Morning Briefing
Summaries of health policy coverage from major news organizations
Opinions On Fixing Obamacare And The Health System: It's Time, And Walking Away Is Not An Option
Utterly flummoxed last week, after only seven years to prepare their promised repeal and replacement of Obamacare, House Republican leaders proclaimed new worlds to conquer -- or just as likely, to be conquered by -- and expressed a desire to move on, most likely to tax reform. (Kevin O'Brien, 3/31)
It's unsettling that President Donald Trump seemed to treat the failure of his plan to repeal and replace the Affordable Care Act like a business venture that had soured. Oh, well, on to the next entrepreneurial adventure, which he said would be tax reform. OK, but who's going to clean up the mess left by the Kill Obamacare fiasco? The law still has flaws that need to be fixed, and they can be without repealing the statute and starting over again. (3/31)
Republicans often suggest that Obamacare is 鈥渃ollapsing鈥 without ever acknowledging the role they鈥檝e played in undermining the law and the state insurance exchanges it created. They have an opportunity now to do even more damage to those exchanges 鈥 and to their constituents 鈥 by reneging on Obamacare鈥檚 commitment to help low-income Americans afford care. Congressional Republicans set up this situation by trying to evade an obligation Congress created in the 2010 law (also known as the Affordable Care Act). The law makes low-income Americans who are not covered by an employer鈥檚 group plan eligible both for tax credits to lower their premiums and for subsidies to reduce their out-of-pocket costs. Without that assistance, poor families may not be able to afford to see a doctor even if they have insurance. (3/31)
Within hours after taking the oath of office, President Donald Trump executed his first official act: an executive order redeeming his campaign pledge to, on 鈥渄ay one,鈥 begin repeal of the Affordable Care Act (ACA).1 The New York Times characterized his action as itself 鈥渟caling back Obamacare,鈥 and the Washington Post said the order 鈥渃ould effectively gut [the ACA鈥檚] individual mandate鈥 to obtain health insurance coverage. But consumer advocate Ron Pollack dismissed Trump鈥檚 action as 鈥渕uch ado about very little.鈥 (Timothy Stoltzfus Jost and Simon Lazarus, 3/29)
Here鈥檚 a radical idea for reframing the health-care debate on the ruins of the GOP鈥檚 half-baked plan: Let鈥檚 listen to doctors rather than politicians. And let鈥檚 begin with a simple formula offered last week by the National Academy of Medicine: 鈥淏etter health at lower cost.鈥 Better and cheaper. It鈥檚 hard to argue with that prescription. Because the real health-care crisis in America is about delivery of care, more than the insurance schemes that pay the bills. Costs are continuing to rise, even as public health in America declines. We鈥檙e getting less for more. And the GOP鈥檚 proposal to starve Obamacare will make that downward spiral worse. (David Ignatius, 3/30)
The recent Republican debacle on health care could prove to be an opportunity. It highlighted, yet again, the complexity of the U.S. system, which continues to be by far the most expensive and inefficient in the advanced world. But President Trump could actually use the legislative collapse to fix health care if he went back to basics and to his core convictions on the topic, which are surprisingly intelligent and consistent. (Fareed Zakaria, 3/30)
Shortly after the election in November, the incoming Trump administration and the Republican leadership in Congress decided on an approach that was risky, and proved to be fatally flawed. They wanted to move rapidly, before opposition could coalesce, to pass a repeal-only bill using budget reconciliation so that Republicans could muscle it through the Senate without needing any Democratic votes. After passing repeal, with a delay of two or three years for terminating key provisions of the ACA, the plan was then for Congress to take its time to bring forward a replacement plan, perhaps broken up into several different bills addressing different features of the health system. (James C. Capretta, 3/31)
When Speaker of the House of Representatives Paul Ryan鈥檚 plan to repeal the Affordable Care Act and replace it with a hastily crafted alternative was scuttled last week, two things became clear. First, after seven years of decrying 鈥淥bamacare鈥 and more than 50 votes to amend or repeal the health care plan, the GOP had failed to craft a palatable replacement. The American Health Care Act instantly became a historically unpopular piece of legislation, with just 17 percent of the public favoring the plan in polls taken just before its consideration by the House. (3/31)
Repeal-and-replace (for Obamacare) is not quite dead. It has been declared so, but what that means is that, for now, the president has (apparently) washed his hands of it and the House Republicans appear unable to reconcile their differences. Neither condition needs to be permanent. There are ideological differences between the various GOP factions, but what鈥檚 overlooked is the role that procedure played in producing the deadlock. And procedure can easily be changed. (Charles Krauthammer, 3/30)
I had the great fortune to chat with my daughter鈥檚 preschool class last week about what I do as a health care ethicist 鈥 not the easiest thing to explain to 5-year-olds. I decided to talk with them about fairness and then play a game about resource allocation that seemed apropos of discussions we are having in the United States about health care. (Ryan F. Holmes, 3/29)