Our Views: If not that, then what?

As the fall presidential election comes nearer, the need grows for clarity on the part of Republicans about health care and the uninsured.

“Repeal and replace” the new health-care law is a good pithy slogan, but it raises the question: Replace it with what?

That’s not to say that Democrats have all the answers, but they do have in the new health-care law a slew of specific ways that health care should be managed, and with some exceptions there have been changes for the better. No one liked the old system in which people were denied insurance coverage because of pre-existing conditions, for example.

But if that is repealed, how does one put into law protections against the old system coming back? That new provision on pre-existing conditions costs insurers money, and without a mandate to buy insurance, it could seriously erode the finances of every private insurer in the country.

Some GOP bills are floating around on this subject, but few of them have gained any prominence in election-year debate.

Republican candidate Mitt Romney has a checkered history on the issue, having fathered the Massachusetts law that was the inspiration for the new law backed by President Barack Obama.

One of his chief spokesmen on this issue is, not surprisingly, a former state and national health official from Louisiana named Bobby Jindal. The governor said Romney “has focused on creating voluntary purchasing pools, on free-market reforms to make health care more affordable, more portable, more accessible without undermining the private sector delivery system.” Phew. Unpacking this, though, doesn’t seem to us to come up with a bill.

Whatever the outcome of the fall elections — and particularly in the House, most of the betting is that the GOP will remain in control — revisiting health care cries out for a GOP alternative that is more specific.

In a meeting with Advocate editors and reporters, U.S. Rep. Charles Boustany, R-Lafayette, said discussions are going on about fleshing out a GOP alternative to the Affordable Care Act, or what some refer to as Obamacare.

Another doctor in the Louisiana delegation, U.S. Rep. Bill Cassidy, R-Baton Rouge, has proposed specific legislation to deal with the financial structure of Medicaid, the big health care program for the poor.

The Cassidy bill is focused on reimbursing states on the basis of conditions treated and managed, rather than today’s broad national formula for Medicaid aid. It is a significant issue, and Cassidy’s bill seems to be a promising start about how to make day-to-day decisions in hospitals and doctors’ offices more cost-effective.

Still, all this doesn’t add up, yet, to a comprehensive approach to a big national problem. We believe that the issue of the uninsured has not received sufficient attention from the GOP. Those with insurance pay a substantial hidden tax when costs of the care of the uninsured are shifted onto those with private-pay or Medicare.

One of the strengths of the ACA is that it aims to tackle that issue, instead of avoiding it — and that’s why, in several ways, the new law seeks to find a combination of savings and new taxes to pay for what is today a hidden tax.

When the new Congress meets, will there be a GOP alternative? And when the American people cast their votes in November, will there be a Romney alternative?

The opposition has the liberty of opposing, but should it not on health care make some specific promises?

Comments

1) Comment by chem - 25/07/2012

Read the article on the ACA and repeal in Wednesday's Advocate, page 3A.

2) Comment by Whatnow - 25/07/2012

@Warreni, JWT said it for me. "How many broken promises does it take for people to stop believing them?" Everyday the CBO and is finding more and more that we are being sold a lying bill of goods. You want to believe a bunch of know liars, that's your business. But calling me ignorant won't win me over, bud. And DMJ, maybe not THIS particular crop of DEM legislators and czars.

3) Comment by JWT - 25/07/2012

Per the Forced Medicaid expansion - Under the law’s unconstitutional Medicaid expansion, states would have been required to expand their Medicaid program to cover all individuals up to 138 percent of the federal poverty level (FPL) or risk losing all of their federal Medicaid funds. As a result of the Supreme Court’s ruling, states are now free to make their own decisions on the Medicaid expansion. As directed by the law, they can expand their Medicaid programs and receive enhanced federal Medicaid funding for this new population. But a state can also choose not to expand its Medicaid program and no longer risk losing their existing federal Medicaid funds. In essence, the ruling makes the Medicaid expansion voluntary. Obamacare depends on two sources for coverage: the Medicaid expansion for persons with incomes up to 138 percent FPL and the new federal subsidies through the exchanges for those persons between 100 percent FPL and 400 percent FPL.

