Who’ll fix Obamacare now?


By Chicago Tribune



This week in Washington, a staggered president and his party dig out from the rubble of their failed Obamacare replacement effort.

As House Speaker Paul Ryan says, there’s no sugarcoating this. The politics of the Republicans’ failure to pass, or even vote on, the American Health Care Act was ugly. House conservatives in the Freedom Caucus sought a full repeal without an effective replacement, guaranteeing the smoldering political debris in Washington. Why be greedy? Millions of Americans gained coverage via Obamacare. You can’t replace something, no matter how gravely flawed, with nothing.

But after a weekend of blame-mongering and political handicapping, let’s set that aside and focus on what’s most important here: What happens now for Americans with Obamacare coverage, for others who’ve rejected that option, and for those who’ll want to buy coverage in the future? The GOP failure won’t halt the turmoil in Obamacare markets. The law will continue to falter: Americans struggle to pay fast-rising premiums and deductibles for insurance that’s less useful to them because of shrinking doctor and hospital networks. Insurers who haven’t already bolted for the exits will soon decide whether they’ll offer coverage next year. Already nearly a third of American counties have but one carrier. What happens if there is none?

President Donald Trump tried to spin defeat into a prediction about imperiled coverage. “The best thing that could happen is exactly what happened — watch,” he told The New York Times. ” … Obamacare unfortunately will explode.”

Not necessarily. His administration could sabotage, or try to shore up, Obamacare. It can make rules that will discourage insurers from entering, or staying in, markets. It can move to reduce subsidies and discourage some lower-income people from buying coverage. That would be a huge mistake.

If the system collapses, if people lose coverage or can’t afford it, Trump imagines that they’ll blame Democrats who passed the law in the first place. No, voters will blame the person in charge. That’s you, Mr. Trump. This is your watch. So be careful what disaster you anticipate.

Trump says he’ll move on to the next items on his agenda. But Congress can still craft a better replacement. Instead of Washington point-and-blame gridlock, here’s a suggestion: Start over. How so?

Hard-right and hard-left House members won’t like this; the former want to exterminate the program and the latter won’t admit that it’s foundering. But Republicans and Democrats from the middle three-fourths of the ideological spectrum can swallow their partisan pride and work to preserve Obamacare’s advantage while fixing its structural flaws and climbing costs. An effective if uneasy alliance could shape a reform bill that would help more people afford insurance. A bill that would pare back premium costs and free people from rigid mandates such as today’s metal-tier hierarchy of benefits.

And Obamacare’s huge Medicaid expansion? In the spirit of the AHCA, the administration should offer maximum flexibility to states that want to experiment with cost-saving, quality-improving reforms.

Our concern is that, unless sensible lawmakers step up, Trump will be correct: Obamacare will collapse of its own weight. The Freedom Caucus won’t relent. Nor will Obamacare die-hards.

Trump, by contrast, isn’t an ideologue. He’d likely work with mainstream lawmakers to craft a flexible, cost-conscious reform plan that would attract millions of Americans to its coverage options.

A Republican Congress with a Republican president couldn’t fix what a Democratic Congress with a Democratic president got wrong. This is the time to shine for Democrats and Republicans who share the same goal — to help Americans buy health coverage they want at prices they can afford.

By Chicago Tribune