EDITORIAL: The next chapter in fixing a floundering Obamacare

March 14--The Congressional Budget Office weighed in Monday on the profound impact of the House Republicans' ambitious Obamacare fix. There's fuel here for both proponents and critics of the bill known as the American Health Care Act.

CBO says 24 million fewer Americans would have health insurance by 2026. Why? Some would choose not to have insurance because the bill ends the mandate that people buy insurance or pay a penalty. Others would forgo insurance because of rising premiums. And many would lose coverage because of dramatic changes to Medicaid.

The overall effect: Americans approaching Medicare coverage at age 65 would pay more and younger Americans less, the CBO says.

At the same time, the bill would reduce the federal deficit by $337 billion by 2026 -- because of less government spending.

Those are, again, CBO estimates. They aren't the final word on whether the current GOP plan would succeed or fail.

Now, the big question: What do House Republicans do? Will these -- should these -- estimates compel GOP leaders to change the bill? We've said before that they should be open to retooling their bill to encourage more people to buy coverage. The urgency here comes not from the tenets of the bill itself but from a much bigger problem: Obamacare is floundering and risks collapse.

We're sure that opponents -- Democrats and conservative Republicans among them -- will marshal these CBO numbers as reasons to scuttle this bill or, conversely, to have it destroy all things Obamacare. Democrats have defended the current law and reject repeal. Conservatives criticize this bill as "Obamacare Lite," replacing one entitlement with another; those lawmakers seek a full Obamacare eradication, including popular features that allow children to remain on parents' policies until age 26 and forbid insurers from denying coverage for pre-existing conditions. That won't and shouldn't happen.

President Donald Trump, House Speaker Paul Ryan and other GOP leaders can remind Americans that they seek to replace Obamacare not because it is the signature achievement of a Democratic president but because it is imploding. Insurers are abandoning markets. Premiums are rocketing. Coverage plans are narrowing. Healthy young people are avoiding Obamacare policies and sicker people are flocking to them. At some point, Obamacare risks plunging into what insurance experts call a "death spiral."

So the next chapter begins: What might an improved bill include?

The GOP plan currently offers some Americans less generous subsidies but would bring market-based reforms that could encourage more Americans to buy insurance. Building in more incentives for younger, healthier people to buy policies simpler than Obamacare's wouldn't only leave more Americans insured. It would lower premiums.

Are there other ways to whittle back the estimated number of people who lose coverage? Yes, probably by adjusting the Medicaid provisions.

If this CBO report propels Democrats who want to preserve today's Medicaid and Republicans who want fewer mandates to the same conference table to hash out a better plan, great.

But remember that if Washington fiddles, Obamacare may burn. "The time is now," Ryan says of Obamacare repair. "This is the moment."

Yes, it is. The CBO just made the Republican task more complicated, but also possibly more clear: Americans need health coverage that is flexible, that they can afford and that includes the doctors and hospitals they want.

GOP leaders may have hoped their plan would float to President Trump's desk as a fait accompli. It won't. Time for Republican leaders to respond and retool.

Join the discussion on Twitter @Trib_Ed_Board and on Facebook.

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