At the age of 29, Molly Young was diagnosed with breast cancer. The Affordable Care Act has been paying for her treatments. NPR’s Michel Martin talks with Young about how she would fare under the new GOP plan.

MICHEL MARTIN, HOST:

We want to talk a bit more about this key question of how the proposed Republican health care bill could affect people who need health care, particularly people with chronic or life-threatening health problems.

Molly Grace Young is a self-employed singer and music teacher living in Baltimore. Last year, at the age of 29, Young was able to get insurance through the Affordable Care Act. Just a month later, she felt a lump in her breast and she was diagnosed with breast cancer.

Luckily, her cancer treatment was covered. But under the proposed Republican health care plan, the extent of her future coverage is uncertain. Molly Young came in a few days ago. And I started our conversation by asking her where she is in her cancer treatment.

MOLLY YOUNG: I’ve had two surgeries. And I am two doses away from being done with chemotherapy. But I will have immunotherapy for a year and six weeks of radiation and five years of hormone therapy. And, yeah, it’s a road. It’s process. But I’m getting there.

MARTIN: Do you have any sense of how much all this would have cost without insurance? Or like, I mean…

YOUNG: Yeah.

MARTIN: …I know, like, looking at those bills has to be traumatic…

YOUNG: (Laughter) yeah.

MARTIN: …But have you ever kind of figured out, like, what the costs of all this treatment would have been?

YOUNG: Yeah. We’re about six months into a treatment process. And so far, out-of-pocket would have been over $120,000. I have a friend who’s going through chemo who every single dose was $25,000. So that was $150 for her right off the bat without anything else. As hard as I might work, I’m not going to be making that much.

MARTIN: You don’t have $120,000 sitting around?

YOUNG: No, I really don’t (laughter).

MARTIN: And just to reiterate for people who are wondering, like, OK, well, what about an employer? What about, like, that – you’re self-employed. You didn’t have an employer who offered insurance.

YOUNG: Right. It’s not that I’m unemployed or that I don’t work. I work very hard. But no one single job is a full-time job for me. It’s kind of a patchwork of a lot of different employments.

MARTIN: You were telling us that one of the reasons that you decided to speak up and, you know, talk about this publicly was that you have been following the efforts to repeal and replace, you know, Obamacare. Like, how have you been following that and what has struck you about that?

YOUNG: I distinctly remember driving home from one of my scans – one of my MRIs, which they’re terrifying, especially if you already have cancer and you know they’re just excavating for more. And you’re wondering, not even will I die, but how fast.

And I was driving home from that and I was listening to live coverage of debate, and it was just horrifying. It sounded so inhumane to me that people were arguing about whether or not people in my position should be allowed to be cared for and be saved because without coverage, without this treatment, I would just die and that’s it.

And it’s terrifying to hear how little people like me can matter in these issues. We’re not really focusing on actual human lives. We’re just looking at dollars and cents, which is a very morbid way to go about it.

MARTIN: When you get through this stage, you will be considered a person with a pre-existing condition. Is that a concern? Because part of this new iteration of the GOP health care plan would not require insurance plans to cover pre-existing conditions. So is that a concern?

YOUNG: Oh, absolutely. Cancer is a lifelong sentence. No matter what – no matter if I get through the next year or the next five years and everything’s fine and I’m eventually, hopefully, pronounced with no evidence of disease, NED, I have many, many years to worry about, not only a recurrence of breast cancer, but any other type of cancer in my body is now an elevated risk because I have been a cancer patient. So I’m absolutely a walking pre-existing condition for the rest of my life.

And as my life changes, if I have to sign up for a new plan somewhere and it’s in a state that decides that they don’t need to protect me, I will be in a position where I need more care than most people, but I have less access to it, which is a little unfair (laughter) in my opinion, but yeah.

MARTIN: So you really see it as something that can dictate the future course of your life, like where you can move and what job opportunities you can take.

YOUNG: Oh, absolutely. To look at it being a state-by-state issue, for someone like me or people with diabetes – the list goes on of all sorts of health concerns. And access to essential health benefits – we know that mammograms are one of the biggest reasons we do catch breast cancer early on in many patients. So if we suddenly have groups of states in our country that won’t provide that, that’s really a death sentence for plenty of Americans.

MARTIN: So before we let you go, I did – I do feel I need to ask you, though, if the people who are the proponents of this new approach or this – the Republican approach, argue that it would create more choice and lower costs. And I just have to ask you whether you think that’s possibly true.

