In the middle of the night on Thursday, Republicans in the U.S. Senate voted to take the first steps toward repealing the Affordable Care Act before the end of the month. Connecticut must be ready to step in when the law finally dies.
Unfortunately, nobody knows what that’s going to look like yet. Republicans are scrambling to put together some kind of replacement. No one seems sure what that replacement will be, or how much of the original law will be kept. President-elect Donald J. Trump has promised to reveal a plan of his own once his Health and Human Services nominee is confirmed, which makes things even more uncertain. There are tons of unanswered questions, such as whether there will be some kind of lengthy transition period between laws or, instead, there will simply be a repeal of the ACA with no replacement at all.
It’s odd that Republicans never bothered to come up with a replacement law until now. It’s almost as if the whole thing was a cynical political stunt that they never expected to have to deliver on.
The agonizing back-and-forth between President-elect Donald J. Trump and congressional Republicans over what to do about Obamacare would be funny if the health care of millions of people didn’t hang in the balance. The GOP is like the dog that caught the car.
It’s not going to be easy for them from here. Plenty of provisions of the law are popular, like young people being able to stay on their parents’ plans until age 26 and insurers not being able to deny people coverage based on pre-existing conditions. It also turns out that the millions of people who bought insurance through the exchanges may not be thrilled if they are suddenly thrown off their plans.
But while Congress desperately tries to get its act together, there are plenty of scared people in Connecticut and the rest of the country who are wondering what they’re going to do when the health care coverage they’ve been depending on goes away or changes. They are not counting on Congress to do what’s right or to even remember they exist.
This is where the states must step in. The Connecticut legislature should be seriously examining ways to ensure that our people, especially the most vulnerable, get the health care and protections they need.
What can the state actually do, though, should Congress lose its collective mind and repeal the ACA without replacing any of it? We have a few options.
First, the state could pass some kind of quick fix that would require insurance plans sold in the state to have a few of the more popular Obamacare/ACA provisions. This wouldn’t be too difficult to do. The state can and does require insurers to include certain things, but it would also leave too many out in the cold should the insurance exchanges and individual mandate disappear.
The second thing we could do is what the state was attempting to do back in 2009 before the ACA became law, which was to set up an insurance pool through which the public could buy plans. That pool would have included state employees and retirees, and it would have been fairly close in practice to what Massachusetts was already doing with MassHealth. It was regrettably named “SustiNet,” which is a cringeworthy play on the state’s motto “Qui Transtulit Sustinet” (“He who transplanted me here sustains me still”).
This law was sidelined after the ACA was passed, because it was no longer necessary. But reviving SustiNet would be a worthy response to the current crisis, and the fact that the insurance pool would be ready-made with state employees and retirees could actually make it stronger. The state would bring its own massive negotiating power to the table to be able to get decent, cost-effective coverage.
The third thing we could consider is something we’ll never do. We don’t have the money, our people are so brainwashed by right wing propaganda that they’d never accept it, and Vermont’s effort to try to do just this failed.
But … if we want to jettison the heartless, costly, and fragile insurance-based system entirely, we could finally try for single-payer health care. The initial cost would be staggering, true, but everyone would finally be covered, and employers wouldn’t have to foot the bill for the health care of their workers anymore. It won’t happen, I know. Still.
The only thing we can’t afford to do is nothing. The last year has taught us that the worst can and will happen. We must be ready.
Susan Bigelow is an award-winning columnist and the founder of CTLocalPolitics. She lives in Enfield with her wife and their cats.
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