EDITORIAL: Trump could sabotage health care. What California should do to protect its residents.

July 30--Now that the Obamacare repeal has crashed and burned in the U.S. Senate, this is what would happen if we had a president who knew how to govern and a Congress that could work together:

There would be a bipartisan summit to come up with ways to fix and strengthen the Affordable Care Act to slow rising premiums and create more competition in California and across the country.

Unfortunately for all of us, that's not what we have in Washington, D.C.

Instead, President Donald Trump declared that he wants to "Let Obamacare implode, and then do it," even though that would devastate millions of Americans, including many who voted for him.

Our vindictive president lashed out at the three Republican senators who showed the political courage to vote "no" on a terrible bill: Susan Collins of Maine, John McCain of Arizona and Lisa Murkowski of Alaska.

Trump shouldn't have been too surprised that they stood up to him. He reportedly sicced Interior Secretary Ryan Zinke to threaten Murkowski for not toeing the line. Trump and McCain have been on the outs since he disrespected the senator two years ago by saying: "He is a war hero because he was captured. I like people who weren't captured." And like other Republican leaders, Trump seems to have ignored Collins' legitimate concerns.

Congressional Republicans, who so far have not delivered on their seven-year promise to repeal and replace Obamacare, richly deserved this epic fail. Majority Leader Mitch McConnell and 12 other white men drafted his first attempt in secret before introducing it in June. Then this week, they tried to get the Senate to approve bills without disclosing what was in them and without much input from groups representing doctors, hospitals, insurers and patients.

If lawmakers listened to these groups, they would realize that there could be short-term measures that could make health care more affordable and accessible.

One big flaw of Obamacare is that it does little to control costs, including prescription drugs. We spend nearly $9,500 a person on health care, double the amount in other rich nations. And because of all the uncertainty surrounding health care, insurance premiums are spiking.

In many parts of the country, there is only one insurer in the individual market and next year, there could be no insurers at all in at least 47 counties.

California is in better shape.

Here, Gov. Jerry Brown's administration has worked to make sure that Covered California works. But because the state has relied on federal money to expand Medi-Cal, many people would lose coverage if the feds were to cut that funding and the state didn't replace it, $24 billion by 2027 under the bill approved by the House. The state has received a reprieve for the time being.

But Trump still could sabotage the individual market in a variety of ways by failing to pay to advertise the Affordable Care Act; failing to enforce the individual mandate requiring people to obtain health insurance; and failing to provide subsidies to help lower income people pay for their care.

The feds provide about $700 million to help poor people in California cover the cost of their deductibles and copayments. That money, which flows to insurance companies, apparently could be cut without congressional approval. Such an irresponsible action would be a direct hit on insurance companies and disrupt what now is a functioning market.

The state should sue to force the feds to make good on that commitment, and if the feds fail to enforce the individual mandate. But lawmakers also ought to explore ways to impose a state mandate to help ensure that the system works.

Healthy people buy insurance knowing that good health is fleeting, and understanding that part of their premiums help cover costs for people who are ill. That is fundamental to our civilized society. We help one another.

And at least for now, 51 U.S. senators reinforced the concept that an individual's wealth must not determine a person's health.

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