Focus on Plan O Fully

Sen. John McCain.

During a 78-minute stretch early Friday morning, the U.S. Senate rejected a last-chance health care bill known as skinny repeal 51-49.

The vote, spurred by Majority Leader Mitch McConnell, broke the Republican Party’s seven-year promise to repeal the Affordable Care Act — Obamacare.

Three Republicans joined with Democrats. The vote pronounced that all Americans deserve health care.

Worry about administrative or legislative trickery taking away the protections of Obamacare will linger.

Directly after the vote, President Donald Trump took to Twitter. He wrote: “As I said from the beginning, let Obamacare implode, then deal. Watch!”

Trump and those in his administration charged with operating Plan O must do the opposite. Their legal charge is to follow the requirements of the Affordable Care Act.

As the president wrote on Twitter later Friday, “We will always ENFORCE our laws.” Obamacare counts.

The same applies to Republicans in Congress who might be equally eager to ensure failure through nonfeasance.

The government must enforce legal mandates for employers to provide health insurance and for individuals to obtain health insurance. Also, it must fund cost-sharing agreements. All are needed to keep the cost of coverage down.

PHYSICS

Meetings of the U.S. Senate are not the most physical gatherings.

Nonetheless, three physical properties of Sen. John McCain made impressions during the Tuesday-through-Friday effort to eliminate Obamacare.

McCain, R-Ariz., walked onto the Senate floor Tuesday to deliver a speech upon his return after surgery July 14 for a blood clot behind his skull and above his left eye. Stitches above his eye and bruises beneath marked the medical work.

McCain’s raised-and-spread right hand, and his right thumb, would complete the visual memories by which many people will remember the week’s erratic effort to govern.

In his speech, McCain said the Senate was not accomplishing anything and all of its members would have to work together if they hoped to succeed.

McConnell countered cooperation by dishing out soggy bowls of his health care Alpha-Bits. Never mind that the senators had not supported Plan A, Plan B or Plan C the previous week.

McConnell should have heeded McCain’s message.

After all, five days after surgery, the Mayo Clinic said tests found that McCain has an aggressive type of brain cancer. If any senator was thinking deeply about health care, it was the 80-year-old Arizonan.

“Our deliberations,” McCain said in his speech, “can be sincere and principled. But they are more partisan, more tribal more of the time than any other time I remember.” He added, “Right now, they aren’t producing much for the American people.”

Both sides are to blame for the partisan rift, including individuals such as himself, McCain said. “Sometimes, I’ve let my passion rule my reason. Sometimes, I made it harder to find common ground because of something harsh I said to a colleague. Sometimes, I wanted to win more for the sake of winning.”

The Senate is “getting nothing done,” McCain said. “Our health care insurance system is a mess,” he said. “We Republicans have looked for a way to end it and replace it with something else without paying a terrible political price. We haven't found it yet, and I’m not sure we will.”

With McConnell’s ABCs piling up, he switched to descriptive names Tuesday. The Senate voted down a new variation of the Republican bill, known as repeal and replace, 57-43. The bill included an amendment from Sen. Ted Cruz, R-Texas, to allow low-coverage, low-cost insurance plans that do not meet Obamacare standards.

Wednesday, the Senate voted down partial repeal 55-45. The proposal would have removed the bulk of Obamacare after two years, allowing the Senate to write a new plan in the meantime. The same proposal was called Plan C the previous week. It would eliminate health insurance for 17 million people in 2018, compared to present, 27 million in 2020 and 32 million in 2026, estimated the nonpartisan Congressional Budget Office on June 19.

CLOCK

Just after midnight on Friday, McConnell placed one more plan, known as skinny repeal, before the Senate.

Skinny repeal would have removed the mandate for most people to have health insurance and it would have cut several lesser requirements. It would eliminate health insurance for 15 million people in 2018, compared to present, 15 million in 2020 and 16 million in 2026, estimated the CBO on Wednesday.

Then McCain acts on his convictions.

