Congress’ proposed alternative to Obamacare would not force anyone off the Oregon Health Plan. Let’s be clear about that.
But let’s be equally clear: Hundreds of thousands of Oregonians could lose their health insurance.
That contradiction exists because the so-called American Health Care Act is not health care reform. It is financial reform, or at least change. The plan put forth by congressional Republicans and the Trump administration would slash federal spending on health care, shifting much of that responsibility to the states.
Still, it’s disingenuous for Republicans to say no one would be kicked off Medicaid, or for Democrats to say millions of Americans would be, as if those outcomes were guaranteed. As with the health plan’s predecessor — the Affordable Care Act, or Obamacare — no one knows precisely what will happen.
The question for Congress and the American people comes down to how much our government should spend on health coverage for low- and moderate-income Americans.
If states have the money — which few, if any, will — they could continue serving all their Medicaid recipients. In Oregon, where most Medicaid coverage is through the Oregon Health Plan, that could cost the state an additional $2.6 billion over five years. That is why state officials say as many as 375,000 people could lose Oregon Health Plan coverage by 2023.
Democratic Gov. Kate Brown said last week that the number of uninsured Oregonians would triple, from the current 5 percent of the population to 15 percent. That is because of bureaucratic hurdles imposed by the American Health Care Act, as well as reduced subsidies and Oregon’s inability to cover the increased costs.
The Republican plan would repeal and replace the Affordable Care Act, which had little to do with health-care reform either. The reform was in insurance coverage, although Oregon was able to improve care while reducing price hikes. The key was the establishment of coordinated care organizations, whose collaborative model of overall health care reduced emergency room visits and hospital admissions. On the other hand, Cover Oregon was an expensive fiasco, and it is still costing Oregon money.
The Affordable Care Act and the new congressional plan share other similarities — unfortunate ones, starting with lack of clarity at the outset.
Changes in the American Health Care Act are likely because the current proposal appears to please no one. Conservatives in the Republican congressional majority contend the plan remains too much like Obamacare. Minority Democrats complain that it undoes Obamacare’s good points.
Unfortunately, congressional Republicans appear ready to follow the Democrats’ bad example and ram their health-finance plan down the throats of the opposition. That strategy resulted in the Affordable Care Act we currently have — a mix of flaws, successes and uncertainties.
A Republican plan that follows a similar unilateral approach will yield a similar outcome.