What happens when the federal government demands that you buy health insurance but no company will sell it to you?

That’s the question thousands of low-income rural Nevadans are asking themselves after this week’s announcement that one health exchange insurer is leaving the state and the other plans to serve only three counties in 2018.

If Republicans and Democrats continue to engage in their wild finger-pointing blame game back in Washington, D.C., their sickly constituents could end up wandering the streets like ragged zombies in search of a tasty insurance agent under this apocalyptic scenario.

Prior to Nevada’s 14 rural counties being put on the chopping block, at least 45 other counties in the U.S. had no Obamacare insurer planning to serve them, while 1,388 counties had only one insurer to choose from.

Republicans blame the Obama administration for setting up a house of cards, while Democrats blame uncertainty fueled by the Trump administration.

The Affordable Care Act promised to do what seemed impossible: bring down the cost of health care by making it equally available to everyone. But the complex system was barely off the ground before insurance companies started jacking up prices and abandoning markets.

What can rural Americans do?

Take two aspirin and don’t worry about calling anyone in the morning – they won’t be there.

Health care spending in the U.S. was skyrocketing before Obamacare and it has continued to skyrocket after Obamacare. Americans have some of the worse health habits on the planet and by far the biggest appetite for medical care and prescription drugs. Per capita health care spending exceeds $9,000 in the United States, which is more than twice the global average among developed countries and three times the amount spent in places like Spain and Italy. Spending on pharmaceuticals is similar – about $1,000 a year per person in the U.S. compared with an average of $500 in other countries.

It’s a basic law of economics that increased demand leads to increased prices or decreased availability, so the current situation under Obamacare should not be a surprise to anyone. Nor does there seem to be any political solution. Republicans have tried every way imaginable to reslice the pie, but it still comes up short.

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When we asked Assemblyman John Ellison what he thought, his answer was clear: Insurance companies that want to serve any part of Nevada should be required to serve all of Nevada, otherwise the market should be opened across state lines.

Republican Rep. Mark Amodei called the pullout “another symptom of the sickness that is killing America’s health care system” and said the law “is in need of serious repair.”

We didn’t hear a peep out of Sen. Dean Heller on the issue. The broad consensus is that Heller will get the boot in 2018 if he supports any GOP-backed reform, and probably even if he doesn’t. Like many Republican representatives, Heller is stuck between Trump and a hard place when it comes to getting anything accomplished in D.C.

Democratic Sen. Catherine Cortez Masto said the pullout “is a direct result of the crisis of Republican leadership in Washington.” She and many other Democrats signed onto the “Marketplace Certainty Act,” which calls for Congress to authorize Cost Sharing Reductions — a government subsidy that Trump hasn’t promised will continue under a revised health exchange system.

Trump has tried several strategies to bring Obamacare off life support. None of the options have been good, and neither can “marketplace certainty” be guaranteed by government subsidies.

The history of the Affordable Care Act prior to November 2016 proves that it needs to be fixed. It is wishful thinking, however, to believe that the cure will be better than the disease.

Members of the Elko Daily Free Press editorial board are Travis Quast and Jeffry Mullins.


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