LEILA FADEL, HOST:
It's been a month since the federal government shut down, and Republican and Democratic lawmakers have still not agreed on a way to end it. Central to the impasse is a fight over the extension of subsidies for Affordable Care Act marketplaces. Thursday, we heard from Dr. Ezekiel Emanuel, considered one of the architects of the ACA, about the creation of the act and some of the challenges it now presents.
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EZEKIEL EMANUEL: It reduced the uninsured rate. It controlled costs. Now we need even more extensive reform to reform the health insurance system, to reform the delivery system and how we pay. Those things we couldn't get to without the Affordable Care Act being a step in the right direction, but it wasn't a finished product.
FADEL: Open enrollment starts tomorrow. Today, we hear from Julie Rovner about the conversations lawmakers are having about the health care system. She's the chief Washington correspondent for KFF Health News, which is a reporting partner of NPR.
So I want to start with where things stand on the subsidies. Are there any compromises either within or between the parties taking shape?
JULIE ROVNER: Well, we are hearing that there are talks that are happening, apparently not among the leaders in Congress, but among some of the rank-and-file members of Congress because everybody would like to see this resolved. I think both sides are getting tired of this sort of standoff.
FADEL: Yeah. Now, Republicans have said they're open to negotiating over subsidies once the government has reopened. Speaker Mike Johnson also had this to say about them this week.
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MIKE JOHNSON: The expiring Obamacare subsidy at the end of the year is a serious problem because if you look at it objectively, you know that it is subsidizing bad policy. We're throwing good money at a bad, broken system, and so it needs real reforms.
FADEL: So a bad, broken system that needs real reforms. Are the Republicans proposing any solutions?
ROVNER: Not any new solutions. What we're seeing is a rerun of pretty much every health idea that Republicans have had since the 1990s. Some of which have been tried and haven't really worked, and some of which never even got off the launchpad.
FADEL: Democrats are arguing for the extension of these subsidies, but beyond those, what do Democrats propose to address concerns about the cost of health coverage and how to pay for it?
ROVNER: Well, one of the things that Democrats were doing during the Biden administration is trying to go after the consolidation that we've seen in the health care industry, which is one of the things that's driving up prices. We've seen what we call this vertical consolidation where insurers are buying doctor practices and pharmacy benefit managers, and all the people who are supposed to provide the checks and balances are now all under one umbrella, and that enables them to basically have monopoly prices. That was something that the Federal Trade Commission was actually working on, and that's been pretty much stopped under the Trump administration.
FADEL: Everybody needs health care, will have to go to the hospital at some point. I mean, what makes this such a seemingly attractable political issue?
ROVNER: I think everybody agrees on the problem. We spend too much. We're not getting great results. The system is confusing for everybody - the people who are in it and the people who are trying to use it. But nobody really has a good idea of how to fix it, and there's certainly no agreement on any ideas about how to fix it. There's a little bit of nibbling around the edges. Congress has been working on ways to make prescription drug pricing more transparent by regulating pharmacy benefit managers. Just - they passed a bill to get rid of surprise billing for out-of-network providers. Sort of little things, but nobody's really got a big idea for the big things that can garner anywhere near a majority vote.
FADEL: That's Julie Rovner, chief Washington correspondent for KFF Health News, a reporting partner of NPR. Thank you, Julie.
ROVNER: Thank you.
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