Should Republicans fail to pass the health-care repeal-and-replace plan they unveiled this week, some compromises might be possible to amend the Affordable Care Act, Rep. Nancy Pelosi (D) of California, the House minority leader, said at a breakfast meeting with reporters Friday hosted by The Christian Science Monitor.
Failure of the GOP plan, the American Health Care Act, is a distinct possibility, even in the House, where Republicans hold a significant majority. While House Speaker Paul Ryan (R) of Wisconsin says he’s “confident” he has the votes to pass the plan, he can afford just 21 defections, and opposition from moderate and hard-liner Republicans could sink it.
For Democrats, the battle now is still to stop repeal of the ACA, Representative Pelosi said. If the Democrats succeed, she sees three scenarios: Republicans do nothing; they go back to the drawing board; or they reach out to Democrats to fix the current law, dubbed “Obamacare.”
She called such outreach the “less likely” of the three scenarios, but said nevertheless that she would welcome it.
One of the Republican ideas that she thinks her caucus could accept would be the expansion of personal Health Savings Accounts – tax-exempt savings for medical care.
One of the features of the GOP plan is to nearly double the amount of money that consumers could save in such accounts. The Republican plan also gives consumers refundable tax credits instead of federal subsidies to help them buy health insurance.
Democrats – and independent analysts – say the savings accounts are not a workable option for the poor, and that the tax credits would be substantially less than the subsidies now provided under Obamacare.
“We’d be able to swallow, I think … some things that they may think are a good idea which we think are too costly and geared to the rich, if that’s the price to pay to do something else, depending on what else they’re willing to do.”
She implied that Democrats would push for the expansion of Medicaid to cover more people, which 31 states plus the District of Columbia have chosen to do. Medicaid is the federal-state program that covers health care for the poor.
The Supreme Court made Obamacare’s expansion of Medicaid voluntary, and the GOP plan would only allow Medicaid expansion through the end of 2019. It would also cap the federal monies available to the states for Medicaid based on a state’s Medicaid population.
Pelosi also hinted that Democrats would look for ways to help insurers weather the more risky private market exchanges set up by Obamacare.
“If they have some suggestions that improve predictability, fairness to all the participants – including insurance companies – then we have something to talk about,” she said.
Fundamentally, Democrats and Republicans disagree over the role of government in health care, reflecting the debate over the role of government that is part of the history of the country, she said.
“That’s a legitimate debate,” she said. But if Republicans say they don’t share the view that health care is a right and not a privilege, “then we don’t have much to talk about.”