The latest Republican attempt to repeal and replace the Affordable Care Act has failed.
South Carolina GOP Sen. Lindsey Graham, co-sponsor and leading spokesman for the most recent legislation aimed at Obamacare, says the effort is not over. And he is getting support from President Donald Trump, who contends the GOP will win the day on health care, even if not this year.
Graham’s bill would have turned over much of the health care system to the states by taking the same Obamacare dollars and appropriating them in the form of block grants. The concept is to get rid of one big umbrella system in favor of separate systems for each state.
There is no agreement on the merits of such a new system, though reality is that so much differs from state to state now. And what of the continuing forecast of trouble ahead for Obamacare? Graham and others say it will collapse. Even supporters acknowledge there are problems.
Graham and Republicans warn that those looking to fix Obamacare are interested in moving toward a single-payer health care system that makes the government the single payer – essentially “Medicare for all.” So they frown on efforts to “reform” the ACA.
Yet Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., the chairman and ranking minority member of the Senate health committee, had been working on legislation that would address ACA flaws. The focus on the Graham-Cassidy legislation upstaged their work.
As a pragmatist willing to work across the aisle, Graham should be expected at this point to join such bipartisan efforts – even as he stands by his steadfast opposition to a single-payer system and cries foul where proposals will not make real improvements.
He and other senators – Republican and Democrat – could start by addressing immediate Obamacare challenges as identified by the Kaiser Foundation’s Kaiser Health News:
1. Insurers face uncertainty. Wednesday was the deadline for health insurers to finalize rates for the 2018 individual market open enrollment season, which starts Nov. 1. Yet there has been no resolution to the question of whether the federal government will continue to reimburse insurers for subsidies known as “cost-sharing reductions.” Those are payments insurers are required to provide to moderate-income enrollees to help them afford deductibles and out-of-pocket costs. The law says the federal government is supposed to make those payments, but a lawsuit has left that an open question, and the Trump administration has repeatedly threatened to stop making the payments.
2. The Trump administration has cut funding for efforts to sign people up for insurance. Administration officials announced major cuts to the “navigator” program, which provides funding to community groups that guide people through the complex task of signing up for health insurance through the online marketplaces. Some groups are losing more than 90 percent of their budgets.
3. The 2018 enrollment period is half the length of 2017’s, and now it will be shorter still. Trump officials are also slashing by 90 percent the advertising budget that reminds people about open enrollment and how to sign up — from $100 million to $10 million. The cuts are even more significant this year because, for the first time since the law’s implementation, open enrollment for healthcare.gov starts in November, rather than December, and lasts only 45 days.
4. The Trump administration is delaying giving states flexibility to stabilize their markets. In March, Health and Human Services Secretary Tom Price and Centers for Medicare & Medicaid Services chief Seema Verma, who oversees the ACA, sent a letter to states encouraging them to use the law’s waiver process to improve the functioning of their individual insurance markets. In particular, they suggested states could create “reinsurance” programs that would help lower premiums by providing a payment mechanism for the most expensive patients.
But when Minnesota took up that invitation, the administration delayed its response. When it finally did grant permission this past week, HHS also informed the state that it will lose significant funding for a program that provides insurance to the state’s low-income residents.
None of the “fixes” would end the debate over the ACA and its future. Republicans are sure to try again for a replacement, but as long as Obamacare is to be health care system for America, making it work as much as possible is a priority. This is more than a political game.