​​​​​​​Partisan health reform requires lawmakers to ‘cater to the extremes,’ experts say

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No bill is perfect, but partisan bills are more difficult to fix when that's called for, says the American Medical Association's Richard A. Deem.

WASHINGTON, D.C.—What exactly a Republican healthcare bill will look like is up in the air, but some GOP senators are looking to bridge the gap with Democrats, a move experts say could improve a reform effort’s chance for success.

Sen. Bill Cassidy, R-La., addressed the Senate’s repeal and replace efforts at a panel discussion Wednesday morning, saying that the process has been “initiated,” but “where it goes, I’m not sure.”

Cassidy and Sen. Susan Collins, R-Maine, unveiled their version of a healthcare reform bill, the Patient Freedom Act, in January, and Cassidy said he’s hoping to revive elements contained in that legislation as the Senate continues to make amendments. Cassidy is now working to reintroduce elements of that bill with Sen. Lindsey Graham, R-S.C.

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His legislation would hopefully “bridge tensions” between wings of the Republican party and also between members of Congress on both sides of the aisle, he said.

Cassidy also admitted that much of the process in the Senate has occurred behind closed doors, which doesn’t really gel with his calls to reach out to Democrats. He said he wouldn’t defend the process led by Majority Leader Mitch McConnell, R-Ky., but that he understands how Senate Republican leaders were pushed to a very partisan approach.

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He claimed Democrats did the same when crafting the ACA, so argued it was understandable that McConnell’s view on getting things done was “fatalist.” Of course, Democrats held months of hearings on the final bill and took comments from the public before voting on a motion to proceed on the ACA.

There are repercussions to creating a bill in a partisan fashion, other panelists at the event said. Alice M. Rivlin, Ph.D., senior fellow of economic students at the Brookings Institute’s Center for Health Policy, said that forces policymakers to “cater to the extremes” when crafting legislation. It’s a “mistake” for Republicans, and was a mistake in 2010 for the Democrats as well, she said.

Panelist Richard A. Deem, senior vice president of advocacy for the American Medical Association, said that a partisan approach also forces one group to own the legislation, for better or worse, making future change difficult.

“It’s easier to make adjustments when both parties own” the final product, he said, as no piece of legislation is perfect and will almost certainly require changes down the line.

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The goal of Cassidy's original bill was to give states more flexibility by allowing some to maintain the current regulations of the ACA if they choose—and provide other options for those that want to take a different path, he said. States that would prefer another option would instead cover the uninsured by offering high-deductible plans with basic pharmacy coverage and certain preventive care benefits, backed by prefunded health savings accounts.

Cassidy said that a Congressional Budget Office score on his proposed provisions is not likely before a possible vote on a healthcare reform bill of some kind this week.

Much of the negative response to the GOP’s healthcare reforms—both the Senate’s original Better Care Reconciliation Act and the House’s American Health Care Act were unpopular with industry groups and the public—has been related to people’s fear of change and not necessarily to the fact that they don’t like the Republican’s proposals, Cassidy argued.

“People do not like uncertainty,” he said.

Deem said the uncertainty around the repeal effort is worrying for his organization and others, as senators are discussing a “skinny repeal” that no one has actually seen yet. One of the key elements of the skinny proposal would be ending the ACA’s individual mandate, but if that’s done without also changing requirements to cover people with pre-existing conditions, it could greatly destabilize the individual markets, Deem said.

Richard Bankowitz, executive vice president of clinical affairs for America’s Health Insurance Plans, likened it to removing one of the legs on a three-legged stool, which would surely fall over.

“I don’t see how they come out this with a viable bill,” Rivlin said.