A popular idea that would prevent harm to a large number of Americans is headed for failure in Congress. Sound familiar? It should.

This time it’s stabilizing health insurance markets, but last month it was immigration reform, and sometime in between it was a meaningful response to gun violence. Each time, tribal distrust and a lack of commitment from key leaders doomed the effort.

The health care bill sponsored by Republican Sens. Susan Collins and Lamar Alexander is far from perfect. It would restore cost-sharing subsidies that help keep care affordable for lower-income people who buy health insurance on the individual market, and would make money available to states to cover extraordinary insurance claims, holding down premiums for everyone else.

But under this measure, that new funding would not be available to insurance plans that cover abortion, even if those services are not paid for with public money. That caused Democrats to walk away from the bill, and since Republicans are divided on anything that can be labeled “Obamacare,” it has little chance of passing.


It’s tempting to blame both parties for the latest stalemate, but Republicans own most of this one because they control the process.


During the Obama years, Republicans in the House and Senate would not consider incremental changes to the Affordable Care Act, because they saw it as a potent political issue. Over the past year, Republican leaders expended significant political capital unsuccessfully trying to repeal the ACA, even though it would leave tens of millions of people without coverage.

Last fall, President Trump unilaterally canceled cost-sharing subsidies, with the intention of destabilizing the health care market.

In December, without a single Democratic vote, Republicans passed a tax reform package that eliminated the penalty for people who don’t buy health insurance, even though that would likely drive the healthiest people out of the market, making premiums more expensive for everyone else in the pool.

The Republican Party should be leading the fight to fix the markets that they destabilized, but, with a few exceptions, that hasn’t been the case.


Collins took a brave stand against repeal of the ACA last summer, but she was on board with the tax bill even though she knew it would have a bad effect on health insurance markets. At the time, Senate Majority Leader Mitch McConnell promised that Collins’ proposal to offset that disruption would get a vote, but House Speaker Paul Ryan made no such commitment.

So it should be no surprise that Democrats aren’t clamoring to get on board what appears to be a doomed effort to fix self-inflicted Republican wounds, especially when it puts coverage for abortion services in doubt.

It is disheartening to see the failure of another piece of legislation that, at least in concept, is fairly popular. But that has become the standard these days.

Collins and two other Republicans were able to stop what could have been a disastrous health care bill last summer. Making positive change, however, will take a bigger commitment from the party in power.

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