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For the first time since Donald Trump became president — backed by Republican majorities in the Senate and House — Democrats will soon have significant political leverage to secure some of their policy priorities.
There’s a fresh opening for Democrats to enact policies including extending immigration protection for DREAMers, stabilizing health insurance marketplaces under the Affordable Care Act, extending funding for the Children’s Health Insurance Program (CHIP) and community health centers — and possibly more. Each of these matters, at one time or another, has had significant support from key Republicans.
This unusual and important opportunity arises because of the imminent debates over government funding for fiscal year 2018 and over extending the nation’s debt ceiling. Although these bills are expected to follow separate tracks, failure to do both of these things in a timely way — this December for the federal funding bill and not long after that for the debt ceiling extension — could shut down the government.
Most Republicans won’t want to risk a shutdown, and “reconciliation” isn’t an option
President Trump sometimes blusters about the desirability of shutting down the government, but doing so would cause great peril for Republicans. Given their unified control of the government, Republicans would surely take most blame if national parks close, Social Security checks are withheld, Medicare and Medicaid payments aren’t made, and military active-duty pay is delayed. A government shutdown and a default on US legal obligations would also create a tailspin in the stock and bond markets.
Such a shutdown would undoubtedly place Republican congressional majorities at major risk during the 2018 elections — and, despite their bravado, Republicans know this.
Until recently, House Speaker Paul Ryan (R-WI) and Senate Majority Leader Mitch McConnell (R-KY) have only consulted fellow Republicans on their top legislative priorities: ACA repeal and tax changes. Both of those measures, unlike fiscal year funding and the debt ceiling increase, have been authorized to use the unusual so-called reconciliation process that enables them to pass those bills in the Senate with only 50 votes. (The relatively rare reconciliation process, only allowed in 2017 for health and tax legislation, prohibits Senate filibusters.)
Reconciliation made it possible to ignore Democrats when Republicans sought to repeal the ACA and to decimate the safety net Medicaid program. Thankfully, that approach failed. Now Republicans are similarly going it alone trying to adopt major tax changes with a proposal offering huge windfalls to the rich and large corporations while ballooning the deficit.
But funding of this fiscal year’s budget and debt ceiling bill have a much different dynamic, for two reasons. First, passage of the bills is likely to require 60 votes in the Senate, and Republicans only have 52 members. At least as significantly, many Republicans have a chronic aversion to vote for an increase in the debt ceiling — and, as history shows, a large portion of the party’s most conservative members will not do so. This means that substantial Democratic votes will be needed for passage of the debt ceiling in both the Senate and House.
So the Democrats have leverage. How should they use it?
Instead of being mere supplicants, therefore, Democrats will have real clout. But they will have to play their cards carefully.
Measures like protecting the DREAMers, promoting ACA market stabilization, and funding CHIP and community health centers have not yet moved forward. Even though they enjoy significant bipartisan support, they have been stalled, or subjected to unacceptable conditions, by hardcore right-wingers — at least when they were presented as standalone bills.
These measures, however, have a far better chance of being adopted if they are part of the upcoming “must-pass” bills like the fiscal year 2018 budget and the debt ceiling extension. And their inherent popularity will put Democrats on solid political grounds when Republicans inevitably seek to shift the blame to Democrats if a shutdown looms.
Protecting the DREAMers
DREAMers — the Deferred Action for Childhood Arrivals (DACA) recipients — were given limited but crucial protections by the Obama administration in June 2012. Through a memorandum issued by the Department of Homeland Security, undocumented individuals who entered the country as minors became eligible to receive renewable two-year periods of deferred deportation protection and became eligible for work permits. Altogether, approximately 800,000 youth enrolled in the program, and they are a very sympathetic group.
In September, President Trump denounced the DACA program and indicated he would phase it out in six months, thereby making the DREAMers eligible for deportation in March 2018. But then came the waffling. In response to criticism, Trump tweeted that the six-month delay would give Congress an opportunity to legalize DACA-related protections through legislative action. He also ambiguously indicated that he would “revisit this issue” if Congress failed to act.
During a dinner meeting in September with Senate Democratic leader Chuck Schumer and House Democratic leader Nancy Pelosi, Trump indicated he would be willing to sign DACA protection legislation even if it did not include funding for his signature wall along the Mexican-US border. And he called the DREAMers “good, educated, and accomplished young people.”
Since then, Trump has backtracked once again. But he seems genuinely uneasy with the prospect of moving aggressively against the DREAMers — as surely do many Republican members of Congress. Including the DACA continuation as part of must-pass legislation would give them political cover while providing much-needed protections to youthful immigrants.
Stabilizing health insurance marketplaces
Although Republicans have failed in their repeated attempts to repeal the ACA, President Trump is sabotaging its implementation — from radically shortening the open enrollment period to radically reducing ads informing Americans about ACA coverage opportunities, to, most significantly, ending cost-sharing reduction (CSR) payments to insurers. These CSRs underwrite discounts for low-income people who can’t afford insurance deductibles and copayments. Without the CSRs, insurers predictably increased premiums for people in the marketplaces.
These developments brought together Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA), the chair and ranking minority member of the Senate Health, Education, Labor, and Pensions Committee, to devise a plan to stabilize insurance marketplaces. The plan includes restoring CSR payments for two years and provides greater flexibility for states to experiment with some aspects of ACA implementation — a Republican priority.
Although the Alexander-Murray bill has attracted at least 60 supporters in the Senate, and although it would reduce the ACA’s costs by bringing down premiums, its enactment is far from certain. President Trump encouraged the senators’ collaboration but hasn’t endorsed the bill. Attaching it to one of the must-pass bills might be a deal that President Trump would have difficulty saying no to.
Extending funding for CHIP and community health centers
Finally, there’s the Children’s Health Insurance Program. Thanks to CHIP, today’s uninsured rate among children is at a historic low — less than 5 percent. (That’s a third of the figure in 1997, when the program started.) It has always enjoyed strong bipartisan support, starting with its original sponsorship by Sen. Orrin Hatch (R-UT) and former Sen. Edward Kennedy (D-MA).
Similarly, community health centers enjoy bipartisan accolades and provide critically important care, serving approximately 24 million patients in nearly 10,000 medically underserved communities.
Unfortunately, federal CHIP funding expired on September 30. If funding is not reinstated soon, states will begin to terminate health coverage for their low-income children. The Health Centers Fund, one of two key sources of federal health center support, also ended on September 30, a move that could lead to closures of 2,800 centers.
Although there continues to be strong bipartisan support for extending CHIP and health center funding, such legislation is stalled. The key impediment is House Republicans’ determination to pair such funding with ACA-related cuts, especially the Prevention and Public Health Fund that, among its health services, vaccinates children and fights the opioid epidemic. Inclusion of CHIP and health center funding extension to the earliest must-pass bill would help to break the stalemate.
Democrats should be steadfast about using their new and unusual leverage. They may even be able to add one or more measures, perhaps including expanded aid to Puerto Ricans afflicted by Hurricane Maria, including support for the island’s financially strained Medicaid program.
But DACA, ACA stabilization, CHIP, and community health center funding are where to start. They’re the bargaining chips that have the greatest bipartisan support. These are the policies that Republicans would be hardest-pressed to oppose, and Democrats should push them hard.
In a time when Democrats have few chances to go on the offensive, this opportunity must not be squandered.
Ron Pollack served as the founding executive director of the consumer health organization Families USA for more than three decades, and he is currently the organization’s chair emeritus. He played a leading role promoting the adoption and implementation of the ACA as well as the expansion of Medicaid. The opinions expressed in this article are his own. Find him on Twitter @Ron_Pollack.
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