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Senate Health Bill Would Make High Premiums Worse, Dr. Emanuel Says


We have a little more time - nobody knows how much time - to talk over a Senate health care bill. Republican leaders postponed any plans to vote because they need every vote, and Senator John McCain is recovering from surgery. The result is that, although the Senate has held no hearings on its proposal, there will be more of a public hearing of sorts. Zeke Emanuel is going to be one voice in that discussion. He was among the authors of the Affordable Care Act that Republicans want to replace. He's in our studios once again. Good morning, sir.

ZEKE EMANUEL: Nice to be here.

INSKEEP: Thanks for coming by. So you get some extra days to talk about this. What is one thing you would like the public to know?

EMANUEL: Well, I think one of the important factors is that the Senate bill does not change the repeal of the expansion of Medicaid. And, again, this expansion of Medicaid covered mostly people who were working whose employers didn't provide them health insurance. But they were able-bodied adults, as we say, and they weren't eligible for Medicaid before. The ACA expanded it. And the Republican bill is going to eliminate that expansion. Fifteen million people lose coverage.

INSKEEP: I guess we better just review here. The Affordable Care Act had several parts. There's a House bill that changed insurance for people on the exchanges, as well as Medicaid. The Senate bill has tried to tweak the House bill in a couple of different ways. And you're saying the Medicaid thing stays essentially the same.

EMANUEL: Essentially the same. And the Congressional Budget Office estimated 15 million people would lose coverage since that doesn't change. That your baseline of the number of people losing coverage. I find it just unconscionable that we would throw 15 million people off insurance. There are stories after stories of people who've been helped. Most people who get Medicaid actually turn out to like it because low cost sharing - and they actually can use the hospital and doctors that get a lot of their health problems solved.

INSKEEP: Here's something else that has not changed, though. Obamacare is still seen as rather troubled. Is doing nothing an option?

EMANUEL: Doing nothing's not an option. Even Hillary Clinton, when she ran - there was a number of things that needed to be done. We need to do two main things. One is to shore up the exchanges. It's not rocket science what you need to do. You need to enforce the mandate. You need to actually have these cost-sharing subsidies guaranteed. You need to give some reinsurance to the insurance companies in case they get a lot of sick people.

INSKEEP: Do the things that Republicans really hate about this bill - when you talk about enforcing the mandate.

EMANUEL: I understand. But it's necessary if you're going to get young, healthy people in and keep the exchanges stable. And then the other thing you need to do, which is nowhere in the Republican bills, is cost control for the long term. People are worried about affordability. And the key to solving the affordability problem is cost control, getting unnecessary care out of the system, making the system much more efficient. And that's not in this bill at all.

INSKEEP: Health and Human Services Secretary Tom Price talked about this over the week on ABC's "This Week," And here's how he characterized Obamacare right now.


TOM PRICE: We've got premiums that are skyrocketing, deductibles that are so high that individuals have coverage, but they don't have care. This is a system that is crying out for reform and revision. And that's what we're trying to do.

INSKEEP: He said premiums are skyrocketing. That's the thing that you just said. Here's my question. Wasn't Obamacare itself supposed to have provisions to control costs of insurance?

EMANUEL: Oh, we actually did control costs of insurance. And they've gone up much slower than under Bush. That's the first thing. The second thing, I would say, is one of the reasons you have these rise in premiums is because of Mr. Price and the administration. The uncertainty creates a situation where insurance companies don't know what's going to happen. And they raise premiums as a risk protection for themselves.

The second point I would make is he talks about the high deductibles. Let me tell you. You haven't seen high deductibles until you've seen the Republican plan in action. They are actually going to raise deductibles, not lower deductibles. So they, on the one hand, bemoan the high deductibles. But on the other hand, they have a bill that is actually going to make them worse. And again, let me just emphasize - in the long term, to make health insurance and those premiums more affordable, you need to reduce the health care costs in this country or at least reduce the increase, as it were, that complicated phrase health economists say. They are doing none of that.

INSKEEP: Is Ted Cruz's alternative viable here?

EMANUEL: It's worse.

INSKEEP: Because Cruz has a proposal. Let's just explain for people. Insurance companies, as long as they keep an Obamacare compliant plan out there, they can also offer a bare-bones plan to people. Why is that worse?

EMANUEL: It's worse because it does what's called split the pool. So it takes the healthy people and says, buy a skimpy plan and go over here. And the sick people - we're going to concentrate you in the exchanges. And that just raises their costs and just raises the premiums that they confront. It is absolutely guaranteed to undermine the individual insurance market and probably to kill it. And that is a surreptitious way of saying, oh, yes, we're giving freedom to young, healthy people to buy these skimpy plans. Well, that freedom undercuts the freedom of cancer patients like ones I've cared for, patients with Parkinson's and other diseases to actually get affordable insurance.

It also gives the lie to the notion that they're going to keep the pre-existing disease exclusion - so that if you have a disease like cancer, diabetes or heart disease, you can actually get a reasonable plan at a reasonable premium - not sky-high. This totally undermines that option. And the idea that, well, we're putting in some money to offset those costs increases - they don't have anywhere near enough money.

INSKEEP: One of many voices we're sure to hear as the Obamacare debate continues. Zeke Emanuel, thanks for coming by. Really appreciate it.

EMANUEL: Great to be here. Transcript provided by NPR, Copyright NPR.