WASHINGTON ― After seven years of promises, Republicans just can’t find the votes to repeal and replace the Affordable Care Act.
They don’t know what to do now.
Senate Majority Leader Mitch McConnell (R-Ky.) appears to have exhausted his options for alternative GOP bills. Early next week, senators are expected to vote down an effort to begin debate on a bill to gut Obamacare without a replacement. The proposal is similar to one Republicans in the House and Senate sent to President Barack Obama’s desk in early 2016.
The problems Republicans have decried about the Affordable Care Act, however, while often overstated, will persist. A handful of rural counties still don’t have an insurer lined up to offer plans in 2018, and quite a few more counties ― about one-fifth of total exchange enrollment ― have only one option and have seen a spike in premiums in the last year or two.
Democrats contend lawmakers could easily fix those problems with a little more money to bring down premiums and a guarantee to insurers that the federal government will make the Cost Sharing Reduction (CSR) payments that help reduce expenses for low-income individuals.
But Republicans appear split on whether they ought to stabilize the Obamacare insurance market or try to blow up the law and force Democrats to the negotiating table to do something else. In fact, Republicans don’t know what they’re supposed to do if, or more likely when, their repeal-only bill fails.
Sen. John Barrasso (R-Wyo.), who is in GOP leadership, had no response when asked what happens next if his party can’t pass the repeal bill.
Sen. Pat Roberts (R-Kan.) managed to spit out one word: “Prayer.”
GOP Conference Chairman John Thune (R-S.D.) said only that Republicans would “regroup and see where we go from here.”
President Donald Trump’s plan seems to be chaos and pain.
Trump told The Associated Press on Tuesday that Republicans should “let Obamacare fail.” One easy way to expedite that failure would be for Trump’s administration to stop making CSR payments. Already the uncertainty of the administration continuing the payments has caused insurers to increase prices.
Republican senators themselves don’t seem as convinced.
Sen. Ron Johnson (R-Wis.) has been suggesting for months that Republicans ought to work with Democrats on a CSR package, potentially coupled with some other reforms. Republicans refused to include CSR payments in an April omnibus deal. But in the aftermath of McConnell’s prolonged failure to repeal and replace Obamacare, the idea of a CSR package ― essentially the bare bones of a bipartisan fix to the Affordable Care Act ― was making its rounds Tuesday on Capitol Hill.
“Maybe it’s too late for that now,” Johnson told HuffPost. “I really don’t know. This is not good what’s happened here. I argued, I think, pretty strongly that we ought to just bite the bullet, stabilize the markets, a couple months ago.”
Johnson said that, “politically,” Republicans would have been given credit for governing responsibly. “But that was something leadership didn’t want to do, I suppose,” Johnson said, adding that leaders may have wanted to preserve the option of adding CSR payments to their health care bill “to obtain votes at the eleventh hour.”
Republican leaders did, in fact, include CSR payments in their health care bill. The plan was to help stabilize the insurance markets as the GOP changes were taking effect. Absent those other reforms, however, there seem to be GOP reservations about making Obamacare more workable.
“I’m not interested in a bailout for insurance companies, alone without reforms,” Majority Whip John Cornyn of Texas told reporters. Asked specifically about just guaranteeing CSR payments, Cornyn clarified that “that’s what I call a bailout for insurance companies.”
Other Republicans still don’t seem to have given up on their dream of repealing and replacing Obamacare. Sen. Ted Cruz (R-Texas) told reporters that he continues to believe Republicans will find consensus on health care. “The path to Obamacare repeal has been bumpy, and this week was no exception,” Cruz said.
But McConnell seems to have come to terms with the reality that there is not sufficient consensus on a health care bill. “It’s pretty obvious we don’t have 50 members who can agree on a replacement,” he said, opening to the door to possibly working with the 46 Democrats and two independents in the Senate.
After Senate Republicans vote down the upcoming procedural motion to begin debate on the Obamacare repeal bill, which is expected early next week, McConnell said the Senate “will have demonstrated that Republicans by themselves are not prepared at this particular point to do a replacement.”
“And that doesn’t mean the problems all go away,” he continued. “You’ll have to look at our committee chairmen and their ranking members. My suspicion is there will be hearings about the crisis that we have, and we’ll have to see what the way forward is.”
“My suspicion is there will be hearings about the crisis that we have, and we’ll have to see what the way forward is.”
- Senate Majority Leader Mitch McConnell
That way forward is certainly one Democrats prefer.
Senate Minority Whip Dick Durbin (D-Ill.) sarcastically suggested Republicans hold hearings, saying they could give Sen. Lamar Alexander (R-Tenn.) a committee and call it the Health, Education, Labor and Pensions Committee and bring in experts to testify. (That’s a real Senate committee, and he chairs it.)
“How ’bout that? Is that a radical idea?” Durbin asked.
Durbin said Republicans hadn’t contacted him about a bipartisan approach, but he warned that voters would blame the GOP if it attempted to sabotage Obamacare. “They seem to have this notion that they can be a majority party and control the White House and not be responsible for bringing down the health care system in our country. It doesn’t work that way.”
He noted that funding the CSR payments would be an important step toward stabilizing the market, but he said he didn’t know what legislative vehicle would be used to do that.
One obvious vehicle would be the upcoming reauthorization of the Children’s Health Insurance Program. Another possible bill would be an omnibus spending deal, on which Democrats might have more leverage, though that measure might come too late in the year to effectively shore up insurance markets.
“Finding common ground and middle ground starts with a conversation,” Durbin said. “So far we haven’t had that conversation. It’s been a secret bill, produced in private, dropped on us five days before a vote with no [Congressional Budget Office] analysis.”
Jonathan Cohn contributed to this report.
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