April 26, 2018
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Republicans, Obama waste time in health care squabbling


President Barack Obama’s remarks this week on the Affordable Care Act had the trappings of importance: members of Congress in the audience, ordinary citizens on stage. All that was missing, as is too often the case in the health care debate, was anything important to say.

The president made a show of saying that, thanks to the law, 8.5 million Americans will get 2012 premium rebates from their insurance companies, averaging $100 a family. That amounts to less than 5 percent of all Americans with health insurance, he neglected to note, and the checks aren’t a lot of money, given that the average annual worker contribution for employer-provided family coverage last year was $4,316.

In his defense, Obama was responding to an even more farcical bit of political theater staged by House Republicans, who voted to delay the health law’s mandate that individuals buy insurance. It was the 38th time the House has voted, futilely, to stop or slow Obamacare.

Such posturing only contributes to public confusion over the law — and keeps Republicans and Democrats alike from addressing essential steps toward health-care reform.

Instead, it seems, the closer the law gets to fully taking effect, the more misleading and irrelevant the political arguments become.

Supports and detractors of the law alike have, for example, made an issue of how much insurance plans sold on the new state exchanges will cost. Republicans argue that premiums in California will be higher than what people now pay for individual coverage; Democrats say premiums in New York will be lower.

Both are half right. Premiums for individuals probably will be higher in some states, and for good reason — insurance plans sold on exchanges will be required to provide good coverage, and insurers will be prohibited from turning away people with pre-existing medical conditions.

And yes, some New York premiums will be 50 percent lower, but only for people who buy insurance on their own — a group that now includes just 17,000 people, according to the New York Times. Even this limited success probably won’t be replicated elsewhere, because few other states have placed the same requirements on insurers that have made coverage so expensive in New York.

In any case, there’s little point in trying to predict state-by-state premium prices when much larger issues loom. The exchanges themselves still need to be set up, and half the states have yet to agree to expand Medicaid coverage under the law. Republicans and Democrats should address their differences over how to make both these programs work.

Much remains to be done, as well, to rein in health care costs. The Affordable Care Act contains several pilot projects that aim to reduce the growth of health care spending by encouraging doctors and other providers to operate more efficiently. These efforts have far more potential to lower insurance premiums than the rebate requirements Obama touted this week do.

So far, however, their prospects are at best unclear. This week, we learned that nine of 32 hospitals and health systems taking part in a flagship experiment with “accountable care organizations” dropped out; none had seen the savings the program was meant to achieve. Leaders of both parties should be looking for ways to improve these and other cost-saving strategies.

Every time Republicans and Democrats stage votes and speeches over Obamacare that won’t go anywhere or don’t much matter, they squander an opportunity to improve the law.

Bloomberg News (July 19)

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