ASPECTS OF OBAMACARE THAT NEED FIXING THAT REPUBLICANS AND DEMOCRATS SHOULD WORK ON TOGETHER USING REGULAR ORDER.
Yesterday John McCain returned to the Senate after brain surgery to vote on whether to allow a vote on some (unknown) measure(s) to repeal (and maybe replace) Obamacare. McCain cast a vote that made the count 50-50 enabling Mike Pence to vote yea and allow voting. While I had hoped that vote would be against allowing voting on the measure(s), I can understand McCain’s view that led him to vote for allowing voting on the measures.
I have included the full text of McCain’s remarks at the end of this post. I believe it is well worth reading. Here, I will just list the main points of what McCain said:
- IN THE PAST SENATORS OFTEN HAD VERY SERIOUS DISAGREEMENTS ABOUT HOW BEST TO SERVE THE NATIONAL INTEREST. “BUT THEY KNEW THAT HOWEVER SHARP AND HEARTFELT THEIR DISPUTES, HOWEVER KEEN THEIR AMBITIONS, THEY HAD AN OBLIGATION TO WORK COLLABORATIVELY TO ENSURE THE SENATE DISCHARGED ITS CONSTITUTIONAL RESPONSIBILITIES EFFECTIVELY.”
- THE SENATE’S “ARCANE RULES AND CUSTOMS ARE DELIBERATELY INTENDED TO REQUIRE BROAD COOPERATION TO FUNCTION WELL.”
- “OUR DELIBERATIONS TODAY. . . ARE MORE PARTISAN, MORE TRIBAL MORE OF THE TIME THAN ANY OTHER TIME I REMEMBER . . . RIGHT NOW THEY AREN’T PRODUCING MUCH FOR THE AMERICAN PEOPLE.”
- “I HOPE WE CAN AGAIN RELY ON HUMILITY, ON OUR NEED TO COOPERATE, ON OUR DEPENDENCE ON EACH OTHER TO LEARN HOW TO TRUST EACH OTHER AGAIN AND BY SO DOING BETTER SERVE THE PEOPLE WHO ELECTED US. STOP LISTENING TO THE BOMBASTIC LOUDMOUTHS ON THE RADIO AND TELEVISION AND THE INTERNET. TO HELL WITH THEM. THEY DON’T WANT ANYTHING DONE FOR THE PUBLIC GOOD. OUR INCAPACITY IS THEIR LIVELIHOOD.
- “LET’S TRUST EACH OTHER. LET’S RETURN TO REGULAR ORDER. WE’VE BEEN SPINNING OUR WHEELS ON TOO MANY IMPORTANT ISSUES BECAUSE WE KEEP TRYING TO FIND A WAY TO WIN WITHOUT HELP FROM ACROSS THE AISLE. THAT’S AN APPROACH THAT’S BEEN EMPLOYED BY BOTH SIDES, MANDATING LEGISLATION FROM THE TOP DOWN, WITHOUT ANY SUPPORT FROM THE OTHER SIDE, WITH ALL THE PARLIAMENTARY MANEUVERS THAT REQUIRES.”
- “LET THE HEALTH, EDUCATION, LABOR, AND PENSIONS COMMITTEE UNDER CHAIRMAN ALEXANDER AND RANKING MEMBER MURRAY HOLD HEARINGS, TRY TO REPORT A BILL OUT OF COMMITTEE WITH CONTRIBUTIONS FROM BOTH SIDES. THEN BRING IT TO THE FLOOR FOR AMENDMENT AND DEBATE, AND SEE IF WE CAN PASS SOMETHING THAT WILL BE IMPERFECT, FULL OF COMPROMISES, AND NOT VERY PLEASING TO IMPLACABLE PARTISANS ON EITHER SIDE, BUT THAT MIGHT PROVIDE WORKABLE SOLUTIONS TO PROBLEMS AMERICANS ARE STRUGGLING WITH TODAY.”
So, I hope McCain’s words can inspire enough of his colleagues to allow for regular order and a deliberative process that can lead to a bill that will improve the current Obamacare legislation.
Going to regular order is TIME CONSUMING. I believe that a main reason for the current rush to get a bill passed is pressure that Trump is putting on McConnell and Ryan to MAKE SOMETHING HAPPEN QUICKLY. That’s Trump’s ADHD and his lack of understanding that meaningful legislation requires a great deal of work and time consuming effort. It reflects Trump’s lack of awareness that creating meaningful legislation is difficult. (“Who knew that reforming healthcare would be so difficult.” Well, actually everyone but you, Trump.)
So, if they are to get back to regular order, there are many aspects of the current law that need fixing that Republicans and Democrats can work on together using regular order. Here are some of them. (You can find an LA Times article linked to this post that describes 14 fixes they can jointly work on.) Perhaps none of them are workable but using regular order both sides can explore possibilities and with a great deal of time consuming work develop a measure that has bipartisan support.
EXPAND THE SUBSIDIES: Obamacare’s premium subsidies are too low, and the income cutoff too sharp, to make coverage truly affordable for many working- and middle-class families.
STEP UP EDUCATION AND OUTREACH. The effectiveness of such efforts is well-established. States with vigorous public outreach programs, such as California, consistently have experienced higher ACA exchange enrollment than those that neglected them or even interfered.
CAP PAYMENTS TO DOCTORS AND HOSPITALS. Reduced competition among health plans in some regions, a problem under the ACA touted incessantly by the GOP, leads to higher reimbursement rates for medical providers and consequently higher premiums.
REPLACE THE INDIVIDUAL MANDATE. This is by far the most unpopular element of the Affordable Care Act, and the focus of the GOP’s pitch that Americans shouldn’t be forced to buy anything they don’t want. But how can people be encouraged to purchase health insurance if they are not forced to do so? Perhaps by using a version of the late-enrollment penalties imposed under Medicare Parts B and D. These voluntary parts of Medicare, covering doctor and outpatient visits and prescription drugs, are partially paid by enrollees. But instead of using lifetime penalties imposed by current Medicare, change those penalties to one or two years — instead of permanent. The goal is to “make the penalties strong enough to be effective in maximizing enrollment, yet not so punitive” that people wouldn’t be able to afford coverage if they’re subject to the penalties.
KILL THE EMPLOYER MANDATE. Even pro-ACA economists acknowledge that it achieves little, especially when balanced against its unpopularity.
Read the LA Times article to see all of the possibilities they are suggesting. If the Senate returned to regular order, these and many more possibilities would be discussed and debated over the long period of time needed to craft a meaningful bill rather than a quick and dirty meaningless measure needed to satisfy Trump’s need to make things happen quickly.