GOP health effort on hold indefinitely

GOP health effort on hold indefinitely
The Republican push to repeal ObamaCare is officially on ice.
Now the question is when -- if ever -- the GOP will try again.
Senate Majority Leader Mitch McConnell (R-Ky.) insisted Tuesday that Republicans "haven't given up on changing the American health care system." Yet he made clear that, for now, they are moving on to other priorities.
"Where we go from here is tax reform," McConnell said.
It's a sobering moment for the GOP.
After seven years of campaign promises, the Senate on Tuesday gave up on a last-gasp ObamaCare repeal bill from Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.).
The decision effectively ended any chance Republicans had of repealing ObamaCare this year, and potentially before the 2018 midterm elections.
Republican senators put on a brave face, with many insisting that they would return to health-care legislation again once their top legislative priority, tax reform, is on the books.
"Patience is a virtue," said Graham.
"Time is actually on our side. The votes we were lacking were more about process than substance. We can fix the process and we can improve the substance, so that's why I'm optimistic."
But the road ahead is daunting.
At the start of the year, the House and Senate passed reconciliation instructions allowing them to pass ObamaCare repeal through the Senate on a simple majority vote.
That budget tool expires on Saturday, putting them back at square one.
Republicans are determined to use their next set of reconciliation instructions on tax reform, even if it requires putting health care on the backburner.
Some Republicans this week floated combining tax reform and ObamaCare repeal into one bill, but that idea was quickly shot down.
"Heavens, no. We're not going to do that," said Sen. Orrin Hatch (R-Utah), chairman of the Senate Finance Committee. "It would just screw up the whole thing."
Lawmakers warned that combining the two bills could jeopardize a tax overhaul the economy desperately needs.
Theoretically, Republicans could pass tax reform in early 2018 and return immediately to health care. But that timeline seems unlikely.
It would thrust health care into the middle of the midterm election season, a time when it is hard for any major legislation -- let alone something as controversial as ObamaCare repeal -- to pass. Further complicating the schedule, lawmakers will likely spend much of their time in 2018 on the campaign trail.
That means Republicans will likely have to wait until the 2019 budget to use the fast-track process, known as reconciliation, to pass a repeal bill with just a simple majority.
Vice President Pence sought to encourage senators in their lunch meeting Tuesday, urging them not to give up. Sen. Mike Rounds (R-S.D.) said Republicans still want to act on health care before the Congress ends in January 2019.
In the meantime, ObamaCare remains the law of the land -- and with just as much uncertainty.
Senators who helped thwart the latest repeal bill, including Susan Collins (R-Maine) and John McCain (R-Ariz.), are pushing for Sen. Lamar Alexander (R-Tenn.) to restart talks with Democrats on a bill to stabilize the ObamaCare markets.
"I believe that offers great promise for stabilizing the insurance markets and helping to lower premiums," Collins told reporters Tuesday.
But the White House and Speaker Paul Ryan (R-Wis.) have made clear that legislation stabilizing ObamaCare is a nonstarter, and conservatives in both chambers of Congress say they aren't ready to give up on repeal.
"I think most of the members would suggest they really don't know that they can stabilize [ObamaCare] at this stage," Rounds said. "And I think there's a number of them that are going to be very hesitant to try to put more money into a system that they are convinced is going south."
Sen. John Thune (R-S.D.), a member of leadership, said Alexander's Health Committee should continue its work but said he isn't optimistic a deal can be reached.
"There are going to be some things in the near term that may have to be done to stabilize markets, and that kind of thing can be done in a bipartisan way," Thune said.
"If they can produce something, more power to them," he added. "I'm not optimistic about that. It seemed like they really had a hard time getting consensus when they went down this path before."
With repeal on hold, much of the attention will turn to how the Trump administration manages ObamaCare. A new enrollment period is set to begin on Nov. 1.
Major insurance companies are fearful that Trump will cut off subsidies that help them cover the cost of low-income enrollees. The administration, meanwhile, insists the system will soon collapse under its own weight, raising fears on the left of sabotage.
Insurers must make final decisions about rates and participation for the 2018 plan by Wednesday, just one day after the repeal effort's collapse.
Cassidy acknowledged that ObamaCare remains in place, at least for now, but said it comes with a heavy price.
"Yes, it lives. It continues to exert that sort of effect on those families so that they're paying $29,000 a year when they earn $82,000 a year," he said. "In that sense it lives, but that is not a very good life."
Rachel Roubein, Nathaniel Weixel and Jordain Carney contributed.