Is legislative health-care reform really dead?
Most of Congress seems to think so, and President Trump agrees, if his irate tweets about taking executive action to fix health care on his own are any indication. But the fact remains that Obamacare exchanges are still struggling all across the country. While a GOP-led repeal bill might not be on the table again anytime in the near future, some lawmakers continue to float possible solutions.
In the House, a group of about 40 centrist lawmakers hopes to lead the effort to stabilize the Obamacare exchanges. Called the Problem Solvers caucus, the group includes some moderate congressmen from the New Democrat Coalition and the GOP's Tuesday Group.
Led by Democratic congressmen Tom Reed (N.Y.) and Josh Gottheimer (N.J.), the caucus is primarily focused on continuing to fund the Affordable Care Act's cost-sharing-reduction subsidies (CSR payments), which reduce the significant costs to insurers of covering low-income Americans under Obamacare.
The bipartisan group also wants to establish a federal stability fund that states could access to reduce premiums for citizens with high-cost medical needs. The moderate lawmakers hope to alter the employer mandate so that it applies only to companies with over 500 workers, which would relieve the tax burden on small businesses that choose not to provide insurance plans.
The Problem Solvers caucus has also rallied behind a few ideas that have gained bipartisan support in the past, including abolishing the ACA's medical-device tax and expanding states' ability to seek waivers from some of the bill's coverage rules.
On Wednesday, Republican congressman Mark Meadows, chair of the House Freedom Caucus, said health-care reform isn't over. He also said that he has met with the Trump administration to discuss the path forward, and he's confident they can develop a new plan. Meadows was one of the key GOP members to broker the deal for an amendment that enabled the American Health Care Act to pass the House in April.
Over in the Senate, a handful of moderate GOP senators have suggested providing block-grant health-care funding to the states. This proposal was put forth in an amendment last week by GOP senators Lindsey Graham and Bill Cassidy, but it has yet to receive a vote. It would need to be scored by the CBO before a floor vote could take place.
Graham and Cassidy, along with moderate GOP senator Dean Heller (Nev.), met with Trump on Friday to discuss their plan. The White House, eager to capitalize on any idea to advance reform after last week's debacle, seems intent upon using this plan as a means of gathering momentum for further health-care negotiation.
Meanwhile, Republican senator Lamar Alexander (Tenn.) and Democrat Patty Murray (Wash.) announced Tuesday afternoon that the Senate Health, Education, Labor, and Pensions committee will hold bipartisan hearings throughout September to discuss possible ways to stabilize the ACA marketplaces.
For his part, Trump has threatened to stop doling out CSR payments, apparently with the goal of further exacerbating the problems that already exist on the Obamacare exchanges. Trump seems to believe that further devolution of the exchanges would force lawmakers to implement an immediate health-care solution, but ending CSR payments would almost certainly lead to utter chaos in the insurance markets, making a fix even more difficult.
These efforts, while uncertain and rather uncoordinated, reveal a basic fact: We simply can't afford to give up on health-care reform. The fact that bipartisan cooperation is emerging only now is shameful; Democrats should have cooperated to begin with. Obamacare reform was always going to be necessary, in one form or another. With earlier Democratic support, it might've been feasible to develop legislation that could fix at least some of the problems with the exchanges and garner enough support to be passed into law.
Legislative efforts may be effectively dead for the near future, but as health-care policy expert Avik Roy wrote on the Corner just after the Senate vote failed early Friday:
"The GOP cannot simply 'move on' and give up on health care. Health care is the biggest driver of our debt and deficit, the biggest driver of growth in government, and one of the biggest drivers of economic insecurity for those in the middle class and below. Take some time to reflect, yes. Come up with a better strategy, yes. But to give up on health-care reform is to give up on everything conservatives stand for."
If nothing else, the evident failures of Obamacare — premium costs constantly on the rise, more insurers fleeing the ACA exchanges across the country, leaving many states with just one or two insurance options on the exchanges — preclude anyone in Washington from giving up on reform for good.
Commentary by Robert VerBruggen, a deputy managing editor at National Review. Follow him on Twitter @RAVerBruggen .
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©2017 National Review. Used with permission.