robert: the healthcare debate under the microscope. i'm robert costa. we examine what's inside the senate republican's rewrite of the affordable care act tonight on "washington week." >> we agreed on the need to free americans from obamacare's mandates. we'll repeal the individual mandate so americans are no longer forced to buy insurance they don't need or can't afford. robert: senate republicans rolled out their healthcare plan after weeks of closely guarded discussions. democrats argue the bill is even worse than the version that came out of the house. >> simply put, this bill will result in higher costs, less care, and millions of americans will lose their health insurance. robert: but a revolt by a handful of republicans could put this newest bill in jeopardy. >> we need common-sense reforms in the bill that lower the cost

of premiums. >> we also need to negotiate over what's good, what's bad and what we can get in the bill to make it better. robert: president trump remains optimistic, there is room for compromise. president trump: we will hopefully get something done and it will be something with heart and very meaningful. robert: we look at the real costs and benefits of this latest prescription. plus, the blame game, how this week's special election in georgia is reverberating on capitol hill, raising questions about the leadership of the democratic party. we explore it all with susan davis of npr, sarah kliff of vox, philip rucker of "the washington post," and kelly o'donnell of nbc news. >> celebrating 50 years, this is "washington week." funding is provided by -- >> their leadership is instinctive.

they understand the challenges of today. and research the technologies of tomorrow. some call them veterans. we call them part of our team. >> additional funding is provided by newman's own foundation, donating all profits from newman's own food products to charity and nourishing the common good. koo and patricia yuen. through the yuen foundation, committed to bridging cultural differences in our communities. the corporation for public broadcasting, and by contributions to your pbs station from viewers like you. thank you. once again, live from washington, moderator, robert costa.

robert:good evening. the senate republicans' plan to dismantle the affordable care act continues to get pushed back, not just from democrats but from fellow republicans. senate majority leader mitch mcconnell stands by the bill, saying it will repeal most of president obama's signature healthcare law, reduce government-paid healthcare and return power to states. democrats insist the g.o.p. plan will increase premiums and take healthcare away from millions of elderly and low-income americans. complicating matters for mcconnell today are five republican senators -- ted cruz, ron johnson, dean heller, mike lee and rand paul -- four of whom immediately rejected the bill saying it does not go far enough to gut obamacare. >> we can do better than this and my hope is not to defeat the bill but to make the bill better. robert: moderate dean heller of nevada was the latest to speak out against the senate bill. at this point it seems no one seems to love it but as

republican senator pat roberts of kansas said, the senate bill was not the best possible bill but the best bill possible. we're looking at a real challenge for senate majority leader mitch mcconnell. what's he going to do, kelly, to close it? kelly: he's going to work all weekend and so will all the people on the team. the phone lines will be burning up. the personal meetings will be happening and they're looking for ways to find some things that can induce some of these members. one to be watching for, opioid. opioid money is an attractive inducement to some of the members. i'm thinking of rob portman of ohio who could be brought along. shelly morcappitto of. a low-key donald trump, where the president is helping but a bit under the radar, letting mitch mcconnell run this but it's high stakes. i haven't talked to anyone who will say it will pass but

they're going to work like heck to get there and they think that if they don't do this, it's a major failure for the party. the house did act, however their process was, however messy and unpopular their bill is, senate republicans feel immense pressure that they have to do something and we've got a recess coming when they'll have some judgment at home. but if they could get it done, they can then move on to some other things that might be more popular to build up momentum for those that are up for re-election and may be vulnerable. >> mitch mcconnell has going for him what house speaker paul ryan had going for him is that every single republican in his caucus campaigned and won their elections saying they were going to do this and to senator roberts' point, they don't love this bill. there is something in this bill for every republican to have a problem with but this is the repeal and replace bill that they have and i think the way you saw the house bill come together, there is just tremendous pressure not only from the party's base but as you said, i think we underestimate how much the white house wants a bill because they have had such

a light touch in the policy shaping of it and the message that i hear from senate republicans as the white house is telling them, we just want a bill. and i don't think we can underestimate the power of the presidency putting the pressure on his own party in power in congress to deliver on the single unifying campaign promise of the republican party for the better part of the last decade. robert: you said it was low key on the white house's end. phil, you're the bureau chief for the post." what's the story with the president's involvement with the healthcare bill. at one point he said the bill was mean, a word he used in a private meeting. but now he was making a call, i was told, on thursday, to senator cruz, trying to get him to come along. is there an intense effort to get it passed? philip: one thing, the president's impatient. this is not a man known to want to wait for things. he's impatient about the legislative process. he wants a victory. he's been in office five months and there's no signature legislation yet, this could be

