In repeal failure, Dems find potential game plan
WASHINGTON» Outnumbered but emboldened, progressive Democrats who watched Republicans fail to unwind the Affordable Care Act are thinking harder about passing major expansions of health-care coverage. For many younger activists and legislators, the push to undo the ACA with just 51 Senate votes is less a cautionary tale than a model of how to bring about universal coverage.
The ambitious idea, discussed on the congressional backbenches and among activists, is not embraced by Democratic leaders. In the hours after the repeal push stalled, Senate Minority Leader Charles E. Schumer, D-N.Y., suggested that Republicans “sit down and trade ideas” with Democrats. House Minority Leader Nancy Pelosi, DCalif., suggested that Republicans fully fund subsidies for current ACA exchange plans — money that President Donald Trump frequently threatens to cut off.
But for many younger Democrats and activists, the Republicans’ near miss on repeal demonstrated boldness from which a future left-wing majority could learn. Democrats passed the ACA through regular order, with a fleeting, fractious Senate supermajority. Republicans proved that major healthcare policy changes can be pushed nearly to the finish line in the reconciliation process, with just 50 supportive senators and a vice president ready to break a tie.
Rep. Ro Khanna, D-Calif., a freshman who favors universal Medicare coverage, said that Republicans have rewritten the playbook. “When we do have a Democratic president, and when we do have a Democratic majority, I’d support getting this through with 51 votes in the Senate,” said Khanna of a universal coverage, single-payer plan. “That will diminish the role of lobbyists and special interests in trying to get a few senators to block something that everyone in this country will want.”
Democrats who endured previous efforts to expand health insurance had rarely considered a reconciliation strategy. In 2009, the Obama administration and Democrats in the House and Senate included veterans of the failed 1993-94 health-care push, who remembered the insurance industry’s effectiveness in sinking their bills.
The 2009 approach brought insurers on board; it adopted the mandate for individuals to obtain health insurance, an idea cooked up in conservative policy circles, and went into effect slowly to avoid piling up costs.
“How much time and effort did they spend in trying to make the ACA bipartisan?” asked Rep. Ruben Gallego, D-Ariz., a rising Democratic star elected in 2014. “It’s never going to happen. Our bills shouldn’t be about getting the most amount of Republicans on board; they should be about insuring the biggest number of people.”
When Democrats lost control of the House in 2010, it taught party activists that there was little to gain from compromise. This year, the ACA policy that proved most intractable was not the mandate — a “skinny bill” to repeal it got 49 Senate vote — but instead the expansion of Medicaid, which up to nine Republican senators refused to roll back.
To progressives, this was proof that they’d been right to demand more in 2009 — from a public option to a Medicare buy-in for younger people to single-payer health care itself. Adam Green, the co-founder of the Progressive Change Campaign Committee, recalled that Democrats had ridiculed the “professional left” for supporting a public option in reconciliation. In conversations since the start of the repeal debate, they’ve come to agree with him.
“In 2009, what we consistently got from Democratic senators was: Hey, reconciliation was a procedural can of worms. We don’t want to go there,” said Green. “Republicans have made very clear that you can go there and push your ideas into law. But our ideas will be more popular. It’s pretty clear that the center of gravity has shifted.”
Last week, as the Senate debated then waylaid the repeal bills, the PCCC held all-day training sessions for 2018 Democratic candidates in a hotel near the Capitol. Many swing-district hopefuls said they embraced single-payer health care or described it as an obvious goal to work toward.
“The image I have in my head is that everyone who wants to see a doctor can see one, without going to the ER or going bankrupt,” said Rick Neal, an international aid worker who was exploring a run against Rep. Steve Stivers, R-Ohio. “Health care doesn’t fit in this free-market fantasy that people have, because people will do anything to see a doctor. The high premiums we’re seeing right now are an indication of market failure.”
Andy Kim, a former National Security Council staffer now running against Rep. Tom MacArthur, R-N.J., described the ideal process for passing a bill in now-common progressive terms — starting with what voters want, not what might win over Republicans.
“The way you start something that’s bipartisan is by starting with the American people,” he said. “Bipartisanship starts with them.”
Democrats have not yet formed a consensus on how to approach health care again. On Thursday, as the repeal effort headed for the cliff, Sen. Steve Daines, RMont., needled Democratic senators by introducing the text of a single-payer bill sponsored by Rep. John Conyers Jr., D-Mich. For the first time, most House Democrats have co-sponsored Conyers’ bill; 43 members of the Senate minority voted “present.”