robert: no holiday for healthcare. the senate bill is stalled. the affordable care act, under siege. many americans just want to know, where does that leave me and my family? we have some answers tonight on "washington week." >> we know that we cannot afford to delay on this issue. we have to get this done for the american people. robert: but delay they did. senate republicans punt the replacement healthcare bill past the july 4 recess as the divide continues between conservatives and moderates. among sticking points, medicaid policies, tax relief for the wealthy and assistance for low and moderate income americans. >> the central focus needs to be on lowering premiums. the current draft doesn't do nearly enough to fix that problem. >> it's difficult for me to see how any tinkering is going to

satisfy my fundamental and deep concerns. robert: polls show most americans do not support the g.o.p. legislation but leadership remains confident compromise is possible. >> legislation of this complexity almost always takes longer than anybody else would hope. but we're going to press on. robert: meanwhile, problems for the affordable care act as more insurers are pulling out of the exchanges and premiums, co-pays and deductibles are going up. democrats insist the law should be repaired, not replaced. >> throw away this mantra of repeal obamacare and work with us. robert: we examine the state of healthcare in america with sarah kliff of vox. yamiche alcindor of "the new york times," michael scherer of "time" magazine, and nancy cordes of cbs news. >> celebrating 50 years, this is "washington week." funding is provided by --

>> we've all been affected by cancer some way, somehow. dana farber cancer institute is pursuing breakthroughs every day to help end cancer, like identifying genetic mutations for targeted therapies and teaching your immune system to attack cancerous cells. by constantly using information in completely new ways, we're cracking the cancer code. learn more at discovercarebelieve.org. >> additional funding 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 pbs station from viewers like you.

thank you. once again, live from washington, moderator, robert costa. robert:good evening. senate republicans left washington without passing a healthcare bill. why? a revolt by conservative hard-liners and moderates. president trump says he supports the senate measure but this morning he delivered a mixed message via tweet. he wrote, "if republican senators are unable to pass what they're working on now, they should immediately repeal and then replace at a later date." it prompted immediate questions about the bill's political future but for most americans, there are bigger questions than that. tonight, we check the pulse of healthcare under president obama's affordable care act and how it could change under the proposals that are being brought forth by republicans. we will also share some viewer emails about the real-life struggles and concerns people have about coverage and care. let's start with the law better

known as obamacare. today, there are more than 28 million uninsured americans. who are these people? well, they're people who could not find an affordable plan, people who decided not to get health insurance even if they qualify for a tax credit. low income americans in the 19 states that did not expand medicaid. undocumented workers who are ineligible for coverage and those who have coverage are facing other challenges. a viewer, catherine, in florida, who works full-time, wrote us and said that insurance for her and her husband runs a little over $18,000 a year. that's twice what we pay for our mortgage. charles in new mexico wrote, "my premiums and deductibles have escalated to the point that my insurance has been useless since the implementation of the a.c.a." we got so many of these letters and so many people concerned about coverage but sarah, it's not just coverage. for people who don't have coverage and for people who do

have coverage, they're concerned about cost. how effective has the a.c.a. been at lowering that? sarah: so it hasn't really tackled what i think is the crucial problem in healthcare which is the fact that our prices are so much incredibly higher. i hear from a lot of my readers who tell me stories about going to the emergency room and one story, they ended up for a $629 bill for getting a band-aid on their child's finger and that's a uniquely american story. one of the reasons republicans are struggling with the healthcare effort is no one is talking about the prices, lowering the per-unit cost when we walk into the doctor's office or go to the hospital. one of the things that surprises me as a healthcare reporter is americans don't go to the doctor more than people in other countries but every time we walk through the door we get a bill that's double or triple other countries. the affordable care act did include reforms to reduce the overall volume of care to make doctors smarter about when they

provide care, try to get them to order less unnecessary care. it didn't take aim at the actual prices and i think that's at the heart at the frustrations. the reason we have high deductibles and co-pays, it's a product of the really high prices. michael: i think that was the political problem with obamacare. remembering back back to 2009, president obama said we'll expand coverage and control prices so the american people expected prices to be under control and from that point forward, every time things went up again, even under employer coverage, you were paying more and getting less,, deductibles were going up and republicans said it was obama's fault while the health system was out of control and no one able to put a cap on it. robert: we're really having a debate not just about the a.c.a., but about medicaid.

