Repeal and Replace: RIP

Maine’s Republican Sen. Susan Collins drove a metaphorical stake through the heart of her party’s effort to “repeal and replace” the Affordable Care Act on Monday when she announced she could not in good conscience support the Graham-Cassidy bill, which would would strip millions of Americans of their health insurance.

Ms. Collins’ principled stand made her the third of the chamber’s 52 Republican senators to turn thumbs down on the measure, thus prompting Senate Majority Leader Mitch McConnell to announce today that he wouldn’t insist his Republican colleagues go through the motions of a vote they were virtually certain to lose. (The other two GOP opponents of the bill were Sens. Rand Paul of Kentucky and John McCain of Arizona; all 48 Senate Democrats and independents opposed the measure.)

That’s just as well since the bill Ms. Collins rejected was truly an awful piece of legislation that never should have gotten as far as it did. It was condemned virtually unanimously by all the major stakeholders in the health care system, from insurance companies and patients’ rights advocates to physicians and the pharmaceutical industry. Now that this legislative nightmare finally seems dead, it’s time for Congress to do what it should have been doing all along, which is to hammer out a bipartisan agreement that fixes the flaws of the Affordable Care Act while maintaining the promise that every American have access to health care coverage.

That’s going to be a lot easier said than done, however, because Republicans have spent the last seven years doing their best to convince voters that the ACA was a failure and that they could quickly come up with something much better. Now, after scattershot ideas for replacement, there can be no denying that the GOP was wrong on both counts. Since the ACA went into effect, millions of Americans have been able to buy insurance they otherwise couldn’t have afforded. Meanwhile, Republicans repeatedly have shown they haven’t the slightest idea how to come up with an alternative that doesn’t impose higher insurance premiums, sharper limits on coverage, denial of coverage to people with pre-existing conditions and drastic cuts in Medicaid. This latest bill, according to a preliminary Congressional Budget Office score, would have trimmed $133 billion from the budget over 10 years but at a cost of millions more without insurance — the same fault that had plagued all previous repeal-and-replace iterations.

As recently as a couple of weeks ago there was hope Congress could get its act together around a bipartisan health care reform effort led by Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander, a Tennesee Republican, and Sen. Patty Murray, a Washington Democrat. But that movement ran out of steam when all the media attention turned to the partisan Graham-Cassidy bill, and there appears to be little appetite among Republicans for reviving the earlier talks, even though Senate Democratic Majority Leader Chuck Schumer has called on GOP colleagues to work with his caucus on devising a viable alternative.

But that effort has gone nowhere as well. Senator Alexander said that the partisan gridlock in his chamber was simply too toxic for either side to trust the other, and that "we stopped the bipartisan talks ... because my goal wasn't just to get a bipartisan agreement — it was to get a bipartisan result,” he said. “I didn't see any way to get one in the current political environment."

What that means, we have no idea, but we’re pretty sure a bipartisan result requires a bipartisan process. Congress isn’t going to be able to kick this can down the road indefinitely. As with any major piece of legislation, Obamacare needs refinements — not to mention a president and Congress who will make sure it is implemented the way it was intended. The GOP base may have been conditioned to hate Obamacare, but they are no more interested in seeing millions lose health insurance or go bankrupt from medical expenses than anyone else. That undoubtedly was a key factor in the decision by Ms. Collins and Mr. McCain to reject the Graham-Cassidy bill. (Mr. Paul’s reasons are, as usual, his own.) We can only wonder how long it will be before a critical mass of the 49 other members the GOP Senate caucus comes to the same conclusion.

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