EDITORIAL: Obamacare could implode or explode if Trump tries to undermine — rather than fix — it

March 30--Before last Friday, the Republican-controlled House of Representatives voted more than 50 times on measures to repeal or gut the Affordable Care Act. Many of the bills and amendments were passed, but all went nowhere in the more thoughtful Senate and would have been vetoed by President Barack Obama.

Then, when Republicans, egged on by President Donald Trump who made repealing the ACA a top priority, could take a meaningful vote on amending the nation's health care laws, they couldn't drum up enough support for passage. Despite Republican control of the House and Senate and the White House, House Speaker Paul Ryan could not rally enough support to pass the American Health Care Act, a mishmash of changes to the ACA and big tax breaks for the wealthy. Ryan pulled the bill from consideration last Friday.

"We were a 10-year opposition party, where being against things was easy to do. You just had to be against it," Ryan said at a March 24 press conference, in a rare moment of honesty.

"Doing big things is hard," he said earlier in his remarks. This echoes Trump's lament that "nobody knew health care could be so complicated." Obviously, lots of people know health care policy, especially insurance, is very complicated, but Trump and Ryan weren't interested in listening to any of those people or hearing their ideas for a successful plan.

Instead, they perpetuate the dangerous myth that Obamacare, the derisive name for the ACA, will simultaneously implode and explode, as the president has tweeted.

Neither is true -- if Ryan and Trump don't undermine it.

The ACA has increased the number of people with health insurance. In 2008, nearly 17 percent of non-elderly Americans were uninsured, according to data from the Centers for Disease Control. By 2016, that dropped to 11 percent. According to Department of Health and Human Services calculations, 20 million Americans have gained health insurance since the ACA was passed in 2010.

These people don't want to lose their insurance. After Republicans released their plan and the nonpartisan Congressional Budget Office concluded that 24 million fewer Americans would have health insurance under their plan than under the ACA by 2026, the popularity of Obamacare rose. Last week, 49 percent of Americans supported the ACA, its highest level of support ever. Only 17 percent supported the skimpier Republican plan, which would have raised premiums on older Americans especially in rural states.

Critics of the ACA say rising premiums doom the law. Premiums are rising, yes, and that is a problem. But they are rising at a slower rate than before the act was implemented. In other words, rising insurance costs are a problem, regardless of the status of the ACA. Of course, the more politicians talk about changing or gutting the act, the more unstable the market becomes because of unneeded uncertainty.

There are many ways to improve America's health insurance landscape. Instituting a universal, single-payer system, which is the norm in every other developed nation, would be the most straightforward. It, of course, would face stiff opposition in Congress.

On a smaller scale, lawmakers can learn the lessons from the doomed Republican plan. Americans appreciate the consumer protections in the ACA -- insurers can't drop your coverage or charge you more if you have a pre-existing condition, essential health care must be covered, young people can stay on their parents insurance until they are 26.

The option for states to expand Medicaid is also popular -- and works. Thirty-one states have used the expansion to provide insurance to low-income residents and more, including Kansas and North Carolina, are poised to do so after the failure of the Republican plan leaves the ACA in place. Gov. Paul LePage has repeatedly vetoed bills to expand Medicaid in Maine. Lawmakers will consider it again this session. If it fails in the State House, it must go to a public referendum.

Congress should leave these aspects alone. Instead, they must ensure premiums and deductibles remain affordable. They can do this by strengthening cost-sharing reductions, a mechanism in the ACA which can lower co-pays, deductibles and out-of-pocket payments for low-income ACA participants. House Republican leadership has challenged these payments in court.

This is among the recommendations from Andy Slavitt, a former health care industry executive and acting administrator for the Centers for Medicare and Medicaid Services, who is a USA TODAY contributor. He also recommends tougher enforcement of the individual mandate to bring more people into the insurance marketplaces. These two changes could reduce costs by up to 30 percent, he wrote.

The Affordable Care Act needs tweaks, but it will neither implode nor explode if Congress takes reasonable steps to improve it.

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