Deal — or No Deal?

Terry H. Schwadron

Oct. 19, 2017

If Congressional parties could be depicted as fighters in the health care ring, exhausted boxers would have emerged from their corners in late rounds to find agreement on a bill that no one really likes almost too late to be of real effect.

Maybe that’s alone is enough to say it ought to be adopted immediately.

As it stands, the agreement announced by Senators Lamar Alexander (R-Tenn) and Patty Murray (D-Wash) stands as the closest thing that may be possible as a bipartisan, temporary deal to extend federal supports for Obamacare for up to two years. President Trump seemed to back it, even without knowing much about the details, then within a day seemed to disown it — basically for the same reason, temporary restoration of more flexible status quo. The two senators, chairman and ranking member of the Senate Health Committee, say the deal would extend the payments to insurers for two years in return for giving states more flexibility to change Obamacare rules.

The negotiations had been aimed at stabilizing insurance markets, a move made more than necessary by Trump’s abrupt decision — against advice — to use an executive order to stop all support payments to insurance companies who lose otherwise lose money selling insurance in rural areas. Now Trump seems to be doubling down.

In other words, the President killed supports so that he could turn around two days later to support them, under certain conditions. “Yes, we have been involved and this is a short-term deal because we think ultimately block grants going to the states is going to be the answer,” said Trump, referring to a Republican push to block grant health-care financing individually to states.

You can’t make health policy day to day.

It took folks almost no time to run to their ideological corners. House conservative Republicans, for example, immediately attacked the package as “propping up” Obamacare. Senate Majority Leader Mitch McConnell was slow to announce support for the deal, leaving it a question as to whether this deal will come up for a vote soon, or whether there will be 60 votes for it.

Still, there were the upsides:

  • For Trump, if he could stay with it, there was the idea of a temporary agreement would be an invite for Republicans to pass a more complete repeal and replace measure, possibly next Spring. But ideological concerns may prover too much for him.
  • For Democrats, the deal clearly would continue the Affordable Care Act for the time being, allowing more time for consideration of alternatives to repeal.
  • For Republicans, the deal would give more flexibility to states to offer additional lower-cost plans that would cover less but that would remain within the rules of Obamacare. In particular, the bill would ease the appeal of states for waivers to allow specific types of health care, and would support more “catastrophic” policies, policies that offer lower-cost policies with much higher deductibles for those who bet that they won’t get sick.

In general, the big winner in the deal was the deal itself, the idea that under “regular order” of information-gathering and hearings, good-minded government representatives could indeed work together in quiet ways to achieve a bipartisan agreement. It was a victory for process more than one for substance.

The other big promise of the deal was stability of marketplaces. By allowing a designated amount of time — two years, in this case — insurance companies can know how to plan and deliver health care policies.

Altogether, however, this is still about money and politics rather than essentially being about actual health. Nevertheless, we ought to publicly salute the pair of senators for trying hard to achieve something serious that should receive actual consideration.

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