Why a Bipartisan Health Care Compromise Is Simply a Delusion

Why a Bipartisan Health Care Compromise Is Simply a Delusion

Puck/Library of Congress

Senate Republicans bought themselves a little more time this week to deliver on their top agenda item, repealing and replacing Obamacare. Majority Leader Mitch McConnell agreed to trim two weeks off the August recess, responding to a number of calls within his caucus to expand the legislative calendar. The big question, however, is whether it will help and whether there are any options left if it doesn’t.

McConnell has called a meeting Thursday morning  with the entire GOP caucus, presumably to roll out the new version of the Better Care Reconciliation Act (BCRA). Sen. Pat Toomey first mentioned the new effort on Monday, predicting that it would bridge the gap between moderates and conservatives within Republican ranks. “There’s still a shot at getting to 50 [votes],” Toomey said on CNBC’s Squawk Box.

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It got off to a bad start even before the big reveal. Sen. Rand Paul wrote a blistering op-ed at Breitbart on Wednesday to announce his rejection of the new version of the BCRA, calling it “worse than Obamacare-lite.” Paul accused Republicans of bolstering federal authority over health insurance, retaining too much of the Affordable Care Act’s taxes and regulations, and “creating a giant insurance bailout superfund.” Paul decried the lost opportunity to fulfill pledges made during the past seven years to repeal Obamacare “root and branch.”

Unfortunately, the opportunity to repeal Obamacare “root and branch” came and went five years ago when Republicans failed to beat Barack Obama’s re-election bid. Too much of Obamacare has already been implemented, which has distorted the markets considerably and recast political incentives. Donald Trump himself recognized this in his presidential campaign, promising that the repeal of Obamacare would come with a replacement program that ensured the least amount of disruption possible.

Republican Senators from rural states worry that a flat-out repeal without any transitional support would hit hard in the very areas where they won elections. A straight repeal would require 60 votes as it goes beyond merely budgetary issues, but it would be unlikely to get close to 50 even if it qualified for the reconciliation process.

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Trump made it clear in an interview with CBN’s Pat Robertson on Wednesday that he expects the Senate to act on Obamacare. “Mitch has to pull it off,” Trump said, noting that Obamacare was “a failed experiment,” and that Congress had to act. When Pat Robertson asked what would happen if McConnell failed to deliver a repeal bill, the president replied, “I think it would be very bad. I will be very angry about it, and a lot of people will be upset.”

That may be a rare case of understatement from President Trump. A new poll from Politico and Morning Consult shows that two-thirds of Republican voters expect the GOP to honor their promises and repeal Obamacare. Forty percent of voters overall want a repeal bill passed (with 47 percent opposed, it should be noted), which makes for considerable pressure on Senate Republicans. Interestingly, though, the poll also shows that a majority of GOP voters (54 percent) want Republicans to work with Democrats on a bipartisan reform of the system.

It’s not the first time that’s been suggested. Mitch McConnell warned last week that a failure of Republicans to coalesce around a solution would force him to work with Democrats on temporary fixes for Obamacare exchanges. John McCain and Bill Cassidy both called for negotiations across the aisle last week, with McCain saying, “That’s what democracy is supposed to be all about.”

Don’t expect to find any escape hatch in that direction, though. Toomey called this option “grim” on Monday for a reason; Democrats are fighting to protect Obamacare. They could get Senate Minority Leader Chuck Schumer to work with them “as long as nothing gets repealed, the mandates don’t go away, taxes remain in place, and Medicaid stays on a completely unsustainable fiscal train wreck,” Toomey told CNBC.

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Even renegade Democratic centrists don’t offer much hope for peeling off enough for a bipartisan compromise. A handful of House Democrats issued a proposal called, “Solutions over Politics” (SoP) to redirect the debate over health-care reform. "We are proposing real, concrete solutions that will stabilize and improve the individual market,” Rep. Kurt Shrader (D-OR) declared, “making Obamacare work better for everyone, and getting us closer to universal coverage for all Americans."

Unfortunately, this agenda looks very close to the same laundry list Schumer has pushed in the Senate. Shrader wants a permanent subsidy for insurance companies to make up for the losses they incur, guaranteeing a perpetual river of red ink from Obamacare. The original reinsurance funds were time-limited because Democrats insisted that markets would stabilize after the first few years and would become self-sufficient. This “solution” concedes the Republican argument that Obamacare is unsustainable without heavy government spending, and is structurally unsound.

Even where it differs from the official Democratic Party line, the SoP proposal doesn’t stray very far. It endorses health-savings accounts (HSAs), but only for “plans compliant with the ACA,” where Republicans want to expand the use of HSAs to allow for non-compliant innovation. The SoP proposal retains all of the mandates while allowing for “catastrophic health insurance plans … for younger enrollees,” without acknowledging that Obamacare’s high-deductible plans already act in practical terms as catastrophic coverage at high premium levels. Their solution for poor enrollment figures is not to repeal the unsound structure of mandates and narrow choice of coverages that creates it, but “robust marketing around open enrollment periods.”

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Simply put, there is no basis for compromise between one side that sees Obamacare as an abject failure in need of repeal, and another that sees a lack of government funding and a better PR campaign as the only problems in need of solutions.

No, Republicans must do this on their own if it is to be done at all. That is the Hobson’s choice that faces Senate Republicans, and the sooner they realize it, the quicker they will find a way to move forward on a solution. If they don’t, Trump will almost certainly be proven prescient when voters weigh in on seven years of broken promises.