it but he's taking a back seat to mitch mcconnell, he knows he won't be effective persuading more moderate senators to come on board but he's working with members quietly on the phone to try to make a deal happen. he doesn't care so much about the details of the bill but just wants something to sign but sean spicer today, the press secretary, said at the white house, that the president likes the senate version better than the house version. he thought the house version was too mean on poor people. robert: let's talk about some of the specifics here. there are challenges from the senator and from the right. the senate version of this bill eliminates the individual insurance mandate and obamacare taxes on the wealthy, slashes federal funds for medicare and phases out the expansion of medicaid. it allows states to waive a federal mandate to essential health benefits raising questions about coverage or pre-existing conditions.

it shrinks obamacare subsidies to pay for premiums. what remains unchanged, young people could stay on their parent's plan until age 26. sarah, it's great to have you here. you're an expert on healthcare. what everyone's wondering is, if this senate bill passes and becomes law, what does it mean for people who rely on the affordable care act? sarah: it means a lot of changes, it would overhaul the way healthcare works for a group of 20 million people, generally people who don't get health insurance through work but get it through medicaid or the individual market. folks on medicaid would probably notice the biggest change with medicaid expansion phasing out starting in 2021. by 2024, that program would be gone and that covers an estimated about 12million orso low-income americans, people earning less than $15,000. people in the rest of the medicaid program would notice very big changes, as well. one of the big things this does that isn't about obamacare, it rejiggers how the medicaid

program is funded. right now, the federal government has an open-ended funding commitment. under this bill, the bills would be capped, essentially. that for each person there would be a lump sum of money and do the best you could as a state to cover that person for that set amount of money so that would be a big change and i think the concerns you hear democrats raising are that this lump sum wouldn't be enough to cover those on medicaid and would grow slower than medicaid typically grows. you also have big changes in the individual market where people would see much smaller tax credits, much less help from the government and they would generally see skimpier health insurance plans so one of the things that a lot of obamacare enrollees i talk to, they complain about high deductibles. you heard mitch mcconnell talk about high deductibles. this plan seems clear the deductibles would go up and people have to pay more out of pocket before getting to their

benefits. robert: often this bill is talked about a tax cut for the wealthy, a bill to overhaul obamacare but what you're really saying is it's also an overhaul of medicaid, a program that's been around decades. sarah: i don't think it's an underestimation to say it would be the biggest change to medicaid since it were created in 1965, changing the relationship the government has had with medicaid saying no matter what the bills are, we'll kick in a portion and states will kick in the rest. it would be a pretty unprecedented rollback of welfare programs. usually one of the things we see in the united states and abroad is it is very hard to roll back benefits once they're out and it's a key challenge that republicans have dealt with in this debate, is that there are 20 million or so people relying on obamacare and it's very hard to take something away once it's been given out. robert: phil, you were on the campaign trail with president

trump and you heard him say he doesn't want to go after medicare and medicaid but now he seems to be rallying behind this ideological agenda of congressional republicans on healthcare. why? philip: he wants to win. he wants to be able to do what he said he would do, get rid of obamacare and change it which he calls a disaster so he wants a change but it's risky for him. he was elected on the backs of working class people in states like michigan, wisconsin, pennsylvania. he had so much support in west virginia and these are states that are really probably going to be battered by these changes to the markets. >> and where there is policy, there's also process. it's not as sexy to talk about but one of the issues republicans have, they only have 52 votes. they can only spare two and they have the vice president to come in and break a tie. when the affordable care act was put into place, democrats had 60 votes. they had a lot more flexibility. and under reconciliation, which is a term used to describe this kind of legislation, all of the

specifics are so narrow. if we watch courtroom dramas, you know sometimes there are rules of evidence that come in and only that can argue the case. for republicans, they have to thread a needle of difficult rules and that is part of where it's tough because they can't necessarily bring in some of the things that people might want to bring them along because they have to fulfill certain requirements under the legislation. it's a boring part of it but it is the underpinning of why this is so hard. robert: sue, what's your read on who determines how this bill shakes out? is it moderates? is it heller? is it murkowski or conservatives like cruz? susan: we saw dean heller from nevada is the only republican in a blue state up for re-election next year who has probably come up so far the harshest against it although he gave himself room to go for a yes at the end. on one hand, you have conservatives who say this is

obamacare light, not what we came here to do and then you have moderates like susan collins of maine and lisa murkowski of alaska who have other issues with the bill including the proposal to block planned parenthood reimbursements so how mcconnell skins that cat to get the various parties to hold hands and vote for the bill will be tricky. how much do conservatives have to say, i don't really like the bill the way it is, maybe give them amendments, get to say they improve the bill and get to yes in the end. robert: what about pre-existing conditions? this was the big hangup when it was being written in the house. how does it look in the senate? sarah: it would not allow pre-existing continues to be treated differently but it still creates a market that isn't friendly to people with serious health conditions.