YOUNG: As I said before – trying to educate myself about it – to me, as a patient, from the outside looking in, that looks like a great way to drive up costs and create a profit-based market to make money off of people like me who are dying for no reason.

I didn’t do anything to earn breast cancer. It’s not in my family. They tested my genes. It’s just bad luck. And the same way we as a country can look to any kind of natural disaster that just sort of happens and we all want to reach out and help one another, I think that’s no different than wanting to create more of a community in terms of health insurance and not have it be based on who can afford it.

And it’s very frustrating to me to hear lawmakers discuss this knowing that they’re in a tax bracket that they could probably take these costs on themselves, if they had to, out of pocket and also knowing that they’re not subjecting themselves to the same plan that we have to take on.

MARTIN: That’s Molly Grace Young. She spoke with us from our Washington, D.C., studios. Tomorrow, we will have several more conversations with people with different perspectives and opinions about the American health care system, including a deep dive on how a single-payer health system would work.

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 Ailsa Chang talks to Sen. Maggie Hassan, D-N.H., about what’s next in the health care debate after Sen. John McCain, R-Ariz., said he will not support the Graham-Cassidy proposal.

AILSA CHANG, HOST:

President Trump is vowing that any Republican who votes against the latest attempt to undo the Affordable Care Act will be known as the Republican who saved Obamacare. And that’s what Democrats are looking for – Republicans to save Obamacare both by voting against this new bill and by agreeing to bipartisan fixes to the ACA. New Hampshire Democrat Maggie Hassan sits on the Senate health committee, and she joins us on the line now. Welcome, senator.

MAGGIE HASSAN: Thanks for having me.

CHANG: First, I just want to catch up on where Republicans stand now on shoring up support for this latest bill. It’s called Graham-Cassidy. And this afternoon, Republican John McCain of Arizona announced he would not support it. Kentucky Senator Rand Paul said he’s a no. That leaves 50 Republicans left. Who else are you hoping to see peel off?

HASSAN: Well, first of all, I’m just really grateful to John McCain for his leadership. What he expressed in his statement was how important health care is for every single American and to about a sixth of our economy. So it’s really critical that as we go about looking to stabilize our health insurance markets, lower costs for Americans and businesses in health care and improve outcomes that we do it carefully, in a bipartisan way. And that’s really what a number of us are committed to.

We obviously know that there are still some unknowns out there on the Graham-Cassidy bill. I am hopeful that other of my Republican colleagues will join senators McCain and Paul and really get us back to the process that we have been engaged in – bipartisan talks involving experts and leaders from both parties, from many different perspectives – so that we can really make sure that what we do in terms of policy doesn’t hurt real people. It’s really important for us to understand how things really work on the ground.

CHANG: You know, even though – if Graham-Cassidy does fail, there still is another challenge ahead because there does need to be some legislative fixes to Obamacare. What are you willing to put on the table as possible fixes to strike a deal with Republicans?

HASSAN: Well, we – a number of us have been talking about the need to improve the Affordable Care Act and address certain weaknesses in it. The first thing…

CHANG: Like what?

HASSAN: Well, we’ve heard from experts and we all agree that we need to really commit to making those cost-sharing reduction payments that people may have heard about. That’s really a way to make sure that people who are buying insurance on the exchange can afford their out-of-pocket costs and their deductibles. There’s general consensus that we should be helping states with reinsurance programs so that we’re helping with the most expensive health care cases, people who have really serious illnesses that drive the cost of premiums and a plan up for everybody.

And then I’m also on a bill that would address what’s known as the income cliff in the Affordable Care Act, which would make the tax credits for premiums more available to more families. And those are the types of things that we’ve all been hearing testimony about and talking about. It’s the type of things a bipartisan group of governors have proposed as well.

CHANG: But I just want to take a – I just want a reality check. I mean, how possible is meaningful bipartisanship on this? Because on the very same day that senators Graham and Cassidy introduced their bill, almost a third of the Senate Democrats stood behind Bernie Sanders as he reintroduced Medicare for All, which obviously is a far more liberal idea than Obamacare ever was. So are the two parties just veering too far apart to find common ground on this?

HASSAN: Well, certainly every senator is free to introduce legislation that is important to them and that represents what they think we should do on something. But what I think is important is that you saw on our health committee over the last four weeks or so real bipartisan discussion in progress about how to stabilize the Affordable Care Act and how to improve outcomes, lower costs. One of the other things that I think we can find common ground on is how we lower the cost of prescription drugs, which are really squeezing a lot of families right now.