At 12:34 a.m., “McCain is in his seat and Alaska Sen. Lisa Murkowski, one of two Republicans expected to vote no, starts to talk. McCain makes a thumbs-down motion to Murkowski, but few notice it,” wrote Lisa Desjardins for the PBS NewsHour.

At 1:16 a.m., after a series of discussions with senators of both parties, as well as Vice President Mike Pence, McCain leaves to take a phone call.

At 1:28 a.m., McCain re-enters through a tall pair of wooden doors at the rear.

He walks to a clerical desk on the Senate floor, stands straight, sticks his right arm out rigidly and opens his right hand wide to signal readiness to vote.

McCain receives a nod of recognition. He turns his thumb down and says one sharp word, “No.”

His act shifts the balance and leads to the defeat of skinny repeal, the final effort to kill Obamacare.

Trump could have learned about leadership and cooperation by paying attention to McCain.

While McCain criticizes Obamacare for its problems, he recognizes that it has provided health insurance for more than 20 million Americans. Any change or replacement must be an improvement.

In a statement Friday, McCain said skinny repeal “offered no replacement to actually reform our health care system and deliver affordable, quality health care to our citizens.”

Now, Democrats and Republicans in the House of Representatives and Senate, as well as the president, should focus on Plan O fully.

POPULACE

The people understand.

In a Kaiser Health poll released July 14, respondents said congressional Republicans should work with Democrats to improve Obamacare, not repeal the law, 71 percent to 23 percent.

In a Washington Post-ABC News poll released July 16, respondents preferred Obamacare over the Republican approach 50 percent to 24 percent.

Health insurance should cover pre-existing conditions. Health insurance should cover young-adult children on parental plans. Health insurance should cover preventive tests and lab work to detect problems when small and curable. Health insurance should cover emergencies to take substantial cases directly from an emergency room to a hospital room. Health insurance should cover mental care equally with medical care. Health insurance should cover maternity care for mother and child. Health insurance should continue to provide coverage, regardless of total payout, to enable care in cases that are difficult or require long-term treatment.

The only plan that provides such meaningful coverage is the Affordable Care Act — Obamacare.

Protect and bolster the superior treatment made possible by Plan O. Focus on changes that improve health care for Americans. Ensure that everyone is covered fully.

Adapted from “Path Back to Plan O.”

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Path Back to Plan O

Sen. John McCain.

John McCain is the U.S. senator most seriously involved with health care today. He told a series of truths Tuesday that both made predictions and provided guidance for health care deliberations.

McCain, R-Ariz., underwent surgery for a blood clot behind his skull and above his left eye on July 14. The Mayo Clinic said July 19 that tests by its doctors found that McCain has an aggressive type of brain cancer.

The Senate has not accomplished anything, McCain said Tuesday, and the whole body must work together if it hopes to succeed.

President Donald Trump scolded Senate Majority Leader Mitch McConnell and the rest of Republican senators last week for their inability to pass three separate bills. The bills aimed to repeal the Affordable Care Act — Obamacare — and install a weaker replacement.

The failed bills became known as Plan A, Plan B and Plan C. They are variations of the Better Care Reconciliation Act, written by Senate Republicans and guided by McConnell. They set out to improve the House of Representatives’ punitive American Health Care Act, passed May 4.

The House bill would eliminate health insurance for 14 million people in 2018, compared to present, 19 million in 2020 and 23 million in 2026, estimated the nonpartisan Congressional Budget Office on May 24.

REWIND

McConnell moved the Senate to formal votes this week.

Tuesday, with the ABCs piling up, the Senate switched to descriptive names. It defeated a new variation of its bill, known as repeal and replace. The bill included an amendment from Sen. Ted Cruz, R-Texas, to allow low-coverage, low-cost insurance plans that do not meet Obamacare standards for coverage. It failed with 43-57.

Wednesday, the Senate voted on partial repeal. The proposal would repeal the bulk of Obamacare after two years, and the Senate would write a new plan in the meantime. The same proposal was called Plan C last week. It would eliminate health insurance for 17 million people in 2018, compared to present, 27 million in 2020 and 32 million in 2026, estimated the CBO on June 19.

