Gutting Obamacare gets us nowhere; better to work with what we have

opinions

January 10, 2017 - 12:00 AM

President-elect Trump often said during his campaign that among his first actions on taking office would be to repeal the Affordable Care Act, better known as Obamacare.
The legislation was designed to give millions of Americans their first shot at health insurance. Today, that number is an estimated 20 million.
The Medicaid feature, which Gov. Brownback has denied Kansans, adds another layer of healthcare that had been missing. Another important aspect is to give coverage to people with pre-existing conditions that had priced them out of traditional markets.
The program had problems from the start, predictable for such a signature measure. With young and healthy people declining coverage in return for a financial penalty, participation by insurance companies suffered and premiums rose.
Robert B. Reich recently wrote an analysis for RealClear Politics, an online medium that offers pros, cons and much in-between on any number of issues.
Reich, the Chancellor’s Professor of Public Policy at the University of Southern California at Berkeley, was President Clinton’s secretary of labor and was judged by Time Magazine as one of the most effective cabinet secretaries of the 20th century. With those credentials, what Reich has to say is well worth a listen.
Reich gives three reasons why “Republicans can’t replace Obamacare.”
— Republicans proclaim their replacement will be market-based. The ACA already relies on private, for-profit health insurers, i.e., market-based, to provide plans.
Reich thinks the enormity of the health insurance market gives insurers an influence so great they can “get the deals they want from the government by threatening to drop out of any insurance system Republicans come up with.” That has occurred with the ACA.
— The components of Obamacare are dependent on each other. “Trump says he’d like to continue to bar insurers from denying coverage for individuals with pre-existing conditions. But this popular provision depends on healthy people being required to pay into the insurance pool, a mandate Republicans vow to eliminate.”
— Of enrollees, 80 percent receive federal subsidies. “Revoking tax increases in Obamacare, a key part of repeal, would make it impossible to finance these subsidies,” and put many of the 20 million recipients back on the outside looking in.

THE BETTER approach than wholesale gutting of the program would be for Republicans, in concert with Democrats, to find ways to tweak it.
Even with the 20 million enrolled, another 30 million, give or take, are estimated to face each day knowing a serious illness or injury would be their financial undoing.
President Obama has received more than his fair share of criticism for many things that have occurred during his past eight years as president.
With a mission of helping those with little means and even less hope, the Affordable Care Act is something of which we all should be immensely proud.

— Bob Johnson

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