Obamacare architects: Here’s how to fix it
As GOP struggles, ACA backers push to stabilize system
As Senate Republicans struggle to find the votes to repeal the Affordable Care Act, the architects of Obamacare have an idea to try if they fail. Just fix it. Tuesday, Senate Majority Leader Mitch McConnell, R-Ky., delayed the vote planned for this week on the Republican health care plan as complaints from competing wings of his party made it uncertain whether he commanded the support even to begin debate, much less pass the bill.
Those who oppose repealing the Affordable Care Act cautioned that the GOP’s failure to act would create complications of its own, for those who gained insurance coverage through the Obama initiative and just about everybody else.
“There’s nothing insurance companies hate more than uncertainty, and one of the things they do to respond to uncertainty is to increase their premiums,” Ezekiel Emanuel, a bioethicist and University of Pennsylvania professor, said in a Capital Download interview Tuesday at the Aspen Ideas Festival.
Premiums for those who buy insurance through the Obamacare exchanges, already rising, would increase more, pricing some Americans out of the market.
Those who get insurance through their employers would feel the effect as hospitals spread the costs of treating the uninsured.
“The notion that anyone in America is going to be better off if the Affordable Care Act crashes and burns is ludicrous,” he told USA TODAY’s video
newsmaker series. “All of us will pay for it in the end. There is no free lunch here.”
Emanuel played a key role in the Obama White House in devising the Affordable Care Act. He met with President Trump three times after the election in November to discuss health care policy.
His sessions with Trump left him perplexed, Emanuel said. “He wants to get everyone covered; he wants costs to be under control, so people aren’t being denied care because of the deductibles or the co-pays; he wants drug costs to come down,” he said. “This (Senate) bill does none of that, so it seems like a total discord between what his guts tell him to do and what the bill does.”
Emanuel and Kathleen Sebelius, who was secretary of Health and Human Services as the law was devised, debated and implemented, said there could be bipartisan agreement on steps that would stabilize the health system, help control costs and protect care.
Among their suggestions: Reassure skittish insurance companies. “Very, very quickly, the Republicans need to say to insurance companies, ‘As we work on a new theory of replacement, we will keep this law in place,’ ” Sebelius said, including a commitment to continue the subsidies that help lowerincome Americans afford premi-
ums. Announcing that the law’s mandate to have health insurance is going to be enforced would help as well, Emanuel said. Change the way doctors
and hospitals are paid. If they receive federal payments through Medicare, Medicaid or the military’s Tricare system, Emanuel proposed a mandate that they spend a rising percentage of those funds on models that focus on wellness and prevention rather than a fee for each procedure performed.
Negotiate lower drug prices for Medicare and Medicaid.
Provide incentives for insurance companies to participate in the exchanges.
There’s limited optimism about the prospect for any bipartisan cooperation in the foreseeable future.
“We agree on 70% of policy,” Emanuel said.
Republicans decided not to reach out to Democrats during the debate, arguing their opposition was set.
Democrats see no percentage in rescuing Republicans from their political straits, at least not before next year’s midterm elections.
“When you piss off the other side and basically spit in their eye — ‘We’re not going to talk to you; we’re not going to involve you; we’re going to keep all the marbles; we’re not holding public hearings; we’re not debating this’ — what’s their motivation for working with you?” Emanuel asked. “It’s zero.”
Who gets the political blame if the nation’s health care system becomes a fiasco?
Sebelius, who saw the political damage that Obamacare’s stumbles created for Democrats in 2010, predicted it would be the GOP: “I believe that whoever is in charge when the collapse happens owns the collapse.”
“It seems like a total discord between what (Trump’s) guts tell him to do and what the bill does.” Ezekiel Emanuel, University of Pennsylvania