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Two Views: How GOP health bill could stave off collapse of Obamacare


Health care is an emotional issue for millions of Americans — and that is understandable.

But let us get a few objective facts on the table about the American Health Care Act.

First, the health care bill that House Republicans passed to replace Obamacare, which is collapsing, will not become law.

The Senate is just now beginning its own process from a clean sheet of paper. If they can advance a bill through committee and then through the floor — which requires losing no more than two Republicans — surely that bill will be different than the House bill. If the Senate passes a bill, then a conference committee must be appointed to work out the differences, and that final bill would need to pass both the House and the Senate.

These are large hurdles — and no guarantee that Republicans ultimately can rise above them.

If we are to analyze the House GOP bill, it is fair to say that the legislation is not ideal, as it does not fully repeal Obamacare and could result in a lower number of Americans covered in the short-term. But it would cut taxes, which could jolt the economy, and it could prevent the full collapse of Obamacare.

As Speaker of the House Paul Ryan said last week: “What we’re doing is a rescue operation. Last week … the last insurer (in Iowa) said, ‘We’re pulling out.’ That means in 94 of 99 (Iowa) counties, no health insurance choices. Five states are down to one insurer left. Maryland just announced a 58 percent premium increase for next year. Aetna just pulled out of Virginia. This law is collapsing.”

The simple fact is that Obamacare is rapidly making health care insurance inaccessible for hundreds of thousands of Americans.

I do believe that the House GOP bill will reduce premiums and offer more choices. Insurers will create new plans unburdened by federal mandates. If health insurance is more affordable, millions of young and healthy Americans will be more likely to buy insurance rather than pay a modest fine, as many have chosen to do.

What would this mean for Texas?

Texas chose not to expand Medicaid as part of Obamacare.

At the time, then-Gov. Rick Perry said Texas would not be a part of “something as foolish as Medicaid expansion.” In 2013, he said, “Texas will not be held hostage by the Obama administration’s attempt to force us into this fool’s errand of adding more than a million Texans into this broken system.”

One of the chief concerns of those who opposed Medicaid expansion was a reasonable fear that their state would be on the hook for millions of dollars if the federal government did not continue to shoulder at least 90 percent of the cost of Medicaid expansion. Since states cannot print money, they cannot run deficits.

One of the more controversial elements of the House GOP bill could be utilized by our state.

The bill allows states to create their own high-risk pools for more expensive patients, who are generally those who have serious pre-existing conditions. Several states have already done this very successfully.

Alaska and Maine are two examples of states that have created their own high-risk pools, which are tailored to the unique populations of their states and spread the cost and the risk of this population broadly. The House GOP bill provides $8 billion to help offset higher premiums in these pools.

If states opt out and create their own high-risk pools, it would be up to them to decide whether the pre-existing condition exclusion would be part of their individual high-risk pools.

Democrats have deliberately stoked fear in millions of Americans by confusing people about how the House bill works.

Anyone with a pre-existing condition who is on Medicare, Medicaid, Social Security, has employer-based health care or maintains continuous coverage would face no risk of their pre-existing condition preventing future coverage. This addresses the most Americans who have a pre-existing condition.

Much of the fear over the House bill is either false or needless, as any final legislative product is likely to look very different, not happen for many months, or perhaps not happen at all.

But Obamacare is unquestionably failing. Republicans felt it was their duty to devise a better system. That work continues.

Mackowiak is syndicated columnist, an Austin-based Republican consultant and a former Capitol Hill and Bush administration aide.



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