The utter failure of congressional Republicans to replace Obamacare two weeks ago was a good thing. The U.S. House Republican plan would have thrown an estimated 24 million Americans off coverage over 10 years while handing tax cuts to the wealthy and a bonanza to insurers.
The failure speaks to at least two realities and offers a slender ray of hope.
One, the GOP is in such a state of civil war nationally that agreements between its tea party wing and its less-extreme congressional members are difficult to achieve in Washington, D.C. That gives moderates, who often like to solve problems, new incentive to work with Democrats of the same mind.
Two, the U.S. House plan to ditch the Affordable Care Act and replace it with worse coverage was horrendous policy. In no universe is taking away access to health coverage for 24 million people even remotely a good idea.
The House speaker’s proposal was extreme in its harsh treatment of the poor and older, lower-income adults, enough so that some Republicans who really wanted to repeal Obamacare were balking. Among them was U.S. Rep. Jaime Herrera Beutler, who represents the 3rd Congressional District that takes in a sliver of south Thurston County and most of southwest Washington.
Herrera Beutler’s main objection was that Medicaid would be undermined for children. She was right to be concerned.
In states like Washington that expanded Medicaid in 2013 under terms of the ACA, poor and low- to moderate-income families benefited greatly. Our state’s ranks of uninsured fell from about 14 percent to less than 6 percent — with some 600,000 to 700,000 more people getting access to care than before Congress enacted the controversial health law in 2010.
Some Washingtonians are getting their kids in for checkups at long last or seeing dentists for the first time. Others in need of mental health and drug treatment services are getting them, which assures they are in good enough shape to stay in jobs or look for them.
Mike Kreidler, the fifth-term Washington state insurance commissioner, says there is room for improving the ACA, if Trump stops trying to wreck what we have.
“His first action has got to be, stop the war. That is the part I’m most worried about. Even though we are in pretty good shape in our state and the CBO (Congressional Budget Office) says the ACA is stable in most states, you have the potential of seeing destabilization taking place at the federal level,” Kreidler said in a recent interview.
Kreidler is concerned by executive orders Trump has signed and policy changes taken by his agencies. The administration halted public outreach to remind consumers who lack insurance they could buy it on the exchanges; another weakened the mandate that all must have insurance. Another misstep was to claim — with apocalyptic, but untruthful fervor — that the ACA is in a death spiral.
Our hope is this: Having failed to produce a replacement plan that is better than Obamacare, Republicans should turn to repairing its flaws. Democrats who have long seen a need to upgrade the Obamacare system of selling private insurance policies through a government exchange should also seek middle ground.
The stuff to agree on is obvious: holding down the costs of care; making everyone participate; continuing the ACA’s prohibition against insurers denying coverage for those patients with preexisting conditions; letting parents keep adult children on their policies until age 26; and giving financial assistance or subsidies based on income, not age.
Insurers also need protection against catastrophic losses. Kreidler says state legislation to extend that protection into 2018-19 is moving through our Legislature.
U.S. Rep. Denny Heck, D-Olympia, notes there are other problems to address. Some 200 counties in the country are not going to be served by even one insurer in the individual market.
Other steps are needed to protect the safety net. Ohio Gov. John Kasich has embraced the expansion of Medicaid, because it let his state address a growing opioid addiction problem, including in rural areas that voted for Trump.
Even the reliably red Kansas Legislature voted to expand Medicaid last week. On Monday, those lawmakers fell three votes shy of overriding a veto by hard-right GOP Gov. Sam Brownback.
There is no excuse for treating health care as a privilege of the well-to-do. Free market voodoo is no cure. Changes to Obamacare must help Americans, not harm them.