Affordable Care Act is grounded 
in principles once endorsed by GOP

By Michael Pramenko

Guilty. Guilty as charged.

After my recent columns describing the benefits of Colorado’s upcoming health insurance exchange, I was accused of partisan cheerleading. Here is my mea culpa.

True, I purposefully highlighted two partisan elements of the Affordable Care Act. More specifically, my latest columns defended the individual mandate and the new health insurance exchanges.

Indeed, both of the concepts originated from the Republican side of the aisle. So, please excuse my partisan bias and my apologies to all the liberals out there that would prefer a single-payer system. 

Colorado’s version of a health insurance exchange passed through the Colorado Legislature two years ago in bipartisan fashion. At that time, Republicans in the state controlled the House. And, long before it became law here in Colorado, the concept of a health exchange was regularly touted as a principle component to Republican plans for health reform. 

The individual mandate has even more impressivee Republican origins. Starting out in 1989 at the conservative Heritage Foundation, the individual mandate was once used regularly by Republicans as a reasoned alternative to the health reform plan proposed by then President Bill Clinton.

Here’s the deal. There remain two legitimate models that allow for our fellow Americans — who either can’t afford insurance or are too sick to obtain it — to qualify for insurance:

✔ A single-payer health care system.

✔ A private system with subsidies to address the affordability issue and guaranteed issue requirements to ensure pre-existing health conditions can’t be used by insurance companies to deny coverage.

Critics of both choices should be consistent with their politics and policy. If you don’t want either of the two options, then should you not be advocating for removal of access to America’s emergency rooms for those that can’t pay for the service? No money – no care.

As I have written repeatedly over the last five years, America’s emergency rooms are the most expensive “universal” health care system on the entire planet. We are all paying for their overuse via increased insurance premiums. In effect, this is a “tax.”

A reformed health care system will guide people away from expensive emergency rooms for non-emergency care to patient-centered provider clinics. The individual mandate and the insurance exchanges move our health system in that direction. 

Access to affordable health care should not be considered a liberal idea. It’s a human idea. It’s an idea consistent with advanced civilization. It’s an idea endorsed by the American Medical Association, Colorado Medical Society, Club 20 and numerous other organizations in Colorado. 

Finally, don’t take my word for it. Check out the following excerpt from an opinion piece written by J.D. Kleinke of the conservative American Enterprise Institute. His opinion piece in The New York Times last Sept. 29 included this observation:

“The core drivers of the health care act are market principles formulated by conservative economists, designed to correct structural flaws in our health insurance system — principles originally embraced by Republicans as a market alternative to the Clinton plan in the early 1990s.”

The concepts are solid — we are wasting time on politics. We should be focusing our current efforts on fixing the real Holy Grail of any health reform plan — cost control. Certainly, excluding people from health insurance and access to care is not the answer.


Michael J. Pramenko M.D. is the executive director of Primary Care Partners. He serves on the Club 20 Health Care Reform Committee and is a past president of the Colorado Medical Society.


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Dr. Michael Pramenko’s guest column – “Affordable Care Act is grounded in principles once endorsed by GOP” (August 11, 2013) – and today’s timely editorial – “Obamacare at risk?” – accurately bracket the real threat to affordable health care for millions of Americans:  unprincipled partisanship.

If “the law’s problems” are only “growing pains” typical of any grand new government program, then Congress is remiss for not already “tweaking” the Affordable Care Act to quickly ameliorate them.  If those problems are more serious, then Congress is derelict for not intervening to avert the predicted “train wreck”.

As Dr. Pramenko explained, in addition to the financial collapse and two wars President Obama inherited from his Republican predecessor, he also faced accelerating health care costs impelled by profit-driven providers and health insurer’s who gouged their insureds while investing millions in “death panels” devoted to denying claims.

Because rising premiums and health care costs threatened to bankrupt the “middle class” and Medicare/caid, “doing nothing” was never a choice.  Liberals wanted “Medicare for All” – a “public option” that would have freed employers from health insurance costs, raised taxes, and essentially eliminated private health insurance companies.

Republicans long-advocated a more market-driven approach—which co-opted existing for-profit insurers by imposing individual/employer “mandates”, was successfully implemented in Massachusetts (“RomneyCare”), and was the model for “ObamaCare”. 

Now, hypocritical House Republicans are reluctant to hold oversight hearings on the implementation of “Obamacare” – lest doing so publicly promulgate its benefits and confirm that recent “problems” are ultimately insignificant.  These saboteurs – including Scott Tipton—would rather demagogue “ObamaCare” for partisan political advantage than fix it. 

Instead, irresponsibly opportunistic Republicans are cynically inciting inter-generational divisiveness between younger/healthier Americans—whose premiums are essential to the “risk pool”, and older/sicker Americans (and especially, women)—who are already benefiting from access to more affordable health care.

Critics of Club 20 should know that its Educational Foundation performed an invaluable public service yesterday by hosting a “Regional Health Care Forum” – attended by such “notables” as Tillie Bishop, Kathy Hall, and County Commissioner John Justman.

While Congressman Tipton has repeatedly voted to de-fund and/or repeal it, and while Republican congressional leaders dissuaded the N.F.L. from partnering in “p.s.a.’s” to educate Americans on their new health insurance options, many local community leaders recognize that the Affordable Care Act is already – and will remain—“the law of the land”, and that both individuals and businesses need to be better-informed about it. 

Hospice Director Dr. David West traced the evolution of the Grand Valley’s progressive and cooperative health care delivery mechanisms – highlighting both its unique and nationally-recognized strengths and remaining weaknesses (including costs).

Against that background, Linda Gann, Western Slope Outreach Coordinator for “Connect for Health Colorado”, outlined the plans that will be available beginning in October on its insurance exchange website.  While the “devil is in the details”, and final premium rates are not yet published, “Connect-Colorado” seems well-ahead of the Nation.

The combination of competitive insurance exchanges and individual/employer mandates – the market-based approach proposed by the conservative Heritage Foundation in 1992, successfully implemented as “RomneyCare” in Massachusetts in 2006, and embraced by Governor Owens’ “Blue Ribbon Commission on Healthcare Reform” in 2008 (in which Club 20 actively participated and endorsed) – is also the crux of “ObamaCare”.

Despite continuing political “noise”, the beneficial local impacts of the Affordable Care Act will likely be substantial – enabling both the Marillac Clinic and Family Health West to expand their services, and perhaps their facilities.  Hopefully, the increased availability of both basic primary care and mental health services to the previously uninsured and/or impoverished will also work to lower Mesa County’s unfortunately high suicide rate.

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