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New clothes vs. old

Mar 17, 2017 By Steven R. Peck

The proposed replacement for Obamacare needs to find a clear reason for being

The Affordable Care Act, which commonly is referred to by the nickname Obamacare, had one central principle going for it: Get as many people covered by health insurance as possible.

The new health care law now being debated in Congress cannot claim a similar quality, and that's what has it bogged down already.

Formulating comprehensive health care legislation for the United States isn't easy. It wasn't when the Affordable Care Act was passed, and clearly it hasn't gotten any easier now that a new president and a new Congress are hell-bent on replacing it.

If getting more people insured was Obamacare's defining characteristic, the closest the replacement model can come to having a core idea is "It's not Obamacare." The bill probably will need more than that if it is to have a chance of passage and implementation.

Wyoming joins all other states in keeping a close eye on the new health care debate. We opted not to participate fully in Obamacare, specifically by rejecting federal money to help expand Medicaid (that's health insurance for low-income residents) for several years. Gov. Mead eventually came around to the idea, but legislators wouldn't go for it.

That clearly was a political statement against anything former President Barack Obama wanted to do, but Wyoming justified it in part by saying the federal governmentunder Obama and, by extension, his presumed successor, Hillary Clinton, couldn't be trusted to fulfill its commitments on Medicaid.

Other states weren't so ideologically rigid. They recognized the opportunity afforded by Medicaid expansion on the federal dime, and they leapt at the chance. Vice President Mike Pence, mow a heated critic of Obamacare, seized the opportunity when he was governor of Indiana, for example. He took the Obamacare money, set up some specific requirements in his state, and 345,000 more Indiana residents now have insurance.

During the presidential campaign, Donald Trump said repeatedly that he would replace the Affordable Care Act with "a fantastic plan that means insurance for everybody," and similar promises to that effect. But the plan put forth under the primary leadership of House Speaker Paul Ryan would, in the calculated estimate of the Congressional Budget Office, lead to 24 million fewer people with insurance less than10 years from now.

The biggest reason is Medicaid. If the GOP plan were implemented exactly as described, millions of people who now are insured under expanded Medicaid would lose that benefit unless states picked up the tab. Most states can't do it.

Wyoming spurned the chance to insure at least 15,000 more residents by rejecting Obamacare. But the new law wouldn't even give us the chance to decide, because the expanded Medicaid opportunity would be eliminated.

Looking at the proposed law, it turns out the Wyoming critics were right when they said the federal government couldn't be trusted to fulfill its promises on Medicaid -- but neither Barack Obama nor Hillary Clinton can be blamed for it.

What is the point of the new legislation? If, as Trump vowed, it is "insurance for everybody," then there is a heck of a lot of work to be done before any claim can be made that the new clothes fit any better than the old ones did.

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2017-10-22