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Health care law: uncertain outcome after multiple diagnoses

WASHINGTON — The Affordable Care Act — on the examination table since President Donald Trump came into office — has been poked, prodded and even pronounced dead while the fight to keep it alive keeps going.

President Trump told Cabinet members Oct. 16: "Obamacare is finished. It's dead. It's gone. ... There is no such thing as Obamacare anymore," but that isn't how health-care reformers, including Catholic leaders, see it, and it isn't the general public's view either, according to a recent poll.

According to the Kaiser Family Foundation poll, seven in 10 Americans think it is more important for Trump to help the current health care law work than cause it to fail. Sixty-six percent of Americans want Trump and Congress to work on legislation to bolster the health insurance marketplaces rather than continuing their efforts to repeal and replace the ACA.

The poll, conducted by the Washington-based group that examines key health policy issues, was released Oct. 13, the day after Trump announced some changes to the current health care law.

By executive order, he directed federal agencies to make regulatory changes to the ACA to allow consumers to buy health insurance through association health plans across state lines and lifting limits on short-term health care plans. He also announced that he was ending federal subsidies to health insurance companies that help pay out-of-pocket health care costs for those with low incomes.

The Obama administration had authorized the subsidies, but in 2016, Republicans filed a lawsuit, saying they were illegal because Congress hadn't authorized the payments.

The president's plan to end the subsidy payments prompted swift criticism from Democrats, U.S. health care groups and the U.S. Conference of Catholic Bishops.

Bishop Frank J. Dewane of Venice, Fla., chairman of the USCCB's Committee on Domestic Justice and Human Development, said the bishops "will closely monitor the implementation and impacts of this executive order by the relevant administrative agencies."

Bishop Dewane said flexible options for people to obtain health coverage are important strategies, but he also cautioned that "great care must be taken to avoid risk of additional harm to those who now receive health care coverage through exchanges formed under the Affordable Care Act."

A possible fix to Trump's cuts that would continue federal subsidies to insurance companies through 2019 was offered in a bipartisan Senate proposal by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D- Wash..

By Oct. 20, there was no word on when the bill — which also aims to provide states flexibility to skirt some requirements of the health care law — might come to the Senate floor for a vote. Several senators have said they are waiting to see more details in the bill's text. Support from the House doesn't seem likely since House Speaker Paul Ryan, R-Wis., has said he opposes it.

Sister Carol Keehan, a Daughter of Charity and president and CEO of the Catholic Health Association, a leadership organization of more than 2,000 Catholic hospitals and health care facilities, has been keeping a close eye on the president's action on health care and the response by Congress.

"Working out a deal to keep the subsidies for a longer-term plan is something that is very important and critical to the future, particularly for the most vulnerable among us," she said.

Sister Keehan, who also is a nurse, told Catholic News Service Oct. 18 that she encourages the House and Senate to take immediate action to stabilize the insurance markets and delivery and "allow time for us to have a national conversation" about improving the health care law without letting those now covered with health insurance lost it or for "premiums to go out of sight."

Dr. Steven White, a pulmonary specialist in Ormond Beach, Fla., who is chairman of the Catholic Medical Association Health Care Policy Committee, said he is awaiting to see how new rules and regulations are written but is hopeful that some changes will be a move in the right direction.

White said his association sees less federal control and more patient control as a good thing and also would like the health law to offer more options, freedom and flexibility.

He said Oct. 18 that pouring more money into health care isn't the solution, but he also echoed Bishop Dewane's concern that changes shouldn't be made on the backs of those with low incomes. He said if Congress backs legislation that supports subsidies, they need to balance that with the realization that such a plan "can't last forever." 

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