Democrats Appeal for Compromise: Alter, but Don’t Gut, the Health Law

With Republican leaders pressing to dismantle the Affordable Care Act, possibly within weeks, moderate Senate Democrats reached out on Thursday to Republicans, appealing for them to slow down the repeal efforts and let lawmakers try to find acceptable, bipartisan changes to make the existing law work better.

Democrats also had new reason to hope for possible Republican defections after Speaker Paul D. Ryan of Wisconsin said that the repeal measure would cut off federal funds for Planned Parenthood. But for now, Republican leaders are holding firm. Senator Mitch McConnell of Kentucky, the majority leader, denounced the law, President Obama’s signature domestic achievement, as “a lesson to future generations about how not to legislate.”

Well before Republicans seized control of Washington, moderate Democrats and Republicans in the Senate had begun exploring ways to change the law, tempering its impacts on small business, seeking lower-cost insurance options and changing how quickly subsidies to help purchase insurance policies would phase out with rising incomes.

But those efforts were stymied by Republican leaders who had no interest in improving the health law and by Democratic leaders who saw reopening the law as a political Pandora’s box. Now, Democrats have every interest in opening that box as repeal efforts barrel forward, and they would need to peel off only a few Senate Republicans to slow the fast-track repeal movement.

A possible pressure point is the effort to end funding for Planned Parenthood in the same measure that guts the health law. Already, that has raised questions about the support of two Republicans, Senators Susan Collins of Maine and Lisa Murkowski of Alaska.

“We ought to be talking about reform,” Senator Tim Kaine of Virginia, who led the group of Democrats who reached out to Republican leaders, said on Thursday. “And if Republicans want to call it ‘replace’ and we want to call it ‘reform’ or ‘improvement’ — I don’t care what we call it.”

“There’s so much we can improve, but by pushing an immediate repeal through a partisan budget process, we won’t have the opportunity to work together to build on that common ground,” Mr. Kaine, who was the Democratic vice-presidential nominee, added.

Senate Republicans plan to muscle through a budget blueprint next week that clears the way for the repeal of major parts of the Affordable Care Act without the prospect of a Democratic filibuster. The House plans to take up the blueprint as soon as the Senate approves it.

House and Senate committees would then have until Jan. 27 to produce legislation that eviscerates a law that has extended health coverage to 20 million Americans and protected millions more from discriminatory insurance practices. But it has also been plagued by rising premiums and limited insurance company participation.

If Republicans succeed in gutting the law, they would need Democratic help to find a replacement, because the Republicans’ narrow Senate majority would surely face a filibuster of a partisan health bill. “We want their ideas,” Mr. McConnell said. “We want their input.”

But the effort to quickly undo a law that cost the Democrats so much effort and political capital could poison any chance of cooperation later this year.

Senator Chuck Schumer of New York, the Democratic leader, said on Thursday that Mr. McConnell and his colleagues have two options. One, he said, is for Republicans to devise a plan on their own to replace the health care law.

“Or don’t repeal and come talk to us about how to make some improvements,” Mr. Schumer said. “We’re willing to do that.”

For now, though, Republican leaders are in no mood to compromise. Senator John Cornyn of Texas, the No. 2 Senate Republican, dismissed the appeal from the group of Democrats as an “act of desperation.”

“The fact is the wheels have been coming off of Obamacare for a long time now,” he said, adding that he understood that the Democratic senators, “as a political matter,” feel that they need to defend the health care law.

The request for Republicans to slow down and work with them on changing the health care law came in a letter from 13 senators — 12 Democrats and an independent, Angus King of Maine.

Moderate Democrats for years have been suggesting changes in the Affordable Care Act, based in part on complaints they were hearing from constituents.

In 2014, for example, Senators Heidi Heitkamp of North Dakota and Mark Warner of Virginia, both Democrats, proposed a lower-cost, high-deductible option — a “copper plan,” to go along with bronze, silver, gold and platinum plans already available under the law. Both signed Mr. Kaine’s letter.

As a possible model for bipartisan cooperation, senators pointed to a bill signed by Mr. Obama in October 2015 that protected small and midsize businesses from increases in health insurance premiums. Senators Jeanne Shaheen, Democrat of New Hampshire, and Tim Scott, Republican of South Carolina, led efforts to pass that bill. Ms. Shaheen also signed Mr. Kaine’s letter.

White House officials said Mr. Obama did not particularly like that legislation but signed it after it won broad bipartisan support.

As Republicans moved ahead with their plans for repeal, the Planned Parenthood issue began picking up steam after Mr. Ryan said on Thursday that the health law repeal measure would cut off funds for the organization.

Such a provision could trouble moderate Senate Republicans whose votes are critical to passing repeal legislation.

“Yes, I’d have concerns,” Ms. Murkowski said. “I’ve long been a supporter of Planned Parenthood.” But Ms. Murkowski said she did not know, without seeing a bill, if cutting the funding would be enough to cause her to vote against the health care repeal.

In 2015, Ms. Collins voted against a repeal bill because it would have cut off funds for Planned Parenthood. She expressed hope on Thursday that such a provision would not be in the repeal legislation this year.

In another possible trouble spot, members of the hard-right House Freedom Caucus met on Thursday with Senator Rand Paul, Republican of Kentucky, about the budget blueprint, weighing the possibility of opposing the measure because of its increases in federal spending and debt.

The group of conservatives has a history of opposing spending measures, often against the wishes of their party’s leaders. Mr. Paul has said he will not support the budget blueprint because it would allow the government to add trillions of dollars to the federal debt in the coming decade.