Me­dia my­opia on health care

The Washington Post Sunday - - SUN­DAY OPIN­ION - BY GARY ABER­NATHY Gary Aber­nathy is pub­lisher and ed­i­tor of the (Hills­boro, Ohio) Times-Gazette.

hills­boro, ohio

In small ru­ral com­mu­ni­ties such as mine — places that largely sup­ported Don­ald Trump for pres­i­dent but have higher-thanaver­age unin­sured pop­u­la­tions — con­flict­ing feel­ings about what to do about re­form­ing health care run deep. There are di­vi­sions be­tween health­care providers and the pop­u­la­tions they serve, and di­vi­sions even within in­di­vid­u­als them­selves, as an in­her­ent anti-gov­ern­ment po­lit­i­cal bent col­lides with real-world strug­gles to pay for med­i­cal needs.

The Af­ford­able Care Act has brought some un­de­ni­able ben­e­fits, espe­cially for our lo­cal hos­pi­tals, by ex­pand­ing Med­i­caid cov­er­age and al­low­ing more peo­ple to seek pre­ven­tive care.

Even so, ris­ing pre­mi­ums and the frag­ile state of the in­surance ex­changes have peo­ple wor­ried. They want to see Re­pub­li­cans fol­low through on their prom­ise to re­peal Oba­macare, but ques­tions about what comes next leave them anx­ious.

One real-world per­spec­tive comes from High­land Dis­trict Hospi­tal, a small fa­cil­ity in south­ern Ohio gov­erned by ru­ral town­ship trustees, where of­fi­cials are not at all torn. They cheered Ohio Gov. John Ka­sich’s de­ci­sion to ex­pand Med­i­caid in 2013, not­ing that the per­cent­age of unin­sured peo­ple here in High­land County was higher than the state av­er­age and that the costs of treat­ing them were driv­ing up costs for ev­ery­one else.

That opin­ion hasn’t changed much. Randy Len­nartz, the hospi­tal’s chief ex­ec­u­tive, told me that while Oba­macare isn’t per­fect, it did re­sult in a wave of peo­ple seek­ing med­i­cal care who had pre­vi­ously ig­nored pre­ven­tive­care vis­its. Those num­bers have tailed off, but Len­nartz said he be­lieves that’s largely be­cause their con­di­tions were suc­cess­fully treated.

The down­side of Oba­macare, he said, was that most peo­ple who signed up through the in­surance ex­changes chose the cheap­est plans avail­able, plans that came with de­ductibles in the $5,000-to-$10,000 range that few can af­ford. The me­dian house­hold in­come in High­land County is just un­der $40,000, ac­cord­ing to cen­sus fig­ures.

As in other states, in­surance pre­mi­ums rose un­der Oba­macare, and choices con­tin­ued to shrink. Just a few weeks ago, An­them Blue Cross and Blue Shield an­nounced it will not sell poli­cies in Ohio in the Oba­macare mar­ket­place in 2018. On the heels of that an­nounce­ment, Premier Health Plan said it is also pulling out, leav­ing as many as 20 Ohio coun­ties with no health in­surer on the state ex­change.

It’s not sur­pris­ing that some peo­ple look at this mess and say, “I told you so.” Still, Re­pub­li­cans in Con­gress find them­selves in a dilemma. Oba­macare is not work­ing as ad­ver­tised, but it works for some, even here.

With the opi­oid cri­sis in Ohio and other Mid­west­ern states, GOP law­mak­ers such as my old boss, Sen. Rob Port­man — a long­time pro­po­nent of re­cov­ery and “sec­ond chance” pro­grams — aren’t com­fort­able with the re­duc­tion in Med­i­caid growth con­tained in the GOP health-care pro­pos­als.

But Port­man is well aware of the 2016 pres­i­den­tial elec­tion re­turns from Ohio, and he likely wants to find a way to sup­port a re­peal-and-re­place bill. Along those lines, Port­man took the lead in pro­mot­ing a sep­a­rate $45 bil­lion fund ded­i­cated to opi­oid treat­ment that was added to the Se­nate bill, sig­nif­i­cantly in­creas­ing the chances of get­ting him to “yes.”

Pass­ing a plan that hurts ru­ral com­mu­ni­ties through Med­i­caid cut­backs is a risk. But for many GOP law­mak­ers, not re­peal­ing Oba­macare is a big­ger risk among vot­ers in those same com­mu­ni­ties, where Trump reigns supreme and where peo­ple don’t look to the gov­ern­ment to solve all their prob­lems.

That there are such peo­ple is what a lot of folks in Wash­ing­ton have trou­ble un­der­stand­ing. The cam­paign by the Democrats and many in the me­dia to save Oba­macare re­lies largely on dire warn­ings about how many peo­ple will lose health-care cov­er­age un­der the GOP plan. They won­der: How can Trump’s sup­port­ers stick with him when his pro­pos­als hurt them the most?

What they fail to grasp is that Trump’s sup­port­ers, by and large, are more ded­i­cated to the prin­ci­ple of free­dom from gov­ern­ment man­dates than they are wor­ried about the loss of gov­ern­ment sub­si­dies or pro­grams that so­cial ac­tivists in Wash­ing­ton think they need.

Un­til Democrats can fig­ure that out, their ef­forts to pry Trump’s sup­port­ers away from him — on health care or any other sub­ject — will con­tinue to be an end­less source of frus­tra­tion.

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