Photographs by AP/J. SCOTT APPLEWHITE
“It’s pretty obvious that our problem on health care was not the Democrats,” Senate Majority Leader Mitch McConnell said Tuesday. “We didn’t have 50 Republicans.”
Wednesday, August 2, 2017
WASHINGTON -- Even as President Donald Trump renews his threat to undermine the Patient Protection and Affordable Care Act, senior Republican and Democratic senators announced plans Tuesday to begin work on a bipartisan effort to stabilize the 2010 health care law.
The move -- by Sen. Lamar Alexander, R-Tenn., chairman of the Senate Health, Education, Labor and Pensions Committee, and Sen. Patty Murray, D-Wash., the committee's senior Democrat -- does not ensure the end of Republicans' long-running campaign to repeal the Affordable Care Act.
But after last week's collapse of the Senate GOP repeal effort, it signaled a new willingness by Republican senators to begin work on fixing weaknesses with the current law rather than trying to roll it back.
The effort led by Alexander and Murray will begin with a series of hearings starting the week of Sept. 4, Alexander said Tuesday, announcing his interest in producing legislation by the end of that month to "stabilize and strengthen the individual health insurance market" for 2018.
"Any solution that Congress passes for a 2018 stabilization package would need to be small, bipartisan and balanced," Alexander said as he invited the committee's Democrats to participate in the process.
He publicly urged Trump to continue paying subsidies to health insurance companies to offset poor customers' out-of-pocket medical expenses.
The No. 2 Senate Republican also suggested that the two parties should seek common health care ground. Sen. John Cornyn of Texas said on the Senate floor, "We are forced to work together to try to solve these problems, and I think, frankly, bipartisan solutions tend to be more durable."
In addition, Senate Majority Leader Mitch McConnell rebuffed Trump's demands that the Senate change its rules so it can pass a health overhaul with a simple majority vote. McConnell, R-Ky., said the Senate lacks the votes to end filibusters of legislation as Trump wants, and he noted that getting the 60 votes needed to end filibusters wasn't why Republicans lost.
"It's pretty obvious that our problem with health care was not the Democrats. We didn't have 50 Republicans," McConnell told reporters, referring to efforts last week not to pass bills but to move them along with a simple majority vote.
The Senate health panel's effort comes as a bipartisan effort in the House, where a group of Republicans and Democrats -- who have called themselves the Problem Solvers Caucus -- has begun meeting to talk about fixes to the current law.
Most patient advocates, physician groups, hospitals and even many health insurers have been saying for months that targeted fixes to insurance marketplaces make more sense than the kind of far-reaching overhaul of government health programs that Republicans had been pushing.
The marketplaces, though a pillar of the Affordable Care Act, represent a small part of the U.S. health care system, with about 10 million people obtaining coverage through them. But rate increases and the decision by many insurers to exit markets over the current political uncertainty in Washington has threatened consumers' access to health plans.
Most independent experts, industry officials and state regulators say stabilizing the markets and controlling premium increases could be relatively straightforward. One critical step, they say, is the continuation of paying subsidies to low-income consumers to help offset their co-payments and deductibles.
The subsidies -- known as cost-sharing reduction payments -- are included in the original law.
But Trump has the power to stop those payments because a federal district judge ruled in May 2016 that President Barack Obama's administration was illegally making the payments in the absence of a law explicitly providing money for the purpose.
The Obama administration appealed the ruling, and the case is pending before the U.S. Court of Appeals for the District of Columbia Circuit.
Now, Trump administration officials are threatening to cut off the payments, a threat the White House renewed in recent days.
Alexander said Tuesday that Trump needs to approve the payments for August and September and that Congress should, "in a bipartisan way," approve a continuation of the payments through 2018.
"Without payment of these cost-sharing reductions," he said, "Americans will be hurt. Up to half the states will likely have bare counties with zero insurance providers offering insurance on the exchanges, and insurance premiums will increase by roughly 20 percent, according to America's Health Insurance Plans" -- a trade group for insurers.
Alexander said the early September hearings would cover "the actions Congress should take to stabilize and strengthen the individual health insurance market so that Americans will be able to buy insurance at affordable prices in the year 2018."
"We will hear from state insurance commissioners, patients, governors, health care experts and insurance companies," Alexander said.
Alexander said the proposal was a necessary response to an imminent crisis.
"It is reasonable to expect that if the president were to approve continuation of cost-sharing subsidies for August and September, and if Congress in September should pass a stabilization plan that includes cost-sharing for one year," Alexander said, "it is reasonable to expect that the insurance companies in 2018 would then lower their rates."
Many Republicans said the administration should not take any steps that would harm consumers.
Asked if the president should stop making the payments to insurers, Sen. John Kennedy, R-La., said: "I don't think anybody ought to do anything to hurt the American people. Obamacare is not working. It's bad enough on its own. Until we can get the thing fixed, I think we have to try to maintain the status quo."
The cost-sharing payments help people with incomes from 100 percent to 250 percent of the federal poverty level -- that is, about $12,060 to $30,150 a year for an individual. Some Republicans say that providing the money would amount to "a bailout for insurance companies," in the words of Sen. Ted Cruz, R-Texas.
"It's what the Democrats want," Cruz said Tuesday. "The Democrats are the party of the big insurance companies. The big insurance companies have had their profits double under Obamacare, and the only solution the Democrats have is to give yet more billions in corporate welfare to the insurance companies while working men and women are seeing their premiums skyrocket."
Trump used similar language in a tweet last week that said that if the Senate didn't approve health care legislation, "BAILOUTS for Insurance Companies" would end "very soon!"
Rep. Chris Collins, R-N.Y., an ally of Trump's in Congress, said on CNN on Monday that he had suggested to Trump that he end the payments.
"The courts have ruled they're illegal," Collins said. "For anyone to suggest that Trump would be pulling the rug out from under the individual marketplace when the federal courts have ruled the payments are illegal -- let's follow the law. Let's end them."
While the courts work out whether the Obama health care law properly approved the payments, law experts said that ending the government payments could put Trump in a legal bind.
One said Trump would be handing insurers a solid court case while undermining his own leverage to compel Democrats to negotiate, especially if premiums jump by 20 percent as expected after such a move.
"Trump thinks he's holding all the cards. But Democrats know what's in his hand, and he's got a pair of twos," said University of Michigan law professor Nicholas Bagley. Democrats "aren't about to agree to dismantle the Affordable Care Act just because Trump makes a reckless bet."
Information for this article was contributed by Noam N. Levey and David Lauter of Tribune News Service; by Robert Pear and Thomas Kaplan of The New York Times; and by Alan Fram and Ricardo Alonso-Zaldivar of The Associated Press.
A Section on 08/02/2017
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