the w.h.o. predicts by 2030 it will be the world's seventh biggest killer. scientists say there is a clear link between poverty and the prevalence of that disease. ♪ it the challenges to the law are the inside story. the republican cries

of replea and replace setting an ununoble number of challenge challeo this president in the last years in office, still, republicans are marching in lock step toward dismantling or at least reaching the effect of the affordable care act. one question being raised is it insuring enough people, and at what cost. and to add more fuel to the fire, controversial comments from an adviser suggesting americas were intentionally mislead. does that really matter? maybe not what does is a coming supreme court, and some ideas republicans have that may have teeth. >> the closed door vote was unanimous thursday morning republicans of the senate want mitch mcconnell to be their next majority leader in the 114th congress. way will be voting on these issues both the overall obama care issue

and the various pieces of it. topping the list of things to do is to lead in the g.o.p. loud ohs war cry, repeal or replace elements of the affordable care act. now, better known as obama care. >> the house i am sure, at some point will move to repeal obama care, because it should be, and it should be replaced with common sense reforms. >> it's been more than a year since the law went effect by the end of next year, it is projected 9 million people. at this pace, the question can the a.c.a. reach it's goat of 25 million people by 2017. one of the main sticking points for congressional republicans and even some of the most lip real democrat is something called the medical device tax. the tariff was designed

to help fund the care act, with an estimated $30 billion out ten years. a number of law uh makers are moving to repeal the tax. >> the bottom line is this device tax is so poorly conceived it kills jobs, it is stifling life saving and life enharassing invasion. and both republicans and democrats agree on this. >> recently cup bidding covered video capture one of the chief authorsism plying the administration capitalized on naive voters. >> lack of transparency huge advantage, and basically call the stupidity of the american voter or whatever, but basically that was really critical to get it to pass? the white house moved swiftly to denounce comments. the fact is the process associated with implements of the

affordable care act has been extraordinarily transparent. then last week, another obstacle, the supreme court decided it will waive the legality of taxpayer money sub citizen dieding programs. because the language doesn't specifically call for it. leaving everyone wondering if you rip out the sup siddys duh the affordable care act fall on it's face? so while perhaps not a shining moment for obama care, do the comments change anything? and open enrollment is just ahead as republicans call open season on the law and specific parts of it. what matters here and what doesn't? he was deputy secretary

in 2007 to 2008, welcome, gentlemen. >> thank you. >> so open enrollment number two is upon us. things got off to a rocky start last year. a lot of allegations floating around, that enrollment was being held back, because premiums were going up, already we at right now? >> so open enrollment started on saturday. we're at about 7 million people currently which is about where estimated put potential enrollment. it started. there's some debate now about how many more people can get signed up, the big challenge now for the a ba ma administration, is to get the current people to sign up again, and then to get millions more to come these marketplaces. and select a health plan. >> speaking about getting people interested is that the goal, why slice the window in half.

>> you have to have a relatively short enrollment period, than you can just wait until you got sick to get care. so three months is probably a good amount of time, but uh it does make me nervous, and it isn't clear to me that we have the right three months. >> as no waymentions about 7 million people, i don't think a lot of people would call that a convincing embrace. what do you see as the difficulty of getting people on boor? >> that the administration hit it's goal, or almost go the goal, it is sort of a fake scoreboard. but the challenges are you don't have a lot of people that don't necessarily want to pay the premiums. they don't see the

benefit of it. there's all sorts of obstacles, there's a reason we have had 47 million people uninsured p. there's people in different categories and who did not have insurance for different reasons. this projecting about 9 million this year, does the mat work? do we get to 25 million? >> i don't think we will get to 25 million in three years. and the obama administrationist has tried to downgrade some of those expectations. to the point about the expectation game, that's something that happened here in washington. i think the important thing to keep in mind, and the reason there are goals and targets is in order for a lot of work, you to have enough people in the marketplaces to make them sustainable.

