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McConnell's threat

Senate Majority Leader Mitch McConnell is threatening to work with Democrats on health care? That's rich.
Our view: The Senate majority leader who worked tirelessly to keep any Republicans from supporting Obamacare is now talking about working with Democrats on his health bill? That’s rich

With the 4th of July congressional recess upon us and no Affordable Care Act repeal and replacement in sight, Republicans are clearly getting loopy. President Donald Trump is pushing full-bore for passage of the Senate's health care bill, unless he's floating the idea of repealing now, replacing later, per Nebraska Sen. Ben Sasse's suggestion.

And Senate Majority Leader Mitch McConnell, perhaps remembering why Republicans rejected the idea of throwing out the ACA without anything to take its place, is now suggesting something truly radical: working with Democrats.

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Senate Majority Leader Mitch McConnell
Senate Majority Leader Mitch McConnell (Alex Brandon / Associated Press)

Radical for Mr. McConnell, that is. The Kentucky Republican famous for saying his caucus' top goal was ensuring the defeat of former President Barack Obama's re-election campaign also had some interesting observations at the time of the Affordable Care Act debate in 2009-2010. For example: "It was absolutely critical that everybody be together because if the proponents of the bill were able to say it was bipartisan, it tended to convey to the public that this is OK," he told the New York Times about his ACA strategy in 2010. Any hint that the bill was bi-partisan would give it some legitimacy, and that he could not abide.

But, of course, the ACA was far more bi-partisan in its conception and development than the Senate health care bill Mr. McConnell produced. It was based on an idea Republicans had been proposing since at least the George H.W. Bush presidency — a requirement that individuals buy health insurance as a means to avoid adverse selection, or the phenomenon in which only the sick have coverage. Its precise mechanisms were modeled on Massachusetts' universal health coverage system that was championed by former Gov. Mitt Romney. And particularly in the early stages of debate, the ACA was shaped by negotiations between Senate Democrats and Republicans. Senate and House committees held extensive public hearings and adopted hundreds of amendments to their proposals, including many from Republicans. (Politifact notes that virtually all of the adopted Republican amendments were technical in nature, but even so, that does reflect the presence and engagement of both parties in the process.)

The ACA passed with no Republican votes, it's true. But that wasn't the plan. Democrats and President Obama spent months seeking Republican support before concluding that it would never be forthcoming and moving ahead on their own.

By contrast, the Senate health care bill was the process of secret negotiations among 13 Republican senators and was, reportedly, more or less Mr. McConnell's product in the end. There was never any attempt to consult with Democrats, much less seek compromise with them.

But compromise is the most obvious path forward, and the one that has the best chance of producing a good product that will be embraced by the public. There's much discussion about the rift in the Republican caucus between conservatives who think the Senate bill doesn't go far enough in extirpating Obamacare and those who worry that it cuts too deeply and throws too many people off the insurance rolls. But throw Democrats into the mix, and it's clear that the political center of gravity lies with maintaining the ACA's structure, its expansion of Medicaid and its basic protections for consumers but amending it to provide more stability in insurance markets and better mechanisms to control long-term costs. Republicans are already veering in this direction, for example by considering amendments that would leave in place some Obamacare taxes and continue subsidies for insurers that they had previously fought.

Would Democrats actually work in good faith with Republicans on a bi-partisan health care bill? They say they would, and there's good reason to believe it because it's happened before. A decade ago, President George W. Bush pushed through a Medicare prescription drug benefit that Democrats opposed with the kind of unanimity Republicans would later bring to the Obamacare fight. But when Democrats took control of Congress, rather than voting repeatedly to repeal the program, they worked to fix its flaws. It's not necessarily because they are better, less partisan people but because expanding health care coverage is central to their platform in a way it is not to Republicans.

President Donald Trump ran on a promise of better, more affordable health care that maintains protections for those with pre-existing conditions. He can deliver — if he and Senator McConnell will only reach out to the other party.

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