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Glassheim: A path forward for health care

The Republican health care bill being considered by the Senate is so devastating to millions of people that some Republican senators are reluctant to vote for it.

Having heard from the North Dakota medical community how destructive the bill would be to Medicaid recipients and rural hospitals, even John Hoeven, who usually goes along with Majority Leader Mitch McConnell, is a provisional No vote. McConnell has threatened that if he can't get 50 Republican votes he may have to let Republicans work with Democrats

Democrats and Republicans of good will see this as a moment of opportunity when the country's decade of partisan gridlock can be reversed.

A strong plurality of the public (50 percent favorable, about 25 percent unfavorable) like the provisions of the Affordable Care Act.

They like: no annual or lifetime caps, protection for those with preexisting conditions, free preventive checkups, keeping children on policies until they're 26, Medicaid Expansion, subsidies for low and middle income people who buy on the individual market, and 20 million more people insured.

It's unlikely that Democrats would negotiate away those elements of the ACA which are supported by the American people. And they will hold the line against the gutting of Medicaid in order to pay for a tax cut for the wealthy.

But there are rational complaints about the ACA that need immediate attention. The two major concerns I've heard are: lack of competition in some markets and significant increases in premiums and out-of-pocket costs in some markets.

Also, some people resent the mandate to buy coverage when they feel perfectly healthy. This feeling is understandable, but it doesn't hold up as public policy. The law requires that you have car insurance or you can't drive. The banks require that you have insurance on your house before you can get a loan. You support public schools through property taxes whether you have children going to school or not. It's how society accomplishes things individuals couldn't afford on their own.

Health care is no different. If a young person chooses not to buy health insurance, what happens when, two years later, he finds he has cancer or diabetes? Who pays for his treatment which could cost $100,000 or more a year? The emergency room? The hospital? His doctors? His friends?

Ah! Taxpayers. (When his savings are gone, Medicaid will have to subsidize his "free" choice.)

Or, ratepayers. (Hospitals will raise their rates to cover their uncompensated care; insurance companies will raise the cost of their premiums to cover the increased rates.) Pay me now or pay me later.

The other two concerns are real and need to be addressed immediately by Republicans and Democrats working in good faith to find areas of agreement.

Several weeks ago, Sen. Heidi Heitkamp, who has always been a common-sense problem-solver rather than a party ideologue, led 15 Senate Democrats onto the Senate floor to ask Republicans to work with them in finding a short-term solution to premium increases in the individual market. Serious market instability has been caused by uncertainty created by administrative actions and provisions in the Republican bill. Insurance companies are significantly raising 2018 rates to protect themselves in case Congress pulls the rug out from subsidies promised in the past but uncertain in the future.

Calling on Congress to "park the ideology at the door," Heitkamp proposed a permanent reinsurance fund in the individual market and making cost-sharing reduction payments permanent. These two measures would stabilize the insurance markets and give insurance companies the certainty that they don't need to raise premiums excessively to protect themselves against huge unanticipated losses.

Once markets are stabilized for next year, there will be time for Republicans and Democrats to return to the regular committee process to hammer out a bipartisan bill which retains aspects of current law the public likes, but makes changes that will lower costs, improve access, and improve quality in health care.

In a recent national Kaiser poll, 71 percent wanted both parties to work together to make improvements to the ACA.

As of late Monday night, it appears that at least four Republicans will vote "no" on the unpopular Senate health care bill, dooming it for now.

It would still be important for Sen. Hoeven to vote "no." It would signal his willingness to take a path forward by working with moderates in both parties to make health care work better.

If the bill fails, it does not mean there will be no changes to current law. Congress can move directly to stabilize insurance markets and provide for additional competition in underserved counties. Following that, Congress can return to the regular committee process and work on the bipartisan bill the American people want.

Eliot Glassheim is a former state lawmaker from Grand Forks. His column is published every other Thursday in the Herald.