EDITORIAL: Health care battle lives on

March 28--Democrats may rejoice about the Republican Party's civil war that doomed its ill-conceived attempt to "repeal and replace" the Affordable Care Act, but the battle over the national health care program isn't over.

"We're going to be living with 'Obamacare' for the foreseeable future," said House Speaker Paul Ryan, R-Wis., after pulling the American Health Care Act before a vote.

Republicans still can mortally wound it. As President Donald Trump said, "The best thing politically is to let Obamacare explode."

Yet that's a big political risk because ACA provisions are far more popular than its faulty implementation.

Pre-existing conditions can't be a factor in obtaining a policy. Young adults younger than 26 can remain on their parents' policies. Older Americans cannot be charged more than three times as much as their younger counterparts for a comparable policy.

Insurers are required to cover "essential benefits," including outpatient care, emergency services, hospitalization, pregnancy, maternity and newborn care, mental health and substance abuse treatment, prescription drugs, rehabilitation, laboratory and diagnostic tests, preventive care (including birth control), wellness services and pediatric care, including children's dental and vision services.

Only 9.1 percent of Americans now are uninsured compared to 16.3 percent in 2010. The ACA expanded the Medicaid federal-state partnership program assisting the poor and disabled, which now covers 11 million. Subsidies help two-person households with incomes less than $64,080 buy private policies.

Its survival may depend on whether the House Republicans' suit against the Obama administration to stop the subsidies prevails -- if Trump even wants to defend them in court.

Trump also issued an executive order to "minimize the unwarranted economic and regulatory burdens of the Act," which could mean abandoning penalties for ACA mandates -- individuals lacking coverage and businesses failing to offer coverage to employees.

And Obamacare could fall under its own weight. Insurers are wary of its formulas making it more attractive to older people and those with medical problems rather than healthy, younger people. A third of all counties have only one ACA marketplace option.

Republicans constantly complained about the ACA for the past seven years but offered neither fixes nor alternatives. They were woefully unprepared to "repeal and replace."

"This is not all that hard to figure out, except this," said former House Speaker John Boehner, R-Ohio. "In the 25 years that I served in the United States Congress, Republicans never, ever one time agreed on what a health care proposal should look like. Not once."

Its version of health care reform seemed driven by the twin Republican goals of eliminating ACA's taxes on the wealthy and reducing its $1 trillion, 10-year budget impact, which would help pave the way for income tax cuts. Ryan rushed the legislation through committees with little debate.

The AHCA would have eliminated $883 million in taxes over 10 years -- the 3.8 percent tax on investment income and 0.9 percent levy on income more than $200,000 for individuals and $250,000 for married couples filing jointly. Conversely, it would have increased maximum contributions to tax-free Health Savings Accounts for individuals from $3,400 to $6,550 and for a family from $6,750 to $13,100 -- essentially a $19 billion tax cut.

Get news headlines sent daily to your inbox

1

html

subscribe

The Courier

CDT

[email protected]

Sign Up!

4EB045FEF6973258422D8D20F9799A61

WcfCourier.com Daily Headlines

4EB045FEF6973258509828871CF470A2

Obituaries

I understand and agree that registration on or use of this site consitutes agreement to its user agreement and privacy policy.

But it was skewed against the poor and the elderly, putting the brakes on Medicaid expansion and basing tax credits on age, not need. In addition, the ACA cap of three times the cost of coverage for older Americans was bumped to five times.

The nonpartisan Congressional Budget Office initially estimated it would reduce the budget impact by $337 billion by 2026. However, 14 million more would have been uninsured by 2018, 21 million by 2020 and 24 million by 2026.

The jeopardized Obamacare has increased in popularity from 43 percent to 49 percent, according to a Kaiser Family Foundation poll, while a Quinnipiac University poll indicated just 17 percent liked the AHCA, 56 percent didn't and 26 percent were undecided.

The Republican Party's Freedom Caucus -- numbering around 40, including Rep. Rod Blum, R-Dubuque, with its tea party heritage -- was decidedly against the AHCA's retention of Obamacare's essential health benefits. They cited services not everyone uses or may want, including mental health, maternity, preventive care and prescription drug coverage.

Ryan couldn't afford those defections with Democrats united against the AHCA. But the Freedom Caucus demands also alienated House GOP moderates such as Rep. Don Young of Des Moines and potentially female Republican senators by eliminating requirements such as maternity care (women could buy insurance "pregnancy riders" costing up to $1,600 monthly, according to the Kaiser Family Foundation) and mental illness. Others opposed the AHCA's Medicaid limits.

Now the political parties will have to weigh fixing the ACA or calculating any advantage if it collapses. Given the dysfunctional nature of partisan politics today when even the party in power lacks cohesion, we suspect they'll focus on capitalizing on fallout rather than acting responsibly.

___

(c)2017 Waterloo-Cedar Falls Courier (Waterloo, Iowa)

Visit Waterloo-Cedar Falls Courier (Waterloo, Iowa) at www.wcfcourier.com

Distributed by Tribune Content Agency, LLC.