under the senate bill, states could apply for a waiver from those benefits, covering things like maternity care, mental health services, prescription drugs -- things that were often left out in the individual market because they can be excite expensive to cover. so this can, essentially, be a back-door way of getting the sick people out of the insurance market because let's say you have a health insurance plan that doesn't cover cancer treatment or certain prescription drugs. it technically accepts everybody. so it is certainly true these plans do not discriminate on pre-existing conditions but it's also not attractive to someone who actually needs to use a lot of healthcare. so it is both true that republicans can say, our plan treats people with pre-existing conditions the exact same and democrats can say, you're creating a market that is worse for sick people. robert: president obama has weighed in with a forceful reaction to this senate bill, saying it's something that really goes against everything he tried to do to cover people. is that going to have an impact? philip: i don't know that it's going to have an impact with the votes in the senate but it

certainly has an impact with the politics surrounding all of this. i think he's trying to help galvanize democrats who don't really have a strong national party leader right now. obama's been very quiet through a lot of the trump presidency so far. he's nod weighed in -- not weighed in as he did on healthcare this week and that's because this is his signature bedrock historic acomeempt from his presidency and he wants to protect it. robert: the healthcare industry doesn't seem to like the bill but the business community seems to like it as a tax cut. kelly: part of how you can look at the two bills, the obama era healthcare and what the republicans are talking about -- the republicans are talking about trying to have entitlements but also trying to drive people to private insurance, also a core republican view. part of what the democrats were trying to do was expand coverage so it did create a much larger pool to try to drive down costs.

we've seen that, didn't quite play out. so what republicans need to do and it will be difficult, is to try to support an insurance market that has taken hit after hit after hit. it's not clear how they will bolster, when we've seen different insurers leave market places -- but they're trying to find a way to drive people toward private insurance and incentivize that and not to incentivize an expansion of government-backed insurance. part of that is they're looking down the corner and around when perhaps democrats are back in power and it could not be far from single payer so deep philosophical differences about how this would play out. robert: sue, when you're talking to lawmakers on capitol hill, republicans, how do they weigh promising the base to repeal obamacare with being maybe tagged as the party that went after medicaid? susan: that is a great question. there's a raw political answer to this when we look at the midterm elections and the fact of the matter is you could not

have a better map in the senate to put forward a politically risky bill like this. republicans aren't that vulnerable in the senate and they're on the offense, not on defense. so if you're going to take a political risk, it's a good election cycle to do it. mitch mcconnell is a raw political strategist. i'm sure he's looked at the map. it's absolutely a political risk, though. as a matter of health policy which people feel very deeply about this country, and to kelly's point, this is also a bill that at its heart a tax cut and fundamental reimagining of an entitlement program and those are two huge victories for conservatism. robert: i spoke to senator toomey of pennsylvania, republican, a few hours ago. he said there will still be a vote next week but we'll have to wait and see. a lot of looming issues for this healthcare bill. as healthcare consumes washington, we're also getting clues on how that and other issues are playing out across the country. i began the week in georgia covering tuesday's special election. republicans won the $50 million

political battle. the democratic defeat stoked sharp discussions about how democrats can win in red states. republican karen handel beat first-time democratic candidate, john ossif, to win georgia's sixth district. president trump took a victory lap during a rally in iowa the day after the election. president trump: all we do is win, win, win. we won last night. i can't believe it. we're 5-0 in special elections. 5-0. robert: phil, how vulnerable -- it was the fourth special election -- excuse me -- for democrats last year. a small but vocal group of democrats in that party are suggesting the party needs new leadership at the top and are taking aim at minority leader nancy pelosi, the california

lawmakers who remains defiant. >> we're paving the way for a new generation of leadership. i respect any opinion my members have but my decision about how long i stay is not up to them. robert: president trump couldn't resist the chance to show his support for pelosi. he tweeted "i certainly hope the democrats do not force nancy p out, that would be very bad for the republican party and please let crying chuck stay." phil, back to you. what is the state of the democratic party right now? are they rallying against leader pelosi or is she pretty safe? philip: the one thing that could keep her in this position is she's such a prodigious fundraiser. all of her members in the congress really rely on her to bring them money but the bigger problem for the democratic party right now is they need fresh faces and a fresh message. they can't run just as the resistance party. that's what we learned in

