mcconnell
McConnell: Repeal, replace not successful
02:17 - Source: CNN

Editor’s Note: Errol Louis is the host of “Inside City Hall,” a nightly political show on NY1, a New York all-news channel. The opinions expressed in this commentary are his own.

Story highlights

Errol Louis: Collapse of health care bill could be an opportunity for compromise

The hurdle will be overcoming the partisan politics that dominate the Senate

CNN  — 

It turns out that Senate Majority Leader Mitch McConnell, one of the shrewdest legislative mechanics on Capitol Hill, can’t round up enough of his fellow Republicans to repeal and replace Obamacare on a straight party-line vote.

That might mean that full repeal won’t happen, despite GOP promises that it will. But it also opens up the possibility of a compromise with Democrats that the Republicans should seriously consider.

Our complex, expensive health care system has plenty of room for reforms that members of both parties could, in theory, support.

Here are some ideas that might allow both sides to declare a partial victory.

Some Republican leaders – notably President Donald Trump in his joint address to Congress given earlier this year – have called for health insurance companies to be allowed to sell policies across state lines. It’s not entirely clear that interstate competition would lower premium prices. As one conservative scholar has suggested, “No one should be under the illusion you can dramatically lower the cost of insurance in Los Angeles if you buy an Arkansas policy.”

But allowing more competition would let free-market conservatives boast about increasing individual choice while dialing back government regulation. Across the aisle, interstate insurance would also give Democrats an answer to critics who point out that Obamacare has led to insurance companies abandoning local markets.

Another area ripe for deal making is the cost of prescription drugs, which have remained high thanks to a political decision by Democrats in 2009 to exempt the pharmaceutical industry from the kinds of sweeping mandates imposed elsewhere in the health care system. At the time, the Obama administration and congressional Democrats made a deal: drugmakers would not oppose Obamacare, and in exchange the final package did not put limits on drug prices, which have continued rising for nearly a decade.

A re-examination of the question could yield surprisingly bipartisan agreement. Allowing groups of Americans – or the government itself, through the Medicare program – to negotiate reduced drug prices would be wildly popular, especially with seniors who benefit from Medicare. And earlier this year, a related bill that would allow the importation of cheaper Canadian drugs – a bill introduced by none other than Sen. Bernie Sanders – even got 12 Republican votes.

A third area of common ground is a reduction or repeal of the so-called Cadillac tax, a special levy on insurance plans that provide comprehensive, top-level benefits. Many labor unions offer such plans, and are up in arms over a tax that could increase the cost of insurance by a whopping 40% in a few years. Anti-tax Republicans and union-backed Democrats can probably find agreement on the need to dial back the tax.

Now while there’s a great deal of potential for agreement on substance, the real challenge for the Senate is the politics.

Even before the defections that doomed the latest bill, McConnell signaled he’s ready to cut a deal with Democrats. But even mild gestures in the direction of compromise drew a furious response from influential conservative groups like Heritage Action for America, which warned: “If the Republican Party wants to work with Democrats to bail out Obamacare, the results will be catastrophic for the party. For seven years it has pledged it is the party of repeal and now is the time to work toward that goal.”

Follow CNN Opinion

  • Join us on Twitter and Facebook

    That kind of apocalyptic drawing of lines in the sand is exactly why the GOP is now stuck in a rut. If McConnell hopes to salvage some combination of reform, repeal or replacement of Obamacare, he’ll need to tell everyone – the President, the public and the party’s conservative base – that when it comes to changing the regulations that cover almost one-sixth of the economy – compromise is a necessity, not an option.