It's time to check in with the governing party to see how its plan to replace Obamacare is progressing.
On Capitol Hill, the majority Republican leadership's latest plan is to unite its extremist and moderate wings by ignoring President Donald Trump's pledge to protect people with previous medical conditions. Meanwhile, many representatives are returning from spring break after hearing an earful from constituents afraid of losing their newly acquired health insurance.
One can only imagine the schadenfreude of former White House occupant Barack Obama after he learned that Rep. Joe Wilson, the conservative South Carolinian who shouted "you lie" during his 2009 address to Congress, was now on the receiving end of the same taunt.
Speaking of the White House, the last we heard from the president was his threat to withhold cost-sharing subsidies, which defray the out-of-pocket expenses of low-income exchange plan purchasers. He's using it as a bargaining chip to get Democrats to vote for a Republican replacement plan.
In doing so, the president revealed ignorance about politics as well as healthcare. Using threats to get Democrats to back Medicaid block grants or premium tax credits will be as effective as using military threats to get North Korean dictator Kim Jong-un to abandon his nuclear program.
So where do we go from here? Just as the 2016 election put "repeal and replace" on the political agenda, the special election to fill HHS Secretary Tom Price's Georgia seat could take it off. There's an outside chance 30-year-old Democrat Jon Ossoff, who garnered 48% of the vote in a district that hasn't elected a Democrat since the Carter administration, will win the June 20 runoff.
Will Republican frontrunner Karen Handel, a former Georgia secretary of state, embrace "repeal and replace" during the runoff campaign? Handel once worked for the Susan B. Komen Foundation and lobbied for the inclusion of women's health issues in any essential benefits package. She should be pressed on her support for legislation that would end healthcare coverage for thousands of her potential constituents.
Indeed, the harm caused in Georgia by its leaders' anti-Obamacare stance is emblematic of the conundrum red state officials face across the country. Compare the uninsured rate in the state-14%-to the national average, which is 10%.
Or, better yet, compare it to another red state that embraced the Medicaid expansion. Ohio under Gov. John Kasich saw its uninsured rate plummet to 6% in 2015 from 12% just two years earlier.
The failure to use every option available in the ACA to reduce the ranks of the uninsured affects everyone in a state, a realization that may finally be dawning on suburban swing voters. A quick search of the Modern Healthcare financials database reveals that hospital systems in Ohio cut their bad debt by 45% since 2013. Ohio hospitals' bad debt stood at just 4% of total operating revenue in 2015.
Georgia hospital systems, on the other hand, saw their bad debt decline by just 15% over those two years, and it remained at 11% of total operating revenue in 2015. When people can't pay their bills because they're uninsured or face unaffordable co-pays and deductibles, everyone else's premiums must rise to cover the cost.
Last week, insurance industry officials trekked to Washington to ask CMS Administrator Seema Verma to maintain the subsidies that her boss now uses as a bargaining chip. Without them, rates on the exchanges next year could soar 20% or more in most states.
Don't expect early word on how the Trump administration will respond. Earlier this year, the CMS extended the deadline for filing those rates until August.
Given the administration's willingness to put the health insurance of millions of people at risk, the most likely scenario over the next few months will be continued uncertainty over what plans and rates will be available on the exchanges for 2018.
