On Monday, as GOP leaders tried to rally Republican lawmakers to support their health care proposal, the non-partisan Congressional Budget Office released a report showing that the plan would lead to an estimated 14 million fewer people with health insurance by next year.
The CBO also found the proposed plan would reduce the federal deficit by $337 billion.
Atul Gawande is a cancer surgeon at Brigham and Women's Hospital in Boston, Mass., and a staff writer at The New Yorker magazine. He has spoken out against the GOP bill, expressing concern that it would cause poor and sick people to lose health coverage.
The stakes for patients, he argues, are "extremely high," and he says the bill is at the "center of the debate [about] what our responsibilities are for covering people over the course of their lives."
Gawande discusses the Republican plan with NPR's Robert Siegel, including how his experience as a surgeon changed after the first universal health care bill was passed in his state, the ways in which the Affordable Care Act could be improved and the problem of high medical costs. The interview has been edited for length and clarity.
On the potential effects for his patients of repealing parts of the Affordable Care Act
"Well, I'm a cancer surgeon, and in many ways it will affect the patients widely. [President] Trump has said his aim is better coverage than the [Affordable Care Act] at lower cost, and if that were where it was going, it would likely protect the people that unexpectedly come in to see me. But that is in conflict with this other goal that Republicans have, which is actually to dismantle the ACA and its funding, and it's that pull that lies in the middle of this."
On how people who use the Medicaid program could be affected by the bill
"Before Romneycare, [which is] a version of the ACA passed here in Massachusetts where I practice, about 10 to 15 percent of my cancer patients were people who didn't have coverage. They gained coverage in two ways. One way was that they gained coverage by Medicaid. Second, they gained coverage, if they didn't have an employer who covered them, on the online exchanges.
"I haven't taken care of an uninsured patient in years."
On how the Affordable Care Act could improve
"There are some obvious things to do. We have the group of people who don't have coverage under Medicare, don't have coverage under Medicaid, and their employer is not providing coverage or they don't have an employer. They are in the online exchanges, going to Healthcare.gov, and with some tweaks we would get more young and healthy [people] in to go along with the sicker, older population and that would help flatten the premiums and keep that system [grow].
"One thing that has people really angry is ... where you have multi-thousand-dollar deductibles and copayments, so you still have some major barriers in your care. We've made huge progress [on that] and should be making more."
On the goals of the Republican health bill
"What is the human goal of this bill? What's it aiming to solve? If the aim is to solve the problems they criticize, they've not put forward solutions that actually do that. There are directions to get there. And there's a moment when [President] Trump talked about [the fact] that he could get a bipartisan group around this goal of insurance for everybody.
"But what we have right now is a bill that doesn't ... [address those] problems that have been singled out. Now we just are waiting to see how much worse the costs will be for individual people."