Americans want a better Obamacare

The following editorial appeared in the Chicago Tribune on Monday.

House Speaker John Boehner is catching a little heat for making fun of his fellow Republicans’ reluctance to deal with immigration reform. “Here’s the attitude: ‘Ohhh. Don’t make me do this. Ohhh. This is too hard,’ ” he told a Rotary Club crowd in Ohio on Thursday.

“They’ll take the path of least resistance,” Boehner said.

That’s some welcome truth-telling from the speaker. He relayed another political truth at the Ohio event: Congress is not going to repeal Obamacare.

“(To) repeal Obamacare … isn’t the answer. The answer is repeal and replace. The challenge is that Obamacare is the law of the land. It is there and it has driven all types of changes in our health-care delivery system. You can’t re-create an insurance market over night.”

Boehner has a sound message there for Republicans and Democrats. Obamacare is not going to vanish. It does, though, need to be fundamentally recalibrated to let insurance and health care markets function.

When President Barack Obama recently declared that 8 million people have signed up for health insurance under the Affordable Care Act, he admonished Republican lawmakers to stop talking about repeal of the law and move on.

“This thing is working,” he said. “The repeal debate is, and should be, over. We’ve been having a political fight about this for five years. We need to move on to something else.”

So he and Boehner seem to agree that repeal isn’t in the cards.

That part about “moving on,” though. That’s just Democrats’ wishful thinking.

People understand the Affordable Care Act has deep-seated problems. The RealClearPolitics average of seven recent polls on Obamacare found 41.3 percent of the public supports the law and 52.7 percent opposes it. That’s going to be a factor in the mid-term elections.

That points to why the congressional debate over an Obamacare overhaul is gaining momentum among Republicans and Democrats. There are still plenty of questions, plenty of doubts.

Republicans are asking how many of those 8 million people who signed up have paid their premiums. State and industry officials estimate about 10 percent to 20 percent have not yet paid, suggesting that, though they signed up, they won’t stay with coverage. Many consumers will struggle to pay high premiums or will feel cheated by high deductibles and narrow coverage.

Many of the newly insured are discovering the high costs and sharp limits of their new Obamacare-mandated coverage.

One example: Steve Pickett, a Californian who signed up for a platinum plan — the highest level of Obamacare coverage available — learned that two of the orthopedic surgeons listed as being in network would not take his insurance. “I felt totally blindsided,” he told a Tribune reporter. He’s not an isolated case.

The White House announced that 28 percent of enrollees on the federal marketplaces were ages 18 to 34. That’s a good sign for the future of Obamacare. Insurers need a heavy dose of healthy people paying premiums to offset the costs of sicker people. If not, premiums rocket and the law totters.

However, many insurers had hoped for higher numbers of healthier people; closer to 40 percent of the overall pool. That has prompted projections of a major premium increase next year, on top of premium spikes many consumers saw this year. Some insurers have warned of double-digit rate increases next year.

There is also the unanswered question of whether the employer mandate to provide coverage will be enforced in the future. Last year, the White House granted larger businesses a one-year delay. (Smaller businesses got a longer extension.)

The debate on Obamacare is far from over. As unlikely as it sounds, the country needs Republicans and Democrats to work together on loosening the mandates and restrictions to tame premium increases and give consumers and insurers flexibility to buy and sell the coverage people want and can afford.

Back to Boehner in Ohio: “So the biggest challenge we are going to have … is the transition of Obamacare back to a system that empowers patients and doctors to make choices that are good for their own health as opposed to doing what the government is dictating they should do.”

The reaction from Congress to that? As Boehner might scoff: “Ohhh. Don’t make me do this. Ohhh. This is too hard.”

Get it done.