Capital in confusion over Obamacare RX -- Feb. 16, 2017 column

By MARSHA MERCER

President Donald Trump turned to House Speaker Paul Ryan the other day and said: “He’s working on Obamacare. It’s going to be very soon -- right?”

“Yes,” Ryan replied, as cameras rolled in the Oval Office.

More than a nudge from the president, Ryan could use some Lyndon Johnson-style arm twisting to make good on the Republicans’ long-term promise to repeal and replace the Affordable Care Act.   

Trump has left details of reforming health insurance to Ryan and other Republicans in Congress, but they are floundering in a sea of options.  

Trump still sounds like he’s an outsider on the campaign trail. When Humana became the latest major insurer to say it will stop selling coverage on Obamacare exchanges in 2018, Trump tweeted: “Obamacare continues to fail. Will repeal, replace and save health care for ALL Americans.”

Yet he has presented no plan of his own and the goal of replacement seems to be slipping farther into the future.

As a House member, Tom Price, the new Health and Human Services secretary, offered a plan, one of many. None of the other plans has galvanized widespread support even within the GOP, let alone with Democrats. It’s unclear what Senate Republicans will accept.  

Ryan went door-to-door, trying to build a consensus around his “Better Way” plan, but Republicans even disagree on timing -- repeal and replace at the same time or repeal first and take time on a replacement.

Trump has said repeal and replace will be “essentially simultaneous.”

But Ryan told reporters this week that reform “affects every person and every family in America,” and a deliberate, “step-by-step approach” is needed for stability.

House Republicans received plan options at a party caucus before they headed home for the week-long Presidents Day break.

Meanwhile, the House Freedom Caucus, a group of about 35 to 40 of the most conservative Republicans, wants to repeal the law now and is backing a plan by Sen. Rand Paul of Kentucky.

Paul’s plan would undo most of the Obamacare rules, rely on expanded health savings accounts, allow people to buy insurance across state lines and join associations to increase purchasing power.  

Paul would also jettison the Medicaid expansion that was a state option under the Affordable Care Act. That’s a sticking point. It’s always easier to give people a benefit than take one away.

Before he left office, President Barack Obama urged Democrats not to “rescue” Republicans in their efforts to replace Obamacare. House Republicans voted scores of times to repeal Obamacare since the law was enacted in 2010 without a single Republican vote.

Despite the years of controversy over Obama’s signature law, it appears many Americans remain surprisingly uninformed. More than one in three either thought the Affordable Care Act and Obamacare are different programs or didn’t know whether they are the same or different, a poll by Morning Consult reported last month.

The Trump administration is taking actions that actually could make the law more palatable to critics. 

The Internal Revenue Service is relaxing a key enforcement mechanism scheduled to take effect this year. The IRS was to withhold tax refunds from people who failed to comply with the mandate to purchase health insurance or pay a tax penalty. Instead, IRS will process returns and refunds as usual.

In addition, HHS just proposed new rules aimed at stabilizing the exchanges to encourage insurers to keep offering coverage and customers more plan choices.     

Obama promised Americans if they liked their doctors or their health insurance plans, they could keep them. The claim turned out to be false and was a source of anger that motivated many voters.

Trump promised to get rid of Obamacare and put something better in its place while retaining the law’s popular provisions. 

People hate paying higher insurance premiums – which they blame on Obamacare even though premiums were rising before the law. But they like keeping children under 26 on their insurance plans and not being denied, or priced out of, coverage because of pre-existing medical conditions.

It’s a curious turn that, for the time being anyway, Republican dithering on Capitol Hill means Trump is keeping Obamacare alive.  

©2017 Marsha Mercer. All rights reserved.

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

By MARSHA MERCER

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.

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