[Chris Cuomo, Cnn Anchor:] If you look at health care from a purely political perspective, Senate Majority Leader Mitch McConnell's in a tough spot. If he moves forward with a vote on the Graham-Cassidy bill, he may take another "l." That's tough for him because he's supposed to be able to deliver. But if he doesn't have the vote, he's basically admitting to defeat, and that then creates a problem for, how does he move forward? Now, the bigger problem is, he doesn't have enough Republicans here. So let's talk about that. Let's talk about where this goes from here. We have CNN senior political commentator and former senator, Rick Santorum. He's one of the architects of the GOP bill. And Kathleen Sebelius, a former Health and Human Services secretary who played a key role in Obamacare. Rick, start us off here. How do you see the state of play? Do you think Graham-Cassidy is dead? Where does it go from here, if so?
[Rick Santorum, Cnn Senior Political Commentator:] I think Graham- Cassidy will replace Obamacare, it's just a matter of when that's going to happen. You know, there there right now there's some challenges because of the timeframe and obviously changes that were made to the bill over the weekend that, you know, haven't really gotten out there to folks. So this compressed time frame has made it very, very difficult. I mean I think one of the disappointing things that the Senate did not stay in session through August and actually continue to work on this. I think had they, we'd be in a lot better shape right now. We'd have a lot more information out about the bill. This this is an approach that's going to work. Whether it works this week, I'm not I'm not 100 percent confident. But I am very confident that whether it's in the next reconciliation package, which is coming up here in a few weeks that they're going to do on taxes, whether health care could be added to that, or in 2019, which would be, you know, February of next year, we'll have another opportunity to do the same thing. This is this is the approach that that it makes the most sense. It is a centrist approach. It doesn't completely, you know, upend the apple cart. What it says is, for those states that want to keep Obamacare, they can. If you want to try something different, you can. And here are the resources to do it. It's a practical, common sense approach to solving the problem.
[Cuomo:] Kathleen, critics have not seen it as centrist or common sense. How do you see it and its reality going forward?
[Kathleen Sebelius, Former Health And Human Services Secretary:] Well, I think, Chris, at the end of the day, we've got to start with people. This is about people. It's not about Senate process. It's not about campaign promises. It's about millions and millions of Americans who now can rely on health care that they didn't have before, who are parents and pregnant moms and workers. So the focus has to stay on the people. This bill, I think, is a very dangerous approach because it really allows states to kind of make up their own rule book, figure out what it is that they think should be a package that would be available to people. Allow insurance companies, once again, to medically underwrite, to charge very different things based on your health condition and make it unaffordable for a lot of people with serious conditions to get insurance.
[Cuomo:] OK.
[Sebelius:] So I think it the focus has to stay on the millions of people the CBO has just said would lose coverage under this bill.
[Cuomo:] A testing point for each of you. First for you, Kathleen Sebelius. The most common criticism will be, not only did you do me wrong on the keep your doctorkeep your plan with the ACA, but my premiums have gone up. I know that's not people overall, but there's about 7 to 10 percent of that individual market
[Sebelius:] Sure.
[Cuomo:] In that individual market who say, man, I've skyrocket because you have attached me to everybody. My deductibles pop, my premiums pop. I don't like it. Let me get my own plans. My prices will go down. I worry about my family. What do you say to those people?
[Sebelius:] Well, I think they're right. Premiums continue to rise. And we can address that. I think the best way I'm a I'm actually an open market person. The best way to address it is competition. And this administration has an enormous bully pulpit to try and get insurance companies to play in markets where there is too little competition in the monopolies. They've done just the opposite. They have really actively worked to drive companies away. Refused to tell companies if they're actually going to follow the rules and pay the ongoing subsidies for lower income Americans. So the competition is the best way to keep prices low. And you see that in states across the country. Where there's active participation, heavy enrollment, an active governor and legislative involvement, there are many companies participating and rates have stayed relatively modest throughout the country. In states that that hasn't happened, driven a lot by the politics of the state, you see just the opposite, a monopoly marketplace and rates continue to rise.
[Cuomo:] Rick, respond and then I have a question to you.
