PERSPECTIVE FROM THE 19^TH HOLE: This is the title I chose for my personal blog, which is meant to give me an outlet for one of my favorite crafts – writing – plus use an image from my favorite sport, golf. Out of college, my first job was as a reporter for the Daily Astorian in Astoria, Oregon, and I went on from there to practice writing in all of my professional positions, including as a Congressional press secretary in Washington, D.C., an Oregon state government manager in Salem and Portland, press secretary for Oregon’s last Republican governor (Vic Atiyeh), and a private sector lobbyist. This blog also allows me to link another favorite pastime – politics and the art of developing public policy – to what I write.

If you go back to the presidential campaign trail, you heard a lot about ObamaCare, the federal health care coverage program inaugurated by President Barack Obama and his Democrat colleagues in Congress.

But campaigning by Republicans to get rid of or reform ObamaCare is easier than actually doing it.

Even President Donald Trump, who campaigned heavily against ObamaCare, signaled that he understands doing the deed is incredibly complicated. So do members of the Republican majorities in the House and Senate.

The goal is to find a way to reform health care without it being just a “Republican deal.” The lack of bi-partisanship was one of the major problems with ObamaCare; not one Republican voted for it. It was only a Democrat deal.

According to the Wall Street Journal last week: “A growing number of Republican state leaders, not content to wait as Congress struggles to repeal the Affordable Care Act and overhaul Medicaid, are mobilizing in an effort to reshape how health care is delivered in their states.

“Encouraged by a Trump administration that appears receptive to such moves, more than a half-dozen states are seeking federal permission to impose coverage restrictions on many Medicaid beneficiaries, including drug testing and lifetime enrollment caps, some of which would be unprecedented.

“Maine, for example, may limit most people on Medicaid to five years of benefits. Kentucky could require many recipients to work. Wisconsin wants to drug-test enrollees.”

It’s not clear yet what Oregon will do, especially with Democrats in control of the legislature and the governor’s office. Budget gaps, as described below, will demand action of some kind.

Washington, D.C. sets broad guidelines for Medicaid, but states have some flexibility and the federal government can provide more through waivers.

Oregon recently gained approval of a new waiver that gave the state permission for what officials claim will be five more years of stability in how health care is delivered to Oregon’s poor – stability perhaps, but with problems over how much money is available.

The Oregonian newspaper wrote that the Oregon Health Authority, even with waiver approval, must come up with a new $350 million to pay for the program. The federal government’s contribution to Oregon’s Medicaid operation is decreasing from 78 percent to 75 percent of the total. That $350 million is just one of the factors contributing to a $935 million budget gap at the Oregon Health Authority, state officials confirmed.

To make matters worse, Oregon did not get $1.25 billion in federal money it had requested to add to the state’s coordinated care organizations, the new regional operations the state created in 2012 to manage healthcare for the poor and that now provide care for more than one million Oregonians.

Meanwhile, a U.S. House committee chaired by Oregon’s Greg Walden is proposing a new way to reshape the Medicaid program, an effort to resolve one of the most divisive issues in the debate among Republicans over how to replace the Affordable Care Act.

The Wall Street Journal carried an article this morning suggesting that Walden will need to use all of his honed political instincts to surmount opposition among Republicans, not to mention Democrats.

Under the committee’s plan states that grew their Medicaid programs under the health law could maintain their expanded programs until 2020 before federal funding would decrease. In a nod to states that did not expand Medicaid under ObamaCare and were concerned they would be penalized for not doing so, the committee proposed to allocate more Medicaid dollars to those states.

Beyond Medicaid, another approach reportedly under consideration by Republican leaders is to propose a wide-ranging reform bill and, in effect, challenge their Republican colleagues to oppose it. The belief is they won’t say no if given a chance to vote affirmatively on repeal and replace, given all their promises on the campaign trail.

Walden and his House colleague, Republican Kevin Brady from Texas, are planning to move forward on a full repeal-and-replace legislation in the next few days. They presented their plan to GOP senators at a meeting last week as part of an effort to get the House and Senate on the same page.

Tax credits for health care expenses are likely to be part of the House Republican leaders’ plan. They cited Trump’s endorsement of a tax credit to help people purchase insurance, saying it meant the president was on the same page. But conservative House Freedom Caucus members, who see the tax credit as a new entitlement, countered that Trump did not commit to refundable credits, a priority for the Caucus.

With all the to’ing and fro’ing, here is a quick summary of my own ObamaCare replacement plan, which I describe, not because I will have anything to do with the issue in Washington, D.C., but simply to indicate that I have thought about a plan, not just controversy about all of the politics.

1. Require all citizens to have health insurance. [As I’ve written before, think of this way. All of us who drive cars are required to have automobile insurance. If we don’t, we pay a price. The same policy should exist for health insurance, though it will be difficult for many Republicans to stomach this mandate.]
2. Provide a catastrophic health insurance plan for those who cannot afford regular insurance and who need a lower-cost option.
3. Accommodate people with pre-existing health conditions.
4. Allow broad access to health-savings accounts.

Will “my plan” solve all of this nation’s health care problems? No. But, if elected officials of good will and good intent – yes, there are both in Congress – work together to find middle ground, health care issues could be resolved in a bi-partisan fashion without relying so much on too many government mandates and funding. A functioning marketplace can deliver high-quality care at lower cost.