Dear Sen. McConnell,
I have some ideas for getting us out of our health care quagmire.
- The debate and attempt to change the ACA is leading nowhere. Emotions are running too high and political positions are too entrenched for a successful resolution in the next week or two. However, time is rapidly running out. Unless this is resolved quickly, it needs to be put on hold so that more pressing issues like the budget and the debt ceiling can be dealt with.
- You cannot repeal the ACA without help from the Democrats; you have already said as much.
- You will not get enough votes for any “replacement” plan given the projections that the CBO puts forth.
- President Trump has no health care policy in mind, except a generic “repeal and replace.” All that he wants is a “bill that I can sign,” and then he will be able to proclaim victory. You cannot count on him for any meaningful assistance. You must find a way to keep him from commenting on the negotiations. But you can play to his need to be able to say that he “made a good deal.”
- A law to “repeal in two years,” giving time to craft a “replacement” in the interim, is doomed to failure. It will just “kick the can down the road.” Congress can’t meet any deadlines now, even those set by law, such as approving a budget. In two years the situation will be unchanged, except that the ACA will be a more significant part of America’s DNA, and will be even harder to replace. In the meantime, the health care market will continue to respond negatively to the uncertainty about payment, resulting in even more Americans left without health insurance and health care.
- Despite the President’s comments to the contrary, the Republicans now “own Obamacare.” The ball is in your court.
- We are using the wrong paradigm and words to frame the health care debate. We see it as a bilateral contest. The paradigm needs to abandon the “us vs. them” model, and shift to a model that ONLY addresses what is best for the American people. Therefor, the way we talk about this issue also needs to change.
- First, meet one-on-one with Speaker Ryan to tell him what your plan is. You will need his full support to reconcile the House and Senate bills.
- Do not hold a vote to “repeal in two years,” unless you need that to clearly demonstrate that nothing can be done without help from the Democrats.
- Then ask Sen. Schumer to appoint a few Democratic Senators to work with your Republican task force to craft a health care bill.
- Ask Mr. Trump to stop making public comments about this debate. This means NO tweets, NO criticism of any member of Congress, and NO press conferences whatsoever until the bill is ready for approval. However, he MUST provide “political cover” for you when you negotiate with Democrats. This should be the ONLY time he publicly comments on health care legislation. It may be most effective to have Secretary Price and/or Mr. Kuschner deliver this message to him.
- Ask the President to call those Democrats who will work on the task force to encourage their efforts. This will allow him to later tout his ability to “make a deal,” as he can then claim that he was the one who caused some Democrats to “cross over” to approve the new legislation.
- Change the language that is used. This will require an experienced politician like yourself. Stop talking about “repeal” or “repeal and replace” as the only options. Lead your colleagues to accept the fact that the only politically viable possibility is to amend the ACA.
- Lead members of Congress to say things like, “replace the flawed funding mechanism,” and “reinstitute the beneficial programs that Americans have come to rely on,” such as portability, coverage of previous medical conditions, and care for those unable to obtain health care coverage (obviously this is a euphemism for Medicaid). This new paradigm and new language may satisfy those fixated on “repeal and replace,” as it essentially says what they want to hear, but actually means that you will amend the ACA to keep the good and repair the bad. It may have broader appeal to those of all political persuasions and entrenched positions.
- When you have a bill that will garner enough bi-partisan support for passage, then ask the President to publicly praise the Republicans and Democrats who have made this happen and to give his full support for the bill.
- Then hold the vote.
Given your extensive experience and reputation for pulling together legislators with diverse viewpoints, I am sure that you can improve upon this suggested course of action. I hope that these ideas are useful in moving the country forward to resolve this very heated and controversial issue.
James F. Loomis, MPA