The health high wire
Republicans are walking a high wire as they move toward the long-sought goal of repealing “Obamacare.” Moving too fast could mean trouble. On one side are conservatives who denounce the House plan as Obamacare-lite. They bristle at anything short of the full repeal that’s been the goal for years.
On the other side are Americans who stand to lose coverage. Some are older, lower-income people who fueled the Trump revolution. If they start telling their stories on social media, the GOP may pay a price in the 2018 midterm elections. Let’s be clear: Reform is essential. Yet the task of replacing Obamacare got more complicated with the release of the nonpartisan Congressional Budget Office analysis, which says 14 million people will lose health coverage by 2018 under the House repeal-and-replace plan. By 2026, the number rises to 24 million.
The Trump administration has tried to dismiss the CBO report, but, as Republican Sen. Bill Cassidy said: “You have to have an umpire.” Otherwise, you are simply listening to yes men. It’s worth considering the consequences.
Another example of unintended consequences: Arizona could lose $46.8 million in federal dollars for publichealth programs that cover such things as childhood immunizations, diabetes management and threats to public health, according to reporting by The Republic’s Ken Alltucker.
Federal funding to states for public health predates Obamacare, but the House repeal-and-replace bill eliminates it.
Promises from the White House and others to make improvements to this bill are encouraging. But it will be hard to fix everything at the speed this is moving.
Republicans who want to emerge with good public policy and a political advantage should take a long view. They need to remember how they criticized Obamacare for being pushed through with too little attention to detail.
Doing it right is better than doing it fast. Obamacare created expectations. As Arizona Sen. John McCain puts it: “We cannot abandon any group of Americans who have become accustomed to receiving health care.” President Donald Trump has also pledged that no one would lose coverage, though his White House has equivocated on that since.
The House plan bowed to the reality that it is tough to eliminate the more popular parts of the Affordable Care Act, such as the provisions on pre-existing conditions and coverage for offspring to age 26. Keeping these mandates is politically smart but will make it harder to create the market-driven system conservatives want.
What’s more, the refundable tax credits in the House proposal are seen by some conservatives as uncomfortably similar to the taxpayer subsidies available under Obamacare.
Another part of the reform deals with the Medicaid expansion that many states — including Arizona — used to extend coverage to low-income people. The federal government currently picks up most of the cost.
The House GOP plan phases out the expansion after 2020, which means Arizona would have to pay steadily rising costs or people would lose coverage.
During the recession, when enrollment was frozen in this state’s Medicaid program, the Arizona Health Care Cost Containment System, 250,000 people lost coverage, leading to a surge in people seeking emergency-room care, according to reporting by Alltucker.
Arizona hospitals faced big costs to provide uncompensated care to these vulnerable individuals who lacked any other option. This is why hospitals supported — and were willing to help pay for — Medicaid expansion in our state.
Republicans in Congress need to carefully consider the consequences of destabilizing the health-care industry nationwide.
The House plan restructures Medicaid as block grants to states, which could result in caps on the number of people covered. This change could also allow states more flexibility and result in cost savings. These are significant changes in a safety-net program.
The consequences need to be fully understood and supported by the public.
Republicans have long wanted to repeal Obamacare. Now they have the opportunity. But racing along the high wire could have significant adverse consequences.
It is better to go slowly and do this right.