Speeches & Floor Statements

Senator Alexander with Axios: "A conservative victory requires a result”

Posted on October 18, 2017

Mike Allen: Senator Lamar Alexander, Republican of Tennessee, Chairman of the Senate Health, Education, Labor and Pensions Committee. Mr. Chairman, thank you so much for coming. Appreciate you being here. Senator Alexander, I have been covering you since I had hair and you had flannel.

LA: That's a long time.

Allen: So Senator, Caitlin Owens always has the news break and Caitlin just whispered a scoop to me-- she said you just got off the phone with President Trump, what did he say? 

LA: He called me to say that, number one, he wanted to be encouraging about the bipartisan agreement that Senator Murray and I announced yesterday. Number two, he intends to review it carefully to see if he wants to add anything to it. Number three, he is still for block grants sometime later, but he is going to focus on tax reform this year. I was thinking this morning that there’s sort of this parlor game around Washington is President Trump doesn't know what he's doing. On health care he probably does. In September against the advice really of Paul Ryan and Mitch, he sort of cleaned out the last half of September so the senate could consider the Cassidy-Graham bill you just talked about. He completely engineered the bipartisan agreement that Senator Murray and I announced yesterday in this way. He talked to Senator Schumer and encouraged him to ask me to do it, he called me twice over the last ten days to talk to me about a  bipartisan agreement for the short-term. A bridge, so people are not hurt. And he checked in this morning.

Allen: Why doesn't he just say he is for it?

LA: Well I think he wants to reserve his options. What we're going to do is with a number of Republican and Democratic senators we are going to introduce the bill Thursday, or put on the senate floor so people can see it. Then we'll see where it goes from there. And my guess is that it will be a part of discussions between the president, Speaker Ryan, Senator Schumer, Mitch McConnell, and I predict it will pass in some form before the end of the year. My experience here is that usually most ideas fail for lack of the idea, this is a very carefully thought out compromise that advances some Republican principles that haven't been advanced in eight years, and some Democratic ones as well. So I think it will happen before the end of the year. And I appreciate the fact that he encouraged me to do it, and I understand the fact that a president, any president, would want to review it, maybe try to add something to it and make it part of a larger negotiation before it's done. 

Allen: And what did he indicate as far as his general feeling about it? Did indicate how he was inclined?

LA: He hasn't read it yet. He's been busy and we just introduced it yesterday, but he called me ten days ago and encouraged me to do it. I was impressed with the fact that he was willing -- he understands that the Graham-Cassidy bill, for example, or any other bill to repeal or replace Obamacare doesn't take effect until 2020 or 2021, so what do you do in the meantime? What you don't want to do in the meantime is create chaos and hurt millions of Americans by skyrocketing premiums and some counties where you can't buy insurance. The Congressional Budget Office said without the cost-sharing payments up to 16 million Americans might live in counties where they can't buy insurance. Well, what does chaos do? It’s a four lane highway to a single-payer solution. It's a birthday present for Bernie Sanders. I think the president is pretty shrewd to understand there's a gap here that needs to be filled and the only way to fill it is by a bipartisan agreement like the one we suggested yesterday. 

Allen: And Chairman Alexander, you alluded to the fact there sometimes questions about the president’s mastery of policy but you said in health care you believe he does know what he's doing. Tell us about that. 

LA: Well, I think he knows, I think I just did. In September he cleared the way so we could deal with the Cassidy bill. In this case he recognized there's a gap and he worked with me so that I would work with Patty Murray and produce a bipartisan agreement to fill the gap.

Allen: A better way to ask is that is what do you believe either based on what he said are what you intuit about what his big goal is, what he is trying to achieve

LA: I think his big goal is the same as my big goal, which is to move more decisions about the kind of policies that are written for Americans who buy health insurance out of Washington back to the states so people have more choices and lower prices.

Allen: Do you believe –

LA: That's 80% of the dispute that's created the partisan statement over the last eight years. And by the way, there are three or four steps in the Alexander-Murray agreement that move in that direction. It is the first such steps we’ve had in eight years. It’s a compromise, so Democrats have some things, too, but you don't get a conservative win without a result. And we haven't had any results. We had a lot of speeches and a lot of lost votes. That's not a conservative victory. 

