EDITORIAL: Republicans’ health care reform itself needs reform

March 19--It's well-documented that the Affordable Care Act, also called Obamacare, has its drawbacks. The rollout was clumsy and confusing, the infamous promise by former President Barack Obama that patients could keep their doctors turned out not to be totally true, the exchanges didn't bring in as many people as hoped, many patients on the exchanges face steep premium increases, the individual mandate rubbed many the wrong way, and more insurers are dropping out of exchanges and reducing consumer options in many parts of the country.

But the ACA did increase coverage dramatically nationwide and in the Yakima Valley, thanks largely to the expansion of Medicaid, the federal-state program that serves as a medical safety net. Across the nation, an estimated 20 million people now have insurance who didn't before, including at least 600,000 residents of Washington, The state Office of Financial Management reports that between the ACA's launch in 2013 and 2015, the percentage of uninsured Yakima County residents dropped from 21.9 percent to 10.2 percent. Many of the ACA's provisions, including a ban on insurer caps and coverage of pre-existing conditions and young adults, have proven popular.

House Republicans, led by Speaker Paul Ryan, have taken their first step toward their own seven-year promise to repeal and replace the ACA. Called the American Health Care Act, it is touted as cheaper and better than the ACA, and it is indeed cheaper: the Congressional Budget Office estimates it would reduce federal deficits by $337 billion over the next 10 years. But the GOP plan has its own drawbacks that don't make it better than the ACA: Serious gaps in coverage would exist for large numbers of people, especially Medicaid recipients who are well-represented in the Yakima Valley. Those approaching retirement age but not yet eligible for Medicare would pay much more. Under the plan, Washington state could lose more than $1 billion a year in federal money.

Meanwhile, the CBO has announced that the plan eventually would result in an estimated 24 million fewer Americans with health care coverage, and those that are covered would pay higher deductibles with less-extensive plans. Some Republicans took issue with the CBO figures, noting that it had overestimated the number of people who would take part in the ACA exchanges. That may be true, but the numbers from the nonpartisan CBO are the best that anyone has, and they are to be taken seriously.

Ryan's effort, perhaps best perceived as a negotiating position, needs a lot of work before it becomes law -- and Republicans know it. An area of serious contention is a proposed tax credit to cover insurance costs; a clamorous coterie of conservatives says that it creates a new entitlement, while Democrats argue that it would help fewer poor people and not cover costs of health care.

The Democrats, in the minority in both houses of Congress, also take aim at tax cuts that would benefit high-income Americans and corporations.

As for the overhaul in general, Democrats may be quite happy to sit on their hands and watch the GOP squirm, as payback for the ACA's tortuous approval, which came in 2009 without a single Republican vote. There are many dynamics that pose a tricky balancing act for Ryan.

Republicans need to keep in mind that whatever they do has real-life impacts on real people. They need to reconsider whether the American Health Care Act is the proper vehicle to deliver tax cuts. For cost savings, they could explore ways to reduce prescription costs or remove duplicate coverage for those who qualify for both Medicaid and Medicare.

Frankly, it's difficult to see how the American Health Care Act improves what is in place, whatever the flaws of the ACA. Central Washington's congressional representatives, Dan Newhouse in the 4th District and Dave Reichert in the 8th, need to think long and hard before signing off on this proposal.

Amid the zeal to repeal and replace, Congress now needs to rethink.

-- Members of the Yakima Herald-Republic editorial board are Bob Crider and Frank Purdy.

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