RACHEL MARTIN, HOST:
Republicans in Congress have tried over and over to repeal Obamacare to no avail. Now, they control both houses of Congress, and they've got an ally in the White House. And now the path is much clearer. Here's Donald Trump just before the election.
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DONALD TRUMP: Obamacare has to be repealed and replaced. And it has to be replaced with something much less expensive for the people. And otherwise, this country's in even bigger trouble than anybody thought. So we're going to repeal and replace Obamacare.
MARTIN: The repeal part is already underway, although Trump and other Republicans say they want to keep some popular parts of the plan, which makes the whole thing more complicated. Today, Vice President-elect Mike Pence is up on Capitol Hill talking with Republicans about how to move forward with repeal. President Obama is also up there huddling with Democrats about how best to respond. Should they work with them to try to preserve as much of the law as possible or oppose them at every turn?
One of the architects of the Affordable Care Act, Zeke Emanuel, told us yesterday on this program that he's optimistic about what the ultimate result will be under Trump.
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EZEKIEL EMANUEL: He really does, I think, genuinely want a bill and health care system that works for all Americans that achieves universal coverage, no pre-existing disease exclusions. And I think, therefore, there is some ray of optimism that we could actually get a compromise bill rather than just something rammed down the country's throat by the Republicans.
MARTIN: Joining me now to talk about all this is NPR national political correspondent Mara Liasson.
Good morning, Mara.
MARA LIASSON, BYLINE: Hi, Rachel.
MARTIN: What can you tell us at this point about how Trump and the Republicans are going to go about this?
LIASSON: Republicans have already laid down the procedural groundwork for gutting the ACA. But there is still a big internal debate inside the Republican Party about whether it's a good idea to repeal the law without having a replacement ready to go. And Republicans haven't been able to agree on a replacement yet that would give everyone access to affordable, quality insurance. And Trump, as you just heard, wants to keep some popular parts of the law, like letting young people stay on their parents' plans, not banning people with pre-existing conditions.
But the big question is how you do that without keeping the law's mandates and subsidies. And then there's the difficulty of, quote, "repeal and delay," which is another Republican idea, where they repeal the law but put an expiration date on it. In other words, the repeal wouldn't take place for several years, kind of try to freeze the law in place. It's not clear if that's realistic because insurers, once they know the law is going away, would probably just leave the individual marketplaces. And the whole thing might just collapse.
MARTIN: So what kind of leverage do President Obama and the Democrats actually have in this dynamic?
LIASSON: They don't have a lot of leverage. I think they would like to communicate to Trump voters, many of whom are among the 19 million people who get health care through the ACA or the Medicaid expansion, about what's happening. Ironically, some of the parts of the country that depend the most on Obamacare are those rural, low-income, high-unemployment counties that voted for Trump. And those are the parts of the country where it's not so easy to get health insurance. Democrats want to make sure those voters know that Trump and the Republicans have just made their lives much harder.
But that being said, Democrats also say, as you heard from Zeke Emanuel, that if Republicans are serious about a replacement, they might be willing to participate in a debate. Of course, the joke is that Republicans could just change a few paragraphs in the ACA, rename it Trumpcare (ph) and Republicans would love it (laughter).
MARTIN: But as you pointed out, a lot of people who were part of the electorate that brought Donald Trump into the White House are beneficiaries of Obamacare. So there's clear - there is a political risk here for Republicans.
LIASSON: I think there are many political risks for Republicans. It's a risk either way. They have to repeal this law. They promised to do it. It was their No. 1 promise. Their base expects them to repeal it. But if they do, will they be blamed for huge disruptions in the health insurance system if 19 million people start losing their coverage or if they have to pay even more because they no longer have subsidies, just like President Obama and the Democrats were blamed when people weren't able to continue seeing their doctors or they had to change plans or their rates rose.
So there are consequences to repeal or to repeal-and-delay, and the consequences could be very complicated. And Republicans would be doing this on a partisan vote, on a party-line vote, with no Democratic support for repeal, just like Obama and the Democrats did to pass the ACA. And back then, we were told, the lesson was supposed to be that big changes in social programs are better done on a bipartisan basis. And that doesn't seem to be the case this time either.
MARTIN: The industry, health care, has been trying to play catch-up just making all the changes necessary to put into place Obamacare. This uncertainty can't be good for that industry. When is there going to be any kind of clarity about what's going to happen?
LIASSON: Well, I think the big question is - are they going to repeal it with a replacement, or are they going to repeal it without a replacement? And can they freeze the system in place until they come up with a replacement? Those are all big questions, and we don't have the answers to them yet.
MARTIN: NPR political correspondent Mara Liasson.
Thank you so much, Mara.
LIASSON: Thank you. Transcript provided by NPR, Copyright NPR.
