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Trump's Pick For HHS Chief Could Foreshadow Plans For Obamacare


President-elect Donald Trump has said repeatedly that he's going to walk back one of President Obama's signature achievements, the Affordable Care Act. Trump wants to replace major aspects of Obama's health care legislation, including subsidies that help some people afford their insurance. And here's Trump's running mate, Vice President-elect Mike Pence talking about this.


MIKE PENCE: Repealing Obamacare will be the first priority in a session that will be characterized by tax reform, rebuilding the military infrastructure...

UNIDENTIFIED MAN: Now, Mr. Vice President...

PENCE: ...Ending illegal immigration. And that's where we're focused.

GREENE: Now, we reached Dr. Zeke Emanuel, who was one of the key architects of Obamacare, to see what he thinks of this.

EZEKIEL EMANUEL: What I was interested in is that Mike Pence said repeal, and he didn't say replace it. And that, I think, is a serious issue that everyone has to be worried about.

GREENE: Now, Donald Trump has said he will replace the law. He has vowed that people will not be kicked off coverage, and he has said people with pre-existing conditions will not be excluded, although Democrats have doubted those promises. As for specifics, well, there are different plans from different Republicans, and one comes from Republican Congressman Tom Price from Georgia, who is a physician. He is also reportedly being considered by Trump for secretary of health and human services. We asked Dr. Emanuel if he would be open to working with Price.

EMANUEL: I think the issue is we need to have health insurance that covers all Americans, that controls health care costs and that improves the consistency of quality. And frankly, as a person interested in those goals, I'd work with anyone who wants to pursue those goals. But I would say all of the Republican plans leave millions of people who have been covered by President Obama's Affordable Care Act with less insurance.

GREENE: Let me just ask you broadly - isn't it worth Democrats at least listening to the Trump administration and Republicans when they take over? You know, listen to their ideas, and dig in and work out some of these specifics with an open mind.

EMANUEL: Oh, look, I'm completely open as to how to go. You know, I think there are other ways to get to universal coverage than the Affordable Care Act. It's not the only way. What I would say, though, is that the plans the Republicans have proposed so far get you far below that. They throw millions of Americans off coverage, and their guarantee of insurance if you have a pre-existing condition is not so solid.

It's very, very mushy. So I'm - I think we will have to negotiate, and we will have to have exchanges of ideas. But what we shouldn't have an open mind about is that you need a replacement if you're going to repeal. You can't kick the replacement years down the line and say, oh, everything will be fine because it won't be fine.

GREENE: Dr. Emanuel, let me ask you - I mean, you worked very hard on this law. If negotiations begin, if they reach a place where you feel the law is improved but Donald Trump takes this new law and says we have, quote, unquote, "repealed Obamacare" and replaced it with something - I don't know if people start calling it TrumpCare (ph), let's say - would that be - would that be hard for you to swallow?

EMANUEL: No. No, I - I'm not - I'm not wedded to any particular thing. I'm wedded to getting the United States the best health care system it can have. It has to have a universal health care coverage system. It has to guarantee people who have illnesses that they can get affordable insurance.

It has to innovate in the delivery of care so we have higher quality care at consistently lower costs. That's the goal. There are many ways to that goal, but we've got to agree on those four elements as the goal. And it seems to me I'm willing to work on lots of different ideas that get you to that goal.

GREENE: All right. We've been speaking to Dr. Zeke Emanuel. He is chair of the department of medical ethics and health policy at the University of Pennsylvania and a senior fellow at the left-leaning Center for American Progress. Dr. Emanuel, thanks so much for your time.

EMANUEL: Thank you for having me on. I appreciate it. Transcript provided by NPR, Copyright NPR.