Health Care Under Donald Trump

http://www.nytimes.com/2016/12/10/opinion/sunday/health-care-under-donald-trump.html

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Readers discuss the challenges the G.O.P. will face with its promise to replace Obamacare.

To the Editor: Re “A G.O.P. Plan on Health Act: Rescind Slowly” (front page, Dec. 3):

This article is just the latest indication that health care legislation is going to be a huge problem for Republicans. As the former chief executive of John Hancock Insurance Company, which once sold health insurance, I think it is fair to say that health insurance sold on an individual basis is a difficult proposition no matter how it is done.

If it is sold like any other product, people with pre-existing or chronic conditions will be turned down or will not be able to afford it. If exceptions are made, insurance companies will struggle to make a profit. None of the ideas being trotted out for the “replace” portion of the “repeal and replace” have much effect on the basic problem. This is not to say Obamacare is great; it isn’t. As one example, the penalty for not buying insurance was much too low. However, the idea of repealing before knowing exactly what will replace it is a recipe for chaos for everyone involved.

Republicans are also spending far too little time on trying to deal with the underlying problem of costs. A couple of suggestions: How about requiring hospitals to publish their prices, and allowing Medicare to negotiate drug prices (which Donald Trump backed as a candidate)?

STEPHEN BROWN

Palm Beach, Fla.

To the Editor: This is some of the nuttiest, ill-thought-out political rationalizing I have ever seen. According to this article, Republicans plan to strip out the mandate and tax penalties in Obamacare, leaving the remainder to deal with later.

President Obama’s handling of the Affordable Care Act was among the most artless, bungled bits of leadership in recent history. To order significant parts of the population to buy something they didn’t think they needed or could afford and then slap them with a penalty for not doing it before getting their buy-in was amateurish in the extreme. That doesn’t change the fact that a mandate was essential for creating a working risk pool. Then delaying enforcement of the mandate made escalation of premiums inevitable, further strengthening the argument that the plan was flawed. But Republicans will not be able to devise a workable, affordable insurance program without a mandate. It is simple mathematics.

While Republicans play petty politics and twist themselves into pretzels just to vent their petulant resentment against Barack Obama, millions of people’s lives are being toyed with, and we watch in horror a charade of governing by people without the least idea of what they are doing.

ROBERT MILLSAP

Woodland, Calif.

To the Editor: While Republicans in Congress debate “repeal and replace” health care for millions of us, what about their guaranteed health care? That’s an entitlement program to question. Why do members of Congress have better guaranteed health care than the people whom they represent? Let’s ask them how they would like the changes they are considering proposing for us. Would they like their health care insurance program repealed and gradually replaced? Would they enjoy health savings accounts? If they were not re-elected, they might need to seek another job. Would they want their pre-existing conditions to possibly not be covered by their next insurer?

BARBARA ELER

New Milford, Conn.

To the Editor: It’s the height of hypocrisy for the House majority leader, Kevin McCarthy, to complain of Democrats “playing politics” with Obamacare and to call for good-faith negotiation. Republicans had the opportunity for this discussion in 2009 when President Obama articulated his openness to any proposal that expanded coverage without adding to the debt. They could readily have obtained many of the adjustments they now propose had they been willing to engage at that time. Instead they opted for calculated party-line opposition focused entirely on handing the president a political defeat, and outrageous anti-Obamacare hyperbole has poisoned the discussion in the years since.

By all means let’s stop playing politics, but this means abandoning the overheated and vacuous repeal rhetoric and engaging in good-faith discussion on possible adjustments to the existing framework, not playing chicken with the coverage for millions of people.

STEVE LEOVY

Boulder, Colo.

To the Editor: “Why It Will Be Hard to Repeal Obamacare” (nytimes.com, Dec. 3) lays out the obstacles in undoing the Affordable Care Act. It explains how the G.O.P.’s restructuring of Obamacare could bring chaos to America’s health insurance industry, not to mention the millions of Americans whose health and quality of life would be compromised.

Chaos doesn’t come cheap. The operational costs alone to implement the changes bandied about by Speaker Paul Ryan and Tom Price, the nominee to head Health and Human Services, would be staggering. Every state would be affected, many of which are still upgrading their state-funded and federally subsidized programs to accommodate Obamacare policies.

A bit of prognostication: Since Paul Ryan’s “repeal and replace” approach to Obamacare has morphed into “repeal and delay,” the “repeal” bills will pass easily in both the Senate and the House. But the Republicans are nowhere near coming up with the “replace” part. Congressional Democrats, in contrast to the last eight years, will and should be the obstructionists.

RICH AVILLA

Sequim, Wash.

The writer has been an analyst and senior consultant on state Medicaid programs and federal projects with the Center for Medicare and Medicaid Services.

To the Editor: From the start it’s been clear that the best-known and most valued parts of Obamacare are (A) features like prohibiting penalties for pre-existing conditions and allowing people to remain on their parents’ policies until age 26.

It’s been equally clear that the most troublesome parts are (B) forcing people to buy health insurance, paying for the subsidies the system requires and keeping health care costs down.

So the Democrats will get credit for (A), provisions that are now too popular for the Republicans to repeal, while the Republicans in their pending health care redesign will be saddled with the problems that (B) will entail. Chalk one up for President Obama.

ANTHONY M. PAUL

Coral Gables, Fla.

To the Editor: There is a simple solution to the Republican quandary over repealing Obamacare while keeping many of its provisions: Pass a law renaming it Trumpcare. Problem solved.

CLAUDE FISCHER

Berkeley, Calif.