Health care: The promise, and the perils, of bipartisanship

This story has been updated.

Last week, when Republican senators unveiled their revised health-care plan, reporters swamped Sen. Susan Collins (R) of Maine, a crucial swing vote, pinning her against a wall just steps from the Capitol’s magnificent rotunda.

The moderate Mainer explained her objection to the new version’s deep cuts to Medicaid, and to the closed, partisan process in which the bill was crafted. Inching her way forward, reporters flowing along like flotsam and jetsam, she urged starting anew with a bipartisan, open approach – the way significant bills of the past were forged in Congress.

Asked why she thought that could work, given the poisonous partisanship of today and the midterm elections of 2018, Senator Collins answered: “Because I believe that the Democrats are going to be forced to come to the table … and because I have had numerous Democrats say to me that they want to work on a bill.”

Indeed, on Tuesday morning, the Senate Democratic leader, Charles Schumer of New York, took to the Senate floor to say that “the door is open right now, Republican leadership only needs to walk through it.” This, after Republican support for the GOP health-care plan collapsed on Monday evening, prompting majority leader Mitch McConnell (R) of Kentucky to announce a last-ditch effort at delayed repeal – an idea that also looked to be going nowhere.

The unraveling of the Republicans' go-it-alone approach to the Affordable Care Act could well end up involving Democrats in the search for a solution. But finding common ground between the parties could be just as difficult, if not more so.

On Tuesday, President Trump said he wanted Republicans to let Obamacare “fail,” so that Democrats would come to them. “We’re not going to own it,” he said. Democrats called that sabotage against Americans.

“I think bipartisanship is still possible, but it’s a harder goal than it’s been in a long time,” says Nathan Gonzales, editor and publisher of Inside Elections, which provides nonpartisan campaign analysis. A polarizing president, an unpopular GOP plan, and Democrats thinking Republicans will suffer in the next elections – those factors help explain why coming together could be very tough, he says.

How bipartisanship worked in the past

As lawmakers and historians point out, the way that Congress has passed big controversial policy in the past has been by coming together through the often slow and grinding legislative process known as “regular order” – committee hearings, debate, and amendments. That has produced bipartisan landmark legislation on everything from the civil rights laws of the 1960s to welfare reform under former President Bill Clinton and education reform under former President George W. Bush.

That’s the way the Founding Fathers designed it. Collins argues that the troubles of Obamacare, pushed through Congress without a single Republican vote, prove her point that it takes both parties to tackle big controversial issues.

But there has been tremendous turnover in Congress in recent years, with many new lawmakers inexperienced in this legislative history. They emerge from a polarized nation, which is reflected in a polarized Congress. 

And compromise has come to be viewed as a sign of weakness in the base of both parties, most acutely in the Republican tea party movement. Last month, Senator McConnell tried to rally his troops with the bludgeon of bipartisanship, threatening that if they did not unite over the health care, Republicans would have to work with Democrats to fix Obamacare’s collapsing individual insurance exchanges.

“I’m not sure that voters want bipartisanship,” Mr. Gonzales adds. “When voters say, ‘just work together and get something done,’ what they mean is, ‘Do what I want you to do and then have other people agree with my stance and we’ll call it bipartisanship,’ ” he said, adding that sometimes the media glorifies the idea when “that’s sometimes not the political realities of the constituencies that a lot of these members represent.”

Move to repeal also lacks support

As the day wore on Tuesday, Republicans seemed resigned that they do not have the support for even the fallback plan to revive the Obamacare repeal effort of 2015, which passed both Republican-controlled chambers but was vetoed by President Obama. That bill delayed repeal by two years so that lawmakers would have time to work out a replacement.

But the uncertainty of coming to an agreement on a replacement, or what an eventual replacement might look like, concerned several Republicans.

“As I have said before, I did not come to Washington to hurt people,” Sen. Shelley Moore Capito (R) of West Virginia said in a statement Tuesday. "I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians.”

Senators Capito and Collins, and Sen. Lisa Murkowski (R) of Alaska, said on Tuesday they opposed the effort at straight repeal with a delay – enough to kill Senator McConnell’s Plan B.

The majority leader told reporters he still plans to go ahead with the vote, which he now plans for next week. When asked about what happens when it fails, he said committee chairs and ranking minority members would likely hold hearings on the crisis to look for a way forward.

‘A freighted religious issue’

Republicans complain that Democrats only want to “throw money” at individual insurance marketplaces of Obamacare, which have seen premiums steeply rise and insurers pull out. They also charge that Democrats are not interested in reforming and controlling the cost of Medicaid, which expanded under the Affordable Care Act and now covers 1 in 5 Americans.

But Democrats are already airing a number of ways to shore up Obamacare that they believe could gain GOP support – from ways to bring down the price of prescription drugs to “reinsurance,” which is reimbursement for insurance companies that have very high-cost participants in the insurance marketplaces.

“There are a number of things that are bipartisan that members have been talking about for years, but we have not had that door open,” Sen. Amy Klobuchar (D) of Minnesota told reporters Tuesday.

“I’m hopeful that this is our moment in time,” says Senator Klobuchar, noting it appears Republicans don't have the votes to pass a delayed-repeal measure. “They get this vote over with.... And then we start.”

In a previously scheduled meeting, the moderate wings of both parties in the House – the New Democrats and the Tuesday Group – met together over lunch today on Capitol Hill.

“Health care is such a freighted religious issue for people that I don’t think a failure on the Senate side leads to next week kumbayas and bipartisan action,” New Democrats Chairman Jim Himes told Roll Call. “I think it’s much more likely on infrastructure, potentially on tax reform. But you got to start somewhere.”