Editor's note: This article is part of a multi-page special report, 8 Ways to Fix the Affordable Care Act.
In the 7 years after it was passed in October 2009, the House of Representatives voted more than 50 times to repeal or amend the Affordable Care Act. As the count climbed toward 40, the editors at FierceHealthcare began to debate whether we should continue to write about each and every House effort, knowing that no bill would ever pass the Senate, let alone get by then-President Barack Obama’s veto pen.
This year, the GOP—with majorities in the House and the Senate and a Republican in the White House—came closer to repeal (or at least “skinny repeal”) than ever before. But they still haven’t managed to repeal or replace the healthcare reform law, which has been steadily growing in popularity among voters.
Over the years, the debate shifted focus from intrusive big-government boondoggle to the right to affordable and equitable healthcare. Yet many lawmakers are reluctant to recognize that and change gears.
But here’s the thing: The Affordable Care Act really does need to be fixed. Premiums for individual insurance plans really are skyrocketing. The United States really does spend more on healthcare than other wealthy nations, yet ranks dead last on equity, access, efficiency, care delivery and healthcare costs.
The only way to reverse those trends and fix the Affordable Care Act is for Republicans and Democrats to come together and find a bipartisan solution.
Even Obama has said the healthcare reform law needs a bipartisan fix, although, at the time, Republicans panned that overture. Perhaps that attitude is changing in the wake of more failed efforts to repeal the ACA and the emergence of a group of Democratic and Republican lawmakers who’ve dubbed themselves the Problem Solvers Caucus.
Co-chaired by Rep. Tom Reed, R-N.Y., and Rep. Josh Gottheimer, D-N.J., they’ve already come up with a set of recommendations that draws on ideas from both sides of the aisle. “The last great hope for this country is that Republicans and Democrats prove they can work together,” Reed said recently.
It’s a good start, but fixing healthcare will require a dedicated, sustained effort, and that starts with two immediate steps:
Tone down the rhetoric
The right uses “Obamacare” as a pejorative, and “Trumpcare” is a dig when it comes from the left. President Donald Trump is fond of calling Democrats obstructionists and has said they have “no good ideas.”
The Democrats have become nothing but OBSTRUCTIONISTS, they have no policies or ideas. All they do is delay and complain.They own ObamaCare!— Donald J. Trump (@realDonaldTrump) June 26, 2017
And although it’s difficult to participate in debate when you’re largely barred from deliberations, Democrats could stand to be more open about the ACA’s problems and must be very clear about what policies and solutions they’re willing to back, taking steps beyond their opposition to full-on repeal.
And let’s not forget that both sides have suffered their share of marketing missteps. (Think Obama saying, “If you like your doctor, you can keep your doctor,” and Senate Majority Leader Mitch McConnell describing one version of his own party’s repeal efforts as a “pig in a poke.”)
It’s astounding that this even has to be said, but rather than crafting legislation behind closed doors and asking members to vote for it even if they do not want it to ever become law, it’s time to let the sunshine in.
Sen. Lamar Alexander, a Republican from Tennessee, has promised that the Senate Health Committee will hold bipartisan hearings on how to repair the individual insurance market, but talks need to go much further than that. And testimony should come from health insurance industry leaders and providers, including the nurses, doctors and other clinicians who are at the heart of the healthcare system. Listen to health information technology innovators, from the big-name companies to the scrappy startups that are trying to improve care quality and lower costs, and don't forget to include employers.
And take a best-practice lesson from those in the healthcare industry: Focus your discussions around caring for patients, always.
Many organizations have a patient advisory board or put patients on their boards of trustees. Some payers and providers even have rules that every meeting must include at least one patient. Patients and their advocates need a seat at the table in Washington, too.