This item originally appeared in the Texas Tribune.
Republicans won control of Congress and the White House based largely on a single promise: they’d rid the world of Obamacare, despite that law’s reduction of the number of uninsured people in this country by 20 million. “Obamacare is death,” the president told us, shortly before Congress voted to maintain it.
After so closely tracking various iterations of GOP healthcare proposals, everyone from patient advocates to healthcare provider groups to policy wonks — and lawmakers themselves — are now scratching their heads. What happens now?
Make no mistake: nobody wins by indefinitely preserving the status-quo of Obamacare.
The law was designed with a focus on expanding coverage, but it didn’t do a good enough job addressing the high price for consumers. For those middle-class families and individuals who buy insurance through Obamacare marketplace exchanges, deductibles are often more than $5,000. Obamacare isn’t working for that population.
Meanwhile, a lack of competition in these exchanges threatens their sustainability. In Texas next year, nearly 40 percent of counties are projected to have just one insurer in the exchange — not exactly a stimulus to reducing the price. Fewer insurer options means higher prices and fewer choices of physicians for consumers.
So what can a bitterly divided Congress do? Lawmakers may have more common ground than they realize. Republicans want fewer entitlements, increased competition, lower healthcare premiums and reduced taxes. Democrats want more people covered with adequate insurance, increased competition and lower total out-of-pocket healthcare expenses. Not all aspects of these agendas are mutually exclusive.
In the short-term, Congress needs to work with the president and request that he not deliberately cripple Obamacare. President Trump has the ability to withhold payments to insurers that subsidize healthcare costs for some low-income Americans. If he did, the exchanges are likely to fold, and most of the 1.2 million Texans who get insurance through the Obamacare exchanges would be uninsured.
Congress made its will clear with its recent vote on Russia sanctions, which passed with overwhelming majorities. This was the most bipartisan action taken since the 2016 election — maybe they can do it again and see how good it feels to be bipartisan.
In the short-term, the Congress should re-instate Obamacare’s re-insurance provisions, which are being phased out. Those provisions helped to spread the cost of expensive patients. Some lawmakers have highlighted the instability in the exchanges as a justification for working to repeal Obamacare. Instead, they should use their power to reform those exchanges and make them work as designed.
Members of Congress should also meet as soon as possible with the insurance companies to develop recommendations for preserving the exchanges’ stability. For example, in places that are losing competition from insurers, incentives could be developed to get them in the markets. Patients could have options such as temporarily buying into the health plan for federal employees.
Work also needs to be done to ensure people who are eligible for Medicaid or the exchanges actually get enrolled. Part of that effort needs to include an overhaul of the exchanges to make them user-friendly. Despite a 40-year career in medicine, I tried to help a friend enroll in an exchange, and I couldn’t figure out the entire process.
In the intermediate-term, the insurers should work with Congress to create a catastrophic plan that covers things like accidents, pregnancy and serious illness. Those plans should be affordable to low-income people (with some subsidies likely necessary), and they could have higher levels of coverage for more expensive plans. The plans could build on the limited catastrophic plans available through Obamacare.
In the long-term, we need a well-thought-out bipartisan plan that achieves the goals Republicans and Democrats have in common, including how best to deliver care to low-income Americans. Maybe it is time to look at how Medicaid funding could be applied with other subsidies to create the best seamless care for those who can’t afford health insurance.
No plan can succeed without directly attacking rising healthcare costs. Nearly $1 trillion in wasted on healthcare spending in this country each year, according to a paper in the Journal of the American Medical Association. We can attack waste by refusing payment for unnecessary tests and procedures. We can give patients real incentives to live healthy lifestyles. And we can start a serious discussion — with the drug and medical device industries — about how to reduce soaring prices. Private sector innovation, for example, improved health IT and can also be part of the solution.
The stakes are much higher than they were seven years ago when Obamacare was enacted. Since then, healthcare expenses have increased at more than twice the rate of wages. Americans need Congress to fix healthcare now more than ever before.
