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Regardless of whether you call it the Affordable Care Act, Obamacare, Better Care Reconciliation Act or the U.S. House of Representatives' version, the federal health care bill should be called the "Mission Impossible Act."
It's a classic example of a "push me-pull you" dilemma and the Republican U.S. Senators are demonstrating that situation quite well. You don't even need to interject what Congressional Democrats want to demonstrate the strife.
So far, neither President Trump nor Senate Majority Leader Mitch McConnell has been able to pull enough strings or impose enough political pressure to guarantee a successful vote on the floor of the U.S. Senate. Thus, the delay to call a vote on the legislation before the 4th of July break. Remember, if all of this political maneuvering by the Republicans fails, Obamacare will still be the law of the land.
Medicaid is the lynch pin
When the nonpartisan Congressional Budget Office announced their analysis on the Republican Senate's version, the stage was set. The damaging news indicated that 22 million Americans would be left uninsured under their plan. Another important finding was that federal spending would be reduced by a projected $321 billion by 2026 compared to the House's version of $119 billion.
Moderate Republican Senators want to reduce the impact on the number of people who rely on Medicaid for their health coverage or in other words reduce the 22 million figure. On the other hand, some R's say the fiscal spending cuts on health care do not go far enough in their conservative way of thinking.
While there are numerous provisions which are different in either Republican plan versus current Obamacare provisions, it really gets down to the Medicaid component. How many low income people are to be provided health care benefits, under what level of coverage and at what expense make up the crux of the issue? The pre-existing condition coverage and family coverage of children to age 26 don't seem to be challenged at this point.
Major factors not addressed in any plan
An additional pair of financial factors which are NOT included in Obamacare or either Republican version which could have a reasonable decrease in the plan's cost, would be "Big Pharma" and medical practice insurance costs. Both the big pharmacutical firms and the trial lawyers' lobbying power have blocked cost reductions which could be realized if "the best interests of the public" were to be served. Prescription costs and medical practice liability insurance premiums have been negative factors in the whole health care "formula." Congress should have the "manhood" to resolve both of these influences in any final version of legislation.
Conflicting "drivers" in this issue
So, the fundamental policy issue is how much is the federal government - in other words, us taxpayers - willing or able to pay for lower income individuals and families to have health coverage. It's a moral question and a fiscal question. Unfortunately, the two are in conflict with each other.
From the start, I have said and believe that our country cannot afford the collective fiscal impact of health coverage spelled out in Obamacare. While my wish would be for every American child and adult to have reasonable health care coverage, it is beyond the financial reach of American government under the current fiscal terms.
The only way to make Obamacare "balance" from a fiscal point of view is to have an across-the-board tax increase and we all know where that would end up.
From my perspective, continually increasing the federal debt is not a viable approach either. Furthermore, do we want to end up like some of the socialistic European countries with universal health care with much, much higher income taxes?
Tough decisions to be made
So, if we as a country cannot financially afford coverage for all nor be willing to go deeper in debt, where do the policymakers draw the line on who is "in" and who is "out"? I know it sounds cruel and cold, but it is reality. Do you leave all but 5 million people in the plan under Medicaid or 10 million - or 15 million? It's a numbers game.
That is where we stand today over the 4th of July Congressional break. My conclusion is either let Obamacare "run into the ground" financially or bite the bullet and reduce the number of people currently covered under Medicaid. It's a tough call, but it needs to come to a conclusion so that the federal government can get on with its other business.
Let's remember that while the issue of health care is among the top issues facing our federal government, there are other fiscally impacting challenges on the table for Congress and President Trump to address. Public infrastructure replacement and expansion are badly in need of additional funding. National defense is high on the agenda especially given the level of unrest in the world. Furthermore, the increasing impact of our national debt must be addressed.
Bill Christopher is a former Westminster city manager and RTD board member. His opinions are not necessarily those of Colorado Community Media.
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