President Trump said he supports a bipartisan effort that would effectively shore up the Affordable Care Act. But he’s also distanced himself from it. What’s behind the complicated politics at play?

ARI SHAPIRO, HOST:

For more on President Trump’s role in all of this, NPR’s Geoff Bennett joins us now from the White House. Hi, Geoff.

GEOFF BENNETT, BYLINE: Hey, Ari.

SHAPIRO: So as we’ve just heard, this morning the president distanced himself from the bipartisan Alexander-Murray health care deal, saying he can never support bailing out insurance companies. But Geoff, yesterday he seemed to embrace the bill. Walk us through this.

BENNETT: Well, he did. Early yesterday, the president was holding a news conference in the White House Rose Garden with the prime minister of Greece just as news broke on the Hill about this tentative agreement. And when asked about it, the president praised the two senators involved and said he was aware of what they were working on. And he appeared to take partial credit for it.

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PRESIDENT DONALD TRUMP: Yes, we have been involved. And this is a short-term deal because we think ultimately block grants going to the states is going to be the answer. That’s a very good solution.

BENNETT: So you hear him call it a very good solution. But then hours after that yesterday in a speech before the conservative Heritage Foundation, President Trump changed his tone, saying the bill provides, as he put it, bailouts to insurance companies. And then this afternoon, Ari, White House Press Secretary Sarah Huckabee Sanders said the Alexander-Murray bill, while it’s a worthy pursuit, doesn’t go quite far enough.

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SARAH HUCKABEE SANDERS: We think that this is a good step in the right direction. This president certainly supports Republicans and Democrats coming to work together. But it’s not a full approach, and we need something to go a little bit further to get on board.

SHAPIRO: Geoff, that’s a quick pivot from hot to cold. What’s going on here?

BENNETT: I think what accounts for this is a Republican Party that doesn’t want to be in what they view as an untenable political position of having to vote to prop up the Affordable Care Act after pledging for seven years to scrap it. So you have groups like FreedomWorks, Heritage Action, the Club for Growth all casting this bill as a betrayal of the Republican promise to repeal and replace Obamacare.

But I’ll tell you. Democrats are really infuriated by what they view as the president’s shifting stance. Senate Minority Leader Chuck Schumer today while speaking with reporters called the president the obstructionist-in-chief for not being able to stick to a position, as Schumer put it. Here he is on the floor of the Senate earlier today.

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CHUCK SCHUMER: He’s totally inconsistent – for it one day, against it the next day. You can’t govern. Mr. President, you cannot govern a country. You cannot keep America great if you don’t know what’s in the bills and don’t have a consistent policy about them.

SHAPIRO: Does this mean it’s the end of the road for this bipartisan health care proposal?

BENNETT: Well, Lamar Alexander told my colleague Sue Davis, who covers the Hill, that he sees the White House pushback as part of the overall legislative process. But I think it’s impossible for Republican lawmakers to support this deal without President Trump’s stated endorsement. There’s just not enough political cover for Republicans to vote for it. And then over in the House, you have House Speaker Paul Ryan saying he wouldn’t even bring such a stabilization bill to the House floor for a vote. So right now, it seems that there aren’t enough votes for it. And without the president’s support, it looks like this bill doesn’t really go very far.

SHAPIRO: So if this bill doesn’t go very far and congressional efforts to repeal and replace the Affordable Care Act have failed, where do things stand?

BENNETT: Well, there are other options facing lawmakers. But again, there’s just – the incentive structure, particularly on the Republican side, just does not exist for the – for Republicans to stand up and to give yes votes for this bill on the floor either in the House or the Senate. So right now we’re really at an impasse.

SHAPIRO: That’s NPR White House correspondent Geoff Bennett telling us about the latest developments on the health care debate. Thanks, Geoff.

BENNETT: You’re welcome.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

NPR’s Kelly McEvers talks to Scott Higham of The Washington Post about the paper’s investigation of drug industry efforts to lobby the Drug Enforcement Administration and Congress to weaken enforcement on opioid abuse.

MARY LOUISE KELLY, HOST:

I’m Mary Louise Kelly in Washington where in the Rose Garden today President Trump had to defend his nominee to lead the White House Office of National Drug Control Policy. That would be the position known as the drug czar.

