Now that the Coburn-Burr-Hatch health care proposal is on the table, it's safe to say that the GOP has finally started inching away from its obsession with repealing Obamacare and leaving only a smoking husk in its place. Even if CBH goes nowhere, it's a sign that at least some Republicans are starting to grapple with the reality that their only option now is to offer up an alternative that's based on reforming Obamacare, not killing it outright.
So what options are realistically on the table? Andrew Sprung talked with a couple of moderate liberals and one moderate conservative to see how much common ground there might be around a proposal that uses Obamacare as a base but makes substantial changes to it. Here is Yevgeniy Feyman of the Manhattan Institute, our designated conservative:
Feyman enthusiastically embraces CBH as a vehicle for more thoroughgoing reform. Paradoxically, he sees the possibilities for conservative redesign widening, not because supporters of the ACA have been weakened, but because the Tea Party has. The CBH rollout signals that some Republicans at least are ready to deal.
"We've seen the hardliners lose a good deal of influence since the shutdown," Feyman said. "If they don't gain more seats and influence, I imagine that a bill like this could pass." Feyman is most excited by the prospect of maintaining subsidies for private insurance but ending the state exchanges' monopoly of subsidized plans...."In the employer market," Feyman said, "exchanges are doing a great job directing employees into best locations for care," providing cost and quality information and incentives to chose the cheapest and best. He would like to see states encourage private exchanges in the individual market, and innovate in other ways, such as providing services that help consumers track their spending or set up HSAs.
The whole piece is longish, but worth a read if you want to dive into the details of possible Obamacare compromises. In my mind, the big question that underlies this is: Why should Democrats even think about making a deal? After all, Obamacare is safe at least through 2016, and almost certainly longer. Even in the unlikely event of a Republican sweep in 2016, they'd still have to deal with two things: Democratic filibusters in the Senate and enormous institutional resistance to changing a program that's been in place for years. Nobody in the health care industry is going to support big changes after spending half a decade massively modifying their businesses to comply with Obamacare.
The answer, probably, is twofold. First, a compromise would represent a peace of sorts and would truly solidify Obamacare's survival. Second, Democrats might get some things they want. Donald Taylor, for example, wants to see Obamacare and Medicaid expansion accepted in the South:
For Taylor, a lifelong southerner, the imperative to expand health insurance access in the South is personal...."If I were to argue for negotiation from a pro-ACA perspective," Taylor said, "I'd be most worried about the uneven rollout, with the South left out. I'd look to come up with some way to make the South willing to expand insurance coverage."
...."Medicaid expansion is not that consequential in California or Massachusetts [where eligibility was already extensive pre-ACA], but in North Carolina, you could cover a half million people in a year, and that's a huge change. You can leverage $4.1 billion in federal money in 2016 alone. It's painful to watch that deal go begging."
I'm not especially optimistic about any of this happening anytime soon. Or even anytime not so soon. On the Republican side there's just too much tea party energy dedicated to the idea that any compromise is a sellout, and on the Democratic side it's hard to imagine a compromise deal that would provide enough benefits to make up for Republican demands. But it's not completely out of the question. If you read Sprung's piece you'll know enough to make up your own mind.