Reform, don’t repeal, the Affordable Care Act

Republicans once again are trying to overturn the Affordable Care Act, this time by repealing the individual mandate as part of the Senate’s broader tax bill. In lieu of pushing for a repeal — which would do far more harm than good, given how many healthy people it would drive from the market — the GOP should implement what’s working in the states where Obamacare is successful.

There are similarities among the states that aren’t struggling. Congress could use those as a road map to real reform. For instance, most of these states chose to expand Medicaid and dedicate resources to bringing more of their residents onto the exchanges. New York, for one, elected to maintain its Affordable Care Act advertising at around $14 million in wake of those deep federal cuts. Other states instituted reinsurance programs.

Contrary to popular belief, many states have robust Affordable Care Act insurance marketplaces. California has 11 insurers offering plans. New York has 15 and the state, along with Oregon and Wisconsin, was quoting potential premium decreases for people prior to President Trump’s decision to end key subsidy payments to insurers this October.

More Americans are:

Shopping at the exchanges — New numbers from the Centers for Medicare & Medicaid Services show 1.5 million people purchased a health plan between Nov. 1 and Nov. 11 on Healthcare.gov, the federal website for the health insurance marketplace. This lifts 2018 open enrollment numbers by more than 40 percent year over year. (Californians can buy insurance at the state-run Covered California website.)

Finding affordable policies — A Kaiser Family Foundation analysis has more than half of the 10.7 million people eligible for 2018 plans paying a premium cheaper than the tax penalty for forgoing health insurance. In some states, high-deductible bronze plans are selling for $0.

That the Affordable Care Act hasn’t self-destructed in the wake of the Republicans’ efforts to undermine the law suggests it’s worth saving. (In addition to ending cost-sharing payments which reduce the cost to consumers, President Trump shortened the 2018 open enrollment period and cut $90 million from the federal marketplace’s advertising budget.)

A few state exchanges were in crisis before the Trump administration moved to undermine Obamacare via executive order. Iowa was nearly without insurers until Medica stepped in at the last minute to provide coverage — at a 43.5 percent average premium increase.

Repealing the Affordable Care Act remains little more than an exercise in vanity. If GOP lawmakers put as much effort into reforming the act as they have trying to repeal it, then they would come a lot closer to delivering on their promise of affordable health care for all.