Shoe now is on other foot

Shoe now is on other foot

After complaining for years about President Barack Obama's flawed health care plan, Republicans face the challenge of trying to do better.

Six years after the then-nascent Obama administration began work on the gargantuan legislative proposal that became known as Obamacare, new President Donald Trump and congressional Republicans are taking the first initial steps to repeal and replace.

But hardly out of the gate, congressional Democrats, unanimously, and Republicans, a relative handful, are raising serious objections for very different reasons. How could it be otherwise?

As Trump said recently, addressing shortcomings in this country's health care system is a "complicated" business.

That's obviously true. That's why their work requires the utmost care as well as a thoughtful, deliberative legislative process.

Obama and his backers thought, thought and thought about their bill before they passed it. The result was a legislative morass in which those who bought insurance through Obamacare exchanges paid too much (excessive premiums) and got too little in return (excessive deductibles). Many younger and healthier people refused to comply with the legislative mandate to purchase health insurance, running the risk of paying tax penalties as punishment for their refusal.

Meanwhile, millions of uninsured people across the country were added to the welfare roll. In Illinois alone, roughly 600,000 people were put on Medicaid. Adding new enrollees to the previous Medicaid recipients means that one in four Illinois residents is on Medicaid.

(Democratic House Speaker Michael Madigan ought to reflect on that appalling, astonishing percentage before rejecting out of hand Gov. Bruce Rauner's argument that legislative changes are necessary to boost the state's flagging economy.)

Here, in a nutshell, are the highlights of the legislative proposal aimed at repealing and replacing Obamacare:

— The new measure would replace the tax subsidies for health care purchase with refundable tax credits tied to individual age and income. The tax credits are aimed at helping Americans who don't have employer-provided health insurance.

— The legislation would end the controversial mandate that requires people to buy health insurance or pay tax penalties for not doing so. Starting in 2018, it repeals multiple taxes associated with Obamacare, including the medical-device tax as well as other levies imposed on upper-income earners to help pay for the cost of lower-income Obamacare enrollees.

— Finally, it would freeze funding in 2020 for the 31 states that expand their Medicaid rolls to accommodate the Obamacare benefits package.

House Speaker Paul Ryan said the measure, just the first in a series of proposals Trump has promised, offers market-based solutions that are intended to introduce competition into the health insurance market and make it easier for the uninsured to buy health insurance.

But some conservative Republicans have dismissed it as "Obamacare-lite," characterizing the tax credits as another spending entitlement similar to Obamacare's tax subsidies. Meanwhile, Democrats, who continue to hold to their almost unanimous opposition to everything the president proposes, say the measure is a disaster in waiting, one under which the currently insured will lose coverage.

What's next?

House committees are reviewing the proposals and considering amendments to it. They show signs of rushing, a potentially big mistake on an issue of this magnitude and complexity.

Nonetheless, having run on the issue since the 2012 election, they have a moral responsibility to keep their word. If they don't, Democrats will run against Trump's proposal just as Republicans ran against Obamacare.

It's unfortunate, of course, that the two parties can't work together to address the multiple failings of Obamacare. It requires buy-in from both parties to pass programs that affects every American, dramatic changes like Social Security and Medicare. But the Democrats are determined to be just as obstinate under Trump as the Republicans were under Obama.

Still, legislating at this level is a dicey business. GOP lawmakers need to take their time and consider all sides of the question. This effort is just too important to rush.

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