[Santorum:] Yes. Well, the fact of the matter is, she talk about you talk about the individual market and how prices have spiked. Obamacare was about the individual market. Obamacare didn't reform the employer market, didn't reform Medicare, didn't reform Medicaid. It was all about the individual market and that's the part of the economy that's a part of the health care market that's imploding. So to say, well, it's just this little piece, but that's what Obamacare was designed to correct. And you and the secretary talks about competition. Obamacare is completely anti-competitive. It says you have to do all of these things. It doesn't provide any flexibility for insurance companies to be able to design programs and products that actually can be competitive. That's what we're trying to that's what we're trying to address here. Look, health insurance is not a nationally delivered project. You have regional health insurers. You have some statewide health insurers. But you don't have any national health insurance companies to speak of. What you have is every state has historically and even today, designs their own insurance market, now with the heavy hand of Obamacare saying you can only do certain things. What we're saying, let's get back to that where let let insurance market function and let the competition do work.
[Cuomo:] Right, but we left it for a reason.
[Sebelius:] Chris.
[Cuomo:] We left it for a reason. Rick, and the reason that we left it was that your standards were all over the place. People were getting closed out, especially as you get more sick and you have less money.
[Santorum:] And that's why the beautiful thing, Chris, the beautiful thing about our bill
[Cuomo:] That's why we moved away.
[Santorum:] Yes, I understand that.
[Cuomo:] The ACA was about insuring outcomes, not just pricing.
[Santorum:] I understand that, but I understand that.
[Cuomo:] And you're taking that away.
[Sebelius:] And and for the first time actually forcing companies to compete about service and price
[Santorum:] But let me let me just say let me let me respond to you, Chris. Right Right. Yes.
[Sebelius:] Not about who they could cherry-pick the market.
[Cuomo:] Right.
[Santorum:] Yes.
[Sebelius:] Who could drive out the sickest people? Who could make money?
[Santorum:] But Graham-Cassidy, as you well know, Madame Secretary, Graham-Cassidy does make sure that preexisting people with preexisting conditions are covered.
[Sebelius:] Not not true. Absolutely not true.
[Santorum:] Yes. I wrote the bill, Madame Secretary.
[Sebelius:] Well
[Santorum:] I know what's in the bill, OK?
[Sebelius:] Congratulations. But it actually allows insurance companies to go back to medical underwriting.
[Santorum:] And what it says let me let me tell you let me tell you let me tell you exactly what it says. It says that every insurance company under Graham-Cassidy has to cover people with preexisting condition. Every state has to
[Sebelius:] Can they charge them a lot more?
[Santorum:] Has
[Sebelius:] Can they price them out of the market?
[Santorum:] Well, you can't you know what, the reality is that the state can get a waiver, just like, by the way, they can under Obamacare
[Sebelius:] To put people in different risk pools, that's what the bill says.
[Santorum:] Excuse me, Madame Secretary, if you'll allow me to finish. Under Obamacare there's a 13 there's a waiver process in Obamacare that allows people to get waivers. Now, no state has done it. But we you can get waivers under Obamacare. We provide
[Cuomo:] So, Rick, just to be clear, is your answer yes to that question, yes they can underwrite it the way they want, they can charge people with preexisting conditions what they want? Is the answer yes?
[Santorum:] If the if the state the state has to get a waiver, just like they do under Obamacare, but they have to get a waiver from the secretary. But, again, no state is
[Cuomo:] But right now you can't price it the way you want?
[Santorum:] Let me
[Sebelius:] Correct.
[Santorum:] Let me let me finish.
[Cuomo:] But it matters. You've got to answer the question, bud.
[Santorum:] I am answering the question, but you're not giving me the chance to answer it.
[Cuomo:] It's a yesno answer.
[Santorum:] Well, it's not a yesno answer. Under both laws, the states can get a waiver on the on the issue of pre-existing conditions. And under ours, if it says you get a waiver, then you have to show the secretary that you can you are providing affordable and accessible insurance.
[Cuomo:] Kathleen, how is it different than what now?
[Santorum:] So the answer is, yes, they will get affordable insurance.
[Sebelius:] Well, the waiver the senator, unfortunately
[Cuomo:] Affordable is not the same as it is now. Go ahead, Kathleen.
[Sebelius:] Well, and the and the senator is just wrong. The waiver that is in the current Affordable Care Act says, if a state can figure out a way to insure as many people and to keep prices adequate, can they use the federal money in various ways to provide that insurance
[Santorum:] That's exactly that's exactly what do under this bill. In fact, better.
