With the Syria crisis entering a new phase, the focus among Washington policymakers has shifted to the debate over the debt ceiling and efforts by far-right Republicans to try and defund the Affordable Care Act. While it makes for good political theater, this effort will fail and the administration will try and claim it as a follow-on victory to last year’s Supreme Court fight. Regardless of one’s stance, the law remains incredibly unpopular and a Bloomberg Bloomberg poll released earlier this week illustrates the urgency of righting the political ship (and fast). According to the poll, 49 percent of respondents view Mr. Obama unfavorably.
For Democrats and Republicans, it is critical to move beyond this week’s theatrics and focus on reshaping the health care debate. By all accounts, Americans are willing to stand behind certain provisions of the 2010 law, but will continue to vocally oppose others. While policymakers and pundits re-litigate the most contentious elements, there are other politically-dangerous provisions set to go into effect that could pose an even greater headache for candidates running in next year’s elections.
Nowhere is this more relevant than in Oregon, where a little-known Commission is poised to upend longstanding Medicaid policy and create genuine uncertainty among seniors and other Americans who are in need of end-of-life care options. Politically-speaking, it represents the exact opposite direction of where most Americans want to take the debate over the future of the nation’s health care system.
A bit of background first: in 2011, the state legislature created the Health Evidence Review Commission (HERC), which was tasked with lowering Medicaid costs by making a point to prioritize a range of health care services. On paper, the Commission has full authority to rank specific services, procedures, medicines and other patient needs, similar in nature to the unpopular Independent Payment Advisory Board (IPAB) that has attracted broad opposition from both sides in Congress.
One example of the Oregon provision: a guideline that singles out cancer treatments for some of the state’s most vulnerable patients, running counter to the Affordable Care Act’s restriction on including life expectancy as a factor for treatment decisions. While quality of care has been a bipartisan theme in the national debate, picking and choosing who gets it carries significant consequences.
Unless CMS steps in before October 1st, the Commission will begin implementing harmful measures and limiting care options at the expense of patients.
For Democrats, this only elevates the death panel comparisons that Sarah Palin and the Tea Party have broadly socialized to oppose Obamacare. As it’s clear that the administration wants to move on with its agenda and claim momentum on the jobs front, the implementation of the Oregon structure threatens to add fuel to an already-hot fire at the same time that millions of Americans are encouraged to sign up for health plans through the state exchanges.
For Republicans, the senior vote has never been more on the line. While the GOP carried seniors in 2010 and 2012, winning control of the Senate (and there’s a real chance of this) will likely require a gain among seniors in key states and districts. Any semblance of support for provisions that limit end-of-life-care options could jeopardize this support.
This brings me back to an earlier point: it’s in everyone’s best interest to focus on the good and do away with the bad. Both sides agree that health costs will continue to rise and we need to take near-term steps to address this concern. Preventing insurers from limiting or denying coverage, pursuing policies to better coordinate care among health professionals and making plans more affordable will always garner widespread support.
At some point, however, the health care debate will enter a new phase and move away from up-or-down support for Obamacare. Introducing new provisions that restrict end-of-life care will only prevent a more constructive dialogue on how we reduce costs without harming patients. If policymakers embrace this dialogue, it’s something that will undoubtedly be rewarded when voters go to the polls next year.
