EDITORIAL: First step toward bipartisanship on health care

July 30--Mitch McConnell cautioned his Republican colleagues: If they didn't come together on a bill to repeal and replace the Affordable Care Act, they would have to work with Democrats to repair the law. Perhaps the Senate majority leader merely was trying to jolt his caucus into action. As of early Friday morning, it remained fractured, deeply so.

Three Senate Republicans sided with Democrats to defeat the last-ditch "skinny" repeal. Susan Collins of Maine and Lisa Murkowski of Alaska voiced early opposition to the direction McConnell and allies wanted to take. John McCain provided the decisive vote in dramatic fashion, holding to his earlier cudgeling of the process.

The Arizona senator also provided cover for the Rob Portmans and Shelley Moore Capitos, the legislation not close to what they desired yet needing to protect, as Bill Clinton famously put it, their "political viability." So, Republicans are more divided than the outcome of the vote suggests.

Which means there is a bipartisan majority for repair, after accounting for those in both parties camped at the extremes.

Part of why Republicans failed to advance legislation is that each version would leave additional millions of Americans without adequate health coverage or any insurance at all. In that way, they now have an obligation to help stabilize the ailing online exchanges where individuals can purchase insurance on the own.

If they do not, many will be at risk of losing their coverage.

The timing is crucial. Insurers have roughly two weeks to make final adjustments to their plans for participating, or not, in the exchanges. The Trump White House and Republican Congress would send a most helpful signal if they backed the continuation of cost-sharing reduction payments.

These subsidies assist people with the expense of deductibles and co-payments. That bolsters the confidence of insurers in the exchanges and the likelihood they will participate. If the president has sent conflicting signals, even tweeting since Friday his willingness to see the Affordable Care Act crash, Rob Portman and other Republicans have recognized the importance of the cost-sharing payments. They were part of the Senate legislation.

Recall, again, that the exchanges started as a Republican concept, as a way to extend affordable health coverage via competition in the private marketplace. The Congressional Budget Office, Standard & Poor's and other independent analysts argue the essential structure of the exchanges is sound.

What the exchanges require, in part, is a government cushion against growing pains and unintended turns. Most needed now is for the president and Republican majorities to address the uncertainty surrounding the exchanges, insurers reluctant to enter if the government won't do its part.

That begins with ensuring the cost-sharing reduction payments keep flowing, Democrats and Republicans rallying to prevent many from facing hardship.

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