EDITORIAL: There can be no repeal without replacement

Santa Fe New Mexican, The (NM)

Jan. 08--Too much time and energy has been wasted discussing "Obamacare," or the Affordable Care Act, without the necessary work to develop better health care for Americans.

Now, the GOP Congress wants to repeal Obamacare -- when has it not? -- yet has no plan to replace it, a move that would leave millions of Americans without health insurance and access to care, increase the deficit and likely damage the economy. Let's be clear. By winning the presidency and both houses of Congress, even if the president-elect is a popular-vote loser, the Republicans have won the right to put forth a different health care plan. That they come to governing without such a proposal is inexcusable.

A big part of the problem is the popular name given to the Affordable Care Act -- by labeling it Obamacare, it became tied to the president who pushed mightily for all Americans to have health insurance and better access to care. But this debate cannot be about President Barack Obama. He has health insurance, both as president and later, as ex-president. The members of Congress who are failing to come up with a plan? They have health insurance, too, provided by the government. All of the people debating health care will be taken care of, whatever happens to the rest of us.

Stop debating Obamacare. Start discussing how to provide health care access to all Americans. Work on improving the Affordable Care Act by reining in costs and offering more choices. Every big piece of legislation arrives imperfect, needing improvement. We've had years to see what is wrong with the health care act, so it's a good time to make changes. But lawmakers with sense, do not let Congress repeal the Affordable Care Act without a prudent plan to replace it.

A few GOP legislators are thinking more broadly. Sen. Rand Paul is against the current proposal to repeal the law because he believes it would increase the government debt by $9.7 trillion over the next 10 years. "Is that really what the Republican Party represents?" Paul said during Senate floor debate. Arkansas Sen. Tom Cotton told MSNBC, "I think when we repeal Obamacare we need to have the solution in place moving forward. Again, that solution may be implemented in a deliberate fashion. But I don't think we can repeal Obamacare and say we're going to get the answer two years from now." Sens. Bob Corker of Tennessee and Susan Collins of Maine also are expressing reservations.

The repeal effort can, and should, be slowed. (One powerful way to make lawmakers think twice is to tell the stories of individuals whose lives were saved because they had health insurance. The Obamacare Saved My Life Facebook page is an important witness to what it means to very sick people to have health insurance and proper care.)

Some 20 million Americans now have health insurance because of this legislation, whether because they are buying insurance on health care exchanges or because they are covered by an expanded Medicaid, the program that insures poor people. The uninsured rate is at an all-time low, around 10 percent, and would be lower if all states had accepted the expansion of Medicaid. Should the repeal go through, without any replacement, the Urban Institute estimates some 30 million people would lose coverage. Insurance markets, evidently, need time to adjust. Additionally, a repeal would leave an additional 4 million children without health insurance. They deserve -- they need -- to keep their care.

But it's not easy, because the structure of the Affordable Care Act is complicated. Healthy people buying insurance helps pay the costs so that people with pre-existing conditions are covered. That requirement -- covering people with pre-existing conditions -- is one of the most popular parts of the Affordable Care Act. So is the removal of a lifetime cap on benefits. But they are not cheap, and the GOP repeal faction must tell us how they will pay for such essential coverage.

New Mexicans have particular interest in what is happening in Washington, D.C. Health Action New Mexico estimates that in New Mexico, a repeal would cause some 266,000 people to lose health insurance. The expansion of Medicaid has been good for New Mexicans. We, and all Americans, deserve more certainty than a promise from lawmakers that they will come up with a plan -- someday.

What's interesting about this debate is that repealing the Affordable Care Act -- no matter the rhetoric on the campaign trail -- is not even popular, according to a recent poll. Citizens want a replacement plan ready before, not after, any repeal. The Kaiser Family Foundation, in its poll released Friday, found that 75 percent of Americans are saying they either want Obamacare left alone or repealed only when a new law is ready.

These numbers make sense. After all, it is the men, women and children of America who stand to lose their health care. They must say no, to repeal without replacement or to repeal and delay, with no plan for what comes next. Their lives are on the line.

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