Republicans could easily reduce premiums, increase the number of people with health insurance and stabilize the wobbly Obamacare markets.
The catch? They’d have to get past their stunning Senate loss on the repeal vote and work with Democrats to boost funding, set up new government programs and grant more state flexibility.
House and Senate lawmakers have already begun to contemplate a series of bipartisan fixes meant to shore up the Obamacare markets and prevent mass insurer defections. But those efforts — and the future of Obamacare markets serving roughly 10 million people — depend largely on whether GOP leadership is willing to set aside its repeal pledge after seven years.
There are signs of life on this front — a bipartisan House group of 40 lawmakers met Friday to discuss ways to stabilize Obamacare, even though conservatives want nothing to do with helping keep the law alive, much less pouring more money into the system.
Premiums for 2018 health plans are already set to rise across much of the nation, and insurers warn that continued uncertainty about Obamacare’s future could persuade them to flee the marketplaces or jack up rates even further. Roughly 25,000 Obamacare enrollees may have no coverage options next year, and a further 20 percent of enrollees could be left with just one insurer.
“We have been talking to Republicans, and I think the message that I delivered to Republicans is now they ought to put their ideas out there, present them to leadership,” said Rep. Ami Bera (D-Calif.), who’s part of the bipartisan group that’s been quietly discussing Obamacare fixes. “I don’t think we’re that far apart.”
Still, agreeing on even the smallest fixes requires Republicans and Democrats first to call a cease-fire on an issue that’s divided Congress for almost a decade. Democratic leaders have refused to negotiate until the GOP abandons its quest to repeal Obamacare, and top Republicans — including President Donald Trump — aren’t yet ready to give up the fight.
“As I said from the beginning, let ObamaCare implode, then deal. Watch!” the president tweeted after Republican Sens. Susan Collins, Lisa Murkowski and John McCain sank the repeal bill Friday. Meanwhile, Mark Meadows, who chairs the conservative House Freedom Caucus, said he’s working with Republicans on a new repeal bill he hopes can get through the Senate.
Absent a revived GOP repeal plan, the immediate steps that Congress can take to stabilize the individual marketplace have been discussed in Washington for months.
Insurers have long lobbied Congress to guarantee federal funding for the health care law’s cost-sharing subsidies, worth an estimated $7 billion this year, to help them cover out-of-pocket costs for low-income customers. Trump has repeatedly told advisers he wants to cut off the funding, spooking insurers who have requested higher-than-expected premiums this year just to guard against that possibility.
The cost-sharing subsidies “are far and away the clearest area of need and signal of stability that the market is looking for,” said Mike Consedine, CEO of the National Association of Insurance Commissioners. “Insurance markets cannot operate in an environment of uncertainty, and this is by definition a very uncertain market right now.”
Democrats are also pitching a nationwide reinsurance program to offset expenses tied to the market’s sickest patients, reducing costs throughout the system. It’s an idea that has some bipartisan appeal. The Trump administration recently approved Alaska’s request to set up its own reinsurance program, and the Department of Health and Human Services has encouraged more states to follow suit.
Other proposed tweaks include making it easier for states to seek federal permission to make changes to their insurance markets. Sen. Claire McCaskill (D-Mo.) has also offered a bill allowing people with no coverage options to purchase insurance from the marketplace in Washington, D.C.
Those could provide starting points for Republican lawmakers worried about keeping the Obamacare markets afloat as they work toward a broader replacement package.
House Ways and Means Chairman Kevin Brady (R-Texas) is among those who have called for appropriating permanent funding for insurers’ cost-sharing subsidies. And in the Senate, moderate Republicans spent the past two months calling for hearings and bipartisan negotiations to address the health care system.
“Neither party has a monopoly on good ideas,” Collins said in a statement on Friday. “We must work together to put together a bipartisan bill that fixes the flaws in the [Affordable Care Act] and works for all Americans.”
But it’ll also require widespread buy-in from party leaders — and there’s little appetite so far for signing onto anything that pours more money into the current health care system.
“Bailing out insurance companies with no thought of any kind of reform is not something I want to be part of,” Majority Leader Mitch McConnell (R-Ky.) said on the Senate floor early Friday morning, minutes after the repeal bill was defeated. “I suspect that there are not many folks over here that are interested in that.”
Then there’s the Trump administration. The president could single-handedly tank the Obamacare markets by cutting off funding for cost-sharing subsidies as early as mid-August, just days before insurers make final decisions on whether to sell plans for 2018.
And while HHS has championed state-level waivers aimed at customizing and stabilizing individual markets, the agency has taken an openly antagonistic attitude toward Obamacare as a whole.
“I’m not sure we’re operating under the same rules of the road anymore,” Consedine said, adding that state insurance regulators fear HHS will stop enforcing the law’s unpopular but crucial individual mandate. “Failure, implosion, none of those should really be in our lexicon at this point.”
Trump has waved off the consequences of neglecting the Obamacare markets and said he won’t be responsible for the fallout, despite polling showing most Americans will blame the GOP for future problems with the law. Where congressional Republicans fall on that question after the collapse of their longtime repeal pledge could determine how the party moves forward on health care now.
“Maybe this had to happen to actually begin to have a conversation,” said Sen. Bill Cassidy (R-La.), who’s pushed for bipartisan talks on his own replacement plan. “It can’t be over.”
Brent Griffiths contributed to this report.