With ‘Repeal, Replace’ in Ashes, Democrats Can ‘Repair’

The front-page failure of Republicans’ effort to repeal the Affordable Care Act last week has opened a remarkable and unexpected opportunity to get beyond the rhetoric of repeal and undertake a thoughtful repair of the shortcomings of our current health care system. As former staff to two of the Democratic Party’s most constructive, collaborative, and accomplished health care lawmakers of the last half century — Sens. Ted Kennedy and Max Baucus — we see last week’s legislative failure as an opportunity to explore a chance for real progress.

If last year’s voters could agree on anything, it was that policymakers of all partisan stripes needed to address inflation in the cost of care and bolster the number of insurance options available in parts of the country with dwindling coverage options. While the Affordable Care Act has been unable to solve these complex challenges, Democrats have uniformly joined with Republicans in acknowledging that they exist, and moreover, recognized that there is an urgent need to find a solution.

Unfortunately, however, the GOP’s American Health Care Act was not that solution. For all of its poorly thought-out and ideological provisions, the bill’s chief failure was its inability to address the legitimate failings that persist in our health care system.

Now that Republicans are facing the fact that they must live with the ACA for the foreseeable future, however, they have a choice to make: either wait for, and even encourage, an “explosion” of the ACA as President Trump has suggested, or enact policies to mitigate premium inflation and inadequate competition in partnership with Democrats. There is no question as to which option is in the best interest of Trump’s voters; allowing the ACA to “explode” through mal-intent or intentional neglect will destroy millions of Americans’ lives and create tremendous and unnecessary dislocation throughout our health care sector. For America’s citizenry of every political inclination, access to appropriate health care is not a game and only the most cynical politician would risk their well-being to score political points.

The truth is, if we can move past the dysfunctional politics of health care reform, finding bipartisan policy solutions for these two challenges may not be as hard as one might think.

For starters, the cost-sharing subsidies included in the ACA must be stabilized. The House v. Burwell (now renamed House v. Price) case, which you’ll remember is a legal challenge to the ACA’s cost-sharing subsidies filed by then Speaker John Boehner in 2014, continues to hang over the health care system like a dark cloud. President Donald Trump can lift it temporarily by continuing the administration’s appeal of the case. Perhaps he can cite the constitutional issue at stake — that the congressional branch cannot sue the executive branch — rather than the health policy one. But regardless of how it’s argued, the White House can make a true statement of its intentions to pursue real reform by defending the ACA in court and simultaneously offering support for a fix in Congress.

Further, as health insurers have widely requested, the premium stabilization programs protecting plans that cover high-cost patients should be fully funded. The administration has already taken some steps the industry says will help, such as limiting enrollment periods, and with the support of Congress, they can go a step further to ensure markets can succeed in 2018.

But to put these policy proposals in play, it’s going to take leadership, creativity, and political courage, especially after such a spectacular failure in the House. For Senate Democrats, the specter of publicly offering an olive branch on ACA reform is a real gambit because it is a process that could easily become hijacked by conservatives intent on rolling back Medicaid or popular ACA insurance protections, or pilloried by those on the party’s left wing who are again clamoring for an unrealistic single payer system. Additionally, such an approach would require some degree of confidence that Speaker Ryan could ever offer a floor vote on a more limited bipartisan approach that sidelines hardliners in his own party. Plus, Democrats would probably have to be willing to play ball with Republicans on some of their priorities such as repealing the medical device tax, relaxing ineffective regulations, and encouraging broader pooling of markets via multi-state or multi-employer compacts.

Under normal circumstances, it might not make for good politics for either Senate Democrats or Republicans to take on bipartisan ACA reform. But this year, with ACA repeal all but dead, a looming coverage risk for millions of Americans, and a non-ideological president desperate for closure on this issue, the chance to establish a de facto bipartisan truce on health care reform is too important to ignore. Senators Kennedy and Baucus had the courage to make this kind of move, to take this kind of risk in the interest of building long-term consensus on a politically vexing issue. Who are those members of Congress today?

Leave a Comment