Opinions

Alaska congressional delegation casts confusion on 'Obamacare' replacement plans

The members of the Alaska congressional delegation want to repeal "Obamacare" all right — that's been a Republican litmus test for six years — but there are no easy alternatives.

They haven't said exactly what they want to replace the Affordable Care Act with, but there is much to learn from the bill Sens. Lisa Murkowski, Dan Sullivan and Rep. Don Young championed a year ago — the Restoring Americans' Healthcare Freedom Reconciliation Act.

Had that bill with the impressive title — let's call it "Freedomcare" for short — not been vetoed by President Barack Obama, it would have meant higher costs and 32 million more Americans without health care coverage in a decade, according to a new report.

Murkowski said the veto a year ago by Obama was disappointing. Sullivan and Young said it was unfortunate.

Some will say now that every member of Congress knew the bill was headed for a veto and that its contents would have been modified and its worst elements improved had anyone thought otherwise.

But given the waffling of recent days on such key questions as to whether Medicaid expansion will be overturned or if subsidies will continue, I think the specifics of a year ago are all we have as guideposts.

Both Murkowski and Sullivan declined to answer "yes" or "no" when I asked if they now want to repeal Medicaid expansion. Both released noncommittal statements saying they want people to have affordable health care and don't want people to lose coverage, etc. Young's office did not respond.

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A year ago there were clear-cut answers in the Freedomcare bill. The plan was to end insurance penalties and subsidies and stop the expanded Medicaid program in a couple of years.

And, according to a new analysis by the nonpartisan Congressional Budget Office, the bill would have destabilized the health insurance market in the United States.

The CBO report estimates that companies would have stopped writing individual policies in many states because without subsidies and mandates, there would not be enough paying customers to stay in business. It would hit states with half the U.S. population a year after the subsidies ended.

This upheaval "would most directly affect people without access to employment-based coverage or public health insurance."

Alaska would almost certainly have been one of the states with no individual health insurance coverage had Freedomcare become law.

Without subsidies and the requirement that people have insurance, Premera, the only company selling that kind of insurance here, would have found a good reason to stop, ending coverage for about 18,000 people.

The bill would have also ended Medicaid expansion funding in Alaska, cutting off the 27,415 low-income Alaskans who have acquired coverage through Medicaid expansion.

The economics of health care are complicated and private insurance companies are never going to make money caring for those who need insurance the most — sick people with pre-existing conditions. That is the major problem with the Affordable Care Act in Alaska.

The Alaska delegation proposed a plan last year to make insurance cheap again by eliminating the minimum coverage standards in the health law. This would allow companies to sell much cheaper policies, attractive to anyone who skips the fine print.

Giving people the option to buy lousy insurance that won't cover what they think it covers is more of a con job than cure.

Another way to lower costs is to give insurance companies the freedom to deny coverage or charge higher rates to sick people. This is not one of the ideas that the Alaska delegation is backing, knowing that this is a popular Affordable Care Act regulation.

But it is a costly element at the heart of the struggle over health care policy and economics. Companies can't make money selling insurance to sick people unless they charge extreme prices.

The Republican Party has trapped itself by opposing the basic elements of Obamacare — promoted by conservatives a quarter-century ago — that a mixture of private insurance, government subsidies, regulation and an insurance mandate would be the best way to extend health insurance to more Americans and keep private companies in the game.

A complicated scheme to avoid a so-called "single payer" system like Medicare, run by the government — the option still favored by many fed up with insurance companies — was the original goal of conservatives.

The other day Murkowski said that Congress would "inject a level of great uncertainty into an already uncertain environment if we don't give people a clear indication as to what will come once we repeal."

But clear indications of what comes next are in short supply.

President-elect Donald Trump added to the uncertainty when he told The Washington Post that he wants "insurance for everybody" with "much lower deductibles" and lower costs.

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This may have been a statement that just popped out of his mouth with nothing behind it, but the next edition of Freedomcare in Congress — perhaps a brilliant secret plan that has yet to be revealed — will now be measured against the boast that all Americans will be "beautifully covered" by Trumpcare.

Columnist Dermot Cole can be reached at dermot@alaskadispatch.com. 

The views expressed here are the writer's and are not necessarily endorsed by Alaska Dispatch News, which welcomes a broad range of viewpoints. To submit a piece for consideration, email commentary@alaskadispatch.com. Send submissions shorter than 200 words to letters@alaskadispatch.com or click here to submit via any web browser.

Dermot Cole

Former ADN columnist Dermot Cole is a longtime reporter, editor and author.

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