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Opinion We’re finally having the health-care debate we need

The 2017 homepage. (Pablo Martinez Monsivais/Associated Press)

Thanks to a horribly constructed Republican bill that satisfies no one and a late-night TV host, we are finally having the debate we need on health care.

The Republicans who have for seven years promised to repeal the Affordable Care Act — but keep the parts they like such as protection for those with preexisting conditions — are now scrambling to pass a bill that does not really do either. Faced with the prospect of actually passing a bill and its impact on tens of millions of people, the GOP realized it couldn’t really repeal Obamacare. In its first iteration, the American Health Care Act left in place many Obamacare requirements, such as the essential level of benefits insurance plans must offer. More important, at least in principle, Republicans insisted they were committed to access to health care for everyone, a permanent and substantial federal guarantee. It may have been poorly designed, shortchanged rural and elderly Americans, rolled back Medicaid and handed the very rich a huge tax break, but it wasn’t really repeal of Obamacare.

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In its latest version, Republicans still don’t really repeal all of Obamacare, but now the promise of protection for preexisting conditions is undermined by states’ ability to opt out. But they said they’d keep protection for preexisting conditions! Sorry, they decided not to. But, but, what about “high-risk pools” — the supposed magic solution to protect people with preexisting conditions without imposing a community rating system? Well, House Speaker Paul Ryan’s and other Republicans’ bluff has been called: These things don’t work because they are horribly expensive and run out of money.

As Republicans push out new revisions to save the health-care plan, The Post's Paige Cunningham explains the disputes behind the internal fighting over the bill (Video: Jenny Starrs/The Washington Post, Photo: Melina Mara/The Washington Post)

As the AHCA teeters on the brink of failure, some Republicans ask if maybe the federal government could guarantee the high-risk pool be funded. Thunk. Well, now we’re really not abandoning the ACA’s universal coverage concept or “re-establishing an individual health-care market.” And if you are going to have to guarantee funding for high-risk pools (an uncapped entitlement, if you will), then you might just as well allow people with preexisting conditions to stay in the general individual policy market with the promise they won’t be charged more than others — which is exactly what Obamacare does. In or out of the main individual health-care market, they are going to need to have affordable coverage; that’s what the public wants and what the GOP now must grapple with.

Moreover, as the Republicans struggle to find a mechanism to bolster high-risk pools, they confirm the underlying problem, namely that they run out of money. A possible $8 billion infusion over 5 years from the feds won’t come close to making sure the pools are funded. Experts say that would take as much as $30 billion per year. And if it costs more, will the Republicans provide, in essence, a new funding stream — a new entitlement in effect?

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How did Republicans get so muddled? They wanted to repeal Obamacare but not force voters to suffer the consequences — e.g., loss of essential benefits, protection for preexisting conditions. To paraphrase President Trump, they want to have their cake — a beautiful piece of delicious chocolate cake — and eat it, too. They have essentially conceded the public will not stand for true repeal of the ACA, so they are forced to create a crazy quilt of fixes that duplicate Obamacare’s results. Those fixes are unsatisfying and ineffective, so you wind up with a bill no one likes and many people hate.

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And this brings us to Jimmy Kimmel. He, in essence, explained why it is now politically impossible to really repeal Obamacare and why politicians now must accede to the demand for universal coverage, not just theoretical access to health insurance. In an emotional monologue about his infant son’s heart defect, he told the crowd:

We were brought up to believe that we live in the greatest country in the world, but until a few years ago millions and millions of us had no access to health insurance at all. You know, before 2014 if you were born with congenital heart disease like my son was, there was a good chance you’d never be able to get health insurance because you had a preexisting condition. You were born with a preexisting condition and if your parents didn’t have medical insurance you might not live long enough to even get denied because of a preexisting condition. If your baby is going to die and it doesn’t have to, it shouldn’t matter how much money you make.
Whatever your party, whatever you believe, whoever you support, we need to make sure that the people who are supposed to represent us, people who are meeting about this right now in Washington, understand that very clearly. Let’s stop with the nonsense. This isn’t football. There are no teams. We are the team. It’s the United States. Don’t let their partisan squabbles divide us on something every decent person wants. We need to take care of each other

Republicans should hide under their desks after that recitation. No doubt 99 percent of Americans agree with Kimmel. Hence, Republicans are trapped. They cannot repeal Obamacare and substitute merely the promise of access; they have to make certain there is coverage for all the infants, children and adults who otherwise would not have insurance. Obamacare moved the goalposts, or rather, acceded to a public demand that we not have anyone who would lack coverage and the peace of mind that goes along with it. 

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Sorry, Republicans, but it is no longer politically viable to offer merely theoretical access. Public expectations have changed, and politicians are not willing to face the onslaught of ads featuring parents like Kimmel. That means they cannot remove the federal government from the health-care equation or do away with actual protection for preexisting conditions. They could — but they’d lose their seats. They know that, which is why it becomes more unlikely every day that we’ll see something approaching a repeal of Obamacare. 

Republicans now are watching from a defensive crouch the real debate about health care play out: Are we as a society willing to say the federal government should not be guaranteeing coverage for just about everyone? Judging from the reaction to Kimmel, the answer is no. Republicans have been preaching something that was unattainable and unwanted for seven years. Maybe it is now time to move on to tax reform.