yamiche, you've seen how the expansion of medicaid under the affordable care act is having an effect on people's lives. yamiche: we talk about healthcare a lot of times, i'm sick, can i see a doctor? when medicaid does so many other things. medicaid pays for nursing homes, medicaid helps special needs students get their needs met. medicaid does things for families and covers them in a way that goes far beyond just showing up for the doctor, being sick. it's those issues which i think is why a lot of republicans are worried about taking away medicaid because they realize medicaid can be a safety net for other things. i wrote a story about a young man having seizures because he couldn't get health insurance and doctors partnered with housing to get him an apartment and use medicaid and section 8 together to get him in an apartment and his seizures stopped immediately. if you're homeless and stressed

out and can't get access to medicaid because you don't understand it, the moment you get someone to help you understand what the programs can do for you, your life can change. this is a guy in his 30's who can now work. that is wi think people worry about when they talk about medicaid. >> that's part of the reason so many democrats and some republicans are wondering why is medicaid on the chopping block in this debate? haven't republicans spent seven years saying they're going to repeal obamacare. why are they aiming to cut medicaid by 35% over 12 years, according to the latest c.b.o. analysis and partly it's because obamacare expanded who can be covered under medicaid but also partly it's because in the house, where this all originated, it's something that has been a dream of paul ryan's for decades, is to scale back medicaid. he says to make it more sustainable, and it's also because republicans are trying to generate some revenue in this bill so that they can then go ahead and move on to tax reform.

>> that's such a smart bill because the affordable care act is no longer a political football. it's something that's actually associated with people's health coverage and benefits and sarah, it's not just people associating the a.c.a. with medicaid but republicans have rallied against the taxes under the a.c.a., the regulations under the a.c.a., but there's also pre-existing condition coverage within the a.c.a. that's made the bill quite popular, the law quite popular. sarah: that's a big part of the affordable care act and it really speaks to how entrenched the healthcare law has become in our society. i think this is something democrats really hoped for. they kind of expected once this rolls out, once people get coverage, they won't want people to take it away. i remember an advocate once told me, we'll know this law has made it when people say take your government hands off my obamacare. like people say that about medicare and those reforms have become entrenched. people like the pre-existing

conditions ban but obamacare, because it's associated with a president who really was quite divisive in this country, it has not, as a concept, become something that democrats, up until very recently and definitely not republicans, have rallied around and said i want to protect this law. robert: so people may like the medicaid provisions and protections, but michael and yamiche, when you travel, you hear about complaints about the insurance market not working. michael: when people say they're upset about obamacare, they're usually saying they're upset about what they're paying for healthcare. that's not what this bill is meant to address. this is a long-time entitlement cut republicans have been looking for for 30 years. has nothing to do with obamacare or cuts to medicaid, like nancy said. and it's an effort to change the structure of insurance so people can pay lower premiums and get less care but the things people are worried about are still going to be here in five years or 10 years and now obamacare

won't be the boogie man, it will be something else. yamiche: when i talk to people, the thing they love is like you said, pre-existing conditions and being able to have that. i think that's across the board, democrats and republicans when i've interviewed voters in the campaign and afterwards since president trump took office. the thing is that people also have -- don't like the fact that the government told them they had to buy a product so there are people that love the fact that they can get covered with pre-existing conditions but don't really understand that it's because healthy people had to buy insurance, that's why you can pay and convince companies to say, you're going to have really, really sick people but you'll also have young people paying into the system that you won't likely have to pay for so those are the two things i've found that people are angry about. also, in all this conversation, obamacare, the fact that it's named that, to me as a reporter, people are angry at the politics of it and i think there's always going to be a racial dynamic to

this which is that people don't like the fact that they have to think about the president, people who don't like him for political reasons or how he represented us, they also have that problem going on, too. >> i think the fact that obamacare's more popular after he left proves that pound. robert: we hear about the republican effort to repeal and replace but are democrats, post obamacare being passed, are they looking for more government involvement? could a single-payer system, more federal spending, could that be on the agenda if the democrats get back in power? nancy: in their dreams, many democrats believe that's the best way to bring down prices but they are realistic and don't think that will happen soon. but it doesn't stop them from