[Sebelius:] Abut they don't. Senator, you said they could waive they could waive preexisting conditions. That's absolutely false. That is absolutely
[Santorum:] No, I they have to guaranteeing people with preexisting conditions affordable and accessible insurance.
[Sebelius:] They no. And they have to offer a package of benefits that guarantees if you are sick, you will have the medical care you need.
[Santorum:] That's right. And under
[Sebelius:] The Graham-Cassidy bill waives
[Santorum:] That's not true.
[Sebelius:] Allows states to waive the essential health benefits and allows states to put people in risk pools.
[Santorum:] That is that is true. They can put that in their plans.
[Sebelius:] That totally undermines the preexisting condition.
[Santorum:] As you know, Madam Secretary no it doesn't totally undermine it.
[Sebelius:] I was an insurance commissioner, senator. I also ran the Medicaid
[Santorum:] Well, Madam Secretary, again, I wrote the bill and this bill
[Sebelius:] I great.
[Santorum:] Runs the program through the CHIP program, which requires 70 percent actuarial value for the program.
[Sebelius:] It's just not accurate. It's not accurate.
[Santorum:] So you can't write, quote, cheap insurance.
[Cuomo:] Well, but, wait, hold on. But, Rick Rick Rick, well here's the
[Santorum:] If you say CHIP is cheap insurance, fine. People like the CHIP program.
[Cuomo:] Here but here's the main process. But saying it goes through the CHIP program is a little deceptive, right? Because while the mechanism is basically the same, the requirements aren't.
[Sebelius:] That's correct.
[Cuomo:] I don't understand why you just don't own the reality of what this bill is. We're going to take money out
[Santorum:] The requirements are that you have to have a 70 percent actuarial value of products. That's not cheap insurance.
[Cuomo:] We're going to take we're going to take money out of this bill. Lots and lots of money that we're going to use for something else. Less people will get covered, but we are OK with that in the interests of some people getting cheaper insurance.
[Santorum:] Let's let's talk about that, Chris. Let's talk about that for a minute. One of the criticisms we're getting from the right, in fact heavy criticism, is we spend too much money. If you look at what money is taken out of the system, we take out the individual mandate. The individual employer mandate. And, by the way, the employer mandate, which the secretary
[Cuomo:] The CBO says it's going to be savings of well over $200 billion over the course of this initial legislation.
[Santorum:] So, again, let me let me explain. $250 about $250 billion in tax reductions. And we say, oh, we're giving these tax all we're doing is removing the employer and employee mandate. That results in about $250 billion in less revenue coming in.
[Cuomo:] Right, money that's needed to fund these states' Medicaid.
[Santorum:] And, by the way, Madame Secretary, you delayed the employer mandate the employer mandates now, for the first time and everyone says Obamacare is working. It's not even in fully effect. The Obamacare mandate of an employer actually goes into effect next month and 90,000 businesses are going to get tax bills totaling over $5 billion. So we haven't even seen the full effect of Obamacare and its effect on the economy. All we're saying is, let's take that money out. If the states want to reinstate the mandate, they can. They can collect the money.
[Cuomo:] But it won't be enough.
[Santorum:] But the rest of the money, other than that employer mandate taken out, the rest of the money is going to be spent. So don't talk about all this cutting
[Cuomo:] All right.
[Sebelius:] Well, that that is absolutely not accurate.
[Santorum:] It absolutely is accurate.
[Sebelius:] It's the other cut in the bill, it's a huge cut in the bill is to Medicaid and the underlying Medicaid program, not just the expansion, Chris.
[Cuomo:] Right.
[Sebelius:] Not just the working adults who now states had an opportunity, and 31 states did, expand their Medicaid program.
[Cuomo:] Right. Look
[Sebelius:] So two-thirds of the state, including the senator's home state, expanded. But the bill also caps the traditional Medicaid program in a way that I can guarantee you every state budget in the country would see a hit. Costs have shifted to states.
[Cuomo:] All right. Let's leave it let's
[Santorum:] Chris, I have to address
[Cuomo:] All right, just a quick button and we'll leave it there. It's a bigger discussion in one segment. And we'll we'll do it again, but go ahead.
