The middle 
strikes back

It wasn’t President Donald Trump who turned health care into a partisan battleground, but his “repeal or bust” strategy certainly hasn’t encouraged middle-ground solutions.

Or has it? From the beginning, Obamacare has represented the worst of America’s two-party political system. We passed it the wrong way — with no Republican support. And we tried to kill it the wrong way — with no Democratic support. Each party is constantly trying to impose its own will on the other party — and the nation — to debilitating effect.

The problem with this approach is that it misses the obvious easy fix. How about preserving the fundamentals of the Affordable Care Act and fixing what’s broken or needs attention? If you’re a member of the party that rose to power on a promise to repeal, that can be a tough pill to swallow. But after the Senate’s recent failure to push a “skinny repeal” through, isn’t it time to recognize the futility of an all-or-nothing approach?

In rejecting the Senate’s attempt to repeal, Sen. John McCain said it was time to return to “regular order.” He was referring to the Senate tradition of bipartisanship. President Trump seems bent on making Democrats “own” the ACA and therefore is reluctant to do anything to stabilize it. In fact, Trump-induced uncertainty surrounding cost-sharing reduction payments is already forcing insurers to raise prices.

But letting the law collapse helps no one — except the politicians who are more interested in scoring political points than tuckpointing a sector of economy whose spending is expected to reach 20 percent of GDP by 2025.

Fortunately, a bipartisan group of lawmakers is saying “enough” to dysfunction and working on a way to fix, rather than replace, Obamacare. This group, the “Problem Solvers Caucus” is split nearly evenly between Democrats and Republicans. On Monday it released a five-point compromise focused on stabilizing health-care markets.

According to USA Today, the group’s health care prescription would:

• Provide mandatory funding for “cost sharing reduction” payments to insurance companies to hold down out-of-pocket costs such as deductibles and co-payments in Obamacare plans for households earning below 250 percent of the poverty level;

• Create a stability fund that states can use to reduce premiums and limit insurer losses, especially for people with pre-existing conditions;

• Change the mandate that employers provide coverage to apply only to companies with 500 or more employees, compared with the current 50-employee threshold, and define a full-time workweek as 40 hours, up from 30 hours;

• Repeal the 2.3 percent sales tax on medical devices;

• Modify sections of the Affordable Care Act to make it easier for states to innovate and enter into compacts to allow for the sale of coverage across state lines.

In case it’s not obvious, this package includes several proposals that should appeal to Republicans — particularly the tax repeal. It also allows states to get creative with new ways to cover their people.

So, maybe Trump’s steadfastness — his insistence on a repeal — has helped create a tipping point toward cooperation. It doesn’t matter how we got here. What matters is how we move forward from a paralyzing impasse. Insurers have already submitted rates for the individual marketplace for the coming year. Lawmakers should move to take action on this plan before insurers set the rest of their rates.


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Given its declining circulation among local “conservatives” – as noted by Peter Hessler in The New Yorker (“How Trump Is Transforming Rural America”, July 24, 2017) – the sanguine sophistry of the Sentinel’s Wednesday editorial (“The middle strikes back”) is perhaps understandable.

First, the Sentinel’s editors wistfully credit Donald Trump with maneuvering the health care debate so as to “encourage middle ground solutions”, when every available fragment of objective evidence suggests that Trump has no grasp whatsoever of health care policy.

Second, the Sentinel blithely regurgitates the familiar talking point that the Affordable Care Act (ACA) was “passed the wrong way – with no Republican support”, while conveniently forgetting that the ACA was originally a “conservative” proposal and that Republicans participated in months of public hearings and amended the ACA over 100 times (including adding the end-of-life counseling provision which precipitated Sarah Palin’s infamous “Death Panel” meme that Republicans then cynically embraced). 

The Sentinel’s cavalier resurrection of this “false equivalency” also disregards the fact that the absence of Republican votes had little to do with the substance of the ACA (which had already proven its merit as RomneyCare in Massachusetts), but rather was an integral element of their avowed obstructive strategy to “deny President Obama a second term”.

Third, and contrary to the Sentinel’s conciliatory canard, it matters very much “how we got here” – because the failure to learn from that sordid history creates the opportunity for more Republican chicanery.  For example, the ACA itself provides for interstate compacts, but the contiguous “Red States” that would benefit the most from pooling their underserved rural counties are the same states that refused to expand Medicaid and whose Republican-appointed insurance commissioners jealously guard their parochial prerogatives.

In sum, regardless of the ACA’s admitted flaws as a premise for the health care dialectic,  Republicans’ Faustian antithesis – as reflected in their seven years of falsehood-based opposition to and sabotage of the ACA while offering no credible alternative – has now been exposed as an utter fraud.  Therefore, it is at best intellectually dishonest to credit the latter with “encouraging middle ground solutions” when the eventual synthesis will be much more attributable to growing support for the former and principled rejection of the latter.

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