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Would failure of Obamacare repeal in the Senate be the straw that gets Democrats and Republicans to work together on health reform?

REUTERS/Aaron Bernstein
Senate Majority Leader Mitch McConnell plans to hold a Senate vote advancing GOP repeal-and-replace plans on Tuesday. But the fate of that vote, and subsequent votes, is uncertain.

The Republican effort to repeal and replace Obamacare may have struggled in the House of Representatives, but in the Senate, it’s traveled a truly tortured path — one that reaches a critical juncture today with a vote to advance health care legislation.

For the past several weeks, the GOP’s bill, called the Better Care Reconciliation Act, has seen its fortunes rise and fall almost daily; the content of the legislation has been changed so often that even lawmakers have a hard time saying exactly what’s in it at any given moment.

Today’s vote to begin debate on a health care measure could easily fail; even if that motion does succeed, the Senate could easily vote down the legislation once debate is over. Congressional Democrats are making the case that the Senate GOP’s struggles clearly indicate their effort is doomed, and that both parties should come together to improve the Affordable Care Act.

Republicans aren’t united on what the path forward should be. Some are in favor of continuing to work on repeal and replace within their own party until they get it right, while others are more inclined to work with Democrats through the committee process to come up with fixes to the health care system that both sides can agree on.

The prevailing sentiment in both parties, though, is that it’s time for the other side to accept political reality — either Obamacare is broken or the GOP effort to kill it is — but few are willing to be the first to blink.

A tough path in the Senate

In May, Republicans in the House of Representatives were able to pass their bill, the American Health Care Act, by a four-vote margin, narrowly overcoming the 20 GOP lawmakers who voted no. Since being passed the repeal-and-replace baton, Republican leadership in the Senate has struggled to find a way forward.

With a narrow, 52-seat majority and no Democratic support for their mission of repealing Obamacare, the Senate GOP’s success has hinged on how many of its own members can get behind one piece of legislation.

The slim margin of error, combined with a wide ideological gulf between the moderate and conservative wings of his conference, has made this job very difficult for Majority Leader Mitch McConnell. For months, he and his leadership team have struggled to come up with health care legislation that satisfies enough Republicans while ensuring that no more than two Republican senators oppose it — the threshold that would kill any bill.

The original version of the Senate’s legislation, introduced in June, was immediately unpopular among the GOP’s most moderate and conservative members. Maine Sen. Susan Collins and others voiced concern that the Senate plan’s cuts to Medicaid were too severe, for example, while Kentucky Sen. Rand Paul and other conservatives slammed the bill as ‘Obamacare Lite,’ arguing it didn’t go far enough to undo the taxes and regulations the ACA established.

Outside of leadership, few rank-and-file GOP senators were eager to publicly defend the bill. Because of the lack of support, anticipated votes to advance BCRA were scuttled several times.

McConnell attempted to make concessions to moderates and conservatives to try to get them on board: a version of the bill, updated in mid-July, included increased funding to counter the opioid crisis, along with language that would allow insurers to offer consumers plans that would be cheaper, but would not include the set of health benefits that the ACA required all plans to have.

But those add-ins didn’t move the needle; shortly after the new version was released last week, a total of four Republican senators were publicly opposed to the bill, effectively killing it.

McConnell then proposed a measure that would fully repeal Obamacare, with a two-year delay for Republicans to devise a replacement. That proposal also failed to get traction, with three senators announcing their opposition shortly after McConnell floated it.

Democrats: The jig is up

Though they broadly agree that Obamacare has its issues, not a single Democrat in Congress has stepped forward to support the GOP’s plans to repeal and replace the law. Their unified opposition has put the pressure squarely on Republicans, and spotlighted tensions within the party over policy and politics.

As they watch the Senate GOP struggle to agree on a health care plan, Democrats are saying the time has come for Republicans to give up their quest, and join them in fixing issues with Obamacare.

That will be easier said than done: Though there are some areas where there’s bipartisan agreement on health care, such as tackling the high price of prescription drugs, the issue of fixing many states’ broken insurance marketplaces is far more divisive.

