EDITORIAL: GOP has an opportunity and a duty to repair the flaws in the Affordable Care Act

March 29--THE stunning defeat of the Obamacare replacement leaves President Trump and the Republican leadership in Congress with one clear option. And it is exactly the opposite of what Trump said after last week's debacle: "The best thing we can do, politically speaking, is let Obamacare explode."

If the GOP is going to be a governing party, and not just the raucous opposition, it has an opportunity and a duty to repair the flaws in the Affordable Care Act, aka Obamacare. Contrary to the hot talk from Trump, it is not exploding. But it needs work.

Premiums on the individual market are rising faster than they should in some parts of the nation -- although less so in Washington -- and insurers are skittish about the future. San Juan and Klickitat counties are among the 1,000 counties nationwide with only a single insurance-company option for individual plans.

Yet the Affordable Care Act still covers tens of millions of people who lacked coverage before it passed, mostly due to Medicaid expansion, and health-care inflation has been lower than before its passage.

The House proposal, called the American Health Care Act, likely would have covered 24 million fewer people, would have bankrupted older Americans and handed the superwealthy a massive tax cut. After at least 50 votes over seven years to repeal Obamacare, that's the best they could do?

U.S. Rep. Jaime Herrera Beutler, R-Vancouver, showed principled leadership in breaking with her caucus over this potentially disastrous replacement.

Now is the moment for leadership in Congress, if that is still possible. In an ideal world, Republicans would partner with Democrats and make overdue fixes. Those words, however, seem hollow even as they appear on the page. If this moment should fail to happen, Washington state should take advantage of some flexibility offered under the existing law and focus on changes to the individual market where there is the most concern and turmoil.

There is no shortage of good ideas, and no shortage of innovation in Washington's health-care industry. There is just a will to be bold.

Insurance Commissioner Mike Kreidler, a Democrat, said luring more insurers to the health-care exchange can be accomplished with a stronger commitment to reinsurance -- essentially insurance for the insurers, covering extraordinarily high-cost medical cases. Alaska recently created a high-risk pool, with the goal of bringing down its unusually high premiums.

Kreidler also notes that luring young, relatively healthy citizens is the key to a stable, affordable individual market. President Trump undermined the ACA in backing away from the individual mandate, which includes penalties for people who fail to get insurance. Kreidler says those so-called "young invincibles" can be lured in with stronger subsidies.

"We all know the ACA had challenges," said Kreidler. "Every major policy act has had them, and we had to go back and make changes." But the now-failed GOP plan to replace it instead thwarted those fixes, Kreidler said.

House Speaker Paul Ryan, after his defeat this weekend, conceded, "We're going to be living with Obamacare for the foreseeable future." Health care is a quarter of the American economy, and a cornerstone of American society. Letting it "explode" is not just terrible governance, it is inhumane.

Editorial board members are editorial page editor Kate Riley, Frank A. Blethen, Donna Gordon Blankinship, Brier Dudley, Mark Higgins, Jonathan Martin, William K. Blethen (emeritus) and Robert C. Blethen (emeritus).

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