How Trump, Congress can replace Obamacare in a bipartisan way

The Affordable Care Act was a good idea poorly executed at a politically divisive time. Come Jan. 20, the Republican Party will control the federal government, and scrapping the act — which is so tied to President Barack Obama that even he calls it Obamacare — will be a top priority of President Donald Trump and probably House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell as well.

The San Diego Union-Tribune Editorial Board has long urged Congress and the White House to try to fix the ACA, believing that it would never be replaced so long as Democrats held the White House or controlled part or all of Congress. When the GOP runs Washington, a better idea is to dismantle the ACA while keeping what’s best about the 2010 law.

This could well happen. There appears to be broad support among lawmakers for retaining popular ACA provisions allowing children to remain on their parents’ health insurance policies until they are 26 and for banning insurers from denying coverage based on pre-existing conditions. The even better news is that there is a chance that rolling back and improving Obamacare could be a genuinely bipartisan effort, unlike the brutal 2009-2010 cage fight before the law’s enactment.

Coming off an ugly campaign, that may seem unlikely. Why won’t congressional Democrats behave in the same disputatious way toward a Republican president as congressional Republicans have toward Obama? Why wouldn’t they proudly defend a bold initiative that has led to 20 million more Americans having health insurance? Why wouldn’t Democratic senators filibuster such a bill and defy McConnell to follow in the footsteps of Nevada Democratic Sen. Harry Reid who as majority leader put some limits on the blocking tactic?

Here’s why: Because while ACA has worked out reasonably well in California and some other large states, it is on its way to being a disaster in many small and midsized states, with insurers pulling out of money-hemorrhaging state exchanges, premiums soaring and deductibles going ever higher. A recent analysis predicts that by next year, in one-third of the nation, Obamacare enrollees will have only one insurer option. Bill Clinton spoke for a lot of Democrats — especially House Democrats up for reelection in 2018 — when he called what’s become of the ACA “the craziest thing in the world.”

By contrast, Republicans fighting the prospect of Obamacare faced little downside because polls in 2009 showed most Americans were fairly satisfied with the health care status quo. That’s not true now.

So let’s not wait until Jan. 20 to get to work. Trump and Ryan have put out position papers calling for allowing insurers to offer policies in all 50 states under one federal standard. They propose giving tax credits and creating IRA-like health savings accounts to help individuals buy coverage. Republicans should ask Sen. Ron Wyden, D-Oregon, for input. The 2008 health reform proposal he helped craft was thoughtful and serious, and he has already worked with Ryan on Medicare reform.

There are many knotty problems to address. But we can do much better than a system that gives people incentives to game it by not buying insurance until they’re sick and gives businesses incentives to hire part-time workers instead of full-time workers so they don’t have to provide health insurance.

Democrats should join Republicans to scrap what they should and salvage what makes sense.