The slippery slope

Will GOP fix Obamacare or walk political plank?

It was always going to be easier to talk about “repeal and replace” of the ailing Affordable Care Act, aka Obamacare, than to do it, but House Republicans, at the urging of President Trump, have taken the first major step in that direction — albeit into the unknown.

By a razor-thin margin of 217-213, the GOP-controlled chamber last week gave Speaker Paul Ryan, R-Wis., and the president a major legislative victory while delivering on a major campaign promise.

Whether the legislation, which is derided by Democrats, assailed by activists and replete with questions, will lead to a better system or the equivalent of politically assisted suicide for Republicans is the subject of much debate. The legislation was stitched together at a frenetic pace with the goal of getting enough Republican moderates and conservatives on board to pass it in Trump’s first 100 days.

There was no hope of any Democrat help — any more than there was any Republican support for Obamacare. Sadly, that’s just how they practice medicine in Washington, D.C., today.

While Democrats were almost giddy at the prospect of voter revolt over House passage of “Trumpcare,” there are some things voters should keep in mind:

Obamacare is broken. Premiums are soaring. Mounting deductibles are a killer for many families. Most of the Obama-established cooperatives that were supposed to change the face of health care insurance and delivery have gone out of business. Insurance companies are bailing out of the exchanges; on Wednesday, health insurance giant Aetna announced it will not participate in any Obamacare exchanges in 2018 because of massive losses. A spokesman explained that “our individual commercial products lost nearly $700 million between 2014 and 2016, and are projected to lose more than $200 million in 2017 despite a significant reduction in membership.”

And Medicaid? Lots of new people did, in fact, get new insurance via Medicaid expansion: Cadillac insurance plans with no deductibles and virtually no co-pays. Want name brand drugs instead of generics? No problem. Want to go to the emergency room with sniffles because it’s convenient? That’s OK, too.

But there are two big problems with the Medicaid golden goose: Providers say reimbursements aren’t meeting their actual costs, and it is busting state budgets, including New Mexico’s. And that doesn’t even take into account the unintended social consequence of people opting not to take a job, or a raise, or work more hours because the higher income would threaten their Medicaid and other benefits.

House Republicans say their legislation will lead to lower premiums, while protecting people with pre-existing conditions. Those claims and others are up for debate. And as for fiscal impact, who knows? The legislation was pushed through without even waiting for a Congressional Budget Office score.

That’s a real problem because there is a lot of cryptic language in the bill. For example:

While health insurers could deduct their executives’ compensation on their taxes under Obamacare, there was a $500,000 cap that applied to all executives. Under the House version just passed, health insurers can deduct up to $1 million of an executive’s salary and there is no cap on what they can deduct when it comes to other forms of executive compensation, like performance pay. The Joint Committee on Taxation points out it would allow Aetna to write off most, if not all, of its CEO’s $17 million in pay and Cigna to do the same with its chief executive’s $13 million-plus.

And that’s a drop in the bucket — the government is expected to lose approximately $600 billion under the plan, mainly from tax repeals.

Now it’s up to the Senate to take up the issue and either build on and modify the House version or do its own.

Either way, senators need to step up to the task, and there are some things that should be considered. To name a few:

A federally funded pool to cover pre-existing conditions and serious medical issues. There must be protections for those in this category, but having those extreme cases in general pools simply drives up the cost too much.

A real plan to bring down prescription drug prices. Medicaid block grants to the states, along with allowances for work requirements, meaningful co-pays and other market signals.

Portability across state lines so insurance companies compete nationally for business and co-ops can purchase insurance for members on a national scale.

Tort reform that would bring down the high cost of malpractice premiums and the practice of “defensive medicine.”

Health savings accounts and expansion of governmentsubsidized health clinics to deliver care.

And there need to be public hearings on the bill — something that did not happen in the House.

While it’s fair to criticize House Republicans for some aspects of the legislation, as well as the process, they also deserve some credit. It might be bitter medicine, but this process had to start somewhere if the patient is going to survive.