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PRESIDENT DONALD TRUMP: As far as Tom Marino – so he was a very early supporter of mine – the great state of Pennsylvania. He’s a great guy. I did see the report. We’re going to look into the report. We’re going to take it very seriously.

KELLY: The president referring there to a new report by The Washington Post and “60 Minutes.”

KELLY MCEVERS, HOST:

The investigation found that a bill sponsored by Tom Marino and pushed by the drug industry helped pump more painkillers into parts of the country that were already in the middle of the opioid crisis. Scott Higham helped write the story for The Washington Post.

SCOTT HIGHAM: Say a distributor in Ohio or in Michigan was sending pills downstream to pharmacies in Florida. And one month, that pharmacy was ordering 10,000 pills, and the next month, that pharmacy was ordering a hundred thousand pills. Well, that’s supposed to be reported to the DEA as a suspicious order. And a lot of these companies were not doing that.

MCEVERS: The Drug Enforcement Agency, the DEA, would call that an imminent threat to a local community and freeze drug shipments from the company’s warehouse. Marino’s bill changed that standard to an immediate threat, which doesn’t sound like a big difference, but it is.

HIGHAM: It’s almost impossible to show that a company that is a thousand miles away is posing an immediate threat to a community. Now, they may be able to show that a doctor in your hometown or a pharmacist in your hometown is posing an immediate threat, and they can shut that person down. But the big companies, the distributors and the manufacturers – they’re not going to be able to go after them.

MCEVERS: Co-Sponsors of Marino’s bill say that DEA enforcement was getting in the way of seniors and veterans, people who legitimately needed painkillers. I mean, is that a valid concern?

HIGHAM: Well, you know, you hear that from time to time. I mean, some of this comes from groups that are funded by the industry, but that’s not to diminish that there are people out there who sometimes have trouble getting their medications. But what we’re talking about here is the abuse and sale of hundreds of millions of doses of oxycodone and Vicodin to the black market.

MCEVERS: Yeah.

HIGHAM: And that’s the thing that the DEA was trying to shut down.

MCEVERS: And officials at the DEA opposed these changes for years but eventually backed down. And this bill, you know, in the end sailed through Congress, and President Obama signed it. What happened?

HIGHAM: That’s exactly right, Kelly. We’ve obtained internal memos, emails, other documents from the DEA and from the Justice Department that show that the DEA and the Department of Justice for many years was opposed to this. They had written memos. They had written emails saying this is going to upend our ability to go after these companies. Why are you doing this? And Marino had introduced this legislation in 2014, and the DEA got it killed; and in 2015, and the DEA got it killed.

And then there was a change in leadership. Eric Holder stepped down. Loretta Lynch took over the AG’s office. And then there was a new DEA administrator who came in who said that, I think that we need to work with these people. And there was also enormous amounts of pressure being placed on the DEA by Capitol Hill to pass this bill. And it was at the behest of the pharmaceutical industry. In fact, the bill was written by a pharmaceutical industry attorney who used to be a DEA attorney, one of – a senior DEA attorney. So it’s, you know, the classic kind of revolving door in Washington.

MCEVERS: Wow. And so what’s happened since this bill went into effect?

HIGHAM: So the number of immediate suspension orders has plummeted to zero against major manufacturers and distributors. There have been some immediate suspensions orders filed against smaller companies. But these very big companies, the ones that were backing this bill – they’ve had no actions taken against them at all.

MCEVERS: Senator Claire McCaskill of Missouri said today she will introduce a bill to repeal the Marino law. And Senator Joe Manchin of West Virginia wrote a letter to President Trump asking him to withdraw his nomination of Marino as drug czar. Do you think either of these efforts will go anywhere?

HIGHAM: Well, we’ll see. Not a lot’s happening in Washington these days, as we all know. Our reporting shows that a lot of the members of Congress weren’t really aware what was in this bill and what the import of this bill was because it was just passed by unanimous consent, which means that, you know, there’s no vote. There’s really no debate. They took the word of the leadership that this bill was OK. But you know, we’ll have to wait and see what happens. And as far as Mr. Marino’s tenure, it’s now in the hands of the president.

MCEVERS: Scott Higham of The Washington Post, thanks a lot.

HIGHAM: Thank you, Kelly.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.