OK Democrats, in another two months it’s going to be time to put up or shut up. We got the House over the finish line, and we did it the old fashioned way, we worked our collective ass off for it. We won like any political party does, by making promises. But this time is different, because voters believed those promises for the simple reason that a lot of the people making them weren’t lying politicians for a change.
We ran on healthcare. This was a dream issue to run on, for several reasons. For one thing, once you give people stuff, they tend to like it. It was always known that the ACA would be a slow developing program, 4 years to implement completely, with the real meat and potatoes coming in the last two years. Republicans could run against it only until it started working as intended. Once it did, people in states that had it wanted to keep it, and people in states that didn’t have it wanted it. And the GOP came off looking like schmucks.
Healthcare was the overriding political issue of 2018, no matter how badly Trump wanted it to be about barefoot brown people going us all leprosy. But you know what? 2020 is going to be all about healthcare too. And the Democrats, specifically the Democrats in the House, have the chance to hone that issue, and jam it up the Republicans ass with a telephone poll.
This doesn’t have to be like 2009 all over again. The Democrats don’t have to create some massive, intricate overhaul of the system. We already did that in 2009. The beauty of the ACA was that when it was implemented, it became an interwoven part of the healthcare system. This is why the GOP couldn’t just repeal the ACA, even the health insurance companies knew that if they did, the old system would collapse, because the structure of the system had been fundamentally changed. Hence, the GOP tinkering with the individual mandate, support payments, and junk policies only destabilized the system, making it a ripe issue for Democrats.
The Democrats don’t need to try to do everything at once, in fact that would be a mistake. The more complicated something is, the harder it is to explain, and the easier it is for the GOP to misrepresent it, we found that out the hard way in 2009, with all of that “granny death panel” nonsense. There are several things that the Democrats can do immediately, but do them one at a time. First of all, small simple things are easier to explain, and their benefits ore apparent. Second, a steady stream of bill passages on healthcare will show that the Democrats are making good on their word. And third, every parent knows that if you hide the strained peas, you can con the kid into thinking that every spoonful is the last one, making it easier to get it into their mouth.
First things first. Pass a bill that restores the original pre-existing conditions language of the ACA. The GOP will have a hard time fighting that, since so many of them swore fealty to covering those in their own campaigns. And since they’ll have a hard time fighting it, add in language that restores the original individual mandate, and makes the high risk pool safe from GOP tinkering. Restoring a healthy high risk pool for lower and middle class families to buy health insurance on the exchanges will quiet insurance companies fears of being left holding the bag on healthcare premiums.
Next, pass a bill allowing Medicare and Medicaid to negotiate directly with drug companies for lower cost prescription drugs for their patients. Big Pharma will be on their hind legs about that one, but who cares? Because, the democrats can tell them on the quiet that if they oppose the measure, the next bill to come down the pipe will be one that allows for the importation of FDA approved drugs across the border from Canada to US markets. Negotiating directly with Medicare and Medicaid at least offers the drug companies a chance to control the pricing narrative to some extent, something they would lose entirely if Canadian drug companies get a chance to flood the market with lower cost drugs.
Third, find a way to sweeten the Medicaid expansion, to make it harder for GOP controlled states to resist it. States who accepted the Medicaid expansion are singing its praises, and residents of GOP controlled states that rejected it are getting more and more tired of seeing their federal tax dollars going to other states. Not only are people who could qualify for Medicaid dying because of rok headed decisions by their Governors, but people already on Medicaid in those states are being threatened with dying because of the increasing number of small, rural hospitals being forced into bankruptcy. The Democrats flipped almost 400 state legislative seats in 2018, this issue could flip 400 more in 2020. And just in time for the 2020 census.
There are two very favorable pressure points that the Democrats can bring to bear here. The first is on the Senate. The House can pass these bills without any GOP support, putting the spotlight on the Senate. There are 22 GOP incumbents up for reelection in 2020, and they all saw what happened in the House. And in state legislatures. They also saw challengers like Josh Hawsey and Rick Scott campaign on protecting pre-existing conditions. How badly do they want to risk the ire of their own constituents in 2020?
The second pressure point is the nature of the Democratic wave in 2018. It was a badge of honor for Democratic challengers to be able to brag that they were running their campaigns with no special interest money at all. 15 GOP incumbents with “A” ratings from the NRA went down in flames. What good does insurance company or drug company campaign cash do you if it makes you a sell out to your constituents? And you can bet that every challenger in 2020 will be following the FEC campaign donation filings the way a baseball fan follows the box scores. Lobbyists of all stripes may find their jobs a whole lot harder to do in the next two years.
The beauty of this thing is that, if the Democrats manage it properly, it’s a win-win for them heading into 2020. If they get these bills passed, and Trump signs them, then it’s the Democrats who claim the glory for having broken through the gridlock of DC with their bold, new leadership on the #1 issue facing the country, and the one the most people demanded action on. And if the GOP dominated Senate blocks the measures, then the Democrats will have healthcare as their #1 issue to tun on again in 2020, and 22 brand new chew toys in the Senate to blame it on. If this familiar, it should, the Republicans have run from the same playbook for the last 8 years. Two can play at that game Mitch.
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