COMMENTARY

This presidency hangs on an Obamacare fix

Americans, whatever they think of the health-reform law, need to see more progress soon

11/24/2013

Portman

ASSOCIATED PRESS

Which of these outcomes do you think is more likely: (1) Obamacare ultimately will be made to work more or less as the President has said it will, or (2) the folks who are determined to kill it will replace it with a better health-care reform program?

I’m still betting on the first option. But this month’s Affordable Care Act fiascoes — the kludgy healthcare.gov Web site, President Obama’s broken promise about keeping coverage you like, his hastily improvised patches and tweaks and reversals — have shaken my confidence, and lots of other Americans’ as well.

Mr. Obama twice won election on the appealing premise that government can be both compassionate and efficient. So if his administration can’t make his most important domestic initiative work, and quickly, then that display of incompetence will pose an ominous threat to his ability to get anything else done in the final three years of his presidency.

Perhaps before he offered and repeated his coverage guarantee, the President should have anticipated that a fair number of Americans will buy all manner of worthless junk, including health insurance that doesn’t cover much of anything, merely because it’s cheap. And there’s no excuse for his supposedly tech-savvy administration botching the rollout of the online insurance exchange so badly.

Mr. Obama now needs to redeem his pledge that the Web site will show clear improvement by the end of the month, to regain the public trust he has lost. Because the question remains: What’s the alternative?

The goals of Obamacare — providing valuable and affordable health insurance to tens of millions of Americans who don’t have it; restraining the growth of health-care costs, both overall and for individual consumers, and ensuring that all coverage includes a package of essential benefits — remain as urgent as they ever were.

If the President’s most strident critics, mostly Republican politicians and their ideological allies, have a more effective, equally comprehensive health-care plan to offer — something more than “nyah-nyah-nyah” in response to Obamacare’s flubs — they have yet to produce it. They appear to feel we’d be better off going back to the good old days when, among other things, insurance companies routinely denied coverage to people with pre-existing conditions.

And if you agree that returning to the status quo that prevailed before Obamacare is desirable, you might want to reconsider. A new report from the Commonwealth Fund, a private foundation that does research aimed at achieving “a high-performance health system,” reminds Americans how badly our system has performed compared to those of other industrialized countries that provide universal (or nearly so) coverage.

We still spend a lot more per person on health care than these nations do, the study finds. But we get a lot less, often foregoing doctor’s visits or prescriptions because we can’t afford them. Even when we can pay, we routinely wait longer to get care. And we spend a lot of time squabbling with insurance companies over coverage disputes.

I don’t see how repealing Obamacare would improve these metrics. But Sen. Rob Portman, as you might imagine, doesn’t agree. The moderate Ohio Republican notes that when he asked Health and Human Services Secretary Kathleen Sebelius this month how many Ohioans have had their insurance plans canceled because they don’t meet Affordable Care Act standards, she could not say.

Like his Republican colleagues, Mr. Portman advocates repeal of the Affordable Care Act. Unlike too many of them, he has plausible thoughts about what might replace it.

“The whole theory [of Obama-care] doesn’t work with our health care system,” Mr. Portman told me during a visit to The Blade last Friday. “There’s a much better way — rely on the transparency and choice of the market system. That’s the only way to get costs under control.”

That includes requiring insurance companies to sell across state lines, revising antitrust laws to enable groups to bargain more readily with insurers, discouraging “frivolous” malpractice lawsuits, and expanding tax incentives to encourage individual consumers to buy health insurance, he says.

Other Republicans continue to insist they don’t want to destroy Obamacare — they just want to slow down its rollout while both parties work with the White House to fix it. But these expressions of goodwill have been more asserted than shown.

Gov. John Kasich was absolutely right to work around the obstructionist Republican leadership in the General Assembly to expand Ohio’s Medicaid program of low-income health insurance — a key feature of Obamacare, for which Washington will bear almost all of the cost. Our state’s efficient operation of Medicaid, one of his administration’s strengths, should give Ohioans confidence that the expansion will work well.

So why has Mr. Kasich been so adamantly opposed to allowing his health-care transformers to set up a state insurance exchange, instead of forcing Ohioans to rely on the problem-plagued federal exchange? People who live in the 14 states with their own online marketplaces are having far less trouble buying insurance than those who must use healthcare.gov.

An Ohio-specific exchange could have been a national model. But the Republican governor’s acquiescence in Obamacare evidently goes only so far.

Efforts to write the Affordable Care Act’s obituary are, for now, wishful thinking. The Obama Administration is sensibly looking for ways to expand online opportunities for consumers to sign up for coverage. But Americans, whatever they think of the health-reform law, need to see more progress soon.

Most people whose insurance from the individual market is getting canceled will be able to buy cheaper, subsidized coverage under the reform law, according to a new study by the pro-Obamacare advocacy group Families USA. But some won’t, and they’ll likely remember the President’s rash promise when they vote next year.

Worse, Obamacare’s failures are giving Republicans in Congress an excuse not to act on other vital White House priorities: immigration reform, an equitable budget agreement, sane gun control, an end to workplace discrimination, job-creating infrastructure repair, more-effective schools. GOP lawmakers don’t need even more cover to block these items on the President’s agenda, which polls suggest most Americans support.

So make Obamacare work, Mr. President. Make it a program that you’ll be proud to have your name attached to, as your legacy. That will be the most effective rebuttal you can provide to those carping antagonists who express their vision of government exclusively with the word “no.”

David Kushma is editor of The Blade.

Contact him at: dkushma@theblade.com or on Twitter @dkushma1