Courier Journal

The health care roller coaster ride has left Americans feeling increasingly sick to their stomachs. It has been ugliness at every turn.

In just the past week, Sen. Ted Cruz, R-Texas, insisted on a backroom amendment to undermine insurance markets. Vice President Mike Pence was called on the carpet for stretching the truth in belittling the Medicaid program he aimed to cut in Ohio. Senate Majority Leader Mitch McConnell offered payoffs to fellow Republicans, trying to buy their loyalty for a bill that hurt their states. And to top it off, McConnell was caught red-handed by Sen. Ron Johnson, R-Wis., telling moderate Republicans not to worry about voting for Medicaid cuts because they would never actually happen.

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But the rushed deals, the untruths, the payoffs, the threats and the double-dealing were all only a precursor to President Donald Trump's response to the chaos. Apparently caught off guard, he first insisted on a vote to repeal the Affordable Care Act with no replacement, then blamed the Democrats and anyone who voted against him, and finally implied that he would both allow the ACA to fail and take no responsibility for its failure. “The Dems scream death as OCare dies!” he tweeted Wednesday, then summoned senators to the White House to pressure them with statements that couldn't withstand fact-checking.

You can't blame ordinary Americans for being exhausted by the whole ordeal.

It's time for the grown-ups in Washington to make themselves known. If we've learned anything, it's to take Trump at his word when he claims he will take vengeful action if he doesn't "win." If he can't get a health bill through Congress, he has plenty of ability to damage the Affordable Care Act through pure mismanagement. He can drive premium hikes and insurer pullouts by stopping cost-sharing payments that keep coverage affordable for low-income Americans.

Already, Trump has destabilized the markets by refusing to enforce the law, which has increased prices and reduced competition. More games are not what Americans are looking for from the president.

The ACA is far from perfect, but it is also far from broken.

Most Americans live in areas that are quite stable, and according to a new report on 2017 exchange results, insurance companies have stemmed losses and are on solid financial ground. Insurers are indicating that what they need now is enough certainty from Washington for them to be able to stay in the market, expand, and make their premiums more competitive.

If the administration refuses to provide that certainty by making cost-sharing payments, Congress should authorize the payments.

If the administration refuses to enforce the law, Congress should hold oversight hearings to hold the White House to it.

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If the administration spends its resources making propaganda videos to scare people from enrolling instead of helping Americans enroll, the General Accounting Office needs to investigate.

And if Trump's actions violate the law and cause Americans harm, he will end up in territory familiar to him — in court.

At this point in his presidency, he has well trained his opposition. Each provocative, harmful action by Trump creates an opposite and forceful reaction of anger, fear and resistance. People with disabilities and parents of medically fragile children have made it clear they can and will not surrender without a fight.

Accepting the ACA as the law of the land after all that has transpired might not be in Trump’s DNA. As a result, he is unlikely to achieve what great presidents have a knack for, reading a situation well enough to turn a loss into a win.

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Americans seem ready to see the politics of health care die down and crave the leadership that will put their concerns ahead of party loyalty.

There are some in Washington who are not mired in subterfuge and games, notably three Republican women: Sens. Susan Collins of Maine, Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska.

The strongest message is coming from a gang of governors, among them Republicans Brian Sandoval of Nevada, John Kasich of Ohio and Charlie Baker of Massachusetts, and Democrats Steve Bullock of Montana, John Bel Edwards of Louisiana and John Hickenlooper of Colorado. They are giving us a sorely needed vision of bipartisan statesmanship.

Trump and McConnell are planning yet more arm-twisting followed by another vote next week to either repeal the ACA or jam through some tragically inadequate replacement. Anything can happen. More than ever, America is looking for grown-ups in Washington to stand up, make themselves known, and move us somewhere constructive.

Andy Slavitt, a member of USA TODAY's Board of Contributors, is a former health care industry executive who was acting administrator for the Centers for Medicare and Medicaid Services from 2015 to 2017. Follow him on Twitter: @ASlavitt