Currently, premiums are increasing and insurers are fleeing Obamacare’s state insurance exchanges because it has grown too costly for them to insure patients under the law’s rules, and without the support insurers thought they would get from the federal government.

Democrats are saying that this problem, sometimes called the “death spiral,” is what needs to be addressed most urgently, and most agree that insurers need to be offered financial incentives to remain in state markets to cover patients.

Sen. Amy Klobuchar told MinnPost that there’s “nowhere else to go” for the Senate GOP.

“I don’t see a path forward except one, and that path forward is [Republicans] working with us on a bipartisan solution, which is changes to the ACA,” she said. “That includes strengthening the exchanges with some proposal, a la what Minnesota did on reinsurance, but doing it nationally.”

Klobuchar pointed to McConnell’s public consideration of shoring up the ACA’s state insurance exchanges if the GOP’s efforts fail. (In the past, however, McConnell has held out the prospect of working with Democrats as something of a threat to members of his own conference.)

“The most damaging thing right now is that we’re not making the changes we need to make,” Klobuchar said. “There are always problems with major pieces of legislation, so that’s what really bothers me, is they’re stopping us from making even common-sense changes that Republican governors and Republican legislatures have supported within the states.”

In June, Sen. Al Franken told MinnPost that, if the GOP effort goes down in flames, he would expect Republicans to come to the table and work with Democrats to shore up the state exchanges.

In the House, Minnesota Democrats were not exactly optimistic that they will soon be working alongside their Republican counterparts on a bipartisan health care fix, but they did say that the Senate’s failure to pass a bill could move them closer to that goal.

First District Rep. Tim Walz said, “This had to happen to them to now come back, and I think we should willingly lock arms to try to find a solution.”

“I don’t think now is the time to say, they’re floundering, that’s wonderful,” he told MinnPost. “It’s not wonderful. People’s premiums are going up; we need to address that.”

Seventh District Rep. Collin Peterson, one of the three remaining House Democrats to have voted against the ACA in 2010, said Democrats are ready to work with Republicans, and the ball is in the GOP’s court.

“This is not going to get fixed, in my opinion, until you get both parties at the table so both parties are culpable,” Peterson said. “Because whatever we do, it’ll be screwed up to some extent, and it’s going to have to be fixed. It’s not going to be enough just to have 10 Blue Dog Democrats, you need to have both parties at the table.”

To 5th District Rep. Keith Ellison, both parties being at the table isn’t a good result on its own — he’s more interested in what those bipartisan talks would produce.

“Bipartisanship is fine, but it doesn’t have merit for its own sake,” Ellison said. “It has merit if it benefits the people.”

He said regardless of how the Senate proceeds, Democrats “should continue to build a national coalition to make sure health care gets to every single person. … I hope Republicans want to be a part of that.”

Republicans divided

On Tuesday, reports indicated that McConnell is considering advancing legislation that would repeal Obamacare’s individual and employer mandates, along with the medical device tax, allowing the House and Senate to go to conference to craft a compromise bill.

If that narrow repeal is advanced today, the Senate would proceed to 20 hours of debate on the measure before voting on it — which would present an entirely new challenge.

Elements of the congressional GOP believe that they should press on with repealing and replacing Obamacare, no matter the outcome of today’s vote.

South Dakota Sen. John Thune, the No. 3 Republican in the Senate, said on Sunday that Obamacare will go — it’s simply a matter of when, not if.

Some in his conference do not agree. Maine Sen. Susan Collins, a moderate who has consistently and vocally opposed the GOP health care plans, said Republicans need to work with Democrats to stabilize the insurance markets. That process, she said, should start over at the committee level — a key step in the legislative process that McConnell, to this point, has bypassed.

There’s pressure from influential senators to jump-start that process. Tennessee Sen. Lamar Alexander, who chairs the Senate health panel, has called for hearings to explore solutions to the "death spiral" and to help the insurance exchanges function.

