By Bobby Clark
July 28, 2017 at 5:00 am ET
It is anybody’s guess as to what will happen with health care this week. One moment the Republican effort to repeal and replace the Affordable Care Act is dead. The next, it’s been brought back to life.
Trying to prophesize legislative outcomes is a time-honored tradition in Washington, but these days it’s increasingly hard to read the tea leaves.
Still, it remains a real possibility that Republicans in Congress will not be able to coalesce around a single health care proposal and send it to President Donald Trump’s desk.
If Congress fails to act, how should it and the president proceed? President Trump has already revealed what may be his preferred approach. On multiple occasions, he has said that he will let Obamacare “fail” or “explode” and that “Republicans will not own it.”
This is a modern-day version of Newt Gingrich’s declaration to let Medicare wither on the vine. A word of caution, Mr. President, that approach didn’t work out so well for Speaker Gingrich.
And let’s be clear, the Affordable Care Act is not currently collapsing. But it could. The president could try to undermine the program — as some Republicans have been trying to do since the ACA was passed.
Now with all the levers of government at their disposal, Republicans could throw more sand into the gears that keep Obamacare operating. Let’s also be clear on this point. Should that happen, it’s not a failure of Obamacare. It’s a failure of the Republicans to implement the program as intended. And yes, they will own that.
Instead of trying to sabotage the program — and the health care coverage belonging to millions of Americans — President Trump could take a page out of the Clintons’ playbook after they experienced their own failings on health care.
Then-first lady Hillary Clinton, who President Bill Clinton tapped to lead his health reform efforts, suffered a tremendous setback after Congress failed to pass their plan. But out of the ashes came incremental progress that both parties could support — the Children’s Health Insurance Program.
Hillary Clinton helped pass this landmark legislation that provides health care coverage to millions of low-income children. This accomplishment also could not have happened without the leadership of two Senators from opposing parties who were willing to work together: Sens. Orrin Hatch (R-Utah) and Ted Kennedy (D-Mass.).
As the current chairman of the Senate Finance Committee, Hatch would be well positioned to play the role of dealmaker once again. He is no stranger to the give-and-take that bipartisan compromise requires.
Where to start? Incrementalism is the key, as is focusing on where there are gaps. First, Congress should restore certainty to the individual insurance marketplace. They could do this by providing full and continuous funding for the cost-sharing reduction subsidies that help provide stability in the marketplaces and lower costs for consumers.
Second, Congress should revisit the concept of a public option for marketplaces that lack competition. This idea was considered as part of the debate on the Affordable Care Act, but was ultimately not included. It is time to reconsider a backstop that ensures Americans have access to healthcare coverage if individual insurers are unwilling to enter a particular area.
Third, we need to provide assistance to those people who fall into the coverage gap. These are people who live in states that did not expand Medicaid under the ACA and thus do not qualify for health coverage through that program. Nor do they qualify for subsidies to help them buy insurance in their state health insurance exchange. Congress needs to remedy this situation.
For now, Congressional Republicans and the President seem focused on fully repealing and replacing Obamacare. That would be a disaster in my opinion for the health and well-being of millions of Americans. But should they come up short, there is a bipartisan path forward that Hillary Clinton could probably tell them a thing or two about.
Bobby Clark is co-founder of Concordis: Strategy and Analytics and serves as counsel at Winning Strategies Washington. He previously served as a senior health policy adviser for the House of Representatives and the Department of Health and Human Services during the Obama administration.
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