A majority of senators found none of McConnell’s proposals an improvement over Obamacare. Plan O has brought health insurance to more than 20 million Americans.

Thursday, Republican senators tried to repeal Obamacare during a 20-hour debate.

Next on the Senate’s schedule is a segment known as vote-a-rama. This period allows any senator to offer amendments to the bill. The amendments could reach into the hundreds. One problem: McConnell has not said which version of the Senate bill will be considered.

McCAIN’S SENATE

This helter-skelter is no way to run our government.

McCain explained why in a speech during his return to floor of the Senate on Tuesday. “Our deliberations,” he said, “can be sincere and principled. But they are more partisan, more tribal more of the time than any other time I remember.” He added, “Right now, they aren’t producing much for the American people.”

Both sides are to blame for the partisan rift, including individuals such as himself, McCain said. “Sometimes, I’ve let my passion rule my reason. Sometimes, I made it harder to find common ground because of something harsh I said to a colleague. Sometimes, I wanted to win more for the sake of winning.”

The Senate is “getting nothing done,” McCain said. “Our health care insurance system is a mess,” he said. “We Republicans have looked for a way to end it and replace it with something else without paying a terrible political price. We haven't found it yet, and I’m not sure we will.”

The Trump-McConnell approach of governance by whiplash is irresponsible. Americans count on the federal government to set up a framework that allows those who cannot get coverage at work to buy insurance with proper terms at an affordable price, or to register for Medicaid. They rely on this coverage not only for health care but, in many cases, for life itself.

SKINNY REPEAL

If all else fails, McConnell plans to introduce a final approach known as skinny repeal.

It would repeal the mandate for most people to have health insurance and it would cut several lesser requirements.

Skinny repeal would eliminate health insurance for 15 million people in 2018, compared to present, 15 million in 2020 and 16 million in 2026, estimated the CBO on Wednesday.

Eliminating the mandate for health insurance would result in many signing up only when they get sick. This would throw insurance-industry finances off balance. It would increase premiums greatly for those who need insurance for ongoing health care — a death spiral.

The American Academy of Actuaries warned against this Tuesday.

“Eliminating the mandate, by lowering financial penalties or exempting particular categories of individuals from its requirements, would likely have significant implications for health insurance coverage, and costs both to consumers and the federal government,” the academy wrote to Senate leaders.

The Blue Cross Blue Shield Association issued a similar warning Wednesday.

“If there is no longer a requirement for everyone to purchase coverage, it is critical that any legislation include strong incentives for people to obtain health insurance and keep it year-round,” the association said. “A system that allows people to purchase coverage only when they need it drives up costs for everyone.”

The Republican House and Senate bills treat Americans with disdain.

Their minimalistic approach to health care ignores a fundamental rule of insurance: Plan for the worst.

The Republican proposals ignore that wisdom by planning for the routine.

Plan O has proved itself as a lifesaver, even though it has some problems.

Republicans have blocked improvements and updates to Obamacare since they gained the congressional majority and now the presidency.

However, as McCain told the Senate, passion should not overrule reason.

Rather than looking for ways to undermine Obamacare, Republicans — along with Democrats — should work to repair and improve this valuable advancement in the American Way.

The people understand. In a Washington Post-ABC News poll released July 16, respondents preferred Obamacare over the Republican approach 50 percent to 24 percent.

Health insurance should cover pre-existing conditions. Health insurance should cover young-adult children on parental plans. Health insurance should cover preventive tests and lab work to detect problems when small and curable. Health insurance should cover emergencies to take substantial cases directly from an emergency room to a hospital room. Health insurance should cover mental care equally with medical care. Health insurance should cover maternity care for mother and child. Health insurance should continue without a payout cap so a person’s coverage can provide crucial care in cases of illnesses that are difficult or require long-term treatment.

The only plan that provides such meaningful coverage is the Affordable Care Act — Obamacare.

