NPR News:特朗普发表就职后首次国会演讲 医保方案成焦点

President Trump presented his vision for the future of health care in his address to Congress last night. He repeated his call for lawmakers to repeal and replace the Affordable Care Act. And he laid out what he called principles that should govern that replacement process. Joining us now is NPR health policy correspondent Alison Kodjak to go over what the president said and what's going on in Congress. Good to see you.
ALISON KODJAK, BYLINE: Hi, Robert.
SIEGEL: Was any of what the president said last night about health care new?
KODJAK: No. There were no specifically new ideas. He had mentioned some of the things he's been mentioning since he was on the campaign trail. He wants to have health savings accounts, which are tax-advantaged accounts to pay for health care. He wants people to be able to buy policies across state lines. But the other proposals, the whole slew of proposals he mentions, align very closely with the plan House Speaker Paul Ryan laid out last week. And that suggests that at least for now, the president and the speaker are on the same page. And up until last night that wasn't really clear.
SIEGEL: Does that mean that there is a clear road ahead for the Republicans to move forward on health care?
KODJAK: Oh, no, it doesn't mean that at all. Even though the president and Speaker Ryan seem to be in agreement right now, within Congress House Republicans don't agree. They don't necessarily agree with the Senate. They're really kind of all over the place. There's one major sticking point, and that's how much help the government should give people to buy insurance. Here's what the president said last night.
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PRESIDENT DONALD TRUMP: We should help Americans purchase their own coverage through the use of tax credits and expanded health savings accounts. But it must be the plan they want, not the plan forced on them by our government.
(APPLAUSE)

KODJAK: And it's that term tax credits that's really an issue. In Speaker Ryan's proposal, those tax credits are refundable, which means that even people who don't pay federal income taxes can get a refund to buy insurance. But there are many more conservative Republicans who have come out against that — they don't want people who don't pay taxes to get the credit — including Senator Ted Cruz and members of the Freedom Caucus in the House. And then, you know, beyond that, there are members of the House and Senate who don't think this is generous enough and they're afraid a lot of people are going to lose their insurance.
SIEGEL: So you have some saying it could be too generous. Who's saying that it isn't generous enough? And what do they mean exactly?
KODJAK: Well, for instance, Senator Susan Collins said she's concerned about the proposal to roll back Medicaid, which would...
SIEGEL: She's the main Republican, right?
KODJAK: Yeah, she's a main Republican.
SIEGEL: The centrist Republican.
KODJAK: And there are a lot of senators and Republican governors who are worried about — the Medicaid rollback will throw a lot of low-income people off health care plans.
SIEGEL: Well, you've tracked this issue very closely over the past several months. And hearing the speech last night, what's your takeaway of what the president had to say about health care?
KODJAK: Well, one main takeaway is that he is now backing off earlier promises that he made during the campaign and early in his presidency that he wanted to see everybody get insurance coverage. And instead, he's embracing what is the Republican talking point, that everybody will have access to coverage, which means they will be able to buy coverage. That means people with pre-existing conditions can get insurance and they won't be excluded. But it doesn't necessarily mean people will have enough money to buy insurance if those plans are too expensive. And that's a big change because in the past, the president has said he doesn't want anybody to lose their health care.
SIEGEL: So — and the president said recently that his plan would make health care better and cheaper. He still stands by those descriptions of what he's going to deliver?
KODJAK: Well, he has said that as well. And it's — what he's learning and he said earlier this week is that it's much more complicated than, as he's put it, anybody knew. I think a lot of people knew it's quite complicated to reform the health care system. And now he's beginning to see how complex that is.
SIEGEL: NPR's Alison Kodjak. Thanks.
KODJAK: Thank you.