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We don’t know what will happen if no bill is passed or if the ACA is repealed without a replacement.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.

The leaked Republican replacement

The text of a draft bill to repeal and replace Obamacare leaked on Friday. Because the draft hews to principles that Republicans have outlined before, its basic contours aren’t that surprising. As I explained to Greg Sargent at the Washington Post:

The emerging GOP replacement would repeal tax hikes on the very rich and, instead, impose a tax [on employer coverage] that would hit many more people, including lots of public employees like schoolteachers and police officers. At the same time, it would slash Medicaid for the poorest Americans, as well as subsidies that the near-poor rely on to buy private coverage.

Drilling down to details, I had some observations. Take these with a big grain of salt: the leaked draft is dated February 10, so we don’t know how closely it resembles what’s currently under discussion in the House.

http://www.chcf.org/publications/2017/01/pulling-the-plug-on-the-aca?utm_source=CHL&utm_content=From%20The%20Foundation&utm_campaign=Footer

http://www.rollcall.com/news/politics/demint-to-congress-repeal-obamacare-now

Conservatives rallying here are calling for their congressional brethren to keep the faith and quickly gut the 2010 health care law, dismissing concerns about lost health coverage and motivated voters at town halls.

Reported remarks by former Speaker John A. Boehner, R-Ohio, far away from the conservatives gathered at the convention hotel provided the latest cause for alarm. Boehner had said that repeal and replace was “not going to happen,” according to Politico.

“The last I checked, Boehner doesn’t have a vote anymore,” Sen. Ted Cruz of Texas told Roll Call just as a cacophony of barking came from nearby police canines.

“This is a test. It’s a test for Republicans in the executive and both Houses of Congress. Do we honor the promises we made? This election was a referendum on repealing Obamacare,” Cruz said in a brief interview. “I think failure is not an option.”

“We’ve got to keep that promise, and I believe we will,” Cruz said.

 Cruz, who has been among the loudest voices for rolling back as much of the 2010 law as possible, was one of few lawmakers appearing at CPAC during the February congressional recess, flying back from Texas for the occasion. He got a heroes welcome from the conservative activists and media assembled at the hotel just outside D.C.

Heritage Foundation President Jim DeMint, the former South Carolina Republican senator, called on activists attending the Conservative Political Action Conference to push their members of Congress to send to President Donald Trump the same legislation that dismantled the law and was vetoed by President Barack Obama with all due haste.

“We must and we can repeal Obamacare now,” DeMint said. “They should send that same bill to President Trump right now.”

DeMint called the idea that there needs to be a replacement on the front end, “absolutely ludicrous.”

http://www.politico.com/story/2017/02/obamacare-progressives-town-halls-235333

Obamacare is blowing up congressional town hall meetings from California to Virginia. But high rollers aren’t stepping up to write checks to defend the law and possibly turn voter outrage over losing coverage into a sustainable movement.

Though many Republicans charge the town hall sessions are stoked by moneyed interests and professional protesters, health care groups and foundations that have been crucial to the Affordable Care Act cause have remained on the sidelines. Without cash, the smaller progressive organizations left could be hard-pressed to fight a long battle as conservatives spend heavily to pressure lawmakers to finish off the law and, possibly, revamp Medicaid.

“If you’re looking for where funding used to go to fight for the health care bill … I think you gotta keep looking,” said Ezra Levin, a former Democratic congressional staffer now helping direct the Indivisible Project, which is organizing pro-Obamacare demonstrations and other protests against President Donald Trump’s agenda. “It’s not coming to us, at least not right now.”

The flow of funds began slowing not long after the law was passed. After securing former President Barack Obama’s signature domestic policy achievement, key players involved with messaging and advocacy declared victory and moved on without fully completing the sales job. The Health Care for America Now coalition, one of the most audible voices in getting the law enacted, folded in late 2013 after mounting a $60 million campaign to pass Obamacare and protect it during implementation.

It’s left to groups such as the Indivisible Project to confront GOP lawmakers and tap outrage or voter anxiety over the party’s repeal-replace effort. The progressive forces also include the Protect Our Care campaign backed by health consumer groups, and some of the original backers of Health Care for America Now. Another group, the Alliance for Healthcare Security, has aired several rounds of ads that are largely being funded by the Service Employees International Union, though the SEIU declined to specify how much it had contributed.

Huge amounts of cash for advertising and outreach may not be as essential in a social media-fueled crucible, where town hall confrontations can almost instantly go viral and organizers can rely on Facebook and other tools to mobilize. The pro-ACA groups scoff at the notion advanced by the Trump administration and some GOP lawmakers that Democrats are paying protesters to make a ruckus over Obamacare at town halls. “To say that we’re a ‘grasstops’ thing is a complete lie,” said Indivisible Project co-founder Angel Padilla.

But the pro-ACA groups are up against formidable foes. Republicans intent on not only dismantling the ACA but capping the open-ended nature of Medicaid are getting backing from money powerhouses such as the American Action Network, which is aligned with House Republicans, and One Nation, a group with ties to Senate GOP leadership that’s spending millions of dollars targeting vulnerable Democratic senators up for reelection in 2018.