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Obamacare Architect: Compromise Is Possible With GOP Foes


A new era of one-party control begins today in Washington. The new Congress begins work with Republicans still controlling both houses and feeling pretty emboldened with their party about to control the White House as well.


One major priority for them will be to dismantle Obamacare. And you'd think that would make for a depressing start to the year for Zeke Emanuel. He's one of the architects of the health care law.

GREENE: But he has actually been feeling pretty optimistic about a compromise that could save parts of the law. And Rachel, he's in the studio with us (laughter), and just looking at him, you don't look all that downtrodden, Dr. Emanuel.

ZEKE EMANUEL: I don't know. Well...

MARTIN: Could be the lighting, (unintelligible).

EMANUEL: I'm always optimistic.


GREENE: Well, good. Well, talk to me about why you are optimistic. I mean I know you've been connected to some of the White House conversations in talking about how to save the bill. You've met once with President-elect Donald Trump. Where do you see a compromise coming together if there is one?

EMANUEL: Well, one of the things the Republicans frequently criticize the Democrats over the ACA is the fact that it was passed only with Democratic votes.

GREENE: The Affordable Care Act, yeah.

EMANUEL: Right. It would seem crazy, then, for them to go around and say, well, we're going to pass a repeal and replacement bill only with Republican votes.

GREENE: Might seem crazy to you, but I don't know if Republicans...

EMANUEL: Well, consistency...

GREENE: ...Would say it was that crazy.

EMANUEL: Right, but consistency suggests that they want a - they would want a bipartisan bill. And I understand that the president-elect, Donald Trump, wants a bipartisan bill. He really does I think genuinely want a bill and a health care system that works for all Americans, that achieves universal coverage, no preexisting 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.

GREENE: OK, we should say you're mentioning some of the things that Donald Trump has positive comments on in terms of things potentially keeping, but how will this come together? You've got Republicans coming in saying it's priority one; dismantle the law.

They have been out there on the campaign trail I mean for months, more than a year, for a long time it seems promising voters that they are going to get rid of Obamacare. So what - how could they actually do this compromise with you and Democrats and still save face?

EMANUEL: Well, Jim Capretta, who's a conservative health policy expert at the American Enterprise Institute, reminds Republicans, his fellow people, that they ran on repeal and replace, not repeal and delay.


EMANUEL: And so that you really do need to repeal and replace, and you need to do it in one bill. Otherwise, you're really going to disrupt the individual insurance market in a very bad way, and you'll be responsible for millions of people losing their coverage but also health insurance premiums going up. And I think that is not a scenario that a lot of Republicans really want.

GREENE: Well, then how can they delay? What would give them in terms of process now? What would make it seem like they were following through on this promise but delaying enough to figure out a way to replace it?

EMANUEL: So one possibility is that they pass a resolution saying that they will then come back and pass a bill that will repeal parts of the Affordable Care Act and at the same time have a replacement for those parts of the Affordable Care Act...

GREENE: A resolution to be voting on party lines...

EMANUEL: ...In the same...

GREENE: ...And saying, we want it...

EMANUEL: The resolution should be...

GREENE: ...We officially want it gone.

EMANUEL: The resolution can be party lines, but the bill would then have to construct both the repeal part but simultaneously the replacement part. And I think if you do it that way, you could begin to negotiate with Democrats. If you just have a repeal and we'll be back in three years and tell you how we're going to fix it, then the Democrats are simply going to walk away. Chuck Schumer has made that clear.

And they should walk away because then it's all - it's the old pottery barn principle that Colin Powell made famous, which is, you break it; you have to fix it, and you take responsibility. And the Democrats will not want their fingerprints anywhere near the breaking of Obamacare and the disruption of the insurance industry in the United States.

GREENE: Well, let's keep talking about this. Let's say step one is some sort of resolution. Republicans can tell their voters that we have taken the first step. We are carrying through on this promise. Doesn't that then open the door for Republicans to begin defunding Obamacare, which really would begin the process pretty quickly of dismantling it?

EMANUEL: So the budget resolution allows the Republicans to pass a piece of legislation. The resolution itself doesn't actually repeal the Affordable Care Act.

GREENE: I see.

EMANUEL: It allows the Republicans to pass a bill with 50 votes. That's the key. It doesn't have to pass with 60 votes, the filibuster-proof majority.


EMANUEL: But they could pass a bill with 50 votes. The question is, what is the shape of that bill? Is it just a repeal bill, or is it a repeal with replacement? And that negotiation about that bill could take several months. My own estimate is if both sides come with good faith, they could probably hammer this out in about six months. It's not a small item. I mean health care reform is big.

The question is, what are the gives and takes? I do think - again, one of the reasons I'm optimistic is that when you look at conservative and liberal health policy experts, there's about 70 or 80 percent overlap between the two groups about the shape of the future and what you would need. And I think that's, again, why I'm optimistic - because there aren't that many ways of doing health care reform. They're really limited.

GREENE: OK, we have just about 20 or 30 seconds left. President Obama goes to the Hill, meets with congressional Democrats this week. What's his message going to be?

EMANUEL: Oh, I think his message is going to be, we have to get the message out about the strength of the Affordable Care Act. You have to hold strong that it's got to be repeal with a replacement simultaneously and be clear about the principles like universal coverage and no preexisting disease exclusions that we're going to defend for the American people.

GREENE: OK, Zeke Emanuel - Dr. Zeke Emanuel's chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania and also one of the architects of Obamacare. Thanks as always for coming in.

EMANUEL: It was great and a pleasure. Transcript provided by NPR, Copyright NPR.