washington journal is alive every morning. your comments by phone facebook, and twitter. c-span, created by america's cable companies and brought you as a public service. host: republican senator bill cassidy. sen. cassidy: thank you. host: let me begin with the supreme court ruling. what is republican alternative? sen. cassidy: i introduce something called the patient freedom act. it repeals the individual

employer mandate and lowers costs by returning jurisdiction control over insurance back to the insurance commissioners in the state, where it was before obamacare put on mandates. then we take the money the state receives and distributed among those eligible for credits. we lower the cost of insurance. we also give patients protection by giving them portability between plans, giving them price transparency, and protection against pre-existing conditions. host: do you have any sense what the court will decide? sen. cassidy: i do not. state exchanges means state exchanges.

and it would seem from jonathan gruber's videos indicate that was done on purpose. >> if you say that you'd you not want all of these people, these 6.4 million people to be out on the streets without health insurance coverage. i am wondering -- you have a plan, this senator leadership plan how close are republicans , to having a more cohesive solution you guys can present not only to members, but to the public and say this is our alternative. senator cassidy: these folks are receiving subsidies to buy insurance. insurance that obamacare mandates and increases the costs

dramatically. we do not want a woman receiving chemotherapy to lose the insurance that she needs to pay for therapy. there is a consensus we will hold that woman, that person that family harmless. as regards whether or not there is a replacement the decision , against obamacare would effectively repeal a portion of obamacare. i think what there is not a consensus off is whether we should put forth a plan to replace that segment. the patient freedom act replaces that segment with pro-market reforms, but i could not say all have signed on to it. ms. haberkorn: it seems like one of the issues is how do you protect those people? some people want to restore the subsidies. others feel that doing so would be seen as embracing of obamacare do you think the party can get together?

senator cassidy: i think so. the obama administration implemented the law illegally. that is what will be determined if the supreme court rules against them. folks are paying to magically -- dramatically higher premiums premiums have skyrocketed since , obamacare has passed. although the president thinks of the cost of health care being flat, and he is right, it started before obamacare, but it is right, but the premiums have gone up like this. most recently with premium increases of 20% to 60% across the nation. there is always good to be someone who disagrees, but as a rule we recognize she did not do anything wrong to it was the administration and we should not penalize her. host: melissa? >> thank you, senator. your plan has a repeal of the individual mandate. i know a lot of republicans have that included. it seems like something that is unlikely for president obama to actually sign. i am wondering if there is room

for middle ground when the two parties actually have to sit down and figure out what is going to happen for these people losing assistance? senator cassidy: sometimes you get the sense that the president is protecting the law and not the patient. the individual mandate has resulted in 33 million people being uninsured. in the state of louisiana, our rate of insurance was 20% before the law passed. it is 20% now. if the goal is to get access to coverage, the individual mandate has failed. premiums are going up in some states as much as 60%. the rationale was premiums would be lower. in the patient freedom act, we give states the option to enroll someone unless they choose not to be. if you look at 401k data, it shows under that system that you have much higher participation

rates than if people have to opt in, if you will. i think under the patient freedom act, which by the way that is also in the house proposal, another republican proposal, would give you more coverage than with the individual mandate. if you just want to protect the law, he is going to veto it. if the real goal is to take care of patients, i sure hope he will look at a different way of giving people access to coverage, a way which frankly cannot do worse than what his plan has done. host: one of the fundamental arguments has been that those without insurance use er rooms as their primary care physician? how do you go beyond that? that, as you well know, costs significantly higher in terms of health care costs. senator cassidy: there is an irony here. the administration says the rate of uninsured is as low as it ever has been. most of those folks are on medicaid. medicaid pays providers so

little that still the person with medicaid does not have access to a physician. she is still going to the emergency room. this is the worst of all worlds. we have the state tax of payer now paying for someone to go to the emergency room because the insurance gives them the illusion of coverage without the power of access. we take the money to vacate and the money when people sign up for obamacare and we've give credits used by health savings accounts with first dollar coverage. obamacare, you have a $6,000 deductible. under the patient freedom act, you would have first dollar coverage and the academic literature shows the individual says, oh, my gosh if i go to the urgent care center, i spend less, i save more. we think the patient freedom act is a better way to go than the $6,000 deductibles of obamacare

or medicaid which is the illusion of coverage without the power of access. >> do you get the impression from your republican colleagues that the repeal of the individual mandate would be necessary for republican response in order to keep the subsidies flowing? senator cassidy: mandates from the federal government are coercive and i think most americans perceive as un-american. most americans do not want to be told by the federal government what to do. we accept income tax. we accept the draft in times of war. but do we otherwise expect the federal government to say, we're going to penalize you? we are going to come after your wages? no, we don't. we do not expect the federal government to come to an employer and basically incentivize them to lay people off to avoid penalties. that is what the law does. so republicans believe in , freedom. we think the individual, the patient should have the power,

