Some Democrats say they hope to recruit President-elect Donald Trump to support their efforts to retain as much ACA coverage as possible in the face of congressional GOP efforts to roll it back.

Nov. 21—It appears too soon to know whether Congress can find bipartisan coverage options to replace the Affordable Care Act, but some early areas of agreement are emerging.

The incoming Trump administration and Republican majority in Congress appear to remain committed to repealing and replacing the Affordable Care Act (ACA).

“Decisions have been made  by the president-elect that he wants to focus out of the gate on repealing Obamacare and beginning the process of replacing Obamacare with the kind of free-market solutions that he campaigned on,” Vice President-elect Mike Pence said Nov. 20 on “Fox News Sunday.”

But a growing number of Republicans appear willing to replace the coverage with a bipartisan approach that would survive the next power change in Washington, D.C.

Gail Wilensky, administrator of Medicare and Medicaid for President George H. W. Bush, said at a Nov. 16 forum sponsored by the Alliance for Health Reform that a Republican-led Congress could repeal much of the ACA quickly but a replacement would require at least eight Democratic senators because of the rules of that chamber.

Although some of the most liberal senators, such as Sen. Bernie Sanders (I-Vt.) have pledged no cooperation, Wilensky said other Democrats may be interested in a compromise. One area of possible compromise is Medicaid—some Democrats might accept a Republican block-granting push in return for keeping the program’s current overall funding levels.

“That would give you a lot of maneuvering room in your block granting of Medicaid,” Wilensky said.

Another area of compromise could involve replacing the individual mandate with an approach more like the one that incentivizes enrollment in Medicare Parts B and D. That provision increases premiums for every month that Medicare beneficiaries delay enrollment.

“Nobody has ever called what Medicare does, to my knowledge, a mandate,” Wilensky said. “I’ve never heard that term phrased, but it is a really heavy-duty incentive to go buy the coverage.”

Democrats have not dismissed the idea of such a replacement for the individual mandate.

Chris Jennings, a former healthcare adviser to the Obama administration, said some Democrats have had an issue with the individual mandate as well.

“If it work, it works,” Jennings said about the Medicare approach.

The Democrats’ Approach

Some Democrats have raised doubts about the feasibility of a bipartisan approach to replace the ACA’s coverage of about 20 million people through government-run insurance marketplaces and Medicaid.

“It’s hard to imagine you’re going to get a lot of Democratic enthusiasm for health savings accounts or Medicaid block grants,” said Bruce Fried, a partner in the healthcare practice at Dentons and healthcare adviser to former President Bill Clinton.

Fried said in an interview that he couldn’t think of any areas of bipartisan agreement about ways to cover people.

Other Democrats have embraced the campaign rhetoric of President-elect Donald Trump regarding healthcare coverage and hope to appeal to him to retain existing coverage levels.

“I’m just saying the president-elect has a vision of covering every American in an affordable way and helping reduce deductibles,” Jennings said. “If that’s his vision, I think a lot of Democrats would like to work with him to that end.”

Congressional Perspective

Although the process of repealing and replacing the ACA remains in the preliminary phase, some Republican leaders have emphasized areas of bipartisan concern. For instance, a staff member of the Senate Health, Education, Labor and Pensions Committee said at the Alliance for Health Reform event that the committee’s chairman, Sen. Lamar Alexander (R-Tenn.) aims to ensure that the ACA marketplaces will remain “stable” during the replacement process.

Emily Murry, a Republican staff member for the powerful House Ways and Means Committee, expressed hope that legislators will be able to build on the areas of the ACA where bipartisan support has emerged for changes, such as repealing the so-called Cadillac and device taxes.

“We’re certainly interested in trying to pursue that bipartisan approach to see if there are areas we can agree on,” Murry said at the Alliance event.

She highlighted previous health insurance coverage bills that drew bipartisan support, such as the Healthy Americans Act, which was a 2009 health insurance coverage bill cosponsored by Sens. Ron Wyden (D-Ore) and Robert Bennett (R-Utah).

“All I can say is that I hope the Republicans do reach out to us,” said Wendell Primus, a senior policy adviser for House Minority Leader Nancy Pelosi (D-Calif.). “I have a great number of great President-elect Trump quotes that shows me clearly we could work with the president-elect, and I think Democrats understand that the Affordable Care Act was not perfect.”

Democrats have expressed skepticism that Republicans can craft a replacement bill anytime soon, given that the 2010 healthcare law was preceded by a year of debate and another year of stakeholder meetings and position papers.

But Republicans cite various Republican policy papers, such as House Republicans’ “A Better Way” plan, as well as lower-profile efforts to garner stakeholder input for replacing the ACA.

“That type of input is actually really important and something that we’ve been doing maybe a little quietly, but for some time,” Murry said.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Tuesday, November 22, 2016