Aug 26, 2022
By Kathleen Stoll

I really liked David Fryson’s recent op-ed in the Gazette-Mail. He thanks Sen. Joe Manchin, D- W.Va., for his support of the Inflation Reduction Act and yet still notes that the act could included more to help lower-income working families.

I don’t like everything in the act. I would have liked to see additional provisions included. To pass legislation requires give and take among many competing interests. Do I need to like everything in the act to be ready to thank Manchin? No. Rather, I can list the items for which I am grateful. And, at the same time, I can critique what I don’t like without negating my sincere thanks to our senator, who could have just said no.

So, thank you, Sen. Manchin, for the act’s many provisions that help West Virginia families. The act will reduce prescription drug costs for 317,000 West Virginians with Medicare Part D and caps insulin copays at $35 a month. The act will lower the cost of health insurance for tens of thousands of West Virginians, with savings of more than $10,000 a year for many older people who don’t have health coverage through a job and are not yet eligible for Medicare. And the act permanently extends coal miners’ black lung benefits.

Here’s why I think this approach is so important. Over the past few years, politics has become extreme — extreme in the sense that you are either 100% with me or 100% against me. While policy can be deeply personal and emotional, nothing is gained by Super Gluing “friend” or “foe” labels on the other side in a policy debate. For democracy to function, diverse opinions must be expressed and respected. It it is essential that any policy decisionmakers — and those of us who try to influence them — work together on issues and solutions on which we we can agree, while we “agree to disagree” on others.

Sometimes foes also are allies. Here’s an illustration. A diverse national coalition of health stakeholders began meeting in 2007 to define what successful health reform could look like after the defeat of the effort during the Clinton presidency. At this roundtable were major health care provider associations, key labor-union groups, pharmaceutical industry leaders, health insurance companies and patient/consumer organizations.

Meetings were frequent and good food was served (always important). Initially, structured conversation was professionally facilitated. But it didn’t take long for this table of strong personalities to override even the best facilitation techniques.

Yet, the resulting dialogue did not disintegrate into ugliness. Rather, disagreement was strongly expressed — and, often, a bit heated — yet, at the lunch break, everyone engaged in friendly banter about raising kids and vacation plans. People were able to strongly disagree yet continue discussion and remain civil.

This strange-bedfellow group outlined the basic proposal that became the Affordable Care Act. The consumer advocates made it clear that they could support a health reform package only if it expanded the eligibility for the state-federal Medicaid public health insurance program to 100% of the federal poverty level (with states receiving higher federal matching money). For us, Medicaid’s affordability protections were critical for low-income people.

When the topic of Medicaid expansion came up, the pharmaceutical industry folks at the table said, “Why 100%? Shouldn’t it be expanded to a higher level — we would support 150% or 200%.” It took a few seconds for the consumer advocates to realize that not only had the pharmaceutical folks stepped up as our allies, but they were asking for more than we were. Sure, they had their own reasons, but that didn’t negate the value of their support.

Consumer advocates and the pharmaceutical industry reps worked together to keep the Medicaid expansion in the proposal we were developing. That alliance was critical, as others at the table were opposed to any Medicaid expansion and wanted a strictly private market approach.

Clearly, the consumer reps and the pharmaceutical folks didn’t agree on a lot of other issues. In fact, a big push for Medicare prescription drug negotiation had begun at that same time. I authored a media report that documented the incredibly high levels of compensation paid to pharmaceutical CEOs.

Some of those CEOs were at the health reform table. I remember one of those CEOs coming across the room with my report in his hand. I cringed. He laughed and said, “I would have picked up the tab for lunches without this report — if you had just asked me first.” That roundtable agreed to not agree about Medicare prescription drug price negotiation. And pharmaceutical companies continued proactively supporting the Medicaid expansion.

Today, 190,000 West Virginians benefit from the Affordable Care Act’s Medicaid expansion provisions.

I don’t know if that kind of civility — and the ability to agree on one issue while agreeing to disagree on others — still exists in Congress. As Fryson wisely pointed out, “Governing is difficult under normal circumstances, much less under the current hyper-politicized environment. The give and take of making law, likened by Otto Van Bismark in the 19th century to the distasteful process of making sausage, will always demand a level of compromise that is seldom pretty.”

I love making good sausage. And I believe that the art of give and take, of finding compromise and common ground, of agreeing to disagree and yet still working together on what we can agree on is a beautiful thing.

While hard to find in Washington right now, I believe that civility can survive under many state capitol domes. I hope that this is true in Charleston over the next couple of years. There is no question that tough, emotional issues — the abortion issue at the top of the list — will challenge us all to preserve civility and still work together on many other areas of policy common ground.

Kathleen Stoll is policy director for West Virginians for Affordable Health Care (wvahc.org) and operates a policy and economic consulting business, Kat Consulting.