Next chapter on health bill to be written

July 21--If the past is prologue, and that past includes Republican congressional failure to pass an Obamacare repeal, the next chapter might be bipartisanship.

So believes Sen. Claire McCaskill, a Missouri Democrat who says the "lopsided agitation" over the stymied repeal effort might push the U.S. Senate to a workable compromise that improves the current federal health care law.

"There is developing a consensus that we've got to get busy on fixing the problems in the individual markets," McCaskill said. "I'm hopeful that you will see bipartisan public hearings, bipartisan efforts. We're going to get this thing out of the back room."

In a conference call with Missouri reporters, the senator walked through a series of ideas that could be discussed in "regular order" committee hearings, all aimed at shoring up the ailing federal exchanges.

McCaskill mentioned:

* Extending a reinsurance program, phased out in its earlier incarnation. It was meant to subsidize the costs of insurers that enroll higher-cost individuals.

* Adding a system plan to provide free prevention coverage, having a high deductible but then activating if an individual needs catastrophic care. Such a plan is meant to attract younger people to the exchanges.

* Exploring the concept of automatic program enrollment with a provision to opt out. Such a move, McCaskill said, might draw in people not realizing how inexpensive coverage can be with the subsidies provided.

The senator said she did not necessarily endorse these plans, but that a full and open debate on them would allow lawmakers, and the American public, to determine their merit.

"There are a variety of things I'm willing to look at in order to get a bipartisan compromise," McCaskill said.

McCaskill has introduced "bare counties" legislation, a measure to let individuals in counties with no participating insurers buy the same insurance plans available to members of Congress.

Republican Majority Leader Mitch McConnell pulled from the Senate calendar this week a planned vote on a procedural measure to advance a GOP-crafted health care bill. A vote to repeal the Obama-era Affordable Care Act without a replacement program has been talked about for next week.

Any vote on a health care bill gets complicated for Republicans because the 50 votes necessary for passage seemed not to be available even before Sen. John McCain, a likely "yes," had to remain in Arizona after surgery and a subsequent cancer diagnosis.

A Congressional Budget Office report Wednesday said the so-called "repeal only" bill would mean 32 million more Americans without health insurance by 2026.

On Thursday, House Minority Leader Nancy Pelosi, a California Democrat, regarded with optimism a McConnell overture to work with her party if the GOP-only efforts failed.

"Our doors have always been open, our hand always extended to work with the Republicans in a bipartisan way to improve and update the Affordable Care Act," she said. "They have to set aside repeal, abandon cuts to Medicaid that are there and abandon their huge tax breaks for the wealthy."

In her conference call Wednesday, McCaskill criticized President Trump for his remarks blaming Democrats for the failure of federal health care programs and that he would not "own" their demise.

She summoned the spirit of one of her Missouri senatorial forebears.

"Harry Truman would probably try to not-so-gently explain to him about the principle of 'The Buck Stops Here,'" McCaskill said.

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