great conversation. >> my pleasure. >> every monday night. >> i lived that character. >> go one on one with america's movers and shakers. >> we will be able to see change. >> gripping... inspiring... entertaining. "talk to al jazeera". monday, 6:00 eastern. only on al jazeera america. ♪ the ceo of united healthcare says he has concluded taking his company into the obamacare exchanges was a bad decision, and talked about withdrawing from the american insurance program. after he made the announcement, his company's shares rose. what investors see as good news for a company, may disastrous news for the future of the

affordable care act. this may hurt a bit. that's the inside story. ♪ welcome to "inside story." i'm ray suarez. the premise behind obamacare wasn't all that complicated in its broadest strokes. compel everyone to buy health insurance and the risk pools would have more sick people and a lot more healthy people. once earn was insured prizes would rise more slowly, premiums might go down even if insurance couldn't turn away people with preexisting conditions. now united healthcare is threatening a pullout from the exchanges. united health says fining up for the affordable care act will cost the company almost half a billion dollars this and next

year. what happened? is the basic structure of the insurance plan turning out to be unworkable? >> we're going to be moving the obamacare repeal bill in the senate this week. >> storm clouds in congress gathering around president obama's signature achievement. >> it has been a catastrophic -- had a catastrophic impact on our economy and we intend to do everything we can to get rid of it. >> senate republicans introduced legislation tuesday that would repeal key portions of the affordable care act,ing is their counterparts in the house approved in october. all of the promises the president made in trying to sell obamacare have prove tone be false. if you like what you have, you can keep it. premiums will go down by a family of four by $2,500.

>> they also want to repeal the so-called cadillac tax on premium plans, but all legislation needs a signature from the president, so without support from the oval office the bills amount to nothing more than pandering. though there may be a kyled card in the deck. >> we along with others have been closely watching exchange trends. we have been staying optimistic this market would improve, but our own experience worsened. >> ceo of united health care speaking tuesday. reinforcing his assertion last month that the nation's largest healthcare insurance provider will likely withdraw from public exchanges if it can't turn a profit by 2017. >> we needed to reflect what was

predicted. >> united health blames obamacare for more than $425 million in losses this year. but another culprit could be senator and presidential candidate marco rubio, he killed a provision in the affordable care act that was designed to cushion bottom lines. now with lower enrollment numbers than expected and mounting opposition from providers, the fate of obamacare may be cloudier than ever before. >> there likely won't be a singly broadly accepted marketplace conclusion for sometime. >> united health and the aca this may hurt a bit. we'll begin with john mcdunna, the author of the book "inside national health reform".

we just heard that all of the promises of obamacare haven't turned out to be true. is that right? >> no, that is not correct. there have been significant improvements in changes since the aca has taken full effect. the number of americans who don't have health insurance is estimated to have dropped by about 17 million. to the lower rate that we have since we have been counting the numbers of uninsured. we have seen increased protections for literally tens of millions of americans who would have been subjected to preexisting condition exclusions. we have seen important advances in the security of coverage for folks with mental illness, with all different kinds of health needs, so there's been a lot of achievement. we have also seen over the past five years the lowest rates of growth in the nation's health

care spending since we started counting this data back in the 1960s. we have seen significant progress in terms of improving the quality of care. we just saw a report yesterday from the federal government that since 2010, we have had a 17% drop in a element called hospital acquired conditions what that refers to are hospital infections, adverse drug reaction, ulcers, the result of those improvements since 2010 have saved an estimated 87,000 lives of individuals who otherwise would have died in u.s. hospitals from errors in medical care, and these are directly tied to changes in how healthcare is delivered in hospitals and elsewhere. so those are a couple of signals. are there problems? absolutely. this is a brood, complex law,

with many moving parts. every single day of the week, you will see good news. you will see bad news. you will see mixed news. it's almost like following the performance of the u.s. stock market. but the overall trends are clear in terms of broader coverage, better protections for americans in terms of their coverage needs. and we're seeing for the first time since we have really been tracking it, a significant improvement in the quality, efficiency and effectiveness of medical care delivered all over the country. >> your answer is a reminder of how many discrete moving parts there were in this big piece of legislation. but here we have united health care saying, look, we're losing money on this deal. aren't insurance companies, at least willing participants, at the beginning of this long saga?

