One doesn’t need to engage in speculation in order to determine what President Trump thinks about the Affordable Care Act (ACA). He’s repeatedly referred to the healthcare law of the land as a “disaster.” And when the GOP attempt to declare it dead failed by one vote, he publicly derided the three Republican senators for breaking from their party and vowed to let the ACA “implode.”
Trump may not be able to singlehandedly repeal President Obama’s signature legislation, but clearly he’s planning to do everything within his power to injure it (and claim it was suffering from a pre-existing condition). From slashing subsidies that help middle- and low-income families and individuals afford coverage to slashing the outreach budget that brings people to the ACA marketplace and assists them in navigating it, he is determined to weaken the mechanism that, ironically, has never been more popular.
If Trump had the “easy” alternative that would insure “everybody” as he promised on the campaign trail, his dogged insistence on wresting healthcare from tens of millions of Americans would be easier to swallow. But it’s evident that the “replace” step in the GOP equation was never of particular interest to him.
Millions heaved big sighs of relief at the repeal’s failure. But the issue may not be dead, especially in light of the fact that several conservative legislators are still convinced the ACA has got to go. And if Trump gets his way, Republican lawmakers will circle right back to surgery, armed with sharper scalpels next time.
Is “bipartisan cooperation” an oxymoron?
However, those three GOP “nay” votes may be cause for hope. Not only did the senators dare to vote with their consciences in opposition to their party, but they did so in the face of extraordinary and hostile pressure from the president.
So perhaps some Republicans are ready to agree with Democrats that healthcare is kind of, sort of, most definitely a very big deal for Americans?
Bipartisanship, at least when it comes to healthcare, is in the air lately.
John Hickenlooper, Democratic governor of Colorado, and John Kasich, Republican governor of Ohio, are leading a bipartisan group of eight governors in thinking up ways to shore up, rather than tear down. The governors sent leaders in Congress a seven-page letter suggesting fixes for ailing insurance markets; for example, allocating federal money for the reduction of coinsurance for low-income consumers and for assisting insurers with the financial burden of high-risk patients.
“As Congress considers reforms to strengthen our nation’s health insurance system, we ask you to take immediate steps to make coverage more stable and affordable,” the governors wrote. “The current state of our individual market is unsustainable, and we can all agree this is a problem that needs to be fixed. Governors have already made restoring stability and affordability in this market a priority, and we look forward to partnering with you in this effort.”
In another display of bipartisanship, “The Problem Solvers Caucus” is a House group that has been wrangling with how to prop up flagging insurance markets.
And a third example: Senators Patty Murray (D-Wa.) and Lamar Alexander (R-Tenn.) head up the Senate Health Committee, and this legislative session has commenced with a new tack … bipartisan hearings that may pave the way for measures that can add stability to what’s ailing the ACA.
Compromise at the state level
Over the past few years, several states have relied on bipartisan compromise when it comes to healthcare. For instance, Alaska. The Last Frontier’s healthcare costs are among the highest in the country. This reality prompted state leaders to look past politics; they developed a means of controlling insurance premiums via a new government fund (not unlike the Medicare Part D program method for capping prescription drug plan prices).
Lori Wing-Heier is Alaska’s nonpartisan insurance commissioner. “I don’t think anyone here — Democrat or Republican — didn’t believe that we needed to make sure our residents could get healthcare,” she told the Los Angeles Times. Last year Wing-Heier rolled up her sleeves and worked with state lawmakers in both parties with an eye to curbing high insurance premiums.
And Alaska isn’t alone in its local, bipartisan attempts to stabilize insurance markets. Arkansas, Indiana, Iowa, Minnesota, and Oklahoma are working toward that goal as well.
Arkansas and Indiana have come up with initiatives for expanding Medicaid coverage yet at the same time sticking to their red-state conservative ideals (for instance, requiring enrollees to contribute to the cost of commercial health plans). This obviously strays from the healthcare vision long held by Democrats, but they may be in a position to consider these types of compromises when the alternative is no coverage at all.
Perhaps the best summation is this line from the letter written by the group of governors: “Lasting solutions will need support from both sides of the aisle.”
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