By Jessie Hellmann - 09-01-17 06:00 AM EDT
The Senate will take a new approach to ObamaCare next week - bipartisanship.
Following the stunning defeat to the GOP's repeal bill, the Senate Health Committee will turn to passing bipartisan legislation aimed at shoring up insurance markets for 2018.
The odds are against bipartisanship - particularly when it comes to ObamaCare.
President Trump has talked about letting ObamaCare "implode," suggesting he has little desire to sign legislation improving the markets.
Many Republicans have campaigned for years on promises to repeal ObamaCare, not to save it. It is difficult to see conservatives who have described the law as a disaster turning around to work on measures to fix it.
At the same time, Sen. Lamar Alexander (R-Tenn.), chairman of the Health, Education, Labor and Pensions panel, quit a post in leadership six years ago because he wanted to work on policy measures that would need support from both sides to survive.
And the panel's ranking member, Sen. Patty Murray (D-Wash.), partnered with then-House Budget Committee Chairman Paul Ryan (R-Wis.) on a bipartisan budget deal in 2013.
Alexander and Murray have been able to work together on difficult areas before, including the 21st Century Cures Act, a far-ranging bill that boosted funding for medical research.
"In this case, there's a shared goal, there's a shared recognition that there's some things Congress can do to help stabilize premiums, help stabilize the market for the next plan year," said one GOP aide, offering hope that a deal is achievable. "There wasn't that kind of agreement the first half of the year on broader reforms and a broader repeal effort."
Staff has worked on the bill over recess, and there's a general agreement that it will continue ObamaCare's insurer payments and make changes to the law's state waivers.
But there are still disagreements over what the specifics will be, and members of the diverse panel will have to engage in some give and take.
Members include Sen. Rand Paul (R-Ky.), who opposed earlier GOP repeal bills as keeping too much of ObamaCare alive; and two moderates who helped sink the GOP's repeal bill: Sens. Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine). Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.), both possible White House candidates in 2020, are also on the panel.
The membership suggests Alexander and Murray will have their work cut out for them in getting legislation through the committee. And if they do, they still have to worry about the full House and Senate.
"Switching gears in this way, I think, is going to be a challenge for both sides - to sort of move away from some of the open hand-to-hand combat we've had to a more measured tone in which both sides sort of restrain their more partisan impulses and look at some very specific issues very carefully," said a senior Democratic Senate aide.
Still, the aide said Murray is "cautiously optimistic we'll be able to turn the page and treat the Affordable Care Act much as we've treated Medicare over the last decade - as a program that's here to stay, that we can make bipartisan tweaks to and work together on."
Alexander has said the stabilization bill is likely to be short-term and narrow. He thinks that the less substantive the bill is, the more likely both parties can agree on it.
"Congress doesn't do comprehensive well, and I think it makes much more sense to go step-by-step especially since the last seven years have been so partisan," Alexander said in an interview with The Tennessean last week.
"If we can agree on a single, limited bipartisan step in September ... then we could take second steps, and there are obvious steps."
Republicans and Democrats generally agree on funding key ObamaCare insurer payments, called cost-sharing reduction subsidies.
The Trump administration has made the payments on a month-to-month basis, while insurers have pleaded for long-term certainty.
While Alexander has said the bill should continue the payments through 2018, Democrats are pushing for multiple years of funding, a Democratic aide said.
"The idea of doing it just month-to-month everyone agrees is crazy. Trying to do it year-to-year is better but not much better," said Washington state Democratic insurance commissioner Mike Kreidler, who will testify at the Sept. 6 hearing along with other state insurance officials.
"You have to permanently fund them, or fund them so it's not month-to-month. It definitely needs to be out there for several years. That's the kind of planning schedule insurers are on. If you're doing it month-to-month or year-to-year, it becomes tenuous whether they can count on it or not."
Alexander and other Republicans have said the stabilization bill should also include some health-care reforms, namely through the expansion of ObamaCare's state waivers.
Democrats took issue with language in the Senate GOP's health bill, which would have expanded those waivers and made it easier for states to waive some ObamaCare requirements.
It's unclear what an expansion of waivers would look like in the bipartisan bill, but Democrats don't want to see anything that could result in coverage losses.
"We think we can have productive discussions about both market stabilization and some of the state flexibility ideas without getting into policy ideas that really take a chunk out of coverage," said the senior Democratic aide.
But Republicans are adamant that the bill contain some reforms, and not just subsidies, which some call a bailout for insurance companies.
"If the Democrats are willing to support some real reforms rather than just an insurance company bailout, I would be willing to take a look at it," Senate Majority Leader Mitch McConnell (R-Ky.) said earlier this month, according to The Associated Press.
But there are still Republicans who would never support a bill that includes the subsidies.
"Lol, no," said a spokesman for Sen. Mike Lee (R-Utah), when asked if he would support a bill funding cost-sharing reduction subsidies.
"Sen. Lee wasn't elected to bailout industries enjoying record high profits."
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