KELLY MCEVERS, HOST:

Our next guest says that if Republicans succeed in passing a tax bill that repeals Obamacare's individual mandate, it will create unintended consequences that they don't appear to comprehend. Robert Laszewski is a health policy consultant and a former health insurance executive. Welcome to the show.

ROBERT LASZEWSKI: Good to be here.

MCEVERS: So before we talk about your concerns, I just want to talk about why the individual mandate is part of Obamacare in the first place. I think this is something that people might have forgotten over the years.

LASZEWSKI: Well, in order for a health insurance pool to work well - a health insurance program to work well, you've got to get enough healthy people signing up to pay the claims of the sick. You need many more healthy because obviously the sick are very expensive. Unfortunately the individual mandate hasn't worked very well. When we look at the people who are eligible for subsidies, only 40 percent of the subsidy-eligible have signed up. So even with the mandate, we haven't gotten enough people signed up.

MCEVERS: So then if Congress does pass a tax overhaul that removes this mandate, what do you think will happen?

LASZEWSKI: Well, even though the individual mandate has not been terribly effective and hasn't done the job we thought it would do, it certainly has attracted some people. So getting rid of the individual mandate can only make things a little bit worse. I expect that insurance companies, if they see the individual mandate going away, will simply raise the rates another 10 or 20 percent.

You know, it's ironic that right now with Obamacare and the trouble that it's in with not enough people having signed up, insurance companies are actually starting to make money. And they've done that because they've just raised the rates to holy heaven. And the unsubsidised people in particular are seeing that.

MCEVERS: So you're saying if it's - if we want to do something to keep costs down for people, then this is the opposite of what should happen.

LASZEWSKI: This is the opposite of what should happen. And there's even a bizarre consequence here. People who are getting subsidies - and that's about 60 percent of the people in the individual market - are actually seeing affordable health insurance because the subsidies bring their premiums down so far. But the people who are not getting subsidies - and that's 40 percent of the market both on and off the exchanges - are paying the full price.

And so what we've got now with the insurance companies raising money and able to make money themselves - we've got these extraordinarily high prices that are pushing the unsubsidized out of the market. It's not uncommon to see a family of four paying $15,000 for family health insurance with a $7,000 deductible, meaning they have to pay $22,000 before they get anything.

MCEVERS: But what do you say to people who just don't want to be told what to do by the government?

LASZEWSKI: Well, I don't have a problem with getting rid of the individual mandate per se. I think there were better ways to do it. We could have, for example, said that you can buy insurance when you want to. Don't buy it when you don't want to. But if you don't buy when you're first eligible, you're locked out for perhaps six months, so you can't just come in and out whenever you get sick. There were other ways of doing this than the individual mandate. And the Republicans would do well to replace the mandate with something that's even more effective like that.

MCEVERS: Rather than just doing away with it altogether.

LASZEWSKI: That's correct.

MCEVERS: So yeah, why do you say Republicans don't appear to comprehend all the things that you're saying?

LASZEWSKI: What I don't think the Republicans understand here is that, you know, Obamacare is really the tale of two cities here. Those who get subsidies are not impacted by these rate increases, but 40 percent of the people make too much money in the middle class to qualify for subsidies. Many of these people went to the Trump rallies. They're the ones that are getting hurt hardest by Obamacare and its high prices. And when the day is done, what we're going to see is the very people that President Trump is trying to protect paying far higher prices and being unable to afford any kind of health insurance.

MCEVERS: Robert Laszewski is president of Health Policy and Strategy Associates. Thank you so much.

LASZEWSKI: You're welcome. Transcript provided by NPR, Copyright NPR.