Trump’s opportunity to repair and rebrand health care
President Trump says he has a new strategy to address problems with the Affordable Care Act. He is going to wait “to let Obamacare explode” and then wait some more to let the Democrats “come to us” so we can “make one beautiful deal for the people.”
But waiting is what created Friday’s legislative disaster in which Trump and House Speaker Paul Ryan poured all their political capital into a failed effort to repeal the 7-year-old law, only to abort the mission at the last minute.
Republicans have voted to repeal, weaken or delay the ACA dozens of times since 2011. But they did not rush to come up with an alternative. Nor did Trump, despite endless vows to “repeal and replace” Obamacare. The Trump-Ryan American Health Care Act was 18 days old when House Republicans killed it.
There is an alternative to waiting for an explosion: Reach out to Democrats now. Drop the repeal-and-replace rhetoric. Try repair and rebrand instead. Some of Trump’s rhetoric presaged just this approach, particularly his promises to get terrific health care for everybody and his vow to leave nobody worse off. He now has a ready-made opportunity to swoop in and “save” Obamacare.
He would have plenty of allies. One of the most welcome revelations of the past week was the size and clout of the House GOP moderate forces. This group has the potential to grow in districts in which conservative voters have seen or experienced the value of insurance coverage made possible by the Affordable Care Act.
Democrats are no more eager than Republicans to see insurers quit markets and leave people in the lurch, or raise premiums and deductibles so high people can’t afford them. It would be nice if Republicans were equally enthused about expanding coverage. Short of that, they should at least want to make sure existing coverage doesn’t erode.
There is plenty for Republicans and Democrats to discuss if both parties can focus on repair.
That could mean restoring some of the ACA protections Republicans have challenged, such as money meant to help people cope with high deductibles (“cost sharing reductions”). It could mean more states expanding Medicaid and creating reinsurance pools, both of which lead to lower rates for private plans; finding a way to lower prescription drug prices; or requiring transparent pricing of medical services. It does not mean decimating Medicaid and repealing tax increases that finance ACA in order to cut taxes for wealthy Americans.
Insurance companies and the country will be looking for signals from Trump, Ryan and Tom Price, the secretary of Health and Human Services. Will they stand by and wait for Obamacare to explode? Will they intervene and make sure it does? Or will they work with a structure that is serving millions well and could be fixed for those it is hurting? A structure that originated with the conservative Heritage Foundation, came to fruition under Republican Gov. Mitt Romney in Massachusetts, and was so successful that Democrats used it as a model for national coverage?
Only option 3 will serve America well. The sooner Trump starts working with Democrats and Republican moderates, the healthier the insurance markets — and Americans — will be.