No repeal of ACA without a sure-thing replacement
Leading or governing with slogans is never the best plan. Anyone remember former President George W. Bush standing under a banner declaring that the U.S. military occupation of Iraq was “Mission Accomplished”?
Unfortunately, our country is poised to take another step on a track to nowhere. This time it is with the Affordable Care Act of 2010 that provided health care to 20 million Americans who didn’t have it before. About 750,000 of the newly insured under Obamacare are in Washington.
If you ask a newly insured person about it, gratitude or relief is a common refrain.
Yet two weeks into 2017, congressional Republicans are hell-bent on repealing the 2010 law also known as Obamacare. A replacement plan, which many candidates promised, could be years in the future — if ever.
So what exactly is better by repealing the law and waiting to do something better?
To say this is irresponsible is to understate the obvious. Repeal without a clear plan for replacement — and a clear plan for transition to a new system — is a harmful move.
Unfortunately, the 2010 law associated with President Barack Obama became a rallying point for Republicans in Congress and their campaigns.
They promised action if elected and now find themselves eager to vote but lacking a feasible plan for replacing the ACA with something better.
Polling done after the November election for the Kaiser Family Foundation, a nonpartisan organization that follows health care policy, showed just one in four Americans now wants the next president, Donald Trump, to repeal the full law. Just 52 percent of Republicans want the ACA repealed entirely, down from 69 percent before the election.
There is support across party lines, according to the poll of 1,202 adults nationwide with an overall sampling error of 3 percent, for elements of Obamacare. These include letting young adults be covered on their parents’ plans until age 26, no co-pays for some preventive services, government help with premium payments, expanded Medicaid for lower-income families and keeping insurers from denying coverage based upon a prior condition.
A lot of smoke has been blown around higher premiums for health insurance. That trend was actually worse before the ACA. We’ve yet to hear of any GOP plan that can reliably reverse that trend.
That is why a better approach for Congress and the incoming administration is to offer real improvements to the insurance reforms that came to be known as Obamacare. Let the nation and Congress debate them. Build credibility for a new plan, and then make improvements, if real improvements can be found.
If on the other hand, there is a sense of emergency due to insurance premiums that went up this year, then consider adjusting tax credits to make the policies more affordable in the short term. Or raise the Medicaid eligibility to let more lower- and moderate-income families into the state-federal plan.
Like it or not, Obamacare has extended health-insurance protections to millions of Americans who never had it, and the uninsured rate in Washington is now under 6 percent.
Moreover, elements of the ACA ensure that patients cannot be denied coverage because of preexisting conditions, and parents can cover their children up to age 26 on their own plans. And older Americans on Medicare are protected against higher out-of-pocket costs for prescription drugs.
Republicans have been quick to vilify Obamacare since it began under a Democrat-controlled White House, Senate and House. Keeping the ACA is now a cause for Democrats, who, like Gov. Jay Inslee, are urging public support for the law in Congress. Those Democrats are right: Repeal of the ACA without health security for those who now have coverage is dangerous and wrong.
The Washington Office of Financial Management estimates this state would lose $3 billion a year in federal money, including premium subsidies and expanded Medicaid funds, if the ACA is simply repealed. Another $330 million would be needed every two years to resume programs that the ACA replaced.
But Republicans are also right. Obamacare could be better. But the GOP had many chances to improve the law over the past four years and didn’t.
With Trump headed to an inaugural this week, this is the GOP’s turn to make health coverage better for more Americans — not just cheaper for wealthy people who already can afford it.
In the medical world, the prescription is this: Do no harm.
This story was originally published January 14, 2017 at 8:45 PM with the headline "No repeal of ACA without a sure-thing replacement."