More than half a dozen Republican and Democratic senators have discussed alternatives to the embattled GOP healthcare bill, even as Majority Leader Mitch McConnell said he plans a vote next week to muscle the Obamacare repeal measure through the Senate.
Talks about a bipartisan fallback are based on the idea that Obamacare insurance markets have problems and would need to be fixed if the healthcare bill dies. For Democrats, it would avert a repeal of a signature achievement that they admit needs improvement. For some GOP moderates, it would be a concrete act that would help their constituents amid a maelstrom of partisan bickering.
The main ideas involve creating a reinsurance fund and authorizing cost-sharing payments for insurers so they don’t have to raise prices for covering a sicker pool of customers.
“We don’t agree with Obamacare, but recognize the fact that these markets are collapsing; insurance companies need it to provide the certainty of how they’re going to price the 2018 premiums,” said Senator Ron Johnson, a Wisconsin Republican.
Congress should "bite the bullet and stabilize those markets," Johnson said. There is substantial Republican support for that idea—the original McConnell healthcare bill included $50 billion in insurer funds to stabilize markets and reduce premiums.
Senator Lindsey Graham, a South Carolina Republican, said Tuesday he’ll release an outline of an alternative healthcare plan this week. He said he’s seeking support from governors and senators of both parties.
Senator Susan Collins, a moderate Republican from Maine, said she’s spoken with Graham many times, and also has been talking with about a half-dozen Democrats who want a compromise with Republicans.
"Anyone who has looked at the state of the individual and small-group markets across this country knows that doing nothing is not an option," Collins said.
One Democrat who said he has spoken with Collins about a bipartisan way forward is Bill Nelson of Florida. He, too, endorsed the idea of a stability fund to bolster the Obamacare marketplaces, and key Republicans said they expect to see it in a Plan B.
"I think there will be a lot of stabilization," said Senate Finance Chairman Orrin Hatch, a Utah Republican. "There will be a lot more spending, that’s for sure. And the American people are going to be ripped off a lot more than they should be. But that’s what happens what you have to go that route" of bipartisanship.
“If we don’t pass it next week, we’ve got to do something, because people are going to get hurt,” said Senator David Perdue, a Georgia Republican.
Senator Tom Carper, a Delaware Democrat and former governor, also said he’s speaking with senators in both parties and governors of a number of states about a possible bipartisan plan. He said he has approached about one-fourth of the GOP governors and one-third of the Republican senators, including Collins, Lamar Alexander of Tennessee and Bill Cassidy of Louisiana.
"Ultimately, we need to do a fair amount more than shoring up the exchanges,” Carper said.
Carper wants to hold down premium costs on the insurance exchanges. To get his support, he said, a bill would need to stabilize the exchanges to ensure "they’re not just full of sick, unhealthy people” but cover healthy people as well. A plan also needs to keep in place the requirement that individuals have insurance or something else "that is at least as effective" to get people to buy coverage, he said.
He said he wants more generous subsidies for poorer people buying insurance in the exchanges. States should be allowed to experiment with ideas that might even include a single-payer approach, Carper said.
Graham insisted he hasn’t shut the door to McConnell’s GOP-only measure, but also made clear he’s not happy with it.
"I want to do the best I can, and I think the best we can is not on the table right now," he said.
McConnell said Tuesday the Senate will move toward a healthcare vote next week, although he doesn’t plan to release a final bill until Thursday or appear to have the votes needed to pass it. He contemplated what failure would mean last week at home in Kentucky.
“If my side is unable to agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur,” McConnell said on July 6. “No action is not an alternative,” he said. “We’ve got the insurance markets imploding all over the country.”
This week, Senate Minority Leader Chuck Schumer of New York had a response: Let’s do it.
In a letter Monday cosigned by his leadership team, the New York Democrat told McConnell he appreciated his remarks and called on him to focus on “immediately advancing policies to provide stability and certainty to the health insurance markets.”
In addition to more cost-sharing funds and reinsurance, the Democrats proposed allowing Americans with no options on their local exchange to buy insurance from the District of Columbia marketplace, and phasing out the “subsidy cliff” so people earning just above 400 percent of the federal poverty level don’t lose the entire subsidy.
Some Republican senators began pushing fall-back options earlier this year when the House Republican healthcare bill appeared to be dead.
Alexander, the health committee chairman, and fellow Tennessee Senator Bob Corker have proposed keeping Obamacare but allowing Americans without insurance options in the individual market to use their subsidy to buy a state-approved policy outside their exchange.
“If things continue to unravel and there’s no solution in sight, I would hope that it would be taken up, and I think there’s a likelihood that it would pass,” Corker said in April. “It would solve a lot of problems for people across the country.”
Another problem governors are confronting is that federal matching funds for states that accepted Obamacare’s Medicaid expansion are set to automatically wind down from 95 percent in 2017 to 90 percent in 2020. That’s a problem for states that have expanded Medicaid, and Cassidy said it may “force a deal” on a fix.
“Louisiana is on the hook for $300 million every year. Ten percent of a big number is a big number,” Cassidy said. “States can’t afford all this money.”
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