Our Editorial: Find rational fix for health law

What to do about health care in America is a central theme of the 2016 presidential race. On the Republican side, most of the talking points revolve around repealing the Affordable Care Act — one of President Barack Obama’s signature achievements. The health care law has led to higher health insurance costs for many Americans, fewer options for coverage and high fees. And if fixes aren’t made, it will get worse.

Six years have passed since the Affordable Care Act became law, so it won’t be easy for states to extricate themselves from its mandated insurance exchanges and additional requirements.

Candidates with realistic plans to repeal and replace the health care law with a workable solution will have the best shot of actually seeing their proposals realized.

Resistance to the law has not gone away. States weren’t eager to set up the exchanges mandated in the law; 34 never did, including Michigan. The federal government had to step in and do it for them. Similarly, Medicaid expansion was at the heart of the law, but 19 states have resisted — despite the law’s promise of covering most of the expense.

And Obamacare has already faced multiple Supreme Court challenges. While it’s survived legal fights so far, the Obama administration got its hand slapped a few years ago when it lost a case to Hobby Lobby, the company that sued over being forced to offer a wide variety of birth control in its employee health plans.

The High Court has taken on another case this spring, in which the Little Sisters of the Poor — a group of nuns who care for impoverished elderly — feel their religious liberty is harmed by having any involvement with birth control coverage.

Republican candidates are right to tackle health care, although some have thought through their plans more than others. Donald Trump has been all over the map, saying he’s going to repeal the health care law and replace it “with something so much better.” Like so many of Trump’s promises, what that would look like isn’t clear. He’s supported a free enterprise system, although he’s also indicated in the past he would back universal health care.

At a recent debate, Ben Carson, a retired neurosurgeon, laid out some details of his plan, which includes a system that resembles health savings accounts. Those accounts would offer families more flexibility and control of health costs. It’s an intriguing idea.

Ted Cruz has said that socialized medicine leads to “rationing” of medical services. Instead, he’s supporting purchasing insurance across state lines — a popular GOP alternative. Like Carson, he is a fan of health savings accounts. And Cruz thinks insurance should be a benefit attached to the individual, and not employment.

Marco Rubio, who has voted in the Senate to repeal large portions of the health care law, has said he’d repeal Obamacare and create an advanceable and refundable tax credit for Americans to purchase health insurance. Michael Cannon, the director of health policy studies at the Cato Institute, argues the Florida senator’s plan contains an individual mandate — one of the most disliked parts of the health care law.

As governor of Ohio, John Kasich was one of only a few GOP governors who supported the expansion of Medicaid under Obamacare — Gov. Rick Snyder did, too. Kasich has received a lot of criticism for this decision, since expanding Medicaid is seen as offering a win for the health care law and no one can be certain of future costs to the state.

But Kasich — and 30 other governors — thought it made good financial sense, given the federal government’s offer of fiscal support.

His plans for overhauling health care are similarly rational. He would like to see a more market-driven model and move to a system that upholds quality services from doctors and hospitals.

On the Democratic front, Hillary Clinton is pretty much following Obama’s lead, saying she’d continue what he started and not stop until all Americans are covered. Part of her plan includes expanding autism insurance and spending $2 billion on Alzheimer’s research.

Bernie Sanders takes his health care plan to an extreme, which fits in with his platform. He wants universal health care — something he describes as Medicare for everyone. But he doesn’t have a good explanation for how the government would pay for such coverage.

Special series

This is one in an occasional series examining issues in the upcoming presidential primary election. Find the other editorials in this series at detroitnews.com/opinion.