美国国家公共电台 NPR Obamacare Is First Item On Congress' Chopping Block（在线收听）

RACHEL MARTIN, HOST: 

Today in Your Health, the future of the Affordable Care Act. On Wednesday, President Obama will meet with congressional Democrats about how to protect the health care reform plan that bears his name. Republican leaders have said they'll repeal Obamacare as soon as they take the reins in Washington. My co-host David Greene spoke with NPR health policy correspondent Alison Kodjak about the longstanding tension over this legislation.

ALISON KODJAK, BYLINE: In 2010, the Democrats kind of ran through this law without any Republican support. It was huge, it was complicated, thousands of pages long and ever since, Republicans have been pretty mad about how it passed. And they've refused to help fix it, and, instead, they've just promised over and over again to repeal. And in fact, the House has already voted more than 60 times to do just that over the years.

DAVID GREENE, BYLINE: And now they have - they'll have a Republican president, both houses in Republican control. Looks like it can happen. What exactly does it mean to repeal?

KODJAK: Well, they can't really repeal it outright because the Democrats in the Senate can filibuster that and block it, but Democrats can't filibuster anything that has to do with the budget. So what the Republicans probably will do is eliminate the financial parts of the law, the tax and budget items.

But that means they'll eliminate the penalty for people who don't buy health insurance, and they'll eliminate the subsidies that help people pay for insurance under the law. That's really the core of the Affordable Care Act. So what's not clear is how quickly they're going to cut off the money. They're trying to come up with a replacement plan, and so they may delay that for months or even years.

GREENE: So lack of clarity, delays could mean a lot of people left in limbo, I imagine.

KODJAK: Millions. Right now, the estimate's about 20 million people get their insurance through Obamacare one way or another. You've got about 10 million people who buy plans through the exchanges that have been set up by the federal and state governments and then there are millions more who have insurance because of the expansion of Medicaid under the law. About 31 states and D.C. have expanded Medicaid to people who have a little bit more money just over the poverty line. And a lot of that is in the Affordable Care Act and could be reversed as well.

GREENE: Democrats have made the charge that people could be cut off if Republicans act very boldly and very quickly. Is that possible? Could Republicans literally cut people off who would get insurance under this?

KODJAK: Well, I don't think that they want to. They have said over and over again - Republican leaders - that they have no intention of just throwing people off their insurance policies. But there's a lot that they have to consider. Before the Affordable Care Act, people with existing medical conditions - they often couldn't get any insurance or they were very much priced out of the market. And there are also a whole group of people who had lifetime limits like a million dollars. And when you have a severe illness, you can reach that limit. So there's this whole slew of people who did not have insurance, and they're pretty happy with Obamacare, that they can get coverage now. But then there are other people like Will Denecke. I talked to him last October just before he was going to start shopping for insurance for this year, and he was pretty mad because his costs were rising.

WILL DENECKE: Incredibly, we got a notice from our health care company, Moda, which has had financial problems saying that my premium was going up to $930.

KODJAK: So Denecke's self-employed and unlike most people on Obamacare, he makes too much money to qualify for government subsidies. So before the ACA, he paid about $340 a month for insurance, but that's all changed.

DENECKE: I've had health insurance my whole life, but it's just offensive, you know, in principle to think about spending a thousand dollars a month for health care insurance. I just don't make enough to, you know - to pay that kind of percent of my income on health insurance.

KODJAK: But on the other side of the equation, you have people like Leigh Kvetko. She lives in Texas, and she takes about 10 medications every day because she's had two organ transplants. And after Obamacare passed, she was able to quit her job at a big company, start her own business because she could finally get her own insurance.

LEIGH KVETKO: This particular plan - the fact that they cannot discriminate against me because of how I was born was a lifesaver, literally.

GREENE: OK. So Alison Kodjak, that voice right there is someone who really relied on this law because she had preexisting conditions, she could make a big change, start her own company and she would still get insurance. She wouldn't lose it.

KODJAK: Exactly. And that's who the law was really directed at in the first place, people like her.

GREENE: OK. So some of the things you've talked about - Congress could come in, they could defund a lot of parts of this law, the president - you know, President Trump once he comes in will probably sign that. What happens next?

KODJAK: Well, if they vote to defund, all the money could go away to implement and support the law. But some elements stay in place, including the requirement that insurance companies cover people who have ongoing medical conditions, people like Leigh Kvetko. And Trump has said over and over again that he wants to keep that provision because it's very popular. Here he is with Lesley Stahl on "60 Minutes" just after the election.

(SOUNDBITE OF TV SHOW, "60 MINUTES")

LESLEY STAHL: When you replace it, are you going to make sure that people with pre-conditions are still covered?

DONALD TRUMP: Yes. Because it happens to be one of the strongest assets.

STAHL: You're going to keep that?

TRUMP: Also with the children living with their parents for an extended period, we're...

STAHL: You're going to keep that?

TRUMP: ...Very much try and keep that in.

KODJAK: The problem with that is that some experts warn that the individual insurance market could collapse altogether if that part of the law is preserved, but young, healthy people stop paying for insurance 'cause it gets too expensive.

GREENE: Because there'd be less money in the system to actually support the people who need the insurance.

KODJAK: Exactly.

GREENE: That's the argument that Democrats are making.

KODJAK: Exactly.

GREENE: So do the Republicans have kind of a broad plan that would give us some idea of, you know, something comprehensive that would be replacing Obamacare?

KODJAK: Well, so what they have is they don't have legislative language. There's a lot of ideas out there. Various members of Congress have put out proposals, but they don't have a definitive plan which is where this talk of delay comes in. They may vote to repeal, but not cut off the money immediately while they come up with their replacement plan.

But included in those ideas there are some general principles. One is that instead of requiring people to buy insurance which is really unpopular, they would instead create incentives for people to buy insurance by offering tax credits toward your insurance premiums. But there's not a definitive proposal out there. And Republicans are talking about perhaps waiting years before they find a replacement to the Affordable Care Act.

GREENE: All of which is to say you're going to be a very busy reporter covering all of this in this year and the coming year.

KODJAK: I'm sure I will be (laughter).

GREENE: All right. That's NPR's health policy correspondent Alison Kodjak. Thanks, Alison.

KODJAK: Thanks, David.