It's complicated ... so let's simplify

Republican members of Congress are catching hell from constituents after their votes to repeal the Affordable Care Act and replace it with ... well, something different. The bill that eked through the House made a lot of changes in federal health care regulations. One of the most significant of the changes eliminates the guarantee that a pre-existing condition will not prevent you from getting health insurance. Instead of Obamacare's blanket prohibition against discrimination against people for pre-existing conditions, the new GOP rules would make insurance available to people with epilepsy, cancer, diabetes, heart conditions, etc., but only after a waiting period and only at much higher costs, if at all. An estimated 20 million-plus people would die in the next decade because of these changes.

"Obamacare" was passed on a party-line vote seven years ago in an attempt to standardize health insurance nationwide by setting standards that health insurers were required to follow -- free birth control and other services; pre-existing conditions could not be excluded from coverage, all policies had to cover maternity care; health insurers could make only so much profit; etc. Meeting all the requirements of the ACA strained health insurers, leading many to forgo writing policies in some states or to pull out of some places after finding their premiums did not cover costs.

As new-President Trump admitted, "Who knew health care could be so complicated?" Well, the Democrats who tried to pass health care mandates in 1993 and finally succeeded in 2010 knew. Health insurance is an arcane, complicated business. Throwing government regulation into the equation made it more so.

My prediction is that the health care plan that comes out of the Republican-led Senate will not satisfy consumers. The Affordable Care Act tried to make the system work by mandating coverage, penalizing with tax penalties those who refused to sign on and subsidizing those too poor to afford premiums. Doing all that requires a lot of regulations and a lot of monitoring. Mandating coverage creates a large enough pool, most of whom are healthy, that the costs are evenly and fairly distributed.

Instead of increasing the complexity of health insurance, why not simplify it? The way to do that is though a federally run health insurance program (like Medicare). Every employee and every employer would pay into the system, but every employee and employer would no longer have to pay private health care premiums. A single-payer system would enjoy great economies of scale and could operate more efficiently than the hundreds of scattered insurance companies and agents across the country.

Everyone would get the same coverage and pay a standard amount with the wealthiest and/or most unhealthy paying more. This system works well in England, France, Canada and most western nations. It works because if the entire population is in the "pool," the healthy can help pay for the care of others without exploding premiums.

The reason to pass a single-payer health-care plan is not because there is a "right" to health care (the Constitution is silent on this issue). It should pass because anything else is either too complicated or too controlled by a greedy health-care and insurance industry that sees sick patients as sales to be maximized.

Freedom Caucus sells out constituents

The House Freedom Caucus succeeded yesterday in stopping a vote on the Republican bill to replace the Affordable Care Act. Even after President Trump met with the coalition and begged them to come around and allow the bill to pass, the caucus refused. They wanted more concessions. Already, they had wrangled enough concessions out of the GOP leadership to frighten some more moderate members of the party.

The Freedom Caucus leaders criticized the GOP replacement for the ACA as "Obamacare Light." They wanted more than just a halt to some of the essential elements of the ACA; they wanted every vestige of the 2010 legislation ripped from federal law. A ban on pre-existing conditions as grounds for refusing coverage? Out! Allowing 26-year-olds to remain on their parents' insurance? Gone! Coverage of contraception? No! Coverage of mental health as well as physical health? Nope! Limits on higher premiums for older people? No way! Ending limits on lifetime coverage? Out!

The Freedom Caucus is getting its way (even as Republicans in and out of Congress work to find a way to shove their bill through the House), but Republican candidates everywhere might rue the day when the Freedom Caucus succeeded. For all the criticism of "Obamacare" and the GOP's ridiculously redundant votes to repeal "Obamacare," much of the legislation in the ACA has been quite popular. As Americans pay more attention to the details of the law that is being eliminated, it is growing in popularity, even as conservatives in Congress try to eliminate any clause that has any resemblance to the ACA. 

Republicans have a quandary. They can vote to destroy every whiff of "Obamacare" and hope the electorate does not rebel against the loss of decent health insurance coverage, or they can leave the ACA or popular parts of it in place and face questions about why they wasted time voting against the ACA dozens of times but couldn't pull the trigger given the opportunity, at last, to destroy it.

The Freedom Caucus, a basically Libertarian organization, has taken an odd role as the defender of insurance companies' profits. Instead of quashing government intrusions into personal lives (the Libertarian philosophy) and cutting federal spending, the Freedom Caucus is demanding changes that hurt individual taxpayers and benefit wealthy insurance companies.

Have the high principles of the Freedom Caucus been sold out to the insurance industry's billions in campaign donations?

Supreme Court resuscitates health care act

The U.S. Supreme Court, to the surprise of many, validated the Affordable Care Act Thursday. The 6-3 decision held that it was not the intent of Congress to limit subsidies for health care premiums to only those states with state health exchanges. Residents of states without exchanges, who had to go to the national health exchange to get coverage, would continue to receive subsidies under the ACA. Chief Justice John Roberts provided a key vote and wrote the majority opinion.

Ironically, then-Sen. Barack Obama had voted against Roberts' nomination to the Supreme Court. Now Roberts has twice saved Obama's signature legislation. Three years ago, Roberts' perception of the statutory penalties for not buying health insurance as a tax saved the ACA.

Republican opponents of the ACA immediately jumped on Thursday's decision, declaring that the ACA was "broken" and would have to be repealed in its entirety. None of the GOP spokesmen explained how the legislation was "broken," which seemed to be an odd description considering the millions of people who have signed up and who are receiving health care insurance because of the 2009 legislation.

Republicans may get their chance at repealing the bill if they retain control of Congress and can win the presidency. Congress has taken dozens of votes to repeal the act, but none of them have taken effect because they could not pass in the Senate or because President Obama would veto the repeal if it ever passed Congress.

A controlling majority in the Senate and continued control in the House could make it possible for repeal legislation to pass after the 2016 election. If voters put one of the dozen or more GOP presidential candidates in the White House, then the ACA could be repealed without threat of veto.

But would GOP leaders really go that far? Already millions of Americans are depending on the ACA for health care coverage. Repealing the act would revoke their health insurance, and that would certainly pose a political risk for the party responsible for taking away a benefit Americans want and need, especially if the GOP has no alternative legislation — only a vitriolic hatred of "Obamacare."