not a government bureaucrat. republicans are about repealing those individual mandates. ms. haberkorn: one of the concerns the insurers and health policy experts site is that if you get rid of the individual mandates, you will cause a debt spiral. the insurers will be overburdened with people who are very sick and costly to cover. how do you keep the insurance markets afloat if you do not have the incentive for everyone to get in the pool and covered through insurance? senator cassidy: we are seeing an incipient death spiral now. some states, the insurers are requesting premium increases of 60%. if you look at health insurance premiums that obamacare passed they have skyrocketed. health care costs flat. insurance premiums skyrocketing. that is number one. let me go back to what i said earlier.

under the patient freedom act and other republican proposals, the individual, the state would have the option of enrolling someone unless they opted out. so under the patient freedom act, the proposal i am supporting, you would either be on medicaid, medicare, social security, v.a., tri-care something like that, or you get your insurance through your employer. for those who do not have public or employer-sponsored insurance most of them would get a credit. if they did nothing the state , would have the option of enrolling them in insurance unless they opted out. that way you get greater participation than we have under obamacare. somewhat estimate as much as 95% participation. i think you probably heard me say earlier, in louisiana, our rate of uninsured is 20%. we can do better than that. the individual mandate has been ineffective. we can replace it was something that is effective and a benefit

to those insurers. ms. attias: senator cassidy, we are talking about a scenario where the government loses in king v. burwell. if the government wins the case have you see that playing out? senator cassidy: i think the health-care law is on tenuous ground. interest premiums are increasing 20% to 60% across the nation. this is with deductibles of $6,000. we were told we had to pass the law to protect people from medical bankruptcy, and yet unpaid medical expenses are climbing because of $6,000 deductibles. im a doctor. i have been working in a hospital for the uninsured for 25 years. if you went to one of my patients, who are good people and said, oh, you have to come up with $6,000 before your insurance kicks in, they would look at you like you are crazy.

$6,000 for someone having a tough time paying rent is impossible. people who work episodically they paint the house, go to months without then paint to more houses they get a credit and then because they went too high on obamacare credit, next year it will be clawed back. and that may be between the houses they are painting. anyone that thinks this law is working, for working families, does not know working families. if you have cancer or als and it is giving you coverage you could not otherwise get, hey, i'm glad you have coverage. i would just say there is a less expensive way to get there. for someone who does not use it very often they are getting , stuck with bills they cannot afford. it is a policy that does not work for working people, not for the patients i saw. ms. haberkorn: senator, i wanted to ask you about your work with the uninsured. i know you worked for a long

time in louisiana's uninsured hospitals. did you ever have patients say that this law is a good thing? is there anything in this law where you have seen it is having positive impact? senator cassidy: again, if someone has als and could not otherwise get coverage, as a doctor, i am so happy they are getting coverage. but more typical is the woman, tina, from jefferson parish, louisiana. i always smile when i say this story because i did not know where the conversation was going. she walks up to me and she says, you know, i am 56 years old and i have a hysterectomy and i have no kids. and i am thinking, ok. [laughter] and she says, i am paying $500 a month on insurance with a $6,000 deductible. another woman walks up and says i'm 58 in my husband is 57. unless my name is sarah and he is abraham, we do not need to be paying for obstetrical services.

and by the way, my policy has gone from $12,000 to $22,000 a year. i said that on the campaign trail. a reporter wanted to fact check me. we looked it up. no, she is wrong. it is $25,000 a year. those are the stories i hear much more commonly. host: do you think we will see a decline in the number of primary care physicians because of the affordable care act? senator cassidy: doctors are discouraged. they are retiring early, if they can. this, plus other requirements they are so discouraging. i would like to think that madison is a noble field. as a doctor, i can go to someone and know their most personal story and participate sometimes in saving their life that is an incredible privilege. what you don't want is someone who goes in to the ground down.

