When it comes to health care, America keeps getting let down by its leaders. President Donald Trump’s executive order Thursday undermining the Affordable Care Act is just the latest example. If he can’t repeal and replace it, he’ll gut Obamacare one order and one budget cut at a time. Yet presidents whipsawing health care from one political extreme to another is no way to govern — or ensure stability of a system we all depend on eventually.
This isn’t to heap praise on the ACA. While it deserves kudos for helping 20 million Americans get access to health care through expansions of Medicaid and subsidized insurance, the law’s reforms left America’s bloated, complex and inefficient health care system intact. And while conservatives decry “socialized medicine,” public funds covered more than 64 percent of total U.S. health care costs in 2013. Despite spending more taxpayer money per capita on health care than nations with single-payer systems, America’s system yields worse health care outcomes than those seen in other wealthy nations.
Americans would have been better served had President Barack Obama and the Democrats who controlled Congress in 2009 and 2010 sought to start from scratch, copying simple, outcome-driven health care systems that have worked well in France, Taiwan and other nations. Instead, concluding drastic change was impossible, Democrats came up with the ACA.
But while Obamacare did sharply reduce the number of uninsured Americans, its flaws are plain — starting with the fact that it’s so easy for individuals who are required to buy health insurance to avoid the obligation. Given political resistance and the fact that the ACA needs heavy buy-in to keep premium costs down, Obamacare was always shaky.
This weakness is why Trump’s executive order — which allows for cheaper health plans not subject to Obamacare regulations — could trigger an insurance “death spiral” in some states.
Having cheaper plans will help healthy people who have struggled with Obamacare’s costs. But it inevitably will mean higher premiums for more expensive plans that provide ACA-level coverage — coverage which many sick Americans sorely need. To keep down overall costs, ACA insurance pools need plenty of healthy enrollees. Trump’s order makes that unlikely. Since many ACA-compliant policies have the triple burden of high premiums, high co-pays and high deductibles, healthier people are likely to flock to cheaper coverage.
And even though they save money, these individuals could be at risk as well. California Insurance Commissioner Dave Jones warns that allowing non-ACA compliant health plans will “promote a race to the bottom, where insurers choose to incorporate in the state with the weakest laws and requirements providing the fewest benefits and skimpiest consumer protections.” Unfortunately, this risk is not something that seems likely to bother the president.
Even more unfortunately, too many Republicans will see Trump’s executive order as a victory. But it’s hard to see how a wealthy nation making health care more costly for the sick and vulnerable is shrewd governance for any political party.
Instead, the cruelty of this plan is fresh testament to the wisdom of starting from scratch in building a humane health-care system that takes care of more people for less money.
— The San Diego Union-Tribune