Allen: Chairman Alexander, you’re sitting down, have you had coffee this morning?

LA: No I haven’t, I’ve been to the gym.

Allen: Ok so you’ve been to the gym so you’re relaxed so you can take this question. Do you expect or want Republicans to revive full blown repeal and replace in 2018? 

LA: In 2018, I expect the president to recommend that. I expect Senator Cassidy to introduce a bill to do that and if he does and it’s the same bill he introduced before, I would vote for it. 

Allen: Do you believe it will pass?

LA:  I don't predict the Senate very well. Although I did just predict that the Alexander-Murray agreement will probably, in one form or another, pass before the end of the year. I hope it will. The major problem with the Affordable Care Act is what I just said, is that too many of the decisions about the kind of insurance policies that are written, are written in Washington and it doesn't take into account what happens in the states. And in the states, as former governor I know, we want to help people even more than people in Washington do and we can make decisions about that and we can lower prices and we can offer more choices. That is what that's about and that’s why I would vote for it. 

Allen: Mr. Chairman, you know Caitlin Owens of Axios, she is going to ask a question in 30 seconds, but first, is there a risk with the way this is being done in pieces and with bridges? Is there risk that insurance companies will say the roller coaster is too much, exchanges just aren’t worth the trouble? 

LA: No. I think a two-year bridge to whatever comes next is something that insurance companies can easily plan for. 2018 rates are mostly set, but they now would have plenty of time to make their 2019 rates. What we will try to do is to find a mechanism to make sure consumers get the benefit of the cost-sharing payments in 2018, not the insurance companies. And In 2019, consumers will automatically get those benefits. 

I would expect if we pass our agreement sometime before the end of the year, that it will have some effect on rates in 2018, they won’t go up as much, and then in 2019 rates will go down. 

Allen: You wear a lot of hats, but you’re one of the great minds of the Republican party is, someone who actually knows the country. As you look ahead to a tough midterm election next year, are you actually fortunate that repeal and replace didn't pass, are you actually fortunate that you don't 100% own it? 

LA: No, I don't think so. I don't quite look at life that way.

I am a result-oriented person, that’s why we announced that agreement yesterday. I want to get something done while I'm here. We did that with fixing No Child Left Behind. That was The Wall Street Journal said, the biggest devolution of federal power back to the states in 25 years. That was the result.

I don't know if I get we elected or unelected based on that but it’s the reason I'm here.

So I would like to see us succeed on changing the Affordable Care Act. Now there are a variety of ways to do it. We could have a short-term agreement to start with. Executive orders are another way -- the president started with that. We do need to take a new look at the Affordable Care Act and I would like to see power moved out of Washington back to the states. I don't know what the effect of that would be in the November elections in 2018 but it's what we ought to be doing.  

Allen: Senator, I take your point about No Child Left Behind, your accomplishment you announced yesterday. You are talking to a young senator, someone who wants to be a leader, someone who wants to accomplish things. What is the secret to passing something bipartisan? What is the secret to pulling off even something modest with a prominent member of the other party? 

LA: Number one, get to know them. I mean, it's no secret. If you don't know each other, and you don't know about areas of agreement. Number two, don't always try to do something comprehensive. Go a step at a time. That’s a good way to get where you want to go. Number three, have a lot of patience. Number four, keep your word. Those are things that are important. If you do that, you can get a result.

I like working with Senator Murray. She is part of the Democratic leadership, so we don't agree on a lot, but she can do all of those things that I just mentioned.

Owens: Hey, senator. I actually two questions for you that I will ask at the same time so I don't get cut off.

First one is about this deal that you reached yesterday. Some conservatives are already blasting it as insurer bailouts. If the Republican Party in the House, Senate, president successfully passed the bill and sign it into law, is this a win for Republicans and is this something Trump gets to say he forced to deal or is this something going especially into the November elections that the Republicans say they only passed an insurer bailout.  

Allen: We will come back. 

LA: A conservative victory requires a result. Now, it's been eight years now. We've had 50 votes to repeal Obamacare and we’ve lost them all. We've made a thousand speeches. We've gotten no results. There are three or four results embedded in this compromise.

