Sohn: Alexander, Corker move to Band-aid Obamacare

Health care professionals joined hundreds of people march through downtown Los Angeles earlier this month protesting President Donald Trump's plan to dismantle the Affordable Care Act. Congress postponed a vote on the American Health Care Act, and now Tennessee senators have proposed a bill to help the working poor in areas where insurers have pulled out of the market. (AP Photo/Reed Saxon)
Health care professionals joined hundreds of people march through downtown Los Angeles earlier this month protesting President Donald Trump's plan to dismantle the Affordable Care Act. Congress postponed a vote on the American Health Care Act, and now Tennessee senators have proposed a bill to help the working poor in areas where insurers have pulled out of the market. (AP Photo/Reed Saxon)

Here we are exactly one week after the GOP's seven-year effort to repeal and replace Obamacare died a demoralizing death as Republicans feuded among themselves over the so-called replacement bill we dubbed GOPcare.

In the middle of that one week, Tennessee Republican Sen. Lamar Alexander, with backing of fellow Sen. Bob Corker, proposed legislation to help millions of working poor people here and in other states where there are no insurers selling policies on the federal health insurance marketplace.

It looks and smells to us like it might be the beginning of a bipartisan plan to fix the Affordable Care Act - not just throw the baby out with thebathwater because the ACA carried the stamp of Obamacare and the Obama administration.

Alexander's proposal would allow people who receive government subsidies to buy insurance to use that money to purchase any state-approved plan on the private market if no insurer is selling policies on the federal exchange in their area. Currently, the subsidies can be used only to buy a plan on the exchanges - plans that meet certain coverage standards. Plans on the private market don't necessarily meet those standards.

But as Republicans governors squeezed the ACA with obstruction in recent years and GOP state governors refused to expand Medicaid as the program was originally designed, insurers with policies on the exchanges reported losses and withdrew from the exchanges, leaving millions with no place to use the promised subsidies.

Some 11 million working Americans buy insurance through one of the ACA exchanges, and 85 percent of them get subsidies to make the premiums more affordable. In Tennessee, 230,000 people buy insurance on the exhange, but in a large portion of the state, there are few if any providers participating in the exchange, according to the Associated Press.

As of this week, only one insurer is offering coverage in 32 percent of the counties in the United States, which together include 21 percent of the nation's population. In five states-Alabama, Alaska, Oklahoma, South Carolina, and Wyoming - there is only one insurer participating in the state's online marketplace, according to Timothy Jost of the healthcare.org blog.

"Given the current political, regulatory, and financial uncertainty, there is a very real possibility that some counties may have no marketplace insurers for 2018," Jost wrote Thursday.

But there are uncertainties for progressives in Alexander's bill, co-sponsored by Corker.

The bill also would remove the tax penalty for failing to buy a policy if the working Americans who receive subsidies have zero options on the exchanges. That completely makes sense for the family of four who might face a penalty as high as $2,000 because no approved policy is available to them. But it also removes the incentive for healthy individuals who join the plans to avoid the tax penalty, and that in turn results in plans having fewer healthy members and more unhealthy members, causing insurers to lose more money, which drives up the cost of premiums.

Jost's blog also cautions that if the Alexander/Corker bill allows coverage for plans that don't meet the standards of minimum essential coverage - such as short-term, fixed indemnity, or specified disease coverage, that too undermines both consumers and health care. If sub-par coverage is allowed to be paid for using premium tax credits, the policies might be underwritten to exclude preexisting conditions, omit essential health benefits, and impose annual and lifetime limits. Such policies are lightly regulated by state law and are not considered "individual health insurance coverage" under federal law. Allowing premium tax credits to pay for them would radically undermine the protections offered by the ACA.

Remember Trump saying soon before throwing up his hands: "Who knew health care could be so difficult?" Well, apparently everyone knew except Trump. Like ecology, many things in our lives - health care, the economy and our tax bills - are intertwined.

The stock market on Monday morning played the funeral dirge for GOPcare as the Standard & Poor's 500 stock index fell to its lowest level in six weeks. Things haven't really looked up since. Analysts say the drop reflects investors' waning confidence in Trump's ability to deliver on his campaign promises - especially tax reform.

GOPcare died because Republicans are eating their young and Trump, the so-called great deal maker, is not a deal maker, let alone a leader. Trump threw in the towel after just the first fracas when the Freedom Caucus of hard-right conservatives didn't warm to his "closer" methods. Perhaps his self-described "Closer" nickname should be spelled without the C.

But most of all GOPcare failed because there was no plan. Not last week, not last year, not in the past seven years. GOPcare would have cost more and insured fewer - 24 million fewer. How that could be called a plan was always a mystery.

Let's hope now that this Alexander/Corker effort to make lemonade when life gives us lemons can truly find its way to recognizing that Obamacare was built on a Republican program, Romneycare. Let's hope that our senators are walking away from the partisan GOP mentality that Republicans should wash their hands of it just because Democrats employed it.

Let's hope. But let's not forget that it continues to be up to us - voters - to keep up the pressure on Republicans to find their way back to common-sense fixes - not the assassination by a thousand cuts - of the Affordable Care Act.

Upcoming Events