Republicans Plan To Repeal Affordable Care Act In New Session

Congress is expected to take up repeal of the Affordable Care Act this week. The plan is still sketchy, but some details are starting to emerge.

ARI SHAPIRO, HOST:

Let's talk more now about how Republicans are planning to repeal and possibly replace the Affordable Care Act. NPR health policy correspondent Alison Kodjak is here. Hi, Alison.

ALISON KODJAK, BYLINE: Hi, Ari.

SHAPIRO: What are you hearing Republicans are likely to do?

KODJAK: Well, what they're looking to do, at least they tell me, is that they want to gut the law essentially by removing all the taxes that pay for subsidies for people to buy insurance. There's a whole bunch of taxes in Obamacare, taxes on medical devices, taxes on health insurance companies. Wealthy people pay a surtax. And all the money used by those taxes goes to subsidies so that lower- and middle-income people can buy insurance at an affordable price.

SHAPIRO: If those subsidies and those taxes go away, are people who are currently getting their insurance through the Affordable Care Act going to lose their coverage?

KODJAK: Well, that's unclear. Republicans say they don't want millions of people to suddenly lose their coverage. They want to sort of allow a transition period so that they can come up with a replacement for Obamacare after they vote on this repeal.

So what they would do is phase out the parts of the law that they want to repeal over time, probably a two-year period or something. We don't know exactly how that's going to work. The best model we have is a law that they passed a year ago that President Obama vetoed where they phased out most of the law over two years.

But one thing they did was they got rid of the individual mandate that requires people to buy insurance immediately, and that could undermine their whole plan if that is in the new version of the bill.

SHAPIRO: Because if they get rid of the individual requirement that everybody buy insurance, then healthy people won't buy it. Sick people will, and it costs the insurance company a whole lot more money.

KODJAK: Right, exactly because, you know, then they raise premiums, and healthy people are even less likely to buy insurance - just this spiral that goes out of control.

SHAPIRO: So we know that Republicans say they don't want people to lose their insurance, but if it looks like a repeal vote will come as far as two years before a replace vote and we don't know what the replace vote looks like, sounds like it's hard to say for sure whether people will lose their insurance or not.

KODJAK: It is. It - there's just so much up in the air. And you know, what you have is people not sure if they're going to lose their insurance, less motivated to buy insurance. Plus, you have the insurance market, which is a big wildcard here. Insurance companies haven't been making a lot of money or have been losing money on the Obamacare market over the last few years. They've remained committed because the law was there, and they were trying to figure out how to make a product that would be profitable.

If they know the law is going away, there's not a lot of motivation for them to continue trying to sell insurance into this market. And so what you'll have is Republicans trying to keep this market going while they come up with a replacement, but they can't always get the insurance companies to cooperate. They can't force them to sell insurance into the market.

SHAPIRO: If Republicans in Congress have known for years that repealing and replacing Obamacare was one of their top priorities - and this is one of Donald Trump's top priorities for the entire year-plus of the presidential campaign - why wouldn't they have a replacement model all set up and ready to go the minute they took power?

KODJAK: You know, that's a good question. There's been a lot of talk about why over six to eight years they haven't come up with a plan. There have been a lot of proposals out there. They're details vary. And I think the issue is that there's different motivations behind different Republican plans.

Some want to keep as many people covered as are covered now. Others want to give people the option of having insurance and the option of not having insurance. Others are really focused on lowering health care costs.

So what you're finding now - what we're seeing is the variety of different policies out there seem to be focused on universal access to insurance, making insurance available to everybody but getting rid of that mandate that Republicans can't stand which is requiring people to have insurance.

SHAPIRO: Alison, open enrollment in these insurance exchanges is happening now and scheduled to continue through the Trump inauguration and beyond. What happens to that?

KODJAK: Well, the Trump administration will have to at least see this open enrollment through, which, you know, will last a few weeks after he's inaugurated. And then depending on how long it takes for the Republicans to come up with a replacement plan if they want to keep Obamacare going while they - through this transition, they may be into another open enrollment period next fall.

SHAPIRO: NPR's Alison Kodjak, thank you.

KODJAK: Thanks, Ari.

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