not create the legal uncertainty over the payments and so far as they did not draft the bill they created what one judge has there is some backandforth and you can see how complicated this weekend if it were played out as a nickel debate and blame game. Nt kn right now we dont know, the white house is not committed to paying these funds. They paid them a little bit and part keeping the lawsuit alive. Democrats tried to get a permanent appropriation for it under the spending bill cut earlier this year when they couldnt get the deal they walked away from it and pursued other goals. Louise both talking about the future of u. S. Healthcare. No skull is linda in dallas, texas, go ahead. Healthca caller im quite please with the healthcare that i have. Under that healthcare didnt go to the clinic or my chores it really is good and im hoping with new Health Care Bill it does not change in a bit my dr. Would get referrals and also id like to say that im hopinge that nothing changes to the hospitals that take care of the low income residents in my district. They go to parkland hospital. They take care of them under their special insurance. Im hoping nothing changes there. Fi thank you. Someone who is satisfied with healthcare. How does that change depending on what happens . Gu it sounds like she is that a Medicare Advantage plan. The somewhat untouched with whats going on in the hill. Commun she is also raising questions about the future of programs in her community that to rely to some extent of federal money some of which is affected by the legislation that legislation iss debating right now. Eek the big question that will remain regardless of what happens next week are beyond which is there are around 25 Million People in the United States right now without healthlt insurance who rely Community Funds and Charity Programs and if the republican bill passes will certainly raise the number of insured. Democrats would argue theyre headed in the right direction although it was not clear under the Affordable Care act that it would go down much more. You have a problem now and you might have a bigger issue a few years from now. Con doesnt even matter anymore as far as the score is concernedit anyone on the republican side to they considered anymore . It will be very interesting to see that the cbo scores expected on monday or tuesday next week. Its interesting to see where the numbers and how Senate Republicans talk about it. I can see where the house 23 americans lose coverage. And they say look we improved a bad bill and made this better that is still a significant number of people losing Health Insurance. As the popul