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One small step for Obamacare
Portsmouth Herald - 9/4/2017
This appeared in Sunday's Washington Post.
The Affordable Care Act is not collapsing. But the health system could be on firmer footing. Over the next several weeks, Congress ought to put aside the past seven acrimonious years and make that happen.
Despite unjustified Republican alarmism, and despite the GOP's varied efforts to undermine the law, the Affordable Care Act is chugging along. The Centers for Disease Control and Prevention announced last week that the rate of Americans lacking health coverage through the first three months of this year was nearly identical to the same time in 2016, sitting at 8.8 percent. That number should be zero, but the fact that it is finally out of double digits, and seems to be staying down at only about half of what it was in 2010, is Obamacare's great achievement.
The CDC's announcement followed news that Ohio insurance officials have persuaded at least one insurer to sell individual market health plans in every county in the state. So, barring a last-minute shift, there will be no "bare" counties anywhere in the country next year. Republicans construed the existence of bare counties as a sign that the law was coming apart. Now the lack thereof says something about its resilience; it's more evidence that the law needs to be fixed, not torn up.
Fixes it does need, however, and there are signs that message is finally sinking in on Capitol Hill. Bloomberg News reports that nearly a quarter of people buying insurance in Obamacare's individual markets will only have one insurer to choose from. Another quarter will only have two options. Many of these near-bare counties are in rural or otherwise hard-to-cover areas that insurers are wary of entering, particularly because insurance companies are also anxious about what Republican leaders may do to their business next year.
The first way to calm markets is to remove the unnecessary uncertainty Republicans have injected into them. The Trump administration's move to defund Obamacare advertising in the coming enrollment period sends a bad signal. More important is that, whether in a desperate attempt to get negotiating leverage or out of pure spite, President Donald Trump has threatened to cut off subsidy payments the federal government promised insurance companies. The Senate Committee on Health, Education, Labor and Pensions will hold hearings this week and may soon craft a bill that would guarantee these payments are made, relieving skittish insurers.
In return for approving permanent funding, Republicans would demand that states are offered more flexibility in experimenting with health insurance rules. In the coming debate, Democrats will seek to protect Obamacare's signature protections, such as those mandating coverage for people with pre-existing conditions, certain levels of coverage quality and comprehensive health benefits. But Democrats should be able to agree to offer states some more leeway.
A bill along these lines would be narrow, but it would nevertheless represent a significant political shift. It would signify some willingness among Republicans to administer, rather than sabotage, the nation's health-care system, and it would show that Democrats are not interested in a scorched-earth defense of Obamacare's every letter. Republicans and Democrats could shake hands on any number of small-scale fixes to the Affordable Care Act, if they could agree to agree. We hope that process begins in the Senate this month.