So overall, there is extraordinary common ground when you think about what the bipartisan group of governors have come forward with. And you also see enormous bipartisan opposition to Graham-Cassidy right now. I mean, 50 state Medicaid directors have expressed their opposition to it from red and blue states. So again – again, this is a…

CHANG: But on the fixes – you think that will be an easy lift on the fixes, the bipartisan fixes?

HASSAN: I think that whenever you have to actually get into policy nitty-gritty that affects every single American it is always a lot of work. But that’s what we’re elected to do. We have seen really good progress with Chairman Alexander and ranking member Murray, and I think we can do it.

CHANG: All right. Democratic Senator Maggie Hassan of New Hampshire, thank you very much for joining us.

HASSAN: Thank you.

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.

In the GOP’s attempt to repeal the Affordable Care Act, California would lose a lot of federal funding. Texas would gain a lot in the short term, but experts worry Texas would not use the money well.

AILSA CHANG, HOST:

The Senate is taking one more stab at repealing the Affordable Care Act. Republicans say they’ll vote on what’s known as the Graham-Cassidy bill next week. Among other things, it would dramatically redistribute federal funds to states. And generally, states that expanded Medicaid stand to lose billions of dollars. The rest would see a short-term influx of funds. We’re going to hear from one of those states, Texas, in a minute. First, from KQED in San Francisco, April Dembosky explains why California would be one of the hardest hit states.

APRIL DEMBOSKY, BYLINE: The new Graham-Cassidy legislation would take money from states that have invested heavily in the Affordable Care Act, then redistribute it to other states that haven’t. Aviva Aron-Dine is with the Center on Budget and Policy Priorities.

AVIVA ARON-DINE: For a state like California or a Massachusetts or a New York, exactly the states that might be most motivated to at least try to preserve the ACA coverage gains – those are the states that would face the deepest cuts to their federal resources.

DEMBOSKY: The bill’s authors say their plan gives states more flexibility to build their own health systems. But California would lose 35 percent of its funding by 2026. That means millions of people with Medicaid and exchange plans would lose their insurance. A lot of those people are entrepreneurs and their employees. The head of the Small Business Majority in California, Mark Herbert, says the health funding cuts are bad for the economy, too.

MARK HERBERT: It would be massively destabilizing to the ability of small employers to attract talent. It would be very difficult for entrepreneurs and self-employed folks to access some level of coverage.

DEMBOSKY: Under the Affordable Care Act in California, a million and a half small business owners and employees got health coverage, and the state’s overall uninsured rate dropped by more than half. For NPR News, I’m April Dembosky in San Francisco.

ASHLEY LOPEZ, BYLINE: I’m Ashley Lopez in Austin. At first glance, it looks like Texas comes out as one of the big winners. Texas will get a windfall of $35 billion to help replace Obamacare exchanges and other programs, more than any other state. State officials get to decide how they want to spend that money. But Stacey Pogue with the Center for Public Policy Priorities in Austin says that doesn’t necessarily mean this is an improvement.

STACEY POGUE: Regardless of the size of the block grant, there’s just no assurance that it would translate into good coverage or coverage that’s affordable as what we have today.

LOPEZ: Texas already has the highest number of uninsured folks, and Pogue says the state just doesn’t have the infrastructure in place to expand coverage to more people. It didn’t expand Medicaid, and the state didn’t set up its own exchange. They used healthcare.gov.

POGUE: There’s no planning and no thought put into, how would we create affordable coverage for low-income Texans unlike the 31 states that have expanded Medicaid, have done some central planning? And Texas would be starting from scratch.

LOPEZ: She says it will also take a lot of political will to make sure the state is expanding health care. Pogue says that has been lacking among state lawmakers for years. And in order to get the block grant, states need to create something workable by 2020. For comparison, it took Massachusetts four years to set up its pre-Obamacare insurance market.

STACY WILSON: We are very concerned.

LOPEZ: That’s Stacy Wilson. She’s the president of the Children’s Hospital Association of Texas. She says this pot of money from Cassidy-Graham also doesn’t solve problems for Medicaid, 70 percent of which covers children. Wilson says that’s because the federal government would pay a fixed amount per person per capita cap, which locks in how much the state gets per Medicaid enrollee.

WILSON: We have very low per-capita costs already, and we get locked into that forever.

LOPEZ: A conservative policy group in Texas is also not happy about the bill. However, their concern is that it actually doesn’t go far enough to repeal Obamacare. For NPR News, I’m Ashley Lopez in Austin.

CHANG: This story is part of a partnership with NPR, local member stations and Kaiser Health News.

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.