Unwind Obamacare with Caution
Eric Borgerding, President/CEO, Wisconsin Hospital Association
January 4, 2017
After six years of upheaval and realignment in health care, the 2016 election has, again, left many asking "What’s next?"
The immediate answer seems certain with the coming inauguration of a president who will sign a repeal of Obamacare. The real uncertainty, the real high stakes, comes in the "when" and "how" the Affordable Care Act is replaced.
Republicans now occupy center stage in this ongoing saga, moving from antagonist to protagonist in a role reversal that brings great expectations and new accountability. Objective observers agree that Obamacare is in need of repair if not overhaul, but while it still exists, its flaws remain the property of its namesake.
Repealing it, however, means owning what comes next, a shift that should underscore how serious a policy and political undertaking replacing Obamacare will actually be. Because for all its warts, the quandary that is Obamacare has given something to nearly a quarter of a million (and growing) Wisconsinites that they and their families do not want to lose—health insurance.
Love it or hate it, it is an undeniable fact that Obamacare has extended health insurance to millions of people across the country, in congressional districts both red and blue. In increasingly red Wisconsin, our already low uninsured rate dropped another 38 percent since Obamacare kicked in, the result of Gov. Scott Walker’s strategy of combining Wisconsin-style Medicaid expansion with Obamacare’s premium subsidized insurance exchanges.
Wisconsin’s successful hybrid approach could be a national model going forward and proves that expanding health insurance coverage is a bipartisan aim. The differences come in the means of achieving this goal and, more importantly today, sustaining Wisconsin’s gains.
The fact is there’s simply too much here to quickly unwind and political leaders from both parties know this. The challenge is a complicated (and politically risky) one of scale, pace and effectively translating campaign pledges into post-election policy, all against a backdrop of growing Obamacare enrollments, falling uninsured rates and teetering exchanges.
Indeed, the "how" of replacing Obamacare is as important as the "what." Our health care delivery and insurance systems have seen massive upheaval and realignment during the past few years. While Wisconsin health care is a national quality and value standout, its leaders forward-looking, nimble and adaptive, an abrupt U-turn could backfire, causing even greater dissatisfaction and frustration than already exists.
This means replacing Obamacare will not happen overnight. Ample time must be allowed to implement and transition, or "bridge," any major changes. Ironically, Congress may need to fix Obamacare before it can fully replace Obamacare.
Wisconsin’s low uninsured rate coupled with high-quality care means we have much to either gain or lose in the coming debate. If Obamacare is repealed, the 225,000 people it now helps cover in Wisconsin will need a better alternative.
There’s a lot at stake in replacing the law that delivered that coverage. Fortunately, Wisconsin could be in a strong position. With Congressman Ryan in the speaker’s chair and Gov. Walker now leading the Republican Governors Association, no other state should be as well positioned to shape "what’s next" and sustain the coverage gains we have achieved in the process.
Bottom line is we should be prepared for more changes coming to health care, along with the imperative that we engage in defining "what’s next" for Wisconsin. It’s a task the Wisconsin Hospital Association and our member hospitals and health systems are prepared to undertake in partnership with our elected leaders.
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