Still, the turn of events in the Senate is a huge disappointment to 2nd District Rep. Jason Lewis, the freshman Republican who has been the Minnesota delegation’s most vocal supporter of GOP plans to repeal and replace Obamacare. (Reps. Tom Emmer and Erik Paulsen declined to comment on the issue before the Senate votes.)

“It’s a shame,” Lewis told MinnPost last week. “We did our jobs. … To see it get squandered away over there, I’ll be blunt, I think it’s horribly disappointing and irresponsible.”

He argued that working with Democrats would only extend the failures of the ACA; the federal funding to offset insurers’ losses in the early years of the law, called the “risk corridors,” is tantamount to an insurer bailout, Lewis said.

“We’ve already done that, and it’s failed,” he added. “Now they want more money. That’s not the way to fix the system.”

Lewis wouldn’t say whether he agreed with President Donald Trump, who proclaimed that Republicans could easily allow Obamacare to fail, which Democrats which would then own, eventually forcing them to the negotiating table.

“I do think that we were sent here to actually make the health care market work, and to the degree we don’t get that done, we’ll get some blame for that,” he said.

Indeed, Republicans control both chambers of Congress and the White House; Obamacare is a law designed by Democrats. Rep. Walz said both parties have to shoulder the burden. “The repeal and wait, the irresponsible ‘let it fail,’ none of us can say that,” he said. “If any Democrat would say, ‘Well the Republicans own this, let it fail,’ I disagree with that, too.”

“We all own this.”

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Comments (12)

No. And no it shouldn't

You have to been on another planet for the last 30 years if you haven't noticed the fact that Republicans never believed we had a health crises in the first place, and the only crises we have now is the mere existence of Obamacare. So I don't what you have to work with there. All Republicans can offer is magical thinking, and the Democrats buy into that in any way shape of form it's a bad thing. Democrats already gave magic a try over the last three decades and they've proven it doesn't work.

I mean what options does anyone think "moderate" Republicans will vote for? If the problem is uninsured people and rising costs, the solutions are expanding Medicare, and regulating prices, i.e. letting Medicare negotiate prices with Pharma, etc. All of these are non-starters even with "moderate Republicans". If Republicans were to agree to some part of some of these provisions... they'd demand concessions, like "tort reform" or some other nonsense that would make problems worse so the best you'd get is a wash, not any real "fix". I mean seriously do anyone think that 8 or 10 Republicans will join the Democrats and pass legislation that the rest of the Party fundamentally opposes? Despite House and Senate leadership?

Republicans simply don't have clue, so it falls on Democrats to fix this without the Republicans.

I shudder to imagine the kinds of "concessions" Neoliberal Democrats would make in order to simply get something passed.

I Reject The Supposition

That the GOP is even interested in healthcare, except as using Obamacare to win elections. What really motivates them to repeal Obamacare is that is has a minor tax that falls on the wealthiest Americans. And when the put repeal & replace aside, they'll move on to the only thing that really drives them: cutting taxes on the most fortunate among us, even if it takes a tanker full of red ink.

Obamacare

Obamacare, when it was originally enacted by Congress and signed by the president, WAS already the straw meant to get Republicans and Democrats working together, but Republicans passed on it, just as they are trying to pass any Democratic input now on what is essentially the same as done by Republicans, i.e., Trumpcare is essentially Obamacare without a heart.

The only way out for Republicans now is getting together with Democrats and fixing the real problems with Obamacare (better Medicaid funding and premium help for those using the exchanges), providing single payor insurance (Medicare for all) or allowing states to offer public plans with adequate funding.

They are basically screwed if they try to do anything else because you can only lie so long before folks catch on.

Solution

Now I am not for or against ACA, I see benefits and costs to it.

It seems though that your solution is to throw more money at it which of course has to be taken out of someone's pockets. And those usually are not the pockets of the ones receiving the Medicaid benefits and/or the ACA Subsidy.

With that in mind how do you think this "no work requirement welfare program' works out in the long run? How do you think it helps to encourage people to live healthier lives?

