National Opinions

How Congress can get a second chance on health care

There are two possible roads ahead on health care reform. One — for Republicans to try again to ram through a bill on a party-line vote — would be unpopular and politically difficult. The second — a return to regular order and bipartisan compromise — is also a political long shot, but it is the best way to achieve improvements that would strengthen insurance markets and help consumers, not punish them.

We know from painful experience in the Obama administration how difficult and elusive this bipartisan approach could be. The conventional wisdom about the Affordable Care Act is that one reason the law generated such lasting anger from Republicans and backlash from voters is that it was passed with only Democratic votes. It's true we didn't get Republican support, but that wasn't for lack of trying.

One of President Barack Obama's first initiatives was holding a bipartisan White House health care summit with dozens of members of Congress. Throughout the legislative process, the president met with the entire House and Senate Republican caucuses several times, and he and other administration officials had countless meetings with congressional Republicans. Near the end, the president made one last try with a bipartisan day-long meeting at Blair House.

In Congress, Democratic Massachusetts Sen. Edward Kennedy's Health Committee spent 13 days marking up its version of the bill and had more than 47 bipartisan hearings on health care. As chair of the Finance Committee, Montana Sen. Max Baucus, D-Mont., spent months negotiating as part of the "Gang of Six" — three committee Democrats and three committee Republicans — in a fruitless search for consensus; his committee markup stretched for eight days. The Senate spent 25 consecutive days in session on health reform, the second longest consecutive session in history. On the other side of the Capitol, House Democrats held 79 bipartisan hearings and markups in public.

The outreach didn't succeed. An especially revealing moment came in the Oval Office in August 2009 when the president asked a congressional Republican health care leader if he would support a bill if all of his changes were accepted. The answer — no — was disappointing but not a surprise. With the tea party movement growing, consensus seemed synonymous with political suicide.

That history invariably makes real bipartisanship seem hopeless. Technology has made it much more difficult for legislators to work in a traditional and effective way. That's why Arizona Republican Sen. John McCain's advice to "stop listening to the bombastic loudmouths on the radio and television and Internet" is so important.

Even more, the courage of Sens. Susan Collins, R-Maine, Lisa Murkowski, R-Alaska, and McCain to do the right thing and insist that policy match rhetoric — and that regular order is followed — creates a new, if narrow, window for progress. The resolve of congressional Democrats, especially those in red states, to refuse to be stampeded into swallowing bad policy cracks that window open a bit further. And the absence of significant and genuine Republican grass-roots anger over the recent defeat keeps the window open.

ADVERTISEMENT

To make the most of this opportunity, congressional Republicans don't have to match the hundreds of bipartisan hearings, markups and other meetings when the ACA was being considered. But consensus isn't possible unless Republican leaders discuss their ideas to change the law with their Democratic colleagues. Congressional Democrats say they want to meet and negotiate. Now is the time for the Republican leadership to accept that challenge.

Independent health care experts agree that the Affordable Care Act has resulted in the lowest percentage of uninsured Americans ever and the slowest rate of inflation in health care spending in 50 years. Incentives in the law are improving the quality of care, Medicare beneficiaries have saved nearly $27 billion on prescription drugs, nearly 600,000 unnecessary hospital readmissions have been prevented and the cost of premiums in the individual market today is almost exactly where the Congressional Budget Office predicted it would be eight years ago. The law is also projected to reduce federal deficits by more than a trillion dollars in coming years.

That's an impressive record, but serious repairs are needed. While most marketplaces are stable, some are in danger of collapse. Costs are still too high for many families, and uncertainty over federal policy is making it treacherous for plans to price premiums accurately.

Both Republicans and Democrats have already proposed remarkably similar solutions targeted to solve these problems. They are affordable, not technically difficult to implement and would help families in all parts of our country. And they demonstrate that the law, and all the good it has done, doesn't need to be destroyed to make needed improvements.

What the Senate did recently reflected a belief that the legislation would severely hurt many Americans and that Congress can do better, both on process and policy. If we take advantage of this window — and Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., leaders of the Senate Health Committee, seem ready to try — Congress may get a second chance not just on health care but also to return to a model of civil governing that has served our country well for decades.

Nancy-Ann DeParle is a partner in the health care private equity firm Consonance Capital Partners. Phil Schiliro is co-founder of and senior adviser to the nonprofit Grow New Mexico. Both were health care advisers to President Barack Obama during the drafting of the Affordable Care Act.

ADVERTISEMENT