EDITORIAL: Path to health care reform is bipartisan compromise

Sept. 24--The third time apparently is not the charm for Senate Republicans in Congress.

At least three times this year, GOP senators have proposed a way to repeal and replace the Affordable Care Act. The first two failed and the third one -- which was being heavily pushed last week -- appeared to be on the road to defeat after Sen. John McCain, R-Arizona, announced Friday that he "cannot in good conscience" vote for the bill.

Sen. Rand Paul, R-Kentucky, had already said he wasn't going to, and it was widely expected that Sen. Susan Collins, R-Maine, also would not support the bill; on Friday the Portland Press Herald reported Collins said she was "leaning against the bill." Republicans can only afford to lose two votes.

Even if the Senate passed the measure, it would face an uphill battle in the House, which Politico reported would have to approve the measure with no changes due to the rules under which the Senate is considering it. House Republicans barely scraped together the votes needed to pass its version back in May, which was drastically different than anything the Senate has considered.

This latest version, proposed by Sens. Lindsey Graham, R-South Carolina, and Bill Cassidy, R-Louisiana, would repeal the structure the ACA was built around and instead give states block grants to fund health care. Among its other changes, the proposed measure would roll back the Medicaid expansion that happened in 2010, and there's concern those with pre-existing conditions would again struggle to find affordable insurance.

It's hard to find support for this bill. AARP opposes it. So do the American Hospital Association, the American Medical Association and the American Cancer Society. Even insurance companies came out against it: Blue Cross Blue Shield Association and America's Health Insurance Plans both said Wednesday they were against it.

The Congressional Budget Office is still scoring it, so it's unknown how many people would be at risk of losing insurance. Other studies of the bill have painted a grim picture: AARP found that a 60-year-old earning $25,000 who wanted to keep their current coverage could see their premiums and out-of-pocket costs rise by as much as $16,174. The Brookings Institute's analysis estimated that the number of people with insurance coverage would be reduced by 21 million by 2026. That analysis did stress the estimate was "subject to considerable uncertainty."

And that is a key problem here -- uncertainty. The CBO said its analysis likely wouldn't be ready before the Senate was considering a vote, so senators wouldn't even know what they're voting for. It smacks of this vote being more about politics -- Republicans have been promising to repeal the ACA since it was signed into law back in 2010 -- than truly creating what we're still waiting for, which is a health care law that works for the majority of Americans.

What is clear is that it's likely those who would be hurt by this bill are the ones who need it most, and that members of Congress continue to ignore the path that could lead to a better health care system. The ACA is far from perfect, but there's no reason to start from scratch. Republicans could fix the existing law, and do it through bipartisan compromise -- something Democrats didn't do when they initially crafted the ACA. McCain said as much in his statement Friday: "I believe we could do better working together, Republicans and Democrats, and have not yet really tried."

No, they haven't tried. And there's time for them to do so. They can stop pretending this has to be done by the end of the month. That self-imposed deadline is important only if lawmakers are shooting for approving the bill with only Republicans voting in favor (due to previously approved measures and Senate rules, only a simple majority is needed to pass bills if action is taken by Sept. 30; after that it takes 60 votes and there are only 52 Republicans).

The could get the needed votes in October -- if they came together and crafted a measure that fixed the ACA's flaws and retained its good parts.

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