My biggest pet peeve with ACA is that it does little to strongly pressure citizens to make healthier life style choices, it just makes other citizens pay the bills for them.
https://www.cdc.gov/nchs/data/databriefs/db219.pdf

I have not discussed a solution other than making

I have not discussed a solution other than making things work, but the ACA, a concept taken directly from a proposal of the Heritage Foundation which Massachusetts under Mitt Romney's tenure made work (some none too happy about switching to federal control), works; the fact is that it works better than what was happening before, although it is true that it worked way better for insurance folks than it did for those stuck with the mandate now paying through for premiums.

My solution would be Medicare for all and cutting the insurance companies and HMOs loose to find their own way and why this has not become an existential question for these folks is a mystery.

As far as your pet peeve goes, it is not really an ACA specific problem. There are ways to incentivize life style choices already in use by the insurance companies and HMOs. You could take them further by cracking down on liberty in a big way that I know is quite popular in your camp (this is irony, I think); however, it makes sense to me to find ways to limit costs by not pouring resources into care of folks suffering non-communicable disease with no demonstrable lifestyle changes—the trouble is that there are major economic sectors working against these folks (purposely killing them). Ideally, you would tax the folks spreading non-communicable disease out of existence.

We tried that already.....

Is the Dem position -"We need to fix Obamacare with more Obamacare?"

Of course they can't work together

Non compromise is possible. Democrats want to give more people access to health care. Republicans want to cut rich people's taxes, and the only way to do that is end access for tens of millions of people. Only blind fools see room for compromise in there.

No

When you have one party that is interested in seeing that people have access to affordable health care, and the other party is not interested in that, I'm not sure how you work together. Do you care about the sick and the poor or not? Are you willing to pay for other people to get healthcare or not? The differences are fundamental.

Jason Lewis' ignorance and Risk Corridors

Rep. Lewis betrays a deep ignorance of healthcare law when he refers to the Risk Corridors as a Federal bailout of health insurance companies. That isn't the way that Risk Corridors work.

Risk Corridors share the risk between healthcare insurance companies. If an insurance company loses money because they got more than their fair share of sick people, they get subsidies that are funded by those insurance companies that were profitable because they got more than their share of healthy people. The Federal government was an intermediary in this transfer, but was not the source of the funds. Risk Corridors kept premiums down because they gave insurance companies confidence that they're risks would be stabilized.

If Rep. Lewis (and others like him) can't understand basic concepts of health insurance policy, they should seek advice from experts (which the Republicans didn't do) or they shouldn't be voting on bills that affect tens of millions of US citizens and 1/6 of our economy. This is the real world, not conservative talk radio.

7 years and 70+ tries

7+ years and 70+ tries to repeal the ACA and the Republicans don't have any answers. It's time to fix the ACA. The Republicans are sacrificing their campaign promises all for one word - REPEAL, as they flail and fail. The Republican Party is set up to obstruct, not lead.

What deeply saddens this

What deeply saddens this citizen watching the Senate (and the House) flounder and scramble to pass an anti-Obamacare bill--ANY anti-Obamacare bill--is that everyone is focusing on the horse-race aspect of this, Mitch McConnell's need to have something--ANYTHING--to justify a notch in his gunbelt. The vote is all, not the WHAT they're voting on.

The Senators don't know at all what it is they're supposed to be voting on.

When did American politics get so empty of policy details?

What don't we get about healthcare in this country?

Our system in the USA is fraught with perverse incentives among three parties: the provider, the "patient," and the payer insurance company. These incentives must be understood if we are to deal with the healthcare crisis. The resulting forces mean that we will continue spending more and more on healthcare -– higher premiums, larger government subsidies, and a greater share of our GDP. For more information go to: http://geverest.umn.edu/home/papers-and-publications/healthcare . Whatever we have tried to do with the ACA or with some of the Republican proposals, they won't work, although they might push the problem further into the future. We have a system in which the insurance companies cannot lose, while (some) patients and the tax payers lose.