Repeal is under way, but what about a valid replacement?
It’s not exactly breaking news that President Trump’s veracity has come into question from time to time, but when it comes to his oft-repeated campaign pledge to dismantle the Affordable Care Act, more commonly known as Obamacare, he appears to be a man of his word.
His first executive order after taking the oath of office last week directed all federal agencies to “waive, defer, grant exceptions from or delay” any section of the law that would impose financial or regulatory burdens on pretty much anyone. According to a Washington Post story, that would include consumers, doctors, health-care providers (including hospitals), insurance companies and drug companies.
Robert Laszewski, president of the Health Policy and Strategy Associates consulting firm, told the Post that the president had essentially tossed a “bomb” into an already fragile insurance market.
Laszewski is no friend of the ACA. The newspaper describes him as a “longtime critic” of Obamacare. But he’s not in favor of throwing the baby out with the bath water.
“Instead of sending a signal that there’s going to be an orderly transition, they’ve sent a signal that it’s going to be a disorderly transition,” said Laszewski. “How does the Trump administration think this is not going to make the situation worse?”
A better question might be, does the Trump administration care?
What might take the place of the ACA if Trump and his Republican partners in Congress succeed in scuttling it? That’s a good question, because despite years of calling for action to “repeal and replace” Obamacare, the GOP’s leaders in Congress have yet to put forward a workable plan to fill the void.
However, two Republicans in the Senate came forward this week with what they see as a compromise in the health-care debate.
Sen. Susan Collins of Maine, a member of the endangered breed known as moderate congressional Republicans, and Sen. Bill Cassidy of Louisiana, a physician, said their proposal would allow states more leeway in making decisions about what health coverage their citizens could access. They said states could opt to keep the ACA in place, or they could come up with other programs, for which they would receive a like amount of federal money. This sounds an awful lot like a voucher program, which would be a terrible step in the wrong direction. But regardless of what path a state might choose, the Collins-Cassidy plan would abolish any penalties on people who fail to obtain insurance.
A New York Times report suggests that conservative Republicans are unlikely to back any plan that keeps Obamacare alive, and if the reaction of Senate Minority Leader Chuck Schumer is any indication, Democrats aren’t likely to be climbing on board, either.
“Millions of Americans would be kicked off their plans, out-of-pocket costs and deductibles for consumers would skyrocket, employer-based coverage for working families would be disrupted, and protections for people with pre-existing conditions, such as cancer, would be gutted. All while the wealthiest few get a tax cut,” said the New York lawmaker. “It is nearly impossible to keep the benefits of the Affordable Care Act without keeping the whole thing.”
Leaders who care about the people of this country would not be trying to kill the Affordable Care Act. They would be working to improve it, which could best be achieved by created a system of Medicare for all, excising the insurance companies in the process and requiring that the pharmaceutical industry negotiate drug prices.
Any outcome that leads to millions of people losing their access to quality health care without a reasonable ability to recover it is simply unconscionable and unacceptable.
We can, and we must, do better.