(Bloomberg) — Republicans in Congress have insisted the only way to fix the Affordable Care Act — Obamacare — is to repeal it. But with Barack Obama about to leave the White House, several Republicans sound willing to tweak it rather than kill it.
These Republicans suggest that a Hillary Clinton presidency could shift the debate over the ACA just enough to work on improvements with someone who isn't the law's namesake.
Rep. Scott DesJarlais, a Tennessee Republican and a doctor who has strongly backed Donald Trump, said his party would "certainly" consider a Clinton plan to revise a law he says is in a death spiral.
"She would be able to to look at what has failed," he said in an interview. "Obviously, we wouldn't be closed-minded. The bottom line is, how do we take care of people and make it affordable for them?"
Pete Sessions, a Texas Republican who runs the influential House Rules Committee, said he remains opposed to the health care law, but he also conceded that it's unlikely, for both political and financial reasons, that the law could be repealed outright.
Obama's departure, he said in an interview, will be "an opportunity to see there are other ideas, not just that there's a continual battleground."
Most Republicans still insist Obamacare must go, and a Trump presidency would all but guarantee much bigger change because he too has called for its repeal.
But faced with a Democratic president and a possible Democratic Senate, some Republicans see an opening to make the law more to their liking, particularly because the party has never coalesced around a replacement.
More than half a decade after Democrats passed the health law without any Republican votes, the ACA is showing its seams. Enrollment in coverage sold through new government-run insurance exchanges has lagged expectations. The nation's largest commercial insurer by market value, UnitedHealth Group, has joined Aetna and several smaller companies in retreating from the program. Insurers that remain complain that patients are sicker and costlier than they expected, and that provisions in the law intended to prod young people to sign up are toothless or haven't been enforced.
House Speaker Paul Ryan is still backing a six-part ACA replacer proposal. (Photo: Ryan's office)
Little consensus
Fixing the law won't be easy, as there's little consensus on what should be changed.
Many of the insurance industry's top suggestions, such as lowering premiums for young people and raising prices for older customers, are opposed by consumer advocacy groups. The possibility looms large that any legislation could become mired in the same partisan warfare that almost halted the ACA itself.
But Clinton may succeed at convincing Congress to act by virtue of not being named Obama. The tactics the president employed to pass the health law, including passage of a companion bill under procedures that prevented a Senate filibuster, enraged and alienated Republicans, preventing him from negotiating any meaningful changes later.
AshLee Strong, a spokeswoman for House Speaker Paul Ryan, a Wisconsin Republican, said that a plan to repeal and replace the Affordable Care Act — included in the six-part House Republican agenda that Ryan calls "A Better Way" — remains the party's position. But she added: "The speaker has said we're a party of ideas."
Ryan has endorsed Trump for president. Clinton, however, holds about a seven percentage-point lead on Trump in an average of national polls maintained by the Pollster.com website.
Clinton's proposals
Clinton has proposed changes to the Affordable Care Act, including more generous subsidies to offset rising premiums and a new tax credit for deductibles, co-payments and other out-of-pocket expenses, the subject of frequent complaints by patients, notes Jesse Ferguson, a spokesman for Clinton's campaign. She also supports creating a new government-run insurer, known as the "public option," to increase consumers' choices in areas where private plans have withdrawn.
In negotiations with Congress, though, Clinton would have to navigate both Republican demands that she may find unpalatable and the conflicts between insurers and consumer advocates.
"Compromise is not really that bad of a word. But to continue to simply do nothing is bad," Rep. Dennis Ross, a Florida Republican, said in an interview. "Just continuing this standoff, just leaving it alone, is going to make it worse for the American people."
