KELLY MCEVERS, HOST:
Someone who is very familiar with the Affordable Care Act, both its strengths and its weaknesses, is Kavita Patel. She helped draft the law for the Obama White House. Seven years after the ACA was signed, Patel still very much believes in it, but she says there is room for improvement.
KAVITA PATEL: The single biggest area that needs to be fixed is the rise in cost which goes hand-in-hand with attracting people to buy the insurance, namely young, healthy people.
MCEVERS: How do you do that?
PATEL: So that's where it becomes a little more complicated. So just remember; younger people generally also have lower incomes. And so one of the areas to make it attractive is to continue to provide those cost-sharing subsidies or ways to help people buy health care, and that's something that the Trump administration has been discussing getting rid of.
The second thing that will help is to also actually ironically put into place a more serious penalty if you don't buy insurance. And then the third thing is really to look at direct ways to change benefits to actually reduce the cost of health care. All those three things combined will help to bring down costs as we increase the number of people who buy health insurance who need it.
MCEVERS: And we know that Republicans I mean throughout the debate opposed most of the things that you mentioned, so how can we imagine a Republican-controlled Congress and a Trump White House coming together to do some of those things?
PATEL: Well, I think you saw from the votes and the potential votes last week that there actually are Republicans who have heard from their constituents and are probably willing to work with Democrats to make some of these improvements if it translates to lowering the cost and not forcing people to do some of the things that they would be worried about.
Now, I think you're right that in general, Republicans are still going to be nervous about supporting Obamacare, but there are Republicans who are actually willing to work across the aisle and support ways to improve the law.
MCEVERS: If this problem that you've addressed - this one problem of keeping premium costs down - is not addressed, what is going to happen to the Affordable Care Act?
PATEL: So if the premiums continue to rise the way they have, then we're going to start to see an effect of people who really need insurance but are willing to pay the penalty and not get the insurance because it's too expensive to get the insurance. So we're going to start to see people who need care who don't get it, which is exactly why we started working on health insurance and health care reform with President Obama in the first place.
MCEVERS: And so this idea of it exploding - is that possible?
PATEL: The explosion is a little overplayed. I mean the explosion is really if everybody dropped insurance. But as we've already seen, people who really need health care are probably going to do things like not pay for food, not pay for their rent and keep their health insurance because that's going to be a much higher priority. But it's - where we lose people is going to be people potentially who don't use health care that much and they think, well, why should I pay these premiums?
MCEVERS: Right.
PATEL: So we're not going to have this, quote, unquote, "death spiral." But what we will see is that the cost of insurance will continue to go up in a way that continues to discourage younger or generally more healthy people from getting it.
MCEVERS: Kavita Patel helped draft the Affordable Care Act while working for the Obama White House. She's now a fellow at the Brookings Institution. Thank you so much for talking to us.
PATEL: Thanks for having me. Transcript provided by NPR, Copyright NPR.
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