House Trumpcare measure fails primary test — First, do no harm (Tulsa World editorial)

By World’s Editorial Writers

By a narrow margin, the U.S. House of Representatives has passed the American Health Care Act, the long awaited “repeal and replace” alternative to “Obamacare.”

The bill eliminates one of the least popular elements of “Obamacare,” the individual mandate, which was enforced by tax fines, but replaces it with a provision that allows insurance companies to penalize customers up to 30 percent if they do not maintain continuous coverage. Perversely, that moves from an incentive to become insured to an incentive to remain uninsured.

The measure would cap Medicaid funding to states and send that funding in the form of block grants while reducing Medicaid funding by $839 billion over 10 years. While that means greater freedom to how states use the money, it also means the states inevitably will be hit with more and more costs.


The measure hands over many choices, such as what would be included in an essential benefits package, to states and sets the stage for health insurance companies to offer bargain products across state lines. With waivers, insurers could charge people with pre-existing illnesses far higher rates than healthy customers, boost prices for older people, and ignore a mandate that they cover specified services like pregnancy care. Again, the quality of your insurance will be subject to the Legislature’s whims.

The measure also eliminates “Obamacare” taxes on higher-earning people and the health industry, leading a New York Times analyst to describe it as a tax cut disguised as health-care reform. As the Oklahoma Policy Institute has shown, just about everybody except the wealthy loses out in the new system of tax credits and age-banded ratings. Many lose out a lot.

The House intentionally passed the measure blind, not knowing how much it would cost, what effect it would have on the deficit or how many people would lose their health-care coverage as a result. By definition, that’s bad lawmaking.


The proposal fails the fundamental test of reforming health care: First, do no harm. It puts too much at risk and solves too few problems.

There is much we would change in “Obamacare,” but we also recognize that all the pieces of the puzzle are so interlinked that there are no simple solutions.

By all reports, the drafting process starts from scratch in the Senate. We hope that second effort produces bipartisan participation and reform that actually moves health-care policy forward instead of simplistic changes for change sake.

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