WITH ONE more repeal-and-replace effort in flames, Republicans face a choice. They can continue to live in a fantasy world in which it is possible simultaneously to uproot Obamacare, slash federal spending on health care and widen health-care coverage. Or they can finally accept reality and strike a deal with Democrats to improve the Affordable Care Act.
Democrats, contrary to GOP rhetoric of recent weeks, are ready and willing. It was Republicans who shut down bipartisan negotiations this month in an attempt to push a repeal-and-replace bill through Congress. The bipartisan process could restart quickly.
Senate leaders decided Tuesday not to hold a vote on their most recent health-care bill, Cassidy- Graham, once it became clear that they lacked enough votes to pass it. Sen. John McCain (R-Ariz.) struck a blow against it last week by sticking to his principled stand in favor of a fair, bipartisan process — the opposite of what has taken place here. Then on Monday the Congressional Budget Office reported that the bill would result in "millions" losing coverage. Congress's official scorekeeper has found the same about every major repeal-and-replace bill.
So now what? Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-Tenn.) and lead committee Democrat Patty Murray (Wash.) have held hearings on stabilizing Obamacare insurance marketplaces, gathered input from colleagues and bargained over the outlines of a deal. The emerging framework would satisfy neither Republicans calling for drastic reductions in government spending and regulation nor Democrats seeking a public-option health-care plan. But it is the obvious first step that an ideologically diverse yet functional Congress would take to stabilize the health-care system.
Under such a compromise, Republicans would agree to fund subsidies that help poor people with out-of-pocket expenses. Obamacare funding was intended to be permanent, but Republicans have threatened to eliminate it. More money might also go into programs to encourage insurance enrollment and to establish "reinsurance" programs, which help insurers cover high-cost enrollees. Reinsurance has driven down premiums in high-cost states such as Alaska.
Democrats, meanwhile, would allow states more room to experiment. For example, instead of forcing every state that wants to change rules within the Obamacare system to get a complex waiver, federal authorities could offer a pre-vetted "menu" of options. If a state did not like the menu, the waiver process itself would also get less onerous. These sorts of reforms could do a lot toward what Republicans insist their current health-care bill is meant to do — allow states freedom to design new health-care systems — while preserving the basic Obamacare guarantee of coverage for all.
Democrats might also allow Americans to buy into "copper" health-insurance plans, designed to cover fewer costs, but at lower premiums, than current Obamacare offerings. This would address another Republican complaint — that Obamacare is too prescriptive in the sort of coverage it forces Americans to buy.
If Republicans really want a solution, and not just someone to blame, a bipartisan deal is at hand.
Read more here: