Pull health care out of its ‘death spiral’

By any means they can, Donald Trump and the Republican rulers in Congress remain hell-bent on destroying the Affordable Care Act that has given better health care and peace of mind to millions of Americans. If the GOP can’t shred the law outright, as Senate Majority Leader Mitch McConnell still intends to try to do this week, then the president will sabotage it with deliberate neglect.

“If we don’t get it done,” Trump told the New York Times, “we are going to watch Obamacare go down the tubes, and we’ll blame the Democrats. And at some point they are going to come and say, ‘You’ve got to help us.’ ”

This cynical scheme is breathtaking in its immorality. It plays political blackmail with the lives and financial security of virtually the entire American public.

Trump is deluding himself about who would get the blame. Polls show Americans disapproving by large and growing majorities of what the Republicans are up to. They prefer Obamacare. In recent results cited by the Kaiser Family Foundation, 61 percent disliked the congressional tack; 44 percent viewed it “very” unfavorably. More than seven in 10, including nearly half of Trump supporters, want a bipartisan effort to improve the ACA.

For a senator, the only responsible vote this week is to refuse to begin floor debate on any version of McConnell’s rapidly mutating monstrosity. Instead, the Housepassed bill should be sent to a committee for thoughtful and bipartisan consideration. It is an issue that involves nearly 18 percent of the entire economy and potentially affects every citizen in one way or another.

Overall, most indicators show the health insurance industry to be in good and improving health. But there’s work to be done.

Among other things, the ACA needs protection from the “death spiral” that Trump intends. The administration has pulled support that has helped many Americans shop for coverage on Obamacare’s insurance exchanges. It keeps threatening to discontinue vital cost-sharing payments to insurers to subsidize copays and deductibles for low-income enrollees. It may refuse to enforce the requirement that people who can afford insurance must buy it or pay a tax and has stopped encouraging people to do so. The Republican Congress is attempting to forbid enforcement through so-called riders on vital appropriations bills.

Without the mandate — which was originally a Republican idea — the entire system would become unaffordable.

The uncertainty over the law’s future is probably more responsible than any other factor for those premiums that are rising faster than they should. Predictability is essential to any form of insurance.

Another problem that Congress needs to address is the lack of competition where there are no insurers, or only one, listed on the exchanges. One plausible proposal is to allow people living in such places to purchase their coverage through the exchange for the District of Columbia, where most members of Congress and their staffs get theirs.

(The “gold,” top of the line plan that members must purchase on that exchange if they want taxpayer support is similar to those offered on exchanges elsewhere. The government’s subsidy of 72 percent of premium cost compares to 71 percent that private employers offered on average in 2014, according to the Kaiser Family Foundation. But members are also eligible for low-cost care through the Office of the Attending Physician and free emergency treatment at any military facility in the Capital region. They pay the total cost of vision and dental coverage. The bottom line: Contrary to rumor, members of Congress don’t get totally free health care, but they do have guaranteed access to an excellent, well-run plan.)

Nothing good can happen so long as Florida’s Marco Rubio and other Republican senators remain fixated on a vote to repeal or ruin the ACA. To hear some of them, nothing could be worse than giving the other party — and the people whom Democrats represent — a voice in the matter.

It’s a tactic familiar to anyone who was threatened as a child, “The bogeyman will get you if you don’t watch out.” The Democrats are McConnell’s bogeyman. He has been warning holdout senators on both sides of his split party — those few who think his bill is too harsh and a number who say it’s not mean enough — to put party loyalty above principle if they don’t want Democrats at the table.

That attitude bears comparison, as the New York Times did Sunday, with the process of enacting Obamacare seven years ago. That no Republicans voted for the final product belies their substantial role in shaping it through multiple House and Senate committees and in floor debate. Of the 374 amendments that were adopted along the way, 188 had Republican sponsorship and 17 were bipartisan. The Republicans prevailed virtually half the time, losing only 201 of their amendments.

But in the House earlier this year, Democrats succeeded in none of the 29 amendments they offered. Trump’s speech Monday blamed Democrats, but put the onus on both parties prior to a possible vote today.

“The question for every senator, Democrat or Republican, is whether they will side with Obamacare’s architects, which have been so destructive to our country, or with its forgotten victims,” Trump said. “Any senator who votes against starting debate is telling America that you are fine with the Obamacare nightmare, which is what it is.”

Senate parliamentarian Elizabeth MacDonough’s advice last week that much of McConnell’s bill is subject to filibuster should have put an end to it. The rules she referenced exist for a purpose: full and fair debate of the public’s business.

There are explanations, but no good ones, why one of our two major parties is so committed to hurting so many people — not just the 32 million who would lose coverage if the ACA is repealed (and not replaced), but the millions more who benefit from guaranteed insurability, portability, and an end to lifetime coverage limits.

Sheer spite is one of those reasons. Another is the burden of right wing special interests and the outside influence of hardcore conservatives in party primaries. Then there is the party’s historic opposition to any new social program. McConnell’s bill would gouge not just the Medicaid expansion that came with Obamacare, but also original Medicaid as it was enacted in 1965.

The American people deserve and expect better than this. They will be watching the Senate very closely this week. Editorials are the opinion of the SunSentinel Editorial Board and written by one of its members or a designee. The Editorial Board consists of Editorial Page Editor Rosemary O’Hara, Andrew Abramson, Elana Simms, Gary Stein and Editor-in-Chief Howard Saltz.