Trump can’t eas­ily dump Oba­macare

Daily Local News (West Chester, PA) - - OPINION -

Don­ald Trump said dur­ing his ac­cep­tance speech that he found cam­paign­ing tough. Wait un­til he tries gov­ern­ing.

His web­site has promised: “On day one of the Trump Ad­min­is­tra­tion, we will ask Congress to im­me­di­ately de­liver a full re­peal of Oba­macare.” Trump walked back that prom­ise Fri­day in an in­ter­view with the Wall Street Jour­nal, say­ing he might re­tain some of the most pop­u­lar por­tions of the Af­ford­able Care Act.

The pres­i­dent-elect has fig­ured out — or maybe knew all along — that a to­tal re­peal would be ex­ceed­ingly dif­fi­cult. Dou­bly so if he in­tends to ful­fill his prom­ise of a new sys­tem to im­prove the health care of all Amer­i­cans.

That’s one Trump prom­ise both po­lit­i­cal par­ties should hold him to. It’s in the GOP’s best in­ter­ests. A plan that leaves out many of the peo­ple who voted for Trump will quickly turn his fan base sour.

A full re­peal would be sub­ject to a fil­i­buster in the U.S. Se­nate, mean­ing Repub­li­can Se­nate lead­ers would need to con­vince a hand­ful of Democrats to help make up the 60 votes needed to end it.

The only al­ter­na­tive is rewrit­ing the fil­i­buster rules, but Se­nate Ma­jor­ity Leader Mitch McCon­nell has been dis­in­clined to do that for good rea­son. He fears what would hap­pen when Democrats some­day re­gain con­trol of the Se­nate.

Trump prob­a­bly will use the bud­get rec­on­cil­i­a­tion process to shoot down as many Oba­macare pro­vi­sions as he can. Bud­get rec­on­cil­i­a­tion re­quires only a ma­jor­ity vote. But it would be lim­ited to the parts of the Af­ford­able Care Act that deal with ex­pen­di­tures and rev­enue.

He could re­tain the parts of the law he says he likes, in­clud­ing pro­tect­ing peo­ple with pre-ex­ist­ing con­di­tions and al­low­ing chil­dren to stay on their par­ents’ plans un­til age 26. Then, he could push the Se­nate to do away with much of the fi­nanc­ing for the rest of Oba­macare. But that would come at a heavy po­lit­i­cal price: Tak­ing away health in­sur­ance from as many as 22 mil­lion Amer­i­cans, sub­stan­tially cut­ting into in­sur­ance com­pany prof­its and dras­ti­cally in­creas­ing costs for hos­pi­tals, which would be forced to pro­vide char­ity care for the mil­lions of newly unin­sured.

Per­haps be­cause of his un­ex­pect­edly long con­ver­sa­tion with Pres­i­dent Obama Thurs­day, Trump ap­pears to be re­al­iz­ing the chal­lenge of en­tirely re­plac­ing the Af­ford­able Care Act. He’s never been spe­cific about how, and no won­der. Repub­li­cans have been try­ing for eight years to come up with an al­ter­na­tive that doesn’t get laughed out of the room when pre­sented to health care ex­perts.

The three ma­jor GOP ideas are giv­ing Amer­i­cans tax cred­its for health sav­ings ac­counts, al­low­ing in­sur­ance com­pa­nies to sell poli­cies across state lines and giv­ing states block grants for Med­i­caid ex­penses.

Health sav­ings ac­counts are great for the wealthy, but do lit­tle or noth­ing for low-in­come fam­i­lies barely putting food on the ta­ble — which is to say, a large ma­jor­ity of the Amer­i­cans who now ben­e­fit from Oba­macare.

Sell­ing in­sur­ance across state lines is sup­posed to cut costs by dodg­ing reg­u­la­tions in states such as Cal­i­for­nia, which re­quires plans to meet cer­tain stan­dards. Con­sumer groups op­pose it be­cause it would lure in­sur­ers to states (think Mis­sis­sippi) with the weak­est pro­tec­tions for pa­tients. But here’s some­thing Trump might not have re­al­ized: In­sur­ers hate it, too. A race to the bot­tom is less prof­itable for them than a broader mar­ket for cov­er­age that of­fers real value.

States dis­like block grants be­cause they in­evitably shrink over time, re­gard­less of the need. States with large pop­u­la­tions of poor peo­ple are hurt the most be­cause they have the least re­sources to make up the dif­fer­ence.

In cre­at­ing the Af­ford­able Care Act, Pres­i­dent Obama learned it was a com­plex and chal­leng­ing puz­zle, bring­ing the in­sur­ance in­dus­try and med­i­cal providers to­gether to pro­vide cost-ef­fec­tive care. Let’s face it. It was ugly.

Trump prom­ises his own pro­gram is go­ing to be “beau­ti­ful, so beau­ti­ful.” His best bet for that will likely be im­prov­ing upon Oba­macare, not re­peal­ing it. — San Jose Mer­cury News,

Dig­i­tal First Me­dia

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.