schumer talks to reporters.  | ap photo/bebeto matthews his strategy will be critical as gop looks to replace aca by dan goldberg 11/13/16 11:47 am est what becomes of republican plans to replace the affordable care act may well rest in the strategy laid out by new york<u+2019>s senior senator. charles schumer, almost certain to become senate minority leader in 2017, will have enormous sway over whether his caucus chooses to work with president-elect donald trump and his allies, or takes a page out of the republican playbook and obstructs for as long as possible. story continued below <u+201c>you can look back and say it was a successful strategy for republicans,<u+201d> said paul howard, a senior fellow at the manhattan institute and director of health policy. similarly, the republican triumvirate <u+2014> house speaker paul ryan, senate majority leader mitch mcconnell and trump <u+2014> will have to decide whether they want to repeat the mistake they say president barack obama and the democrats made in 2010 when they enacted the aca without a single republican vote. "the threshold question is whether republicans want to repeat history and pass whatever they can through reconciliation, or do they want to think about a replacement plan that can get 60 [senate] votes,<u+201d> said douglas holtz-eakin, a former director of the congressional budget office who served as chief economic policy adviser to sen. john mccain's 2008 presidential campaign. <u+201c>it<u+2019>s a tough needle to thread.<u+201d> the republican desire to repeal obamacare isn<u+2019>t in question. mcconnell said it is a <u+201c>pretty high item on the agenda.<u+201d> it<u+2019>s a near certainty that schumer and his caucus will oppose the repeal effort, particularly if the republicans do not have a replacement plan ready to go. republicans already are squabbling over how quickly a repeal effort should move ahead. senate democrats can filibuster any republican plan, and it is an open question as to whether the republicans can accomplish all their health care goals through reconciliation, a parliamentary move that would skirt the filibuster, and one that requires republicans and the white house to agree on a budget. the question consuming the health care sector is whether there is any replacement plan that could plausibly bring along a meaningful number of senate democrats without alienating house republicans. and even if ryan and mcconnell were to move to the center while somehow keeping their own caucuses in line, might schumer find trump and the republicans more useful as a foil than as friend, as mcconnell dealt with obama? <u+201c>is it better to let it burn?<u+201d> howard asked. <u+201c>it would give the democrats a cudgel with which to beat republicans for the next couple of years.<u+201d> for now, schumer is keeping his options open, going so far as to say he believes an obstructionist party will pay a political price in 2018, when senate democrats must defend 25 seats. about half of them are in states that voted for trump or where trump narrowly lost. (republicans will be defending just eight senate seats in 2018.) and schumer has never been opposed to amending the aca, calling, for example, for the repeal of the medical device tax. still, wholesale repeal will not sit well with most democrats, nor is it something any leader will trade on the cheap. nor are democrats likely to agree on much of what ryan has often championed, such as high-risk pools and block grants for medicaid. if schumer chooses to be a steadfast obstructionist, however, he'll face several challenges. democrats may not be able to exploit the aca's repeal as as effectively as republicans did with the law itself, said steve parente, a professor of health finance and associate dean at the carlson school of management at the university of minnesota. <u+201c>the democrats have never been that ruthlessly organized,<u+201d> he said. further, if the law is repealed, some people may see a reduction in premiums, even if benefits are reduced as well. it's the premium spikes that drive people to the polls, and if those disappear, democrats may find obstruction a rather dull instrument. if mcconnell is clever, parente said, he<u+2019>ll tell schumer that obamacare has been the gift to republicans that keeps on giving and taking the issue off the table is valuable to both sides. ryan and mcconnell could also create a medicaid block grant program that ends up insuring more people overall because it is appealing to conservative states that declined to take up medicaid expansion through the aca. that would put democrats in the position of opposing a plan to insure more americans in the poorest parts of the country. alternatively mcconnell and ryan could call schumer<u+2019>s bluff, repeal the law and tell the democrats that only a bipartisan replacement plan will be brought to the floor. <u+201c>does schumer recognize that something through ryan is better than nothing through reconciliation?" parente asked. the wild card, everyone agrees, is trump, a man who prides himself on his deal-making skills and has a long history with schumer. he may be more amenable to offering schumer and democrats liberal goodies such as infrastructure money in exchange for fixing the law. <u+201c>at the end of the day, he is a new yorker and so is schumer,<u+201d> parente said. <u+201c>they are of the same cloth. when things get rough, there could be a dinner between trump and chuck where one says <u+2018>our airports are crap, let<u+2019>s make laguardia a museum and move on.<u+2019><u+201d> last friday, trump provided obamacare proponents with a measure of hope, pulling back on the absolutism of repeal and telling the wall street journal that he<u+2019>d like to preserve the ban on insurers denying coverage to those with pre-existing conditions, also known as guaranty issue, and the ability for adult children to stay on their parents<u+2019> plan until they are 26. those provisions have always polled well, even as support for the broader law remained low. the other factor sure to influence republicans, democrats and the new president alike is how the insurance industry responds and what demands it makes of both sides in any revision of the law. <u+201c>health policy is back in a very big way,<u+201d> said karen ignagni, who helped obama pass the aca when she led ahip, the health insurance lobby. ignagni now leads emblemhealth, which offers insurance plans on the individual market, the small business market, as well as medicaid plans and an essential plan. <u+201c>insurance companies will prioritize the stability of their markets,<u+201d> ignagni said. <u+201c>there are a number of people in congress, on a bipartisan basis, who support guaranty issue,<u+201d> she said. <u+201c>the experience in the states is that without a [mandate], guaranty issue doesn<u+2019>t work.<u+201d> that dynamic makes repealing the least popular parts of the law <u+2014> mandates and taxes <u+2014> while keeping the most popular parts <u+2014> guaranteed coverage and other consumer protections <u+2014> a difficult proposition. <u+201c>we haven<u+2019>t had this scale of policy discussion in almost eight years,<u+201d> ignagni said. <u+201c>i think that for a number of years now the focus has been on the aca <u+2014> yes or no. the focus now shifts to access, affordability and quality.<u+201d> that is, to the extent that both sides see political value in having a real discussion. a free synopsis of our pro morning email about new york education policy and politics a free synopsis of our pro morning email about new york energy policy and politics a free synopsis of our pro morning email about new york health care policy and politics a free synopsis of our pro morning email about new york real estate policy and politics our morning email with must-read analysis and breaking news on state news and politics a morning email with must-read analysis and breaking news on city news and politics. a weekly round-up of legislation in city council for 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schumer at the center of coming health care fight
dan goldberg