MICHEL MARTIN, HOST:
We're going to spend much of today's program trying to understand what happened on Capitol Hill yesterday and what happens now. As you probably know by now, House Republicans pulled back their version of health care reform, which was meant to repeal and replace the health care initiatives adopted by the Obama administration because they did not have enough votes. We'll be talking with a former top congressional Republican about this in a few minutes, former Majority Leader Tom DeLay, and a top Democrat, the chairman of the Democratic National Committee, Tom Perez.
But we wanted to start by talking about what this might mean to you and your health care in the near future, so we called Mary Agnes Carey. She's a senior correspondent for Kaiser Health News. She's been covering the politics and policy of health care for many years now. And she was kind enough to join us in our studios in Washington, D.C. Mary Agnes Carey, thanks so much for joining us once again.
MARY AGNES CAREY: Thanks for having me.
MARTIN: So let's start with the big question that's probably on a lot of people's minds, which is what does this mean for most Americans right now when it comes to health insurance?
CAREY: Well, right now, if you have health insurance on the exchanges, these marketplaces under the Affordable Care Act where you can buy insurance, you're fine. Many of us get it from our employers. Some people are on Medicaid. Some people are on Medicare. I think the next big thing to look for if you do get health insurance on the exchanges is what will happen in 2018. So how will the insurance industry react? For the exchanges, do they stay in, do they leave? What will the rates be like? We've had some issues with higher rates. But the thought is what's going to happen in 2018, and will things settle down?
MARTIN: So President Trump said he is going to sit back and wait for the Affordable Care Act - Obamacare - to explode. This is what he said to White House reporters yesterday.
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PRESIDENT DONALD TRUMP: I've been saying for the last year and a half that the best thing we can do politically speaking is let Obamacare explode. It is exploding right now.
MARTIN: Is it, in fact, exploding?
CAREY: It is not exploding, but there are definitely some problems in particular areas. For example, in 2017, a lot of people heard about this average 25 percent rate increase.
MARTIN: You're talking about premiums.
CAREY: Premiums, exactly. Premiums have been climbing. Also there have been - there's been a lot of attention - and fairly so - to high out-of-pocket costs in addition to the premium we all pay, our deductibles, our co-pays. Those things have been adding up. So while there have been issues, there are other pockets of the country where things have not been so traumatic. Understandably, a lot of sicker people who are more expensive to take care of came into the system. Insurers may have priced under to get into the market and kind of get some market share, and then they had all these sick folks come in. It's been very expensive. There's been some federal programs under the health law to try to offset those costs. Those - one of them is going away this year. So the thought is looking at 2018, what will happen?
MARTIN: What about younger and/or healthier people? I mean, one of the ways that the system has been stabilized is by requiring people to have health insurance somehow, and that has expanded the pool of people in the system. There has been some talk about the administration not enforcing that mandate. Is that going to happen, and if that does happen, do they just stop getting in?
CAREY: Well, that has been a chronic problem, as you've noted. They wanted to get more younger people and to balance the cost - hasn't really happened. And again, one thing looking forward to 2018 enrollment, how aggressive would the Trump Administration be in promoting the program anyway? It's not their health law. They wanted to get rid of it. So the point that you noted - what the administration has done has said that if you don't check that you had health insurance on your tax return, that will no longer be a problem going forward. But they also say you still have to pay the penalty. It's kind of a mixed message.
But here's the takeaway for me. You can decide that you don't want to have health insurance, and people make that decision, but you will pay the consequences of that if something happens to you. You could go to the emergency room and find out, for example, you have Type 1 diabetes, right? At that moment, you'll be taken care of, but you don't - you won't be insured to help cover the costs, and you're going to have to wait probably till the next enrollment period to get health insurance. And all that time, you'll have these medical expenses. So you can make that decision, but if you don't have insurance, you don't have insurance, and you may be on the hook for a lot of those costs if you get sick.
MARTIN: Before we let you go, what are the big questions? You've been talking about some of them over the course this conversation. What are the big questions that you have going forward?
CAREY: I think affordability remains an issue, whether you are buying on the exchanges or off the exchanges. As we know it, 8 out of 10 people that enroll in the health insurance exchanges get some kind of help with their subsidies or out-of-pocket costs. But there are still 10 million people that - on the individual market that buy health insurance and have - they don't qualify for the financial assistance. What happens to them? Rural areas - you need to have more providers, you need to have more insurance companies in there. How will that change, if at all? That's where we've had some pockets of problems. And how do you shape the health care system to make it more efficient? That does not go away, whether you have an Affordable Care Act or you don't.
MARTIN: That's Mary Agnes Carey. She's a senior correspondent for Kaiser Health News. It is not affiliated with the health care company. And she was kind enough to join us in our studios in Washington, D.C. Mary Agnes Carey, thanks so much for joining us once again.
CAREY: Thank you. Transcript provided by NPR, Copyright NPR.
