The second course of action would be to design a more conservative option that substituted tax-subsidized HSAs combined with catastrophic insurance for the Obamacare subsidies and rolled Medicaid expansion into a block grant that saved money over time. Even if it could or they choose to eliminate the filibuster altogether—a possibility Senate Majority Leader Mitch McConnell has expressly ruled out , Republicans would face a lot of outraged constituents, many of them in their own party.
Several Republican Senators have voiced concern about moving too quickly and leaving people without coverage. One additional approach that might help resolve the conflicts would be to allow the states a lot of flexibility to decide what they want the replacement for Obamacare to be in their state.
But this line is blurring. Obamacare contained provisions notably the Section waiver process that would allow states increasing latitude in spending their federal money. Governors have often proved more adept at brokering compromises across party lines than deeply polarized Washington. There are many ways to accomplish increased state control that might be part of a replacement for Obamacare.
Senators Collins and Cassidy have a startlingly straightforward proposal. Their bill would let states choose between something close to Obamacare, a Republican-type alternative featuring HSAs and subsidies unrelated to income, or nothing at all. The Collins-Cassidy bill is complicated and has many details to be worked out. Both Democrats and Republicans have already attacked it. But the concept of state flexibility might serve as a catalyst for crafting a compromise replacement proposal that could command bipartisan support.
Read the original article here. Alice M. Rivlin Former Brookings Expert. Burwell explained Brendan Mochoruk and Louise Sheiner. Related Books. View the discussion thread. Skip to main content. A must-read political newsletter that breaks news and catches you up on what is happening. Most Popular - Easy to read, daily digest of the news from The Hill and around the world. There are, of course, areas where the recommendations could be more robust and other areas where further refinements are needed.
But, on whole the proposal is a good start. Proof of concept came in , in Massachusetts , when its Republican governor, Mitt Romney, teamed up with the Democratic state legislature to pass a plan that fit neatly into the new vision. It had the backing from a broad coalition, including insurers and progressive religious organizations.
Ted Kennedy, the liberal icon and U. Kennedy was not alone in his belief that the champions of universal coverage would have to accept big concessions in order to pass legislation.
Obama had a similar experience putting together health-care legislation in the Illinois state legislature—where, despite proclaiming his support for the idea of a single-payer system, he led the fight for coverage expansions and universal coverage by working with Republicans and courting downstate, more conservative voters.
He also was a master of policy detail, and as president, when it was time to stitch together legislation from different House and Senate versions, he presided over meetings directly highly unusual for a president and got deep into the weeds of particular programs. Obama could do this because the concept of universal coverage fit neatly within his conception of a just society as one in which people act through government to protect themselves from harm. It helped that he had surrounded himself with policy advisers widely recognized as thought leaders in the field of health policy.
That included Lambrew and Nancy-Ann DeParle, who had been in charge of Medicare and Medicaid during the Clinton administration, as well as Zeke Emanuel, a physician, bioethicist, and prolific writer on health policy.
The key Democratic lawmakers had similarly deep benches of seasoned policy advisers. And as the legislative effort got under way in , those advisers were in constant communication with one another and with the White House.
There were daily and sometimes twice-daily conference calls led by DeParle or Lambrew, in order to coordinate messaging and keep the proposals from diverging too much. Those calls were not always fun, and Lambrew, during her frequent trips to Capitol Hill, usually drew the duty of listening to staff from each chamber vent about the other. But the back-and-forth meant that each committee and chamber understood the absolute limits of what the others could tolerate.
Despite all of these conversations and all the preparations that came before them, the journey of the Affordable Care Act through Congress was halting and difficult, and on several occasions the whole project seemed on the verge of failure.
That was no small thing, as Republicans were about to discover. Following the midterms, and big Republican gains in Congress, DeMint filed a new version of his legislation. This time, every single GOP senator signed on as a co-sponsor.
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