Sen. Lamar Alexander had barely announced his plans to hold hearings next month on the Health, Education, Labor and Pensions Committee on stabilizing the insurance markets for Obamacare when the idea started getting panned.
Keep in mind there are no specific hearings scheduled yet, no witnesses, no bill written, and few parameters of what is on or off the table. Alexander, the committee chairman, has only said that he wants a final product to be “small, bipartisan, and balanced,” but he hasn’t said what that means, other than flexibility for states and short-term triage for the exchanges.
But just the idea of preventing the exchanges around the country from collapsing for the 11 million people who get their health insurance through them has been enough to set people in Washington off. Within days of Alexander’s announcement, and without evidence, Breitbart News declared that the Tennessee senator’s effort was “in dire straits.” Heritage Action renamed Obamacare “Zombiecare” and said any effort to stabilize the markets while Congress comes up with a larger overhaul would be “unacceptable.” For weeks President Donald Trump has said he’d be willing to let Obamacare collapse and just blame Democrats for the mess in the end because “they own it.”
And those were Sen. Alexander’s fellow Republicans. Democrats may have been more open to the concept of saving the exchanges, but they want a permanent fix, not a temporary one that Alexander is talking about.
Unfortunately for Alexander, nowhere is the arduous politics of health care on more vivid display than on the HELP Committee where he’ll have to get a bill through, with an assist from ranking member Patty Murray, D-Wash.
Add the Democrats’ vice presidential nominee from 2016 (Sen. Tim Kaine, D-Va.) and toss in two of the three Republicans who voted against the repeal-and-replace efforts two weeks ago (Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska), along with two senior committee chairmen — Sen. Orrin Hatch, R-Utah, and Sen. Mike Enzi, R-Wyo., who both plan to have their own major legislation to move in the Senate this fall that does not include health care, and you’ll see why the idea of passing any Obamacare-related legislation through the HELP committee starts to look like the running of the bulls.
But the politics of health care are often at odds with the realities of what’s happening in everyday Americans’ lives, and this is a case in point. Senators may disagree on what to do about health care reform, but there is no disagreement about the death spiral that is likely to take place in the health insurance markets if Congress does not address the group of people who buy their insurance through the exchanges and receive subsidies to help pay for it.
Without with premium support payments, or APTCs, cost sharing reduction payments, or CSRs, or both, people who get subsidies now likely won’t be able to afford insurance at all in the future. Massive costs would shift to the people on the exchanges already paying full fare, who may in turn no longer be able to afford their new health insurance. Insurance companies would leave the markets and the exchanges would collapse.
Realities on the ground
Especially for GOP senators on the HELP committee, doing anything related to Obamacare may seem impossible, but doing nothing related to the cost-sharing subsidies could be even worse. That’s because the states poised to be hardest hit without congressional action are, by and large, represented by the committee’s Republicans.
Take Sen. Tim Scott’s state of South Carolina, where 91 percent of people on the exchange receive some sort of federal subsidy to afford health insurance, including 73 percent of people who rely on CSR payments, according to the Centers for Medicare and Medicaid Services. Sen. Bill Cassidy’s home state of Louisiana has similar stats, with 92.6 percent of participants on the exchange using subsidies and 64 percent requiring CSR payments. Of the twelve GOP senators on the committee, subsidies help at least 80 percent of exchange participants pay for their insurance. For a remote state like Alaska, the average premium support alone is $750 per month.
The good news for Alexander and Murray is that Democrats seem even more motivated than Republicans to strengthen the exchanges, even though their constituents mostly rely less on subsidies to buy their insurance on the exchanges. For the first time in a long time, both sides have a motivation to act on health care. The result could be a bipartisan consensus to do something, not only in that committee, but in the House and Senate, too, even if it’s just a short-term fix for a fraction of Americans struggling to afford insurance.
Nothing that passes will be comprehensive. And it won’t solve the underlying problems plaguing health care in America today. But for millions of people who need it, thanks to Sen. Alexander, HELP may finally be on the way.
Roll Call columnist Patricia Murphy covers national politics for The Daily Beast. Previously, she was the Capitol Hill bureau chief for Politics Daily and founder and editor of Citizen Jane Politics. Follow her on Twitter @1PatriciaMurphy.