EDITORIAL: Apply the Portman test

July 16--U.S. Sen. Rob Portman has been consistent in describing what he wants. The Ohio Republican reiterated his view in a statement last week after Mitch McConnell, the Senate majority leader, unveiled the latest proposal to overhaul the Affordable Care Act. Portman says he wants "to create a more workable [health care] system that lowers the cost of coverage, provides access to quality care and protects the most vulnerable in our society."

The senator opposed the initial draft put forward by McConnell, albeit just after it was withdrawn. He rightly objected to the changes in Medicaid, the joint federal-state health care program for the poor, disabled and indigent elderly. He indicated the draft did not do enough to slow rising premiums and deductibles, or ensure adequate choices for those buying health coverage on their own. He long has criticized the Affordable Care Act for falling short of these marks.

How does the new draft perform against the Portman test?

Not well. The senator eventually may persuade himself that enough improvements have been made, or see support as some kind of political necessity. On the merits, this version fails to address the concerns he has voiced.

Take Medicaid. The expansion, which has proved so helpful for Ohio, would end, essentially. The shrinking federal support would leave states with a financial burden they could not afford. Medicaid overall would be slashed through harsh limits on annual spending increases, the program 35 percent below current projections by 2036. That would come at the expense of the "most vulnerable," including many children, one of every two in Ohio covered by Medicaid.

The new draft does include an additional $45 billion to address the opioid epidemic during the next decade, attending to a leading Portman concern. That may seem like a large sum. Then again, Ohio alone spends nearly $1 billion a year on the epidemic.

As many experts in the field stress, those with addictions need more than drug treatment. They often require care for mental illnesses and a range of other ailments and conditions.

The proposal also allows room for easing the spending limits in public health emergencies. Yet this provision would expire in 2024, and it hardly begins to make up for the overall reduction of $770 billion or so in Medicaid.

The senator must be disappointed to see the inclusion of the Cruz amendment, which invites insurers to offer skimpy, less costly coverage to healthier people while excluding others with prior illnesses. Thus, markets would be divided, much as they were before the Affordable Care Act, those with pre-existing conditions, in particular, at a loss, facing the escalating premiums and deductibles the senator seeks to avoid.

The expectation is that by early next week, the Congressional Budget Office will report its score of the new proposal. If Mitch McConnell has added tweaks and sweeteners, the basic structure of this cruel overhaul remains the same. And if, as the debate continues next week, Senate Republicans find a way to reduce by half the current estimate of adding 22 million to the uninsured, 11 million would be acceptable?

Rob Portman has promised to deliver something better. That actually could get done -- once he holds to what he wants, provides the vote to reject this version, Democrats and Republicans with little choice but to work together on the repairs the Affordable Care Act needs.

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