EDITORIAL: Time for some real health-care reform

March 12--A FUNNY thing happened to the Republicans on their way to repealing the Affordable Care Act (Obamacare). Turns out lots of people who now have it like it and want to keep it. Even if they don't like it, they need it and want to keep it. But they want it to work better.

Before ACA, conservatives insisted the government has no business helping people to get medical care. After 20 million more people got health-care coverage through ACA, a sizable number of Republican members of Congress (including those from Philadelphia's suburbs) took to complaining that the premiums and deductibles for individual insurance in ACA are too high (which they are.) They talked like they planned to do something about it.

But the American Health Care Act, the plan that's currently being rushed through Congress, would make premiums and co-pays even higher -- that is, for the people who don't lose insurance altogether because of eventual caps on Medicaid. For good measure, the replacement plan eliminates two Medicare taxes on the wealthiest Americans, giving them a windfall while reducing the life of the Medicare trust fund by four years.

Some conservatives ridicule the ACHA as Obamacare 2.0, but it's more like Obamacare 0.25. Many of the ACA protections remain: people can't be denied coverage because of pre-existing conditions, there are no lifetime caps on coverage, children can stay on parents' health care until age 26. But by changing the way subsidies are figured, as well as providing less money for them, millions of people who now get insurance through ACA will no longer be able to afford it. Oh, but they will have access.

It's time to get back on the phones -- and streets -- to tell Republican members of Congress that you do not want to finance $600 billion in tax cuts for the rich by endangering the lives of millions of Americans.

But that's not all. At the same time, urge Democrats to come up with a real Obamacare 2.0. For example:

Include a "public option," a government-run health-care alternative to private insurance plans that, like Medicare, would use its increased buying power to keep costs low and provide competition to private insurers. (We are not going to think about how many of Obamacare's current problems could have avoided if the law had included a public option in the first place.)

Allow people over 55 to buy into Medicare, as also considered in the run-up to passing original ACA legislation. Early retirees or older workers not covered by employers usually have higher medical costs. Buying into Medicare even at higher cost than for those over 65 would still mean lower premiums and co-pays for them, while removing older people from the insurance market would lower costs for younger people.

In addition, increase Medicaid eligibility beyond the current 138 percent of poverty (currently $16,643 for an individual and $33,948 for a family of four). There is a indefensible reduction in the affordability and quality of coverage between people poor enough to qualify for Medicaid and those who make a modest amount more.

No question that a true Obama-care 2.0 is a political impossibility now. But while proclaiming (loudly) what we are against, it's also essential to make clear what we are "for."

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