海角大神

Sen. Susan Collins was 鈥渄isappointed鈥� 鈥� decorous Senate speak for really, really unhappy.聽

The Mainer is arguably the most moderate Republican in the Senate, a reliable bridge-builder across the partisan divide. She came to the floor聽on Monday聽to introduce a compromise bill co-sponsored with Sen. Bill Cassidy, a Republican doctor from Louisiana, to replace the Affordable Care Act.

But Democrats panned the bill before it got out of the starting gate 鈥� even while observers say it could point the way out of the political wilderness over what to do about Obamacare.

The compromise is unique to Republican legislation in that it allows states that want to keep Obamacare to do so. Other states could choose a more flexible approach that lets them drop the much-maligned mandate that requires individuals to purchase health insurance or pay a fine.聽

Minority leader Charles Schumer (D) of New York described the bill as an 鈥渆mpty fa莽ade鈥� that would create 鈥渃haos鈥� not care.

To Senator Collins, Senator Schumer鈥檚 response was disappointing for reasons beyond her bill 鈥� and speaks to Washington鈥檚 challenge going forward. At a time when both parties appear to be playing by hyperpartisan rules 鈥� oppose anything from the other side first, ask questions later 鈥� the space for people trying to find solutions is minuscule.

Her expectation was not that her bill would be accepted in full down to the last comma and ampersand. But negotiations have to start somewhere, and if every bill from the other side is summarily rejected, then the next few months 鈥� or years 鈥� will amount to very little.

鈥淚 guess what disappoints me most,鈥� Collins said, 鈥渋s that the Democratic leader鈥檚 response really represents what鈥檚 wrong with Washington, D.C.鈥�

鈥淚f we are going to have a leader on the other side of the aisle denounce to the press and come to the Senate floor to criticize a bill 鈥� that has not even been introduced yet, where are we?鈥� she added.

Politically appealing

The Cassidy-Collins bill is important because of the political dynamics around Obamacare.

Republicans can unite around repealing Obamacare, but they have not been able to coalesce around a plan to replace it. Democrats are doing everything they can to thwart and blame Republicans.

While Republicans can use a budgetary maneuver to easily repeal the guts of the ACA, at some point, replacement legislation is going to have to go through the Senate, where most legislation has to clear a 60-vote threshold to pass. That will necessarily involve Democratic buy-in given the GOP鈥檚 slim 52-to-48 majority.

That鈥檚 where Senators Cassidy and Collins come in.

鈥淚f you can say to a blue-state senator who鈥檚 really invested in supporting Obamacare, 鈥榊ou can keep Obamacare, but why force it upon us?鈥� we think that helps us get to 60,鈥� Cassidy told reporters on Monday.

Such a 鈥渟tate-choice鈥� strategy could work politically, says Cynthia Cox, an expert on the law鈥檚 insurance marketplaces at the Kaiser Family Foundation. 鈥淪tates that really have embraced the ACA, especially California, have shown it can work.鈥�

On the other hand, she says, states that have not embraced the law鈥檚 benefits, such as expanding Medicaid to cover more poor people, 鈥渕ay want to take one of these alternative paths the proposal offers.鈥�

In describing their bill, the Patient Freedom Act, Cassidy told reporters that allowing states to decide what they want follows a 鈥淩epublican principle鈥� and will help his colleagues accept an Obamacare option for states that want it.

The bill鈥檚 key alternative option for states would do away with individual and employer mandates and benefit requirements, and instead auto-enroll everyone who isn鈥檛 covered by employer or public healthcare in a basic package.

That package would include individual, federally funded health savings accounts, a high-deductible health plan, and a basic pharmacy benefit. People could opt out of the plan, or purchase more insurance. This alternative would enlarge the pool of covered customers, the bill鈥檚 authors explain, theoretically covering all of a state's uninsured population.

It would keep the popular parts of the Affordable Care Act, including no life-time caps on care, no prohibition of pre-existing conditions, and allowing young adults to stay on their parents鈥� insurance.

And it would reportedly be paid for with the taxes and Medicare savings that now fund the Affordable Care Act. States would also receive funding for the current law鈥檚 Medicaid expansion 鈥� even if they do not expand Medicaid.

That funding sounds 鈥渇airly generous,鈥� says Ms. Cox. But it鈥檚 also another reason why budget-hawk Republicans would oppose the plan.

Voices of opposition

Indeed, Rep. Mark Meadows of North Carolina, the leader of the hard-right Freedom Caucus, has come out against the bill, saying Obamacare needs to go entirely.

Democrats, meanwhile, won鈥檛 like the uneven standards for Americans, with consumers in ACA states having a higher level of benefits than those in non-ACA states.

鈥淵ou could be setting up a situation where you have individuals in similar situations, but in different states, who might receive different healthcare insurance coverage,鈥� says G. William Hoagland, senior vice president at the Bipartisan Policy Center.

Still, he says he sees the bill as 鈥渁 good step forward,鈥� adding that 鈥淪usan Collins鈥檚 involvement on this, particularly, is important, from a bipartisan perspective.鈥�

Schumer鈥檚 rejection of the bill should not be taken as a final no, suggests Lawrence Jacobs, a political scientist at the Humphrey School of Public Affairs at the University of Minnesota.

鈥淚 think Schumer was saying 鈥榃e鈥檙e not a cheap date,鈥� 鈥� Professor Jacobs says. The minority leader鈥檚 only leverage is to keep Republicans anxious that repeal and replace will take a long time, or won鈥檛 happen at all, he explains.

It鈥檚 unclear what strategy Republicans will eventually settle on, but Jacobs says the Cassidy-Collins bill could become the 鈥渂asis of negotiation and creativity.鈥� It has something for Democrats. It has something for Republicans. Both parties have to give up something.

鈥淐ollins may not have the last say,鈥� according to Jacobs, 鈥渂ut she鈥檚 had a very important first say.鈥