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The Obamacare repairs [Editorial]

ElectionsLaws and LegislationAffordable Care Act (Obamacare)InsuranceBarack Obama

The Latin phrase, Primum non nocere, or "first, do no harm," is one of the central tenets of the medical profession. It ought to be held as dear by those in Washington who suddenly want to "fix" Obamacare — they first should make sure they aren't doing more harm than good.

The fix offered by President Barack Obama on Thursday — to allow insurers to keep recently "dropped" customers on their former health plans — is not likely to help many who stand to lose coverage, but it's probably the best the federal government can do at the moment. Insurance companies may still drop customers on the individual market, but they won't necessarily be able to blame Obamacare for the decision (although even that is open to debate).

It's difficult to tell whether the White House's corrective action is a policy decision or a political one — assuming the president even has the authority under the law to take it without Congressional action. The mounting public frustration and anger toward the health care reform law's recent travails, both the failure of the website and the dropped coverage, has not been lost on Democrats, particularly those in swing states and/or facing reelection next year.

The danger is that Congress may go further than Mr. Obama, either by requiring insurers to grandfather existing policies or by allowing insurance companies to offer those (and perhaps other) policies forever, essentially gutting the law. Neither approach strikes us as workable. They would either financially punish insurers through no fault of their own or negate health care reform — and thus put at risk the benefits of Obamacare such as coverage of pre-existing conditions and insuring millions of Americans who previously lacked insurance.

It's worth noting that even Mr. Obama's call for insurers to continue selling existing plans would require them to inform customers that they might still do better on a health care exchange with more coverage for less money. That's an essential warning. One of the oddities of the current uproar is that individuals who have been dropped — as painful as that notification may be — may yet find cheaper, better insurance elsewhere.

Of course, they'd be far more likely to find that affordable insurance if the federal website worked properly. As Mr. Obama also noted Thursday, his administration's failure to roll out the ACA smoothly has put a huge political burden on Democrats who supported it. Of course, it didn't help that so many Republican-controlled states chose not to create their own websites or expand federally-financed Medicaid to provide coverage to millions at no cost to them.

The president may have over-generalized the benefits of the ACA before and after its passage, particularly the pledge that everyone could keep their existing coverage. But the story being told these days by the GOP — that Obamacare has done more harm than good — is a bigger prevarication. The health care system wasn't working long before the ACA.

This is a complex business. Insurance companies have made a lot of decisions regarding the terms of their policies and the amount of their premiums based on the mandates of Obamacare (such as the expectation that more people will have to buy coverage). Tinker with the law too much now and you put many of its best features at risk.

Democrats are clearly on their heels. Opinion polls show voters have lost confidence in the president and his party. Never mind that some of these problems have been badly blown out of proportion (cancellations on the individual market, which serves only about 5 percent of the public, have always been commonplace). Republicans are just delighted to see the recent government shutdown cast in a wholly different context now — less a partisan temper tantrum and more a valiant attempt to delay an ill-prepared program from moving forward.

The best strategy right now would be to focus more on getting the marketplaces working — whether by fixing the websites or beefing up call centers. That mostly requires patience and a thick skin. The biggest mistake Washington could make right now would be to pass Rep. Fred Upton's bill that essentially guts the ACA by allowing insurers to sell just about any old policy to meet the requirements of the individual mandate. Obamacare may be flawed, but it's far better than any alternative we've heard so far.


To respond to this editorial, send an email to talkback@baltimoresun.com. Please include your name and contact information.

Copyright © 2014, The Baltimore Sun
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