Washington’s approach to health care over the past decade is yet another example of America’s lawmakers’ increasing distance from the rest of the country. First, one party rams through a rigid, convoluted plan that drives up costs though unsustainable mechanisms that are now unravelling. Then the other party pursues fixes that go too far the other way — and again ignores ideas from the other side.
Neither extreme is cutting it, and the quick opposition that doomed the Senate plan reflects how unacceptable its ideas are to so many. The American people want and deserve reasonable, balanced, sustainable health care so that they can live without the fear of bankruptcy if they get sick, its most vulnerable neighbours are treated with compassion and those who seek to improve their lives can get healthy, confront addiction and get work.
Despite weeks of hard effort, the Senate plan was rejected by governors in both parties because of its unsustainable reductions to Medicaid. Cutting these funds without giving states the flexibility to innovate and manage those cuts is a serious blow to the states’ fiscal health at a time when most — Ohio included — are feeling headwinds from a softening national economy. And, unlike the federal government, states must balance their budgets. Particularly problematic was the bill’s failure to adequately meet addiction and mental health needs — which often occur together. Diverting funds away from the comprehensive, integrated physical and mental health care that is proving effective is a step backward.
The Senate plan also failed to repair Obamacare’s damage to the insurance markets. Insufficient tax credits would make coverage unaffordable for many lower income Americans: Two of the subsidies in the bill would be temporary and a third would likely be unsustainably underfunded. Congress should avoid doing anything likely to cause further instability in the huge and complex private insurance market.
In the uncertainty created by the Senate plan’s collapse, Congress should guard against a hasty next step. Just taking up the fatally flawed House plan is not an answer, and this idea should be immediately rejected for the same reasons senators rejected the Senate’s own proposal. Also, simply repealing Obamacare without having a workable replacement is just as bad. Both would simply yank health coverage out from under millions of Americans who have no other alternative.
After two failed attempts at reform, the next step is clear: Congress should first focus on fixing the Obamacare exchanges before it takes on Medicaid. If we want to move Americans off Medicaid, there must be somewhere stable for them to go. For all its faults, at least Medicaid is currently a stable system for those who need it. The exchanges are anything but, and need immediate improvements.
One vital improvement would be to provide adequate tax credits, which would help keep health plans in the individual market and encourage — not undermine — robust competition. Companies should also be required to continue following reasonable guardrails like ensuring minimum coverage that is genuinely useful and covers pre-existing conditions. Once we see these repairs taking hold, Congress should then take up needed improvements to Medicaid as part of comprehensive entitlement reform.
States are willing to assume greater financial risk by transitioning to a block grant or per capita cap, but will also need new flexibilities, such as tools to manage the rising cost of pharmaceuticals — the fastest-growing component of Medicaid. And states cannot expect the federal government to continue paying 90 per cent of Medicaid expansion costs given America’s historic debt; they must accept a gradual return to traditional cost-sharing levels.
Finally, Americans can never truly fix the rising cost of health care unless they start paying for value rather than volume. They are making this transition in Ohio by paying physicians for providing better care, not simply more care, in order to pursue better health outcomes.
In resetting health care reform in these ways — and I don’t rule out that other, balanced approaches bear consideration also — Congress can surmount the fatal flaws of both Obamacare and the current approaches: The reflection of a single partisan point of view. Health-care policy is only partisan in the abstract. When you or your loved one is sick and needs care, ideology is irrelevant; getting well is all that matters. That same common sense must be reflected in the way we fix Obamacare. Another one-sided plan, driven hard by one party against the wishes of another, can never succeed because it will essentially maintain the status quo: Partisan opposition and no real solutions.
The best next step is for members of both parties to ignore the fear of criticism that can come from reaching across the aisle and put pencil to pad on these and other ideas that repair health care in real, sustainable ways. America needs it, and I know that a bipartisan group of governors, including myself, stands ready to help in any way we can to provide an affordable, sustainable and responsible system of health care for the American people.
— New York Times News Service
John Kasich is the Republican governor of Ohio.