EDITORIAL: Wednesday Americans want health care repaired

Oct. 25--So if President Donald Trump can't repeal and replace Obamacare, he'll just destroy it.

That may work for a man who filed six times for bankruptcy in private business, but it is bad public policy.

The fact is that most Americans want the Affordable Care Act improved.

And many Americans who are suffering from the lack of health care are the ones who put Trump in office.

Of the 10 states with the highest percentage of consumers receiving subsidies, nine voted for Trump, reported The Associated Press.

Trump last week announced that he would end the cost-sharing subsidies that help about 6 million Americans afford health insurance on the exchanges. And one of the major issues with Obamacare is that a large number of working poor can't obtain the subsidies.

Without federal subsidies, insurance companies will have to raise premiums, which will cause consumers to drop out, leaving only the sickest people on the federal exchanges.

There is a description for this kind of insurance: death spiral.

One way or another, insurance doesn't work unless there are enough healthy people paying premiums to pay for the sick people.

What Trump is about to create is two kinds of insurance: cheap insurance for the healthy and unaffordable insurance for the sick.

There are only two ways to make sure an insurance pool has enough healthy people in it: mandates or incentives.

Medicare, for instance, is based on withholding taxes that working people pay. These taxes are not voluntary.

Obamacare included tax penalties, but they were not steep enough to lure people to sign up for Obamacare. And Americans hate mandates.

Republicans prefer incentives in their various replacement proposals, but it seems nobody wants to fund them.

And so here we are: A national health insurance program that is falling apart.

Rather than repeal and replace, Americans want repair for the people.

SICK VOTED FOR TRUMP

Areas with poor health voted in large numbers for Trump for president, according to research from Massachusetts General Hospital at Harvard Medical School and the MIT Department of Political Science.

Counties that voted for Trump were doing poorly on measures of food insecurity, teen birth rates and diabetes.

So it's no wonder that people who were hurting would be interested in a candidate who promised to shake up Washington and get things done.

For counties and states that switched from Barack Obama to Trump, the public health connection was especially strong. In effect, they were voting for a different kind of hope and change.

It's doubtful, however, that these people were voting to lose their federal health care.

DEMOCRATS LOOK FOR ANSWERS

Democrats along with most of the news media missed the anger and frustration that propelled Trump to victory, especially in the flyover states of the rust belt.

The party, their allies in the Northeast media and the think tanks have been visiting the hinterlands in search of answers.

A story in The Washington Post describes Democratic Party visits to Iowa where loyal Democrats switched to the Trump wave.

"We left behind Americans who run lunch counters and small businesses across this great nation," said U.S. Rep. Seth Moulton of Massachusetts.

RACIAL VOTING GAP

In the 2016 presidential election, heavily white neighborhoods voted more Republican than ever while heavily black neighborhoods voted less Democratic.

An analysis by The Washington Post showed that African-Americans were more likely to either vote Republican or decline to vote in 2016.

VISITING the WORKING CLASS

Not all of the pressures on the working class are political. Sorting out the problems and solutions is the goal of a ideologically mixed study group that includes Opportunity America, the Brookings Institution and the American Enterprise Institute.

The group recently visited a classic middle American area, western Kentucky and southern Indiana.

They spoke with laid-off workers, visited a drug treatment center and visited a community college job training operation.

They spoke to mostly workers who are struggling to get by on low wages and part-time work. Their insights:

--The opioid epidemic is worse than they thought. It touches everyone around the addicts.

--Those providing treatment are committed to finding solutions that will work. It's going to be expensive.

--Government services are too often marred by red tape and poor service.

--Families are breaking under stress. Marriages are breaking up, mothers moving from boyfriend to boyfriend, children being raised in traumatic conditions.

--An advanced manufacturing technician training program pioneered by Toyota offers promise because it's run by private industry. It involves a two-year apprenticeship that combines soft skills, classroom work and on-the-job training. The program is designed to pay for itself. Students leave debt-free and gain good-paying jobs.

TAX REFORM

Now that Republicans appear resigned to not replacing Obamacare, tax reform is next on the agenda. As a Brookings paper explains, this will be difficult, too.

--Many Republican plans involve raising the federal debt, which will put plans in the crosshairs of GOP debt hawks.

--Any plan is likely to create winners and losers. The losers will scream. The winners are likely to be the 1 percent who already have captured much of the income growth in the last decade.

--Even good goals may conflict, such as spurring economic growth and creating more fairness.

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