What could fix the Affordable Care Act

The biggest problem with the failed Republican effort to kill the Affordable Care Act is it was based on a lie. Even now, its detractors insist Obamacare is collapsing, despite evidence that with some structural fixes it could be as effective as Medicare in providing health insurance to millions of Americans.

The medicine needed to cure the ACA became clear soon after the rocky rollout of its exchanges in 2013. But instead of addressing its flaws, Republicans used the wave of public displeasure with Obamacare to solidify their hold on both houses of Congress and win the presidency. Failing to deliver on their promise to repeal Obamacare, though, is likely to cost them in future elections.

The Republicans should salve the wounds to their pride and collaborate with Democrats on legislation that would improve the ACA. For that to happen, Republicans must get over their fear of crossing the GOP’s tea-party wing, which has been calling the Republican senators who refused to support the repeal effort traitors.

President Trump has been playing to that crowd ever since his election campaign. He’s not about to abandon it now that his dwindling poll numbers suggest tea-party support is crucial to ensure the faithfulness of Republican lawmakers who don’t feel the same love for him.

Outside Washington, Americans can only hope Democrats and Republicans will one day put the needs of the public above partisanship and fix Obamacare. For months, observers with ties to the health care and insurance industries have spelled out what needs to be done. But their recommendations have been ignored by Republican leaders who want to kill the patient, not save it.

… Anyone who has ever run a business knows you must build a customer base to be successful — and that there might be some lean times until you do. Same thing goes for Obamacare, which was built on a hybrid business model to garner the support of insurance companies worried about the potential for drooping profits.

A private business uses discounts and other incentives to build its customer base. But as a government program, Obamacare could use a carrot-and-stick approach. The carrot: subsidies to cover the higher premiums some consumers would pay. The stick: tax penalties on individuals who could afford but didn’t buy health insurance, and on larger companies who didn’t offer coverage to employees.

Congress could make more people eligible for subsidies, increase the size of subsidies to get more people to buy insurance, or make the penalties larger so fewer people would opt to pay them instead of buying insurance. Or it could do a combination of all three. Increase the number of customers buying insurance and premiums should go down….

— The Philadelphia Inquirer