Lawmakers from both parties and President Trump have talked about their shared desire to end surprise medical bills and rein in rising prescription drug prices. But their ongoing feud over the Affordable Care Act may stop them from any meaningful legislative action on those problems.
At issue are a set of proposals that would tweak the U.S. healthcare system, not overhaul it. The more ballyhooed and ambitious offerings that lawmakers have been touting — the single-payer Medicare for All model advanced by liberal Democrats and Sen. Bernie Sanders (I-Vt.), and the block-grant-based alternative to Obamacare pushed by some Republicans — haven’t drawn any serious action.
Instead, the House and a key Senate committee — Health, Education, Labor and Pensions — have advanced bills that would protect consumers against unexpectedly high bills for a trip to the emergency room and promote competition among prescription drugs by reducing barriers to generic versions. And while those goals are narrow, they’re important. More significant, they are achievable because of the broad bipartisan support they engender. That’s a rarity in Congress these days on any issue of substance.
The problem is that some Democrats aren’t satisfied with taking only the steps that Republicans also support. They want to shore up the state insurance exchanges that the ACA created and roll back some of the steps the Trump administration has taken to undermine President Obama’s signature healthcare law.
A good illustration comes from Sen. Elizabeth Warren (D-Mass.), a Medicare for All supporter who voted against the proposal in committee last week. Although she said in a statement that the bill includes several provisions she supports, she insisted that she “cannot vote for a bill claiming to lower healthcare costs that does not take meaningful steps to halt the administration’s shameful sabotage of health coverage for millions of Americans or hold drug companies accountable for soaring prices that force families to decide between medications they need and paying rent or putting food on the table.”
In other news, the perfect remains the enemy of the good.
The House bill includes some of the elements that Warren wants in the bill, including provisions reversing two Trump administration actions that reopened the door to non-comprehensive (also known as “junk”) insurance plans and ended efforts to enroll more people in ACA plans. Those pieces turned what could have been a bipartisan effort to slow the growth of prescription drug prices into a bill only five of the chamber’s Republicans supported.
I don’t fault Democrats for pushing to fix the problems in the ACA-created state insurance exchanges that the Trump administration has exacerbated in its zeal to pull younger, healthier people into cheaper, less comprehensive policies. The question is whether they have their eyes on a bill that can pass the GOP-controlled Senate and be signed into law or on a measure they can campaign on. Passing the HELP Committee’s bill into law, after all, will give Trump the chance to crow about how he solved the problem of surprise ER bills.
Then again, it may not come to that. The Senate HELP Committee’s chairman, Lamar Alexander (R-Tenn.), is much more interested in legislating improvements to the healthcare system than the man who sets the chamber’s agenda, Majority Leader Mitch McConnell (R-Ky.). Plus, there’s opposition from some hospitals and physicians who don’t like the proposed fix for surprise ER bills, which would force out-of-network providers to accept the average fee paid to in-network doctors and hospitals. So it’s possible that the legislation founders before the House and Senate can fight over its scope.
That would certainly spare House Democrats from having to make another touch choice between what they really want and what’s politically possible.