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This is the way to bringing a sensible and workable plan with bipartisan support. No matter what the plan patients and providers need to get behind the plan . There is not perfect plan, and the perfect plan is the enemy of the good.
Trumpcare failure is an opportunity to end the divisiveness that hampered the Obamacare era.
The failure of Trumpcare last week can be seen as a rejection of policies that Americans judged would move the country backwards. But it also presents the opportunity to end the divisiveness that hampered the Obamacare era and move forward in a bipartisan direction that focuses not on destructive rhetoric, but squarely on reducing premiums and expanding access for all Americans.
The policies and the politics of Trumpcare were extreme and favored by only 17% of voters as compared with the Affordable Care Act (ACA), which enjoys support from 50%. The central plank of the bill cut care for the neediest children, elderly and disabled to pay for a large tax cut for the wealthy. The process, likewise, began with the most partisan approach possible. Republicans skirted Democratic input, avoided public hearings, and ended up rushing a bill without enough time for impartial evaluation.
The president has a chance now to turn this around. Last week, he invited Ezekiel Emanuel, a Democratic policy expert who helped craft the ACA, to the White House. Emanuel and I had dinner after his visit to the Oval Office, and he reviewed the commonsense ideas he shared with the president that were neither Democratic- nor Republican-leaning. The president had already chosen to head down a partisan path, but by inviting Emanuel, he might have signaled a potential interest in a bipartisan approach should that one fail.
Trump has an immediate opportunity to help Americans reduce their costs by choosing to enforce and properly steward what House Speaker Paul Ryan rightly called the "law of the land." The administration has the power to impact the cost of insurance by 25% to 30% with two simple decisions, according to a conversation I had with Mario Molina, CEO of Molina Health, one of the largest insurers in the exchange.
First, the administration, with support from Congress, should commit to permanently funding payments that reduce the size of deductibles for lower-income Americans (called cost-sharing reductions). Republicans need to drop a lawsuit they filed to stop these payments, or Trump needs to say they are going to continue. Second, the administration should enforce the individual insurance mandate until a different approach can be agreed upon. Those two actions will reduce costs for millions and need to be done now before insurers submit initial premiums for next year, or inaction will drive up premiums. Americans should watch this intently.
A third step would be to grant states the flexibility to increase competition and reduce costs. Non-partisan analysts such as Standard & Poor's confirm that the online exchanges that sell ACA insurance policies are stable, but in some states the cost of insurance is out of reach for those who earn too much to receive tax credits.
The administration has tools to do this, including a section of the ACA designed to allow states to pursue different approaches, including those more suited to their political philosophy, so long as they continue to meet the basic aims of covering more people with high-quality coverage. Alaska was the first to use this process last year by creating a statewide reinsurance pool. Such pools protect insurers against losses in high-cost cases, and the savings are passed along to consumers. In Alaska, the result was a dramatic reduction in premiums.