How do congressional Democrats want to fix Obamacare? We asked 8 of them. – Updated by Jeff Stein Jun 30, 2017


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Senate Majority Leader Mitch McConnell gave President Donald Trump a warning this week: If their health care bill falls apart, Republicans will have to negotiate with Senate Democrats.

“If we fail, we’re going to be negotiating with [Democratic leader] Chuck Schumer,” one Republican staffer told Politico.

But what do Senate Democrats want to see to fix Obamacare? On Wednesday and Thursday, I interviewed six Democratic senators and two Democratic House members to ask what the party would want at the top of their health care asks from Senate Republicans.

Some of them advanced piecemeal fixes, like additional funding to help insurers cover high-cost patients, or a new “copper plan” on the Obamacare exchanges that would allow patients to enroll in cheap plans with higher deductibles. Others rejected the premise of the question altogether, arguing that it would be foolish for Democrats to divert their attention when Senate Republicans’ bill represented such an imminent threat.

“Right now, we’re focused on trying to save bill because the bill they put forward is very detrimental,” said New York Rep. Carolyn Maloney. “The only proactive agenda we could have right now is working with the Republicans. And they haven’t said, ‘Come and sit down and we’ll talk about it.’”

Democrats were unified in their party’s top demands: that the GOP drop the repeal bill, tax cuts, and Medicaid cuts, and that the Trump administration continue making the bill’s cost-sharing reduction payments, which help make copays and deductibles cheaper for lower-income people who get insurance through Obamacare. Many of them also reflected what a senior aide referred to as two of Senate Democrats’ key ideas for improving Obamacare: reforms to bring down the costs of prescription drugs, and bills that would give state insurance commissioners the ability to keep rates down.

Senate Republicans’ proposed health care overhaul has proven massively unpopular, with their bill polling below 20 percent and sparking dozens of protests across the country.

Can Democrats articulate a winning countervision? See what you think: Transcripts of my conversations with congressional Democrats are below.

Sen. Ed Markey (D-MA): use an individual mandate to lower costs

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Jeff Stein

There was a report today that McConnell reached out to Trump and said, “If we don’t get the votes, we’ll have to negotiate with Senate Democrats.” What main policy fixes — either to the exchanges or to health care more broadly — should be the Democrats’ top demands?

Ed Markey

You can’t package $800 billion in Medicaid cuts and package it as a tax break —

Jeff Stein

But assuming we’re in the world where this bill is killed completely … what is your first policy proposal for health care?

Ed Markey

My first proposal would be to keep the funding levels where they are for Medicaid and begin to work on ensuring that together we are trying to lower the premiums while increasing access to health care. That’s not what this discussion has been about.

Jeff Stein

How do you do that? How do you lower premiums while increasing access to health care?

Ed Markey

Well, we have to increase the number of healthy, younger people who are inside the health care system, and that will lower costs for everybody.

Jeff Stein

How do you do that? A tougher individual mandate?

Ed Markey

We would need an individual mandate to ensure that younger, healthier people are getting into the pool, and in doing that we would end up with lower costs.

Jeff Stein

So for you personally, the big thing you’d do is get more young people signed up for a tougher mandate?

Ed Markey

That’s right.

Jeff Stein

Is there anything else?

Ed Markey

Well, and keeping the funding level there.

Jeff Stein

So I’m talking about a hypothetical world in which the bill is defeated. Is there anything else policy-wise to improve the American health care system? For instance, Sen. Warner talked to me about reviving the “copper plans” on the exchanges.

Ed Markey

First, the principle thing is, we have to keep all the funding, and if they don’t agree on that, the whole thing is operating on a flawed premise.

I don’t understand [about the copper plans. Aide interjects: “He’s got to run.”]

Sen. Joe Manchin (D-WV): improve savings, efficiency in health care system

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Jeff Stein

What’s the main policy fix Democrats want to see to Obamacare, assuming Republicans move on from this bill completely?

Joe Manchin

First of all, we don’t want you to callously throw people off.

Jeff Stein

But assuming they kill this bill.

Joe Manchin

If you’re giving me the expansion, give me some instructions of how I can keep it. Of how I can live a better lifestyle. You never told me anything. For the last 20 years, I’ve been going to the emergency room. I know it’s high-cost. That’s all I have. I have no options. So if I want any type of health care, I’d go to the emergency room. Show me how to live a better-quality and healthier life.

