By Roger Stark
Republicans won a resounding victory in the November national elections. The party will control the U.S. House, theSenate and the White House starting next year.
Many candidates, including President-elect Trump, campaigned on repealing and replacing the unpopular Affordable Care Act, known as Obamacare. Stunned by rising premiums and lost access to their own doctors, voters went to the polls in search of a better national health care policy.
Unquestionably, the ACA has helped some people, but it is a failed policy and has never come close to reaching the two goals supporters of “Health Care for All” promised; coverage for everyone and lower health care costs. The law is simply too complex, too expensive and imposes too large a regulatory burden on Americans.
The problem we now face is how to make a seamless and painless transition from Obamacare to some form of replacement. Twenty million Americans now receive their health insurance either through the exchanges or through the expanded Medicaid entitlement.
In Washington state, 170,000 people receive health insurance through the state exchange and most of these people receive federal subsidizes. Another 600,000 Washingtonians were placed in the expanded Medicaid program, where 90 percent of the costs are paid by federal taxpayers.
We have some indication of the future direction of health care policy. This past year, Congressional Republicans published a series of white papers called “A Better Way” which include health care reform principles based on increasing patient-control and reducing government intervention.
Replacement of Obamacare will require either Republican collaboration with Democrats in the Senate (the better approach) or a series of bills passed with party-line votes. In my view, the strictly partisan approach is to be avoided, since that is how the flawed Obamacare law was passed in the first place.
Through a process known as reconciliation, a simple majority in the Senate can amend the parts of the law that specifically deal with financing. Reconciliation could defund the Medicaid expansion and could stop the subsidies in the Obamacare exchanges. The process can not repeal the individual mandate, the employer mandate or the insurance mandates in Obamacare.
Republicans must offer reasonable alternatives to people who might lose their health coverage. This will be difficult to accomplish unless the mandates in the law can be repealed. For example, simply allowing purchase of health insurance across state lines would not increase competition if all plans must include the 10 benefit mandates required in Obamacare. Eliminating the individual mandate would not be successful unless insurance companies can offer affordable mandate-free, or mandate-light, plans based on low-cost health savings accounts and high-deductible plans.
Through the years, Washington state elected officials have bent to interest group pressure and added 58 mandates to health insurance plans sold in the state. Many of these overlap with the Obamacare mandates. These 58 must be reduced to make regulatory reform of the insurance industry meaningful. For example, why should a 28-year-old unmarried man pay for obstetrical coverage in his health insurance plan?
Comprehensive health care reform must include changes to Medicare and Medicaid to guarantee their sustainability. This will require bipartisan support to make effective changes and will require educating the American public to understand the financial crises facing these enormous entitlements.
If Obamacare is repealed, the huge cost burden of the insurance exchanges and the Medicaid expansion would shift from federal to state taxpayers. Elected officials in Washington state should be prepared to either close the exchange and the expansion or be ready to explain to state taxpayers why their taxes will increase dramatically to pay for these entitlements
State Insurance Commissioner Mike Kreidler says he is committed to retaining Obamacare and says he will resist changes proposed by the new Administration and the new Congress. We should remember that Commissioner Kreidler pushed to make Washington an early-adopter of Obamacare, and that he is partly responsible for its shortcomings and wide unpopularity. After six years of failing to make the law work, and based on what voters are telling us, it is time for fresh thinking.
Health care reform and changes to Obamacare are critically important and are a priority of the new Administration. From what we learned in the November election, Democrats should understand the mood of Americans and show a willingness to collaborate with Republicans in achieving meaningful reform that puts patients, rather than the government, in charge of their health care.
Dr. Roger Stark is a retired heart surgeon and the health care policy analyst at Washington Policy Center, a non-partisan, non-profit, public policy think tank based in Seattle, www.washingtonpolicy.org
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