Don't repeal and replace the ACA, rethink it

By Laura McClure 
The Daily Star (Oneonta, N.Y.), March 3, 2017 

Donald Trump and fellow Republicans rode into office, in part, on a wave of understandable anger at our complicated, expensive and unfair health care system. Much of the fury was focused on the Affordable Care Act, also known as Obamacare. Republicans promised to quickly “repeal and replace” the law.

But in a closed-door meeting in Philadelphia just after Trump’s inauguration, GOP lawmakers were filled with doubt, the Washington Post reported. How were they going to get rid of Obamacare without causing millions of Americans to lose their health care coverage? How on Earth were they going to keep insurance premiums affordable? 

Our new local member of Congress, John Faso, was at the meeting. He worried about the political heat he’d get if Republicans tried to defund Planned Parenthood as part of the ACA repeal.

“Health insurance is going to be tough enough for us to deal with without having millions of people on social media come to Planned Parenthood’s defense,” he said. 

Faso is right to be worried about the impact of ACA repeal. Without the law, an estimated 2.7 million New York state residents would lose their health care coverage — including 5,785 people in Otsego County and 4,461 people in Delaware County.

The state budget would take a $3.7 billion hit. (Be aware that if you are getting health insurance through Medicaid or got your insurance through the New York State of Health exchange, your coverage is at risk.) Repealing ACA without having a better plan in place would endanger millions of people. 

But as of this writing, Republicans don’t have a consensus plan for replacing Obamacare. It’s not a comfortable spot to be in, and that’s probably one reason why many Republican legislators appear to be hiding from their constituents. They’re avoiding potentially explosive town hall meetings filled with people who are afraid they’re about to lose their health insurance.

As of this writing, Rep. Faso has scheduled no public events during the Congressional recess, which is usually legislators’ time for connecting with voters. Although Faso voted “yes” on a recent resolution to open up ACA repeal, he says he wants to “fix” ACA rather than repeal it.

Yet “repeal” is still the word on the lips of Faso’s Republican colleagues. Just before the recess, House Republican leaders came out with a sketch of a health plan to give lawmakers something to say to constituents.

The plan would slash the state funding that helps low-income people and their families get health insurance through Medicaid. And it would replace the ACA’s subsidies for insurance with tax credits and health savings accounts — devices that are helpful mainly to people with higher incomes. In other words: if you’re struggling to make ends meet, this plan is scary.

House Speaker Paul Ryan has gone even further by arguing that Republicans should privatize Medicare and turn it into an ACA-like “marketplace” of private plans. This would essentially mean the end of guaranteed quality health insurance for seniors. 

That would be an even bigger catastrophe, and would take us in the opposite direction from which we need to go. Instead of ditching Medicare, we should improve it and expand it. We should replace Obamacare — with Medicare for all. 

The good thing about Obamacare was that it rescued some 20 million Americans from being uninsured. (Though tragically, another 28 million people are still uncovered.) It also forbid insurance corporations, both inside and outside the ACA, from excluding people because of prior health conditions, and it ensured some preventive care.

The bad thing was that rather than repair our broken system, Obamacare propped it up. The plan was a deal the Obama administration cut with the health insurance corporations, the pharmaceutical corporations, and the medical industry: The government would guarantee them more customers by requiring Americans to buy their wares, in exchange for imposing new rules on their businesses.

Propping up our current health care system, and defending ACA as the best we can do, is wrong both morally and strategically. We have the industrialized world’s worst-performing health care system. It is far more costly than any other system, and has poorer results.

Anyone who has to use our health care system extensively (ACA included) knows its nightmarish complexity and irrationality. We slog our way through the inexplicable claims, rules, and exclusions. We sweat over ever-rising premiums, gigantic deductibles, and mounting out-of-pocket expenses. We’re caught in billing wars between health insurance corporations and hospitals, both trying to profit from our illness. Since most of the people who use the health care system heavily are sick, elderly or both, navigating through this expensive mess is overwhelming, if not impossible. 

Republicans’ proposals would make the system even worse by inviting even more profiteers and administrators into the system and by forcing millions more low-income Americans (the great majority from working families) to go without insurance altogether.

Under a single-payer health care system, everyone would be covered through one insurer: the federal government. We’d all have Medicare, which would guarantee coverage for all. Health care itself would still be provided by a range of public, nonprofit, and private clinics, hospitals and doctors. 

A December 2015 Kaiser poll found that 58 percent of Americans support a single-payer plan. Bernie Sanders’ vocal support for single-payer is one reason he beat his opponent, Hillary Clinton, in the Democratic primary in almost every county in upstate New York. (Sanders got 61% of the vote to Clinton’s 39% in Delaware County. In Otsego County, it was 59% to 40%.) 

Believe it or not, Donald Trump once supported single-payer. He wrote in his 2000 book “The America We Deserve:” “We must take care of our own. We must have universal health care … The Canadian-type, single-payer system in which all payments for medical care are made to a single agency (as opposed to the large number of HMOs and insurance companies with their diverse rules, claim forms, and deductibles) … helps Canadians live longer and healthier than Americans.” 

Although Trump has since changed his tune about single-payer, he still seems to crave its results. Just before his inauguration, Trump described his dream health care plan: “We’re going to have insurance for everybody,” he told the Washington Post. “It will be in a much-simplified form. Much less expensive and much better … They’ll be beautifully covered.” Yes. That would be single-payer. 

Democrats and independents, take heart: If you believe in single-payer health care, fight for it. Republicans, join us. You and your loved ones deserve high-quality health care, too. Everybody in, nobody out.