Republicans have vowed for seven years to repeal and replace Obamacare, but in light of dire projections the drafted GOP healthcare bill would have on uninsurance rates and Medicaid cuts, a single Republican is publicly calling more strongly for an entirely different approach: Fix Obamacare rather than gut it and do so by working with Democrats.
The centrist Republican, Sen. Susan Collins from Maine, made the suggestion Monday on Twitter, after a Congressional Budget Office report projected that the bill, the Better Care Reconciliation Act, by 2016 would cut Medicaid by $772 billion and cause 22 million more people to become uninsured.
"I want to work w/ my GOP & Dem colleagues to fix the flaws in ACA. CBO analysis shows Senate bill won't do it. I will vote no on mtp," she said, meaning she would oppose the motion to proceed that would have allowed debate on the GOP healthcare draft to move forward.
Democrats have said that they are open to fixes to Obamacare, though they have said that repeal is a nonstarter for them and have focused their messaging on defending the law rather than unifying behind specific policies that would lead to improvements. On the Senate floor Wednesday, however, Senate Minority Leader Chuck Schumer, D-N.Y., called for Republicans to "start over" on healthcare and instead take a bipartisan approach.
Instead, Republicans have been working behind closed doors to make changes to Obamacare through reconciliation, which would not require any Democratic support. Senate Majority Leader Mitch McConnell, R-Ky., initially told the chamber that a vote should come before the Fourth of July recess, which began Thursday, but he postponed the vote after it became clear that it did not have enough Republican support to pass it. In recent days he has been meeting with Republicans to address their concerns and to see what changes are needed to gain their support. To pass the bill through reconciliation, he cannot lose votes from more than two members of his party.
At least nine senators oppose the bill, including Collins, who said Thursday that tinkering with the bill would be inadequate to win her support, saying an overhaul instead would be necessary. She suggested Thursday, on Maine local radio program WGAN, that a good place to start might be to look at a healthcare bill she introduced with with Sen. Bill Cassidy, R-La., which would allow states to keep Obamacare or craft their own plans.
She met Thursday with Sen. Joe Manchin, a centrist Democrat from West Virginia.
"We're ready to start working in a bipartisan way, to have everyone come together and fix what's out there and what's wrong with the Affordable Care Act," Manchin told the Washington Examiner, using the formal name for Obamacare. "I think that Susan has been very engaging and we are going to keep talking."
He suggested that other centrist Democrats would be open to proposals, citing Sens. Heidi Heitcamp of North Dakota, Claire McCaskill of Missouri, Joe Tester of Montana and Joe Donnelly of Indiana.
"The moderates have always wanted to work something out," he said.
McCaskill told the Washington Examiner that she agreed with Collins on her call for bipartisanship and confirmed that she has had private talks about healthcare with many Republicans.
"Many of them have said that Mitch is really intent on doing this just with Republican votes," she said. "But if they're willing to give up some of the tax cuts for wealthy folks and willing to leave Medicaid alone, I think there is a lot we could agree on in a bipartisan basis. Not everybody, but certainly enough to get it across the finish line."
But Sen. Patty Murray, D-Wash, expressed doubt that bipartisanship on healthcare was possible, given how Republicans have proceeded in recent months.
"They're not negotiating with us right now, so the question is kind of moot," Murray said. "We have made very clear from the very beginning that we are willing to sit down and say, 'Within the healthcare system what can we do to make costs more affordable?' Their plan doesn't do that and they're not talking to us."
Still, McConnell has told Republicans and President Trump that if they fail to pass a healthcare bill, they will have to work with Democrats to stabilize the Obamacare exchanges ahead of next year. Residents in several states are facing the prospect of having no insurer to buy tax-subsidized plans from in 2018, and middle-class customers who do not receive subsidies are facing double-digit rate increases on premiums.
Various Democrats and Republicans have said in recent months that they cannot work together on healthcare because they fundamentally disagree on the mission ahead: Repealing a law versus finding ways to repair it. As a result, Trump has called Democrats "obstructionist" and framed Republicans as the party looking to salvage a healthcare system suffering from the troubles the law faces. Democrats have blamed the Trump administration for injecting uncertainty into Obamacare's future and purposely sabotaging the exchanges.
Manchin acknowledged the difficulties Obamacare has faced, but stressed that a repeal bill would not be negotiable.
"I just want to make sure that we don't repeal it," he said. "You have enough good parts in place. Fix the ones that aren't working. The markets aren't working, we understand that there needs to be more accountability and responsibility."
Republicans and Democrats have achieved bipartisanship on Obamacare before, as part of a budget package agreement, but at the time each side used different semantics to describe the same policy outcomes. When Congress delayed the Cadillac tax on high-cost insurance plans and suspended the health insurance tax for a year, Democrats celebrated the move as an improvement to Obamacare while Republicans framed it as a dismantling of Obamacare.
As for a possible path forward on bipartisanship, it's not clear whether the bill Collins sponsored, the Patient Freedom Act, would be backed by Democrats.
Manchin said he had discussed the bill at length with Collins and Cassidy, but expressed some reservations over whether it could adequately guarantee enough help for different states. The bill allows states to keep coverage for residents through tax subsidies or expanded Medicaid under Obamacare, or to use that federal funding toward setting up similar coverage in different ways, such as through an auto-enrollment policy.
"Take a state like mine," Manchin said of West Virginia. "The bill gives a lot of options, and that's wonderful, I guess, if you have the budget and you have the legislature that would work in a responsible manner. But our state budget is upside down so bad that I can guarantee you they'll just take the path of least resistance and cut a lot of people off. They are not going to match that."
McCaskill said she had read the Patient Freedom Act.
"There are some things in it that I think are great," she said. "I think the thing we need to do now is start and build on the things we agree on and go from there in a bipartisan way. I'm hoping when we get back [from recess] that the Republicans would be willing to do that. So far they have not been willing to do that."