By Robert Reich
Very soon Senate
Republicans will have to decide what to do about Trumpcare. Their choice is
severely limited.
The Congressional
Budget Office has made it crystal clear that the House version of Trumpcare
will cause 23 million Americans to lose their health coverage.
Which means that
unless Senate Republicans repudiate their own Congressional Budget Office
(whose director they appointed), they’ll have to either vote to take away
healthcare for 23 million people, or come up with their own plan.
But if they try to
come up with their own plan, they’ll soon discover there’s no way to
insure those 23 million without (1) mandating that healthy people buy
insurance, so that sick people with pre-existing conditions can afford it; and
(2) keeping the existing taxes on rich people so that poor people can afford to
buy health insurance.
In other words,
they’ll be back to the Affordable Care Act.
Some Senate Republicans will no doubt claim that the Affordable Care Act can’t be sustained in its present form because private insurers are beginning to bail out of it.
That’s an awkward
argument for Republicans to make because Republicans themselves have been
responsible for this problem.
In 2010 Congress
established “risk corridors” to protect insurers against uncertainties in
setting the level of insurance premiums when they didn’t know who would sign
up. Since then, Republicans have reduced or eliminated this backup. And the
Trump Administration has done everything possible to generate even more
uncertainty among insurers.
The obvious solution
is to restore this backup and reduce uncertainty, in order to attract insurers
back in.
This is surely
better than repealing the Affordable Care Act and taking away health
insurance coverage for 23 million people.
The only alternative
is a single-payer plan – Medicare for all – that would provide universal
coverage more cheaply than our present system, as embraced by most other
advanced nations.
But Senate Republicans
won’t get near a single payer.
Which means, as a
practical matter, they have no choice. They may wrap it up in different garb
and call it by a different name, but in the end the logic is unavoidable:
They’ll have to strengthen the Affordable Care Act.
ROBERT B. REICH is Chancellor's Professor of
Public Policy at the University of California at Berkeley and Senior Fellow at
the Blum Center for Developing Economies. He served as Secretary of Labor in
the Clinton administration, for which Time Magazine named him one of the ten
most effective cabinet secretaries of the twentieth century. He has written
fourteen books, including the best sellers "Aftershock", "The
Work of Nations," and"Beyond Outrage," and, his most recent, "Saving
Capitalism." He is also a founding editor of the American Prospect
magazine, chairman of Common Cause, a member of the American Academy of Arts
and Sciences, and co-creator of the award-winning documentary, INEQUALITY FOR
ALL.
