Stop gloating about an 'Obamacare meltdown' and fix it

Among the most grating aspects of the super-partisanship that infested Washington throughout the Obama presidency was the relentless opposition to the Affordable Care Act, the historic effort to expand health insurance to some 50 million Americans who did not have it and whose health care was a costly burden to those of us who did.

Despite dozens of unsuccessful attempts by Republicans to repeal the ACA, the opposition remains in place, with its most negative consequences for low-income families in red states. According to the Kaiser Family Foundation, 18 states with Republican governors and/or legislatures, most of them in the South or Midwest, have refused to accept a major provision of the ACA: billions of federal dollars for the expansion of Medicaid, health insurance for their poorest citizens.


Jonathan Weiner, a health policy expert at the Johns Hopkins Bloomberg School of Public Health in Baltimore, talks Obamacare with wonkish elegance; he's a great explainer. I've interviewed him numerous times over the last seven years — most recently in June, for my podcast — and always found him to be objective in his assessments of the ACA and reluctant to characterize its opponents.

But he does not hold back on the refusal of Texas, Mississippi, Maine, Virginia and other states to take federal money set aside for Medicaid expansion. "It's hard to estimate exactly how many, but hundreds of people die every month because they do not have an insurance card," Weiner says. The decision by Republican governors and legislators to refuse Medicaid funds, he says, constitutes "the biggest case of political malpractice I've seen in my life."

So, while they failed to stop the ACA in Congress and at the Supreme Court, Republicans and conservative organizations have effectively kept the law from being fully implemented, denying health insurance to thousands of Americans who cannot otherwise afford it.

That has been the most reprehensible aspect of this unnecessary and counterproductive battle – the partisan, pigheaded politics that directly affects people's lives.

But there's something else that grates, and you're going to be hearing more about it in the coming months: gloating over the failures of the ACA.

It's being called the "Obamacare meltdown," and the law's opponents are relishing it. People who fought the ACA, who bad-mouthed it at every opportunity, who supported efforts to have it overturned by the Supreme Court, and members of Congress who tried to sabotage the law — they're all now sitting back and savoring the bad news: Private companies bugging out of health insurance exchanges in some of the states that established them, leaving customers with fewer affordable options. Deductibles too high. Premiums going up everywhere. (As if rate increases would not have occurred without the ACA.)

Adding to the "meltdown" narrative is the collapse of the nonprofit health insurance co-operatives that were written into the ACA and established with federal loans. In the ideal, these co-ops were to provide competition for insurance companies and affordable plans for customers. Patient wellness — not profits — was their primary concern.

Conceptually, it sounded great. But by now, only five of the 23 co-ops that opened for business as the ACA rolled out are still in operation. Here in Maryland, Evergreen Health managed to grow to about 40,000 members, despite the rocky inaugural year of enrollment through the state exchange. But last week, the co-op's progressive founder and CEO, Dr. Peter Beilenson, announced that Evergreen would convert to a for-profit model, taking on investors to survive.

All of this is being held up as evidence of Obamacare's impending collapse when there's far more evidence that the law, despite significant flaws, is here to stay. Most of the doomsday predictions, particularly about the law's costs and its effect on employment, were wrong. Polls show that most of the 20 million people who managed to obtain health insurance under the ACA like it. Those of us with employer-provided health insurance enjoyed some of the ACA's provisions, too: being able to keep a son or daughter on a family plan until age 26; no denial of coverage or benefits for people with pre-existing conditions.

At the same time, it's obvious that the law needs to be fixed. That's been obvious all along. (More young, healthy people need to buy into a plan, and there need to be more plans, including a public option.)

But instead of joining in the tinkering, Republicans have voted repeatedly to junk the whole thing, and, according to Kaiser, they have succeeded in keeping insurance from up to 3 million adults by rejecting Medicaid expansion.

The party's presidential nominee calls Obamacare a "disaster" and vows to replace it. Like a lot of what Donald Trump proposes, that's neither necessary nor smart.

With 20 million Americans now insured under its provisions, the ACA is part of the country's social infrastructure. It does not need to be junked. It does not need gloating over its flaws. It needs grown-ups willing to fix it.