As the U.S. Senate engaged in frenzied gavel-to-gavel combat, trying to vanquish the Affordable Care Act, a quieter effort was underway on the other end of the Capitol building. Forty-three members of the House of Representatives, split almost evenly between Republicans and Democrats, spent much of July doing something downright radical: working together to try to fix Obamacare rather than destroy it. What’s more, over tacos and beer and plenty of tough but respectful conversation, they arrived at a real plan, which they announced yesterday.
The most immediate aim of the group, which calls itself “the Problem Solvers caucus,” was to stabilize the shaky individual health insurance marketplace, said Congressman Tom Reed, a Republican from upstate New York, who co-led the effort with Congressman Josh Gottheimer, a freshman Democrat from New Jersey. The caucus plan would, first off, continue the ACA’s cost-sharing payments to insurers in order to offset the cost of covering sicker patients in the exchange plans—and avoid the market-rupturing disruption that would almost certainly be caused by their sudden removal, said Reed on a conference call yesterday afternoon. (Such a rupture, of course, is precisely what President Trump has gleefully tweetened—my portmanteau for a threat delivered in 140 characters or less—in recent days, as he slammed those payments as mere “bailouts” to the insurance companies.)
The plan also pushes some legislative liberalization. “We’ve committed to the state stability funds a significant sum of money that would allow states to innovate and put together programs to try to stabilize their own marketplaces, be it through reinsurance, high-risk pools, etcetera,” said Reed. And the group has, importantly, proposed a change to the ACA’s employer mandate. In the current law, “if you have 50 employees, as you all know, you’re mandated to have health insurance. We raised that threshold to 500 employees,” Reed said. (The group backs a tweak to the rule that defines the number of hours a person needs to work in order to be guaranteed coverage as a “full-time” employee, from the current 30 hours per week to 40.)
In addition, the bipartisan caucus is supporting the elimination of an Obamacare tax on medical devices (a change Republicans have sought), encourages the cross-state sale of insurance (a provision that is already part of the ACA), and puts in place some Medicare reimbursement policies (that Democrats have wanted), particularly those that reward quality healthcare as opposed to the quantity of procedures performed.
“That’s what brought 43 members together as a block of the Problem Solvers Caucus,” said Reed, who noted that each of these provisions managed to reach consensus among at least 75% of the group—the threshold necessary to be included in the collective proposal. “We are now ready to govern and organized to get to ‘Yes,’” he said.
The Problem Solvers have been buttressed along the way by another cabal of unabashed cooperators, a nonprofit organization called No Labels, cofounded by veteran politicos Nancy Jacobson and Bill Galston, along with a dozen others. In an age when government has become so bitterly polarized, groups like No Labels (featured in Fortune last year) and the Problem Solvers are practically antiestablishment.
And more essential than ever. “When you’re in the middle and getting beaten up by both sides, it’s good to know there are people who have got your back,” said first-termer Gottheimer. “I just want to praise all my colleagues who put a lot of political capital on the line and who are going to get beaten up by people because of it. I tell you, my phone has been ringing off the hook today by as many people who want to complain about different aspects of this as by people who say, ‘Good job.’”
Indeed, that’s what makes the Problem Solvers’ proposal worth celebrating, said No Labels cofounder Galston on the same call. “It’s worth backing away from the details [of the proposal] and just making a large, obvious point: It has been a very long time since a group of Democrats and Republicans, who have to answer to their respective electorates, have been able to sit down and reason together and come to a consensus on significant issues regarding healthcare. So we can argue about particular details, but I think the significance of the overall moment is beyond question.”
This essay appears in today’s edition of the Fortune Brainstorm Health Daily. Get it delivered straight to your inbox.
