KELLY MCEVERS, HOST:

Now we're going to talk to South Dakota Republican Senator John Thune. Thanks for joining us.

JOHN THUNE: Thanks, Kelly. It's great to be with you.

MCEVERS: So what are the problems with Obamacare that you feel this bill fixes?

THUNE: Well, first and foremost, the problem with Obamacare is that you got markets that are in a state of collapse, prices that are going through the roof. And couple that with higher deductibles and out-of-pocket costs. It's just become unaffordable for people. So we figure in order to fix it, we've got to bring stability to the marketplace - one. Two, we got to, you know, improve the affordability for people when it comes to being able to buy a plan, protect people who have preexisting conditions. That's something we all agree on. And...

MCEVERS: That's something from Obamacare - yeah.

THUNE: Yeah. And then we've got to be able to make Medicaid sustainable, which it's not today, and give states flexibility to design plans that work better for their populations but that don't pull the rug out from people who really, really need help.

MCEVERS: You talk about making Medicaid sustainable. But what the bill does is it cuts Medicaid pretty dramatically so that states will have to pay a lot of the money or cut services if they can. And this is happening as baby boomers are retiring. Many of them will depend on Medicaid for nursing-home care, long-term care. How will they get the coverage they need?

THUNE: Well, Medicaid in this plan continues to grow year over year at the rate of inflation. And, yes, there are more people who are, you know, reaching retirement age, which obviously puts more of a burden on our, you know, nursing homes and assisted living facilities. But we also have seen firsthand what states have done in coming up with innovative ideas that have saved a lot of money. There are lots of examples around the country where they work and partner with insurance providers and also health care providers to come up with a way of managing care so that you bring down costs.

MCEVERS: But not every state can do that with Medicaid, right? Like, some would have to fund one thing at the expense of something else, including possibly people with disabilities, right?

THUNE: Yes, there are certainly populations within Medicaid that are more expensive to cover. And that's taken into consideration. But what we're trying to accomplish is to design and tailor this program in a way that maximizes the good ideas at the state level and run this program in a more efficient way.

MCEVERS: This bill needs 51 votes to pass in the Senate. And as we just heard, at least four Republicans say they will not vote for it, which means you don't have the votes. How do you change their minds?

THUNE: Right. Well, I think the answer to that, Kelly, is that, you know, we have (laughter) - we have to figure out over the course the next few days what it takes to get some people to yes. But there are features in this bill that are dialable, things that we can do I think...

MCEVERS: Like what?

THUNE: Well, I mean I think there's some things you can do on taxes. There's some things you can do on Medicaid. But I think at the moment, right now, a lot of the objections that are being raised are people who also think that there are too many heavy-handed government requirements and mandates in the bill and that there aren't enough what they would call market reforms. And so, you know, we'll take a look at those things and see if there is a way to hopefully bring some of the people who may have questions about voting for this around to yes.

MCEVERS: Do you believe the leader will bring this to the floor if it is not clear the bill has the votes to pass?

THUNE: You know, I think the leader has indicated that we need to vote on this one way or the other. And I expect that will be the case. I was also thinking - I'm optimistic maybe (laughter) in thinking this - that eventually when push comes to shove and people are faced with voting for, you know, a failed system that we have today or an alternative that at least offers a different, better path, that they'll choose that alternative. But sometimes you don't know that until you actually get to a vote.

But you know, again, we've got a few days here, and we'll get some feedback from the Congressional Budget Office over the weekend. And then we'll see if there are some things that we can dial in the bill that might find that sweet spot that gets us to 50 votes plus perhaps the vice president and the chair to get this passed. I think in the end, the American people want to see action. They want to see results. And I think we have a responsibility to do everything we can to ensure that we get them that.

MCEVERS: South Dakota Senator John Thune, who was among the 13 Republicans who crafted the Senate's health care bill, thanks a lot.

THUNE: Thanks, Kelly. Great being with you.

(SOUNDBITE OF YOUNG GALAXY SONG, "HARD TO TELL") Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. 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.