Senators should protect and bolster the superior treatment made possible by Plan O. Focus on changes that improve health care for Americans. Make sure that everyone is covered fully.

Adapted from “Upgrade Health Plan O.”

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Upgrade Health Plan O

Senate Majority Leader Mitch McConnell.

Senate Majority Leader Mitch McConnell and many of his fellow Republican senators told the nation they could improve health care and cut costs by paring down insurance.

McConnell said they could cover people with serious illnesses and pre-existing conditions too.

Overall, their lightweight insurance proposal saved money by focusing on colds and flu, aches and pains, and other problems that require everyday care by a doctor or nurse practitioner.

This minimalism ignored a fundamental rule of insurance: Plan for the worst.

McConnell’s proposal did the opposite by planning for the routine.

This backward approach would strand patients with difficult diseases. It would cut coverage short for extended hospitalization or long-term treatment.

Thankfully, the nation has a plan in place that takes health care seriously — the Affordable Care Act.

Better known as Obamacare, it needs some maintenance and upgrades.

The reason: A wanton blockade by the Republican Congress and Trump administration has halted updates, routine upkeep and promotion of Obamacare — all in hope of failure.

Now is the time for Republicans to invite Democrats to join an equal effort to eliminate inefficient aspects of the program and put better practices in place.

However, since Trump’s election, he and congressional Republicans have intensified their attack on Obamacare and, thus, on the health of Americans.

Their disregard for the nation’s people continues with a Trump demand for a vote to repeal Obamacare and create a replacement through Senate debate. McConnell says the vote will be next week.

PLAN AND PLAN AGAIN

The House of Representatives passed the American Health Care Act on May 4. The bill was intended to replace Obamacare.

If any Republican group was going to tame the draconian House bill and treat health care sensibly, the national expectation was that it would be the Senate majority — 52 of the 100 senators. The Senate is known for deliberation, experience and caution in comparison to the House.

McConnell took the opposite tack. He appointed an all-male, all-Republican group of senators to meet in a series of closed sessions to write the bill. Suspicion spiked.

In what would become known as Plan A, McConnell rolled out the Better Care Reconciliation Act on June 22. It split his caucus.

Conservatives complained it retained too many Obamacare tenets. Moderates, a number of whom were backed by their state governors, bemoaned stark cuts to Medicaid and other coverage on which many of their constituents rely for health care — and for life itself.

Not enough Republicans supported Plan A. No Democrat supported any Obamacare replacement.

McConnell rolled out Plan B on July 13. It aimed to pull in more conservative and moderate Republicans alike. 

Plan B’s lack of support proved the contradiction of its premise.

Tuesday, the ever-more-desperate McConnell proposed Plan C. It would have eliminated Obamacare two years from now, with the Senate using the interim to write a new health care bill from scratch. Trump and Vice President Mike Pence stated their support. Plan C collapsed almost as quickly as it was proposed.

Wednesday, Trump changed his mind and insisted that Obamacare should both be repealed and replaced — immediately. “We have to stay here. We shouldn’t leave town, and we should hammer this out and get it done — and not just a repeal,” the president told a large group of Republican senators during a White House luncheon.

McConnell acted on Trump’s instruction promptly. Outside the White House, after the lunch meeting, McConnell said, “No harm is done by getting on the bill.” He added that the bill would be “wide open for amendment.”

Left unclear by McConnell was which version of the bill would be debated. If the idea gains the 50 votes needed for discussion, a hagglefest will result.

With Trump’s influence among senators weakened by limp leadership that includes his erratic proclamations and changes of course, a chance of victory is barely visible.

TOOLBOX

Plan O is a more productive way to go. Grab the toolbox and pound out the dents in Obamacare. Time has identified them, but Republican interference has made repairs impossible until now.

The nation prefers Obamacare over the Republican approach 50 percent to 24 percent, says a Washington Post-ABC News poll released Sunday.