One is a catastrophic plan for the first time for people of all ages, so a medical catastrophe doesn't turn into a financial catastrophe.

Two is, and more importantly, a change in the affordability guardrail, now this is getting very wonky, but it gives more states opportunities to do waivers like the Alaska waiver, Iowa waiver, Oklahoma waiver, Minnesota waiver, the New Hampshire waiver.

All of these are different ways of doing things. And as I said earlier, the single biggest objective of Republicans is to move decisions out of Washington back to the states. It also encourages interstate compacts on health insurance. It also streamlines the waiver system. That’s four results in this compromise agreement. That’s four more results than conservatives have achieved in eight years despite all the votes and all the speeches. That's what I would say to people who ask me about it. 

Owens: Just following up on that, if this happens the president can say this is a deal he directly influenced? Is this a deal the president directly influenced? If this passes, how much of an impact did Trump have? Is this something he can say he owned and is responsible for the result? 

LA: Well, the president engineered the bipartisan agreement by calling me and asking me to work with Senator Murray to do it. I’ve talked with him three times in the last 10 days about it, including 30 minutes ago. Sohe has it out there as an option if he decides in the end to make it part of something he signs, then of course it'll be something he supports when he gets there. He's been pretty shrewd in the whole process in this case by giving himself a bipartisan option that could give him three or four conservative wins on the way to trying to get block grants again.

Owens: So in the longer-term, asking you as Senator Alexander, not speaking for your entire caucus. You said this is a bridge to whatever comes next.  What is your ideal version of whatever comes next?

LA: I think Bill Cassidy did a good job with his bill. He's got time to improve it between now and the next time he comes up. The idea again, pretty fundamental, allow states to make more decisions about a variety of insurance policies as a goal of having lower prices and more choices. that's it. That's most of the difference with Obamacare.

And so, I think step one in the process is the executive orders that the president issued last week. Step two would be a bipartisan agreement to make sure that people aren't hurt, that we don't have chaos that leads to a single-payer system, that we have a few conservative wins in the meantime, and step three would be whatever we can agree to on long-term change.

Long-term change won't take effect until 2020, 21, 22. What are we going to do in the meantime? I think the Alexander-Murray agreement is an option and I hope it is one that Congress will adopt. 

Owens: But that step three that comes after is that something you can work with Senator Murray on? Can Democrats and Republicans work together on the bigger longer-term solution? 

LA: This is step one. There’s probably step two. There are other issues can be considered like the employer mandate is about to kick in and a lot of employers are about to be charged a lot of money. We could repeal that retroactively. That would cost some money. There is bipartisan support for changing the 30 hour to a 40 hour work week standard in the Affordable Care Act.

So there are other smaller things in the Affordable Care Act that could be changed in step two and three. When you get to things like the block grant proposals or the Senate bill or the House bill and there is just still a fundamental difference between Republicans and Democrats. Democrats like decisions made here. Republicans like decisions made in the states. That’s likely to continue to be partisan.

Allen: Caitlin, did you have anything you wanted?

Caitlin: Is it sustainable to have this debate every time the president changes? Or do you eventually have to decide on something both parties can live with?

LA: It's better to do something that’s durable. One of the advantages of our bill to pass No Child Left Behind is nobody's trying to repeal it every year because we worked it out in a consensus. Senator McConnell said the 21st Century Cures Bill which we worked out last year was the most important bill in Congress, probably was – medical miracles, speeding things through  the FDA – very contentious, very hard to do. But nobody is trying to repeal it because we had a consensus. We need to eventually get to that on healthcare, it’s just hard to do. In the meantime I think the smart thing to do is to  take step one – recognize a win when you see it, make sure people aren’t hurt, make sure there is stability.. People would like to see us get results. And as I said—and I’m going to have to say it a lot, I guess-- is you don't get a conservative victory unless you get a result. And you don't get a result in the senate unless you get 60 votes. The things that we might be able to get the block grants with 51 votes but we will not get the results that are in the Alexander-Murray agreement because the most important ones in there require 60 votes.