News Brief: The Latest On The GOP Tax Bill; CVS Buys Aetna

Dec 4, 2017
Originally published on December 4, 2017 7:09 am
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STEVE INSKEEP, HOST:

Republicans are taking the next step toward turning a tax bill into law.

RACHEL MARTIN, HOST:

Here's how it works. The Senate passed a tax bill in the wee hours of Saturday morning. A different version had already passed the House. Now negotiators are trying to merge these two. And Senate Majority Leader Mitch McConnell told ABC's "This Week" that he is feeling confident.

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MITCH MCCONNELL: We'll be able to get to an agreement in the conference. I'm very optimistic about it. And we think this will make a big difference in getting our economy moving again and providing jobs and opportunity for the American people.

INSKEEP: OK, sounds good. But what really ends up in the final bill? NPR's Scott Detrow covers Congress. He's with us once again. Good morning, Scott.

SCOTT DETROW, BYLINE: Good morning, Steve.

INSKEEP: How different are these two pieces of legislation?

DETROW: Well, there's a lot of technical details. And some of them are pretty key to the whole process. I mean, the House and Senate versions have different bracket definitions for who gets taxed at what rate. The Senate had an expiration date on individual tax cuts. The House did not. That's a key thing. And amid all of this, Trump threw a curve ball in over the weekend saying that he might be open to changing one big thing that both sides agreed on, and that's lowering the corporate tax rate to 20 percent. Trump indicated over the weekend he might be OK with 22 percent.

That got Marco Rubio, a Florida senator, pretty upset because he and Mike Lee of Utah had pushed on the Senate floor to increase that rate to 21 percent, shift some of that money to child tax credits. It was defeated.

INSKEEP: The president said, no, no, never, absolutely not.

DETROW: Yeah, and Rubio said, oh, interesting that 22 percent might be an option now.

INSKEEP: And when you're talking here, Scott, I'm reminded that real people's lives will be affected here. You mention that the Senate has some tax cuts that expire primarily, if I'm not mistaken, for middle-income people. There are a lot of people under that Senate bill who would end up paying higher taxes rather than low taxes, right?

DETROW: Yeah. And the thinking with putting an expiration date on the individual taxes was that that was a way to keep the deficit increase in line but also a political calculation that whoever's in charge 10 years from now would not be too excited about raising taxes on individuals.

INSKEEP: Isn't there also a bunch of extra non-tax stuff tucked into the Senate version of the bill?

DETROW: There's a lot in here. The Senate version opens up part of the Arctic National Wildlife Refuge, ANWAR, to oil drilling.

INSKEEP: This is to get a vote, right?

DETROW: Yeah. And this is something that Republicans and the oil industry have wanted to do for decades and never gotten it across the finish line. It's been a long pet project of Alaska Senator Lisa Murkowski and a big reason why she's voting for this. This also repeals the individual mandate from Obamacare. Of course, the mandate is a tax, the Supreme Court famously ruled that but not something that many people think of as a specific tax issue. One other thing that's in the Senate language is repealing the Johnson Amendment.

That's something that President Trump campaigned heavily on. That's language that restricts how religious organizations talk about politics. It does have to do with their tax status as nonprofits. But again, kind of a bigger-picture political issue in this bill.

INSKEEP: Yeah, so a lot of horse trading to get the votes to pass the bill. And now there's another round of horse trading, which is all in private, right?

DETROW: Well, there's a conference committee that's going to be set up. The House takes the first step toward authorizing that today. It's a committee made up of House members, of Senate members. They're going to come together with one bill that neither chamber can change that they have to vote up or down. But, yeah, I think a lot of the action coming up will be behind closed doors.

INSKEEP: And a lot of news will be in the details. Scott, thanks very much, really appreciate it.

DETROW: Thank you.

INSKEEP: That's NPR's Scott Detrow.

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INSKEEP: And now let's turn to what would be, if it happens, one of the largest healthcare mergers in history.

MARTIN: Yeah, drugstore chain CVS is preparing to buy health insurance giant Aetna for $69 billion. This is a mammoth acquisition, obviously. It would pair a company that runs more than 9,000 drugstores with an insurer that covers around 22 million people. We should note Aetna is an occasional sponsor of NPR programming.

INSKEEP: And with that disclosure out of the way, let's talk about this with NPR health policy reporter Alison Kodjak. Alison, good morning.

ALISON KODJAK, BYLINE: Good morning, Steve.

INSKEEP: So if I go to a CVS, how is my experience going to be any different if this merger takes place?

KODJAK: Well, what CVS and Aetna are saying is that they want to create sort of this seamless, simple medical experience where if you're an Aetna-insured customer and you go to a CVS store, it would be like a little health care hub. Not just a drugstore but you can go and maybe get blood tests, get your - talk to your pharmacist about the medications you're on. And all of it, perhaps, may come without a copay. That's sort of something they're dangling. They haven't announced all the details, of course, of what this will look like.

But they're talking about creating this sort of medical experience that's cheaper and simpler than either running to the ER when you're sick or making an appointment with your doctor.

