‘Repeal and Replace’ fails; now Obamacare needs fixing

Trudy Lieberman
Rural Health News Service

The failure of the Republican-led effort to repeal and replace Obamacare represents a big victory for all kinds of citizens and interest groups that analyzed the proposed legislation and said no dice.

The day before House Speaker Paul Ryan decided not to take a vote on the American Health Care Act, a Quinnipiac Poll found that only 17 percent of American voters approved of the GOP’s legislation while 56 percent did not.

You can hardly call that a vote of support for what the bill was trying to do. Too many people would be hurt, and the public along with editorial writers in newspapers across the country, got that message: The GOP plan would cause real pain. Members of Congress heard it loud and clear, and many responded to what they heard.

Older Americans would have had to pay more, sometimes thousands of dollars more to get health insurance. In 32 states, millions of Americans with incomes slightly above the poverty line who had gained coverage under their state’s Medicaid expansion program would have lost their coverage.

Others already on Medicaid or joining in the future would also have been affected. The proposal called for cutting back the federal government’s commitment to fund healthcare for the poor by changing the way it would pay for its share of program.

That would have left the states, which jointly fund Medicaid, strapped for funds to cover everyone needing medical treatment as well as middle class families who required help paying for long-term care. Medicaid pays for about half of all nursing home stays.

The Affordable Care Act (ACA), or Obamacare, had mandated that every insurance policy sold in the individual market

where people without employer or government coverage must shop had to include 10 essential benefits. Under the Republicans’ plan, that mandate – that all plans include things like prescription drug coverage, emergency room services, maternity care and mental health treatment – would have disappeared.

Dropping any of the essential benefits would have helped some insurance companies whose individual policies provided only bare bones coverage until 2010 when the ACA required essential benefits to be included. Insurers would have been able to sell skimpy and cheaper coverage to those willing to gamble.

Now, even though the “repeal and replace,” effort failed, we are left with a health law that needs repairs of its own.

“Many of the criticisms of the ACA are, in fact, valid,” said RoseAnn DeMoro, executive director of the National Nurses United, the largest union and professional organization of registered nurses. “For all the improvements under the ACA – primarily the expansion of Medicaid and crackdown on some insurance abuses – the ACA still left 28 million without health coverage – and millions more struggling with un-payable bills and escalating out-of-pocket costs.”

DeMoro’s assessment hits home to many readers of this column who have complained about higher and higher premiums, sky-high deductibles and coinsurance, and lack of choice. Many have limited choice of doctors, hospitals and other providers in insurers’ restrictive networks. Even worse, in some parts of the country there’s only one insurer to buy from.

Those problems stem from the underlying premise of Obamacare itself. The ACA was built on top of the existing private insurance system, which means that it will work only if insurers find it to be good business. As the years went on and sick people with pre-existing conditions flocked to buy coverage, which the law guaranteed they could do, insurers found that Obamacare was not good business. They left the market or made consumers pay more out of pocket or through higher premiums.

The ACA did not provide for any serious cost containment, and the GOP plan didn’t call for any either. Medical inflation continues as doctors, hospitals and drug companies raise their prices, and new expensive medical technology comes on the market before there is good evidence that it works. One consulting actuary put it this way, “Medical inflation will continue until doctors decide they have enough money and don’t raise their fees.”

It’s not clear that the country’s divisive politics will allow for any fix of the ACA’s problems, let alone put any teeth into cost control measures. There could be renewed interest in a public option that could allow people to choose government-sponsored insurance rather than a policy from a commercial carrier.

Or maybe there would be a move to let people in their 50s or early 60s buy into Medicare, which could spark the beginning of a movement toward Medicare for all.

I’m not betting on any of this right now, but as the failure of the GOP’s “repeal and replace” shows, the public is demanding a seat at the table.

 How would you fix the Affordable Care Act?  Write to Trudy at trudy. [email protected]

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