Exclusive: Q-and-A with the CEO of the Affordable Care Act

Posted at 6:00 AM, Jan 05, 2017
and last updated 2017-01-05 06:22:11-05

Attacking Obamacare is priority one for the new Congress and the new Trump administration, and repeal of the landmark legislation is on the agenda of the new leadership in Washington. President Obama and Vice President-elect Mike Pence were both on Capitol Hill Wednesday strategizing on the fate of the health care law with their respective political parties.

At the same time, thousands of people continue to enroll in health plans offered through, the portal to Obamacare health plans. Since its inception, more than 350,000 people in Ohio, Kentucky and Indiana have found health insurance through The enrollment deadline for this year is Jan. 31. 

With all this going, the WCPO editorial board interviewed Kevin Counihan, the CEO of and the man who runs Obamacare, about the future of the legislation. Here are excerpts:

WCPO: Why should people enroll in Obamacare if, as Republicans promise, it's going to be repealed?

Kevin Counihan

Counihan: Right now, you’ve 20 million people insured; you’ve got both sides of the aisle saying they want to keep people protected. You’ve got the president-elect saying he wants to keep the ban on pre-existing conditions. He wants to keep kids enrolled up to age 26. They're sympathetic to no lifetime caps and not having women charged twice what men are charged, which is what existed before the ACA. Those are foundations that limit what kind of big changes you can make.

When I think about what Trumpcare looks like, it starts out looking a lot like the ACA.

What's going to happen?

This involves so many stakeholders and 18 percent of the GDP. You’ve got hospitals to think about, pharmaceutical companies to think about, physicians to think about. You’ve got a lot of stakeholders. Tweaking something is one thing. Radically changing something, that’s a big nut to chew on.

I think were all adapting to this new world. Everyone's trying to figure out how this is going to play out, but I think the good news is it appears that both sides of the aisle want to do the right thing.

What's the latest?

There’s going to be a long, long discussion. My understanding of what was discussed this morning by the vice president-elect was a "repeal and delay" plan. That’s seductive because it makes it sound like some dramatic action been's taken. But the actual impact of that is something that’s going to occur years down the road.

Is that a problem?

You’ve got a lot of insurance companies that are saying, 'I don’t know if I’m going to participate in this thing in future years.' They’ve been saying, 'If we don’t have more specifics in the next couple of months about what this thing is going to look like, we're not sure what our future participation in ongoing years is going to look like.' If that occurs, then you’ve got a death spiral of insurance companies bailing out.

If they bail out, then the individual insurance market erodes. If that erodes, Trumpcare has got a whole new set of issues.

Could the Affordable Care Act be fixed rather than repealed?

I think that’s exactly what’s going to happen.

This idea of "replace" makes for nice sound bites, but what it's going to end up being is "repeal and amend." 

Is this a perfect law? Absolutely not. Medicare is still being tweaked. Social Security is still being tweaked. All these things are always open to being changed, and they should be.

I think there's a lot of campaign rhetoric going on. I think when the serious people really get down to how this is meant to work, we're going to see more amendment than replacement.

Why all the talk about repeal, then?

It's kind of a seductive campaign term. It probably appeals to a certain base of people who either are concerned about government programs or government engagement in providing social safety nets, but you're talking about something that is almost 20 percent of our GDP. You pull on one string, and you just have to be careful that a whole bunch of others don’t unravel.

What are the pitfalls?

The strategy of repeal and delay is just very, very risky for the stability of the individual market. This is very complicated technical stuff, and if you repeal something like this, you’ve got to replace it. You’ve got to come in with something and say "Here’s the new plan, here's how the new program’s going to work." When you kick the can down the road and say, 'Give us three or four years to figure this out,' the message being sent to the insurance companies is a potentially confusing one. I just think we have to be very careful that this individual market doesn’t unravel.