EDITORIAL: In St. Louis, the only ‘nightmare’ about Obamacare is that it could disappear

St. Louis Post-Dispatch (MO)

Feb. 25--Vice President Mike Pence told an invitation-only gathering at Fabick Caterpillar Sales in Fenton on Wednesday, "The nightmare of Obamacare is about to end."

Nightmare? A greater percentage of Americans have health insurance today than at any point since the government began keeping track.

Nightmare? The United States will spend about $2.6 trillion less on health care over a five-year period than was predicted after the passage of the Affordable Care Act in 2010.

Nightmare? Americans no longer have to worry about being bankrupted by health care costs. People who were uninsurable aren't. They're seeing doctors before they get sick, staying out of emergency rooms, keeping health care costs from being passed on to the privately insured.

Nightmare? Then why was Pence, as governor of Indiana, so eager to take credit for his Healthy Indiana Plan, a modified Obamacare Medicaid expansion program? If Pence wants a nightmare, let him return to St. Louis in a couple of years if President Donald Trump doesn't keep his promise to replace Obamacare with better insurance at a lower cost.

Here's what the nightmare would look like if Obamacare is repealed without a better replacement:

--About 504,000 Missourians would lose coverage, the Economic Policy Institute estimates. In the 16-county St. Louis metro area, about 200,000 people bought health insurance policies on the federal or Illinois health exchanges, many of them family policies.

--In St. Louis and five surrounding counties, more than 100,000 people are enrolled for health insurance through the ACA. The effect of repeal would be like revoking insurance, all at once, for the entire workforces of BJC HealthCare, Boeing, Washington University, Scott Air Force Base, Enterprise Rent-a-Car, Express Scripts, Monsanto, Wells Fargo Advisers, Edward Jones and Anheuser-Busch InBev.

--The EPI estimates that repealing Obamacare would cost 14,077 jobs in Missouri. Given the size of the health care sector in the St. Louis economy, it's safe to say 6,000 or more jobs would be lost here. The Census Bureau estimates that Missouri gained only 10,000 new jobs in all of 2016.

--People on Medicare would be on the hook for higher Part B insurance premiums and co-pays. All told, Medicare spending would increase about $80 billion a year ($802 billion over 10 years) without the cost savings built into the ACA.

--Congress, looking for ways to offset some costs, is eyeing the tax exclusion for private health insurance plans. That would mean higher income taxes for employers and employees alike.

--With Obamacare repealed, contraceptive coverage would be gone as well as automatic coverage for pregnancy. Before Obamacare, pregnancy was considered a "pre-existing condition."

--The nonpartisan Kaiser Family Foundation estimates that 52 million Americans, including about 1 million in Missouri, have pre-existing conditions -- including genetic diseases and chronic illnesses -- that often made them ineligible to buy insurance before Obamacare. That's 27 percent of the non-Medicare-age adult population.

--The ACA prohibits insurance companies from charging higher rates for older people or those with pre-existing conditions. That would stop.

--Before Obamacare, insurance companies often canceled policies when a large claim was filed even if the premiums had been paid. Cast adrift, many people couldn't buy insurance on their own at any price.

--Obamacare allows parents to cover their children on a family policy up to the age of 26. That allows young adults who are just starting out in life to maintain health coverage until they finish school or establish themselves on their own.

Last week, Republican leaders released a 19-page outline of their vision for a replacement. But the document contains no details about the difficult tradeoffs required to achieve the same level of coverage for the 31 million people (20 million on the exchanges and 11 million in Medicaid expansion programs) now insured thanks to Obamacare.

The uncertainty has caused at least two insurance companies, Cigna and Humana, to withdraw from exchange markets. That has exacerbated the difficulties of rural Americans accessing care.

Trump continues to drop hints that his replacement plan is coming, perhaps as early as mid-March. But Sen. Orrin Hatch, R-Utah, who'd have to get it through the Senate, says he doesn't think the plan exists.

Congressional Republicans' hard-core Freedom Caucus wants to repeal Obamacare and not worry about replacing it. More responsible members of the party -- especially those who've had the courage to face their constituents in town hall meetings -- are leery. None of Missouri's six GOP House members, by the way, has been willing to face constituents. They think their seats are safe, which is all that matters.

No one is arguing that Obamacare was perfect. It's what was possible in 2010, and all things considered, it has improved and extended life for 31 million Americans. It's cost affluent Americans a little more in taxes on earnings and investment income over $200,000 a year. It hasn't affected the rest of us much at all, including most of the people who complain about it.

Forget compassion if you'd like. If nothing else, ending Obamacare would be an economic disaster for St. Louis. Business groups, labor groups, civic groups and responsible citizens must come together and make clear to their representatives in Congress: This is precious. You break it, you own it.

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