House Republicans squeaked through an Obamacare replacement bill Thursday, prompting President Donald Trump and Speaker Paul Ryan to break out the smiles and declare victory.
Not yet. Action now shifts to the Senate.
How should Americans view this fitful process? Three things we know:
— The House bill is a beginning, not an end. There almost surely aren’t 51 senators who will buy this version intact. Expect much to and fro. Will that process deliver a new law? Maybe, maybe not. That said, you can disparage elements of this plan, but you also have to acknowledge the larger imperative here: Obamacare is flopping. Every discussion about what’s happening in Washington should start with that admonition. Congress got yet another dose of reality in recent days when insurance giant Aetna pulled out of Virginia’s health exchanges for 2018.
—All eyes are on pre-existing conditions. Obamacare is simple: Insurers have to cover people with pre-existing conditions and can’t charge them more. The GOP bill is more complicated. Insurers still would have to cover people with pre-existing conditions. But states could apply for waivers so insurers could charge more to customers with pre-existing conditions — if those people let their insurance coverage lapse. States that waive the pre-existing condition rule also would have to set up high-risk pools for the sickest people, or participate in programs that subsidize insurance companies to lower premiums for everyone. This isn’t a radical notion; before Obamacare, Illinois and many other states had these pools.
The GOP bill includes more than $100 billion for state-run high risk pools over several years. Will that be enough to cover everyone who needs it? Unclear. Senators, get an answer to this key question. People with serious pre-existing conditions that require expensive treatment need help paying bills more than they need low-premium insurance coverage. The flip side: With pools covering the highest-cost patients, premiums for other citizens could fall. In sum, high-risk pools can work — if they are adequately funded.
—All eyes should also be on Medicaid. Medicaid soon could cost Illinois more — but that’s not news. Obamacare’s generous federal assistance enticed Illinois and many other states to massively expand their rolls. That federal honey pot couldn’t last. The new GOP plan phases out that increased federal assistance starting in 2020. Illinois Gov. Bruce Rauner says the GOP bill “continues to be of deep concern.” One reason: the potential impact on 650,000 residents who gained coverage via that Obamacare Medicaid expansion. Bottom line: Illinois needs to rethink its Medicaid program. Under Obamacare or its replacement, Washington likely won’t be willing or able to keep paying nearly all of the expansion costs.
So, Senators, get to work. We’ve supported this effort because it provides Americans far more flexibility to buy the more affordable policies that people demand — not coverage the government mandates. Under this bill, for instance, states can redefine the “essential” health benefits insurers must offer. That could also trim costs substantially and lure young, healthy people to get insured.
We’ll soon have an updated Congressional Budget Office estimate of how many Americans would be able to buy insurance under this legislation. That should help guide the Senate. CBO estimated that under an earlier House bill, 24 million fewer Americans would have insurance by 2026. That’s daunting.
The even worse alternative: Lawmakers could stand back and let more insurers flee Obamacare. Let premiums, deductibles and co-pays keep rising. Let people keep losing access to their doctors and hospitals. That is, let Obamacare collapse. And let all those people scramble to find coverage, if they can.
A fourth thing we know: No one wants that.
— The Chicago Tribune,
May 5
