What comes next for healthcare?
Congress will now be home for the Easter recess, and given the fact that the Affordable Care Act (ACA) replacement bill has stalled, we have a chance to consider what might come next.
It allows us to get change right. I’ve found that seeming stopping points can ultimately prove to be beginning points. The back-and-forth built into hearings and legislative cajoling allows an idea to “bake,” as it’s transformed into law. This was skipped in the hurried debate that occurred. In fact, this bill was given just 17 legislative days before the intended vote last Friday. In contrast, the debate surrounding Medicare Part D saw 166 legislative days; the ACA saw 187 legislative days.
In fact, this pause brings many benefits. Some in leadership wanted to take the vote on the seven-year anniversary of the signing of the Affordable Care Act. That was grandstanding. Something that commands almost a fifth of the American economy needs to be given the consideration it’s due rather than artificially scheduled to be a good talking point.
This also gives us a chance to listen to people at home a bit more. I believe concerns have been unduly discounted during this debate. Avoiding the people you represent or calling them “paid protestors” seems to conflict with the job description and signal a lack of interest. Some wanted to check this box prior to our going home so they wouldn’t have to deal with constituents on this issue. I had seven town hall meetings over the time of this debate, and while some were a bit rowdy, I learned a lot. Too often, Washington has treated healthcare in partisan terms. Democrats passed the ACA on a party line vote; Republicans were going to return the favor.
Finally, this pause gives us a chance to keep the debate on healthcare - on healthcare. We shouldn’t rush a bill because it helps with the next debate or to simply check the healthcare box. This bill happened to have a $1 trillion “pay for” that would be most helpful in the upcoming tax debate. As important as that is, and the bill is for the President, momentum and signaling Republicans’ ability to govern...I simply think it’s crucial we get healthcare right before we worry about the way changes in it could be used to pay for other bills in Washington.
In short, I think this pause will prove to be constructive.
In crafting a bill, I believe that there are many key tenets - and they happen to be found in a bill that Senator Rand Paul and I have offered. Here are two that I think are vital to whatever comes next:
One, we have to make affordable insurance legal again. The ACA prohibited this. Things like essential health benefits and community ratings found in Title I represented central wiring in its construction. They were well-intended but fatal flaws because they drove up the cost of insurance for most in the individual insurance marketplace. If you were required to buy a $1.5 million policy for your $200,000 home, would you buy the policy? In the case of healthcare, millions of young people said no, and this proved to be the mathematical failing of the ACA. Good insurance is insurance that works for you. Let people buy what works for them.
Two, our healthcare needs will stretch well beyond a job; as such, it should be portable. Who would have thought a historical event would become a driver in today’s health insurance market? Yet that’s the case. In an effort to circumvent the wage and price controls of World War II, health insurance and employment were coupled. This is not so with the other things we insure, and along with keeping people with a boss they don’t like, it brings with it many marketplace distortions.
There are a host of other things in play, ranging from health savings accounts to group purchasing power. In all this, I want you to know that my efforts to slow the bill have not been based on belligerence or a view that perfection should be the standard for legislation. This bill just wasn’t there yet, and I genuinely believe that my and others’ efforts to slow it will make the end product better. When as many people from very different political philosophies are as concerned as they were on this bill, it should tell all of us something about the power of the pause.
I believe it will move forward. There is consensus in maintaining coverage for pre-existing conditions and things like staying on a parent’s plan. But it’s now time for another change, so people have more choice, the marketplace is included, plans are sustainable, and insurance can once again be insurance.
Mark Sanford is a Republican and represents the First District of South Carolina, which includes Daniel Island. He was sworn into the 113th Congress after winning a special election in May 2013.