By Trudy Lieberman

The failure of the Republican-led effort to repeal and replace Obamacare represents a big victory for all kinds of citizens and interest groups that analyzed the proposed legislation and said no dice. 

“Many of the criticisms of the ACA are, in fact, valid,” says RoseAnn DeMoro, executive director of the National Nurses United, the largest union and professional organization of registered nurses. “For all the improvements under the ACA – primarily the expansion of Medicaid and crackdown on some insurance abuses – the ACA still left 28 million without health coverage – and millions more struggling with un-payable bills and escalating out-of-pocket costs.”

DeMoro’s assessment hits home to many readers of this column who have complained about higher and higher premiums, sky-high deductibles and coinsurance, and lack of choice. Many have limited choice of doctors, hospitals and other providers in insurers’ restrictive networks.  Even worse, in some parts of the country there’s only one insurer to buy from.

Those problems stem from the underlying premise of Obamacare itself. The ACA was built on top of the existing private insurance system, which means that it will work only if insurers find it to be good business.

As the years went on and sick people with pre-existing

conditions flocked to buy coverage, which the law guaranteed they could do, insurers found that Obamacare was not good business.

They left the market or made consumers pay more out of pocket or through higher premiums.

The ACA did not provide for any serious cost containment, and the GOP plan didn’t call for any either.  Medical inflation continues as doctors, hospitals and drug companies raise their prices, and new expensive medical technology comes on the market before there is good evidence that it works. One consulting actuary put it this way, “Medical inflation will continue until doctors decide they have enough money and don’t raise their fees.”

It’s not clear that the country’s divisive politics will allow for any fix of the ACA’s problems, let alone put any teeth into cost control measures. There could be renewed interest in a public option that could allow people to choose government-sponsored insurance rather than a policy from a commercial carrier. Or maybe there would be a move to let people in their 50s or early 60s buy into Medicare, which could spark the beginning of a movement toward Medicare for All.

I’m not betting on any of this right now, but as the failure of the GOP’s “repeal and replace” shows, the public is demanding a seat at the table.

How would you fix the Affordable Care Act?  Write to Trudy at trudy. Lieberman@gmail.com.