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Morning News Brief: Senate Republicans Release Health Care Bill, China Vs. Golf


And we're going to dig into the new Senate health care bill this morning.


So much to discuss. Republicans released their version of the replacement of the Affordable Care Act. And here's a remarkable fact. Obamacare provided health insurance subsidies through tax credits. That was the basic idea. After years and years of political combat, the House replacement does the same thing. And after saying they would try some different approach, Senate Republicans follow the same principle, too.

Now, the big difference in each measure is how much you get subsidized. There are big winners and losers compared with Obamacare. And there's a huge difference over Medicaid, the health program for the poor, including many of the working poor, expanded under the Affordable Care Act. But the House and Senate versions take different approaches to removing money from Medicaid.

MARTIN: All right, so those are the broad strokes of this bill. NPR congressional reporter Scott Detrow is on the line. Scott, does this bill that Steve has just outlined, does this thing stand a chance?

SCOTT DETROW, BYLINE: Well, yes and no. Right now, (inaudible) it may be in some trouble because you have four conservative Republicans - Rand Paul, Ted Cruz, Mike Lee and Ron Johnson - coming out with a statement yesterday saying right now they are a no vote. Now, that is enough to sink the bill. But they are all saying they're open to negotiation. They have concerns. They want to see this look less like Obamacare, more like a full repeal and lower the cost of health care.

So they're saying - they're not saying they're going to definitely vote against the bill. They're saying they are open to negotiation. And that's a pretty good place to be when you're a key vote on a bill that leadership wants to pass on a tight deadline.

MARTIN: So this bill is getting attacked from the right wing of the party. What about the more moderate wing?

DETROW: Right, it's a narrow margin. They can only lose two votes. And anything you do to make the Rand Pauls of the world happier with the bill is probably going to concern members on the more moderate end of the spectrum. People like Susan Collins from Maine, Lisa Murkowski from Alaska haven't been as definitive yet, but they've indicated they have concerns.

I think one key lawmaker to watch on the more moderate side is Dean Heller. He is a Republican from Nevada. He's up for re-election next year in a state that keeps trending more toward Democrat. He's basically the only vulnerable Senate Republican next year. He said he has serious concerns about what this does to Medicaid because he represents a state that took the Medicaid expansion.

MARTIN: OK, Scott, stay with us. We're going to bring in another voice to the conversation. Alison Kodjak covers health care policy for us. She is in the studio. And Alison, I want to talk about how this bill jives with what President Trump himself has talked about as his health care priorities. In a joint session of Congress earlier this year, he laid out his goals on this. I want to tick through some of these with you and see how they stack up with this new bill. Let's listen to this first clip.


PRESIDENT DONALD TRUMP: We should ensure that Americans with preexisting conditions have access to coverage and that we have a stable transition for Americans currently enrolled in the health care exchanges.


MARTIN: Does the Senate bill do that, Alison?

ALISON KODJAK, BYLINE: Well, like everything in health care, it's pretty complicated. The language in the Senate bill does state - it says insurance companies have to offer insurance to people with preexisting conditions, and they can't charge them more. But then there's a huge loophole, and this exists in the House bill, too, in a slightly different form. States can opt out of federal regulations by asking for a waiver. And then they can change the list of health issues that have to be covered in an insurance policy.

And they can also do what's called medical underwriting, which means they can charge people more if they are ill. And so what that ends up being is if you have medical issues, you could end up having to pay for insurance that you can't afford or buy a policy that doesn't cover your issue.

INSKEEP: Wait a minute. You're saying that you're saved from preexisting conditions unless you're not, essentially.

KODJAK: Exactly, it kind of could depend on what state you live in.

MARTIN: All right, let's listen to another clip from the president about his health care goals.


TRUMP: We should give our state governors the resources and flexibility they need with Medicaid to make sure no one is left out.

MARTIN: I mean, this bill, Alison, is definitely putting the power back with the states when it comes to Medicaid. So that's in line with the Senate bill. But in terms of making sure no one gets left out...

KODJAK: (Unintelligible) is resources. This bill includes a rollback of the Medicaid expansion. And that, you know, granted health insurance coverage to about 10 million people. And over time, those people are going to eventually move off the Medicaid program. But in addition, it reduces the growth rate of Medicaid, which means health care will - costs will go up for the poor and the disabled, which Medicaid covers. But the money going toward Medicaid isn't going to go up at the same rate.

MARTIN: So, Scott, how do they make sense of this? Because this is a feature that has been controversial about the House bill and now the Senate bill. How are the lawmakers supposed to sell this thing when they go home?

DETROW: You know, that's - I think that's a reason why they'll want to vote so quickly. Mitch McConnell wants to get this vote done next week before they take a break for the July Fourth recess, I think, a large part because they don't want opposition to materialize. Interesting poll came out just a couple days ago from NBC News and The Wall Street Journal. It said only 16 percent, one-sixth percent of respondents thought that this health care repeal by the Republicans was a good idea.

These are stark numbers they're facing. The problem is, politically, that the base of Republican voters, that the energized voters who Republicans turn to year after year, have made repealing Obamacare a central core goal for years. So they feel like they have to do this. And the lawmakers want to do this.

MARTIN: So what - and I'll put this to both of you - what needs to change in this Senate bill to get to the 50 votes that they need? Alison.

KODJAK: You know...

DETROW: I think that...