We haven’t done anything. When we say [the bill] doesn’t have any heart and soul, if you’ve got a heart and soul and a little bit of compassion in you, let me try to help you.

Jeff Stein

But policy-wise, how would you try to fix the exchanges in a dream world where McConnell surrenders this tomorrow and everyone says, “Hey, Sen. Manchin, you’re our guy. What do you want?”

Joe Manchin

You mean in the insurance exchanges?

Jeff Stein

Yeah.

Joe Manchin

Well, the market — you’ve got to get the products on the market that match up. You can’t force a product on the market where people won’t buy it. And think you’re going to beat them over the head and make them buy it? You can’t do that. We’re a capitalist society; you can shop for anything you want. Except you never shop for health care because we never taught you to do it.

Jeff Stein

So how do you do that? Is it more generous subsidies for people? Fewer regulations?

Joe Manchin

Well, first of all, you don’t take $600 billion-plus away. You don’t cut from $600 bil —

Jeff Stein

Right, but acknowledging that and imagining they don’t do this —

Joe Manchin

How do you use it more effectively and efficiently? Can you have savings within? Absolutely. Can you have a better productive lifestyle? Can you have a better productive workforce? Absolutely.

At the rate we’re going right now with the opioid crisis, we’re going to run out of workers.

Sen. Jon Tester (D-MT): need to get “good-thinking senators” into a room

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Jeff Stein

I understand Senate Democrats’ focus right now is overwhelmingly on defending Obamacare. Assuming [Republicans] don’t come up with the votes, if they have to work with Senate Democrats, policy-wise what do you think they should do?

Jon Tester

I welcome the opportunity, and it should have been done months ago to work together to find a bill that fixes the problems with the ACA and moves it forward.

Jeff Stein

Policy-wise — how would you do that?

Jon Tester

There’s about 2 million people in the exchange … who aren’t so rich that they don’t care and don’t get paid the subsidies and the deductibles are too high.

If we focus on that group, and get some doctors and some hospital administrators and some patient groups and some good-thinking senators, we can come up with some solutions.

Jeff Stein

What would those policies be?

Jon Tester

I don’t know yet. But the truth is, we fixed it so we’re the only country in the world with a fixed-rate 30-year mortgage. It’s apples and doughnuts, but the truth is we can do that if we get the people in the room, brainstorm some ideas, and walk in there with an open mind.

Sen. Mark Warner (D-VA): reintroduce “copper plans” as a way to insure those not covered by Obamacare

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Jeff Stein

Obviously, Senate Democrats are overwhelmingly focused on killing this [bill]. But if this fails and McConnell asks Schumer, “What policies do Democrats want to advance in the health care system?” — what do you say?

Mark Warner

We do have ways to shore up the individual market and lower premiums. I’m just speaking for myself, but I think there is a legitimate way to ensure consumer protections but sell insurance across state lines for more competition across state lines. I’m open to that.

I’m open to actuarially cheaper opportunities. We had a plan a couple years ago. You know there’s gold, silver, bronze [plans on the exchanges]. We had a copper lower-level, cheaper plan — that was going to be one of our suggestions in a Democratic package of changes for the ACA that we worked on a few years ago.

So having some of those ideas. We have to get beyond some of these semantics of repeal. … But I think rational people can get to a way where we can get to the language where we can talk about it.

Jeff Stein

How do you see the copper plan working?

Mark Warner

It would be the option that might attract younger people to buy a health plan, but it would also have higher deductibles, so there’d be pluses and minuses. I think the country would love to see after this over-the-top debate folks from both sides sitting down and saying, “Hey, how do we actually take on the challenges on health care?” And there are a whole lot of us who would love to do that.

Jeff Stein

Are Senate Democrats at all open to capping the rate of the increases in Medicaid spending?

Mark Warner

I think that gets very challenging. I’d have some real problems with that without some more systemic reform. If you combined that with meaningful ways to bring down drug prices. If you could find some way to bring down, for example through negotiations with the companies or moving to a system that’s based more on quality than content. You could broaden the aperture.