that is what doctors are now confronting. obamacare is another layer of bureaucracy in which doctors feel oppressed by it. instead of what they hope to do, which is cure, they feel like they are dealing with bureaucrats. i to give patients the power that is a better system that obamacare. ms. attias: you just mentioned the issues of meaningful use. i'm wondering what opportunities you see their, and what you see can be done to lessen burdens . senator cassidy: first, we'd

taxpayers put up $30 billion with a promise that medical records can pass easily between providers. i save the expense of a doctor treating me. he has immediate access. that has not happened. there is evidence that some of the major vendors of electronic medical records as part of their business plan are blocking access from other institutions to these records. you and i paid $30 billion and somebody is part of a business plan are blocking access -- you and i should be very angry. here is what we can do. we can hope that industry collaborates over barriers that have been erected or we can ask , the administration do this. i am told that the department that has the responsibility for this has had a department from the get go on interoperability. if so, it has not worked very well. lastly we can pass legislation. , to me, that is the least favorite option, but if that is what it takes, i am willing to

go there to get the taxpayer a bargain. host: pope francis released his encyclical on climate change. he says it is one of the principal challenges facing humanity. in your mind is climate change , for real? senator cassidy: if climate change is for real -- let me rephrase that question, if you will. i would stipulate for the sake of argument that climate change is real, but i think people who ask that question are presupposing that we structure and regulate the economy the way in which they prescribed. one of the major redactors of somebody's health is their job -- major predictors of somebody's health is their job their prosperity. do they have income? there is such a strong statistical correlation between

how well someone does financially and their health. it's all predicted by family prosperity. if we just stipulate for the sake of argument -- we need to worry about climate change? what i am worried about, the prescriptions that would destroy jobs. we heard this morning that 4500 jobs have been destroyed in kentucky by the epa's war on coal. that was said in committee hearing this morning. 4500 jobs in kentucky. whole communities devastated. this may have been west virginia. your only asset is your home. you can sell it to no one because everyone else has lost the home. the health of those people has just begun its the klein. i would rather move the argument to what are we going to do to make people healthier? if it is somehow involved in climate change, we should consider that, if we can show

that is really what matters. when we do that, let's not make them poor, because poverty is one of the major predictors of people not doing well in their help in every other aspect of their life. host: what is your reaction to this encyclical? he said that global warming is a moral imperative? senator cassidy: i have not read it. i was told it was a moral imperative because the poor are the most likely to be affected. i would point out that we in the united states can do some good things. natural gas creates jobs taking families that are struggling and giving them better jobs of better benefits, can be exported around the world and we can give construction jobs by building export terminals and maritime jobs by shipping it and natural gas is one of the best btu for carbon footprints there is. so, if the administration is truly concerned about this, then

we should do our best to take natural gas productions to record levels and as soon as possible export it around the world. let me also say one more thing. keystone xl pipeline is predicted by the state department to have a negligible effect on lifecycle carbon release, to actually save workers lives because it is safer to ship oil through pipelines than over trains and trucks and barge, and also it creates the prosperity for those working families that are struggling. now, keystone xl pipeline is something we could do to address the moral problem of poverty and climate change. ms. haberkorn: senator, could you talk a little bit about how you feel the relationship is between president obama and congressional republicans? i am wondering particularly if the court does rule for the

challengers in king versus burwell, the president has already says he wants a one sentence solution that would restore subsidies. clearly congressional republicans do not feel the same way. there is a lot of space for potential negotiation there. where do you think that relationship is right now? do you feel like if the court did rule for the challengers there is any room to negotiate? , senator cassidy: a couple things. you cannot fix a 2700 page bill with one sentence. there's lots of problems with this. as we discussed earlier, since the bill pass insurance premiums have skyrocketed as much as 60% in a state. most recently a month ago. 25% in louisiana. you do not fix that with one sentence. if the president's goal is to protect the law with his name on it, there probably is not room to negotiate. if the president will accept my goal, how do we take care of that woman who a been diagnosed

with breast cancer and needs insurance for chemotherapy? if we make her the centerpiece of our discussion not protecting the law, but taking care of patients we have lots of common , ground. and i will come in good faith. for 25 years i have been caring for the uninsured. my wife is a recently retired breast cancer surgeon. i will meet him and i think others will, too. we care about patients, not about a law. i hope he cares more about patients to. ms. attias: we spoke about the mandate and the challenge republicans are seeking as part of the response. what about smaller provisions? today the house voted on a , repeal of the medical device tax? is that enough to get republicans to rally around financial assistance? is it going to take something more? senator cassidy: king versus burwell does not address the tax code.

if the medical device tax comes up, there may be some who are interested in that. but it is actually another part of the code, and we have to go a bit further afield to incorporate that. melissa what i have been focused , on is the scope of king versus burwell. first, those 5-8,000,000 people who may lose the coverage they have because the obama administration implemented coverage illegally and what can we do to bring coverage? we can bring in a lot of other things, but from my perspective, i want to take care of those 5 million people to 8 million people number and number two, i one. want to take care of those states doing poorly under the law. what can we do to protect those states better? host: your colleague in the statehouse, governor bobby jindal is about to enter the , republican race. what are his chances? senator cassidy: oh, my gosh.

