In the midst of a battle over U.S. health care, the debate over the effectiveness of the Affordable Care Act (ACA) has remained at the forefront.

Doug Elmendorf, dean of the Kennedy School of Government and the former director of the Congressional Budget Office from 2009 to 2015, told Yahoo Finance’s Rick Newman that the ACA (also known as Obamacare) “is working” and trying to repeal it is counterproductive.

“More than 20 million Americans have health insurance today who would not have it without the Affordable Care Act,” Elmendorf said at the Milken Conference. “That’s a huge improvement in their access to health care and a reduction in the out-of-pocket costs that they face.”

Elmendorf continued: “Is the law perfect? No. Can we do more to expand health insurance coverage further? Yes. But we’ve wasted almost a decade now in discussing ways to tear apart that act. We should be looking for ways to build on it and move forward.”

‘We’ve made good progress’

Since Obamacare went into effect in 2012, it has been met with opposition from Republican politicians who have made numerous attempts to repeal the legislation. And in December 2018, a Texas judge called ACA’s legality into question after ruling that its mandate was unconstitutional — and if that part of the law was invalid, so was the rest of the law. The case is currently under appeal. (The Trump administration has made it clear that it sides with the judge on the issue.)

In the meantime, the country is still split on the issue. According to a recent Gallup poll, 50% of Americans approve of the ACA, while 48% disapprove. And health care costs continue to be a main concern, as a different Gallup poll indicated that over 50% of Americans worry “a great deal” about the availability and affordability of health care.

“We’ve made good progress in expanding health insurance coverage, so more Americans are covered,” Elmendorf said. “I think the big challenge now is reducing costs. And that’s not so much to be accomplished through plans like Medicare for All, but through changes in how we pay for health care and organize the delivery of health care.

‘Blowing up the system ... I don’t think is the best approach’

Politicians have recognized the public for a wider health care net, and many have made it a key campaign issue heading into the 2020 presidential election. Senator and Presidential candidate Bernie Sanders (I-VT) has proposed a Medicare for All plan.

However, Elmendorf doesn’t think Medicare for All is the right approach.

“The right way to improve the American health care system is incrementally,” Elmendorf said. “Blowing up the system in order to put everybody into a new program I don’t think is the best approach.”

Medicare for All would cost an estimated $32.6 trillion over its first 10 years and would get rid of the private insurance system, eliminating the need for employers to provide insurance for their workers. Federal health care spending would rise to $3.5 trillion per year, according to a Rand analysis.

There are several incremental ways to improve the health care system incrementally, Elmendorf said, including “how we pay for care to pay for keeping people healthy, rather than paying for each piece of care they receive.”

“The problem we have in our health care system is that we’re not staying healthy enough, and we’re being forced to treat a lot of diseases,” he said. “If we paid for keeping people healthy, then we’d have fewer diseases to treat.”

Adriana is an associate editor for Yahoo Finance. Follow her on Twitter @adrianambells.

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