How to end Obamacare and improve coverage

Few people lie awake at night worried about the federal debt. So the Republicans' plan to allow "temporary" COVID-19-era enhanced subsidies for Obamacare to expire because of their exorbitant cost won't win many votes.

It will save Uncle Sam money. A staggering 93% of premiums are currently paid directly by the federal government to the insurance companies, reports the Paragon Health Institute. But will it win votes in the coming midterm elections? No.

Democrats are gloating that reducing the subsidies will mean higher costs for enrollees and an increase in the number of people who go without insurance. Sen. Chris Murphy (D-Conn.) predicts that Republicans "are going to get their clocks cleaned."

Democrats cynically insist on continuing to spend huge sums of taxpayers' money — some $450 billion over the next 10 years — to prop up lousy insurance, defending the indefensible because it's called Obamacare.

Obamacare is an utter failure. It was supposed to bend the cost curve. But premiums for a family of five can exceed $50,000 a year before subsidies, according to the KFF Health Insurance Marketplace Calculator. Premiums are up 129% since the plans were launched in 2014, rising twice as fast as plans offered by employers and four times as fast as inflation.

Deductibles are outrageous, insurers deny claims 10 times as often as they did before Obamacare, and networks are so skimpy that it can take months to get an appointment with a doctor. Forget seeing a specialist in network.

But Democrats are counting on the simple truth that something is better than nothing.

Politically, they're right. Republicans who want to stop the skyrocketing subsidies also have to show they care about the quality of care and intend to fix what's broken.

Armageddon is just weeks away. The enhanced subsidies will expire Jan. 1, 2026, hiking Obamacare enrollee's costs if no action is taken. Republican lawmakers should offer to extend them, phasing them out over one or two years, in exchange for reforms that will improve the Obamacare experience while Congress considers a broad overhaul.

Republicans finally have a second chance to fix health care. They should seize it.

Here's the simple truth: If your insurance company routinely denies claims or keeps the network so narrow that you can't get a doctor's appointment for months, you're not really insured. Both these problems should be fixed in the current session of Congress, with Republicans taking the lead.

In 2013, before the Affordable Care Act regulations kicked in, insurers denied roughly 1.5% of claims, according to the American Medical Association. Now ACA plans refuse to pay 17% of claims, and some nix 30% or more, according to Kaiser Family Foundation research. Those denials rates should be made public for every consumer to see.

Insurers are also increasingly demanding prior authorization, even for routine prescriptions, which can delay care for weeks. Some states are putting time limits on prior authorizations, saying for example that if the insurer doesn't respond within 48 hours, you're good to go. Whatever bill Republicans agree on to extend enhanced subsidies should crack down on these abuses.

Insurers are also gaming the system — deliberately offering narrow networks that exclude specialists and cancer hospitals in order to discourage people with serious health problems from choosing their plans. Why? Because the ACA prohibits insurers from charging sick people more than healthy ones.

Just 5% of the population accounts for more than 50% of health care spending, according to the Agency for Healthcare Research and Quality. It's a fact of nature. Asking insurers to cover the healthy and those with preexisting conditions at the same price is like trying to feed a Chihuahua and Great Dane for the same price.

Former President Barack Obama bragged about protecting people with preexisting conditions. But now those same people find themselves stuck in ACA plans without access to the specialty care they need.

Yet Congress can fix this problem. Continue allowing consumers to enroll without providing a health history, but once they're in a plan, their insurer can request the federal government provide an enhanced subsidy to those with preexisting conditions. Call it an actuarially adjusted subsidy — a remedy also proposed by former House Speaker and health care expert Newt Gingrich. It will eliminate the major reason insurers skimp on networks and also bring down premiums for the healthy who are currently being overcharged.

As Armageddon nears, various Republicans are proposing to cap income eligibility for subsidies and curb the massive fraud in the system. All good ways to help Uncle Sam save money. But they also need to improve the patient experience to defuse Democrats' fearmongering.

Obamacare is an expensive mess. Pouring in a steady stream of taxpayer money without insisting on immediate quality improvements and opening the door to a major health insurance redo in the next Congress would betray taxpayers and consumers. Twelve years of Obamacare is enough.

Betsy McCaughey is a former Lt. Governor of New York State and Chairman & Founder of the Committee to Reduce Infection Deaths at www.hospitalinfection.org. To find out more about Betsy McCaughey and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at www.creators.com.

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