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Some Congress members have a radical idea on Obamacare: work together to improve it

Rep. Charlie Dent (R-PA), leader of the moderate Republican “Tuesday Group.” (Photo By Douglas Graham/CQ Roll Call)

While Republican leaders try again to piece together votes to repeal Obamacare in the House, the party’s moderate wing is looking leftward — trying to work with centrist Democrats toward a series of smaller-scale health care compromises, according to interviews with four members of Congress.

Since the repeal bill championed by House Speaker Paul Ryan failed to garner enough Republican support to pass the House last month, some members of the “New Democrats” caucus have resumed health care talks with members of the Republican “Tuesday Group.” The ideas under discussion include a delay of some Obamacare taxes and modest attempts to reduce health premiums.

This year’s polarized health care debates appeared to offer little potential for cross-aisle collaboration, despite President Donald Trump’s proclamation last week that he would seek to work with Democrats on a new bill.

Ryan said on Thursday, for instance, that Republicans will continue down the path of pursuing health reform without seeking votes from the Democratic caucus. And some conservative advocates are already furious about even the possibility of a Tuesday Group/New Democrats health care coalition, given the split in the GOP on the issue.

“Moderate Democrats don't exist anymore. If this is the direction that certain members of the party take, if they take their ball and run over to the Democrats — as opposed to working with conservatives and rank-and-file Republicans on what they campaigned on — that would be a massive problem for the party,” said Dan Holler, vice president of communications and government relations for Heritage Action for America, a right-wing group, in an interview.

But Rep. Charlie Dent (R-PA), chair of the Tuesday Group, confirmed in an interview that he is “having discussions already with some folks” in the New Democrats caucus. “I’ve gotten very affirmative responses from them,” Dent said, “particularly on fixing the individual insurance markets and on taxes we both agree are problematic.”

Though its chair, Rep. Jim Himes (D-CT), said no formal talks were underway, several New Dems expressed hope that the groups could find common ground. “There are things we work on and can agree on. A lot of us are having these conversations,” said Rep. Ami Bera (D-CA), a doctor and New Democrats member. “There are some good guys out there: We meet regularly with the Tuesday Group to talk about our ideas and discuss how to implement them.”

Building off all the “informal chatter when the reporters aren’t around”

Since the new Congress convened, the Tuesday Group and the New Democrats have only held one official joint meeting, back in early February. Himes said the health care part of that meeting mostly involved Rep. Greg Walden (R-OR), one author of Ryan’s American Health Care Act, explaining the bill to the centrist Democrats.

But in more informal discussions since then, members of both caucuses have explored ways a bipartisan coalition might step in to legislate amid the impossibly large internal divisions in the Republican majority. Those conversations build on discussions from previous years, which never yielded that much successful legislation.

“Our groups have felt frustrated for a while that the agenda is being driven by the far left and the far right,” said Rep. Ron Kind (D-WI), a New Democrat who is close friends with Dent.

Interviews with the members suggest three potential health care buckets on which the groups may be able to work together — driving down premiums, repealing some of Obamacare’s taxes, and lifting some of its regulations.

Multiple members talked about the need to expand on Obamacare’s “delivery and payment reforms,” which reduced health care costs by reimbursing providers on the basis of the value of the services, rather than simply their volume. Accelerating that work, they believe, might find bipartisan support.

Another is through repealing certain health care taxes. For instance, Kind has co-sponsored a repeal of the medical device tax with Rep. Erik Paulsen (R-MN), a member of the Tuesday Group.

Additionally, there are some regulations that members of both groups may be open to repealing. Kind and Rep. Lynn Jenkins (R-KS) have co-sponsored the Restoring Access to Medication Act, which would allow patients to use their health savings accounts to purchase over-the-counter prescription drugs. (Obamacare outlawed doing so.)

Bera, meanwhile, has proposed a bill with Rep. Phil Roe (R-TN), a member of the conservative Republican Study Committee, to fund disposal sites for prescription drug medications. He pointed to a 2013 bill he passed with Rep. Charles Boustany (R-LA), which delayed a health insurance tax for two years, as a reason to believe bipartisan compromises could continue to pass Congress.

“There’s a lot of informal chatter — on the floor, at the gym, particularly when the cameras aren’t running and the reporters aren’t around — but you can talk to your Republicans friends and say, ‘How did it turn out EpiPens are $7,000?” Himes said.

The potential compromises largely avoid the major partisan disagreements over the Affordable Care Act, and they would not likely assuage Americans’ largest concerns about health costs. Timothy Jost, a health expert at Washington & Lee University, noted that none of the floated proposals — with the exception of delaying the medical device tax — would do too much to fix Obamacare’s insurance markets.

“None of these will have a huge impact on the market, or keeping insurers in the individual market,” Jost says. “It’s particularly easy if you don’t pay for it.”

While acknowledging none of the ideas were transformative, Dent argued that starting small could allow a bipartisan group to build toward more aggressive proposals. “I’ve always felt that we should try to reform the health care system from the center out, first by identifying areas of agreement and then working up,” he said.

Experts doubt the possibility of real bipartisan health care work

That strategy faces long odds.

Members of the New Democrats are quick to stress that none of the bills seem feasible as long as Republican leadership continues to try to repeal Obamacare. The New Dems may be more moderate than House Minority Leader Nancy Pelosi, but they share with her the premise that Obamacare has to be preserved.

“All of this is contingent on Republicans getting over their health care fever dream of tax cuts for the wealthy,” Himes said. “As long as they do that, it will put the New Dems in the position of having to stand up against what is good and right in the universe — and the Tuesday Group back in the position of trying to figure out what to do.”

Dent downplayed that gulf: “There are Democrats who love the ACA but know it needs to be fixed and repaired,” he said. “And there are Republicans who detest the ACA but realize aspects of this must be maintained. So I think there are opportunities for substantial reform here.”

Ryan largely controls which bills can make it to the House floor for a vote. And — unsurprisingly, given what happened to former Speaker John Boehner (R-OH) — he’s shown little appetite to circumvent the far-right Freedom Caucus.

“It’s good that these legislators are trying to see commonality with the opposite side. The problem is they’re swimming against the current and on a basis that hasn’t worked in more than a decade,” said Josh Huder, a congressional expert at Georgetown University.

“The significance of what Charlie Dent says is different from the significance of what Paul Ryan thinks of the significance of what Charlie Dent says,” Huder said.