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Former Congressman Dr. Phil Gingrey provides public policy and government relations counsel to clients on a variety of issues. Here at Phil on the Hill, Phil draws upon his long career in public service to provide perspective and context on policy topics such as health care, the federal budget, annual appropriations, regulatory reform, and life sciences.

Health Care Bill: Time for Retain, Repair and Revise

Tuesday, July 11, 2017

Before I was an elected official, I was a physician. Over 27 years in private practice as an OB/GYN, I delivered more than 5,000 babies. Along the way, I’ve had to weigh risks and make tough decisions in the best interests of my patients and their children.

Some of the toughest legislative calls are now being made on health care. 

Every day it seems another Republican member of the U.S. Senate declares an inability to support the GOP’s replacement of President Obama’s Affordable Care Act (ACA). 

More conservative senators — Ted Cruz of Texas, Mike Lee of Utah, Ron Johnson of Wisconsin and Rand Paul of Kentucky — believe the Senate measure is a “lite” version of the ACA. Others, such as Senator Dean Heller of Nevada, object to the bill’s reduction of Medicaid expansion, which could remove 300,000 Nevadans from the program’s rolls. Senators Susan Collins of Maine, Rob Portman of Ohio and Shelley Moore Capito of West Virginia have spoken up about the need to expand opioid treatment as well as other Medicaid expansion issues.

If this were an operating room instead of a legislative chamber, I’d be calling “Code Blue” for a Senate health care bill. Like every doctor, however, I’ve seen even the most critically ill patients revive, survive and even thrive.

Recovery begins when all sides — not just conservative and moderate Republicans, but Democrats as well — come together to create a transparent process with a willingness to examine the best ideas, regardless of their provenance.

We should all recognize that the dominant health care policy and program we are living under today is not the ACA, but uncertainty. Insurance providers, troubled by the uncertainty of the future of cost-sharing subsidies and the future insurance market generally, are pulling out of ACA exchanges in state after state.

The polls show, however, that most Americans see the American Health Care Act (AHCA) passed by the House Republicans as an unacceptable replacement.

According to the non-partisan Congressional Budget Office, the House’s AHCA would cut 24 million Americans from health insurance rolls over nine years. The House measure would increase premiums for single policyholders in the non-group market by as much as 20 percent in the next two years, followed by modest reductions. Notably, the policies with lower premiums are likely to be less generous, causing critics of the bill to note that people may be paying a little less out of pocket while getting a lot less coverage.

A solution cannot be so generous that it crushes the wallets of taxpayers. It cannot be stingy, either, raising premiums and throwing people off the rolls.

Senator Johnson is asking his colleagues to take more time to come up with better solutions. The GOP-controlled Congress, which has given itself to the end of September to finalize legislation under FY 2017 budget reconciliation, might question its self-imposed deadline.

Perhaps Congress should consider canceling the August recess to work on a more thorough approach — one that brings market discipline, lower costs and wider, deeper coverage — rather than rushing a hastily conceived bill developed under the pressure of paying for tax reform.

While complete repeal and replacement may have made sense in 2010 —when the GOP first took back control of the Congress and the ACA was not yet implemented— too much time has passed and too much of our nation’s health care infrastructure has been altered to get all the toothpaste back into the tube. A solution today should focus on keeping what works, fixing what is broken and tweaking the areas that need refinement and revision. Perhaps a more accurate name than “repeal and replace” would be “retain/repair/revise.”

Health care will soon consume almost one-fifth of the economy. It is a life-or-death issue for individuals and our nation. If Congress takes more time, engages in more compromise and avoids the high risk of “fast but wrong,” it will be well worth it — even if it means enduring the long, humid days of Washington in August.