EDITORIAL: Now make a deal to repair the Affordable Care Act?

March 18--President Trump describes the Affordable Care Act as "imploding." Paul Ryan, the House speaker, and other Republicans on Capitol Hill prefer the imagery of a "death spiral." On Monday, the Congressional Budget Office set things straight. If its projection about the loss of health coverage (24 million by 2026) and higher costs made the headlines, the CBO also argued that the insurance exchanges, where individuals can go to purchase coverage, "would probably be stable in most areas" going forward.

Put another way, the structure is sound enough. Trump, Ryan and the rest are misrepresenting things, mostly to justify their ill-conceived intervention.

The CBO analysis reveals the severe shortcomings in the House Republican proposal. The plan would make coverage less affordable for many who are least able to pay, especially the old and the sick. One striking example is a 64-year-old with $20,000 in annual earnings facing a premium increase from $1,700 to $14,600. That goes to the proposed redesign of the tax credits. Resources largely would be redistributed from poorer to wealthier households.

This and other unsettling news, including a reduction of $880 billion in Medicaid during the next decade, putting many children, seniors and disabled at risk, has rattled a significant share of Republicans. The question follows: Is there an alternative to "repeal and replace"?

How about taking seriously a bipartisan approach to making repairs? If the framework of the Affordable Care Act makes sense, expanding and improving coverage through Medicaid and market-oriented exchanges, it also requires obvious and necessary fixes.

Take, for instance, the many lower- and moderate-income households with premiums and deductibles still beyond their means. They need more help in the form of larger tax credits or subsidies, something that is affordable, in part, because individual buyers make up 7 percent of the market.

Residents in many smaller counties now have just one choice for coverage. A public option would add competition. Effective, too, would be engineering improved incentives for healthier (and often younger) people to buy coverage. In their plan, Republicans nod in this direction (at the expense of the vulnerable, unfortunately). Bring larger numbers of healthier people into the pool, and insurers are more likely to stay, return or jump into the market.

One logical improvement would be a stronger individual mandate, increasing the penalty for failing to have insurance, stressing the virtue of personal responsibility. The mandate incentive once was a Republican idea, just as the insurance exchanges were.

Perhaps after the tumult of the past week, the party of repeal exposed as lacking a replacement along the lines it promised, more coverage at lower costs than the Affordable Care Act, enough Republicans are ready to weigh a practical alternative.

The makings of a compromise long have been there, Republicans accepting victory in Democrats borrowing their ideas, both pleased to see the country move much closer to the worthy objective of universal coverage. President Trump even could claim credit for changing Washington if he takes the lead in sealing such a deal. Thus, the Congressional Budget Office has achieved more than exposing the weaknesses of the House Republican plan. It has reminded that the Affordable Care Act offers a solid template upon which to make improvements.

Correction

The March 16 editorial, "Road to recovery at Summa," erred in identifying the previous physician group staffing the emergency departments at Summa Health. It is Summa Emergency Associates.

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