A bipartisan solution to health care is really necessary
Just when one thinks that the health care mess can’t get more complicated, it does.
The failure of the U.S. Senate to come up with a health care bill that can get the support of at least 50 of the Senate’s Republican majority of 52 leaves the subject up in the air.
It means that the basic provisions of the Affordable Care Act will remain in place. However, the Senate could repeal some of the financial requirements of the bill that would make things worse. Without the income for subsidies for lower income people that the ACA gets from taxes on the wealthy and required fees from the healthy who choose not to buy insurance, the source of income for the subsidies themselves could go away. That would create a mess with millions unable to purchase insurance. Those who could would find greater premium increases.
That would leave insurance companies with a difficult decision, pull out of more markets or increase rates further, which would also cause them to have fewer people able to afford policies.
Republicans have campaigned against the ACA, which they called Obamacare, but have found that it is almost impossible to come up with a replacement that is either better or less expensive, and that is what was promised by President Donald Trump and leaders in Congress.
Complicating the problem is that not all Republicans can agree on what the proper solution is. Some on the conservative side in both the House and Senate would prefer the government stay out of health care altogether.
Some others see that the expansion of Medicaid has been beneficial to their states. Some think that now that we have the ACA, the government no longer can get out of health care, such as by a total repeal. With no consensus within the majority party in Congress it should be no surprise there is no solution upon which they can agree.
Maybe this sets the stage for the best plan yet, something that can be agreed to by a majority of representatives and senators that involves both Republicans and Democrats.
The biggest political problem the ACA faced, and faces, was that it was passed solely with Democratic votes.
Republicans didn’t want to have anything to do with it. That made the ACA vulnerable to political games ever since. Part of the reason for the large individual market premium increases starting in 2016 was that ACA supporters could not get the reinsurance package that protected insurers from losses extended beyond 2015. Faced with losses, insurance companies either raised rates or pulled out of markets. That is what is causing the “death spiral.”
A second problem is that providing guaranteed coverage for people with pre-existing conditions is very expensive. Sick people signed up, and not enough healthy people did in spite of the “mandate.” An answer to that problem has not been developed.
A new health care bill, or a revised ACA that solves some of its problems, that had support from both political parties would be more stable. Members of both sides of the aisle would be more willing to make the fixes that just about every bill needs now and then. Something that is more stable politically would make it better for insurers, health care providers and the public.
There is a group of members of Congress, both Republicans and Democrats, working on the health care issue. They haven’t received much attention because the House and Senate leadership has been heading in other directions.
Maybe now their work will start to be seen as a way to solve the leadership’s problem and give them a solution that will lead them to a “fix” for the health care issue.
Health care is expensive and getting more so. And costs will increase until we take a serious look at how we can slow cost increases. That, too, will be painful. We need a long-term solution, and there can be no serious long-term solution without considering how we can reduce the rate of increase of health care costs. A bipartisan solution is really necessary.