MARTIN: Go ahead, go ahead, Scott.

DETROW: I'll go ahead just real quick. Rand Paul, his concern said, this just looks too much like Obamacare. This is an amendment to Obamacare. He's particularly concerned about the high amount of subsidies, in his mind, in there.

KODJAK: And the other thing we have is there's this issue of states like Maine, like West Virginia, where Senator Shelley Moore Capito is on the fence, worried about the opioid epidemic. A lot of those people are covered by Medicaid. So there's talk about a fund separately to help cover those people and ensure there's substance abuse treatment in this bill.

INSKEEP: We should remember there's a political reality. Can you pass it? There's also a practical reality. Does it work? Does it make sense? Alison was talking earlier about preexisting conditions. You're not supposed to be excluded for a preexisting condition. Part of the trade-off there under Obamacare, though, was a mandate. You were mandated to buy insurance. Alison, am I wrong that there's no mandate here in this Senate bill, so we don't know how it's going to work?

KODJAK: There's no mandate here. And that means that people can go and buy a policy once they get sick. And insurance companies aren't going to like that at all.

MARTIN: All right, Alison Kodjak, she covers health policy for us - also Scott Detrow, who covers Congress. Hey, thanks to both of you.

KODJAK: Thank you, Rachel.

DETROW: Thanks.


MARTIN: All right, Steve, there's a battle being waged on China's turf.

INSKEEP: That's a pun because turf - well, this is a battle over golf courses, to be precise. There may be no more potent symbol of Western bourgeois capitalist life than a golf course, which is why communist China once banned them. Later, they were allowed. But now the government has re-banned a new golf course construction and even shut down more than 100 golf courses across the country.

MARTIN: NPR's China correspondent Rob Schmitz is going to explain all of this to us. Hi, Rob.

ROB SCHMITZ, BYLINE: Good morning from the bourgeois NPR bureau...


INSKEEP: (Laughter).

MARTIN: ...So bougie (ph). I know...

SCHMITZ: Bougie.

MARTIN: ...You've been practicing your golf swing.

INSKEEP: There's four uses of bourgeois now, one podcast.

MARTIN: What's going on? What is wrong with golf in China?

SCHMITZ: Well, you know, otherwise - I mean, it's a slightly boring sport. But other than that, I mean, I think - I'm just joking, of course, about that. Golf is a fantastic sport. But there are two reasons why China's government is not fond of it. The biggest one is that the construction of golf courses has been rife with corruption here in China.

Many courses in China have involved the illegal seizure of farmland. And forcibly seizing property from people is one of the big ways local governments in China have generated revenue. This practice, though, is being cracked down on. So 111 golf courses in China have been forced to shut down. That's a fifth of all courses in the country. And there's a ban on the construction of new ones.

MARTIN: So what happens? I mean, will they just go in, and they say, you, golf course, are now closed?

SCHMITZ: Yeah, there's been a lot of inspections over the last decade or so, and it's been on kind of an accelerated pace in the last year. And they're also sort of cracking down on government officials who play golf. A lot of government officials are playing with their business colleagues. But now, officials have been warned to stay away from courses during business hours. And I spoke to Ozzie Ling, who manages the Yingyi Golf Club here in Shanghai. And he told me government inspection squads are now showing up at his club unannounced.

OZZIE LING: So they will come and check on you. And then they will say, OK, so on this day this guy was here. They actually look through your computers, and then they start checking, you know, day by day. It's this and that and how much he spends, you know, how much he - you know, who he's playing with and all that.

MARTIN: That's crazy.


SCHMITZ: Yeah. He actually told me that many government officials will actually use aliases when they play to avoid getting caught. But in this environment, lying about who you are can also be sort of risky.

INSKEEP: Also, what if they find out your handicap? I mean, there's all kinds of things. There's information...

SCHMITZ: (Laughter).

INSKEEP: ...That can be really, really damaging...

SCHMITZ: Humiliating.

MARTIN: Speak for yourself.

INSKEEP: ...If people know how you play golf.

MARTIN: Speak for yourself.

INSKEEP: Anyway, go on.

MARTIN: So is this taking a toll on the tourist industry in China? I mean, do people...

SCHMITZ: Well...

MARTIN: ...Go there to golf? Or at least, you know, business deals - people, like, get out. And they, like, you know, make business deals over golf.

SCHMITZ: Yeah, yeah, of course. And, you know, for the millions of government officials in China, they've - you know, obviously they've gotten the message loud and clear. But that leaves 1.3 billion other people. And some of them are becoming more curious about this sport. China's one of golf's biggest growth markets. Chinese players like Feng Shanshan on the women's tour...


SCHMITZ: ...Are some of the best golfers in the world. So it's...

MARTIN: We're going to keep following the golf drama in China. NPR's Rob Schmitz. Transcript provided by NPR, Copyright NPR.

Scott Detrow is a White House correspondent for NPR and co-hosts the NPR Politics Podcast.
Alison Fitzgerald Kodjak is a health policy correspondent on NPR's Science Desk.
Rob Schmitz is NPR's international correspondent based in Berlin, where he covers the human stories of a vast region reckoning with its past while it tries to guide the world toward a brighter future. From his base in the heart of Europe, Schmitz has covered Germany's levelheaded management of the COVID-19 pandemic, the rise of right-wing nationalist politics in Poland and creeping Chinese government influence inside the Czech Republic.
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