CAN WASHINGTON COOPERATE ON HEALTH CARE? RECENT HISTORY SAYS "YES."

Last month, House of Representatives Speaker Paul Ryan pulled the Republican’s “Obamacare” repeal bill, despite seven years of GOP promises to kill portions of the law, known more properly as the “Affordable Care Act.” With zero Democratic support, the Republicans could afford few defections on their side, and as we know, a combination of GOP conservatives and moderates effectively killed the proposal. In the wake of the bill’s collapse, some commentators called for Republican leaders to reach out to Democrats for another try, and even President Trump hinted at such outreach. So far, there are few actual signs of such cooperation. Is such a thing even possible in the current, super-charged political atmosphere? Some say “no way.” But recent history says “definitely,” at least given the right circumstances.

 

As I blogged over a year ago, the Democrats and President Obama had by that time actually worked with Congressional Republicans on 15 different occasions to make revisions to the Affordable Care Act. Per the Congressional Research Service, these included repeal of one full title of the ACA (Title VII), which would have established a voluntary, long-term care insurance program to pay for community-based services; removing the cap on small health plan deductibles; extending funding for numerous ACA mandated programs; amending the ACA’s definition of “small employer” to ease the health insurance regulatory burden on such employers; and more. Thereafter, the Republican controlled Congress passed, and President Obama signed into law, revisions to the ACA on 5 more occasions. 

 

And that wasn't all. Obama, Democrats and the GOP also worked together to enact two other major health care bills in the last two years of his term, even while they were publicly at loggerheads. In October 2015, overcoming stubborn opposition from the House’s conservative Freedom Caucus, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) with overwhelming bi-partisan support. The MACRA fundamentally revised how Medicare pays for services, rewarding health care providers based on performance (or quality of care) rather than for giving more services (or quantity of care).  Few federal laws (other than the ACA itself, of course) have had a more significant impact on the health care system, since Medicare payment models tend to be adopted by commercial insurance companies.

 

Then, in the final weeks of the Obama presidency, following one of the most contentious elections in American history and this time overcoming mostly liberal opposition, Congress passed and Obama signed into law the “21st Century Cures Act,” which, per the New York Times, “would increase funding for disease research, address weaknesses in the nation’s mental health systems and vastly alter the regulatory system for drugs and medical devices.” The law included funding for then Vice President Biden's "Cancer Moonshot"--and it also included a number of tweaks to the ACA itself. Maine’s Republican Senator Susan Collins was quoted in the same article as saying “I doubt that there is a family in America who will not be touched by this important legislation.” 

 

In short, there is clear evidence that the two parties can work together to enact significant health care legislation, and even to improve the ACA. Will they actually do so this year? One can only hope.

 

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