EDITORIAL: A way forward for fixing Obamacare

Dec. 13--An incoming Republican president paired with a Republican Congress means changes are coming for the Affordable Care Act.

The scope and timing of these changes are yet to be determined.

But we can suggest this overriding principle: Health care on a national scale must address costs as the No. 1 priority along with choice.

Everyone knew that health care costs would be increasing as the baby boomer cohort reach their later, expensive health care years.

In addition, some of the people just now getting insurance through Obamacare are sicker and costlier than expected.

In fact, the nation's health care bill rose at the fastest rate in eight years in 2015, reported The Associated Press.

It grew at 2 percentage points faster than the overall economy, driven in large part by federal spending on Medicaid expansion.

Also new specialty medications are expensive while the price of some generics has shot up.

The price of a medication to treat heroin overdoses shot up 500 percent in just two years.

Health spending in 2015 averaged nearly $10,000 per person.

While the president liked to say that Obamacare was based on Mitt Romney's model in Massachusetts, it's obvious that what works for Massachusetts wouldn't necessarily work in other states such as Romney's other home states of Michigan and Utah.

What the nation needs is something closer to insurance that does not leave families bankrupt after an illness.

One of the most pragmatic and common-sense prescriptions we have seen comes from Alice Rivlin on the Brookings website.

An expert in monetary, fiscal and health policy, Rivlin served as Office Management and Budget director under President Bill Clinton. She was also vice chair of the Federal Reserve Board and co-chaired with former Sen. Pete Domenici the Bipartisan Policy Center's Task Force on Debt Reduction.

Rivlin suggests that a replacement keep the best aspects of Obamacare, fix its flaws and make it sustainable under a new name.

The basic structure of Obamacare includes private markets, so the foundation is there.

And there are many detailed Republican plans on the drawing board.

Donald Trump and most Republicans like the parts of Obamacare that allow people to sign up for insurance with pre-existing conditions and for young people to remain on their parents' plans until age 26.

But both of those features drive up costs for insurers, so there must be other ways to raise revenues.

One troublesome feature of Obamacare is that rates are set so that young people pay too much and are effectively subsidizing their elders. Unless the young and healthy sign up, the costs of the insurance will turn into a death spiral -- which already is happening as major insurers cut back.

The mandate won't be needed if costs are low enough and insurance options are wide enough. In any case, there must to be protections to stop people from signing up only when they get sick.

Catastrophic coverage, paired with health savings accounts funded in part with refundable tax credits, is one key option.

Allowing people to buy insurance across state lines is no panacea but it offers more hope than many realize. In the highly populated Northeast, it could be practical. And many large cities were settled along rivers with another state across the river. Think of Louisville and Cincinnati along the Ohio River.

States could be given more flexibility to deal with Medicaid. Block grants would be the ultimate option.

Presumably, many of the Republican states that have not signed up for Medicaid expansion could accept plans crafted by the new administration.

Senate Majority Whip John Cornyn, R-Texas, told The Wall Street Journal that one of the failures of Obamacare was it was pushed through without consensus.

Returning to bipartisan work is the key. And Rivlin's proposal offers a smart outline for a way forward.

VICTORY FOR MENTAL HEALTH

A major victory for the health of Americans happened last week as the Senate passed a bill by the overwhelming bipartisan margin of 94 to 5.

Called the 21st Century Cures Act, it includes many of the features this page has advocated via Rep. Tim Murphy of suburban Pittsburgh.

Through lengthy congressional hearings and investigations, Murphy's committee documented that the federal government has been expert at spending billions on mental health with little to show for it.

He described an often "fatal disconnect" between 112 federal agencies that spend $130 billion that often involves watching mental illness get worse in the nation.

"We didn't get everything we needed," Murphy said, "but we needed everything we got."

A few of the key elements of the bill:

--Mental health: Enforcement of mental health parity will be stepped up with laws that require mental health and physical illnesses to be treated equally. Legal rights of people with mental illness will be protected. Suicide prevention will be boosted.

Paul Gionfriddo, CEO of Mental Health America, called this the most significant mental health legislation in 50 years.

--A total of $1 billion over two years will be spent on the opioid epidemic will be combated.

--Medical research will be beefed up, including competitions to advance biomedical research.

--Combating eating disorders, the most fatal form of mental illness, will receive funding. Included will be more professional training to boost recognition, ending exclusion of eating disorders from insurance policies. For too long, eating disorders have been treated as a stigma within the mental health community.

All in all, mental health is finally coming out of the shadows in both Washington and Tallahassee.

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