Why Senator Tim Kaine Is Optimistic About the ACA

Senator Tim Kaine, D-Virginia, is feeling surprisingly optimistic about the future of healthcare reform in the United States.

During a plenary session at the AcademyHealth National Health Policy Conference, Kaine discussed the Affordable Care Act (ACA) and efforts to replace it or at least change it. On January 3, when the 115th Congress convened for its first day, Kaine felt odds were very high for an ACA repeal. At that point, it seemed like there would be a repeal with a delayed implementation date and a replacement coming 2 or 3 years down the line.

“I thought the idea was ridiculous,” for a number of reasons, he said. “The idea of repeal and replace later is like ‘jump off of a cliff and figure out how to land when you’re in mid-air.’”

But the most important reason why it was unacceptable was because it would promote great uncertainty. Healthcare coverage isn’t just something for when a person gets sick, he explained, it’s also there when people are healthy and worry about getting sick or something happening to their children. Healthcare coverage is peace of mind.

The uncertainty of a repeal and replace later strategy would also extend to hospitals looking to expand business and the country’s economy in general.

“Healthcare is one-sixth of the economy,” Kaine said. “You can’t inject uncertainty into one-sixth of the national economy without having spillover consequences on other things. Just like you can’t do immigration orders targeting certain people without affecting the technology industry.”

In just a few weeks, the approach to repeal and replace has changed. Republicans have come around to supporting repeal and replace simultaneously, which they understand means having a plan for replacement ready. According to Kaine, wiser heads have prevailed and understand there can’t be a “big question mark” hanging over the healthcare industry for years.

Recently, Republicans have proposed 2 replacement plans, but it is important to get more ideas on the table. At the beginning of the 115th Congress, Kaine and 13 other Democrat senators signed a letter explaining that if Republicans want to replace the ACA and they have ideas of how to better provide care, the Democrats would be happy to sit down and discuss them.

“You can call it a replacement; we’ll call it a reform,” he said. “Or a repair or an improvement. I don’t care what any of us call it.”

However, the Democrats made it clear: if Republicans push for repeal and create chaos in the marketplace without an adequate or any replacement, Democrats won’t be willing to sit at the table and help come up with a way to fix the situation.

To avoid that situation, Republicans and Democrats need to get into the same room with stakeholders and just listen to providers, patients, small business owners, individuals on the exchanges, and representatives from pharmaceutical, insurance, and biomedical companies. And he thinks it’s possible that Democrats and Republicans will come to an agreement and find a solution.

Recently, he spoke with former President Barack Obama, who wanted Kaine’s take on ACA replacement. Kaine told him that in a way, “we’ve already kind of won.” Republicans are pushing for a repeal but promising that no one will lose coverage, no one’s costs will go up, and quality of insurance won’t go down.

Kaine’s sense of optimism stems from the idea that improvements can be made and both parties will embrace together. When he entered the Senate 4 years ago, Democrats wouldn’t entertain the idea of improving the ACA because they thought it would be admitting that the law wasn’t perfect, and Republicans would only consider repealing it or letting it fail on its own. But now, Democrats are happy to make improvements, and Republicans understand they can’t just pull coverage away from the 20 million people who now have insurance.

“I think society has decided, ‘We may hate Obamacare, but we’re sure not going backwards,’” he said.