When they went home for the July 4th recess, Republican members of Congress did one of two things: Either they met with constituents and were pummeled with angry questions about their disastrous health-care bill, or they hid out, trying to avoid their constituents so that they wouldn’t be pummeled with angry questions about their disastrous health-care bill. Predictably, support for the bill among Republican senators is slipping away, which is not surprising given that this is the most unpopular piece of legislation in the history of polling.
So the time has come for Republicans to cut their losses and do the right thing. It won’t be easy, but there are no easy options left for them.
Republicans need to admit to themselves that there is no great victory to be had. There will be political fallout no matter what — the 2018 elections are going to be brutal — but their choice now is between passing nothing, passing a bill that is so dreadful that it wins them the undying rage of the public, or a compromise that actually helps solve some of the problems they profess to care about.
What Republicans need to do now is drop the idea of repealing the Affordable Care Act and join together with Democrats to fix the problems in the individual market. It’s not what they hoped for, but it’s a lot better than the alternative — for everyone.
They have to start by acknowledging that despite their cries that the ACA is in a death spiral, that it’s a disaster and that its implosion is imminent, things on the individual market in fact are not as bad as you might think. Here’s a report out today from the Kaiser Family Foundation on how the markets are doing so far this year:
Early results from 2017 suggest the individual market is stabilizing and insurers in this market are regaining profitability. Insurer financial results show no sign of a market collapse. First quarter premium and claims data from 2017 support the notion that 2017 premium increases were necessary as a one-time market correction to adjust for a sicker-than-expected risk pool. Although individual market enrollees appear on average to be sicker than the market pre-ACA, data on hospitalizations in this market suggest that the risk pool is stable on average and not getting progressively sicker as of early 2017. Some insurers have exited the market in recent years, but others have been successful and expanded their footprints, as would be expected in a competitive marketplace.
In other words, insurers are making profits in the individual market, which means that they’ll keep offering plans and won’t have to raise premiums as much as some have feared.
But what about all those places where there’s only one insurer, or even where the last insurer has pulled out? Funny thing about that: It turns out, as Brian Dew and Dean Baker of the Center for Economic and Policy Research found when they examined the data, that it’s almost entirely a phenomenon of Republican states. In states controlled by Democrats — which accepted the expansion of Medicaid and worked to make their exchanges function properly — the individual market is quite healthy. It’s only in those places where the state governments have been trying to sabotage the ACA from the beginning that they have screwed over their own constituents and left them with few insurance options.
So what can Republicans do now? There are some things I’d like to see that would run up against conservative ideology — like encouraging the 19 holdout states to accept the Medicaid expansion — but I’m not going to pretend that Republicans will accept them. However, there are some steps that could be taken to further stabilize the individual market that Republicans should be able to live with.
For instance: We should resolve the dispute over cost-sharing payments, which help cover co-pays and deductibles for low-income Americans. The uncertainty over the future of these payments has left insurers unable to determine how high to set premiums or whether they’ll be able to make profits, which has been a major contributing factor in limiting the number of insurers offering coverage. We can take other steps to reduce risks and keep insurers in the markets, like reviving the risk corridor program. And (though Republicans won’t like it), we can increase the penalty for not carrying insurance to make sure the risk pool is as wide as possible. (If you want a longer list of things that could be done to shore up the individual markets, Charles Gaba has a list of 20 suggestions here.)
You’d have to negotiate a bill to do those things, and there would be some differences between the parties. But an agreement would be possible to achieve — if Republicans are willing to say, “We’re not going to try to remake the entire health care system, at least not right now. Our immediate task is to make the insurance exchanges work.” If they joined those negotiations in good faith — and put aside anything that would result in millions losing their coverage, which Democrats will never accept — they might even be able to get some concessions. For instance, they could win some flexibility for states to experiment with how their exchanges are structured. Democrats will be wary, but if they’re getting something they want too, there could be a chance at compromise.
What would Republicans get out of it? For starters, they could limit the political damage their health-care fiasco will do to them. They control the entire government, and they’ll be held accountable for the operation of the health-care system, whether it was what they originally favored or not. The better that system functions, the less likely they’ll be to incur the wrath of an increasingly disgusted public.
But more importantly, they could actually help solve the problem. They’ve spent a lot of time complaining about the individual market — indeed, it’s almost all they talk about when it comes to health care, even though it covers only 7 percent of the public — so if they’re sincerely concerned about the well-being of the people who are on it, they should be more than eager to fix it in any way they can, even if they can’t get everything they want.
It would require them to swallow some things they don’t like. They wouldn’t get to say, “We repealed Obamacare!” They’d have to put off their goal of destroying Medicaid for another day. But it would at least show the public that they’re capable of seriously addressing a policy challenge. And it might even do something to help people. Imagine that!