Now that the American Health Care Act bill is dead (or, at least, playing dead, in a convincing way; without fidgeting), other players may get a little attention for other proposals for shoring up the Affordable Care Act system.
Here’s my BellCare 2017 proposal: Recognize that the ACA system itself is supposed to be a leaky emergency pup tent, not a brick house; admit that the critical killer problem is in the individual major medical market; and stabilize the individual major medical market for 2017 and 2018 by using full funding of the ACA individual and small-group subsidy programs through at least 2019 to pull insurers back into the market.
1. Stop thinking of the ACA as ‘Obamacare.’
One of the biggest barriers to the Trump administration and Republicans in Congress shoring up the current system is the absurd idea that the ACA is ‘Obamacare,’ and that many Democrats like the parts that have to do with the commercial health insurance market.
The ACA is a huge legislative package, created from the Patient Protection and Affordable Care Act of 2010 and the health care parts of the Health Care and Education Reconicliation Act of 2010. The only parts that normal well-read people know about are the parts that expanded Medicaid, set new commercial health insurance market rules, created the ACA public exchange system, and imposed new taxes and fees in an effort to make Medicaid expansion and changed the commercial health insurance market.
Three House committees and three Senate committees fought tooth and nail over what would go into the ACA. Aides to Sen. Harry Reid, D-Nev., the Senate majority leader at the time, assembled it in some spring-water-filled backroom at the last minute.
I’ve watched many streaming videos of ACA-related press conferences and congressional hearings. Since then, I’ve seen many Democrats praise the Medicaid expansion program, and ACA health insurance “patients’ bill of rights” type rules, such as the ban on medical underwriting. When Republicans were trying to kill the ACA exchange system, Democrats responded by attacking Republicans for being nasty obstructionists.
I’ve never seen Democratic lawmakers go into any detail about how great the ACA exchange system is, or how much they love the health coverage they get from the ACA public exchange for the District of Columbia. Democratic lawmakers never seem to brag about the wonderful luncheon conversations they’ve had with ACA public exchange administrators. Democratic lawmakers never seem to go into any detail whatsoever when defending the ACA subsidy programs, or, for example, trying to defend the ACA Consumer Operated and Oriented Plans.
The Obama administration itself seemed to shrug when Republicans cut ACA CO-OP funding out of budget bills.
I think the the Obama administration did just barely enough to keep the biggest ACA commercial health programs staggering forward because the ACA is not really Obamacare. To the Democrats in Washington, the ACA is really Harry Reid’s Annoying Step-Nephew Care.
The Obama administration and Democrats in Congress defended the ACA as a whole because they liked Medicaid expansion and some of the ACA commercial market rules and subsidies. But, in general, they hated the ACA public exchange system. They also hated the individual mandate, and they were cool or cold toward ACA taxes and fees that affect Democrats. They defended the commercial health insurance market component because letting it collapse would involve loss of political face, not because they liked it.
To put it another way: The Democrats wanted the ban-on-medical-underwriting cookie without having to eat their individual mandate penalty broccoli.
For the Democrats, the ACA individual health market system was an emergency storm shelter made out of a trash bag. It existed to give poor people and sick people some kind of temporary protection while Democrats built up the political capital to push Medicare for all through Congress.
If Republicans can recognize how much Democrats in Washington despised the ACA exchange system and the need for individual market subsidies to keep the system going, maybe they can come to this important, helpful realization: Keeping the ACA exchange system stable, and commercial sellers of ordinary individual major medical coverage in the game, would be a pretty good way to stick it to the Democrats.
The Affordable Care Act “three R’s” subsidy programs and exchange plan user subsidy programs were supposed to act like helpful giants who enjoyed keeping the individual heath market from tipping over. (Image: iStock)
2. The ‘Obamacare crisis’ is mostly an individual major medical market crisis.
Most parts of the ACA are either working well enough, or dying slowly and quietly enough, that they’re not that big of a deal.
Medicaid expansion may, eventually, do bad things to our health care system and contribute to national insolvency, but probably not next year.
Enforcement of the ACA penalty on people who fail to own the minimum required level of health coverage may not be going all that way, but the government seems to be collecting some penalty money.