Sue Lani Madsen: Healthcare – it’s complicated

Health care reform has been a political slogan generator for more than a decade. Repeal and Replace! Medicare for All!

Republicans have predictably championed bringing more competition into the health care marketplace to reduce insurance premiums and make health care more affordable. The speaker of the U.S. House made the following remarks to introduce HR 4626, the Health Insurance Industry Fair Competition Act, as an opportunity to pass “legislation that increases leverage for the people by changing the playing field, a playing field that has been dominated by the insurance industry for over 65 years.”

According to the speaker, 400 mergers in 14 years between health insurance companies is creating monopolies and stifling competition, resulting in “many areas of our country (being) dominated by just one or two private insurers today.”

We’ve acutely experienced that lack of competition in rural Washington.

HR 4626 would have repealed the McCarran-Ferguson Act of 1945, which grants insurance companies an exemption from anti-trust laws. It passed the U.S. House of Representatives with overwhelming bipartisan support by a vote of 406-19. Rep. Cathy McMorris Rodgers voted aye. So did Speaker Nancy Pelosi. It was spring 2010, before the Affordable Care Act was pushed through Congress. HR 4626 died in committee in the then-Democratic-controlled Senate.

McCarran-Ferguson reforms have had strong bipartisan support in the House in every Congress since. This year’s bill is HR 372, passing by a vote of 416 to 7. It looks headed for a similar death in the Republican-controlled Senate.

The Senate is traditionally just slower to take up bills.

“That’s unfortunately the fate of a lot of bills that the House passes,” said Olivia Hnat, spokeswoman for McMorris Rodgers, adding that “735 bills are stuck in the Senate as of this week.”

Democrats tried reforming health care through the Affordable Care Act, stuffing everything including the kitchen sink, the bathtub and the water troughs down at the old corral into a single bloated bill. Speaker Nancy Pelosi was pilloried for saying we’d have to “pass it to know what’s in it.” An unfortunate word choice. “What’s in it?” turned into the inevitable unintended consequences, which brought out the unintended victims supported by Republican partisans.

Republicans tried repealing the whole thing, knowing it wouldn’t go anywhere with a Democrat still in the White House. Small reforms passed quietly with bipartisan support, fixing functional flaws in the original ACA. A few substantial health care bills made it out of the Republican Congress to be signed by a Democratic president. Hnat pointed to the “21st Century Cures Act,” co-sponsored by McMorris Rodgers, as an example of that bipartisanship.

Then the White House changed hands.

After politicizing the massive size of the ACA and its accompanying regulations, Republicans tried an incremental strategy. Instead of one big bill to repeal and replace, there would be a series of bills, each dependent on the others to provide the complete reform but able to pass through regular order.

That was the theory. In practice, it bogged down and created a lot of small targets for Democratic partisans to politicize.

We are a compassionate country. We have consensus on protecting people with pre-existing conditions, even if there’s no consensus on how best to do it. There’s consensus on keeping Medicare for the elderly. We know there are fragile families in our communities. We want everyone to have access to health care. But nobody believes anybody’s claims anymore.

The truth is, the ACA did not deliver on promised savings. Deductibles have risen relative to wages, based on the Kaiser Family Foundation report issued in 2015. The average premium increase approved in Washington this year is over 13 percent, when inflation is barely 2 percent.

The new slogan is “Medicare for All!” But it has a big price tag, adding more than $32 trillion to the federal budget in its first 10 years. The current system relies on a mix of Medicare and private insurance to cover costs. Medicare pays about 40 percent of what private insurance pays. Low reimbursements are already hurting Medicare-dependent rural hospitals. Even without expansion, Medicare is not sustainable without major changes.

We still need health care reform, and there’s one big idea with bipartisan support. Convincing the Senate to pass HR 372, the Competitive Health Insurance Reform Act of 2017, would be a start. Trouble is, there’s no group providing pressure. Bipartisan ideas don’t let anyone score points. They’re complicated.