As if Sen. Lamar Alexander didn’t face enough difficulties trying to craft a bipartisan bill to shore up Obamacare, he’s taking hostile fire from one of his most powerful Republican colleagues — the other health care chairman.
Alexander is “stealing our jurisdiction,” Senate Finance Chairman Sen. Orrin Hatch told POLITICO, referring to the turf split between his panel and Alexander’s HELP Committee. “It’s pretty hard to get excited about what he’s doing.”
The long-simmering battle between the two Senate heavyweights over health care jurisdiction, a precious Senate commodity, came to a head with Hatch’s comments Wednesday, which followed his scathing Washington Post op-ed the week before. The op-ed didn’t mention Alexander by name but made clear Hatch opposed the bill to stabilize Obamacare, which he called a “bailout” of insurance companies that “would do little more than shore up the bad policies already in place with another slate of bad policies.”
And the sniping, unusual in the typically staid and well-mannered Senate, has grown bolder and personal in recent days as Republicans wrestle between Lindsey Graham and Bill Cassidy’s last-ditch attempt to repeal Obamacare and Alexander’s attempt to shore up next year’s insurance markets. Alexander hopes to cut a deal by early this week with Democratic Sen. Patty Murray. If he can do that, Hatch’s opposition could be a huge barrier in getting other Republicans to go along.
The dispute tracks the GOP philosophical rift on Obamacare: Alexander argues the GOP has a responsibility to protect Americans from a collapsing health care market. Hatch, in a sentiment echoed by Senate leaders Mitch McConnell and John Cornyn, are skeptical of repairing the Democrats’ faulty law without significant structural changes.
“He’s got a very broad jurisdiction but it isn’t as broad as he sometimes thinks,” the Utah Republican said of his colleague. “That doesn’t mean he can’t do legislation that’s outside of his jurisdiction — he can. But if he’s doing it, it ought to at least be something he runs by us.”
Alexander argues the policy is more important than the jurisdiction.
“The jurisdiction, I think, should be of secondary importance to the people of this country who can’t afford a $1,000 or $1,500 increase in their premiums,” the Tennessee Republican said. “The Finance Committee is free to deal with these same issues if it would like to. And they could have a hearing on the Graham-Cassidy bill if that’s a better option.”
At the heart of the dispute is which committee gets to control the 1332 waiver program that gives state officials flexibility to ignore some of Obamacare’s requirements under certain conditions.
The tentative plan from Alexander, one of the Senate’s few bipartisan dealmakers, would fund a cost-sharing subsidy program for up to two years that Democrats are intent on saving. In exchange, the Republicans wants to give states additional flexibility with those waivers. It’s unclear so far whether Democrats will go along with the changes — or whether Republicans like Hatch will agree the flexibility goes far enough to warrant continued funding of subsidies to shore up the Democrats’ health law.
“If Congress doesn’t act by the end of the month, premiums go up 20 percent, 5 percent of the counties have no insurance companies selling and the federal debt goes up by nearly $200 billion to pay for increased subsidies,” Alexander said. “If that happens, it’s a big incentive to head toward a single payer system.”
But the waivers are smack in the middle of the Venn diagram separating Finance and HELP’s oversight of health care. Complicating matters is the fact that the original 1332 waivers were inserted in the Affordable Care Act by Sen. Ron Wyden, the top Democrat on the Finance committee. He’s adamant that the waivers should not be substantially changed — and that they belong to Finance.
The Senate parliamentarian has said the two panels have shared jurisdiction, according to Republican sources. A bill dealing with waiver funding would land in Finance. If it’s about insurance markets, it would go to HELP. For instance, the parliamentarian ruled that a Senate Obamacare repeal bill that changed waivers was in HELP’s jurisdiction.
Both chairmen say they have the right to address the waivers. But Alexander said if he and Murray get a deal on an Obamacare bill, he won’t hold a formal vote in his committee, a tacit acknowledgment that he’s at least toeing the line.
“We’re certainly not going to try to mark up a bill in our committee that doesn’t belong in our committee,” Alexander said.
Alexander and Hatch, both of whom are close with McConnell, have worked together closely on health issues in the past. In 2015, as the Supreme Court took up an Obamacare case that could have immediately tanked the health markets, they got together to publicly promise swift repairs.
There’s also significant overlap between the committees. Nine members of the Finance Committee — including Sen. Richard Burr (R-N.C.) — also sit on HELP.
“Lamar has got part of the jurisdiction on health care,” Burr said. “He’s making every attempt to see if you can reach some kind of bipartisan agreement for a very small slice of the health care pie. I’m glad that he is pursuing it.”
In general, HELP oversees insurance regulations and the individual market, including the Obamacare exchanges — a smaller slice of the health care pie.
Finance is the more powerful of the two committees, overseeing the massive Medicare and Medicaid programs, as well as just about anything in Obamacare that touches money, such as the taxes and subsidies.
The committee’s jurisdiction covers more than 50 percent of the federal budget. In health care and other issues, the Finance Committee is regularly asked to find a way to pay for the big ideas introduced by other committees. Over time, that dynamic has made the committee’s chairmen, whether Republican or Democrat, very protective of their territory.
But the Affordable Care Act, including the state waivers, muddied the well-defined jurisdictional lanes a little bit.
“It’s really one of the reasons the Affordable Care Act wasn’t very well written because both committees wrote it,” Alexander said. “We have shared jurisdiction on health care and it’s awkward but it’s no reason for inaction.”
In fact, it may make his effort to pass a bipartisan bill to try to stabilize the markets an even heavier lift.