Clarence Fanto | The Bottom Line: It's time to refine Affordable Care Act, not repeal it


LENOX >> Beware of House Republicans led by Speaker Paul Ryan bearing gifts in the form of a repeal-and-replace health care law, especially at a time when many Americans will have to swallow a bitter pill in the form of sharply higher insurance premiums next year.

The Affordable Care Act has not loomed large during the presidential campaign so far, but in the four months, two weeks remaining, it is bound to, especially if Trump buys into what Ryan & Co. prescribe for President Obama's signature domestic achievement.

"Obamacare" has ailments caused mostly by private, for-profit insurance companies hoping to jack up their rates effective next year by double-digit percentages for most of the plans offered on the national and state exchanges. Other worries include narrowing networks of physicians and hospitals covered by insurers as well as deductibles, co-pays, co-insurance (the patient's share of the bill) and complex rules for prescription payments.

As the insurance companies tell it, they assumed more healthy customers would sign up for coverage, offsetting the cost of caring for sicker patients. But too many healthier folks are choosing to pay the ever-rising income tax penalty instead.

Add to the mix ever-increasing, more complex hospital bills and physician charges. No wonder anyone struggling to make sense of it all may be open to the Republican cure-all, particularly if Trump wins the election.

The 20,000-word Ryan plan, which he labels "A Better Way," calls for so-called health savings accounts, sales of policies across state lines and other familiar formulas that most nonpartisan experts find to be anything but what the doctor ordered. The Republicans also seek a gradual increase in Medicare eligibility from 65 to 67 along with what they call "a fully competitive market-based model known as premium support."

Translation: Medicare premium bills would rise, and support would decline.

The Ryan plan also cuts into Medicaid for lower-income Americans by discontinuing the Affordable Act's expansion of the program, which more than 20 governors have rejected anyway, and leaving it up to states entirely to distribute a limited amount of money for each individual or a lump sum of federal funds for a state's Medicaid program.

Most Americans are still covered by workplace health plans, and their employers would not be spared by the Ryan "cure" that would impose limits on tax-free benefits, The New York Times reported.

"This would be a new tax on benefits, on working families, and could eventually threaten the employer-sponsored health insurance that so many Americans enjoy," according to James P. Gelfand, senior vice president of the Erisa Industry Committee, a trade association for large employers.

Ryan's most dangerous proposal would eliminate the federal requirement that most Americans must purchase health insurance. Instead, people who buy their own insurance would get a flat tax credit, regardless of their health, the premiums they pay or income. This would be a tremendous setback for patients dealing with illness and prescription requirements as well as for anyone of middle income or below.

Even worse: the Republican plan would alter the most popular provision of President Obama's health care law which forbids insurers from denying coverage or charging exorbitant rates for pre-existing medical conditions. According to published reports, anyone who allows an interruption of their coverage would be penalized by higher rates that would factor in a customer's health history.

Want more? Right now, insurers can't charge older Americans who don't qualify yet for Medicare more than three times the rates paid by younger people. The GOP proposal would allow the companies to set rates five times higher or even more, depending on state regulations.

All this could come to pass if Republicans maintain their grip on Congress and capture the White House.

While universal health care, aka "Medicare for All," championed by Bernie Sanders has about as much chance of success on Capitol Hill as meaningful gun control, a more modest yet significant proposal favored by Hillary Clinton could gain support should she win and if Democrats take back the Senate.

That would be the "public option" setting up a government insurance plan to compete with private insurers. When first considered in 2009, the idea won majority public support in opinion polls as well as backing from more than half of physicians surveyed by medical journals. Unfortunately, the option did not make it into the Affordable Care Act.

The latest poll conducted this spring by Kaiser Health shows 49 percent of all adults view the current health care law unfavorably, with 38 percent expressing a favorable opinion. The results are similar to findings a year ago.

The Affordable Care Act needs some fine tuning, at least. The results of the November election will determine whether middle-class and lower-income Americans feel the sting of continuously rising costs combined with stingier benefits, or whether a genuinely better way can ease some of the health insurance burden weighing down on citizens who can least afford it.

Contact Clarence Fanto at The opinions expressed by columnists do not necessarily reflect the views of The Berkshire Eagle.


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