[Santorum:] The secretary talked about the secretary talked the secretary talked about a cap on Medicaid. The cap on Medicaid that is being put forth by in this bill is actually more generous than a cap on Medicaid that President Clinton and four every Democratic senator in 1995 proposed this exact same cap that was actually tougher. Our cap puts Medicaid on the future growth future
[Cuomo:] That was long time ago.
[Sebelius:] And it isn't it isn't in place now. It has never been in place. And we
[Cuomo:] Right, it's a
[Santorum:] But they proposed it. Democrats proposed it.
[Cuomo:] But it was a different time.
[Sebelius:] Excuse me.
[Santorum:] Democrats unanimously supported this and all of
[Cuomo:] It was as different time. There were different
[Sebelius:] There was a cap that doesn't exist right now and it would hurt every state in the
[Santorum:] Yes, but
[Cuomo:] And there's a reason it doesn't exist right now, Rick.
[Santorum:] OK, you think Bill Clinton and Ted Kennedy were cruel and horrible when they put a cap they on Medicaid that's tougher than the cap we put in place.
[Cuomo:] But, Rick, it's a specious it's a specious argument. It's a specious argument. The times are different. They lost for a reason. The needs are greater. Just own the reality that you're going to take money out and that's your political priority. And less people will get covered.
[Santorum:] The needs are I mean the fact is the fact is that Medicaid that Medicaid
[Sebelius:] Seniors in nursing home, disabled children and adults, pregnant moms and kids, but that's in the Medicaid program.
[Santorum:] The Medicaid program
[Cuomo:] I know it's gone up. All right, Kathleen, Rick, listen, I hear you. I hear you both.
[Santorum:] It's exploding. It's exploding.
[Cuomo:] I hear you both. There's no question that there's a legitimate debate about how much money gets put into health care. There's no question. That's a debate to have.
[Santorum:] It's exploding and there's no cap. So that point
[Cuomo:] And that is going to be the argument you need to have that
[Santorum:] At some point we have to put some controls in the system.
[Cuomo:] That's fine.
[Santorum:] We thought we'd take a Democratic idea and actually make it nicer because Democrats froze it at a lower inflation rate than what Republicans were proposing and all of a sudden we're cruel.
[Cuomo:] It was it's not apples to apples.
[Santorum:] This is this is the
[Cuomo:] It's not apples to apples.
[Santorum:] This is a hypocrisy. It is exactly apples to apples.
[Cuomo:] It's not apples to apples. The situation was different.
[Santorum:] in fact, it's worse than apples to apples, Chris, because health care because health care costs are so much higher now than they were 20 years ago.
[Sebelius:] It didn't pass. It
[Cuomo:] And it didn't pass for a reason. All right, there's no question that costs are too high. They have to come down. There's a political debate to be had. But you don't want to you don't want to Honestly, it's not about what I want or don't want. Don't say what I want or don't want. You have to have the conversation with other lawmakers and get it done. Right now you're falling short. We'll leave this segment for today. You're always welcome back. Kathleen, Rick, thank you very much. Alisyn.
[Alisyn Camerota, Cnn Anchor:] A lot of conversation there about apples. It's making me hungry. Meanwhile, our other top story, President Trump just thanking the mayor of San Juan moments ago after she describe on NEW DAY the dire situation in Puerto Rico. Mayor Carmen Yulin Cruz was emotional with us as she described the humanitarian crisis that is unfolding this morning on the island.
[Mayor Carmen Yulin Cruz, San Juan, Puerto Rico:] Every time we find a person that is gasping for air and I'm not pointing a poetic picture. I am telling you, I have seen them. I have held them in my arms. I have helped move them into an ambulance. Every time we do that, of course we get a little frail and of course we get a little afraid. But we also get a lot more resolve to push on, to move on and to do whatever. Our bodies are so tired, but our souls are so full of strength.
[Camerota:] OK. So our Bill Weir is in Puerto Rico this morning to show us exactly what it looks like on the ground. Watch this.
[Bill Weir, Cnn Correspondent:] It is so hard to move around this island because Puerto Rico is a tangled mess of shattered trees and downed power lines and endless gas lines where the desperate can wait half a day under a blazing sun for a few precious gallons. In the rural highlands south of the capital, it looks like a bomb went off. Once lush green hillsides are now brown and broken by the power of Maria's wind. And it's up here where most of the 28,000 residents of Aguas Buenas had no choice but to shelter in place and pray as this camper was tossed like a toy. Diana and her family were huddled in their home across the street.
