If you’ve been following the Obamacare repeal and replace struggle, you know this much: The GOP-backed bill that passed the House won’t become law. It’s DOA in the Senate. Senators are crafting their own version.
But that House bill, known as the American Health Care Act, was valuable because it reminded us of a larger truth about the 2010 law President Barack Obama championed: America has not one Obamacare population, but two.
Twelve million people enrolled in Obamacare to obtain insurance in state or federal marketplaces, often with subsidies to help them afford it. They now face a toxic combination of rising premiums, narrowing provider networks and a fast-dwindling number of insurers. It’s fine to support Obamacare as-is, provided you also acknowledge it’s been unraveling for years and now risks leaving those 12 million people with no health coverage.
The House would allow states more flexibility in letting insurers tailor programs and prices to appeal to a wider number of customers. But those insurers also could charge people with pre-existing conditions more.
But there’s another population: the 11 million newly eligible people who gained Medicaid coverage under the Obamacare expansion. Don’t confuse this with the marketplace exchanges that connect the first Obamacare population with private insurers; the Medicaid beneficiaries have coverage largely because Washington has given a lot more money to many state Medicaid programs. The health law’s generous federal assistance persuaded Illinois and other states to expand their rolls. Some 650,000 Illinois residents gained coverage via that infusion of federal dollars; today 1 of 4 Illinoisans is a Medicaid beneficiary.
But the House GOP plan phases out that increased federal assistance starting in 2020 while making dramatic changes in the way the federal government funds the overall program. That’s another red flag for some Republican senators, particularly those in states like Pennsylvania and Ohio, which expanded Medicaid. Those lawmakers want a less draconian rollback of the Medicaid expansion. Remember, though, that now-U.S. House Speaker Paul Ryan has warned for years that, no matter which political party controls Washington, the huge federal subsidy for state Medicaid programs surely wouldn’t, couldn’t, survive.
So states that expanded Medicaid likely will face a dilemma: Pay more to keep insuring people who gained coverage via Obamacare. Or change the rules — possibly reverting to pre-Obamacare days? — so that thousands are no longer eligible. That sounds harsh, but there’s another way to think about this: Medicaid was designed to help the neediest Americans, not able-bodied adults capable of holding jobs. Many states are reshaping their Medicaid programs to preserve the safety net for the neediest, while providing a more temporary safety net for others who can be job-trained or encouraged to find work so they can buy their own coverage.
Illinois should be launching an aggressive post-Obamacare strategy on Medicaid now.
Senate leaders say they hope to have an Obamacare replacement bill as early as July. Meanwhile, for lack of new instructions from Washington, the private insurers that remain in Obamacare are working on plan offerings and prices for 2018.
But never forget how shaky the old system is. An effective Obamacare replacement law is not elective surgery. Congress and the president have to get this done.
It’s essential to affordable, quality health care coverage for millions of Americans. Surging health premiums, shrinking networks of doctors and hospitals, and all those fleeing insurers are signs of intense distress.
They’re severe symptoms of a law that doesn’t work as promised. If nothing is done, those symptoms only intensify.
Senators, move America beyond the House bill you dislike.
And you, Illinois’ governor and legislators: What’s your plan for reshaping Medicaid if and when Washington changes the rules?
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