Troubles remain for health-care proposal

It’s too early to be lining up in favor of or in opposition to the new Republican health care bill. The good news is that the legislative approach allows for debate, which means the final bill may look substantially different if or when it passes than it does right now.

Obamacare was supposed to improve accessibility to health care and make it more affordable while preserving a health insurance market.

What we’re seeing with the GOP plan is the pulling of several levers within a complex system without addressing the core problem, which is keeping the young and the healthy in the insurance market to disperse costs.

The new GOP plan would repeal the current law’s unpopular fines on people who don’t carry health insurance. So there’s no coverage mandate, but there’s a “continuous coverage penalty” — a 30-percent surcharge for people who let their health insurance coverage lapse. This sets up a perverse incentive. Making it more expensive to get coverage is likely to keep people out of the market until they desperately need treatment.

We could end up with risk pools full of very sick people, which could make health insurance premiums even more expensive than they are now — a big problem on the Western Slope.

That’s no better than Obamacare’s biggest shortcoming: sick people getting health insurance, receiving the hospital treatments, then stopping payment on their insurance until they need another procedure. That’s not insurable risk that any actuary could possibly write a policy around. 

This was one of several observations shared with the Sentinel’s editorial board Wednesday by representatives of the Colorado Center for Law and Policy and the Colorado Consumer Health Initiative.

They want to preserve the level of access Colorado has achieved under Obamacare or even improve it. We think that’s a fair goal of any fix for Obamacare. But that can’t happen if Congress limits future federal funding for Medicaid.

The bill effectively ends the Medicaid expansion because Colorado is not going to be able to afford to keep it after 2020, which means 450,000 Coloradans will lose Medicaid coverage, said Elisabeth Arenales of the Colorado Center for Law and Policy

Because the bill puts a fixed cap on the amount of money Colorado can spend on Medicaid, it reduces the flexibility needed to account for the needs of the state and individuals served by the program. The bill also rolls back coverage of children. Even before passage of the ACA, Colorado made the decision to expand coverage for impoverished children. The new bill takes away that option for the state.

These are just a few of the shortcomings of the long-promised GOP cure for Obamacare — and those concerns cross political lines. There are plenty of Republicans who are worried that new tax credits establish new entitlements or that other changes will leave Americans without coverage.

The Republican-led Congress has a unique opportunity to fix Obamacare, but it has to get it right. Without a fix to the foundational problem of very sick people entering and exiting the system, paying into it only when they need treatment, the system will surely crater. And that will lead to calls for a single-payer system.


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