Pull the plug on re­peal-and-re­place

The Washington Post - - WASHINGTON FORUM - EUGENE ROBIN­SON

House Repub­li­cans are ap­par­ently ready for yet an­other at­tempt to snatch health in­sur­ance away from con­stituents who need it. Some­one should re­mind Speaker Paul Ryan of a say­ing of­ten at­trib­uted to his leg­endary pre­de­ces­sor Sam Ray­burn: “There’s no ed­u­ca­tion in the sec­ond kick of the mule.”

Hav­ing failed mis­er­ably to win pas­sage of an abom­i­na­tion of a bill — the Amer­i­can Health Care Act — Ryan (R-Wis.) and his min­ions are back with some­thing even worse. A draft frame­work be­ing cir­cu­lated this week would pre­tend to keep the parts of Oba­macare that peo­ple like, but al­low states to take th­ese ben­e­fits away. We see what you’re do­ing, folks.

This is get­ting silly. What part of “for­get it” do Repub­li­cans not un­der­stand?

I re­al­ize there is great pres­sure to fol­low through on the GOP prom­ise to “re­peal and re­place” the Af­ford­able Care Act. And I re­al­ize that Pres­i­dent Trump, near­ing the 100-day mark, sorely needs a leg­isla­tive vic­tory to tweet about. King Pyrrhus needed a win, too, but that didn’t work out too well for him.

Repub­li­cans don’t talk much about the prac­ti­cal rea­son for mov­ing ur­gently on health care, which is to set the stage for tax re­form: They want to take money now used to sub­si­dize health care for low­in­come Amer­i­cans and give it to the wealthy in the form of big tax cuts. Again, we can see you.

I’m sure the crowds at GOP town halls will be un­der­stand­ing. Just be sure to check at­ten­dees at the door for tar and feath­ers.

The new pro­posal — bro­kered by Rep. Tom MacArthur (R-N. J.), of the mod­er­ate Tues­day Group, and Rep. Mark Mead­ows (R-N.C.), of the far-right Free­dom Cau­cus — is like a par­ody, as if life-or-death ac­cess to health care were fod­der for a “Sat­ur­day Night Live” sketch.

This is get­ting silly. What part of “for­get it” do Repub­li­cans not un­der­stand?

Nom­i­nally, the MacArthur amend­ment would re­tain the Es­sen­tial Health Ben­e­fits stan­dard im­posed by the ACA, which re­quires in­sur­ance poli­cies to cover even­tu­al­i­ties such as hos­pi­tal­iza­tion, ma­ter­nity and emer­gency care — ba­si­cally, all the things you’d ever need health in­sur­ance for.

The amend­ment would also ap­pear to main­tain the ACA’s guar­an­tees that any­one could buy health in­sur­ance, in­clud­ing those with pre­ex­ist­ing con­di­tions, and that par­ents could keep adult chil­dren on their poli­cies un­til age 26. That all looks fine — but it’s an il­lu­sion.

Af­ter spec­i­fy­ing that th­ese pop­u­lar pro­vi­sions will stay, the amend­ment then gives states the right to snatch them away. States would be able to ob­tain waivers ex­empt­ing them from the Es­sen­tial Health Ben­e­fits stan­dards. They would also be able to ob­tain waivers from the pre­ex­ist­ing con­di­tions re­quire­ment by cre­at­ing a “high-risk pool” to pro­vide cov­er­age for those who are un­well.

There would no longer be a pro­hi­bi­tion, how­ever, against charg­ing “high-risk” in­di­vid­u­als more — so much more, in fact, that they would po­ten­tially be priced out of the mar­ket. We would go back to the pre-ACA sit­u­a­tion in which se­ri­ous ill­ness could mean los­ing a home or fil­ing for bank­ruptcy.

This may sat­isfy GOP ide­o­log­i­cal im­per­a­tives — Ayn Rand would be so proud — but it is atro­cious pol­icy, even if you put aside con­sid­er­a­tions such as com­pas­sion and com­mu­nity.

We live at a time of enor­mous eco­nomic dis­lo­ca­tion. The man­u­fac­tur­ing sec­tor has shrunk dra­mat­i­cally, and now re­tail may be start­ing down the same path; long-lost jobs in in­dus­tries such as coal min­ing are not com­ing back, no mat­ter what Trump says. Work­ers need to be able to move to where jobs are be­ing cre­ated — which means that health in­sur­ance should ide­ally be por­ta­ble. But Repub­li­cans are head­ing in the other di­rec­tion by try­ing to set up a sys­tem with rad­i­cally dif­fer­ent health-in­sur­ance rules in dif­fer­ent states. In today’s world, how does that make sense?

Un­changed from last month’s failed bill are pro­vi­sions that would strip mas­sive amounts of money out of Med­i­caid, by far the na­tion’s big­gest source of pay­ment for nurs­ing-home care. So Repub­li­cans might not want to show their faces any­where near re­tire­ment com­mu­ni­ties.

The Af­ford­able Care Act changed the way most peo­ple in this coun­try think about health care. It did not, how­ever, change the think­ing of many House Repub­li­cans, who con­tinue to be­lieve in­di­vid­u­als should be held fi­nan­cially li­able for a ge­netic pre­dis­po­si­tion to­ward di­a­betes or a ran­dom cel­lu­lar mu­ta­tion that leads to can­cer.

An­other ab­ject fail­ure to re­peal the ACA would be a ter­ri­ble po­lit­i­cal out­come for Repub­li­cans. But far worse, look­ing ahead to the 2018 midterms, would be for Trump to sign this lat­est mon­stros­ity into law.

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