so if enrollment continues to tick up, those marketplaces can sustain themselves. if enrollment plateaus or if it goes down, then i think there's a serious problem for the law. that's why how many people sign uhl and whether it goes up or down is important. >> everybody has been talking about them, there are at least three of them that are out now. one of the key actor texts saying that the administration intentionally mislead people, he referred to voters as too stupid to figure it out, what kind of leverage does that give republicans now in their attempt to repeal or overhaul the act. >> i wouldn't want to understate his importance. he was paid for consulting on the affordable care act. and he is rightly called anorak ticket of the law. he is snobbish in his comments where he talked about the stupidity of

the american voter, about intentional lack of transparency, and these taxes. for example the xaiz tax that will continue to have more and more impact on more plans in a way that it raises more and more revenue. but done in a way that did not necessarily raise political concerns at the time. so i think republicans are rightly indignant. what does it mean. we were talking about this before, i don't know how many people in congress are going to change their minds but it does give the republicans an argument. >> it certainly can impact american sentiments. he calls him snobbish, but how reflective are his comments of the intent of the administration? and how much are americans going to read into it and have a real distaste for the aca bases on this. >> it is total silly season. the less effective they will be in getting the types of changes they want to see through the

law. this was debated every issue talked about was debated myself, and tevi believe. and many many other people, we talks about the transfer to young and old, we talks at a locket of thing i work in the immaterial ployier community, so what we learned as an mit professor is an elite snob that's not learning anything at all. >> you agree, it doesn't matter? >> i don't think it matters that much, i think the consequence of the silly season, which is right to characterize it that way, is there are a series of challenges next year, democrats and republicans. in addressing marts oif law that need to be revisited. to the extent that is difficult to do, when people are trying to relitigate what somebody said or didn't say four

years ago, whether somebody was central or not, whether or not they are a snob or not, i think it is distracting and frankly, it -- i think in many ways is reflective of why it is so difficult to make progress because people aren't focusing on issues that are important to americans like how do you get health insurance, how do you improve a system that needs improvement. >> we are going to unpack this more after the break, the political fight that lies ahead, republicans still want to kill it outright, but president obama has the veto pen, what changes if any may he go for, we'll be right back.

it is no secret that republicans want to strike down the affordable care act, but can congress chip away at

the law? the tax on medical device which is is slated to bring in $30 billion over the next ten years. so this is the tax on all medical wises use, why is it so controversial, and can it dismantle the affordable care act? if that doesn't come through. >> so, most taxes are troll, particularly for the people that have to pay them. medical device industry doesn't like the tax, for obvious reasons. from a broader perspective the problem with the tax on any industry is that maker industry usually passes along those taxes to consumers. so when it is written. which was it is expensive to provide more health coverage to millions of americans. and in order to do that you have to come up with a way to generate the new mexico to do that, so they went to hospitals,

device makers, doctors and said we would like everybody to basically give at the office, all of you stand to benefit presumably from more people having health insurance, you need to give back. the medical device act, i don't think you can say is any more less or controversial than the others. the reason why it has made it to the front of the cue uh, because it is not popular with democrats. so a lot of the device industry. >> is based in -- >> is based in states that have domic representatives in washington. minnesota, massachusets. so it happens there are a group of democratic senator whose have joined the republicans to say we don't like this tax. >> we just mentioned that obama is not going to sign off on a repeal, what else do you think will be on the table and

why? >> i think there are a number of issues it is important when they get bipartisan support. there will be repeat in both the house and senate. in terms of other issues besidesides the medical device act, i think the excise tax is unpopular. >> explain that. >> it is the so called cadillac tax. as another way he was trying to trick the american people, but the xaiz tax is posed on what are so called high value plans examensive plans. we mound in a new study is that the xaiz tax by 2031 is going to hit the average value family healthcare plan. >> because the cost keeps escalates. >> and the thresholds don't increase. so the excite tax is up there. the independent payment advisory boor, which is a medicare advisory board that suggests which treatments should and

shouldn't be treatment. that's always been unpopular, and then the definition of the work week is 30 hours rather than 40 is something that you can also get support from getting rid of talk more about that, it says if you employ someone 30 hours or more, you have to provide insurance, a lot of employers are now moving to 29 hours to avoided that, do you think it will gain support if it moves to a 40 hour marker. >> i think that's less likely to gain support than other things we have exploded manied. but here is the irony, all of the things we are talking about doing away with, all out the thing oz. republicans wish lift for doing away with, will increase the cost of the law and decrease the amount of revenue to promote the law. so they will increase deficit and debt.

