SPARE US A DO-OVER ON HEALTH CARE
When the system depends on the vagaries of who’s in power, no one sleeps well at night
From the day I left the Obama administration in January, I have been haunted by a scenario I didn’t want to imagine was ever possible in this country — the loss of health coverage and deterioration of the Medicaid safety net that was at the heart of every Republican health care proposal.
Having overseen the Affordable Care Act, Medicaid and Medicare, I thought I knew these programs well. But my travels over the past six months taught me a lot more about the families whose lives depend on them, and how tightly Americans’ connection to the middle class is tied to their access to affordable care.
I ended up face to face with a family fearful over what it would mean to lose pre-existing conditions protection for their child now in remission from cancer. I talked to a woman in Minnesota whose mental illness was controlled by medication she was finally able to afford because of the ACA. A young man in Ohio told me that there were no jobs in his neighborhood offering insurance, and that the ACA Medicaid expansion was providing the first regular care for many friends.
I had known these things, but the more time I spent walking near the shoes of these people, the more it became clear to me: Proposals aimed not at improving the ACA, but at taking away money from care for working American families, had to be stopped.
Everywhere I turned, as I listened to people’s stories, I heard another fainter, but still distinct, note. When and how do we make the cycle of partisanship stop?
One thing I’ve learned is that the desire to have a regular source of care and not worry about going bankrupt from a medical bill is not a partisan sentiment, it’s a human one. And when the human system depends on the vagaries of who’s in power in Washington, no one can sleep well at night. GOADING THE GOP President Trump is on a different page. He is still goading his party to run over rather than work with Democrats. He also has repeatedly expressed his intention to do real damage to the insurance markets, and he has the arsenal to make it happen. He may follow through as soon as this week on his threats to cut off subsidy payments that make health coverage affordable for low-income people.
Lawmakers in both parties ought to use every tool they have to hold him accountable for deli- vering for the American public.
Any long-term solution lies at least in part in an end to our epic partisan battles. When I left government, I began to meet with Republican counterparts and trade ideas with policymakers, state officials and policy experts from both sides. As I advocated against a bill I believed would harm our country, I found it challenging to listen to people who disagreed with me. Sometimes I was too dismissive of their points.
There is no lack of pragmatic ideas on how to make health care more affordable and accessible, but we often get so hemmed in we don’t listen. Supporters of the ACA need to understand that for all its successes, some people feel left behind and struggle with high costs. Democrats need to be more open to Republican ideas, such as giving states more flexibility to create their own solutions.
Republicans should focus not on cutting money for health programs, which just shifts burdens to states and consumers, but on structural changes — and recognize that Americans want improvements, not a complete do-over.
Finding bipartisan solutions is not an impossible dream. This month, for example, I wrote a paper for the Journal of the Ameri
can Medical Association with Gail Wilensky, a former George H.W. Bush health official. We laid out Medicaid reforms that have potential appeal to both parties. OWN THE OUTCOME We can’t have a system where one party is pulling on one side of the rope and the second party on the other, and expect to get anywhere. If the party in charge calls all the shots and the minority party reserves the right to find fault or create mischief, our health system will be in limbo and our politics will remain broken. And we can’t change our health care system with each election. Both sides should agree to avoid fast-track processes that allow one party to be excluded from the debate, and both should agree to take half a loaf if, in the end, everyone owns the outcome.
Families I’ve heard from since the collapse of the Senate health bill last week feel safer with the ACA intact. But it will take bipartisan support of health care — not called Obamacare, not called Trumpcare — for Americans to feel truly secure. Sometimes, it takes partisanship to fall flat for bipartisanship to rise. We would be wise to seize this moment.