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Health reform troubles not ended

President Donald Trump speaks during a meeting in the Oval Office of the White House, Tuesday, Oct. 10, 2017, in Washington. Senior administration officials have said Trump is expected sign an executive order this week to expand the use of health plans offered through associations.
President Donald Trump speaks during a meeting in the Oval Office of the White House, Tuesday, Oct. 10, 2017, in Washington. Senior administration officials have said Trump is expected sign an executive order this week to expand the use of health plans offered through associations. AP

“I see a bad moon rising; I see trouble on the way.”

Credence Clearwater Revival

There is trouble on the horizon for health reform and Obamacare. Rising ACA premiums in Georgia and elsewhere have been widely publicized. Due to his vehement opposition to the ACA, there remain serious questions about how hard Insurance Commissioner Ralph Hudgens tried to get increases reduced for our state.

Last year, we were one of the six highest states for ACA rate increases (Money, 10-18-16). This year, rate increases for the ACA insurance exchange range from 57.5 percent with Blue Cross to 51 percent with Ambetter of Peachstate (Georgia Health News, 9/27).

Hudgens also permitted outrageous increases in car insurance last year and this year. According to the Atlanta Journal-Constitution (7/23): “A decade ago, when Georgia Insurance Commissioner Ralph Hudgens was a state lawmaker, he backed a bill that would free auto insurers from a rigorous pre-approval process when they wanted to jack up rates.”

The question now becomes: “Is Hudgens unwilling or unable to keep insurance rates down?” With Hudgens retiring, we now have a real opportunity to make progress here if we can get a new insurance commissioner who is consumer oriented and actually has a strong background in health care and/or insurance, as opposed to Hudgens. There is at least one announced candidate who fits the bill as a consumer advocate.

However, to a large extent increases were inevitable due to: A. The way Obamacare is structured (with financial penalties that are not harsh enough to compel the healthy to obtain insurance) and B. Actions taken, or not taken, by both the administration and Congress, especially in regard to reducing risk for insurance companies (see below).

The recent failure of the numerous highly unpopular and questionable reform bills in the Senate and House is the culmination of eight months of totally partisan congressional efforts to repeal the ACA in order to carry out GOP campaign pledges made over the last seven years. Oddly, details within these bills were seemingly not understood by either GOP congressmen or the president, who continually cited alternate facts (i.e. made factually incorrect assertions) or just recited vague talking points when asked about provisions within the bills.

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Sen. Lindsey Graham, R-S.C., center, joined by, from left, Sen. John Barrasso, R-Wyo., Sen. Bill Cassidy, R-La., and Senate Majority Leader Mitch McConnell, R-Ky., talks to reporters as they face assured defeat on the Graham-Cassidy bill, the GOP's latest attempt to repeal the Obama health care law, at the Capitol in Washington, Tuesday, Sept. 26, 2017. The decision marked the latest defeat on the issue for President Donald Trump and Senate Majority Leader Mitch McConnell in the Republican-controlled Congress. J. Scott Applewhite AP

The GOP failed because the few moderate Republicans (we are a vanishing breed) that remain in Congress stood firm and would not let their fellow Americans be decimated by right-wing reform theories. In fact, for the first time ever, the ACA is now supported by 55 percent of Americans (Gallup, 4/17).

Trumpcare, on the other hand, has proven to be one of the least popular pieces of legislation in recent history with only 17 percent of Americans supporting it (Quinnipiac, 3/17). The real surprise is not that these bills failed but rather how all but three or four GOP senators could support these ill-conceived, disastrous bills that they apparently did not understand.

Obviously, Trump and Sen. Mitch McConnell put their faith in the wrong people, namely right-wing ideologues like Speaker Paul Ryan and former Secretary Tom Price of the Department of Health and Human Services. The extreme, unproven free market concepts in Trumpcare were taken directly from bills and policy papers previously authored by these men over the last seven years.

Even odder is the fact that the president and Senate leadership decided to scuttle bi-partisan, productive talks (led by Republican Sen. Lamar Alexander and Democratic Sen. Patty Murray) in favor of divisive and one-sided reform initiatives which would have caused tens of millions of Americans to lose coverage and would have given tax breaks of $600 billion to the wealthy and corporations.

President Trump has instructed his staff to refuse to enforce the already weak insurance mandate, requiring everyone to either have health care insurance or pay a small fine via taxes. Without this requirement, only the sickest will purchase health care insurance. Thus, as stated above, rates will rise via what is known in the insurance industry as “adverse selection,” a form of cherry picking.

My fellow Republicans have succeeded thus far in causing premiums to go through the roof here and elsewhere by making it too risky for many insurers to provide coverage on the exchanges. Republicans accomplished this via raising the very real possibility of them gutting federal subsidies and the Trump administration’s policy of not enforcing the federal mandate that everyone buy insurance or be fined.

The real question at this point is: how long will GOP congressmen be able to continue along this path before the certain backlash bites them electorally? The 2018 elections should give us an answer.

Jack Bernard, the first director of Health Planning for Georgia, has been a senior executive with several national health care firms. A Republican, he’s a former chairman of the Jasper County Commission and Republican Party.

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