To a health policy watcher outside of Washington, it may look as if the Republicans in Congress have no sincere interest in making Patient Protection and Affordable Care Act (PPACA) rules and programs work better.
It may look as if the Democrats have little interest in admitting that any significant PPACA problems exist, let alone in talking candidly about ideas for fixing the problems.
Joel White, president of Horizon Government Affairs and president of the Council for Affordable Health Coverage (CAHC), said he sees things differently.
In spite of all of the talk of Republicans moving farther to the right, and Democrats moving farther to the left, White said there are still plenty of pragmatists on both sides who want to find ways to make the health care system work better.
"We work with them every day," White said.
CAHC helps health insurers, the National Association of Health Underwriters (NAHU), the U.S. Chamber of Commerce, pharmaceutical groups, and provider groups, such as the American Academy of Ophthalmology, promote their proposals for using market-based mechanisms to improve the quality of the U.S. health care system and hold down the cost of care.
CAHC has lobbied for ideas such as limiting hospital mergers, improving implementation of electronic health record (EHR) standards, and having private websites take over at least some of the functions of the PPACA private exchange system.
White, who worked on health issues on the staff of the House Ways and Means Committee from 2001 to 2007, said at least 12 PPACA changes have become law since President Obama signed the bills that created it and its sister, the Health Care and Education Reconciliation Act of 2010 (HCERA).
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This year, for example, a new measure will expand the amount of public health program data the U.S. Department of Health and Human Services (HHS) shares with private entities. Another, better-known measure has given each state the ability to decide whether the maximum size of a small group in its jurisdiction should be 50 employees or 100 employees.
"We wouldn't have gotten these two laws signed" if there weren't still pragmatists in Congress, White said.
White said some policymakers who look in public as if they have dug in their heels sound more flexible when they are talking behind closed doors.
For Democrats, he said, the wave of failures of Consumer Operated and Oriented Plan (CO-OP) carriers is one reason for soul searching. A second reason is lower-than-expected public exchange plan enrollment numbers.
