Sen. Tammy Baldwin, D-Wis., attends a press conference in July highlighting the positive aspects of the Affordable Care Act.

Sen. Tammy Baldwin, D-Wis., attends a press conference in July highlighting the positive aspects of the Affordable Care Act. Andrew Harnik/AP

How Democrats Would Change Obamacare

If they keep the White House and win the Senate—and don’t have to focus their energy on blocking repeal—Democrats have some things about the Affordable Care Act they’d like to fix.

With the GOP in con­trol of both cham­bers of Con­gress, Demo­crats have spent the lat­ter part of Pres­id­ent Obama’s time in of­fice fight­ing to pre­serve his sig­na­ture policy achieve­ment—the Af­ford­able Care Act.

But with Demo­crats now po­ten­tially in po­s­i­tion to both keep the White House and cap­ture the Sen­ate in Novem­ber, the party can try to fo­cus on ways to re­form and ex­pand Obama­care, rather than just block­ing Re­pub­lic­ans from re­peal­ing it.

Demo­crats don’t think the ACA is per­fect. On their wish list are small tweaks or ad­di­tions they hope lead to more af­ford­able and uni­ver­sal cov­er­age—and they hope the GOP, which most ex­perts still fa­vor to keep the House, can move past its “re­peal and re­place” calls.

In in­ter­views, Sen­ate Demo­crats poin­ted to items like sort­ing out the “Ca­dillac tax,” build­ing on de­liv­ery-sys­tem re­forms, mak­ing sure states are af­forded flex­ib­il­ity in the law, and more. The Demo­crat­ic pres­id­en­tial front-run­ner, Hil­lary Clin­ton, has based her own health plat­form on pro­tect­ing and build­ing on the Af­ford­able Care Act. Her pro­pos­als in­clude adding a new tax cred­it to help with ex­cess­ive out-of-pock­et med­ic­al costs, cap­ping monthly pre­scrip­tion-drug costs, and al­low­ing three free sick vis­its per year, to name a few.

The Af­ford­able Care Act was the product of much polit­ic­al wrangling, passing in 2009 without a single Re­pub­lic­an vote. At least 18 times, le­gis­la­tion has been en­acted amend­ing the ACA, in­clud­ing some tech­nic­al ad­just­ments and cla­ri­fic­a­tions in the 111th Con­gress and some sub­stant­ive bi­par­tis­an al­ter­a­tions later on, ac­cord­ing to a Feb­ru­ary Con­gres­sion­al Re­search Ser­vice re­port. But the law’s con­ten­tious polit­ics don’t make changes and health care le­gis­lat­ing easy.

The ACA “was a com­plex un­der­tak­ing,” Demo­crat­ic Sen. Tammy Bald­win told Na­tion­al Journ­al, “and there were things ob­vi­ously that need per­fect­ing, need re­vis­it­ing. Even if it were per­fect, over time we would have ad­apt­a­tions we’d need to make, and so I think we would ab­so­lutely want to strengthen it.”

To bol­ster the law, Bald­win’s of­fice poin­ted to sev­er­al pieces of Demo­crat­ic le­gis­la­tion she has co­sponsored over the years: grant­ing the same fed­er­al funds to states choos­ing to ex­pand Medi­caid after 2014 as those that made the de­cision earli­er; fix­ing the “fam­ily glitch,” which keeps fam­il­ies with un­af­ford­able em­ploy­er cov­er­age from ac­cess­ing tax cred­its; and re­peal­ing the Ca­dillac tax with a sense-of-the-Sen­ate that the rev­en­ue be off­set.

“Oh, I think there’s a list,” Sen. Claire Mc­Caskill said of changes she’d like to see to the ACA. “And this is prob­ably not a hall­way con­ver­sa­tion, but there’s a list of things we could im­prove upon.”

But the Mis­souri Demo­crat began to quickly tick off a whole host of items any­way: con­tinu­ing to re­align in­cent­ives so the fo­cus for doc­tors is help­ing people stay well, and ex­amin­ing how to lower Amer­ic­ans’ health care costs while still “giv­ing them skin in the game, so that they care how much they’re spend­ing on health care.” And she poin­ted to an is­sue im­pact­ing Mis­souri and oth­er con­ser­vat­ive-lean­ing states: “work­ing with the states to provide as much flex­ib­il­ity as pos­sible so that we can ex­pand Medi­caid in those states that have stub­bornly re­fused to.  

“That is a huge prob­lem in my state,” she told Na­tion­al Journ­al. “And I know it is in dozens of oth­ers.”

She wasn’t the only mem­ber to men­tion provid­ing more flex­ib­il­ity to the states. The top Demo­crat on the Fin­ance Com­mit­tee, Sen. Ron Wyden, poin­ted to Clin­ton’s plan to build upon the Af­ford­able Care Act, which in­cludes let­ting gov­ernors pur­sue a pub­lic op­tion through flex­ib­il­it­ies offered un­der the law it­self. This could pos­sibly be done through the state in­nov­a­tion waiver—a pro­vi­sion in the ACA au­thored by Wyden that al­lows states to re­ceive per­mis­sion to waive parts of the law start­ing in 2017 (as long as cov­er­age is still af­ford­able and com­pre­hens­ive by ACA stand­ards).

And there’s been bi­par­tis­an agree­ment on re­peal­ing the Ca­dillac tax. Last Decem­ber’s om­ni­bus bill delayed the im­ple­ment­a­tion of the tax levied on pricey em­ploy­er-sponsored health cov­er­age, and a vote for re­peal passed 90 to 10 (though it was an amend­ment tacked onto the re­con­cili­ation bill, which Pres­id­ent Obama ve­toed). Many Demo­crats are in fa­vor of get­ting rid of the tax for good, sev­er­al—such as Sens. Ben Cardin and Chris Murphy—said they would want to make sure any po­ten­tial im­pact from the lost rev­en­ue is dealt with re­spons­ibly.

But however long or short the wish list of changes or ad­di­tions may be, Wyden says, if the Demo­crat­ic Party wins the White House and the Sen­ate, there’s a “threshold ques­tion” to tackle first: “Can we get bey­ond the de­bate of re­peal­ing the Af­ford­able Care Act?”

Be­cause, as Murphy put it, there’s “more to the health care sys­tem than the Af­ford­able Care Act.” The Con­necti­c­ut Demo­crat said it’s time to move on, that there’s a “next gen­er­a­tion of health care re­form” to tackle, such as ad­dress­ing high pre­scrip­tion-drug costs and re­form­ing the coun­try’s men­tal-health sys­tem.

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.