In a fog of dysfunction, acrimony and ignorance that surrounds the health-care “debate” in Washington, a flicker of light could be seen yesterday in the form of a letter signed by eight governors (two Republicans, five Democrats and one Independent). Led by Colorado Gov. John Hickenlooper (D) and Ohio Gov. John Kasich (R), the group recommended a health-care package. They explained:
“Continuing uncertainty about the direction of federal policy is driving up premiums, eliminating competition, and leaving consumers with fewer choices. Proposed premiums for the most popular exchange plans are expected to increase 18 percent in 2018 and 2.5 million residents in 1,400 counties will have only one carrier available to them on the exchange. Despite these headwinds, states continue to try to stabilize the individual market and have developed innovative solutions to preserve coverage while making insurance more affordable. …
“Based on these guiding principles, we recommend (1) immediate federal action to stabilize markets, (2) responsible reforms that preserve recent coverage gains and control costs, and (3) an active federal/state partnership that is based on innovation and a shared commitment to improve overall health system performance. Just as these proposals have brought together governors from across the political spectrum, we are confident they can attract support across party lines in both chambers of Congress.”
Included in their package were items such as a commitment that “should put to rest any uncertainty about the future of [cost-sharing reduction] payments by explicitly appropriating federal funding for these payments at least through 2019”; a federal reinsurance fund to help stabilize premiums and deductibles; and increasing outreach efforts to sign up younger, healthier Americans (the Trump administration is sabotaging the system by cutting advertising for sign-ups by 90 percent). Those items should please many Democrats. On the reform front that may please Republicans, the governors suggest allowing states more flexibility in choosing essential health benefits (EHB). (“The Secretary of Health and Human Services (HHS) should allow states more flexibility in choosing reference plans for the ten EHB categories than are currently allowed by regulation. HHS should give states that develop alternatives to EHBs that meet the requirements of Section 1332 of the [Affordable Care Act] the opportunity to pursue and implement innovative approaches.”) The plan includes all sort of ideas on easing the process for state waivers (which still abide by basic ACA requirements) and payment innovation. For now, the governors agree that the individual mandate should stay in place.
Hey, how come no one consulted these guys, who seem to know an awful lot about health care? Republicans, in short, were so set on ripping out Obamacare and so ignorant of the consequences of their actions that they wanted no hearings, no methodical negotiations and no bipartisanship. Well, that didn’t work out so well.
Without getting into the weeds of the idea, Jared Bernstein, former chief economist for Vice President Joe Biden and now a senior fellow at the Center on Budget and Policy Priorities, told me, “Their proposals to stabilize the private insurance market through steady CSR payments, reinsurance, and commitment to the individual mandate make a lot of sense and should be an easy bipartisan play in this space.”
Likewise, Sen. Tom Carper (D-Del.), who introduced his own plan in June, had a positive reaction to the plan. “The plan proposed by Governors Kasich and Hickenlooper is a positive example of how bipartisan teamwork can move the needle on health care,” he said. “What they’ve offered is a constructive solution to improve the individual health insurance market and reduce health care costs. This bipartisan plan includes funding for cost-sharing reduction payments for two years and, similarly to legislation I introduced earlier this year and Republican health care plans, calls for a stability fund to strengthen the individual insurance markets.” He added: “For months, I’ve been urging my colleagues in Congress to give our governors a seat at the table and a voice in the health care debate. I look forward to hearing more from our governors in the coming weeks.”
That sounds an awful lot like what Sen. John McCain (R-Ariz.) said in The Post, imploring his colleagues once again to “return to regular order, letting committees of jurisdiction do the principal work of crafting legislation and letting the full Senate debate and amend their efforts” and rediscover the value of “compromise between opposing sides to protect the interests we share.” (As he notes, that is especially crucial since the president “has no experience of public office, is often poorly informed and can be impulsive in his speech and conduct.”)
The governors’ plan may have flaws or omissions; reasonable centrists on each side may have additions. But perhaps it is time for a mini-revolt against the mindlessness exhibited by Republican leaders and the White House, on one side, and the left flank of the Democrats on the other. The combination of centrist Republicans and large numbers of Democrats can produce something that is, if not perfect, at least sane and helpful. Put it on President Trump’s desk, bless it as “Trumpcare” and let him take a victory lap. He won’t know or care what’s in it.
Jennifer Rubin writes the Right Turn blog for The Post, offering reported opinion from a conservative perspective. Follow @JRubinBlogger
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