The Gordian knot of health care has ensnared Congress

If the casual observer didn’t know how complicated the health care issue is in America, the last two efforts by the House of Representatives and now the U.S. Senate should have given clues. And the words of the same politicians who faulted the process employed by the Obama administration are now reaping the same wrath — from many in their own party — for using the same playbook.

In 2010, House Speaker Nancy Pelosi famously said, “But we have to pass the (health care) bill so that you can find out what’s in it....” She attempted to explain it away by saying the Senate had not yet passed the bill so what was in it had not been finalized. Whatever. That explanation didn’t prevent her words from being used as a jackhammer against her and the Democrats who passed the Affordable Care Act without a single Republican vote. We are just beginning to understand what an incredible feat that was as Republicans have been unable to corral their own caucus.

Fast forward to 2017 and in the immortal words of baseball great Yogi Berri, “It’s deja vu all over again.” The first effort by the House would have saved, according to the Congressional Budget Office, around $330 billion over 10 years, but it would have left 24 million people without health insurance, raised insurance deductibles and would have led to rollbacks of Medicaid coverage. After seeing it would not pass as written, House Speaker Paul Ryan went back to the drawing board and adjusted the plan, and quickly got it passed, barely, 217 to 213, before the CBO could evaluate it.

While it made it out of the House, Senate Republicans are now left with the baffling task of coming up with its own plan and it can’t seem to get it done. President Trump, after praising the House effort, later called it “mean,” because 23 million fewer Americans would have health insurance within a decade. This left the Senate with little wiggle room when Majority Leader Mitch McConnell revealed his version — written behind closed doors — that could be termed “meaner.”

Even though it would only throw 22 million people out of the health insurance door — it would save the government, by cutting Medicaid, $772 billion over ten years and it would eliminate $408 billion in subsidies for low income people, children, those captured by opioids, pregnant mothers, the disabled and the most vulnerable in our society. Read an excellent piece on one aspect of the consequences faced my new mothers by former Macon native Allison (Gaudet) Yarrow on Vox. (https://www.vox.com/science-and-health/2017/6/26/15872734/what-no-one-tells-new-moms-about-what-happens-after-childbirth).

With all the conversation about who gets health care and who does not, those walking the halls of our Capitol are really only focusing on who pays for it, not the consequences of their actions. They have yet to put a human face on the issue.

What our lawmakers are trying to do is untie a Gordian knot. If you pull on one side, say subsidies, it tightens the strings of who can afford coverage, if it can be afforded at all. If you allow states to decide what coverage to offer Medicaid recipients, which states might drop maternity or emergency room coverage? Georgia eligibility for Medicaid is already woefully inadequate. A family of four can’t earn more than $7,836 per year.

And there in lies the essential rub. Hospitals are required to treat everyone who ends up at their doorsteps regardless of their ability to pay. If the federal government pulls on the knot in one direction and states can’t afford to equalize the dynamics in the other direction, hospitals, clinics and nursing homes, are left in the lurch.

Rural hospitals, already hanging by a thread would disappear. Nursing homes would have to restrict patients they accept to those who can pay. And, truth be told, everyone’s health insurance premiums would have to rise to pay for the uninsured. In other words, we would be right back where we were before the Affordable Care Act — only much worse.

Obamacare is far from perfect and needs extensive tweaking. Change the name if that’s what’s required, but the bottom line is simple: the ACA has brought health insurance to millions of Americans and stability to the health care system. It’s in a death spiral because of Washington’s neglect and nothing more. After this July Fourth recess, lawmakers should stop beating a dead horse and start grooming the horse that’s already in the stable. That will enable them to move on to other items on their overloaded plate.

This story was originally published July 1, 2017 at 9:00 PM with the headline "The Gordian knot of health care has ensnared Congress."