Caitlin Owens

Senate health chairman calls for bipartisan Obamacare bill

(Ron Sachs / CNP/MediaPunch/IPX)

Sen. Lamar Alexander, chairman of the Senate Health, Education, Labor and Pensions Committee, told reporters Tuesday the next step for Obamacare should be a bipartisan, short-term stabilization package:

The most constructive thing would be for there to be a bipartisan proposal that would stabilize the market for the next three years while we create long-term solutions to the Affordable Care Act.

He said he's hearing from insurers that they need stabilization steps taken "within the next few weeks," as 2018 participation deadlines loom. While the administration can take some action, it's also "incumbent upon Congress to act."


Zombie Trumpcare not good signal to worried insurers

(Jose Luis Magana / AP)

House Republicans' decision to keep trying to repeal and replace Obamacare is not a good signal to insurers, who must decide soon whether or not to participate on exchanges in 2018. Whether or not Republicans are interested in stabilizing the marketplace will be key to their decision. Reopening repeal and replacement talks is not stabilizing, as it creates mass unpredictability about the future.

"If Republicans are clearly invested in your failure, as an insurer, you need to be concerned," said Rodney Whitlock, a former GOP Senate Finance Committee aide.

Our thought bubble (h/t Bob Herman): Insurers have just a couple months left before they file rates. And another game of patty cake in the House isn't going to make any insurer happy.


House GOP: We're bringing back zombie Trumpcare ... somehow

J. Scott Applewhite) / AP

House Republican leaders told the GOP conference this morning that they're going to keep plugging away on Obamacare repeal — using the budget reconciliation bill, just like before. The one thing Republicans couldn't describe after the meeting: an actual plan for doing it.

What they're doing: "it's just reevaluating more than anything else," Republican Study Committee chairman Mark Walker told reporters. "Is this something that we're going to leave on the American people? Specifically, Obamacare. Or is this something we're willing to come back to the table and say what can we do to get this thing done? That's the reality of it."

What it means: Republicans are upset that Ryan said Obamacare is "the law of the land," and the GOP leadership is now aligning with Vice President Mike Pence's message from this weekend, when he said the Trump administration is still committed to repealing Obamacare. But that doesn't mean they have a serious plan to do it. More likely, Republicans will need a cooling-off period.


Republicans face damage control because of House Obamacare lawsuit

Evan Vucci / AP

Trumpcare might be dead, but the Obamacare fight continues.

Next up: Republicans have to settle the future of Obamacare's subsidies to insurers — and the House lawsuit that's trying to get rid of them.

Why it matters: The deadline is quickly approaching for cleaning up a mess that Republicans created.

  • If the Trump administration decides to stop appealing a federal judge's ruling against the subsidies, the payments — called cost-sharing reduction subsidies — will stop, health insurers will lose billions of dollars, and the individual market could collapse because the insurers will have to keep helping low-income enrollees whether they're getting the payments or not.
  • Republicans could just drop the lawsuit and give the insurers the money, to prevent a meltdown. But their next chance is the short-term spending bill due at the end of April — which is already almost certain to be mired in a fight over Planned Parenthood funding and money to build a wall along the southern border. The subsidies could get added to that spending bill, but "only if insurers agree not to abandon the market in the next couple weeks," a senior GOP aide told me. And the payments could lead to a fight among Republicans, in addition to their likely battles over Planned Parenthood and the wall.

This is all the legacy of a lawsuit congressional Republicans filed when the Obama administration was running Obamacare — long before the White House changed hands.

Oops: Even before Trumpcare's failure, GOP aides acknowledged that the lawsuit seemed like a better idea at the time than it does now. Then, it was hard to ignore the awkwardness of Republicans potentially giving money to the insurers they've complained about for seven years. Now, they face the even more unpleasant prospect of helping stabilize a law they just failed to get rid of.

Kristine Grow, a spokeswoman for America's Health Insurance Plans, said the payments "are essential for the stability of the market." Deadlines for 2018 participation are quickly approaching within the next few weeks, she said, and "more clarity sooner rather than later would be tremendously helpful."

But there are real constitutional questions involved in the lawsuit, which is why this was a fight Republicans were poised to win and also why the House is highly unlikely to drop the case. The most likely scenario is that the administration drops the appeal, and Congress appropriates the money. But that's easier said than done, especially in the post-Trumpcare political climate.

The issue: The House says the administration is illegally paying insurers the cost-sharing reduction subsidies under Obamacare. These are payments made to insurers to reduce out-of-pocket costs for low-income enrollees.

