Point and Counterpoint: Health Care

Though Far From Perfect, ACA Is a Good Starting Point

Before passage of the Affordable Care Act (Obamacare), too many people simply went without medical care, declared bankruptcy because of huge medical bills, or utilized expensive emergency rooms for routine health care problems. And not enough younger, healthier Americans purchased insurance to help spread the risk.

Obamacare solved some of these problems, but not all. There were successes, especially in the early years. Overall, insurance companies were making a profit, emergency room visits were down, and many young adults, up to the age of 26, were able to remain on their parents’ policies.

And in the state of New York, where the ACA has been fully embraced and managed as it was designed, the uninsured today make up just a tiny fraction of the population, a bit over 5 percent.

The ACA may well have been a better product if the Republicans had chosen to engage in the crafting of it. But since they declined — and immediately starting attacking it — we’re now faced with a conundrum.

Americans have clearly demonstrated they want the ACA. And they want their leaders to figure out how to fix it. Yet how do those Congress members, committed to killing a law they have detested for nearly a decade, suddenly find the energy and enthusiasm to help craft a better version?

And what of those on the other side, who fought so hard to keep the ACA from being repealed? How do they muster interest in working with those they believe do not have the heart or commitment to do the difficult and painstaking work of creating a better ACA?

First and foremost, Republicans need to figure out how to respectfully work across the aisle with the opposition party. The Democrats did the heavy lifting in giving America the ACA, and they fought hard to keep it. If the Republicans are truly interested in fixing it, they need to come to the table prepared to work with Democrats who are offering concrete solutions.

As many Democrats warned, Obamacare is not a problem-free answer to this country’s health care issues. Though there are some Dems who believe that if the president would cease threatening to withhold cost-sharing subsidies to insurers and enforce the rules regarding the purchase of insurance or payment of penalties, the law would work just fine.

Other Democratic leaders think there are parts of the ACA that do need some tinkering. Among their suggestions are higher subsidies and the addition of a “copper” option, beneath bronze in the list of plan choices. This plan would have cheaper premiums and higher deductibles and would be marketed to younger, healthier folks, encouraging them to purchase some form of basic health insurance.

In addition to the suggestions mentioned above about ways to strengthen and improve the ACA (there are dozens more that have been put forward by Democrats across the country) here are additional steps that I believe our lawmakers should seriously consider:

— Shore up the insurance markets. About 200 companies left the markets because the plans they offered provided almost no coverage and the ACA forbid the sale of them. Many of the states that had few choices in insurance providers before Obamacare still have few choices.

— Add a public option to the insurance markets. It would help drive down costs.

— Tell states to immediately expand Medicaid. This act alone will help stabilize hospitals, particularly rural health centers, which still have to provide care even when there is no avenue for reimbursement.

— Allow Medicare to negotiate lower drug prices. It is ridiculous that the VA can bargain with drug companies but Medicare cannot.

While it may be a less-than-perfect vehicle, the ACA has been a much needed starting point in addressing a host of entrenched problems. Check out the Commonwealth Fund’s most recent performance rankings on health care systems worldwide. Of all the wealthy nations, the United States ranks dead last on most measures. It should be manifestly shameful to every American that the United States spends as much money as it does on health care and ranks this low.

Yet it is still a very useful document if we pay attention to what it is saying. Essentially it reports that we still have a considerable amount of work to do to repair our broken system. But it offers us enough successful models to study so that ultimately — if we create fixes in the existing law, continue and build upon those favorable outcomes now taking place under the ACA, and perhaps borrow from what has worked in other countries (the Netherlands has a successful model similar to Obamacare) — the United States could have a health care system that insures everyone and is second to none.

The ball is in your court, congressional Republicans. Will you cooperate with the Democrats to build a better ACA and a healthier America?

(To view this article, and Mr. Rowerdink’s opinion, click here)