For six years, Democrats taunted Republicans for holding dozens of votes to repeal Obamacare without rallying around a legislative alternative, while Republicans saw little need to craft and vote on a plan that President Obama would kill with his veto pen.
Yet now it’s Democrats who enter the debate without a clear plan, left to defend a law that has fallen far short of its goals and was shedding insurers and failing to win over customers even before President Trump took office.
Though they say they will help solve the problems plaguing the law, Democrats have yet to settle on an alternative to the Republicans’ repeal. Some say there is no need to bother right now, while others said it would be nice to try.
“Democrats continue to say they are willing to work with Republicans to fix Obamacare. But I haven’t seen a single Democrat admit openly to what they think is wrong with Obamacare, much less give us a list of their proposed fixes,” said Robert Laszewski, a health care policy consultant in Alexandria, Virginia.
Senate Minority Leader Charles E. Schumer of New York laid out broad goals for Democrats’ participation, though their ideas have been nonstarters for Republicans, who say adding more government involvement is not the solution.
“Different people have different ideas. We didn’t lay out our exact specific plan,” Mr. Schumer told reporters. “We laid out where we want to go.”
Democrats say that until Republicans forswear any repeal, there is no point in negotiation anyway.
“If what we really want to do is mend it — not end it — the thing to do is to defeat ‘repeal’ and then let’s sit down and have a conversation as adults,” said Sen. Thomas R. Carper, Delaware Democrat.
His made the comment one day after major insurer Aetna said it was pulling out of his state next year — yet another blow to the Affordable Care Act that Democrats have promised would expand coverage, lower costs and provide more choices.
It has indeed expanded coverage to tens of millions more Americans, though it has not done much to lower health care costs, and the choices are drying up in many states.
Sen. Jeanne Shaheen, New Hampshire Democrat, said the successes shouldn’t be dismissed.
“I think we have a plan: We start with the Affordable Care Act,” said Mrs. Shaheen. “Now are there ways to improve on that and fix some of the challenges? Absolutely, and I wish the Republicans would come to the table with us so we could do that.”
Asked whether Democrats planned to write competing legislation in the meantime, Mrs. Shaheen said: “I haven’t heard anybody calling for that.”
Sen. Christopher A. Coons, Delaware Democrat, said it “would be constructive,” however, for his party to revive proposals that address some of Obamacare’s challenges. Mr. Coons co-sponsored legislation in the previous Congress to expand tax credits for small businesses hoping to provide coverage for employers.
“I do think it’s our responsibility to not just say, ‘This doesn’t work, this doesn’t work,’ but to say, ‘Here’s what we would suggest,’ so that we begin to have a constructive conversation,” Mr. Coons said.
In this Congress, Senate Democrats have filed bills designed to protect women’s health care services, drive down drug costs and introduce a government-run “public option.”
Sen. Sheldon Whitehouse of Rhode Island proposed the public option to target a core problem with the exchanges: a lack of competition. Yet his legislation has only three Democratic co-sponsors and likely would face blanket opposition from Republicans.
A Senate Democratic aide said other, unspecified proposals should be introduced in the coming weeks but argued that Mr. Trump could take steps to bolster the markets on his own by committing to critical insurer reimbursements known as cost-sharing reductions and enforcing the individual mandate requiring Americans to hold insurance or pay a tax.
Members of both parties say they would like to find a bipartisan solution to health care, but the battle lines were drawn seven years ago.
Democrats muscled the 2010 Affordable Care Act to passage without a single Republican vote. Republican leaders retaliated with dozens of repeal votes during the Obama years, knowing they would go nowhere.
That strategy caught up to them in March when Mr. Trump and House Republicans struggled to turn their campaign blueprint for repealing and replacing the Affordable Care Act into consensus legislation.
Holdouts said Obamacare’s struggles brought them around to “yes” this month, shifting the debate to the Senate, where leaders are using the same game plan to rally votes and cast Democrats as doing nothing to fix an ailing marketplace.
“We would love to have them work with us. That’s why I thought we were sent here by our constituents: to work together for the common good. But right now, they’ve just been sitting on the sidelines and doing nothing,” Sen. John Cornyn, Texas Republican, told reporters.
Strategist Jim Manley said Senate Democrats should remain focused on preventing the House-passed bill from “ever seeing the light of day.” He argues that Republicans won’t be constructive partners if Democrats exhaust themselves on specific fixes now.
“I understand the need to have something to rally around, but given the fact Republican aren’t going to negotiate, I honestly see no need to go forward with that,” said Mr. Manley, a former spokesman for Sen. Harry Reid of Nevada, who retired in January.
Democrats also say their challenge to improve an existing part of Obamacare — the health care insurance exchanges — shouldn’t be compared to the Republicans’ partisan push to end a far-reaching program that has extended coverage to 20 million.
“Make no mistake: Trumpcare would repeal the law — not replace it — taking insurance away from 24 million Americans, driving up costs including for people over age 50, slashing Medicaid, gutting protections including for Americans with pre-existing conditions, and shortening the life of the Medicare Trust Fund,” said Caroline Behringer, a spokeswoman for House Minority Leader Nancy Pelosi, California Democrat. “Americans overwhelmingly want Congress to work together to improve the current law and lower costs, not replace it with this cruel monstrosity.”
Still, some Republicans say Democrats aren’t serious about reforming the private insurance market, but rather expanding the federal role in health care.
“Their plan is socialized medicine for all,” Republican Party strategist Ford O’Connell said. “They have no incentive whatsoever to do anything. When the individual market tanks, they’ll say the Republicans were in control.”