A Damaged Car: Experts Discuss the Next Healthcare Bill Moves

After the last of a series of rejected replace-and-repeal bills proposed by the Senate majority for the Affordable Care Act (ACA), the prognosis looks vague.

Following the announced rejection of vote for the Graham-Cassidy healthcare bill this week, indications from Republican leaders pointed towards a suspension of efforts to repeal “Obamacare.”

Lindsay Graham (R-SC), coauthor of the most recently rejected Republican healthcare, said Tuesday that he would support turning attention to tax reform plans and delaying healthcare reform until 2018, according to the Washington Post.

Graham said he would want to address healthcare in “the most advantageous way.”

“ So patience is a virtue, and time is actually on our side,” Graham said.

Patience will have to be practiced to reach a repeal, some experts observed later this week. But that doesn’t make for any sense of optimism.

In a panel co-hosted by the Harvard T.H. Chan School of Public Health (HSPH) and Reuters, public health and government relations experts depicted a foggy future for the state of healthcare debate.

Robert Blendon, a professor of Health Policy and Political Analysis at HSPH and Harvard Kennedy School, said the debate for the future of the ACA is not over, but that Republicans “don’t know they should know it’s over.”

Blendon noted that the public has misperceived the Democratic party’s support of ACA as a preference for the health care bill and not as just a “commitment to not dropping the 30 million people from coverage” — a rate projected in recent Republican repeal bills.

“They did not fall in love with the ACA, and that’s where they get mixed up,” Blendon said.

There is likely going to be a debate about “an ‘it’,” Blendon said, without there being agreement on “what that ‘it’ should look like.”

The Harvard professor projected there will be a lot of people wanting some alternative to the ACA plan. He shared some recent polls conducted by himself and the HSPH, which showed a recent contrarian opinion to the current Republican lawmaker mindset of moving on to tax reform issues.

The first poll, from this month, showed that 71% of gauged Republicans would rather try to develop an alternative to the ACA, rather than “move on to other issues” (26%). Including Democrats (39% for the former, 57% for the latter), the total majority (51%) preferred an ACA alternative versus moving on.

Two of Blendon’s polls showed a correlated interest over recent years in both supporting the ACA and advocating for a federally-provided universal healthcare plan, which were both rejected by the majority as recent as 2014 before coming into popular opinion in 2017.

Ironically, a 2016 Gallop poll presented by Blendon showed that, while more people have come to favor government-based healthcare, the majority still prefer a private insurance system (53%) — just as they had in 2010, the first year of ACA’s implementation (61%).

The ongoing debate will pertain to single-payer versus state-funded programs, Robert Moffit, a senior fellow of The Heritage Foundation’s Center for Health Policy Studies, said. But the big issue of the debate — which Moffit believes Democrats will ultimately lose — lies in the “payoff of increased taxes.”

However, it’s still an important debate for the country to have, Moffit said.

Senators Patty Murray (D-WA) and Lamar Alexander (R-TN) are currently in discussion of a bipartisan health care plan that could stabilized insurance markets, after having been rejected by the Senate majority for the partisan Graham-Cassidy bill earlier.

But if this effort at bridging the gap fails, Moffit projects “parliamentary guerilla warfare in Congress.”

“That means the Republicans will use any opportunity to make some attack on one or more provisions of the ACA,” Moffit said. “They will use the appropriations prospect, the budget process, they will use program authorizations, reauthorizations.”

Senators have the flexibility to make such actions, Moffit said, and he imagines it will send Democratic leaders on the defense of the issue over the next few years.

With such a long game being projected, the focus by the senate will likely turn to short-term gains, Sheila Burke, chair of the Government Relations and Public Policy Group, Baker Donelson, and an adjunct lecturer in Public Policy at Harvard Kennedy School, said.

The senate generally functions in solving short-term and long-term plans, Burke said. Issues surrounding Medicaid, expansion population, and who gets financed under the current plan play into the short-term plans.

Rather than debate single-payer versus overall Medicare, Burke said the focus will be on “what can you do over the next 2 years to stabilize rates, to essentially keep people in the market, essentially keep plans in the market.”

Moffit opined the only predictability in the steps moving forward are in the “unpredictability of (President) Donald Trump.” Due to bipartisan efforts of his own behalf on the debt limit issue, Trump saw a boost in public support and approval, Moffit noted. He could possibly reach across the table again for healthcare, for a similar boost.

John McDonough, professor of the Practice of Public Health at HSPH, more readily pointed to the Trump administration’s faults in the current problem, and not their potential involvement in a bipartisan solution.

“The Trump administration is not exercising benign neglect of the insurance market,” McDonough said. “It’s exercising malignant neglect, in the sense that they’re deliberately pulling out the advertising, they’re defunding the navigators that played a crucial role in helping people understand their choices.”

Many efforts are being made deliberately to “undermine and weaken the markets,” McDonough said.

McDonough likened the ACA to a damaged car that either be replaced or repaired. To him, it’s “pretty clear we don’t need to buy a new car,” and that it can still be made to work. There’s going to be partisan back-and-forth until some kind of breakthrough — but McDonough doesn’t know what that breakthrough will be.

“For the time being, we’re in a very dangerous and difficult situation,” McDonough said.

The panel discussion can be viewed here.