American presidents since Harry S. Truman have voiced support for extending health-care coverage to Americans who do not have it. Medicare and Medicaid brought coverage to many elderly and poor in the 1960s, but by 2009, nearly 50 million Americans still went to bed without coverage.
President Barack Obama called for a bipartisan effort to address this problem. There was vigorous debate in committees where hundreds of bipartisan amendments were adopted, but, in the end, the Affordable Care Act (ACA) passed with votes largely on party lines.
One of the cornerstones of the ACA was taken from the conservative Heritage Foundation. It was a market-based approach offered as the Republican alternative to “Hillarycare” in 1993. Cosponsored by 23 Republican senators — including Orrin Hatch and Chuck Grassley — the plan called for establishing large purchasing pools, called exchanges, in each state. The cost of premiums would be reduced by a sliding-scale tax credit that phased out as one’s income increased. To ensure there would be a healthy mix of people in the exchanges, those who chose to go without coverage would face a fine that gradually increased over time. Employers with significant numbers of employees would be required to offer them coverage. Finally, health-insurance companies could not deny coverage to people with preexisting conditions. Though not adopted in 1993, this same plan reappeared 13 years later in Massachusetts as “Romneycare.”
Three years later, it was a major piece of the ACA. Those of us who worked on the ACA included it because we thought Republicans had a good idea. Ironically, our Republican friends in Congress have spent much of the last six years trying to kill their good idea.
The repeated inability of the GOP to move forward legislation repealing the ACA should be viewed by both sides as an opportunity to do what most Americans are clamoring for us to do: work together to fix the parts of the ACA that need to be fixed, while preserving the parts that need to be preserved.
We should start by stabilizing the exchanges in all 50 states so that health insurers will reenter these markets, creating a competitive environment that will drive down premiums, co-pays, and deductibles.
How do we do this? First, make it clear that the individual mandate, or something equally effective, will be enforced. Second, create a reinsurance program like the one Sen. Tim Kaine (D., Va.) and I proposed this year. A similar program has helped make Medicare Part D successful. Third, make it clear that subsidies, which help buy down the cost of co-pays and deductibles for lower-income people in the exchanges, aren’t going away.
By doing these things, we can bring down premiums in the exchanges by as much as 35 percent. That will save money for the people buying their coverage, while saving money for Uncle Sam, too.
Working together to help stabilize the exchanges can serve as a confidence builder between the two parties and allow Congress to return to regular order. It will bolster the effort Sens. Lamar Alexander (R., Tenn.) and Patty Murray (D., Wash.) announced this month to hold bipartisan hearings when the Senate reconvenes after Labor Day. I hope they will invite a broad range of witnesses — governors, insurance commissioners, physicians, nurses, hospital administrators, health economists, insurers, and others — to testify. I also hope this is just the first step in our work to send a bipartisan bill to the president.
The American people aren’t interested in a Republican victory, a Democratic victory, or a Trump victory on health-care reform. They want a win for America and its families. They want us to demonstrate that government of the people, for the people, and by the people still has the juice to deliver what its citizens need and want — life, liberty, and the pursuit of happiness.
Henry Ford used to say, “If you think you can, or you think you can’t, you’re right.” I think we can. And if we do, we’ll disappoint our enemies and delight our friends, while taking a big step toward making America stronger and more just for future generations.
Tom Carper (D.) is a U.S. senator from Delaware. @SenatorCarper