Editorial: With Obamacare preserved, it’s time to move forward
The Supreme Court decided 6-3 Thursday that Obamacare will continue. Of course, the judges decided on a narrower point: and that was to permit the Affordable Care Act to continue to subsidize people currently insured through “exchanges” run by the federal government.
An exchange is like an insurance company that allows people to choose their own insurance plan, but also pays for most of the premium for patients who qualify for subsidies. This is tremendously important to Texans as our legislature and governor have chosen to forgo a state exchange, leaving the federal exchange as the only option for Texans. If the Supreme Court had voted the other way, at least 1 million Texans would have lost their health insurance subsidies. Most could not have afforded the premium and would have been dropped from their plans. Millions in the future would have been unable to get insurance.
That’s the part that is visible today. The importance of the decision is deeper and, as I said, permits Obamacare to continue. Much of the country has been holding its breath, not only for the millions who would again become uninsured, but others as well.
1. The Republican Party has for the past five years opposed Obamacare and its underlying principles. The case that the Supreme Court decided Thursday seemed to be an easy way to get rid of Obamacare. Surely, if the vote had gone the other way, Obamacare would have imploded. Perhaps even more important, parties, ever mindful of the presidency, could have used the Supreme Court vote to repudiate the president personally and perhaps gain popular traction in voting Republican for the next president. Since that has not happened, the Republican Party will need to regroup and slog it out.
2. Some Republican governors and legislatures can exhale – as, in the absence of Obamacare and an acceptable substitute, focus would have been on the individual states to come up with their own plans for the uninsured.
3. Heath care insurers and large employers were treading water, making few decisions about pricing their premiums and co-pays. There has also been a sense that the strategic decisions of the next three to five years, such as better ways of improving cost and quality, have been on hold.
4. Leaders of safety-net providers such as Harris Health, but also Memorial Hermann, Texas Children’s and other not-for-profit systems that provide so much charity care, have been anxious for two reasons. If the court had decided differently, newly uninsured patients might have threatened the solvency of some of these providers. Many of these systems might have cut back operations — or even closed. In addition, there would have been no chance of covering the mostly working poor who are uninsured and ineligible for Medicaid.
Perhaps it is time for our Texas leaders to take stock. In our Texas Medical Center poll of 1,000 Texans chosen randomly, 88 percent said that health care coverage for all was important and 83 percent said it was at least very important to them. Following release of the survey, the Houston Chronicle wrote an editorial entitled “Tone deaf:”
“Health insurance is important to Texans, but our top elected leaders don’t see it that way. Do Texans really care? Apparently it matters a great deal, according to a first-of-its kind survey commissioned by the Texas Medical Center. An astounding 83 percent said that having health insurance was either ‘very important’ or ‘absolutely essential.’
“Do the elected officials who purportedly represent these Texans believe that medical insurance is important? Well, not so much. Here’s Gov. Greg Abbot, respond[ing] with the same, tired tea-party talking points when asked earlier in the week about expanding Medicaid, so that more Texans would have coverage… It’s astounding to us how elected officials can be so hidebound by ideology that they lag behind their fellow Texans on a number of issues, including Medicaid expansion.”
In light of the Supreme Court decision, it is time to move on and cover the uninsured of Texas. If the leaders do not want to call this “Medicaid expansion,” so be it – call it Harriet. A number of us have worked on ways to do this – at least one has a block grant and is being considered by another state. Let’s get going.
*This column previously ran in the Houston Chronicle.
