Bipartisan fix needed for Obamacare

Count us as pleased that U.S. Sen. Cory Gardner is calling for the Senate to slow down its push for a replacement healthcare act, even offering to work through the upcoming recess. But much more work is needed.

The two proposals on the table can’t be characterized as anything other than, as former President Barack Obama eloquently put it: “a massive transfer of wealth from middle-class and poor families to the richest people in America.”

But Obama’s criticism of the Republican bill goes too far in its absolute condemnation. Change is justified by the current cost of Medicaid and private insurance.

So what should Republicans come up with?

The problem is Republicans will likely be heading the wrong direction if they try to pick up hard-line repeal advocates Sens. Ted Cruz, Rand Paul, Mike Lee and Ron Johnson who are threatening billblocking “no” votes unless there’s a more dramatic move to free-market principles.

If only there were four moderate Democrats willing to offer their services to Republicans in this moment of GOP fracture. And if only Congress weren’t so divided that Majority Leader Mitch McConnell could accept such an offer to move the debate to the center.

Doing so would require Senate Democrats to admit that the current level of coverage under Medicaid is unsustainable. It would require Republicans to admit that because health insurance is so expensive in this country, Medicaid must cover more people than it once did.

What would that middle ground look like?

Lawmakers would have to maintain the unpopular taxes on the medical industry and the massive 3.8 percent tax on investment income. Senate Republicans already planned to keep the Cadillac tax on highcost insurance plans, but they shouldn’t delay it for almost another decade.

Those tax increases were supposed to fund the Affordable Care Act. Now that money could be used to either maintain a higher level of funding for Medicaid than is proposed by the House and Senate plans or to increase tax credits and subsidies to the poor who would be kicked off Medicaid under the current Republican plans.

More people in the private insurance network — even if they are impoverished — will in theory help drive down prices. That could give the failing private insurance market a needed boost and could prevent them from balking about having to continue to insure people with pre-existing conditions even as the individual mandate goes away.

We’ve maintained that reforming this nation’s Medicaid system — beyond Obama’s expansion — is an issue that should be taken up on its own, rather than tacked onto an Obamacare repeal effort. But if this effort continues, any bill reforming Medicaid payments (absent the expansion population) should be a datadriven analysis of funding levels needed to protect the most at-risk patients. Kids make up more than half of the original Medicaid population. We would hope there would be bipartisan support to hold funding for kids harmless from cuts. The Senate version of repeal and replace includes a provision championed by Gardner for disabled children and those with medically complex conditions to be exempt from spending limits placed on states.

More should be done to ensure that as we reform the flawed Medicaid payment system (one that rewards spending rather than good care and efficiency) it doesn’t create health-care instability for our most vulnerable populations.