Repeal and replace. These two words have been echoing through the halls of Congress and on the campaign trail for years. Since its enactment, the Affordable Care Act (ACA) has survived two Supreme Court challenges and more than 60 repeal votes. But, with Republicans running the House, Senate and Oval Office, most people felt it was just a matter of time before this campaign promise became a legislative reality. Not so fast.
With the latest attempts to give ObamaCare a little “R&R” hanging on by a thread, it appears that a few Republicans are coming around to a more open process while some are still set on repeal. So why is the commonsense approach of repairing ObamaCare, as Sen. Chuck SchumerChuck SchumerPricing methane and carbon emissions will help US meet the climate moment Democratic senator: Methane fee could be 'in jeopardy' Manchin jokes on party affiliation: 'I don't know where in the hell I belong' MORE (D-N.Y.) called for this week, still not on the list of options to help solve issues like high deductibles, rising premium costs and availability of insurers? Well, it's political, especially when the consequence of repeal is kicking up to 32 million people off insurance.
The other fact is that most of the people who voted for the repeal of ObamaCare will be negatively impacted by the dissolution of coverage of pre-existing conditions, preventive care, essential health benefits, kids up to the age of 26, mental health and rehabilitation services. Since “repeal and replace” is a non-starter for Democrats and 50 percent of Americans, here are a few ways that Republicans can reach across the aisle to repair ObamaCare and successfully fulfill their duty to do what’s best for their constituents, politics aside.
The biggest and most meaningful fix to ObamaCare is to authorize the cost-sharing reductions. These are the subsidies provided to insurers to help share the cost of premiums for low-income consumers and one of the real reasons we are seeing many carriers pulling out of markets and limiting choice.
As it stands, Republicans have the CSRs tied up in legislative limbo and it is unclear if the Trump administration will approve these payments. The President’s recent vow to “let ObamaCare fail” doesn’t do much to restore confidence among carriers. But if the intent behind the repeal and replace promise is more than just politics, then this move will help millions of Americans struggling to pay premiums and thousands whose carrier options are limited to one or none.
Second, instituting a public option or re-committing to the insurance co-ops for those Americans who find themselves without affordable options for care is another way we can win for Americans. As one of the architects of the ACA, I saw first-hand the support for the public option that never saw the light of day due to lobbying and politics.
I also saw how the co-ops where non-profits can use federal funds to establish insurance pools were underfunded and quickly fell by the wayside. Bringing either (or both) of these ideas to the table will help expand choice and bring down costs. Requiring those insurers who participate in Medicaid and Medicare to also offer individual health plans through the ACA exchanges is another option for stopping this alleged “death spiral.”
Last, and this is more about the process, but transparency and inclusion are the pillars of legislative success on healthcare. Secrecy and exclusion caused the failure of “Hillary Care” in the 1990s and will ultimately prove detrimental to the recent Senate efforts. The ACA became law mostly due to its open and thoughtful process.
It was hashed out over several months in the public arena and everyone — yes, even Republicans — contributed to the process. Reconciliation (yet another dreaded “r” word) is often used to circumvent the usual legislative process and should never be used to restructure major entitlement programs like Medicaid. No matter how politically expedient.
A campaign promise is a campaign promise. But the fate of ObamaCare impacts every single American, not just those who voted for the other side or those who get their coverage through the exchanges. If the goal is to ensure everyone has affordable coverage, then repairing and building is the only course of action. But if the goal is politics as usual, legislators should shoot straight with Americans who are only asking for their interests to come before doomed campaign promises.
Daniel E. Dawes is the executive director of health policy and external affairs at Morehouse School of Medicine and a lecturer within Morehouse's Satcher Health Leadership Institute and Department of Community Health and Preventive Medicine. He founded and chaired the National Working Group on Health Disparities and Health Reform and is the cofounder of the Health Equity Leadership and Exchange Network. He is also the author of the new book “150 Years of ObamaCare.”
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