Bipartisanship on health care?

If you’re not a government policy wonk, you probably won’t make it all the way through this column. It’s about health care legislation, and Iowa’s two national senators’ votes on it two weeks ago.

But before you sign off, I’ll give you the message at the end: Congress may be about to commit bipartisanship.

In my column four weeks ago, I wrote about my sympathy with Sens. Grassley and Ernst concerning health care legislation. Both were on record in favor of repealing the Affordable Care Act (Obamacare). Both had cast such a vote in 2015 during Obama’s administration.

But Iowans are deeply split on the issue, and no senator is eager to alienate a big chunk of constituents.

So both Grassley and Ernst explained that they would defer their decision on Senate versions of repeal bills until they viewed them in final form.

Because amendments could be offered on the Senate floor, that meant they might not know the final version of the final bill until a few minutes before the vote was taken. So their constituents would not have a chance to know what their senators would do in advance.

The Grassley-Ernst explanation is legitimate as well as convenient. It’s theoretically possible that some major amendment could be offered that would change the bill in a major way.

I had an instructive email exchange over a period of several days with Michael Zona in Grassley’s press department. He was patient with me and tried to provide answers to my questions. I used material he gave me in my column four weeks ago.

But part of his emails was misleading, at least to me.

On July 10, with health care legislation heating up in the Senate (it came to a head two weeks later), I asked Zona what Grassley thought of the “repeal now, replace later” proposal regarding Obamacare, among other questions.

His July 11 response on that point reads as follows: “Sen. Grassley has also said he opposes a delayed repeal to give Iowans and the insurance markets certainty.”

I was pleased to learn that information, and my July 13 column reported, “Neither senator has given support to the proposal, floated by President Trump and others, that Congress repeal Obamacare now and replace it later.”

But both Grassley and Ernst voted for that form of the bill when it came to the floor two weeks ago.

They also then voted for a partial repeal of Obamacare that week, and also for a so-called “skinny” repeal version that eliminated just a few items in Obamacare.

When I emailed Zona to ask why Grassley had voted for the delayed repeal, he wrote back that Grassley had said that “if this is the only way to get Obamacare repealed and to get a replacement done, he would vote for it.”

It is difficult for me to avoid the conclusion, given the significant differences among the three bills, that for Grassley and Ernst, their number one intention and goal all along was to get rid of Obamacare, in whatever form that effort might require and despite the number of Americans who would be deprived of health care.

All three votes failed: repeal and replace by 43-57, partial repeal by 45-55, and “skinny” repeal by 49-51.

The Congressional Budget Office (CBO) had not yet scored the particular version of “repeal and replace” that the Senate voted on, but under two previous versions, some 22 million more Americans would be deprived of health care insurance by 2026 than at present. Most of those would be Medicaid patients.

The partial repeal version would have resulted in 32 million losing health care coverage by 2026, the biggest drop among the three versions.

The “skinny” version would have cost 16 million their coverage by 2026, with premiums 20 percent higher than without that bill.

Some senators explained that their purpose in considering three different versions of the legislation was to approve something — anything — in order to get legislation to a conference committee with the House, which had previously passed its own version of Obamacare repeal.

I believe that. Had it happened, of course, whatever the conference committee came up with would require subsequent approval in exactly the same form by both the full House and full Senate, a very dicey prospect given the deep conservative-moderate split within the Republican Party.

The “skinny” version’s defeat was the third and final attempt by Senate Republican leadership.

Three Republican senators voted no, and they were sufficient to kill the bill.

One of those was Sen. John McCain of Arizona.

During Senate debate he had said that he would not vote for any form of the bill that did not follow from “regular order.” Regular order in the Senate means going through the committee hearing process, with witnesses and experts testifying before a committee, and the committee then reporting its version of the bill to the full Senate — or refusing to do so.

The Republican majority had ignored regular order in crafting its various bills.

The other two Republican Senate opponents of the skinny repeal bill were Sen. Susan Collins of Maine and Sen. Lisa Murkowski of Alaska. They opposed all three bills on substance, in addition to any other reasons they might have had.

The bottom line, after all is said and done, is that no alternative appears possible other than Republicans sitting down with Democrats to cooperate on repair and correction of the problems that now exist with Obamacare.

It’s about time.

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