Democrats have a duty and a need to ensure that Plan O is upgraded effectively and to show the way forward. They passed Obamacare, over Republican opposition, in 2010. Respondents in the Post-ABC poll said the Democratic Party “just stands against Trump” rather than “stands for something” 52 percent to 37 percent.

Health insurance should cover pre-existing conditions. Health insurance should cover young-adult children on parental plans. Health insurance should cover preventive tests and lab work to detect problems when small and curable. Health insurance should cover emergencies to take substantial cases directly from an emergency room to a hospital room. Health insurance should cover mental care equally with medical care. Health insurance should cover maternity care for mother and child.

The only plan that provides such meaningful coverage is the Affordable Care Act — Obamacare.

Republicans should swallow their party pride and join with Democrats on Plan O. It is the people’s preference 2-to-1. Solve Obamacare’s problems to protect and improve the health of Americans in every state.

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APPENDIX I — CBO CHARTS

APPENDIX II — CBO DATA

Under the House’s American Health Care Act, the Congressional Budget Office estimated on May 24 that:

• Fourteen million people would lose health insurance in 2018, compared to present, 19 million in 2020 and 23 million in 2026.
• Over 10 years, an $834 billion cut to Medicaid would result in 14 million people among those uninsured coming from that program.
• Premiums would be 20 percent more in 2018, compared to present, and 5 percent more in 2019. The amount in later years is uncertain.
• The federal deficit would decrease $119 billion over 10 years.

Under Plan A of the Senate’s Better Care Reconciliation Act, the CBO estimated on June 26 that:

• Fifteen million people would lose health insurance in 2018, compared to present, 19 million in 2020 and 22 million in 2026.
• Over 10 years, a $772 billion cut to Medicaid would result in 15 million people among those uninsured coming from that program.
• Premiums would be 20 percent more in 2018, compared to present and 10 percent more in 2019, but 30 percent less in 2020 and 20 percent less in 2026.
• The federal deficit would decrease $321 billion over 10 years.

Under Plan B of the Senate bill, the CBO estimated on July 20 that:

• Fifteen million people would lose health insurance in 2018, compared to present, 19 million in 2020 and 22 million in 2026.
• Over 10 years, a $756 billion cut to Medicaid would result in 15 million people among those uninsured coming from that program.
• Premiums would be 20 percent more in 2018, compared to present, and 10 percent more in 2019, but 30 percent less in 2020 and 25 percent less in 2026.
• The federal deficit would decrease $420 billion over 10 years.

Under Plan C of the Senate bill, the repeal-only Obamacare Repeal Reconciliation Act, the CBO estimated on June 19 that:

• Seventeen million people would lose health insurance in 2018, compared to present, 27 million in 2020 and 32 million in 2026.
• Over 10 years, an $842 billion cut to Medicaid would result in 19 million people among those uninsured coming from that program.
• Premiums would be 25 percent more in 2018, compared to present, and 50 percent more in 2020 and 100 percent more in 2026.
• The federal deficit would decrease $473 billion over 10 years.

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Make Sure Price Is Right

Tom Price, secretary of health and human services.

As the nation has learned in 2½ months of Donald Trump’s presidency, little is as it appears. Worse, little is as he says.

The problem is that his comments, pro and con, rotate around an important issue as quickly as the International Space Station orbits Earth.

When the House of Representative’s health care bill failed March 24, following mighty pushing and schmoozing by Trump and House Speaker Paul Ryan, the two were glum.

“This is a setback, no two ways about it,” Ryan said. “Obamacare is the law of the land,” he said, and it will be “for the foreseeable future.”

“I’m disappointed,” Trump said. Before the day was through, Trump circled around the other side of the health care globe to say, “I want to have a great health care bill and plan — and we will.”

Ryan said Tuesday that he would allow House Republicans to try again on health care. “We are all going to work together and listen together until we get this right.” Ryan did not provide a plan or schedule.

While Trump and Ryan entertain wishful thinking, the executive branch is obligated to carry out every aspect of the Affordable Care Act, as Obamacare is titled.

