Senate Republicans appear unlikely to attempt a complete overhaul of the 2010 health care law next year and instead have shifted their focus toward stabilizing the insurance markets.
Members say the repeal of the penalty for not having insurance that was included in the GOP tax plan removes a crucial aspect of the law, rendering it largely unworkable.
Now, they say a bipartisan fix will be necessary. And Republicans are focusing more on “reform” than “repeal,” at least in their rhetoric.
“We ought to try to move to some sort of bipartisan solution,” Senate Majority Whip John Cornyn of Texas said. “Without the individual mandate, it’s hard to see how that is going to be the ultimate solution.”
“It strikes a blow at the heart of Obamacare,” Senate Republican Conference Chairman John Thune of South Dakota said. “There are other things that we will need to do and I think at some point we need to come up with a replacement for it.”
McConnell himself pivoted away from repealing the 2010 health care law in a Thursday interview with NPR.
“Well we obviously were unable to completely repeal and replace with a 52-48 Senate,” McConnell said. “We’ll have to take a look at what that looks like with a 51-49 Senate. But I think we’ll probably move on to other issues.”
President Donald Trump, who exerted immense pressure on congressional Republicans earlier this year to overhaul the law, seems comfortable with what was accomplished in the tax measure.
“The individual mandate is being repealed. When the individual mandate is being repealed, that means Obamacare is repealed,” he told reporters Wednesday.
Any compromise health care bill between Republicans and Democrats would require 60 votes to pass.
While a partisan attempt at a broader repeal has not been ruled out entirely, it would be a much more difficult task this time around. A smaller majority next year means the GOP would have to convince two of the three Republicans who joined with Democrats to sink the prior effort to change their minds.
Sen. Lisa Murkowski of Alaska, a member of that trio, says she is hesitant to make any other drastic changes to the law until the full effect of the repeal of the individual mandate is known.
“I’m going to be one that is very, very cautious about doing anything right out of the gate when it comes to any further effort to repeal any parts of the ACA,” she said Thursday. “I think we need to see what the lay of the land looks like going forward.”
Democrats agree work will need to be done to address the loss of the mandate, but by-and-large the party holds a starkly different view than some Republicans on how to fix it. And after largely getting shut out of the process this year, it remains to be seen how willing they will be to engage.
But there is recognition among GOP members that something will need to be done.
“There are some holes left that have got to be fixed,” Sen. Johnny Isakson, R-Ga., said.
Isakson, Cornyn and others cited some examples of legislation that Congress could use as a foundation for a compromise health care package.
One is from Senate Health, Education, Labor and Pensions Chairman Lamar Alexander of Tennessee and Sen. Patty Murray of Washington, the top Democrat on the panel. Their bill, among other things, would broaden the authority states have over so-called 1332 waivers, which allow for greater flexibility in how the law is implemented.
Collins had staked her vote for the Republican tax bill in part on a promise from Senate Majority Leader Mitch McConnell to move both those measures before the year ends.
But Alexander and Collins announced Wednesday the bills would not be added to the short-term funding bill in December. Instead, the duo said they would wait to try to add them to a broader spending bill in January.
Slim margins drive agenda
With a slimmed-down majority in the Senate, any effort to overhaul the law on a partisan basis becomes much tougher.
Republicans will lose a seat once Doug Jones — who won the special election in Alabama to fill Attorney General Jeff Sessions’ former Senate seat — is sworn in. Should the GOP choose to use the fast-track budget procedure known as reconciliation to advance a bill on a partisan basis, Senate leadership could only afford to lose the support of one member.
Acknowledging the difficult margins, Senate Majority Leader Mitch McConnell said Thursday an entitlement overhaul was unlikely next year given Democratic opposition.
Some members are hopeful the repeal of the mandate will give Republicans some cover to turn away from health care.
“By removing that, there is a certain amount of steam that’s been let off the top here when it comes to the objections that so many had with the ACA,” Murkowski, a strong supporter of both Alexander-Murray and Nelson-Collins, said.
But some lawmakers are still calling for major changes to the 2010 law. And the GOP base will likely also continue to push for a broader overhaul.
“Medicaid is a runaway entitlement, unlimited. So it’s not sustainable. There are huge things that have to be fixed,” Sen. David Perdue, R-Ga., said. “The individual mandate though opens the door to move towards some of those other fixes.“
The inclusion of provisions to end the law’s Medicaid expansion and place the entitlement program on a per-capita cap model was a key reason why the prior GOP attempt to repeal it failed.
If Republicans were to try to advance a bill on a party-line basis, even the most ardent supporters of past efforts to overhaul the law say a new approach would be needed.
One major reason for that is the loss of additional revenue that would have come through a repeal of the individual mandate. The Congressional Budget Office previously estimated its removal would generate an additional $338 billion in federal revenue over ten years, money the GOP opted to use to offset the cost of tax cuts.