Obamacare needs fixing, not gutting

It’s hard to imagine a more awful rollout for new elements of the Patient Protection and Affordable Care Act, known, more and more derisively these days, as Obamacare.

Technological failures kept uninsured Americans eagerly seeking coverage from signing onto the online federal health exchange and many state exchanges, including Hawaii’s.

And now millions of Americans who have private insurance, including about 170,000 here, are being notified that their policies are being canceled or altered, because they fail to meet the coverage standards mandated by the new law.

It’s been bungled, no doubt, leaving consumers and insurance companies alike feeling misled, confused and angry. Still, even amid the chaos, it’s not difficult to imagine an even worse scenario: the health care system we used to have.

Then, some 50 million Americans had no coverage, insurance companies could deny coverage to patients with pre-existing conditions, young adults could not stay on their parents’ insurance plans, and financial reimbursements flowed based on the number of medical transactions, with little heed to patient outcomes.

Obamacare was envisioned to combat all that, and at its core the law remains sound, a market-based approach to control- ling the cost of health care, making treatment and management systems more efficient and expanding cover- age to more Americans. Under the law, anyone who does not receive coverage from their employer or via programs such as Medicare is required to purchase it on the open market. Costs are subsidized by the government based on income, and individuals face fines if they do not eventually purchase health insurance.

It’s important to take the long view as competing proposals emerge to address the needs of Americans who are losing coverage despite President Barack Obama’s repeated assurances that anyone who liked his or her current insurance plan would be able to keep it. That turned out to be untrue for the 5 percent of individual policyholders whose current coverage lacks the benefits and consumer protections required under the law. Insurance companies are no longer allowed to offer these so-called "junk policies" –some of which offer limited coverage and high out-of-pocket fees — so they are booting current policyholders. While this problem does not affect 95 per- cent of the people insured in the United States, it is a huge political liability for Obama — whose basic integrity is being questioned — and Democrats facing re-election in 2014, not to mention the individuals losing their health insurance.

Obama has proposed the best short-term fix by proposing to temporarily allow insurers to renew "current policies for current enrollees," although even that is sure to disrupt the insurance marketplace and potentially raise the cost of premiums. Worse, though, is a Republican bill just approved in the House — with the support of 39 Democrats — that would not only keep the substandard policies in force now, but allow companies to sell them to new customers next year. This is nothing more than a thinly veiled attempt to kill the Affordable Care Act.

That must not happen. Even with all the missteps on the federal level, state-level health exchanges are clearly attracting the uninsured to purchase affordable, comprehensive coverage. Kentucky, for example, is enrolling 1,000 people a day via an efficient, state-run system that supplements online access with personal assistance.

Too bad the same can’t be said for Hawaii, which has enrolled a total of 257 people in six weeks via the online marketplace known as the Hawaii Health Connector. The Connector was the last in the nation to go live — two weeks late — due to software problems that have continued to plague it.

There’s been a lack of accountability at the Connector, a private, nonprofit quasi-governmental agency that is funded by millions of taxpayers’ dollars but has been shielded from public scrutiny during its rocky Obamacare rollout. From its inception, organizations such as the League of Women Voters and AARP Hawaii objected to the Connector’s nonprofit status — unique among the nation’s health exchanges — and said it should be subject to Hawaii’s ethics and open-government laws. The fact that insurance industry executives whose companies stand to profit from the exchange sit on its board also raised red flags. It’s even more obvious now that those concerns were well-grounded.

Greater transparency is overdue.