There is only one thing wrong with Obamacare, which is that it isn't working.
Everyone was supposed to buy affordable health insurance on newly competitive exchanges. This insurance was supposed to be made newly competitive and thus affordable by the vast universality of the customer base. That was supposed to lure health insurance providers into a market bonanza.
The richness of an insurance pool comprising the entire population was supposed to permit insurance carriers to cover expensive pre-existing conditions while charging basic premiums, meaning the same the non-diseased pay.
But not everyone bought health insurance. Healthy young people, invincible by hormone level, chose to pay insufficiently onerous tax penalties for not complying. Insurance premiums rose steeply, especially in higher-cost areas, mainly rural ones lacking high concentrations of customers and abundant access to health-care providers.
Insurance companies pulled out of markets, leaving little to no competition.
Arkansas fared better than most because of the brilliance of our self-styled Medicaid expansion plan. It used federal expansion money not to cover Medicaid recipients directly, but to buy private insurance for them that added 300,000 customers to the state's pool. The plan essentially used public money to hold down premiums for the rest of us, while helping poor people and saving rural hospitals.
It was smart government and good government, which is why it remains under constant threat of demise.
This private option is such a raging success that Gov. Asa Hutchinson has labored mightily to save it by putting Republican branding on it.
Then, last week in Washington ...
House Republicans passed a "repeal and replace" bill for Obamacare that is beset only by three problems:
• It is mean to poor people in that it proposes to phase out Medicaid expansion--that which has worked so smashingly by Arkansas adaptation--and cast those people into a private market for which public subsidies would be steeply reduced and based on age rather than income.
• It is frightfully uncertain for sick people because it proposes to allow states to get waivers to remove pre-existing conditions from the main insurance pool. States could propose to move those clients into a high-risk pool to cover the higher costs--presumably funded by federal and state money. But that funding perhaps would be sufficient only to provide lesser benefits to victims of cancer and other diseases than those now mandated by Obamacare.
• It was thrown together less as serious policymaking than as a means for a preposterous and egomaniacal president to declare a legislative victory--his first, and only an incremental one, and then not real in its incrementalism. Even as this creature called Donald Trump hailed the House bill as magnificent, and bragged on himself, he crowed that the U.S. Senate will now make it "even better," which is euphemistic for tearing up and starting over.
One thing the House bill does not do is proclaim that victimization of rape and sexual assault is a pre-existing condition perhaps not to be covered.
Some state with draconian leadership--Arkansas and a couple of others come to mind--might try to get a waiver effectively imposing something like that. But the likelihood is dim and the chances of waiver acceptance amid the moral outrage would not be good.
Democrats and liberals spread the rape and sexual-assault allegation irresponsibly and, I suspect, cynically.
Most likely, a Democratic political consultant said the Republican plan could more effectively be assailed as an assault on women than on poor people, which it expressly is. There are more women than poor people. Women keep up with issues more closely than poor people. Women are more likely to vote, especially in midterms.
Is there, then, a credible solution to the health-care dilemma?
Actually, there are two.
One is universal single-payer health care, meaning Medicare for all.
The other would be to leave in place Medicaid expansion and current income-based subsidies, but make the mandate to buy insurance real and enforceable with onerous financial penalties.
It would be to charge those with pre-existing conditions the same premiums as the rest of us, but to get the greater expense of their coverage paid by a guaranteed federal pool big enough to keep their bills paid and the carriers compensated without a loss of benefits.
Separating pre-existing conditions is only a bad idea if they aren't then covered.
Are we really a country so ridiculous and mean as to resist using taxpayer money to subsidize heavily the exorbitant medical costs of the gravely ill while, in turn, keeping health-insurance premiums affordable for the general population?
It appears the U.S. Senate will now answer that for us. Tom Cotton is among 13 senators working on it. But maybe there's hope anyway.
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John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, was inducted into the Arkansas Writers' Hall of Fame in 2014. Email him at jbrummett@arkansasonline.com. Read his @johnbrummett Twitter feed.
Editorial on 05/09/2017