On Thursday in the Orange County Convention Center in Orlando, HIMSS17 attendees were given uncommonly “insider-y” views of the national American political scene from two veteran politicians from the two main U.S. political parties, Republican John A. Boehner and Democrat Ed Rendell. Boehner, who served as a Republican congressman from Ohio’s eighth congressional district from January 1991 through October 2015, including service as Speaker of the House of Representatives from January 2011 through October 2015, and Rendell, who served as Governor of Pennsylvania from January 2003 through January 2011, met on the stage of the Valencia Ballroom on Thursday morning, for a public conversation moderated by H. Stephen Lieber, the president and CEO of HIMSS (the Chicago-based Healthcare Information & Management Systems Society), the conference’s host organization.
The conversation was very loosely structured, and while it did not result in any “bombshell revelations,” the discussion was quite frank in relation to the parameters of typical political conversations involving members of both major political parties, with Boehner and Rendell sharing fairly straightforward perceptions of the current political situation on Capitol Hill right now. And, perhaps without meaning it, Boehner left attendees with perhaps the closest to a newsy takeaway, stating pretty much without qualification that he believed that congressional Republicans’ stated intention to “repeal and replace” the Affordable Care Act (ACA) will not lead ultimately to repeal. but instead, to the “repair” that some Republicans have begun speaking of, of late.
Dissecting the past, present, and future of the ACA
After brief introductory remarks, HIMSS’s Lieber plunged straight into a broad discussion of the ACA—what had happened as that law was shaped and passed, how its current status looks in terms of potential repeal and replacement by a Congress with Republican majorities in both houses and with a Republican presidential administration, and how the legislation might look years from now. “Let’s go back to 2009-2010, and the discussion around the Affordable Care Act,” Lieber said to Boehner and Rendell. “What did the Democrats do right, what did they do wrong, what did the Republicans do right, do wrong?”
“What they did right was to make an attempt to offer affordable healthcare to all Americans,” Boehner said. “What they did wrong was to try to force people to be a part of that system who didn’t want to. And then they tried to force it through on a party-line basis. Things that are sustained are done on a bipartisan basis.”
Former House Speaker John Boehner and former Governor Ed Rendell converse with HIMSS's Steve Lieber
“I thought there were two goals” to the ACA, Rendell said: “to increase accessibility and affordability. We certainly succeeded in the first instance. Before Obamacare, there were 48 million Americans without health insurance coverage; that number went down to 28 million without health insurance” after the law’s passage in March 2010, “and we’re down to 8.2 percent uninsured now, which is the lowest ever. In terms of what he sees that could be improved, Rendell cited the need to add new innovations into the law, such as support for such innovative approaches as telehealth. “I’m the president of the board of Jefferson University Health System” in Philadelphia, he noted, “and we use telehealth throughout Pennsylvania, especially in rural areas. Many small communities have lost their primary care physicians altogether, and telehealth has done an enormous job” in terms of bridging essential gaps in medical care. The ACA, he said, “left a lot of things off the table in reducing the cost of the delivery system, he said, while immediately noting that all transformational legislation requires repeated changes and tweaks to respond to ongoing needs; he cited the original Social Security legislation as an example of this, while others have frequently noted that the original Medicare legislation has been amended in some form nearly every year since it was passed in the 1960s. “What the Republicans did was not trying to work harder to reach consensus,” Rendell added. “There was that group that started out with Sen. Grassley that I thought would be useful,” but which in the end did not cooperate with Democrats to pass the ACA as a bipartisan law. “But the remedy is easy: we should get rid of ‘Obamacare,’ and keep the Affordable Care Act!” he said, to knowing laughter from the audience.
“Take us back, though: you were in the House,” Lieber said to Boehner. “You had to have been part of some conversations, and at some point, it broke down.”
“No, no,” Boehner replied. “On the House side, we were never invited to be a part of a conversation. After it passed in the Senate on Christmas Eve, 2011, Ted Kennedy passed away, and it didn’t pass the House. And they couldn’t then change it in House and pass it again in the Senate. So they knew they had a flawed piece of legislation, but they never went back and fixed it.”
Of course, Rendell reminded Boehner, nearly all foundational federal legislation gets amended over time. “If they had opened the door,” Boehner countered, referring to congressional Democrats in the months following the ACA’s passage in March 2010, “we would have made some changes; but they had no interest in what we had to offer.”
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