The GOP's health care revisionism


As Republicans in Congress struggle with fulfilling their pledge to repeal and replace Obamacare, it is time for a little Health Policy 101. Let's go back in time to before the Affordable Care Act was conceived, written and passed. There were numerous problems with the American health care system.
One was the tens of millions of people who were uninsured. They mostly would not and could not see doctors or pay for needed drugs, certainly not get preventive care, and ended up in emergency rooms when crisis hit. Besides the human tragedies, that became a major burden on the system. At the same time, health inflation was greater than other kinds of inflation, squeezing people and raising health as a share of GDP at a high rate.
Now move to the insured, especially those not covered by employers. For many, the system was a true nightmare. If you or a family member had a preexisting condition, you might find your coverage dropped or be unable to get insurance.
If you had insurance but got hit with a costly health problem, your insurer might deny payment by saying you had a preexisting condition you did not disclose. Or you might find in the fine print that the illness or disease you had was not a part of your policy or had severe limits on its coverage.
If you had insurance, were hit with a catastrophic illness and did have coverage,
you might find after an intensive bout of treatment that you had hit your lifetime limit in expenses and would be on your own for payment -- something that became the No. 1 cause of personal bankruptcy in the U.S.
If you were on Medicare and had prescription drug coverage under Part D, you could easily get hit by the "doughnut hole" -- drugs paid for up to an annual limit, then payment stopping until a much higher level in costs caused the plan to kick in again.
How to eliminate or ameliorate those and other problems? It could be done as other countries have by creating a single-payer system. Or it could be done, as Obamacare did, by creating competitive insurance exchanges and letting a marketplace set rates. To effectively eliminate the nightmare of preexisting conditions required broadening the risk pool for insurers -- and the only comprehensive way to do that and provide some assurance for the insured is via an individual mandate, bringing in more healthy people so that the pool can cover all the costs.
To enable children up to 26 to stay on parents' policies, eliminate the lifetime limit on insurance payouts, eliminate the doughnut hole and make insurance affordable for working-class and poor
Americans -- while being fiscally responsible -- required finding revenues to pay for these benefits, which included taxes on providers, higher premiums on high-income Medicare recipients, a tax on gold-plated insurance plans, and more. The logic was strong, the execution not so much.
But the successes in insuring more than 20 million people, seeing cost increases slow dramatically and providing piece of mind to tens of millions more are real.
Seven years of nonstop demonization by Republicans have half of Americans wanting repeal -- although most of them want a replacement plan first.
But all of the things that were done, except for the individual mandate, are highly popular. And if you eliminate the individual mandate, you blow up the system because of the need to broaden the risk pool. Indeed, that logic is why conservatives, in their 1993 alternative to Bill Clinton's health reform and in Heritage Foundation options, used the same framework.
Remember why we passed this law
In June 2009 -- 390 weeks ago -- Republican House leader Eric Cantor said the alternative to the Democratic plan was "weeks away." The same week, the Republican pointman on health reform, now-Sen. Roy Blunt, said, "I guarantee we will provide you with a bill." Instead, we have had 60 separate votes in the House to repeal with no leadership replacement plan yet in sight.
Last week, Trump confidant Rep. Chris Collins said on MSNBC that repeal will come first, but no one at all will be affected in their insurance coverage until 2019. Then he said "things like the medical device tax, the health insurance tax on the insurance company, the employer mandate and the employee mandate will be repealed immediately."
Repeal the individual mandate? The insurance market will be in turmoil, and lots of people will either lose their insurance or see their rates skyrocket. Take away the revenues? Another huge hole in the deficit.
Virtually every idea proposed by individual Republican lawmakers would leave many more Americans uninsured or at major risk,
with bare-bones catastrophic plans as their major option. The price of tribalism -- everything President Obama and the Democrats are for, we have to condemn -- is that you have few workable ideas left.
Or we will see how adeptly congressional Republicans and the President-elect can sell their base on replacing Obamacare with . . . Obamacare.
Ornstein is a resident fellow at the American Enterprise Institute.

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