John McCain’s vote is not the only good news for what ails Affordable Care Act: Our view
The events of Thursday night and Friday morning were dramatic, with Sen. John McCain casting the deciding vote to block the one Republican health bill that looked like it might actually pass.
In all likelihood, McCain was acting with the blessing of many GOP colleagues who did not want to buck their party base, but knew that even a slimmed down repeal of the Affordable Care Act would bring a disastrous end to the market for individual insurance policies. McCain might also have greatly relished his role thwarting a plan pushed by President Trump, a man who has denigrated his service during the Vietnam War and picked infantile fights with him.
The question now is what should Congress do. The obvious answer is to adopt bipartisan legislation that would preserve the fundamentals of the ACA, also known as Obamacare, but would fix what ails it.
The law is not collapsing, as some claim. But it is fraying. In much of the Deep South and the lower Midwest, only one insurance company is participating in the law’s exchange. In some counties, mostly in rural Ohio and Missouri, there could be no insurance company active at all.
The good news is that there is already some action towards a bipartisan approach. In the Senate, many Republicans have spoken openly about the need to cooperate, and a bipartisan group met Wednesday night. In the House, centrist Democrats have unveiled a plan to shore up the exchanges. Senate Democratic leader Chuck Schumer has reached out to House Speaker Paul Ryan about working together as well.
Among other things, their plan would revive a reinsurance program that existed from 2014 to 2016 to encourage insurers to enroll high-cost patients. It would also include a Medicare buy-in, allowing people ages 55-64 to join Medicare at cost, rather than the subsidized rate enjoyed by seniors. This would take some of the more expensive people out of the ACA exchanges, a move that would be popular with insurers, while reducing the average age of Medicare patients.
To be sure, there are some things that are missing, such as an increase in the penalties for not having insurance. But it is a good starting point and could be enhanced with some Republican ideas, such as ending the mandate that employers provide coverage.
The fact that some Democrats are willing to admit not all is hunky-dory with the ACA is a significant development. The party’s leadership has taken the position that the law has no problems apart from GOP efforts to undermine it. Perhaps a little candor on the Democratic side would be reciprocated by Republicans.
For all its faults, the ACA has been the most successful health care program since the creation of Medicare in 1966, adding more than 20 million people to the ranks of the insured. The simple fact is there is no Republican alternative just over the horizon that would work better. In fact, much of the ACA was blatantly stolen from a Republican plan of the 1990s.
Centrist Democrats have taken a critical step with their legislation aimed at reforming Obamacare. Now they need Republicans to acknowledge that their partisan approach to health care has failed and agree to a more constructive approach.
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