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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.

Go deeper

These technologies could bring America to net zero emissions by 2050

Illustration: Sarah Grillo/Axios

The newest section of a project from Third Way, the Bipartisan Policy Project and Clean Air Task Force examines how energy breakthroughs could accelerate America's transition to reach net zero greenhouse gas emissions by 2050.

Why it matters: The report chapter, provided first to Axios, is part of a broader effort known as the Decarb America Research Initiative, which explores the best ways to move the U.S. toward a net zero carbon emissions future by 2050.

"No-code" miracle for startups

Expand chart
Data: Interactive Advertising Bureau; Table: Axios Visuals

The U.S. has reached a tipping point in its shift from the industrial economy — one that relied on the buildout of hardware — to an information economy that relies on the transfer, storage and implementation of data, according to a new report.

Why it matters: This shift towards a data and information-based economy has allowed more businesses to establish themselves and scale quickly and at a very low cost. As such, the number of jobs created by the commercial internet has more than tripled since 2012.

Amazon's small business shield

Illustration: Aïda Amer/Axios

Amazon is touting the success of small sellers on its platform through the pandemic — and warning that antitrust legislation could jeopardize that success and blow up its open-marketplace model.

Why it matters: As online shopping became a lifeline for both businesses and consumers during the pandemic, Amazon reaped big benefits, but also saw its regulatory risk grow.