The campaign against the Affordable Care Act hit a wall Thursday, with the Republican congressional leadership unable to muster the votes to pass its replacement.
The impact sent out shock waves to states already shaken by the uncertain future for their health insurance markets — and for the patients they cover.
Thus, Hawaii lawmakers are wise to do what they can to stabilize our own health-care landscape. This week they took a step in the right direction by advancing House Bill Opens in a new tab552 Opens in a new tab, a measure that seeks to secure the benefits established by the ACA (“Obamacare”) when that law was enacted in 2010.
What passed the state Senate Commerce, Consumer Protection and Health Committee was more of a vehicle than a finalized piece of legislation, which is fine. It’s still unknown exactly what protections Hawaii may need, given the chaotic and sometimes irrational negotiations over the “repeal and replace” bill in the U.S. House.
So far, President Donald Trump’s efforts to nail down the required votes have been stymied by basic math: Changing the measure to add votes from the conservative wing only succeeds in subtracting support from the moderates.
Muscling through a bill in this way is an effort to meet a political mandate in any form possible, even if it falls far short of good policy.
Hawaii, luckier than most states, has had the advantage of its own statute, the Prepaid Health Care Act, for more than 40 years. It mandates that employers provide health coverage for everyone putting in 20 hours a week or more, and requires richer benefits than what’s in the ACA. Over time, the state law has given Hawaii one of the nation’s lowest uninsured rates.
That said, the ACA further improved coverage, and HB 552 would provide some certainty to the market by keeping the status quo in place as much as possible.
The chief concern is to maintain the expansion of Medicaid, the federal program states implement to cover the vulnerable, especially lower-income residents. Hawaii already had relatively generous rules qualifying more people above the poverty line than in many other states.
The ACA expanded that further. About 110,000 adults are covered under the expansion program — about one-third of the state’s total Medicaid population. A federal law that phases out the expansion means Hawaii would have some $230 million less to cover these people. In a state already struggling with homelessness and one of the highest costs of living, cutting people from the health-care rolls would further strain the social safety net. It should be a state priority to avoid that outcome.
Obamacare also has meant an extension of parental coverage to young adults up to age 26, as well as “guaranteed issue,” meaning one can’t be turned away from a health plan because of pre-existing conditions.
There are flaws in the ACA that could be corrected, in theory — regulatory fixes that could improve markets and make the system less burdensome. But in practice, that would require a fuller rewrite of the law, and under Senate rules, bipartisan cooperation would be needed to muster the 60 votes for passage. No such bipartisanship exists in the current, poisonous political climate.
HB 552 is not without its critics. Some have advocated an overhaul of the state system to achieve something even closer to universal coverage.
Lawmakers clearly should not let the perfect be the enemy of the good where health care is concerned. The “good,” in this case, would be providing some certainty to the businesses that provide health insurance to most of Hawaii’s citizens. A hurricane is raging in the nation’s capital, but this state can bring a measure of calm to these stormy seas.
