When the clock struck midnight last night, the United States saw something it hasn’t seen in a very long time: bipartisan consensus to make the health care system better. After first voting for another Medicare SGR patch, the Senate came back late in the evening, and with the support of Senate Majority Leader Harry Reid and Minority Leader Mitch McConnell, the Senate reconsidered its early vote for a temporary one-year patch and instead voted out the bipartisan and bicameral permanent SGR repeal and Medicare physician payment reform bill previously agreed to by the Senate and House Medicare committees. On the other side of the Capitol, Speaker John Boehner and Minority Leader Nancy Pelosi agreed to immediately enter into negotiations with the Senate on how to pay for the bill. “We blew it last week when we used a parliamentary sleight-of-hand to pass the patch” Speaker Boehner told the Washington Post. “Patients and their doctors deserve better. This time, we will do the right thing and find a way to get an agreement with the Senate on permanent SGR repeal. Yes, it will be tough, but that is why we are here, isn’t it?”
The other sea change occurred when it appeared that Republican leaders took heed of the latest Obamacare enrollment numbers and dropped their insistence on repealing the law. “Look, we can count the numbers” said one highly placed GOP strategist” in a phone call with this blogger. “Despite the debacle with the government website, it is now looking like enrollment in Obamacare’s marketplace plans may meet or exceed the original target of 7 million. All along, the GOP strategy has been based on the idea that people will vote with their feet and reject Obamacare, with a nudge from us” he continued, “but they haven’t. Total Obamacare enrollment, including the marketplace plans, young adults on their parents’ plans, and Medicaid, may fall between 13 and 16 million people this year. And it appears that more than 9 million of them were previously uninsured, and that number will grow as more sign up for Medicaid during the year. And fewer than one million of the people whose insurance was ‘canceled’ actually lost coverage. So yeah, we get it, we won’t win by kicking all of these people off Obamacare. We have our work cut out for us though in persuading our Tea Party base to let go of repeal.” On the record, Republican leaders were more muted, with Senator McConnell noting that he was hearing from large numbers of Kentucky residents who were benefiting from Obamacare, “Yes, I hear them. I still think Obamacare is a mistake—we could have helped a lot of folks with a lot less money. If it was up to me, I would start over and pass something different. But it is clear now that the law is here to stay, so I will reach out to my Democratic friends and President Obama to seek common ground on how to make it better. “
A relieved but chastened President Obama said “Make no mistake, I blew it when I told everyone they could keep their health plans. I blew it by the disastrous roll-out earlier this fall. Yet somehow, people still signed up in droves, exceeding my own downsized expectations. We can make it better though, and today I pledge to reach out to my Republican and Democratic friends in Congress to find bipartisan approaches to improve it.”
Okay, April Fools—most of the above didn’t happen. The Senate joined the House in passing a one-year SGR patch instead of permanent repeal and reform of the physician payment system. There was no agreement between the chambers to enter into negotiations on passing and paying for the bipartisan and bicameral repeal bill that was agreed to by their Medicare committees. There was no admission by congressional leaders that they made a mistake by pushing through a patch. Read ACP’s statement (this one’s for real) on the Senate vote.
There was no indication that Republicans are re-thinking their Obamacare repeal demands—if anything, they are doubling down, believing that it is their ticket to re-taking the Senate in the 2014 mid-terms. No pledge to work with the President to improve it. No new admissions of fault by President Obama and efforts to reach out to Congress to improve it.
Yet this part is true: Enrollment in the ACA marketplace plans as of last night’s “soft” open enrollment deadline was projected to near or exceed the original (pre-website debacle) target. Charles Gaba, who has had a remarkable record of accuracy in totaling up Obamacare enrollment, estimates that total ACA enrollment—qualified plans bought on the marketplace, qualified plans bought outside of the marketplace, Medicaid, and young adults on their parents’ plans—reached between 14.6 and 22.1 million people. A new study estimates that nine and a half million of them were previously uninsured and fewer than a million of those whose health plans were “cancelled” still do not have coverage that meets the law’s requirements. Yet the ACA’s critics are still in denial about the ACA enrollment surge, argues New Republic’s Jonathan Cohn.
As I wrote a month ago in my Philadelphia Inquirer blog, caution is in order in drawing conclusions too quickly on the Obamacare enrollment numbers. Yet all indications are that enrollment will be on the high side, and more than 10 million previously uninsured will get covered in 2014, a potentially remarkable achievement given all of the obstacles (ones the administration imposed on itself, like the initial failed launch, and ones created by the unrelenting opposition to the law including the efforts in many states to impede enrollment).
In that sense, today is a banner day for U.S. health care, no foolin’. Just think of how much better it could have been if only the rest of this blog were true, if Congress decided to get rid of the SGR rather than just patch it, and if Republicans and Democrats alike, Congress and the President, called a cease-fire on Obamacare repeal and worked instead to find bipartisan ways to improve it. If only.
Today’s question: what do you think about the developments over the past 24 hours on the SGR and the ACA (the true parts) and what might have been?