Senate Republicans are planning to vote on their version of the long-awaited health-care replacement bill as early as next week; this is the latest development in the contentious process of dismantling the Affordable Care Act. The unveiling of the "Better Care Reconciliation Act" sets up another showdown of competing narratives: ACA supporters will accuse Republicans of cutting coverage and reducing benefits and the GOP will point to a flawed system that is losing insurers and forcing double-digit premium increases on families across the country.
This face-off is nothing new. The conversation has played out repeatedly over the past six months. But one thing no one seems to be talking about is that Republicans are the only ones attempting to address the rising costs, declining quality of coverage, and increasing lack of choice in the health-care marketplace.
Democrats seem to be content with the status quo of the Affordable Care Act. Premium and deductible costs are rising and choice and competition are decreasing. As of now, over 1,200 counties will have only one insurance provider available on the individual market next year, and 35,000 individuals will live in counties with no options available at all. These numbers are expected to increase as insurers finalize their 2018 plans in the upcoming weeks, and yet, Democratic lawmakers have not introduced any major legislation to try and fix the system. They have taken the easy way out: showboating and complaining instead of working on a solution to stabilize the health-insurance market.
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Liberals often accuse the GOP of intentional sabotage, but premiums were increasing and insurers were fleeing long before the GOP victories of last November 8. If Democrats are worried about the effects of the replacement plan, they should be proposing their own ideas, not just placing blame. Symbolic protests and legislative obstruction might play well in Washington, D.C., but they do nothing for the families all across the country being crushed by the consequences of the ACA. Republican messaging to date has focused only on the collapsing marketplace; it must also emphasize that Democrats have done nothing to improve Obamacare.
The Democrats' refusal to change current law most likely stems from an unwillingness to admit that the ACA has not lived up to its promises.
The reform conversation has been framed as a decision to cut coverage and reduce benefits, but what most on the left leave out is that the biggest driver of reduced insurance coverage is cost. A report issued by the Department of Health and Human Services last month showed that premiums have increased 105 percent since the implementation of the ACA. Average monthly premiums in the 39 states using HealthCare.gov (the federal health-insurance exchange) increased from $232 in 2013 to $476 in 2017. In 24 of those states, premiums have doubled since the implementation of the ACA. Another report, released by the Centers for Medicare and Medicaid Services (CMS), showed that 2 million people have dropped individual-market insurance coverage since January. Of those people, 46 percent cited lack of affordability as their reason for canceling their plans.
Some Democrats have suggested that a lack of funding is the only problem with the ACA, but throwing more money at the problem by increasing tax credits and bailing out insurance companies does not fix the law's underlying problems. Any person with basic math skills should know that increasing the amount of money spent on a program does not lower its expenses. This is just cost shifting, not cost reduction. The actual cost of the product is not any lower. Americans are just hit twice, first in the form of higher insurance premiums and then again in higher taxes to cover the cost of government subsidies.
This week, Senate Democrats added holding the floor, a legislative maneuver to slow down routine Senate business, to their grandstanding efforts. A few Democratic senators also livestreamed a field trip to the Congressional Budget Office as a form of protest, taking time to snap a selfie in front of the CBO in an effort to bring attention to their cause. Late-night speeches, cellphone snaps, and scavenger hunts do nothing to help those living in counties with no insurance provider. There is no moral high ground in claiming to care about those struggling to obtain health care while not attempting to bring forth any ideas for reform.
Republicans should no longer let their colleagues across the aisle get a free pass on the health-care-reform discussion. They cannot assume that just because the ACA is unpopular with their conservative base, replacing it will be a political win for the party. In addition to highlighting the merits of their own bill, Republicans must also continue to show the country that the ACA is a disastrous law, but one that Democrats are nonetheless committed to preserving.
The Democrats' refusal to change current law most likely stems from an unwillingness to admit that the ACA has not lived up to its promises. Conservatives predicted eight years ago that a government-heavy health-care system would lead to decreased competition and increased costs. Democrats should not let embarrassment that those predictions came true prevent real solutions and lasting reform.
There is still plenty of debate and dialogue to be had between the parties on specific crucial matters such as Medicaid funding, tax credits, and benefit waivers in the new bill, but this should not distract from the larger issue at hand: The market today is not a functioning place to buy high-quality, affordable insurance. Republicans need to go on the offensive and remind voters that they are the only ones working to remedy the problems the ACA caused. The GOP is stepping in to save an already failing system. Its push to repeal and replace is not the cause of Obamacare's collapse. The collapse is a consequence of a poorly designed law. That is on the Democrats, Republicans should not let them get away with it.
Commentary by Juliana Darrow, a public interest fellow at National Review. Follow her on Twitter @julianakdarrow.
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