NO EXCUSE

Tom Price, secretary of health and human services, has that duty. Obamacare is healthy. The nonpartisan Congressional Budget Office predicted March 13 that insurance markets will remain stable.

As such, Price has no excuse for anything other than vigorous support for Obamacare as its executive leader and through his Department of Health and Human Services.

Neither may Price fall back on the ultraconservative, anti-Obamacare positions he held as a Republican member of the U.S. House. In the House, Price was a member of the Tea Party, much of whose outlook is shared by the House Freedom Caucus. Caucus members opposed the conservative House health bill as too liberal.

Concern about Price’s willingness to meet the requirements of his position has proved valid in the short time since his Feb. 10 confirmation by the Senate.

Price’s agency delayed a health rule March 21. The HHS notice pushed back reform of Medicare payment for follow-up treatment after a heart attack, or heart-bypass or joint-replacement surgery. For months, Trump has promised no Medicare reductions.

PROTECTIONS

This mischief shows just a sliver of the worrisome possibilities. Price must keep at full strength a wide range of Obamacare protections, particularly its essential health benefits. Among them:

• The individual mandate, which requires nearly all to have health insurance or pay a tax penalty. This makes possible the coverage of people with pre-existing conditions.
• Preventive coverage. Examinations and tests find problems about which patients are unaware. Early detection makes treatment easier and reduces cost. The benefits of laboratory-test coverage and chronic-disease management are similar.
• Emergency coverage ensures that one can receive comprehensive hospital care immediately. Before Obamacare, too many could not get beyond emergency rooms and too many died.
• Maternity care for mother and child is important for them and future society. Often, it was an exception before Obamacare. Mental health was covered at a reduced rate. Equal mental health coverage helps both patient and populace.

Between insurance exchanges and Medicaid expansion, some 20 million Americans have health insurance because of Obamacare. The CBO projects the percentage of uninsured people to stay between 9.5 percent and 10 percent for a decade. Before, it reached 16.3 percent.

The Affordable Care Act needs an advocate at the top level of government. Because he accepted nomination, was confirmed and swore to uphold his duty, Tom Price is that advocate.

Price must perform. President Trump, Congress and the people must hold him accountable.

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Killer Health Care ‘Choice’

Mick Mulvaney, director of the Office of Management and Budget.

Since his election as president, Donald Trump has promised to improve health care in the United States, offer coverage to all and to make it less expensive.

As the months progressed, Trump added “choice.” Consider it lesser coverage.

Trump lieutenants use choice to explain away the contradictions of a policy that promises more, better and cheaper health insurance simultaneously. The number of people covered is secondary, they say, ignoring the danger of losing health insurance.

Choice would fool many into buying cheap, insufficient insurance. This would cause the cost of robust coverage to increase.

THE PROMISES

“It’ll be better health care, much better, for less money,” Trump told Lesley Stahl of CBS News in a “60 Minutes” interview conducted three days after his election.

“We’re going to have insurance for everybody,” Trump told The Washington Post in an interview the weekend before his Jan. 20 inauguration. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

“I am also calling on this Congress to repeal and replace Obamacare with reforms that expand choice, increase access, lower costs and, at the same time, provide better health care,” Trump said Feb. 28 to a joint session of the House of Representatives and the Senate.

THE POLS

“The fact that certain groups will pay less tax is not central to the issue,” said Mick Mulvaney, director of the Office of Management and Budget. Mulvaney was responding to a March 12 question from George Stephanopoulos of ABC News on “This Week.” Stephanopoulos had asked if predictions were correct that the House’s health care bill would cover millions fewer Americans, force millions of those with health insurance to pay more and cut taxes for wealthy people.

“Congressman Morgan Griffith from Virginia had some really good ideas regarding things like changing the expansion date or perhaps putting work requirements in on Medicaid — those are great ideas that would improve the bill,” Mulvaney said. Stephanopoulos had asked about House Republicans, such as Griffith, meeting with Trump and discussing the end of Medicaid expansion in 2018 rather than 2020, as proposed by the bill.

