The dramatic debate over the repeal and replacement of the Affordable Care Act was on full display on Capitol Hill Thursday.
House Democratic leaders and Republican Senator Rand Paul led reporters on a scavenger hunt type search for a draft health care bill being worked on by Republican leadership.
“You have a bill that's being shown to members of Congress, that's behind closed door with police protection,” said Washington State Insurance Commissioner Mike Kreidler, tracking the developments from his office in Olympia.
“You have to ask the question what are you trying to hide? If it’s a great bill, it should be able to stand on its own. And let the light of the public look at it, without being ashamed of it,” Kreidler told KING 5.
While exact details of the bill remain unknown, President Donald Trump on Tuesday laid out "guiding principles," including a talking point he's used before: the ability to buy insurance across state lines.
“That’s an idea that's been bumping around for years, well before the Affordable Care Act,” said Kreidler “Half a dozen states wound up adopting legislation to permit cross state sales; not a single state has ever been able to make it work.”
Part of the challenge comes from very different standards and provider networks from state to state, according to health policy experts.
“I use purchasing insurance across state lines as a code for just increasing competition, adding more insurance companies, adding more insurance plans,” said Dr. Roger Stark of the Washington Policy Center.
Stark favors repeal and replace, arguing the Affordable Care Act isn’t working. However, he acknowledges that the idea of buying coverage across state lines isn’t a silver bullet.
Another idea mentioned by Trump and touted by House Speaker Paul Ryan is offering tax credits and expanded health savings accounts.
“If we're truly going to drive the cost of healthcare down and maintain quality, then we've got to introduce the concept of consumerism, allowing people to use their own dollars to make healthcare decisions,” said Stark.
However, GOP lawmakers are divided over what kind of tax credit. Ryan has pushed for a refundable tax credit, but conservatives in the party believe that amounts to a new entitlement.
Democratic critics, meanwhile, including Commissioner Kreidler view the funding plan as too regressive.
“It gives the same type of tax break if you're Bill Gates or truly very low income,” he said. “It’s one that quite frankly you look at it, it would make a lot more sense if it was wage based
Heated town halls nationwide add to the complexities of the policy debate, along with fear of the unknown.
Meanwhile, insurance companies must begin setting 2018 rates in late spring. Kreidler says a tentative date is set for early May.
“They could end up breaking the system without ever passing legislation,” said Kreidler of the uncertainty. “Everybody agrees it needs some changes, but it's not one where you go in do the hard repeal."
“I think there’s enough momentum,” countered Stark of the mood among Republicans in Congress.
“It's going to get solved. There's going to be an answer, but what is the unknown is what is the timeframe going to be,” he said. “I’m not a betting man, but if you put my feet to the fire, I would think it it’s going to be 2019, 2020 when we see a full repeal.”