Dreams of A Compromise Obamacare Fix

So after the GOP’s Obamacare repeal effort failed with three Republican Senators joining the Democrats to vote it down, Senate Majority Leader Mitch McConnell made a statement mostly bemoaning the failure. He largely blamed the Democrats for not joining in the effort to dismantle Obama’s signature law but did at one point say, “So now I think it’s appropriate to ask, ‘what are their ideas?’ It will be interesting to see what they suggest as the way forward.” He even repeated the sentiment by later saying, “It’s time for our friends on the other side to tell us what they have in mind, and we will see how the American people feel about their ideas.” While his sincerity is undercut by the tone of his statement, I’m willing to be irrationally optimistic and take him at his word. With their partisan, one-sided repeal effort dead, let’s assume the road is open to bipartisan compromise and a real Obamacare fix.

I realize there are partisans on both sides of the political divide that will oppose any such effort. Some of my friends on the left think we should oppose the GOP on every front, never compromising, never allowing any legislative successes that Trump might call a win… essentially adopting the GOP approach during Obama’s Presidency. On the right, some of my friends would prefer to let Obamacare crash and burn, believing the Democrats will receive all the blame for it. Both of these arguments are elevating politics above policy, rationalizing that any short term damage is worth it if it serves the party. Once the party gains more power, it can advance the policy agenda, and then everything will be better (or so goes the argument).

I cannot subscribe to that sort of thinking. Despite my tendency to support Democrats much more then Republicans, I do so only only because they tend to advance policies I agree with it. The moment they stop doing that is the moment they lose my support. I don’t agree with Democrats on everything (nor do I always disagree with Republicans), and I truly believe compromise is a necessary component of representative governance. No matter how much I dislike the Presidency of Donald Trump or the hyper-partisan way in which McConnell has been running the Senate, I nevertheless think it is the responsibility of elected officials to advance policy that helps their constituents even if that means compromising with their political opponents. Serving America has to come before serving the party.

So assuming enough of our elected representatives agree with me, what might a compromise Obamacare fix look like? First, I think it needs to stabilize the insurance markets, and that means fully funding Cost Sharing Reduction payments. Some sort of reinsurance program to help insurance companies enter new markets would also be a good idea. Both would help hold down premiums and encourage insurers to enter new regions in the ACA exchange. To bring Republicans to the table, the bill could also support Health Savings Accounts (HSA), perhaps pairing them with lower cost catastrophic policies on the exchange. To make things more affordable, how about a middle class tax cut that can be credited directly into that HSA. That provides one potential solution to the rising deductibles problem using a mechanism (tax cuts) that conservatives should find more acceptable than just increasing the subsidies. Streamlining the process for selling insurance across state lines could also be a candidate for bipartisan compromise. It would help address the problem of too few insurers in some geographic markets.

Of course I would love to see Medicare for all, or at least an optional Medicare buy-in, included in any deal, but that might be a lot to hope for with the GOP in control of Congress. I think you definitely open with everything on the table to give yourself more bargaining chips as you negotiate down to a workable compromise. Whatever we end up with is likely to fall far short of what we (both left and right) really want, but if it improves the situation by holding down costs and increasing insurance choice, it will be worth doing.

The real question, however, is if Mitch McConnell is really willing to come to the table, or was his interest in the ‘ideas of the other side’ just empty rhetoric? I must admit, my inherently optimistic nature is warring with a pessimism born of experience on this one. Nevertheless, I think Democrats have to make the effort. Take him at his word. Offer your ideas.

Let’s see where it goes.

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