Seize the mo­ment

Maryland Independent - - Community Forum -

The Con­gres­sional Bud­get Of­fice weighed in Mon­day on the profound im­pact of the House Repub­li­cans’ am­bi­tious Oba­macare fix. There’s fuel here for both pro­po­nents and crit­ics of the bill known as the Amer­i­can Health Care Act.

CBO says 24 mil­lion fewer Amer­i­cans would have health in­sur­ance by 2026. Why? Some would choose not to have in­sur­ance be­cause the bill ends the man­date that peo­ple buy in­sur­ance or pay a penalty. Oth­ers would forgo in­sur­ance be­cause of ris­ing pre­mi­ums. And many would lose cov­er­age be­cause of dra­matic changes to Med­i­caid.

The over­all ef­fect: Amer­i­cans ap­proach­ing Medi­care cov­er­age at age 65 would pay more and younger Amer­i­cans less, the CBO says.

At the same time, the bill would re­duce the fed­eral deficit by $337 bil­lion by 2026 — be­cause of less gov­ern­ment spend­ing.

Those are, again, CBO es­ti­mates. They aren’t the fi­nal word on whether the cur­rent GOP plan would suc­ceed or fail.

Now, the big ques­tion: What do House Repub­li­cans do? Will these — should these — es­ti­mates com­pel GOP lead­ers to change the bill? They should be open to re­tool­ing their bill to en­cour­age more peo­ple to buy cov­er­age. The ur­gency here comes not from the tenets of the bill it­self but from a much big­ger prob­lem: Oba­macare is floun­der­ing and risks col­lapse.

We’re sure that op­po­nents — Democrats and con­ser­va­tive Repub­li­cans among them — will marshal these CBO num­bers as rea­sons to scut­tle this bill or, con­versely, to have it de­stroy all things Oba­macare. Democrats have de­fended the cur­rent law and re­ject re­peal. Con­ser­va­tives crit­i­cize this bill as “Oba­macare Lite,” re­plac­ing one en­ti­tle­ment with an­other; those law­mak- ers seek a full Oba­macare erad­i­ca­tion, in­clud­ing pop­u­lar fea­tures that al­low chil­dren to re­main on par­ents’ poli­cies un­til age 26 and for­bid in­sur­ers from deny­ing cov­er­age for pre-ex­ist­ing con­di­tions. That won’t and shouldn’t hap­pen.

Pres­i­dent Don­ald Trump, House Speaker Paul Ryan and other GOP lead­ers can re­mind Amer­i­cans that they seek to re­place Oba­macare not be­cause it is the sig­na­ture achieve­ment of a Demo­cratic pres­i­dent but be­cause it is im­plod­ing. In­sur­ers are aban­don­ing mar­kets. Pre­mi­ums are rock­et­ing. Cov­er­age plans are nar­row­ing. Healthy young peo­ple are avoid­ing Oba­macare poli­cies and sicker peo­ple are flock­ing to them. At some point, Oba­macare risks plung­ing into what in­sur­ance ex­perts call a “death spi­ral.”

So the next chap­ter be­gins: What might an im­proved bill in­clude?

The GOP plan cur­rently of­fers some Amer­i­cans less gen­er­ous sub­si­dies but would bring mar­ket-based re­forms that could en­cour­age more Amer­i­cans to buy in­sur­ance. Build­ing in more in­cen­tives for younger, health­ier peo­ple to buy poli­cies sim­pler than Oba­macare’s wouldn’t only leave more Amer­i­cans in­sured. It would lower pre­mi­ums.

Are there other ways to whit­tle back the es­ti­mated num­ber of peo­ple who lose cov­er­age? Yes, prob­a­bly by ad­just­ing the Med­i­caid pro­vi­sions.

If this CBO re­port pro­pels Democrats who want to pre­serve to­day’s Med­i­caid and Repub­li­cans who want fewer man­dates to the same con­fer­ence ta­ble to hash out a bet­ter plan, great.

But re­mem­ber that if Wash­ing­ton fid­dles, Oba­macare may burn. “The time is now,” Ryan says of Oba­macare re­pair. “This is the mo­ment.”

Yes, it is. The CBO just made the Repub­li­can task more com­pli­cated, but also pos­si­bly more clear: Amer­i­cans need health cov­er­age that is flex­i­ble, that they can afford and that in­cludes the doc­tors and hos­pi­tals they want.

GOP lead­ers may have hoped their plan would float to Pres­i­dent Trump’s desk as a fait ac­com­pli. It won’t. Time for Repub­li­can lead­ers to re­spond and re­tool.

This editorial orig­i­nally ap­peared in the Chicago Tri­bune on March 14.

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