using it as a negotiating ploy, saying that we're for single-payer and maybe we'll meet somewhere in the middle with republicans. right now, they're sitting on the sidelines and watching and hoping that republicans cannot craft a compromise within their own party because that suddenly gives democrats some power which is something that is in pretty short supply for them. michael: it's amazing to watch democrats and republicans have a different response. if the law collapses, democrats think more government could be the answer and republicans think less government. let's talk about the republican plan dominating capitol hill, currently stalled in the senate for days. the c.b.o. estimates 22 million people would be left uninsured over the next 10 years under the g.o.p. plan. polls show it's unpopular, that most americans don't support it. only 17% of those supported in the npr "newshour" poll, 12% in

the "u.s.a. today" suffolk university poll and the fox poll showed only 27% of americans approve of the republicans' plan. while mitch mcconnell rallies votes, rand paul, a doctor, remains one of the most strident healthcare holdouts. he wants the senate to fully repeal obamacare and work on replacement later. some republican governors are working against the measure and it's put mcconnell in a box. we see this with the republican governors, not democrats -- republican governors -- returning to the point of medicaid being popular in terms of expansion in the states. they seem to be a key stakeholder in the debate. sarah: they really are and they've been more vocal than i would have expected but a lot of republican governors are getting a lot of money in their states for medicaid expansion and this is especially important in states suffering from the opioid epidemic, places like ohio where john kasich is governor, they

feel they need medicaid expansion to continue. one of the things that was surprising, last week we saw nevada's governor give a press conference where he sounded like a spokesperson for obamacare, a republican governor talking about how important this law has been and how great it has been and it is interesting to see this intraparty divide. robert: and sandoval is the one who pressured senator dean heller, not to back the bill. michael, you've written about the power of the g.o.p. governors. could they tilt the debate? michael: i think they already are. in nevada, you see rob portman hesitant. but i think that's having an impact. it's not just the medicaid expansion. one of the things that hasn't been fully debated because i think it hasn't been presented to the american people is that under the senate plan and in a different way under the house plan, after 2025, it's not just the medication expansion that

goes away. it's that medicaid, as it has existed since 1965. changes. the way it has existed is you pay for someone and the federal government will match the amount paid. under this plan, after 2025, the money is capped. they cap it in slightly different ways and it's indexed to regular inflation and that's really important because that means over time, healthcare costs are going to keep rising faster than regular inflation. over time, the medicaid program shrinks more and more so these governors, when looking at this, are not just thinking about the people who've gained insurance. they're thinking about, ok, in 10 years or five years, i've going to be faced with trying to tell people they can't be in nursing homes or trying to tell sick kids who have very expensive treatments -- robert: does this fill the bill? nancy: i interviewed governor kasich and he said what's the point of flexibility if i don't have any money, then i really

don't have any more flexibility than i did before, i probably have less. and i think it just is emblematic of the fact that republican leaders, as they're trying to sell this plan to their own members, to the public, don't have many outside allies to turn to. you would imagine republican governors would be their champions but instead they're sitting on their hands or arguing against it. yamiche: when we talk about block granting medicaid, the experts i have been talking to go back to the 1990's, and say, remember block granting, welfare reform, and we thought it was great, cash assistance. cash assistance almost doesn't exist in many states because of block granting, the fact that you limit the money you give to a state and tell them to decide what to do with it, it changes the criteria and you need new eligibility requirements so that states figure out who are the neediest of the neediest and that's why you end up with people needing cash assistance and in some ways it's going to end up like housing where there

are so many people who need housing assistance but only a fraction that can get it. robert: these issues cloud the debate, as mcconnell looks for vote over the july 4 holiday. is there a way for the majority leader to get moderates on board to give them tweaks to the medicaid provision of the bill and getting conservatives on board by giving states more flexibility? do you see that as a political possibility? sarah: they were able to pull it off in the house so it's not impossible. one of the things that's instructive as we look at the house, we saw a failed book, paul ryan couldn't get the votes together. people took a few weeks off, came together and came to agreement. i don't think we can underestimate the drive of republicans to repeal this law and -- robert: because it's a promise they've made for years? sarah: exactly. nobody wants to be the person standing in the way. as different people say, yes, we can support this, it's hard to be in the hotseat and say, you're the person standing in the way.

