Are we returning to the bad old days before Obamacare?

No matter your opinion of President Barack Obama’s signature legislative accomplishment, the Affordable Care Act, it has become increasingly clear, as Congress attempts to untie the Gordian Knot, how difficult it must have been to wrangle all of the health care players, lawmakers and various lobbyists to support the ACA in the first place.

After running into a brick wall of competing interests within the Republican Party’s own ranks, House leaders gave up on an earlier attempt to repeal and replace Obamacare in March after the Congressional Budget Office scored the proposal and said it would leave 24 million Americans without insurance within a decade. The House returned for another bite of the apple earlier this month and approved and sent it on to the Senate before the CBO scored it. The results of that scoring were released Wednesday.

The CBO report is not pretty. The House bill would leave 14 million more Americans uninsured next year than under the ACA. The House plan would reduce Medicaid spending by $834 billion. In a decade, 23 million more Americans would be added to the list of uninsured. In 2026, the number of uninsured according to the CBO, would be about the same as before the ACA was implemented. The CBO also reported that the proposal would reduce the deficit by $119 billion over a decade.

Most Americans could care less about what goes on in Washington, D.C. What are the practical impacts of this proposal? Medicaid, in its present form is insufficient. It doesn’t pay enough now for the services rendered. Right now, people who did qualify for Medicaid are no longer eligible because requirements have changed. The result? More people are sick and they are getting sicker, sooner.

And where do the uninsured go when they get sick? Your friendly neighborhood hospital. Hospitals have to care for every person who presents at their doors, and if the past is any indicator, those without insurance present at the facilities most expensive entrances: the emergency rooms. And those without insurance arrive there sicker because they haven’t received regular care.

There was a time when hospitals could cost shift — charge paying patients and those with good insurance plans more for procedures to help defray the cost of the uninsured and to cover the medigap. Those days are gone. Insurance companies have played hard ball with providers to get the best prices and to improve their bottom lines. Hospitals are already operating on razor-thin margins.

According to Becker’s Hospital Review, 21 hospitals closed in 2016, including North Georgia Medical Center in Ellijay. Five have declared bankruptcy this year. One year ago, Washington County Regional Medical Center in Sandersville was on the verge of shutting its doors. Voters approved borrowing $15 million to keep the facility open.

The House health care proposal now sits in the Senate and a working group there has basically said they are ignoring it and drafting their own bill. Why? The House bill has clearly identified winners — young, healthy and wealthy — and losers, those on Medicaid, children, the disabled, poor, sick and older Americans.

Add to that list, something the CBO recognized. The House bill would destabilize the health-care system. An amendment that was added would turn some of the responsibilities for what’s covered over to states. Using waivers, some states could allow offering insurance plans that cover next to nothing as was the case before Obamacare, or plans that are clearly unaffordable, allowing lawmakers to crow that they made insurance available to everyone.

Obamacare clearly needs fixing. It is far from perfect, but it has taken a huge step toward fulfilling its promise. If lawmakers are sincere in their efforts to provide health insurance to many Americans who would clearly be left out in the cold if this House proposal were ever to see the light of day, they will fix Obamacare, re-brand it, claim credit and live to fight another day. If they don’t, the Gordian Knot they are attempting to unravel could land around their necks with the electorate pulling the ends ever tighter.

This story was originally published May 27, 2017 at 9:01 PM with the headline "Are we returning to the bad old days before Obamacare?."