[Weir:] How are you? How is how is life? How are you surviving? I thank God I'm still alive, she tells me. I can't describe the storm. I've never seen anything like it in my life. It's hard to tell from the road, but the back of this house is built on concrete stilts driven into the hillside. So imagine the anxiety as Maria really picked up strength. Diana inside, she's caring for her invalid husband. She's worried that the back end of the house, his bedroom, is going to just slide into the ravine. So she moves the whole family into the living room. They hear the crash of this power tower go down on the neighbor's roof. Water is coming in through the shutters. She's trying to keep it up. And at one point she tells me they prepared to die together. Which is scarier, combat in Vietnam or Hurricane Maria? The hurricane is worse. Miguel survived a combat tour in Cambodia, and now Diana worries about the last file of his insulin at risk of spoiling in a powerless refrigerator. Yet with textbook hospitality, she takes the time to make us coffee. A few miles up the road, more kindness and much more misery. Here's a drone shot of this area before Maria and here it is today. This is what a category four hurricane will do to wood construction. The roof, who knows what happened to the roof. It's amazing the walls held the way they did. Trophies earned by Wilfrado's grandkids still stand in a room with no roof. He was released from prostate surgery the day the storm hit, holed up with his whole family in a local church, and all survived. But now he has little left but his faith. How would you describe peoples' desperation? Are you seeing looting? Are you seeing anger? There has been looting, the mayor of Aguas Buenas tells me. There have been robberies. And when it comes to the feelings of the people of this town, we are saddened because we're still looking for people. As an American, I wonder, how do Puerto Ricans feel about being an American territory in times like this? Do you do you think America will come save you? Do you hope they will? Yes, he tells me. President Donald Trump has approved a disaster declaration. We will move forward with the help of the United States.
[Gladys Hernandez, Survivor:] What they can give us, we'll receive with a lot of love. Thank you.
[Weir:] You're welcome. You're welcome.
[Hernandez:] Very much.
[Weir:] We're thinking of you. Bill Weir, CNN, Aguas Buenas, Puerto Rico.
[Camerota:] Well, look, needless to say, it's still helpful to have Bill Weir there, as well as our producer, Jennifer Revera, who you saw there translating in real time between she's Puerto Rican between the locals there and Bill. I mean that is he's giving us a glimpse into the desperate situation. That's just one small sample of people who are about to run out of medication.
[Cuomo:] Right. And the reason we're going to keep telling you the stories is I know that there could be a sameness to it. Like, all right, we get it, we get it. You don't get it. You couldn't live in those situation for a week. They're going to be living like that for months and months. Those are Americans there as well. And even if that doesn't move your spirit, it's going to move your pocket book because we have to have the federal government get involved there. The president's right, they do have infrastructure problems. They do have debt problems. That's only going to increase the need for help. So this is going to be a real situation that all of America is going to live with. So we need to keep it in our sights.
[Camerota:] Yes, and we're doing that. Thank goodness. And I know it is moving all of your spirits as well. So, President Trump, though, is not backing down against the NFL players taking a knee. Is he winning this culture war? What does his base think about it? We have "The Bottom Line" for you.
[Cuomo:] But first, a Georgia non-profit is helping refugee mothers and their young kids to get off to a good start in the United States. Their story in CNN's "Impact Your World."
[Unidentified Female:] These women share a common experience of being displaced from their home countries with young children. Refugee Family Literacy Program is a two-generation program providing education for refugee mothers and their young children. You could you get hurt surprising someone like that. Children come to our school and participate in an early childhood development program so that when they start school some day they'll hit the ground running. Mothers are upstairs learning English. Our students are from about 20 different countries.
[Unidentified Male:] I'm from Burma.
[Unidentified Female:] They didn't want to leave their home country. They left because they did not have any choice. That common experience transcends language. These women are able to support each other. I think a misconception is that most refugees were uneducated and impoverishes. Many refugees have strong education, strong skillsets and so much to offer us. If we think of them as uneducated just because they don't know English. Really it's our loss.