georgia and the other special elections. they need a vision for the future, a message, an agenda, some policy ideas. go out in the country, try to figure out what a movement could look like and they're not there yet. they might get there by 2018 but they have a lot of work to do as a party. robert: this is a party of mostly baby boomers at the top. susan: the frustration with nancy pelosi is symptomatic of a bigger problem. the top three leaders in the democratic caucus have 93 years of service. there hasn't been a lot of turnover at the top. luminaries in the party, popular people in the party but they've been around for a long time and there is a lot of frustrated ambition particularly in the democratic caucus. at the beginning of the congress, pelosi was challenged and a third of her colleagues voted against her staying on and she said if hillary clinton would have won, she was prepared to step down. we're certainly in the twilight years of nancy pelosi's

leadership. it's unclear how much longer she'll serve but i think there is a real concern that in these races where you have to win on the margins in tough seats that she could be the margin, that she's an anchor in swing suburban districts where they're trying to appeal to a republican constituency and that republican constituency does not like nancy pelosi. >> if she weren't from san francisco, that builds into the ad so nicely, when they want to talk about california values or hollywood values, that makes her an easy target. she also has enormous name i.d. which makes her an easy foil in gain ads but her ability to raise money, she's the velvet hammer of the democratic party with a soft touch but really delivers. she has a way of keeping her caucus together and it's tough at the top because it's almost as if they were all waiting for the other one to retire and it's really tight at the top but i think she really showed her resolve. no one's going to tell her to leave until she's ready.

robert: she's a tough politician who grew up in baltimore, whose father was the mayor. she thinks she could be the next speaker of the house. but how democrats handle the policy front. do you see democrats fully seizing the healthcare issue? sarah: it's interesting and i think a lot of it will depend on what happens over the next week, if the healthcare bill passes, you can bet that democrats are going to be out there campaigning on it. one of the interesting fissures to watch is if you do see single pair or more national healthcare system movement emerge out of this. it seems possible to me that at this point democrats might look at what the republicans are doing and say, you know what, we tried to do the compromise route. we thought the affordable care act was our attempt to do kind of a part-public program with medicaid, part private with the marketplaces. what we really wanted in our hearts, what president obama will tell you, if i could start from scratch, i would do single-payer and i think that

will be interesting to watch. to phil's point, that would certainly be a policy to run on, a very different and bold statement. i don't know how exactly it would play out. we've never seen the democratic party embrace single payer but i think it will be interesting to watch in the wake of the republican debate, if they want to really re-fuel around this particular provision. robert: as the democrats think it through, phil, the president wases in iowa celebrating, defiant as we saw in the clip, win, win, win. he's had a string of success in special elections but what does it tell us about -- what's revealing about the president's confidence at this moment? philip: you've got to put the rally in context. it's the first time he's been out there on the political front, a campaign-style rally since russia heated up, since firing comey and the comey testimony and special council -- counsel and he's had all this energy stewing, pent up in the white house and he let it rip. he didn't talk about russia specifically except for a

reference to a witch hunt but he was taking victory lap in that arena and loving it and he loved the adoration of the crowd. that's him in his element. he's not a governing president but a campaigning president and i know the white house officials want to get him out there. robert: what's the debate within the democratic party about russia, about whether to target that ahead of 2018 or not? >> i don't think democrats see russia as the most potent campaign issue. regular voters have a hard time connecting russia to their lives. it's amorphous and hard to understand. i think healthcare, if the bill moves forward, if it passes and becomes law, i think healthcare is familiar ground that they'd rather litigate the 2018 midterms on although part of the reason why the loss in georgia was so rattling to democrats is i think they thought this was a test case for those messages and

coming up short has kept them soul searching and part of the situation with georgia, it showed trump's win was not a fluke. robert: what a week. $25 million in that georgia race, the most expensive house race in history -- $50 million overall. thanks, everyone. our conversation continues online on the "washington week" extra where we'll tell you why president trump, admitting he does not have tapes of his conversations with former f.b.i. director james comey, has a few people scratching their heads. you can find that friday after 10:00 p.m. at pbs.org/washingtonweek. i'm robert costa. thanks for watching. enjoy your weekend.

>> funding for "washington week" is provided by -- boeing. newman's own foundation, donating all profits from newman's own food products to charity and nourishing the common good. koo and patricia yuen through the yuen foundation, committed to bridging cultural differences in our communities. the corporation for public broadcasting and by contributions to your p.c.p. -- pbs station from viewers like you. you. thank you.

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