Two dis­as­trous health-care ideas

It’s time for mod­er­ate Re­pub­li­cans to buck con­ser­va­tives and work with Democrats to im­prove Oba­macare.

The Washington Post Sunday - - SUN­DAY OPIN­ION -

WHEN OBA­MACARE re­peal-and-re­place stalled in the House, GOP law­mak­ers re­vived it by erod­ing reg­u­la­tions pro­tect­ing vul­ner­a­ble peo­ple, thereby at­tract­ing sup­port from the far right of the Re­pub­li­can cau­cus. Con­ser­va­tives are now an­gling to do the same in the Se­nate.

Fac­ing op­po­si­tion from both mod­er­ates and right-wingers, Ma­jor­ity Leader Mitch McCon­nell (R-Ky.) put off a vote on the Se­nate ver­sion of re­peal-and-re­place, which he had hoped to take up be­fore the July 4 break. Now, as Mr. McCon­nell woos mod­er­ates with more spend­ing on treat­ment for opi­oid ad­dic­tion, con­ser­va­tives are de­mand­ing more ag­gres­sive dereg­u­la­tion of the in­surance in­dus­try, float­ing ideas that would un­ravel the Af­ford­able Care Act’s care­fully de­signed mar­kets for in­di­vid­ual health in­surance.

Sen. Ted Cruz (R-Tex.) pro­posed al­low­ing in­surance com­pa­nies to sell plans that do not com­ply with Oba­macare man­dates, which re­quire them to serve peo­ple with pre­ex­ist­ing con­di­tions and cover a set of es­sen­tial health-care ser­vices. The com­pa­nies would still be re­quired to sell at least one com­pli­ant plan, too, but that should be lit­tle com­fort to peo­ple with health con­di­tions, older peo­ple and oth­ers at risk of in­surance com­pany dis­crim­i­na­tion.

In­stead of group­ing many peo­ple with vary­ing health-care needs to­gether, spread­ing costs so that no one pays an in­sup­port­able amount, Mr. Cruz’s plan would cre­ate a two-tiered sys­tem. In­surance com­pa­nies would sell cheaper, non­com­pli­ant plans to healthy, low-risk cus­tomers. Sicker and older peo­ple would be left in the ACA-com­pli­ant mar­ket, where costs and pre­mi­ums would soar. Only peo­ple with ex­pen­sive med­i­cal needs would shell out for cov­er­age, in­surance com­pa­nies would have to boost pre­mi­ums to cover their costs, and more cus­tomers would exit the mar­ket. As the pool be­came ever-sicker, pre­mi­ums would go ever-higher.

In the­ory, fed­eral sub­si­dies could pro­tect vul­ner­a­ble peo­ple from cost spikes, at least for a time. But the sub­si­dies would get skimpier un­der the Se­nate plan, and many peo­ple would not qual­ify for them. Ab­sent a mas­sive in­fu­sion of money, other funds in the bill meant to sta­bi­lize pre­mi­ums could only do so much to hold back the spi­ral, and they would even­tu­ally ex­pire any­way. Peo­ple with se­ri­ous med­i­cal needs would surely get hurt.

Equally de­struc­tive would be Sen. Ben Sasse’s (R-Neb.) pro­posal to re­peal Oba­macare with­out si­mul­ta­ne­ously re­plac­ing it. Af­ter pass­ing a bill end­ing Oba­macare at a cer­tain date, the think­ing goes, Con­gress would have more in­cen­tive to en­act a con­ser­va­tive re­place­ment. The GOP seemed to have aban­doned this idea ear­lier this year, yet it re­ceived an un­ex­pected boost from Pres­i­dent Trump, who tweeted fa­vor­ably about the strat­egy late last month.

Mr. Trump has re­peat­edly threat­ened to tank Oba­macare mar­kets to com­pel Con­gress to pass a health bill. That may not be what Mr. Sasse has in mind, but it would be the ef­fect of his ap­proach. Ab­sent a clear re­place­ment and tran­si­tion plan, in­dus­try and pol­icy ex­perts warn that in­sur­ers would quickly aban­don Oba­macare mar­kets slated to be elim­i­nated, strand­ing cus­tomers who cur­rently de­pend on them. A spokesman for Mr. Sasse ar­gues that Oba­macare mar­kets “are al­ready in col­lapse,” a twisted take on re­al­ity that gets no more con­vinc­ing the more Re­pub­li­cans re­peat it. Even if it were so, Re­pub­li­cans would bear much of the blame for mis­man­ag­ing the sys­tem.

Nei­ther of these ideas de­serves a hear­ing. In­stead of con­tin­u­ing with a re­peal-and-re­place ef­fort that con­ser­va­tives are pulling in a dis­as­trous di­rec­tion, mod­er­ate Re­pub­li­cans should fi­nally work with Democrats in good faith to im­prove Oba­macare.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.