Health Care

Republicans, Start Over on Health Care

The Graham-Cassidy bill is a bad product flowing from a bad process. There's a better way.

Circles that don't square.

Photographer: Jim Watson/AFP/Getty Images

It's possible for a bad political process to yield a good result. There's even a saying for it -- the one comparing making laws to making sausages. In the case of the latest Republican effort to repeal the Affordable Care Act, however, the process and substance have both been inexcusably reckless. Now that Republican senators' last-gasp effort appears to be on life support, it's time to go back to the drawing board -- and to let Democrats into the process.

Monday brought the sole scheduled public hearing on the Graham-Cassidy health-care bill in the Senate, which means Congress is applying roughly the same level of care and scrutiny to revolutionizing the health-care system as it generally brings to renaming a post office.

Republican leaders want to pass a bill before Saturday, when the current fiscal year expires -- and with it, authority for a reconciliation process enabling them to avoid a Democratic filibuster. They have spent the past week frantically tinkering with the draft in hopes of winning 50 votes, which seems increasingly unlikely after a third Republican senator, Susan Collins of Maine, vowed to vote against the bill -- for good reasons.

Graham-Cassidy would eliminate many consumer protections of the Affordable Care Act, including requirements that insurance plans cover a list of essential benefits and preventive services. It appears to leave patients with pre-existing conditions vulnerable to drastic increases in the cost of their insurance. It would cut tens of billions in federal funding in the coming decade, possibly followed by hundreds of billions in cuts after 10 years. It would dispense that reduced amount in the form of block grants to states, which would be able to spend those funds in ways that don't necessarily benefit patients.

The proposal is opposed by almost every group with a stake in American health care: hospitals, insurers, doctors, nurses, and -- most important -- patients. Most health-care economists are either appalled, baffled or both. The Congressional Budget Office hasn't had time to fully analyze the bill and estimate its fiscal impact, but on Monday the CBO said it would result in loss of insurance for "millions."

Meanwhile, a bipartisan health-care bill with the goal of improving the existing law has languished in the Senate. Lamar Alexander of Tennessee, a Republican, and Patty Murray of Washington, a Democrat, had been working on a compromise to give states more flexibility in administering Obamacare in exchange for bolstering state health-insurance exchanges, which in some states were under duress even before President Donald Trump's campaign to undermine them began earlier this year.

Alexander said last week that he and Murray were abandoning the effort, since they were unable to build the "necessary consensus." It's hard to build consensus on repairing a law when at the same time the majority party's leaders are still bent on destroying it.

If Republicans are genuinely committed to an ideological alternative to Obamacare, they should write a plan worthy of their constituents, vet it through public hearings and open debate, and bring it to a vote next year. They are in power; that's their prerogative. Given that they have had seven years to come up with such an alternative without success, the better course would be to acknowledge the law has enabled almost 20 million Americans to obtain health insurance -- and start working with Democrats to fix its flaws rather than end its benefits.

This is basically the plea that Senator John McCain made on the Senate floor in July, when he helped kill an earlier version of a repeal bill, which also had been hastily assembled and considered. His party didn't listen then. It should now.

    To contact the editor responsible for this story:
    David Shipley at davidshipley@bloomberg.net

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