Health law’s woes drive repeal call

Pence appeals for GOP support

WASHINGTON, March 12, (Agencies): President Donald Trump and Republican leaders say drastic action is needed because the Obama-era healthcare overhaul is a disaster, with soaring premiums and insurers bailing out.

It’s true that major parts of the 2010 law are clearly troubled, but others are working fairly well.

The risk is that the GOP’s “rescue mission” will inflict collateral damage on what’s working and cause new problems. Or that promised solutions might disappoint.

The Affordable Care Act, or ACA, expanded coverage in two main ways. It offered subsidized private health insurance through online markets such as HealthCare.gov that cater to people without workplace coverage. It also allowed states to expand their Medicaid programs to cover more low-income adults.

Together, those features have helped push the nation’s uninsured rate below 9 percent, a historic law.

A look at some of the law’s major elements, their current status, and how they might be affected by the repeal and replace legislation advancing in the House:

Status: Thirty-one states have expanded Medicaid under the health law. The federal-state healthcare program for low-income people now covers about 1 in 5 people in the United States, from newborns to elderly nursing home residents. About half of the expansion states have Republican governors. Gov John Kasich, R-Ohio, says it has allowed his state to offer “a stable source of care” for the working poor, the drugaddicted, and the mentally ill. Although Medicaid is a notoriously stingy payer, hospitals have strongly supported the expansion as preferable to treating uninsured patients.

Impact: The House bill would repeal the Medicaid expansion, which now covers about 11 million people. Currently the federal government offers a generous matching payment to states that expand their programs. Starting in 2020, that payment would only be available for beneficiaries already enrolled under the expansion, not for any new ones.

In an even bigger change, the bill would end Medicaid’s open-ended entitlement status, moving to a system of limited federal financing. Washington would pay the states a fixed amount per beneficiary, based on Medicaid spending in each state, adjusted annually for medical inflation. Supporters say the change would bring needed fiscal discipline and encourage states to innovate. Critics say it will ultimately harm the poor and goes far beyond addressing issues with the ACA.

Status: The health law was meant to expand and stabilize the market for individual health insurance, through which roughly 20 million people get coverage. It’s been a roller-coaster ride instead. As sicker, costlier customers came into the market, premiums and deductibles shot up. Consumers eligible for the law’s income-related financial assistance were cushioned, but millions who still pay their own way are in shock. Former President Bill Clinton, in a candid moment, called it a “crazy system.” Recently, Aetna CEO Mark Bertolini pronounced the ACA’s health insurance markets in a “death spiral.”

Bill

Impact: The House bill would rework the ACA’s tax credit subsidies and loosen some of its major requirements on insurers. It would allow people to set aside more money in taxsheltered health savings accounts. More people would be eligible for the GOP subsidies, but the assistance may not go far enough for those with modest incomes. The GOP tax credits are not designed to keep pace with rising premiums, as the Obama subsidies do. Insurers would be able to experiment with redesigned plans that hold the promise of lower premiums. The pros and cons will become clearer as more detail and analysis emerges.

Status: HealthCare.gov froze up the day it was launched in 2013, an episode that embarrassed the Obama White House and prompted a high-tech repair job lasting weeks. Since then, the federal website has improved, now serving as the backbone of a system that insures about 12 million people nationwide. Several states operate similar websites.

Impact: The GOP bill does not repeal the provisions that created HealthCare. gov and its state counterparts, but their future is unclear nonetheless. “The federal and state marketplaces would likely shrink,” said Larry Levitt of the nonpartisan Kaiser Family Foundation. With smaller tax credits, there wouldn’t be as many customers. The GOP bill allows consumers to use their tax credits for coverage purchased outside the government markets as well.

Meanwhile, Health Secretary Tom Price says he “firmly” believes that “nobody will be worse off financially” under the health care overhaul the Trump administration and congressional Republicans envision replacing President Barack Obama’s law.

Price tells NBC’s “Meet the Press” that people will have choices as they select the kind of coverage they want as opposed to what the government forces them to buy.

Price says success would mean more people covered and at an average lower cost than now.

In related news, Vice-President Mike Pence appealed for total GOP congressional support for a White Housebacked health overhaul during a brief visit Saturday to Kentucky, where the Republican governor and junior senator are among the plan’s skeptics.

“This is going to be a battle in Washington, D.C. And for us to seize this opportunity to repeal and replace Obamacare once and for all, we need every Republican in Congress, and we’re counting on Kentucky,” Pence said at an energy company where business leaders had gathered.

He said President Donald Trump would lean on House Republicans — including two Kentucky lawmakers in the audience, Reps. Andy Barr and Brett Guthrie — to vote to replace former President Barack Obama’s law.

Pence’s trip was part of an effort to reassure conservatives who have raised objections to the House plan. In a sign of the high stakes, Pence’s motorcade passed a long line of demonstrators who chanted, “Save our care.”

Almost at the time Pence landed in Louisville, Trump tweeted: “We are making great progress with health care. ObamaCare is imploding and will only get worse. Republicans coming together to get job done!”