Thursday, December 8, 2016

Out with Obamacare, in with . . . Trumpcare -- Dec. 8, 2016 column


You’d think they’d be ready by now.

For nearly seven years, congressional Republicans have promised to “repeal and replace” Obamacare with something better and more affordable.

Repeal is easy. Since President Barack Obama got the Affordable Care Act through Congress in 2010 without a single Republican vote, the House has voted more than 60 times to repeal all or part of it.

On the campaign trail, Donald Trump called the law “a total disaster” and vowed to repeal and replace it on Day One.  

Senate Majority Leader Mitch McConnell said Tuesday repeal will be the first item of business in the New Year when the Senate returns Jan. 3.

Replace is hard. Republicans have yet to agree on a path forward for what inevitably will be known as Trumpcare. 

Even Trump now wants to keep two popular provisions of the health law. After he met with Obama in the Oval Office, the president-elect said he favors allowing children under 26 to stay on their parents’ health insurance plans and requiring coverage of people with existing medical conditions.

Trump’s a big-picture guy, so replacement details will fall to Congress, where, until the election, many were more interested in politics than policy. I know you’re surprised.

Only on Dec. 2 did House Majority Leader Kevin McCarthy send a letter to governors and state insurance commissioners asking for their ideas about health care reform.That way, if Trumpcare goes bad, state officials can share the blame.

McCarthy said the two-step repeal and replace process could take much of next year and beyond. House Speaker Paul Ryan also lowered expectations of speedy action.

“Clearly there will be a transition and a bridge so that no one is left out in the cold, so that no one is worse off,” Ryan said Monday in an interview with Craig Gilbert of the Milwaukee Journal Sentinel.

Ryan would not hazard a guess about how long the transition might take.

“It will clearly take time. It took them about six years to stand up Obamacare. It’s not going to be replaced come next football season,” he said.

One possibility is for Republicans to resurrect the repeal bill Obama vetoed last January. It called for a two-year delay in the effective date of replacement. Some Republicans say six months is enough.

Republican leaders invited Democrats to work with them, even though Republicans refused to cooperate with Obama. Senate Democratic leader Chuck Schumer derided Republicans as “the dog who caught the bus,” saying, “They don’t know what to do.”
Repeal without replacement will cause “huge calamity from one end of America to the other,” Schumer said. “Bring it on.”

In a letter to Trump, the American Hospital Association and the Federation of American Hospitals urged him and Congress not repeal Obamacare without a replacement. If that happens, Congress should restore funding to hospitals that was cut by Obamacare, the groups said, so hospitals can defray some of their costs.

The nonpartisan but left-leaning Urban Institute warned in an analysis this week that repeal without a clear replacement could throw into chaos the private health insurance market. Millions of Americans buy insurance directly rather than through an employer.

The number of uninsured could rise to 59 million by 2019, the study said. That’s far more than the 41 million who lacked insurance in 2014 when major provisions of Obamacare went into effect. About 28.5 million remained uninsured last year, according to the Kaiser Family Foundation.

Trump’s pick to lead Health and Human Services, House Budget Chairman Tom Price, wants to replace Obamacare with modest tax credits pegged to age, not income, to help people buy insurance on the private market.

Price’s proposed Empower Patients First Act also calls for grants to help states create “high-risk” insurance pools and expands health savings accounts.  

Republicans have not rushed to embrace the plan. Critics say it’s woefully underfunded and millions of Americans would lose coverage.

Taking time is not necessarily bad. Rushing could be worse.

But if members of Congress are going to blow up Obama’s signature legislation, they should be held to their promises and do no harm to the more than 20 million people who have insurance because of Obamacare.

To do anything less is to risk disappointing and disillusioning more Americans at a time when trust in government and politicians is badly frayed.  

©2016 Marsha Mercer. All rights reserved.


No comments:

Post a Comment