STEVE INSKEEP, HOST:
Here's the dilemma facing Republicans, who will soon control both Congress and the White House. They have unanimously said for years they want to repeal Obamacare. Yet, because the law provides benefits to many millions of people, Republicans also acknowledge they must replace it with something that does many of the same things. They haven't agreed on what that should be.
It's in this atmosphere that Zeke Emanuel visited President-elect Trump this week. Emanuel was one of the architects of the Affordable Care Act, and he's in our studios. Good morning.
EZEKIEL EMANUEL: Nice to be here.
INSKEEP: So how'd the meeting go with President-elect Trump?
EMANUEL: It went very well.
INSKEEP: What's he like to talk to about health care?
EMANUEL: I found him engaged, curious, and he asked a lot of thoughtful questions and had a lot of opinions, as you might expect.
INSKEEP: Did you have a sense that he knows what he wants to do and what he wishes Congress to do?
EMANUEL: Well, I'm not going to reveal what we talked about. That's for the president-elect's team to decide what they want to reveal. But I'll say he was definitely engaged and definitely asked a lot of thoughtful questions.
INSKEEP: Well, let's talk about this situation. Here is President Obama's signature achievement - or one of them, anyway - which Republicans have vowed to repeal for years. But the president-elect has let it be known in public statements and elsewhere that he wants to keep some of the popular provisions, for example, making it so that you can't lose your health coverage because of a pre-existing condition or making it possible to keep your health insurance if you're a young adult and you're still on your parents' insurance. Republicans in Congress have put out their plans.
What is your sense of what's going to happen here? Do you believe this law's going to - going to survive in some form, just under a different name?
EMANUEL: Well, I think we're going to have to provide coverage for all Americans. I believe, on the campaign trail, President-elect Trump was committed to providing health coverage to all Americans. I think he has - he's said that publicly. And I think threading that needle is why health care is complicated.
It's just as complicated for Democrats as Republicans, getting a way that's fiscally responsible to cover all Americans and a structure that is as simple as possible, but it's never going to be very simple. I mean, I think most people have to remember - it's a $3 trillion industry in America, 18 percent of GDP. That makes any change a very complicated arrangement.
INSKEEP: Is that part of the - not just the practical problem, but the political problem here? Whatever you did in 2009, people barely understood it. People barely understand it now. And whatever changes are made, people are barely going to understand them.
EMANUEL: That is only partially the problem. Remember, as you pointed out, there are many, many popular provisions in the bill. People like the fact that they don't have to pay deductibles or co-pays for preventative services - that was part of the legislation - that there are essential benefits which everyone can get, including mental health benefits and other benefits for drugs. So there are lots of popular provisions of the bill. The only unpopular provision, by polling, is really the individual mandate. But lots and lots of individual provisions get, like, 75 or 80 percent of the public supporting it. And I think that's an important point.
INSKEEP: OK, let's cut to the chase here. That is the thing that Republicans hate most, the mandate, forcing people to buy insurance or else pay a tax penalty. It's been said, though, that it's connected to this other thing, making sure you don't lose your insurance for pre-existing conditions. It's been said you can't do one without the other.
However, Republicans say, yeah, we've got ways to do that, there's some way to do that. Do you believe that this law can survive while getting rid of the mandate that many people hate?
EMANUEL: There are only four ways - you have to get everyone in the system if you're actually going to get the pre-existing condition exclusion in there.
INSKEEP: Everybody's got to be involved, you're saying.
EMANUEL: Everyone's got to be involved. There are only four ways of doing that - an individual mandate with some kind of penalty, continuous coverage with serious penalties, some way of you have to pay more if you delay getting the bill, or we actually pre-re-enroll you - automatic enrollment and you can opt out. The problem with the continuous coverage provision and the provision for a penalty if you delay is that they don't work very well. So a mandate and automatic enrollment are ways that really work.
INSKEEP: Are you arguing, in just about five seconds, the bottom line here is that people are going to have to pay something? They're going to have to be committed to something, whether they like it or not?
EMANUEL: It's either through taxes or premiums or some way. People have to be involved in the system and engage if we want to actually cover everyone and make sure people who have cancer or other diseases get coverage.
INSKEEP: Zeke Emanuel, thanks for coming by.
EMANUEL: My pleasure. It was a pleasure to be with you.
INSKEEP: He's at the University of Pennsylvania
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