An al­ter­na­tive to “re­peal and de­lay”

The Denver Post - - OPINION - By Jen­nifer Ru­bin

There is a grow­ing re­al­iza­tion on the right and left that re­peal­ing Oba­macare with the prom­ise that some­thing bet­ter will come along would be a pol­icy and po­lit­i­cal disas­ter. In­sur­ers would ac­cel­er­ate their with­drawal from ex­changes, height­en­ing the demise of the ex­changes. In­di­vid­u­als would lose cov­er­age, health care hor­ror sto­ries would spread like wild­fire, and the GOP would pay an aw­ful price.

There are two al­ter­na­tives: 1) Re­peal and re­place all at once; or 2) Grand­fa­ther ev­ery­one.

The first is the most log­i­cal. Re­pub­li­cans say they have a bet­ter way. Let’s see it and find out if they can pass it. Truth be told, they don’t have agree­ment among them­selves, let alone with Democrats. In that sense the “re­peal and re­place” prom­ise is fraud­u­lent. If they can­not re­place it, don’t prom­ise to re­peal it.

The next al­ter­na­tive comes from con­ser­va­tive health care guru James Capretta of the Amer­i­can En­ter­prise In­sti­tute:

He ar­gues the GOP shouldn’t push peo­ple out of the in­sur­ance un­der ACA. If Congress es­tab­lished a new sys­tem of in­sur­ance cov­er­age, over time there would be a nat­u­ral tran­si­tion from the ACA to the re­place­ment plan. Such a tran­si­tion would al­low those en­rolled in an in­sur­ance plan of­fered on the ex­changes to con­tinue to be eli­gi­ble for those plans, with ACA’s pre­mium sub­si­dies pro­vided. It would also mean al­low­ing all those who be­came eli­gi­ble for Med­i­caid, be­cause of the ACA ex­pan­sion of the pro­gram, to re­main there, even if a re­place­ment plan later low­ers el­i­gi­bil­ity lev­els for prospec­tive Med­i­caid ap­pli­cants.

“Al­low­ing peo­ple to keep what they have to­day on an in­def­i­nite ba­sis will help sta­bi­lize the mar­ket­place and al­low for an or­derly, rather than a chaotic, tran­si­tion,” Capretta says.

But what about, say, the 27 year old who comes off his par­ents’ plan in 2017? What about some­one who starts work­ing full time, in­creas­ing her in­come beyond the Med­i­caid cut­off ? We should want her to keep work­ing, so let’s give her the ben­e­fit of the sub­si­dized ex­changes also. The per­son who loses his job and falls into the in­come level cov­ered by Med­i­caid? We don’t want him to be de­prived of cov­er­age when oth­ers who hap­pened to lose their job and got the ben­e­fit of ex­panded Med­i­caid gets theirs, do we? That would be per­versely un­fair.

Yeah, we kinda fudged in sug­gest­ing grand­fa­ther­ing was a stand-alone op­tion.

Un­til the GOP can pass some­thing with bi­par­ti­san sup­port and solves the ACA prob­lems it has iden­ti­fied, it should do noth­ing. The ul­ti­mate “grand­fa­ther­ing” — leave the sys­tem in place. That is the only real so­lu­tion po­lit­i­cally or pol­i­cy­wise that doesn’t cre­ate a raft of vic­tims. The sooner the GOP fig­ures this out, the bet­ter.

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