Diagnosis for Democracy
Insights into the State of Our Union
A Blog by Rob Tenery, MD


Crossing the Aisle on Healthcare Reform is the Only Option

By Rob Tenery, MD on September 27, 2017

Yesterday's failure by the U. S. Senate to pass the Graham/Cassidy bill demonstrates that the Republicans in Washington cannot put together a consensus to repeal the Affordable Care Act (ACA). The premise of taking something back once it is given could not be truer when it comes to health care benefits. When President Obama signed his legislation into law on March 23, 2010 there were an estimated 48 million people who had no health care coverage. Today that number has decreased to about 28 million.

With all its flaws and rising premium costs, the ACA has provided coverage for 20 million more lives than before it was enacted. Although the state exchanges, the Employer Mandate and the Individual Mandate clauses of the legislation have contributed to this decrease in uncovered lives, it was the increase of the state Medicaid programs that has been the major contributing factor. Since the Medicaid expansion under the new legislation went into effect, 15 million more lives are covered as of July 2016 that translates into a 26.5% increase.

Any new plan to repeal Obama's current legislation that would jeopardize these newly covered or already covered lives would probably cause disastrous results at the ballot box, come the next electoral cycle. The three Republican Senators, Susan Collins, John McCain and Rand Paul, who did not support the recent proposals put forward by their Party have brought the health care initiative to a standstill. Paul, who basically opposes the block grants to the states, advocates for first repealing the ACA, then developing a new plan during a transition period. McCain has reservations about restructuring of the Medicaid programs and how to approach pre-existing conditions. Susan Collins echoed similar concerns as expressed by John McCain.

Passing any new health care bill under reconciliation (a simple majority) expires at the end of September. The health debate is not going away, however. The escalating premiums, dwindling number of carriers in the exchanges and Donald Trump will see to that. The President has already demonstrated that he has no qualms about reaching across the imaginary aisle that far too often keeps Washington at a standstill.

There is a growing consensus that the Republican claim of repealing Obama's health plan is unrealistic. When the leadership in the U.S. Senate agrees what is best for the country has priority over what is best for their particular Party, then a revised plan will probably move on to the White House for the President to sign. The Republican control in he House of Representatives should insure support for a compromise bill that comes out of the Senate.

At this point, there are two individuals who can break the stalemate--- Senators Mitch McConnell and Chuck Schumer. Both are holding their ground, but for different reasons. McConnell is because virtually all the Republican candidates in the last several electoral cycles campaigned and won on repealing the ACA. Schumer has stayed out of the fracas because he already knows that if the ACA fails, the only other option is some form of single payer system--- a system most of the progressive leadership has advocated all along.

Who loses if the ACA stays unchanged? The people who will continue to pay more than they can afford for coverage. The people who stay in a job only because they will lose their coverage if they leave. The patients who are unable to qualify for coverage that is too expensive because of their age or preexisting medical conditions. The patients who have a catastrophic medial event that face bankruptcy or a life of debt.

It's time for McConnell and the Republican leadership to reach across the aisle and find common ground. If they don't, my bet is that Trump will. If the Democratic leadership in the Senate doesn't join in that effort, then both Parties can assume the consequences of their own failures.

The health care payment system we currently have today is growing more and more expensive with every renewal date. The options of obtaining coverage decrease with each passing year. Our system is broken. Surprisingly, it can be fixed, if we just take the politics out of it!





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