4) Comment by JWT - 25/07/2012

How many broken promises does it take for people to stop believing them? - Where are you getting the numbers that everyone is insured? - Though the Supreme Court allowed Obamacare’s individual mandate to stand as a tax, it struck down the law’s FORCED Medicaid expansion as unconstitutional. - Since day one, it’s been clear that Obamacare will not achieve universal coverage, and every time CBO revisits the law, the numbers show just that. In March 2010, when the law passed, CBO predicted that there would be 22 million people still without insurance in 2019. In March 2012, the estimate increased to 27 million in 2022. Now, the number has once again increased—to 30 million. So Obamacare leaves just as many people uninsured as it covers. According to a new study from consulting firm Deloitte, almost one of out of 10 employers said they are going to drop coverage for their employees because of Obamacare, while another 10 percent said they “remain unsure” about what they are going to do. The vast majority of Americans have health insurance through their workplaces .But as the CBO said, “what states will be able to do and what they will decide to do are both highly uncertain. As a result…[the] estimates reflect an assessment of the probabilities of different outcomes.” Those outcomes are up in the air, because many of the nation’s governors haven’t decided whether to expand their Medicaid programs yet. States that do may face “a large extra cost,” the CBO said.

5) Comment by DMJ - 25/07/2012

Republicans seem to have wholeheartedly forgotten that the individual mandate was THEIR idea to begin with. This is what happens when a political party is taken over by the base elements of that party. The irony would be amusing if it weren't so bad for the country.

6) Comment by warreni - 25/07/2012

Whatnow: Are you asking a serious question here? This has been answered so many times before that if you don't actually know then you're just wantonly ignorant. When previously-uninsured people have insurance they can get preventative care as opposed to going to the emergency room, which is the only way some people see doctors right now. ERs are required by law to triage and treat all comers. However, emergency care (when conditions have escalated to the point where treatment costs rise dramatically) is almost by definition vastly more expensive than sometimes much simpler and invariably much cheaper preventative care (i.e., catching problems earlier through simple measures like actually going to primary care physician for an annual checkup). Because everyone is insured, this lowers costs for everyone; who foots the bill for expensive emergency-room care? Medical care facilities and providers and taxpayers. Something needs to change dramatically to halt the ever-rising costs of healthcare in this country. Either we need to decide that we're a country of "rugged individuals" who don't give a tinker's cuss about anyone and drop the requirements that people get any kind of care (including emergency care) or we need to seriously look at implementing a single-payer system (put everyone on Medicare or the Congressional health plan). The real problem is that one of the two parties is at least trying to do something to make things better. As the writer points out, the GOP leaders love to be obstructionist, even playing the underdog card when they're lucky enough to be in the minority, but when have you seen them proposing any kind of sweeping legislative or executive changes that are not solely or primarily for the purpose of benefiting the most well-off folks in America? Why does the GOP hate the ACA? Not because of the insurance mandate--that's just a convenient excuse to lure in all of the armchair constitutional scholars--it's because implementing it has and will cost private businesses that fund their campaigns (health insurance companies like United HealthCare) money. The Republicans have no plan of their own and they don't really want one, or we'd have seen it by now.

7) Comment by DMJ - 25/07/2012

8.6, Cassidy's efforts are all well and good, but they have nothing to do with covering the uninsured who don't qualify for Medicaid. That's where the mandate comes in. And that link you keep posting is about how the IRS will withhold your tax refunds if you don't pay the penalty or get insurance. So what?

