This is an archived article that was published on sltrib.com in 2017, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

"We're going to be living with Obamacare for the foreseeable future."

— Speaker of the House Paul Ryan

If neither political party wants to suffer the blame for the collapse of the American health care system — and the failure Friday of the Republicans' only real shot at repealing and replacing the Affordable Care Act suggests that neither of them does — then it is time for members of both parties to stop sniping at one another and fix what we have.

And what we have is Obamacare.

And, while members of Congress are working — or failing to work — on that, it is time for Utah to join a handful of states that will reverse an earlier mistake and finally implement the expansion of Medicaid that was always key to the success of that law.

For seven years, the Republicans who rule this state without significant opposition have been so obsessed with their dislike for the Democratic president's signature legislation that they have left what now amounts to some $940 million in federal Medicaid funds on the table.

They chose that rather than play along with a plan to spare many of the state's lower-income households a life without the kind of access to health care that all residents of civilized nations have long taken for granted. Rather than boost the state's health care sector. Rather than receive millions that would make significant dents in the state's homelessness, addiction and criminal justice problems.

Four years ago, Gov. Gary Herbert put forward a workable alternative called Healthy Utah which, he hoped, would be unique and business-oriented enough to be approved. The Legislature blocked it, arguing, among other things, that it was unwise to hitch Utah's wagon to Obamacare's star because it would be going away, if not soon, then at least whenever a Republican entered the White House.

Now that we have all been disabused of that fantasy, it is time to dispose of some other fairy tales as well.

The Republican claims that Obamacare is in a "death spiral," that costs are shooting up and jobs are being destroyed right and left, are false. The law has extended coverage to millions of American who would otherwise lack it and started to bend down the curve of decades of skyrocketing health care inflation.

And if the ACA were in danger of collapse, just standing by and watching it happen — which seems to be the outcome preferred by Utah's Sen. Mike Lee, among others — would be unconscionable.

Not that there isn't a lot of work to be done to keep the benefits in place without busting the budget. Many tweaks and fixes are needed.

The penalty for refusing to buy insurance should be stiffer, in order to push more of the young, healthy buyers into a market that any health care pool must have to succeed. The kinds of subsidies promised to keep a choice of providers — including some nonprofit insurers — in every market must be provided.

It may cost more money than some feel comfortable spending. But a system that keeps the population healthy and health care providers responsibly solvent is a long-term benefit to the whole nation, in terms both human and fiscal.

Until someone has a better idea, Obamacare is the structure we have to build on. Let's get on with it.