bobby, when he first ran for governor and no one thought he had a chance, he came in a close second. never underestimate the fellow. right now, you would look at the polls and say that he is not in the top 10. that would mitigate against him. i have not focused on that steve, beyond occasionally looking at the paper when i am home. when i am home i talk to my mother, my wife, and my daughters and believe it or not i do not talk about politics. i try not to. i try to think about my family. host: would you make an endorsement in the race? senator cassidy: whichever candidate makes a solution that puts the patient in the middle of that solution. i will endorse that candidate. i am passionate. how do we replaced that portion of the law with something that gives the patient the power, not a bureaucrat.

host: david vetter is running for the statehouse. will you endorse him? senator cassidy: i already have. he is a pragmatic man who will work hard. i think he will do a good job as governor. there are other good candidates running, by the way, but i have chosen to endorse david. host: senator bill cassidy. republican of louisiana at joining us on capitol hill. thank you for being with us. senator cassidy: thank you. host: i going to begin with what is happening behind the scenes in advance of this ruling, if the supreme court does strike down the subsidy issue. what is happening at the white house? and what is happening on capitol hill? >> the white house is said there is not much they can do. it will be up to congress and state to fix this. the people that i talked to say they assume hhs is working on how they can flex their muscles through the regulatory recess and make it easier for states to pursue the exchange, but

clearly, congress is going to have to do it. hint, hint, congress is not going to get their act together in time. on capitol hill republicans are , meeting, talking about this like senator cassidy mentioned but i think there is a little more -- the republican party, i think, is pretty far apart on what they want that replacement to look like. there's some who want subsidies and there's some who are very fearful of getting anywhere close to saying i am going to help out obamacare. i think that's going to be a hard divide to find. host: i saw this headline earlier in the month -- it really is putting republicans in a quandary. why? ms. haberkorn: it's a very difficult situation because they have spent five years advocating for a repeal of the law. they spent many votes on the repeal in the house and now they , are basically put in a position where they are going to have to benefit those who are

receiving subsidies under the law. the challenge is that they do not want to be portrayed as helping the law, continuing the law, because they have worked so hard to betray the message that they want to repeal it. and that will be particularly challenging with the presidential election. 2016 host: what did you learn with senator cassidy? ms. attias: he will push very hard for his plan. i think i heard a little bit of apprehension for embracing the leadership outline. i think it is more generous to call it an outline that a plan at this point. i think he will be one of those people who really wants to make sure this is not perpetuating obamacare. host: we talked a little bit about climate change and this is -- this encyclical issue by pope

francis because the republicans and democrats embracing the pope when it comes to washington in september, and yet on this issue you can see real divide between what the pope is calling for an republicans on capitol hill. >> yes, there is a divide. i focus mostly on health care, but climate change is one of those issues where there is a divide between parties, just like on the health care law. it will be interesting to see how they respond. host: jennifer? ms. haberkorn: same thing. no republican wants to come out and say what the pope is saying is awful, but they disagree. they are trying to thread that needle. host: when the supreme court ruling does come down, give us a sense of what will be happening in this town. melissa? ms. attias: we will look for a sign from the administration whether they call for the subsidies to continue. that one page solution that we talked about earlier if it does , go for the challengers and how quickly the republicans can coalesce around a plan it is

, still uncertain whether more conservative members of the party would be amenable to extending anything to the health care law. so, we will be looking for the administration and republicans as to what their opening bids are in what would undoubtedly be a very long negotiation. host: justice kennedy? ms. attias: justice kennedy and justice roberts could be swing vote on this case. there is a lot of speculation that he's going to want to preserve that and be looking at the court's legacy when he makes his decision. a lot of people were surprised last time when justice kennedy ruled against the aca in 2012 and are wondering if that will influence his decision this time. i think you need to look of the court decision. if they rule for the challenger, that is pouring a big tank of gasoline on the simmering obamacare divisions in washington. it will reignite them. not only will it pose a policy problem for both parties but a

, political problem and there is , no clear solution. host: jennifer haberkorn and cq roll call. thank for joining us on "newsmakers". we appreciated. >> c-span gives you the best access to congress, live congress and house. bringing you events that shape public policy. every morning, washington journal is live with elected officials and journalists and your comments by phone, facebook and twitter. c-span, created by america's cable companies and brought to you as a public service by your local cable or satellite provider. >> thursday, c-span set down with 2016 presidential candidate ted cruz of texas.