Pivoting to a bipartisan fix of Obamacare won’t be quick or easy if Senate Republicans’ repeal efforts fail.
A handful of Republicans are preparing potential repairs to the existing health care system as a fallback option, talking up the prospect of a compromise that could win some Democratic support to fix Obamacare and stabilize the market.
But many in the GOP privately say they might need a break between seven years of repeal attempts and a sudden repair effort. And some Democrats are already calling for single-payer health care — an automatic non-starter for Republicans. The sharp political divide underscores just how hard it would be for the parties to come together amid the ashes of a failed repeal.
“I don’t think Republicans can do that,” Senate Finance Chairman Orrin Hatch (R-Utah) said of giving up repeal. “I think we have to live up to our intention that we’re going to change it.”
Republican leaders, who fanned fears that the health system will collapse under Obamacare, are still scrambling to get the 50 votes needed to pass a repeal bill as planned next week. But some lawmakers are working on Plan B. The goal would be to shore up insurance markets, which are struggling in some parts of the country under sky-high premiums or a lack of insurers willing to offer coverage. But the parties disagree about how to do so: Democrats would want to add funding, and Republicans would want to change or repeal pieces of Obamacare.
The most prominent challenge is cost-sharing reduction subsidies, an $8 billion piece of the health care law that President Donald Trump could stop at a moment’s notice. Insurance companies say that uncertainty has caused them to increase premiums.
Even Republicans say finding a solution won’t be easy.
“It would have to be more than just bailing out insurance companies,” said Sen. John Cornyn (R-Texas).
The prospect of a failed repeal vote heading into the August recess threatens to further fragment Senate Republicans already at odds over how to tackle health care. The conference would have to decide whether to keep the repeal movement alive or admit defeat, a difficult prospect given their seven-year-long campaign pledge and Trump’s frequent calls for repeal.
Conservative Rep. Rand Paul (R-Ky.) wants a renewed push for repealing Obamacare outright — despite the fact that Senate Republicans as a group have already rejected that strategy.
“The president has indicated he’s open to a clean repeal. So has the vice president,” Paul said.
On the other end of the spectrum, Sens. Susan Collins (R-Maine) and Bill Cassidy (R-La.) are holding up their own plan — which would let states keep Obamacare if they want — as a fresh bipartisan rallying point. But even their most likely Democratic collaborators have balked at core parts of the proposal.
Some Republicans say the bill currently on the Senate floor is evidence the GOP has backed off its full repeal effort — proof, they say, that they’re already working on repairing the health care law.
“That’s what we’ve just been discussing for the last several weeks,” said Sen. Pat Roberts (R-Kan.). The current Senate draft — “it’s repair.”
Sen. John McCain (R-Ariz.) charitably likened a bipartisan bill being written by his friend Sen. Lindsey Graham (R-S.C.) to a “noose around my neck,” hinting at fatigue over another round of Obamacare talks.
The failure of a repeal bill would put Democrats at a philosophical crossroads, too. They could craft a compromise that appeals to moderates, or rally the base with an all-out push for a public option or single-payer system.
High-profile senators like Elizabeth Warren (D-Mass.) and Bernie Sanders (I-Vt.) have made single-payer a key plank of their political platforms, energizing liberal groups intent on pushing the party further to the left. And if the GOP’s repeal bid fails, it’ll only intensify the outside pressure on Democrats to seize the momentum and demand that any reforms include a public option at the very least.
That’s not a battle that Democrats have either the votes or the political will to fight at this point — there’s still considerable skepticism even within the party about single-payer, and Republicans are sure to refuse any attempt to give the government more control over health care.
“In this environment, that’s all it’ll be,” said Montana Sen. Jon Tester, a moderate Democrat, of liberals’ hopes for single-payer. “It’s just talk.”
“It’s totally unrealistic to think, I think, that in a Republican administration with a Republican House and Republican Senate, that this is the moment in time that single-payer would be viable,” said Sen. Claire McCaskill (D-Mo.), another moderate. “It doesn’t make much sense to me.”
But there’s just as much concern about disillusioning voters by appearing soft on health care and overly willing to compromise, especially if Republicans are emerging from a spectacular legislative meltdown. Democrats in recent days have tried to find a middle ground, proposing a series of small Obamacare fixes and emphasizing the need to shore up the markets ahead of any broader health care overhaul.
“The Affordable Care Act’s made a lot of progress. Now is the time to fix it,” said Rep. Ami Bera (D-Calif.), one of 10 House Democrats pushing a five-point plan to stabilize Obamacare.
And in the Senate, several lawmakers have met with moderate Republicans in a bid to find common ground. Sen. Heidi Heitkamp (D-N.D.) this week introduced a bill to provide more subsidies to middle-income people to help them buy health insurance.
But even those overtures come with the requirement that any bipartisan package needs to improve Obamacare by pouring significantly more money into the system.
“We need to make sure that these subsidies that are currently funded by the federal government in the exchanges, that reduce co-pays, reduce deductibles for poor people — make sure that that funding continues,” said Sen. Tom Carper (D-Del.), referring to the cost-sharing program.
He added that any big health care bill also needs to maintain or strengthen Obamacare’s individual mandate, an already unpopular provision that would likely be a non-starter for many Republicans.
A repair bill would mark the first major changes to Obamacare since it was approved in 2010.
Most major legislation is followed up by fixes. But there have been very few changes to the Affordable Care Act — and those that have been enacted were very narrow.
Sen. Tammy Baldwin (D-Wis.) said the difference now is that the repeal effort has driven tremendous public attention to health care.
“This repeal bill was supposed to sweep through the House and Senate in January, and it’s mid-July now,” she said. “I don’t think the American public is going to fall asleep after this.”
If the GOP bill fails next week, Republicans would have three weeks of August to go home, regroup and potentially tone down the partisan rhetoric — something that normally doesn’t happen during recess.
Heated rhetoric, said Sen. Dick Durbin (D-Ill.), “doesn’t cool during the month of August. It gets hotter.”