When Congress returns next month, some Senate Republicans plan to turn from yet another effort to repeal and replace the Affordable Care Act, nicknamed Obamacare, and make a bipartisan effort to fix some of the current system’s most pressing problems.
But the recent antagonistic exchanges between Majority Leader Mitch McConnell and President Donald Trump raise questions about whether any such effort can succeed. Even if it gets the 60 votes needed to pass the Senate, it would need support from the more repeal-friendly House and the president’s signature.
Unfortunately, despite some bipartisan stirrings in the House, Speaker Paul Ryan so far opposes action and the crowded congressional calendar complicates matters further. But some action is necessary.
Since Congress recessed, Trump has pressed Senate GOP leaders to make another try at the Affordable Care Act repeal measure that failed last month by a single vote. But that seems unlikely unless the Senate’s membership changes, since the three GOP opponents remain solidly in favor of a more traditional legislative approach. Still, Sens. Lindsey Graham and Bill Cassidy hope to propose yet another repeal-and-replace bill that would transfer much of the health care burden to the states.
But McConnell, who first raised the prospect of a bipartisan effort aimed at fixing problems with the current law last month, seems to have thrown cautious support behind the effort for possible bipartisan action, though he called its prospects “somewhat murky.”
As anticipated, the Senate lead is being taken by Tennessee Sen. Lamar Alexander, chairman of the Senate Health, Education, Labor and Pensions Committee, and its ranking Democrat, Sen. Patty Murray of Washington. The two have a history of bipartisan cooperation, exemplified by last year’s legislation to update the No Child Left Behind education law.
“If your house is on fire, you want to put out the fire, and the fire in this case is in the individual health insurance market,” Alexander said.
The main goal would be to help insurance companies avoid big 2018 premium increases.
In the House, the 40-member bipartisan Problem Solvers Caucus is backing proposals to fix Obamacare that include mandatory funding of the subsidies, creation of a stability fund to bolster the exchanges, repeal of the tax on medical devices and revision of the employer mandate to require only companies with more than 500 employees to provide insurance, rather than 50.
But members of the conservative Freedom Caucus want Ryan to allow a vote on repealing Obamacare, without any accompanying replacement plan.
Trump remains the biggest potential obstacle. Earlier this month, he reacted badly when McConnell suggested he doesn’t understand that complex legislation takes time in Congress, unleashing an array of anti-McConnell tweets. “After 7 years of hearing Repeal & Replace, why not done?” he demanded.
In fact, congressional Republicans bear much of the blame for the impasse. They failed to prepare legislation that could pass if the GOP won the presidency, set unreasonable expectations of quick action and mismanaged the process by producing inadequate proposals.
But Trump bears responsibility for failing to make specific legislative proposals to fulfill his campaign promise “to take care of everybody” with “great health care” at a lower cost. His repeated threats to cut off subsidies helping millions of Americans pay for Affordable Care Act policies haven’t helped to create a positive climate for congressional action.
The time is long overdue for all involved to recognize the reality that the Affordable Care Act is here to stay. The need now is to fix some of its worst problems so millions of Americans are not left in the lurch.