While insurers clearly must pass along the help to enrollees by law, Republicans have argued Congress never actually gave the Obama administration the money for the program that's being used to pay insurers. A district court judge has sided with them, but the Obama administration appealed the case. It was delayed in February and is currently on hold, with an update due in May.

What this all comes down to: If the Trump administration stops fighting the case and the payments stop, insurers will lose $10 billion next year, according to a recent Congressional Budget Office report. Insurers are already having a hard time on the individual market, and a $10 billion loss could easily be enough to convince those still participating to leave at the end of the year.

Some of their problems were due to structural flaws in Obamacare, and insurers made errors in setting premiums. But they have also lost a lot of money after Republicans successfully blocked the government from making payments designed to help plans deal with risk.

If Republicans want to make sure the Obamacare markets "explode," as President Trump has predicted they will, their best course of action would be to leave the payments unfunded. But this is politically risky: People have a tendency to blame their problems on those in charge, and many people would surely lose coverage or see massive premium increases if the GOP goes this route.

The problem: Conservatives want to keep trying to repeal Obamacare, and appropriating the money could be dubbed as giving up. Rep. Mark Meadows, chairman of the hardliner Freedom Caucus, said earlier this year he supports making the payments, but only as long as they're part of a longer-term repeal and replace effort.


The Republican divide over life after Trumpcare

Evan Vucci / AP

President Trump and Republican leadership are signaling Trumpcare is dead, at least for the foreseeable future.

Some members will undoubtedly follow leadership's example and move on to other big-ticket items, like tax reform. But not the Freedom Caucus — who arguably brought the House bill down in their quest for a more complete repeal bill. They want to start over from scratch.

"The responsible thing to do is get back to work doing what we told the American people we were going to do, which is repealing Obamacare and replacing it with something that lowers premiums for middle-class families," Rep. Jim Jordan, a member of the Freedom Caucus, told me. "I think we do that along with all the other important things we told the American people we were going to do."

Ok, but: There are a lot of Republicans who are furious with the Freedom Caucus right now and who are blaming them for this embarrassing failure. Leadership has had it with them. It's hard to see there being any appetite among the rest of the GOP to work with them on a new Obamacare plan right now.


Trumpcare won't even get a vote

J. Scott Applewhite / AP

The House Obamacare repeal and replacement bill failed to advance to a vote in the House on Friday afternoon, a stunning defeat for a party that campaigned on repeal for the last seven years.

President Trump called Speaker Ryan at 3pm today, asking him to pull the bill, according to a House leadership aide.

From Rep. Tim Murphy (R-PA): "The speaker said the president said that he's not coming back to it."


Paul Ryan is going to the White House

J. Scott Applewhite / AP

House Speaker Paul Ryan is headed to the White House to brief President Trump on the health care bill, Bloomberg reports. This comes amidst reports that, despite Trump's now-or-never vote ultimatum, the bill still doesn't have the votes to pass the House.


New Trumpcare amendment would require states to define essential health benefits

(Alex Brandon / AP)

A final amendment to the American Health Care Act was introduced Thursday night by the authors of the legislation, a last-minute attempt to win conservatives over by requiring states to define what services insurers must offer enrollees.

Here's what's in the amendment, which will be voted on in the Rules Committee tomorrow before the bill heads to the House floor for a final vote:

  • Beginning in 2018, states will determine essential health benefits. There are currently 10 federal ones under Obamacare, which apply to the individual and small group markets.
  • The repeal of the Medicare payroll tax on high earners would be delayed until 2023.
  • The original bill's Patient and State Stability Fund would get an extra $15 billion to be used for maternity coverage and newborn care, as well as mental health and substance abuse disorder treatment.

Updated Trumpcare estimate: less savings, same number uninsured

Andrew Harnik / AP

The Congressional Budget Office released a new estimate of the impact of the American Health Care Act this afternoon, showing less federal savings than the original bill but roughly the same coverage loss over 10 years. It was updated to include the proposed amendments to the legislation that were released on Monday night, but not any of the additional changes the White House has been discussing with the Freedom Caucus.

The takeaways:

  • The bill would save $150 billion between 2017 and 2026. The original bill would have saved $337 billion.
  • In 2018, 14 million people would lose coverage. This number would increase to 24 million in 2026. This number did not change.

Rules Committee pauses Trumpcare consideration until Thursday

(J. Scott Applewhite / AP)

House Rules Committee Chairman Pete Sessions, after more than 13 hours of partisan debate over the House Obamacare replacement bill, said the committee will break for the night. It will vote to make a rule for the bill tomorrow, the same day the bill is expected to come to the House floor for a vote.

The decision comes amidst reports of last-minute dealmaking, with substantive changes to the bill possible.