Reality Check

Health Care and an Unreliable Congress

A tragic story of promises made and broken, leaving the American public holding the bag

The Affordable Care Act was passed in 2010. In seven years, no viable alternative to the ACA was developed and vetted by Republicans (instead they waited until December 2016 to begin drafting an alternative that was dead on arrival), and in seven years Democrats failed to proffer any amendments to the ACA that would fix its deficiencies. It is a tragic story of promises made and broken, leaving the American public holding the bag. And of course, while the ACA ship sinks the juvenile blame game continues.

Now, ACA repeal with or without a replacement is being proffered as the Republicans’ next option. Notably, “working together” does not appear to be a consideration. Perhaps this is because the Democrats are obstinate and refuse any type of negotiation. That isn’t what they appear to be saying, but it’s hard to know as we can’t get through the party bickering and sound bites to determine the truth.

What we do know is repealing the ACA without a viable replacement plan will instill chaos in the health care industry. The reason why laws are so difficult to pass and amend is because we rely on them. We plan our personal and business budgets in reliance on income sources and expenses. For seven years, the health care industry and the American public has relied on the ACA, and have modified business practices to adapt to the ACA. We have insurance exchanges that rely on the promises of a federal subsidy in exchange for providing coverage to virtually anyone that applies. Repeal the ACA and those subsidies are automatically extinguished, yet the obligation to provide coverage for those insured under the policies continues. That is an expense the insurers on the exchange did not account for because they relied on the promises made in the law. Montana has chosen to expand Medicaid to 138 percent of the federal poverty line; repeal the ACA and those on Medicaid due to Medicaid expansion automatically lose coverage. And hospitals and clinics lose a payer source that they relied on in creating their budgets. Don’t forget the folks who will lose coverage and then go without preventative health care, relying on over-burdened and enormously expensive emergency rooms for care.

Keeping the ACA in its present form is a recipe for failure as well. It’s simply too expensive – with unreliable insurance premiums – and doesn’t do enough to address the increasing costs associated with health care. Placing more folks on Medicaid creates a source of payment for hospitals and doctors as well as coverage for recipients, but the taxpayers ultimately foot the bill. So Americans with wages above 138 percent of the federal poverty line either pay for care provided to the poor and disabled through taxes or increases in costs to their own health care. Truly, health coverage is a shell game – the costs are always paid, it’s simply which pockets costs are pulled from.

A repeal without a replacement is an ill-conceived haphazard approach and defies concepts of judicious lawmaking. Americans cannot live their lives, and employers cannot continue to invest and re-invest in a country whose laws are unreliable. For the good of the country, I hope a replacement law immediately follows repeal, one that: 1) actually addresses the cost of health care, 2) doesn’t knock folks off of health insurance who want it, and 3) allows emergency rooms to redirect patients to a lower level of care when appropriate without violating federal law.