Even after narrow passage of the American Health Care Act in the House this month, we don’t fully know what Trumpcare will become. But we do know what Obamacare has produced—broken promises, disappointment, government overreach and dysfunctional health insurance markets around the country. And we do know that after the Senate has its say on the issue, the final version will be better than Obamacare, even though that’s admittedly setting a pretty low bar. What’s ahead for GOP health care reform? Cautious steps in a different direction to re-balance our investments in health care and hopefully better health.
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Of the 498 rating regions in the United States, 146 had only one insurer selling nongroup coverage through its state marketplace in 2017; 125 had just two insurers. Markets with one insurer include the entire states of Alaska, Alabama, North Carolina, Oklahoma, most of Arizona, and rural areas of several states. Markets with only one or two marketplace insurers tend to be much less populated than areas with more competing insurers.
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Health insurance giant Aetna said Wednesday that it will not be participating in any Obamacare exchanges in 2018.
“Our individual commercial products lost nearly $700 million between 2014 and 2016, and are projected to lose more than $200 million in 2017 despite a significant reduction in membership,” T.J. Crawford, Aetna spokesman, said in an email.
The reason for the losses, he said, came from structural issues within the exchanges “that have led to co-op failures and carrier exits, and subsequent risk pool deterioration.”
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After the House voted last week to repeal and replace ObamaCare, Democrats quickly launched a barrage of false attacks. Minority Leader Nancy Pelosi asserted that the bill would “gut” protections for patients with pre-existing conditions. Never one to shy away from melodrama, she added: “This is deadly. This is deadly.” Apparently the GOP proposal is the second health-care bill Mrs. Pelosi didn’t read. The legislation makes clear: “Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.”
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Immediately following the vote on the House GOP’s American Health Care Act (AHCA), misinformation about the bill began spreading like wildfire, stoking fears and outrage. The issue which seems to be getting the most attention is the potential impact this legislation could have on people with pre-existing conditions.
Under AHCA, the federal guaranteed issue requirement would NOT be repealed, meaning that insurers in every state would still be prohibited from denying insurance coverage to anyone on the basis of a pre-existing condition. In no circumstance would this protection be denied, though it seems much confusion surrounding this protection has stemmed from the adoption of several amendments to the underlying legislation. It is unlikely that many Americans will be impacted by the provisions of one particular amendment in question, the MacArthur amendment. It is also important to remember that the AHCA must still be passed by the Senate and is likely to undergo significant reforms before it does, in which case, the legislation would again have to be passed by the House.
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I voted Thursday for the American Health Care Act, and given the intensity of feelings and thoughts surrounding this bill, I wanted to explain my reasoning.
Despite all the hyperbole, ultimately the vote came down to one simple question: do we kill the bill and stop the debate from advancing to the Senate — or not?
In its original form back in March, my vote was indeed to kill the bill. It was rushed and not ready. With the three amendments that came after my and others’ efforts to shut down the bill, it’s my belief that it was at least worth letting the Senate debate it.
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If you’ve only followed coverage of the Republican health-care bill loosely in the media, you might believe that House Republicans, after much effort, passed legislation to deny people with pre-existing conditions health insurance. The issue of pre-existing conditions has dominated the debate over the GOP health-care bill out of all proportion to the relatively modest provision in the legislation, which is being distorted — often willfully, sometimes ignorantly — into a threat to all that is good and true in America. The perversity of it all is that the legislation is properly understood as doing more to preserve the Obamacare regulation on pre-existing conditions than to undermine it.
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Barack Obama emerged from his short-lived political retirement on Sunday to call on Members of Congress to show the “political courage” to preserve ObamaCare. But wait. That plea doesn’t square with the deluge of recent stories predicting that Republicans have doomed their majority in 2018 by voting last week to repeal ObamaCare. How does it take “political courage” to oppose something that everyone claims is politically suicidal?
Perhaps because the predictors of Republican doom could be wrong. The midterm election is still 18 months away, and many events will intervene that could influence the result. But even if the campaign does turn on repealing ObamaCare, we’d argue that the politics are better for Republicans if they pass their reform and fulfill a campaign promise than if they fail and then duck and cover.
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Although it’s said that victory has hundreds of fathers and defeat is an orphan, the temporarily triumphant Trump White House might need to engage more effective “adoption” counselors. If and when a Senate bill to repeal and replace the ACA passes, it’s highly likely to differ from the House measure and require working out a shaky compromise in conference committee. If Republicans finally succeed in snatching legislative victory from the still-ominous jaws of defeat, then their next challenge of implementing new law and policy for health care could remind them of the “Winner’s Curse” in such endeavors.
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With the House’s passage of the American Health Care Act, House Republican leaders have handed their Senate counterparts the biggest legislative weapon they have held in their entire careers. At this point, Senate Republicans should learn from a bit of wisdom often attributed to one of the wittiest and most clear-eyed Founders, Ben Franklin: “We must, indeed, all hang together,” he supposedly told the Continental Congress in 1776, “or most assuredly we shall all hang separately.” If the 52 GOP senators agree to stay together and maneuver through the next month together, they could bring about a huge breakthrough for the country and a rejection of the gridlock that has consumed the Senate for years.
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