>> well, it's a curious story, because the insurance industry was one of the most vigorous opponents of the law in 2009, and '10, but they have been enormous beneficiaries of this law. if you look at the growth in value of health insurance companies on the stock market since 2010, they have been huge winners from many of the elements of healthcare reform in terms of united healthcare, it's important to remember, united got into the health insurance exchanges late in a limited way, and they were one of the insurers that had a virtually no experience prior to getting involved with individual health insurance. their market is selling to employers, and selling in the medicare market. and so it's different for united than other insurers. the other insurers are staying

with the programs of the aca, and are saying that they are intending to stick with it. the total number of insurers who are participating in the health insurance marketplaces this year is more than it was the year before, and more than it was the year before that, so, yes, it would have been great if united had been able to figure out a way to stay with the affordable care act and their presence. if they leave is it a fatal blow in not by a long shot. >> and it's not a done deal, is it? quickly before we have to go, if they work out the pricing mechanisms over the next year or so, could they still stay in the plan? >> oh, they could. it's not final. i mean, and part of it is an issue with senator marco rubio's preventing the redistribution of funds from the insurance industry's winners to losers,

during this year, which was a significant and surprising crimp that lead to some adverse consequences, particularly among smaller, more vulnerable insure insurers. united healthcare was not one of those that was effected by that. a lot of the so-called co-op insurers were in fact affected. so there are ups and downs in this program. this is complicated it takes time and adjustment along the way, and i am not foreseeing any catastrophic implications at this point. and a lot of the people who are crying wolf and saying the law is near the end and its collapsing have been saying that for the last five and a half years endlessly every day. >> good to have you with us. with or without united health, do the numbers add up? have the's assumptions embedded

in the affordable care act turned out to be correct? will they in the future? this may hurt a bit. stay with us. it's inside story.

♪ >> you are watching "inside story." i am ray suarez. this may hurt a bit. we're looking at the structure and finances of the affordable care act after threats to withdraw from one of the biggest participants in the country,

united health. joining me now is senior research fellow, and a former health insurance executive and author of "nation on the take." brian place, the professor left us with this idea that it's way too early to start writing the obituaries for the affordable care act. that eventually people will dial in how to do this, and the country will be better off for it. is this something that can be fixed by time? >> so a recent paper, i looked at the predictions that were made for obamacare in 2010 when the law pasz -- passed. and it turned out based on what the administration has released as their estimate and other main stream estimates that it will be less of half of what was

predicted. and the reason is the plans are not appealing to people who are relatively young and healthy. and what you are seeing is the risk pools are dominated by people who have expensive medical seasons. with united health one of the reasons they gave is the system is bringing in people with expensive conditions. they are then using healthcare, united and other insurers are paying their bills and then they are dropping coverage, because -- >> as blunt of an instrument as it is, weren't the fines fees and penalties suppose to nudge those into the pool over time, so their presence would even out with those people that are entering because they are sick and need insurance. >> it's a great question, and that's what the theory was. the theory was there were subsidies available. and the individual mandate penalty, which in 2015 equalled

2% of your income to bring, you know, higher income, middle class people into the markets, and that hasn't worked. there is a lot of except shufrps to the penalty. it's difficult for the irs to enforce. it appears that the experts overestimated the effect the individual mandate would have on bringing people into the markets, which is why you have a disproportionate amount of sicker and older people in there. >> we misjudge human nature and carrot and stick when designing this thing? >> not really. we're still pretty early into this. it's important to go back to what common practices were before it was passed. insurance companies were able to refuse to sell coverage to people who would be expensive or they would charge a lot more

than they would for people who didn't have those conditions. and they charged people who were older far, far more than those who were younger. so people were not able to get coverage at all or they were priced out of the market. so you were seeing this huge pent-up demand for coverage, which the affordable care act enables. so it shouldn't surprise anyone the first people to enroll would be people that were shot out by insurance practices before the affordable care act was passed. it has skewed more towards those who are older and sicker because they need coverage -- >> is brian blaze right when he said the estimates way overstated those who actually signed up. >> i think they were more optimistic than what we are

seeing. but the rate of insurance has dropped significantly. 17 million now have coverage who didn't have it before. that's significant. while that may not be as much as the congressional budget office suggested it might be in the next year, it is still a huge amount of people. and we're talking about individuals and families. we can't just talk about numbers. that means a heck of a lot to a lot of people. the other thing about the penalties, the first year, and the insurance industry predicted this, and i think they were correct, the penalties initially were really quite low. they are increasing with each year. so people who don't sign up in 2016, the penalty for not buying insurance will be significantly more. so i think you will start seeing the fat will come into play as well. >> there are at least two plausible theories about what happens next. one over time the numbers do smooth out, as reluctant states join, more people get the hang of using the eggs changes, or

number, the numbers never really work, and the president's signature domestic achievement, bleeds customers, red ink, and partners. we'll take at lose -- at those futures.

