Clarence Page: Obamacare: Mend it, don’t try to end it
If Congress were a little less wacko these days, both parties would be arguing less about whether to repeal Obamacare and more about how to repair it.
You don’t have to be an opponent of the Affordable Care Act, also known as Obamacare, to think parts of it need fixing.
And you don’t have to be a defender of President Obama’s signature achievement to see that further repeal or defunding efforts (like the more than 40 votes House Republicans already have taken) would be a waste of time.
“Defunding this monstrous legislation ... is even more unpopular than the bill itself,” concedes conservative editor-publisher Steve Forbes in his Forbes magazine. “People feel that would be underhanded: If it’s bad, repeal it or substantially change it.”
The problem, Forbes acknowledges, is that any such move would not survive the Democrat-controlled Senate or the president’s veto.
“So what should the GOP do?” Forbes continues. “It should take the president up on his taunt that the Republicans have no alternative.”
The “taunt” quoted by Forbes: “There’s not even a pretense now that they’re going to replace it with something better,” President Obama said.
During the health care debates in Obama’s first term, Republicans assured everyone they wanted to “repeal and replace” Obamacare with something better. More recently we don’t hear much about the “replace” part.
In fact, individual Republican lawmakers have come up with a variety of suggested replacements, but they haven’t been able to coalesce around one alternative plan.
Plans that they have produced have fallen short of achieving the big goals of Obama’s plan: insuring the uninsured while controlling health care costs that have skyrocketed in recent decades.
A plan recently unveiled by the Republican Study Committee, for example, calls for such ideas as allowing interstate shopping for insurance, expanding health savings accounts, extending tax deductions for insurance premiums (currently limited to businesses and the self-employed) to everyone, encouraging high-risk pools to lower costs for everyone else and legislate medical malpractice reform.
Sound familiar? Most of their ideas have been proposed in some combination for at least the past five years by various Republicans, including President George W. Bush.
Democrats objected to these market-driven alternatives as inadequate, particularly for the low-income uninsured and residents of states where individual coverage is less accessible or affordable. If barriers against shopping across state lines were dropped, for example, a Congressional Budget Office study found that older and sicker people would likely have to pay more money.
But evidence also suggests that Obamacare may be falling way short of helping all of those whom it was intended to help.
For example, a New York Times analysis of census data concludes that the program still misses two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance.
Some 8 million Americans who are impoverished, uninsured and ineligible for help remain so because they live in states largely controlled by Republicans that have declined to participate in Obamacare’s expansion of Medicaid, the medical insurance program for the poor, the Times says.
The problem for the excluded is that they make too much money to qualify for federal subsidies on the new health exchanges that went online Oct. 1 — and they’re too poor to qualify for Medicaid in its current form in some states where the income ceiling can be as low as $11 a day.
Leaders of three major unions also have called for revision of a provision that encourages small-business employers to limit their workers to fewer than 30 hours per week to avoid providing health insurance. Nonprofit insurance plans in union contracts also won’t get the same federal subsidies as for-profit plans, say the union leaders, who usually support Obama.
Questions also have been raised about financing the program by forcing large numbers of young and healthy people to buy insurance, but reducing their incentive to buy coverage. After all, you can obtain coverage during each year’s enrollment period at the same price whether you’re healthy or sick.
These problems, like the notorious computer glitches after the exchanges opened up online, can be fixed. But that calls for reasonable people who are willing to work together to fix them. That seems to be too much to ask of Washington these days. Lawmakers, heal thyselves.
Clarence Page’s column is distributed by Tribune Media Services. Email him as firstname.lastname@example.org. Representations of fact and opinions are solely those of the author.