Sen. Lamar Alexander has found himself in an uncommon position for most Republicans this year: Trying to save the shaky insurance markets created by the 2010 health care law before attending to a major overhaul of the law.

The opinions of the Tennessee’s senior senator carry significant weight among his colleagues. He is a close confidant of Senate Majority Leader Mitch McConnell and also chairs the Health, Education, Labor and Pensions Committee.

And while Alexander has been a near constant critic of former President Barack Obama’s signature domestic achievement, he is now one of the leading voices in the chamber for saving it, at least for 2018 and 2019.

“We might have to do some things and authorize some things in those two years that we wouldn’t do long-term,” he said last week. “And then in 2020, we would hope to have our long-term solution for the people that don’t have the insurance.”

Republicans are employing a budget tool known as reconciliation to push forward legislation to repeal large portions of the law. The method requires only a simple majority to pass the Senate. That means the GOP, which holds 52 seats in the chamber, can advance the measure with only Republican support. The House passed its own repeal bill earlier this month in a narrow 217-213 vote.

An uphill battle

But now, Alexander is trying to sell his colleagues on a two-step process that includes using the fiscal 2017 reconciliation instructions to pass short-term market stabilization measures, effectively delaying any major repeal efforts. He recognizes, however, that obtaining support for such an approach could be an uphill battle. 

“There’s a strong bias towards taking both steps at the one time because the urgency of what might happen in 2018 and 2019 gives us an incentive to pass the long-term plan, too,” he said. “We need to do something immediately to help the 2018 and ’19, but I hope it’s connected to a long-term solution.”

A GOP aide said this year’s reconciliation measure is being looked at for several purposes outside of strictly repealing the health care law, including stabilizing the insurance markets and putting Medicaid on a budget.

Such a move would have a dramatic impact on the GOP’s legislative agenda and could be a tough sell among some members of the conference. Passing a package of stabilization measures would require Republicans to essentially support, at least in the short term, a law members spent the past seven years criticizing. It could also make a tax overhaul, the next major legislative item on the GOP agenda, more difficult and push some substantial work on health care until an election year, a notoriously difficult time for passing major legislation.

Some members, however, expressed early support for the proposal.

“It sounds like a pretty decent idea. If we are going to lower premiums, we better start soon,” Louisiana GOP Sen. Bill Cassidy said. “It’s more important to get it right than to get it sooner, so I just want to get it right because there’s a lot of lives at stake.”

Several GOP members said they would need to see more details on what exactly would be proposed.

“He’s looking for ideas that make the transition work. So the idea is to transition from what we have to repeal and replace,” North Dakota Sen. John Hoeven said. “We’re working on a number of different ways to make transition.”

Other efforts

The topic has come up during semiweekly meetings of a health care working group initially charged with writing the bill. GOP lawmakers leaving a meeting last week said the group was looking at legislative solutions, as well as actions that can be taken unilaterally by the executive branch.

“This is merely a short-term stabilization. We’ve got to do that because those markets are collapsing,” Wisconsin Sen. Ron Johnson said. “Then, I think, we’ve got to take a look at what the long term is.”

Johnson has been discussing a two-part strategy of stabilize and repeal as well. 

“I don’t think we are going to be able to come to a conclusion quickly enough to stabilize these markets,” he said Tuesday, acknowledging the tricky politics of shoring up the exchanges created by a law the GOP has excoriated for years. “The way you sell it to members is [to] get the reality out on the table, that premiums aren’t going up because of Republicans. Premiums are going up because Obamacare is collapsing these markets.”

While Alexander did not provide many specifics on what exactly he would propose as part of the stabilization efforts, he suggested funding in 2018 and 2019 the law’s so-called cost-sharing subsidies, which help lower out-of-pocket costs for lower income individuals, as an initial step.

The Trump administration on Monday asked for another 90-day delay in a case brought by the House of Representatives in 2014 against the Obama administration that questioned the constitutionality of those payments. Insurance companies have expressed their dismay at the lack of clarity regarding the payments, which they need to understand in order to formulate insurance policies. 

Alexander has also been pushing a bill he sponsored along with fellow Tennessee Republican Bob Corker that would allow individuals in counties with no insurer on the individual market to use the law’s tax credits on noncompliant plans.

Erin Mershon contributed to this report.