♪ welcome back to "inside story," i'm ray suarez. this may hurt a bit, this time on the program, united healthcare says it is losing big money after joining the affordable care act, and could stop its part advertise payings on that program. if that is the case, what happens? my experts are still with me. yes, it's not though only provider, by a long shot, brian, but it is a me -- pretty big

fish in this marketplace. >> it is not just united health, 12 of the 23 coopts have collapsed because of major losses. now the largest insurer in the company who saturday out in 2014, and then came in, and now their ceo said it was a mistake, things don't look good. insurance companies now are trying to rely on this -- which was discussed by your first guest this bailout, and the rubio bill did not prevent loss -- insurance companies that made money from transferring those profits to insurance companies that lost money. it just prevented taxpayer money from going in to make up the deficit. and remember those risk order payments are on top of additional benefits that insurance companies got. they got an individual mandate,

they got enormous subsidies on the front end that reduced premiums and out of pocket payment, and back end subsidies to offset the cost of their most expensive enrollees. i think the evidence suggests that the core part of it is unworkable and perhaps unsustainable. >> wendell potter what do you think? >> insurance companies are making a lot of money. this is one small segment of the population that they are trying to serve. it's important to keep in mind that the ceo of united who he was talking to when he was talking about the possibility the company getting out of the exchanges in 2017. he was talking to investors. and that from having worked with two of the largest insurance companies for 20 years -- that is who they listen to most. and this is not a profit center for them yet. and they -- they -- they think

very short-term. they have to meet wall street's financial expectations every three months. and if they are not, investors say, look, is this a good place for you to be. >> let me jump in there, in response to his announcement, united health shares went up 2.5% in the next day's trade. >> exactly. because that's what those investors wanted to hear. at least they saw that united was possibly considering doing something that might make sure that they emphasize other aspects of the business where there are higher profit margins. anthem which has more people enrolled than united does, operates a lot of blue cross-companies across the country. and those companies have a long history of serving this individual market, which united does not, nor did cigna. so they are seeing possibilities, and while the first years are not good in

terms of profitability for most of the insurers that are serving this market, there is -- there will be as -- as this pool stabilizes more, and as the insurance companies can figure out more what kinds of plans they can offer, how to change the networks to make it more suitable for them -- or make it more possible for them to make money. so there are a lot of things that the insurance companies can do and will be doing to make sure they are assured a profit in the years going forward. >> that sounds like a plausible scenario to me, brian blaze, that once insurers get the handle of selling this product, they'll make money. >> they are larger deductibles, larger premiums, and more narrow networks. that is making obama plan patients less attractive. your guest talked about

obamacare insuring a lot of people. most of those 17 million are people that are either getting coverage basically for free through a medicaid proam that has a lot of problems, or who are receiving enormous subsidies. if people have to pay for these plans with their own money, they are choosing not to. right? and obamacare is not going to be sustainable if it is just a program for people above the poverty line. if it's not attracting individuals in the middle class to use their own hard-earned dollars to purchase these plans, the risk pools are not going to stabilize. >> and that will be the fight of the next two decades, gentlemen, because more and more people are working full-time at jobs where their employer do not provide insurance for them. i want to thank both of my guests, wendell potter, and brian blaze, a senior research fellow at george mason

university. i'll back in a moment with a final thought about healthcare. stay with us. it's inside story, and send us our thoughts on twitter, or follow me and get in touch. or visit our facebook page and tell us what you think. will other companies follow united lead and pull out of the healthcare act? we would love to hear from you. ♪

♪ bending the cost curve was the rallying cry echoing in capitol hill hallways during the day baits over the passage of the affordable care act and the years that followed. healthcare costs have been steadily on the rise, growing faster than inflation for all of the other things we buy in most years. the total bill for the united states in much higher at about one-sixth of the entire

economy, than the bite taken in other modern democracies, and many countries pay less, have better overale health, fewer uninsured and longer life expectancies. buying healthcare in the u.s. is unlike any other buying experience imaginable. it's almost impossible to compare price to price,. like the result or not, getting the affordable care act passed was an audacious attempt to get both tens of millions of people insured and keep private enterprise as part of the system. now with the united healthcare, they are threating to pull out all together. the next president who tries to do something big may hesitate, if his or her plans involve

cooperation from an enormous industry, making big money without changing anything. i'm ray suarez. that's the "inside story." ♪ this is al jazeera america live from new york city. i'm tony harris. chicago releases another deadly police shooting video. adz the justice department says it will investigate the police department. political ideologies, officials say'd farook and his wife had been radicalized for sometime and went to a shooting range just days before the attack. donald trump is turning up his anti-muslim rhetoric, calling for a