“Nobody will be worse off financially in the process that we’re going through, understanding that they’ll have choices that they can select the kind of coverage that they want,” said Tom Price, secretary of health and human services, on the March 12 “Meet the Press.”

THE DOCTOR

“Lack of access. Lack of jobs. Very poor health care in the past,” said Dr. Mitch Jacques of the Cabin Creek Health Clinic in Dawes, West Virginia. He was answering a question from Michael Barbaro of The New York Times about health conditions before Obamacare. The March 10 edition of “The Daily” podcast, which Barbaro hosts, contains the interview.

“It was not uncommon for someone to go to the emergency room and have a major heart procedure, and not follow up with anyone,” Jacques said about pre-Obamacare treatment in the coal-mining area of southern West Virginia.

“By 2020, there may be virtual elimination of the Medicaid expansion, under the Affordable Care Act,” Jacques said in answer to a Barbaro question of effects expected if the House bill succeeds Obamacare. “If that occurs, many of our patients will lose their insurance,” he said. The group that operates the clinic estimates a loss of 20 percent to 30 percent.

“What would that do to the community?” Barbaro asked.

“Without question, if the Republican policy goes through, and health care is withdrawn from 20 to 25 percent of our patients, a number of those people will die for lack of appropriate health care,” Jacques said.

Choice is the word. For too many, death would be the sentence.

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21st-Century Health Insurance

President Donald Trump said he would "make health insurance available to everyone" when he addressed Congress on Tuesday night.

Trump asked Congress to "repeal and replace Obamacare with reforms that expand choice, increase access, lower costs and, at the same time, provide better health care."

The Affordable Care Act, the formal name for Obamacare, set 21st-century standards for coverage. For a "Trumpcare" plan to succeed, it must equal the 2010 act's rigor.

The standards protect people with insurance obtained through employers, as well as plans obtained via Obamacare.

With Trump's challenge to Congress on Tuesday, he crossed the starting line with his campaign promise to kill Obamacare and replace it with something superior. Despite his rush, the race could prove long.

First, the president and Congress must produce a detailed plan. The people should examine each point deeply.

They should demand of their representatives and senators no slippage in coverage. That has been the case with previous congressional plans.

STANDARDS

Health insurance in the United States must continue to cover:

• People with pre-existing conditions. (Trump called on Congress to do so.)
• Dependents, typically adult children on parental insurance, until age 26.
• Patients beyond the time of an illness. Coverage cannot be dropped for getting sick.
• Medical costs, regardless of total cost — no coverage caps.
• Medical expenses up to an annual limit on patient payments. This year, the caps for out-of-pocket costs are $7,150 for an individual and $14,300 for a family.
• Mental health, substance abuse and behavioral-health treatment at the same rate as for general medical care — at parity. This includes psychotherapy and counseling.
• Preventive care, without cost sharing — insurance covers the full cost. This includes screenings and vaccines.
• Emergency care. The cost for out-of-network emergency care is charged at no more than the cost for emergency care within an insurance plan's network of doctors and hospitals.
• Ambulatory care. Commonly called outpatient care, this is health care that does not require hospitalization.
• Chronic-disease management. Such management coordinates care for ongoing disease. It includes screenings, checkups and related education for the patient. Among its aims is limiting the effects of a disease on the patient.
• Hospitalization.
• Laboratory services.
• Maternity-and-newborn care, including for plans obtained after the mother becomes pregnant and for a newborn child added to a plan after birth.
• Pediatric dental-and-vision care.
• Prescription drugs.
• Rehabilitative and habilitative services — to regain or gain health and ability.

Before Obamacare, many of these services were not covered by health insurance, or were covered partially or at extra cost.

Some members of Congress favor repealing Obamacare without replacing it. The public would not stand for such selfishness, nor, it appears, would the president.

Trump's call for a replacement plan to guarantee health insurance for all people in the United States is important. Nonetheless, that is nothing more than what we have.

Trumpcare can cross the finish line and claim victory only if it includes or improves upon every aspect of 21st-century health insurance.

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