Health care, with its interlocking systems of public and private insurers and providers, is complex, so health care reform is never easy.
But for the last four election cycles we have heard Republican office seekers say that it’s really simple. All you have to do is repeal “Obamacare,” they said, and replace it with something better.
But replace it with what? Anyone who can remember back before 2010, when you could be denied insurance because of a pre-existing condition, lose your insurance for getting too sick or find your medication unaffordable because you fell into a “doughnut hole,” knows that some things are worse than Obamacare.
Now some Republicans in Congress are saying that the solution should be “repeal and delay,” cutting out the legs from the health reform law and spend the next three years designing an alternative. As if what America really needs is three years of uncertainty and upheaval in the health care economy.
A recent study by the Urban Institute puts some of what’s at stake into perspective. If congressional Republicans pass a partial repeal of the Affordable Care Act through budget reconciliation (a process that requires only a majority vote in the Senate), they could eliminate Medicaid expansion, and tax credits for people who buy insurance on the exchanges, as well as individual and employer mandates.
While we wait for the new plan to take shape, this is what we could expect to see:
n 22.5 million would drop insurance they can’t afford without a subsidy.
n The individual market would collapse, driving insurance companies out, leaving millions more Americans without options.
n Hospital costs for uncompensated care would skyrocket.
There is a better way, even if it won’t match the hot rhetoric of the campaign trail.
While Republicans have talked about replacing the Affordable Care Act, Democrats have said that it should be fixed. There might be enough improvements that both parties could agree on that would satisfy the Republican promises in the short run, while the new administration takes on a more thorough reform.
Negotiating prescription drugs and expanding payment reform trials that reward wellness are among the small changes that could make a big difference.
Maine Sen. Susan Collins said that until she sees a bill, she’s not sure how she would vote on a plan to dismantle the ACA without replacing it right away.
But she did express her concern about the order of the steps that some of her colleagues are proposing. “I think what we need to focus on first is what would we replace it with and what are the steps to do that,” she told the Press Herald last week.
Collins is a longtime critic of the ACA, and would be a good source for recommendations on how it could be changed. We urge her to offer those ideas and fight an irresponsible repeal and delay strategy.
Incremental reforms are not the easy fix that some members of Congress are promising, but they’re a much better way to approach a problem for which no fix is easy.
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