Jay Bhattacharya, an economics/medicine professor at Stanford University, who has studied the healthcare market for 20 years.

He recently chatted with a scholar at his institution, Devon Zuegel, and offered a long list of problems and concerns with Obamacare.

The Affordable Care Act requires insurance companies to accept all clients, including those with pre-existing conditions. Some experts have voiced concerns about eliminating risk from an inherently risk-based market. What are your thoughts on this subject?

The way insurance companies work is that they look at the predicted health costs of a given risk pool and set premiums based on that. Affordable Care Act provisions make it so that it’s more expensive to cover this pool, because you have to cover more services and riskier people; in turn, the premiums end up being higher. There’s no such thing as a free lunch. You have to pay for these provisions somehow.

In the same vein, the legislation prohibits insurance companies on the individual market from discriminating based on preexisting conditions, though they are allowed to discriminate based on “age, premium rating area, family composition, and tobacco use.” What are the consequences of this?

There are some constitutional restrictions on what you can price on. So for instance, I don’t think you’re constitutionally permitted to price based on race, even though minorities on average tend to have higher health costs. Also, politically, they didn’t want to allow different prices based on gender, even though women tend to have higher health costs than men. Instead, all these groups are pooled together. This makes insurance look like a better deal for those people who would typically have relatively high health costs. But what that means is that it’ll be much more difficult to get the people with low health costs to sign up, because insurance will look like a bad deal for those people. This is a problem called “adverse selection,” and people are very worried about it in the insurance market, because of these community rating laws, which make it so that people get charged the same premium for health insurance no matter what their risk.

Now this sounds good, but it actually has some important negative economic consequences. The first is that … insurers aren’t going to charge the young an actuarially fair price. Instead, what they’ll charge is a much higher price than the young would normally have to pay for health insurance.