EDITORIAL: With repeal’s shortfall, a cure for what ails ‘Obamacare’ could be within reach

March 30--There have been as many mixed signals about what is next for health care reform in the aftermath of the Republicans' failed attempt at repealing the Affordable Care Act as there have been fingers pointed at who to blame for its failure.

Initially, President Donald Trump blamed Democrats for not voting for the bill that would have dismantled the 7-year-old health care law, also known as "Obamacare." Then Trump blamed the Republican Freedom Caucus in the House, who thought the bill -- which would have scaled back the Medicaid expansion to participating states and cut subsidies, ultimately removing more than 24 million Americans from having coverage -- was too generous. Finally, Trump appeared to blame House Speaker Paul Ryan for his failure to deliver the necessary votes; the president tweeted for his supporters to watch Fox News host Jeanine Pirro, who on her program over the weekend called on Ryan to step down as speaker.

And Trump, for whom the buck stops everywhere else, appeared ready to move on to other matters after it became clear that House Republicans wouldn't have enough votes to pass Ryan's American Health Care Act.

But since the beginning of the week, there have been renewed calls (at least between Trump and House Republicans -- the Senate continues to insist there is no stomach for health care reform there) to try again to repeal the ACA.

Such an effort would likely be another minefield. Aside from the fact that the effort to corral votes among so many warring factions in the House proved so elusive, House Republicans also got an earful from their constituents at town hall meetings as the repeal effort began to gather steam in February and March. Add to this that the repeal effort had not a single Democratic vote.

In the days after the repeal effort failed, Trump intoned that Democrats would come around once Obamacare collapses, and he suggested he might be willing to allow that to happen. While some Republicans have taken to claiming that Obamacare is in a "death spiral" with the same glee that they leveled charges of "death panels" against the law six years ago, the Affordable Care Act is not in danger of collapsing, despite being precarious in several individual state markets. But letting Obamacare fail would be as bad an outcome for the individual marketplace as making "Trumpcare" the law of the land -- skyrocketing premiums and co-payments, millions unable to afford health care coverage.

We think a better way for Trump to bring Democrats on board would be to take steps to strengthen Obamacare, not subvert it. As Michael Grunwald notes in a recent piece for Politico, that can be done without asking Democrats to go all in on health savings accounts, or expecting Republicans to suddenly get sentimental about a public option. Instead, Grunwald says, helping to stabilize Obamacare could be as easy as the House withdrawing from a lawsuit that challenges the legality of insurer subsidies and for the ACA to consider adding two provisions from Trumpcare -- one that would allow older consumers to be charged slightly more for policies than the current 3-to-1 ratio of Obamacare and for the addition of a reinsurance fund to help cover the most expensive patients. Trump would also find an ally in Democrats if he made negotiating drug prices a priority, Grunwald said.

Can such a repair effort be accomplished in such deeply partisan conditions as exist right now between Democrats and Republicans -- and, let's face it, between Republicans and Republicans? Given that in the aftermath of Trumpcare's failure a number of legislatures in red states moved to expand Medicaid (as allowed under Obamacare) and some positive reviews have been forthcoming for new enrollment rules by the Department of Health and Human Services that are designed to help insurers, there might be a few reasons to be optimistic.

___

(c)2017 The Frederick News-Post (Frederick, Md.)

Visit The Frederick News-Post (Frederick, Md.) at www.fredericknewspost.com

Distributed by Tribune Content Agency, LLC.