In re­peal fail­ure, Dems find po­ten­tial game plan

The Denver Post - - NEWS - By David Weigel

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.”

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