Obamacare repeal advocates haven’t offered good alternatives
By Michael Pramenko
“If you like your health insurance, you can keep it.” These words will continue to be played over and over again in 2014, as health reform remains a major political football.
The fight over Obamacare has consumed politics for the last four years. And, being an election year, 2014 promises to be no different.
There is no question that President Barack Obama took it on the proverbial chin with the initial failed roll-out of the federal government’s health care exchange. Certainly, several of the state-run health care exchanges had similar difficulties. For example, Oregon’s state-run health exchange is still limping along and Maryland’s might need major reconstructive surgery.
Given the troubled roll-out and sudden loss of insurance that many individuals experienced as their non-grandfathered health plans were dropped, political scorekeeping would certainly grant some momentum to the anti-Obamacare politicos.
Nevertheless, as a physician and a student of health policy, I’m still frustrated by the lack of detail from Obamacare critics with respect to their “repeal and replace” policy.
Sure, I’ve heard about selling insurance across state lines and plans for reducing defensive medicine. But, these ideas still leave the uninsured and under-insured without the consumer protections that Obamacare provides.
To truly address the problem, one must separate the politics from the policy — a nearly impossible task as most Americans now view health reform through a political lens foisted upon us by the media. That is unfortunate. Patients rely on policy — not politics.
✔ Current policy under Obamacare now allows people with pre-existing health conditions guaranteed access to health insurance.
✔ Current policy outlaws lifetime caps on how much insurance companies will pay when a patient is faced with a catastrophic health problem.
✔ Current policy, to date, has now enabled over 2 million Americans to be covered by private health insurance via Obamacare. Expanded Medicaid covers many more.
✔ Current policy does not allow health insurance companies to sell junk insurance policies designed more for their shareholders than for the patient.
What might seem like a wonderful political football in January may look entirely different when the leaves turn color this fall. Over the course of this year, millions more Americans can and will sign up for health insurance.
By Election Day 2014, repealing Obamacare would mean revoking the insurance coverage for millions of Americans. And in this case, it will not be because of grandfathered-verus-non-grandfathered health insurance policies.
For conservatives, repealing Obamacare will intentionally, and with great exuberance, remove folks from their health insurance or Medicaid.
Seriously, it appears many conservative candidates will be campaigning this year to make sure that many Americans do not have health insurance. With some Americans having private insurance for the first time in their lives, it seems an awkward political stance. For some Americans who have pre-existing health conditions, it seems borderline immoral. Have party leaders thought this out?
Apparently not. Now, nearly four years after the passage of Obamacare, Americans are still left wondering what exactly the plan is for replacement after the repeal. After repeated Republican House votes to repeal Obamacare, there has not been one vote cast on a replacement. Aside from several “band-aid” proposals, we have not been presented a true choice from conservatives regarding comprehensive health system reform.
Meanwhile, our leaders could be working together to make Obamacare work better by filling coverage gaps, instituting cost-control measures and addressing defensive medicine.
So, as we continue this debate into the next cycle of elections, I would encourage thoughtful voters to ask candidates what their alternative plan would be to Obamacare. It’s not an easy task. A genuine alternative, allowing for coverage of pre-existing conditions for those previously uninsured, is not simple policy and it is not simple politics.
For now, we must assume that the “repeal” proponents favor pre-Obamacare insurance industry tactics. And, for now, the politics that defines much of conservative policy on health care could be stated as: “If you like your new health insurance, we’re trying to repeal it.”
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.