Democrats Torn Between Playing Offense And Defense On Health Care

“It would be stupid of us to daydream about a perfect health care system while Republicans quietly dismantle the health care system we actually have.”

As the Democratic Party turns to the future on health care — with more than a dozen senators coming out this week in support of Sen. Bernie Sanders' single payer bill — the window to repeal the Affordable Care Act remains open and some in the party are worried that Republicans could act to kill or at least maim the law, while Democrats are looking elsewhere.

Sanders released a Medicare-for-all bill this week with the endorsement of 16 Democratic senators. It could represent the next Democratic vision of health care reform to be pitched in future elections.

But meanwhile, the Affordable Care Act’s individual markets, while stable, remain expensive in many rural areas due to a void of insurance options. The White House seems uninterested in improving the markets, and the president openly muses about letting them collapse. While the Affordable Care Act’s defenders though they could rest easy after repeal failed over the summer, proponents of another repeal bill insist they are gaining momentum and are close to securing the votes they would need to pass it.

This has some Democrats saying the current focus needs to be not on pitching future reforms, but protecting and improving Obamacare.

“My main goal is to fix what we’ve got. And then we can look at anything they want to bring forward through a normal process later, whether it’s Bernie[‘s bill] or whatever it’ll be,” said West Virginia Senator Joe Manchin.

“We ought to have our eye on the ball right now.”

One Democratic aide warned that while the party needs to plan for the future, it also can’t let their base forget about the fights that are ongoing right now. Obamacare repeal efforts sparked a wave of grassroots protests across the country, and some worry that by focusing on the future they’re letting their guard down now.

“Republicans are still trying to repeal Obamacare and the White House’s sabotage campaign is just now ramping up. It would be stupid of us to daydream about a perfect health care system while Republicans quietly dismantle the health care system we actually have,” said the aide. “We’ve gotta keep our head in the game right now, or millions of people will be hurt before any of our awesome plans gets a hearing or a vote.”

Several Democrats said Thursday that their main concern is the Trump White House’s potential to undermine Obamacare, and the fixes that need to be made regardless.

Ohio Sen. Sherrod Brown said that when those are resolved he’ll turn his attention to expanding Medicare and eventually creating a publicly run health insurance pool available to everyone, a system known as the public option. But in the meantime, his focus is on the fights of today.

“To me it’s continuing to beat back their efforts to compromise or repeal the Affordable Care Act, to stop the president from trying to undermine it,” he said said.

Talks about stabilizing the Obamacare markets are currently taking place. Sen. Patty Murray, the ranking Democrat on the Senate Health Committee, is working out a short-term bill to stabilize Obamacare with committee chairman Sen. Lamar Alexander. The bill would guarantee federal subsidies to the individual market, removing the risk that the Trump administration could simply stop making them one month, through at least the end of 2018.

But that could put Congress in the exact same bind next year, where insurers threaten to spike premiums because they don’t know whether federal subsidies will continue.

There’s also the lingering threat of full-on repeal, despite its seeming defeat over the summer. Republican Sens. Lindsey Graham and Bill Cassidy are pushing their last-ditch Obamacare repeal plan, and insisting it has a chance, despite a tight timeline. Republicans have just two weeks before budget reconciliation — the special process that allows them to pass a bill through the Senate with 50 votes instead of 60 — expires.

Graham said Thursday that if the vote were held now “47 or 48” senators would support it, putting it just shy of passage. On Friday, Cassidy upped that to 48 or 49 votes. But the bill would still need to go through several procedural hurdles and pass the House, all in two weeks, to become law.

Some on the left are ringing alarm bells that the bill could be closer to passing than people realize. Senate Majority Leader Mitch McConnell has asked the Congressional Budget Office for a quick score of the bill, and only one Republican senator, Rand Paul of Kentucky, has flat-out said he would not vote for it.

Democrats didn’t seem too concerned about the Cassidy-Graham bill on Thursday. Instead they listed fixing the markets and White House undermining as their main concerns. Sens. Tim Kaine and Dianne Feinstein both said Thursday they didn’t think Republicans realistically had enough time to pass the bill.

But many Democrats are not letting this get in the way of their vocal support of single payer health care. Several big names who are rumored to be among the contenders for the 2020 presidential candidacy were among the 16 senators who endorsed Sanders’ bill on Wednesday. It’s likely to be an increasing part of the party’s identity over the coming years.

“We need to be able to multi-task,” said California Sen. Kamala Harris. “There’s no question we have to continue to defend the Affordable Care Act, but also clearly I’m supporting Medicare for all, I think it’s the right thing to do.”

Rhode Island Sen. Sheldon Whitehouse said one key task for Democrats over the next three years is keeping public attention on Donald Trump if he continues to “sabotage” the Affordable Care Act. But he said that the party is able to do both, and keeping that pressure on does not mean Democrats can’t also start talking about the future.

“Making that point about their sabotage, I don’t think should distract us from also looking at ways we can continue to make the health care system better,” said Whitehouse. “The health care system does not begin and end with Obamacare.”

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