and actually move it up to 40, then they will drop coverage for a lot of people under 40, there will be more subsidies and the law will be more expensive. it is a big irony? >> how far do you think obama will go? if they keep insisting we will pull it out i think they will get very little. if they said look, there's a number of elements. the employer shared responsibility requirement, is a mets and the boal administration has already delayed it. it will be possible to look at doing away with that entirely. but the republicans are in this wier bind, because a lot of them say let's not get rid of the ink thises people dislike, or people might start liking the law so they have a tactical game. >> do you think they are putting the law in pearl

if what you say is true, and it ends up pricing people out of the plan. >> well, it wouldn't price people out, in fact, it will just put people -- it will make the law itself more expensive. so if you get rid of the taxes that fund it, that mean more people will be subsidized then the law is more expensive. >> how does a more expensive law, equal more expense for the consumer. >> because the consumeser getting the subsidy from the federal government. it does equal more expense for the taxpayer. >> but for the individual consumer, if they leave employer sponsored coverage, if they have an income that goes up to a good middle class income, they are getting a subsidy from the federal government. >> the taxes to cover the subsidies may go up. >> the obama

administration says the reforms can save $200 billion over $1 trillion over the second decade, time to rethink the numbers. >> well, those numbers are always being rethought. so i think if, in fact, as micah mentioned you start pulling out some of the parts of the law that offset the costs, then the overall cost of the law and the overall cost of ensuring millions more people goes up. and at that point, you run the risk of pushing the law into deficit. and contributes to the federal budget deficit. >> one of the things that was unusual, is that it was what we say in washington is budget neutral the revenues that it generated offset the costs, ard cooing the the congressional budget office. which cores these sorts of things. you may recall that was not true of the invasion

of iraq, for example. or medicare part d, which was the drug benefit, which was not offset with additional revenue. so if the law is preserved as a essentially pays for, in the checkbook from the national gourd is balances. then it will stay -- presumably, those numbers will stay on the plus side but if the renew is taken away, like a checkbook, if there's less money you go into the red. >> so if republicans are successful taking away some of these, you have to have revenue from somewhere. >> i don't think the law is at this point will be revenue neutral, or budget neutral. one they take away the class act, which brought in revenue in a short period but cost as lot in the long period, i think once they took out, because it was unsound, the revenue projects all right went up p i agree that if you are going to

take out revenue sources, this republican congress will want to have things scores so that they are budget neutral so you will have to have pay fors. it isn't clear where they are going to come, but i think we will be seeing budget neutral recommendations from them. >> all right, when we come back, we will move to the new aca challenge, now before the supreme court, this is inside story.

a key provision of the affordable care act is that the government helps pay for the coverage. 4 million people guilty subsidies now. still with us as we does the future, in san francisco, of the bay area council, of the american health pollty. if they buy insurance through health exchanges quote established by the state.

do they qualify, is this about defining state? it's about defining state run. so the law allowed states to set up their own marketplace. what was the intent of lawmaker whose wrote this, did they intend for residents where the federal government ran the exchanges to get access to these subsidies. if they meant that, then we will continue the way we are. only to residents of states that run their own marketplaces. more than half the country can lose

access which are critical. >> what is at stake here in terms of the long term survival of the affordable care act? >> well, i think it is important to understand. that this is a mer rest let case, however, the street court decides things based o education fever lodgeky. that we are going to break with centuries and make a decision to strip them from the federally run exchanges. if they do that, that's a huge problem for the law. there are some worken as. some have already started looking at enable legislation.

they don't need to be concerned in the abstract, however, it is difficult to see it create as very unstable situation. depending on how the court ruled it could go away. the law could be destroyed. one thing to keep in mind, is that it is destabilizing and certainly changes the impact of the law. one thing to keep in mind, is that stakes would have the option to move presumably to a state run marketplace and retain

access there's a good indication that a fair number would do happen p the thing that is more struggling about this, is the intent, is that the law was designed in large measure to provide a uninorm safety net essentially to americans for the first time. and others providing none or very little of one. and when the court decided that medicaid would be an option, it essentially widened the gap rather than closed it, and should they decide again that they can be an option, i think the big risk is you get a

divide where part of the country will have one form of a healthcare system, and the other part of the country will have something very different great point. >> on the future of obama-care? >> well, first of all, it is not a meritless lawsuit. second of all, this would be very destabilizing justice roberts the point that noah made, may decide that he would go along with the plaintiffs because it wouldn't get rid of the law but change it dramatically. >> all right, that brings us to the end of this edition of inside story, thank you for being with us, from washington, d.c.

>> announcer: this is al jazeera. ♪ hello welcome to the news hour live from doha, i'm martine dennis. coming up in the next 60 minutes, executions, amputations, and public beatings, the u.n. paints a bleak picture of life in syria under isil control. note the particular violations committed against syria's women, children, and minority