INSKEEP: Which all sounds great in theory but you can also see some of the antitrust implications, I suppose, of this giant synergy of these different kinds of companies, things the federal government will have to think about. But is it really going to make - I mean, why would the experience be any cheaper just because the companies have the same owner?

KODJAK: Well, so the way the health care industry works with insurance companies - and what CVS is other than a drugstore chain is what's called a pharmacy benefit manager. It's just sort of this horrible term for a company that manages your prescription insurance. So when you get - if you have Aetna Insurance, CVS already manages your prescription drug plan. And each company takes a little bit off the top to make their profit. So the theory is that by combining them, there'll be fewer middlemen. They may have more of an incentive to lower costs because the insurance company and the drug company, the pharmacy benefit company are the same.

But at the same time, there's this whole secondary problem, which is that this will create an enormously powerful company in the health care system that will have a lot of leverage. And pharmacy benefit managers, historically, haven't been known for really lowering prices according to their competitors in the health care industry.

INSKEEP: Yeah, so who is pushing against this deal in the way that you're describing?

KODJAK: Well, right now what I've seen is a lot of consumers questioning it. If you look on Twitter, there's a lot of people going, how can they possibly let this happen? And there are experts who are wondering how this can possibly lower prices. Last year, the Justice Department blocked two huge insurance company mergers. But because CVS right now isn't a traditional insurance company, it's hard to say whether they'll take that same action.

INSKEEP: Well, there you go. I mean, has the Trump administration said anything that would suggest their attitude about this merger?

KODJAK: They haven't said anything on this particular merger at this point, but they certainly are expected to be friendlier toward mergers in general than the Obama administration was. And they'll be taking a look, but it's hard to say that they'll see the same problems.

INSKEEP: Even though they recently went after this AT&T-Time Warner merger, which among other things, involved CNN, a TV network the president dislikes.

KODJAK: Exactly.

INSKEEP: Alison, thank you very much, really appreciate it.

KODJAK: Thanks, Steve.

INSKEEP: That's NPR's Alison Kodjak.

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INSKEEP: OK, over the weekend, a plane flew from Washington, D.C., toward Cuba. It carried a military judge, prosecution and defense teams, interpreters, journalists and relatives of people killed in the 9/11 attacks.

MARTIN: Yeah, the destination was Guantanamo Bay. Every other month or so for the past five and a half years, a war tribunal has assembled there. It has struggled to bring to trial five men accused of plotting the 9/11 attacks, including the alleged mastermind Khalid Sheikh Mohammed. This will be the 26th time that this tribunal gathers in session. The whole proceeding is expected to take about a week.

INSKEEP: NPR's David Welna is just outside the courtroom and is on the line. Hi, David.

DAVID WELNA, BYLINE: Good morning, Steve.

INSKEEP: Just want to note, 16 years since 9/11 and Khalid Sheikh Mohammed was captured not so long after that. Why has it been so hard to put him and others on trial?

WELNA: Well, you know, Steve, this is likely going to be the trial of the century if it ever gets to that point. But thousands of pretrial motions have been filed. And almost all of them are coming from the lawyers defending these five men, who face possible death penalties. And it's all happening in this remote corner of Cuba in a court that was largely created to try these men as war criminals. Three years ago, the Senate Intelligence Committee documented that all five of these men were brutally interrogated in secret CIA-run jails called black sites.

And a lot of what went on here, on there, I should say, is still being kept secret by the government and prosecutors. So the defense teams keep trying to put the focus on what their clients went through. And there's been considerable wrangling. It could be years before an actual trial begins.

INSKEEP: So the treatment of the suspects themselves and the creation of a special court to try them is part of the delay here, part of the slowness of it. So now you have this latest round of pretrial motions. What will they be discussing?

WELNA: Well, it may be the most interesting issue will be a jurisdictional challenge that one of the defense teams is bringing up. They say that their client should not even be tried in this war court. Walter Ruiz is the lead lawyer on that team. And he argues that there was no war going on between the U.S. and al-Qaida when the 9/11 attacks occurred, so his client could not be guilty of war crimes. And Ruiz says this war court was created mainly to keep a lid on what the CIA did to these defendants.

But he says it's up to the prosecution to show that the man he defends should be tried for war crimes. Here's Ruiz.

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WALTER RUIZ: They have to argue that it is a law of war court to keep it here in Guantanamo under this kind of control. If not, then it doesn't get to be tried here. It gets tried as a number of other cases where people are accused of terrorist acts under domestic statutes and violations of domestic law in federal courts.

INSKEEP: OK, David, is there any chance that the court could side with the lawyer there and say that his client is in the wrong court?

WELNA: Well, you know, the judge, who's an army colonel, has already ruled that Ruiz makes a plausible argument. But he hasn't said whether he agrees with him. If he does, that could throw this whole case into further disarray because it would really call into question the whole arrangement they have here of trying detainees under the law of war. You can be sure the prosecution, whose lead lawyer no longer speaks to reporters, will make a strong case that this court is where they belong.

INSKEEP: OK, David, always a pleasure talking with you. Thank you very much.

WELNA: You're welcome, Steve.

INSKEEP: That's NPR's David Welna at Guantanamo Bay. Transcript provided by NPR, Copyright NPR.