This editorial was first published in The Providence (Rhode Island) Journal, a fellow GateHouse Media publication. Guest editorials don't necessarily reflect the Daily Messenger's opinions.
After promising for seven years to repeal and replace the Affordable Care Act — known popularly as Obamacare — Republicans are finding it difficult politically to do so. The chances for passage of a Senate plan, for example, appear to be dimming.
Certainly, congressional Republicans seem fearful and confused. Given more than a half-decade to fashion a satisfactory alternative to President Barack Obama’s widely unpopular law, the House produced a bill this spring that few think will solve the long-term challenge of helping everyone get decent care. (It was almost as if House Republicans, along with just about everybody else on the planet, did not expect Donald Trump to be elected president.)
Conservatives blanched at the fact that it left many of Obamacare’s regulatory strictures in place, instead of using market forces to improve care. More liberal Republicans hated its reductions in Medicaid spending, which the Congressional Budget Office determined would have resulted in large coverage losses. And Democrats hated, well, everything about it.
Still, the House just managed to narrowly pass the bill in May. Senate Majority Leader Mitch McConnell, for his part, promised that his chamber would fashion a bill entirely of its own. And then it released one that was very similar to the House bill.
Similar political splits emerged. Libertarians such as Rand Paul of Kentucky and Utah’s Mike Lee led the charge from the right, charging that the bill was little more than Obamacare Lite. Centrists such as Maine’s Susan Collins and Nevada’s Dean Heller, meanwhile, argue that the bill is too stingy toward the poor. And Democrats, again, have opposed it en masse.
Mr. McConnell has promised to revise the bill, but its prospects look muddled at best. Indeed, the majority leader is faced with a seemingly intractable political problem: Move the bill to the right, and he risks losing more centrists. Make the bill more liberal in spending, and more conservatives will oppose it. With just 52 Republican seats in the Senate, and Democrats determined to oppose any GOP plan, McConnell can only lose two of his members.
So is this the end for legislation on health care?
Doing nothing will not work. The Affordable Care Act desperately needs reform, regardless of the fate of McConnell’s bill. Some of the Obamacare exchanges, where people shop for insurance on the individual market, are wobbly or worse.
Customers have tended to be older and sicker than insurance companies expected — more expensive for them, in other words. Therefore, they’ve had to raise premiums and deductibles, which has driven the healthy and the young away from the marketplace. But the markets need the young and healthy to help subsidize the costs of the old and the sick.
It would be a good idea, for instance, to legalize less comprehensive insurance than Obamacare currently allows — say, catastrophic insurance, which can be bought cheaply — to entice younger folks into the market. An infusion of true market forces — offering people a choice of the level of insurance they wish to carry — could help to bring down costs. Some action to help rein in Medicaid spending seems necessary, too, perhaps by allowing states more flexibility in how they manage the program.
Should the Senate bill die, we hope that a different approach will be tried.
It would be wonderful if members of both parties could stop their Resistance movement against each other, come together and find pragmatic ways to bring down health-care costs and therefore increase people’s access to the care they need.