Here’s what’s next for health care — if Republicans can rise from the mat

The collapse of the GOP plan to repeal the Affordable Care Act doesn’t mean we’re done. Congress, after all, accomplished nothing at all during four months of brawling over the issue. The ACA still needs help. Heck, the entire U.S. health care system is a mess. Will Washington ever fix it?

Probably not — until a crisis requires action. But there are murmurs of bipartisan action later this year or next, so Ethan Wolff-Mann, Alexis Christophorous and I lay out a road map for what needs to be done, in the podcast above (which you can also download from iTunes.)

First, Obamacare, as the ACA is known. The failed effort to kill it left several major flaws — that cause real harm to real Americans — unaddressed. President Trump has threatened to withhold subsidies the government is supposed to pay insurance companies, which offset discounts on insurance offered to low-income people. Trump has pledged to “let Obamacare implode,” and this would be one way to do it. Insurers will be fine, but without the subsidies, they’ll raise premiums for people insured through the ACA by around 19%, according to the nonpartisan Kaiser Family Foundation. Higher prices mean there will be fewer buyers, or fewer people with health insurance.

The Trump administration could also choose not to enforce the individual mandate requiring everybody to buy insurance, which would lead more healthy people to forego insurance and leave a sicker pool of people covered by Obamacare. That would also drive up premiums. The ACA has also relied on promotional efforts to make sure people know about it and can figure out the nuances. Trump has eased back on that since coming into office, another reason some people may not sign up in the future.

There are several ways to tighten up the ACA that have more or less bipartisan support.  Bryan Woolston | Reuters.

A solution in sight

These problems are fixable, if Congress is willing to do it and Trump signs off. Trump could signal his willingness to pay the insurer subsidies and resolve that uncertainty with a single tweet. That would improve insurers’ ability to anticipate future costs, and give them more confidence about staying in the program. The same goes for government efforts to promote the ACA, which Trump could also order done. The individual mandate — which is genuinely unpopular — could even be eliminated and replaced with penalties for buying insurance after the open-enrollment period, which would still provide an incentive to keep healthy people in the program, while giving conservatives a reform they favor. There are several other ways to tighten up the ACA that have more or less bipartisan support.

That would fix Obamacare. But Obamacare only covers about 7% of the US population. People with insurance from other sources must still contend with soaring costs, coverage shortfalls and many inefficiencies of the American system. And 28 million still don’t have insurance. Bernie Sanders continues to press for “Medicare for all,” but there are other ways to pursue universal health coverage without putting it all in the hands of the government. We provide an overview in the podcast, and make the case for better efforts to fix the U.S. health care system than we’ve seen so far this year.

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Rick Newman is the author of four books, including Rebounders: How Winners Pivot from Setback to Success. Follow him on Twitter: @rickjnewman