Where is the Democratic ACA replacement bill?

David Leonhardt says that the Republicans are “unable to agree on a [health care] policy” and “don’t have the votes to pass [an ACA replacement] plan.” OK, but what I want to know is, what is the Democratic alternative?

On the face of things, this is a strange question, because the Democrats cannot pass a bill in this Congress. Nevertheless, the Democrats should think about what they want to see in a replacement. There is a chance that the Republicans will fail to pass a bill that replaces the ACA without harming lots of Americans, including Republican voters. Here’s why:

  • As Nicholas points out, the Republican’s draft bill that recently leaked showed that they are not close to coming up with a coherent plan. Their current draft could lead to higher costs for insurance, or loss of insurance, for many people currently covered under the ACA. This isn’t playing well.
  • The far-right House Freedom Caucus has announced that it will oppose any bill that does not fully repeal the ACA. If all 32 HFC members took this view, the remaining House Republicans would not hold a majority. The leader of the larger but less conservative House Republican Study Group has also said that he “couldn’t support the party’s existing Obamacare replacement strategy.”
  • There are only 52 Republicans in the Senate and a few of them are moderates on the ACA. So it’s not clear that a bill acceptable to the radical right in the House can pass the Senate.
  • Let’s put this gently: President Trump lacks well-formed views about health care policy. He may not be willing or even able to coordinate the Republican factions.

We don’t know what will happen if no bill is passed or if the ACA is repealed without a replacement. But the Women’s March, the flash protests in response to the Travel Ban, and the uptick in support for the ACA suggest that the Republicans will face well-mobilized opposition if they screw up. If so, the GOP could be looking at the 2018 election with a deeply unpopular president and chaos in the health care system for less affluent Americans. If there is a prospect of losing their majorities, the Congressional Republican leadership might be willing to work with Democrats to pass a bipartisan ACA replacement.

As I described here, there is a left argument that Democrats should refuse any compromise and let the Republicans reap the consequences of their policies. A centrist counter-argument is that a lasting change in health care institutions requires bipartisan legislation, and the best time to get a deal is when Republicans are desperate.

Do I think that it’s likely that the Republicans will be willing to negotiate with Democrats about an ACA replacement? No. The lesson of 2016, however, is that anything is possible. So if the opportunity to negotiate arrives, the Democrats will need to have thought through what compromises they would be willing to accept.


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