Once Upon a Time … Bipartisanship and Health Care Weren’t Dirty Words

There was a time when lawmakers of opposing parties not only worked together, but also got along. They shared meals and got to know family members. And this was good for business.

Senate leaders Tom Daschle (D-S.D.) and Trent Lott (R-Mo.) were famously friends at a time when presidents of one party battled daily with Congresses led by the opposing party. So were good buddies Sens. Orrin Hatch (R-Utah) and Ted Kennedy (D-Mass.), who shared membership on the Senate Health, Education, Labor and Pensions Committee.

Even presidents got in on the comradery — House Speaker Tip O’Neill (D-Mass.) and President Gerald Ford (R) were unlikely friends, as were O’Neill and President Ronald Reagan (R).

History is replete with scores of monumental legislative victories won only because of bipartisan efforts — and compromise — made by both sides.

Health care is no exception.

Johnson’s 1965 creation of Medicare and Medicaid, part of his “Great Society,” owes a debt to bipartisan efforts of Congress.In 1984, Hatch and Congressman Henry Waxman (D-Calif.) sponsored the Hatch-Waxman Act to help boost the development of generic drugs. Kennedy and Hatch worked together to pass the Ryan White AIDS Act as well as the State Children’s Health Insurance Program.

It’s a common refrain that there are now two Americas — one red, one blue — and their differences are irreconcilable. But this is not the real issue. Times and opinions will change, and differences can narrow. What we should fear is whether rule changes and tactics in the Senate and House have altered Congress to permanently eliminate the need for bipartisanship. Will these changes kill the need to reach across party lines for decades, and how will this reshape our legislative future?

Senate Democrats lowered the threshold for confirming executive branch nominations and federal judicial appointments (other than to the Supreme Court) in 2013, to sidestep Republican opposition to President Barack Obama’s nominees.

Earlier this year, Republicans dismantled the 60-vote threshold for Supreme Court justices to ensure President Donald Trump’s nominee, Neil Gorsuch, would be confirmed despite Democratic opposition.

Since Trump’s inauguration, Senate Democrats have boycotted numerous executive committee sessions to delay committee votes on presidential nominees.

So far in 2017, every major legislative effort by Republicans is being executed in a strictly partisan fashion — the very design of reconciliation bills for the passage of health care reform and tax reform sidesteps the need for bipartisanship by lowering the threshold for passage to 51 votes. While there are Democrats and Republicans alike who would like to move reform in a bipartisan fashion, to date those efforts have been undertaken behind closed doors by leaders of the majority party.

Today, replacing the Affordable Care Act hinges on what’s known as a “Byrd bath,” the process the Senate Parliamentarian will go through to determine what parts of the American Health Care Act pass muster in the Senate under the narrow guidelines of a reconciliation bill. Without Democratic participation, Republicans must figure out what they can pass with only 51 votes.

The scary thing is that health care is not even a “must pass” effort in the way that several looming deadlines are – this fall Congress faces hard deadlines for the FY 2018 budget, FDA user fee reauthorization, and CHIP reauthorization, not to mention the need to increase the debt ceiling. Each of these must be dealt with in the next four months, and all must be passed with 60+ votes in the Senate. Republicans will have no way around Democrats to resolve these critical issues.

Certainly, we have seen examples of bipartisanship, even during recent years – the 21st Century Cures Act, MACRA, and the aversion of several fiscal cliffs, not to mention a major highway funding bill in 2015, and foreign policy efforts in Iran, Russia, Syria, and elsewhere. However, the wins seem fewer and farther between, and broad efforts (like the grand fiscal bargain President Obama and Speaker Boehner attempted in 2011, or the super committee that ultimately brought us the sequester) appear that much further out of reach.

Current battles beg the question: where are the lawmakers willing to put country before party and do what’s best for the American people? Are there Republicans who will stand up and insist that health care reform protect and provide for those who need it most? Are there Democrats willing to work across the aisle to stabilize a faltering system?

Who will be this Congress’s Daschle and Lott, or Kennedy and Hatch? Senate Majority Leader Mitch McConnell (R-Ky.) and Senate Minority Leader Chuck Schumer (D-N.Y.) are still feeling one another out, but McConnell isn’t known to have had a particularly productive relationship with Schumer’s predecessor, Harry Reid (D-Nev.). Will it be House Speaker Paul Ryan (R-Wis.) who finds a partner in House Minority Leader Nancy Pelosi (D-Calif.) or Minority Whip Steny Hoyer (D-Md.)? Or perhaps President Trump will find a willing Democratic partner in Congress.

Whoever the pair (or more) turns out to be, one thing is clear — whatever grand plans for this country are held by our leaders, meeting the other side halfway is the only proven means of getting lasting change implemented. Otherwise, we can be nearly guaranteed of legislative overhauls each time a new party is in power. And that is not good for business.

Now to find lawmakers who don’t fear bipartisanship … if it’s not moot.


Ipsita Smolinski is managing director of Capitol Street, where she advises clients on national health care policy and emerging trends.

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