The Doolittles and the Destroyers

The health care fight in September is fixing to be a battle between two extremes: those who want to do little, stabilizing the individual market for now and waiting till later to revisit big changes, and those who are still bent on immediate destruction.

In the “destruction” corner, we have Lindsey Graham (with coauthors Bill Cassidy, R-Louisiana, and Dean Heller, R-Nevada), whose plan proposes getting rid of the individual and employer mandates, and letting the states take care of the law’s other provisions themselves.

The plan may have a shot, but it’s tough to imagine Graham winning over all the other Republican Senators. Neither those who refused to vote for the last bill back in July, nor Mitch McConnell, who hasn’t endorsed it and may be moving on to other things, are likely to come aboard. The plan would mollify Trump, who has consistently called for the destruction of his predecessor’s signature law. The public? Not so much, or even at all: polls suggest that Americans want a health care fix, not a dramatic upset.

In the opposite corner are Senators Lamar Alexander (R-Tennessee) and Patty Murray (D-District of Columbia), who will open bipartisan hearings on healthcare reform next week. A bipartisan proposal from Governors John Kasich (R-Ohio) and John Hickenlooper (D-Colorado), released yesterday, serves as something of a preview of where they may be heading.

The Kasich-Hickenlooper proposal would stabilize the individual market by making sure that Congress appropriates funds for insurance subsidies (called cost-sharing reductions, or CSRs), while keeping most of the law intact, including the hated individual mandate. The plan’s sweetener for Republicans is a certain amount of flexility granted to the states, allowing them to suspend some provisions (like the employer or individual mandates) if they want to, but making them stick to others (like permitting children to be on their parents’ insurance until age 26, and providing coverage to those with preexisting conditions). The catch is that the states’ experiments can’t contribute to the Federal deficit.

Yet the Doolittles don’t have much going for them, either. They will find it tough to convince Republicans with their hearts set on repeal to stabilize the individual market, especially since the rewards Republicans get in return seem comparatively underwhelming. And of course, Trump, who regularly bellows about subsidies given to shady insurers, will hate it. The bright side: Republicans may decide they need to pass something to steady the market in 2018 (which they’d have to do before September 27, the date by which insurers must submit their final plans). Otherwise, they’ll be causing trouble for Americans without anything to show for it. They may also be drawn to the attractions of calm bipartisanship after a bruising congressional session this past spring, and summer full of presidential offenses.

Nonetheless, bipartisanship seems to have less pull nowadays that polarization. Kasich and Hickenlooper revealed their plan a few days after denying that they would run together on an independent ticket in 2020. Astonishing as it may be, Trump may not have failed badly enough in the public’s eyes to make bipartisanship and caution a surefire path to electoral success. (Which is not to say he’s making a favorable impression.) Perhaps if both healthcare plans fail, and Congress succumbs to another round of futile hostilities this fall, that may change.

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