Millions of Americans whose healthcare coverage was imperiled can breathe a sigh of relief now that congressional Republicans’ reckless efforts to dismantle the Affordable Care Act have foundered. They can thank a handful of courageous moderates in the Senate Republican Caucus for being unwilling to repeal the ACA without having a replacement ready that wouldn’t make matters worse for their constituents.
Merely stopping bad legislation, however, won’t solve the problems that helped to drive the “repeal and replace” effort this year. Major insurers have withdrawn from the individual market in several states, leaving some counties with no one to serve residents who don’t have coverage through their jobs, Medicare or Medicaid. And other counties are seeing staggering premium increases. At least some of these problems resulted directly from the crippling uncertainties created by Republican policymakers.
With characteristic graciousness, President Trump has now called on Congress to “let Obamacare fail,” something made only more likely by his ongoing efforts to sabotage it. Meanwhile, Senate Republican leaders say they’ll vote next week on the repeal bill, evidently for no better reason than to prove they can’t pass it. That’s a waste of time. The responsible thing to do would be to shore up the markets created by the ACA for individual policies. This needs to be done soon, given that insurers have to set their offerings and rates for 2018 within the next couple of months.
The problems start with the uncertainty over who will sign up for coverage and how much it will cost — a situation that applies to states with robust individual markets, such as California, as well as to those with ailing ones, such as Iowa and Tennessee.
The Trump administration can’t continue to disregard the ACA’s mandate that adult Americans obtain insurance, at least not without an alternative way to persuade healthy people to sign up. Otherwise, insurers will have too few healthy people and too many costly ones in their risk pools. Congress and the administration also need to commit publicly to paying for the subsidies that the law requires insurers to provide to low-income consumers for out-of-pocket costs. The threats to the mandate and the subsidies have led some insurers to drop out of the market and others to seek larger rate hikes, further discouraging healthy consumers from buying insurance.
Those steps may not be enough to help some less populous states, where too much cost is being spread across too few people. Reviving the ACA’s reinsurance program for health insurers there would help hold down premiums.
There’s broad consensus within the industry about the need to make these moves. The problem is that Republicans have campaigned against some or even all of them. Now, however, they’ll have to put politics aside in order to spare the individual markets in their states the chaos they’ve set in motion.
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