EDITORIAL: Obamacare replacement needs drastic surgery

March 19--The adage for doctors is to do no harm. That is why Republicans in the U.S. House need to take their health care reform proposal back into the surgery room.

Their plan needs a heart transplant if it is to ever replace the Affordable Care Act, which came to be known as Obamacare.

Ryan-care (or Trump-care, as some are calling it) results in a likely loss of health coverage for millions of Americans who -- unlike the majority of us -- buy it individually on the private market. They do this either because they can't buy coverage through an employer or they don't qualify for federal entitlement programs like Medicare.

The GOP proposal forgets that, despite some flaws, Obamacare helped our state cut the rate of medically uninsured by at least half.

The plan offered by House Speaker Paul Ryan, R-Wisconsin, and his caucus is steamrolling blindly in the other direction.

The Congressional Budget Office says the GOP proposal would result in about 14 million losing coverage in 2018 and a cumulative 24 million losing it by 2026. This would bring the total uninsured to over 50 million while offering tax cuts for the highest income individuals and families.

The CBO's nonpartisan staff analysis may not be as cut and dried as the stone tablets Moses carried down from a mountain. But they are a fair guide to what could go wrong.

And that likely outcome is unacceptable. Is it really worth risking this kind of harm to ensure that the most wealthy get tax cuts worth hundreds of millions of dollars over the next decade?

State Insurance Commissioner Mike Kreidler and Gov. Jay Inslee claimed last week that 600,000 to 700,000 Washingtonians could lose health coverage under the GOP plan. A share of that would come from Ryan's proposal to roll back Medicaid expansion and turn the program into block grants for states. The amount allotted would be capped based on enrollments, not actual care needs, for the shared federal-state program.

Under President Obama, eligibility for Medicaid was expanded to cover childless adults, and it raised the income threshold to qualify. In Washington this helped add more than a half million people to the coverage rolls. Imagine getting to see a doctor or dentist for the first time in years.

Republican state Rep. Joe Schmick of Colfax disputes Inslee and Kreidler's figures. Schmick leads his House caucus on health issues, and he argues that consumers receiving Medicaid under the expansion of eligibility in 2013 won't necessarily fall off coverage.

But Schmick acknowledges that many would lose insurance because the Obamacare mandate to buy insurance would be repealed, meaning individuals would not pay a tax penalty if they chose not to buy insurance. But an insurer could charge them a lot more once they did seek to buy coverage.

There are good, popular pieces in the GOP plan. As with Obamacare, it lets parents keep their children on policies until age 26 and insurers cannot refuse to offer a policy. But insurers can jack up rates for those with preexisting conditions, making it unaffordable; and lifetime caps on benefits are eliminated.

The congressional budget analysis found premiums costs would be lower under the GOP plan in a decade than if Obamacare continued without changes.

It is possible that block grants -- giving states set amounts for their Medicaid programs while removing regulatory mandates -- can spur innovation by the states and as a result lower costs for care delivery. Washington previously sought waivers as a way to stretch Medicaid dollars to cover more of the uninsured.

On the down side, block grants leave Medicaid vulnerable to federal spending cuts in 2020. The size of President Trump's proposed budget cuts for discretionary programs last week is a warning about the direction his party is heading.

Given opposition to Ryan's plan from members of his own party, it's a good bet that he hauls his plan back into surgery. If Ryan does, he'll be smart to make sure that access to health care means that people can actually afford it.

That means retaining tax credits or help for those too poor to buy insurance, not the rich. His proposal for age-related tax credits -- $2,000 for younger consumers and $4,000 for older ones -- ignores one's ability to pay.

Most developed countries look out for everyone's medical needs. Returning the U.S. health care system to a place where only wealthy or fairly well-off families can obtain insurance is the dead-wrong direction.

Turn this car around.

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