Welcome to Public Health On Call, a podcast from the Johns Hopkins Bloomberg School of Public Health,

where we bring evidence, experience, and perspective to make sense of today's leading health challenges.

If you have questions or ideas for us, please send an email to public health question at jhhhu.edu.

That's public health question at jhhhu.edu for future podcast episodes.

It's Lindsay Smith Rogers.

Today, a look at what the budget reconciliation bill will mean for the Affordable Care Act.

Liz Fowler is an expert in federal health policy and a Bloomberg distinguished scholar at Johns Hopkins.

She has worked at the Centers for Medicare and Medicaid Services, and prior to that, she served on the Senate Finance Committee playing a major role in the drafting and passage of the Affordable Care Act.

Let's listen.

Liz Fowler, thank you so much for joining us on Public Health on Call.

Would you tell us a little bit about your work and your background?

Thanks, Lindsay.

It's great to be here.

I am currently a distinguished scholar at the Bloomberg School of Public Health at Johns Hopkins

and also with the Carey Business School before this. I was leading the CMS Innovation Center. That's the Innovation Center that's part of the Center for Medicare and Medicaid Services. But I think the reason we're talking today is because during the drafting of the Affordable Care Act, I was the chief health Council of the Senate Finance Committee, which had

jurisdiction over Medicare, Medicaid, and many other policies that were part of the ACA that's

become known as Obamacare. And now we'll be undergoing some changes as a result of the

legislation that just passed. That is exactly what we want to talk to you about today.

There's a lot that we're still unpacking about budget reconciliation, particularly on health care and the ACA. But to start us off, what is the Affordable Care Act? What did it do? The ACA was really an attempt at covering the uninsured. So our uninsured rate, the people without health insurance coverage in the U.S. was about 18 percent in 2009, 2010, when we're not going to be able to be in the insured rate, the people without health insurance coverage in the U.S.

was about 18% in 2009, 2010 when the ACA was drafted and when it passed. And the ACA, instead of

creating a whole new health care system, sought to build on the existing health care system,

as messy and complicated as it is, tried to build on the pieces

...