robert: what do you make of president trump in all of this? he's called the house bill mean. he said any bill that passes should have heart. that's his phrase. we also see him getting behind the republican idea of full repeal, just get rid of the law and return to it in a few months. what to make of it? michael: i think heart and mean are about as specific as he's been about the policy. he doesn't get into the weeds here. what he said this morning in a tweet which was sort of contradicted by sarah huckabee sanders in the briefing was maybe we just do repeal and that seems like a negotiating tactic. >> and it was greeted by an uh, by republicans. he'll probably have a different solution 24 hours from now. michael: president trump wants a win and wants to move on to tax reform and it's clear if this crashes and burns, it will be harder to get tax reform, not

just because you won't have the money to play with, but dysfunction will continue to grow. yamiche: republicans understand that even if they give him a win, if people realize how terrible this bill is, they'll be completely on their own. the fact that he will absolutely go out there and say this was congress' fault and i tried to get you the best bill and this is what they gave me so i signed what i had -- when we talk about twitter, we stay sometimes this is a shrug and trump being trump but it's turned into a political atmosphere where people do not trust him which means it's a calculation people realize is a wildcard. >> he has limited influence on these senators because they now believe he'll tell them one week to vote for this bill, they have to do it for the sake of the party and the next week he'll say, it was a terrible bill and leave them hanging. and then beyond that, he's been the perfect example that you don't always have to toe the party line, that you can go out on your own and you don't have to sacrifice for the party to get ahead. he's in the white house.

robert: they see him really as the living embodiment of the republican base but they're weighing the political cost, as well, what happens if millions lose insurance? >> if you're dean heller from nevada, you're more worried about what your own constituents face under this new bill than worried about the fact that mitch mcconnell's going to be angry with you if you don't side with him. michael: and even if you're talking about the base, you have to define your terms because there is the traditional ideological base which wants less government. they wanted obamacare out. then there's the trump populace base who believed trump during the campaign when he does i'm not going to cut medicaid or medicare or social security, i'm going to give the working poor more, not less, and he's pushing a bill to give them less, not more. and he's taking that money and very directly at least right now giving it to wealthy people. robert: why do you think, sarah, that the president got behind

the ideology of house speaker paul ryan and conservative republicans if he's not declined to declined -- inclined to do the sweeping overhaul. sarah: i think he's someone who wants a win and he's not very engaged in the policy details. there was a revealing question, he was asked basic questions about the bill and he would say things like everybody is covered and deductibles will go down and those simply aren't true about the bills that republicans are proposing, that these are bills that will cover fewer people, raise deductibles. i think it's a good point about the people who voted for trump. i spent a lot of time in an area, southeastern kentucky, that went really high for trump. and these people listened to the campaign, watched the debates and saw trump promise to fix the healthcare system and i think they heard i am frustrated with the prices, i'm frustrated with the costs and this president will make my healthcare costs less. and he is not working waybill

right now that would deliver that promise. robert: a lot of people in kentucky rely on the a.c.a. yamiche: i was in jackson, mississippi, recently, and i think i take away from both trump supporters and others is that while they voted for donald trump and understand that, they also are sticking with him in this way that to me is still very interesting to me. so the budget comes out and the administration says, you know, social security disability isn't really social security, even though it's named social security disability. and i went to mississippi and talked to people and said you're going to lose your coverage and they're like, i understand the president has to make difficult decisions and i'll figure it out as long as he builds that wall so the idea is that people are in some ways willing to suffer for the idea that donald trump is going to keep the other people out of the country and that is something that's really important. >> i was talking to susan collins the other day, senator from maine, and she handed me

this chart and i don't expect you to be able to see this. but she's handing it out to everyone she talks to and it's the potential cost under this new bill for someone inia, -- in northern maine. but according to her calculations, these are the deductibles under the new plan. her average resident is going to pay $5500 in deductibles compared to $800 now so the key promise of republicans leading up to this bill has been, we want to bring costs down. robert: every republican senator evaluating the bill is looking at a chart just like that, what's the cost for my state, not for the party, but my state. >> and she's saying until this looks better, i'm not voting for it. robert: thanks, everybody. our conversation will continue online on the "washington week" extra. we'll talk about the backlash over president trump's fake

"time" magazine cover and his tweets about a couple of morning news anchors. friday night after 10:00 p.m. at pbs.org/washingtonweek. don't forget to tune in next tuesday night to pbs' equip a -- "a capital fourth." for now, i'm robert costa. thanks for watching. enjoy your weekend. >> funding for "washington week" 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 -- farber cancer institute. more at discovercarebelieve.org. 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. thank you. >> you're watching pbs.elevisio.

♪ ♪