It was only minutes after Senate Republicans’ health care bill fell apart Monday night that Democrats tried to step in to fill the void.
“It's time for Senate Republican leaders to reject Trumpcare like the vast majority of patients and families nationwide, stop sabotaging the health care system, and start working with Democrats on policies that actually help the people we serve,” Sen. Patty Murray (D-WA) told me in an email.
On Monday night, Sens. Jerry Moran (R-KS) and Mike Lee (R-UT) announced their opposition to Republicans’ Better Care Reconciliation Act, temporarily delaying — or maybe even extinguishing — any hope the party has of repealing Obamacare. With Sens. Susan Collins (R-ME) and Rand Paul (R-KY) already rejecting the bill and Sen. John McCain (R-AZ) still recovering from surgery, Senate Majority Leader Mitch McConnell announced late Monday night that he’d be putting a full Obamacare repeal bill up for a vote — just as some members in his caucus urge the opposite.
"The Senate should return to regular order, hold hearings and receive input from senators of both parties, and produce a bill that finally provides Americans with access to affordable and quality healthcare," McCain said in a statement, in an apparent rebuke to McConnell.
But if he wants help from across the aisle, McConnell is going to have to meet some key conditions that may prove nonstarters for most of his own members. Above all else, Senate Democrats have made protecting Medicaid a nonnegotiable demand, in addition to the demand that McConnell drop proposed tax cuts for the rich and preserve Obamacare’s protections for preexisting conditions.
Beyond that, Democrats are also advancing their own policy ideas for fixing Obamacare — including prescription drug policy and a plan to incentivize insurers in underserved markets — which they believe can be the starting point for bipartisan hearings and lawmaking in Senate committees, provided McConnell is first willing to drop the BCRA in its entirety.
Senate Democrats have been united against the Republican health bill
Shortly after the election, some progressive activists on the Hill worried that they’d have a tough time ensuring that moderate Senate Democrats didn’t go over and work with Republicans on repealing Obamacare.
They wound up not having much to worry about. Sens. Joe Manchin (D-WV), Heidi Heitkamp (D-ND), and John Tester (D-MT) have all proven reliably opposed to both the House health care bill and the updated version that was released in the Senate this June; it never looked like an even remote possibility that they’d defect to support a Republican bill polling under 20 percent nationally.
“It maintains severe cuts to Medicaid, raises costs for seniors, and denies access to coverage for those who desperately need substance abuse treatment,” Manchin, one of the most moderate Senate Democrats, said in a statement shortly after the health care bill’s initial release in the Senate. “It also gives a tax break to 11,000 of the wealthiest West Virginians without doing anything for the other 920,000 taxpayers — and it pays for these cuts on the backs of our most vulnerable neighbors.”
The good news for Senate Minority Leader Chuck Schumer is that he can enter any negotiation knowing that his caucus has been unified in the position that any Obamacare repair bill will have to begin with McConnell dropping the BCRA in its entirety.
Senate Democrats have their own ideas about a way forward
If McConnell were to agree to drop the BCRA, according to a senior aide, then the Democratic Party would make three key demands for how to improve Obamacare in the short term.
The first is a guarantee that the Trump administration continue making the bill’s cost-sharing reduction payments, which help make copays and deductibles cheaper for lower-income people who get insurance through Obamacare.
As Vox’s Dylan Scott has explained, President Donald Trump has repeatedly threatened not making the CSR payments— a move that “destabilized” the markets by making it unclear to insurers if they could count on the payments being there. Democrats would make a precondition of any negotiation the demand for the CSR payments to continue to be made. About 20 Senate Democrats have signed on to a bill by Sen. Jeanne Shaheen (D-NH) that would ensure the CSR payments continue to be made.
Democrats’ second request: bipartisan reforms to bring down the costs of prescription drugs. “That includes changing the law so that for 41 million seniors, we can negotiate prices for Medicare — for lower prices, like the VA does,” Sen. Amy Klobuchar (D-MN) said in an interview last month, citing her own legislation. “It includes encouraging more generics, so there can be more competition.”
Klobuchar also noted to me that there’s bipartisan support for the idea of legalizing drug importation from Canada to increase competition. A similar proposal from Sen. Bernie Sanders (I-VT) received more than a dozen votes from Republican senators this January, though it was ultimately defeated.
Senate Democrats also appear to be coalescing around a proposal called “reinsurance.” Included in two recent proposals — one from House Democrats and another from the Center for American Progress — reinsurance would give states federal money to give insurers funding for their most expensive, high-cost enrollees.
Maine and Alaska — two states with moderate Republican senators — have already adopted similar approaches in their states that have shown signs of success. Because the reinsurance fund would reduce premium costs, and thus the amount of tax credits the government would have to pay out, the Blue Cross Blue Shield Association says the $15 billion fund would only cost the federal government $4 billion.
“If you have a backstop for high-cost individuals — a reinsurance package — it allows pricing to be done at a more normal level,” Sen. Tim Kaine (D-VA), who unveiled a new reinsurance package this June, told me. “It brings premiums down by maybe 10 or 15 percent.”
The idea would likely unite Democrats, with progressives like Oregon Sens. Ron Wyden and Sen. Jeff Merkley also telling me they’d support something like Kaine’s reinsurance proposal. The left will demand that Democrats immediately call for either a public option or a single-payer health insurance system — but even single-payer advocates on Capitol Hill say they’d support piecemeal fixes like reinsurance in the event that McConnell seeks Democratic cooperation.
“If you want to ensure some stability in the marketplace, everyone in the insurance world recognizes there has to be some form of insurance against getting a disproportionate care of the deeply ill individuals in the marketplace,” Merkley said in an interview. “That’s if you want the marketplace to work.”