Republicans pull their American Healthcare Act before a vote, and dodge a catstophe. But, their good fortune will be short lived without action before year’s-end.

There are a lot of folks pointing fingers at each other and casting blame upon conservatives for the House leadership’s decision to pull the AHCA. The Freedom Caucus is being criticized but the Republican Party should thank the Caucus for its courage and for honoring its commitment to voters. The AHCA would not have been successful in any of its goals and would have been a devastating burden to Republicans if it had passed not to mention the extra pain for all of us premium paying citizens.. 

Didn’t you think it was actually embarrassing to watch, over and over again, as proponents referred to the AHCA as a “repeal” of the ACA. How could anyone say with a straight face and a modicum of conscience that the AHCA was a “repeal” bill?

If passed, the AHCA would have left in tact the mandate for individuals yet no real incentive to enroll which would have decimated insurers and forced rates higher than they might otherwise have gone. The AHCA left the mandate for employers along with the burdensome annual reporting requirements intact. The AHCA addressed the “mandate” issue by setting the penalty to zero. These actions would have left intact the means for future Congresses to re-instate the mandate penalties thus re-instating the mandates for individuals and employers.

It also retained the Cadillac tax , the benefit mandates including the essential health benefits, and included no steps to expand ERISA or make selling across state lines a reality as well as many of the taxes and most of the premium increasing restrictions. There are many more aspects of the ACA left intact by the AHCA all of which would have caused premiums to continue to increase, discouraged insurers from participating, and allow future congresses to restart all of the ACA with little effort.

So, the Freedom Caucus saved their Republican colleagues butts (I meant major embarrassment) and certainly trouble in the 2018 elections. But this good fortune for the Republicans won’t last long if they don’t follow up with a real plan to repeal and replace before the end of 2017. If our citizens, especially the ones paying premium but receiving no subsidy, are still suffering from the burden of the ACA come January/February of 2018 then the elections in 2018 will be a disaster for Republicans. The Democrats will be able to take advantage of this Republican failure for huge gains.

Let’s face facts, the Republicans had 7 years to create a replacement for the ACA with Paul Ryan as Speaker for 2+ years. One would think that 7 years is more than enough time to craft a better product than they tried to force through and upon us last week.

But Dems should not cheer too long or too loudly  because without major corrections the ACA, which Dems currently own, will implode from its own ill-conceived creation causing untold harm to our citizens, providers, businesses and our economy. I’m not being political, merely stating the obvious.

Now, there is time and support for the Republicans to redeem themselves in the eyes of their supporters who heard the campaign promise over & over of “repeal and replace”. I know I make it sound simple but they do have a blank canvas on which to create the true replacement for a repealed ACA.

Let it start with the Repeal Bill that both Houses passed 15 months ago when it didn’t mean anything. But this time add the provisions to phase out Medicare expansion while phasing in the means to help the poor, phase in the tax credits and tax deductibility and so forth. They could add in all of the other provisions we have discussed in previous blog posts.

Do that and the “moderate” Republicans along with many moderate Democrats would be forced to stand side by side to support the bill. If it repealed the ACA entirely as the candidates promised, eased in the changes to state-run Exchanges and Medicaid with concern for our most vulnerable citizens, create provisions that allow small insurers to compete with the BUCAs, and expand ERISA, then it would pass. Plus, it would gain votes from a surprising number of Democrats, at least those in areas plagued with the ACA-caused trouble  of only one insurer and no real choices for citizens.

Didn’t it feel like the effort to push the AHCA was rushed and poorly prepared? Now, if they truly want to honor their commitment to voters, the Leadership can take action to repeal and replace in a timely yet thorough manner that brings people along with the legislature. Pushing the AHCA, as the proponents tried to do last week, smelled to much like the Democrat processes in early 2010 and late 2009. And wow did that smell, right?

Bernie Sanders says he plans to introduce a “Single Payer” bill in the Senate, for the umpteen time, so maybe the Republicans can introduce a free-market working reform solution that that doesn’t leave the less fortunate in a jam while giving the remaining 300,000,000 of us Americans access to truly affordable quality health plans.

Rather than criticize the House and Senate leadership for concocting the inadequate AHCA that would serve no purpose let’s focus on potential solutions and results.
After all that’s why it’s called “the Solutions Based Healthcare Blog”.

I’m interested in what you think and remember, we’re all in this together.

Mark Reynolds, RHU

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