Our new, national survey explores how patients and doctors believe we can work together to improve the nation's health care system. RSVP for our FREE discussion of the results Nov. 12 at the @TXMedCenter https://t.co/CPE6Li96NV #healthpolicy
Our new, national survey explores how patients and doctors believe we can work together to improve the nation's health care system. RSVP for our FREE discussion of the results Nov. 12 at the Texas Medical Center. https://t.co/PxrBf6RsR6 #healthpolicy https://t.co/2iezf0KXUT
What do consumers think of Medicare-for-all? How much do doctors want to get paid? And how can we REALLY fix U.S. health care for good? Hear the results of our annual survey Nov. 12 in Houston #healthpolicy https://t.co/CPE6Li96NV https://t.co/43OdNIyoKj
We'll be speaking with @KPRC2Khambrel at 10:30 a.m. this morning on @KPRC2 in Houston. Can't wait to share findings from our new book, "Exposing the Medical Myths: Why Everything You Know about Health Care Is Wrong and How We Can Make It Right." #healthpolicy
Thanks for hosting us, @KPRC2Khambrel ! Be sure to watch Houston Newsmakers on @KPRC2 at 10:30 a.m. Sunday. We'll discuss our brand new book, "Exposing the Medical Myths: Why Everything You Know about Health Care Is Wrong and How We Can Make It Right." #healthpolicy https://t.co/VMQOadhvIL
The big day is here! Join us TONIGHT in Houston at the @TXMedCenter for a discussion of our institute’s brand new book that busts myths about US health care. More info and free registration at https://t.co/MRV3Ns7nwe #healthpolicy
Thanks for hosting us, @KOAColorado. Learn more about the book at https://t.co/MRV3Ns7nwe https://t.co/ga25VzsPQa
An American MRI costs 14 times an Australian one. An American hip replacement costs 80% more than a British one. Why the big difference? Join us Oct. 15 in Houston to discuss: https://t.co/MRV3NsoYnM https://t.co/iwk3drB6dl
Our brand new book highlights 20 big, pervasive myths about U.S. health care policy. What would you include on the list? Tell us using #healthcaremyths and join us at our book event in Houston Oct. 15 https://t.co/MRV3Ns7nwe https://t.co/7vtyoXZVUq
One of the big myths about US health care is that if you have a job, you can get insurance. What do you think are other myths and misunderstandings about US health care? Join us and discuss Oct. 15 in Houston https://t.co/MRV3Ns7nwe #healthcaremyths https://t.co/2t8JeWGA9T
Our new book’s title is a mouthful because we want you to know exactly what it's about. Learn more about “Exposing the Twenty Medical Myths: Why Everything You Know about Health Care Is Wrong and How to Make It Right” and RSVP for our talk in Houston. https://t.co/MRV3Ns7nwe https://t.co/qcgOblvad9
If you think the market can fix health care, think again. Without perfect information & perfect competition, this will be a challenge. Learn more in our new book published by @RLPGBooks https://t.co/MRV3Ns7nwe #healthpolicy https://t.co/uDc2gqVNWM
How much of US health care spending is wasteful? 10 percent? 25 percent? Try nearly a THIRD. We’ll discuss why it's so much at a discussion of our new book in Houston Oct. 15 https://t.co/MRV3Ns7nwe https://t.co/PulyEJeeZz
“The best way to increase the physician supply is to decrease retirement,” says Tim Garson, director of the @TXMedCenter Health Policy Institute. Hear the rest of our discussion with @HoustonPubMedia about the looming doctor shortage: https://t.co/uEtgi1KokE #healthpolicy https://t.co/aYfvW7cwtt
If you think the uninsured get adequate health care through the ER, think again. We bust that myth — and many more — in our new book “Exposing the Twenty Medical Myths.” Join us Oct. 15 in Houston to learn more: https://t.co/MRV3Ns7nwe https://t.co/wGxkThYxxZ