Changes to Obamacare won't take place until 2018, the medical reform law's architect Dr. Ezekiel Emanuel said Monday, but he warned not to count on radical changes to take place even then.
"I wouldn't bet your last nickel on 2018 that they make a major move either to repeal or replace the Affordable Care Act," Emanuel told Fox News' "Fox & Friends" program. "But you can't change the whole ship in a short amount of time."
Emanuel pointed out that while President-elect Donald Trump called to end Obamacare during his campaign, there are still many aspects of the program he'd like to keep.
Trump last week told The Wall Street Journal, and repeated on "60 Minutes" Sunday night, that he wants to keep the parts of the law that allow young adults to stay on their parents' plans until they are 26-years-old, and to keep the provision governing preexisting conditions.
"A lot of upper middle class parents and their children have benefited from that," Emanuel said of the age clause. "It's very popular. And not excluding people who have a preexisting condition like cancer and heart disease from health insurance and getting a reasonable rate is important."
However, he said, Republicans "have to realize and have a come-to-Jesus moment" on the fact that people with preexisting conditions can't be covered at a reasonable rate without a mandate that rules all Americans become involved in the system.
"It just doesn't work," said Emanuel. "They're going to have to choose how to do that. If you're really going to be serious about the preexisting conditions and the polling shows that 75 percent, 80 percent of Americans support that requirement."
Obamacare also closes the "doughnut hole" for seniors' drug coverage, a provision "extremely popular with seniors," said Emanuel.
Trump has also called for across-state insurance, but Emanuel said that has not worked in states that have tried it, for several reasons, including higher premiums.
There are many things Washington could do to make the exchanges work better, said Emanuel, including ending the Independent Payment Advisory Board.
"Let me remind your viewers, the exchanges are a Republican idea," said Emanuel. "If we get rid of the exchanges, it's going to be very hard to see how you get universal coverage."