McDonough said that if President-elect Donald Trump and his allies on Capitol Hill move too rapidly or recklessly to dismantle the Affordable Care Act, the vast majority of Americans -- and not just those insured through health care exchanges -- will pay a high price.
"If (Republicans) mishandle this, they're going to affect not just the 23 million people who got coverage now through the marketplaces, they're going to affect the nearly 200 million people who get it through their employer," McDonough told David Axelrod on "The Axe Files" podcast, produced by the University of Chicago Institute of Politics and CNN.
Given the complexity of the private insurance system, precipitous changes absent suitable replacement steps cannot be taken "without creating an awful lot of instability in the marketplace."
Turning to the executive actions Obama signed to confront the challenge of climate change, McDonough said that it is misinformed to suggest that the next administration could dismantle these rules and regulations with "just the stroke of the pen."
Such steps would require the same laborious process of rule making -- and likely litigation -- it took to enact them.
Moreover, the growth over these eight years of natural gas reserves and renewable sources of energy such as wind and solar have made coal less economically attractive.
"The market has a say," McDonough said.
McDonough also reflected on his nearly eight years serving in various roles in the administration and the professional highs and lows he's experienced during that time. Assessing the administration's response to the Syrian civil war and the humanitarian disaster that's taking place there, McDonough acknowledged the seeming absence of any solutions or relief, and said he thinks every day about whether things could have been done differently.
"There's not been a day when I haven't thought about this," McDonough said, "(and) there's not been a day when the President of the United States hasn't thought about this."
He said the problem has been so vexing, the President invited some of his most vociferous critics to the White House to see if they could generate ideas the administration hadn't thought of.
"And so far we've not come up with anything," he said. "It just turns out that this is a really hard problem."
To hear the whole conversation with McDonough, which also covered his experience growing up in a house with 10 brothers and sisters; the searing experience, when he was a Senate aide, of working on the 2003 Iraq War resolution; why it's important to maintain perspective when working in the White House; and much more, click on http://podcast.cnn.com
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