Lamar Alexander’s preferred metaphor for the current state of the Affordable Care Act is that of a collapsing bridge. Rising premiums and fewer coverage options in many states have destabilized the law’s insurance exchanges, the veteran Republican senator argues, and Congress must step in to rescue consumers trapped in a system of dwindling and increasingly expensive health-care plans.
Most Republicans in Washington share this view, but they and Alexander differ on what to do about the bridge. Ardent conservatives and their allies in the party leadership want to level the thing right away and build a new overpass immediately—or as quickly as legislatively possible in the slow-motion ways of Congress. That’s the “repeal-and-replace” mantra that Republicans have sounded on Obamacare for nearly seven years, right up through the election of President Trump.
Alexander, however, is talking up a different approach. He wants first to repair the law—to prop it up for as long as two or three years—to protect Americans who currently rely on its provisions while lawmakers figure out how to replace it. “What do you do about a collapsing bridge? You don’t go to the edge of the bridge and argue about whose fault it was that it’s in disrepair,” he said last week near the end of a Senate hearing he convened. “You send in a rescue team and you go to work to repair it so that nobody else is hurt by it. And you start to build a new bridge, and only when that new bridge is complete and people can drive safely across it, you close the old bridge.”