8) Comment by 8point6 - 25/07/2012

"The opposition has the liberty of opposing, but should it not on health care make some specific promises?" Looks like "our views" passed this article then read it: "Another doctor in the Louisiana delegation, U.S. Rep. Bill Cassidy, R-Baton Rouge, has proposed specific legislation to deal with the financial structure of Medicaid, the big health care program for the poor. The Cassidy bill is focused on reimbursing states on the basis of conditions treated and managed, rather than today’s broad national formula for Medicaid aid." Don't forget this: http://news.yahoo.com/tax-man-cometh-police-health-care- 115736849--finance.html

9) Comment by DMJ - 25/07/2012

Full coverage isn't a fix-all, but it's a fundamental part of the solution. Since the ACA can't actually make anyone buy insurance, perhaps a cultural attitude change is needed. I know lots of people who think health insurance is a scam, who don't care about their credit rating and don't mind leaving hospitals on the hook for their treatments. It's about personal responsibility. Surely, conservatives (who claim to love personal responsiblity) and liberals who support the ACA can find some common ground to work together on this issue. Maybe not THIS particular crop of GOP legislators, but maybe some less yahoo-ish ones, ones more concerned with improving the country rather than politically defeating President Obama. We shall see....

10) Comment by DMJ - 25/07/2012

The ACA attempts to achieve full coverage. You see...when a uninsured person goes to the hospital, the hospital eats that visit (anyone who can afford to pay cash for a hospital visit already has insurance). The hospital compensates in two ways: 1. raising prices. 2. ordering unnecessary tests and procedures on people who ARE insured. The latter increases premiums. If everyone was insured, hospitals wouldn't eat those costs. This is how the ACA will lower costs over time.

11) Comment by Whatnow - 25/07/2012

There DMJ goes again with twisting what Nancy said. She was talking to Congress, not Americans. The Americans nor Congress knew what was in it. It is a Pandora's Box. And Warreni, how does Obamacare lower the cost of healthcare? Nothing was done to reign in the outrageous charges of hospitals, medical and pharmaceutical companies. And the promise that you can keep your healthcare? Companies are already dropping worker's insurance.

12) Comment by DMJ - 25/07/2012

Gerald...are you saying that those with half a brain think we have the best system in the world? If so, I agree with you. And Host, the "pass the bill to find out what's in it" refers to the fact that Americans can only benefit (find out what's in it) from a bill if it's passed. This refers to the presumption that Americans will like the ACA once it's gone into effect and they benefit from it. Besides, it took Democrats decades and a 60 seat majority in Congress to get it passed. It will take Republicans the same to repeal it. Not gonna happen. The best thing for the country is for both parties to work together to get as many people covered as possible, which is the first step to reducing costs.

13) Comment by warreni - 25/07/2012

rgeraldwallace: That is without a doubt the dumbest comment I've read in this discussion. The old system was broken. The new system is still pretty broken but some improvements have been made. Repealing the ACA and going back to the old system will GUARANTEE that rising healthcare costs will ultimately bankrupt all of us. As the writer points out, the Republicans stand around chanting mantras while working- and middle-class people in this country struggle with unaffordable medical and prescription drug bills. Instead of proposing alternative solutions, the GOP is content to fall back on the same absurd idea that have gotten us nowhere in the last generation: somehow an unregulated free market will solve all of our problems. In fact, an unregulated free market, which we've basically had in so many sectors since at least the Reagan administration, ensures that we will continue to see this country evolve into an oligarchy, where juridical persons and the wealthy reign over the rest of us like feudal lords over their serfs.

14) Comment by [e-mail] - 25/07/2012

Repeal it, and replace it with what we had before, which was the best in the world for anyone with a half a brain.

15) Comment by The_Host - 25/07/2012

Well from what I hear voting has consequences. If the people vote in a Republican Congress and President they can change or repeal the law. Who knows maybe they will actual read any new one they try to pass before passing it. But I am sure all you liberals would be happy to simply have them tell you. "We need to pass the bill to find out what's in it" that should be just fine right? That whole goose and gander thing ya know!