Payment reform, drug pricing reform — then you can say you’re going to bring system [costs] down, and we can create a different inflation factor. But you have to start with things that will actually lower the costs.

Sen. Amy Klobuchar (D-MN): lower drug prices, introduce “reinsurance” plan

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Jeff Stein

There was a report today [that] McConnell told Trump they may have to work with Schumer and Senate Democrats. Assuming they drop this [bill] at some point — and recognizing that’s a big assumption and that all the Democrats’ energy will be on killing it — what do you think Democrats’ first Obamacare fix should be?

Amy Klobuchar

One of the major things I would want — and I’m not going to speak for the whole party — would be doing something on prescription drug prices. None of these bills in the House or the Senate does anything with prescription drug prices.

That includes changing the law so that for 41 million seniors, we can negotiate prices for Medicare — for lower prices, like the VA does. It includes encouraging more generics, so there can be more competition.

Jeff Stein

And drug importation from Canada?

Amy Klobuchar

Yes, that, and doing some more work on the exchanges through reinsurance and cost sharing and other things. But we’re not there yet. Phase one is that the administration can sabotage what we have on the books right now, and secondly, we have to make changes to improve it.

Jeff Stein

What would you propose for fixing the Obamacare exchanges?

Amy Klobuchar

[Democratic Sens.] Tim Kaine and Tom Carper have a bill on reinsurance, and that’s a better leveraging of risks for some of the exchanges. We have done something like that in Minnesota and Alaska, with a Republican governor, and so I think bringing that out in a national level would be a good start.

[I explained the “reinsurance” proposal on Thursday, since it is part of a proposal released by the Center for American Progress.]

Rep. Joe Crowley (D-NY): stop the assault on the Medicaid expansion

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Jeff Stein

If Senate Republicans say fuck it, this is a dumpster fire, we need to work with Democrats in Congress, what are the policies that you send over to McConnell’s office or [Paul] Ryan’s office to say, “This is what we need?”

Joe Crowley

We need to stop the assault on the Medicaid expansion, that’s for sure. It’s keeping in place the law we have right now and enhancing it — working on the individual market to shore that up.

Jeff Stein

So how do you do that?

Joe Crowley

Well, that’s the question we have to figure out. One of the things we can do [is] to help bolster those insurance markets that are failing right now where we see these premiums going up.

What’s been created by the lawsuit that was filed that the president keeps talking about is that they keep perpetuating the notion that maybe the federal government won’t be there for these insurance companies. What we know about insurance is that it requires assurance.

Jeff Stein

So how do you fix that? Is it more generous subsidies?

Joe Crowley

It’s about the subsidies; it’s about insuring in those risk corridors that those states that did not conform to the Affordable Care Act that we’re there to help bolster them.

As long as they’re under the impression that the federal government may not be there to help them, they need to know we’ll be there.

Rep. Carolyn Maloney (D-NY): “We’re just fighting to save health care”

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Jeff Stein

In a world where this bill is dead and buried — “we give up, we have to work with Schumer and Pelosi” — what should Democrats’ top demand be for proactive fixes to the health care system?

Carolyn Maloney

When we get to that point, we’ll discuss it. Right now we’re focused on trying to save bill, because the bill they put forward is very detrimental. According to the nonpartisan Congressional Budget Office, it would remove health care for 22 million people, it would raise premiums, particularly for older people, and is particularly dangerous for women.

They’re not coming to the table and say[ing], “Work with us.” We’re willing to go to the table and work with them.

Jeff Stein

But when that happens, what will the policies be?

Carolyn Maloney

When that happens, we’ll put our policies forward.

Jeff Stein

Do you think it’s important for Democrats to have a proactive health care agenda now?

Carolyn Maloney

Well, the only proactive agenda we could have right now is working with the Republicans. And they haven’t said, “Come and sit down and we’ll talk about it.”

Jeff Stein

The argument you hear from the left is that it’s important for Democrats to have a proactive agenda for health care too. And there are 30 million people who still don’t have health insurance, and people have seen their premiums increase by more than 100 percent.

Carolyn Maloney

We’re in the minority. Guess what? We’re just fighting to save health care. They’re repealing it; they’re repealing it. So right now people know where we stand — we passed the Affordable Care Act, and we’re supporting it. And we’re fighting for its existence.

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