The Obamacare repeal attempt that just won’t die

You mean there are still some Republicans trying to repeal the Affordable Care Act?

Just when you thought your health insurance was safe.

The Senate failed to pass a plan to repeal the Affordable Care Act—their attempts at “replacements” were too pathetic to even qualify as such. Many Republican senators have seemingly thrown in the towel. Majority Leader Mitch McConnell has declared that it’s time to move on from the health care fight.

Utah Republican Orrin Hatch was designated as the poor slob GOP senator who would deliver the bad news to the White House. “There’s just too much animosity and we’re too divided on health care,” Hatch told Reuters.

Divided they may be, but a bipartisan group of senators has scheduled hearings on how to shore up the ACA health insurance marketplace. The effort is being led by Tennessee Republican Lamar Alexander and Washington Democrat Patty Murray, and the hearings will be held after senators return from an August break. “If your house is on fire, you want to put out the fire, and the fire in this case is the individual health insurance market,” Alexander said in a statement. “Both Republicans and Democrats agree on this.”

There’s also a bipartisan effort moving forward in the House. Before the House went on recess, a group of more than 40 House members—Democrats and Republicans—offered the beginnings of a plan to stabilize individual markets and provide other fixes. This is aimed at strengthening the ACA, not repealing it.

Too bad Donald Trump refuses to hear that message.

“Don’t give up Republican senators, the world is watching: Repeal & Replace” was just one of Trump’s tweets demanding continued action on what Trump always calls “failing Obamacare.” In another tweet, he threatened not only the insurance markets but also the insurance of members of Congress themselves if lawmakers don’t keep up the repeal-and-replace battle. “If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!”

Trump keeps repeating threats to defund the ACA’s cost-sharing reduction (CSR) payments that subsidize health insurance for low-income people with the greatest health care needs who buy individual policies in ACA marketplaces. Not paying those subsidies would destabilize insurance markets, especially as insurers are due to submit rates for 2018 by September 27. Trump’s budget director, Mick Mulvaney, says the administration will review the payment policies on a month-by-month basis.

The bipartisan Senate efforts are aimed specifically at a one-year fix, to appropriate money for the CSR payments. Sen. Alexander, who chairs the Senate Health, Education, Labor, and Pensions Committee that deals with health policy, is aiming to involve not only all members of his committee in the process but the Senate Finance Committee as well. As explained by Alexander and reported by Talking Points Memo:

“I hope to get a consensus about how to stabilize the individual market, keep premiums down, keep insurance companies in the individual market so people can buy affordable insurance,” Alexander told reporters Wednesday, saying he hopes to pass such a bill before the end of September, when insurance companies will submit their 2018 rates. “I would expect them to lower their prices as a result of the certainty that Congress is providing.”

Senate Democrats want more than a one-year fix but are willing to talk.

“Insurance companies want to know that these payments will be there not just this year, but next year,” Sen. Chris Murphy (D-CT) told reporters Wednesday. “They make long-term decisions when they choose what rates to set and how long to stick around. We should set our sights higher than just fixing this for a year.”

Murphy, who sits on Alexander’s committee, said he’s well aware Republicans will likely demand some “flexibility”—code for deregulation and the rollback of protections—in exchange for appropriating the money, and Democrats are willing to hear them out.

“There’s a big middle ground between existing law and the Cruz amendment, between the existing minimum health benefits and the total elimination of the minimum health benefits,” he said.

Unfortunately, cutting off CSR payments is just one of the ways Trump could muck up the ACA. According to a separate piece on TPM, Trump has five sabotage arrows in his quiver. He also could—and did—redirect funds intended to spread the word about ACA signups to anti-ACA ads. He’s already shut down ACA assistance centers in 18 cities. The Trump administration could stop enforcing the insurance mandate, sending a signal that it’s okay to skip buying insurance—the IRS won’t bother with the tax penalty. And the Dept. of Health and Human Services could expand waivers for states to get around some of the law’s requirements.

Too bad for Trump that states can now join the lawsuit on the legality of the payments. Even if Trump decides to stop CSR payments, those states’ actions—potentially, at least—could force the payments to continue during litigation.

The bipartisan House proposal, meanwhile, is a five-point plan from a group calling itself the “Problem Solvers Caucus.” While the plan may never see the light of day, given House Speaker Paul Ryan’s reticence to allow anything that would save rather than repeal the ACA, it would:

  • Provide mandatory CSR funding.
  • Create a stability fund that states can use to reduce premiums and limit insurer losses, especially for people with preexisting conditions.
  • Change the employer-sponsored insurance mandate from companies with 50 employees to those with 500 employees. It also would define a full-time workweek as 40 hours instead of 30 hours.
  • Repeal the medical device sales tax.
  • Give states greater leeway to innovate and allow for the sale of health insurance across state lines.

These bipartisan efforts from lawmakers are getting support from organized medical groups like the American Medical Association.

“While we are relieved that the Senate did not adopt legislation that would have harmed patients and critical safety net programs, the status quo is not acceptable,” [AMA President David O.] Barbe said in a statement. “We urge Congress to initiate a bipartisan effort to address shortcomings in the Affordable Care Act.”

ACA repeal is still technically possible for the Senate through the reconciliation process, which would mean it needs only 51 votes. The proposals senators failed to pass were all amendments, rather than a vote on the House-passed American Health Care Act itself. We can’t be lulled into complacency by talks of bipartisanship.

A few Republican senators—Ohio’s Rob Portman and South Carolina’s Lindsey Graham—apparently are still on the ACA repeal Trump train. Graham, along with Republican Sens. Bill Cassidy of Louisiana and Dean Heller of Nevada, is floating a proposal to let states make their own decisions through block grants, saying, “We haven’t tried all options yet.” The fact that this version would eliminate all subsidies and end Medicaid expansion doesn’t seem to be stopping the effort despite its slim chances and the estimates that millions would lose coverage.

Give it up, Sen. Graham. George Romero, who directed the 1968 zombie cult classic, The Night of the Living Dead, died in mid-July. Let Trumpcare die, too.

Originally posted on Daily Kos, Aug. 6, 2017.

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