It’s easy to make fun of Republican efforts to repeal, repair, replace or re-upholster the Affordable Care Act, because, if you read them in the right frame of mind, they’re pretty funny.

Related: The end of the Republican Party’s health care charade

Those poor guys want to give us cheap, plentiful health care, and low taxes, and freedom from death panels. And, probably, a pony. If they could figure out how to get UPS to deliver a pony to my door, they would be thinking up a way to get me a pony.

But, as vague and funding-challenged as the Republican ACA repair and replace proposals tend to be, at least Republicans have the excuse that, deep down, they believe, or try to get themselves to believe, that the free market is the best manager of care.

A pure free-market Republican ACA replacer bill would boil down to, “Kill the ACA, kill most of the health insurance laws other than the ones involving contract enforcement, kill most of the taxes, and let ‘er rip.”

Democrats, on the other hand, believe that government does have a role in helping to provide and administer health care for civilians.

Sen. Sheldon Whitehouse, R-R.I., has introduced a bill, S. 194, that could make some kind of government-run, “public option” health plan available through the ACA exchange system.

Rep. Peter DeFazio, D-Ore., has introduced H.Res. 130, which expresses the sentiment that it would be nice for the ACA exchange system to offer everyone access to a public insurance option.

Those appear to be the only Democratic bills in the Congress.gov bill tracking system that contain the search terms “affordable care act” or “health insurance marketplace” in the text and would have much effect on the ACA exchange system or the ACA commercial health insurance rules.

Sen. Bernie Sanders, I-Vt., has introduced single-payer health care system bills in every Congress, and maybe he will introduce a similar bill again. (Or he has already introduced such a bill, and I overlooked it.) But, in my opinion, that bill would be a single-payer health care system bill, not a bill reforming the current ACA system.

Republicans have occasionally paused long enough from carrying on about how everything about the ACA is the work of Satan to identify specific, fixable problems with the ACA exchange system and ACA commercial health insurance rules.

I’ve hardly ever seen the Democrats in Congress who participate in congressional hearings do that. They’ve complained some about website glitches here and there, and occasionally about lack of local ACA exchange plan menu options. But mostly they’ve just brought out people who said they were helped by the ACA, or people who said they’d be hurt by the end of the ACA, and that’s about it. They’ve rarely shown any evidence that they know anything about how the ACA works.

Of course, they may have avoided looking too hard at ACA rules and programs because they believed Republicans would block all efforts to improve the system, and they might have been right. But it’s striking that, even now, I don’t really have any centrist Democratic proposals for improving the ACA exchange system in anyway.

Insurers, actuaries, brokers and Sen. Bill Cassidy, R-Louisiana, and Rep. Pete Sessions, R-Texas, seem to be doing what they can to come up with ideas for improving the exchange system, and that’s about it.

Centers for Medicare & Medicaid Services employees who came in under Obama have proposed some minor HealthCare.gov fixes, and some Democrats in Congress have badmouthed even those friendly patching efforts.

Democrats let strangers take charge of diagnosing and trying to cure their unloved ACA child’s sickness, and so it looks, at least for now, as if the Democrats have lost any chance to shape that child’s care. 

Allison Bell is a senior editor at LifeHealthPro.com. 

Related:

Policymakers should eat their ACA change supper

Tennessee hints at chaos if Republicans leave the ACA in limbo

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