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Sen. Lamar Alexander. (Photo: Mark Wilson / Getty Images)

Things are looking worse by the day for efforts to stabilize the Affordable Care Act's insurance markets. You might think Democrats would want to protect President Obama's signature achievement, or that Republicans would be motivated to prevent big premium hikes heading into midterms. But other political considerations are proving more influential.

Why this matters: If Congress doesn't step in, coverage will likely become more unaffordable for more people, and insurers may exit some markets altogether.

Where it stands: The proposal would fund the ACA's cost-sharing subsidies (known as CSRs) and fund a new reinsurance program, in return for new regulatory flexibility. All of that has been bipartisan in the past.

  • But it's hit a huge snag on abortion —whether to leave existing ACA language intact, or add new restrictions (which apply to other federal health care programs) that would prevent plans receiving the CSR payments from covering abortion.

Between the lines: The policy disagreements are very real, as are the real-world implications. But both sides are also weighing hefty political pressures, especially with the midterms only a few months away.

The Republican politics:

  • The party needs pro-life voters to turn out in November. "Can't depress the pro life crowd," one GOP operative said. "We just need every opportunity to motivate them."
  • Voting to strengthen the ACA is still a tough pill to swallow for a lot of Republicans, and conservative groups like Freedom Partners are pushing hard against the effort.
  • Republicans are, unsurprisingly, picking up on some Democrats' second thoughts about funding CSRs, and wondering why they should take such a politically difficult vote if it won't actually help.

The other side: "Do I think 20% premium increases will be a major problem for us this November? Yes," a House Republican aide said.

The Democratic politics:

  • Abortion is a huge base issue for Democrats, too. Caving on this fight won't do them any favors with their base.
  • Some are skeptical the proposed package would do much good anyway. The proposal amounts to "providing reinsurance to health insurance companies, while at the same time making coverage less affordable for low-income and working families," the pro-ACA group Families USA said in a statement.
  • Democrats are increasingly confident that voters will blame Republicans for premium hikes in the fall, and plan to campaign hard on health care regardless of whether a stabilization bill passes or not.

The other side: Democrats wrote and passed the ACA. While most aren't worried about being held responsible for the health care market now that Republicans are in charge, this is still the market structure they created — and will likely need to work within for the foreseeable future.

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Why it matters: Wall Street has curtailed its exposure to industries like guns, oil and private prisons, driven by both public and shareholder pressures. This new rule could reverse that trend.

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Axios' Caitlin Owens and former FDA commissioner Mark McClellan. Photo courtesy of Axios Events

Having a reliable supply of pharmaceutical drugs throughout America will be "absolutely critical" to boosting affordability in health care during the Biden administration, former Food and Drug Administration (FDA) commissioner Mark McClellan said at a virtual Axios Event on Friday.

The big picture: McClellan, who served under President George W. Bush, says drugs having limited supply and limited competition leads to elevated pricing. He considers drug supply to be a national security and public health issue.

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