It’s unsettling that President Trump seemed to treat the failure of his plan to repeal and replace the Affordable Care Act like a business venture that had soured. Oh, well, on to the next entrepreneurial adventure, which he said would be tax reform.
OK, but who’s going to clean up the mess left by the Kill Obamacare fiasco? The law still has flaws that need to be fixed, and they can be without repealing the statute and starting over again.
House Speaker Paul Ryan took a political risk in trying to pilot an Obamacare replacement bill for a man he was reluctant to endorse for president after a video showed Trump bragging about improperly touching women. Instead of praising Ryan for his loyalty, Trump seemed to send him a veiled message by encouraging Twitter followers to watch a Fox TV show whose host urged Ryan to resign as speaker. The White House says Trump didn’t know Jeanine Pirro planned to do that when he touted her show.
The president sent clearer signals to the so-called Freedom Caucus, the conservative House members who helped abort Trumpcare by denying it their votes. “Democrats are smiling in D.C. that the Freedom Caucus, with the help of Club For Growth and Heritage, have saved Planned Parenthood & Ocare!” Trump tweeted.
A rift between Trump and the Republican right, which has long been suspicious of his political persuasion, could benefit the nation if it gets to work with some Democrats too. “I probably identify more as Democrat,” Trump said in a 2004 interview. He would become a game-changer if he broke through the partisanship that has mired Congress in a sea of indolence for nearly a decade.
Repairing the Affordable Care Act would be a great place for bipartisanship to break out. It’s easy to see the ACA’s main problem. Insurance companies aren’t making the profits they expected because Obamacare has brought them more old and sick clients than they anticipated. To compensate for that, the insurance companies are jacking up premiums in some markets or pulling out altogether.
Those solutions only exacerbate the problem. Higher premiums lead to fewer enrollees, which leads to insurance companies dropping out of markets, which decreases competition, which leads to higher premiums. The preferable cure for what ails the insurance companies is to get more young and healthy people to enroll in their ACA plans. But how?
Providing larger subsidies to insurance purchasers is one way to do that. That’s the route used in 2003 by another Republican Congress and president, George W. Bush, to get more Medicare enrollees to also purchase private coverage through the Medicare+Choice program, now known as Medicare Advantage. A third of all Medicare beneficiaries today also have private coverage.
Larger subsidies are just one idea. Another is providing a public option for insurance purchasers, which would ratchet up competition and lower prices. That may be a bridge too far for conservatives who get the vapors at the mention of anything they construe as socialized medicine. But the point is that Obamacare’s predicted implosion can be avoided if the people elected to make laws that work would put aside politics and get busy.
— The Philadelphia Inquirer