STEVE INSKEEP, HOST:
Let's question one of the Republicans who opposes a replacement for the Affordable Care Act. House leaders have delayed a vote on that bill but insist they will try today. The replacement has been criticized from the left for taking money out of Medicaid and for cutting health care subsidies so much that millions of people across the country will drop coverage. It's also been criticized from the right by many members of a Republican group called the Freedom Caucus. Congressman Andy Harris is a member of that group. He represents Maryland's Eastern Shore, and he's on the line. Congressman, good morning.
ANDY HARRIS: Good morning.
INSKEEP: So we're told President Trump delivered an ultimatum last night, says this is your one-chance vote for this plan or he's walking and Obamacare stays. Did he change your mind?
HARRIS: No. Look, that's all part of the negotiation. I've been in the legislature now - this is my 19th year in the legislature. We've heard this many times just before a vote, but somehow these votes get resurrected if, you know, if there's a problem along the way.
INSKEEP: So it's still a - you're still a no.
HARRIS: You know, the president made a - made an offer yesterday to remove the essential health benefits and send them back to the states for states to decide and then sent us a letter outlining what he can do through the secretary. So I'm going to take a look at that today. It's - you know, it's a long letter. I'm going to fit the final amendment in. If I think that premiums are going to come down enough as a result of these actions then I could be a yes. But, you know, that's - my yardstick is will premiums come down enough under these actions.
INSKEEP: Well, I want to explain what you're talking about there but just so we understand where things stand in the vote. It sounds like you're a little more of a maybe, you'll think about it. I know you're looking around and talking with other members of the Freedom Caucus. Do you think there are a number of members who are in that somewhat undecided category right now?
HARRIS: I think so because the movements and efforts made in the last two days - we've specifically said we need to see motion toward premiums coming down. And we think that both those efforts actually have done something toward that. So the question is whether it's enough because Americans just have to get out from these premiums that, you know, increased last year 25 percent. We've got to stop that.
INSKEEP: OK. So let's talk about what you're describing there because people have different goals here. Their goal might be to get the maximum number of people insured. It might be to get the people the best possible coverage. You're focused on what it is costing Americans to buy health insurance, and you say you want the premiums to go down. And the proposal that's on the table to lower premiums that you're describing is removing essential health benefits, which - let's be frank, that means that Americans would not be assured of a plan that covers everything or even covers most things and that's how they'd get a cheaper plan is by buying less insurance. Is that right?
HARRIS: You would - what we - what the proposal does is send those decisions back to the states. So in a state like Maryland where I live, we had a fairly generous essential (ph) health benefits mandates even before the Affordable Care Act. So in a some states, it will make no difference. In some states, it may make a difference, but it's up to the state. You know, I'm from Maryland. I shouldn't tell Mississippi how they should sell insurance in Mississippi. So let's send these decisions back to the states and see what that'll do. The other thing that does this are re-creating high-risk pools, is taking the highest risk patients out of the normal risk pool so that - and that drives premiums down a lot.
INSKEEP: But let's be clear on this. You're sending it back to the states. That sounds like a good idea, but the way it would lower premiums is if states drop the essential health benefits and, say, for example, that you wouldn't have maternity care anymore. That's how you'd offer somebody a cheaper plan under this notion.
HARRIS: If - a state could to decide to do that. You know, in Maryland, I'm comfortable we're not going to do that. And then it establishes high-risk pools, which the majority of states had before the Affordable Care Act, which again removes the highest risk patients, the highest cost patients out of the insurance pool, lowering the premiums for everyone else pretty dramatically.
INSKEEP: I want to understand something else that's changed in recent days. We're told that the Medicaid changes have evolved in such a way that states would be given a block grant under Medicaid, which means a set amount of money that they would be given to spend, however, regardless of how many people need Medicaid. Is that your understanding, and are you comfortable with that?
HARRIS: That's a choice a state could make. A state is now going to have a choice. It can take a block grant or it could take what we call a per capita block grant. The per capita one means that if more people enroll in state, the state will get more money. The state has the choice, though, which one they want to do, just a block grant - fixed block grant or a per capita block grant. Again, it's moving the decisions into the states.
INSKEEP: I want to follow up on something we discussed with the National Review writer Jonah Goldberg earlier in the program. Is this an unusual and difficult vote for you because what you are doing is proposing legislation to cover people with health insurance to do something that as a conservative you really don't want to be doing at all? You don't actually want the government to be doing this.
HARRIS: Well, you know, you're right. And a perfect example is the high - are the high-risk pools. I mean, high-risk pools are not necessarily a conservative idea, but they do drive down premiums, and they restore insurance to its real meaning. For - the reason why young, healthy people are not buying insurance is because you have high-risk patients in that pool. If you take those high-risk patients out and fund them a different way, as many states did before the Affordable Care Act, it'll dramatically bring premiums down. So with the goal of bringing premiums down, which I think is a conservative goal, we have to go through methods like high-risk pools that are not necessarily conservative ideas.
INSKEEP: One other thing - it's been widely reported that your group, the Freedom Caucus, would like to undermine the speaker of the House, Paul Ryan, that that's part of what's happening here. Do you want to undermine Paul Ryan?
HARRIS: Oh, not at all. I - we all voted for Paul Ryan not to be speaker. Almost all of us did. I certainly did. No, we want Paul to succeed, and we're trying to work with - we have been trying to get to yes for two weeks now. We want to get to yes because we need this to be a win for the Republicans, for the new president, for the speaker of the House. We're all - all our oars are pulling in the same direction.
INSKEEP: But you're making it difficult for him.
HARRIS: Look, this is a legislative negotiation. Legislative negotiations on a bill this serious are never easy.
INSKEEP: OK. Congressman, thanks very much. It's been a pleasure talking with you.
HARRIS: Thank you.
INSKEEP: Congressman Andy Harris is a Republican who represents Maryland's first district that includes the Eastern Shore. Transcript provided by NPR, Copyright NPR.