Senate Republicans return to Washington, D.C., on Monday from a 10-day recess no closer to a deal on legislation to overhaul the U.S. health insurance system, with little time left on the calendar and other agenda items piling up.
And as conservative and moderate GOP lawmakers continue to spar over just how much of the 2010 health care law to repeal and replace, Senate Majority Leader Mitch McConnell is signaling that a bipartisan compromise to help stabilize the shaky insurance markets created by the law could be the fallback strategy.
The Kentucky Republican had intended for the chamber to vote on the measure, which would change the law’s subsidies that help individuals afford insurance and restrict Medicaid funding over the next 10 years, before lawmakers left for the Fourth of July break.
But now, in the fallout of that abandoned timeline, more members are expressing concerns over the current draft, raising the stakes for the majority leader who is trying to live up to his reputation as a master deal-maker.
It’s “almost impossible to try to solve when you’re trying to do it with 51 votes in the United States Senate, in which there is not significant consensus on what the final result ought to be,” Sen. Jerry Moran of Kansas said during a Thursday town hall, one of the few Republican members to host public events during the recess.
Moran is among a handful of GOP senators to come out in opposition to the existing proposal after McConnell pulled the expected vote on the legislation, a group that now includes Sen. John Hoeven of North Dakota.
Prior to departing Capitol Hill, Senate leadership sent several policy options over to the Congressional Budget Office for review.
Among those was a proposal from Sen. Ted Cruz of Texas that would allow insurers to offer plans that are noncompliant with the current health care law, so long as they offer one that is.
The amendment, for which language is not yet publicly available, has received praise from conservative members and groups. But the proposal has faced pushback from some moderate lawmakers. And health care experts have warned that such a system could lead to higher health care costs for sicker individuals.
Some members, however, believe there is a way to structure it to avoid that problem.
Sen. Bill Cassidy said Thursday that allowing insurers to offer the two plans, but maintaining a single risk pool for both, would help avoid shifting the cost burden to the sicker individuals. The Louisiana Republican warned, however, that using two separate pools of individuals would be troublesome for the markets.
“If it is two plans and two risk pools … that is actuarially unsound and will require a bailout using taxpayer money,” Cassidy said, adding that he “cannot support a plan” that would require an insurer bailout.
McConnell will only have a few weeks to try to corral the 50 votes needed to advance the proposal before lawmakers leave Washington again for the August recess. (Some members, though, are already urging leadership to postpone the break to continue work on health care and other items on the GOP’s legislative agenda.)
Should the current effort fail, McConnell appears ready to work with Democrats on a measure to help shore up the insurance markets ahead of the open enrollment period for 2018.
“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, according to The Associated Press. “No action is not an alternative.”
One option on the table is to remove the controversial provisions in the current draft — such as a phaseout of the Medicaid expansion included in the 2010 health care law — but to keep the funding intended to help states lower premiums. Such a move would likely receive broad bipartisan support but receive ample resistance from conservatives.
“Talk of a bipartisan bailout of Obamacare would have two major effects: It would embolden Republican moderates as they continue to hold out in an attempt to keep as much of Obamacare on the books as possible, and it would undermine honest efforts that empower states to get out from under Obamacare’s burdensome regulations,” Michael Needham, CEO of the conservative Heritage Action, said in a statement. “If the Republican Party wants to work with Democrats to bailout Obamacare, the results will be catastrophic for the party.”
The current draft would provide $50 billion in short term funding and $62 billion in long-term funding to states.