Editorial: Take time to get ACA fix right
Republicans have a new plan for repealing and replacing Obamacare, but it is at risk of meeting the same fate as the original version. Key GOP Congress members have opposed the American Health Care Act 2.0, although recent policy compromises should help.
These more moderate members have felt the rewrite went too far to please the conservatives who sank the first attempt.
Michigan’s Fred Upton and others voiced concerned with built-in waivers that would allow insurers to charge those with pre-existing conditions much higher rates for policies. But Upton now supports the health care bill after getting President Donald Trump’s support for an amendment that would provide $8 billion in additional money directly into high-risk pools in states that seek a waiver.
Democrats are objecting to any reforms of the Affordable Care Act, content to allow it to continue collapsing in hopes of sticking Republicans with the blame.
Congress and Trump must face some other basic truths if they hope to come up with an Obamacare solution that meets the goals of providing access to affordable health care to all Americans.
For starters, they should slow down. Implementing the ACA took more than five years and billions of dollars. The entire health care system was upended and rebuilt. Insurance companies completely reworked their business models.
A viable replacement can’t be crafted in a hurry. Trump and congressional leaders should convene a wide range of experts from the insurance and health care delivery industries, as well as consumer groups, to determine what fixes are needed for Obamacare.
Democrats have an obligation to join this effort. They rushed through Obamacare on a strictly partisan vote, and that helped contribute to its failure. They can’t shirk responsibility for their work.
Without bipartisan support, the public will never fully embrace a replacement, and health insurance will continue to serve as a political wedge.
Upton raises a good point that a guarantee of coverage for pre-existing conditions is useless if those policies are priced out of the reach of average consumers.
And yet the idea of allowing more flexibility in crafting coverage is a good one. One proposal offered by the GOP would let states apply for waivers from the ACA’s essential health benefits requirement, which mandates coverage in 10 major health categories.
Letting states craft rules that work best for their citizens would encourage them to innovate and come up with cheaper, and perhaps more effective, policies.
Congress, this time, should focus far more on controlling health care costs than it did in the Affordable Care Act. Tort reform, demanding adherence to best practices, reducing paperwork and better patient education on end-of-life care would all help slash the cost of delivering health care, and thus lower insurance premiums.
Cost controls are essential. On average, Obamacare premiums rose 25 percent for 2017, while deductibles topped $6,000 for individuals and $12,000 for families. Again, the high prices are making insurance all but useless even for those who have coverage.
Competition must also be restored. In 70 percent of the counties in America, there are only one or two insurers participating in the exchanges, and an increasing number of counties have no insurer available.
The recent compromise over coverage for pre-existing conditions should be linked to individuals maintaining continuous policies. As Obamacare has proven, the system won’t work if people are allowed to jump in and out, buying policies only when they think they need them.
Continuous coverage spreads risk over a larger group, and for a longer period of time, thus keeping costs in check.
Fixing Obamacare is not an impossible assignment, nor should it be so difficult to build a broad consensus on the right path. But it will take time, and it must have the commitment of both parties to work together.