Actually, a Health Care Deal Is Possible

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Arianna Vairo

The Republican leadership seems to have thrown in the towel on repealing the Affordable Care Act, at least for now. That’s one piece of good news. Here’s another: Two senators of different parties have resumed negotiations that offer a more productive path, one that could preserve the best of Obamacare while offering adjustments that both parties can accept.

The talks between Lamar Alexander, a Republican from Tennessee, and Patty Murray, a Democrat from Washington, might not succeed, of course. Republican leaders scuttled a previous attempt by the two senators because they wanted another shot at repeal, an effort that failed ignominiously last week. Mr. Alexander and Ms. Murray hope to offer Congress a way out of the morass with a modest bill that could help strengthen the A.C.A.’s individual insurance markets, which are used by about 10 million people, without overhauling the whole system in ways that could deprive millions of people of subsidized care.

Mr. Alexander is a Senate veteran and former governor, and Ms. Murray an accomplished legislator. They have worked well together in the past. They could soon reach a deal that would guarantee appropriations for subsidy payments to insurers that President Trump has threatened to stop. The payments compensate insurers for selling policies with lower deductibles to low-income people. If Mr. Trump got rid of them, the government would actually end up spending more money to subsidize premiums, which companies would jack up to make up for the lost revenue.

The senators’ compromise would also offer states more freedom than the A.C.A. now allows to attract insurers; some rural states are down to just one insurer in their marketplaces, and premiums have jumped. Democrats have resisted such changes before, fearing that any waiver from federal rules would be exploited by states to reduce mandated services like those for maternity care, cancer and pre-existing conditions. Ms. Murray is said to be insisting, as she must, that any new flexibility for states does not become a back door for watering down protections.

Any deal will involve compromise. Democrats could agree to more flexibility for states as long as the A.C.A.’s bedrock protections are undisturbed. For Republicans, the issue is a bit more complicated. Though the deal would be far more humane than the one proposed by Senators Lindsey Graham and Bill Cassidy, which would have increased the number of the uninsured by millions, there will nevertheless be immense pressure on the Republican leadership in Congress to torpedo it. Big Republican donors and far-right activists have been adamant that the party needs to deliver on the promise that it has been making for seven years to repeal and replace Obamacare. Many Republicans are clearly worried that if they don’t heed these calls they could lose primary elections to candidates who can demonstrate greater enthusiasm for undoing Barack Obama’s legacy.

But those same Republicans, through compromise, might benefit even more than they realize. One poll found that just 24 percent of people supported the Graham-Cassidy bill, and most patient advocacy and health care industry groups — including the AARP, the American Hospital Association and the American Medical Association — opposed earlier efforts at repeal-and-replace. Standard & Poor’s has said that Graham-Cassidy would have led to the loss of 580,000 jobs and $240 billion in economic activity by 2027.

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