Sen. Bill Cassidy, R-La. speaks during a news conference on Capitol Hill in Washington, Monday, Jan. 23, 2017, to announce the Patient Freedom Act of 2017, a possible GOP replacement bill for the Affordable Care Act. President Donald Trump's congressional agenda has made a priority of repealing and replacing President Barack Obama's health care law. (AP Photo/J. Scott Applewhite)

J. Scott Applewhite

If the goal of health policy is to keep people healthier, there is a lot of room for debate over how to go about that process. If the measurement is insurance coverage, so that medical care is more easily available and affordable, "Obamacare" is a big success.

While the officially named Affordable Care Act is under criticism by the new powers-that-be in Washington, those states which have taken full advantage of the law's provisions have drastically improved insurance availability.

A big-sample Gallup survey found Louisiana with among the best results, better than a 9 percentage point drop in persons having no insurance. Gov. John Bel Edwards naturally touted that report, as it was his first major decision to expand Medicaid health insurance for the working poor, as allowed under the Affordable Care Act.

We supported that decision, and we believe it is a real accomplishment. What would not be acceptable, we think, is for a new Obamacare replacement to drive that uninsured number up, for several reasons.

First of all, as Edwards has frequently stressed, working people can't work if dogged by poor health. The governor notes how many people in Louisiana over the last year have received life-saving diagnoses and treatments under the new regime.

Secondary to that is the availability of primary care — a newly insured person being able to see a doctor in an office, rather than waiting until sicknesses get treated in the more expensive setting of an emergency room. While the decline in the uninsured population is a good number, a decline in ER visits should also be a goal among those having policies on the ACA exchanges or via Medicaid.

Families with traditional insurance policies are hurt as costs of the uninsured go up, and health care providers must charge more to balance the books; the settings of treatment are an important issue.

And as Gallup commented, there is a third measure of success that is more of a value judgment, how well one feels.

"Reducing the rise in healthcare costs and improving Americans' overall health were two (other goals of ACA)," the organization reported. "The latter goal has not yet been realized, as fewer Americans rated their health as 'excellent' in 2016 than in 2010 when the healthcare law was signed into effect. Obesity, diabetes and clinical diagnoses of depression are at their highest points since Gallup and Healthways began measurement in 2008."

To some extent, oddly, medical care can be a victim of success, in that people diagnosed with an illness might feel worse, and may be hurting because of drugs or other treatments. For the long term, of course, they are much better off.

As President Donald Trump said, the nation wants "better health care for more people at a lesser cost." The details, such as those being worked on by U.S. Sen. Bill Cassidy, R-La., will require a great deal of thought and insight into the financial consequences for many people living paycheck to paycheck, particularly in low-wage jobs.

Those are the people being reached by Medicaid expansion, and we can't leave them behind in a new version of health care policy.