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End Of Health Care Subsidies To The Poor Is Another Blow To Obamacare


Late last night, President Trump took another swipe at the Affordable Care Act. The White House said it plans to halt monthly payments to insurers. These are payments that make it easier for low-income Americans to get health coverage. This came just hours after Trump signed an executive order weakening Obamacare by making it easier for small businesses to buy alternative types of health insurance. One of the architects of Obamacare was Dr. Zeke Emanuel, and he's on the line this morning. Dr. Emanuel, welcome.

ZEKE EMANUEL: Nice to be with you.

GREENE: Let me start with the subsidies. If they were to end, what happens?

EMANUEL: Well, first of all, the estimates are that a million more Americans would become uninsured. And premiums in 2018 will go up 20 percent because the health insurance companies are responsible for giving the subsidies out. And if they don't get the money back from the federal government, they will actually have to raise premiums to cover those costs. And the last thing is because the premiums go up, the federal government over 10 years will spend on nearly 200 billion additional dollars paying for health insurance for people who get subsidies in the exchange.

This is a, you know, we now know what Trumpcare looks like and it's pretty ugly. And in particular, the people who are really going to hurt are the people who don't get any subsidies because the subsidies that they don't - they have to just buy their own insurance and it'll go up 20 percent.

GREENE: Well, let me just ask you, if I can, about the argument from the president. And it's an argument that has been repeated by Republicans, and you're familiar with it, that these subsidies are actually illegal because Congress doesn't appropriate them. And there was a judge who agreed with that argument, although an appeals court disagreed. But it sounds like that's a legitimate legal question, right?

EMANUEL: It's definitely a legitimate legal question, but there was a agreement. When the Trump administration came in, the first thing they did is they asked for the judge to stay the decision and not implement it so that they could actually give out the subsidies. And they could have asked for that again. And the administration could actually have worked with Congress to pass these subsidies and to ensure that they were actually paid. There is the so-called Alexander-Murray negotiations that was going on just about these subsidies and other ways to help the exchanges.

GREENE: Well, I'm glad you brought up that bipartisan effort. I mean, those are two senators - one Republican, one Democrat - looking at an effort that would stabilize the exchanges, the markets. And the president tweeted this morning what seems like an invitation to Democrats to come to the table, saying, Democrats should call me to fix this. I mean, there's no timeline for these subsidies to stop from the White House. Could this be an effort by the president to get some sort of bipartisan action going?

EMANUEL: Well, I certainly hope so. It was rumored last week that he talked to Chuck Schumer about health care. You know, I've said for a long time I think there's a deal to be had about things like stabilizing the exchanges, bringing down costs to make things more affordable by addressing various - changing how we pay doctors, changing drug costs. So I - you know, that would be the best way to get it. But this sort of combination of we're going to weaken the exchanges by having these association health plans and draw out the healthy people so that they can get a different program, we're going to weaken the exchanges by getting rid of the cost-sharing subsidies.

They already had decreased the open enrollment period. They decreased the amount of time that they were going to spend on advertising and helping people get insurance. This does not look like a program to actually fix the health system. And so, you know, I would love to see a bipartisan agreement. I think there is plenty of overlap. But the combination of activities taken on by the administration over the last few days does not suggest that's the direction they've been moving.

GREENE: Dr. Zeke Emanuel is chair of the department of medical ethics and health policy at the University of Pennsylvania and one of the architects of the Affordable Care Act, Obamacare. Dr. Emanuel, always appreciate your time.

EMANUEL: Thank you, David. Take care. Transcript provided by NPR, Copyright NPR.

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