There’s never been a major bipartisan Obamacare bill, and the path to passing one now — after the death of Senate Republicans’ repeal effort — is steep.
Senate HELP Chairman Lamar Alexander (R-Tenn.) and ranking Democrat Patty Murray of Washington are up against both time and history in their race to stabilize the shaky Obamacare markets and solidify their status as the chamber’s top dealmakers.
The pair has just a few weeks before a self-imposed deadline to bridge deep partisan divisions over the health care law and pass a bill by the end of September, when insurance companies make their final decisions on 2018 Obamacare plans. And that’s assuming they can first unite their own committee — a patchwork of political interests that includes iconoclastic conservative Rand Paul, moderate Republicans Susan Collins and Lisa Murkowski and liberal firebrands Bernie Sanders and Elizabeth Warren.
“Lamar Alexander and Patty Murray shepherded a bill through — [the update to] No Child Left Behind – that made the school-choice people happy and made the teachers unions happy, so stranger things have happened,” said Sen. Roger Wicker (R-Miss.).
Alexander and Murray want a bill to stabilize the Obamacare insurance markets in time for next year’s plans. Lawmakers who are warm to the idea agree the contours would combine expanded state flexibility for Republicans with market stability — such as funding critical Obamacare cost-sharing subsidies — for Democrats.
Republicans will seek a more flexible 1332 waiver — an existing Obamacare provision that allows states to make changes to the law’s requirements, according to GOP sources. Democrats say funding the approximately $7 billion annual payment to insurance companies to help cover low-income people is the minimum requirement for a deal. The Trump administration has said it is ready to pull the monthly payments at any time in response to the failed repeal effort, a move that could immediately drive companies off the exchanges and further undermine the Obamacare markets.
Alexander says he’s ready to fund the program, but adds "it also should include greater flexibility for states in approving health insurance policies. Any solution that Congress passes for a 2018 stabilization package would need to be small, bipartisan and balanced.”
But first, Alexander needs to win over skeptics in his own party, which is coming off an exhausting and ultimately fruitless effort to repeal and replace Obamacare. Other Republicans have likened the cost-sharing program to a “bailout” for insurance companies.
Several conservative senators, as well as President Donald Trump, haven’t given up on repealing the law outright. Sens. Ted Cruz (R-Texas) and Paul have balked at any proposal that aims to fix Obamacare rather than roll it back.
"I think it would be a serious mistake to bail out the insurance companies instead of honoring our promise to repeal Obamacare," Cruz said.
Senate GOP leaders have made clear that they’ve tried everything on Obamacare and are ready to move on. But they’ve left the door open to any Obamacare bill that has the votes. Alexander and Senate Majority Leader Mitch McConnell are close friends, and it is unlikely the chairman would move forward with a bipartisan bill if his leader was opposed.
“Show me 51 or show me 60, I guess, and I’m happy to talk,” said Senate Majority Whip John Cornyn.
Alexander and Murray — who have made deals on the No Child Left Behind update, the 21st Century Cures Act and an updated Medicare payment policy, among other things — have their work cut out for them. The HELP Committee is a diverse mix of Republicans and Democrats representing a cross-section of ideological spectrums. On the Republican side, HELP has conservatives Tim Scott (R-S.C.) and Pat Roberts (R-Kan.), the libertarian Paul and moderates Murkowski and Collins. On the other side of the dais are the Senate’s most liberal Democrats — Warren and Sanders — and more moderate lawmakers, such as Bob Casey (D-Pa.) and Tim Kaine (D-Va.).
Should Alexander and Murray get a bill through committee, it would have a strong shot at passage in the full Senate. The group will need to find common ground quickly — Alexander has set a mid-September deadline to strike a deal propping up the Obamacare markets, in hopes of speeding a bill through Congress by the end of a month. That leaves just a few weeks for the committee to hold hearings, negotiate a stabilization package and then win broader Senate support on an issue that Republicans and Democrats have fought over for nearly a decade. Staff is expected to work on the plans while members are in their home states in August.
Democrats and Republicans have starkly different visions for the future of the health care system, and there’s little appetite on either side to give in. That means crafting a narrow bill that props up Obamacare in the short term without shaping the longer-term debate.
“If you start piling on everybody’s pet priorities, it’s a dangerous path to go down,” said Sen. Brian Schatz (D-Hawaii), an advocate for single-payer health care. “Just because Chairman Alexander and I don’t agree on the Affordable Care Act doesn’t mean that either of us think that lighting the individual market on fire is a good idea.”
Still, it remains unclear what qualifies as neutral ground. Both sides have floated funding stabilization efforts, either through a federal reinsurance system or by sending more money to the states. And Kaine said he’s intrigued by a proposal from Sens. Bill Cassidy (R-La.) and Collins to automatically enroll individuals in basic health plans.
But Republicans remain loath to pour more money into Obamacare without a clear path toward rolling back some of its regulations — a suggestion that still makes Democrats nervous.
“The notion of flexibility to the states, I think that’s good,” Kaine said. “But sometimes flexibility to the states leads to a race to the bottom line. Sometimes flexibility to the states is actually perceived by the states as the feds just pushing off hard decisions on them.”
Democrats are already pushing back on Alexander’s suggestion that a compromise bill fund cost-sharing subsidies for only a year.
“Solving the CSR problem for a year doesn’t keep the insurance companies in,” said Sen. Chris Murphy (D-Conn.), one of the Senate’s strongest Obamacare defenders. “If we’re going through the trouble of bringing Republicans and Democrats together to forge a compromise, let’s do it for more than one year.”
For now, though, some rank-and-file lawmakers are just excited hearings have been planned.
“I love it,” Murkowski said of the hearings. “Smart people making good things happen.”
Collins, who with Murkowski played a pivotal role in sinking the GOP’s repeal bills, was equally enthusiastic: “Lamar Alexander is a master at getting bills through.”