EDITORIAL: Here we go again: GOP bill replacing ACA is about budget cuts, not reform

Sept. 22--Republicans have spent more than seven years attacking the Affordable Care Act. It may not seem to be the case in California, where the ACA has worked relatively well, but the GOP has plenty of ammunition. While the landmark 2010 law has smart provisions that have helped insure 20 million more Americans, it is also so awkwardly constructed that it encourages people to game health care and only sign up for nominally mandatory health insurance when they get sick.

This and other structural problems have left many smaller states worrying their health exchange programs may be a year or two from "death spirals," in which the insured disproportionately includes the very sick, driving up the cost of premiums and leading more healthy insured to drop coverage. This prospect in turn has led more and more insurers to quit local and state markets. This year, one-third of the nation's counties and one-fifth of Obamacare's enrollees had only one insurer on their health exchanges. This is not what success looks like.

With the GOP in control of the White House and Congress, Republicans and everyone else disappointed with Obamacare expected the party to present a thoughtful alternative. Instead, the GOP has spent eight months trotting out proposals that amount to huge, cruel budget cuts masquerading as health reform. The latest -- by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana -- has now quickly gained momentum because of a Sept. 30 deadline to pass the Senate on a simple majority vote using budget reconciliation rules.

The Graham-Cassidy bill's most interesting idea is that states should be allowed to experiment with health care outside Obamacare's strictures. In a vacuum, this sounds promising. But in this case, states would face disincentives to innovate because of the risks associated with experimentation, starting with the huge financial downside. While federal block grants would be provided to states, Graham-Cassidy would eliminate mandatory Obamacare funding for insurance subsidies for lower- and middle-income families and would end the expansion of Medicaid allowed under the ACA. These grants, which states would need to match to a degree with their own payments, could be used to fund high-risk pools -- stabilizing the insurance market, at least in theory -- or to subsidize insurance for poor households. But they couldn't come close to covering the range of services available under the ACA even in states that balked at expanding Medicaid.

It's no wonder then that Sen. Charles Grassley, R-Nebraska, essentially said he would vote for Graham-Cassidy not because it was humane or a good idea but because it would keep a GOP campaign promise. Or that late-night comedian Jimmy Kimmel called Cassidy a liar on national TV.

If the bill is enacted, the likely result will be bare-bones programs in most states that both provide less coverage than residents have under Obamacare and cost so much more that millions decline insurance. Given that a new Pew Research Center report on state finances questions how most states will be able to afford promised health care for government retirees, it's hard to see how these states would add health care services for the general public.

Unless, that is, not just individual states but America as a whole breaks out of the shackles of a health-care system that is riddled with redundancy and bureaucracy and starts from scratch. If other nations have built better, cheaper health systems -- and they have, they have -- then Washington should not be too proud to copy what works. Starting with thoughtful, thorough bipartisan debate.

Twitter: @sdutIdeas

Facebook: San Diego Union-Tribune Ideas & Opinion

___

(c)2017 The San Diego Union-Tribune

Visit The San Diego Union-Tribune at www.sandiegouniontribune.com

Distributed by Tribune Content Agency, LLC.