![]() It can take a block grant or it could take what we call a per capita block grant. HARRIS: That's a choice a state could make. Is that your understanding, and are you comfortable with that? 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. INSKEEP: I want to understand something else that's changed in recent days. 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. You know, in Maryland, I'm comfortable we're not going to do that. HARRIS: If - a state could to decide to do that. That's how you'd offer somebody a cheaper plan under this notion. 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. 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. ![]() So let's send these decisions back to the states and see what that'll do. I shouldn't tell Mississippi how they should sell insurance in Mississippi. In some states, it may make a difference, but it's up to the state. So in a some states, it will make no difference. 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. HARRIS: You would - what we - what the proposal does is send those decisions back to the states. 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. ![]() You're focused on what it is costing Americans to buy health insurance, and you say you want the premiums to go down. It might be to get the people the best possible coverage. Their goal might be to get the maximum number of people insured. So let's talk about what you're describing there because people have different goals here. 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. And we think that both those efforts actually have done something toward that. 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. Do you think there are a number of members who are in that somewhat undecided category right now? I know you're looking around and talking with other members of the Freedom Caucus. It sounds like you're a little more of a maybe, you'll think about it. INSKEEP: Well, I want to explain what you're talking about there but just so we understand where things stand in the vote. But, you know, that's - my yardstick is will premiums come down enough under these actions. If I think that premiums are going to come down enough as a result of these actions then I could be a yes. So I'm going to take a look at that today. 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. INSKEEP: So it's still a - you're still a no. 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. I've been in the legislature now - this is my 19th year in the legislature. Look, that's all part of the negotiation. 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. He represents Maryland's Eastern Shore, and he's on the line. Congressman Andy Harris is a member of that group. It's also been criticized from the right by many members of a Republican group called the Freedom Caucus. 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. House leaders have delayed a vote on that bill but insist they will try today. ![]() Let's question one of the Republicans who opposes a replacement for the Affordable Care Act.
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