Health care plan has serious flaws

Republicans, defending their efforts to “repeal and replace” the Affordable Care Act, attempt to ward off criticism of the most recent Senate proposal by insisting that it’s not the final measure, that it will undergo further revision in the amendments process.

Even if enough time was allotted for amendments (it wasn’t), Americans can’t afford to wait another moment before making their voices heard on the issue.

The ACA (“Obamacare”) does need stabilization of its insurance markets, but Congress seemingly wants evisceration, not repair. The GOP bill would leave many poorer citizens largely on their own to contend with health-care costs spiraling skyward, as Medicaid and subsidies for private insurance are curbed.

The Senate majority leadership is pushing hard to take a vote on what it calls the Better Care Reconciliation Act before Congress leaves for its Fourth of July holiday.

That means this week is a crucial decision point. And the Senate needs to hear from constituents, in stark terms, just what a bad decision this bill represents.

However it’s titled, it’s a misnomer. Neither the House nor the Senate version of “repeal and replace” either fully repeals Obamacare or replaces it with anything workable. As for the Better Care Reconciliation Act, by no description would this be better for millions of Americans already struggling with basic living costs.

“Reconciliation” is the Senate’s term for its process allowing for legislation addressing budgetary items to be passed by only a simple majority. The GOP’s thin, 52-member majority allows for the defection of only two senators to pass it. Leadership is short of the needed votes, with Sen. Dean Heller becoming on Friday the fifth to publicly say no.

Among voters, both House and Senate measures are unpopular, and the call to vote on an unpopular bill poses a political risk. That’s why the next few days offer the best opportunity for the public to weigh in, while they still may sway more votes.

And many of the “no” votes could swing to “yes” with the addition of a cosmetic amendment or two, meaning passage in the next few days remains a distinct possibility. Nobody has ruled out voting for the bill, finally, so its status is fluid.

Among the key elements in the Senate bill:

>> In the short term, it would phase out the ACA’s expansion of the Medicaid program more gradually than the House version, over the course of five years.

>> It would make deeper cuts in the legacy Medicaid program by basing funding increases on a slower growth index.

>> It would offer subsidies to lower-income Americans who don’t qualify for Medicaid, but many patients now in the program — those earning 350-400 percent of the federal poverty level — would be dropped due to new program caps.

>> It would allow states to waive the requirement to provide essential benefits offered under the ACA. This poses a threat to expensive but critical services such as maternity care. It’s no wonder; the bill was drafted without one woman in the room.

The deregulation of benefits would essentially lead to a race to the bottom in what consumers get for their health-care dollar. The Kaiser Family Health Foundation studied what plans were offered on the individual market before the ACA; maternity care and substance abuse treatment were most likely dropped. Both are crucial needs, across the U.S.

Supporters in the Senate include some conservatives, who praise its repeal of almost all Obamacare’s taxes and funding mechanisms.

The entire legislative push is being seen as a first step in providing broad tax reform that is aimed to benefit wealthier citizens. Within the context of this measure, it does so on the backs of poorer Americans, many of whom are working but at low-paying jobs that can’t support health insurance.

This is a repugnant notion.

At the heart of this partisan divide is a philosophical dispute. On one side are those who see a role for government in providing a very basic level of health coverage for the population. On the other are those who believe government supports prop up the cost of care that would decline if left to market forces.

But the health-care sector does not behave entirely like the market for commodities. People without insurance will not “shop” for care when they are well and services are inexpensive; they use their limited income to cover other costs.

Then, when their health becomes dire and the instinct for self-preservation kicks in, they end up on the hospital doorstep, in the emergency room, where delivery of care is the costliest.

Hawaii has a long history of mandating employer-based care, and so its congressional delegation is out in force to blast the Better Care Reconciliation Act, and its cousin in the House. The Legislature passed, and Gov. David Ige signed, a bill to seek ways of mitigating a potential repeal.

But it’s citizen voices that convey the message most plainly, that message being: Fix, don’t hobble, the ACA.