If Democratic Sen. Patty Murray and GOP Sen. Lamar Alexander are successful in reaching a bipartisan health-care agreement, it could show the U.S. that Congress is capable of fixing problems.
During her re-election campaign last fall, Sen. Patty Murray promised repeatedly to work with Republicans to break gridlock in Congress. That promise was quickly put to a stiff test after the presidential election by the partisan chasm on health care.
President Trump and the GOP pushed to repeal Obamacare, and Murray’s conciliatory campaign prose turned combative. At times, Murray, who has a record of bipartisan deal-making, sounded like a partisan warrior.
“A message to Senate Republicans: stop sabotaging the health care system in ways that raise families’ costs and create uncertainty,’’ she wrote in a Facebook post in July. “And drop Trumpcare and the partisan, political effort to repeal the Affordable Care Act. Families nationwide have rejected Trumpcare — and that couldn’t be clearer.”
Now, after months of lobbing salvos at Trump, Murray has pivoted back to deal-making mode as she works with Republican colleagues on a long-shot effort to stabilize premiums in the individual markets where about 18 million Americans buy their health insurance.
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It’s a small bite out of the big problems surrounding health care in the United States, but one that, if successful, can show the country that Congress is still capable of fixing problems. Given the short time frame and the fact there has never been a major bipartisan bill to revamp Obamacare, success could remain elusive.
Murray’s dance partner this go-round is Sen. Lamar Alexander, the Tennessee Republican with whom she successfully worked to revamp George W. Bush’s troubled No Child Left Behind law in 2015.
She and Alexander, who chairs the Senate Committee on Health, Education, Labor and Pensions, are in the midst of hearings focused on quickly bringing stability to the nation’s individual health-insurance markets.
During hearings last week, Alexander cited his work with Murray on No Child as evidence of the committee’s ability to find solutions to even the most thorny and controversial topics.
Despite the long odds, he was confident, he said, that they could find a solution before Sept. 27, when insurers finalize their Obamacare plans and rates with the federal government for 2018.
Thursday, Alexander burnished Murray’s reputation as a dealmaker, telling those assembled in the committee chamber, “People know the high respect I have for Sen. Murray. When she gets involved and tries to get a result, we usually get one.”
Murray, the committee’s ranking Democrat, thanked her colleague and vowed to work toward a bipartisan agreement but then criticized Trump for “sabotaging” the program by creating uncertainty around federal funding.
Trump has threatened to stop making payments that reimburse Obamacare insurers for offering lower cost-sharing options to low-income consumers. Without the federal subsidies, premiums for the individual market could rise as much as 20 percent, experts say.
The deal Murray and Alexander are working out would take the president out of the payment loop. Instead, the payments would be authorized by Congress through legislation for at least one year, possibly several if Murray gets her way.
Guaranteed reimbursement to the insurers would bring a measure of predictability to the insurance markets, helping to stave off large premium increases, proponents say.
But Congress has to get the deal done by the end of the month.
Both sides seem to agree that the only sustainable fix is a bipartisan one, especially since a majority of the public supports Obamacare.
During last week’s hearings, the outlines of an agreement were visible as witnesses chosen by both sides talked about the need to continue federal subsidies for low-income consumers, and provide states with more flexibility to manage President Barack Obama’s signature health-care program.
Sarah A. Binder, a political-science professor at George Washington University who studies Congress and stalemates, said the outline of the current discussion seems to fit a pattern of bipartisan deals that have been forged by Murray and her GOP partners on other controversial topics, including a 2013 budget agreement she forged with U.S. Rep. Paul Ryan of Wisconsin to prevent a federal government shutdown.
Binder said bipartisan deals these days have less to do with compromise or finding common ground than allowing each side to come away with something valuable.
“We have this notion in our head that a deal is just made because there’s some ideological sweet spot,’’ said Binder, a fellow at the Brookings Institution centrist think tank in Washington, D.C. “That model doesn’t really fit a Murray/Ryan deal, and it doesn’t really fit where Murray and Alexander are going.”
The agreements Murray has negotiated, Binder said, “enlarge the pie. Both sides get their most preferred outcome. They have to want it so bad that they’re willing to give the other side what they want.”
In this case, Alexander, who favored repealing Obamacare, wants flexibility for states and a one-year extension on subsidies. Murray wants the payments extended for several years while allowing states more flexibility by improving an existing provision in Obamacare that allows for that.
Those types of deals, Binder said, require trust.
“Both Alexander and Murray know each other very well,” she said. “They’ve dealt with each other, and that’s something unusual. It’s less usual in today’s Senate than it was 30 years ago. In order to make a deal, you have to know what the other side wants.”
The specter of failure also favors a deal, she said.
“Republicans understand they’re in power, and they will be blamed for the collapse of the Obamacare system,’’ Binder said. “That surely ensures cooperation on an item they hadn’t cooperated on before.”
In an interview before the hearings, Murray said both sides agree: “We have to bring stability to the market.” The uncertainty surrounding the payments, she said, is already driving higher costs to consumers.
Health insurance works by spreading the anticipated costs of care over a group of people. The larger and healthier the group, the lower the premiums tend to be. If only sick people sign up for the program, premiums are more expensive.
While Republicans might not agree that Trump is actively sabotaging the system, “They do know what he has been doing in threatening not to make the payments has raised rates,’’ Murray said.
“It’s going to be hard,’’ she said, but noted that for some Republicans, the issue of repealing and replacing Obamacare is a dead one after the Senate and the House — both controlled by the GOP — failed to produce an agreement.
Murray earned a reputation for working across the aisle when she and Ryan, now House speaker, negotiated the 2013 budget deal that headed off a government shutdown.
That deal was possible because it relied on “nonpartisan fact-finding,” familiarity among the players, their staffs and aides, mutual fear of failing, and enough space for negotiations to take place in private, according to research by the Brookings Institution’s Center for Effective Public Management.
Talking about the deal at a Fortune magazine event, Murray said, “(Ryan) needed a story about what he won, and I needed a story about what I won. Before I could do that, I had to find out what was most important to him.”
When she was working with Alexander to replace No Child Left Behind with the Every Student Succeeds Act in 2015, Democrats were a minority. Working with Alexander, a former U.S. education secretary and the son of a kindergarten teacher and a principal, Murray helped change a law that was widely viewed as failing.
“I knew we would disagree on a lot of policy,” Murray said after the compromise was approved, “but we agreed the law was broken. We had many times when we looked at each other and said, ‘We can’t do this.’ And then one would say, ‘No, we have to do this,’ and we would go back to work in our offices.”
She said the current negotiations have parallels to the budget agreement she forged with Ryan.
“I hope we can focus on areas of common ground rather than getting bogged down in ideology again that drove that Trumpcare debate. And if we can do this, I believe a bipartisan agreement on health-care reform is possible. Not easy, but possible.”