Health care fixes scramble political divide in Washington

Washington – Six months after U.S. Rep. Angie Craig made health care the central focus of her successful campaign to unseat a Republican incumbent, her first major bill is based on an idea championed by Minnesota Republicans.

Seeking to reduce the cost of health insurance, the centrist Democrat proposed a $10 billion annual infusion of federal money to insurance companies to offset premium hikes driven by coverage for high-cost patients. Minnesota is currently one of a handful of states that already employs this tactic. Craig wants to take it national.

"This is widely accepted as a way to stabilize the individual marketplace," Craig said in an interview. She called federal reinsurance "one piece of the puzzle. It's not the whole solution, but we can't wait for the perfect solution. My constituents need relief for their premiums now."

Craig's push reflects the prolonged partisan standoff over the Affordable Care Act (ACA), the Obama-era health care law that President Donald Trump and his Republican allies in Congress are committed to repealing. Without the needed votes, even from Republicans, the law remains in place, but under legal threat from the administration and a coalition of GOP-led states.

Meanwhile, Republican efforts to formulate replacement legislation that can win broad political support remain on hold. That has left lawmakers in both parties looking for more incremental ways to tame rising premiums and deductibles, scrambling the politics of health care for lawmakers from Minnesota and across the country.

Craig's legislation cleared a House committee last week, and House Democratic leaders are planning to incorporate it into a larger package of fixes to the ACA. While that's a win for a freshman member of Congress, the bill's prospects of becoming law remain perilous: Most Republicans in Washington continue to oppose any efforts to fix the existing law.

"Such efforts are not a response to the underlying problems of the law that fuel these increased costs," read a March report by the Heritage Foundation, an influential conservative think tank in Washington. "They are merely a patch that masks the real problem."

Next year's elections could similarly pivot around health care. The Trump administration is backing a recent Texas judge's ruling, now under appeal, that struck down the ACA in its entirety.

"I was shocked and dismayed that the president once again seemingly wants to strip millions of people of their health coverage," Phillips said. "What we should be doing is redoubling our efforts to make health care more affordable and to expand coverage."

Trump recently declared that Congress should wait until after the 2020 elections to pass a replacement for the ACA, betting that he will be re-elected and that Republicans will hold the Senate and retake the House majority.

For some Republican lawmakers, that's a long bet. Another Minnesota freshman, Republican Rep. Pete Stauber, wants the ACA replaced — but, he said, not until a new health care law can be put in place, one that retains some of the ACA's more popular provisions. Last week, Stauber was one of only eight House Republicans who voted for a Democratic resolution in the House that criticized the administration's legal efforts to kill the current health care law.

"When we have a plan that replaces it and that's bipartisan, I look forward to supporting that type of legislation," said Stauber, who last year captured a northeastern Minnesota district long dominated by Democrats. He stressed that he would unequivocally oppose any legislation that strips the ACA's guarantee of coverage for people with pre-existing medical conditions.

Minnesota's other new House Republican, Rep. Jim Hagedorn of southern Minnesota, was more in line with fellow congressional Republicans in his criticism of Democratic proposals.

"Democrats' political show vote this week did absolutely nothing to address the health care concerns facing the American people," Hagedorn wrote on Facebook. He said his constituents "are ready for real solutions that place downward pressure on cost and expand access to care."

Those values — reducing treatment costs, expanding access, helping Americans avoid financial ruin brought on by medical bills — are frequently expressed by politicians from both sides of the aisle. But the partisan grudges that have accrued around health care at times appear insurmountable.

"Right now, if a proposition is issued from the left or the right, the other side feels like they have to object to it," Phillips said.

Craig's reinsurance bill is a good example. In Minnesota, Republican legislators championed the law in 2017; former Gov. Mark Dayton frequently expressed reservations, but ultimately signed it into law. Minnesota Republicans still are fighting to preserve the system statewide. But in Washington, Craig has yet to find a single Republican cosponsor for her legislation.

"I want to pass legislation that actually helps us drive down costs," he said.

Since reinsurance became law in Minnesota, the system has been credited with reducing insurance rates by 20 percent for some 160,000 Minnesotans who purchase off the individual market. Dayton's successor, Democratic Gov. Tim Walz, wants to direct the money now spent on reinsurance to other health programs. He's offered a 20 percent rebate to individual market customers who don't qualify for federal tax credits.

But if Craig's proposal were to become law, Minnesota insurance customers could continue to benefit from downward pressure on their premiums from reinsurance, and the state could then redirect the money now spent on the program to other costs. A spokesman said Walz supports Craig's measure.

"It makes absolutely no sense that we can't all sit in a room together and figure out what we're going to do to make health care more affordable for folks," Craig said. "If it has to wait until after another election, it means we're thinking of politics more than we're thinking of people."