“Uncertainty” was the rhetorical chisel used to chip away at health care reform as it was being devised and implemented. Now it’s the uncertainty surrounding repeal that is shaking the foundation.
Though congressional Republicans took scores of votes to repeal the law, they never settled on a replacement. That’s a problem, not just for people who would lose coverage, but for hospitals, clinics, individual practitioners and insurance companies. It’s also a problem for state legislatures, especially in states that run health care exchanges, such as Washington and Idaho. Uncertainty surrounding Medicaid is also a problem. It’s difficult to put together a budget and governing strategy when a huge item like health care is in limbo.
President-elect Donald Trump has told Congress to replace the Affordable Care Act quickly. But Republicans are like the dog who caught the bus. Now what? They may not even have the votes to repeal, because some Republican senators are urging a go-slow approach.
During those repeal votes, Republican leaders said coming up with replacement would’ve merely been a veto snack for President Barack Obama. But without one, they don’t have a way to move quickly.
In the meantime, governors and legislators will be hammering out budgets without knowing the future of health care. The uncertainty is stark.
About 750,000 Washington residents gained coverage through the ACA. What becomes of them when they lose coverage? Does Washington state revive the Basic Health Plan?
Idaho’s health care exchanges have also been a success, and the state has been considering ways to cover about 78,000 more people while rejecting the obvious solution: Accept Medicaid expansion. But with the turmoil in Washington, D.C., the governor wants to back off.
“Beyond continuing to seek elusive answers to the policy questions that we’ve been asking for years, we now have the option of waiting to see what the Trump administration and Congress do with Obamacare,” Gov. Butch Otter told the Legislature on Monday.
He did propose an $11 million mental health package for parolees and probationers, a state expenditure that would be unnecessary under expanded Medicaid.
Health care reform has led to big changes in the medical industry. Many patients have been moved from emergency rooms to clinical settings; outcome-based metrics have been introduced to improve treatment and cut costs, and hospital readmissions have dropped. These are positive developments the medical community wants to build upon.
Health care is complicated. Changing course won’t be easy, and it shouldn’t be rushed. The public should be given time to evaluate whether a replacement is an improvement.
If congressional Republicans are determined to proceed, they need to announce a definitive strategy soon. If they don’t have a better way, they need to say so, and then find ways to improve the ACA. Because uncertainty is undermining the current market and disrupting government closer to home.
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