A re­pair for health care

Un­tan­gle the mess of Oba­macare

Northwest Arkansas Democrat-Gazette - - EDITORIAL PAGE -

WHAT A tan­gled web. Now it’s all in ev­ery­body’s hair. Oba­macare—or the at­tempts to get out of it—re­minds us of the Devil’s Snare in Harry Pot­ter books. The more you strug­gle with it, the more en­tan­gled you get.

Now the lead­er­ship in the U.S. Se­nate is talk­ing about a straight re­peal of Oba­macare, but not for an­other two years! This keeps get­ting worse! If they don’t re­peal this thing for an­other 24 months, it means we have 24 more months of Oba­macare, and who knows what will hap­pen af­ter the next con­gres­sional elec­tions? (If Democrats gain seats, as ex­pected, everything is off.)

How about an al­ter­na­tive ap­proach?

The coun­try—tax­pay­ers, politi­cians, We the People— should re­mem­ber that the Af­ford­able Care Act is re­ally two dif­fer­ent pro­grams tied into one pack­age. One pro­gram pro­vides free med­i­cal care for the poor and those mak­ing up to 138 per­cent of the poverty line. (Where they came up with that num­ber is any­body’s guess.) As we know, only about half of the states opted to par­tic­i­pate in ex­pand­ing Med­i­caid for this pur­pose.

In this half of the equa­tion, many sen­a­tors (and cer­tain gov­er­nors back home) are re­luc­tant to vote to re­peal this ex­pan­sion be­cause there are so many people on ex­panded Med­i­caid back in their states. Like the one you’re in now, Mr. and Mrs. Arkan­sawyer. His­tory shows it is ex­tremely dif­fi­cult to take away an en­ti­tle­ment once it’s given. In fact, when was the last time that hap­pened?

The sec­ond part of Oba­macare is not free med­i­cal care, but rather sub­si­dized med­i­cal care. That’s where there are a lot of prob­lems. This is where we read of in­surance com­pa­nies pulling out of states, not re­quir­ing people to sign up for in­surance un­til af­ter they get sick, and forc­ing ev­ery­one into one-size-fit­sall in­surance with 10 es­sen­tial ser­vices, bal­loon­ing the cost of health-care pre­mi­ums.

A big step on fix­ing Oba­macare would be to split the two parts and only deal with the sec­ond part to be re­pealed and re­placed. Leave the Med­i­caid ex­pan­sion alone. This should elim­i­nate the re­sis­tance of sen­a­tors who op­pose re­duc­ing the num­ber of those cov­ered by free health in­surance in their states. It would also elim­i­nate the prob­lems of the Con­gres­sional Bud­get Of­fice con­tin­u­ally say­ing how many mil­lions of people will no longer have in­surance.

Of course, this is not a per­fect so­lu­tion, with some states like Arkansas and Ken­tucky hav­ing ex­panded Med­i­caid, and other states like Texas not so much. But the states that did ex­pand it will have to live with it.

There is no doubt there is go­ing to be a day of reck­on­ing when the fed­eral govern­ment has to start re­form­ing its en­ti­tle­ment pro­grams, and Med­i­caid will be one that it has to ad­dress. Could Med­i­caid lower its start­ing point and cover people not liv­ing above the poverty line?

Arkansas’ costs from its Med­i­caid ex­pan­sion will prob­a­bly in­crease from around $100 mil­lion a year to about $200 mil­lion as the fed­eral govern­ment pays less, re­duc­ing the per­cent­age it pays from 95 per­cent at the be­gin­ning of Oba­macare to 90 per­cent over the next few years. (That was writ­ten into the law.) Arkansas will just have to deal with that fis­cal prob­lem, since it is a fis­cal prob­lem our state leg­is­la­tors cre­ated by agree­ing to the ex­pan­sion in the first place. The states that did not ex­pand Med­i­caid would have a lighter load, and any fu­ture ex­pan­sion of Med­i­caid in those states can be han­dled by fu­ture leg­is­la­tion in their cap­i­tals.

Congress can take other, smaller steps now on the sub­si­dized in­surance that would help clean up this mess. First, it should ad­dress the prob­lem of people not hav­ing to buy in­surance un­til they get sick. This will al­ways re­sult in higher pre­mi­ums for ev­ery­one. Imag­ine if you could buy home­own­ers’ in­surance af­ter your home caught fire. Ev­ery­one’s in­surance would cost more in that case. Just as health in­surance does now un­der Oba­macare.

The House bill ad­dresses this prob­lem by re­quir­ing much larger pre­mi­ums for people who do not buy in­surance un­til af­ter they get sick. Congress might even con­sider re­tain­ing the penalty for people who don’t buy in­surance, since it is fairly nom­i­nal any­way, and that would please the Democrats. Or have dif­fer­ent de­ductibles, with lower de­ductibles for those who buy in­surance be­fore they get sick, and much higher de­ductibles for those who wait till they are sick.

IF THE Congress would di­vide Oba­macare into two dis­tinct sec­tions, and ad­dress one of them now, it could prob­a­bly get leg­is­la­tion passed and re­duce in­surance pre­mi­ums, which would en­cour­age more people to sign up. Congress could ad­dress Med­i­caid and other mat­ters when it even­tu­ally takes up en­ti­tle­ment re­form.

An­other step would be to elim­i­nate the “one size fits all” re­quire­ment for Oba­macare in­surance. It goes by an­other more eu­phemistic name, the Ten Es­sen­tial Ser­vices. But why not re­quire in­surance com­pa­nies to of­fer these 10 in some pack­ages, but also let them of­fer six, or eight, or 18 ser­vices in others? That would al­low con­sumers to choose which in­surance plan they want. And no doubt it would let con­sumers get the type of in­surance they want, and many would pay lower pre­mi­ums. An­other word for this ap­proach is “free­dom.”

Let’s take Oba­macare apart and start chang­ing the parts that can be im­proved now.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.