Health care can still be fixed

It’s hard to argue with President Donald Trump’s frustration that “nobody knew health care could be so complicated.” He’s right: It is complicated and extremely costly — and most of us do not know what our insurance (if we have it) actually covers until it’s too late.

Health care now appears to be so broken that it can’t be fixed. Gridlock feeds cynicism, and cynicism ensures that gridlock continues. Congress can’t, or won’t, solve this problem. But our recently approved Maryland model for hospital payments offers stability and opportunity for the near term. Personal health insurance is, however, more precarious. Many families face absolute financial ruin from ballooning medical costs.

It’s time we started looking elsewhere — in states and municipalities where the voters are still heard — for solutions.

A group of governors — John Hickenlooper, Tom Wolf, Brian Sandoval, John Kasich and Bill Walker; two Democrats, two Republicans and an independent — recently released a strategy, called A Bipartisan Blueprint to Improve Our Nation's Health Care System. And in Maryland, Gov. Hogan and the state’s Democratic legislature worked together to stabilize the health insurance market for individual purchasers. More states, but not all, are taking direct action to address their specific needs. What had become a federal government dispute may find solutions in statehouses. Boundaries are clearer and consumers are willing to show up at a lawmaker’s town hall.

But not everything can be managed by the states. At the national level, the Patient Protection and Affordable Care Act of 2010 (ACA) offered legislative solutions to insurance market failures and unrestrained health care cost increases. The intent was there, but the law was complicated and polarizing. Still, nearly a decade later, the ACA’s resilience continues to confound its opponents. As the law ages and crippling piecemeal changes reverse gains, many of us are wondering what is next.

First, let’s use the lessons of the past. President George H. W. Bush’s Medicare Catastrophic Coverage Act (MCCA) of 1988 also began with serious shortcomings. It met crucial needs — access to outpatient pharmaceuticals and catastrophic coverage to blunt bankruptcy risks — but having higher prices for those with higher incomes was fatally unpopular. Although it passed with overwhelming popularity, one year later it was repealed. Later, President George W. Bush’s Medicare Modernization Act of 2003 (MMA) also included outpatient prescription drugs, but in a more acceptable way than in the earlier law. Despite its flaws, the MMA provided needed benefits. Subsequent improvements gave it a solid footing that helped it avoid what has become the ACA’s troubled legacy. Nobody now campaigns on “repeal and replace” the MMA.

Second, when it comes to reform, the names of things matter. The ACA, formally known as the Patient Protection & Affordable Care Act of 2010, has been permanently branded “Obamacare.” That’s politics for you. It signals a thumbs up/thumbs down positioning on the law — and that’s not helpful, on purpose. Did activists call Medicare and Medicaid “JohnsonCare”? Was the MCCA known as Bushcare I, or the MMA as Bushcare II? Nor should the ACA be called Obamacare since “Obamacare” never existed as actual legislation.

Finally, let’s keep in mind that bipartisanship is how our system works — it’s in our national interest to work inside those lines. I’d like to believe that when it comes to the ACA, we’re well past the “repeal and replace” era. Complete repeal of the law now would destabilize health insurance markets even more and lead to explosive premium increases. We are seeing this with premium hikes for fall 2018. The Medicare Modernization Act of 2003 benefited from the failed Medicare Catastrophic Care Act of 1988 — it retained catastrophic coverage but did not include income-based beneficiary payments. Similarly, the remaining elements of the ACA are a start, but they require constructive additions to make health insurance reliable and affordable.

Although we continue to battle over what is a fair system for all, I’m optimistic that bipartisanship can move us forward. The Blueprint to Improve and other state initiatives are putting the electorate’s needs for quality, affordable insurance above politicians’ needs for short-term political wins.

There are solutions, but they require bipartisan hard work. Even if there are Democratic majorities after the mid-term elections, the best long-term solutions will still be bipartisan.

Alan Lyles serves as the Henry A. Rosenberg Professor of Government, Business and Nonprofit Partnerships in the University of Baltimore’s College of Public Affairs. His email is calyles@ubalt.edu.

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