RACHEL MARTIN, HOST:
Republicans have been fighting for seven years to repeal the Affordable Care Act. Now that effort could be over. Earlier this week, the Senate voted down a bill to overturn all of Obamacare. Then Republicans proposed a bill that would roll back just parts of it. It was something they called the skinny repeal. Last night, that bill failed, a bill that, if passed, would've left many millions of Americans without health care. It all came down to three Republicans who broke ranks and voted no, Lisa Murkowski of Alaska, Susan Collins of Maine and John McCain of Arizona. Senate Majority Leader Mitch McConnell blamed Democrats.
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MITCH MCCONNELL: Our friends on the other side decided early on they didn't want to engage with us. And in a serious way, they did everything they could to prevent the Senate from providing a better way forward, including such things as reading amendments for endless amounts of time. So now I think it's appropriate to ask, what are their ideas?
MARTIN: So what are their ideas? We have now Governor John Hickenlooper of Colorado on the line. He's a Democrat and one of the authors of a letter to Senate leaders that urged Republicans and Democrats to come together to fix the Affordable Care Act. Governor, thanks for being with us this morning.
JOHN HICKENLOOPER: You bet. My pleasure.
MARTIN: So this is a victory for your side. Are you celebrating, as Mitch McConnell predicted Democrats would?
HICKENLOOPER: No, I don't think it's a time for celebration. I think it's - you know, it's a time to roll up our sleeves and say, all right. You know, doing something in secret with no debate and no national discussion, you know, where people really could see what was being proposed - that's not the right way to change our health care system or to improve it. What we've got to do now is say, all right, we know we've got to control costs. We know there are improvements we have to make. How can we get Republicans and Democrats to work together to make the system better?
MARTIN: So I want to talk about what those proposed solutions might be. But, first, don't you have to agree on the set of problems? I mean, is there a consensus on the issues that need to be fixed?
HICKENLOOPER: Well, maybe - I'm not sure there's a consensus on all the problems. But we understand a number of the problems. In other words, the fact that the individual mandate and the, you know, business mandate didn't really work as they were intended - I think we can all agree to that. We ended up with, in many of the exchanges and in some of the private marketplaces - we saw people - we had pools that were concentrated with people that were in very poor health. So, therefore, they became very high-cost pools of insurance. We've got to figure out how to make those pools larger and make them so that the average rate that - you know, the insurance - the cost of insurance in those pools - doesn't keep going up and up and up.
MARTIN: How do you do that?
HICKENLOOPER: Well, there's a number of different things that have been discussed. This is where you have to sit down with Republicans and Democrats. One way to look at it is to take the people - there are certain - usually, a very small number of people that have very serious illnesses and are very, very expensive. Sometimes, we have a couple of patients in Colorado that are, you know, $4 million a year, $5 million a year. Maybe there's a way to take them out of the pool - right? - and make sure that the government somehow subsidizes the insurance companies that are providing them with medical insurance. By taking them out of the pool, it allows the insurance industry to really function in a much more effective way without having the cost inflation and rising cost of care that has driven many people out of that marketplace.
MARTIN: Yeah. So taking the people who have the higher health care costs out of the pool. But then what happens to those people?
HICKENLOOPER: Well, the people - the goal here is that the people that are very high-cost cases - so they have chronic medical issues that are very, very expensive. In many cases, this is towards the end of their lives, usually in a very tragic situation. Their insurance company who's been covering them will get some support from the government. Now, what level that support comes - how much is that support? That is what you'd have to work out and discuss. But by pulling those very expensive cases out of the pool of insurance that is, you know, what insurers are using to kind of estimate what they will have to charge individuals and companies in order to make sure they have insurance, that allows that pool to be - you know, it's not going to have - insurance companies won't have as high an expectation of what...
HICKENLOOPER: ...The costs will be. And they'll be able to lower their premiums for individuals.
MARTIN: So let me ask you - one of the most unpopular provisions of Obamacare is the penalty for people who don't get insurance. Is there a way to keep the individual mandate but get rid of that penalty?
HICKENLOOPER: Well, I think there are other ways that people have discussed that modify what people find most objectionable. Many people say, well, why are we being forced to get an insurance plan that we don't need? So let's say women that are in their 50s end up with, you know, pediatrics or, you know, maternity...
HICKENLOOPER: ...Insurance, which they don't need. I think those are all things that could be discussed. In many cases, they don't make a big difference in terms of cost. But I think it's time to sit down and say, all right, let's go through each one of those cases that people are having to pay for something they don't need. And let's make sure it is something that they do need. And how can we get that cost down to the lowest possible rate for individuals?
MARTIN: Let me ask you in our seconds remaining - your Senator Cory Gardner - Republican - voted for the bill that ultimately went down last night, so-called skinny repeal. Have you reached out to him? Do you plan to to try to bring consensus here?
HICKENLOOPER: Yes. I absolutely intend to reach out after - now that this has been voted down. We talked before. And, you know, that's - I mean, 49 Republican senators supported this thing, which we had a lot of problems with.
HICKENLOOPER: I mean not just me. I mean governors. So we had a number of Republican governors like John Kasich and Charlie Baker...
MARTIN: And you plan to reach out to them. We'll have to leave it there. And we'll bring you back to talk about what those conversations turned into. Governor John Hickenlooper, a Democrat from Colorado - thank you.
HICKENLOOPER: Thank you. Transcript provided by NPR, Copyright NPR.