The GOP alternative to the Affordable Care Act (ACA), dubbed the American Healthcare Act, was hastily crafted and doomed to failure from the start.
Tweaking the initial draft withdrawn from the House floor in mid-March due to lack of sufficient support, Trump and his cronies strong-armed Republicans in Congress to garner a narrow margin of 217 to 213 when the bill passed the House on May 4.
Rather than devoting the time and effort necessary to achieve consensus on a sound proposal that would benefit all Americans, Trump was driven by an overriding obsession to replace Obamacare within his first 100 days, come hell or high water.
A reckless gamble, and a pyrrhic victory at best.
While Obamacare as it presently stands is far from perfect, the law has introduced much needed reform. Insurers can no longer deny coverage to patients with pre-existing conditions, Medicaid coverage has become available to 7 million additional Americans, including 400,000 in Arizona, with an additional 1.5 million waiting for applications to be processed. Millions of other previously uncovered Americans now have health insurance, often with premiums partially subsidized by the government.
By contrast, the non-partisan Congressional Budge Office estimates that 24 million Americans would lose health coverage by 2026 under the Trump-Ryan proposal. Furthermore, the proposal would decimate Medicaid as we now know it. Expanded Medicaid coverage would cease, and the current Medicaid system would be replaced by block grants to the states, with federal support cut back to roughly 70 percent of present funding. The GOP proposal was clearly designed to favor the affluent, replacing subsidies to purchase health insurance with tax credits and healthcare savings accounts, both of which are of little benefit to near poor and middle class working Americans.
A Changing Ballgame
Following approval by the House by a razor-thin margin, the GOP-sponsored bill is now in the hands of the Senate. Significantly, Sen. Lamar Alexander of Tennessee, who chairs the Senate Health Committee, and several other key Senate Republicans have stated they will set aside the narrowly-passed House bill and write their own. Alaska’s Lisa Murkowski, who has been very critical of the House bill, advocates that the Senate start with “a clean slate”!
The prevailing climate in the Senate gives cause for hope that the Senate will produce a bill that differs substantially from the House version. Significantly, the GOP controls the Senate by a narrow margin of 52-48. That means that if three or more Republican Senators deflect from the ultra conservative content of the House version, passage of a bill that lays the groundwork for truly meaningful reform becomes a distinct possibility.
Notably, a number of House Republications who succumbed to pressure to support the measure did so only after consulting with colleagues in the Senate to gain assurance that their colleagues would support changes from the House version to protect their constituencies. Foremost among these concerns are the House bill’s elimination of Obamacare’s Medicaid expansion provision, and changes that would make health coverage unaffordable for patients suffering from debilitating pre-existing conditions.
Requisites for Truly Meaningful Healthcare Reform
I firmly believe that any legislation coming out of the Senate and signed by the President must retain the key provisions of Obamacare, while concurrently fixing major problems plaguing implementation of the law. These problems primarily stem from gross underfunding.
A key reason why major insurers have pulled out from the program is grossly inadequate subsidization by the government -- subsidization needed to ensure that participating carriers are able to cover the mandated services without incurring unacceptable losses. This has been particularly true concerning added costs entailed in covering enrollees with pre-existing conditions. The risk pool subsidization by the feds has always been grossly underestimated and underfunded.
Looking four months down the road, the President’s proposed budget for FY 2018 severely jeopardizes the premium subsidies that have enabled the majority of private enrollees to secure coverage.
Another key problem is that the ACA, which indeed provides a viable option for millions of currently uninsured patients, has never been effectively marketed as an attractive option for the “healthy uninsured.” As a result, enrollees attracted to the private side of the program have largely consisted of people with significant health problems and older enrollees not yet eligible for Medicare. Without a strong contingent of younger, healthier enrollees to balance this off, the disproportionate share of enrollees with high treatment costs has created an actuarial nightmare.
Finally, the ACA (together with all other universal or near-universal coverage proposals to date) has failed to deliver on true health care cost containment. This stems from the fact that these proposals have universally failed to address at the root cause level our nation’s exorbitantly high outlays for medical care.
We will never obtain effective control over health care costs until we transform our heavily profit-dominated sickness care system into a true health care system that fully empowers and incentivizes both health professionals and rank and file citizens to work together to enable all Americans to take charge of their health!
Toward that end I strongly urge that whatever health care bill emerges from the Senate Chamber must contain a strong preamble that unequivocally states that “An underlying intent of this legislation is to ultimately transform our current health care system into a wellness-oriented system that both empowers and incentivizes everyone to take charge of their health!”
Where Will the Money Come From?
In sum, I am advocating a reform strategy that retains the current federally-subsidized Medicaid expansion, enables everyone with pre-existing conditions to attain the high quality care they truly need, and precludes benefit cut-backs in Medicaid, Medicare or individual coverage.
How will this be financed? Quite simply, by weaning ourselves from our collective addiction to high-end medical treatment. Our nation’s leadership must somehow find ways to motivate the corporate sector that dominates American health care to embrace as their core mission the provision of compassionate and cost-effective health care for all Americans.
To get the Affordable Care Act back on track in fulfilling its stated mission, our nation must commit to an initial investment to cover start-up costs associated with enabling citizens burdened with pre-existing conditions to secure the care they need without penalization, while enabling insurance carriers to cover their actual costs of expanded coverage under the law, and continuing to provide Medicaid coverage to millions of additional needy Americans who were previously denied access.
As a former health services administrator and senior health care policy analyst at a major university, I am fully confident that we will recoup these start-up costs many times over, provided that we are willing and able to transform our current sickness care system into a wellness oriented system that empowers everyone to take charge of their health. No small task, to be sure.
To secure the requisite initial funding, citizens must demand that the President’s FY 2018 budget proposal be revised to provide fully adequate funding for health and human services. I propose that this be accomplished through either eliminating or drastically reducing the proposed $52 billion increase in military spending, together with the proposed monumental tax cuts for the rich along with grossly reduced corporate income taxes.
We must all work together to effectively promote the health and well-being of all Americans.